Abstract
BackgroundHousing adaptations have been identified as an important environmental and prevention intervention for older adults, which may improve health and quality of life. The onset of disability in bathing can act as a warning for further disability in other activities and may therefore be a judicious time-point for intervention. The aim of this study was to determine the feasibility of conducting a Randomised Controlled Trial (RCT) of bathing adaptations, to evaluate whether they improve older adults’ perceived health status and quality of life, prevent further functional deterioration, and reduce the use of other health and social care resources. This study was conducted in preparation for a powered RCT.MethodEligibility criteria were aged > 65 and referred to local authority housing adaptations service for an accessible flush-floor shower. Participants were randomised to either usual adaptations (3–4 month wait) or immediate adaptations (no wait). Outcomes were assessed at 3, 6 and 9 months and included perceived physical and mental health status, health and social care related quality of life, independence in activities of daily living (ADL) and bathing, and falls. Data on costs and the use of health and social care resources were collected during follow-up in order to inform a definitive health economic evaluation.ResultsSixty participants were recruited and randomised, 31 to immediate adaptations and 29 to waiting list control. Mean age was 77(SD8), 58% women and 58% living alone. Follow-ups were completed with 90, 85 and 72% at 3, 6 and 9 months respectively. Adaptations were delivered to 65% of participants within the requisite timescales as there were delays with some privately owned properties. There were improvements from baseline in both groups on all outcome measures following the completion of the adaptations.ConclusionsThis is the first RCT of housing adaptations in the UK. We demonstrated the feasibility of using a waiting list control, subject to minor alterations to the timescales for privately owned properties. A powered trial would evaluate the impact on older adults’ quality of life and investigate the impact of waiting times on functional outcomes and health and care resource use.Trial registrationISRCTN14876332 Registered 12 July 2016.
Highlights
Housing adaptations have been identified as an important environmental and prevention intervention for older adults, which may improve health and quality of life
We focused on information related to assistance with personal care and time spent by paid or unpaid carers (Additional file 1: Tables S3 and S4); there was a particular reduction in the need for assistance from unpaid carers aiding with bathing following the installation of the shower
We found that it was feasible to conduct an Randomised Controlled Trial (RCT) of bathing adaptations for older adults in collaboration with a local authority housing adaptations partner
Summary
Housing adaptations have been identified as an important environmental and prevention intervention for older adults, which may improve health and quality of life. The onset of disability in bathing has been shown to be a important event for older adults, often rapidly followed by disability in other daily activities [8], and even acting as a warning point for nursing home admissions [9]. It may represent a judicious time-point for intervention to prevent or delay further disability
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