Ng T P, Nyunt M S Z, Feng L, Feng L, Niti M, Tan B Y, Chan G, Khoo S A, Chan S M, Yap P, Yap K B
A/P Tze-Pin Ng, Gerontology Research Programme, National University of Singapore, Department of Psychological Medicine, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore 119228 Fax: 65-67772191, Tel: 65-67723478 Email:
J Nutr Health Aging. 2017;21(8):918-926. doi: 10.1007/s12603-016-0867-y.
We investigated the effect of multi-domain lifestyle (physical, nutritional, cognitive) interventions among frail and pre-frail community-living older persons on reducing depressive symptoms.
Participants aged 65 and above were randomly allocated to 24 weeks duration interventions with nutritional supplementation (N=49), physical training (N=48), cognitive training (N=50), combination intervention (N=49) and usual care control (N=50). Depressive symptoms were assessed by the Geriatric Depression Scale (GDS-15) at baseline (0M), 3 month (3M), 6 month (6M) and 12 month (12M).
Mean GDS scores in the control group increased from 0.52 (0M) and 0.54 (3M) to 0.74 (6M), and 0.83 (12M). Compared to the control group, interventions showed significant differences (∆=change) at 6M for cognitive versus control (∆=-0.39, p=0.021, grouptime interaction p=0.14); physical versus control (∆ =-0.37, p=0.026, grouptime interaction p=0.13), and at 12M for nutrition versus control (∆ =-0.46, p=0.016, grouptime interaction p=0.15). The effect for combination versus control was significant at 6M (∆ =-0.43, p=0.020) and 12M (∆ =-0.51, p=0.005, grouptime interaction p=0.026). Estimated 12-month cumulative incidence of depressive symptoms (GDS≥2) relative to control were OR=0.38, p=0.037 (nutrition); OR=0.71, p=0.40 (cognitive); OR=0.39, p=0.042 (physical training) and OR=0.38, p=0.037 (combination). Changes in gait speed and energy level were significantly associated with changes in GDS scores over time.
Multi-domain interventions that reverse frailty among community-living older persons also reduce depressive symptomatology. Public health education and programmatic measures combining nutritional, physical and cognitive interventions for at-risk frail older people may likely benefit psychological wellbeing.
我们调查了针对社区生活的体弱和准体弱老年人进行多领域生活方式（身体、营养、认知）干预对减轻抑郁症状的影响。
将65岁及以上的参与者随机分配到为期24周的干预组，包括营养补充（N = 49）、体育锻炼（N = 48）、认知训练（N = 50）、联合干预（N = 49）以及常规护理对照组（N = 50）。在基线（0个月）、3个月、6个月和12个月时，采用老年抑郁量表（GDS - 15）评估抑郁症状。
对照组的GDS平均得分从0.52（0个月）和0.54（3个月）增加到0.74（6个月）和0.83（12个月）。与对照组相比，干预组在6个月时，认知训练组与对照组相比有显著差异（∆ = 变化值，∆ = -0.39，p = 0.021，组时间交互作用p = 0.14）；体育锻炼组与对照组相比（∆ = -0.37，p = 0.026，组时间交互作用p = 0.13）；在12个月时，营养补充组与对照组相比（∆ = -0.46，p = 0.016，组时间交互作用p = 0.15）。联合干预组与对照组相比在6个月时效果显著（∆ = -0.43，p = 0.020），在12个月时（∆ = -0.51，p = 0.005，组时间交互作用p = 0.026）。相对于对照组，抑郁症状（GDS≥2）的估计12个月累积发病率为：营养补充组OR = 0.38，p = 0.037；认知训练组OR = 0.71，p = 0.40；体育锻炼组OR = 0.39，p = 0.042；联合干预组OR = 0.38，p = 0.037。步态速度和能量水平的变化与GDS得分随时间的变化显著相关。
逆转社区生活老年人身体衰弱的多领域干预措施也能减轻抑郁症状。针对高危体弱老年人的结合营养、身体和认知干预的公共健康教育及计划性措施可能有益于心理健康。
