It Depends: Reasons why nursing home residents change their minds about care preferences

Purpose of the Study: Understanding and honoring preferences are fundamental in the promotion of well-being for frail elders. This study aims to understand and describe nursing home residents' perspectives on why the importance of their preferences may change in daily care. Design and Methods: Secondary data analyses of cognitive interviews with 39 cognitively capable nursing home residents regarding their importance of preferences for everyday living were completed. Interviews were coded by 5 team members for reasons why residents may change their minds about the importance of their preferences or why their preferences may be restricted; discrepancies were reconciled through consensus. Results: Content analysis revealed 4 major domains: within person (e.g., functional ability, personal schedule), facility environment (e.g., facility schedule, facility policy), social environment (e.g., quality and type of interactions), and global environment (e.g., weather, current events, special occasions). Residents reflected that the importance of their preferences fluctuated "depending upon" the circumstances related to these factors or their ability to perform the preference (i.e., barriers they encountered). A total of 27 themes for dependencies and barriers were identified. Implications: Findings indicate that nursing home residents' preferences may change in importance or fulfillment in relation to personal or environmental circumstances. In order to develop formal care that matches older adults' preferences, regular assessment of both elders' preferences and the contextual factors affecting preferences is needed. However, given the changing nature of preference importance, there is also a need to determine how to best balance older adults' changing preferences within care delivery environments.