IT-based wellness tools for older adults: Design concepts and feedback

A codesigned web platform for reducing social isolation and loneliness in older people: a feasibility study

Social isolation and loneliness are associated with negative health outcomes, physical as well as cognitive. Information and communication technology (ICT) can be effective tools for preventing and tackling social isolation and loneliness among older people. Our objective was to evaluate the feasibility of the Fik@ room, a web platform for social interaction designed for older people. A mixed methods design was applied, where both quantitative and qualitative data were collected during a 12-week period (n = 28, Md age 74). Experiences of loneliness were reduced using the Fik@ room. The results highlight the feasibility issues surrounding the recruitment process, adoption, pattern of use, usability, support service, and technical infrastructure. In particular, the importance of offering ICT solutions with few technical issues, and to provide easily accessible and appropriate support. The Fik@ room is a feasible tool for older people to develop new friendships, reduce loneliness, and grow their social networks. However, it is not a communication option that fits all. The results offer a compilation of feasibility issues that can serve as an inspirational guide in the design and implementation of similar technologies.

Perspectives of Primary Care Clinicians in Massachusetts on use of Telemedicine with Adults aged 65 and Older during the COVID-19 Pandemic

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PCPs have disparate attitudes towards telemedicine primary care for adults >65.

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Multilevel interventions are needed to optimize telemedicine care for older adults.

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PCPs find telemedicine most effective for chronic disease management.

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PCPs appreciate telemedicine’s convenience but worry about the lack of touch.

To learn how to improve telemedicine for adults >65, we asked primary care clinicians (“PCPs”) affiliated with one large Boston-area health system their views on using telemedicine (which included phone-only or video visits) with adults >65 during the COVID-19 pandemic. In open-ended questions, we asked PCPs to describe any challenges or useful experiences with telemedicine and suggestions for improving telemedicine as part of a larger web-based survey conducted between September 2020 and February 2021. Overall, 163/383 (42%) PCPs responded to the survey. Of these, 114 (70%) completed at least one open-ended question, 85% were non-Hispanic white, 59% were female, 75% were community-based, and 75% were in practice >20 years. We identified three major themes in participants’ comments including the need to optimize telemedicine; integrate telemedicine within primary care; and that PCPs had disparate attitudes towards telemedicine for older adults. To optimize telemedicine, PCPs recommended more effective digital platforms, increased utilization of home medical equipment (e.g., blood pressure cuffs), and better coordination with caregivers. For integration, PCPs recommended targeting telemedicine for certain types of visits (e.g., chronic disease management), enabling video access, and reducing administrative burdens on PCPs. As for PCP attitudes, some felt telemedicine enhanced the doctor-patient relationship, improved the patient experience, and improved show rates. Others felt that telemedicine visits were incomplete without a physical exam, were less rewarding, and could be frustrating. Overall, PCPs saw a role for telemedicine in older adults’ care but felt that more support is needed for these visits than currently offered.

Design Considerations for Mobile Health Applications Targeting Older Adults

Mobile technologies are becoming ubiquitous in the world, changing the way we communicate and provide patient care and services. Some of the most compelling benefits of mobile technologies are in the areas of disease prevention, health management, and care delivery. For all the advances that are occurring in mobile health, its full potential for older adults is only starting to emerge. Yet, existing mobile health applications have design flaws that may limit usability by older adults. The aim of this paper is to review barriers and identify knowledge gaps where more research is needed to improve the accessibility of mobile health use in aging populations. The same observations might apply to those who are not elderly, including individuals suffering from severe mental or medical illnesses.

Can caregivers trust information technology in the care of their patients? A systematic review

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that healthcare providers allow patients to engage in their healthcare by allowing access to their health records. Often patients need informal caregivers including family members or others to help them with their care. This paper explores whether trust is a key factor for informal caregivers' decision to use health information technologies (HIT) including electronic health records (EHR), patient portals, mobile apps, or other devices to care for their patient. Six reviewers conducted a comprehensive search of four literature databases using terms that pertained to a caregiver and trust to investigate the role trust plays when caregivers use HIT. While trust is a key factor for the use of HIT, it the researchers only identified ten articles that met the research question thresholds. Four main topics of trust surfaced including perceived confidentiality, perceived security, technological malfunction, and trustworthiness of the information. Trust is a critical factor for informal caregivers when using HIT to assist in the care of their patient (child, loved one, parent, or acquaintance). Based on the findings, it is clear that more research on the use of HIT by caregivers is needed.

Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review

BACKGROUND

Rising telehealth capabilities and improving access to older adults can aid in improving health outcomes and quality of life indicators. Telehealth is not being used ubiquitously at present.

OBJECTIVE

This review aimed to identify the barriers that prevent ubiquitous use of telehealth and the ways in which telehealth improves health outcomes and quality of life indicators for older adults.

METHODS

This systematic review was conducted and reported in accordance with the Kruse protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviewers queried the following four research databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE), Web of Science, and Embase (Science Direct). Reviewers analyzed 57 articles, performed a narrative analysis to identify themes, and identified barriers and reports of health outcomes and quality of life indicators found in the literature.

RESULTS

Reviewers analyzed 57 studies across the following five interventions of telehealth: eHealth, mobile health (mHealth), telemonitoring, telecare (phone), and telehealth video calls, with a Cohen κ of 0.75. Reviewers identified 14 themes for barriers. The most common of which were technical literacy (25/144 occurrences, 17%), lack of desire (19/144 occurrences, 13%), and cost (11/144 occurrences, 8%). Reviewers identified 13 medical outcomes associated with telehealth interventions. The most common of which were decrease in psychological stress (21/118 occurrences, 18%), increase in autonomy (18/118 occurrences, 15%), and increase in cognitive ability (11/118 occurrences, 9%). Some articles did not report medical outcomes (18/57, 32%) and some did not report barriers (19/57, 33%).

CONCLUSIONS

The literature suggests that the elimination of barriers could increase the prevalence of telehealth use by older adults. By increasing use of telehealth, proximity to care is no longer an issue for access, and thereby care can reach populations with chronic conditions and mobility restrictions. Future research should be conducted on methods for personalizing telehealth in older adults before implementation.

TRIAL REGISTRATION

PROSPERO CRD42020182162; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020182162.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/15490.

Exploring Early Adopter Baby Boomers' Approach to Managing Their Health and Healthcare

The Patient 3.0 Profile is used to explore to the patient engagement strategies of early adopter baby boomers' in three domains: 1) patient relationships, 2) health information use and 3) consumer health technology (CHT) use. Findings from six focus groups with early adopter boomers challenge prior notions about older adults' passive approach to patient engagement. Baby boomers want to make final healthcare decisions with input from providers. While adept at finding and critically assessing online health information for self-education and self-management, boomers want providers to curate relevant and trustworthy information. Boomers embrace CHTs offered through providers (i.e., patient portals, email and text messaging) and sponsored by wellness programs (i.e., diet and activity devices and apps). However, there is no indication they add information to their online medical records or use CHT for diagnosis, treatment or disease management. Additional resources are needed to encourage widespread adoption, support patient effectiveness, and confirm cost-benefit.