May 14, 2012

Expert on aging to expand outreach study with Balto. seniors

A research team headed by Sarah L. Szanton, an assistant professor in the Johns Hopkins University School of Nursing, has received a $4 million grant over five years from the National Institutes of Health to extend the team’s home-based intervention study with low-income older adults in Baltimore City.

In a successful pilot program completed in 2010, the school’s investigators tested an initiative called CAPABLE, for Community Aging in Place: Advancing Better Living for Elders. The pilot intervention included up to six in-home visits with an occupational therapist, up to four in-home visits with a nurse and an average of $1,200 in household handyman repairs and modifications. The team’s goal was to test the effectiveness of multiple complementary strategies to increase the subjects’ functioning and mobility while improving their physical environments, so that older low-income adults could continue to live at home.

While most elders would prefer to stay in their familiar surroundings, many require admission to a nursing home or other facility because they cannot perform the basic activities of daily living.

Such “disabilities” are the primary predictor of nursing-home admissions. And the annual cost of such out-of-home care in the United States currently totals approximately $150 billion, most of which is publicly funded through Medicaid and Medicare.

But Szanton points out that often a “disability” may be modified by addressing the disconnect between a person’s ability to function and the environment in which he lives. “We designed CAPABLE to improve self-care ability and mobility,” she said, “by intervening directly on these abilities as well as on the factors that modify them: pain, medication management, strength and balance, depression and the physical environment of the home.”

The Nursing team believes that given the increasing number of disabled, low-income older adults and the resulting costs to health care systems, testing novel, cost-effective interventions to enhance daily functioning at home should be a public health priority.

Based closely on the successful pilot program, the extended study will be a randomized controlled trial that exposes participants to either a physical intervention with three components (pain management, medication adherence and dealing with depression; exercise, strengthening and adapting; and physical improvement of the home to facilitate livability and safety) or a cognitive intervention (which includes sequenced life-review interviews that have been shown to help with memory and mood).

Participants will be enrolled from now through March 2015 and will experience up to 10 in-home sessions over a four-month period. The expanded study will involve 300 predominantly African-American low-income residents of Baltimore City, age 65 or older, who live at home but have difficulty with such daily functions as housework, preparing meals, taking medications as prescribed, managing finances, personal hygiene or toileting.

In addition to measuring short-term improvements in functionality and quality of life, Szanton and her team will test the longer-term effects of the interventions and weigh their economic value by assessing the impact on total health care costs over the 52 weeks following randomization. If successful, the planned cost analyses will offer the potential for wider translation of the strategies, positioning CAPABLE to reduce Medicare and Medicaid costs while decreasing health disparities among minority and low-income older adults.