Investigating the impact of sociodemographic factors on training efficacy and its correlation with technology usability in older adults: Lessons learned in Italian and Murcian pilots

INTRODUCTION

Technology training supports technology adoption among older adults. However, guidelines and insights into personal and sociodemographic factors affecting its effectiveness are lacking. This study explores how these factors influence training effectiveness in older adults and its impact on technology usability.

METHODS

This paper focuses on two pilot sites of the Pharaon project that implemented similar health monitoring scenarios. A total of 114 older adults were recruited and trained on monitoring technologies following which they filled in sociodemographic and usability questionnaires.

RESULTS

Our findings indicate that age, digital literacy, educational attainment, and perceived loneliness significantly affect training evaluation, while quality of life and gender do not show a significant impact. Training efficacy was also found to be connected to system usability (all p < 0.005). Furthermore, the experience of professionals involved with providing training to older adults was elaborated highlighting the importance of tailored training approaches and continuous support mechanisms to enhance technology adoption among older populations.

DISCUSSION

The results showed that training programs aimed at enhancing usability should consider tailoring the content to the user, as there are personal factors which can influence how the training is received. Finally, the results provide actionable recommendations for optimizing training protocols to facilitate the integration of digital health solutions across diverse environments.

CONCLUSIONS

The findings highlight the need for standardized yet adaptable training guidelines that address individual differences, offering practical direction for future implementations and policies to support long-term technology adoption in older adults.

Using technology to provide individualized respite for caregivers in rural communities

Introduction

Caregiving for older adults-by family and friends-is an essential component of the U.S. health and long-term care systems. Though often rewarding, caregiving is associated with higher rates of poor health. Respite is valued by caregivers and associated with positive outcomes; however, access is limited. Exhale-The Family Caregiver Initiative, known as Exhale, was established to support the development of respite programming consistent with local priorities.

Methods

Exhale respite programs participate in an evaluation, which includes caregiver assessments. This paper focuses on results from one Exhale-supported program, Caregiver Tech Solutions (CTS). CTS provides digital technology and coaching to caregivers in rural New York, offering an alternative to place-based respite and allowing caregivers to achieve short breaks from tasks or worries within their homes, on their terms.

Results

Evaluation findings show that most CTS caregivers were children of the care recipients and cared for someone age 75+. Most had not participated in a respite program previously. Significant increases in respite were reported at follow-up: 25% of participants reported respite "every day or almost every day" at follow-up, compared to 12% at baseline. There were also significant declines in caregiver burden.

Conclusions

CTS is not unique in use of electronic resources; however, literature remains sparse. Furthermore, pairing technology with coaching is uncommon. Finally, the outcomes demonstrated by CTS counter perceptions that technology-based solutions are not appropriate for older adults or in rural communities. Rather, flexible programs such as CTS represent a promising approach to addressing the needs of rural caregivers.

Barriers to Using Mobile App-Based Cognitive Testing in Older Adults with Probable Alzheimer's Disease: A Qualitative Study

Background/Objectives: Smart technologies have the potential to be rapid, sensitive, and cost-effective tools for real-life monitoring of cognitive function among older adults. Identifying barriers to using remote cognitive testing in older adults' daily lives is essential. However, obstacles of utilizing digital cognitive tests in community-dwelling older adults with probable Alzheimer's Disease (AD) remain unclear. The purpose of this study was to investigate barriers of older adults with probable AD toward using mobile app-based cognitive assessment. Methods: This was a qualitative study. Older adults with probable AD and their family caregivers were recruited from an outpatient clinic at a hospital's neurological department. Semi-structured interviews were performed. Characteristics of the participants were analyzed using descriptive statistics. Thematic analysis was conducted to identify barriers to using mobile app-based cognitive testing. Results: The study sample consisted of 32 older adults with probable AD and 19 family caregivers involving the use of at-home mobile app-based cognitive assessment every two weeks over 12 months. In this study, three main themes were identified, including barriers related to availability of family support, health-related barriers, and app-related barriers. Conclusions: Mobile app-based cognitive assessment could be a promising tool for detecting AD and monitoring cognition among older adults. A better understanding of the barriers to using at-home digital cognitive testing can facilitate the development of patient-centered and custom-built mobile applications for older adults with probable AD and improve their cognitive function.

The Role of Environmental Factors in Technology-Assisted Physical Activity Intervention Studies Among Older Adults: Scoping Review

BACKGROUND

The rapidly emerging integration of both technological applications and environmental factors in physical activity (PA) interventions among older adults highlights the need for an overarching investigation.

OBJECTIVE

This scoping review compiled the current literature and aimed to provide an overview of the role of physical, social, socioeconomic, and systemic environmental factors in technology-assisted PA interventions for older adults.

METHODS

We systematically searched 6 common databases up to September 16, 2024, for original longitudinal studies (with at least one preintervention measurement and one postintervention measurement) that reported on the role of environmental factors in technology-assisted PA interventions for independently living, community-dwelling older adults. In a stepwise process, data on study characteristics (step 1), environmental factors and their role in the included studies (step 2), and intervention outcomes and effects by type of environmental factor (step 3) were summarized.

RESULTS

A total of 8020 articles were screened, and 25 (0.31%) were included. Most studies were conducted in Europe (11/25, 44%), followed by North America (5/25, 20%), Asia (5/25, 20%), and Oceania (4/25, 16%). Social environmental factors were most often considered (19/25, 76%), followed by factors from the physical (8/25, 32%), socioeconomic (1/25, 4%), and systemic environment (1/25, 4%). Environmental factors were used as the outcome (8/25, 32%), setting variable (7/25, 28%), moderator or facilitator (8/25, 32%), and intervention component (3/25, 12%). In most studies (19/25, 76%), the intervention had a beneficial effect on the outcome of interest, and the included environmental factor played a supportive role in achieving this effect. In some studies, no effect (3/25, 12%), mixed effects (2/25, 8%), or adverse effects (1/25, 4%) of the interventions were reported.

CONCLUSIONS

This is the first comprehensive description of how environmental factors interact with technology-assisted interventions to increase or optimize PA in older adults. It was found that the investigation of environmental factors in this field is at an early stage. Environmental factors were found to play a supportive role in achieving beneficial effects of technology-assisted PA interventions, but the findings were based on a heterogeneous empirical platform. Still, certain aspects such as the application of virtual reality environments and social (or peer) comparison have shown significant potential that remains to be leveraged. A better understanding of intervention results and support in tailoring intervention programs can be provided through the inclusion of environmental aspects in technology-assisted PA interventions for older adults.

Association between physical activity practice and sleep quality of older people in social isolation during the COVID-19 pandemic and Health Guidelines and future studies for the post-COVID period: a systematic review

PURPOSE

Physical activity (PA) is considered an alternative to mitigate the negative impacts of the COVID-19 pandemic on the sleep of older adults. The objective was to verify the association between physical activity and the sleep quality of older people in social isolation during the COVID-19 pandemic, to analyze the Health Guidelines, and suggest future studies for the post-COVID period.

METHODS

This systematic review followed PRISMA recommendations, and the protocol was registered in PROSPERO (CRD 42023406471). The search for articles occurred in April 2024 in the databases PubMed, Web of Science, SCOPUS, and gray literature. Data were extracted and checked in a Microsoft Excel® spreadsheet. The quality assessment was performed using tools from the National Institutes of Health.

RESULTS

In total, 1582 studies were found in the databases, of which nine were included in the analyses. Four studies reported a negative association of reduced levels of PA during the pandemic with sleep quality, while one study showed a positive association of PA with sleep quality. Four studies demonstrated no association.

CONCLUSIONS

PA was associated with the sleep quality of older adults during the COVID-19 pandemic and reduced levels of PA during this period demonstrated a negative association with sleep quality. Practice of PA is recommended for this post-COVID scenario, as a measure to reduce social isolation and its negative effects and improve the quality of sleep in older adults.

A case study on experiences with integrated technologies in a care home for older adults

To facilitate independent living for the growing population of older adults, innovative housing solutions such as novel concepts of care homes with integrated technologies have been developed. This case study exposes a significant gap between the intended goal of fostering independence in older adults and the actual impact of technology on their daily lives. The study explored perceptions, experiences, and needs regarding residents' use of integrated technologies along with the technologies' contribution to handling their everyday life in a Care+ home. Data were analyzed through qualitative content analysis. The key finding is that one size does not 'fit' all, indicating that the standardized technology installed in the apartments often fails to meet the users' individual needs. This research identifies a critical gap in tailoring technologies to the unique needs of older users. Aligning technological solutions with aging-in-place policies focused on autonomy and well-being is essential for enhancing care environments.

Exploring Social Support Strategies and Socio-Cultural Factors Influencing Social Isolation and Loneliness: The Role of Digital Literacy

BACKGROUND/OBJECTIVES

Social isolation (SI) and loneliness (L) are the long-standing critical concerns impacting the mental well-being of older adults. The COVID-19 pandemic has exacerbated existing vulnerabilities, leading to a notable rise in perceived social isolation (PSI) and its associated risks among an aging population. Reportedly, nearly 35% of older Americans felt lonely before the pandemic, with the pandemic further intensifying these feelings. This commentary examines the multifaceted factors contributing to PSI, including demographic and socio-economic characteristics.

METHODS

We outline the health risks associated with PSI, including cardiovascular diseases and mental health conditions.

RESULTS

This commentary addresses the potential of information and communication technology (ICT) to alleviate loneliness, despite significant barriers such as the digital divide and technological anxiety among older adults.

CONCLUSIONS

This commentary advocates targeted digital literacy interventions and theoretical frameworks to enhance technology adoption and mitigate PSI, ultimately aiming to improve health outcomes and quality of life for the aging population.

A Digital Communication Intervention to Support Older Adults and Their Care Partners Transitioning Home After Major Surgery: Protocol for a Qualitative Research Study

BACKGROUND

Older adults (aged ≥65 years) account for approximately 30% of inpatient procedures in the United States. After major surgery, they are at high risk of a slow return to their previous functional status, loss of independence, and complications like delirium. With the development and refinement of Enhanced Recovery After Surgery protocols, older patients often return home much earlier than historically anticipated. This put a larger burden on care partners, close family or friends who partner with the patient and guide them through recovery. Without adequate preparation, both patients and their care partners may experience poor long-term outcomes.

OBJECTIVE

This study aimed to improve and streamline recovery for patients aged ≥65 years by exploring the communication needs of patients and their care partners. Information from this study will be used to inform an intervention developed to address these needs and define processes for its implementation across surgical clinics.

METHODS

This qualitative research protocol has two aims. First, we will define patient and care partner needs and perspectives related to digital health innovation. To achieve this aim, we will recruit dyads of patients (aged ≥65 years) who underwent elective major surgery 30-90 days prior and their respective care partners (aged ≥18 years). Participants will complete individual interviews and surveys to obtain demographic data, characterize their perceptions of the surgical experience, identify intervention targets, and assess for the type of intervention modality that would be most useful. Next, we will explore clinician perspectives, tools, and strategies to develop a blueprint for a digital intervention. To achieve this aim, clinicians (eg, geriatricians, surgeons, and nurses) will be recruited for focus groups to identify current obstacles affecting surgical outcomes for older patients, and we will review current assessments and tools used in their clinical practice. A hybrid deductive-inductive approach will be undertaken to identify relevant themes. Insights from both clinicians and patient-care partners will guide the development of a digital intervention strategy to support older patients and their care partners after surgery.

RESULTS

This study has been approved by the Massachusetts General Hospital and Harvard Institutional Review Boards. Recruitment began in December 2023 for the patient and care partner interviews. As of August 2024, over half of the interviews have been performed, deidentified, and transcribed. Clinician recruitment is ongoing, with no focus groups conducted yet. The study is expected to be completed by fall 2024.

CONCLUSIONS

This study will help create a scalable digital health option for older patients undergoing major surgery and their care partners. We aim to enhance our understanding of patient recovery needs; improve communication with surgical teams; and ultimately, reduce the overall burden on patients, their care partners, and health care providers through real-time assessment.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59067.

A Deep Learning-Based Rotten Food Recognition App for Older Adults: Development and Usability Study

BACKGROUND

Older adults are at greater risk of eating rotten fruits and of getting food poisoning because cognitive function declines as they age, making it difficult to distinguish rotten fruits. To address this problem, researchers have developed and evaluated various tools to detect rotten food items in various ways. Nevertheless, little is known about how to create an app to detect rotten food items to support older adults at a risk of health problems from eating rotten food items.

OBJECTIVE

This study aimed to (1) create a smartphone app that enables older adults to take a picture of food items with a camera and classifies the fruit as rotten or not rotten for older adults and (2) evaluate the usability of the app and the perceptions of older adults about the app.

METHODS

We developed a smartphone app that supports older adults in determining whether the 3 fruits selected for this study (apple, banana, and orange) were fresh enough to eat. We used several residual deep networks to check whether the fruit photos collected were of fresh fruit. We recruited healthy older adults aged over 65 years (n=15, 57.7%, males and n=11, 42.3%, females) as participants. We evaluated the usability of the app and the participants' perceptions about the app through surveys and interviews. We analyzed the survey responses, including an after-scenario questionnaire, as evaluation indicators of the usability of the app and collected qualitative data from the interviewees for in-depth analysis of the survey responses.

RESULTS

The participants were satisfied with using an app to determine whether a fruit is fresh by taking a picture of the fruit but are reluctant to use the paid version of the app. The survey results revealed that the participants tended to use the app efficiently to take pictures of fruits and determine their freshness. The qualitative data analysis on app usability and participants' perceptions about the app revealed that they found the app simple and easy to use, they had no difficulty taking pictures, and they found the app interface visually satisfactory.

CONCLUSIONS

This study suggests the possibility of developing an app that supports older adults in identifying rotten food items effectively and efficiently. Future work to make the app distinguish the freshness of various food items other than the 3 fruits selected still remains.

Technology Usability for People Living With Dementia: Concept Analysis

BACKGROUND

Usability is a key indicator of the quality of technology products. In tandem with technological advancements, potential use by individuals with dementia is increasing. However, defining the usability of technology for individuals with dementia remains an ongoing challenge. The diverse and progressive nature of dementia adds complexity to the creation of universal usability criteria, highlighting the need for focused deliberations. Technological interventions offer potential benefits for people living with dementia and caregivers. Amid COVID-19, technology's role in health care access is growing, especially among older adults. Enabling the diverse population of people living with dementia to enjoy the benefits of technologies requires particular attention to their needs, desires, capabilities, and vulnerabilities to potential harm from technologies. Successful technological interventions for dementia require meticulous consideration of technology usability.

OBJECTIVE

This concept analysis aims to examine the usability of technology in the context of individuals living with dementia to establish a clear definition for usability within this specific demographic.

METHODS

The framework by Walker and Avant was used to guide this concept analysis. We conducted a literature review spanning 1984 to 2024, exploring technology usability for people with dementia through the PubMed, Web of Science, and Google Scholar databases using the keywords "technology usability" and "dementia." We also incorporated clinical definitions and integrated interview data from 29 dyads comprising individuals with mild Alzheimer dementia and their respective care partners, resulting in a total of 58 older adults. This approach aimed to offer a more comprehensive portrayal of the usability needs of individuals living with dementia, emphasizing practical application.

RESULTS

The evidence from the literature review unveiled that usability encompasses attributes such as acceptable learnability, efficiency, and satisfaction. The clinical perspective on dementia stages, subtypes, and symptoms underscores the importance of tailored technology usability assessment. Feedback from 29 dyads also emphasized the value of simplicity, clear navigation, age-sensitive design, personalized features, and audio support. Thus, design should prioritize personalized assistance for individuals living with dementia, moving away from standardized technological approaches. Synthesized from various sources, the defined usability attributes for individuals living with dementia not only encompass the general usability properties of effectiveness, efficiency, and satisfaction but also include other key factors: adaptability, personalization, intuitiveness, and simplicity, to ensure that technology is supportive and yields tangible benefits for this demographic.

CONCLUSIONS

Usability is crucial for people living with dementia when designing technological interventions. It necessitates an understanding of user characteristics, dementia stages, symptoms, needs, and tasks, as well as consideration of varied physical requirements, potential sensory loss, and age-related changes. Disease progression requires adapting to evolving symptoms. Recommendations include versatile, multifunctional technology designs; accommodating diverse needs; and adjusting software functionalities for personalization. Product feature classification can be flexible based on user conditions.

Exploring the mediating influence of acceptance of change: A study on gerontechnology acceptance, mental well-being, and urban-rural disparities among older adults

BACKGROUND

The global aging population necessitates leveraging technology for older adults' independence and mental well-being. Gerontechnology, tailored for older users, thrives when accessible and accepted, with the pivotal role of acceptance of change shaping its adoption.

AIMS

This study investigates the mediating role of acceptance of change in the relationship between gerontechnology acceptance and mental well-being among older adults and explores disparities in urban and rural settings DESIGN & METHODS: A cross-sectional, correlational design adhering to STROBE guidelines collected data through an interview survey from 802 older adults. Instruments included the Older Adult Structured Survey, Short Version of Senior Technology Acceptance, Acceptance of Change Scale, and the World Health Organization Well-Being Index.

RESULTS

The results underscore a significant correlation between technology adoption, adaptability, and mental well-being among 60-year-olds and older. Notably, an individual's openness to change significantly influences the technology-mental well-being relationship, emphasizing its impact on overall health. Urban areas exhibit a stronger positive correlation between technology acceptance and mental well-being, whereas rural regions demonstrate a more pronounced negative correlation.

CONCLUSION

This research contributes valuable knowledge for addressing the unique challenges older adults face in diverse geographic settings, paving the way for targeted and effective initiatives.

IMPLICATIONS

Nurses should prioritize understanding the nexus between gerontechnology acceptance, change adaptability, and mental wellness, integrating technology education and culturally sensitive interventions to enhance care strategies for older adults in diverse geographic settings. This study lays the groundwork for developing person-centered geriatric nursing care plans, underscoring the importance of harnessing technology for improved mental well-being.

Best practices for implementing a technology-based intervention protocol: Participant and researcher considerations

Technology-based interventions present a promising approach to support health and wellness for older adults with a range of cognitive abilities. Technology can enhance access to interventions and support scaling of programs to reach more people. However, the use of technology for intervention delivery requires particular attention to users' needs and preferences and ensuring the materials are adaptable and supportive of a diverse range of technology proficiency levels. We share best practices based on lessons learned from the deployment of a randomized controlled trial (RCT) wherein we delivered an 8-week social engagement intervention through a video technology platform called OneClick for older adults with varying cognitive abilities. We developed a set of best practices and guidelines informed by the lessons learned through this RCT implementation. Technology-based interventions require attention to the application (e.g., video calls), system requirements (e.g., system memory, broadband internet), training (e.g., adaptability based on user competency), and support (e.g., handouts, live contact). These best practices relate to user needs; training design; personnel responsibility; structuring delivery and content; and evaluating success. These research-based best practices can guide the design, development, and implementation of technology-based interventions to support older adults with varying cognitive abilities.

Enhancing active aging through IRAGE: Mitigating social isolation with intergenerational gaming

This paper presents the outcomes of a pioneering study that explores the potential of remote intergenerational communication to combat social isolation among children and older adults, especially under constraints posed by pandemics such as COVID-19. Acknowledging the limited mobility of many older adults, this research aims to provide insights into how digital platforms can facilitate meaningful exchanges between generations. Utilizing a mixed methodology approach, the study first conducted a user interaction analysis to outline guidelines for participant engagement with the Information and Communication Technology (ICT)-based tool called IRAGE (Intergenerational Remote Access to Gaming Experiences) designed specifically for this purpose. Following the development of the ICT tool, three sessions of the remote intergenerational experience were held, during which participants' interactions were recorded and subsequently analyzed quantitatively and qualitatively. Key findings from the study reveal that remote intergenerational communication can significantly mitigate feelings of isolation among older adults, contributing to their mental health and emotional well-being. Moreover, the study highlights the effectiveness of the web-based platform in facilitating these interactions, with older adults and children finding the user interface intuitive and the overall experience engaging. These outcomes underscore the importance of leveraging technology to maintain social connections during challenging times and offer valuable guidelines for developing ICT tools that cater to the needs of diverse user groups. By demonstrating the feasibility and benefits of remote intergenerational communication, this research contributes to the broader discourse on active aging and the role of digital technologies in promoting social inclusion and emotional health.

Application of artificial intelligence in active assisted living for aging population in real-world setting with commercial devices - A scoping review

BACKGROUND

The aging population is steadily increasing, posing new challenges and opportunities for healthcare systems worldwide. Technological advancements, particularly in commercially available Active Assisted Living devices, offer a promising alternative. These readily accessible products, ranging from smartwatches to home automation systems, are often equipped with Artificial Intelligence capabilities that can monitor health metrics, predict adverse events, and facilitate a safer living environment. However, there is no review exploring how Artificial Intelligence has been integrated into commercially available Active Assisted Living technologies, and how these devices monitor health metrics and provide healthcare solutions in a real-world environment for healthy aging. This review is essential because it fills a knowledge gap in understanding AI's integration in Active Assisted Living technologies in promoting healthy aging in real-world settings, identifying key issues that require to be addressed in future studies.

OBJECTIVE

The aim of this overview is to outline current understanding, identify potential research opportunities, and highlight research gaps from published studies regarding the use of Artificial Intelligence in commercially available Active Assisted Living technologies that assists older individuals aging at home.

METHODS

A comprehensive search was conducted in six databases-PubMed, CINAHL, IEEE Xplore, Scopus, ACM Digital Library, and Web of Science-to identify relevant studies published over the past decade from 2013 to 2024. Our methodology adhered to the PRISMA extension for scoping reviews to ensure rigor and transparency throughout the review process. After applying predefined inclusion and exclusion criteria on 825 retrieved articles, a total of 64 papers were included for analysis and synthesis.

RESULTS

Several trends emerged from our analysis of the 64 selected papers. A majority of the work (39/64, 61%) was published after the year 2020. Geographically, most of the studies originated from East Asia and North America (36/64, 56%). The primary application goal of Artificial Intelligence in the reviewed literature was focused on activity recognition (34/64, 53%), followed by daily monitoring (10/64, 16%). Methodologically, tree-based and neural network-based approaches were the most prevalent Artificial Intelligence algorithms used in studies (32/64, 50% and 31/64, 48% respectively). A notable proportion of the studies (32/64, 50%) carried out their research using specially designed smart home testbeds that simulate the conditions in real-world. Moreover, ambient technology was a common thread (49/64, 77%), with occupancy-related data (such as motion and electrical appliance usage logs) and environmental sensors (indicators like temperature and humidity) being the most frequently used.

CONCLUSION

Our results suggest that Artificial Intelligence has been increasingly deployed in the real-world Active Assisted Living context over the past decade, offering a variety of applications aimed at healthy aging and facilitating independent living for the older adults. A wide range of smart home indicators were leveraged for comprehensive data analysis, exploring and enhancing the potentials and effectiveness of solutions. However, our review has identified multiple research gaps that need further investigation. First, most research has been conducted in controlled testbed environments, leaving a lack of real-world applications that could validate the technologies' efficacy and scalability. Second, there is a noticeable absence of research leveraging cloud technology, an essential tool for large-scale deployment and standardized data collection and management. Future work should prioritize these areas to maximize the potential benefits of Artificial Intelligence in Active Assisted Living settings.

Smartphone-delivered approach bias modification for reducing harmful drinking amongst middle-older age adults: Secondary analyses of a single-arm pilot study

INTRODUCTION

Novel, scalable, low-cost interventions are needed to reduce harmful drinking amongst middle-older adults. Approach bias modification (ApBM) is a promising form of cognitive training for preventing/reducing alcohol use that can be delivered via smartphone. This study explored the acceptability and preliminary effectiveness of smartphone delivered and personalised ApBM amongst Australians ≥55 years, an age cohort at risk of alcohol-related harms.

METHODS

Secondary analyses in a middle-older adult subsample (≥55 years, n = 289) of an open-label pilot study using a retrospective, repeated measures design. We explored acceptability (adherence, user mobile acceptability ratings, free-text responses) and preliminary effectiveness (changes in drinking quantity and frequency, craving, dependence and proportion drinking within government-recommended guidelines) of two sessions/week over 4 weeks of evidence-based ApBM training, adapted to include personalisation and smartphone delivery amongst Australians ≥55 years.

RESULTS

Although minor adaptations to training were suggested, the intervention was acceptable amongst survey completers, with 72% training adherence. Relative to baseline, there was a significant increase in the proportion of drinking within recommended single-session and weekly guidelines post-training (from 25% to 41% and 6% to 28%, respectively, p < 0.001), with past-week standard drinks significantly decreasing by 18% (p < 0.001) and significant reductions in drinking days, mean craving and dependence scores (p < 0.001).

DISCUSSION AND CONCLUSIONS

Findings suggest smartphone ApBM is acceptable amongst middle-to-older aged Australians and may support this 'at risk' cohort to remain within government-recommended alcohol consumption guidelines to optimise healthy aging, although, in the context of a single-arm study, preliminary results should be interpreted cautiously.

Development of the intelligent knee osteoarthritis lifestyle app: a person-based approach

BACKGROUND

Knee osteoarthritis is one of the most prevalent long term health conditions globally. Exercise and physical activity are now widely recognised to significantly reduce joint pain, improve physical function and quality of life in patients with knee osteoarthritis. However, prescribed exercise without regular contact with a healthcare professional often results in lower adherence and poorer health outcomes. Digital mobile health (mHealth) technologies offer great potential to support people with long-term conditions such as knee osteoarthritis more efficiently and effectively and with relatively lower cost than existing interventions. However, there are currently very few mHealth interventions for the self-management of knee osteoarthritis. The aim of the present study was to describe the development process of a mHealth app to extend the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through self-management, personalised physical activity, education, and social support.

METHODS

The development of the intelligent knee osteoarthritis lifestyle application intervention involved an iterative and interconnected process comprising intervention 'planning' and 'optimisation' informed by the person-based approach framework for the development of digital health interventions. The planning phase involved a literature review and collection of qualitative data obtained from focus groups with individuals with knee osteoarthritis (n = 26) and interviews with relevant physiotherapists (n = 5) to generate 'guiding principles' for the intervention. The optimisation phase involved usability testing (n = 7) and qualitative 'think aloud' sessions (n = 6) with potential beneficiaries to refine the development of the intervention.

RESULTS

Key themes that emerged from the qualitative data included the need for educational material, modifying activities to suit individual abilities and preferences as well as the inclusion of key features such as rehabilitation exercises. Following a user-trial further changes were made to improve the usability of the application.

CONCLUSIONS

Using a systematic person-based, development approach, we have developed the intelligent knee osteoarthritis lifestyle application to help people maintain physical activity behaviour. The app extends the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through personalised physical activity guidance, education, and social support.

Training to use smart tablets to access reliable online health information in older adults' post-pandemic: A focused pilot intervention study

BACKGROUND

Older adults are becoming more accepting and interested in using digital technologies, but difficulties and barriers remain for accessing reliable health-related information. The purpose of this focused pilot intervention study was to: (1) understand older adults' firsthand experiences and challenges while using smart tablets post-COVID-19 pandemic, and (2) gather suggestions for age-appropriate training materials, preference of training materials, and resources to access reliable online health information.

METHODS

A focused pilot intervention study that involved training older adults to use smart tablets followed by focus group of a convenience sample of 13 older adults (65-85 years old; 91.6% female) on their experiences of using smart tablets.

RESULTS

Thematic analysis revealed three themes: tablets are convenient to access online information and older adults reported technical, security concerns, emotional and cognitive challenges regarding use of smart tablets. Older adults also requested one-on-one support, assistance, and topic specific learning for future training sessions.

CONCLUSIONS

Future studies should focus on providing detailed, clear instructions at an acceptable pace for older adults.

Technology Use, Barriers, and Future Needs Among Community-Dwelling Older Adults

PURPOSE

Social isolation and loneliness are social determinants of health (SDOH) that can negatively affect the well-being of older adults. Using technology has the potential to reduce social isolation; thus, increasing safe use of technology among older adults can positively impact their health and promote aging in place.

METHOD

Older adults (N = 730) were surveyed regarding their use of, access and barriers to, satisfaction with, and anticipated future needs related to technology.

RESULTS

Survey respondents found technology was a significant resource for staying connected; however, low levels of satisfaction with devices and fear of scams indicate the need for additional training on the best and safest use of technology.

CONCLUSION/IMPLICATIONS

By screening older adults for SDOH, identifying their current and anticipated needs, and advocating for changes in health care and communities to meet these needs, nurses can help facilitate safe and healthy aging in place for their patients. [Journal of Gerontological Nursing, 50(2), 26-31.].

The use of technology to address loneliness and social isolation among older adults: the role of social care providers

BACKGROUND

Addressing loneliness and social isolation among older adults remains a public health priority. The restrictions enforced during the COVID-19 pandemic simultaneously heightened the need for services to overcome social isolation and reduce loneliness among older adults, while also limiting social care providers' ability to deliver these. The aim of this study was to explore the experiences of social care providers in using technology to address loneliness and social isolation among older adults during the pandemic.

METHODS

This was a mixed methods study involving an online survey and interviews with providers of older adult social care in Wales, UK. Invitations to participate were sent to commissioners and providers of adult social care services, including those working in the voluntary and community sectors, across all local authorities in Wales. Data was collected between September 2021 and January 2022.

RESULTS

Sixty-one service providers completed the survey, 19 of whom also took part in an interview. Addressing loneliness and isolation among older adults was reported as a key concern by nearly all survey respondents. While telephone calls were the most common means of facilitating social interaction, many service providers also tried to support older adults to make more use of devices that they already had (e.g., smartphones to hold video calls). Where funding was available, organisations purchased devices, such as tablets and smart speakers, for older adults. Analysis of interviews resulted in three themes: (1) The potential and limitations of technology; (2) Individuals' capabilities, confidence, motivations and values; and (3) The wider system.

CONCLUSIONS

Technology was employed in a variety of ways during the pandemic to address loneliness and social isolation among older adults; many service providers continue to use technology in a hybrid system of care now that pandemic-related social restrictions have been lifted. Our findings emphasise a need for technology-assisted interventions to be designed and deployed in alignment with service users' values, motivations and capabilities. Further, there is a need to better support service providers to assess loneliness and social isolation among older adults, and to acknowledge the important role providers play in helping older adults to adopt technology-assisted interventions.

Affordance trajectories and the usefulness of online records access among older adults in Sweden

Objective

The current understanding of the breadth of individual differences in how eHealth technologies are perceived as useful for different purposes is incomprehensive. The aim/purpose of the study is to improve the understanding of diverse perceptions of the usefulness of technologies by exploring older adults' use of their patient-accessible electronic health records (PAEHRs).

Methods

The study applies and extends Affordance Theory based on an empirical analysis of data from the NORDeHEALTH 2022 Patient Survey on attitudes toward PAEHR in Norway, Sweden, Finland, and Estonia. Responses from 3964 participants in Sweden, aged 65 + years were analysed. Data included demographics and agreement ratings to reasons for using PAEHR. To analyse variation in the reasons for using PAEHR, group comparisons were conducted based on gender (male/female), age group (65-74, 75-84 and 85+) and earlier encouragement to use PAEHR.

Results

Overall, the findings suggest that PAEHRs have multiple parallel affordance trajectories and affordance potencies that actualise differently depending on needs. The top reasons, pointing to both orientational and goal-oriented affordances for using PAEHR, were improving understanding of health issues, getting an overview of medical history/treatment and ensuring understanding of what the doctor said. Men reported more often sharing information with relatives or friends as a reason to access PAEHR. Women were more inclined, albeit similarly to men less frequently, to read their PAEHR for detecting errors. Age had little influence on reasons for using PAEHR.

Conclusions

The study applies and extends Affordance Theory in the context of older adults' PAEHR use based on findings from the largest national investigation of reasons for older users to access PAEHR in Sweden demonstrating the applicability of the theory in improving the understanding of the diversity of individual perceptions on eHealth technologies.

Information and Communication Technology Adoption Strategies Among Iranian Older Adults: A Qualitative Evaluation

In today's world, it is unavoidable for older adults to use technology, which causes some challenges for them. In this qualitative study, we used grounded theory to evaluate information and communication technology (ICT) adoption strategies among Iranian older adults. The participants included 18 older adults, five experts, and five family members of older adults. The data collection method included conducting semi-structured interviews, taking field notes, and observation. The data were analyzed using the Corbin and Strauss approach. Three main themes were extracted as follows: support from others, effort for learning, and smart choice. The subthemes of support from others included creativity in educating older adults; having access to an educational supporter; and receiving informational, emotional, and financial support. The subthemes of effort for learning included utilizing aids, adaptive measures, shortcut techniques, and self-learning. The subthemes of smart choice included physical characteristics, technical features, price sensitivity, and availability of an active sales representative. Accordingly, it is essential to teach older adults to increase their ICT adoption rate and continued use of technology. In this respect, developing a standard ICT manual for older adults can be beneficial.

Motives behind low-acuity geriatric emergency medicine attenders: a picture from free healthcare system

BACKGROUND

Current evidence about the low-acuity ED visits of old patients has been generated in various healthcare systems; however, this is not a well-researched area in middle-income countries by patients' perspectives.

METHODS

A study of 231 patients attending the ED of a tertiary public hospital was conducted using a structured questionnaire from June to August 2021. Eligible patients were community-dwelling, aged > 65 years, who presented with lower clinical urgency. The questionnaire tool was developed using questions from available studies on health service utilization. Additional commentary was obtained from the patients regarding on the reasons for attending the ED and was administered on weekdays between 8:00 am and 5:30 pm.

RESULTS

The study included 221 patients over 65 years of age, with a mean age of 72.21 ± 4.2. A total of 58.4% of the patients thought that they should be examined urgently, 15.4% had symptoms that had lasted more than one month, and 59% requested emergency imaging. Patients preferred the ED via treatment, imaging, transportation opportunities of emergency department, past negative experiences, and access problems with family medicines or appointment problems with specialist outpatient clinics with expectations of continuity of care.

CONCLUSION

Old individuals have unique healthcare needs, and the motives behind this group of patients with low-acuity problems to apply to the ED is complex. As one of the key objectives of healthcare policies is to make sure that patients are assessed at proper time and place, studies that consider patient perspectives might lead to accurate conclusions for this aim.

Gluu Essentials Digital Skills Training for Middle-Aged and Older Adults That Makes Skills Stick: Results of a Pre-Post Intervention Study

BACKGROUND

A number of real-world digital literacy training programs exist to support engagement with mobile devices, but these have been understudied.

OBJECTIVE

The purpose of this study was to examine the effectiveness and program acceptability of a digital skills training program among middle-aged and older adults (aged ≥50 years) and to gather participants' recommendations for lifelong digital skills promotion.

METHODS

The Gluu Essentials digital skills training program includes learning resources to support tablet use. Through pre-post surveys, this study assessed mobile device proficiency, confidence in going online and in avoiding frauds and scams, the frequency of engaging in online activities, program engagement, acceptability, and suggestions for continued support.

RESULTS

A total of 270 middle-aged and older adults completed baseline surveys. Of these 270 participants, 145 (53.7%) completed follow-up surveys. Our findings indicate that mobile device proficiency increased (P<.001), whereas confidence was unchanged. Participants also reported going online more frequently to shop (P=.01) and access government services (P=.02) at follow-up. Program engagement varied considerably, but program acceptability was high. Participants' recommendations included the need for providing ongoing programs for support and training because technology constantly changes, reducing costs for technology and internet access, and keeping learning resources simple and easy to access.

CONCLUSIONS

The Gluu Essentials digital skills training program increased mobile device proficiency and frequency of web-based activities (shopping and accessing government services) among middle-aged and older adults.

Health Access, Health Promotion, and Health Self-Management: Barriers When Building Comprehensive Ageing Communities

A new intervention model for promoting healthy ageing grounded on integrated value-based care was developed and tested in the city of Valencia (Spain). Its implementation raised relevant barriers for older adults in their access to health, health promotion, and health self-management linked with their health and digital literacy. This new intervention model included several aspects. On the one hand, researchers together with older adults and their informal caregivers participating in the study, designed personalized care plans, based on older adults' specific needs, to be implemented with the support of a digital solution. On the other hand, researchers and health and social professionals implemented a series of workshops in different locations of the city to encourage a sense of community among participants, reinforcing their trust in the new care model and increasing their adherence. Social activities were at the core of the workshops to understand older people's interaction with the health and social services provided in the neighborhood. Qualitative and quantitative methods were combined to extract information from older participants on how to engage them as active actors of their health and understand their values and preferences. In the present manuscript, we focus on the qualitative results, which show that after a post-pandemic situation, they were more concerned about social isolation and desired face-to-face contact with their professional care team; however, feelings of loneliness and/or sadness were not considered among the reasons to visit health professionals. Some of the conclusions revealed that the use of technology as a supportive tool is well received but with a stress on its role as "supportive", and not replacing the close contact with healthcare professionals. Professionals recognized the benefits of this new approach but required more time and incentives to dedicate the effort needed. The main aim of this study was to present these barriers related to health access, health promotion, and health self-management, as well as the actions developed to face them.

Gerontechnology for better elderly care and life quality: a systematic literature review

Gerontechnology as multidisciplinary research has expanded in recent years due to its significant role in ensuring better care and improved quality of life for older adults and their caregivers. With a substantial increase in studies on reasons behind less inclination of older individuals to accept gerontechnology, barriers to its non-acceptance appear to be persistent. In addition, there is a dearth of research on the adoption of gerontechnology from the perspectives of social caregivers, given that caregivers bear a substantial burden in the form of chronic stress, which adversely affects their health and that of older people. Therefore, the aim of this study is to present a holistic perspective of older adults and their caregivers by systematically reviewing literature on gerontechnology acceptance. Adopting the preferred reported items for systematic and meta-analysis (PRISMA) framework, publications specifically on gerontechnology from 2002 to 2022 in Scopus, Web of Science and PubMed, that focused on older people (50 years and above) and caregivers (informal and formal) were reviewed. We critically evaluated 25 publications and synthesised them thematically. The results highlight that gerontechnology acceptance by older adults and their social caregivers is highly contingent on certain personal, physical, socio-cultural and technological indicators. However, this paper concludes that a generalised policy approach for gerontechnology and a better quality of life may be ineffective, considering that older adults and social caregivers constitute two heterogeneous groups.

Older adults' experiences with using information and communication technology and tech support services in New York City: findings and recommendations for post-pandemic digital pedagogy for older adults

Introduction

Although Information and Communication Technology (ICT) has great potential to help older adults cope with challenges associated with aging, the intended benefits of ICT are not always realized in this population due to access barriers and low digital literacy. During the COVID-19 pandemic, numerous tech support initiatives for older adults got underway. However, evaluation of the effectiveness of these initiatives is less common. This research partnered with a large, multi-service organization in New York City that gave some groups of their clients ICT devices, unlimited broadband, and access to technology training in response to COVID-19 lockdowns. This study investigates older adults' experiences with ICT and ICT support services to better inform the existing and emerging tech support for older adults during and beyond the pandemic.

Methods

Data were obtained from interviewer-administered surveys of 35 older adult recipients of ICT devices, connectivity, and training in New York City. The average age was 74 years (range = 55-90 years). The group was diverse regarding race/ethnicity (Black 29%, Latino 19%, White 43%). All had low incomes. Surveys consisted of multiple-choice items and open-ended responses.

Results

The study found that one size does not fit all when it comes to ICT training and support for older adults. While connection to devices and services and tech support led to a degree of ICT adoption, the newly learned skills did not always lead to expanded device usage. The readily available tech support training and support do not guarantee service utilization, as success with tech services is related to one's pre-existing ICT competence.

Discussion

The study concludes that customized training based on individuals' skills rather than age is needed. Tech support training should start by understanding an individual's interests and incorporate tech education to help users identify a wide range of existing and emerging online services that can meet their needs. Service organizations should consider including an assessment of ICT access, use, and skills into their standard intake protocols to ensure effective service delivery.

Acceptance of digital health services among older adults: Findings on perceived usefulness, self-efficacy, privacy concerns, ICT knowledge, and support seeking

Background

Over the last decade, the rapid advancements in information and communication technologies (ICTs) have also driven the development of digital health services and applications. Older adults could particularly benefit from these technologies, but they still have less access to the Internet and less competence in using it. Based on the empirical literature on technology acceptance among older adults, this study examines the relations of perceived usefulness, self-efficacy, privacy concerns, ICT knowledge, and support seeking (family, informal, formal/institutional) with older adults' intention to adopt new digital health services.

Methods

The study included 478 older adults who participated in an online or paper/pencil questionnaire (M = 70.1 years, SD = 7.8; 38% male). Sociodemographic characteristics, subjective health status, and variables related to technology acceptance were assessed.

Results

Latent structural equation modeling revealed that higher perceived usefulness, higher self-efficacy regarding digital health technologies, and lower privacy concerns contributed to a higher intention to use digital health services among older adults. Contrary to our expectations, general ICT knowledge was not a significant predictor. Older adults who reported seeking more support regarding technology problems from family members and formal/institutional settings also reported higher usage intentions, whereas informal support was not as relevant. Furthermore, higher age was associated with higher perceived usefulness and lower self-efficacy.

Discussion

Future studies should further explore mediating factors for intention and actual use of digital health services and develop educational programs including follow-up assessments.

An Investigation Into the Sensitivity of Personal Information and Implications for Disclosure: A UK Perspective

The perceived sensitivity of information is a crucial factor in both security and privacy concerns and the behaviors of individuals. Furthermore, such perceptions motivate how people disclose and share information with others. We study this topic by using an online questionnaire where a representative sample of 491 British citizens rated the sensitivity of different data items in a variety of scenarios. The sensitivity evaluations revealed in this study are compared to prior results from the US, Brazil and Germany, allowing us to examine the impact of culture. In addition to discovering similarities across cultures, we also identify new factors overlooked in the current research, including concerns about reactions from others, personal safety or mental health and finally, consequences of disclosure on others. We also highlight a difference between the regulatory perspective and the citizen perspective on information sensitivity. We then operationalized this understanding within several example use-cases exploring disclosures in the healthcare and finance industry, two areas where security is paramount. We explored the disclosures being made through two different interaction means: directly to a human or chatbot mediated (given that an increasing amount of personal data is shared with these agents in industry). We also explored the effect of anonymity in these contexts. Participants showed a significant reluctance to disclose information they considered “irrelevant” or “out of context” information disregarding other factors such as interaction means or anonymity. We also observed that chatbots proved detrimental to eliciting sensitive disclosures in the healthcare domain; however, within the finance domain, there was less effect. This article's findings provide new insights for those developing online systems intended to elicit sensitive personal information from users.