Reducing disability via a bundled bio-behavioral-environmental approach

描述(由申请人提供)：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，但由于日常生活的基本或工具性活动(ADL或IADL)的限制，许多人需要疗养院入院。因为这些昂贵的入场费用 改善不良反应的可预防、新的、成本效益高的干预措施应该是公共卫生的优先事项。以前的研究没有全面讨论个人及其活动环境，但低收入老年人在其功能和家庭环境方面都存在健康差距。我们提出了一项两组随机试验来测试我们的生物行为环境干预措施的有效性，社区老龄化到位-为老年人推进更好的生活(CAPEAR)，它结合了循证护理、职业治疗和杂工成分。在随机对照先导试验中，比较干预组和对照组从基线到随访的平均变化时，有能力的干预对降低ADLS和IADLS难度的初步效应大小分别为0.63和0.62。这些试点研究结果证明有必要进行疗效试验。我们将从巴尔的摩住房能源援助计划招募低收入老年人(EAGE 65岁)，主要是非裔美国人，患有e 1 ADL或e 2 IADL限制的成年人。我们将在家里采访他们，并将参与者随机分为治疗组(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最多10次的家庭治疗--职业治疗师的d6次访问和护士的d4次访问--以及持证杂工提供的1200美元的安全和改造服务。每个治疗参与者将收到每个干预部分，但干预者将根据协议系统地根据参与者的风险概况和目标定制内容。控件中的参与者 小组将接受同等数量的探视，其中将包括由训练有素的研究助理(RA)进行的久坐活动。所有参与者将在16周和52周时由戴着面具接受治疗的RA亲自重新评估。主要终点是在随机化后16周无困难地完成ADL和IADL的能力。其他终点包括随机化后16周的下肢活动能力、与健康相关的生活质量和家庭安全，以及52周的ADL和IADL限制。我们将研究治疗成功的调节因素和调节机制。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。这项研究的目的是在意向治疗分析中检测干预组和对照组在ADL或IADL限制方面有临床意义的改善，其中80%的力量(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，这种干预可能会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.