Enormous health care resources are used to manage acute and subacute illnesses among this country's 1.5 million frail elderly nursing home (NH) residents. The most common of such illnesses is infection. Two primary risk factors for infection and hospitalization due to infection in NH residents are immobility and incontinence. Immobile and incontinent NH residents are also prone to skin problems and frequently suffer from acute sickness episodes other than infections. Furthermore significant health care resources are spent to treat sickness above those resources required for routine NH care. This study evaluates an intervention that is directed toward both in incontinence and immobility risk factors that are associated with high health care utilization in NH residents. The intervention (FIT) is designed to improve endurance and incontinence, and is based on principles set forth in the AHCPR Clinical Practice Guidelines on incontinence and pressure ulcer prevention. The primary purpose is to evaluate the effectiveness of the intervention in reducing sickness episode frequency and to relate the costs of the intervention to savings that might result from the improved outcomes. A secondary purpose is to begin to identify physiological mechanisms that might underlie the intervention's effects. NH residents will be randomized into the FIT intervention group or 'usual care' control group. The FIT subjects will receive the intervention protocol from research staff for five days a week, ten hours per day. Usual care subjects will receive normal NH care, but these usual care practices will be carefully described in terms of incontinence management and mobility activities. Incontinence frequency, physical activity and endurance, health care utilization and related costs, and other outcomes will be monitored during a six-month baseline, an eight-week conditioning, and a 24-week conditioning maintenance phase. During the 24-week conditioning maintenance phase, intervention subjects will, based on data from our previous research, have demonstrated improved dryness, physical activity, and mobility endurance as compared to the baseline phase. It is hypothesized that the FIT subjects will have reduced sickness episodes and health care utilization costs during this 24-week conditioning maintenance phase as compared to the usual care control group.
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