Feasibility of Remote Home Support Coaches to Decrease the Physical and Psychological Impact of Social Distancing on Older Adults

Background: Millions of older Americans have to practice social distancing due to the COVID-19pandemic. It is anticipated that this will need to continue for many older people until an effectivevaccine is available. Due to these restrictions, most older people cannot take part in their regularphysical and social activities. Physical deconditioning occurs rapidly when older people reduce theiractivity level. This increases the risk of people becoming so weak that it limits their ability to do basicmobility activities like climbing stairs and walking outdoors. Muscle weakness and balance impairmentsare also major risk factors for falls and fall-related injuries, including fractures. Because people have losttheir usual sources of social connection, there is likely to be an increased incidence of loneliness (i.e. thefeeling of being isolated), social isolation (i.e. the lack of social connection and support) and depressionamong older people. Loneliness and social isolation were already serious problems for older peoplebefore this pandemic. Many organizations have put in place telephone calls by volunteers or paidemployees to reduce loneliness and social isolation by engaging in friendly companionshipconversations. However, there is evidence that tele-interventions by lay people that use brief behavioralactivation coaching are significantly more effective in changing important health outcomes thanconversational calls. Methods: This study will explore the feasibility, acceptability and preliminaryevidence of efficacy of telephone-based Behavioral Activation Coaching telephone calls to reduceloneliness and prevent deconditioning in n=50 older people recruited from primary care practices inBoston or senior living/assistive living centers near Baltimore. The intervention will be delivered entirelyremotely in 10 sessions over 4 months. Outcomes include measures of feasibility, safety andacceptability. Efficacy will be explored by measuring changes in daily steps walked using a wearablesensor, loneliness, function, disability, social isolation, depression, anxiety, and health care utilization.Patient reported outcomes will be measured by trained telephone assessors at baseline - and 4-monthspost enrollment. Implications: If the Behavioral Activation Coaching telephone calls are found to beeffective this model could be quickly disseminated to volunteer organizations, health systems orbusinesses that wish to support people who are social isolating due to COVID-19. The materials andresources to implement the Behavioral Activation Coaching will be made freely available online.