Sitting in my upstairs office at home, I can hear My Lovely Wife gamely climbing the stairs. It’s a bit of a production. To reduce the pressure on her bum right knee, she braces herself on the wall with her right hand and ascends slowly, one step at a time — left, brace, right . . . left, brace, right . . . left, brace, right. The stairs creak in a way that suggests sympathy.
Typically, this sort of moment passes without comment; MLW walks down the hall, disappears into her studio, and I return to whatever I am doing. That quirky knee has been a topic of conversation for all of the 40-some years we’ve been together, and usually there’s no elaboration necessary. Some days it’s fine, some days not so much. But as we shuffle slowly toward septuagenarian status, there are times when we can’t help but admit that any particular limitation we experience may be less an aberration than evidence of an unpromising trend: We’re getting old.
On those occasions, our discussions generally veer toward home-modification strategies: a second bathroom upstairs, part of a suite of rooms for a live-in personal-care assistant; grab bars for the downstairs bathtub; a railing on the front sidewalk steps; first-floor office and studio space. That none of these projects has advanced beyond lively dinner-table conversation probably testifies to our procrastinating natures — as well as an anemic retirement account. That doesn’t mean we’re not planning for a more challenging future. It’s just that certain contingencies will always take priority over others. Besides, we’re not that old.
And I’m heartened by recent developments on the in-home personal-care front. Kaiser Health News last week reported that a revolutionary new approach to helping vulnerable elders live independently is gaining traction nationwide.
A program called Community Aging in Place – Advancing Better Living for Elders (CAPABLE) operates on a completely different premise from conventional healthcare models. Rather than focusing on what’s wrong with their clients, CAPABLE staff ask them to describe the activities they currently aren’t able to do that they’d most enjoy doing again. Then they devise practical ways to make those activities possible.
We’re not talking about octogenarians yearning to run a marathon. Many seniors just wish they could cook their own meals again, make their beds, get up and down the stairs, or simply get out of the house for a walk or a trip to church. So, while the solutions tend to be relatively simple — a grab bar here and there, a new walker, some timely kitchen-navigation advice — the effect can be transformative.
Results of a randomized clinical trial, published in JAMA Internal Medicine, showed that elderly adults who participated in the CAPABLE program reported 30 percent fewer difficulties in their daily activities. That’s not an insignificant outcome, said John Haaga, director of the Division of Behavioral and Social Research at the National Institute on Aging. “If someone found a drug that reduced disability in older adults by 30 percent, we’d be hearing about it on TV constantly.”
Researchers divided the 300 study subjects — nearly all of whom were African-American women, 75 years old on average, living on a low income, and suffering from multiple chronic illnesses — into two groups. Half of the participants enrolled in the CAPABLE program, which offered six visits from an occupational therapist, four visits from a registered nurse, and $1,300 worth of home-improvement services during the five-month trial. Members of the control group met 10 times with a research assistant, who encouraged them to engage in various activities, including board games, social media — or simply spending some time reminiscing about the past.
Surveyed after the trial’s conclusion, both groups reported quality-of-life improvements, but the CAPABLE crew fared better than the control group. Eighty-two percent said the program made their lives easier and their homes safer; nearly 80 percent noted that they felt more confident about living independently and handling daily challenges.
The program changed Hattie Ashby’s life. The 90-year-old resident of suburban Denver, who struggles with high blood pressure and COPD, told the CAPABLE staff who visited her that she wanted to use the stairs more easily and get out of the house more often. “They got me a walker and made arrangements for me to put my oxygen tank on it so I could go to the mall,” Ashby said. “They fixed the wall in my bathroom and put something I could hold onto to get in and out of my bathtub. And going up and down my stairs, they put another rail on the wall where I would be able to hold onto.”
Ashby’s experience explains why this approach is so successful, noted Amanda Goodenow, CAPABLE program manager at the Colorado Visiting Nurse Association: “[It works] because we’re guided by what people want, and in order to get better, you have to want to get better. It has to be important to you.”
The nonprofit program, originally developed at the Center for Innovative Care in Aging at the Johns Hopkins School of Nursing, has spread to 26 locations in 12 states — demonstrating a cost-effectiveness that nursing homes cannot match. And, more importantly, it allows seniors to stay in their homes, where most of us prefer to live out our lives.
Researchers admit that CAPABLE’s benefits waned for participants over time, so there’s talk of offering follow-up visits and assessments as the program matures. That will take additional grant funding, however, because Medicare and private insurance don’t currently cover this sort of service.
Perhaps they’ll have ironed out all the kinks by the time MLW and I are hobbling into our dotage; for now, we’ll continue our dinner-table dreaming. Maybe someday I’ll get around to putting up a matching railing so MLW can navigate those stairs to her studio more easily. Or maybe not. After all, we’re not that old.
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