Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania.
Clinical and Translational Institute, School of Nursing, Pennsylvania.
Gerontologist. 2020 Jan 24;60(1):e52-e65. doi: 10.1093/geront/gnz026.
BACKGROUND AND OBJECTIVES: Minimizing disability is critical to reduce the costly health care associated with disability and maintain quality of life into old age. We examined the effect sizes of nonpharmacological intervention studies in reducing disability and explored the active ingredients of interventions. RESEARCH DESIGN AND METHODS: A scoping review was conducted via PubMed, PsycINFO, and CINAHL databases. Thirty-one randomized controlled trials were included. Eight active ingredients were identified by three experts (exercise, problem-solving, cognitive behavioral therapy, environmental modification, education, goal setting, comprehensive geriatric assessment, and cognitive training). RESULTS: The range of Cohen's d was -0.85 to 1.76 across 31 studies (included 33 interventions); 67% studies (n = 22) obtained small-to-negative effect sizes (d = -0.85 to 0.18), accounting for 83% participants across studies. Interventions that incorporated exercise, problem-solving, cognitive behavior therapy, and environmental modification were associated with stronger effect sizes. Interventions that incorporated comprehensive geriatric assessment obtained small effect sizes. DISCUSSION AND IMPLICATIONS: Majority of intervention studies found little or no effect in reducing disability for older adults. To optimize the effects of nonpharmacological interventions, we recommend researchers to (i) develop a screening tool for "risk of disability" to inform those who are early on the disability progression, yet not experience any difficulties in activities of daily living and instrumental activities of daily living; (ii) specify the active ingredients embedded in complex interventions to facilitate change in disability; and (iii) select sensitive tools to capture the progression of disability in late life.
背景和目的:最大限度地减少残疾对于降低与残疾相关的昂贵医疗保健费用和维持老年生活质量至关重要。我们研究了非药物干预研究在减少残疾方面的效果大小,并探讨了干预措施的有效成分。
研究设计和方法:通过 PubMed、PsycINFO 和 CINAHL 数据库进行了范围综述。共纳入 31 项随机对照试验。三位专家确定了 8 种有效成分(锻炼、解决问题、认知行为疗法、环境调整、教育、目标设定、综合老年评估和认知训练)。
结果:31 项研究(包括 33 项干预措施)的 Cohen's d 范围为-0.85 至 1.76;67%的研究(n=22)获得了小到负的效果大小(d=-0.85 至 0.18),占研究中所有参与者的 83%。纳入锻炼、解决问题、认知行为疗法和环境调整的干预措施与更强的效果大小相关。纳入综合老年评估的干预措施获得了较小的效果大小。
讨论和意义:大多数干预研究发现,对于减少老年人的残疾几乎没有或没有效果。为了优化非药物干预的效果,我们建议研究人员:(i)开发一种“残疾风险”筛查工具,以便告知那些处于残疾进展早期但日常生活活动和工具性日常生活活动没有任何困难的人;(ii)明确嵌入复杂干预措施中的有效成分,以促进残疾的改变;(iii)选择敏感的工具来捕捉晚年残疾的进展。
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