Toward a psychological science of advanced technology design for older adults

Older Adults' Experiences Using a Commercially Available Monitor to Self-Track Their Physical Activity

Background

Physical activity contributes to older adults’ autonomy, mobility, and quality of life as they age, yet fewer than 1 in 5 engage in activities as recommended. Many older adults track their exercise using pencil and paper, or their memory. Commercially available physical activity monitors (PAM) have the potential to facilitate these tracking practices and, in turn, physical activity. An assessment of older adults’ long-term experiences with PAM is needed to understand this potential.

Objective

To assess short and long-term experiences of adults >70 years old using a PAM (Fitbit One) in terms of acceptance, ease-of-use, and usefulness: domains in the technology acceptance model.

Methods

This prospective study included 95 community-dwelling older adults, all of whom received a PAM as part of randomized controlled trial piloting a fall-reducing physical activity promotion intervention. Ten-item surveys were administered 10 weeks and 8 months after the study started. Survey ratings are described and analyzed over time, and compared by sex, education, and age.

Results

Participants were mostly women (71/95, 75%), 70 to 96 years old, and had some college education (68/95, 72%). Most participants (86/95, 91%) agreed or strongly agreed that the PAM was easy to use, useful, and acceptable both 10 weeks and 8 months after enrolling in the study. Ratings dropped between these time points in all survey domains: ease-of-use (median difference 0.66 points, P=.001); usefulness (median difference 0.16 points, P=.193); and acceptance (median difference 0.17 points, P=.032). Differences in ratings by sex or educational attainment were not statistically significant at either time point. Most participants 80+ years of age (28/37, 76%) agreed or strongly agreed with survey items at long-term follow-up, however their ratings were significantly lower than participants in younger age groups at both time points.

Conclusions

Study results indicate it is feasible for older adults (70-90+ years of age) to use PAMs when self-tracking their physical activity, and provide a basis for developing recommendations to integrate PAMs into promotional efforts.

Trial Registration

Clinicaltrials.gov NCT02433249; https://clinicaltrials.gov/ct2/show/NCT02433249 (Archived by WebCite at http://www.webcitation.org/6gED6eh0I)

Wearable sensors and Mobile Health (mHealth) technologies to assess and promote physical activity in stroke: a narrative review

Stroke is a leading cause of disability worldwide, with approximately one third of people left with permanent deficits impacting on their function. This may contribute to a physically inactive lifestyle and further associated health issues. Current research suggests that people after stroke are not meeting the recommended levels of physical activity, and are less active than people with other chronic illnesses. Thus, it is important to understand how to support people after stroke to uptake and maintain physical activity. Wearable sensors and mobile health (mHealth) technologies are a potential platform to measure and promote physical activity. Some of these technologies may incorporate behaviour change techniques such as real-time feedback. Although wearable activity trackers and smartphone technology are widely available, the feasibility and applicability of these technologies for people after stroke is unclear. This article reviews the devices available for assessment of physical activity in stroke and discusses the potential for advances in technology to promote physical activity in this population.

Prototype Development of a Responsive Emotive Sensing System (DRESS) to aid older persons with dementia to dress independently

BACKGROUND

Prior research has critiqued the lack of attention to the stressors associated with dementia related dressing issues, stigmatizing patient clothing, and wearable technology challenges. This paper describes the conceptual development and feasibility testing of an innovative 'smart dresser' context aware affective system (DRESS) to enable dressing by people with moderate memory loss through individualized audio and visual task prompting in real time.

METHODS

Mixed method feasibility study involving qualitative focus groups with 25 Alzheimer's family caregivers experiencing dressing difficulties to iteratively inform system design and a quantitative usability trial with 10 healthy subjects in a controlled laboratory setting to assess validity of technical operations.

RESULTS

Caregivers voiced the need for tangible dressing assistance to reduce their frustration from time spent in repetitive cueing and power struggles over dressing. They contributed 6 changes that influenced the prototype development, most notably adding a dresser top iPad to mimic a familiar 'TV screen' for the audio and visual cueing. DRESS demonstrated promising overall functionality, however the validity of identification of dressing status ranged from 0% for the correct pants dressing to 100% for all shirts dressing scenarios. Adjustments were made to the detection components of the system raising the accuracy of detection of all acted dressing scenarios for pants from 50% to 82%.

CONCLUSIONS

Findings demonstrate family caregiver acceptability of the proposed system, the successful interoperability of the built system's components, and the system's ability to interpret correct and incorrect dressing actions in controlled laboratory simulations. Future research will advance the system to the alpha stage and subsequent testing with end users in real world settings.

One size does not fit all: older adults benefit from redundant text in multimedia instruction

The multimedia design of presentations typically ignores that younger and older adults have varying cognitive strengths and weaknesses. We examined whether differential instructional design may enhance learning in these populations. Younger and older participants viewed one of three computer-based presentations: Audio only (narration), Redundant (audio narration with redundant text), or Complementary (audio narration with non-redundant text and images). Younger participants learned better when audio narration was paired with relevant images compared to when audio narration was paired with redundant text. However, older participants learned best when audio narration was paired with redundant text. Younger adults, who presumably have a higher working memory capacity (WMC), appear to benefit more from complementary information that may drive deeper conceptual processing. In contrast, older adults learn better from presentations that support redundant coding across modalities, which may help mitigate the effects of age-related decline in WMC. Additionally, several misconceptions of design quality appeared across age groups: both younger and older participants positively rated less effective designs. Findings suggest that one-size does not fit all, with older adults requiring unique multimedia design tailored to their cognitive abilities for effective learning.

Older Adult Self-Efficacy Study of Mobile Phone Diabetes Management

The purpose of this study was to evaluate participant self-efficacy and use of a mobile phone diabetes health intervention for older adults during a 4-week period. Participants included seven adults (mean age, 70.3 years) with type 2 diabetes cared for by community-based primary care physicians. Participants entered blood glucose data into a mobile phone and personalized patient Internet Web portal. Based on blood glucose values, participants received automatic messages and educational information to self-manage their diabetes. Study measures included prior mobile phone/Internet use, the Stanford Self-Efficacy for Diabetes Scale, the Stanford Energy/Fatigue Scale, the Short Form-36, the Patient Health Questionnaire-9 (depression), the Patient Reported Diabetes Symptom Scale, the Diabetes Stages of Change measure, and a summary of mobile system use. Participants had high self-efficacy and high readiness and confidence in their ability to monitor changes to control their diabetes. Participants demonstrated ability to use the mobile intervention and communicate with diabetes educators.

The patient work system: an analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers

Human factors and ergonomics approaches have been successfully applied to study and improve the work performance of healthcare professionals. However, there has been relatively little work in "patient-engaged human factors," or the application of human factors to the health-related work of patients and other nonprofessionals. This study applied a foundational human factors tool, the systems model, to investigate the barriers to self-care performance among chronically ill elderly patients and their informal (family) caregivers. A Patient Work System model was developed to guide the collection and analysis of interviews, surveys, and observations of patients with heart failure (n = 30) and their informal caregivers (n = 14). Iterative analyses revealed the nature and prevalence of self-care barriers across components of the Patient Work System. Person-related barriers were common and stemmed from patients' biomedical conditions, limitations, knowledge deficits, preferences, and perceptions as well as the characteristics of informal caregivers and healthcare professionals. Task barriers were also highly prevalent and included task difficulty, timing, complexity, ambiguity, conflict, and undesirable consequences. Tool barriers were related to both availability and access of tools and technologies and their design, usability, and impact. Context barriers were found across three domains-physical-spatial, social-cultural, and organizational-and multiple "spaces" such as "at home," "on the go," and "in the community." Barriers often stemmed not from single factors but from the interaction of several work system components. Study findings suggest the need to further explore multiple actors, contexts, and interactions in the patient work system during research and intervention design, as well as the need to develop new models and measures for studying patient and family work.

Exploring the Relationship Between Hearing Aid Self-Efficacy and Hearing Aid Management

Hearing loss is a highly prevalent condition affecting a significant portion of the adult population. Hearing aids are an effective and common rehabilitation strategy for individuals with hearing loss. A wide range of factors, however, can hamper and even preclude successful hearing aid use. Self-efficacy, a concept that reflects perceptions of one's ability to perform particular tasks or behaviors, has been shown to be an important factor in the successful management of chronic illness including conditions such as diabetes, cardiovascular disease, as well as arthritis and other sources of chronic pain. Improving or strengthening patients' self-efficacy beliefs can improve health outcomes. The role of self-efficacy in the management of hearing loss and hearing aids is still being explored; hence, the extent to which, and the ways in which, self-efficacy may be related to audiologic outcomes remains largely unexplained. The purpose of this article is to examine emerging evidence regarding the relationship between perceived self-efficacy and rehabilitation outcomes among adult hearing aid users and to discuss an apparent discrepancy between patients' reported self-efficacy and their demonstrated skill in managing hearing aids.

Advancing the Aging and Technology Agenda in Gerontology

Interest in technology for older adults is driven by multiple converging trends: the rapid pace of technological development; the unprecedented growth of the aging population in the United States and worldwide; the increase in the number and survival of persons with disability; the growing and unsustainable costs of caring for the elderly people; and the increasing interest on the part of business, industry, and government agencies in addressing health care needs with technology. These trends have contributed to the strong conviction that technology can play an important role in enhancing quality of life and independence of older individuals with high levels of efficiency, potentially reducing individual and societal costs of caring for the elderly people. The purpose of this "Forum" position article is to integrate what we know about older adults and technology systems in order to provide direction to this vital enterprise. We define what we mean by technology for an aging population, provide a brief history of its development, introduce a taxonomy for characterizing current technology applications to older adults, summarize research in this area, describe existing development and evaluation processes, identify factors important for the acceptance of technology among older individuals, and recommend future directions for research in this area.

Everyday-like memory and its cognitive correlates in healthy older adults and in young patients with traumatic brain injury: a pilot study based on virtual reality

PURPOSE STATE: A pilot-study with a comparison approach between aging and traumatic brain injury (TBI) is proposed to investigate everyday object memory patterns using a virtual HOMES test.

METHODS

Sixteen young controls, 15 older adults and 15 TBI patients underwent the HOMES test and traditional tests.

RESULTS

Older adults and TBI patients exhibited similar HOMES performances: poor recall, a greater recognition benefit, high false recognitions, but intact clustering and proactive interference effects. The age-related differences for HOMES measures were mainly mediated by executive functioning, while the HOMES performances in the TBI group were correlated with memory measures.

CONCLUSION

The differential cognitive mediating effects for a similar everyday-like memory pattern are discussed by highlighting the need for more cautious interpretations of cognitive mechanisms behind similar behavioral patterns in different populations especially in clinical and rehabilitation settings.

Promoting safe and effective use of OTC medications: CHPA-GSA National Summit

Research on the ways older people use prescription medications (Rx) is a mainstay of the gerontological literature because use of Rx medications is common, and appropriate use is central to effective management of chronic disease. But older adults are also major consumers of over-the-counter (OTC) medications, which can be equally significant for self-care. Nearly half of older adults aged 75-85, for example, are regular users of an OTC product. Ensuring that consumers safely and effectively use OTC products is critical in order to minimize potential drug-drug interactions and unintentional misuse. Yet we know surprisingly little about the ways older adults select OTC medications and decide when to start or stop use, how older people actually take these medications, or how involved clinicians and family members are in older adult OTC behavior. Research in this area is critical for developing interventions to help ensure safe and appropriate OTC use. For this reason, The Gerontological Society of America (GSA), in partnership with the Consumer Healthcare Products Association (CHPA), convened a summit of experts to set an agenda for research in OTC behaviors among older adults. The panel suggested a need for research in 5 key areas: Health literacy and OTC behavior, decision making and OTC use, the role of clinicians in OTC medication behavior, older adult OTC behavior and family care, and technologies to promote optimal use of OTC medications.

Older adults' performance in technology-based tasks: cognitive ability and beyond

Considering both demographic and technological changes in society, the potential of technology to support older adults has recently attracted much attention. For physically frail individuals with cognitive impairment, user-friendly technologies may facilitate activities of daily living. The current study assessed the performance of older adults without cognitive impairment (n = 27) and with mild cognitive impairment (n = 26) using three types of technology. Relationships between performance in the technology-based tasks and cognitive abilities (e.g., visual-spatial abilities), personality characteristics (e.g., self-efficacy), and previous technology experience were examined using a mixed-methods approach including video analyses and psychological testing. Findings underscore that both cognitive abilities and personality-related characteristics contribute to individual differences in users' performance. Nuanced knowledge of older adults' specific difficulties, abilities, and resources may help improve the fit between user needs and technological requirements, with implications for technology developers and practitioners.

Cognitive aging: is there a dark side to environmental support?

It has been known for some time that memory deficits among older adults increase when self-initiated processing is required and decrease when the environment provides task-appropriate cues. We propose that this observation is not confined to memory but can be subsumed under a more general developmental trend. In perception, learning or memory, and action management, older adults often rely more on external information than younger adults do, probably both as a direct reflection and indirect adaptation to difficulties in internally triggering and maintaining cognitive representations. This age-graded shift from internal towards environmental control is often associated with compromised performance. Cognitive aging research and the design of aging-friendly environments can benefit from paying closer attention to the developmental dynamics and implications of this shift.

Performance barriers among elderly chronic heart failure patients

Applications of the human factors and ergonomics (HFE) approach in the healthcare domain have largely targeted the work of healthcare professionals. Here, we argue for the importance of targeting the work of patients and their lay caregivers, a relatively underdeveloped approach we call patient-engaged HFE. A multi-method study of the barriers to the self-care work of elderly chronic heart failure patients (N=27) and caregivers (N=11) illustrates the approach. Analyses of interview data using a macroergonomic Work System framework revealed a large variety of barriers unique to patient work as well as to CHF self-care. The most common person-related barriers were physical limitations and knowledge gaps. Task-related barriers included medication complexity and side-effects. Tool and technology barriers included lack of or overdependence on aids. Context barriers were organizational (e.g., no indoor gyms), social (e.g., sodiumrich food culture), and physical-environmental (e.g., stairs). Findings motivate further applying HFE concepts and methods (e.g., workload, decision support, distributed cognition, resilience) to patient work.

Skill acquisition with text-entry interfaces: particularly older users benefit from minimized information-processing demands

Operating information technology challenges older users if it requires executive control, which generally declines with age. Especially for novel and occasional tasks, cognitive demands can be high. We demonstrate how interface design can reduce cognitive demands by studying skill acquisition with the destination entry interfaces of two customary route guidance systems. Young, middle-aged, and older adults performed manual destination entry either with a system operated with multiple buttons in a dialogue encompassing spelling and list selection, or with a system operated by a single rotary encoder, in which an intelligent speller constrained destination entry to a single line of action. Each participant performed 100 training trials. A retention test after at least 10 weeks encompassed 20 trials. The same task was performed faster, more accurately, and produced much less age-related performance differences especially at the beginning of training if interface design reduced demand for executive control, perceptual processing, and motor control.

Relocation remembered: perspectives on senior transitions in the living environment

The experience of aging may necessitate transitions in living environments, either through adaptations to current residences or through relocations to more supportive environments. For over a half century, the study of these transitions has informed the work of researchers, health and mental health providers, policymakers, and municipal planners. In the 1970s and 80s, knowledge about these transitions advanced through Lawton and Nahemow's ecological theory of competence and environmental press, Wiseman's behavioral model of relocation decision making, and Litwak and Longino's developmental perspective on senior migrations. This article revisits influential theoretical frameworks that contribute to our understanding of senior transitions in living environments. These seminal works are shown to inform recent studies of relocation and gerontology. This article concludes with a call for a view on housing transitions that reflects the contemporary context.

Evidence and Deployment-Based Research into Care for the Elderly Using Emotional Robots

Global aging, particularly in Japan and Europe, an associated shortage of qualified healthcare personnel, and a general preference for living at home, have all sparked an interest in the possibilities offered by robot therapy in improving quality of life. To date, however, both evidence-based research and psychological theory building on whether, and if so how and why, robots can influence the life of the elderly are rather sparse and scattered across many scientific disciplines and countries. The present paper argues in favor of a psychological, cross-cultural framework for evidence-based analyses of emotional robots. Against the background of this framework, we present building blocks for an evidence-based approach to the assessment of emotional robots and discuss interactions between evidence- and deployment-based research.

Ergonomics/Human factors needs of an ageing workforce in the manufacturing sector

BACKGROUND

As the effects of demographic transition are realised around the world, many in-dustrial societies are facing the effects of a baby boom generation, increased life expectancies, decreased birth rates and recent changes to retirement legislation with the result that older work¬ers are set to comprise a greater proportion of the labour force.

METHODS

This paper reviews the evidence for the physical and cognitive factors that characterise an ageing workforce in manufacturing. From an ergonomics and human factors (E/HF) pers¬pective, characteristics of manufacturing tasks and the effects of ageing provide an insight into how the industry will have to adapt to support the user needs of the older worker in the future. The approach taken is drawn from Ilmarinen's framework of age, experience, and work performance, from which specific E/HF issues are explored.

RESULTS

There would appear to potential to support physical decline in older workers within manufacturing jobs through increased mechanisation and automation; however, those factors associated with cognitive human factors are less clear. Increased mechanisation and automation can place greater loads and demands on the older worker where cognitive decline is more subtle and varied between workers.

CONCLUSION

Using historical and contemporary findings and the relationship between age, experience, and work performance is redrawn to include both cognitive skills and physical attributes to provide recommendations for future job design and worker needs.

The relationship between computer experience and computerized cognitive test performance among older adults

OBJECTIVE

This study compared the relationship between computer experience and performance on computerized cognitive tests and a traditional paper-and-pencil cognitive test in a sample of older adults (N = 634).

METHOD

Participants completed computer experience and computer attitudes questionnaires, three computerized cognitive tests (Useful Field of View (UFOV) Test, Road Sign Test, and Stroop task) and a paper-and-pencil cognitive measure (Trail Making Test). Multivariate analysis of covariance was used to examine differences in cognitive performance across the four measures between those with and without computer experience after adjusting for confounding variables.

RESULTS

Although computer experience had a significant main effect across all cognitive measures, the effect sizes were similar. After controlling for computer attitudes, the relationship between computer experience and UFOV was fully attenuated.

DISCUSSION

Findings suggest that computer experience is not uniquely related to performance on computerized cognitive measures compared with paper-and-pencil measures. Because the relationship between computer experience and UFOV was fully attenuated by computer attitudes, this may imply that motivational factors are more influential to UFOV performance than computer experience. Our findings support the hypothesis that computer use is related to cognitive performance, and this relationship is not stronger for computerized cognitive measures. Implications and directions for future research are provided.

Use of personal call alarms among community-dwelling older people

Having a fall and then lying on the floor for an hour or more is known as a ‘long lie’, which is associated with serious injury and an elevated risk of admission to hospital, long-term care and death. Personal call alarms are designed to prevent long lies, although little is known about their use. Using cross-sectional data from the English Longitudinal Study on Ageing, this study investigated the proportion of self-reported users of personal call alarms among 3,091 community-dwelling adults aged 65+ who reported difficulties of mobility or activities of daily living. The characteristics of users were then explored through logistic regressions comparing those living alone with those living with others. One hundred and eighty people self-reported using a personal call alarm (6%). Multivariate regression found the following to significantly predict personal call alarm use among both those living alone and with others: greater difficulty with activities/instrumental activities of daily living, older age, and for those living with others only: lower score on the quality of life subscale for control. Personal call alarm use may be markedly lower than the 30 per cent annual incidence of falls among community-dwelling older people. Better understanding is needed of the reasons for low usage, even amongst those at highest falls risk for whom such alarms are most likely to be beneficial.

Evaluating the effectiveness of a memory aid system

BACKGROUND

The ability to remember future intentions is compromised in both healthy and cognitively impaired older adults. Assistive technology provides older adults with promising solutions to cope with this age-related problem. However, the effectiveness and efficiency of such systems as memory aids is seldom evaluated in controlled, randomized trials.

OBJECTIVES

We evaluated the effectiveness of a memory aid system, the InBad (engl. InBath), for bathroom-related daily care. Conceptually, the InBad learns user behavior patterns and detects deviations from the learned pattern in order to notify the user of a forgotten task.

METHODS

We simulated a challenging morning routine consisting of 22 bathroom activities with a sample of 60 healthy older adults. Participants were randomly assigned to three groups: (1) 'no memory support', i.e., participants received no support at all, (2) 'list support', i.e., participants could retrieve a list of all activities, and (3) 'system support', i.e., participants received prompts for specific activities that had not yet been executed.

RESULTS

Both support groups executed significantly more activities compared to the 'no support' group. In addition, system support resulted in significantly better performance compared to list support with no significant differences between the two groups in overall task duration.

CONCLUSION

The assistive support system was the most effective and efficient memory aid. The results suggest that assistive technology has the potential to enable older adults to remain safe and independent in their own home.

What do users want from "smart" wheelchairs?

Technological advances have made it possible to integrate a variety of functions into "smart" wheelchairs that include robotics but also sensors that support telehealth and communication applications. The purpose of this study was to identify possible features that current older adult wheelchair users identify as being most helpful and most important and to use scenarios to determine acceptability of potential features. A small pilot study including 5 wheelchair users residing an assisted living facility was conducted that included a questionnaire and a focus group. The participants identified safety-related features as most helpful and important. Within the scenarios presented, the safety-related features were identified as highly acceptable. Features that were available with current technology (e.g. communication with family) were least highly rated. While more research is needed on user preferences, "smart" wheelchair developers will want to include user preferences and focus on safety and telehealth features.

Aging well and the environment: toward an integrative model and research agenda for the future

PURPOSE OF THE STUDY

The effects of the physical-spatial-technical environment on aging well have been overlooked both conceptually and empirically. In the spirit of M. Powell Lawton's seminal work on aging and environment, this article attempts to rectify this situation by suggesting a new model of how older people interact with their environment.

DESIGN AND METHODS

Goals of the paper include (a) integration of the essential elements of the ecology and aging literature, particularly in regard to Lawton's research, (b) development of connections between traditional theories of ecology of aging and life span developmental models of aging well, (c) acknowledgment of the pronounced historical and cohort-related changes affecting the interactions of older people with their environment, and (d) discussion of the implications of this analysis for concepts and theories of aging well.

RESULTS

The model builds on a pair of concepts: environment as related to agency and belonging, founded in motivational psychology, and developmental science.

IMPLICATIONS

After describing the model's key components, we discuss its heuristic potential in four propositions for future gerontological research and identify implications of the model for future empirical research.