Promoting Seniors' Health With Home Care Aides

Study Overview
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Brief Summary
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This study aims to test whether a safe physical activity program with a built-in motivational enhancement component, performed in a seated position, preserves the function and well-being of older home care clients.

Detailed Description
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Regular physical activity benefits older adults physically and mentally. However, the availability and the evidence for physical activity programs that are safe and appropriate for home-bound older adults at risk for nursing home admission are limited. The current project aims to examine the effectiveness of a safe physical activity program, led by home care aides who regularly help hard-to-reach older home care clients with housekeeping and routine personal care services in the home. The primary aim is to test whether the safe physical activity program with a built-in motivational enhancement component, performed in a seated position, preserves the function and well-being of home care clients. The secondary aim is to understand for whom the program is efficacious, the extent to which the program can reach the target population, the extent to which participants drop out of the program, the extent to which program participants maintain the behavioral change introduced by the intervention, and what the program's cost-effectiveness is. Building on a pilot project that demonstrated the program's feasibility in a large home care program funded by the state and Medicaid, this randomized controlled trial will inform future expansion of the physical activity program into real-world home care settings.

Official Title
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Promoting Seniors' Health With Home Care Aides: A Randomized Controlled Trial

Conditions
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Muscle Weakness

Intervention / Treatment
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* Behavioral: Healthy Moves for Aging Well (Healthy Moves)
* Behavioral: Active Mind for Aging Well (Active Mind)


Participation Criteria
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Eligibility Criteria
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HOME CARE CLIENTS Inclusion Criteria: English or Spanish-speaking older adults aged 60+ Receiving Illinois Department on Aging Community Care Program In-Home service from the collaborating home care agency Able to sit in a chair independently for >=15 minutes (it is fine if the person needs help with transferring to a chair) Cognitive status sufficient to follow directions and respond to survey questions as determined by the Six-Item Screener (Callahan, et al., 2002) (the instrument used in the phone screening) and the Modified Mini-Mental State (3MS) Examination (the instrument used in the in-home screening) Willing to be assigned to either intervention program Willing to have the research team notify the primary care physician of the client's study participation Exclusion Criteria: Having a legal guardian appointed Bedridden or unable to sit in a chair independently Receiving hospice care or having a terminal diagnosis Self-reported inability to read large print books HOME CARE AIDES Inclusion Criteria: English or Spanish-speaking home care aide caring for an older home care client eligible for the study Age 18 and older Willing to implement the intervention program routine with their eligible client(s) for the full 4 months Willing to be randomly assigned to either intervention program Intend to be a home care aide for the next 12 months Exclusion Criteria • Not having a home care client who participates in the study

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 110 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Home care aide-client pairs will be randomly assigned to one of two groups in parallel for the duration of the study. Home care aides will not be allowed to have multiple participating clients assigned to different groups to prevent group contamination.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Healthy Moves<br>Home care aides (HCAs) will be trained to deliver Healthy Moves for Aging Well (Healthy Moves), a gentle physical activity program, to their clients. On the first home care visit after the training, HCAs will introduce the program, assess their clients' readiness for the activity and have their clients set personally meaningful goals, and teach the three chair-bound moves. Home care clients will be asked to do the three moves every day. HCAs remind clients of their activity as part of their regular home care visits throughout the 4-month intervention period. | Behavioral: Healthy Moves for Aging Well (Healthy Moves)<br>* A safe physical activity program which consists of a brief motivational enhancement and three movements to be performed in a seated position. The intervention will be delivered by home care aides for their clients.<br>|
| Active Comparator: Active Mind<br>Home care aides (HCAs) will be trained to deliver Active Mind for Aging Well (Active Mind), a gentle thinking activity program, to their clients. On the first home care visit after the training, HCAs will introduce the program, assess their clients' readiness for the activity and have their clients set personally meaningful goals, and teach the activity. Home care clients will be asked to do a word search puzzle every day. HCAs remind clients of their activity as part of their regular home care visits throughout the 4-month intervention period. | Behavioral: Active Mind for Aging Well (Active Mind)<br>* A word puzzle program which consists of a brief motivational enhancement and word search activities. The intervention will be delivered by home care aides for their clients.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline Function (Daily activity difficulties and dependency in older home care clients) at Month 4 | Activities of daily living that are specifically targeted by the intervention (6-items scale; each task will be scored 0-no difficulty/no help; 1=difficulty but no help; 2=need help; summed score, range 0-12) | Month 4 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Short Physical Performance Battery (SPPB) | Range 0-12 (Guralnik et al., 1994) | Baseline, Month 4, Month 8 | 
| Exercise-related social support from home care aides | Frequency of support from home care aides. Three items, range 3-9. Adapted from Sallis et al. (1987) | Baseline, Month 4, Month 8 | 
| Self-rated health | General self-rated health, range 1-5 (poor to excellent) | Baseline, Month 4, Month 8 | 
| Pain interference | Interference with daily activities due to pain (not at all to extremely), range 1-5 | Baseline, Month 4, Month 8 | 
| Fear of falling | Short Falls Efficacy Scale-International (FES-I), seven items, 4-point scale (not at all worried to very worried), range 7-28 (Kempen et al., 2008). | Baseline, Month 4, Month 8 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Exercise, Frail Elderly, Homebound Persons, Activities of Daily Living, Mobility Limitation, Home Care Services, Long-Term Care, Dual MEDICAID MEDICARE Eligibility