Annals of Long Term Care

A Randomized Trial of a Multicomponent Home Intervention to Reduce Functional Difficulties in Older Adults
Laura N. Gitlin, PhD, Laraine Winter, PhD, Marie P. Dennis, PhD, EdM, Mary Corcoran, PhD, OTR/L, Sandy Schinfeld, MPH, and Walter W. Hauck, PhD

OBJECTIVES: To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance self-efficacy and adaptive coping in older adults with chronic conditions.

DESIGN: A prospective, two-group, randomized trial. Participants were randomized to a treatment group or no-treatment group.

SETTING: Urban community-living older people.

PARTICIPANTS: Three hundred nineteen community-living adults aged 70 and older who reported difficulty with one or more activities of daily living.

INTERVENTION: Occupational and physical therapy sessions involving home modifications and training in their use; instruction in strategies of problem-solving, energy conservation, safe performance, and fall recovery techniques; and balance and muscle strength training.

MEASUREMENTS: Outcome measures included self-rated functional difficulties with ambulation, instrumental activities of daily living, activities of daily living, fear of falling, confidence performing daily tasks, and use of adaptive strategies. Observations of home hazards were also conducted.

RESULTS: At 6 months, intervention participants had less difficulty than controls with instrumental activities of daily living (P=.04, 95% confidence interval (CI)=−0.28–0.00) and activities of daily living (P=.03, 95% CI=−0.24 to −0.01), with largest reductions in bathing (P=.02, 95% CI=−0.52 to −0.06) and toileting (P=.049, 95% CI=−0.35–0.00). They also had greater self-efficacy (P=.03, 95% CI=0.02–0.27), less fear of falling (P=.001, 95% CI=0.26–0.96), fewer home hazards (P=.05, 95% CI=−3.06–0.00), and greater use of adaptive strategies (P=.009, 95% CI=0.03–0.22). Benefits were sustained at 12 months for most outcomes.

CONCLUSION: A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality improvements in community-dwelling older people who had functional difficulties, with most benefits retained over a year. J Am Geriatr Soc 2006;54(5):809-816.

Risk Factors and Prediction of Postoperative Delirium in Elderly Hip-Surgery Patients: Implementation and Validation of a Medical Risk Factor Model
Kees J. Kalisvaart, MD, PhD, Ralph Vreeswijk, RN, MSc, Jos F. M. de Jonghe, PhD, Tjeerd van der Ploeg, MMath, Willem A. van Gool, MD, PhD, and Piet Eikelenboom, MD, PhD

OBJECTIVES: To evaluate risk factors for postoperative delirium in a cohort of elderly hip-surgery patients and to validate a medical risk stratification model.

DESIGN: Prospective cohort study.

SETTING: Medical school–affiliated general hospital in Alkmaar, the Netherlands.

PARTICIPANTS: Six hundred three hip-surgery patients aged 70 and older screened for risk factors for postoperative delirium.

MEASUREMENTS: Predefined risk factors for delirium were assessed on admission. One point was assigned for each of four risk factors present, resulting in three groups: low, intermediate, and high risk. Baseline screening and assessment included the Mini-Mental State Examination, the standardized Snellen test for visual impairment, chart review to determine Acute Physiological and Chronic Health Evaluation II score, and blood urea nitrogen to creatinine ratio. The primary outcome was postoperative delirium, as defined using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria.