Program Implementation of CAPABLE With Community-Dwelling Older Adults During the COVID-19 Pandemic

PURPOSE: Currently the implementation and feasibility of evidence-based programs to increase safety and independence within the homes of older adults is critical [1,2]. Within the US an estimated 12 million people aged ≥65 who are living in their own homes need equipment to aid with basic ADLs, however roughly five million seniors lack those items [3].The CAPABLE (Community Aging in Place Advancing Better Living for Elders) program model utilizes an interdisciplinary and client-centered approach for older adults/seniors who reside within low economic residential areas [1]. CAPABLE focuses on improving safety and functional independence within the home environment through services provided by an OT, RN, and home contractor [1]. The purpose of this study is to contribute to the gap in evidence to understand the implementation and outcomes of the CAPABLE program within a midwest major city; where older adult residents are more likely to live alone than those within 37 peer regions in the US [4].

DESIGN: For this program, 53 older adults were screened based on referrals from our non-profit community organization during July 2020-July 2021. Inclusion: ≥60 years of age, homeowner, has difficulty with ≥1 ADL/ IADL, score ≥4 on the STEADI fall risk scale, score ≥7 on the SPMSQ cognitive Scale, and ≤10 on the PHQ-8 depression scale. The data was gathered through various quantitative surveys and self-report measures completed throughout the CAPABLE program.

METHOD: A comprehensive pre and post assessment was given, which included: ADL independence, functional mobility, cognition, frailty, pain, sarcopenia, nutrition, medication use; along with home environmental hazards/issues. Along with the Client-Clinician Assessment Protocol (C-CAP) which is an OT/RN pre/post assessment based on the CAPABLE implementation protocol and addresses functional ability/tasks, readiness for change, and client directed goals. A descriptive analysis was used to assess the sociodemographic composite, pre and post implementation data, home repairs/modifications completed, and durable medical equipment provided.

RESULTS: 31 (58.4%) participants completed the CAPABLE program; 1 unenrolled (1.9%) and 21 (39.6%) declined program participation. A descriptive analysis of the demographics include: 1) Gender: 29 women (93.5%); 2) Race/Ethnicity: 26 (83.9%) identified as Black/African-American and 4 White (12.9%) 3) Average Age: 71; and 4) Average Income: $23,304. Through a descriptive analysis a 0.8 point increase was observed from the baseline Readiness to Change Score of 1.8 where a client considers a change in habits/routines within the next 6 months; to the post score of 2.6 which indicates a change within a month with a defined plan of action. Of the 88 OT ADL/IADL goals addressed 55 (61.3%) were met, and of the 51 RN functional goals addressed 35 (68.7%) were met. PEG-Pain scale of 0-10, there was a 0.9 average score reduction from pre (6.1) to the post (5.2) assessment, which fell within the moderate pain range. PHQ-8 depression scale showed an average score reduction from the pre (6.6) mild to the post (4.5) none-minimal range. The DME provided (N = 129): bathing (28.7%), toileting (10.9%), dressing (19.4%), and mobility (17.1%). Finally, 96.6% participants reported benefitting a ‘great deal’ from the program, and 86.2% believed the program made their lives exceptionally easier.

CONCLUSION: CAPABLE was feasible to implement amidst COVID-19 restrictions, and demonstrated within this cohort of older adults improved ADLs/IADLs independence; decreased pain and symptoms of depression; increased readiness to change habits and routines toward tasks, and client satisfaction with the therapeutic intervention and home repair/modification services.

References

1. Szanton, S. L., Xue, Q. L., Leff, B., Guralnik, J., Wolff, J. L., Tanner, E. K., & Gitlin, L. N. (2019). Effect of a biobehavioral environmental approach on disability among low-income older adults: a randomized clinical trial. JAMA Internal Medicine, 179(2), 204-211. https://doi.org/10.1001/jamainternmed.2018.6026

2. Stark, S., Keglovits, M., Arbesman, M., & Lieberman, D. (2017). Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic review. American Journal of Occupational Therapy, 71(2), 7102290010p1-7102290010p11.

3. Lam K, Shi Y, Boscardin J, Covinsky KE. Unmet Need for Equipment to Help With Bathing and Toileting Among Older US Adults. JAMA Internal Medicine, Published online March 22, 2021. https://doi.org/10.1001/jamainternmed.2021.0204

4. East-West Gateway Council of Governments.(April, 2020).Where We Stand. The Strategic Assessment of the St. Louis Region. 8th edition, Update 5. https://www.ewgateway.org/wp-content/uploads/2020/04/wws08_update05_COVID-19_2020-04_final.pdf