A preventative lifestyle intervention for older adults (lifestyle matters): a randomised controlled trial

Abstract

Objectivesto test whether an occupation-based lifestyle intervention can sustain and improve the mental well-being of adults aged 65 years or over compared to usual care, using an individually randomised controlled trial.Participants288 independently living adults aged 65 years or over, with normal cognition, were recruited from two UK sites between December 2011 and November 2015.Interventionslifestyle Matters is a National Institute for Health and Care Excellence recommended multi-component preventive intervention designed to improve the mental well-being of community living older people at risk of decline. It involves weekly group sessions over 4 months and one to one sessions.Main outcome measuresthe primary outcome was mental well-being at 6 months (mental health (MH) dimension of the SF-36). Secondary outcomes included physical health dimensions of the SF-36, extent of depression (PHQ-9), quality of life (EQ-5D) and loneliness (de Jong Gierveld Loneliness Scale), assessed at 6 and 24 months.Resultsdata on 262 (intervention = 136; usual care = 126) participants were analysed using intention to treat analysis. Mean SF-36 MH scores at 6 months differed by 2.3 points (95 CI: −1.3 to 5.9; P = 0.209) after adjustments.Conclusionsanalysis shows little evidence of clinical or cost-effectiveness in the recruited population with analysis of the primary outcome revealing that the study participants were mentally well at baseline. The results pose questions regarding how preventive interventions to promote well-being in older adults can be effectively targeted in the absence of proactive mechanisms to identify those who at risk of decline.Trial RegistrationISRCTN67209155.

Group leader and participant perceptions of Balancing Everyday Life, a group-based lifestyle intervention for mental health service users

“…Many group leaders and participants desired more time for the intervention. This could be further researched as it seems that many other programs inspired by the Well Elderly studies are three to four months long [16,38,39]. However, the original Well Elderly study was nine months long [17], and the Well Elderly Study II was six months long [18].…”

<p>Lifestyle Matters Randomized Controlled Trial of a Preventive Health Intervention for Older People: Qualitative Sub Study with Participants and Intervention Facilitators</p>

“…24 Despite the Lifestyle Redesign intervention demonstrating efficacy in the US 2,3 the trial of the UK adapted intervention found that the intervention had a neutral impact upon quality of life, although there was significant improvement to perceived loneliness. 15 One potential reason for neutral trial results may be that, although the intervention did have a positive effect on participants, this effect was not great enough to elicit a significant improvement to the trial primary outcome (SF-36 score). Participants recruited to the Lifestyle Matters trial were not necessarily in contact with health or social care services and had a relatively high SF-36 score at baseline.…”

“…Participants recruited to the Lifestyle Matters trial were not necessarily in contact with health or social care services and had a relatively high SF-36 score at baseline. 15 In contrast, both US studies were conducted with specific populations; the first with people living in low-cost sheltered housing and the second with those already engaged with different forms of day service and who were therefore highly likely to have identified needs. Additionally, as the results of these interviews demonstrate, participants may have required more assistance than was available to them to benefit fully from the intervention and sustain any gains that they may have obtained.…”

“…In contrast, delivery of a multi-component multi component preventive physical health intervention to frail older people aged 80 and over did report short-term positive outcomes in the shorter term, underscoring the importance of intervention targeting. 28 The Lifestyle Matters trial 15 highlighted the difficulties of recruiting those most in need of such an intervention; namely people who had become lonely, isolated, and inactive. The previously undertaken feasibility study of the same intervention 6 recruited those who met these criteria, demonstrating the limits of using recruitment data from feasibility studies to predict recruitment in larger randomized trials where a rapid recruitment drive is usually required, 29 and in particular recruitment to trials of interventions with a group element such as Lifestyle Matters.…”

“…13 The primary RCT outcome was the mental health component of the SF-36, 14 which was not significantly different between the control and intervention groups at either 6 or 24 months. 15 Overall impact of the intervention assessed by interviews at 24 months post randomization with the same trial participants and those who were also randomized to the control arm has been reported. 16 Despite this, it was considered that a shorter term analysis of the experience of the intervention would be beneficial in order to elicit participants' immediate reflections of their involvement in Lifestyle Matters.…”