Moving from your home to a nursing home or assisted living is stressful and depressing. Or is it?

(L-R) Linda Curry, Charles Walker and Mildred Hogstel.

Fort Worth, TX

4/2/2009

By: Shannon Rossman Allen

There’s no question older adults face myriad challenges related to aging, but when nursing professors Linda Cox Curry and Charles Walker ’77 (BSN ’83) looked into the effects of moving to a long-term care (LTC) facility, they discovered that assumptions didn’t connect to reality. In fact, their research revealed just the opposite — such a move often provides relief from worries and improves quality of life.

“The symptoms of relocation stress were conspicuously missing from the interview transcripts, which was both unmistakable and surprising,” Curry says.

The absence of relocation stress-supported data led the research team to believe that relocation stress may be more related to a negative perception of long-term care rather than the actual move.
Sadly, those perceptions can be problematic. The diagnosis of relocation stress syndrome may be overused and might not appropriately address a patient’s psychological needs.

Relocation Stress: Myth or Reality?

Relocation stress is a common nursing diagnosis, especially for older adults moving from one environment to another. Yet Walker and Curry, executive director of the Center for Healthy Aging; and Mildred O. Hogstel, nursing professor emerita, found that this diagnosis may be incorrect.

Characterized by symptoms including anxiety, confusion, hopelessness and loneliness, relocation stress typically presents itself in older adults shortly after they move from a private home to a long-term care (LTC) facility, such as assisted living or a nursing home, Curry notes.

Building on more than a decade of previously published research, Walker, Curry and Hogstel set out to validate the symptoms of relocation stress syndrome through eight nursing home residents and eight assisted-living facility residents. These 16 participants were interviewed two to 10 weeks after LTC admission, when relocation stress symptoms are most likely to occur. Sixteen participants is an adequate sample in qualitative research and generally interviews continue until these become redundant.

“Our overarching goal was to verify the nature and kind of distress associated with relocation stress syndrome, validate diagnostic criteria among older adults residing in nursing homes and assisted living facilities, and determine whether relocation stress syndrome manifests differently among residents of one facility versus the other,” Walker says. Three research questions served as the cornerstone of this study:

1. How do older adults experience moving from their primary residence to a LTC facility?
2. Does the relocation experience differ for older adults transitioning to a nursing home versus an assisted-living facility?
3. Is relocation to a LTC facility uniformly perceived as stressful?

Research participants were chosen based on their suspected vulnerability to relocation stress syndrome, with formal consent coming from the administration of the LTC facilities being entered, as well as the individual participants and their families, where applicable. Each of the 16 residents participated in audio-taped interviews with licensed, mental health professionals for 45 to 90 minutes, two to 10 weeks after admittance into the facility, Curry notes. The audiotapes were then transcribed by the interviewers to ensure trustworthiness and consistency.

Specifically, the participants were asked to describe:
· Disappointments
· Expressions of grief
· Aspects of their lives (prior to relocation) that they missed most
· Eating and sleeping habits
· Perceived health status
· Performance of daily living activities
· Family participation
· Coping strategies

The research findings proved interesting to the TCU researchers, who found that all 16 participants claimed their moves to LTC were decisions they made on their own or in consultation with their families. “There was really no reluctance or resistance to their relocation,” Curry says of the participants.

When examining the data, the trio found that participants’ responses to relocation were similar, especially in regard to eating (they were pleased with meals provided and not having to plan them themselves), sleeping patterns (they expressed some difficulty getting comfortable and sleeping at night), and their ability to make informed and independent decisions in their new homes.

“While the participants expressed sadness at leaving their homes, they did not look at their moves to LTC as the end of the world,” Walker notes.

Overall, the study showed that participants were pleased with their relocation experience and expressed gratitude for their lives made easier, healthier and safer in LTC.

“While there are some limitations to our study, such as the participant self-selection and the fact that those who took part had only mild cognitive impairment, there was a genuine absence of data that supported relocation stress,” Curry says. This led us to believe that relocation stress may be more related to a negative perception of long-term care rather than the actual move.”

The research team noted the difficulty of distinguishing relocation stress from other disorders, such as depression, but they did not take the symptoms of depression lightly if encountered during the interview process: Participants exhibiting signs of depression were referred to a geropsychologist for mental health evaluation rather than simply diagnosing them with relocation stress syndrome.

“Adjustment to loss is a key component of relocation syndrome,” Walker says, “and these individuals did not have a negative reaction to the loss of their home lives as a result of moving into long-term care.”

This study suggests that the incidence of relocation stress syndrome may be overestimated. “Relocation may explain how or why an older adult reacts negatively to a transition from home to long-term care,” Curry shares, “but relocation stress syndrome should not be too readily applied because it may delay an appropriate diagnosis and course of treatment.”

An Unexpected Topic

Sometimes future research topics spring up in the most unlikely places. An unexpected, but eye-opening, aspect of the study emerged when one resident courageously revealed her experience as a lesbian in LTC. Her story inspired Curry, Walker and Hogstel, to enlist Harriet Cohen and David Jenkins, both associate professors of social work, in a new study about what older lesbians and gay men experience when relocating to LTC.

“This woman bravely shared how she felt like she had to ‘retreat back into the closet’ because she feared discrimination or harassment from staff or other long-term care residents,” Walker said.
Cohen, the research lead, commented in a recent online TCU article that, “older lesbians and gay men often feel they must go back into hiding when they become ill, vulnerable and dependent on others.” The interdisciplinary research team found it troubling that these women and men might hide a critical part of their identity in order to feel physically and emotionally safe in nursing homes, assisted living facilities or retirement communities.

A literature review titled “Older Lesbians and Gay Men: Long Term Care Issues” in the February 2008 issue of Annals of Long-Term Care, found that a lack of culturally sensitive services exists for older lesbians and gay men. The formal research study, “Perceived Disclosure Vulnerability of Lesbian and Gay Older Adults Living in Long-Term Care Facilities” is currently funded and data collection has begun.

The team’s research is based on a common gauge that between three and five percent of the older population uses nursing home care. It is expected that between 120,000 to 300,000 older lesbians and gay men will live in U.S. nursing homes by 2030. Cultural competence training for staff, residents and their families can assist LTC facilities in providing an environment where older lesbians and gay men do not need to be fearful or hide their identities, but rather can experience the same quality of life as older adults in general, the authors conclude.

In exploring the limited research that exists on this topic, the research team found that the health care community does not acknowledge “chosen families.” Same-sex partners are oftentimes denied visitation privileges in hospitals and care facilities and are not consulted in health emergencies nor contacted when a loved one’s health status changes or when, in dire circumstances, death occurs.

“Lesbians and gay men agonize about accessing long-term-care services because they worry that their quality care may be compromised by homophobic and heterosexist attitudes and practices among staff, fellow residents and residents’ families,” Cohen states. “As a result, older lesbians and gay men worry about the loneliness and vulnerability, as they are not able to display pictures or keepsakes or to reflect on their shared life experiences with significant others and friends.”

 

Contact researchers at l.curry@tcu.edu; or c.walker@tcu.edu. Comment at tcumagazine@tcu.edu. Researchers detailed their findings in the January 2007 issue of the Journal of Psychosocial Nursing in an article titled “Relocation Stress Syndrome in Older Adults Transitioning from Home to a Long-Term Care Facility: Myth or Reality?”

Linda Cox Curry is a professor of nursing at the Harris College of Nursing & Health Sciences. She earned her undergraduate and master’s degrees at the University of Florida, Gainesville, and her doctorate at the University of North Texas, Denton. Her area of expertise is women’s health, and her research interests include healthy aging, osteoporosis and caregiving by families.

Charles Walker is a professor of nursing at the Harris College of Nursing & Health Sciences. He earned undergraduate degrees at TCU, a master’s at University of Texas, Arlington, and a doctorate at Texas Women’s University, Denton. His research interests include aging readiness, mid-life transitions, baby boomers and lay caregiving.

Source: TCU Endeavors