At-home program lowers mortality among elderly

NEW YORK, June 20 (Reuters) A training program of occupational and physical therapy individually tailored for older people living on their own not only helps them stay independent longer; it may help them live longer, too.

Dr Laura N Gitlin of Thomas Jefferson University in Philadelphia and her colleagues had previously reported that among 319 men and women 70 and older, those who participated in the six-month program had an easier time with activities of daily living like bathing and going to the bathroom, and were less afraid of falling.

The intervention consisted of four 90-minute visits and one telephone interview with an occupational therapist and a 90-minute visit with a physical therapist. Participants worked with the therapists to set goals to help them cope with difficulties they were experiencing in daily life, and to install modifications to their homes to make them safer, such as handholds and railings for bathrooms. Participants also received instruction on problem-solving techniques and training in balance and muscle strength and fall recovery.

Half of the study group underwent the intervention, while the other half received no training or instruction and served as a comparison ''control'' group.

In the June issue of the Journal of the American Geriatrics Society, Gitlin and her team report on a 14-month follow-up of that study. During that time, 1 per cent of the people who participated in the intervention died, compared with 10 per cent of those who received no treatment.

While none of the 31 active study participants who had been hospitalized previously died during the follow-up period, 21 per cent of those previously hospitalized in the control group did.

Among the participants who were ranked the lowest on using control-oriented coping strategies -- such as self-pacing or using special equipment -- at the study's outset, 3 per cent of those in the training group died, compared to 11 per cent in the no-training group. Among those who scored highest on using such strategies, none in the active group died, compared to 9 per cent in the control group.

''The intervention appears to have afforded added protection for those who were most compromised,'' Gitlin and her team write.

They conclude: ''These study results provide preliminary evidence that addressing the everyday difficulties of functionally vulnerable older people by introducing home modifications and other control-oriented strategies may reduce mortality risk. This appears to be the case in particular for those who are most compromised, who are hospitalized, or who do not use control-oriented strategies.'' Reuters CH GC0844