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document
Preventing disability and managing chronic illness in frail older adults : a randomized trial of a community-based partnership with primary care . BACKGROUND Effective new strategies that complement primary care are needed to reduce disability risks and improve self-management of chronic illness in frail older people living in the community . OBJECTIVE To evaluate the impact of a 1-year , senior center-based chronic illness self-management and disability prevention program on health , functioning , and healthcare utilization in frail older adults . DESIGN A randomized controlled trial . SETTING A large senior center located in a northeast Seattle suburb . The trial was conducted in collaboration with primary care providers of two large managed care organizations . PARTICIPANTS A total of 201 chronically ill older adults seniors aged 70 and older recruited through medical practices . INTERVENTION A targeted , multi-component disability prevention and disease self-management program led by a geriatric nurse practitioner ( GNP ) . MEASUREMENTS Self-reported Physical function , physical performance tests , health care utilization , and health behaviors . RESULTS Each of 101 intervention participants met with the GNP from 1 to 8 times ( median = 3 ) during the study year . The intervention group showed less decline in function , as measured by disability days and lower scores on the Health Assessment Questionnaire . Other measures of function , including the SF-36 and a battery of physical performance tests , did not change with the intervention . The number of hospitalized participants increased by 69 % among the controls and decreased by 38 % in the intervention group ( P = .083 ) . The total number of inpatient hospital days during the study year was significantly less in the intervention group compared with controls ( total days = 33 vs 116 , P = .049 ) . The intervention led to significantly higher levels of physical activity and senior center participation and significant reductions in the use of psychoactive medications . CONCLUSIONS This project provides evidence that a community-based collaboration with primary care providers can improve function and reduce inpatient utilization in chronically ill older adults . Linking organized medical care with complementary community-based interventions may be a promising direction for research and practice .
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Intervention_Physical
A targeted , multi-component
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Intervention_Educational
disability prevention and disease self-management program
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Intervention_Physical
led by a geriatric nurse practitioner ( GNP )
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Outcome_Physical
disability
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Outcome_Physical
managing chronic illness
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Outcome_Mental
improve self-management
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Outcome_Physical
chronic illness
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Outcome_Physical
chronic illness
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Outcome_Mental
self-management
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Outcome_Other
disability prevention program on health
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Outcome_Other
functioning
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Outcome_Physical
healthcare utilization
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Outcome_Other
Self-reported Physical function
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Outcome_Other
physical performance tests
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Outcome_Physical
health care utilization
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Outcome_Mental
health behaviors
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Outcome_Other
less decline in
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Outcome_Physical
function
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Outcome_Other
disability days
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Outcome_Other
lower scores
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Outcome_Physical
Health Assessment Questionnaire
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Outcome_Physical
SF-36
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Outcome_Other
number of hospitalized participants
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Outcome_Other
total number of inpatient hospital days
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Outcome_Physical
physical activity
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Outcome_Mental
senior center participation
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Outcome_Physical
use of psychoactive medications
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Outcome_Physical
function
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Outcome_Other
inpatient utilization
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Participant_Condition
frail
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Participant_Age
older adults
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Participant_Condition
frail
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Participant_Age
older people
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Participant_Sample-size
201
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Participant_Age
70 and older
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Participant_Sample-size
101
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Participant_Condition
chronically ill
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Participant_Age
older adults