title: Long-term effect on mortality of a home intervention that reduces functional difficulties in older adults: results from a randomized trial.
abstract: OBJECTIVE
  To evaluate the long-term mortality effect of a home-based intervention previously shown to reduce functional difficulties and whether survivorship benefits differ according to initial mortality risk level.
  
  
  METHODS
  Two-group randomized trial with survivorship followed up to 4 years from study entry.
  
  
  METHODS
  Homes of urban community-living elderly people.
  
  
  METHODS
  Three hundred nineteen adults aged 70 and older with difficulties performing daily activities.
  
  
  METHODS
  Occupational and physical therapy sessions to instruct participants in compensatory strategies, home modifications, home safety, fall recovery techniques, and balance and muscle strength exercises.
  
  
  METHODS
  Survival time was number of days between baseline interview and date of death, as determined using data from the National Death Index or December 31, 2005. Participants were stratified according to baseline mortality risk (low, moderate, high) using a prognostic indicator.
  
  
  RESULTS
  At 2 years, intervention participants (n=160) had a 5.6% mortality rate (n=9 deaths) and controls (n=159) a 13.2% rate (n=21 deaths; P=.02). Mortality rates remained lower for intervention participants up to 3.5 years from study entry. At 2 years, intervention participants with moderate mortality risk had a 16.7% mortality rate (n=16 deaths/96), compared with 28.2% for equivalent control group participants (n=24 deaths/85; P=.02). By 3 years, mortality rates were not statistically significantly different between the experimental and control groups.
  
  
  CONCLUSIONS
  The intervention extended survivorship up to 3.5 years and maintained statistically significant differences for 2 years. Subjects at moderate mortality risk derived the most intervention benefit. Findings suggest that the intervention could be a low-cost clinical tool to delay functional decline and mortality.
authors.affiliation: Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, Philadelphia, Pennsylvania 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: Marie P
authors.initials: MP
authors.lastname: Dennis
authors.forename: Laraine
authors.initials: L
authors.lastname: Winter
authors.forename: Nancy
authors.initials: N
authors.lastname: Hodgson
authors.forename: Sandy
authors.initials: S
authors.lastname: Schinfeld
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000203:Activities of Daily Living / Q000145:classification*; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000401:mortality* / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006699:Home Care Services; D006801:Humans; D008297:Male; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D011379:Prognosis; D018570:Risk Assessment; D012449:Safety; D012931:Social Environment; D016019:Survival Analysis