Home-Based Care Program Reduces Disability And Promotes Aging In Place

Szanton, Sarah L.; Leff, Bruce; Wolff, Jennifer L.; Roberts, Laken; Gitlin, Laura N.

doi:10.1377/hlthaff.2016.0140

Cited by 174 publications

(167 citation statements)

References 19 publications

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“…This is evident in recent research on a 5‐month Medicare and Medicaid demonstration project called CAPABLE (the Community Aging in Place, Advancing Better Living for Elders program), which delivered care at home to 281 adults aged 65 years and older from 2012 to 2015, via visits from an occupational therapist (six visits), a nurse (four visits), and a handyman (one all‐day visit). They found this interprofessional care improved activities of daily living and promoted aging in place . Another recent study found integration of HCBC services and providing LTSS at Independence at Home (IAH) demonstration sites for frail, older nonveteran adults delayed the need for long‐term institutionalization .…”

Section: Discussionmentioning

confidence: 99%

Dedicated to the Mission: Strategies US Department of Veterans Affairs Home‐Based Primary Care Teams Apply to Keep Veterans at Home

Haverhals

Manheim

Gilman

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES The US Department of Veterans Affairs (VA) Home‐Based Primary Care (HBPC) Program provides interdisciplinary, long‐term primary care for frail, disabled, or chronically ill veterans. This research identifies strategies used by HBPC teams to support veterans in their homes, rather than in institutionalized care. DESIGN Focus groups and semistructured interviews were conducted with HBPC interdisciplinary team (IDT) members, including program directors, medical directors, and key staff, from September 2017 to March 2018. Field observations were gathered during visits to veterans’ homes and IDT meetings. SETTING In‐person site visits were conducted at eight HBPC Programs across the United States. Sites varied in location, setting, and primary care model. PARTICIPANTS A total of 105 HBPC professionals. MEASUREMENT Qualitative thematic content analysis. RESULTS Four main strategies drive and support the shared mission of IDTs to support veterans at home: fostering frequent communication among IDT members, veterans, caregivers, and outside agencies; development of longitudinal, trusting, reliable relationships within IDTs and with veterans and caregivers; ongoing, consistent education for IDT members and veterans and caregivers; and collaboration within and outside IDTs. Adhering to this mission meant providing timely and efficient care that kept veterans in their homes and minimized the need for acute hospitalizations and nursing home placement. CONCLUSION HBPC IDTs studied worked together across disciplines to effectively create a dedicated culture of caring for veterans, caregivers, and themselves, leading to keeping veterans at home. Focusing on the strategies identified in this research may be useful to achieve similar positive outcomes when caring for medically complex, homebound patients within and outside the VA. J Am Geriatr Soc 67:2511–2518, 2019

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Section: Discussionmentioning

confidence: 99%

Dedicated to the Mission: Strategies US Department of Veterans Affairs Home‐Based Primary Care Teams Apply to Keep Veterans at Home

Haverhals

Manheim

Gilman

et al. 2019

J American Geriatrics Society

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“…Indeed, proven geriatric models of care have already been successfully delivered to vulnerable middle-aged adults (43, 44). Novel models of care that improve functioning in low income older adults (45) may hold similar promise for low income adults in middle age.…”

Section: Discussionmentioning

confidence: 99%

Functional Impairment and Decline in Middle Age

et al. 2017

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Background Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these functional problems, including the extent to which they share common features with functional impairment in older adults. Objective To determine the epidemiology and clinical course of functional impairment and decline in middle age. Design Cohort study. Setting The Health and Retirement Study. Participants 6874 community-dwelling adults aged 50–56 who did not have functional impairment at enrollment. Measurements Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years over a maximum follow-up period of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed using multi-state models which estimate probabilities of different outcomes. Results Twenty-two percent of participants developed ADL impairment between ages 50 and 64. Among these individuals, further functional transitions were common. Two years after the initial impairment, 4% (95% CI, 3%–5%) of participants had died, 9% (CI, 8%–11%) had experienced further ADL decline, 50% (CI, 48%–52%) had persistent impairment, and 37% (CI, 35%–39%) had recovered independence. In the 10 years following the initial impairment, 16% (CI, 14%–18%) had one or more episodes of functional decline, and 28% (CI, 26%–30%) recovered from their initial impairment and remained independent throughout. The pattern of findings was similar for IADLs. Limitations Functional status was self-reported. Conclusions Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, interventions currently used to prevent functional decline among older adults may hold promise for adults in middle age. Primary Funding Source National Institute on Aging and the National Center for Advancing Translational Sciences through the UCSF-Clinical and Translational Sciences Institute

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“…Existing depression treatment studies targeted to the homebound population have rarely addressed these comorbidities (Bruce et al, 2015; Choi et al, 2014; Ell et al, 2007). The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) intervention is one of the handful of interventions that simultaneously address multiple domains of functional limitations (Szanton, Leff, Wolff, Roberts, & Gitlin, 2016). Preliminary analyses showed that depressive symptoms improved in 53% of the CAPABLE participants at 5-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

Correlates of Depressive Symptoms among Homebound and Semi-Homebound Older Adults

Xiang

Brooks

2017

Journal of Gerontological Social Work

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This study aimed to provide a national profile of homebound and semi-homebound older adults with depressive symptoms and to compare risk factors of depressive symptoms by home-bound status. A sample of 1,885 homebound and semi-home-bound older adults was selected from Round 1 of the National Health and Aging Trends Study (NHATS). The prevalence of depressive symptoms was 43.9% in homebound older adults and 28.1% in semi-homebound older adults, representing over 830,000 and 1.4 million individuals in the population, respectively. Nearly two-thirds of homebound and over half of semi-homebound older adults with clinically significant depressive symptoms also had significant anxiety symptoms. Results from logistic regression showed that younger age, certain medical morbidities, severity of functional limitations, and pain were common risk factors for depressive symptoms among home-bound and semi-homebound older adults. Some differences in the risk factor profile emerged between the homebound and the semi-homebound populations. Alleviating the burden of depression in the semi-homebound population may focus on early prevention that considers the diversity of this population. Home-based, integrated programs of health and mental health services that simultaneously address the medical, psychiatric, and neurologic comorbidities and disabilities of homebound older adults are needed to meet the complex needs of this population.

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Home-Based Care Program Reduces Disability And Promotes Aging In Place

Cited by 174 publications

References 19 publications

Dedicated to the Mission: Strategies US Department of Veterans Affairs Home‐Based Primary Care Teams Apply to Keep Veterans at Home

Dedicated to the Mission: Strategies US Department of Veterans Affairs Home‐Based Primary Care Teams Apply to Keep Veterans at Home

Functional Impairment and Decline in Middle Age

Correlates of Depressive Symptoms among Homebound and Semi-Homebound Older Adults

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