Development of a new computer simulated environment to screen cognition: assessing the feasibility and acceptability of Leaf Café in younger and older adults.

BACKGROUND: Existing traditional cognitive screening tools for dementia have various limitations, including overreliance on tests assessing verbal memory and, to a lesser extent, on some aspects of executive functioning. Comprehensive neuropsychological assessment is sensitive to impairment but time-intensive and expensive. Virtual reality may provide a dynamic and unique understanding of cognitive performance and increase the ecological validity of cognitive assessment. The use of virtual reality in screening for cognitive function in older persons is promising, but evidence for its use remains sparse. OBJECTIVE: Our primary aim was to examine the feasibility and acceptability of a newly developed, virtual reality assessment module, 'Leaf Café', a computer-based program that assesses cognition in an engaging, efficient, and ecologically relevant way. The secondary aim was to assess the ability of the module to discriminate between performances of younger and older adults. METHODS: A cross-sectional study was carried out in Sydney, Australia, targeting adults aged 18 years and above. Participants completed a traditional cognitive screening tool (Telephone Interview for Cognitive Status-Modified, TICS-M) and Leaf Café, a low-immersive virtual reality module designed to evaluate learning and memory, perceptual-motor function, and executive functioning. The total performance score for each participant, ranging from 0 to 180, was correlated with their cognitive performance assessed by TICS-M, using Pearson's correlation coefficient. Following module completion, participants were presented with an open and closed-question survey to capture their perceptions, attitudes, and feedback on the module, encompassing practicality, acceptability, and enjoyment. Both descriptive and content analyses were employed to interpret the obtained data. RESULTS: A sample of 131 participants (mean age 54.9 years, SD = 20.8, range 20-85) took part. The majority were female (71.8%) and born in an English-speaking country (75.8%). The mean amount of time spent in the module was 32.8 min (SD = 13.3) with a mean module score of 107.6 (SD = 38.7). Most participants completed the highest level (5; 80.5%). There was a significant correlation between Leaf Café total scores with TICS-M cognitive scores overall, and for both younger (aged 18-64 years) and older adult (aged 65 + years) groups. No significant difference was found on performance between age groups on TICS-M performance, however, younger adults had significantly better performance on the Leaf Café module than older adults (M = 124.1 vs 95.9; p < .001). Participants had similar response proportions regarding user experience with most agreeing that the module was easy to use (84%) and to navigate (85%). Compared with younger adults, older adults had lower rates of agreement on the module's design (36.8% vs 64.3%; p = .020) and support experienced (20.5% vs 53.6%; p = .007). Participants highlighted the significance of practicality and the cognitive challenges presented by the module, in terms of memory strain and user interface concerns. Feedback encompassed different opinions on the usefulness of music, with suggestions for improvements centred around clearer instructions, varied game dynamics, and considerations for diverse user needs. CONCLUSIONS: Leaf Café is a feasible and acceptable tool to be used for screening for cognitive impairment in older adults and has real-world assessment value. Further verification on the game's utility in detecting cognitive impairment is required.

"Provided a window on the world and lessened my feeling of isolation": older adults' perceived COVID-19 impact and technology use in Australia during recurrent lockdowns.

BACKGROUND: An informed understanding of older adults' perceptions of the impact (positive or negative) of recurrent COVID-19 long lockdowns is important for the development of targeted interventions and resources for future restrictions. This study aimed to understand self-reported impacts of COVID-19 recurrent restrictions on older adults and how technology has been used to mitigate these. METHODS: A cross-sectional national study of 257 community-dwelling older Australians based in Victoria (mean age = 67.6 years [SD = 7.2]; 20.6% male) completed an online or postal survey as part of a larger study examining the physical and mental health impacts of a second extended COVID-19 lockdown period. This secondary analysis reports on the findings from free-text responses to two open-ended questions included in that survey that asked participants to comment on the greatest impacts of the COVID-19 lockdowns (positive or negative) and the role of technology in supporting their wellbeing during this time. Responses were collected between July and September 2020. Data were analysed using content (COVID-19 impacts) and thematic (role of technology) analysis. RESULTS: Respondents gave more negative responses (75.5%) than mixed (15.2%) and positive responses (6.2%) in reporting on the biggest impact of COVID-19 lockdowns. Inductive content analysis revealed two first-order main categories (Positive impacts and Negative impacts). Axial coding of main categories showed five second-order categories (Environmental, Physical Health, Social, Mental Health, and Personal) for both negative and positive main categories (totalling 10 second-order categories). Overall, respondents highlighted social loss as the key negative experience (70%), with acute feelings of social isolation contributing to negative impacts on mental wellbeing. The most commonly reported positive impact reported (11%) was having more time for relationships, relaxation, and new hobbies. Technology was primarily used to sustain socialisation and provide access to essential resources, services, and goods, which respondents perceived to contribute to maintaining their wellbeing. CONCLUSIONS: Findings suggest a critical need for interventions that address the social loss experienced by older adults during COVID-19 recurrent lockdowns, particularly to alleviate the associated negative impact on mental wellbeing. Recognising the positive aspect of increased time for relationships and leisure activities indicates potential areas for resilience-building strategies. The pivotal role of technology in mitigating adverse effects highlights its significance in building social connections and supporting overall wellbeing during challenging times. These implications can guide future efforts to enhance older adults' resilience, mental health, and holistic wellbeing in future public health crises.

Hear Me Out: A Meta-Analysis of Third-Party Disability Due to Presbycusis.

OBJECTIVES: Hearing-related third-party disability is the transferrable impact of presbycusis on an affected individual's surrounding social network. Previous research suggests that interventions to overcome hearing-related communication challenges benefit both the individual with presbycusis and their communication partner. However, there have been no comparisons of the effects of different interventions on third-party disability. We conducted meta-analyses of hearing aid or communication-based longitudinal interventions to determine if: both kinds of interventions significantly benefit communication partners across three categories of third-party disability (communication, emotional health and lifestyle outcomes), hearing aid and communication interventions differ in the size of treatment effects, and demographic variables moderate intervention efficacy. DESIGN: Four databases were systematically searched for studies published after 1990 that included preintervention and postintervention data for communication partners of individuals receiving a hearing aid or communication-based intervention. Studies were included if participants had presbycusis, were aged 45 or over, with no known physical or mental disorders, and had a willing study partner over 18 years old. Databases were last comprehensively and hand-searched in January 2023. One researcher applied the inclusion and exclusion criteria to select studies and complete data extraction. Depending on study design, risk of bias was assessed using the "Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group" or the "Risk of Bias 2." Random effects models were run for effect sizes for both intervention types (together and separately) for each third-party disability category. Meta-regressions were run to inspect the effect of demographic variables on intervention efficacy. RESULTS: Six studies satisfied inclusion criteria and showed that for both hearing and communication interventions, communication partners experienced significant improvements in all three outcomes. Communication interventions showed greater benefits for lifestyle outcomes, but hearing aid and communication interventions did not differ for communication and emotional health outcomes. Meta-regressions revealed previously undetected relationships between demographic variables and intervention efficacy. CONCLUSIONS: The results of this meta-analysis and meta-regressions may have clinical and real-world implications in terms of highlighting the widespread benefits of these interventions, and the need to build in greater consideration of an individual's wider network when designing and implementing interventions. Noted limitations included certain combinations of intervention type and third-party disability category that were underrepresented (in absolute and/or relative terms), a lack of combined intervention (hearing aids and communication training) studies, and variation in the types of questionnaires used between studies. The current study discusses possible ways to unite the current literature for more consistent research practices.

Protocol for a pre-post, mixed-methods feasibility study of the Brain Bootcamp behaviour change intervention to promote healthy brain ageing in older adults.

INTRODUCTION: Behaviour change interventions represent key means for supporting healthy ageing and reducing dementia risk yet brief, scalable behaviour change interventions targeting dementia risk reduction in older adults is currently lacking. Here we describe the aims and design of the three-month Brain Bootcamp initiative that seeks to target multiple dementia risk and protective factors (healthy eating, physical, social and cognitive inactivity), through the use of multiple behaviour change techniques, including goal-setting for behaviour, information about health consequences and physical prompts to change behaviours that reduce dementia risk among older adults. Our secondary aim is to understand participants' views of dementia prevention and explore the acceptability and integration of this campaign into daily life. METHODS: Brain Bootcamp is a pre-post feasibility trial conducted in Sydney, Australia beginning in January 2021 until late August. Participants aged ≥65 years living independently in the community (n = 252), recruited through social media and flyers, will provide information about their demographics, medical history, alcohol consumption, smoking habits, mental health, physical activity, cognitive activity, and diet to generate a dementia risk profile at baseline and assess change therein at three-month follow-up. During the intervention, participants will receive a resource pack containing their individual risk profile, educational booklet on dementia risk factors and four physical items designed to prompt physical, social and mental activity, and better nutrition. Outcome measures include change in dementia risk scores, dementia awareness and motivation. A qualitative process evaluation will interview a sample of participants on the acceptability and feasibility of the intervention. DISCUSSION: This will be the first short-term multi-domain intervention targeting dementia risk reduction in older adults. Findings will generate a new evidence base on how to best support efforts targeting lifestyle changes and to identify ways to optimise acceptability and effectiveness towards brain health for older adults. TRIAL REGISTRATION NUMBER: ACTRN 381046 (registered 17/02/2021); Pre-results.

Teaching Elaborative Reminiscing to Support Autobiographical Memory and Relationships in Residential and Community Aged Care Services.

Memories of the past are critically important as we age. For older adults receiving formal care in a range of settings, reminiscing with care staff may provide frequent opportunities for recalling autobiographical memories with a supportive conversational partner. Importantly, prior research suggests that some reminiscing conversations are more supportive than others. In the developmental literature, a long tradition of sociocultural memory research has shown how children's autobiographical memory is scaffolded and supported by parents during reminiscing, when parents use a particular kind of conversational technique, known as "elaborative reminiscing". In the current project, we aimed to examine whether we could enhance conversations between staff and older people receiving aged care by teaching care staff about these beneficial conversational techniques and supporting them to reminisce more often with residents/clients. We also aimed to determine whether staff members' use of elaborative reminiscing techniques was associated with autobiographical memory details recalled by residents/clients during routine conversations. We conducted a workshop with 16 staff within a residential aged care and community care setting. We followed this with a 4-week training-and-feedback period during which staff recorded their conversations with residents and clients. Staff feedback indicated successful use of the scaffolding techniques overall, and benefits as well as barriers to their use in day-to-day practice. Analysis of the conversations demonstrated that the use of particular elaborative reminiscing techniques by staff was associated with increased recall of episodic and semantic autobiographical memory details by residents/clients. Overall, findings suggest that the principles of elaborative reminiscing may apply across the lifespan, and that the benefits of elaborative reminiscing for autobiographical memory may be particularly important in times of cognitive need. Practically, training aged care staff in specific and practical conversational tools can facilitate reminiscing for people receiving aged care.

Stress and Coping in Older Australians During COVID-19: Health, Service Utilization, Grandparenting, and Technology Use.

OBJECTIVES: This study examined the impacts of COVID-19 lockdown on health and lifestyle factors for older adults in Sydney, Australia. The study examined demographic differences, social engagement, loneliness, physical activity, emotion regulation, technology use, and grandparenting experiences and their contribution to emotional health and quality of life during lockdown. METHODS: Participants were 201 community-dwelling older adults (60-87 years, M = 70.55, SD = 6.50; 67.8% female) who completed self-report scales measuring physical and emotional health outcomes, quality of life, health service utilization, changes in diet and physical activity, impacts on grandparenting roles, and uptake of new technology. RESULTS: One-third of older adults experienced depression, and 1 in 5 experienced elevated anxiety and/or psychological distress during lockdown. Specific emotion regulation strategies, better social and family engagement, and new technology use were associated with better emotional health and quality of life; 63% of older adults used new technologies to connect with others. CONCLUSIONS: Older adults were adaptable and resilient during lockdown, demonstrating high uptake of new technologies to remain connected to others, while negative emotional health outcomes were linked to loneliness and unhelpful emotion regulation. CLINICAL IMPLICATIONS: Further diversifying use of video technologies may facilitate improved physical and emotional health outcomes.

Hearing loss, cognition, and risk of neurocognitive disorder: evidence from a longitudinal cohort study of older adult Australians.

Addressing midlife hearing loss could prevent up to 9% of new cases of dementia, the highest of any potentially modifiable risk factor identified in the 2017 commissioned report in The Lancet. In Australia, hearing loss is the second-most common chronic health condition in older people, affecting 74% of people aged over 70. Estimates indicate that people with severe hearing loss are up to 5-times more likely to develop dementia, but these estimates vary between studies due to methodological limitations. Using data from the Sydney Memory and Aging Study, in which 1,037 Australian men and women aged between 70 and 90 years were enrolled and completed biennial assessments from 2005-2017, investigations between hearing loss and baseline cognitive performance as well as longitudinal risk of neurocognitive disorder were undertaken. Individuals who reported moderate-to-severe hearing difficulties had poorer cognitive performances in the domains of Attention/Processing Speed and Visuospatial Ability, and on an overall index of Global Cognition, and had a 1.5-times greater risk for the neurocognitive disorder during 6-years' follow-up. Hearing loss independently predicted risk for MCI but not dementia. The presence of hearing loss is an important consideration for neuropsychological case formulation in older adults with cognitive impairment. Hearing loss may increase cognitive load, resulting in observable cognitive impairment on neuropsychological testing. Individuals with hearing loss who demonstrate impairment in non-amnestic domains may experience benefits from the provision of hearing devices; This study provides support for a randomized control trial of hearing devices for improvement of cognitive function in this group.

A national survey on COVID-19 second-wave lockdowns on older adults' mental wellbeing, health-seeking behaviours and social outcomes across Australia.

BACKGROUND: The impact of severe second lockdown measures on older adults' wellbeing is unknown. We aimed to (i) identify the impact of the second lockdown that resulted from the second wave of COVID-19 cases on older Australians' quality of life; (ii) compare the impact of second wave lockdowns in Victoria, Australia's second most populous State, to those in other States and Territories not in lockdown. METHODS: A national cross-sectional study of community-dwelling older adults completed online questionnaires for quality of life, social networks, healthcare access, and perceived impact of COVID-19 between July to September 2020. Tobit regression was used to measure the relationships of healthcare service access and social networks with quality of life of older adults in Victoria compared to those in the rest of Australia. RESULTS: A total of 2,990 respondents (mean [SD] age, 67.3 [7.0]; 66.8 % female) participated. At time of data collection, Victoria's second COVID-19 lockdown had been in force for an average 51.7 days. Median quality of life scores were significantly higher in Victoria compared to the rest of Australia (t2,827=2.25 p = 0.025). Being female (95 % CI, -0.051-0.020), having lower educational attainment (95 % CI, -0.089--0.018), receiving government benefits (95 % CI, -0.054--0.024), having small social networks (95 % CI, 0.006-0.009) and self-reported physical chronic health conditions were all independent predictors of lower quality of life. CONCLUSIONS: Longer-term studies are required to provide more robust evidence of the impact as restrictions lift and normal social conventions return.

Long-term relapse rates after cognitive behaviour therapy for anxiety and depressive disorders among older adults: A follow-up study during COVID-19.

OBJECTIVE: This study assessed the long-term symptom relapse rates among older adults previously treated with cognitive behaviour therapy (CBT) for anxiety and/or depression during COVID-19. METHODS: Participants were 37 older adults (M = 75 years, SD = 5; 65% female) previously treated with CBT for anxiety and/or unipolar depression who were re-assessed an average of 5.6 years later, during the first Australian COVID-19 lockdown. RESULTS: On average, there was no significant group-level change in anxiety, depression or quality of life. When assessing change in symptoms based on clinical cut-off points on self-report measures, results suggest only 17%-22% showed a relapse of symptoms by the COVID-19 pandemic. CONCLUSIONS: Findings suggest that CBT may be protective in coping with life stressors many years after treatment ends. However, results warrant replication to attribute continued symptom improvement to CBT given the lack of control group.

The Impact of Self-Reported Hearing Difficulties on Memory Collaboration in Older Adults.

Cognitive scientists and philosophers recently have highlighted the value of thinking about people at risk of or living with dementia as intertwined parts of broader cognitive systems that involve their spouse, family, friends, or carers. By this view, we rely on people and things around us to "scaffold" mental processes such as memory. In the current study, we identified 39 long-married, older adult couples who are part of the Australian Imaging Biomarkers and Lifestyle (AIBL) Study of Ageing; all were cognitively healthy but half were subjective memory complainers. During two visits to their homes 1 week apart, we assessed husbands' and wives' cognitive performance across a range of everyday memory tasks working alone (Week 1) versus together (Week 2), including a Friends Task where they provided first and last names of their friends and acquaintances. As reported elsewhere, elderly couples recalled many more friends' names working together compared to alone. Couples who remembered successfully together used well-developed, rich, sensitive, and dynamic communication strategies to boost each other's recall. However, if one or both spouses self-reported mild-to-moderate or severe hearing difficulties (56% of husbands, 31% of wives), couples received less benefit from collaboration. Our findings imply that hearing loss may disrupt collaborative support structures that couples (and other intimate communicative partners) hone over decades together. We discuss the possibility that, cut off from the social world that scaffolds them, hearing loss may place older adults at greater risk of cognitive decline and dementia.

Divergent patterns of social cognition performance in autism and 22q11.2 deletion syndrome (22q11DS).

Individuals with developmental disorders frequently report a range of social cognition deficits including difficulties identifying facial displays of emotion. This study examined the specificity of face emotion processing deficits in adolescents with either autism or 22q11DS compared to typically developing (TD) controls. Two tasks (face emotion recognition and weather scene recognition) were used to explore group differences in visual scanpath strategy and concurrent recognition accuracy. For faces, the autism and 22q11DS groups demonstrated lower emotion recognition accuracy and fewer fixations compared to the TD group. Individuals with autism demonstrated fewer fixations to some weather scene stimuli compared to 22q11DS and TD groups, yet achieved a level of recognition accuracy comparable to the TD group. These findings provide evidence for a divergent pattern of social cognition dysfunction in autism and 22q11DS.