PDF(Pubmed)
Abstract：
UNASSIGNED: Older adults are particularly vulnerable to loneliness and its physical and psychosocial sequelae, but scalable interventions are lacking, especially during disasters such as pandemics.
UNASSIGNED: To compare the effects of layperson-delivered, telephone-based behavioral activation and mindfulness interventions vs telephone-based befriending on loneliness among at-risk older adults.
UNASSIGNED: This assessor-blinded, 3-arm randomized clinical trial screened Chinese older adults through household visits and community referrals from April 1, 2021, to April 30, 2023, in Hong Kong. Eligible participants (≥65 years of age) who were lonely, digitally excluded, living alone, and living below the poverty line and provided consent to participate were randomized into behavioral activation, mindfulness, and befriending groups. Assessments were conducted at baseline, 1 month, and 3 months.
UNASSIGNED: As part of the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) dual randomized clinical trial, 148 older laypersons were trained to deliver a twice-weekly 30-minute intervention via telephone for 4 weeks.
UNASSIGNED: The primary outcome was loneliness measured by the UCLA Loneliness Scale (range, 20-80) and the De Jong Gierveld Loneliness Scale (range, 0-6), with higher scores on both scales indicating greater loneliness. Secondary outcomes were depression, perceived stress, life satisfaction, psychological well-being, sleep quality, perceived social support, and social network.
UNASSIGNED: A total of 1151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) were randomized to the behavioral activation (n = 335), mindfulness (n = 460) or befriending (n = 356) group. Most were widowed or divorced (932 [81.0%]), had primary education or below (782 [67.9%]), and had 3 or more chronic diseases (505 [43.9%]). Following intention-to-treat principles, linear mixed-effects regression model analyses showed that loneliness measured by the UCLA Loneliness Scale was significantly reduced in the behavioral activation group (mean difference [MD], -1.96 [95% CI, -3.16 to -0.77] points; P < .001]) and in the mindfulness group (MD, -1.49 [95% CI, -2.60 to -0.37] points; P = .004) at 3 months compared with befriending. Loneliness measured by the De Jong Gierveld Loneliness Scale was not significantly reduced at 3 months in the behavioral activation group (MD, -0.06 [95% CI, -0.26 to 0.13] points; P > .99]) but was in the mindfulness group (MD, 0.22 [95% CI, 0.03 to 0.40] points; P = .01) at 3 months compared with befriending. In the behavioral activation and mindfulness groups, sleep quality improved compared with befriending, but perceived stress increased. Psychological well-being and perceived social support improved in the behavioral activation group. No statistically significant between-group differences were observed in depression, life satisfaction, or social network.
UNASSIGNED: In this randomized clinical trial, scalable psychosocial interventions delivered remotely by older laypersons appeared promising in reducing later life loneliness and addressing the pressing mental health challenges faced by aging populations and professional geriatric mental health workforce shortages. Further research should explore ways to maximize the clinical relevance and cost-effectiveness of these interventions.
UNASSIGNED: Chinese Clinical Trial Registry Identifier: ChiCTR2300072909.
UNASSIGNED: To compare the effects of layperson-delivered, telephone-based behavioral activation and mindfulness interventions vs telephone-based befriending on loneliness among at-risk older adults.
UNASSIGNED: This assessor-blinded, 3-arm randomized clinical trial screened Chinese older adults through household visits and community referrals from April 1, 2021, to April 30, 2023, in Hong Kong. Eligible participants (≥65 years of age) who were lonely, digitally excluded, living alone, and living below the poverty line and provided consent to participate were randomized into behavioral activation, mindfulness, and befriending groups. Assessments were conducted at baseline, 1 month, and 3 months.
UNASSIGNED: As part of the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) dual randomized clinical trial, 148 older laypersons were trained to deliver a twice-weekly 30-minute intervention via telephone for 4 weeks.
UNASSIGNED: The primary outcome was loneliness measured by the UCLA Loneliness Scale (range, 20-80) and the De Jong Gierveld Loneliness Scale (range, 0-6), with higher scores on both scales indicating greater loneliness. Secondary outcomes were depression, perceived stress, life satisfaction, psychological well-being, sleep quality, perceived social support, and social network.
UNASSIGNED: A total of 1151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) were randomized to the behavioral activation (n = 335), mindfulness (n = 460) or befriending (n = 356) group. Most were widowed or divorced (932 [81.0%]), had primary education or below (782 [67.9%]), and had 3 or more chronic diseases (505 [43.9%]). Following intention-to-treat principles, linear mixed-effects regression model analyses showed that loneliness measured by the UCLA Loneliness Scale was significantly reduced in the behavioral activation group (mean difference [MD], -1.96 [95% CI, -3.16 to -0.77] points; P < .001]) and in the mindfulness group (MD, -1.49 [95% CI, -2.60 to -0.37] points; P = .004) at 3 months compared with befriending. Loneliness measured by the De Jong Gierveld Loneliness Scale was not significantly reduced at 3 months in the behavioral activation group (MD, -0.06 [95% CI, -0.26 to 0.13] points; P > .99]) but was in the mindfulness group (MD, 0.22 [95% CI, 0.03 to 0.40] points; P = .01) at 3 months compared with befriending. In the behavioral activation and mindfulness groups, sleep quality improved compared with befriending, but perceived stress increased. Psychological well-being and perceived social support improved in the behavioral activation group. No statistically significant between-group differences were observed in depression, life satisfaction, or social network.
UNASSIGNED: In this randomized clinical trial, scalable psychosocial interventions delivered remotely by older laypersons appeared promising in reducing later life loneliness and addressing the pressing mental health challenges faced by aging populations and professional geriatric mental health workforce shortages. Further research should explore ways to maximize the clinical relevance and cost-effectiveness of these interventions.
UNASSIGNED: Chinese Clinical Trial Registry Identifier: ChiCTR2300072909.
摘要：
■老年人特别容易受到孤独及其身体和心理后遗症的影响，但是缺乏可扩展的干预措施，尤其是在大流行等灾难期间。
■要比较非专业人员提供的效果，在有风险的老年人中，基于电话的行为激活和正念干预与基于电话的孤独感的关系。
■这位评估员失明，从2021年4月1日至2023年4月30日在香港进行的三臂随机临床试验通过家庭访问和社区转诊对中国老年人进行了筛查。符合条件的参与者（年龄≥65岁）孤独，数字排除，独自生活,生活在贫困线以下并同意参与的行为被随机分为行为激活，正念,和交友团体。在基线时进行评估，1个月,和3个月。
■作为帮助缓解香港老年人孤独感（HEAL-HOA）双重随机临床试验的一部分，148名年龄较大的外行人接受了为期4周的每周两次通过电话进行30分钟干预的培训。
■主要结果是通过加州大学洛杉矶分校孤独感量表（范围，20-80)和DeJongGierveld孤独量表(范围，0-6),在两个尺度上都有较高的分数表明更大的孤独感。次要结果是抑郁，感知压力，生活满意度,心理健康，睡眠质量,感知到的社会支持，和社交网络。
■总共1151名参与者(平均[SD]年龄，76.6[7.8]年；843[73.2%]女性）被随机分配到行为激活（n=335），正念组(n=460)或结交组(n=356)。大多数人丧偶或离婚(932[81.0%])，受过小学或以下教育(782[67.9%])，并有3种或更多的慢性疾病（505[43.9%]）。遵循意向治疗原则，线性混合效应回归模型分析表明，在行为激活组中，由加州大学洛杉矶分校孤独量表衡量的孤独感显着降低(平均差异[MD]，-1.96[95%CI，-3.16至-0.77]分；P<.001]）和正念组（MD，与交友相比，3个月时-1.49[95%CI，-2.60至-0.37]点；P=.004）。行为激活组在3个月时通过DeJongGierveld孤独量表测量的孤独没有显着降低（MD，-0.06[95%CI，-0.26至0.13]分；P>.99])，但属于正念组(MD，与交友相比，3个月时为0.22[95%CI，0.03至0.40]点；P=0.01）。在行为激活和正念组中，与交朋友相比，睡眠质量有所改善，但是感知到的压力增加了。行为激活组的心理健康和感知的社会支持得到改善。在抑郁方面没有观察到统计学上显著的组间差异,生活满意度,或社交网络。
■在这项随机临床试验中，由老年人外行远程提供的可扩展的社会心理干预措施在减少以后的生活孤独感和解决人口老龄化和专业老年精神卫生劳动力短缺所面临的紧迫的精神卫生挑战方面似乎很有希望。进一步的研究应该探索如何最大限度地提高这些干预措施的临床相关性和成本效益。
■中国临床试验注册标识符：ChiCTR2300072909。
■要比较非专业人员提供的效果，在有风险的老年人中，基于电话的行为激活和正念干预与基于电话的孤独感的关系。
■这位评估员失明，从2021年4月1日至2023年4月30日在香港进行的三臂随机临床试验通过家庭访问和社区转诊对中国老年人进行了筛查。符合条件的参与者（年龄≥65岁）孤独，数字排除，独自生活,生活在贫困线以下并同意参与的行为被随机分为行为激活，正念,和交友团体。在基线时进行评估，1个月,和3个月。
■作为帮助缓解香港老年人孤独感（HEAL-HOA）双重随机临床试验的一部分，148名年龄较大的外行人接受了为期4周的每周两次通过电话进行30分钟干预的培训。
■主要结果是通过加州大学洛杉矶分校孤独感量表（范围，20-80)和DeJongGierveld孤独量表(范围，0-6),在两个尺度上都有较高的分数表明更大的孤独感。次要结果是抑郁，感知压力，生活满意度,心理健康，睡眠质量,感知到的社会支持，和社交网络。
■总共1151名参与者(平均[SD]年龄，76.6[7.8]年；843[73.2%]女性）被随机分配到行为激活（n=335），正念组(n=460)或结交组(n=356)。大多数人丧偶或离婚(932[81.0%])，受过小学或以下教育(782[67.9%])，并有3种或更多的慢性疾病（505[43.9%]）。遵循意向治疗原则，线性混合效应回归模型分析表明，在行为激活组中，由加州大学洛杉矶分校孤独量表衡量的孤独感显着降低(平均差异[MD]，-1.96[95%CI，-3.16至-0.77]分；P<.001]）和正念组（MD，与交友相比，3个月时-1.49[95%CI，-2.60至-0.37]点；P=.004）。行为激活组在3个月时通过DeJongGierveld孤独量表测量的孤独没有显着降低（MD，-0.06[95%CI，-0.26至0.13]分；P>.99])，但属于正念组(MD，与交友相比，3个月时为0.22[95%CI，0.03至0.40]点；P=0.01）。在行为激活和正念组中，与交朋友相比，睡眠质量有所改善，但是感知到的压力增加了。行为激活组的心理健康和感知的社会支持得到改善。在抑郁方面没有观察到统计学上显著的组间差异,生活满意度,或社交网络。
■在这项随机临床试验中，由老年人外行远程提供的可扩展的社会心理干预措施在减少以后的生活孤独感和解决人口老龄化和专业老年精神卫生劳动力短缺所面临的紧迫的精神卫生挑战方面似乎很有希望。进一步的研究应该探索如何最大限度地提高这些干预措施的临床相关性和成本效益。
■中国临床试验注册标识符：ChiCTR2300072909。
