Technology-Enabled Service for Caregivers of Older Adults with Depression

For many older adults, home is an extension of the health system. Homebound older adults are more likely than their ambulatory peers to suffer from depression. While over 70 percent receive pharmacotherapy, most homebound older adults with depression cannot access needed psychological services since they are unable to leave the home for ongoing care. For homebound older adults, family caregivers commonly play the role of care coordinator, implementing provider recommendations and encouraging the loved one with depression, usually without adequate support. Family caregivers often experience high levels of stress, burden and anxiety coping with and in some instances attempting to alleviate depressive symptoms.

Older adults have often been on the fringe of benefitting from technology. However, voice-controlled intelligent personal assistants (VIPAs; e.g., Google Home, Amazon Echo), with their natural interaction style and ease of use, are technologies with simple interfaces that may be useful to older adults with depression in the home setting. Family caregivers would be able to schedule and follow the older adults and their VIPAs. The VIPAs could provide functional, cognitive and social stimulation as well as improve anti-depressant medication adherence through reminders to homebound older adults. The aim of this study is to create a technology-enabled service connected with VIPA (TES-VIPA) to provide family caregivers with the skills and tools to act as a care manager of the homebound older adult with depression.

Through user-centered design (UCD) we will adapt the VIPA technologies to assist the older adult with psychoeducation, goal setting, monitoring, feedback and reminders, as well as dashboard tools to enable the caregiver to manage the tool and support the older adult. The resulting low-cost, commonly used technology has the potential to deliver effective care to millions of homebound older adults, who currently are unable to access effective treatment.

To achieve these goals, we have the following three aims, which will develop the TES and pilot the procedures for a larger randomized controlled trial:

Design and tailor a Technology Enabled Service via a Voice-Controlled Intelligent Personal Assistant (TES-VIPA) to support family caregivers of homebound older adults with depression.
Conduct an Optimization, Effectiveness, Implementation (OEI) Hybrid trial of the TES-VIPA: We will pilot the procedures of an OEI Hybrid trial that extends the hybrid (type 1) effectiveness-implementation trial design, including recruitment, assessment, and statistical analyses to evaluation the delivery of the TES-VIPA treatment in the context of a geriatric service, resulting from user-centered design (UCD) and optimization, compared to a control arm.
Experimental Therapeutics Aims: We will explore the impact of core UCD targets, including usability, usefulness and satisfaction on technology and their downstream effects on depression severity as well as explore other moderating effects of older adult characteristics on engagement and treatment response.

The PIs are Emily Lattie, PhD and Sara M Bradley, MD.

Project Name

Technology-Enabled Services to Support Family Caregivers of Older Adults with Depression

Funding

National Institute of Mental Health, Grant Number: P50 MH119029