Abstract
BackgroundThis study investigates the use of an information and communication technology (Elder Tree) designed for older adults and their informal caregivers to improve older adult quality of life and address challenges older adults face in maintaining their independence (for example, loneliness and isolation, falling, managing medications, driving and transportation).Methods/DesignThis study, an unblinded randomized controlled trial, will evaluate the effectiveness and cost of Elder Tree. Older adults who are at risk for losing their independence - along with their informal caregivers, if they name them - are randomized to two groups. The intervention group has access to their usual sources of information and communication as well as to Elder Tree for 18 months while the control group uses only their usual sources of information and communication. The primary outcome of the study is older adult quality of life. Secondary outcomes are cost per Quality-Adjusted Life Year and the impact of the technology on independence, loneliness, falls, medication management, driving and transportation, and caregiver appraisal and mastery. We will also examine the mediating effect of self-determination theory. We will evaluate the effectiveness of Elder Tree by comparing intervention- and control-group participants at baseline and months 6, 12, and 18. We will use mixed-effect models to evaluate the primary and secondary outcomes, where pretest score functions as a covariate, treatment condition is a between-subjects factor, and the multivariate outcome reflects scores for a given assessment at the three time points. Separate analyses will be conducted for each outcome. Cost per Quality-Adjusted Life Year will be compared between the intervention and control groups. Additional analyses will examine the mediating effect of self-determination theory on each outcome.DiscussionElder Tree is a multifaceted intervention, making it a challenge to assess which services or combinations of services account for outcomes in which subsets of older adults. If Elder Tree can improve quality of life and reduce healthcare costs among older adults, it could suggest a promising way to ease the burden that advancing age can place on older adults, their families, and the healthcare system.Trial registrationClinicalTrials.govNCT02128789. Registered on 26 March 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0713-2) contains supplementary material, which is available to authorized users.
Highlights
IntroductionChallenges to aging in place include isolation and loneliness [2], falling [3], managing medications [4], and driving and transportation [5]
This study investigates the use of an information and communication technology (Elder Tree) designed for older adults and their informal caregivers to improve older adult quality of life and address challenges older adults face in maintaining their independence
Elder Tree is a multifaceted intervention, making it a challenge to assess which services or combinations of services account for outcomes in which subsets of older adults
Summary
Challenges to aging in place include isolation and loneliness [2], falling [3], managing medications [4], and driving and transportation [5]. Half (46.5%) of adults 65 and older have more than one chronic condition [7], and care for people with multiple chronic conditions accounts for an estimated 95% of Medicare spending [8]. Without innovative interventions, these and other costs are expected to escalate as the proportion of older adults in the population increases. Between 2005 and 2030, the number of US adults aged 65 and older will almost double, from 37 million to more than 70 million [9]
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