Chan Mi Park1, Gahee Oh2, Heayon Lee3,4, Hee-Won Jung3, Eunju Lee3, Il-Young Jang3,5, Dae Hyun Kim2,6. 1. Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea. 2. Hebrew SeniorLife, Marcus Institute for Aging Research, Boston, Massachusetts, USA. 3. Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 4. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 5. PyeongChang Health Center and County Hospital, PyeongChang, Republic of Korea. 6. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Abstract
BACKGROUND/ OBJECTIVES: To evaluate the long-term association between a multicomponent intervention program and disability in socioeconomically vulnerable older adults. DESIGN: This was a nonrandomized prospective intervention trial. SETTING: The setting was a community. PARTICIPANTS: Participants included older Koreans living alone or receiving government assistance from a low-income program. INTERVENTION: The intervention was a 24-week multicomponent program compromising group exercise, nutritional supplementation, management of depression, deprescribing, and home hazard reduction (n = 187) versus usual care (n = 196). MEASUREMENTS: The number of dependencies in 17 basic and instrumental activities of daily living was measured every 3 months for 30 months (range: 0-17; greater values indicated worse disability). Inverse probability weighting Poisson regression was used to model the number of dependencies to adjust for confounding bias and higher dropout rates of those with greater disability. RESULTS: The study population had a mean age of 76 years, and 26% were men. During the 30-month follow up, 17 died (n = 8, intervention; n = 9, control), 62 (n = 16, intervention; n = 46, control) were institutionalized or received nursing home care, and 34 (n = 15, intervention; n = 19, control) were lost to follow up. After inverse probability weighting, the mean number of dependencies at baseline was 1.21 and 1.29 for the intervention group and the control group, respectively (P = .80). The intervention group had fewer dependencies than the control group, but the difference was attenuated over time: 1.08 versus 1.60 at 6 months (P = .04), 1.29 versus 1.87 at 12 months (P = .03), 1.62 versus 2.17 at 18 months (P = .06), 2.08 versus 2.51 at 24 months (P = .18), and 2.73 versus 2.90 at 30 months (P = .67). CONCLUSION: A 24-week multicomponent intervention was associated with a slower progression of disability; however, the diminishing association from 24 months and beyond suggests that reassessment and intervention may be necessary. Due to a lack of randomization, our findings should be interpreted with caution.
BACKGROUND/ OBJECTIVES: To evaluate the long-term association between a multicomponent intervention program and disability in socioeconomically vulnerable older adults. DESIGN: This was a nonrandomized prospective intervention trial. SETTING: The setting was a community. PARTICIPANTS: Participants included older Koreans living alone or receiving government assistance from a low-income program. INTERVENTION: The intervention was a 24-week multicomponent program compromising group exercise, nutritional supplementation, management of depression, deprescribing, and home hazard reduction (n = 187) versus usual care (n = 196). MEASUREMENTS: The number of dependencies in 17 basic and instrumental activities of daily living was measured every 3 months for 30 months (range: 0-17; greater values indicated worse disability). Inverse probability weighting Poisson regression was used to model the number of dependencies to adjust for confounding bias and higher dropout rates of those with greater disability. RESULTS: The study population had a mean age of 76 years, and 26% were men. During the 30-month follow up, 17 died (n = 8, intervention; n = 9, control), 62 (n = 16, intervention; n = 46, control) were institutionalized or received nursing home care, and 34 (n = 15, intervention; n = 19, control) were lost to follow up. After inverse probability weighting, the mean number of dependencies at baseline was 1.21 and 1.29 for the intervention group and the control group, respectively (P = .80). The intervention group had fewer dependencies than the control group, but the difference was attenuated over time: 1.08 versus 1.60 at 6 months (P = .04), 1.29 versus 1.87 at 12 months (P = .03), 1.62 versus 2.17 at 18 months (P = .06), 2.08 versus 2.51 at 24 months (P = .18), and 2.73 versus 2.90 at 30 months (P = .67). CONCLUSION: A 24-week multicomponent intervention was associated with a slower progression of disability; however, the diminishing association from 24 months and beyond suggests that reassessment and intervention may be necessary. Due to a lack of randomization, our findings should be interpreted with caution.
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