Low-Tech Devices, Home Adaptations Preserve Independence, Reduce Health-Care Costs For Physically Frail Elderly

BUFFALO, N.Y. -- A case-control study of frail elderly, in which half of the participants received assistive devices and home adaptations as needed and half received "usual care services," has shown that participants in the intervention group sustained a higher level of independence at the end of the 18-month study.

The treatment group also spent significantly less on health care -- an average of $14,173 per person, compared to $31,610 per person in the control group.

The study, published in the May/June issue of Archives of Family Medicine, is the first randomized controlled trial of the effectiveness of environmental interventions and assistive devices in maintaining independence and reducing home-health-care costs among home-based frail elderly

"The study demonstrates that a relatively inexpensive intervention can result in significantly lower health-related expenses," said William C. Mann, Ph.D., professor and chair of the Department of Occupational Therapy in the University at Buffalo School of Health Related Professions and principal researcher on the study. "Most importantly, higher levels of independence brought improved quality of life, and fewer and shorter hospitalizations."

At the study's inception, all participants -- 104 frail elderly living at home -- underwent a comprehensive assessment of their home environment and their functional abilities, using the Functional Independence Measure (FIM), an assessment tool developed at UB and now used internationally. FIM employs a 7-point scale to quantify performance in a wide range of daily living activities.

Participants then were assigned randomly to either the intervention group or the control group. The treatment group received the necessary assistive devices or home modifications

indicated by their assessment. The control group's "usual care" involved hospital or nursing home care, at-home health care and any services provided by community agencies for the elderly, such as Meals on Wheels, and help with shopping, household chores and personal care.

All participants were contacted by phone once a month to collect information on new problems or services received, and in the treatment group, to find out if they needed new or different assistive devices or home modifications. Participants also received an in-home assessment every six months to determine their functional status, health and costs of care.

Findings showed that individuals in the treatment group had received an average of 14 devices from the study, or a total of 681. The control group averaged about two additional devices per person from usual service providers, for a total of 80. Assistive devices provided by the study were very low-tech for the most part, involving primarily bath benches, meal-preparation aids, canes, walkers and a variety of devices to help with fine-motor skills.

The treatment group received a total of 69 home modifications, while the control group received a total of eight, the findings showed. Most environmental interventions cost less than $500. The most frequent modifications were addition of handrails, lowering shelves and making storage more accessible.

Assessment of the participants' functional change at the end of the 18-month study showed that while all participants lost some ability to function, the control group declined more than the treatment group in all categories, and had spent four times more on health care. Mann said the functional differences appeared to be directly related to the interventions.

"For example, the control group showed significant decline in the FIM walking item, from 5.43 to 4.77, while treatment group participants who received ambulation equipment and instruction did not show a significant decline. Similarly, the dressing item on the FIM instrument indicated there was no significant decline for the treatment group, but the control group declined more than one point."

A one-point decline on the FIM scale, in this case from 5.29 to 4.09, represents a change in the amount of care required, Mann said. A decline from 5 to 4, for example, represents a change from "supervision only" to "minimal assist," he noted.

UB researchers are following both groups to monitor differences in functional status and health-related expenditures over time. "Low-cost assistive technology and environmental interventions may prevent and postpone morbidity in the frail elderly," Mann said. "As our aging

population grows, obtaining definitive answers on the usefulness and cost effectiveness of these interventions become increasingly important."

Additional researchers on the study were Kenneth J. Ottenbacher, Ph.D., of the School of Allied Health Sciences, University of Texas Medical Branch, Galveston; Linda Fraas and Machiko Tomita, Ph.D., of the UB Department of Occupational Therapy, and Carl V. Granger, M.D., of the Center for Functional Assessment Research in the UB School of Medicine and Biomedical Sciences.

The research was supported by the National Institute on Disability and Rehabilitation Research in the U.S Department of Education, the U.S. Department of Health and Human Services, and the AARP Andrus Foundation.