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Summary of Findings

-Addressing environmental barriers using the Canadian


Occupational Performance Measure (COPM) and
providing home modifications improved client satisfaction
in occupational performance

-Home modifications were effective in reducing difficulty
in performing daily life tasks and the amount of personal
support needed

-Home modifications need to be installed as soon as
possible after the needs have been identified to prevent
further functional decline

-Client perception of housing environment to support daily
activities improved after home modifications were
installed

-Identifying meaningful activities that older adults have
given up and providing home modifications to address
specific participant activities improved client satisfaction
with performance

-Home modifications may add years to the lives of older
adults living in their homes and prevent further decline in
health and wellness

-Areas of the home that clients reported had the most
environmental barriers for daily activities were the
bedroom, bathroom, entrances, stairways, and doorways

Implications for Occupational
Therapy

-The clinical and community-based practice of
occupational therapy: Home modifications are effective in
improving occupational performance in ADL/IADLs,
increasing safety, and improving survivorship for older
adults with functional difficulties while aging in place

-Societal needs: Lack of self-efficacy is noted in the aging
population and cites the need for home modifications to
improve independence, occupational performance, and
meet the goal of most older adults to age in place

-Healthcare delivery and policy: Home modifications may
prevent development of health problems, healthcare needs,
and functional dependency and therefore reduce healthcare
costs

-Education and training of occupational therapy
students: All students should be taught a variety of home
modifications and assistive technology to benefit older
adults with diverse disabilities as well as assessments to
identify environmental barriers within a clients home

-Refinement, revision, and advancement of factual
knowledge or theory: Further research in cost-
effectiveness, objective functional performance measures,
how much training is necessary, and usability of home
modifications is necessary

What is the Effectiveness of Home Modification I nterventions to
I mprove Performance for Older Adults With Functional Difficulties?
Johnny V. Rider, OTS and Gary L. Pearson, OTS

Touro University Nevada, School of Occupational Therapy
Introduction

-Functional disability is an adverse outcome of age related
conditions in older people. Difficulties performing ADLs
and/or IADLs represent pivotal events that may trigger the
need for personal assistance or relocation, thus increasing
financial burden and further limiting occupational
engagement. Functional disability is associated with a
diminished quality of life, poor self-efficacy, shorter life-span,
and high healthcare costs. Functional disabilities left
unaddressed lead to secondary complications that result in
social isolation, anxiety, depression, falls, and further
functional decline (Gitlin, 2006). Barriers in the home
compound minor limitations into major limitations. Home
modification can eliminate or reduce environmental barriers
to improve functional performance and quality of life.
Environmental modifications may forestall the need for more
costly traditional medical services (Stearns et al., 2000).

Level of
Evidence
Study Design/Methodology of
Selected Articles
Number
of
Articles
Selected
I Systematic reviews, meta-analysis,
randomized controlled trials
4
II Two groups, nonrandomized
studies (e.g., cohort, case-control)
3
III One group, nonrandomized (e.g.,
before and after, pretest and
posttest)
3
IV Descriptive studies that include
analysis of outcomes (single-
subject design, case series)
0
V Case reports and expert opinion,
narrative literature reviews and
consensus statements
0
Other Qualitative Studies 0
TOTAL: 10
Inclusion and Exclusion Criteria

Inclusion Criteria:
-Peer-reviewed scientific literature published in English
-Published since 2004
-Intervention focused on home adaptations or home
environment modifications
-Intervention is within the scope of practice of OT
-Older adults (age 55 or older) experiencing functional
difficulties/limitations completing activities/instrumental
activities of daily living in the home
-Level I, II, and III evidence

Exclusion Criteria:
-Published prior to 2004
-Non-peer reviewed research literature
-Studies with participants that did not have documented
functional limitations or younger than 55 years of age
-Studies focused on safety and fall prevention
-Studies that did not examine and apply interventions
focused on home/home environment modifications
-Level IV and V evidence and qualitative studies

Evidence Table
References

-Gitlin, L., Winter, L., Dennis, M., Corcoran, M., Schinfeld,
S., & Hauck, W. (2006). A randomized trial of a
multicomponent home intervention to reduce functional
difficulties in older adults. Journal of The American
Geriatrics Society, 54(5), 809-816. doi:10.1111/j.1532-
5415.2006.00703.x

-Szanton, S. L., Thorpe, R. J., Boyd, C., Tanner, E. K., Leff,
B., Agree, E., & Gitlin, L. N. (2011). Community aging in
place, advancing better living for elders: A biobehavioral-
environmental intervention to improve function and health-
related quality of life in disabled older adults. Journal of The
American Geriatrics Society, 59(12), 2314-2320.
Doi:10.1111/j.1532-5415.2011.03698.x

-Wilson, D., Mitchell, J., Kemp, B., Adkins, R., & Mann, W.
(2009). Effects of assistive technology on functional decline
in people aging with a disability. Assistive Technology, 21(4),
208-217. doi:10.1080/10400430903246068