title: A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults.
abstract: OBJECTIVE
  To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance self-efficacy and adaptive coping in older adults with chronic conditions.
  
  
  METHODS
  A prospective, two-group, randomized trial. Participants were randomized to a treatment group or no-treatment group.
  
  
  METHODS
  Urban community-living older people.
  
  
  METHODS
  Three hundred nineteen community-living adults aged 70 and older who reported difficulty with one or more activities of daily living.
  
  
  METHODS
  Occupational and physical therapy sessions involving home modifications and training in their use; instruction in strategies of problem-solving, energy conservation, safe performance, and fall recovery techniques; and balance and muscle strength training.
  
  
  METHODS
  Outcome measures included self-rated functional difficulties with ambulation, instrumental activities of daily living, activities of daily living, fear of falling, confidence performing daily tasks, and use of adaptive strategies. Observations of home hazards were also conducted.
  
  
  RESULTS
  At 6 months, intervention participants had less difficulty than controls with instrumental activities of daily living (P=.04, 95% confidence interval (CI)=-0.28-0.00) and activities of daily living (P=.03, 95% CI=-0.24 to -0.01), with largest reductions in bathing (P=.02, 95% CI=-0.52 to -0.06) and toileting (P=.049, 95% CI=-0.35-0.00). They also had greater self-efficacy (P=.03, 95% CI=0.02-0.27), less fear of falling (P=.001, 95% CI=0.26-0.96), fewer home hazards (P=.05, 95% CI=-3.06-0.00), and greater use of adaptive strategies (P=.009, 95% CI=0.03-0.22). Benefits were sustained at 12 months for most outcomes.
  
  
  CONCLUSIONS
  A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality improvements in community-dwelling older people who had functional difficulties, with most benefits retained over a year.
authors.affiliation: Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9th Street, Philadelphia, PA 19130, USA. laura.gitlin@jefferson.edu
authors.forename: Laura N
authors.initials: LN
authors.lastname: Gitlin
authors.forename: Laraine
authors.initials: L
authors.lastname: Winter
authors.forename: Marie P
authors.initials: MP
authors.lastname: Dennis
authors.forename: Mary
authors.initials: M
authors.lastname: Corcoran
authors.forename: Sandy
authors.initials: S
authors.lastname: Schinfeld
authors.forename: Walter W
authors.initials: WW
authors.lastname: Hauck
mesh_terms: D000057:Accident Proneness; D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged / Q000502:physiology* / Q000523:psychology; D000369:Aged, 80 and over; D004779:Environment Design; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D020377:Self Efficacy; D016896:Treatment Outcome