Attitudes Towards and Limitations to ICT Use in Assisted and Independent Living Communities: Findings from a Specially-Designed Technological Intervention

Information and Communication Technology Adoption Strategies Among Iranian Older Adults: A Qualitative Evaluation

In today's world, it is unavoidable for older adults to use technology, which causes some challenges for them. In this qualitative study, we used grounded theory to evaluate information and communication technology (ICT) adoption strategies among Iranian older adults. The participants included 18 older adults, five experts, and five family members of older adults. The data collection method included conducting semi-structured interviews, taking field notes, and observation. The data were analyzed using the Corbin and Strauss approach. Three main themes were extracted as follows: support from others, effort for learning, and smart choice. The subthemes of support from others included creativity in educating older adults; having access to an educational supporter; and receiving informational, emotional, and financial support. The subthemes of effort for learning included utilizing aids, adaptive measures, shortcut techniques, and self-learning. The subthemes of smart choice included physical characteristics, technical features, price sensitivity, and availability of an active sales representative. Accordingly, it is essential to teach older adults to increase their ICT adoption rate and continued use of technology. In this respect, developing a standard ICT manual for older adults can be beneficial.

Older adults' needs and requirements for a comprehensive exergame-based telerehabilitation system: A focus group study

Introduction

Telerehabilitation in older adults using information and communication technologies (ICTs) provides therapy, which is potentially equally effective as traditional rehabilitation, yet more accessible. This study aimed to analyze the needs and requirements of older adults (OA) and healthcare-professionals (HP) toward ICTs and telerehabilitation in general as well as toward a specific novel exergame-based telerehabilitation system (COCARE system, Dividat).

Materials and methods

The COCARE telerehabilitation system enables individual training based on exergames, as well as an assessment system and a digital centralized case management. Six focus groups with in total 34 participants were conducted. A mixed-methods approach was used comprising questionnaires and semi-structured interviews.

Results

Both OA and HP would engage to an exergame-based telerehabilitation program. Major motivating factors are the relevance of such a training for health and the entertainment component of exergames. Main requirements are simplification of the system, variety, a personalized training, a constantly available contact person, and comprehensive instructions for use. Besides, HP praised the system's motivational effect, but remained concerned about risk of falls and social isolation.

Conclusion

ICTs for telerehabilitation are accepted by OA and HP but should be adapted hardware- and software-wise to address OA' age-stemming vulnerabilities (e.g., risk of falls) and low ICT literacy.

Co-Creating ICT Risk Strategies with Older Australians: A Workshop Model

As digital inclusion becomes a growing indicator of wellbeing in later life, the ability to understand older adults' preferences for information and communication technologies (ICTs) and develop strategies to support their digital literacy is critical. The barriers older adults face include their perceived ICT risks and capacity to learn. Complexities, including ICT environmental stressors and societal norms, may require concerted engagement with older adults to achieve higher digital literacy competencies. This article describes the results of a series of co-design workshops to develop strategies for increased ICT competencies and reduced perceived risks among older adults. Engaging older Australians in three in-person workshops (each workshop consisting of 15 people), this study adapted the "Scenario Personarrative Method" to illustrate the experiences of people with technology and rich pictures of the strategies seniors employ. Through the enrichment of low-to-high-digital-literacy personas and mapping workshop participant responses to several scenarios, the workshops contextualized the different opportunities and barriers seniors may face, offering a useful approach toward collaborative strategy development. We argued that in using co-designed persona methods, scholars can develop more nuance in generating ICT risk strategies that are built with and for older adults. By allowing risks to be contextualized through this approach, we illustrated the novelty of adapting the Scenario Personarrative Method to provide insights into perceived barriers and to build skills, motivations, and strategies toward enhancing digital literacy.

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.

Demographic and generational determinants of Poles’ participation in the sharing economy: Findings from a survey data analysis

The fast development of technologies in today’s world is accompanied by the mushrooming of digital platforms constituting the core of the ecosystem of sharing economy. This multifaceted phenomenon and its ever-increasing presence have become a subject of public interest and debate, as well as encouraging research and scientific discourse. The article presents the results of the first study of Poles’ participation in sharing economy derived from a questionnaire survey of a representative sample (n = 1000). The purpose of the study was to characterise Poles participating in the digital economy and to determine how they differ in the use of sharing platforms depending on their age group and generation. The analysis has shown that the rates of Poles participating in the digital economy are the smaller, the older the age group, and that a rising number of the users of digital economy solutions translates into greater acceptance of sharing platforms. Among the oldest Poles, 70% do not participate in the digital economy and as much as 80% in the sharing economy. The numbers sharply contrast with generations Z and Y that participate in the sharing economy almost without exception. The most popular of sharing services turned out to be accommodation reservation indicated by every third respondent.

The Impact of an Internet Use Promotion Programme on Communication, Internet Use, and the Extent of Social Networks among Low-Income Older Adults

We examined whether an internet use promotion intervention influences low-income older adults’ communication modes, internet use, and social networks using existing data collected for an intervention. Participants living in public senior housing facilities in the United States (n = 77) completed surveys before and after a 12-week computer and internet training. The six-item Lubben Social Network Scale (LSNS-6) was used to measure the extent of older adults’ social networks. The primary mode of communication shifted from more traditional means to internet-based communications (p < .0005 in a Fisher’s exact test). The frequency of internet use significantly increased (p < .00005 in a one-sided Sign test). Overall, the LSNS-6 score increased by 4.1 points (p < .00005 in a Welch’s t-test). The LSNS-6 score increase was significantly larger among African Americans than Whites, controlling for gender (p < .05 in negative binomial regression). Moderate (p < .005) and frequent internet users (p < .05) had higher LSNS-6 scores than rare internet users at posttest when gender and race were controlled for in linear regression. Comparatively more improvement in the extent of social networks among African Americans suggests greater benefits of such interventions for population groups of disadvantaged backgrounds. Larger social networks among moderate and frequent internet users than rare users suggest positive impacts of internet communications on social networks.

Technology: Saving and Enriching Life During COVID-19

The pandemic of COVID-19 has arrested the life of 7.8 million people living on this earth. However, some people are more vulnerable to the risk of this deadly virus. The frailty of senior citizens put them at the top of this list. The past 6 months have not only presented a threat to their physical health but to mental health also. Although lockdown was necessary to check the spread of the coronavirus it culminated in an exponential rise in the problems of loneliness, anxiety, fear, helplessness, and depression. The present paper reviews the role of social networking sites, apps, and other digital platforms in saving and enriching the lives of the elderly, especially those who spent the lockdown alone and were devoid of a regular support system due to unavailability of transport and administrative restrictions on the movement of people. It also analyzes the efficiency of the virtual world in reducing their anxiety of being alone by connecting them with others and also make them feel empowered. The review is based on the online data collected about the insurgence in the percentage of elderly people using such platforms, recent studies analyzing the effects of the COVID 19 pandemic on senior citizens. Besides this personal telephonic discussions were conducted with some elderly people who spent their lockdown alone in their homes. The study was primarily focused on three objectives. Firstly it attempts to understand the ways in which senior citizens made use of social networking sites and various digital platforms for managing life better. Secondly, it analyses the process of adopting technology, and finally, it examined the width and depth of the impact technology created in their life and also the permanence of this change. The analysis clearly suggests an increase in the digital life of elderly people. The process moved in distinct stages from utter confusion to relative ease in using technology, thereby significantly reducing the loneliness, and bringing relatively stable change in the way they lead their life.

A Double Burden of Exclusion? Digital and Social Exclusion of Older Adults in Times of COVID-19

The COVID-19 pandemic has excluded older adults from a society based on physical social contact. Vulnerable populations like older adults also tend to be excluded from digital services because they opt not to use the internet, lack necessary devices and network connectivity, or inexperience using the technology. Older adults who are frail and are not online, many of whom are in long-term care facilities, struggle with the double burden of social and digital exclusion. This paper discusses the potential outcomes of this exclusion and provides recommendations for rectifying the situation, with a particular focus on older adults in long-term care facilities.

Perioperative telemonitoring of older adults with cancer: Can we connect them all?

Objectives

Although the increasing cancer incidence in older patients is widely recognised, older patients remain underrepresented in clinical cancer trials and eHealth studies. The aim of this research is to identify technological and patient-related barriers to inclusion of this population in a clinical eHealth study.

Material and Methods

This is a retrospective analysis of a prospective cohort study with older patients (≥ 65 years) undergoing cancer-related surgery, who were identified for a perioperative telemonitoring study. Reasons for ineligibility and refusal had been prospectively registered. Characteristics and postoperative outcomes were compared between participants and non-participants.

Results

Between May 2018 and March 2020, 151 patients were assessed for eligibility, resulting in 65 participants and 86 non-participants. The main reason for ineligibility was lack of internet access at home (n = 16), while main reasons for refusal were perceived high mental burden (n = 46) and insufficient digital skills (n = 12). Compared with participants, non-participants were significantly older (mean age 75 vs. 73, p = 0.01); more often female (64% vs. 35%, p = 0.00), unmarried (42% vs. 8%, p = 0.01) living alone (38% vs. 19%, p = 0.02); had a higher ASA classification (43% vs. 19%, p = 0.00); often had polypharmacy (67% vs. 43%, p = 0.00); and were more often discharged to skilled nursing facilities (0% vs. 15%, p = 0.00).

Conclusion

Our results confirm the underrepresentation of older female patients with little support from a partner and higher comorbidity. We should be aware of technological and patient-related barriers to including older adults with cancer, in order to avoid further dividing patients with low and high digital health literacy.

Enhancing older adult access to lifelong learning institutes through technology-based instruction: A brief report

The number of lifelong learning institutes serving older adults in the U.S. has increased in the last few decades. To date, these institutes have functioned primarily in traditional, in-person classroom, and seminar formats; however, technology-enhanced methods may help provide greater access to high-quality lifelong learning experiences. This research note reports the results of a cross-institutional survey of Osher Lifelong Learning Network participants. The survey participants' high levels of computer utilization and experience with modern distance education capabilities opens the possibility that Technology-Based Instruction (TBI) can augment or supplement in-person lifelong learning experiences. Specifically, TBI may be effective in expanding access for older adults who have mobility or other health limitations, as well as those who live far from the location of any such program. Example approaches are suggested for developing blended, hybrid in-person, and online lifelong learning environments, which may offer enriching intellectual engagement and meaningful socialization.

Potential of Augmented Reality and Virtual Reality Technologies to Promote Wellbeing in Older Adults

Older adults face significant loss and limitations in terms of mobility, cognitive ability, and socialization. By using augmented reality and virtual reality technologies they have the potential to overcome such loss and limitations, and to eventually improve their quality of life. However, this group is often excluded in augmented reality and virtual reality deployment. Further, limited studies address their challenges when using augmented reality and virtual reality. Therefore, for a critical review of augmented reality and virtual reality for older adults, we developed a framework to evaluate related factors, including physical, social, and psychological wellbeing. Through the critical review, we identified that most augmented reality and virtual reality studies focus on physical wellbeing of older adults but also make substantial efforts to increase their psychological wellbeing. Fun factors that would motivate them are also extensively considered. Further, social isolation continues to be a significant issue for older adults, but the appropriate content to increase their social wellbeing is insufficient, although many commercial products have been developed. The contribution of the present study is to provide a contextual framework and an evaluation framework for the critical review of augmented reality and virtual reality technologies to promote wellbeing in older adults. This study also suggests the augmented reality and virtual reality research direction for studies on this group by identifying the research gap through the critical review process. Lastly, this study investigates design directions of augmented reality and virtual reality for older adults by introducing challenges and design issues that emerged through the critical review.

Silver surfers from a European perspective: technology communication usage among European seniors

Filling a gap in our understanding of how senior citizens use information and communication technologies (ICTs), we identified several profiles of technology communication use among European seniors (aged 65+). These profiles include: Digitally immersed communicators, Asynchronous communicators and Phone enjoyers. We outline the importance of a broader distinction, one that surpasses the non-user and user dichotomy, and explores the singularities of the seniors who overcome the challenge of adopting and using ICT. We consider the digital divide concept as a starting point for the theoretical background that we reviewed in order to explain the process through which senior citizens accept and adopt this technology. Analysing data gathered within the Eurobarometer (Standard Eurobarometer 84 Autumn 2015-media use in the European Union. https://dbk.gesis.org/dbksearch/sdesc2.asp?no=6642, 2015), we applied K-Means Cluster analysis and discriminant analysis in order to identify three types of older Internet users. We run the analysis on a sample of 4404 respondents aged between 65 and 99 years. Our results help with increasing the adequacy of Digital Single Market policies for European seniors, as well as with more suitably targeting senior for social care and medical care programmes in the digital environment. Providing suggestions for further research, we argue for an in-depth classification of ICT users, based on characteristics such as gender, education, ethnicity or social class.

Information and Communications Technology as a Health Promotion Method for Older Adults in Assisted-Living Facilities: Three-Arm Group-Randomized Trial

Background

The application of technology is an important and growing aspect in the field of long-term care. Growing evidence shows the positive impact of technology aids in helping the lives of the elderly. However, it is not known which aspects of information and communications technology (ICT) are preferred by older adults living in long-term care facilities.

Objective

The goal of the research was to compare the impact of ICT-communication, ICT-entertainment, and conventional care on older adults’ health and psychological change after interventions among older adults in assisted-living facilities.

Methods

A three-arm group-randomized trial design was used to evaluate participants who resided in three different but comparable assisted-living facilities and received different aspects of the ICT interventions. A total of 54 older adults with disabilities received one of the three interventions over 12 weeks and completed pre- and postevaluations on quality of life, social support, and psychological well-being.

Results

Participants completing this study had a mean age of 73 (SD 11.4) years, and 50% (27/54) were male. Both the ICT-communication and ICT-entertainment groups showed significant improvement in the mental component of quality of life (4.11, P=.012 and 37.32, P<.001, respectively), family/friend–related social support (0.05, P=.001 and 0.04, P<.001, respectively), happiness (0.79, P=.038 and 3.72, P=.001, respectively), and depressive symptoms (–2.74, P=.001 and –7.33, P<.001, respectively). Importantly, participants in the ICT-entertainment group improved significantly more than the other two groups. The ICT-entertainment group also showed improvement in the physical component of quality of life (20.49, P<.001) and health care worker–related social support (0.1, P=.008).

Conclusions

Results suggest that the entertainment but not the communication part of ICT is the most effective health promotion method for improving the health and psychological well-being of older adults in assisted-living facilities.

Comparison of prompting procedures to teach internet skills to older adults

The Internet and information and communications technologies (ICTs) have been found to produce meaningful social interactions and greater social support among older adults (White et al., ). Despite these benefits, the Internet and ICTs are not widely used among the older-adult population (Cresci, Yarandi, & Morrell, ). The purpose of the current study was to compare the effectiveness and efficiency of video prompting and text-based instructions on the acquisition of three tablet-based tasks: emailing, video calling (FaceTime® application), and searching for a YouTube™ video. Both video prompting and text-based instructions were effective for all three participants, with text-based instructions being slightly more efficient for one participant and video prompting being more efficient for two participants, suggesting that both prompting procedures can be used to teach older adults Internet and ICT skills.

Multi-stakeholder perspectives on information communication technology training for older adults: implications for teaching and learning

Objectives: The objective of this research was to identify and conceptualize barriers and strategies for effective implementation of information communication technology (ICT) training for older adults. Methods: A grounded theory approach was used to collect and analyze qualitative data from 61 participants in three stakeholder groups: older-adult ICT trainees, care providers and ICT trainers. Results: Care providers expressed older adults' reluctance, lack of affinity, fears and socio-contextual attributes as barriers to overcome with ICT training. ICT trainers highlighted motivation, trainer-trainee relationship, patience, self-reliance and mutual value as strategic themes. ICT trainees elucidated occupational accomplishment, challenges and a sense of competence as themes from their experience with training. Discussion: While digital literacy and skill building have traditionally been the key focus of ageing-centred ICT training, a deeper approach to address internal (personal) and external (socio-contextual) barriers, as conceptualized in the study finding, is vital in yielding successful outcomes. Implications for rehabilitation Information communication technology (ICT) is a vital resource for older adults to age-in-place and for health professionals in delivery of tele-rehabilitation. Family members and care providers realize the scope of ICT for ageing-in-place but raise doubts on the inherent motivation and abilities of older adults to adopt ICT. On the other hand, older adults who engage in one-on-one ICT training value their new-found sense of accomplishment and competence in using the Internet and social media. Graduate students who provided the training greatly appreciate their own learning experience, and stress the need for mutual trust, patience and simplicity in teaching ICT. A major precursor to imparting digital literacy and skills in older adults who lack ICT exposure is to help them overcome deep-seated attitudinal and socio-contextual barriers through a one-on-one approach.

Discontinued Information and Communication Technology Usage among Older Adults in Continuing Care Retirement Communities in the United States

BACKGROUND

Older adults are increasingly using information and communication technologies (ICTs). Recent studies show beneficial effects of using ICTs for older adults, particularly in terms of reducing loneliness and depression. However, little is known about the factors that may prevent discontinued ICT use in populations that may be at greater risk, such as those in continuing care retirement communities (CCRCs).

OBJECTIVES

The purpose of this study is to examine a range of factors that may influence discontinued (1) ICT use, (2) searching for health information, and (3) searching for general information over time among CCRC residents.

METHODS

We use longitudinal data from a randomized controlled trial conducted with residents of 19 CCRCs. We use flexible parametric models to estimate the hazard ratio or hazard rate over 5 waves of data to determine what factors significantly predict discontinued (1) ICT use, (2) health information searching, and (3) general information searching.

RESULTS

The analysis reveals that independent living residents who took part in an 8-week ICT training intervention were less likely to stop using ICTs. Age and the number of instrumental activities of daily living (IADL) impairments significantly predicted an increased likelihood of stopping ICT use. When examining specific ICT-related activities, the analysis reveals that independent living residents who took part in the ICT training intervention were less likely to stop searching for health information and general information online. In addition, age and the number of IADL impairments were associated with increased likelihood of discontinued health information searches and discontinued general information searches.

CONCLUSION

ICT training interventions may motivate residents of CCRCs to stay connected by increasing the ICT skill level and promoting confidence, thus decreasing the probability that they will discontinue using ICTs and searching for general information. However, the effects of ICT training on motivating continued ICT usage may be more pronounced among independent living residents. Limitations in the number of IADL impairments is a key factor leading to discontinued use of ICTs among CCRC residents, suggesting that designers of ICTs should be cognizant of the cognitive and physical limitations among this group.

The Physical-Digital Divide: Exploring the Social Gap Between Digital Natives and Physical Natives

Older adults are the most digitally divided demographic group. The present study explores how older adults perceive the physical use of information and communication technologies (ICTs), particularly across generations and contexts. Data for the present study come from nine focus groups. Seniors acknowledge that ICTs help them connect with geographically distant social ties, but that they lead to feelings of disconnection with geographically close social ties. We label this phenomenon the "physical-digital divide," which exists when a group feels ostracized or offended when those around them engage with ICTs while they themselves are not or cannot engage with ICTs. Younger generations are often referred to as "digital natives" and older generations as "digital immigrants." A more apt label for older adults may be "physical natives," as their preferred method of communication involves physical face-to-face interactions and traditional codes of etiquette. Suggestions are made for reducing the physical-digital divide.

Is it love or loneliness? Exploring the impact of everyday digital technology use on the wellbeing of older adults

Loneliness is a prevalent phenomenon within the older adult population. Previous literature suggests that technology use, specifically internet use, can alleviate loneliness and improve wellbeing. This research study follows 32 people over the age of 65 using a digital technology for six months. A mixed-method approach was used to collect quantitative and qualitative data throughout the time period. The repeated questionnaire measured changes in frequency of use, emotional attachment towards a device, a sense of belonging and perceptions of self-worth, whilst an event-based diary was used to note usages and influences of technology on lifestyle. Results revealed positive relationships between frequency of use and emotional attachment and frequency of use and perceptions of self-worth. There was no significant relationship between frequency of use and a sense of belonging for the aggregate data. There was, however, a negative relationship between emotional attachment towards a device and a sense of belonging, suggesting a fine balance between technology use to improve self-esteem through connections with social networks and an over-dependence on technology that can actually reduce feelings of belonging.

Social Support and "Playing Around": An Examination of How Older Adults Acquire Digital Literacy With Tablet Computers

This study examines how older adults learn to use tablet computers. Learning to use new technologies can help older adults to be included in today's digital society. However, learning to use new technologies is not always easy, especially for older adults. This study focuses on how older adults learn to use a specific technology, tablet computers, and the role that social support plays in this process. Data for this project are from 21 in-depth interviews with individuals who own tablet computers. We examine how older adults engage with tablet devices and increase their digital literacy. The findings suggest that, for older adults to start to use tablets, social support plays an important role. In addition, a key way that many participants report gaining expertise with the technology is through "playing around" with the tablets. Suggestions for how to help older adults learn to use new technologies are detailed.

An Exploratory Investigation of Communication Technologies to Alleviate Communicative Difficulties and Depression in Older Adults

OBJECTIVE

To explore associations between older adults' communicative difficulties, depressive symptoms, and e-mail and telephone use with adult children.

METHOD

We examined these associations using data from 1,634 participants (age M = 71.16, SD = 0.89; 54% female) in the 2011 wave of the Wisconsin Longitudinal Study.

RESULTS

Better vision and worse speech were associated with more frequent e-mail contact with the selected child. Worse hearing was associated with more depressive symptoms for participants with low e-mail use but not for those with average or high e-mail use. Telephone use was not associated with communicative difficulties or depressive symptoms.

DISCUSSION

This study provides preliminary evidence that older adults might use communication technologies such as e-mail in their close relationships to compensate for communicative difficulties. The text-based format of e-mail might also help older adults mitigate hearing impairments and associated depressive symptoms.