The goal of this 3-year, anthropological research is to examine the health-related factors that affect the transition from living along successfully to increased dependence among the oldest old. The study has 3 specific aims, to be carried out by studying 100 persons over the age of 80 for one year each, using primarily qualitative methods and some quantitative measures: 1) to examine the personal meanings and experience of living independently in advanced old age; 2) to examine the losses associated with the health problems, hospitalization, and changes in living arrangements; 3) to examine the full range of this experience by studying 4 groups of 25 respondents each, as follows: a) those successfully living alone; b) those living alone at the time of a hospital admission during year 01; c) those referred to a geriatric assessment service due to problems living alone; d) those discharged from a hospital in the year preceding year 01. The study population will be selected from 5 sources at Mt. Zion Hospital and Medical Center, S.F. Data will be collected via semi-structured interviews, participant-observation, standardized measures, and assessment of functional status. In data analysis, the four groups (a-d) above will be treated as four analytic cells. From an ethnographic standpoint, they represent different stages in the transition from independence to dependence. Variables that impinge upon the transition process, autonomy, and its meanings may include: living arrangements, availability of social support, availability of care, gender, ethnic background, religious affiliation, income, education, health status, and extent of utilization of community services. In this study of process, analysis of qualitative data (90%) will include: cross-sectional comparison, thematic analysis, frequencies of response, representational analysis using Ethnograph, and the case study approach. Quantitative analysis (10%) will be complementary to and interactive with qualitative approaches.
