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Randomized Controlled Trial
. 2009 Mar;57(3):476-81.
doi: 10.1111/j.1532-5415.2008.02147.x. Epub 2009 Jan 23.

Long-term effect on mortality of a home intervention that reduces functional difficulties in older adults: results from a randomized trial

Laura N Gitlin  1 , Walter W Hauck, Marie P Dennis, Laraine Winter, Nancy Hodgson, Sandy Schinfeld
Affiliations
Randomized Controlled Trial

Long-term effect on mortality of a home intervention that reduces functional difficulties in older adults: results from a randomized trial

Laura N Gitlin et al. J Am Geriatr Soc. 2009 Mar.

Abstract

Objectives: To evaluate the long-term mortality effect of a home-based intervention previously shown to reduce functional difficulties and whether survivorship benefits differ according to initial mortality risk level.

Design: Two-group randomized trial with survivorship followed up to 4 years from study entry.

Setting: Homes of urban community-living elderly people.

Participants: Three hundred nineteen adults aged 70 and older with difficulties performing daily activities.

Intervention: Occupational and physical therapy sessions to instruct participants in compensatory strategies, home modifications, home safety, fall recovery techniques, and balance and muscle strength exercises.

Measurements: Survival time was number of days between baseline interview and date of death, as determined using data from the National Death Index or December 31, 2005. Participants were stratified according to baseline mortality risk (low, moderate, high) using a prognostic indicator.

Results: At 2 years, intervention participants (n=160) had a 5.6% mortality rate (n=9 deaths) and controls (n=159) a 13.2% rate (n=21 deaths; P=.02). Mortality rates remained lower for intervention participants up to 3.5 years from study entry. At 2 years, intervention participants with moderate mortality risk had a 16.7% mortality rate (n=16 deaths/96), compared with 28.2% for equivalent control group participants (n=24 deaths/85; P=.02). By 3 years, mortality rates were not statistically significantly different between the experimental and control groups.

Conclusions: The intervention extended survivorship up to 3.5 years and maintained statistically significant differences for 2 years. Subjects at moderate mortality risk derived the most intervention benefit. Findings suggest that the intervention could be a low-cost clinical tool to delay functional decline and mortality.

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Conflict of interest statement

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.

Figures

Figure 1
Figure 1
Estimates of survival by treatment group. Note: Vertical lines on the survival curves show dates of censoring. The two vertical lines on the x-axis mark two and three years of follow-up.
Figure 2
Figure 2
Estimates of survival by level of risk.
Figure 2
Figure 2
Estimates of survival by level of risk.
Figure 2
Figure 2
Estimates of survival by level of risk.
See this image and copyright information in PMC

Comment in

References

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