Implementation of Remote Interventions in Older Adults: Lessons Learned During COVID-19 Isolation

Abstract Recommendations for older adults to socially isolate during the COVID-19 pandemic will have lasting impacts on body weight and physical activity. Due to the pandemic, two in-person RCT weight-loss interventions in obese older adults with prediabetes, Veterans Achieving Weight Loss and Optimizing Resilience-Using Protein (VALOR-UP, n=12) and the Egg-Supplemented Pre-Diabetes Intervention Trial (EGGSPDITE, n=7), were converted to remote formats and weekly nutrition (EGGSPDITE and VALOR-UP) and exercise (VALOR-UP only) classes were delivered using synchronous videoconference technology (Webex); classes were accessed via tablet/desktop/laptop or smart phone. Steps taken to transition participants to remote formats included technology training, implementation of staff tech-support, and delivery of nutrition education, tablets, scales, and exercise bands. The time to successfully transition participants was 1 week for early adopters (n=10) and up to 4 weeks for those with significant technology barriers (n=9); their difficulties included internet access, camera and microphone access and use, and electronic submission of weight and food records. Even with these challenges, in the first 3 months of remote delivery, participant dropout rate was low (10.5%, n=2), attendance was high (87.6% nutrition class (n=19); 76.4% exercise class (VALOR-UP, n=12)), and weight loss was successful (>2.5% loss (n=13); >5% loss (n=8)), showing that lifestyle interventions can be successfully adapted for remote delivery. Remote interventions also have potential for use in non-pandemic times to reach underserved populations who often have high drop-out rates due to caretaker roles, transportation limitations, and work schedules. These barriers were significantly reduced using a virtual intervention platform.

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INNOVATIVE STRATEGIES TO SUPPORT OLDER ADULTS AND THEIR FAMILIES IN HOSPICE AND PALLIATIVE CARE

Innovation in Aging ◽

10.1093/geroni/igz038.718 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S199-S199

Author(s):

George Demiris ◽

Karen Hirschman

Keyword(s):

Older Adults ◽

Palliative Care ◽

Hospice Care ◽

Geographic Distance ◽

Smart Phone ◽

Evidence Base ◽

Lessons Learned ◽

Ethical Challenges ◽

Rural Settings ◽

Hospice And Palliative Care

Abstract In order to better support older adults with life-limiting illness and their families, many initiatives utilize information technology and other innovative platforms to increase access to supportive services and bridge geographic distance. Such technologies cover a broad range of systems ranging from smart phone applications to wearables and traditional telehealth platforms. There is a growing evidence base for such interventions but technical, clinical and ethical challenges remain when utilizing technology in the context of hospice and palliative care especially for older adults, including the concerns for caregiver burden, privacy, security, confidentiality, obtrusiveness and accessibility. In this symposium we provide an overview of innovative tools available for interventions in palliative and hospice care designed for patients and/or family caregivers in urban and rural settings. We provide lessons learned from three NIH funded studies testing different technology-based interventions in various settings including home hospice and outpatient palliative care. Discussion will follow focused on the clinical, ethical and practical challenges of innovation and the unique considerations for technology-mediated intervention design in a variety of palliative and hospice care settings. This symposium aims to provide: 1. an overview of existing technology-based interventions for older adults and their families in palliative care and hospice 2. evidence-based recommendations resulting from clinical trials in urban and rural settings for the design and implementation of innovative tools in hospice and palliative care 3. a discussion of challenges and opportunities for the use of technology to support older adults and their families

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Overcoming Health Promotion Barriers in Rural Health: A Qualitative Analysis

Innovation in Aging ◽

10.1093/geroni/igab046.492 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 128-128

Author(s):

John Batsis

Keyword(s):

Older Adults ◽

Health Promotion ◽

Weight Loss ◽

Qualitative Analysis ◽

Rural Areas ◽

Team Member ◽

Adult Weight ◽

Health Promotion Interventions ◽

Weight Loss Interventions ◽

Weight Loss Study

Abstract Weight loss interventions are fraught with difficulties for older adults in rural areas due to transportation difficulties, reduced availability of staff, and lack of programs. Telemedicine can overcome these barriers. A qualitative analysis of data from 44 exit-interviews from a rural-based, older adult weight loss study, informed by thematic analysis, was conducted. Participant’s age was 73 years (73% female) and BMI was 36.5kg/m2. Distance to the site was 24 miles (31 min). Key themes included: a) telemedicine can help improve one’s health, is more practical than in-person visits, is less costly, and time efficient; b) the majority (60%) were initially apprehensive about using telemedicine, a fear that resolved quickly; c) setting up telemedicine was easy and acceptable, despite a quick learning curve; d) having a team member for troubleshooting was important. Using telemedicine in older adults with obesity residing in rural areas should be considered in health promotion interventions.

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Lessons Learned in the Delivery of Live Remote Group Weight Loss and Physical Activity Interventions for Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.1088 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 281-281

Author(s):

Jason Fanning ◽

Barbara Nicklas

Keyword(s):

Older Adults ◽

Weight Loss ◽

Exercise Program ◽

Health Behavior Change ◽

Careful Consideration ◽

Lessons Learned ◽

Technology Selection ◽

Exercise Interventions ◽

Aerobic Activity ◽

Effective Group

Abstract Social connection lies at the root of lasting health behavior change, and as such most effective interventions are built around social tools. Group leaders and peers provide education, and act as models of successful change and collaborators in addressing common barriers to behavioral adoption and maintenance. Unfortunately, many older adults do not have access to high quality group programs due to factors such as limited transport options, lack of local availability, or worries over personal safety. Importantly, developing effective, synchronous remote group programming is not as simple as delivering an in-person session via teleconference software. Instead, careful consideration must be paid to technology selection, fostering effective group communication, and developing confidence for use of remote intervention tools. This symposium provides key lessons learned from three group-based activity and weight loss interventions for older adults that focused on live, remote interaction. Jason Fanning will share lessons from the MORPH study, which paired remote group-mediated behavioral counseling with dietary weight loss and the accumulation of aerobic activity across the day. Christina Hugenschmidt will share her experiences adapting a group program involving improvisational dance or social gaming for remote delivery. Kushang Patel will present results from a mixed-methods study on the feasibility and acceptability of a remotely-delivered exercise program for older adults with knee osteoarthritis. Finally, Barbara Nicklas will place these experiences in the context of the development of exercise interventions for older adults over time, and highlighting vital next steps for ensuring more older adults have access to this important behavioral medicine.

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Benefit-to-Risk Balance of Weight Loss Interventions in Older Adults with Obesity

Current Diabetes Reports ◽

10.1007/s11892-019-1249-8 ◽

2019 ◽

Vol 19 (11) ◽

Cited By ~ 3

Author(s):

Peter R. DiMilia ◽

Alexander C. Mittman ◽

John A. Batsis

Keyword(s):

Older Adults ◽

Weight Loss ◽

Risk Balance ◽

Weight Loss Interventions

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Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial (Preprint)

10.2196/preprints.29013 ◽

2021 ◽

Author(s):

Jason Fanning ◽

Amber K Brooks ◽

Katherine L Hsieh ◽

Kyle Kershner ◽

Joy Furlipa ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Chronic Pain ◽

Weight Loss ◽

Pilot Study ◽

Cognitive Theory ◽

Lessons Learned ◽

Control Group ◽

Intervention Package ◽

Improve Health

BACKGROUND Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults’ chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program’s scalability and potential efficacy. OBJECTIVE The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial. METHODS The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory–based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools. RESULTS Recruitment is ongoing as of January 2021. CONCLUSIONS Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain. CLINICALTRIAL ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/29013

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