Improving Social Connectedness for Homebound Older Adults: Randomized Controlled Trial of Tele-Delivered Behavioral Activation Versus Tele-Delivered Friendly Visits

Abstract

Objective: To test the acceptability and effectiveness of a lay-coach-facilitated, videoconferenced, short-term behavioral activation (Tele-BA) intervention for improving social connectedness among homebound older adults.

Methods: We employed a two-site, participant-randomized controlled trial with 89 older adults (averaging 74 years old) who were recipients of, and initially screened by, home-delivered meals programs. All participants reported loneliness; many reported being socially isolated and/or dissatisfaction with social support. Participants received five weekly videoconference sessions of either Tele-BA or Tele-FV (friendly visits; active control). Three primary outcomes were social interaction (Duke Social Support Index [DSSI] Social Interaction Subscale), subjective loneliness (PROMIS Social Isolation Scale), and DSSI Satisfaction with Social Support Subscale. Depression severity (PHQ-9) and disability (WHODAS 2.0) were secondary outcomes. Mixed-effects regression models were fit to evaluate outcomes at 6- and 12-weeks follow-up.

Results: Compared to Tele-FV participants, Tele-BA participants had greater increase in social interaction (t [81] = 2.42, p = 0.018) and satisfaction with social support (t [82] = 2.00, p = 0.049) and decrease in loneliness (t [81] = -3.08, p = 0.003), depression (t [82] = -3.46, p = 0.001), and disability (t [81] = -2.29, p = 0.025).

Conclusion: A short-term, lay-coach-facilitated Tele-BA is a promising intervention for the growing numbers of homebound older adults lacking social connectedness. The intervention holds promise for scalability in programs that already serve homebound older adults. More research is needed to solidify the clinical evidence base, cost-effectiveness and sustainability of Tele-BA delivered by lay coaches for homebound and other older adults.

Trial registration: ClinicalTrials.gov NCT04131790.

Keywords: Social isolation; behavioral activation; friendly visit; lay-coach facilitation; loneliness; tele-delivery.

Conflict of interest statement

Conflict of Interest

No disclosures to report for any author.

Copyright © 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.. CONSORT Flow chart

1Telephone screening refusal reasons: Not interested; not feeling lonely; moving soon; not having time (due to caregiving or medical appointments; not liking videoconference delivery (n=5); already have a counselor 2Refusal reasons when eligible: Not perceiving social isloation, too busy, loss of contact; lack of interest; health problems 3Ineligibility reasons: UCLA Loneliness scales < 6 (n=10); PHQ-9 >10 (n=47); cognitive impairment (BOMC >9; n=2); other (poor vision, poor hearing, not meeting age cutoff, unable to answer questions; n=7).