EXploring Patterns of Use and Effects of Adult Day Programs to Improve Trajectories of Continuing CarE
Trial statusNot yet recruiting
Trial phaseNot listed
Trial typeObservational
Biological sexAll
Age65+
SponsorYork University
About this trial
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).
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
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)
Disqualifiers
None
Trial population
The study focuses on community care systems in Alberta, British Columbia, and Manitoba, all of which assess day program eligibility using comparable processes, criteria, and assessments (i.e. RAI-HC). The yearly average number of completed RAI-HC assessments is \~20,000-30,000 in Alberta, \~34,000-39,000 in British Columbia, and \~10,000 in Manitoba. The estimated number of day program attendees is \>20,000/year (\>200,000 within the study period), each with multiple assessments.
Trial design
Design model
Cohort
Time perspective
Retrospective
Treatments tested in this trial
Adult day program use
Other interventionDay 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)
Other interventionAny 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).
Treatment groups
500,000 Participants
are divided into 2 treatment groupsGroup A: Day program attendees1 intervention
Group B: Non-attendees1 intervention
Trial outcomes
Primary outcomes
1
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).
Time frame
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 outcomes
1
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.
Time frame
Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first2
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.
Time frame
Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first3
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.
Time frame
Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first4
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.
Time frame
Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came firstLocations
Sponsors and contacts
Click on the lead sponsor to view all of their trials.
York University
Lead sponsor
Carswell Family Foundation
Collaborator
Alzheimer Society of York Region
Collaborator
Source ClinicalTrials.gov
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