A Community Health Worker Program to Support Rural Older Adults

Summary

This study will investigate an intervention delivered by community health workers for older adults with signs of cognitive impairment, mobility loss, and depression in the rural primary care setting.

Conditions

• Frail Elderly
• Cognitive Impairment
• Mobility Limitation
• Depressive Symptoms

Interventions

BEHAVIORAL

Tai Ji Quan: Moving for Better Balance

TJQMBB is an evidence-based, Centers for Disease Control and Prevention (CDC)-recommended, group falls prevention program based in Tai Chi that has been shown to reduce falls risk, improve physical function, and improve cognition. The program is delivered in 1-hour sessions twice weekly over 24 weeks, with the first 12 weeks spent learning the basic Tai Ji Quan forms and the second 12 weeks focused on variations in practice that progressively increase physical and cognitive demands. A physical therapist at Dartmouth is an authorized TJQMBB trainer and will train the CHWs to deliver the intervention and provide remote supervision monthly.

BEHAVIORAL

Behavioral Activation

BA is a brief intervention for depressive symptoms that focuses on engagement in positively-reinforcing activities and decreasing activity avoidance. CHWs will be trained by Dartmouth psychologists to deliver a brief behavioral activation program to encourage participants to increase their involvement in meaningful activities. BA will be delivered in one-hour sessions in the home every other week for 12 weeks. Supervision will be provided remotely on a weekly basis.

OTHER

Resource Navigation

CHWs will assess participants' unmet psychosocial needs and assist them in identifying and connecting them with resources to address these needs.Types of assistance may include identifying transportation services, assisting with applications for benefits, linking participants to Meals on Wheels and other local food resources, and connecting participants to community programs for older adults. We expect that participant needs and services delivered will vary and acknowledge that this intervention component will not be standardized due to the nature of this work.

OTHER

Enhanced Usual Care

Comparison participants will receive a detailed resource guide on community supports for older adults. The research team will facilitate referrals to local resources (e.g. the Dartmouth Aging Resource Center) if desired by participants. Data from research assessments of cognition, depressive symptoms, mobility, and functional status will be provided to the primary care team for follow-up and intervention as needed.

Sponsors & Collaborators

• Central Vermont Medical Center

  collaborator UNKNOWN

• Dartmouth College

  collaborator OTHER

• Dartmouth-Hitchcock Medical Center

  collaborator OTHER

• MaineHealth

  collaborator OTHER

• MaineGeneral Health

  collaborator OTHER

• Maine-Dartmouth Family Medicine Residency

  collaborator UNKNOWN

• Dartmouth SYNERGY Clinical and Translational Science Institute

  collaborator UNKNOWN

• Northern New England Clinical and Translational Research Network

  collaborator UNKNOWN

• University of Vermont

  lead OTHER

Principal Investigators

• Michael A LaMantia, MD, MPH · University of Vermont

Study Design

Allocation

NON_RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2019-06-10

Primary Completion

2020-04-28

Completion

2020-07-02

Countries

• United States

Study Locations