Social participation and mild cognitive impairment in low- and middle-income countries

Healthy aging meta-analyses and scoping review of risk factors across Latin America reveal large heterogeneity and weak predictive models

Models of healthy aging are typically based on the United States and Europe and may not apply to diverse and heterogeneous populations. In this study, our objectives were to conduct a meta-analysis to assess risk factors of cognition and functional ability across aging populations in Latin America and a scoping review focusing on methodological procedures. Our study design included randomized controlled trials and cohort, case-control and cross-sectional studies using multiple databases, including MEDLINE, the Virtual Health Library and Web of Science. From an initial pool of 455 studies, our meta-analysis included 38 final studies (28 assessing cognition and 10 assessing functional ability, n = 146,000 participants). Our results revealed significant but heterogeneous effects for cognition (odds ratio (OR) = 1.20, P = 0.03, confidence interval (CI) = (1.0127, 1.42); heterogeneity: I2 = 92.1%, CI = (89.8%, 94%)) and functional ability (OR = 1.20, P = 0.01, CI = (1.04, 1.39); I2 = 93.1%, CI = (89.3%, 95.5%)). Specific risk factors had limited effects, especially on functional ability, with moderate impacts for demographics and mental health and marginal effects for health status and social determinants of health. Methodological issues, such as outliers, inter-country differences and publication bias, influenced the results. Overall, we highlight the specific profile of risk factors associated with healthy aging in Latin America. The heterogeneity in results and methodological approaches in studying healthy aging call for greater harmonization and further regional research to understand healthy aging in Latin America.

The 2022 symposium on dementia and brain aging in low- and middle-income countries: Highlights on research, diagnosis, care, and impact

Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.

Functional teeth and cognitive function among the Chinese elderly: The chain mediating effect of depressive symptoms and social participation

The objective of this study was to investigate the chain mediating effects of depressive symptoms and social participation between functional teeth and cognitive function based on the biopsychosocial model. Data from the 2018 China Health and Retirement Longitudinal Study were analyzed. The findings revealed a favorable connection between the lack of edentulism and cognitive function, persisting even when accounting for the mediating factors of denture usage, depressive symptoms, and social participation. Furthermore, the study identified six indirect pathways in this relationship. The present study has substantiated the correlation between edentulism and cognitive function, thereby proposing that interventions aimed at denture usage, depressive symptoms, and social participation could potentially serve as preventive measures against cognitive decline in elderly individuals afflicted with edentulism. This underscores the significance of addressing these factors to alleviate cognitive decline.

Digital Storytelling Intervention for Enhancing the Social Participation of People With Mild Cognitive Impairment: Co-Design and Usability Study

BACKGROUND

Community-based social participation has shown promise in delaying cognitive decline in older adults with mild cognitive impairment (MCI) who are at risk of developing dementia. Although group storytelling interventions have proven effective, the need for a skilled workforce to support people with MCI can limit broader community implementation. Technology-based interventions may offer a solution to this limitation by replicating the abilities of therapists.

OBJECTIVE

This study aims to co-design a digital storytelling intervention and evaluate its usability.

METHODS

This co-design process involved 3 stages, engaging people with MCI (n=12), their caregivers (n=4), and therapists (n=5) in Beijing, China. In the first stage, we used card sorting and voting methods to identify potential incentives for social participation and target the specific abilities that people with MCI wanted to enhance. In the second stage, we conducted brainstorming sessions with people with MCI and their caregivers to identify the potential features of a digital storytelling application named Huiyou ("meeting new friends" in Chinese). Finally, we assessed Huiyou's usability with people with MCI and therapists, leading to iterative improvements based on the usability findings.

RESULTS

We uncovered a crucial link between boosting the self-confidence of people with MCI and their ability to address social participation challenges. Notably, we identified memory improvement and enhanced language expression as key factors for effective communication with grandchildren. Subsequently, participants suggested features and interfaces to address these challenges, leading to the development of Huiyou, a group-based digital storytelling application featuring functions such as generating story materials, conducting memory retrieval activities, and sharing stories. It received an "excellent" rating in the User Experience Questionnaire benchmark, displaying high levels of attractiveness, dependability, stimulation, and novelty. People with MCI achieved an average task completion rate of 87% (n=19; SD 0.13) of the 22 tasks. However, feedback from people with MCI and therapists highlighted usability issues in navigation, activity management, user interface, and feature optimization, indicating a need for improved accessibility and efficiency.

CONCLUSIONS

The co-design approach contributed to developing the Huiyou prototype, supporting community-based social participation. User feedback highlighted the potential of Huiyou to enhance well-being and facilitate meaningful social interactions while maintaining crucial existing relationships.

Depressive Symptoms Associated With Social Participation in Older Adults Living With Mild Cognitive Impairment

Mild Cognitive Impairment (MCI) affects 15% of adults 50 years old and over. Individuals living with MCI have shown decreased social participation, a critical activity as it may delay cognitive decline. Depression may be a key factor in limiting participation. This study is a secondary data analysis of 30 older adults living with MCI, looking for associations with participation. Participation was examined using the Patient Reported Outcomes Measurement Information System (PROMIS®) Satisfaction with Participation in Social Roles Computer Adaptive Test (CAT) form. Depressive symptoms were reported using the PROMIS Quality of Life in Neurological Disorders Depression CAT form and the Patient Health Questionnaire (PhQ-9) form. Results showed that demographics (age, sex) were not significantly associated with participation, but depressive symptoms were significantly associated. This suggests that adults living with MCI who have higher levels of depressive symptoms may be a uniquely vulnerable population who benefit from interventions that support participation.

Association between self-perception of aging and cognitive function in Chinese older adults: The mediation effect of health behaviors

OBJECTIVE

To investigate the association between self-perception of aging (SPA) and cognitive function in Chinese older adults, and to explore the mediating role of health behaviors.

METHODS

This study included 5,445 Chinese older adults from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Correlation, linear regression and mediation effect analysis were employed to evaluate the association.

RESULTS

SPA is significantly related to the health behaviors (r = 0.160, P < 0.01) and cognition (r = 0.086, P < 0.01), and health behaviors exhibited a positive correlation with cognition (r = 0.179, P < 0.01). SPA and health behaviors significantly impacted cognition (β = 0.032, P = 010; β = 0.103, P < 0.001). Health behaviors partially mediated the effect of SPA on cognitive function, accounting for 27.12 % of the total effect.

CONCLUSION

Health behaviors mediate the association between SPA and cognitive function. Healthcare providers should prioritize addressing SPA of older adults and encourage them to engage in health behaviors for cognitive health.

Digital storytelling intervention to enhance social connections and participation for people with mild cognitive impairment: a research protocol

Introduction

Interventions utilizing the principles of digital storytelling can improve cognitive ability by cultivating positive emotions and framing a new way to enhance social participation among people with mild cognitive impairment. However, existing research has understudied group-based storytelling, focusing instead on building individual stories and connections with family and friends. In response to this research gap, this paper proposes co-designing a digital storytelling intervention for people with Mild Cognitive Impairment (MCI) to enhance their social participation and build meaningful connections.

Methods

We will conduct two co-design workshops with people with MCI (n = 12), their caregivers (n = 4-12), and therapists (n = 5) in Beijing, China, to facilitate the co-development of the digital storytelling application. During the first workshop, we will utilize card sorting and voting to define potential facilitators of social participation, identifying the abilities people with MCI want to improve through storytelling. During the second workshop, we will build on these findings to facilitate people with MCI and their caregivers to visualize the interfaces. After reflexive thematic analysis of the co-design workshops, we will develop a digital storytelling application and test its usability and efficacy among people with MCI and therapists, respectively. A single-blinded field test will be conducted with 20 community-dwelling adults with MCI (Age: 65+). The testing will consist of an intervention group of 10 participants who use the co-designed digital storytelling intervention and a control group of 10 participants who will not use the co-designed intervention on the waiting list. The intervention period will extend over 7 weeks, with individual intervention sessions lasting 30 min. We will evaluate its efficacy in terms of social participation, social connectedness, self-efficacy, subjective sense of happiness, and user experience of people with MCI.

Discussion

This study will examine an innovative digital storytelling intervention to enhance social participation among people with MCI. This study is expected to advance the concept of community-centric social groups in social health service contexts by integrating technological solutions with the self-identified needs and lived experiences of people with MCI, increasing the motivation of people with MCI to cultivate social participation.

Ethics and dissemination

Swinburne University of Technology's Human Research Ethics Committee gave ethics approval for this research (Approval Number: 20226525-11105; Date: 26/09/2022). Our findings shall be reported in peer-reviewed journal articles and at relevant conferences.

Social connections and participation among people with mild cognitive impairment: barriers and recommendations

Objective

Social connections and participation are essential for individuals with mild cognitive impairment (MCI) to prevent the progression of cognitive decline and enhance their overall well-being. However, existing research has primarily focused on environmental barriers, overlooking personal factors and the interconnected nature of these barriers. Moreover, there is a lack of understanding regarding social connections and participation challenges specific to people with MCI in low- and middle-income countries. Therefore, this study aimed to explore the barriers that hinder social connections and participation among people with MCI in China and investigate opportunities to design appropriate supportive interventions.

Methods

Thirty-one people with MCI (13 males and 18 females; mean age = 82.74 years, SD = 7.69; mean MoCA score = 21.26, SD = 2.44) and 13 caregivers were recruited to attend focus groups. In addition, 10 therapists were interviewed using a semi-structured interview guide. Focus groups and interviews were audio-recorded, transcribed, and analyzed using a framework analysis approach.

Results

We found that the ability to build social connections among people with MCI is affected by mobility challenges, intensive grandparenting responsibilities, availability of suitable activities, and feelings of exclusion in a closed-minded community environment. Personal reasons, such as lower social efficacy, inability to find suitable social activities, and intensive family responsibilities, discourage people with MCI from social participation. The digital literacy of people with MCI depends on their motivation to learn and use digital tools; people with MCI who live in a community have a higher digital literacy than those living in care centers. The motivation to achieve digital literacy is affected by perceived benefits, costs of technology use, and social influence.

Conclusion

Multidimensional initiatives are needed to address barriers to social connections, participation, and technology adoption among individuals with MCI. This includes organizing and engaging in social activities, promoting awareness and education on the importance of social participation, and exploring technology-based interventions to improve memory and storytelling abilities. These efforts can create a supportive environment and empower individuals with MCI to participate actively in social interactions, enhancing their overall well-being.

The Mediating Role of Social Participation in Motoric Cognitive Risk and its Relation to Depression and Loneliness in Older Adults

BACKGROUND

Motoric cognitive risk syndrome (MCR) reduces the quality of life, independence, and social interaction in older adults. Social participation is a potentially modifiable factor that benefits cognitive and mental health. This study explored the mediating roles of social participation between MCR and depression and between MCR and loneliness.

METHODS

We performed a secondary analysis of data from the 2015-2016 National Social Life, Health, and Aging Project. Slow gait speed and cognitive decline were used to assess MCR. Mediation analysis was applied to two models, both of which used MCR as an exposure and social participation as a mediator. The outcomes were depression and loneliness for each model, respectively.

RESULTS

Among 1,697 older adults, 196 (11.6%) had MCR. The mediating role of social participation was statistically significant in both models. The indirect effect (β=0.267, p=0.001) of MCR on depression through social participation comprised 11.97% of the total effect (β=2.231, p&lt;0.001). The indirect effect (β=0.098, p=0.001) of MCR on loneliness through social participation was 19.48% of the total effect (β=0.503, p&lt;0.001).

CONCLUSION

Interventions to increase social participation may reduce depression and loneliness of older adults with MCR.