Older adults aging-in-place Reform evaluation and dyadic methodology to include people living with dementia and their informal caregivers

Many countries have reformed their long-term care system to focus on aging-in-place policies that try to enable older adults to live at home for as long as possible. The objective of this thesis was to evaluate national aging-in-place reforms and to create a methodology for persons with dementia and informal caregivers to provide their aging-in-place care preferences. Part one used reforms from Japan and the Netherlands to evaluate effects on quality indicators such as location of death and hospital utilization. Findings indicated that enabling older adults to stay at home until death is difficult to achieve in Japan. In the Netherlands, aging-in-place reforms were associated with a temporary increase in acute hospitalizations and length of stay was longer than expected. Part two focused on creating a methodology to enable greater participation of persons with dementia and informal caregivers to age-in-place and provide evidence of their care preferences. Five key care components were identified: social network, formal care, information, emotional support, and easier access to care. Care priorities of persons with dementia were related to support with day-to-day activities whereas the priorities of informal caregivers were related to organizing and coping with dementia caregiving. Furthermore, a template for dementia-friendly dyadic discrete choice experiments was created, that can enable preference elicitation of informal caregivers and persons with dementia on a larger scale. This thesis examines effects of aging-in-place by evaluating population-level quality indicators while also providing an evidence base for people living with dementia and informal caregivers to maximize aging- in-place.