Telehealth Intervention Program for Older Adults

Social isolation has profound negative impacts on the mental health of older adults
(generally those aged ≥60), such as stress, anxiety, cognitive decline, and depression.
Depression is the #1 cause of disability worldwide. Prior to the pandemic, mental disorders
were affecting >10-15% older adults and more than 1,000,000 Canadians, with an estimated
annual cost of $15 billion, which will increase with COVID-19.

There are 4.5 billion people globally in voluntary confinement and practicing social
distancing. Older adults are more isolated and face risks to their health: i.e. increased
risk for depression, ER visits and hospital admissions. Older isolated individuals are 4-5
times more likely to be rehospitalized. Moreover, older adults with stress, anxiety, and/or
depression, have 50% higher healthcare costs and at 2 times increased mortality. Together
these factors threaten to further overwhelm a healthcare system already strained from
managing the direct morbidity and mortality of COVID-19.

During the pandemic, with an increased burden on health professionals who can be burnt out,
reassigned, or infected with COVID-19, engaging lay volunteers may be beneficial to increase
capacity. During COVID, many people are currently unable to work/study, are
underemployed/unemployed, and able to volunteer. In a low-resource part of India, an
in-person lay volunteer intervention was able to improve depression and other mental health
symptoms in older adults. However, a systematic review of volunteer interventions in older
individuals with mental health found that the evidence-base is limited with small sample
sizes, few randomized controlled trials, especially for remote service delivery. Telehealth
has been successful in connecting with socially isolated adults. Telehealth can be adopted in
areas where healthcare access is limited and has evidence for improving depression and
anxiety. However, telehealth programs that use the internet, tablets, smartphones apps or
computers may not be accessible to or preferred by older adults; a survey of 500 older adults
found that while only 10% used the internet, 77% did own a mobile phone. In the current
COVID-19 context, many such interventions are not feasible for rapid implementation due to
lack of infrastructure, training, and low rates of digital literacy in older adults. In a
telephoning initiative prior to COVID, older isolated adults reported forming satisfying
relationships as well as gaining confidence, engaging in the community and being more
socially active. Given these limitations and need for immediate support for vulnerable older
adults facing isolation during COVID-19, telephone-based support with volunteers is
considered a potential fast, inexpensive, scalable, and convenient intervention option
requiring further investigation.

The Telehealth Intervention Program (TIP-OA) for older adults was created during the COVID-19
pandemic to support the health of older adults who are isolated or have mental
health/cognitive issues. Within the TIP-OA program, volunteers provide friendly phone calls
once a week to older adults (age 60+).

The TIP-OA program provides once a week friendly phone calls from trained volunteers to older
adults (age 60+), particularly to older adults struggling with mental health/cognitive
issues. The clinical program does not provide any kind of treatment to the program user.
Rather, the volunteer-based friendly telephone/telehealth calls adopt a simple and proactive
communication technique: e.g., calling seniors to inquire about their general wellbeing,
giving out information about COVID-19, asking if the seniors need any help or support (e.g.
food delivery, medication from their pharmacy), connecting seniors with community
organizations offering services (e.g. grocery delivery), or just talking and giving friendly
company on the phone to increase a sense of connection. Moreover, program users are given a
phone number for queries, comments, or complaints regarding the program or their volunteer.
This study evaluates the effectiveness of the clinical service TIP-OA in 1) reducing stress
(Perceived Stress Scale), 2) improving the mental health of service users (Patient Health
Questionnaire-9, Generalized Anxiety Disorder-7, Fear of COVID-19 Scale), 3) improving mental
healthcare utilization (e.g. hospital visits, hospitalizations, and outpatient visits), 4)
compare mental health outcomes based on service users baseline risk, as well as 5) understand
the experiences of service users, volunteers, and other stakeholders to improve TIP-OA and
related future programs.

Using mixed-methods, the impact of the program will be evaluated systematically. The
investigators will assess mental health outcomes in 200 older adults at baseline, 4- and
8-weeks (primary study endpoint). In addition, the investigators will perform qualitative
analyses focus groups and/or individual semi-structured interviews with older adult
participants, volunteers, community partners, and team members. The investigators anticipate
that the TIP-OA program will be associated with improvements in stress, anxiety, and
depression. If this is indeed the case, the investigators hope to share results with
colleagues who could also develop similar programs internationally.