Effectiveness of Comprehensive Environmental Support for Community-Dwelling Older Adults: A Single-Blind Randomized Controlled Trial

Abstract

Abstract Importance: The importance of developing age-friendly environments is globally recognized. However, few clinical trials have comprehensively evaluated physical and social components of environments and examined the effects of offering support. Objective: To clarify the effectiveness of occupational therapy–based comprehensive environmental support for community-dwelling older adults. Design: A single-blind parallel-groups randomized controlled trial with blinded participants. Setting: Eight community-based settings under the long-term-care insurance system in regional towns and cities throughout Japan. Participants: Sixty older adults age ≥65 yr who were new users of adult day care or adult day health care and allocated by stratified block randomization on the basis of age. Intervention: Comprehensive environmental support was provided to participants for 3 mo according to results on the Comprehensive Environmental Questionnaire for older adults (CEQ) to make improvements in environmental factors participants wanted to change to create a more satisfying life. Outcomes and Measures: The primary outcome measure was the Japanese Medical Outcomes Study 36-Item Short-Form Health Survey (SF–36) score at 3 mo postrandomization. Additionally, scores on the Short-Form Six-Dimension utility index were calculated. Results: The experimental group showed significant improvements in the SF–36’s Role/Social Component Summary (p = .005) and Role–Physical (p = .02), Role–Emotional (p = .01), and Mental Health (p = .05) domains, with moderate effect sizes. The number needed to treat was 3.46, showing statistical significance. Conclusions and Relevance: Occupational therapy–based comprehensive environmental support based on CEQ scores was effective, resulting in moderate improvements in health-related quality of life among community-dwelling older adults. Plain-Language Summary: Older adults experience a decline in physical and mental functions along with changes in social relationships. These problems make it challenging for older adults to perform valuable occupations, thus reducing their quality of life. This study demonstrated that occupational therapy based on the Comprehensive Environmental Questionnaire for older adults can improve health-related quality of life among community-dwelling older adults. Our findings pave the way for the development of an effective compensatory intervention model in occupational therapy practice.