Reviving social interaction for healthy aging


Reviving social interaction for healthy aging: participatory engagement of older adults in dementia prevention in rural African and Montreal contexts

Most people with dementia live in low- and middle-income countries (LMIC), where lack of care resources underline the need for prompt investment in prevention. This study pilots a real-life participatory intervention that could prevent cognitive loss while improving care of older adults in LMIC. Observational studies associate dementia with reduced social contact. Formal trials of social activity as dementia prevention suggest social engagement might reduce age-related cognitive loss. Social interventions improved aspects of executive function, loss of which defines some dementias.

Older adult care in LMIC is home based. Our pilot explores three mechanisms of participatory research with older adults and their caregivers: 1) engage in governance to balance personal and collective interests; 2) analyse and apply local evidence, and 3) support innovation to address shared interests. If the mechanisms of participatory research key off corresponding elements of executive function, this could revitalize cognitive capacity and prevent or delay dementia in an affordable and realistic way.

This study tests feasibility and acceptability of develop a participatory intervention with older adults in a rural LMIC setting. We will recruit older women and older men in two very similar rural communities in south-eastern Botswana during their monthly collection of state pensions. We will document their use of and problems with services, social networks and support mechanisms. A participatory intervention in one community will begin with older adults identifying challenges in living conditions, using fuzzy cognitive mapping. With a focus on collaborative solutions, the intervention will collate evidence, discuss solutions, and share results for local actions. Visual/arts-based methods will clarify the participant needs, levelling the playing field for those with hearing and visual disabilities.

In before-after and time-matched comparisons, we will compare intervention participants with older adults in the second community receiving the usual care for their situation. We will measure deterioration using a neuro-psychology tool that is now standard in Botswana’s routine cognitive testing of all older adults, in addition to ecologically valid real-world assessments. We will establish the feasibility of measuring reduced risk of dementia, while improving wellbeing, social engagement, healthcare, and adherence to existing therapies. Economic analysis will focus on intervention cost, quality of life and sustainability. Indicative statistical analysis will assess variances and potential confounders to inform design of a larger multi-centre study of the impact of authentic participation in preventing dementia.

Research Settings: Rural, Botswana

Dates: 2024 to 2027

Funding: Institutes of Health Research (CIHR): Appl. # 507532 Total: $888,165 (Canadian dollar)