MEMO+: Efficacy,Durability and Effect of Cognitive Training and Psychosocial Intervention in Individuals with Mild Cognitive Impairment

Background/Objectives

There is no consensus on the efficacy of cognitive training in persons with mild cognitive impairment (MCI) because of the paucity of well‐designed randomized controlled trials. The objective was to assess the effect of memory training on the cognitive functioning of persons with MCI and its durability and to evaluate whether this effect generalizes to daily life and whether positive effects could be obtained from psychosocial intervention.

Design

Single‐blind randomized controlled trial.

Setting

Research centers of the Institut Universitaire de Gériatrie de Montréal and Institut Universitaire en Santé Mentale de Québec.

Participants

Older adults meeting criteria for amnestic MCI (N = 145).

Intervention

Participants were randomized to cognitive training, a psychosocial intervention, or a no‐contact control condition. Interventions were provided in small groups in eight 2‐hour sessions.

Measurement

Outcome measures were immediate and delayed composite performance memory scores, psychological health (depression, anxiety, well‐being), and generalization effects of the intervention (strategy use in everyday life, difficulties in complex activities of daily living, memory complaints). Testing was administered before training and immediately, 3 months, and 6 months after training.

Results

Participants in the cognitive training condition improved on the delayed composite memory score and on strategy use in everyday life. Improvement was maintained at the 3‐ and 6‐month follow‐up assessments. Participants in the psychosocial and no‐contact conditions did not show any significant improvement.

Conclusion

Cognitive training improves the memory of persons with amnestic MCI. The effect persists over a 6‐month period, and learned strategies are used in everyday life. Cognitive training is a valid way to promote cognition in MCI.     

Falls in Cognitively Impaired Older Adults: Implications for Risk Assessment And Prevention

Objectives

To provide an overview of the role of cognition in falls, with potential implications for managing and preventing falls in older adults.

Design

Review.

Setting

Observational and interventional studies addressing the role of cognition on falls.

Participants

Community‐dwelling older adults (65 years and older).

Measurements

The relationship between gait and cognition in aging and neurodegeneration was reviewed in the medical literature to highlight the role of brain motor control deficits in fall risk. The benefits of dual‐task gait assessments as a marker of fall risk were reviewed. Therapeutic approaches for reducing falls by improving certain aspects of cognition were appraised.

Results

Low performance in attention and executive function are associated with gait slowing, instability, and future falls. Drug‐enhancement of cognition may reduce falls in Parkinson's disease, and cognitive training, dual‐task training, and virtual reality modalities are promising to improve mobility in sedentary older adults and in those with cognitive impairment and dementia.

Conclusion

Falls remain common in older people, with higher prevalence and morbidity in those who are cognitively impaired. Disentangling the mechanism and contribution of cognitive deficits in fall risk may open new treatment approaches. Mounting evidence supports that cognitive therapies help reduce falls.     

New Institutionalization in Long‐Term Care After Hospital Discharge to Skilled Nursing Facility

Background/Objectives

Approximately half of individuals newly admitted to long‐term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective was to examine characteristics associated with new institutionalizations of older adults on this care trajectory.

Design

Retrospective cohort study.

Setting

SNFs and LTC NHs.

Patients

Medicare fee‐for‐service beneficiaries admitted to 7,442 SNFs in 2013 (N = 597,986).

Measurements

We used demographic and clinical characteristics from Medicare data and the Minimum Data Set. We defined “new institutionalization” as LTC NH residence for longer than 90 non‐SNF days, starting within 6 months of hospital discharge.

Results

For individuals who survived 6 months after hospital discharge, the overall rate of new LTC institutionalizations was 10.0% (N = 59,736). Older age, white race, being unmarried, Medicaid eligibility, higher income, more comorbidities, cognitive impairment, depression, functional limitations, hallucinations and delusions, aggressive behavior, incontinence, and pressure ulcers were associated with higher adjusted odds of new LTC institutionalization. In analyses stratified according to race and ethnicity, higher income was associated with lower odds of LTC institutionalization for whites (odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.89–0.96) and greater odds for blacks (OR = 1.40, 95% CI = 1.27–1.55) and Hispanics (OR = 1.44, 95% CI = 1.25–1.66). Moderate or severe depression, functional limitations, hallucinations and delusions, aggressive behavior, and being unmarried were stronger risk factors for LTC for cognitively intact individuals than for those with moderate to severe cognitive impairment. Being unmarried and having more comorbidities were stronger predictors in those aged 66 to 70 than in those aged 81 to 85 and 91 and older.

Conclusion

Associations between risk factors and new LTC institutionalizations varied according to race and ethnicity, age, and level of cognitive function. Programs that target older adults at greater risk may be an effective strategy for reducing new institutionalizations and fostering aging in place.     

Effect of Mindfulness‐Based stress reduction in rheumatoid arthritis patients

Objective

To assess the effect of a meditation training program, Mindfulness‐Based Stress Reduction (MBSR), on depressive symptoms, psychological status, and disease activity in patients with rheumatoid arthritis (RA) through a randomized, waitlist‐controlled pilot study.

Methods

Participants were randomized to either an MBSR group, where they attended an 8‐week course and 4‐month maintenance program, or to a waitlist control group, where they attended all assessment visits and received MBSR free of charge after study end. Participants received usual care from their rheumatologists throughout the trial. Self‐report questionnaires were used to evaluate depressive symptoms, psychological distress, well‐being, and mindfulness. Evaluation of RA disease activity (by Disease Activity Score in 28 joints) included examination by a physician masked to treatment status. Adjusted means and mean changes in outcomes were estimated in mixed model repeated measures analyses.

Results

Sixty‐three participants were randomized: 31 to MBSR and 32 to control. At 2 months, there were no statistically significant differences between groups in any outcomes. At 6 months, there was significant improvement in psychological distress and well‐being (P = 0.04 and P = 0.03, respectively), and marginally significant improvement in depressive symptoms and mindfulness (P = 0.08 and P = 0.09, respectively). There was a 35% reduction in psychological distress among those treated. The intervention had no impact on RA disease activity.

Conclusion

An 8‐week MBSR class was not associated with change in depressive symptoms or other outcomes at 2‐month followup. Significant improvements in psychological distress and well‐being were observed following MBSR plus a 4‐month program of continued reinforcement. Mindfulness meditation may complement medical disease management by improving psychological distress and strengthening well‐being in patients with RA.     

Hepatitis C Virus Clearance in Older Adults

Objectives

To determine whether older adults with the hepatitis C virus (HCV) achieve a sustained viral response (SVR) after treatment with direct‐acting antiviral therapy.

Participants

Individuals aged 80 and older with chronic HCV infection (N = 253; n = 213 with cirrhosis, n = 40 with advanced fibrosis).

Measurements

We investigated the efficacy, safety, and global clinical effect of treatment with different combinations of direct antiviral agents (DAAs). Participants with cirrhosis were staged according to Child‐Pugh‐Turcotte class, Model for End‐Stage Liver Disease score, and the D'Amico staging system. The type and number of comorbidities at baseline and hepatic and nonhepatic events during follow‐up were registered.

Results

Ninety‐five percent of participants with cirrhosis and 95% of those with advanced fibrosis attained SVR. The rate was independent of sex, HCV genotype, and treatment schedule. During a mean follow‐up of 14 ± 4 months (range 5–23 months), 34 events occurred in 27 participants: 10 hepatocellular carcinomas, 12 hepatic decompensations, 9 nonhepatic events, 3 deaths. Multivariate analysis of risk factors for experiencing adverse events during follow up showed that participants in D'Amico Stages 4 and 5, with a baseline serum albumin level of 3.5 mg/dL or less, and 3 or more comorbidities were the most at risk.

Conclusion

In a real‐world setting, DAAs are safe and effective in older adults with HCV‐related advanced fibrosis or cirrhosis. Individuals with preserved albumin synthesis and fewer than 3 comorbidities at baseline have the most to gain from long‐term DAA therapy.     

Online acceptance and commitment therapy as treatment for loneliness among older adults: Report of a pilot study

Background

Loneliness has been linked to cognitive decline, cardiovascular risk, and risk of mortality among older adults. Creative approaches are needed to increase access for older adults to evidence-based intervention programs. One possible approach is acceptance and commitment therapy (ACT). The aim of this study was to pilot test a novel ACT-based online intervention to decrease loneliness in older adults living in the community.

Methods

A self-paced online ACT program consisting of eight interactive modules designed to teach participants skills to address common contributors to loneliness was evaluated. It was delivered to a sample of 529 men and women, aged 65 or over, who were assessed pre-intervention, postintervention, and at a one-month follow-up, with a short 10-item version of the UCLA Loneliness Scale.

Results

For participants who completed all eight modules of the intervention, average levels of loneliness significantly decreased from pre- to posttreatment, b = −0.013, t (385) = −4.69, p < 0.001 (Cohen's d = 0.30). The improvement in loneliness was maintained at the one-month follow-up assessment. These improvements were particularly robust for individuals who were lonely at outset (Cohen's d = 0.73). The change in loneliness among these individuals was significantly greater than that observed in members of a “hold-out” group of lonely individuals that did not participate in the intervention (Cohen's d = 0.24).

Conclusions

This pilot investigation suggests the feasibility of this program for decreasing loneliness in older adults. Future controlled investigations with long-term follow-up assessments are needed to confirm the effectiveness and sustained benefits of the program.     

Tai Chi in Australia: acceptable and effective approach to improve balance and mobility in older people?

Objective: To evaluate the effects of 24 form Tai Chi Quan (TCQ) on balance and related measures, and factors associated with participation in the program. Methods: Twenty‐three older subjects (mean age 71.0 years, SD 5.6 years) commenced the three times weekly 1 h TCQ sessions. Subjects were measured on balance (Functional Reach, Step Test), gait (velocity, double support phase duration), activity level, leg muscle strength, and the Modified Falls Efficacy Scale (MFES) before and following the 3 month program. Participants also completed a survey investigating participation and perceived benefit of the program. Results: Nineteen participants completed the program, averaging attendance at 68% of classes. There was significant improvement in balance (Step Test, P < 0.01) and non‐significant improvement in gait double support duration (P = 0.04), Functional Reach (P = 0.04) and activity level (P = 0.06). Most participants incorporated some home practice as well as the formal program, and reported both the physical (balance) components and remembering sequences of movements as the most challenging aspects of the program. Conclusions: Twenty‐four form TCQ is a practical form of exercise for older people that improves dynamic balance performance.     

Enabling social care services for older adults during periods of long-term social isolation: Service provider perspectives

Objective

To investigate how small, local organisations were impacted by and responded to COVID-19 in their delivery of social care services to older adults (70 years and older). Lessons learnt and future implications are discussed.

Methods

Six representatives from four social care services (five females and one male) participated in individual semistructured interviews. Responses were analysed thematically.

Results

The key themes identified were service providers' experience, perceived needs of older adults and adapting services. Service providers positioned themselves as front-line essential workers for their older adult clients, resulting in some emotional toll and distress for the service providers. They provided information, wellness checks and at-home assistance to keep their older adult clients connected.

Conclusions

Service providers feel more prepared for future restrictions but flag the potential of training and supporting older adults to use technology to stay connected, as well as the need for more readily available funding to allow services to adapt quickly during times of crisis.     

Road Test and Naturalistic Driving Performance in Healthy and Cognitively Impaired Older Adults: Does Environment Matter?

Objectives

To relate the standardized road test to video recordings of naturalistic driving in older adults with a range of cognitive impairment.

Design

Cross‐sectional observational study.

Setting

Academic medical center memory disorders clinic.

Participants

One hundred three older drivers (44 healthy, 59 with cognitive impairment) who passed a road test.

Measurements

Error rate and global ratings of safety (pass with and without recommendations, marginal with restrictions or training, or fail) made by a professional driving instructor.

Results

There was fair agreement between global ratings on the road test and naturalistic driving. More errors were detected in the naturalistic environment, but this did not affect global ratings. Error scores between settings were significantly correlated, and the types of errors made were similar. History of crashes corrected for miles driven per week was related to road test error scores but not naturalistic driving error scores. Global cognition (Mini‐Mental State Examination) was correlated with road test and naturalistic driving errors. In healthy older adults, younger age was correlated with fewer errors on the road test and more errors in naturalistic driving.

Conclusion

Road test performance is a reasonable proxy for estimating fitness to drive in older individuals' typical driving environments, but differences between performance assessed using these two methods remain poorly understood and deserve further study.     

Study of Mental Activity and Regular Training (SMART) in at risk individuals: A randomised double blind,sham controlled,longitudinal trial

Background

The extent to which mental and physical exercise may slow cognitive decline in adults with early signs of cognitive impairment is unknown. This article provides the rationale and methodology of the first trial to investigate the isolated and combined effects of cognitive training (CT) and progressive resistance training (PRT) on general cognitive function and functional independence in older adults with early cognitive impairment: Study of Mental and Regular Training (SMART). Our secondary aim is to quantify the differential adaptations to these interventions in terms of brain morphology and function, cardiovascular and metabolic function, exercise capacity, psychological state and body composition, to identify the potential mechanisms of benefit and broader health status effects.

Methods

SMART is a double-blind randomized, double sham-controlled trial. One hundred and thirty-two community-dwelling volunteers will be recruited. Primary inclusion criteria are: at risk for cognitive decline as defined by neuropsychology assessment, low physical activity levels, stable disease, and age over 55 years. The two active interventions are computerized CT and whole body, high intensity PRT. The two sham interventions are educational videos and seated calisthenics. Participants are randomized into 1 of 4 supervised training groups (2 d/wk × 6 mo) in a fully factorial design. Primary outcomes measured at baseline, 6, and 18 months are the Alzheimer's Disease Assessment Scale (ADAS-Cog), neuropsychological test scores, and Bayer Informant Instrumental Activities of Daily Living (B-IADLs). Secondary outcomes are psychological well-being, quality of life, cardiovascular and musculoskeletal function, body composition, insulin resistance, systemic inflammation and anabolic/neurotrophic hormones, and brain morphology and function via Magnetic Resonance Imaging (MRI) and Spectroscopy (fMRS).

Discussion

SMART will provide a novel evaluation of the immediate and long term benefits of CT, PRT, and combined CT and PRT on global cognitive function and brain morphology, as well as potential underlying mechanisms of adaptation in older adults at risk of further cognitive decline.

Trial Registration

Australia and New Zealand Clinical Trials Register (ANZCTR): ANZCTRN12608000489392

     

A Model Program of Community‐Based Supports for Older Adults at Risk of Nursing Facility Placement

Transitioning an older adult into a nursing facility is a major life event for older adults (care recipients, CRs) and their family caregivers (CGs). This article describes the implementation of a community living program and presents findings on important health and well‐being indicators. One hundred ninety‐one participants aged 60 and older not eligible for or currently enrolled in Medicaid and meeting four risk domains (functional, health, cognitive/emotional, informal support system) were enrolled for the 10‐month program. Two evidence‐based interventions were blended into a comprehensive community‐based approach to long‐term care that included $750 per month for home care services. Measures were conducted at baseline and 6 and 12 months. Nine (6%) participants did not complete the program because of nursing facility admission. CRs had fewer physician visits (4.1 vs 7.3, P < .001), emergency department visits (0.3 vs 1.4, P < .001), hospital stays (0.4 vs 0.9, P < .001), and total nights in the hospital (0.8 vs 5.1, P < .001) at 12 months than at baseline. Center for Epidemiologic Studies Depression Scale (CES‐D) scores also improved significantly (6.8 vs 9.4, P < .001). CGs had improvements in CES‐D scores (5.9 vs 3.9, P < .001) and CG burden (14.7 s 12.6, P = .01) from baseline to 12 months. This multicomponent program improved the physical and mental health of CGs and CRs at risk of nursing facility placement. Future studies are needed to compare the overall placement rate to determine the success of diverting nursing facility placement in this population of older adults.     

A group study on the effects of a short multi-domain cognitive training in healthy elderly Italian people

Background

Alongside physiological cognitive ageing, nowadays there is an alarming increase in the incidence of dementia that requires communities to invest in its prevention. The engagement in cognitively stimulating activities and strong social networks has been identified among those protective factors promoting successful cognitive ageing. One aspect regarding cognitive stimulation concerns the relevance of the frequency of an external intervention. For this reason, the aim of this study was to evaluate the efficacy of a 3-month cognitive training program, once per week, in a group of healthy elderly aged over 60?years old. Their results were compared with those of a passive control group.

Methods

The training consisted of a weekly session of multi-domain and ecological cognitive exercises performed in small homogenous (i.e. same cognitive level) groups. The scores obtained in a neuropsychological assessment by the experimental and control groups were compared at pre- and post-training. In addition, by means of a questionnaire, we also evaluated the indirect effect of the program on participants’ mood, socialization and perceived impact on everyday activities.

Results

Overall, the experimental group showed a general improvement in cognitive functioning following the training program, even with the frequency of once per week. Greater improvements were observed mainly on executive functions and short-term memory, but general cognitive functioning and non-verbal reasoning also showed a tendency to an improvement. It is noteworthy that a majority of the participants reported to have subjectively experienced an improvement in their everyday life and a positive influence on both mood and socialization.

Conclusions

These results show that even a low-intensity training program is able to promote some of the protective factors that support successful cognitive ageing. Moreover, this multi-domain approach proved to be an excellent training method to transfer gains not only to other cognitive domains, but also to everyday living.

Trial registration

NCT03771131; the study was retrospectively registered on December 7th 2018.

     

A Cognitive Training Program Based on Principles of Brain Plasticity: Results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) Study

OBJECTIVES: To investigate the efficacy of a novel brain plasticity–based computerized cognitive training program in older adults and to evaluate the effect on untrained measures of memory and attention and participant‐reported outcomes. DESIGN: Multisite randomized controlled double‐blind trial with two treatment groups. SETTING: Communities in northern and southern California and Minnesota. PARTICIPANTS: Community‐dwelling adults aged 65 and older (N=487) without a diagnosis of clinically significant cognitive impairment. INTERVENTION: Participants were randomized to receive a broadly‐available brain plasticity–based computerized cognitive training program (intervention) or a novelty‐ and intensity‐matched general cognitive stimulation program modeling treatment as usual (active control). Duration of training was 1 hour per day, 5 days per week, for 8 weeks, for a total of 40 hours. MEASUREMENTS: The primary outcome was a composite score calculated from six subtests of the Repeatable Battery for the Assessment of Neuropsychological Status that use the auditory modality (RBANS Auditory Memory/Attention). Secondary measures were derived from performance on the experimental program, standardized neuropsychological assessments of memory and attention, and participant‐reported outcomes. RESULTS: RBANS Auditory Memory/Attention improvement was significantly greater (P=.02) in the experimental group (3.9 points, 95% confidence interval (CI)=2.7–5.1) than in the control group (1.8 points, 95% CI=0.6–3.0). Multiple secondary measures of memory and attention showed significantly greater improvements in the experimental group (word list total score, word list delayed recall, digits backwards, letter–number sequencing; P<.05), as did the participant‐reported outcome measure (P=.001). No advantage for the experimental group was seen in narrative memory. CONCLUSION: The experimental program improved generalized measures of memory and attention more than an active control program.     

Olfactory dysfunction and cognition among older adults in the United States

Background

In this work we assess the association between olfactory dysfunction and cognition in a nationally representative sample of older adults in the United States.

Methods

Participants aged ≥60 years (n = 1236) from the 2013–2014 National Health and Nutritional Examination Survey underwent both olfactory and cognitive testing. Olfaction was assessed by both objective test (8‐odor Pocket Smell Test: smell impairment defined as score ≤2) and self‐report. Cognitive assessment consisted of the Digit Symbol Substitution Test (DSST), the Animal Fluency Test, and the Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Regression models were used to examine the association between olfaction and cognition while adjusting for demographics, cardiovascular factors, and associated medical history.

Results

The prevalence of smell impairment in US older adults was 18.0% (95% confidence interval [CI], 14.0‐22.0%) and 22.0% (95% CI, 18.5‐25.6%) based on objective smell test and self‐report, respectively. In a multivariate model adjusted for relevant factors, low smell test scores were consistently associated with low scores on cognitive assessments, with a DSST score difference of ?1.5 (95% CI, ?2.2 to ?0.8), Animal Fluency Test score difference of ?0.4 (95% CI, ?0.7 to ?0.1), and CERAD Word List score difference of ?0.4 (95% CI, ?0.6 to ?0.2) per 1‐point decrease in smell test score. There was no association between self‐reported smell impairment and cognition.

Conclusion

Objectively measured olfactory dysfunction is independently associated with cognitive impairment. These findings are consistent with previous studies and suggest the utility of objective olfactory tests as an indicator for cognitive impairment as compared with self‐reported olfactory dysfunction, which is an uncertain indicator.

     

The effects of vigorous exercise training on physical function in children with arthritis: A randomized,controlled, SINGLE‐BLINDED trial

Objective

To examine the effectiveness of high‐intensity aerobic training compared with low‐intensity training in terms of energy cost of locomotion, peak oxygen uptake, peak power, and self‐reported physical function in children with juvenile idiopathic arthritis (JIA).

Methods

Eighty children with JIA, ages 8–16 years, were enrolled in a randomized, single‐blind controlled trial. Both groups participated in a 12‐week, 3‐times–weekly training program consisting of high‐intensity aerobics in the experimental group and qigong in the control group. Subjects underwent exercise testing measuring submaximal oxygen uptake at 3 km/hour (VO _2submax) as the primary outcome, maximal oxygen uptake, and peak power at the beginning and end of the program. Physical function was measured using the Child Health Assessment Questionnaire (C‐HAQ).

Results

The exercise program was well tolerated in both groups. There was no difference in VO _2submax or any other exercise testing measures between the groups through the study period and no indication of improvement. Both groups showed significant improvements in C‐HAQ with no difference between the groups. Adherence was higher in the control group than the experimental group.

Conclusion

Our findings suggest that activity programs with or without an aerobic training component are safe and may result in an important improvement in physical function. The intensity of aerobic training did not seem to provide any additional benefits, but higher adherence in the qigong program may suggest that less intensive regimens are easier for children with JIA to comply with, and provide a degree of benefit equivalent to more intensive programs.     

Measuring changes in activity participation of older Australians: Validation of the Activity Card Sort – Australia

Objectives: This study explored the psychometric properties of the Australian version of the Activity Card Sort (ACS‐Aus), a recently developed measure of activity participation for use with older adults. Concurrent, convergent construct, and discriminative construct validity were examined. Methods: The study included 93 Australian adults aged 60–95 years. Participants completed the ACS‐Aus, as well as an existing Australian measure of activity participation (The Adelaide Activities Profile) and an Australian measure of subjective well‐being (the Personal Well‐being Index). Results: The ACS‐Aus demonstrated moderate concurrent validity (r = 0.434), moderate convergent construct validity (r = 0.354), and strong discriminative validity (P = 0.000). Conclusions: The World Health Organization has recently promoted participation as an important component of the healthy ageing process. This study has validated the use of the ACS‐Aus in measuring participation of community‐dwelling older adults in Australia.     

Supporting a comprehensive and coordinated evaluation of the elderly with diabetes by integrating cognitive and physical assessment in the evaluation process

Background

Successful ageing with diabetes is challenged by co‐morbidities, which may present barriers to self‐care. Currently, measurement of physical and cognitive status is not part of routine care of the older person with diabetes, and these are not taken into account when devising the treatment plan.

Objective

To describe a novel approach that integrates cognitive and physical assessment into the routine evaluation of the older person with diabetes and the tailor‐made treatment plan devised accordingly. To provide estimates of the relative contribution of cognitive and physical disabilities in this population.

Methods

Cognitive and physical assessments were added to the standard evaluation. A composite measure of cognitive and of physical status categorizing each individual to intact, mild, or severe impairment was generated. In addition, all recommendations provided were categorized and tabulated.

Results

Of 119 individuals, over the age of 60 with type 2 diabetes who were referred because of difficulties in managing their disease, 16% and 3% of individuals met the criteria for severe cognitive/physical impairment, respectively, and 42% and 21% met the criteria for mild cognitive/physical impairment; 72%, 12.5%, 61% received recommendations related to intensification of physical activity, cognitive treatment, change in pharmacological agents, respectively. 25% were referred for further emotional treatment.

Conclusions

These data suggest that a substantial proportion of individuals with diabetes over the age of 60 may have cognitive/physical impairment. It highlights the importance of measuring these as part of the multidisciplinary evaluation and being able to provide a tailor made treatment plan.     

A Randomized Controlled Trial of a Community-based Behavioral Counseling Program

Background

The US Preventive Services Task Force (USPSTF) recommends that clinicians refer obese adults for intensive, multicomponent behavioral counseling, yet most obese Americans choose a self-help approach to lose weight. The current study examined weight loss between a community-based, intensive behavioral counseling program (Weight Watchers program) and a self-help condition.

Methods

A total of 292 participants were randomized to either a Weight Watchers condition (WW) (n = 147) or a self-help condition (n = 145). Participants in the WW condition were provided with 3 ways to access the treatment: weekly meetings; WW mobile application; and WW online tools. Weights were measured at baseline and at 3 and 6 months. Additionally, self-report use of access modes was collected at 3 and 6 months.

Results

Participants in the WW condition significantly decreased their body mass index at 6 months (F = 36.7, P <.001) and were 8.0 and 8.8 times more likely to achieve a 5% and 10% reduction in weight, respectively, compared with those in the self-help condition. In a secondary analysis, high usage of all 3 access modes resulted in the greatest weight loss (P <.001).

Conclusion

Use of the WW program yielded significantly greater weight loss than a self-help approach, suggesting it is a viable community-based provider of weight loss treatment, as recommended by the USPSTF. Further, high usage of 3 access modes was associated with greater weight loss results.     

Experiential Service Learning: Building skills and sensitivity with Kolb’s learning theory

ABSTRACT

Preparing a healthcare workforce able to respond to the growing complexity of health issues facing older adults is a critical issue for interprofessional educators. Students are in need of experiences promoting confidence and skill in communicating with older adults with cognitive issues. Student emotional and cognitive responses to an interprofessional Music and Memory® project in long term care facilities were evaluated. Forty-eight students met with assigned adults weekly to develop personalized music playlists and complete a journal entry. Student participants demonstrated improved interpersonal connections, enhanced professional skills, and increased empathy toward clients. Results are explored within the context of Kolb’s Learning Theory and application of the evaluation outcomes for interprofessional education.     

Dyadic,Self-Administered Cognitive Intervention for Healthy Older Adults: Participants’ Perspectives

ABSTRACT

Dyadic, home-based wellness interventions may reach older adults with transportation, mobility, scheduling, and caregiving barriers. This qualitative study aimed to examine participants’ experiences with dyadic cognitive training. Participants (n = 14; age M = 74.36) completed self-administered, paper-and- pencil cognitive training where they took turns training one another. The dyads included spouses, friends, neighbors, and previously unfamiliar adults. Post- intervention interviews were analyzed. Individuals reported that intervention flexibility overwhelmingly contributed to their ability and willingness to participate in the program. Thus, dyadic format is accessible, flexible, and relatively low cost, and may be applicable to a variety of behavioral interventions in aging.