3D Team Care for Cognitively Vulnerable Older Adults

UConn Health

Status: Completed

Conditions: Delirium; Depression; Dementia

Treatments: Other: Home Based Care Team; Other: Telephone Based Care Team

Study type: Interventional

Funder types: Other

Identifiers

NCT02945085

17-021-1

Details and patient eligibility

About

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.

Full 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.

Enrollment: 506 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 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

Exclusion criteria

• 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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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506 participants in 2 patient groups

Home Based Care Team

Experimental group

Description:

Primarily in-home treatment provided by team led by nurse practitioner with geriatrics and geriatric psychiatry expertise.

Treatment:

Other: Home Based Care Team

Telephone Based Care Team

Active Comparator group

Description:

Primarily telephone-based treatment provided by existing care management program offered by collaborating Medicare Advantage insurer.

Treatment:

Other: Telephone Based Care Team