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 chron ic illness in frail older people living in the community. OBJECTIVE: T o evaluate the impact of a 1-year, senior center-based chronic illness self-management and disability prevention program on health, function ing, and healthcare utilization in frail older adults. DESIGN: A rando mized controlled trial. SETTING: A large senior center located in a no rtheast Seattle suburb. The trial was conducted in collaboration with primary care providers of two large managed care organizations. PARTIC IPANTS: A total of 201 chronically ill older adults seniors aged 70 an d older recruited through medical practices. INTERVENTION: A targeted, multi-component disability prevention and disease self-management pro gram led by a geriatric nurse practitioner (GNP). MEASUREMENTS: Self-r eported Physical function, physical performance tests, health care uti lization, and health behaviors. RESULTS: Each of 101 intervention part icipants met with the GNP from 1 to 8 times (median = 3) during the st udy year. The intervention group showed less decline in function, as m easured by disability days and lower scores on the Health Assessment Q uestionnaire. Other measures of function, including the SF-36 and a ba ttery of physical performance tests, did not change with the intervent ion. The number of hospitalized participants increased by 69% among th e controls and decreased by 38% in the intervention group(P=.083). The total number of inpatient hospital days during the study year was sig nificantly less in the intervention group compared with controls (tota l days = 33 vs 116, P =.049). The intervention led to significantly hi gher levels of physical activity and senior center participation and s ignificant reductions in the use of psychoactive medications. CONCLUSI ONS: This project provides evidence that a community-based collaborati on with primary care providers can improve function and reduce inpatie nt utilization in chronically ill older adults. Linking organized medi cal care with complementary community-based interventions may be a pro mising direction for research and practice.