UNCORRECTED PROOF Patient Education and Counseling xxx (2017) xxx-xxx Contents lists available at ScienceDirect Patient Education and Counseling journal homepage: www.elsevier.com Review article What are the contents of patient engagement interventions for older adults? A systematic review of randomized controlled trials Julia Menichetti a, ⁎ , Guendalina Graffigna a , Aslak Steinsbekk b a Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy b Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ARTICLE INFO Article history: Received 11 July 2017 Received in revised form 7 November 2017 Accepted 9 December 2017 Available online xxx Keywords: Systematic review Older adults Patient engagement Patient activation Intervention classification ABSTRACT Objective To describe the contents of interventions reported in RCTs focusing on patient engagement of older adults. Methods A systematic literature review based on a search for “patient engagement/activation/empowerment/in- volvement/participation”. Interventions were classified according to: (i) specific components (micro level), (ii) single/multiple dimensions (educational, behavioral, affective) (meso level), and (iii) the studies’ main ed- ucational, behavioral or affective dimension (macro level). Results After screening 2749 articles, 35 were included. 20 unique components were identified, mostly behavioral or educational (45.5% each) (e.g., goal setting or written informational materials). Most interventions with a single-focus were classified as educational (31%), one was solely affective (3%). Half of the interventions covered more than one dimension, with four (11%) combining all three dimensions. Studies mainly focusing on the affective dimension included older participants (72 vs. 67 years), had a higher proportion of females (71% vs. 44%), and included other dimensions more frequently (67% vs. 31%) than did studies with a main focus on the educational dimension. Conclusion The contents of the interventions that focused on patient engagement of older adults tend to focus more on behavioral and educational dimensions than the affective dimension. Practice implications The possibility of adding the affective dimension into behavioral and/or educational interventions should be explored. © 2017. 1. Introduction By the year 2025, the number of people worldwide aged 60 and over will exceed 1.2 billion [1]. This will create significant demands on healthcare services [2], along with the risks of exacerbating al- ready long wait times for visits, reducing access to care for vulner- able patients, and lowering older patients’ quality of life [3]. Mak- ing older patients participants in their own health and care manage- ment has been argued to be a key strategy [4,5]. Research has demon- strated that individuals who are engaged in their health are more likely to achieve better physical [6,7], psychological [8], relational [9], and organizational outcomes [10]. Older patients in particular ⁎ Corresponding author at: Largo Gemelli 1, 20123, Milan, Italy. Email addresses: Juliapaola.menichettidelor@unicatt.it (J. Menichetti); Guendalina.graffigna@unicatt.it (G. Graffigna); aslak.steinsbekk@ntnu.no (A. Steinsbekk) should play an active role in their care, because of the multiple self-care tasks and healthcare decisions they are asked to manage [4]. Considering individuals’ role in the care process may mean differ- ent things, including considering how patients comply and adhere to medical recommendations and treatments [11]. “The extent to which a person's behavior coincides with medical advice” (i.e., patient com- pliance) [12], or “the extent to which patients follow the instructions they are given for prescribed treatments” (i.e., patient adherence) [13], are important aspects to be considered to ensure that prescribed treat- ments are properly followed by patients. Concepts like patient participation, engagement and activation have become more common in recent years [14]. Patient participation and involvement point to the role of the patient as an active partici- pant within the clinical consultations to allow for shared medical de- cisions [15–17]. Concepts like patient empowerment and patient acti- vation focus on enabling patients to play an engaged role in their care management [16,18,19]. Patient engagement has been described as an umbrella term for all these new concepts, reflecting a multi-dimen- sional psychosocial process wherein the patients play an active role https://doi.org/10.1016/j.pec.2017.12.009 0738-3991/© 2017.