In a study comparing interventions designed to prevent loss of independence in activities of daily living among adults age 80 or better, Swedish researchers found that compared to home visits, group meetings of elderly adults led to more positive long-term outcomes.
This study included a representative sample of 459 independent and community-dwelling older adults, who were randomly assigned to three groups. One group received a preventative home visit from either an occupational therapist, a registered physiotherapist, a registered nurse, or a social worker. These professionals provided information and advice on municipal services available, and identified environmental fall risks in the home. The second group participated in four weekly group meetings with other older adults, which were administered by an occupational therapist, a registered nurse, a physiotherapist, and a social worker. These group leaders were trained to encourage and guide the participants in a process that acknowledged the older adults’ expertise and encouraged an exchange of knowledge among all present as opposed to a one-way transfer of knowledge from the professional to the participants. Topics included the aging process and possible health consequences, as well as strategies for solving problems that might arise in the home environment. These sessions were followed by a one-on-one home visit two to three weeks later to discuss group topics in more depth. Lastly, there was a control group which had access to the ordinary range of community services offered by municipal care for the aged, but did not take part in any intervention.
At the start of the study, all participants were independent in activities of daily living. In the one-year follow-up, 61 percent of the participants in the group meetings remained independent, compared to 53 percent of participants who had the preventative home visit and 45 percent of the control group. The difference between the group meeting participants and the other two groups was statistically significant, but the difference between the home visit group and the control group was not. Two years after the interventions, there were no statistical differences between the number of participants in any of the groups who remained independent in all activities of daily living.
The study also examined differences between the groups in the number of activities of daily living in which individuals required assistance. The scale used to measure independence asked about participants’ need for assistance with or inability to perform nine activities of daily living. One year after the interventions, 20 percent of the home visit participants and 15 percent of group meeting participants were no longer independent in two or more activities of daily living, compare to 39 percent of the control group. Looking at participants who were no longer independent in three or more activities of daily living, only 7 percent of group meeting and home intervention participants were no longer independent in three or more activities, compared with 17 percent of controls. At a the two-year follow-up, 25 percent of the participants in the group meetings were no longer independent in three or more activities of daily living, compared to 40 percent of controls. (The difference between controls and home intervention participants was not statistically significant.)
Looking at those participants in most need of assistance two years after the intervention, 14 percent of participants in the group meetings needed assistance in four or more activities, compared to 29 percent of control group participants. (Again, the difference between home intervention and control participants was not statistically significant.)
While the differences between group meeting participants and the control group in this study may not be surprising, the improved impact of the group meeting participants over the home intervention participants is particularly noteworthy. Greater independence in activities of daily living has been associated with greater life satisfaction among older adults, as well as better health status and lower demands and costs for caregivers.
The authors also suggest some possible reasons for the more positive outcomes for group meeting participants. Group meeting participants may be benefiting from the knowledge and advice from other older adults as well as the experts facilitating these meetings. Being exposed to other older adults may also play a role in motivating behavioral change in these group meeting participants. Other research on such group meetings suggests that in these meetings “the benefits of making a change, seeing solutions, and planning to take action are more apparent.” In order to improve on the positive impact of group meetings observed here, the authors suggest that a greater number of meetings in the intervention or booster sessions after the original intervention might lead to even greater beneficial outcomes.
Zidén L, Häggblom-Kronlöf G, Gustafsson S, et al. Physical function and fear of falling 2 years after the health-promoting randomized controlled trial: elderly persons in the risk zone. The Gerontologist. (2013). DOI: 10.1093/geront/gnt078