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

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

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.

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).