The vast majority of adults older than 65 desire to age in their communities, yet they find it increasingly difficult because of “how communities are constructed and [the lack of] … services offered.” In response, many community-based organizations have initiated peer-to-peer support services to promote aging in place; they train older adults to provide support to their peers through social visits and opportunities to access health- and non-health-related activities in their shared community. It is not clear how effective these services are. Given that 13 percent of the US population was > 65 years of age in 2010 and more than 90 percent of them desire to age in place, the question of how to promote aging in place among older adults through “real world,” easily disseminated and implemented interventions is highly relevant and important.
Our overall objective is to investigate the comparative effectiveness of peer-to-peer support programs in preventing acute emergency department visits and hospitalizations and nursing home placement in older adult populations at risk for needing these services; we will also investigate how they promote health and wellness in this population. We have chosen these outcomes, in addition to rates of nursing home placement, because use of acute health services and declining wellness are risk factors for nursing home placement and because they matter to older adults, their families, community organizations, healthcare providers, and state insurers.
Our specific aims are
- To compare the effectiveness of peer-to-peer community support in preventing hospitalization, emergency department (ED) use, and nursing home placement in an at-risk older adult population relative to those just getting community services.
- To compare the effect of peer-to-peer community support on measures of health and overall wellness such as depression and anxiety, relative to those just getting standard community services.
We will accomplish our aims by building on an established relationship between the University of Wisconsin School of Medicine and Public Health and stakeholders at The Alliance for Children and Families and three community-based organizations. Together we will follow older adults in three diverse US communities (Los Angeles, California; Palm Beach, Florida; and Rochester, New York) and compare health outcomes in the group receiving the peer-support services and among similar older adults in the same communities who are not receiving peer support.
We expect that older adults in the peer-to-peer support group will have lower rates of hospitalization, ED visits, and nursing home placement compared with the standard service group, and that they will also have higher self-rated health and overall wellness and less depression and anxiety compared with the standard service group.