Dosage and Efficacy in Behavioral Interventions With Community Dwelling Older Adults: Lifestyle Redesign Revisited.

Objectives: Behavioral interventions with community dwelling older adults often utilize multiple modes of treatment, which contributes to variation in participation and high rates of nonadherence. The objective of this report was to assess the treatment efficacy of one such study. Methods: We conducted an as-treated analysis of the Well Elderly II trial, where 322 individuals underwent 6 months of individual and group treatment and participated in community outings. We utilized inferential and graphical methods to assess the relationship between treatment received and depression change. Results: Individual treatment and community outings had similar small indirect effects on depressive symptoms, but a selection effect was present for individual treatment, where individuals with high baseline depression scores were the most likely to participate. Discussion: The results provide nuance that is unavailable using intent-to-treat. Future research should expand on our methods for as-treated analyses after intent-to-treat has shown aggregate improvements.

Comparing life review writing with active control groups: Results of a feasibility study.

INTRODUCTION: Life review writing can be used to improve depressive symptoms in well older adults, but it is unclear whether the reminiscing, writing, or socialising is associated with the improvements. This study assessed the feasibility of a controlled trial comparing life review writing with two active control groups designed to isolate the acts of (a) engaging in a meaningful leisure activity and (b) socialising. METHODS: Twenty-four participants from a 100-bed assisted living facility were enrolled in the study. Participants ranged in age from 70 to 98 years (M = 83.9, SD = 7.6). Eight 1-hour weekly sessions were held, with participants assigned to one of three groups: (a) life review writing, (b) painting, or (c) coffee from around the world. At baseline, participants completed a demographic and health questionnaire, the Mini-Cog, and the Geriatric Depression Scale Short Form (GDS-15). The GDS-15 was administered again at weeks 4 and 8, along with the health questionnaire at post-test. RESULTS: Nearly 25% (N = 24) of the facility's residents attended at least one session, with an average attendance rate of 66.4%, or 5.3 sessions. However, to achieve this participation rate, our original plan to employ random assignment had to be abandoned. The groups were a partial success insofar as we successfully isolated engaging in a meaningful activity in the painting group, but the writing group engaged in less reminiscing than hoped. At post-test, seven participants reported health, mood, and social life benefits. GDS-15 scores fluctuated over time, with no significant improvement from pre- to post-test. CONCLUSION: The residents' low willingness to be randomised creates a serious selection bias, but randomising volunteers into different activities runs counter to client-centred therapy. To scrutinise the mechanisms of change of life review writing, we recommend comparing two writing groups: one that reminisces and one that does not.