Interventions Used to Increase Participation Among Older Adults Experiencing Mild Cognitive Decline: A Systematic Review

Importance: Mild cognitive decline is more likely to affect older adults and often progresses to dementia. Occupational therapists play a key role in delivering interventions that can enhance or sustain participation in meaningful activities. Objective: To examine occupational therapy interventions used with older adults experiencing mild cognitive decline and determine their effectiveness on participation outcomes. Data Sources: CINAHL, MEDLINE, and Embase. Study Selection and Data Collection: Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. Inclusion criteria were randomized or quasi-randomized controlled trials published in English from inception to August 2024 that evaluated an intervention to address mild cognitive decline delivered or supervised by an occupational therapist. The quality of the included studies was assessed using the Cochrane risk-of-bias tool (ROB2). Results were synthesized both narratively and using a meta-analysis. Findings: Eleven articles described 10 studies that met the inclusion criteria. All involved cognitive training interventions using a remediation (seven studies) or compensation (one study) approach or both (two studies). Eight studies measured participation and were included in the meta-analysis. Results of the meta-analysis indicate that occupational therapy interventions are effective in enhancing participation of older adults with mild cognitive decline immediately after treatment (standardized mean difference [SMD] = 0.504, 95% confidence interval [CI] [0.194, 0.813]; I2 = 68%) and up to 6 mo later (SMD = 0.271, 95% CI [−0.090, 0.631]; I2 = 71%) but with considerable heterogeneity. Conclusions: Occupational therapy–delivered interventions are effective for older adults with mild cognitive decline, although further evidence is needed for greater confidence. Plain-Language Summary: Mild cognitive decline is a deterioration in a person’s thinking and memory that does not have a medical cause. Although it is more likely to affect older adults, it is not considered part of normal aging. However, it can occasionally progress to more severe forms of dementia. Staying active and independent is known to preserve quality of life among older adults with mild cognitive decline. Occupational therapists play a crucial role in supporting older adults in maintaining their independence and quality of life. This study examined different interventions used by occupational therapists to minimize the impact of mild cognitive decline. The authors found that a range of occupational therapy interventions can effectively enhance participation in meaningful activities; these benefits were observed immediately after treatment and up to 6 months later. However, more evidence is needed to understand the full impact of occupational therapy in this context.