Background SYNchronizing Exercises, Remedies in GaIt and Cognition @Home (SYNERGIC@Home/SYNERGIE~Chez soi) is a home-based, double-blind, randomized controlled trial. Sixty community dwelling older adults (aged 60–90 years), living in New Brunswick, Canada, who were at risk of dementia participated remotely using secure videoconferencing. Participants underwent 16 weeks (three sessions/week) of cognitive and physical interventions. This research aimed to determine the frequency, severity, and relationship of adverse events (AEs) that occurred during the physical and cognitive intervention phase of the SYNERGIC@Home study. This study addressed a critical question: Whether AEs occurring during a remote exercise and cognitive intervention for older adults at risk of dementia can be managed safely and effectively to optimize participation. Methods All AEs were recorded, including type, severity, and their relatedness to the intervention. Intervention modifications due to AEs were also recorded. Results Participant’s mean age was 69.5 years (SD=6.47), 76.7% were female, and 58.4% were living in suburban or urban communities. A total of 88 AEs affected 42 (70.0%) participants. Most AEs (71.6%) were unrelated to the intervention, and 69.3% were classified as mild, with musculoskeletal issues being the most common AE (39.8%). One unrelated serious AE was recorded. Modifications to the physical intervention were made for 31 participants, and two discontinued due to unrelated medical issues. Conclusions When delivered remotely, physical and cognitive interventions resulted in no serious related AEs and the few related, mostly mild AEs, were safely managed through modifications to the physical interventions.
Psychosocial interventions targeting cognition improve objective cognitive test performance, strategy use, emotional well-being, and quality of life in individuals with mild cognitive impairment and early dementia. These interventions have been labeled as cognitive training, cognitive remediation, cognitive rehabilitation, cognitive stimulation, and overlap with cognitive (psycho)therapy. The inconsistent labeling of the interventions has resulted in ambiguity of what a cognitive intervention entails and limits the translation of interventions into clinical practice. To address this, we propose a new frame-work, “PICC-M”, that classifies cognitive interventions based on five active ingredients or the mechanisms resulting in clinically significant change. These ingredients are psychotherapeutic support (P), individualized patient goals (I), cognitive exercises (C), compensatory strategies (C), and metacognitive strategies (M). We examine three intervention programs to illustrate how this framework clarifies each intervention’s active ingredients and their relation to cognitive, psychological, and functional outcomes. The PICC-M framework lays the foundation for dismantling studies to isolate and test the effectiveness of specific active ingredients and ultimately support clinical delivery of evidence-based interventions for older individuals with neurocognitive deficits.
Social isolation and loneliness are associated with many adverse health outcomes. The COVID-19 pandemic increased its prevalence and disproportionately affected older adults. Since telephone befriending was a potentially feasible and safe intervention during the pandemic, the McMaster Phone-a-Friend Program (PFP) was developed using this strategy to try to reduce social isolation and loneliness among older adults. Thus, this study aimed to evaluate the effectiveness and long-term feasibility of PFP. Community-dwelling older adults in Ontario, Canada were matched to trained university student volunteers, who provided social engagement and pandemic-related education through weekly telephone calls. Two main referral sources were used: 1) older adults identified by their primary care provider as at risk for social isolation; and 2) older adults referred for multi-modal frailty rehabilitation, where telephone befriending was a desired component intervention. Older adults completing ≥4 calls were contacted to participate in a telephone survey to provide program feedback. Of the 220 active participants in August 2021, 60 participated in our survey. At the time of survey completion, the mean number of calls completed was 8.3. The mean age of participants was 75.6 years and 71.7% (n=43) identified as female. Furthermore, 58.3% (n=35) of the participants agreed or strongly agreed that they felt less lonely after participating in the program and 68.3% (n=41) stated they would participate in the program after the pandemic resolves. The intergenerational PFP telephone befriending program is a safe and effective method of reducing or possibly preventing social isolation and loneliness among at-risk community-dwelling older adults.
Sarcopenia is an age-related skeletal muscle disorder characterized by decreased muscle mass, strength, and physical function, which increases the risk of adverse outcomes in older adults. Recently, ultrasound has emerged as a practical tool for estimating muscle thickness as a proxy for muscle quantity. However, standardized protocols, reference data, and diagnostic cut-off values for ultrasound-based muscle assessment remain lacking. This study pooled participants from three cohorts in which quadriceps muscle thickness was assessed in B-mode with a linear probe using point-of-care ultrasound (POCUS). Of 391 participants, 389 were included in the final analysis. Age was categorized into five-year groups (65-69, 70-74, 75-79, 80-85, and over 85 years old). Means and standard deviations (SD) of quadriceps thickness were calculated by sex and age group. Mean age was 77 ± 7 years. Quadriceps muscle thickness followed a normal distribution with a standard deviation of 0.5 cm. Mean thickness declined with advancing age. Our pooled analysis found a mean quadriceps muscle thickness of 2.0 cm. The decline with advancing age was modest, with the lowest value observed in participants aged 85 years and older (1.8 ± 0.4). On average, muscle thickness decreased by approximately 0.1 cm per decade after age 65. These findings provide age- and sex-specific reference values for quadriceps muscle thickness measured by POCUS, and support its potential utility as a feasible tool for muscle assessment in older adults.
Emotion-focused model of care delivery creates a supportive environment for persons with dementia. There is a lack of certainty regarding one such emotion-focused model's effectiveness (Butterfly) in an acute care environment, primarily because prior research has been confined to long-term care (LTC) facilities. Studies have demonstrated reduced neuropsychiatric symptoms (NPS) when person-centred dementia care models are deployed for persons living with dementia (PLWD). A multi-site cross-sectional design assessed NPS in PLWD using the NPI-Q scale in hospitalized patients on a Emotion-focused unit for 7-21 days. We identified 177 PLWD (88 from an acute care for elderly unit, 89 from general medicine units). The two cohorts had 40 female and 48 male patients in the ACE unit and 35 female and 54 male patients in the general medicine unit. The average age between the two groups was 83 and 84 yrs, respectively. NPI-Q symptom severity was lower on the ACE unit in comparison to the general medicine unit. Mean improvement for motor behaviours and sleep were significant. Caregiver distress scores were significantly lower for delusions, agitation, anxiety, irritability, motor behaviour and sleep. Emotion-focused care made a statistically significant change in NPS severity and caregiver distress when compared to care provided in general medicine units.
