Approximately 45% of older adults in the U.S. have 2 or more chronic health conditions (e.g., arthritis, hypertension, diabetes) in addition to functional limitations that prevent performance of health self-management activities. Self-management continues to be the gold standard for managing MCC, but functional limitations create difficulty with these activities (e.g., physical activity, symptom monitoring). Restricted self-management accelerates the downward spiral of disability and accumulating chronic conditions which, in turn, increases rates of institutionalization and death by 5-fold. Currently, there are no tested interventions designed to improve independence in health self-management activities in older adults with MCC and functional limitations. Research suggests that older adults are more likely to change behavior with interventions that assist with planning health-promoting daily activities, especially when contending with complex medical regimens and functional limitations. Combined with occupational therapy (OT), behavioral activation (BA) shows promise to improve health self-management in populations with chronic conditions and/or functional limitations. This innovative combination uses the goal setting, scheduling/monitoring activities, and problem-solving components of the BA approach as well as the environmental modification, activity adaptation, and focus on daily routines from OT practice. The investigators will test the effect of this combined approach in a Stage I, randomized controlled pilot feasibility study compared to enhanced usual care. The investigators will recruit 40 older adults with MCC and functional limitation and randomize 20 to the PI- delivered BA-OT protocol. This research will inform modification and larger-scale testing of this novel intervention and provide data for a federally funded career development award.
at least 2 chronic conditions
at least 1 functional limitation
intention to set at least 1 physical activity goal
live within 15 miles of University of Oklahoma (OU) Schusterman Center
life expectancy less than 6 months
progressive neurological condition
in active treatment for cancer
not English speaking
Parallel
Behavioral Activation + Occupational Therapy
BehavioralIn the BA-OT Approach, the PI will use an evidence-based 4-step process (Goal-Plan-Do-Check) to assist the older adults to develop strategies to plan and execute daily health self-management activities. BA-OT teaches older adults with MCC and functional limitations to 1) set achievable and meaningful activity goals, 2) engage in action planning that includes brainstorming strategies to overcome barriers, 3) evaluate the results after performing the activity, and 4) to modify the plan or choose a new goal, then generalize strategies to new problems. By assisting participants to develop daily routines and integrate safe health self-management activities into these routines, occupational therapists are providing strategies that support adaptation in the face of stressful situations.. Goal examples may include adapting and scheduling exercise plans, or exploring assistive devices and strategies for safe and healthy meal preparation.
Enhanced Usual Care
BehavioralFitbit, 1 hour training, handout on managing chronic conditions
Change in Canadian Occupational Performance Measure (COPM) from baseline to 22 weeks
self-report, self-rated activity performance
Change in Self-management Assessment Scale from baseline to 22 weeks
self-report measuring effective self-management of chronic conditions. Scores range from 10 - 60, where higher is better.
Change in Behavioral Activation for Depression Scale from baseline to 22 weeks
self-report mood, depression. Scores range from 0 - 150, with higher scores indicating greater activation.
Change in Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy managing chronic conditions from baseline to 22 weeks
self-report self-efficacy for managing chronic conditions. Range from 20 - 100, higher scores indicate greater self-efficacy. covers topics such as managing daily activity, managing medications, managing symptoms, managing social interactions, and managing emotions.
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University of Oklahoma
Lead sponsor
Presbyterian Health Foundation
Collaborator
