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

NCT ID: NCT06440447

Last Updated: 2025-01-24

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Total Enrollment: 500000 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2025-03-01
• Study Completion Date: 2027-06-30

Brief 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).

Detailed 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.

Conditions

Adult Day Programs; Continuing Care; Old Age; Dementia; Family/friend Caregivers

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: RETROSPECTIVE

Study Groups

Day program attendees

Older adults (65+ years) attending an adult day program in Alberta, British Columbia, or Manitoba

Adult day program use

Intervention Type: OTHER

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.

Non-attendees

Older adults with an initial Resident Assessment Instrument - Home Care (RAI-HC), who are not attending a day program in Alberta, British Columbia, or Manitoba

Other community care (non-attendees)

Intervention Type: OTHER

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).

Interventions

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.

Intervention Type: OTHER

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).

Intervention Type: OTHER

Eligibility Criteria

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

• Minimum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Carswell Family Foundation

UNKNOWN

Sponsor Role: collaborator

Alzheimer Society of York Region

UNKNOWN

Sponsor Role: collaborator

York University

OTHER

Sponsor Role: lead

Responsible Party

Matthias Hoben

Associate Professor, Helen Carswell Chair in Dementia Care

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Matthias Hoben, PhD

Role: PRINCIPAL_INVESTIGATOR

York University

Central Contacts

Matthias Hoben, Dr rer medic

Role: CONTACT

mhoben@yorku.ca

+1 437-335-1338

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Other Identifiers

563198b

Identifier Type: -

Identifier Source: org_study_id