Home-Based, Self-Administered Dyadic Cognitive Training for Healthy Older Adults

259 Pages·2017·6.7 MB·English

Florida International University
FIU Digital Commons
FIU Electronic Theses and Dissertations University Graduate School
6-28-2016
Home-Based, Self-Administered Dyadic Cognitive
Training for Healthy Older Adults: Feasibility Study
Natalia Shtompel
Florida International University, [email protected]
DOI:10.25148/etd.FIDC000718
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Shtompel, Natalia, "Home-Based, Self-Administered Dyadic Cognitive Training for Healthy Older Adults: Feasibility Study" (2016).
FIU Electronic Theses and Dissertations. 2606.
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FLORIDA INTERNATIONAL UNIVERSITY
Miami, Florida

HOME-BASED, SELF-ADMINISTERED DYADIC COGNITIVE TRAINING FOR
HEALTHY OLDER ADULTS: FEASIBILITY STUDY

A dissertation submitted in partial fulfillment of
the requirements for the degree of
DOCTOR OF PHILOSOPHY
in
SOCIAL WELFARE
by
Natalia Shtompel

2016
To: Dean Tomas Guilarte
Robert Stempel College of Public Health and Social Work

This dissertation, written by Natalia Shtompel, and entitled Home-Based, Self-
Administered Dyadic Cognitive Training for Healthy Older Adults: Feasibility Study,
having been approved in respect to style and intellectual content, is referred to you for
judgment.

We have read the dissertation and recommend that it be approved.

Mark Macgowan

Nicole Ruggiano

Raul Gonzalez

Barbara Thomlison, Major Professor

Date of Defense: June 28, 2016.

The dissertation of Natalia Shtompel is approved.

Dean Tomas Guilarte
Robert Stempel College of Public Health and Social Work

Andrés G. Gil
Vice President for Research and Economic Development
And Dean of the University Graduate School

Florida International University, 2016

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ABSTRACT OF THE DISSERTATION
HOME-BASED, SELF-ADMINISTERED DYADIC COGNITIVE TRAINING FOR
HEALTHY OLDER ADULTS: FEASIBILITY STUDY
by
Natalia Shtompel
Florida International University, 2016
Miami, Florida
Professor Barbara Thomlison, Major Professor
The negative effects of cognitive decline and impairment can be devastating for older
adults and their families, and extremely costly for the healthcare system and the society.
Cognitive training aims to maintain or improve cognition by utilizing repetitive tasks that
target specific cognitive skills. The majority of cognitive training studies in healthy older
adults involved home-based, individual, computerized approach or onsite, group, paper-
and-pencil format. These approaches may not be suitable for individuals with serious
health or mobility issues, caregiving responsibilities, limited transportation, or limited
computer or internet access. A novel, home-based, self-administered cognitive training
intervention was developed to address these barriers. It involves two older adults taking
turns to administer paper-and-pencil tasks to one another. The purpose of the study was
to evaluate feasibility and participant acceptability of this novel approach to cognitive
training. Eighteen participants (9 dyads) 65-91 years (M = 75.94, SD = 7.66) underwent
assessment and began intervention. Assessment included measures of cognitive skills and
self-reported quality of life, health status, and daily functioning. Four dyads were married
couples who had sessions at home. Other dyads met at various public locations and

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included friends, neighbors, or unfamiliar older adults connected by the researcher.
Fourteen participants (7 dyads) completed cognitive training intervention that included 9-
24 sessions (M = 15.14, SD = 5.30) over 4-21 weeks (M = 12.21, SD = 5.44), post-
intervention assessment, and detailed interviews. Quantitative data demonstrated that the
sample did not decline on any cognitive measures and exhibited improvement on
visuospatial skills and delayed visual memory (Cohen’s d = .67 & -1.10). Additional
analyses revealed that the results were mainly attributable to improvement in females
(Cohen’s d = -1.84 & -1.35), who demonstrated weaknesses in these cognitive skills at
baseline. The participants reported that the dyadic approach was flexible, convenient, and
enjoyable. They also provided valuable feedback and suggestions for modifying the
content and other aspects of the intervention. The findings suggest that dyadic cognitive
training is feasible and well-received by older adults. Those with weaknesses in cognitive
domains may show larger gains in respective domains and benefit most from cognitive
training.

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© Copyright 2016 by Natalia Shtompel
All rights reserved.

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TABLE OF CONTENTS

CHAPTER PAGE

I. INTRODUCTION......................................................................................... 1

II. BACKGROUND .......................................................................................... 2
Age-Related Cognitive Decline ............................................................... 2
Negative effects ........................................................................... 5
Individuals and families .................................................... 5
Healthcare system and the society .................................... 8
Risk and protective factors ........................................................... 9
Cognitive Training ................................................................................ 10
Theoretical frameworks ............................................................. 12
Psychosocial frameworks ............................................... 12
Cognitive frameworks .................................................... 13
Neurophysiological frameworks ..................................... 14
Previous studies on cognitive training ........................................ 19
Randomized controlled trials .......................................... 19
Summary of findings ...................................................... 34
Criticisms of cognitive training ....................................... 36
Peer-based interventions ............................................................ 37
Collaboration in cognitive training ................................. 38
Social Factors and Cognition ................................................................. 42
Summary and Statement of the Problem ................................................ 43
Present Study ......................................................................................... 45
Purpose ...................................................................................... 45
Conceptual framework ............................................................... 45
Practical and economic reasons .................................................. 47
Research questions and hypotheses ............................................ 49

III. METHODS ................................................................................................. 51
Research Design .................................................................................... 51
Sample .................................................................................................. 52
Population .................................................................................. 52
Participants ................................................................................ 52
Eligibility ................................................................................... 53
Inclusion criteria ............................................................. 53
Exclusion criteria............................................................ 54
Sample size ................................................................................ 54
Tests and Measurements ........................................................................ 55
Screening measures .................................................................... 55
Slosson Oral Reading Test- Revised .............................. 55
Mini-Mental State Examination ..................................... 56
Patient Health Questionnaire (Depression)...................... 57
Cognitive measures .................................................................... 57

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Stroop Color and Word Test ........................................... 58
Trail Making Test ........................................................... 58
Repeatable Battery for the Assessment of the
Neuropsychological Status- Update ................................ 59
Self-report measures .................................................................. 61
World Health Organization Quality of Life- Older
Adult ............................................................................. 61
Research and Development 36-Item Short-Form Health
Survey ........................................................................... 61
Bayer Activities of Daily Living ..................................... 61
Intervention ........................................................................................... 62
Setting, frequency, and duration ................................................. 62
Materials .................................................................................... 62
Manual ........................................................................... 63
Sources ............................................................... 63
Task adaptation ................................................... 66
Functions targeted ............................................... 67
Procedure .............................................................................................. 68
Institutional review .................................................................... 68
Expert panel .............................................................................. 68
Test trial..................................................................................... 68
Participant recruitment ............................................................... 69
Pre-screening ............................................................................. 69
Screening and pre-intervention assessment ................................. 71
Intervention................................................................................ 72
Post-intervention assessment ...................................................... 73
Post-intervention interviews ....................................................... 73
Incentives................................................................................... 73
Data collection and processing ................................................... 73

IV. RESULTS ................................................................................................... 75
Sample .................................................................................................. 75
Participant screening .................................................................. 75
Demographic characteristics ...................................................... 75
Participant retention ................................................................... 76
Participant adherence ................................................................. 78
Statistical Analyses ............................................................................... 79
Data Screening ..................................................................................... 79
Retention and Adherence Variables ...................................................... 80
Pre-Intervention Assessment.................................................................. 83
Cognitive measures .................................................................... 83
Demographic variables .................................................. 91
Self-report measures .................................................................. 93
Demographic variables .................................................. 95
Post-Intervention Assessment ................................................................ 96
Cognitive measures .................................................................... 96

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Demographic variables ................................................ 100
Self-report measures ................................................................ 107
Illustrative case studies ............................................................ 108
Case A.......................................................................... 109
Case B .......................................................................... 112
Post-intervention interviews ................................................................ 116
Dyadic format .......................................................................... 117
Setting .................................................................................... 119
Scheduling ............................................................................... 120
Frequency and duration ............................................................ 120
Materials .................................................................................. 121
Content .................................................................................... 122
Adherence ................................................................................ 125
Perceived outcomes ................................................................. 126
Suggestions for improvement ................................................... 127
Overall experience ................................................................... 128

V. DISCUSSION ........................................................................................... 131
Recruitment ......................................................................................... 132
Retention ............................................................................................. 134
Adherence ........................................................................................... 135
Quantitative Findings .......................................................................... 136
Qualitative Findings ............................................................................ 144
Study Strengths and Limitations .......................................................... 148
Strengths .................................................................................. 148
Limitations............................................................................... 152
Significance of the Study .................................................................... 155
Relevance to Social Work .................................................................... 156

REFERENCES ............................................................................................... 161

APPENDICES ................................................................................................ 173

VITA .............................................................................................................. 247

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LIST OF TABLES
TABLE PAGE

1. Description of Cognitive Functions and Corresponding Measures ........................... 60
2. Recruitment Sources ............................................................................................... 71
3. Dyad Types ............................................................................................................ 76
4. Descriptive Statistics for Cognitive Test Scores at Pre-Intervention Assessment ..... 85
5. Bivariate Correlations among Cognitive Measures .................................................. 95
6. Descriptive Statistics for Self-Report Measures....................................................... 93
7. Descriptive Statistics for Cognitive Test Scores at Pre-Test and Post-Test and
Paired-Samples T-Tests .......................................................................................... 98
8. Numbers of Participants Who Demonstrated Increase, Decrease, or No Change on
Cognitive Test Scores ........................................................................................... 105
9. Each Participant’s Changes in Scores on Cognitive Measures. .............................. 107
10. Qualitative Descriptors for Scaled and Domain Scores .......................................... 108
11. Qualitative Descriptors for Repeatable Battery for the Assessment of
Neuropsychological Status (RBANS-U) Subtest Percentile Ranges ...................... 109
12. Case A: Pre-Test and Post-Test Cognitive Scores.................................................. 111
13. Case B: Pre-Test and Post-Test Cognitive Scores .................................................. 115

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