Abstract
BackgroundThe 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/DesignThe 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.DiscussionFeasibility 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 RegistrationClinicalTrials.gov ID NCT00985283
Highlights
The search for preventive methods to mitigate functional decline and unwanted relocation by older adults living in the community is important
In light of these circumstances, there is a distinct need to develop a solution that will enhance the well-being of older adults in these domains and allow them to stay at home longer as well as remain functional, relatively healthy and satisfied
We indicate screening measures, measurement observations conducted by a blinded research associate, and measures collected by occupational therapist (OT) during their intervention visits
Summary
The current state of affairs in population aging and gerontology in the USA and abroad set the stage for this study protocol. The ability to remain at home can help an older adult maintain mental and physical health through engagement in daily activities—such as housekeeping or social interactions—if adaptations to the aging process can be learned and used. In another systematic review soon after, Elkan et al [13] criticized van Haastregt and colleagues for not pooling the results of the studies they reviewed The results of their 15 study meta-analysis focused on preventive home visits by trained nurses and suggested that they are associated with a decrease in mortality and a reduction in admissions to long term care institutions. The one comprehensive OT intervention study that was of high quality and with positive results [18,19] used outcome measures for participation, function, life satisfaction, and health. We used hypotheses such as the following examples to structure the measurement and analysis of outcomes: (H1) the experimental group will exhibit greater (more positive or less negative) functional ability across the study period than the comparison group, (H2) the experimental group will show a significantly better slope for life satisfaction across the study period than the comparison group, and (H3) the experimental group will have significantly lower rates of referral to rehabilitation, skilled nursing or assisted living facilities than the comparison group
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