title: CAPABLE trial: a randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: rationale and design.
abstract: BACKGROUND
  As the population ages, it is increasingly important to test new models of care that improve life quality and decrease health costs. This paper presents the rationale and design for a randomized clinical trial of a novel interdisciplinary program to reduce disability among low income older adults based on a previous pilot trial of the same design showing strong effect.
  
  
  METHODS
  The CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial is a randomized controlled trial in which low income older adults with self-care disability are assigned to one of two groups: an interdisciplinary team of a nurse, occupational therapist, and handyman to address both personal and environmental risk factors for disability based on participants' functional goals, or an attention control of sedentary activities of choice. Both groups receive up to 10 home visits over 4 months.
  
  
  RESULTS
  The primary outcome is decreased disability in self-care (ADL). Secondary outcomes are sustained decrease in self care disability as well as improvement in instrumental ADLS, strength, balance, walking speed, and health care utilization. Careful cost tracking and analysis using intervention data and claims data will enable direct measurement of the cost impact of the CAPABLE approach. CAPABLE has the potential to leverage current health care spending in Medicaid waivers, Accountable Care Organizations and other capitated systems to save the health care system costs as well as improving low income older adults' ability to age at home with improved life quality.
authors.affiliation: Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States. Electronic address: Sszanto1@jhu.edu.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Szanton
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States.
authors.forename: J W
authors.initials: JW
authors.lastname: Wolff
authors.affiliation: Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States.
authors.forename: B
authors.initials: B
authors.lastname: Leff
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States.
authors.forename: R J
authors.initials: RJ
authors.lastname: Thorpe
authors.affiliation: Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States.
authors.forename: E K
authors.initials: EK
authors.lastname: Tanner
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States.
authors.forename: C
authors.initials: C
authors.lastname: Boyd
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States.
authors.forename: Q
authors.initials: Q
authors.lastname: Xue
authors.affiliation: University of Maryland Medical School, United States.
authors.forename: J
authors.initials: J
authors.lastname: Guralnik
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States.
authors.forename: D
authors.initials: D
authors.lastname: Bishai
authors.affiliation: Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, United States; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, United States.
authors.forename: L N
authors.initials: LN
authors.lastname: Gitlin
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006792:House Calls; D006801:Humans; D057187:Independent Living; D008297:Male; D053580:Muscle Strength; D009726:Nurses; D009788:Occupational Therapy; D010342:Patient Acceptance of Health Care; D004856:Postural Balance; D011203:Poverty; D011788:Quality of Life; D012107:Research Design; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States
keywords: Disability; Health disparities; Older adults; Person–environment fit