Implementation of Cognitive (Neuropsychological) Interventions for Older Adults in Clinical or Community Settings: A Scoping Review.

Abstract

Despite compelling evidence that cognitive interventions for older adults improve cognition, mood, and everyday function, few are implemented in clinical or community practice. This scoping review aims to understand the implementation frameworks and methods used and their contribution to implementation success of cognitive interventions for older adults. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR), and searched CINAHL, EMBASE, MEDLINE, and PSYCINFO databases, using terms related to cognitive interventions, implementation, and older adults. This resulted in 5002 studies, of which 29 were included following an iterative process. Most studies reported on implementation of cognitive stimulation for people with dementia. Only four studies used formal implementation frameworks, with three using RE-AIM, and one a process evaluation using complexity theory. The most frequently addressed implementation concepts were Acceptability, Feasibility, and Effectiveness, while Cost, Cost-Effectiveness, and Maintenance were rarely reported. Solutions to common barriers included the importance of good stakeholder relationships and engagement, a manualised intervention flexible enough to adapt to the context, and ensuring facilitators were well-trained, confident, and enthusiastic.