Development and Usability Evaluation of a Mobile Health Intervention to Support Healthful Dietary Choices in Older Persons with Dementia

摘要 虚弱和阿尔茨海默病（AD）以及AD相关痴呆（[ADRD]以下称为痴呆）是进行性的 这些疾病影响同一年龄组，并具有许多共同的风险因素和临床特征。在 事实上，虚弱和痴呆是相互关联的，因此痴呆可能会导致虚弱的表现， 虚弱可能影响AD患者痴呆的临床表现。鉴于没有 治疗可以预防和减缓痴呆症的进展，虚弱可能是干预的实际目标 旨在降低痴呆症患者认知能力下降的严重程度。生活方式干预，如 健康饮食可以降低身体虚弱和大脑退化风险。虽然一些脆弱和大脑友好的饮食 地中海饮食（MedD）是特别相关的，因为它具有心脏保护，抗 炎症和促代谢特性，所有这些都与虚弱和AD的病理生理学有关。 也有证据表明MedD对AD患者的认知益处。既往行为饮食 然而，由于干预措施的费用高昂， 干预交付。移动保健干预措施，价格低廉，技术先进 先进的，提出了一个有吸引力的替代方案，提供可扩展的饮食干预，在这一人群。我们 我建议扩展我们以前的工作，在这项工作中，我们开发了一种移动健康干预措施，以提高对 MedD在有虚弱但无认知缺陷的老年人中， 有虚弱和认知障碍的成年人。具体而言，我们建议使用以人为本的原则， 设计，以定制我们以前开发的应用程序，也适应老年人与轻度至中度 老年痴呆症及其护理伙伴我们设想将应用程序作为一个共享工具使用， 痴呆症患者可能会与他们的护理伙伴合作使用它的某些方面。拟议的研究活动将 包括与痴呆症、营养和行为健康专家的访谈，以及与个人的焦点小组的访谈 轻度到中度痴呆症患者和他们的护理伙伴。我们还会涉及人机交互 具有无障碍设计经验的专家。我们将采用迭代设计原则， 移动的应用程序。这是一个很好的机会来扩展我们目前的工作， 有早期认知丧失的人及其护理伙伴，以确保该应用程序可以通过此 人口在最初的申请中，我们建议排除有认知缺陷的人，但通过涉及 在应用程序开发过程中，我们将确保具有不同认知能力水平的人， 最终的设计将支持最广泛的人口使用。因此，该应用程序可能会在未来使用 在二次痴呆风险降低研究中。

ABSTRACT Frailty and Alzheimer's Disease (AD), and AD-related dementias ([ADRD]hereafter dementia) are progressive conditions that disproportionally affect the same age group and share many risk factors and clinical features. In fact, frailty and dementia are interrelated such that dementia might precipitate manifestation of frailty, and frailty might influence the clinical manifestation of dementia in person with AD brain pathology. Given that no treatments prevent and slow the progression of dementia, frailty might be a practical target for interventions aimed at reducing the severity of the cognitive decline in persons with dementia. Lifestyle interventions such as healthy eating reduce risks of frailty and brain degeneration. While several frailty and brain-friendly dietary interventions exist, the Mediterranean diet (MedD), is especially pertinent because of cardioprotective, anti- inflammatory and pro-metabolic properties, all of which are linked to the pathophysiology of frailty and AD. Evidence also emerge on cognitive benefits of MedD in persons with AD. Previous behavioral dietary interventions, however, were limited for implementation at the population level because of the high cost of intervention delivery. Mobile-based health (mHealth) interventions, being inexpensive and technologically advanced, present an attractive alternative for delivering scalable dietary interventions in this population. We propose to extend our previous work, in which we developed a mHealth intervention to improve adherence to MedD in older adults with frailty but without cognitive deficits, to a growing multimorbid population of older adults with frailty as well as cognitive impairment. Specifically, we propose to use principles of human-centered design to tailor our previously developed app to also accommodate older adults with mild-to-moderate dementia and their care partners. We envision the use of the app as a shared tool, where the user with dementia may work with their care partners for some aspects of its use. The proposed study activities will include interviews with experts in dementia, nutrition, and behavioral health and focus groups with individuals with mild-to-moderate dementia and their care partners. We will also involve human-computer interaction experts with experience in accessible design. We will employ iterative design principles to refine and enhance the mobile app during usability studies. This is a perfect opportunity to extend our current work and engage people with an early cognitive loss and their care partners to ensure that the app is accessible by this population. In the original application, we suggested to exclude people with cognitive deficits, but by involving people with different levels of cognitive abilities in the app development process, we will ensure that the ultimate design will support access by the broadest demographic. As such, the app may be used in the future in secondary dementia risk reduction studies.