Community Aging in Place, Advancing Better Living for Elders: A Bio‐Behavioral‐Environmental Intervention to Improve Function and Health‐Related Quality of Life in Disabled Older Adults

Abstract

Objectives To determine effect size and acceptability of a multi-component behavior and home repair intervention with low-income, disabled older adults Design Prospective randomized controlled pilot trial Setting Participants’ homes Participants 40 low income older adults with difficulties in at least 1 Activity of Daily Living (ADL) or 2 Instrumental Activities of Daily Living (IADL). Intervention Coordinated occupational therapy (OT), nursing (RN), and handyman (HM) visits compared to attention-control visits. The intervention consisted of up to 6 visits with an OT, up to 4 visits with an RN and an average of $1,300 in HM repairs and modifications. Each intervention participant received all components of the intervention clinically tailored to risk profile and goals. Each attention-control participant received the same number of visits as the intervention participants, involving sedentary activities of their choice. Measurement Primary Outcome: difficulty in performing ADL and IADLs. Secondary outcomes: Health related quality of life and falls–efficacy. Results Thirty five of 40 adults (87%) completed the 6-month trial and 93% and 100% of the control and intervention group, respectively, stated the study benefited them. The intervention group improved on all outcomes. When comparing the mean change in the intervention group compared to the mean change in the control group from baseline to follow up, the CAPABLE intervention had an effect size of 0.63 for reducing difficulty in ADLs, 0.62 for reducing difficulty in IADLs, 0.89 for Quality of Life, and 0.55 for Falls-efficacy. Conclusion The multi-component CAPABLE intervention was acceptable to participants, feasible to provide, and showed promising results, suggesting that this multi-component intervention to reduce disability should be evaluated in a larger trial.

Fatores preditores para incapacidade funcional de idosos atendidos na atenção básica

“…It is of paramount importance to identify the functional capacity of the elderly, as well as to relate it with environmental conditions, to then investigate which may be subject to interventions. The knowledge gained may become a subside for the implementation of programs, planning of strategies and appropriate interventions to the reality of the country (5)(6) . On light of the above, the present study aimed to evaluate the predictive factors to the functional incapacity of the elderly in primary health care.…”

Cluster analysis to identify elderly people's profiles: a healthcare strategy based on frailty characteristics

“…Furthermore, it is important to recognize the initial symptoms of cognitive impairment before starting pharmacological treatment and rehabilitation procedures. 15,46 One possible criticism of the present study is that although a limited number of years of education does not have immediate functional implications, it is a limiting factor in cognitive assessments on these individuals. Irrespective of this, identification of groups with preserved physiological function, but with cognitive deficit, allows these groups to be characterized and the requirements for rehabilitation and maintenance of functional capacity in these groups to be predicted.…”

“…3,8,9,11,13,15,21 Thus, although development of profiles identifying groups that are at most risk of functional impairment may not be of immediate relevance to family members, physicians or caregivers, whose attention is focused on the individual, it allows strategies for care of the elderly to be planned. More recently, studies have correlated vulnerability and functionality to the concept of frailty among the elderly.…”

“…This study identified groups with specific care requirements that would reduce the limitations and loss of quality of life resulting from both disabilities and cognitive deficit. 15,[40][41][42][43] Maintenance of functional status is related to subjective wellbeing, self-efficacy and greater resilience and should take priority over primarily clinical and medical approaches. Studies have shown that functional losses can be reversed or minimized through approaches that modify living habits and training for ADLs and IADLs, with positive consequences for self-perception of health.…”

“…Studies have shown that functional losses can be reversed or minimized through approaches that modify living habits and training for ADLs and IADLs, with positive consequences for self-perception of health. 14,15,21,40,41,[43][44][45] It should also be noted that the presence or otherwise of a cognitive deficit should be taken into account when planning care actions, as this is an important parameter in overall geriatric assessment. 41,42,46 Recent studies have shown that, regardless of whether cognitive impairment is a cause or an effect, it is associated with frailty among the elderly.…”