Feasibility and effects of preventive home visits for at-risk older people: design of a randomized controlled trial

Malcolm P Cutchin, Susan Coppola, Vibeke Talley, Judie Svihula, Diane Catellier, Kendra Heatwole Shank, Malcolm P Cutchin, Susan Coppola, Vibeke Talley, Judie Svihula, Diane Catellier, Kendra Heatwole Shank

Abstract

Background: The search for preventive methods to mitigate functional decline and unwanted relocation by older adults living in the community is important. Preventive home visit (PHV) models use infrequent but regular visits to older adults by trained practitioners with the goal of maintaining function and quality of life. Evidence about PHV efficacy is mixed but generally supportive. Yet interventions have rarely combined a comprehensive (biopsychosocial) occupational therapy intervention protocol with a home visit to older adults. There is a particular need in the USA to create and examine such a protocol.

Methods/design: The study is a single-blind randomized controlled pilot trial designed to assess the feasibility, and to obtain preliminary efficacy estimates, of an intervention consisting of preventive home visits to community-dwelling older adults. An occupational therapy-based preventive home visit (PHV) intervention was developed and is being implemented and evaluated using a repeated measures design. We recruited a sample of 110 from a population of older adults (75+) who were screened and found to be at-risk for functional decline. Participants are currently living in the community (not in assisted living or a skilled nursing facility) in one of three central North Carolina counties. After consent, participants were randomly assigned into experimental and comparison groups. The experimental group receives the intervention 4 times over a 12 month follow-up period while the comparison group receives a minimal intervention of mailed printed materials. Pre- and post-intervention measures are being gathered by questionnaires administered face-to-face by a treatment-blinded research associate. Key outcome measures include functional ability, participation, life satisfaction, self-rated health, and depression. Additional information is collected from participants in the experimental group during the intervention to assess the feasibility of the intervention and potential modifiers. Fidelity is being addressed and measured across several domains.

Discussion: Feasibility indications to date are positive. Although the protocol has some limitations, we expect to learn enough about the intervention, delivery and effects to support a larger trial with a more stringent design and enhanced statistical power.

Trial registration: ClinicalTrials.gov ID NCT00985283.

Figures

Figure 1
Figure 1
Conceptual framework for preventive home visits study.
Figure 2
Figure 2
Participant flow chart.

References

    1. Sabia JJ. There's no place like home: A hazard model analysis of aging-in-place among older homeowners in the PSID. Res Aging. 2008;30(3):3–35. doi: 10.1177/0164027507307919.
    1. Fänge A, Ivanoff SD. The home is the hub of health in very old age: Findings from the ENABLE-AGE Project. Arch Gerontol Geriatr. 2009;48(3):340–5. doi: 10.1016/j.archger.2008.02.015.
    1. Ozer DJ, Benet-martinez V. Personality and the prediction of consequential outcomes. Annu Rev Psychol. 2006;57:401–421. doi: 10.1146/annurev.psych.57.102904.190127.
    1. Carlson M, Clark F, Young B. Practical contributions of occupational science to the art of successful ageing: how to sculpt a meaningful life in older adulthood. J Occup Sci. 1998;5(3):107–118.
    1. Iwarsson S, Isacsson A, Persson D, Schersten B. Occupation and survival: A 25-year follow-up study of an aging population. Am J Occup Ther. 1998;52:65–70.
    1. Mendes de Leon CF, Glass TA, Beckett LA, Seeman TE, Evans DA, Berkman LF. Social networks and disability transitions across eight intervals of yearly data in the New Haven EPESE. J Gerontol B Psychol Sci Soc Sci. 1999;54:S162–172.
    1. Mendes de Leon CF, Glass TA, Berkman LF. Social engagement and disability in a community population of older adults: The New Haven EPESE. Am J Epidemiol. 2003;157:633–642. doi: 10.1093/aje/kwg028.
    1. Welin L, Larsson B, Svardsudd K, Tibblin B, Tibblin G. Social network and activities in relation to mortality from cardiovascular diseases, cancer and other causes: a 12 year follow up of the study of men born in 1913 and 1923. J Epidemiol Community Health. 1992;46:127–132. doi: 10.1136/jech.46.2.127.
    1. Pearlin LI, Pioli MF, McLaughlin AE. In: Handbook of Aging and the Social Sciences. Binstock RH, George LK, editor. San Diego: Academic Press; 2001. Caregiving by adult children: Involvement, role disruption, and health; pp. 238–254.
    1. Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: A meta-analysis of controlled trials. Lancet. 1993;342:1032–1036. doi: 10.1016/0140-6736(93)92884-V.
    1. Byles JE. A thorough going over: Evidence for health assessments for older persons. Aust N Z J Public Health. 2000;24:117–123. doi: 10.1111/j.1467-842X.2000.tb00131.x.
    1. Van Haastregt JCM, Diederiks JPM, van Rossum E, de Witte LP, Crebolder HFJM. Effects of preventive home visits to elderly people living in the community: Systematic review. Br Med J. 2000;320:754–758. doi: 10.1136/bmj.320.7237.754.
    1. Elkan R, Kendrick D, Dewey M, Hewitt M, Robinson J, Blair M, Williams D, Brummell K. Effectiveness of home based support for older people: Systematic review and meta-analysis. Br Med J. 2001;323:1–9. doi: 10.1136/bmj.323.7315.719.
    1. Huss A, Stuck AE, Rubenstein LS, Egger M, Clough-Gorr KM. Multidimensional preventive home visit programs for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials. J Gerontol A Biol Sci Med Sci. 2008;63A:298–307.
    1. Avlund K, Vass M, Kvist K, Hendriksen C, Keiding N. Educational intervention toward preventive home visitors reduced functional decline in community-living older women. J Clin Epidemiol. 2007;60:954–962. doi: 10.1016/j.jclinepi.2005.06.015.
    1. Vass M, Avlund K, Hendriksen C. Randomized intervention trial on preventive home visits to older people: Baseline and follow-up characteristics of participants and non participants. Scand J Public Health. 2007;35:410–417. doi: 10.1080/14034940601160763.
    1. Steultjens EM, Dekker J, Bouter LM, Jellema S, Bakker EB, Ende CHM van den. Occupational therapy for community dwelling elderly people: A systematic review. Age Ageing. 2004;33:453–460. doi: 10.1093/ageing/afh174.
    1. Clark F, Azen SP, Zemke R, Jackson J, Carlson M, Mandel D, Hay J, Josephson K, Cherry B, Hessel C, Palmer J, Lipson L. Occupational therapy for independent-living older adults: A randomized controlled trial. JAMA. . 1997;278(16):1321–1326.
    1. Clark F, Azen SP, Carlson M, Mandel D, LaBree L, Hay J, Zemke R, Jackson J, Lipson L. Embedding health-promoting changes into the daily lives of independent-living older adults: Long-term follow-up of occupational therapy intervention. J Gerontol B Psychol Sci Soc Sci. 2001;56B:P60–P63.
    1. Gitlin LN, Winter L, Vause Earland T, Adel Herge E, Chernett NL, Piersol CV, Burke JP. The tailored activity program to reduce behavioral symptoms in individuals with dementia: Feasibility, acceptability, and replication potential. Gerontologist. 2009;49:428–439. doi: 10.1093/geront/gnp087.
    1. Vass M, Avlund K, Hendriksen C, Philipson L, Riis P. Preventive home visits to older people in Denmark. Z Gerontol Geriatr. 2007;40:209–216. doi: 10.1007/s00391-007-0470-2.
    1. World Health Organization. International classification of functioning, disability, and health. . Geneva. 2001.
    1. American Occupational Therapy Association. Am J Occup Ther. 2. Vol. 62. 2008. Occupational therapy practice framework: Domain and process; pp. 625–683.
    1. Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, Roth C, MacLean CH, Shekelle PG, Sloss EM, Wenger NS. The Vulnerable Elders Survey: A tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001;49(12):1691–1699. doi: 10.1046/j.1532-5415.2001.49281.x.
    1. Haley SM, Jette AM, Coster WJ, Kooyoomjian JT, Levenson S, Heeren T, Ashba J. Late Life Function and Disability Instrument: II. Development and evaluation of the function component. J Gerontol A Biol Sci Med Sci. 2002;57A:M217–M222.
    1. Jette AM, Haley SM, Coster WJ, Kooyoomjian JT, Levenson S, Heeren T, Ashba J. Late Life Function and Disability Instrument: I. Development and evaluation of the disability component. J Gerontol A Biol Sci Med Sci. 2002;57A:M209–M216.
    1. Diener E, Oishi S, Lucas RE. Personality, culture, and subjective well-being: Emotional and cognitive evaluations of life. Annu Rev Psychol. 2003;54:403–425. doi: 10.1146/annurev.psych.54.101601.145056.
    1. Diener E, Emmons R, Larsen J, Griffin S. The satisfaction with life scale. J Pers Assess. 1985;49:71–75. doi: 10.1207/s15327752jpa4901_13.
    1. Pavot W, Diener E, Colvin CR, Sandvik E. Further validation of the satisfaction with life scale: Evidence for the cross-method convergence of well-being measures. J Pers Assess. 1991;57:149–161. doi: 10.1207/s15327752jpa5701_17.
    1. Pavot W, Diener E. Review of the satisfaction with life scale. Psychol Assess . 1993;5(2):164–172.
    1. Ware JE. SF-36 health survey update. Spine. 2000;25:3130–3139. doi: 10.1097/00007632-200012150-00008.
    1. Ware JE, Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233. doi: 10.1097/00005650-199603000-00003.
    1. Chachamovich E, Fleck M, Laidlaw K, Power M. Impact of major depression and subsyndromal symptoms on quality of life and attitudes toward aging in an international sample of older adults. Gerontologist. 2008;48(5):593–602.
    1. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale) Am J Prev Med. 1994;10:77–84.
    1. Irwin M, Artin KH, Oxman MN. Screening for depression in the older adult: Criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D) Arch Intern Med. 1999;159(15):1701–1704. doi: 10.1001/archinte.159.15.1701.
    1. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short orientation-memory-concentration test of cognitive impairment. Am J Psychiatry. 1983;140:734–739.
    1. Brooke P, Bullock R. Validation of a 6 item cognitive impairment test with a view to primary care usage. Int J Geriatr Psychiatry. 1999;14 (11):936–940.
    1. Frank JC, Coviak CP, Healy TC, Belza B, Casado BL. Addressing Fidelity in Evidence-Based Health Promotion Programs for Older Adults. J Appl Gerontol. 2008;27:4–33. doi: 10.1177/0733464807308621.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2. New Jersey: Lawrence Erlbaum; 1988.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi