Mindfulness-Based Interventions for Older Adults: A Mixed-Methods Investigation

Abstract

Background: Older adults engage in mindfulness practices and programs to support their mental health, overall wellbeing, and age-related challenges. While existing research on mindfulness-based interventions (MBIs) are promising, evidence about their effectiveness, underlying mechanisms, and nuances about for whom and under what circumstances MBIs are more likely to work are limited.

Aims: This PhD thesis provides a multidimensional examination of mindfulness in later life by exploring i) how older adults practice and perceive mindfulness in everyday life (Chapter 2), ii) the potential mechanisms and context-mechanism-outcome configurations that shape the effectiveness of MBIs (Chapter 3), and iii) the overall effectiveness of MBIs in older adults (Chapter 4).

Methods: Three interrelated studies were conducted through a critical realist lens. First, a qualitative thematic analysis using in-depth interviews with older adults explored everyday mindfulness practices in everyday life. Second, a realist synthesis consisting of a systematic review and qualitative interviews with MBI instructors and older participants identified key CMO configurations. Third, a systematic review and multi-level meta-analysis of randomized controlled trials assessed the effects of MBIs on depression, anxiety, cognition, sleep, and pain in adults aged 60 and older.

Results: Study one (Chapter 2) identified six core themes that collectively suggest that participants understand their mindfulness practice as a continuously evolving process that can be adapted in response to their needs, preferences and personal routines, and that mindfulness can provide benefits at individual, interpersonal, and societal levels. Study two (Chapter 3) identified six contexts, eight mechanisms, and six outcome groups, highlighting that certain mechanisms may work synergistically and be more important for certain older adults than others. Study 3 (Chapter 4) showed medium to large pooled effect sizes on depression and anxiety, and small effects on cognition and sleep. However, results were greatly limited by small sample sizes, large confidence intervals, and overall low-quality GRADE evidence ratings, highlighting the need for larger studies and better reporting practices.

Discussion: Overall, the studies collectively showcase the potential of MBIs to address a range of challenges in later life when participant needs and preferences are matched with appropriate program delivery. The success of MBIs appears not only to rely on its content, but also the relational and processual aspects like instructor facilitation style and group dynamics and support. Larger, more robust, and better reported realist-informed studies are needed to examine how participant characteristics and contexts can be accounted for in MBI delivery to better leverage the key mechanisms that lead to improved outcomes. More research is also needed to clarify the mechanisms through which MBIs work, and how older adults can be supported to continuously practice mindfulness after MBI completion. These future efforts require interdisciplinary and mixed-methods research that can be supported by critical realism as a meta-theoretical framework. These insights will have important policy and practice implications to enable local, provincial/territorial, and national level governments in Canada to better support healthy aging.