Brain Healthcare Quotient as a Tool for Standardized Approach in Brain Healthcare Interventions

In addressing the challenge of assessing healthy brain aging across diverse interventions, this study introduces the use of MRI-derived Brain Healthcare Quotients (BHQ) for comprehensive evaluation. We analyzed BHQ changes in 319 participants aged 24-69, who were allocated into dietary (collagen peptide, euglena, matcha, isohumulone, xanthophyll) and physical activity (hand massage with lavender oil, handwriting, office stretching, pink lens, clinical art) groups, alongside a control group, over a month. These interventions were specifically chosen to test the efficacy of varying health strategies on brain health, measured through BHQ indices: GM-BHQ for gray matter volume, and FA-BHQ for white matter integrity. Notably, significant improvements in FA-BHQ were observed in the collagen peptide group, with marginal increases in the hand massage and office stretching groups. These findings highlight BHQ's potential as a sensitive tool for detecting brain health changes, offering evidence that low-intensity, easily implemented interventions can have beneficial effects on brain health. Moreover, BHQ allows for the systematic evaluation of such interventions using standard statistical approaches, suggesting its value in future brain healthcare research.

Apoio social e o cuidado integral à saúde do idoso

Resumo O crescente envelhecimento populacional e as transformações socioculturais do nosso tempo conduzem a novas necessidades, não somente de cuidado, mas também para atender a uma nova perspectiva do conceito de saúde, no qual cuidar da doença se tornou ação limitada. Este estudo trata-se de um ensaio baseado na literatura científica e se propõe a pensar sobre uma pequena parte desta grande questão: o apoio social como parte da atenção integral à saúde do idoso. Para isso, realizou-se uma revisão narrativa da literatura nas bases de dados Pub Med/MedLine, Crochane e Scopus, bem como nas listas de referências dos artigos encontrados. Parte-se da compreensão do papel do apoio social e das redes microssociais na saúde do idoso. A seguir, discutimos formas de avaliar o apoio e a rede social e refletimos sobre o papel do apoio social no Sistema Único de Saúde. Por fim, aborda-se o manejo do apoio social. Como considerações finais, são destacados os principais desafios para que o Apoio Social seja realmente considerado um determinante da saúde das pessoas.

A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research

OBJECTIVES

We conducted a review of the peer-reviewed literature since 2003 to catalogue reported methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research.

METHODS AND RESULTS

We worked with stakeholders before, during and after the review was conducted to: define the primary and key research questions; conduct the literature search; screen titles, abstracts and articles; abstract data from the articles; and analyze the data. The literature search yielded 2,062 abstracts. The review was conducted on 70 articles that reported on stakeholder engagement in individual research projects or programs.

FINDINGS

Reports of stakeholder engagement are highly variable in content and quality. We found frequent engagement with patients, modestly frequent engagement with clinicians, and infrequent engagement with stakeholders in other key decision-making groups across the healthcare system. Stakeholder engagement was more common in earlier (prioritization) than in later (implementation and dissemination) stages of research. The roles and activities of stakeholders were highly variable across research and program reports.

RECOMMENDATIONS

To improve on the quality and content of reporting, we developed a 7-Item Stakeholder Engagement Reporting Questionnaire. We recommend three directions for future research: 1) descriptive research on stakeholder-engagement in research; 2) evaluative research on the impact of stakeholder engagement on the relevance, transparency and adoption of research; and 3) development and validation of tools that can be used to support stakeholder engagement in future work.

Cognitive health and older workers: policy implications

Cognitive health, memory complaints, and cognitive impairment among older workers have begun to receive attention in the research, practice, education, and policy arenas. With the aging population of the United States continuing to increase, projections are that the number of workers 65 and older is also expected to increase. Concerns regarding cognitive impairment and job performance in older workers are being raised. Being familiar with the policies and regulations that protect older workers and offering support and guidance to older adults as they contemplate major life transitions, such as retirement, are important role components for gerontological nurses. Using the five levels of analysis in the social ecology model, selected public policies to support older adults in the workforce are reviewed, and recommendations are presented for fostering positive workplace policies that can promote cognitive health.

Beliefs about promoting cognitive health among Filipino Americans who care for persons with dementia

We examined beliefs about promoting cognitive health among Filipino Americans who care for persons with dementia, their awareness of media information about cognitive health, and their suggestions for communicating such information to other caregivers. We conducted three focus groups (25 participants). The constant comparison method compared themes across focus groups. Caregivers most frequently described cognitive health benefits of social engagement and leisure; next in emphasis were benefits of healthy diets. There was less emphasis on physical activity. Participants had heard from television that avoiding smoking, alcohol, and drugs might promote cognitive health. Ways to inform others about cognitive health included information in Filipino newspapers, and handouts in Filipino languages, distributed in Filipino stores, workplaces, community organizations, and health care facilities. Findings suggest an opportunity to develop public health messages promoting cognitive health that are in-language, published in ethnic-specific media, and that are culturally appropriate for Filipino and other Asian Americans.

Promoting cognitive health: a web site review of health systems, public health departments, and senior centers

Growing evidence suggests that healthy behaviors such as being physically active, having a heart healthy diet, and being socially involved may promote cognitive health. The United States has recently begun encouraging such behaviors for that purpose. To help evaluate the diffusion of this policy, we sought to measure a baseline of activity in this area. We examined Web sites of 156 large health care systems, the health departments of all 50 states and the 20 largest US cities, and 181 nationally accredited senior centers, to identify information, products, programs, or services recommended for cognitive health. Among health care systems, 40% promoted cognitive health: 24% recommended mental activity, 20% healthy diets, 20% physical activity, and 16% social involvement. Among health departments, 30% promoted cognitive health in the same ways. Among senior centers, 21% offered strategies, primarily mental activity. Results suggest emerging activity in this area and opportunities for continued development.

Assessing the relationship between physical fitness activities, cognitive health, and quality of life among older cancer survivors

Chemotherapy-related cognitive impairment, known as "chemobrain," has been described as a side effect of chemotherapy and is associated with cognitive changes on quality of life especially among older cancer survivors. This longitudinal feasibility study examined the relationship between physical fitness, cognitive health, and quality of life among two groups of older adults: those on chemotherapy, and those who have completed chemotherapy. To assess cognitive health, we used the Montreal Cognitive Assessment and demographic information from the Healthy Brain Questionnaire. For quality of life, we used the McGill Quality of Life assessment. Physical activity was assessed using Metabolic Equivalency Tasks from the Compendium of Physical Activities classification system. t-Tests and regression analyses indicated that at Time 1 those on chemotherapy had lower cognitive health scores than those off chemotherapy. Yet at Time 2, as physical activities increased, cognitive health and quality of life improved for those on chemotherapy. However, those who had completed chemotherapy also benefited from an increase in physical activities over time. The results have implications for health care practitioners in oncology settings to better inform patients of cognitive challenges resulting from chemotherapy and the importance of participation in physical activities. Future research should compare different age groups among a larger sample.

Experiences and concerns of family caregivers providing support to people with dementia: A cross-cultural perspective

Abstract:

We examined experiences and concerns among caregivers of community-dwelling people with dementia from two ethnic groups. We conducted a thematic analysis of responses to the question, ‘What is your life like as a caregiver?’ in nine focus groups ( n = 75) with Filipino and non–Hispanic White caregivers. Constant comparison methods identified themes by ethnicity. Experiences and concerns expressed across groups were related to care recipient symptoms commonly associated with dementia, including severe memory loss and behavioral changes. Participants in both ethnic groups described strategies that help them cope, such as receiving help from family and friends, receiving respite support, and participating in support groups. Filipino caregivers more often emphasized positive aspects of caregiving, whereas Whites often expressed that others do not understand the daily experiences of caregiving. Filipinos more commonly described caregivers as a ‘good person’ or ‘saint’ and emphasized that caregiving made them stronger.

A content analysis of cognitive health promotion in popular magazines

Health behaviors, particularly physical activity, may promote cognitive health. The public agenda for health behaviors is influenced by popular media. We analyzed the cognitive health content of 20 United States magazines, examining every page of every 2006-2007 issue of the highest circulating magazines for general audiences, women, men, African Americans, and the health conscious (n = 178). Diet was the greatest focus. Physical activity coverage was limited. Important behavior-related cognitive health risks, including hypertension and diabetes, were not mentioned. Publications for African Americans had little cognitive health content. Coverage of cognitive health was not commensurate with growing evidence that health behaviors may help to maintain it. Findings may be useful to public health officials, health care providers, non-profit organizations that promote cognitive health, individuals evaluating cognitive health information in popular media, and those responsible for magazines or other media.

Use of dietary supplements for cognitive health: results of a national survey of adults in the United States

We studied use of vitamins, minerals, herbs, and other dietary supplements for cognitive health. We refer to these products as supplements. Data were from the 2007 National Health Interview Survey, which asked about complementary and alternative medicine (n = 22 783). Chi-square and multivariate logistic analyses were weighted for national representativeness, accounting for the survey design. Among supplement users, about 8.8% of those without cognitive problems used them for cognitive health; 15.7% of those with cognitive problems did so. Fish oil, Ginkgo biloba, and vitamins were commonly used for cognitive health. Among supplement users, 38% did not tell health care providers. In adjusted results, adults reporting cognitive problems were more likely than others to use supplements for cognitive health (odds ratio 1.77, confidence interval 1.39-2.25). Adults are more likely to use supplements to treat or cure cognitive problems than to prevent them. Many do not discuss this use with health care providers.

How do older people describe others with cognitive impairment? A multiethnic study in the United States

We studied how older people describe others with cognitive impairment. Forty-two focus groups represented African Americans, American Indians, Chinese Americans, Latinos, Vietnamese Americans, and Whites other than Latinos (Whites) (N = 396, ages 50+), in nine locations in the United States of America. Axial coding connected categories and identified themes. The constant comparison method compared themes across ethnic groups. African Americans, American Indians and Whites emphasised memory loss. African Americans, American Indians, Latinos and Whites stressed withdrawal, isolation and repetitive speech. African Americans, American Indians, Vietnamese Americans and Whites emphasised ‘slow thinking’. Only Whites described mood swings and personality changes. Many participants attributed dementia to stress. Terms describing others with dementia included ‘Alzheimer's’, ‘dementia’, ‘senile’ and ‘crazy’. Euphemisms were common (‘senior moment’, ‘old timer's disease’). Responses focused on memory, with limited mention of other cognitive functions. Differences among ethnic groups in descriptions of cognitive health and cognitive impairment underscore the need to tailor public health messages about cognitive health to ways that people construe its loss, and to their interest in maintaining it, so that messages and terms used are familiar, understandable and relevant to the groups for which they are designed. Health promotion efforts should develop ethnically sensitive ways to address the widely held misperception that even serious cognitive impairment is a normal characteristic of ageing and also to address stigma associated with cognitive impairment.

Multisite qualitative study of primary care physicians' and midlevel providers' self-reported practices and perceptions about maintaining cognitive health

INTRODUCTION

To facilitate national efforts to maintain cognitive health through public health practice, the Healthy Brain Initiative recommended examining diverse groups to identify stakeholder perspectives on cognitive health. In response, the Healthy Aging Research Network (HAN), funded by the Centers for Disease Control and Prevention (CDC), coordinated projects to document the perspectives of older adults, caregivers of people with dementia, and primary care providers (PCPs) on maintaining cognitive health. Our objective was to describe PCPs' perceptions and practices regarding cognitive health.

METHODS

HAN researchers conducted 10 focus groups and 3 interviews with physicians (N = 28) and advanced practice providers (N = 21) in Colorado, Texas, and North Carolina from June 2007 to November 2008. Data were transcribed and coded axially.

RESULTS

PCPs reported addressing cognitive health with patients only indirectly in the context of physical health or in response to observed functional changes and patient or family requests. Some providers felt evidence on the efficacy of preventive strategies for cognitive health was insufficient, but many reported suggesting activities such as games and social interaction when queried by patients. PCPs identified barriers to talking with patients about cognitive health such as lack of time and patient reactions to recommendations.

CONCLUSION

Communicating new evidence on cognitive health and engaging older adults in making lasting lifestyle changes recommended by PCPs and others may be practical ways in which public health practitioners can partner with PCPs to address cognitive health in health care settings.

How do top cable news websites portray cognition as an aging issue?

PURPOSE OF THE STUDY

We examined messages that the websites of the top cable news companies (MSNBC, FOX, and CNN) conveyed about cognition between January 2007 and March 2010. Drawing on agenda-setting theory, this work assessed the frequency, prominence, and attributes of cognitive topics in messages targeting an aging audience.

DESIGN AND METHODS

We used quantitative content analysis to examine the frequency and prominence of cognitive topics and cognitive goals, as well as how the cognitive discussions were framed. Chi-square analyses were conducted to compare cognitive health information discussed in news items that did and did not target an "aging audience." Qualitative analysis of the aging audience subgroup was used to further examine age-associated cognitive messages.

RESULTS

Within the 229 cognitive items identified, we found significantly more coverage of cognitive functioning and unspecified dementia and significantly less coverage of cognitive disease not dementia, specified dementia, and accidents or injury for the aging audience. Our qualitative analysis of news items aimed at an aging audience documented a focus on maintaining functioning and avoiding decline through various individual lifestyle behaviors. However, contextual information about level of cognition to be maintained, particular cognitive functions targeted, specific norms about cognitive aging, and how cognitive function is determined was lacking.

IMPLICATIONS

Our research points to a communication gap in the delivery of academic research findings to a lay audience through online journalism. We suggest more clarity by researchers in defining cognitive concepts and measurement of cognitive function for journalistic translation and public consumption.

Ethnically Diverse Older Adults' Beliefs about Staying Mentally Sharp

This study examined diverse older adults' ( n = 396, ages 50+) views about how to stay mentally sharp. We conducted 42 focus groups in four languages at nine United States locations using a standardized discussion guide and methods. The groups represented African Americans, American Indians, Chinese Americans, Latinos, Whites other than Latinos, and Vietnamese Americans. All groups mentioned benefits of social interaction. All groups, especially Chinese and African Americans, mentioned benefits of community engagement. Participants in all groups expressed their belief that mental stimulation, particularly reading, promoted cognitive health; African Americans and Whites were especially likely to say that mental exercises (e.g., puzzles) were useful. Results suggest opportunities for education about potential cognitive health benefits of being socially connected through senior center activities and volunteer programs.

Physical Activity and Cognitive-Health Content in Top-Circulating Magazines, 2006–2008

Physical activity may promote cognitive health in older adults. Popular media play an important role in preventive health communication. This study examined articles discussing associations between physical activity and cognitive health in top-circulating magazines targeting older adults. 42,753 pages of magazines published from 2006 to 2008 were reviewed; 26 articles met inclusion criteria. Explanations regarding the link between physical activity and cognitive health were provided in 57.7% of articles. These explanations were generally consistent with empirical evidence; however, few articles included empirical evidence. Physical activity recommendations were presented in 80.8% of articles; a wide range was recommended (90–300 min of physical activity per wk). Socioeconomic status and education level were not mentioned in the text. Results suggest an opportunity for greater coverage regarding the role of physical activity in promoting cognitive health in popular media. Magazine content would benefit from including more empirical evidence, culturally sensitive content, and physical activity recommendations that are consistent with U.S. guidelines.

Older adults' concerns about cognitive health: commonalities and differences among six United States ethnic groups

We studied concerns about cognitive health among ethnically diverse groups of older adults. The study was grounded in theories of health behaviour and the representation of health and illness. We conducted 42 focus groups (N=396, ages 50+) in four languages, with African Americans, American Indians, Chinese Americans, Latinos, Whites other than Latinos (hereafter, Whites) and Vietnamese Americans, in nine United States locations. Participants discussed concerns about keeping their memory or ability to think as they age. Audio recordings were transcribed verbatim. Constant comparison methods identified themes. In findings, all ethnic groups expressed concern and fear about memory loss, losing independence, and becoming ‘a burden’. Knowing someone with Alzheimer's disease increased concern. American Indians, Chinese Americans, Latinos and Vietnamese Americans expected memory loss. American Indians, Chinese Americans and Vietnamese Americans were concerned about stigma associated with Alzheimer's disease. Only African Americans, Chinese and Whites expressed concern about genetic risks. Only African Americans and Whites expressed concern about behaviour changes. Although we asked participants for their thoughts about their ability to think as they age, they focused almost exclusively on memory. This suggests that health education promoting cognitive health should focus on memory, but should also educate the public about the importance of maintaining all aspects of cognitive health.

Older Adults’ Perceptions of Physical Activity and Cognitive Health: Implications for Health Communication

Messages promoting physical activity (PA) to maintain cognitive health (CH) may increase PA and enhance CH among older persons. This study examined older adults’ perceptions of PA and CH. We conducted 10 focus groups with irregularly active older Black and White women and men ( N = 55), ages 65 to 74 in South Carolina. Constant comparison methods compared themes by gender and race/ethnicity groups. Most participants perceived cognitive decline as a severe threat, and they were primarily concerned about losing their independence. Most reported feeling susceptible to cognitive decline. Although most recognized the link between PA and CH, several White men said the association was not clear. Participants recommended a wide range of PA amounts needed to achieve CH benefits. Many suggested that evidence of PA benefits for CH would enhance message credibility. Participants suggested messages be paired with social support to increase PA. Results suggest a need for evidence-based, credible communication promoting PA and CH.

Older adults' perceived physical activity enablers and barriers: a multicultural perspective

This study identified perceived physical activity (PA) enablers and barriers among a racially/ethnically and geographically diverse group of older adults. Data were from 42 focus groups conducted with African Americans, American Indians, Latinos, Chinese, Vietnamese, and non-Hispanic Whites (hereafter Whites). Constant-comparison methods were used to analyze the data. Common barriers were health problems, fear of falling, and inconvenience. Common enablers were positive outcome expectations, social support, and PA program access. American Indians mentioned the built environment and lack of knowledge about PA as barriers and health benefits as an enabler more than participants in other groups. Whites and American Indians emphasized the importance of PA programs specifically designed for older adults. Findings suggest several ways to promote PA among older people, including developing exercise programs designed for older adults and health messages promoting existing places and programs older adults can use to engage in PA.

Primary care providers' sources and preferences for cognitive health information in the United States

In most countries, physicians and other health-care providers play key roles in promoting health. Accumulating scientific evidence suggests that providers may soon want to include cognitive health among the areas they promote. Cognitive health is the maintenance of cognitive abilities that enable social connectedness, foster a sense of purpose, promote independent living, allow recovery from illness or injury and promote effective coping with functional deficits. The US Centers for Disease Control and Prevention has established health promotion about cognitive health as a policy priority, with health providers included as one key group to participate in this effort. This study presents results from focus groups and interviews with primary care physicians (n = 28) and midlevel health-care providers (physician assistants and nurse practitioners, n = 21) in three states of the US. Providers were asked about their sources of information on cognitive health and for their ideas on how best to communicate with primary care providers about research on cognitive health. In results, providers cited online sources, popular media and continuing medical education as their most common sources of information about cognitive health. Popular media sources were used both proactively and reactively to respond to patient inquiries. Differences in sources of information were noted for physicians as compared with midlevel providers, and for rural and urban providers. Several potential ways to disseminate information about cognitive health were identified. Effective messaging is likely to require multiple strategies to reach diverse groups of primary care providers, and to include continuing medical education.

Attitudes about aging well among a diverse group of older Americans: implications for promoting cognitive health

PURPOSE

To examine perceptions about aging well in the context of cognitive health among a large and diverse group of older adults.

DESIGN AND METHODS

Forty-two focus groups were conducted with older adults living in the community (N = 396; White, African American, American Indian, Chinese, Vietnamese, and Hispanic). Participant descriptions of "someone who you think is aging well" were analyzed. Constant comparison methods examined themes by race/ethnicity.

RESULTS

There were notable race/ethnicity differences in perceptions of aging well. Compared with other racial/ethnic groups Chinese participants were more likely to emphasize relationships between mental outlook and physical abilities, Vietnamese participants were less likely to emphasize independent living. American Indians did not relate aging well to diet or physical activity. Important themes that emerged about aging well for all racial/ethnic groups were as follows: living to advanced age, having good physical health, having a positive mental outlook, being cognitively alert, having a good memory, and being socially involved.

IMPLICATIONS

To promote cognitive health among diverse populations, communication strategies should focus on shared perceptions of aging well, such as living to an advanced age with intact cognitive function, having a positive attitude, and being mobile. Health promotions may also create a range of culturally sensitive messages, targeted to views that are more salient among some racial/ethnic groups.

The two voices of Alzheimer's: attitudes toward brain health by diagnosed individuals and support persons

PURPOSE

Most individuals with Alzheimer's are cared for in their homes by unpaid family members. Research on caregiving focuses disproportionally on costs of care, service utilization, and negative psychosocial outcomes. Few narrative accounts of Alzheimer's exist; those that do suffer similar pejorative framings and narrow foci. No studies that we are aware of examine the health beliefs of diagnosed individuals and support persons, or their attitudes about brain health. This research reports perceptions of "aging well" held by those most intimately acquainted with Alzheimer's.

DESIGN AND METHODS

Diagnosed individuals and their support persons (N = 85) were enrolled into 14 focus groups. Grounded theory methods were used to collect, code, and analyze textual interview data into overarching themes.

RESULTS

Respondents found physical and mental health, social activity, independence, and happiness integral to aging well. An acceptance of various limitations was also deemed crucial. Support persons placed more emphasis on lifestyle factors and memory loss as potential obstacles. Diagnosed respondents defined memory loss in less medicalized terms, whereas support persons labeled it Alzheimer's and negatively characterized those affected. Both groups warned against discussing "prevention" of dementia: Diagnosed individuals noted the implication of "aging poorly" and support persons cautioned against blaming diagnosed individuals.

IMPLICATIONS

These findings can be used to encourage positive health beliefs and behaviors tailored to the needs of diagnosed seniors and their families, to help practitioners and researchers identify and become sensitive to differences between and among older adults, and to further advance the utility of narrative accounts for informing health interventions and education efforts.

Gender differences in views about cognitive health and healthy lifestyle behaviors among rural older adults

PURPOSE

Research suggests that men and women often differ in knowledge and beliefs about causes and treatments of a variety of diseases. This study examines gender differences in views about cognitive health and behaviors that have been associated with its maintenance, focusing on older adults living in rural areas.

DESIGN AND METHODS

We conducted 6 focus groups in rural West Virginia. Participants included 37 women and 30 men, aged 55 years and older.

RESULTS

Men and women held similar views of cognitive decline, as well as largely similar views about causes of Alzheimer's disease (AD). However, women were more concerned about developing AD than were men. Gender differences were also noted with respect to healthy lifestyle beliefs, including diet, leisure-time physical activity, and strategies to maintain cognitive health.

IMPLICATIONS

Findings illustrate the importance of considering gender with respect to health beliefs, health behaviors, and health promotion, and emphasize the need to develop interventions designed for specific populations. Results highlight a critical need to translate research findings to the community.