ABSTRACT
Regular participation in physical activity benefits older adults physically and mentally. However, the availability and assessment of physical activity programs that are safe and appropriate for homebound older adults at risk for nursing home admission are limited. Here we describe the protocol for a randomized controlled trial that examines the effectiveness of a gentle physical activity program. Delivered by home care aides who regularly help hard-to-reach older home care clients with housekeeping and routine personal care services in the home, this program is implemented in a real-world context of caregiver-client dyads in a Medicaid-funded home care program. The trial uses a two-group repeated measures design (baseline, Month 4, and Month 8) with 300 pairs of eligible home care clients and their home care aides. The results from this trial could provide evidence and guidelines for a new model of home care, which would facilitate the working together of older home care clients and their home care aides to maintain or improve the functional status of nursing home-eligible older adults.
Subject(s)
Home Care Services , Home Health Aides , Homebound Persons , Aged , Exercise , Frail Elderly , Humans , Randomized Controlled Trials as TopicABSTRACT
OBJECTIVE: To address the gap of knowledge about slips, trips, and falls (STFs) among home care aides (HCAs) who work in clients' homes. METHODS: This mixed method study used survey and focus group data of HCAs in a Medicaid-funded homecare program. RESULTS: STFs were common with over 12% of HCAs reporting occurrence in the previous 12 months, of whom 58% fell to the ground. Both survey and focus group data identified ice, clutter, workload, rushing and other hazards. Focus group data explained the reasons for not reporting STFs, even among those who sustained injury, and added HCAs' voices to the understanding of causes, consequences and prevention strategies for STFs. CONCLUSIONS: Empowering HCAs with knowledge, training, and involvement may transform "near miss" STFs into opportunities to prevent STFs among care workers and their clients.
Subject(s)
Accidental Falls/statistics & numerical data , Accidents, Occupational/statistics & numerical data , Home Health Aides/statistics & numerical data , Accidental Falls/prevention & control , Accidents, Occupational/prevention & control , Adolescent , Adult , Aged , Female , Focus Groups , Humans , Ice , Male , Middle Aged , Risk Factors , Surveys and Questionnaires , Workload , Young AdultABSTRACT
Purpose: Regular physical activity (PA) benefits older adults. However, frail older adults lack opportunities to be physically active. This pilot study aimed to test and enhance the feasibility of a PA program delivered by home care aides (HCAs) for community-dwelling older adults in a Medicaid-funded home care setting and to generate preliminary efficacy and cost data. Design and Methods: HCAs were trained to deliver a brief motivational enhancement and three chair-bound movements to motivate their older clients to do PA daily and to help maintain their independence in the community. Mixed methods were used to evaluate clients' function and health before and after the 4-month intervention. Results: Clients' daily activity function and health outcomes (physical fitness, self-rated health, pain interference, and fear of falling) improved significantly. The program was well-received by clients (N = 54) and their HCAs (N = 46) as indicated by high retention rates among client participants (93%) and remarks provided by clients. Implications: Building PA into the everyday care of older adults and the routine work of HCAs is feasible. The intervention has the potential for further implementation and dissemination.
