Smart eldercare in Singapore: Negotiating agency and apathy at the margins

Systematic scoping review of ageing in place strategies in Japan, Singapore and Thailand: A comparative analysis

OBJECTIVE

Given the differing cultural contexts and service needs of older persons in the west and the east, programs or policies should be thoughtfully redesigned to accommodate these diverse societies. This paper presents a systematic scoping review of ageing in place (AIP) strategies in Japan, Singapore and Thailand, emphasising how they are tailored to address the unique challenges of ageing populations in Asia.

METHODS

A systematic literature search was conducted through seven databases. Empirical, peer-reviewed studies in English that discussed AIP-related programs or policies involving aged populations in the target countries were included. Themes were identified using the policy triangle framework, allowing for a comprehensive comparison of AIP across the countries.

RESULTS

Three key components of AIP, place, support network and workforce, were identified from 44 included studies. Each country exhibits distinctive approaches to implementing these components. Japan has extensive AIP systems with comprehensive services and strong community and family support. Singapore offers innovative aged care with significant government involvement, though on a smaller scale. Thailand's localised initiatives focus on community health care and age-friendly city assessments, with a less developed AIP infrastructure.

CONCLUSIONS

The study proposes a comprehensive framework for developing ageing policies in Asia, emphasising the need for a person-centred approach in developing AIP strategies that cater to the diverse needs of ageing populations, and underscores the importance of integrating health-care services, community support and home environment modifications. The three AIP elements advocate for a person-centred approach, providing valuable insights for policymakers to effectively manage challenges of rapidly ageing populations.

Factors influencing older adults' acceptance of voice assistants

Introduction

Voice assistants (VAs) have the potential to uphold and enhance the quality of life for older adults. However, the extent to which older adults accept and benefit from VAs may be relatively modest.

Methods

This study developed a comprehensive model combined with product and personal characteristics to explain the acceptance of VAs among older adults, using semi-structured interviews (Study 1) and questionnaires (Study 2).

Results

Results revealed that in terms of product characteristics, perceived usefulness and perceived enjoyment significantly affect behavior intention. Regarding personal characteristics of older adults, technological self-efficacy and dispositional resistance to change significantly affect behavior intention. However, no direct impact of perceived ease of use and perceived trust on behavior intention. Additionally, perceived enjoyment influenced both perceived ease of use and perceived usefulness.

Discussion

Results suggested the significant role of technology self-efficacy and dispositional resistance to change in predicting the acceptance of VAs among older adults. Our newly developed model offers valuable insights for tailoring VAs to this demographic during design and implementation.

Barriers to clinical nurse participation in the internet-based home visiting program: a qualitative study

BACKGROUND

Home visits are an important part of home care. With increasing demand and the rapid development of information technology, an increasing number of regions are experimenting with the use of information technology in home visits, hoping to meet the needs of more patients through technological interventions. However, most of the current studies have focused on patient health improvement through home visits, neglecting to consider the actual experience of nurses as service providers in participating in Internet-based programs. Thus, the purpose of this research is to explore what is holding nurses back from participating after the Internet has been added to traditional home visiting programs.

METHODS

This research was designed with an exploratory-descriptive qualitative analysis method. Semistructured interviews were used to collect information on barriers to nurses' participation in the Internet-based home visiting program. Participants included 16 clinical nurses working in various hospitals in Nanjing, China. The thematic analysis method was used to analyze the information.

RESULTS

This research identified three themes and twelve subthemes that hinder clinical nurse engagement in the Internet-based home visiting program. The three themes included multiple barriers to individuals, different service modes, and emerging organizational problems.

CONCLUSIONS

As a new form of traditional home visiting program in information society, Internet-based home visiting has many shortcomings in the overall program design and service management specifications. For more patients living at home to receive quality care services, it is necessary to take more effective measures to encourage nurses' participation at three levels: nurse demand, service process, and organizational management.

Long-Term Adoption or Abandonment of Smart Technology in the Chinese Elderly Home Care Environment: A Qualitative Research Study

China's rapidly aging population and shortage of care resources have made it difficult for its traditional model to meet the home care needs of the elderly. On this premise, China is implementing home digital health interventions based on smart technology. During implementation, instead of the expected explosion in long-term adoption, there has been a large amount of abandonment. But so far, the relationship between service experience and these behaviors has been ignored. This study aims to explore the reasons for the long-term adoption or abandonment behaviors of technology by elders in the home care environment. A qualitative study was conducted based on Golant's framework of smart technology adoption behaviors among elders. Semi-structured interviews were conducted with 26 elders who are long-term or former users of smart technology in a home care environment, and data from the interviews were analyzed using directed content analysis. This study identified three themes that influence elders' adoption behaviors of smart technology in the home care environment, including immediate effectiveness, long-term usability, and possible collateral damage. The findings indicated that the experience of the elders is the key point that affects long-term adoption behavior. For more elders to use smart technology in the home care environment, it is necessary for the government, technology developers, and nursing institutions to further reform the existing system.

The development of smart eldercare in China

Background

Many countries have tried to establish an optimal model for managing population aging that can be replicated and promoted. With the increasing societal task of delivering care to older adults with chronic conditions, China has started to harness the power of digital technologies to help address the growing demands for eldercare. China is exploring a unique "Smart Eldercare" model to respond to the social service needs of older adults.

Methods

Using a Delphi method, this study highlights a hierachy of approaches and findings from a cognitive support tool for those with mild cognitive impairment.

Findings

From the central committee to local governments, the Chinese government has developed policies aimed at supporting the development of the Smart Eldercare service industry.

Interpretation

This viewpoint article sheds light on this development in health care services based on an onsite research investigation, which can potentially impact the Western Pacific region and beyond in years to come.

Funding

The Non-profit Central Research Institute Fund of the Chinese Academy of Medical Sciences, Grant No. 2021-JKCS-026.

Understanding people's intention to use facial recognition services: the roles of network externality and privacy cynicism

Purpose

Based on the cognition–affect–conation pattern, this study explores the factors that affect the intention to use facial recognition services (FRS). The study adopts the driving factor perspective to examine how network externalities influence FRS use intention through the mediating role of satisfaction and the barrier factor perspective to analyze how perceived privacy risk affects FRS use intention through the mediating role of privacy cynicism.

Design/methodology/approach

The data collected from 478 Chinese FRS users are analyzed via partial least squares-based structural equation modeling (PLS-SEM).

Findings

The study produces the following results. (1) FRS use intention is motivated directly by the positive affective factor of satisfaction and the negative affective factor of privacy cynicism. (2) Satisfaction is affected by cognitive factors related to network externalities. Perceived complementarity and perceived compatibility, two indirect network externalities, positively affect satisfaction, whereas perceived critical mass, a direct network externality, does not significantly affect satisfaction. In addition, perceived privacy risk generates privacy cynicism. (3) Resistance to change positively moderates the relationship between privacy cynicism and intention to use FRS.

Originality/value

This study extends knowledge on people's use of FRS by exploring affect- and cognitive-based factors and finding that the affect-based factors (satisfaction and privacy cynicism) play fully mediating roles in the relationship between the cognitive-based factors and use intention. This study also expands the cognitive boundaries of FRS use by exploring the functional condition between affect-based factors and use intention, that is, the moderating role of resistance to use.

Eldercare's Turnover Intention and Human Resource Approach: A Systematic Review

Eldercare workers' turnover intentions have caused serious concern given their high demand and pivotal role in ensuring elderly individuals' well-being. This systematic review examined the main factors of eldercare employees' turnover intentions with the purpose of identifying gaps and structure a novel human resource (HR) approach framework for eldercare social enterprises through a global literature review and realistic conclusions. A total of 29 publications appeared between 2015 and 2021 were digitally extracted from six databases and are extensively discussed in this review. Resultantly, eldercare workers' turnover intentions were positively impacted by job burnout, low job motivation, and restricted job autonomy. The findings of this study correspond to those of past literature, which highlighted the necessity of thoroughly examining eldercare worker retention practices from an organisational (HR) perspective. Furthermore, the current study outlines the factors influencing eldercare workers' turnover intentions as well as determine proper HR approaches to mitigate employee turnover issues among eldercare workers for organisational sustainability.

Perspectives on the popularization of smart senior care to meet the demands of older adults living alone in communities of Southwest China: A qualitative study

Background

Older adults who live alone face challenges in daily life and in maintaining their health status quo. Currently, however, their growing demands cannot be satisfied with high quality; therefore, these demands expressed by elders may be settled in the form of smart senior care. Hence, the improvement in smart senior care may produce more positive meanings in promoting the health and sense of happiness among this elderly population. This study aimed to explore the perceptions of demands and satisfaction with regard to the provision of senior care services to the community-dwelling older adults who live alone in Southwest China, thus providing a reference for the popularization of smart senior care.

Methods

This study adopted a qualitative descriptive approach on demands and the popularization of smart senior care. Semi-structured and in-depth individual interviews were conducted with 15 community-dwelling older adults who lived alone in Southwest China between March and May 2021. Thematic analysis was applied to analyze the data.

Results

Through data analysis, three major themes and subcategories were generated: "necessities" (contradiction: more meticulous daily life care and higher psychological needs vs. the current lower satisfaction status quo; conflict: higher demands for medical and emergency care against less access at present), "feasibility" (objectively feasible: the popularization of smart devices and applications; subjectively feasible: interests in obtaining health information), and "existing obstacles" (insufficient publicity; technophobia; patterned living habits; and concerns).

Conclusions

Smart senior care may resolve the contradiction that prevails between the shortage of medical resources and the increasing demands for eldercare. Despite several obstacles that stand in the way of the popularization of smart senior care, the necessities and feasibility lay the preliminary foundation for its development and popularization. Decision-makers, communities, developers, and providers should cooperate to make smart senior care more popular and available to seniors living alone, facilitating independence while realizing aging in place by promoting healthy aging.

Digital Engagement of Older Adults: Scoping Review

BACKGROUND

Digital technologies facilitate everyday life, social connectedness, aging at home, well-being, and dignified care. However, older adults are disproportionately excluded from these benefits. Equal digital opportunities, access, and meaningful engagement require an understanding of older adults' experience across different stages of the technological engagement life cycle from nonuse and initial adoption to sustained use, factors influencing their decisions, and how the experience changes over time.

OBJECTIVE

Our objectives were to identify the extent and breadth of existing literature on older adults' perspective on digital engagement and summarize the barriers to and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement.

METHODS

We used the Arksey and O'Malley framework for the scoping review process. We searched MEDLINE, PsycINFO, CINAHL, Web of Science, and ACM digital library for primary studies published between 2005 and 2021. The inclusion and exclusion criteria were developed based on the Joanna Briggs Institute (participants, content, and context) framework. Studies that investigated the digital engagement experience as well as barriers to and facilitators of older adults' digital technology engagement were included. The characteristics of the study, types of digital technology, and digital engagement levels were analyzed descriptively. Content analysis was used to generate tentative elements using a congruent theme, and barriers and facilitators were mapped over the capability, opportunity, and motivation behavior change model (COM-B) and the theoretical domain framework. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews).

RESULTS

In total, 96 publications were eligible for the final charting and synthesis. Most of the studies were published over the past 5 years, investigated the initial adoption stage of digital engagement, and focused on everyday technologies. The most cited barriers and facilitators across the engagement stages from each COM-B component were capability (eg, physical and psychological changes and lack of skill), opportunity (eg, technological features, environmental context, and resources), and motivation (eg, optimism from perceived usefulness and beliefs about capability).

CONCLUSIONS

The COM-B model and theoretical domain framework provide a guide for identifying multiple and intertwined barriers and facilitators at each stage of digital engagement. There are limited studies looking into the whole spectrum of older adults' digital technology experience; in particular, studies on technological nonuse and sustained use stages are rare. Future research and practice should focus on tailored interventions accounting for the barriers to older adults' digital engagement and addressing capabilities, motivation, and opportunities; affordable, usable, and useful digital technologies, which address the changes and capability requirements of older adults and are cocreated with a value framework; and lifelong learning and empowerment to develop older adults' knowledge and skills to cope with digital technology development.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/25616.

An Integrated mHealth Campaign to Reduce the Risk of Falling for Older Adults

The number of falls among older adults is rising due to an aging population worldwide. An integrated communication campaign utilizing mHealth (mobile health) encouraged older adults to perform strength, balance, and flexibility exercises to reduce their risk of falling. Campaign development was guided by a mixed-method approach which incorporated expert interviews ( N = 3), qualitative interviews ( N = 22), and a quantitative baseline pre-campaign survey ( N = 274) with older adults. We evaluated the campaign impact with a pre-post survey analysis (post n = 141). Impact was measured by knowledge, attitudes, self-efficacy, and behaviors as key Social Cognitive Theory factors to exercise adoption. Results showed that respondents with campaign exposure had a significant increase in all factor scores from pre- to post-campaign survey, which was significantly higher in the group with campaign exposure. The impact evaluation illustrated how digital mobile channels effectively provide means to reach older adults to reduce their risk of falling.

A Study on Singapore’s Ageing Population in the Context of Eldercare Initiatives Using Machine Learning Algorithms

Ageing has always directly impacted the healthcare systems and, more specifically, the eldercare costs, as initiatives related to eldercare need to be addressed beyond the regular healthcare costs. This study aims to examine the general issues of eldercare in the Singapore context, as the population of the country is ageing rapidly. The main objective of the study is to examine the eldercare initiatives of the government and their likely impact on the ageing population. The methodology adopted in this study is Cross-Industry Standard Process for Data Mining (CRISP-DM). Reviews related to the impact of an ageing population on healthcare systems in the context of eldercare initiatives were studied. Analysis methods include correlation and machine learning algorithms, such as Decision Tree, Logistic Regression and Receiver Operating Characteristics curve analysis. Suggestions have been provided for various healthcare and eldercare systems’ initiatives and needs that are required to transform to cope with the ageing population.