Intervention IP-080: Community Aging in Place—Advancing Better Living for Elders (CAPABLE)
Summary
Community Aging in Place, Advancing Better Living for Elders (CAPABLE) is an intervention focused on improving the health of racial and ethnic minorities and other populations with health disparities who need assistance aging at home. The intervention is a 10-session, home-based interprofessional program that addresses older adults' self-identified functional goals by enhancing individual capacity and home environmental supports. Findings show that CAPABLE reduces the impact of functional impairment and disability, hospitalizations and nursing home days.
Overview
Community Aging in Place, Advancing Better Living for Elders (CAPABLE) is an intervention program that has been shown to greatly improve both physical function and mental health outcomes in older adults, while also making homes safer.
Research-Tested — Interventions with strong methodological rigor that have demonstrated short-term or long-term positive effects on one or more targeted health outcomes to improve minority health and/or health disparities through quantitative measures; Studies have a control or comparison group and are published in a peer-review journal; No pilot, demonstration or feasibility studies.
Intervention Details
Both Community and Academic/Clinical Researchers
Citations:
Yes
ABLE
Dr. Laura Gitlin, Drexell University College of Nursing and Health Professions, lng45@drexel.edu
https://pubmed.ncbi.nlm.nih.gov/21876812/
Citations:
-
Jutkowitz E, Gitlin LN, Pizzi LT, Lee E, Dennis MP. Cost effectiveness of a home-based intervention that helps functionally vulnerable older adults age in place at home. Journal of aging research. 2012;2012:680265. Epub 2011 Aug 16. PubMed
PubMed Central DOI
Yes
Contact Information
Dr. Sarah Szanton
Johns Hopkins School of Nursing
https://nursing.jhu.edu/faculty_research/research/projects/capable
sarah.szanton@jhu.edu
410.955.7544
Results
Improve minority health or the health of other populations with health disparities (e.g. rural populations, populations with low SES)
Functional impairment and disability, hospitalizations and nursing home days
Self-care disability and improvement in instrumental Activities of Daily Living (IADLs), strength, balance, and health care utilization, depression, and medication management
The program resulted in substantial improvements in ADLs and IADLs in all six reviewed trials with other secondary outcomes improvements varying across studies. For every study but one, measurements were asked of study participants both at baseline before the start of CAPABLE and again at the conclusion of the program. Participants rated their ability to complete essential ADLs including walking, bathing, dressing, eating, toileting, grooming, and transferring in and out bed. Compared with participants' baseline measurements, programs implemented with original number of visits and amount of home modification yielded strong Cohen's D effect sizes for ADLs ranging from moderate to very strong. Three studies reported a decrease in depressive symptoms and four studies showed improved falls efficacy. Taken together, this review shows that CAPABLE can be replicated with rigor and cost-effectiveness.
To determine changes in ADLs, the research team collected self-report information about whether participant had difficulty in performing one or more of eight essential ADLs. This method has high test-retest reliability and sensitivity and predicts future morbidity. A summary disability score ranges from 0 – 16 and a change in one point was considered clinically meaningful and a change in two points was associated with increased risk of nursing home or death.
Yes
Evaluations and Assessments
Yes
Economic Evaluation: Studies reported cost savings of $22,120 on average per person compared with a cost of $2882 per person.
Demographic and Implementation Description
Frailty
African American or Black, Hispanic or Latino, White
People with Lower Socioeconomic Status (SES), Racial and Ethnic Minority Populations, Underserved Rural Communities, People with Disabilities
Older Adults (65+ years)
Socio-demographics / Population Characteristics
Rural, Suburban, Urban / Inner City
People with Low Education
All U.S. States
Low SES
Minority Health and Health Disparities Research Framework
| Levels of Influence | |||||
|---|---|---|---|---|---|
| Individual | Interpersonal | Community | Societal | ||
| Determinant Types | Biological | ||||
| Behavioral | ✔ | ✔ | ✔ | ||
| Physical / Built Environment | ✔ | ✔ | |||
| Sociocultural Environment | ✔ | ✔ | |||
| Health Care System | ✔ | ||||
Community Involvement
The community's role in different areas of the Intervention (Choices are "No Role", "Participation", and "Leadership"):
No Role
Participation
Participation
Leadership
Leadership
Leadership
Leadership
Leadership
Characteristics and Implementation
Behavior Change, Patient-Clinician Communication, Physical Environmental Change
Palliative/Quality of Life Care, Primary Prevention
Home
In-person
Healthcare Professional (Physician, Nurse, Technician)
Conceptual Framework
Stages of Change / Trans-theoretical Model, Society to Cells Resilience Theory, Person-Environment Fit Theory, Control Theory
None
Implementation
Individual Randomized Controlled Trial/Comparative (requires random assignment, a control/comparison group, and pre and post intervention outcome assessments)
5380
5380
2009
2018
Intervention Exposures
4-6 months
Delivery of intervention is provided through CAPABLE’s interprofessional team, an occupational therapist (OT), registered nurse (RN) and handy worker. The program consists of six OT and four RN visits (ten total home visits) and a home repair visit.
9-10 Sessions
1-2 Hours
Individual
Unspecified
Adaptations and Modifications
| Intervention Elements | Modified |
|---|---|
| Content |
Yes |
| Context |
Yes |
| Implementation |
No |
| Funding |
No |
| Organization |
No |
| Participants |
No |
| Providers |
No |
| Sociopolitical |
No |
| Stages of Occurrence | Yes |
Modification Details
| Explanation | |
|---|---|
| Content | |
|
Adding Elements, Lengthening, Tailoring |
CAPABLE is an adaptation of the ABLE program designed by Dr. Laura Gitlin., which improves Activities of Daily Living ability and quality of life and reduces mortality through occupational therapy (OT) and home modifications. ABLE is a six-month intervention in which people received four 90-minute visits with an occupational therapist, as well as one 20-minute telephone contact, one 90-minute physical therapy (PT) visit and home modifications. In crafting CAPABLE, researchers replaced the PT component with an expanded nursing (RN) role and enlarged the home modifications from durable goods to include home repairs and everyday items. Juxtaposed to ABLE, CAPABLE is a four- to five-month intervention in which clients receive 10 in-person visits from an OT and RN and expanded home modifications. |
| Context | |
|
Personnel |
CAPABLE replaces the physical therapy component with an expanded nursing role. |
| Stages of Occurrence | |
|
Planning/Pre-implementation/Pilot |
CAPABLE was adapted from the ABLE program during the planning and pilot stages of development. |
Impact, Lessons, Components
Yes
CAPABLE demonstrated consistent, clinically significant reductions in ADL and IADL disability and some improvements in secondary outcomes. In the three studies that reported depressive symptoms, the mean scores reduced from, on average, mild depressive symptoms to remission. CAPABLE improved falls efficacy (confidence in doing ADLs without falling) in the four studies that reported it. Together with primary outcomes, the secondary outcomes create a positive cycle of change toward more independence that positions older adults to address future challenges.
CAPABLE is participant-driven rather than clinically driven. Clinicians accomplish this via active listening and using motivational interviewing techniques. Thus, goals are NOT types of goals typically chosen in a rehabilitation or treatment plan directed by a clinician. clinician training
CAPABLE demonstrated consistent, clinically significant reductions in ADL and IADL disability and some improvements in secondary outcomes. In the three studies that reported depressive symptoms, the mean scores reduced from, on average, mild depressive symptoms to remission. CAPABLE improved falls efficacy (confidence in doing ADLs without falling) in the four studies that reported it. Together with primary outcomes, the secondary outcomes create a positive cycle of change toward more independence that positions older adults to address future challenges.
Lessons Learned
Research identified key drivers of effective implementation: strong internal champion, senior leadership support, supportive organizational climate, sufficient staff/resource capacity, belief in program value, robust peer networks and technical assistance; supportive external environment.
Insights Gained During Implementation
| Insight Category | Insight Description |
|---|---|
| Cost of Implementing or Sustaining | Two studies reported cost savings. Implemented at full dose, the savings were $22,120 on average per person compared with a cost of $2882 per person. Taken together, this review shows that CAPABLE can be replicated with rigor and cost-effectiveness. |
| Logistics | Improvements were not as consistent in the setting that had less home modification and used usual home care assessment to measure pain and depression outcome among those nursing home eligible. Each one of these (measurement, sample, and less home modification) may have affected the results. |
| Training / Technical Assistance | CAPABLE has distinctive elements such as an interprofessional team and participant as the driver of setting goals. These unique aspects—coupled with the partnership, funding, and recruitment/outreach strategies require robust training for organizations interested in implementing the program. |
| Staffing | We found that the one study reporting CAPABLE implementation with fewer RN visits and less funds allocated for home modification or repair had less improvement in main outcomes than in studies implementing CAPABLE fully. |
| Recruitment | Once an implementing organization has set selection criteria and determined the source(s) of referrals, the process from referral to recruitment to enrollment should be mapped out, including identifying, screening, inviting the potential participant, and securing participant’s agreement. |
Intervention Components
Yes
No
Products, Materials, and Funding
This intervention requires a significant amount of training for RNs and OTs and technical support to an implementing organization. Therefore, there is a cost associated for technical support and a license agreement to implement the intervention. Please contact researcher for guidance and additional materials.
| Used for Implementation | Needed for Sustainability | |
|---|---|---|
| Expertise | ||
|
Patient Navigation |
Yes | Yes |
|
Clinical Care |
Yes | Yes |
|
Health communication, health marketing/publicity |
Yes | Yes |
|
Policy/Legislation |
No | Yes |
| Partnerships | ||
|
Community groups (e.g. faith-based organizations, barbershops, beauty-salons, laundromats, food markets, community centers, cultural associations, tribal groups) |
Yes | Yes |
|
Government agencies (city/state/county health department, law enforcement/criminal justice agencies) |
No | Yes |
|
Private organizations, foundations |
Yes | Yes |
|
Local leaders/families |
Yes | Yes |
| Funding Sources | ||
|
Private funding (e.g., foundations, corporations, institutions, facilities) |
Yes | Yes |
|
Public funding (e.g., federal, state or local government) |
Yes | Yes |
Product/Material/Tools
| Tailored For Language | Language(s) if other than English | Material | |
|---|---|---|---|
| Outreach/Recruitment Tools | |||
|
Publicity Materials (e.g. Posters, Flyers, Press Releases) |
No |
https://capablenationalcenter.org/
|
|
| Participant Educational Tools | |||
|
Brochures/Factsheets/Pamphlets |
No |
https://capablenationalcenter.org/
|
|
|
Brochures/Factsheets/Pamphlets |
No |
https://capablenationalcenter.org/
|
|
| Measurement Tools | |||
|
Standardized Instrument/Measures |
No |
https://capablenationalcenter.org/
|
|
Implementation Materials and Products
| Material | |
|---|---|
| Implementation/Delivery Materials | |
| No Implementation/Delivery Materials provided. | |
| Implementation/Output Materials | |
| No Implementation/Output Materials provided. | |
Articles Related to Submitted Intervention
| Article | |
|---|---|
| Reports/Monographs | |
| No Reports/Monographs provided. | |
| Additional Articles | |
| No Additional Articles provided. | |