Programs For Older Adults Research Articles

Using an academic-community partnership model to deliver evidence-based falls prevention programs in a metropolitan setting: A community case study.

Prevention is an effective approach for mitigating the negative health outcomes associated with falls in older adults. The Administration for Community Living (ACL) has sponsored the implementation of evidence-based falls prevention programs (EBFPPs) across the United States through cooperative agreement grants to decrease the health and economic burden of falls. Marymount University received two of these grants to deliver three EBFPPs into the northern Virginia region. This community case study describes the development of a collaboration between a university and community-based organizations to adopt and implement multiple evidence-based programming in an area where none previously existed. Through an academic-community partnership, EBFPPs were introduced to and implemented by senior-focused organizations. Target adopters were senior and community centers, multi-purpose senior services organizations, recreational organizations, and residential facilities serving older adults. The three EBFPPs were (1) Stay Active and Independent for Life (SAIL), (2) a Matter of Balance (MOB) and (3) Otago Exercise Program (OEP). Key interdependent project elements included: (1) fostering ongoing community organization collaboration, (2) introducing programs in the community, (3) growing and sustaining delivery sites, (4) preparing trained program leaders, and (5) building community demand for the programs. From August 2016-June 2022, 5,857 older adults participated in one of the three EBFPPs. SAIL classes were offered at 33 sites and MOB workshops at 31 with over 70% of them occurring at community or senior centers. OEP was offered at 4 sites. Factors that influenced the implementation of these programs included having: key advocates at host organizations, programs embedded into site workflows, sufficient capacity and workforce, engaged invested partners, and flexibility in working with a complex set of agencies and systems with different administrative structures. By connecting academic faculty with various community members from multiple sectors, new initiatives can be successfully implemented. Results from this ACL-funded project indicate that using an academic-community partnership model to build relationships and capacity for ongoing delivery of health promotion programming for older adults is feasible and effective in delivering EBFPPs. In addition, academic-community partnerships can develop a strong network of invested partners to foster continued support of fall prevention activities.

Music and Movement for Health: Protocol for a pragmatic cluster-randomised feasibility pilot trial of an arts-based programme for the health and wellbeing of older adults.

Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022).

The application and evaluation of an augmented-reality-based physical and cognitive stimulation programme for older adults

The aim of this paper is to present the results of research analysing the incorporation of virtual or augmented reality into a programme based on physical and cognitive stimulation in older adults and to evaluate its effects following its application. The specific objectives were to verify whether the intervention had a positive effect on the cognitive deterioration of older adults as far as their mobility and fall risk were concerned and whether it was possible to observe any significant differences. A total of 18 people over the age of 65, all of whom were users of a day centre for the elderly, participated in this research. In terms of methodology, the study employed a quasi-experimental approach with two groups and both a pretest and a posttest to analyse the data quantitatively and descriptively. Three scales adapted to a Spanish population were used to measure cognitive deterioration, mobility and fall risk and to evaluate mental disorders in old age. As far as the results are concerned, although no statistically significant data have been found, it has been possible to appreciate slight improvements which suggest that virtual or augmented reality is a tool which can be used to complement physical and cognitive intervention programmes and activities in day centres for the elderly, incorporating aspects of an interactive nature which allow people to exercise and recover basic abilities in their everyday life, particularly in the area of cognition.

Characteristics and effects of physical exercise programs for older adults during the COVID-19 pandemic: an integrative review

Objective: To evaluate the characteristics of physical exercise programs for older adults and their effects during the COVID-19 pandemic. Methods: An integrative review was conducted between January and March 2022. A search was conducted in MEDLINE via PubMed, Lilacs via BVS, PEDro, and Cochrane Library. Experimental articles (randomized clinical trials, non-randomized trials, or quasi-experimental studies) published from 2019 to 2021, with no language restriction, and that used physical exercise programs for older adults (> 60 years) in their intervention were included. The studies were selected by reading the title, abstract, and full text. The selected articles had their results extracted using an online form, tabulated using an electronic spreadsheet, and analyzed qualitatively and quantitatively. Results: 113 studies were identified; 7 met the eligibility criteria and were included in the review, all randomized controlled trials. The multi-component exercise programs were more frequent (resistance, balance, flexibility, and aerobic), delivered remotely and performed 2 to 7 times a week, lasting between 30 and 50 minutes. Significant effects were observed on physical function, body composition, blood triglycerides, the incidence of falls, physical activity, and functional capacity. Conclusions: The physical exercise programs used during the COVID-19 pandemic showed promising results for older adults. The programs proved to be a viable alternative for maintaining the physical, mental, and cognitive functions of older adults in times of public calamity.

Effectiveness of an Exercise Program for Older Adults Using an Augmented Reality Exercise Platform: A Pilot Study.

With the rapid progression of population aging worldwide, the health management of older adults is emerging as an important topic. To help prevent declines in physical and cognitive function due to aging, older adults must maintain consistent physical activity. The development of digital technology has recently allowed the optimization of exercise programs for older adults using augmented reality (AR) game technology. Fifteen older adult females were enrolled in an AR-based exercise program. The program was conducted for 30 min, three times weekly, for a total of six weeks. To verify the effectiveness of the program and assess physical function before and after exercise, the following tests were performed: timed up-and-go test, five-time sit-to-stand test, one-minute sit-to-stand test, lung capacity test, respiratory muscle strength test, and bioelectrical impedance analysis. The Trail Making Test was used to evaluate cognitive function. For statistical analysis, a paired t-test was used to verify the effects on physical and cognitive function before and after exercise. The study results confirmed improved overall physical and cognitive function. The timed up-and-go test, maximal inspiratory pressure, and Trail Making Test part B scores showed significant increases. This study verified the effectiveness of AR exercise in community-dwelling older adult women. In the future, exercise programs with game elements that increase the interest and motivation of participants to engage in exercise routines should be developed and applied.

Feasibility, Usability, and Acceptability of Online Mind-Body Exercise Programs for Older Adults: A Scoping Review.

Objectives: Engaging in mind-body exercises (MBEs: e.g., Tai Chi and yoga) can have physical and mental health benefits particularly for older adults. Many MBEs require precise timing and coordination of complex body postures posing challenges for online instruction. Such challenges include difficulty viewing instructors as they demonstrate different movements and lack of feedback to participants. With the shift of exercise programs to online platforms during the COVID-19 pandemic, we conducted a scoping review to examine the feasibility, usability, and acceptability of online MBE classes for older adults. Materials and Methods: We followed the scoping review methodology and adhered to the PRISMA reporting checklist. We searched five databases: Medline, Embase, CINHAL, Web of Science, and ACM digital library. Screening of articles and data extraction was conducted independently by two reviewers. Settings/Location: Online/virtual. Subjects: Older adults ≥55 years of age. Outcome Measures: Feasibility measures. Results: Of 6711 studies retrieved, 18 studies were included (715 participants, mean age 66.9 years). Studies reported moderate to high retention and adherence rates (mean >75%). Older adults reported online MBE classes were easy to use and reported high satisfaction with the online format. We also identified barriers (e.g., lack of space and privacy and unstable internet connection) and facilitators (e.g., convenience and technical support) to the online format. Opinions related to social connectedness were mixed. Conclusion: Online MBE programs for older adults appear to be a feasible and acceptable alternative to in-person programs. It is important to consider the type of exercise (e.g., MBE), diverse teaching styles, and learner needs when designing online exercise classes.

Effects of a cognitive stimulation program on physical and cognitive dimensions in community-dwelling faller older adults with cognitive impairment: study protocol

BackgroundCognitive functioning is an important dimension among the elderly. Cognitive maintenance is vital for aging due to its association with autonomy and independence. Considering the importance of preventive programs in older adults’ health, this study aims to share an intervention protocol of a falls prevention program for community-dwelling faller older adults with cognitive impairment.MethodsThis is the protocol of an experimental and longitudinal study, consisting of cognitive stimulation associated with physical exercise in a 16-week fall prevention program. For cognitive intervention, the APG Cognitive Training Protocol will be used. Participants will be assessed pre-and post-intervention and will be randomly allocated to experimental or control groups. The screening protocol is composed of the TUG, FES-I, LAWTON & BRODY, ACE-R, GAI and fall survey instruments, focusing on the assessment of balance and mobility, fear of falling, performance on IADL, cognitive and anxiety tracking, respectively.DiscussionThis study can determine the long-term effects of multimodal cognitive training, providing evidence for its replication in the provision of care for the elderly. The objective is to promote improvements in the cognitive performance, mobility and balance of the elderly, with a focus on reducing the number of falls, fractures, hospitalizations and institutionalization, serving as an alternative to interrupt the cycle of falls.Trial registrationThe research was approved by the Research Ethics Committee with Human Beings at the Federal University of São Carlos, CAAE: 3654240.9.0000.5504 and Brazilian Registry of Clinical Trials (REBEC) RBR—3t85fd, registered on the 25th of September, 2020.

Feasibility of a Modified Otago Exercise Program for Older Adults With Cognitive Vulnerability.

Cognitive vulnerability, that is, clinically significant symptoms of dementia, depression, or delirium, puts older adults at high risk for physical inactivity and falls. Programs addressing activity and falls are needed. The purpose was to determine feasibility of an in-home, modified, Otago Exercise Program (OEP) for those with cognitive vulnerability, based on acceptability (retention and adherence), safety (pain intensity and falls), and potential positive effects (change in short physical performance battery (SPPB)). This secondary analysis of a randomized controlled trial included 80 participants who received the OEP; 64 completed it, 48% had depression, 22% had dementia, and 30% had a combination dementia/depression/delirium. Adherence to home exercise was low to moderate; pain was stable over 16weeks; 31% of participants reported falls unrelated to OEP. SPPB increased from 6.95 to 7.74 (p < .01); age by time and diagnosis by time interactions were not significant. The modified OEP shows promising feasibility for older adults with cognitive vulnerability.

Improving balance in community-dwelling elders using trained volunteers within faith-based institutions: a mixed methods feasibility study

Purpose To investigate the feasibility and acceptability of a volunteer-led balance programme for older adults. Methods A feasibility cluster RCT with focus groups were conducted in faith-based institutions. Eligibility criteria were: participants were ≥65 years, able to do five times sit -to-stand, had no falls in the previous six months and had good mental capacity. The intervention included supervised group exercises and exercise booklets for six months, education and a fall poster. Assessments included, TUG, MCTSiB, FTST, FES, mABC, OPQoL and DGLS at baseline, 6 weeks, and 6 months. Feasibility measures included numbers of volunteers, sessions, and volunteers” time commitment, views of participants about sustainability of program using qualitative focus groups and volunteers' ability to deliver programme. Results Three churches participated with 31 participants in each group. Participants had a mean age of 77.3 years, were 100% British, and 79% female. The sample size estimate for a future trial using TUG, was 79 per group. Focus groups showed perceived social and physical improvements in participants, need to extend the programme to the wider community, and increased confidence, participation and socialisation. Conclusion The community-based balance training in faith-based institutions, was feasible and acceptable in one geographical area and requires evaluation in cohesive diverse communities. Implications for Rehabilitation If an institution or a community is united through faith, culture, national roots, or tradition, then these groups are ideal for such balance rehabilitation programmes, because of the familiarity of the location and people, cohesive culture or their ideology to help their communities. Participants and volunteers perceived improved participation, confidence and socialisation and were keen to continue programme. It is important to develop community-based falls prevention programmes that the National Health Service (NHS) can partially support using volunteers to reduce the burden of falls in the community and for the NHS.

The Effect of Social Pension on Material Hardship among Older Adults in Korea: Regression Discontinuity Estimation

Abstract The goal of this study was to examine the effect of a social pension programme for older adults in South Korea, Basic Pension Scheme (BPS) on material hardship and subjective well-being. We apply a regression discontinuity design (RDD) to estimate the effect of the BPS on the material hardship and life satisfaction of older people between the ages of sixty-one and sixty-eight. Data come from Korea Welfare Panel Study (KOWEPS) wave 12 survey (2017, N = 3,932). The BPS benefit reduces the risks of housing hardship, bill payment delay and food insecurity. Interestingly, while the effect sizes of the BPS on mitigating the material hardship increase as income decreases, the lower-income groups were less satisfied with the pension provision than middle- and upper-income groups. This study contributes to the growing body of literature on material hardship for older adults in an Asian country facing persistent old-age poverty and immature public pensions.

Paraquat, Parkinson's Disease, and Agnotology.

Paraquat, Parkinson's Disease, and Agnotology.

Effects of cognitive stimulation program on cognition and mood in older adults, stratified by cognitive levels: A randomized controlled trial

Purpose of the researchCognitive stimulation (CS) is defined as activities that involve cognitive processing, usually conducted in a social context and often in a group. This study aims to evaluate the effects of a personalized-adapted CS program in older adults on global cognition, neuropsychological constructs, activities of daily living (ADLs), and mood. Materials and methodsThe randomized controlled single-blind trial involving 337 participants (235 women and 102 men) ≥ 65 years of age in a Primary Care centre classified participants into 4 groups: 101 for the no deterioration (ND) group; 100 for the subjective cognitive impairment (SCI) group; 108 for the level deterioration (LD) group and 28 for the moderate deterioration group. The intervention consisted of a personalized CS adapted program for 10 weeks. Follow-up assessments were conducted post-intervention, and at 6 and 12 months. The primary outcome was global cognition measured by the Spanish version of the Mini-Mental State Examination. The secondary outcomes were measured by the Barthel Index, the Lawton and Brody Scale, the Goldberg Questionnaire (anxiety sub-scale) and the abbreviated Yesavage Geriatric Depression Scale. ResultsThe intervention showed a tendency of improvement on global cognition and different cognitive functions for groups with no deterioration or level deterioration. The group with moderate deterioration improved in anxiety. ConclusionsThe findings demonstrated benefits in global cognition, different cognitive functions, semantic fluency, IADLs and anxiety. The most benefits are given in the intermediate groups, SCI, and LD. Moreover, the intervention works by increasing the benefits in the different phases.

Enhancing Physical and Community MoBility in OLDEr Adults with Health Inequities Using CommuNity Co-Design (EMBOLDEN): Results of an Environmental Scan.

Using the comparatively new environmental scan methodology, a protocol was developed and conducted to inform the co-design and implementation of a novel intervention to promote mobility among older adults in Hamilton, Ontario, Canada. The EMBOLDEN program seeks to promote physical and community mobility in adults 55 years and older who face barriers accessing community programs and who reside in areas of high inequity in Hamilton, and to address the following areas of focus: physical activity, nutrition, social participation, and system navigation supports. The environmental scan protocol was developed using existing models and drew insights from census data, a review of existing services, organizational representative interviews, windshield surveys of selected high-priority neighbourhoods, and Geographic Information System (GIS) mapping. A total of 98 programs for older adults from 50 different organizations were identified, with the majority (92) supporting mobility, physical activity, nutrition, social participation, and system navigation. The analysis of census tract data identified eight high-priority neighbourhoods characterized by large shares of older adults, high material deprivation, low income, and high proportion of immigrants. These populations can be hard to reach and face multiple barriers to participation in community-based activities. The scan also revealed the nature and types of services geared toward older adults in each neighbourhood, with each priority neighbourhood having at least one school and park. Most areas had a range of services and supports (i.e., health care, housing, stores, religious options), although there was a lack of diverse ethnic community centres and income-diverse activities specific to older adults in most neighbourhoods. Neighbourhoods also differed in the geographic distribution number of services, along with the number of recreational services specific to older adults. Barriers included financial and physical accessibility, lack of ethnically diverse community centres, and food deserts. Scan results will inform the co-design and implementation of the Enhancing physical and community MoBility in OLDEr adults with health inequities using commuNity co-design intervention-EMBOLDEN.

Ethical challenges in caring for healthy older adults: Qualitative perspectives.

Healthy aging is one of the essential aspects of a health promotion program in the elderly. Exploring ethical challenges in healthy elderly care from the perspective of nurses, older adults, and families in the Iranian context. This qualitative study was conducted using a content analysis approach in 4 health centers in northeastern Iran from 2017 to 2019. Semi-structured interviews, observation, review of elderly files, and focus groups were used to collect data. The ethics committee of the university approved this study in Iran. This study adhered to the principles of the Helsinki Declaration. Ethical principles autonomy, confidentiality, and anonymity were considered for the participants. Participants were informed about the purpose of the study and submitted written informed consent regarding their participation. The central theme was: An unfair approach to caring for healthy older adults. The three categories were as follows: Forgotten human care, disrespect, and lack of a meaningful and trustworthy relationship. The 14 subcategories highlighted the ethical challenges of healthy aging care in health centers. The findings showed that due to nurses' unfamiliarity with the concept of healthy aging, older adults are discriminated against in care centers. Creating a standard care program for healthy older adults ensures that ethical principles are followed for these clients. Various individual and organizational factors lead to an unfair approach to caring for healthy elderly in health centers. The following factors can help improve the care of healthy aging and reduce ethical challenges in this area: Introducing nurses to the concept of healthy old age and its dimensions, creating a community-based approach in health centers, prioritizing health issues over health issues, Involvement of families and older adults in needs assessment-goal setting-implementation and evaluation of health services, and design of home visit programs to provide services to healthy elderly.

The case for transitional services and programs for older adults reentering society: a narrative review of US departments of correction and recommendations

PurposeOlder adults who are or have been incarcerated constitute a growing population in the USA. The complex health needs of this group are often inadequately addressed during incarceration and equally so when transitioning back to the community. The purpose of this paper is to discuss the literature on challenges older adults (age 50 and over) face in maintaining health and accessing social services to support health after an incarceration and to outline recommendations to address the most urgent of these needs.Design/methodology/approachThis study conducted a narrative literature review to identify the complex health conditions and health services needs of incarcerated older adults in the USA and outline three primary barriers they face in accessing health care and social services during reentry.FindingsChallenges to healthy reentry of older adults include continuity of health care; housing availability; and access to health insurance, disability and other support. The authors recommend policy changes to improve uniformity of care, development of support networks and increased funding to ensure that older adults reentering communities have access to resources necessary to safeguard their health and safety.Originality/valueThis review presents a broad perspective of the current literature on barriers to healthy reentry for older adults in the USA and offers valuable system, program and policy recommendations to address those barriers.

The implementation of a community-centered first aid education program for older adults—community health workers perceived barriers

BackgroundOlder adults are a high-risk group for accidental injuries, and strengthening training in first aid for older adults can improve their first aid capabilities and minimize their post-accident mortality. Community health workers are the greatest option to equip older adults with first aid instruction and training. However, the development of first aid education for the public by community health workers fails to take into account the elderly population. In view of this, this study aims to explore the barriers and challenges of first aid training for older adults from the perspective of community health workers and to provide a basis for better first-aid training for older adults in the community.MethodsThis study adopted a qualitative research design. A total of 18 community health workers were recruited from two community health service centers in Qujing and one community health service center in Guangzhou from May to July 2022 to participate in the study. Participants were interviewed face-to-face using semi-structured in-depth interviews. The interview data were analyzed using Krippendorff's thematic clustering technique.ResultsThe results of the study identified community health workers' perceived challenges and barriers to providing first aid training to older adults in the community as older adults-level barriers, community health workers-level barriers, management systems–level barriers, and society-level barriers.ConclusionsCommunity health workers are highly aware of multiple barriers and challenges in providing first aid training to community-based elderly populations. In particular, lack of professional training, heavy workloads, and limited resources and financial support. Therefore, supportive training, policies, and government funding are crucial for community health workers to conduct first aid training for older adults.

Pragmatic Evaluation of a Low-Threshold Sports Program for Older Adults in Group Homes.

Physical activity (PA) reduces with older age, ill health, and disability. For these groups, guidance recognizes the benefit of small increases in PA and low-intensity PA. This study evaluated a low-threshold intervention that addressed known barriers to older people's participation in PA in residential care and sheltered housing. Ten, competitive sport sessions were delivered by coaches at 49 sites with the aim that they be sustained in-house. Using quasi-experimental methods, participants reported reduced sitting time, increased moderate/vigorous PA, increased participation in sports and improved scores for both health quality of life and fear of falling at 6months. The program engaged 29% of residents and was sustained at 50% of sites at 8months. The findings suggest that low-threshold sports programs that overcome known barriers to older people's participation in PA have the potential to provide a gateway to increased PA in group homes and to be sustained in-house.

Sex differences in muscle SIRT1 and SIRT3 and exercise + weight loss effects on muscle sirtuins.

The sirtuins, SIRT1 and SIRT3, are involved in the control of cellular processes to maintain metabolic homeostasis. The purpose of this study was to determine the effects of a 6-month aerobic training + weight loss program and hyperinsulinemia on SIRT1 and SIRT3 expression in skeletal muscle and to compare their expression between men and women. Thirty-five adult men (n = 18) and postmenopausal women (n = 17), (X ± SEM, age: 61 ± 1 years, BMI: 31.3 ± 0.7 kg/m2) completed 6 months 3×/week of aerobic exercise and 1×/week dietary instruction to induce weight loss (EX + WL). Participants had a VO2max test, vastus lateralis muscle biopsies at baseline and 2 h into a hyperinsulinemic-euglycemic clamp, a total body dual-energy X-ray absorptiometry scan, and abdominal computed tomography scan. Skeletal muscle SIRT1, SIRT3, and PGC1-α mRNA expression were quantified by qRT-PCR. Skeletal muscle SIRT1 and SIRT3 mRNA expression are higher in women than men (P < 0.005). Body weight, body fat, and abdominal obesity decreased and VO2max and glucose utilization (M) increased after EX + WL (P < 0.001). Basal SIRT1 decreased following EX + WL (P < 0.05). This change in basal SIRT1 was not related to changes in VO2max, M or fat mass, nor was it different by gender. Insulin stimulation increased SIRT1 expression (P < 0.001) and PGC1-α expression (P < 0.01) following EX + WL (insulin-basal post). Sex differences in the levels of these sirtuins did not affect changes with EX + WL. Skeletal muscle SIRT1 decreases after a long-term combined exercise and weight loss program in middle-aged and older adults.

Economic evaluations of interventional opportunities for the management of mental–physical multimorbidity: a systematic review

ObjectivesEconomic evaluations of interventions for people with mental–physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective.DesignA systematic review.Data sourcesMEDLINE, CINAHL Plus,...

Effects on Language and Verbal Fluency of a Cognitive Stimulation Program in Older Adults: Randomized Controlled Trial

The efficacy of cognitive stimulation programs for the elderly is sufficiently documented. However, few studies have addressed the effectiveness of language stimulation programs by cognitive levels in this population. This randomized controlled trial was conducted on 308 participants from a primary care center and followed the CONSORT guidelines. A stratified randomization was carried out. The primary variable was the MEC-35, validated Spanish version of the Mini-Mental State Examination (MMSE). The secondary outcome variable was set-test, which evaluates verbal fluency in four categories. These tests were assessed for all outcome measures at baseline, at 10 weeks, at 6 months, and 1 year after the intervention. The intervention consisted of 10 sessions of 45 min/week for 10 weeks through mental activation notebooks that comprehensively work on the different cognitive functions. The results show that the comparisons between the control and intervention group turn out to be significant (p &lt; 0.05) at the three time points. The comprehensive cognitive stimulation program has made it possible to improve the global aspects of cognition, language proficiency, and verbal fluency. To optimize and maintain these results, it is necessary to consider other clinical, functional, psychological, and occupational aspects, as well as related educational aspects, which prevent mild cognitive impairment.