January 07, 2019
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Home-based intervention program targeting functional goals may reduce disability

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A home-based, multidisciplinary program focusing on both the individual and the environment decreased disability in low-income adults aged 65 years or older while increasing ease-of-life, suggesting that disability may be modifiable, according to a study published in JAMA Internal Medicine.

“Disabilities are common among adults aged 65 years or older and are associated with poor quality of life, further functional decline, hospitalization, increased mortality, and triple the medical costs,” Sarah L. Szanton, PhD, professor at Johns Hopkins University School of Nursing, and colleagues wrote. “We tested the CAPABLE program, a person-directed intervention that helps older adults identify and achieve their own functional goals through a combination of strategies, including targeting the individual and the home environment.”

To test the effect of a home-based intervention program on disability, researchers conducted a randomized clinical trial of 300 low-income adults with a disability in Baltimore who were cognitively intact but had self-reported difficulty with one of more activities of daily living or two or more instrumental activities of daily living between March 2012 and April 2016.

Researchers randomized participants to either the CAPABLE intervention group (n = 152; 87.5% women; mean age, 75.7 years; 82.9% black), which consisted of 10 home visits by occupational therapists, registered nurses and home modifiers to target specific functional goals — like walking down stairs or showering without pain — or the control group (n = 148; 87.2% women; mean age, 75.4 years; 89.9% black), which consisted of 10 home visits with a research assistant who helped participants choose sedentary activities in which to engage.

Research assistants interviewed participants at baseline, 5 months and 12 months to determine disability with activities of daily living and instrumental activities of daily living. Each task was self-scored from 0 to 2 based on if the individual did not have difficulty or need help with the task in the previous month, if they did not need help but had difficulty or if they needed help due to the difficulty of completing the task.

Researchers found that, at 5 months, individuals assigned to the CAPABLE group had a 30% reduction in activities of daily living disability scores (RR = 0.7; 95% CI, 0.54-0.93) compared with the control group.

In addition, participants in the CAPABLE group were more likely to report that the program made their life easier (82.3% vs. 43.1%; P < .001), allowed them to better take care of themselves (79.8% vs. 35.5%; P < .001) and assisted in giving confidence to manage daily challenges (79.9% vs. 37.7%; P < .001).

“Despite its predictive value and strong relevance to value-based care and population health efforts, functional status is not commonly prioritized in primary and specialty care,” the researchers wrote. “Functional status is often a hidden feature in electronic medical health records, if the feature exists at all, the reason for which may be the widely held belief that functional decline is not modifiable. Our work suggests that function can be improved.” – by Melissa J. Webb

Disclosure: Szanton reports inventing the CAPABLE training program.