Healthy Aging Project-Brain: A Psychoeducational and Motivational Group for Older Veterans
Introduction: Positive health behaviors can promote brain health with age. Although healthy lifestyle factors are often encouraged by health care providers, many older adults experience difficulty incorporating these into their daily life.
Methods: To address this gap, we developed a novel health education and implementation group for older veterans (aged > 50 years). The primary objectives of this group were to provide psychoeducation about the link between behaviors and brain health, increase personal awareness of specific health behaviors, and promote behavior change through individualized goal setting, monitoring, and support. Based on input from medical providers, group content targeted behaviors known to support cognitive functioning: physical activity, sleep, cognitive stimulation, and social engagement.
Results: Thirty-one veterans participated in six 90-minute weekly classes and attended 5 of the 6 groups on average. The average age for the predominantly male (90%) and white (70%) group was 71 years. Qualitative feedback indicated high satisfaction and increased awareness of health behaviors. Results of paired samples t tests comparing baseline to posttreatment self-report measures revealed a significant decline in depressive symptoms ( P = .01) and increases in satisfaction with life ( P = .003) and self-efficacy ( P = .008).
Conclusions: This development project showed evidence of increased awareness of health behaviors and improved mood. Expanded data collection will strengthen power and generalizability of results (increase sample diversity). It will also allow us to examine moderating factors, such as perceived self-efficacy, on outcomes.
Strengths and Limitations
This study had a limited sample size and no control group. However, evidence of significant improvements in depressive symptoms, self-efficacy, and life satisfaction in the development groups without a control group is encouraging. This is particularly noteworthy given that older veterans as a group have higher rates of frailty and mortality than do other similarly aged counterparts.17An additional weakness is the absence of a brief cognitive assessment or other formal assessment as part of the inclusion/exclusion criteria. However, this program development project provides data from a realistic condition (recruited broadly and with few exclusions, offered in similar format as other VA classes), thus adding strength to the interpretation and possibly the generalizability of these findings.
Conclusions
Future directions include disseminating HAP-B materials and procedures across a variety of sites, both VA and non-VA. In line with this goal, we hope to increase sample size and sample diversity while optimizing protocol integrity during the exportation phase. With a greater sample size and power, we aim to examine the role of self-efficacy and other premorbid factors (eg, cognitive functioning at baseline) as mediators for observed changes in pre-/postmeasures and outcomes. We also hope to incorporate objective measures of behavior change, such as fitness trackers, heart rate/pulse monitors, and actigraphy for monitoring sleep. Finally, we are interested in conducting follow-up with past and future participants to detect changes that may occur with learning new skills following the completion of the group (eg, changes in sleep behavior that take time to take effect) and the extent to which participants continue to use the health behavior skills and strategies to maintain or enhance progress in behavioral goals. Finally, although this intervention was initially designed for use with older veterans receiving health care through the VA, we believe the concepts and work products described here can be used with older adults across a wide range of health care settings. Providers interested in trialing HAP-B at their local site are encouraged to contact the authors.
