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.

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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. http://dx.doi.org/10.5014/ajot.2010.08065