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Am J Geriatr Psychiatry. 2019 Dec;27(12):1299-1313. doi: 10.1016/j.jagp.2019.08.008. Epub 2019 Aug 13.

Effectiveness of a Disability Preventive Intervention for Minority and Immigrant Elders: The Positive Minds-Strong Bodies Randomized Clinical Trial.

Author information

1
Disparities Research Unit, Department of Medicine, Massachusetts General Hospital (MA, MCG, SLM, YW, LH, LF, YG, UG, ZR, JYW, CKC), Boston, MA; Department of Psychiatry, Harvard Medical School (MA), Boston, MA. Electronic address: malegria@mgh.harvard.edu.
2
Departments of Physical Medicine, Rehabilitation and Sports Medicine and Physiology and Biophysics, University of Puerto Rico (WF), Río Piedras, Puerto Rico.
3
Disparities Research Unit, Department of Medicine, Massachusetts General Hospital (MA, MCG, SLM, YW, LH, LF, YG, UG, ZR, JYW, CKC), Boston, MA.
4
Department of Population Health, Department of Medicine, New York University School of Medicine (CTS), New York, NY.
5
Department of Psychiatry, Massachusetts General Hospital (RZI, GP), Boston, MA.
6
Ariadne Labs, Brigham and Women's Hospital, Harvard T. H. Chan School of Public Health (EV), Boston, MA.
7
Department of Psychology, West Chester University of Pennsylvania (JP), West Chester, PA.
8
Greater Boston Chinese Golden Age Center (MC), Boston, MA.
9
Hamilton Madison House (JW), New York, NY.
10
Department of Psychology, University of Puerto Rico (AJ), San Juan, Puerto Rico.
11
The Mongan Institute, Massachusetts General Hospital (SJB), Boston, MA.
12
Department of Psychiatry, Columbia University (ND), New York, NY.
13
Department of Psychology, New York University (PES), New York, NY.

Abstract

OBJECTIVE:

To test the acceptability and effectiveness of a disability prevention intervention, Positive Minds-Strong Bodies (PMSB), offered by paraprofessionals to mostly immigrant elders in four languages.

DESIGN:

Randomized trial of 307 participants, equally randomized into intervention or enhanced usual care.

SETTING:

Community-based organizations in Massachusetts, New York, Florida, and Puerto Rico serving minority elders. Data collected at baseline, 2, 6, and 12 months, between May 2015 and March 2019.

PARTICIPANTS:

English-, Spanish-, Mandarin-, or Cantonese-speaking adults, age 60+, not seeking disability prevention services, but eligible per elevated mood symptoms and minor to moderate physical dysfunction.

INTERVENTIONS:

Ten individual sessions of cognitive behavioral therapy (PM) concurrently offered with 36 group sessions of strengthening exercise training (SB) over 6 months compared to enhanced usual care.

MEASUREMENTS:

Acceptability defined as satisfaction and attendance to >50% of sessions. Effectiveness determined by changes in mood symptoms (HSCL-25 and GAD-7), functional performance (SPPB), self-reported disability (LLFDI), and disability days (WHODAS 2.0).

RESULTS:

Around 77.6% of intervention participants attended over half of PM Sessions; 53.4% attended over half of SB sessions. Intent-to-treat analyses at 6 months showed significant intervention effects: improved functioning per SPPB and LLFDI, and lowered mood symptoms per HSCL-25. Intent-to-treat analyses at 12 months showed that effects remained significant for LLFDI and HSCL-25, and disability days (per WHODAS 2.0) significantly decreased 6-month after the intervention.

CONCLUSIONS:

PMSB offered by paraprofessionals in community-based organizations demonstrates good acceptability and seems to improve functioning, with a compliance-benefit effect showing compliance as an important determinant of the intervention response.

KEYWORDS:

CHW; Racial/ethnic minority elders; anxiety; depression; disability; immigrants

PMID:
31494015
PMCID:
PMC6842701
[Available on 2020-12-01]
DOI:
10.1016/j.jagp.2019.08.008

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