Brief, telephone-delivered behavioral activation and mindfulness interventions produced modest but sustained reductions in loneliness and improved well-being in older adults over a 12-month period, according to a randomized clinical trial published in JAMA Network Open. The study evaluated low-intensity psychosocial approaches delivered by trained lay counselors to individuals at high risk of social isolation. The findings may help inform scalable behavioral health programs as health systems increasingly address loneliness as a clinical risk factor.
The Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) trial enrolled 1,151 adults aged 65 years or older who were living alone, digitally excluded, experiencing loneliness, and reporting financial hardship. Participants were randomized to receive telephone-delivered behavioral activation (Tele-BA), telephone-delivered mindfulness (Tele-MF), or telephone-delivered befriending (Tele-BF), which served as an attention control. Each intervention consisted of eight 30-minute telephone sessions delivered over 4 weeks by trained lay counselors.
Loneliness was the primary outcome and was measured using the UCLA Loneliness Scale and the De Jong Gierveld Loneliness Scale. Secondary outcomes included perceived stress, depressive symptoms, anxiety, sleep quality, social support, life satisfaction, and psychological well-being. Assessments were conducted at baseline and at 1, 3, 6, and 12 months. Social isolation was measured using the Lubben Social Network Scale and evaluated as a potential mediator.
At 12 months, participants receiving Tele-BA or Tele-MF demonstrated statistically significant reductions in loneliness compared with the befriending control. Improvements were observed on the UCLA Loneliness Scale for both interventions, while Tele-BA also showed a modest reduction on the De Jong Gierveld scale. Effect sizes were small, indicating that the interventions reduced loneliness but did not eliminate it. A subset of participants achieved clinically meaningful reductions in loneliness.
Participants in the active intervention groups also demonstrated improvements in sleep quality, psychological well-being, perceived social support, life satisfaction, depressive symptoms, anxiety, and perceived stress. Mediation analyses indicated that reductions in social isolation at 6 months partially explained the reduction in loneliness at 12 months.
The interventions were well tolerated. No serious adverse events related to the interventions were reported. Two deaths occurred during follow-up in the mindfulness group, but these were determined to be unrelated to the study interventions.
The authors noted that the findings may be most applicable to older adults with similar cultural and socioeconomic characteristics, as the study was conducted in Hong Kong among individuals with limited resources. Additional studies are needed to assess generalizability and cost-effectiveness.
Source: JAMA Network Open
