Implementation of a Telephone-Based Cognitive Rehabilitation Group for Older Adult Veterans

ABSTRACT

Background: Cognitive rehabilitation group therapies, such as Motivationally Enhanced Compensatory Cognitive Training for Mild Cognitive Impairment (ME-CCT-MCI), are associated with improvements in cognitive functioning, cognitive complaints, and subjective daily functioning domains. While traditionally delivered via in-person, the COVID-19 pandemic resulted in a transition to video visit delivery by many providers and health organizations, including the VA. However, many older adults are unable to participate in video telehealth due to low technological literacy or lack of internet access. Expanding dissemination approaches to include telephone- based delivery may improve access to cognitive rehabilitation services for many older adults. This study assessed the feasibility, acceptability, and preliminary efficacy of an 8-week, telephone-based ME-CCT-MCI group for older adult veterans without technical literacy during the COVID-19 pandemic. Methods: A convenience sample of eleven older adult veterans (Mage=77.72, SD=4.12) with subjective memory complaints and stated inability to use the VA's Video Connect system for video visits was recruited from geriatric clinics within a Veterans Affairs Medical Center. Two rounds of 8-week ME-CCT-MCI groups were conducted, with each group meeting by telephone for one hour a week. Participants completed a battery of measures before and after participation and change over time was evaluated using paired samples t-tests. Measures included the Montreal Cognitive Assessment - Blind, Multifactorial Memory Questionnaire, Geriatric Depression Scale, Geriatric Anxiety Scale, Short Form Health Survey (SF-12) and a group satisfaction questionnaire. Results: Feasibility was demonstrated through good rates of session attendance (M = 6.72 out of 8 sessions), and acceptability was demonstrated through excellent self-reported measures of group satisfaction (M = 9.18/10). Participants demonstrated significant improvements in cognitive functioning (p = .03), subjective memory satisfaction (p = .01) and subjective memory abilities (p < .01) between pre-test and post-test measures. No differences were found for subjective memory strategies, depression, anxiety, or perceived health. Conclusions: Findings offer preliminary support for the feasibility, acceptability, and efficacy of telephone-based ME-CCT-MCI for technologically unready older veterans.