Digital health technologies supporting the application of comprehensive geriatric assessments in long-term care settings or community care: A systematic review.

Objective: To provide high-quality elderly care, digital health technologies (DHTs) can potentially assist in reaching the full capacity of comprehensive geriatric assessments (CGAs) to improve communication and data transfer on patients' medical and treatment plan information and health decision-making. This systematic review aimed to describe the evidence on the feasibility and usability, efficacy and effectiveness, and implementation outcomes of DHTs developed to facilitate the administration of CGAs for long-term care settings or community care and to describe their technical features and components. Methods: A search strategy was conducted in three databases, targeting studies evaluating the DHTs facilitating the administration of CGAs used in long-term care settings or community care. Studies in English and Spanish published up to 5 April 2023 were considered. Results: Four DHTs supporting the administration of the CGAs were identified. Limited information was found on the technical features and required hardware. Some of the barriers identified regarding usability can be overcome with novel technologies; however, training of health professionals on the assessments and staff knowledge regarding the purpose of the data collected are not technology related and need to be addressed. Conclusions: Barriers regarding usability were related to experienced difficulties navigating the software, unstable network connectivity, and length of the assessment. Feasibility obstacles were associated with the lack of training to use the DHT, availability and accessibility to hardware (e.g. laptops), and lack of insight into the clinical benefits of collected data. Further research must focus on these areas to improve the implementation and usefulness of these DHTs.

Perceptions of Older People with Cognitive Impairment, Caregivers, and Professionals about ehcoBUTLER (Tablet Health Care Platform): A Qualitative Focus Group Study.

EhcoBUTLER is a tablet platform mainly aimed at the elderly with mild cognitive impairment (MCI) to promote their well-being and health. The main objective of this study was to explore the perceptions and feedback level of the ehcoBUTLER potential users and stakeholders to improve its development. Through this exploration, the secondary objective was to contribute to the development of software/apps that promote their integral health. Focus groups were conducted (13 elderly with MCI, 13 with dementia, 12 caregivers, 11 professionals). The content and feedback level were analyzed. Participants liked the appearance of ehcoBUTLER, would like to use it, and were mainly interested in the emotional, healthy lifestyle, cognitive, and ergonomic tools. It is necessary to have prior training, more intuitive/customizable apps, low-price/free, offline/USB content, and add other activities/features. EhcoBUTLER is well-oriented to meet the needs and preferences of potential users. However, improvements in its usability, accessibility, and sustainability are needed. The participants' perspectives provided a comprehensive view to improve ehcoBUTLER, so that in the future, it can benefit the elderly to be active agents in their health; support caregivers in their role and to have a respite; and professionals to have a multi-intervention platform. The present findings can contribute to the development of tablet software/apps that promote the integral well-being of this population.

Determinants of Adherence to a "GRADIOR" Computer-Based Cognitive Training Program in People with Mild Cognitive Impairment (MCI) and Mild Dementia.

BACKGROUND: Computer-based programs have been implemented from a psychosocial approach for the care of people with dementia (PwD). However, several factors may determine adherence of older PwD to this type of treatment. The aim of this paper was to identify the sociodemographic, cognitive, psychological, and physical-health determinants that helped predict adherence or not to a "GRADIOR" computerized cognitive training (CCT) program in people with mild cognitive impairment (MCI) and mild dementia. METHOD: This study was part of a randomized clinical trial (RCT) (ISRCTN: 15742788). However, this study will only focus on the experimental group (n = 43) included in the RCT. This group was divided into adherent people (compliance: ≥60% of the sessions and persistence in treatment up to 4 months) and non-adherent. The participants were 60-90 age and diagnosed with MCI and mild dementia. We selected from the evaluation protocol for the RCT, tests that evaluated cognitive aspects (memory and executive functioning), psychological and physical health. The CCT with GRADIOR consisted of attending 2-3 weekly sessions for 4 months with a duration of 30 min Data analysis: Phi and Biserial-point correlations, a multiple logical regression analysis was obtained to find the adherence model and U Mann-Whitney was used. RESULTS: The adherence model was made up of the Digit Symbol and Arithmetic of Wechsler Adult Intelligence Scale (WAIS-III) and Lexical Verbal Fluency (LVF) -R tests. This model had 90% sensitivity, 50% specificity and 75% precision. The goodness-of-fit p-value of the model was 0.02. CONCLUSIONS: good executive functioning in attention, working memory (WM), phonological verbal fluency and cognitive flexibility predicted a greater probability that a person would be adherent.

The Effectiveness of GRADIOR: A Neuropsychological Rehabilitation Program for People with Mild Cognitive Impairment and Mild Dementia. Results of a Randomized Controlled Trial After 4 and 12 Months of Treatment.

BACKGROUND: Computer-based cognitive training programs have been developed with promising results on the maintenance/improvement of cognitive performance in people with dementia. OBJECTIVE: The objective was to evaluate the effectiveness of the cognitive rehabilitation program "GRADIOR" in people with mild cognitive impairment and mild dementia. METHOD: This study was a single-blind multicenter randomized clinical trial. Participants were recruited from hospitals/day centers. The experimental group (EG) and control group (CG) received computer-based cognitive training (CCT) and routine daily care, respectively. Outcome measures at T0: baseline, T1: at 4 months, T2: at 12 months were compared within and between-groups. RESULTS: Significant differences or important effect sizes were detected at the intragroup and intergroup level for most variables, observing a trend of improvement and/or maintenance at 4 months by Visual Reasoning of Cambridge Cognitive Examination (CAMCOG), Digit and Arithmetic of WAIS-III, Semantic Verbal Fluency, Mini-Mental State Exam (MMSE), Trail Making Test (TMT)-A-Mistakes and at 12 months by Visual Reasoning of CAMCOG, Digit Symbol of WAIS-III, TMT-B-mistakes, Visual Memory of Rivermead Behavioural Memory Test, Lexical Verbal Fluency-P, Yesavage's Geriatric Depression Scale (GDS), TMT-A-time scales whose objective was to evaluate some executive functions and/or the memory. The CG presented a worsening trend for most of the measures towards 12 months. There was also a significant interaction between "time and group" for MMSE (F = 8.971; p = 0.03; η2 = 0.019) and the GDS (F = 3.414; p = 0.04; η2 = 0.041), as well as small effect sizes for TMT-A-time (F = 1.641; p = 0.21; η2 = 0.021) and TMT-A-mistakes (F = 0.908; p = 0.41; η2 = 0.019). CONCLUSION: CCT with GRADIOR has been proved to benefit cognitive functions (ISRCTN:15742788).

Usability and User Experience of Cognitive Intervention Technologies for Elderly People With MCI or Dementia: A Systematic Review.

INTRODUCTION: Incorporating technology in cognitive interventions represents an innovation, making them more accessible, flexible, and cost-effective. This will not be feasible without adequate user-technology fit. Bearing in mind the importance of developing cognitive interventions whose technology is appropriate for elderly people with cognitive impairment, the objective of this systematic review was to find evidence about usability and user experience (UX) measurements and features of stimulation, training, and cognitive rehabilitation technologies for older adults with mild cognitive impairment (MCI) or dementia. METHOD: The Medline, PubMed, Scopus, ScienceDirect, and PsycINFO databases were searched for literature published in the last 10 years (2009-2019), and three researchers independently reviewed potentially eligible studies, following specific inclusion criteria. A systematic review of the studies was conducted, presenting a qualitative synthesis of usability and UX measures with their outcomes, study characteristics and features of the cognitive intervention technologies. RESULTS: Ten studies were selected: five were cognitive stimulation and five were cognitive training. Most of them (60%) were computer-based programs with a serious game format. Efficiency and effectiveness were the most frequent measurements used for collecting objective usability data, showing that elderly people with cognitive impairment require more time (45%) and help (40%) but can complete tasks (60%). Regarding UX or subjective usability data, questionnaires and scales were the most used methods, reporting positive experience despite certain difficulties with the interface in five studies. CONCLUSION: Measuring usability and UX in cognitive intervention technologies for older adults with MCI or dementia provides an integrated view that can contribute to their development according to the needs and characteristics of the target population. More research is required to include this population group in usability and UX studies, as well as standardized tools and consensus on the relationship of these terms to guarantee the future effectiveness of cognitive intervention technologies. REVIEW REGISTRATION: This review was registered in the PROSPERO (CRD42020158147) International Register of Systematic Review Protocols.

Computer-based cognitive rehabilitation program GRADIOR for mild dementia and mild cognitive impairment: new features.

BACKGROUND: The growing number of older people and, with it, the increase of neurological impairments such as dementia has led to the implementation of the use of computer programs for cognitive rehabilitation in people with dementia. For 20 years, we have been developing the GRADIOR cognitive rehabilitation program and conducted several studies associated with its usability and effectiveness. This paper describes the development of the latest version of the GRADIOR computer-based cognitive rehabilitation program for people with different neurological etiologies, especially mild cognitive impairment and mild dementia. RESULTS: GRADIOR is a program that allows cognitive evaluation and rehabilitation of people affected by cognitive impairment. The new version of GRADIOR is characterized by a structure that is dynamic and flexible for both user and therapist, consisting of: Clinical Manager, Clinical History Manager, Treatment Manager and Report Manager. As a structure based on specific requirements, GRADIOR includes a series of modalities and sub-modalities, each modality comprising a series of exercises with different difficulty levels. DISCUSSION: Previous studies associated with earlier versions of GRADIOR have allowed the development of a new version of GRADIOR. Taking into account aspects associated with user experience, usability and effectiveness. Aspects that have made it possible to achieve a program that can meet the needs of older people with dementia.

Study on the Acceptability of an ICT Platform for Older Adults with Mild Cognitive Impairment.

EhcoBUTLER is an Information and Communication Technology (ICT) solution funded by the European Union (H2020; ID: 643566) and intended especially for elderly people with mild cognitive impairment (MCI) to improve their health, independence and quality of life, particularly at the social level. The purpose of this study is to assess the acceptability of ehcoBUTLER based on a survey delivered to potential users and actors involved in their care, exploring their expectations and preferences, while anticipating the system's functional requirements. The survey was delivered online to 313 participants (11% end users, 25% informal caregivers, 48% formal caregivers and 16% administration/management staff) from eight countries. Participants rated the different functionalities of ehcoBUTLER positively, 86.1% perceiving it as an interesting and useful system. Likewise, they assessed it as a commercially attractive product (75.1%). End users expressed a stronger preference for the social module. Nevertheless, they would be ready to pay a low monthly price for ehcoBUTLER. Professionals would be willing to pay choosing its functionalities modularly, but they would also expect it to be funded by the National Health System, centres or businesses. The conclusion is that all participants found ehcoBUTLER interesting, useful and ergonomic. However, to effectively implement it, it is necessary to bridge the digital gap and address the issue of insufficient investment in products aimed at older adults with cognitive impairment. To supplement cognitive training systems with social, emotional or entertainment functionalities could improve adherence to their use.

Addressing Suicide Risk According to Different Healthcare Professionals in Spain: A Qualitative Study.

This study analyzes the views of four groups of healthcare professionals who may play a role in the management of suicidal behavior. The goal was to identify key factors for suicide prevention in different areas of the healthcare system. Qualitative research was conducted using focus groups made up of different healthcare professionals who participated in the identification, management, and prevention of suicidal behavior. Professionals included were primary care physicians, psychologists, psychiatrists, and emergency physicians. 'Suicide' was amongst the most relevant terms that came up in discussions most of the times it appeared associated with words such as 'risk', danger', or 'harm'. In the analysis by categories, the four groups of professionals agreed that interventions in at-risk behaviors are first in importance. Prevention was the second main concern with greater significance among psychiatrists. Primary care professionals call for more time to address patients at risk for suicide and easier access to and communication with the mental health network. Emergency care professionals have a lack of awareness of their role in the detection of risk for suicide in patients who seek attention at emergency care facilities for reasons of general somatic issues. Mental health care professionals are in high demand in cases of self-harm, but they would like to receive specific training in dealing with suicidal behavior.

Facilitating Factors and Barriers to the Use of Emerging Technologies for Suicide Prevention in Europe: Multicountry Exploratory Study.

BACKGROUND: This study provides an analysis on the use of emerging technologies for the prevention of suicide in 8 different European countries. OBJECTIVE: The objective of this study was to analyze the potentiality of using emerging technologies in the area of suicide prevention based on the opinion of different professionals involved in suicide prevention. METHODS: Opinions of 3 groups of stakeholders (ie, relevant professionals in suicide field) were gathered using a specifically designed questionnaire to explore dimensions underlying perceptions of facilitating factors and barriers in relation to the use of emerging technologies for suicide prevention. RESULTS: Goal 1 involved facilitating factors for the use of emerging technologies in suicide prevention. Northern European countries, except for Belgium, attach greater relevance to those that optimize implementation and benefits. On the other hand, Southern European countries attach greater importance to professionally oriented and user-centered facilitating factors. According to different stakeholders, the analysis of these facilitating factors suggest that professionals in the field of social work attach greater relevance to those that optimize implementation and benefits. However, professionals involved in the area of mental health, policy makers, and political decision makers give greater importance to professionally oriented and user-centered facilitating factors. Goal 2 was related to barriers to the usability of emerging technologies for suicide prevention. Both countries and stakeholders attach greater importance to barriers associated with resource constraints than to those centered on personal limitations. There are no differences between countries or between stakeholders. Nevertheless, there is a certain stakeholders-countries interaction that indicates that the opinions on resource constraints expressed by different stakeholders do not follow a uniform pattern in different countries, but they differ depending on the country. CONCLUSIONS: Although all countries and stakeholders agree in identifying resource constraints as the main barrier to the use of emerging technologies, factors facilitating their use in suicide prevention differ among countries and among stakeholders.

Online interventions for caregivers of people with dementia: a systematic review.

INTRODUCTION: The elderly population is growing driven by the increase in life expectancy, which in turn entails an increase in the number of people with chronic diseases such as dementia. The vast majority of people suffering from this illness is assisted by informal caregivers, who play a key role in fulfilling the patients’ needs, promoting the possibility for people with dementia to live in their home environment. The Internet as a support tool in psychoeducational programs can significantly improve accessibility of them, becoming a currently consolidated interactive resource for the training of patients with acute and chronic diseases, and their caregivers. POPULATION AND METHOD: A literature search of the Pubmed, PsyINFO, Scopus, SciELO and Psicodoc databases was performed to systematically review those studies related to web-based interventions for informal caregivers of people with dementia or cognitive impairment. RESULTS: On balance, the studies show a significant improvement after the psychoeducational intervention. Specifically, the improvement in caregivers’ wellbeing can be observed in the measures for self-efficacy, anxiety and depression. CONCLUSIONS: Online interventions are a promising strategy for the care of people with dementia. It would be advisable to perform further randomized trials to assess the reasons for lack of adherence to intervention, as well as usability studies to test the different software programs used.

Intervenciones online para cuidadores de personas con demencia: revisión sistemática / Online interventions for caregivers of people with dementia: a systematic review

Introducción. La población de edad avanzada está creciendo debido al aumento de la esperanza de vida, lo que lleva a un incremento de personas con enfermedades crónicas, como la demencia. La mayoría de la población que sufre esta enfermedad es atendida por cuidadores informales, quienes juegan un papel muy importante en el cumplimiento de las necesidades, favoreciendo que puedan seguir viviendo en su ambiente. Internet se presenta como una herramienta de apoyo a los programas de psicoeducación que mejore la accesibilidad de los mismos, estableciéndose, en la actualidad, como un recurso interactivo para la formación de pacientes con enfermedades agudas y crónicas así como a sus cuidadores. Población y método. Mediante una búsqueda bibliográfica en las bases de datos Pubmed, PsyINFO, Scopus, SciELO y Psicodoc, se revisaron sistemáticamente los estudios relativos a intervenciones basadas en internet para cuidadores informales de personas con demencia o deterioro cognitivo. Resultados. En conjunto, los estudios indican una mejoría significativa tras la intervención psicoeducativa. Concretamente, la mejora del bienestar de los cuidadores se aprecia en las medidas de autoeficacia, ansiedad y depresión. Conclusiones. Las intervenciones online constituyen una estrategia prometedora para la intervención de cuidadores de personas con demencia. Serían convenientes mayores estudios aleatorizados, que evalúen tanto los motivos de falta de adherencia a la intervención como estudios de usabilidad de los diversos programas de software empleados (AU)

Introduction. The elderly population is growing driven by the increase in life expectancy, which in turn entails an increase in the number of people with chronic diseases such as dementia. The vast majority of people suffering from this illness is assisted by informal caregivers, who play a key role in fulfilling the patients’ needs, promoting the possibility for people with dementia to live in their home environment. The Internet as a support tool in psychoeducational programs can significantly improve accessibility of them, becoming a currently consolidated interactive resource for the training of patients with acute and chronic diseases, and their caregivers. Population and method. A literature search of the Pubmed, PsyINFO, Scopus, SciELO and Psicodoc databases was performed to systematically review those studies related to web-based interventions for informal caregivers of people with dementia or cognitive impairment. Results. On balance, the studies show a significant improvement after the psychoeducational intervention. Specifically, the improvement in caregivers’ wellbeing can be observed in the measures for self-efficacy, anxiety and depression. Conclusions. Online interventions are a promising strategy for the care of people with dementia. It would be advisable to perform further randomized trials to assess the reasons for lack of adherence to intervention, as well as usability studies to test the different software programs used (AU)

Influencia del ejercicio físico en la prevención del deterioro cognitivo en las personas mayores: revisión sistemática / The influence of physical exercise in the prevention of cognitive deterioration in the elderly: a systematic review

Introducción. La población española mayor de 65 años continua creciendo, por lo que la atención a adultos mayores se convierte en un objetivo de salud publica cada vez más relevante. La actividad física está siendo reconocida como un factor altamente protector de las funciones cognitivas en el envejecimiento, y se establece, en la actualidad, como una estrategia psicosocial prometedora para la protección de las facultades cognitivas. Pacientes y métodos. Mediante una búsqueda bibliográfica en las bases de datos PubMed, PsycINFO, Psicodoc, Scopus y SciELO, se revisaron sistemáticamente los estudios relativos a la influencia del ejercicio físico en la prevención del deterioro cognitivo en adultos mayores sanos y en la reversión o en el mantenimiento del declive cognitivo una vez ya iniciado. Se seleccionaron y utilizaron 31 artículos como unidades de análisis. Resultados. En conjunto, estos estudios indicaron que un mayor índice de actividad física se relacionaría con un menor deterioro de las funciones cognitivas en adultos mayores sanos y con deterioro cognitivo ya manifiesto. Conclusiones. El ejercicio físico constituye una estrategia psicosocial prometedora para la intervención de adultos mayores con y sin signos de deterioro cognitivo. Serian convenientes mayores estudios que empleen una metodología experimental, mayor homogeneidad en cuanto a los instrumentos de recogida de datos de funciones cognitivas y una profundización en la frecuencia e intensidad necesaria en las intervenciones (AU)

Introduction. In Spain, the number of elderly people is increasing, reason why the improvement in the attention given to the older adults has become a significant objective and requirement of health care systems. The physical activity is being recognized as a highly protective factor of the cognitive functions in aging, becoming a promising psycho-social strategy for the protection of the cognition in elderly population. Patients and methods. PubMed, PsycINFO, Psicodoc, Scopus y SciELO sources were searched. We analyze the influence of the physical exercise in the prevention of the cognitive functions in healthy elderly and in the improvement or maintenance of the cognitive decline in older adults with early cognitive impairment. Thirty-one studies were selected and analysed. Results. These studies indicated that a greater amount of physical activity is related with a decrease of cognitive decline in aging. Conclusions. The physical activity constitutes a promising psychosocial strategy for older adults with and without cognitive impairment. More experimental studies and homogeneity in the assessment instruments are needed. A deeper study of the convenience in the frequency and intensity of the interventions is also required (AU)

[The influence of physical exercise in the prevention of cognitive deterioration in the elderly: a systematic review]. / Influencia del ejercicio físico en la prevención del deterioro cognitivo en las personas mayores: revisión sistemática.

INTRODUCTION: In Spain, the number of elderly people is increasing, reason why the improvement in the attention given to the older adults has become a significant objective and requirement of health care systems. The physical activity is being recognized as a highly protective factor of the cognitive functions in aging, becoming a promising psycho-social strategy for the protection of the cognition in elderly population. PATIENTS AND METHODS: PubMed, PsycINFO, Psicodoc, Scopus y SciELO sources were searched. We analyze the influence of the physical exercise in the prevention of the cognitive functions in healthy elderly and in the improvement or maintenance of the cognitive decline in older adults with early cognitive impairment. Thirty-one studies were selected and analysed. RESULTS: These studies indicated that a greater amount of physical activity is related with a decrease of cognitive decline in aging. CONCLUSIONS: The physical activity constitutes a promising psychosocial strategy for older adults with and without cognitive impairment. More experimental studies and homogeneity in the assessment instruments are needed. A deeper study of the convenience in the frequency and intensity of the interventions is also required.

TITLE: Influencia del ejercicio fisico en la prevencion del deterioro cognitivo en las personas mayores: revision sistematica.Introduccion. La poblacion espanola mayor de 65 anos continua creciendo, por lo que la atencion a adultos mayores se convierte en un objetivo de salud publica cada vez mas relevante. La actividad fisica esta siendo reconocida como un factor altamente protector de las funciones cognitivas en el envejecimiento, y se establece, en la actualidad, como una estrategia psicosocial prometedora para la proteccion de las facultades cognitivas. Pacientes y metodos. Mediante una busqueda bibliografica en las bases de datos PubMed, PsycINFO, Psicodoc, Scopus y SciELO, se revisaron sistematicamente los estudios relativos a la influencia del ejercicio fisico en la prevencion del deterioro cognitivo en adultos mayores sanos y en la reversion o en el mantenimiento del declive cognitivo una vez ya iniciado. Se seleccionaron y utilizaron 31 articulos como unidades de analisis. Resultados. En conjunto, estos estudios indicaron que un mayor indice de actividad fisica se relacionaria con un menor deterioro de las funciones cognitivas en adultos mayores sanos y con deterioro cognitivo ya manifiesto. Conclusiones. El ejercicio fisico constituye una estrategia psicosocial prometedora para la intervencion de adultos mayores con y sin signos de deterioro cognitivo. Serian convenientes mayores estudios que empleen una metodologia experimental, mayor homogeneidad en cuanto a los instrumentos de recogida de datos de funciones cognitivas y una profundizacion en la frecuencia e intensidad necesaria en las intervenciones.