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

Objective: To evaluate PEARLS effectiveness for increasing social connectedness among underserved older adults with depression. Design: Multisite, 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: A total of 320 homebound older adults (mean(SD) age 72.9(9.6), 79% female, 44% people of color, 81% lowincome, 61% living alone, average four chronic conditions) with clinically significant depression (PHQ-9 mean(SD) 12.7(4.6)). Intervention: Four to 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. Conclusion: 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.