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

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

Rush University, National Opinion Research Center, National Institute on Minority Health and Health Disparities (NIMHD)

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.

EngAGE will allow care partners send older adults encouragement which will be read aloud to the older adult through the EngAGE app.

Care partners can encourage their older adult partner using traditional / existing communication mechanisms.

Participants are asked to hold a side-by-side, semi-tandem and tandem balance pose each for 10 seconds.

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).

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