Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Many evidence-based home and community programs designed to support aging in place do not include care partners, including the well-known Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program. How OT practitioners can include care partners in CAPABLE and which strategies may work best for care partners are currently being explored. This presentation will discuss recent evidence on how to adapt CAPABLE to include care partners.
Primary Author and Speaker: Beth Fields
Additional Authors and Speakers: Pamela Toto
Contributing Authors: Molly Ennis, Caylee Yanes
PURPOSE: Older adults frequently turn to care partners (i.e., family members or friends) for support to age independently or remain in their home and community as long as possible (AARP, 2019). Yet, many evidence-based home and community programs designed to support aging in place do not include care partners, including the well-known Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program (Szanton et al., 2011; Szanton et al., 2014). This is problematic because care partners help older adults complete a range of tasks including self-care activities, household chores, and complex medical and nursing routines. Including care partners in CAPABLE may further improve the health outcomes, experiences, and costs for older adults (Rodakowski et al., 2017). Therefore, the purpose of this study was to adapt the CAPABLE program to include care partners.
DESIGN: A descriptive qualitative study was conducted and guided by the Cultural Adaptation Process (CAP) Framework.
METHOD: Data collection occurred with key stakeholders from a local Area Agency on Aging in Western Pennsylvania. Two, 60-minute focus groups were conducted with frontline providers (n = 7) and administrators (n = 7). Ten, 30-minute individual interviews were conducted with AAA consumers including older adults (n = 5) and their care partners (n = 5). Focus groups and interviews provided in-depth perspectives of CAPABLE with respect to benefits, limitations, barriers, and facilitators for including care partners in the program. Thematic analysis of interview data were completed using NVivo 12 Pro.
RESULTS: Stakeholders described three central themes to consider when adapting CAPABLE to include care partners: older adult preference and care partner willingness, clear guidelines and expectations, and hands-on training. Older adults and care partners recognized the need to allow them ‘to decide when and why the care partner should be involved in the program.' Frontline providers and administrators explained the importance of ‘determining whether older adults and care partners should have shared or separate goals for the program.' All stakeholders expressed that including care partners would ‘reaffirm the educational and hands-on information like fall risks and equipment use.' Illustrative quotes from stakeholders' focus groups and interviews were expounded to further develop the understanding of these themes.
CONCLUSION: The stakeholder perspectives shed light on how to include care partners in the CAPABLE program and why. Information gleaned from this study may help researchers think about ways in which to adapt other evidence-based programs to include care partners. Findings may also help occupational therapy and other health care providers target and support care partners in the delivery of their services. These implications for research and practice will help close the gap in recognizing care partners in facilitating aging in place and improving the health outcomes, experiences, and costs for older adults.
References
Szanton, S.L., Thorpe, R.J., Boyd, C., Tanner, E.K., Leff, B., Agree, E., Xue, Q.L., Allen, J.K., Weiss, C., Seplaki, C.L., Guralnik, J.M., Gitlin, L.N. (2011). CAPABLE: A bio-behavioral-environmental intervention to improve function and health-related quality of life of disabled, older adults. Journal of the American Geriatrics Society, 59(12), 2314-2320.
Szanton, S.L., Wolff, J.W., Leff, B.L., Thorpe, R.J., Tanner, E.K., Boyd, C., Xue, Q., Guralnik, J., Bishai, D., Gitlin, L.N. (2014). CAPABLE trial: a randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: rationale and design. Contemporary Clinical Trials, 38(1), 102-112.
Rodakowski, J., Rocco, P. B., Ortiz, M., Folb, B., Schulz, R., Morton, S. C., James, A. E. (2017). Caregiver integration during discharge planning for older adults to reduce resource use: A metaanalysis. Journal of the American Geriatrics Society, 65(8), 1748-1755.
AARP. (2019). Valuing the invaluable 2019 update: Charting a path forward. Retrieved from https://www.aarp.org/ppi/info-2015/valuing-the-invaluable-2015-update.html).This/
