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a New England Research Institutes, Watertown, MA
b Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, and School of Nursing and Department of Medicine, Duke University Medical Center, Durham, NC
c Center for Study of Aging and Human Development, Long Term Care Resources Program, Duke University Medical Center, Durham, NC
Correspondence: Stephanie J. Fonda, PhD, New England Research Institutes (NERI), 9 Galen St., Watertown, MA 02472. E-mail: sfonda{at}neri.org.
Decision Editor: Laurence G. Branch, PhD
Purpose: This is the second article reporting a project that (a) characterized the longitudinal functional patterns of residents in an affordable, assisted living housing (ALH) milieu for low-income people and (b) compared the ALH residents' functional patterns with those for similarly low-income, community-dwelling people. Design and Methods: Functioning was defined as the ability to perform activities of daily living and instrumental activities of daily living and respondents' competing risks such as death and institutionalization. The comparison samples were selected from the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. The analyses involved description of functional patterns and multinomial logit models to assess the relative likelihood that study participants experienced each pattern of functioning and competing risks. Results: About 42.4% of the ALH residents had stable high functioning, 32.9% deteriorated (e.g., had increased impairment, institutionalization, death), 3% improved in functioning, 6% exhibited moderate to severe impairment throughout the study, and the remainder returned to the community. Comparison of the ALH residents' functional patterns with those of the community-dwelling respondents indicated that the ALH residents' patterns generally were similar and in some ways better, adjusting for social–demographic factors and health; for example, the ALH residents were no different (statistically) in terms of improvement, decline, and death, but they were more likely to have stable high functioning. Implications: The results suggest that the affordable ALH milieu enabled low-income residents to maintain function or cope well with functional decline. The comparison with community-dwelling participants provides evidence that the affordable ALH milieu was comparatively beneficial.
Key Words: Functional patterns • Long-term care • Longitudinal assessment • Transition
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