Psychosocial-Behavioral Interventions

An intervention involves actions that alter, or are intended to alter, relationships between observable phenomena. Prototypical characteristics of intervention studies include a clearly defined starting and ending point, a detailed manual describing the intervention protocol, one or more postintervention outcome measures, and a baseline measure or comparison group against which individuals exposed to the intervention can be compared. Intervention studies typically occur in real world settings, as opposed to the laboratory, and if well designed, yield strong causal conclusions about the relationships between the intervention and the observed outcomes.

Intervention studies with older adults have been commonplace for at least three decades, but there has been an explosion of intervention research since the early 1990s and the pace of research continues to accelerate. This growth was in part stimulated by the vast quantities of descriptive and observational data collected in prior decades and the desire to effectively address the needs of older adults in American society. The majority of psychosocial and behavioral interventions targeted at older adults aim to maintain or enhance physical health, mental health, or cognitive functioning. Such interventions are commonly an outgrowth of research which has identified factors that have a significant impact on older adults and that seem to be amenable to change. Psychosocial and behavioral interventions are increasingly used as an alternative or supplement to surgical or pharmacological approaches due to their general efficacy and relative cost effectiveness (Schulz, Lawton, and Maddox).

Physical health and functioning is the most common target goal of interventions for older adults, as illustrated by interventions to reduce falls, increase muscle strength necessary for independent functioning, enhance urinary continence, lower blood pressure, detect prostrate cancer, lower cholesterol levels, increase bone mineral density, enhance self-care behaviors (e.g., medication compliance, exercise) and decrease the frequency of unhealthy behaviors (e.g., smoking, alcohol use). Mental health interventions for older adults are often aimed at reducing anxiety and depressive symptomatology, enhancing sleep quality, and increasing feelings of global or domain-specific satisfaction and perceived control. Some psychosocial interventions are directed at improving quality of life in individuals suffering from psychiatric illness whereas other interventions are directed at individuals who are at risk for psychiatric illness due to common late-life stressors such as chronic illness, spousal caregiving, and bereavement. Other common goals of psychosocial interventions are enhanced relationship quality, increased recreational or leisure activity, and improved cognitive functioning. Although most intervention studies are primarily focused on physical health, mental health, or cognitive functioning, improvements obtained in any one of these domains are likely to carry over to the other domains.

Common intervention approaches include cognitive or behavioral training; physical activity training; peer support for dealing with specific stressors; education; and counseling or psychotherapy that is provided in an individual or group setting. Educational interventions are perhaps the most general approach, in that individuals can be educated in regard to a multitude of issues, such as how to manage medications, how to cope with grief, and how to modify their home to make it more accessible. Other approaches include preventive health screening, special packaging of medications, pet therapy, music therapy, light therapy, intergenerational programs, adult day care, and cognitive training. It is becoming more common to target older adults both directly and indirectly through changes in their environment or to target multiple entities within a single intervention (e.g., the older adult, informal or formal caregivers, and the physician) (Council on Scientific Affairs, American Medical Association). Important synergies are likely to be achieved by such simultaneous targeting of multiple individuals with intervention strategies that focus both on the pragmatic and psychological aspects of a given health-related problem.

A critical aspect of psychosocial interventions is the evaluation of these approaches for their ability to effect change in targeted outcomes. Interventions that have demonstrated efficacy include educational interventions for the management of chronic illness, behavioral interventions for incontinence, relaxation training for insomnia, and physical activity interventions for reduction of falls and bone fractures.