Pub Date : 2025-11-01DOI: 10.1016/j.lanhl.2025.100790
Amaia Calderón-Larrañaga PhD , Elisa Fabbri MD , Ana Isabel González MD , Prof Rafael Perera-Salazar PhD , Nina Grede PhD , Prof Bruce Guthrie MD , Prof José M Valderas MD , Caterina Gregorio PhD , Prof Christiane Muth MD , Davide L Vetrano MD , Prof Gabriele Meyer PhD , Luigi Ferrucci MD , Jeanet W Blom MD , Kerstin Bernartz MSc , Lara Schürmann MSc , Maria Hanf MSc , Prof Martin Scherer MD , Prof Michael A Steinman MD , Prof Mieke Rijken PhD , Prof Sharon Straus MD , Marjan van den Akker PhD
Multimorbidity, the coexistence of multiple chronic diseases or conditions, poses a major challenge for health-care systems worldwide. Traditional research has largely relied on cross-sectional studies, offering limited insight into multimorbidity evolution over time. This Personal View advocates for a paradigm shift towards longitudinal approaches that capture multimorbidity trajectories. Tracking the sequence, pace, and severity of disease accumulation can enhance our understanding of underlying mechanisms, inform early interventions, and improve patient care. Drawing on expert discussions from an international workshop held in Bielefeld, Germany, in May, 2024, we outline key themes and findings to guide future research on the dynamic processes underlying multimorbidity trajectories. Specifically, we summarise previous work, examine the challenges and opportunities of existing data resources, and highlight priority areas for further investigation. Advancing this field will require the standardisation of longitudinal multimorbidity phenotypes, integration of health and social care processes, and testing the usefulness of trajectories for patient-relevant outcomes and risk stratification. Progress will also depend on methodological innovation, patient and public involvement, harmonisation of diverse data sources, and close interdisciplinary collaboration. Ultimately, a trajectory-based framework for multimorbidity research can enable more personalised, efficient, and equitable health-care strategies, improving outcomes in ageing populations.
{"title":"Understanding changes in complex care needs over time: key research insights into multimorbidity trajectories","authors":"Amaia Calderón-Larrañaga PhD , Elisa Fabbri MD , Ana Isabel González MD , Prof Rafael Perera-Salazar PhD , Nina Grede PhD , Prof Bruce Guthrie MD , Prof José M Valderas MD , Caterina Gregorio PhD , Prof Christiane Muth MD , Davide L Vetrano MD , Prof Gabriele Meyer PhD , Luigi Ferrucci MD , Jeanet W Blom MD , Kerstin Bernartz MSc , Lara Schürmann MSc , Maria Hanf MSc , Prof Martin Scherer MD , Prof Michael A Steinman MD , Prof Mieke Rijken PhD , Prof Sharon Straus MD , Marjan van den Akker PhD","doi":"10.1016/j.lanhl.2025.100790","DOIUrl":"10.1016/j.lanhl.2025.100790","url":null,"abstract":"<div><div>Multimorbidity, the coexistence of multiple chronic diseases or conditions, poses a major challenge for health-care systems worldwide. Traditional research has largely relied on cross-sectional studies, offering limited insight into multimorbidity evolution over time. This Personal View advocates for a paradigm shift towards longitudinal approaches that capture multimorbidity trajectories. Tracking the sequence, pace, and severity of disease accumulation can enhance our understanding of underlying mechanisms, inform early interventions, and improve patient care. Drawing on expert discussions from an international workshop held in Bielefeld, Germany, in May, 2024, we outline key themes and findings to guide future research on the dynamic processes underlying multimorbidity trajectories. Specifically, we summarise previous work, examine the challenges and opportunities of existing data resources, and highlight priority areas for further investigation. Advancing this field will require the standardisation of longitudinal multimorbidity phenotypes, integration of health and social care processes, and testing the usefulness of trajectories for patient-relevant outcomes and risk stratification. Progress will also depend on methodological innovation, patient and public involvement, harmonisation of diverse data sources, and close interdisciplinary collaboration. Ultimately, a trajectory-based framework for multimorbidity research can enable more personalised, efficient, and equitable health-care strategies, improving outcomes in ageing populations.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 11","pages":"Article 100790"},"PeriodicalIF":14.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The WHO Integrated Care for Older People programme: a key strategy for addressing ageing in sub-Saharan Africa","authors":"Maturin Tabue-Teguo , Marie-Josiane Ntsama-Essomba , Moustapha Drame , Mamadou Coume , Nadine Simo","doi":"10.1016/j.lanhl.2025.100784","DOIUrl":"10.1016/j.lanhl.2025.100784","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 10","pages":"Article 100784"},"PeriodicalIF":14.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.lanhl.2025.100770
Prof Nicholas F Taylor PhD , Paul D O’Halloran PhD , Prof Jennifer J Watts MCom(Econ) , Casey L Peiris PhD , Prof Luke A Prendergast PhD , Prof Judi Porter PhD , Prof Katherine E Harding PhD , David A Snowdon PhD , Christina L Ekegren PhD , Made U Rimayanti PhD , Raphael Hau FRACS , Shalika Bohingamu Mudiyanselage MHHSM , Kate E Noeske BPhysio , Megan Snowdon BPhysio , Scott Williams BAHons , Prof Nora Shields PhD
<div><h3>Background</h3><div>Hip fracture has profound psychosocial effects but there is little guidance about how to incorporate management of psychosocial factors into rehabilitation. We aimed to assess the effect of telephone-based motivational interviewing on physical activity in community-dwelling older adults after hip fracture.</div></div><div><h3>Methods</h3><div>We conducted a 12-month, assessor-masked, open-label, multisite, randomised controlled trial in three health networks (Eastern Health, Peninsula Health, and Alfred Health) in Melbourne, VIC, Australia. Each health network included acute hospitals, sub-acute (rehabilitation) hospitals, and community rehabilitation programmes from which eligible participants were recruited. Community-dwelling adults with hip fracture, aged 65 years and older, were randomly assigned (1:1) by an external provider with a random number generator to an experimental group receiving ten 30-min sessions of motivational interviewing over 16 weeks from one of 13 trained health professionals or to an attention-control group receiving an equivalent dosage of dietary advice from one of nine accredited dietitians. Assessors were masked to group allocation. The primary outcome, assessed in the intention-to-treat population, was physical activity expressed as accelerometer-measured daily walking time at week 52. All available data were used in the linear mixed effects models. To account for missing data, multiple imputation was completed as a sensitivity analysis. The study was registered prospectively (ACTRN12619000936123).</div></div><div><h3>Findings</h3><div>From Sept 29, 2019, to June 27, 2022, 1246 potentially eligible patients were screened, 1046 were excluded (611 were deemed ineligible, 359 declined to participate, and 76 were unable to be contacted) and the resulting 200 were randomly assigned to an intervention (98 assigned to the motivational interviewing group and 102 assigned to the nutritional education control group). 146 (73%) participants were female, 54 (27%) were male, the average age of participants was 79 years (SD 7), and participants were a mean of 89 days (SD 40) days post-surgery at baseline. Daily walking time at week 52 was a median of 53·1 min (IQR 28·8 to 73·8) in the motivational interviewing group and 63·7 min (42·6 to 89·2) in the control group, with no significant between-group differences (mean difference 4·1% [95% CI –16·6 to 21·1). There were no serious harms related to the intervention. There were seven deaths during the period from baseline to week 52, three in the motivational interviewing group and four in the control group. There were a small number of non-serious adverse events related to the intervention with a total of seven (1%) short-term skin reactions out of 668 assessments in response to the activity monitor being held in place on the thigh with dressing.</div></div><div><h3>Interpretation</h3><div>Motivational interviewing was no more effective than dietary advice
{"title":"The effect of motivational interviewing on physical activity after hip fracture: a multisite, open-label, randomised controlled trial in Australia","authors":"Prof Nicholas F Taylor PhD , Paul D O’Halloran PhD , Prof Jennifer J Watts MCom(Econ) , Casey L Peiris PhD , Prof Luke A Prendergast PhD , Prof Judi Porter PhD , Prof Katherine E Harding PhD , David A Snowdon PhD , Christina L Ekegren PhD , Made U Rimayanti PhD , Raphael Hau FRACS , Shalika Bohingamu Mudiyanselage MHHSM , Kate E Noeske BPhysio , Megan Snowdon BPhysio , Scott Williams BAHons , Prof Nora Shields PhD","doi":"10.1016/j.lanhl.2025.100770","DOIUrl":"10.1016/j.lanhl.2025.100770","url":null,"abstract":"<div><h3>Background</h3><div>Hip fracture has profound psychosocial effects but there is little guidance about how to incorporate management of psychosocial factors into rehabilitation. We aimed to assess the effect of telephone-based motivational interviewing on physical activity in community-dwelling older adults after hip fracture.</div></div><div><h3>Methods</h3><div>We conducted a 12-month, assessor-masked, open-label, multisite, randomised controlled trial in three health networks (Eastern Health, Peninsula Health, and Alfred Health) in Melbourne, VIC, Australia. Each health network included acute hospitals, sub-acute (rehabilitation) hospitals, and community rehabilitation programmes from which eligible participants were recruited. Community-dwelling adults with hip fracture, aged 65 years and older, were randomly assigned (1:1) by an external provider with a random number generator to an experimental group receiving ten 30-min sessions of motivational interviewing over 16 weeks from one of 13 trained health professionals or to an attention-control group receiving an equivalent dosage of dietary advice from one of nine accredited dietitians. Assessors were masked to group allocation. The primary outcome, assessed in the intention-to-treat population, was physical activity expressed as accelerometer-measured daily walking time at week 52. All available data were used in the linear mixed effects models. To account for missing data, multiple imputation was completed as a sensitivity analysis. The study was registered prospectively (ACTRN12619000936123).</div></div><div><h3>Findings</h3><div>From Sept 29, 2019, to June 27, 2022, 1246 potentially eligible patients were screened, 1046 were excluded (611 were deemed ineligible, 359 declined to participate, and 76 were unable to be contacted) and the resulting 200 were randomly assigned to an intervention (98 assigned to the motivational interviewing group and 102 assigned to the nutritional education control group). 146 (73%) participants were female, 54 (27%) were male, the average age of participants was 79 years (SD 7), and participants were a mean of 89 days (SD 40) days post-surgery at baseline. Daily walking time at week 52 was a median of 53·1 min (IQR 28·8 to 73·8) in the motivational interviewing group and 63·7 min (42·6 to 89·2) in the control group, with no significant between-group differences (mean difference 4·1% [95% CI –16·6 to 21·1). There were no serious harms related to the intervention. There were seven deaths during the period from baseline to week 52, three in the motivational interviewing group and four in the control group. There were a small number of non-serious adverse events related to the intervention with a total of seven (1%) short-term skin reactions out of 668 assessments in response to the activity monitor being held in place on the thigh with dressing.</div></div><div><h3>Interpretation</h3><div>Motivational interviewing was no more effective than dietary advice","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 10","pages":"Article 100770"},"PeriodicalIF":14.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.lanhl.2025.100774
Prof Rupert A Payne PhD , Prof Peter S Blair PhD , Barbara Caddick PhD , Prof Carolyn A Chew-Graham MD , Prof Tobias Dreischulte PhD , Lorna J Duncan PhD , Prof Bruce Guthrie PhD , Cindy Mann PhD , Roxanne M Parslow PhD , Prof Jeff Round PhD , Prof Chris Salisbury MD , Prof Katrina M Turner PhD , Nicholas L Turner PhD , Deborah McCahon PhD
<div><h3>Background</h3><div>Polypharmacy is a major and growing challenge for patient safety and health outcomes, and associated with inefficient use of resources. Management requires balancing therapeutic benefits and risks, aligned with clinical and patient priorities. High-quality evidence supporting current guidance for the management of polypharmacy is scarce. The aim of the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) study was to examine whether a complex intervention could reduce potentially inappropriate prescribing among patients experiencing polypharmacy in primary care.</div></div><div><h3>Methods</h3><div>A pragmatic, open-label, two-arm, parallel cluster-randomised trial was conducted in UK general practices providing National Health Service primary medical care. Practices were required to use the EMIS electronic health records system and have more than 4000 registered patients. For inclusion in the study, participants were required to be aged 18 years or older, prescribed at least five regular medications (ie, medicines recorded in the clinical system as repeat prescriptions, and thus available for recurrent ordering by patients without having to see a clinician) irrespective of when the drug was last issued, and with at least one indicator of potentially inappropriate prescribing identified by an informatics tool. Practices were randomly allocated to deliver the polypharmacy intervention or continue usual care. The complex intervention comprised a structured, collaborative, and patient-centred approach to medication review, supported by informatics, clinician training, performance feedback, and financial incentivisation. In each practice, adults receiving five or more regular medications, with at least one indicator of potentially inappropriate prescribing, were reviewed over a 6-month period. The primary outcome was number of indicators of potentially inappropriate prescribing at 26 weeks’ follow-up, analysed on an intention-to-treat basis. The trial was registered with the ISRCTN registry (90146150) and is complete.</div></div><div><h3>Findings</h3><div>Between Jan 26, 2022, and June 20, 2022, 37 general practices were recruited. 33 745 patients were potentially eligible, and 11 022 of these were randomly sampled for study inclusion. 1471 were excluded after general practitioner screening, 9551 were invited to participate, and 1950 provided consent and were randomly assigned (944 patients from 18 practices assigned to usual care and 1006 patients from 19 practices assigned to the intervention). 1727 participants were enrolled in the trial (836 in the usual care group and 891 in the intervention group). Participants’ median age was 73 years (IQR 66−79), 881 (51%) were male and 846 (49%) were female, and they had a median of four long-term conditions and a median of eight medications. There was no evidence of a difference in the primary outcome of number of potentially inappropriate prescribing indi
背景：多种用药是对患者安全和健康结果的一个重大且日益严峻的挑战，并与资源的低效利用有关。管理需要平衡治疗益处和风险，与临床和患者优先事项保持一致。目前支持多药管理指南的高质量证据很少。改善初级保健中使用多种药物的患者的药物使用（IMPPP）研究的目的是检查复杂干预是否可以减少初级保健中使用多种药物的患者潜在的不适当处方。方法：在英国提供国家卫生服务初级医疗保健的全科实践中进行了一项实用的、开放标签的、双臂的、平行的集群随机试验。诊所被要求使用EMIS电子健康记录系统，并有超过4000名注册患者。为了纳入研究，参与者被要求年满18岁或以上，开具至少五种常规药物（即，临床系统中记录为重复处方的药物，因此患者无需见临床医生即可反复订购），而不考虑药物最后一次开具的时间，并且至少有一个由信息学工具确定的潜在不适当处方指标。实践随机分配，提供综合干预或继续常规护理。复杂的干预包括一个结构化的、协作的、以患者为中心的药物审查方法，由信息学、临床医生培训、绩效反馈和财政激励支持。在每个实践中，接受五种或更多常规药物治疗的成年人，至少有一个潜在的不当处方指标，在6个月的时间内进行审查。主要结果是26周随访时潜在不适当处方的指标数量，以意向治疗为基础进行分析。该试验已在ISRCTN注册中心注册（90146150），并且已经完成。研究结果：在2022年1月26日至2022年6月20日期间，招募了37名全科医生。33 745名患者可能符合条件，其中11 022名患者被随机抽样纳入研究。1471名全科医生筛查后被排除，9551名被邀请参加，1950名提供同意并随机分配（来自18个诊所的944名患者分配到常规护理组，来自19个诊所的1006名患者分配到干预组）。1727名参与者参加了试验（836名在常规护理组，891名在干预组）。参与者的中位年龄为73岁（IQR 66-79），男性881人（51%），女性846人（49%），他们有中位4种长期疾病和中位8种药物。在调整随机化前基线后的26周随访中，干预组和对照组之间潜在不适当的处方指标数量的主要结局没有证据差异（每组平均2.3；平均差异为- 0.007 [95% CI - 0.21至0.20];p= 0.95）。干预组有13人死亡，99人有一次或多次计划外入院，对照组有12人死亡，91人有一次或多次计划外入院。入院或死亡都不被认为与干预有关。解释：复杂的药物优化干预并没有减少多药患者潜在的不适当处方。这些发现与当前推动数字医疗保健解决方案的政策、对临床药学人员的投资以及促进结构化药物审查的政策不一致。应相应地重新审视有效利用这种战略的问题。资助：国家卫生和保健研究所。
{"title":"Optimising polypharmacy management in primary care through general practitioner−pharmacist collaboration, informatics, and enhancing clinician engagement: the IMPPP cluster-randomised trial","authors":"Prof Rupert A Payne PhD , Prof Peter S Blair PhD , Barbara Caddick PhD , Prof Carolyn A Chew-Graham MD , Prof Tobias Dreischulte PhD , Lorna J Duncan PhD , Prof Bruce Guthrie PhD , Cindy Mann PhD , Roxanne M Parslow PhD , Prof Jeff Round PhD , Prof Chris Salisbury MD , Prof Katrina M Turner PhD , Nicholas L Turner PhD , Deborah McCahon PhD","doi":"10.1016/j.lanhl.2025.100774","DOIUrl":"10.1016/j.lanhl.2025.100774","url":null,"abstract":"<div><h3>Background</h3><div>Polypharmacy is a major and growing challenge for patient safety and health outcomes, and associated with inefficient use of resources. Management requires balancing therapeutic benefits and risks, aligned with clinical and patient priorities. High-quality evidence supporting current guidance for the management of polypharmacy is scarce. The aim of the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) study was to examine whether a complex intervention could reduce potentially inappropriate prescribing among patients experiencing polypharmacy in primary care.</div></div><div><h3>Methods</h3><div>A pragmatic, open-label, two-arm, parallel cluster-randomised trial was conducted in UK general practices providing National Health Service primary medical care. Practices were required to use the EMIS electronic health records system and have more than 4000 registered patients. For inclusion in the study, participants were required to be aged 18 years or older, prescribed at least five regular medications (ie, medicines recorded in the clinical system as repeat prescriptions, and thus available for recurrent ordering by patients without having to see a clinician) irrespective of when the drug was last issued, and with at least one indicator of potentially inappropriate prescribing identified by an informatics tool. Practices were randomly allocated to deliver the polypharmacy intervention or continue usual care. The complex intervention comprised a structured, collaborative, and patient-centred approach to medication review, supported by informatics, clinician training, performance feedback, and financial incentivisation. In each practice, adults receiving five or more regular medications, with at least one indicator of potentially inappropriate prescribing, were reviewed over a 6-month period. The primary outcome was number of indicators of potentially inappropriate prescribing at 26 weeks’ follow-up, analysed on an intention-to-treat basis. The trial was registered with the ISRCTN registry (90146150) and is complete.</div></div><div><h3>Findings</h3><div>Between Jan 26, 2022, and June 20, 2022, 37 general practices were recruited. 33 745 patients were potentially eligible, and 11 022 of these were randomly sampled for study inclusion. 1471 were excluded after general practitioner screening, 9551 were invited to participate, and 1950 provided consent and were randomly assigned (944 patients from 18 practices assigned to usual care and 1006 patients from 19 practices assigned to the intervention). 1727 participants were enrolled in the trial (836 in the usual care group and 891 in the intervention group). Participants’ median age was 73 years (IQR 66−79), 881 (51%) were male and 846 (49%) were female, and they had a median of four long-term conditions and a median of eight medications. There was no evidence of a difference in the primary outcome of number of potentially inappropriate prescribing indi","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 10","pages":"Article 100774"},"PeriodicalIF":14.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.lanhl.2025.100777
Harriet Demnitz-King PhD , Mariam Adeleke PhD , Prof Julie A Barber PhD , Michaela Poppe PhD , Jessica Budgett MSc , Sweedal Alberts MRes , Larisa Duffy BSc , Prof Anne-Marie Minihane PhD , Rachel Gillings MSc , Hannah Chapman MSc , Rosario Isabel Espinoza Jeraldo MSc , Oliver Kelsey MSc , Malvika Muralidhar MSc , Sedigheh Zabihi MSc , Elisa Aguirre PhD , Nicholas Bass MD , Anna Betz BA , Henry Brodaty MD , Alexandra Burton PhD , Prof Paul Higgs PhD , Prof Claudia Cooper PhD
<div><h3>Background</h3><div>Trials of high-intensity, multidomain interventions show that modifying lifestyle and psychological risk factors can slow cognitive decline. We aimed to evaluate the effectiveness of a lower-intensity, personally-tailored dementia prevention programme in improving cognition in adults with subjective cognitive decline or mild cognitive impairment.</div></div><div><h3>Methods</h3><div>We conducted a single-masked, multisite, randomised controlled clinical trial recruiting older adults with subjective cognitive decline or mild cognitive impairment across 11 sites in England. Participants were randomly assigned (1:1) to the 12-month Active Prevention in People at Risk of Dementia through Lifestyle, Behaviour Change and Technology to build Resilience (APPLE-Tree) intervention or to the control condition (usual care plus brief written information about dementia prevention). Randomisation was blocked and stratified by site, with allocations assigned via a remote web-based system. The intervention promoted healthy lifestyles, social connections, enjoyable activities, and self-management of long-term conditions. It comprised ten 1-h group video-call sessions over 6 months, supplemented with alternating, informal, 40-min video-call sessions (termed tea breaks) and individual goal-setting calls between sessions. From months 6 to 12, participants continued with monthly online tea breaks. The primary outcome was cognition (Neuropsychological Test Battery [NTB] score) at 24 months, analysed using an intention-to-treat approach. This trial was pre-registered with the ISRCTN Registry (ISRCTN17325135); further analyses are ongoing.</div></div><div><h3>Findings</h3><div>Between Oct 5, 2020, and Dec 31, 2022, we screened 1287 individuals for eligibility and randomly assigned 746 to the APPLE-Tree intervention (n=374) or control treatment (n=372). There were 177 (47%) women and 194 (52%) men in the intervention group and 173 (47%) women and 198 (53%) men in the control group. The primary outcome analysis included 635 (85%) of 746 participants. Mean NTB scores increased in both groups over time, with greater improvement in the intervention group than in the control group (mean 24-month NTB 0·33 [SD 0·67] <em>vs</em> 0·21 [0·75]; adjusted mean difference 0·06 [95% CI –0·001 to 0·128]; p=0·055). Serious adverse events occurred in 35 (9%) participants in the intervention group and 30 (8%) participants in the control group; none were intervention-related.</div></div><div><h3>Interpretation</h3><div>APPLE-Tree is an accessible intervention associated with small improvements in cognition, although these results were not statistically significant. Low-intensity interventions that can be delivered remotely by non-clinical facilitators have the potential for wide-scale implementation to support adults with memory concerns. However, further work is needed to optimise the intervention for delivery in routine settings.</div></div><div><h3>Funding</h3
背景：高强度、多领域干预的试验表明，改变生活方式和心理风险因素可以减缓认知能力下降。我们的目的是评估低强度、个性化的痴呆预防方案在改善主观认知能力下降或轻度认知障碍的成人认知方面的有效性。方法：我们在英国的11个地点进行了一项单蒙面、多地点、随机对照临床试验，招募有主观认知能力下降或轻度认知障碍的老年人。参与者被随机（1:1）分配到12个月的通过生活方式、行为改变和技术建立恢复力的痴呆症风险人群积极预防（苹果树）干预或控制条件（常规护理加关于痴呆症预防的简短书面信息）。随机化被阻止并按地点分层，通过远程网络系统分配分配。干预措施促进了健康的生活方式、社会联系、愉快的活动和对长期状况的自我管理。它包括在6个月内进行10次1小时的小组视频通话，辅以交替进行的40分钟非正式视频通话（称为茶点休息）和会议之间的个人目标设定电话。从第6个月到第12个月，参与者继续每月在网上喝茶。主要结果是24个月时的认知（神经心理测试电池[NTB]评分），使用意向治疗方法进行分析。该试验已在ISRCTN注册中心预注册（ISRCTN17325135）；进一步的分析正在进行中。研究结果：在2020年10月5日至2022年12月31日期间，我们筛选了1287名符合条件的个体，并将746名随机分配到苹果树干预组（n=374）或对照治疗组（n=372）。干预组女性177例（47%），男性194例（52%）；对照组女性173例（47%），男性198例（53%）。主要结局分析包括746名参与者中的635名（85%）。两组平均NTB评分均随时间增加，干预组比对照组改善更大（24个月平均NTB 0.33 [SD 0.67] vs 0.21[0.75]；调整后平均差异0.06 [95% CI - 0.001 ~ 0.128]; p= 0.055）。干预组35例（9%）、对照组30例（8%）发生严重不良事件；没有一个是干预相关的。解释：APPLE-Tree是一种可获得的干预措施，与认知能力的小幅改善有关，尽管这些结果没有统计学意义。可以由非临床辅助人员远程提供的低强度干预有可能大规模实施，以支持有记忆问题的成年人。然而，需要进一步的工作来优化在常规环境中实施的干预措施。资助：经济和社会研究理事会和国家卫生和保健研究所方案赠款。
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Pub Date : 2025-10-01DOI: 10.1016/j.lanhl.2025.100788
Sandrine Sourdet , Laurent Balardy
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