The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials

Effects of visual impairment and its restoration on electroencephalogram during walking in aged females

BACKGROUND

Visual input significantly influences cerebral activity related to locomotor navigation, although the underlying mechanism remains unclear. This study aimed to analyze the effects of chronic visual impairment and its rehabilitation on sensorimotor integration during level walking in patients with age-related cataract.

METHODS

This prospective case series enrolled 14 female patients (68.4 ± 4.7 years) with age-related cataract, scheduled for consecutive cataract surgeries at the Department of Ophthalmology in Peking University Third Hospital from June 2019 to June 2020. Electroencephalogram (EEG) signals during level walking were recorded using a portable EEG system before and 4 weeks after visual restoration. Walking speed was assessed using the Footscan system. Spectral power of the theta and alpha bands was analyzed with repeated-measures analysis of variance, with Assignment (rest and walking), Phase (preoperative and postoperative), and Electrode sites (F3, Fz, F4, O1, and O2) as within-subject factors.

RESULTS

Compared to the visual impairment state, theta band power significantly decreased after visual restoration (13.16 ± 1.58 μV 2vs. 23.65 ± 3.48 μV 2 , P = 0.018). Theta activity was notably reduced during walking (17.24 ± 2.43 μV 2vs. 37.86 ± 6.62 μV 2 , P = 0.017), while theta power at rest was not significantly different between the two phases (9.44 ± 1.24 μV 2vs. 9.08 ± 1.74 μV 2 , P = 0.864). Changes in walking speed were correlated with alterations in theta power at electrode sites of O1 ( r = -0.574, P = 0.032) and O2 ( r = -0.648, P = 0.012). Alpha band power remained stable during walking and was unaffected by visual status.

CONCLUSIONS

Chronic visual impairment from age-related cataract triggers enhanced cerebral activation of sensorimotor integration to compensate for visual decline during locomotion. This cerebral over-activation is effectively alleviated by visual restoration.

Promoting healthy aging using new digital solutions in Italy: A scoping review

Age-related changes can impact cognitive and physical health, reducing quality of life and independence. While technologies are increasingly used in healthcare to support older adults, their application highly depends on cultural factors. Italy, with one of Europe's highest aging populations and low digital advancement, offers an interesting scenario for discussing the digitalization of healthcare services for older adults. This study provides a state-of-the-art overview of technologies used in Italy to promote healthy aging. We systematically searched PubMed, Embase, and Scopus databases for primary studies published from 2000 to May 2024 that employed technological solutions for healthcare in healthy Italian older adults. Fifteen studies met the criteria: four assessed the impact of technological interventions on health variables like physical efficiency, nutrition, and cognition, with positive results; 13 examined usability, user experience, and expectations, overall finding good acceptance and positive attitudes. While research on technology use in promoting healthy aging in Italy is still limited, our findings suggest that digital solutions are feasible for the older population. These results are considered within the context of the Italian healthcare system, with suggestions for future directions for clinicians.

Benefits and challenges of using assistive technology in the education and rehabilitation of Individuals with visual impairments

PURPOSE

Individuals with visual impairments use assistive technology in various aspects of life. Professionals who work with visually impaired people need to know about assistive technologies. The purpose of this study was to analyse the benefits and challenges of assistive technologies by assessing the degree of satisfaction with assistive technologies in different life situations expressed both by users and by professionals.

MATERIALS AND METHODS

Data were collected from 36 individuals with visual impairments and 27 professionals using online questionnaires. Further information was obtained from five individuals with visual impairments through focus group interviews.

RESULTS

The results show that 26 (72.2%) individuals with visual impairments and almost all professionals (N = 25; 92.6%) acknowledge the benefits of using assistive technology. They recognise the importance of assistive technology in independent living for individuals with visual impairments. However, 27 (75%) individuals with visual impairment and 26 (96.3%) professionals consider financial constraints to be the biggest problem.

CONCLUSION

More cost-effective technologies need to be developed, and social policies and opportunities created so that every individual with visual impairment can obtain assistive technologies that meet their needs. This would increase the independence of individuals with visual impairments in all areas of life.

Effect of a digital two-dimensional animation program on attitude toward walking aids, performance, and fall avoidance behaviors among older adults in assisted living facilities

The study investigated the impact of a two-dimensional animation program on attitudes towards walking aids, performance, and fall avoidance behaviors among older adults in assisted living facilities. A quasi-experimental pretest-posttest control group study was conducted on 128 older adults aged 60 years and above. The intervention group showed more favorable attitudes towards walking aids, improved cane and walker use, and reduced fall concerns. The 2D animation program proved to be an innovative teaching strategy that positively influenced attitudes, performance, and fall-related concerns among elderly residents. Integration into care settings could enhance mobility, reduce fall risks, and contribute to overall well-being.

Smartphone use by older adult in the healthy ageing process: a theory based on data

BACKGROUND

(1) Older adult are still segregated from young people when it comes to technology.

BACKGROUND

(2) On a daily basis, older people recognize the need, usefulness and applicability of the smartphone.

BACKGROUND

(3) Older adult are gradually moving towards digital skills.

BACKGROUND

(4) Digital tools are means of enhancing healthy ageing.

BACKGROUND

(5) WhatsApp ® groups help older people to engage virtually with peers.

to understand the feelings and recognitions of older adults when they experience the use of smartphones in everyday life, as well as the implications for the healthy aging process.

qualitative research, using the Unified Theory of Acceptance and Use of Technology; the Senior Technology Acceptance & Adoption Model and the methodological framework of Constructivist Grounded Theory. We intentionally recruited people aged 60+; smartphone users; participants for 6 months or more in an extension project, without cognitive impairment, determined by theoretical sampling. A semi-structured script guided data collection. Constant and concomitant comparative analysis followed the steps of initial and focused coding, supported by memos, until theoretical saturation. The Sankey diagram was used to analyze the data, using Atlas.ti software.

37 participants were allocated to two sample groups. We present the category "Experiencing technological evolution during the aging process" and two subcategories: "Experiencing feelings when aging in the face of technological development"; "Using the smartphone and recognizing new experiences".

when experiencing the use of smartphones, older adult understand and recognize the search for digital skills based on their need for usefulness and applicability of information and communication technology in their daily lives, integrating it into the healthy ageing process.

[Care models for older people based on a case study-Geriatrics as an active discipline]

Geriatrics can enable and monitor a holistic care of older people through a comprehensive geriatric assessment in a structured way. Therefore, it must be integrated much more closely with preventive, rehabilitative and acute care units. Geriatrics are not seen in any aspects as a replacement for general practitioners or in-hospital structures but much more as a supplement to them. With its function-oriented concept, geriatrics can best coordinate the demographically necessary triage between prevention, acute treatment, rehabilitation and palliative care, thus avoiding undertreatment and overtreatment. This can only succeed in collaboration with general practitioners and specialist colleagues. The article categorizes geriatric care structures, such as preventive home visits, acute complex medical treatment, delirium prevention, outpatient and inpatient rehabilitation services based on a case example and makes proposals for structural changes that urgently need to be considered in the current healthcare reform, such as outpatient geriatric centers (AGZ).

Perceived Benefit and Satisfaction With a Tablet Computer and an Emergency Smartwatch by Older Adults and Their Relatives: Prospective Real-World Pilot Study

Background

Assistive technologies (ATs) have the potential to promote the quality of life and independent living of older adults and, further, to relieve the burden of formal and informal caregivers and relatives. Technological developments over the last decades have led to a boost of available ATs. However, evidence on the benefits and satisfaction with ATs in real-world applications remains scarce.

Objective

This prospective, real-world, pilot study tested the perceived benefit and satisfaction with different ATs in the real-world environment.

Methods

Community-dwelling adults aged ≥65 and their relatives tested a tablet computer with a simplified interface or a smartwatch with programmable emergency contacts for 8 weeks in their everyday life. Perceived benefits and satisfaction with ATs were assessed by all older adults and their relatives using different assessment tools before and after the intervention. Outcome measures included the Technology Usage Inventory, Quebec User Evaluation of Satisfaction with Assistive Technology 2.0, and Canadian Occupational Performance Measure.

Results

A total of 17 older adults (tablet computer: n=8, 47% and smartwatch: n=9, 53%) and 16 relatives (tablet computer: n=7, 44% and smartwatch: n=9, 56%) were included in the study. The number of participants that were frail (according to the Clinical Frailty Scale) and received care was higher in the smartwatch group than in the tablet computer group. Older adults of the smartwatch group reported higher technology acceptance (Technology Usage Inventory) and satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0) scores than those of the tablet computer group, although the differences were not significant (all P>.05). In the tablet computer group, relatives had significantly higher ratings on the item intention to use than older adults (t12.3=3.3, P=.006). Identified everyday issues with the Canadian Occupational Performance Measure included contact/communication and entertainment/information for the tablet computer, safety and getting help in emergency situations for the smartwatch, and the usability of the AT for both devices. While the performance (t8=3.5, P=.008) and satisfaction (t8=3.2, P=.01) in these domains significantly improved in the smartwatch group, changes in the tablet computer group were inconsistent (all P>.05).

Conclusions

This study highlights the remaining obstacles for the widespread and effective application of ATs in the everyday life of older adults and their relatives. While the results do not provide evidence for a positive effect regarding communication deficits, perceived benefits could be shown for the area of safety. Future research and technical developments need to consider not only the preferences, problems, and goals of older adults but also their relatives and caregivers to improve the acceptability and effectiveness of ATs.

The Role of Assistive Technology in Enabling Older Adults to Achieve Independent Living: Past and Future

In this viewpoint, we present evidence of a marked increase in the use of assistive technology (AT) by older adults over the last 25 years. We also explain the way in which this use has expanded not only as an increase in terms of the total number of users but also by going beyond the typical scopes of use from its inception in 1999 to reach new categories of users. We outline our opinions on some of the key driving forces behind this expansion, such as population demographic changes, technological advances, and the promotion of AT as a means to enable older adults to achieve independent living. As well as our review of the evolution of AT over the past 25 years, we also discuss the future of AT research as a field and the need for harmonization of terminology in AT research. Finally, we outline how our experience in North Norfolk (notably the United Kingdom's most old age-dependent district) suggests that cocreation may be the key to not only successful research trials in the field of AT but also to the successful sustained adoption of AT beyond its original scope of use.

Does assistive technology contribute to safety among home-dwelling older adults?

BACKGROUND

Assistive technology carries the promise of alleviating public expenditure on long-term care, while at the same time enabling older adults to live more safely at home for as long as possible. Home-dwelling older people receiving reablement and dementia care at their homes are two important target groups for assistive technology. However, the need for help, the type of help and the progression of their needs differ. These two groups are seldom compared even though they are two large groups of service users in Norway and their care needs constitute considerable costs to Norwegian municipalities. The study explores how assistive technology impacts the feeling of safety among these two groups and their family caregivers.

METHODS

Face-to-face, semi-structured interviews lasting between 17 and 61 min were conducted between November 2018 and August 2019 with home-dwelling older adults receiving reablement (N = 15) and dementia care (N = 10) and the family caregivers (N = 9) of these users in seven municipalities in Norway. All interviews were audio-recorded, fully transcribed, thematically coded and inductively analyzed following Clarke and Braun's principles for thematic analysis.

RESULTS

Service users in both groups felt safe when knowing how to use assistive technology. However, the knowledge of how to use assistive technology was not enough to create a feeling of safety. In fact, for some users, this knowledge was a source of anxiety or frustration, especially when the user had experienced the limitations of the technology. For the service users with dementia, assistive technology was experienced as disturbing when they were unable to understand how to handle it, but at the same time, it also enabled some of them to continue living at home. For reablement users, overreliance on technology could undermine the progress of their functional improvement and thus their independence.

CONCLUSION

For users in both service groups, assistive technology may promote a sense of safety but has also disadvantages. However, technology alone does not seem to create a sense of safety. Rather, it is the appropriate use of assistive technology within the context of interactions between service users, their family caregivers and the healthcare staff that contributes to the feeling of safety.

Factors related to training time and achieving proficiency with visual-assistive mobile applications in visually impaired older adults

SIGNIFICANCE

A majority of visually impaired older adults were able to learn to proficiently use visual-assistive iPhone applications (apps) following a median 1 hour and/or multiple training sessions, which should be considered when planning vision rehabilitation service delivery, including the option for remote telerehabilitation for those who prefer that modality.

PURPOSE

Older adults with low vision are increasingly using technology to improve their visual functioning. We examined whether age-related comorbidities were potential barriers to success in learning to use visual-assistive apps on a smartphone.

METHODS

A clinical trial assessed visual-assistive apps in 116 older adults aged 55+ years (mean [standard deviation], 72 [10] years). Subjects were randomized to use an app (SuperVision+, Seeing AI, or Aira) preloaded to a loaner iPhone and completed one-on-one training. App proficiency was measured by the participant's ability to use the iPhone/app without cueing at the end of training sessions. Training time was recorded for the initial session and totaled after subsequent sessions. Multiple regression models explored significant factors associated with training time and proficiency.

RESULTS

Median initial and total training times were 45 and 60 minutes, respectively. Increased initial and total training times were both significantly related to increased age (p<0.001), legal blindness (p<0.007), Seeing AI versus SuperVision+ app (p<0.03), and participants from New England versus California (p<0.001). Most (71%) achieved proficiency after the initial training session; those odds were significantly greater among younger participants (p=0.04), those who opted for telerehabilitation (p=0.03), those who had higher cognitive scores (p=0.04), or those who were from New England (p=0.04). The majority (90%) was ultimately proficient with the app; those odds were significantly greater among participants who already had an optical magnifier (p=0.008), but were unrelated to other factors including study site.

CONCLUSIONS

Following multiple, extensive training sessions, age, mild cognitive loss, or level of visual impairment did not preclude gaining proficiency with visual-assistive apps by visually impaired seniors, but those factors were associated with longer training times. Telerehabilitation can be a viable option to provide app training remotely for visually impaired seniors who choose that modality.

Rehabilitation delivery models to foster healthy ageing-a scoping review

Introduction

Rehabilitation is essential to foster healthy ageing. Older adults have unique rehabilitation needs due to a higher prevalence of non-communicable diseases, higher susceptibility to infectious diseases, injuries, and mental health conditions. However, there is limited understanding of how rehabilitation is delivered to older adults. To address this gap, we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults' functioning/functional ability and foster healthy ageing.

Methods

We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models.

Results

Out of 6,933 identified records, 585 articles were assessed for eligibility, and 283 studies with 69,257 participants were included. We identified six rehabilitation delivery models: outpatient (24%), telerehabilitation (22%), home (18.5%), community (16.3%), inpatient (14.6%), and eldercare (4.7%). These models often involved multidisciplinary teams (31.5%) and follow integrated care principles (30.4%). Most studies used a disease-centred approach (59.0%), while studies addressing multimorbidity (6.0%) and prevalent health problems of older adults, such as pain, low hearing, and vision, or incontinence were scarce. The most frequently provided interventions were therapeutic exercises (54.1%), self-management education (40.1%), and assessment of person-centred goals (40%). Other interventions, such as assistive technology (8.1%) and environmental adaptations (7.4%) were infrequent.

Conclusions

Focusing on primary studies, this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention, including a lack of systematic assessment of functioning/functional ability, a predominance of disease-centred rehabilitation, and a scarcity of programmes addressing prevalent issues like pain, hearing/vision loss, fall prevention, incontinence, and sexual dysfunctions. Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing. Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness. Future research in the field is needed to expand and validate our findings.

Scoping Review of Technological Solutions for Community Dwelling Older Adults and Implications for Instrumental Activities of Daily Living

Aging in place is not without its challenges, with physical, psychological, social, and economic burdens on caregivers and seniors. To address these challenges and promote active aging, technological advancements offer a range of digital tools, applications, and devices, enabling community dwelling older adults to live independently and safely. Despite these opportunities, the acceptance of technology among the older adults remains low, often due to a mismatch between technology development and the actual needs and goals of seniors. The aim of this review is to identify recent technological solutions that monitor the health and well-being of aging adults, particularly within the context of instrumental activities of daily living (IADL). A scoping review identified 52 studies that meet specific inclusion criteria. The outcomes were classified based on social connectedness, autonomy, mental health, physical health, and safety. Our review revealed that a predominant majority (82%) of the studies were observational in design and primarily focused on health-related IADLs (59%) and communication-related IADLs (31%). Additionally, the study highlighted the crucial role of involving older adults in study design processes, with only 8 out of the 52 studies incorporating this approach. Our review also established the interview method as the most favoured technology evaluation tool for older adults' studies. The metrics of 'usability' and 'acceptance' emerged as the most frequently employed measures for technology assessment. This study contributes to the existing literature by shedding light on the implications of technological solutions for community dwelling older adults, emphasizing the types of technologies employed and their evaluation results.

[Functionality and everyday suitability of commercially wristwear products for frail older people - a comparative product testing]

BACKGROUND AND AIM

There is a wide range of smartwatches and emergency watches on the market that are specifically designed for older people. The products are freely available, which is why there is an urgent need for information about the reliability and functionality of the products among potential users, but also health professionals and decision-makers. As part of a systematic product comparison test, the functionality and quality of seven smartwatches were investigated.

METHOD

Four watches for seniors, one watch for adults and two watches for children, but with comparable functionalities, were included in the test. For the test, real-life situations were simulated and, in addition to emergency calls, GPS tracking, fall detection and geofencing, the battery life, call quality, stability/robustness of the products and service/support were evaluated. From the total number of points, a grade was determined based on the German school grading system (1 = very good to 6 = insufficient).

RESULTS

All smartwatches evaluated were rated at least "3-satisfactory". The two best-rated watches received a score of 1.8. The differences were particularly evident in the emergency call functionality, battery life, precision of the tracking function, and service/support. The call quality, with one exception, and the stability/robustness were consistently rated as "1-very good". Three watches in the test were able to detect falls with variable results.

CONCLUSION

The functionality and usability of the tested products differed considerably. A focus on a few main functions can even provide added value for older, frail people. Continuous comparative testing of products for this target group with new and updated products is desirable.

Using Virtual Home Assistants to Address Vulnerable Adults' Complex Care Needs: An Exploratory Feasibility Study

Harnessing technology has been proposed as one strategy to meet the social and health needs of older adults who prefer to age in place, but solutions remain elusive. In the current study, we evaluated the feasibility of using voice-activated virtual home assistants (VHAs; i.e., Amazon Echo "Alexa" devices) with older adults participating in the Program for All-Inclusive Care of the Elderly (PACE) over 4 months. Study methods included process evaluations, tracking participants' VHA use, and qualitative feedback from PACE participants and staff. The most common VHA activities were voice-activated smart lighting and asking for information. Participants infrequently used VHA activities that could promote physical or cognitive function (e.g., chair yoga, word recall game). Participants enjoyed using the VHAs, and PACE staff were enthusiastic about the potential for VHAs to facilitate aging in place and provided recommendations to increase participants' use of functional health activities. [Journal of Gerontological Nursing, 49(6), 33-40.].

Racial disparities among older adults with acute myocardial infarction: The SILVER-AMI study

BACKGROUND

Despite an aging population, little is known about racial disparities in aging-specific functional impairments and mortality among older adults hospitalized for acute myocardial infarction (AMI).

METHODS

We analyzed data from patients aged 75 years or older who were hospitalized for AMI at 94 US hospitals from 2013 to 2016. Functional impairments and geriatric conditions were assessed in-person during the AMI hospitalization. The association between race and risk of mortality (primary outcome) was evaluated with logistic regression adjusted sequentially for age, clinical characteristics, and measures of functional impairment and other conditions associated with aging.

RESULTS

Among 2918 participants, 2668 (91.4%) self-identified as White and 250 (8.6%) as Black. Black participants were younger (80.8 vs 81.7 years; p = 0.010) and more likely to be female (64.8% vs 42.5%; p < 0.001). Black participants were more likely to present with impairments in cognition (37.6% vs 14.5%; p < 0.001), mobility (66.0% vs 54.6%; p < 0.001) and vision (50.1% vs 35.7%; p < 0.001). Black participants were also more likely to report a disability in one or more activities of daily living (22.4% vs 13.0%; p < 0.001) and an unintentional loss of more than 10 lbs in the year prior to hospitalization (37.2% vs 13.0%; p < 0.001). The unadjusted odds of 6-month mortality among Black participants (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.4-2.8) attenuated to non-significance after adjustment for age, clinical characteristics (OR 1.70, 95% CI 1.7, 1.2-2.5), and functional/geriatric conditions (OR 1.5, 95% CI 1.0-2.2).

CONCLUSIONS

Black participants had a more geriatric phenotype despite a younger average age, with more functional impairments. Controlling for functional impairments and geriatric conditions attenuated disparities in 6-month mortality somewhat. These findings highlight the importance of systematically assessing functional impairment during hospitalization and also ensuring equitable access to community programs to support post-AMI recovery among Black older adults.

Artificial intelligence and digital medicine for integrated home care services in Italy: Opportunities and limits

Home healthcare in the Italian health system has proven to be an essential factor in adequately responding to the health needs of an increasingly aging population. The opportunities offered by digitization and new technologies, such as artificial intelligence (AI) and robotics, are a lever for making home care services more effective and efficient on the one hand, and on the other for improving remote patient monitoring. Telemedicine devices have enormous potential for telemonitoring and telerehabilitation of patients suffering from chronic disabling diseases; in particular, AI systems can now provide very useful managerial and decision-making support in numerous clinical areas. AI combined with digitalization, could also allow for the remote monitoring of patients' health conditions. In this paper authors describe some digital and healthcare tools or system of AI, such as the Connected Care model, the Home Care Premium (HCP) project, The Resilia App and some professional service robotics. In this context, to optimize potential and concrete healthcare improvements, some limits need to be overcome: gaps in health information systems and digital tools at all levels of the Italian National Health Service, the slow dissemination of the computerized medical record, issues of digital literacy, the high cost of devices, the poor protection of data privacy. The danger of over-reliance on such systems should also be examined. Therefore the legal systems of the various countries, including Italy, should indicate clear decision-making paths for the patient.