Tailoring multidomain intervention programs to reduce cognitive and physical decline in older adults: Examining rural-urban differences in a nationwide cluster-randomized controlled trial

Min-Yin Ho; Wei-Ju Lee; Ko-Han Yen; Chih-Kuang Liang; Li-Ning Peng; Ming-Hsien Lin; Ching-Hui Loh; Fei-Yuan Hsiao; Liang-Kung Chen

doi:10.1016/j.tjpad.2025.100231

Tailoring multidomain intervention programs to reduce cognitive and physical decline in older adults: Examining rural-urban differences in a nationwide cluster-randomized controlled trial

J Prev Alzheimers Dis. 2025 Jun 12:100231. doi: 10.1016/j.tjpad.2025.100231. Online ahead of print.

Authors

Min-Yin Ho¹, Wei-Ju Lee², Ko-Han Yen³, Chih-Kuang Liang⁴, Li-Ning Peng³, Ming-Hsien Lin⁵, Ching-Hui Loh⁶, Fei-Yuan Hsiao⁷, Liang-Kung Chen⁸

Affiliations

¹ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Child Welfare League Foundation, Taipei City, Taiwan.
² Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan County, Taiwan,. Electronic address: leewju@gmail.com.
³ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,. Electronic address: ck.vghks@gmail.com.
⁵ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁶ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Center of Health and Aging, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien County, Taiwan.
⁷ Center of Health and Aging, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien County, Taiwan,; Graduate Institute of Clinical Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan.
⁸ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan,; Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.

PMID: 40514302
DOI: 10.1016/j.tjpad.2025.100231

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.

Keywords: Cognitive impairment; Frailty; Multidomain intervention; Rural-urban disparity.

Associated data

ClinicalTrials.gov/NCT03056768