In Baltimore City, dozens of older adults are now aging safely in their homes, thanks to the work of Assistant Professor Sarah L. Szanton, PhD, CRNP, at the Johns Hopkins University School of Nursing.
Through years spent providing house calls to low-income older adults, Szanton knew that their environmental challenges were often as pressing as their health challenges. In response, she developed the CAPABLE study, a community outreach research project—now in its pilot year—to identify solutions to these challenges. She notes, "Half of the people who have ever lived to be 65 in the history of humans are alive now. We have to come up with cost-effective strategies for aging at home."
One of the study's success stories, 68-year-old Mrs. G, has so many musculoskeletal problems that she has several orthopedic doctors, an arthritis doctor, and a physical therapist. She also takes care of her elderly mother who is debilitated from a stroke. And, she lives in an unsafe home, survives on a limited income, and has high stress levels. With Szanton's help—and despite these overwhelming challenges—Mrs. G is now able to remain independent in her senior years.
As a participant in the portion of the study group identified for physical intervention, Mrs. G—and 24 others—first met with an occupational therapist (OT) who found environmental challenges in their homes, assessed their ability to function, and developed a list of goals with them. The OT saw that one of Mrs. G's biggest challenges was stress, so her action plan said that she should make more time for herself. For example, Mrs. G could stop taking phone calls for two hours a day, and instead use that time as "me time."
Then, a construction specialist repaired problems that affected each participant's mobility and independence. In Mrs. G's home, the specialist installed grab bars in her three bathrooms, lowered her microwave and the bars in her closets so she could reach them, and replaced part of the sinking floor in her kitchen. Since Mrs. G also had a hard time walking into her garage because the step was so steep, the specialist built an additional step and installed a railing.
"Going down that step in the garage, [now] I don't have to feel timid. I don't have to worry about my mother stepping down there," Mrs. G says. "I'm more conscious of safety around the house."
Finally, the study participants were visited a maximum of four times by a nurse who helped address issues such as pain management, depression, and medication adherence. The nurse helped Mrs. G with balance and strength, and introduced her to Tai Chi; an activity Mrs. G. discovered that she really likes. She took a couple of classes with special instructors who came to her home, began attending Monday night classes with the same instructors at a local church, and even practiced Tai Chi while doing other activities.
"The thing I like about it best is that it's something that I can integrate into every day…even in Church, I'm doing Tai Chi. [And] I can tell the difference. Even in my pain level. Everything is better."
Mrs. G says her physical therapist also saw improvement. "Medicare only pays for [so many] physical therapy visits. [But] I told [my physical therapist] I was at a point where I could continue without her, especially since I have the Tai Chi as something else in its place."
Szanton says that early results from her study show that participants who received physical intervention to address their challenges had much less difficulty completing daily living activities such as bathing, dressing, meal preparation, using the telephone, shopping, and doing housework. They also showed a 24 percent improvement in their lower extremity function.
Szanton found participants through the Baltimore City Commission on Aging and Retirement, the Baltimore Housing Authority, and Comprehensive Housing Assistance (CHAI), a Jewish organization that helps older adults age in place. Mrs. G and 41 other participants were placed in two groups: the physical intervention group which received three services - occupational therapy, nursing, and the assistance of a construction specialist who made necessary home repairs—and an attention intervention group which participated in life-review interviews only.
The CAPABLE study's pilot year was funded by the National Institutes of Health Career Development training grant, the John A. Hartford Foundation Claire M. Fagin Fellowship in geriatric nursing research, and the Hopkins Population Center. Szanton is currently applying for additional funding to enlarge and verify her results with 300 older adults in Baltimore City.
When Szanton is ready to find more participants, Mrs. G says she has plenty of names. "I've told all my senior relatives and friends about the program and they said, 'Oh, how can I get in it?'" she says. "They make you feel like they care about you...it was an excellent program."
Unclear responsibilities hinder oral health care in nursing homes