Waldersen Brian W, Wolff Jennifer L, Roberts Laken, Bridges Allysin E, Gitlin Laura N, Szanton Sarah L
Johns Hopkins School of Medicine and School of Public Health, Baltimore, MD.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Arch Phys Med Rehabil. 2017 May;98(5):896-903. doi: 10.1016/j.apmr.2016.11.017. Epub 2016 Dec 19.
To describe functional goals and factors associated with goal attainment among low-income older adults with disabilities living in the community.
Secondary analysis.
Participants' homes.
Older adults (N=226) with disability who participated in the Community Aging in Place, Advancing Better Living for Elders trial.
A 5-month, home-based, person-directed, structured program delivered by an interprofessional team: occupational therapist, registered nurse, and handyman.
Process of occupational therapist goal setting and attainment at the final occupational therapist visit.
Participants identified 728 functional goals (mean of 3.2 goals per participant), most commonly related to transferring (22.0%; n=160 goals), changing or maintaining body position (21.4%; n=156 goals), and stair climbing (13.0%; n=95 goals). Participants attained 73.5% (n=535) of goals. Goal attainment was highest for stair climbing (86.3%), transferring (85.6%), and self-care (84.6%); walking goals were less likely attained (54.0%). Goal attainment was not associated with age, sex, education, depressive symptoms, function, or health-related quality of life but was less likely among participants who had severe pain compared with those without pain (adjusted odds ratio, 0.38; 95% confidence interval, 0.17-0.86). When participant readiness to change score increases by 1 point on the 4-point scale, goal attainment was 62% more likely (adjusted odds ratio, 1.62; 95% confidence interval, 1.14-2.29).
Home-based collaborative goal setting between older adults and occupational therapists is feasible and particularly effective when individuals are ready or willing to adopt new strategies to achieve identified goals.
描述居住在社区中的低收入残疾老年人的功能目标以及与目标达成相关的因素。
二次分析。
参与者家中。
参与“就地养老，提升老年人生活质量”试验的残疾老年人（N = 226）。
由职业治疗师、注册护士和杂工组成的跨专业团队提供的为期5个月的居家、个性化、结构化项目。
职业治疗师设定目标的过程以及在最后一次职业治疗师访视时目标的达成情况。
参与者确定了728个功能目标（每位参与者平均3.2个目标），最常见的与转移（22.0%；n = 160个目标）、改变或维持身体姿势（21.4%；n = 156个目标）以及爬楼梯（13.0%；n = 95个目标）有关。参与者实现了73.5%（n = 535）的目标。爬楼梯（86.3%）、转移（85.6%）和自我护理（84.6%）的目标达成率最高；行走目标的达成可能性较小（54.0%）。目标达成与年龄、性别、教育程度、抑郁症状、功能或健康相关生活质量无关，但与无疼痛的参与者相比，有严重疼痛的参与者目标达成的可能性较小（调整优势比，0.38；95%置信区间，0.17 - 0.86）。当参与者在4分制的改变准备度评分上增加1分时，目标达成的可能性增加62%（调整优势比，1.62；95%置信区间，1.14 - 2.29）。
老年人与职业治疗师之间基于家庭的协作式目标设定是可行的，当个体准备好或愿意采用新策略来实现已确定的目标时，这种方式尤其有效。
