Dosage and Efficacy in Behavioral Interventions With Community Dwelling Older Adults: Lifestyle Redesign Revisited

Objectives: Behavioral interventions with community dwelling older adults often utilize multiple modes of treatment, which contributes to variation in participation and high rates of nonadherence. The objective of this report was to assess the treatment efficacy of one such study. Methods: We conducted an as-treated analysis of the Well Elderly II trial, where 322 individuals underwent 6 months of individual and group treatment and participated in community outings. We utilized inferential and graphical methods to assess the relationship between treatment received and depression change. Results: Individual treatment and community outings had similar small indirect effects on depressive symptoms, but a selection effect was present for individual treatment, where individuals with high baseline depression scores were the most likely to participate. Discussion: The results provide nuance that is unavailable using intent-to-treat. Future research should expand on our methods for as-treated analyses after intent-to-treat has shown aggregate improvements.