User Requirements for Technology to Assist Aging in Place: Qualitative Study of Older People and Their Informal Support Networks

Digital home care interventions and quality of primary care for older adults: a scoping review

BACKGROUND

Population aging is forcing the transformation of health care. Long-term care in the home is complex and involves complex communication with primary care services. In this scenario, the expansion of digital health has the potential to improve access to home-based primary care; however, the use of technologies can increase inequalities in access to health for an important part of the population. The aim of this study was to identify and map the uses and types of digital health interventions and their impacts on the quality of home-based primary care for older adults.

METHODS

This is a broad and systematized scoping review with rigorous synthesis of knowledge directed by the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The quantitative data were analyzed through descriptive statistics, and the qualitative data were analyzed through basic qualitative content analysis, considering the organizational, relational, interpersonal and technical dimensions of care. The preliminary results were subjected to consultation with stakeholders to identify strengths and limitations, as well as potential forms of socialization.

RESULTS

The mapping showed the distribution of publications in 18 countries and in the Sub-Saharan Africa region. Older adults have benefited from the use of different digital health strategies; however, this review also addresses limitations and challenges, such as the need for digital literacy and technological infrastructure. In addition to the impacts of technologies on the quality of health care.

CONCLUSIONS

The review gathered priority themes for the equitable implementation of digital health, such as access to home caregivers and digital tools, importance of digital literacy and involvement of patients and their caregivers in health decisions and design of technologies, which must be prioritized to overcome limitations and challenges, focusing on improving quality of life, shorter hospitalization time and autonomy of older adults.

Design and psychometric properties of the family support for older people questionnaire

Background and objectives

The population of older people is increasing across the world. Older people need care and support from their families to be able to live independently. This study aimed to design and evaluate the psychometric properties of the family support for older people (FSOP) questionnaire.

Methods

In this instrument development study using a mixed-methods design, the psychometric properties of the FSOP questionnaire in terms of validity and reliability were evaluated.

Results

The FSOP questionnaire consisted of 50 items in six domains. It was shown to have appropriate qualitative and quantitative validities (score > 1.5). The indicators of content validity (CVR > 0.62, ICVI ≥ 0.80, and SCVI > 0.94) and confirmatory factor analysis (indexes of χ²/df = 2.50, CFI = 0.96, GFI = 0.97, AGFI = 0.96, NNFI = 0.96, PNFI = 0.89, TLI = 0.96, and RMSEA = 0.06) were satisfactory. Cronbach's alpha coefficient for reliability was 0.94, indicating an optimal score.

Conclusions

Healthcare providers and family caregivers are suggested to use the FSOP questionnaire for improving the quality of life of older people at home.

Meaning of Respect for Older People in Family Relationships

Background: Older people have various physical and mental health needs and often receive help from their family members to perform their daily life activities. This research aimed to explore the meaning of respect for older people in family relationships. Methods: A qualitative study using a content analysis approach was conducted. Semi-structured interviews were performed with sixteen older people and four family members. Results: Three main categories were developed: “respect for personal interests”, “kind and sincere respect” and “respect for autonomy”. Understanding of the meaning of respect for older people was influenced by special expectations from family members in terms of meeting personal needs, consideration of preferences and interests and empowerment and support to help preserve older people’s independence and autonomy. Conclusions: Family members should be informed and educated with regard to their expected roles in family relationships, and should consider respect as an important factor affecting older people’s well-being.

Global Aging and Cancer: Advancing Care Through Innovation

The oncology field, like many others, is digitalizing rapidly, a phenomenon that may have been accelerated by the COVID-19 pandemic. This movement is creating opportunities and challenges. Another rapidly developing change is the aging of the global population; because cancer is a disease of aging, there is a need for health systems to adapt to taking care of such patients. In this article, we address how these innovative technologies can be leveraged to improve the care of older patients with cancer beyond academic centers, such as in underserved areas and low- and middle-income countries. We review how digital technologies can be used to enhance the follow-up of patients in low- and middle-income countries. We also tackle the issue of training a global workforce to treat cancer in an aging population and how to leverage innovations in this matter. Finally, we review opportunities to expand the usefulness of big data and machine learning beyond academic centers to support private practices and underserved areas.

User Requirements for Co-Managed Digital Health & Care (Preprint)

Background

The sustainability of health and social care has led to an imperative to shift the balance of care to communities and support person-centered, integrated, preventive, comanaged, and sustainable care. The digital tool set can support this shift; however, it must extend beyond a clinical focus to include broader personal, social, and environmental needs, experiences, and outcomes. The existing digital health and care design and user requirements literature focuses mainly on specific digital products or design methods. There is little whole-system or whole-of-life consideration, which is crucial to enacting more significant transformations that span different groups and domains.

Objective

This study aimed to present a set of recurring user requirements and themes for comanaged digital health and care services derived from the body of co-design projects within a digital health and care program. This study aimed to enable people and organizations looking to reorient their approach to health and care research and delivery from a system-led and condition-specific approach to a more person-centric, whole-of-life model.

Methods

Participatory design formed the core methodological approach in underlying the design research, from which user requirements were derived. The process of surfacing requirements involved a selection framework for the identification of eligible projects and a structured review process to consolidate user requirements.

Results

This paper presents a set of 14 common user requirements that resulted from a review of co-design projects. The findings demonstrate overlapping and reinforcing sets of needs from citizens and care professionals related to how data are comanaged to improve care and outcomes. This paper discusses the alignment, contrasts, and gaps with broader, comparable literature. It highlights consensus around requirements for personal health storytelling, sharing data on care experiences and how this can support personalized guidance, visualize trends to support decision-making, and generally improve dialog between a citizen and care professionals. These findings identify gaps around how groups and networks of people engage, posing difficult questions for people designing support services as some of the user requirements are not easily met by organizations operating in silos.

Conclusions

This study proposes future recommendations for citizens as active, informed, and consenting partners using new forms of privacy-preserving digital infrastructure that puts the citizen in firm control. It is also recommended that these findings be used by people developing new digital services to ensure that they can start with knowledge of the broader user requirement context. This should inform domain-specific research and development questions and processes. Further work is needed to extend these common requirements to more explicitly consider the trust framework required when citizens comanage their data and care across a broad range of formal and informal actors. Consideration of how authority, delegation, and trust function between members of the public will be critical.

Typology of Family Support in Home Care for Iranian Older People: A Qualitative Study

The world population is rapidly aging. In older people, age-related biological decline in most body systems causes functional decline, an increase in dependence, and an increased need for support, especially by their family members. The aim of this study was to explore the main aspects of family support for older parents in home care. This qualitative study was conducted using a deductive qualitative content analysis approach. Participants were 21 older parents living in their own homes, as well as four family members of some participants. Data were collected using semi-structured interviews and then were analyzed using the primary matrix developed based on the existing literature. The main aspects of family support for older parents were grouped into five predetermined categories and one new category: "instrumental support", "financial support", "psycho-emotional support", "healthcare-related support", "informational-technological support", and "social preference support ". Family support for older people in home care is a multi-dimensional phenomenon. Family members can identify the needs of their older parents and provide them with appropriate support in collaboration with healthcare professionals to enhance their quality of life, autonomy, and satisfaction with life.

Requirements for Unobtrusive Monitoring to Support Home-Based Dementia Care: Qualitative Study Among Formal and Informal Caregivers

BACKGROUND

Due to a growing shortage in residential care, people with dementia will increasingly be encouraged to live at home for longer. Although people with dementia prefer extended independent living, this also puts more pressure on both their informal and formal care networks. To support (in)formal caregivers of people with dementia, there is growing interest in unobtrusive contactless in-home monitoring technologies that allow caregivers to remotely monitor the lifestyle, health, and safety of their care recipients. Despite their potential, these solutions will only be viable if they meet the expectations and needs of formal and informal caregivers of people with dementia.

OBJECTIVE

The objective of this study was to explore the expected benefits, barriers, needs, and requirements toward unobtrusive in-home monitoring from the perspective of formal and informal caregivers of community-dwelling people with dementia.

METHODS

A combination of semistructured interviews and focus groups was used to collect data among informal (n=19) and formal (n=16) caregivers of people with dementia. Both sets of participants were presented with examples of unobtrusive in-home monitoring followed by questions addressing expected benefits, barriers, and needs. Relevant in-home monitoring goals were identified using a previously developed topic list. Interviews and focus groups were transcribed and inductively analyzed. Requirements for unobtrusive in-home monitoring were elicited based on the procedure of van Velsen and Bergvall-Kåreborn.

RESULTS

Formal and informal caregivers saw unobtrusive in-home monitoring as a support tool that should particularly be used to monitor (the risk of) falls, day and night rhythm, personal hygiene, nocturnal restlessness, and eating and drinking behavior. Generally, (in)formal caregivers reported cross-checking self-care information, extended independent living, objective communication, prevention and proactive measures, emotional reassurance, and personalized and optimized care as the key benefits of unobtrusive in-home monitoring. Main concerns centered around privacy, information overload, and ethical concerns related to dehumanizing care. Furthermore, 16 requirements for unobtrusive in-home monitoring were generated that specified desired functions, how the technology should communicate with the user, which services surrounding the technology were seen as needed, and how the technology should be integrated into the existing work context.

CONCLUSIONS

Despite the presence of barriers, formal and informal caregivers of people with dementia generally saw value in unobtrusive in-home monitoring, and felt that these systems could contribute to a shift from reactive to more proactive and less obtrusive care. However, the full potential of unobtrusive in-home monitoring can only unfold if relevant concerns are considered. Our requirements can inform the development of more acceptable and goal-directed in-home monitoring technologies to support home-based dementia care.

Attitudes and Perceptions Toward Healthcare Technology Adoption Among Older Adults in Singapore: A Qualitative Study

Smart Nation is a key initiative of Singapore to move toward digitalization of its industries including healthcare. The complex negotiations of aging amid Smart Nation are addressed in this paper, where we study the challenges faced to adapt the elderly for the digital revolution while ensuring dignified aging. While the healthcare industry accelerates its study and use of health technologies to improve diagnostics, treatment, and the quality of life of those in the aging category, the elderly socially construct these technological insertions that challenge the dominant understandings of what these technologies can do for their health outcomes. The study reveals re-constructions of these technological insertions through the voice of the elderly in their negotiations with health technologies in their everyday lives. Here, narratives reveal key themes that proliferate technology negotiation as barriers to everyday lived experiences.

Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals

Background

Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies.

Objective

The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being.

Methods

Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed.

Results

The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns.

Conclusions

The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

Ethics in Telehealth: Comparison between Guidelines and Practice-based Experience -the Case for Learning Health Systems

OBJECTIVES

To understand ethical issues within the tele-health domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives.

METHODS

We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth.

RESULTS

Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level issues related to technology and maintaining data security in patient-provider interactions while practitioner concern is focused on applying the guidelines to specific micro level contexts.

CONCLUSIONS

Ethics guidelines on telehealth have a macro level focus in contrast to the micro level needs of practitioners. Work is needed to close this gap. We recommend that both telehealth practitioners and ethics guideline developers better understand healthcare systems and adopt a learning health system approach that draws upon different contexts of clinical practice, innovative models of care delivery, emergent data and evidence-based outcomes. This would help develop a clearer set of priorities and guidelines for the ethical conduct of telehealth.

Prediction of the use of mobile device interfaces in the progressive aging process with the model of Fitts' law

PURPOSE

As the population ages, so do the potential users of technology, and older adults' behaviors when using mobile device interfaces are becoming increasingly important. A representative model for detecting older adults' behaviors and performance on the use of mobile device interfaces is needed to provide individualized designs. This research aimed to investigate the applicability of the broadly used model of Fitts' law to detect the progressive changes in the use of mobile device interfaces in older adults. The effect of experience with using technology on performance on a Fitts task was also examined.

METHOD

A sample of 135 older adults was recruited to test the application of Fitts' model to the use of technology by older adult users. Each participant was asked to finish tasks at 9 levels of difficulty, from easy to difficult, in a multidirectional tapping task. Analysis of variance was employed to examine the effect of age on performance on the Fitts task, movement time, and the standard deviation of movement time. Stepwise regression was used to investigate how well age and technology use could predict performance on the Fitts task.

RESULT

Performance on the Fitts task was sensitive to the gradual changes in abilities with aging. Rather than the amount of experience in using technology, age was the stronger predictor of older adults' performance on the Fitts task. Additionally, compared with the younger groups, the users above 80 years old demonstrated significantly higher behavioral variation during the use of mobile device interfaces.

CONCLUSION

This research confirmed that Fitts' law is applicable to the evaluation of the effects of aging on the use of mobile device interfaces. Adults above the age of 80 years should be a major focus for special individualized interface design. This finding can inform future designers and researchers in the development of individualized interface designs for older adult users to enhance their user experiences of mobile device technology.

RELEVANCE TO INDUSTRY

Future designers and researchers can apply the finding on Fitts' law in this research to develop user-friendly interface designs for mobile technology for older adults and thereby improve their user experiences to enhance their independence and quality of life through the use of technology.

A Web-Based Mobile App With a Smartwatch to Support Social Engagement in Persons With Memory Loss: Pilot Randomized Controlled Trial

Background

It is estimated that the number of individuals living with dementia worldwide will increase from 50 million in 2017 to 152 million by 2050. Assistive technology has been recognized as a promising tool to improve the lives of persons living with memory loss and their caregivers. The use of assistive technology in dementia care is expanding, although it is most often intended to manage care and promote safety. There is a lack of assistive technology designed to aid persons with memory loss in participating in meaningful activities. The Social Support Aid (SSA) is a mobile phone-based app that employs facial recognition software. It was designed to assist persons with memory loss remember the names and relationships of the people they interact with to promote social engagement.

Objective

This study uses a pilot randomized controlled trial (RCT) design to evaluate the SSA. The objectives were to ascertain (1) the feasibility and utility of the SSA, (2) whether the outcomes of SSA use suggest potential benefits for persons living with memory loss and their care partners, and (3) how study design components could inform subsequent RCTs.

Methods

Persons with memory loss were randomized to the SSA (n=20) or the usual care control group (n=28). Quantitative data were collected at three timepoints (baseline, 3 months, and 6 months). Participants in the intervention group participated in qualitative interviews following completion of their 6-month survey.

Results

Participant eligibility, willingness to be randomized, and retention were not barriers to conducting a full-scale RCT; however, recruitment strategies should be addressed before doing so. Feasibility and utility scores indicated that participants felt neutral about the technology. Use of the SSA was not significantly associated with changes in quality of social interactions or quality of life measures over the 6 months of follow-up (P>.05). The qualitative analysis revealed three themes that described how and why the SSA worked or not: (1) outcomes, (2) reasons why it was or was not useful, and (3) recommendations.

Conclusions

There is a need to develop effective assistive technology that improves the quality of life of persons with memory loss. Assistive technology that allows persons living with memory loss to maintain some level of autonomy should be a priority for future research. This study suggests reasons why the SSA facial recognition software did not appear to improve the quality of social interaction and quality of life of people with memory loss. Results also provide recommendations for future assistive technology development and evaluation.

Trial Registration

ClinicalTrials.gov NCT03645694; https://clinicaltrials.gov/ct2/show/NCT03645694 (Archived by WebCite at http://www.webcitation.org/78dcVZIqq)

Engaging Aging Individuals in the Design of Technologies and Services to Support Health and Well-Being: Constructivist Grounded Theory Study

Background

Changes noted within the aging population are physical, cognitive, as well as emotional. Social isolation and loneliness are also serious problems that the aging population may encounter. As technology and apps become more accessible, many basic services, such as those offered by social services, well-being organizations, and health care institutions, have invested in the development of supportive devices, services, and Web-based interactions. Despite the perceived benefits that these devices and services offer, many aging individuals choose not to engage, or engage in a limited manner. To explore this phenomenon, we developed a theory to describe the condition for engagement.

Objective

The main objective of this study was to understand the perceptions of an aging South African population regarding Web-based services and technologies that could support aging in place (AiP). Although the concept of AiP speaks to a great number of everyday activities, this paper explores aspects of health and well-being as being central to AiP.

Methods

The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, category development, and data comparisons. Data were collected through qualitative methods, including interviews (13 participants aged between 64 and 85 years), 2 participatory workshops (15 participants), and observations. The study focused on Charmaz’s approach to constructivist GT, which puts forward the premise that theory or knowledge cannot take shape in a purely objective manner. Instead, theory is constructed through the interaction of the researcher and research participant. Coding and data analysis were supported with ATLAS.ti (ATLAS.ti Scientific Software Development GmbH).

Results

The study resulted in a substantive theory exploring the process of interaction and engaging factors through user insights and experiences. The emerging design theory, Ageing User Decision-Driven Engagement (AUDDE), explored the elements that support engagement with technology and supportive apps, which could offer access to required health and wellness services.

Conclusions

In AUDDE, the perceived value of the interaction is a crucial catalyst for engagement. Aging users continuously make meaning of their experiences, which affects their current and future actions.

Ambient Assisted Living as Support for Aging in Place: Quantitative Users' Acceptance Study on Ultrasonic Whistles

Background

Given the fact of an aging society, new supply measures and living concepts are needed, especially as health impairments along with care dependency increase with age. As many elderly people wish to stay at home for as long as possible, ambient assisted living (AAL) represents a support for aging in place.

Objective

AAL combines medical and care technology within living environments and is, therefore, a promising approach to cope with demographic change in terms of fast-growing care needs and fewer skilled workers. Ultrasonic whistles represent one innovative technical possibility for such supportive housing solutions. Central fields of application are home automation, emergency service, and positioning. As AAL technologies affect sensitive areas of life, it is of great interest under which conditions they are accepted or rejected, taking individual user requirements into account. Hence, the aim of this study was to investigate users’ perception and evaluation of ultrasonic whistles.

Methods

In this study, we examined the acceptance of ultrasonic whistles in home care by function and room using a Web-based questionnaire. Besides an evaluation of the overall usefulness, we focused on the intention to use ultrasonic whistles; 270 participants assessed home automation, emergency service, and positioning as specific functions of ultrasonic whistles. Furthermore, bathroom, bedroom, and living room were evaluated as specific usage locations (rooms). With regard to the user’s perspective, the focus was set on age and attitudes toward aging of care receivers.

Results

This study revealed a significant influence of function (F_2,269=60.444; P<.001), room (F_2,269=41.388; P<.001), and the interaction of function and room (F_4,269=8.701; P<.001) on the acceptance of ultrasonic whistles. The use of emergency services within the bathroom represented the most accepted alternative, whereas positioning within the living room received the comparably lowest evaluations. Although user diversity played a minor role for acceptance overall, the assessment of single applications differed among user groups, particularly with regard to age differences (F_20,500=1.988; P<.01) in the evaluation of specific installation options such as automated doors.

Conclusions

The study revealed profound insights into the user-centered assessment of ultrasonic whistles in home care and discovered function and room as influencing acceptance parameters. Concerning user characteristics, age, and attitude toward aging partly affected these evaluations, forming the basis for and showing the importance of further investigations in this context.