Promoting cognitive health: a virtual group intervention for community-living older adults

Vasques, Tamires Nicodemos; Almeida, Maria Helena Morgani de; Toldrá, Rosé Colom; Batista, Marina Picazzio Perez

doi:10.1590/1980-5764-DN-2022-0020

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Dementia & Neuropsychologia

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Sumário

Original Article • Dement. neuropsychol. 17 • 2023 • https://doi.org/10.1590/1980-5764-DN-2022-0020 copy

Promoting cognitive health: a virtual group intervention for community-living older adults

Promoção da saúde cognitiva: uma intervenção de grupo virtual para idosos que vivem na comunidade

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Group cognitive interventions can promote a sense of self-efficacy to older adults. Due to restrictive social distancing measures in the COVID-19 pandemic, face-to-face interventions that aimed to promote cognitive health needed to be adapted to a virtual offering.

Objectives:

This study aimed to analyze the effects of promoting cognitive health in a virtual group intervention for community-living older adults.

Methods:

This is a mixed, prospective, and analytical study. Before and after the intervention, the tests were applied: Brief Cognitive Screening Battery (BCSB) and the Subjective Memory Complaints Questionnaire (MAC-Q). Data were collected at semi-structured interviews related to the adoption of memory strategies. Statistical tests were conducted for initial and final intragroup comparison. The qualitative data were assessed using thematic analysis.

Results:

A total of 14 participants concluded the intervention. With respect to mnemonic strategies, the most relevant for the qualifier “Did not use it before and started to do so after the group” were association (n=10; 71.4%) and dual-task inhibition (n=9; 64.3%). According to the tests, the intervention improved incidental, immediate, and delayed recall, as well as the perception of memory for “Remembering the name of the person they just met,” “Remembering the telephone number you use at least once a week,” “Remembering where they put an object,” “Remembering news from a magazine article or television program,” and “In general, how would you describe your memory now compared to when you were 40 years old.”

Conclusions:

The synchronous virtual group intervention was shown to be feasible for the elderly in the community who participated in the study.

Keywords:
Aged; Cognition; Remote Consultation; COVID-19

Theme at the meeting	Contents
Session 01 Dynamics of presentation Focus on memory	“Affective memory wall” which enabled the participants to present themselves from a photo of what they represent in sense and meaning. Memory concept and functions. The three phases for memory retention were addressed (capture, storage, and recall). Importance of Intention to learn and the meaning of information. Strategies to compensate for impaired senses (glasses, hearing aid), environment (lighting, low noise), and behavioral changes (use of more than one sense, use more keen sense, better times to perform activities).
Session 02 Types of memory	Explicit/declarative memory, short-term and long-term memory. Content-retrieval activities: Who am I?, Popular sayings and What kind of memory is this?
Session 03 Types of attention	Attention: selective, alternating, and divided. Content-retrieval activities: Looks like but isn’t/Figure-background, Lynx eyes game, and Senior dance.
Session 04 Demystifying aging	Cognitive aging. Content-retrieval activities: Myth or truth; Reflection on “Age and Change” and “Utopia of the Perfect Age”.
Session 05 Lifestyle and memory	Diet balanced, practice of physical and mental activities, combating stress, controlling diseases and their relationship with memory. Content-retrieval activities: 21-Day Theory (Building Habits).
Session 06 e 07 Strategies for memory	Association; dual-task inhibition; increased attention; multiple coding; categorization; external device; environmental change and planning; emotion attribution; change in lifestyle; repetition; change in routine and behavior. Content-retrieval activities: memory palace.
Session 08 Memory and emotion	Emotion interferes with capture, storage, and evocation. Storage strategy: attribution of emotion to information, assigns a prominent place in memory. Content-retrieval activities: sensory experiences.
Session 09 Content review	Rescue of main contents, resolution of doubts, closing dynamics, and speech space for suggestions.

Variables		n	%
Sex	Female	14	100
Sex	Male	0	0
Age (years)	60–69	9	64.2
	70–79	4	28.5
	80 years or older	1	7.1
Schooling	Incomplete secondary	1	7.1
Schooling	University graduate	13	92.9
Access to Google Meet	Required access tutorial	5	35.7
	Refused to need the access tutorial	9	64.2
	Total	14	100

Memory strategy	Did not use it before and started to do so after the group (%)	Already used it and started to use it more after the group (%)	Did not use it before and continued not using it after the group (%)	Already used it and after the group continued using it to the same extent (%)
Association	10 (71.4)	3 (21.4)	0	1 (7.1)
Dual-task inhibition	9 (64.3)	2 (14.3)	3 (21.4)	0
Increased attention	8 (57.1)	3 (21.4)	2 (14.3)	1 (7.1)
Multiple coding	6 (42.9)	5 (35.7)	1 (7.1)	2 (14.3)
Categorization	6 (42.9)	3 (21.4)	0	5 (35.7)
External device	1 (7.1)	8 (57.1)	0	5 (35.7)
Environmental change and planning	1 (7.1)	5 (35.7)	2 (14.3)	6 (42.9)
Emotion attribution	3 (21.4)	6 (42.9)	4 (28.6)	1 (7.1)
Change in lifestyle	2 (14.3)	6 (42.9)	1 (7.1)	5 (35.7)
Repetition	3 (21.4)	4 (28.6)	5 (35.7)	2 (14.3)
Change in routine and behavior	1 (7.1)	5 (35.7)	3 (21.4)	5 (35.7)

Item	Before		After		p
Item	Median [IR]	Mean (sd)	Median (IR)	Mean (sd)	p
Incidental recall		6.71 (1.684)		7.64 (1.393)	0.031
Immediate recall	9 [8.75–10]		10 [10–10]		0.02
Learning	9 [9–10]		10 [10–10]		0.059
Delayed recall	9 [7.75–10]		10 [10–10]		0.006
Recognition	10 [10–10]		10 [10–10]		0.564
Verbal fluency		20.14 (5.895)		21.93 (5.717)	0.425
Clock drawing	9 [9–10]		10 [9–10]		0.679
Total score		72.71 (8.801)		78.21 (6.192)	0.052

Item	Before		After		p
Item	Median [IR]	Mean (sd)	Median [IR]	Mean (sd)	p
Remembering the name of a person they just met	4 [3–4]		3 [2–4]		0.016
Remembering the telephone number used at least once a week	3.50 [3–4.25]		3 [3–3.25]		0.039
Remembering where they put an object	4 [3–4]		3 [2–4]		0.018
Remembering news from a magazine article or television program	4 [3–4]		3 [2–3.25]		0.016
Remembering things that they intended to buy when they arrived at a store	4 [3–4]		3 [2–4]		0.058
In general, how would you describe your memory now compared to when you were 40 years old	8 [8–10]		8 [4–8.5]		0.023
Total score		26.43 (3.631)		21.36 (5.271)	0.002

Thematic analysis		Transcription of participants’ speeches/performance observation
Benefits	Impact of the group on their daily life	P (1) “(...) you gave us the content with affection, it was very beautiful in this moment that we are in isolation, to feel this affection”. P (2) “(...) for those who are feeling depressed, this group soon morning can help”. P (9) “(...) despite having some things that we already used, it’s nice to know that it’s good, useful, that we’re on the right track and outside of the other things we had no idea about, like the strategy of using emotion to record information, this was new.”
	Socialization	P (12) “meeting new people from different universes was very gratifying (...)”. P (13): “This group is an opportunity for me to make friends and make plans for the future when we can meet in person”.
	Demystify beliefs	P (4) “(...) I always had trouble remembering the names of the people and I was a teacher, now I can see that it involves attention and the use of memory strategies”. P(7) “(...) I realize that when I demand control of everything, sleep is troubled, I accept the kind of life I lead today, I manage my life, I’m very dynamic... these are lessons I’m having with myself even, not to demand more from me than I am able to do (...)” P (14) “I always thought that the fact of making millions of things at the same time were positive, for me it broke this paradigm, I thought that it would save me from losing my memory.”
	Remote consultation	P (10) observed the optimization of the time and savings with transportation “(...) we are at home, it is economical and viable, you don’t need to take a car, bus and park”. P (9) “(...) it’s good that we start at ten o’clock and you can turn on the computer at five to ten, it’s not like it’s at USP that we have to leave the house well before”. P (12) was the only participant who reported having already participated in a face-to-face group with a similar proposal at his basic health unit of reference. It is there that he experienced a greater good among his participations” (...) so the group dispersed, out of affinity and empathy we approached to help with the coordinator’s guidance. What I feel in the virtual is that we are all seeing each other at the same time, there is a proximity, we are all interacting. At first I thought we would be further apart, on the contrary, I feel that the interest that leads to a good result.”
Difficulties	Device chosen for access	P (5): “(...) the cell phone limits more, the sound is not so good, the screen is small, the fact of being online challenges people of our age group who still are getting used to it”.
Difficulties	Technology barriers/troubleshooting difficulty	There were interruptions that made it difficult to participate, these referred to the routine of the home, for example, family members passing by of the person and environmental noises such as those experienced by P (14) who was with works on the building and P (13) who lived near the airport. P (6), for example, could not turn on the microphone and, in an attempt to solve, entered and left the online room. There were, for example, episodes of problems with internet connection, interruptions while using the microphone when more than a person wanted to talk.

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E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Correspondence: Tamires Nicodemos Vasques; Email: tamires.vasquees@gmail.com.