TY - JOUR
T1 - A Scoping Review of Nonpharmacological Interventions to Reduce Disability in Older Adults
AU - Wu, Chao Yi
AU - Rodakowski, Juleen L.
AU - Terhorst, Lauren
AU - Karp, Jordan F.
AU - Fields, Beth
AU - Skidmore, Elizabeth R.
N1 - Funding Information:
This work was supported by the National Center for Advancing Translational Sciences [KL2 TR000146 to J.R.]. The funding source had no role in the study’s design, conduct, and article’s development and publication.
Publisher Copyright:
© 2019 The Author(s). Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.
PY - 2020/1/24
Y1 - 2020/1/24
N2 - 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.
AB - 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.
KW - Active ingredients
KW - Complex interventions
KW - Intervention efficacy
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U2 - 10.1093/geront/gnz026
DO - 10.1093/geront/gnz026
M3 - Review article
C2 - 31002312
AN - SCOPUS:85078558533
VL - 60
SP - E52-E65
JO - The Gerontologist
JF - The Gerontologist
SN - 0016-9013
IS - 1
ER -