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

背景：由于COVID-19，数百万美国老年人不得不保持社交距离 流行病预计这将需要继续为许多老年人，直到有效的 疫苗是可用的。由于这些限制，大多数老年人不能参加他们的常规活动。 体育和社会活动。当老年人减少他们的体重时， 活动水平。这增加了人们变得如此虚弱的风险，以至于限制了他们做基本工作的能力。 移动活动，如爬楼梯和户外行走。肌肉无力和平衡障碍 也是福尔斯和跌倒相关损伤（包括骨折）的主要危险因素。因为人们失去了 他们通常的社会联系来源，可能会增加孤独的发生率（即 被孤立的感觉），社会孤立（即缺乏社会联系和支持）和抑郁症 在老年人中。孤独和社会孤立已经是老年人面临的严重问题 在这场大流行之前许多组织已通过志愿者或付费电话联系 员工通过友好的陪伴减少孤独和社会孤立 对话。然而，有证据表明，使用简短行为的外行人的远程干预 激活教练在改变重要的健康结果方面比 通话方法：本研究将探讨其可行性、可接受性和初步的 基于电话的行为激活训练的有效性证据 从初级保健实践中招募的n = 50名老年人的孤独感和预防失调， 波士顿或巴尔的摩附近的老年生活/辅助生活中心。干预措施将完全由 在4个月的10次远程治疗中。结果包括可行性、安全性和 可接受性将通过使用可穿戴设备测量每日步行步数的变化来探索疗效。 传感器，孤独，功能，残疾，社会隔离，抑郁，焦虑和医疗保健利用。 将由经过培训的电话评估员在基线和4个月时测量患者报告的结局 登记后。含义：如果发现行为激活教练电话是 这种模式可以迅速传播到志愿者组织、卫生系统或 希望支持因COVID-19而陷入社交孤立的人的企业。的材料和 实施行为激活指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.