Implementation and effectiveness of a multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres

Abstract

To address the paucity of research investigating the implementation of multi-domain dementia prevention interventions, we implemented and evaluated a 24-week, bi-weekly multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres (SCs). It comprised dual-task exercises, cognitive training, and mobile application-based nutritional guidance. An RCT design informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework was adopted. Outcome measures include cognition, quality of life, blood parameters, and physical performance. Implementation was evaluated through questionnaires administered to participants, implementers, SC managers, attendance lists, and observations. The program reached almost 50% of eligible participants, had an attrition rate of 22%, and was adopted by 8.7% of the SCs approached. It was implemented as intended; only the nutritional component was re-designed due to participants’ unfamiliarity with the mobile application. While there were no between-group differences in cognition, quality of life, and blood parameters, quality of life reduced in the control group and physical function improved in the intervention group after 24 weeks. The program was well-received by participants and SCs. Our findings show that a multi-domain program for at-risk older adults has benefits and can be implemented through neighborhood SCs. Areas of improvement are discussed.Trial registration: ClinicalTrials.gov NCT04440969 retrospectively registered on 22 June 2020.

Cognitive Training with Older Adults Using Smartphone and Web-Based Applications: A Scoping Review

“…They only mentioned that they were old adults or adults. Considering the stage of dementia, 3 studies did not include any dementia or impairment ( 37 – 39 ), and one study did not mention any information regarding the state of mental and cognitive health ( 36 ), and 2 other studies analyzed subjects at risk of dementia ( 40 , 41 ). The remaining 28 studies included subjects with mild to moderate impairment or even with a diagnosis of Alzheimer’s disease.…”

“…The duration of the interventions was quite varied, with a range of 20 ( 42 ) to 600 ( 37 , 38 ) minutes per week of practice in the technologies, with a range of 10 ( 36 , 40 ) to 240 minutes per session. Also, the frequency varied between 2 ( 18 , 41 , 43 – 53 ) to every day ( 36 ) (of all the studies that explicitly mentioned the frequency) and lasted from just one week with 10 intensive hours ( 37 , 38 ) to 12 months ( 54 ).…”

“…The wide variation in intervention protocols, such as the type, duration, intensity, and frequency of cognitive training, may lead to inconsistent findings and limit the ability to compare and generalize the results. For instance, while the overall studies implemented an average of two sessions per week ( 18 , 45 , 47 , 51 , 59 , 60 ), one study implemented cognitive training sessions on all days of week ( 61 ). Also, the duration of cognitive training was widely widespread, from a minimum of 20 minutes to a maximum of 600 minutes per week ( 37 , 38 , 42 ).…”

Effects of multidomain lifestyle interventions on cognitive decline and Alzheimer's disease prevention: A literature review and future recommendations

“…Whilst some multidomain lifestyle interventions are free and easy to implement, other are less so, particularly for older adults with cognitive impairment or mobility issues, and longer term implementation feasibility research is lacking [23] . Besides this, cognitive decline or AD may be a long-term condition due to slow mental decline, and the long-term sustainability of multidomain lifestyle interventions has not been well studied.…”

Broadening the reach of dementia risk-reduction initiatives: strategies from dissemination models

“…Dissemination agents may be able to play a role in broadening the reach of dementia risk-reduction initiatives. For example, a recent Singaporean initiative was delivered through dissemination organisations (seniors' centres) in public housing complexes and effectively reached people with primary or lower education levels [38]. Advocacy organisations such as the Alzheimer's Association and Dementia Australia may also act as dissemination agents, producing and promoting dementia risk-reduction initiatives.…”