| Objectives1.To develop a Second Language Learning(SLL)cognitive intervention program based on bilingual cognitive effect for older adults with mild cognitive impairment(MCI)in residential care homes(RCHs)and evaluate its feasibility.2.To explore the effects of the SLL cognitive intervention program on the cognitive function of older adults with MCI in RCHs.MethodsPart Ⅰ:Development of an SLL cognitive intervention program based on bilingual cognitive effect for older adults with MCI in RCHsA theoretical framework for the development of the SLL cognitive intervention program was developed by retrieving relevant guidelines and studies on SLL cognitive interventions and bilingual cognitive effect from multiple Chinese and English databases.A qualitative interview with the older adults and staff in the residential care home was conducted to determine the acceptance of English learning in the target group,their preferences for learning content and methods,and strategies to improve compliance.Based on the laws of language learning and the physiological and psychological characteristics of older adults,the first draft of the SLL cognitive intervention program was developed.The Delphi method was utilized to adjust the first draft of the intervention program,and pre-experimentation was conducted to identify potential issues with program implementation.Feedback from the pre-experiment subjects was gathered to improve the SLL cognitive intervention program and ensure its feasibility,leading to the final draft of the program.Part Ⅱ:Implementation and effects of the SLL cognitive intervention programIn this study,older adults with MCI in a large residential care home in Suzhou were screened according to the inclusion criteria.A total of 76 participants were randomly selected with a 1:1 ratio using computer random number method,and divided into two groups.The intervention group(38 participants)received the SLL cognitive intervention program developed in Part I,along with routine care services of the RCH(including health education,medication guidance,blood pressure measurement and so on),for continuous intervention over a period of 16 weeks.The course frequency was set at 45 minutes per session,once a week,with 10-15 minutes of homework per day,for 7 days per week.Due to high-temperature weather conditions,3 weeks of the course were conducted online.The control group(38 participants)only received routine care services in the RCH.After the intervention,SLL cognitive intervention was implemented for individual participants in the control group upon their wishes,as ethical compensation following the intervention program,but no data statistics were performed.The outcome indicators,including the Montreal Cognitive Assessment Scale(MoCA),Huashan version of the Auditory Verbal Learning Test(AVLT),Stroop Color Word Test(SCWT),Activity of Daily Living scale(ADLs),and Geriatric Depression Scale-15(GDS-15),were used to measure the participants’ cognitive function,daily living activities,and depression levels before and after 16 weeks of intervention.Data entry and analysis were performed using SPSS22.0 software to evaluate the application effect of the intervention program.ResultsPart Ⅰ:This study identified three theoretical foundations and one consensus as the basis for constructing intervention program through literature review,and collected and extracted the opinions and suggestions of the staff in the residential care home on the construction of SLL cognitive intervention program through a semi-structured interview.A preliminary draft of the intervention program was formed.And then,a scientific and feasible SLL cognitive intervention program was developed through two rounds of Delphi expert consultation on the first draft of the program.Expert activity was high(100%in both rounds)and the experts had a high degree of authority in the research field(Cr=0.804).The degree of expert opinion coordination,as indicated by the Cv value,decreased from 0.118 in the first round to 0.073 in the second round,and Kendall’s W increased from 0.361 in the first round to 0.601 in the second round,indicating that experts’ opinions on each item of the program tended to be unified.The SLL cognitive intervention program was divided into two parts.Part 1 included the intervention content for 8 cognitive domains,consisting of 14 items.Part 2 designed the specific intervention program for 5 learning modules,including 12 items.Small classes of 10-15 students were set up for the SLL course to facilitate classroom management and care for the older adults’ learning progress.38 participants of intervention group were divided into three classes,with each class consisting of 14,14,and 10 students respectively.The intervention frequency was once per week for 16 weeks,and the weekly intervention duration included a 45-minute course,a 10-15 minute recess,and 10-15 minutes of homework per day for 7 days.The course included five modules:the letter module(8 weeks),the digital module(2 weeks),the color module(2 weeks),the orientation module(2 weeks),and the family member module(2 weeks).The Total Physical Response didactics(TPR)teaching method was adopted,and the teaching content involved cognitive training in 8 cognitive domains:Visuospacial/Executive Functions,Naming,Memory,Attention,Language,Abstraction,Delayed Recall,and Orientation.Part Ⅱ:During the 16-week SLL cognitive intervention,6 participants were lost in the intervention group,leaving 32 remaining,while the control group lost 4 participants,leaving 34 remaining.No statistically significant difference was observed in the general data between the two groups in terms of age,gender,marital status,level of education,pre-retirement occupation,personal monthly income,immigration status,number of chronic diseases,and family history of cognitive impairment(P>0.05).At the same time,no significant difference was found between the two groups in the baseline comparison of various outcome indicators(including MoCA,AVLT,SCWT,ADLs,IADLs,GDS-15)before the start of the intervention.After the 16-week intervention,significant improvements were observed in the intervention group’s MoCA,AVLT-long delay recall and AVLT-recognition scores,as well as a significant decrease in SCWT reaction time and number of errors,IADL,and GDS-15 scores compared to before the intervention(P<0.05).The intervention group also showed significant differences compared to the control group(P<0.05).In contrast,the control group showed significant further impairments in overall cognitive function,episodic memory function,inhibitory control function,and depressive symptoms(P<0.05).After the intervention,a semi-structured qualitative interview was conducted with the participants in the intervention group.Three main themes were identified:subjective learning feeling,cognitive function improvement,and program design evaluation,along with nine sub-themes.The interview results showed that the SLL cognitive intervention program was interesting,interactive,and humanistic,and that the interviewees felt that their cognitive functions had improved,such as memory,thinking ability,and overall cognitive function.Finally,the the interviewees affirmed the effectiveness of the teaching methodology,online course,and homework assignments in the program design.Conclusion1.This study developed a scientifically innovative,feasible,and engaging SLL cognitive intervention program based on the bilingual cognitive effect.The program was specifically designed for older adults with MCI in RCHs.2.The results of this study confirmed the effectiveness of the SLL cognitive intervention program in improving overall cognitive function,episodic memory function,inhibitory control function,instrumental activity of daily living,and geriatric depression symptoms in older adults with MCI in RCHs.This program provides a practical and effective approach for managing cognitive impairment in RCHs,and may provide insights for future research on cognitive health in older adults. |
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