3D Team Care for Cognitively Vulnerable Older Adults
- Conditions
- DepressionDeliriumDementia
- Interventions
- Other: Home Based Care TeamOther: Telephone Based Care Team
- Registration Number
- NCT02945085
- Lead Sponsor
- UConn Health
- Brief Summary
This study addresses how to achieve better outcomes for cognitively vulnerable community-dwelling older adults and their families. Cognitive vulnerability means living with dementia, depression, and/or a recent episode of delirium (the 3Ds). The investigators will test the effectiveness of a team care model focused on the 3Ds (Home Based Care Team) guided by nurse practitioners with expertise in geriatrics and geriatric psychiatry. Specific aims are to determine Home Based Care Team effects on hospitalization or emergency department use, and other outcomes including depression, disability, and quality of life.
- Detailed Description
This study addresses how to achieve better outcomes for cognitively vulnerable community-dwelling older adults and their families. Cognitive vulnerability means living with dementia, depression, and/or a recent episode of delirium (the 3Ds). Cognitive vulnerability in older adults is often overlooked by primary care and hospital-based providers, and represents a marker for overall vulnerability or frailty often missed when disease-specific approaches are emphasized in the care for older adults. Such patients often cannot adequately self-manage their comorbidities. Many studies of older adults and their families have demonstrated the great burden of living with cognitive vulnerability. The investigators will test the effectiveness of a team care model focused on the 3Ds (Home Based Care Team) guided by nurse practitioners with geriatrics expertise. Other team member disciplines will include pharmacy, social work, occupational and physical therapy, nutrition, and community health worker. Long-term objectives are to determine whether this care model can become a widely available approach for improving healthcare systems for older adults with cognitive vulnerability and their families, while improving outcomes of importance to these patients and families. A project Steering Committee, including cognitively vulnerable patients and family caregivers, will provide extensive input into many aspects of the research process.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 506
- Evidence of dementia, depression, and/or delirium, based on diagnostic codes found in medical claims data and based on screening at time of study screening.
- Living in the community, including assisted living facility, at time of randomization
- Plan to live in geographic area for 12 months
- Speak or understand English
- Willing to be randomly assigned to intervention or active comparator group
- Diagnosed schizophrenia or bipolar disorder
- Bedbound and non-communicative
- Life expectancy <12 months
- Already enrolled in active comparator program
- For individuals with dementia, family caregiver is unavailable or unwilling to enroll in study
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Home Based Care Team Home Based Care Team Primarily in-home treatment provided by team led by nurse practitioner with geriatrics and geriatric psychiatry expertise. Telephone Based Care Team Telephone Based Care Team Primarily telephone-based treatment provided by existing care management program offered by collaborating Medicare Advantage insurer.
- Primary Outcome Measures
Name Time Method Proportion hospitalized or used emergency department without hospitalization 12 months Evidence of hospitalization or visit to emergency department without hospital admission will be based on data from the Medicare Advantage insurer's medical claims data warehouse.
- Secondary Outcome Measures
Name Time Method Family caregiver perceived well-being 12 months Self-reported well-being among family caregivers who enroll in the study
Patient Health Questionnaire (PHQ9) 12 months This outcome will be used for study participants with depression but not dementia or recent episode of delirium at baseline. Individual scores will be aggregated into group mean scores to compare intervention and active comparator groups on this outcome.
Caregiver Assessment of Function and Upset (CAFU) 12 months This measure yields a score for each individual reflecting level of assistance required to conduct 7 self-care activities of daily living (ADLs) and 8 instrumental ADLs. In a structured interview format, family members report these items for their relatives with dementia and/or a recent history of delirium. Individual scores will be aggregated into group mean scores to compare intervention and active comparator groups on this outcome.
Trial Locations
- Locations (1)
UConn Center on Aging
🇺🇸Farmington, Connecticut, United States