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Background global population aging and forecasted trends of modifiable risk factors for dementia and Alzheimer's disease (AD) make prevention of these conditions an urgent priority. The World‐Wide FINGERS (WW‐FINGERS) global network of multidomain trials for dementia risk reduction and prevention is at the forefront of efforts to find effective and sustainable solutions for diverse population. The COVID‐19 pandemic has caused changes in the mental and physical health of older adults, which can influence dementia risk and prevention opportunities. Methods The WW‐FINGERS‐SARS‐CoV‐2 survey was developed to assess direct and indirect effects of the COVID‐19 pandemic in older adults. The questionnaire measures changes in lifestyle factors (e.g., diet, physical activity), management of chronic noncommunicable diseases (e.g., diabetes, hypertension), and psychosocial factors ‐including depressive symptoms, sleep disorders, social isolation‐ that are relevant to cognition. Both a pen‐and‐paper and a digital version of the survey have been developed in several languages. The digital version is supported through REDCap (Research Electronic Data Capture), which is used also for harmonized data collection. Results 30 countries are participating in the survey. As for January 2022, data have been collected from 20 countries, with 23000+ participants. Local adaptations and piloting were done to optimize implementation in clinical‐based and population‐based settings. Participants are in the at‐risk spectrum for dementia: from normal cognition to pre‐dementia cognitive symptoms. Timing of the survey implementation varies across populations, allowing to capture short, medium and long‐term effects of the pandemic and restrictions measures. Some countries have used the survey to recruit participants in multimodal prevention trials. An updated report of the survey status and main results will be presented. Conclusion The WW‐FINGERS‐SARS‐CoV2 survey is a joint global action of the WW‐FINGERS network which can inform better care of older adults in the context of a pandemic. The survey is also a valuable tool for pre‐screening of participants for prevention trials, and results can inform adaptions to ensure successful recruitment and adherence in forthcoming multidomain trials for dementia prevention in older adults.
ABSTRACT
PURPOSE OF REVIEW: The potential for dementia prevention is deemed substantial if modifiable risk factors were addressed. First large-scale multidomain lifestyle interventions aiming at reducing risk of cognitive decline and dementia have yielded mixed but promising evidence. RECENT FINDINGS: Despite the impact of the COVID-19 pandemic on trials conduction, causing interruptions and delays, the research landscape on multidomain interventions is growing rapidly. The successful Finish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) has led to an adaptation of the FINGER model in trials underway or being planned in over 40 countries. Recent studies identified barriers and facilitators of and adherence to multidomain interventions, showed the suitability of dementia risk scores as surrogate outcomes, and suggested mechanisms. Multidomain interventions are increasingly conducted in the Global South, and study protocols are increasingly testing expanded FINGER models, for example, with pharmacological components, in digital/remote settings and co-designed personalized interventions. SUMMARY: Though results remain mixed, the many ongoing trials will provide more conclusive evidence within the next few years and help to optimize interventions. Continued international collaboration is pivotal to scale and accelerate the development and implementation of effective multidomain interventions as part of larger public health strategies to counteract the global dementia increase.
Subject(s)
COVID-19 , Cognitive Dysfunction , Dementia , Aged , COVID-19/prevention & control , Cognitive Dysfunction/prevention & control , Dementia/prevention & control , Humans , Pandemics , Risk Reduction BehaviorABSTRACT
The COVID-19 pandemic and its related restrictions have affected the everyday life of older people. Advanced age is a significant predisposing factor for a more severe COVID-19 infection, increasing the risk for hospitalization and mortality. Even though restrictions have been, thus, well-grounded, they may also have had detrimental effects on the social well-being of older people. Personal networks and social activity are known protective factors against the premature decline in health and functioning, and it is widely acknowledged that social isolation increases feelings of loneliness, poor quality of life, and even the risk for diseases and disabilities among older adults. This qualitative study investigated changes in personal networks among community-dwelling oldest-old individuals (persons aged 80 and over) during the first and second waves of the COVID-19 pandemic in Finland. The data is part of the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE85+) study, which is an ongoing large longitudinal population-based study in Finland. In this qualitative sub-study, we analyzed fifteen in-depth telephone interviews using directed content analyses and identified five types of changes in personal social networks during the pandemic. In type 1, all social contacts were significantly reduced due to official recommendations and fear of the virus. Type 2 included modified ways of being socially active i.e., by deploying new technology, and in type 3, social contacts increased during the lockdown. In type 4, personal social networks were changed unexpectedly or dramatically due to a death of a spouse, for example. In type 5, we observed stable social networks, which had not been affected by the pandemic. At an individual level, one person could have had different types of changes during the pandemic. These results highlight the heterogeneity of the oldest olds' personal social networks and changes related to them during the exceptional times of the COVID-19 pandemic. Social activity and personal networks play an important role in the well-being of the oldest old, but individual situations, needs, and preferences toward personal social networks should be taken into account when planning social activities, policies, and interventions.
ABSTRACT
Risk reduction and prevention of dementia in older adults is a growing research area. In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER randomized controlled trial) a 2-year multidomain intervention -dietary counseling, exercise, cognitive training, vascular and metabolic risk monitoring- improved cognition in older adults from the general population who had increased dementia risk. The intervention was associated also with improvement of other clinical outcomes (e.g., multimorbidity, functional status). The FINGER model is being adapted and tested in different populations and settings through the World-Wide FINGERS, the first global network of multidomain prevention trials, including over thirty countries. The network goal is to identify effective and feasible solution for dementia risk reduction across the spectrum of cognitive decline - from at-risk asymptomatic states to early-symptomatic stages. Through the World-Wide FINGERS-SARS-CoV-2 initiative, the network aims to assess the effects of the COVID-19 pandemic in older adults.
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Background Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a randomized trial that showed beneficial effect on cognition with a 2-year multidomain lifestyle intervention. During the post-intervention follow-up, COVID19 pandemic emerged resulting in lockdown and reduced services. Our aim is to investigate how lifestyle and behavior changes during the pandemic are related to lifestyle earlier in the study. Method The FINGER cohort included 1260 individuals aged 60-77 years at baseline and at risk of dementia, randomized into multidomain intervention or control groups. A postal survey was sent to all eligible participants from the FINGER study in June 2020 (end of the first wave of the pandemic in Finland), on average 10 year after the baseline. 859 (68%) were still alive and eligible for the survey. Result Total of 735 responders (85% of the eligible participants) were on average 78 years old. They were younger, had higher baseline cognition, and were more often from the former control group than non-responders (p<0.05 for all). The intervention allocation showed no association with self-reported lifestyle changes during the pandemic in diet, exercise, or cognitive activity. Among older participants (>78 y), the intervention group reported more increase in remote contact with friends and relatives (p=0.013) and health care (p=0.042) than the control, and also less pandemic-related reduction in overall contact with friends (p=0.045). Among all, reductions in physical exercise were reported among those who were less physically active earlier in the study. Both increase and decrease in contact with friends and family were reported by those more cognitively active earlier in the study. They also had more increase in remote contacts. Changes in diet were positive (increase in fruit and vegetable intake), but they were not related to earlier diet. Conclusion The FINGER participants reported only minor change in their lifestyle and behavior during the first wave of the COVID pandemic related lockdown. For physical activity, the pandemic appeared to have negative effect particularly among those with lower levels earlier, possibly adding inequalities. Intervention was related to more remote contacts, probably due to better computer literacy after the cognitive training.
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Background U.S. POINTER is testing whether multidomain lifestyle interventions focused on physical exercise, nutrition, cognitive challenge, and risk factor management reduces risk of cognitive decline in a heterogeneous population of at-risk older adults in America. The study adapts the FINGER (Finnish Intervention Geriatric Study to Prevent Cognitive Impairment and Disability) interventions to fit the United States culture and delivers the intervention within the community at 5 sites across the country. Method U.S. POINTER is a 2-year RCT that will enroll 2000 cognitively unimpaired older adults who are at risk for cognitive decline due sedentary lifestyle, poor diet and other factors. Participants are randomized to one of two lifestyle intervention groups that differ in format and intensity. In 2020, the COVID-19 pandemic presented a number of challenges for the study that affected recruitment, assessment schedules, and intervention delivery. Result As of March 2020, when COVID-19 incidence was on an exponential rise in the US, 240 participants had been enrolled in U.S. POINTER. In response to local and national safety mandates, study activities were paused from March 23rd to July 13th. During the pause, sites remained in contact with study candidates and enrolled participants to provide ongoing support to keep them engaged in the trial. Enrollees also received regular telephone calls to encourage continued adherence to their assigned lifestyle intervention. In response to the multiple pandemic-related challenges, study protocols and procedures were adapted to facilitate and encourage participant adherence to intervention activities. At study re-start, retention was 98%. Despite climbing COVID-19 infection rates nationwide, enrollment at all 5 sites has continued at a steady rate (N=540 as of Jan2021), virtual Team Meeting attendance for both lifestyle groups exceeds 80%, and participants continue to successfully work toward their intervention goals. Conclusion The COVID-19 pandemic presented unprecedented challenges, but it also provided a unique opportunity to adapt intervention delivery so that a nonpharmacological community-based trial could continue ? even during a debilitating global health crisis. U.S. POINTER?s adaptations to pandemic-related challenges may ultimately increase the resilience of its interventions to even the most challenging of circumstances that older adults will face now and in the future.
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Background Restrictions enforced in many counties during the COVID-19 pandemic may have both short- and long-term effects on the risk factors relevant for cognitive impairment and dementia. The COVID-19 pandemic occurred during the post-intervention follow-up phase of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) postponing the planned follow-up visits of the participants. We investigated how the first phase of the COVID-19 pandemic affected lifestyles and other risk factors among the FINGER participants using a postal survey. Method A survey was sent in June 2020 to 859 eligible FINGER participants. The survey was developed to assess the effects of the COVID-19 pandemic and related infection-control measures on lifestyles, daily life, commitment to distancing measures, access to healthcare and social services, and changes in cognitive and social activities, as well as emotional health and wellbeing. Result A total of 735 participants responded to the survey (85% of the eligible participants). They were on average 78 years old at the time of the survey. Majority of the participants adopted some distancing practices during the first months of the pandemic. Older participants were more likely to practice total isolation than younger ones. Pandemic-related changes were reported in social engagement, including less contact with friends and family, and less frequent participation in cultural events or associations, but on the other hand the frequency of remote contacts with others was increased. About a third of the participants reported that their physical activity was reduced, and this was more common among those who had been less active earlier. Pandemic-related changes in lifestyle and activities were more evident among those living alone. Conclusion Finnish older persons were mainly reporting that they coped in the pandemic situation quite well. Older participants seemed to be more susceptible to negative changes. Also persons with less physical activity previously were likely to reduce their activities even more. This may have long-term consequences on the cognitive health of older adults, and it may also impact the longer-term effects of the FINGER intervention.
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Background The coronavirus disease-19 (COVID-19) pandemic presents challenges to the conduct of randomized clinical trials of lifestyle interventions. Method World-Wide FINGERS is an international network of clinical trials to assess the impact of multidomain lifestyle intervention on cognitive decline in at-risk adults. Individual trials are tailoring successful approaches from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) to local cultures and environments. The network convened forums for researchers to discuss statistical design and analysis issues they faced during the pandemic. We will provide an updated report on experiences of trials that, at various stages of conduct, altered designs and analysis plans to navigate these issues. We provide recommendations for future trials to consider as they develop and launch behavioral intervention trials. Result The pandemic led researchers to change recruitment plans, interrupt timelines for assessments and intervention delivery, and move to remote intervention and assessments protocols. The necessity of these changes add emphasis to the importance, in study design and analysis, of intention to treat approaches, flexibility, within site stratification, interim power projections, and sensitivity analyses. Conclusion Robust approaches to study design and analysis are critical to negotiate issues related to the intervention. The World Wide Network of similarly oriented clinical trials will allow us to evaluate the effectiveness of responses to the pandemic across cultures, local environments, and phases of the pandemic.
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Background Older adults have higher risk of cognitive impairment and dementia, and they also represent the group most severely affected by the SARS-CoV-2 (COVID-19) pandemic in terms of higher morbidity and mortality. The World-Wide FINGERS (WW-FINGERS) global network of multidomain trials for dementia risk reduction and prevention (Kivipelto et al., 2020) provides a unique framework to explore how the pandemic has affected factors related to mental and physical health of populations at increased risk of dementia, while accounting also for country-specific strategies to contain the spread of the infection. Methods The WW-FINGERS-SARS-CoV2 survey has been developed to explore direct and indirect effects of the pandemic in midlife and older age. The questions aim to measure changes in lifestyle factors (e.g., diet, physical activity), management of chronic noncommunicable diseases (e.g., diabetes, hypertension), as well as psychosocial factors - including depressive symptoms, sleep disorders, social isolation - that are relevant to cognition and are expected to be affected by the pandemic. The survey measures also established and possible epidemiologic risk factors for severe COVID-19. To facilitate distribution is different settings, both a pen-and-paper and a digital version of the survey have been developed in several languages. The digital version is supported through REDCap (Research Electronic Data Capture), a secure web-based software that is being also used for harmonized data collection. Results Over 25 countries are taking part in the survey. Local adaptations and piloting are being done to optimize implementation in both clinical-based and population-based settings. Participants are in the at-risk spectrum for dementia: from cognitively normal persons to individuals with pre-dementia cognitive symptoms. An updated report of the survey status will be presented. Conclusion the survey is a joint global action of the WW-FINGERS network which can inform better care of older adults in the context of a pandemic. The survey is also a valuable tool for pre-screening of participants for prevention trials, and results can inform adaptions to ensure successful recruitment and adherence in forthcoming multidomain trials for dementia prevention in older adults.
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In many countries, the COVID-19 pandemic has led to strong restrictions and changed the everyday lives of older people. In Finland, people aged 70 and over were instructed to stay at home under quarantine-like conditions. Existing studies from other countries have reported increases in negative experiences and symptoms as a result of such restrictions, including psychosocial stress. However, little focus has been given to older people's experiences of meaningfulness during the pandemic. Using survey and interview data, we ask to what extent have community-dwelling oldest old (80+) experienced meaningfulness during the pandemic, what background factors are associated with meaningfulness and what factors have contributed to everyday life meaningfulness during the pandemic. The data was collected as part of the COVID-19 sub-study of the third follow-up of the Cardiovascular Risk Factors, Aging and Dementia (CAIDE85+) study, a Finnish population-based cohort study carried out in the eastern part of the country. In the quantitative analyses, meaningfulness was assessed as part of the Experiences of Social Inclusion Scale. The association of meaningfulness with different background factors (gender, age, living alone, self-chosen quarantine or physical isolation, self-rated health, physical functioning, and cognitive capacity) was explored with the Chi-square test. The quantitative findings indicate that the majority of the participants experienced meaningfulness during the pandemic. Participants who did not practice any physical isolation measures and participants with higher self-rated health experienced more meaningfulness. There was no evidence for difference in the prevalence of meaningfulness and other background factors. The qualitative data was analyzed using thematic analysis. The findings indicated that factors contributing to meaningfulness in everyday life were social contacts, daily chores and activities, familiar places and seasonal changes. The small sample size does not provide possibilities for generalizing the results into the wider population of older adults. However, the results provide new understanding of the oldest old's experiences of meaningfulness in everyday life during the global pandemic. The findings may help find ways to support older people's meaningfulness in challenging times.
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Aims: This study aimed to describe how the first phase of the coronavirus disease 2019 (COVID-19) pandemic affected older persons from the general Finnish population who are at risk of developing or have cognitive impairment, specifically, to describe whether participants experienced a change in risk factors that are relevant for the prevention of cognitive decline including diet, physical activity, access to medical care, socially and cognitively stimulating activities, and emotional health and well-being. Method: A postal survey was sent in June 2020 to 859 participants from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), an ongoing longitudinal study. The survey was developed to assess the effect of the COVID-19 pandemic and related infection-control measures on daily life, specifically commitment to distancing measures, access to health care and social services, daily activities, and changes in cognitive and social activities. Results: By September 2020, 613 (71%) participants responded (mean age = 77.7 years, 32% lived alone, and 80% had at least one chronic condition). Three quarters adopted some distancing practices during the first months of the pandemic. Older participants were more likely to practice total isolation than younger ones (29 vs. 19%; p = 0.003). Non-acute health-care visits were canceled for 5% of the participants who needed appointments, but cancellations in dental health care (43%), home aid (30%), and rehabilitative services (53%) were more common. Pandemic-related changes were reported in social engagements, for example, less contact with friends (55%) and family (31%), or less frequent attendance in cultural events (38%) or associations (25%), although remote contact with others increased for 40%. Feelings of loneliness increased for 21%, particularly those who were older (p = 0.023) or living alone (p < 0.001). Physical activity reduced for 34%, but dietary habits remained stable or improved. Pandemic-related changes in lifestyle and activities were more evident among those living alone. Conclusions: Finnish older persons generally reported less negative changes in lifestyles and behaviors during the pandemic than expected. Older people and those living alone seemed more susceptible to negative changes. It is important to compare how coping strategies may compare with other European countries to identify factors that may help older individuals to maintain healthy lifestyles during future waves of COVID-19.