Mild cognitive impairment: how does it influence the outcomes of people participating in a behaviour change intervention? Secondary data analysis from a randomised controlled trial (HomeHealth)

Problem

Interventions to help people age well and manage health problems are delivered to older adults (aged over 65) in primary care and community services. Despite the prevalence of mild cognitive impairment in people over 65 (estimated between 5-20%), these interventions are commonly delivered to all older adults in the same way. Previous reviews have found that improvements in outcomes following health promotion interventions, such as falls prevention services, are lesser in those with mild cognitive impairment, in comparison to those with healthy cognition for their age. Here we aim to compare how the effectiveness of a health promotion intervention for people with mild frailty varies according to the presence and absence of mild cognitive impairment for functioning, unplanned admissions, and wellbeing outcomes.

Approach

Secondary data analysis on the HomeHealth trial data was conducted, using data from the intervention group only. HomeHealth trial intervention participants (n=195) received up to 6 sessions of a tailored, person-centred behaviour change intervention to help them maintain their independence by setting goals around mobility, nutrition, psychological wellbeing and/or socialising. Using linear regression, the relationship between the Montreal Cognitive Assessment (MoCA) and functioning (Nottingham Extended Activities of Daily Living index (NEADL)); unplanned admissions; and wellbeing (Warwick-Edinburgh Mental Wellbeing Scale and/or General Health Questionnaire) at 6-months (post-intervention) and 12-months (maintenance) was explored. Public contributors were involved throughout the trial to assist with intervention development, outcome measure choice, and dissemination. Two additional public contributors with lived experience of mild cognitive impairment have been involved throughout the project, helping to identify the research questions and outcomes of interest and with interpretation of findings.

Findings

In line with the trial findings, where no improvements in functioning outcomes were found, a non-significant relationship between improved NEADL score with a higher/better MoCA score was identified at 6-months (β=0.450 [-0.110 to 1.010]) and 12-months (β=0.290 [-0.342 to 0.920]). Analyses of unplanned admissions and wellbeing data are ongoing, with the main trial analysis finding improvements in the intervention group over 6- and/or 12-months for both outcomes.

Consequences

If the improvements seen from the intervention group for unplanned admissions and wellbeing are related to participants’ MoCA score and therefore cognitive impairment, these findings will add to the growing evidence base that health promotion interventions for older adults are not as beneficial for people with mild cognitive impairment. Therefore, interventions will need to be adapted and further support provided for those with cognitive impairment, to ensure they have the same beneficial outcomes as those with healthy cognition for their age. If no relationship is found, we will explore which components of the HomeHealth intervention may explain this finding, with differing results from other health promotion interventions, to improve outcomes in other health promotion interventions for those with cognitive impairment.