Health Education for Diverse Older Adults: Cognitive and Psychosocial Effects of Remote vs. In-Person Delivery Methods Open Access

Abstract

Significance: Educational seminars related to healthy-aging research may improve health literacy, cognition and psychosocial health in older adults. There is a need to better understand differences between remote and in-person delivery methods. The DREAMS program included and compared in-person and remote learning groups.

Objective: To evaluate the DREAMS program, a health and wellness series, by evaluating feasibility, satisfaction, adherence, and comparing attrition of a remote versus in-person program.

Participants: 130 diverse, older adults (M age: 70.89 ± 9.27 years; In-person n=95; Remote, n=35) enrolled. Data from 115 completers (In-person n=80; Remote n=35) were analyzed for performance outcomes.

Measures: Benchmarks for feasibility, adherence, and satisfaction were evaluated. Participants were tested at baseline, immediately post-intervention, and 8 weeks post-intervention. Adjusting for baseline performance, outcomes on cognitive, motor cognitive, health literacy, and psychosocial measures were compared between in-person and remote groups after intervention (at post-test and at eight-week follow-up) using adjusted mean differences (β coefficients).

Results: Fifteen individuals from the in-person program withdrew before completing six modules. All remote participants completed at least six of eight modules. Both programs had high satisfaction and feasibility. Post participation, compared to in-person participants, remote participants had significantly better global cognition (MoCA (p=0.015)), task switching (TMT B (p=<.001), TMT B-A (p=0.003)), less inhibition/switching errors (CWIT Inhibition/Switching scaled error score (p=0.045)), visuospatial cognition consistency and function (Reverse Corsi Blocks correct trials (p=0.012) and product score (p=0.033)), mental tracking capacity (Serial 3 Subtractions (p=<.001)), and better whole body spatial cognition (BPST completed trials (p=<.001), span (p=<.001), product score (p=<.001)). Compared to the remote group, the in-person group was significantly better with planning/organization (ToL mean first move time scaled (p=0.023)), visuospatial processing (TMT A (p<.001)), processing speed of word reading (CWIT Word Reading (p=0.042)) and inhibition/switching (CWIT Inhibition/Switching (p=0.044)), faster motor cognition (TUG-COG (p=0.026)), lower depression (BDI-II (p=0.002); GDS (p =0.02)) and higher mental quality-of-life (SF-12 MCS (p=0.008)).

Conclusion: This work links knowledge acquisition from in-person group learning and remote solo coaching methods to health wellness and performance. Future studies will remove barriers found in the study to reduce health disparities in diverse, older adults.

Table of Contents

INTRODUCTION .............................................................................................................1-5

METHODS ......................................................................................................................6-16

RESULTS ........................................................................................................................17-20

DISCUSSION ..................................................................................................................21-29

TABLES .........................................................................................................................30-37

    TABLE 1: DEMOGRAPHIC CHARACTERISTICS ..............................................................30-31

    TABLE 2: DREAMS PROGRAM TOPICS ..........................................................................32

    TABLE 3: SATISFACTION ..............................................................................................33

    TABLE 4: COGNITIVE & MOTOR COGNITIVE OUTCOME MEASURES .............................34-36

    TABLE 5: PSYCHOSOCIAL OUTCOME MEASURES .........................................................37

REFERENCES ................................................................................................................38-49

APPENDICES ................................................................................................................50-82

    APPENDIX A .............................................................................................................50-80

    APPENDIX B .............................................................................................................81

    APPENDIX C .............................................................................................................82

About this Honors Thesis

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School	Emory College
Department	Neuroscience and Behavioral Biology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Biology, Neuroscience Education, Health
Keyword	Health Education Psychosocial Wellness Telehealth Cognition Older Adults
Committee Chair / Thesis Advisor	Hackney, Madeleine, Emory University
Committee Members	Mascaro, Jennifer, Emory University Lennard, Paul, Emory University

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