• Madeline McKelway, Abhijit Banerjee, Erin Grela, Frank Schilbach, Miriam Sequeira, Garima Sharma, Girija Vaidyanathan, and Esther Duflo.
• Dartmouth College, Hanover, New Hampshire (M.M.).
• Ann. Intern. Med. 2023 May 1; 176 (5): 632641632-641.

BackgroundA growing number of older persons in developing countries live entirely alone and are physically, mentally, and financially vulnerable.ObjectiveTo determine whether phone-based cognitive behavioral therapy (CBT) or a cash transfer reduce functional impairment, depression, or food insecurity in this population.DesignRandomized controlled trial. (ClinicalTrials.gov: NCT04225845; American Economic Association RCT Registry: AEARCTR-0007582).SettingTamil Nadu, India, 2021.Participants1120 people aged 55 years and older and living alone.InterventionsA 6-week, phone-based CBT and a 1-time cash transfer of 1000 rupees (U.S. $12 at market exchange rates) were evaluated in a factorial design.MeasurementsThe World Health Organization Disability Assessment Schedule (WHODAS), the Geriatric Depression Scale, and food security, all measured 3 weeks after CBT for 977 people and 3 months after for 932. Surveyors were blind to treatment assignment.ResultsThe WHODAS score (scale 0 to 48, greater values representing more impairment) decreased between baseline and the 3-week follow-up by 2.92 more (95% CI, -5.60 to -0.23) in the group assigned cash only than in the control group, and the depression score (ranging from 0 to 15, higher score indicating more depressive symptoms) decreased by 1.01 more (CI, -2.07 to 0.06). These effects did not persist to the 3-month follow-up, and CBT alone and the 2 together had no significant effects. There were no effects on food security.LimitationsThe study cannot say whether more sustained or in-person therapy would have been effective, how results would translate outside of the COVID-19 period, or whether results in the consented sample differ from those in a larger population. Primary outcomes were self-reported.ConclusionAmong older people living alone, a small cash transfer was effective in alleviating short-term (3 weeks) functional impairment, produced a small but not clinically or statistically significant reduction in depression, and had no effect on food security. There were no short-term effects from CBT or the 2 interventions together. None of the interventions showed any effect at 3 months.Primary Funding SourceNational Institute on Aging (NIA).

12 keywords...

hide…