Cash transfers ease short-term functional impairment in older persons living alone

A study in India has shown the effectiveness of a small cash transfer in alleviating short-term functional impairment among older people who are living alone. However, cash transfers do not produce a clinically or statistically significant decrease in depression and show no impact on food security.

On the other hand, cognitive behavioural therapy (CBT), with or without cash transfers, provides no short-term effects. Additionally, both interventions fall short of producing any effect at 3 months.

The investigators conducted this randomized controlled trial in Tamil Nadu, India, in 2021. A total of 1,120 people aged ≥55 years and living alone underwent a phone-based CBT and a one-time cash transfer of 1,000 rupees (USD 12) for 6 weeks.

The investigators measured the World Health Organization Disability Assessment Schedule (WHODAS), the Geriatric Depression Scale, and food security 3 weeks after CBT in 977 participants and 3 months after in 932 individuals.

From baseline to the 3-week follow-up, the WHODAS score (scale 0 to 48, greater values indicating more impairment) decreased by 2.92 more (95 percent confidence interval [CI], ‒5.60‒0.23) in participants receiving cash only, while the depression score (ranging from 0 to15, higher score representing more depressive symptoms) dropped by 1.01 more (95 percent CI, ‒2.07 to 0.06).

“These effects did not persist to the 3-month follow-up, and CBT alone and the two together had no significant effects,” the investigators said. “There were no effects on food security.”

This study has certain limitations. The investigators could not determine whether more sustained or in-person therapy would have been effective and how the results would turn out outside of the COVID-19 period. They could also not say whether results in the consented sample differed from those in a larger population. Moreover, primary outcomes were self-reported.