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

Published:August 13, 2019DOI:https://doi.org/10.1016/j.jagp.2019.08.008

      Highlights

      • This multisite clinical trial tests whether Positive Minds-Strong Bodies (PMSB), a disability prevention intervention offered in four languages, is acceptable to minority and immigrant elders and feasible to be offered by paraprofessionals.
      • The 6-month intent-to-treat analyses showed significant intervention effects in improving late-life functioning and lowering mood symptoms while the 12-month analyses showed sustained significant effects on self-reported disability, disability days, and mood symptoms.
      • The PMSB intervention shows promise in preventing disability in a diverse sample of minority and immigrant elders.

      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.

      Key Words

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