CAPABLE trial: A randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: Rationale and design
Open accessAbstract
BACKGROUND: As the population ages, it is increasingly important to test new models of care that improve life quality and decrease health costs. This paper presents the rationale and design for a randomized clinical trial of a novel interdisciplinary program to reduce disability among low income older adults based on a previous pilot trial of the same design showing strong effect. METHODS: The CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial is a randomized controlled trial in which low income older adults with self-care disability are assigned to one of two groups: an interdisciplinary team of a nurse, occupational therapist, and handyman to address both personal and environmental risk factors for disability based on participants' functional goals, or an attention control of sedentary activities of choice. Both groups receive up to 10 home visits over 4 months. OUTCOMES: The primary outcome is decreased disability in self-care (ADL). Secondary outcomes are sustained decrease in self care disability as well as improvement in instrumental ADLS, strength, balance, walking speed, and health care utilization. Careful cost tracking and analysis using intervention data and claims data will enable direct measurement of the cost impact of the CAPABLE approach. CAPABLE has the potential to leverage current health care spending in Medicaid waivers, Accountable Care Organizations and other capitated systems to save the health care system costs as well as improving low income older adults' ability to age at home with improved life quality.
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The CAPABLE program cost less than $3000 per participant and provided a 10-fold return on investment via reduced healthcare utilization.
“The program cost less than $3000 per participant and provided a 10-fold return on investment via reduced healthcare utilization.”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [87]
There were significant improvements in activities of daily living (ADLs) and independent activities of daily living (IADLs) and reductions in depressive symptoms in the CAPABLE program.
“There were significant improvements in activities of daily living (ADLs) and independent activities of daily living (IADLs) and reductions in depressive symptoms.”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [87]
In an RCT of the CAPABLE program, 79% of participants improved.
“In an RCT of the program, 79% of participants improved [87].”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [87]
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Improvements of Disability Outcomes in CAPABLE Older Adults Differ by Financial Strain Status
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Older People’s Descriptions of Their Engagement in Fall Prevention
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The Cleveland Clinic Pharmacy Population Health Management Summit
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Innovations for aging in place
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Module 2: Skills for Feeling: Recognizing and Managing Strong Emotions
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- Authors
- Szanton, S. L., Wolff, J. W., Leff, B., Thorpe, R. J., Tanner, E. K., Boyd, C., Xue, Q., Guralnik, J., Bishai, D., & Gitlin, L. N.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Szanton, Sarah L.
- ORCID
- Venue
- Contemporary Clinical Trials
- Publisher
- Elsevier BV
- Published
- 2014-05
- Volume
- 38
- Issue
- 1
- Pages
- 102-112
- ISSN
- 1551-7144 (ISSN-L)
- PMC
- PMC4074085
- OpenAlex
- W1983685374
- Cited by
- 138
- References
- 62
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 10 · 2023: 10 · 2022: 9 · 2021: 44 · 2020: 11 · 2019: 16 · 2018: 5 · 2017: 7 · 2016: 10 · 2015: 3
- FWCI
- 6.63
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Contemporary Clinical Trials (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01-AG040100)
- Robert Wood Johnson Nurse Faculty Scholars Program (69351)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Health Professions › Occupational Therapy › Occupational Therapy Practice and Research
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- self-care disability, older adults, low income, interdisciplinary care teams, nurses, occupational therapists, home visits, aging in place, activities of daily living, instrumental activities of daily living, environmental risk factors, health care costs, Medicaid waivers, accountable care organizations, capitation
- MeSH terms
- Activities of Daily Living, Aged, Postural Balance, Female, Persons with Disabilities, Disabled Persons, House Calls, Humans, Male, Nurses, Occupational Therapy, Patient Acceptance of Health Care, Poverty, Quality of Life, Research Design, Risk Factors, Socioeconomic Factors, United States, Muscle Strength, Independent Living
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