Efficacy of an Intelligent and Integrated Older Adult Care Model on Quality of Life Among Home-Dwelling Older Adults: Randomized Controlled Trial.

BACKGROUND

Integrated care models enhanced by the clinical decision support system offer innovative approaches to managing the growing global burden of older adult care. However, their efficacy remains uncertain.

OBJECTIVE

This study aimed to evaluate the efficacy of an intelligent and integrated older adult care model, termed the SMART (Sensors and scales [receptor], a Mobile phone autonomous response system [central nervous system in the spinal cord], a Remote cloud management center [central nervous system in the brain], and a Total care system [effector]) system, in improving the quality of life (QOL) for home-dwelling older adults.

METHODS

In this stratified randomized controlled trial, we consecutively recruited older adults aged 65 years or older from November 1, 2020, to December 31, 2020. Eligible participants were randomly allocated 1:1 to either the SMART group, receiving routine discharge instructions and personalized integrated care interventions across 11 domains (decreased or lost self-care ability, falls, delirium, dysphagia, incontinence, constipation, urinary retention, cognitive decline, depression, impaired skin integrity, and common diseases) generated by the SMART system, or the usual care group, receiving only routine discharge instructions. The intervention lasted for 3 months. The primary end point was the percent change in QOL from baseline to the 3-month follow-up, assessed using the World Health Organization Quality of Life Instrument - Older Adults Module. Secondary end points included functional status at the 3-month follow-up and percent changes in health self-management ability, social support, and confidence in avoiding falling from baseline to the 3-month follow-up. Data were analyzed following the intention-to-treat principle, using covariance or logistic regression models, as appropriate. Subgroup and sensitivity analyses were conducted to assess result consistency and robustness.

RESULTS

In total, 94 participants were recruited, with 48 assigned to the SMART group. The personalized and integrated care by the SMART system significantly improved the QOL among the older adults, with an estimated intervention difference of 11.97% (95% CI 7.2%-16.74%, P<.001), and social support and health self-management ability as well, with estimated intervention differences of 6.75% (95% CI 3.19%-10.3%, P<.001) and 4.95% (95% CI 0.11%-10%, P=.003), respectively, while insignificantly improving in the Modified Falls Efficacy Scale score. Similarly, the SMART system had a 66% reduction in instrumental activities of daily living disability (odds ratio [OR] 0.34, 95% CI 0.11-0.83, P=.02). However, the SMART system did not significantly affect activities of daily living disability or the Modified Falls Efficacy Scale score. The subgroup and sensitivity analyses confirmed the robustness of the findings.

CONCLUSIONS

The personalized and integrated older adult care by the SMART system demonstrated significant efficacy in improving QOL, health self-management ability, and social support, while reducing instrumental activities of daily living disability among home-dwelling older adults.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR-IOR-17010368; https://tinyurl.com/2zax24xr.