JMIR Publications

ABSTRACT

Background:

Over 60% of US adults age 65 and older have multiple chronic health conditions, with consequences that include reduced quality of life, increasingly complex but less person-centered treatment, and higher healthcare costs. A previous trial of ElderTree, an eHealth intervention for older adults, found socio-emotional benefits for those with high rates of primary care use.

Objective:

This study tested the efficacy of an ElderTree intervention designed specifically for older patients with multiple chronic conditions to determine whether combining it with primary care improved socio-emotional and physical outcomes.

Methods:

In a non-blinded randomized controlled trial, 346 participants recruited from primary care clinics were assigned 1:1 to the ElderTree intervention or an attention control and followed for 12 months. All participants were age 65+ and had electronic health record diagnoses of at least 3 of 11 chronic conditions (eg, hypertension, diabetes). Primary outcomes were mental and physical quality of life; psychological well-being (feelings of competence, connectedness, meaningfulness, optimism); and loneliness. Tested mediators of effects of study arm on changes in primary outcomes over time were 6-month changes in health coping, motivation, feelings of relatedness, depression, and anxiety. Tested moderators were gender, scheduled healthcare use, and number of chronic conditions. Data sources were surveys at baseline, 6, and 12 months comprising validated scales, and continuously collected ElderTree usage.

Results:

At 12 months, 76.14% of ElderTree participants were still using the intervention. There was a significant effect of ElderTree (vs. control) on improvements over 12 months in mental quality of life (arm x timepoint interaction: b=0.76, 95% Cl 0.14–1.37, P=.015) but no such effect on the other primary outcomes of physical quality of life, psychological well-being, or loneliness. Gender moderated effects of study arm over time on mental quality of life (b=1.33, CI 0.09 to 2.58, P=.036) and psychological well-being (b=1.13, CI 0.13 to 2.12, P=.027), with stronger effects for women than men in both cases. The effect of study arm on mental quality of life was mediated by 6-month improvements in relatedness (α=1.25, P=.037, b=0.31, P<.001). Analyses of secondary and exploratory outcomes showed minimal effects of ElderTree.

Conclusions:

As in our earlier RCT for the previous iteration of ElderTree, the current iteration designed for older patients with multiple chronic conditions showed signs of improving socio-emotional outcomes but no impact on physical outcomes. This may reflect the choice of chronic conditions for inclusion, which need not have impinged on patients’ physical quality of life. Two ongoing RCTs are testing more specific versions of ElderTree targeting older patients coping with (1) chronic pain and (2) greater debilitation owing to at least 5 chronic conditions. Clinical Trial: ClinicalTrials.gov NCT03387735; https://clinicaltrials.gov/study/NCT03387735. International Registered Report Identifier (IRRID): DERR1-10.2196/25175.