Peer-to-Peer Support and Changes in Health and Well-being in Older Adults Over Time
Authors: Rebecca J. Schwei, Scott Hetzel, KyungMann Kim, Jane Mahoney, Kali DeYoung, Jenni Frumer, Ross P. Lanzafame, Jenny Madlof, Alis Simpson, Erika Zambrano-Morales, Elizabeth A. Jacobs
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Literature on peer-to-peer (P2P) programs suggests they improve health and well-being of older adults. Analysis from a previous study showed P2P to be associated with higher rates of hospitalization and no significant differences in rates of emergency department or urgent care visits; however, it is not known whether measures of health and well-being varied by group over time. <h3>Objective</h3> To compare the association between receiving P2P support and secondary outcomes (ie, health status, quality of life, and depressive and anxiety symptoms) with receiving standard community services (SCS) over time. <h3>Design, Setting, and Participants</h3> This cohort study was conducted among a volunteer sample of older adults (≥65 years) who were new to P2P or were already receiving P2P and a corresponding control group. Participants were matched between groups on age, sex, and race/ethnicity. The study was conducted from March 2015 to December 2017 at 3 community-based organizations that delivered P2P in California, Florida, and New York. Data analysis was performed from October 2018 through May 2020. <h3>Exposures</h3> P2P support, provided by trained older adult volunteers. <h3>Main Outcomes and Measures</h3> Mental and physical components of the health status and quality of life measure and depressive and anxiety symptoms were collected over 12 months. The hypothesis was that older adults receiving P2P support would maintain higher health status and quality of life than the SCS group. <h3>Results</h3> A total of 503 participants were screened, 456 participants were enrolled and had baseline data, and 8 participants only had baseline information with no follow-up data, leaving 448 participants (231 [52%] in the SCS group; 217 [48%] in the P2P group; 363 [81%] women; mean [SD] age, 80 [9] years). The P2P group had improvements in mental health (change at 12 months, 1.1 points; 95% CI, −0.8 to 3.0 points) and physical health (change at 12 months, 1.0 points; 95% CI, −0.7 to 2.8 points). However, the difference of differences between the 2 groups did not differ significantly from baseline to 12 months (mental health: 0.2 points; 95% CI −2.3 to 2.7 points; physical health: 1.7 points; 95% CI, −0.6 to 3.9 points). The P2P and SCS groups had a statistically significant difference of differences in anxiety symptoms of 0.36 points (95% CI, 0.04 to 0.61 points). There were no significant differences in depressive symptoms or mental and physical components of the health status and quality of life. <h3>Conclusions and Relevance</h3> These findings suggest that receiving P2P support did not slow the decline of health and well-being in older adults compared with those who received SCS. Baseline imbalance in key characteristics, even after adjusting for the imbalance using the propensity score method, may explain the results. Randomized trials are needed.