Virtual Needs Assessment for Older Adults with Cognitive Impairment
TimeThursday, April 152:51pm - 2:53pm EDT
DescriptionUnderstanding the daily challenges older adults with cognitive impairment face is important for finding appropriate solutions and supports to maintain and improve healthcare and quality of life. Needs assessment is a basic method in human factors/ergonomics and is a valuable first step to guide interventions and technology design to support older adults (e.g., Boot et al., 2020). However, such assessments do not typically include older adults with cognitive impairment. Moreover, interactions with participants, especially older adults, has been exceedingly difficult during the pandemic. We have developed a method to conduct a needs assessment, virtually, with protocols tailored to the unique capabilities and limitations of older adults with different types of cognitive impairment.
In preparation for our Everyday Needs Assessment for Cognitive Tasks (ENACT) study, we interviewed subject matter experts to develop a longitudinal needs assessment for older adults with mild cognitive impairment (MCI), traumatic brain injury (TBI), or post-stroke cognitive impairment (PSCI). The ENACT study will provide insights into the functional impairments experienced within and across these three different populations, what strategies work best for them, and the impact on their health and quality of life. We will conduct the ENACT study entirely via videoconference. In this presentation, we will discuss the considerations for conducting needs assessments in a virtual format for older adults with cognitive impairment, with discussion of 1) participant needs; 2) design adaptations; and 3) recommendations for virtual needs assessments for older adults.
We plan to recruit from three distinct populations to capture how types of cognitive impairment can affect the functional challenges that people are experiencing during their daily lives. Individuals with MCI are most commonly characterized by impairments in episodic memory, whereas those with TBI and PSCI have primary impairments that are largely dependent on the type of injury and the area of the brain that received the most damage. As such, the barriers and restrictions that individuals may experience during data collection may vary from person to person. It is therefore critical that the diverse set of challenges experienced by these individuals are considered when developing research protocols, especially in the context of a virtual format.
To better understand older adults' needs in these three population groups, formal and informal Subject Matter Experts (SMEs) were consulted. More specifically, we interviewed those who worked professionally with these population groups and care partners of individuals in the population groups. We conducted semi-structured interviews with 10 SMEs, who provided detailed feedback on the procedures and materials of the ENACT needs assessment protocol (e.g., suggested additional questions to the interview script) and accommodations that should be taken to ensure our participants' comfort during the interview (e.g., visual supports).
A qualitative interview and quantitative assessment battery was developed to understand the daily life experiences in a variety of domains (health, social engagement, transportation, domestic life, leisure, and recreation) of community-dwelling adults over the age of 60 with MCI, TBI, or PSCI. The qualitative interview, based on previous research by the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) project (Koon et al., 2020) was created to understand the daily life challenges individuals experience due to changes in their thinking, memory, or concentration. Individuals are also asked about the types of supports or strategies they currently use to overcome these challenges. The quantitative assessment battery included a myriad of cognitive assessments to characterize the sample, including the California Verbal Learning Test (CVLT-3, Delis et al., 2007), Montreal Cognitive Assessment (MoCA, Nasrredine et al., 2005), Oral Trail Making Test (Mrazik, 2010), Category Fluency (Goodglass, 2001), and a narrative-procedural discourse task (adapted from Chapman et al., 2005 and Fleming & Harris, 2008). Additionally, measures of technology proficiency, social support and well-being, and mental health were collected to better characterize the individuals’ emotional and social health.
Originally designed for an in-person format, all procedures were moved to a virtual format with careful considerations of the participants’ cognitive limitations to make appropriate adjustments. These adjustments included conducting all parts of the assessment via a video platform, Zoom, and creating virtual workbooks for participants to look at during the needs assessment. Additionally, considerations were made when training assessors, understanding that communicating over a virtual platform may present unique barriers to individuals with cognitive impairment. This presentation is intended to help both researchers and clinicians to understand the challenges and opportunities of conducting a mixed-methods virtual needs assessment. The methodology will be discussed in detail to facilitate shared learning and guide future virtual needs assessments.
In sum, this presentation will discuss the considerations of creating and conducting needs assessments for older adults with cognitive impairments, namely, MCI, TBI, and PSCI. Additionally, we will include a discussion of alterations needed to deliver these assessments in a virtual format and the strengths, limitations, and future directions of using virtual platforms to understand the needs of older adults with cognitive impairment.