Social support is associated with technology use in old age

Role of Meaningful Social Participation and Technology Use in Mitigating Loneliness and Cognitive Decline Among Older Adults

IMPORTANCE

Community social participation aids dementia prevention and alleviates loneliness among older adults. Incorporating occupational therapy using information and communications technology (ICT) could potentially delay dementia onset and reduce loneliness.

OBJECTIVE

To quantify how meaningful social participation, participation frequency, ICT use, and expanded social networks influence cognitive function and loneliness among socially active older Japanese adults.

DESIGN

Cross-sectional exploratory study using structural equation modeling.

SETTING

Meetings organized by older adults at seven community gathering places in Osaka Prefecture, Japan.

PARTICIPANTS

One hundred thirteen healthy older adult cohort members.

MEASURES

Cognitive function assessed via Mini-Cog; loneliness assessed via the condensed UCLA Loneliness Scale.

RESULTS

The final model demonstrated excellent fit, χ2(23) = 28.291, p = .205 (root mean square error of approximation = .045, 90% confidence interval [.000, .094]; confirmatory factor index = .995; Tucker-Lewis Index = .993). ICT use directly affected social networks (β = 0.472), which directly influenced participation frequency (β = 0.324) and meaningful social participation (β = 0.381). The indirect effect of meaningful participation significantly improved cognitive function (β = 0.237). The only indirect effect of meaningful interpersonal participation was a reduction in loneliness (β = -0.235).

CONCLUSIONS AND RELEVANCE

ICT use contributes to the expansion of social networks among elderly people. Furthermore, the frequency of social participation and the meaningfulness of such participation are related to reduction in loneliness and maintenance of cognitive function. Although the frequency of social participation was not directly related to these outcomes, the results suggest that meaningful social participation may play an important role in reducing loneliness and maintaining cognitive function. Plain-Language Summary: The promotion of social participation among older people is a global phenomenon, driven by the recognition of its positive relationship with cognitive function and the alleviation of loneliness. Nevertheless, older people's social participation is constrained by a combination of physical and social factors. To address this issue, there has been a push to promote social participation based on information and communications technology (ICT). However, no specific study has been conducted on occupational therapists' perspective in capturing social participation and the use of ICT. The findings of this study show that using ICT has the potential to enhance opportunities for social interaction for older adults, thereby improving the quality and quantity of social participation. The quality of social participation was identified as the sole factor that had a positive impact on cognitive function and loneliness. This study suggests the need for occupational therapists to consider means of facilitating the use of ICTs among older adults as well as interventions that use occupational therapy theory to enhance the meaningfulness of existing social participation opportunities.

Digital health literacy and its determinants among community dwelling elderly people in Taiwan

Background

Digital Health Literacy (DHL) is crucial in navigating digital health environments, yet few studies focus on older adults.

Objective

Explore the associations of digital health information and resource utilization, IT-related social support, and barriers/enhancers to digital health service usage with DHL among older adults.

Methods

A cross-sectional study was conducted from January 2022 to April 2023, involving 417 individuals over the age of 60 who were interviewed using an instrument for collecting data on DHL, social support, barriers/enhancers influencing use of digital health resources and personal/demographic data. Multi-regression models were used to examine the associations.

Results

Higher DHL scores were associated with daily use of digital interaction with healthcare (B = 0.28; 95% confidence interval [CI] = 0.07, 0.49; p = .01), daily use of other digital health resources (B = 0.22; 95% CI = 0.05, 0.40; p = .01), ease in finding assistance for online navigation (B = 0.27; 95% CI = 0.08, 0.45; p = .01), self-perceived digital proficiency ("usually very good at surfing the internet," B = 0.35; 95% CI = 0.18, 0.52; p = .01), assistance from relatives/others in internet browsing (B = 0.20; 95% CI = 0.02, 0.37; p = .02), and having access to a computer, tablet, or smartphone (B = 0.29; 95% CI = 0.11, 0.47, p = .01). Conversely, barriers like "no access to a computer, tablet, or phone at all times" (B = -0.19; 95% CI = -0.34, -0.04; p = .01), "difficulty understanding online content" (B = -0.22; 95% CI = -0.36, -0.07; p = .01), and "believing to be too old for online services" (B = -0.18; 95% CI = -0.32, -0.03; p = .02) were associated with lower DHL scores.

Conclusions

Engagement with digital health platforms, including making online appointments and accessing personal health records, is associated with higher DHL levels. Support from relatives or others, a modifiable attribute, is also associated with elevated DHL among older adults.

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.

Understanding Older Adults' Experiences With Technologies for Health Self-management: Interview Study

BACKGROUND

Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments.

OBJECTIVE

This study aimed to understand the types of technologies that older adults use to support their health and the factors that motivate them to use their chosen technologies to support their health. In addition, we aimed to understand the factors that enable the effective use of technologies for health self-management and to identify the barriers that can negatively affect the adoption of technologies.

METHODS

A total of 22 older adults participated in semistructured interviews regarding their experiences of using technologies for health self-management. Interview transcripts were analyzed through an in-depth thematic analysis.

RESULTS

The interviews revealed that a range of technologies, such as videoconferencing software, fitness trackers, and other devices, were being used by older adults to support their health. Interviews showed that participants were motivated to use technologies to monitor health issues, to stay active and connected, and to record and change their behavior in the light of foreseen risks related to their future health status. Enablers that facilitated the effective use of technologies include social and organizational influence, convenient access to health care and safety provided by the technology, and easy setup and low cost of the technology. Barriers include information overload and a sense of futility about future health decline; telehealth being an inadequate substitute for in-person consultation; concerns about trust related to privacy and accuracy; and technologies being stigmatizing, uncomfortable to use, expensive, and unfamiliar.

CONCLUSIONS

This study suggested that older adults were using a variety of technologies to prevent or prepare for future health decline, evidencing a resilient attitude toward health and aging. In addition, older adults were willing to continue using the technology when there was a perceived need. The enabler mentioned by most participants was the social and organizational influence that included health care staff, family, friends, and organizations. This analysis provides a better understanding of how older adults use technologies to support their health and can guide the provision of appropriate health technologies for them.

Who Are We Missing: Does Engagement in Patient-Reported Outcome Measures for Breast Cancer Vary by Age, Race, or Disease Stage?

INTRODUCTION

Patient-reported outcome measures (PROM) are used to assess value-based care. Little is known as to whether PROM response in breast cancer reflects the diverse patient population. The BREAST-Q, a validated measure of satisfaction and quality of life, and Recovery Tracker, a postoperative assessment tool, are PROM routinely delivered to all patients undergoing breast surgery at our institution. Here we determine whether response to PROM differs by age, race, language, or disease stage.

METHODS

All patients who had a breast operation between January 2020 and July 2021 were requested to complete the BREAST-Q and Recovery Tracker. Non-responders did not complete the PROM at any timepoint; responders completed 1 or more. Primary outcomes included rates of non-response versus response overall.

RESULTS

Of 6374 patients identified, 5653 (88.7%) responded to either PROM [4366/4751 (91.9%) BREAST-Q; 2746/3384 (81.1%) Recovery Tracker]. On univariate analysis, non-responders were older (60 years versus 55 years, p < 0.001) and more often non-English speaking (p < 0.001), Hispanic ethnicity (p = 0.031), and Black race (p < 0.001), versus responders. On multivariate analysis, non-responders were significantly more often Black race and non-English speaking (p < 0.001). Non-English speakers were significantly less responsive among all ethnicities and races except Black race. Although breast cancer stage did not reach significance for response, patients with malignant disease and those receiving neoadjuvant chemotherapy responded more often.

CONCLUSIONS

Our findings demonstrate high patient engagement using 2 different PROM following breast surgery, but suggest that PROM results may not reflect the experience of the entire breast cancer population. Care process changes based solely on PROM should consider these findings to ensure that the views of the entire spectrum of patients with breast cancer are represented.

Patterns of Engagement With an Application-Based Dietary Self-Monitoring Tool Within a Randomized Controlled Feasibility Trial

Introduction

The Dietary Approaches to Stop Hypertension dietary pattern is a proven way to manage hypertension, but adherence remains low. Dietary tracking applications offer a highly disseminable way to self-monitor intake on the pathway to reaching dietary goals but require consistent engagement to support behavior change. Few studies use longitudinal dietary self-monitoring data to assess trajectories and predictors of engagement. We used dietary self-monitoring data from participants in Dietary Approaches to Stop Hypertension Cloud (N=59), a feasibility trial to improve diet quality among women with hypertension, to identify trajectories of engagement and explore associations between participant characteristics.

Methods

We used latent class growth modeling to identify trajectories of engagement with a publicly available diet tracking application and used bivariate and regression analyses to assess the associations of classifications of engagement with participant characteristics.

Results

We identified 2 latent classes of engagement: consistent engagers and disengagers. Consistent engagers were more likely to be older, more educated, and married or living with a partner. Although consistent engagers exhibited slightly greater changes in Dietary Approaches to Stop Hypertension score, the difference was not significant.

Conclusions

This study highlights an important yet underutilized methodologic approach for uncovering dietary self-monitoring engagement patterns. Understanding how certain individuals engage with digital technologies is an important step toward designing cost-effective behavior change interventions.

Trial registration

This study is registered at www.clinicaltrials.gov NCT03215472.

The Upside of Negative Emotions: How Do Older Adults From Different Cultures Challenge Their Self-Growth During the COVID-19 Pandemic?

Background and Objective

The outbreak of Coronavirus Disease 2019 (COVID-19) has raised increased challenges for older adults' personal growth in diverse cultural settings. The aim of this study was to analyze negative emotions and their role on older adults' self-growth in Mexico, Italy, Portugal, and Spain, during the COVID-19 pandemic. For this purpose, a cross-national qualitative research was carried out.

Methods

Data were collected from 338 community-dwelling participants aged 65 years and older, using a semi-structured interview protocol. Older adults were asked about negative emotions that significantly contribute to their self-growth during the COVID-19 pandemic. Content analysis was used to identify key themes.

Results

Seven main negative emotions (fear, sadness, anger, grief, boredom, loneliness, and shame) significantly contributed to seven themes of self-growth, across the samples: sharing difficult experiences with others, supportive partner, spiritual practices, engagement with life, generativity, volunteering activities, and intimacy and sexual satisfaction. Sharing difficult experiences with others was most pertinent to Mexican (13.9%) and to Italian (3.0%) participants, and a supportive partner to Portuguese (12.1%), and to Spanish participants (6.5%).

Conclusion

The findings of this study indicate that negative emotions during the COVID-19 pandemic contributed to their older adults' self-growth. This study highlighted the cultural diversity of experiences during the pandemics and underlined the upside of negative emotions and its relation to older adults' self-growth during this period.

Digitally Savvy at the Home Office: Computer Skills of Older Workers During the COVID-19 Pandemic Across Europe

Digital skills can be a valuable resource in work life, especially in such times as the current COVID-19 pandemic, during which working from home has become new reality. Although increasing numbers of older employees (aged 50 years and above) are using digital technologies to work remotely, many of these older adults still have generally lower digital skills. Whether the pandemic will be a push factor for the acquisition of computer skills in late working life remains unclear. This study investigated the explanatory factors of the computer skills gained by older workers who were working from home during the COVID-19 pandemic, using representative data for 28 countries from the Survey of Health, Aging and Retirement in Europe (SHARE). The analysis of the survey responses of 11,042 employed persons aged 50 years and older revealed that, 13% worked only at home due to the pandemic, while 15% said they worked at home and in their usual workplace. The descriptives indicate that full-time homeworking is more of an option among those with tertiary education and who already have some computer skills. Of the older employees who worked only at home, 36% reported an improvement in their computer skills, whereas of the older workers who worked at home and at their usual workplaces, only 29% reported such an improvement. Our results based on logistic regressions suggest that significantly more women, younger employees, respondents with tertiary educational qualifications, and those whose work was not affected by unemployment or even business closure acquired new computer skills, regardless of whether they were working permanently or only partly from home. The study underlines the importance of investigating the possible digital skills gained from the home office situation resulting from the pandemic.

A Scoping Review for Usage of Telerehabilitation among Older Adults with Mild Cognitive Impairment or Cognitive Frailty

Older adults are vulnerable towards cognitive frailty that can lead to adverse health outcomes and telerehabilitation appears to be a potential platform to reverse cognitive frailty among older adults. The aim of this coping review is to identify the usage of telerehabilitation and its common platform of delivery among older adults with mild cognitive impairment (MCI) or cognitive frailty (CF). Articles published from January 2015 until October 2020 were selected. Out of the 1738 articles retrieved, six studies were identified. Two articles were randomized controlled trials, one was a pilot study and three were qualitative studies. The outcome suggests that telerehabilitation may improve the quality of life among participants as well as it can be a useful and supportive digital platform for health care. Some types of technologies commonly used were smartphones or telephones with internet, television-based assistive integrated technology, mobile application and videoconference. Telerehabilitation utilization in managing cognitive frailty among older adults is still limited and more research is required to evaluate its feasibility and acceptability. Although telerehabilitation appears to be implemented among older adults with MCI and CF, some social support is still required to improve the adherence and effectiveness of telerehabilitation. Future research should focus on the evaluation of acceptance and participants’ existing knowledge towards telerehabilitation to achieve its target.

Factors Associated With Informational Support in Transitional Care for Older Adults With Chronic Diseases: A Cross-Sectional Study

To evaluate the current situation and associated factors of informational support for older adults with chronic diseases in transitional care. Study was conducted in five hospitals of five different cities in Jiangsu Province, China. A random cluster sample of 800 older adults with chronic diseases responded to the informational support questionnaire of transitional care survey. Descriptive analysis, t-tests, variance analysis, and stepwise multiple linear regression were used to analyze data. The STROBE statement for observational studies was applied. Total score of ISQTC for older adults with chronic diseases was (44.05 ± 17.21). Marital status, educational level, past occupation, close friends, medical insurance, complications, and exercise habits were significantly correlated with informational support. The level of informational support in transitional care for older adults with chronic diseases was low. Clinical staff should periodically and primarily assess their informational support, help find information resources for those who have low initial informational support, and identify which information they preferred to carry out accurate transitional care.

The digital inclusion of older people in Spain: technological support services for seniors as predictor

While life expectancy increases in developed countries and there is evidence that demonstrates the potential of the internet to optimise or compensate for the losses associated with ageing, there is a high proportion of older people who continue to be disconnected from the digital world. In this scenario, the technological support offered by public institutions has the potential to be an accessible source for the digital literacy of older people. This study, using the model of digital inequality, had the aim of analysing the ability of these institutional supports to determine and predict the digital inclusion of older people. The sample was retired adults (over 54 years) residing in Spain who are users of technological support services in four organisational contexts: nursing homes, senior community centres, University Programs for Seniors and adult education programmes. Through binary logistic regression analysis, we found that the ability of the availability of literacy support to determine and predict access, autonomy, skills and use of the internet for social connectivity depends on the social and organisational context of the technology support service. These findings support empirically the situated nature of technological support for the digital inclusion of older people and provide a useful comparative vision for the design of accessible support services adapted to the needs of its users.

[Digital transformation in the households of older people]

BACKGROUND

Digital technologies play an important role in people's everyday lives and this applies not just to younger people but increasingly to older people. The study examined how the use of and attitudes towards such technology have changed over the last 10 years through a comparison of 3 cross-sectional population surveys.

MATERIAL AND METHODS

The data came from three Swiss surveys (2009: n = 1105; 2014: n = 1037; 2019: n = 1130) of people aged 65 years and over, each of which was conducted as a standardized telephone interview and combined with an optional written survey.

RESULTS

The use of both the internet and mobile devices (smartphones, tablets) increased from 2009 to 2019: in 2009, 37.8% of the respondents used the internet, rising to 74.2% in 2019; however, people over 80 years old used these technologies less frequently. Although more and different internet resources were being used in 2019 than in 2009, the reasons given for not using the internet were similar and included security concerns, claims that using the internet is too complicated and the belief that learning to use it is too difficult. There has also been little change in the attitudes toward technology and the factors explaining internet use.

CONCLUSION

Even though the digital transformation is progressing, inequalities in the use of technology remain. Even when these are levelling out, new technologies will likely create new inequalities.

From Online to Offline and Vice Versa: Change in Internet Use in Later Life Across Europe

The internet can be a valuable source of social participation in modern society. Although increasing numbers of older adults are using the internet, numerous older adults also cease using the internet and become "offliners." The question of which factors in usage change (i.e., switching from onliner to offliner, and vice versa) are most influential remains unclear. This study investigates changes in internet use among the older European population using two waves of representative panel data for 13 countries from the Survey of Health, Aging and Retirement in Europe (SHARE). The analyses were based on 34,149 respondents aged 50 years and older. In general, the results indicate a positive trend by a slight (2%) increase in usage, from 51% in 2013 to 53% in 2015. However, the results also show that a total of 6% had not recently used the internet, although they had done so in the past. Our multilevel results suggest that both the onset of and cessation of internet usage are primarily driven by changes in socioeconomic resources (income and occupation), health resources (subjective health and grip strength), living situation (via relocation), and social factors (partnership and distance to children) as well as contextual factors such as country-specific wealth and social indexes and internet infrastructure. The study underlines the importance of investigating the influencing factors for commencing internet usage and of determining which factors lead to its increase.