SENSE-Brain Health Pro for Older Adults With Sensory Loss (SENSE-BHPro)

SENSE-Brain Health Pro (SENSE-BHPro) is a prospective, multi-site study using a one-group pretest-post-test design with an embedded mixed-methods process evaluation. The study evaluates the accessibility, acceptability, usability, and outcomes associated with participation in the web-based Brain Health Pro (BHPro) program among older adults with self-reported hearing and/or vision difficulties.

Hearing and vision difficulties are common in older adulthood and are associated with increased risk of cognitive decline and dementia. Digital dementia prevention programs have the potential to reach large numbers of older adults; however, sensory difficulties may create barriers to accessing and engaging with digitally delivered interventions. The original BHPro program was not specifically implemented in a population selected for hearing and/or vision difficulties, and its accessibility and usability in this population have not been systematically evaluated. SENSE-BHPro addresses this gap by examining both intervention outcomes and the accessibility and implementation of BHPro for older adults with sensory difficulties.

Approximately 300 community-dwelling adults aged 55 years and older with self-reported hearing difficulties, vision difficulties, or combined hearing and vision difficulties will be recruited across Canada. Participants will have no self-reported diagnosis of dementia. Individuals who are cognitively unimpaired, report subjective cognitive concerns, or have mild cognitive impairment may participate if they otherwise meet the study eligibility criteria.

Participants will complete the BHPro program, a web-based multidomain psychoeducational dementia risk-reduction program. BHPro provides individualized feedback on potentially modifiable dementia risk factors and evidence-based educational content addressing lifestyle, vascular, psychosocial, and cognitive health domains. Participants receive a personalized risk profile, practical recommendations, and structured guidance intended to support goal setting and self-management. The core intervention is delivered progressively through structured online modules over six months.

Assessments will occur at screening, baseline, Month 3, and Month 6. The primary outcome is change in knowledge about Alzheimer's disease from baseline to Month 6, assessed using the Alzheimer's Disease Knowledge Scale (ADKS). Secondary and exploratory evaluations include self-efficacy, uptake of risk-reducing behaviours, psychological well-being, lifestyle factors, usability, acceptability, accessibility, and engagement with the intervention.

Accessibility is a central component of the study. Participants will receive information and guidance regarding accessibility features available within BHPro and on their own devices, such as captions, text magnification, contrast settings, and audio adjustments, as appropriate. Use of accessibility features and assistive technologies will be documented to better understand how participants with different sensory profiles engage with the digital intervention.

Outcomes and implementation experiences will also be examined across three sensory subgroups: participants with hearing difficulties, vision difficulties, and combined hearing and vision difficulties. The study will also examine individual characteristics that may influence engagement and outcomes, including sensory profile and severity, demographic characteristics, cognitive status, and the perceived functional effects of sensory difficulties.

An embedded process evaluation will examine recruitment pathways, participant engagement, adherence patterns, accessibility needs, barriers and facilitators to participation, and implementation considerations relevant to integrating BHPro within primary care and community-based settings serving older adults with hearing and/or vision difficulties. Findings are intended to inform future adaptations and implementation of accessible digital dementia risk-reduction programs.