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（2025）
Abstract
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.
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