Evaluation of Peer-to-Peer Support and Health Care Utilization Among Community-Dwelling Older Adults

Question Is a community-designed and community-implemented peer-to-peer (P2P) support program for older adults associated with lower acute health care utilization? Findings In this comparative effectiveness study, there was a statistically significant higher rate of hospitalization in the P2P group than the standard community services group during the 12 months of observation. There were no significant differences in the rates of emergency department and urgent care visits or in the composite outcome of any health care utilization between the 2 groups. Meaning These findings suggest that P2P support programs may change the way in which older adults access health care and lead to greater hospitalization. This comparative effectiveness study investigates whether a community-designed peer-to-peer support program is associated with lower acute health care utilization compared with standard community services among older adults. Importance The vast majority of older adults desire to age in their communities, and it is not clear what helps them be successful at aging in place. Objective To investigate the comparative effectiveness of community-designed and community-implemented peer-to-peer (P2P) support programs vs standard community services (SCS) to promote health and wellness in at-risk older adults. Design, Setting, and Participants This comparative effectiveness study involved a longitudinal cohort of adults aged 65 years and older conducted between 2015 and 2017. The setting was 3 communities in which community-based organizations delivered P2P services to older adults in California, Florida, and New York. Participants in the P2P group and in the SCS group were matched at enrollment into the study according to age, sex, and race/ethnicity at each site. Data analysis was performed from October 2018 to May 2020. Exposures P2P support was provided by trained older adult volunteers in the same community. They provided support targeted at the needs of the older adult they served, including transportation assistance, check-in calls, social activities, help with shopping, and trips to medical appointments. Main Outcomes and Measures Rates of hospitalization, urgent care (UC) and emergency department (ED) use, and a composite measure of health care utilization were collected over 12 months of follow-up. Results A total of 503 participants were screened, 456 participants were enrolled and had baseline data (234 in the SCS group and 222 in the P2P group), and 8 participants had no follow-up data, leaving 448 participants for the main analysis (231 in the SCS group and 217 in the P2P group; 363 women [81%]; mean [SD] age, 80 [9] years). Participants in the P2P group more often lived alone, had lower incomes, and were more physically and mentally frail at baseline compared with the SCS group. After adjusting for propensity scores to account for baseline differences between the 2 groups, there was a statistically significant higher rate of hospitalization in the P2P group than in the SCS group (0.68 hospitalization per year vs 0.44 hospitalization per year; risk ratio, 1.54; 95% CI, 1.14-2.07; P = .005) during the 12 months of observation. There were no significant differences between the 2 groups in the rates of ED or UC visits or composite health care utilization over the 12 months of the study. Conclusions and Relevance P2P support was associated with higher rates of hospitalization but was not associated with other measures of health care utilization. Given that this is not a randomized clinical trial, it is not clear from these findings whether peer support will help older adults age in place, and the topic deserves further study.