REUTERS: A program that combines home modifications with specialized counseling may help seniors disabled by aging stay in their homes longer, a new study suggests.
The program helped seniors regain independence and accomplish more activities of daily living, such as bathing, walking across a small room, dressing themselves, grooming, using the toilet and getting in and out of bed, researchers reported in JAMA Internal Medicine.
"For someone to be able to age in place, it's important to work on both the home environment and also the person," said Sarah Szanton, professor and director of the Center on Innovative Care in Aging at the Johns Hopkins School of Nursing and the Johns Hopkins School of Public Health.
"With our program, a nurse and an occupational therapist come into the home and address only what the older adult cares about," she said. "They may want to sleep upstairs in their own bed instead of the La-Z-Boy downstairs or they may want to be able to go to the bathroom by themselves rather than having a grandson have to pull them up."
The hope is that this will allow seniors to stay in their homes and out of hospitals and nursing homes, Szanton said. Another goal is to prevent injuries like hip fractures and heart attacks, she added.
For a 12-month study, Szanton's team enrolled 300 seniors aged 65 and older who had difficulty with one or more activities of daily living. Half the group got up to US$1,300 worth of home improvements along with up to four one-hour visits from a nurse and up to six one-hour visits from an occupational therapist. The other half, the control group, received 10 one-hour home visits from a research assistant who helped seniors identify sedentary activities they would like to learn or enjoy, such as learning to use the internet, playing board games and listening to music.
Nurses helped seniors in the active treatment group learn strategies to help manage depressive symptoms and balance problems. Occupational therapists helped participants to identify feasible ways to surmount physical limitations.
The home modifications included leveling and repairing flooring, stabilizing stairs, replacing the toilet with one that had a higher seat, installing grab bars and adding a second banister to help those with weak legs who wanted to go up and down stairs.
Szanton points to the case of an elderly man who got around his apartment in a wheelchair but wanted to be able to shave standing up and to go outside to watch the birds without needing someone to pick him up and carry him over his back stoop. "We put in grab bars where he shaved and at the back stoop so he could get out by himself and shave standing up," Szanton said. "Before that he only got out when he was picked up for dialysis. Now he can get out all the time."
The researchers interviewed the study volunteers about their inability to accomplish activities of daily living at the study's start and then again at five and 12 months. By the end of the study, those in the active treatment group were more likely to say the program made their lives easier (82.3 percent versus 43.1 percent), helped them take care of themselves (79.8 percent versus 35.5 percent) and helped them gain confidence in managing daily challenges (79.9 percent versus 37.7 percent).
The new study showed improvement in a group of elderly people who were "at high risk of decline," said Steven Albert, a professor and chair of the department of behavioral and community health sciences at the Graduate School of Public Health at the University of Pittsburgh Medical Center. "They do show benefits with this tailored support."
"You really want to see people be independent and able to manage without help from their families or from paid services," Albert said. "Presumably if you can improve function with the activities of daily life, you reduce the risk of nursing home placement."
A limitation of the study is that it depended on seniors' self-evaluations rather than those of an outside observer, Albert said. "Self-report could introduce bias because people want to believe these things are helping them."
Still, Albert said, "it's a step in the right direction. This is a very good way to go and it's low cost."