Engaging Caregivers in Health-Related Housing Decisions for Older Adults With Cognitive Impairment: A Cluster Randomized Trial

Abstract

Background and Objectives Informal caregivers are rarely as involved as they want to be in the housing decisions of cognitively impaired older adults. Lack of awareness of available options and their benefits and risks may lead to decisions that do not reflect older adults’ preferences, and to guilt and regret. We assessed the effect of training home care teams in interprofessional shared decision-making (SDM) on the proportion of caregivers who report being active in this decision. Research Design and Methods In a two-arm pragmatic cluster randomized trial with home care teams working in health centers in the Province of Quebec, we randomized health centers to receive training in interprofessional SDM (intervention) or not (control). Eligible caregivers had made a housing decision for a cognitively impaired adult aged 65 years or older who was receiving services from a home care team. The primary outcome was the proportion of caregivers reporting an active role in decision making. We performed intention-to-treat multilevel analysis. Results We consecutively enrolled a random group of 16 health centers and recruited 309 caregivers, among whom 296 were included in the analysis. In the intervention arm, the proportion of caregivers reporting an active role in decision making increased by 12% (95% CI −2% to 27%; p = .10). After removal of an influential cluster outlier, the proportion increased to 18% (95% CI: 7%–29%; p < .01). Discussion and Implications Training home care teams in interprofessional SDM increased caregiver involvement in health-related housing decisions for cognitively impaired older adults.

Decision Regret among Informal Caregivers Making Housing Decisions for Older Adults with Cognitive Impairment: A Cross-sectional Analysis

“…We performed a secondary analysis of cross-sectional data collected in a multicenter cluster randomized trial. 29 The Decision making On Location of Care with the frail Elderly and their informal caregivers (the DOLCE) trial was conducted under the leadership of the Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation. 30 The DOLCE trial obtained ethics committee review approval from the CHU de Que´bec Multicenter Ethics Committee (approval number: MP-CHU-QC-14-001).…”

“…Full details of the trial, including context and methods, are published elsewhere. 22,29,31 Participants Eligible participants were informal caregivers of older adults aged 65 years who 1) were cognitively impaired (i.e., unable to provide informed consent according to the clinical judgment of their interprofessional home care team) and were receiving care from a home care team; 2) could read, understand, and write French or English; and 3) gave individual written informed consent for the DOLCE trial. 29…”

A Scoping Review of Evidence on the Use and Effectiveness of Decision Aids in Adult Social Care

“…None of the above methods identified the 'DOLCE' randomised controlled trial referred to by Garvelink et al (2016), for which their decision guide about location of care was developed. A final online search identified a paper by Adekpedjou et al (2020) on ResearchGate which described a trial investigating the effectiveness of an intervention to engage care-givers in health-related housing decisions for older adults. The intervention included the use of the decision guide developed by Garvelink et al (2016).…”

Variations in factors associated with healthcare providers’ intention to engage in interprofessional shared decision making in home care: results of two cross-sectional surveys

“…According to the results of the cRT [15], training the home care team in IP-SDM did seem to increase caregivers' participation in their loved ones' housing decisions [15]. We had hypothesised that this outcome would occur because post-training, the healthcare providers would involve caregivers more in the decisionmaking and give them more support.…”