"Our study provides strong evidence that functional decline among the most physically frail and aged persons can be slowed, if not prevented, with the kind of program used in our study," said principal investigator Thomas M. Gill, M.D., associate professor of internal medicine and geriatrics at Yale School of Medicine. "The program focused on improving underlying impairments in muscle strength, balance and mobility."
The study looked at 188 physically frail people living at home who were 75 years of age or older. Most participants had some disability at the start of the study. Ninety-four were randomly assigned to receive physical therapy in their homes consisting of daily balance exercises lasting 10 to 15 minutes each and muscle training with elastic resistance bands three days a week. The other half were assigned to a control group that received an array of educational materials on preventive subject matter, such as vaccinations, proper nutrition and proper footwear. Both interventions lasted for six months, with follow-up at seven months and 12 months. Participants in the physical therapy program were asked to continue the exercises for a full year. They completed 75 to 80 percent of the exercises.
Gill and his team looked at whether activities essential to independent daily living, such as walking, bathing, upper- and lower- body dressing, transferring from a chair, using the toilet, eating and grooming, were improved with either intervention. They developed a disability scale that measured how well each group managed these eight essential activities of daily living. Scores on the scale ranged from zero to 16, with higher scores indicating more severe disability.
"We found that the physical therapy intervention was effective in preventing functional decline, while the control group showed a steady decline over the year," said
Gill. "At seven months, the average disability scores were 2.0 in the physical therapy group and 3.6 in the control group. This reflects a 45 percent reduction in disability for the physical therapy group relative to the control group. These results give weight to the role of 'prehabilitation' or preventive therapy for physically frail elderly persons living at home."
Gill said this kind of program could cut down on nursing home and health care costs for the elderly. There were reductions in nursing home use among the participants in the physical therapy program. They were less likely to be admitted and if they were, spent less time in the nursing home and had fewer fall-related injuries.
"The cost of the physical therapy program was less than $2,000 per participant, which is relatively modest over the course of a year, given the large cost of each day spent in a nursing home," said Gill.
The study was funded by the National Institute on Aging through the Yale Claude D. Pepper Older Americans Independence Center.
Other authors on the study included Dorothy I. Baker, research scientist in the Department of Epidemiology and Public Health at Yale School of Medicine (EPH); Margaret Gottschalk in the Department of Rehabilitation Services at Yale-New Haven Hospital; Peter N. Peduzzi, associate professor in EPH; Heather Allore, research associate in geriatrics; and Amy Byers, doctoral candidate in EPH.
Journal
New England Journal of Medicine