Clinical trial NCT04076319: Implementing CAPABLE in PSH
Official title: Implementing CAPABLE in Permanent Supportive Housing
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Accidental Fall
Frailty
Depression
Activities of Daily Living
Housing Problems
Lead sponsor: University of Southern California
Sponsor class: OTHER
First posted: 2019-09-03
Enrollment: 60
Sex: ALL
Minimum age (years): 50
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Waitlist control design
Primary purpose: SUPPORTIVE_CARE

Brief summary: This pilot project seeks to implement an intervention known as CAPABLE (Community Aging in Place-Advancing Better Living for Elders) for formerly homeless adults living in permanent supportive housing. This home-based intervention that consists of time-limited services (no more than 6-months) from an occupational therapist, a nurse, and a handyman is intended to improve functioning and decrease falls among this population that prematurely ages and is at increased fall risk.

Detailed description: Permanent supportive housing (PSH) using a housing first approach is an evidence-based intervention to end chronic homelessness by providing low-barrier affordable housing paired with flexible health and social services. In Los Angeles County (LAC), where the number of PSH units is expected to increase dramatically over the next 10 years, clinical guidelines and/or standards for support services are lacking. This is especially problematic given the that the target population is older and prematurely aging. The chronically homeless population in the United States has an average age approaching 60 years old and experiences accelerated aging, including an elevated prevalence of geriatric syndromes such as functional impairment, falls, and urinary incontinence that can jeopardize PSH tenants' ability to live independently and age in place. Current support services are not equipped to address these needs, which ultimately jeopardizes the success of PSH to maintain high rates of housing stability while tenants "age in place."

The investigators propose conducting a pilot project to implement the CAPABLE model in PSH. CAPABLE, which stands for "Community Aging in Place-Advancing Better Living for Elders" is a client-directed home-based intervention that consists of time-limited services (no more than 6-months) from an occupational therapist, a nurse, and a handyman working collaboratively with the older adult client. CAPABLE was developed to target older adults who are returning to independent living after hospitalization and has been shown to improve functioning (activities of daily living - ADLs and instrumental activities of daily living - IADLs), decrease falls and nursing home admissions, and reduce healthcare costs based on multiple studies including several randomized control trials. CAPABLE has the potential to be used in PSH as a model of support services that can address needs of prematurely aging tenants, which could help transform PSH from an intervention that ends homeless to an intervention that addresses homelessness and supports successful aging in place.

The specific aims of this study are to:

1. Examine the impact of CAPABLE on PSH client outcomes (e.g. ADLs, IADLs, falls). This aim will be accomplished using a pre-/post-design with a wait-list control group.
2. Determine what adaptations, if any, need to be made to implement CAPABLE in PSH. The investigators will accomplish this aim using the Dynamic Adaptation Process (DAP) implementation approach, which was designed to allow for an evidenced-based practice to be adapted in a planned and considered, rather than ad hoc, manner.

Important to note is that this project was conducted during the COVID-19 pandemic so that adaptations to CAPABLE may be due to the context of the pandemic as opposed to being implemented in PSH.

Eligibility criteria: Inclusion Criteria:

* Older than 50 years in age
* cognitively intact or have only mild cognitive impairment
* have some or a lot of difficulty performing ADLs
* tenant of Skid Row Housing Trust

Exclusion Criteria:

* see above

Primary outcomes:
measure: Activities of Daily Living Limitations Score
timeFrame: Change of ability to perform activities of daily living from baseline to 6-month follow up (post-intervention).
measure: Instrumental Activities of Daily Living Score
timeFrame: Change of ability to perform IADLs from baseline to 6-month follow up (post-intervention).
measure: Depression
timeFrame: Change in depression symptoms from baseline to 6-month follow up (post-intervention).
measure: Falls Efficacy
timeFrame: Change of falls efficacy from baseline to 6-month follow up (post-intervention).
measure: Pain Interference With Usual Activities
timeFrame: Change in the degree that pain interferes with usual activities from baseline to 6-month follow up (post-intervention).
measure: Number of Falls in the Past Year or 6 Months
timeFrame: Number of falls in the past year reported at 6-month follow up.
Secondary outcomes:
measure: Self-rated Health
timeFrame: Change in self-rated health from baseline to 6-month follow up (post-intervention).
measure: Overall Quality of Life
timeFrame: Change in quality of life from baseline to 6-month follow up (post-intervention).
Other outcomes:
measure: Proportion of Participants With Emergency Room Visits in Past 6 Months
timeFrame: Proportion of participants with ER visits in past 6 months reported at 6-month follow up.
measure: Number of Emergency Room Visits in Past 6 Months
timeFrame: Number of ER visits in past 6 months reported at follow up.
measure: Proportion of Participants With Hospitalizations in Past 6 Months
timeFrame: Proportion of participants with hospitalizations in past 6 months reported at 6-month follow-up
measure: Number of Overnight Hospitalizations in Past 6 Months
timeFrame: Number of overnight hospitalizations in past 6 months reported at 6-month follow up.
Locations:
city: Los Angeles
country: United States
facility: Skid Row Housing Trust
state: California
Study officials:
affiliation: University of Southern California
name: Benjamin F Henwood, PhD
role: PRINCIPAL_INVESTIGATOR
References: