Our work provides an important first step to understanding how older adults plan for aging and frailty and provides a foundational understanding of this field of aging research that might serve as a benchmark for future studies. This was the first known study to explore the understanding of factors that influence readiness for planning for aging and frailty. The use of the TTM as a health behavior change theory allows the application of behavior change towards planning and to facilitate advancement towards action and maintenance stages.
Interpretation of Results Based upon Study Aims
Results of this study contribute new knowledge and science in planning for aging and frailty. In Aim 1a (Chapter 2), we described the prevalence of stages of change related to readiness to plan for aging and frailty and described the impact of personal experiences and experience with others within the five domains of aging. Indeed, results revealed that the
distribution of stages of change varied across domains with opportunities for further activation of planning, especially in the three domains of cognitive status, environmental/transportation, and physical care/dependence that had the lowest stages of planning. Also, increased prevalence of experiences with others as compared with oneself emerged as a prominent finding leading to the thought that recognizing aging and frailty in others may be more acceptable, as compared to the realization how it may affect oneself. Participant characteristics associated with activation stages of planning for aging and frailty included older age, marital status, and living situation.
In Aim 1b (Chapter Three), we explored how people perceive the concept of planning for aging and frailty, and identified the facilitators and barriers to their planning efforts.
Interestingly, rich data from participants emerged describing the great value and importance they
planning process from a micro to macro level, they undoubtedly voiced significant barriers to their planning including internal and system-level barriers. Our findings support the need for triggers, resources, and interventions to help people overcome these barriers and prompt people to ponder earnestly about the need to plan.
Finally, in Aim 2 (Chapter Four), we examined the associations between contextual factors and stages of change for readiness to plan for aging and frailty. Social support was found to be strongly associated with planning across all domains except physical care/need for
caregiver. This is perhaps related the presence of family/friends in one’s life may cause one to assume that the need for a caregiver is already in place, negating the need to plan. Additionally, older age and increasing vulnerability was found to be associated with increased planning across three domains, and living situation, whether living with others or living alone, influenced
planning behaviors. Our study found no associations between income and health status with planning.
Comparison to Existing Research
Our study offers an interesting comparison to existing research. While previous
researchers have explored future care planning from various lens, no known studies exist which specifically examine readiness to plan along the stages of change, include measures of frailty or vulnerability, or explore personal experiences and experiences with others and how these factors may influence planning behaviors. Therefore, our study represents a novel contribution to gerontology research.
The results of our study were consistent with existing research which demonstrated future care planning rates as lower among community-dwelling African Americans vs White older adults (Kahana et al., 2019), and higher as educational levels and income rise (Prenda &
Lachman 2001). Older adults who have better support systems are more likely to plan (Sorensen
prior studies indicating older adults don’t like to think about aging and changes they may
encounter in physical and cognitive states (Allen, 2016; Harris & Dollinger, 2003; Klemmack &
Roff, 1984; Momtaz et al., 2021).
Our study differed from previous research on future care planning. First, we chose
variables that represented the comprehensive nature of an aging older adult through measurement of functional status, frailty, health status, and social support. Second, we explored participants perceptions, facilitators, and barriers in planning providing a rich description of older adults lived experiences.
Limitations
Our study has several limitations. First, the generalizability of the study findings may be limited due to the lack of diversity across socio-demographic variables. Also, participants were recruited from a convenience sample of local community locations and within a national online database, all sites where people intentionally join or seek out resources for their health,
education, and lifestyle, which may not be fully representative of the older adult population.
Second, in the semi-structured interviews, we utilized a new and untested interview guide and conducted the interviews on the phone rather than in-person which may have prompted greater connection with the interviewer. Third, the COVID-19 pandemic has greatly affected the domain of communication/socialization possibly contributing to a higher prevalence of readiness to plan given exposure to quarantine isolation and increased usage of technology to maintain social connectedness. Finally, despite careful planning, our online recruitment process was corrupted twice by online hacking which prompted us to shut down the website. The PI then personally confirmed existing data and the study shifted to utilizing ResearchMatch in order achieve the remaining sample size.
The results of our study reveal important implications for the care of older adults. First, the normalization of the aging process through the concept of planning for aging and frailty, may help older adults, healthcare systems, and society engage in the aging process through awareness, education, and proactive planning. Second, there is a natural progression of planning for aging and frailty to serve as an upstream initiative to prepare the way for advance care planning.
Clinicians can implement lifespan planning within established clinician-patient relationships that may segue to serious illness conversation and end-of-life discussions. Third, clinicians may practice patient-and-family centered care through the recognition of the influence of life experiences on one’s perception of planning. Clinicians may inquire about past family/friend aging experiences to prompt discussion and promote a focus on one’s holistic care.
Implications for Policy
Planning for aging and frailty as significant implications from a policy perspective given the multidimensional aging process and the influence of aging on all sectors of life. There is great opportunity to examine this planning concept not only from the individual level, but from the systems and societal levels. Future research may be explored on the collaboration across public and private sectors to transform the concept of planning from micro to macro level. Social determinants of health and socio-economic structuring of individuals’ ability to plan also must be further examined.
Implications for Research
Planning for aging and frailty is an innovative concept that has potential for future research within the life course perspective. This comprehensive view of aging allows for adults to recognize the aging process and normalize life transitions. Integrating this concept into other life course planning events, such as retirement planning, financial planning, estate planning, and long-term care planning, may allow adults to have greater control of their aging process.
Additionally, further research is warranted to develop interventions to help older adults recognize and actively plan for aging, and address barriers in planning.
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