#3-63E. Scaling Connection: Lay-Delivered Interventions for Geriatric Loneliness (JAMA Netw Open, 2026)

Loneliness in older adults is a critical public health issue associated with significant morbidity, yet long-term, scalable solutions remain elusive in clinical practice. This episode examines a large-scale randomized clinical trial involving 1,151 solitary, low-income older adults in Hong Kong, which assessed the efficacy of telephone-delivered behavioral activation (Tele-BA) and mindfulness (Tele-MF) administered by trained lay counselors. The study demonstrated that both interventions significantly reduced loneliness and improved psychological well-being at 12 months compared to a befriending control, with improvements partially mediated by a reduction in social isolation. These findings suggest that addressing objective isolation is a key mechanism for alleviating subjective loneliness. However, critical appraisal is necessary, as the study faced a high attrition rate of approximately 60% by the 12-month follow-up, partly due to COVID-19 disruptions, which may introduce survival bias. For physicians, this research is highly relevant as it validates a low-cost, scalable non-pharmacological model using lay personnel, offering a practical framework to prescribe or recommend for mitigating loneliness and its health risks in aging populations.

Citation: Tang VFY, Jiang D, Kwok JYY, et al. Behavioral Activation and Mindfulness Interventions in Reducing Loneliness and Improving Well-Being in Older Adults. JAMA Network Open. 2026. DOI: 10.1001/jamanetworkopen.2025.57170

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