Disability Clinical Trial
Official title:
Early Screening and Exercise for Prevention of Disability in Persons Residing in Continuing Care Retirement Communities
The purpose of this study is to test the effectiveness of a structured physical activity program, relative to a wellness program, in preventing the onset and progression of disability in the setting of senior housing communities, which are sometimes called housing with services.
As the baby boom population ages, a large number of older adults have found that continuing
care retirement communities (CCRCs) offer an attractive residential option. These
communities include independent apartments, assisted living and skilled nursing options and
often provide a menu of wellness services and a "safety net" of higher level care if/when
that care is needed. CCRCs have proliferated in recent years and the number of older adults
selecting this residential option is expected to continue. CCRCs represent a largely
untapped provider setting in which interventions that have been proven effective in
clinically-oriented, controlled studies of community-dwelling elderly can be translated into
practice.
Multiple randomized studies have shown the benefits of physical activity interventions such
as resistance and endurance exercises on a number of performance measures including walking
speed, balance and ability to stand from a chair. These studies have shown that if given an
exercise program matched to their needs, the onset and progression of disability can be
decreased among persons who are identified at high risk of disability. However, most data
supporting the beneficial effect of exercise in old age have been generated from studies
conducted in highly controlled clinical trial settings, not in "real world" provider
settings in which older adults live and function day-to-day. Thus, it is not known if
screening for disability and implementing an exercise program among high risk elders can be
effectively implemented in residential settings in a manner that not only promotes health
and prevents disability, but that is also attractive to providers from a business standpoint
and that can be incorporated into typical staffing patterns.
The American Association of Homes & Services for the Aging (AAHSA) is conducting a trial
that builds on a strong evidence base of the beneficial effect of exercise in old age in an
effort to accelerate translation of research into practice in CCRCs. The trial will screen
CCRC residents for disability using a short set of performance measures called the Short
Physical Performance Battery (SPPB). After identification of persons at risk for disability,
we will enroll 320 CCRC residents to a program of moderate exercise or an active control arm
focused on general wellness. The primary study endpoint is the SPPB score. Secondary
endpoints include falls; hospitalizations, and death.
A key feature of the current proposal is that it seeks to extend findings from clinical
studies into routine practice in the CCRC setting. This represents true translation of
research into practice, and will offer providers an evidence base upon which to make
informed decisions.
The trial will take place in 8 CCRCs operated by the Good Samaritan Society, the largest
nonprofit provider of services to older adults in the country. Because of its large size and
existing dissemination capacity, Good Samaritan is in a unique position to take a leadership
role among aging services providers in terms of dissemination of effective, innovative
programs in diverse residential settings, including CCRCs.
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Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
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