FIGURE IT OUT… moderate functional problems lead old people to move to a nursing home rather than to a priori dedicated "intermediate housing" option

Jeanne BARDINET, an epidemiologist, studies the role of intermediate housing (IH) in the residential trajectories of older adults—either as service-equipped housing open to a broad population or as a response to emerging support needs, before institutionalization in nursing homes (NH). She examines how disability influences these transitions.

She uses the sample of 5,264 individuals (65+) from the French cohorts PAQUID (1988–2018), 3-Cités (1999–2018), and AMI (2007–2017). Participants were initially visited at home and followed regularly, for up to 30 years for some of them. Three levels of disability are considered: mild (difficulty for moving around independently), moderate (restrictions in instrumental activities of daily living, IADL), and severe (restrictions in basic activities of daily living, ADL). Cognitive limitations are measured using a performance score (MMSE ≤ 23/30). A multi-state model estimates transition probabilities between home, IH, and NH, depending on functional status.

The average probability of moving out own's house is estimated at 16% over the study period: more often for a NH (12%) than for IH (4%). Cognitive impairment increases the probability of moving into NH, but not into IH. Autonomous people rarely move into NH, and significantly less than people with mild disability; but compared with the latter, the probability is three times higher with moderate disability and six times higher with severe disability. Moving into IH is also less likely for autonomous people than for those with mild disability; transitions are slightly more frequent with moderate disability and slightly less with severe disability (not statistically significant).

Overall, IH appears to meet the need for support mild disability, whereas moderate or severe disability drives moves into NH. These results highlight the complementarity of NH and IH but raise questions about the attractivity of IH or adequately support for people with moderate disability.