Is home always the best place to live? Preferences for place of residence and long-term care among the community-dwelling oldest old in Finland

The aging in place policy emphasizes the older people's own desire to live at home. However, there is limited evidence on preferences for place of residence and long-term care, especially regarding the oldest old people. This study aims to fill this knowledge gap by identifying the preferences and associated factors of community-dwelling people aged 90+. Survey data, including a total age cohort of 90 years and older in one geographic area in Finland was analyzed descriptively and with multinomial logistic regression. The total study population was 1834 of which two-thirds were community-dwellers. Of the community-dwellers 71% preferred to live at their current homes, 18% preferred to live at their current homes if they received more help, and 11% would prefer to live in a residential care facility. Those who preferred to live at home had better functioning, rarely experienced dizziness, tiredness, loneliness, and pain, were more often satisfied with their life, and had better self-rated health compared to other preference groups. Preferences shifted gradually: the poorer the respondents' health, functional capacity, and well-being, the more likely they preferred to get more help at home or live in residential care. One-third of the respondents either preferred to have more help in their current home or to move to residential care, indicating that home was not the best place for them to live at that time. Findings suggest that the preferences for living at home are not stable but a dynamic process among the oldest old people.