TECH preserves global cognition of older adults with MCI compared with a control group: a randomized controlled trial.

BACKGROUND: Cognitive training using touchscreen tablet casual game applications (apps) has potential to be an effective treatment method for people with mild cognitive impairment (MCI). AIMS: This study aimed to establish the effectiveness of 'Tablet Enhancement of Cognition and Health' (TECH), a novel cognitive intervention for improving/preserving cognition in older adults with MCI. METHODS: A single-blind randomized controlled trial with assessments pre-, post-, and at 6-month follow-up was conducted. TECH entailed 5 weeks of daily self-training utilizing tablet apps, facilitated by weekly group sessions. Global cognition was assessed by the Montreal Cognitive Assessment (MoCA), and specific cognitive components were assessed using WebNeuro computerized battery. Short Form Health Survey (SF-12) assessed health-related quality of life (HRQoL). Intention-to-treat analysis was conducted and the %change was calculated between pre-post and between pre-follow-up. Cohen's d effect size was also calculated. RESULTS: Sixty-one participants aged 65-89 years were randomly allocated to TECH (N = 31, 14 women) or to standard care (N = 30, 14 women). Pre-post and pre-follow-up MoCA %change scores were significantly higher in TECH than control (U = 329.5, p < .05; U = 294.5, p < .05) with intermediate effect size values (Cohen's d = .52, Cohen's d = .66). Forty percent of TECH participants versus 6.5% of control participants achieved a minimal clinical important difference in MoCA. Pre-post between-group differences for specific cognitive components were not found and HRQoL did not change. DISCUSSION AND CONCLUSIONS: TECH encouraged daily self-training and showed to preserve global cognition of older adults with MCI. The implementation of TECH is recommended for older adults with MCI, who are at risk for further cognitive decline.

Experiences of Older Adults with Mild Cognitive Impairment from Cognitive Self-Training Using Touchscreen Tablets.

Background: "Tablet Enhancement of Cognition and Health" (TECH) is a cognitive intervention that includes two components: 5 weeks of daily self-training using puzzle-game apps on a touch screen tablet and weekly group sessions. This study aimed to (i) explore experiences of older adults with mild cognitive impairment (MCI) following their participation in TECH, (ii) identify hindering and enabling factors to self-training, and (iii) describe participants' perceived and objective cognitive changes and examine factors associated with their satisfaction from TECH. Materials and Methods: We used quantitative and qualitative measures; a phenomenological qualitative design using focus groups and interviews of 14 older adults with MCI and a focus group of the TECH facilitators. Satisfaction with TECH, self-training time, and perceived and objective cognitive changes (using the Montreal Cognitive Assessment) were evaluated. Results: Qualitative data were classified into three categories: Memory problems, Hindering and enabling factors to self-training, and Meaningful group sessions. The TECH facilitators reported positive changes, less cognitive complaints, and commitment and satisfaction of the participants. Participants reported overall satisfaction from TECH and performed a median interquartile range of 22.6 (19.9-42.8) self-training hours. Higher satisfaction was correlated with a higher objective cognitive change (r = 0.95, P < 0.01) and less training time (r = -0.91, P < 0.01). Discussion and Conclusions: Participants in the current study actively engaged in daily self-training using touch screen-tablet-puzzle-game and functional apps, driven by both internal and external motivators. Despite the lack of cognitive improvement, they expressed satisfaction with their participation in TECH. Therefore, encouraging older adults to engage in meaningful cognitive stimulating activities is recommended.

The Effect of Daily Practice of Puzzle-Game Apps on Cognition in Two Groups of Older Adults: A Pre-Post Experimental Study.

There is an urgent need for non-pharmacological cognitive interventions to delay the onset and modify the progression of the cognitive deterioration of older adults with early stages of cognitive decline. 'Tablet Enhancement of Cognition and Health' (TECH) is such an intervention. We aimed to assess the suitability of TECH for older adults with and without mild cognitive impairment (MCI). Specifically, we wanted to explore the feasibility and to determine the initial effectiveness of TECH for older adults with Pre-Mild Cognitive Impairment (pre-MCI) as well as with MCI. This is pre-post experimental design, including two groups of older adults. Feasibility included group session attendance (adherence), self-training time (compliance), and satisfaction from the TECH intervention. The Montreal Cognitive Assessment (MoCA) assessed global cognition and the WebNeuro computerized battery assessed specific cognitive components. Twenty-eight participants with MCI (8 women, aged 65-87), and ten participants with pre-MCI (5 women, aged 65-86) participated in TECH. High adherence, compliance, and satisfaction were reported by both groups. Memory recall improved for the MCI group (z = -2.7 p = 0.006). In addition, for the MoCA an intermediate effect size (Cohen's d = 0.52) and a small effect (Cohen's d = 0.18) were found for the MCI and pre-MCI groups, respectively. Large to small effect size values for WebNeuro cognitive components were found for both groups. Both groups of older adults were motivated, performed daily self-training, which gave them enjoyment and a sense of control. TECH seems to have potential to preserve cognition over time. Additional research with a longer follow-up is needed to determine whether TECH can prevent cognitive decline in older adults with MCI but especially with pre-MCI.

The Contribution of Frailty to Participation of Older Adults.

BACKGROUND: Participation, which is involvement in life situations, is an important indicator of human health and well-being of older adults. Frailty is known to be related to difficulties in activities of daily living (ADL) but the association with participation restriction has not been sufficiently researched. Therefore, we aimed to (1) to assess the correlations between frailty, ADL, and participation; and (2) to identify the contribution of frailty to explaining the participation restriction of older adults. METHODS: A cross-sectional study included home visits to community-dwelling older adults aged 75 and older. The Reintegration to Normal Living Index (RNL-I) assessed participation, PRISMA-7 assessed frailty, and the Functional Independence Measure and IADL questionnaire assessed the basic and instrumental ADL. Cognition, which may explain participation, was also assessed (The Montreal Cognitive Assessment) and demographic information was collected. RESULTS: Older adults (N = 121, 60 women), aged 75 to 91 years (mean (SD)-79.6 (3.1)), were included. Older adults demonstrated full to restricted participation (RNL-I-mean (SD)-78.2 (18.0)/100). Frailty was identified in 39 (32%) older adults (mean (SD) PRISMA-7-2.9 (1.4)/7points). A negative moderate significant correlation was found between participation and frailty (r = -0.634, p < 0.001). The variance of participation was significantly explained by frailty, 31.5%, and basic ADL, 5.6% (after controlling for age and cognition); the total model explained 44.6% (F = 23.29, p < 0.001). CONCLUSIONS: Frailty is significantly associated with participation restriction. Since participation has many health benefits, understanding which factors are associated to participation is central to developing interventions for older adults. These findings may help health professionals in the future develop interventions for maintaining and promoting the participation of older adults.

The Development and Feasibility of TECH: Tablet Enhancement of Cognition and Health, a Novel Cognitive Intervention for People with Mild Cognitive Impairment.

Objectives: Cognitive training using technology has potential to be an effective treatment method for people with mild cognitive impairment (MCI). Touchscreen tablet applications might provide a fun and motivating way to engage in cognitive training for people with MCI. This study presents the development of TECH: "Tablet Enhancement of Cognition and Health," a novel cognitive intervention utilizing touchscreen tablet applications for self-training, and we aimed to examine TECH's feasibility and satisfaction for older adults with MCI. Materials and Methods: TECH development was based on the review of research evidence to identify important demands for effective cognitive training, and discussions with occupational therapists with experience using touchscreen tablets for treating individuals with cognitive impairments. Feasibility of TECH was assessed in terms of adherence (session attendance), compliance (total self-training hours), and satisfaction from the intervention. Results: Twenty-eight community-dwelling older adults with MCI participated in the study and received TECH. Participants attended at least 80% of group sessions, they self-trained a mean (standard deviation [SD]) 20.9 (7.2) sessions for 5 weeks, mean (SD) total training time of 24.4 (11.9) hours, 4.9 h/week. Very high satisfaction with the intervention was reported by 78% of the 23 participants who filled in the questionnaire. Conclusions: The newly developed TECH intervention was found to be feasible for older adults with MCI. Participants were willing and able to perform the self-training at home, which provided a motivating cognitive leisure activity facilitated by weekly group sessions. Data are now collected to establish the effectiveness of TECH as a cognitive intervention, compared with a control group, for people with MCI.

To check or not to check. Rectal ESBL colonization in hospitalized elderly patients.

BACKGROUND: The worldwide spread of extended-spectrum-beta-lactamase (ESBL) producing bacteria has affected health care. ESBL confers resistance to the majority of beta-lactam antibiotics. MATERIALS AND METHODS: We intended to quantify the rates of rectal ESBL-positive and negative patients that eventually developed fever and urinary tract infection (UTI). All rectal ESBL-positive patients were to be initially treated with the conventional antibiotics that have anti-ESBL activity (amikacin or ertapenem), while ESBL-negative patients were given ceftriaxone. RESULTS: Most patients were rectal ESBL-positive (60.7%). Fever was in 51% patients; 67.8% of them developed signs and symptoms of UTI. Most patients with UTI were urinary ESBL-positive (79%), most rectal ESBL-negative patients were urinary ESBL-negative (75%), (χ2 = 18.5, df = 1, P < .001). Overall mortality was higher in the febrile group (39, 34.8%) versus the afebrile (1, 0.9%) (χ2 = 42, df = 1, P < .001). The mortality rate in the febrile group was significantly higher in the rectal ESBL-positive patients (χ2 = 7.5, df = 1, P = .006). DISCUSSION: The direct correlation of rectal ESBL-positive and negative and respectively urinary ESBL-positive and negative patients' advocate for the use of antibiotics with anti-ESBL activity as an empiric treatment of rectal ESBL-positive patients with suspected UTI. CONCLUSION: In our opinion, it is worthwhile to identify rectal ESBL-positivity on hospital admission.

Clostridium difficile-associated disease: A primary clinical evaluation of elderly patients in a geriatric hospital.

The purpose of this study was to screen all cases of Clostridium difficile-associated disease during a 2-year period in a geriatric hospital to determine the incidence and clinical characteristics related to this risk. Twenty percent of suspected cases were diagnosed as positive and analyzed. The C difficile disease-associated clinical factors were ischemic heart disease and chronic obstructive pulmonary disease. Use of acetylsalicylic acid, other nonsteroidal anti-inflammatory drugs, and steroids were more frequently found in the non-C difficile group. There were fewer cases in men than in women and more in patients residing in skilled nursing wards.