Increasing Social Connectedness for Underserved Older Adults Living with Depression: A Pre-Post Evaluation of PEARLS

ABSTRACT Objective To evaluate PEARLS effectiveness for increasing social connectedness among underserved older adults with depression Design Multi-site, pre-post single-group evaluation Setting Community-based social service organizations (N=16) in five U S states, purposively sampled for maximum variation of participants and providers Participants 320 homebound older adults (mean(SD) age 72 9(9 6), 79% female, 44% people of color, 81% low-income, 61% living alone, average four chronic conditions) with clinically significant depression (PHQ-9 mean(SD) 12 7(4 6)) Intervention 4-6 month home-based depression care management model delivered by trained front-line providers Measurements Brief validated social connectedness scales: Duke Social Support Index 10-item (DSSI-10), PROMIS-Social Isolation (6-item), UCLA-Loneliness (3-item);sociodemographic and health measures Results At baseline, PEARLS participants overall and with >/=1 of the following characteristics were less socially connected: younger (50-64), white, LGBTQ+, not partnered, not caregiving, living alone, financial limitations, chronic conditions, and/or recently hospitalized Six-months post-PEARLS enrollment, participants significantly increased social interactions and satisfaction with social support (DSSI-10 t[312]=5 2, p<0 001);and reduced perceived isolation (PROMIS t[310]=6 3, p<0 001);and loneliness (UCLA t[301]=3 7, p=0 002), with small to moderate effect sizes (Cohen's d DSSI-10: 0 28, PROMIS-SI: 0 35, UCLA: 0 21) Increased social connectedness was associated with reduced depression Improvements in social connectedness (except social interactions) persisted during early COVID-19 Being Latino and/or having difficulty paying for basic needs was associated with less improvement in post-PEARLS social connectedness Conclusions PEARLS has potential to improve social connectedness among underserved older adults, though additional supports may be needed for persons facing multiple social determinants of health Further research is needed to establish causality