WISE@HOME: Wellness, Independence, Social Connection, and Emotional Health for Seniors at Home

Principal Investigator: Xiaoling Xiang, PhD

There are two million homebound seniors, who never or rarely go out the house due to mobility impairments, illness, and lack of help. About 10 million older adults are at risk of becoming homebound due to their mobility impairments. The state of homebound is frequently associated with medical comorbidities, cognitive impairment, social isolation, and depression, making homebound seniors at risk of hospitalizations, nursing home admissions, and pre-mature death. However, mental health treatments and other wellness programs are often out of reach for homebound seniors due to their mobility impairments and other psychosocial disadvantages. The lead researcher, Dr. Xiaoling Xiang at U-M School of Social Work, saw the urgent need to develop person-centered, accessible, and scalable service models to help these vulnerable older adults live healthy and independently at home.

Non-medical home care provides personal care, housekeeping, transportation, and companionship to help seniors stay independently at their homes. There are over 1.4 million home care workers employed by home care companies to provide these services. Integrating evidence-based health and wellness programs into the routine work of these home care workers has great potential to make these programs accessible to an otherwise hard-to-reach population. Recognizing this potential, Dr. Xiang conceptualized WISE@HOME, a series of research projects and efforts aimed at helping homebound seniors stay happy, socially connected, and healthy at the comfort of their homes by mobilizing home care workers and using technology.

The first series of Dr. Xiang’s projects focus on addressing the unmet needs for depression treatments among homebound seniors. According to a recent study by Dr. Xiang, one in two homebound seniors suffer from probable depression; 14% had major depression and 37% had subthreshold depression. Current treatment patterns feature heavy reliance on medication, which can be a quick fix but not without limitations, particularly for seniors with cognitive impairments. Psychotherapy, which requires multiple sessions and visits to a mental health professional, however, is out of reach for homebound seniors due to transportation, cost, stigma, provide shortage, and other barriers.

The first funded project in this series was a mixed-methods study exploring the feasibility of integrating psychotherapy into non-medical home care. This project is funded by the Michigan Center for Urban African American Aging Research, a research center funded by the National Institute on Aging (P30 AG015281). Dr. Xiang conducted qualitative interviews with different stakeholders, including home care agency directors, nurses, social workers, dozens of direct care workers, and a diverse group of seniors receiving home care in Southeast Michigan. She also developed and administered an online survey, which was filled out by over 80 direct care workers. These interviews and surveys provided valuable information on the opportunities and potential challenges of training home care workers to administer internet-based cognitive behavioral therapy (iCBT), which is automated psychotherapy delivered via the internet. Moving forward, Dr. Xiang is developing research projects to implement an evidence-based iCBT program in the home care setting. This and later projects will help identify best strategies for implementing iCBT programs in home care that are practical and sustainable.

In the future, Dr. Xiang hopes to expand her research to develop, evaluate, and implement other evidence-based programs that promote social connection, physical activity, and quality of life among homebound seniors by mobilizing home care workers and using technology.

If you are interested to learn more about Dr. Xiang’s research or want to participate in her projects, please email xiangxi@umich.edu or call 734-763-6581.

Key publications:

1. Xiang, X., Leggett, A., Himle, J., & Kales, H. (Accepted) Major depression and subthreshold depression among older adults receiving home care. American Journal of Geriatric Psychiatry.

2. Xiang, X., An, R., Oh, H. (Online advance). The bidirectional relationship between depressive symptoms and homebound status among older adults. The Journal of Gerontology: Series B. doi:10.1093/geronb/gbx180

3. Xiang, X., Danilovich, M., K., Tomasino, K. N. & Jordan, N. (2018). Depression prevalence and treatment among older home health services users in the United States. Archives of Gerontology and Geriatrics, 75, 151-157. doi:10.1016/j.archger.2017.12.005

4. Xiang, X., Brooks, J. (2017). Correlates of depressive symptoms among homebound and semi-homebound older adults. Journal of Gerontological Social Work, 60(3), 201-214. doi:10.1080/01634372.2017.1286625

5. Xiang, X., An, R., & Heinemann, A. (online advance). Depression and unmet needs for assistance with daily activities among community-dwelling older adults. The Gerontologist. doi:10.1093/geront/gnw262

For a complete list of Dr. Xiang’s publications, please visit her faculty website at:
https://ssw.umich.edu/faculty/profiles/tenure-track/xiangxi