Challenges for Home Health Care Providers: A Needs Assessment

Home health care provides substantial benefits over traditional, hospital-based health care, such as supporting older adults' independence and quality of life, as well as being more cost effective. This aspect of the health care industry could be enhanced through increased technological supports. When providing health care in a home setting, caregivers are faced with many challenges that impede their ability to perform their jobs. Technological interventions have the potential to alleviate many of these challenges. However, to achieve this potential, new technologies must be created to meet the needs of home health care providers. To date, these providers' specific and most critical needs are not thoroughly understood. This understanding can be gained by conducting a detailed needs assessment that captures the common challenges and difficulties that home health care providers encounter. We conducted a needs assessment comprising three phases: 1) an extensive literature review; 2) subject matter expert interviews; and 3) structured interviews with home health care providers. We identified several significant sources of frustration and difficulty faced by providers including: medical device usage; patient education; family involvement; provider isolation; and barriers to communication. This analysis provides an understanding of the challenges confronting home health care providers that can provide guidance for interventions. Future home health care technology can be developed to specifically target these workers' most urgent needs and allow them to perform their jobs with greater ease.

Diffusion of Technology: Frequency of Use for Younger and Older Adults

OBJECTIVES: When we think of technology-savvy consumers, older adults are typically not the first persons that come to mind. The common misconception is that older adults do not want to use or cannot use technology. But for an increasing number of older adults, this is not true (Pew Internet and American Life Project, 2003). Older adults do use technologies similar to their younger counterparts, but perhaps at different usage rates. Previous research has identified that there may be subgroups of older adults, "Silver Surfers", whose adoption patterns mimic younger adults (Pew Internet and American Life Project, 2003). Much of the previous research on age-related differences in technology usage has only investigated usage broadly -- from a "used" or "not used" standpoint. The present study investigated age-related differences in overall usage of technologies, as well as frequency of technology usage (i.e., never, occasional, or frequent). METHODS: The data were gathered through a questionnaire from younger adults (N=430) and older adults (N=251) in three geographically separate and ethnically diverse areas of the United States. RESULTS: We found that younger adults use a greater breadth of technologies than older adults. However, age-related differences in usage and the frequency of use depend on the technology domain. CONCLUSION: This paper presents technology usage and frequency data to highlight age-related differences and similarities. The results provide insights into older and younger adults' technology-use patterns, which in turn provide a basis for expectations about knowledge differences. Designers and trainers can benefit from understanding experience and knowledge differences.

Toward a psychological science of advanced technology design for older adults

OBJECTIVES

Technology represents advances in knowledge that change the way humans perform tasks. Ideally, technology will make the task easier, more efficient, safer, or perhaps more pleasurable. Unfortunately, new technologies can sometimes make a task more difficult, slower, dangerous, or perhaps more frustrating. Older adults interact with a variety of technologies in the course of their daily activities and thus products should be designed to be used by people of varying ages.

METHODS

In this article, we provide an overview of what psychology has to offer to the design of technology-from understanding what people need, to identifying their preferences for design characteristics, and to defining their capabilities and limitations that will influence technology interactions.

RESULTS

We identify how research in the field of psychology and aging has advanced understanding of technology interactions and how research on technology interactions can inform theories of aging.

DISCUSSION

Design for aging involves understanding the unique capabilities and limitations of older adults; identifying their needs, preferences, and desires for technology in their lives; and involving them in the design process.

Recognizing Emotion in Virtual Agent, Synthetic Human, and Human Facial Expressions

A growing interest in the HCI community is the design and development of embodied agents in virtual environments. For virtual environments where social interaction is needed, an agent's facial expression may communicate emotive state to users both young and old. However, younger and older adults differ in how they label human facial expressions (Ruffman et al., 2008). Such possible age-related differences in labeling virtual agent expressions may impact the user's social experience in a virtual environment. The purpose of the current research was to investigate age-related differences in emotion recognition of several on-screen characters of varying degrees of human-likeness. Participants performed a recognition task with three characters demonstrating four basic emotions or neutral. The results indicated age-related differences for all character types. Older adults commonly mislabeled the human and synthetic human emotions of anger, fear, sadness, and neutral. For the virtual agent face, older adults commonly mislabeled the emotions of anger, fear, happiness, and neutral.

Checking it Twice: Age-related Differences in Double Checking During Visual Search

Visual search is an integral part of functioning in everyday life and a primary component of some occupational tasks. Older adults typically exhibit longer response times on visual search tasks compared to younger adults. Mechanisms proposed as explanations of these age-related differences include general slowing of the speed of information processing, amount of internal noise, attentional capacity, selective attention, and inhibition. This study evaluated the possibility that age-related differences in visual search may be partly due to older adults double checking to a greater degree than younger adults. Older adults did in fact double check more so than younger adults. Moreover, speed stress instructions reduced double checking behavior as well as age-related differences in double checking.

Do Younger and Older Adults Differentially Depend on an Automated System?

Various factors, including trust, system reliability, and error type have been found to affect how people interact with automated systems. Another variable that is becoming increasingly important is the role of age in human-automation interaction. As automation continues to emerge in numerous domains, including the home, older adults will likely interact with these types of systems to a greater extent than ever before. Therefore, understanding if age-related changes in cognition, such as diminished working memory capacity or processing speed, affect how older adults use automated systems is critical to ensure these systems are designed and implemented effectively. This study examined the role of age in a simulated dual task environment using an automated aid. Younger adults outperformed older adults in both tasks. When the automation was incorrect, younger adults exhibited less dependence than older adults. Further, when older adults verified the automation's suggestion, they took significantly more time to do so than younger adults. Additionally, older adults reported greater trust in the automation and higher workload compared to younger adults.

Including the public in pandemic planning: a deliberative approach

Background

Against a background of pandemic threat posed by SARS and avian H5N1 influenza, this study used deliberative forums to elucidate informed community perspectives on aspects of pandemic planning.

Methods

Two deliberative forums were carried out with members of the South Australian community. The forums were supported by a qualitative study with adults and youths, systematic reviews of the literature and the involvement of an extended group of academic experts and policy makers. The forum discussions were recorded with simultaneous transcription and analysed thematically.

Results

Participants allocated scarce resources of antiviral drugs and pandemic vaccine based on a desire to preserve society function in a time of crisis. Participants were divided on the acceptability of social distancing and quarantine measures. However, should such measures be adopted, they thought that reasonable financial, household and psychological support was essential. In addition, provided such support was present, the participants, in general, were willing to impose strict sanctions on those who violated quarantine and social distancing measures.

Conclusions

The recommendations from the forums suggest that the implementation of pandemic plans in a severe pandemic will be challenging, but not impossible. Implementation may be more successful if the public is engaged in pandemic planning before a pandemic, effective communication of key points is practiced before and during a pandemic and if judicious use is made of supportive measures to assist those in quarantine or affected by social isolation measures.

Long-Term Retention of a Spatial Mental Model for Younger and Older Adults

Mental models are knowledge structures that are used to describe, predict, and explain the system that they represent. Mental models can be useful for both younger and older adults. Past research (Gilbert & Rogers, 1999, Journal of Gerontology: Psychological Sciences, 54B, P246-P255) indicated that both younger and older adults were able to acquire and utilize a new spatial mental model. Younger and older adult participants from that research returned after a 2-week interval and a group of younger adult participants returned after 4 weeks to determine if their mental model was retained over time. Retention was best for the younger adult 2-week group; performance did not differ for the older adult 2-week and younger adult 4-week groups. Participants who were able to reconstruct the map initially were able to utilize the information very well, regardless of age or retention interval. In addition, both younger and older adults who showed lower initial retention benefited from a brief study time. Implications for refresher training are discussed.

An ethical justification for the Chronic Care Model (CCM)

BACKGROUND

Chronic diseases are major causes of morbidity and mortality in developed countries. Their effects can be mitigated by high quality evidence-based care, but this is not the norm in most systems. The Chronic Care Model (CCM) is an evidence-based policy response to this practice gap, which uses multiple strategies to promote the quality of chronic care.

OBJECTIVE

To review CCM with an ethical lens.

METHODS

We reviewed the published empirical and non-empirical articles of CCM to analyse the ethical underpinnings of this model.

RESULTS AND CONCLUSIONS

We argue that its principal ethical value lies in the institutional cooperation it builds between the stakeholders involved in health care services. First, we briefly describe CCM and argue that the pathways through which it aims to improve patients' health outcomes are not made explicit. Second, we argue that the potential of CCM to be more beneficent, compared with traditional health care systems, depends on its capacity to promote mutual trust between health care providers and patients. There is no evidence to date that the implementation of CCM enhances mutual trust between health care professionals and patients. Third, we argue that CCM seeks to enhance human agency, allowing increased expression of individual autonomy and increased respect for individuals thereby expanding human freedom and avoiding social discrimination. However, we review the communication patterns that characterize the model of doctor-patient relationship promoted by this model and argue that these communication patterns raise ethical concerns that may prevent the model from reaching its expected outcomes.

Credit where credit is due? Regulation, research integrity and the attribution of authorship in the health sciences

Despite attempts at clear direction in international, national and journal guidelines, attribution of authorship can be a confusing area for both new and established researchers. As journal articles are valuable intellectual property, authorship can be hotly contested. Individual authors' responsibilities for the integrity of article content have not been well explored. Semi-structured interviews (n = 17) were conducted with staff, student advocates and doctoral candidates working in health research in two universities in Australia. Stratified sampling ensured participants reflected a range of experience across biomedical, clinical and social science disciplines. Participants were asked about their experience with research publication and their views on the responsibilities of authorship. Participants gave a variety of reasons for attribution of authorship including: writing the paper; seniority; and student supervision. Gift authorship was seen by some participants as: a way of maintaining relationships; a reward; a means to increase a paper's credibility; or a demonstration of collaboration between authors. Norms and beliefs differed markedly between disciplines for authorship attribution and, to a lesser extent, for authors' responsibility for content integrity. Discussions about the effect of power differentials on authorship were common across disciplines. This paper describes a broad range of beliefs, values and practice norms held by health science researchers with respect to attribution of authorship and author responsibility for scientific publications. The findings support the need for clarity in relation to authorship, and a research environment which is supportive of ethical behaviour in the publication of research.

Hazards in the home: using older adults' perceptions to inform warning design

Older adults' perceptions of hazards associated with home product usage and beliefs about product warnings were assessed. Focus group interview data were coded along the dimensions of (a) product type; (b) hazard type; (c) hazard knowledge; (d) hazard avoidance; (e) product warning presence; and (f) product warning necessity. A survey supplemented the focus group results by gathering measures of usage patterns and usability difficulties associated with various types of household products. Older adults reported routine use of products they considered to be hazardous and identified an array of home safety concerns. Furthermore, personal experience was an important source of older adults' hazard knowledge and they described a number of hazard avoidance strategies. These data provide insight into older adults' home safety behaviour and suggest a number of approaches to improving hazard communication and warning design.

Pandemic influenza communication: views from a deliberative forum

OBJECTIVE

To use a deliberative forum to elicit community perspectives on communication about pandemic influenza planning, and to compare these findings with the current Australian national communication strategy.

DESIGN

Deliberative forum of 12 persons randomly selected from urban South Australia. Forum members were briefed by experts in infection control, virology, ethics and public policy before deliberating on four key questions: what, how and when should the community be told about pandemic influenza and by whom?

RESULTS

The forum recommended provision of detailed and comprehensive information by credible experts, rather than politicians, using a variety of media including television and internet. Recommendations included cumulative communication to build expertise in the community, and specific strategies to include groups such as young people, people with physical or mental disabilities, and rural and remote communities. Information provided should be practical, accurate, and timely, with no 'holding back' about the seriousness of a pandemic. The forum expressed confidence in the expert witnesses, despite the acknowledged uncertainty of many of the predictions.

DISCUSSION AND CONCLUSION

The deliberative forum's recommendations were largely consistent with the Australian national pandemic influenza communication strategy and the relevant literature. However, the forum recommended: release of more detailed information than currently proposed in the national strategy; use of non-political spokespersons; and use of novel communication methods. Their acceptance of uncertainty suggests that policy makers should be open about the limits of knowledge in potentially threatening situations. Our findings show that deliberative forums can provide community perspectives on topics such as communication about pandemic influenza.

The Persistence of Content Knowledge

Research has shown that changes in the way a website works or how it is laid out affects how well people are able to use that website. This study examined how changes in the content and procedures of a website-like system affect the way people recover from not being able to find information in that system. Participants were placed in one of four learning conditions, differing by the content and procedures taught for a simple website-like system. They were then tasked with finding certain pages in that system or systems with different procedures, content, or both. The first test (System B Online Test) showed that participants who had to learn new content were less efficient at finding that content, while participants who had to learn new content and procedures were the only ones slowed down. The second test (System C Online Test) showed that participants who had experienced a previous change in content responded to the new change faster, whereas people who started with inconsistent procedures (as compared to consistent) made fewer errors towards the end.

More than a Servant: Self-Reported Willingness of Younger and Older Adults to having a Robot perform Interactive and Critical Tasks in the Home

Many companies are developing robots for the home, including robots specifically for older adults. There is little understanding, however, about the types and characteristics of tasks that younger and older individuals would be willing to let a robot perform. In a mailed questionnaire, participants were asked to indicate their willingness to have a robot perform each of 15 robot tasks that required different levels of interaction with the human owner and different levels of task criticality. The responses of 117 older adults (aged 65-86) and 60 younger adults (aged 18-25) were analyzed. The results indicated that respondents of both groups were more willing to have robots perform infrequent, albeit important, tasks that required little interaction with the human compared to service-type tasks with more required interaction; they were least willing to have a robot perform non-critical tasks requiring extensive interaction between robot and human. Older adults reported more willingness than younger adults in having a robot perform critical tasks in their home. The results suggest that both younger and older individuals are more interested in the benefits that a robot can provide than in their interactive abilities.

Older Adults' Needs for Home Health Care and the Potential for Human Factors Interventions

Demand for home health care is expected to increase as more people are living longer and because older adults rely on home health services to a greater extent than any other population (CDC, 2000). This paper provides an overview of older adults' home health care needs as well as guidance for potential human factors interventions to reduce medical errors and improve quality of care and independence for older patients. Factors discussed include reducing transition and handoff errors, ensuring proper use of medical devices, managing medication, and optimizing home health settings. The importance of considering the role of normal age-related changes in abilities when evaluating patients' needs is highlighted. The goal of this analysis is to provide guidance for human factors interventions in home health care.

Comprehension of Warning Symbols by Younger and Older Adults: Effects of Visual Degradation

The goal of this study was to investigate the effects of visual degradation on warning symbol comprehension across warning symbol types and age groups. Twenty-seven black and white ANSI symbols of four different types (prohibition, course of action, information, and hazard symbols) were presented to older (N = 21, M = 73.1) and younger adults (N = 20, M = 21.4) via computer at three degradation levels (0%, 30%, 40% of pixels inverted); accuracy and response time in answering yes-no questions about the symbols were recorded. Younger adults were more accurate and faster overall than older adults (p < .01). Regarding degradation, 0% and 30% inverted symbols did not significantly differ in comprehension (p ≥ .25), but both were comprehended better than 40% inverted symbols (p < .01); no interactions were observed. For degraded warning symbols, results suggest symbols must be substantially degraded to affect base comprehensibility, and age differences exist. These data have practical implications for warnings in environments susceptible to degradation.

Understanding Aging in Place for Older Adults: A Needs Analysis

A goal of many older adults is to remain in their own homes as they age (Beyond 50.05 Survey, 2005). However, a detailed assessment is lacking of the needs of older adults as they age in place. Using focus groups, twenty-six independently living older adults (mean age 78.8 years) from the Atlanta metropolitan area were asked to describe the tasks they perform to maintain their homes, as well as any difficulties they have performing these tasks. Participants described performing a wide range of tasks and focused primarily on physical difficulties. However, participants also reported solutions to manage these difficulties that fell into three broad categories: "Cessation," "Perseverance," and "Compensation." These categories represent classes of opportunities for interventions that may help older adults remain independent in their homes longer. By understanding the nature of home maintenance problems older adults encounter while aging in place, interventions and redesign efforts can be more effective. These data suggest that interventions should start with answering physical issues.

EMOTION RECOGNITION OF VIRTUAL AGENTS FACIAL EXPRESSIONS: THE EFFECTS OF AGE AND EMOTION INTENSITY

People make determinations about the social characteristics of an agent (e.g., robot or virtual agent) by interpreting social cues displayed by the agent, such as facial expressions. Although a considerable amount of research has been conducted investigating age-related differences in emotion recognition of human faces (e.g., Sullivan, & Ruffman, 2004), the effect of age on emotion identification of virtual agent facial expressions has been largely unexplored. Age-related differences in emotion recognition of facial expressions are an important factor to consider in the design of agents that may assist older adults in a recreational or healthcare setting. The purpose of the current research was to investigate whether age-related differences in facial emotion recognition can extend to emotion-expressive virtual agents. Younger and older adults performed a recognition task with a virtual agent expressing six basic emotions. Larger age-related differences were expected for virtual agents displaying negative emotions, such as anger, sadness, and fear. In fact, the results indicated that older adults showed a decrease in emotion recognition accuracy for a virtual agent's emotions of anger, fear, and happiness.

Using Direct and Indirect Input Devices: Attention Demands and Age-Related Differences

Researchers have suggested that attention is a key moderating variable predicting performance with an input device [e.g., Greenstein & Arnaut, 1988] without directly assessing the attention demands of devices We hypothesized that the attentional demands of input devices would be intricately linked to whether the device matched the input requirements of the on-screen task. Further, matching task and device should be more important for attentionally reduced groups, such as older adults. Younger and older adults used either a direct (touch screen) or indirect (rotary encoder) input device to perform matched or mismatched input tasks under a spectrum of attention allocation conditions. Input devices required attention - more so for older adults, especially in a mismatch situation. In addition, task performance was influenced by the mach between task demands and input device characteristics. Though both groups benefited from a match between input device and task input requirements, older adults benefited more and this benefit increased as less attention was available. We offer an a priori method to choose an input device for a task by considering the overlap between device attributes and input requirements. These data have implications for design decisions concerning input device selection across age groups and task contexts.

Attitudinal and Intentional Acceptance of Domestic Robots by Younger and Older Adults

A study was conducted to examine the expectations that younger and older individuals have about domestic robots and how these expectations relate to robot acceptance. In a questionnaire participants were asked to imagine a robot in their home and to indicate how much items representing technology, social partner, and teammate acceptance matched their robot. There were additional questions about how useful and easy to use they thought their robot would be. The dependent variables were attitudinal and intentional acceptance. The analysis of the responses of 117 older adults (aged 65-86) and 60 younger adults (aged 18-25) indicated that individuals thought of robots foremost as performance-directed machines, less so as social devices, and least as unproductive entities. The robustness of the Technology Acceptance Model to robot acceptance was supported. Technology experience accounted for the variance in robot acceptance due to age.

Age-related differences in reliance behavior attributable to costs within a human-decision aid system

OBJECTIVE

An empirical investigation was done to determine if there are age-related differences attributable to costs in reliance on a decision aid.

BACKGROUND

Costs of reliance on a decision aid may affect reliance on the aid. Older and younger adults may not perceive and respond to a dynamic cost structure equally or objectively.

METHOD

Sixteen older adults (65-74 years) and 16 younger adults (18-28 years) performed a counting task with an imperfect decision aid. Two types of costs were manipulated: (a) cost of error (CoE) and (b) cost of verification (CoV). The percentage of trials in which participants agreed with the decision aid and did not perform the task manually was recorded as reliance.

RESULTS

Participants decreased their reliance as the CoE increased and increased their reliance with a lower CoV; however, they tended to underrely on the decision aid. Younger adults tended to change their reliance behavior more than older adults did with the changing cost structure.

CONCLUSIONS

Older and younger adults appear to interpret costs differently, with older adults being less responsive to changes in costs. Older adults may have been less able to monitor the changing costs and hence not adapt to them as well as younger adults.

APPLICATION

Designers of decision aids should consider explicitly stating costs associated with reliance on the aid, as individuals may differ in how they interpret and respond to changing costs.

The role of spatial abilities and age in performance in an auditory computer navigation task

Age-related differences in spatial ability have been suggested as a mediator of age-related differences in computer-based task performance. However, the vast majority of tasks studied have primarily used a visual display (e.g., graphical user interfaces). In the current study, the relationship between spatial ability and performance in a non-visual computer-based navigation task was examined in a sample of 196 participants ranging in age from 18 to 91. Participants called into a simulated interactive voice response system and carried out a variety of transactions. They also completed measures of attention, working memory, and spatial abilities. The results showed that age-related differences in spatial ability predicted a significant amount of variance in performance in the non-visual computer task, even after controlling for other abilities. Understanding the abilities that influence performance with technology may provide insight into the source of age-related performance differences in the successful use of technology.

Older Adults' Training Preferences for Learning to Use Technology

Older adults may benefit from using technology in their everyday lives. However, adults over 65 may need more training than their younger counterparts given they have had less experience with technology. In this study, 113 adults between the ages of 65 and 85 participated in focus group interviews discussing their training needs and preferences for technology items used in the home. Participants expressed an interest in receiving additional training, particularly for specific tasks. Participants also discussed preferences for various characteristics of training, such as who should conduct the training and for their preferred method of training. One of the most frequently discussed preferences was for self-training using text materials, such as a manual.

Developing a Framework for Intuitive Human-Computer Interaction

Many technology marketing materials tout the intuitive nature of products, but current human-computer interaction (HCI) guidelines provide limited methods to help designers create this experience beyond making them easy to use. This paper proposes a definition for intuitive interaction with specific attributes to allow designers to create products that elicit the target experience. Review of relevant literatures provides empirical evidence for the suggested working definition of intuitive HCI: interactions between humans and high technology in lenient learning environments that allow the human to use a combination of prior experience and feedforward methods to achieve an individual's functional and abstract goals. Core concepts supporting this definition were compiled into an organizational framework that includes: seeking user goals, performing well-learned behavior, determining what to do next, metacognition, knowledge in the head, and knowledge in the world. This paper describes these concepts and proposes design approaches that could facilitate intuitive behavior and suggests areas for further research.