RecruitingNot ApplicableNCT05011864

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

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

Sponsor

University of Texas at Austin

Enrollment

320 participants

Start Date

Nov 1, 2021

Study Type

INTERVENTIONAL

Conditions

Fall Depression, Unipolar

Summary

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.

Eligibility

Min Age: 50 YearsMax Age: 100 Years

Inclusion Criteria4

Age 50+
English or Spanish proficiency
item Hamilton Rating Scale for Depression score \> 15
item Fall Risk Questionnaire score \>4

Exclusion Criteria7

Recently (\< 4 weeks) initiated or modified antidepressant pharmacotherapy
High suicide risk
Probable dementia
Bipolar disorder
Substance use/misuse
Current participation in any psychotherapy or FP program
Bedbound status

Interventions

BEHAVIORALBehavioral 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.

BEHAVIORALFall 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.

OTHERTelephone 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.