Research Platform
Issue Date: July 01, 2015
Published Online: February 09, 2016
Updated: January 01, 2020
Home Modifications to Improve the Performance and Participation of Older Adults With Chronic Conditions
Author Affiliations
  • Washington University in St. Louis
  • Washington University in St. Louis
Article Information
Geriatrics/Productive Aging / Home Accessibility/Environmental Modification / Rehabilitation, Participation, and Disability / Prevention and Intervention
Research Platform   |   July 01, 2015
Home Modifications to Improve the Performance and Participation of Older Adults With Chronic Conditions
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911515046.
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911515046.

Date Presented 4/16/2015

Home modifications improve daily activity performance and could potentially affect other important health outcomes, including community participation for older adults with chronic conditions.

SIGNIFICANCE: There is a growing pool of evidence that suggests the favorable outcomes of home modifications. These studies have demonstrated immediate benefits (such as improved function and independence) and long-term gains (such as decreased health service utilization or improved life expectancy). There is a lack of evidence that examines the intermediate effects of this intervention, such as community participation.
INNOVATION: What difference does it make in someone’s life if he or she is able to get in and out of his or her home or bathe independently? Clinically, we have noted that after older adults gain independence in their homes, they are more likely to engage in community activities. Is it possible that simple, inexpensive changes to the homes of older adults can modify their health behaviors?
The purpose of this study was to determine whether an environmental modification intervention can improve community participation of older adults with chronic conditions and to determine feasibility of translating findings into a national home modification program.
METHOD: We conducted a randomized controlled feasibility trial of home modifications in a sample of 28 older adults with chronic conditions. We measured their performance before and after the intervention with a 6-mo follow-up. Treatment was provided by occupational therapists according to a manualized intervention protocol.
We assessed the ability to perform daily activities and the presence of environmental barriers in the home using the In-Home Occupational Performance Evaluation—a performance-based assessment. Global positioning satellite data (latitude, longitude, altitude, speed, direction, and street location) were collected via cellular phones every 60 s for a 24-hr period. The generalized linear model (GLM) procedure was used to examine the between-groups change in occupational performance and participation.
RESULTS: The average age of the participants was 78.8 yr. Most (78%) were female. The average number of comorbidities was nine. The average number of daily activity problems addressed was six. For the primary endpoints of performance of activities and satisfaction with activities, there is a main effect of improved performance and satisfaction in the treatment group (p < .000). Geo-coded maps of before and after intervention community participation indicate differential patterns of community participation. There was an increase in community participation as measured by the total number of destinations and distance traveled for the treatment compared to the control group.
CONCLUSIONS: The intervention and assessment procedures were well tolerated. Home modifications do improve the performance of daily activities at home and may affect community participation. Limitations of the study include a brief activity monitoring period and no control for seasonal differences.
Gitlin, L. N., Hauck, W. W., Winter, L., Dennis, M. P., & Schulz, R. (2006). Effect of an in-home occupational and physical therapy intervention on reducing mortality in functionally vulnerable older people: Preliminary findings. Journal of the American Geriatrics Society, 54, 950–955.
Gitlin, L. N., Winter, L., Dennis, M. P., Corcoran, M., Schinfeld, S., & Hauck, W. W. (2006). A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults. Journal of the American Geriatrics Society, 54, 809–816.
Mann, W. C., Ottenbacher, K. J., Fraas, L., Tomita, M., & Granger, C. V. (1999). Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly: A randomized controlled trial. Archives of Family Medicine, 8, 210–217.
Petersson, I., Lilja, M., Hammel, J., & Kottorp, A. (2008). Impact of home modification services on ability in everyday life for people ageing with disabilities. Journal of Rehabilitation Medicine, 40, 253–206.
Stark, S. L., Somerville, E. K., & Morris, J. C. (2010). In-Home Occupational Performance Evaluation (I-HOPE). American Journal of Occupational Therapy, 64, 580–589.