Background In the face of extensive waiting times for outpatient psychotherapy, prescriptible digital health applications
(DiGA) are a useful and efective addition to the range of available therapy options for patients with mild
to moderate depression. However, older adults face a particular challenge in implementing DiGA since higher age
is a decisive predictor of lower digital health literacy. The necessity of an independent use of the prescribed DiGA
is therefore associated with challenges for older patients and providers. In practice, it is crucial not to leave patients,
especially older adults, alone after prescribing, but to maintain close contact to overcome technical and motivational
barriers and to ensure that the novel application is used. However, this is difcult for physicians and psychotherapists
due to the critical healthcare system situation in Germany described above. Another support system is needed.
Hence, the main hypothesis of this study is that the additional implementation of digital nurses leads to a higher
percentage of older patients with depressive symptoms starting DiGA use compared to a prescription and information
alone.
Methods Two DiGA for mild to moderate depression in older patients were available and permanently approved
at the time of the funding application. Using the most suitable one of them, as shown in a pilot study, the feasibility
of implementation will be examined within a randomized proof of concept study. In our study, a digital nurse
is trained to support patients with depression in using a DiGA. The main outcome is DiGA use (frst session started:
yes/no) after 8 weeks. Major secondary outcomes are patient‑relevant outcomes, feasibility of recruitment and intervention,
and factors moderating the efect or predicting DiGA use in the target group. Best practice guidelines will be
elaborated on how to support and improve DiGA prescription and successful use in this population.
Discussion In Germany, the approved DiGA are currently little used, especially by people with a low digital afnity.
This proof of concept study will use the example of older people with depressive disorders to show whether it is possible to increase the usage rate of a DiGA with the support of a digital nurse so that a DiGA can become a serious
therapy option.