Functional Goals and Predictors of Their Attainment in Low-Income Community-Dwelling Older Adults

Abstract

Objective To describe functional goals and factors associated with goal attainment among low-income older adults with disabilities living in the community. Design Secondary analysis from two studies of CAPABLE. Functional goals were coded using the International Classification of Functioning, Disability, and Health (ICF) framework. The percentage of goals attained at five months follow-up was computed within each ICF domain. Multivariate logistic regression was used to identify factors associated with goal attainment. Setting Participants’ homes in Baltimore, Maryland Participants CAPABLE participants (n=226) Interventions A five-month, home-based, person-directed, structured program delivered by an inter-professional team: occupational therapist (OT), registered nurse (RN), and handyman. Main Outcome Measure(s) Process of OT goal setting and attainment at the final OT visit. Results Participants identified 728 functional goals (average of 3.2 per participant), most commonly related to transferring (22.0%, n=160 goals), changing or maintaining body position (21.4%, n=156 goals), and stairclimbing (13.0%, n= 95 goals). Participants attained 73.5% (n=535) of goals. Goal attainment was highest for stairclimbing (86.3%), transferring (85.6%), and self-care (84.6%); walking goals were less likely attained (54.0%). Goal attainment was not associated with age, gender, education, depressive symptoms, function, or health-related quality of life but was less likely among participants who had severe pain compared to those without pain (aOR: 0.38, 95% CI: 0.17, 0.86). When participant readiness to change (RTC) score increases by one point on the four-point scale, goal attainment was 62% more likely (aOR 1.62; 95% CI: 1.14–2.29). Conclusion Home-based collaborative goal-setting between older adults and OTs is feasible and particularly effective when individuals are ready or willing to adopt new strategies to achieve identified goals.

Goal planning in person-centred care supports older adults receiving case management to attain their health-related goals

“…Goals in the physical cluster were the most likely to be attained and goals in the pain and mobility clusters seemed the most difficult to attain. Again, Waldersen et al also found that goals related to mobility (walking) and pain (within body functions) had the lowest attainability [37]. There is little evidence explaining the difference in goal attainability across clusters.…”

“…Health is thus an important goal, even when seen in a broader life-goal perspective. Indeed, in the study of Waldersen et al [37] among community-living older adults receiving occupational therapy at home, goals were mainly focused on mobility and the least on self-care. Similar to our results, in this study it was found that 72% of goals were attained.…”

Examining Life Goals of Community-Dwelling, Low-Income Older Adults

“…While not a consideration in the study, personal tenacity and the ability to modify personal goals over time may contribute to increased life satisfaction (Bailly, Gana, Hervé, Joulain, & Alaphilippe, 2014). Using a collaborative goal setting model, Waldersen et al,(2014) found when older adults were flexible and willing to adopt new strategies, opportunity for goal attainment increased.…”

Dissemination of the CAPABLE Model of Care in a Medicaid Waiver Program to Improve Physical Function

“…Expanding upon ABLE, CAPABLE is a 16-week structured program delivered by OTs who conduct six home visits and provide assistive devices, RNs who conduct four home visits, and a handyman who provides home alterations (ie, installs devices, makes environmental modifications, and performs home repair). [15][16][17][18][19] Similar to ABLE, the CAPABLE interdisciplinary team provided consultation with older adults to help them identify daily activity goals (eg, taking a shower and walking to the bathroom), evaluated barriers to achieving those goals, and attained outcomes collaboratively. 11,18 The OT assists older adults to perform ADLs, instrumental ADLs (IADLs), and discretionary activities that are challenging at home, such as functional mobility, meal preparation, bathing, and dressing.…”