Towards Evidence-based Care: Promoting Cognitive Well-being of Older People

The article by Mamayson and Lacanaria¹ in Acta Medica Philippina summarized the available evidence on the effects of cognitively stimulating activities (CSA) on the overall cognitive functioning of older people with mild cognitive impairment (MCI). Aside from the new evidence, it also provided insights on how the findings of study will inform the nursing profession in terms of clinical practice, leadership and policy, research, and education.

Utilizing a meta-analysis of three randomized controlled trials (RCTs), the authors reported that cognitive training using CSA improves overall cognitive function among older people with MCI.¹ Calligraphy, cognitive, and language trainings were the cognitively stimulating activities included in the reviewed RCTs which were conducted over the past years in Hong Kong, China, and Greece, respectively. The authors acknowledged that such activities are effective and practical, inexpensive, non-pharmacological approaches to slow down cognitive decline.¹ The strength of the paper is the inclusion of good methodical quality studies and only RCTs which are considered gold standard for evaluating the effectiveness of interventions. However, the authors emphasized that the interpretation of study results requires caution. This is due to the small number of studies reviewed which limits the generalizability of the findings.

Older people with mild cognitive impairment are at increased risk of dementia since aging is a primary predictor of MCI progression to dementia.² The Global Action Plan on the Public Health Response to Dementia 2017-2025 outlined the growing consensus on protective measures which can reduce the risk of cognitive decline and dementia. These measures include healthy lifestyle (e.g., physical activity, balanced diet, smoking, and alcohol cessation), management of hypertension and diabetes, social engagement, and promotion of cognitively stimulating activities and learning.³ These are aligned with the recommendations of the Lancet Commission which emphasized that dementia prevention is about policy and individuals. Preventive actions require both public health strategies and individually-tailored interventions.⁴

In the Philippines and as mandated by the Republic Act No. 9994 or also known as the Expanded Senior Citizens Act, the Department of Health (DOH) in coordination with relevant stakeholders shall institute a national health program and provide an integrated health service for senior citizens.⁵ The DOH developed the Health and Wellness Program for Senior Citizens⁶ and several policies on the care of older people^7,8. Specific policies relevant to cognition include the 2022 Omnibus Health Guidelines for the Elderly. The guidelines contain the conduct of cognitive stimulation therapy by a psychologist or mental health specialist for people with cognitive decline who may benefit from cognitive stimulation.⁷ The implementation of this specific guideline is challenging due to the limited number of health workforce. In particular, there are only approximately 1600 psychologists and 500 psychiatrists serving about 110 million Filipinos.⁹

In the era of and prior to the introduction of evidence-based practice, nurses are one of the major key players in the care of older people. The study of Mamayson and Lacanaria added evidence which will be useful in guiding the current and future professional nursing practice.¹ Nurses can promote cognitive wellness by educating the older patient, family members, and the community on the importance of engaging in appropriate cognitively stimulating activities and the potential benefits of these non-pharmacological approaches. The recommendations on the incorporation of the findings into the gerontology courses, introduction of certification programs for dementia and MCI care specialists, and advocating for policy changes call for action. These recommendations can be put into action in close coordination with the right stakeholders. The involvement of key national government agencies namely Commission on Higher Education, Professional Regulation Commission, Department of Health, National Commission of Senior Citizens, as well as academic institutions, and professional societies such as the Philippine Nurses Association, Gerontology Nurses Association of the Philippines, and the Philippine Society of Geriatrics and Gerontology is crucial.

The research recommendations outlined by Mamayson and Lacanaria highlighted the conduct of future studies with larger samples, longer follow ups, less language restrictions, and more rigorous analysis.¹ It is notable that no local study on cognitively stimulating activities that was cited or included in the review. Given this, the country should strengthen local evidence generation to develop age-, gender-, culturally-sensitive, and responsive interventions. The most recent National Unified Health Research Agenda of the Philippines included geriatric health and tailoring novel mental health interventions to different life-stages as priority topics.¹⁰ This is an opportunity for professional societies, academe, and research institutions to pursue research, contribute to the local evidence base, promote cognitive well-being, and ultimately, improve the care and quality of life of older Filipinos.

Angely P. Garcia, RN, MPH
Research Assistant Professor 2
Institute on Aging, National Institutes of Health,
University of the Philippines Manila
Affiliate Faculty, College of Nursing,
University of the Philippines Manila