Mind over memory: reducing fear and avoidance of memory loss (REFRAME) study in older adults

Abstract

AbstractBackgroundFear of Alzheimer’s disease and related dementias (ADRD) is a growing concern among older adults. High levels of fear are associated with poorer health outcomes, lower levels of psychological well‐being, and the perpetuation of harmful cognitive‐behavioral cycles that can potentially hasten cognitive decline. Interventions that disrupt these cycles could bring both immediate and long‐term benefits for reducing ADRD‐related fears. Given the projected increase in the number of people living with ADRD and accompanying fears, effective interventions are needed to address the emotional needs of older adults. We evaluated a brief psychological intervention aimed at promoting adaptive coping in older adults with heightened ADRD‐related fear and examined its effects on broader health outcomes.MethodEighty‐one older adults experiencing heightened ADRD‐related fear were recruited to participate in a 3‐week online intervention aimed at reducing fear (primary outcome) and improving secondary health‐related outcomes (i.e., anxiety, depression, social function). Participants were randomly assigned to REFRAME or active comparison group. Both groups completed psychoeducation and mindfulness activities designed to reduce fear. The REFRAME group completed an additional behavioral activation module designed to disrupt patterns of avoidant behavioral coping. Participants completed measures at baseline, weeks 1‐3 of the intervention, post‐intervention, and 4‐week follow‐up. Outcomes were analyzed using linear mixed effects models.ResultParticipants ranged from 55 to 90 years, (M = 65.4, SD = 7.1). Intervention adherence was high (>75%) across both groups. ADRD‐related fear decreased significantly over time in both groups. Anxiety, depression, and self‐reported memory failures also decreased significantly in both groups, while social function and well‐being improved. The REFRAME group exhibited a greater reduction in depression compared to the control group.ConclusionOur brief psychological intervention had positive effects on ADRD‐related fear among older adults. However, further research is needed to determine the long‐term benefits and their effectiveness in at‐risk populations (e.g., people with a family history of dementia), as well as the acceptability of this intervention in clinical settings. These findings highlight the potential benefits of disrupting harmful cognitive‐behavioral cycles, as this may encourage older adults to stay engaged in healthy behaviors for longer, ultimately improving their quality of life.