1. Well-being among elderly community
dwellers and assisted living residents:
A comparative analysis
Sara Carmel, Hava Tovel, Zinovi Shraga
The Center for Multidisciplinary Research in Aging
Faculty of Health Sciences
Ben-Gurion University of the Negev
Supported by:
The Israel Ministry for Senior Citizens
The Abraham and Sonia Rochlin Foundation

2. Quality of life and subjective well-being –
societal needs and challenges
 Decreased quality of life is one of the
phenomena accompanying prolonged life,
with significant implications for the elderly,
their families, and society as a whole.
 Finding the best social solutions for this
relatively vulnerable population group has
become a challenge to all nations.

3. Purpose of the study
 The leading worldwide approach for maintaining
successful aging is to enable older people to
"age in place" – in their homes and
communities.
 The purpose of this study was to question this
dominant approach by comparing subjective
well-being (SWB) of assisted-living residents
(ALR) to that of community dwellers (CD).

4. Assisted living (AL) in Israel
In Israel, AL sites (also called “sheltered housing”)
are run by for-profit and non-profit organizations.
Both provide high quality services.
(165 sites/21,000 units)
Services provided:
- Personal safety arrangements
- 24-hour availability of medical services
- Immediate assistance for any need
- Restaurant services
- Home cleaning and repairs
- A variety of social, cultural and physical activities
The degree of use of each service depends on the resident.

5. Method
Structured home interviews were conducted with
two groups of people aged 75+, living in 3 major
Israeli cities - Tel-Aviv, Beer-Sheva, Haifa.
1. An ALR group, based on agreement to participate in
the study from 8 large facilities (n=215)
2. A CD group - of elderly matched for age, gender,
family status, economic status, ADL, and IADL
(n=215)

6. Comparison between CD and ALR on health, function,
and socio-demographic characteristics
CD ALR t 2 df p
Gender Male Female Male Female 2 =.30, df=1, p=.58
59 (27%) 156 (73%) 54 (35%) 161(75%)
Spouse yes no yes no 2 =1.66, df=1, p=.198
80 (37%) 135 (63%) 67 (31%) 147 (69%)
Age (M/SD) 83.9 (4.19) 83.9 (5.38) t=-.100, df=428, p=.920
Health (M/SD) 3.13 (.94) 3.09 (.84) t= .515, df=428, p=.607
IADL (M/SD) 1.39 (.55) 1.33 (.55) t=1.25, df=426, p=.211
Education low High low High
15 98 101 21 78 114
(7%) (46%) (47%) (10%) (37%) (53%)
Economic Bad good Very bad good Very 2 =4.85, df=2, p=.089
status good good
16 171 28 16 154 45
(7%) (80%) (13%) (7%) (72%) (21%)

7. Comparison between CD and ALR on indicators of SWB
Well-being CD ALR
M (SD) M (SD)
t
Life satisfaction (Neugarten) 3.45 (.68) 3.65 (.61) -3.24, p=.001
Life satisfaction (Carmel) 3.96 (.66) 4.17 (.55) -3.57, p<.000
Successful aging (subjective) 7.58 (1.83) 8.03 (1.62) -2.65, p=.008
Loneliness (high score = low loneliness) 4.71 (1.25) 5.03 (1.12) -2.72, p=.007
Happiness 5.29 (1.26) 5.50 (1.03) -1.85, p=.064
Morale (Lawton et al.) 2.85 (.64) 2.96 (.52) -2.21, p=.032
Will to live 3.43 (.88) 3.43 (.72) .105, p=.920
GDS (high score = low depression) 11.18 (3.42) 11.96 (2.99) -2.53, p=.012
Fear of dying 3.72 (1.19) 4.04 (1.12) -2.86, p=.004
Fear of death 1.55 (.81) 1.38 (.63) 2.37, p=.018

8. Antecedents of different aspects of well-being ()
LS-N LS-C Success- Loneli- Happin- Morale Will to GDS Fear of Fear
ful aging ness ness live dying of
death
Gender .099* .119** .108* .146* .053 .041 -.089 .067 .142* -.023
Spouse -.167** -.124* -.059 -.228** -.058 -.086 -.067 -.110* -.081 -.063
Econo. .139** .146* .079 .045 .083 .080 -.014 .069 -.083 .072
status
Health -.331** -.313** -.358** -.125* -.266** -.398** -.291** -.247** .185** .073
status
IADL -.134** -.146** -.149** -.095 -.054 -.121* -.025 -.246** -.146* .088
Resid- .138** .150** .109** .137** .080 .082 -.004 .104* .143** -.100*
ence
R2 .26** .25** .24** .11** .11** .26** .10** .22** .08** .02*
LS-N – Life satisfaction (Neugarten et al., 1961) , LS-C – Life Satisfaction Carmel, 1997
Morale – Philadelphia Geriatric Center Moral Scale (Lawton, 1975), Loneliness – Hughes et al. , 2004,
Happiness – Lyubomirsky et al., 1999,
GDS – Geriatric Depression Scale (Zalsman et al., 1998).

9. Addressed needs and satisfaction in AL
Degree of addressed needs in AL (on a scale of 0-5):
A high degree of response to needs with average
scores from 4.84 (SD= .44) to 4.34 (SD=1.38) .
Exception – reference to meals (3.00, SD=2.2) due to
great variability in use.
The highest scores were given for: ability to manage an
independent life, to continue life as usual, feeling
comfortable in the apartment, physical security,
accessibility of medical services, and privacy.
Satisfaction with relocation to AL was high –
87% responded as very satisfied.

10. Experienced changes in AL
What are the 3 most important changes for you with relocation?
(% out of all responses in each category)
Positive (202 out of 215 responded – 365 responses):
- Social life - 29% - Release from household
- Personal security - 22% duties - 7%
- Leisure activities - 13% - Easier life - 7%
- Personal tranquility - 9% - Medical security - 5%
- Housing conditions - 5%
Negative (83 out of 215-responded, 23 responded - no negative change,
altogether only 49 responses):
- Condition of neighbors - 22% - Adjustment difficulties - 10%
- Housing conditions - 22% - Loss of neighborhood - 10%
- Loss of privacy - 8% - Faraway from town - 6%
- Lacking pets - 4%
- Other issues - 16%

11. Summary of results
 The two groups were similar in socio-demographic
characteristics, self-rated health, ADL, and IADL.
 ALR ranked themselves significantly and systematically
higher than CD on indicators of well-being including:
Satisfaction with life (two measures)
Self-perceived successful aging
Happiness
Morale
Fear of death (inverse direction)
Depression (inverse direction)
Loneliness (inverse direction)
(8 out of 10)
ALR ranked themselves worse regarding fear of dying.

12. Summary of results (cont.)
 The best predictors of SWB across 10 different
measures, in order of importance, were:
- self-evaluated health status
- type of residence
- IADL
- gender
- having a spouse
- self-evaluated economic status.
Most of the responses to needs addressed in AL
and changes with relocation indicated a high
level of satisfaction with relocation

13. Conclusions
 Type of residence plays an important role in influencing
older adults' SWB, assisted living being preferable.
 The residence effect is stronger than age, gender,
economic status, having a spouse, and IADL.
 These findings and their practical implications shatter the
currently dominant beliefs and practices regarding best
residence solutions for elderly people.
 Replications of this study in Israel and other countries
are needed in order to ascertain these findings and the
derived implications.
 We must continuously promote evidence-based best
responses to the needs of older adults and society.

14. Life is beautiful

15. Comparison between CD and ALR on indicators of SWB
Men only (n=113)
Well-being CD ALR
M/SD M/SD
t
Life satisfaction (Neugarten) 3.41 (.71) 3.70 (.59) -2.32, p=.022
Life satisfaction (Carmel) 3.93(.73) 4.18 (.55) -2.06, p<.041
Successful Aging (subjective) 7.43 (1.83) 8.04 (1.72) -1.69, p=.093
Loneliness (high score = low loneliness) 4.50 (1.35) 5.11 (1.11) -2.59, p=.011
Happiness 5.21 (1.32) 5.60 (1.16) -1.64, p=.103
Morale (Lawton et al.) 2.89 (.70) 3.01 (.50) -1.00, p=.318
Will to live 3.56 (.82) 3.64 (.54) -.650, p=.517
GDS (high score = low depression) 11.17 (3.84) 12.26 (2.75) -1.75, p=.084
Fear of dying 3.72 (1.19) 4.04 (1.12) -2.16, p=.033
Fear of death 1.51 (.70) 1.46 (.74) .380, p=.705

16. Comparison between CD and AR on indicators of SWB
Women only, n=317
Well-being CD ALR
M/SD M/SD
t
Life satisfaction (Neugarten) 3.46 (.67) 3.63(.61) -2.37, p=.018
Life satisfaction (Carmel) 3.97 (.63) 4.16 (.56) -2.89, p<.004
Successful Aging (subjective) 7.64 (1.74) 8.02 (1.60) -2.04, p=.042
Loneliness (high score = low loneliness) 4.80 (1.21) 5.00 (1.13) -1.56, p=.121
Happiness 5.32 (1.25) 5.46 (1.00) -1.13, p=.260
Morale (Lawton et al.) 2.84 (.61) 2.97 (.53) -1.93, p=.054
Will to live 3.39 (.89) 3.36 (.77) .366, p=.714
GDS (high score = low depression) 11.18 (3.26) 11.86 (3.01) -1.91, p=.057
Fear of dying 3.85(1.16) 4.11 (1.11) -1.94, p=.053
Fear of death 1.56 (.86) 1.35 (.59) 2.49, p=.013