Relationship between Empowerment and Functioning and Disability in Older Japanese Patients: A Covariance Structure Analysis

Effectiveness of Integrated Digital Solutions to Empower Older Adults in Aspects Related to Their Health: Systematic Review and Meta-Analysis

BACKGROUND

Digital solutions, such as mobile apps or telemonitoring devices, are frequently considered facilitators in the process of empowering older adults, but they can also act as a source of digital exclusion or disempowerment if they are not adequate for older adults' needs and characteristics.

OBJECTIVE

This study aimed to synthesize and critically evaluate existing evidence on the effectiveness of integrated digital solutions that enable interaction for empowering older adults in aspects related to their health and to explore potential factors (eg, type of technology, participants' characteristics) impacting effectiveness.

METHODS

A systematic search was carried out in PubMed, ScienceDirect, SCOPUS, EBSCO, and SciELO using a combination of terms informed by previous reviews on empowerment. Screening of references was performed against predefined inclusion criteria. Data extraction and the methodological quality of included studies using the PEDro (Physiotherapy Evidence Database) scale were performed by 2 authors. The certainty of evidence was graded for the main comparisons and outcomes of the review using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. When at least 3 studies were available within the same domain of empowerment (knowledge, support by others, capacities, and behaviors) and comparison group, a meta-analysis was performed.

RESULTS

A total of 30 manuscripts were included in the review. Regarding knowledge, there was very low certainty of evidence of a medium effect size (ES) favoring the digital intervention group (k=5, ES=0.40, 95% CI 0.07-0.73, I2=79%). Regarding capacities, there was low certainty of evidence of no between-group differences (k=5, d=0.13, 95% CI -0.02 to 0.29, I2=0%) when comparing digital solutions against no intervention, low certainty of evidence of a medium ES favoring the digital intervention group (k=13, d=0.29, 95% CI 0.07-0.52, I2=79%) when comparing digital solutions against usual care, and very low certainty of evidence of no between-group differences (k=4, d=0.97, 95% CI -0.62 to 2.56, I2=97%) when comparing digital interventions to face-to-face interventions. Regarding social support and behaviors, no meta-analysis was possible, and existing evidence is conflicting.

CONCLUSIONS

There is very-low-to-low certainty of evidence that using integrated digital solutions results in increased knowledge and increased capacities (mainly self-efficacy) when compared to usual care and impacts capacities to an extent similar to face-to-face interventions at postintervention. Interestingly, results also suggest, with low certainty of evidence, that there are no differences between using digital solutions and no intervention for improving capacities. Included studies and technologies were diverse, and meta-analysis showed high heterogeneity, which limits the confidence in the results and suggests that further research might affect the conclusions of this review.

TRIAL REGISTRATION

PROSPERO CRD42022346823; https://tinyurl.com/39k29pzc.

Association between health-related empowerment and health-protective behaviors among community-dwelling older adults

BACKGROUND

Empowerment is a broad concept seen as a critical approach for helping older adults who lack power to gain control over various aspects of their lives, including their health-protective behaviors.

AIM

The study investigated the association between health-related empowerment and health-protective behaviors in older adults.

DESIGN

A cross-sectional correlational research design was used by recruiting a convenient sample of 200 older adults.

TOOLS

The Elder Health Empowerment Scale and Health Protective Behavior Scale were used to collect the participant data.

RESULTS

It showed a significant positive correlation between health-related empowerment and health-protective behaviors in older adults (r = 0.891, p = 0.001), indicating that as health-related empowerment increases, engagement in health-protective behaviors also increases. Furthermore, health-related empowerment accounted for a large proportion of the variation in health-protective behaviors (85.7 %).

CONCLUSION

Overall, these findings suggest that there is a need for interventions to improve the health-related empowerment of older adults, particularly in terms of their ability to turn their health goals into actionable plans, overcome barriers to health, and make informed healthcare choices. However, the studied older adults generally engage in health protective behaviors; there is variability in the extent to which they engage in specific behaviors, which may provide valuable insights for developing targeted health promotion programs and interventions.