Results Summary
What was the research about?
To help older adults live on their own, community-based organizations, or CBOs, offer services such as meal delivery and basic health care. Some CBOs have trained elderly volunteers who provide peer support. These volunteers help older adults find services, such as transportation or Spanish-language services.
In this study, the research team wanted to learn if a peer support program helped older adults remain at home. They compared healthcare use and quality of life among older adults receiving CBO services who either were or weren’t in a peer support program.
What were the results?
Over 12 months, compared with older adults who weren’t in the peer support program, those in the program were less likely to visit an urgent care clinic. The two groups didn’t differ in hospital visits, emergency room use, or nursing home stays.
Older adults in the peer support program reported more anxiety and less ability to manage their stress than those who weren’t in the program. The two groups didn’t differ in reports of
- Physical health
- Mental health
- Feeling depressed or lonely
- Ability to manage daily life tasks, such as dressing or shopping
- Support from family and friends
Who was in the study?
This study included 456 adults age 65 and older. Of these, 78 percent were white, 11 percent were African American, and 1 percent were Asian or other races; 10 percent were Hispanic. The average age was 80, and 81 percent were women. All were receiving services at one of three CBOs, one each in California, Florida, and New York.
What did the research team do?
The research team identified older adults who were in peer support programs at one of the three CBOs. The team compared these adults with adults with similar traits, such as age, who weren’t in the program.
All older adults in the study had access to support services from CBOs. These services included health and social activities, care planning, resource referrals, and access to a food pantry or meal delivery. The peer support programs at the three CBOs were similar. For example, peers helped older adults get involved in social activities. The CBOs also had services specific for their communities. For instance, one CBO trained peers on how to help adults who didn’t speak English well.
Participants filled out surveys about healthcare use 3, 6, 9, and 12 months after the start of the study. They also completed surveys about quality of life at the start of the study and 6 and 12 months later.
Older adults receiving peer support, children of older adults receiving peer support, peer support volunteers, and people who worked at CBOs provided input during this study.
What were the limits of the study?
At the start of the study, older adults in the peer support program differed from adults who weren’t in the program. For example, adults in the program were more likely to be frail. The study results may be due to these differences rather than the peer support program.
Future research could look at whether some older adults, such as people older than age 80, would benefit more than others from peer support.
How can people use the results?
CBOs can use the results when considering whether to provide peer support services to older adults so these adults can remain at home.
Professional Abstract
Objective
To compare the effect of peer support plus access to community services versus access to community services alone on healthcare use among older adults living in their own homes.
Study Design
| Design Elements | Description |
|---|---|
| Design | Observational: cohort study |
| Population | 456 adults age 65 and older living year-round in their own homes |
| Interventions/ Comparators |
|
| Outcomes |
Primary: hospitalization, emergency department use, urgent care use, nursing home stays Secondary: physical health, mental health, depressive symptoms, anxiety symptoms, loneliness, self-efficacy, resilience, social support, self-reported disability |
| Timeframe | 1-year follow-up for primary outcomes |
This prospective cohort study compared the effect of a peer support program plus community services versus access to community services alone on healthcare use among older people living year-round in their own homes.
Researchers identified two groups of adults age 65 and older who had access to community services at one of three community-based organizations in California, Florida, and New York. Adults in each group had access to health, wellness, socialization, and enrichment activities; case management and counseling; resource referrals; and a food pantry and meal delivery. In one group, participants received peer support services. Each organization’s peer support program included standardized core elements, such as a peer support volunteer who helped participants, as needed, with social engagement and transportation to services. Each peer support program also had community-specific elements, such as services addressing the needs of people who spoke limited English.
The study included 456 participants. Of these, 78% were white, 11% were African American, and 1% were Asian or other races; 10% were Hispanic. The average age was 80, and 81% were female.
Participants completed healthcare utilization surveys at 3, 6, 9, and 12 months and secondary outcome surveys at baseline and 6 and 12 months later. Researchers matched participants in the two groups on age, gender, and race and ethnicity.
Recipients of peer support services, children of older adults receiving peer support services, peer support volunteers, and representatives of aging services organizations helped plan and conduct the study.
Results
Over 12 months, compared with participants who did not receive peer support, those who did were less likely to use urgent care (odds ratio=2.63; 95% confidence interval: 1.21, 5.70). The groups did not differ in hospitalizations, emergency department use, or nursing home stays.
Participants who received peer support reported a greater increase in anxiety and a greater decrease in resilience (both p<0.05) than participants who did not receive peer support. The groups did not differ in any other secondary outcomes.
Limitations
Despite matching participants on age, gender, and race and ethnicity, the groups varied significantly on baseline measures. For example, participants who received peer support were more physically and psychologically frail than participants who did not receive peer support.
Conclusions and Relevance
Compared with participants who did not receive peer support, those who did were less likely to use urgent care, but the two groups did not differ in other measures of healthcare use. In addition, possibly because they were frailer at the beginning of the study, participants who received peer support reported higher anxiety and less resilience.
Future Research Needs
Future research could examine the effectiveness of peer support with community services for specific subpopulations, such as individuals age 80 or older. In addition, studies could use randomization to minimize variation between groups receiving the interventions.
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
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 and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers indicated that they had difficulty matching the aims and hypotheses laid out at the beginning of the report with the methods and results described in the body of the report, particularly in relation to the outcome of nursing home placement. The researchers revised the report to better link the aims and hypotheses to the methods and results. They added a conceptual framework to help explain how they chose the outcomes they did. They also clarified the reasons why nursing home placement did not end up being a main outcome for the study.
- The reviewers recommended adjusting the presentation of qualitative interviews the researchers completed, saying that this information was important but not described fully in the report. The researchers created Appendix F to present the qualitative methods and interview results. They noted that they included only direct quotes that they felt represented the participant’s point of view accurately.
- The reviewers questioned the report’s assertion that the study findings were highly generalizable. The reviewers pointed out that the three sites had very different characteristics, and it was not clear how generalizable the results from these sites would be for rural settings or for populations mostly comprised of individuals from minority racial and ethnic groups. The researchers said they thought the results were generalizable to urban populations across the United States since the study enrolled participants from three very different cities, and they modified the discussion to say so.
- The reviewers questioned how the researchers described their results from analyses of participants older than 80 years of age. The reviewers considered these to be subgroup analyses of participants over and under 80 years old and suggested a number of revisions to the analyses and the text. Because these analyses seemed to be more confusing to the reader, the researchers removed all subgroup analyses from the report. They explained that the subgroup analyses were not intended as intermediary measures and their inclusion did not affect the main analyses.