The research, led by geriatrician and University of Otago, Christchurch researcher Dr Hamish Jamieson, found negative social factors were often more compelling reasons for elderly to enter care than health issues such as incontinence and falls.

The findings come from surveys of more than 54,000 elderly New Zealanders over a five year period. During that period 11,000 of the 54,000 people surveyed entered care. The average age of those surveyed was 81.

The study, published recently in The Journal of American Medical Directors Association (JAMDA), found:

  • People who said they were lonely (11,000 of 54,000 people) were almost 20 per cent more likely than others to go into a rest home, even when physically well.
  • Those living alone (27,000 people) were 43% more likely to enter care
  • Those with stressed carers (16,000) were 28% more likely than others to enter care
  • Those lacking in positive social interactions (5,000) were 22% more likely to enter care. This includes elderly experiencing conflict with friends or family.

Dr Jamieson says the Ageing Well National Science Challenge-funded study quantifies the significant impact social factors have on people entering rest care facilities. “While we know this is a problem it is really important to measure the size of the impact and also how big this is compared to other more medical factors,” he says.

“This study shows the importance of social factors in driving elderly into residential care, including people whose health is good for their age.  Previous research found urinary incontinence increased rest home entry by 11% and faecal incontinence by 7%. This compares with loneliness increasing the risk of going into a rest home by almost 20 per cent.’’

He says carer stress is also a common cause of elderly entering rest homes, even when they are in relatively good health for their age.

“Families or whanau often do everything they can to support their loved ones staying at home.  However, this constant caring can become exhausting for families which leads to admission into aged care facilities.”

Dr Jamieson says New Zealand is one of many countries that have developed health and social policies to provide early intervention and allow older people to live healthily in their own home. These strategies often focus on health but this study shows social factors are just as powerful in a person’s decision, or the decision of their family or whanau, to make the move into aged residential care.

Data for the study was gathered during Ministry of Health InterRAI assessments done prior to 2015. These comprehensive assessments are done routinely for elderly people in the community or in aged care facilities to determine what support they may need.  The assessments typically take two hours and assess myriad factors such as their health and wellbeing.

Carers NZ has welcomed the research and its highlighting of carer stress and incontinence as factors for entry to residential care.

“Carers do their best but New Zealand doesn’t adequately recognise or support them,” says CEO Laurie Hilsgen. “It’s a role families have always played so we take it for granted.”

Carers NZ and the Carers Alliance of 45 national not for profits are calling for more investment and focus on respite, so carers can have adequate breaks to sustain them. The economic realities of caring also impact families, she says.

“Giving family carers the option of fair payment so they can make the choice to care is an alternative to residential care. Two thirds of carers are women, many in middle or later age, and almost 90% are of workforce age. High living, housing, and transport costs mean people have to work and combining employment with caregiving can be difficult.”

The social contract government often uses as an excuse to minimise investment in family caregiving, saying families must turn to each other before asking for public support, is outdated, Hilsgen says.

“At a time when we are debating raising the age of retirement we’re neglecting the issues that mean many carers never make it to retirement because they leave work to care, or can’t be paid for the caring work they do.”

The carer movement is awaiting a response from government about how it will improve its contentious Funded Family Care policy.

It has recognised the need for better support for carers helping a loved one manage incontinence at home by commissioning a paper to learn about how this impacts carer stress and may contribute to residential care entry. The results of the Synergia research, with input from more than 400 carers, will be released this month.


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