Can remote healthcare interventions mitigate psychological impact of COVID-19 restrictions in older people?

In a recent study posted to the medRxiv* pre-print server, researchers evaluated whether a remotely delivered healthcare intervention could help reduce depression and loneliness in elderly with long-term conditions (LTCs) during the coronavirus disease 2019 (COVID-19) pandemic.

Study: Acceptability of a behavioural intervention to mitigate the psychological impacts of COVID-19 restrictions in older people with long-term conditions: a qualitative study. Image Credit: fizkes / Shutterstock

Background

In the next 25 years, England will see a 60% spike in the number of individuals over 60 years. It is common knowledge that aging results in reduced social contact, isolation, and loneliness, accentuating the risk of cognitive impairment, depression, and mortality in the elderly. The COVID-19 pandemic further worsened the mental health of the elderly in England. Accordingly, the government made improving the well-being of the elderly in England a top public health priority.

About the study

In the present study, researchers first familiarized themselves with the Behavioral Activation in Social IsoLation (BASIL) data using thematic analysis (TA). Later, they presented the data analysis using the theoretical framework of acceptability (TFA).

The study population constituted 16 old adults with two or more LTCs and nine BASIL support workers (BSWs) who participated in the BASIL pilot trial organized by National Health Service (NHS) in England between June and October 2020. The elderly participants consented to take part in an interview during the BASIL trial only; however, they approached BSWs via telephone after they completed their BASIL intervention training.

The team used semi-structured interviews conducted between September and November 2020 to assess the acceptability and feasibility of the behavioral activation (BA) intervention. BA, a brief psychological intervention, works on the principle that inactivity results in low mood and loss of positivity in the absence of pleasurable activities.

The researchers recorded the interviews digitally using an encrypted dictaphone and transcribed them with professional help. The BSW interviews ranged between 39 and 60 minutes, while other interviews lasted 30 to 56 minutes. These interviews explored three main areas, BA intervention delivery context, study processes, and thoughts around intervention content, all sensitized by the seven constructs of the TFA.

Notably, TFA had seven domains, burden, affective attitude, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. The researchers derived the meaning of each TFA domain and then indexed data relevant to these domains.

Study findings

The TA suggested that the recruitment procedures for the BASIL pilot trial and BA intervention, including the self-help booklet, were acceptable. Moreover, the study participants found the self-help booklet engaging and relevant. Likewise, most study participants readily accepted remote delivery of the BA intervention.

In other words, both older adults and BSWs had a positive affective attitude towards the BASIL intervention. Some BSWs were positive about how the study adapted in response to the COVID-19 pandemic. However, the positive affective attitude attenuated due to the challenges in activity planning amid COVID-19-induced restrictions.

Older adults appeared to have a good understanding of the correlation between mood, activity, and physical health, indicating that the BA intervention was understandable. Interestingly, BSWs revealed that when people did not have low moods, the BA intervention made less sense to them.

The ethicality domain of TFA was challenging to interpret and sometimes overlapped with the affective attitude domain. Self-efficacy increased over time for both older adults and BSWs, with greater self-efficacy in older adults as they experienced positive effects from taking part in the BASIL trial. The self-efficacy for BSWs grew with the experience of delivering the intervention. However, it reduced as the gap between training and BA intervention delivery increased.

Both older adults and BSWs valued the opportunity to demonstrate altruism during the COVID-19 pandemic, but older adults also appreciated the assistance in seeking healthcare provision. Furthermore, the BA intervention had a low opportunity cost for both BSWs and older adults. The BSWs described how intervention delivery fitted in with their work routine. Similarly, older adults described how the BA intervention was flexible and could be planned around their other activities.

Conclusions

The initial TA was valuable in evaluating the psychological impact of COVID-19. However, despite being a relatively novel method, TFA examined the acceptability of BA as a healthcare intervention in older adults with LTCs through seven dimensions and ensured the identification of all the factors to inform a future trial.  

Overall, the study analysis shed light on all the aspects of the acceptability of healthcare interventions while also evaluating brief psychological interventions which could aid in preventing depression in elderly populations during the COVID-19 pandemic.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Neha Mathur

Neha is a digital marketing professional based in Gurugram, India. She has a Master’s degree from the University of Rajasthan with a specialization in Biotechnology in 2008. She has experience in pre-clinical research as part of her research project in The Department of Toxicology at the prestigious Central Drug Research Institute (CDRI), Lucknow, India. She also holds a certification in C++ programming.