One problem faced by seniors is that many come to find the normal activities of daily life difficult and eventually impossible to perform. This includes things most people take for granted, such as getting in and out of bed and getting dressed. Often, dealing with the situation simply requires learning new ways to accomplish an old task or making minor modifications in the home.Often, dealing with the situation simply requires learning new ways to accomplish an old task or making minor modifications in the home.
That's where the intervention program comes in.
Laura Gitlin is director of the Jefferson Center for Applied Research on Aging and Health, and a professor in the Department of Occupational Therapy at Thomas Jefferson University. For years, she's been involved in a program that seeks to help seniors find solutions to the increasing challenges of living at home. A previous study on the short term effects of this program found it to be effective at helping seniors and increasing their quality of life. A new study followed participating seniors for four years.
Each senior talked with an occupational therapist five times, both in the senior's home and over the phone. They discussed the needs of the senior and the therapist went through the house, to get an idea of what modifications would make life easier for each senior. The therapist then taught the senior different ways to perform everyday tasks, ways that often required less energy usage. According to Gitlin, this can work for seniors of any age. Each senior also had at least one visit with a physical therapist to evaluate their balance and teach them how to deal with falling: their fears, how to fall safely and how to recover from a fall.
Over the four-year course of this study, seniors who received this intervention lived an average of 3.5 years longer than those who received no intervention. After two years of intervention, the mortality rate of those who received intervention was less than half as high as those who received no intervention. Taken together, the two studies indicate that the program helped seniors live longer and better.
The long-term study was performed on 319 people, average age 79, who were just beginning to encounter some functional challenges from living at home. Half of these people received home-based intervention; half did not.
The results of this study were published in the March, 2009 issue of the Journal of the American Geriatrics Society.
But If Do Need to Be Hospitalized?
While the study did not specifically address the issue of hospitalization, it seems reasonable that the intervention program also reduced hospitalizations. When an elderly person has a non-injurious fall and is found by a neighbor or family member unused to such a situation, the result is often a call to an ambulance and hospitalization. According to a new study of Medicare patients, that can begin a downward spiral: when the elderly are hospitalized, they often begin a cycle of repeat hospitalizations.
This second study showed that 20% of all Medicare patients discharged from the hospital are re-admitted within 30 days; 50% are readmitted within a year.
There are many different interpretations of what these numbers really mean. To study author Dr. Stephen F. Jencks, they point to problems in the hospital discharge process. Often, the parts of the discharge process that don't feel right to patients really aren't right; this places as undue burden on patients, forcing each to be their own advocate. Not only do discharged patients need to know how to care for themselves at home and who to call if they have a problem, they also need to make sure that a follow-up appointment with a physician is scheduled before they leave the hospital.
Jencks believes that better care coordination would both prevent many of these hospitalizations and lift a burden from the patients. He also suggests that immediate action is imperative: "The evidence is that the system is not working right and it's causing a great deal of patient and family misery. We need to get cracking on it."
The re-hospitalization study looked at records of nearly 12 million patients who had been discharged from a hospital between October 2003 and December 2004. The results of the study appear in the April 2, 2009 issue of the New England Journal of Medicine.
