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Reducing disability via a bundled bio-behavioral-environmental approach

通过捆绑的生物行为环境方法减少残疾

基本信息

批准号：
8827230
负责人：
Sarah L Szanton
金额：
$ 57.9万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-01 至 2016-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8827230
关键词：
Activities of Daily Living Address Adherence Admission activity Adult African American Age Aging American Analgesics Attention Baltimore Behavioral Budgets Caring Clinical Trials Color Communication Communities Complex Control Groups Cost Analysis Disabled Persons Discipline of Nursing Economics Elderly Environment Equilibrium Exercise Expenditure Funding Goals Health Care Costs Health Personnel Health Services Accessibility Healthcare Systems Home Nursing Care Home environment Housing Income Individual Intention Intervention Interview Licensing Life Long-Term Effects Low income Lower Extremity Masks Measures Mediating Medical Medicare/Medicaid Medication Management Mental Depression Minority Modification Nurses Nursing Homes Occupational Therapist Occupational Therapy Pain Participant Patients Performance Persons Pharmaceutical Preparations Phase Population Problem Solving Protocols documentation Provider Public Health Quality of life Randomized Randomized Controlled Trials Recruitment Activity Regimen Registered nurse Reporting Research Research Training Resources Risk Safety Self Care Services Testing Training Translating Translations United States United States National Institutes of Health Visit base cost cost effective cost effectiveness daily functioning design disability economic value effective intervention efficacy testing efficacy trial environmental intervention evidence base fall risk fear of falling follow-up functional decline functional disability group intervention health care service utilization health disparity health related quality of life improved innovation instrumental activity of daily living intervention effect novel patient oriented pilot trial programs prospective public health priorities randomized trial repaired sedentary success theories

项目摘要

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.

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，特别是对于低收入城市有色人种来说。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）受到限制，许多人需要入住疗养院。由于这些昂贵的入场费可预防的、测试新颖的、具有成本效益的干预措施以改善日常生活活动应该成为公共卫生的优先事项。先前的研究尚未全面解决个人及其所处的环境问题，但低收入老年人在其功能和家庭环境方面都存在健康差异。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“社区老龄化——促进老年人更好的生活”(CAPABLE) 的有效性，该干预措施结合了循证护理、职业治疗和勤杂工组成部分。在一项随机对照试点试验中，当比较干预组与对照组从基线到随访的平均变化时，CAPABLE 干预对于降低 ADL 和 IADL 难度的初步效果分别为 0.63 和 0.62。这些试点结果值得进行有效性试验。我们将从巴尔的摩住房能源援助计划部招募具有 e 1 ADL 或 e 2 IADL 限制的低收入老年人（65 岁），主要是非裔美国人。我们将在家采访他们，并将参与者随机分为治疗组（有能力干预）或对照组（注意力控制）。治疗组的参与者将接受最多 10 次家庭治疗——职业治疗师的 6 次就诊和护士的 4 次就诊——以及持照杂工提供的 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组件，但干预专家将根据协议系统地根据参与者的风险状况和目标定制内容。参与控制小组将接受同等次数的访问，其中包括与训练有素的研究助理（RA）一起进行静坐活动。所有参与者将在 16 周和 52 周时由 RA 亲自进行重新评估，并告知治疗情况。主要终点是随机分组后 16 周时顺利完成 ADL 和 IADL 的能力。其他终点包括下肢活动能力、健康相关的生活质量和 16 周时的家庭安全，以及随机分组后 52 周时的 ADL 和 IADL 限制。我们将研究治疗成功的调节因素和中介机制。我们还将根据干预措施和医疗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 限制方面有临床意义的改善，在意向治疗分析中具有 80% 的功效 (alpha = 0.05)。这项创新研究将为理论驱动的干预措施提供经济证据，从而控制日益增长且日益多样化的老年人口的成本。