Relationships Impact Well-Being in Older Adults in Assisted Living
Medically reviewed by Paul Sietes, MD.
Different types of relationships — whether friendship, long-term marriage, or a new intimate partnership — significantly influence the well-being and quality of life of older adults in assisted-living facilities, according to new research published in the journal The Gerontologist.
The study explored the benefits and downsides of a variety of relationships among married and unmarried couples in assisted living facilities. The findings reveal the complexity and range of later-life couples’ intimate and social lives.
Older adults typically move to assisted living because of declining health, shifting dependence patterns, and an inability or reluctance to stay in their former homes. While married couples are still a minority in assisted living facilities, they may become more common as the population ages.
Until now, there has been very little research exploring the complexity of later-life couples’ daily lives and experiences, particularly in the contexts of advanced age, health decline, and long-term care settings such as assisted living.
For the study, the researchers collected data for one year on 29 couples (26 married and three unmarried) in eight diverse assisted-living facilities in Georgia. The 26 married couples were in long-term relationships, while the three unmarried couples had met in the assisted living facility, which shows that intimate relationships can develop late in life and in assisted living.
“The nice thing about these communal settings is there are a lot of widowed, divorced, and never married people, and there is potentially opportunity to develop relationships,” said Dr. Candace Kemp, associate professor in the Gerontology Institute and Department of Sociology at Georgia State University.
“It makes a huge difference in the quality of life and the day-to-day life experience to have that intimate connection with somebody else. These were probably unexpected relationships for the unmarried couples, but very fulfilling relationships for those who manage to find a partner.”
The small number of couples in the study is due to high impairment levels and gender imbalance in assisted living.
Researchers found significant benefits in having late-life intimate partnerships including companionship, support, and affection. However, some of the downfalls included feeling the burden of caregiving, feeling defined by one’s spouse and having limited choices.
Other negatives of couplehood in assisted living included the potential for other partners, induced jealousy and marital infidelity. Unmarried couples, particularly women, were gossiped about, revealing the different cultural norms that still apply to older men and women and married and unmarried couples.
“I think doing work in this setting is important and it’s quite possible with people living longer that there will be more couples in these situations, whether they’re married or unmarried. We certainly know very little about unmarried couples in later life,” said Kemp.
“These are important relationships and to the extent that they can be supported have really significant implications for well-being and quality of life for older adults. In some cases, particularly with the married couples, these are marriages that are 60 and 70 years in the making, and to separate people and not facilitate them aging in place together can be problematic.”
For example, one person in the partnership might become ill while the other remains healthy. If a husband or wife suffers from cognitive impairment, the assisted-living facility might decide to move the ailing person to a dementia care unit and leave his or her spouse on the assisted-living side, which separates the couple, Kemp said.
Friendships were found to be of particular importance as well. While many assume couples have each other and don’t necessarily need other types of relationships, the frailty of participants in this study and the range of marital quality revealed that coupled residents could not always depend on their intimate partners for support.
In fact, fellow residents may step in to act as important confidantes, companions and friends to coupled residents in assisted living. Friends can also help buffer against negative health outcomes associated with marital transitions, such as when a spouse is ill or passes away.
The researchers suggest that strategies aimed at supporting couples in assisted living should focus on individual needs and shared needs as a couple, particularly as couples experience physical and cognitive decline over time.
“There are some scenarios, particularly if the caregiving spouse is doing so much work and worrying so much, that they can compromise their health by trying to do more than they’re able to do,” Kemp said. “I think it’s finding that balance between what’s best for both the individual and the couple and sometimes those are in conflict.”
Source: Georgia State University