Decision Making and Implementation of Aging-in-Place/Long Term Care Plans among Older Adults

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The goal of this research is to better understand how older adult aging-in-place decision making and implementation is impacted by cognitive changes seen with Alzheimer’s disease, functional loss, social influences, and environmental factors. Remaining in one’s own home is a priority for many older adults. Decision making and planning is critical to ensure successful aging-in-place, especially when older adults are diagnosed with Alzheimer’s disease. The most important decision that many adults navigate is how to balance progressively worsening cognition, seen in Alzheimer’s disease, and increasing disability with their support needs. Although a great number of older adults will need support, prior research has shown that many may dismiss planning for their home support needs outright (e.g. I plan to die in my sleep before I ever need help). Most older adults do not want to leave their home and yet very few people plan for their home-based needs that they will require to age-in-place safely, as their cognition and function worsens. Through our previously PCORI-funded research, we developed a tool, PlanYourLifespan (PYL), which facilitates making decisions and planning to age-in-place, specifically with Alzheimer’s disease. Through education about future health and home-based needs as well as access to these resources, older adults can make choices and share them with loved ones for their future needs. PYL was tested in a multi-site randomized controlled trial of 385 community-dwelling older adults with 3 month follow-up and found to be significantly efficacious in improving decision making behaviors towards aging-in-place options among older adults. With the short follow-up, we were limited in determining how these decision making plans of older adults translated into goal concordance towards aging-in-place. A gap exists in how decision making for aging-in-place is impacted by older adults’ changes in cognition, functional loss, social factors, and environments. How these plans translate into timely adoption as well as the impact that loved ones have on goal concordance have also been unexplored. Through this research, we aim to: Aim 1. Determine how decision making and planning for aging-in-place is impacted by older adults’ cognition changes (e.g. as experienced with Alzheimer’s disease), functional changes, multi-chronic conditions, social influences (e.g. adult offspring, spouses), and environments (e.g. rural/urban, home type). Aim 2. Examine the mediating/ moderating interactions between older adult cognition, function, social influences, and environments in decision making for aging-in-place choices. Aim 3. Assess whether decision making and planning for aging-in-place translates into timely adoption and goal concordance for older adults and their surrogate/caregiver decision makers. To achieve these aims, we will leverage both an NIA-funded cohort (LitCog, n=700) with extensive cognitive testing and a PCORI-funded intervention: PlanYourLifespan.org. We will conduct a 42 month longitudinal study of older adults from the LitCog cohort who will receive the PYL intervention on Day 1. Surveys will be conducted every 6 months in conjunction with the active LitCog research, where cognitive, social, functional, health literacy data is being collected. Additionally, data will be collected on decision changes, resource use, timing of plan implementation, and goal concordance.