{"doi":"10.1111/jgs.18536","title":"Fluctuating decision making about aging‐in‐place/long term care planning among older adults","abstract":"Older adults often do not understand or plan for the support services that they need for their future aging-in-place and long-term care (AIP/LTC).1 Over their lifetime, people living with dementia require extensive supportive services and increasing care coordination over time.2 When they do not make AIP/LTC plans prior to worsening cognitive loss, decisions fall to unprepared families and friends—often during a crisis and without an understanding of the older adult goals.3 AIP planning entails making decisions about the structural feasibility of the home, identification of potential supporters, and determining proximity to healthcare.4, 5 LTC planning entails making decisions about residential communities, financing, and determining fit with perceived future needs.6 Prior research on healthcare decision-making (e.g., end-of-life, elective surgery, vaccine use) has often utilized the transtheoretical model of health behavior change which delineates the stages as follows: (1) precontemplation, (2) contemplation, (3) preparation, (4) action, (5) maintenance, and (6) termination.7 With AIP/LTC decision-making, a gap exists in the literature on whether it fits this model. We sought to understand the process older adults use to make AIP/LTC decisions, specifically if they were to develop Alzheimer's disease in the future. The PlanYourLifespan-LitCog study examines longitudinal AIP/LTC decision-making among a cohort of older adults (65 years+), who have extensive health literacy and cognitive testing.8 Subjects in the cohort were provided the intervention: PlanYourLifespan.org, which is an evidence-based planning tool that has been shown effective in facilitating older adults' AIP/LTC understanding and decision-making.9 Research staff conducted surveys at baseline (BL), administered PlanYourLifespan, and then re-surveyed subjects at 1 month and 6 months. Subjects were specifically asked “If you developed Alzheimer's or memory loss and could no longer live independently in your own home, have you decided what your living preferences would be?” and responses were collected as “no”, “yes,” or “unsure” with follow-up open-ended “What were those plans?”. Responses were analyzed using a mixed-methods approach with open-ended responses coded by three coders using constant comparative analysis.10 Of the 293 subjects, characteristics were mean-age 73.0 years, 72.7% (n = 213) female, 66.8% (n = 196) White, 28.7% (n = 84) Black, 5.1% (n = 16) Hispanic, 3.1% (n = 9) Asian, 1.4% (n = 4) more than one race. With cognition, 22.2% (n = 65) had mild or moderate impairment. Retention rates were 98.0% (n = 287) at one-month and 96.9% (n = 284) at 6-month (Figure 1). Older adults fluctuate in their AIP/LTC decision-making and can exhibit circular patterns over a period as brief as 1–6 months. The course of AD is often prolonged, necessitating planning for a wide range of issues including caregiver preferences, living situation, financing, and healthcare preferences. Identifying decision-making patterns in these areas may be helpful in establishing impactful decision-making processes so individuals' LTC plans reflect their decision-making to reflect their current situations and preferences. Our results demonstrate the need to revisit these AIP/LTC discussions often with older adults. A limitation of this study was the follow-up of 6 months and it is unclear if decisions will continue to fluctuate over time. While the decision-making pattern we observed reflected the living setting (home versus LTC); over time, it may also involve caregiver preferences and healthcare preferences. As we plan to follow subjects for an additional 36 months, we will be able to further examine experiences that may influence older adults' changing AIP/LTC decisions. In conclusion, older adults make changes to their AIP and LTC plans over time – contemplating and making decisions and then re-contemplating at times. These findings highlight the need for supporters/providers to h","journal":"Journal of the American Geriatrics Society","year":2023,"id":355770,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9595,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":721420,"name":"Amber Miller‐Winder","orcid":null,"position":1,"is_corresponding":false},{"id":1104564,"name":"Alaine Murawski","orcid":null,"position":2,"is_corresponding":false},{"id":1104565,"name":"Raven Relerford","orcid":null,"position":3,"is_corresponding":false},{"id":1104566,"name":"Charles Olvera","orcid":null,"position":4,"is_corresponding":false},{"id":969626,"name":"Anna Liggett","orcid":null,"position":5,"is_corresponding":false},{"id":721421,"name":"Vanessa Ramirez‐Zohfeld","orcid":null,"position":6,"is_corresponding":false},{"id":302259,"name":"Lee A. Lindquist","orcid":"0000-0002-4290-5081","position":7,"is_corresponding":false},{"id":1104563,"name":"Allison Schierer","orcid":null,"position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-19T01:13:21.145955Z","pmid":"37555587","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}