The ability to live comfortably, safely, and independently in one?s home and community ? often called ?aging in place? ? is a key component of quality of life for older adults. Yet the ability to age in place is severely compromised among the nearly 3 million older adults living in federally-subsidized housing, whose risk for nursing home admission is seven times that of the general population. Although some resources are available to help these vulnerable older adults to age in place, existing programs have not been found to decrease rates of nursing home placement or to improve other key aspects of aging in place, including function and quality of life. Thus, there is a need to develop more effective strategies to identify at-risk individuals in subsidized housing and deliver targeted interventions to improve aging in place.
The aims of the parent grant for this application are to determine barriers and facilitators to a two-component intervention to improve aging in place for older adults living in subsidized housing, including (a) case-finding to identify high-risk individuals and (b) Function-Focused Care to improving function and aging in place (Aim 1); and to pilot test the feasibility and preliminary effectiveness of this intervention for improving function and aging in place for older adults living in subsidized housing (Aims 2 and 3). Subsidized housing residents have a disproportionate prevalence of cognitive impairment, with nearly 30% screening positive for dementia. However, the parent award focuses on addressing the needs of individuals with functional impairment and does not recruit sufficient participants with dementia nor perform the assessments needed to understand their unique needs. The objective of this administrative supplement is to address this gap by adapting and refining the parent intervention to meet the needs of people with Alzheimer?s disease and related dementias (ADRD) and determining the feasibility and preliminary effectiveness of this adapted intervention for people with ADRD. We propose the following specific aims: first, to expand the qualitative parent study to identify the unique needs of people with ADRD, allowing us to adapt and refine the intervention for older adults with ADRD living in subsidized housing (Aim 1); and second, to expand the parent case-finding and Function-Focused Care pilot intervention to include rigorous cognitive assessments and increased enrollment of people with ADRD, allowing us to determine its feasibility and preliminary effectiveness for people with ADRD. Relevance/public health significance: Completing these aims will provide valuable preliminary data which will inform an R01 application employing this intervention, to be submitted in Year 3 of the K76 award. If successful, this intervention could have a transformative impact for vulnerable older adults with ADRD living in subsidized housing, enhancing their freedom to live in the least restrictive setting while also decreasing costs for long-term care.
Millions of older adults with low incomes live in federally-subsidized housing and are at disproportionate risk for nursing home admission, yet we currently lack effective approaches for maintaining aging in place for this vulnerable population. The objective of this supplement is to leverage the infrastructure and resources of the parent K76 award to adapt and pilot test an intervention to improve aging in place for older adults with Alzheimer?s disease and related dementias (ADRD) living in subsidized housing, which will be formally tested in an R01-level grant to be submitted at the end of the K76 period. Ultimately, this intervention has the potential to be widely disseminated to address disparities in aging in place and improve quality of life for many vulnerable older adults with ADRD living in subsidized housing.
| Nicosia, Francesca M; Spar, Malena J; Steinman, Michael A et al. (2018) Making Function Part of the Conversation: Clinician Perspectives on Measuring Functional Status in Primary Care. J Am Geriatr Soc : |
