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Randomized Controlled Trial
. 2020 Jul 15;60(5):947-957.
doi: 10.1093/geront/gnz045.

Engaging Caregivers in Health-Related Housing Decisions for Older Adults With Cognitive Impairment: A Cluster Randomized Trial

Rhéda Adekpedjou  1 , Dawn Stacey  2 , Nathalie Brière  3 , Adriana Freitas  1 , Mirjam M Garvelink  1 , Maman Joyce Dogba  4 , Pierre J Durand  4 , Sophie Desroches  5   6 , Jordie Croteau  1 , Louis-Paul Rivest  7 , France Légaré  1
Affiliations
Randomized Controlled Trial

Engaging Caregivers in Health-Related Housing Decisions for Older Adults With Cognitive Impairment: A Cluster Randomized Trial

Rhéda Adekpedjou et al. Gerontologist. .

Abstract

Background and objectives: Informal caregivers are rarely as involved as they want to be in the housing decisions of cognitively impaired older adults. Lack of awareness of available options and their benefits and risks may lead to decisions that do not reflect older adults' preferences, and to guilt and regret. We assessed the effect of training home care teams in interprofessional shared decision-making (SDM) on the proportion of caregivers who report being active in this decision.

Research design and methods: In a two-arm pragmatic cluster randomized trial with home care teams working in health centers in the Province of Quebec, we randomized health centers to receive training in interprofessional SDM (intervention) or not (control). Eligible caregivers had made a housing decision for a cognitively impaired adult aged 65 years or older who was receiving services from a home care team. The primary outcome was the proportion of caregivers reporting an active role in decision making. We performed intention-to-treat multilevel analysis.

Results: We consecutively enrolled a random group of 16 health centers and recruited 309 caregivers, among whom 296 were included in the analysis. In the intervention arm, the proportion of caregivers reporting an active role in decision making increased by 12% (95% CI -2% to 27%; p = .10). After removal of an influential cluster outlier, the proportion increased to 18% (95% CI: 7%-29%; p < .01).

Discussion and implications: Training home care teams in interprofessional SDM increased caregiver involvement in health-related housing decisions for cognitively impaired older adults.

Keywords: Home care; Interprofessional; Nursing homes; Patient engagement; Shared decision making.

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Figures

Figure 1.
Figure 1.
Flow chart of the study.
Figure 2.
Figure 2.
Effect of the intervention on role caregiver assumed in decision making. Note: Generalized estimated equations (GEEs) were used and adjustment was made for clustering. Passive role was the reference category.
See this image and copyright information in PMC

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