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Kwok JYY, Jiang D, Yeung DYL, Choi NG, Ho RTH, Warner LM, Chou KL. Layperson-Delivered Telephone-Based Behavioral Activation Among Low-Income Older Adults During the COVID-19 Pandemic: The HEAL-HOA Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2416767. [PMID: 38888923 PMCID: PMC11185980 DOI: 10.1001/jamanetworkopen.2024.16767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 06/20/2024] Open
Abstract
Importance Older adults are particularly vulnerable to loneliness and its physical and psychosocial sequelae, but scalable interventions are lacking, especially during disasters such as pandemics. Objective To compare the effects of layperson-delivered, telephone-based behavioral activation and mindfulness interventions vs telephone-based befriending on loneliness among at-risk older adults. Design, Setting, and Participants This assessor-blinded, 3-arm randomized clinical trial screened Chinese older adults through household visits and community referrals from April 1, 2021, to April 30, 2023, in Hong Kong. Eligible participants (≥65 years of age) who were lonely, digitally excluded, living alone, and living below the poverty line and provided consent to participate were randomized into behavioral activation, mindfulness, and befriending groups. Assessments were conducted at baseline, 1 month, and 3 months. Intervention As part of the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) dual randomized clinical trial, 148 older laypersons were trained to deliver a twice-weekly 30-minute intervention via telephone for 4 weeks. Main Outcomes and Measures The primary outcome was loneliness measured by the UCLA Loneliness Scale (range, 20-80) and the De Jong Gierveld Loneliness Scale (range, 0-6), with higher scores on both scales indicating greater loneliness. Secondary outcomes were depression, perceived stress, life satisfaction, psychological well-being, sleep quality, perceived social support, and social network. Results A total of 1151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) were randomized to the behavioral activation (n = 335), mindfulness (n = 460) or befriending (n = 356) group. Most were widowed or divorced (932 [81.0%]), had primary education or below (782 [67.9%]), and had 3 or more chronic diseases (505 [43.9%]). Following intention-to-treat principles, linear mixed-effects regression model analyses showed that loneliness measured by the UCLA Loneliness Scale was significantly reduced in the behavioral activation group (mean difference [MD], -1.96 [95% CI, -3.16 to -0.77] points; P < .001]) and in the mindfulness group (MD, -1.49 [95% CI, -2.60 to -0.37] points; P = .004) at 3 months compared with befriending. Loneliness measured by the De Jong Gierveld Loneliness Scale was not significantly reduced at 3 months in the behavioral activation group (MD, -0.06 [95% CI, -0.26 to 0.13] points; P > .99]) but was in the mindfulness group (MD, 0.22 [95% CI, 0.03 to 0.40] points; P = .01) at 3 months compared with befriending. In the behavioral activation and mindfulness groups, sleep quality improved compared with befriending, but perceived stress increased. Psychological well-being and perceived social support improved in the behavioral activation group. No statistically significant between-group differences were observed in depression, life satisfaction, or social network. Conclusion and Relevance In this randomized clinical trial, scalable psychosocial interventions delivered remotely by older laypersons appeared promising in reducing later life loneliness and addressing the pressing mental health challenges faced by aging populations and professional geriatric mental health workforce shortages. Further research should explore ways to maximize the clinical relevance and cost-effectiveness of these interventions. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2300072909.
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Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - Da Jiang
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Dannii Yuen-lan Yeung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
| | - Rainbow Tin Hung Ho
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lisa Marie Warner
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Kee-Lee Chou
- Department of Social Sciences and Policy Studies, The Education University of Hong Kong, Tai Po, Hong Kong
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Warner LM, Jiang D, Yeung DYL, Choi NG, Ho RTH, Kwok JYY, Song Y, Chou KL. Study protocol of the 'HEAL-HOA' dual randomized controlled trial: Testing the effects of volunteering on loneliness, social, and mental health in older adults. Contemp Clin Trials Commun 2024; 38:101275. [PMID: 38435428 PMCID: PMC10904923 DOI: 10.1016/j.conctc.2024.101275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
Background Interventions to reduce loneliness in older adults usually do not show sustained effects. One potential way to combat loneliness is to offer meaningful social activities. Volunteering has been suggested as one such activity - however, its effects on loneliness remain to be tested in randomized controlled trials (RCT). Methods This planned Dual-RCT aims to recruit older adults experiencing loneliness, with subsequent randomization to either a volunteering condition (6 weeks of training before delivering one of three tele-based loneliness interventions to older intervention recipients twice a week for 6 months) or to an active control condition (psycho-education with social gatherings for six months). Power analyses require the recruitment of N = 256 older adults to detect differences between the volunteering and the active control condition (128 in each) on the primary outcome of loneliness (UCLA Loneliness Scale). Secondary outcomes comprise social network engagement, perceived social support, anxiety and depressive symptoms, self-rated health, cognitive health, perceived stress, sleep quality, and diurnal cortisol (1/3 of the sample). The main analyses will comprise condition (volunteering vs. no-volunteering) × time (baseline, 6-, 12-, 18-, 24-months follow-ups) interactions to test the effects of volunteering on loneliness and secondary outcomes. Effects are expected to be mediated via frequency, time and involvement in volunteering. Discussion If our trial can show that volunteers delivering one of the three telephone-based interventions to lonely intervention recipients benefit from volunteer work themselves, this might encourage more older adults to volunteer, helping to solve some of the societal issues involved with rapid demographic changes.
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Affiliation(s)
- Lisa M. Warner
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Da Jiang
- The Education University of Hong Kong, 10 Lo Ping Rd, Tai Po, Hong Kong
| | - Dannii Yuen-lan Yeung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Ave, Kowloon Tong, Hong Kong
| | - Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, USA
| | - Rainbow Tin Hung Ho
- Department of Social Work & Social Administration, Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Youqiang Song
- Department of Biochemistry, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kee-Lee Chou
- The Education University of Hong Kong, 10 Lo Ping Rd, Tai Po, Hong Kong
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Kennedy MA, Stevens CJ, Pepin R, Lyons KD. Behavioral Activation: Values-Aligned Activity Engagement as a Transdiagnostic Intervention for Common Geriatric Conditions. THE GERONTOLOGIST 2024; 64:gnad046. [PMID: 37068017 PMCID: PMC10943502 DOI: 10.1093/geront/gnad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Indexed: 04/18/2023] Open
Abstract
Scalable, transdiagnostic interventions are needed to meet the needs of a growing population of older adults experiencing multimorbidity and functional decline. Behavioral activation (BA) is a pragmatic, empirically supported treatment for depression that focuses on increasing engagement in values-aligned activities. We propose BA is an ideal transdiagnostic intervention approach for older adults because it (a) specifically targets activity restriction, a shared characteristic of common conditions of aging; and (b) has strong potential for scalability through delivery by a broad range of clinician and nonclinician interventionists and via telehealth. We describe the history of BA and review recent literature demonstrating impacts beyond depression including on cognition, social isolation, and disability. We also describe the feasibility of delivering BA across interventionists, settings, and modalities. Our approach advances scholarship by proposing BA as a scalable, transdiagnostic behavioral intervention to address functional decline in older adults with common geriatric conditions.
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Affiliation(s)
- Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Courtney J Stevens
- Department of Psychiatry, Dartmouth-Hitchcock Medicine Center, Lebanon, New Hampshire, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Renée Pepin
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kathleen D Lyons
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, Massachusetts, USA
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Chan DYL, Chong CY, Teh PL, Lee SWH. What drives low-income older adults' intention to use mobility applications? Geriatr Gerontol Int 2024; 24 Suppl 1:342-350. [PMID: 38169136 DOI: 10.1111/ggi.14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/13/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
AIM Mobility applications have the potential to support low-income older adults in facing mobility challenges. However, there is a generally lower uptake of technology in this segment. To understand factors affecting the intention to use a mobility app, we drew upon the Protection Motivation Theory, and tested a model of low-income older adults' technology adoption. METHODS A cross-sectional survey was conducted across seven states in Malaysia among community-dwelling low-income older adults aged ≥60 years old (n = 282). Measurement items were adapted from pre-validated scales and 7-point Likert Scales were used. Partial least squares structural equation modeling was utilized to assess the hypothesized model. RESULTS Mobility technology awareness was found to shape an individual's threat and coping appraisals associated with their intention to use a mobility app. The decision of a low-income older adult to adopt a mobility app as a protective action is not a direct function of threat and coping appraisals but is indirect, and mediated by the underlying cost-benefit perceptions of non-adoption and adoption of the mobility app. In terms of technology perceptions, perceived usefulness is a significant predictor, but not perceived ease of use. CONCLUSIONS This study entails a new model by uncovering the psychological factors encompassing mobility technology awareness, threat-coping appraisals, and cost-benefit perceptions on Technology Acceptance Model studies. These insights have important implications for the development and implementation of a mobility app among low-income older adults. Geriatr Gerontol Int 2024; 24: 342-350.
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Affiliation(s)
| | - Chun Yong Chong
- School of Information Technology, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Pei-Lee Teh
- School of Business, Monash University Malaysia, Bandar Sunway, Malaysia
- Gerontechnology Laboratory, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Shaun Wen Huey Lee
- Gerontechnology Laboratory, Monash University Malaysia, Bandar Sunway, Malaysia
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- School of Pharmacy, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
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Peng R, Li X, Guo Y, Ning H, Huang J, Jiang D, Feng H, Liu Q. Barriers and facilitators to acceptance and implementation of eMental-health intervention among older adults: A qualitative systematic review. Digit Health 2024; 10:20552076241234628. [PMID: 38444518 PMCID: PMC10913496 DOI: 10.1177/20552076241234628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
Objective Electronic mental health interventions are effective but not well promoted currently among older adults. This study sought to systematically review and summarize the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults. Methods We comprehensively retrieved six electronic databases from January 2012 to September 2022: PubMed, Web of Science, Embase, Scopus, PsycINFO, and CINAHL. The JBI-QARI was used to assess the quality of the research methodology of each publication. Eligible studies underwent data coding and synthesis aligned to inductive and deductive methods. The Consolidated Framework for Implementation Research 2.0 was used as a deductive framework to guide a more structured analysis. Results The systematic review screened 4309 articles, 17 of which were included (eight with mixed methods and nine with qualitative methods). We identified and extracted the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults: (1) innovation: technology challenges, optimized functions, and contents, security and privacy; (2) outer setting: community engagement and partnerships, financing; (3) inner setting: leadership engagement, available resources, incompatibility, intergenerational support, training and guidance; (4) individuals: perceptions, capability, motivation of older adults and healthcare providers; and (5) implementation process: recruit, external assistance, and team. Conclusion These findings are critical to optimizing, promoting, and expanding electronic mental health interventions among older adults. The systematic review also provides a reference for better evidence-based implementation strategies in the future.
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Affiliation(s)
- Ruotong Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xiaoyang Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yongzhen Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jundan Huang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Dian Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Oceanwide Health Management Institute, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qingcai Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Chan DYL, Lee SWH, Teh PL. Factors influencing technology use among low-income older adults: A systematic review. Heliyon 2023; 9:e20111. [PMID: 37809586 PMCID: PMC10559849 DOI: 10.1016/j.heliyon.2023.e20111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
As the world's aging population increases, leveraging technology to support aging is proving advantageous. Notably, technology adoption studies among older adults have received increasing scholarly attention, but findings from these studies do not reflect the context of low-income older adults. Studies focusing on low-income older adults were relatively few and it remains unclear which factors influence this group's technology use. This systematic review aims to synthesize findings on factors influencing technology use among low-income older adults to provide directions and opportunities for future research in information systems. Observing the literature through the lens of Social Cognitive Theory, we identified avenues for future research and further integrated the framework with Maslow's hierarchy of needs to elucidate the phenomenon. Findings from this systematic review suggest that both personal and environmental factors, such as cognitions, affects, sociodemographic characteristics, technological and social environment are significant predictors of technology use among low-income older adults. Specifically, factors related to accessibility and affordability, such as income, perceived cost, and accessibility to technology are salient in a resource-limited setting. More importantly, the technology usage behavior elucidate the embeddedness of fundamental human needs which plays a central role underlying technology use among this segment. However, more research is needed to understand the interaction between person, environment and behavior determinant shaping technology use among low-income older adults from diverse economic and cultural setting. This study also sheds light on disciplinary gaps and the lack of investigations anchored on theoretical foundations, and suggests avenues for future research and implications for practice.
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Affiliation(s)
- Diana Yian Lian Chan
- School of Business, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
- School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia
- Gerontechnology Laboratory, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Pei-Lee Teh
- School of Business, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
- Gerontechnology Laboratory, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
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Anvari MS, Hampton T, Tong MP, Kahn G, Triemstra JD, Magidson JF, Felton JW. Behavioral Activation Disseminated by Non-Mental Health Professionals, Paraprofessionals, and Peers: A Systematic Review. Behav Ther 2022; 54:524-538. [PMID: 37088508 DOI: 10.1016/j.beth.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
There is a striking disparity between the number of individuals with significant mental health concerns and those who are able to access care globally. One promising solution to expanding the mental health taskforce is task-sharing, or employing nonspecialists in the delivery of evidence-based interventions. Behavioral activation (BA), a brief intervention that focuses on scheduling rewarding activities into one's daily life, may have promise for delivery using task-sharing approaches due to its straightforward, flexible nature. The aim of this systematic review was to examine the current state of the literature on non-specialist-delivered BA and evaluate the evidence base of this approach. Three databases (Pubmed, PsycInfo, and Cochrane) were searched, and all articles were screened for inclusion criteria by two research assistants, included the review of titles, abstracts, and full-text. The final dataset consisted of 13 research studies, represented through 15 articles. A meta-analysis was conducted to examine the overall pooled effects of peer-delivered BA on depressive symptoms (the most widely examined clinical outcome). Studies reported on effectiveness and implementation outcomes of non-specialist-delivered BA for depression, substance use, loneliness, trauma survivors, and individuals with comorbid physical health conditions. Results provide initial support for the effectiveness of BA utilizing a task-sharing approach, and highlight the feasibility and acceptability of using nonspecialists to deliver BA in a variety of contexts, including low-resource settings.
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Affiliation(s)
| | - Tessa Hampton
- Center for Health Policy & Health Services Research, Henry Ford Health
| | | | - Geoffrey Kahn
- Center for Health Policy & Health Services Research, Henry Ford Health
| | - Justin D Triemstra
- Spectrum Health, Helen DeVos Children's Hospital; College of Medicine, Michigan State University
| | | | - Julia W Felton
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit
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Zhang Y. The effect of incontinence on depression among older adults: a longitudinal study in China. Public Health 2022; 212:58-65. [DOI: 10.1016/j.puhe.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/09/2022] [Accepted: 08/30/2022] [Indexed: 11/11/2022]
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Choi NG, Vences K, Caamano J. Reasons for refusing referrals and challenges to effectual engagement in tele-treatment for depression among low-income homebound older adults. Aging Ment Health 2022; 26:1127-1135. [PMID: 33843370 PMCID: PMC8853830 DOI: 10.1080/13607863.2021.1910789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: To describe reasons for refusal to be referred to or enroll in a depression treatment study and post-enrollment challenges to treatment engagement and technology-related problems among low-income homebound individuals aged 50+ years with depression.Methods: Data came from a 3-arm randomized clinical trial that evaluated real-world effectiveness of lay counselor-delivered behavioral activation (BA) versus clinician-delivered problem-solving therapy (PST). Interventionists were embedded in a large home-delivered meals program and treatment sessions were videoconferenced; hence Tele-BA and Tele-PST. We described refusal reasons of those who refused initial case manager referrals (n = 279), telephone screening (n = 64), enrollment (n = 47), or post-enrollment baseline assessments (n = 18). We used inductive thematic analysis to explore challenges to effectual treatment engagement and tele-delivery-related problems among Tele-PST or Tele-BA participants (n = 183) from the interventionists' tele-session process recordings.Results: More than a third of potentially eligible older adults refused their case managers' referral, and a quarter of those who accepted referral refused further screening or enrollment. Three quarters of those who refused reported no interest or need or declined to talk about depression. Others refused given their busy schedule with medical appointments and caregiving. Nearly 80% of Tele-BA or Tele-PST participants had some challenges to effectual engagement in treatment sessions due to environmental and health-related conditions and other life stressors including financial distress. Though many tele-sessions had connectivity and other technology-related problems, these did not affect depression outcomes.Conclusion: Mental health service providers for low-income older adults need to be aware of these challenges when adopting best practice strategies for them.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Kelly Vences
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Julieta Caamano
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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Pepin R, Stevens CJ, Choi NG, Feeney SM, Bruce ML. Modifying Behavioral Activation to Reduce Social Isolation and Loneliness Among Older Adults. Am J Geriatr Psychiatry 2021; 29:761-770. [PMID: 32980253 PMCID: PMC7933361 DOI: 10.1016/j.jagp.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe our modification of Behavioral Activation to address social isolation and loneliness: Brief Behavioral Activation for Improving Social Connectedness. Our recent randomized clinical trial demonstrated the effectiveness of the intervention, compared to friendly visit, in alleviating loneliness, reducing depressive symptoms, and increasing social connectedness with lonely homebound older adults receiving home-delivered meals. METHODS We modified Brief Behavioral Activation Treatment for Depression to address social isolation and loneliness by addressing each of its key elements: Psychoeducation; intervention rationale; exploration of life areas, values and activities; and activity monitoring and planning. The intervention consisted of six weekly sessions, up to 1 hour each. Interventionists were bachelor's-level individuals without formal clinical training who participated in an initial 1-day training as well as ongoing supervision by psychologists and social workers trained in BA throughout the study delivery period. RESULTS We provide three case examples of participants enrolled in our study and describe how the intervention was applied to each of them. CONCLUSIONS Our preliminary research suggests that Behavioral Activation modified to address social connectedness in homebound older adults improves both social isolation and loneliness. This intervention has potential for scalability in programs that already serve homebound older adults. Further research is needed to solidify the clinical evidence base, replicate training and supervision procedures, and demonstrate the sustainability of Brief Behavioral Activation for Improving Social Connectedness for homebound and other older adults.
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Affiliation(s)
- Renee Pepin
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Health (RP, CJS, SMF, MLB), Lebanon, NH.
| | - Courtney J Stevens
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Health (RP, CJS, SMF, MLB), Lebanon, NH
| | - Namkee G Choi
- The University of Texas, Steve Hicks School of Social Work (NGC), Austin, TX
| | - Sharon M Feeney
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Health (RP, CJS, SMF, MLB), Lebanon, NH
| | - Martha L Bruce
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Health (RP, CJS, SMF, MLB), Lebanon, NH
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