Authors: (including presenting author): :
Law CCC (1), Leung SC (1)
Affiliation: :
(1) Occupational Therapy Department (OTD), Kowloon Hospital (KH)
Keyword 1: :
treatment adherence
Keyword 2: :
computerized cognitive training program
Keyword 3: :
memory concerns
Keyword 5: :
occupational therapy
Introduction: :
Regular cognitive training is recognized as an effective strategy for maintaining and improving cognitive functions in older adults, especially those with memory complaints (Silva et al., 2022). Various cognitive training programs are implemented in KH OT psychogeriatric (PGT) outpatient department. However, individuals often struggle to maintain continuous engagement in home training programs, undermining potential benefits. To overcome limitations of traditional face-to-face interventions, online home-based cognitive training has emerged as an alternative for the elderly population. Computerized cognitive training program (CCTP) delivered at home allows greater flexibility and accessibility, and studies have demonstrated its efficacy particularly for memory improvement in this population (Chan et al., 2024). Nonetheless, adherence to CCTP remains a significant issue, with many participants discontinuing participation prematurely (Klaming et al., 2022). Understanding factors that predict adherence is critical to optimizing outcomes and developing targeted strategies to support sustained engagement.
Objectives: :
This paper aims to investigate predicting factors of the adherence in CCTP for elderly with memory concerns.
Methodology: :
Among various tools that are available in KH OT PGT outpatient department, NeuroGym was chosen for this study as it provides back-office data that allows for an objective understanding and monitoring of participation rather than relying on self-reports. NeuroGym focuses on 6 cognitive domains, namely attention, working memory, memory, visual perception, executive function, and language. After conducting functional and cognitive assessments, therapists would prescribe NeuroGym to clients who showed memory concerns. Guidance of access to the program and instructions of cognitive training activities were provided to clients and caregivers. Therapists would assign cognitive training modules that align with participant’s cognitive performance, training needs, and interests. Regarding the predictors of adherence, age, gender, educational level, living status, physical activity level, leisure activity level, and outcome expectation were collected before the start of program. Presence of caregivers was not included in the analysis as all the participants have assistance from carers. The adherence to CCTP was measured by number of weeks of sustained participation in CCTP according to records extracted from the back-office of NeuroGym. The adherence to CCTP was measured by number of weeks of sustained participation in CCTP according to records extracted from the back-office of NeuroGym.
Result & Outcome: :
From February 2024 to May 2025, 32 clients with a mean age of 82.4 were recruited. Multiple linear regression modelled adherence as a function of age, gender, education, living status, physical activity level, leisure activity level, and outcome expectation. Female gender (β = −0.42, p = 0.025), higher education (β = 0.38, p = 0.038), lower leisure activity level (β = −0.39, p = 0.042), and greater positive outcome expectation (β = 0.38, p = 0.028) were found to be significant predictors for a larger number of weeks of participation in CCTP, indicating better adherence to CCTP. Greater adherence in females is possibly due to the higher awareness about dementia risk and the caregiving role, leading to motivation for consistent engagement (Meulen, 2023). For influence of educational level, research has shown that technology literacy is correlated with educational attainment (Holm, 2024). It is also evidenced that stronger beliefs of benefits provided by treatment programs facilitates the persistence of engagement (Stetler, 2013). However, for elderly population who is already engaged in social activities and stimulating daytime engagement might deprioritize home-based CCTP (Sugimoto et al., 2025). This study revealed that adherence to CCTP improves when participants are female, more educated, and hold optimistic expectations to the program, whereas extensive leisure commitments may impede engagement. For the implication to future practice, CCTP might be prescribed to clients who are more educated and have less leisure engagement. More support and motivating factors that enhances the outcome expectation to CCTP would be beneficial to those who are already engaged in various leisure activities. Use of implementation goals might boost adherence by enhancing positive expectations (Sugimoto et al., 2025). In the future study, it would be beneficial to explore strategies, including providing more support and use of implementation goals, to enhance the adherence to CCTP.
