Modifying a manualised Behavioural Activation intervention for use with older adults at risk of depression and loneliness during the COVID-19 pandemic

Problem

Depression in older adults (aged 60 years and over) is often under-diagnosed and under-treated. Older adults are less likely to access mental health services due to perceived stigma, lack of awareness about services and fear of being a burden. Older adults are more likely to have long-term physical conditions which increases the risk of depression, and worsens outcomes of all conditions. Older adults may be socially isolated or experience loneliness, both of which can increase the risk of depression and lead to exclusion from society.

Behavioural Activation (BA), within a Collaborative Care framework ,is an effective evidence-based intervention for depression in older adults and people with multiple long-term conditions (MLTCs).

In addition, BA can be delivered by non-specialist practitioners.

The research team were working on a programme of work (MODS) to develop and test an intervention to improve the outcomes of older adults with MLTCs and depression. In March 2020, the COVID-19 pandemic was declared and the team achieved ‘Urgent Public Health COVID-19 status’ to modify the MODS intervention to instead tackle depression and loneliness in older adults who were isolating due to COVID-19 restrictions.

Approach

Ethics approvals obtained.

We will describe the modification and refinement of a BA intervention for older adults at risk of depression and loneliness due to Covid-19 mitigations. We will describe earlier stages of development of the intervention for the MODS trial, focusing on the contributions of our Patient and Public Involvement Advisory group (PPI AG) and the consensus work with stakeholders that supported the intervention modification, Support Worker training materials and training package. All this work was conducted face-to-face. This developmental phase was conducted within the conceptual framework for complex interventions as outlined in the Medical Research Council Complex Interventions Framework.

From March 2020, refinement of the BA intervention for BASIL (Behavioural Activation for Social IsoLation), with PPI AG and consensus group work, and training of Support Workers all conducted online.

Findings

We will describe the challenges and facilitators we encountered modifying an intervention for use to reduce depression and loneliness in older adults during the COVID-19 pandemic. A qualitative evaluation during the initial BASIL feasibility study enabled us to further refine the intervention for the full randomised trial (BASIL+). Additional post-feasibility study modifications were discussed and agreed with the PPI AG and stakeholders.

Consequences

We now have a BA intervention, materials for older adults and Support Workers and a training package for Support Workers which can be used for older adults at risk of depression and loneliness which could be appropriately used outside of COVID-19 restrictions. Our qualitative evaluation within the BASIL+ trial has enabled us to further modify our intervention for the MODS full randomised trial which is currently recruiting.