CAPABLE Care + Connect for Social Isolation in Older Adults

This study is testing an intervention called CAPABLE Care + Connect to help older adults who are experiencing social isolation or loneliness. This program combines an existing home-based care program (CAPABLE) with home-based primary care services (JHOME) to improve quality of life and reduce physical disability. You might be able to join if you are at least 50 years old, are currently in the JHOME program, and are at risk for or experiencing social isolation or loneliness. Researchers will measure changes in your daily activities, how you manage household tasks, and your pain levels to see if the program is successful. The current status of this study is unclear, and it plans to enroll 450 participants.

Study design
This is an interventional study with two groups receiving CAPABLE Care + Connect. It plans to enroll 450 participants.
What's involved
You would receive home visits from an occupational therapist (about 6 visits) and a registered nurse (about 4 visits) over 4 months. These visits would be for an hour or less.
Compensation
Not stated in the trial record.
Follow-up
Your function and pain will be assessed at the beginning of the study and again after 16 weeks.

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NCT07123298

CAPABLE Care + Connect

Recruiting
NAAges 50+InterventionalPrevention
Johns Hopkins University
~450 participants
Updated 2026-06-02 on ClinicalTrials.gov
What's tested:CAPABLE Care + Connect - Open Label PilotCAPABLE Care + Connect - Pilot

At a glance

Recruiting sites
1 of 1 listed site is recruiting right now
RecruitingSuspended, closed, or not yet open
What they're measuring
Change in Function as assessed by the Katz Index of Independence in Activities of Daily Living Scale
Measured over Baseline, 16 weeks
+13 more outcomes measured
Social Isolation in Older Adults
Social Isolation or Loneliness
Social Isolation
Quality of Life
Disability Physical
Homebound Persons
1 sites across 1 states
Maryland1
  • Thomas Cudjoe, MD, MPH, MA · PRINCIPAL_INVESTIGATOR · Johns Hopkins University

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Eligibility criteria

Inclusion

Any patient currently in JHOME
At risk for or experiencing social isolation as defined by the Lubben Social Network Scale 6 item score less than or equal 12 points or loneliness as defined by the UCLA Loneliness Scale 3 item score of 6 to 9 points
English speaking (measures are standardized in English)
Ability to participate in an approximately 45-60 min virtual or in person meeting
Eligible for CAPABLE
50 years or older
Not hospitalized over night more than 4 times in the last 12 months
Have some difficulty with any ADL
Cognitively intact
Live in Baltimore County or Baltimore City
Not receiving active cancer treatment
Interested in participating in CAPABLE Care partners will be included if the care partners provide \> 10 hours of care/week

Exclusion

Terminally ill
live in long term care setting
receiving active cancer treatment
  • Change in Function as assessed by the Katz Index of Independence in Activities of Daily Living ScaleBaseline, 16 weeks

    6 questions, each 1 point for a total score range of 1- 6. A score closer to 6 indicates high patient independence, better outcome.

  • Change in Function as assessed by Lawton & Brody's assessment of Instrumental Activities of Daily Living Scale (IADL)Baseline, 16 weeks

    Participants rate their ability to perform daily tasks on a 5-point scale (1 = no difficulty, 2 = a little difficulty, 3 = moderate difficulty, 4 = a lot of difficulty, 5 = unable to do). Score range 8 to 40, higher scores represent greater difficulty performing ADLs, worse outcome.

  • Change in Pain as assessed by the Brief Pain Inventory Scale (Short Form)Baseline, 16 weeks

    The Brief Pain Inventory - Short Form is a 9 item self-administered questionnaire used to evaluate the severity of a patient's pain and the impact of this pain on the patient's daily functioning. For the 10 point scale, 0 indicated no pain and 10 indicates the worst imaginable pain. Score range 0-90, higher score worse outcome.

  • Change in Function as assessed by the American Community Survey Disability MeasureBaseline, 16 weeks

    This measure is used to identify whether a person is considered to have a disability based on responses to six standardized questions. A person is considered to have a disability if the person answers "Yes" to at least one of the six questions. There is no composite score.

  • Change in Depression as assessed by the Patient Health Questionnaire Depression Scale (PHQ-8)Baseline, 16 weeks

    The PHQ-8 contains 8 questions, with a 0-3 scale. A score of 10 or greater is considered major depression, 20 or more is severe major depression. Score range 0-24, higher score worse outcome.

  • Change in Social Connection as assessed by the Lubben Social Network ScaleBaseline, 16 weeks

    The Lubben Social Network Scale - 12 item version (LSNS-12) includes 12 questions, each scored from 0 to 5 based on the number of social contacts, with total scores ranging from 0 to 60, where lower scores indicate greater social isolation, worse outcome.

  • Change in Social Connection as assessed by the University of California Los Angeles (UCLA) Loneliness ScaleBaseline, 16 weeks

    The UCLA Loneliness Scale (20-item version) includes 20 questions, each rated on a 1 to 4 scale, with total scores ranging from 20 to 80, where higher scores indicate greater perceived loneliness, worse outcome.

  • Change in Social Connection as assessed by qualitative questionsBaseline, 16 weeks

    2 open ended questions about social network. Qualitatively look at answers from descriptive perspective

  • Change in Caregiver Burden as assessed by Zarit Burden InventoryBaseline, 16 weeks

    The Zarit Burden Interview - 12 item version includes 12 questions, each scored from 0 (never) to 4 (nearly always), for a total score range of 0 to 48, with higher scores indicating greater caregiver burden, worse outcome.

  • Change in Perceived Change in Function Scale16 weeks

    14 questions related to perceived improvement in function. Scale of -2 (gotten much worse) to 2 (improved a lot). The higher the overall score, the greater the improvement, better outcome.

  • Change in Caregiver Burden as assessed by the Oberest Caregiver Burden ScaleBaseline, 16 weeks

    The Oberst Caregiver Burden Scale includes 15 items rated on a 5-point scale assessing the time and difficulty of caregiving tasks, with total scores ranging from 15 to 75 per subscale and higher scores indicating greater burden.

  • Change in Caregiver Outcomes as assessed by the Bakas Caregiving Outcomes ScaleBaseline, 16 weeks

    The Bakas Caregiving Outcomes Scale includes 15 items, each rated on a 7-point scale from -3 (changed for the worst) to +3 (changed for the best), with total scores reflecting the caregiver's perceived changes in life due to caregiving. Higher score better.

  • Change in Pain as assessed by the Brief Pain Inventory (Short Form)Baseline, 16 weeks

    The Brief Pain Inventory - Short Form is a 9 item self-administered questionnaire used to evaluate the severity of a patient's pain and the impact of this pain on the patient's daily functioning on a 10 point scale. 0 = no pain and 10 indicates the worst imaginable pain. Higher score worse outcome.

  • Change in Pain as assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Short FormBaseline, 16 weeks

    The PROMIS Pain Interference Short Form includes 6 questions, each rated on a 5-point scale, with raw scores summed and converted to a T-score, where higher scores indicate greater interference from pain in daily activities.