Predictors of Performance in Everyday Technology Tasks in Older Adults With and Without Mild Cognitive Impairment

Association of frailty with workplace social activity, physical activity, and well-being among older employees: a moderated mediation in two income-variant samples

BACKGROUND

Research suggests that frailty is associated with lower physical activity and well-being in old age, but social activities at work may facilitate physical activity and its positive effect on well-being among older employees with frailty. This study, therefore, ascertained whether there is a moderated mediation of the association of frailty, Workplace Social Activity (WSA), and well-being by Physical Activity (PA).

METHODS

The study adopted a cross-sectional design with relevant sensitivity analyses for confounding. The participants were within two Ghanaian samples with different income levels (low-income, n = 897, and higher income, n = 530). The minimum samples were calculated, and the statistical models were tested with Haye's Process Model through structural equation modelling.

RESULTS

Frailty was negatively associated with PA, and this relationship was moderated by WSA in both samples. Higher frailty was directly and indirectly associated with lower well-being in the higher-income sample but only indirectly associated with lower well-being in the low-income sample. The mediation of PA in the frailty-well-being relationship is partial in the higher-income sample but complete in the low-income sample. There was evidence of moderated mediation in both samples.

CONCLUSION

WSA may reduce the strength of the negative association of frailty with PA and well-being among older employees in both samples. Workplace interventions aimed at enhancing WSA may encourage PA and enhance well-being among older employees with frailty.

Factors influencing female students' entrepreneurial intention in vocational colleges: A multi-group analysis based on household income

Female entrepreneurs have irreplaceable status and essential significance in entrepreneurship research. Improving females' entrepreneurial intentions is an important topic in this area. Accordingly, this study, based on the theory of planned behavior, investigates the factors that affect female students' entrepreneurial intention at China's vocational colleges and whether household income moderates the relationship between entrepreneurial education, attitude, competence, self-efficacy and entrepreneurial intention. 2149 females from vocational colleges in Guangdong Province, Zhejiang Province, and Jiangxi Province were randomly chosen to participate in the study. They had taken part in entrepreneurial courses throughout 2021-2022. In addition, data were analyzed by structural equation modeling partial least squares. The results demonstrate that entrepreneurial education did not directly affect female students' intentions. Entrepreneurial competence, self-efficacy, and attitude positively affect entrepreneurial intention. It is further concluded that household income significantly moderates the relationship between entrepreneurial education, attitude, competence, and intention. However, there is no significant difference in the relationship between self-efficacy and entrepreneurial intention between high and low-household-income students. While females continue to confront sexism in the workplace, it is crucial that we conduct empirical research into the factors influencing female entrepreneurial intention to boost economic growth and gender parity. This research helps bridge a gap in the prior literature and adds substantial value to encouraging female entrepreneurs.

Enhancing neurocognitive health, abilities, networks, & community engagement for older adults with cognitive impairments through technology: a scoping review introducing the ENHANCE Center

PURPOSE

Age associated cognitive impairments (CIs) result in difficulties with a wide range of daily activities. As the older adult population increases, so does the importance of understanding and supporting the needs and disabilities of those with CIs. The Enhancing Neurocognitive Health, Abilities, Networks, and Community Engagement (ENHANCE) Centre was established with a focus on developing assistive technology to support the socialisation, transportation, and prospective memory needs of older adults with CIs. The extent to which relevant literature in these domains existed was unknown.

MATERIALS AND METHODS

A scoping review identified existing research meeting the following criteria: participants aged 50+ years classified as having a CI due to mild cognitive impairment (MCI), traumatic brain injury (TBI), or stroke; and a focus on technology-based support for socialisation, transportation, and/or prospective memory activities.

RESULTS

Qualitative and quantitative data are reported from relevant studies. In addition to few studies available, it was common for studies to include 20 or fewer participants. Most assessed technology interactions at one time and few studies examined longitudinal use and benefit. While each paper examined one aspect of user-centred design, no technologies were reported that underwent all stages of the user-centred design process, from needs assessment to iterative design and usability testing, to efficacy trial.

CONCLUSIONS

Gaps highlight notable directions for future research and the important role ENHANCE can play in addressing the needs and disabilities of older adults with CIs. IMPLICATIONS FOR REHABILITATIONAlthough older adults with common cognitive impairments often experience challenges in the domains of socialisation, transportation, and/or prospective memory, few studies exist that examine assistive technology solutions in these domains.Additional research with more robust designs and larger sample sizes is needed to discover and assess assistive technology solutions for the needs and disabilities of older adults with mild cognitive impairment (MCI), traumatic brain injury (TBI), and post-stroke cognitive impairment (PSCI).The ENHANCE Centre will employ a systematic process of needs assessments, user testing, and efficacy tests to develop novel technology solutions to support the needs of older adults with common cognitive impairment.

Everyday technology use among people with Parkinson's disease

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

A Model for Cognitive Personalization of Microtask Design

The study of data quality in crowdsourcing campaigns is currently a prominent research topic, given the diverse range of participants involved. A potential solution to enhancing data quality processes in crowdsourcing is cognitive personalization, which involves appropriately adapting or assigning tasks based on a crowd worker's cognitive profile. There are two common methods for assessing a crowd worker's cognitive profile: administering online cognitive tests, and inferring behavior from task fingerprinting based on user interaction log events. This article presents the findings of a study that investigated the complementarity of both approaches in a microtask scenario, focusing on personalizing task design. The study involved 134 unique crowd workers recruited from a crowdsourcing marketplace. The main objective was to examine how the administration of cognitive ability tests can be used to allocate crowd workers to microtasks with varying levels of difficulty, including the development of a deep learning model. Another goal was to investigate if task fingerprinting can be used to allocate crowd workers to different microtasks in a personalized manner. The results indicated that both objectives were accomplished, validating the usage of cognitive tests and task fingerprinting as effective mechanisms for microtask personalization, including the development of a deep learning model with 95% accuracy in predicting the accuracy of the microtasks. While we achieved an accuracy of 95%, it is important to note that the small dataset size may have limited the model's performance.

Technology use and subjective cognitive concerns in older adults

OBJECTIVES

How technology impacts the day to day cognitive functioning of older adults is a matter of some debate. On the one hand, the use of technologies such as smartphones and social media, may lead to more subjective cognitive concerns (SCC) by promoting distractibility and reliance on devices to perform memory tasks. However, continued digital engagement in older adults may also be related to better cognitive functioning. Given these competing viewpoints, our study evaluated if frequency of digital device use was associated with greater or less subjective cognitive concerns.

METHOD

Participants were 219 adults over the age of 65 (mean age =75 years) who had internet access. Measures assessing frequency of digital device use along with SCC were administered. Hierarchical multiple regression was used to gage association between frequency of device use and SCC, controlling for relevant demographic and lifestyle factors.

RESULTS

Increased frequency of digital device use was associated with less SCC, over and above the influence of demographic factors, across cognitive (but especially in executive) domains. This effect was observed for general device usage, with no statistically significant associations were observed between texting/video call, social media use and SCC.

DISCUSSION

Results were broadly consistent with the technological reserve hypothesis in that digital engagement was associated with better experienced cognitive functioning in older adults. While device use may contribute to distractibility in certain cases, the current results add to a burgeoning literature that digital engagement may be a protective factor for cognitive changes with age.

The experiences of carers in supporting a person living with dementia to participate in virtual cognitive stimulation therapy during the COVID-19 pandemic

OBJECTIVES

Cognitive stimulation therapy (CST) is an evidence-based group intervention for people with dementia. In response to the COVID-19 pandemic, many existing CST groups moved virtually and this required carers of people living with dementia to assist with setting up the appropriate technology. This study aimed to explore the roles and experiences of carers in accessing virtual CST (vCST).

METHODS

This qualitative study used semi-structured individual interviews, via telephone or videoconference, to explore the roles and experiences of carers. Interviews were recorded, transcribed verbatim and thematically analysed.

RESULTS

Twelve family carers (age: 51-75 years) reported a range of experiences, from novice to expert knowledge in terms of accessing digital devices (mainly laptops and iPads) and connecting to Zoom. Accessing vCST provided carers an immediate application of new knowledge. Carers reported positive responses to vCST that provided their family member living with dementia with social contact and cognitive stimulation during lockdown.

CONCLUSION

Accessing vCST required carers to have an existing adequate level of technological competence in order to learn and use the Zoom platform. Adult learning principles can be used to improve carers' digital literacy required for vCST and other telehealth initiatives.

Implications of refrigerator management on subjective memory complaints among Japanese community-dwelling older adults

AIM

Older adults with subjective memory complaints (SMC) may experience very minor difficulties in daily activities. Although caregivers and occupational therapists who support community-dwelling older adults are aware of the existence of characteristic behaviours related to refrigerator management, no specific studies have been conducted. This study aimed to examine the implications of refrigerator management for older adults with SMC.

METHODS

A self-administered questionnaire was sent to 3000 randomly selected members of Consumer's Co-operative Kagoshima. Of the returned responses, a total of 282 older adults were analyzed. Analyzed subjects were divided into two groups: SMC (+) group (n = 74) and SMC (-) group (n = 192). A questionnaire was created by four occupational therapists and used to assess the characteristics of analyzed subjects and their abilities to manage the refrigerator. The observation list for early signs of dementia was also utilised. A multiple logistic analysis was performed to examine the association between SMC and refrigerator management.

RESULTS

The SMC (+) group had a significantly higher number of refrigerator management errors than the SMC (-) group (P = 0.008). The SMC (+) group had more errors than the SMC (-) group in the following four items regarding refrigerator management; the refrigerator has a lot of the same foods / expired food, the person does not know what's in the refrigerator, the person cannot find what he/she needs in the refrigerator. Moreover, SMC was associated with the item 'the person does not know what is in the refrigerator' (odds ratio 7.44, 95% CI 1.51-43.8, P = 0.02).

CONCLUSIONS

Our results showed that older adults with SMC had several problems regarding refrigerator management. Evaluating refrigerator management among older adults with SMC may help consider multifaceted support.

Acceptance of digital health services among older adults: Findings on perceived usefulness, self-efficacy, privacy concerns, ICT knowledge, and support seeking

Background

Over the last decade, the rapid advancements in information and communication technologies (ICTs) have also driven the development of digital health services and applications. Older adults could particularly benefit from these technologies, but they still have less access to the Internet and less competence in using it. Based on the empirical literature on technology acceptance among older adults, this study examines the relations of perceived usefulness, self-efficacy, privacy concerns, ICT knowledge, and support seeking (family, informal, formal/institutional) with older adults' intention to adopt new digital health services.

Methods

The study included 478 older adults who participated in an online or paper/pencil questionnaire (M = 70.1 years, SD = 7.8; 38% male). Sociodemographic characteristics, subjective health status, and variables related to technology acceptance were assessed.

Results

Latent structural equation modeling revealed that higher perceived usefulness, higher self-efficacy regarding digital health technologies, and lower privacy concerns contributed to a higher intention to use digital health services among older adults. Contrary to our expectations, general ICT knowledge was not a significant predictor. Older adults who reported seeking more support regarding technology problems from family members and formal/institutional settings also reported higher usage intentions, whereas informal support was not as relevant. Furthermore, higher age was associated with higher perceived usefulness and lower self-efficacy.

Discussion

Future studies should further explore mediating factors for intention and actual use of digital health services and develop educational programs including follow-up assessments.

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

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

Product Interfaces for Older Adult Users With Cognitive Impairment

The aim of this study is to explore the usability of multiple forms of television remote control interfaces for older adult users and users with mild cognitive impairment (MCI) to clarify the operation performance requirements of these two user groups. The test interfaces were constructed through programming and were capable of recording participants’ task completion time, operation errors, and the locations of their taps. The results show that users with MCI could not perform their initial action quickly and accurately; buttons with larger sizes provided greater operation performance for older adult users and users with MCI.

Difficulties in the Use of Everyday Technology among Older Adults with Subjective Memory Complaint and Cognitive Decline

INTRODUCTION

The ability to use everyday technology (ET) is becoming increasingly necessary for maintaining domestic and social lives. For older adults, difficulties with using ETs can begin at the mild cognitive impairment (MCI) state and may indicate increasing cognitive decline. The aim of this study was to conduct a detailed investigation into the ability to use ETs among Japanese older community-dwelling adults at 3 stages of cognitive function and the ability to carry out daily activities.

METHOD

We analyzed family members' responses to questions about older adults with cognitive decline in their families. A total of 168 older adults with subjective memory complaints (SMC) or cognitive decline and inconvenience in daily life were analyzed. A questionnaire was used to assess the characteristics, ability to use ETs, and ability to manage refrigerator contents, all of which can be early signs of dementia. Participants were divided 3 groups by the type of dementia: SMC (n = 77), MCI (n = 36), and Alzheimer's disease (AD) (n = 55) for comparison.

RESULT

The observation list of early signs of dementia (OLD) total score indicated a significant positive correlation with the number of ET errors (r = 0.37, p < 0.001) and number of difficulties with refrigerator management (r = 0.18, p = 0.031). Regarding number of ET errors, there was a significant main effect for the 3 groups, and the SMC group made significantly fewer errors than the AD group (p = 0.02). In 7 of the 11 ET categories, errors with using ETs were associated with all 3 groups, with the SMC group making fewer errors, and the AD group making more. Regarding difficulties with refrigerator management, 2 out of 9 problems were associated with the 3 groups, with the SMC group having fewer difficulties and the AD group having more.

DISCUSSION/CONCLUSION

The results indicated that the ability to use ETs and to manage refrigerator contents begins to decline at the SMC stage. Further evaluation of the ability to use ETs is needed for older adults with SMC so that adequate support in the context of the individual can be provided.

Digital Assistive Technology to Support Everyday Living in Community-Dwelling Older Adults with Mild Cognitive Impairment and Dementia

Objective

The objective of this review was to explore whether knowledge about and practice of technology for older adults with mild cognitive impairment (MCI) and dementia (D) had developed since our 2017 review. Furthermore, we wanted to explore the usability and acceptability of technology in the newer trials, and how these may impact quality of life, occupational performance and human dignity.

Materials and Methods

We searched for primary studies published between 2017 and 2020 reusing medical subject heading (MeSH) terms in five databases – Medline, PsycINFO, Embase, Amed and Cinahl – and obtained 1452 titles. The titles were divided in six piles, two for each of the three authors. The titles were sorted utilizing the Rayyan web tool. Fourteen studies were included in this review. The Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the studies examined.

Results

This review included almost twice as many participants as in the 2007–2017 review. Since 2017, a shift seems to have occurred toward technologies that can be worn on the body to monitor body functions and report states, or imbalances. Moreover, research interest is now focused on mobile phone apps and wearables providing reminders and timely support, rather than on separate devices at home.

Conclusion

The studies conducted since 2017 report on wearable and environmental digital assistive technologies and often with multiple purposes. Three strategies for support seem evident: prompting and reminding people with dementia, monitoring people with dementia at home using environmental sensors and biosensors and providing safety outdoors. Thus, there is still a need for further research on the impact of technologies promoting occupational performance, quality of life, and human dignity for independent living.

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.

“Aging Means to Me… That I Feel Lonely More Often”? An Experimental Study on the Effects of Age Simulation Regarding Views on Aging

Over the last decades, educational programs involving age simulation suits (ASS) emerged with the ambition to further the understanding of age-related loss experiences, enhance empathy and reduce negative attitudes toward older adults in healthcare settings and in younger age groups at large. However, the impact of such “instant aging” interventions on individuals’ personal views on aging have not been studied yet. The aim of the current study is to address possible effects of ASS interventions on multiple outcomes related to views on aging, i.e., aging-related cognitions (i.e., expectations regarding social losses), awareness of age-related change (AARC) and age stereotypes. Moreover, we explore effects on broader constructs with relevance to aging, i.e., perceived obsolescence, risk perceptions, as well as desired support through technology. In a within-subjects design, N = 40 participants (M = 61.4 years, SD = 6.16) went through a series of established geriatric assessments (i.e., Timed up and Go) with and without an ASS. Views on aging constructs were assessed in standardized questionnaires before and after the ASS intervention. Changes in aging-related cognitions were observed, with more negative expectations regarding social integration and continuous development after wearing the ASS. AARC and age stereotypes did not change from pre- to post-assessment, but participants reported an increased susceptibility to age-associated impairments and stronger feelings of obsolescence. Those participants who exhibited higher difficulties in geriatric assessments while wearing the suit reported higher openness to be supported by intelligent assistive devices or robots afterwards. We conclude that ASS interventions should only be combined with education on losses and gains during the aging process to prevent negative effects on individual views on aging. On the other hand, potentials regarding technology acceptance and formation of intentions to engage in prevention and health behaviors among middle-aged to young-old adults are discussed.

Interface Design for Products for Users with Advanced Age and Cognitive Impairment

The aim of this study is to investigate the problems and needs of users with advanced age and cognitive impairment regarding the design and operation of daily living products. Television remote controls and an electric rice cooker were applied as the research tools, and focus group interviews with control older adults and interviews with individuals with MCI or mild dementia were conducted regarding the operation of the products. The control participants stressed that the operating procedures should not be excessively complex, the number of functions and buttons should not be overly high, and buttons and text should be enlarged. For those with MCI or mild dementia, in addition to the size and number of buttons, text size, and functions, their operation of product interfaces was affected by the complexity of the operating procedures. The solutions recommended by the participants included interface design involving direct operation and voice control.

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.

Benefits, Satisfaction and Limitations Derived from the Performance of Intergenerational Virtual Activities: Data from a General Population Spanish Survey

The growing social gap between people of different generations has led to a greater interest in the study of intergenerational interactions. Digital technologies have become necessary for people of all ages to perform daily activities, increasingly including older people. The use of information and communication technologies (ICTs) and virtual tools can provide older people with excellent opportunities to connect with other generations, improving their quality of life and well-being. The aim of this study was to examine the benefits, satisfaction, and limitations of intergenerational interactions generated by the use of virtual tools. The participants are subjects of any age and different social groups residing in Spain and have completed an online survey. The analysis of sociodemographic data of the respondents showed that there is a significant correlation between the use of social networks and all the variables analyzed, except for their level of autonomy. Most participants who participated in intergenerational virtual activities reported the benefits of their social participation, relationships, mood, mental health, and academic education. Moreover, most participants were quite or very satisfied with the person with whom they used the virtual tools, especially if the person was a friend, their partner, sibling, another relative, or colleague. Except for grandparents, people who participated in intergenerational virtual activities and who had no limitations or disabilities were more frequently reported by the participants. In conclusion, intergenerational interactions through the use of virtual tools can contribute to improving the social inclusion and relationships of all people involved.

Self-Perceptions of Aging and Everyday ICT Engagement: A Test of Reciprocal Associations

OBJECTIVES

Everyday information and communication technologies (EICTs), involving digital services, such as online shopping, e-banking, and video calling, are perceived to be associated with youth and a modern lifestyle. On the other hand, older adults are often portrayed as technology-alienated, less willing, and incapable of using EICT. The internalization of potentially negative age stereotypes may compromise actual later life engagement and the ability to perform EICT. At the same time, low engagement in EICT may also contribute to negative self-perceptions of aging (SPA), for example, related to physical loss, social loss, and personal competence. This study was, hence, designed to evaluate the temporal reciprocal associations of SPA and older adults' EICT use.

METHODS

The article was based on 2 waves (2014 and 2017) from the German Ageing Survey (DEAS), a nationally representative survey of middle-aged and older individuals aged 40 and older. A cross-lagged model (N = 3,600) was estimated to examine the reciprocal associations of SPA and EICT.

RESULTS

The lagged effect of SPA on EICT engagement was nonsignificant, whereas the lagged effect of EICT engagement on SPA in the domain personal competence was significant, indicating that greater EICT engagement predicted more positive SPA related to personal competence 3 years later.

DISCUSSION

These findings encourage researchers and policymakers to put further emphasis on the empowerment of older individuals in their EICT engagement. Interventions that promote lifelong learning and age-friendly environments can enhance a more positive aging experience.

Self-Efficacy of Older People Using Technology to Self-Manage COPD, Hypertension, Heart Failure, or Dementia at Home: An Overview of Systematic Reviews

BACKGROUND AND OBJECTIVES

Although telehealth research among the general population is voluminous, the quality of studies is low and results are mixed. Little is known specifically concerning older people and their self-efficacy to engage with and benefit from such technologies. This article reviews the evidence for which self-care telehealth technology supports the self-efficacy of older people with long-term conditions (LTCs) living at home.

RESEARCH DESIGN AND METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) guidelines, this overview of systematic reviews focused on four LTCs and the concept of "self-efficacy." Quality was appraised using R-AMSTAR and study evaluation was guided by the PRISMS taxonomy for reporting of self-management support. Heterogeneous data evidencing technology-enhanced self-efficacy were narratively synthesized.

RESULTS

Five included articles contained 74 primary studies involving 9,004 participants with chronic obstructive pulmonary disease, hypertension, heart failure, or dementia. Evidence for self-care telehealth technology supporting the self-efficacy of older people with LTCs living at home was limited. Self-efficacy was rarely an outcome, also attrition and dropout rates and mediators of support or education. The pathway from telehealth to self-efficacy depended on telehealth modes and techniques promoting healthy lifestyles. Increased self-care and self-monitoring empowered self-efficacy, patient activation, or mastery.

DISCUSSION AND IMPLICATIONS

Future research needs to focus on the process by which the intervention works and the effects of mediating variables and mechanisms through which self-management is achieved. Self-efficacy, patient activation, and motivation are critical components to telehealth's adoption by the patient and hence to the success of self-care in self-management of LTCs. Their invisibility as outcomes is a limitation.

A Typical Week With Mild Cognitive Impairment

BACKGROUND AND OBJECTIVES

Identifying the experience of people with mild cognitive impairment (MCI) may help develop research agendas, interventions, and other supports to better match individuals' needs. The purpose of this study was to explore the subjective experience of a "typical week" living with MCI to document (a) important activities, (b) barriers to usual activities, and (c) facilitators and supports.

RESEARCH DESIGN AND METHODS

We conducted remote individual photo-elicitation interviews with 11 community-dwelling adults aged 55 years or older with MCI. Participants each provided 5-10 photographs of daily life taken over 1 week to facilitate a semistructured qualitative interview. Interview transcriptions were coded in Dedoose software and analyzed using thematic analysis.

RESULTS

Participants shared photos and narratives highlighting the important activities in a typical week, in which physical activity, social engagement, spiritual and religious practice, hobbies, and cognitive stimulation were central. Many also shared disruptions to former routines and reduction of activities alongside increased use of new strategies and environmental supports (e.g., calendars, smartphones). Finally, emergent themes centered on disclosure of their diagnosis and reflections about the future.

DISCUSSION AND IMPLICATIONS

Participant-generated images aided data collection and facilitated discussion of sensitive topics with individuals with MCI. Such narratives may illustrate the needs and opportunities to promote well-being in individuals with MCI, including engagement in meaningful and health-promoting activities, assessing barriers to important daily activities, and considering supports that match the experience and needs of those with MCI.

Effects of peri-traumatic stress experienced during Hurricane Sandy on functional limitation trajectories for older men and women

BACKGROUND AND METHODS

Although the short-term effects of disasters on the physical health of mid-life and older people have been documented, little is understood about the long-term effects that disasters have on the physical health of these people. Based on the environmental docility hypothesis and research regarding gender effects on functional limitations and disaster, our analyses examined the effects of peri-traumatic stress experienced during Hurricane Sandy using longitudinal data from 5688 people aged 50 and older collected over six waves (2006-2019).

RESULTS

We found that functional limitations follow three trajectories, with people in each group having a significant linear increase over time and all but the highest functioning people also having a significant quadratic effect, indicating that the linear increase peaked post-Hurricane and then slowed in later waves.

CONCLUSION

Consistent with the environmental docility hypothesis, peri-traumatic stress had its greatest impact on people with more functional limitations before the hurricane. Men experiencing peri-traumatic stress during Hurricane Sandy were more likely to experience an increase in functional limitations than women. These findings, which identify people most likely to experience long-term health effects following a disaster, can be used to inform health policies before, during, and after disaster strikes.

Person–Environment Resources for Aging Well: Environmental Docility and Life Space as Conceptual Pillars for Future Contextual Gerontology

A variety of different disciplines in the study of aging have long acknowledged that individual functioning and development are profoundly shaped by the contexts people live in. The Gerontologist has played a central role in publishing and fostering theoretical and empirical work geared toward better understanding many of the questions that revolve around the how and the why. To illustrate, we consider in a first step the environmental docility hypothesis and the life space construct as two landmark concepts published in The Gerontologist and review how these—in conjunction with the later introduced proactivity perspective—have shaped for decades and continue to shape the larger field of (contextual) gerontology. In a second step, we discuss how these two entirely separate conceptualizations could be integrated in a late pas-de-deux. In doing so, we also make use of Wahl & Gerstorf's conceptual framework for studying COntext Dynamics in Aging (CODA) to discuss how these classic concepts can promote future gerontological research.

Improving gesture-based interaction between an assistive bathing robot and older adults via user training on the gestural commands

BACKGROUND

Gesture-based human-robot interaction (HRI) depends on the technical performance of the robot-integrated gesture recognition system (GRS) and on the gestural performance of the robot user, which has been shown to be rather low in older adults. Training of gestural commands (GCs) might improve the quality of older users' input for gesture-based HRI, which in turn may lead to an overall improved HRI.

OBJECTIVE

To evaluate the effects of a user training on gesture-based HRI between an assistive bathing robot and potential elderly robot users.

METHODS

Twenty-five older adults with bathing disability participated in this quasi-experimental, single-group, pre-/post-test study and underwent a specific user training (10-15 min) on GCs for HRI with the assistive bathing robot. Outcomes measured before and after training included participants' gestural performance assessed by a scoring method of an established test of gesture production (TULIA) and sensor-based gestural performance (SGP) scores derived from the GRS-recorded data, and robot's command recognition rate (CRR).

RESULTS

Gestural performance (TULIA = +57.1 ± 56.2 %, SGP scores = +41.1 ± 74.4 %) and CRR (+31.9 ± 51.2 %) significantly improved over training (p < .001). Improvements in gestural performance and CRR were highly associated with each other (r = 0.80-0.81, p < .001). Participants with lower initial gestural performance and higher gerontechnology anxiety benefited most from the training.

CONCLUSIONS

Our study highlights that training in gesture-based HRI with an assistive bathing robot is highly beneficial for the quality of older users' GCs, leading to higher CRRs of the robot-integrated GRS, and thus to an overall improved HRI.

The Effects of the Digital Platform Support Monitoring and Reminder Technology for Mild Dementia (SMART4MD) for People With Mild Cognitive Impairment and Their Informal Carers: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Many countries are witnessing a trend of growth in the number and proportion of older adults within the total population. In Europe, population aging has had and will continue to have major social and economic consequences. This is a fundamentally positive development where the added life span is of great benefit for both the individual and the society. Yet, the risk for the individual to contract noncommunicable diseases and disability increases with age. This may adversely affect the individual's ability to live his or her life in the way that is desired. Cognitive conditions constitute a group of chronic diseases that predominantly affects older people. Recent technology advancements can help support the day-to-day living activities at home for people with cognitive impairments.

OBJECTIVE

A digital platform (Support Monitoring and Reminder for Mild Dementia; SMART4MD) is created to improve or maintain the quality of life for people with mild cognitive impairment (PwMCI) and their carers. The platform will provide reminders, information, and memory support in everyday life, with the purpose of giving structure and lowering stress. In the trial, we will include participants with a diagnosed neurocognitive disorder as well as persons with an undiagnosed subjective memory problem and cognitive impairment, that is, 20 to 28 points on the Mini-Mental State Examination.

METHODS

A pragmatic, multicenter RCT is being conducted in Spain, Sweden, and Belgium. The targets for recruitment are 1200 dyads-split into an intervention group and a control group that are in usual care. Intervention group participants will be provided with a data-enabled computer tablet with the SMART4MD app. Its core functionalities, intended to be used daily at home, are based on reminders, cognitive supporting activities, and sharing health information.

RESULTS

Inclusion of participants started in December 2017, and recruitment is expected to end in February 2019. Furthermore, there will be 3 follow-up visits at 6, 12, and 18 months after the baseline visit.

CONCLUSIONS

This RCT is expected to offer benefits at several levels including in-depth knowledge of the possibilities of introducing a holistic multilayered information and communication technology solution for this group. SMART4MD has been developed in a process involving the structured participation of PwMCI, their informal carers, and clinicians. The adoption of SMART4MD faces the challenge of this age group's relative unfamiliarity with digital devices and services. However, this challenge can also be an opportunity for developing a digital device tailored to a group at risk of digital exclusion. This research responds to the wider call for the development of digital devices which are accessible and affordable to older people and this full scale RCT can hopefully serve as a model for further studies in this field.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/13711.

Mild cognitive impairment in maintenance hemodialysis patients: a cross-sectional survey and cohort study

Introduction

Few studies focused on mild cognitive impairment (MCI) in maintenance hemodialysis (MHD) patients. This study was conducted to survey the prevalence, the potent risk factors of MCI in MHD patients, and further observe the progress of MCI in a period of 6 months.

Methodology

Mini-Mental State Examination, and Montreal Cognitive Assessment were used to assess cognitive condition. MHD patients were enrolled from The First Affiliated Hospital of Nanjing Medical University, who had a stable hemodialysis history for more than 3 months.

Results

Sixty-four MHD patients and 54 general subjects were finally included. The average age of both groups was more than 60 years. The prevalence of MCI in the MHD group was significantly higher than that in general population (60.9% vs 29.6%, P<0.05). Spearman correlation analysis indicated that MCI was related to age, comorbidities, education years, uric acid, serum albumin, and blood pressure. The prevalence and severity of MCI in the MHD group remained unchanged during the 6 months (prevalence: 59.5%–66.6%, MoCA scores: 22.9–22.5).

Conclusion

MHD patients sustain a fairly high prevalence of MCI. Multiple risk factors influence the incidence and progression of MCI in MHD patients. More attention should be paid to this special population.