Development of a novel mind-body activity and pain management program for older adults with cognitive decline.

BACKGROUND AND OBJECTIVES Chronic pain (CP) and cognitive decline (CD) often cooccur in older adults, which can reinforce a "disability spiral". Early interventions teaching pain coping skills and gradual increases in activity (walking) are needed to promote overall wellbeing and potentially delay further decline of cognition and daily functioning. The goal of this mixed-methods study was to guide the development of two mind-body activity programs for CP and CD which focus on increasing walking using time goals (Active Brains) or step-count reinforced by a Fitbit (Active Brains-Fitbit). RESEARCH DESIGN AND METHODS Older adults with CP and CD (N = 23) participated in a one-time focus group (four total) and completed measures of physical, emotional, and cognitive functioning. Qualitative analyses identified population-specific needs, preferences, and perceptions of proposed program skills. Quantitative analysis compared clinical characteristics to population norms and explore intercorrelations among treatment targets. RESULTS Thematic analyses revealed six main themes: (1) challenges living with CP and (2) CD, (3) current walking, (4) technology (Fitbit) to increase walking, (5) perceptions of proposed program skills (e.g., mind-body, pain, increased walking), and (6) program barriers and facilitators. Quantitative analyses showed that: (1) participants had physical function below reference values, and (2) higher self-efficacy correlated with higher cognitive, emotional, and physical functioning. DISCUSSION AND IMPLICATIONS Focus group participants were enthusiastic about the proposed program skills. Current work includes open pilot testing, qualitative interviews, and a small randomized controlled trial to optimize the programs and methodology in preparation for efficacy testing against an educational control.