CAPABLE trial: a randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: rationale and design.

BACKGROUND: As the population ages, it is increasingly important to test new models of care that improve life quality and decrease health costs. This paper presents the rationale and design for a randomized clinical trial of a novel interdisciplinary program to reduce disability among low income older adults based on a previous pilot trial of the same design showing strong effect. METHODS: The CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial is a randomized controlled trial in which low income older adults with self-care disability are assigned to one of two groups: an interdisciplinary team of a nurse, occupational therapist, and handyman to address both personal and environmental risk factors for disability based on participants' functional goals, or an attention control of sedentary activities of choice. Both groups receive up to 10 home visits over 4 months. OUTCOMES: The primary outcome is decreased disability in self-care (ADL). Secondary outcomes are sustained decrease in self care disability as well as improvement in instrumental ADLS, strength, balance, walking speed, and health care utilization. Careful cost tracking and analysis using intervention data and claims data will enable direct measurement of the cost impact of the CAPABLE approach. CAPABLE has the potential to leverage current health care spending in Medicaid waivers, Accountable Care Organizations and other capitated systems to save the health care system costs as well as improving low income older adults' ability to age at home with improved life quality.

Assessment of a health-promotive lifestyle.

Health promotion is an imperative goal for our nation. One needs only to look at the major causes of morbidity and mortality to know that lifestyle factors are major contributors. Nurses are in a unique position that allows them to assist people in examining their lifestyle behaviors. The nursing role in health promotion centers around assessment of behaviors that promote, protect, and maintain health status. A health-promotion assessment should include the following components: nutrition, exercise and fitness, stress management, family planning, sexual history, tobacco use, alcohol and chemical substance abuse, exposure to environmental hazards and injury, as well as the psychological, spiritual, and social resources that enhance a person's ability to engage in behaviors that promote health. Information gained from assessment can guide the nurse and client in making personal decisions for changing behavior and using inner resources to enhance the existing level of health and well-being.