Multi-dimensional health risk appraisal, advance practice nurse assessments and an empowerment model of well-aging among adults with disabilities

Adults with life-long or acquired disabilities face challenges to well-aging. We present findings of a program of research based on three studies that aim to prevent health problems and promote well-aging among adults with disabilities. We set the program and policy context by describing steps taken to integrate an empowerment model into state affiliated programs and policies. This model evolved from the successful demonstration of comprehensive geriatric assessment (CGA) as a preventive intervention among able-bodied older adults. Our model has two components: (1) A multi-dimensional health risk appraisal (HRA) produces a profile of health risks and strengths, standardized feedback, and recommendations for actions to address health risks; and, (2) An advance practice nurse (APN) delivers an in-home CGA, head-to-toe assessment, health education, and personalized recommendations. We have conducted a pilot study (N = 201) of persons with intellectual and/or developmental disability (IDD) randomized to HRA vs. APN; a small (N = 93) study of HRA among persons with acquired disability; and a longitudinal study (expected N = 150) including concurrent use of HRA and APN. The pilot established feasibility among persons with IDD, demonstrated high prevalence of health problems among adults with IDD, and suggested possible health risk reduction. The second study tested the psychometric properties of the HRA and indicated high risk levels in population with acquired disabilities. The most current study and work with a state department of public health focus on understanding the relationship between healthy behaviors and health outcomes and broad dissemination of the model.