Holistic care in healthy aging: Caring for the wholly and holy human

Health care should address the holistic gap between health outcomes, spirituality, religion, and humanistic care to optimize patient care. Treating the whole person encompasses both physical and metaphysical elements. Patients want health care professionals to recognize their spiritual and religious preferences, because these matter in their approach to illness, coping, and long-term outcomes.

Multimorbidity, Social Engagement, and Age-Related Cognitive Decline in Older Adults from the Rancho Bernardo Study of Healthy Aging

Background

Multimorbidity is associated with increased rate of cognitive decline with age. It is unknown whether social engagement, which is associated with reduced risk of dementia, modifies associations between multimorbidity and cognitive decline.

Objective

To examine the associations of multimorbidity with longitudinal cognitive test performance among community-dwelling older adults, and to determine whether associations differed by levels of social engagement.

Methods

We used data from the Rancho Bernardo Study of Healthy Aging, a community-based prospective cohort study. Starting in 1992-1996, participants completed a battery of cognitive function tests at up to 6 study visits over 23.7 (mean = 7.2) years. Multimorbidity was defined as≥2 of 14 chronic diseases. Social engagement was assessed using items based on the Berkman-Syme Social Network Index. Multivariable linear mixed-effects models were used to test associations of multimorbidity and cognitive performance trajectories. Effect measure modification by social engagement was evaluated.

Results

Among 1,381 participants (mean age = 74.5 years; 60.8% women; 98.8% non-Hispanic White), 37.1% had multimorbidity and 35.1% had low social engagement. Multimorbidity was associated with faster declines in Mini-Mental State Examination (MMSE; β= -0.20; 95% CI -0.35, -0.04), Trail-Making Test Part B (β= 10.02; 95% CI 5.77, 14.27), and Category Fluency (β= -0.42; 95% CI -0.72, -0.13) after adjustment for socio-demographic and health-related characteristics. Multimorbidity was associated with faster declines in MMSE among those with low compared to medium and high social engagement (p-interaction < 0.01).

Conclusions

Multimorbidity was associated with faster declines in cognition among community-dwelling older adults. Higher social engagement may mitigate multimorbidity-associated cognitive decline.

Association of psychological resilience and cognitive function in older adults: Based on the Ma' anshan Healthy Aging Cohort Study

OBJECTIVES

The purpose of this study was to explore whether psychological resilience can influence changes in cognitive function in older adults and provide clues and rationale for improving cognitive function and preventing the onset of dementia in the geriatric population.

METHODS

A total of 2495 older adults aged 60 years or older from the Ma' anshan Healthy Aging Cohort were included in the study. Participants' cognitive functioning and psychological resilience were measured using the MMSE (mini-mental state examination) scale and the SRQS (stress resilience quotient scale) scale during the 5 years of follow-up, and the association was explored. Those with MMSE scores ≤ 17 in the illiterate group, ≤ 20 in the elementary school group, and ≤ 24 in the secondary school and above group were considered cognitive impairment.

RESULTS

The prevalence of cognitive impairment increased from 6.89% to 14.30% during the five years of follow-up. At 5-year follow-up, the group with the highest psychological resilience had 41 (6.83%) individuals whose cognitive functioning changed from normal to cognitive impairment, while the group with the worst psychological resilience had 114 (18.33%) individuals. The study also found a significant effect of different levels of psychological resilience on changes in cognitive functioning after adjusting for potential confounders. Compared with Q1 (the reference group), the Odds ratio of cognitive decline in Q2, Q3 and Q4 groups were 0.51(0.42,0.64), 0.37(0.29,0.47) and 0.19(0.13,0.27), respectively.

CONCLUSIONS

Improving the level of psychological resilience in older adults may be one way to prevent the incidence of cognitive impairment.

The little intervention that could: creative aging implies healthy aging among Canadian seniors

OBJECTIVES

Through a process of 'creative ageing', there is increased interest in how active participation in the arts can help promote health and well-being among seniors. However, few studies have quantitatively examined the benefits of a foray into artistic expression, and even fewer employ rigorous identification strategies. Addressing this knowledge gap, we use a series of quantitative techniques (ordinary least squares and quantile regression) to analyze the impact of an arts-based intervention targeting the elderly.

METHODS

Recruited from Saint John, New Brunswick (a city of about 125,000 people in Eastern Canada), 130 seniors were randomly assigned to the programme, with the remaining 122 serving as the control. This intervention consisted of weekly 2-h art sessions (i.e. drawing, painting, collage, clay-work, performance, sculpting, and mixed media), taking place from January 2020 until April 2021.

RESULTS

Relative to the control group, the intervention tended to reduce participant loneliness and depression, and improve their mental health. Outcomes were more evident toward the latter part of the programme, were increasing in attendance, and most efficacious among those with initially low levels of well-being.

CONCLUSION

These findings imply that creative ageing promotes healthy ageing, which is especially noteworthy given COVID-19 likely attenuated our results.

Age-friendly initiatives: Mexico

While the implementation of these initiatives varies globally and continues to face low uptake in the global south, it is crucial to underscore key ongoing efforts, particularly in developing nations. This allows us to have knowledge about progress and identify areas that require more effective strategies to advance the cause of global healthy aging. The aim of this mini-review was to describe some of the key age-friendly initiatives made in Mexico through Governmental and Non-Governmental entities to promote healthy aging, at different levels of health and social institutions, covering the healthcare systems, community, and education.

Quantifying Healthy Aging in Older Veterans Using Computational Audio Analysis

BACKGROUND

Researchers are increasingly interested in better methods for assessing the pace of aging in older adults, including vocal analysis. The present study sought to determine whether paralinguistic vocal attributes improve estimates of the age and risk of mortality in older adults.

METHODS

To measure vocal age, we curated interviews provided by male U.S. World War II Veterans in the Library of Congress collection. We used diarization to identify speakers and measure vocal features and matched recording data to mortality information. Veterans (N = 2 447) were randomly split into testing (n = 1 467) and validation (n = 980) subsets to generate estimations of vocal age and years of life remaining. Results were replicated to examine out-of-sample utility using Korean War Veterans (N = 352).

RESULTS

World War II Veterans' average age was 86.08 at the time of recording and 91.28 at the time of death. Overall, 7.4% were prisoners of war, 43.3% were Army Veterans, and 29.3% were drafted. Vocal age estimates (mean absolute error = 3.255) were within 5 years of chronological age, 78.5% of the time. With chronological age held constant, older vocal age estimation was correlated with shorter life expectancy (aHR = 1.10; 95% confidence interval: 1.06-1.15; p < .001), even when adjusting for age at vocal assessment.

CONCLUSIONS

Computational analyses reduced estimation error by 71.94% (approximately 8 years) and produced vocal age estimates that were correlated with both age and predicted time until death when age was held constant. Paralinguistic analyses augment other assessments for individuals when oral patient histories are recorded.

Roles of Baseline Intrinsic Capacity and its Subdomains on the Overall Efficacy of Multidomain Intervention in Promoting Healthy Aging among Community-Dwelling Older Adults: Analysis from a Nationwide Cluster-Randomized Controlled Trial

BACKGROUND

Impaired intrinsic capacity (IC), which affects approximately 90% of older adults, is associated with a significantly heightened risk of frailty and cognitive decline. Existing evidence suggests that multidomain interventions have the potential to enhance cognitive performance and yield positive effects on physical frailty.

OBJECTIVE

To examine roles of baseline IC and its subdomains on the efficacy of multidomain interventions in promoting healthy aging in older adults.

DESIGN

a cluster-randomized controlled trial.

SETTING AND PARTICIPANTS

1,054 community-dwelling older adults from 40 community-based clusters across Taiwan.

INTERVENTION

A 12-month pragmatic multidomain intervention of exercise, cognitive training, nutritional counseling and chronic condition management.

MEASUREMENTS

Baseline IC was measured by 5 subdomains, including cognition (Montreal Cognitive Assessment, MoCA), sensory (visual and hearing impairment), vitality (handgrip strength or Mini-Nutritional Assessment-short form), psychological well-being (Geriatric Depression Scale-5), and locomotion (6m gait speed). Outcomes of interest were cognitive performance (MoCA scores) and physical frailty (CHS frailty score) over a follow-up period of 6 and 12 months.

RESULTS

Of all participants (mean age:75.1±6.4 years, 68.6% female), about 90% participants had IC impairment at baseline (2.0±1.2 subdomains). After covariate adjustment using a generalized linear mixed model (GLMM), the multidomain intervention significantly prevented cognitive declines and physical frailty, particularly in those with IC impairment ≥ 3 subdomains (MoCA: coefficient: 1.909, 95% CI: 0.736 ~ 3.083; CHS frailty scores: coefficient = -0.405, 95% CI: -0.715 ~ -0.095). To assess the associations between baseline poor capacity in each IC subdomain and MoCA/CHS frailty scores over follow-up, a 3-way interaction terms (time*intervention*each poorer IC subdomains) were added to GLMM models. Significant improvements in MoCA scores were shown for participants with poorer baseline cognition (coefficient= 1.138, 95% CI: 0.080 ~ 2.195) and vitality domains (coefficient= 1.651, 95% CI: 0.541 ~ 2.760). The poor vitality domain also had a significant modulating effect on the reduction of CHS frailty score after the 6- and 12-month intervention period (6 months: coefficient= -0.311, 95% CI: -0.554 ~ -0.068; 12 months: coefficient= -0.257, 95% CI: -0.513 ~ -0.001).

CONCLUSION AND IMPLICATIONS

A multidomain intervention in community-dwelling older adults improves cognitive decline and physical frailty, with its effectiveness influenced by baseline IC, highlighting the importance of personalized strategies for healthy aging.

Speech Acts as a Window to the Difficulties in Instrumental Activities of Daily Living: A Qualitative Descriptive Study in Mild Neurocognitive Disorder and Healthy Aging

Background

Executive functions (EF) are central to instrumental activities of daily living (IADL). A novel approach to the assessment of the impact of EF difficulties on IADL may be through the speech acts produced when performing IADL-inspired tasks in a laboratory-apartment. Speech acts may act as a window to the difficulties encountered during task performance.

Objective

We aim to 1) qualitatively describe the speech acts produced by participants with mild neurocognitive disorder (mild NCD) and healthy controls (HC) as they performed 4 IADL-inspired tasks in a laboratory-apartment, and to then 2) compare their use in both groups.

Methods

The participants' performance was videotaped, and speech acts produced were transcribed. Qualitative description of all speech acts was performed, followed by a deductive-inductive pattern coding of data. Statistical analyses were performed to further compare their use by mild NCD participants and HC.

Results

Twenty-two participants took part in the study (n mild NCD = 11; n HC = 11). Meta-categories of data emerged from pattern coding: strategies, barriers, reactions, and consequences. Mild NCD participants used significantly more strategies and barriers than did HC. They were more defensive of their performance, and more reactive to their difficulties than HC. Mild NCD participants' verification of having completed all tasks was less efficient than controls.

Conclusions

An assessment of speech acts produced during the performance of IADL-inspired tasks in a laboratory-apartment may allow to detect changes in the use of language which may reflect EF difficulties linked to cognitive decline.

Wearable Technologies for Healthy Ageing: Prospects, Challenges, and Ethical Considerations

Digital technologies hold promise to modernize healthcare. Such opportunity should be leveraged also to address the needs of rapidly ageing populations. Against this backdrop, this paper examines the use of wearable devices for promoting healthy ageing. Previous work has assessed the prospects of digital technologies for health promotion and disease prevention in older adults. However, to our knowledge, ours is one of the first attempts to specifically address the use of wearables for healthy ageing, and to offer ethical insights for assessing the prospects of leveraging wearable devices in this context. We provide an analysis of the considerable opportunities associated with the use of wearables for healthy ageing, with a focus on the five domains of intrinsic capacity: locomotion, sensory functions, psychological aspects, cognition, and vitality. We then highlight current limitations and ethical challenges of such approach to healthy ageing, including issues related to access, inclusion, privacy, surveillance, autonomy, and regulation. We conclude by discussing the implications of our analysis in light of current debates on the ethics of digital health, and suggest measures to address the identified challenges.

Emotional eating behaviors in later life: Identifying key factors for healthy aging

BACKGROUND

Pathological, physiological, and psychosocial factors could influence the eating behaviors of older adults in Egypt. Nurses and other healthcare professionals should understand this complex interaction to effectively address their nutritional issues. This study aimed to identify the predictors of emotional eating behaviors among older adults.

METHODS

The study followed a cross-sectional survey. A probability sampling technique was used to select the participants. Data was collected using the Emotional Eating Questionnaire and Perceived Stress Scales.

RESULTS

98 % of the respondents were identified as moderate or severe emotional eaters. The study found a significant positive correlation between perceived stress and emotional eating behaviors (r = .436; p = .000). Multivariate analysis revealed that perceived stress, age, gender, marital status, and body mass index (BMI) have a significant positive relationship with emotional eating behaviors (p < .001), accounting for 39.3 % of the variation.

CONCLUSION

Emotional eating is common among older adults and is influenced by factors such as age, gender, marital status, BMI, and perceived stress. Nurses can use these findings to develop nutritional plans to promote healthy eating habits of this population.

Healthy aging: Linking causal mechanisms with holistic outcomes

Identifying and understanding the impact of differing exposures over the lifecourse necessitates contextualizing different levels of influence ranging from genetics, epigenetics, geography, and psychosocial networks.

Dose-Responsive Impacts of Social Frailty on Intrinsic Capacity and Healthy Aging among Community-Dwelling Middle-aged and Older Adults: Stronger Roles of Social Determinants over Biomarkers

OBJECTIVE

The intricate relationship between social determinants, e.g., social frailty, biomarkers and healthy aging remains largely unexplored, despite the potential for social frailty to impact both intrinsic capacity (IC) and functional ability in the aging process.

DESIGN

Retrospective longitudinal cohort study.

SETTING AND PARTICIPANTS

Participants aged 50+ years from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan, stratified into three age groups: 50-64, 65-74 and 75+.

MEASUREMENTS

Social frailty was defined based on a score derived from four domains: exclusion from general resources, social resources, social activity, and fulfillment of basic social needs. The scores were categorized as score=0 (no social frailty), 1 (social pre-frailty), and 2+ (social frailty). Multivariable logistic regression and Cox proportional hazard models were employed to examine the dose-responsive relationship between social frailty, low IC, functional and psychological health, and mortality.

RESULTS

Of 1015 study participants, 24.9% and 7.9% were classified as social pre-frailty and social frailty, respectively. No significant differences were observed in most biomarkers between those with social frailty and those without. A dose-responsive relationship was found between social frailty and increased risk of low IC (social pre-frailty: aOR 2.20 [95% CI 1.59-3.04]; social frailty: 5.73 [3.39-9.69]). Similar results were found for functional and psychological health. However, no significant association between social frailty and all-cause mortality was found at the 4-year follow-up (social pre-frailty: aHR 1.52 [95% CI 0.94-2.43]; social frailty: 1.59 [0.81-3.09]).

CONCLUSIONS

The significant association between social frailty and low IC, functional limitations, cognitive declines, and depressive symptoms underscores the pressing need for research on intervention strategies to enhance healthy aging in the lifespan course.

Cohort profile: Beijing Healthy Aging Cohort Study (BHACS)

The Beijing Healthy Aging Cohort Study (BHACS) was established to supplement the limited data of a large representative cohort of older people based on the general population and was designed to evaluate the prevalence, incidence, and natural history of cognitive decline, functional disability, and conventional vascular risk factors. The aim was to determine the evolution of these conditions by estimating the rates and determinants of progression and regression to adverse outcomes, including dementia, cardiovascular events, cancer, and all-cause death. It can therefore provide evidence to help policy makers develop better policies to promote healthy aging in China. BHACS consisted of three cohorts (BLSA, CCHS-Beijing, and BECHCS) in Beijing with a total population of 11 235 (6281 in urban and 4954 in rural areas) and an age range of 55 years or older (55-101 years) with a mean age of 70.35 ± 7.71 years (70.69 ± 7.62 years in urban and 69.92 ± 7.80 years in rural areas). BHACS-BLSA conducted the baseline survey in 2009 with a multistage stratification-random clustering procedure for people aged 55 years or older; BHACS-CCHS-Beijing conducted the baseline survey in 2013-2015 with a stratified multistage cluster random sampling method for people aged 55 years or older; and BHACS-BECHCS conducted the baseline survey in 2010-2014 with two-stage cluster random sampling method for people aged 60 years or older. Data were collected through questionnaires, physical measurements, and laboratory analyses. Topics covered by BHACS include a wide range of physical and mental health indicators, lifestyles and personal, family, and socio-economic determinants of health. There are no immediate plans to make the cohort data freely available to the public, but specific proposals for further collaboration are welcome. For further information and collaboration, please contact the corresponding author Yao He (e-mail: yhe301@x263.net).

Investigating the impact of healthy aging on memory for temporal duration and order

Temporal information, including information about temporal order and duration, is a fundamental component of event sequence memory. While previous research has demonstrated that aging can have a detrimental effect on memory for temporal order, there has been limited insight into the effect of aging on memory for durations, particularly within the context of sequences. In the current study, neurologically healthy young and older participants were administered two temporal match-mismatch tasks: one in which they were instructed on each trial to compare the temporal order or duration information of stimulus sequences presented first in a study phase and then, after a short delay, in a test phase (event sequence task); and a second in which participants were required to compare single durations or sequences of durations across study and test phases of each trial (pinwheel task). Consistent with the literature, the older participants were significantly poorer compared to their younger counterparts at making temporal order match-mismatch judgments in the event sequence task. In addition to this, data from both tasks suggested that the older adults were also less accurate at match-mismatch judgments based on duration information, with tentative evidence from the pinwheel task to suggest that this age-related effect was most prominent when the duration information was presented within a sequence. We suggest that age-related changes to medial temporal and frontal lobe function may contribute to changes in memory for temporal information in older adults, given the importance of these regions to event sequence memory.

The value of healthy ageing: Estimating the economic value of health using time use data

INTRODUCTION

Economic arguments in favour of investing in health and health care are important for policy making, yet demonstrating the potential economic gains associated with health at older ages can be empirically challenging due to older peoples' limited attachment to the labour market.

METHODS

We develop a novel method to quantify the economic value of health through time use data. Using data on people aged 65 years-old and older from the United Kingdom Time Use Survey (UKTUS) 2014-15, we apply survey-weighted generalized linear models to predict the time spent in non-market productive activities conditional on characteristics including age and self-perceived health. We weight these estimates of predicted minutes spent in each activity using household satellite accounts to quantify the monetary value of time spent engaging in non-market productive activities according to health status and simulate the monetary impact of health gains at older ages.

RESULTS

Both age and self-perceived health status were associated with minutes spent in many non-market productive activities. Summing the monetized predictions of minutes spent across all types of activities indicates that being in "very good" instead of "very bad" self-perceived health is associated with an additional production of 439£, 629£ and 598£ (in real 2015 GBP) per month for an average individual aged 65 to 74 years-old, 75 to 84 years-old and 85 years-old and older, respectively. Using our simulation model, if 10% of older people in "very bad" health in the United Kingdom were to transition to "very good" health it could lead to an increase of up to 278£ million through the production of non-market activities.

CONCLUSIONS

Health at older ages creates considerable economic value which is not observed using standard national accounting measures. Our method to quantify the monetary value of health can be adapted to other settings to make the economic case for investing in healthy ageing.

Frontoparietal function and underlying structure reflect capacity for motor skill acquisition during healthy aging

While capacity for motor skill acquisition changes with healthy aging, there has been little consideration of how age-related changes in brain function or baseline brain structure support motor skill acquisition. We examined: (1) age-dependent changes in functional reorganization related to frontoparietal regions during motor skill acquisition, and (2) whether capacity for motor skill acquisition relates to baseline white matter microstructure in frontoparietal tracts. Healthy older and younger adults engaged in 4 weeks of skilled motor practice. Resting-state functional connectivity (rsFC) assessed functional reorganization before and after practice. Diffusion tensor imaging indexed microstructure of a frontoparietal tract at baseline, generated by rsFC seeds. Motor skill acquisition was associated with decreases in rsFC in healthy older adults and increases in rsFC in healthy younger adults. Frontoparietal tract microstructure was lower in healthy older versus younger adults, yet it was negatively associated with rate of skill acquisition regardless of group. Findings indicate that age-dependent alterations in frontoparietal function and baseline structure of a frontoparietal tract reflect capacity for motor skill acquisition.

Integrated multicomponent interventions to support healthy aging of the whole person

Healthy aging is an integrated "whole person" process that involves an individual's biology, behavior, and social/physical environment. With the recent development of antiaging drugs, careful consideration of the respective roles of pharmacologic and nonpharmacologic approaches to both health and aging is in order. Recent advances in understanding the cellular and molecular mechanisms of aging are providing new measures that can be used as clinical outcomes in studying the impact of antiaging interventions in humans. This paper outlines the strategic interest of the National Center for Complementary and Integrative Health (NCCIH) in supporting the development, testing, and implementation of effective, scalable, and integrated multicomponent interventions to support healthy aging of the whole person.

Timing and level of educational attainment and late-life cognition in the KHANDLE study

INTRODUCTION

The timing of educational attainment may modify its effects on late-life cognition, yet most studies evaluate education only at a single time point.

METHODS

Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study cohort participants (N = 554) reported educational attainment (dichotomized at any college education) at two time points, and we classified them as having low, high, or later-life high educational attainment. Linear mixed-effects models estimated associations between educational attainment change groups and domain-specific cognitive outcomes (z-standardized).

RESULTS

Compared to low educational attainment, high (β= 0.59 SD units; 95% confidence interval [CI]: 0.39, 0.79) and later-life high educational attainment (β = 0.22; 95% CI: 0.00, 0.44) were associated with higher executive function. Only high educational attainment was associated with higher verbal episodic memory (β = 0.27; 95% CI: 0.06, 0.48).

DISCUSSION

Level and timing of educational attainment are both associated with domain-specific cognition. A single assessment for educational attainment may inadequately characterize protective associations with late-life cognition.

HIGHLIGHTS

Few studies have examined both level and timing of educational attainment on cognition. Marginalized populations are more likely to attain higher education in adulthood. Higher educational attainment in late life is also associated with higher cognition.

Different meanings… what we want in our lives… a qualitative exploration of the experience of Aboriginal and/or Torres Strait Islander peoples in a co-designed community rehabilitation service

PURPOSE

Promoting positive psychological, social and functional health outcomes for Aboriginal and Torres Strait Islander people requires health services to be culturally safe, respecting culture as central to the individuals and their communities. This study explored the experience of Aboriginal and Torres Strait Islander people, participating in a co-designed student-assisted community rehabilitation service in a remote Aboriginal community in Far North Queensland.

MATERIALS AND METHODS

Observation, informal yarning and semi-structured interviews with older Aboriginal and Torres Strait Islander people (n = 6) engaged in the service was conducted over a 7 week period. Interpretive phenomenological analysis was applied through inductive thematic analysis.

RESULTS

Four themes illustrated that experiences within the program promoted: A connection to people, both within the program and those significant in people's lives; a connection to past experiences, roles and events; a connection to the future of cultural knowledge; and a sense of achievement and fun. Participants shared their unique stories on their positive experience of the culturally responsive approach in the activities.

CONCLUSIONS

These results suggest that knowledge translation and reciprocity provide a strong foundation for rehabilitation programs that support healthy ageing for Aboriginal and Torres Strait Islander people and encourage active and ongoing individual and community involvement.

Memory support training and lifestyle modifications to promote healthy aging in persons at risk for Alzheimer's disease: a digital application supported intervention (Brain Boosters)

BACKGROUND

Evidence-based interventions to protect against cognitive decline among older adults at risk for Alzheimer's disease and related dementias (ADRD) are urgently needed. Rehabilitation approaches to support memory and behavioral/lifestyle interventions are recognized as promising strategies for preserving or improving cognitive health, although few previous interventions have combined both approaches. This paper describes the protocol of the Brain Boosters intervention, which synergistically combines training in compensatory and healthy lifestyle behaviors and supports implementation and tracking of new behaviors with a digital application.

METHODS

The study utilizes a single-site, single-blinded, randomized controlled design to compare a structured lifestyle and compensatory aid intervention to an education-only self-guided intervention. We plan to enroll 225 community-dwelling adults (25% from underrepresented groups) aged 65 + who endorse subjective cognitive decline (SCD) and low baseline levels of healthy lifestyle behaviors. Both interventions will be administered in group format, consisting of 15 two-hour classes that occur weekly for ten weeks and taper to bi-monthly and monthly, for an intervention duration of 6 months. Participants in both interventions will receive education about a variety of memory support strategies and healthy lifestyle behaviors, focusing on physical and cognitive activity and stress management. The structured intervention will also receive support in adopting new behaviors and tracking set goals aided by the Electronic Memory and Management Aid (EMMA) digital application. Primary outcomes include global cognition (composite of memory, attention, and executive function tests) and everyday function (Everyday Cognition Questionnaire). Data will be collected at baseline and outcome visits, at approximately 6, 12, and 18 months. Qualitative interviews, self-report surveys (e.g., indicators of self-determination, health literacy) and EMMA data metrics will also be used to identify what components of the intervention are most effective and for whom they work.

DISCUSSION

Successful project completion will provide valuable information about how individuals with SCD respond to a compensation and preventative lifestyle intervention assisted by a digital application, including an understanding of factors that may impact outcomes, treatment uptake, and adherence. The work will also inform development, scaling, and personalization of future interventions that can delay disability in individuals at risk for ADRD.

TRIAL REGISTRATION

ClinicalTrials.gov. (NCT05027789, posted 8/30/2021).

"It doesn't feel like exercise": a realist process evaluation of factors that support long-term attendance at dance classes designed for healthy ageing

Introduction

Dance can positively impact older people's health and wellbeing across cultures and socioeconomic groups, countering age-related physical, sensorimotor and cognitive decline.

Background/objectives

The RIPE (Really Is Possible for Everyone) Dance program aims to improve older people's physical, mental, cognitive and social wellbeing by integrating engaging dance sequences with evidence-based fall prevention exercises. We sought to identify what mechanisms support observed long-term participation in this program, including by people living with challenging health conditions.

Methods

Following a realist evaluation approach, we co-developed and tested program theories iteratively with participant interviewees (n = 20), dance teachers (n = 2) and via observation of a dance class. Initial data were dual-coded and emergent findings were interrogated by the research team. Findings were organised to express Program activities + Context + Mechanism = Process outcomes configurations.

Results

We identified four program theories comprising 14 mechanisms which explained long-term attendance: 1. RIPE Dance benefits my body and mind (trust in the program, belief in health benefits), 2. RIPE Dance helps me feel good about myself (self-efficacy, pride in achievement, psychological safety, defying expectations, feeling valued), 3. RIPE Dance creates camaraderie (social connection, mutual support, rapport with the teacher), and 4. RIPE Dance is uplifting (raised spirits, fun, synchrony, musical reactivity).

Conclusion

The RIPE Dance program provides effective and enjoyable 'exercise in disguise' for older people with diverse mobility profiles.

Significance/implications

This research confirms that participation in dance can contribute significantly to healthy, happy ageing. Findings detail program activities that were most strongly associated with process outcomes, offering guidance for further program development, implementation and scaling up.

'Ageing with an alcohol problem is not what I envision': reclaiming agency in shaping personal ageing trajectory and recovery from alcohol problems

BACKGROUND

Eliciting and understanding older persons' descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing.

METHODS

Eight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews.

RESULTS

Three themes were identified: "Tipping the balance", "Staying behind a veil" and "Lifting the vail". First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery.

CONCLUSIONS

Older persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons' desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.