title: The effects of a life goal-setting technique in a preventive care program for frail community-dwelling older people: a cluster nonrandomized controlled trial.
abstract: Frailty among older people is associated with an increased risk of needing care. There have been many reports on preventive care programs for frail older people, but few have shown positive effects on disability prevention. Physical exercise programs for frail older people affect elements such as physical fitness and balance, but are less effective for disability outcomes and are not followed up in the longer term. We developed a life goal-setting technique (LGST). Our objective was to determine the effect of a LGST plus standard preventive care program for community-dwelling frail older people.
  
  
  
  We used a cluster nonrandomized controlled trial with seven intervention and nine matched control groups, with baseline assessment and follow-up at 3, 6, and 9 months. Participants were 176 frail older people, aged 65 years or over, living in the community in Izumi, Osaka, Japan. All participants attended regular 120 min preventive care exercise classes each week, over 3 months. They also received oral care and nutrition education. The intervention groups alone received life goal-setting support. We assessed outcomes longitudinally, comparing pre-intervention with follow-up. The primary outcome measure was health improvement according to the Japanese Ministry of Health, Labour and Welfare's "Kihon Checklist" for assessment of frailty and quality of life (QOL), analyzed with a two-way ANOVA and post-test comparison. Secondary outcomes included physical functions and assessment of life goals.
  
  
  
  The improvement on the Kihon Checklist for the intervention group was approximately 60 % from baseline to 9-months follow-up; the control group improved by approximately 40 %. The difference between groups was significant at 3-month (p = 0.043) and 6-month (p = 0.015) follow-ups but not at 9-month (p = 0.098) follow-up. Analysis of QOL yielded a significant time × group interaction effect (p = 0.022). The effect was significant at 3 months in the intervention group, but at no time in the control group.
  
  
  
  A 3-month exercise program helped to decrease frailty and improve QOL in frail older people, and the addition of LGST increased its effectiveness. The LGST is a feasible and promising intervention for reducing risk of needing care.
  
  
  
  UMIN000021485 . Registered 15 March 2016.
authors.affiliation: Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Osaka, Japan. yuri@tamateyama.ac.jpAQ3.|Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan. yuri@tamateyama.ac.jpAQ3.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Yuri
authors.affiliation: Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takabatake
authors.affiliation: Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nishikawa
authors.affiliation: Elderly Care Office, Izumi, Osaka, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Oka
authors.affiliation: Izumi Rehabilitation Home-Visit Nursing Care Station, Osaka, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Fujiwara
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006040:Goals; D006801:Humans; D057187:Independent Living / Q000523:psychology / Q000592:standards; D007564:Japan / Q000453:epidemiology; D008297:Male; D010809:Physical Fitness / Q000502:physiology / Q000523:psychology; D026741:Physical Therapy Modalities / Q000458:organization & administration / Q000523:psychology; D011314:Preventive Health Services / Q000379:methods / Q000592:standards; D015397:Program Evaluation; D058996:Quality Improvement; D011788:Quality of Life; D040242:Risk Reduction Behavior; D012946:Social Welfare
keywords: Cluster nonrandomized controlled trial; Frail older people; Goal-setting; Living in the community