Paper Session 13: Aging

Importance:
About 80% of patients with Parkinson’s disease (PD) experience impaired balance and mobility, including freezing of gait (FOG), increased fall risk, and reduced health-related quality of life (HRQOL).

Objective:
To examine the effects of a mHealth-delivered, home-based program ‘Mindfulness Yoga—Practice Awareness through Cognitive-based Exercise’ (MY-PACE) on balance and mobility, and its acceptability among PD patients.

Design, setting and participants:
We conducted an assessor-blind, two-arm randomized waitlist-controlled trial. A total of 139 PD patients reporting impaired balance were recruited and randomized into either the MY-PACE program (n=69) or waitlist control (n=70).

Interventions:
The MY-PACE group participated in a 12-week MY-PACE program delivered via videoconferencing (Zoom), focusing on enhancing mind-body coordination through mindful yoga training. The control group continued routine outpatient services and received MY-PACE after the study.

Main outcomes and measures:
Primary outcomes were functional balance (Berg Balance Scale). Secondary outcomes included perceived FOG severity (FOG Questionnaire), balance confidence (Activities-specific Balance Confidence Scale), motor symptom (MDS-UPDRS-III), anxiety/depression (Hospital Anxiety and Depression Scale), mindfulness (Five-Facet Mindfulness Questionnaire, Short-form), and HRQOL (PD Questionnaire-8). Assessments were conducted at baseline and 3 months.

Results:
Participants had a mean age of 65 years, with nearly half (49.5%) male and most experiencing moderate-PD (72.9%). The attendance rate was 81.7%. Generalized estimating equations analyses showed that MY-PACE significant improved functional balance (time-by-group interaction, β=1.2, p=0.039), balance confidence during on-state (β=7.2, p<.01) and off-state (β=11.6, p=0.003), and reduced depression (β=-1.2, p=0.023) compared to the control.

Conclusion and relevance:
The MY-PACE program was well accepted as a complementary treatment for balance and mobility in PD patients, significantly improving functional balance, increasing balance confidence, and reducing depression. These findings suggest that mHealth mind-body modalities are effective home-based rehabilitation strategies for PD, highlighting their clinical significance and warranting further research on long-term effects and scalability.

Presenter - Jojo Yan Yan Kwok, PhD, MPH, BN (Hons), RN, FHEA, FAAN,
The University of Hong Kong

Co-Author - Man Auyeung, MBChB, MRCP (UK), MHKCP, FHKAM (Med), FHKCP,
Pamela Youde Nethersole Eastern Hospital

Co-Author - Shirley Yin Yu Pang, BSc, MBBS, FHKCP, FHKAM (Med), FHKCP (Neurology),
Queen Mary Hospital

Background: Using health technology like mobile apps to reduce sedentariness is gaining popularity but is not yet common in older cohorts. Experience-based co-design engages stakeholders in design processes based on their lived experiences, and is especially beneficial when developing technology for older people. Because effective health technology taps theoretically sound behavior change techniques, the Persuasive Systems Design (PSD) model offers a useful framework for embedding persuasive design strategies into technology meant to facilitate behavior change. Purpose: To describe older adults’ recommendations, as mapped to PSD principles, for a FitSitt companion app—an app to accompany the FitSitt active seating system, which is designed to break up long bouts of immobile sitting with pedaling. Methods: Co-design ensued in 2 phases: 1) Co-design workshops—older adult end users (N=15; Mdn age=71) tested assigned commercial health apps to prepare for a half-day remote workshop. At the workshops, users discussed their experiences with and features of the trialed apps. Following prioritization and concretization activities, users articulated an envisioned FitSitt app. 2) In-home phase—end users (N=15; Mdn age=73) trialed a FitSitt system prototype, including a low-fidelity companion app, in home for 3 days. Users were interviewed about their perspectives on an ideal FitSitt app. A manifest content analysis was applied to data generated from each phase, with the most frequent words/concepts synthesized to inform themes. A deductive approach was used to map desired app features and characteristics to PSD principles. Results: End users favored integration of PSD primary task support features, particularly reduction (making complex behaviors manageable; ex. offer easy-to-follow guided sessions), self-monitoring (ex., display pedaling progress), tailoring (ex. prime features for more active users), and personalization (ex. customizable goals to improve sitting routines). In contrast, they deemphasized social support principles such as competition. Users felt a FitSitt app’s strongest opportunity for impact was via raising awareness about sitting behaviors and boosting motivation to change unhealthy patterns. Conclusion: Study findings provide useful insights into what older adults desire in tech-forward systems that target unhealthy sitting patterns and what may be effective in persuading older people to use that technology to transform a sedentary lifestyle.

Author - Stacey L. Schepens Niemiec, PhD, OTR/L, DipACLM,
University of Southern California

Co-Author - Gene Lee, OTD, OTR/L,
University of Southern California

Co-Author - Jiehong Shi, OTD,
University of Southern California

Introduction: Age-related macular degeneration (AMD) is one of the common causes of vision loss in older adults. Given patients with AMD will endure irreversible vision loss, psychosocial support is crucial for patients to be psychologically prepared for their changes in vision. This study examined the effects of an eight-week expressive arts intervention on the psychosocial well-being of patients with AMD.
Methods: This study is an ongoing randomized controlled trial that has recruited 50 patients with AMD from local hospitals and the community. The mean age of participants was 67.76 years (SD = 5.95). Most participants were female (62.0%) and experienced AMD in both eyes (66.0%). Participants were randomly allocated to the EXAT (N=28) and treatment-as-usual control group (CG) (N=22). Participants in EXAT received eight weekly 1.5-hour sessions, whereas participants in CG continued their habitual routines. The psychosocial well-being of participants was assessed in three waves: baseline (T0), two months after baseline/post-intervention (T1), and five months after baseline (T2), by self-report questionnaire. The questionnaire included measures including resilience, imagination, perceived social support, psychosocial adaptation, vision-related quality of life, and depressive and anxiety symptoms. 2x3 repeated measures ANOVAs were computed to examine the intervention effect on outcome measures.
Results: Independent T-tests showed EXAT had significantly higher social support than CG at T0 (t=2.021, p=.049) but no significant differences in other outcome measures. Repeated measures ANOVAs revealed moderate intervention effects (group x time) in self-acceptance subscale of psychosocial adaptation questionnaire (η2 =.120, p=.003), imagination (η2 =.097, p =.008), and depressive symptoms (η2 =.077, p=.025). Participants in the EXAT exhibited significantly higher self-acceptance in the psychosocial adaptation questionnaire, higher imagination, and lower depressive symptoms across time points when compared with the participants in CG. No significant intervention effects were found in other outcome measures (η2 =.001-.055, p=.075-.966).
Conclusion: The findings supported that EXAT provided psychosocial improvement to patients with AMD, particularly in enhancing the level of self-acceptance, the ability to apply imagination in facing life challenges, and diminishing depressive symptoms.

Co-Presenter - Temmy L. T. LO, PhD,
Centre on Behavioral Health, The University of Hong Kong

Author - Bonnie H. T. WONG,
Centre on Behavioral Health, The University of Hong Kong

Author - W. C. CHAN, PhD,
Department of Psychiatry, The University of Hong Kong

Author - Allen M. Y. CHEONG, PhD,
School of Optometry, The Hong Kong Polytechnic University

Author - Q. LI, PhD,
Ophthalmology, Grantham Hospital, Hospital Authority

Author - Adrian H. Y. WAN, PhD,
Centre on Behavioral Health, The University of Hong Kong

Presenter - Rainbow T. H. HO, PhD,
Centre on Behavioral Health, The University of Hong Kong

Background
Cardiometabolic risk factors are strongly associated with risk of dementia and cognitive decline. Greater risk factors have been associated with a higher prevalence and severity of white matter disruptions to periventricular and deep white matter brain structures. Greater cardiometabolic risk has also been associated with poorer microvascular endothelial functioning and cognitive function among older adults with hypertension and obesity. Emerging data also suggest that intra-individual variability in cognitive performance enhances dementia prediction and has been associated with greater systemic medical vulnerabilities, leading some to label these variabilities in cognitive performance as markers of ‘cognitive frailty’. We examined the cross-sectional associations between microvascular endothelial function, cognitive performance, and cognitive frailty in secondary analyses of individuals participating in the ENLIGHTEN study.
Methods
ENLIGHTEN was a 2X2 factorial, randomized trial among 160 older adults (> 55 years of age) who were sedentary, had at least one cardiometabolic risk factor, and showed evidence of cognitive impairment on a brief screening assessment. Participants underwent baseline assessments of vascular functioning, including flow mediated dilation (FMD) of the brachial artery and forearm microvascular endothelial function. Cognitive functioning was assessed using a 45-minute test battery assessing executive functioning and memory. Intra-individual variability in executive functioning performance was quantified as the standard deviation of demographically-normative t-scores across all executive functioning subtests. Regression analyses were used demographic factors, stroke risk, APOE genotype, and medication burden.
Results
Analyses revealed that better microvascular functioning independently associated with better Memory performance (hyperemic velocity: B = -0.25, P = .005; hyperemic flow: B = -0.21, P = .012), whereas FMD was not (B = 0.03, P = .719). Neither of hyperemic response metrics, nor brachial artery FMD, associated with Executive Functioning (Ps>.400), although microvascular responses associated with higher levels of cognitive frailty in the Executive Functioning domain (hyperemic velocity: B = 0.23, P = .036).
Discussion
Better microvascular functioning associated with better Memory performance and less cognitive frailty among older adults with cardiometabolic risk factors and cognitive impairment.

Presenter - Patrick J. Smith, PhD, MPH,
University of North Carolina at Chapel Hill

Co-Author - James A. Blumenthal, PhD, FSBM, PhD, FSBM,
Duke University Medical Center

Co-Author - Stephanie Mabe, MS,
Duke University Medical Center

Co-Author - Alan Hinderliter, MD,
University of North Carolina at Chapel Hill

Co-Author - Andrew Sherwood, PhD, FSBM, PhD, FSBM,
Duke University Medical Center