Design and Testing of a Person-centered Telecare Model for Healthy Aging in Bogotá

Study Design and Framework This study is a mixed-methods research project (quantitative and qualitative) centered on a randomized clinical trial to evaluate a person-centered sociosanitary telecare model. The model is based on the World Health Organization Integrated Care for Older People (ICOPE) strategy and the Comprehensive Geriatric Assessment (CGA). It focuses on maintaining functional capacity and intrinsic capacity through five domains: locomotion, vitality (nutrition), sensory capacity, cognition, and psychological well-being.

Intervention Plan

The intervention group will receive a multifaceted telecare program integrated through a simplified technological device specifically designed for older adults. The intervention consists of three core components:

Healthy Aging Interventions: Tailored health activities based on the ICOPE guidelines.

Training: Education for participants on self-care and for participants' social support network (family, caregivers, and community "case managers") on supporting functional maintenance.

Case Management and Resource Linkage: Identification and mobilization of social and health resources within participants' homes, neighborhoods, and city to create a robust support portfolio.

Implementation Phases

Phase 1 (Months 1-4): Characterization of participants through a baseline home visit (Visit 0) using CGA and ICOPE screening. Participatory design and production of the telecare device prototype.

Phase 2 (Implementation): Deployment of the telecare model, including training for "gestores" (care managers) and participants.

Phase 3 (Follow-up): Continuous monitoring with formal evaluations every 6 months over a 24-month period.

Assessment and Outcomes

The study evaluates the model's impact on:

Primary Outcome: Change in physical capacity measured by the Short Physical Performance Battery (SPPB).

Secondary Outcomes: Mortality, frequency of emergency room visits, hospitalizations, institutionalization rates, and changes in quality of life (Euro-QoL), cognitive function (MMSE/MOCA), and depressive symptoms (Yesavage).

Statistical Considerations The trial aims for a total sample of 152 participants (76 per arm), accounting for a 20% estimated loss to follow-up, to achieve 90% statistical power. Participants are randomly assigned to either the intervention group or the "usual care" control group using a computerized system.

Eligibility Criteria

Inclusion criteria

• Adults aged 80 years or older.
• Residents of the urban area of Bogotá, Colombia.
• Affiliated with the health insurance provider (EPS) Compensar.
• Functionally independent or with mild dependence (defined by the ability to perform basic activities of daily living).
• Ability to communicate via telephone (landline or mobile).
• Signed informed consent to participate in the study.

Exclusion criteria

• Severe cognitive impairment that prevents following instructions or using the telecare device (e.g., advanced dementia).
• Severe sensory impairments (total blindness or profound deafness) that preclude the use of the technology provided.
• Participants currently enrolled in another clinical trial or intensive home-care program that overlaps with the study intervention.
• End-of-life condition or terminal illness with a life expectancy of less than 6 months.
• Total functional dependence (bedbound or requiring permanent assistance for all daily activities).