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Northwestern University Feinberg School of Medicine
Center for Applied Health Research on Aging
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LitCog Plan Your Lifespan

Title:

Decision Making and Implementation of AIP/LTC Plans among Older Adults

Dates:

March 2019 - February 2024

Funding Source:

National Institute of Aging (NIA)

Grant Number:

R01AG058777

Background:

Remaining in one’s own home is a priority for many older adults. Decision making and planning is critical to ensure successful aging-in-place. The most important decision that many adults navigate is how to balance age-related changes (e.g. worsening cognition, increasing disability) with their needs. The lifetime probability of becoming disabled in at least two activities of daily living or of being cognitively impaired is 68% for people age 65 and older. Through our previously PCORI-funded research, we developed a tool, PlanYourLifespan (PYL), which facilitates making decisions about aging-in-place. Through education about future health, home-based needs, and available resources, older adults can make choices and share them with loved ones for their future needs.

Abstract:

The goal of this study is to better understand how older adult aging-in-place decision making and implementation is impacted by age-related changes (e.g. cognition, function, chronic condition), social influences, and environmental factors. Remaining in one’s own home is a priority for many older adults. Decision making and planning is critical to ensure successful aging-in-place. The most important decision that many adults navigate is how to balance age-related changes (e.g. worsening cognition, increasing disability) with their needs. Although a great number of seniors will need support, prior research has shown that seniors may dismiss planning for their home support needs outright (e.g. I plan to die in my sleep before I ever need help). The majority of seniors do not want to leave their home and yet very few people plan for their home-based needs that they will require to age-in-place safely. Through our previously PCORI-funded research, we developed a tool, PlanYourLifespan (PYL), which facilitates making decisions and planning to age-in-place. Through education about future health and home-based needs as well as access to these resources, older adults can make choices and share them with loved ones for their future needs. PYL was tested in a multi-site randomized controlled trial of 385 community-dwelling older adults with 3 month follow-up and found to be significantly efficacious in improving decision making behaviors towards aging-in-place options among older adults. With a 3 month follow-up, we were limited in determining how these decision making plans of older adults translated into goal concordance towards aging-in-place. A gap exists in how decision making for aging-in-place is impacted by older adults’ age-related changes, social factors, and environments. How these plans translate into timely adoption as well as the impact that loved ones have on goal concordance has also unexplored. Through this proposal, we aim to close these gaps by: Aim 1. Determine how decision making and planning for aging-in-place is impacted by older adults’ age-related changes (e.g. function, cognition, multi-chronic conditions), social influences (e.g. adult offspring, spouses, friends), and environments (e.g. rural/urban, home type). Aim 2. Examine the mediating and moderating interactions between older adult age-related changes, social influences, and environments in decision making for aging-in-place choices. Aim 3. Assess whether decision making and planning for aging-in-place translates into timely adoption and goal concordance for older adults and their surrogate/caregiver decision makers. To achieve these aims, we will leverage both an NIA-funded cohort (LitCog, n=700) with extensive cognitive testing and a PCORI-funded intervention: PlanYourLifespan.org. We will conduct a 42 month longitudinal study of older adults from the LitCog cohort who will receive the PYL intervention on Day 1. Surveys will be conducted every 6 months in conjunction with the active LitCog research, where cognitive, social, functional, health literacy data is being collected. In addition, data will be collected on decision changes, resource use, timing of plan implementation, and goal concordance.

ClinicalTrials.gov identifier:

NCT03960476

Contact:

• Principal Investigator: Lee Lindquist, MD MPH
• Project Lead: Vanessa Ramirez, MPH

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