APPLE‐Tree remote secondary dementia prevention; opportunities for scalable public health interventions to reduce dementia risk

Abstract

AbstractBackgroundNearly half of people aged 60+ experience memory impairments that infer an increased risk of dementia. The UK APPLE‐Tree (Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce) trial is evaluating a secondary dementia prevention intervention for people at increased dementia risk, delivered by group video call. It is potentially the first such intervention to be scalable to whole populations.MethodIn 2020‐22, We randomized 748 people aged 60+ with subjective or objective memory impairment, without dementia, 1:1 to the APPLE‐Tree intervention or usual care. In a visual ethnography sub‐study, we recruited intervention participants, purposively for diversity of background and experiences, to participate in photo‐elicitation interviews and workshops with a professional photographer/artist; where they created and shared photographs reflecting what they valued in their daily lives, their experiences of memory concerns, and the intervention. We used qualitative thematic methods to analyse interview, observational and visual data, exploring their experiences of active dementia prevention and the intervention.ResultsWe will present findings from our qualitative sub‐study. Nineteen intervention participants took part. We developed themes around: (1) connections to nature as a lifeline; (2) anchoring experiences within relationships to family; (3) reflecting on self‐growth: making active health and lifestyle changes intended to address memory concerns that were not perceived as inevitable. (4) exploring how enduring self‐identity underpinned a resilience to ageing stereotypes, and enabled adaptation and coping in response to challenges of memory concerns, ageing and the pandemic. We will describe the resulting co‐designed exhibition that was launched in London and exhibited at the Houses of Parliament.ConclusionWe describe experiences of the first group video‐call intervention which seeks to address key risk factors for dementia, including social isolation. The shift to remote delivery of psychosocial interventions has potential gains in terms of scalability and cost‐effectiveness, but risks increasing digital exclusion in vulnerable older people, especially those with memory concerns. We will discuss what our qualitative findings tell us about the effectiveness of our strategies to develop an inclusive, useful intervention.