Effectiveness of an Intelligent and Integrated Older Care Model on Quality of Life among Home-dwelling Older Adults: A Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Integrated care facilitated by Information and Communication Technology offers a promising approach to actively responding to the global older care burden. However, its effectiveness remains unclear. OBJECTIVE This study aimed to evaluate the effectiveness of an intelligent and integrated older care model (SMART system) in improving the quality of life for older people living at home. METHODS A randomized controlled trial was conducted. After assessing eligibility, participants were randomly allocated in a 1:1 ratio to receive the personalized integrated care delivered by the SMART system or usual care for 3 months from November 1, 2020, to December 31, 2020. The primary endpoint was the percent change in quality of life from baseline to the 3-month follow-up, while secondary endpoints included functional status and percent changes in health self-management ability, social support, and confidence in avoiding falling of older individuals from baseline to the 3-month follow-up. All data analysis followed the intention-to-treat principle. A covariance model or logistic regression model was performed to estimate the effectiveness as appropriate. Subgroup and sensitivity analyses were also conducted to verify the robustness of our findings. RESULTS Of 94 participants included, 48 were assigned to the SMART Group. The SMART system demonstrated a statistically significant improvement in quality of life among home-dwelling older participants, with an estimated intervention difference of 11.97% (95% CI: 7.20%-16.74%, p<0.001). Similarly, it substantially enhanced health self-management ability and social support compared to the usual care (difference: 4.95%, p<0.05; difference: 6.75%, p<0.001). Furthermore, the SMART system significantly reduced instrumental activities of daily living (IADL) disability (OR: 0.34, 95%CI: 0.11-0.83, p=0.024), while no statistically significant reduction in activities of daily living (ADL) disability was observed. The subgroup and sensitivity analyses yielded identical results. CONCLUSIONS Personalized and integrated care provided via the SMART system significantly improved quality of life, health self-management ability, and social support among older individuals, while also reducing IADL disability. CLINICALTRIAL This study was prospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR-IOR-17010368) on 12/01/2017.