Computerized cognitive interventions (CCIs) have been increasingly widely implemented among older adults with mild cognitive impairment (MCI). However, the efficacy of CCIs in maintaining or improving older adults' cognitive and functional health has been modest and highly variable. Older individuals' attitudes toward technology use may help explain some of the variability in CCI effects. The goal of this R21 is to generate proof-of-concept for an intervention that may improve attitudes toward computers among those with MCI, in turn improving engagement with and efficacy of a subsequent CCI. Person-centered care?that is, integrating individuals' preferences throughout the process of intervention--has improved intervention engagement among older persons, including those with MCI. A recent intervention predicated on this person-centered approach is called ?multi-functional interactive computer systems? (MICS). MICS involve a database of individualized computer-led leisure activities. Our recent pilot data in assisted living facilities suggest that MICS promotes psychological well-being among older persons with MCI, and may shift computers from dauntingly complex or personally irrelevant devices to familiar, enjoyable technology. These results are consistent with a number of theories indicating that exposure to pleasurable experiences with an object or task improves several dimensions of attitudes, including affective and cognitive components, as well as behavior and motivation. Grounded in both this pilot data and the theory around it, we seek to take the next step in an arc of research ultimately intended to improve the efficacy of CCIs. We propose a small randomized controlled trial (RCT) to assess whether an initial period of MICS, followed by a standard CCI, improves a) attitudes toward computers, b) engagement with the CCI, and c) cognitive outcomes, compared to an attention control period followed by CCI. Our design involving stratified random assignment of 50 assisted living residents with MCI from 4 assisted living facilities to these two groups. The initial phase involves 4 weeks of either attention control or MICS, a ?dose? suggested by prior work on attitude change and computers, followed by 6 weeks of CCI for both groups (a period our prior work indicates is sufficient for change in key cognitive domains among this population). We partner with New York Foundation for Quality Care, who manages the assisted living facilities and with whom we have successfully collaborated. This application is the first of which we are aware striving to augment CCIs, which are now ubiquitous, by addressing an attitudinal or affective element of the person, which are often ignored in the cognitive intervention literature. The adjuvant of MICS also answers increasing calls for ?personalized? or ?person-centered? behavioral interventions with older persons. We thus feel that the study's impact upon the rapidly developing field of CCIs is potentially high, and ideal for the ?high-risk high-reward? or proof-of-concept spirit of the exploratory, developmental R21 mechanism. Support for study hypotheses would form the foundation for a subsequent R01 taking the approach to full scale.
Computerized cognitive interventions have become an important tool to try to stave off cognitive decline in older persons. However, negative attitudes towards computers among older people can limit the effectiveness of these interventions. This project seeks to generate proof of concept for a means to address negative attitudes towards computer use, and to see if changes in these attitudes lead to greater efficacy of a standard computerized cognitive intervention among older persons.
