Can Occupation-Based Interventions for People Living with Dementia and Their Spousal Caregivers Support Positive Aspects of Caregiving? A Scoping Review.

This scoping review aimed to explore the characteristics and outcomes of occupation-based interventions for people living with dementia and their spousal caregivers relating to positive aspects of caregiving. A conceptualization of positive aspects of caregiving was developed based on the existing literature encompassing three domains - quality of the caregiver/care receiver relationship, meaning of the caregiver's role in daily life, and caregiver's feeling of accomplishment. Arksey and O'Malley's guidelines were used and four databases were searched to identify studies discussing occupation-based interventions involving spousal caregivers and persons living with dementia in the community that addressed at least one of three domains of positive aspects of caregiving identified in our conceptualization. After screening 1,560 articles, 18 articles were included for analysis. Three types of interventions were identified (i.e. music therapy, reminiscence therapy and a tailored activity program) involving three components contributing to positive aspects of caregiving: socializing outside the dyad, producing tangible end products, and education for the caregiver or dyad. Findings indicate that occupation-based interventions can support positive experiences for the dyad by improving the quality of the dyadic relationship and caregivers' feelings of accomplishment.

Codevelopment and Deployment of a System for the Telemonitoring of Activities of Daily Living Among Older Adults Receiving Home Care Services: Protocol for an Action Design Research Study.

BACKGROUND: Telemonitoring of activities of daily living (ADLs) offers significant potential for gaining a deeper insight into the home care needs of older adults experiencing cognitive decline, particularly those living alone. In 2016, our team and a health care institution in Montreal, Quebec, Canada, sought to test this technology to enhance the support provided by home care clinical teams for older adults residing alone and facing cognitive deficits. The Support for Seniors' Autonomy program (SAPA [Soutien à l'autonomie des personnes âgées]) project was initiated within this context, embracing an innovative research approach that combines action research and design science. OBJECTIVE: This paper presents the research protocol for the SAPA project, with the aim of facilitating the replication of similar initiatives in the future. The primary objectives of the SAPA project were to (1) codevelop an ADL telemonitoring system aligned with the requirements of key stakeholders, (2) deploy the system in a real clinical environment to identify specific use cases, and (3) identify factors conducive to its sustained use in a real-world setting. Given the context of the SAPA project, the adoption of an action design research (ADR) approach was deemed crucial. ADR is a framework for crafting practical solutions to intricate problems encountered in a specific organizational context. METHODS: This project consisted of 2 cycles of development (alpha and beta) that involved cyclical repetitions of stages 2 and 3 to develop a telemonitoring system for ADLs. Stakeholders, such as health care managers, clinicians, older adults, and their families, were included in each codevelopment cycle. Qualitative and quantitative data were collected throughout this project. RESULTS: The first iterative cycle, the alpha cycle, took place from early 2016 to mid 2018. The first prototype of an ADL telemonitoring system was deployed in the homes of 4 individuals receiving home care services through a public health institution. The prototype was used to collect data about care recipients' ADL routines. Clinicians used the data to support their home care intervention plan, and the results are presented here. The prototype was successfully deployed and perceived as useful, although obstacles were encountered. Similarly, a second codevelopment cycle (beta cycle) took place in 3 public health institutions from late 2018 to late 2022. The telemonitoring system was installed in 31 care recipients' homes, and detailed results will be presented in future papers. CONCLUSIONS: To our knowledge, this is the first reported ADR project in ADL telemonitoring research that includes 2 iterative cycles of codevelopment and deployment embedded in the real-world clinical settings of a public health system. We discuss the artifacts, generalization of learning, and dissemination generated by this protocol in the hope of providing a concrete and replicable example of research partnerships in the field of digital health in cognitive aging. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/52284.

Social Isolation of Older Adults Living in a Neighbourhood of Montreal: A Qualitative Descriptive Study of the Perspectives of Older Adults and Community Stakeholders.

The purpose of this study was to describe the social isolation of older adults in the Côte-des-Neiges neighbourhood (Montreal, Canada) from the perspectives of older adults and community stakeholders. To do so, a descriptive qualitative study was conducted, involving community-dwelling older adults and a variety of key stakeholders from the neighbourhood. Seven focus groups were held, with a total of 37 participants. Focus group transcripts were analyzed using the approach of Miles, Huberman, and Saldaña. Participants reported that social isolation of older adults is characterized by gaps in social interactions (scarcity of social interactions, lack of social support, and unsatisfying relationships) as well as by low social participation that can be depicted in three ways: (1) exclusion by society, (2) self-restriction of participation, and (3) low eagerness to socialize. This study highlights that there is a diversity in how social isolation of older adults manifests itself. It can be the result of a deliberate choice (or not), as well as being desired (or not). These aspects of the phenomenon of social isolation of older adults are still not well described. However, they offer relevant avenues for rethinking approaches to intervention development.

Developing the Driving and Dementia Roadmap: a knowledge-to-action process.

OBJECTIVES: Despite three decades of research, gaps remain in meeting the needs of people with dementia and their family/friend carers as they navigate the often-tumultuous process of driving cessation. This paper describes the process of using a knowledge-to-action (KTA) approach to develop an educational web-based resource (i.e. toolkit), called the Driving and Dementia Roadmap (DDR), aimed at addressing some of these gaps. DESIGN: Aligned with the KTA framework, knowledge creation and action cycle activities informed the development of the DDR. These activities included systematic reviews; meta-synthesis of qualitative studies; interviews and focus groups with key stakeholders; development of a Driving and Dementia Intervention Framework (DD-IF); and a review and curation of publicly available resources and tools. An Advisory Group comprised of people with dementia and family carers provided ongoing feedback on the DDR's content and design. RESULTS: The DDR is a multi-component online toolkit that contains separate portals for current and former drivers with dementia and their family/friend carers. Based on the DD-IF, various topics of driving cessation are presented to accommodate users' diverse stages and needs in their experiences of decision-making and transitioning to non-driving. CONCLUSION: Guided by the KTA framework that involved a systematic and iterative process of knowledge creation and translation, the resulting person-centered, individualized and flexible DDR can bring much-needed support to help people with dementia and their families maintain their mobility, community access, and social and emotional wellbeing during and post-driving cessation.

Application of the Person-Centered Care to Manage Responsive Behaviors in Clients with Major Neurocognitive Disorders: A Qualitative Single Case Study.

OBJECTIVES: Our study aimed to describe "how" and "why" the person-centered care (PCC) approach was applied within a long-term care (LTC) community to manage responsive behaviors (RBs) in individuals with major neurocognitive disorders. METHODS: A descriptive holistic single case study design was employed in the context of an LTC community in Quebec, using semi-structured interviews and non-participatory observations of experienced care providers working with clients with RBs, photographing the physical environment, and accessing documents available on the LTC community's public website. A thematic content analysis was used for data analysis. RESULTS: The findings generated insight into the importance of considering multiple components of the LTC community to apply the PCC approach for managing RBs, including a) creating a homelike environment, b) developing a therapeutic relationship with clients, c) engaging clients in meaningful activities, and d) empowering care providers by offering essential resources. CONCLUSIONS: Applying and implementing the PCC approach within an LTC community to manage clients' RBs is a long-term multi-dimensional process that requires a solid foundation. CLINICAL IMPLICATIONS: These findings highlight the importance of considering multiple factors relevant to persons, environments, and meaningful activities to apply the PCC approach within LTC communities to manage RBs.

What facilitates the acceptance of technology to promote social participation in later life? A systematic review.

BACKGROUND: Social participation is an important aspect of health and well-being across the lifespan, but older adults might encounter some barriers, which has been highlighted in the current Covid-19 pandemic situation, where technology has become the primary way to maintain contact with family and friends. In fact, technology can serve both as a facilitator and barrier to social participation in later life, and this issue needs to be further understood. AIM: To identify the barriers and facilitators encountered by older adults in using technology to promote social participation. METHODS: A systematic review was conducted. Studies were included if they were peer-reviewed, written in English or French, included participants 50 years or older, included technology to promote social participation, and reported potential barriers or facilitators regarding such technologies. Four databases were included: MEDLINE, CINAHL, PsychINFO and, ERIC. Each study was reviewed by two independent reviewers. The quality of the study was appraised using the Crowe Critical Appraisal Tool. RESULTS: Seventeen studies were included in this report. Four main themes emerged from the data: perceived benefits of the technology, self-confidence and knowledge about using the technology efficiently and safely, affordability of the technology, and ability of the technology to adapt to the physical and cognitive declines in later life. CONCLUSION: These findings can help health care professionals to make better decisions when deciding to recommend technology for their older clients.IMPLICATIONS FOR REHABILITATIONAcceptance of technology to promote social participation in later life is a multi-complex process. There is no "one size fits all" approach, a person-centered intervention must be used.When introducing new technologies, using an adapted/tailored training approach could potentially increase self-efficacy in using technology.Rehabilitation professionals' misconceptions concerning the use of technology in later life can be a barrier to acceptance. It's important to be aware of our own believes and attitudes in this context.

A scoping review of family-centered interventions in dementia care.

Families of persons living with dementia provide varying levels and forms of support to their loved ones and experience changes in familial dynamics, roles, and responsibilities over time. Family-centered care can enable their successful adaptation and participation in meaningful occupations. This scoping review aimed to explore available familycentered interventions for persons living with dementia, with a focus on occupational therapy. Three databases were searched and 31 eligible studies were found. Thirteen family-centered interventions were identified that were mostly multicomponent in nature, of which three involved occupational therapy. These interventions were investigated using a range of study designs and addressed outcomes related to the person with dementia, primary caregiver, and extended social network. With respect to study context, most interventions were developed in the United States and other Western countries with a limited number located in other contexts. The review findings underline the need for developing more family-centered interventions within occupational therapy, particularly for different contexts and cultures, and for translating available interventions to practice.

Videogame and Computer Intervention Effects on Older Adults' Mental Rotation Performance.

Objective: This article examined older adults' performance on two components of a mental rotation task (reaction time and rotation rate) in a home-based intervention study of videogame (Crazy Taxi [CT]) and computerized cognitive training (PositScience InSight). Materials and Methods: Participants were randomized to one of three groups: one group played an off-the-shelf videogame (i.e., CT), the second group engaged in a computerized training program focused on fast perceptual comparisons, visuospatial working memory, rapid scanning of a visual array and pattern recognition, visual discrimination, and selective and divided attention and processing speed (i.e., InSight), and the third (control) group received no training. Training in the two intervention conditions consisted of 60 training sessions of 1 hour each, which were completed in 3 months (5 hours a week). As part of a larger study, participants received mental rotation testing, which was administered immediately before (baseline), after (post-test), and 3 months after (follow-up) training. Results: Although the InSight group showed greater improvements in rotation rate at the immediate post-test, by the 3-month follow-up, the combined treatment groups (CT and InSight) had improved more than controls. Conclusion: The improvements in mental rotation performance found at 3-month follow-up add additional support to previous research, showing visuospatial benefits of both videogame play and cognitive training in older adults. Common elements of both interventions may include expansion of the attentional field of view and faster visual comparison efficiency.

Older drivers are at increased risk of fatal crash involvement: Results of a systematic review and meta-analysis.

Older adults have become a larger part of the driving population, but whether they are at increased risk of being involved in fatal crashes remains unclear. METHODS: We performed a systematic review of studies investigating fatal crash involvement of older vs non-older drivers by searching the following databases: PubMed, Cochrane Library, Embase, LILACS, SciELO, Web of Science, and ProQuest. Studies that used fatal crash involvement rates per distance driven as a measure of frequency were selected for meta-analysis. RESULTS: We analyzed 14 studies published between 2001 and 2018. Of these, 12 reported a higher rate of fatal crashes involving older drivers than non-older drivers; 9 of them used involvement rates per distance driven, which is considered the most appropriate metric. The meta-analysis revealed high heterogeneity between studies. The meta-regression attributed 40% of the heterogeneity to age (older vs non-older drivers) (p<0.005). CONCLUSION: Age appears to be associated with higher driver involvement rates for fatal crashes among older persons.

Canadian Occupational Therapists' Use of Technology With Older Adults: A Nationwide Survey.

As rehabilitation specialists, occupational therapy practitioners play a gateway role regarding recommendation of various technologies for homecare. However, no study has investigated current occupational therapy practices concerning information and communication technology (ICT) for older adults in Canada. The objective of this study was to identify Canadian occupational therapists' (OTs) knowledge and practices of ICT with older adults as well as factors associated with its recommendation. A Canada-wide, cross-sectional, online survey was conducted. Of 387 OTs, only 12.4% reported recommending ICT in practice. ICTs supporting communication and cognition were the main types recommended. The reported barriers to use in practice differed between ICT familiar users and nonusers. Multivariate logistic regression analyses showed that clinicians with more years of clinical experience were more likely to recommend ICT. Clinicians' services, work environments, and client diagnosis were also factors associated with ICT recommendation. Additional research is needed to understand how to overcome barriers to ICT recommendation in OT practice.

Using Ambient Assisted Living to Monitor Older Adults With Alzheimer Disease: Single-Case Study to Validate the Monitoring Report.

BACKGROUND: Many older adults choose to live independently in their homes for as long as possible, despite psychosocial and medical conditions that compromise their independence in daily living and safety. Faced with unprecedented challenges in allocating resources, home care administrators are increasingly open to using monitoring technologies known as ambient assisted living (AAL) to better support care recipients. To be effective, these technologies should be able to report clinically relevant changes to support decision making at an individual level. OBJECTIVE: The aim of this study is to examine the concurrent validity of AAL monitoring reports and information gathered by care professionals using triangulation. METHODS: This longitudinal single-case study spans over 490 days of monitoring a 90-year-old woman with Alzheimer disease receiving support from local health care services. A clinical nurse in charge of her health and social care was interviewed 3 times during the project. Linear mixed models for repeated measures were used to analyze each daily activity (ie, sleep, outing activities, periods of low mobility, cooking-related activities, hygiene-related activities). Significant changes observed in data from monitoring reports were compared with information gathered by the care professional to explore concurrent validity. RESULTS: Over time, the monitoring reports showed evolving trends in the care recipient's daily activities. Significant activity changes occurred over time regarding sleep, outings, cooking, mobility, and hygiene-related activities. Although the nurse observed some trends, the monitoring reports highlighted information that the nurse had not yet identified. Most trends detected in the monitoring reports were consistent with the clinical information gathered by the nurse. In addition, the AAL system detected changes in daily trends following an intervention specific to meal preparation. CONCLUSIONS: Overall, trends identified by AAL monitoring are consistent with clinical reports. They help answer the nurse's questions and help the nurse develop interventions to maintain the care recipient at home. These findings suggest the vast potential of AAL technologies to support health care services and aging in place by providing valid and clinically relevant information over time regarding activities of daily living. Such data are essential when other sources yield incomplete information for decision making.

Using a cognitive orthosis to support older adults during meal preparation: Clinicians' perspective on COOK technology.

INTRODUCTION: Occupational therapists promote safety and autonomy of older adults with cognitive impairments. A technology, named COOK, offers support on a touch screen installed next to the stove to support task performance while correcting risky behaviors. We aimed to document (1) the functional profiles according the diagnosis (2) the types of interventions used to increase autonomy in the kitchen (3) the facilitators and obstacles to the implementation of COOK with this clientele. METHODS: Four focus groups were conducted with occupational therapists (n = 24) and were transcribed and analyzed using thematic analysis, including coding and matrix building. RESULTS: Occupational therapists identified different (1) functional profiles and (2) interventions for both diagnoses. The use of COOK (3) could be more beneficial in mild cognitive impairment, as many barriers occur for the use in Alzheimer's disease. Some parameters, such as digital control of the stove and complex information management, need to be simplified. DISCUSSION: According to occupational therapists, this technology is particularly applicable to people with mild cognitive impairment, because this population has better learning abilities. CONCLUSION: This study documented the specific needs of older adults with cognitive impairments as well as interventions used by occupational therapists. The perspectives of caregivers should be captured in future research.

Computer and Videogame Interventions for Older Adults' Cognitive and Everyday Functioning.

OBJECTIVE: This study compared older adults' gains in cognitive and everyday functioning after a 60-session home-based videogame intervention with gains seen under formal cognitive training and usual care/no intervention. MATERIALS AND METHODS: Participants were randomized to one of three groups: one group played an off-the-shelf videogame (i.e., Crazy Taxi), the second group engaged in a computerized training program focused on visual attention and processing speed (i.e., PositScience InSight), and the third group received no training. Training in the two intervention conditions consisted of 60 training sessions of 1 hour each, which were completed in 3 months (5 hours a week). Participants received a broad battery of cognitive and everyday functioning assessments immediately before (pretest), after (post-test), and 3 months after (follow-up) training. RESULTS: Both training conditions improved on direct assessments of trained outcomes. In the InSight-trained group, we found transfer to untrained measures of visual attention and processing speed that were similar to the trained tasks, and these gains endured for up to 3 months. Participants in the videogame condition showed small additional benefits, not emerging until 3 months after intervention completion, on a measure of both attention and mood. No trained groups showed gain on visuospatial skills or memory. CONCLUSION: Training effects were highly specific to the target of training. Training effects to visual attention and processing speed were, as expected, larger for InSight-trained participants but were also seen for videogame participants. Given that past research has shown that videogame training leads to greater engagement than cognitive training, videogame interventions may represent a choice for more modest gains in a more engaging context.

Older Adults' Engagement During an Intervention Involving Off-the-Shelf Videogame.

OBJECTIVE: The overall goal of our current study was to examine older adults' experience of Flow (i.e., subjective engagement) during the course of a home-based cognitive training program. MATERIALS AND METHODS: In this study, participants took part in a home-based training program. They were randomized to one of the two training groups. One group played an off-the-shelf videogame (i.e., Crazy Taxi), and the other group played a brain training game (i.e., Insight). Training consisted of 60 training sessions of 1 hour each, which were completed in 3 months (5 hours a week). After each training session, participants completed a Flow questionnaire to measure their engagement with the training. RESULTS: The analysis was performed with a linear growth curve model. The results indicate that on average, there was no change in flow for the Insight group between time points. There was no difference between the initial flow status of the Insight group and the Crazy Taxi group. However, the interaction between group membership and time was statistically significant, indicating that the participants in the Crazy Taxi group increased their scores at each week at a rate that was 0.99 larger than those in the Insight group. CONCLUSION: The analyses revealed that both groups experienced increase in Flow over the period, but only participants in the Crazy Taxi group significantly improved in Flow. This has long-term implications since we would expect participation to go beyond 12 weeks in a real-world scenario.

Critical appraisal of questionnaires to assess functional impairment in individuals with mild cognitive impairment.

BACKGROUND: Mild deficits in instrumental activities of daily living (IADLs) have consistently been reported in the individuals with mild cognitive impairment (MCI). A variety of functional assessment tools, including self-and informant report questionnaires and performance-based measures, have been employed in MCI. Previously, a limited focus has been directed at appraising the quality of questionnaires. The goal of this study was to identify the questionnaires that have been validated in the MCI population. Additionally, the quality of validation studies and psychometric attributes of these questionnaires were appraised. METHODS: Relevant articles were systematically searched in PsychINFO, Ovid MEDLINE, and CINAHL against specific eligibility criteria. To evaluate the methodology of the psychometric studies, the COSMIN checklist was employed. Also, the psychometric properties of the assessment tools were evaluated based upon Terwee's criteria. RESULTS: A total of five psychometric studies and questionnaires were critically evaluated. Varying psychometric properties were available for the chosen tools. None of the studies received the best possible rating for their methodological quality. It was found that questionnaires with high discriminative ability to distinguish MCI from other diagnostic groups were: Disability Assessment in Dementia-6 (DAD-6), Functional Activity Questionnaire (FAQ), and Alzheimer's Disease Cooperative Study/Activities of Daily Living scale adapted for MCI patients (ADCS-MCI-ADL-24). CONCLUSION: Psychometric studies with strong methodological rigor are required in the future. Considering the fact that IADL decline has been associated with dementia, early detection of functional difficulties in MCI needs to be encouraged as it will allow suitable and timely interventions to prolong functional independence of affected individuals.

The Instrumental Activity of Daily Living Profile in Aging: A Feasibility Study.

BACKGROUND: Dysfunctions in complex activities of daily living (ADLs) are a normal part of the aging process. However, differentiating functional decline associated with healthy aging from the subtle decline experienced by individuals with mild cognitive impairment and early dementia constitutes a challenge. Finding an appropriate tool that can capture these subtle but important functional changes represents a priority. OBJECTIVES: The aims of this study were to evaluate the feasibility of using the Instrumental Activities of Daily Living Profile (IADL Profile) with elderly participants and to describe their level of difficulty encountered in each task. METHODS: The tool was administered to a group of 40 elderly participants living in the community. RESULTS: The IADL Profile was found to be feasible to use in older individuals; the tool also showed sensitivity to the difficulties experienced by this population in everyday functioning. CONCLUSION: The IADL Profile is a promising ecological tool to evaluate independence in aging and may help to identify individuals with MCI. This tool may also contribute to the development of tailored interventions to enhance everyday functioning in the older population.

Identification and assessment of functional performance in mild cognitive impairment: a survey of occupational therapy practices.

BACKGROUND/AIM: Despite the amount of research evidence pointing to functional changes experienced by individuals with mild cognitive impairment (MCI), we still do not understand how occupational therapists are currently addressing these concerns. Thus, we designed a national study to investigate Canadian occupational therapists practices with this clientele. METHODS: We conducted a Canada-wide online survey to investigate occupational therapists' practices with clients with potential MCI. Clinicians were prompted by a case vignette that described two clients: one vignette included cues associated with amnestic MCI (aMCI), the other non-amnestic MCI (naMCI). Specifically, clinicians were asked to identify potential concerns and to indicate the screening and assessment tools they would use in clinical practice. RESULTS: Two hundred and eighty-five participants met the inclusion criteria and were included in the final analysis. The average clinician age was 38.6 (SD = 10.3), 92% were female and 71.2% worked full-time. Almost all clinicians identified a concern in both vignettes, with cognitive concerns being identified more frequently than functional concerns [i.e. Instrumental Activities of Daily Living (IADL) concerns]. In terms of assessment practices, 18 standardised IADL assessments and 10 standardised cognitive assessments have been reported. CONCLUSION: Encouragingly, almost all clinicians identified a concern. However, some are still missing the IADL cues. Moreover, the lack of consensus in terms of which assessment practices to employ indicates that clinicians might benefit from guidelines in this area of practice.

Video game training to improve selective visual attention in older adults.

The current study investigated the effect of video game training on older adult's useful field of view performance (the UFOV® test). Fifty-eight older adult participants were randomized to receive practice with the target action game (Medal of Honor), a placebo control arcade game (Tetris), a clinically validated UFOV training program, or into a no contact control group. Examining pretest-posttest change in selective visual attention, the UFOV improved significantly more than the game groups; all three intervention groups improved significantly more than no-contact controls. There was a lack of difference between the two game conditions, differing from findings with younger adults. Discussion considers whether games posing less challenge might still be effective interventions for elders, and whether optimal training dosages should be higher.

Older adults' engagement with a video game training program.

OBJECTIVES: The current study investigated older adults' level of engagement with a video game training program. Engagement was measured using the concept of Flow (Csikszentmihalyi, 1975). METHODS: Forty-five older adults were randomized to receive practice with an action game (Medal of Honor), a puzzle-like game (Tetris), or a gold-standard Useful Field of View (UFOV) training program. RESULTS: Both Medal of Honor and Tetris participants reported significantly higher Flow ratings at the conclusion, relative to the onset of training. DISCUSSION: Participants are more engaged in games that can be adjusted to their skill levels and that provide incremental levels of difficulty. This finding was consistent with the Flow theory (Csikszentmihalyi, 1975).

Feasibility of machine-based prompting to assist persons with dementia.

Nearly 14% of people over age 71 have some form of dementia, with prevalence increasing to nearly 40% of those over age 90. As dimentia progresses, it impacts a person's independent functions and can increase the burden on caregivers. The use of assistive devices can help individuals with dementia live more independently. However, older individuals with cognitive impairment have difficulties using assistive technology devices because the devices are not designed to address their needs. The development of "smart devices" has potential in assisting older adults with cognitive impairment. Eleven community-dwelling seniors with moderate cognitive impairment (Mini-Mental State Examination scores ranging from 12-20) participated in this study. The Functional Independence Measure scores of participants were also collected to determine participants' current level of independence on selected tasks. Three tasks were selected to represent three levels of complexity: drinking water, brushing teeth, and upper body dressing. Participants were prompted through these tasks with simulated smart machine-based prompting. The need for prompts was highly individual, but given appropriate machine-delivered messages, participants completed the tasks an average of 86% of the time across the three self-care tasks. Machine-based prompting devices could aid caregivers as well as increase independence in some tasks.