Improving Aging in Place in Subsidized Housing

Not Applicable

Completed

• Conditions: Physical Disability; Physical Activity; Cognitive Impairment
• Interventions: Behavioral: Independent Living Program for Affordable Housing.

• Registration Number: NCT04212442
• Lead Sponsor: University of Pennsylvania

Brief Summary

This pilot study will evaluate the feasibility and preliminary effectiveness of an adapted version of the Function Focused Care intervention, delivered by telephone, for improving aging in place for older adults living in subsidized housing. The study will include participants with and without mild cognitive impairment or mild dementia and will examine whether the study outcomes differ by cognitive status. Findings from this study will provide new information about how to optimize function and physical activity among older adults with and without cognitive impairment living in subsidized housing.

Detailed Description

Millions of older adults with low incomes live in federally-subsidized housing and are at disproportionate risk for nursing home admission. Effective approaches are needed to improve aging in place for this vulnerable population. The objective of this study is to pilot test the feasibility and preliminary effectiveness of a telephone-based intervention to improve aging in place for older adults living in subsidized housing. In the first phase of this study, the investigators used methods of implementation science to adapt an existing intervention, Function Focused Care for Assisted Living, to the unique setting of affordable housing. Function Focused Care is a philosophy of care in which assisted living staff members engage residents in functional and physical activity during all care interactions. Prior research supports the effectiveness of Function Focused Care for maintaining function and increasing physical activity among older adults in assisted living settings.

In the first phase of this study, the investigators interviewed subsidized housing stakeholders - including residents, staff members, and caregivers - to identify barriers, facilitators, and needed adaptations to Function Focused Care for Assisted Living. The investigators used the findings from these interviews to adapt the intervention. In this 2-month pilot study, the investigators will use a wait-list control design with site randomization to assess the feasibility and preliminary effectiveness of the adapted intervention. The investigators will recruit individuals with and without mild cognitive impairment or mild dementia and will examine whether the study outcomes differ by cognitive status. The findings from this study will provide new information about how to optimize function and physical activity among older adults with and without cognitive impairment living in subsidized housing.

Study Timeline

• Study First Submitted: 2019-12-16
• Study First Submitted QC: 2019-12-23
• Study First Posted: 2019-12-27
• Study Start: 2020-01-13
• Primary Completion: 2023-01-24
• Study Completion: 2023-03-02
• Disposition First Submitted: 2023-11-08
• Disposition First Posted: 2023-11-30
• Results First Submitted: 2024-08-06
• Status Verified: 2024-11
• Results First Submitted QC: 2024-11-09
• Last Update Submitted: 2024-11-09
• Results First Posted: 2024-11-15
• Last Update Posted: 2024-11-15

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 75

Inclusion Criteria

Not provided

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Exclusion Criteria

Not provided

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Wait-list Control	Independent Living Program for Affordable Housing.	Two months after study enrollment, participants receive the adapted telephone-based intervention, the Independent Living Program for Affordable Housing, for two consecutive months.
Immediate Intervention	Independent Living Program for Affordable Housing.	Upon enrollment, participants receive the adapted telephone-based intervention, the Independent Living Program for Affordable Housing, for two consecutive months.

Primary Outcome Measures

Name	Time	Method
Change in Precipitating Events Project (PEP) Functional Status Scale From Baseline to 2 Months for Immediate Intervention Sites and Waitlist Control Sites	Baseline, 2 months	Self-reported ability to perform 7 ADLs, 5 IADLs, and 3 mobility tasks (Range, 0-30; higher scores indicate more functional impairment)
Change in Short Physical Performance Battery Score From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites	Baseline, 2 months	Objective measure of lower extremity functioning in older adults (Range, 0-12; higher scores indicate worse lower extremity functioning); The measure will be collected only if in-person contact is possible during the COVID-19 outbreak.
Change in Average Step Counts From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites	Measured continuously from 0-2 months	Measured using Fitbit
Change in Time Spent in Differing Levels of Activity From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites	Measured continuously from 0-2 months	Measured using Fitbit (minutes spent in each of 4 levels of activity: sedentary; lightly active; fairly active; very active)
Acceptability Assessed Using a Survey Question	2 months	Self-reported acceptability of the intervention (5-point Likert scale ranging from very unacceptable (1) to very acceptable (5); higher numbers indicate higher acceptability)
Change in Physical Activity Scale for the Elderly (PASE) Score From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites	Baseline, 2 months	Self-reported physical activity (Range, 0-793; higher scores indicate greater physical activity)
Feasibility of Study Recruitment, Measured as Percentage of Eligible Participants Recruited	0-4 months	Assessed using participant responses to invitation to participate in the study (enrolled vs. refused)
Feasibility of Study Retention, Measured as Percentage of Participants Retained Over Study Follow-up	0-4 months	Assessed as percentage of participants who remain enrolled in the study
Number of Participants With High Fidelity to Treatment Protocol, Measured Using Fidelity Checklist	0-4 months	Number of participants with \>80% fidelity to treatment protocol, measured using fidelity checklist including each study protocol task
Fidelity to Motivational Interviewing, Measured Using the Motivational Interviewing Treatment Integrity Scale (MITI 4)	2 months	Assessed by psychologist (4 global scores, scored on a 5-point Likert scale from 1 (low) to 5 (high))

Secondary Outcome Measures

Name	Time	Method
Change in EuroQol 5 Dimensions (EQ-5D-5L) Scale From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites	Baseline, 2 months	Self-reported measure (Range, 11111-55555, converted to a single index utility score ranging from of 0-1; higher scores indicate better quality of life)
Change in Geriatric Depression Scale Short Form (GDS Short Form) Score From Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites	Baseline, 2 months	Self-reported measure of depressive symptoms (Range, 0-15; score of 5-8 suggests mild depression, 9-11 moderate depression, and 12-15 severe depression)
Percentage of Participants With a Hospitalization During the Study Period (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)	Baseline, 2 months	Self-reported hospitalization
Change in Number of Hospitalizations During the Study Period (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)	Baseline, 2 months	Self-reported number of hospitalizations
Percentage of Participants With an Emergency Department Visit During the Study Period (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)	Baseline, 2 months	Self-reported emergency department visit
Change in Number of Emergency Department Visits During the Study Period (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)	Baseline, 2 months	Self-reported number of emergency department visits
Percentage of Participants With a Move to a Higher Level of Care (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)	Baseline, 2 months	Self-reported or emergency contact-reported move to a higher level of care, defined as a move to assisted living, board and care, or nursing home
Percentage of Participants With a Skilled Nursing Facility Stay (Baseline to 2 Months for Immediate Intervention and Waitlist Control Sites)	Baseline, 2 months	Self-reported skilled nursing facility stay

Trial Locations

Locations (13)

St. Francis VIlla; 🇺🇸 Philadelphia, Pennsylvania, United States

Casa Carmen Aponte; 🇺🇸 Philadelphia, Pennsylvania, United States

Greenway Presbyterian Apartments; 🇺🇸 Philadelphia, Pennsylvania, United States

Jackson Place; 🇺🇸 Philadelphia, Pennsylvania, United States

Mantua Presbyterian Apartments; 🇺🇸 Philadelphia, Pennsylvania, United States

Paschall Senior Housing; 🇺🇸 Philadelphia, Pennsylvania, United States

Haven House; 🇺🇸 Cape May, New Jersey, United States

Stonegate 2; 🇺🇸 Pennsauken, New Jersey, United States

Northgate 2; 🇺🇸 Camden, New Jersey, United States

Victorian Towers; 🇺🇸 Cape May, New Jersey, United States

Stonegate 1; 🇺🇸 Pennsauken, New Jersey, United States

Old City Presbyterian Apartments; 🇺🇸 Philadelphia, Pennsylvania, United States

Neumann Senior Housing; 🇺🇸 Philadelphia, Pennsylvania, United States