Enhancing family-based long-term care with a model of community integrated intermediary care (CIIC) service for Thai older adults in Chiang Mai, Thailand: Protocol for a cluster randomized controlled trial (Preprint)

BACKGROUND Thailand is one of the most rapidly aging countries in Asia. Traditional family-based care that has been the basis of most care for the older people is becoming unsustainable as families become smaller. In addition, women tend to be adversely affected as they still form the bulk of caregivers for older people, and many are likely to exit the labour market in order to provide care. Many family caregivers also have no or minimal training, and they may be called upon to provide quite complex care, raising the spectre of older people receiving sub-optimal care if they rely only on informal care that is provided by families and friends. Facing a rising burden of non-communicable diseases and age-related morbidity, Thai communities are increasingly in need of community integrated care model for older persons which can link existing health system and reduce the burden upon caring families. This need is common to many countries in the Association of Southeast Asian Nations (ASEAN). OBJECTIVE In this study, we aimed to assess the effectiveness of community-integrated intermediary care (CIIC) model to enhance family-based care for older people. METHODS This paper describes a cluster randomized controlled trial, comprising six intervention clusters and six control clusters that aim to recruit 2000 participants in each arm. This research protocol has been approved by the World Health Organization (WHO) Ethics Review Committee (ERC). The intervention clusters will receive an integrated model of care structured around 1) a community respite service, 2) the strengthening of family care capacity; and 3) an exercise program that aims to prevent entry into long-term care for older people. Control group clusters receive usual care i.e., the current system of long-term care common to all provinces in Thailand, consisting principally of a volunteer-assisted homecare service. The trial will be conducted in a period of two years. The primary outcome is the burden of family caregivers measured at a six month follow up, applying the caregiver burden inventory. Secondary outcomes consist of bio-psychosocial indicators including functional ability applying activity of daily living scale, depression applying geriatric depression scale and quality of life of older people applying the EuroQol 5-dimensions 5-levels scale. Intention-to-treat analysis will be followed. RESULTS n/A CONCLUSIONS Since ASEAN and many Asian countries share similar traditional family-based long-term care systems, the proposed CIIC model and the protocol for its implementation and evaluation may benefit other countries wishing to adopt similar community integrated care models for older people at risk of needing long-term care. CLINICALTRIAL World Health Organization Ethical Review Committee approval: WHO/ERC ID; ERC.0003064 Thailand Clinical Trial Registry, Trial registration number TCTR20190412004