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Activities of Daily Living Function and Disability in Older Adults in a Randomized Trial of the Health Enhancement Program

¹ Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle.
² Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle.
³ Sticht Center on Aging, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
⁴ Department of Medicine, Division of General Medicine, University of Washington, Seattle.
⁵ Research and Training Institute, Hebrew Rehabilitation Center for Aged, Boston, Massachusetts.

Address correspondence to Elizabeth A. Phelan, MD, Division of Gerontology and Geriatric Medicine, University of Washington, 325 9th Avenue, Box 359755, Seattle, WA 98104-2499. E-mail: phelane{at}u.washington.edu

Background. Disability in basic activities of daily living (ADLs) implies a loss of independence and increases the risk for hospitalization, nursing home admission, and death. Little is known about ways by which ADL disability can be prevented or reversed. The authors evaluated the efficacy of the Health Enhancement Program in preventing and reducing ADL disability in community-dwelling older adults.

Methods. The authors analyzed data from a 12-month, randomized, single-blinded, controlled trial of a disability prevention, chronic disease self-management program involving 201 adults aged 70 years and older that was conducted from February 1995 to June 1996 at a senior center in western Washington state. Activities of daily living disability incidence, improvement, and worsening were assessed using intention-to-treat methods.

Results. The cumulative incidence of ADL disability among those who were not ADL disabled at baseline (n = 56 in the intervention group, n = 57 in the control group) was modestly lower in the intervention group than in the control group at 12 months (14.3% vs 21.3%, p =.466). Cumulative improvement in ADL function among those who reported any ADL disability at baseline (n = 41 in the intervention group, n = 43 in the control group) was greater in the intervention group at 12 months (80.5% vs 46.5%, p =.026). The likelihood for ADL improvement was greater in the intervention group compared with controls at 12 months (adjusted hazard ratio, 1.84; 95% confidence interval, 1.05 to 3.22; p =.020). Cumulative worsening of ADL function was slightly lower in the intervention group at 12 months (18.6% vs 26.5%, p =.237). Intervention participants tended to be at lower risk for ADL worsening (adjusted hazard ratio, 0.71; 95% confidence interval, 0.38 to 1.30; p =.266) compared with control participants.

Conclusion. The Health Enhancement Program intervention led to improved ADL functioning in those who were disabled initially and thereby offers a promising strategy for limiting or reversing functional decline in disabled elderly persons.