The Cambridge City over-75s Cohort Study (CC75C) has been taking place for over 30 years and is one of the largest and longest-running longitudinal observational studies of ageing into older age.
It was started in 1985 from a survey of over 2,600 men and women aged 75 and above. Intensive assessments were carried out and every few years follow up surveys, interviews and tests were carried out with sample groups.
Several topics were looked at including use of health and social services, socio-demographics and social contact, depression, the “older old” approaching the end of life, cognitive decline and dementia, and falls and functional ability.
The focus in the latter part of the study shifted to quality of life issues of “older old” people near the end of life. Findings from this area of research were recently presented and focussed on three specific topic areas: “moving in very old age”, “experiences of formal and informal care in older old age”, and “end of life care issues – attitudes and preferences of very old people”.
The Silverlinks initiative focusses on people’s choices about housing & care in later life, so the findings on moving in very old age (aged 95 and over) are of particular relevance.
59% of participants in this sample group moved, many into care homes (76% of those that moved) and almost all were reactive moves as a result of a crisis such as hospitalisation (e.g. as a result of a fall), increased cognitive impairment or following a bereavement. Only two people made a pro-active move.
One of the findings/reflections given by the study that stood out to me was that: “older people experienced regret and loss when they did not feel they owned the decision to move”.
This is very pertinent and conveys the importance of thinking ahead and the availability of I&A around housing options. Although some decisions to move have to be made on medical grounds, for example if a is person experiencing severe cognitive decline, the question arises – had these people been able to plan ahead for their future housing & care needs, would they be experiencing these feelings of regret? Is a decision made at a time of crisis – and perhaps by another person – always the best decision for the older person?
The study also found that those that moved into more familiar surroundings, whether a proactive or reactive move, were happier and experienced reduced feelings of isolation – for example if they moved to a care home where they had friends or knew someone that worked there. This again suggests that being able to plan ahead and choose a particular residential setting (which is not always possible or practical) where a person has connections to the place or people may have a positive effect on wellbeing. The study found that day care centres and schemes provide an important stepping stone allowing older people to build connections in their locality, potentially making a move to a residential setting easier. This highlights an issue around local availability and choice.
People that did not know anyone within their setting more frequently reported feelings of loneliness. One lady who moved into a residential care home, miles from her home but close to her family, reported increased loneliness after moving. Although she had proactively decided to move, she found that the unfamiliar surroundings and people and not being able to visit friends had a greater impact than she anticipated.
One of the other key findings and reflections on the study was that “older people need support to make housing decisions prior to crisis”. This is exactly what the work carried out by Silverlinks is aiming to address through working with groups of older people and through our local projects.
Interestingly, although not surprisingly, all of those that moved were single households (single, widowed or divorced) and overwhelmingly female with only one of the group being male. This highlights the need for housing options information & advice to be spread to as many people as possible in an accessible way. Knowing where to go for information & advice about housing options is a key factor in reaching the right decision. The Silverlinks “Pass it On” talks aim to do this by reaching those older people that are perhaps more active (e.g. those that attend community or church groups) who then pass on information to their neighbours, friends and family who may be more isolated and need support in finding information about housing and care. The Silverlinks peer support model also becomes particularly important in allowing older people – perhaps in particular those that are single or may not have relatives – to talk through their options enabling them to reach the decision that is right for them.
A useful addition to the Cambridge study from a Silverlinks point of view would be a follow up with those people that chose not to move, to explore why they made this decision and what the impact of this has been. It would also be interesting to see if any of these people had adaptations or moderations to their home to help them with daily living, and the difference this had made to their lives.
The study was focused on people aged 95 and over – it would be useful to see some findings from younger participants or those who moved at an earlier stage – did they experience the same in terms of decision making, were they able to plan ahead, how many of them proactively moved and how did they come to this decision? Do they feel it was the right decision for them?
This is just part of a huge study into ageing, in which many topics are addressed. For Silverlinks, the observations around moving in old age are pertinent as they provide further evidence that more support, advice and information is needed for older people who are facing decisions about housing and care, and that a lack of ownership of a decision can cause feelings of regret, loss and increased isolation.
Further information on the study can be found at http://www.cc75c.group.cam.ac.uk/.