Older women’s perceptions of wearable and smart home activity sensors

Mobility Assessment Instruments

OBJECTIVES

Review commonly used mobility assessment instruments and discuss their use in multidisciplinary research and clinical practice.

METHODS

Data sources include peer-reviewed articles sourced in electronic databases (PubMed, CINAHL), government websites, national, and international best practice guidelines to describe frequently used mobility assessment instruments.

RESULTS

Numerous clinician-, observer-, patient-reported, and performance outcome instruments and evidence-based implementation program resources exist, though these vary in their intended purpose and setting. Wearable and ambient sensors provide new opportunities to collect passive, objective physical activity data and observe changes in mobility across settings.

CONCLUSIONS

Selection among multiple assessment tools requires consideration of the available evidence for use in the desired population, the outcomes of interest, whether use is feasible for the setting, and the strength of validity and reliability data for the tool.

IMPLICATIONS FOR NURSING PRACTICE

Nurses, especially in the inpatient setting, are typically in most frequent contact with patients and are well-positioned to assess mobility and ensure that safe, progressive mobility care plans are in place. Development of an organization-wide mobility culture requires a systematic, multidisciplinary approach and long-term commitment.

Privacy Barriers in Health Monitoring: Scoping Review

BACKGROUND

Health monitoring technologies help patients and older adults live better and stay longer in their own homes. However, there are many factors influencing their adoption of these technologies. Privacy is one of them.

OBJECTIVE

The aim of this study was to provide an overview of the privacy barriers in health monitoring from current research, analyze the factors that influence patients to adopt assisted living technologies, provide a social psychological explanation, and propose suggestions for mitigating these barriers in future research.

METHODS

A scoping review was conducted, and web-based literature databases were searched for published studies to explore the available research on privacy barriers in a health monitoring environment.

RESULTS

In total, 65 articles met the inclusion criteria and were selected and analyzed. Contradictory findings and results were found in some of the included articles. We analyzed the contradictory findings and provided possible explanations for current barriers, such as demographic differences, information asymmetry, researchers' conceptual confusion, inducible experiment design and its psychological impacts on participants, researchers' confirmation bias, and a lack of distinction among different user roles. We found that few exploratory studies have been conducted so far to collect privacy-related legal norms in a health monitoring environment. Four research questions related to privacy barriers were raised, and an attempt was made to provide answers.

CONCLUSIONS

This review highlights the problems of some research, summarizes patients' privacy concerns and legal concerns from the studies conducted, and lists the factors that should be considered when gathering and analyzing people's privacy attitudes.

Old age or cognitive decline? Examining the usability of a mobile health app for older Australians

There is a growing literature on the role of mobile health applications (mHealth apps) in supporting older adults and the self-management of personal health. The purpose of this pilot study is to assess the usability of a government-funded mobile health app amongst older Australians and to evaluate whether cognitive function and demographic characteristics (i.e. age, gender, education) are associated with usability. A total of 28 older adults living in a regional city in Australia took part in the study. The participants were recruited using purposive sampling. Data collection instruments consisted of validated cognitive tests, task-based usability tests, and a questionnaire. The data was analyzed using non-parametric strategies. The findings of this study demonstrated that a government-funded, mHealth app was usable by older adults. Users were able to perform basic tasks in an effective and efficient manner. The hypothesis that elderly age would be significantly associated with performance on cognitive tests, as well as usability, was not supported. Performance on some cognitive tests was significantly and positively related to usability. Education and gender were not related to usability. The results suggest that traditional stereotypes surrounding aging and cognitive decline need to be reexamined.

Associations between perceived usefulness and willingness to use smart healthcare devices among Chinese older adults: The multiple mediating effect of technology interactivity and technology anxiety

Objective

This study aims to explore the mediating roles of technological interactivity and technological anxiety in the relationship between perceived usefulness and the willingness to use a smart health device to provide insight into the decision-making process of older adults in relation to the adoption of smart devices.

Methods

A cross-sectional survey was conducted in Jiangsu, China involving 552 older adults. The study utilized structural equation modeling (SEM) to analyze the relationship between the independent variable 'perceived usefulness' and the dependent variable 'willingness to use.' It also examined the multiple mediating effects of technological interactivity and technological anxiety between the independent and dependent variables.

Results

The results indicate that the direct effect of perceived usefulness on willingness to use was insignificant. However, technological interactivity completely mediated the relationship between perceived usefulness and willingness to use. Additionally, technological interactivity and technological anxiety were found to have a serial mediating effect on the impact of perceived usefulness on willingness to use smart healthcare devices.

Conclusions

These findings suggest that increasing older adults' intention to use smart healthcare devices requires not only raising awareness of their usefulness, but also addressing technological anxiety and enhancing the interactivity of these devices to improve the overall user experience.

Factors that predict the acceptance and adoption of smart home technology by seniors in Australia: a structural equation model with longitudinal data

Smart Home Technology presents an exciting opportunity to support seniors living independently in their homes. Despite widespread interest in Smart Homes, seniors' readiness to adopt Smart Home Technology is low. To determine the factors underpinning Australian seniors' acceptance and adoption of Smart Home Technology using an extended UTAUT model that includes Trust, Resistance to Change and Technology Anxiety. A longitudinal study was conducted to validate the proposed model prior to and after the implementation of a pilot Smart Home Modification program for seniors. Structural Equation Modeling has been applied to test the proposed hypotheses using a sample of 60 seniors in regional Australia. Perceived Usefulness is an important predictor of Smart Home Technology adoption by seniors. Trust was found to indirectly predict adoption of Smart Home Technology via Perceived Usefulness. This study showed that Perceived Usefulness and Trust are critical factors for the acceptance and use of SHT by seniors, validating the extension of UTAUT with a Trust factor. This makes a unique theoretical contribution to the literature with implications for aged care providers and policymakers to consider seniors' perceived usefulness and trust in the design, development, and implementation of Smart Home solutions.

Factors affecting wearable ECG device adoption by general practitioners for atrial fibrillation screening: cross-sectional study

Introduction

Atrial fibrillation (AF) is a challenging cardiovascular disease worldwide. Wearable electrocardiograph devices (WEDs) have great potential to improve the detection rate of AF in primary care. However, the factors that influence general practitioners' (GPs) perception and acceptance of WEDs are not well understood. To identify factors that influence the intention of GPs to utilize WEDs in a clinical setting to screen patients for AF.

Method

The research hypotheses and questionnaire items were designed and developed based on the unified theory of acceptance and technology (UTAUT) framework. We used stratified sampling and obtained the data through an online survey. Structural equation modeling was used to analyze the collected data.Results: A total of 1,004 valid questionnaires from GPs across Sichuan province in China were collected. Three factors increased GPs' intention to utilize WEDs to screen patients for AF, including performance expectancy (β = 0.121, p = 0.004), social influence (β = 0.356, p < 0.001), and price perception (β = 0.587, p < 0.001). Perception risk (β = -0.059, p < 0.001) decreased usage intention, while effort expectancy (β = -0.079, p = 0.155) and facilitating conditions (β = -0.014, p = 0.868) did not affect usage intention. Gender (β = -0.022, p = 0.179), age (β = 0.006, p = 0.699), education level (β = -0.22, p = 0.184) and training (β = 0.007, p = 0.69) were not significantly correlated with usage intention, and these four factors had no moderating effect on the path coefficients.

Discussion

GPs' intention to utilize WEDs is affected by performance expectancy, price perception, perception risk and social influence. Researcher should improve the usability and perception of WEDs for screening and carry out studies to provide high-quality evidence for the security and efficacy of wearable devices.

Community-dwelling older adults' acceptance of smartwatches for health and location tracking

BACKGROUND

Despite rapid growth in the popularity of smartwatches, evidence lacks regarding older adults' acceptance of smartwatches. Since most wearable sensors are not designed specifically for older adults, there is a need to examine wearability and usability challenges of wearable sensing devices faced by older adults to facilitate the use of objective measurements of health and mobility.

OBJECTIVES

We aimed to examine older adults' perceptions of GPS-enabled smartwatches and to identify potential barriers and facilitators of smartwatch and sensor data use.

METHODS

As part of a larger feasibility study, we conducted a mixed-methods study that included a descriptive content analysis of interviews and a brief usability survey with 30 participants aged 60 years and older after they had used a smartwatch for 3 days.

RESULTS

Most participants perceived wearable activity trackers including smartwatches and sensor-based data as useful for tracking health, finding activity patterns and promoting healthy behaviours. Privacy was of little concern, leading to willingness to share activity and location data with others. Participants identified barriers to usability as clumsy design, lack of aesthetic appeal, and difficulty reading the display and using the GPS tracking function. In contrast, identified facilitators of adoption included a big display, high-tech look, self-awareness and possible behaviour change.

CONCLUSIONS

Smartwatches have the potential of personalised detection of health deterioration and disability prevention, based on analysis of older adults' activities in free-living environments. The usefulness of this technology for older adults can be significantly increased by addressing usability issues and providing instructions on challenging features.

IMPLICATIONS FOR PRACTICE

To support sustained self-monitoring behaviours through wearable sensor devices in older adults, it is critical to examine how they perceive those devices and identify factors affecting technology acceptance that can maximise adoption.

The willingness and influencing factors to choose smart senior care among old adults in China

Background

Population aging has become an escalating issue in China resulting in increasing healthcare demand. Smart senior care has the potential to help older adults live independently and relieve the pressure of healthcare including home-based care. This study aimed to explore Chinese older adults’ preferred access models and service content of smart senior care and factors affecting their willingness to choose smart senior care.

Methods

This was a cross-sectional study. A total of 760 community-dwelling older adults from Xuzhou, China were included in this study. Their demographics, family support, health status, smart senior care use, and willingness to choose smart senior care were collected. The Chi-square test was used for single factor analysis of each variable. The statistically significant variables were included in the logistics regression model to analyze factors influencing older adults’ willingness to choose smart senior care. The chi-square goodness of fit test was used to analyze the preferred content and access models of smart senior care; the Bonferroni method was used to correct the results.

Results

The finding indicated that participants’ age, number of children, frequency of children visiting parents, adequate senior care, self-reported health, chronic diseases, smartphone use, and attitude toward smart senior care were significantly associated with their willingness to choose the smart senior care (p < 0.05). For smart senior care access models, participants preferred the remote monitoring model, telephone call model, and the community site model over the health smart home model and the smart application platform model. There was no statistical difference among these three preferred access models (p’ > 0.005). Regarding service content, participants desired medical care service the most (p’ < 0.005).

Conclusions

Chinese older adults’ willingness to choose smart senior care is affected by personal, family, health, and other factors. To develop China’s senior care, we should consider their demand and preference for smart senior care. It is important to enrich the content of smart senior care, especially on medical care services, and maintain the dynamic balance between supply and demand using a diverse supply approach.

Stakeholder Perspectives on Implementation of Smart Speakers for Aging in Place in Low-Income Senior Housing: A Qualitative Study

In the current study, a smart speakers-based system (Amazon^® Echo Dot device, a safety pendant, and facility tailored functionalities) for supporting aging in place was implemented in one low-income senior housing property. We aimed to explore perceived benefits, concerns, and expectations about this system among three stakeholder groups (older adults, housing staff, and technology developers) to identify facilitators of and barriers to system implementation. A qualitative analysis of individual interviews using inductive coding methods was performed to identify emerging themes. All stakeholder groups perceived smart speakers as valuable for convenience in daily living and safety. Older adults and system developers identified user difficulty with setting up functions they wanted to use, suggesting the need for user-centered technology support. There were differences in priorities for smart speaker use among three stakeholder groups. This work contributes to the identification of factors affecting smart speaker adoption and use among low-income older adults who often have limited technology experience and support. [Journal of Gerontological Nursing, 48(10), 33-39.].

Telemedicine Technologies Selection for the Posthospital Patient Care Process after Total Hip Arthroplasty

For many years, the importance of using telematic technologies in medicine has been growing, especially in the period of the coronavirus pandemic, when direct contact and supervision of medical personnel over the patient is difficult. The existing possibilities of modern information and communication technologies (ICTs) are not fully used. The aim of the study is to identify the telemedicine technologies that can be used in future implementation projects of the posthospital patient care process after total hip arthroplasty (THA). The literature search is reported according to PRISMA 2020. The search strategy included databases and gray literature. In total, 28 articles (EMBASE, PubMed, PEDro) and 24 records from gray literature (Google Search and Technology presentations) were included in the research. This multi-source study analyzes the possibilities of using different technologies useful in the patient care process. The conducted research resulted in defining visual and wearable types of telemedicine technologies for the original posthospital patient care process after THA. As the needs of stakeholders in the posthospital patient care process after THA differ, the awareness of appropriate technologies selection, information flow, and its management importance are prerequisites for effective posthospital patient care with the use of telemedicine technologies.

Depressed Mood Prediction of Elderly People with a Wearable Band

Depression in the elderly is an important social issue considering the population aging of the world. In particular, elderly living alone who has narrowed social relationship due to bereavement and retirement are more prone to be depressed. Long-term depressed mood can be a precursor to eventual depression as a disease. Our goal is how to predict the depressed mood of single household elderly from unobtrusive monitoring of their daily life. We have selected a wearable band with multiple sensors for monitoring elderly people. Depression questionnaire has been surveyed periodically to be used as the labels. Instead of working with depression patients, we recruited 14 single household elderly people from a nearby community. The wearable band provided daily activity and biometric data for 71 days. From the data, we generate a depressed mood prediction model. Multiple features from the collected sensor data are exploited for model generation. One general model is generated to be used as the baseline for the initial model deployment. Personal models are also generated for model refinement. The general model has a high recall of 80% in an MLP model. Individual models achieved an average recall of 82.7%. In this study, we have demonstrated that we can generate depressed mood prediction models with data collected from real daily living. Our work has shown the feasibility of using a wearable band as an unobtrusive depression monitoring sensor even for elderly people.

mHealth-Supported Interventions With Potential to Address Sedentary Behavior in Older Adults: A Scoping Review

Sedentary behavior (SB) is an independent risk for negative health outcomes in older adults. Mobile health (mHealth) technology has potential to address SB in this population. This scoping review aimed to describe, synthesize, and identify gaps in literature on mHealth-supported interventions with potential to reduce sedentariness in older people. Following an iterative search of five major databases, 13 studies were included in the final review. Only three papers described SB-related factors as the primary target of intervention. mHealth-Driven components were frequently paired with nonmobile approaches and aided self-regulation of physical activity as opposed to SB. Most SB-related outcomes were not statistically significant or were inconclusive. This scoping review revealed a paucity of research applying mHealth-supported approaches to directly overcome sedentariness in older people. Protocol studies included in the review provide evidence that efforts to address this research gap continue to be made, but the need for additional high-quality research remains.

Smart Home Adoption: The Impact of User Characteristics and Differences in Perception of Benefits

Despite the various benefits offered by smart homes, they have not yet been widely adopted by mainstream users. This study was designed to identify user perceptions in the association between smart home service preference and adoption and to identify factors affecting the adoption and service preferences of smart homes. In order to achieve the goal of the study, an online survey was conducted among 400 potential users in the Republic of Korea. The main findings are as follows: First, there were considerable needs for the services that can support the independent lives of residents, such as safety and convenience services, among all age groups. Second, the study findings suggested that those who preferred environmental control service most were more likely to become relatively active adopters. Third, a significant association between the preference for smart home services and the intention to use was identified. Finally, the study findings suggested that the number of service preferences and adoption was not directly proportional. The findings reported in this study can improve the overall understanding of the process of adopting smart homes, and can provide important insights into user-centered strategies to promote the adoption of smart home services.

Ethics and acceptance of smart homes for older adults

Societal challenges associated with caring for the physical and mental health of older adults worldwide have grown at an unprecedented pace, increasing demand for health-care services and technologies Despite the development of several assistive systems tailored to older adults, the rate of adoption of health technologies is low. This review discusses the ethical and acceptability challenges resulting in low adoption of health technologies specifically focused on smart homes for older adults. The findings have been structured in two categories: Ethical Considerations (Privacy, Social Support, and Autonomy) and Technology Aspects (User Context, Usability, and Training). The findings conclude that older adults community is more likely to adopt assistive systems when four key criteria are met. The technology should: be personalized toward their needs, protect their dignity and independence, provide user control, and not be isolating. Finally, we recommend researchers and developers working on assistive systems to: (1) provide interfaces via smart devices to control and configure the monitoring system with feedback for the user, (2) include various sensors/devices to architect a smart home solution in a way that is easy to integrate in daily life, and (3) define policies about data ownership.

Implementation of welfare technology: a systematic review of barriers and facilitators

PURPOSE

Although studies addressing barriers to and facilitators of implementation of welfare technology have been published, no systematic review synthesising evidence on such factors has been found. The purpose of this study was therefore to identify and synthesise existing primary research on facilitators and barriers that influence the implementation of welfare technology for older people, people with disabilities and informal caregivers.

MATERIALS AND METHODS

A systematic search in 11 databases was performed using predefined inclusion and exclusion criteria to identify empirical studies that assess the implementation of welfare technology for older people, people with disabilities or informal caregivers. The search identified 33 publications with quantitative, qualitative and mixed method designs. The reported findings were thematically synthesised and conceptualised into themes.

RESULTS

Six themes of facilitators and barriers that influence the implementation of welfare technology emerged: capacity, attitudes and values, health, expectations, participation and identity and lifestyle. These were presented from five perspectives: older persons and persons with disabilities, informal caregivers, health and care personnel, organisation and infrastructure and technology. The findings may be used as a means to structure the planning and evaluation of implementation processes of welfare technologies for older persons and persons with disabilities and to understand the complexities of implementation.

CONCLUSIONS

This knowledge generates deepened insights and structures to guide and evaluate the implementation processes of welfare technologies and engenders an understanding of the complexities of implementation.Implications for rehabilitationWhen planning for the implementation of welfare technology for older people and persons with disabilities, it is important to consider capacity, attitudes and values, health, expectations, participation, and identity and lifestyle.Using the result from the study facilitates deepened insights and structures for evaluation of implementation processes of welfare technologies and brings an understanding of the complexities of implementation.Welfare technology should be available, safe, usable and fit the user's daily lives.Implementable welfare technology should focus on needs, but also consider design and possible experienced stigma related to the identity of being a welfare technology user.

Enhancing smart healthcare in dentistry: an approach to managing patients' stress

This paper presents a model of a smart healthcare service for stress management in dental patients during the interventions. The main goal is to provide dental clinics with a model that enables introducing a stress management service into everyday practice and provides patients with a better experience in a typically stressful situation. The approach is based on employing wearable sensors for monitoring physiological parameters, and a mobile application for progressive muscle relaxation therapy. Dental patients were divided into experimental and control groups. Participants from the experimental group were treated with progressive muscle relaxation through mobile health application with audio content, and patients from the control group were not exposed to any relaxation method. Heart rate was measured in both groups through three test phases: pre-intervention, intervention, and post-intervention. Evaluation of the anxiety level was performed using the STAI test. Results show that the measured heart rate in the post-intervention phase is lower than in the intervention phase in both testing groups, as well as in the pre-intervention phase. STAI scores were significantly higher in the control group through all test phases. The research found that the proposed system applied to dentist patients may relieve their anxiety symptoms and decrease stress level, which improves the patients' experience and leads to higher patients' satisfaction.

Elderly Perception on the Internet of Things-Based Integrated Smart-Home System

An integrated smart home system (ISHS) is an effective way to improve the quality of life of the elderly. The elderly’s willingness is essential to adopt an ISHS; to the best of our knowledge, no study has investigated the elderly’s perception of ISHS. Consequently, this study aims to investigate the elderly’s perception of the ISHS by comprehensively evaluating its possible benefits and negative responses. A set of sensors required for an ISHS was determined, and interviews were designed based on four factors: perceived comfort, perceived usability, perceived privacy, and perceived benefit. Subsequently, technological trials of the sensor-set followed by two focus group interviews were conducted on nine independently living elderly participants at a senior welfare center in South Korea. Consistent with previous studies, the results of this investigation indicate that elderly participants elicited negative responses regarding usability complexity, and discomfort to daily activities. Despite such negative responses, after acquiring enough awareness about the ISHS’s benefits, the elderly acknowledged its necessity and showed a high level of willingness. Furthermore, these results indicate that for a better adoption of an ISHS, sufficient awareness regarding its benefits and development of elderly-friendly smart home sensors that minimize negative responses are required.

Risk recognition and identification of sports activities in colleges and universities

Recently, Intense training in specialized sport among colleges and universities has steadily improved. Although most sportspeople accept that some degree of expertise in sport is required to achieve the elite stage, there is controversy over risk recognition and identification of sports activities in colleges and universities to optimize future performance. There is concern that a young athlete can suffer from sports specialization before adolescence due to various risk factors such as injuries, social tension, and hypertension etc..,. Furthermore, PubMed and OVID are looking to discuss sports specialization and athlete experience-based consensus opinions and position statements based on Universities and Colleges. Risk recognition and identification tools are developed to identify the locations of athletes within the specialization spectrum using Linear Structural Modeling (LSM). Here, a degree of sports expertise is needed to create elite skill levels to overcome risk factors that have been suggested in the linear model. In most sports, though, such accelerated preparation should be deferred until late adolescence to reduce risk factors. The psychological burden has been analyzed for recognition, and classification based on the case study has been firmly researched in this paper.

Attitudes and Perceptions Toward Voice-Operated Smart Speakers Among Low-Income Senior Housing Residents: Comparison of Pre- and Post-Installation Surveys

Smart speakers have the potential to support independent living and wellness among low-income senior housing (LISH) residents. The aim of this study was to examine and compare LISH residents’ attitudes and perceptions toward smart speakers at two time points: before and after technology use (N = 47). A descriptive survey was administered to ask questions about hedonic motivation, perceived ease of use, self-efficacy, perceived usefulness of some potential or existing smart speaker features, cost, and privacy. Participants were initially favorable toward using a smart speaker and its digital agent (e.g., Alexa) as a daily assistant and wellness tool. They especially liked the smart speaker’s potential functionality of detecting harmful events and notifying someone to receive immediate help. The comparison of pre- and post-use responses revealed non-significant declines in most items, with the exception of willingness to use Alexa as a reminder system (p < .01), asking Alexa for help (p < .01), and asking for help in using Alexa (p < .01). This finding may reflect confusion or frustration with the device among participants. We conclude with recommendations for the design of smart speakers specifically tailored to the needs of LISH residents.

Older Adults' Perceptions of the Usefulness of Technologies for Engaging in Physical Activity: Using Focus Groups to Explore Physical Literacy

Insufficient physical activity (PA) levels observed among older adults remain extremely high and pose a danger to developing and maintaining their physical literacy (PL). Each person’s level of PL partly depends on their physical and cognitive skills, confidence level, and degree of motivation to practice PA daily. New technologies, such as exergames and wearable fitness trackers, may enable older adults to increase their PL, stimulating uptake and ongoing PA participation. Objective: This focus group study aims to describe older adults’ perceptions of the use of technologies to engage in physical exercise programs. Methods: Fifteen participants were randomly selected from a sample of 40 older adults who completed a randomized controlled trial that investigated the benefits of using technology in the context of group-based exercise programs. Separate post-intervention focus groups were performed with an exergaming group, a conventional physical training group, and a no training group (control). Data were mapped onto constructs from the four domains of PL: affective, physical, cognitive, and behavioral. Results: Generally, participants expressed positive perceptions about the benefits of using technology to engage in PA. These positive feelings outweighed the costs and the lack of familiarization with technology. Common themes for the three groups emerged from the discussions and included familiarization with technology, using fitness tracker to monitor PA, previous exposure to technology, and interaction with peers, staff members, and relatives. In particular, participants from the exergaming group explored the ideas of training their cognitive skills while using the exergame accessories, exercising in an alternative way, competitive versus cooperative play, changes in sense of humor, skill transferability from game to real environment, progressions of the exercise intensities, and the potential use of exergames for rehabilitation. Conclusions: Participants in this study reported positive perceptions about implementing technology into exercise. Emphasizing the benefits of using technology in group-based exercise programs may increase older adults’ PL levels and their future technology adoption. The potential implementation of technology into conventional exercise programs should focus on older adults’ lifelong values, biopsychosocial conditions, and the possibility of reducing age-related risk of injuries and chronic diseases.