Behavioral Activation for Independence in Older Veterans
Trial Parameters
Brief Summary
As Veterans age, chronic health conditions increase their risk of functional limitations, or difficulty completing day-to-day activities independently. Older adults with functional limitations are more likely to be hospitalized or admitted to long-term care facilities. Maintaining independence at home and in the community is a high priority for many older Veterans. The goal of this study is to support the physical, cognitive, and social functioning of older Veterans by developing a program based on behavioral activation, an evidence-based brief psychosocial intervention that helps individuals increase their engagement in activities aligned with their values (i.e. what matters most to them). The study consists of 3 aims. Aim 1 involves adapting an existing behavioral activation program for older Veterans at risk for functional decline to be delivered by video telehealth and seeking feedback from Veterans and VA staff about the program materials. Aim 2 involves testing the program in a group of 10 Veterans to learn whether it is satisfactory to Veterans; the investigators will make improvements to the program based on the information gathered in this aim. Aim 3 is a randomized controlled trial that will test the behavioral activation program compared to usual care in older adulthood in 48 Veterans. This will help determine whether the program is possible to deliver as planned and acceptable to Veterans, and assess the potential effects of the program on functioning and related health outcomes.
Eligibility Criteria
Inclusion Criteria: * Receiving VA primary care * Community-dwelling (living outside nursing homes) * At risk for functional decline (VES-13 score 3 or higher in Aim 2; VA frailty index higher than 0.2 in Aim 3) Exclusion Criteria: * Non-English speaking * Currently receiving physical therapy, occupational therapy, or psychotherapy * Advanced cognitive impairment (MIS-T 3 or lower) * Uncorrectable hearing or visual impairment that would preclude participation * Unstable physical or mental health condition: * ongoing evaluation of new cardiac or respiratory symptoms * receiving hospice or palliative care services * anticipated surgery in the next 3 months * severe depressive symptoms (PHQ-9 14 or higher) * active suicidal ideation * likely substance use disorder (positive TICS) * schizophrenia * psychosis in the past 6 months * (Aim 2 and 3) Currently receiving physical therapy, occupational therapy, or psychotherapy * (Aim 3 only) No access to video-capable device (tablet, smartphone,