Kenneth Lam, MD, MAS, a geriatrician with extensive experience advising families about when and how their older relatives should transition into nursing homes or assisted living facilities, emphasizes the complexity of such decisions. Lam, an assistant professor of geriatric medicine at the University of Colorado School of Medicine, has spent years in clinical practice developing an intuition for the most suitable care settings for older adults based on their individual needs. However, transitioning into a research role, he became acutely aware of the lack of data guiding these critical life decisions. This realization led him to pursue research aimed at filling this gap.
In his study published on November 6 in JAMA Internal Medicine, titled “The Natural History of Disability and Caregiving Before and After Long-Term Care Entry,” Lam sought to understand the typical ages at which individuals enter care facilities and their levels of disability before doing so. Utilizing the National Health and Aging Trends Study, which annually tracks older adults’ capabilities and the extent of assistance they require, Lam explored the independence levels of these individuals before they transition to a care facility and the type and amount of help they receive.
Lam’s research revealed that the average age of individuals entering care facilities is 84, often after experiencing several months of severe disability and increasing levels of care, usually provided by unpaid family members. Specifically, he found that those moving into nursing homes typically already face severe disabilities and receive around 27 hours of care weekly for at least a month before their move. In contrast, those transitioning to assisted living facilities are less likely to be severely disabled but still receive an average of 18 hours of care weekly.
The study highlights the significant amount of care and the challenges of severe disability that families manage at home for extended periods before the transition to nursing homes occurs. Lam notes that the situation is somewhat different for those moving into assisted living facilities, reflecting the socio-demographic advantages of this group. Interestingly, Lam discovered that within one to two years, the level of severe disability among those in assisted living facilities approaches that of nursing home residents, raising questions about the long-term viability of assisted living as a permanent solution.
Lam points out that the decision to move into a nursing home often comes late in the disability trajectory. This phenomenon raises questions about the underlying reasons, such as stigma or financial constraints. The study offers a glimpse into the critical moment when individuals and society confront the need to make significant care decisions, often dictated by affordability and the desire to maintain independence as long as possible.
Following this quantitative study, Lam is conducting qualitative research to gain deeper insights into the experiences of those who have recently moved into long-term care facilities, including their social lives and the impact of dementia on such decisions. This approach aims to provide a more comprehensive understanding of the factors influencing the decision to transition into long-term care and to offer advice to others facing similar choices.
Lam hopes his research will serve as a foundation for clinicians, patients, and families to discuss and navigate the complex decisions surrounding long-term care for older adults. By establishing an average age of entry into such facilities, the study offers a basis for discussions about the timing of this transition, inviting further exploration into whether the timing of entry significantly impacts outcomes. Lam’s work underscores the importance of a nuanced approach to these decisions, recognizing the individuality of each situation and the need for ongoing discussion and research in this area.
More information: Kenneth Lam et al, The Natural History of Disability and Caregiving Before and After Long-Term Care Entry, JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2023.5427
Journal information: JAMA Internal Medicine Provided by University of Colorado Anschutz Medical Campus
