American Journal of Geriatric Psychiatry
Volume 27, Issue 12, 2019, Pages 1299-1313

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

Alegría M.* , Frontera W. , Cruz-Gonzalez M. , Markle S.L. , Trinh-Shevrin C. , Wang Y. , Herrera L. , Ishikawa R.Z. , Velazquez E. , Fuentes L. , Guo Y. , Pan J. , Cheung M. , Wong J. , Genatios U. , Jimenez A. , Ramos Z. , Perez G. , Wong J.Y. , Chieng C.-K. , Bartels S.J. , Duan N. , Shrout P.E.
  • a Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States, Department of Psychiatry, Harvard Medical School, Boston, MA, United States
  • b Departments of Physical Medicine, Rehabilitation and Sports Medicine and Physiology and Biophysics, University of Puerto Rico, Río Piedras, Puerto Rico
  • c Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
  • d Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
  • e Department of Population Health, Department of Medicine, New York University School of Medicine, New York, NY, United States
  • f Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
  • g Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
  • h Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
  • i Ariadne Labs, Brigham and Women's Hospital, Harvard T. H. Chan School of Public Health, Boston, MA, United States
  • j Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
  • k Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
  • l Department of Psychology, West Chester University of Pennsylvania, West Chester, PA, United States
  • m Greater Boston Chinese Golden Age Center, Boston, MA, United States
  • n Hamilton Madison House, New York, NY, United States; Y., Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
  • o Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
  • p Department of Psychology, University of Puerto Rico, San Juan, Puerto Rico
  • q Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
  • r Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
  • s [Affiliation not available]
  • t Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
  • u The Mongan Institute, Massachusetts General Hospital, Boston, MA, United States
  • v Department of Psychiatry, Columbia University, New York, NY, United States
  • w Department of Psychology, New York University, New York, NY, United States

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. © 2019 American Association for Geriatric Psychiatry

Author Keywords

immigrants Disability Depression Anxiety CHW Racial/ethnic minority elders

Index Keywords

rating scale Generalized Anxiety Disorder scale Puerto Rico immigrant exercise Massachusetts intention to treat analysis minority group human Self Report protocol compliance controlled study cognitive behavioral therapy randomized controlled trial Aged Geriatric Depression Scale Florida New York male female preventive health service patient satisfaction Article major clinical study adult disability program acceptability clinical effectiveness
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85071669678&doi=10.1016%2fj.jagp.2019.08.008&partnerID=40&md5=a7e783c64874ebd165e099c74418ded4
DOI: 10.1016/j.jagp.2019.08.008
ISSN: 10647481
Cited by: 1
Original Language: English