Technology use characteristics among older adults during the COVID-19 pandemic: A cross-cultural survey

Beyond the Digital Divide: Factors Associated With Adoption of Technologies Related to Aging in Place

While technology holds great promise for promoting independent living, older adults still encounter challenges with technology adoption. The current study identified classes of technology users among older adults and examined associations between technology user class and individual characteristics. The Technology Assessment Procedure method was utilized. Participants (N = 187, ages 65-92) were presented with technologies spanning domains of transportation, leisure, health, and new learning, and rated various measures related to technology adoption. Two user groups, "open to technology" and "reluctant to technology," were identified. The "reluctant to technology" group, indicated needing more help with new technologies, had less confidence using technology, perceived greater losses associated with aging, and reported less technology experience. In contrast, the "open to technology" group showed higher levels of crystallized intelligence, greater openness to experience, and lower perceptions of aging-related loss. Interventions promoting technology adoption should focus on boosting technology-efficacy, confidence, and accessibility of technology applications.

The impact of the COVID-19 pandemic on symptoms of depression and anxiety among older adults: the MYHAT study

OBJECTIVES

To identify subgroups of older adults whose mental health was affected by the COVID-19 pandemic.

METHODS

Interrupted time series (ITS) analyses were used to measure the long-term impact of the COVID-19 pandemic on symptoms of depression (mCES-D) and anxiety (GAD-7) among participants aged 65 years and older (n = 708) from a prospective, longitudinal cohort study.

RESULTS

Symptoms of depression, but not anxiety, significantly increased at the start of the pandemic, while long-term trends in depression and anxiety during the pandemic were similar to pre-pandemic trends. Participants aged 75 years and older exhibited a more rapid decline in depression symptoms over time than expected after an initial increase. Women experienced a greater immediate increase in anxiety that decreased over time, while men's anxiety increased over time. Cognitively normal participants experienced a greater than expected immediate increase in symptoms of depression that decreased over time, while symptoms were unchanged by the pandemic for those with cognitive impairment.

CONCLUSION

Despite an initial increase in depression symptoms, the pandemic did not result in elevated symptoms of depression and anxiety long-term. The impact of the pandemic on mental health varied by age, gender, and cognitive status, suggesting some groups may have been more vulnerable than others.

Improving Acceptability of mHealth Apps-The Use of the Technology Acceptance Model to Assess the Acceptability of mHealth Apps: Systematic Review

BACKGROUND

Mobile health apps (MHAs) are increasingly used in modern health care provision. The technology acceptance model (TAM) is the most widely used framework for predicting health care technology acceptance. Since the advent of this model in 1989, technology has made generational advancements, and extensions of this model have been implemented.

OBJECTIVE

This systematic review aimed to re-examine TAM models to establish their validity for predicting the acceptance of modern MHAs, reviewing relevant core and extended constructs, and the relationships between them.

METHODS

In this systematic review, MEDLINE, Embase, Global Health, APA PsycINFO, CINAHL, and Scopus databases were searched on March 8, 2024, with no time constraints, for studies assessing the use of TAM-based frameworks for MHA acceptance. Studies eligible for data extraction were required to be peer-reviewed, English-language, primary research articles evaluating MHAs with health-related utility, using TAM as the primary technology acceptance evaluation framework, and reporting app use data. Data were extracted and grouped into 5 extended TAM construct themes. Quality assessment was conducted using the Joanna Briggs Institute (JBI) tools. For cross-sectional methodologies (9/14, 64%), the JBI checklist for analytical cross-sectional studies was used. For non-cross-sectional studies (5/14, 36%), the JBI checklist most relevant to the specific study design was used. For mixed methods studies (1/14, 7%), the JBI checklist for qualitative studies was applied, in addition to the JBI checklist most suited to the quantitative design. A subsequent narrative synthesis was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology.

RESULTS

A total of 2790 records were identified, and 14 were included. Furthermore, 10 studies validated the efficacy of TAM and its extensions for the assessment of MHAs. Relationships between core TAM constructs (perceived usefulness, perceived ease of use, and behavioral intention) were validated. Extended TAM constructs were grouped into 5 themes: health risk, application factors, social factors, digital literacy, and trust. Digital literacy, trust, and application factor extended construct themes had significant predictive capacity. Application factors had the strongest MHA acceptance predictive capabilities. Perceived usefulness and extended constructs related to social factors, design aesthetics, and personalization were more influential for those from deprived socioeconomic backgrounds.

CONCLUSIONS

TAM is an effective framework for evaluating MHA acceptance. While original TAM constructs wield significant predictive capacity, the incorporation of social and clinical context-specific extended TAM constructs can enhance the model's predictive capabilities. This review's findings can be applied to optimize MHAs' user engagement and minimize health care inequalities. Our findings also underscore the necessity of adapting TAM and other acceptability frameworks as the technological and social landscape evolves.

TRIAL REGISTRATION

PROSPERO CRD42024532974; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024532974.

Remote versus face-to-face fall risk assessment in home dwelling older adults: a reliability study

BACKGROUND

Falls are a leading cause of severe injury and death in older adults. Remote screening of fall risk may prevent falls and hence, advance health and wellness of older adults. While remote health care is becoming a common practice, we question if remote evaluation of fall risk is as reliable as face-to-face (FTF).

OBJECTIVE

To assess the inter-tester reliability of synchronized remote and FTF fall risk assessment.

METHODS

This inter-format, inter-rater reliability study included 48 home dwelling older adults aged 65 and over. Five valid functional and balance tests were conducted: 30 Second Sit-to-Stand (STS), MiniBESTest, Timed up and go (TUG), 4-Meter Walk (4MWT), and Berg Balance Scale (BBS). Instructions were provided via videoconferencing, and two physiotherapists scored performance simultaneously, one remotely, and one in the room. Inter-rater reliability between remote and FTF scores was analyzed using intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimal detectable change (MDC95) and Bland and Altman analysis.

RESULTS

Excellent ICCs were found for STS, MiniBESTest, TUG, and BBS (0.90-0.99), and moderate for 4MWT (0.74). SEM and MDC95 values were STS (0.37,1.03 repetitions), MiniBESTest (1.43,3.97 scores), TUG (1.22,3.37 seconds), 4MWT (0.17,0.47 m/second), and BBS (1.79,4.95 scores). The Bland and Altman analysis showed excellent agreement between remote and FTF assessments of the STS. All other tests showed low to moderate agreement. Mean difference ± SD and 95%LOA were as follows: STS (-0.11 ± 0.52), (-1.13,0.91) repetitions, MiniBESTest (0.45 ± 1.98), (-3.43,4.32) scores, TUG (-0.35 ± 1.54), (-3.37,2.67) seconds, 4MWT (-0.08 ± 0.22), (-0.35,0.51) meter/second, and BBS (0.04 ± 2.53), (-4.93,5.01) scores.

CONCLUSIONS

The findings support the responsible integration of remote fall risk assessment in clinical practice, enabling large-scale screenings and referrals for early intervention to promote healthy aging and fall prevention.

Determinants of Telehealth Adoption Among Older Adults: Cross-Sectional Survey Study

BACKGROUND

The aging population and the accompanying rise in chronic diseases have intensified the need to study the adoption of telehealth services. However, the success of telehealth services depends not only on their ease and usefulness but also on addressing broader concerns. Despite being a substantial user group in traditional health services, older adults may encounter barriers to adopting telehealth services. Increasing the adoption of telehealth among the older adult population is crucial for enhancing their access to care and managing the challenges of aging effectively.

OBJECTIVE

We aimed to explore factors influencing the adoption of telehealth services among older adults in Malaysia, going beyond the conventional framework by incorporating transition cost and subjective well-being as additional constructs.

METHODS

A cross-sectional survey was conducted among 119 adults aged ≥60 years in Malaysia, using 39 survey items adapted from existing studies. Data analysis was performed using partial least squares structural equation modeling, with both the measurement model and structural model being evaluated. To determine the predictive relevance of the model, PLSpredict was applied. In addition, importance-performance map analysis was conducted to further expand on the structural model results by assessing the performance of each variable.

RESULTS

Of the 119 participants, 52 (43.7%) were women and 67 (56.3%) were men. The study found that subjective well-being (β=0.448; P<.001) was the most significant factor, followed by attitude (β=0.242; P<.001), transition cost (β=-0.163; P<.001), and perceived usefulness (β=0.100, P=.02) in influencing telehealth service intention. Furthermore, perceived ease of use (β=0.271; P<.001), availability (β=0.323; P<.001), subjective well-being (β=0.261; P<.001), and trust (β=0.156, P=.004) positively influenced perceived usefulness, while inertia (β=0.024, P=.22) did not. In addition, availability (β=0.420; P<.001) and subjective well-being (β=0.260; P<.001) were positively related to perceived ease of use, with inertia (β=-0.246; P<.001) having a negative impact. The importance-performance map analysis results showed that subjective well-being (importance=0.532) was the most crucial factor for older adult users, while availability (importance=70.735) had the highest performance in telehealth services.

CONCLUSIONS

This research underscores the importance of catering to the subjective well-being of older adults and optimizing the availability of telehealth services to encourage adoption, ultimately advancing health care accessibility and quality for this vulnerable demographic.

Characterizing the attitudes, proficiency, and usage patterns for daily technology among older adults with a cognitive impairment

PURPOSE

Older adults with a cognitive impairment may be challenged by the demands associated with technology systems used to support everyday activities. We investigated technology attitudes, proficiency, and usage across the domains of health, social, transportation, leisure, and domestic activities among older adults with mild cognitive impairment, traumatic brain injury, and post-stroke cognitive impairment. We examined whether age, gender, health, cognition, or technology attitudes (comfort, interest, efficacy) predicted technology proficiency and usage patterns. All variables were measured with validated questionnaires.

MATERIALS AND METHODS

Participants (N = 163, age range 60-93) were part of the Everyday Needs Assessment for Cognitive Tasks (ENACT) study.

RESULTS

The participants were largely proficient in using technologies and had generally positive attitudes toward technology. Usage patterns varied across domains, with participants most engaged in technology uses to support social and domestic activities, followed by health activities. Technology was used least frequently to support transportation and leisure activities. Findings highlighted the complex interplay of demographic factors, cognition, and attitudes towards technologies in shaping older adults with cognitive impairments' adoption and use of technology across the various domains. Older age was associated with lower technology use, whereas positive attitudes towards technology (interest, comfort, and efficacy) were associated with higher use. Gender differences were evident in social, domestic, and leisure technology domains.

CONCLUSION

These findings underscore that older adults with a cognitive impairment can use and are receptive towards technology. The findings provide valuable insights for tailoring interventions to meet the needs and preferences of older adults with a cognitive impairment.

Perspectives on Technology Use in the Context of Caregiving for Persons With Dementia: Qualitative Interview Study

BACKGROUND

Examining ways to support persons with dementia and their caregivers to help minimize the disease's impact on individuals, families, and society is critical. One emerging avenue for support is technology (eg, smartphones and smart homes).

OBJECTIVE

Given the increasing presence of technology in caregiving, it is pertinent to appreciate whether and how technology can be most useful to a care partner's everyday life. This study aims to further understand care partner technology use, attitudes, and the potential role of off-the-shelf technologies (eg, smartphones and smart homes) in supporting caregiving from the perspective of care partners for persons with dementia.

METHODS

We conducted a telephone cross-sectional survey using random digit dialing with 67 self-identified care partners of persons with dementia across one Canadian province. Participants were asked about attitudes toward technology, barriers to and facilitators for technology use, technology use with caregiving, and demographic information. Eight open-ended questions were analyzed using content analysis; 2 closed-ended questions about comfort with and helpfulness of technology (rated on a scale of 1 to 10) were analyzed with frequencies. From these data, an in-depth semistructured interview was created, and 10 (15%) randomly sampled care partners from the initial collection of 67 care partners were interviewed approximately 1 year later, with responses analyzed using content analysis.

RESULTS

Frequency analysis rated on a scale of 1 to 10 suggested that care partners were comfortable with technology (wearable technology mean 7.94, SD 2.02; smart home technology mean 6.94, SD 2.09), although they rated the helpfulness of technology less strongly (mean 5.02, SD 2.85). Qualitatively, care partners described using technology for functional tasks and some caregiving. Barriers to technology use included cost, lack of knowledge, security or privacy concerns, and undesirable features of technology. Facilitators included access to support and the presence of desirable features. Some care partners described merging technology with caregiving and reported subsequent benefits. Others stated that technology could not be adopted for caregiving due to the degree of impairment, fear of negative consequences for the person living with dementia, or due to incongruity with the caregiving philosophy. Furthermore, care partners noted that their technology use either increased or was unchanged as they moved through the COVID-19 pandemic.

CONCLUSIONS

The 2 analyses were conducted separately, but there was notable overlap in the data, suggesting temporal stability of identified content. Both analyses suggested care partners' relative comfort with technology and its use, but other care partners noted concerns about integrating technology and caregiving. Care partners' reports of increased technology use throughout the COVID-19 pandemic may also suggest that the pandemic impacted their perceptions of the usefulness of technology, being influenced by the requirements of their reality. Future investigations should examine how to support care partners in adopting relevant technology.

Digital Literacy in the Informal Economy of Ghana: Life-long Learning and Extending Working Lives of Older Persons in Post-Covid-19 Era

The COVID-19 pandemic has underscored the growing importance of digital technologies for economic resilience, especially for vulnerable groups like older workers in the informal sector. However, barriers to access and digital literacy create challenges alongside potential opportunities, particularly in less developed countries such as Ghana. Using older adults over 50 years engaged in informal work in Kumasi's Central Business District in Ghana as a case, this paper explores older informal workers' use of digital technologies in Ghana during the pandemic. Findings suggest that older informal workers relied heavily on their mobile phones as the only critical technological tool to sustain their businesses during the COVID-19 pandemic. However, the findings also reveal critical gaps in skills, training, and support, alongside resourcefulness in leveraging digital tools for business continuity. Key policy implications include expanding mobile-centric digital literacy programs, addressing infrastructure divides, and integrating capacity building into social protection. The paper contributes insights on strengthening lifelong learning and extending the working lives of older persons in the informal sector in the post-COVID era.

Habit and Help-Experiences of Technology Use During the COVID-19 Pandemic: Interview Study Among Older Adults

BACKGROUND

The COVID-19 pandemic compelled older adults to engage with technology to a greater extent given emergent public health observance and home-sheltering restrictions in the United States. This study examined subjective experiences of technology use among older adults as a result of unforeseen and widespread public health guidance catalyzing their use of technology differently, more often, or in new ways.

OBJECTIVE

This study aimed to explore whether older adults scoring higher on the Unified Theory of Acceptance and Use of Technology questionnaire fared better in aspects of technology use, and reported better subjective experiences, in comparison with those scoring lower.

METHODS

A qualitative study using prevalence and thematic analyses of data from 18 older adults (mean age 79 years) in 2 groups: 9 scoring higher and 9 scoring lower on the Unified Theory of Acceptance and Use of Technology questionnaire.

RESULTS

Older adults were fairly competent technology users across both higher- and lower-scoring groups. The higher-scoring group noted greater use of technology in terms of telehealth and getting groceries and household items. Cognitive difficulty was described only among the lower-scoring group; they used technology less to get groceries and household items and to obtain health information. Qualitative themes depict the role of habit in technology use, enthusiasm about technology buttressed by the protective role of technology, challenges in technology use, and getting help regardless of technology mastery.

CONCLUSIONS

Whereas the pandemic compelled older adults to alter or increase technology use, it did not change their global outlook on technology use. Older adults' prepandemic habits of technology use and available help influenced the degree to which they made use of technology during the COVID-19 pandemic.

Perspectives and Experiences on eHealth Solutions for Coping With Chronic Pain: Qualitative Study Among Older People Living With Chronic Pain

BACKGROUND

Chronic noncancer pain (CNCP) is a major health issue among the older population, affecting multiple aspects of individual functioning. Recently, the use of eHealth solutions has been proposed in supporting chronic pain self-management even among older adults, although some barriers have emerged. Few qualitative studies, with none conducted in Mediterranean countries, have explored older people's experiences and perceptions regarding the types of strategies used to cope with chronic pain and eHealth tools for chronic pain management.

OBJECTIVE

This study's objectives were to explore the perspectives and experiences of older adults regarding the coping strategies used to manage chronic pain, the use of digital technologies in everyday life, and the potentiality and barriers in using those technologies for health and pain management.

METHODS

A multimethod approach (ie, self-report questionnaires and a semistructured interview) has been adopted targeting older adults (ie, those who are aged 65 to 80 years and presenting different types of CNCP) who are attending a pain therapy center in Italy. Qualitative answers were analyzed using thematic analysis.

RESULTS

Overall, participants reported using a variety of pain coping strategies; however, they showed an attitude of resignation to their CNCP condition. Nearly 70% (12/18) of the interviewees referred to using digital technologies for purposes related to health and pain management, mostly involving very basic management activities. The participants' opinions on the useful functions that need to be incorporated in eHealth tools for chronic pain management have been categorized into four themes: (1) specific pain self-management skills, (2) support in organizing various health-related aspects, (3) sharing experiences with others, and (4) increasing pain-related personal knowledge. Conversely, the following potential barriers to adopting eHealth tools emerged: (1) computer illiteracy, (2) negative effects or risks, (3) impersonal interaction, and (4) physical limitations.

CONCLUSIONS

The use of eHealth solutions still seems low, often being accompanied by a perceived lack of digital skills or attitude among a sample of older adults from Italy with CNCP. Before introducing innovative eHealth solutions, it would be of primary importance to take action to enhance, on the one hand, self-efficacy in pain management and, on the other, the digital literacy level among older people.

Stroke caregivers' perception on instant messaging application use for psychological intervention: a qualitative study

In caring for patients with stroke, the leading cause of death and disability affecting over 80 million people worldwide, caregivers experience substantial psychological and physical burdens and difficulties in help-seeking owing to physical and time-constraints. Social distancing measures imposed during the coronavirus disease 2019 (COVID-19) pandemic further restricted them from using caregiver support services. While the use of telehealth emerged as a global prevailing trend during the COVID-19 pandemic, evidence for utilising instant messaging (IM) applications for psychological intervention is scanty. This study aimed to explore stroke caregivers' perceived potential utility of IM-delivered psychological intervention. Between January and August 2020, 36 adult family stroke caregivers in Hong Kong were recruited to individual telephone semi-structured interviews using purposive sampling. The interviews were audio-recorded, transcribed verbatim and analysed using an interpretive description approach. Three themes of caregivers' perceptions towards IM-delivered psychological intervention emerged: perceived high convenience and ease of use, perceived advantages that overcome existing barriers to services and message delivery tailored to individual needs. Our findings suggested that there is an imminent need among stroke caregivers for personalised psychological interventions and that IM is a potential modality for overcoming existing barriers in delivering accessible support to caregivers in real-time, real-world settings. Our study highlighted caregivers' acceptance and perceived benefits of IM-delivered psychological intervention and provided practical insights into the design of IM-delivered psychological interventions.

Three Perspectives on Older Adults' Daily Performance, Health, and Technology Use During COVID-19: Focus Group Study

Background

During COVID-19 lockdowns, older adults' engagement in daily activities was severely affected, causing negative physical and mental health implications. Technology flourished as a means of performing daily activities in this complex situation; however, older adults often struggled to effectively use these opportunities. Despite the important role of older adults' social environments-including their families and health professionals-in influencing their technology use, research into their unique perspectives is lacking.

Objective

This study aimed to explore the daily activity performance, health, and technology use experiences of healthy independent Israeli adults (aged ≥65 years) during COVID-19 from a 3-dimensional perspective: older adults, older adults' family members, and health professionals.

Methods

Nine online focus groups, averaging 6-7 participants per group, were conducted with older adults, family members, and health professionals (N=59). Data were analyzed using thematic analysis and constant comparative methods.

Results

The intertwining of daily activity performance and health emerged as a central theme, with differences between the groups. Older adults prioritized their self-fulfilling routines based on motivation and choice, especially in social-familial activities. In contrast, family members and health professionals focused on serious physical and mental health COVID-19-related consequences. A consensus among all three groups revealed the meaningful role of technology use during this period in bridging functional limitations. Participants delved into technology's transformative power, focusing on the need for technology to get engaged in daily activities.

Conclusions

This study illustrates the profound interplay between daily activity performances, physical and mental health, and technology use, using a 3-dimensional approach. Its focus on technology's uses and benefits sheds light on what older adults need to increase their technology use. Interventions for improving digital activity performance can be tailored to meet older adults' needs and preferences by focusing on motivational and preference-related activities.

"It's Incapacitated Me in so Many Ways": Older Adults' Lived Experience With Postoperative Symptoms at Home After Major Elective Surgery

OBJECTIVE

This qualitative study aimed to explore the challenges faced by older adults regarding the postoperative symptom experience after major elective surgery.

BACKGROUND

Although extensively studied in oncology settings, the impact of postoperative symptom burden remains largely underexplored in elective major surgery among older adults.

METHODS

We employed convenience sampling to recruit adults aged 65 years or above undergoing major elective surgery at the University of California, San Francisco. Semistructured interviews regarding the surgical experience were conducted at 1 and 3 months postoperatively. An inductive qualitative approach was used to identify emerging themes. Symptoms revealed by participants during interviews were also captured.

RESULTS

Nineteen participants completed a 1-month postoperative interview, and 17 additionally completed a 3-month interview. Three themes emerged: (1) postoperative symptoms significantly impacted valued life activities and psychosocial well-being, (2) participants felt "caught off guard" by the intensity and duration of postoperative symptoms, and (3) participants expressed the need for additional support, resources, and education on symptom management. The most frequently mentioned symptoms were postoperative pain (n=12, 63.1%), gastrointestinal discomfort (n=8, 42.1%), and anxiety/stress (n=8, 42.1%) at 1-month postsurgery compared with pain and depression (both n=6, 35.3%) at 3 months.

CONCLUSIONS

Study participants were surprised by the negative impact of postoperative symptoms on their psychosocial well-being and ability to engage in valued life activities. Symptom burden is an important patient-reported outcome that should be assessed postoperatively. Interventions to minimize postoperative symptom burden in older adults could optimize quality of life and participation in meaningful activities during surgical recovery.

Associations of Depression/Anxiety with Technology Use, Discontinued Use, and Nonuse in Older Adults

OBJECTIVES

To examine correlates of the changes in technology use among older adults and the associations of depression/anxiety symptoms with technology use changes.

METHODS

We used the 2019-2021 U.S. National Health and Aging Trends Study (N = 3,063; age 70+). We fitted multinomial logistic regression models to examine: (1) correlates of never use and discontinued use versus use of email/texting and the internet during the 3-year study period; and (2) associations of past-month depression/anxiety symptoms in 2021 with use and discontinued use versus never use of email/texting and social network site (SNS).

RESULTS

The findings show age, socioeconomic, and health barriers to technology use. Email/texting and SNS use in 2021, compared to never use in all 3 years, was associated with a lower likelihood of moderate/severe depression/anxiety symptoms in 2021 (RRR = 0.54, 95% CI = 0.37-0.81 for email/texting use; RRR = 0.56, 95% CI = 0.33-0.97 for SNS use). Video calls with family/friends were not associated with depression/anxiety symptoms.

CONCLUSIONS

The findings expand the existing knowledge base regarding potential impact of technology use on mental health beyond the early months of the COVID-19 pandemic.

CLINICAL IMPLICATIONS

More concerted efforts are warranted to help older adults' technology uptake and continued use and to promote mental health benefits of technology use.

Assessing the older population acceptance of healthcare wearable in a developing Country: an extended PMT model

Wearable healthcare devices (HWDs) got prominence, especially during the COVID-19 pandemic. Aiming to know the proliferation of the HWDS, this study tries to evaluate the intentions of the old-age population to use the devices. To this end, the protection motivation theory (PMT) coupled with health information accuracy, perceived novelty, perceived ease of use, hedonic motivation, health anxiety, and health consciousness were investigated as predictors of HWDs among senior Pakistani citizens. A total of 310 participants who knew how the smartwatches could be used as a health monitoring device, were surveyed to empirically test the model. The required data were then analyzed using structural equation modeling. The findings reveal that the protective, utilitarian, and personal attributes of HWDs play a significant role in choosing the HWDs. While addressing their healthcare issues, senior citizens are highly receptive to perceived usefulness, accurate information accuracy, self-efficacy, perceived severity, health consciousness, and perceived vulnerability during COVID-19. These factors have a positive impact on their willingness to use HWDs. The study educates healthcare management and users to focus on the determining factors that can enhance the use of HWDs.