PROBLEM SOLVING/PHYSICAL INTERVENTIONS AND AGING

说明(改编自调查员摘要)： 在美国，活到老年的人已经上升 在过去的几十年里戏剧性地增长，预计将继续上升 爬上去。随之而来的是寻找帮助衰老的方法的兴趣与日俱增 成年人保持他们的健康、功能独立性和整体素质 生活。这项建议的主要目标是评估随机对照的 一项旨在改善情绪健康的干预的临床试验， 增加健康行为，增强解决问题的能力。这 干预将提供关于成功的两个决定因素的技能培训 衰老：解决问题和锻炼身体。248 75岁以上居住在社区的成年人将被随机分配到四个人中的一个 2×2析因设计中的处理条件：问题解决(PS) 仅限运动(EX)、PS+EX和常规护理控制(UCC)。主题将是 从一群老年人中招募，他们是以社区为基础的 已经有大量数据可用的卫生与健康组织。主要结果衡量标准 包括老年抑郁量表(用于评估抑郁和情绪 幸福感)、SF-36(用于评估健康和功能)和日常生活 问题解决测试(用于评估解决问题的能力)。次要结果 衡量标准将评估抑郁和情绪健康、身体健康、成本 关爱和死亡。结果衡量标准将在以下时间收集 登记参加研究(基线)、3个月(治疗后)和4个月 在两年的随访过程中。据推测，PS 和前任条件将有效地改善情绪健康和 身体健康。私人助理计划将有效地改善问题的解决；以及 PS+EX联合干预比单独干预更有效 在改善所有领域方面。还假设这些影响将是 保持2年以上，PS、EX和PS+EX科目将在 残疾和独立性、卫生利用和费用的衡量标准。

DESCRIPTION (adapted from investigator's abstract): The proportion of individuals in the United States who are living into old age had risen dramatically in the past several decades and is expected to continue its upward climb. With this has come a growing interest in identifying ways to help aging adults maintain their health, functional independence, and overall quality of life. The primary goal of this proposal is to evaluate a randomized controlled clinical trial of an intervention designed to improve emotional well-being, increase health behaviors, and enhance problem-solving skills. This intervention will provide skills training in two determinants of successful aging: problem solving and physical exercise. Two hundred forty-eight community-residing adults over age 75 will be randomly assigned to one of four treatment conditions in a two-by-two factorial design: Problem-solving (PS) only, Exercise (EX) only, PS+EX, and Usual Care Control (UCC). Subjects will be recruited from a cohort of older adults who are members of a community-based HMO on whom extensive data are already available. Primary outcome measures include the Geriatric Depression Scale (for assessing depression and emotional well-being), the SF-36 (for assessing health and function), and the Everyday Problem-Solving Test (for assessing problem-solving skills). Secondary outcome measures will assess depression and emotional well-being, physical health, cost of care, and mortality. Outcome measures will be collected at the time of enrollment into the study (baseline), at 3 months (post-treatment), and four times over the course of the 2-year follow-up. It is hypothesized that the PS and EX conditions will be effective in improving emotional well-being and physical health. PS will be effective in improving problem-solving; and the combination of PS+EX will be more effective than the individual interventions in improving all areas. It is also hypothesized that these effects will be maintained over 2 years, and that subjects in PS, EX, and PS+EX will improve on measures of disability and independence, health utilization and cost.