Strategies that increase safety and accessibility within the home, thereby reducing activity limitations and increasing functional independence in older women, are an important public health priority. Difficulty performing basic and instrumental activities of daily living may increase the need for long-term care services such as personal assistance or relocation to a residential care facility, the combined costs of which are 200-300 billion dollars annually. Although activity limitation and functional disability due to chronic illess and late-life aging decrease the capacity of older women to age in place, little is known about the prevalence and patterns of home environmental modifications (HEMs) strategies or their relationship with distal functional independence. Recent research in small samples has indicated that occupational therapy interventions, which include the provision of HEMs, have a positive impact on functional independence, survivorship, and cost savings. Remaining gaps in knowledge include the prevalence and patterns of HEMs, associated risk factors, and how longitudinal functional independence varies as a function of HEMs. The proposed latent class analyses will be conducted using data from the Women's Health Initiative (WHI), an annual mailed survey of approximately 67,500 households that provides a representative sample of older community- dwelling women over age 75.
The Specific Aims of this proposal are to: 1) Characterize HEMs classes in older women. 2) Determine the relationships between hypothesized risk factors and HEMs classes, and 3) Determine concurrent and distal functional independence conditional on HEMs classes, controlling for hypothesized risk factors. This research will characterize the prevalence and patterns of HEMs, the association of key risk factors such as falls and co- morbidities, and examine longitudinal functional independence conditional on HEMs classes in a cohort that is potentially more vulnerable to loss of functional abilities because of age and gender. Increased knowledge about how simple preventive and complex compensatory strategies influence concurrent and distal functional independence will address an NIA Strategic Direction for Research on Aging, to improve our understanding of healthy aging and disease and disability among older adults, and inform public health initiatives and guide future grant proposals to develop interventions that facilitate aging in place.
Although functional disability in older women over age 75 is high, strategies to improve participation and independence in daily life activities are under-studied, impeding late-life planning, allocation of public and private resources, and development of interventions targeting this potentially vulnerable population. The proposed research will use Women's Health Initiative survey data to characterize the prevalence and patterns of home environmental modifications (HEMS), the key associated risk factors such as falls and co-morbidities, and examine how longitudinal functional independence varies as a function of HEMs latent classes in a sample of approximately 67,500 older women over age 75 at risk for functional decline.
