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The journal of prevention of Alzheimer's disease. 2025 Jun 12:100231. doi: 10.1016/j.tjpad.2025.100231 Q17.82024

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

针对农村和城市地区差异制定多领域干预项目以减少老年人的认知和身体功能下降：一项全国范围集群随机对照试验的研究 翻译改进

Min-Yin Ho  1, Wei-Ju Lee  2, Ko-Han Yen  3, Chih-Kuang Liang  4, Li-Ning Peng  3, Ming-Hsien Lin  5, Ching-Hui Loh  6, Fei-Yuan Hsiao  7, Liang-Kung Chen  8

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作者单位

  • 1 Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Child Welfare League Foundation, Taipei City, Taiwan.
  • 2 Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan County, Taiwan,. Electronic address: leewju@gmail.com.
  • 3 Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
  • 4 Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,. Electronic address: ck.vghks@gmail.com.
  • 5 Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
  • 6 Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Center of Health and Aging, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien County, Taiwan.
  • 7 Center of Health and Aging, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien County, Taiwan,; Graduate Institute of Clinical Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan.
  • 8 Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan,; Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.

    • DOI: 10.1016/j.tjpad.2025.100231 PMID: 40514302

    摘要 中英对照阅读

    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.

    Keywords: Cognitive impairment; Frailty; Multidomain intervention; Rural-urban disparity.

    Keywords：multidomain intervention; cognitive decline; physical decline; rural-urban differences; randomized controlled trial

    背景： 衰弱和认知障碍是老龄化人口面临的主要挑战。多领域干预措施针对身体、认知和营养健康显示出潜力；然而，关于农村与城市地区在疗效上的差异的证据仍然有限。

    目的： 评估城乡差距对老年人群中为期12个月的认知和身体多领域干预临床效果的影响。

    设计： 集群随机对照试验。

    地点： 台湾五个城市/县的社区集群。

    参与者： 共有40个社区集群中的1082名年龄≥65岁的成年人被随机分配到干预组或对照组。

    干预措施： 干预组接受了为期12个月的项目，包括身体锻炼（每次45分钟）、认知训练（每次1小时）和营养指导（每次15分钟）。对照组接受电话健康教育。该试验已在ClinicalTrials.gov注册（NCT03056768），评估指标包括基线、6个月和12个月时的行走速度、握力、体力活动（METs）、衰弱（CHS评分）以及认知功能（MoCA）。

    结果： 城市参与者在视觉空间/执行功能方面的改善显著大于农村地区，12个月时差异为0.63（95% CI：0.26 - 1.03），行走速度的提高也较大，12个月时差异为0.12 m/s（95% CI：0.05 - 0.19）。农村地区参与者在握力方面表现出更好的改善，12个月时差异为-2.59 kg（95% CI：-3.91 - -1.27），语言功能也有所提高，12个月时差异为-0.38（95% CI：-0.68 - -0.09）。12个月时城市地区在减少衰弱方面表现更明显（-0.21, 95% CI: -0.38 - -0.03, p = 0.025），但在农村地区的参与者改善不大。

    结论： 城乡差距影响多领域干预措施的效果。需要量身定制的策略来优化不同环境下的健康结果。

    关键词： 认知障碍；衰弱；多领域干预；城乡差异。

    关键词：多领域干预; 认知衰退; 身体机能下降; 城乡差异; 随机对照试验

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    期刊名：Jpad-journal of prevention of alzheimers disease

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    ISSN：2274-5807

    e-ISSN：2426-0266

    IF/分区：7.8/Q1

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