Home and Community Care Digest
Methods: 319 community dwelling seniors were screened for cognitive and functional abilities, and were randomly placed in a treatment and a non-treatment group. The treatment group participated in a 6- month intervention which consisted of five occupational therapy contacts (four 90 minute visits and one 20 minute phone call) and one physical therapy visit which lasted 90 minutes. Visits addressed participant-identified problem areas and focused on education and problem solving, home modifications, energy conserving techniques, balance, muscle strengthening and fall recovery techniques. In the six months following the intervention, participants received three phone calls from the occupational therapist to reinforce the strategies and develop new strategies if needed. The effectiveness of the intervention was measured in a variety of ways. Participants were evaluated using self-reporting measures of physical function (activities of daily living (ADLs), instrumental activities of daily living (IADLs), mobility/transferring), fear of falling (confidence performing various activities without falling), and selfefficacy (i.e., the belief that you can do what you want to do).
Participants were also evaluated for adaptive behavioural, cognitive and environmental strategies as well as the presence of potential tripping and falling hazards in their home.
Findings: After the 6-month period, the treatment group reported fewer difficulties with IADLs and ADLs than the control group. However, there was no improvement on the mobility-transfer scores. The treatment group reported less fear of falling, higher confidence in managing daily functional activities, greater use of control-orientated strategies, and fewer home hazards. Additionally, there was a significant improvement in the scores for bathing, grooming and preparing meals in the treatment group. At the 12- month follow-up, many of the improvements were still present; specifically, improvements in functional difficulties in ADL and IADL, fear of falling, presence of home hazards and use of control-orientated strategies. The improvements on self-efficacy scores, however, were no longer present after 12 months.
Conclusions: This study focused on a group of older people who were not already receiving home care services but who stood to gain from a home intervention. The multicomponent home intervention is different from traditional home care programs because it is aimed at helping participants to develop their own strategies, involving the collaboration of occupational and physical therapists, often present in traditional home care programs. Ultimately, this study has important implications for policy-makers looking to reduce health care costs due to institutionalisation. The occupational therapist-physical therapist (OT-PT) community intervention appears to reduce functional difficulties in community dwelling elderly and supports them to remain living in their own homes longer.
Reference: Gitlin LN, Winter L, Dennis MP, Corcoran M, Schinfeld, S, & Hauck WW. "A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults." Journal of the American Geriatrics Society, 2006; 54, 809-816.
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