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Name: Johnny Rider, OTS & Gary Pearson, OTS

Date: 10/2/2014

Focus Question: What is the effectiveness of home modification interventions to improve performance for older adults with
functional difficulties?

Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table:

Inclusion Criteria:
-Peer-reviewed scientific literature published in English with full-text, abstract, and references available
-Published since 2004
-Intervention examined and applied in studies focused on home or home environment modifications
-Intervention is within the scope of practice of occupational therapy, although it did not have to be administered by an occupational
therapist
-Any study meeting the criteria represented in the focused question
-Participants in the studies were older adults (age 55 or older) experiencing functional difficulties/limitations completing
activities/instrumental activities of daily living in the home
-Level I, II, and III evidence

Exclusion Criteria:
-Published prior to 2004
-Non-peer reviewed research literature
-Presentations, conference proceedings, dissertations, theses
-Studies with outcomes not reported
School of Occupational Therapy Touro University Nevada
OCCT 643 Systematic Reviews in Occupational Therapy Critically Appraised Topic Project
EVIDENCE TABLE WORKSHEET
-Studies with participants that did not have documented functional limitations
-Studies focused on safety and fall prevention
-Studies that did not examine and apply interventions focused on home adaptation or home environment modifications
-Studies with participants younger than 55 years of age
-Level IV and V evidence
-Qualitative studies

Author/
Year
Study Objectives Level/Design/
Subjects
Intervention and
Outcome Measures
Results Study
Limitations
Implications for OT
Gitlin,
Winter,
Dennis,
Corcoran,
Schinfeld,
& Hauck
(2006)
To investigate the
efficacy of a
multicomponent
intervention to
reduce functional
difficulties, home
hazards, enhance
self-efficacy and
adaptive coping in
older adults with
chronic conditions.
Level I
Randomized Control
Trial

Subjects: 285/319
community living
older adults
completed the study:
(149 control, 136
experimental)

All participants were
over 70, cognitively
intact, English
speaking, were not
receiving home care,
and reported need
for help with two or
more IADLs, and
one or more ADLs.






Intervention: Obtained
at baseline, follow-up
at 6 months and 12
months post
intervention. The
ABLE program was
utilized to address
modification to home
environments and task
performance. The
ABLE program
consisted of a 6 month
intervention including
5 OT contacts and 1
PT contact. Home
modifications were
ordered and installed.

Outcome measures:
Measures used were
the ADL Index,
Confidence Scale, and
Home Hazard Index

Outcome areas: ADLs,
mobility/transferring,
The intervention
participants had
less difficulty with
IADLs and ADLs
but the changes
were not
statistically
significant.

Statistical
significance was
obtained for
bathing (P=.04),
grooming (P=.04),
and preparing
meals (P=.02).

Average cost for
home
modifications was
$439.
-Unclear whether
one intervention
component was
more effective
than others.
-The findings may
not be
generalizable to a
wider population
due to the study
being voluntary.
-No treatment
control group.
Clinical and
Community-based
practice: Home health
OTs can help implement
home modifications to
improve functional
performance in ADLs.
Program
Development:
Functional difficulties
should be identified
within the home of all
elder adults.
Societal Needs: Lack of
self-efficacy is noted in
the aging population
citing the need for home
modifications.
Healthcare Delivery
and Policy:
Multicomponent home
interventions are used to
reduce functional
difficulties.
Education: All students
should be exposed to
and IADLs. various home
modifications.
Refinement, Revision,
and Advancement:
Further research should
include objective
functional performance
measures to address
gains made from home
modifications.
Petersson,
Lilja,
Hammel,
& Kottorp
(2008)
To explore the
influence of home
modifications on
self-rated ability
while completing
daily tasks for
individuals aging
with disabilities.
Level II Cohort

Subjects: 105/114
completed the study
(37 control, 68
intervention)

The average age of
participants was
75.3. All
participants lived in
a community-based
dwelling, able to
communicate, have
problems in
everyday life and
requested home
modifications.

Intervention: The
installation and use of
personalized home
modifications. A
baseline measure was
obtained and a follow-
up measure was
obtained 2 months
after the home
modifications were
installed for the
intervention group and
2 months after baseline
for the control group.

Outcome measures: A
self-rated ability in
everyday life was
measured at baseline
and follow-up using
the Swedish version of
the Client-Clinician
Assessment Protocol
(C-CAP) Part I.

Outcome areas:
Significant
differences were
found in self-
reported difficulty
(P=0.001) and
safety (P=0.001).

The self-rated
level of
independence did
not have a
statistically
significant change.

The main areas
found to have a
difference were
bath/shower,
grooming, toilet
transfers, and
transferring in and
out of bed.
(P<0.05)
-Focused on the
population that
uses the most
community
services.
-Limited sample
of individuals
living in an urban
area who applied
for home
modifications. -
Sample size
relatively small.
-C-CAP has
limited use in
research.
-Whether the
intervention was
directly related to
the improved C-
CAP score or due
to outside factors.
-Individuals in
intervention group
had applied for
modifications
Clinical and
Community-Based
Practice: Home
modifications have a
positive impact on self-
rated ability related to
decreasing an
individuals level of
difficulty and increasing
safety.
Program
Development:
Demonstrates how
grants can be used to
prolong community
living.
Societal Needs: By
applying environmental
modifications to an
individuals home they
are provided with an
opportunity to stay
within their home longer
which is a concern of
the aging population.
Healthcare Delivery:
Independence,
difficulty, and safety
with ADLs and
IADLs.
related to
transfers.
-Comparison
group rated
themselves higher
on all 3 scales at
baseline.
Home modifications can
reduce health care costs
and improve quality of
life.
Education: All students
should be exposed to the
appropriate use of
adaptive equipment for
aging individuals with
disabilities.
Refinement, Revision,
and Advancement: It
could be questioned
whether independence
alone is a suitable
outcome measure and
should be further
investigated.
Stark
(2004)
To examine the
effectiveness of an
occupational
therapy home
modification
intervention
program by
examining
differences in self-
reported
occupational
performance before
and after
intervention in a
population of
community-
dwelling older
adults with
Level III: One
group,
nonrandomized,

Subjects: 16/ 29
subjects who were
identified by a not-
for-profit agency
that provides free or
low cost
modifications in
partnership with an
OT.

All subjects reported
impairments
affecting their
ability to perform
Intervention: Based on
occupational goals and
priorities (from
COPM) a home
modification plan was
developed by the OT
to eliminate the
environmental barriers.
Home modifications
included A/E,
architectural
modifications and
major home
renovations.
Interventions were
limited to
compensatory
strategies. After
The COPM
satisfaction
subscale was
reported as having
a statistically
significant change
between pre and
post-tests in the
areas of
occupational
performance
(P=0.001) and
satisfaction with
performance
(P=0.001).

Average number
of barriers for
-Small sample size
and limited
follow-up
demand.
-Sample does not
represent general
population of
older adults with
disabilities
because they were
primarily African
American
Women.
-Not all barriers
were addressed
which limited
generalizability of
modifications as a
Clinical and
Community-Based
Practice:
Results support the
theoretical models of
person-environment-fit
and the importance of
environmental factors in
contributing to
occupational
performance.
Program
Development: Client-
centered approach
should be incorporated
into environmental
modifications.
Societal Needs: Aging
disabilities. ADLs and had no
cognitive deficits.
completion of baseline
assessment by an OT
home modifications
were installed by a
construction team. OT
provided training in the
use of the
modifications as well
as follow-up visits
during, and at 3 and 6
months.

Outcome Measures:
FIM, COPM, Enviro-
FIM Baseline and post-
test interviews

Outcome areas:
Severity of disability,
occupational
performance, Identify
and quantify the
environmental barriers
that impacted
occupational
performance goals
(photographed).
each participant
was 4.7 and each
participant was
provided with 2.5
modifications.
Overall, 45 of the
75 barriers
identified were
resolved.



whole.
-Time lapse was
up to 12 months
for baseline info
to installation.
population is continually
faced with an increased
amount of
environmental barriers
in the home.
Healthcare Delivery:
Home modifications
need to be delivered in
the natural environment
with a client-centered
approach to be effective.
Education: All students
should be competent in
the use of the COPM to
identify home
modifications priorities.
Refinement, Revision,
and Advancement:
Further studies should
focus on client-centered
approaches to problem
identification and
interventions needed.


Petersson,
Kottorp,
Bergstrom
, & Lilja
(2009)
To investigate
longitudinal
impacts of home
modifications on
the difficulty of
performing
everyday life tasks
for people aging
with disabilities,
Level II: Quasi-
experimental, 2
groups non-
randomized.

Subjects: 84/103 (64
intervention, 20
comparison)particip
ants were recruited
Intervention: Home
modifications were
identified and installed
based on reducing
difficulty with ADL
performance.

Outcome Measures:
Swedish version of C-
Baseline personal
ability measure,
time from
application to
installation of
home
modification in
months, as well as
intervention group
-C-CAP
assessment is
relatively new and
the only study
found to measure
difficulty in
everyday life
tasks.
-Various
Clinical and
Community-Based
Practice: Difficulties
performing everyday
tasks increases each
month while awaiting
home modification,
therefore OTs need to
install home
and to investigate
whether other
factors had any
additional impacts
on difficulty in
everyday life tasks
for people
receiving home
modifications.
from an Agency for
Home No difference
between groups in
terms of age, gender,
social situation,
cognitive status, and
number of applied
home modifications.
CAP (Part 1) was used
at baseline, first
follow-up (at 2 months
after home
modification), and
second follow-up (at 6
months after home
modification)

Outcome Areas:
Impact of home
modifications on self-
reported difficulty in
everyday life.

vs comparison
group results were
all statistically
significant
(P=0.023).

Overall results
indicate that
participants
receiving home
modification
experienced less
difficulties in
everyday life up to
6 months after the
home
modification
installation in
relation to
comparison group.
Home
modifications
were found to be
effective in
decreasing
difficulty in
performing
everyday life tasks
up to 6 months
after installation.
It was also found
that home
modifications
need to be
installed as soon
as possible after
circumstances for
the participants in
both groups made
the analysis
challenging and
opens up doors for
client factor
biases.
-Methodological
issues that were
challenging for the
author to analyze.
modifications as soon as
needs are identified.
Program
Development: Identify
programs with an
decreased timeline from
evaluation to
implementation of home
modification
installation.
Societal Needs: Older
adults have the right to
investigate whether
home modifications
have additional impacts
on everyday life.
Healthcare Delivery:
Longer wait time to
install home
modifications results in
further decline in
function and additional
healthcare costs. It is
possible that home
modifications may
prevent the development
of health problems,
healthcare needs, and
functional dependency
due to their effect in
reducing difficulty in
everyday life.
Education: All students
should be given a
rationale for timely
installation of home
the need has been
identified.
modifications.
Refinement, Revision,
and Advancement: The
author hypothesizes that
home modifications may
prevent the development
of health problems,
healthcare needs, and
functional dependency.
This opens up future
questions for research.
Wilson,
Mitchell,
Kemp,
Adkins, &
Mann
(2009)
To define whether
the appropriate use
of an AT
intervention
program (AT
devices, home
modifications,
environmental and
behavioral
changes) for aging
individuals who
acquired an early
onset disability
improves function
and reduces the rate
of functional
decline.
Level I
Randomized Control
Trial

Subjects: 91/107
completed the study
(47 treatment group,
44 control group)

The average age of
participants was 62
and was diagnosed
with an early onset
disability that could
benefit from
receiving first-time
or additional
assistive technology.
Need for equipment
was related to
impairments
reported in mobility,
splints or braces,
DME, or home
modifications.
Intervention: Each
participant received
customized in-home
evaluations in relation
to task performance
and the need for home
modifications and
assistive technology.
(completed by an OT).
The evaluation helped
to identify what was
needed and assistance
was provided in
purchasing the items or
installation of the
items.

Outcome measure: In
home interviews
covering functional
outcomes were given
at baseline, 12 months,
and 24 months. The
OARS and FIM were
used to address
FIM scores
reported a slower
decline in function
for the treatment
group compared to
the control group
over time. (At 6
months P=0.001
and at 12 months
P=0.01)

The treatment
group maintained
function through
the 24 month
period while the
control group
declined
significantly in the
first 12 months
and leveled off at
24 months.

No significant
changes were
-Cannot be
generalized to all
individuals aging
with an early-
onset disability.
-OARS and FIM
both penalize
individuals for
using a device to
accomplish a task.
-Control group
had no access to
equipment
through the study
but still reported
acquiring
equipment
through outside
sources.
-Scheduling of the
contractor to
install equipment
was not always
done in a timely
manner.
Clinical and
Community-Based
Practice: Use of
equipment helped to
improve function within
the home, specifically
for mobility and safety
in the bathroom, for a
generalized population
of adults with
disabilities.
Program
Development:
Bathrooms should be an
emphasis on home
modification
implementation.
Societal Needs:
Regardless of the
disability, functional
decline as people age
will occur earlier for
individuals aging with a
disability.
Healthcare Delivery:
functional outcomes.

Outcome areas:
Functional limitations
while performing
ADLs and IADLs.
reported in
relation to the
OARS scale.
However, the
treatment group
had a higher
percentage of
participants who
experienced a
desired change.
Early onset of disease
requires additional and
more frequent home
modifications.
Education: All students
should have an ability to
address the increased
needs of an individual
with an early onset
disability.
Refinement, Revision,
and Advancement:
Further research is
needed to identify
participants who have
the ability to improve
independence based on
their decreasing
functional status.
Fange &
Iwarsson
(2005)
To explore changes
over time in
relation to ADL
dependence and
aspects of usability
among clients
receiving housing
adaptations.
Level III One
group,
nonrandomized,
longitudinal study

Subjects: 131/131 at
T1, 104/131 at T2
and 98/131 at T3.
The mean age of the
participants was 71
years. Enrollment
occurred over 18
months and included
participants who
requested home
modifications.
Intervention: Housing
modifications were
installed within the
participants homes.
The majority of
adaptations included
the bathroom,
entrances, stairways,
and doorways. Data
was collected at
baseline (T1), first
follow-up (T2), and
second follow-up (T3)

Outcome measures:
The ADL Staircase
(revised version), The
Usability in My Home
Instrument, and House
Enabler.

Outcome areas: Self-
care, transfers,
toileting, dressing, and
bathing. ADLs and
IADLs were also
measured in relation to
specific housing
outcomes including
personal and social
aspects.
At baseline 15%
of participants
were found to be
independent, 48%
were considered
dependent in
ADLs, and 37%
were dependent in
ADLs and IADLs.

There were no
statistically
significant
changes reported
between T1 and
T3 in ADL and
IADL
dependence.
(Between T3 and
T2 fewer
participants
reported
dependence in
bathing.
P=0.0020).

The perception of
the housing
environment to
support daily
activities did have
a statistically
significant change
between T1 and
T2 (P=.045).
-Relatively small
sample size.
-Sample of men
was significantly
lower than women
with an increased
dropout rate.
-Participants
received mobility
devices during the
study.
-Participants
found other ways
to obtain housing
modifications
during the study.
Clinical and
Community-Based
Practice: The
importance of utilizing
an appropriate
assessment measure for
ADL dependence and
home modifications.
Program
Development:
Developing efficient
strategies for evaluating
housing adaptations
within the practice of
OT needs to be
expanded.
Societal Needs:
Majority of home
adaptations older adults
needed included the
bathroom, entrances,
stairways, and
doorways.
Healthcare Delivery:
Addressing the usability
of the housing
adaptations on top of
installing them is
necessary.
Education: All students
should understand the
importance of utilizing
appropriate assessment
measures.
Refinement, Revision
and Advancement:
Longitudinal studies that
specifically target
activity and usability of
specific items are
necessary. The use of
different assessment
instruments for different
participants to improve
the efficiency of the
assessment and
evaluation methods
should be further
investigated.
Liu &
Lapane
(2009)
To quantify the
effect of residential
modifications on
decreasing risk of
physical function
decline in 2 years
among community
dwelling older
adults.
LEVEL II: Cohort
study

Subjects: Sampling
was taken from two
waves of the Second
Longitudinal Study
on Aging which
included 9,447
participants. Civilian
non-institutionalized
population aged 70
years and older in
the US.
Intervention: No direct
intervention was
provided. A propensity
scores method was
used to control for
baseline differences
between individuals
with residential
modifications and
those without
residential
modifications.

Outcome measures: A
binary outcome
variable, decline in
functional ability, was
created based on the
reported baseline and
follow-up (2 years post
baseline) disability
level.
Respondents were
considered to have
functional decline if
they died or reported a
higher level of
disability at follow-up.
Respondents were
considered to not have
functional decline if
they were in the same
group or in a group
with lower disability
levels at follow-up.

19% of all
respondents had 1
residential
modification, and
an additional 19%
had multiple
residential
modifications.

There was no
association
between a baseline
home
modification and
decline in
functional ability
in the unadjusted
logistic regression
model. However,
after adjusting for
quintile of
propensity score,
they found that
sample persons
with baseline
residential
modification were
less likely to
experience
subsequent
decline in
functional ability.

Difference
between
residential
-Outcome
measure relied on
self-reported
difficulty and
individuals
interpretation of
what the task
entails. Self-
reports might be
inconsistent with
actual ability.
-2 years, the time
between data
collection, may be
too broad to
capture disability
transitions that
occurred between
waves or too short
to evaluate the
impact of physical
function decline
amenable to
prevention by
residential
modifications.
-Definitions of
modifications and
assistive
technology are
subjective.
Clinical and
Community-Based
Practice: Results of this
study show modest
decrease in likelihood of
functional decline and
suggest that widespread
adoption of residential
modifications among
older adults could
potentially reduce the
overall population
estimates of decline in
ADLs in the short term.
Program
Development:
Housing policy should
continue to promote
widespread provision of
home modifications.
Societal Needs: A
better understanding of
the role of residential
modifications will have
serious implications for
the individual and the
society at large.
Healthcare Delivery:
Health care
professionals might
want to include
questions about home
architectural factors
when assessing their
patients.
Education: All students
Outcome areas:
Difficulty with ADLs.
ADLs were used to
measure independence
of personal care.
Difficulties with
bathing, dressing,
eating, getting in and
out of bed, walking,
toileting, etc. Measures
used:

modifications and
no modifications
were clinically
meaningful.

Results of this
study show
modest decrease
in likelihood of
decline suggest
that widespread
adoption of
residential
modifications
among older
adults could
potentially reduce
the overall
population
estimates of
decline in ADLs
in the short term.
should have practice
interviewing clients
about their home
environment, including
architectural factors.
Refinement, Revision,
and Advancement:
Further research should
be done to evaluate
timelines to assess
disability transitions and
impact of physical
function decline.



Stark,
Landsbau
m,
Palmer,
Somervill
e, &
Morris
(2009)
To describe a
client-centered
occupational
therapy, home
modification
intervention
program and
examine the impact
of the intervention
on daily activity
performance over
time. Costs were
also examined.
Level III: One
group,
nonrandomized,
Quasi-experimental
design

Subjects:
Convenience sample
of 317 older adults
volunteered to
participate in a
cross-sectional study
to identify their
needs for health and
Intervention: A single
group pre/post/post
prospective study over
a period of 2 years was
utilized to assess the
efficacy of a range of
home modification
strategies, such as
adaptive equipment,
architectural
modifications, major
home renovations, and
training using the
compensatory supports
The participants
(67) identified 719
activities they had
difficulty
completing and
100 activities they
had given up. 3.9
problems per
participant were
addressed.
Average cost and
type of
modifications was
reported.
-Small sample size
-No control group
-Functional
abilities were only
measured at
baseline and at
first posttest.

Clinical and
Community-Based
Practice: Older adults
who are aging in place
can improve their
functional abilities with
home modifications and
thus improve their
performance of daily
activities. Compensating
for functional loss by
providing environmental
support appears to be a
promising solution.
social services. All
subjects lived within
a naturally occurring
retirement
community.
and strategies during
daily activities.
Intervention was
conducted by an OT
with 2 years
experience. 3 months
after modifications
were completed; the
same OT re-
administered the
posttest assessment
battery. 2 years after
the final treatment
visit.

Outcome measures:
COPM, Modified
Activity Card Sort,
Lighthouse Near
Acuity Vision Test,
Get up and Go Test,
ROM/MMT, Hearing
Screen, FIM.

Outcome areas:
Important occupations
and areas the client
wants to
assess/intervene related
to home modifications.
Visual acuity,
mobility, cognition,
ROM/MMT, hearing,
and Independence in
ADLs.
Significant results
were shown for
satisfaction with
performance
(P=0.0001) from
baseline to post-
test, functional
independence
(P=0.0001) from
baseline to post-
test, and for a
decrease in
barriers within
their home
environment
(P=0.0001)
baseline to two
years.
Program
Development: Program
should emphasize the
person-environment-fit
theories in the home as
an intervention strategy.
Societal Needs: The
surge in the aging
population will begin
taxing existing
healthcare services
unless solutions to
dealing with the
functional losses
associated with aging
are identified.
Healthcare Delivery:
Environmental
modifications could
forestall
institutionalization and
allow older adults to age
in place and reduce
healthcare costs.
Education: All students
should be instructed in
the ecological frames of
references/models of
practice to enhance
person-environment-fit.
Refinement, Revision,
and Advancement: The
research could be
further enhanced by
increasing sample size
and adding a control
group. Because the
majority of older adults
live in private housing,
reducing disability by
improving person-
environment-fit in the
home is an important
intervention strategy
that deserves further
study.
Szanton,
Thorpe,
Boyd,
Tanner,
Leff,
Agree,
&Gitlin
(2011)
To compare the use
of Aging in Place:
Advancing Better
Living for Elder
(CAPABLE) as a
multicomponent
behavior and home
repair intervention
for low-income
disabled older
adults with an
attention-control
condition.
Level I
Randomized Control
Trial

Subjects: 35/40
participants
completed the study.
(20 intervention, 15
control)

Participants were
aged 65 and older
(average age of 78),
demonstrated
cognitive function,
reported difficulty
with one or more
ADLs or two or
more IADLs,
considered low
income, and be able
to stand without
assistance.
Intervention: Pre and
post-test data was
gained at baseline and
at 6 months. The
CAPABLE
intervention was used
which utilizes 10 in-
home therapy sessions
lasting 60 minutes over
a six month period.
Interventions include
housing safety, self-
care, communication,
medication
management, strength
and balance,
depression and pain.
An occupational
therapist was used to
address home
modifications in
relation to self-care,
strength, and balance.
The most common
modifications
implemented were
44% of
participants
reported
difficulties with
three or more
ADLs at baseline
(getting in and out
of bed, dressing,
bathing, toilet
transfers, eating)
and all
participants
reported difficulty
in at least two
IADL (preparing
meals, doing light
housework,
shopping, using
the telephone,
taking
medications,
money
management).

The study
demonstrated
-Study design and
size prohibited
determination of
the relative value
of each individual
intervention
component.
-The selection
system may have
been flawed in
relation to
selecting from
waiting lists,
whereas
participants may
have been selected
who differed in
important ways
from individuals
with the same
needs but were
absent from the
list.
-The study only
included two men
and was 76%
Clinical and
Community-Based
Practice: The findings
of the study suggest the
importance of a
multicomponent
intervention that
integrates home repair,
nursing, and
occupational therapy to
improve daily function
and well-being.
Program
Development:
Importance was found
in the ability of the
CAPABLE to address
functional limitations in
program development
for home modifications.
Societal Needs:
Functional decline in the
aging population is not
limited to ADLs. Older
adults also experience
decline in IADLs.
adding railings or
banisters, diminishing
tripping hazards,
installing grab bars,
repairing stairs, and
tightening carpets.

Outcome measures:
The C-CAP and EQ-
5D was used for
evaluation at baseline
and post-intervention.
EQ-5D

Outcome areas: Safety,
efficiency, difficulty,
and environmental
barriers and support
(observation and self-
report). Quality of life
(EQ-5D)


moderate to strong
effect sizes for
differences in
mean change
between the
intervention and
control groups
from baseline to
follow-up. (Effect
size of 0.63 for
reducing ADL
difficulty, 0.62 for
reducing IADL
difficulty, 0.89 for
quality of life, and
0.55 for falls
efficacy)
94% of the
intervention group
reported
participation in
CAPABLE made
their life easier,
compared to 53%
of the control
group.
African American. Healthcare Delivery:
Should include a
multicomponent
intervention including
home repair, nursing,
and occupational
therapy.
Education: All students
should be comfortable
with home modification
equipment as well as
adaptive equipment.
Refinement, Revision,
and Advancement: A
different study design
and selection process of
participants would
improve generalization.

Gitlin,
Hauck,
Dennis,
Winter,
Hodgson,
&
Schinfeld
(2009)
A follow-up study
to evaluate the
long-term mortality
rate of a home-
based intervention
which previously
exhibited a
reduction in
functional
difficulties and
Level I
Randomized Control
Trial

Subjects: 285/319
community living
older adults
completed the study:
(149 control, 136
experimental)
Intervention: (original
study) Information
obtained at baseline,
follow-up at 6 months
and 12 months post
intervention.
The ABLE program
was utilized to address
modification to home
environments and task
76 of the 319
participants had
passed away. 42
(55%) from the
control group and
34 (45%) from the
intervention
group. An initial
survival rate of 3.5
years was found
-Controlling
clinical variables
which included:
comorbidities,
health service
utilization, and
hospitalizations.
These areas are
out of the control
of the ABLE
Clinical and
Community-Based
Practice: The
implementation of a
home modification plan
improved survivorship
older adults.
Program
Development: Teaching
elderly people modified
whether
survivorship
benefits differ
according to initial
mortality risk level.

All participants were
over 70, cognitively
intact, English
speaking, were not
receiving home care,
and reported need
for help with two or
more IADLs, and
one or more ADLs.
performance. The
ABLE program
consisted of a 6 month
intervention including
5 OT contacts and 1
PT contact. Home
modifications were
ordered and installed.

Outcome measures:
ADL index, confidence
scale, Home Hazard
Index to assess ADLs,
mobility/transferring,
and IADLs.

Outcome areas: This
follow-up study
examined the National
Death Index to see
how many of their
original participants
had passed away since
the original study
ended. Results were
reported as survival
time which was the
number of days
between the baseline
interview and date of
death.
for the treatment
group.

At 2 years after
baseline interview
the treatment
condition had a
statistically
significant affect
(P=.02).

At 3 and 4 years
after baseline the
amount of deaths
in relation to the
control group was
more than the
intervention group
but not
statistically
significant.
intervention but
significantly
impact health and
quality of life.
approaches to
participating in
meaningful activities
should be included in
home modification
programs.
Societal Needs: The
study demonstrated that
by teaching elderly
people modified, safe
approaches to
performing meaningful
activities they were able
to add years to their life.
Healthcare Delivery:
Factors other than
medical concerns should
be evaluated when
looking at mortality
rates. Participation in
meaningful activities
should be evaluated by
OT.
Education: All students
should be aware that
medical conditions are
not the only factor in
determining mortality
rates. Meaningful
occupations must
always be addressed
when working with
older adults.
Refinement, Revision,
and Advancement:
Better study design
should control clinical
variables, such as
comorbidities, health
service utilization, and
hospitalizations.