CAPABLE Aimed at Helping Elders Have Skills, Assistance to Remain at Home
Many elders want to remain at home as they age. Sometimes that isn’t possible due to health reasons, but some people believe that there may be ways for seniors with chronic conditions to stay at home for a longer period of time by addressing limitations caused during activities of daily living or instrumental activities of daily living. These elders could be experiencing mild cognitive impairment themselves. Or they may be struggling with these daily activities while also serving as a caregiver for a spouse who is experiencing cognitive decline.
That’s why a lot of policymakers, advocacy groups and health care organizations are watching a new project out of John Hopkins University’s School of Nursing. This project, called Community Aging in Place, Advancing Better Living for Elders (CAPABLE), is designed to address individual needs as well as the environment in which they live. The CAPABLE website notes that this is important because the number of older adults is expected to jump to 71 million by 2030. Currently, the United States spends $250 billion each year on medical care for older adults, especially those who have chronic conditions. “Even though many chronic conditions lead to disability, little information exists on interventions that can delay the onset of chronic-disease related disability,” the website states. “Given the multi-factorial nature of many of the age-related conditions and their associated risk factors, the best interventions are likely multi-component with the components synergistically targeting multiple risks for disability.”
This research project involves a two-group randomized trial to test CAPABLE, which focuses on evidence-based nursing, occupational therapy and handyman components. The researchers did a pilot trial of the components of CAPABLE and found that there was enough of a change to warrant an efficacy trial.
In the efficacy trial, the project will involve low-income older adults who are at least 65 years of age and primarily African Americans. Participants who are selected will have to have difficulty with at least one activity of daily living or at least two instrumental activities of daily living. These participants will be randomly assigned to two groups. One of the groups will receive six visits with an occupational therapist and four visits from a nurse. These participants also will receive to $1,200 in safety and modification services from a licensed handyman. While each participant in this group will receive all three types of assistance, the interventions will be tailored to the participants’ risk profile and goals. Participants in the control group will receive a similar number of visits, which will involve sedentary activities with a trained research assistant.
The participants will be assessed at 16 and 52 weeks in person. The goal is for the study participants to complete activities of daily living and instrumental activities of daily living without limitations at the 16-week mark. The researchers also will focus on lower extremity mobility, health-related quality of life, and home safety at the 16-week mark, and limitations in both activities of daily learning and instrumental activities of daily learning at 52 weeks.
So what are activities of daily living? PBS provides a list of these activities as well as a way to gauge an elder’s capability. These activities include: bathing, dressing, grooming, oral care, toileting, transferring, walking, climbing stairs, eating, shopping, cooking, managing medications, using the phone, housework, doing laundry, driving, and managing finances. Each of these is assessed based on whether the elder can do the task independently, needs help, is dependent, or does not do this activity.
And let’s look at instrumental activities of daily living, which overlap to a certain degree activities of daily living. These include the ability to use a telephone, shopping, food preparation, housekeeping, laundry, model of transportation, responsibility for own medications, and ability to handle finances. Again, these activities are assessed as to whether the elder can do this activity for themselves or needs some level of assistance.
While the CAPABLE project does not specifically address the early stages of Alzheimer’s and other dementias, some findings may emerge that will help people who are experiencing mild cognitive impairment or their spouses who might be struggling with these activities while also serving as a caregiver remain at home for a longer period of time. Stay tuned….
Primary Sources for This Sharepost:
Johns Hopkins School of Nursing. (nd). Community Aging in Place—Advancing Better Living for Elders (CAPABLE).
Lawton & Brody. (1969). Instrumental activities of daily living (IADL). University of Iowa.
Neergaard, L. (2013). Fixing up seniors' homes to help them age in place. Livewell Nebraska.
PBS.com. (2008). Caring for your parents: Checklist of activities of daily living.