Peer-to-peer support did not slow health decline among older adults

Peer-to-peer support did not slow the decline in health and well-being in older adults who received it compared with those who received standard community services, according to results of a cohort study published in JAMA Network Open.

“While there is substantial literature suggesting that receiving [peer-to-peer] support improves general health and well-being for older adults, many of these studies were qualitative, had small sample sizes or did not have a control group for comparison,” Rebecca J. Schwei, MPH, of the department of emergency medicine at the University of Wisconsin Madison School of Medicine and Public Health, and colleagues wrote. “We sought to expand on the existing literature by comparing the differences in a variety of measures of health and well-being over 1 year between older adults receiving [peer-to-peer] support and older adults who were receiving standard community services using a large sample size across three different organizations with a 12-month follow-up period.”

Schwei and colleagues included a volunteer sample of 448 participants aged 65 years or older who were new to peer-to-peer support or who had already been receiving it, as well as a corresponding control group. They matched participants between groups via age, sex and race/ethnicity. They conducted the study between March 2015 and December 2017 at three community-based organizations that delivered peer-to-peer support in California, Florida and New York. Peer-to-peer support provided by trained older adult volunteers served as the exposures. Mental and physical components of the health status and quality of life measures and depressive and anxiety symptoms, collected over 12 months, served as the main outcomes and measures. A total of 231 individuals participated in the standard community services group and 217 participated in the peer-to-peer support group; 81% of total participants were women, and the mean participant age was 80 years.

Results showed improvements in mental health, for a change at 12 months of 1.1 points (95% CI, 0.8 to 3 points), and physical health, for a change at 12 months of 1 point (95% CI, 0.7 to 2.8 points), among the peer-to-peer support group; however, the two groups did not differ significantly in the difference of differences 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). Both groups exhibited a statistically significant difference of differences in anxiety symptoms of 0.36 points (95% CI, 0.04-0.61). The researchers observed no significant differences in depressive symptoms or mental and physical components of the health status and quality of life.

“It may be that [peer-to-peer] programs do not help maintain or slow the decline of health and well-being in older adults,” Schwei and colleagues wrote. “It is also possible that our failure to account for important differences between the groups at baseline is why we were not able to show clear patterns of association. Well-conducted randomized trials with extended follow-up periods are needed to determine the association between [peer-to-peer] services and measures of health and well-being.

“This study highlights additional factors, such as social support, social isolation and transportation, that would be important to account for at baseline when conducting future studies,” they added.

In a related editorial, Brett D. Thombs, PhD, and Andrea Carboni-Jiménez, BA, both of the department of psychiatry at McGill University in Canada, noted that it is important not to too quickly dismiss peer-to-peer support programs based on the findings of the current study.

“Given the overall evidence base and recent successful use of lay-led or peer-led interventions during COVID-19, there is hope, albeit a great deal of uncertainty, that peer to-peer interventions may be scalable, effective options to improve quality of life for older adults,” Thombs and Carboni-Jiménez wrote. “Well-conducted [randomized clinical trials] are needed, however. Ideally, primary outcomes in such trials will be patient-important outcomes, related to quality of life.”