# Integrated Tele-Behavioral Activation and Fall Prevention for Low-income Homebound Older Adults with Depression

> **NIH NIH R01** · UNIVERSITY OF TEXAS AT AUSTIN · 2022 · $633,908

## Abstract

PROJECT SUMMARY
Depression and falls are significantly higher in low-income, racially diverse homebound seniors than in the
general older-adult population; however, the existing systems of care are not equipped to address disparities in
mental health and fall prevention services for these vulnerable older adults. The long-term objective of the
proposed study is to improve access to depression treatment and fall prevention for growing numbers of low-
income homebound seniors. Specific aims are to compare clinical and cost effectiveness of integrated tele-
delivered behavioral activation (Tele-BA) and fall prevention (FP) by bachelor’s-level lay counselors/coaches to
Tele-BA or FP alone and attention control (AC). The current and projected shortages of licensed clinicians and
the costs of deploying highly trained professionals pose barriers to providing services to older adults in general
and low-income homebound seniors in particular. A more scalable option is to utilize lay counselors/coaches,
and our recent clinical trial (1R01MD009675) and a FP pilot study show that lay counselors/coaches are as
effective as licensed clinicians. The study participants will be 320 low-income, racially diverse homebound
seniors who are served by a home-delivered meal (HDM) program and other aging-service agencies in Central
Texas. The lay counselors/coaches will be co-located in the HDM program for seamless referral and care
coordination. In a 4-arm, pragmatic clinical trial with randomization prior to consent (a preferred public health
approach), the participants in the integrated Tele-BA and FP (TBF hereafter) arm will receive 5 Tele-BA
sessions and 4 in-home FP sessions. Those in the Tele-BA or FP alone arms will receive the respective
intervention and 4 bimonthly telephone check-in (booster) calls, and those in the AC arm will receive 5 weekly
telephone check-in calls followed by 4 bimonthly follow-up calls. Study hypotheses are: At 12, 24, and 36
weeks after baseline, (1) TBF will be more effective than Tele-BA or FP alone, and Tele-BA or FP alone will be
more effective than AC in reducing depression (the 24-item Hamilton Rating Scale for Depression), falls, and
fall injuries; (2) TBF than Tele-BA alone or FP alone will be more effective in reducing disability (WHODAS 2.0)
and healthcare and social service use; and (3) TBF will be more cost effective than Tele-BA alone or FP alone.
Cost-effectiveness analysis (CEA) will be based on depression free days, prevented falls, and health-related
quality adjusted life-year measured by EuroQol-5 (EQ-5D). We will also conduct budget impact analysis (BIA)
of TBF relative to Tele-BA or FP. Both CEA and BIA will employ a hybrid public program perspective of the
Administration for Community Living and the Centers for Medicare and Medicaid. Public health significance of
this study is that it will provide empirical data needed for real-world adoption of an intervention delivery model
that targets to intervene for the two mo...

## Key facts

- **NIH application ID:** 10443574
- **Project number:** 5R01MD009675-08
- **Recipient organization:** UNIVERSITY OF TEXAS AT AUSTIN
- **Principal Investigator:** NAMKEE G CHOI
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $633,908
- **Award type:** 5
- **Project period:** 2015-06-26 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10443574

## Citation

> US National Institutes of Health, RePORTER application 10443574, Integrated Tele-Behavioral Activation and Fall Prevention for Low-income Homebound Older Adults with Depression (5R01MD009675-08). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10443574. Licensed CC0.

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