HCA 502 Module 7 Paper: Research and/or Evaluation for Aging Issues Report Example

Calls That Last: A Proposed Six-Month Trial of Layperson Telephone Support for Homebound Older Adults in Maricopa County

Student Name

MA in Aging, Arizona State University

HCA 502: Research and Program Evaluation Issues in Aging

Instructor Name

Month Day, Year

Calls That Last: A Proposed Six-Month Trial of Layperson Telephone Support for Homebound Older Adults in Maricopa County

Introduction

Loneliness is common among older adults and predicts decline in daily functioning and death. In a national cohort of adults over 60, 43% reported loneliness, and lonely participants had a 45% higher adjusted hazard of death over six years (Perissinotto et al., 2012). Pooled data from 148 studies tied stronger social relationships to roughly 50% better odds of survival (Holt-Lunstad et al., 2010). Homebound older adults are especially exposed: in interviews, they describe dependence, helplessness and isolation, and value regular contact with others (Cheng et al., 2022).

Literature and Gap

Interventions to reduce loneliness among older people are numerous, but a review of 38 studies judged the evidence generally weak (Gardiner et al., 2018). One of the strongest recent tests was a randomized trial with 240 Meals on Wheels clients in Texas, in which young lay callers trained in empathetic conversation phoned participants for four weeks; loneliness, depression and anxiety improved compared with controls (Kahlon et al., 2021). Qualitative work in six programs found that social connection services built friendships and helped clients feel "like a person again" (Gadbois et al., 2024).

The gap is duration and setting. No trial in this literature tested whether such calls reduce loneliness for six months or longer, whether benefits last after calls stop, or whether they work for Hispanic and Spanish-speaking homebound adults in the Southwest. Agencies deciding whether to fund ongoing call programs need that evidence.

Research Questions and Hypotheses

RQ1. Among homebound older adults receiving home-delivered meals in Maricopa County, do six months of layperson empathy-focused telephone calls reduce loneliness compared with usual meal service?

H1. Loneliness scores at six months will be lower in the call group than in the usual-service group.

RQ2. Are effects maintained three months after calls end?

H2. The call group will retain a smaller but significant advantage at nine months.

RQ3. Do effects differ for Spanish-speaking participants?

RQ4 (qualitative). How do participants experience the calls, and what makes them valuable or not?

Study Type and Design

A two-arm, parallel randomized controlled trial with an embedded qualitative component, making this a mixed-methods study. Randomization addresses confounding that limits cohort evidence, and the qualitative strand explains how and for whom the program works.

Sample and Recruitment

Participants will be clients of home-delivered meal programs in Maricopa County who are 60 or older, homebound and score as lonely at screening. People with severe cognitive impairment that prevents phone conversation will be excluded. Meal program staff will introduce the study, and trained research staff, not callers, will obtain consent by phone and in writing in English or Spanish. A target of 300 participants, 150 per arm, allows for about 20% attrition while retaining power to detect a moderate difference similar to that seen in the earlier four-week trial.

Data Collection and Measures

Primary outcome: loneliness, measured by the three-item short loneliness scale developed for large surveys of older adults (Hughes et al., 2004), administered by phone by assessors blinded to group. Secondary outcomes: depressive and anxiety symptoms on standard brief scales, self-rated health and emergency department visits from meal program records with consent. Process data: number and length of calls and reasons for stopping. Qualitative data: semi-structured interviews with about 25 call recipients and 10 callers at six months, purposively sampled by language and benefit.

Analysis

The primary analysis will compare six-month loneliness between arms using linear mixed models with all randomized participants, adjusting for baseline loneliness. Effect modification by language will be tested with an interaction term. Interviews will be analyzed thematically by two coders, with differences resolved by discussion, and themes compared with quantitative results.

Ethics

The study involves minimal risk but includes a vulnerable population. It will be reviewed by the ASU Institutional Review Board, and all staff will complete CITI training. Callers will follow a protocol for reporting risk of self-harm, neglect or medical emergencies, and control participants will be offered calls after the study ends.

Limitations

Self-reported loneliness may be influenced by the social desirability of pleasing callers, which blinded outcome assessors only partly address. Results from one county's meal programs may not generalize to rural areas, and volunteer turnover could reduce intervention consistency.

Conclusion

If six months of calls reduce loneliness and benefits persist, home-delivered meal programs would have evidence to fund social connection as a standing service. If not, the study will show how long and how often contact is needed.

References

Cheng, J. M., Batten, G. P., & Yao, N. A. (2022). A qualitative study of the social and lived experiences of homebound older adults. Journal of Applied Gerontology, 41(3), 744-753. https://doi.org/10.1177/07334648211040383

Gadbois, E. A., Brazier, J. F., Turner, J., Hawes, C., Florence, L. C., & Belazis, L. (2024). "It made me feel like a person again": Benefits of Meals on Wheels-based social connection programs. Journal of Applied Gerontology, 43(12), 1924-1938. https://doi.org/10.1177/07334648241257798

Gardiner, C., Geldenhuys, G., & Gott, M. (2018). Interventions to reduce social isolation and loneliness among older people: An integrative review. Health & Social Care in the Community, 26(2), 147-157. https://doi.org/10.1111/hsc.12367

Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLOS Medicine, 7(7), e1000316. https://doi.org/10.1371/journal.pmed.1000316

Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys: Results from two population-based studies. Research on Aging, 26(6), 655-672. https://doi.org/10.1177/0164027504268574

Kahlon, M. K., Aksan, N., Aubrey, R., Clark, N., Cowley-Morillo, M., Jacobs, E. A., Mundhenk, R., Sebastian, K. R., & Tomlinson, S. (2021). Effect of layperson-delivered, empathy-focused program of telephone calls on loneliness, depression, and anxiety among adults during the COVID-19 pandemic: A randomized clinical trial. JAMA Psychiatry, 78(6), 616-622. https://doi.org/10.1001/jamapsychiatry.2021.0113

Perissinotto, C. M., Stijacic Cenzer, I., & Covinsky, K. E. (2012). Loneliness in older persons: A predictor of functional decline and death. Archives of Internal Medicine, 172(14), 1078-1083. https://doi.org/10.1001/archinternmed.2012.1993