Computational Thinking as a Novel Framework for Enhancing Cognitive Organization in Older Adults with Cognitive Frailty

Dear Editor,

We read with great interest the study by Low et al.¹) on the impact of physical and cognitive frailty on long-term mortality in older surgical patients. The authors' findings regarding the significant influence of cognitive frailty on outcomes highlight the continued need for innovative approaches to support cognitive function in vulnerable older adults. Specifically, their identification of cognitive frailty as an independent predictor of mortality underscores the urgency of developing targeted cognitive support interventions for perioperative care.

While established interventions such as the Guiding an Improved Dementia Experience (GUIDE) Model²) excel at care coordination and service delivery, and cognitive stimulation therapies demonstrate efficacy in targeting specific cognitive domains,³) we propose that computational thinking (CT) offers a complementary meta-framework. This proposal is grounded in an interdisciplinary synthesis of computer science heuristics, cognitive psychology principles, and gerontological care practices. Unlike existing approaches, CT directly addresses disruptions in cognitive organization by guiding the internal structuring of thought, attention, and memory. This framework may help older adults navigate instructions, routines, and care transitions more effectively by promoting systematic strategies for processing, organizing, and prioritizing information.

CT, originating from computer science, offers structured methods for parsing information, identifying patterns, prioritizing essential details, and sequencing thoughts and tasks.⁴) These processes align very closely with executive functions often compromised in cognitive frailty. Perhaps counterintuitively from its name, CT requires no digital tools whatsoever; rather, it centers on a methodical mindset for managing information, one that has the potential to promote consistent cognitive habits over time. Evidence from educational contexts supports CT’s cognitive benefits: Tsarava et al.⁵) observed gains in cognitive flexibility and organizational skills following CT-based interventions. Related principles have also shown promise in stroke rehabilitation, where task decomposition improved functional outcomes. Similarly, in aphasia care, structured supports for communication and shared decision-making rely on breaking down complex information into manageable units.⁶) These findings suggest that decomposition strategies grounded in CT may be transferable to broader contexts of cognitive impairment, including cognitive frailty in older adults. Though direct applications to cognitive frailty remain untested, these parallel findings highlight its potential.

While CT has yet to be explicitly applied in dementia care or cognitive rehabilitation, insights from related domains point to promising directions. In motor rehabilitation, for example, Rossini et al.⁷) showed that, in a neurotherapeutic context, performance improved significantly when complex movements were decomposed into rhythmic submovements. This finding aligns with CT's decomposition strategy, presumably by reducing cognitive load and supporting functional reorganization. This human-machine interface exemplifies Wing's foundational assertion⁴) that CT transcends implementation contexts, serving as a universal framework for problem-solving that applies equally to humans and nonhumans. The convergence of evidence from robotic systems and human rehabilitation contexts underscores decomposition's domain-agnostic utility as a fundamental organizing principle. Likewise, the other core components of CT (i.e., pattern recognition, abstraction, and algorithm design) appear to align well with cognitive strengths often retained in mild to moderate dementia. Pattern recognition could leverage procedural memory and implicit learning to identify familiar routines. Abstraction might help individuals focus on essential elements by filtering out less relevant details. Algorithm design could support step-by-step planning and reasoning for daily tasks. This strengths-based approach represents a departure from deficit-focused interventions, potentially promoting cognitive reorganization and functional independence in aging populations. However, these applications remain purely speculative, as no research has yet examined CT in dementia care contexts.

Table 1 illustrates how CT concepts can augment existing tools like pill organizers and discharge protocols. For instance, a "triple-check" medication card with fold-over sections applies decomposition principles to enhance cognitive load management beyond simple reminder systems. Similarly, color-coded pathway markers integrate pattern recognition with established wayfinding systems, leveraging preserved implicit memory.

Table 1.

Potential computational thinking (CT) framework as enhancement to existing care models

CT component	Cognitive challenge	Enhancement to current practice	Implementation tool	Expected added value
Decomposition	Managing complex medication regimens	Builds on existing pill organizers by adding systematic task breakdown	"Triple-check" medication card with fold-over sections revealing one step at a time	Enhanced cognitive load management beyond simple reminder systems
Pattern recognition	Disorientation in hospital or other living facility environment	Enhances existing environmental modifications with consistent cognitive cuing	Color-coded pathway markers integrated with established wayfinding systems	Systematic approach to environmental design that leverages implicit memory
Abstraction	Overwhelming discharge instructions	Complements existing discharge planning with information hierarchy principles	Three-tier discharge materials building on current patient education	Structured information filtering that reduces cognitive demands while preserving autonomy
Algorithmic thinking	Inconsistent rehabilitation approaches	Systematizes existing rehabilitation protocols with invariant procedures	Standardized exercise sequences that integrate with current therapy programs	Enhanced procedural memory utilization within established care pathways

Implementation could follow a three-step process: (1) using existing assessments like the Montreal Cognitive Assessment to identify organizational vulnerabilities; (2) applying CT principles to tailor interventions; and (3) integrating enhancements into established pathways. This approach does not replace current systematic frameworks but provides theoretical foundation for optimizing how interventions are cognitively structured and delivered.

The significance extends beyond individual care to system-level enhancement. As healthcare systems implement comprehensive models like GUIDE, CT offers a cognitive–organizational perspective that could amplify effectiveness of evidence-based practices. Previous systematic reviews have demonstrated the complexity of effective dementia care interventions, particularly those feasible in homecare contexts,⁸) and strategy-based cognitive training shows promise for executive function improvement.⁹) CT provides a unifying framework for organizing these varying approaches. Given the escalating economic burden of dementia care in many communities, CT-enhanced interventions could provide cost-effective approaches emphasizing cognitive scaffolding over resource-intensive solutions.

Naturally, establishing CT's efficacy in geriatric populations will require empirical validation through case studies and controlled trials. Future research should investigate whether CT-enhanced interventions yield measurable improvements in functional outcomes, care transitions, and quality of life among cognitively frail older adults.

We appreciate the opportunity to propose how CT might enhance existing intervention approaches. As the geriatric care community continues advancing integrated care, we believe CT integration will offer a novel cognitive-organizational perspective uniquely suited to mild-to-moderate cognitive decline, potentially establishing new interdisciplinary standards for addressing cognitive vulnerabilities.