Older Adults' Motivators and Barriers to Using Mindfulness Apps for Stress Management in Brain Health Interventions:...

Population aging is driving a rapid rise in dementia cases worldwide, posing a major challenge for health care systems around the globe, including in the Netherlands. Digital multidomain lifestyle interventions, which target multiple lifestyle domains simultaneously, can protect against cognitive decline in at-risk older adults but struggle to sustain engagement. Addressing stress in these interventions is crucial, as it can directly increase dementia risk and may promote unhealthy behaviors in other domains targeted in these interventions, including physical activity, diet, and sleep.

This study explores the motivators and barriers for Dutch adults aged 60 years and older to use mindfulness apps for stress management within digital multidomain lifestyle interventions. Despite their potential, it remains unclear which stress-related needs would motivate older adults to use mindfulness apps in these interventions and whether these apps effectively address those needs. Moreover, little is known about how older adults practice mindfulness independently in everyday settings alongside other lifestyle priorities.

We conducted 15 semistructured interviews with former participants of a 26-week multidomain lifestyle intervention study (the "HELI" [Hersenfuncties na Leefstijlinterventie] study) that included a mindfulness app for stress management. Participants (8 females; age range 61-73 years) were first invited to describe their practices to improve brain health to see whether stress and mindfulness emerged spontaneously. Follow-up questions and scenarios explored experiences with stress and mindfulness before these concepts were explicitly introduced midway through the interview, providing insight into their roles in participants' lives free from associations with the terms. Data were analyzed using template analysis.

Older adults reported experiencing fewer minor daily stressors than earlier in life and having developed effective coping strategies with age. These strategies often included elements associated with mindfulness, such as acceptance and deliberate attention to the present moment. However, many frequently worried at night about major concerns, including personal health, the well-being of loved ones, and global issues. These findings suggest that older adults may be more motivated to use mindfulness apps to cope with nighttime worry than with minor daily stressors. At the same time, older adults reported barriers to using mindfulness apps, including negative associations with the term "mindfulness" (eg, perceived as too spiritual) and challenges in maintaining focus during exercises.

We discuss how older adults develop mindfulness skills with age and how these skills help older adults cope with daily stressors but not with nighttime rumination. Specifically, we argue that diminished cognitive resources at night, fewer distractions, and metacognitive patterns may sustain worry before sleep. This study highlights the importance of tailoring multidomain lifestyle interventions to the unique challenges of older adults. We also offer recommendations to present mindfulness in ways that help older adults stay focused during practice.