Fear of loss of independence and nursing home admission in older Australians.

A prerequisite for the success of any health or social care policy is the ability to address the concerns of the target group. The findings described in the present paper form part of a larger study of the hopes and fears that older people hold for their future. Data were collected through a cross-sectional, population-based telephone interview survey conducted in New South Wales, Australia, from 1999 to 2000. The participants (n = 8881) were randomly selected, community-dwelling older people (>/= 65 years). Survey weights were used for estimating proportions and for all statistical inferences. The prevalence of expressing fears for the future was estimated, and analyses of selected predictors of specific fears for self were conducted by logistic regression modelling, with males and females modelled separately. The present paper focuses on two of the reported fears for self: loss of independence and nursing home admission, which have implications for healthcare and service use; and the authors identify the extent of their association with sociodemographic, health and lifestyle factors. Apart from the fear of losing one's physical health, the participants' main fear for self was of losing their independence [20.4% of males, 95% confidence interval (CI) = 18.5-22.3%; 34.5% of females, 95% CI = 32.3-36.4%], with a specific fear of nursing home admission (4.9% of males, 95% CI = 3.9-5.9%; 9.5% of females, 95% CI = 8.3-10.6%), with confidence intervals indicating a significantly higher prevalence of both in females. Living alone was significantly associated with fear of loss of independence in females only [odds ratio (OR) = 1.62, 95% CI = 1.38-1.90], and with fear of admission to a nursing home in both males and females (OR = 1.82, 95% CI = 1.16-2.85 in males; OR = 1.42, 95% CI = 1.08-1.89 in females). This is the first population-based survey that has elicited fears for the future in older Australians. The findings presented here provide quantitative evidence to support policies and expansion of practices that enable older people to remain in the community for as long as possible, rather than enter institutional care prematurely. They also emphasise that, while a large proportion of older people are concerned about losing their independence, only a small minority have specific concerns about nursing home admission.