Cognitive interventions for older adults: does approach matter?

Caregiver training: Evidence of its effectiveness for cognitive and functional improvement in older adults

AIMS AND OBJECTIVES

The objectives of this study were to assess the benefits of a caregiver training programme on the cognitive and functional status of older adults, and to compare the effects of this programme according to type of caregiver (professional vs. family caregiver).

BACKGROUND

Due to demographic changes that have resulted in an aging population, the role of caregiver of an older adult has become very important in recent years.

DESIGN AND METHODS

The sample was composed of 160 older adults: (a) 100 received care from caregivers who had taken the three-month training programme (treatment group), of which 60 were professional caregivers and 40 were family caregivers, and (b) 60 received care from caregivers who had not taken the programme (control group). In order to evaluate programme effects on cognitive and functional status, we used both direct measures answered by the older adults (MMSE, CAPE and EuroQol) and caregiver reports (Barthel and RMPBC). We used a quasi-experimental, pre-post design. We followed SQUIRE 2.0 guidelines for reporting.

RESULTS

The results showed that older adults who were cared for by caregivers that had participated in the training programme showed gains in quality of life and cognitive ability and maintenance of functional ability. Within the treatment group, although everyone significantly improved their scores, the older adults cared for by family caregivers improved in more of the cognitive sub-items than did their peers in the professional caregiver group.

CONCLUSIONS

The data obtained show that a caregiver training programme based on cognitive stimulation produces cognitive, functional and health-related quality-of-life benefits in older adults. Furthermore, the caregivers reported increased satisfaction with their work.

RELEVANCE TO CLINICAL PRACTICE

The improvements obtained in the older adults and in caregivers show the relevance of this type of intervention when working in the clinical field of caregiving.

Increasing autonomy through improved care: effects of a professional care-giver training programme on the functional status of older adults

The aim of the present research was to evaluate the effectiveness of a care-giver training programme that trains professional care-givers in cognitive stimulation strategies for functional maintenance in care-dependent older adults. The sample contained 69 older adults (37 in the treatment group, 32 control group) assessed with the Barthel Index, the Mini-Mental State Examination and the Clifton Assessment Procedure for the Elderly (Cognitive Scale). Participants in the treatment group were treated by professional care-givers who were trained with the programme CUIDA-2 in communication and cognitive stimulation strategies. The results from the Barthel Index showed significant differences in the post-intervention assessment and in the follow-up assessment, where the treatment group obtained higher scores, and there were significant differences within the treatment group between the initial assessment and the post-treatment assessment, as well as between the initial assessment and the follow-up. The data obtained reflect that a training programme to train professional care-givers produced functional benefits in the older adults, and these improvements persisted over time. Moreover, the care-givers saw themselves as more competent and more satisfied with their work.

Qigong for the treatment of depressive symptoms: Preliminary evidence of neurobiological mechanisms

OBJECTIVES

Qigong has been shown to effectively reduce depressive symptoms in older adults with chronic physical illness. Here, we sought to evaluate the effects of qigong on serotonin, cortisol, and Brain-derived Neurotropic Factors (BDNF) levels and test their roles as potential mediators of the effects of qigong on depressive symptoms.

METHODS

Thirty older adults with chronic physical illness participated in a randomized clinical trial. They were randomly assigned to a qigong group (n = 14) or a control group for cognitive training of executive function and memory (n = 16). The participants provided blood and saliva samples at baseline and post-intervention. Levels of cortisol were measured from the salvia samples, and serotonin and BDNF were measured from the blood samples.

RESULTS

Consistent with the study findings presented in the primary outcome paper, a significant Group × Time interaction effect emerged on depressive symptoms, explained by greater reductions in the qigong group than the control group. Qigong participants had significantly larger increases in serotonin and BDNF, and decreases in cortisol levels, compared with control group participants. Moreover, treatment-related changes in cortisol levels (but not serotonin or BDNF) fully mediated the beneficial effects of qigong on depressive symptoms.

CONCLUSION

The findings provide preliminary evidence that treatment-related changes in cortisol may mediate the benefits of qigong on depressive symptoms. Given the limitation of small sample size of the present study, future studies with larger sample sizes and more extended follow-up assessment are warranted to determine the reliability of these findings.

The influence of cognitive decline on rural identity: perspectives of older women

PURPOSE

The purpose of this study was to examine the perspectives of community-dwelling rural, older women concerning the meaning of cognitive decline and to ascertain how cognitive decline affects their lives and the lives of those around them.

DESIGN

An ethnographic design guided 1 year of cultural immersion in a rural, farming county in Nebraska.

METHOD

Four life history interviews, participant observations, field notes, and cultural artifacts were collected for case-focused analysis.

FINDINGS

Cognitive decline was believed to threaten one's social identity as a "good woman" because of three strongly held beliefs that (1) the rural lifestyle protected health, (2) demands of the farm were more important than personal health needs, and (3) mainstream health care services were unnatural and insensitive, and therefore best avoided. Using mainstream health care also resulted in the loss of informal social support, which existed as a protective social silence and helped sustain older women's rural identity. The older women feared developing cognitive decline and believed the loss of one's life purpose would be the outcome of the condition.

CONCLUSIONS

Holistic nursing actions that preserve older women's rural identity and social support may increase the likelihood that women accept rural health care aimed at treating cognitive decline.