In a recent article published in BMC Public Health, researchers described the protocol of the MEDITAGING study conducted among old Portuguese-speaking migrants in Luxembourg.
This double-blinded, monocentric, randomized controlled trial quantitatively and qualitatively evaluated the effects of mindfulness-based stress reduction (MBSR) vis-à-vis a health promotion program (HPP) developed based on the literature in the field.
Study: The MEDITAGING study: protocol of a two-armed randomized controlled study to compare the effects of the mindfulness-based stress reduction program against a health promotion program in older migrants in Luxembourg. Image Credit: Jorm Sangsorn/Shutterstock.com
Background
Luxembourg has a large inflow of first-generation immigrants (born in the 1960s/70s) from Portugal, who are now in advanced ages. Per the 2020 census, they make up 47% of the population in the country, of which >4% are Portuguese migrants aged ≥65 years.
These senior immigrants face language barriers, have fewer socioeconomic resources, and have poor emotional and social support. Thus, they are at high risk of adverse cognitive and health outcomes, which may increase the need for care for this population.
In the past, studies done on low-income African-American older adults have established the feasibility of a mindfulness-based program, such as MBSR.
MBRS interventions address both attention training and stress relief; thus, it is a promising tool to counteract age-related structural and functional loss underlying the reduction of attention, a cognitive skill, which, in addition to stress, may exacerbate cognition and physical decline, especially in vulnerable older people.
About the study
Thus, in the present study, researchers pursued evidence of the effects of mindfulness interventions in older populations of Portuguese-speaking immigrants in Luxembourg.
During the study recruitment, they invited them to participate via multiple institutions, e.g., recreation clubs, Portuguese Associations, and mass media channels operating in Luxembourg.
All study participants were ≥55 years old with no psychiatric /neurological disorders or illness. They scored ≥22 on the Mini-Mental State Examination (MMSE) and were literate, which was necessary to carry out the activities proposed in this study.
The team needed 90 participants in this study, 45 in each arm considering intergroup interaction, with 80% power and 5% type I error probability.
They chose this group because they are the largest (over one-third) and most susceptible group of immigrants in Luxembourg who could benefit the most from study interventions targeting the preservation of cognitive functioning.
Moreover, their inability to speak English negatively influenced their social relationships, feelings of belonging, and well-being after migration to Luxembourg.
The site where researchers conducted study group sessions was the premise of a company (Zitha) that provides geriatric care in Luxembourg.
During the index meeting with the participants, researchers made baseline assessments; for instance, they enquired about their sociodemographic and health via questionnaires, cognitive tests, and qualitative interviews.
Specifically, they assessed executive functioning, cognitive ability, sleep quality, perceived stress, depression, anxiety, and mindfulness traits.
Additionally, the researchers explored potential moderating factors, anticipating that the MBSR group would show improved cognitive tasks and stress relief than the HPP group.
At the culmination of the baseline session, the team randomly assigned all participants to one of the two study groups (MBSR or HPP). Later, they made two assessments, one after the final session and another after a three-month interval.
All the study sessions were delivered weekly in face-to-face sessions of two and a half hours each in groups of nine people.
A psychologist qualified to apply for the MBSR program by the UC San Diego Center for Mindfulness oversaw all sessions and asked all participants to practice for ~40 minutes at home daily. Participants also received a printed manual outlining program content and activities.
In these sessions, they trained participants to be mindful, i.e., live in the present and be attentive, to respond consciously to their circumstances while acknowledging all experiences, including negative ones.
The MEDITAGING program also encompassed a four-hour silent retreat to address meditation skills and allow for introspection.
The HPP covered a psychoeducation program aiming to positively impact lifestyle and well-being by addressing risk factors for dementia, unhealthy behaviors, cognitive stimulation, etc.
Post-administration of intervention, researchers evaluated the need for adjustments and any difficulties encountered during the program and analyzed the adherence and dropout rates.
Other notable aspects of the study protocol were that they provided training to assessors to ensure participant safety and assessment quality.
They used Positive and Negative Affect Schedule (PANAS), Visual Analog Scale (VAS), and post-intervention interviews to assess adverse effects.
Further, the researchers periodically reviewed risks and updated protocol changes. They pseudonymized data, thus, used codes to replace names to ensure anonymity, stored data in a database, never transferred personally identifiable data to the laboratory, and checked its quality.
Further, the team conducted statistical analyses on the modified intention-to-treat (ITT) population using mixed-effect regression models and a significance threshold of <5%.
They computed effect sizes for each cognitive score and ran separate models to analyze demographic factors and other variables.
It is worth mentioning that authors shared the findings and aggregated data of the MEDITAGING project via scientific journals and conferences, from where public talks and mass media (e.g., newspapers, Twitter) could further disseminate these in the larger community.
Conclusion
Researchers used an innovative control condition in this study, unlike passive conditions used in earlier studies. So, the researchers postulated that both the MBSR and the HPP groups benefitted from the interventions.
Nonetheless, due to the nature of the intervention condition, they assumed that the MBSR group would present more gains in executive functioning and stress relief.
The use of these surrogate measures, such as cortisol and HRV measures, very well complemented the neuropsychological assessment, which reinstate the efficacy of the MBSR interventions.
Overall, this study underscores the importance of initiatives like MEDITAGING that use non-pharmacological interventions to promote healthy aging, especially in more vulnerable populations, such as immigrants.
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