Improving aging in place for older adults living in subsidized housing

项目总结/摘要 在自己的家中和社区中舒适、安全和独立生活的能力-通常 称为“就地养老”，是老年人生活质量的一个关键组成部分。然而，在原地老化的能力是 在近300万居住在联邦补贴住房中的老年人中， 与普通人群相比，他们被送进疗养院的风险不成比例。这种高风险是 主要由功能和认知障碍驱动，并因获得家庭支持的机会有限而加剧 能够识别并解决这些缺陷的方法。虽然有一些资源可以帮助这些 脆弱的老年人年龄在地方，这些计划尚未发现降低护理率 家庭安置或影响就地养老的其他关键方面，包括功能和生活质量。因此，在本发明中， 迫切需要制定更有效的战略，以确定补贴住房中的风险个人 并提供有针对性的干预措施，以改善功能和老龄化。本提案的目的是 通过完成以下3个目标来弥补这一差距：（1）确定实施一项 两部分干预措施，以改善居住在补贴住房中的老年人的老龄化，并使用 这些发现，以适应和完善干预;（2）确定的可行性和准确性的情况下，发现 计划，以确定居民在高风险的养老院入院;（3）确定的可行性， 以功能为中心的护理干预对改善高血压住院患者功能的初步效果 进入疗养院的风险。方法：采用定性访谈的关键利益相关者从4补贴 在旧金山弗朗西斯科湾区的住房网站，我们将首先确定障碍，促进因素，并需要调整 （a）病例发现计划，以确定高风险老年人;和（B）以功能为重点的护理干预 以改善高危人群的功能。然后，我们将在2个住宅区试点测试这种适应性干预措施 并确定其可行性和初步有效性。目标2的可行性措施 3包括招募、保留、干预保真度和可接受性。对于目标2，我们将评估 由建筑物工作人员进行的病例发现计划的准确性，以确定老年居民的高风险， 疗养院入院，比较研究收集的数据的参考标准。目标3： 通过检查以下主要结局从基线到6个月的变化来评估初步有效性： 功能状态我们将使用客观指标（短期身体表现）和 电池）以及自我报告的日常生活活动能力的测量。相关性/公众 健康意义：完成这些目标将提供有价值的初步数据，这些数据将为R 01提供信息 使用这种干预的申请，将在K76奖的第3年提交。如果成功，这 干预措施可以对生活在补贴住房中的弱势老年人产生变革性影响， 增强他们在限制最少的环境中生活的自由，同时降低长期护理费用。

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.