Evaluation of LifePlanning: Impact of Health and Environment of Aging in Place
Background and Significance
“Aging in place” has become a popular concept as the U.S. population ages and prepares to retire (Wiles et al., 2011). This notion of “aging in place” is more than an emotional attachment to a physical home (Wiles et al., 2011); rather it is the individual’s ability to perform self-care tasks, access socialization, and maintain the autonomy to choose where to live and not become institutionalized in a nursing home as a result of a chronic illness (Ahn et al., 2020; Wiles et al., 2011).
“Aging in place” is an individual’s conscious decision to remain in a home of their choice for as long as they can to maintain what is most important to them (Ahn et al., 2020). As individuals age, they are more susceptible to developing chronic illnesses (Maresova et al., 2019). In the United States, six in ten older adults have one chronic illness, while four in ten older adults have two or more chronic illnesses (Maresova et al., 2019). For older adults to successfully “age in place” and to maintain quality of life (QOL), their community environments should be easily accessible and must have avenues to manage or maintain chronic health conditions (Farber et al., 2011; Maresova et al., 2019).
The number of older adults in the United States has increased over the past 10 years and will continue to grow (Barron & Jaul, 2017). The number of “Baby Boomers,” defined as individuals born between the years of 1946 to 1964 (Marriam and Webster Dictionary, 2021), will not only double in the next 25 years but also have longer life expectancies; by 2030 they will account for nearly 20% of the population (Mather et al, 2019). Most (90%) older adults strive to age in their own homes (Ball, 2014). Older adults who lose their autonomy and the ability for self-care could become a great burden-physically, emotionally, and financially-to themselves, their families, the community, and the healthcare system (Wiles et al., 2011). Thus, it is favorable for older adults to remain in an environment in which they are familiar and for as long as possible (Wiles et al., 2011).
The AgingOptions’ LifePlanning program is designed to empower older adults to age in a place of their choosing. The program focuses on five domains (Health, Housing, Family, Finance, and Legal). The purpose of this project was to evaluate the efficacy of the program and to assess whether the specific domains of Health and Housing provide the best possible approach in guiding older adults in the process of aging.
Forty-two individuals (family members and Durable Power of Attorneys [DPOAs] of deceased clients who have completed the LifePlanning program and died in the last 48-months) were identified and met the eligibility criteria: individuals 18 years or older, spoke English proficiently, and had a reading and oral comprehension at the junior high level or higher. Individuals who recently passed were selected because the effects of LifePlanning were more apparent in their last two years of life. A survey questionnaire consisting of Likert sale and yes or no questions was utilized as it could help gain insight regarding whether the LifePlanning program was able to perform what was desired.
Of the 42 eligible subjects, seven consented to participate; however, one of the participant’s loved one only completed the Legal portion of the LifePlanning program and was excluded from the study. Because of the exclusion, there were only six participants in the final sample size. The majority of participants (83.3%, n = 5) were females, and 100% of the participants were 40 years and older (one individual between 40-49; two individuals between 50-59; one individual between 60-69; two individuals between 70-79).
From the Health domain, only 16.7% (n = 1) of participants increased the activity level, 16.7% (n =1) consulted a nutritionist, 50% (n = 3) engaged in preventative care such as visiting a geriatric practitioner. All (n = 6) of individuals made a housing decision, and 83% (n = 5) felt that the housing decisions were moderately or strongly important. As 66.7% (n = 4) took specific actions to avoid institutional care as a result of a health crisis, it may be inferred that the Housing domain was effective as more individuals made housing decisions/changes as a direct result of LifePlanning.
Sustainability of the LifePlanning program could evolve as future Doctor of Nursing Practice (DNP) students sample additional LifePlanning participants. It would be valuable to evaluate the LifePlanning process from both the qualitative and quantitative perspectives. While the current survey data provided some insights regarding the success of LifePlanning, future qualitative data such as client interviews, and a larger sample size may provide more rich data. Sustainability of the program may be maintained with additional collaboration between future DNP students and AgingOptions; this can help the LifePlanning program to continue to evolve to better serve the aging population.
Implications for Practice
The AgingOptions’ LifePlanning program is designed to guide individuals and family members on planning for their final days and how to accomplish those plans. If successfully implemented, end-of-life planning can reduce the family burden, make important healthcare plans, and protect valuable assets by reducing unnecessary nursing home admissions. As a result, more older adults may remain in an age-friendly location of their choice.
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Ball, M. (2014). The overview of aging in place. Rural Health Information Hub. https://www.ruralhealthinfo.org/toolkits/aging/1/overview
Farber, M., Shinkle, D., Lyncott, J., Grage, W., & Harrel, R. (2011). Aging in place: A state survey of livability policies and practices. The National Conference of State Legislatures and the AARP Public Policy Institute. https://assets.aarp.org/rgcenter/ppi/liv-com/aging-in-place-2011-full.pdf
Maresova, P., Javanmardi, E., Barakovic, S., Husic, J. Tomsone, S., Ondrej, K., & Kuca, K. (2019). Consequences of chronic diseases and other limitations associated with old age. BMC Public Health, 19, 1431-1439.
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Zhang, Tai Lai, "Evaluation of LifePlanning: Impact of Health and Environment of Aging in Place" (2022). Doctor of Nursing Practice (DNP) Scholarly Projects. 888.