Donelle Lorie, Regan Sandra, Kerr Michael, Zwarenstein Merrick, Bauer Michael, Warner Grace, Isaranuwatchai Wanrudee, Zecevic Aleksandra, Borycki Elizabeth, Forbes Dorothy, Weeks Lori, Leipert Bev, Read Emily
Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
Department of Family Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada.
JMIR Res Protoc. 2020 Jan 10;9(1):e15027. doi: 10.2196/15027.
Significant chronic disease challenges exist among older adults. However, most older adults want to remain at home even if their health conditions challenge their ability to live independently. Yet publicly funded home care resources are scarce, private home care is expensive, and family/friend caregivers have limited capacity. Many older adults with chronic illness would require institutional care without the support from family member/friend caregivers. This role raises the risk of physical health problems, stress, burnout, and depression. Passive remote monitoring (RM), the use of sensors that do not require any action by the individual for the system to work, may increase the older adult's ability to live independently while also providing support and peace of mind to both the client and the family member/friend caregiver.
This paper presents the protocol of a study conducted in two provinces in Canada to investigate the impact of RM along with usual home care (the intervention) versus usual home care alone (control) on older adults with complex care. The primary outcome for this study is the occurrence of and time to events such as trips to emergency, short-term admission to the hospital, terminal admission to the hospital awaiting admission to long-term care, and direct admission to long-term care. The secondary outcomes for this study are (1) health care costs, (2) client functional status and quality of life in the home, (3) family/friend caregiver stress, and (4) family/friend caregiver functional health status.
The design for this study is an unblinded pragmatic randomized controlled trial (PRCT) with two parallel arms in two geographic strata (Ontario and Nova Scotia). Quantitative and qualitative methodologies will be used to address the study objectives. This PRCT is conceptually informed by the principles of client-centered care and viewing the family as the client and aims at providing supported self-management.
This study is supported by the Canadian Institutes for Health Research. A primary completion date is anticipated in fall 2022.
Findings from this real-world rigorous randomized trial will support Canadian decision-makers, providers, and clients and their caregivers in assessing the health, well-being, and economic benefits and the social and technological challenges of integrating RM technologies to support older adults to stay in their home, including evaluating the impact on the burden of care experienced by family/friend caregivers. With an aging population, this technology may reduce institutionalization and promote safe and independent living for the elderly as long as possible.
International Standard Randomised Controlled Trial Number (ISRCTN) 79884651; http://www.isrctn.com/ISRCTN79884651.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15027.
老年人面临着重大的慢性病挑战。然而，大多数老年人即使健康状况对其独立生活能力构成挑战，仍希望居家养老。然而，公共资助的家庭护理资源稀缺，私人家庭护理费用昂贵，家庭/朋友护理人员的能力也有限。许多患有慢性病的老年人如果没有家庭成员/朋友护理人员的支持，将需要机构护理。这增加了身体健康问题、压力、倦怠和抑郁的风险。被动远程监测（RM），即使用无需个人采取任何行动即可运行的传感器，可能会提高老年人的独立生活能力，同时也为客户及其家庭成员/朋友护理人员提供支持并使其安心。
本文介绍了在加拿大两个省份进行的一项研究方案，该研究旨在调查远程监测与常规家庭护理（干预措施）相比，单纯常规家庭护理（对照）对需要复杂护理的老年人的影响。本研究的主要结局是诸如前往急诊、短期住院、等待入住长期护理机构的末期住院以及直接入住长期护理机构等事件的发生情况和时间。本研究的次要结局包括：（1）医疗保健费用；（2）客户在家中的功能状态和生活质量；（3）家庭/朋友护理人员的压力；（4）家庭/朋友护理人员的功能健康状况。
本研究采用非盲实用随机对照试验（PRCT）设计，在两个地理区域（安大略省和新斯科舍省）设置两个平行组。将使用定量和定性方法来实现研究目标。该PRCT在概念上以以客户为中心的护理原则为指导，并将家庭视为客户，旨在提供支持性自我管理。
本研究得到了加拿大卫生研究院的支持。预计主要完成日期为2022年秋季。
这项严格的现实世界随机试验的结果将有助于加拿大的决策者、提供者、客户及其护理人员评估健康、福祉、经济效益以及整合远程监测技术以支持老年人居家养老所面临的社会和技术挑战，包括评估对家庭/朋友护理人员护理负担的影响。随着人口老龄化，这项技术可能会减少机构化，并尽可能促进老年人的安全和独立生活。
国际标准随机对照试验编号（ISRCTN）79884651；http://www.isrctn.com/ISRCTN79884651。
国际注册报告识别码（IRRID）：DERR1-10.2196/15027。
