Agenda - 01-24-2006-5l - Laserfiche WebLink

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Feasibility and Effects of Preventive Home Visits Project Summary A. SPECIFIC AIMS Aging in place is now recognized as a policy goal as well as an objective of most older adults. While medically driven interventions such as home health care assist older adults to age in place, these occur not as true preventive measures but as reactions to losses in function or health. The search for preventive methods to mitigate decline and an unwanted move from home and community is important. One such method, Preventive Home Visits (PHVs), has been utilized in parts of Europe for approximately two decades. The PHV model is based on infrequent but regular visits to an older adult's home by a trained practitioner (typically occupational therapist or nurse). The visit is designed to assess the older person's situation and provide information and advice to optimize function and well-being. Evidence about PHV efficacy is mixed but generally supportive, and there is a distinct need to create and examine a preventive non-medical intervention in the USA. A successfully developed and implemented approach could enhance quality of life for older adults and their families as well as save health care costs. Based on a well-grounded, theoretical framework, we aim to implement and evaluate such a PHV intervention model in Orange County, North Carolina to assess the feasibility and effects of home visits with older adults, We will use an experimental, repeated measures design in which approximately 120 older (75+ years) community-dwelling adults are randomly assigned to experimental and comparison groups. The experimental group will receive the PHV intervention four times across a 12 month period. The comparison group will receive a minimal intervention of two informational phone calls and printed materials about local services during the same period, An occupational therapist with the requisite training and experience in home-based evaluation and intervention will conduct the experimental intervention. We will administer a set of standardized scales to both groups immediately pre-intervention, and again at regular intervals that fall two months after each intervention. These outcome measures will cover the primary dimensions that we hypothesize PHVs will have a positive influence on: functional ability, participation in occupations (meaningful activities), self-efficacy, life satisfaction, self-reported health/well-being. Secondary outcomes include hospitalization and institutionalization.. We plan to augment the quantitative data with qualitative data collection and analysis to develop a better understanding about how the intervention worked and how it can be improved for a subsequent study. The specific aims of the proposed project include the following: 1. Determine if the PHV intervention used in the proposed project is feasible in an American context. By tracking time, effort, costs, adherence to recommendations, participant recruitment and retention rates, and participant feedback, we expect to be able to provide data that both supports the feasibility of the intervention and helps us improve it for a subsequent study. 2- Establish if the PHV intervention creates improved outcomes in functional ability (the level activity performance as measured by the Late Life Function and Disability Instrument). The following directional hypotheses are based on this aim: Hl: The intervention group will exhibit a significantly better (more positive or less negative) slope for functional ability scores across the study period than the comparison group. 3. Ascertain if the PHV intervention causes improved psychosocial outcomes that relate to well- being. The following directional hypotheses follow from this aim: HZ: The intervention group will show a significantly better slope for general self-efficacy scores across the study period than the comparison group.