Functional Goals and Predictors of Their Attainment in Low-Income Community-Dwelling Older Adults

Abstract

Objective: To describe functional goals and factors associated with goal attainment among low-income older adults with disabilities living in the community.

Design: Secondary analysis.

Setting: Participants' homes.

Participants: Older adults (N=226) with disability who participated in the Community Aging in Place, Advancing Better Living for Elders trial.

Interventions: A 5-month, home-based, person-directed, structured program delivered by an interprofessional team: occupational therapist, registered nurse, and handyman.

Main outcome measures: Process of occupational therapist goal setting and attainment at the final occupational therapist visit.

Results: Participants identified 728 functional goals (mean of 3.2 goals per participant), most commonly related to transferring (22.0%; n=160 goals), changing or maintaining body position (21.4%; n=156 goals), and stair climbing (13.0%; n=95 goals). Participants attained 73.5% (n=535) of goals. Goal attainment was highest for stair climbing (86.3%), transferring (85.6%), and self-care (84.6%); walking goals were less likely attained (54.0%). Goal attainment was not associated with age, sex, education, depressive symptoms, function, or health-related quality of life but was less likely among participants who had severe pain compared with those without pain (adjusted odds ratio, 0.38; 95% confidence interval, 0.17-0.86). When participant readiness to change score increases by 1 point on the 4-point scale, goal attainment was 62% more likely (adjusted odds ratio, 1.62; 95% confidence interval, 1.14-2.29).

Conclusions: Home-based collaborative goal setting between older adults and occupational therapists is feasible and particularly effective when individuals are ready or willing to adopt new strategies to achieve identified goals.

Trial registration: ClinicalTrials.gov NCT01743495 NCT01576133.

Keywords: Frail elderly; Person-centered therapy; Rehabilitation; Self care.