Overcoming Barriers for Older Adults to Maintain Virtual Community and Social Connections during the COVID-19 Pandemic

Case Reports in the Integration of Technology with Cognitive Rehabilitation for Individuals with Memory Concerns and Their Care Partners

OBJECTIVE

Technology can be combined with psychological interventions to support older adults with memory concerns. Using a bi-phasic design, cognitive rehabilitation (CR) was integrated with off-the-shelf technology and delivered to two people with cognitive impairment, and one care partner.

METHOD

Pre- and post-intervention assessments were completed for all participants. Individuals with memory problems received pre- and post-intervention remote neuropsychological assessment (i.e., Rey auditory verbal learning test; mental alternations test; animal fluency), and the hospital anxiety and depression scale (HADS). The care partner completed the HADS, Zarit burden interview, and neuropsychiatric inventory questionnaire. Change metrics incorporated reliable change indices where possible. Goals were tracked using the Canadian occupation performance measure; these data were analyzed through visual inspection. A research journal (used to document intervention process) was analyzed thematically.

RESULTS

Results cautiously suggested our integration was feasible and acceptable across several technologies and varying goals. Across participants, significant changes in goal progress suggested the integration of technology with CR successfully facilitated goal performance and satisfaction. The research journal underscored the importance of a visual component, intervention flexibility, and a strong therapeutic alliance in integrating technology and CR.

CONCLUSIONS

CR and technology present a promising avenue for supporting people living with cognitive impairment. Further exploration of technology and CR with a range of etiologies and target goals is warranted.

Spatial Mobility Change Among Older Chinese Immigrants During the COVID-19 Pandemic: The Role of Physical, Social, and Virtual Environmental Factors

BACKGROUND

Vast spatial mobility changes happened globally during the COVID-19 pandemic, profoundly affecting older adults' well-being and active aging experience. This study aims to examine how the virtual environment and cyberspace, in conjunction with the physical and social neighbourhood environments, influence outdoor activities and spatial mobility for older immigrants.

METHODS

Four online focus groups were conducted with 25 older Chinese immigrants aged 65 and over in the Greater Toronto Area, Canada. The focus groups explored coping strategies during the pandemic and spatial mobility patterns related to different activity types such as grocery shopping, leisure activities and physical exercises, social and familial activities, and healthcare. Qualitative thematic analysis was conducted guided by the neighbourhood and health theoretical framework.

RESULTS

The overall engagement of older Chinese immigrants in various types of outdoor activities declined drastically and the spatial mobility pattern was complex. This change was shaped largely by the intersecting physical/built (e.g., residential conditions, access to public spaces), social (e.g., social support, interpersonal cohesion) and virtual (e.g., online communities and internet-based resources) environmental factors, as well as individual risk perceptions towards COVID-19 and public health interventions during the pandemic.

CONCLUSIONS

Virtual environment emerged as an important domain that compensates for the heavily reduced spatial mobility of the group during the pandemic. It functioned as a vital channel for older Chinese immigrants to sustain the necessary leisure, social, and healthcare-related activities and maintain well-being during the pandemic. The study provides implications for addressing neighbourhood-level factors in policymaking and implementing initiatives to enhance active ageing experience of older Chinese immigrants.

Being and Doing Together in a Naturally Occurring Retirement Community: Pandemic Experiences of Older Adults

Developing effective, sustainable strategies that promote social inclusion, reduce isolation, and support older adults' wellbeing continues to be important to aging communities in Canada. One strategy that targets community-living older adults involves identifying naturally occurring retirement communities (NORCs) and supporting them through supportive service programs (NORC-SSPs). This qualitative descriptive study utilized semi-structured interviews to explore how older adults living in a NORC supported by an SSP, sought to build, and maintain, a sense of community during the COVID-19 pandemic. Analysis revealed how changes in context prompted changes in the program and community, and how despite lack of in-person opportunities participants continued to be together and do occupations together in creative ways that supported their sense of community. NORC-SSPs, like Oasis, play an important role in supporting older adults' capacity to build strong, resilient communities that support wellbeing, during a global pandemic and in non-pandemic times.

Perspectives on Technology Use in the Context of Caregiving for Persons With Dementia: Qualitative Interview Study

BACKGROUND

Examining ways to support persons with dementia and their caregivers to help minimize the disease's impact on individuals, families, and society is critical. One emerging avenue for support is technology (eg, smartphones and smart homes).

OBJECTIVE

Given the increasing presence of technology in caregiving, it is pertinent to appreciate whether and how technology can be most useful to a care partner's everyday life. This study aims to further understand care partner technology use, attitudes, and the potential role of off-the-shelf technologies (eg, smartphones and smart homes) in supporting caregiving from the perspective of care partners for persons with dementia.

METHODS

We conducted a telephone cross-sectional survey using random digit dialing with 67 self-identified care partners of persons with dementia across one Canadian province. Participants were asked about attitudes toward technology, barriers to and facilitators for technology use, technology use with caregiving, and demographic information. Eight open-ended questions were analyzed using content analysis; 2 closed-ended questions about comfort with and helpfulness of technology (rated on a scale of 1 to 10) were analyzed with frequencies. From these data, an in-depth semistructured interview was created, and 10 (15%) randomly sampled care partners from the initial collection of 67 care partners were interviewed approximately 1 year later, with responses analyzed using content analysis.

RESULTS

Frequency analysis rated on a scale of 1 to 10 suggested that care partners were comfortable with technology (wearable technology mean 7.94, SD 2.02; smart home technology mean 6.94, SD 2.09), although they rated the helpfulness of technology less strongly (mean 5.02, SD 2.85). Qualitatively, care partners described using technology for functional tasks and some caregiving. Barriers to technology use included cost, lack of knowledge, security or privacy concerns, and undesirable features of technology. Facilitators included access to support and the presence of desirable features. Some care partners described merging technology with caregiving and reported subsequent benefits. Others stated that technology could not be adopted for caregiving due to the degree of impairment, fear of negative consequences for the person living with dementia, or due to incongruity with the caregiving philosophy. Furthermore, care partners noted that their technology use either increased or was unchanged as they moved through the COVID-19 pandemic.

CONCLUSIONS

The 2 analyses were conducted separately, but there was notable overlap in the data, suggesting temporal stability of identified content. Both analyses suggested care partners' relative comfort with technology and its use, but other care partners noted concerns about integrating technology and caregiving. Care partners' reports of increased technology use throughout the COVID-19 pandemic may also suggest that the pandemic impacted their perceptions of the usefulness of technology, being influenced by the requirements of their reality. Future investigations should examine how to support care partners in adopting relevant technology.

Impact of a national dementia research consortium: The Canadian Consortium on Neurodegeneration in Aging (CCNA)

The Canadian Consortium on Neurodegeneration in Aging (CCNA) was created by the Canadian federal government through its health research funding agency, the Canadian Institutes for Health Research (CIHR), in 2014, as a response to the G7 initiative to fight dementia. Two five-year funding cycles (2014-2019; 2019-2024) have occurred following peer review, and a third cycle (Phase 3) has just begun. A unique construct was mandated, consisting of 20 national teams in Phase I and 19 teams in Phase II (with research topics spanning from basic to clinical science to health resource systems) along with cross-cutting programs to support them. Responding to the needs of researchers within the CCNA teams, a unique sample of 1173 deeply phenotyped patients with various forms of dementia was accrued and studied over eight years (COMPASS-ND). In the second phase of funding (2019-2024), a national dementia prevention program (CAN-THUMBS UP) was set up. In a short time, this prevention program became a member of the World Wide FINGERS prevention consortium. In this article, the challenges, successes, and impacts of CCNA in Canada and internationally are discussed. Short-term deliverables have occurred, along with considerable promise of impacts in the longer term. The creation of synergy, networking, capacity building, engagement of people with lived experience, and economies of scale have contributed to the considerable success of CCNA by all measures. CCNA is evidence that an organized "centrally-organized" approach to dementia research can catalyze important progress nationally and yield significant and measurable results.

Linking personal initiative and family help as well as social support: a case study of learning challenges and solutions for older adults in rural China during the COVID-19 pandemic

Background

The sudden outbreak of the COVID-19 Pandemic has caused serious damage to the continuous learning of older adults around the world. While the existing literature focused more on older adults' learning in developed countries, few studies explored older adults' learning in developing countries with low social and cultural capital.

Methods

This study took family-school cooperation in China as the platform and explored learning challenges and solutions through unstructured interviews with 12 older adults.

Results

The study found that due to policies of working and studying from home, older adults face obstacles in accessing physical learning institutions and digital learning knowledge, skills, and psychology. I further found that the older adults were not forced to accept the challenge passively, but created a lifelong learning model with Chinese characteristics by building self-learning based on personal initiative, developing sustainable intergenerational learning rooted in Chinese family culture, and participating in online learning in schools and enterprises under the government guidance.

Conclusion

This study provided new knowledge for understanding the learning challenges and solutions of older adults in rural China. It is emphasized that policy value and practice enlightenment were highlighted and discussed in conversations with active aging, intergenerational learning, and harmonious societies.

Brief virtual intervention associated with increased social engagement and decreased negative affect among people aging with HIV

Virtual Villages-online communities that deliver supports to promote aging in place-are proposed to mitigate isolation and support the health of aging populations. Using a community-engaged approach, we developed and pilot-tested a Virtual Village intervention tailored for people living with HIV (PLWH) aged 50+ . The intervention employed a Discord server featuring social interaction, regional and national resources, expert presentations, and mindful meditation exercises. In 2022, a sample of PLWH aged 50+ from three U.S. study sites participated in a four-week pilot. Pre- and post-intervention surveys assessed participants' demographic characteristics; degree of loneliness, social connectedness, HIV-related stigma, and technology acceptance; mental wellbeing and physical health outcomes; and user experience. Participants (N = 20) were socioeconomically and racially/ethnically diverse, aged 51-88 years, and predominantly identified as gay or bisexual men (75%). Paired t-tests revealed a significant increase in participants' mean social engagement scores and a significant decrease in participants' mean negative affect scores, following the intervention. User experience scores were acceptable and participants reported a positive sense of connectedness to the Virtual Village community. Results suggest that a virtual community can be accessible to older PLWH and may enhance social engagement and improve aspects of mental wellbeing.

Services for older adults in rural primary care memory clinic communities and surrounding areas: a qualitative descriptive study

BACKGROUND/OBJECTIVES

As part of a larger study, and in collaboration with rural primary health care teams, RaDAR (Rural Dementia Action Research) primary care memory clinics have evolved and continue to spread in communities across southeast Saskatchewan, Canada. This study focuses on the geographical areas of the four communities where RaDAR memory clinics were first developed and implemented and describes the services and supports available to older adults including memory clinic patients and families living in these areas. Our goal was to identify and describe existing programs and gaps, create inventories and maps, and explore the service experiences of family caregivers of people living with dementia in these rural areas.

METHODS

Using a qualitative descriptive design, an environmental scan of services was conducted from December 2020 to April 2021 using focus groups (n = 4) with health care providers/managers (n = 12), a secondary source (e.g., program brochures) review, and a systematic internet search targeting four RaDAR memory clinic communities and surrounding areas via community websites, online resources, and the 211 Saskatchewan service database. Data were analyzed using content analysis; findings informed semi-structured interviews with caregivers (n = 5) conducted from March to July 2022, which were analyzed thematically. Geographic areas explored in this study covered an area of approximately 5666 km2.

RESULTS

From the scan, 43 services were identified, categorized into 7 service types, and mapped by location. Seventeen services were dementia-related. Services included social/leisure activities (n = 14), general support/referrals (n = 13), transportation (n = 7), information/education (n = 4), respite (n = 2), in-home care (n = 2), and safety (n = 1). Service levels included local (n = 24), provincial (n = 17), and national (n = 2), and were offered in-person, remotely (or both) with 20 services across 4 service types offered remotely. In general, most services had no fees, involved self-referral, and providers had a range of education/training. Key interview themes reflected the need for locally available, accessible services that offer (i) individualized, flexible, needs-based approaches, (ii) in-home care and continuity of care, and (iii) both formal and informal supports. Key gaps were identified, including (i) locally accessible, available services and resources in general, (ii) dementia-related training and education for service providers, and (iii) awareness of available services. Benefits of services, consequences of gaps, and recommendations to address gaps were reported. In general, service providers and program participants were an even mix of females and males, and program content was gender neutral.

CONCLUSIONS

Findings highlight a range of available services, and a number of varied service-user experiences and perspectives, in these rural areas. Key service gaps were identified, and caregivers made some specific recommendations to address these gaps. Findings underscore multiple opportunities to inform service delivery and program participation for rural and remote people living with dementia and their families.

Promoting Late-Life Volunteering With Timebanking: A Quasi-Experimental Mixed-Methods Study in Hong Kong

Background and Objectives

This study explores the impact of timebanking, where individuals earn time credits, nonmonetary currency, on promoting volunteerism among older adults.

Research Design and Methods

This study employed a quasi-experimental design with 116 timebank group (TBG) participants and 114 comparison group (CG) participants from 2021 to 2022. TBG received time credits to exchange for rewards, while CG received no time credits (i.e., volunteering as usual). The intervention of timebanking lasted for 1 year. Volunteering behaviors were tracked via an app, and intentions to volunteer were assessed at baseline (T0), after 6 months (the midpoint of the intervention, T1), and after 12 months (the endpoint of the intervention, T2). The use of rewards by TBG participants was also recorded (e.g., for personal use or sharing with others). Furthermore, focus group interviews were conducted to understand how rewards influenced participants' volunteerism.

Results

TBG had significantly higher weekly volunteer hours at T2 (β = 1.37, p = .021) and increased intent to volunteer at T1 (β = 0.54, p = .001) and T2 (β = 0.51, p = .001) compared with CG. Participants using rewards personally volunteered more at T2 (β = 2.09, p = .014), although sharing rewards with family and friends or donating rewards to others did not yield the same effect. The qualitative study suggested that a sense of feeling recognized generated by timebanking may encourage increased volunteering and that personal reward use enriched the volunteer experience, and individuals sharing rewards with family and friends experienced a sense of fulfillment and reinforcement of their prosociality.

Discussion and Implications

Timebanking effectively encourages late-life volunteering. The study provides practical implications for promoting volunteering among older people.

Loneliness, Social Isolation, and Obsession with COVID-19 among Older Adults

During the COVID-19 pandemic, older people were socially isolated for their protection against the virus impacting their mental health. Aiming to explore the role of loneliness and social isolation in the obsession with COVID-19 among older adults, we conducted an anonymous online survey with 300 older adults aged 65-80 years in South Korea between January and February 2023. The survey collected demographic information, past psychiatric history, medical disease, current psychological distress, and experiences related to COVID-19. Rating scales were the Obsession with COVID-19 Scale (OCS), Coronavirus Reassurance-seeking Behaviors Scale (CRBS), Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), and Loneliness and Social Isolation Scale (LSIS). The regression analysis revealed that CRBS (β = 0.55, p < 0.001) and SAVE-6 (β = 0.34, p < 0.001) were significant predictors of obsession with COVID-19 (adjusted R2 = 0.63, F = 126.9, p < 0.001). Mediation analysis showed that loneliness and social isolation had a positive total effect on obsession with COVID-19, mediated by reassurance-seeking behavior and viral anxiety (Standardized Estimator = 0.21, standard error = 0.05, p < 0.001, 95% confidence interval 0.20-0.41). Loneliness and social isolation were found to be indirectly linked to obsession with COVID-19 through reassurance-seeking behavior and viral anxiety. The findings highlight the importance of addressing loneliness and social isolation among older adults during the COVID-19 pandemic to prevent obsession with COVID-19.

From crisis to capacity: Lessons learned from youth e-mentoring during the COVID-19 pandemic

The COVID-19 pandemic and associated need for social isolation left in-person youth mentoring programs scrambling to keep mentees and mentors connected, and many programs turned to e-mentoring. To better understand the transition period and to inform e-mentoring practice in a post-COVID world, this study explored the experience of mentoring programs shifting to e-mentoring during the first year of the pandemic. Seven remote focus group discussions were conducted with twenty-three staff members from twenty U.S. youth mentoring organizations that used the iCouldBe e-mentoring platform during Spring/summer 2020 or Fall/Winter 2020-2021. Thematic content analysis was used to uncover insights from the data. E-mentoring was successful overall for keeping mentees and mentors in touch, especially for matches with a strong connection before the pandemic. Zoom and text messaging were the most used virtual communication methods. Programs faced many challenges but also experienced unexpected positives, including a strong interest in future e-mentoring implementation. Participants recommended that programs interested in e-mentoring start small and with intention; they also requested a central website with e-mentoring support and ways to connect with other programs and mentors. Although the literature on e-mentoring remains limited, this study contributes a picture of e-mentoring success even during a global crisis.

Barriers and facilitators to acceptance and implementation of eMental-health intervention among older adults: A qualitative systematic review

Objective

Electronic mental health interventions are effective but not well promoted currently among older adults. This study sought to systematically review and summarize the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults.

Methods

We comprehensively retrieved six electronic databases from January 2012 to September 2022: PubMed, Web of Science, Embase, Scopus, PsycINFO, and CINAHL. The JBI-QARI was used to assess the quality of the research methodology of each publication. Eligible studies underwent data coding and synthesis aligned to inductive and deductive methods. The Consolidated Framework for Implementation Research 2.0 was used as a deductive framework to guide a more structured analysis.

Results

The systematic review screened 4309 articles, 17 of which were included (eight with mixed methods and nine with qualitative methods). We identified and extracted the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults: (1) innovation: technology challenges, optimized functions, and contents, security and privacy; (2) outer setting: community engagement and partnerships, financing; (3) inner setting: leadership engagement, available resources, incompatibility, intergenerational support, training and guidance; (4) individuals: perceptions, capability, motivation of older adults and healthcare providers; and (5) implementation process: recruit, external assistance, and team.

Conclusion

These findings are critical to optimizing, promoting, and expanding electronic mental health interventions among older adults. The systematic review also provides a reference for better evidence-based implementation strategies in the future.

Understanding the impact of the COVID-19 pandemic on U.S. older adults: self-reported pandemic-related concerns and consequences in a cross-sectional survey study

Background and objectives

The purpose of this study was to explore COVID-19 pandemic-related concerns among a racially and ethnically representative sample of older adults in the U.S.

Research design and methods

Participants were 501 English-speaking adults 60 years and older recruited online nationally across the U.S. from Amazon Mechanical Turk (mTurk) and Prolific Research Platforms during June of 2020. Data comes from a larger cross-sectional survey. We content analyzed open-ended responses about pandemic-related concerns and observed responses to a checklist of items created by the research team to assess for specific physical, social, and financial consequences experienced due to the pandemic.

Results

A majority of the sample (92%) reported at least one pandemic-related concern, with the highest percentage expressing concerns coded as Concern for Others (28%), Physical Health (27%), Socializing (24%), Finance (15%) and Socio-Political-Economic (14%). Participants reported high concern severity (M = 4.03, SD = 1.04) about their concerns mentioned in response to the open-ended concerns question. When prompted with a checklist of items, participants frequently endorsed disruption in social activities as a consequence of the pandemic (83%), disruptions that could impact physical health (45%), and concern over finances as a consequence of the pandemic (41%).

Discussion and implications

Older adults most frequently mentioned concerns about the well-being and behavior of others, one's own physical health, and the impacts of the pandemic and social distancing policies on social activities. Findings align with the Socioemotional Selectivity Theory and point to the importance of supporting older adults to maintain meaningful social engagement under conditions of a pandemic and social distancing policies.

Virtually-Delivered Emotion Focused Mindfulness Therapy (EFMT) Group vs. Wait-List Control for Late-Life Anxiety: A Randomized Controlled Trial

BACKGROUND

The worldwide annual prevalence of anxiety in older adults is estimated to be between 6% and 10%. Emotion Focused Mindfulness Therapy (EFMT) is a mindfulness-based group intervention that has been demonstrated to reduce symptoms of anxiety in community dwelling adults. No study has yet assessed EFMT for older adults with late-life anxiety. The aim of this study was to determine the feasibility of video-delivered group EFMT for older adults living in community settings, a novel and potentially scalable intervention.

METHODS

This was a feasibility randomized controlled trial (RCT) of 48 older adults (≥55 years old), recruited through primary care, community organizations and snowball methods. Participants were randomized to group EFMT delivered by Zoom vs. a wait-list control. Data were collected at baseline (T1), 9 weeks following baseline (T2, primary study endpoint) and 17 weeks following baseline (T3). Random allocation was conducted immediately after each group of 12 participants had been enrolled into the trial, with groups beginning on a rolling basis each time a block of 12 participants had been enrolled. The main efficacy outcome examined changes over time to anxiety.

RESULTS

Recruitment was successfully completed in 32 weeks. Enrollment was calculated at 62.3% (48 of 77 people screened). Retention (80.0%) and adherence (100.0% for intervention group participants) were excellent. The EFMT group had significant improvements in anxiety at T2 compared to the wait-list control group (-3.47 [4.12] vs.-1.22 [3.25] points, p = 0.05).

CONCLUSIONS

Virtually-delivered EFMT appears to be a feasible, acceptable, and efficacious group treatment to improve late-life anxiety.

Video call and depression among older adults during the COVID-19 pandemic in Japan: The JAGES one-year longitudinal study

Evidence of video call on preventing late-life depression during the COVID-19 pandemic is limited. We examined the associations of social contact (in-person, voice call, and video call) with incidence of depressive symptoms and evaluated whether specific factors (particularly, age and change in the frequency of in-person contact) affect these associations. We used longitudinal data from the 2019 and 2020 waves of the Japan Gerontological Evaluation Study, including 10,523 participants aged ≥65 years in 10 municipalities. Depressive symptoms were measured by the 15-item Geriatric Depression Scale (GDS-15) score ≥5 in main analysis, and GDS-15 score ≥4, 10, or continuous variable in sensitivity analyses. Social contact represented frequency changes before and during the pandemic: non-contact (reference), decreased-contact, maintained-contact, and increased-contact. We employed modified Poisson regression analysis. Compared to non-contact of video call, the association of increased-contact of video call with depressive symptoms was insignificant in main analysis (GDS-15 ≥ 5: risk ratio (RR) = 0.89, 95% confidence interval (CI): 0.79-1.01), whereas significant in sensitivity analyses (GDS-15 ≥ 4: RR = 0.89, 95% CI: 0.82-0.98; GDS-15 ≥ 10: RR = 0.71, 95% CI: 0.53-0.97; GDS-15 = continuous variable: Β = -0.17, 95% CI: -0.33 to -0.002). In-person contact was significantly associated with lower incidence of depressive symptoms (non-contact: reference; maintained-contact: RR = 0.92, 95% CI: 0.85-0.99; increased-contact: RR = 0.84, 95% CI: 0.77-0.91), whereas voice call was not. Age and change in the frequency of in-person contact did not show significant effect modifications on the associations of video call with incidence of depressive symptoms after Bonferroni correction for multiple testing. In conclusion, this study suggests that the evidence supporting video call as a way to protect against depressive symptoms among older adults during the pandemic appears weak compared to the evidence for in-person contact.

Socialisation Agents' Use(fulness) for Older Consumers Learning ICT

This research investigates the socialisation agents older consumers use to learn about information and communication technologies (ICT). We surveyed 871 older consumers in Victoria, Australia, about whom they would most likely turn to for advice (i.e., their preferred socialisation agents) if they needed help using or fixing an ICT device. They were asked to identify the most and second most likely source of advice. Participants were also asked to assess the usefulness of the advice received from their preferred agents and to estimate their level of ICT knowledge. The findings reveal that older consumers tend to rely on younger family members. Still, the agency they receive from non-familial sources is essential when preparing for a digital consumer role. Surprisingly, ICT knowledge is determined by the socialisation agency received by older adults' second advice option-which is less likely to be their own adult children. This research expands current knowledge about how older consumers perceive various ICT socialisation agents. Consumer socialisation theory suggests that socialisation agents impact how consumers function in the marketplace. Although the first choice of socialisation agent may be perceived as beneficial for older adults, the advice given does not relate to marketplace functioning regarding improved ICT knowledge.

How an Intergenerational Book Club Can Prevent Cognitive Decline in Older Adults: A Pilot Study

Older adults are at higher risk for social isolation because of widowhood, loss of friends, retirement, physical limitations, geographic relocation, and caregiving demands. Behavioral interventions aimed at increasing social contact may help to maintain cognition and prevent cognitive decline. The purpose of this pilot study was to examine a novel intervention for social isolation with an intergenerational book club that had weekly in-person and virtual meetings of college students and older adults. We wanted to know whether the study was feasible and if our methods would be likely to generate meaningful results should it be expanded to a larger number of participants. We predicted that wellbeing and cognition would improve following participation in the book club. Results found that while measures of quality of life and affect were not statistically different before and after participation in a book club, scores on a measure of cognition (the Montreal Cognitive Assessment) were statistically significant between groups (intervention and control) showing greater improvement among book club participants.

Experiences of Home-living Vulnerable Older Adults with Clinical Depression during the COVID-19 Pandemic: A Qualitative Study

OBJECTIVES

Little is known about the diversity of older adults' experiences during the COVID-19 pandemic. We therefore investigated the pandemic experiences of home-living vulnerable older adults with depression, an understudied subpopulation.

METHODS

We conducted unstructured interviews with N= 20 older (60+ years) adults with clinical depression receiving care in their homes in June and again in December 2020. Interviews were coded according to the grounded theory approach.

RESULTS

We identified eight themes. Participants described feeling disconnected before and during the pandemic, which they attributed to their physical impairments and old age. Their social relations with family, medical providers, and caregivers helped them feel connected. Participants did not feel significantly impacted by the COVID-19 pandemic, but they missed social and physical contact. During the pandemic, isolation was normalized. Participants therefore experienced loneliness due to their isolation, but also a sense of togetherness with the rest of society. Isolation within the home was re-framed as cocooning, which provided a sense of autonomy. Participants nevertheless expressed resignation.

CONCLUSIONS

Home-living vulnerable older adults with depression experienced loneliness but also a degree of relief during the pandemic.

CLINICAL IMPLICATIONS

Positively re-framing isolation and the stability of formal caregiving helped participants endure feeling disconnected during the pandemic.

Governing digital health for infectious disease outbreaks

ABSTRACTHow can governing digital health for infectious disease outbreaks be enhanced? In many ways, the COVID-19 pandemic has simultaneously represented both the potential and marked limitations of digital health practices for infectious disease outbreaks. During the pandemic's initial stages, states along with Big Data and Big Tech actors unleashed a scope of both established and experimental digital technologies for tracking infections, hospitalisations, and deaths from COVID-19 - and sometimes exposure to the virus SARS-CoV-2. Despite the proliferation of these technologies at the global level, transnational and cross-border integration, and cooperation within digital health responses to COVID-19 often faltered, while digital health regulations were fragmented, contested, and uncoordinated. This article presents a critiquing reflection of approaches to conceptualising, understanding, and implementing digital health for infectious disease outbreaks, observed from COVID-19 and previous examples. In assessing the strengths and limitations of existing practices of governing digital health for infectious disease outbreaks, this article particularly examines 'informal' digital health to build upon and consider how digitised responses to addressing and governing infectious disease outbreaks may be reconceptualised, revisited, or revised.

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.

The Use of Telemedicine in Older-Adults During the COVID-19 Pandemic: a Weekly Cross-Sectional Analysis in Ontario, Canada

The COVID-19 pandemic led to rapid adoption of telemedicine for health-care service delivery. There are concerns that older adults, the highest users of the health-care system, would be left behind because of this shift. It remains unclear how the pandemic impacted telemedicine and other health-care service use in this group. We conducted a population-based, weekly cross-sectional study using administrative data from Ontario, Canada. Telemedicine use was measured for the overall older-adult population aged 65+ and across sociodemographic groups from January 2018 to March 2021. We also assessed the use of key health-care services between high and low patient users of telemedicine who were diagnosed with dementia. We found that telemedicine visits outnumbered in-person visits in older adults during the pandemic (average of 74 vs. 62 visits per 1000 per week). Of all specialties, psychiatrists delivered the most telemedicine visits, reaching 90% of visits in a week. Higher rates of telemedicine use during COVID-19 were found for patients who resided in urban regions (84 visits per 1000 per week), but no differences were found across income quintiles. Among dementia patients, high telemedicine users had higher health-care utilization than low telemedicine users (i.e., 21,108 vs. 3,276 outpatient visits per week) during the pandemic. Findings suggest that telemedicine was crucial in helping older adults, a group most vulnerable to COVID-19, maintain access to care during the pandemic. Telemedicine presents an important opportunity for older adults; however, future research should focus on barriers to equitable access and quality of care provided through telemedicine.

Technology use characteristics among older adults during the COVID-19 pandemic: A cross-cultural survey

Personal computers, tablets, and smartphones may support older adults' engagement when people are required to stay home and opportunities to engage in meaningful activities are reduced during the COVID-19 period. This study aims to screen older adults' technology-use characteristics across social, leisure, and education domains during the COVID-19 pandemic from a crosscultural viewpoint. The sample included 576 participants aged 60 and older from France (n = 62), Spain (n = 110), and Israel (n = 404). Participants completed the technology-use survey, which consists of questions about their facilities, technology usability, need for adaptations to support technology use, and changes in technology use since COVID-19. Significant differences were found between countries in facilities, χ2 (2) = 25.16, p < .001, and usability, χ2 (2) = 64.14, p < .001, across the three domains. Furthermore, 34% of technological usability was predicted by country and facilities, F (4, 568) = 72.39, p < .001. Participants noted a willingness to use technology if it was adapted for social (61%-73%), leisure (51%-71%), or educational (67%-76%) activities and that they devoted substantially more time to technology across domains (>58%) due to COVID-19. These findings highlight culture and facilities as factors that play an imperative role in supporting and enhancing the usability of technology among older adults.

Changing Relationships Between Social Contact, Social Support, and Depressive Symptoms During the COVID-19 Pandemic

OBJECTIVES

Given the longstanding consensus that social contact can promote older adult well-being, many have focused on how social contact changed during the pandemic. Less is known, however, about whether the link between social contact and health changed during the pandemic. This study sought to understand how associations between social contact, social support, and depressive symptoms changed during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

Data from 2 waves of the Health and Retirement Study were used. Respondents reported both virtual and in-person social contact, as well as perceived positive and negative social support. Path models were used to estimate relationships between social contact, social support, and depressive symptoms. Bootstrapping was used to estimate the change in associations between 2016 and 2020.

RESULTS

Estimates show that associations between positive social support and depressive symptoms, as well as between in-person social contact and depressive symptoms, attenuated during the pandemic. Virtual social contact played a relatively minor role in determining outcomes such as social support and depressive symptoms, compared to in-person social contact.

DISCUSSION

Findings suggest that researchers and policymakers should not only focus on the changing quantity of social interactions when events such as the COVID-19 pandemic happen, but also the changing content and efficacy of the social interactions that remain.

Examination of the Feasibility, Acceptability, and Efficacy of the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) Program for Older Adults: Results from a Single-Arm Pre-Post Trial (Preprint)

BACKGROUND

Memory strategy training for older adults helps maintain and improve cognitive health but is traditionally offered face-to-face, which is resource intensive, limits accessibility, and is challenging during a pandemic. Web-based interventions, such as the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program, may overcome such barriers.

OBJECTIVE

We report on OPTIMiSE's feasibility, acceptability, and efficacy.

METHODS

Australians aged ≥60 years reporting subjective cognitive decline participated in this single-arm pre-post web-based intervention. OPTIMiSE is a 6-module web-based program offered over 8-weeks with a 3-month booster. It has a problem-solving approach to memory issues, focusing on psychoeducation about memory and aging, knowledge and practice of compensatory memory strategies, and personalized content related to individual priorities. We examined the feasibility (recruitment, attrition, and data collection), acceptability (recommendation to others, suggestions for improvement, and withdrawal reasons), and efficacy (change in goal satisfaction, strategy knowledge and use, self-reported memory, memory satisfaction and knowledge, and mood; thematic content analysis of the most significant change; and the application of knowledge and strategies in daily life) of OPTIMiSE.

RESULTS

OPTIMiSE was feasible, demonstrated by strong interest (633 individuals screened), a satisfactory level of attrition (158/312, 50.6%), and minimal missing data from those completing the intervention. It was acceptable, with 97.4% (150/154) of participants agreeing they would recommend OPTIMiSE, the main suggestion for improvement being more time to complete modules, and withdrawal reasons similar to those in in-person interventions. OPTIMiSE was also efficacious, with linear mixed-effects analyses revealing improvements, of moderate to large effect sizes, across all primary outcomes (all P<.001): memory goal satisfaction (Cohen d after course=1.24; Cohen d at 3-month booster=1.64), strategy knowledge (Cohen d after course=0.67; Cohen d at 3-month booster=0.72) and use (Cohen d after course=0.79; Cohen d at 3-month booster=0.90), self-reported memory (Cohen d after course=0.80; Cohen d at 3-month booster=0.83), memory satisfaction (Cohen d after course=1.25; Cohen d at 3-month booster=1.29) and knowledge (Cohen d after course=0.96; Cohen d at 3-month booster=0.26), and mood (Cohen d after course=-0.35; nonsignificant Cohen d at booster). Furthermore, the most significant changes reported by participants (strategy use, improvements in daily life, reduced concern about memory, confidence and self-efficacy, and sharing and shame busting with others) reflected the course objectives and were consistent with themes arising from previous in-person interventions. At the 3-month booster, many participants reported continued implementation of knowledge and strategies in their daily lives.

CONCLUSIONS

This feasible, acceptable, and efficacious web-based program has the potential to enable access to evidence-based memory interventions for older adults worldwide. Notably, the changes in knowledge, beliefs, and strategy use continued beyond the initial program. This is particularly important for supporting the growing number of older adults living with cognitive concerns.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12620000979954; https://tinyurl.com/34cdantv.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.3233/ADR-200251.

Social and satisfied? Social uses of mobile phone and subjective wellbeing in later life

The current study examined the associations between socio-demographic background and engagement in social uses of mobile phone, and between the engagement in these uses and life satisfaction and health satisfaction in later life through the lens of digital divide and uses and gratifications theories. The data, collected from the retired Internet users (62 and older) residing in seven countries (N = 5713), were analyzed using logistic and linear regression models. The results show that education and age predicted the engagement in social uses in the most consistent way. A number of social uses positively related to both life and health satisfaction. Of the particular uses, e-mailing and instant messaging were positively associated with life and health satisfaction. The results imply that socio-demographic background predicts the engagement in social uses of mobile phone in later life, that the engagement in such uses plays an overall significant role in wellbeing in later life, and that some particular uses play a greater role than others in this regard.

Perceptions of risk in people with inflammatory arthritis during the COVID-19 pandemic

Objective

People with inflammatory arthritis have an increased incidence of serious illness and mortality, placing them at risk of poor outcomes from coronavirus disease 2019 (COVID-19). This study explored patients' perceptions of risk from COVID-19 over a longitudinal period of the pandemic.

Methods

Fifteen adults with inflammatory arthritis attending a National Health Service rheumatology service each took part in three semi-structured telephone interviews conducted between 16 September 2020 and 29 July 2021. Interpretive phenomenological analysis was undertaken by two researchers and two public contributors.

Results

Four main themes relating to perceptions of risk from COVID-19 were identified: inflammatory arthritis; medications and co-morbidities; immediate social environment; health policy communication; and media influence. Participants recognized that having inflammatory arthritis increased their individual risk. Perceptions of risk and associated fear increased during the pandemic, influenced by family/friends who had had COVID-19 and health policy communications. The perceived constant use of negative messages led to many participants disengaging with the media. At the final interviews, when the vaccination programme was well established, participants continued to assess the risk and benefits of engaging in activities.

Conclusion

This study demonstrates the breadth of factors that influenced perceptions of risk in people with an inflammatory arthritis. As health professionals, we have only a small sphere of influence over some of these factors, namely health-care communications. People with inflammatory arthritis appropriately knew that their condition increased their infection risk, but more could be done to consider how and to what extent we involve patients in explaining risk at times of crisis.

Understanding Variation in Adoption of Video Telehealth and Implications for Health Care Systems

BACKGROUND

Telehealth has rapidly expanded since COVID-19. Veterans Health Administration (VHA), the largest integrated health care system in the United States, was well-positioned to incorporate telehealth across specialties due to existing policies and infrastructure.

OBJECTIVES

The objective of this study is to investigate predictors of occupational therapy (OT) practitioners' adoption of video telehealth.

METHODS

This study presents data from a convenience sample of VHA occupational therapy (OT) practitioners administered pre-pandemic, in fall 2019. Survey development was guided by the Promoting Action on Research Implementation in Health Services framework, and gathered clinician attitudes, experiences, and perspectives about video telehealth to deliver OT services. Items included telehealth usage, perceived effectiveness of specific OT interventions, and perceptions about evidence. Our outcome variable denoted practitioners' level of adoption of video telehealth: telehealth users (adopters), non-users who want to use telehealth (potential adopters and reference group), and non-users who do not want to use telehealth (non-adopters). In multiple multinomial logistic regressions, we tested whether level of adoption was associated with years of VHA work experience and perceived strength of evidence.

RESULTS

Of approximately 1455 eligible practitioners, 305 VHA occupational therapy practitioners participated in the survey (21% response rate). One hundred and twenty-five (41%) reported using video telehealth, whereas 180 (59%) reported not using video telehealth. Among non-users, 107 (59%) indicated willingness to adopt telehealth whereas 73 (41%) were not willing. More VHA work experience predicted higher odds of being an adopter than a potential adopter; perceptions of stronger evidence regarding video telehealth predicted higher odds of being a potential adopter than a non-adopter.

CONCLUSION

Clinician beliefs and years of experience exerted an influence on clinicians' use or willingness to use video telehealth. Efforts to enhance adoption of video telehealth should address clinicians' beliefs regarding the innovative nature of and organizational resources necessary to foster utilization.

Exploring Perceptions of Technology Use to Support Self-Management Among Older Adults with Cancer and Multimorbidities

OBJECTIVES

Our objective was to explore and describe how older adults engage with technology to support cancer self-management behaviors, particularly as they live with multimorbidity.

DATA SOURCES

We used a qualitative descriptive approach and semi-structured interviews with older adults with cancer who had at least one other chronic condition. Two authors analyzed the data using a descriptive thematic analysis approach using NVivo 12 software.

CONCLUSION

We found that older adults are interested in, if not already, engaging with technology and internet searching to manage their cancer diagnosis and treatment. Data were grouped into three themes: (1) Using technology to take control; (2) Confidence in technology supports competence in self-management; and (3) Desired features for future interventions. Participants felt they might need extra support learning how to craft a search, filter facts, and digest information from the internet to manage their cancer. Those who reported using technology to keep records about their health made more statements reflecting confidence in their technology usage.

IMPLICATION FOR NURSING PRACTICE

Older adults are interested in engaging technology to support self-management. The specific implications that arise from this study are that (1) older adults' interest in engaging with technology has a unique potential to support foundations for self-management behaviors and activities and (2) empowering self-management behaviors and attitudes through technology may result in better treatment outcomes, as evidenced by increased capabilities in the six core self-management skills.

Volunteers' Support of Carers of Rural People Living with Dementia to Use a Custom-Built Application

There is great potential for human-centred technologies to enhance wellbeing for people living with dementia and their carers. The Virtual Dementia Friendly Rural Communities (Verily Connect) project aimed to increase access to information, support, and connection for carers of rural people living with dementia, via a co-designed, integrated website/mobile application (app) and Zoom videoconferencing. Volunteers were recruited and trained to assist the carers to use the Verily Connect app and videoconferencing. The overall research design was a stepped wedge open cohort randomized cluster trial involving 12 rural communities, spanning three states of Australia, with three types of participants: carers of people living with dementia, volunteers, and health/aged services staff. Data collected from volunteers (n = 39) included eight interviews and five focus groups with volunteers, and 75 process memos written by research team members. The data were analyzed using a descriptive evaluation framework and building themes through open coding, inductive reasoning, and code categorization. The volunteers reported that the Verily Connect app was easy to use and they felt they derived benefit from volunteering. The volunteers had less volunteering work than they desired due to low numbers of carer participants; they reported that older rural carers were partly reluctant to join the trial because they eschewed using online technologies, which was the reason for involving volunteers from each local community.