Long-Term Effect on Mortality of a Home Intervention that Reduces Functional Difficulties in Older Adults: Results from a Randomized Trial

• Published in: Journal of the American Geriatrics Society (JAGS) 2009-03, Vol.57 (3), p.476-481
• Main Authors: Gitlin, Laura N., Hauck, Walter W., Dennis, Marie P., Winter, Laraine, Hodgson, Nancy, Schinfeld, Sandy
• Format: Article
• Language: English
• Subjects: Accidental Falls - prevention & control; Activities of Daily Living - classification; Aged; Aged, 80 and over; Biological and medical sciences; Chronic Disease - mortality; Chronic Disease - rehabilitation; Clinical trials; Combined Modality Therapy; Diseases of the osteoarticular system. Orthopedic treatment; Effects; Epidemiology; Exercise Therapy; Female; Follow-Up Studies; Frail Elderly - statistics & numerical data; frailty; General aspects; home care; Home Care Services; Home health care; Humans; Intervention; Long term; Male; Medical sciences; Mortality; Occupational Therapy; Older people; physical therapy; Physical Therapy Modalities; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Risk Assessment; Safety; Social Environment; Survival Analysis; survivorship
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2008.02147.x

OBJECTIVES: To evaluate the long‐term mortality effect of a home‐based intervention previously shown to reduce functional difficulties and whether survivorship benefits differ according to initial mortality risk level. DESIGN: Two‐group randomized trial with survivorship followed up to 4 years from study entry. SETTING: Homes of urban community‐living elderly people. PARTICIPANTS: Three hundred nineteen adults aged 70 and older with difficulties performing daily activities. INTERVENTION: Occupational and physical therapy sessions to instruct participants in compensatory strategies, home modifications, home safety, fall recovery techniques, and balance and muscle strength exercises. MEASUREMENTS: Survival time was number of days between baseline interview and date of death, as determined using data from the National Death Index or December 31, 2005. Participants were stratified according to baseline mortality risk (low, moderate, high) using a prognostic indicator. RESULTS: At 2 years, intervention participants (n=160) had a 5.6% mortality rate (n=9 deaths) and controls (n=159) a 13.2% rate (n=21 deaths; P=.02). Mortality rates remained lower for intervention participants up to 3.5 years from study entry. At 2 years, intervention participants with moderate mortality risk had a 16.7% mortality rate (n=16 deaths/96), compared with 28.2% for equivalent control group participants (n=24 deaths/85; P=.02). By 3 years, mortality rates were not statistically significantly different between the experimental and control groups. CONCLUSIONS: The intervention extended survivorship up to 3.5 years and maintained statistically significant differences for 2 years. Subjects at moderate mortality risk derived the most intervention benefit. Findings suggest that the intervention could be a low‐cost clinical tool to delay functional decline and mortality.