Refinement of a piano improvisation training intervention to reduce cognitive inactivity among older adults with and without mild cognitive impairments.

Background and Objectives: Cognitive inactivity in later life (aged 60 and above) is associated with cognitive decline and other poor health outcomes. Cognitive training interventions are increasingly being studied to help reduce cognitive inactivity among older adults, and the use of music-based training interventions is one potential strategy. The objective of the study is to describe the multistep process used to adapt a candidate music-based intervention for older adults. Research Design and Methods: Using the Transcreation Framework for Community-engaged Behavioral Interventions and three other frameworks, we completed a multistep and multistakeholder process to adapt a candidate piano improvisation intervention to promote late-life cognitive engagement. We enrolled 22 adults aged 60 and older with and without mild cognitive impairments (mean age = 71.5 years, 86% female participants, 75% from diverse racial/ethnic backgrounds). We used interviews, participant observation, and surveys to obtain feedback to adapt the intervention. Results: We completed all steps of the Transcreation Framework that involved establishing collaborations with aging services and confirming the theory. Participants completed three intervention refinement cycles, which resulted in modifications of the intervention and creation of a manual. The final step included finalizing the study design and building capacity for a subsequent feasibility and acceptability randomized controlled trial (RCT). Discussion and Implications: The Transcreation Framework facilitated an efficient, multistep refinement process that resulted in an adapted music-based training intervention and the preparations for the RCT. This framework can be considered for adapting other community-based behavioral interventions.