Voice-Activated Technology to Improve Mobility & Reduce Health Disparities (EngAGE)

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Voice-Activated Technology to Improve Mobility & Reduce Health Disparities: EngAGEing African American Older Adult-Care Partner Dyads

Conditions
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Frailty

Intervention / Treatment
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* Behavioral: Enhanced Engagement
* Behavioral: Standard Engagement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age greater than or equal to 65 years self-identifies as African American 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 8 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).

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: EngAGE<br>Older adult subjects will receive an Alexa Echo Show that runs an exercise app called EngAGE. | Behavioral: Enhanced Engagement<br>* EngAGE will allow care partners send older adults encouragement which will be read aloud to the older adult through the EngAGE app.<br>|
| Active Comparator: Physical Exercise Handouts<br>Older adults subjects will receive a paper booklet containing exercise instructions. | Behavioral: Standard Engagement<br>* Care partners can encourage their older adult partner using traditional / existing communication mechanisms.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Timed Chair Stands | 5 repeated chair stands | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Grip Strength | Dominant grip strength measured with a dynamometer, average of 3 attempts | 6 months | 
| Loneliness | Measured with the 9-item UCLS loneliness scale | 6 months | 
| 4 meter usual walk | Participants walk 4 meters 2 times at their usual pace, fastest of 2 attempts. | 6 months | 
| Static Balance Poses | Participants are asked to hold a side-by-side, semi-tandem and tandem balance pose each for 10 seconds. | 6 months | 
| Physical activity | Wrist accelerometers will be worn for 7 full days in the free living environment. | 6 months |