Aging Gracefully in Place: An Evaluation of the Capability of the CAPABLE© Approach

2021 ◽  
pp. 073346482110426
Author(s):  
Jill Breysse ◽  
Sherry Dixon ◽  
Jonathan Wilson ◽  
Sarah Szanton
Keyword(s):  
Older Adults ◽  
Low Income ◽  
Aging In Place ◽  
Intervention Group ◽  
Health Improvement ◽  
Control Group ◽  
Adult Health ◽  
Age In Place ◽  
Home Based

As American adults live longer, society must prioritize effective strategies promoting safe aging-in-place and decreasing institutional health care costs. Social determinants of health, especially housing, critically influence older adult health, particularly for disadvantaged, low-income older adults. Johns Hopkins University developed Community Aging in Place—Advancing Better Living for Elders (CAPABLE©), a client-centered, home-based program to improve older adults’ function and capacity to age in place. This evaluation studied CAPABLE’s long-term effectiveness in four distinct locations in California, North Carolina, Pennsylvania, and Vermont. Seven months after CAPABLE, intervention group participants experienced greater improvements than the control group in activities of daily living limitations (2-point vs. 0.7-point improvement, p = .012), falls efficacy (8.9-point improvement vs. 0.1-point worsening, p = .012), depression (1.3-point improvement vs. 0.4-point worsening, p = .021), and pain (1.5-point improvement vs. 0.3-point worsening, p = .002). These results add to existing research on short-term effectiveness in urban locales, showing CAPABLE yields long-term health improvement for older adults in micropolitan and small urban locations, with different implementation organizations, housing stocks, and clients.

scholarly journals Improvements of Disability Outcomes in CAPABLE Older Adults Differ by Financial Strain Status

2020 ◽  
pp. 073346482097555
Author(s):  
Minhui Liu ◽  
Qian-Li Xue ◽  
Laura Samuel ◽  
Laura N. Gitlin ◽  
Jack Guralnik ◽  
...  
Keyword(s):  
Older Adults ◽  
Low Income ◽  
Daily Living ◽  
Aging In Place ◽  
Low Energy ◽  
Attention Control ◽  
Financial Strain ◽  
Home Based ◽  
Home Based Intervention ◽  
Strain Status

The Community Aging in Place–Advancing Better Living for Elders (CAPABLE) program reduces disability in low-income older adults. In this study, we used CAPABLE baseline and 5-month data to examine whether its effects in reducing activities of daily living (ADLs) and instrumental ADLs (IADLs) difficulties differed by participants’ financial strain status. At baseline, participants with financial strain were more likely to report higher scores on depression ( p < .001), have low energy ( p < .001), and usually feel tired ( p = .004) compared with participants without financial strain, but did not differ in ADL/IADL scores. Participants with financial strain benefited from the program in reducing ADL (relative risk [RR]: 0.61, 95% confidence interval [CI]: 0.43, 0.86) and IADL disabilities (RR: 0.69, 95% CI: 0.54, 0.87), compared with those with financial strain receiving attention control. Individuals with financial strain benefited more from a home-based intervention on measures of disability than those without financial strain. Interventions that improve disability may be beneficial for financially strained older adults.

Long-Term Care for Older Adults in ASEAN Plus Three: The Roles of Family, Community, and the State in Addressing Unmet Eldercare Needs

2018 ◽  
Vol 30 (10) ◽  
pp. 1499-1515 ◽  
Author(s):  
Wei-Jun Jean Yeung ◽  
Leng Leng Thang
Keyword(s):  
Older Adults ◽  
Low Income ◽  
Long Term Care ◽  
Elderly Women ◽  
Unmet Need ◽  
Care Plan ◽  
Cultural Norms ◽  
Term Care ◽  
Home Based

Objective: To introduce this Special Issue that focuses on understanding the issues surrounding the long-term care (LTC) in selected societies in Southeast and East Asian countries. Method: We first provide demographic and socioeconomic context for these countries and then summarize the seven articles in this issue. Results: The articles highlight the rapidly rising demand for LTC in this region in the next few decades given the declining fertility, lengthening life expectancy, and increasing migration. They also discuss challenges and strategies in meeting these demands. Most countries are ill prepared to cope with the demand for LTC with older adults heavily rely upon female family members for care. Elderly women in low-income households have the greatest unmet need. Discussion: Home-based and community-based services are set to become an integral part of the LTC system. It is important to incorporate older adults’ cultural norms and wishes in their care plan and provision.

scholarly journals A Home-Based Individual Cognitive Stimulation Program for Older Adults With Cognitive Impairment: A Randomized Controlled Trial

2021 ◽  
Vol 12 ◽  
Author(s):  
Rosa Silva ◽  
Elzbieta Bobrowicz-Campos ◽  
Paulo Santos-Costa ◽  
Ana Rita Cruz ◽  
João Apóstolo
Keyword(s):  
Older Adults ◽  
Randomized Controlled Trial ◽  
Cognitive Impairment ◽  
Controlled Trial ◽  
Intervention Group ◽  
Cognitive Stimulation ◽  
Attrition Rate ◽  
Control Group ◽  
Randomized Controlled ◽  
Home Based

Objective: This study aims to assess the feasibility and meaningfulness of a home-based individual cognitive stimulation (iCS) program delivered by caregivers to persons with cognitive impairment (PwCIs). It also aims to assess whether the older adults receiving this program improved their cognitive, neuropsychiatric, and depressive symptoms and quality of life and whether their caregivers improved their mental and physical health.Methods: A randomized controlled trial (RCT) was conducted with PwCI-caregiver dyads recruited from the community. Participants were allocated to two groups: intervention (n = 28) and control (n = 24). The intervention group received the European Portuguese version of the Individual Cognitive Stimulation Program—Making a Difference 3 (MD3-P). The control group received usual care. The iCS therapy program was implemented three times a week for 12 weeks. Caregivers were supported by the researchers to deliver the sessions at home. Participants were assessed at baseline and at the end of the intervention (week 13). Feasibility and meaningfulness were assessed through the attrition rate, adherence, and degree of satisfaction with the sessions. Four interviews were conducted (after week 13) to understand participants’ experiences.Results: The attrition rate was 23.1%. The dyads reported that they did not have high expectations about the iCS program before starting the study. Nevertheless, as the program evolved, caregivers noted that their family members had improved some areas of functioning. Intention-to-treat analysis based on group differences revealed a significant improvement in PwCIs’ cognition, specifically in their orientation and ability to follow commands. The intervention had no impact on other variables such as caregivers’ physical and mental health.Conclusion: The iCS program implemented by caregivers showed promising results in improving PwCIs’ cognition. The participants who completed the intervention attributed a positive meaning to the MD3-P, confirming it as a valid non-pharmacological therapeutic approach to reducing frailty in PwCIs in community settings.Clinical Trial Registration:www.ClinicalTrials.gov, identifier [NCT03514095].

scholarly journals Effects of the Intervention “Reflective STRENGTH-Giving Dialogues” for Older Adults Living with Long-Term Pain: A Pilot Study

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Lena Hedén ◽  
Mia Berglund ◽  
Catharina Gillsjö
Keyword(s):  
Older Adults ◽  
Pilot Study ◽  
Musculoskeletal Pain ◽  
Rating Scale ◽  
Short Form ◽  
Intervention Group ◽  
Community Dwelling ◽  
Control Group ◽  
Depression Symptoms

Background. Long-term musculoskeletal pain is a major, often undertreated, disabling health problem among an increasing number of older adults. Reflective STRENGTH-giving dialogues (STRENGTH) may be a tool to support older adults living with long-term pain. The main aim of this pilot study was to investigate the immediate and longitudinal effect of the intervention STRENGTH on levels of pain, wellbeing, occurrence of depression symptoms, and sense of coherence (SOC) among community-dwelling older adults suffering from musculoskeletal pain compared to a control group. Methods. The study was semiexperimental with an intervention group and a control group. The effect of a single STRENGTH intervention was reported on the Numeric Rating Scale (NRS) regarding pain and wellbeing. To evaluate the longitudinal effect of STRENGTH, using the Brief Pain Inventory-Short Form (BPI-SF), the Geriatric Depression Scale-20 (GDS-20), SOC-13 at baseline (T1), and six months after the intervention/no intervention (T2), a total of 30 older adults, aged 72 to 97 years (Mdn 86 years), were included consecutively and fulfilled the intervention series (n = 18) or untreated controls (n = 12). Results. The intervention with STRENGTH decreases pain (NRS 6 Mdn versus NRS 4 Mdn, p<0.001) and increases wellbeing (NRS 7 Mdn versus NRS 8 Mdn, p<0.001). After a six-month study period with STRENGTH, no longitudinal effect difference was found compared to baseline. Compared to the control group, there was an increasing trend between decreased pain level and increased SOC level for STRENGTH intervention. Conclusions. This pilot study supports STRENGTH’s effect as a pain-alleviating model that provides a decrease in pain levels and an increase of wellbeing in older adults with long-term pain. STRENGTH dialogues could be a useful intervention to provide individually holistic care in older adults living with long-term pain.

Abstract P200: Effects Of A 2-year Randomized Controlled Trial Physical Activity Intervention On Accelerometer-measured Sleep Characteristics Among Older Adults In Senior Center Communities

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Kelsie M Full ◽  
Katie Crist ◽  
Marta Jankowska ◽  
Pamela L Lutsey ◽  
Loki Natarajan
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Sleep Duration ◽  
Low Income ◽  
Controlled Trial ◽  
Intervention Group ◽  
Sleep Efficiency ◽  
Control Group ◽  
Senior Center ◽  
Intervention Effect

Background: Targeting daily increases in physical activity (PA) is a common lifestyle strategy for cardiovascular disease (CVD) risk reduction. While less targeted in lifestyle interventions, poor sleep is also consistently linked to CVD. Emerging evidence connects changes in daily PA to beneficial changes in sleep; however, little is known about the impact of community-based PA interventions on habitual sleep among older adults. We leveraged accelerometer data from the Peer Empowerment Program for Physical Activity in Low Income & Minority Seniors (PEP4PA) randomized controlled trial to examine the effect of a PA intervention on accelerometer-measured sleep characteristics among older adults in low income and diverse senior center communities. Methods: PEP4PA participants (N=476; mean age=71.0 ± 9 years, 75% female, 60% low income, 36% non-white) were recruited from senior centers and randomized to a healthy control condition(n=209) or a peer-lead walking intervention (N=267). The peer-led PA intervention included self-monitoring techniques, health coach counseling, group walks, and community advocacy to improve walking conditions. Participants wore Actigraph GT3X+ accelerometers on the wrist at baseline, 6, 12, and 24 months. Data were processed for sleep characteristics including weekly average sleep duration and sleep efficiency. Mixed effects regression models provided estimates of the intervention effect on sleep characteristics at each time point. Models were adjusted for age, sex, and race. Three way interaction terms (time*treatment*sleep duration status) were used to assess differential intervention effects by short (<7) and long (>8 hours) sleep duration status at baseline. Results: At baseline, the average sleep duration of participants was 7 hours (SD: 1.07 hours) and the average sleep efficiency was 87.0% (SD: 6.2%). Compared to participants in the control group, participants in the intervention group had shorter sleep durations (7.1 hours vs 7.0 hours; p value: 0.08) and poorer sleep efficiency 86.0% vs 88.2%; p<0.001) at baseline. At 12 or 24-months, there was no intervention effect on participants’ average sleep duration or efficiency. Although not significant, at 6 months, long sleepers in the intervention group experienced an average 6-minute reduction in sleep duration (-B: 6.25, p=0.45) compared to those in the control group. Conclusions: Over the 2-year period, the PA intervention did not appear to have an impact on participants’ average sleep duration or quality. More investigation is needed into the temporal and daily relations of PA and sleep among older adults in interventions to understand if increases in daily PA are associated with better sleep characteristics at night.

scholarly journals Examining the effectiveness of a cognitive intervention to improve cognitive function in a population of older adults living with HIV: a pilot study

2017 ◽  
Vol 5 (1) ◽  
pp. 19-28 ◽  
Author(s):  
Judy A. Frain ◽  
Ling Chen
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Cognitive Training ◽  
Intervention Group ◽  
Training Intervention ◽  
Control Group ◽  
Post Intervention ◽  
Cognitive Improvement ◽  
Home Based ◽  
Living With Hiv

Objective: The purpose of this randomized-controlled pilot study was to explore the effectiveness of a home-based computerized cognitive training intervention in improving cognitive function in a population of older adults with mild cognitive impairment who are living with HIV. Methods: In all, 24 participants were enrolled in this study. All study participants were impaired [defined as Montreal Cognitive Assessment (MoCA) score < 26]; 12 were randomly assigned to a computer-training intervention group and 12 to a control group. The intervention group used a home-based computerized cognitive training program for 8 weeks, while the control group received health-related newsletter via email and follow-up phone calls. Cognitive function was measured at study entry, immediately post intervention, and 8 and 16 weeks post intervention Results: This study achieved a 92% retention rate, losing two persons from the intervention group. Participants in the intervention group scored significantly higher on cognitive testing immediately post intervention compared to the control group: F(1, 19) = 4.92, p = 0.04. The partial Eta squared of 0.32 indicates a small to moderate effect size. Discussion: Cognitive improvement was seen immediately after the intervention, and cognitive improvement was still evident 16 weeks post intervention. Cognitive training could be considered as an option for older adults with HIV experiencing mild cognitive impairment.

scholarly journals Challenges and Supports to Aging in Place in a Gentrifying Context

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 873-873
Author(s):  
Manish Kumar ◽  
Laura Richman
Keyword(s):  
Older Adults ◽  
Social Capital ◽  
Affordable Housing ◽  
Low Income ◽  
Healthy Aging ◽  
Aging In Place ◽  
Well Being ◽  
Neighborhood Change ◽  
Structured Interviews ◽  
Age In Place

Abstract Neighborhoods play a central role in healthy aging, with changes to neighborhoods having a profound impact on older adults’ ability to age in place. Using gentrification as an indicator of neighborhood change and applying the theoretical framework of the Environmental Press model (Lawton and Nahemow, 1973), this study examined the relationship between changing environments, affordable housing, and environmental attributes that support and hinder the health and well-being of older adults. A qualitative, case-study approach was used to interview low-income, majority Black older adults in a gentrifying area of Washington DC. 32 individuals (16 in non-profit and 16 in for-profit affordable housing) aged 55 and older participated in semi-structured interviews on perceptions of gentrification, neighborhood change, and challenges and supports to aging in place. Transcripts were then analyzed using the framework method of analysis. Although participants generally reported that gentrification improved their neighborhood’s built environment, many attributed it to a decline in social capital. Affordable housing provided an ability to age in place, though participants expressed uncertainty over their long-term ability to age in the context of continuing change. These findings suggest that while the physical changes accompanying gentrification may support older adults’ ability to age in place, its detrimental impact on social capital further increases their risk for social isolation. While affordable housing may enable older adults to age in place, fostering a greater sense of permanence and well-being will require additional policies that both increase accessibility to the physical amenities provided by gentrification and preserve older adults’ social capital.

scholarly journals Effects of Adachi Rehabilitation Programme on older adults under long-term care: A multi-centre controlled trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0245646
Author(s):  
Yoshihiko Baba ◽  
Chika Ooyama ◽  
Yasushi Tazawa ◽  
Masahiro Kohzuki
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Daily Step ◽  
Term Care ◽  
Care Facilities ◽  
At Home

Objectives We developed the Adachi Rehabilitation Programme (ARP), a community rehabilitation program. Under the supervision of professional caregivers, older adults cleaned and planted flowers in the park and they walked and shopped in the community. We examined the effects of ARP on individuals receiving small-group multifunctional at-home care at community facilities. Methods This was a multi-centre controlled trial at thirteen small multifunctional at-home care facilities in Adachi, Tokyo. The primary outcomes of the study were daily step counts and timed up & go (TUG). Secondary outcomes included gait speed, step length, Barthel Index for Activities of Daily Living, Functional Independence Measure, Mini-Mental State Examination (MMSE) and EuroQOL 5 Dimension. Results Ninety-six individuals at thirteen small multifunctional at-home care facilities were recruited for participation in December 2017. They were allocated to intervention (38) and control (40) groups. The average daily step count of the control group decreased from 852 to 727, but it increased by approximately 650 steps, from 990 to 1635, for the intervention group. Average TUG decreased from 16.1 s to 14.0 s and MMSE score increased from 15.9 to 16.3 for the intervention group, but a significant interaction was not found. On non-intervention home days, the daily step counts of the intervention group increased significantly from 908 steps to 1485 steps, while those of the control group decreased from 865 steps to 722 steps. Conclusions ARP may have effectively increased the physical activity of older adults under long-term care by increasing motivation and changing behaviour.

scholarly journals Evaluating the effects of an exercise program (Staying UpRight) for older adults in long-term care on rates of falls: study protocol for a randomised controlled trial

2019 ◽  
Author(s):  
Lynne Taylor ◽  
John Parsons ◽  
Denise Taylor ◽  
Elizabeth Binns ◽  
Sue Lord ◽  
...  
Keyword(s):  
Older Adults ◽  
Cost Effectiveness ◽  
Long Term Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Exercise Program ◽  
Community Dwelling ◽  
Control Group ◽  
Term Care

Abstract Background Falls are two to four times more frequent amongst long-term care (LTC) than community-dwelling older adults and have deleterious consequences. It is hypothesized that a progressive exercise program targeting balance and strength will reduce falls rates when compared to a seated exercise program and do so cost effectively. Methods/Design This is a single blind, parallel-group, randomized controlled trial with blinded assessment of outcome and intention-to-treat analysis. LTC residents (age ≥65 years) will be recruited from LTC facilities in New Zealand. Participants (n= 528 total; with a 1:1 allocation ratio) will be randomly assigned to either a novel exercise program (Staying UpRight), comprising strength and balance exercises designed specifically for LTC and acceptable to people with dementia, (intervention group) or a seated exercise program (control group). The intervention and control group classes will be delivered for 1 hour twice weekly over 1 year. The primary outcome is rate of falls (per 1000 person years) within the intervention period. Secondary outcomes will be risk of falling (the proportion of fallers per group), falls rate relative to activity exposure, hospitalisation for fall-related injury, change in gait variability, volume and patterns of ambulatory activity and change in physical performance assessed at baseline, 6 and 12 months. Cost effectiveness will be examined using intervention and health service costs. The trial commenced recruitment on 31 November 2018. Discussion This study evaluates the efficacy and cost effectiveness of a progressive strength and balance exercise program for aged-care residents to reduce falls. The outcomes will aid development of evidenced-based exercise programs for this vulnerable population.

scholarly journals Effects of 1 Year of Lifestyle Intervention on Institutionalized Older Adults

2021 ◽  
Vol 18 (14) ◽  
pp. 7612
Author(s):  
Daniele Magistro ◽  
Fabio Carlevaro ◽  
Francesca Magno ◽  
Martina Simon ◽  
Nicola Camp ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Lifestyle Intervention ◽  
Long Term Care ◽  
Social Care ◽  
Care Home ◽  
Intervention Group ◽  
Control Group ◽  
Term Care

The socio-economic and health consequences of our ageing population are well documented, with older adults living in long-term care facilities amongst the frailest possessing specific and significant healthcare and social care needs. These needs may be exacerbated through the sedentary behaviour which is prevalent within care home settings. Reducing sedentary time can reduce the risk of many diseases and improve functional health, implying that improvements in health may be gained by simply helping older adults substitute time spent sitting with time spent standing or in light-intensity ambulation. This study identified the impact of 1 year of lifestyle intervention in a group of older adults living in a long-term care setting in Italy. One hundred and eleven older adults (mean age, 82.37 years; SD = 10.55 years) participated in the study. Sixty-nine older adults were in the intervention group (35 without severe cognitive decline and 34 with dementia) and 42 older adults were in the control group. Data on physical functioning, basic activities of daily living (BADL) and mood were collected 4 times, before, during (every four months) and after the 1 year of intervention. The lifestyle intervention focused on improving the amount of time spent every week in active behaviour and physical activity (minimum 150 min of weekly activities). All participants completed the training program and no adverse events, related to the program, occurred. The intervention group showed steady and significant improvements in physical functioning and a stable situation in BADL and mood following the intervention in older adults with and without dementia, whilst the control group exhibited a significant decline over time. These results suggest that engagement in a physical activity intervention may benefit care home residents with and without dementia both physically and mentally, leading to improved social care and a reduced burden on healthcare services.

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