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Adult Day ProgramsEXPEDITENCT06440447

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

An observational study of Adult Day Programs and Continuing Care, run by York University.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial 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… Read more about this study

Who is it for?
Ages 65 years and older
What is being tested?
Adult day program use and Other community care (non-attendees)
How many people
500,000 participants
Where
No sites listed yet
Study dates
1 Mar 2025to 30 Jun 2027
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 65 years and older
  • All sexes
  • No healthy volunteers
  • Older adult

Study 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.

Who may be able to join

  • 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)

Who cannot join

  • No receipt of any community-based continuing care service

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

Matthias Hoben, Dr rer medic contact

+1 437-335-1338

mhoben@yorku.ca

About this study

Official title: EXploring Patterns of Use and Effects of Adult Day Programs to Improve Trajectories of Continuing CarE (EXPEDITE)

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).

Read the 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.

Being tested
Adult day program use, Other community care (non-attendees)
Keywords
Adult day programs, Older adults, Program evaluation, Cohort studies, Health administrative data
Medical subject headings
Alzheimer Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Adult day program useOther

    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.

  • Other community care (non-attendees)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).

Study groups in NCT06440447
Study groupRoleWhat they receive
Day program attendeesOlder adults (65+ years) attending an adult day program in Alberta, British Columbia, or Manitoba
Receives: Other: Adult day program use
Non-attendeesOlder adults with an initial Resident Assessment Instrument - Home Care (RAI-HC), who are not attending a day program in Alberta, British Columbia, or Manitoba
Receives: Other: Other community care (non-attendees)

What is being measured

The primary outcome is the main question the study is designed to answer.

  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).

    Measured: 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 (6)

  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.

    Measured: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first

  2. 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.

    Measured: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first

  3. 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.

    Measured: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first

  4. 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.

    Measured: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first

  5. Hospital stays

    The Discharge Abstract Database (DAD) includes information on all inpatient hospital stays, including diagnoses and length of stay. The outcome will be the yearly average number of a person's hospital stays.

    Measured: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first

  6. Primary care provider visits

    Care provider claims data includes health service claims submitted for payment by primary care providers (e.g., general practitioners, nurse practitioners, geriatricians, geriatric psychiatrists, neurologists, therapists). The outcome will be the yearly average number of a person's primary care provider visits.

    Measured: Baseline (date of home care admission) and annually until study end (Dec 31, 2024) or loss to follow up, whichever came first

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Jun 2024
  2. Study start1 Mar 2025 (estimated)
  3. Primary completion30 Jun 2026 (estimated)
  4. Study completion30 Jun 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
500,000 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06440447
Sponsor's protocol ID
563198b
Acronym
EXPEDITE
Status last verified
Jan 2025
First submitted
16 May 2024
Last updated
24 Jan 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: The health administrative data used in this study are owned by the respective provincial health authorities. Provincial data policies do not allow public sharing of these data. The research team will work with an in-house health system data analyst in each of the provinces to carry out the analyses. Data are required to stay within the respective province and within the province's protected and secure data repository.

Publications

  • European Commission. The 2018 ageing report: Economic and budgetary projections for the 28 EU member states (2016-2070). Luxembourg: European Commission; 2018. Report No.: 79. Available from: https://economy-finance.ec.europa.eu/publications/2018-ageing-report-economic-and-budgetary-projections-eu-member-states-2016-2070_en#files [accessed Sep 2, 2022]

  • Federal/provincial/territorial ministers responsible for seniors. Core community supports to age in community. Ottawa: Government of Canada; 2019. Available from: https://www.canada.ca/en/employment-social-development/corporate/seniors/forum/core-community-supports.html [accessed Sep 2, 2022]

  • MacDonald B-J, Wolfson M, Hirdes JP. The future co$t of long-term care in Canada. Toronto, ON: National Institute on Aging; 2019. Available from: https://www.nia-ryerson.ca/reports [accessed Sep 2, 2022]

  • Thomas KS, Applebaum R. Long-term services and supports (LTSS): A growing challenge for an aging America. Public Policy & Aging Report 2015;25(2):56-62. doi: 10.1093/ppar/prv003

  • Whitman DB. Unsolved mysteries in aging policy. Public Policy & Aging Report 2015;25(2):67-73. doi: 10.1093/ppar/prv006

  • 2022 Alzheimer's disease facts and figures. Alzheimers Dement. 2022 Apr;18(4):700-789. doi: 10.1002/alz.12638. Epub 2022 Mar 14.

    PubMed 35289055

  • Prince MJ, Wimo A, Guerchet MM, Ali GC, Wu Y-T, Prina M. World Alzheimer Report 2015 - The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends. London: Alzheimer's Disease International; 2015. Available from: https://www.alzint.org/resource/world-alzheimer-report-2015/ [accessed Sep 2, 2022

  • Public Health Agency of Canada. Dementia in Canada. Ottawa: Public Health Agency of Canada; Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia.html [accessed Sep 2, 2022]

  • Nguyen H, Manolova G, Daskalopoulou C, Vitoratou S, Prince M, Prina AM. Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies. J Comorb. 2019 Aug 22;9:2235042X19870934. doi: 10.1177/2235042X19870934. eCollection 2019 Jan-Dec.

    PubMed 31489279

  • The Academy of Medical Sciences. Multimorbidity: a priority for global health research. London: The Academy of Medical Sciences; 2018. Available from: https://acmedsci.ac.uk/policy/policy-projects/multimorbidity [accessed Sep 2, 2022]

  • Canadian Institute for Health Information (CIHI). Quick stats - Home Care Reporting System (HCRS) profile of clients in home care 2020-2021. Available from: https://www.cihi.ca/en/quick-stats [accessed Sep 2, 2022]

  • Morgan T, Ann Williams L, Trussardi G, Gott M. Gender and family caregiving at the end-of-life in the context of old age: A systematic review. Palliat Med. 2016 Jul;30(7):616-24. doi: 10.1177/0269216315625857. Epub 2016 Jan 26.

    PubMed 26814213

  • Quesnel-Vallée A, Willson A, Reiter-Campeau S. Health inequalities among older adults in developed countries: Reconciling theories and policy approaches. In: George L, Ferraro K, editors. Handbook of aging - social sciences 8th ed. London: Elsevier; 2016.

  • Quesnel-Vallée A, Farrah J-S, Jenkins T. Population aging, health systems, and equity: Shared challenges for the United States and Canada. In: Settersten Jr. RA, Angel JL, editors. Handbook of sociology of aging New York, Dordrecht, Heidelberg, London: Springer; 2011.

  • McGrail K. Long-term care as part of the continuum. Healthc Pap. 2011;10(4):39-43; discussion 58-62. doi: 10.12927/hcpap.2011.22190.

    PubMed 21593615

Questions about this trial

What is this clinical trial studying?

An observational study of Adult Day Programs and Continuing Care, run by York University.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 24 Jan 2025. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Matthias Hoben, Dr rer medic (+1 437-335-1338, mhoben@yorku.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time to admission to a long-term care homes (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)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06440447, which also lists 26 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Jan 2025.

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