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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：
9042913
负责人：
Sarah L Szanton
金额：
$ 49.43万
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 2017-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9042913
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 Physical Performance Population Problem Solving Protocols documentation Provider Public Health Quality of life Randomized Randomized Controlled Trials Recruitment Activity Regimen Registered nurse Reporting Research Research Assistant 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 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 activity success theories treatment group

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）：老年人残疾是一个主要的公共卫生问题，特别是在城市低收入有色人种中。大多数残疾老年人强烈希望住在家里，但由于基本或日常生活工具活动（ADLs或IADLs）的限制，许多人需要住进养老院。因为这些昂贵的入学费用