Structured external memory aid treatment (SEMAT) for older adults with mild cognitive impairment: long-term adherence and acceptability of treatment

Abstract

ABSTRACT Background The Structured External Memory Aid Treatment (SEMAT) is a recently developed compensatory cognitive intervention that systematically teaches external memory aids (EMAs) and strategies to older adults with mild cognitive impairment (MCI). Preliminary efficacy evidence for the SEMAT is encouraging and suggests that treatment effects (i.e., using EMAs) may persist over a year after treatment. However, it is unknown which component(s) of the SEMAT are most contributory to long-term adherence and sustained treatment effects. Aims The aims of this study were to conduct a thematic analysis of interviews conducted with adults with MCI who completed the SEMAT 18 months prior to explore the factors that influenced participants’: 1) long-term adherence to the EMAs taught during the SEMAT and 2) treatment acceptability. Methods & Procedures Six female participants, ages 74–90, with MCI participated in the present study. Participants completed semi-structured interviews 18 months following the six-week SEMAT. We used a reflexive thematic framework for data collection and analysis. Outcomes & Results Our thematic analysis revealed seven major themes related to adherence: (1) multiple types of EMAs used, (2) idiosyncratic modifications to the EMAs, (3) EMA use enhanced the completion of everyday tasks, (4) EMAs were used for reassurance, (5) EMA use supported independence and safety, (6) EMA location and use within daily routine, and (7) difficulties with features of the EMAs. Four major themes emerged regarding treatment acceptability: (1) metamemory skills, (2) appropriate length of treatment, (3) eased memory concerns, and (4) group dynamic. Conclusions Findings from the present study, along with the associated quantitative and qualitative SEMAT studies, provide preliminary evidence for the SEMAT as a novel, person-centered, semi-structured, and functional treatment that aims to promote lasting treatment effects for older adults with MCI up to 18 months after treatment. These findings reinforce the importance of implementing compensatory interventions early during cognitive decline that are designed to promote independence. Future research should investigate the effectiveness of the SEMAT with a larger and more rigorous clinical trial design.