Warm Homes for Elder New Zealanders (WHEZ)

Warm Homes for Elder New Zealanders: a Community Trial of People With COPD

Aim

The purpose of this study is to evaluate whether fuel subsidies reduce exacerbations of COPD among people aged over 55, and therefore whether providing such subsidies is a cost-beneficial policy initiative.

The Warm Homes for Elder New Zealanders Study enrolled community-dwelling people aged over 55 with moderate or worse COPD. Prior to the study commencing the houses were insulated (if feasible, & the house-owner agreed). Data were collected on the health and energy use of the participants.

The households randomly assigned to the "early" intervention group had a subsidy to their power account their first winter in the study. The subsidy was the intervention and was designed to enable the participants, if they chose to do so, to keep their house warmer during the winter.

Study Overview

• Status: Completed
• Conditions: Chronic Obstructive Pulmonary Disease
• Intervention / Treatment: Behavioral: Energy Voucher; Behavioral: No intervention : control arm

Detailed Description

Warm Homes for Elder New Zealanders (WHEZ)

Background Although there has been considerable recent work on the prevention, management and causes of Chronic Obstructive Pulmonary Disease (COPD), the contribution of housing has not been well researched. This is despite the socio-economic patterning of COPD (Maori women have the highest rate of COPD that has been recorded for any group of women), and the relationship between socio-economic deprivation and housing conditions.

It is likely that improved heating would reduce exacerbations of COPD as:

• COPD patients with the most advanced disease tend to be older people who often live on a fixed income and may be unable to afford adequate heating
• There is a high excess of winter hospitalisations in COPD patients indicating COPD exacerbations may be triggered by cold conditions.
• About one third of exacerbations of COPD are triggered by respiratory infections.
• The Housing, Insulation and Health Study demonstrated a reduction in self-reported respiratory disease after houses were insulated. Therefore improving the heating in households with a COPD patient may reduce respiratory infections and this in turn would reduce the number and severity of exacerbations.

The percentage of people over 65 in New Zealand will increase from 12% to 22% over the next 25 years. Therefore it will become increasingly important to find cost-effective ways of reducing the morbidity of the older age group. As COPD is a significant cause of morbidity amongst older people, this study investigates a potentially cost effective intervention to reduce both the likelihood of expensive hospital stays and improve the quality of life for older people.

Aim To evaluate whether fuel subsidies reduce exacerbations of COPD among people aged over 55, and therefore whether providing such subsidies is a cost-beneficial policy initiative.

Potential Benefits The potential benefits of the study include reducing the burden of disease. The patients and their caregivers may experience improved quality of life. Hospitals may experience fewer patients requiring treatment during the winter. A cost-benefit analysis will quantify the benefits.

• Study Type: Interventional
• Enrollment (Actual): 522
• Phase: Not Applicable

Contacts and Locations

Study Locations

• New Zealand
  • Christchurch, New Zealand
    • Christchurch
  • Wanganui, New Zealand
    • Wanganui / Manawatu
  • Wellington, New Zealand
    • Wellington / Hutt/ Porirua

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 55 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Post Bronchodilator FEV1/FVC ratio < Lower Limit of Normal (NHanesIII)
• Post Bronchodilator FEV1 < 80% of the predicted FEV1 (NHanesIII)

OR - In the last three years either went to hospital for their COPD or took antibiotics/steriods for their COPD

Exclusion Criteria:

• Not planning to stay in the same dwelling until the end of the study
• Does not want to take part in research
• Unwilling to answer inclusion questionnaire
• Unable to communicate effectively

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Voucher; Receive the intervention ("Energy Voucher") the first winter enrolled in the study. The intervention is a electricity voucher and a short pamphlet describing how to work out how much heat the voucher can buy.	Behavioral: Energy Voucher; Receive the intervention the first winter enrolled in the study. The intervention is a electricity voucher and a short pamphlet describing how to work out how much heat the voucher can buy.
Other: Control; Receive the intervention the second winter enrolled in the study (thus "No intervention : control arm"). The intervention is a electricity voucher and a short pamphlet describing how to work out how much heat the voucher can buy.	Behavioral: No intervention : control arm; Do not receive the money or pamphlet in the initial study year

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Moderate or severe exacerbations of COPD during winter for which hospitalisation, systemic corticosteroids and/or antibiotics are required to treat the exacerbation	Four months

Secondary Outcome Measures

Outcome Measure	Time Frame
Severe exacerbations of COPD during winter for which hospitalisation is required to treat the exacerbation	Four months
Moderate exacerbations of COPD during winter; which will be defined as requiring treatment with systemic corticosteroids and/or antibiotics	Four months
All-cause hospitalisation during winter	Four months
Temperature in the living and bedrooms during winter	Four months
Electricity usage during winter	Four months
Costs to health care system of index participant during winter	Four months
Self-reported quality of life for index participant during winter	Four months
Respiratory health of other people living in household during winter	Four months
Any changes in index participant baseline lung function	course of study ( up to 18 months)
Study withdrawals due to death or greater dependency	course of study (up to 18 months)
Support person burden	course of study (up to 18 months)

Collaborators and Investigators

• Sponsor: University of Otago
• Collaborators: Health Research Council, New Zealand
• Investigators: Principal Investigator: Philippa L Howden-Chapman, PhD, University of Otago

Publications and helpful links

General Publications

• Viggers H, Howden-Chapman P, Ingham T, Chapman R, Pene G, Davies C, Currie A, Pierse N, Wilson H, Zhang J, Baker M, Crane J. Warm homes for older people: aims and methods of a randomised community-based trial for people with COPD. BMC Public Health. 2013 Feb 26;13:176. doi: 10.1186/1471-2458-13-176.

Helpful Links

• Website for Housing and Health Research Programme

Study record dates

Study Major Dates

• Study Start: April 1, 2009
• Primary Completion (Actual): February 1, 2013
• Study Completion (Actual): February 1, 2013

Study Registration Dates

• First Submitted: August 2, 2011
• First Submitted That Met QC Criteria: June 20, 2012
• First Posted (Estimate): June 25, 2012

Study Record Updates

• Last Update Posted (Estimate): June 17, 2015
• Last Update Submitted That Met QC Criteria: June 15, 2015
• Last Verified: June 1, 2015

More Information

Terms related to this study

• Keywords: COPD; COAD; CORD
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
• Other Study ID Numbers: HRC08/072AR