Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: results of the Well Elderly 2 Randomised Controlled Trial
- Florence Clark1,
- Jeanne Jackson1,
- Mike Carlson1,
- Chih-Ping Chou2,
- Barbara J Cherry3,
- Maryalice Jordan-Marsh4,
- Bob G Knight5,
- Deborah Mandel1,
- Jeanine Blanchard1,
- Douglas A Granger6,
- Rand R Wilcox7,
- Mei Ying Lai2,
- Brett White8,
- Joel Hay9,
- Claudia Lam2,
- Abbey Marterella1,
- Stanley P Azen10
- 1Division of Occupational Science and Occupational Therapy, School of Dentistry, University of Southern California, Los Angeles, California, USA
- 2Department of Preventive Medicine, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- 3Department of Psychology, California State University, Fullerton, California, USA
- 4School of Social Work, University of Southern California, Los Angeles, California, USA
- 5Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- 6Center for Interdisciplinary Salivary Bioscience Research, The Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- 7Department of Psychology, University of Southern California, Los Angeles, California, USA
- 8Family Medicine at Gabriel Park, Oregon Health and Science University, Portland, Oregon, USA
- 9Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, California, USA
- 10Division of Biostatistics Statistical Consultation and Research Center, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Correspondence to Dr Florence Clark, Division of Occupational Science and Occupational Therapy, School of Dentistry, University of Southern California, 1540 Alcazar Street, CHP 133, Los Angeles, CA 90089-9003, USA;
Contributors FC, as principal investigator, obtained funding for the study and is guarantor. SPA, FC, JJ, MC, DM, JB, BW, C-PC, MJ-M, JH, BC, BGK and DAG provided substantial contributions to conception and design of the study. DM, JB, C-PC, MJ-M and BC acquired the data. SPA, MC, DM, C-PC, RW, MYL, CL, JH and DAG analysed the data. SPA, FC, JJ, MC, DM, JB, AM, C-PC, RW, MYL, CL, MJ-M, JH, BC, BGK and DAG interpreted the data. SPA, FC, JJ, MC, DM, AM, MYL, CL, JH and BC drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final version.
- Accepted 28 April 2011
- Published Online First 2 June 2011
Background Older people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people.
Methods A randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60–95 years (mean age 74.9±7.7 years; 53% <$12 000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area.
Results Intervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps<0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p<0.02), which was achieved cost-effectively (US $41 218/UK £24 868 per unit). No intervention effect was found for cognitive functioning outcome measures.
Conclusions A lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people.
Trial Registration clinicaltrials.gov identifier: NCT0078634.
- Lifestyle interventions
- occupational therapy
- randomised controlled trial
- quality of life
- qual of life measmnt
- randomised trials
Role of study sponsors: All data acquisition was inspected and reviewed annually by the designated data safety and monitoring board.
Funding This research was supported by National Institutes of Health grant R01 AG021108 from the National Institute on Aging.
Competing interests None.
Ethics approval This study was conducted with the approval of the institutional review board at the University of Southern California, and all participants gave informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.
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