Training older adults to use new technology

Mapping of technological strategies for reducing social isolation in homebound older adults: A scoping review

BACKGROUND

Homebound older adults (HOAs) are particularly vulnerable to social isolation and loneliness, which engender a poorer physical and mental health, and greater cognitive decline. The purpose of this review is to map the literature to identify potential technological strategies that reduce social isolation in HOAs, and to understand facilitators and barriers for adoption and implementation.

METHODS

Six databases including PubMed (MEDLINE), Google Scholar, Cochrane Database, EBSCOHost, National Library ProQuest, Web of Science, and the Journal of Medical Internet Research were searched for relevant articles. Peer-reviewed literature published in English from Jan 2014 to Feb 2024 that employed technological strategies applicable to HOAs and assessed social isolation or connectedness as an outcome measure were included.

RESULTS

107 studies were reviewed and classified into different technological categories based on their functions and features. A social technology framework encompassing delivery, hardware, software, content, training, and support was conceptualized with core characteristics identified from the reviewed technological strategies. Cost and complexity of technology, and resource commitment were identified as barriers while user-friendliness, content curation and a supportive ecosystem may facilitate the adoption of a technological strategy to address social isolation in HOAs.

CONCLUSION

There is a need for early and concerted effort to identify HOAs, provide technology training, and empower them to tap on the digital world to complement and/or supplement social interactions. Development of cost-effective and rapid-to-implement technology is vital for HOAs who are at highest risk to social isolation.

A framework for evaluation and adoption of industrial exoskeletons

Work-related Musculoskeletal Disorders (WMSDs) account for a significant portion of worker illnesses and injuries, resulting in high costs and productivity losses to employers globally. In recent years, there has been an increased interest in the use of exoskeleton technology to reduce rates of WMSDs in industrial worksites. Despite the potential of exoskeletons to mitigate the risks of WMSDs, the required steps to properly assess and implement the technology for industrial applications are not clear. This paper proposes a framework that can help organizations successfully evaluate and adopt industrial exoskeletons. Through a focus group of industry professionals, researchers, and exoskeleton experts, and by building on existing literature, an overarching adoption framework is developed. The identified stages and tasks within the framework enable an organization to evaluate and adopt exoskeletons through a systematic approach and to identify the existing gaps in their technology adoption process. The findings also highlight the areas where further studies are needed to promote the adoption of industrial exoskeletons, including large-scale field studies and long-term monitoring.

Design and Evaluation of Personalized Services to Foster Active Aging: The Experience of Technology Pre-Validation in Italian Pilots

Assistive devices could promote independent living and support the active and healthy aging of an older population; however, several factors can badly influence the long-term use of new technologies. In this context, this paper presents a two-step methodology called “pre-validation” that aims to identify the factors that can bias the use of new services, thus minimizing the risk of an unsuccessful longer trial. The proposed pre-validation methodology is composed of two main phases that aim to assess the usability and the reliability of the technology assessed in a laboratory environment and the usability, acceptability, user experience, and reliability of the technology in real environments. The tested services include the socialization scenario, in which older adults are better connected to the community via technological solutions (i.e., socialization applications), and the monitoring scenario, which allows for the introduction of timely interventions (technologies involved include environmental monitoring sensors, a telepresence robot, wearable sensors, and a personalized dashboard). The obtained results underline an acceptable usability level (average System Usability Scale score > 65) for the tested technologies (i.e., socialization applications and a telepresence robot). Phase Two also underlines the good acceptability, user experience, and usability of the tested services. The statistical analysis underlines a correlation between the stress related to the use of technology, digital skills, and intention of use, among other factors. Qualitative feedback also remarks on a correlation between older adults with low digital skills and an anxiety about using technology. Positive correlation indexes were highlighted between the trust and usability scores. Eventually, future long-term trials with assistive technology should rely on motivated caregivers, be founded on a strong recruitment process, and should reassure older adults—especially the ones with low digital literacy—about the use of technology by proposing personalized training and mentoring, if necessary, to increase the trust.

A Grand Challenge for Psychology: Reducing the Age-related Digital Divide

World-wide population aging and rapid diffusion of digital technology have converged to produce an age-related digital divide in technology adoption, as seen in use of the internet and ownership of smartphones. Given the centrality of these technologies for full participation in modern society, reducing that gap is an important challenge for psychologists. We outline more and less malleable factors associated with technology adoption. We argue that interventions that can change both the aging user and the design of products will be necessary. Adaptive technology systems that incorporate artificial intelligence and extended reality represent promising new approaches to reducing the age-related digital divide.

Iterative Development and Applicability of a Tablet-Based e-Coach for Older Adults in Rehabilitation Units to Improve Nutrition and Physical Activity: Usability Study

BACKGROUND

Maintaining nutrition and exercise strategies after rehabilitation can be difficult for older people with malnutrition or limited mobility. A technical assistance system such as an e-coach could help to positively influence changes in dietary and exercise behavior and contribute to a sustainable improvement in one's nutrition and mobility status. Most apps do not provide a combination of nutrition and exercise content. In most cases, these apps were evaluated with healthy individuals aged <70 years, making transferability to vulnerable patients, with functional limitations and an assumed lower affinity for technology, in geriatric rehabilitation unlikely.

OBJECTIVE

This study aims to identify the potential for optimization and enhance usability through iterative test phases to develop a nutrition and mobility e-coach suitable for older adults (≥65 years) based on individual health behavior change stages in a rehabilitation setting.

METHODS

Iterative testing was performed with patients aged ≥65 years in a rehabilitation center. During testing, participants used an e-coach prototype with educational elements and active input options on nutrition and mobility as a 1-time application test. The participants performed navigation and comprehension tasks and subsequently provided feedback on the design aspects. Hints were provided by the study team when required, documented, and used for improvements. After testing, the participants were asked to rate the usability of the prototype using the System Usability Scale (SUS).

RESULTS

In all, 3 iterative test phases (T1-T3) were conducted with 49 participants (24/49, 49% female; mean 77.8, SD 6.2 years). Improvements were made after each test phase, such as adding explanatory notes on overview screens or using consistent chart types. The use of the user-centered design in this specific target group facilitated an increase in the average SUS score from 69.3 (SD 16.3; median 65) at T1 to 78.1 (SD 11.8; median 82.5) at T3. Fewer hints were required for navigation tasks (T1: 14.1%; T2: 26.5%; T3: 17.2%) than for comprehension questions (T1: 30.5%; T2: 21.6%; T3: 20%). However, the proportion of unsolved tasks, calculated across all participants in all tasks, was higher for navigation tasks (T1: 0%, T2: 15.2%, T3: 4.3%) than for comprehension tasks (T1: 1.9%, T2: 0%, T3: 2.5%).

CONCLUSIONS

The extensive addition of explanatory sentences and terms, instead of shorter keywords, to make it easier for users to navigate and comprehend the content was a major adjustment. Thus, good usability (SUS: 80th-84th percentile) was achieved using iterative optimizations within the user-centered design. Long-term usability and any possible effects on nutritional and physical activity behavior need to be evaluated in an additional study in which patients should be able to use the e-coach with increasing independence, thereby helping them to gain access to content that could support their long-term behavior change.

How Older Adults Learn ICT—Guided and Self-Regulated Learning in Individuals With and Without Disabilities

Learning to use information and communication technologies (ICT) may be more difficult for older people due to decreases in fluid intelligence, generational effects, and other age-related effects. Especially older people with intellectual disabilities (ID) are at a high risk of digital exclusion. To enable all older adults to use ICT, individualized technology training may be provided. However, little is known about the ICT learning preferences among older people with ID. Based on semi-structured interviews with older adults (n = 7, mean age = 76.6 years) and older adults with ID (n = 14, mean age = 62.4 years), this paper analyzes learning strategies, preferences, and learning settings. The results from content analysis show that guided learning with personal explanations in a one-to-one setting is the most preferred learning format in both groups of older adults. While many older adults without ID additionally favor self-regulated learning (i.e., learning with manuals or videos), older adults with ID mostly rely on guided learning with personal assistance. The differences can be explained by different abilities (e.g., reading skills) and social networks (e.g., living situation, having children). Not all older adults have a family or an institutional support network to help them learn ICT and community organizations may provide additional support. Researchers and practitioners should be aware of the diverse knowledge backgrounds and competencies in the group of older adults. ICT training in old age should be ideally composed in a modular way embedding self-regulated learning formats into guided learning modules.

Technology Support Challenges and Recommendations for Adapting an Evidence-Based Exercise Program for Remote Delivery to Older Adults: Exploratory Mixed Methods Study

BACKGROUND

Tele-exercise has emerged as a means for older adults to participate in group exercise during the COVID-19 pandemic. However, little is known about the technology support needs of older adults for accessing tele-exercise.

OBJECTIVE

This study aims to examine the needs of older adults for transition to tele-exercise, identify barriers to and facilitators of tele-exercise uptake and continued participation, and describe technology support challenges and successes encountered by older adults starting tele-exercise.

METHODS

We used an exploratory, sequential mixed methods study design. Participants were older adults with symptomatic knee osteoarthritis (N=44) who started participating in a remotely delivered program called Enhance Fitness. Before the start of the classes, a subsample of the participants (n=10) completed semistructured phone interviews about their technology support needs and the barriers to and facilitators for technology adoption. All of the participants completed the surveys including the Senior Technology Acceptance Model scale and a technology needs assessment. The study team recorded the technology challenges encountered and the attendance rates for 48 sessions delivered over 16 weeks.

RESULTS

Four themes emerged from the interviews: participants desire features in a tele-exercise program that foster accountability, direct access to helpful people who can troubleshoot and provide guidance with technology is important, opportunities to participate in high-value activities motivate willingness to persevere through the technology concerns, and belief in the ability to learn new things supersedes technology-related frustration. Among the participants in the tele-exercise classes (mean age 74, SD 6.3 years; 38/44, 86% female; mean 2.5, SD 0.9 chronic conditions), 71% (31/44) had a computer with a webcam, but 41% (18/44) had little or no experience with videoconferencing. The initial technology orientation sessions lasted on average 19.3 (SD 10.3) minutes, and 24% (11/44) required a follow-up assistance call. During the first 2 weeks of tele-exercise, 47% of participants (21/44) required technical assistance, which decreased to 12% (5/44) during weeks 3 to 16. The median attendance was 100% for the first 6 sessions and 93% for the subsequent 42 sessions.

CONCLUSIONS

With appropriate support, older adults can successfully participate in tele-exercise. Recommendations include individualized technology orientation sessions, experiential learning, and availability of standby technical assistance, particularly during the first 2 weeks of classes. Continued development of best practices in this area may allow previously hard-to-reach populations of older adults to participate in health-enhancing, evidence-based exercise programs.

Creating a Social Learning Environment for and by Older Adults in the Use and Adoption of Smartphone Technology to Age in Place

Smartphone technologies can support older adults in their daily lives as they age in place at home. However, they may struggle to use these technologies which impacts acceptance, adoption, and sustainable use. Peer to peer community learning has the potential to support older adults to learn using (smartphone) technologies. This paper studies such a learning community approach and how it can support older adults to learn using and adopt the smartphone application GoLivePhone. This technology assists older adults in their daily living by supporting them through fall detection and activity tracking. In particular, the interface of this application can evolve and adapt as older adults become more knowledgeable during the use process or as their abilities change. This paper shows a field study with seven older adults learning and using the GoLivePhone technology through a living lab approach. These older adults participated in this research in a technology learning community that was set-up for research purposes. For this we used ordinary Samsung A3 smartphones with the simplified GoLivePhone software, particularly designed for older adults. At the end of the learning class we conducted an additional focus group to both explore factors facilitating older adults to learn using this technology and to identify their main personal drivers and motivators to start and adopt this technology. We collected qualitative data via open questions and audio recording during the focus group. This collected data was subject to a thematic analysis, coding was primarily performed by the first author, and reviewed by the other authors. We provide insights into how peer to peer community learning can contribute, and found both super-users and recall tools to be helpful to support sustainable use of smartphone technology to support older adults to age in place.

Factors Affecting the Initial Engagement of Older Adults in the Use of Interactive Technology

Smart environments and the use of interactive technology has the potential to improve the quality of life for the senior community as well as to support the connections among the senior community and the world outside their community. In addition to the increasing number of studies in the field of aging and technologies, research is needed to understand the practical issues of user focus, adoption, and engagement for older adults to accept interactive technologies in their lives. In this study, we use two commercial technological interventions (uDraw and GrandPad) to understand technology-related perceptions and behaviors of older adults. We present five case studies that emerge from empirical observations of initial engagement with technology through research methods such as focus group discussions, in-depth interviews, observations, and diary studies. The contributions of this study are identification of the key factors that influence the initial engagement with interactive technology for older adults.

Feasibility Trial of a Mind-Body Activity Pain Management Program for Older Adults With Cognitive Decline

BACKGROUND AND OBJECTIVES

The relationship between chronic pain (CP) and cognitive decline (CD) is bidirectional among older adults. The CP-CD comorbidity can progressively worsen cognitive, physical, emotional, and social functioning with aging. We explored the feasibility and outcomes associated with two mind-body activity programs for CP and CD that focus on increasing walking using time goals (Active Brains) or step-count reinforced via Fitbit (Active Brains-Fitbit).

RESEARCH DESIGN AND METHODS

Older adults with CP and CD participated in a non-randomized open pilot of Active Brains (n = 6) and Active Brains-Fitbit (n = 6) followed by exit interviews. Quantitative analysis explored feasibility markers and signals of improvement on physical, cognitive, and emotional function, as well as additional program targets. Qualitative analyses were predominantly deductive and applied the Framework Method to enhance the programs and methodology.

RESULTS

Both programs met a-priori feasibility benchmarks. We found within-group improvements for pain intensity, pain-specific coping, physical function, and cognitive function in both programs. Exit interviews confirmed high satisfaction with both programs.

DISCUSSION AND IMPLICATIONS

Our mixed methods data provide preliminary evidence of feasibility, showed promise for improving outcomes, and yielded critical information to further enhance the programs. We discuss "lessons learned" and future directions.

Bridging the Digital Divide for Older Adults via Observational Training: Effects of Model Identity from a Generational Perspective

The proliferation of technology offers potential solutions for enhancing the well-being of older adults. However, older adults often have low digital literacy and are disengaged from the digital world. With age-appropriate training, older adults are expected to acquire a wide range of technological skills and bridge the digital divide. Through the lens of social cognitive theory, this study aims to investigate the effectiveness of observational training through behavior modeling in enhancing technology acceptance in older adults. The moderating effects of model identity on training outcomes from a generational perspective are examined. An empirical training experiment was completed with 59 community-dwelling older adults. Training outcomes were measured using cognitive knowledge, affective variables, and meta-cognition. The results ascertain the effectiveness of observational training in improving their technological knowledge, self-efficacy, outcome expectations, and sense of social connectedness when using technologies. From a generational perspective, the older adult behavior model is more effective than the young or child behavior models in increasing self-efficacy and willingness to use technology. The model identity further enhances the positive outcomes of training. The results of this study contribute to designing educational interventions to bridge the digital divide.

Community Health Care Workers' Experiences on Enacting Policy on Technology with Citizens with Mild Cognitive Impairment and Dementia

Purpose

Assistive technologies and digitalization of services are promoted through health policy as key means to manage community care obligations efficiently, and to enable older community care recipients with mild cognitive impairment (MCI) and dementia (D) to remain at home for longer. The overall aim of this paper is to explore how community health care workers enacted current policy on technology with home-dwelling citizens with MCI/D.

Participants and Methods

Twenty-four community health care workers participated in one of five focus group discussions that explored their experiences and current practices with technologies for citizens with MCI/D. Five researchers took part in the focus groups, while six researchers collaboratively conducted an inductive, thematic analysis according to Braun & Clarke.

Results

Two main themes with sub-themes were identified: 1) Current and future potentials of technology; i) frequently used technology, ii) cost-effectiveness and iii) “be there” for social contact and 2) Barriers to implement technologies; i) unsystematic approaches and contested responsibility, ii) knowledge and training and iii) technology in relation to user-friendliness and citizen capacities.

Conclusion

This study revealed the complexity of implementing policy aims regarding technology provision for citizens with MCI/D. By use of Lipsky’s theory on street-level bureaucracy, we shed light on how community health care workers were situated between policies and the everyday lives of citizens with MCI/D, and how their perceived lack of knowledge and practical experiences influenced their exercise of professional discretion in enacting policy on technology in community health care services. Overall, addressing systematic technology approaches was not part of routine care, which may contribute to inequities in provision of technologies to enhance occupational possibilities and meaningful activities in everyday lives of citizens with MCI/D.

Trial registration

NSD project number 47996.

User performance effects with graphical icons and training for elderly novice users: A case study on automatic teller machines

This study investigated the effects with training and graphical icons on task performance for elderly novice users on automatic teller machines (ATMs). 124 elderly novice users who had no prior ATM experience participated in the training and test of ATM usage. Participants in the control group (n = 62) were training to use the traditional text-based ATM interface meanwhile those in the experimental group (n = 62) were training to use the alternative ATM interface with graphical icons. They were asked to learn how to perform three major tasks of ATMs. A test immediately following the training and a test one month after training was carried out. Task completion score was used for measuring user performance. The results showed although training could help elderly novice users succeed in learning to use ATMs, they still had a significant decline in user performance in the test one month later compared with the immediate test. Participants of the experimental group outperformed those of the control group in both the immediate test and one month test after training, especially in the latter. The finding suggested graphical icons could help to improve the learning and retention of ATM usage for elderly novice users, especially the latter, which would compensate for the drawback of training and reduce forgetting rate to some extent. Well-designed graphical icons could benefit elderly novice users much from learning phase to retention phase. The findings of this study can be applied to guide the design and development of ATMs or other public technology devices considering elderly novice users.

Machinery-Related Perceived Risks and Safety Attitudes in Senior Swedish Farmers

OBJECTIVES

To perform an ergonomic analysis of work and machinery-related risks in a group of Swedish older farmers, investigating farmers' attitudes and perceptions about: 1) health status and work motivation, 2) physical and cognitive workload and difficulties in the interaction with machinery and technological innovations, and 3) risks and safety practices.

METHODS

Nine Swedish male farmers aged 65+ were administered a semi-structured interview and a questionnaire.

RESULTS

Participants perceived themselves as being in good health and considered farming as a good proxy of their health status. They reported an increased physical workload but did not describe any cognitive workload. Technology was reported to have low usability, and thus its benefits cannot be fully exploited. Older farmers acknowledged the existence of "new risks" related to the aging process and mainly referred to the common sense and previous experience as the best safety practices.

CONCLUSION

Multilevel interventions focused on the capabilities and limits of the older farmers should be developed, involving both training activities and design solutions for the machinery that can support older farmers' health and safety.

Guidelines for Creating Senior-Friendly Product Instructions

Although older adults feel generally positive about technologies, many face difficulties when using them and need support during the process. One common form of support is the product instructions that come with devices. Unfortunately, when using them, older adults often feel confused, overwhelmed, or frustrated. In this work, we sought to address the issues that affect older adults’ ability to successfully complete tasks using product instructions. By observing how older adults used the product instructions of various devices and how they made modifications to simplify the use of the instructions, we identified 11 guidelines for creating senior-friendly product instructions. We validated the usability and effectiveness of the guidelines by evaluating how older adults used instruction manuals that were modified to adhere to these guidelines against the originals and those that were modified by interaction design researchers. Results show that, overall, participants had the highest task success rate and lowest task completion time when using guideline-modified user instructions. Participants also perceived these instructions to be the most helpful, the easiest to follow, the most complete, and the most concise among the three. We also compared the guidelines derived from this research to existing documentation guidelines and discussed potential challenges of applying them.

Enhancing Home Health Mobile Phone App Usability Through General Smartphone Training: Usability and Learnability Case Study

Background

Each year, millions of older adults fall, with more than 1 out of 4 older people experiencing a fall annually, thereby causing a major social and economic impact. Falling once doubles one’s chances of falling again, making fall prediction an important aspect of preventative strategies. In this study, 22 older adults aged between 65 and 85 years were trained in the use of a smartphone-based fall prediction system. The system is designed to continuously assess fall risk by measuring various gait and balance parameters using a smart insole and smartphone, and is also designed to detect falls. The use case of the fall prediction system in question required the users to interact with the smartphone via an app for device syncing, data uploads, and checking system status.

Objective

The objective of this study was to observe the effect that basic smartphone training could have on the user experience of a group that is not technically proficient with smartphones when using a new connected health system. It was expected that even short rudimentary training could have a large effect on user experience and therefore increase the chances of the group accepting the new technology.

Methods

All participants received training on how to use the system smartphone app; half of the participants (training group) also received extra training on how to use basic functions of the smartphone, such as making calls and sending text messages, whereas the other half did not receive this extra training (no extra training group). Comparison of training group and no extra training group was carried out using metrics such as satisfaction rating, time taken to complete tasks, cues required to complete tasks, and errors made during tasks.

Results

The training group fared better in the first 3 days of using the system. There were significant recorded differences in number of cues required and errors committed between the two groups. By the fourth and fifth day of use, both groups were performing at the same level when using the system.

Conclusions

Supplementary basic smartphone training may be critical in trials where a smartphone app–based system for health intervention purposes is being introduced to a population that is not proficient with technology. This training could prevent early technology rejection and increase the engagement of older participants and their overall user experience with the system.

Understanding Older People's Readiness for Receiving Telehealth: Mixed-Method Study

Background

The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face. Since most care is delivered to older people, the prospect of telehealth raises the question of whether this population is ready for this new way of receiving care. To study this, we created a theoretical framework consisting of 6 factors associated with older people’s intention to use technology.

Objective

The objective of this study was to understand community-dwelling older people’s readiness for receiving telehealth by studying their intention to use videoconferencing and capacities for using digital technology in daily life as indicators.

Methods

A mixed-method triangulation design was used. First, a cross-sectional survey study was performed to investigate older people’s intention to use videoconferencing, by testing our theoretical framework with a multilevel path analysis (phase 1). Second, for deeper understanding of older people’s actual use of digital technology, qualitative observations of older people executing technological tasks (eg, on a computer, cell phone) were conducted at their homes (phase 2).

Results

In phase 1, a total of 256 people aged 65 years or older participated in the survey study (50.0% male; median age, 70 years; Q1-Q3: 67-76). Using a significance level of .05, we found seven significant associations regarding older people’s perception of videoconferencing. Older people’s (1) intention to use videoconferencing was predicted by their performance expectancy (odds ratio [OR] 1.26, 95% CI 1.13-1.39), effort expectancy (OR 1.23, 95% CI 1.07-1.39), and perceived privacy and security (OR 1.30, 95% CI 1.17-1.43); (2) their performance expectancy was predicted by their effort expectancy (OR 1.38, 95% CI 1.24-1.52); and (3) their effort expectancy was predicted by their self-efficacy (OR 1.55, 95% CI 1.42-1.68). In phase 2, a total of 6 men and 9 women aged between 65 and 87 years participated in the qualitative observation study. Of the primary themes, 5 themes were identified that could provide greater understanding of older people’s capacities and incapacities in using digital technology: (1) “self-efficacy and digital literacy,” (2) “obstacles to using technology,” (3) “prior experience and frequency of use,” (4) “sources of support and facilitating conditions,” and (5) “performance expectancy.” These 5 themes recurred in all 15 observations.

Conclusions

Performance expectancy, effort expectancy, and perceived privacy and security are direct predictors of older people’s intention to use videoconferencing. Self-efficacy appeared to play a role in both older people’s intention to use, as well as their actual use of technology. The path analysis revealed that self-efficacy was significantly associated with older people’s effort expectancy. Furthermore, self-efficacy and digital literacy appeared to play a major role in older people’s capacities to make use of digital technology.

VA FitHeart, a Mobile App for Cardiac Rehabilitation: Usability Study

Background

Cardiac rehabilitation (CR) improves outcomes for patients with ischemic heart disease or heart failure but is underused. New strategies to improve access to and engagement in CR are needed. There is considerable interest in technology-facilitated home CR. However, little is known about patient acceptance and use of mobile technology for CR.

Objective

The aim of this study was to develop a mobile app for technology-facilitated home CR and seek to determine its usability.

Methods

We recruited patients eligible for CR who had access to a mobile phone, tablet, or computer with Internet access. The mobile app includes physical activity goal setting, logs for tracking physical activity and health metrics (eg, weight, blood pressure, and mood), health education, reminders, and feedback. Study staff demonstrated the mobile app to participants in person and then observed participants completing prespecified tasks with the mobile app. Participants completed the System Usability Scale (SUS, 0-100), rated likelihood to use the mobile app (0-100), questionnaires on mobile app use, and participated in a semistructured interview. The Unified Theory of Acceptance and Use of Technology and the Theory of Planned Behavior informed the analysis. On the basis of participant feedback, we made iterative revisions to the mobile app between users.

Results

We conducted usability testing in 13 participants. The first version of the mobile app was used by the first 5 participants, and revised versions were used by the final 8 participants. From the first version to revised versions, task completion success rate improved from 44% (11/25 tasks) to 78% (31/40 tasks; P=.05), SUS improved from 54 to 76 (P=.04; scale 0-100, with 100 being the best usability), and self-reported likelihood of use remained high at 76 and 87 (P=.30; scale 0-100, with 100 being the highest likelihood). In interviews, patients expressed interest in tracking health measures (“I think it’ll be good to track my exercise and to see what I’m doing”), a desire for introductory training (“Initially, training with a technical person, instead of me relying on myself”), and an expectation for sharing data with providers (“It would also be helpful to share with my doctor, it just being a matter of clicking a button and sharing it with my doctor”).

Conclusions

With participant feedback and iterative revisions, we significantly improved the usability of a mobile app for CR. Patient expectations for using a mobile app for CR include tracking health metrics, introductory training, and sharing data with providers. Iterative mixed-method evaluation may be useful for improving the usability of health technology.

"There's Not Enough Knowledge Out There": Examining Older Adults' Perceptions of Digital Technology Use and Digital Inclusion Classes

Older adults' definitions of digital technology, and experiences of digital inclusion sessions, were examined using qualitative approaches. Seventeen older adults (aged between 54 and 85 years) participated in two focus groups that each lasted approximately 90 min to explore how older adults understood technology within their lived experience. Interpretative phenomenological analysis yielded two main themes: thirst for knowledge and a wish list for digital technology sessions. A separate content analysis was performed to identify what technology older adults identified as digital technology. This analysis revealed that the older adults most frequently defined digital technology as computers and telephones. The findings support the conclusions that this group of older adults, some of whom were "successful users," have a wide knowledge of digital technology, are interested in gaining more skills, and desire knowledge acquisition through personalized one-to-one learning sessions.

Teach or Design? How Older Adults’ Use of Ticket Vending Machines Could Be More Effective

The dominance of computer technology in work and leisure poses challenges for older people. Their lack of computer experience and computer literacy impedes their ability to explore and use new interactive systems. This is particularly challenging for the design of public access systems, such as ticket vending machines (TVM). This article describes a conflict relevant for many designers considering age-related differences in technology use: should the user be taught to use the existing design or should the design be changed to accommodate older users? An experiment was conducted to directly compare these alternative approaches with each other and with a simulation of an existing TVM. It compares three TVM designs regarding the usability criteria of effectiveness, efficiency and satisfaction, controlling for age, and cognitive and motivational characteristics. 62 older (M = 68 years) and 62 younger (M = 25 years) participants were split into three groups: The control group solved 11 tasks using a simulation of the TVM, the video group watched a brief instructional video before solving the same tasks with the same TVM, and the wizard group used a redesigned wizard interface instead. Results indicate that young and old participants’ performance improved after watching the video, but older participants improved more, reaching the effectiveness of the young control group. In the wizard condition, age differences in effectiveness and satisfaction were eliminated; however, speed differences remained in all conditions. The results suggest that the simple integration of minimal video instruction or a task-oriented wizard design can make public access systems truly universally usable, and that the wizard TVM was a true “walk-up-and-use system.”

Speed of Visual Search in Old Age: 1950 to 2016

OBJECTIVES

To review work on the effects of old age on speed of visual search and of discriminations between signals and choices of responses between 1950 and 2016.

METHODS

Literature review and Brain Google.

RESULTS

Mild existential despondency.

DISCUSSION

Models for age changes in discrimination between signals and choices of responses have been based on comparisons of speed. The concept of speed has been used in four distinct ways: as a directly measured task performance index, as a hypothetical functional system performance characteristic, as a factor in psychometric models computing mutual variance in calendar age and as a neurophysiological performance characteristic. Since 1950, these measures have, in turn, determined models for speed of perceptual discriminations. Since the 1990s, advances in neuroimaging have not only transformed the data available, but also the nature of the questions that we ask.

An Analysis of Age, Technology Usage, and Cognitive Characteristics Within Information Retrieval Tasks

This work presents two studies that aim to discover whether age can be used as a suitable metric for distinguishing performance between individuals or if other factors can provide greater insight. Information retrieval tasks are used to test the performance of these factors. First, a study is introduced that examines the effect that fluid intelligence and Internet usage has on individuals. Second, a larger study is reported on that examines a collection of Internet and cognitive factors in order to determine to what extent each of these metrics can account for disorientation in users.

This work adds to growing evidence showing that age is not a suitable metric to distinguish between individuals within the field of human-computer interaction. It shows that factors such as previous Internet experience and fluid-based cognitive abilities can be used to gain better insight into users’ reported browsing experience during information retrieval tasks.

Adapting Telemonitoring Technology Use for Older Adults: A Pilot Study

Telehealth technologies are increasing health care access for patients in the home and in community, rural, and underserved areas. Older adults may be challenged to use new technologies due to aging-related changes, lack of experience, and different attitudes toward their use. The current pilot study evaluated potential issues in one-on-one training/instructions and use of a telemonitoring application. Older adults may benefit from specific adaptations and training to use new health care technologies, and behavioral coding is an effective way to evaluate the user interface for new technologies. Feedback from the current study will be used to adapt the application and training to support dementia caregivers.

Older Adult Self-Efficacy Study of Mobile Phone Diabetes Management

The purpose of this study was to evaluate participant self-efficacy and use of a mobile phone diabetes health intervention for older adults during a 4-week period. Participants included seven adults (mean age, 70.3 years) with type 2 diabetes cared for by community-based primary care physicians. Participants entered blood glucose data into a mobile phone and personalized patient Internet Web portal. Based on blood glucose values, participants received automatic messages and educational information to self-manage their diabetes. Study measures included prior mobile phone/Internet use, the Stanford Self-Efficacy for Diabetes Scale, the Stanford Energy/Fatigue Scale, the Short Form-36, the Patient Health Questionnaire-9 (depression), the Patient Reported Diabetes Symptom Scale, the Diabetes Stages of Change measure, and a summary of mobile system use. Participants had high self-efficacy and high readiness and confidence in their ability to monitor changes to control their diabetes. Participants demonstrated ability to use the mobile intervention and communicate with diabetes educators.

Retrieval practice and spacing effects in young and older adults: An examination of the benefits of desirable difficulty

In the present study, we examined how the function relating continued retrieval practice (e.g., one, three, or five tests) and long-term memory retention is modulated by desirable difficulty (R. A. Bjork, 1994). Of particular interest was how retrieval difficulty differed across young and older adults and across manipulations of lag (Exp. 1) and spacing (Exp. 2). To extend on previous studies, the acquisition phase response latency was used as a proxy for retrieval difficulty, and our analysis of final-test performance was conditionalized on acquisition phase retrieval success, to more directly examine the influence of desirable difficulty on retention. The results from Experiment 1 revealed that continued testing in the short-lag condition led to consistent increases in retention, whereas continued testing in the long-lag condition led to increasingly smaller benefits in retention for both age groups. The results from Experiment 2 revealed that repeated spaced testing enhanced retention relative to taking one spaced test, for both age groups; however, repeated massed testing only enhanced retention over taking one test for young adults. Across both experiments, the response latency results were overall consistent with an influence of desirable difficulty on retention. The discussion focuses on the role of desirable difficulty during encoding in producing the benefits of lag, spacing, and testing.

Correlates of, and barriers to, Internet use among older adults

Older adults constitute the group with the greatest increase in Internet usage in the past decade; however, usage varies greatly within this population. Services to older adults require a current understanding of Internet-use trends. This study utilized a quantitative survey method to examine correlates of, and barriers to, current Internet use in a demographically diverse county in Southern California. Findings indicate that the presence of a computer at home, a job requiring computer use, age, education, and ethnicity are important factors in predicting Internet use in older adults. Implications for social work practice with older adults is discussed.

Access to mobile communications by older people

AIM

To investigate how older people effectively identify, select and learn to use mobile communications technologies to enhance communication and safety, and support independent living.

METHODS

One hundred and fifty-three older South Australians participated in a purpose-designed survey questionnaire.

RESULTS

Older people relied on family and friends for information and advice (76%), and their children's assistance with buying (45%) and learning to use (48%) new technology. The most preferred learning method was face-to-face training (56%). Less than half (44%) were interested in trying out new designs/applications, functions and capabilities that could assist with independent living. The highest need was for personal security and emergencies (88%).

CONCLUSIONS

Findings suggest that the family and friends of older people play an important role in identifying, selecting and learning to use mobile communication technologies. The safety and emergency capabilities of mobile communications technologies were more important than having functions that could assist with independent living.

Gerontechnology acceptance by elderly Hong Kong Chinese: a senior technology acceptance model (STAM)

The purpose of this study was to develop and test a senior technology acceptance model (STAM) aimed at understanding the acceptance of gerontechnology by older Hong Kong Chinese people. The proposed STAM extended previous technology acceptance models and theories by adding age-related health and ability characteristics of older people. The proposed STAM was empirically tested using a cross-sectional questionnaire survey with a sample of 1012 seniors aged 55 and over in Hong Kong. The result showed that STAM was strongly supported and could explain 68% of the variance in the use of gerontechnology. For older Hong Kong Chinese, individual attributes, which include age, gender, education, gerontechnology self-efficacy and anxiety, and health and ability characteristics, as well as facilitating conditions explicitly and directly affected technology acceptance. These were better predictors of gerontechnology usage behaviour (UB) than the conventionally used attitudinal factors (usefulness and ease of use).

Skill components of task analysis

Some task analysis methods break down a task into a hierarchy of subgoals. Although an important tool of many fields of study, learning to create such a hierarchy (redescription) is not trivial. To further the understanding of what makes task analysis a skill, the present research examined novices' problems with learning Hierarchical Task Analysis and captured practitioners' performance. All participants received a task description and analyzed three cooking and three communication tasks by drawing on their knowledge of those tasks. Thirty six younger adults (18-28 years) in Study 1 analyzed one task before training and five afterwards. Training consisted of a general handout that all participants received and an additional handout that differed between three conditions: a list of steps, a flow-diagram, and concept map. In Study 2, eight experienced task analysts received the same task descriptions as in Study 1 and demonstrated their understanding of task analysis while thinking aloud. Novices' initial task analysis scored low on all coding criteria. Performance improved on some criteria but was well below 100 % on others. Practitioners' task analyses were 2-3 levels deep but also scored low on some criteria. A task analyst's purpose of analysis may be the reason for higher specificity of analysis. This research furthers the understanding of Hierarchical Task Analysis and provides insights into the varying nature of task analyses as a function of experience. The derived skill components can inform training objectives.

Rapid instructed task learning: a new window into the human brain's unique capacity for flexible cognitive control

The human ability to flexibly adapt to novel circumstances is extraordinary. Perhaps the most illustrative, yet underappreciated, form of this cognitive flexibility is rapid instructed task learning (RITL)--the ability to rapidly reconfigure our minds to perform new tasks from instructions. This ability is important for everyday life (e.g., learning to use new technologies) and is used to instruct participants in nearly every study of human cognition. We review the development of RITL as a circumscribed domain of cognitive neuroscience investigation, culminating in recent demonstrations that RITL is implemented via brain circuits centered on lateral prefrontal cortex. We then build on this and the recent discovery of compositional representations within lateral prefrontal cortex to develop an integrative theory of cognitive flexibility and cognitive control that identifies mechanisms that may enable RITL within the human brain. The insights gained from this new theoretical account have important implications for further developments and applications of RITL research.

Effect of a computerized brain exercise program on cognitive performance in older adults

OBJECTIVES

Research indicates an association between stimulating mental activities and better memory performance as people age, but studies on computerized mental stimulation programs are limited. We explored whether computerized brain training exercises improved cognitive performance in older adults.

METHODS

In local retirement communities, a convenience sample was randomized into an intervention group (N = 36), who used a computer program 5 days a week for 20-25 minutes each day, or a wait-list control group (N = 33). All were older adults without dementia (mean age: 81.8 years; SD: 6.1; 67% female). Neuropsychological testing was completed at baseline (Time 1), 2 months (Time 2), and 6 months (Time 3). Three cognitive domains (Immediate Memory, Delayed Memory, Language) were compared in the two groups as a function of time using mixed models.

RESULTS

The intervention group used the computerized program (Brain Fitness, Dakim Inc., Santa Monica, CA) for an average of 43 (SD: 4.4) sessions by Time 2 and 81 (SD: 37.5) sessions by Time 3. Mixed models examining cognitive domains as function of time revealed significant group differences in Delayed Memory (F(2,72) = 4.7, p = 0.01) but not Immediate Memory and Language; no significant improvements were noted for the control group. Among all participants, anyone playing at least 40 sessions over the 6 months improved in all three domains (Immediate Memory, Delayed Memory, and Language).

CONCLUSION

Participating in a computerized brain exercise program over 6 months improves cognitive abilities in older adults. These results extend literature indicating the benefit of training exercises, whether in a classroom format or via a computerized self-paced program.

How Older Adults Learn to Use Mobile Devices

Mobile computing devices, such as smart phones, offer benefits that may be especially valuable to older adults (age 65+). Yet, older adults have been shown to have difficulty learning to use these devices. In the research presented in this article, we sought to better understand how older adults learn to use mobile devices, their preferences and barriers, in order to find new ways to support them in their learning process. We conducted two complementary studies: a survey study with 131 respondents from three age groups (20--49, 50--64, 65+) and an in-depth field study with 6 older adults aged 50+. The results showed, among other things, that the preference for trial-and-error decreases with age, and while over half of older respondents and participants preferred using the instruction manual, many reported difficulties using it. We discuss implications for design and illustrate these implications with an example help system, Help Kiosk, designed to support older adults’ learning to use mobile devices.

Outcomes from a peer tutor model for teaching technology to older adults

A key component of social work ethics is social justice and equitable access to resources. Increasingly, this includes access to technology. This study addresses issues related to the ‘digital divide’ by testing a peer tutor model (Technology and Aging Project, TAP2) to teach adults aged 60 and older how to use information and communication technologies (ICTs) such as email, the internet, online chat rooms and discussion groups, internet-based support groups, and voice technology and webcams. Participants from the control group of a previous programme, TAP1 (N=19) participated in a six-month computer training programme. Six participants who had successfully completed the TAP1 training were selected to be peer tutors. Data were collected from tutors and learners at baseline, three months, six months and nine months (three months after the end of training). The current study reports on learner outcomes only. Measures include computer, social support, and mental health-related outcomes. Learners reported a significant and consistent increase over time in their confidence completing certain computer-related tasks and their overall use of ICTs. Mental health and social support outcomes did not change. Overall, the peer tutor model appeared to be at least as effective as the previous staff-directed model.

The technology - activities of daily living questionnaire: a version with a technology-related subscale

BACKGROUND

Information and communication technology (ICT) has become an increasingly important part of daily life. The ability to use technology is becoming essential for autonomous functioning in society. Current functional scales for patients with cognitive impairment do not evaluate the use of technology. The objective of this study was to develop and validate a new version of the Activities of Daily Living Questionnaire (ADLQ) that incorporates an ICT subscale.

METHOD

A new technology-based subscale was incorporated into the Spanish version of the ADLQ (SV-ADLQ), entitled the Technology version of the ADLQ (T-ADLQ). The T-ADLQ was administered to 63 caregivers of dementia patients, 21 proxies of mild cognitive impairment patients and 44 proxies of normal elderly subjects (mean age of the sample ± SD: 73.5 ± 8.30 years). We analysed the convergent validity, internal consistency, reliability cut-off point, sensitivity and specificity of the T-ADLQ. The results of the T-ADLQ were compared to the SV-ADLQ.

RESULTS

The T-ADLQ showed significant correlations with the Mini-Mental State Examination (MMSE), the Frontal Assessment Battery (FAB) as well as other measures of functional impairment and dementia severity (MMSE: r = -0.70; FAB: r = -0.65; Functional Assessment Questionnaire: r = 0.77; Instrumental Activities of Daily Living Scale: r = -0.75; Clinical Dementia Rating Scale: r = 0.72; p < 0.001). The T-ADLQ showed a good reliability with a relatively high Cronbach's α-coefficient (Cronbach's α = 0.861). When considering a functional impairment cut-off point greater than 29.25%, the sensitivity and specificity of the T-ADLQ were 82 and 90%, respectively. The area under the receiver-operating characteristic curve was 0.937 for the T-ADLQ and 0.932 for the original version of the test.

CONCLUSIONS

The T-ADLQ revealed adequate indicators of validity and reliability for the functional assessment of activities of daily living in dementia patients. However, the inclusion of technology items in the T-ADLQ did not improve the performance of the scale, which may reflect the lack of widespread use of technology by elderly individuals. Thus, although it appeared reasonable to add technology use questions to the ADLQ, our experience suggested that this has to be done cautiously, since the sensitivity of these additional items could vary in different populations. The T-ADLQ needs to be validated in a different population of dementia subjects.

Application of cognitive rehabilitation theory to the development of smart prompting technologies

Older adults with cognitive impairments often have difficulty performing instrumental activities of daily living (IADLs). Prompting technologies have gained popularity over the last decade and have the potential to assist these individuals with IADLs in order to live independently. Although prompting techniques are routinely used by caregivers and health care providers to aid individuals with cognitive impairment in maintaining their independence with everyday activities, there is no clear consensus or gold standard regarding prompt content, method of instruction, timing of delivery, or interface of prompt delivery in the gerontology or technology literatures. In this paper, we demonstrate how cognitive rehabilitation principles can inform and advance the development of more effective assistive prompting technologies that could be employed in smart environments. We first describe cognitive rehabilitation theory (CRT) and show how it provides a useful theoretical foundation for guiding the development of assistive technologies for IADL completion. We then use the CRT framework to critically review existing smart prompting technologies to answer questions that will be integral to advancing development of effective smart prompting technologies. Finally, we raise questions for future exploration as well as challenges and suggestions for future directions in this area of research.

Procedural instructions, principles, and examples: how to structure instructions for procedural tasks to enhance performance, learning, and transfer

OBJECTIVE

The goal of this article is to investigate how instructions can be constructed to enhance performance and learning of procedural tasks.

BACKGROUND

Important determinants of the effectiveness of instructions are type of instructions (procedural information, principles, and examples) and pedagogical goal (initial performance, learning, and transfer).

METHOD

Procedural instructions describe how to complete tasks in a stepwise manner, principles describe rules governing the tasks, and examples demonstrate how instances of the task are carried out. The authors review the research literature associated with each type of instruction to identify factors determining effectiveness for different pedagogical goals.

RESULTS

The results suggest a trade-off between usability and learnability. Specific instructions help initial performance, whereas more general instructions, requiring problem solving, help learning and transfer. Learning from instructions takes cognitive effort, and research suggests that learners typically opt for low effort. However, it is possible to meet both goals of good initial performance and learning with methods such as fading and by combining different types of instructions.

CONCLUSION

How instructions are constructed influences their effectiveness for the goals of good initial performance, learning, and transfer, and it is therefore important for researchers and practitioners alike to define the pedagogical goal of instructions.

APPLICATION

If the goal is good initial performance, then instructions should highly resemble the task at hand (e.g., in the form of detailed procedural instructions and examples), but if the goal is good learning and transfer, then instructions should be more abstract, inducing learners to expend the necessary cognitive effort for learning.

Toward a psychological science of advanced technology design for older adults

OBJECTIVES

Technology represents advances in knowledge that change the way humans perform tasks. Ideally, technology will make the task easier, more efficient, safer, or perhaps more pleasurable. Unfortunately, new technologies can sometimes make a task more difficult, slower, dangerous, or perhaps more frustrating. Older adults interact with a variety of technologies in the course of their daily activities and thus products should be designed to be used by people of varying ages.

METHODS

In this article, we provide an overview of what psychology has to offer to the design of technology-from understanding what people need, to identifying their preferences for design characteristics, and to defining their capabilities and limitations that will influence technology interactions.

RESULTS

We identify how research in the field of psychology and aging has advanced understanding of technology interactions and how research on technology interactions can inform theories of aging.

DISCUSSION

Design for aging involves understanding the unique capabilities and limitations of older adults; identifying their needs, preferences, and desires for technology in their lives; and involving them in the design process.

Multi-Layered Interfaces to Improve Older Adults’ Initial Learnability of Mobile Applications

Mobile computing devices can offer older adults (ages 65+) support in their daily lives, but older adults often find such devices difficult to learn and use. One potential design approach to improve the learnability of mobile devices is a Multi-Layered (ML) interface, where novice users start with a reduced-functionality interface layer that only allows them to perform basic tasks, before progressing to a more complex interface layer when they are comfortable. We studied the effects of a ML interface on older adults’ performance in learning tasks on a mobile device. We conducted a controlled experiment with 16 older (ages 65--81) and 16 younger participants (age 21--36), who performed tasks on either a 2-layer or a nonlayered (control) address book application, implemented on a commercial smart phone. We found that the ML interface’s Reduced-Functionality layer, compared to the control’s Full-Functionality layer, better helped users to master a set of basic tasks and to retain that ability 30 minutes later. When users transitioned from the Reduced-Functionality to the Full-Functionality interface layer, their performance on the previously learned tasks was negatively affected, but no negative impact was found on learning new, advanced tasks. Overall, the ML interface provided greater benefit for older participants than for younger participants in terms of task completion time during initial learning, perceived complexity, and preference. We discuss how the ML interface approach is suitable for improving the learnability of mobile applications, particularly for older adults.

Facilitating Technology Use in Older Adulthood: The Person-Environment-Occupation Model Revisited

This mixed methods study used a cross-comparative case study design to explore how previous experiences with technology can influence collaboration between older married couples during first-time use of technology, namely an in-vehicle navigation system.

Previous research suggests that, with age, collaboration with a married partner can maintain or, in some cases, even improve performance on cognitive-based, memory retrieval tasks. However, few studies have evaluated how older adults problem solve collaboratively through such tasks. Driving a car has been identified as a context in which older drivers and copilots (that is, spouse) work together to get to the places they need to go safely. With the advent of vehicular technology, including navigation systems, older drivers expect to share the cognitive load with their copilot.

Using the Person-Environment-Occupation Model, this investigation highlights key factors that influence the shared adoption and use of technology in later life. For occupational therapists, the results from this study can guide clinical decision-making when prescribing technology and considering collaborative training strategies that facilitate occupational performance in older adulthood.