voice-activated technology to improve mobility & reduce health disparities (engage)

Conditions: Frailty

Summary: the purpose of this study is to test the efficacy of engage (an interactive, voice-activated app) vs usual care on improving older adult physical and social function.

physical activity is essential for all age groups, across all comorbidities and geriatric syndromes; it has been described as the 'ideal' intervention for aging. increasing physical activity among homebound, multimorbid, african american (aa) older adults (oas) requires a shift in interventions to target the older adult-care partner (cp) pair (dyad) and to test innovative vehicles for remote intervention delivery. our research goal is to create an evidence-based intervention that leverages technology to reach multimorbid oa-cp dyads in the home, promotes long-term mobility and social engagement among those least able to access community resources, and empowers informal care partners with tools. we developed a socially-motivated exercise tool for multimorbid oa-cp dyads called engage that leverages voice-activated technology. we propose to conduct a 6-month, randomized, in-home trial of engage (intervention) versus paper exercise handouts (usual care) in 124 multimorbid, homebound, aa oa-cp dyads recruited from 2 hospital systems and the community. our overall hypothesis is that engage will improve both physical and social function of older adults. all oa subjects will undergo an in-home baseline visit where we will collect data about physical function, social function, activity and frailty. oa-cp dyads will be randomized (1:1) to a physical activity intervention: either engage or usual care. all subjects will be asked to complete exercises 3-6 times per week. care partners will be instructed to encourage their older adult partner to perform physical activities on a regular basis. there is a two week run-in period to troubleshoot the engage app and acclimate the oa subjects to the study intervention. oa subjects will be monitored via phone visits on a monthly basis. in home study visits will take place at month 3 and month 6. data about oa subject physical function, social function, activity and frailty will be collected at these visits.

Eligibility criteria:
inclusion criteria: * age greater than or equal to 65 years * has at least 2 chronic conditions * requires any assistance to leave the home (this may include requiring someone to drive, requiring the use of a cane or walker, or similar) * can read 14 point font from a 2-foot distance on a tablet-sized screen * can hear spoken voice from 2-foot distance * sppb score of less than or equal to 9 but greater than 3 on a 12-point scale to target moderate but not severe functional impairment. exclusion criteria: * reported history of moderate to advanced cognitive impairment; * inability to stand unassisted; * inability to understand english (because the intervention is currently only available in english); * life expectancy less than 12 months or enrolled in hospice; * a medical condition making unsupervised physical activity potentially unsafe including: stroke within prior 12 months, acute myocardial infarction or unstable angina in the prior 6 months, uncontrolled arrhythmias, dissecting aortic aneurysm, acute endo/pericarditis, acute thromboembolism, acute or severe heart or respiratory failure, uncontrolled hypertension greater than 180/100, fracture or joint replacement within the prior 3 months, infections affecting one's general health condition, severe peripheral vascular disease. * severe functional impairment as indicated by an sppb score less than 3 (out of 12); * baseline montreal cognitive assessment of less than or equal to 18/30; * inability to understand consent (teach back).