Ho Min-Yin, Lee Wei-Ju, Yen Ko-Han, Liang Chih-Kuang, Peng Li-Ning, Lin Ming-Hsien, Loh Ching-Hui, Hsiao Fei-Yuan, Chen Liang-Kung
Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Child Welfare League Foundation, Taipei City, Taiwan.
Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan County, Taiwan,.
J Prev Alzheimers Dis. 2025 Sep;12(8):100231. doi: 10.1016/j.tjpad.2025.100231. Epub 2025 Jun 12.
Frailty and cognitive impairment are major challenges in aging populations. Multidomain interventions targeting physical, cognitive, and nutritional health show promise; however, evidence on rural-urban differences in efficacy remains limited.
To evaluate the impact of rural-urban disparities on the clinical efficacy of a 12-month multidomain intervention for cognitive and physical outcomes in older adults.
Cluster-randomized controlled trial.
Community clusters in five cities/counties across Taiwan.
A total of 1082 adults aged ≥65 years from 40 community clusters were randomized to intervention or control groups.
The intervention group received a 12-month program including physical exercise (45 min/session), cognitive training (1 hour/session), and nutritional guidance (15 min/session). The control group received telephone-based health education. This trial was registered at ClinicalTrials.gov (NCT03056768) MEASUREMENTS: Outcomes included walking speed, grip strength, physical activity (METs), frailty (CHS score), and cognitive function (MoCA), assessed at baseline, 6, and 12 months.
Urban participants showed significantly greater gains in visuospatial/executive function at the 12 month (rural-urban difference 0.63, 95 % CI: 0.26 -1.03), and walking speed at the 12 month (rural-urban difference 0.12 m/s, 95 % CI: 0.05 - 0.19). Rural participants demonstrated better improvements in grip strength at the 12 month (rural-urban difference -2.59 kg, 95 % CI: -3.91 - -1.27) and language function (rural-urban difference -0.38, 95 % CI: -0.68 - -0.09). Frailty reduction was more pronounced in urban areas at the 12 month (-0.21, 95 % CI: -0.38 - -0.03, p = 0.025), but showed minimal change in the rural participants.
Rural-urban disparities influence the effectiveness of multidomain interventions. Tailored strategies are needed to optimize health outcomes across diverse settings.
衰弱和认知障碍是老年人群面临的主要挑战。针对身体、认知和营养健康的多领域干预显示出前景；然而，关于城乡疗效差异的证据仍然有限。
评估城乡差异对老年人认知和身体结局的12个月多领域干预临床疗效的影响。
整群随机对照试验。
台湾五个市县的社区群组。
来自40个社区群组的共1082名年龄≥65岁的成年人被随机分为干预组或对照组。
干预组接受为期12个月的项目，包括体育锻炼（每次45分钟）、认知训练（每次1小时）和营养指导（每次15分钟）。对照组接受基于电话的健康教育。该试验已在ClinicalTrials.gov注册（NCT03056768）。测量：结局包括步行速度、握力、身体活动（代谢当量）、衰弱（CHS评分）和认知功能（蒙特利尔认知评估量表），在基线、6个月和12个月时进行评估。
城市参与者在12个月时视觉空间/执行功能有显著更大的改善（城乡差异0.63，95%置信区间：0.26 - 1.03），以及在12个月时步行速度有显著更大的改善（城乡差异0.12米/秒，95%置信区间：0.05 - 0.19）。农村参与者在12个月时握力（城乡差异-2.59千克，95%置信区间：-3.91 - -1.27）和语言功能（城乡差异-0.38，95%置信区间：-0.68 - -0.09）有更好的改善。在12个月时，城市地区衰弱减轻更为明显（-0.21，95%置信区间：-0.38 - -0.03，p = 0.025），但农村参与者变化最小。
城乡差异影响多领域干预的效果。需要制定针对性策略以优化不同环境下的健康结局。
