The use of everyday technology by people with dementia living alone: mapping out the difficulties

Well-being and dignity in innovative digitally-led healthcare for aged adults

Dignity is a central value in care for aged adults, and it must be protected and respected. With demographic changes leading to an aging population, health ministries are increasingly investing in digitalization. However, using unfamiliar digital technology can be challenging and thus impact aged adults' dignity and well-being. The INNOVATEDIGNITY project aims to research new, dignified ways of engaging with aged adults to shape digital developments in care delivery. This qualitative study aimed to explore how innovative digitally-led healthcare have influenced aged adults' well-being and dignity through three studies conducted as part of the INNOVATEDIGNITY project: a scoping review, an empirical study and a policy analysis. The three documents were analysed to uncover meanings relevant to the research problem revealing four main themes: the advantages of new technologies in facilitating aged adults' well-being, the rupture of dignity due to bewilderment in the digital world, aged adults' dignity is affected by their worries about human face of care being replaced by technology and preserving aged adults' dignity in digitally-led healthcare. Digitalization in healthcare impacts aged adults' well-being as providing new opportunities for care, but preserving aged adults' dignity when working with unfamiliar digital innovations is challenging. Aged adults need to be informed about the use of technology in their care and supported to develop the necessary digital skills to better adapt to digitally-led healthcare. The circumstances, conditions and needs of individuals should remain central when implementing new technologies in healthcare settings in a dignified way.

Digitalization of Activities of Daily Living and Its Influence on Social Participation for Community-Dwelling Older Adults: A Scoping Review

Everyday technology (ET) has been defined as the broad set of devices and artefacts that are currently present in people's lives both inside and outside of the home. A subgroup within ET is known as everyday information and communication technologies (EICTs). The main characteristic of these technologies is that they can facilitate or disrupt the engagement of individuals in their daily activities. This scoping review aims to identify what is known about how ET can function as facilitators or barriers to occupations, such as the social participation of older adults. The proposed scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines and checklist. The scoping review was conducted across five online databases (PubMed, Scopus, Web of Science, MEDLINE and PsycoINFO [EBSCO]) to identify published, peer-reviewed records. Studies were screened by two independent reviewers against the inclusion criteria. This review considered studies concerning the use of ET or EICTs in community-dwelling adults aged over 60 years, with or without cognitive impairment or dementia. All of the articles were in English, and reviews were not included. Eleven papers were selected and showed that despite the increasing demand for technologies of daily life and the digitalization of society and processes, according to our research, few studies addressed the limitations in the social participation of older adults. In conclusion, ET can provide a way to promote and maintain the personal autonomy for older adults in community dwellings. However, cognitive impairment hinders the use of electronic technologies and increases perceived problems.

Person-Environment Exchange Processes in Transition into Dementia: A Scoping Review

BACKGROUND AND OBJECTIVES

The important role that the environment plays in the lives of older people is widely acknowledged. To date, little is known about person-environment processes during the early stages of dementia. This scoping review aims to provide an overview of the processes involved during early dementia and the relationship to different dimensions of their life space.

RESEARCH DESIGN AND METHODS

A scoping review was conducted according to the Johanna Briggs Institute Manual, which involved searching for research on early dementia and the environment across 3 databases.

RESULTS

A total of 1,358 records were screened, with 284 sources included in the first categorization of the diverse relationships that exist between the environment and the person living with early dementia. Finally, 102 sources were selected that describe person-environment exchange processes of agency, belonging, or stress. People living with dementia actively shape, use, seek out, and avoid their environment as a reaction to both declining abilities and environmental barriers. Specifically, feelings of connectedness and familiarity are important.

DISCUSSION AND IMPLICATIONS

Taking both an environmental gerontology perspective and a processual, that is, transition perspective broadens the understanding of the experience and behavior of people living with early dementia. They constantly interact with and shape their environment and desire a sense of belonging. This sense of belonging might be threatened by dementia but can be actively reinforced by people living with dementia. These person-environment processes and their dynamics over time should be further investigated. Especially, quantitative data and data on socioeconomic environments are lacking.

Designing technology to support greater participation of people living with dementia in daily and meaningful activities

Background

People living with dementia should be at the center of decision-making regarding their plans and goals for daily living and meaningful activities that help promote health and mental well-being. The human-computer interaction community has recently begun to recognize the need to design technologies where the person living with dementia is an active rather than a passive user of technology in the management of their care.

Methods

Data collection comprised semi-structured interviews and focus groups held with dyads of people with early-stage dementia (n = 5) and their informal carers (n = 4), as well as health professionals (n = 5). This article discusses findings from the thematic analysis of this qualitative data.

Results

Analysis resulted in the construction of three main themes: (1) maintaining a sense of purpose and identity, (2) learning helplessness and (3) shared decision-making and collaboration. Within each of the three main themes, related sub-themes were also constructed.

Discussion

There is a need to design technologies for persons living with dementia/carer dyads that can support collaborative care planning and engagement in meaningful activities while also balancing persons living with dementia empowerment and active engagement in self-management with carer support.

Everyday technology use among people with Parkinson's disease

OBJECTIVES

To explore the relevance of and ability to use everyday technology (ET) among people with Parkinson's Disease (PD) and to explore associations between ET use and global cognition and motor ability.

MATERIALS AND METHODS

Cross-sectional data was collected from 34 people with PD using the Short Everyday Technology Use Questionnaire+ (S-ETUQ+), the Movement Disorder Society-Unified Parkinson's Disease Rating Scale and the Montreal Cognitive Assessment (MoCA).

RESULTS

Out of 41 ETs in the S-ETUQ+, the mean number perceived as relevant was 27.5 (min-max 19-35, SD 3.6). A good ability to use ET was reported where many ETs had a challenge measure below participants' ability to use them. A strong positive correlation between the ability to use ET and global cognition (MoCA) (r = .676, p = <0.01) was shown.

CONCLUSIONS

ET use has become integrated into everyday life and is important for participation. This study showed a high relevance of and good ability to use ET and a correlation between ET use and global cognition among people with mild-moderate PD. Evaluation and support to use ET in PD are important for maintaining independence and participation, especially among those with cognitive decline.

'I can see what's going on without being nosey…': What matters to people living with dementia about home as revealed through visual home tours

OBJECTIVES

This paper considers home from the perspective of people living with dementia supporting ongoing discourse around ageing in place and the significance of creating more inclusive communities.

METHODS

Forty-six home tour interviews led by people living with dementia were conducted in England and Scotland to better understand the connectivity between home and neighbourhood for people living with dementia. These interviews used a range of participatory and creative approaches including video, photographic images and in situ interviews. Data were analysed via reflexive thematic analysis.

RESULTS

Three themes were identified in data analysis. 1. Connected home and neighbourhood, where participants revealed the dynamic relationship between home and neighbourhood; 2. Practices of home, where participants discussed the everyday nature of their homes and routines; and 3. Displaying home and family, which reflected participant's biographical homes in the context of living with dementia.

DISCUSSION

The findings show that home holds multiple meanings for people living with dementia. For example, home is understood as a part of the neighbourhood and an extension of the home space into gardens and backyards, thus extending existing discourses that solely focus on the inside of people's homes. For people living with dementia, homes are also sites of negotiation and renegotiation where new meanings are created to reflect the changing nature and context of the home. There is not one fixed solution to these issues. Support and understanding for people living with dementia will need to evolve to adapt to the shifting dynamics and multiple meanings of home.

Daily time management in dementia: qualitative interviews with persons with dementia and their significant others

BACKGROUND

Persons with dementia encounter time-related problems and significant others often need to provide support in daily time management and use of time assistive technology (AT). Further research has been requested on how time AT for persons with dementia affects the situation of significant others. Moreover, there are a few previous qualitative studies on the experiences of time AT by persons with dementia. This study explores the experiences of persons with dementia and significant others in daily time management and their perceptions on how time AT affects everyday life.

METHOD

Semi-structured interviews with persons with mild to moderate dementia (n = 6) and significant others (n = 9) were conducted three months after receiving prescribed time AT. Interviews were analysed using qualitative content analysis.

RESULTS

A main category "Support by significant others is always part of daily time management", and three categories "Facing new challenges", "Using strategies to handle changes", and "Time assistive technology in daily life" illustrated that significant others provided support for daily time management in all phases of dementia. This support was often embedded in other kinds of support for emerging challenges. Support in time management was needed from an early stage in dementia, and responsibility for time management was gradually transferred to significant others. Time AT could support time orientation and were important for sharing the time management conducted by others but did not enable independent time management.

CONCLUSIONS

Time-related assessments and interventions should be offered at an early stage of dementia to increase the possibility of maintaining daily time management skills. Using time AT to communicate time might increase agency and participation in daily occupations for persons with dementia. Given the central role of significant others for daily time management, the society needs to adequately support persons with dementia lacking support from significant others.

"You Know, I Swipe My Card and Hope for the Best": Technology and Cognition as Dual Landscapes of Change

Mild cognitive impairment (MCI), or objective and subjective cognitive decline, affects an estimated 15%–20% of individuals over the age of 65 . People with MCI generally live in community settings but may be at risk for functional changes in out-of-home participation, particularly when their instrumental activities are cognitively demanding or complex. Technology is part of the interface in complex person-place relationships. The purpose of this study is to examine the nature of everyday technology use in the context of out-of-home participation for community-dwelling older adults with MCI. Community-dwelling older adults with MCI (MoCA <26, >17; (n = 10)) were recruited for data collection using a Go-along method (naturalistic observation, semi-structured interviews, and photography) for multiple out-of-home activities. Findings from this project suggested that participants felt that technology, like their cognition, was out of their control and difficult to predict or change. Four ways the participants experienced the “technology landscape” in their daily lives included: enabling being present, facilitating participation, impeding goals, and constricting options. We present a model of the intersection of cognition, participation, and technology in daily life, and discuss ways that technology can most effectively be used to extend well-being for a population aging in place.

Mobile Phone Use by People with Mild to Moderate Dementia: Uncovering Challenges and Identifying Opportunities: Mobile Phone Use by People with Mild to Moderate Dementia

With the rising usage of mobile phones by people with mild dementia, and the documented barriers to technology use that exist for people with dementia, there is an open opportunity to study the specifics of mobile phone use by people with dementia. In this work we provide a first step towards filling this gap through an interview study with fourteen people with mild to moderate dementia. Our analysis yields insights into mobile phone use by people with mild to moderate dementia, challenges they experience with mobile phone use, and their ideas to address these challenges. Based on these findings, we discuss design opportunities to help achieve more accessible and supportive technology use for people with dementia. Our work opens up new opportunities for the design of systems focused on augmenting and enhancing the abilities of people with dementia.

Cognitive Function and the Ability to Operate Long-Term Oxygen Therapy Equipment: An Exploratory Study

Chronic respiratory disease patients with severe hypoxia receive long-term oxygen therapy (LTOT). The proper operation of LTOT equipment is essential for continuing treatment. This exploratory study investigated the relationship between cognitive impairment as a comorbidity in patients receiving LTOT and their ability to operate the LTOT equipment. The study measured responses to questions based on the ability of participants to operate the equipment and applied the Montreal Cognitive Assessment (MoCA). The ability of groups with MoCA scores ≤ 25 and >25 to operate LTOT equipment was compared to confirm the correlation between MoCA and ability to operate the equipment. An aggregate of 60 participants receiving LTOT were recruited, of whom 45 (75%) were MoCA score ≤ 25. The group of MoCA score ≤ 25 demonstrated a lower ability to operate LTOT equipment than group of MoCA score > 25 (p = 0.012). Additionally, a correlation was found between the ability to operate LTOT equipment and MoCA (rs = 0.743, p < 0.001). The results indicated that the group of MoCA score ≤ 25 indicated a lower ability to operate LTOT equipment than that of MoCA score > 25. Cognitive impairment in patients receiving LTOT can affect their ability to operate LTOT equipment.

Assessing Older Adults' Intentions to Use a Smartphone: Using the Meta-Unified Theory of the Acceptance and Use of Technology

Barriers to smartphone use often exist among older adults, and increasing smartphone use is beneficial to increasing older adults' quality of life. Studies of older adults' smartphone use intentions have mostly adopted the technology acceptance model or unified theory of acceptance and use of technology (UTAUT). However, these models have their limitations. A meta-UTAUT has been developed, but it has not been extensively verified with older adults. This study used the meta-UTAUT model to explore the influences on older adults' smartphone use intentions and behaviors. A total of 311 adults aged 60 to 75 years who had minimal experience with smartphones were recruited. They participated in a 16 h smartphone training and then completed a questionnaire. The results demonstrated that the meta-UTAUT model can predict older adults' smartphone use intentions and behaviors. Performance expectancy (PE) and social influence significantly influenced behavioral intention (BI) and attitude toward using smartphones (AT). PE was the strongest factor influencing BI. AT also affected BI. Although facilitating conditions did not significantly affect BI, they had a high influence on AT. To increase smartphone use among older adults, training can be implemented to teach smartphone skills and emphasize the benefits of using smartphones.

The acceptance and use of smartphones among older adults: differences in UTAUT determinants before and after training

Purpose

This article aims at a Unified Theory of Acceptance and Use of Technology (UTAUT) model framework that was used to investigate the impact of a 16-h smartphone training program on the correlations among different constructs of smartphone use in a sample of older adults.

Design/methodology/approach

A total of 208 participants aged 60–78 (mean: 65.4) years completed a questionnaire that collected information on demographic variables and the frequency and duration of smartphone use as well as the answers to questions on the six UTAUT constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and behavioral intention and usage behavior. The data were analyzed using partial least squares analysis.

Findings

This study was the first to compare post-training changes in the correlations among UTAUT constructs. The results revealed significant post-training changes in all construct correlations. Behavioral intention and facilitating conditions were shown to significantly impact usage behavior both before and after training and performance expectancy was shown to impact behavioral intention before training. After training, both effort expectancy and social influence were found to impact behavioral intention significantly. Moreover, the impact of facilitating conditions on usage behavior was significantly increased after training.

Originality/value

To date, no study published in the literature has investigated the impact of technological training on the technology-use intentions and behaviors of older adults. The findings of this study suggest that, for older adults, the results of the acceptance and use model for smartphones change significantly and positively between pre-smartphone training and post-smartphone training time points. The findings support that technology training has a positive impact on smartphone use in older adults.

Understanding How Sensory Changes Experienced by Individuals with a Range of Age-Related Cognitive Changes Can Effect Technology Use

Clinical researchers have identified sensory changes people with age-related cognitive changes, such as dementia and mild cognitive impairment, experience that are different from typical age-related sensory changes. Technology designers and researchers do not yet have an understanding of how these unique sensory changes affect technology use. This work begins to bridge the gap between the clinical knowledge of sensory changes and technology research and design through interviews with people with mild to moderate dementia, mild cognitive impairment, subjective cognitive decline, and healthcare professionals. This extended version of our ASSETS conference paper includes people with a range of age-related cognitive changes describing changes in vision, hearing, speech, dexterity, proprioception, and smell. We discuss each of these sensory changes and ways to leverage optimal modes of sensory interaction for accessible technology use with existing and emerging technologies. Finally, we discuss how accessible sensory stimulation may change across the spectrum of age-related cognitive changes.

Investigating the Potential of Artificial Intelligence Powered Interfaces to Support Different Types of Memory for People with Dementia

There has been a growing interest in HCI to understand the specific technological needs of people with dementia and supporting them in self-managing daily activities. One of the most difficult challenges to address is supporting the fluctuating accessibility needs of people with dementia, which vary with the specific type of dementia and the progression of the condition. Researchers have identified auto-personalized interfaces, and more recently, Artificial Intelligence or AI-driven personalization as a potential solution to making commercial technology accessible in a scalable manner for users with fluctuating ability. However, there is a lack of understanding on the perceptions of people with dementia around AI as an aid to their everyday technology use and its role in their overall self-management systems, which include other non-AI technology, and human assistance. In this paper, we present future directions for the design of AI-based systems to personalize an interface for dementia-related changes in different types of memory, along with expectations for AI interactions with the user with dementia.

Telehealth and digital developments in society that persons 75 years and older in European countries have been part of: a scoping review

BACKGROUND

Demographic changes are leading to an ageing population in Europe. People are becoming more dependent on digital technologies and health ministries invest increasingly in digitalisation. Societal digital demands impact older people and learning to use new telehealth systems and digital devices are seen as a means of securing their needs.

METHODS

The present study undertakes a scoping review in order to map relevant evidence about telehealth and digital developments in society involving citizens aged 75 and over in European countries. It focuses on their experiences and the main barriers to, and facilitators of, societal digital demands. A framework proposed by Arksey and O`Malley was used to guide the scoping review process. The studies included in the review covered telehealth, digital technology and digital devices, and the context covered participants` own home or surroundings. A comprehensive search on PubMed/MEDLINE, CINAHL, Scopus, Embase and Open Grey was undertaken.

RESULTS

Out of 727 identified citations, 13 sources which met the inclusion criteria (9 original study articles, 2 theses, 1 letter about a product and 1 project report). Few of the studies identified have investigated European citizens 75 years and older separately. The studies included varied in their design, location and focus. Older people have experienced both telehealth and digital devices making life easier and the opposite. The outstanding facilitator found was that technology should be easy to use, and difficulty in remembering the instructions was seen as an important barrier. Interestingly, both social support and lack of social support were found as facilitators of using new devices.

CONCLUSIONS

Telehealth may give a sense of security but learning to use a new device often takes extra effort. Older people were more open to new devices if the possible advantages of the new technology outweighed the effort that would be involved in adopting a new strategy. As technology develops rapidly, and life expectancy in Europe is anticipated to rise continually, there is a need for new and additional research among older European citizens. Future research should cover the technical solutions most relevant to older people today, social support and participants` access to the devices.

Exploring the feasibility of an individual cognitive stimulation therapy application and related technology for use by people with dementia and carers in Indonesia: A mixed-method study

BACKGROUND

Cognitive stimulation therapy (CST) is a psychosocial intervention for people with dementia and can benefit cognition and quality of life. A touch-screen individualised CST (iCST) application has been developed to improve on accessibility and provide increased interactivity. This study aimed to explore the attitudes of people with dementia, carers and healthcare professionals in Indonesia towards the iCST application and related technology.

METHODS

Four focus groups were organised: one comprising family carers (n = 3), two comprising people with dementia and family carers (n = 12) and one made up of family carers and home care workers (n = 3). Participants discussed the uses of technology, tried out the iCST application and completed a usability and acceptability questionnaire. Furthermore, 21 healthcare professionals attended an expert meeting to discuss the potential of implementing the iCST application in the community.

RESULTS

Attitudes towards technology were positive but lack of experience, difficulties with operating devices and a limited infrastructure to support technology were described as barriers. The iCST application was seen as an interesting tool to support mental stimulation. Compared with people with dementia, carers were more willing to use the application and rated its usability higher. Healthcare professionals were positive about the interactive features of the application and judged that it could be useful within the family context.

DISCUSSION

Low-cost and low-infrastructure technology like iCST can meet the needs for stimulation of people with dementia in Indonesia and other countries. By understanding the attitudes of people with dementia and carers towards IT and their willingness to adopt technology like the iCST application, we are better placed to overcome potential obstacles to its implementation. It appears that systemic changes are needed to facilitate wider use of IT particularly in dementia care. These include needs to empower end users, strengthen access and connectivity to technology, and improve diagnostic support.

The Impact of a Global Pandemic on People Living with Dementia and Their Care Partners: Analysis of 417 Lived Experience Reports

Background:

The COVID-19 pandemic is impacting the physical and emotional health of older adults living with dementia and their care partners.

Objective:

Using a patient-centered approach, we explored the experiences and needs of people living with dementia and their care partners during the COVID-19 pandemic as part of an ongoing evaluation of dementia support services in British Columbia, Canada.

Methods:

A survey instrument was developed around the priorities identified in the context of the COVID-19 and Dementia Task Force convened by the Alzheimer Society of Canada.

Results:

A total of 417 surveys were analyzed. Overall, respondents were able to access information that was helpful for maintaining their own health and managing a period of social distancing. Care partners reported a number of serious concerns, including the inability to visit the person that they care for in long-term or palliative care. Participants also reported that the pandemic increased their levels of stress overall and that they felt lonelier and more isolated than they did before the pandemic. The use of technology was reported as a way to connect socially with their loved ones, with the majority of participants connecting with others at least twice per week.

Conclusion:

Looking at the complex effects of a global pandemic through the experiences of people living with dementia and their care partners is vital to inform healthcare priorities to restore their quality of life and health and better prepare for the future.

Evaluation of FindMyApps: protocol for a randomized controlled trial of the effectiveness and cost-effectiveness of a tablet-based intervention to improve self-management and social participation of community-dwelling people with mild dementia, compared to usual tablet use

BACKGROUND

For the rising number of people living with dementia, cost-effective community-based interventions to support psychosocial care are needed. The FindMyApps intervention has been developed with and for people with dementia and their caregivers, to help them use tablets to facilitate self-management and engagement in meaningful social activities. A feasibility study and exploratory pilot trial evaluating FindMyApps have been carried out. This definitive trial further evaluates the effectiveness of the intervention and, for the first time, the cost-effectiveness.

METHODS

A randomized controlled non-blinded single-center two-arm superiority trial will be conducted. Community-dwelling people with Mild Cognitive Impairment (MCI), or dementia with a Mini Mental-State Examination (MMSE) of > 17 and < 26, or Global Deterioration Scale 3 or 4, with an informal caregiver and access to a wireless internet connection will be included. In total, 150 patient-caregiver dyads will be randomly allocated to receive either usual care (control arm - tablet computer; n = 75 dyads) or usual care and the FindMyApps intervention (experimental arm - tablet computer and FindMyApps; n = 75 dyads). The primary outcomes are: for people with dementia, self-management and social participation; for caregivers, sense of competence. In addition to a main effect analysis, a cost-effectiveness analysis will be performed. In line with MRC guidance for evaluation of complex interventions a process evaluation will also be undertaken.

DISCUSSION

Results of the trial are expected to be available in 2023 and will be submitted for publication in international peer-reviewed scientific journals, in addition to conference presentations and reporting via the EU Marie Sklodowska-Curie DISTINCT ITN network. By providing evidence for or against the effectiveness and cost-effectiveness of the FindMyApps intervention, the results of the trial will influence national implementation of FindMyApps. We hope that the results of the trial will further stimulate research and development at the intersection of technology and psycho-social care in dementia. We hope to further demonstrate that the randomized controlled trial is a valuable and feasible means of evaluating new digital technologies, to stimulate further high-quality research in this growing field.

TRIAL REGISTRATION NUMBER

Netherlands Trial Register: NL8157 ; registered 15th November 2019.

The experience and acceptability of smartphone reminder app training for people with acquired brain injury: a mixed methods study

Smartphones are useful compensatory memory aids, yet training on how to use them is seldom offered as part of rehabilitation for acquired brain injuries (ABIs). We aimed to explore the experience and acceptability of a smartphone training intervention in 26 people with ABI who participated in a pilot randomized controlled trial comparing three skills training approaches. Participants completed questionnaire ratings and a semi-structured interview, six weeks post-training. Most participants rated the training as enjoyable (80.8%) and reasonable in duration (88.5%). Others reported that more than one training session was needed to learn the app (34.6%). Five themes were identified from qualitative data through thematic analysis: (1) Attitudes and pre-existing factors, (2) Experiencing the intervention, (3) Tailoring the intervention to the individual, (4) Facilitators and barriers to implementation and (5) Enhancing smartphone use in everyday life. These themes were juxtaposed with a theoretical framework of acceptability, which indicated that some elements (e.g., having a structured session and a supportive trainer) contributed to the acceptability of the intervention by minimizing training burden and increasing self-efficacy. Tailoring the training to the individual's technological skills and lifestyle, providing post-training resources and involving family members were identified as factors that could improve intervention acceptability.

New Insights into Activities of Daily Living Performance in Chronic Obstructive Pulmonary Disease

Purpose

There have been calls for more knowledge of activities of daily living (ADL) performance in order to address interventions in pulmonary rehabilitation effectively. Everyday technology (ET) has become an integrated dimension of ADL, impacting the ways in which ADL is performed. To improve everyday functioning and quality of life, the use of ADL and ET use needs to be evaluated and addressed effectively in interventions. Therefore, the aim of this study was twofold: 1) to explore the quality of ADL performance, and 2) to investigate the relationship between observation and self-reported ADL performance and ability to use everyday technologies in people living with COPD.

Methods

This cross-sectional study involved 84 participants aged 46–87 years. Participants were recruited through healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were collected using standardized assessments that investigated different ADL perspectives: self-reported ADL tasks and ET use, observed motor and process ability, and need for assistance. Data were analysed and presented using descriptive statistics and Pearson’s correlation coefficient.

Results

The most affected ADL tasks were mobility within or outside the home, lower dressing, bathing, pedicuring, cooking, shopping, cleaning and washing clothes. New insights into the quality of ADL performance in people living with COPD were presented in terms of detailed ADL motor skills and ADL process skills, as well as the predicted need for support to function in the community. Moreover, new insights into the relationship between observation and self-reported ADL performance (r=0.546, p<0.01; r=0.297, p<0.01) and between ADL performance and self-perceived ability to use ET (r=0.524, p<0.01; r=0.273, p<0.05; r=0.044, p=0.692) were presented.

Conclusion

Overall, the knowledge from the present study is valuable for focusing interventions that address challenging ADL performance and ET use through relevant and realistic activities. The ability to use ET is important to evaluate and target pulmonary rehabilitation.

Investigating Best Practices for Remote Summative Usability Testing with People with Mild to Moderate Dementia

People with dementia may miss out on the benefits of using technology, because they often find it difficult to use. Usability testing is one method to identify barriers and areas for improvement in technology. Unfortunately, usability testing is often not conducted with people with dementia, independent of their caregivers. Difficulty recruiting local participants with dementia who regularly use technology further compounds the problem. Remote methods have been proposed as one approach to recruiting hard-to-reach populations. Currently, it is unclear how to effectively conduct remote summative usability testing with people with dementia. We recruited 15 participants. Five took part in the pilot study and 10 participated in the main study. We identify best practices and make suggestions for remote summative usability tests with people who have mild to moderate dementia, independent of caregivers. We discuss our findings in three sections: (1) logistics for planning remote summative usability testing, (2) approaches for conducting remote summative usability testing, including modifications of research methods, and (3) considerations when evaluating findings from remote summative usability sessions. We also present modified usability testing methods we developed to meet the unique needs of users with mild to moderate dementia, and summarize lessons learned and new directions for research on this topic.

Presenting an analytic framework facilitating a situationally oriented analysis of the use of digital technology for engagement in occupation

BACKGROUND

Digital technology is closely intertwined with and influences people's everyday lives. Within occupational science and occupational therapy, research is therefore warranted into situationally oriented analysis of the use of digital technology for engagement in occupation.

OBJECTIVE

To contribute with an analytic framework facilitating a situationally oriented analysis of the use of digital technology for engagement in occupation.

MATERIAL AND METHODS

An operationalisation of Dewey's theory of transaction and inquiry in conjunction with an occupational science approach served as the analytical framework for exploring how underprivileged adults use digital technology for engaging in health-related occupation.

FINDINGS

The analytical framework proved useful for a situationally oriented analysis of digital technology use for engagement in occupation: by fostering identification and registration of digital technology artefacts used for engagement in occupation, by making transparent the complexity that the situation creates for the participant, by identifying problems with and needs for inquiries in relation to engagement in occupation and, finally, by facilitating a situation-oriented analytical language.

CONCLUSION

The analytical framework presented is useful for conducting a situationally oriented analysis of digital technology use for engagement in occupation. Future research and validation of the analytical framework are needed.

The use of everyday technology; a comparison of older persons with cognitive impairments’ self-reports and their proxies’ reports

Introduction

Older persons with cognitive impairment have often been disregarded in providing information on their own perceptions. This study explored the number of relevant everyday technologies and the ability to use everyday technologies as perceived by persons with cognitive impairment in comparison with their proxies’ estimates using the Short Everyday Technology Use Questionnaire.

Method

In this cross-sectional study, persons with cognitive impairment ( n = 21) and their proxies ( n = 21) were interviewed on separate occasions with the Short Everyday Technology Use Questionnaire, which measures the number of relevant everyday technologies and the ability to use everyday technologies. The data were analysed with t-tests, z-comparisons, and Fisher’s exact test. The level of significance was set at p < 0.05.

Results

At the group level, no significant differences were found between persons with cognitive impairments’ perceptions and their proxies’ estimates regarding the number of relevant everyday technologies or the ability to use everyday technologies. On the individual level, significant differences were found in the ability measures within four out of the 21 dyads.

Conclusion

The persons with cognitive impairment and their proxies verified each other’s responses, providing evidence that persons with cognitive impairment should be the primary source for information about their own everyday technology use.

The Role of Sensory Changes in Everyday Technology use by People with Mild to Moderate Dementia

Technology design for dementia primarily focuses on cognitive needs. This includes providing task support, accommodating memory changes, and simplifying interfaces by reducing complexity. However, research has demonstrated that dementia affects not only the cognitive abilities of people with dementia, but also their sensory and motor abilities. This work provides a first step towards understanding the interaction between sensory changes and technology use by people with dementia through interviews with people with mild to moderate dementia and practitioners. Our analysis yields an understanding of strategies to use technology to overcome sensory changes associated with dementia as well as barriers to using certain technologies. We present new directions for the design of technologies for people with mild to moderate dementia, including intentional sensory stimulation to facilitate comprehension, as well as opportunities to leverage advances in technology design from other disabilities for dementia.

Does the purpose matter? A comparison of everyday information and communication technologies between eHealth use and general use as perceived by older adults with cognitive impairment

BACKGROUND AND OBJECTIVE

Everyday information and communication technologies (EICTs) are increasingly being used in our society, for both general and health-related purposes. This study aims to compare how older adults with cognitive impairment perceive relevance and level of EICT challenge between eHealth use and general use.

METHODS

This cross-sectional study includes 32 participants (65-85 years of age) with cognitive impairment of different origins (due to e.g., stroke or dementia). The Short Everyday Technology Use Questionnaire+ (S-ETUQ+) was used, providing information about the relevance of EICTs and measuring the EICT level of challenge. Data were analysed with descriptive statistics, standardized z-tests and Fisher's exact tests. The significance level was set to p < .05.

RESULTS

The result shows that the perceived amount of relevant EICTs for eHealth use was lower in all 16 EICTs compared to those of general use. About the perceived level of challenge, a significant difference was detected in one of the seven included EICTs between eHealth use and general use.

CONCLUSIONS

In this sample, all EICTs were perceived as having lower relevance for eHealth use compared to general use, suggesting that the purpose of using an EICT affects the perceived relevance of it. Also, once an EICT is perceived as relevant and used for eHealth purposes, there seem to be little to no differences in perceived challenge compared to the same EICT used for general purposes.Implications for rehabilitationAll stakeholders, including health care providers, need to be aware of the hindrances that come with digitalization, making it challenging to many citizens to make use of digital solutions.It is of great importance that social services including eHealth services be tailored to suit the individual/target group.Older adults may need support and an introduction to EICTs to discover the potential relevance of the specific device and/or service.

Managing medicines in the time of COVID-19: implications for community-dwelling people with dementia

COVID-19 has changed life beyond recognition for millions of individuals, as countries implement social distancing measures to prevent disease transmission. For certain patient groups, such as community-dwelling older people with dementia (PwD), these restrictions may have far-reaching consequences. Medicines management may be adversely affected and deserves careful thought. PwD face unique challenges with medicines management compared to other older people, often relying upon support from family/carers and primary healthcare professionals. This article considers potential issues that PwD may face with each component of medicines management (prescribing, dispensing, administration, adherence, review), and based on previous research, highlights strategies to support PwD and their carers during this time. Primary healthcare professionals must be attentive to medicines-related needs of community-dwelling PwD, particularly those living alone, both during the pandemic and as restrictions are lifted. Carers of PwD continue to have a critical role to play in medicines management, and also require support.

The perceived challenge of everyday technologies in Sweden, the United States and England: Exploring differential item functioning in the everyday technology use questionnaire

Background: The changing technological environment is reflected in regular updates made to the everyday technology (ET) use questionnaire (ETUQ). Newly added ETs may not present comparable challenges across countries and diagnoses.Aims: To identify whether country context, or dementia diagnosis, impact ETs' challenge level.Material and methods: 315 older adults from three countries were included; Sweden (n = 73), United States (n = 114), England (n = 128), and had a confirmed diagnosis of mild dementia (n = 99) or no known cognitive impairment (n = 216). Differential Items Functioning (DIF) analysis was performed on 88 ETs included in the ETUQ by country and diagnosis. The impact of DIF was evaluated in a Differential Test Functioning (DTF) analysis.Results: Nine items (10.2%) in the ETUQ showed statistically significant DIF between countries; five of which were public space ETs and none of which were information and communication technologies (ICTs). Three ICT items, and no others, showed significant DIF by diagnosis. The items' DIF was shown to have no impact upon person measures of ability to use ET in the DTF.Conclusions and significance: The utility of the ETUQ in occupational therapy practice and research internationally is highlighted through the stability of the challenge hierarchy and lack of impact on person measures.

Numeric input operation on electronic devices among individuals with visuospatial working memory impairment

ABSTRACTIn human-computer interactions, higher-level visuospatial function is likely needed to effectively use the interface. The aim of this study is to clarify whether individuals with visuospatial defects can use electronic devices effectively. We quantitatively and qualitatively analyzed the ability of seven individuals with Bálint syndrome and seven individuals with left-unilateral spatial neglect (USN) to input a digit sequence into a flat touch interface. Control groups consisted of seven individuals with memory deficits and 11 healthy individuals. Participants with Bálint syndrome took longer and had more hesitations than the USN group and the two control groups to input numerical sequences (Steel-Dwass test, p < .01). In addition, participants with Bálint syndrome had a high percentage of hesitations for exploration of the button array on the interface relative to USN and the memory deficit group (Fisher's exact test, p < .05). Regarding neuropsychological data, participants with Bálint syndrome had a lower score for visuospatial working memory than participants with USN and the memory deficits control group (Steel-Dwass test, p < .01). The results shed some light on the relation between visuospatial working memory deficits and the spatial perception of interface layouts and spatial control during electronic device operation.

A Multi-Sensor Cane Can Detect Changes in Gait Caused by Simulated Gait Abnormalities and Walking Terrains

Due to the increasing rates of chronic diseases and an aging population, the use of assistive devices for ambulation is expected to grow rapidly over the next several years. Instrumenting these devices has been proposed as a non-invasive way to proactively monitor changes in gait due to the presence of pain or a condition in outdoor and indoor environments. In this paper, we evaluated the effectiveness of a multi-sensor cane in detecting changes in gait due to the presence of simulated gait abnormalities, walking terrains, impaired vision, and incorrect cane lengths. The effectiveness of the instrumented cane was compared with the results obtained directly from a shank-mounted inertial measurement unit. Results from 30 healthy participants obtained while simulating gait abnormalities and walking over different terrains demonstrated the ability of the cane to reliably and effectively discriminate among these walking conditions. Moreover, the results obtained while walking with impaired vision and incorrect cane lengths indicate the ability of cane to detect changes in gait during these scenarios as well.

Association Between Everyday Technology Use, Activities of Daily Living and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease

Purpose

A decline in the ability to perform activities of daily living (ADL) and ability to use everyday technology can pose threats to independent living, healthcare management and quality of life (QOL) of patients suffering from chronic obstructive pulmonary disease (COPD). Evidence of the relationship between these variables remains limited. The dual aim of this study was, first, to investigate if health-related QOL (HRQOL) was associated with quality in ADL performance and everyday technology use; second, to examine whether lung function, years with COPD diagnosis, living status or educational level affected physical and mental domains of HRQOL.

Methods

This cross-sectional study included (N=80) participants aged 46-87 years recruited at healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were gathered through standardized assessments and analysed using multiple regression analysis.

Results

The regression model explained 50.6% (R2=0.506) of the variation in HRQOL-physical. The following four variables were statistically significantly associated with HRQOL - physical: years since COPD diagnosis (p=0.023), ability to use everyday technology (p=0.006), amount of relevant everyday technologies (p=0.015) and ADL motor ability (p<0.01). The regression model explained 22.80% (R2=0.228) of HRQOL - mental. Only the variable ability to use everyday technology was statistically significantly associated with HRQOL - mental (p=0.009).

Conclusion

Quality of ADL performance and everyday technology use seem to be associated with HRQOL in people living with COPD. The only demographic variable associated with HRQOL was years with COPD. This indicates that healthcare professionals should enhance their attention also to ADL-performance and everyday technology use when striving to increase the HRQOL of persons living with COPD.

The use of everyday information communication technologies in the lives of older adults living with and without dementia in Sweden

Background: Increasingly services and interventions involve everyday information communication technologies (EICTs) in provision, however, use of EICTs among people with dementia is little known. Therefore, this study aimed to investigate the relevance, use, and ability to use EICTs between a group of older adults with dementia and a comparison group with no known cognitive impairment. Method: Interviews with 35 people with dementia, 34 comparison participants using the standardized Everyday Technology Use Questionnaire. Variables were compared using descriptive statistics, t-tests and correlation analyses. Results: Median 7 EICTs (maximum 31) were relevant to the group with dementia; significantly less than the comparison group's 11 (p< .05, d= 0.64). The difference in use appeared more pronounced (group with dementia 5, comparison group 10.5; p< .001, d= 0.93). Large, significant relationships were evident between ability to use technology, and relevant or used EICTs in the group with dementia. No such relationships in the comparison group. Conclusion: Differences in the amounts of EICTs relevant and used among people with and without dementia are further reflected in the dementia group's ability to use technology. Accommodating the demands that EICTs place on users and harnessing the dominant EICT relevancies and abilities of people with dementia better contributes towards an inclusive, dementia-friendly society.

When technology cares for people with dementia: A critical review using neuropsychological rehabilitation as a conceptual framework

Clinicians and researchers have become increasingly interested in the potential of technology in assisting persons with dementia (PwD). However, several issues have emerged in relation to how studies have conceptualized who the main technology user is (PwD/carer), how technology is used (as compensatory, environment modification, monitoring or retraining tool), why it is used (i.e., what impairments and/or disabilities are supported) and what variables have been considered as relevant to support engagement with technology. In this review we adopted a Neuropsychological Rehabilitation perspective to analyse 253 studies reporting on technological solutions for PwD. We analysed purposes/uses, supported impairments and disabilities and how engagement was considered. Findings showed that the most frequent purposes of technology use were compensation and monitoring, supporting orientation, sequencing complex actions and memory impairments in a wide range of activities. The few studies that addressed the issue of engagement with technology considered how the ease of use, social appropriateness, level of personalization, dynamic adaptation and carers' mediation allowed technology to adapt to PWD's and carers' preferences and performance. Conceptual and methodological tools emerged as outcomes of the analytical process, representing an important contribution to understanding the role of technologies to increase PwD's wellbeing and orient future research.

The Precarity of Older Adults Living Alone With Cognitive Impairment

PURPOSE OF THE STUDY

To examine the lived experience of older adults living alone with cognitive impairment to better understand their needs and concerns. Based on our previous work suggesting that older adults living alone often experience a sense of precarity, we were interested in exploring this construct in older adults living alone with a diagnosis of cognitive impairment. The notion of precarity points to the uncertainty deriving from coping with cumulative pressures while trying to preserve a sense of independence.

DESIGN AND METHODS

This is a qualitative study of 12 adults aged 65 and older living alone with cognitive impairment. Six participants had a diagnosis of Alzheimer's disease; 6 had a diagnosis of mild cognitive impairment. Participants' lived experiences were elicited through 40 ethnographic interviews and participant observation in their homes. Using a qualitative content analysis approach, interview transcripts and fieldnotes were analyzed to identify codes and themes.

RESULTS

Qualitative analysis of transcripts revealed three themes. Theme 1 described the distress stemming from the uncertainty of having cognitive impairment that has an unpredictable course. Theme 2 drew attention to the tendency of participants to feel responsible for managing their cognitive impairment. Theme 3 described the pressures stemming from the lack of appropriate services to support independent living for persons with cognitive impairment.

IMPLICATIONS

These 3 themes all pointed to facets of precarity. Findings also suggest the dearth of programs to support older adults living alone with cognitive impairment and the need to develop novel programs and interventions.

Experiences from using eHealth in contact with health care among older adults with cognitive impairment

RATIONALE

Since health care is facing challenges, with fewer caregivers providing care to more clients, eHealth plays a crucial role. Through eHealth, people are expected to be more involved in their own care. On the part of health care users, eHealth requires use of everyday technology such as telephones and computers, and services through the Internet which might be challenging for older adults with cognitive impairment.

AIM

To investigate experiences of using eHealth in contact with health care among older adults with cognitive impairment.

METHOD

Individual, semi-structured interviews were conducted with nine participants, aged 65-84 years, with cognitive impairments of varying origins. A constructivist Grounded Theory approach was used. Data collection and analysis were performed simultaneously using a constant comparative method.

ETHICAL ISSUES

Ethical approval (Dnr: 2014/906-32) was obtained from the regional ethical committee, Stockholm.

RESULTS

The core category, the eHealth staircase supported by habits, is presented as a model that visualises the result. The model includes three steps showing different ways of being in contact with health care through the use of technological devices and services that mirrors different levels of complexity of eHealth use as follows: (i) Analogue use, (ii) One-way-use and (iii) Interactive use. The participants' location on the eHealth staircase was affected by several aspects described in three categories united by habits; A stable relationship with technology: a prerequisite for use; The importance of interpersonal relationships within health care and Being supported by significant others: a prerequisite in contact with health care.

CONCLUSIONS

Older adults with cognitive impairments seemed to prefer common and less complex eHealth when contacting health care. Therefore, it is necessary that health care providers offer different possibilities for patients to contact them, that is, both through the Internet and by personal telephone service.

A Multi-Sensor Matched Filter Approach to Robust Segmentation of Assisted Gait

Individuals with mobility impairments related to age, injury, or disease, often require the help of an assistive device (AD) such as a cane to ambulate, increase safety, and improve overall stability. Instrumenting these devices has been proposed as a non-invasive way to proactively monitor an individual’s reliance on the AD while also obtaining information about behaviors and changes in gait. A critical first step in the analysis of these data, however, is the accurate processing and segmentation of the sensor data to extract relevant gait information. In this paper, we present a highly accurate multi-sensor-based gait segmentation algorithm that is robust to a variety of walking conditions using an AD. A matched filtering approach based on loading information is used in conjunction with an angular rate reversal and peak detection technique, to identify important gait events. The algorithm is tested over a variety of terrains using a hybrid sensorized cane, capable of measuring loading, mobility, and stability information. The reliability and accuracy of the proposed multi-sensor matched filter (MSMF) algorithm is compared with variations of the commonly employed gyroscope peak detection (GPD) algorithm. Results of an experiment with a group of 30 healthy participants walking over various terrains demonstrated the ability of the proposed segmentation algorithm to reliably and accurately segment gait events.

Test-retest and inter-rater reliability of the Danish version of the management of everday technology assessment for use with older adults with and without COPD

BACKGROUND

The trend towards telemedicine increasingly requires clients to manage everyday technology (ET) to access and use health services. The Management of Everday Technology Assessment (META) is an observation-based instrument developed to evaluate the ability to manage ET.

AIM

To examine test-retest (TRR) and inter-rater reliability (IRR) of the Danish translation of the META for older adults with and without COPD.

METHOD AND MATERIALS

47 older adults with COPD (n = 23) and without (n = 24) were recruited. IRR was examined by four raters paired across 30 participants. TRR was examined for 21 participants by the same rater administering the META twice within four weeks. A rank-based method for paired ordinal data was used to calculate percentage agreement (PA) and measures of systematic disagreement and individual variability. Mann Whitney U tests were used to compare PA to health status (presence/absence of COPD).

RESULTS

Inter-rater PA was acceptable across 10 of 11 items and test-retest PA across 8 of 11 items. Systematic disagreement was present for one item in TRR. No significant differences in PA were found regarding health status.

CONCLUSION

The Danish META generates reliable scores for this sample. However, conclusive statements cannot be made for all items.

Personalisation, customisation and bricolage: how people with dementia and their families make assistive technology work for them

Assistive technologies (ATs) are being ‘mainstreamed’ within dementia care, where they are promoted as enabling people with dementia to age in place alongside delivering greater efficiencies in care. AT provision focuses upon standardised solutions, with little known about how ATs are used by people with dementia and their carers within everyday practice. This paper explores how people with dementia and carers use technologies in order to manage care. Findings are reported from qualitative semi-structured interviews with 13 people with dementia and 26 family carers. Readily available household technologies were used in conjunction with and instead of AT to address diverse needs, replicating AT functions when doing so. Successful technology use was characterised by ‘bricolage’ or the non-conventional use of tools or methods to address local needs. Carers drove AT use by engaging creatively with both assistive and everyday technologies, however, carers were not routinely supported in their creative engagements with technology by statutory health or social care services, making bricolage a potentially frustrating and wasteful process. Bricolage provides a useful framework to understand how technologies are used in the everyday practice of dementia care, and how technology use can be supported within care. Rather than implementing standardised AT solutions, AT services and AT design in future should focus on how technologies can support more personalised, adaptive forms of care.

Ethical adoption: A new imperative in the development of technology for dementia

INTRODUCTION

Technology interventions are showing promise to assist persons with dementia and their carers. However, low adoption rates for these technologies and ethical considerations have impeded the realization of their full potential.

METHODS

Building on recent evidence and an iterative framework development process, we propose the concept of "ethical adoption": the deep integration of ethical principles into the design, development, deployment, and usage of technology.

RESULTS

Ethical adoption is founded on five pillars, supported by empirical evidence: (1) inclusive participatory design; (2) emotional alignment; (3) adoption modelling; (4) ethical standards assessment; and (5) education and training. To close the gap between adoption research, ethics and practice, we propose a set of 18 practical recommendations based on these ethical adoption pillars.

DISCUSSION

Through the implementation of these recommendations, researchers and technology developers alike will benefit from evidence-informed guidance to ensure their solution is adopted in a way that maximizes the benefits to people with dementia and their carers while minimizing possible harm.

Usability and acceptability of technology for community-dwelling older adults with mild cognitive impairment and dementia: a systematic literature review

Background

The objective of this review was to obtain an overview of the technologies that have been explored with older adults with mild cognitive impairment and dementia (MCI/D), current knowledge on the usability and acceptability of such technologies, and how people with MCI/D and their family carers (FCs) were involved in these studies.

Materials and methods

Primary studies published between 2007 and 2017 that explored the use of technologies for community-dwelling people with MCI/D were identified through five databases: MEDLINE, PsycINFO, Embase, AMED, and CINAHL. Twenty-nine out of 359 papers met the criteria for eligibility. We used the Mixed Methods Appraisal Tool for quality assessment.

Results

A wide range of technologies was presented in the 29 studies, sorted into four domains: 1) safe walking indoors and outdoors; 2) safe living; 3) independent living; and 4) entertainment and social communication. The current state of knowledge regarding usability and acceptability reveals that even if researchers are aware of these concepts and intend to measure usability and acceptability, they seem difficult to assess. Terms such as “user friendliness” and “acceptance” were used frequently. User participation in the 29 studies was high. Persons with MCI/D, FCs, and staff/other older adults were involved in focus groups, workshops, and interviews as part of the preimplementation process.

Conclusion

Research regarding technologies to support people with MCI/D seems optimistic, and a wide range of technologies has been evaluated in homes with people with MCI/D and their FCs. A major finding was the importance of including people with MCI/D and their FCs in research, in order to learn about required design features to enhance usability and acceptability. Surprisingly, very few studies reported on the consequences of technology use with regard to quality of life, occupational performance, or human dignity.

Electronic memory aids for people with dementia experiencing prospective memory loss: A review of empirical studies

This paper details a review of the literature on the use of electronic aids for prospective memory for people with dementia. Key findings of the review are that: electronic memory aids show potential for supporting people’s prospective memory but the devices and software applications need further development in order to function reliably; sample sizes of studies are often very small, limiting the generalisability of their findings; few studies of devices are conducted in users’ home environments; and most of the studies focus on the effectiveness of the electronic memory aid, rather than outcomes for users, such as improved daily functioning, quality of life, or social connectedness. The review concludes that future studies with robust devices are required that explicitly focus on the varying needs and capacities of people with dementia, in order to generate additional evidence for the effectiveness of electronic memory aids for this cohort.

ELECTRONIC DEVICES FOR COGNITIVE IMPAIRMENT SCREENING: A SYSTEMATIC LITERATURE REVIEW

OBJECTIVES

The reduction in cognitive decline depends on timely diagnosis. The aim of this systematic review was to analyze the current available information and communication technologies-based instruments for cognitive decline early screening and detection in terms of usability, validity, and reliability.

METHODS

Electronic searches identified 1,785 articles of which thirty-four met the inclusion criteria and were grouped according to their main purpose into test batteries, measures of isolated tasks, behavioral measures, and diagnostic tools.

RESULTS

Thirty one instruments were analyzed. Fifty-two percent were personal computer based, 26 percent tablet, 13 percent laptop, and 1 was mobile phone based. The most common input method was touchscreen (48 percent). The instruments were validated with a total of 4,307 participants: 2,146 were healthy older adults (M = 73.59; SD = 5.12), 1,104 had dementia (M = 74.65; SD = 3.98) and 1,057 mild cognitive impairment (M = 74.84; SD = 4.46). Only 6 percent were administered at home, 19 percent reported outcomes about usability, and 22 percent about understandability. The methodological quality of the studies was good, the weakest methodological area being usability. Most of the instruments obtained acceptable values of specificity and sensitivity.

CONCLUSIONS

It is necessary to create home delivered instruments and to include usability studies in their design. Involvement of people with cognitive decline in all phases of the development process is of great importance to obtain valuable and user-friendly products. It would be advisable for researchers to make an effort to provide cutoff points for their instruments.

Everyday technology use among older adults in Sweden and Portugal

BACKGROUND

Technology use is relevant for engaging in everyday occupations and aging in place and difficulties might limit participation.

AIM

The aim of the present study was two-fold: to investigate the internal scale validity of the Everyday Technology Use Questionnaire (ETUQ) in a matched Portuguese and a Swedish sample of older adults without known cognitive impairments and to compare everyday technology use (i.e., the relevance of Everyday Technology (ET) and perceived difficulty of using ET).

METHODS

The Rasch rating scale model was used to investigate the psychometric properties of the data from the two countries. Analyses were then used to compare the samples.

RESULTS

There is evidence of internal scale and person response validity in the Swedish and Portuguese ETUQ datasets. The Swedish sample demonstrated almost 25% more ETs to be relevant, as compared to the Portuguese sample (p < .05). The samples' means of perceived difficulty in using ETs were similar.

CONCLUSIONS

The results support that the ETUQ is a valid assessment for measuring the relevance of and perceived difficulty of ET use and is able to detect differences and similarities between older adults in these European countries in relation to ET use in the home and society.