Introduction
As the tide of global aging rises, the urgency for informed public health interventions and policy development in the domain of gerontology, particular for mental and cognitive health becomes paramount. Mental health in the elderly is characterized not only by the absence of mental disorders but also by the presence of emotional resilience and the capacity to navigate life’s challenges (World Health Organization, 2022). Cognitive functioning, encompassing memory, attention, language, problem-solving abilities, and more, is equally vital for autonomy and well-being in later life (Gross et al., 2011). Many studies have shown that mental health and cognitive functioning are pivotal determinants of quality of life in older adults (Gerino et al., 2017; Hill et al., 2017), a group that is steadily increasing, particularly in highly developed nations such as Switzerland. Switzerland, with its high standard of living and comprehensive social support and health care systems, presents a unique showcase for examining how mental health in older adults is both protected and challenged within Europe. As the most recently published Swiss Health Survey 2022 (Federal Statistical Office, 2022) shows, aging in the Swiss context does not shield one from the vulnerabilities associated with declining mental health and cognitive functioning. The intersection of biological aging, psychological stress, socioeconomic inequality, and even the potential social isolation in a society as diverse as Switzerland, are all factors that can affect an older adult’s mental and cognitive health. As revealed by the survey, 13% of the population state that their health status is worse than before the COVID-19 pandemic, an effect that is magnified in individuals with a lower educational background. This is especially true among people aged 75 and over. Moreover, even though the majority of older people are in good mental health, 10% of men and 17% of women state that they experience a medium or even high mental health burden.
A particular challenge in this context is the well-documented increase in problems regarding cognitive functioning, from the normal age-related decline in central cognitive functions that underlie independent and autonomous daily living in the digital era to the dramatic rise of age-related neurodegenerative diseases such as Alzheimer’s dementia or Parkinson’s disease (Deary et al., 2009; Murman, 2015). Currently, about 153,000 people are living with dementia in Switzerland. Each year, there are 32,900 new cases (Alzheimer Schweiz, 2023). These developments not only represent one of the key threats to well-being in old age but are also responsible for billions of Euros in health care costs in old age (Kraft & Simon, 2019; Wieser et al., 2014). Knowing that different factors such as physical health, stigma, or educational and socioeconomic reserves moderate the relationship between mental and cognitive health, underlines the multifaceted challenges in this area for healthcare systems, policymakers, and society at large (Bauermeister & Bunce, 2015; Ihle et al., 2018; Wang & Blazer, 2015). While it is crucial to tailor public health interventions to the specific context of the target population, international studies serve as a vital foundation and should be used as guidance in designing these interventions.
Globally, various intervention programs have been shown to effectively stabilize and enhance mental health and cognitive functioning in “healthy” older adults. “Healthy” in this context refers to individuals without pathological cognitive impairments, severe mental disorders, or another clinical diagnostic, while accounting for the variability associated with typical age-related cognitive decline and mental health (Zuber et al., 2024).
Many mental health interventions for this population include psychological process-focused approaches, often drawing on cognitive-behavioral therapy principles or elements of behavioral activation and strategy training. These approaches aim to reframe problematic thoughts and teach strategies to reduce their psychological impact, as in the Self-help+ program for stress management (World Health Organization, 2021; Brinkhof et al., 2023). Mindfulness-based and mind-body approaches have also been effective in reducing depressive and anxiety symptoms in older adults by enhancing physiological stress regulation and emotional processing (Kishita et al., 2017; Laird et al., 2018). Exercise interventions further support mental health by promoting neurobiological processes, reducing stress, encouraging social interaction, improving sleep, and fostering behavioral change mechanisms, such as self-regulatory skills and self-efficacy (Smith & Merwin, 2021). Multidomain interventions combine several lifestyle factors such as exercise, cognitive stimulation, and social interaction (Bigarella et al., 2022; Clark et al., 2012). This approach aims to optimize several factors, each individually contributing to older adults’ ability to pursue their personal goals and sense of flourishing, hence ultimately improving their well-being. Finally, interventions addressing environmental factors focus on creating age-friendly communities globally or reducing mental health stigma and ageism (Fulmer et al., 2020; Burnes et al., 2019; De Mendonça Lima et al., 2003).
Interventions targeting cognitive health include cognitive training programs that use structured exercises and video game-like digital tasks to maintain cognitive abilities and enhance specific functions, such as memory, attention, executive functions, and problem-solving (Karbach & Verhaeghen, 2014; Kliegel et al., 2017). Metacognitive training programs aim to improve older adults’ understanding of their cognitive abilities and help them apply effective strategies (Hertzog et al., 2012; Lachman et al., 1992; Dunlosky et al., 2003; Sella et al., 2023). Additionally, cognitively engaging leisure activities, such as learning an instrument or joining a choir, stimulate various cognitive functions, including memory, attention, and problem-solving (Kim & Yoo, 2019; Marie et al., 2023). Physical exercise, especially when combined with cognitively engaging elements like exergames or mind-body practices, is another widely recommended intervention. Exercise supports cognitive function and lowers the risk of cognitive decline by enhancing spatial awareness, cardiovascular health, blood flow to the brain, and reducing stress (Coelho-Junior et al., 2022; Falck et al., 2019; Gheysen et al., 2018; Gouveia et al., 2020; Stojan & Voelcker-Rehage, 2019; Lannon-Boran et al., 2023; Taylor-Piliae et al., 2010). Neuroscientific interventions, such as biofeedback and neurofeedback, provide real-time information about physiological processes, allowing individuals to learn how to control functions like heart rate and brainwave activity, potentially leading to improved cognitive control and focus (Tinello et al., 2022). As with mental health interventions, research in cognitive health has also explored the efficacy of combined or multidomain interventions that incorporate elements such as exercise, cognitive training, social interaction, and dietary modifications. By addressing multiple aspects of cognitive health, these comprehensive programs may offer greater cognitive benefits than any single, isolated intervention (Law et al., 2014; Kuo et al., 2018; Gavelin et al., 2021; Guo et al., 2020; Karssemeijer et al., 2017; Rieker et al., 2022; Zhu et al., 2016).
While interventions aimed at improving mental health and cognitive functioning in older adults have shown promising results in controlled laboratory settings internationally, achieving a significant health impact at the population level requires effective implementation and scaling of these programs. Unfortunately, research on healthy aging interventions has primarily focused on assessing their effectiveness, not the implementation processes underpinning them (Owusu-Addo et al., 2021). Instead of seeking to eliminate contextual confounders, which represent the normal conditions into which interventions must be integrated to be workable in practice, efforts should focus on working with them. Therefore, it is important to explore the implementation process of interventions targeting mental health and cognitive functioning (e.g., recruitment, delivery mode) and to identify barriers and facilitators for effective intervention implementation.
In addition to the social, political, economic, and geographical structure of the country where the intervention should be implemented, two additional aspects are important to consider for effective intervention implementation. the degree of vulnerability and the level of stigmatization the target population may experience. Vulnerability, as discussed in the works of Cullati et al. (2018), Ihle et al. (2023), and Stern (2006, 2009), generally refers to the susceptibility of individuals to adverse outcomes when exposed to stressors due to diminished resilience or lack of protective resources. In the context of their research, vulnerability particularly addresses the likelihood of experiencing significant declines in health or functioning when encountering physical, social, or psychological challenges. This concept emphasizes the importance of identifying at-risk individuals and tailoring interventions that enhance their capacity to cope with and adapt to life’s stressors, ultimately aiming to prevent deterioration and promote well-being. Stigma can manifest in various forms, including social stigma from the community, self-stigma, and institutional stigma within healthcare policies and practices. Stigmatization can discourage the target population from joining an intervention due to fear of judgment or discrimination (Hill et al., 2022; Schnyder et al., 2017). Additionally, the effectiveness of interventions may be compromised if these programs are not sensitive to the stigma experienced by participants, potentially resulting in poor engagement and reduced efficacy (Sun et al., 2022).
Rationale of the review
Available studies provide evidence for beneficial effects of a broad range of interventions on both mental health and cognitive functioning in older adults. Yet, despite the variety of interventions available, older adults often encounter barriers to access, such as a shortage of (mental) health professionals, financial constraints, and lingering stigma surrounding mental health and cognitive functioning (Elshaikh et al., 2023; Sanchini et al., 2022). Therefore, the development of tailored, cost-effective and easily scalable interventions targeting mental health and cognitive functioning to a broader audience, such as self-help programs or technology-based solutions, emerges as a pressing challenge for the future (Bartels et al., 2019; Corpas et al., 2022). However, different countries exhibit distinct challenges regarding mental health and cognitive functioning, which vary for different populations within those countries, influenced by factors such as urbanization, socio-demographic transitions, socio-economic inequalities, migration patterns, and access to healthcare services. Taking these contextual variations into account would enable the design of context-sensitive strategies for implementing and scaling up mental health promotion and prevention interventions, ultimately strengthening mental health support systems (World Health Organisation, 2021). A significant limitation of international evidence is the inability to draw conclusions about inter- and intra-national differences in cultural, social, and economic contexts, which are crucial for developing sustainable interventions which target the groups most at risk for vulnerability within specific countries. Besides general evidence of the effectiveness of interventions, context-specific information is of paramount importance.
Therefore, this desk review aimed to dissect and analyze key components of existing interventions that have targeted the enhancement of mental health and cognitive functioning in the older population, drawing on international published scientific studies including a Swiss sample, and national gray literature. By focusing on older adults without cognitive or mental disorders, we aim to capture the nuances of typical age-related cognitive decline and mental health changes, which inherently exhibit significant variability. Including individuals with more pronounced cognitive or mental impairments would further increase this variability, potentially confounding the findings and hindering our ability to draw clear conclusions about the typical aging process. Interventions targeting these specific populations would be better addressed in a separate review. A particular focus was placed on the vulnerability and stigmatization associated with aging in the Swiss population, as well as on implementation aspects such as recruitment, delivery mode, and stigma prevention. Through a systematic examination these interventions and the targeted population, the review provides a knowledge base from which policymakers, researchers, and practitioners can extrapolate effective strategies and identify gaps in current approaches. It seeks to chart a course for the creation of robust, evidence-based interventions and policy strategies that ensure older adults in Switzerland not only live longer but also enjoy better mental health and cognitive functioning.
Method
This desk review draws on the guidance developed for scoping reviews (Levac et al., 2010) and is based on the methodological framework for scoping studies developed by Arksey & O’Malley (2005). Our review is further informed by the toolkit on mental health needs assessment in humanitarian settings developed by the World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR), and by key desk review parameters discussed for situations of humanitarian crises (Greene et al., 2017). The desk review followed the structure outlined by a protocol developed within the ADVANCE project (see supplementary material S1). The structure and methodology (e.g., eligibility criteria, search strategy) were thereby targeted, but also cost-effectiveness (e.g., investigating only studies on intervention programs from scientific literature but including further appropriate gray literature sources when not enough knowledge was available). All supplementary materials are available on Zenodo, a free and open platform for preserving and sharing research output (https://doi.org/10.5281/zenodo.11544952).
Eligibility criteria for articles
We included both scientific and gray literature (e.g., information distributed outside of traditional peer-reviewed academic publishing channels) in our review. Publications were eligible if they met the inclusion criteria depicted in Table 1. We further included gray literature where appropriate (1) addressing the impact of threats for mental health and cognitive functioning; and/or (2) reporting on mental health or well-being or cognitive functioning outcomes of target groups in Switzerland; and/or (3) referring to stigmatization and stigma mitigation strategies.
Table 1
Inclusion and exclusion criteria.
| INCLUSION CRITERIA | EXCLUSION CRITERIA | |
|---|---|---|
| Year of publication | Between January 1st 2018 until October 10th 2024 | Before January 2018 |
| Language of the publication | English or one of the main local languages of Switzerland (German, Italian, French) | Any other language than English, German, Italian, or French |
| Type of publications | Systematic/scoping reviews, and meta-analyses; original observational or experimental studies, including quantitative, qualitative or mixed methods research; study protocols | Publications not referring specifically on our target population (e.g., meta-analysis and reviews reporting data from Swiss older adults beneath others, to draw conclusions on the general population of older adults) |
| Participants/population | Mean age of the population is ≥ 60 years* AND the minimal age is ≥ 50 years; age-adapted normal cognitive functioning (MMSE > 27, MoCa > 22); living in Switzerland | Mean age of the population is <60 years OR the minimal age is <50 years; any neurological disease leading to age-adapted non-normal cognitive functioning (mean MMSE ≤ 27, mean MoCa ≤ 22); not living in Switzerland |
| Intervention | Any intervention, program or project related to promotion or prevention of mental health and cognitive functioning: exercise, cognitive training, cognitive-behavioral programs, cognitive enrichment, multimodal programs | Interventions including ONLY pharmaceutical treatment, TCDS, neurofeedback; interventions for rehabilitation; cross-sectional or longitudinal studies showing association between “lifestyle” and mental health/cognitive functioning |
| Outcomes | Mental health, well-being, quality of life, self- and provider stigma, cognitive health / functioning, functional health, and independence | Physical fitness, motor functions, falls, (neuro-) biological marker |
[i] Note. *People aged 60 or over are considered older adults according to the United Nations definition, which is commonly used as a threshold in aging research; MMSE = Mini Mental State Examination; MoCa = Montreal Cognitive Assessment.
Information sources and search strategy
PubMed, PsycINFO and Scopus databases were searched from January 1st, 2018, until October 10th, 2024. The seven-year time frame was applied to limit findings to the most up-to-date literature. The basic search strategy was developed by a research team of the ADVANCE project responsible for guiding the desk reviews of all included countries. It was then adapted by five researchers from the CIGEV (Geneva, Switzerland). The search strategy included the following search terms: (“older adults”) AND (“prevention” OR “intervention” OR “promotion”) AND (“mental” OR “cognition”) AND (“Switzerland”). Search parameters were adapted to database requirements. The complete search strategy can be found in the supplementary material (S2). Gray literature was identified by a Google search using the keywords described above and by manually searching the included studies.
Study selection
Study selection was performed using the reference management system Rayyan (Ouzzani et al., 2016). Search results were imported into Rayyan and any duplicate entries were eliminated. Study selection was carried out in two steps. During the first step, pairs of reviewers independently screened the titles and abstracts of their assigned studies. In the event of any discrepancies or disagreements between the two reviewers, a third reviewer conducted an independent evaluation based on the eligibility criteria. Studies that met the inclusion criteria in this first step were then assigned to other pairs of reviewers for a comprehensive review of the full-text articles. This second step followed the same process as the title and abstract screening. To ensure adherence to the established workflow and eligibility criteria, detailed guidelines for the study selection process were provided to reviewers, and training sessions were conducted as necessary. The studies selected during these different steps were organized and saved within Rayyan in designated directories. (see supplementary material S3, S4)
Data extraction
For each included study, we extracted the following information if available: (1) author names; (2) year published; (3) profile of the population (medical condition; cognitive, physical and mental status; education); (4) types of adversity experienced; (5) cognitive and mental issues addressed by the study; (6) number of participants; (7) sociodemographic characteristics (age, % female, % Swiss); (8) intervention aim; (9) intervention characteristics (intervention duration, number of sessions, session duration, mode of delivery, setting of delivery; recruitment strategy); (10) intervention adherence; (11) stigma (type of stigma, source of stigma, stigma prevention); (12) cultural aspects related to mental health issues; idioms of distress; (13) psychosocial service (available, target population); (14) economic evaluation; (15) barriers and facilitators of the intervention implementation process; (16) study type. These dimensions were extracted by one author and further crosschecked by the research team. To ensure adherence to the established workflow and eligibility criteria, detailed guidelines for the data extraction process were provided to reviewers (see supplementary material S5), and training sessions were conducted.
Collating, summarizing, and reporting the results
The data collected were summarized descriptively under five overarching themes: (1) groups at risk for vulnerability; (2) sources of stigma; (3) intervention types; (4) intervention delivery modes; (5) stigma-related aspects and stigma mitigation strategies; and (6) recruitment strategies.
Results
An overview of the search and the selection process can be found in Figure 1. After removal of duplicates, a total of 1200 records identified through database search were screened for inclusion, yielding 26 articles. Of those 26 articles, 21 were scientific reports and five were study protocols. In addition, we identified five gray literature sources as relevant to our review (Bundesamt für Gesundheit BAG, 2019; Jacobshagen, 2020; Kessler & Bürgi, 2019; Seifert et al., 2020; Weber, 2022). From the identified studies, eleven scientific reports and four of the study protocols were randomized controlled trials, four scientific reports and one study protocol were intervention studies without a control group, two scientific reports were qualitative studies, one scientific report was a position paper, and one scientific report was a non-randomized trial (see Table 2). Of the 26 included studies, six reported only on mental health outcomes, 14 only on cognitive functioning outcomes, and six on both.
Table 2
Overview of scientific studies included in the desk review.
| ARTICLE | NUMBER OF PARTICIPANTS | MEAN AGE | TYPE OF INTERVENTION | INTERVENTION DURATION | OUTCOME | STUDY DESIGN | DELIVERY LOCATION | SETTING | SOCIAL INTERACTION |
|---|---|---|---|---|---|---|---|---|---|
| Adcock et al. (2019) | 21 | 75.69 | Multidomain intervention | 8 weeks | CF (+) | Intervention study (pilot study) | On site | Individual | Independent |
| Adcock et al (2020a) | 31 | 73.85 | Exergame | 16 weeks | CF (+) | RCT | At home (digital) | Individual | Independent |
| Adcock et al. (2020b) | 19 | 71.40 | Exergame | 7 weeks | CF (+) | Intervention study (pilot study) | On site | Individual | Independent |
| Belleville et al. (2023) | 110 | 71.33 | Exergame | 26 weeks | CF (+) | RCT | At home (digital) | Individual | Independent |
| Brasser et al. (2022) | 82 | 71.54 | Multidomain intervention | 5/10 weeks | MH (+), CF (+) | RCT | At home (digital) | Individual | Independent |
| Dziemian et al. (2021) | 20 | 69.07 | Cognitive training | 4 weeks | CF (+) | RCT | At home (digital) | Individual | Independent |
| Kipfer et al. (2024) | 22 | 67.40 | Psychoeducation | 6 weeks | MH (+) | Non RCT | On site | Group | Supervised |
| Kliesch et al. (2022) | 61 | 68.40 | Language training | 30 weeks | CF (+) | Non RCT | On site & at home (digital) | Individual & group | Independent & supervised |
| Krebs et al. (2021) | 59 | 71.70 | Transcranial stimulation + cognitive training | 5 weeks | CF (+) | RCT | On site | Individual | Independent |
| Lenouvel et al. (2022) | NA | NA | Multidomain intervention | NA | MH+ | Position paper | On site & at home (digital) | Individual & group | Independent & supervised |
| Najberg et al. (2021) | 57 | 67.08 | Cognitive training | 3 weeks | CF (+), MH (-) | RCT | On site | Individual | Independent |
| Neumann et al. (2018) | 12 | 70.27 | Exergame | 12 weeks | MH (-) | Intervention study | At home (digital) | Individual | Independent |
| Ringgenberg et al. (2022) | 12 | 75.70 | Exergame | NA | CF+ | Qualitative study | At home (digital) | Not reported | Not reported |
| Schättin et al. (2019) | 42 | 67.23 | Exergame | 10 weeks | CF (+) | RCT | On site | Individual | Supervised |
| Schmitt et al. (2023) | 62 | 69.54 | Speechtraining | 3 weeks | CF (+) | RCT | At home (digital) | Individual | Independent |
| Seinsche et al. (2023) | 18 (7 Swiss) | 72.00 | Exergame | NA | CF | Qualitative study | At home | Individual | Independent & supervised |
| Studer-Luethi et al. (2021) | 542 | 71.47 | Multidomain intervention | 5 months | CF (+), MH (+) | Cross-sectional study | At home (digital) | Individual & group | Independent & supervised |
| Studer-Luethi et al. (2023) | 78 | 70.50 | Cognitive training | 4 weeks | CF (+) | RCT | At home (digital) | Individual | Independent |
| Thalmann et al. (2021) | 13 | 80.50 | Multidomain intervention | NA | CF+ | Qualitative study | On site | Individual | Independent |
| Tinello et al. (2023) | 34 | 70.84 | Multidomain intervention | 10 weeks | CF (+) | RCT | On site | Individual | Independent |
| Zuber et al. (2021) | 90 | 64.10 | Cognitive training | 3 weeks | CF (+), MH (-) | RCT | At home (digital) | Individual | Independent |
| Belleville et al. (2020)* | 128 | NA | Multidomain intervention | 26 weeks | CF, MH | RCT | On site & at home (digital) | Individual & group | Independent & supervised |
| Brodbeck et al. (2022)* | 85 | NA | Psychol. intervention | 10 | MH | RCT | At home (digital) | Individual | Independent & supervised |
| Ledermann et al. (2021)* | 30 | NA | Psychol. intervention | 8 weeks | MH | Intervention study | At home (digital) | Participant + caregiver/ nurse | Independent |
| Pereira et al. (2023)* | 30 | NA | Psychol. intervention | 5 weeks | CF, MH | RCT | At home (digital) | Participant + caregiver/ nurse | Supervised |
| Van Velsen et al. (2020)* | 315 | NA | Psychol. intervention | NA | MH | RCT | On site | Individual | Independent & supervised |
[i] Note. NA = not applicable; CF = cognitive functioning; MH = mental health; (+)/(-) = beneficial effect/no beneficial effects of the intervention; psychol. Interventions were based on strategy- and process-based principles and includes psychoeducational activities; Articles marked with * are study protocols; all other articles are scientific reports. Outcomes marked with + means that no outcomes were measured but potential effects on possible outcomes were discussed.
Figure 1
Desk review flowchart
Note. *A single article might fall under various exclusion criteria.
Groups at risk for vulnerability
The majority of studies (n = 16) considered older adults to be, generally, a vulnerable population and focused on them without targeting a specific subpopulation. The remaining studies (n = 10) investigated specific situational vulnerabilities (Table 3). In particular, these studies focused on pre-frail older adults (Belleville et al., 2020, 2023), mobility-impaired older adults (Thalmann et al., 2021), older adults with fear of falling (Lenouvel et al., 2022), older adults affected by age-related hearing loss (Schmitt et al., 2023), older adults with chronic pain (Ledermann et al., 2021), older adults developing a prolonged grief disorder (Brodbeck et al., 2022; van Velsen et al., 2020), and older adults who are family caregivers (Kipfer et al., 2024).
Table 3
Information endorsing the selection of groups at risk for vulnerability according to adversity and stigma.
| GROUPS AT RISK FOR VULNERABILITY | TYPES OF ADVERSITY | TYPES OF STIGMA | |
|---|---|---|---|
| 1 | Older adults in general | Decline in cognitive functions (Brasser et al., 2022; Dziemian et al., 2021; Kliesch et al., 2022; Krebs et al., 2021; Najberg et al., 2021; Schättin et al., 2019; Seinsche et al., 2023; Studer-Luethi et al., 2021, 2023; Tinello et al., 2023; Zuber et al., 2021) | |
| Decline in physical abilities and physical health (Adcock et al., 2019; Adcock et al., 2020a, Adcock et al., 2020b; Neumann et al., 2018; Ringgenberg et al., 2022; Schättin et al., 2019; Seinsche et al., 2023) | Self-stigma (Adcock et al., 2019) and public stigma (Adcock et al., 2019; Neumann et al., 2018) | ||
| Impaired mental health (Krebs et al., 2021; Najberg et al., 2021; Seinsche et al., 2023) | |||
| 2 | Pre-frail older adults | Frailty risk state associated with one or two of the following criteria: unintentional weight loss; weakness or poor handgrip strength; self-reported exhaustion; slow walking speed; and low physical activity (Belleville et al., 2020, 2023) | Public stigma (Belleville et al., 2023) |
| 3 | Mobility impaired older adults | Mobility limitations are usually accompanied by physical and cognitive decline and can be further associated with gait changes, which might be the reason for the increased risk of falling (Thalmann et al., 2021) | Self-stigma and public stigma (Thalmann et al., 2021) |
| 4 | Older adults with fear of falling | Lasting concern about falling that leads to an individual avoiding activities that they could otherwise perform (Lenouvel et al., 2022) | Self-stigma and public stigma (Lenouvel et al., 2022) |
| 5 | Older adults affected by age-related hearing loss | Hearing loss (Schmitt et al., 2023) | |
| 6 | Older adults with chronic pain | Chronic pain (Ledermann et al., 2021) | Self-stigma (Ledermann et al., 2021) |
| 7 | Polymedicated older adults | Multiple chronic conditions (Pereira et al., 2023) | |
| 8 | Older adults developing a prolonged grief disorder | Older adults developing experiencing divorce or marital bereavement (Van Velsen et al., 2020; Brodbeck et al., 2022) | Self-stigma and public stigma (Van Velsen et al., 2020) |
| 9 | Older adults as family caregivers for people with dementia | Physical, emotional, social, and financial challenges (Kipfer et al., 2024) | Self-stigma and public stigma (Kipfer et al., 2024) |
We identified three dimensions of older adults’ risks of vulnerability: cognitive functions, physical abilities and health, and mental health. A first risk factor for vulnerability in later adulthood is represented by a decline in cognitive function and the risk of developing dementia (Brasser et al., 2022; Dziemian et al., 2021; Krebs et al., 2021; Najberg et al., 2021; Schättin et al., 2019; Studer-Luethi et al., 2021, 2023; Tinello et al., 2023; Zuber et al., 2021). This risk factor includes age-related declines in processing speed (Studer-Luethi et al., 2023) and executive functions (Schättin et al., 2019), in particular, working memory (Dziemian et al., 2021; Zuber et al., 2021) and inhibitory control (Najberg et al., 2021; Tinello et al., 2023).
A second risk factor for vulnerability in old age relates to a decline in physical abilities, such as reduction in movement ranges, muscular strength, and endurance (Neumann et al., 2018). Degenerative changes in motor and sensory systems entail difficulties in the performance of daily activities, including gait issues, falls, injuries, and mobility restrictions (Adcock et al., 2019; Adcock et al., 2020a; Adcock et al., 2020b; Ringgenberg et al., 2022). Lenouvel et al. (2022) further discussed fear of falling as a critical risk factor for vulnerability, associated with social, functional, physical, and psychological symptoms. In this regard, other studies also identified pre-frailty – a state of functional decline which can lead to loss of autonomy and functional capacity (Belleville et al., 2020, 2023), and mobility limitations as risk factors for older adults (Thalmann et al., 2021). Another risk factor for vulnerability in the physical health domain is hearing loss (Schmitt et al., 2023), the most prevalent sensory impairment in older adults, which, when untreated has been linked to depression, reduced quality of life, and increased risk for dementia. Similarly, chronic pain was identified as a complex problem for many older adults that affects both physical functioning and psychological well-being (Ledermann et al., 2021). Furthermore, older adults might be affected by multiple chronic health conditions, which can increase the risk of medication-related problems and adverse health outcomes, with potential repercussions on physical and cognitive functioning (Pereira et al., 2023).
A third risk factor for vulnerability identified in the literature relates to a deterioration of older adults’ mental health. In particular, two studies focused on prolonged grief. When older adults lose their partner, they often lose the most important person in their life. Some of them develop severe or persistent grief symptoms, with a clinical diagnosis of a prolonged grief disorder or other mental health issues such as depression and post-traumatic stress disorder (Brodbeck et al., 2022; van Velsen et al., 2020). Another study focused on older adults as family caregivers of people with dementia (Kipfer et al., 2024). Caring for a person with dementia often brings chronic stress and high personal burden, leading to physical, emotional, social, and financial challenges. Family caregivers must navigate behavioral changes in their loved ones, take on new responsibilities, and plan for the future, yet many feel unprepared and lack the necessary caregiving skills.
Two grey literature sources pointed out that aging in Switzerland can be divided into two phases, the so-called third age, which is characterized by high life satisfaction an active participation in social life, and the fourth age, which is more likely associated with vulnerability because there is an increase in health issues and a higher need of care (Jacobshagen, 2020; Weber, 2022). It was further emphasized that older adults are a very heterogeneous group. Health is not equally distributed in old age and depends on a series of factors such as education, income, gender, and migratory status, which might contribute to older adults’ vulnerability (Weber, 2022).
Sources of stigma
Only eight studies addressed stigma-related issues concerning older adults. Among these, six studies discussed stigma originating from public institutions and the community (Adcock et al., 2019; Belleville et al., 2023; Kipfer et al., 2024; Lenouvel et al., 2022; Neumann et al., 2018; Thalmann et al., 2021), five highlighted the individual (Adcock et al., 2019; Kipfer et al., 2024; Ledermann et al., 2021; Lenouvel et al., 2022; van Velsen et al., 2020), and two studies further mentioned health professionals (Lenouvel et al., 2022; Thalmann et al., 2021). Both individualized and public stigma was also addressed in the report from Health Promotion Switzerland (Bundesamt für Gesundheit BAG, 2019), which was included as a grey literature source in the review.
Several articles identified elements of self-stigma as the main source of stigma, by which older people internalize negative stereotypes. For example, Lenouvel et al. (2022) argued that older adults might deny or underestimate the risk of falling and the presence of fear of falling. They are fatalist, and their resigned passivity, such as feeling too old to start, makes them less likely to participate in interventions. In addition to stigmatizing themselves, from a social perspective older adults might be reluctant to participate in mental health interventions because they fear stigmatization by others (Bundesamt für Gesundheit BAG; 2019, Ledermann et al., 2021; Lenouvel et al., 2022). Family caregivers often feel they are not allowed to express negative feelings about their caregiving responsibilities or to ask for support, as they feel guilty about distancing themselves from the person with dementia (Kipfer et al., 2024).
Public institutions and the community are other identified sources of older adults’ stigma. This can be in terms of inaccessible information, lack of services and resources, costly interventions, and the lack of federal directives specific for the old age (Adcock et al., 2019; Bundesamt für Gesundheit BAG, 2019; Ledermann et al., 2021; Lenouvel et al., 2022). Another element of stigma that emerged from the studies relates to older adults’ mobility. Face-to-face interventions are less accessible to older adults living in remote areas with no or scarce access to community resources and to older adults with mobility impairments (Belleville et al., 2023).
Concerning the stigma coming from health professionals, Lenouvel et al. (2022) highlighted that physicians are sometimes pressed for time or lack of resources and vary in their attitudes towards mental health. Furthermore, it is also unfortunately common for health professionals to infantilize their older patients (Jacobshagen, 2020; Zhang et al., 2020). This translates to health providers using “elderspeak” (i.e., speaking slowly, with simple sentences like one would do with a child), not taking the time to explain the situation to the patient (e.g., giving a medication without explaining why or what are the risks and benefits), or ignoring the patient and mainly asking questions to their children or younger caregivers. This may constitute a barrier to older adults’ participation in interventions and restrict individuals’ motivation to seek professional help. Furthermore, health promotion and prevention measures tend to more easily reach groups of the population with a medium or high socio-economic status (Bundesamt für Gesundheit BAG, 2019).
Intervention types
The studies reported on a diverse range of intervention types. For intervention targeting mental health, two studies reported results from cognitive trainings (Najberg et al., 2021; Zuber et al., 2021), two from multimodal interventions targeting different lifestyle factors and cognitive training (Brasser et al., 2022; Stueder-Luethi et al., 2021), and one from a physical exergame training (Neumann et al., 2018). Two protocol studies described cognitive behavioral therapy inspired intervention to support acceptance of the loss of a spouse (or divorce) and adaptation to a new life in older adults showing prolonged grief symptoms (Brodbeck et al., 2022; van Velsen et al., 2020). The third study protocol described a combined physical and cognitive training (Belleville et al., 2020), while the last protocol study described a psychoeducational intervention for teaching self-management of pain and reducing pain-related disability in older adults with chronic pain (Ledermann et al., 2021).
Regarding interventions targeting cognitive functioning, cognitive trainings and multimodal interventions were the most frequently applied approaches (with five and seven articles respectively, see Table 1), whereas physical activity or exercise, isolated exergames, bio- and neurofeedback each were only applied within one of the articles. Four of the seven multimodal interventions included exergaming in combination with other interventions (e.g., nutritional supplements, cognitive training, Tai-Chi, and dancing), whereas the remaining three relied on combinations of other modalities. Further interventions aiming to improve cognitive functioning were transcranial stimulation (Krebs et al., 2021), a Spanish language training (Kliesch et al., 2022), and a multicomponent interprofessional intervention for which informal caregivers and health care professionals supported older adults to reduce medication-related problems (Pereira et al., 2023).
Intervention efficacy
Efficacy depended on the intervention type and varies for mental health and cognitive functioning outcomes. For cognitive functioning, all included studies that assessed the efficacy of the intervention found benefits (see Table 2) – at least for certain target outcomes, typically in the domains that were trained, or in participants’ evaluation of the intervention. Performance improvements were observed in cognitive domains such as memory, attention, and executive functions (inhibitory control, working memory, cognitive flexibility), and even in global cognition.
For mental health outcomes, the picture looks more heterogeneous. Cognitive training interventions alone did not significantly improve mental health as reported by Najberg et al. (2021) and Zuber et al. (2021), who found no sizable improvements on impulsivity, depression, anxiety or stress after training. Only a negligeable improvement for quality of life was found by Najberg et al. (2021) in the classic working memory training group, whereas participants from the gamified cognitive training intervention showed a slight decline in quality of life. Similarly, an intensive exergaming training targeting daily tasks at home for at least 18 hours over twelve weeks did not show any improvement on subjective quality of life or restrictions to their participation in everyday living (Neumann et al., 2018). In contrast, multimodal interventions, targeting both lifestyle factors and cognitive training, proved successful in improving mental health. A first, cross-sectional, study from Stueder-Luethi et al. (2021) showed that participants who underwent a five-month long educational program targeting (1) physical health; (2) cognitive training; (3) social activity; (4) mindfulness; (5) creativity delivered through digital technologies at home subjectively reported that this improved their well-being and their confidence in their brain’s ability to still learn and perform well. Brasser et al. (2022) then followed up on this study using a randomized controlled single-blind trial design to compare the efficacy of a multimodal intervention to a classical cognitive training and a waitlist control group. Although all three groups decreased their stress levels in the first five weeks of the intervention, this improvement was stronger for the multimodal intervention.
Intervention delivery modes
The studies assessed included a broad range of delivery modes varying in terms of delivery location, setting, and social interaction.
Delivery location
Fourteen of the reviewed studies included intervention approaches that were or will be exclusively administered within participants’ homes (n = 14, see Table 2). In contrast, ten studies included intervention approaches that were or will be exclusively delivered on site, typically in university laboratories. In three studies a hybrid approach was or will be implemented, with some intervention components conducted at home and others on-site (see Table 2). Specifically, Belleville et al. (2020) provided comprehensive introduction sessions in the laboratory, followed by at-home intervention. Kliesch et al. (2022) and Lenouvel et al. (2022) included a mix of at-home and on-site training sessions.
Setting
Among the examined studies, there was a noteworthy divergence in the settings in which the interventions were or will be implemented. The predominant approach in most studies involved individualized intervention delivery, wherein participants take on a self-managed role (n = 16, see Table 2). Participants typically had a degree of flexibility in determining the timing of task execution, with the primary requirement being adherence to prescribed session frequencies and durations. In two studies, the intervention was conducted in an individual setting, however the sessions took place on-site in small groups (Krebs et al., 2021; Schättin et al., 2019). In the study by Schättin et al. (2019), for example, several participants were invited to the laboratory at the same time to carry out their training sessions individually on a separate exergame device. In only one study, the intervention was conducted entirely in a group setting on-site, with the purpose of fostering interaction (Kipfer et al., 2024). Furthermore, several studies have adopted, or are planning to adopt a hybrid approach, integrating both group and individual settings into their intervention protocol. These group settings exhibit variability in their composition and structure. In some studies, the group setting consisted of a group of participants or participants were asked to engage with friends or family members (Kliesch et al., 2022; Lenouvel et al., 2022; Studer-Luethi et al., 2021), in other studies the reported group setting included the participant alongside a research nurse and/or an informal caregiver (Ledermann et al., 2021; Pereira et al., 2023). In one study, only the comprehensive introductory sessions take place in groups, while the subsequent training sessions are conducted individually (Belleville et al., 2020).
Social interaction
Regarding the incorporation of social interaction within the context of the interventions, it is noteworthy that 15 studies adopted an approach without social interaction (see Table 2). In these studies, the intervention protocols were structured such that tasks and exercises were performed independently by each participant. In contrast, only three studies reported that they exclusively incorporated social interaction within a laboratory environment (Kipfer et al., 2024; Pereira et al., 2023; Schättin et al., 2019). Five studies adopted a more comprehensive approach, encompassing both individual activities and activities that take place in online group settings (Belleville et al., 2020; Brodbeck et al., 2022; Seinsche et al., 2023; Studer-Luethi et al., 2021; van Velsen et al., 2020), often facilitated through mediums such as chatrooms, as exemplified in the work by Belleville et al. (2020). One study reported including both individual activities and social interaction in present in their intervention program (Kliesch et al., 2022) and one study reported including all three, individual activities, social interaction online and social interaction in present (Lenouvel et al., 2022).
Barriers and facilitators
Since nearly all studies reported beneficial effects in either the cognitive outcomes or the mental health outcomes, no conclusion can be drawn concerning whether beneficial effects are specific to the different delivery modes. However, some studies discussed the facilitators and barriers of different delivery modes, even if only to a limited extent. For instance, certain studies have pointed out that the use of computerized remote approaches, which allow interventions to be conducted entirely in the participants’ homes, may reach a larger audience than face-to-face interventions in the laboratory. Self-administered in-home interventions therefore can be facilitators because they are cost-effective in the long term, they increase accessibility and flexibility, and they allow for the personalization of activities (Belleville et al., 2023). In contrast, barriers were especially discussed for delivery modes at home with digital devices such as exergames, including technical issues during the intervention activities (Adcock et al., 2020b), general discomfort with technology (Ledermann et al., 2021; Ringgenberg et al., 2022; Thalmann et al., 2021), and fear of feeling unsafe while performing the activities. Health Promotion Switzerland (Weber, 2022) highlighted that for the delivery of interventions in Switzerland, and therewith also the modes of delivery, a variety of factors play a role. Municipal administrations as well as cantonal and federal governments are particularly involved in planning, coordination, and financing. Meanwhile, non-governmental organizations such as Pro Senectute, Caritas, and regional health leagues play a primary role in the implementation of interventions. For successful implementation, good collaboration among all actors is crucial.
Health Promotion Switzerland (Weber, 2022) also noted that digital technology is increasingly being used by older adults, although there are age-related and sociocultural differences. In 2019, 95% of people aged 65 to 69 used the internet regularly (several times per week). However, frequency of use decreases with age, and particularly individuals aged 80 and older use these technologies less frequently. In addition to age, education, income, and interest in technology also influence internet use (Seifert et al., 2020). People with lower educational status, lower income, and little interest in technology are among the infrequent internet users. The main reasons for not using the internet in old age include security concerns and the belief that use is too complicated or learning to use the internet is too difficult. Costs are less of a factor. A similar pattern is observed for the use of smartphones and tablets. In 2019, 64% of people used a smartphone, and 40% used a tablet. Here, too, there is a difference between younger and older individuals (Seifert et al., 2020). While the use of wearables (e.g., smart watches, bracelets) is increasing, it is still significantly lower than for younger people. Only 8% of people over 65 use a fitness tracker, and only 3% use a smartwatch (Seifert et al., 2020).
Stigma-related aspects and stigma mitigation strategies
As seen in the section on vulnerability above, the promotion of mental and cognitive health can encounter several challenges, among which age-related stigma plays a central role. However, it is also possible to identify effective practices to prevent or reduce the stigma experienced by older adults. In particular, the studies included in the current desk review pointed to the use of strategies that do not reinforce the age stereotype and support older adults, such as the provision of transcripts for individuals with a hearing impairment, a simple layout of written materials, no time restrictions, and orientation sessions where older adults can learn to navigate the materials of the intervention (Ledermann et al., 2021). Another key aspect highlighted by Ringgenberg et al. (2022) was the importance of social interactions, both with the person leading the intervention and with other older adult peers with whom they can confront experiences and build a feeling of connectedness.
A key element that emerged from the literature relates to the promotion of equity, diversity, and inclusion. Considering the heterogeneity among older people, it is important to promote a differentiated image of older age, particularly in social debate, in professional contexts that are in direct contact with older people, but also among older people themselves and in their social context (Weber, 2022). The design of interventions targeting older adults should focus on the high inter-individual variability in later adulthood, including differences in health and sociodemographic characteristics, and the development of personalized interventions and adapt activities to the age, needs, and wishes of the participants (Belleville et al., 2023; Neumann et al., 2018). Similarly, a gamification of the interventions can increase older adults’ motivation (Ringgenberg et al., 2022). Neumann et al. (2018) also recommended the use of new technologies, such as communication technologies and digital electronics, to facilitate cooperative care and training between older individuals and their nonprofessional caregivers. The use of technological devices was discussed both as a barrier and facilitator of interventions for older adults. On the one hand, older adults can struggle with the use of new technologies and can be reticent to use them (Seinsche et al., 2023). On the other hand, however, digital and remote interventions confer similar benefits as in-person interventions but can reach a larger audience (Ledermann et al., 2021). Furthermore, they are cost-effective in the long-term (Belleville et al., 2023). Therefore, it is important to use digital media wisely: while they are becoming an integral part of older adults’ daily life, analog solutions should be made available to the so-called offlliners (Weber, 2022).
Different authors also highlighted the relevance of a co-creation phase preceding the intervention, where older adults can contribute to the design of the activities (Ledermann et al., 2021; Neumann et al., 2018). For example, Neumann et al. (2018) involved older adults in the design of the exercises used in their interventions and older adults appreciated this cooperative approach. That is, older people and other stakeholders should be involved as early as possible, during the conception and planning stage, and continue to do so during the implementation and evaluation of the intervention (Bundesamt für Gesundheit BAG, 2019). Furthermore, Brasser et al. (2022) discussed the importance of a multimodal intervention, which can be combined easily with other daily activities. In particular, they pointed to the relevance of an autonomy-supportive, psychoeducational approach targeting age-stereotypes, in light of the association between positive attitude and a slower and smaller amount of cognitive decline. Mental health, physical activity and cognitive functioning are closely related, suggesting that they can promote each other. Therefore, it seems important to develop holistic interventions that consider and promote these interactions. Finally, it is important to support the transition from the third to the fourth age and the progressive decline and increasing frailty that characterize the fourth age, strengthen interpersonal relationships, and enhance structural measures, as a person’s individual resources are closely related to the environmental resources (Gesundheitsförderung Schweiz, 2022).
Recruitment strategies
Recruitment of participants was done by a broad range of recruitment endeavors. In ten out of 25 studies, participants were and will be recruited with the help of/within different senior organizations including (1) consulting and service organizations for older adults such as “Senioren- und Selbsthilfe-Organisationen der Schweiz” (VASOS) and “Pro Senectute” (Belleville et al., 2020; Neumann et al., 2018); (2) communities for older adults such as the “pensioner community ETH Zurich” (Adcock et al., 2019; Adcock et al., 2020b), sport and leisure clubs for older adults (Kliesch et al., 2022; Zuber et al., 2021), self-help groups (Kliesch et al., 2022), and senior universities (Brasser et al., 2022; Kliesch et al., 2022; Schättin et al., 2019; Seinsche et al., 2023); and (3) senior residencies/nursing homes (Brasser et al., 2022; Schättin et al., 2019). Seven studies reported that they recruited or will recruit their participants with the help of/in a variety of primary and secondary care services including (1) clinics (Adcock et al., 2020a); (2) physiotherapist (Adcock et al., 2020a; Thalmann et al., 2021); (3) rehabilitation centers (Ringgenberg et al., 2022); (4) memory clinic (Belleville et al., 2023); (5) or not further specified (Brodbeck et al., 2022; Pereira et al., 2023).
Therefore, the type of recruitment was mostly not further specified. Only Brasser et al. (2022) and Schättin et al. (2019) reported using flyers, and Brasser et al. (2022) additionally using a newsletter. In seven studies, participants were or will be recruited by public advertisement in local newspapers (Adcock et al., 2019; Adcock et al., 2020a; Adcock et al., 2020b; Brodbeck et al., 2022; Kliesch et al., 2022; Thalmann et al., 2021), in supermarkets (Adcock et al., 2020a), in public transportation (Zuber et al., 2021), on websites (Kliesch et al., 2022), or on social media (Brasser et al., 2022; Brodbeck et al., 2022; Ledermann et al., 2021; Zuber et al., 2021). Two studies reported recruiting participants by word-of-mouth, such as through friends (Brasser et al., 2022; Studer-Luethi et al., 2023), and one study reported reviewing patient lists to find eligible participants (Ringgenberg et al., 2022). Five studies did not report how they did or plan to do the participant recruitment (Krebs et al., 2021; Lenouvel et al., 2022; Schmitt et al., 2023; Studer-Luethi et al., 2021; van Velsen et al., 2020).
Almost no information was reported on the effectiveness of the recruitment strategies. Only Neumann et al. (2018), who recruited their participants using the VASOS, reported that they had recruitment problems in Switzerland because the older adults considered themselves independent and fit (Neumann et al., 2018). Health Promotion Switzerland (Kessler & Bürgi, 2019) pointed out that for health promotion and prevention programs, the recruitment of older men is especially difficult and differ from the recruitment of older women. Thereby, several approaches seem to be effective. The peer approach via typical “male settings” such as (senior) organizations or clubs, and family members have proven particularly effective. Likewise, addressing them through general practitioners or other professionals, as well as access via the media, are suitable methods.
Moreover, older men should be particularly addressed following significant social or health changes. Without support, they often change their behavior permanently at such moments, to the detriment of their health. Many men have fewer coping strategies in stressful situations and are less able to express their feelings than women. However, it is precisely in such situations that they are more receptive to support. The aspect of language is also central. “Psycho-language” (the use of psychological terminology) is generally not well-received by healthy men aged 65 and over. It is recommended to use terms such as “lectures,” “health management,” or “training” instead of “courses,” “prevention,” or “exercise.” In communication with older men, conveying simple technical solutions has proven effective. However, the message should not only be dry and factual, but should also emphasize the pleasure and fun factor. Emphasizing aspects of “activity,” “performance,” and “movement” tends to be well-received. Furthermore, men should be directly addressed in the offer advertisement. Terms like “age” or “older men” can be a deal-breaker in the promotion of an offer. This should also be taken into account in the visual language of advertising materials and presentations (Kessler & Bürgi, 2019).
Discussion
This desk review examined international scientific studies published in the last seven years that included Swiss samples, as well as national grey literature, focusing on the key components of interventions intended to support mental health and cognitive functioning in older adults. In doing so, it is the first to provide evidence directly relevant to designing intervention scenarios and stigma mitigation strategies for interventions targeting mental health and cognitive functioning in older adults living in Switzerland.
To summarize the results of the review, three dimensions of risk for vulnerability in older adults were identified: cognitive functions, physical abilities and health, and mental health. It also highlights that the stigmatization of older adults is a persistent issue. Stigmatization manifests as both self-stigma, where older adults internalize negative age-related stereotypes, and public stigma, often stemming from limited services and infantilizing attitudes (Levy, 2009). The review further found that cognitive and multimodal interventions are commonly employed to support older adults, each offering potential benefits for cognitive health, resilience, and overall well-being. Cognitive training interventions tend to improve specific domains such as memory and attention, while multimodal interventions – including components like physical activity, social engagement, and cognitive exercises – provide a more comprehensive approach that addresses both mental and cognitive health. Intervention delivery methods varied widely, with home-based, on-site, and hybrid models used to accommodate diverse needs. However, access barriers such as stigma and digital literacy challenges persisted. To reduce stigma, the review suggests strategies such as adapting interventions and materials to meet older adults’ needs (e.g., using simple layouts and offering orientation sessions) while avoiding reinforcement of age-related stereotypes. Including older adults in the intervention design process and facilitating social interactions to share experiences were also found to be beneficial. Although the review provides limited data on the effectiveness of different recruitment strategies, it recommends using inclusive language and avoiding stigmatizing terminology when engaging older adults in interventions.
In terms of vulnerability, the populations of older adults included in the studies were primarily characterized by three types of risk factors for vulnerability: (1) cognitive functions, (2) physical abilities and health, and (3) mental health. However, findings further suggest that individual characteristics such as education, income, and sex might also contribute to older adults’ vulnerability. For instance, the high out-of-pocket expenditures in Switzerland can act as a barrier to accessing appropriate healthcare, causing individuals with lower income to avoid preventive healthcare for economic reasons (Guessous et al., 2012; Moreno-Serra & Smith, 2012). This might differ for countries that have more extensive public funding models, such as those in Scandinavia, where financial barriers to healthcare access are generally lower.
The heterogeneity and also the interrelationship and transient nature of vulnerability, aligns with the literature. Sanchini et al. (2022), for example, highlighted in their review on the concept of vulnerability in aged care that vulnerability is not a fixed condition but rather one that encompasses varying degrees. They suggest that the same person, or category of individuals, may be situationally vulnerable in some contexts but not in others. Furthermore, vulnerability can increase or decrease over time as individuals acquire or lose additional factors contributing to their vulnerability throughout life.
The results of the review are further in line with different theoretical frameworks on aging and age-related vulnerability. For instance, the World Health Organization describes healthy aging as the process of developing and maintaining the functional capacity that enables well-being in older age. Thereby, functional capacity includes intrinsic capacity, described as the sum of all of an individual’s physical and mental capacities along with relevant environmental characteristics, and the interactions between the individual and these characteristics (Beard et al., 2016; Cesari et al., 2018; Michel et al., 2021). Similarly, models focusing on mental and cognitive health emphasize the importance of distinguishing between functional capacity/outcome behavior and age-related neurobiological states/changes (Cullati et al., 2018; Ihle et al., 2023; Stern, 2006, 2009). These models underscore the significance of building reserves throughout the lifespan to maintain functional capacity and consider the impact of environmental circumstances and adversities. In accordance with those theoretical frameworks, vulnerability in older age is suggested to be a transient state (rather than a trait), resulting from inadequate reserve accumulation across various life domains, the individual’s ability to activate reserves, and environmental circumstances.
To conclude, accurately assessing an individual’s degree of vulnerability involves more than identifying a single overarching factor. Instead, it requires a thorough evaluation of various risk factors for vulnerability and their manifestations, which occur along a continuous spectrum at the individual level and at a specific point in time. In addition, as risk factors for vulnerability often accumulate (Bodenmann et al., 2015), further attention should be given to their combined impact.
Regarding stigma, the studies included in the review primarily focused on aspects of age-related stigma, covering both self-stigma (e.g., internalizing negative stereotypes) and public stigma (such as lack of resources, inaccessible information, and tendencies to infantilize or patronize older adults). This aligns with the international literature, which suggests that merely being of a certain age can lead to stereotyping and stigma (Allen & Sikora, 2023; Hausknecht et al., 2020; Martinson & Berridge, 2015). This phenomenon, known as ageism, is one of the most widespread and accepted forms of prejudice globally (Palmore, 2001; World Health Organization, 2021). Additionally, it is important to recognize that mental health issues are significant sources of stigma. As a result, older individuals dealing with mental health issues might face a compounded burden and may be particularly stigmatized (Graham et al., 2003).
It is important to note that, although ageism is a global phenomenon, it encompasses different aspects of age discrimination that vary across countries and cultures (Kim et al., 2021; Schuurman et al., 2022). For example, Kim et al. (2021) examined structural age discrimination in 15 OECD countries and found that Turkey was the most likely, while South Korea was the least likely to practice age discrimination in the workplace. However, South Korea had the highest score for discrimination against seniors based on economic status. Consequently, stigma-mitigation strategies may require a careful analysis of country-specific sources of stigma. It is also noteworthy that none of the studies included in this review specifically assessed or analyzed stigma.
Process-based cognitive training and multidomain interventions were applied to enhance both cognitive functioning and mental health. For mental health specifically, additional interventions included techniques inspired by cognitive behavioral therapy and psychoeducational elements. While all intervention types were effective for cognitive outcomes, multimodal interventions appeared to be the most effective in improving mental health. These findings align with the international literature, which provides meta-analytic evidence that multidomain interventions may be beneficial in enhancing cognitive functioning, mental health, and overall intrinsic capacity (Gavelin et al., 2021; Guo et al., 2020; Karssemeijer et al., 2017; Liao et al., 2023; Rieker et al., 2022; Zhu et al., 2016). Regarding process-based cognitive training, research suggests that the transferability and broader benefits of these interventions may be relatively limited (Sala et al., 2019). Therefore, for public health interventions targeting cognitive functioning, multidomain interventions should be prioritized over standalone process-based cognitive interventions.
While several studies included in the review investigated the efficacy of interventions, only one focused on the implementation aspects of an intervention, examining factors such as the relationship between time investment and attitudes toward perceived benefits (Studer-Luethi et al., 2021). The study concluded that an autonomy-supportive lifestyle intervention for cognitive health, offering a selection of evidence-based exercises and activities, could increase both the frequency of cognitively stimulating activities integrated into daily life and improvements in perceived cognitive fitness and well-being. This aligns with findings from a rapid review of effective implementation approaches for healthy aging interventions conducted internationally (Owusu-Addo et al., 2021). Emerging from this review, key drivers of successful implementation were the use of behavioral change techniques, social interaction, tailoring interventions to individual needs, booster sessions, and a multi-component, multi-professional team approach to the design and delivery of interventions.
Behavior change techniques have been also investigated in various efficacy-interventions for healthy aging, demonstrating promising results in promoting and maintaining desired behaviors, such as increased physical activity or healthier eating habits, both at the end of the intervention and during follow-up stages (Ahmed et al., 2024; Lara et al., 2014). However, stage models of health behavior change highlight that each stage has distinct cognitive demands, necessitating tailored behavior change techniques for optimal effectiveness (Gollwitzer, 1990). The Transtheoretical Model (Prochaska & DiClemente, 1983), for example, outlines several distinct stages, ranging from being unaware of an issue (precontemplation) to taking action and maintaining the desired behavior. These theoretical frameworks underscore the importance of using tailored behavior change techniques that align with specific stages to facilitate the adoption and long-term maintenance of behaviors that promote cognitive functioning and mental health.
The studies in this review utilized a diverse array of recruitment strategies to engage participants, ranging from channels such as organizations and healthcare services serving older adults to methods such as word-of-mouth, friends, flyers, and social media. However, almost none of these studies provided information on the effectiveness of these methods. Only one gray literature source specifically addressed this topic, focusing on the recruitment of male participants. It suggested that using appropriate language and avoiding stigmatization are crucial for effectively recruiting male participants. However, Forsat et al. (2020) published a review on the recruitment and retention of older adults in clinical research, identifying significant barriers and offering solutions. They found several key reasons for poor recruitment of older adults: exclusion criteria, patients’ families or physicians often advising against participation, lack of interest, and transportation issues. Their results also showed that monitoring and adapting recruitment methods, along with a flexible research team and providing transportation, were helpful for initial recruitment. Effective strategies for maintaining high retention included financial incentives, regular updates about the study’s progress, low staff turnover, flexibility in scheduling appointments, and showing appreciation to participants through letters, gifts, and cards.
Research also states that to date, recruiting socially disadvantaged older individuals for health research remains a challenge, leading to their underrepresentation in trials due to multiple structural barriers (Buttgereit et al., 2021). This self-selection bias was also observed in the studies included in this review. In several studies, the average education duration was twelve years or higher, indicating that particularly well-educated individuals, potentially with higher economic status, participated in these studies. Proposed solutions deemed effective included spending more time maintaining close contact with participants, taking appropriate measures to show appreciation, and reimbursing travel expenses. It is reasonable to assume that the results found internationally are also applicable to the Swiss population.
The interventions in the review were implemented using a range of delivery modes, involving combinations of locations (on-site vs. digital) and formats (individual vs. group). Although most studies reported beneficial effects and frequently used a mixture of these modes, it is not possible to draw definitive conclusions about the specific benefits of each mode. While not the main focus of the studies, various facilitators and barriers were mentioned. Digital interventions, in particular, were highlighted for their advantages, including increased accessibility and flexibility, but also for disadvantages such as technical issues and discomfort with technology. The dual nature of this issue is also reflected in the international literature (Andrews et al., 2019; Boekhout et al., 2019; Essery et al., 2021). Andrews et al. (2019) showed in their qualitative study, which included interviews and interactive activities with various technologies to improve mental health in older adults, that older individuals were motivated to use technology to improve their well-being. However, they found also some barriers including fear of consequences and the impact of low mood on the readiness to engage with technology, as well as a lack of prior knowledge about digital technologies. Similar results were found by Essery et al. (2021), who outlined a theory-, evidence-, and person-based development of a multi-domain digital behavior change intervention to reduce cognitive decline among older adults. They concluded that a digitally delivered intervention with minimal support could be acceptable and potentially engaging for older adults with varying levels of cognitive performance if the content is tailored for acceptability and engagement.
Boekhout et al. (2019) compared web-based and digital-based interventions to promote physical activity in older adults to identify participant characteristics linked to preferences for web-based versus printed delivery modes and to explore any associations between delivery modes, participant characteristics, and attrition rates in an intervention. They found that 41% of participants chose the web-based delivery mode, indicating a potential interest among older adults with physical impairments in web-based interventions. However, higher attrition rates were observed in the web-based mode, with lower educational attainment identified as a predictor of attrition. Characteristics favoring the printed delivery mode included being older and having less social support. Although web-based delivery modes are generally less costly and easier to distribute, offering a printed option alongside the web-based mode might be advisable to avoid excluding a significant portion of the target population. Also group web-based intervention might offset some of the reluctance toward a tech-based intervention.
In terms of individual vs. group format, much of the international literature favors the group format for various types of interventions. These range from health promotion interventions targeting social isolation and loneliness (Cattan et al., 2005; Dickens et al., 2011) to physical activity interventions (Burke et al., 2006). This preference for group-based interventions is supported by evidence from social capital literature, which suggests that older adults who are more socially engaged tend to be healthier and experience better well-being. The benefit of social groups is often attributed to their role in shaping our sense of self, providing a sense of meaning, purpose, and direction (Haslam et al., 2015).
From both the Swiss and international literature, it might be concluded that different modalities are suitable for different populations. For example, for the average group, activities in a group setting often outperform individual-based activities. However, group-based interventions often lead to the exclusion of certain groups due to factors like mobility constraints or discomfort in group settings. In these cases, individual-based interventions might be more appropriate. Similarly, well-designed digital interventions could be most suitable for older adults who are familiar with digital devices, offering possibilities for individual adaptations and scalability. Given the relatively high digital literacy of older adults in Switzerland within a European context (Eurostat, 2024), leveraging digital platforms may be a particularly effective way to deliver interventions. However, it is important to provide alternative options for those who are less digitally inclined.
Promoting mental and cognitive health in older adults can face several challenges, with age-related stigma being a central issue. The reviewed studies suggest various strategies to combat stigmatization: employing a simple layout for materials, imposing no time restrictions, offering orientation sessions, encouraging social interactions both with the team and peers for experience sharing, promoting a differentiated image of old age, focusing on the high interindividual differences among older adults, thoughtful use of digital technology with paper-based alternatives, engaging in a co-creation process, and emphasizing the importance of multidomain interventions due to the close interrelation of mental health, physical functions, and cognitive functions. These measures align with the international literature, which advocates for multifaceted stigma mitigation strategies targeting different pathways (e.g., psychological, behavioral, and physiological), and includes strategies for prevention and combating stigma at various levels (the individual, educators, policy; Graham et al., 2003; Steward, 2022). Notably, it is suggested that interventions promoting successful and productive aging pursuits, such as physical activity, volunteering, technology use, and stress management, may already serve as effective means of stigma prevention (Steward, 2022).
Conclusion
This desk review highlights the complexity of addressing mental health and cognitive functioning among older adults in Switzerland. The studies reviewed provide valuable insights into various intervention strategies, yet also underline significant gaps in understanding the implementation processes and the contextual factors that influence these interventions. The evidence further suggests that while numerous interventions show promise in controlled settings, their real-world applicability and scalability remain underexplored. In conclusion, it is essential to develop tailored, multifaceted interventions that incorporate behavioral change techniques, social interaction, and personalization to individual needs. Additionally, addressing stigma and ensuring the inclusion of vulnerable groups are critical for the success of these interventions. Future research should focus on detailed implementation studies to better understand the practical aspects of delivering these interventions across diverse settings in Switzerland. By integrating international evidence with local knowledge, more effective and sustainable mental health and cognitive functioning interventions can be developed for Swiss older adults, ultimately enhancing their quality of life and well-being.
Transparency Statement
We reported how we determined the sample size and the stopping criterion. We reported all experimental conditions and variables. We report all data exclusion criteria and whether these were determined before or during the data analysis. We report all outlier criteria and whether these were determined before or during data analysis.
Additional Files
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Supplementary material S3
Guidelines for title and abstract screening. DOI: https://doi.org/10.5334/spo.81.s3
Acknowledgements
We would like to thank our student assistants, Doha Sadouk and Mathieu Zaugg, for their assistance during study screening and data extraction. We also extend our gratitude to the entire ADVANCE consortium – especially the members from Work Package 1, as well as Wietse Anton Tol and Falco Hüser – for their valuable feedback and discussions.
Funding Information
This work package has received funding from the Swiss State Secretariat for Education, Research and Innovation (SERI) and the EU Horizon Programme under Grant Agreement No. 101080323 (2023–2028).
Competing interests
The authors have no competing interests to declare.
Author contributions
Conceptualization: CF, MK, MM, CS, RT; Data curation: EJB, MM, CS, SZ; Formal Analysis: EJB, MM, CS, SZ; Funding Acquisition: MK, CS; Investigation: EJB, MM, CS, SZ; Methodology: CF, MK, MM, CS, RT; Project administration: MM; Resources: MM; Software: MM; Supervision: MK; Validation: EJB, MK, MM, CS, SZ; Visualization: MM; Writing Original Draft Preparation: EJB, MK, MM, CS, SZ; Writing Review & Editing: EJB, CF, MK, MM, CS, RT, SZ.