Dosage and Efficacy in Behavioral Interventions With Community Dwelling Older Adults: Lifestyle Redesign Revisited
Abstract
Objectives: Behavioral interventions with community dwelling older adults often utilize multiple modes of treatment, which contributes to variation in participation and high rates of nonadherence. The objective of this report was to assess the treatment efficacy of one such study. Methods: We conducted an as-treated analysis of the Well Elderly II trial, where 322 individuals underwent 6 months of individual and group treatment and participated in community outings. We utilized inferential and graphical methods to assess the relationship between treatment received and depression change. Results: Individual treatment and community outings had similar small indirect effects on depressive symptoms, but a selection effect was present for individual treatment, where individuals with high baseline depression scores were the most likely to participate. Discussion: The results provide nuance that is unavailable using intent-to-treat. Future research should expand on our methods for as-treated analyses after intent-to-treat has shown aggregate improvements.
Get full access to this article
View all access and purchase options for this article.
References
Beekman A. T. F., Deeg D. J. H., Van Limbeek J., Braam A. W., De Vries M. Z., Van Tilburg W. (1997). Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): Results from a community-based sample of older subjects in the Netherlands. Psychological Medicine, 27(1), 231–235.
Clark F. A., Azen S. P., Zemke R., Jackson J., Carlson M., Mandel D., . . . Lipson L. (1997). Occupational therapy for independent-living older adults. A randomized controlled trial. Journal of the American Medical Association, 278(16), 1321–1326.
Clark F. A., Blanchard J., Sleight A., Cogan A., Florindez L., Gleason S., . . . Vigen C. (2015). Lifestyle Redesign: The intervention tested in the USC Well Elderly studies. AOTA Press.
Clark F. A., Jackson J., Carlson M., Chou C.-P., Cherry B. J., Jordan-Marsh M., . . . Azen S. P. (2012). Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2 Randomised Controlled Trial. Journal of Epidemiology & Community Health, 66(9), 782–790.
Coninck L. D., Bekkering G. E., Bouckaert L., Declercq A., Graff M. J. L., Aertgeerts B. (2017). Home- and community-based occupational therapy improves functioning in frail older people: A systematic review. Journal of the American Geriatrics Society, 65(8), 1863–1869.
Eizenman D. R., Nesselroade J. R., Featherman D. L., Rowe J. W. (1997). Intraindividual variability in perceived control in an older sample: The MacArthur successful aging studies. Psychology and Aging, 12(3), 489–502.
Ellenberg J. H. (1996). Intent-to-treat analysis versus as-treated analysis. Drug Information Journal, 30(2), 535–544.
Feinman R. D. (2009). Intention-to-treat. What is the question? Nutrition & Metabolism, 6(1), 1.
Food and Drug Administration. (2008). Guidance for sponsors, clinical investigators, and IRBs: Data retention when subjects withdraw from FDA-regulated clinical trials. U.S. Department of Health and Human Services. https://www.fda.gov/media/75138/download
Hernán M. A., Hernández-Díaz S. (2012). Beyond the intention-to-treat in comparative effectiveness research. Clinical Trials, 9(1), 48–55.
Hu L. T., Bentler P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55.
Jackson J., Carlson M., Mandel D., Zemke R., Clark F. (1998). Occupation in lifestyle redesign: The well elderly study occupational therapy program. American Journal of Occupational Therapy, 52(5), 326–336.
Jackson J., Mandel D., Blanchard J., Carlson M., Cherry B., Chou C.-P., . . . Clark F. (2009). Confronting challenges in intervention research with ethnically diverse older adults: The USC Well Elderly II Trial. Clinical Trials, 6(1), 90–101.
Juang C., Knight B. G., Carlson M., Schepens Niemiec S. L., Vigen C., Clark F. (2018). Understanding the mechanisms of change in a lifestyle intervention for older adults. The Gerontologist, 58(2), 353–361.
Little R., Yau L. (1996). Intent-to-treat analysis for longitudinal studies with drop-outs. Biometrics, 52(4), 1324–1333.
Lubben J. E. (1988). Assessing social networks among elderly populations. Family and Community Health, 11(3), 42–52.
MacCallum R. C., Browne M. W., Sugawara H. M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1(2), 130–149.
McCoy C. E. (2017). Understanding the intention-to-treat principle in randomized controlled trials. Western Journal of Emergency Medicine, 18(6), 1075–1078.
Morris J. C., Heyman A., Mohs R. C., Hughes J. P., Van Belle G., Fillenbaum G., Clark C. (1989). The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology, 39, 1159–1165.
Orellano E., Colón W. I., Arbesman M. (2012). Effect of occupation- and activity-based interventions on instrumental activities of daily living performance among community-dwelling older adults: A systematic review. American Journal of Occupational Therapy, 66(3), 292–300.
Radloff L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.
Sainani K. L. (2010). Making sense of intention-to-treat. Physical Medicine and Rehabilitation, 2(3), 209–213.
Schelly D., Ohl A. (2019). Examining clinical meaningfulness in randomized controlled trials: Revisiting the Well Elderly II. American Journal of Occupational Therapy, 73(1), 7301205120p1–7301205120p13.
Smith J. L., Bihary J. G., O’Connor D., Basic A., O’Brien C. J. (2020). Impact of savoring ability on the relationship between older adults’ activity engagement and well-being. Journal of Applied Gerontology, 39, 323–331.
Strout K. A., David D. J., Dyer E. J., Gray R. C., Robnett R. H., Howard E. P. (2016). Behavioral interventions in six dimensions of wellness that protect the cognitive health of community-dwelling older adults: A systematic review. Journal of the American Geriatrics Society, 64(5), 944–958.
Ware J. E. (2000). SF-36 health survey update. Spine, 25(24), 3130–3139.
Wechsler D. (1981). WAIS-R: Wechsler Adult Intelligence Scale Revised. Psychological Corporation.
Wertz R. T. (1995). Intention to treat: Once randomized, always analyzed. Clinical Aphasiology, 23, 57–64.
Wood V., Wylie M. L., Sheafor B. (1969). An analysis of a short self-report measure of life satisfaction: Correlation with rater judgments. Journal of Gerontology, 24(4), 465–469.
Yudkin P. L., Stratton I. M. (1996). How to deal with regression to the mean in intervention studies. The Lancet, 347(8996), 241–243.
Cite article
Cite article
Cite article
OR
Download to reference manager
If you have citation software installed, you can download article citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Article first published online: March 14, 2020
Issue published: September 2021
Keywords
PubMed: 32172626
Authors
Metrics and citations
Metrics
Journals metrics
This article was published in Journal of Applied Gerontology.
VIEW ALL JOURNAL METRICSArticle usage*
Total views and downloads: 648
*Article usage tracking started in December 2016
Altmetric
See the impact this article is making through the number of times it’s been read, and the Altmetric Score.
Learn more about the Altmetric Scores
Articles citing this one
Receive email alerts when this article is cited
Web of Science: 1 view articles Opens in new tab
Crossref: 0
-
Regression to the mean, heteroscedasticity, and prognostic imbalance i...
Figures and tables
Figures & Media
Tables
View Options
Get access
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
loading institutional access options
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.
