Everyday functioning among older adults with subjective cognitive decline: a scoping review.

PURPOSE: Older adults with subjective cognitive decline (SCD) experience cognitive difficulties without objectively measurable cognitive impairments but which may affect their everyday functioning. However, everyday functioning in this population has not yet been characterized. We sought to describe the empirical literature on the everyday functioning of community-dwelling older adults with SCD, their recruitment methods, and the measurements used. METHODS: A scoping review was conducted for primary research articles including at least one measure of everyday functioning. Retrieved records were independently screened. Data were extracted then analyzed using descriptive statistics and summative content analysis. RESULTS: 6544 studies were screened; 21 studies were included. All were observational analytic studies. Most compared an SCD group with a group of healthy control (47.6%), mild cognitive impairment (71.5%), and/or dementia (33.3%). Subjective cognition was measured via interview (28.6%) or clinical question(s) (14.3%). Normal cognition was determined by a wide variety of cognitive tests. The most studied everyday functioning domain was instrumental activities of daily living (90.5%). Most studies used questionnaires (81.0%), and measured ability to do an everyday life task (76.2%). CONCLUSIONS: More research is needed on everyday functioning other than IADL, with greater focus on measures that consider an individual's real-life participation.

These is heterogeneity in the operational definitions and reporting of subjective cognitive decline in the empirical literature.Assessment of everyday functioning in the empirical literature on people with subjective cognitive decline is focused on the individual's ability to do instrumental activities of daily living.There is a need for consensus on: (1) standards to assess subjective and objective cognition in determining subjective cognitive decline; and (2) best practice in assessing changes in everyday functioning in people with subjective cognitive decline.Clinical and research assessment of older adults with subjective cognitive decline should be expanded to functional domains other than instrumental activities of daily living.

Understanding the Early Impacts of the COVID-19 Pandemic on Brain Injury Associations Across Canada: A Qualitative Study.

The COVID-19 pandemic has increased challenges for people living with brain injury and community associations to support this vulnerable population. This study aimed to gain an in-depth understanding of the challenges faced by brain injury survivors during the first year of the pandemic and how community brain injury associations adapted their services to respond to these needs. Findings from seven focus-group with 31 representatives of Canadian brain injury associations revealed 4 main themes: (1) Addressing evolving client needs; (2) Keeping clients safe; (3) Challenges and opportunities navigating the digital world; and (4) Sustaining brain injury associations in the face of uncertainties and disruptions. To comply with public health measures, associations reported pivoting their service delivery online, despite recognizing the difficulties this could create for many brain injury survivors in accessing and using technology. Our findings also highlight concrete directions for not-profit organizations providing instrumental help with activities, acting as a liaison and interpreter of public health guidelines, and in connecting with clients using technology while handling potential cognitive and technological challenges. Addressing these issues has the potential to protect people living with brain injury and community associations from external threats, like pandemics, in the future.

"It's better than nothing, but I do not find it to be ideal": Older adults' experience of TeleRehab during the first COVID-19 lockdown.

This qualitative study used descriptive thematic analysis to explore the experiences of 16 older adults (age: 71 ± 6.4) who transitioned from an in-person to telerehabilitation (TeleRehab) group intervention in March 2020. We found the following themes: (1A) Technology Use, describing challenges and need for support; and (1B) Technology Self-Efficacy, describing how technological ability was attributed to past-experience and/or age. Four themes described the intervention experience. First, "Not The Same, But Better Than Nothing" (2A), reflected a preference for in-person intervention. Specifically, in-person training provided a better social experience (theme 2B), and stronger accountability, although the content was well delivered in both modalities (theme 2C). Contextual factors (theme 2D) that played a role were ease of commute, especially important during the winter, and the context of the lockdown, that positioned the TeleRehab intervention as a meaningful social activity. However, sensory impairments, and/or distractions in the home diminished the TeleRehab experience.

Combining elements of the CO-OP Approach™ with education to promote healthy eating among older adults: A pilot study.

This paper describes an exploratory study developing the Baycrest Brain-healthy Eating Approach (BBEA). Poor diet is a modifiable risk factor for many health problems including dementia. Mediterranean type diets, high in plant-based foods, rich in poly- and mono- unsaturated fatty acids with minimal consumption of saturated fat, red meat, and processed foods, are considered brain healthful. While several dementia prevention trials randomized controlled trials have included nutritional counselling in favor of these diets as one component of their interventions, the extent to which dietary change occurred is not known. Based on observations that a strategy training approach, the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach, was beneficial for promoting lifestyle changes in older adults with complaints of cognitive changes, we undertook to develop the BBEA combining elements of CO-OP with didactic nutrition education. This exploratory, descriptive study assesses the feasibility and acceptability of the BBEA. Healthy community dwelling older adults (n = 5) were recruited using convenience sampling. Participants received five, 2 h, group sessions. During these sessions participants were supported in adopting dietary practices consistent with brain healthy eating. Each participant set specific dietary goals important to them. Feasibility of the intervention was demonstrated through high levels of attendance and by the findings that at each session, all participants set personally meaningful goals and received education on selected brain healthy eating topics. Acceptability was demonstrated through participants' positive reports of their experiences and perspectives obtained via semi-structured interviews. Thus, the BBEA appears to be feasible and acceptable.

Characterizing Cognition in Everyday Life of Older Adults With Subjective Cognitive Decline.

Subjective cognitive decline (SCD), the subjective experience of worsening cognition with no objective cognitive impairment, poses a heightened risk for dementia. This study aimed to characterize cognition in the everyday life of people with SCD, is crucial for understanding and preventing further functional and cognitive decline. One hundred and thirty-five older adults (age 70.7±6.7) with SCD were assessed using functional-cognition measures: Multifactorial Memory Questionnaire (MMQ), Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A), and Multiple Errands Test (MET). The resulted showed that older adults with SCD reported lower memory satisfaction (Hedges's g = 0.41) on the MMQ, and worse metacognition on the BRIEF-A (Hedges's g = 0.63) compared with published normative data. They completed an average of only 6/12 required tasks on the MET. The findings show functional difficulties related to SCD and inform the development of occupational therapy intervention for this population.

Occupational performance issues in older adults with subjective cognitive decline.

PURPOSE: To describe and categorize difficulties in daily activities of older adults with subjective cognitive decline (SCD) compared to individuals with mild cognitive impairment (MCI). METHODS: Deductive quantitative content analysis was used to classify reported issues in the performance of meaningful daily activities, in older adults with SCD (n = 67; age= 70 ± 6.3) or MCI (n = 42; age= 72 ± 6.6). The occupational performance issues were identified using the Canadian Occupational Performance Measure, a semi-structured interview, and categorised using the International Classification of Functioning, Disability and Health (ICF). RESULTS: Both groups identified issues in all nine ICF "Activities and Participation" domains, with no significant group effects on seven of them. The most frequently affected "Activities and Participation" domains in both groups were "Self-care" (e.g. exercise and diet); "Community, social and civic life" (e.g. social-leisure activities); and "General tasks and demands" (e.g. time management). Over 90% of the issues in both groups were described in the context of difficulties in "Mental functions" (e.g. memory and higher-level cognitive functions). CONCLUSIONS: Older adults with SCD, although independent, identified a variety of daily activities that they are not performing satisfactorily, remarkably similar in nature to the occupational performance issues described by older adults with MCI.Implications for RehabilitationOlder adults with SCD identified difficulties in performing social and leisure activities, maintaining healthy lifestyle behaviours, and managing multiple daily tasks.The daily challenges described by older adults with SCD are similar in nature to those identified by those with MCI.Older adults with SCD and MCI describe their daily challenges are related not only to memory problems, but also to executive dysfunction.Interventions for older adults with SCD should aim to improve self-identified problems in everyday functioning.

Stimulating Research to Enhance Aging in Place.

Older adults may benefit from interventions to successfully age in place. Research has an opportunity to test interventions and implementation strategies to fulfill the needs of older adults through collective evidence building. The purpose of this article is to describe the proceedings of the American Occupational Therapy Foundation (AOTF) 2019 Planning Grant Collective and describe the areas of research that were identified as critical. The AOTF convened scientists with expertise in the area of aging in place to catalyze research on aging in place for older adults. Four priority areas in the aging in place literature were highlighted: (a) identification of factors that support aging in place, (b) classification of processes by which family members and care partners are included in aging in place efforts, (c) categorization of technology supporting older adults to age in place, and (d) development of science that clarifies implementation of evidence-based practice.

Out-of-Home Activities and Health in Older Adults: A Scoping Review.

Participating in out-of-home (OOH) activities has been shown to benefit health in older adults. This scoping review aimed to describe the nature of the literature on OOH activities and health in community dwelling older adults, and the operationalization of OOH activity and health-related variables. We followed the Joanna Briggs Institute guidelines. Four databases were searched; studies were selected through title/abstract and full-text screening; and data on study characteristics, sample, and OOH activity and health-related variables were extracted, and summarized descriptively. Sixty articles were identified. There was a considerable focus on leisure and social activities (78% and 75%, respectively) but no predominant health-related outcome was identified. Few studies analyzed sex/gender and/or racial differences (25% and 2%, respectively). Future studies may include systematic reviews focused on health outcomes associated with social and leisure OOH activities; as well as gender-based and/or race-based differences in OOH and health relationships.

Known-Groups and Convergent Validity of the Telephone Rey Auditory Verbal Learning Test total Learning Scores for Distinguishing Between Older Adults With Amnestic Cognitive Impairment and Subjective Cognitive Decline.

OBJECTIVE: To examine known-groups validity of a telephone administration of the total learning scores of the Rey Auditory Verbal Learning Test (RAVLT) in discriminating between people with subjective cognitive decline (SCD) and amnestic mild cognitive impairment (aMCI) and convergent validity of the telephone-RAVLT. METHOD: In total, 83 older adults (age = 71.4 ± 7.0) with SCD or aMCI completed the RAVLT learning trials over the telephone and the Hopkins Verbal Learning Test (HVLT) in-person. RESULTS: Telephone-RAVLT total recall significantly correlated with HVLT total recall (r = .49, p < .001). Significant between group differences were found (effect size = 0.94). CONCLUSIONS: This study provides support for known-groups and convergent validity of the telephone-RAVLT.

Scoping Review on Rehabilitation Scoping Reviews.

OBJECTIVE: To examine the extent, scope, and methodological quality of rehabilitation scoping reviews. DATA SOURCES: A comprehensive list of scoping reviews conducted in the broader health field (inception to July 2014), with a further update of that list (up to February 2017) using similar methods, including searching 9 electronic databases. STUDY SELECTION: Articles were included if they were scoping reviews within rehabilitation. Established review methods were used including (1) a PubMed filter detecting rehabilitation content and (2) title-and-abstract screening by 2 independent reviewers applied sequentially to articles from the existing list of scoping reviews and to the updated search results. Full-text articles were reviewed by 1 reviewer, with discrepancies resolved by another after pilot screening with > 80% agreement. Remaining discrepancies were resolved by external experts. DATA EXTRACTION: Two independent reviewers used piloted and standardized data extraction forms. DATA SYNTHESIS: We screened 1823 records, including 992 full texts, to identify 251 rehabilitation-related scoping reviews. Rehabilitation scoping reviews had an exponential yearly increase since 2008 (r2=0.89; P<.01). The literature addressed diverse topics (eg, spread over 43 condition groupings); 43% were published in Canada. Examples of methodological limitations included: 39% of reviews did not cite the use of a methodological framework, 96% did not include the appropriate flow diagram, 8% did not report eligibility criteria, and 57% did not report data extraction details. CONCLUSIONS: The increasing popularity of scoping reviews in rehabilitation has not been met by high standards in methodological quality. To increase the value of rehabilitation scoping reviews, rehabilitation stakeholders need to use existing methodological standards for the conduct, reporting, and appraisal of scoping reviews.

Measurement Properties of the Multiple Errands Test: A Systematic Review.

OBJECTIVE: To systematically review, summarize, and evaluate published evidence on measurement properties of real-world versions of the Multiple Errands Test (MET) following Consensus-based Standards for the Selection of Health Measurement Instruments guidelines. DATA SOURCES: Four databases were searched in May 2019 using multiple variants of the name of the MET from 1991 onward following the publication of the original MET. STUDY SELECTION: We included peer-reviewed original research articles in English that provided data on measurement properties (reliability, validity, and responsiveness to change) on real-world versions of the MET in any clinical population. DATA EXTRACTION: Data on the MET characteristics, study population, and evidence for each measurement property were extracted using predefined criteria. The review team critically appraised the methodological quality and rated the results from each study as sufficient (+), insufficient (-), or indeterminate (?). DATA SUMMARY: Data on each measurement property were pooled. Pooled results were rated as sufficient (+), insufficient (-), mixed (±), or indeterminate (?). The overall quality of evidence per measurement property was graded based on risk of bias, sample size, and consistency of results. The overall evidence for each measurement property was determined as high, moderate, low, or very low. RESULTS: We found 33 studies that provided data on measurement properties of real-world versions of the MET. Pooled results revealed high-quality evidence for interrater reliability and moderate-quality evidence for known-group validity. Limited support for other kinds of reliability and validity was found. CONCLUSIONS: This review suggests the MET should be used cautiously. Reasons for the limited psychometric support are discussed, the value of generic forms of the MET that do not require site specific adaptations is noted, and areas for further psychometric work are highlighted.

Where did I put my glasses? The lived experience of older adults seeking medical help for perceived memory problems.

Purpose: This study aimed to examine the lived experience of older adults who seek medical help for perceived memory problems, defined as "help-seekers." We examined how they make sense of their experience of memory problems, the effect on everyday life and the role of personal and environmental factors.Materials and methods: A qualitative approach was used. Twelve help-seekers recruited from geriatric clinics participated in qualitative interviews, using thematic analysis with an interpretative phenomenological analysis.Results: Four themes emerged: (1) memory problems in daily life; (2) negative beliefs and emotional responses; (3) coping with memory problems; and (4) memory problems in context. The study describes the implications of memory problems on engagement in meaningful and self-defining occupations, and the negative beliefs and emotions embedded in the experience of memory loss. The results revealed three types of coping responses: active problem solving, reframing perception of the problem and avoidant behaviors. The study highlights the importance of both the social environment and aging process in the lived experience of help-seekers.Conclusions: Multiple personal and social factors interacted and mediated the meaning of memory loss in help-seekers. The study reveals a complex clinical picture that may impede successful occupational engagement of help-seekers.Implications for rehabilitationThe evaluation of older adults reporting memory problems should include assessments of everyday functioning, memory related beliefs, emotional status, self-efficacy, and the social environment.The interaction between memory problems and bio-psycho-social changes related to aging should be considered in treating older adults with reported memory problems.Design of group interventions addressing daily functioning, coping strategies and memory related beliefs are recommended.

Developing and Validating a Big-Store Multiple Errands Test.

The Multiple Errands Test (MET) is an ecologically valid assessment that characterizes how executive dysfunction manifests in everyday activities. Due to the naturalistic nature of this assessment, clinicians and researchers have had to develop site-specific versions resulting in numerous published versions and making it difficult to establish standard psychometric properties. The aim of this study was to develop a standardized, community version of the MET designed to be used in large department stores meeting set criteria that would not require site specific modifications. This paper reports on the development, content validity, feasibility, and inter-rater reliability of a Big-Store MET, and the performance of healthy participants on this test. Items were selected to match previously published versions in relation to quantity and complexity. Content validity was established by having experts (n = 4) on the MET review the proposed Big-Store version and evaluate the task consistency with previously published versions. To assess feasibility of administration, and inter-rater reliability, a convenience sample of 14 community dwelling adults, self-reporting as healthy, were assessed by two trained raters. We found the Big-Store MET to be feasible to deliver (completed within 30 min, scores show variability, acceptable to participants in community environment) and inter-rater reliability to be very high (ICCs = 0.92-0.99) with the exception of frequency of strategy use. This study introduces the Big-Store MET to the literature, establishes its preliminary validity and reliability thus laying the foundation for a standardized, community-based version of the MET.

Predictors of community reintegration and quality of life after hip fracture among community-dwelling older adults.

We aim to explore factors contributing to community reintegration and health-related quality of life (HRQoL) among community-dwelling older adults three months after discharge from inpatient rehabilitation following hip fracture. We performed a prospective cohort study with follow-up. Thirty-three consecutive patients (age 66-89) after surgery for hip fracture repair were recruited from an inpatient rehabilitation unit. Participants were 65+ years old, did not have dementia, and were independent in basic activities of daily living (BADL) at discharge. We examined the contribution of independent variables measuring BADL, cognition, emotional status, pain and social support to the explained variance of two main outcomes: the Reintegration to Normal Living Index (RNLI), measuring self-reported ability to participate in activities and return to life roles; and the Medical Outcomes Study Short-Form Health Survey (SF-12), assessing mental and physical aspects of HRQoL. Stepwise regression analyses revealed that: social support and pain while walking significantly explained 42.1% of variance in the RNLI; social support significantly explained 31.1% of the variance in the SF-12-physical subscale; the number of falls in the previous year, social support and executive functions assessed by the clock drawing test significantly explained 61.9% of the variance in the SF-12 mental subscale. Social support, pain while walking and the number of falls in the previous year can predict community reintegration and HRQoL among older adults three months after discharge from rehabilitation following a surgical hip fracture repair. These factors need to be addressed in rehabilitation programs.

Changes in Activity Participation Among Older Adults With Subjective Cognitive Decline or Objective Cognitive Deficits.

Participation in daily activities is crucial for healthy aging. There is limited research on participation of older adults with subjective cognitive decline (SCD), defined as the experience of cognitive deficits with no evidence of objective cognitive deficits. Therefore, this study examined perceived changes in participation in this population, and compared it to perceived changes reported by individuals with objective cognitive deficits. The study aimed to: (1) examine the reported changes in activity participation of older with SCD; (2) investigate differences in the reported changes in participation between individuals with SCD and those with mild or severe objective cognitive deficits; (3) examine the relationship between activity participation, subjective memory, and objective cognitive status; and (4) explore whether subjective memory explains additional variance in activity participation after accounting for age and objective cognitive deficits. Participants were 115 older adults (60+), divided into three groups based on their Montreal Cognitive Assessment (MoCA) scores: (1) SCD (MoCA≥26; n = 66); (2) mild objective cognitive deficits (MoCA = 20-25; n = 34); and (3) severe objective cognitive deficits (MoCA ≤ 19; n = 15). The Activity Card Sort was used to measure participation in instrumental activities of daily living, social, and leisure activities. The Multifactorial Memory Questionnaire-Ability subscale was used to assess subjective memory. We found that individuals with SCD, mild cognitive deficits and severe cognitive deficits reported participation withdrawal to a level of 80, 70, and 58% of their past participation, respectively. A significant between group difference was found on participation [χ2(2) = 16.44, p < 0.01], with the SCD group reporting higher participation than the other two groups. Participation significantly correlated with both cognitive status (r = 0.40, p < 0.01) and subjective memory (r = 0.45, p < 0.05). A regression analysis revealed that subjective memory contributed significantly to the explained variance in participation, beyond that accounted for by objective cognitive deficits and age. Our findings demonstrate the important role of subjective memory problems in activity participation of older adults, even in the absence of objective cognitive deficits.