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

背景资料：百万美国老年人因新冠肺炎不得不练习社交疏远 大流行。预计许多老年人将需要继续这样做，直到有效的 现已有疫苗可用。由于这些限制，大多数老年人不能参加他们的常规活动 身体和社会活动。当老年人减少他们的身体条件时，身体条件解除会迅速发生 活动级别。这增加了人们变得如此虚弱的风险，从而限制了他们做基础工作的能力 像爬楼梯和户外散步这样的活动。肌肉无力和平衡障碍 也是跌倒和跌倒相关伤害的主要危险因素，包括骨折。因为人们已经失去了 他们通常的社会关系来源，很可能会增加孤独的发生率(即 孤立感)、社会孤立(即缺乏社会联系和支持)和抑郁 在老年人中。孤独感和社会孤立已经成为老年人的严重问题 在这次大流行之前。许多组织已经建立了志愿者电话或付费电话 员工通过友好交往减少孤独感和社交隔离 交谈。然而，有证据表明，非专业人士使用简短行为进行远程干预 在改变重要的健康结果方面，激励性指导明显比 对话呼叫。方法：本研究将探讨其可行性、可接受性和初步意义。 基于电话的行为激活训练减少电话呼叫有效性的证据 从初级保健诊所招募的n=50名老年人的孤独感和阻止条件解除 波士顿或巴尔的摩附近的老年生活/辅助生活中心。干预措施将完全实施 在4个月内远程进行10次会议。结果包括可行性、安全性和 可接受性。通过使用可穿戴设备测量日常步行步数的变化来探索疗效 感官、孤独、功能、残疾、社交隔离、抑郁、焦虑和卫生保健利用。 患者报告的结果将由训练有素的电话评估员在基线和4个月内进行评估 注册后。暗示：如果行为激活辅导电话被发现是 有效的这种模式可以迅速传播到志愿组织、卫生系统或 希望支持因新冠肺炎而与社会隔绝的人的企业。这些材料和 实施行为激活辅导的资源将在网上免费提供。

Background: Millions of older Americans have to practice social distancing due to the COVID-19 pandemic. It is anticipated that this will need to continue for many older people until an effective vaccine is available. Due to these restrictions, most older people cannot take part in their regular physical and social activities. Physical deconditioning occurs rapidly when older people reduce their activity level. This increases the risk of people becoming so weak that it limits their ability to do basic mobility activities like climbing stairs and walking outdoors. Muscle weakness and balance impairments are also major risk factors for falls and fall-related injuries, including fractures. Because people have lost their usual sources of social connection, there is likely to be an increased incidence of loneliness (i.e. the feeling of being isolated), social isolation (i.e. the lack of social connection and support) and depression among older people. Loneliness and social isolation were already serious problems for older people before this pandemic. Many organizations have put in place telephone calls by volunteers or paid employees to reduce loneliness and social isolation by engaging in friendly companionship conversations. However, there is evidence that tele-interventions by lay people that use brief behavioral activation coaching are significantly more effective in changing important health outcomes than conversational calls. Methods: This study will explore the feasibility, acceptability and preliminary evidence of efficacy of telephone-based Behavioral Activation Coaching telephone calls to reduce loneliness and prevent deconditioning in n=50 older people recruited from primary care practices in Boston or senior living/assistive living centers near Baltimore. The intervention will be delivered entirely remotely in 10 sessions over 4 months. Outcomes include measures of feasibility, safety and acceptability. Efficacy will be explored by measuring changes in daily steps walked using a wearable sensor, 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-months post enrollment. Implications: If the Behavioral Activation Coaching telephone calls are found to be effective this model could be quickly disseminated to volunteer organizations, health systems or businesses that wish to support people who are social isolating due to COVID-19. The materials and resources to implement the Behavioral Activation Coaching will be made freely available online.