At-home program lowers mortality among elderly

2006-06-19 (Reuters Health)

NEW YORK (Reuters Health) - A training program of occupational and physical therapy, individually tailored for older people living on their own, not only helps them stay independent longer; it may help them live longer, too.

"Older adults can learn new ways of managing functional decline that obviously directly benefit them," Dr. Laura N. Gitlin of Thomas Jefferson University in Philadelphia, the study's lead author, told Reuters Health. "You're never to old to learn a new trick -- we were able to show that people can learn these strategies at whatever age."

Gitlin and her colleagues had previously reported that among 319 men and women 70 and older, those who participated in the six-month program had an easier time with activities of daily living like bathing and going to the bathroom, and were less afraid of falling, than those who received no training and served as a comparison 'control' group.

In the June issue of the Journal of the American Geriatrics Society, Gitlin and her team report on a 14-month follow-up of that study. During that time, 1 percent of the people who participated in the intervention died, compared with 10 percent of those who received no treatment.

While none of the 31 active participants who had been hospitalized previously died during the follow-up period, 21 percent of those previously hospitalized in the control group did. "That's a pretty big difference," Gitlin said. The intervention also had the strongest effect on those participants who were less likely to use control-oriented coping strategies -- such as self-pacing or using special equipment -- at the beginning of the study.

The intervention consisted of four 90-minute visits and one telephone interview with an occupational therapist and a 90-minute visit with a physical therapist.

"When we go into older people's homes, we work with them to identify and problem-solve what are the most pressing concerns they have in their daily routines," Gitlin explained. "We ... work with them to help them understand the role of their physical and social environment and a whole range of behavioral strategies such as energy conservation techniques that can help them shape what they want to do throughout the day."

She added: "What's important for us in this intervention as well is to leave older adults with skills."

Participants also worked with the therapists to install modifications to their homes to make them safer, such as handholds and railings for bathrooms.

Gitlin and her team conclude: "These study results provide preliminary evidence that addressing the everyday difficulties of functionally vulnerable older people by introducing home modifications and other control-oriented strategies may reduce mortality risk. This appears to be the case in particular for those who are most compromised, who are hospitalized, or who do not use control-oriented strategies."

SOURCE: Journal of the American Geriatrics Society, June 2006.

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