Compensatory Strategy Interventions Among Cognitively Impaired Older Adults: What do Patients Want and Why?

Allyson Goldstein, Rhode Island Hosptial, Providence, United States
Kelli Sullivan, Warren Alpert Medical School of Brown University, Providence, United States
Emily Hallowell, Warren Alpert Medical School of Brown University, Providence, United States
Persis Commissariat, Harvard Medical School, Boston, United States
Jennifer Davis, Warren Alpert Medical School of Brown University, Providence, United States
Seth Margolis, Warren Alpert Medical School of Brown University, Providence, United States


Adults with cognitive impairment are prone to making errors while performing instrumental activities of daily living. Compensatory strategies, such as routines, lists, and reminder systems, are often recommended by neuropsychologists to help patients maintain independence. Understanding patient perceptions and preferences is necessary to develop patient-centered compensatory strategy interventions. We interviewed people with mild cognitive impairment (MCI) and mild dementia about their motivation to improve their strategy use and their interest in various intervention formats.

Participants and Methods:

Participants were 40 older adults with cognitive impairment recruited between January and May of 2021. Average age was 72.65±7.73 years with 14.23+2.97 years of education (63% female; 98% White). Semi-structured qualitative interviews inquired about participants’ motivation to improve strategy use and interest in different intervention formats (one-on-one with an instructor, group, self-directed virtual program, family/friend-patient dyad). Preferred delivery methods (in-person, remote), frequency (multi- or single session), and duration were identified. Facilitators and barriers to each intervention option were explored.


Most of the sample (77.5%) reported some level of motivation to enhance their compensatory strategy use, and on average, were moderately-to-very motivated. Desire for self-improvement and fear of disappointing others facilitated motivation, while lack of perceived need and lack of time were barriers. Fifteen percent of the sample was interested in group but not one-on-one interventions, 20% was interested in one-on-one but not group, and 42.5% was interested in both. Combined, 77.5% of the sample was interested in group/one-on-one interventions in some capacity. Desire to learn from others was a facilitator of group interest, whereas lack of patience with groups or unfavorable past group experiences were barriers to group interest. About half of those interested in groups preferred in-person meetings (52.5%), whereas most participants interested in one-on-one classes favored remote (phone or video) delivery (60%). COVID-19 and lack of transportation were barriers to interest in in-person sessions. Most participants wanted hour-long, multi-session meetings for group or one-on-one classes. About half the sample (52.5%) was interested in a self-directed virtual program (via smartphone app or website) and fewer (45%) were interested in involving a family member/friend. Difficulty with technology and preference for interpersonal interaction were barriers to a self-directed virtual format. A main facilitator of interest in involving family/friends included having a supportive person in mind, while barriers included fear of burdening others, believing others lacked time, and preference for privacy.


Although our findings are limited by a predominantly White, well-educated sample, and the COVID-19 pandemic may have influenced responses, our results highlight that older adults with MCI and mild dementia are motivated to improve compensatory strategy use. Participants were most interested in hour-long, multi-session, in-person group or remote one-on-one formats, with less interest in self-directed virtual programs or involving family/friends. Clinicians/researchers designing and delivering compensatory strategy interventions should consider the aforementioned facilitators and barriers to optimize patient engagement. Future studies should explore these same questions in more diverse populations to create tailored, culturally responsive interventions.

Category: MCI (Mild Cognitive Impairment)

Keyword 1: activities of daily living
Keyword 2: mild cognitive impairment
Keyword 3: everyday functioning