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- Taylor & Francis
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Abstract
JOURNAL OF AGING AND ENVIRONMENT https://doi.org/10.1080/26892618.2023.2210129 Self-Reported Wellbeing among the Elderly in the First Year after Relocation to Senior Housing a a b a Katri Ronkainen , Heidi Siira , Pentti Koistinen , and Sinikka Lotvonen GeroNursing Centre, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; Faculty of Medicine, University of Oulu, Oulu, Finland KEYWORDS ABSTRACT Aging; functional capacity; Growing numbers of older adults relocate to senior housing home care; relocation; facilities when their physical or mental performance declines. senior housing; well-being The relocation is known to affect their well-being and provide both challenges and opportunities in new environment. The aim of this study was to explore self-reported well-being among older adults during the first year in senior housing facility. It was a longitudinal study, with repeated, structured interviews of 71 older adults, living in northern Finland. They were interviewed between June 2014 and December 2015. The interviews were conducted three and 12 months after relocation to senior housing facility. The participants used a five-point Likert scale to evaluate their subjective well-being. A nonparametric homogeneity test was performed to assess the statistical significance of change in well-being across the two measurement points. The participants reported statistic- ally significant increases in security and decreases in inde- pendence, i.e., ability to cope with everyday activities, during the study period. There was a slight decrease in loneliness, but otherwise participants’ well-being decreased during the first year at a senior housing facility. The potential of subject- ive well-being in the relocation process is neither fully under- stood nor taken into account by senior housing organizations. There may be significant social and economic benefits for both carefully planning relocation and supporting the well- being of elderly people at senior housing facilities. Introduction People are now living longer than at any previous point in history, but these additional years do not guarantee better health (WHO, 2018). The prevalence of disabilities increases with age, which means that an aging population will impact many aspects of society, including health care, hous- ing and long-term care (WHO, 2023). While various home-based services CONTACT Sinikka Lotvonen sinikka.lotvonen@oulu.fi GeroNursing Centre, Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland. 2023 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 K. RONKAINEN ET AL. may enable older adults to live in their current homes, there is a growing number of older adults who need to be relocated to senior housing facilities (Sullivan & Williams, 2017; Wu & Rong, 2020). This relocation may be necessary for various reasons, namely, lack of adequate physical or mental capacity, need for special care or support, desire to live in a barrier-free environment, lack of social support or unwillingness to rely on family members (Kao et al., 2004; Crisp et al., 2013; Granbom et al., 2016; Roy et al., 2018). However, relocation to a senior housing facility is a major life change for an older adult, and—as such—can have both positive and negative out- comes (Kao et al., 2004; Sullivan & Williams, 2017). Adaptation to the new environment is a transition process that requires sadness and grief over the loss of independence (Gilbert et al., 2015; Sullivan & Williams, 2017). The negative consequences of relocation include stress and anxiety, increased morbidity and mortality, decline in functional and cognitive capacity, as well as lower perceived quality of life (Morse, 2000; Scocco et al., 2006; Laughlin et al., 2007; Costlow & Parmelee, 2020). In 1992, the North American Diagnosis Association created an official diagnosis of Relocation Stress Syndrome which comprises the negative psychological impact of relocation (Costlow & Parmelee, 2020). It should be noted that certain studies have also shown that relocation does have positive outcomes, e.g., decreased burden of home ownership, improved safety and life quality, access to nursing care whenever necessary, and increased social engagement (Rossen & Knafl, 2003; Gilbert et al., 2015; Wu & Rong, 2020). Perceived aspects of housing can have a considerable impact on the well- being of older adults, especially those with functional limitations (Vaara et al., 2016; Corneliusson et al., 2020). Well-being is a multidimensional concept that does not have an accurate definition in the literature (Galvin & Todres, 2012; Vaara et al., 2016). It may refer to overall life satisfaction, presence of positive feelings or judgment about meaning, and the purpose of life. Material conditions, personal freedom, physical and mental health, along with social and family relationships all affect an individual’s evalu- ation of their well-being (Steptoe et al., 2015). In other words, well-being can be described as having certain resources (e.g., basic needs, social rela- tionships) and being able to use them (e.g., being physically and mentally capable). However, people differ in how they evaluate leading a good life, and emphasis on certain dimensions of well-being change with age (Vaara et al., 2016; WHO, 2020). Previous studies have shown that the link between health and well-being may strengthen with age, and that subjective well-being may even enhance elderly health and survival (Steptoe et al., 2015). Galvin & Todres (2012) suggest that subjective well-being has a JOURNAL OF AGING AND ENVIRONMENT 3 dynamic nature, and can empower individuals to adjust to new circumstan- ces during significant changes and difficulties. In Finland, older adults care has undergone a significant shift during the past decades. Until the 1990s, public institutional care was the main route for older adults care and there was a large amount of institutionalized older patients. Since then, the emphasis of gerontological care has shifted to dif- ferent care policies, notably, personal responsibility and “aging in place” approaches (Anttonen & H€aikio, € 2011). There are currently three predom- inant types of senior living facilities in Finland. Institutional care facilities are most often municipality-owned and offer up to hospital-level and hos- pice care for the most fragile older adults. Nursing homes offer 24-h care for the older people who are unable to take care of themselves, for example, due to memory disorders. Senior housing facilities enable barrier- free living with personalized home care services and community support. Senior housing facilities may be owned by either the municipality or pri- vate corporations or foundations. At these facilities, the residents pay rent for the services they receive. The services are adjusted depending on indi- vidual needs, with the nursing staff visits, meal services, and house cleaning scheduled accordingly. The staff are generally available for approximately 14 h per day, with extra services incurring extra costs. There is no regular nighttime supervision, but the residents usually wear emergency bracelets for cases of accidents, falls or emergencies (Lotvonen et al., 2018). Living environment has an important role in supporting the well-being of older people (Bjornsdottir € et al., 2012). There is a need to examine older adults’ well-being and its change in senior housing because the knowledge of well-being of senior housing residents is scarce. In this study, we explore the self-evaluated well-being of older adults after a major life change like relocation to a senior housing facility. Matherials and methods Aim and research questions The aim of the study was to explore self-reported well-being among older adults during the first year after relocation to a senior housing facility. The research included structured interviews, which were conducted 3 and 12 months after transitioning to a senior housing facility. The research questions were: 1. What is the well-being of an older adult who moved to a senior housing facility 3 and 12 months after the relocation? 2. What is the change in the well-being of an older adult who has moved into a senior housing facility during the first year? 4 K. RONKAINEN ET AL. Table 1. Self-reported well-being among older people during their first year at a senior housing facility. Dimension of well-being 3 months 12 months Increased Decreased No change Significance n (%) n (%) n (%) n (%) n (%) p-Value Independence How well do you feel you cope with everyday 6 (8.5) 28 (39.4) 37 (52.1) 0.000 activities? Very well 5 (7.0) 2 (2.8) Quite well 35 (49.3) 24 (33.8) Moderately well 27 (38.0) 32 (45.1) Quite poorly 2 (2.8) 9 (12.7) Very poorly 2 (2.8) 4 (5.6) Physical capability How well do you perceive your physical 8 (11.3) 14 (19.7) 49 (69.0) 0.143 capability Very good 1 (1.4) 0 (0.0) Quite good 9 (12.7) 10 (14.1) Moderate 52 (73.2) 47 (66.2) Quite bad 7 (9.9) 12 (16.9) Very bad 2 (2.8) 2 (2.8) Mental capability How do you perceive your mental capability? 12 (16.9) 16 (22.5) 43 (60.6) 0.305 (Ability to think clearly) Very good 3 (4.2) 3 (4.2) Quite good 31 (43.7) 23 (32.4) Moderate 30 (42.3) 42 (59.2) Quite bad 7 (9.9) 3 (4.2) Very bad 0 (0.0) 0 (0.0) Social network In your opinion, do you have enough people 15 (21.1) 16 (22.5) 40 (56.3) 0.220 close to you who you can contact if you need help? Absolutely 38 (53.5) 37 (52.1) Nearly enough 23 (32.4) 21 (29.6) Not quite enough 6 (8.5) 6 (8.5) Not nearly enough 4 (5.6) 7 (9.9) I do not have any such people 0 (0.0) 0 (0.0) Loneliness Do you suffer from loneliness, in your own 14 (19.7) 18 (25.4) 39 (54.9) 0.317 opinion? JOURNAL OF AGING AND ENVIRONMENT 5 Not at all 21 (29.6) 25 (35.2) A little 19 (26.8) 18 (25.4) To some extent 21 (29.6) 17 (23.9) Quite a lot 9 (12.7) 9 (12.7) Very much 1 (1.4) 2 (2.8) Security Do you perceive your life as safe or unsafe? 22 (31.0) 8 (11.3) 41 (57.7) 0.033 Very safe 14 (19.7) 30 (42.3) Quite safe 56 (78.9) 37 (52.1) Neither safe nor unsafe 1 (1.4) 3 (4.2) Quite unsafe 0 (0.0) 1 (1.4) Very unsafe 0 (0.0) 0 (0.0) Perceived physical health How do you perceive your state of health? 10 (14.1) 14 (19.7) 47 (66.2) 0.271 Very good 2 (2.8) 1 (1.4) Quite good 10 (14.1) 14 (19.7) Moderate 51 (71.8) 41 (57.7) Quite bad 6 (8.5) 14 (19.7) Very bad 2 (2.8) 1 (1.4) Lifestyle How do you perceive your lifestyle? 9 (12.7) 17 (23.9) 45 (63.4) 0.068 Very good 10 (14.1) 4 (5.6) Quite good 34 (47.9) 37 (52.1) Fair (neither good nor bad) 27 (38.0) 30 (42.3) Quite bad 0 (0.0) 0 (0.0) Very bad 0 (0.0) 0 (0.0) Quality of life How do you perceive your quality of life? 13 (18.3) 14 (19.7) 44 (62.0) 0.500 Very good 0 (0.0) 0 (0.0) Quite good 25 (35.2) 26 (36.6) Moderate 43 (60.6) 40 (56.3) Quite bad 3 (4.2) 5 (7.0) Very bad 0 (0.0) 0 (0.0) Marginal homogeneity test was used for statistical significances (see Dunningham 2013). 6 K. RONKAINEN ET AL. Design We used a longitudinal study design with repeated interviews to record participants’ self-reported well-being 3 and 12 months after relocation to a senior housing facility. A structured Oldwellactive questionnaire was used in the interviews. This is a self-rated wellness-profile with high reliability that was specifically developed to assess older adults’ well-being (Koistinen et al., 2013). The questionnaire was divided into nine domains, with each representing a different dimension of well-being. These domains were independence, physical capability, mental capability, social network, loneliness, security, perceived health, lifestyle and quality of life. The nine dimensions are pre- sented as both constructed scores as evaluated by the interviewer and scores for a so-called “golden standard” question for each dimension of well-being. In this study, only the golden standard questions were a subject of interest. The participants answered these questions using a five-point Likert scale that measured the individual’s extent of agreement with the specific question (Table 1). Sample/participants The following inclusion criteria were applied to study participants: (1) a person moved from their own residence to a senior housing facility 3 months before the first meeting; and (2) the person was willing and both mentally and physically capable to participate in the study. The senior housing facilities (n ¼ 11) were selected so that they were (1) owned by one of the three biggest private providers of care services in Finland; and (2) located in the city of northern Finland. All of the facilities in this study were located in an urban area that was in close proximity to services (e.g., shops, stores and health care center). A target group of 121 older adults was identified. From this group, 22 refused to participate in the study and 18 did not fulfill the selec- tion criteria. Hence, a total of 81 people fulfilled the inclusion criteria and were interviewed 3 months after relocation to a senior housing facility. As 10 people withdrew at some point during the study period, we were able to interview 71 older adults both 3 and 12 months after relocation to a senior housing facility. The reasons for withdrawal from the study were as follows: refusal to continue the study (n ¼ 2); moving to another senior housing facility (n ¼ 2) or apartment (n ¼ 4); and death (n ¼ 2). JOURNAL OF AGING AND ENVIRONMENT 7 Data collection Data were collected via face-to-face interviews during home visits. Structured interviews with a duration of 2 h were first conducted when each study person had lived in the senior housing facility for 3 months. This 3-month baseline point was selected due to the previously observed emotional and physiological stress associated with relocation to a care facil- ity among older adults (Lotvonen et al., 2018; Wu & Rong, 2020). The same interview was repeated when the individual had been living in the senior housing facility for 12 months. All of the data were collected between June 2014 and December 2015, with data collected across different seasons depending on the time of relocation. Ethical considerations The Regional Ethics Committee of Northern Ostrobothnia Hospital District assessed that ethical permission was not needed, as the study did not affect the physical or psychological integrity of the interviewees (TENK, 2019). Permissions (29042014, 01092014, 02092014) to proceed were received from the three organizations that maintain the senior housing facilities. We asked for permission to conduct the interviews from the three organiza- tions that maintained the senior housing facilities. The participants were sent an informational letter and then telephoned to ask about their willing- ness to participate in the study. To ensure that each participant was capable of providing their informed consent, the participants with memory disor- ders were excluded from the study. All of the participants were given writ- ten information about the study, including relevant contact numbers, and asked to sign a statement of informed consent. The participants were also informed about their right to withdraw from the study at any phase with- out a reason. All of the interviews were performed by the same health care professional, who had previous experience of conducting structured interviews. Data analysis The statistical analyses were performed in IBM SPSS Statistics (version 27.0; IBM Corp., Armonk, NY). A nonparametric marginal homogeneity test was used to investigate the changes in self-reported well-being between the 3- and 12-month measurement points. This test was selected by a stat- istician because the data were not normally distributed (see also Dunningham 2013). A p-value of 0.05 was set as the threshold for statistical significance. 8 K. RONKAINEN ET AL. Validity and reliability/rigor The reliability of this study largely depends on the reliability of the employed questionnaire. In previous studies, the Oldwellactive question- naire has shown acceptable internal consistency and good reliability (Koistinen et al., 2013; Lotvonen et al., 2017, 2018). Reliability comprises accuracy, consistency, and reproducibility, parameters, which are measured by calculating Cronbach’s alpha values, item-total correlations, and inter- item correlations. The higher the alpha value, the more consistent the instrument (Kyngas et al. 2020). Testing the internal consistency of the Oldwellactive questionnaire showed that Cronbachs alpha values were between 0.71 and 0.92. According to literature the lowest acceptable value varies between 0.60 and 0.65 (Polit & Beck, 2014) The questionnaire has been designed for assessing perceptions of older people and thoroughly validated (Elo, 2006; Koistinen et al., 2013). Moreover, the questionnaire was specifically developed to evaluate self-estimated well-being in older people (Koistinen et al., 2013). A strength of the study is that interviews were conducted by the same person who was a physiotherapist and had experience of the questionnaire and older adults. This supports the validity of the study. Results The participants had a mean age of 81 years (±7, 7). Sixteen percent of the participants were age 55–75, 52% were age 75–84 and 32% were 85 years or older (age range was 55–94). Most of the participants (70%) were women, while 75% lived alone and 72% used home care services. The most com- mon chronic illnesses among members of the study group were coronary heart, musculoskeletal, and neurological disease. Throughout the study period, 39.4% of participants reported a decreased level of independence, while 52.1% described no change in their independ- ence and 8.5% reported an increased level of independence. The difference in self-reported independence between the 3- and 12-month relocation measurement points was statistically significant (p ¼ 0.000) (Table 1). Percentages agreeing that they coped very well or quite well with everyday activities decreased from 50% to 37%. In addition, percentages feeling that they coped quite or very poorly with everyday activities increased from 6% to 18%. In the second round data collection 12 months after their reloca- tion the strongest agreement expressed by 45% of participants was for the statement that they coped moderately well with everyday activities. Following relocation, the participants’ physical capability changed in a way that at the end of the study more participants reported quite poor physical capability (16.9%) than during the first interview (9.9%). There JOURNAL OF AGING AND ENVIRONMENT 9 was also a deterioration in perceived mental capability across the study period; more specifically, 43.7% of participants reported quite good mental capability at the baseline measurement period, while 59.2% of participants reported moderate mental capability after 12 months in senior housing. Interestingly, 12 participants evaluated their mental capability better at the 12-month measurement point than at the 3-month measurement point. However, the differences in perceived physical and mental capability observed across the study period were not statistically significant (Table 1). The collected data revealed that an almost equal number of participants felt that their social network had increased (n ¼ 15) and decreased (n ¼ 16) during their first year in a senior housing facility. The average shift indi- cated a decrease in self-perceived social network; however, the observed dif- ferences between the 3- and 12-month measurement points were not statistically significant (p ¼ 0.220). After living in the care facility for one year, more participants (35.2%) reported not suffering from loneliness than what was observed 3 months after relocation (29.6%). However, this differ- ence in perceived loneliness was not statistically significant (p ¼ 0.317). The participants reported a perceived increase in security during the study period, and this change from 3 to 12 months was statistically significant (p ¼ 0.033). The amount of participants who felt very safe increased from 19.7% to 42.3% between the 3- and 12-months interviews. However, eight participants did report a decrease in perceived security throughout the study period. Some of the participants felt that their phys- ical health decreased (19.7%) during the study period, while others felt as though it had increased (14.1%) from the 3- to 12-month measurement points; however, none of the results regarding changes in physical health was found to be statistically significant (p ¼ 0.271). The majority (66.2%) of participants reported no change in their perceived physical health. The participants’ perceptions of their lifestyle decreased during the study period; more specifically, 14.1 and 5.6% of participants evaluated their life- style as very good at the 3- and 12-month measurement points, respect- ively. This difference was close to demonstrating statistical significance, with a p-value of 0.068. However, none of the participants evaluated their lifestyle as quite bad or very bad in either interview. Some participants (18.3%) reported increases in their quality of life, while others (19.7%) felt that their quality of life decreased during the study period. None of the participants rated their quality of life highly, with most participants rating this aspect of their life in elderly care as moderate in both interviews. There were no statistically significant differences between the 3- and 12- month evaluations. The participants showed some deterioration in their well-being, with the exception of loneliness and security, during their first year at the senior housing facility (Table 1). 10 K. RONKAINEN ET AL. Discussion The older adults are relocated to senior housing facilities so that they have an environment in which their physical and emotional needs are met for the rest of their lives (Granbom et al 2016; Henning-Smith et al., 2018). In the current study, perceived well-being among the older adults was explored during the first year after relocation to a senior housing facility. These facilities offer barrier-free rental apartments with personalized home care services. The collected data revealed that relocation to a senior housing facility has both positive and negative outcomes, as has been the case in previous studies (see Costlow & Parmelee, 2020 for review). For example, self-rated security among the elderly increased significantly during the first year in a senior housing facility. However, perceived independence, i.e., coping with everyday activities, decreased significantly during the study period. A general deterioration in the other aspects of self-rated well-being (physical and mental capability, social network, perceived health, lifestyle and quality of life) was also observed during the first year after relocation to a senior housing facility, although the participants did report a decrease in loneliness over the study period. In this study, the self-rated independence decreased significantly during the first year in senior housing facilities. Several previous studies have also reported that older adults feel that they lose their independence after relocation to a senior housing (Jungers, 2010; Gilbert et al 2015). Qualitative studies have found that this loss of independence refers to decreased self-sufficiency, limited autonomy, frustration at not being able to set their own schedules, and a feeling of powerlessness (Jungers, 2010; Wu & Rong, 2020). Researchers have previously stated that an older adults perception that they are capable and self-assured might be an indicator of successful transition to a senior housing facility (Rossen & Knafl, 2003; Gilbert et al., 2015). In this study, participants’ perceptions of their inde- pendence likely reflect both ‘not being capable’ and ‘not being enabled’. The increased need for assistance with IADLs can often be a reason for relocation to senior housing. Senior housing provides an accessible envir- onment and home care services to older adults, on the other hand smaller apartments and increased services may reduce their activities of daily living. Therefore opportunities for diverse activities are needed to maintain resi- dents’ functional ability and independence in senior housing. Decreased physical capability is a major reason for why the older adults are relocated to senior housing; however, this decision is somewhat contra- dictory as moving to a smaller apartment that is closer to various services tends to further reduce mobility (Cress et al., 2011), and thus, physical cap- ability (Lotvonen et al., 2017), among the elderly. These changes impair the ability to cope with everyday activities. Although relocation of older adults JOURNAL OF AGING AND ENVIRONMENT 11 has been related to a decline of physical and mental capability (Rossen & Knafl, 2007), the participants in this study did not report a significant decrease in their physical or mental capability. When the Oldwellactive- questionnaire was first used, the interviewees underestimated their physical and mental capability compared to external evaluations (Koistinen et al., 2013). The tendency to evaluate oneself more favorably than what is the truth is widely recognized in social studies, and the elderly may also over- estimate their disabilities (Zell & Alicke, 2011). Moreover, living in a com- munity of people older than the general population may affect an individual’s self-perceptions by changing the frames of reference for cap- ability and health (Lea et al., 2016). In this study, an older adult’s social network describes the people they can contact when in need of help. Over half of the participants reported having enough such close people. Additionally, there was no significant change in the social network of the participants during the first year in a senior housing facility. The social environment, especially emotional sup- port from staff and other residents, was found to be a strong predictor of care facility adjustment (Rossen & Knafl, 2003; Lee, 2010). Also, the ability to stay connected with family members has been repeatedly emphasized as a facilitator of adjustment (Wu & Rong, 2020). While most of the partici- pants were comfortable with their social network, there was a minority who felt that they did not have enough close people to ask for help when it was needed. It is common that the older adults do not wish to be a burden to family members (Jungers, 2010; Wu & Rong, 2020), which could prevent them from asking relatives for help. It is also possible that the services pro- vided by the care home were not sufficient for some of the participants. Unfortunately, the study design did not allow us to clarify why certain par- ticipants noted the lack of a social network. The participants reported a significant improvement in perceived security during the first year after relocation to a senior housing facility. An increase in perceived security has been reported in many studies (Gilbert et al., 2015). This may be explained by the fact that care facilities offer pro- tection from falls and injuries and that staff are available when the resi- dents are in need (Wu & Rong, 2020). Although they felt safe, some of the participants expressed that they were lonely. This phenomenon has been previously reported for the older adults living in senior housing facilities (Slettebø, 2008). Even though self-rated loneliness slightly decreased during the first year after relocation to senior housing, almost 40% of the partici- pants reported suffering from a certain extent of loneliness. This agrees with what has been reported in other studies (Victor, 2012; Jansson et al., 2021a, 2021b). Notably, previous research has revealed that some older adults may experience negative social relationships with co-residents, which 12 K. RONKAINEN ET AL. can lead to a loss of privacy and unwanted social interactions (Jungers, 2010), while others may distrust or dislike the care provider (Wu & Rong, 2020). Furthermore, the new environment may feel unfamiliar, uncomfort- able, and not like home (Wu & Rong, 2020; Jansson et al., 2021a). There are also differences among the elderly residents in terms of social inter- action, with some residents having reported an unmet need for more inter- action with other residents (Jansson et al., 2021a, 2021b), while others felt that social engagement increased at the elderly home (Rossen & Knafl, 2007). A resident’s satisfaction is negatively associated with loneliness (Prieto-Flores et al., 2011); for this reason, senior housing facilities should have more interventions that aim to reduce loneliness (see also Jansson et al. 2021a). Perceived health was identified as an important factor in relocation adjustment (Lee, 2010). At the same time, health challenges may be the preliminary reason for relocation (Jungers, 2010). Accordingly, most of the participants in this study evaluated their physical health as moderate, with no significant changes in self-perceived health observed during the first year after relocation. It is possible that older adults’ health transitions occur regardless of the environment, since there seem to be no differences in the health of older individuals who were relocated to a care facility and those who stayed in their private homes (Lea et al., 2016). The participants’ self-rated lifestyle decreased during the first year in a senior housing facility; however, this change was not statistically significant. Interestingly, the difference between interviews (at 3 and 12 months after relocation) almost demonstrated statistical significance. The participants showed quite optimistic evaluations of their lifestyle, as none gave a rating of ‘quite bad’ or ‘very bad’. Previous research has found that the elderly overestimates their lifestyle compared to external evaluations (Koistinen et al., 2013). At present, it is unknown whether this difference is due to the acceptance that advanced age causes some restrictions on a healthy lifestyle (Koistinen et al., 2013), or whether the phenomenon is explained by a ten- dency to see oneself in a better light (Zell & Alicke, 2011), especially when the frame of reference changes after relocation (Lea et al., 2016). The last dimension of self-rated well-being assessed in this study was quality of life. In our study, there was no significant change in self-rated quality of life during the first year after relocation to a senior housing facil- ity. Participants mostly evaluated their quality of life as moderate. Although closely related to overall well-being, quality of life is a somewhat narrower and more subjective construct (Koistinen et al., 2013). The quality of life of people in senior housing facilities may refer to possibilities for meaningful activities and overall satisfaction with quality of care (Ball et al., 2000). Training for staff to promote residents’ individual functional ability and JOURNAL OF AGING AND ENVIRONMENT 13 well-being is required. Likewise suitable facilities for activities, designed to maintain older adults functional abilities, are needed in senior housing. Programs to support and promote well-being of older adults after reloca- tion to senior housing facilities are needed. For example, regular assessment of physical, mental and social capability, together with possibilities to regu- lar activities designed to promote residents’ physical, mental and social well-being are important to minimize decline of functional ability. Social group activities should be designed for the needs of older adults and the home care staff should be educated to restorative care and to promote resi- dents well-being and empowerment. Limitations The current study included some notable limitations. First, there was lim- ited representation of different population groups, and the study did not involve a control group of older adults living at a care home. The partici- pants represent the current elderly population in Finland as they were all white and native speakers of Finnish. No older adults from minorities were identified when recruiting potential participants. Older adults with memory deficits were not included in the study due to ethical reasons. Since mem- ory loss is a common reason for relocation to a senior housing facility, this decision affects the comparability of results. Conclusion Studying an older adult’s subjective well-being changes the focus from an object of care to personal lived experiences. Well-being is important for the older adult’s because it exerts a protective role on health and survival, as well as improves an individual’s ability to adapt to changes. Subjective well- being is thus crucial to the success of relocation to a care facility. However, it is not well understood how subjective well-being can be utilized to make the relocation process more manageable for most older adults. The purpose of this study was to evaluate self-rated well-being among the older adults during the first year in a senior housing facility. The results show that relocation to a senior housing facility leads to both positive and negative outcomes in terms of self-rated well-being. During the study period, the participants’ feelings of security increased, while perceived loneliness slightly decreased. Furthermore, the ability to cope with everyday activities, as well as every other dimension of well-being, decreased during the first year in a senior housing facility. Future research should investigate whether a planned relocation program aimed at supporting the well-being of resi- dents at senior housing facilities can improve the relocation experience and mitigate the need to transfer the individual to costly 24-h care. 14 K. 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Journal
Journal of Housing for the Elderly – Taylor & Francis
Published: May 19, 2023
Keywords: Aging; functional capacity; home care; relocation; senior housing; well-being