CAPABLE for People After Hospitalization: A Randomized Trial

Abstract

Background: Following hospitalization, nearly 30% of older adults lose some independence. This can lead to rehospitalization, nursing home admission, and increased dependence. CAPABLE, an evidence-based program, increases independence among older adults with functional limitations but has not been tested in recently hospitalized people. Methods: This randomized clinical trial enrolled 268 low-income community-dwelling adults who had been discharged to home from the hospital 60 days prior, had a home health episode, yet had remaining difficulties in at least one activity of daily living. Participants were randomized to no further care or to CAPABLE, which involved up to 10 home visits over 5 months with an occupational therapist, a registered nurse, and a handyworker to address an older adult's self-identified functional goals. Main outcomes were (1) improvement in difficulty with and assistance needed for 10 activities of daily living (range 10–50); (2) five instrumental activities of daily living and mobility: walking up a set of stairs and walking a block. Results: The CAPABLE group decreased their ADL difficulty by −1.76 (CI −2.98, −0.54) and the control group decreased (−0.63: CI −1.86, 0.60) over 5 months, which was not statistically or clinically significant. However, the CAPABLE treatment group demonstrated greater improvement in a composite mobility measure than control participants (−0.52 and −0.02, respectively, p = 0.028). Additionally, among participants with four or more co-morbidities at baseline, the CAPABLE group showed significantly improved ADL independence compared to control participants. Conclusions: Among recently hospitalized persons receiving skilled home health care, CAPABLE did not improve ADLs. However, it improved functional mobility and benefited those with ≥ 4 comorbidities. This study provides novel information on targeting CAPABLE in the post-hospitalization period.