The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce

我们计划制定并测试一项预防计划，以降低老年人患痴呆症的几率。一半的老年人（60岁以上）在“认知”（记忆、定向和其他思维）方面有问题，他们更有可能患上痴呆症，所以我们将设计一种适合他们的方法。我们将与使用、运营和付费的人一起设计我们的项目，并将特别考虑如何为更贫困的人和少数民族的人工作，他们更容易患痴呆症。我们的项目将帮助老年人做出改变，预防痴呆症。这些都是:1。社交和思维更活跃。吃得更健康。多做运动。照顾他们的身心健康。6.戒烟。减少酒精。我们将从那些有效的治疗方法中学习，但这些治疗方法过于耗时和昂贵，无法在研究之外进行。我们将发现的问题1：有记忆问题的人，包括那些来自少数民族或更贫困背景的人，现在做些什么来避免痴呆症？流2：患痴呆症几率较高的人是否从全科医生那里得到了正确的帮助（比如血压检查）来预防痴呆症？是什么让这种情况更有可能发生？流3：我们的面对面的个性化课程应该是什么样的？哪种“应用程序”设计最能帮助预防痴呆症？有记忆问题的人，包括弱势群体的人，会使用它吗？流4：如果我们的项目有效，那些将使用、运行和付费的人认为应该如何设计和使用它？流5：参加我们项目的人在两年内比只收到信息传单的人有更少的认知问题吗？如果有，它是如何工作的，它是否物有所值？我们将回顾过去的研究，并采访大约80名老年人、他们的家人和专业人士，以了解NHS和社会如何帮助老年人过上更健康的生活，预防痴呆症。我们将看看人们是如何看待记忆问题和预防痴呆症的。我们将使用一个包含1400万份英国初级保健记录的数据库，看看哪些人正在接受可以预防痴呆症的医疗保健。我们将与Age-UK、阿尔茨海默氏症协会、护理组织、地方当局和英国公共卫生部合作。我们将随机分配704名没有痴呆的有记忆问题的人，所以他们有同等的机会接受新项目或信息传单。我们计划在6个月内进行10次小组会议。我们将为不能参加团体的人提供单独的课程。两名辅导员将领导小组。他们将由一位经验丰富的心理学家进行培训和监督，以遵守手册，以便每次都以相同的方式进行该计划。小组将在一系列对所有人开放的地方举行。我们将要求参与者在项目开始前以及6个月和24个月后完成问卷调查，包括记忆测试和自愿献血。我们将采访大约50名参与者（包括那些退出的人）或组织小组的人，以了解哪些进展顺利，哪些可以做得更好。随着越来越多的护理和治疗转移到网上，我们可能会把弱势群体抛在后面。我们将要求工程师设计一个易于使用的应用程序，以支持人们改变生活方式，预防痴呆症。我们将支持他们建立它，然后在研究参与者中试用它，包括来自弱势群体的人（如果他们没有自己的电脑并且愿意，我们可以借给他们电脑）。我们可以看看这如何帮助在未来工作中最需要的人获得新项目。我们的项目可以通过减少患痴呆症的人数，对个人、NHS和社会产生巨大影响。

We plan to make and test a prevention programme to lower older people's chances of getting dementia. The half of older people (aged 60+) who have problems with "cognition" (memory, orientation and other thinking) have more chance of getting dementia, so we will design an approach that works for them. We will design our programme with people who will use, run and pay for it, and will think especially about how it will work for people from more deprived and minority ethnic groups, who are more likely to get dementia. Our programme will help older people make changes that can prevent dementia. These are:1. Being more socially and mentally active 2. Eating more healthily 3. Being more physically active4. Looking after their mental and physical health 5. Stopping smoking 6. Reducing alcohol. We will learn from therapies that have worked, but are too time consuming and expensive to run outside of research studies. What we will find outStream 1: What do people with memory problems, including those from minority ethnic or more deprived backgrounds, do now to try to avoid dementia? Stream 2: Do people with a higher chance of getting dementia get the right help from their GPs (such as blood pressure checks) to prevent it? What makes this more and less likely? Stream 3: What should our face to face, personalised programme be like? Which "app" design will work best in helping prevent dementia? Do people with memory problems, including people from vulnerable groups, use it?Stream 4: How do people who will use, run and pay for our programme if it works, think it should be designed and used?Stream 5: Do people who take part in our programme have less cognitive problems over two years than people who only receive an information leaflet? If so, how did it work, and is it good value for money? How we will do itWe will review past research and interview around 80 older people, their families and professionals, to find out how the NHS and society help older people live healthier lives to prevent dementia. We will look at how people think about memory problems and preventing dementia. We will use a database with 14 million UK primary care records, to see who is getting health care that can prevent dementia. We will work with Age-UK, the Alzheimer's society, Care organisations, local authorities and Public Health England.We will randomly allocate 704 people with memory problems without dementia, so they have an equal chance of receiving the new programme or an information leaflet. We plan that the programme will be 10 group sessions over 6 months. We will offer individual sessions for people who cannot come to groups. Two facilitators will lead the groups. They will be trained and supervised by an experienced psychologist to keep to a manual so the programme is delivered in the same way each time. Groups will take place in a range of places to be accessible to all. We will ask people taking part to complete questionnaires, including a memory test and give a voluntary blood sample, before the programme starts and 6 and 24 months later. We will interview around 50 people taking part (including those who drop out) or running the groups to hear what went well and what could be better. As more care and therapies move online, we risk leaving vulnerable people behind. We will ask engineers to design an easy to use app to support people to make the lifestyle changes that prevent dementia. We will support them to build it, then try it out with study participants, including people from vulnerable groups (we can lend them computers if they don't have their own and are willing). We can look at how this helps to get the new programme to people who need it most in future work.Our programme could make a huge difference to individuals, the NHS and society, by reducing the number of people who get dementia.