Community-based Multi-domain Intervention to Detect and Delay Cognitive Decline in Community-dwelling Older Adults: A Pilot Study

Official title

IMPlementation stRategiEs for Scalability and Sustainability - Multidomain INterventions in a Structured Care Pathway to Detect and Delay Cognitive Decline in Community-dwelling Older Adults (IMPRESS-MIND2S): Pilot Test

Overview

The incidence of cognitive impairment and its burden are increasing with a rapidly ageing population. In Singapore, the prevalence of dementia among older adults aged 60 and above is approximately 10%, which will translate to approximately 152,000 older adults living with dementia by the year 2030. Using 2013 data as estimates, the total annual cost of dementia was already estimated at S$532 million while cost per person was estimated at S$10,245 per annum, and a further increase in corresponding costs is expected through 2030 with the projection of increase in persons with dementia (PWDs). There is thus an urgent need for (i) effective, scalable, and sustainable interventions that are widely accessible to detect and delay cognitive decline and frailty in our community-dwelling older adults, and (ii) providing support for their caregivers. This study aims to test the feasibility of a community-based multi-domain intervention for detecting and delaying cognitive impairment for the older population.

Interventions

• Behavioral Social support
  Psychoeducation will be provided for enrolled participants and their caregivers by Community Resource, Engagement \& Support Team (CREST). Visits from CREST teams will be provided on an ad hoc basis, based on older adult participants' needs and circumstances.
• Behavioral Health coaching
  Health coaching aims to control risk factors of dementia by community nurses (CMNs) and wellbeing coordinators (WBCs). These include addressing chronic conditions and lifestyle aspects (diet, exercise, habits stress management, and sleep). Care recipients are encouraged to proactively manage their health journey and establish Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) goals with the support of WBCs and CMNs. This multi-faceted approach has the potential to not only addres
• Behavioral Physical Activity
  Physical Activity that focuses on improving resistance and balance for care recipients. Physical activity will be conducted 2 times/week at the Active Ageing Centres (AACs) with care recipients for a duration of 1-hour and 1-2 times/week at home.
• Behavioral Cognitive activity
  Cognitive activity will be delivered to enrolled care recipients by Community Resource, Engagement \& Support Team (CREST) and AAC staff. With the incorporation of using SilverPad as part of the cognitive activities, care recipients will undergo 1-hour weekly cognitive activity. Youth volunteers will also be engaged to help facilitate the sessions. This will be augmented with additional 1-2 times weekly home-based training sessions supervised by caregivers.

Primary outcome measures

• Care recipients' cognition measured by the Montreal Cognitive Assessment (MoCA) [Time frame: From enrollment to the end of month 6]

Secondary outcome measures (12)

• Care recipients' physical function measured by short physical performance battery (SPPB) [Time frame: From enrollment to the end of month 6]
• Care recipients' frailty measured by FRAIL scale [Time frame: From enrollment to the end of month 6]
• Care recipients' health-related quality of life measured by EuroQol 5-Dimension 5-Level (EQ-5D-5L) [Time frame: From enrollment to the end of month 6]
• Care recipients' health state on a EuroQol Visual Analogue Scale (EQ VAS) [Time frame: From enrollment to the end of month 6]
• Caregivers' caregiving burden measured by Zarit burden interview (ZBI) [Time frame: From enrollment to the end of month 6]
• Care recipients' ability to perform more complex tasks necessary for independent living within the community - Measured by Lawton scale iADL [Time frame: From enrollment to the end of month 6]
• Feasibility outcome - Acceptability, collected from the Acceptability of Intervention Measure (AIM) [Time frame: At the end of months 2, 4, and 6]
• Feasibility outcome - Perceived appropriateness, collected from the Intervention Appropriateness Measure (IAM) [Time frame: At the end of months 2, 4, and 6]
• Feasibility outcome - Perceived feasibility, collected from the Feasibility of Intervention Measure (FIM) [Time frame: At the end of months 2, 4, and 6]
• Feasibility outcome - Care recipients' perceptions of the intervention, collected from qualitative interview [Time frame: Month 6]
• Feasibility outcome - Acceptability, collected from the Acceptability of Intervention Measure (AIM) [Time frame: Month 6]
• Feasibility outcome - Perceived appropriateness, collected from the Intervention Appropriateness Measure (IAM) [Time frame: Month 6]

Eligibility criteria

Inclusion criteria

Older Adults:

• 60 years and older with cognitive concerns or (self-reported or observer reported),
• English and/or Mandarin speaking,
• no physical disabilities that preclude study participation,
• willing to complete all study-related activities,
• no known diagnosis of major cognitive impairment,
• able to provide consent.

Caregivers:

• 21 years and older,
• English and/or Mandarin speaking,
• able to provide consent
• have at least 6-month experience of taking care of older adults with mild cognitive impairment.

Service providers:

• 21 years and older,
• English and/or Mandarin speaking,
• able to provide consent.

Youth Volunteers:

• volunteers from Youth Corps Singapore (YCS)
• English and/or Mandarin speaking,
• able to provide assent

Exclusion criteria

Older adults

• Known diagnosis of moderate dementia and above,
• Montreal Cognitive Assessment (MoCA) score <18,
• Has difficulty in basic activities of daily living,
• disorders that affects safe engagement in the intervention (e.g. symptomatic cardiovascular disease, revascularization within 1 year, major depression or anxiety with ongoing treatment, underlying malignancy),
• Severe vision or hearing impairment or any other disorders preventing cooperation as judged by the study team,
• Major illness with life expectancy <6 months,
• Institutionalized,
• Planned major surgery within the duration of the multi-domain intervention,
• Physical disabilities that preclude study participation.

Caregivers:

• aged below 21 years old,
• not being the primary family caregiver of at least one older individual,
• not being able to read, write, and converse in English/Mandarin,
• their family members (older adults) have not participated in the pilot test for at least one month (1 session of cognitive activity/week, 2 sessions of physical activity/week).

Care providers:

• not working for the older population,
• Not being able to read, write, and converse in English/Mandarin,
• have not provided service during the period of the pilot test for at least one month (1 session of cognitive activity/week, 2 sessions of physical activity/week).

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Health services research

Study locations

Center list to be confirmed — check the primary protocol.

Identifiers

NCT: NCT07099040 · 202503-0001 · NICTran2023-0014

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗