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. Author manuscript; available in PMC: 2022 Oct 1.
Published in final edited form as: Clin Gerontol. 2021 Jan 15;45(5):1144–1154. doi: 10.1080/07317115.2020.1869132

Perceived Decisional Control as a Mediator between Moving to Assisted Living Due to Caregiver Burden and Relocation Adjustment.

Natalie G Regier a,b, Patricia A Parmelee c
PMCID: PMC8879405  NIHMSID: NIHMS1779857  PMID: 33448255

Abstract

Objectives:

The rapid growth of the older population in the United States has led to increased utilization of assisted living facilities (ALFs), and it is important to understand what factors may facilitate better adjustment. This study examined the mediating role of perceived decisional control in the relationship between moving to assisted living (AL) to prevent/alleviate caregiver burden and post-relocation adjustment.

Methods:

Participants were 91 newly-transitioned residents of ALFs in Alabama and Maryland. Data were gathered through in-person interviews and questionnaires. Mediation analyses were done using the PROCESS macro for SPSS, applying 5,000 bootstrap resamples with 95% bias-corrected confidence intervals estimated around the indirect effect.

Results:

The effect of moving to AL to prevent/alleviate caregiver burden on post-relocation depression and socialization was indirect and dependent on the degree of perceived decisional control.

Conclusions:

Perceived decisional control may be a key factor in adjusting to AL, even when the move is catalyzed by such a complex and emotionally laden construct as caregiver burden.

Clinical Implications:

Greater perceived decisional control over potential relocation may facilitate better adjustment, and other parties involved in the decision-making process should strive to involve the older adult in question in this process to the greatest extent possible.

Keywords: Perceived decisional control, assisted living, life transitions, burden, adjustment, aging, older adults, long-term care

Introduction

The rapid growth of the population aged 65 and above in the United States, projected to reach 98 million by 2060 (Mather, Jacobsen, & Pollard, 2015), is creating increased utilization of long-term care facilities. In particular, assisted living (AL) facilities are experiencing and will continue to experience tremendous residential growth (Grabowski, Stevenson, & Cornell, 2012; Silver, Grabowski, Gozalo, Dosa, & Thomas, 2018). This is, in part, due to the characterization of AL as more supportive than independent living communities, yet far less institutional or medicalized than nursing homes (Golant & Hyde, 2016; Silver et al., 2018). Indeed, AL “provides or coordinates personal services, and provides 24-h supervision and assistance (scheduled and unscheduled), activities, and healthrelated-services” (Assisted Living Quality Coalition, 1998) in a more homelike environment than is typically found in nursing homes (Cutchin, 2013; Rantz et al., 2008). Assisted living facilities also endeavor to promote autonomy, dignity, privacy, independence, and quality of life (Cutchin, 2013).

Although it is easier for older adults to feel “at home” in AL as compared to a higher level of care, aging-in-place is preferred (Eckert et al., 2009; National Council on Aging, 2015) and adjusting to a new assisted living facility (ALF) can be a challenge (O’Hora & Roberto, 2019; Samus et al., 2013; Scott & Mayo, 2019). Potential adverse outcomes of the move to AL include negative impacts on mental health (e.g., depression, anxiety, loneliness) (Samus et al., 2013; Walker, Curry, & Hogstel, 2007), disruption of social networks and difficulty forming relationships with residents and staff (Dupuis-Blanchard, Neufeld, & Strang, 2009; Perkins, Ball, Kemp, & Hollingsworth, 2013), decline in physical health (Morgan et al., 2014), decreased autonomy (Cutchin, 2013), and stress over an anticipated future move to a nursing home due to the view of AL residency as temporary (Munroe & Guihan, 2005).

It is not surprising that adverse outcomes of relocation to AL may be catalyzed or compounded by a lack of participation in the decision to move or resistance to the move on the part of the resident (Brownie, Horstmanshof, & Garbutt, 2014). Empowerment and perceived control over decisions are integral components of older adults’ conception of autonomy (Funk, 2004). While the majority of the literature on this topic finds that empowering and involving potential and current LTC residents in decision-making has implications for physical and mental health and quality of care (Brownie et al., 2014), older adults are frequently excluded from this process. The potential adverse effects of a low sense of decisional control on the well-being of older adults are well documented and include sadness, depression, anger, and a threatened sense of self (Armer, 1996; Brownie et al., 2014; Fraher & Coffey, 2011). Conversely, positive outcomes associated with a greater sense of control include emotional well-being, successful coping with stress, better health, desired behavior changes, and improved motor and cognitive performance (Thompson & Spacapan, 1991).

Research finds that the degree of participation in the decision to relocate has effects beyond the outcome of the decision, as resident involvement in the decision-making process may influence subsequent feelings about the new environment (Brownie et al., 2014; Rossen & Knafl, 2007). This is consistent with earlier research across LTC settings that suggests the ability to exercise choice and the desirability of a move are critical to post-relocation adjustment (Deborah, Rutman, & Jonathan, 1988; Porter & Clinton, 1992). For example, Harel and Noelker (1982) found that perceived choice on entry to a nursing home affected satisfaction with treatment and life satisfaction, and Chenitz (1983) found that deciding and wanting to move to LTC was related to patients’ acceptance of the residence and its services.

There are numerous factors contributing to the decision-making process, and the ultimate rationale for relocating to assisted living and other LTC settings is likely multifactorial. One common reason is related to the impact of caregiver burden. The risk of an involuntary move can be greater when caregivers perceive a high level of burden (Afram et al., 2015; Wergeland, Selbæk, Bergh, Soederhamn, & Kirkevold, 2015), usually defined as the physical, psychological or emotional, and social and financial problems that can be experienced by family members caring for impaired older adults (George & Gwyther, 1986). Family caregivers often choose various levels of LTC to alleviate both primary stressors (the demands and tasks of daily care) and secondary stressors (e.g., situations that develop or intensify as caregiving continues) (Aneshensel, Pearlin, & Schuler, 1993). In addition, some older adults opt to move before additional assistance is needed in order to avoid becoming burdensome in the future (Ball, Perkins, Hollingsworth, Whittington, & King, 2009; Krout, Moen, Holmes, Oggins, & Bowen, 2002).

Conceptual framework

The Motivational Theory of Life–Span Development (MTLD; Hechkausen, Wrosch, & Schulz, 2010) provided a theoretical basis for our examination of the effects of perceived decisional control on adjustment to assisted living. This theory posits that the driving force underlying adaptive development is the degree to which an individual achieves control of his or her environment across each life domain, and throughout the lifespan (Heckhausen, 1999; Heckhausen & Schulz, 1995). The concept of “control” is divided into primary and secondary control processes (Rothbaum, Weisz, & Snyder, 1982). Primary control refers to attempts to change one’s external world so that it aligns with personal needs and desires and increases the likelihood of a successful outcome (Wrosch, Heckhausen, & Lachman, 2000). Secondary control refers to internal processes (primarily motivational states) that augment, maintain, or diminish losses in current levels of primary control (Hechkausen et al., 2010).

The MTLD can be applied to the motivational management of life–course transitions. As individuals age, they must restructure their regulatory system for motivated behavior. Aging often brings about significant changes in the way external influences (e.g., the environment) shape the older adult’s goal selection and engagement, as well as behavioral investment (Heckhausen, 2011). Older adults may fight against current and future functional losses through compensatory primary control strategies (Heckhausen & Schulz, 1995), namely modification of their living environment or the move to a higher level of care.

Although increasing numbers of older adults are opting to move to assisted living (Stevenson & Grabowski, 2010), there is minimal literature detailing the experience of this transition and what factors may be influential (Fields, Koenig, & Dabelko-Schoeny, 2012; Koenig, Lee, Macmillan, & Spano, 2013). Thus, the current study examines how perceived decisional control influences the relationship between moving to assisted living for reasons related to caregiver burden and subsequent adjustment to the new residence as indicated by depressive symptomatology and socialization.

Methods

Sample

The volunteer sample was comprised of cognitively intact residents of five ALFs in Alabama and three ALFs in Maryland. Inclusion criteria were a length of residence in the ALF of 3 months or less, age of 60 years and above, and a score on the cognitive screening tool, the Saint Louis University Mental Exam (SLUMS; Tariq, Tumosa, Chibnall, Perry, & Morley, 2006) of at least 20. Conversely, exclusion criteria were a length of residence in the ALF of greater than 3 months, age less than 60 years, and a SLUMS score less than 20. Participants who were cognitively unable to consent, could not clearly answer interview questions in a meaningful way, or who did not express a clear and consistent desire to participate in the study were excluded. Resident demographics can be seen in Table 1.

Table 1.

Demographic characteristics of study participants.

Sample Characteristics M (SD) or % (n)
ALF location (% Maryland) 83.5%
Age 83.21 (7.06)
Gender (% Female) 71.4%
Race (% Caucasian) 96.7%
Marital status
 Widowed 59.3%
 Married/Partnered 27.5%
 Divorced 7.7%
 Single 5.5%
Education in years 13.71 (4.27)
Employment status
 Retired 95.6%
 Volunteering 2.2%
 Employed 2.2%
Mean # of medical diagnoses 3.77 (2.10)
Mean # of medications 6.57 (5.27)
Mean IADL impairment 2.50 (0.92)
Mean ADL impairment 1.55 (0.57)
Mean GDS score 4.22 (3.66)
(R: 0–15)
Mean SLUMS score 25.18 (3.01)
(R: 20–30)
Mean socialization 14.77 (7.19)
(R: 0–24.0)
Mean PDC score 7.42 (3.10)
(R: 3.0– 12.0)
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ALF = assisted living facility; ADL = Activity of daily living; IADL = Instrumental activity of daily living; GDS = Geriatric Depression Scale; R = range; SLUMS = St. Louis University Mental Status Exam; PDC = perceived decisional control

Procedure

This study utilized a cross-sectional design. Variables of interest were assessed via questionnaires and assessment tools administered by the first author, as well as a semi-structured interview designed for a qualitative component of the study. The one-on-one interviews took 60–90 minutes to complete and were conducted in participants’ private apartments or a meeting room. Additional details regarding the qualitative aspect of the study can be found elsewhere (Regier & Parmelee, in press).

Measures

Cognitive impairment

The SLUMS (Tariq et al., 2006), an 11-item cognitive screening tool, was administered to determine cognitive status and eligibility for the study. Scores on this assessment range from zero to 30, and scores of 27–30 are considered normal in a person with a high school education (20–30 for those with less than a high school education), scores between 20 and 27 are suggestive of mild cognitive impairment in persons with high school education, and scores between zero and 19 are indicative of dementia. A cutoff of 20 was used for study participation regardless of education based on the authors’ prior experience that persons with scores of 20 and above were able to provide accurate self-report in research studies and maintained decisional capacity.

Perceived decisional control

Participants were asked three questions related to their sense of control surrounding the move to assisted living: 1) How desirable was the move to you personally? 2) How satisfied were you with your level of involvement in the moving process? and 3) Overall, how much say did you have, and how in control were you over the move? Scores ranged from (1) not at all to (4) completely. A composite variable representing perceived decisional control was calculated by averaging the scores of the three questions (range: 3–12), with higher scores indicating greater control. Preliminary analyses provided support for the creation of this composite, and Cronbach’s alpha was 0.849 for the current sample.

Caregiver burden

Caregiver burden as it relates to the move to assisted living was measured by the following question: Was a factor in the move the need to unburden family members or prevent future caregiver burden? Scores on this item ranged from (1) not at all to (4) the primary factor.

Self-reported functional capacity

The Lawton–Brody Instrumental Activities of Daily Living scale (Lawton & Brody, 1969) assessed independence with complex daily activities (e.g., ability to use the phone or go shopping). The Katz Activities of Daily Living scale (Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963) measured self-care activities in which people engage throughout daily life (e.g., bathing, toileting). A composite variable of these two items was created and used in analyses as an indicator of functional independence. Internal consistency was measured at 0.81.

Depression

The Geriatric Depression Scale-Short Form (GDS-15; Sheikh & Yesavage, 1986) is a 15-item self-report scale tested and used extensively with older adults. Scores of 0–4 are considered normal, while scores of 5–8 signify mild depression, 9–11 signify moderate depression, and 12–15 indicate severe depression. In the present study, the GDS-15 score (α = 0.80) was input as a continuous variable.

Environmental involvement and socialization

Staff ratings were obtained regarding participants’ social integration, activity involvement, social withdrawal, and adjustment to the facility. Items for this assessment were taken from the Withdrawal subscale of the Multidimensional Observation Scale for Elderly Subjects (MOSES; Helmes, 1988). This subscale consists of eight social behaviors (e.g., friendships with other residents, initiation of social contact, apparent preference for solitude, interest in day-to-day events at the residence) rated over the past week on a 4-point scale. Items were recoded – and one item reverse-coded – so that 0 = not at all, 1 = seldom (only 1–3 times during the week), 2 = at times (several times a day on 1–3 days or 1–2 times a day on more than three days), and 3 = often (several times a day on more than three days). The possible range of scores was 0–24, with higher scores indicating greater social engagement. Internal consistency for the present study was α = 0.87.

Analytic strategy

Bivariate correlations among study variables were measured with the Pearson Product-Moments two-tailed correlation coefficient analysis. In order to test whether moving due to caregiver burden had direct and indirect effects on depression, and to define the role of perceived decisional control in this interrelation, we utilized the SPSS PROCESS macro (Hayes, 2015). A standard mediation model (model 4) was used for each outcome variable, as shown in Figures 1 and Figures 2, with the mediation hypothesis assessed by splitting the relationship between caregiver burden and depression or socialization into a direct effect and an indirect effect. The bootstrapping method examined indirect effects, with 5,000 bootstrap samples assessing 95% confidence intervals (CI) of these effects. Statistically significant indirect effects were indicated by CI that did not include zero (Hayes, 2009; Preacher & Hayes, 2004). Significance was set at α =.05.

Figure 1.

Figure 1.

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Association between moving to assisted living for reasons related to caregiver burden and depressive symptomatology, and the mediating effect of perceived decisional control. Model statistics for the direct model: R2 =.103, F3,87 = 3.33, p <.05. For the mediated model: R2 =.161, F4,86 = 4.11, p <.01. Unstandardized path coefficients marked with an asterisk identify 95% bootstrap confidence intervals which do not include zero and significance level (* = p<.05; ** = p<.01; *** = p <.001).

Figure 2.

Figure 2.

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Association between moving to assisted living for reasons related to caregiver burden and socialization, and the mediating effect of perceived decisional control. Model statistics for the direct model: R2 =.240, F3,87 = 9.18, p <.001. For the mediated model: R2 =.349, F4,86 = 11.53, p <.001. Unstandardized path coefficients marked with an asterisk identify 95% bootstrap confidence intervals which do not include zero and significance level (* = p <.05; ** = p <.01; *** = p<.001).

Results

Sample characteristics

Mean age was 83.21 (SD = 7.06; range 68–98 years). The majority of participants were female (71.4%), White (96.7%), widowed (59.3%), and had a high school diploma/GED (22.7%). Performance of activities of daily living (Katz et al., 1963) averaged 1.58 (SD = 0.58; scale 1 = independent to 5 = complete dependence). Performance of instrumental activities of daily living (Lawton & Brody, 1969) averaged 2.47 (SD = 0.94; scale 1 = independent to 4 = complete dependence). Participants had an average of 3.8 medical diagnoses. Additional demographic information can be found in Table 1.

Bivariate associations

Bivariate associations among study variables were examined. Perceived decisional control was significantly associated with depressive symptomatology (r = −.251, p= .017), socialization (r = .523, p< .001), and caregiver burden as a catalyst for the move (r = .522, p< .001). Moving to alleviate or prevent caregiver burden was significantly associated with socialization (r = .479, p< .001). No other correlations were significant.

Mediation testing

Figures 1 and Figures 2 displays the results of the generic mediation model (i.e., total, direct, indirect, and total indirect effects). As seen in Figure 1, the mediation analysis examined the hypothesized role of perceived decisional control as a mediator between moving for reasons related to caregiver burden and subsequent depression, controlling for ALF location, and score on the cognitive screener (SLUMS). Except for path c, which was non-significant (p = .36), traditional mediation criteria were met for perceived decisional control as a mediator between moving due to caregiver burden and post-relocation depression (path a: p < .001, path b: p < .05). The total effect (path c, b = −0.275; p = .36) reduced in significance when the mediator was accounted for (path c,’ b = 0.165; p = .63). The mediating effect of perceived decisional control (indirect effect, path ab) was significant according to bootstrapping results (b = −0.440 [−0.824, −0.127]), as the confidence interval did not include zero. Perceived decisional control was significantly associated with post-relocation depression. Specifically, a one-unit rise in perceived decisional control related to a −1.04 decrease (95% CI [−1.89, −0.19]) in the depression score.

As seen in Figure 2, the total effect of moving for reasons related to caregiver burden on subsequent socialization within the new environment (path c) was significant (b = 0.346; p< .001). This effect reduced in significance when the mediator was accounted for (path c,’ b = 0.198; p = .010). The mediating effect of perceived decisional control (indirect effect, path ab) was significant according to bootstrapping results (b = 0.149 [0.06, 0.24]), as the confidence interval did not include zero. Additionally, a one-unit rise in perceived decisional control related to a 0.35-unit increase (95% CI [0.17, 0.54]) in the socialization score.

Discussion

The aging process is inherently marked by sequential losses and life changes outside the realm of control. Previous research indicates that the perception of control may be particularly important for older adults transitioning to long-term care (Davidson & O’Connor, 1990; Reinardy, 1992; Thompson & Spacapan, 1991), including assisted living. By applying the Motivational Theory of Lifespan Development (Hechkausen et al., 2010) as a theoretical framework, the aim of this study was to explore the mediating role of perceived decisional control in the relationship between moving to alleviate/prevent caregiver burden and post-relocation adjustment.

We found that the effect of moving to assisted living for reasons related to caregiver burden on post-relocation depression and socialization was indirect and dependent on the degree of decisional control perceived by the study participants. Burden did not have a statistically significant direct effect on depressive symptomatology and the variables were not significantly associated at the bivariate level. While the Baron and Kenny (1986) method of mediation considers a correlation between “X” and “Y” to be a necessary ingredient for mediation, modern methods and theories finds that this is not a necessary prerequisite (Hayes, 2013; Hayes & Rockwood, 2017; Kenny & Judd, 2014; Rucker, Preacher, Tormala, & Petty, 2011). Rather, all that matters in terms of determining mediation is whether the “ab” path is significant according to an inferential standard such as a confidence interval (Hayes & Rockwood, 2017), as was used here. While the relationship of desire to minimize or prevent caregiver burden with post-relocation socialization is not necessarily intuitive, this may be explained by Self-Determination Theory (Deci & Ryan, 1991), wherein satisfying one’s need for autonomy, competence, and relatedness is associated with higher emotional well-being (e.g., Altintas & Guerrien, 2014; Reis, Sheldon, Gable, Roscoe, & Ryan, 2000). Proactively moving may help preserve or strengthen a sense of autonomy and competence, and satisfaction of the need for relatedness can be fulfilled through social opportunities provided by assisted living.

The Motivational Theory of Lifespan Development posits that attempting to control one’s environment is central to human functioning and the principal motivator of human behavior (Hechkausen et al., 2010; Heckhausen & Schulz, 1995, 1999). When viewed through the lens of this theory (Heckhausen & Schulz, 1995), participants whose move was influenced by the desire to minimize or prevent caregiver burden may have been striving for primary control. According to the MTLD, this process involves, in part, behavioral means of goal engagement utilized by directly addressing one’s environment. Many participants in this study attained the goal of impacting caregiver burden by changing their residential environment, either as a prophylactic or an intervention for burden. As postulated by the MTLD, primary control also provides adaptive benefits for survival. Improved family relationships due to the relief or prevention of caregiver burden, decreased or absent depressive symptomatology, and increased social engagement are certainly “benefits” that improve older adults’ quality of life.

Potential limitations of this study include a lowerthan-desired sample size of 91 participants (vs. 109, per power analysis) and the cross-sectional nature of the data. As this was a cross-sectional study, we did not have baseline data on depressive symptomatology or socialization prior to the move and cannot infer causality. Future research will ideally be longitudinal in nature to allow for prospective assessment of relationships among the study variables. While our sample was fairly homogenous, research outlining the characteristics of the “typical” assisted living resident has identified the typical resident as female, white, widowed, 87-years-old (Hernandez & Newcomer, 2007), and requiring assistance with more than four IADLs and 1.6–2.6 ADLs (American Association of Homes and Services for the Aging, 2009; Cohen, Shi, & Miller, 2009; Golant & Hyde, 2016), which is a similar profile to our average participant. In the current study, the average participant was female, white, widowed, and approximately 83-years-old, with comparable ADL function to the national statistics. Consequently, it is conceivable that the results of this study have the potential for generalizability to other samples of assisted living residents.

An additional potential limitation is the use of several measures that were developed or culled from existing measures for the express purpose of this study, meaning the psychometric properties of these instruments have not yet been thoroughly assessed. However, the findings do suggest the utility of a measure of perceived decisional control as it specifically relates to the transition to assisted living. A similar potential limitation is the lack of information on the specific nature of the caregiver burden, i.e., whether it was a current burden that the participant moved to alleviate or an anticipated future burden that the participant wanted to avoid. Future studies should separate these two types of caregiver burden in order to examine the distinct main effects. As this variable was not collected, future research should also examine whether the relationship of the caregiver to the relocated older adult is associated with the variables in the present study.

Although available statistics show that minority older adults are more likely to move to nursing facilities and less likely to use assisted living (Howard et al., 2002; Jenkins-Morales & Robert, 2019), future researchers should consider assessing a more diverse sample of assisted living residents in order to have a more culturally competent understanding of how the study variables interact. It would also be useful to examine the impact of potential moderators and other mediators of adjustment post-relocation, such as preparation for the move. For example, Grant, Skinkle, and Lipps (1992) found that nursing home residents who had completed a “preparation program” designed to enhance their sense of control and predictability over the move did not experience adverse relocation effects.

Our results support earlier findings that the perception of decisional control is often a key factor in how older adults will adjust when moving to assisted living (Reinardy, 1992; Thompson & Spacapan, 1991). The results also partially support the assumptions of the current study that specific circumstances prompting relocation can influence perceived decisional control, which in turn leads to varying degrees of adjustment and well-being. Our findings may be useful for several reasons. First, if older adults and their families have access to more detailed information regarding the experience of assisted living placement, they may be better emotionally prepared and more inclined to be proactive when faced with the decision of whether or not to move. They may also be more aware of how to optimize the timing of the move. Second, more than half of older adults may underestimate their future care needs (Walz & Mitchell, 2007). While aging-in-place is preferred by most older adults (AARP, 2019), planning ahead in case this is not possible can enhance access and awareness of residential choices and help individuals maintain control over their environment. Our findings suggest that this increased control over potential relocation and where that destination will be may facilitate better adjustment.

Finally, proactively moving in order to prevent/ alleviate caregiver burden may strengthen well-being through the fulfillment of basic psychological needs as outlined by Self-Determination Theory (Deci & Ryan, 1991). For example, the need for relatedness may be met through the improvement of the caregiver/older adult relationship as well as through the opportunities for interpersonal connections and social engagement offered by the assisted living environment. In addition, the need for autonomy may be met through the assisted living model of person-centered care that promotes autonomy, dignity, privacy, and independence (Cutchin, 2013).

As the relative proportion of older adults in the United States continues to grow, more individuals are moving from private residences to assisted living and other long-term care settings. It is therefore imperative that older adults, family members, and health-care providers have a comprehensive understanding of the factors and conditions that will be most conducive to successful aging and adjustment to relocation. As noted by Johnson and Hlava (1994), “relocation is a process that includes not only the actual moving but the decision to move, the circumstances surrounding the move, and the adjustment period following the move.” The results of this study highlight the importance of maintaining a sense of control over the decision to move to assisted living. It is paramount that other parties involved in the decision-making process, such as family members or care providers, endeavor to maximize the input of the older adult in question, who will ultimately have to live with, and in, the new environment.

Clinical implications.

  • Perceived decisional control may be an important factor in how older adults will adjust when moving to assisted living.

  • Advance planning for scenarios in which an older adult may want to relocate, such as for the prevention of caregiver burden, may increase control over potential relocation destinations and facilitate better adjustment.

  • Family members or care providers should strive to maximize the input of the older adult who may be relocating.

Acknowledgments

We thank Stephanie Lichtenstein and Tyler Thompson for their assistance with data collection. We are indebted to the assisted living residents who shared their time and experiences with us.

Footnotes

Disclosure statement

No, potential conflicts of interest were reported by the authors.

Data Availability Statement

The data that support the findings of this study are available from co-author, NGR, upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from co-author, NGR, upon reasonable request.

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