Background: Cognitive frailty (CF) is identified as one of the main precursors of dementia. Multidomain intervention has been found to delay or prevent the onset of CF. Objective: The aim of our present study is to determine the effectiveness of a comprehensive, multidomain intervention on CF; to evaluate its cost effectiveness and the factors influencing adherence toward this intensive intervention. Methods: A total of 1,000 community dwelling older adults, aged 60 years and above will be screened for CF. This randomized controlled trial involves recruitment of 327 older adults with CF from urban, semi-urban, and rural areas in Malaysia. Multidomain intervention comprised of physical, nutritional, cognitive, and psychosocial aspects will be provided to participants in the experimental group (n = 164). The control group (n = 164) will continue their usual care with their physician. Primary outcomes include CF status, physical function, psychosocial and nutritional status as well as cognitive performance. Vascular health and gut microbiome will be assessed using blood and stool samples. A 24-month intensive intervention will be prescribed to the participants and its sustainability will be assessed for the following 12 months. The effective intervention strategies will be integrated as a personalized telerehabilitation package for the reversal of CF for future use. Results: The multidomain intervention developed from this trial is expected to be cost effective compared to usual care as well as able to reverse CF. Conclusion: This project will be part of the World-Wide FINGERS (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) Network, of which common identifiable data will be shared and harmonized among the consortia.

Older adults are vulnerable towards cognitive frailty that can lead to adverse health outcomes and telerehabilitation appears to be a potential platform to reverse cognitive frailty among older adults. The aim of this coping review is to identify the usage of telerehabilitation and its common platform of delivery among older adults with mild cognitive impairment (MCI) or cognitive frailty (CF). Articles published from January 2015 until October 2020 were selected. Out of the 1738 articles retrieved, six studies were identified. Two articles were randomized controlled trials, one was a pilot study and three were qualitative studies. The outcome suggests that telerehabilitation may improve the quality of life among participants as well as it can be a useful and supportive digital platform for health care. Some types of technologies commonly used were smartphones or telephones with internet, television-based assistive integrated technology, mobile application and videoconference. Telerehabilitation utilization in managing cognitive frailty among older adults is still limited and more research is required to evaluate its feasibility and acceptability. Although telerehabilitation appears to be implemented among older adults with MCI and CF, some social support is still required to improve the adherence and effectiveness of telerehabilitation. Future research should focus on the evaluation of acceptance and participants’ existing knowledge towards telerehabilitation to achieve its target.

BACKGROUND Older adults are vulnerable towards cognitive frailty that can lead to adverse health outcomes such as cognitive frailty, falls, disabilities, hospitalizations and increased morbidity. With advancement of healthcare technology, there is a potential to manage and reverse cognitive frailty among older adults using a multi-domain intervention programme via telerehabilitation. OBJECTIVE In this review, we aimed to identify the feasibility and acceptance towards telerehabilitation and the common technology used for delivering telerehabilitation among older adults with mild cognitive impairment or cognitive frailty. METHODS Five research databases were searched: PubMed (EMBASE), Embase (Science Direct), Cochrane Database of Systematic Review, IEEE Xplore and Scopus. Articles published from January 2015 until October 2020 were selected. A hand search of JMIR Publications journals was also included RESULTS Of the 1758 articles retrieved, six studies were identified that involved implementation of telerehabilitation targeting older adults with cognitive frailty. Two articles were randomized controlled trials, one pilot study and three were qualitative studies. Telerehabilitation can improve quality of life among participants with mild cognitive impairment and cognitive frailty and found to be feasible as supportive digital platform in digital health care. Some types of technologies commonly used in the studies were smartphone or telephone with Internet, television-based assistive integrated technology, mobile application and videoconference. CONCLUSIONS Telerehabilitation utilization in managing cognitive frailty among older adults is still limited and more research is required to evaluate its feasibility and acceptability. Although telerehabilitation appears to be feasible and accepted among older adults with cognitive frailty, some social support in place is required. Future research should focus on evaluation of acceptance and cost effectiveness of multi-domain intervention via telerehabilitation among older adults with cognitive frailty.

Background:Telehealth is an alternative platform in managing and delivering health care services to clients using information and communication technologies (ICT).Usage of digital technology among older adults is influenced by many internal and external factors. However, information related to the readiness of tehnology use in developing multi-domain telehealth among community-dwelling older adults was still lacking.Method: This study was part of the screening phase of an ongoing Ageless trial for developing multi-domain telehealth intervention for CF older adults. This study included community dwelling older adults aged 60 years and above with cognitive frailty assessed using Fried's criteria. A questionnaire related to digital technology usage was administered to evaluate the need assessement of ICT literacy. Sampling method was purposive sampling. Data was analysed descriptively and using the Chi Square test.Result: At this preliminary stage, 170 older adults (68.5 year old ± 5.7) living in Kuala Lumpur city participated. Majority of the participants were females (60.6%), from Malay ethnic group (71.2%), married (60.6%), attained upper secondary education level (29.7%) and retired. About one-third of participants were precognitively-frail (30.4%) and prefrail (32.8%) and were able to access internet (26.7%) at their homes using smartphones (34.1%), followed by computers or laptops (3.0%) and tablets (2.7%).Older adults with CF used less digital technology and reduced playing games on their phone (4.4%). Therefore, the framework of multi-domain telehealth intervention designed for older adults must include senior-friendly specifications for motivating its use among them. Proper training and guidance may boost confidence of older people to use the telehealth. Components in multi-domain telehealth have to provide more educational talks, assistance during session and design more friendly-user. Conclusion:Our preliminary results suggest that older adults with cognitive frailty utilised less digital technology and preferred senior-friendly and less complex digital technology. Promotion and expansion of the use digital technology among older adults with CF especially in rural area must be emphasized. Framework of multi-domain tele-