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Importance: Frailty is common, detrimental, and costly in later life. Interventions can reduce the risk for frailty. Objective: To assess the feasibility of a frailty prevention intervention. Design: A two-arm, prospective randomized controlled trial with blinded participant allocation and data collection at baseline and 1 wk postintervention by data collectors blinded to participant assignment. Setting: Community. Participants: Thirty community-dwelling, English-speaking, older African-Americans who were classified as prefrail were randomly recruited from a university research subject registry. Intervention: The habit formation treatment was delivered face to face during 12 weekly home-based sessions approximately 45 min in length. Outcomes and Measures: We assessed feasibility as reflected in participant recruitment, retention, session attendance, and program satisfaction. Clinical outcomes included sedentary time and dietary quality (primary) as well as frailty status, physical activity, physical function, depression, quality of life, and anthropometry (secondary). Habit formation (mechanism of change) was assessed in the treatment group only. Results: Twenty women (M age = 73.5 yr) completed the study. The recruitment rate was 69.8%, and we retained 95.2% of participants through the end of the study, with session attendance rates of 98.1% and 88.6% for the treatment and control groups, respectively, and mean acceptability scores of 30.3 and 28.0 for the treatment and control groups, respectively. Changes in primary and secondary clinical outcomes were largely in the expected direction. Conclusions and Relevance: The intervention was feasible to deliver. Although future efficacy studies are needed, our preliminary data suggest the potential of an occupational therapy intervention to reduce frailty risk. What This Article Adds: Although it may be possible to slow or prevent the progression to frailty by modifying existing habits and occupations, few occupational therapy interventions address frailty. Our data provide new and much-needed insights about the potential feasibility of an occupational therapy intervention to reduce frailty risk.

Importance: Informal caregivers often receive limited training and support, especially in providing assistance with toileting, a physically and emotionally demanding activity of daily living. This increases caregivers’ risk for physical injury and burnout and jeopardizes older adults’ ability to age in place. Objective: To assess the feasibility, acceptability, and preliminary efficacy of a toileting intervention using an automated bidet to reduce the amount of physical assistance required from caregivers. Design: Randomized wait-list control feasibility study. Setting: Caregiver’s home. Participants: Ten informal caregivers. Intervention: An occupational therapy intervention to educate and train caregiving dyads to use an automated bidet system. Outcomes and Measures: Feasibility was measured in terms of recruitment and retention, bidet installation, ability to operate the bidet, acceptability (a process evaluation), preliminary efficacy (physical barriers and impact on caregiver outcomes of performance, satisfaction, and self-efficacy), and adverse events. Results: All bidets were installed successfully. All caregivers reported that the intervention made toileting easier and increased their confidence. Physical barriers decreased for the treatment group. The bidet had a large effect on self-efficacy for the treatment group. Conclusions and Relevance: The results suggest that the automated bidet intervention is feasible and acceptable and can have a positive impact on caregiver outcomes when assisting with toileting. What This Article Adds: A toileting intervention using an automated bidet is feasible and acceptable for caregivers of older adults and can reduce the amount of physical assistance required from caregivers.

Key Points Question What is the effect of a home hazard removal program on hazard of a fall in community-dwelling older adults at risk for falling? Findings This randomized clinical trial included 310 older adults. There was no difference in the primary outcome, risk of falling, between the intervention and control groups. The intervention group had a 38% reduction in falls, a secondary outcome, compared with usual care. Meaning This randomized clinical trial found that this low-cost behavioral intervention did not result in a significant difference in risk of falling or the number of home hazards removed., This randomized clinical trial examines the effectiveness of a home hazard removal program in reducing risk of falls among older adults., Importance Falls are the leading preventable cause of morbidity, mortality, and premature institutionalization for community-dwelling older adults. Objective To test the effectiveness of a behavioral intervention on fall risk among older adults receiving services from an Area Agency on Aging. Design, Setting, and Participants This randomized clinical trial examined a home hazard removal intervention in the community using a race- and sex-stratified randomization design. Older adults receiving services from the Area Agency on Aging in urban St Louis, Missouri, were assigned to a home hazard removal intervention delivered over 2 weeks with a 6-month booster or usual care control. Eligible participants were adults aged 65 years or older who did not have dementia, were at high risk for falling, and resided in the community. Enrollment occurred from January 2015 to September 2016; 12-month follow-up occurred from February 2016 to October 2017. Data were analyzed from February 2019 to July 2021. Interventions The intervention was a home hazard removal program delivered by an occupational therapist in the home that included a comprehensive clinical assessment and a tailored hazard removal plan. Usual care control consisted of annual assessments and community referral. Main Outcomes and Measures The primary outcome was the hazard of a fall over 12 months. Prespecified secondary outcomes included the rate of falls over 12 months, daily activity performance, falls self-efficacy, and self-reported quality of life. Results A total of 310 participants (mean [SD] age, 75 [7.4] years; 229 [74%] women; 161 Black participants [52%]) were randomized, with 155 participants assigned to the intervention and 155 participants assigned to usual care. Retention was 127 participants (82%) in the intervention group and 126 participants (81%) in the control group. There was no difference for our primary outcome of fall hazard (hazard ratio, 0.90; 95% CI, 0.66-1.27). There was a 38% reduction in the rate of falling in the intervention group compared with the control group (relative risk, 0.62; 95% CI, 0.40-0.95; P = .03). At 12 months, the rate of falls per person-year was 1.5 (95% CI, 1.32-1.75) in the intervention group and 2.3 (95% CI, 2.08-2.60) in the control group. There was no difference in daily activity performance (adjusted difference, −0.20; 95% CI, −0.95 to 0.55; P = .60), falls self-efficacy (adjusted difference, −0.12; 95% CI, −1.25 to 1.01; P = .84), or quality of life (adjusted difference, 0.84; 95% CI, −0.95 to 2.64; P = .35). Conclusions and Relevance This randomized clinical trial found that a brief home hazard removal program did not reduce the hazard of falls among community-dwelling older adults at high risk for falling. The intervention was effective in achieving a reduced rate of falls, a prespecified secondary outcome. This effectiveness study has the potential for delivery through the national aging services network. Trial Registration ClinicalTrials.gov Identifier: NCT02392013

Background and Objectives Older African Americans are at high risk for becoming frail in later life. Interventions can reverse or delay frailty, yet African Americans have largely been excluded from such research. Many interventions are also time- and resource-intensive, and thus inaccessible to socially disadvantaged older African Americans. We evaluated the feasibility of a low-dose frailty prevention intervention integrated with primary care among 60 community-dwelling, prefrail older African Americans aged 55+ recruited from a primary care clinic. Research Design and Methods We conducted a 2-arm randomized control trial. Participants were assigned to a 4-session intervention (1 session per month), delivered by an occupational therapist, or enhanced usual care. Feasibility criteria were set a priori at 75% for participant retention (including attrition due to death/hospitalization), 80% for session engagement, 2 participants/week for mean participant accrual, and 90% for program satisfaction. Results Participants were 65% female with an average age of 76.6 years, 51.7% lived alone and 39.1% reported Discussion and Implications The intervention was feasible to deliver. Qualitative findings from exit interviews suggested changes to the program dose, structure, and content that could improve it for future use.

Falls remain the leading cause of injury, long-term disability, premature institutionalization, and injury-related mortality in the older adult population. Home modifications, when delivered by occupational therapists, can reduce falls among high-risk community-dwelling older adults by 39%. However, home-modification implementation is not standard practice in the United States. The goal of the Home Hazard Removal Program (HARP) study is to implement an evidence-based home modification intervention for older adults designed to reduce the incidence of falls through an aging services network. We will conduct a hybrid effectiveness/implementation trial of 300 older adults at risk for a fall who are randomized and followed for 12 months. Participants who are randomized to treatment will receive the home modification intervention provided by an occupational therapist in addition to usual care, defined as continued services from the area agency on aging. We will compare the effectiveness of the program and usual care using survival analysis with the time to the first fall over 12 months as the primary outcome of interest. Secondary outcomes include daily activity performance, fall self-efficacy, and health-related quality of life. Fidelity, dose, adherence, safety, cost, and health care utilization will also be examined in the implementation component of this study. This intervention targets an underserved, difficult to reach population of older adults. The tailored approach of the study intervention is a strength in improving adherence, as each recommendation is individualized to be acceptable to the participant. The effectiveness/implementation design of the study allows for rapid dissemination of results and implementation of the intervention in a United States social services agency. Clinicaltrials.gov identifier: NCT02392013 . Retrospectively registered on March 5, 2015.

Introduction Comprehensive evaluation and intervention provided by occupational therapists is effective in reducing the presence of fall hazards in the homes of older adults. The purpose of this study was to document known environmental hazards and to update a previous content analysis. A secondary goal reviewed a framework for evaluation and practice. Methods A comprehensive scoping review of published academic articles was performed from 1996 to 2019 to answer: What environmental hazards have been associated with falls in the homes of community-dwelling older adults? Data was extracted in a standardised critical appraisal worksheet and content analysis was conducted. A review of a conceptual framework for assessment and intervention was conducted by international experts (n = 6) in face-to-face interviews. Results Fourteen studies met the inclusion criteria for the scoping study. The studies reported 17 in-home environmental hazards: throw rugs/carpets, clutter, cords/wires, poorly placed light switches, items placed too low, items placed too high, no grab bars, toilet seats too low, uneven floor surfaces, slippery/wet surfaces, snowy/icy surfaces, backless/unsupportive shoes, unsteady stairs, inadequate lighting, inadequate heating/cooling, step stools without railings, and pets. Conclusion A comprehensive list of specific fall hazards in and around the homes of older adults and a guiding framework offers occupational therapists an evidence-based foundation for fall prevention efforts.

The Lifestyle-integrated Functional Exercise Program (LiFE) is proven to have high adherence rates and can significantly reduce falls, but it has not yet been implemented for diverse older adults residing in urban medically underserved (MU) areas. An exploratory sequential mixed methods study was conducted to adapt LiFE and test the adapted program’s preliminary feasibility. Focus groups with MU older adults and service providers were conducted to identify modifications. The new adapted program, Diverse Older Adults Doing LiFE (DO LiFE), was then evaluated with older adults. Thematic analysis revealed health literacy and lack of racial representation as barriers to implementing LIFE in this population. The pilot study showed that DO LiFE was feasible with good retention (89%) and high adherence (81.27%) rates. DO LiFE demonstrated preliminary feasibility for diverse MU older adults. Researchers should proceed to larger studies for translating DO LiFE from research to the community.

Importance: Forty percent to 75% of community-dwelling older adults are not able to adhere to their medication routine. A medication management assessment can correctly identify the reasons for nonadherence and the barriers contributing to it. Objective: To further develop the HOME–Rx, an in-home medication management assessment, by modifying scoring metrics, improving clinical utility, and establishing psychometric properties. Design: In Phase 1, the scoring metrics were modified, and the clinical procedures were evaluated. In Phase 2, the psychometric properties were established. Setting: The homes of older adults. Participants: Older adults who took three or more medications, managed their own medications, and lived in their own home were eligible. Older adults with cognitive impairment were ineligible. Outcomes and Measures: We assessed concurrent validity with the Performance Assessment for Self-Care Skills (PASS) and Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and established interrater reliability. Results: The PASS was positively correlated with the HOME–Rx Performance and Safety subscales; the MedMaIDE was negatively correlated with the HOME–Rx Performance subscale and positively correlated with the Barriers subscale. Interrater reliability was excellent (ICCs = .87–1.00). Conclusions and Relevance: All relationships were as predicted: The HOME–Rx is a valid and reliable performance-based assessment that provides clinicians and researchers with a measure of older adults’ actual medication management ability in the home using their medications. The results can potentially be used to guide treatment planning and improve medication management. What This Article Adds: Occupational therapy practitioners can use the HOME–Rx to adequately determine performance problems, safety concerns, and environmental barriers and potentially to guide treatment planning and improve medication management for older adults.

OBJECTIVE. The aim of this study was to conduct a process evaluation to examine the implementation of a randomized controlled trial of home modifications designed to reduce the risk of falls and improve daily activity performance among community-dwelling older adults. METHOD. A process evaluation was conducted alongside a blinded, randomized sham-controlled trial (n = 92). Participants were followed for 1 yr after intervention. The process evaluation was framed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. RESULTS. The treatment group improved daily activity performance over 12 mo compared with the sham control group (F = 4.13; p = .024). The intervention elements and dose were delivered with greater than 90% accuracy. Participants reported a 91% adherence rate at 12 mo. CONCLUSION. The complex intervention of home modifications examined in this study is acceptable to older adults, is feasible, and can be delivered with high fidelity for frail, community-dwelling older adults.

OBJECTIVE. This study assessed the initial psychometric properties of a novel in-home, performance-based instrument for older adults called the In-Home Medication Management Performance Evaluation (HOME–Rx). METHOD. Content validity of the HOME–Rx was determined through the multistep content validity index (CVI) process. Content experts provided qualitative and quantitative judgment of the instrument’s ability to measure medication management. The assessment’s target population provided qualitative feedback. CVI outcomes informed instrument revisions. RESULTS. Content experts (n = 7) were in agreement that the overall instrument was valid for measuring medication management (scale-level CVI = .95). Six items were deleted because of low agreement (item-level CVI CONCLUSION. The HOME–Rx appears to be a relevant and valid method to assess performance barriers to medication management in the home.

To establish a new method on stratification analysis when the stratification limits of confounding factors was not clear or contradictory.Data on a study of diabetes mellitus in Guangdong province collected in the year of 1997 and 1998 was analyzed using cluster-stratification analysis.The efficiency of stratification analysis was improved and the confounding bias was effectively controlled with information bias avoided when the clusters-stratification analysis was applied.The problem was logically solved using cluster analysis as an assistant stratification means.

A case-control study involving 390 lung cancer cases, matched 1:1 with controls, was carried out in Guangdong Province to compare risk factors for different histopathologic types of lung cancer in both sexes. Female and male lung cancers appear to differ in epidemiological characteristics, pathologic types, and risk factors. The 291 lung cancer cases in males were predominantly squamous cell lung carcinoma (squamous cell carcinoma/adenocarcinoma = 1:0.5), whereas the 99 female lung cancer cases were predominantly adenocarcinoma (squamous cell carcinoma/adenocarcinoma = 1:2.7). The age at which lung cancer was first diagnosed was lower for females than for males (P < 0.0001). Single-factor conditional logistic regression analysis showed an association of lung cancer with family history of tumors, family history of lung cancer, history of chronic bronchitis/emphysema, history of tuberculosis, history of other lung disease, smoking, exposure to environmental tobacco smoke (ETS) in the home and in the workplace, being professional drivers, use of oral contraceptives, and consumption of pickled and salted fish (P < 0.05). Further multivariate logistic regression analysis showed that family history of tuberculosis, history of chronic bronchitis/emphysema, family history of tumors, smoking, exposure to ETS in the home and in the workplace, and consumption of pickled and salted fish were independent risk factors for lung cancer. Using log-linear model analysis, it was confirmed that lung cancer had significant interactions with chronic bronchitis/emphysema, exposure to ETS, history of tuberculosis and smoking. Smoking, however, could only explain 1/5 of the incidence of female lung cancers. Family history of lung cancer and the use of oral contraceptives were related to lung cancer in women. Except for a weak relationship with history of chronic bronchitis/emphysema, adenocarcinoma was found to have no association with the other risk factors.