Improving aging in place for older adults living in subsidized housing

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PROJECT SUMMARY/ABSTRACT The ability to live comfortably, safely, and independently in one's own home and community – often called “aging in place” – is a key component of quality of life for older adults. Yet the ability to age in place is severely compromised among the nearly 3 million older adults living in federally-subsidized housing, who are at disproportionate risk for nursing home admission compared to this general population. This elevated risk is driven largely by functional and cognitive impairments, and compounded by limited access to family supports that can identify and address these impairments. Although some resources are available to help these vulnerable older adults to age in place, these programs have not been found to decrease rates of nursing home placement or to affect other key aspects of aging in place, including functioning and quality of life. Thus, there is a crucial need to develop more effective strategies to identify at-risk individuals in subsidized housing and to deliver targeted interventions to improve functioning and aging in place. The objective of this proposal is to address this gap by completing the following 3 aims: (1) determine barriers and facilitators to implementing a two-component intervention to improve aging in place for older adults living in subsidized housing, and to use these findings to adapt and refine the intervention; (2) determine the feasibility and accuracy of a case-finding program for identifying residents at high risk for nursing home admission; and (3) determine the feasibility and preliminary effectiveness of the Function-Focused Care intervention for improving function in residents at high risk for nursing home admission. Methods: Using qualitative interviews with key stakeholders from 4 subsidized housing sites in the San Francisco Bay Area, we will first identify barriers, facilitators, and needed adaptations to (a) a case-finding program to identify high-risk older adults; and (b) the Function-Focused Care intervention to improve functioning in high-risk individuals. We will then pilot test this adapted intervention in 2 housing sites in San Francisco and determine its feasibility and preliminary effectiveness. Measures of feasibility for Aims 2 and 3 will include recruitment, retention, intervention fidelity, and acceptability. For Aim 2, we will assess the accuracy of a case-finding program conducted by building staff for identifying older residents at high risk for nursing home admission, compared to a reference standard of research-collected data. For Aim 3, we will assess preliminary effectiveness by examining change from baseline to 6 months for the primary outcome of functional status. We will assess function using both an objective measure (Short Physical Performance Battery) as well as a self-reported measure of ability to perform activities of daily living. Relevance/public health significance: Completing these aims will provide valuable preliminary data which will inform an R01 application employing this intervention, to be submitted in Year 3 of the K76 award. If successful, this intervention could have a transformative impact for vulnerable older adults living in subsidized housing, enhancing their freedom to live in the least restrictive setting while also decreasing costs for long-term care.