Developing a Mobile App-Based Intervention to Promote Cognitive Health in Older Chinese Americans

摘要 老年华裔美国人是美国增长最快的人口之一， 社会和经济障碍。超过70%的年长华裔美国人是第一代移民，近20%的人是第一代移民。 生活在贫困线以下（美国老年人中有9%），其中近一半的人英语水平有限 熟练程度。华裔美国老年人所共有的这些社会经济劣势不仅会导致 患阿尔茨海默病和相关痴呆症（ADRD）的风险增加，但也存在不公平的机会 to effective有效strategies战略to promote促进cognitive认知health健康.认知训练是为数不多的干预措施之一 有益于维持或增强认知功能正常或轻度的老年人的认知功能， 认知障碍移动的电话的广泛使用提供了前所未有的机会， 以相对较低的成本远程向大量人口提供认知培训干预。这一点尤其重要 移民人口，因为他们通常居住在种族飞地，严重依赖智能手机和应用程序， 来建立社交网络和获得当地服务。尽管基于移动的应用程序的认知训练有希望， 大多数先前的干预措施仅在非西班牙裔白人中进行了测试。目前，没有定制的认知训练 该计划可以适应独特的移民历史，文化价值观和语言特性 年长的华裔美国人为了解决这一差距，我们的目标是开发一种用于认知训练的mHealth干预措施 与年长的华裔美国人在文化和语言上相关。我们将利用我们强大的合作伙伴关系 与当地的华人社区组织，行业合作伙伴和认知老化的跨学科专业知识， 民族老年学、实施科学和基于经验的协同设计。更具体地说，拟议目标 目标1：将经验支持的认知培训内容纳入文化和语言上的 相关认知训练干预方案。目的2：进行一项初步随机对照试验， 提出认知训练干预的可行性、可接受性评价，并取得初步效果 结果的大小，包括全球认知（初级），心理健康，身体功能和生活质量。 本研究将为多中心大规模随机对照试验提供科学基础，以测试 这种认知训练干预的真实效果。此外，该项目将进一步加深我们对 支持少数民族社区参与临床研究的方法。综合起来看， 这些努力有望最终促进实施有效、可持续和可扩展的 移动健康干预措施，以促进认知老化，特别适合少数民族老年人。

ABSTRACT Older Chinese Americans are one of the fastest growing populations in the United States, who face many social and economic barriers. Over 70% of older Chinese Americans are first generation immigrants, nearly 20% are living below the poverty line (9% in general US older adults), and close to half of them have limited English proficiency. These socioeconomic disadvantages shared by older Chinese Americans will not only contribute to an increased risk of developing Alzheimer's disease and related dementias (ADRD), but also inequitable access to effective strategies to promote cognitive health. Cognitive training is one of the few interventions shown to be beneficial to the maintenance or enhancement of cognitive function in older adults with normal cognition or mild cognitive impairment. The widespread use of mobile phones offers an unprecedented opportunity to deliver cognitive training interventions remotely to a large population at relatively low cost. This is particularly relevant to the immigrant populations as they often reside in ethnic enclaves and rely heavily on smartphones and apps to build social networks and to access local services. Despite the promise of mobile app-based cognitive training, most prior interventions were tested exclusively in non-Hispanic Whites. Currently, no tailored cognitive training program exists that can accommodate the unique immigration history, cultural values, and linguistic properties of older Chinese Americans. To address this gap, we aim to develop a mHealth intervention for cognitive training that is culturally and linguistically relevant to older Chinese Americans. We will leverage our strong partnership with a local Chinese community organization, industry partner, and interdisciplinary expertise in cognitive aging, ethnogeriatrics, implementation science, and experience-based codesign. More specifically, the proposed aims are: Aim 1: To adapt empirically supported cognitive training components into a culturally and linguistically relevant cognitive training intervention protocol. Aim 2: To conduct a pilot randomized controlled trial of the proposed cognitive training intervention to evaluate the feasibility, acceptability, and obtain preliminary effect sizes on outcomes including global cognition (primary), mental health, physical functioning, and quality of life. This study will provide the scientific groundwork for a multi-site large scale randomized control trial to test the real-world efficacy of this cognitive training intervention. In addition, this project will further our knowledge of methods to support engagement of ethnic minority communities in clinical research studies. Taken together, these efforts are expected to ultimately facilitate the implementation of effective, sustainable, and scalable mHealth interventions to promoting cognitive aging specifically suited for ethnic minority older adults.