A Content Analysis of African Americans' Experience of Engaging in Qigong Exercise Intervention in a Community Setting.

Introduction: Although an increasing number of African Americans 50 years of age and older practice qigong, a mind-body exercise, to manage their health conditions, little is known about their perceptions and experiences of engaging in and learning qigong exercise. This study aimed to explore the subjective perceptions of the health benefits, engagement, adherence, and learning of qigong exercise in African Americans 45-85 years of age as a foundation for promoting this approach for African Americans' physical and psychological health. Methods: Fifteen African Americans were enrolled in a 1-h qigong exercise program twice a week for 8 weeks (a total of 16 sessions) in the activity center of a local church. Participants were interviewed after the intervention to explore their perceptions of learning and practicing qigong exercise. Interviews were conducted in person, audio recorded, transcribed verbatim, and analyzed using content analysis. Results: Five themes emerged: (1) Perceived benefits of practicing qigong, (2) helpful strategies for qigong learning, (3) facilitators for home qigong practice, (4) motivators for qigong exercise adherence, and (5) recommending qigong to others. qigong exercise was perceived to be effective for balance, flexibility, muscle strength, sleep quality, emotion regulation, and stress management. Nearly 75% of participants reported home qigong practice at least twice a week. Conclusions: Middle-age and older African Americans' responses provide insights on health benefits associated with practicing qigong exercise, adherence, home practice, and learning, which may serve as the first step to promoting the use of qigong exercise in this population and may be adopted to similar exercise interventions with minority older adults in the future.

Risk factors for inpatient facility admission among home health care patients with diabetes.

BACKGROUND: Home health care (HHC) patients with diabetes are at high risk for inpatient admissions. PURPOSE: To identify variables associated with inpatient admissions among adults age ≥50 with diabetes receiving HHC in the community and in assisted living (AL). METHODS: Retrospective HHC data (collected October 2021 to March 2022 in the Southern United States) from the Outcome and Assessment Information Set D were analyzed with logistic regression (n = 5,308 patients). DISCUSSION: The inpatient admission rate was 29.5%. For community-dwelling patients, multiple hospitalizations, depression, limited cognitive function, decreased activities of daily living (ADL) performance, and unhealed pressure ulcer or injury ≥stage 2 were significantly associated with inpatient admission. For those in AL, multiple prior hospitalizations and decreased ability to perform ADLs were associated with inpatient admission. CONCLUSION: Understanding risk factors for inpatient admissions among patients with diabetes can support the identification of at-risk patients and inform interventions.

The Impact of Online and Offline Social Support on the Mental Health of Carers of Persons with Cognitive Impairments.

The carers of persons with cognitive impairments, including Alzheimer's have migrated to online platforms to seek help, yet studies on the use of online social support within the context of caregiving are underdeveloped. Guided by the social support theory, we examined the association of online and offline social support with depression and anxiety in the United States. Using a subsample from the 2017 and 2018 Health Information National Trends Survey (n = 264), we conducted ordered logistic regression to test mediation and moderation effects, which revealed that only offline, not online social support had a direct association with carers' mental health. In the moderation model, online social support interacted with life stressors, while offline social support interacted with caregiving burden. Findings are supported using a hybrid model that combines online and offline social support to improve carers' mental health.

Patient Activation of Persons With Opioid Use Disorder in Intensive Outpatient Treatment.

BACKGROUND: High patient activation is associated with a variety of positive health outcomes. Although increasing patient activation in persons with opioid use disorder (OUD) in intensive outpatient treatment (IOT) programs may increase engagement and improve outcomes, little is known about how patient activation is manifested in these programs. AIMS: To describe types of instances in which persons play an active role in their IOT or show self-determination in their recovery generally (patient activation) and types of instances in which they play a passive role in their IOT or have recovery directed by others (patient nonactivation). METHODS: A qualitative descriptive study using data from a larger grounded theory study was conducted. Interviews were completed with 14 persons with OUD who attended an IOT program within a large health care system in the Midwest. Content analysis was used to create a typology of instances of patient activation or nonactivation in participants' IOT experiences. RESULTS: Six types of instances were identified: (1) making and enacting one's own treatment decisions, (2) actively collaborating with staff, (3) self-determining one's disclosure in groups, (4) making a commitment to treatment, (5) taking responsibility for one's recovery, and (6) taking actions to avoid return to use. CONCLUSIONS: Patient activation is multidimensional and plays a salient role in IOT experiences. IOT staff should engage patients as active participants in their treatment and encourage mutual goal-setting and shared-decision but should be aware that some approaches used too early in treatment may impede recovery.

Connecting and disconnecting: Experiences of people with opioid use disorder in intensive outpatient treatment.

INTRODUCTION: Opioid use disorder (OUD) is a public health crisis affecting 2 million Americans. Approximately 80% of people with OUD do not receive treatment, and attrition rates in treatment programs are as high as 80%. Previous research has shown intensive outpatient treatment (IOT) has positive outcomes, but enrollment and retention in programs are problematic. To improve outcomes and increase engagement, more information is needed about how persons experience IOT programs. The purpose of this study is to describe processes that people with OUD undergo as they participate in IOT programs. METHODS: The research team conducted a constructivist grounded theory study in IOT programs at two adult academic health centers within a large Midwest health care system. Study staff conducted interviews with 14 persons to elicit narratives about their experiences in the IOT programs. The team transcribed and analyzed interviews using a four-step process consistent with grounded theory methods. RESULTS: Participants described the process of connecting and disconnecting as central to their IOT experience. The process included eight stages: (1) connecting with drugs, (2) disconnecting from everyday life, (3) connecting with the IOT program, (4) connecting with others in the IOT program, (5) disconnecting from drugs, (6) reconnecting with others, (7) reconnecting with self, and (8) disconnecting from the IOT program. CONCLUSIONS: Connections with the IOT program, other patients, and IOT staff are central to beginning sobriety. Findings indicate that clinicians should foster connections and provide a multi-dimensional experience that enables patients to begin recovery.

The Nexus of Sensory Loss, Cognitive Impairment, and Functional Decline in Older Adults: A Scoping Review.

BACKGROUND AND OBJECTIVES: The prevalence of cognitive impairment and sensory loss in hearing or vision increases with age. Based on the Information Processing Model, cognitive impairment coupled with sensory loss may exacerbate disability in late life. Yet this issue has not been systematically studied. The purpose of this scoping review was to examine the literature that studied the relationship between cognitive impairment, sensory loss, and activities of daily living in older adults. RESEARCH DESIGN AND METHODS: Two reviewers independently screened 1,410 studies identified from 5 electronic databases (Medline, EMBASE, PsycINFO, CINHAL, and Web of Science). The search was completed in June 2020. A study was eligible if it included measurements of cognitive function, vision or hearing, and activities of daily living. Additionally, the data analyses must address how cognitive impairment and sensory loss are related to the performance of activities of daily living. RESULTS: The final review included 15 studies. Findings show an additive effect of cognitive impairment and sensory loss on the activities of daily living. Cognitive impairment or vision loss independently relates to the decline in activities of daily living. Hearing loss relates to the decline only when the loss is severe, or if the daily task is hearing - specific. DISCUSSION AND IMPLICATIONS: Older adults with coexisting sensory loss and cognitive impairment have the highest risk or prevalence of disability, comparing to cognitive impairment or sensory loss alone. This finding highlights the importance of developing interventions to reduce the risk of disability for older adults experiencing multiple impairments.

Psychophysiological Markers of Performance and Learning during Simulated Marksmanship in Immersive Virtual Reality.

The fusion of immersive virtual reality, kinematic movement tracking, and EEG offers a powerful test bed for naturalistic neuroscience research. Here, we combined these elements to investigate the neuro-behavioral mechanisms underlying precision visual-motor control as 20 participants completed a three-visit, visual-motor, coincidence-anticipation task, modeled after Olympic Trap Shooting and performed in immersive and interactive virtual reality. Analyses of the kinematic metrics demonstrated learning of more efficient movements with significantly faster hand RTs, earlier trigger response times, and higher spatial precision, leading to an average of 13% improvement in shot scores across the visits. As revealed through spectral and time-locked analyses of the EEG beta band (13-30 Hz), power measured prior to target launch and visual-evoked potential amplitudes measured immediately after the target launch correlated with subsequent reactive kinematic performance in the shooting task. Moreover, both launch-locked and shot/feedback-locked visual-evoked potentials became earlier and more negative with practice, pointing to neural mechanisms that may contribute to the development of visual-motor proficiency. Collectively, these findings illustrate EEG and kinematic biomarkers of precision motor control and changes in the neurophysiological substrates that may underlie motor learning.

Activation in persons with mental health disorders: An integrative review.

WHAT IS KNOWN ON THE SUBJECT?: Evidence indicates a strong relationship between patient activation (i.e. confidence, knowledge and skills to self-manage health) and positive health behaviours and outcomes in a variety of clinical populations. Because persons with mental health disorders experience significant disease burden but often underutilize mental health treatment or experience poor treatment outcomes, they would likely benefit from increases in activation. No systematic reviews have been conducted to summarize and synthesize research on patient activation in persons with mental health disorders. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our knowledge, this is the first comprehensive review to identify factors associated with activation and interventions that have shown to be effective in persons with mental health disorders. This integrative review indicates that better health status, less depression, positive health attitudes and behaviours, and higher quality therapeutic relationships may be associated with higher levels of activation in persons with mental health disorders. This review also indicates that a variety of interventions, most notably educational programs, are effective in increasing levels of patient activation in persons with mental health disorders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychiatric mental health nurses and other clinicians should consider routine assessment of patient activation to inform individualized treatment plans for their clients. Clinicians should aim to form high-quality therapeutic relationships with clients as a way to promote higher levels of activation. Interventions that have been found to be effective in improving activation could be offered in a variety of mental health settings. ABSTRACT: Introduction Patient activation is understanding one's role in the healthcare process and having confidence, knowledge, and skills to self-manage one's health and health care. Researchers have begun to investigate patient activation in persons with mental health disorders, but no systematic reviews have been conducted to summarize and synthesize this research. For psychiatric mental health nurses and other clinicians to develop strategies to increase patient activation in this population, more information is needed about factors associated with activation and interventions that increase activation. Review Questions (1) What factors are associated with levels of activation in persons diagnosed with mental health disorders? (2) What interventions have shown to be effective at increasing levels of activation in persons diagnosed with mental health disorders? Method A 5-stage integrative review as described by Whittemore & Knafl. Results Twenty-nine articles were included in the review. Ten provided correlations between activation and other factors, and 20 examined the effects of interventions on activation. Some studies revealed significant correlations between a variety of health and treatment-related factors, and others revealed that some interventions, most notably educational programs, were shown to increase activation. Discussion The findings of this comprehensive review can inform psychiatric mental health nurses and other clinicians in developing strategies to increase activation in the patients with whom they work. More research is needed to provide a deeper understanding of the role of activation in the recovery and treatment of persons with mental health disorders. Implications for Practice Psychiatric nurses and other clinicians should assess for patient activation and incorporate strategies to increase levels of activation in patients in their practice. Positive therapeutic relationships likely enhance activation in persons with mental health disorders.

Effects of Qigong Exercise on Physical and Psychological Health among African Americans.

Interventions are needed to address physical and psychological health in middle-aged and older African Americans (AAs). The purpose of this pilot study was to evaluate the feasibility and potential benefits of an eight-week Qigong exercise on physical ability and function, balance, frailty, depression and anxiety, and spiritual well-being in AAs using a single-group design. Fifteen AAs with a mean age of 64 years received Qigong exercise over 16 semi-weekly, one-hour sessions. The majority were female (93.3%) and college-level educated (53.3%). Repeat chair stands, physical function, and spiritual well-being improved significantly (p < .05) with effect sizes ranging from .45 to .87. Over 52% of participants showed improved depression scores, fast gait speed, and standing balance. Nearly 42% demonstrated some frailty improvement over baseline. No adverse events were reported. Qigong exercise potentially improves the physical ability and function, and spiritual well-being of AAs and needs further testing in a randomized clinical trial.

Neural Correlates of Positive Emotion Processing That Distinguish Healthy Youths at Familial Risk for Bipolar Versus Major Depressive Disorder.

OBJECTIVE: Familial risk for bipolar disorder (BD) or major depressive disorder (MDD) may lead to differential emotion processing signatures, resulting in unique neural vulnerability. METHOD: Healthy offspring of a parent with BD (n = 29, "BD-risk") or MDD (n = 44, "MDD-risk") and healthy control youths without any personal or family psychopathology (n = 28, "HC") aged 8 to 17 years (13.64 ± 2.59 years) completed an implicit emotion-perception functional magnetic resonance imaging task. Whole-brain voxelwise and psychophysiological interaction analyses examined neural differences in activation and connectivity during emotion processing. Regression modeling tested for neural associations with behavioral strengths and difficulties and conversion to psychopathology at follow-up (3.71 ± 1.91 years). RESULTS: BD-risk youth showed significantly reduced bilateral putamen activation, and decreased connectivity between the left putamen and the left ventral anterior cingulate cortex (vACC) and the right posterior cingulate cortex (PCC) during positive-valence emotion processing compared to MDD-risk and HC (Z >2.3; p <.001). Decreased left putamen-right PCC connectivity correlated with subsequent peer problems in BD-risk (ß = -2.90; p <.05) and MDD-risk (ß = -3.64; p < .05) groups. Decreased left (ß = -0.09; p < .05) and right putamen activation (ß = -0.07; p = .04) were associated with conversion to a mood or anxiety disorder in BD-risk youths. Decreased left putamen-right PCC connectivity was associated with a higher risk of conversion in BD-risk (HR = 8.28 , p < .01) and MDD-risk (HR = 2.31, p = .02) groups. CONCLUSION: Reduced putamen activation and connectivity during positive emotion processing appear to distinguish BD-risk youths from MDD-risk and HC youths, and may represent a marker of vulnerability.

Comparison of Intraocular Pressure, Usage of Topical Steroids, Need for Intraocular Pressure Lowering Drops, and Incidence of Glaucoma Surgery Up to 2 Years After Penetrating Keratoplasty and Endothelial Keratoplasty.

PRECIS: A retrospective review of 239 eyes comparing intraocular pressure (IOP), steroid needs, IOP-lowering drop needs, and incidence of glaucoma surgery between endothelial keratoplasty and penetrating keratoplasties (PKP) at multiple timepoints postoperatively up to 2 years. PURPOSE: The purpose of this study was to compare postoperative IOP, steroid use, IOP-lowering drop use, and need for glaucoma surgery between PKP, Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSEK). MATERIALS AND METHODS: A retrospective chart review of all PKP, DMEK, and DSEK surgeries was performed between July 1, 2012 and July 1, 2017 at the University of California, Irvine. Patients with a prior history of glaucoma, corneal or glaucoma surgery, concurrent major or emergent surgery, active infection, and eye disease with synechiae were excluded. A total of 239 patients who underwent PKP (N=127), DMEK (N=46), or DSEK (N=66) were included. IOP, steroid use, IOP-lowering drop use, and need for glaucoma surgery were compared at postoperative day 1, postoperative week 1 (POW1), and postoperative month 1 to 24 (POM1-24). RESULTS: IOP for PKP was higher than DMEK and DSEK at POW1, POM1, POM6, and POM24 (P<0.05). IOP for PKP was higher than DMEK at POM12 (P=0.028). There was no significant difference in IOP between DMEK and DSEK for all timepoints. PKP required more steroids than DSEK and DMEK at POM3, POM6, POM12, and POM24 (P<0.05). More IOP-lowering drops were required for DSEK than DMEK and PKP at postoperative day 1 and POW1 (P<0.05). More IOP-lowering medications were used for DSEK than DMEK at POM3 and POM12 (P<0.05). About 6% to 7% of patients needed glaucoma surgery by POM24. CONCLUSIONS: Endothelial keratoplasties had decreased IOP and steroid needs compared with PKPs postoperatively up to 2 years. The rate of glaucoma surgery and IOP-lowering drop needs were similar between the groups.

Intervention fidelity in Qigong randomized controlled trials: A method review.

Intervention fidelity has important implications for the reliability and validity of a study. Despite the widely reported health benefits of Qigong exercise interventions, the quality of intervention fidelity is less clear. The purpose of this paper is to use a valid intervention fidelity assessment tool to evaluate how intervention fidelity has been addressed in five areas-design, training, delivery, receipt, and enactment-in Qigong randomized controlled studies. A total of 86 articles were drawn from CINAHL, PubMed, AMED, and Scopus, and 32 were selected for the review. The adherence to intervention fidelity strategies within the intervention design, training, delivery, receipt, and enactment was 0.66, 0.32, 0.22, 0.12, and 0.21, respectively. The findings suggest that intervention fidelity is inadequately implemented or reported in published Qigong studies. Developing a consistent intervention fidelity plan for Qigong interventions is needed. To this aim, we propose a treatment fidelity plan specific to Qigong research.

Change in Depression, Confidence, and Physical Function Among Older Adults With Mild Cognitive Impairment.

BACKGROUND AND PURPOSE: Nearly a quarter of those in the United States older than 71 years experience mild cognitive impairment. Persons with mild cognitive impairment battle depression and progressive disengagement from daily activities, which contribute to participation restriction and activity limitation. Daily engagement in meaningful activity (DEMA) is a tailored intervention designed to benefit persons with mild cognitive impairment and their caregivers through preserved engagement and supported adjustment to cognitive changes. This secondary analysis was guided by the International Classification of Functioning, Disability and Health (ICF) model. Aims were to (i) explore the extent to which change in self-rated activity performance and physical function can predict change in depressive symptoms, (ii) evaluate for difference in confidence and depressive symptoms at ICF levels of activity and participation, and (iii) quantify the impact of daily engagement at the ICF level of participation on physical function. METHODS: A secondary analysis was conducted using data from the parent study, which was a 2-group randomized trial involving persons with mild cognitive impairment and their informal caregivers participating in the Indiana Alzheimer Disease Center DEMA program. Quantitative analysis (dyads: DEMA N = 20, Information Support N = 20) examined outcomes at posttest and follow-up. Analysis employed linear regression to model the relationship between explanatory and dependent variables and independent t test to examine for difference in confidence, depression, and physical function. RESULTS AND DISCUSSION: At posttest, change in self-rated performance predicted change in depressive symptoms. Those in the DEMA group who engaged in activity at the ICF level of participation demonstrated a significant increase in confidence and physical function. Although not significant, the control group posttest results showed a mean decrease in confidence. CONCLUSIONS: Results demonstrate a positive impact of DEMA on depressive symptoms, confidence, and physical function. Change in occupational performance predicted change in depressive symptoms. Confidence significantly improved among those who engaged at the ICF participation level. A larger, randomized controlled longitudinal trial is needed to better assess the impact of DEMA on physical function, activity, participation restriction, and quality of life.

Exploration of Perceived Psychosocial Benefits of Senior Companion Program Participation Among Urban-Dwelling, Low-Income Older Adult Women Volunteers.

BACKGROUND: As the older adult population increases, it is imperative to increase older adults' opportunities for social involvement, thus maintaining their important roles and contributions to society. While there are known health-related benefits of volunteerism among older adults, a dearth of information exists on the perceived benefits of volunteerism among low-income and ethnic minority older adults. PURPOSE: To understand the perceived psychosocial benefits of volunteering in the Senior Companion Program and to present findings of focus groups conducted with urban-dwelling, low-income older adult women volunteers. DESIGN AND METHODS: Inductive content analysis and the Dedoose qualitative data analysis software were used for analyzing data obtained from 59 older adult women Senior Companions who participated in nine focus groups. RESULTS: Content analyses of the focus group transcripts identified four major themes: (1) Reducing social isolation; (2) Improving quality of life; (3) Finding purpose and meaning; and (4) Increasing understanding of aging. The majority of our participants (81%) were African American women, with a mean age of 70 years. Approximately 83.1% had completed high school and 62.7% lived below the poverty line. DISCUSSION AND IMPLICATIONS: Findings provided data rich in descriptions of positive psychosocial outcomes, finding meaning and purpose, and a better understanding of aging in urban-dwelling, low-income older women volunteers. The findings also provide support for the need for policies and programs that promote civic engagement in this population.

Sensorimotor Learning during a Marksmanship Task in Immersive Virtual Reality.

Sensorimotor learning refers to improvements that occur through practice in the performance of sensory-guided motor behaviors. Leveraging novel technical capabilities of an immersive virtual environment, we probed the component kinematic processes that mediate sensorimotor learning. Twenty naïve subjects performed a simulated marksmanship task modeled after Olympic Trap Shooting standards. We measured movement kinematics and shooting performance as participants practiced 350 trials while receiving trial-by-trial feedback about shooting success. Spatiotemporal analysis of motion tracking elucidated the ballistic and refinement phases of hand movements. We found systematic changes in movement kinematics that accompanied improvements in shot accuracy during training, though reaction and response times did not change over blocks. In particular, we observed longer, slower, and more precise ballistic movements that replaced effort spent on corrections and refinement. Collectively, these results leverage developments in immersive virtual reality technology to quantify and compare the kinematics of movement during early learning of full-body sensorimotor orienting.

Randomized Trial of Desktop Humidifier for Dry Eye Relief in Computer Users.

SIGNIFICANCE: Dry eye is a frequently reported problem among computer users. Low relative humidity environments are recognized to exacerbate signs and symptoms of dry eye, yet are common in offices of computer operators. Desktop USB-powered humidifiers are available commercially, but their efficacy for dry eye relief has not been established. PURPOSE: This study aims to evaluate the potential for a desktop USB-powered humidifier to improve tear-film parameters, ocular surface characteristics, and subjective comfort of computer users. METHODS: Forty-four computer users were enrolled in a prospective, masked, randomized crossover study. On separate days, participants were randomized to 1 hour of continuous computer use, with and without exposure to a desktop humidifier. Lipid-layer grade, noninvasive tear-film breakup time, and tear meniscus height were measured before and after computer use. Following the 1-hour period, participants reported whether ocular comfort was greater, equal, or lesser than that at baseline. RESULTS: The desktop humidifier effected a relative difference in humidity between the two environments of +5.4 ± 5.0% (P < .001). Participants demonstrated no significant differences in lipid-layer grade and tear meniscus height between the two environments (all P > .05). However, a relative increase in the median noninvasive tear-film breakup time of +4.0 seconds was observed in the humidified environment (P < .001), which was associated with a higher proportion of subjects reporting greater comfort relative to baseline (36% vs. 5%, P < .001). CONCLUSIONS: Even with a modest increase in relative humidity locally, the desktop humidifier shows potential to improve tear-film stability and subjective comfort during computer use.Trial registration no: ACTRN12617000326392.

Civic Engagement Experiences of Students Preparing for Roles as Clinical Nurse Specialists.

AIM: Clinical nurse specialist (CNS) students at an urban Midwestern university participated in a study to describe their satisfaction with civic engagement (CE) learning activities. METHODS: A descriptive and cross-sectional study design housed a faculty-developed CE learning module with four learning activities: (a) gaining interprofessional collaborative practice leadership experience in a mock incident command experience; (b) identifying, researching, and writing a legislative letter about an area of public and/or health policy concern; and (c) developing a professional online network LinkedIn account with experienced CNSs; (d) identifying potential mechanisms for achieving board membership on a civic or professional nursing organization. Faculty developed an online survey to determine student satisfaction through quantitative and qualitative data. Participants completed the survey at the end of the course. RESULTS: Satisfaction with CE learning activities ranged from a mean of 6.07 to 6.75 on a 7-point Likert scale, with higher scores indicating more satisfaction. The overall mean score for CE activities was 6.27 (SD = 0.61) and mean score for course objectives' satisfaction was 6.55 (SE = 0.70). Students reported high satisfaction with their learning as a result of the CE activities. CONCLUSIONS: CNS students perceived high satisfaction with learning from the CE activities in this study.

Satisfaction With a Family-Focused Intervention for Mild Cognitive Impairment Dyads.

PURPOSE: This article describes satisfaction that persons with mild cognitive impairment (PwMCI) and their caregivers had with the Daily Enhancement of Meaningful Activity (DEMA) intervention. METHODS: This randomized controlled pilot study compared satisfaction (usefulness, ease of use, and acceptability) with DEMA (n = 17 dyads) to an information support (IS) control group (n = 19 dyads). Six biweekly sessions (two in person and four by telephone) were delivered by trained nurses. Data analysis included descriptive statistics, independent-sample t tests, and content analysis. FINDINGS: PwMCI receiving DEMA rated their satisfaction significantly higher (p = .033) than did the control group; there was no difference in satisfaction between caregivers across groups. Qualitative interview data supported the usefulness, ease of use, and acceptability of DEMA for both PwMCI and caregivers. CONCLUSIONS: Results documented PwMCI's satisfaction with DEMA as implemented by nurses to support PwMCI-caregiver dyads' engagement in meaningful activity. DEMA may need revision to increase satisfaction for caregivers. CLINICAL RELEVANCE: The DEMA intervention was evaluated as useful, easy to use, and acceptable to PwMCI and their caregivers based on positive mean ratings. The study findings provide preliminary support of DEMA as a means to improve quality of life by helping to support patient and caregiver engagement in meaningful activities and problem solving.