Table 1 The Active Brains guiding principles
From: Planning and optimising a digital intervention to protect older adults’ cognitive health
Key findings from literature | Key design objective | Intervention feature(s) |
|---|---|---|
Older adults with cognitive impairment tend to experience difficulties in the domains of memory, language, thinking and judgement. Difficulties not so extensive that the individual requires assistance with activities of independent daily living [55, 56] Older adults with cognitive impairments that may affect Internet use are still actively engaging with technology [57] Good evidence of effectiveness and/or acceptability of various features/characteristics of interventions: - Simple goal setting and action planning with clear explanation of benefits/ importance [58] - Reinforcement/encouragement for achievements [59] - Self-monitoring of physical activity behaviours, e.g. using a pedometer [58, 60] - Social support in the form of activity suggestions to be done with others/ local group recommendations [59, 60]; social element of cognitive training may also be beneficial [61] - Promotion of autonomy [59] Strength and balance exercises can be built into daily routines and activities [62] | Minimising cognitive load and dependence on technology | • Clear and simple layout, language and navigation procedures • Support provided for cognitive self-regulation (e.g. planning, reminders, prompts for periodic short-term and long-term self-monitoring) • Utilising non-cognitive/non-digital means of sustaining behaviour (habit formation, environmental restructuring) • Options to print/ save key reference documents/ instructions wherever possible. • Link to existing non-digital sources of advice/ support where appropriate, including peer/ family support if possible |
Individuals more motivated to participate in, and have better recognition memory for, physical activity programmes paired with positively framed messages than in those with negatively framed ones [63] Loss of independence perceived as key threat of cognitive decline [64] Older adults with cognitive impairments very interested in programs offering computer exercises to improve cognition as well as web-based interventions for a range of health concerns and lifestyle factors, including physical activity, diet and nutrition, social engagement [57] Enjoyment of activities is important [52, 53, 65] Different/new activities such as strength, flexibility and balance exercise may be beneficial for long-term engagement [66] Need for evidence-based, credible communication of link between increasing physical activity and cognitive health [64] | Positive framing and promoting immediate-term quality of life benefits | • Framing activities in terms of benefits for: maintaining independence, enjoyment, strength, balance, pain (especially musculoskeletal), mood, general quality of life. • Referring to benefits for Brain Health rather than reduction in dementia risk |
Tailoring for different levels of mobility, having optional exercises important/ preferred [58, 59, 67, 68] Need for activities to be simple and safe highly prioritised [52] | Catering for highly heterogeneous population (capabilities and preferences) | • Tailoring of content to offer options for levels/ types of activities, with steer towards those with best evidence and most likely to be beneficial for user (based on baseline-assessed need and capability, e.g. activity levels, perceptions of current strength and balance skills) • Provision of carefully graded activities with very gradual increases from low activity baseline and help with concerns and barriers for those lacking confidence or capability |