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Lim ML, Zammit C, Lewis E, Ee N, Maiden G, Goldwater M, Kimonis E, Kenning G, Rockwood K, Fitzgerald A, Radford K, Dodge H, Ward SA, Delbaere K, Peters R. A 10-week intergenerational program bringing together community-living older adults and preschool children (INTERACTION): a pilot feasibility non-randomised clinical trial. Pilot Feasibility Stud 2024; 10:37. [PMID: 38383482 PMCID: PMC10880214 DOI: 10.1186/s40814-024-01446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Social isolation and low levels of physical activity are strong drivers for frailty, which is linked to poor health outcomes and transition to long-term care. Frailty is multifactorial, and thus an integrated approach is needed to maintain older adults' health and well-being. Intergenerational programs represent a novel multifactorial approach to target frailty, social isolation and physical decline but these have not yet been rigorously tested in Australia. Here, we present the results of our pilot study which aimed to test the feasibility of a 10-week intergenerational program between older adults and preschool children. METHODS A non-randomised wait-listed controlled trial was conducted. Participants were allocated to either the intervention or wait-list control group. The intervention group received 10 weekly 2-h intergenerational sessions led by trained child educators; the control group continued with their usual routine and received their intergenerational program after the 10-week control period. All participants were assessed at baseline and 10 weeks. The primary outcome was the feasibility and acceptability of the program including measures of recruitment eligibility, adherence and effective data collection across the multiple domains important for frailty, including functional mobility and balance, grip strength, cognitive function, mood, social engagement, quality of life and concerns about falling. RESULTS Nineteen adults were included, with nine in the intervention and ten in the control group. A total of 42% of older adults screened were eligible, 75% of participants were present at each intervention session and the overall attrition rate was 21% (n = 4). The reasons for participant absence were primarily health-related. Missing data was minimal for the majority of assessments but more apparent for the cognitive testing where completion rates ranged from 53 to 79% for baseline tests and 73 to 100% for those who received follow-up testing. CONCLUSIONS The high program compliance and low attrition show that a 10-week intergenerational program embedded in the local community, designed for community-living older adults and preschool children, is feasible and acceptable to older adults. Our next trial will test the efficacy of intergenerational programs in this setting.
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Affiliation(s)
- Mei Ling Lim
- Ageing and Neurodegeneration, Neuroscience Research Australia, Sydney, Australia.
- School of Population Health, University of New South Wales, Sydney, Australia.
- Ageing Futures Institute, University of New South Wales, Sydney, Australia.
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia.
- Neurology, The George Institute for Global Health, Sydney, Australia.
| | - Christine Zammit
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Ebony Lewis
- School of Population Health, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Nicole Ee
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Genevieve Maiden
- War Memorial Hospital, Uniting, South Eastern Local Health District, Sydney, Australia
| | | | - Eva Kimonis
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Gail Kenning
- Ageing and Neurodegeneration, Neuroscience Research Australia, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
- fEEL (felt Experience and Empathy Lab), University of New South Wales, Sydney, Australia
| | | | - Anneke Fitzgerald
- Department of Business Strategy and Innovation, Griffith University, Nathan, Australia
| | - Katrina Radford
- Department of Employment Relations and Human Resource Management, Griffith University, Nathan, Australia
| | - Hiroko Dodge
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- School of Population Health, University of New South Wales, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
| | - Ruth Peters
- Ageing and Neurodegeneration, Neuroscience Research Australia, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
- Neurology, The George Institute for Global Health, Sydney, Australia
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D'Amico D, Alter U, Laurin D, Ferland G, Fiocco AJ. Examining a Healthy Lifestyle as a Moderator of the Relationship between Psychological Distress and Cognitive Decline among Older Adults in the NuAge Study. Gerontology 2024; 70:418-428. [PMID: 38354710 DOI: 10.1159/000535978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The objective of this study was to examine whether a healthy lifestyle composite score of social engagement, physical activity, and Mediterranean diet adherence moderates the association between psychological distress and global cognitive decline among cognitively healthy older adults (67+ years of age at baseline). METHODS A total of 1,272 cognitively intact older adults (Mage = 74.1 ± 4.1 years, 51.9% female) in the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge) completed a series of self-reported questionnaires to measure psychological distress and lifestyle behaviors, and the Modified Mini-Mental Examination (3MS) to assess cognitive performance at baseline and annually over 3 years. RESULTS Controlling for sociodemographic and health-related characteristics, greater psychological distress was associated with steeper cognitive decline over time among males (B = -0.07, 95% CI: [-0.12, -0.02]), but not females (B = 0.008, 95% CI: [0.03, 0.04]). Although a healthy lifestyle composite score did not statistically significantly moderate the distress-cognition relationship (B = -0.005, 95% CI: [-0.02, 0.01]), there was an association between higher psychological distress and greater cognitive decline at low levels of social engagement (B = -0.05, 95% CI: [-0.09, -0.006]), but not at high levels of social engagement (B = 0.02, 95% CI: [-0.03, 0.07]). CONCLUSION This study suggests that the potentially harmful impact of stress on cognitive function may be malleable through specific healthy lifestyle behaviors and emphasizes the importance of taking a sex-based approach to cognitive aging research.
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Affiliation(s)
- Danielle D'Amico
- Institute for Stress and Wellbeing Research, Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada,
| | - Udi Alter
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Danielle Laurin
- Centre de recherche du CHU de Québec-Université Laval, VITAM-Centre de recherche en santé durable, CIUSSS-Capitale Nationale and Institut sur le vieillissement et la participation sociale des aînés, Quebec, Québec, Canada
- Centre d'excellence sur le vieillissement de Québec, Quebec, Québec, Canada
- Faculté de pharmacie, Université Laval and Institut sur la nutrition et les aliments fonctionnels (INAF) de l'Université Laval, Quebec, Québec, Canada
| | - Guylaine Ferland
- Montreal Heart Institute, Department of Nutrition, Université de Montréal, Montreal, Québec, Canada
| | - Alexandra J Fiocco
- Institute for Stress and Wellbeing Research, Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
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Bohn L, Drouin SM, McFall GP, Rolfson DB, Andrew MK, Dixon RA. Machine learning analyses identify multi-modal frailty factors that selectively discriminate four cohorts in the Alzheimer's disease spectrum: a COMPASS-ND study. BMC Geriatr 2023; 23:837. [PMID: 38082372 PMCID: PMC10714519 DOI: 10.1186/s12877-023-04546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Frailty indicators can operate in dynamic amalgamations of disease conditions, clinical symptoms, biomarkers, medical signals, cognitive characteristics, and even health beliefs and practices. This study is the first to evaluate which, among these multiple frailty-related indicators, are important and differential predictors of clinical cohorts that represent progression along an Alzheimer's disease (AD) spectrum. We applied machine-learning technology to such indicators in order to identify the leading predictors of three AD spectrum cohorts; viz., subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and AD. The common benchmark was a cohort of cognitively unimpaired (CU) older adults. METHODS The four cohorts were from the cross-sectional Comprehensive Assessment of Neurodegeneration and Dementia dataset. We used random forest analysis (Python 3.7) to simultaneously test the relative importance of 83 multi-modal frailty indicators in discriminating the cohorts. We performed an explainable artificial intelligence method (Tree Shapley Additive exPlanation values) for deep interpretation of prediction effects. RESULTS We observed strong concurrent prediction results, with clusters varying across cohorts. The SCI model demonstrated excellent prediction accuracy (AUC = 0.89). Three leading predictors were poorer quality of life ([QoL]; memory), abnormal lymphocyte count, and abnormal neutrophil count. The MCI model demonstrated a similarly high AUC (0.88). Five leading predictors were poorer QoL (memory, leisure), male sex, abnormal lymphocyte count, and poorer self-rated eyesight. The AD model demonstrated outstanding prediction accuracy (AUC = 0.98). Ten leading predictors were poorer QoL (memory), reduced olfaction, male sex, increased dependence in activities of daily living (n = 6), and poorer visual contrast. CONCLUSIONS Both convergent and cohort-specific frailty factors discriminated the AD spectrum cohorts. Convergence was observed as all cohorts were marked by lower quality of life (memory), supporting recent research and clinical attention to subjective experiences of memory aging and their potentially broad ramifications. Diversity was displayed in that, of the 14 leading predictors extracted across models, 11 were selectively sensitive to one cohort. A morbidity intensity trend was indicated by an increasing number and diversity of predictors corresponding to clinical severity, especially in AD. Knowledge of differential deficit predictors across AD clinical cohorts may promote precision interventions.
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Affiliation(s)
- Linzy Bohn
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada.
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.
| | - Shannon M Drouin
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - G Peggy McFall
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Darryl B Rolfson
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, 13-135 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Melissa K Andrew
- Department of Medicine, Division of Geriatric Medicine, Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Roger A Dixon
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
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Saposnik G, Ismail Z, Rivard AM, Knifton D, Bromfield G, Terzaghi M, Montoya A, Menard MC. Decision making under uncertainty in the diagnosis and management of Alzheimer's Disease in primary care: A study protocol applying concepts from neuroeconomics. Front Med (Lausanne) 2022; 9:997277. [DOI: 10.3389/fmed.2022.997277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe current management of patients with Dementia, primarily with Alzheimer's Disease (AD) is rapidly evolving. However, limited information is available about the current gaps and decision-making in primary care.ObjectivesTo evaluate factors associated with gaps, risk preferences regarding diagnostic and therapeutic choices in the management of patients with AD by primary care physicians (PCP) from across Canada.MethodsWe propose a non-interventional, cross-sectional pilot study involving 120 primary care physicians referred from the College of Family Physicians of Canada to assess diagnostic and therapeutic decisions in the management of ten simulated AD-related case-scenarios commonly encountered in clinical practice. We initially describe the current landscape and gaps regarding diagnostic and therapeutic challenges in the management of patients with AD in primary care. Then, we provide concepts from behavioral economics and neuroeconomics applied to medical decision-making. Specifically, we include standardized tests to measure risk aversion, physicians' reactions to uncertainty, and questions related to risk preferences in different domains. Finally, we summarize the protocol to be implemented to address our goals. The primary study outcome is the proportion of participants that elect to defer initial investigations to the specialist and the associated factors. Secondary outcomes include the proportion of PCP willing to order cerebral spinal fluid studies, PET scans, or initiate treatment according to the simulated case-scenarios. The study will be conducted in English and French.ConclusionsThe study findings will contribute a better understanding of relevant factors associated with diagnostic and therapeutic decisions of PCP in the management of AD, identifying participant's preferences and evaluating the role of behavioral aspects such tolerance to uncertainty, aversion to ambiguity, and therapeutic inertia.
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O’Toole D. Rapid recommendations: Updates from 2020 guidelines: part 2. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:36-38. [PMID: 35063982 PMCID: PMC9810042 DOI: 10.46747/cfp.680136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Danielle O’Toole
- Practising family physician in Academic Family Medicine and Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont
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Cooper C, Mansour H, Carter C, Rapaport P, Morgan-Trimmer S, Marchant NL, Poppe M, Higgs P, Brierley J, Solomon N, Budgett J, Bird M, Walters K, Barber J, Wenborn J, Lang IA, Huntley J, Ritchie K, Kales HC, Brodaty H, Aguirre E, Betz A, Palomo M. Social connectedness and dementia prevention: Pilot of the APPLE-Tree video-call intervention during the Covid-19 pandemic. DEMENTIA 2021; 20:2779-2801. [PMID: 33913362 PMCID: PMC8679164 DOI: 10.1177/14713012211014382] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background and Objectives The Covid-19 pandemic reduced access to social activities and routine health care that
are central to dementia prevention. We developed a group-based, video-call, cognitive
well-being intervention; and investigated its acceptability and feasibility; exploring
through participants’ accounts how the intervention was experienced and used in the
pandemic context. Research Design and Method We recruited adults aged 60+ years with memory concerns (without dementia).
Participants completed baseline assessments and qualitative interviews/focus groups
before and after the 10-week intervention. Qualitative interview data and facilitator
notes were integrated in a thematic analysis. Results 12/17 participants approached completed baseline assessments, attended 100/120 (83.3%)
intervention sessions and met 140/170 (82.4%) of goals set. Most had not used video
calling before. In the thematic analysis, our overarching theme was social
connectedness. Three sub-themes were as follows: Retaining independence
and social connectedness: social connectedness could not be at the expense of
independence; Adapting social connectedness in the pandemic: participants
strived to compensate for previous social connectedness as the pandemic reduced support
networks; Managing social connections within and through the intervention:
although there were tensions, for example, between sharing of achievements feeling
supportive and competitive, participants engaged with various lifestyle changes; social
connections supported group attendance and implementation of lifestyle changes. Discussion and Implications Our intervention was acceptable and feasible to deliver by group video-call. We argue
that dementia prevention is both an individual and societal concern. For more vulnerable
populations, messages that lifestyle change can help memory should be communicated
alongside supportive, relational approaches to enabling lifestyle changes.
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Affiliation(s)
- Claudia Cooper
- 4919UCL, London, UK; 9747Camden and Islington NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jennifer Wenborn
- 4919UCL, London, UK, 5098North East London NHS Foundation Trust (NELFT), Ilford, UK
| | | | | | | | | | - Henry Brodaty
- 7800University of New South Wales, Sydney, New South Wales, Australia
| | - Elisa Aguirre
- 4919UCL, London, UK; 5098North East London NHS Foundation Trust (NELFT), London, UK
| | - Anna Betz
- 9747Camden and Islington NHS Foundation Trust, London, UK
| | - Marina Palomo
- 9747Camden and Islington NHS Foundation Trust, London, UK
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