Predicting Internet Use and Digital Competence Among Older Adults Using Performance Tests of Visual, Physical, and Cognitive Functioning: Longitudinal Population-Based Study

The interplay between cognitive function and digital health literacy among older adults: Implications for e-health equity and accessibility

BACKGROUND

Digital health literacy is increasingly vital for older adults, yet cognitive decline can impede effective use of online health resources.

OBJECTIVE

This study investigated the relationship between cognitive function and e-health literacy among older adults.

METHODS

A cross-sectional design was employed in six training family health centers across Izmir, Turkey. A total of 211 participants aged ≥ 65 years who reported internet use were included. Cognitive function was measured using the Mini-Mental State Examination, and digital health literacy was assessed using the Turkish version of the eHealth Literacy Scale. Data were analyzed with descriptive statistics, correlation analyses (Spearman).

RESULTS

The mean age was 69.58 ± 4.19 years, and 49.8 % were male. Cognitive function, as measured by the MMSE, demonstrated a significant positive correlation with eHEALS scores (r = 0.609, p < 0.001). Conversely, age was negatively correlated with eHEALS scores.

CONCLUSION

Cognitive function emerged as a key determinant of digital health literacy among older adults, even within the clinically normal MMSE range. This study is the first to highlight that subtle cognitive differences-though considered within normal limits-can significantly influence digital health engagement, our findings underscore the importance of designing user-friendly digital health interventions that accommodate age-related cognitive changes. Enhanced training and support for device usage may further mitigate barriers to effective e-health engagement in aging populations.

Multivariable Prediction Model Development and Validation for Dropout in Community-Based Going-Out Program for Older Adults

BACKGROUND

We aimed to develop and validate a multivariable model for predicting dropout from a community-based going-out program for older adults.

METHODS

The National Center for Geriatric and Gerontology's Study of Geriatric Syndromes, with a prospective cohort of general older adults, was employed. A total of 5905 older adults who were independent in their activities of daily living were recruited and randomly allocated into training, validation, and testing data sets in a 6:2:2 ratio. An outcome was defined as dropping out of a community-based going-out program within 180 days. An extreme gradient boosting algorithm was used to develop the predictive model using training and validation data sets and to identify feature importance. The model's discrimination and calibration were evaluated in the test data set.

RESULTS

The area under the curve for the receiver operating characteristic ( 95% CI) was 0.701 (0.670-0.732). Sensitivity, specificity, positive predictive value, and negative predictive value and their 95% CIs were 0.253 (0.226-0.277), 0.915 (0.899-0.931), 0.588 (0.560-0.612), and 0.718 (0.692-0.743), respectively, and the slope of the calibration plot was 1.046 (0.909-1.182). Cognitive and physical functions and willingness to engage in exercise/sport activities were selected as the most important features.

CONCLUSIONS

The predictive model reliably indicates whether a participant will drop out when classified as negative but not when classified as positive. Physical and cognitive functions and willingness to engage in physical activity may be primary predictors.

A meta-analysis of technology use and cognitive aging

The first generation who engaged with digital technologies has reached the age where risks of dementia emerge. Has technological exposure helped or harmed cognition in digital pioneers? The digital dementia hypothesis predicts that a lifetime of technology exposure worsens cognitive abilities. An alternative hypothesis is that such exposures lead to technological reserve, wherein digital technologies promote behaviours that preserve cognition. We tested these hypotheses in a meta-analysis and systematic review of studies published in Medline, PsycInfo, CINAHL, Science Direct, Scopus, Cochrane Library, ProQuest and Web of Science. Studies were included if they were observational or cohort studies focused on general digital technology use in older adults (over age 50) and included either a cognitive or dementia diagnosis outcome. We identified 136 papers that met inclusion criteria, of which 57 were compatible with odds ratio or hazard ratio meta-analysis. These studies included 411,430 adults (baseline age M = 68.7 years; 53.5% female) from cross-sectional and longitudinal observational studies (range: 1-18 years, M = 6.2 years). Use of digital technologies was associated with reduced risk of cognitive impairment (OR = 0.42, 95% CI 0.35-0.52) and reduced time-dependent rates of cognitive decline (HR = 0.74, 95% CI 0.66-0.84). Effects remained significant when accounting for demographic, socioeconomic, health and cognitive reserve proxies. All studies were evaluated for quality on the basis of a standardized checklist; the primary outcomes replicated when limiting analyses to the highest-quality studies. Additional work is needed to test bidirectional causal interpretations, understand mechanisms that underpin technological reserve, and identify how types and timings of technology exposures influence cognitive health.

Need for and Acceptance of Digital Health Interventions for Self-Management Among Older Adults Living Alone: A Mixed-Methods Approach

PURPOSE

Although digital solutions could mitigate the challenges faced by older adults living alone (OALA), only a few studies investigated the need for and acceptance of digital health interventions for self-management (DHISMs) among this demographic. Thus, we aim to explore this need and acceptance, along with the contextual factors, among OALA.

METHODS

A mixed-methods research approach was adopted. We conducted 1) a quantitative survey (n = 191) to investigate the need for and acceptance of DHISMs using a numeric rating scale and 2) a qualitative study (n = 24) based on focus group interviews to explore contextual factors related to the quantitative results. Qualitative data were analyzed using thematic analysis.

RESULTS

In the quantitative study, the mean scores for the need for and acceptance of DHISMs were 6.41 and 6.53 out of 10, respectively. Emergency response systems had the highest need and acceptance scores, whereas digital interventions for behavioral change (medication adherence, sleep, stress, and diet management) had relatively lower scores. The qualitative analysis revealed two themes and five subthemes: the need for inclusive support for independent living (environmental safety and diverse self-management challenges with limited support) and multidimensional factors related to DHISM acceptance (personal, technological, and relational barriers and facilitators).

CONCLUSIONS

In the future, the unique and multidimensional factors influencing the need for and acceptance of DHISMs among OALA should be carefully considered to support their self-management and independent living. Blended care, which involves integrating age-friendly technology with personalized human interaction, is pivotal for increasing DHISM acceptance in this population.

Exploring Older Adults' Needs for a Healthy Life and eHealth: Qualitative Interview Study

BACKGROUND

Aging brings physical and life changes that could benefit from eHealth services. eHealth holistically combines technology, tasks, individuals, and contexts, and all these intertwined elements should be considered in eHealth development. As users' needs change with life situations, including aging and retirement, it is important to identify these needs at different life stages to develop eHealth services for well-being and active, healthy lives.

OBJECTIVE

This study aimed to (1) understand older adults' everyday lives in terms of well-being and health, (2) investigate older adults' needs for eHealth services, and (3) create design recommendations based on the findings.

METHODS

A total of 20 older adults from 2 age groups (55 to 74 years: n=12, 60%; >75 years: n=8, 40%) participated in this qualitative interview study. The data were collected remotely using a cultural probes package that included diary-based tasks, sentence completion tasks, and 4 background questionnaires; we also performed remote, semistructured interviews. The data were gathered between the fall of 2020 and the spring of 2021 in Finland as a part of the Toward a Socially Inclusive Digital Society: Transforming Service Culture (DigiIN) project (2019 to 2025).

RESULTS

In the daily lives of older adults, home-based activities, such as exercising (72/622, 11.6% of mentions), sleeping (51/622, 8.2% of mentions), and dining and cooking (96/622, 15.4% of mentions), promoted well-being and health. When discussing their needs for eHealth services, participants highlighted a preference for a chat function. However, they frequently mentioned barriers and concerns such as the lack of human contact, inefficiency, and difficulties using eHealth systems. Older adults value flexibility; testing possibilities (eg, trial versions); support for digital services; and relevant, empathetically offered content with eHealth services on short-term and long-term bases in their changing life situations.

CONCLUSIONS

Many older adults value healthy routines and time spent at home. The diversity of older adults' needs should be considered by making it possible for them to manage their health safely and flexibly on different devices and channels. eHealth services should adapt to older adults' life changes through motivation, personalized content, and appropriate functions. Importantly, older adults should still have the option to not use eHealth services.

Association Between Digital Front Doors and Social Care Use for Community-Dwelling Adults in England: Cross-Sectional Study

BACKGROUND

Requests for public social care support can be made through an online portal. These digital "front doors" can help people navigate complex social care systems and access services. These systems can be set up in different ways, but there is little evidence about the impact of alternative arrangements. Digital front-door systems should help people better access services, particularly low-intensity services (high-intensity care is likely to require a full in-person assessment).

OBJECTIVE

This study aimed to investigate the association between 2 primary digital front door arrangements, easy-read information, and self-assessment tools provided on official websites, and the type of social care support that is offered: ongoing low-level support (OLLS), short-term care (STC) and long-term care (LTC).

METHODS

Information on front door arrangements was collected from the official websites of 152 English local authorities in 2021. We conducted a cross-sectional analysis using aggregated service use data from official government returns at the local authority level. The independent variables were derived from the policy information collected, specifically focusing on the availability of online digital easy-read information and self-assessment tools for adults and caregivers through official websites. The dependent variables were the rates of using social care support, including OLLS, STC, and LTC, across different age groups: the adult population (aged 18 and older), younger population (aged between 18 and 64 years), and older population (aged 65 and older). Multivariate regression analysis was used to examine the association between digital front door arrangements and access to social care support, controlling for population size, dependency level, and financial need factors.

RESULTS

Less than 20% (27/147) of local authorities provided an integrated digital easy-read format as part of their digital front door system with about 25% (37/147) adopting digital self-assessment within their system. We found that local authorities that offered an integrated digital easy-read information format showed higher rates of using OLLS (β coefficient=0.54; P=.03; but no statistically significant association with LTC and STC). The provision of an online self-assessment system was not associated with service use in the 1-year (2021) cross-sectional estimate, but when 2 years (2020 and 2021) of service-use data were analyzed, a significant positive association was found on OLLS rates (β coefficient=0.41; P=.21). Notably, these findings were consistent across different age groups.

CONCLUSIONS

These findings are consistent with our hypothesis that digital systems with built-in easy-read and self-assessment may make access to (low-intensity) services easier for people. Adoption of these arrangements could potentially help increase the uptake of support among those who are eligible, with expected benefits for their care-related well-being. Given the limited adoption of the digital front door by local authorities in England, expanding their use could improve care-related outcomes and save social care costs.

Association Between Visual Impairment and Daily Internet Use Among Older Japanese Individuals: Cross-Sectional Questionnaire Study

Background

Older adults might not use computers due to psychological barriers, environmental barriers such as not owning a computer or lack of internet access, and health-related barriers such as difficulties with fine motor skills, low cognitive function, or low vision. Given the health benefits of internet use among older adults, inadequate use of the internet is an urgent public health issue in many countries.

Objective

We aimed to determine whether visual impairment is associated with internet use in a population-based sample of older adults.

Methods

This cross-sectional study sourced data for the year 2016 from the Japan Gerontological Evaluation Study. It included functionally independent community-dwelling individuals aged ≥65 years (N=19,452) in Japan. The respondents reported their visual status by answering the question, "Is your eyesight (without or with usual glasses or corrective lenses) excellent, very good, good, fair, or poor?" We defined "internet user" as a person who uses the internet "almost daily." We used multivariate logistic regression with multiple imputations to analyze visual status, daily internet use, and any correlations between them.

Results

We observed that 23.6% (4599/19,452) of respondents used the internet almost daily. Respondents with good visual status notably tended to use the internet more frequently than those with poor visual status. Specifically, 13% and 31% of respondents with poor and excellent vision, respectively, used the internet almost daily. In contrast, 66% and 45% of respondents with poor and excellent vision, respectively, did not use the internet. Even after adjusting for several covariates (age, sex, equivalized income, years of education, marital status, depression, history of systemic comorbidities, frequency of meeting friends, and total social participation score), significant associations persisted between visual status and daily internet usage. The odds ratios (ORs) tended to increase as visual status improved (P for trend <.001). The adjusted ORs for individuals with excellent and very good visual status who used the internet almost daily were 1.38 (95% CI 1.22-1.56) and 1.25 (95% CI 1.15-1.36), respectively. Conversely, the adjusted OR for those with fair or poor visual status was 0.73 (95% CI 0.62-0.86).

Conclusions

In this study, we reaffirmed what several previous studies have pointed out using a very large dataset; visual impairment negatively impacted daily internet use by older adults. This highlights the need to address visual impairments to promote web use as health care services become more easily accessed on the web.

'With or without you': associations between noteworthy events and cognitive complaints across 100 days

OBJECTIVES

Daily noteworthy events have implications for physical and mental health, but less is known about the role daily events have for self-reported cognition and whether the involvement of close social partners differentiates these associations. The current study examined how daily positive and negative noteworthy events relate to subjective memory and attentional difficulties and whether close social partners moderated associations.

METHOD

We used data from a 100-day microlongitudinal web-based study of 104 older adults (Nobservations=7,051; Mage=63.13 years, SDage=7.81, 88.46% Female). Participants reported on exposure to and valence of noteworthy events, involvement of close social partners, and subjective cognitive complaints at the end of each day.

RESULTS

Logistic multilevel models revealed that days with a negative event were associated with increased odds of forgetting something and trouble concentrating whereas days with positive events were associated with decreased odds of trouble concentrating. Close social partner involvement did not moderate within-person associations.

CONCLUSION

Our results suggest that day-to-day events are correlates of cognitive complaints regardless of close social partner involvement in the events. Research should clarify the role of daily positive and negative events in personalized interventions and determine whether this person-centered approach to self-reported cognitive health helps inform diagnostic practices.

Association Between Daily Internet Use and Intrinsic Capacity Among Middle-Aged and Older Adults in China: Large Prospective Cohort Study

BACKGROUND

Intrinsic capacity (IC), as a comprehensive measure of an individual's functional ability, has gained prominence in the framework for healthy aging introduced by the World Health Organization (WHO). As internet usage continues to integrate into daily life, it is imperative to scrutinize the association between internet use and IC to effectively promote healthy aging among the middle-aged and older population.

OBJECTIVE

This study aimed to investigate whether daily internet use in middle-aged and older adults delays or accelerates the decline in IC.

METHODS

Participants included in the China Health and Retirement Longitudinal Study (CHARLS) comprised individuals aged ≥45 years residing in China. We analyzed 4 years of CHARLS data from the first wave (May 2011-March 2012) to the third wave (July 2015-January 2016). Data from the first and third waves were used for longitudinal studies. Self-reported data encompassed internet use, frequency of use, and demographic baseline characteristics. In addition, the IC evaluation involved physical examination and blood test data. Initially, linear regression was used to assess the relationship between daily internet use and IC, followed by regression splines to explore potential nonlinear associations. Subgroup and sensitivity analyses were used to investigate the heterogeneity of IC in specific conditions and the robustness of our results. Mediation effect analysis was conducted to identify the factors that mediate the relationship between daily internet use and IC, focusing on social participation, physical activity, and health status.

RESULTS

Among the 12,826 participants included in the longitudinal analyses, 12,305 (95.9%) did not use the internet, while 521 (4.1%) reported daily internet use with a mean age of 52.62 (SD 7.67) years. After adjusting for demographic variables, socioeconomic factors, lifestyle behaviors, and health conditions and examining the impact of daily internet use and frequency on changes in IC, our findings indicated important associations. Specifically, daily internet use is significantly linked to a slower decline in IC over time (marginal effect 1.58, 95% CI 1.03-2.12; P<.001). Individuals with moderate and regular internet use frequency exhibit higher levels of maintenance in IC (marginal effect 0.74, 95% CI 0.45-1.03, P<.001). In addition, the relationship between IC changes and internet use frequency demonstrated a nonlinear inverted U-shaped curve (nonlinear P=.003). Subgroup analysis further revealed that improvements in IC vary based on age and gender. Furthermore, mediation analysis denoted that more than 28.78% (95% CI 21.24-40.33) of the observed association is mediated by social participation (P<.001).

CONCLUSIONS

The findings of our research underscore the potential benefits of consistent and moderate internet use in promoting and preserving IC, particularly in cognitive capacity, sensory, vitality, and locomotion. The observed effects may be related to social participation. These insights offer valuable guidance for crafting strategies aimed at fostering healthy aging within the middle-aged and older adult demographics.

Cognitive functioning and sustained internet use amid the COVID-19 pandemic: longitudinal evidence from older adults in Switzerland

This study aimed to investigate the relationship between pre-pandemic objective and subjective cognitive functioning and sustained Internet use during the pandemic among older adults in Switzerland. Data from 1299 respondents of the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2019/2020 and a supplementary technology use questionnaire during the pandemic in 2021 were used. Cognitive functioning was assessed in 2019/2020 through objective measures (delayed and immediate memory, verbal fluency) and self-rated memory. Sustained Internet use was defined as having used the Internet at least once in the past seven days in 2019/2020 and reporting daily or weekly use in 2021. We found that 73.1% of respondents consistently used Internet between 2019/2020 and 2021. Using multivariable probit regression models controlling for sociodemographic and health variables, we found that higher global cognition z-scores, especially in immediate and delayed memory, were associated with a higher likelihood of sustained Internet use. Additionally, respondents with good, very good, or excellent self-rated memory were more likely to sustain their Internet use. These findings highlight the potential critical role of cognitive health in shaping older adults' digital engagement, suggesting that cognitive assessments and training should be further considered in digital literacy initiatives for this population.

Old age or cognitive decline? Examining the usability of a mobile health app for older Australians

There is a growing literature on the role of mobile health applications (mHealth apps) in supporting older adults and the self-management of personal health. The purpose of this pilot study is to assess the usability of a government-funded mobile health app amongst older Australians and to evaluate whether cognitive function and demographic characteristics (i.e. age, gender, education) are associated with usability. A total of 28 older adults living in a regional city in Australia took part in the study. The participants were recruited using purposive sampling. Data collection instruments consisted of validated cognitive tests, task-based usability tests, and a questionnaire. The data was analyzed using non-parametric strategies. The findings of this study demonstrated that a government-funded, mHealth app was usable by older adults. Users were able to perform basic tasks in an effective and efficient manner. The hypothesis that elderly age would be significantly associated with performance on cognitive tests, as well as usability, was not supported. Performance on some cognitive tests was significantly and positively related to usability. Education and gender were not related to usability. The results suggest that traditional stereotypes surrounding aging and cognitive decline need to be reexamined.