Deborah Mandel

Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: results of the Well Elderly 2 Randomised Controlled Trial

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% <

Cost‐Effectiveness of Preventive Occupational Therapy for Independent‐Living Older Adults

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

Confronting challenges in intervention research with ethnically diverse older adults: the USC Well Elderly II Trial

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.

Psychometric Properties of a Chinese Translation of the SF-36 Health Survey Questionnaire in the Well Elderly Study

OBJECTIVES: To evaluate the cost‐effectiveness of a 9‐month preventive occupational therapy (OT) program in the Well‐Elderly Study: a randomized trial in independent‐living older adults that found significant health, function, and quality of life benefits attributable to preventive OT.

Derivation and pilot assessment of a health promotion program for Mandarin-speaking Chinese older adults.

Background Community-dwelling older adults are at risk for declines in physical health, cognition, and psychosocial well-being. However, their enactment of active and health-promoting lifestyles can reduce such declines. Purpose The purpose of this article is to describe the USC Well Elderly II study, a randomized clinical trial designed to test the effectiveness of a healthy lifestyle program for elders, and document how various methodological challenges were addressed during the course of the trial. Methods In the study, 460 ethnically diverse elders recruited from a variety of sites in the urban Los Angeles area were enrolled in a randomized experiment involving a crossover design component. Within either the first or second 6-month phase of their study involvement, each elder received a lifestyle intervention designed to improve a variety of aging outcomes. At 4—5 time points over an 18—24 month interval, the research participants were assessed on measures of healthy activity, coping, social support, perceived control, stress-related biomarkers, perceived physical health, psychosocial well-being, and cognitive functioning to test the effectiveness of the intervention and document the process mechanisms responsible for its effects. Results The study protocol was successfully implemented, including the enrollment of study sites, the recruitment of 460 older adults, administration of the intervention, adherence to the plan for assessment, and establishment of a large computerized data base. Limitations: Methodological challenges were encountered in the areas of site recruitment, participant recruitment, testing, and intervention delivery. Conclusions The completion of clinical trials involving elders from numerous local sites requires careful oversight and anticipation of threats to the study design that stem from: (a) social situations that are particular to specific study sites; and (b) physical, functional, and social challenges pertaining to the elder population. Clinical Trials 2009; 6: 90—101. http://ctj.sagepub.com

Predictors of retention among African American and Hispanic older adult research participants in the Well Elderly 2 randomized controlled trial.

Objectives:To evaluate the psychometric properties of a Chinese translation of the 36-item Short Form Health Survey (SF-36) in theWell Elderly Study—a randomized clinical trial designed to evaluate the effectiveness of preventive occupational therapy services specifically tailored for multiethnic, independent-living, older adults. Methods:Translation and back-translation procedures were used to obtain appropriate meanings for the SF-36 survey questions and to ensure face, functional, and conceptual equivalence. Results:Statistical analyses demonstrated satisfactory reliability and validity, with the results generally similar to those reported for older Anglo adults. Discussion:As the percentage of older adults of diverse ethnicity increases, the need for health care research and service strategies that can effectively include multiple ethnicities becomes paramount. The results of this study suggest that a Chinesetranslated SF-36 can be used to assess multiple dimensions of health in a Mandarinspeaking population of older adults.

Promoting Quality of Life in Elders: An Occupation-Based Occupational Therapy Program

As the percentage of older adults of diverse ethnicities increases in the United States, the call for culturally sensitive health care service strategies that target the special needs of older people grows. The present report describes methods used to adapt a health care program so that it would better meet the needs of a group of well, older Mandarin-speaking Chinese residents of Los Angeles. The specific qualitative research procedures that we used to adapt the treatment program are described, along with the particular adaptations that emerged. Additionally, outcomes from a randomized pilot experiment are presented that are consistent with the notion that the adapted program was effective in reducing health-related declines among older Mandarin-speaking men and women. The overall outcome of this project is in agreement with other reports in the health care literature that address the importance of providing culturally sensitive health care service for elders.

Occupational Therapy for Independent-Living Older Adults: A Randomized Controlled Trial

The purpose of this study was to document predictors of long-term retention among minority participants in the Well Elderly 2 Study, a randomized controlled trial of a lifestyle intervention for community-dwelling older adults. The primary sample included 149 African American and 92 Hispanic men and women aged 60 to 95 years, recruited at senior activity centers and senior residences. Chi-square and logistic regression procedures were undertaken to examine study-based, psychosocial and health-related predictors of retention at 18 months following study entry. For both African Americans and Hispanics, intervention adherence was the strongest predictor. Retention was also related to high active coping and average (vs. high or low) levels of activity participation among African Americans and high social network strength among Hispanics. The results suggest that improved knowledge of the predictors of retention among minority elders can spawn new retention strategies that can be applied at individual, subgroup, and sample-wide levels.

Occupation in Lifestyle Redesign: The Well Elderly Study Occupational Therapy Program

Abstract The practice of occupational therapy for elders is becoming more challenging. This article presents Lifestyle Redesign, an intervention model that promotes quality of life in well elders. Studies will be discussed that demonstrate the long-term efficacy of this treatment and that support the use of occupation-based occupational therapy for independent living. The key concepts of the program and process of delivery will be addressed. Finally, the necessity for cultural sensitivity on a global level will be discussed as it relates to designing similar programs for other cultures.