The goal of this study is to learn whether a telephone-based program that helps people share life memories can reduce loneliness and improve mental well-being, life satisfaction, and social support in older adults and their caregivers living in rural areas.

This study has two parts. In the first part, researchers will gather feedback from a small group of older adults and informal caregivers to see if the updated telephone reminiscence program works well and is easy to use.

In the second part, researchers will test the telephone reminiscence program in a clinical trial study to see whether the updated telephone reminiscence program reduces loneliness and improves social support, life satisfaction, and mental well-being in older adults and their caregivers. The researchers will also examine how the program impacts how often and for what reason you reminisce.

The main questions this study aims to answer are:

• Does the telephone reminiscence program improve social support, life satisfaction, and mental well-being and reduce loneliness in rural older adults and their caregivers? How does the telephone reminiscence impact how often and for what reason participants reminisce?
• How often and how long do participants use the program?
• How satisfied are older adults and informal caregivers with the program? In this study researchers will compare participants who begin the telephone reminiscence program right away with participants who start the program after a 12-week waiting period to see whether starting the program earlier leads to better outcomes.

Participants will:

• Take part in telephone calls 3 times a week that invite older adults to talk about their life experiences.
• Answer brief survey questions about social support, loneliness, and mental well-being, and life satisfaction over time.
• Include both older adults and their informal caregivers, who may also participate by recording questions in their own voice.

Detailed Description This study evaluates a telephone based reminiscence program designed to reduce social isolation and improve mental health among older adults living in rural areas, while also engaging informal caregivers who support them. The study consists of two sequential parts: an initial development and refinement phase, followed by a randomized wait list controlled clinical trial.

Study Overview and Rationale Older adults living in rural areas experience high levels of social isolation and limited access to supportive services due to geographic distance, transportation barriers, and reduced availability of technology based resources. Many older adults in rural communities rely on landline telephones and do not have consistent access to broadband internet, creating barriers to participation in digital health interventions. Telephone based programs that do not require internet access may offer a low burden, scalable approach to supporting mental well being and social connection in these populations.

Reminiscence based interventions encourage individuals to reflect on meaningful life experiences and share personal stories. Prior research suggests that reminiscence can support emotional well being, reinforce identity, and promote a sense of connection. This study builds on previous work evaluating a telephone reminiscence program and extends it by improving accessibility for rural users and formally testing its effectiveness over a longer intervention period.

Part 1: Program Refinement and Feasibility Assessment The first part of the study focuses on refining and enhancing the telephone reminiscence program to improve accessibility, usability, and acceptability for rural older adults and informal caregivers. A total of 16 older adult-caregiver dyads will participate in short term (four week) use of the enhanced program and provide feedback through structured discussions and surveys.

Data collected in this phase inform refinements to the program's functionality, including ease of interaction using landline telephones, clarity of prompts, and caregiver involvement features (such as the ability for caregivers to record questions in their own voice). Findings from Part 1 are used to finalize the version of the program evaluated in the clinical trial phase.

Part 2: Randomized Wait List Controlled Clinical Trial The second part of the study is a randomized, parallel group, wait list controlled clinical trial designed to evaluate the effects of the telephone reminiscence program on social and mental health outcomes in a larger sample of rural older adults and their informal caregivers. A total of 170 older adult-informal caregiver dyads will be enrolled in this phase of the study.

After completion of baseline assessments, eligible participants are randomly assigned to one of two groups:

• An immediate intervention group (85 dyads), which begins the telephone reminiscence program right away
• A wait list group (85 dyads), which begins the same program after a 12 week waiting period All participants eventually receive access to the intervention. The comparison between groups during the initial 12 week period allows evaluation of whether earlier participation in the program leads to improvements in social support, loneliness, and mental well being.

Intervention Description The telephone reminiscence program consists of automated phone calls delivered up to three times per week over a 12 week period. During each call, older adult participants are invited to respond to simple, meaningful questions about their life experiences and memories. Participants may choose how much or how little they wish to share during each call, and calls can be ended at any time.

Informal caregivers associated with participating older adults may also take part by recording personalized questions or prompts in their own voice, enabling a sense of connection and engagement between calls. The intervention does not require internet access, smartphones, or computer use.

Study Outcomes and Assessments Outcome assessments are conducted at baseline and at follow up time points aligned with the intervention and wait list periods. Primary outcomes focus on changes in social support, loneliness, and mental well being among older adults. Secondary outcomes include adherence to the program, frequency and duration of use, and changes in reminiscence patterns. Satisfaction with the program is assessed for both older adults and informal caregivers.

Sample Size and Statistical Considerations The sample size of 170 dyads in the randomized trial phase is based on power calculations informed by prior studies of the telephone reminiscence program and is sufficient to detect moderate differences in primary social and mental health outcomes between the immediate intervention and wait list groups. Statistical analyses will compare changes in outcomes between groups during the first 12 weeks, with additional analyses examining within participant changes over time and associations between program engagement and outcomes.

Ethical Considerations This study is considered minimal risk. All participants eventually receive access to the intervention, and participation is voluntary. The wait list design allows evaluation of intervention effects while ensuring equitable access to the program.

Inclusion Criteria:

• Older adults aged 60 years or older living in a rural area.
• Able to read and speak English.
• Living in a rural area as defined by the U.S. Census Bureau.
• Has an informal caregiver (family member, partner, friend, or neighbor) willing to participate, or is an informal caregiver of an eligible older adult.
• Able to participate in telephone-based activities.

Exclusion Criteria:

• Significant hearing impairment that would interfere with telephone participation.
• Cognitive impairment as indicated by three or more errors on a brief cognitive screening assessment.
• Participation in the program development phase of this study.