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Randomized Controlled Trial
. 2021 Jan;69(1):85-90.
doi: 10.1111/jgs.16808. Epub 2020 Sep 20.

Disability Prevention Program Improves Life-Space and Falls Efficacy: A Randomized Controlled Trial

Minhui Liu  1   2 , Qian-Li Xue  3 , Laura N Gitlin  2   4 , Jennifer L Wolff  5 , Jack Guralnik  6 , Bruce Leff  3 , Sarah L Szanton  2   5
Affiliations
Randomized Controlled Trial

Disability Prevention Program Improves Life-Space and Falls Efficacy: A Randomized Controlled Trial

Minhui Liu et al. J Am Geriatr Soc. 2021 Jan.

Abstract

Objectives: To evaluate the effects of a home-based disability prevention program on life-space and falls efficacy among low-income older adults.

Design: Single-blind two-arm randomized controlled trial.

Setting: Participants' homes.

Participants: Participants were low-income cognitively intact older adults (≥65 years old) with restricted daily activities. Our analytic sample for life-space (n = 194) and falls efficacy (n = 233) varied as the life-space measure was introduced 4 months after the trial began.

Intervention: Up to six 1-hour home visits with an occupational therapist; up to four 1-hour home visits with a registered nurse; and up to $1,300 worth of home repairs, modifications, and assistive devices with a handyman, during a course of 4 months.

Measurements: Life-space was measured by the Homebound Mobility Assessment; falls efficacy was measured using the 10-item Tinetti Falls Efficacy Scale at baseline and 5 months.

Results: Participants were on average 75 years old, predominantly Black (86%) and female (85%-86%). Compared with participants in the control group, participants receiving the intervention were more likely to have improved versus decreased life-space in areas of bathroom (adjusted odds ratio (OR) = 3.95; 95% confidence interval (CI) = 1.20-12.97), front or back porch, patio, or deck (adjusted OR = 2.67; 95% CI = 1.05-6.79), stairs (adjusted OR = 4.09; 95% CI = 1.34-12.48), leaving the house for any reason other than for health care (adjusted OR = 2.40; 95% CI = 1.01-5.73), and overall life-space (adjusted OR = 2.15; 95% CI = 1.10-4.19). Participants who received the intervention also had an 11% improvement in falls efficacy in performing daily activities (exponentiated coefficient = 1.12; 95% CI = 1.04-1.21).

Conclusion: Life-space and falls efficacy were improved through a multicomponent, person-directed, home-based disability prevention intervention. Findings suggest that this intervention should be translated into different settings to promote independent aging.

Keywords: disability; falls efficacy; intervention; life-space; physical independence.

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Conflict of interest statement

Conflict of Interest: Drs Szanton and Gitlin are inventors of the CAPABLE training program, for which the Johns Hopkins University is entitled to fees. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies.

Figures

Figure 1.
Figure 1.
The variable of the Y axis represents the increase of falls efficacy scores from baseline to 5 months and a positive value indicates improvement (N=194). Participants with improved life-space had greatest improvement in falls efficacy scores with a median of 12.0, followed by those with unchanged (median=4.5) and decreased life-space (median=1.0).
See this image and copyright information in PMC

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