title: Effect of an in-home occupational and physical therapy intervention on reducing mortality in functionally vulnerable older people: preliminary findings.
abstract: OBJECTIVE
  To evaluate the effect of a multicomponent intervention on mortality and the role of control-oriented strategy use as the change mechanism.
  
  
  METHODS
  Two-group randomized design with survivorship followed for 14 months. Participants were randomized to intervention or a no-treatment control group.
  
  
  METHODS
  Urban, community-living older people.
  
  
  METHODS
  Three hundred nineteen people aged 70 and older with functional difficulties.
  
  
  METHODS
  Occupational therapy and physical therapy sessions involving home modifications, problem solving, and training in energy conservation, safe performance, balance, muscle strength, and fall recovery techniques.
  
  
  METHODS
  Survival time was number of days between baseline interview and date of death or final interview if date unknown. Control-oriented strategy use was measured using eight items.
  
  
  RESULTS
  Intervention participants exhibited a 1% rate of mortality, compared with a 10% rate for no-treatment control participants (P=.003, 95% confidence interval=2.4-15.04%). At baseline, those who subsequently died had more days hospitalized and lower control-oriented strategy use 6 months before study enrollment than survivors. No intervention participants with previous days hospitalized (n=31) died, whereas 21% of control group counterparts did (n=35; P=.001). Although intervention participants with low and high baseline control strategy use had lower mortality risk than control participants, mortality risk was lower for intervention participants with low strategy use at baseline (P=.007).
  
  
  CONCLUSIONS
  An occupational and physical therapy intervention to ameliorate functional difficulties may reduce mortality risk in community-dwelling older people overall and benefit those most compromised. Instruction in control-oriented strategies may account for the intervention's protective effects on survivorship.
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: Walter W
authors.initials: WW
authors.lastname: Hauck
authors.forename: Laraine
authors.initials: L
authors.lastname: Winter
authors.forename: Marie P
authors.initials: MP
authors.lastname: Dennis
authors.forename: Richard
authors.initials: R
authors.lastname: Schulz
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006699:Home Care Services; D006801:Humans; D008297:Male; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D020377:Self Efficacy; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014505:Urban Population