| BackgroundThe worsening effects of aging in China have made dementia an increasingly severe public health issue for older adults.Timely recognition and intervention for mild cognitive impairment(MCI)in older patients can significantly improve their cognitive function and prevent or delay the onset and progression of dementia.This crucial period provides a window of opportunity for the prevention and treatment of dementia.Meeting the core health needs of older patients with MCI is essential for early intervention.However,multiple factors can influence the decision-making process when choosing an intervention.Therefore,it is imperative to investigate the pressing health issues and decision-making dilemmas faced by older patients with MCI,analyze their health needs,and provide decision support.In light of this,patient-oriented guidelines and decision aids for non-pharmacological interventions in older adults are necessary.These aids can offer adequate information support to guide patients to recognize the disease early and take timely interventions.ObjectivesTo explore the health needs and decision-making issues of older adults with MCI in China,and based on this to construct a patient version of guidelines and patient decision aids on non-pharmacological interventions for older adults with MCI.MethodsThe study was conducted in three stages.In the first stage,the health needs and decision-making issues of older adults with MCI were analyzed.Firstly,we conducted a systematic analysis of 11 qualitative studies investigating disease perceptions and health needs of older adults with MCI and their caregivers.Secondly,phenomenological research methods were used to explore the opinions and decision-making needs of 17 stakeholders regarding decision-making participation in older adults with MCI.In the second stage,we developed the patient version of guidelines on non-pharmacological interventions for older adults with MCI.Following the GIN patient guidelines formulation principles and reporting methodology,we conducted a systematic literature review of published guidelines,expert consensus,systematic reviews and meta-analyses on MCI assessment,risk factors,and non-pharmacological interventions worldwide.Evidence was screened,evaluated,integrated and refined to form recommendations and guidelines.An external review by 13 experts was conducted to assess the availability of recommendations,quality of guidelines,detailed reporting,and completeness to ensure the rigor and feasibility of patient guidelines.In the third stage,we developed the patient decision aids and systems on non-pharmacological interventions for older adults with MCI.According to the Ottawa Decision Support Framework,we used literature research methods and the interactive information system development framework to identify problem lists and develop the decision aids and systems based on the best available evidence.Thirty-four medical professionals and patients were invited to assess the acceptability of the decision aids and systems.Finally,13 external experts evaluated the quality,rigor,and usability of the decision aids.Results(1)The health problems and decision-making issues of older adults with MCI patients were highlighted,which were reduced to three themes:vague disease perception,lack of countermeasures,and weak support systems.Based on the Ottawa decision support framework,four modules were summarized:decision attitude,decision pattern,decision demand,and decision support.(2)Based on 2 high-quality guidelines,3 expert consensuses and 104 systematic reviews and/or meta-analyses,a total of 34 recommendations were formed.The recommendations were summarized into eight topics:disease knowledge,assessment,risk factors,non-pharmacological intervention(cognitive intervention,physical exercise,dietary intervention,emotional intervention),monitoring,prevention,outcome and prognosis,and health education,and divided into 3 chapters and 13 subsections:disease knowledge,assessment and monitoring of MCI,and prevention and intervention of MCI in the patient version of guideline.The concrete report was presented in three parts:introduction,content,and formation of the guideline.The overall usability agreement rate of recommendation was higher than 84.6%.The agreement rate of the guidelines in the four dimensions of reasonable structure,accurate content,good readability and reporting norms was greater than 92.3%.The percentage of criteria in the six fields of the guideline quality evaluation,namely scope and purpose,participants,rigor,clarity,application,and independence were all greater than 60%.(3)The patient decision aid and system on non-pharmacological MCI interventions for older adults with MCI were divided into six modules:decision evaluation,information support,pros and cons analysis,support system,decision confirmation and decision planning.The agreement rate of the nine acceptability measures,namely clarifying issues,information support,analyzing pros and cons,clarifying value,perceived usefulness,and perceived usability,were all over 80%.The agreement rate for the four dimensions of usability assessment,namely structural setting,importance,readability and feasibility,were greater than 76.6%.The results of the three dimensions of quality evaluation were respectively qualification standard(6/6,100%),certification standard(6/6,100%)and quality standard(17/23,73.9%).ConclusionOlder adults with MCI face significant health challenges and require substantial healthcare and decision-making support.The patient version of guidelines on non-pharmacological interventions for older adults with MCI was developed with scientific rigor,resulting in evidence-based,comprehensive,and systematic guidance that is easy to use and holds promise for clinical applications.The guideline provides crucial information and support for older adults with MCI,potentially enhancing their understanding and awareness of the condition.The patient decision aid and system are well-structured,high-quality and user-friendly.Both medical professionals and patients found them highly acceptable and satisfactory.Moreover,these tools help patients articulate decision-making issues,express their values,and understand the pros and cons of various intervention strategies.By addressing the decision-making needs of patients,decision aids and systems empower them to make informed choices about their care. |
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