Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Dec;69(12):3631-3640.
doi: 10.1111/jgs.17383. Epub 2021 Jul 27.

CAPABLE program improves disability in multiple randomized trials

Sarah L Szanton  1   2 , Bruce Leff  3 , Qiwei Li  1 , Jill Breysse  4 , Sandra Spoelstra  5 , Judith Kell  6 , James Purvis  7 , Qian-Li Xue  3 , Jonathan Wilson  4 , Laura N Gitlin  1   8
Affiliations
Review

CAPABLE program improves disability in multiple randomized trials

Sarah L Szanton et al. J Am Geriatr Soc. 2021 Dec.

Abstract

Background: Programs to reduce disability are crucial to the quality of life for older adults with disabilities. Reducing disability is also important to avert unnecessary and costly hospitalizations, relocation, or nursing home placements. Few programs reduce disability and few have been replicated and scaled beyond initial research settings. CAPABLE is one such program initially tested in a randomized control trial and has now been tested and replicated in multiple settings. CAPABLE, a 10-session, home-based interprofessional program, provides an occupational therapist, nurse, and handyworker to address older adults' self-identified functional goals by enhancing individual capacity and home environmental supports. We examine evidence for the CAPABLE program from clinical trials embedded in different health systems on outcomes that matter most to older adults with disability.

Methods: Six trials with peer-reviewed publications or reports were identified and included in this review. Participants' outcomes included basic and instrumental activities of daily living (ADLs, IADLs), fall efficacy, depression, pain, and cost savings.

Results: A total of 1144 low-income, community-dwelling older adults with disabilities and 4236 matched comparators were included in the six trials. Participants were on average ≥74-79 years old, cognitively intact, and with self-reported difficulty with ≥1 ADLs. All six studies demonstrated improvements in ADLs and IADLs, with small to strong effect sizes (0.41-1.47). Outcomes for other factors were mixed. Studies implementing the full-tested dose of CAPABLE showed more improvement in ADLS and cost savings than studies implementing a decreased dose.

Conclusions: The CAPABLE program resulted in substantial improvements in ADLs and IADLs in all six trials with other outcomes varying across studies. A dose lower than the original protocol tested resulted in less benefit. The four studies examining cost showed that CAPABLE saved more than it costs to implement.

Keywords: disability; health disparities; implementation.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Freedman VA, Spillman BC. The residential continuum from home to nursing home: size, characteristics and unmet needs of older adults. J Gerontol B Psychol Sci Soc Sci. 2014;69(February):S42-S50. https://doi.org/10.1093/geronb/gbu120
    1. Freedman VA, Spillman BC. Active life expectancy in the older us population, 1982-2011: differences between blacks and whites persisted. Health Aff. 2016;35(8):1351-1358. https://doi.org/10.1377/hlthaff.2015.1247
    1. Eggermont LHP, Leveille SG, Shi L, et al. Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the elderly Boston study. J Am Geriatr Soc. 2014;62(6):1007-1016. https://doi.org/10.1111/jgs.12848
    1. Covinsky KE, Yaffe K, Lindquist K, Cherkasova E, Yelin E, Blazer DG. Depressive symptoms in middle age and the development of later-life functional limitations: the long-term effect of depressive symptoms. J Am Geriatr Soc. 2010;58(3):551-556. https://doi.org/10.1111/j.1532-5415.2010.02723.x
    1. Smith PD, Becker K, Roberts L, Walker J, Szanton SL. Associations among pain, depression, and functional limitation in low-income, home-dwelling older adults: an analysis of baseline data from CAPABLE. Geriatr Nurs (Minneap). 2016;37(5):348-352. https://doi.org/10.1016/j.gerinurse.2016.04.016

Publication types

MeSH terms

LinkOut - more resources