Challenges faced and lessons learned A multi-component prospective memory training program for Malaysian older adults

Farzin, Azin; Ibrahim, Rahimah; Madon, Zainal; Basri, Hamidon

doi:10.1590/1980-57642018dn12-020012

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 12 (2) • Apr-Jun 2018 • https://doi.org/10.1590/1980-57642018dn12-020012 copy

Challenges faced and lessons learned A multi-component prospective memory training program for Malaysian older adults

Desafios enfrentados e lições aprendidas: Um programa de treinamento de memória prospectiva de vários componentes para adultos idosos da Malásia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The surrounding circumstances and environments of Malaysian older adults could make conducting interventions (mainly in terms of clinical or randomized controlled trials) a challenge. Working with older adults and facing cultural issues could be challenging.

Objective:

This paper illustrates a significant perspective of some of the challenges faced while conducting a randomized controlled trial exploring the impact of a multi-component intervention that included strategy- and process-based prospective memory (PM) training among Malaysian older adults.

Methods:

The current study was a randomized controlled trial (RCT) and therefore the challenges were presented in accordance with the CONSORT statement style.

Results:

A discussion on how these issues were addressed is provided.

Conclusion:

Some suggestions were presented to help researchers plan and create interventions for similar studies and to support a practical method of addressing all related challenges.

Key words:
cross-over studies; aged; prospective memory; cognition disorders; activities of daily living

Study stage	Description
Design	•RCT within-participants cross-over design including a multi-component intervention including strategy- and process-based (computer-based) components. •The study included two conditions: treatment/training and no-contact control conditions. •Ethical approval was sought from the University Putra Malaysia (UPM) ethics committee.
Sample	•40 potential participants were contacted, however only 25 were assessed for being eligible, and formally enrolled into the study based on the inclusion criteria: 1. subjects must be 55 years old and above, 2. educational level must be at least secondary level, and 3. show absence of; [i] history of neurological impairments (measured with MMSE (cut-off value=27) where scores for the sample ranged from 27 to 29 (M=27.68, SD=0.75), [ii] any major psychiatric disorder (taking any psychoactive medication (e.g., anti-depressive)) and learning disabilities, [iii] history of general anaesthesia, head traumas (in the last 6 months prior to the study), cerebrovascular disease, or neurological impairments, and [iv] drug/alcohol abuse. •Informed consents were collected from the participants.
Setting	•The sample was collected from the U3A Kuala Lumpur/Selangor active members, their family members and friends. •The intervention was conducted in the computer lab of the Faculty of Human Ecology, University Putra Malaysia (UPM).
Intervention	•Each intervention session lasted 2 hours. •There was 1 session per week for 6 weeks. •During each session, participants were exposed to intention implementation and other similar strategy-based exercises and a computer-based exercise (playing Virtual Week).
Data collection	•Baseline and post-intervention assessments for 4 outcome measures were assessed: PM (PRMQ and PM-Tasks^* * Prospective Memory-Tasks (PM-Tasks) is a computerized measurement tool developed to evaluate three types of PM tasks (event-based, time-based, and activity-based PM tasks). In the eventbased PM tasks section, a sequence of pictures including four shapes in each picture is presented at the center of the screen, and the participants are required to decide by pressing different keys for different shapes. If there is a bold and white shape in any sequence they are asked to press the spacebar (this is the PM task). In total, five bold and white shapes will be presented. In the time-based PM tasks section, everything is the same as the previous section except that a digital timer appears in the upper part of the screen. Each time the timer turns another full minute (e.g., 02:00, the last two digits are 00), participants are required to press the spacebar (PM task). Moreover, no bold and white shapes appear on the screen. The score ranges from 0 to 5 for this part. At the end of each part of the test, participants see a written phrase displayed on the screen and are asked to press “enter” upon seeing this phrase (activity-based PM task). ), IADL, GDS, and GAS
Data analysis	•Results of pre- and post-test assessments were reported as means (M), and standard deviations (SD). The General Linear Model (GLM) was used to show the effectiveness of the intervention.

Study design	Intervention administration	Retention and treatment fidelity
Selecting the right facility •Cooperation and flexibility •Activities timetable •Necessary equipment The study budgets •Number of participants •Number of research assistants needed •Remuneration The recruitment process •Duration/project timing •Flexibility The screening process •Inclusion and exclusion criteria •Screening tools •Duration of the session	Time of day Duration and frequency of the sessions Participant schedule Transport Weather conditions	Standardized procedure Training the facilitators Measurement tools •Self-reports •Insight/feedback •Reliability and validity Facilitator characteristics •Age •Gender •Nationality •Capability •Attitude Fellow participants’ characteristics •Age •Gender •Nationality •Attitude Training •Training type •Training components •Tolerability •Flexibility (replacement sessions)

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E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Rahimah Ibrahim. Malaysian Research Institute on Aging, University Putra Malaysia (UPM), Serdang, Selangor, 43400, Malaysia, E-mail: imahibrahim@upm.edu.my