Implementing CAPABLE in PSH
Study Details
Study Description
Brief Summary
This pilot project seeks to implement an intervention known as CAPABLE (Community Aging in Place-Advancing Better Living for Elders) for formerly homeless adults living in permanent supportive housing. This home-based intervention that consists of time-limited services (no more than 6-months) from an occupational therapist, a nurse, and a handyman is intended to improve functioning and decrease falls among this population that prematurely ages and is at increased fall risk.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
Permanent supportive housing (PSH) using a housing first approach is an evidence-based intervention to end chronic homelessness by providing low-barrier affordable housing paired with flexible health and social services. In Los Angeles County (LAC), where the number of PSH units is expected to increase dramatically over the next 10 years, clinical guidelines and/or standards for support services are lacking. This is especially problematic given the that the target population is older and prematurely aging. The chronically homeless population in the United States has an average age approaching 60 years old and experiences accelerated aging, including an elevated prevalence of geriatric syndromes such as functional impairment, falls, and urinary incontinence that can jeopardize PSH tenants' ability to live independently and age in place. Current support services are not equipped to address these needs, which ultimately jeopardizes the success of PSH to maintain high rates of housing stability while tenants "age in place."
The investigators propose conducting a pilot project to implement the CAPABLE model in PSH. CAPABLE, which stands for "Community Aging in Place-Advancing Better Living for Elders" is a client-directed home-based intervention that consists of time-limited services (no more than 6-months) from an occupational therapist, a nurse, and a handyman working collaboratively with the older adult client. CAPABLE was developed to target older adults who are returning to independent living after hospitalization and has been shown to improve functioning (activities of daily living - ADLs and instrumental activities of daily living - IADLs), decrease falls and nursing home admissions, and reduce healthcare costs based on multiple studies including several randomized control trials. CAPABLE has the potential to be used in PSH as a model of support services that can address needs of prematurely aging tenants, which could help transform PSH from an intervention that ends homeless to an intervention that addresses homelessness and supports successful aging in place.
The specific aims of this study are to:
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Examine the impact of CAPABLE on PSH client outcomes (e.g. ADLs, IADLs, falls). This aim will be accomplished using a pre-/post-design with a wait-list control group.
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Determine what adaptations, if any, need to be made to implement CAPABLE in PSH. The investigators will accomplish this aim using the Dynamic Adaptation Process (DAP) implementation approach, which was designed to allow for an evidenced-based practice to be adapted in a planned and considered, rather than ad hoc, manner.
Important to note is that this project was conducted during the COVID-19 pandemic so that adaptations to CAPABLE may be due to the context of the pandemic as opposed to being implemented in PSH.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Other: CAPABLE CAPABLE Intervention |
Behavioral: CAPABLE: Community Aging in Place-Advancing Better Living for Elders
CAPABLE is a client-directed home-based intervention that consists of time-limited services from an occupational therapist, a nurse, and a handyman working collaboratively with the older adult client. In most cases, the OT makes 6 visits, the RN makes 4 visits, and a handyman makes 1 to 2 visits to make any modifications to a person's home during a 6-month period. The first visits for the OT and RN are usually 90 minutes each and the later ones are usually an hour each. Visits are spaced to enable older adults to practice new strategies learned in the previous visit. There should be a clear "conclusion/graduation," with the older adult understanding how to use their new skills and apply them to future situations.
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Outcome Measures
Primary Outcome Measures
- Activities of Daily Living [Change of ability to perform activities of daily living from baseline to 1 year]
The modified Katz Activities of Daily Living (ADL) Scale will be used to rate ability to bathe, dress, transfer, toilet, and eat using three categories: (0) no difficulty, (1) a little or some difficulty, (2) a lot of difficulty or (3) inability to perform. Higher scores represent greater difficulty performing ADLs
- Brief Instrumental Functioning [Change in brief instrumental functioning from baseline to 1 year]
The Brief Instrumental Functioning Scale will be used to assess ability to perform in six functions: bathing, dressing, going to toilet, transferring, continence, and feeding. Each area is assessed on a three point scale from without assistance to needing full assistance. Higher scores represent more issues with functioning.
- Falls [Change (or reduction) in falls from baseline to 1 year]
History of falls during the past year and since last assessment period by asking: "Did you fall to the ground in the past year (since the last survey)?"
- Frailty or a decline in physical functioning [Change in frailty from baseline to 1 year]
Frailty will be defined using the Fried criteria, which assesses whether three or more of five characteristics are present: unintentional weight loss, exhaustion, low physical activity, slow walking speed, and weak handgrip.
- Depression [Change in depression symptoms from baseline to 1 year]
The Patient Health Questionnaire 9 will be used to assess depression, with major depression defined as a score of 10 or higher (range 0-27; higher scores indicate more symptoms).
- Hand strength (physical frailty) [Change in hand strength from baseline to 1 year]
Objective measure of handgrip. Grip strength will be tested using a simple handgrip dynamometer.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Older than 50 years in age
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cognitively intact or have only mild cognitive impairment
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have some or a lot of difficulty performing ADLs
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tenant of Skid Row Housing Trust
Exclusion Criteria:
- see above
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Skid Row Housing Trust | Los Angeles | California | United States | 90021 |
Sponsors and Collaborators
- University of Southern California
Investigators
- Principal Investigator: Benjamin F Henwood, PhD, University of Southern California
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- UP-19-00361