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Functional Goals and Predictors of Their Attainment in Low-Income Community-Dwelling Older Adults.

ABSTRACT: To describe functional goals and factors associated with goal attainment among low-income older adults with disabilities living in the community.Secondary analysis.Participants' homes.Older adults (N=226) with disability who participated in the Community Aging in Place, Advancing Better Living for Elders trial.A 5-month, home-based, person-directed, structured program delivered by an interprofessional team: occupational therapist, registered nurse, and handyman.Process of occupational therapist goal setting and attainment at the final occupational therapist visit.Participants identified 728 functional goals (mean of 3.2 goals per participant), most commonly related to transferring (22.0%; n=160 goals), changing or maintaining body position (21.4%; n=156 goals), and stair climbing (13.0%; n=95 goals). Participants attained 73.5% (n=535) of goals. Goal attainment was highest for stair climbing (86.3%), transferring (85.6%), and self-care (84.6%); walking goals were less likely attained (54.0%). Goal attainment was not associated with age, sex, education, depressive symptoms, function, or health-related quality of life but was less likely among participants who had severe pain compared with those without pain (adjusted odds ratio, 0.38; 95% confidence interval, 0.17-0.86). When participant readiness to change score increases by 1 point on the 4-point scale, goal attainment was 62% more likely (adjusted odds ratio, 1.62; 95% confidence interval, 1.14-2.29).Home-based collaborative goal setting between older adults and occupational therapists is feasible and particularly effective when individuals are ready or willing to adopt new strategies to achieve identified goals.

SUBMITTER: Waldersen BW

PROVIDER: S-EPMC5403585 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Functional Goals and Predictors of Their Attainment in Low-Income Community-Dwelling Older Adults.

Waldersen Brian W BW Wolff Jennifer L JL Roberts Laken L Bridges Allysin E AE Gitlin Laura N LN Szanton Sarah L SL

Archives of physical medicine and rehabilitation 20161219 5

<h4>Objective</h4>To describe functional goals and factors associated with goal attainment among low-income older adults with disabilities living in the community.<h4>Design</h4>Secondary analysis.<h4>Setting</h4>Participants' homes.<h4>Participants</h4>Older adults (N=226) with disability who participated in the Community Aging in Place, Advancing Better Living for Elders trial.<h4>Interventions</h4>A 5-month, home-based, person-directed, structured program delivered by an interprofessional tea ...[more]

PMID: 28007445

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Project description:Background and objectivesMedication exposure is a potential risk factor for falls and subsequent death and functional decline among older adults. However, controversy remains on the best way to assess medication exposure and which approach best predicts falls. The objective of the current study was to examine the association between different measures of medication exposure and falls risk among community-dwelling older adults.Research design and methodsThis retrospective cohort study was conducted using Falls Free PA program data and a linked prescription claims data from Pennsylvania's Pharmaceutical Assistance Contract for the Elderly program. Participants were community-dwelling older adults living in Pennsylvania, United States. Three measures of medication exposure were assessed: (a) total number of regular medications (polypharmacy); (b) counts of potentially inappropriate medications derived from current prescription guidance tools (Fall Risk-Increasing Drugs [FRIDs], Beers Criteria); and (c) medication burden indices based on pharmacologic mechanisms (Anticholinergic Cognitive Burden, Drug Burden Index) all derived from claims data. The associations between the different medication risk measures and self-reported falls incidence were examined with univariate and multivariable negative binomial regression models to estimate incidence rate ratios (IRRs).ResultsOverall 343 older adults were included and there were 236 months with falls during 2,316 activity-adjusted person-months (10.2 falls per 100 activity-adjusted person-months). Of the 6 measures of medication risk assessed in multivariate models, only the use of 2 or more FRIDs (adjusted IRR 1.67 [95% CI: 1.04-2.68]) independently predicted falls risk. Among the 13 FRID drug classes, the only FRID class associated with an increased fall risk was antidepressants.Discussion and implicationsThe presence of multiple FRIDs in a prescription is an independent risk factor for falls, even in older adults with few medications. Further investigation is required to examine whether deprescribing focused on FRIDs effectively prevents falls among this population.

Project description:Reablement is a rehabilitation intervention for community-dwelling older adults, which has recently been implemented in several countries. Its purpose is to improve functional ability in daily occupations (everyday activities) perceived as important by the older person. Performance and satisfaction with performance in everyday life are the major outcomes of reablement. However, the evidence base concerning which factors predict better outcomes and who receives the greatest benefit in reablement is lacking.The objective of this study was to determine the potential factors that predict occupational performance and satisfaction with that performance at 10 weeks follow-up.The sample in this study was derived from a nationwide clinical controlled trial evaluating the effects of reablement in Norway and consisted of 712 participants living in 34 municipalities. Multiple linear regression was used to investigate possible predictors of occupational performance (COPM-P) and satisfaction with that performance (COPM-S) at 10 weeks follow-up based on the Canadian Occupational Performance Measure (COPM).The results indicate that the factors that significantly predicted better COPM-P and COPM-S outcomes at 10 weeks follow-up were higher baseline scores of COPM-P and COPM-S respectively, female sex, having a fracture as the major health condition and high motivation for rehabilitation. Conversely, the factors that significantly predicted poorer COPM-P and COPM-S outcomes were having a neurological disease other than stroke, having dizziness/balance problems as the major health condition and having pain/discomfort. In addition, having anxiety/depression was a predictor of poorer COPM-P outcomes. The two regression models explained 38.3% and 38.8% of the total variance of the dependent variables of occupational performance and satisfaction with that performance, respectively.The results indicate that diagnosis, functional level, sex and motivation are significant predictors of outcomes following reablement.

Dataset Information

Functional Goals and Predictors of Their Attainment in Low-Income Community-Dwelling Older Adults.

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Functional Goals and Predictors of Their Attainment in Low-Income Community-Dwelling Older Adults.

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