Long‐Term Effect on Mortality of a Home Intervention that Reduces Functional Difficulties in Older Adults: Results from a Randomized Trial

Abstract

Objectives-To evaluate long-term mortality effects of a home-based intervention previously shown to reduce functional difficulties, and whether survivorship benefits differed by risk level.Design-Two-group randomized trial with survivorship followed up to 4 years from study entry. Setting-Homes of urban community-living elders.Participants-319 adults 70+ years with difficulties performing daily activities.Intervention-Occupational and physical therapy sessions to instruct participants in compensatory strategies, home modifications, safety, fall recovery techniques, and balance and muscle strength exercises.Corresponding Author: Laura N. Gitlin, Ph.D., Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 th Street, Suite 500, Philadelphia, PA, 19130, voice -215-503-2896; fax-215-923-2475; laura.gitlin@jefferson.edu. Author Contributions:Author Name: L. N. Gitlin, Ph.D., principal investigator, developed study concept and design, developed research questions, oversaw scientific integrity and interpretation of data, primary responsibility for preparation of manuscript. Author: W. Hauck, Ph.D., statistician oversaw design development, statistical analyses, and integrity of data interpretation; manuscript preparation. Author Name: M. Dennis, Ph.D., Ed.M., conducted data analysis, constructed manuscript tables, participated in writing of manuscript. Author: L. Winter, Ph.D., co-project director of study, assisted in acquisition of subjects, and manuscript preparation. Author: N. Hodgson, Ph.D., RN., interpretation of data and review of the article for clarity and accuracy Author: S. Schinfeld, MPH, co-project director, assisted with subject recruitment, coordinated data from National Death Index, and reviewed manuscript for accuracy. Clinical Trial Registration: NCT00249925 Conflict of Interest:The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Measures-Survival time was number of days between baseline interview and date of death as determined by data from the National Death Index or December 31, 2005. Participants were stratified by baseline mortality risk (low, moderate, high) using a prognostic indicator. NIH Public AccessResults-At two years, intervention participants (n=160) had a 5.6% mortality rate (n=9 deaths) and controls (n=159) a 13.2% rate (n=21 deaths; p=.020). Mortality rates remained relatively lower for intervention participants up to 3.5 years from study entry. At two years, intervention participants with moderate mortality risk had a 16.7% mortality rate (n=16 deaths/96) compared to 28.2% for equivalent control group participants (n=24 deaths/85; p=.021). By three years, mortality rates were not statistically significantly different between experimental and control groups.Conclusions-The intervention extended survivorship up to 3.5 years, and maintained statistically significant differences for two years. Thos...

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A home‐based intervention resulted in lower mortality rates for up to two years in community‐dwelling older people

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