Program helps disabled elderly stay independent

2006-05-18 (Reuters Health)

By Anne Harding

NEW YORK (Reuters Health) - Working collaboratively with older people who are having difficulties with bathing, dressing themselves and other activities of daily living can help them to remain independent, a new study shows.

Dr. Laura N. Gitlin of Thomas Jefferson University in Philadelphia, the study's lead author and her colleagues tested a six-month intervention in which people received four 90-minute visits with an occupational therapist, as well as one 20-minute telephone contact, and one 90-minute physical therapy visit.

Of 319 men and women 70 and older, half were assigned to the intervention, and half received no training.

Participants told the therapists where they were having difficulties and worked with them to set individual goals. The therapists showed participants how to modify their homes to make them safer, for example putting hand-holds and railings in the bathroom; instructed them on how to solve problems; and provided training in how to recover from a fall as well as balance and muscle strength training.

By six months, the people who received the training reported fewer difficulties with activities of daily living, especially bathing and toileting, compared to those who were not assigned to the intervention. They also reported higher self-efficacy, and less fear of falling. Most of the benefits were sustained at 12 months.

"Fear of falling, a recognized psychological syndrome, is a strong risk factor for falling and functional decline," Gitlin and her team write in the May issue of the Journal of the American Geriatrics Society, pointing out that only one other intervention has been shown to reduce fear of falling in elderly participants.

"To show a reduction in difficulties with bathing is equally important, because bathing is one of the first areas that become difficult for older people who have chronic illness or functional disability," Gitlin told Reuters Health. "That has a lot of ramifications for their ability to age in place and how they feel about themselves and quality of life and so forth."

Unfortunately, Gitlin noted, there is no such program generally available to older people living independently. Medicare will not provide occupational or physical therapy unless a person has been hospitalized or is in a rehabilitation center.

Also, traditional home care is typically not tailored to the individual's personal needs, she added, but generally is more prescriptive. Moreover, in standard home care, occupational therapists and physical therapists may not be able to work together to provide integrated care as they did in the current study.

"People who are living with functional difficulties that are not a consequence of some type of an acute incident or event ... have no access to programs," Gitlin said. "What we would like to see is that primary care physicians make a referral for their older patients who begin to demonstrate difficulties in even bathing or any area."

She added: "The big policy issue here is that insurance needs to pay for home modifications and they don't now -- particularly bathroom equipment."

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

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