VOCALE: A Digital Intervention to Improve Quality of Life and Reduce Frailty Among Older Adults in CCRCs - A Randomized Controlled Trial

SUMMARY This project aims to address the high prevalence of frailty among independently living (IL) residents in Continuing Care Retirement Communities (CCRCs) through the development and evaluation of VOCALE, a scalable digital intervention. Nearly 700,000 residents across 2,000 CCRCs in the United States rely on these communities for levels of care from IL to skilled nursing. Frailty, affecting over half of these individuals, leads to increased vulnerability to adverse health outcomes and care level transitions. Existing multi-component interventions show potential in enhancing quality of life (QoL) for older adults but face barriers in CCRCs, such as limited space and staffing challenges, which impede effective implementation. The current focus in CCRCs on compensatory rather than preventive care in IL often limits resident engagement in proactive health management. VOCALE addresses these challenges with an eight-week web-based program designed for older adults with limited digital literacy. It offers low-bandwidth, asynchronous access to self-care resources, peer support, and problem-solving tools specifically designed to target frailty and improve QoL. Preliminary results from 28 CCRC residents aged 66-92 with frailty indicate VOCALE's feasibility and acceptability. Findings showed a clinically significant 10-point improvement in RAND-36 QoL scores, with large effect sizes in overall QoL and physical function and fatigue subscale improvements (0.5 and 0.8, respectively). Additional gains were observed in other health metrics with sustained engagement and low attrition rates of 20-25%. Building on these findings, we propose a confirmatory Stage II and exploratory Stage III trial to evaluate VOCALE's efficacy, mechanisms of action, and implementation potential within CCRCs. This eight-week, two- arm RCT with 128 frail residents across 10 CCRCs will randomly assign facilities to VOCALE or care-as-usual and will focus on the following aims: 1) To evaluate VOCALE's efficacy in improving QoL and reducing frailty in CCRC residents. Using a cluster-randomized design, we will measure QoL (primary outcome) and Fried's frailty measure (secondary outcome) post-intervention and one-month later; 2) To identify mechanisms through which VOCALE impacts QoL and frailty. We will assess empowerment, social support, and problem-solving skills as mediators, hypothesizing that these factors will mediate the relationship between VOCALE and observed outcomes; 3) To explore VOCALE's implementation potential in CCRCs using the CFIR framework to assess acceptability, feasibility, and organizational readiness for VOCALE's integration into CCRC workflows. Focus groups, interviews, and surveys with administrators and staff will provide insights into adoption, hypothesizing that VOCALE will be well-received with minimal resource demands. This project will provide critical evidence on VOCALE's capacity to fill an unmet need for scalable, preventive interventions that enhance the health, independence, and QoL of IL CCRC residents with frailty, with strong potential for widespread clinical and public health impact. Project Number: 1R01AG088115-01A1 | Fiscal Year: 2026 | NIH Institute/Center: National Institute on Aging (NIA) | Principal Investigator: Oleg Zaslavsky (+1 co-PI) | Institution: UNIVERSITY OF WASHINGTON, SEATTLE, WA | Award Amount: $505,948 | Activity Code: R01 | Study Section: Health Promotion in Communities Study Section[HPC] View on NIH RePORTER: https://reporter.nih.gov/project-details/11224856