A home intervention program significantly decreased disability in lower income older adults who previously had a self-reported disability. Researchers, led by Sarah L. Szanton, PhD, Johns Hopkins University School of Nursing in Baltimore, Maryland, and colleagues published their findings online in JAMA Internal Medicine.
The intervention, better known as Community Aging in Place—Advancing Better Living for Elders (CAPABLE), was a 5-month program that consisted of 10 home visits from health care professionals. The objective of the program was to improve daily function and meet the needs of lower income older adults.
"This well-powered, randomized trial provides further support that the CAPABLE intervention reduces disability scores in a high-risk subset of the older adult population," Dr Szanton and colleagues wrote. "As such, the program merits consideration of inclusion in payment innovations, such as those from [Centers for Medicare & Medicaid Services; CMS] that allow Medicare Advantage to pay for nonmedical costs with the medical budget or through a Special Needs Plan geared toward people with disabilities who are dually eligible for Medicaid and Medicare."
For their study, the research team observed 300 low-income adults who were 65 years of age or older. This patient population lived in Baltimore between March 18, 2012 and April 29, 2016. The participants all had a disability which were defined as, difficulty with one or more activities of daily living or two or more instrumental activities of daily living. There was no evidence of cognitive decline among these participants.
Of the 300 patients, 152 were randomly assigned to receive intervention. Occupational therapists, registered nurses, and home modifiers made 10 home visits during 5 months to these patients. For the control group, a research assistant made 10 visits to 148 participants. The data for the control group was from interviews at baseline, immediately after the intervention at 5 months and 12 months after baseline.
According to the study findings, participation in CAPABLE resulted in a statistically nonsignificant 17% reduction in instrumental activities of daily living compared with control participation. Further, compared with the control group, participants in the CAPABLE group were more likely to report that the program made their life easier, helped them take care of themselves, and helped them gain confidence in managing daily challenges.
“Low-income community-dwelling older adults who received the CAPABLE intervention experienced substantial decrease in disability; disability may be modifiable through addressing both the person and the environment,” the authors concluded.
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