What do a nurse, a handyman, and an occupational therapist have in common? Each plays an integral role in providing in-home health services to older adults through the Community Aging in Place – Advancing Better Living for Elders (CAPABLE) intervention. This multidisciplinary team approach aims to equip low-income older adults to live more comfortably and safely in their homes by letting patients set their own functional goals, like taking a bath or walking to church, while also improving their living environment though renovations like installing hand rails or lowering shelves. Sarah Szanton, Ph.D., RN, ANP, FAAN, a professor at the Johns Hopkins School of Nursing in Baltimore, Md., was recently named an American Academy of Nursing (AAN) Edge Runner for her work as the program’s principal investigator. We spoke with Sarah to learn more about CAPABLE and how it helps older adults “age in place.”
Nursing Notes (NN): Can you share a little bit about your nursing career path?
Sarah Szanton: My first job after nursing school was working with migrant farmworkers, and I learned a lot about the social determinants of health. Even though my patients were young men all doing the same job, they were very different in terms of health. My next job was with homeless adults in Baltimore, and then I went back to school to become a nurse practitioner. After that, I started doing house calls for low-income older adults who found it difficult or impossible to come to clinic visits. Based on my experience with that, I decided to get a Doctor of Philosophy (Ph.D.) in order to develop research that would address the health disparities that people in our country face.
NN: Can you tell us a little more about the CAPABLE program and what makes it unique?
Sarah: CAPABLE is a truly interprofessional model involving occupational therapists, nurses, and handymen. It uses home repair and regular household items to improve people’s functions and decrease their healthcare costs.
For example, someone may want to sleep in their own bed instead of on the couch, but is unable to do so because of muscle weakness, shaky banisters, or crooked stairs. We can address all of those issues to help older adults meet their goals.
Nurses and occupational therapists use their expertise to support the goal-development brainstorming for older adult participants. However, the participants themselves drive the goals and achievements of the program.
NN: What initially inspired the idea for CAPABLE and the research behind it?
Sarah: As a nurse making house calls in Baltimore, I have seen patients who were unable to walk and had to crawl to the front door to let me in. I realized that hiring carpenters and adding nursing visits could be a good fit, and then came across Laura Gitlin’s work with the ABLE program, which we adapted to become CAPABLE.
NN: Do you have a specific example of when you felt that you impacted a certain patient’s life in a big way?
Sarah: One participant we had was very frail and sat on a commode chair all day. When reviewing her medication list, the nurse found that the patient was taking 26 medications. Too many of them were for pain, which was why she was dazed and unable to move around. After medication adjustments, the nurse helped the family make a medication chart that was more clear. Not long after, the participant became more alert and was able to set her own goals. One of her goals was to be able to go downstairs. When she began the program, it took her 30 minutes to walk down the hall to reach the bathroom. By the end of the four months, she was able to get herself out of bed. The first time this happened, her husband burst into tears.
A few months after she completed the program, her granddaughter called us and said that the whole family, including our former patient, was going to Atlantic City. We were overjoyed and moved beyond words. Our participant had been nodding off on her commode chair all day before we met her, and now she was about to go on a family vacation!
NN: What advice do you have for current nursing students looking to make a positive impact on older adult patients and the aging process?
Sarah: A very important thing for nurses working with older adults is to treat each one as an individual with goals and resilient potential, even up until their last weeks of life.
CAPABLE is now available in 17 locations across nine states. To learn more about the program and how it is helping to improve safety and independence for older adults, visit nursing.jhu.edu.