Interviewing Residents on the Decision to Relocate to Nursing Homes

One of the strengths of interview research, and other qualitative methodologies, is that we can empirically study the significance of events to individuals. Quantitative research, often given greater prestige, can present valuable information about a large number of people and events, but is unable to formally address what these numbers mean. Thus, many important research questions are not addressed with sufficient depth or critical analysis.

Nursing research is one area where the meaning of events is clearly significant. A recent article in Clinical Nursing Research addresses the meanings that older adults attributed to the decision to relocate to a nursing home (Johnson et al 2010). The researchers explored whether the residents felt that the decision was theirs, and how much certain personality traits and personal abilities played a role in the decision. A subsample of a larger study of white (N=16) and African-American (N=9) nursing home residents was administered a semi-structured interview by the researchers, in what the article describes as their “large, Midwestern inner-city nursing homes.” Additionally, participants were administered a number of scales of demographics, cognitive functioning, self-assessment, and self-efficacy.

The researchers coded the interviews in categories of “I/we made the decision” and “they made the decision.” In the former group, the researchers identified cooperation between older adults and their families in the decision to relocate, with “involvement, even ownership in the relocation decision.” (Johnson et al, 364) In the latter group, the researchers found reports of minimal participation in the decision making, and even claims of deception. Interestingly, functional limitations did not seem to contribute to membership in the “I/we decided” and “they decided” categories, which the authors point out affirms the notion (as shown in the nursing and disability literatures) that functional abilities are highly contextual, rather than purely an individual trait. The authors also note a lack of consideration of other options such as community care and assisted living.

The authors note some limitations and interesting problems in their study. Sample size is an issue for the quantitative aspects of their study. Additionally, at one nursing home there was active discouragement of participation by some of the staff, concerned that the white university-affiliated researchers were taking advantage of the low-income, vulnerable African-American residents. (This concern was uncharitable toward the researchers in question, but should be seen in light of the many such research abuses of minority and indigenous Americans that have repeatedly taken place during the lifetimes of this older adult population.) This issue points to a potential methodological and interpretive limitation of the research: how were the researchers and the interviews perceived by the participants? How did this perception influence the quality of the data given by the different subpopulations in the study? Additionally, the article is a bit unclear in terms of its treatment of self-reported data, at times appearing to take at face value the reports of the participants.

This is a limitation of structured interview research, particularly that taking place without additional participant-observation or triangulation of data sources (such as participation with family or staff, or more long-term interaction with participants). Despite these limitations, this article illustrates the need to assess the family support and other contexts of decision-making about the lives of older adult, and to avoid making assumptions about the role of family across ethnic groups

Cited: Johnson, Rebecca; Popejoy, Lori and Radina, M. Elise, (2010). “Older Adults’ Participation in Nursing Home Placement Decisions.” Clinical Nursing Research 19(4), 358-375.

Self-Fulfilling ProphecyHow Perceptions of Aging Affect Our Later Years

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