Abstract
Research has shown that relatively few older adults make plans for future care needs. In this study, we explore the thinking processes involved in planning or failing to plan for the future. Interviews were carried out with 39 older adults (M age = 81 years) who were experiencing disability and illness but who lived in their own home. Guiding questions for the interview focused on present living circumstances, but for the present qualitative analysis, all references to the future, and to future residence changes, were extracted. This approach allowed us to observe how older adults spontaneously address issues of future planning when not constrained to do so. Results supported the use of a positivity bias, as well as a risk-aversive decision-making style. These older adults seemed to be prioritizing present emotional well-being by avoiding thoughts of future risks and thereby eschewing proactive coping.
As we age, all of us face important and often difficult decisions about future financial, health-care, and housing options. These decisions can be particularly difficult to make (and tempting to avoid) because we do not know when or whether changes from the status quo will be necessary. From an emotional standpoint, such long-term planning is difficult because it entails thinking about very negative possibilities such as illness, loss of autonomy, and mortality (Pinquart & Sörensen, 2002a). Perhaps not surprisingly, it has been shown repeatedly that few older adults make plans for their future (Kulys & Tobin, 1980; Pinquart & Sörensen, 2002b), although there are suggestions that most older adults are aware of the many threats to their autonomy (Dittmann-Kohli, 1990). How older adults make decisions about possible care needs in the future has received relatively little research, though work in both the coping and the cognitive literatures offers relevant insights. In the present study, we use structured interviews to explore how older adults think about their future care needs (FCN) to better understand how long-term planning occurs (or fails to occur) in real-life settings. We propose that this approach will allow us to contrast how older adults make important decisions in real life with the inconsequential decisions in laboratory settings reported in extant research.
Although most of the coping research has addressed how individuals react to stressful events, a small but growing field of research addresses proactive coping, defined as “efforts undertaken in advance of a potentially stressful event to prevent it or to modify its form before it occurs” (Aspinwall & Taylor, 1997, p. 417). Sougleris and Ranzijn (2011) argued that proactive coping may be particularly relevant in older adults, where certain stressful events are likely. Preparing in advance for potential threats can lead to avoiding the threat altogether, but even if the negative event does occur, advanced preparation often allows the gathering of more resources and more options for dealing with the event, thus minimizing the stress of the experience when it does occur (Aspinwall & Taylor, 1997; Pinquart & Sörensen, 2002a; Sörensen, Dubserstein, Chapman, Lyness, & Pinquart, 2008). In a health-care context, early detection and intervention can often lead to more effective, and less invasive and costly treatments (Sougleris & Ranzijn, 2011). However, proactive coping can lead to investing worry and resources into a threat that never materializes. This is particularly problematic if coping resources are used up when another, unexpected threat occurs (Aspinwall & Taylor, 1997).
Few empirical studies have addressed proactive coping by older adults (Sougleris & Ranzijn, 2011). One exception is a study by Ouwehand, de Ridder, and Bensing (2008) who investigated the relationship between certain personality traits and responses to vignettes describing potential negative changes in the life of an older adult. As expected, the personality traits of future temporal orientation and goal orientation predicted higher rates of proactive coping strategies in response to the scenarios in these 50- to 70-year-olds. Similarly, Ouwehand, de Ridder, and Bensing (2009) used data from a national database and found that education and income were positively related to responses on a proactive coping questionnaire in 50- to 70-year-olds. Sougleris and Ranzijn (2011) also found a positive relationship in older adults between scores on a proactive coping inventory and measures of well-being such as personal growth, purpose in life, and satisfaction with life. These authors point out, however, that one challenge with such correlational studies is that the high level of intercorrelations may simply indicate conceptual overlap between the variables measured. Recently, Sörensen et al. (2008) looked at correlations between the Big Five personality traits and planning for future care in a sample of adults aged 65 years and above. They found that several personality traits (i.e., openness, agreeableness, and neuroticism) were related to awareness of FCN and the gathering of information about such needs but that personality scores did not predict actual concrete planning and decision making. Although Sörensen et al. found a correlation between age and the belief that planning is useful, others (e.g., Kulys & Tobin, 1980; Ouwehand et al., 2008; Sougleris & Ranzijn, 2011) found no relationships between age and measures of planning or proactive coping.
In an earlier study, Pinquart and Sörensen (2002b) measured the relationship between psychological well-being and self-reported level of preparation for FCN in older adults. In one set of analyses, the authors divided participants into three extreme groups based on their amount of awareness and preparedness for FCN: (a) Avoiders (18% of the sample, n = 103) were selected from the 20% of the sample with the lowest levels of awareness, with individuals who had carried out any planning activities excluded, (b) non-planners (6.3%, n = 36) had above-average scores on awareness of FCN while being in the lowest 20% of scorers on the planning scale, and (c) planners (15.3%, n = 88) had above-average scores on awareness and were in the highest 20% of the sample on planning scores. Non-planners were found to have the lowest levels of subjective well-being of the three groups, and avoiders had the lowest levels of worry and depression, although the authors point out that future well-being may be put at risk for these individuals. Pinquart and Sörensen (2002a) also carried out a cross-cultural qualitative study to explore what types of factors promote and prevent preparation for FCN. Issues linked to lack of planning included (a) not perceiving that care would be needed, (b) belief that FCN cannot be anticipated, (c) lack of resources needed to make concrete plans, (d) depending on others, and (e) belief that thinking about FCN would reduce present well-being. A recent qualitative study carried out by Girling and Morgan (2014) identified similar barriers to planning.
In summary, findings suggest that a relatively small number of older adults make concrete plans for FCN, but the root cause for this lack of proactive coping remains in question. One possibility is that many older adults may not have the resources (e.g., educational, financial) available for proactive coping (Ouwehand et al., 2009; Pinquart & Sörensen, 2002a, 2002b). Another possibility, as suggested by Pinquart and Sörensen’s (2002a) results, is that older adults simply prioritize present subjective well-being over potential long-term well-being. This possibility has been discussed at length in the work related to socioemotional selectivity theory.
Carstensen and colleagues (e.g., Carstensen, 1995) have proposed a life-span theory of motivation where the time horizon of the individual determines what goals will be prioritized. In youth, one perceives a long and ill-defined future and long-term goals associated to instrumental needs, such as information gathering, are prioritized. In old age, one’s perceived future is limited, and short-term goals related to affective well-being are most salient (Reed & Carstensen, 2012). One consequence of this shift in motivational goals is the positivity effect, where older adults, unlike younger adults, will preferentially process positive information over negative information (Reed & Carstensen, 2012; Shamaskin, Mikels, & Reed, 2010). The positivity effect has been observed in studies of attention, recall, and decision making (Löckenhoff & Carstensen, 2007), with a few studies looking at processing of health-related materials specifically.
Shamaskin et al. (2010) asked participants to read four pamphlets about health-care issues that contained either positively or negatively framed goal statements. Older adults rated the positive pamphlets as more informative and were similar on a surprise recall test to younger adults on the positive statements but worse on memory for negative statements. The authors concluded that health information presented to older adults with a positive slant would be more likely to be recalled and used. Löckenhoff and Carstensen (2007) came to a similar conclusion in their study of decision making. They used a computer-based task where both information-seeking and choice concerning physicians and health-care plans could be tracked. Results showed that although preferential processing of positive materials was generally present in older adults, this effect could be overridden by situational demands. This conclusion was supported in a meta-analysis carried out by Reed, Chan, and Mikels (2014), who reiterated that the positivity effect was present when processing was not constrained (i.e., when participants were not asked to make specific judgments of stimuli, or warned that a recall test was imminent).
Depping and Freund (2011) reviewed the research addressing the positivity effect in decision making and proposed that decision making by older adults is characterized by an avoidance of loss approach. Similar results have been found in cognitive gambling task studies (e.g., Mikels & Reed, 2009). The interpretation of what is a “good decision” should be seen through the lens of the motivation that drives the individual making the decision. Throughout the process, from scanning the options, evaluating the information, and recalling the information related to the decision taken, the driving force in older adults’ decision making would be to avoid loss and maintain the status quo. Indeed, even putting off decision making can be interpreted as a means to avoid the loss of the present level of subjective well-being (Löckenhoff & Carstensen, 2007; Pinquart & Sörensen, 2002a). Thus, Depping and Freund (2013) showed that older adults could be seen to prioritize negative information when choices had to be made if the processing of negative information was more likely to allow an avoidance of loss (i.e., avoiding a negative experience).
In sum, past research on proactive coping in older adults is limited and has focused on identifying what personality characteristics predict planning behaviors. This approach limits our ability to understand the processes and motivations behind the planning or the lack of planning that occurs spontaneously regarding FCN. Similarly, the positivity and decision-making literature has been critiqued for using artificial tasks and inconsequential decisions as is necessary in a laboratory context. In the present study, we explore how FCN are thought of and discussed by frail older adults during wide-ranging interviews about their present lodging and care experiences. All references to the future throughout the interviews, as well as responses to a specific question about the future, were excerpted and analyzed. Analyses focused on the strategies used by the respondents to make or avoid making decisions about their FCN.
Method
Participants
The 39 older adults who participated in the study were recruited through advertisements and presentations asking for older adults who required assistance to perform some of their daily activities. The present study is part of a larger project addressing aging in place issues in language minorities in Eastern Canada. Four groups of seniors participated in individual interviews: French- and English-speaking seniors from rural and small urban communities. The mean age of interviewees was 81 years and most had a yearly income of Can$50,000 or less. The sample is described in detail in Table 1.
Sample Description.
One person did not provide a health rating.
Self-reported home care frequencies do not include family-provided support.
Data Collection and Analysis
The semi-structured interviews lasted an average of 90 min and were carried out in the participants’ homes in their preferred language. One English-speaking female interviewer carried out nine interviews, and all the others were carried out by a second bilingual female interviewer. Guiding questions asked participants to address how they managed to live in their homes despite their disabilities, to discuss the care and support that they received from others, and to describe any changes or adaptations they had made to their home. Interviews were audio-recorded and transcribed verbatim. For the present article, (a) every statement where the participant mentioned the future or long-term plans, and (b) all answers to the interviewer’s standard question of “how do you see your life in the next few years?” were analyzed. These statements were then coded into a series of coping strategies or approaches by the first author using the qualitative data analysis application NVivo 10 (QSR International, Burlington, MA, USA), and exemplar quotes for each approach were identified. After discussion, the two authors achieved a consensus on the identification of the approaches and exemplars used in the present article. Quotes from the French-speaking participants provided below were then translated by the first author, and these translations were reviewed by the second author.
Results
In analyzing the interview statements that referred to the future, it became clear that these older adults were very aware of the threats to their autonomy but had developed coping strategies or approaches to thinking (or to avoid thinking) about the future that allowed them to cope with the intrinsically difficult task of discussing the future. Three main approaches to thinking about the future were identified in the analyses and were labeled (a) One Day at a Time, (b) Reasons Not to Go (into a nursing home), and (c) If/Then. Two underlying contextual factors, namely, (a) the influence of family members and (b) the availability of resources (financial and otherwise) exerted a subtle, yet important influence on which approach to thinking about the future was used and how these approaches were used.
Approach 1: “One Day at a Time”
Many of the frail older adults who we interviewed avoided talking about FCN simply by stating that they took life one day at a time or that they simply wanted present circumstances to stay the same as long as possible. One 91-year-old man said, “At my age, you know, as they say, I don’t buy any green bananas any more [laughter] but I try to live day by day, not to try to plan too much in advance” (P12). An 81-year-old widow with health problems expressed similar views: Everything is working ok, why would I want to leave here? We never know what tomorrow will bring, or next week, or next month, or next year, but I don’t stay awake at night thinking about those things, because that’s just creating stress for yourself [laughter]. (P48)
Often, a religious element is part of this approach, as is clear from this 84-year-old woman with mobility problems: I don’t think about the future, it’s day to day. When I get up in the morning, I put my two feet on the ground, and I thank God I’m able to put my two feet on the ground. It isn’t much, but that’s what it takes. (P4)
There were a few cases where plans had begun for a transition and then been halted, thereby returning to a “One Day at a Time” coping approach. For example, one couple in their 80s had called a real estate agent and put up their home for sale but then changed their mind. The wife, with mobility, financial, and multiple health concerns stated, “Why would we go into an apartment where we might not like it? We won’t feel at home there. There’s nothing like being at home in our house” (P15). One 89-year-old woman with multiple health problems and reduced mobility put her name on a waiting list for a seniors’ apartment when her husband died, but when they called, she refused: Well it didn’t seem to be any time till they called and they said they had something, and I said look, I’m not ready, I’m fine. I’ve been here ever since and I have no desire to move now. I’m very content, very happy here.
For some, the idea of leaving their home, particularly to enter a nursing home, is a fate worse than death. For these individuals, the need to focus on the present and to avoid thoughts of the future is particularly strong. One 80-year-old widow who had multiple health problems stated, “Really, I can’t say I’ll never go, but I hope I die rather than go into a nursing home, or if I do go, I’ll be lost by then [demented]” (P13). Similarly, a 79-year-old widow with mobility issues and self-reported insufficient income is discussing media reports of abuse in nursing homes and concluded by saying, “That’s why that I say I’d rather die here than go die in the nursing home” (P15). One 69-year-old divorced woman with many health issues felt pressured by her children to move into an apartment: “But I don’t want to do it. I told them, I’m going out of here in a box, that’s it! I’m not moving again” (P30).
Approach 2: “Reasons Not to Go”
In the interviews described in this study, older adults were never asked to explain why they chose not to move into a care environment, but many would spontaneously provide reasons why they did not want to move. In a few cases, these older adults who were themselves frail or ill were still caring for others, and this was an important reason why they could not leave their present circumstances. One 86-year-old woman with reduced financial means lived with a son with a mental disability and said, “But [son] wouldn’t be able to live alone either, and I wouldn’t want to leave him.” A 65-year-old woman said, “With my husband, I’m hoping that I won’t leave him because he’s bipolar and he would be a hard person . . . and I know my children won’t be able to cope” (P59). Even when they were not caregivers, seniors expressed concerns about not being able to provide food and lodging for family members. One 79-year-old woman with self-described low income and six adult children living nearby stated, “I like to have food when the children come because they often have a meal here, and on weekends there’s always visitors. It starts Friday night and ends Sunday night” (P31). A 74-year-old widow who also described her income as insufficient to meet her needs stated, “Like at Christmas . . . I like having them [daughter and son-in-law] for supper because it makes for a nice evening. They stay here. If I was in a home, it wouldn’t be the same thing” (P34). One 83-year-old woman with reduced mobility and multiple health issues described having made all the arrangements for moving into an assisted living facility and then had second thoughts. When she discussed the situation with her nephew who lived in another city, he reportedly said, “Auntie, don’t do that. Look, you’re comfortable in your apartment, and it won’t be the same when we go visit you.” The participant continued, “I told myself, it’s the voice of God, he’s saying it’s not time yet” (P01). Similarly, an 89-year-old widow with mobility and health issues stated, We can all come home, there’s about 26 of us when we come. The house is full but we always have a good time. So that’s one reason, one thing that I like to stay here because I realize that if I was at the [nursing home] or any place, I couldn’t have that many people around. (P42)
Many older adults expressed concerns about having to interact with people who were confused and disoriented, and how this was depressing and upsetting. One 73-year-old widower had spent a few months in a care institution following surgery and commented, “I found a lot of people were in very bad shape and some people talk to you but they didn’t make any sense. Talking to the people who have lost their mind and that, that’s very difficult” (P24). Similarly, an 84-year-old widow said, “You meet someone and they want to talk. They talk, but you don’t understand what they’re saying. They’re confused, it’s sad and it breaks your heart, and you have tears in your eyes when you see what they’ve become” (P10).
Finally, older adults also described inadequate or uncomfortable conditions in nursing homes, such as shared rooms, lack of in suite baths, and lack of activities. One 91-year-old man with mobility problems stated, “You just lay around and go to eat, that’s about it” (P28). It was particularly striking that an 86-year-old man who had worked in a nursing home in the past said, “When you’re in a nursing home, you’re almost in prison, you have to do what you’re told” (P53).
One notable finding was the contrast between people who lived in apartments or condos (after downsizing) and those who lived in single-dwelling homes. Individuals living in apartments or condos expressed contentment with their new home: “I want to stay here in my condo as long as possible because I’m comfortable, I’m close to everything, and I have good neighbors” (P02). It was interesting to note, however, that many seniors still living in their single-dwelling homes used the same arguments against moving into apartments as seniors in apartments used against moving into care facilities. They complained about having nothing to do, about being surrounded by people they wouldn’t enjoy interacting with, and about lack of privacy. They reported hearing negative comments about life in apartments from unspecified others and dismissed or minimized reports from those who said they enjoyed their apartments. For example, a 72-year-old married man with health issues stated, “We could live in an apartment if we had to, but it wouldn’t be the same” (P22). For all seniors, it seemed difficult to imagine being happy anywhere else than where they presently were.
Approach 3: “If/Then”
A common approach to discussing the future was to state that the status quo was preferable and that only “if” something specific changed would a higher level of care or of planning “then” be needed. Most commonly, changes in the ability to do housework, or more generally, declining health were mentioned. One woman in her early 80s simply said, “If it comes to the point where I can’t prepare my own food, I’ll have to go” (P02). Similarly, a 79-year-old woman with mobility issues stated, “There comes a time when you have to go [into a nursing home]. I won’t refuse if I’m too ill” (P15). It is interesting to note that the criteria for seeking care varied along with the abilities of the speaker. Changes such as no longer being able to drive or even no longer being able to wash floors and bake bread were mentioned as criteria by more active seniors, whereas advanced dementia and being unable to walk about in the house were mentioned by more frail seniors.
It is also interesting to note that when the conversation drifted into a discussion of what situation would lead to a need to seek care, many seniors would quickly re-orient the conversation to off-topic issues. This was most striking with one very frail gentleman in his early 90s who had had multiple falls and said, Eventually, I might have to get someone to live with me . . . I’d have to take the computer out of the bedroom there. That would be ideal for me. I shower every morning. Have a good hot shower and I love it. (P28)
In other cases, the senior would shift the topic to focus on how much they could accomplish, “one time I washed the ceiling fan” shared an 80-year-old widow (P13), or how well they were presently, “til then I’ll hang out here . . . My flowers are growing outside. They pick them and bring them in to me” (90-year-old widow with mobility problems [P37]).
Contextual Factors
Throughout the interviews, two factors are implicitly shaping the experiences of these individuals. In the first place is the support received from and required by family. In many cases, these individuals are able to remain at home through the not inconsiderable support of their adult children, and most of these seniors are very much aware of that. An 82-year-old widow said, “I have a son that lives around the corner, and I have 2 sons in [town nearby]. I’ll tell you right now, I’m just spoiled rotten [laughter]” (P45).
In a few cases, there is a recognition that options are limited because the seniors are caregivers for their adult children who themselves have handicaps. One 79-year-old widow said, “My daughter is a person with special needs. My husband died 15 years ago in 95. I don’t know how longer we’ll be able to stay here, but as long as . . .” (P09). Finally, and consistently through all of the interviews is the repeatedly stated unwillingness to be burden to one’s children. Although in many cases the children are clearly highly involved in the senior’s life as caregivers, seniors draw a clear distinction between this and co-residence with their children, which they define as hampering their children’s freedom and well-being. One 84-year-old widow stated, “I don’t want my children to be forced to take me in. They need to live their lives, they’re young, and I wouldn’t want to tie them down because their mother can’t do anything anymore!” (P10). The juxtaposition between their own caregiving history and what they wish for their children is also striking. One 76-year-old widow stated, “I had my dad for 5 years before he passed away and I wouldn’t have given that up for the world. But now, I feel I don’t want to impose myself on my kids” (P47).
A second contextual factor that underlies all of these interviews is the lack of resources for planning that are available to these seniors and, relatedly, the lack of appealing options that are perceived by these seniors. The only option that many of these seniors consider is that of admission to a nursing home. Although other arrangements are sometimes mentioned in a vague way, there seems to be an underlying belief that other arrangements are either not possible financially or simply not realistic. “Eventually I might have to get someone to live with me, even if they didn’t stay here at night. But the ideal set up of course would be to have a middle-aged woman to live with me” (91-year-old widower [P28]). One 82-year-old woman who had had repeated falls said, “In the winter, I’m the one who shovels the entryway and the steps. But now, I’m quite worried that I can’t do it anymore, and there’s no one around, all the neighbors are seniors” (P54). In some cases, the unfinished sentences expressed the lack of options available. One 74-year-old widow with mobility problems sated, “It’s a difficult question. I don’t know . . . I think of it, but I wouldn’t have the means. I would need some help . . . I don’t know really. . . . I’ll try to stay here as long as possible” (P34).
Discussion
The focus of the present article is to explore, through a qualitative analysis of semi-structured interviews, the processes by which older adults make, or fail to make, plans for their FCN. The interviews used here are particularly revealing, because interview questions did not direct these seniors to address FCN specifically but asked questions about their present home. Thus, we were able to observe how seniors spontaneously address issues of future planning when not constrained to do so. This is particularly relevant because findings from laboratory-based decision-making research (see Reed et al., 2014, for a review) suggest that the positivity effect can be overridden by specific situational demands. Thus, if we had forced seniors to address issues of FCN by using direct or confrontative questions, we may not have been able to observe the strategies used by these seniors to avoid thinking deeply about FCN. However, if these already frail older adults had already made specific plans for FCN—none had—they would have had the opportunity to describe these plans when asked to comment on how they see their life in the next few years.
Our analyses yielded three main approaches used by these seniors when discussing the future. One very common approach was to simply hope that present circumstances could be maintained and to approach life “One Day at a Time” even when these circumstances were difficult and tenuous. A second approach was to spontaneously mention “Reasons Not to Go” and reasons why they did not belong in care institutions, suggesting that they constantly feel the need to shore up defensive arguments against the thought of moving out of their present home. A third approach was the use of “If–Then” scenarios, where usually far-off criteria of what would need to happen for a move to become acceptable would be described.
In most cases, the seniors interviewed in this study presented their lives in a positive fashion. They described the activities that they were still doing and wanted to keep doing, and they underlined how different they were from people who needed to be institutionalized. As has been found in other studies (e.g., Wagner, Shubair, & Michalos, 2010; Weeks, Branton, & Nilsson, 2005; Wister, 1985), the older adults in this research wanted to stay in their present location. Whether they had moved to an apartment or still lived in the home where they raised their children, they described their present circumstances as preferable. Indeed, in a few cases, individuals even seemed to dismiss the perceptions of those who were happy in another environment as mistaken, or at least baffling. Clearly, these older adults were successfully managing their opinions to maintain a positive view of their lives, even when objectively the present circumstances seemed difficult—They were making “the best of things.” For the most part, they were also successful in avoiding thinking about negative future outcomes. Indeed, in a few cases where the conversation inevitably led to a negative outcome (e.g., a description of clear disability), the participant seemingly created a distraction by going off on a conversational tangent. Thus, in many ways, the results obtained here support the notion of a positivity effect used to regulate emotional well-being, as proposed by the socioemotional selectivity theory (Carstensen, 1995). As has been found in studies addressing future care planning more specifically, these older adults seem to be prioritizing present emotional well-being by avoiding thoughts of future risks and thereby eschewing proactive coping (Pinquart & Sörensen, 2002a, 2002b).
In their work, Depping and Freund (2011) proposed that the driving force in older adults’ decision-making processes was defensive processing characterized by an attempt to avoid losses. Such findings are replicated here with very different methodology and in a very different context. When discussing the possibility of moving, potential positive outcomes (such as a higher level of care, prepared meals, etc.) are rarely mentioned, yet potential losses are continuously highlighted. It is interesting to consider these findings from an intervention perspective. When an older adult is in need of a higher level of care, family members and friends urging this person to make a decision to move are likely to emphasize all of the advantages of the move. However, it may very well be that such a focus on change (even though the change appears to be a positive one) may not at all serve the intended purpose. Highlighting all of the ways that the older person’s lifestyle would not change may be more helpful. Applied research addressing the effects of social support that focuses on loss reduction rather than increased services during times of crisis would be of great benefit.
Similar to Pinquart and Sörensen (2002b) and Girling and Morgan (2014), we conclude in the present study that the contextual factors of family support and lack of resources underlie the ways that these older adults think about the future. Although our results support those of past studies, they extend them as well. In previous work, some older adults seemingly felt that they need not plan for their FCN because they could depend on others to take care of them. In contrast, the seniors here depended on their adult children in the present, but felt strongly that if the time comes that full-time care is required, that they did not wish to (or expect to) depend on their children’s support. From a planning perspective, this suggests that these older adults are likely to transition abruptly from needing no formal care to high levels of formal care, likely during a crisis period. Moreover, even with the relatively small sample used here, there were multiple cases of seniors who were caregivers themselves of adult children with disabilities. In these specific cases, the presence of such family members constrained the older adult to the status quo in a particularly compelling manner. Given the increasing longevity of adults with developmental or intellectual disabilities, it is likely that the number of older adults caring for adult children will increase. However, little is known about how to best support these increasingly frail caregivers (Taggart, Truesdale-Kennedy, Ryan, & McConkey, 2012). Family responsibilities also hindered change in a more indirect way. Many older adults felt that if they put changes in motion—for example, by selling the home where family gatherings occur—their children’s as well as their own emotional well-being would be affected, even though these children lived independently in their own homes, often with families of their own. The importance of providing physical spaces for family reunions to take place in seniors’ apartments or assisted living facilities may be of particular importance when designing such facilities. In summary, in this study, family support seems to have inhibited planning for FCN in both direct and indirect ways.
The conclusions that can be drawn about the role of lack of resources can also be interpreted as supporting the work of Pinquart and Sörensen (2002b) and Girling and Morgan (2014). In these two studies, the authors highlighted the lack of knowledge about how to plan and a lack of the resources needed to plan. In our data, lack of resources was also an issue but in the sense that for many of these seniors the only form of care that was possible was admission into a nursing home, an outcome all viewed as negative. Thus, lack of options for care, particularly given the low income of some of these participants, likely hindered planning. These findings replicate those of Weeks, Keefe, and MacDonald (2012) who found that the very old, and the least financially well-off seniors were the least likely to be willing to move from their existing homes.
The present study is not without serious limitations. These seniors were selected to have disability, and many were quite frail. Moreover, all were still living at home, and few received formal care. Thus, this sample is not representative of the population of seniors—and may even represent a group that has been particularly unsuccessful in planning gradual transitions into increasingly supportive environments. Despite these limitations, we believe that this research provides insights into why proactive coping is not present in the lives of many older adults that may be useful from a policy and practice perspective. Our results suggest that the lack of available, affordable, and appealing options for higher levels of supportive care is key. We need to determine what features of supportive care environments would appeal to seniors themselves rather than to the professionals providing care. Can we design care environments that allow older adults to still be active and engaged members of their extended family network? And where they can continue to provide care to the extent of their abilities to other loved ones? Moreover, a deeper understanding of older adults’ decision-making style may lead to a recognition that an ideal situation would be one where older adults are recipients of active offers of help and support throughout their elder years (i.e., an opt out model) rather than the older adult having to seek support when they decide it is needed—the opt in model that exists in many places now. Finally, from a practice perspective, research exploring the possibility that risk-averse seniors would be more willing to make changes when those around them emphasize similarities rather than improvements in the new location may be particularly useful.
In conclusion, perhaps the most compelling insight that emerges from this study is the quandary presented to those who organize care services and those who care for elderly loved ones. Lack of planning often leads to crises with particularly negative outcomes. Indeed, increasingly large numbers of seniors are in hospitals awaiting placement in long-term care, as a result of a health (or caregiving) crisis. Many of these could have been avoided with planned and gradual transitions for increased home care, assisted living, or other forms of support. The dilemma that we face, however, is that for these plans to be considered and put into place, serious considerations of very frightening and negative possibilities need to occur—a process that can have a serious negative impact on present emotional well-being. Moreover, as many of our seniors stated during these interviews, these negative outcomes may never come to pass.
Footnotes
Acknowledgements
The authors would like to thank all the seniors who were interviewed as part of this study for inviting us into their homes to be interviewed. We also wish to acknowledge Caroline Gibbons and Sylvia MacNeil Gautreau for carrying out the interviews.
Authors’ Note
Ethic approval was obtained from the respective research ethics boards of both home universities of the co-authors (MTA#2012-018 and UM#1112-033).
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a grant from the Canadian Institutes of Health Research (CIHR) Catalyst Grant: Accessibility to Health Services in Official Language Minority Communities (Application No. 261284) awarded to the authors.