Community-Dwelling Older Adults' Readiness for Adopting Digital Health Technologies: Cross-Sectional Survey Study

BACKGROUND

Digital health technologies offer the potential to improve the daily lives of older adults, maintain their health efficiently, and allow aging in place. Despite increasing evidence of benefits and advantages, readiness for adopting digital interventions among older people remains underexplored.

OBJECTIVE

This study aims to explore the relationships between sociodemographic-, health-, and lifestyle-related factors and technology use in everyday life and community-dwelling older adults' readiness to adopt telemedicine, smartphones with texting apps, wearables, and robotics.

METHODS

This was a cross-sectional, population-based survey study with a stratified probabilistic sample of adults aged 75 years or older living in South Tyrol (autonomous province of Bolzano/Bozen, Italy). A random sample of 3600 community-dwelling older adults living at home was invited to complete a questionnaire including single items (older adults' readiness to use health technology) and scales (PRISMA-7; Program of Research on Integration of Services for the Maintenance of Autonomy). Descriptive and logistic regression analyses were performed to analyze the data.

RESULTS

In total, 1695 community-dwelling older adults completed the survey (for a response rate of 47%). In terms of potential digital health technology adoption, wearable devices were favored by 33.7% (n=571), telemedicine by 30.1% (n=510), smartphones and texting apps by 24.5% (n=416), and assistant robots by 13.7% (n=232). Sociodemographic-, health- and lifestyle-related factors, as well as the use of technology in everyday life, played a significant role in explaining readiness to adopt digital health technologies. For telemedicine, age ≥85 years (odds ratio [OR] 0.74, 95% CI 0.56-0.96), financial constraints (OR 0.68, 95% CI 0.49-0.95), and less than 2 hours of physical activity per week (OR 0.75, 95% CI 0.58-0.98) were associated with nonreadiness, while Italian-speaking participants (OR 1.54, 95% CI 1.16-2.05) and those regularly using computers (OR 1.74, 95% CI 1.16-2.60), smartphones (OR 1.69, 95% CI 1.22-2.35), and the internet (OR 2.26, 95% CI 1.47-3.49) reported readiness for adoption.

CONCLUSIONS

Community-dwelling older adults display varied readiness toward the adoption of digital health technologies, influenced by age, mother tongue, living situation, financial resources, physical activity, and current use of technology. The findings underscore the need for tailored interventions and educational programs to boost digital health technology adoption among community-dwelling older adults.

Administrative burden in Swiss nursing homes and its association with care workers' outcomes-a multicenter cross-sectional study

BACKGROUND

Care workers in nursing homes often perform tasks that are rather related to organizational or management activities than 'direct patient care'. 'Indirect care activities', such as documentation or other administrative tasks are often considered by care workers as a burden, as they increase overall workload and keep them away from caring for residents. So far, there is little investigation into what kind of administrative tasks are being performed in nursing homes, by which type of care workers, and to which extent, nor how administrative burden is associated with care workers' outcomes.

PURPOSE

The objective of this study was to describe care workers' administrative burden in Swiss nursing homes and to explore the association with four care worker outcomes (i.e., job dissatisfaction, emotional exhaustion, intention to leave the current job and the profession).

METHODS

This multicenter cross-sectional study used survey data from the Swiss Nursing Homes Human Resources Project 2018. It included a convenience sample of 118 nursing homes and 2'207 care workers (i.e., registered nurses, licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the administrative tasks and burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics.

RESULTS

Overall, 73.9% (n = 1'561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n = 787) reporting to spend 2 h or more during a "normal" day performing administrative tasks. Ratings for administrative burden ranged from 42.6% (n = 884; ordering supplies and managing stocks) to 75.3% (n = 1'621; filling out the resident's health record). One out of four care workers (25.5%, n = 561) intended to leave the profession, whereby care workers reporting higher administrative task burden (OR = 1.24; 95%CI: 1.02-1.50) were more likely to intend to leave the profession.

CONCLUSION

This study provides first insights on care workers' administrative burden in nursing homes. By limiting care workers' burdensome administrative tasks and/or shifting such tasks from higher to lower educated care workers or administrative personnel when appropriate, nursing home managers could reduce care workers' workload and improve their job satisfaction and retention in the profession.

[Interrater reliability and concurrent validity of 4AT for the detection of postoperative delirium: A prospective cohort study]

Interrater reliability and concurrent validity of 4AT for the detection of postoperative delirium: A prospective cohort study Abstract. Background: Numerous tools for detecting postoperative delirium are available. Guidelines recommend the 4 A's Test (4AT). However, there is little evidence on the validity and reliability of the German version of 4AT. Aim: To assess the interrater reliability of the German version of 4AT test for the detection of postoperative delirium in general surgical and orthopedic-traumatological patients, and the concurrent validity with the Delirium Observation Screening Scale (DOS). Methods: The present work is part of a prospective cohort study with a sample of 202 inpatients (≥ 65 years) who underwent surgery. The interrater reliability of the 4AT (intraclass coefficients) was determined with a subsample of 33 subjects who were rated by two nurses. Concurrent validity between the DOS scale and the 4AT was calculated using Pearson's correlation coefficient. Results: Interrater reliability for the 4AT total score and dichotomized total score were 0.92 (95% CI 0.84-0.96) and 0.98 (95% CI 0.95-0.98), respectively. The correlation between DOS and 4AT (Pearson) was 0.54 (p < 0.001). Conclusions: The 4A test can be used by nurses as a screening instrument for the detection of postoperative delirium in older patients on general surgery and orthopedic traumatology wards. In case of positive 4AT results further assessment by nurse experts or physicians is required.

CARE WORKERS’ ADMINISTRATIVE BURDEN IN SWISS NURSING HOMES: A MULTICENTER CROSS-SECTIONAL STUDY

Apart from ‘direct’ resident care, care workers in nursing homes also perform tasks that are related to organizational or management activities. ‘Indirect’ care activities, such as administrative tasks, are often considered as burdensome, as they increase overall workload and keep care workers away from caring for their residents. So far, there is little investigation on care workers’ administrative burden. The multicenter cross-sectional Swiss Nursing Homes Human Resources Project (2018) study included a convenience sample of 118 Swiss nursing homes and 2207 care workers (i.e., registered nurses and licensed practical nurses). Care workers completed questionnaires assessing the administrative burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied 2-level binomial generalized linear mixed models. Overall, 73.91% (n=1561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n=787) reporting to spend 2h or more during a "normal" day performing administrative tasks. Ratings ranged from 42.6% (n=884; ordering supplies and managing stocks) to 75.3% (n=1621; filling out the patient’s medical record). One out of four care workers (25.5%, n=561) intended to leave the profession, whereby care workers reporting higher administrative burden (OR=1.24; 95%CI: 1.02-1.50) were more likely to leave the profession. This study provides first insights on care workers’ administrative burden in nursing homes, which can inform the development of interventions to reduce the workload related to ‘indirect care activities’ and to improve care workers’ job satisfaction and retention in the profession.

[From bedside to evidence - and back to bedside. 5 years evidence-based guidelines in South Tyrol: methods and experiences]

In South Tyrol we developed guidelines with two different methodological approaches: one relates to the autonomous development of a nursing guideline for oral care using GRADE, and the other relates to the adaptation process of the NICE guideline on the prevention of venous thromboembolism. Both methods do have advantages and disadvantages: by autonomously developing guidelines the guideline panel identifies more with the product but time and effort is much higher than adapting and amending existing (high quality) guidelines. On the other hand there are only few high quality nursing guidelines. Additionally, the experiences in South Tyrol show that nursing guidelines seem to be not really suitable for a 1:1 application into practice because nearly half of the nurses have not changed their practice - although they knew the content of the guideline. Therefore, in order to promote the implementation process multimodal strategies on different organisational levels were adopted. Amongst these was the involvement of management through the negotiations of objectives, training and active participation of staff in the development of user-friendly application tools.