Tech-enabled Functional Health: Bridging Primary Care Gaps for Older Adults with Functional Disabilities - Project summary Functional disabilities (FDs), defined as difficulties with daily activities, represent a significant public health crisis for older adults (OAs). As the U.S.’s fastest-growing segment, OAs frequently suffer from chronic diseases and mobility impairments that lead to physical FDs. These disabilities can progress without proactive intervention, causing falls, loss of independence, institutionalization, and premature death. The economic burden is substantial, with FDs costing tens of thousands of dollars per person annually. Assistive technology (ATs), such as canes and toilet rails, are low-cost, high-value solutions that can prevent injuries and slow disability progression. However, a critical implementation gap exists, as OAs face barriers like limited knowledge, restricted access to services, and the absence of AT interventions in primary care settings. Our long-term goal is to establish a cost-effective, scalable, and sustainable AT intervention as a standard preventive care in primary care settings. This 3-year R01 study will refine and evaluate Viviendo las Ventajas de la Asistencia Tecnológica (VIVE-AT), an innovative group-based AT intervention designed for broad use with OAs. The specific aims of this project are to: 1) refine the protocol of the VIVE-AT to align with the unique needs of the primary health care clinic; 2) assess the efficacy of the VIVE-AT in comparison to a waitlist control arm in decreasing FDs and improving the quality of life among adults aged ≥65 years post-intervention and at six months; and 3) evaluate whether proposed mechanisms of change in FDs, specifically knowledge of AT, motivation for using AT, self-efficacy for using AT, and use of AT, account for the reduction in FDs post-intervention. To achieve these aims, a multidisciplinary team will first refine the intervention based on input from the Implementation Advisory Committee and OAs with FDs through focus groups (Aim 1). Subsequently, 76 OAs with physical FDs recruited from a primary health care facility in Puerto Rico will be randomly assigned to either the VIVE-AT intervention group (n=38) or a waitlist control group (n=38) to assess its efficacy and mechanisms of change (Aims 2 & 3). All participants will receive standard, usual care at the primary health care center. Participants in the intervention group will attend a weekly, two-hour group session for six weeks, facilitated by trained primary healthcare staff, focusing on self-management of FDs through AT. Additionally, participants will receive up to five ATs tailored to their specific needs and training on their usage. All participants will be assessed at baseline, post-intervention, and six months after intervention. The project is significant because it addresses the costly public health burden of FDs by using primary care for early detection and proactive AT intervention. VIVE-AT is an innovative, scalable, and low-cost model that overcomes access barriers by providing group-based training in a primary care setting with existing clinic staff, rather than traditional rehabilitation professionals. The expected outcome is a proven, cost-effective intervention that reduces FDs and improves quality of life, which would then pave the way for a multisite Hybrid Type I RCT and nationwide implementation.
