Telehealth Intervention Program for Older Adults (TIP-OA) for Stress and Mental Health Symptoms: Predictors of treatment response

ABSTRACT

Introduction Prior to COVID-19, psychiatric disorders affected over 10–15% of older adults (>1,000,000 Canadians aged 60+) with estimated costs of $15 billion/year. The pandemic has increased social isolation and limited resources for this vulnerable population, potentially increasing the risk of stress, anxiety, and depression, thus creating an urgent need for support for isolated older adults. To help prevent the development or worsening of mental illness and improve mental health in older adults, we developed an innovative volunteer-based Telehealth Intervention Program for Older Adults (TIP-OA), where volunteers provide weekly friendly phone calls to older adults (clients). TIP-OA has already served 500+ clients in 10+ languages. Although volunteer-based phoning programs may be affordable, scalable, and accessible, there is limited data about their real-world effectiveness and predictors of response. Seeing as TIP-OA is a novel and ongoing intervention program, we aim to identify predictors of treatment response based on client baseline risk ratings and demographic characteristics to help maximize the program's efficacy and benefits, and to detect vulnerable sub-groups of clients who need additional or alternate support. Methods To identify predictors of treatment response, we conducted a longitudinal study. Participants (n=114) were TIP-OA program users (age ≥ 60) who were screened and assigned a risk rating, were living in Montreal, and consented to take part in research. Clients with no/mild ratings were coded as green (low risk), 2+ moderate ratings as orange (medium risk) and 1+ severe rating as red (high risk). Demographic information and the outcome measure responses were collected via phone at baseline, 4- and 8-weeks after receiving their first call. Our primary objective is to identify whether baseline risk level (green low risk, orange medium risk, red high risk) is associated with improved mental health outcomes at 8-week follow-up for stress (primary outcome), depression, anxiety, and COVID fear (secondary outcomes). Our secondary objective is to identify whether baseline demographic characteristics (age, gender, living environment, ethnicity, neighbourhood, languages spoken) are associated with improvement in primary and secondary outcomes. We will compare outcome scores between groups with different baseline risk levels using two-way ANOVA. Additional analysis of covariance (ANCOVAs) will control for variables that differ between groups at baseline. Additional linear mixed-effect regression models, adjusting for covariates such as age, sex, etc., will analyze the effect of TIP-OA in all outcomes collected at baseline and 8-week follow-up. Results We are currently in the process of analyzing the data, and anticipate results by December 2021. Conclusions We anticipate that TIP-OA will be particularly beneficial for improving stress, depression and anxiety symptoms, and fear of COVID-19 over 8-weeks in participants with higher baseline risk levels. If this study is successful, our potential scientific findings will allow us to further refine the intervention and focus future related interventions to patient populations who could benefit most. High-quality, real-time evidence about the predictors of response to this novel intervention for older adults will be generated, allowing for the translation of these findings to the application and further development of TIP-OA or related interventions on a larger scale. Another benefit is that our findings can contribute to a next step in this line of research as older adults are becoming more familiar/comfortable with technology, there is possibility for future high-impact research examining other telehealth and digital health interventions for older adults. This research was funded by TIP-OA received funding support from the Canadian Institutes of Health Research (CIHR#201909PJ8-432903), the Lady Davis Institute, and charitable donations to the Jewish General Hospital Division of Geriatric Psychiatry. The initial training of TIP-OA volunteers through the Touch-Volunteer in Partnership program was funded in part by the What connects us-Ce qui nous lie Dementia Community Investment Public Health Agency of Canada (PI Park Co-PIs Belchior, Valente #1920-HQ-000092). Development and adaptation of the Touch-Volunteer in Partnership manual for telehealth was funded in part by The Canadian Institute of Health Research (PI Park, Primary Knowledge Users Rouleau, Stewart, PHSI #293636 & PI Park, Looper, Stewart, SPOR #397525) and the Jewish General Hospital Foundation (PI Looper).