Abstract
The vast majority of older adults desire to age in their communities, and it is not clear what helps them be successful at aging in place. To investigate the comparative effectiveness of community-designed and community-implemented peer-to-peer (P2P) support programs vs standard community services (SCS) to promote health and wellness in at-risk older adults. This comparative effectiveness study involved a longitudinal cohort of adults aged 65 years and older conducted between 2015 and 2017. The setting was 3 communities in which community-based organizations delivered P2P services to older adults in California, Florida, and New York. Participants in the P2P group and in the SCS group were matched at enrollment into the study according to age, sex, and race/ethnicity at each site. Data analysis was performed from October 2018 to May 2020. P2P support was provided by trained older adult volunteers in the same community. They provided support targeted at the needs of the older adult they served, including transportation assistance, check-in calls, social activities, help with shopping, and trips to medical appointments. Rates of hospitalization, urgent care (UC) and emergency department (ED) use, and a composite measure of health care utilization were collected over 12 months of follow-up. A total of 503 participants were screened, 456 participants were enrolled and had baseline data (234 in the SCS group and 222 in the P2P group), and 8 participants had no follow-up data, leaving 448 participants for the main analysis (231 in the SCS group and 217 in the P2P group; 363 women [81%]; mean [SD] age, 80 [9] years). Participants in the P2P group more often lived alone, had lower incomes, and were more physically and mentally frail at baseline compared with the SCS group. After adjusting for propensity scores to account for baseline differences between the 2 groups, there was a statistically significant higher rate of hospitalization in the P2P group than in the SCS group (0.68 hospitalization per year vs 0.44 hospitalization per year; risk ratio, 1.54; 95% CI, 1.14-2.07; P = .005) during the 12 months of observation. There were no significant differences between the 2 groups in the rates of ED or UC visits or composite health care utilization over the 12 months of the study. P2P support was associated with higher rates of hospitalization but was not associated with other measures of health care utilization. Given that this is not a randomized clinical trial, it is not clear from these findings whether peer support will help older adults age in place, and the topic deserves further study.
Highlights
In 2010, 40 million people aged 65 years and older lived in the US, accounting for 13% of the total population.[1]
After adjusting for propensity scores to account for baseline differences between the 2 groups, there was a statistically significant higher rate of hospitalization in the peer-to-peer per group (P2P) group than in the SCS group (0.68 hospitalization per year vs 0.44 hospitalization per year; risk ratio, 1.54; 95% CI, 1.14-2.07; P = .005) during the 12 months of observation
We examined the effectiveness of P2P community support in preventing factors known to be associated with moving out of the community—frequent health care utilization measured by hospitalization and urgent care (UC) and emergency department (ED) use—in an at-risk older adult population compared with a standard community services (SCS) group
Summary
In 2010, 40 million people aged 65 years and older lived in the US, accounting for 13% of the total population.[1]. Most people aged 65 years and older report their health as good, very good, or excellent, but with age comes increased risk of certain diseases and disorders.[1] These health conditions and the process of aging itself frequently lead to functional decline. Functional decline puts older adults at risk for entering into nursing homes, yet more than 90% of older adults want to continue to age in place, defined as “... Being able to remain in one’s current residence even when faced with increasing need for support.”[3,4,5] The question of how to effectively help older adults age in place is of great national importance given the aging of the US population, the high prevalence of functional limitations among older adults, and this at-risk population’s overwhelming desire to age in their own homes Functional decline puts older adults at risk for entering into nursing homes, yet more than 90% of older adults want to continue to age in place, defined as “... being able to remain in one’s current residence even when faced with increasing need for support.”[3,4,5] The question of how to effectively help older adults age in place is of great national importance given the aging of the US population, the high prevalence of functional limitations among older adults, and this at-risk population’s overwhelming desire to age in their own homes
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