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Falzarano FB, Lucius-Milliman D, Ceruso M, Czaja SJ. A Tablet-Based Application to Enhance Social Connectedness for Individuals With a Cognitive Impairment: Results From the PRISM-CI Pilot Study. J Appl Gerontol 2024; 43:1473-1484. [PMID: 38685877 PMCID: PMC11368626 DOI: 10.1177/07334648241248294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Social engagement is fundamental to successful aging and linked to better emotional, physical, and cognitive health. Maintaining social engagement is challenging for many older adults but especially for those with a cognitive impairment (CI). Information and communication technologies (ICT) can provide enhanced opportunities for social and cognitive engagement for older adults with a CI via increased information, education, and social connectivity access. This study used a pre-test post-test design to evaluate the feasibility, acceptability, and preliminary efficacy of the PRISM-CI software system, a tablet-based application designed to enhance access to resources, information, and social engagement, in 52 individuals with a CI between the ages of 65-88 years who had access to PRISM-CI for five months. Findings show that social isolation, loneliness, and depressive symptoms significantly decreased, and mobile device proficiency significantly increased, from baseline to follow-up. Results highlight ICTs potential to foster social engagement among older adults with a CI.
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Affiliation(s)
- Francesca B Falzarano
- Weill Cornell Medicine, New York, NY, USA
- University of Southern California, Los Angeles, CA, USA
| | - Darby Lucius-Milliman
- Weill Cornell Medicine, New York, NY, USA
- Georgia Southern University, Statesboro, GA, USA
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2
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Mois G, Lydon EA, Mathias VF, Jones SE, Mudar RA, Rogers WA. Best practices for implementing a technology-based intervention protocol: Participant and researcher considerations. Arch Gerontol Geriatr 2024; 122:105373. [PMID: 38460265 DOI: 10.1016/j.archger.2024.105373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/17/2023] [Accepted: 02/18/2024] [Indexed: 03/11/2024]
Abstract
Technology-based interventions present a promising approach to support health and wellness for older adults with a range of cognitive abilities. Technology can enhance access to interventions and support scaling of programs to reach more people. However, the use of technology for intervention delivery requires particular attention to users' needs and preferences and ensuring the materials are adaptable and supportive of a diverse range of technology proficiency levels. We share best practices based on lessons learned from the deployment of a randomized controlled trial (RCT) wherein we delivered an 8-week social engagement intervention through a video technology platform called OneClick for older adults with varying cognitive abilities. We developed a set of best practices and guidelines informed by the lessons learned through this RCT implementation. Technology-based interventions require attention to the application (e.g., video calls), system requirements (e.g., system memory, broadband internet), training (e.g., adaptability based on user competency), and support (e.g., handouts, live contact). These best practices relate to user needs; training design; personnel responsibility; structuring delivery and content; and evaluating success. These research-based best practices can guide the design, development, and implementation of technology-based interventions to support older adults with varying cognitive abilities.
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Affiliation(s)
- George Mois
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States.
| | - Elizabeth A Lydon
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States
| | - Vincent F Mathias
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States
| | - Sarah E Jones
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States
| | - Raksha A Mudar
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States
| | - Wendy A Rogers
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, United States
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Czaja SJ, Charness N, Rogers WA, Sharit J, Moxley JH, Boot WR. The Benefits of Technology for Engaging Aging Adults: Findings From the PRISM 2.0 Trial. Innov Aging 2024; 8:igae042. [PMID: 38854853 PMCID: PMC11154146 DOI: 10.1093/geroni/igae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Indexed: 06/11/2024] Open
Abstract
Background and Objectives Technology has potential for providing support for aging adults. This study evaluated the Personal Reminder Information and Social Management 2.0 (PRISM 2.0) software, in terms of enhancing social engagement and quality of life, and decreasing loneliness among older adults. Research Design and Methods The randomized field trial conducted in diverse living contexts (rural locations, senior housing, and assisted living communities [ALC]). Two hundred and forty-five adults, aged 64 to 99 years, were randomly assigned to the PRISM 2.0 (integrated software system designed for aging through an iterative design process) or a Standard Tablet (without PRISM) Control condition, where participants received the same amount of contact and training as those in the PRISM 2.0 condition. Primary outcomes included measures of loneliness, social support, social connectedness, and quality of life. Secondary outcomes included measures of social isolation, mobile device proficiency, and technology readiness. Data were collected at baseline and 6 and 9 months postrandomization. This article focuses on the 6-month outcomes due to coronavirus disease 2019-related data challenges at 9 months. Results Contrary to our hypothesis, participants in rural locations and senior housing in both conditions reported less loneliness and social isolation, and greater social support and quality of life at 6 months, and an increase in mobile device proficiency. Participants in the ALCs in both conditions also evidenced an increase in mobile device proficiency. Improvements in quality of life and health-related quality of life were associated with decreases in loneliness. Discussion and Implications This study provides compelling evidence about the benefits of technology for older adults in terms of enhancing social outcomes and quality of life. However, the findings also underscore that for technology applications to be successful, they need to be adapted to the abilities and needs of the user group and instructional support needs to be provided. Clinical Trials Registration # NCT03116399.
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Affiliation(s)
- Sara J Czaja
- Center on Aging and Behavioral Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Wendy A Rogers
- College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Joseph Sharit
- College of Engineering, University of Miami, Coral Gables, Florida, USA
| | - Jerad H Moxley
- Center on Aging and Behavioral Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Walter R Boot
- Center on Aging and Behavioral Medicine, Weill Cornell Medicine, New York, New York, USA
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Alfaro AJ, Wielgosz J, Kuhn E, Carlson C, Gould CE. Determinants and outcome correlates of engagement with a mobile mental health intervention for depression and anxiety in middle-aged and older adults. J Clin Psychol 2024; 80:509-521. [PMID: 38157399 DOI: 10.1002/jclp.23636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 11/13/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To examine baseline factors (i.e., age, gender, mobile device proficiency, sensory impairment) associated with app engagement in a 12-week mental health app intervention and to explore whether app engagement predicts changes in depression and anxiety symptoms among middle-aged and older adults. METHOD Mobile device proficiency, sensory impairment, depression, and anxiety symptoms were measured using questionnaires. App engagement was defined by metrics characterizing the core intervention features (i.e., messages sent to therapist, mindfulness meditation minutes, action tasks completed). Multiple regressions and multilevel models were conducted. RESULTS Forty-nine participants (M age = 57.40, SD = 11.09 years) enrolled. Women (β = .35, p < .05) and participants with less sensory impairment completed more action tasks (β = -.40, p < .05). Depressive and anxiety symptoms measured within the app declined significantly across treatment. Clinical significant improvements were observed for depression in 48.9% and for anxiety in 40% of participants. App engagement metrics were not predictive of depression or anxiety symptoms, either incrementally in time-lagged models or cumulatively in hierarchical linear regression analyses. CONCLUSION App engagement is multifaceted; participants engaged differently by gender and ability. Participation in this digital mental health intervention reduced depression and anxiety symptoms, but these findings should be interpreted with caution as the study did not include a control condition. Our findings underscore the importance of considering individual factors that may influence use of a digital mental health intervention.
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Affiliation(s)
- Ana J Alfaro
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph Wielgosz
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Eric Kuhn
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Chalise Carlson
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Christine E Gould
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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Welch V, Ghogomu ET, Barbeau VI, Dowling S, Doyle R, Beveridge E, Boulton E, Desai P, Huang J, Elmestekawy N, Hussain T, Wadhwani A, Boutin S, Haitas N, Kneale D, Salzwedel DM, Simard R, Hébert P, Mikton C. Digital interventions to reduce social isolation and loneliness in older adults: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1369. [PMID: 38024780 PMCID: PMC10681039 DOI: 10.1002/cl2.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background Social isolation and loneliness are more common in older adults and are associated with a serious impact on their well-being, mental health, physical health, and longevity. They are a public health concern highlighted by the COVID-19 pandemic restrictions, hence the need for digital technology tools to enable remotely delivered interventions to alleviate the impact of social isolation and loneliness during the COVID-19 restrictions. Objectives To map available evidence on the effects of digital interventions to mitigate social isolation and/or loneliness in older adults in all settings except hospital settings. Search Methods We searched the following databases from inception to May 16, 2021, with no language restrictions. Ovid MEDLINE, Embase, APA PsycInfo via Ovid, CINAHL via EBSCO, Web of Science via Clarivate, ProQuest (all databases), International Bibliography of the Social Sciences (IBSS) via ProQuest, EBSCO (all databases except CINAHL), Global Index Medicus, and Epistemonikos. Selection Criteria Titles and abstracts and full text of potentially eligible articles were independently screened in duplicate following the eligibility criteria. Data Collection and Analysis We developed and pilot tested a data extraction code set in Eppi-Reviewer and data were individually extracted and coded based on an intervention-outcome framework which was also used to define the dimensions of the evidence and gap map. Main Results We included 200 articles (103 primary studies and 97 systematic reviews) that assessed the effects of digital interventions to reduce social isolation and/or loneliness in older adults. Most of the systematic reviews (72%) were classified as critically low quality, only 2% as high quality and 25% were published since the COVID-19 pandemic. The evidence is unevenly distributed with clusters predominantly in high-income countries and none in low-income countries. The most common interventions identified are digital interventions to enhance social interactions with family and friends and the community via videoconferencing and telephone calls. Digital interventions to enhance social support, particularly socially assistive robots, and virtual pets were also common. Most interventions focused on reducing loneliness and depression and improving quality of life of older adults. Major gaps were identified in community level outcomes and process indicators. No included studies or reviews assessed affordability or digital divide although the value of accessibility and barriers caused by digital divide were discussed in three primary studies and three reviews. Adverse effects were reported in only two studies and six reviews. No study or review included participants from the LGBTQIA2S+ community and only one study restricted participants to 80 years and older. Very few described how at-risk populations were recruited or conducted any equity analysis to assess differences in effects for populations experiencing inequities across PROGRESS-Plus categories. Authors' Conclusions The restrictions placed on people during the pandemic have shone a spotlight onto social isolation and loneliness, particularly for older adults. This evidence and gap map shows available evidence on the effectiveness of digital interventions for reducing social isolation or loneliness in older adults. Although the evidence is relatively large and recent, it is unevenly distributed and there is need for more high-quality research. This map can guide researchers and funders to consider areas of major gaps as priorities for further research.
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Affiliation(s)
- Vivian Welch
- Methods Centre, Bruyère Research InstituteOttawaOntarioCanada
| | | | | | - Sierra Dowling
- Methods Centre, Bruyère Research InstituteOttawaOntarioCanada
| | | | - Ella Beveridge
- Methods Centre, Bruyère Research InstituteOttawaOntarioCanada
| | - Elisabeth Boulton
- School of Health Sciences, Division of Nursing, Midwifery and Social WorkUniversity of ManchesterManchesterUK
| | - Payaam Desai
- Methods Centre, Bruyère Research InstituteOttawaOntarioCanada
| | - Jimmy Huang
- Methods Centre, Bruyère Research InstituteOttawaOntarioCanada
| | | | | | - Arpana Wadhwani
- Methods Centre, Bruyère Research InstituteOttawaOntarioCanada
| | | | | | - Dylan Kneale
- Social Science Research Unit, EPPI‐Centre, UCL Institute of EducationUniversity College LondonLondonUK
| | - Douglas M. Salzwedel
- Department of Anesthesiology, Pharmacology and TherapeuticsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Paul Hébert
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
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Yu DSF, Li PWC, Lin RSY, Kee F, Chiu A, Wu W. Effects of non-pharmacological interventions on loneliness among community-dwelling older adults: A systematic review, network meta-analysis, and meta-regression. Int J Nurs Stud 2023; 144:104524. [PMID: 37295285 DOI: 10.1016/j.ijnurstu.2023.104524] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The highly prevalent late-life loneliness, together with its deleterious health impacts, calls for increasing attention to the need for effective interventions targeting on this growing public health problem. With the increasing evidence on interventions for combating loneliness, it is timely to identify their comparative effectiveness. OBJECTIVE This systematic review, meta-analysis and network meta-analysis was to identify and compare the effects of various non-pharmacological interventions on loneliness in community-dwelling older adults. METHODS Systematic search was conducted in nine electronic databases from inception to 30th March 2023 for studies investigating the effects of non-pharmacological interventions on loneliness among community-dwelling older adults. The interventions were categorized according to the nature and purpose of use. Pairwise meta-analysis and network meta-analyses were sequentially performed to identify the effects of each category of interventions and their comparative intervention effectiveness, respectively. Meta-regression was performed to examine any influence of study design and participants' characteristics on the intervention effectiveness. The study protocol was registered at PROSPERO (CRD42022307621). RESULTS A total of 60 studies with 13,295 participants were included. The interventions were categorized as psychological interventions, social support interventions (by digital and non-digital means), behavioral activation, exercise intervention with and without social engagement, multi-component intervention and health promotion. Pairwise meta-analysis identified the positive effect of psychological interventions (Hedges' g = -2.33; 95%CI [-4.40, -0.25]; Z = -2.20, p = 0.003), non-digital social support interventions (Hedges' g = -0.63; 95%CI [-1.16, -0.10]; Z = 2.33, p = 0.02) and multi-component interventions (Hedges' g = -0.28 95%CI [-0.54, -0.03]; Z = -2.15, p = 0.03) on reducing loneliness. Subgroup analysis provided additional insights: i) social support and exercise interventions which integrated active strategies to optimize the social engagement demonstrated more promising intervention effects; ii) behavioral activation and multicomponent interventions worked better for older adults who were male or reported loneliness, respectively, and iii) counseling-based psychological interventions was more effective than mind-body practice. Network meta-analysis consistently pointed to the greatest therapeutic benefits of psychological interventions, and this was followed by exercise-based interventions, non-digital social support interventions and behavioral activation. Meta-regression further suggested that the therapeutic effects of the tested interventions were independent of the various factors relating to study design and participants' characteristics. CONCLUSIONS This review highlights the more superior effects of psychological interventions in improving loneliness among older adults. Interventions which have an attribute to optimize social dynamic and connectivity may also be effective. TWEETABLE ABSTRACT Psychological intervention is the best to beat late-life loneliness, but increasing social dynamic and connectivity may add an impact.
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Affiliation(s)
- Doris Sau-Fung Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong.
| | - Polly Wai-Chi Li
- School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Rose Sin-Yi Lin
- School of Nursing, University of Rochester, United States of America
| | - Frank Kee
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Alice Chiu
- Improving Health Outcomes Together Team, Alberta Health Services, Calgary, Alberta, Canada
| | - Wendy Wu
- School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
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Zhang S, Boot WR. Predicting Older Adults' Continued Computer Use After Initial Adoption. Innov Aging 2023; 7:igad029. [PMID: 37197443 PMCID: PMC10184684 DOI: 10.1093/geroni/igad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 05/19/2023] Open
Abstract
Background and Objectives Sustained computer and internet use have the potential to help older adults in various aspects of their lives, making predicting sustained use a critical goal. However, some factors related to adoption and use (e.g., computer attitudes) change over time and with experience. To understand these dynamics, the current study modeled changes in constructs related to computer use after initial computer adoption and examined whether these changes predict continued use. Research Design and Methods We used data from the computer arm (N = 150, MAge = 76.15) of a 12-month field trial examining the potential benefits of computer use in older adults. Individual differences identified in the technology acceptance literature (perceived usefulness, ease of use, computer interest, computer self-efficacy, computer anxiety, quality of life, social isolation, and social support) were measured before (baseline), during (Month 6), and after the intervention (post-test). Univariate and bivariate latent change score models examined changes in each predictor and their potential causal relationship with use. Results Results demonstrated large interindividual differences in the change patterns of individual difference factors examined. Changes in perceived usefulness, perceived ease of use, computer interest, computer self-efficacy, and computer anxiety were correlated with but not predictive of change in use. Discussion and Implications Our findings demonstrate the limitation of popular constructs in technology acceptance literature in predicting continued use and point out important gaps in knowledge to be targeted in future investigations.
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Affiliation(s)
- Shenghao Zhang
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Walter R Boot
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Kozlov E, McDarby M, Pagano I, Llaneza D, Owen J, Duberstein P. The feasibility, acceptability, and preliminary efficacy of an mHealth mindfulness therapy for caregivers of adults with cognitive impairment. Aging Ment Health 2022; 26:1963-1970. [PMID: 34428993 DOI: 10.1080/13607863.2021.1963949] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objectives: To examine the feasibility, acceptability, and preliminary efficacy of Mindfulness Coach, an mHealth Mindfulness Therapy intervention.Methods: We recruited 58 informal caregivers of older adults with cognitive impairment for this pilot feasibility trial. Participants completed measures of caregiver burden, stress, anxiety, and depression at baseline, 2 weeks, 4 weeks, and 8 weeks as well as acceptability and usability data at 8-weeks. The mobile app collected in-app use data including minutes spent using the app and number of unique visits to the app.Results: Users found the app acceptable to use and were satisfied with its design and usability. Over the course of the study period, depression, anxiety, caregiver burden and perceived stress improved. These outcome variables also improved more as caregivers spent more time using the Mindfulness Therapy mHealth intervention.Conclusions: Our results suggest that mHealth mindfulness therapy with caregivers of older adults with cognitive impairment is both feasible and acceptable to users, and that it successfully reduces psychological symptoms. Future work should focus on determining the appropriate doses of the mHealth therapy for particular outcomes and strategies to integrate it into routine care. Mindfulness Therapy delivered in an mHealth format may increase access to psychological treatment for caregivers.
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Affiliation(s)
- Elissa Kozlov
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Meghan McDarby
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St Louis, MO, USA
| | - Ian Pagano
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Danielle Llaneza
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Jason Owen
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Paul Duberstein
- School of Public Health, Rutgers University, Piscataway, NJ, USA
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Pech M, Gbessemehlan A, Dupuy L, Sauzéon H, Lafitte S, Bachelet P, Amieva H, Pérès K. Experimentation of the SoBeezy program in older adults during the COVID-19 pandemic: what lessons have we learned? (Preprint). JMIR Form Res 2022; 6:e39185. [DOI: 10.2196/39185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/08/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
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Todd E, Bidstrup B, Mutch A. Using information and communication technology learnings to alleviate social isolation for older people during periods of mandated isolation: A review. Australas J Ageing 2022; 41:e227-e239. [PMID: 35142013 PMCID: PMC9543732 DOI: 10.1111/ajag.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the effectiveness of information and communication technologies (ICTs) in reducing social isolation in older people and draw recommendations from previous literature appropriate for informing ICT use in future mandated periods of isolation. METHODS A systematically conducted review of key databases to identify studies investigating ICT interventions that targeted social isolation or loneliness among older people. RESULTS Fifteen articles were identified. All articles used ICT as an intervention for targeting social isolation with varying results. Most studies reported positive impacts on social isolation, but this was identified more in self-reporting compared to changes in baseline measures. The types of ICT used included videoconferencing, Internet-based applications and purpose-designed applications. A number of factors were also identified throughout the studies that impacted uptake that should be considered when implementing ICT. CONCLUSIONS Overall, we found evidence of ICT improving social connectedness of older people to some extent although more rigorous research in future is needed. Recommendations from previous literature highlight the importance of including older people in purposeful design, engaging families and support networks, and providing ongoing ICT training and support so that systems and skills are in place for future periods of mandated isolation. The literature also warns us not to rely on ICT as the only avenue for social interaction either during or outside periods of social distancing.
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Affiliation(s)
- Emily Todd
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Bronwyn Bidstrup
- Council on the Ageing (COTA) Queensland, Brisbane, Queensland, Australia
| | - Allyson Mutch
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
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Wan X, Lighthall NR, Paulson D. Subjective markers of successful aging and change in Internet use among older adults: The distinctive role of subjective health. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2021.107064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Zhang S, Boot WR, Charness N. Does Computer Use Improve Older Adults' Cognitive Functioning? Evidence From the Personal Reminder Information and Social Management Trial. THE GERONTOLOGIST 2021; 62:1063-1070. [PMID: 34940841 PMCID: PMC9372882 DOI: 10.1093/geront/gnab188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Numerous longitudinal studies suggest that technology use in late adulthood is associated with cognitive benefits. Using data from a randomized controlled trial, the current study examined whether computer use improves cognition in older adults with little to no previous computer experience. RESEARCH DESIGN AND METHODS This study used data from the Personal Reminder Information and Social Management (PRISM) trial. Community-dwelling older adults with little previous computer experience (MAge = 76.15) were randomly assigned to learn and use a computer (the PRISM system, n = 150) or interact with parallel content delivered in a nondigital format (paper binder, n = 150) for 12 months. Objective and subjective cognitive outcomes were measured before (pretest) and after the intervention (posttest). Latent change score models and Bayesian analysis of variances were used to examine cognitive change at the ability and individual measure level. RESULTS Computer training and use for 12 months did not lead to cognitive improvements at the ability level. Strong evidence against cognitive benefits at the individual measure level was also observed. DISCUSSION AND IMPLICATIONS Casual computer use does not provide enough cognitive stimulation to improve cognition in late adulthood. Cognitive benefits observed in longitudinal studies may be mediated by other factors or influenced by confounding variables.
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Affiliation(s)
- Shenghao Zhang
- Address correspondence to: Shenghao Zhang, PhD, Department of Psychology, Florida State University, 1107 W Call St., Tallahassee, FL 32306-4301, USA. E-mail:
| | - Walter R Boot
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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13
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Czaja SJ, Moxley JH, Rogers WA. Social Support, Isolation, Loneliness, and Health Among Older Adults in the PRISM Randomized Controlled Trial. Front Psychol 2021; 12:728658. [PMID: 34675843 PMCID: PMC8525598 DOI: 10.3389/fpsyg.2021.728658] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/03/2021] [Indexed: 12/20/2022] Open
Abstract
Objectives: Social isolation and loneliness are serious public health issues given the association with negative physical, mental; and cognitive health outcomes and increased risk for mortality. Due to changes in life circumstances many aging adults are socially isolated and experience loneliness. We examined the relationships among four correlated but distinct constructs: social network size, social support, social isolation, and loneliness as they relate to indices of health and wellbeing among diverse subpopulations of older adults. Guided by WHO's International Classification of Functioning, Disability and Health (ICF) we also examined factors that predict loneliness and social isolation. Methods: Analyses of baseline data from sample of older adults who participated in an intervention trial that examined the beneficial effects of a software system designed to support access to resources and information, and social connectivity. Participants included 300 individuals aged 65-98, who lived alone, were primarily of lower socio-economic status and ethnically diverse. Participants completed a demographics questionnaire, self-report measures of health, depression, social network size, social support, and loneliness. Results: Loneliness was strongly associated with depression and self-ratings of health. In turn, greater social isolation and less social support were associated with greater loneliness. Social isolation was associated with depression and lower self-ratings of health. The association between social isolation and health was mediated by loneliness. Individuals in the older cohorts (80+) reported less social support. With respect to loneliness, having a smaller social network, more functional limitations, and limitations in engaging meaningful activities was associated with higher levels of loneliness and greater social isolation. Conclusion: The findings underscore the importance of social connectively to wellbeing for older adults and suggest that those in the older cohorts, who have a small social network, and with greater physical and functional impairments may be particularly vulnerable to being socially isolated and lonely. The findings provide guidance for future interventions. In this regard, we discuss how Information and Communication Technologies (ICTs) may be used to promote social connectivity and engagement. Strategies to make the usability and availability of these applications for aging adults are highlighted.
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Affiliation(s)
- Sara J. Czaja
- Division of Geriatrics and Palliative Medicine, Center on Aging and Behavioral Research, Weill Cornell Medicine, New York, NY, United States
| | - Jerad H. Moxley
- Division of Geriatrics and Palliative Medicine, Center on Aging and Behavioral Research, Weill Cornell Medicine, New York, NY, United States
| | - Wendy A. Rogers
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL, United States
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Salehi A, Salehi E, Mosadeghi-Nik M, Sargeant S, Fatehi F. Strengthening positive social pathways via digital social applications in individuals with social skills deficits: A scoping review. Int J Soc Psychiatry 2021; 67:779-787. [PMID: 33076755 DOI: 10.1177/0020764020963354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Effective digital social capital interventions have great potential to establish trusted social pathways to access supportive services and to enable talking about issues contributing to distress. AIM This review explores the digital social capital interventions used in individuals with social skills deficits, and the best social health outcomes achieved. METHOD Four databases (PubMed, CINAHL, PsychINFO, and Web of Science) were used with no time limitation, and 33 papers were included. RESULTS A diverse range of digital social programs was used for social capital improvement based on individuals' characteristics (e.g. age range and illnesses). Programs ranged from digitally-enhanced self-help or self-guided treatment (to enhance the self-efficacy of individuals), to group treatments and/or web-based caregiver support services. They comprised mobile social apps, video blogging, video-communication system/video-conferencing, and online social communication, to more advanced techniques such as virtual reality. All of these modalities were shown to be beneficial for improving the social health of individuals. Interventions targeted two aspects of social capital: (1) cognitive social capital, focusing on enhancing trust and control, self-efficacy on life. Some examples were cognitive behavioural therapy, and increasing the received and more importantly perceived social support. (2) structural social capital, focusing on individuals' relationships with family/carers, friends, peers to other connections at the macro level, such as health care providers and their community as a whole. The two interconnected aspects of social capital play a role in decreasing fears of being judged by others, general fears in social interactions and interpersonal problems. CONCLUSION Guided digital social support interventions result in open and flexible access to various resources through supportive social networks, for patients and their family members/carers.
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Affiliation(s)
- Asiyeh Salehi
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Elham Salehi
- Department of Computer Engineering, Islamic Azad University, Shiraz, Iran
| | | | - Sally Sargeant
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Farhad Fatehi
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia.,School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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15
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Design and Usability Testing of the Stroke Caregiver Support System: A Mobile-Friendly Website to Reduce Stroke Caregiver Burden. Rehabil Nurs 2021; 45:166-177. [PMID: 30418319 DOI: 10.1097/rnj.0000000000000196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to design a mobile-friendly, Internet-based website, modeled on previously described websites for Alzheimer caregivers, to equip stroke caregivers and potentially reduce caregiver burden. DESIGN A mixed-methods study was performed to design and test the usability of the Stroke Caregiver Support System (SCSS). METHODS An iterative, user-centered design approach was employed in three phases: (I) Focus Groups, (II) Structured Interviews, and (III) Usability Testing. Phase I and Phase II provided information for the development of the SCSS website, whereas Phase III helped in gathering data regarding the usability and efficacy of the newly implemented SCSS website. FINDINGS Qualitative data on caregiving and the content and design of the SCSS were obtained from focus groups and interviews. In the usability test, the nine caregivers who completed Phase III (78% women, mean age = 46, SD = 17) exhibited a high level of burden and depressive symptoms (median [Q1, Q3] Zarit burden score = 18 [16, 23], Center of Epidemiologic Studies-Depression Scale = 15 [8, 17]). Caregivers conveyed the usability of the SCSS but also expressed several needed improvements. CONCLUSIONS Participants reported the value of the SCSS, but further refinements are needed to maximize its usability and potential efficacy. CLINICAL RELEVANCE The SCSS has potential to reduce caregiver burden in stroke.
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16
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Choi HK, Lee SH. Trends and Effectiveness of ICT Interventions for the Elderly to Reduce Loneliness: A Systematic Review. Healthcare (Basel) 2021; 9:293. [PMID: 33800099 PMCID: PMC8002106 DOI: 10.3390/healthcare9030293] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 01/22/2023] Open
Abstract
Elderly people are sensitive to loneliness, which may contribute to mental and physical health, serious illness, and increased mortality. This study investigates the development trend of information communication technology (ICT) interventions designed for the elderly to reduce loneliness and synthesize its effect. We searched relevant articles on 23 May 2020 using three databases: Ovid-Medline, Ovid-EMBASE, and the Cochrane library. Data extraction and quality assessment were independently performed by two authors. The development is changing from animal robots to online social platforms and from simple emotional support to a multifaceted system that promotes social participation, cognition, physical activity, and nutrition. Our systematic review reported that ICT interventions are being developed to alleviate loneliness and increase social participation. Our study revealed an increase in the use of ICT interventions among the elderly and a positive change in their attitude toward ICT interventions. ICT interventions in the field of nursing should continue to be developed in the future to meet social, health, and safety needs. In the context of coronavirus disease 2019 (COVID-19), ICT interventions are needed to respond effectively to the needs of the elderly. This study is expected to provide basic knowledge for the development of ICT interventions for the elderly.
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Affiliation(s)
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 21936, Korea;
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17
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Grossman LV, Masterson Creber RM, Benda NC, Wright D, Vawdrey DK, Ancker JS. Interventions to increase patient portal use in vulnerable populations: a systematic review. J Am Med Inform Assoc 2021; 26:855-870. [PMID: 30958532 DOI: 10.1093/jamia/ocz023] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND More than 100 studies document disparities in patient portal use among vulnerable populations. Developing and testing strategies to reduce disparities in use is essential to ensure portals benefit all populations. OBJECTIVE To systematically review the impact of interventions designed to: (1) increase portal use or predictors of use in vulnerable patient populations, or (2) reduce disparities in use. MATERIALS AND METHODS A librarian searched Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews for studies published before September 1, 2018. Two reviewers independently selected English-language research articles that evaluated any interventions designed to impact an eligible outcome. One reviewer extracted data and categorized interventions, then another assessed accuracy. Two reviewers independently assessed risk of bias. RESULTS Out of 18 included studies, 15 (83%) assessed an intervention's impact on portal use, 7 (39%) on predictors of use, and 1 (6%) on disparities in use. Most interventions studied focused on the individual (13 out of 26, 50%), as opposed to facilitating conditions, such as the tool, task, environment, or organization (SEIPS model). Twelve studies (67%) reported a statistically significant increase in portal use or predictors of use, or reduced disparities. Five studies (28%) had high or unclear risk of bias. CONCLUSION Individually focused interventions have the most evidence for increasing portal use in vulnerable populations. Interventions affecting other system elements (tool, task, environment, organization) have not been sufficiently studied to draw conclusions. Given the well-established evidence for disparities in use and the limited research on effective interventions, research should move beyond identifying disparities to systematically addressing them at multiple levels.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | - Natalie C Benda
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Drew Wright
- Samuel J Wood Library, Information Technologies and Services, Weill Cornell Medicine, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Value Institute, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jessica S Ancker
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
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18
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Abstract
Objectives: The purpose of this study was to assess (1) the trends of and (2) the factors associated with health information technology (HIT) use among older adults in the U.S.Methods: A decade (2009-2018) of data from the U.S. National Health Interview Survey (NHIS) was used. The trends of HIT use among older adults (aged 65 over) were reported and compared to younger adults (aged 18-64) using weighted percentages adjusted by NHIS complex sampling design. HIT use, which was assessed with five questions asking whether respondents used the internet to (1) look up health information, (2) use chat groups to learn about health topics, (3) fill a prescription, (4) schedule medical appointments, and (5) communicate with health care providers by email. Andersen's Behavioral Model of Health Services Use was used to select and categorize the covariates. Multivariable logistic regression models were conducted to identify the predictors of HIT use.Results: The prevalence of HIT use significantly increased from 9.3 million (24.8% of the 37.3 million older adults) in 2009 to 22.3 million (43.9% of the 50.9 million older adults) in 2018 (p < .01). Among U.S. older adults, young-older, white females, higher education, higher income, insurance coverage, and good health status were more likely to report HIT use.Conclusions: This study found an increasing trend of HIT use among older adults in the U.S. from 2009 to 2018. Healthcare providers should be conscious of older adults' increased HIT use patterns and guide them to proper health management.
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Affiliation(s)
- Li-Yu Hung
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Jennifer G Lyons
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim HealthCare Institute, Boston, MA, USA
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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19
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Yoon JS, Charness N, Boot WR, Czaja SJ, Rogers WA. Depressive Symptoms as a Predictor of Memory Complaints in the PRISM Sample. J Gerontol B Psychol Sci Soc Sci 2019; 74:254-263. [PMID: 28575476 DOI: 10.1093/geronb/gbx070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/12/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives The current study investigated baseline and longitudinal relationships between memory complaints, depressive symptoms, and cognition in older adults. Method Using the sample from the Personal Reminder Information and Social Management trial, we generated path models predicting self-rated memory complaints measured by the Memory Functioning Questionnaire (MFQ). Results Our baseline models showed that more depressive symptoms were associated with reporting more frequent forgetting incidents and a greater decline in memory function. The baseline models also revealed that higher scores in a latent cognitive function were associated with reporting a greater decline in memory functioning and a greater use of mnemonics. However, cognitive predictors did not mediate the baseline associations between the MFQ measures and depressive symptoms. Further, these predictors were not able to directly predict the 12-month MFQ measures over and above the baseline effects. Including personality traits (neuroticism and conscientiousness) did not significantly affect the models. Discussion Our results suggest that memory complaints about frequency of forgetting can be the most reliable indicator of depression risk among the four factors in the MFQ. We discuss theoretical implications for longitudinal relationships between memory complaints, depressive symptoms, and cognitive function in older adults.
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Affiliation(s)
- Jong-Sung Yoon
- Department of Psychology, Florida State University, Tallahassee
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee
| | - Walter R Boot
- Department of Psychology, Florida State University, Tallahassee
| | - Sara J Czaja
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Florida
| | - Wendy A Rogers
- School of Psychology, Georgia Institute of Technology, Atlanta
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Sharit J, Moxley JH, Boot WR, Charness N, Rogers WA, Czaja SJ. Effects of Extended Use of an Age-friendly Computer System on Assessments of Computer Proficiency, Attitudes, and Usability by Older Non--Computer Users. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2019. [DOI: 10.1145/3325290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the impact of use of a computer software application designed specifically for older people known as PRISM—a Personal Reminder Information and Social Management system—which was installed on a computer that was placed in the homes of adults aged 65 to 98 years, who were at risk for social isolation and had minimal or no computer skills and no computers in their homes. Participants received face-to-face training on the system in their homes over several days and a variety of measures were collected at baseline and at 12 months. A growth mixture model applied to participants’ usage of the system over the course of 12 months revealed two distinct subpopulations of users—less-frequent users and more-frequent users—who after one year of exposure to the system differed in computer proficiency, attitudes toward computers, and ratings of system usability. These two groups did not differ on computer proficiency and computer attitude measures at baseline. The more-frequent user group, however, had significantly higher fluid cognitive abilities. Additional analytical models were used to further examine the relationships among the study measures. The implications of the findings are discussed in terms of the importance of usability for promoting initial engagement with a system and that increased engagement with the system can instill beliefs in these older adults that they can successfully transition to other computer-based technologies and applications. The results also underscore the importance of the user-centered design approach and designing highly usable systems for older adults with low technology proficiency.
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21
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Mitzner TL, Savla J, Boot WR, Sharit J, Charness N, Czaja SJ, Rogers WA. Technology Adoption by Older Adults: Findings From the PRISM Trial. THE GERONTOLOGIST 2019; 59:34-44. [PMID: 30265294 PMCID: PMC6326254 DOI: 10.1093/geront/gny113] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives There is growing evidence of the benefits of computers for older adults. Yet, adoption rates are lower compared with younger adults. Extant theoretical models of technology acceptance are limited in their application to older adults-studies on which these models are based included a limited sample of older adults or none at all; none assessed use of a technology specifically designed for older adults; and most only measured intention to use a technology or short-term use, rather than longer-term use (i.e., adoption). We assessed adoption of a computer system specifically designed for older users, for a diverse sample, over an extended period of time. Research Design and Methods We analyzed archival data from 150 ethnically diverse older adults (65-98 years of age) who participated in the Personal Reminder Information and Social Management (PRISM) randomized controlled trial (Czaja SJ, Boot WR, Charness N, Rogers WA, Sharit J, Fisk AD,…Nair SN. The personalized reminder information and social management system (PRISM) trial: Rationale, methods and baseline characteristics. Contemp Clin Trials. 2015;40:35-46; Czaja SJ, Boot WR, Charness N, Rogers WA, Sharit J. Improving social support for older adults through technology: Findings from the PRISM randomized controlled trial. Gerontologist. 2017;58:467-477). We examined the extent to which attitudes, personal characteristics (e.g., age, gender, and personality), and cognitive abilities predicted mid-term and long-term adoption of a computer system designed for older adults. Results There were individual differences in PRISM use over time. Regression analyses indicated that individual differences in earlier use of the system, executive functioning, and computer efficacy predicted long-term use. Discussion and Implications These data provide insights for broader-based models of technology acceptance to guide design, instruction, and deployment of products for older adults. Specifically, the provision of opportunities to foster efficacy and gain positive experience with computer technologies may play a critical role in the likelihood that older adults adopt such technologies. Trial Registration NCT01497613.
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Affiliation(s)
- Tracy L Mitzner
- Center for Assistive Technology and Environmental Access, Georgia Institute of Technology, Atlanta
| | - Jyoti Savla
- Department of Human Development, Center for Gerontology, Virginia Polytechnic Institute and State University, Blacksburg
| | - Walter R Boot
- Department of Psychology, Florida State University, Tallahassee
| | - Joseph Sharit
- Department of Industrial Engineering, University of Miami, Coral Gables, Florida
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee
| | - Sara J Czaja
- Center on Aging and Behavioral Research, Division of Geriatrics and Palliative Care, Weill Cornell Medicine, New York
| | - Wendy A Rogers
- College of Applied Health Sciences, University of Illinois at Urbana–Champaign, Champaign, Illinois
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Lee CC, Czaja SJ, Moxley JH, Sharit J, Boot WR, Charness N, Rogers WA. Attitudes Toward Computers Across Adulthood From 1994 to 2013. THE GERONTOLOGIST 2019; 59:22-33. [PMID: 29982458 PMCID: PMC6326256 DOI: 10.1093/geront/gny081] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Regardless of the increased deployment of technologies in everyday living domains, barriers remain that hamper technology adoption by older adults. Understanding barriers to adoption such as individual differences in attitudes toward computers is important to the design of strategies to reduce age-related digital disparities. Research Design and Methods This article reports a time-sequential analysis of data from the Edward R. Roybal Center on Human Factors and Aging Research and the Center for Research and Education on Aging and Technology Enhancement (CREATE) on computer attitudes among a large (N = 3,917), diverse sample of community-dwelling adults aged from 18 to 98 years. The data were gathered from 1994 to 2013. Results The findings indicated that there are still age disparities in attitudes; older adults report less comfort with and less efficacy about using computers than younger people. We also found a cohort (birth year) effect; attitudes are generally more positive among more recent birth cohorts. Those who have more education and experience with computers also have more positive attitudes. Males generally have more positive attitudes than females; however, the gender difference decreases with increased age. Discussion and Implications Technology affords potential benefits for older people, but lack of uptake in technology clearly puts older adults at a disadvantage in terms of negotiating today's digital world. This article provides insight into attitudinal barriers that may affect on technology uptake among older adults. The findings have implications for the design of technology training programs, design of technology systems, and policy.
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Affiliation(s)
- Chin Chin Lee
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Florida
| | - Sara J Czaja
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York
| | - Jerad H Moxley
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York
| | - Joseph Sharit
- Department of Industrial Engineering, University of Miami, Florida
| | - Walter R Boot
- Department of Psychology, Florida State University, Florida
| | - Neil Charness
- Department of Psychology, Florida State University, Florida
| | - Wendy A Rogers
- Applied Health Sciences, University of Illinois Urbana—Champaign, Illinois
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Czaja SJ, Boot WR, Charness N, Rogers WA, Sharit J. Improving Social Support for Older Adults Through Technology: Findings From the PRISM Randomized Controlled Trial. THE GERONTOLOGIST 2019; 58:467-477. [PMID: 28201730 DOI: 10.1093/geront/gnw249] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 12/14/2016] [Indexed: 12/20/2022] Open
Abstract
Objectives Information and communication technology holds promise in terms of providing support and reducing isolation among older adults. We evaluated the impact of a specially designed computer system for older adults, the Personal Reminder Information and Social Management (PRISM) system. Design, Setting, and Participants The trial was a multisite randomized field trial conducted at 3 sites. PRISM was compared to a Binder condition wherein participants received a notebook that contained paper content similar to that contained in PRISM. The sample included 300 older adults at risk for social isolation who lived independently in the community (Mage = 76.15 years). Primary outcome measures included indices of social isolation, social support, loneliness, and well-being. Secondary outcome measures included indices of computer proficiency and attitudes toward technology. Data were collected at baseline and at 6 and 12 months post-randomization. Results The PRISM group reported significantly less loneliness and increased perceived social support and well-being at 6 months. There was a trend indicating a decline in social isolation. Group differences were not maintained at 12 months, but those in the PRISM condition still showed improvements from baseline. There was also an increase in computer self-efficacy, proficiency, and comfort with computers for PRISM participants at 6 and 12 months. Discussion The findings suggest that access to technology applications such as PRISM may enhance social connectivity and reduce loneliness among older adults and has the potential to change attitudes toward technology and increase technology self-efficacy.
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Affiliation(s)
- Sara J Czaja
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Florida
| | - Walter R Boot
- Department of Psychology, Florida State University, Tallahassee
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee
| | - Wendy A Rogers
- School of Psychology, Georgia Institute of Technology, Atlanta
| | - Joseph Sharit
- Department of Industrial Engineering, University of Miami, Coral Gables, Florida
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Baker S, Warburton J, Waycott J, Batchelor F, Hoang T, Dow B, Ozanne E, Vetere F. Combatting social isolation and increasing social participation of older adults through the use of technology: A systematic review of existing evidence. Australas J Ageing 2018; 37:184-193. [PMID: 30022583 DOI: 10.1111/ajag.12572] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES There are growing concerns that social isolation presents risks to older people's health and well-being. Thus, the objective of the review was to explore how technology is currently being utilised to combat social isolation and increase social participation, hence improving social outcomes for older people. METHODS A systematic review of the literature was conducted across the social science and human-computer interaction databases. RESULTS A total of 36 papers met the inclusion criteria and were analysed using a four-step process. Findings were threefold, suggesting that: (i) technologies principally utilised social network services and touch-screen technologies; (ii) social outcomes are often ill-defined or not defined at all; and (iii) methodologies used to evaluate interventions were often limited and small-scale. CONCLUSION Results suggest a need for studies that examine new and innovative forms of technology, evaluated with rigorous methodologies, and drawing on clear definitions about how these technologies address social isolation/participation.
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Affiliation(s)
- Steven Baker
- Microsoft Research Centre for Social Natural User Interfaces, School of Computing and Information Systems, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeni Warburton
- John Richards Initiative, College of Science, Health and Engineering, La Trobe University, Wodonga, Victoria, Australia
| | - Jenny Waycott
- School of Computing and Information Systems, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Thuong Hoang
- Microsoft Research Centre for Social Natural User Interfaces, School of Computing and Information Systems, University of Melbourne, Melbourne, Victoria, Australia.,School of Information Technology, Deakin University, Melbourne, Victoria, Australia
| | - Briony Dow
- National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Elizabeth Ozanne
- Department of Social Work, School of Health Sciences, Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Frank Vetere
- Microsoft Research Centre for Social Natural User Interfaces, School of Computing and Information Systems, University of Melbourne, Melbourne, Victoria, Australia
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Boot WR, Moxley JH, Roque NA, Andringa R, Charness N, Czaja SJ, Sharit J, Mitzner T, Lee CC, Rogers WA. Exploring Older Adults' Video Game Use in the PRISM Computer System. Innov Aging 2018; 2:igy009. [PMID: 30480133 PMCID: PMC6177054 DOI: 10.1093/geroni/igy009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background and Objective As part of the PRISM (Personal Reminder Information & Social Management) randomized field trial, a large group of older adults (N = 150) received a computer system in their home that presented them with the opportunity to play eleven different video games. While researchers have often assessed older adults’ gaming preferences and habits through survey data and focus groups, this trial represented a unique opportunity to study gaming behavior “in the wild” over an entire year. Research Design and Methods We present an exploration of game usage data, individual differences in game preferences and gaming habits, and individual difference predictors of game use. Results Although few individual difference variables consistently predicted game use and preferences, there were clear favorites among the different games, and results demonstrate that given the opportunity and training many older adults may become active and long-term gamers. Discussion and Implications Findings have implications for designing video games that older adults enjoy, supporting enjoyable and meaningful interactions with video games across the life span, and for designing cognitive, social, and health interventions involving games.
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Affiliation(s)
- Walter R Boot
- Department of Psychology, Florida State University, Tallahassee
| | | | - Nelson A Roque
- Department of Psychology, Florida State University, Tallahassee
| | - Ronald Andringa
- Department of Psychology, Florida State University, Tallahassee
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee
| | | | - Joseph Sharit
- Department of Industrial Engineering, University of Miami, Florida
| | - Tracy Mitzner
- School of Psychology, Georgia Institute of Technology, Atlanta
| | | | - Wendy A Rogers
- Kinesiology & Community Health, University of Illinois at Urbana-Champaign
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Roque NA, Boot WR. A New Tool for Assessing Mobile Device Proficiency in Older Adults: The Mobile Device Proficiency Questionnaire. J Appl Gerontol 2018; 37:131-156. [PMID: 27255686 PMCID: PMC9394541 DOI: 10.1177/0733464816642582] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Mobile device proficiency is increasingly required to participate in society. Unfortunately, there still exists a digital divide between younger and older adults, especially with respect to mobile devices (i.e., tablet computers and smartphones). Training is an important goal to ensure that older adults can reap the benefits of these devices. However, efficient/effective training depends on the ability to gauge current proficiency levels. We developed a new scale to accurately assess the mobile device proficiency of older adults: the Mobile Device Proficiency Questionnaire (MDPQ). We present and validate the MDPQ and a short 16-question version of the MDPQ (MDPQ-16). The MDPQ, its subscales, and the MDPQ-16 were found to be highly reliable and valid measures of mobile device proficiency in a large sample. We conclude that the MDPQ and MDPQ-16 may serve as useful tools for facilitating mobile device training of older adults and measuring mobile device proficiency for research purposes.
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Hong YA, Cho J. Has the Digital Health Divide Widened? Trends of Health-Related Internet Use Among Older Adults From 2003 to 2011. J Gerontol B Psychol Sci Soc Sci 2017; 72:856-863. [PMID: 27558403 DOI: 10.1093/geronb/gbw100] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 07/21/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives To examine the trend of health-related Internet use (HRIU) among older adults. Methods We analyzed data from the 2003, 2005, and 2011-2012 iterations of the National Cancer Institute (NCI)-sponsored Health Information National Trends Survey (HINTS). HRIU was measured by 4 online behaviors: seeking health information, buying medicine, connecting with people with similar health problems, and communicating with doctors. Results Internet use and HRIU among older adults increased substantially from 2003 to 2011 with more significant increases in seeking health information and communicating with doctors online. Overall, the digital health divide between different demographic groups has narrowed, especially in terms of gender, racial/ethnic group, rural/urban residence, and various health statuses; however, age, education, and household income remain persistent predictors of the digital divide. Those in the oldest group (75 or older), those with less than a high school education, and those with very low income (<$25,000/year) continuously lagged behind their counterparts in all aspects of HRIU. Conclusions Despite an overall increase in HRIU and a narrowed digital divide, significant variations in HRIU in different demographic groups persisted; therefore, we call for more senior-friendly online resources and culturally appropriate interventions to bridge the digital health divide for vulnerable older adults.
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Affiliation(s)
- Y Alicia Hong
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station
| | - Jinmyoung Cho
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station.,Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas
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Mitzner TL, Rogers WA, Fisk AD, Boot WR, Charness N, Czaja SJ, Sharit J. Predicting Older Adults' Perceptions about a Computer System Designed for Seniors. UNIVERSAL ACCESS IN THE INFORMATION SOCIETY 2016; 15:271-280. [PMID: 31186624 PMCID: PMC6557454 DOI: 10.1007/s10209-014-0383-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Although computer technology may be particularly useful for older adults (e.g., for communication, information access), they have been slower adopters than their younger counterparts. Perceptions about computers such as perceived usefulness and perceived ease of use can pose barriers to acceptance and universal access [1]. Therefore, understanding the precursors to these perceptions for older adult non-computer users may provide insight into the reasons for their non-adoption. METHODS We examined the relationship between perceived usefulness and perceived ease of use of a computer interface designed for older users and demographic, technology experience, cognitive abilities, personality, and attitudinal variables in a sample of 300 non-computer using adults between the ages of 64 and 98, selected for being at high risk for social isolation. RESULTS The strongest correlates of perceived usefulness and perceived ease of use were: technology experience, personality dimensions of agreeableness and openness to experience, and attitudes. The emotional stability personality dimension was significantly correlated with perceived ease of use but not perceived usefulness. Hierarchical regression analysis revealed that attitudes (i.e., self-efficacy, comfort, interest) remained predictive of perceptions of usefulness and ease of use when technology experience and personality variables were accounted for. CONCLUSION Given that attitudes are more malleable than other variables, such as demographic and cognitive abilities, these findings highlight the potential to increase technology acceptance through positive experiences, appropriate training, and educational campaigns about the benefits of computers and other technologies.
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Affiliation(s)
- Tracy L. Mitzner
- School of Psychology, Georgia Institute of Technology, Atlanta, GA 30332-0170
| | - Wendy A. Rogers
- School of Psychology, Georgia Institute of Technology, Atlanta, GA 30332-0170
| | - Arthur D. Fisk
- School of Psychology, Georgia Institute of Technology, Atlanta, GA 30332-0170
| | - Walter R. Boot
- Psychology Department, Florida State University, Tallahassee, FL 32306-4301
| | - Neil Charness
- Psychology Department, Florida State University, Tallahassee, FL 32306-4301
| | - Sara J. Czaja
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Joseph Sharit
- Department of Industrial Engineering, University of Miami, Coral Gables, FL 33124-0623
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Mitzner TL, Charness N, Rogers WA. Perceptions of Computer System Usefulness: Insights for Design from Experienced Older Users. HUMAN ASPECTS OF IT FOR THE AGED POPULATION : DESIGN FOR AGING : FIRST INTERNATIONAL CONFERENCE, ITAP 2015, HELD AS PART OF HCI INTERNATIONAL 2015, LOS ANGELES, CA, USA, AUGUST 2-7, 2015. PROCEEDINGS. PART I. ITAP (CONFERENCE) (1ST : 20... 2015; 9193:262-272. [PMID: 31168523 PMCID: PMC6545904 DOI: 10.1007/978-3-319-20892-3_26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Computer systems have the potential to assist older adults by supporting independence, enhancing social communication, and enabling healthcare activities. Yet older adults' adoption rates continue to lag behind younger and middle-aged adults. We report data from 249 older adult computer users (65-93 years of age) that identify the details of their perceptions of computer usefulness for a range of everyday activities. Participants rated the importance of activities to their quality of life and the usefulness of current computer systems for supporting those activities. These experienced computer users indicated that computers were meeting their needs for some activities (e.g., social communication, games) but not for other activities (e.g., calendaring, healthcare, recreation and learning). Our data provide guidance for (a) introducing the potential of computer systems to current non-users and (b) designing systems targeted to meet the needs of older adults and enhancing computing functionality for them.
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Czaja SJ, Boot WR, Charness N, A Rogers W, Sharit J, Fisk AD, Lee CC, Nair SN. The personalized reminder information and social management system (PRISM) trial: rationale, methods and baseline characteristics. Contemp Clin Trials 2014; 40:35-46. [PMID: 25460342 DOI: 10.1016/j.cct.2014.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/28/2014] [Accepted: 11/01/2014] [Indexed: 12/20/2022]
Abstract
Technology holds promise in terms of providing support to older adults. To date, there have been limited robust systematic efforts to evaluate the psychosocial benefits of technology for older people and identify factors that influence both the usability and uptake of technology systems. In response to these issues, we developed the Personal Reminder Information and Social Management System (PRISM), a software application designed for older adults to support social connectivity, memory, knowledge about topics, leisure activities and access to resources. This trail is evaluating the impact of access to the PRISM system on outcomes such as social isolation, social support and connectivity. This paper reports on the approach used to design the PRISM system, study design, methodology and baseline data for the trial. The trial is multi-site randomized field trial. PRISM is being compared to a Binder condition where participants received a binder that contained content similar to that found on PRISM. The sample includes 300 older adults, aged 65-98 years, who lived alone and at risk for being isolated. The primary outcome measures for the trial include indices of social isolation and support and well-being. Secondary outcomes measures include indices of computer proficiency, technology uptake and attitudes towards technology. Follow-up assessments occurred at 6 and 12 months post-randomization. The results of this study will yield important information about the potential value of technology for older adults. The study also demonstrates how a user-centered iterative design approach can be incorporated into the design and evaluation of an intervention protocol.
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Affiliation(s)
- Sara J Czaja
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Walter R Boot
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Wendy A Rogers
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Joseph Sharit
- Department of Industrial Engineering, University of Miami, Coral Gables, FL, USA
| | - Arthur D Fisk
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Chin Chin Lee
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sankaran N Nair
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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