LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy): Proposal for an Online Service Development and Evaluation

Lex van Velsen, Miriam Cabrita, Harm Op den Akker, Lena Brandl, Joana Isaac, María Suárez, Afonso Gouveia, Rute Dinis de Sousa, Ana Maria Rodrigues, Helena Canhão, Nathaniel Evans, DELA Natura- En Levensverzekeringen NV, Marije Blok, Carlos Alcobia, Jeannette Brodbeck, Lex van Velsen, Miriam Cabrita, Harm Op den Akker, Lena Brandl, Joana Isaac, María Suárez, Afonso Gouveia, Rute Dinis de Sousa, Ana Maria Rodrigues, Helena Canhão, Nathaniel Evans, DELA Natura- En Levensverzekeringen NV, Marije Blok, Carlos Alcobia, Jeannette Brodbeck

Abstract

Background: Loss of a spouse is a frequent occurrence in later life. While most older adults successfully process this loss and will return to a normal life, about 10% of the individuals are unable to cope, and progress to prolonged grief (PG). PG, in turn, can result in mental and physical problems including poor sleep, cardiovascular problems, depression, and suicidal tendencies.

Objective: LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy) is an online bereavement program that will support the prevention and treatment of PG, so that elderly mourners can continue to lead an active, meaningful, and dignified life. LEAVES will cater to secondary end users (eg, family, informal caregivers) by reducing stress.

Methods: LEAVES will help older adults to process the loss of a spouse in an online environment, which consists of (1) an existing online grief self-help program LIVIA, (2) the Before You Leave program that allows for storing personal memories, (3) a virtual agent platform, and (4) an accessible front-end design. LEAVES can detect persons at risk for complications, reveal negative trends in their emotional life, and act to counter such trends. The service relies on online support whenever possible but is blended with telephone or face-to-face counseling when necessary.

Results: The project will take place between February 2020 and January 2023 and includes a real-life evaluation in which 315 end users will use the service across 3 countries (the Netherlands, Portugal, and Switzerland). The evaluation of LEAVES will focus on clinical effect, its business case, and technology acceptance. The results will pave the way for smooth integration into existing care paths and reimbursement schemes.

Conclusions: The LEAVES service aims to soften the mourning process, prevents depression or social isolation, strengthens widow(er)s resilience and well-being, and quickens one's return to societal participation.

International registered report identifier (irrid): DERR1-10.2196/19344.

Keywords: aged; bereavement; eHealth; grief; mental health; resilience; telemedicine; widowhood.

Conflict of interest statement

Conflicts of Interest: None declared.

©Lex van Velsen, Miriam Cabrita, Harm op den Akker, Lena Brandl, Joana Isaac, María Suárez, Afonso Gouveia, Nathaniel Evans, Rute Dinis de Sousa, Ana Maria Rodrigues, Helena Canhão, DELA Natura- En Levensverzekeringen NV, Marije Blok, Carlos Alcobia, Jeannette Brodbeck. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 08.09.2020.

Figures

Figure 1
Figure 1
LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy) value chain.
Figure 2
Figure 2
Before You Leave screen where a person is asked to reflect on whom they have learned most from in life.
Figure 3
Figure 3
Online grief self-help program LIVIA.
Figure 4
Figure 4
Example virtual agent "Anja" asking for input from the user on obstacles faced to deal with the loss of a partner.
Figure 5
Figure 5
LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy) service component overview. UI: user interface.
Figure 6
Figure 6
LEAVES (optimizing the mentaL health and resiliencE of older Adults that haVe lost thEir spouSe via blended, online therapy) work package (WP) overview.

References

    1. Prigerson HG, Frank E, Kasl SV, Reynolds CF, Anderson B, Zubenko GS, Houck PR, George CJ, Kupfer DJ. Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses. Am J Psychiatry. 1995 Jan;152(1):22–30. doi: 10.1176/ajp.152.1.22.
    1. Molina N, Viola M, Rogers M, Ouyang D, Gang J, Derry H, Prigerson HG. Suicidal Ideation in Bereavement: A Systematic Review. Behav Sci. 2019 May 14;9(5) doi: 10.3390/bs9050053.
    1. Stahl ST, Schulz R. Changes in routine health behaviors following late-life bereavement: a systematic review. J Behav Med. 2014 Aug;37(4):736–55. doi: 10.1007/s10865-013-9524-7.
    1. Stroebe M, Schut H, Stroebe W. Health outcomes of bereavement. Lancet. 2007 Dec 8;370(9603):1960–73. doi: 10.1016/S0140-6736(07)61816-9.
    1. Parisi A, Sharma A, Howard MO, Blank Wilson A. The relationship between substance misuse and complicated grief: A systematic review. J Subst Abuse Treat. 2019 Aug;103:43–57. doi: 10.1016/j.jsat.2019.05.012.
    1. Ennis J, Majid U. Death from a broken heart?: A systematic review of the relationship between spousal bereavement and physical and physiological health outcomes. Death Stud. 2019 Sep 19;:1–14. doi: 10.1080/07481187.2019.1661884.
    1. Lundorff M, Holmgren H, Zachariae R, Farver-Vestergaard I, O'Connor M. Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. J Affect Disord. 2017 Apr 01;212:138–149. doi: 10.1016/j.jad.2017.01.030.
    1. Kersting A, Brähler E, Glaesmer H, Wagner B. Prevalence of complicated grief in a representative population-based sample. J Affect Disord. 2011 Jun;131(1-3):339–43. doi: 10.1016/j.jad.2010.11.032.
    1. Newson RS, Boelen PA, Hek K, Hofman A, Tiemeier H. The prevalence and characteristics of complicated grief in older adults. J Affect Disord. 2011 Jul;132(1-2):231–8. doi: 10.1016/j.jad.2011.02.021.
    1. Bonanno G, Wortman CB, Lehman DR, Tweed RG, Haring M, Sonnega J, Carr D, Nesse R. Resilience to loss and chronic grief: a prospective study from preloss to 18-months postloss. J Pers Soc Psychol. 2002 Nov;83(5):1150–64. doi: 10.1037//0022-3514.83.5.1150.
    1. Aoun SM, Breen LJ, Howting DA, Rumbold B, McNamara B, Hegney D. Who needs bereavement support? A population based survey of bereavement risk and support need. PLoS One. 2015 Mar 26;10(3):e0121101. doi: 10.1371/journal.pone.0121101.
    1. Ott CH, Lueger RJ, Kelber ST, Prigerson HG. Spousal bereavement in older adults: common, resilient, and chronic grief with defining characteristics. J Nerv Ment Dis. 2007 Apr;195(4):332–41. doi: 10.1097/01.nmd.0000243890.93992.1e.
    1. Eisma MC, Boelen PA, van DBJ, Stroebe W, Schut HAW, Lancee J, Stroebe MS. Internet-Based Exposure and Behavioral Activation for Complicated Grief and Rumination: A Randomized Controlled Trial. Behav Ther. 2015 Nov;46(6):729–48. doi: 10.1016/j.beth.2015.05.007.
    1. Litz BT, Schorr Y, Delaney E, Au T, Papa A, Fox AB, Morris S, Nickerson A, Block S, Prigerson HG. A randomized controlled trial of an internet-based therapist-assisted indicated preventive intervention for prolonged grief disorder. Behav Res Ther. 2014 Oct;61:23–34. doi: 10.1016/j.brat.2014.07.005.
    1. Van der Houwen K, Schut H, Van den Bout J, Stroebe M, Stroebe W. The efficacy of a brief internet-based self-help intervention for the bereaved. Behav Res Ther. 2010 May;48(5):359–67. doi: 10.1016/j.brat.2009.12.009.
    1. Wagner B, Knaevelsrud C, Maercker A. Internet-based cognitive-behavioral therapy for complicated grief: a randomized controlled trial. Death Stud. 2006 Jun;30(5):429–53. doi: 10.1080/07481180600614385.
    1. Brodbeck J, Berger T, Biesold N, Rockstroh F, Znoj HJ. Evaluation of a guided internet-based self-help intervention for older adults after spousal bereavement or separation/divorce: A randomised controlled trial. J Affect Disord. 2019 Jun 01;252:440–449. doi: 10.1016/j.jad.2019.04.008.
    1. Brodbeck J, Berger T, Znoj HJ. An internet-based self-help intervention for older adults after marital bereavement, separation or divorce: study protocol for a randomized controlled trial. Trials. 2017 Jan 13;18(1):21. doi: 10.1186/s13063-016-1759-5.
    1. DELA Innovation Lab Before You Leave App [Internet] 2018. [2020-08-02].
    1. Bickmore TW, Utami D, Matsuyama R, Paasche-Orlow MK. Improving Access to Online Health Information With Conversational Agents: A Randomized Controlled Experiment. J Med Internet Res. 2016 Jan 04;18(1):e1. doi: 10.2196/jmir.5239.
    1. Op den Akker H, Op den Akker R, Beinema T, Banos O, Heylen D, Bedsted B, Pease A, Pelachaud C, Salcedo V, Kyriazakos S, Hermens H. Council of Coaches - A Novel Holistic Behavior Change Coaching Approach. The 4th International Conference on Information and Communication Technologies for Ageing Well and e-Health; March 22-23; Funchal, Portugal. 2018. pp. 219–226.
    1. Worden J. Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner (5th ed.) New York, NY: Springer Publishing; 2018.
    1. Stroebe M, Schut H. The dual process model of coping with bereavement: rationale and description. Death Stud. 1999;23(3):197–224. doi: 10.1080/074811899201046.
    1. Roessingh Research and Development The WOOL Platform. 2020. [2020-08-10]. .
    1. op den Akker H, Jones VM, Hermens HJ. Tailoring real-time physical activity coaching systems: a literature survey and model. User Model User-Adap Inter. 2014 Jun 25;24(5):351–392. doi: 10.1007/s11257-014-9146-y.
    1. Op den Akker H, Cabrita M, Op den Akker R, Jones VM, Hermens HJ. Tailored motivational message generation: A model and practical framework for real-time physical activity coaching. J Biomed Inform. 2015 Jun;55:104–15. doi: 10.1016/j.jbi.2015.03.005.
    1. Faschingbauer T. The Texas Inventory of Grief--Revised. Houston, TX: Honeycomb Publishing; 1981.
    1. Gierveld JDJ, Tilburg TV. A 6-Item Scale for Overall, Emotional, and Social Loneliness. Res Aging. 2016 Aug 18;28(5):582–598. doi: 10.1177/0164027506289723.
    1. Diener E, Emmons RA, Larsen RJ, Griffin S. The Satisfaction With Life Scale. J Pers Assess. 1985 Feb;49(1):71–5. doi: 10.1207/s15327752jpa4901_13.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren