Ways to support older people deciding whether to enter long-term residential care

The decision to enter long-term care is a major life event for older people. It is usually made at a time of crisis and vulnerability, and there is often pressure to make the decision quickly. How the decision is made may affect older people's adjustment to residential care and quality of life, along with those of their carers or family. There are a number of ways that health professionals provide support to older people making this decision. These include a thorough assessment of their needs, provision of adequate information, counselling, providing choices, and the facilitation and timing of the decision-making process.

The review authors could not find any studies that adequately assessed these interventions. This means that there needs to be more studies, not necessarily that the interventions are not helpful.

Older people who were not able to make decisions due to medical conditions were excluded from the review.

Authors' conclusions: 

No eligible studies were identified to inform the use of interventions to support the decision-making process for older people facing the possibility of long-term residential care. This should not be interpreted as demonstrating that these interventions are not effective. The many related studies we identified which did not meet the study design criterion for this review indicate that there is substantial research interest in this topic. It would be useful to summarise the information available in the wider literature using newly-developing methods for synthesising qualitative studies. This could help identify interventions which warrant further research. Rigorously conducted randomised controlled trials of these interventions could then make a valuable contribution to the range of evidence surrounding this significant event in the lives of many older people, informing practice and policy development.

Read the full abstract...

The decision to enter long-term care is often a major life event for older people, made in the context of personal crisis and loss. We hypothesised that the process through which a decision to enter long-term residential care emerges affects the overall psycho-social adjustment to, and acceptance of, this decision, and may have an impact on a range of other outcomes for older persons and their carers, such as health status.


To assess the effects of various decision-support interventions delivered by health or social care providers on the outcomes of older people facing the possibility of entering long-term residential care.

Search strategy: 

We searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2005); MEDLINE (Ovid) (1966 to November week 3 2004); PsycINFO (Ovid) (1872 to February week 4 2005); and other databases. There were no language restrictions.

Selection criteria: 

Randomised controlled trials, quasi-randomised controlled trials/quasi-experimental trials, controlled before and after studies, controlled prospective studies and interrupted time series studies of assessment, information provision, counselling, decision-making facilitation, provision of choice, timing of the process, other communication strategies and any other intervention deemed relevant in supporting decision making for older people facing the possibility of long-term residential care.

Data collection and analysis: 

As there were no studies that met the inclusion criteria no data collection or analysis was conducted.

Main results: 

No studies met the review's inclusion criteria. Although the searches identified a number of studies, they were predominantly opinion pieces or qualitative in nature. While these studies are a potential source of evidence about current practice or people's views, they were not suitable for drawing conclusions about the effects of interventions to support decision-making.