Tailoring multidomain intervention programs to reduce cognitive and physical decline in older adults: Examining rural-urban differences in a nationwide cluster-randomized controlled trial.

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The Journal of Prevention of Alzheimer's Disease Pub Date : 2025-06-12 DOI:10.1016/j.tjpad.2025.100231

Min-Yin Ho, Wei-Ju Lee, Ko-Han Yen, Chih-Kuang Liang, Li-Ning Peng, Ming-Hsien Lin, Ching-Hui Loh, Fei-Yuan Hsiao, Liang-Kung Chen

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Abstract

Background: 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.

Objectives: 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.

Design: Cluster-randomized controlled trial.

Setting: Community clusters in five cities/counties across Taiwan.

Participants: A total of 1082 adults aged ≥65 years from 40 community clusters were randomized to intervention or control groups.

Intervention: 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.

Results: 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.

Conclusion: Rural-urban disparities influence the effectiveness of multidomain interventions. Tailored strategies are needed to optimize health outcomes across diverse settings.

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定制多领域干预方案以减少老年人的认知和身体衰退：在一项全国集群随机对照试验中检查城乡差异。

背景：虚弱和认知障碍是老龄化人口面临的主要挑战。针对身体、认知和营养健康的多领域干预显示出希望；然而，关于城乡疗效差异的证据仍然有限。目的：评估城乡差异对老年人认知和身体结果的12个月多领域干预的临床疗效的影响。设计：成组随机对照试验。环境：台湾五个市/县的社区群。参与者：来自40个社区群的1082名年龄≥65岁的成年人被随机分为干预组或对照组。干预：干预组接受为期12个月的计划，包括体育锻炼（45分钟/次）、认知训练（1小时/次）和营养指导（15分钟/次）。对照组接受电话健康教育。该试验已在ClinicalTrials.gov注册（NCT03056768）。测量：结果包括步行速度、握力、身体活动（METs）、虚弱（CHS评分）和认知功能（MoCA），在基线、6个月和12个月进行评估。结果：城市参与者在12个月的视觉空间/执行功能（城乡差异0.63,95% CI: 0.26 -1.03）和步行速度（城乡差异0.12 m/s, 95% CI: 0.05 - 0.19）方面表现出显著性的提高。农村参与者在12个月的握力（城乡差异-2.59 kg, 95% CI: -3.91 - -1.27）和语言功能（城乡差异-0.38,95% CI: -0.68 - -0.09）方面表现出更好的改善。在12个月内，城市地区的虚弱程度降低更为明显（-0.21,95% CI: -0.38 - -0.03, p = 0.025），但农村参与者的变化最小。结论：城乡差异影响多领域干预的有效性。需要有针对性的战略来优化不同环境下的健康结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

The Journal of Prevention of Alzheimer's Disease Medicine-Psychiatry and Mental Health

CiteScore

9.20

自引率

0.00%

发文量

期刊介绍： The JPAD Journal of Prevention of Alzheimer’Disease will publish reviews, original research articles and short reports to improve our knowledge in the field of Alzheimer prevention including: neurosciences, biomarkers, imaging, epidemiology, public health, physical cognitive exercise, nutrition, risk and protective factors, drug development, trials design, and heath economic outcomes.JPAD will publish also the meeting abstracts from Clinical Trial on Alzheimer Disease (CTAD) and will be distributed both in paper and online version worldwide.We hope that JPAD with your contribution will play a role in the development of Alzheimer prevention.