TELE-BEHAVIORAL ACTIVATION FOR SOCIAL ISOLATION IN OLDER HOME-DELIVERED MEALS RECIPIENTS: PRELIMINARY RESULTS FROM AN ONGOING RANDOMIZED CONTROLLED TRIAL

Homebound older adults are often unable to participate in social interactions and activities that require leaving the home, resulting in a high prevalence of isolation among this population. Isolation is associated morbidity, disability, and mortality. Technology has been explored as a potential avenue for meaningful social interaction for homebound seniors. We present preliminary results of an ongoing randomized controlled trial evaluating the acceptability, feasibility and comparative effectiveness of delivering two interventions by video-conferencing technology to promote social connectedness among homebound older adults receiving home-delivered meals: 1. Behavioral activation (tele-BA) vs. 2. Friendly visitors (tele-FV). To our knowledge, this is the first randomized controlled trial to leverage local Meals on Wheels (MoWs) agencies to engage homebound, socially isolated older adults in a telehealth intervention for social isolation.

Older adults in New Hampshire and central Texas were recruited for our study by local MoWs agencies during the routine annual evaluation of their home-delivered meals clients. After a brief eligibility screening by their MoWs case workers and indicated interest, MoWs clients were referred to our study team and contacted by telephone for a full eligibility assessment. Eligible participants endorsed social isolation (6 or greater on the 3-item UCLA Loneliness Scale), but did not report symptoms of moderate to severe depression (PHQ-9 < 10) or suicidal ideation. Those with hearing, vision, or memory impairment and active psychiatric illness were excluded. Participants were randomly assigned to either participate in the tele-BA intervention or the tele-FV comparison condition for hour-long, weekly videoconference sessions for five weeks. Both interventions were delivered by a trained lay provider. The tele-BA intervention included a version of behavioral activation modified for social isolation and tele-delivery; the comparison condition (tele-FV) consisted of unstructured friendly visits. Participants were assessed at baseline, post-intervention, and 12 weeks post-intervention with the PROMIS 8-Item Social Isolation measure and 9-item Patient Health Questionnaire. Participants were also asked questions related to their experience with tele-BA or tele-FV at the post-intervention assessment.

In the first year of our study, 50 socially isolated older adults (age M±SD73.5±9.2 years; range 51 to 90 years) participated in either the tele-BA intervention (n=28) or tele-FV comparison condition (n=22). Participants were predominantly non-Hispanic white (70%), female (65%), of lower SES (56% less than $20,000 annual income) and living alone (68%). When asked, all participants indicated they would recommend this tele-program to family and friends (Net Promotor Scale 0-10: M±SD 9.7±0.9; range 6-10). Most participants (92%) found these tele-sessions moderately to very acceptable for their social isolation and 95% indicated somewhat positive to very positive general reaction to the program. Preliminary data at 12-week follow-up showed reduction on the 8-item Social Isolation measure and the PHQ-9, with a trend towards greater improvement in participants who participated in the tele-BA group.

Overall, participants found tele-Behavioral Activation and tele-Friendly Visits to be positive experiences and acceptable for their social isolation, and would recommend the program to their friends and family. Preliminary data showed improvement in isolation and depressive symptoms for both groups, which is sustained through 12 weeks of post-intervention follow-up. Our preliminary results suggest the feasibility, acceptability and potential effectiveness of using tele-technology to deliver interventions for homebound older adults who report social isolation. We also found potential evidence of the effectiveness of modified tele-behavioral activation program, compared to friendly visitors, in reducing social isolation and subclinical depressive symptoms in this population. Finally, we demonstrated the feasibility of working in collaboration with community-based Meals on Wheels agencies to identify socially isolated clients and refer them to this program.

AARP-Foundation