How might secondary dementia prevention programs work in practice: a pre-implementation study of the APPLE-Tree program

Rachel M Morse; Iain Lang; Penny Rapaport; Michaela Poppe; Sarah Morgan-Trimmer; Claudia Cooper

doi:10.1186/s12877-024-04762-3

How might secondary dementia prevention programs work in practice: a pre-implementation study of the APPLE-Tree program

BMC Geriatr. 2024 Feb 26;24(1):188. doi: 10.1186/s12877-024-04762-3.

Authors

Rachel M Morse¹, Iain Lang^{2

3}, Penny Rapaport⁴, Michaela Poppe⁵, Sarah Morgan-Trimmer², Claudia Cooper⁵

Affiliations

¹ Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK. rachel.morse.20@ucl.ac.uk.
² Department of Health and Community Sciences, University of Exeter Medical School , Exeter, UK.
³ UK National Institute for Health and Care Research (NIHR) Applied Research Collaboration South West Peninsula (NIHR PenARC), Exeter , UK.
⁴ Division of Psychiatry, University College London, London, UK.
⁵ Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.

Abstract

Background: Over 850,000 people in the UK currently have dementia, and that number is expected to grow rapidly. One approach that may help slow or prevent this growth is personalized dementia prevention. For most people, this will involve targeted lifestyle changes. These approaches have shown promise in trials, but as of yet, the evidence for how to scale them to a population level is lacking. In this pre-implementation study, we aimed to explore stakeholder perspectives on developing system-readiness for dementia prevention programs. We focused on the APPLE-Tree program, one of several low-intensity, lifestyle-based dementia prevention interventions currently in clinical trials.

Methods: We conducted semi-structured interviews with health and social care professionals without previous experience with the APPLE-Tree program, who had direct care or managerial experience in services for older adults with memory concerns, without a dementia diagnosis. We used the Consolidated Framework for Implementation Research to guide interviews and thematic analysis.

Results: We interviewed 26 stakeholders: commissioners and service managers (n = 15) and frontline workers (n = 11) from eight NHS and 11 third sector organizations throughout England. We identified three main themes: (1) favorable beliefs in the effectiveness of dementia prevention programs in enhancing cognition and wellbeing and their potential to fill a service gap for people with memory concerns, (2) challenges related to funding and capacity to deliver such programs at organizations without staff capacity or higher prioritization of dementia services, and (3) modifications to delivery and guidance required for compatibility with organizations and patients.

Conclusion: This study highlights likely challenges in scale-up if we are to make personalized dementia prevention widely available. This will only be possible with increased funding of dementia prevention activities; integrated care systems, with their focus on prevention, may enable this. Scale-up of dementia prevention programs will also require clear outlines of their core and adaptable components to fit funding, patient, and facilitator needs.

Keywords: Dementia; Implementation science; Mild cognitive impairment; Prevention; Subjective cognitive decline.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Dementia* / prevention & control
England
Humans
Social Support

Abstract

Publication types

MeSH terms

Grants and funding