- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02945085
3D Team Care for Cognitively Vulnerable Older Adults
June 22, 2023 updated by: Fortinsky, Richard, UConn Health
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.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed 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.
Study Type
Interventional
Enrollment (Estimated)
576
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Richard H Fortinsky, PhD
- Phone Number: 860-679-8069
- Email: fortinsky@uchc.edu
Study Contact Backup
- Name: Therence James, MPH
- Phone Number: 860-679-3812
- Email: tjames@uchc.edu
Study Locations
-
-
Connecticut
-
Farmington, Connecticut, United States, 06030-5215
- Recruiting
- UConn Center on Aging
-
Contact:
- Principal Investigator
-
Contact:
- Study Coordinator
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
65 years and older (Older Adult)
Accepts Healthy Volunteers
No
Description
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
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Home Based Care Team
Primarily in-home treatment provided by team led by nurse practitioner with geriatrics and geriatric psychiatry expertise.
|
Clinical team will conduct comprehensive clinical assessments focused on cognitive impairment and depression, conduct comprehensive medication review and reconciliation, offer Problem Solving Therapy, and offer brief occupational therapy, physical therapy, nutrition, and social support services.
|
Active Comparator: Telephone Based Care Team
Primarily telephone-based treatment provided by existing care management program offered by collaborating Medicare Advantage insurer.
|
Telephone contact will be made by nurses.
Depending on level of need, follow up telephone and, in some cases, in home visits will be made by nurse or social worker from care management program.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion hospitalized or used emergency department without hospitalization
Time Frame: 12 months
|
Evidence of hospitalization or visit to emergency department without hospital admission will be based on data from the Medicare Advantage insurer's medical claims data warehouse.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
GRID Hamilton Rating Scale for Depression (GRID-HAMD), 17-item version.
Time Frame: 12 months
|
This measure yields a score for each individual reflecting both frequency and intensity of all depression-related symptoms included in the structured interview.
This outcome will be used for study participants with depression but not dementia or recent episode of delirium at baseline.
Individual scores will be aggregated into group mean scores to compare intervention and active comparator groups on this outcome.
|
12 months
|
Caregiver Assessment of Function and Upset (CAFU)
Time Frame: 12 months
|
This measure yields a score for each individual reflecting level of assistance required to conduct 7 self-care activities of daily living (ADLs) and 8 instrumental ADLs.
In a structured interview format, family members report these items for their relatives with dementia and/or a recent history of delirium.
Individual scores will be aggregated into group mean scores to compare intervention and active comparator groups on this outcome.
|
12 months
|
Family caregiver perceived well-being
Time Frame: 12 months
|
Self-reported well-being among family caregivers who enroll in the study
|
12 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
World Health Organization (WHO) Disability Assessment Schedule, 12 item short form.
Time Frame: 12 months
|
This measure yields a score for each individual reflecting self-reported degree of difficulty performing physical activities in the home and community.
Individual scores will be aggregated into group mean scores to compare intervention and active comparator groups on this outcome.
|
12 months
|
Quality of Life-Alzheimer's Disease Scale (QOL-AD)
Time Frame: 12 months
|
This measure, used with individuals with dementia, yields a score for each individual reflecting self-ratings of poor, fair, good, or excellent on 13 items.
Individual scores will be aggregated into group mean scores to compare intervention and active comparator groups on this outcome.
|
12 months
|
Neuropsychiatric Inventory (NPI-C)
Time Frame: 12 months
|
This measure yields a single score that accounts for both frequency and severity of 14 neuropsychiatric symptoms.
Family caregivers provide this information in a structured interview format.
Individual scores will be aggregated into group mean scores to compare intervention and active comparator groups on this outcome.
|
12 months
|
Center for Epidemiologic Studies-Depression Scale (CES-D)
Time Frame: 12 months
|
This measure will be used to determine severity of depression among family caregivers enrolled in the study.This measure yields a score for each individual reflecting frequency of 20 depression-related symptoms within the previous two weeks.
Individual scores will be aggregated into group mean scores to compare intervention and active comparator groups on this outcome.
|
12 months
|
Zarit Burden Scale, 12-item short form
Time Frame: 12 months
|
This measure will be used to determine severity of caregiving-related burden among family caregivers who enroll in the study.This measure yields a score for each individual based on self-reports by family caregivers on the degree of caregiving impact on emotional, physical, social, and financial aspects of life.
Individual scores will be aggregated into group mean scores to compare intervention and active comparator groups on this outcome.
|
12 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Richard H Fortinsky, PhD, UConn Health
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Levine AMP, Emonds EE, Smith MA, Rickles NM, Kuchel GA, Steffens DC, Ohlheiser A, Fortinsky RH. Pharmacist Identification of Medication Therapy Problems Involving Cognition Among Older Adults Followed by a Home-Based Care Team. Drugs Aging. 2021 Feb;38(2):157-168. doi: 10.1007/s40266-020-00821-7. Epub 2020 Dec 23.
- Fortinsky RH, Kuchel GA, Steffens DC, Grady J, Smith M, Robison JT. Clinical trial testing in-home multidisciplinary care management for older adults with cognitive vulnerability: Rationale and study design. Contemp Clin Trials. 2020 May;92:105992. doi: 10.1016/j.cct.2020.105992. Epub 2020 Mar 16.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
March 6, 2017
Primary Completion (Estimated)
July 31, 2024
Study Completion (Estimated)
July 31, 2024
Study Registration Dates
First Submitted
October 23, 2016
First Submitted That Met QC Criteria
October 24, 2016
First Posted (Estimated)
October 26, 2016
Study Record Updates
Last Update Posted (Actual)
June 23, 2023
Last Update Submitted That Met QC Criteria
June 22, 2023
Last Verified
June 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 17-021-1
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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