Abstract
BackgroundIt can be challenging for general practitioners to support their oldest old patients through the complex process of relocation.ObjectiveTo provide a typology of the experiences of moving in very old age that is clinically useful for practitioners navigating very old people’s relocation.MethodsQualitative analysis of data from a mixed-methods UK population-based longitudinal study, Cambridge City over-75s Cohort (CC75C), from Year 21 follow-up onwards. Interviews with participants aged ≥95 years old and proxy informants (Year 21: 44/48, 92%, subsequent attrition all deaths). Thematic analysis of qualitative data available from 26/32 participants who moved before they died.ResultsIndividuals who moved voluntarily in with family experienced gratitude, and those who moved into sheltered house or care homes voluntarily had no regrets. One voluntary move into care was experienced with regret, loss and increased isolation as it severed life-long community ties. Regret and loss were key experiences for those making involuntary moves into care, but acceptance, relief and appreciation of increased company were also observed. The key experience of family members was trauma. Establishing connections with people or place ahead of moving, for example through previous respite care, eased moving. A checklist for practitioners based on the resulting typology of relocation is proposed.ConclusionsMost of the sample moved into residential care. This study highlights the importance of connections to locality, people and place along with good family relationships as the key facilitators of a healthy transition into care for the oldest old. The proposed checklist may have clinical utility.
Highlights
As the population ages, general practitioners (GPs) are increasingly called upon to support their oldest old patients though the challenges of frailty/multi-morbidity and relocation
Two-thirds died before any later survey (30/44, 68%), some with no interview discussion of moving, but relevant qualitative data were available for the majority of participants who moved at any point (26/32, 80% of those who moved): the sample included in this analysis
A voluntary move that severed life-long community ties was experienced with regret and increased isolation due to the absence of a good family or community network
Summary
General practitioners (GPs) are increasingly called upon to support their oldest old patients though the challenges of frailty/multi-morbidity and relocation. Individuals are more likely to make a healthy transition if they are resilient and ‘buy into’ the decision to move, the onus is on care home providers to cultivate a sense of ‘home’, and present a ‘welcoming’ workforce culture for new residents [16]. It can be challenging for general practitioners to support their oldest old patients through the complex process of relocation. Conclusions: Most of the sample moved into residential care.This study highlights the importance of connections to locality, people and place along with good family relationships as the key facilitators of a healthy transition into care for the oldest old.
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