Table 1 Characteristics of included studies
Study, Year | Method/Design | Sample | Key Findings | Themesa |
|---|---|---|---|---|
Abdelrahman et al., 2020 | Qualitative (focus groups) | Cognitively healthy adults age ≥ 55 years | • Participants voiced concerns about deteriorating cognitive health with age, including confusion around normal aging vs. cognitive decline | 2, 3 |
Adelman et al., 2004 | Mixed methods (quantitative survey data; qualitative semi-structured interviews) | Patients and caregivers age ≥ 65 years attending a first visit at a geriatric medicine outpatient clinic (N = 97) | • Some patients stated that they felt it is the physicians’ responsibility to raise this topic • Patients might not be aware of a cognitive problem • Physicians are more likely to raise the issue when only discussing with patient rather than patient and caregiver • Educational programs need to target those individuals who are concerned about a possible cognitive problem and are reluctant or embarrassed to discuss this issue with their physicians • Physicians may be uncomfortable raising this topic | 1, 2 |
Corwin et al., 2009 | Qualitative (focus groups) | Black/African American (N = 42) and White (N = 41) community-dwelling adults age ≥ 50 years | • Concept of aging is multidimensional • Differences in perceptions by race: Black/African Americans believe aging well means being cognitively intact, physically mobile, independent, and free from health problems; White adults described aging well in terms of living a long time, staying physically active, maintaining a positive outlook, and having good genes • The connection between physical activity and remaining independent may be a particularly motivating message for older Black/African American adults, who valued independence • Health communications focused on social involvement, and spirituality may be meaningful to all older adults | 3, 4 |
Day et al., 2012 | Cross-sectional survey | PCCs (N = 972) | • 40% of respondents indicated that they discuss reducing cognitive impairment often or very often in the past 6 months; 38.7% sometimes and 20% rarely • Most common advice given to maintain cognitive health: Physical activity, intellectual stimulation, healthy diet, and social activity (all > 80%) • 40% believe strength of evidence to reduce cognitive impairment is weak or very weak, 50% believe it is moderate, strong, or very strong • The most frequently reported barriers to addressing reducing cognitive impairment risk were lack of reimbursement and time (31.9%), limited scientific evidence or proven treatments (26.3%), and patients’ more immediate health issues (24.6%) | 1 |
Friedman et al., 2009 | Qualitative (focus groups) | Racially diverse group of community-dwelling adults age ≥ 50 years (N = 177) | • Participants indicated that they perceive a lack of information about brain health in the media • When the media does promote brain health, the focus is on diet, physical activity, brain exercises, medication, and supplements • Participants indicated opportunities for brain health education at church, field trips/outings, organized events, and existing social clubs • Participants viewed other seniors, social networks, physicians, friends/family, and TV programs as messengers for brain health education • Individual barriers to discussing cognition included participants’ other health conditions and negative attitudes toward cognitive decline • Structural barriers to discussing cognition included confusing media messages, limited information for laypersons, and perceived cost of cognitive interventions | 3 |
Friedman et al., 2011b | Qualitative (focus groups) | Racially diverse group of community-dwelling adults age ≥ 50 years (N = 396) | • Participants identified several strategies for keeping the brain healthy and maintaining memory, including mental exercises, having a positive attitude, social interaction, physical activity, and healthy diet • Nuances in responses occurred between racial/ethnic groups due to differences in cultural beliefs • One facilitator of discussions around cognition is the consideration of social and cultural factors • Participants indicated that they perceive research around the impact of health behaviors on cognitive health to be uncertain, which presented a barrier to discussing cognition | 3, 4 |
Friedman et al., 2013 | Cross-sectional survey | Consumers (N = 4,728) and PCCs (N = 1,250) | • PCCs indicated that they advise patients to exercise, obtain intellectual stimulation, be socially active, eat a healthy diet, limit alcohol consumption, and maintain a healthy weight to prevent or delay cognitive impairment • Consumers believed that staying mentally stimulated, exercising, eating a healthy diet, maintaining a healthy weight, being socially involved, taking vitamins or dietary supplements, avoiding smoking, and taking prescribed medication could prevent or delay cognitive impairment • The majority of consumers reported that a PCC had not spoken to them about ways to stay mentally sharp in the past 12 months | 3 |
Hochhalter et al., 2012 | Qualitative (focus groups and individual interviews) | Primary care physicians (N = 28) and advanced practice providers (N = 21) | • Few providers talked about risk of cognitive impairment • When they discussed cognitive impairment, it was in the context of the benefits of physical activity on vascular risk, cancer prevention strategies, or screening for risky behaviors • Advice given to patients to maintain cognitive health included staying busy, volunteering, being socially engaged, being physically active, eating healthfully, doing puzzles or games, reading, learning new things or trying new activities, and disease management of other medical conditions • Barriers to discussing cognitive health included both system-level issues (e.g., lack of time, lack of a relationship with a patient) and patient-level issues (e.g., nonadherence to PCC recommendations for behavior change) | 1, 2 |
Laditka et al., 2009b | Qualitative (focus groups) | Racially diverse group of community-dwelling adults age ≥ 50 years (N = 396) | • Participants described their views on aging well as they relate to cognitive health • Views on aging well differed by race and ethnicity • Discussions of cognition should include both culturally sensitive messages and broad messages that apply to many racial and ethnic groups to promote cognitive health | 3, 4 |
Laditka et al., 2011b | Qualitative (focus groups) | Racially diverse group of community-dwelling adults age ≥ 50 years (N = 396) | • Participants discussed their concerns about the ability to keep their memory or ability to think as they age; concerns included memory loss, forgetfulness, becoming a “burden,” stigma, and behavioral changes associated with cognitive decline • Concerns differed by race and ethnicity and geographic location • It may be difficult to convince those to participate in health behaviors that reduce their risk of cognitive decline if the evidence supporting these health behaviors is perceived as uncertain | 2, 3 |
Laditka et al., 2012 | Qualitative (focus groups) | Filipino Americans who provide care to individuals with dementia (N = 25) | • Participants indicated that they saw social engagement, leisure, healthy diets, and avoiding smoking, alcohol, and drugs as beneficial for cognitive health • Authors highlighted that Filipino Americans are more likely to work in health professions and as paid caregivers, which may have an influence on beliefs and attitudes related to cognitive health • Facilitators of conversations around cognition include culturally relevant messaging and educational materials provided in native languages • Media sources and community centers (e.g., churches) can be used to disseminate messaging | 3, 4 |
Light et al., 2022 | Qualitative (individual interviews) | Spanish-speaking immigrants age ≥ 60 years (N = 30) | • Participants perceived healthy aging as including maintaining independence, memory, emotions, and orientation • Participants indicated that physical, social, and cognitive engagement is important to care for the brain • Participants’ knowledge about cognition and brain health came from communities, healthcare settings, and the media • Clear and concise messaging is a facilitator of conversations about cognition • Collaborations between healthcare providers, community centers, community classes, churches or other religious centers, and media outlets can help disseminate brain health information | 3, 4 |
Mace et al., 2022 | Qualitative (focus groups) with a virtual open pilot study | Adults age ≥ 60 years with subjective cognitive decline who were interested in changing ≥ 1 modifiable risk factor (N = 11) | • Participants understood aging and biomedical risk factors for dementia • Participants acknowledged the importance of exercise, mental stimulation, and nutrition for promoting brain health • Participants did not acknowledge the importance of sleep, socializing, and moderation of alcohol or substance use for maintaining brain health • Participants were interested in mindfulness-based lifestyle interventions | 3 |
Olscamp et al., 2019 | Qualitative (focus groups) | Informal caregivers of people with AD (N = 10) | • Participants reported that they had limited exposure to information about physical activity and brain health (i.e., not hearing about the connection between physical activity and brain health in the media) • Participants were concerned with the consistency and reliability of the evidence to support physical activity for brain health • Participants were more likely to trust information from credentialed and licensed professionals (e.g., physicians, therapists) • Facilitators of discussing cognition included using evidence-based information, fostering trust in licensed providers, and delivering consistent messages | 3 |
Onafraychuk et al., 2021 | Cross-sectional survey | Adults age ≥ 18 years (N = 169) | • Participants indicated that they would be willing to invest time in activities to maintain brain health and cognition if they saw those activities as being efficacious • Brain training and aerobic exercise were seen as efficacious, while meditation was seen as less efficacious • Participants’ anticipated enjoyment of an activity was a predictor of their willingness to engage in the activity • Individual limitations (e.g., mobility limitations, physical ailments, etc.) may hinder an individual from discussing cognition or taking steps to maintain brain health | 3 |
Price et al., 2011 | Qualitative (focus groups) and a cross-sectional survey | Black and White adults age 65–74 years (N = 55) | • In general, participants understood the connection between physical activity and cognitive health, but they felt that evidence supporting the connection was lacking • White men expressed less concern about cognitive decline compared to other participants • Black women expressed spiritual undertones in focus groups, highlighting potential benefits of faith-based messages | 3, 4 |
Sharkey et al., 2009 | Qualitative (focus groups) and a cross-sectional survey | Spanish-speaking Mexican American adults age ≥ 55 years (N = 33) | • Participants described aging well as “staying right in the mind” • Not aging well was seen as being lost or “closed off” from other people; there was a possible supernatural malicious element to not aging well related to views on spirituality • Participants’ concerns about aging and memory included being alone in the world and worries about becoming a burden to others • Participants indicated that mental and physical activities contribute to aging well by distracting from “bad thoughts” • Authors highlighted that the results from this study contrasted with a similar study that included English-speaking Hispanic focus groups on the same topic, attributing these differences to language as well as household income, education, neighborhood deprivation, and degree of assimilation | 3, 4 |
Warren-Findlow et al., 2010 | Qualitative (focus groups and individual interviews) and a cross-sectional survey | PCCs, including physicians (N = 28) and advanced practice providers (N = 21) | • Participants indicated that online sources, popular media, and continuing medical education were their most common sources of information about cognitive health • Participants were concerned about inconclusive research on cognitive health (i.e., “The brain is still pretty much a black box”) • Popular media can be both a barrier to and facilitator of discussions of brain health between providers and patients • Having a network of specialists connected to PCCs can facilitate knowledge transfer and improve brain health understanding among providers • Inconclusive brain health research leaves PCCs ill-equipped for these conversations | 1, 2, 3 |
Weiner-Light et al., 2021 | Qualitative (individual interviews | Spanish-speaking Latin American immigrants age ≥ 60 years (N = 30) | • Participants indicated that spirituality and their relationship with God forms the basis of healthy aging and maintaining health in older age • Authors highlighted the potential utility of customized spiritual interventions to increase the effectiveness of brain health promotion efforts among Latin American immigrants | 4 |
Wilcox et al., 2009b | Qualitative (focus groups) | Racially diverse group of community-dwelling adults age ≥ 50 years (N = 396) | • Participants indicated that there is a positive link between physical activity and dietary practices and brain health • Different ethnic groups expressed desire to do different types of physical activity • Different ethnic groups emphasize the importance of different characteristics for a healthy diet • Differences among groups may be attributable to differences in acculturation | 3 |
Wu et al., 2009 | Qualitative (focus groups) | Community-dwelling adults age ≥ 55 years (N = 67) | • Participants expressed some confusion regarding AD vs. normal aging, and they identified underlying causes of dementia as well as preventive strategies for avoiding dementia in later life (e.g., social engagement, physical activity, etc.) • Participants expressed reluctance to address brain health because people who use preventive strategies can still develop AD anyway • Women were more likely than men to take the lead in providing healthcare information for their families • Women were more concerned with difficulty of preparing healthy food while men cited taste preferences, fast-food convenience, and lack of self-control • Women endorsed social/physical activities like group exercise classes while men discussed manual labor and employment in relation to physical exercise • Gender differences may be due to cultural traditional gender roles seen in this age cohort | 3, 4 |
Zhai et al., 2022 | Qualitative (focus groups) | Korean, Samoan, Cambodian, and Chinese Americans age ≥ 50 years (N = 62) | • The majority of participants assumed that memory loss was part of normal aging • Participants were eager to learn the causes of memory loss and dementia and evidence-based practices to delay memory decline • Not all Asian Americans and Pacific Islander individuals have the same understanding of memory loss; differences exist across and within cultures • Different views from each ethnic group might be formed by both cultural beliefs and by social and structural factors that each ethnic group uniquely faces during immigration | 2, 3, 4 |