Reducing disability via a bundled bio-behavioral-environmental approach

老年人的残疾是一个主要的公共卫生问题，特别是在低收入的城市有色人种中。大多数残疾老年人强烈喜欢住在家里，但许多人需要疗养院入院，由于日常生活的基本或工具性活动（ADL或IADL）的限制。由于这些昂贵的入场费是 可预防的，测试新的，具有成本效益的干预措施，以改善ADL应该是公共卫生的优先事项。以前的研究并没有全面解决个人和他们工作的环境，但低收入的老年人在他们的功能和家庭环境中都存在健康差异。我们提出了一个两组随机试验，以测试我们的生物行为环境干预的有效性，社区老龄化的地方-推进更好的生活为老年人（CAPABLE），它结合了循证护理，职业治疗和勤杂工组件。在一项随机对照初步试验中，当比较干预组与对照组从基线到随访的平均变化时，CAPABLE干预在降低ADL和IADL难度方面的初步效应量分别为0.63和0.62。这些初步发现证明了疗效试验的必要性。我们将从巴尔的摩住房能源援助计划部招募低收入老年人（1065岁），主要是非洲裔美国人，患有e 1 ADL或e 2 IADL限制的成年人。我们将在家中采访他们，并将参与者随机分配到治疗组（有能力的干预）或对照组（注意力控制）。治疗组的参与者将接受多达10次的家庭治疗--职业治疗师的d 6次访问和护士的d4次访问--以及有执照的勤杂工提供的1200美元的安全和修改服务。每个治疗参与者将接受每种干预成分，但干预人员将根据参与者的风险状况和目标系统地调整内容。对照组参与者 组将接受相同数量的访视，其中包括与训练有素的研究助理（RA）一起进行的久坐活动。所有受试者将在第16周和第52周由对治疗条件设盲的RA亲自重新评估。主要终点是随机化后16周时完成ADL和IADL无困难的能力。其他终点包括16周时的下肢活动度、健康相关生活质量和家庭安全性，以及随机化后52周时的ADL和IADL限制。我们将研究治疗成功和调解机制的主持人。我们还将根据干预和卫生保健利用的成本来评估成本效益。该研究旨在检测干预组和对照组之间ADL或IADL限制的临床有意义的改善，意向治疗分析的把握度为80%（α = 0.05）。这项创新的研究将为理论驱动的干预提供经济证据，这种干预可以控制不断增长和日益多样化的老年人口的成本。

DESCRIPTION (provided by applicant): Disability in older adults is a major public health problem, particularly among low-income urban people of color. Most disabled older adults strongly prefer to live at home, but many require nursing home admission due to limitation in basic or instrumental activities of daily living (ADLs or IADLs). Since these costly admissions are preventable, testing novel, cost-effective interventions to improve ADLs should be a public health priority. Previous research has not comprehensively addressed individuals and the environment in which they function yet low income older adults suffer from health disparities in both their function and their home environments. We propose a two-group randomized trial to test the efficacy of our bio-behavioral-environmental intervention, Community Aging in Place - Advancing Better Living for Elders (CAPABLE), which combines evidence-based nursing, occupational therapy, and handyman components. In a randomized controlled pilot trial, the CAPABLE intervention had preliminary effect sizes of 0.63 and 0.62 for reducing difficulty in ADLs and IADLs respectively, when comparing the mean changes in the intervention group to the control group from baseline to follow up. These pilot findings warrant an efficacy trial. We will recruit low-income older (eage 65), principally African-American, adults with e 1 ADL or e 2 IADL limitations from the Baltimore Department of Housing Energy Assistance Program. We will interview them at home and randomize participants to either the treatment (CAPABLE intervention) or control (attention-control) group. Participants in the treatment group will receiv up to 10 in-home sessions -- d6 visits with an occupational therapist and d4 visits from a nurse - and d$1200 in safety and modification services from a licensed handyman. Each treatment participant will receive each intervention component but interventionists will systematically tailo content to the participants' risk profile and goals based on protocols. Participants in the control group will receive an equivalent number of visits, which will consist of sedentary activities with trained research assistant (RA). All participants will be reassessed at 16 and 52 weeks in person by an RA masked to treatment condition. The primary endpoint is the ability to complete ADLs and IADLs without difficulty at 16 weeks post-randomization. Other endpoints include lower extremity mobility, health-related quality of life, and home safety at 16 weeks and ADL and IADL limitations at 52 weeks post-randomization. We will examine moderators of treatment success and mediating mechanisms. We will also evaluate cost-effectiveness based on the cost of the intervention and health care utilization. The study is designed to detect clinically meaningful improvement in ADL or IADL limitations between the intervention and control group with 80 percent power (alpha = 0.05) in an intention to treat analysis. The innovative study will provide economic evidence for a theory-driven intervention that could rein in costs of a growing and increasingly diverse older adult population.