journal articles
TAILORING MULTIDOMAIN INTERVENTION PROGRAMS TO REDUCE COGNITIVE AND PHYSICAL DECLINE IN OLDER ADULTS: EXAMINING RURAL-URBAN DIFFERENCES IN A NATIONWIDE CLUSTER-RANDOMIZED CONTROLLED TRIAL
Min-Yin Ho, Wei-Ju Lee, Ko-Han Yen, Chih-Kuang Liang, Li-Ning Peng, Ming-Hsien Lin, Ching-Hui Loh, Fei-Yuan Hsiao, Liang-Kung Chen
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.
CITATION:
Min-Yin Ho ; Wei-Ju Lee ; Ko-Han Yen ; Chih-Kuang Liang ; Li-Ning Peng ; Ming-Hsien Lin ; Ching-Hui Loh ; Fei-Yuan Hsiao ; Liang-Kung Chen (2025): Tailoring multidomain intervention programs to reduce cognitive and physical decline in older adults: Examining rural-urban differences in a nationwide cluster-randomized controlled trial. The Journal of Prevention of Alzheimer’s Disease (JPAD). https://doi.org/10.1016/j.tjpad.2025.100231