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Chong TWH, Macpherson H. Pounding the Pavement: Is the Path to Brain Health Steeper for People Experiencing Greater Socioeconomic Deprivation? J Alzheimers Dis 2024; 99:117-120. [PMID: 38640159 DOI: 10.3233/jad-240095] [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] [Indexed: 04/21/2024]
Abstract
Dementia is a global public health priority. Physical activity has myriad health benefits, including for reducing dementia risk. To increase physical activity, detailed understanding of influencing factors is needed. Socioeconomic deprivation affects many aspects of health and wellbeing. Qualitative research with older people experiencing socioeconomic deprivation is needed to explore barriers and enablers to engaging in physical activity, with the view to co-designing interventions for implementation trials. A whole of society approach is pivotal to improving effectiveness of physical activity interventions for older adults with cognitive impairment, and target support for people experiencing socioeconomic deprivation, to improve their health outcomes.
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Affiliation(s)
- Terence W H Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
- St Vincent's Hospital Melbourne, Fitzroy, Australia
- Royal Melbourne Hospital, Parkville, Australia
| | - Helen Macpherson
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
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2
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Curran E, Palmer VJ, Ellis KA, Chong TWH, Rego T, Cox KL, Anstey KJ, Westphal A, Moorhead R, Southam J, Lai R, You E, Lautenschlager NT. Physical Activity for Cognitive Health: A Model for Intervention Design for People Experiencing Cognitive Concerns and Symptoms of Depression or Anxiety. J Alzheimers Dis 2023:JAD221216. [PMID: 37334591 PMCID: PMC10357152 DOI: 10.3233/jad-221216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND People experiencing cognitive concerns and symptoms of depression or anxiety are at risk for Alzheimer's disease and dementia. We know physical activity can benefit cognition but understanding how to best support engagement is an ongoing challenge. Evidence-based conceptual models of factors underpinning physical activity engagement in target populations can inform intervention tailoring to address this challenge. OBJECTIVE This study (part of a pragmatic physical activity implementation trial) aimed to develop a specified model of physical activity engagement in people experiencing depressive or anxiety symptoms and cognitive concerns, to enable optimized dementia risk reduction intervention tailoring. METHODS We employed a qualitative design, triangulating data from three sources: semi-structured individual interviews with people experiencing cognitive concerns and mild to moderate depressive or anxiety symptoms; review of published evidence; and the Capability, Opportunity and Motivation system of behavior, an existing behavioral science model. Findings were integrated to develop a contextualized model of mechanisms of action for optimizing engagement. RESULTS Twenty-one participants were interviewed, and 24 relevant papers included. Convergent and complementary themes extended understanding of intervention needs. Findings highlighted emotional regulation, capacities to enact intentions despite barriers, and confidence in existing skills as areas of population-specific need that have not previously been emphasized. The final model provides specificity, directionality, and linked approaches for intervention tailoring. CONCLUSION This study demonstrated that people experiencing cognitive concerns and symptoms of depression or anxiety require different interventions to improve physical activity engagement. The novel model can enable more precise intervention tailoring, and, ultimately, benefits for a key at-risk population.
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Affiliation(s)
- Eleanor Curran
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Victoria J Palmer
- ALIVE National Centre for Mental Health Research Translation, Department of General Practice, Melbourne Medical School, The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
- Primary Care Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
| | - Kathryn A Ellis
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Terence W H Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
- St Vincent's Hospital Melbourne, St George's Campus, Melbourne, Australia
| | - Thomas Rego
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Kay L Cox
- Medical School, The University of Western Australia, Perth, Australia
| | - Kaarin J Anstey
- University of New South Wales Ageing Futures Institute, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Alissa Westphal
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Rebecca Moorhead
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Jenny Southam
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Rhoda Lai
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
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3
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Shvedko AV, Versolker Y, Edelstein OE. Translation and Validation of the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) Questionnaire among the General Israeli Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2622. [PMID: 36767987 PMCID: PMC9915287 DOI: 10.3390/ijerph20032622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The need to promote awareness of dementia prevention is broadly emphasized in Israel. Currently, there is no valid version of a Hebrew questionnaire to assess attitudes and beliefs related to dementia prevention. This study aimed to translate and validate the MCLHB-DRR questionnaire among the general Israeli population. METHODS A total sample of 328 participants between the ages of 50-83 years (mean = 58.7, SD = 6.9) were included in this study. Participants completed the online translated MCLHB-DRR questionnaire. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were conducted to assess the questionnaire's validity. Internal consistency was assessed using Cronbach's alpha. RESULTS The EFA analysis revealed a seven-factor model with 27 items. One item related to perceived barriers and two items related to perceived severity were deleted. The CFA analysis confirmed a good model fit with the deleted items (χ2/df = 2.146, CFI = 0.930, TLI = 0.916, RMSEA = 0.049). Cronbach's alpha values ranged from 0.61 to 0.92. CONCLUSIONS The Hebrew MCLHB-DRR questionnaire is a valid and reliable measurement tool for assessing attitudes and beliefs related to health behaviours and lifestyle changes for dementia risk reduction in Israeli adults over the age of 50.
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Chong TWH, Rego T, Lai R, Westphal A, Pond CD, Curran E, Kootar S, Peters R, Anstey KJ, Lautenschlager NT. Preferences and Perspectives of Australian General Practitioners Towards a New "Four-in-One" Risk Assessment Tool for Preventative Health: The LEAD! GP Project. J Alzheimers Dis 2023; 94:801-814. [PMID: 37334606 DOI: 10.3233/jad-230287] [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] [Indexed: 06/20/2023]
Abstract
BACKGROUND Dementia risk reduction is a public health priority and general practitioners (GPs) play a pivotal role in preventative healthcare. Therefore, risk assessment tools should be designed with GPs' preferences and perspectives in mind. OBJECTIVE The LEAD! GP project aimed to investigate Australian GPs' preferences and perspectives relating to design, use and implementation of a new risk assessment tool that simultaneously calculates risk for four outcomes- dementia, diabetes mellitus, myocardial infarct, and stroke. METHODS A mixed methods study using semi-structured interviews of a diverse group of 30 Australian GPs was conducted. Interview transcripts were analyzed thematically. Demographics and questions that elicited categorical answers were analyzed descriptively. RESULTS Overall, GPs felt that preventative healthcare was important with some finding it rewarding, and others finding it difficult. GPs currently use many risk assessment tools. GPs' perception of the usefulness and negatives/barriers of tools related to clinical practice applicability, patient engagement, and practical aspects. The largest barrier was lack of time. GPs responded positively to the concept of a four-in-one tool and preferred it to be relatively short, supported by practice nurses and some patient involvement, linked to education resources, available in different formats, and integrated into practice software. CONCLUSION GPs recognize the importance of preventative healthcare and the potential benefit of a new tool that simultaneously predicts risk for those four outcomes. Findings provide important guidance to inform the final development and piloting of this tool with potential to improve efficiency and practical integration of preventative healthcare for dementia risk reduction.
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Affiliation(s)
- Terence W H Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
- St Vincent's Hospital Melbourne, Kew, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Thomas Rego
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Rhoda Lai
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Alissa Westphal
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
- St Vincent's Hospital Melbourne, Kew, Australia
| | | | - Eleanor Curran
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
- St Vincent's Hospital Melbourne, Kew, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Scherazad Kootar
- School of Psychology, University of New South Wales, Sydney, Australia
- Lifecourse Ageing Research Centre, Neuroscience Research Australia, Sydney, Australia
| | - Ruth Peters
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, Australia
- Lifecourse Ageing Research Centre, Neuroscience Research Australia, Sydney, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
- St Vincent's Hospital Melbourne, Kew, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
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Castellani B, Bartington S, Wistow J, Heckels N, Ellison A, Van Tongeren M, Arnold SR, Barbrook-Johnson P, Bicket M, Pope FD, Russ TC, Clarke CL, Pirani M, Schwannauer M, Vieno M, Turnbull R, Gilbert N, Reis S. Mitigating the impact of air pollution on dementia and brain health: Setting the policy agenda. ENVIRONMENTAL RESEARCH 2022; 215:114362. [PMID: 36130664 DOI: 10.1016/j.envres.2022.114362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Emerging research suggests exposure to high levels of air pollution at critical points in the life-course is detrimental to brain health, including cognitive decline and dementia. Social determinants play a significant role, including socio-economic deprivation, environmental factors and heightened health and social inequalities. Policies have been proposed more generally, but their benefits for brain health have yet to be fully explored. OBJECTIVE AND METHODS Over the course of two years, we worked as a consortium of 20+ academics in a participatory and consensus method to develop the first policy agenda for mitigating air pollution's impact on brain health and dementia, including an umbrella review and engaging 11 stakeholder organisations. RESULTS We identified three policy domains and 14 priority areas. Research and Funding included: (1) embracing a complexities of place approach that (2) highlights vulnerable populations; (3) details the impact of ambient PM2.5 on brain health, including current and historical high-resolution exposure models; (4) emphasises the importance of indoor air pollution; (5) catalogues the multiple pathways to disease for brain health and dementia, including those most at risk; (6) embraces a life course perspective; and (7) radically rethinks funding. Education and Awareness included: (8) making this unrecognised public health issue known; (9) developing educational products; (10) attaching air pollution and brain health to existing strategies and campaigns; and (11) providing publicly available monitoring, assessment and screening tools. Policy Evaluation included: (12) conducting complex systems evaluation; (13) engaging in co-production; and (14) evaluating air quality policies for their brain health benefits. CONCLUSION Given the pressing issues of brain health, dementia and air pollution, setting a policy agenda is crucial. Policy needs to be matched by scientific evidence and appropriate guidelines, including bespoke strategies to optimise impact and mitigate unintended consequences. The agenda provided here is the first step toward such a plan.
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Affiliation(s)
- Brian Castellani
- Durham Research Methods Centre, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom; Centre for the Evaluation of Complexity Across the Nexus, University of Surrey, Guildford, GU2 7XH, United Kingdom; Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton Road, DH1 3LE, United Kingdom; Department of Sociology, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom.
| | - Suzanne Bartington
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Jonathan Wistow
- Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton Road, DH1 3LE, United Kingdom; Department of Sociology, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom
| | - Neil Heckels
- Research and Innovation Services, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom
| | - Amanda Ellison
- Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton Road, DH1 3LE, United Kingdom; Department of Psychology, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom
| | - Martie Van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Steve R Arnold
- School of Earth & Environment, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Pete Barbrook-Johnson
- Centre for the Evaluation of Complexity Across the Nexus, University of Surrey, Guildford, GU2 7XH, United Kingdom; Environmental Change Institute, School of Geography and the Environment, University of Oxford, United Kingdom
| | - Martha Bicket
- Centre for the Evaluation of Complexity Across the Nexus, University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Francis D Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
| | - Charlotte L Clarke
- Department of Sociology, Durham University, Stockton Road, Durham, DH1 3LE, United Kingdom; School of Health in Social Science, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom
| | - Monica Pirani
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, W2 1PG, London, United Kingdom
| | - Matthias Schwannauer
- School of Health in Social Science, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom
| | - Massimo Vieno
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, EH26 0QB, United Kingdom
| | - Rachel Turnbull
- Academic Health Sciences Network, North East and North Cumbria, Nuns' Moor Road, Newcastle Upon Tyne NE4 5PL, United Kingdom
| | - Nigel Gilbert
- Centre for the Evaluation of Complexity Across the Nexus, University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Stefan Reis
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, EH26 0QB, United Kingdom; University of Exeter Medical School, European Centre for Environment and Health, Knowledge Spa, Truro, TR1 3HD, United Kingdom; The University of Edinburgh, School of Chemistry, Level 3, Murchison House, 10 Max Born Crescent, The King's Buildings, West Mains Road, Edinburgh, EH9 3BF, United Kingdom
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6
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Chong TWH, Curran E, Southam J, Cox KL, Bryant C, Goh AMY, You E, Ellis KA, Lautenschlager NT. Factors Influencing Long-Term Physical Activity Maintenance: A Qualitative Evaluation of a Physical Activity Program for Inactive Older Adults at Risk of Cognitive Decline: The INDIGO Follow-Up Study. J Alzheimers Dis 2022; 89:1025-1037. [PMID: 35964180 DOI: 10.3233/jad-220202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Physical inactivity is a modifiable risk factor for dementia, but there remains a research translation gap in effective physical activity (PA) implementation, particularly in the longer-term. The INDIGO trial investigated the effectiveness of a six-month PA intervention for inactive older adults at risk of cognitive decline with subjective cognitive decline or mild cognitive impairment. OBJECTIVE This follow-up study aimed to collect feedback from INDIGO participants about their experience of involvement in the trial, including barriers and enablers to longer-term maintenance of PA. METHODS A qualitative study using semi-structured individual interviews was conducted and transcripts analyzed thematically. All INDIGO trial completers were invited, with 29 participating (follow-up period 27-66 months post-baseline). RESULTS At long-term follow-up, participants described INDIGO trial participation as beneficial. The theme of "Motivation" (subthemes: structure and accountability, knowledge and expected benefits, preferences and motivation, tools) followed by "Situation" (subthemes: environment and time, social aspects, aging and physical health) appeared to be critical to PA "Action". Most participants had a positive view of goal-setting and peer mentoring/support, but there was some polarization of opinion. Key factors to longer-term "Maintenance" of PA were self-efficacy and perceived benefits, habit formation, and for some participants, enjoyment. CONCLUSION PA interventions for older adults at risk of cognitive decline should include behavior change techniques tailored to the individual. Effective techniques should focus on "Motivation" (particularly structure and accountability) and "Situation" factors relevant to individuals with the aim of developing self-efficacy, habit formation, and enjoyment to increase the likelihood of longer-term PA maintenance.
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Affiliation(s)
- Terence W H Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,St Vincent's Hospital Melbourne, Fitzroy, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Eleanor Curran
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,St Vincent's Hospital Melbourne, Fitzroy, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Jenny Southam
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Kay L Cox
- Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Anita M Y Goh
- National Ageing Research Institute, Parkville, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Kathryn A Ellis
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,St Vincent's Hospital Melbourne, Fitzroy, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
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Woodward M, Brodaty H, McCabe M, Masters CL, Naismith SL, Morris P, Rowe CC, Walker P, Yates M. Nationally Informed Recommendations on Approaching the Detection, Assessment, and Management of Mild Cognitive Impairment. J Alzheimers Dis 2022; 89:803-809. [PMID: 35964184 PMCID: PMC9535556 DOI: 10.3233/jad-220288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prior to the usual clinical symptoms of dementia, there can be subtle changes in cognitive function that differ from the normal age-related cognitive decline, which has been termed mild cognitive impairment (MCI). The increase in the numbers of individuals with possible MCI presenting to health care professionals, notably, General Practitioners (GPs), is going to rise dramatically in the coming years. With ever increasing demands on GPs, it is therefore timely to provide information that can be accessed by health care professionals to assist them in making appropriate diagnoses and to provide the most relevant, evidence-based treatment options. We have provided a comprehensive list of recommendations that aim to address key aspects of MCI in primary care. Specifically, these relate to detection and diagnosis; sharing the diagnosis, monitoring, and follow up; practical interventions to potentially delay progression; and personalizing care—planning, engagement, and patient motivation for the long term.
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Affiliation(s)
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | - Maree McCabe
- Dementia Australia, Parkville, Victoria, Australia
| | - Colin L Masters
- Florey Institute and The University of Melbourne, Victoria, Australia
| | - Sharon L Naismith
- School of Psychology, The University of Sydney, New South Wales, Australia
| | - Philip Morris
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Christopher C Rowe
- Austin Health, University of Melbourne, Victoria, Australia.,Florey Institute and The University of Melbourne, Victoria, Australia
| | | | - Mark Yates
- Grampians Health, Deakin University, Victoria, Australia
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8
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Godbee K, Guccione L, Palmer VJ, Gunn J, Lautenschlager N, Francis JJ. Dementia Risk Reduction in Primary Care: A Scoping Review of Clinical Guidelines Using a Behavioral Specificity Framework. J Alzheimers Dis 2022; 89:789-802. [DOI: 10.3233/jad-220382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Primary care practitioners are being called upon to work with their patients to reduce dementia risk. However, it is unclear who should do what with whom, when, and under what circumstances. Objective: This scoping review aimed to identify clinical guidelines for dementia risk reduction (DRR) in primary care settings, synthesize the guidelines into actionable behaviors, and appraise the guidelines for specificity. Methods: Terms related to “dementia”, “guidelines”, and “risk reduction” were entered into two academic databases and two web search engines. Guidelines were included if they referred specifically to clinical practices for healthcare professionals for primary prevention of dementia. Included guidelines were analyzed using a directed content analysis method, underpinned by the Action-Actor-Context-Target-Time framework for specifying behavior. Results: Sixteen guidelines were included in the analysis. Together, the guidelines recommended six distinct clusters of actions for DRR. These were to 1) invite patients to discuss DRR, 2) identify patients with risk factors for dementia, 3) discuss DRR, 4) manage dementia risk factors, 5) signpost to additional support, and 6) follow up. Guidelines recommended various actors, contexts, targets, and times for performing these actions. Together, guidelines lacked specificity and were at times contradictory. Conclusion: Currently available guidelines allow various approaches to promoting DRR in primary care. Primary care teams are advised to draw on the results of the review to decide which actions to undertake and the locally appropriate actors, contexts, targets, and times for these actions. Documenting these decisions in more specific, local guidelines for promoting DRR should facilitate implementation.
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Affiliation(s)
- Kali Godbee
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Lisa Guccione
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department on Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Victoria J. Palmer
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- The ALIVE National Centre for Mental Health Research Translation, University of Melbourne, Melbourne, Australia
| | - Jane Gunn
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- The ALIVE National Centre for Mental Health Research Translation, University of Melbourne, Melbourne, Australia
| | - Nicola Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- The ALIVE National Centre for Mental Health Research Translation, University of Melbourne, Melbourne, Australia
| | - Jill J. Francis
- Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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9
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Siette J, Taylor N, Deckers K, Köhler S, Braithwaite J, Valenzuela M, Armitage CJ. Advancing Australian public health initiatives targeting dementia risk reduction. Australas J Ageing 2022; 41:e190-e195. [PMID: 35235243 PMCID: PMC9314903 DOI: 10.1111/ajag.13049] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 12/15/2022]
Abstract
Public health initiatives aim to improve health outcomes for populations by preventing disease and ill‐health consequences of environmental hazards and natural or human‐made disasters. Whilst public health initiatives have been used successfully to modify behaviours for chronic diseases, many initiatives targeting reduced dementia risk in older adults suffer from conceptual and statistical flaws that greatly limit their usefulness. The limited success in modifying lifestyle dementia risk factors has led us to fall short in building a successful roadmap to dementia risk reduction. Here we argue for adopting a population‐level, holistic approach to dementia risk reduction strategies across the lifespan. This approach is supplemented by 10 strategies that focus on improving social policies, harnessing existing policy, legislature and incentive schemes, and identifying feasible approaches to increase recreational and transport‐related physical activity to creating best practice health care that supports healthy brain ageing for all.
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Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Milperra, New South Wales, Australia.,Australian Institute for Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nathan Taylor
- Australian Institute for Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kay Deckers
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Jeffrey Braithwaite
- Australian Institute for Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Michael Valenzuela
- Skin2Neuron Pty Ltd, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
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10
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Bartlett L, Doherty K, Farrow M, Kim S, Hill E, King A, Alty J, Eccleston C, Kitsos A, Bindoff A, Vickers JC. Island Study Linking Aging and Neurodegenerative Disease (ISLAND) Targeting Dementia Risk Reduction: Protocol for a Prospective Web-Based Cohort Study. JMIR Res Protoc 2022; 11:e34688. [PMID: 35230251 PMCID: PMC8924774 DOI: 10.2196/34688] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Up to 40% of incident dementia is considered attributable to behavioral and lifestyle factors. Given the current lack of medical treatments and the projected increase in dementia prevalence, a focus on prevention through risk reduction is needed. OBJECTIVE We aim to increase dementia risk knowledge and promote changes in dementia risk behaviors at individual and population levels. METHODS The Island Study Linking Aging and Neurodegenerative Disease (ISLAND) is a long-term prospective, web-based cohort study with nested interventions that will be conducted over a 10-year period. Target participants (n=10,000) reside in Tasmania and are aged 50 years or over. Survey data on knowledge, attitudes, and behaviors related to modifiable dementia risk factors will be collected annually. After each survey wave, participants will be provided with a personalized dementia risk profile containing guidelines for reducing risk across 9 behavioral and lifestyle domains and with opportunities to engage in educational and behavioral interventions targeting risk reduction. Survey data will be modeled longitudinally with intervention engagement indices, cognitive function indices, and blood-based biomarkers, to measure change in risk over time. RESULTS In the initial 12 months (October 2019 to October 2020), 6410 participants have provided baseline data. The study is ongoing. CONCLUSIONS Recruitment targets are feasible and efforts are ongoing to achieve a representative sample. Findings will inform future public health dementia risk reduction initiatives by showing whether, when, and how dementia risk can be lowered through educational and behavioral interventions, delivered in an uncontrolled real-world context. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34688.
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Affiliation(s)
- Larissa Bartlett
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Kathleen Doherty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Maree Farrow
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Sarang Kim
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Edward Hill
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Anna King
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Claire Eccleston
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Alex Kitsos
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Aidan Bindoff
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
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11
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Le Couteur DG, Flicker L, Hilmer SN. Geriatric medicine and health care for older people in Australia. Age Ageing 2022; 51:6543102. [PMID: 35253051 DOI: 10.1093/ageing/afac001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Indexed: 11/14/2022] Open
Abstract
Aged care coverage in Australia is universal but fragmented and has been challenged by government policy to deregulate aged care and open it up to market forces. A recent inquiry into aged care (Royal Commission into Aged Care Quality and Safety) documented the outcome of this policy-substandard care at most levels. The provision of services to older Aboriginal and Torres Strait Islander peoples, who have high prevalence of frailty and cognitive impairment, was also identified as inadequate. The effects of yet to be implemented changes in policy and funding in response to this report remain to be seen. Despite this policy backdrop, geriatricians have contributed to a steady growth in medical services and interventions focussed on specific geriatric issues such as dementia, falls, polypharmacy and orthogeriatrics. These are often driven by, or in collaboration with researchers, and aim to generate research data as well as provide patient care. The numbers of academic geriatricians and other aged care health professionals is increasing, and the training of specialist geriatricians now includes a significant research component.
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Affiliation(s)
- David G Le Couteur
- ANZAC Research Institute and Charles Perkins Centre, University of Sydney, Sydney, Australia.,Department of Geriatric Medicine, Concord Hospital, Sydney, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia.,Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
| | - Sarah N Hilmer
- Kolling Institute, University of Sydney, Sydney, Australia.,Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, Australia
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12
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Thompson F, Russell SG, Harriss LR, Esterman A, Taylor S, Quigley R, Strivens E, McDermott R. Using Health Check Data to Understand Risks for Dementia and Cognitive Impairment Among Torres Strait Islander and Aboriginal Peoples in Northern Queensland—A Data Linkage Study. Front Public Health 2022; 10:782373. [PMID: 35252085 PMCID: PMC8888447 DOI: 10.3389/fpubh.2022.782373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objective High rates of dementia are evident in First Nations populations, and modifiable risk factors may be contributing to this increased risk. This study aimed to use a longitudinal dataset to gain insights into the long-term risk and protective factors for dementia and cognitive impairment not dementia (CIND) in a Torres Strait Islander and Aboriginal population in Far North Queensland, Australia. Study Design and Setting Probabilistic data linkage was used to combine baseline health check data obtained in 1998/2000 and 2006/2007 for 64 residents in remote communities with their results on a single dementia assessment 10–20 years later (2015–2018). The relationship between earlier measures and later CIND/dementia status was examined using generalized linear modeling with risk ratios (RRs). Due to the small sample size, bootstrapping was used to inform variable selection during multivariable modeling. Results One third of participants (n = 21, 32.8%) were diagnosed with dementia (n = 6) or CIND (n = 15) at follow-up. Secondary school or further education (RR = 0.38, 95% CI 0.19–0.76, p = 0.006) and adequate levels of self-reported physical activity (RR = 0.26, 95% CI 0.13–0.52, p < 0.001) were repeatedly selected in bootstrapping and showed some evidence of protection against later CIND/dementia in final multivariate models, although these had moderate collinearity. Vascular risk measures showed inconclusive or unexpected associations with later CIND/dementia risk. Conclusions The preliminary findings from this small study highlighted two potential protective factors for dementia that may be present in this population. A tentative risk profile for later CIND/dementia risk is suggested, although the small sample size limits the applicability of these findings.
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Affiliation(s)
- Fintan Thompson
- College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
- *Correspondence: Fintan Thompson
| | - Sarah G. Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Linton R. Harriss
- College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Adrian Esterman
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Robyn McDermott
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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13
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Chong TWH, Kootar S, Wilding H, Berriman S, Curran E, Cox KL, Bahar-Fuchs A, Peters R, Anstey KJ, Bryant C, Lautenschlager NT. Exercise interventions to reduce anxiety in mid-life and late-life anxiety disorders and subthreshold anxiety disorder: a systematic review. Ther Adv Psychopharmacol 2022; 12:20451253221104958. [PMID: 35833057 PMCID: PMC9272174 DOI: 10.1177/20451253221104958] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anxiety disorders are highly prevalent and cause significant distress, disability, and cost. Medication adverse effects and interactions increase in mid-life and late-life, highlighting the need for effective non-pharmacological interventions. OBJECTIVES We aimed to evaluate the extent of evidence supporting exercise interventions for anxiety and subthreshold anxiety disorders in mid-life and late-life. DESIGN Systematic review. DATA SOURCES AND METHODS We searched MEDLINE, PsycINFO, Embase, Emcare, Ovid Nursing, CINAHL Plus, Cochrane Library, Health Collection, Humanities & Social Sciences Collection, and https://clinicaltrials.gov databases for trials published January 1994-May 2019. Randomised controlled trials of exercise interventions involving aerobic exercise or resistance training for adults aged 40 years and above with anxiety or subthreshold anxiety disorders in residential or health settings were identified. The primary outcome was change in anxiety. We excluded trials including participants aged below 40 years, participants with diagnosis of separation anxiety, selective mutism, obsessive-compulsive disorder, acute stress disorder and post-traumatic stress disorder, and head-to-head comparisons of interventions. Trial quality was assessed using the Cochrane Risk of Bias Tool and evidence synthesised in narrative form. RESULTS Four trials totalling 132 participants met inclusion criteria, although some had methodological limitations. Interventions included a home-based resistance training intervention, supervised group-based aerobic intervention, Tai Chi intervention, and supervised group-based aerobic and strength intervention. Three trials included late-life participants and the fourth mid-life. Three trials demonstrated greater reductions in anxiety in the intervention group compared with control. The fourth trial showed pre-post reductions in anxiety in both groups, with between-group difference not reaching statistical significance. CONCLUSION There is limited supportive evidence suggesting that exercise interventions have potential to be effective, feasible and safe non-pharmacological interventions for anxiety and subthreshold anxiety disorders in mid-life and late-life. The heterogeneity, limited number and high risk of bias of some trials meant that we were not able to conduct a meta-analysis. Tailoring of interventions may improve uptake and reduce dropout. The paucity of research in this area with only four included trials demonstrates the urgent need for future and larger trials to provide proof of concept, data about effective types and doses of exercise interventions, and guidance to community, clinical, and public health services.
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Affiliation(s)
- Terence W H Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne and St Vincent's Hospital Melbourne, St George's Campus, 283 Cotham Road, Kew, VIC 3101, Australia
| | - Scherazad Kootar
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Helen Wilding
- St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Sarah Berriman
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Eleanor Curran
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Kay L Cox
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Alex Bahar-Fuchs
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Ruth Peters
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
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14
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Chong TWH, You E, Ellis KA, Cox KL, Harrington KD, Rainey-Smith SR, Ames D, Lautenschlager NT. The Support Person's Preferences and Perspectives of Physical Activity Programs for Older Adults With Cognitive Impairment. Front Public Health 2021; 9:704561. [PMID: 34631645 PMCID: PMC8495209 DOI: 10.3389/fpubh.2021.704561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/19/2021] [Indexed: 12/31/2022] Open
Abstract
Objectives: Physical activity (PA) is beneficial for older adults' cognition. There is limited research investigating perspectives of support persons (SPs) of next-of-kins (NOKs) with cognitive impairment. This exploratory study aimed to investigate perspectives of SPs of older adults with Alzheimer's Dementia (AD) or Mild Cognitive Impairment (MCI). Methods: A telephone survey of 213 SPs of NOKs from the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing (AIBL) was undertaken to quantitatively assess SPs' beliefs and knowledge about PA benefits, current PA level of their NOK, and PA program preferences. The contribution of age, gender, diagnosis and mental health symptoms was assessed using multiple logistic regression analyses. Results: Many SPs were aware of PA benefits for memory (64%) and believed it would help their NOK (72%). Older SP age was associated with less awareness of benefits (p = 0.016). SPs caring for male NOKs were more likely to believe that PA would be helpful than those caring for female NOKs (p = 0.049). NOK AD diagnosis (rather than MCI) (p = 0.014), older age (p = 0.005) and female gender (p = 0.043) were associated with lower PA levels. SPs were mixed regarding preference for their NOKs to participate in individual (45%) or group (54%) PA. Many SPs wanted to participate in PA with their NOK (63%). Conclusions: The results highlight that SPs have high levels of awareness of the cognitive benefits of PA, and describe their preferences regarding PA programs. The findings provide new information to inform targeted public health messaging, PA prescribers and providers, and future research directions.
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Affiliation(s)
- Terence W H Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Epworth Healthcare, Melbourne, VIC, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Kathryn A Ellis
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Kay L Cox
- Royal Perth Hospital Unit, Medical School, University of Western Australia, Perth, WA, Australia
| | - Karra D Harrington
- Centre for Healthy Aging, The Pennsylvania State University, University Park, PA, United States
| | - Stephanie R Rainey-Smith
- Centre of Excellence for Alzheimer's Disease Research and Care, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Sir James McCusker Alzheimer's Disease Research Unit, Hollywood Private Hospital, Nedlands, WA, Australia
| | - David Ames
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,National Ageing Research Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia.,Division of Psychiatry and WA Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia
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15
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Curran E, Chong TWH, Godbee K, Abraham C, Lautenschlager NT, Palmer VJ. General population perspectives of dementia risk reduction and the implications for intervention: A systematic review and thematic synthesis of qualitative evidence. PLoS One 2021; 16:e0257540. [PMID: 34534250 PMCID: PMC8448319 DOI: 10.1371/journal.pone.0257540] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/06/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Evidence for the potential prevention of dementia through lifestyle risk factor modification is growing and has prompted examination of implementation approaches. Understanding the general population's perspectives regarding dementia risk reduction is key to implementation. This may provide useful insights into more effective and efficient ways to help people change relevant beliefs, motivations and behaviour patterns. We conducted a systematic review and thematic synthesis of qualitative evidence to develop an integrated model of general population dementia risk reduction perspectives and the implications for intervention in research and implementation contexts. METHODS AND FINDINGS We searched electronic databases, supplemented by lateral search techniques, to identify studies published since 1995 reporting qualitative dementia risk reduction perspectives of the non-expert general population who do not have dementia. Thematic synthesis, incorporating an expert panel discussion, was used to identify overarching themes and develop an integrated model to guide intervention to support individuals to adopt and maintain dementia risk reduction behaviour patterns. Quality of included studies and confidence in review findings were systematically appraised. We included 50 papers, reflecting the views of more than 4,500 individuals. Main themes were: 1) The need for effective education about a complex topic to prevent confusion and facilitate understanding and empowerment; 2) Personally relevant short- and long-term benefits of dementia risk reduction behaviour patterns can generate value and facilitate action; 3) Individuals benefit from trusted, reliable and sensitive support to convert understanding to personal commitment to relevant behaviour change; 4) Choice, control and relevant self-regulatory supports help individuals take-action and direct their own progress; 5) Collaborative and empowering social opportunities can facilitate and propagate dementia risk reduction behaviour change; 6) Individual behaviour patterns occur in social contexts that influence beliefs through heuristic processes and need to be understood. Findings indicate that, for intervention: 1) education is key, but both content and delivery need to be tailored; 2) complementary interventions to support self-regulation mechanisms and social processes will increase education effectiveness; 3) co-design principles should guide intervention design and delivery processes; 4) all interventions need to be supported by context-specific data. CONCLUSIONS This systematic review and thematic synthesis provides a comprehensive, integrated model of the dementia risk reduction perspectives of the general population and intervention approaches to support behaviour change that can be applied in clinical trial and real-world implementation settings. Findings extend existing knowledge and may assist more effective intervention design and delivery.
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Affiliation(s)
- Eleanor Curran
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- St Vincent’s Hospital Melbourne, Kew, Victoria, Australia
| | - Terence W. H. Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- St Vincent’s Hospital Melbourne, Kew, Victoria, Australia
| | - Kali Godbee
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Charles Abraham
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Nicola T. Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Victoria J. Palmer
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- The Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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