EXploring Patterns of Use and Effects of Adult Day Programs to Improve Trajectories of Continuing CarE

Официальное название

EXploring Patterns of Use and Effects of Adult Day Programs to Improve Trajectories of Continuing CarE (EXPEDITE)

Обзор

This study seeks to understand the impact of Canada's adult day program on attendees and non-attendees, especially those with dementia and other co-morbidities. A retrospective cohort study will be conducted, including older adults in the community who do or do not attend adult day programs in Alberta, British Columbia, and Manitoba, Canada. The objectives are to (1) compare patterns of day program use (including non-use) by Canadian province (Alberta, British Columbia, Manitoba), and time, (2) compare characteristics of older adults by day program use pattern (including non-use), province, and time, and (3) to examine whether those who are exposed to day programs, compared to a propensity-score matched comparison group of non-exposed older adults in the community, enter long-term care homes at later times (primary outcome), are less likely to have depressive symptoms, physical and cognitive change, and have lower use of primary, acute, and emergency care (secondary outcomes).

Подробное описание

Adult day programs provide critical supports to both, older adults living in the community, and their family/friend caregivers. This is essential because ensuring high-quality care in the community for as long as possible and avoiding or delaying long-term care home admissions are key priorities of older adults, their caregivers, and healthcare systems. While most older adults in Canada receive care in the community, about 10% of newly admitted nursing home residents have relatively low care needs that could be met in the community with the right supports. Caregivers provide most of the care in the community, which puts them at high risk for caregiver burden. Day programs intend to mitigate these issues by providing respite to caregivers. However, research on the effectiveness of day programs is inconsistent. Generally, the methodological quality of studies is poor, and especially Canadian research is lacking. The research objectives are to (1) explore changes in patterns of day program use (including non-use) between provinces and over time, (2) compare characteristics of older adults with different day program use patterns (including non-use), and (3) assess whether day program attendees compared to a propensity score matched control group of non-attendees have better outcomes. This retrospective cohort study will use population-based clinical and health administrative data of older adults (65+ years) who received publicly subsidized continuing care in the community in Alberta, British Columbia, and Manitoba between January 01, 2012 and December 31, 2024. Patterns of day program use (i.e., variations in time to attend a day program for the first time, and frequency and duration of attendance) and how these patterns vary by province and over time will be assessed. Characteristics of older adults with different patterns of day program use (e.g., no, low, medium, high) will be compared. Characteristics of the participants will include age, sex, dementia status, frailty level, comorbidity status, socioeconomic status, availability of a caregiver, and caregiver distress. Finally, propensity-matched comparison group (by region, age, gender, cognitive/physical impairment, type/duration of community care received previously) of older adults who have not attended a day program will be created. Time-to-event models and general estimating equations will assess whether day program attendees compared to non-attendees enter continuing care facilities later (primary outcome); use emergency, acute, or primary care less frequently; experience less cognitive and physical decline; and have better mental health (secondary outcomes). Models will include day program exposure as an independent variable and will be adjusted for province, participant demographics, medical and functional conditions, caregiver availability/distress, other community services received (e.g., home care, in-home respite), and (if appropriate) matching variables.

Вмешательства

• Другое Adult day program use
  Day program use patterns will be determined, using Latent Class Analysis. Three continuous variables will be categorized as low, low-moderate, high-moderate, high, using sample distribution quartiles: (1) Time between first RAI-HC assessment and first attendance of a day program, (2) average number of hours of day program attendance (i.e., total number of hours spent in a day program divided by the number of times attended), and (3) total number of days a person attended a day program.
• Другое Other community care (non-attendees)
  Any publicly funded continuing care services in the community, other than adult day programming (e.g., home care, in-home respite). Community care participants will be propensity score matched with day program participants, using RAI-HC variables on day program eligibility (to ensure similarity of non-attendees to day program attendees). Matching variables will include: physical functioning, cognition, behavioural symptoms, bladder/bowel continence, availability of a caregiver, and caregiver dis

Первичные конечные точки

• Time to admission to a long-term care homes [Срок оценки: From date of home care admission until the date of admission to a long-term care home or loss to follow up (i.e., death, move out of province), whichever came first, assessed up to 12 years (between Jan 31, 2012 and Dec 31, 2024)]

Вторичные конечные точки (6)

• Symptoms of depression [Срок оценки: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first]
• Presence or absence of physical decline [Срок оценки: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first]
• Presence or absence of cognitive decline [Срок оценки: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first]
• Emergency room registrations [Срок оценки: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first]
• Hospital stays [Срок оценки: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first]
• Primary care provider visits [Срок оценки: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first]

Критерии участия

Критерии включения

• Persons aged 65 years and over
• Initial RAI-HC assessment completed
• Attendance of an adult day program (for cohort 1)
• Receipt of any community-based continuing care services, other than adult day program (cohort 2)

Критерии исключения

\- No receipt of any community-based continuing care service

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Публикации

• European Commission. The 2018 ageing report: Economic and budgetary projections for the 28 EU member states (2016-2070). Luxembourg: European Commission; 2018. Report No.: 79. Available from: https://economy-finance.ec.europa.eu/publications/2018-ageing-report-economic-and-budgetary-projections-eu-member-states-2016-2070_en#files [accessed Sep 2, 2022]
• Federal/provincial/territorial ministers responsible for seniors. Core community supports to age in community. Ottawa: Government of Canada; 2019. Available from: https://www.canada.ca/en/employment-social-development/corporate/seniors/forum/core-community-supports.html [accessed Sep 2, 2022]
• MacDonald B-J, Wolfson M, Hirdes JP. The future co$t of long-term care in Canada. Toronto, ON: National Institute on Aging; 2019. Available from: https://www.nia-ryerson.ca/reports [accessed Sep 2, 2022]
• Thomas KS, Applebaum R. Long-term services and supports (LTSS): A growing challenge for an aging America. Public Policy & Aging Report 2015;25(2):56-62. doi: 10.1093/ppar/prv003
• Whitman DB. Unsolved mysteries in aging policy. Public Policy & Aging Report 2015;25(2):67-73. doi: 10.1093/ppar/prv006
• 2022 Alzheimer's disease facts and figures. Alzheimers Dement. 2022 Apr;18(4):700-789. doi: 10.1002/alz.12638. Epub 2022 Mar 14. PMID 35289055
• Prince MJ, Wimo A, Guerchet MM, Ali GC, Wu Y-T, Prina M. World Alzheimer Report 2015 - The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends. London: Alzheimer's Disease International; 2015. Available from: https://www.alzint.org/resource/world-alzheimer-report-2015/ [accessed Sep 2, 2022
• Public Health Agency of Canada. Dementia in Canada. Ottawa: Public Health Agency of Canada; Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia.html [accessed Sep 2, 2022]

Идентификаторы

NCT: NCT06440447 · 563198b

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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