CAPABLE trial: a randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: rationale and design

Sarah L Szanton; J W Wolff; B Leff; R J Thorpe; E K Tanner; C Boyd; Q Xue; J Guralnik; D Bishai; L N Gitlin

doi:10.1016/j.cct.2014.03.005

CAPABLE trial: a randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: rationale and design

Contemp Clin Trials. 2014 May;38(1):102-12. doi: 10.1016/j.cct.2014.03.005. Epub 2014 Mar 28.

Authors

Sarah L Szanton¹, J W Wolff², B Leff³, R J Thorpe², E K Tanner⁴, C Boyd⁵, Q Xue⁵, J Guralnik⁶, D Bishai², L N Gitlin⁴

Affiliations

¹ Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States. Electronic address: Sszanto1@jhu.edu.
² Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States.
³ Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States.
⁴ Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States.
⁵ Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States.
⁶ University of Maryland Medical School, United States.

Abstract

Background: As the population ages, it is increasingly important to test new models of care that improve life quality and decrease health costs. This paper presents the rationale and design for a randomized clinical trial of a novel interdisciplinary program to reduce disability among low income older adults based on a previous pilot trial of the same design showing strong effect.

Methods: The CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial is a randomized controlled trial in which low income older adults with self-care disability are assigned to one of two groups: an interdisciplinary team of a nurse, occupational therapist, and handyman to address both personal and environmental risk factors for disability based on participants' functional goals, or an attention control of sedentary activities of choice. Both groups receive up to 10 home visits over 4 months.

Outcomes: The primary outcome is decreased disability in self-care (ADL). Secondary outcomes are sustained decrease in self care disability as well as improvement in instrumental ADLS, strength, balance, walking speed, and health care utilization. Careful cost tracking and analysis using intervention data and claims data will enable direct measurement of the cost impact of the CAPABLE approach. CAPABLE has the potential to leverage current health care spending in Medicaid waivers, Accountable Care Organizations and other capitated systems to save the health care system costs as well as improving low income older adults' ability to age at home with improved life quality.

Keywords: Disability; Health disparities; Older adults; Person–environment fit.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Aged
Disabled Persons / rehabilitation*
Female
House Calls*
Humans
Independent Living*
Male
Muscle Strength
Nurses*
Occupational Therapy*
Patient Acceptance of Health Care
Postural Balance
Poverty
Quality of Life
Research Design
Risk Factors
Socioeconomic Factors
United States

Abstract

Publication types

MeSH terms

Grants and funding