Engaging Older Adults with Memory Challenges in Nature-based Activities: Early Feasibility Findings of the NATURE program

Katherine Wang, Sarah Zwerling, Rebecca Lassell PhD 

Background: Nurturing Aging Through Uplifting-activity in Restorative Environments (NATURE) was co-developedwithindividuals withmemory challengestopromote an active lifestyleand reducerisk forcognitive decline.Givenitsnovelty, this study evaluatesfeasibility and acceptability.

Methods:Participants wererecruitedusingconvenience samplingfromaging organizations and geriatric clinicsin the Northeast and Indiana.Participantswere≥45 years with subjective cognitive decline.Study partnerswere≥18 years and optional.NATURE involved:1) assessment (evaluation, goal setting,atailorednature plan), 2) coaching (strategy training, behavioral activation techniques), and 3) self-monitoring.An occupational therapist delivered4–8 in-person or virtual sessionsandtwophone check-insover 12 weeks.Feasibilityendpoints were≥75%interventioncompletion, attendance, retention, and fidelity. Acceptabilityendpointswere≥75% “yes” responsesontwo questions from the Intervention Acceptability Scale(IAS)andAccessibility of Intervention Measure (AIM)scores of 16-20for study partners.Goal AttainmentScaling(GAS)measuredprogressonthreepersonalizedgoals.Sustainedbehaviorchangeendpoints were“yes”to“Are you still doing your nature activities?Do you plan to do the activities in the future?”at four-week follow-up.

Results: Twenty-fiveparticipants (21with memory challenges,4study partners) enrolled.Participants werenon-HispanicBlack (n=8),Hispanic (n=8), non-Hispanic White (n=7), and (n=2)notreported.Participantswere mostly female (76%), older adults (mean age=65,standard deviation [SD]=9.82),with mild impairment (Telephone Montreal Cognitive Assessmentmean=18,SD=2.41).Twelveparticipants (n=10with memory challenges,n=2study partners)dropped outdue tostaffturnover (n=3), time constraints (n=4),loss ofinterest(n=1),andnolongermeetingeligibility(n=4).Afterbroadeningeligibility, nodropouts occurred. Thirteenparticipants startedNATURE(n=11with memory challenges, n=2studypartners)with88% completion and n=3 in progress.Attendance was100%for scheduled sessions.NATUREwasacceptableto participants(IAS:100%‘yes’)andstudy partners (AIM score:16).Eight participants(88%)met≥2GASgoalsanddemonstratedsustainedbehavior changeat follow-upwith100%indicatingintent to continuetheirnature activities.

Conclusion:Early findingsindicateNATURE is both feasibleandacceptablewith refinements to inclusion criteria.Ongoingimplementationwillinform strategies to optimizedelivery andretention.