This pilot study will evaluate the feasibility and preliminary effectiveness of an adapted version of the Function Focused Care intervention, delivered by telephone, for improving aging in place for older adults living in subsidized housing. The study will include participants with and without mild cognitive impairment or mild dementia and will examine whether the study outcomes differ by cognitive status. Findings from this study will provide new information about how to optimize function and physical activity among older adults with and without cognitive impairment living in subsidized housing.
Millions of older adults with low incomes live in federally-subsidized housing and are at disproportionate risk for nursing home admission. Effective approaches are needed to improve aging in place for this vulnerable population. The objective of this study is to pilot test the feasibility and preliminary effectiveness of a telephone-based intervention to improve aging in place for older adults living in subsidized housing. In the first phase of this study, the investigators used methods of implementation science to adapt an existing intervention, Function Focused Care for Assisted Living, to the unique setting of affordable housing. Function Focused Care is a philosophy of care in which assisted living staff members engage residents in functional and physical activity during all care interactions. Prior research supports the effectiveness of Function Focused Care for maintaining function and increasing physical activity among older adults in assisted living settings. In the first phase of this study, the investigators interviewed subsidized housing stakeholders - including residents, staff members, and caregivers - to identify barriers, facilitators, and needed adaptations to Function Focused Care for Assisted Living. The investigators used the findings from these interviews to adapt the intervention. In this 2-month pilot study, the investigators will use a wait-list control design with site randomization to assess the feasibility and preliminary effectiveness of the adapted intervention. The investigators will recruit individuals with and without mild cognitive impairment or mild dementia and will examine whether the study outcomes differ by cognitive status. The findings from this study will provide new information about how to optimize function and physical activity among older adults with and without cognitive impairment living in subsidized housing.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
75
Two-month program intended to increase physical activity and function, including the following 4 steps: 1. Environmental and Policy Assessments: Nurse facilitator works with the affordable housing staff to identify and recommend feasible interventions to alter the environment, policy, and procedures to optimize resident function and physical activity. 2. Education: Nurse educates residents and study partners in the principles of the Independent Living Program, using established materials and adult learning techniques. 3. Establishing Resident Goals: The nurse completes Capability Assessment Forms and helps resident set goals to increase function and physical activity. 4. The nurse helps to motivate and mentor residents and study partners to achieve and maintain their goals, using evidence-based approaches.
Northgate 2
Camden, New Jersey, United States
Haven House
Cape May, New Jersey, United States
Victorian Towers
Cape May, New Jersey, United States
Stonegate 1
Pennsauken, New Jersey, United States
Stonegate 2
Pennsauken, New Jersey, United States
Mantua Presbyterian Apartments
Philadelphia, Pennsylvania, United States
Old City Presbyterian Apartments
Philadelphia, Pennsylvania, United States
Casa Carmen Aponte
Philadelphia, Pennsylvania, United States
Neumann Senior Housing
Philadelphia, Pennsylvania, United States
St. Francis VIlla
Philadelphia, Pennsylvania, United States
...and 3 more locations
Change in Precipitating Events Project (PEP) Functional Status Scale From Baseline to 2 Months for Immediate Intervention Sites and Waitlist Control Sites
Self-reported ability to perform 7 ADLs, 5 IADLs, and 3 mobility tasks (Range, 0-30; higher scores indicate more functional impairment)
Time frame: Baseline, 2 months
Change in Short Physical Performance Battery Score From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites
Objective measure of lower extremity functioning in older adults (Range, 0-12; higher scores indicate worse lower extremity functioning) The measure will be collected only if in-person contact is possible during the COVID-19 outbreak.
Time frame: Baseline, 2 months
Change in Average Step Counts From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites
Measured using Fitbit
Time frame: Measured continuously from 0-2 months
Change in Time Spent in Differing Levels of Activity From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites
Measured using Fitbit (minutes spent in each of 4 levels of activity: sedentary; lightly active; fairly active; very active)
Time frame: Measured continuously from 0-2 months
Change in Physical Activity Scale for the Elderly (PASE) Score From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites
Self-reported physical activity (Range, 0-793; higher scores indicate greater physical activity)
Time frame: Baseline, 2 months
Feasibility of Study Recruitment, Measured as Percentage of Eligible Participants Recruited
Assessed using participant responses to invitation to participate in the study (enrolled vs. refused)
Time frame: 0-4 months
Feasibility of Study Retention, Measured as Percentage of Participants Retained Over Study Follow-up
Assessed as percentage of participants who remain enrolled in the study
Time frame: 0-4 months
Acceptability Assessed Using a Survey Question
Self-reported acceptability of the intervention (5-point Likert scale ranging from very unacceptable (1) to very acceptable (5); higher numbers indicate higher acceptability)
Time frame: 2 months
Number of Participants With High Fidelity to Treatment Protocol, Measured Using Fidelity Checklist
Number of participants with \>80% fidelity to treatment protocol, measured using fidelity checklist including each study protocol task
Time frame: 0-4 months
Fidelity to Motivational Interviewing, Measured Using the Motivational Interviewing Treatment Integrity Scale (MITI 4)
Assessed by psychologist (4 global scores, scored on a 5-point Likert scale from 1 (low) to 5 (high))
Time frame: 2 months
Change in EuroQol 5 Dimensions (EQ-5D-5L) Scale From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites
Self-reported measure (Range, 11111-55555, converted to a single index utility score ranging from of 0-1; higher scores indicate better quality of life)
Time frame: Baseline, 2 months
Change in Geriatric Depression Scale Short Form (GDS Short Form) Score From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites
Self-reported measure of depressive symptoms (Range, 0-15; score of 5-8 suggests mild depression, 9-11 moderate depression, and 12-15 severe depression)
Time frame: Baseline, 2 months
Percentage of Participants With a Hospitalization During the Study Period (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)
Self-reported hospitalization
Time frame: Baseline, 2 months
Change in Number of Hospitalizations During the Study Period (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)
Self-reported number of hospitalizations
Time frame: Baseline, 2 months
Percentage of Participants With an Emergency Department Visit During the Study Period (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)
Self-reported emergency department visit
Time frame: Baseline, 2 months
Change in Number of Emergency Department Visits During the Study Period (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)
Self-reported number of emergency department visits
Time frame: Baseline, 2 months
Percentage of Participants With a Move to a Higher Level of Care (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)
Self-reported or emergency contact-reported move to a higher level of care, defined as a move to assisted living, board and care, or nursing home
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Time frame: Baseline, 2 months
Percentage of Participants With a Skilled Nursing Facility Stay (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)
Self-reported skilled nursing facility stay
Time frame: Baseline, 2 months