Results Summary
What was the research about?
Many adults would like to remain in their homes as they get older. Falls, illnesses that require hospital stays, or memory loss can make living at home hard. Older adults may be able to remain in their homes and get better care if they plan for home-support services in advance.
The research team created and tested the Plan Your Lifespan website (www.planyourlifespan.org) to help older adults and their families create a plan for getting home care as the older adults age. The website is publicly available and free to use.
What were the results?
Compared with a group of older adults who viewed a website with information about physical activity, older adults who viewed the Plan Your Lifespan website
- Did more planning for future home care needs
- Rated home care planning as more important
- Knew more about available home care services
- Were more satisfied with the website they viewed
There was no difference between groups in how confident older adults were in finding and getting home care services.
Who was in the study?
The study included 385 English-speaking adults ages 65 and older from Illinois, Indiana, and Texas. Of these adults, 63 percent were white and 37 percent were other races. The average age was 72, and 80 percent were women. All adults in the study said they used computers or smartphones.
What did the research team do?
To create the website, the research team talked with older adults about their future health needs and their planning strategies. The team also talked with community leaders, area agencies on aging, nurses, doctors, and others to decide what to put on the website.
Then the research team assigned older adults by chance to one of two groups. The first group viewed the Plan Your Lifespan website. Those in the second group viewed a website about physical activity that had no information about planning for home-support services.
The research team gave a survey to all adults in the study before and after they viewed their assigned website and then again one month and three months later. The survey asked
- How much planning older adults had done
- How important home care planning was
- How confident they were in finding and getting home care services
- How much they knew about available home care services
- How satisfied they were with the website they viewed
What were the limits of the study?
This study wasn’t long enough to find out if older adults used the plans they created. Future research could follow older adults for longer. The older adults who took part in the study were mostly white and female. Future studies could test whether the website works well for a more diverse group of people.
How can people use the results?
Older adults and family members may be able to use a website to help make plans to get the home care they need to remain at home as they age.
Professional Abstract
Objective
To assess the effectiveness of a website to assist older adults in learning about and creating a plan for home-support services they may need in the future
Study Design
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 385 English-speaking adults ages 65 and older who use computers or smartphones |
| Interventions/ Comparators |
|
| Outcomes |
Primary: self-reported home-support-service planning behaviors, including creating plans and communicating plans to family members Secondary: self-reported perception of importance of planning, knowledge of home services, confidence in accessing home-support services, satisfaction with website |
| Timeframe | Up to 3-month follow-up for primary outcome |
This randomized controlled trial tested the effectiveness of the Plan Your Lifespan website (www.planyourlifespan.org) designed to help older adults learn about and plan for home-support services they may need in the future after events like hospitalizations or falls, or in the case of problems such as memory loss. The website is publicly available and free to use.
To create the website, researchers conducted focus groups with adults ages 65 and older about their views regarding future health events, needs, and planning and then solicited input on the focus group findings from a group of older adults, older adult community leaders, and area agencies on aging, nurses, and doctors.
The study of website effectiveness included 385 English-speaking adults ages 65 and older who lived in Illinois, Indiana, and Texas. Of these adults, 63% were white and 37% were other races. The average age of adults in the study was 72, and 80% were female. All participants indicated they used computers or smartphones.
Researchers randomly assigned participants to either the intervention group or the control group. All participants took a baseline survey. Participants in the intervention group then navigated the Plan Your Lifespan website for 15 to 45 minutes. Participants in the control group navigated a control website about physical activity. The control website did not include information on planning for home-support services. All participants took a postintervention survey immediately after viewing their assigned website.
One month and three months after participants’ website experiences, researchers contacted participants by phone to give them the same survey. Researchers compared the changes in outcomes for the intervention and control groups from baseline to postintervention.
Results
Compared with participants in the control group, participants in the intervention group
- Reported significantly more home-support service planning behaviors at the one-month time point (p=0.0054), but not at the three-month time point
- Rated the importance of planning significantly higher at the one-month (p=0.035) and three-month (p=0.047) time points
- Had significantly higher satisfaction with the website at the postintervention (p<0.0001), one-month (p=0.0002) and three-month (p=0.0186) time points
- Had significantly more knowledge of home-support services at the one-month time point (p=0.0005), but not at the three-month time point
The study found no differences between the two groups in participants’ confidence in accessing home-support services at the postintervention, one-month, or three-month time points.
Limitations
The study did not last long enough for the research team to assess whether participants used the plans they made. Study participants were mostly white and female, limiting generalizability to other populations.
Conclusions and Relevance
The Plan Your Lifespan website may be an effective way to help older adults understand and plan for long-term home services and supports.
Future Research Needs
Future research could follow participants for a longer time to determine if participants use the home-support service plans they developed. Studies could also assess the impact of the planning website on a larger and a more diverse group of participants with respect to race, ethnic group, gender, and socioeconomic backgrounds.
Final Research Report
View this project's final research report.
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Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
- Peer reviewers commented about the report and researchers made changes or provided responses. Those comments and responses included the following: The reviewers felt that the study’s focus on advanced care planning in later years was important but noted several methodological concerns. The reviewers asked for additional justification for why the researchers used different types of analyses for the primary and secondary outcomes. Reviewers also asked researchers to further explain why they changed the primary endpoint from three months to one month after the study had started.
- The reviewers noted that originally the primary study endpoint was three months but that it changed to one month once researchers found statistically significant differences in those interim analyses. The investigators indicated that they made this change, and the decision to stop the study early, with input and approval from their stakeholder partners.
- The investigators determined the benefit of the intervention website based on a statistically significant difference between groups on the investigators’ new, unvalidated measure. This measure had no clearly stated prespecified score range for a clinically meaningful difference. Relative to baseline, the intervention group outcome scores did not change; rather, the comparison group scores worsened. Therefore, the reviewers felt that the investigators had not shown that the intervention actually benefited participants. The researchers responded that because this was a new measure and there was no comparison intervention, they were unable to provide insight on what a clinically meaningful difference would be. The investigators did not address the reviewer comment that the intervention group score had not changed at one month relative to baseline. The researchers also could not suggest reasons for the decreased score on the outcome measure for the control group.
- The reviewers expressed concern that the investigators had described the analyses as intent-to-treat, when the investigators used only complete cases—data from participants who completed outcome surveys—in the analyses. The researchers revised the methods section to indicate that they conducted a complete case analysis at one month and three months.
- Overall, the reviewers felt that investigators had not justified their conclusion that the intervention benefits study participants. The reviewers concluded that a number of methodological flaws limited the validity of the results and the conclusions drawn from them. Without further research, the reviewers stated that readers should consider the report’s conclusions with caution.
Given the disagreement between peer reviewers and the researchers about the study’s interpretability, the researchers provided a response to peer-review comments:
The concerns raised in the PCORI peer-review summary only reflect aim 2, which composed one-third of this project. The key issues we found with the peer-review process of our aim 2 were that:
- Our project had been judged by current PCORI Methodology Standards, which had been instituted after our research began in 2013.
- The measures and endpoints used to evaluate the one- and three-month outcomes did not change from the original PCORI-approved statistical analysis plan.
- There are no validated measures of successful aging-in-place, which is why our patient partners and stakeholders helped us to create a new, as of yet unvalidated, measure.
- We identified a statistically significant difference in those subjects who used the intervention compared to subjects in the control arm. Reviewers asked for us to speculate on why the control arm worsened, but we do not feel it is scientifically rigorous to guess.
We feel that we have created a valuable tool, PlanYourLifespan.org, that has demonstrated efficacy in helping older adults plan for their health and support needs that typically occur in the fourth quarter of life. We have published four articles with results in peer-reviewed journals and received additional PCORI funding for both an open science pilot and further dissemination and implementation.