Date Presented 4/9/2016
The Lifestyle Matters study was undertaken with 288 participants randomized to one of two study arms to understand whether the Lifestyle Redesign intervention could be implemented within the United Kingdom. The results will inform the use of such preventive interventions in occupational therapy practice.
Primary Author and Speaker: Gail Mountain
Additional Author and Speaker: Robin Chatters
PURPOSE: The primary aim of this research program was to identify how mental well-being, self-efficacy, and resilience can be supported in older adults by evaluating the clinical and cost effectiveness of a psychosocial intervention to promote healthy aging.
RATIONALE: Occupational engagement is an important factor in helping older adults to age healthily. Active aging is associated with good mental well-being, which can be promoted by participation in meaningful activities. The Well Elderly studies, undertaken in the United States, concerned the efficacy of a health-promoting intervention (Lifestyle Redesign) and was designed to improve older adults’ quality of life and avoid mental and psychical decline (Clark et al., 1997, 2012). In the United Kingdom, we developed and tested a related intervention (Lifestyle Matters) within a randomized controlled trial (RCT).
DESIGN: A pragmatic, two-arm (treatment as usual [TAU] and intervention), individually randomized trial.
PARTICIPANTS: Two hundred eighty-eight participants age 65 yr or older, with reasonable cognitive function, living independently and able to converse in English were recruited via general practitioner mail outs, signposting by local organizations, and community engagement.
METHOD: The primary outcome measure was the SF–36 Mental Health dimension at 6 mo. Outcomes were measured via questionnaires at baseline, 6 mo, and 24 mo. Fidelity assessment and process evaluation were undertaken through interviewing intervention facilitators and recording intervention delivery. Qualitative data were collected from participants at 6 and 12 mo.
ANALYSIS: Intention-to-treat analyses will compare the two arms of the trial to establish whether the intervention is clinically and cost effective. The primary analyses will compare the mean SF-36 scores at 6 mo between the two arms using a linear marginal model. Cost-effectiveness analysis will calculate the incremental cost per quality adjusted life years of the Lifestyle Matters intervention compared with TAU. Fidelity is being analyzed through qualitative analysis of facilitator interviews, combined with quantitative analysis regarding session delivery. Participant qualitative data are being analyzed using framework analysis and has involved identifying participants’ experiences of being involved in the intervention, and any lasting effects through interviews at 24 mo.
RESULTS: At the time of writing, findings are being analyzed. We will present results in full and consider them in light of those produced by our U.S. collaborators.
DISCUSSION: The results of this high-quality RCT will determine whether Lifestyle Matters is clinically and cost effective in the United Kingdom. It will reveal the extent to which facilitators were able to maintain intervention fidelity and through the process evaluation identify the factors that mediate and moderate the intervention efficacy. This will add to the global evidence on interventions based on the original concept of Lifestyle Redesign.
IMPACT STATEMENT: This RCT has the potential to affect older adults in the United Kingdom and elsewhere by providing high-quality evidence regarding the efficacy and implementation of an occupational therapy–based preventive lifestyle intervention (Lifestyle Matters), which has already been incorporated into National Institute for Clinical Excellence guidance.
References
Clark, F., Azen, S. P., Zemke, R., Jackson, J., Carlson, M., Mandel, D., . . . Lipson, L. (1997). Occupational therapy for independent-living older adults: A randomized controlled trial. JAMA, 278, 1321–1326. http://dx.doi.org/10.1001/jama.1997.03550160041036
Clark, F., Jackson, J., Carlson, M., Chou, C. P., Cherry, B. J., Jordan-Marsh, M., . . . Azen, S. P. (2012). Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2 Randomised Controlled Trial. Journal of Epidemiology and Community Health, 66, 782–790. http://dx.doi.org/10.1136/jech.2009.099754
