Integrated Tele-Behavioral Activation and Fall Prevention for Low-income Homebound Seniors With Depression

Conditions studied

Depression, Unipolar, Fall

About this study

This study will test clinical and cost effectiveness of an integrated tele- and bachelor's-level counselor/coach delivered behavioral activation (BA) and fall prevention (FP) for low-income homebound older adults. The long-term objective of the proposed study is to improve access to depression treatment and fall prevention for growing numbers of low-income homebound seniors. We plan to recruit 320 low-income, racially diverse homebound seniors who are served by a home-delivered meal (HDM) program and other aging-service agencies in Central Texas. In a 4-arm, pragmatic clinical trial with randomization prior to consent, the participants in the integrated Tele-BA and FP (TBF hereafter) arm will receive 5 Tele-BA sessions and 4 in-home FP sessions. Those in the Tele-BA or FP alone arms will receive the respective intervention and 4 bimonthly telephone check-in (booster) calls, and those in the Attention Control (AC) arm will receive 5 weekly telephone check-in calls followed by 4 bimonthly follow-up calls. Follow-up assessments will be at 12, 24, and 36 weeks after baseline.

Interventions

• Behavioral: Behavioral Activation — In BA, depressive symptoms are viewed as depressive behaviors. Compared to those without depression, people with depression engage in fewer overt behaviors that provide positive reinforcement and pleasure/enjoyment and in more behaviors that function to escape or avoid aversive stimuli (e.g., staying in bed all day).55-59 Thus, BA is aimed at increasing and reinforcing meaningful, healthy, and enjoyable behaviors while decreasing depressive behaviors and is well-suited to help depressed, disabled older adults increase mood-enhancing activities, self-care management skills, and social connectedness.
• Behavioral: Fall Prevention — Following FP psychoeducation based on the Centers for Disease Control and Prevention (CDC)'s STEADI tool kits, lay coaches will assist clients in implementing evidence-based FP strategies that have been adapted for low-income homebound seniors. These include referrals to healthcare providers as needed, home safety checks, practice of safe ambulation/transfer and mobility aid use, medication review, and in-home exercise routines with an innovative, gamified tablet-based exercise app for balance and strength building.
• Other: Telephone support — Subjects in this arm will receive 9 weekly support calls last 30 minutes each. These calls are intended to provide an opportunity for social support and check safety.

Primary outcomes

• Changes from baseline depressive symptom at 12, 24, and 36 weeks (at 12, 24, and 36 weeks after baseline)
• Changes from baseline fall count and injury at 12, 24, and 36 weeks (monthly (form 12 weeks to 36 weeks))
• Changes from baseline EuroQol-5D score at 12, 24, and 36 weeks (at 12, 24, and 36 weeks after baseline)
• Changes from baseline physical and mental health service use (at 12, 24, and 36 weeks after baseline)
• Changes from baseline disability score at 12, 24, and 36 weeks (at 12, 24, and 36 weeks after baseline)
• Changes from baseline social engagement and activities score at 12, 24, and 36 weeks (at 12, 24, and 36 weeks after baseline)
• Changes from baseline satisfaction with social roles & activities at 12, 24, and 36 weeks (at 12, 24, and 36 weeks after baseline)

Eligibility information

Study locations

• University of Texas at Austin, Austin, Texas 78712-0358 United States