Behavioural Activation in Social IsoLation (BASIL): Is it feasible to deliver a remote study involving a psychological intervention to mitigate depression and loneliness in older adults with long-term health conditions during the COVID-19 pandemic?
Older adults with long-term health conditions have a two-to-three fold increased risk of depression. This physical-mental multimorbidity can lead to poorer health outcomes and poorer quality of life for this group. Social isolation and loneliness are important precipitants for mental ill health. The Covid-19 pandemic has had a disproportionate psychological impact on older people with long-term conditions, further increasing their risk of depression, loneliness and social isolation; addressing this mental health impact is an NHS priority.
The BASIL (Behavioural Activation in Social IsoLation) programme was developed in response to the Covid-19 pandemic. It aims to evaluate the clinical and cost effectiveness of a brief psychological intervention [based on Behavioural Activation (BA) and Collaborative Care] to improve depression and tackle loneliness in older adults with physical-mental multimorbidity during isolation. BASIL was one of only two mental health intervention trials to first receive national priority Urgent Public Health status.The BASIL intervention is based on BA. BA aims to help people to maintain or introduce activities which are important to them and to stay connected with the world and remain active. The BASIL intervention is supported by a self-help booklet. A trained BASIL support worker (BSW) supports the older adult to work through the booklet, monitors depressive symptoms, and facilitates communication with the older adults’ healthcare team as part of collaborative care.The BASIL pilot trial explored the feasibility of recruiting and retaining older adults (65+ years) with two or more long-term health conditions, and remote delivery of the intervention by BSWs. Participants were identified via primary care and randomised 1:1 to receive the BASIL intervention or usual care with signposting information. Study and recruitment processes, intervention delivery and BSW training were adapted to acknowledge and comply with Covid-19 restrictions. Data collection was via telephone. Semi-structured interviews were also conducted with a sample of participants and BSWs.
Ninety-six participants were recruited over 18 weeks. Intervention engagement and delivery was very good; 98% (46/47) of participants randomised to the BA intervention group commenced intervention sessions, with 98% of these completing two or more sessions. Follow-up rates were excellent both at 1 month (94%) and 3 months (90%) post-randomisation. Interview data suggests the remote study processes and self-help booklet were acceptable for older adults; both older adults and BSWs acknowledged the benefit of the intervention and highlighted the importance of a targeted approach.
It is feasible to adapt study and recruitment processes to enable remote delivery of a BA intervention trial for older adults with physical-mental multimorbidity during isolation. These pilot findings have informed the recently commenced definitive main trial (BASIL+ ).