A Randomized Trial of a Multicomponent Home Intervention to Reduce Functional Difficulties in Older Adults

Abstract

OBJECTIVES: To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance self‐efficacy and adaptive coping in older adults with chronic conditions. DESIGN: A prospective, two‐group, randomized trial. Participants were randomized to a treatment group or no‐treatment group. SETTING: Urban community‐living older people. PARTICIPANTS: Three hundred nineteen community‐living adults aged 70 and older who reported difficulty with one or more activities of daily living. INTERVENTION: Occupational and physical therapy sessions involving home modifications and training in their use; instruction in strategies of problem‐solving, energy conservation, safe performance, and fall recovery techniques; and balance and muscle strength training. MEASUREMENTS: Outcome measures included self‐rated functional difficulties with ambulation, instrumental activities of daily living, activities of daily living, fear of falling, confidence performing daily tasks, and use of adaptive strategies. Observations of home hazards were also conducted. RESULTS: At 6 months, intervention participants had less difficulty than controls with instrumental activities of daily living (P=.04, 95% confidence interval (CI)=−0.28–0.00) and activities of daily living (P=.03, 95% CI=−0.24 to −0.01), with largest reductions in bathing (P=.02, 95% CI=−0.52 to −0.06) and toileting (P=.049, 95% CI=−0.35–0.00). They also had greater self‐efficacy (P=.03, 95% CI=0.02–0.27), less fear of falling (P=.001, 95% CI=0.26–0.96), fewer home hazards (P=.05, 95% CI=−3.06–0.00), and greater use of adaptive strategies (P=.009, 95% CI=0.03–0.22). Benefits were sustained at 12 months for most outcomes. CONCLUSION: A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality improvements in community‐dwelling older people who had functional difficulties, with most benefits retained over a year.

Interventions to prevent disability in frail community-dwelling older persons: an overview

“…Out of 15 CGA studies, 9 studies report significant differences in disability in favor of the experimental group (Bernabei et al 1998;Boult et al 2001;Cohen et al 2002;Gitlin et al 2006;Landi et al 2001;Markle-Reid et al 2006;Melin and Bygren 1992;Melis et al 2008;Phelan et al 2004). There are some features that promising interventions have in common.…”

“…Home visits (Williams et al 1987;Bernabei et al 1998;Rockwood et al 2000;Landi et al 2001;Melis et al 2008), telephone calls (Rubenstein et al 2007), or a combination of both (Melin and Bygren, 1992;Phelan et al 2004;Gitlin et al 2006;Markle-Reid et al 2006) are repeatedly used. In three studies, assessment and treatment were done in a (geriatric) clinic (Cohen et al 2002;.…”

Effects of Housing Conditions and Environmental Factors on Accidents and Modification Intention of the Vision Impaired

“…( 2 0 1 2 ) , h o u s i n g modifications could assist in creating a better quality of life as people adapt to vision loss, and reducing difficulties in performing daily activities (Gitlin et al, 2006). Many people with vision impairment make an effort to adapt to their environment and modify their housing so that they can achieve a desired level of daily activity.…”

Maintaining independence after a fall

“…These interventions have used combinations of educational and exercise strategies to increase confidence in engaging in activities of daily living. [42][43][44][45][46] There is some evidence of a modest beneficial effect including reduction in fear of falling, promotion of activity and improvements in balance, social functioning and mobility. 42,[42][43][44][45][46] However, not all interventions have shown a positive effect at reducing falls or fear of falling.…”

“…42 Improved outcomes included competence in instrumental activities of daily living, greater self efficacy and less fear of falling.…”