-Addressing environmental barriers using the Canadian
Occupational Performance Measure (COPM) and providing home modifications improved client satisfaction in occupational performance
-Home modifications were effective in reducing difficulty in performing daily life tasks and the amount of personal support needed
-Home modifications need to be installed as soon as possible after the needs have been identified to prevent further functional decline
-Client perception of housing environment to support daily activities improved after home modifications were installed
-Identifying meaningful activities that older adults have given up and providing home modifications to address specific participant activities improved client satisfaction with performance
-Home modifications may add years to the lives of older adults living in their homes and prevent further decline in health and wellness
-Areas of the home that clients reported had the most environmental barriers for daily activities were the bedroom, bathroom, entrances, stairways, and doorways
Implications for Occupational Therapy
-The clinical and community-based practice of occupational therapy: Home modifications are effective in improving occupational performance in ADL/IADLs, increasing safety, and improving survivorship for older adults with functional difficulties while aging in place
-Societal needs: Lack of self-efficacy is noted in the aging population and cites the need for home modifications to improve independence, occupational performance, and meet the goal of most older adults to age in place
-Healthcare delivery and policy: Home modifications may prevent development of health problems, healthcare needs, and functional dependency and therefore reduce healthcare costs
-Education and training of occupational therapy students: All students should be taught a variety of home modifications and assistive technology to benefit older adults with diverse disabilities as well as assessments to identify environmental barriers within a clients home
-Refinement, revision, and advancement of factual knowledge or theory: Further research in cost- effectiveness, objective functional performance measures, how much training is necessary, and usability of home modifications is necessary
What is the Effectiveness of Home Modification I nterventions to I mprove Performance for Older Adults With Functional Difficulties? Johnny V. Rider, OTS and Gary L. Pearson, OTS
Touro University Nevada, School of Occupational Therapy Introduction
-Functional disability is an adverse outcome of age related conditions in older people. Difficulties performing ADLs and/or IADLs represent pivotal events that may trigger the need for personal assistance or relocation, thus increasing financial burden and further limiting occupational engagement. Functional disability is associated with a diminished quality of life, poor self-efficacy, shorter life-span, and high healthcare costs. Functional disabilities left unaddressed lead to secondary complications that result in social isolation, anxiety, depression, falls, and further functional decline (Gitlin, 2006). Barriers in the home compound minor limitations into major limitations. Home modification can eliminate or reduce environmental barriers to improve functional performance and quality of life. Environmental modifications may forestall the need for more costly traditional medical services (Stearns et al., 2000).
Level of Evidence Study Design/Methodology of Selected Articles Number of Articles Selected I Systematic reviews, meta-analysis, randomized controlled trials 4 II Two groups, nonrandomized studies (e.g., cohort, case-control) 3 III One group, nonrandomized (e.g., before and after, pretest and posttest) 3 IV Descriptive studies that include analysis of outcomes (single- subject design, case series) 0 V Case reports and expert opinion, narrative literature reviews and consensus statements 0 Other Qualitative Studies 0 TOTAL: 10 Inclusion and Exclusion Criteria
Inclusion Criteria: -Peer-reviewed scientific literature published in English -Published since 2004 -Intervention focused on home adaptations or home environment modifications -Intervention is within the scope of practice of OT -Older adults (age 55 or older) experiencing functional difficulties/limitations completing activities/instrumental activities of daily living in the home -Level I, II, and III evidence
Exclusion Criteria: -Published prior to 2004 -Non-peer reviewed research literature -Studies with participants that did not have documented functional limitations or younger than 55 years of age -Studies focused on safety and fall prevention -Studies that did not examine and apply interventions focused on home/home environment modifications -Level IV and V evidence and qualitative studies
Evidence Table References
-Gitlin, L., Winter, L., Dennis, M., Corcoran, M., Schinfeld, S., & Hauck, W. (2006). A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults. Journal of The American Geriatrics Society, 54(5), 809-816. doi:10.1111/j.1532- 5415.2006.00703.x
-Szanton, S. L., Thorpe, R. J., Boyd, C., Tanner, E. K., Leff, B., Agree, E., & Gitlin, L. N. (2011). Community aging in place, advancing better living for elders: A biobehavioral- environmental intervention to improve function and health- related quality of life in disabled older adults. Journal of The American Geriatrics Society, 59(12), 2314-2320. Doi:10.1111/j.1532-5415.2011.03698.x
-Wilson, D., Mitchell, J., Kemp, B., Adkins, R., & Mann, W. (2009). Effects of assistive technology on functional decline in people aging with a disability. Assistive Technology, 21(4), 208-217. doi:10.1080/10400430903246068