Occupational therapy and physical therapy intervention can extend the length and quality of life for older adults by up to 3.5 years, according to recent findings from a follow-up study of Project ABLE (Advancing Better Living for Elders), a home-based program for urban community-dwelling older adults. The outcome is described in the March 2009 issue of the Journal of the American Geriatrics Society.
"The new findings reinforce our understanding that proactive therapeutic intervention has a positive impact on older adults who are experiencing some difficulties with carrying out their everyday activities," says Laura N. Gitlin, PhD, Director of the Jefferson Center for Applied Research on Aging and Health (CARAH) at Thomas Jefferson University, the group that conducted the Project ABLE study. "The ABLE trial demonstrates that teaching elderly people new ways to accomplish personal daily goals provides a survivorship benefit. We are excited to continue this research and to translate this intervention into real world practice."
The goal of Project ABLE was to help older adults compensate for their declining abilities by introducing modifications to home environments and the way they approached tasks. Active intervention lasted six months, during which time each participant received four in-home visits and one phone call from an occupational therapist who identified and prioritized problem areas and developed strategies tailored to meet individual needs and home environmental configurations. During that time, participants also had one visit from a physical therapist that focused on balance and muscle strengthening and trained in fall recovery techniques. A six month maintenance phase followed and included brief check-in phone calls from an occupational therapist and a final home visit to review strategies and obtain closure. Control group participants did not receive intervention contact.
In an earlier report of the results from Project ABLE, Gitlin and her colleagues showed that participants reported improved functional abilities and a survivorship advantage of one year. ABLE participants had a one percent mortality rate, compared to a 10 percent rate in the control group in the first year of the study. The survivorship advantage was higher for participants who had been hospitalized prior to enrolling in the study such that those who received ABLE had a zero percent rate of mortality compared to a 21 percent mortality rate for those in the control group. The significant differences between the two groups led researchers to conduct a follow-up study to determine the extent of the intervention benefit.
The results of the follow-up study show that the intervention of occupational therapy and home modification combined with physical therapy provides participants a 3.5-year survivorship which suggests that this could be a low-cost tool to delay functional decline and death. "This positive feedback takes us to the next step," shares Gitlin. "While both occupational and physical therapy are covered benefits under Medicare Part B, in collaboration with the Erickson Foundation, we are now working to promote the coverage of the array of services provided by ABLE. If this becomes a reality, we hope to be able to incorporate it into many settings including the Erickson continuing care communities and through our own Jefferson Elder Care services."
Jefferson Elder Care is an initiative founded in September 2008 to deliver evidence-based services tested by CARAH and other researchers, train health professionals in these programs and identify new directions in research that address practical problems and service gaps. The home safety assessment program developed and tested as part of Project ABLE is currently being offered as a service by therapists through Jefferson Elder Care.
Founded by Dr. Laura Gitlin, the Jefferson Center for Applied Research on Aging and Health (CARAH) seeks to improve the lives of older adults and their family members through research, training of health professionals and implementation of evidence-based clinical services. CARAH is committed to enhancing the quality of life for older adults and families by developing, testing and disseminating innovative community and home-based health and human services. CARAH explores opportunities for academic-community partnerships and facilitates interdisciplinary approaches to problems of public health importance covering the topics of physical frailty, health disparities, dementia care, end of life comfort care, healthy aging, aging at home and quality of life issues. Learn more about CARAH’s research at http://www.jefferson.edu/jchp/carah/. Learn more about Jefferson Elder Care at http://www.jefferson.edu/jchp/carah/living_laboratory.cfm.