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

Old Age; Dementia Clinical Trial

— EXPEDITE  

Official title:

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

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06440447
• Other study ID #: 563198b
• Status: Not yet recruiting
• Start date: August 1, 2024
• Est. completion date: June 30, 2027

Study information

• Verified date: May 2024
• Source: York University
• Contact: Matthias Hoben, Dr rer medic
• Phone: +1 437-335-1338
• Email: mhoben[@]yorku.ca
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

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).

Description:

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.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 500000
• Est. completion date: June 30, 2027
• Est. primary completion date: June 30, 2026
• Accepts healthy volunteers: No
• Gender: All
• Age group: 65 Years and older

Eligibility

Inclusion criteria:

• 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)

Exclusion criteria:

• No receipt of any community-based continuing care service

Related Conditions & MeSH terms

• Dementia
• Old Age; Dementia

Intervention

Other:
• 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.
• 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 distress. The investigators will also include variables on health and social characteristics (e.g., age, sex, type/duration of publicly funded community care received before the matching index date, deprivation indices).

Locations

Country	Name	City	State
n/a

Sponsors (3)

Lead Sponsor	Collaborator
York University	Alzheimer Society of York Region, Carswell Family Foundation

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* Note: There are 25 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Time to admission to a long-term care homes	Data will come from provincial continuing care registries, which document the start date of any publicly funded continuing care service a person receives, the end date of this service, and the type of service. The outcome will be the time between a person's first RAI-HC assessment and admission to a long-term care home (i.e., an assisted living home or nursing home).	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)
Secondary	Symptoms of depression	To determine the presence or absence of depressive symptoms, the validated RAI-HC Depression Rating Scale (DRS) will be used. DRS scores range from 0-14, and a cut-point of 3 or higher represents clinically meaningful depressive symptoms.	Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first
Secondary	Presence or absence of physical decline	Change in physical functioning will be captured, using the validated RAI-HC Activities of Daily Living Hierarchy (ADLh) scale. The scale ranges from 0 (no impairment) to 6 (maximum impairment), and the outcome will be dichotomous, indicating any increase (versus no change or a decrease) between the previous and follow up measurement in this scale.	Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first
Secondary	Presence or absence of cognitive decline	Change in cognition will be captured, using the validated RAI-HC Cognitive Performance Scale (CPS). The scale ranges from 0 (no impairment) to 6 (maximum impairment), and the outcome will be dichotomous, indicating any increase (versus no change or a decrease) between the previous and follow up measurement in this scale.	Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first
Secondary	Emergency room registrations	The National Ambulatory Care Report System (NACRS) captures all emergency department visits and diagnoses. The outcome will be the yearly average number of a person's emergency department visits.	Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first
Secondary	Hospital stays	The Discharge Abstract Database (DAD) includes information on all inpatient hospital stays, including diagnoses and length of stay. The outcome will be the yearly average number of a person's hospital stays.	Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first
Secondary	Primary care provider visits	Care provider claims data includes health service claims submitted for payment by primary care providers (e.g., general practitioners, nurse practitioners, geriatricians, geriatric psychiatrists, neurologists, therapists). The outcome will be the yearly average number of a person's primary care provider visits.	Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first