Author: Mingyue Hu
Hu, Mingyue, 2023 The multiple optimisation strategy study on non-pharmacological interventions among community-dwelling older adults with mild cognitive impairment based on value-based healthcare., Flinders University, College of Nursing and Health Sciences
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Background: Mild cognitive impairment (MCI) is a transitional stage from normality to dementia, with a transition rate of 46% within 3 years compared with 3% of the age-matched population without MCI. The lack of effective pharmacological interventions on MCI strongly suggests that non-pharmacological interventions to reduce the conversion from MCI to dementia in community-dwelling older adults are much needed.
Aims: This PhD study included three interrelated study aims: (1) to detect the predictors of conversion from MCI to dementia used two waves (2008 to 2014 and 2011 to 2018) of longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS); Moreover, the predictors need to be feasible, economic, and non-invasive based on the value-based healthcare (VBH); (2) To identify non-pharmacological interventions among people with MCI; and (3) To evaluate the effectiveness and cost-effectiveness of an evidence-based non-pharmacological intervention with optimal implementation strategy for community-dwelling older adults with MCI.
Methods: (1) Study on aim 1: The researcher used data from 2008 to 2014 and 2011 to 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) and applied the competing risk model and the Cox proportional hazards model. (2) Study on aim 2: The researcher conducted an overview of systematic reviews and meta-analysis. (3) Study on aim 3: The researcher applied a descriptive qualitative study, and an RCT with a multiple optimization strategy study design.
Results: (1) Study on aim 1: A 1-year increase in the physical activity duration reduced the risk of dementia (HR 0.99, 95%CI 0.99 - 1.00). (2) Study on aim 2: Regarding the intervention effectiveness, muscle-strengthening (SMDs 0.87, 95% CI 0.31-1.43; rank 1), mind-body (0.76, 0.38-1.14; rank 2), and aerobic (0.34, 0.13-0.50; rank 3) were significantly better than the control group and there was no significant difference among these types of intervention. Regarding the acceptability, there was no significant difference among the types of intervention. (3) Study on aim 3: The qualitative study identified that personal factors, environmental factors and behavioral factors influenced the preferences and values regarding physical activity intervention and implementation strategies among community-dwelling older adults with MCI. An intervention named as X-CircuiT (Xiangya Hospital circuit training, X-CircuiT) and implementation strategies (reminding, leading, and goal-setting) were developed to reflect research evidence, the preferences and values of older adults. In the RCT, a total of 107 participants participated in the trial. The results showed that three strategies: reminding (B = 0.31, p < 0.01), leading (B = 0.21, p < 0.01), and goal-setting (B = 0.19, p < 0.01), could significantly improve the physical activity. The strategy of leading (B = 0.68, p = 0.03) could significantly improve cognitive function. The strategy of leading was the most cost-effective strategy with 94.41RMB per increase in one unit of physical activity.
Conclusion: (1) The predictors of the conversion from MCI to dementia were short physical activity duration, old age, female, low education and widow; (2) Physical activity was the current best evidence of the non-pharmacological interventions among people with MCI; (3) The intervention package including the core intervention (X-CircuiT and health education) and the implementation strategy of leading demonstrated effectiveness and cost-effectiveness among community-dwelling older adults with MCI in Hunan Province, China.
Keywords: Mild cognitive impairment; Predictors; Dementia; Research progress
Subject: Public Health thesis
Thesis type: Doctor of Philosophy
Completed: 2023
School: College of Nursing and Health Sciences
Supervisor: Lily Xiao