EXploring Patterns of use and Effects of adult Day programs to Improve Trajectories of continuing care (EXPEDITE): Protocol of a retrospective cohort study (Preprint)

Adult day programs provide critical supports to older adults and their family/friend caregivers. High-quality care in the community for as long as possible, and minimizing facility-based continuing care are key priorities of older adults, their caregivers, and healthcare systems. While most older adults in need of care live in the community, about 10% of newly admitted care home residents have relatively low care needs that could be met in the community with the right supports. However, research on the effects of day programs is inconsistent. The methodological quality of studies is poor, and we especially lack robust, longitudinal research. Our research objectives are to (1) compare patterns of day program use (including non-use) by province (Alberta, British Columbia, Manitoba), and time, (2) compare characteristics of older adults by day program use pattern (including non-use), province, and time, (3) assess effects of day programs on attendees, compared to a propensity score matched cohort of older non-attendees in the community. In this population-based retrospective cohort study, we will use clinical and health administrative data of older adults (65+ years) who received publicly funded continuing care in the community in the Canadian provinces of Alberta, British Columbia, and Manitoba between January 01, 2012 and December 31, 2024. We will compare patterns of day program use between provinces and assess changes over time. We will then compare characteristics of older adults (e.g., age, sex, physical/cognitive disability, area-based deprivation indices, caregiver availability/distress) by pattern of day program use/ non-use, province and time. Finally, we will create a propensity score matched comparison group of older adults in the community, who have not attended a day program. Using time-to-event models and general estimating equations, we will assess whether day program attendees compared to non-attendees enter care homes later; use emergency, acute, or primary care less frequently; experience less cognitive and physical decline; and have better mental health. This will be a 3-year study (July 1, 2024 – June 30, 2027). We received ethics approvals from the relevant ethics boards. Starting on July 1, 2024, we will work with the three provincial health systems on data access and linkage, and we expect data analyses to start in Early 2025. This study will generate robust Canadian evidence on the effects of day programs on older adults and their caregivers. This will improve the quality of care provided to older adults in day programs, ultimately improving the quality of life of older adults and their caregivers. TBD