Promoting dietary awareness: Home-dwelling older adults' perspectives on using a nutrition application

Digital health in geriatric oncology: A Young International Society of Geriatric Oncology review

The integration of digital health technologies in geriatric oncology has the potential to enhance patient care and self-management. This review article discusses the applications of these technologies, including teleassessment, telemonitoring, and teleintervention, within geriatric oncology, and evaluates their potential to improve cancer care and patient outcomes. We also review challenges to the implementation of digital health technologies among populations of older patients with cancer. The article provides a perspective for clinicians, researchers, policymakers, and patients on the integration and utilisation of digital health technologies in current geriatric oncology practice.

A Scoping Review of Nutrition Health for Older Adults: Does Technology Help?

The technological developments in healthcare may help facilitate older adult nutritional care. This scoping review includes research in technology and nutrition to (1) explain how technology is used to manage nutrition needs and (2) describe the forms of technology used to manage nutrition. Five major databases were the foundation for papers published from January 2000 to December 2020. The most common type of technology used is software to (1) "track, plan, and execute" nutrition management and for (2) "assessing" technology use. "Track, plan, and execute" includes tracking food intake, planning for changes, and executing a plan. "Assessing" technology use is collecting nutrition data from a provider's or an older adult's self-use of technology to understand dietary intake. Hardware is the second most type of technology used, with tablet computers for software and internet access. The findings reveal that software for older adults lacks standardization, the Internet of Things is a promising area, the current device emphasis is the tablet computer, and broadband internet access is essential for nutrition care. Only 38 studies were published in the last five years, indicating that nutrition management for older adults with hardware or software has not reached a significant research mass.

The Use of a Decision Support System (MyFood) to Assess Dietary Intake Among Free-Living Older Adults in Norway: Evaluation Study

BACKGROUND

The proportion of older adults in the world is constantly increasing, and malnutrition is a common challenge among the older adults aged ≥65 years. This poses a need for better tools to prevent, assess, and treat malnutrition among older adults. MyFood is a decision support system developed with the intention to prevent and treat malnutrition.

OBJECTIVE

This study aimed to evaluate the ability of the MyFood app to estimate the intake of energy, protein, fluids, and food and beverage items among free-living older adults aged ≥65 years, primarily at an individual level and secondarily at a group level. In addition, the aim was to measure the experiences of free-living older adults using the app.

METHODS

Participants were instructed to record their dietary intake in the MyFood app for 4 consecutive days. In addition, each participant completed two 24-hour recalls, which were used as a reference method to evaluate the dietary assessment function in the MyFood app. Differences in the estimations of energy, protein, fluid, and food groups were analyzed at both the individual and group levels, by comparing the recorded intake in MyFood with the 2 corresponding recalls and by comparing the mean of all 4 recording days with the mean of the 2 recalls, respectively. A short, study-specific questionnaire was used to measure the participants' experiences with the app.

RESULTS

This study included 35 free-living older adults residing in Norway. Approximately half of the participants had ≥80% agreement between MyFood and the 24-hour recalls for energy intake on both days. For protein and fluids, approximately 60% of the participants had ≥80% agreement on the first day of comparison. Dinner was the meal with the lowest agreement between the methods, at both the individual and group levels. MyFood tended to underestimate the intake of energy, protein, fluid, and food items at both the individual and group levels. The food groups that achieved the greatest agreement between the 2 methods were eggs, yogurt, self-composed dinner, and hot beverages. All participants found the app easy to use, and 74% (26/35) of the participants reported that the app was easy to navigate.

CONCLUSIONS

The results showed that the MyFood app tended to underestimate the participants' dietary intake compared with the 24-hour recalls at both the individual and group levels. The app's ability to estimate intake within food groups was greater for eggs, yogurt, and self-composed dinner than for spreads, mixed meals, vegetables, and snacks. The app was well accepted among the study participants and may be a useful tool among free-living older adults, given that the users are provided follow-up and support in how to record their dietary intake.

Malnutrition in older adults

Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.

Mobile health applications for older adults: a systematic review of interface and persuasive feature design

OBJECTIVE

Mobile-based interventions have the potential to promote healthy aging among older adults. However, the adoption and use of mobile health applications are often low due to inappropriate designs. The aim of this systematic review is to identify, synthesize, and report interface and persuasive feature design recommendations of mobile health applications for elderly users to facilitate adoption and improve health-related outcomes.

MATERIALS AND METHODS

We searched PubMed, Embase, PsycINFO, CINAHL, and Scopus databases to identify studies that discussed and evaluated elderly-friendly interface and persuasive feature designs of mobile health applications using an elderly cohort.

RESULTS

We included 74 studies in our analysis. Our analysis revealed a total of 9 elderly-friendly interface design recommendations: 3 recommendations were targeted at perceptual capabilities of elderly users, 2 at motor coordination problems, and 4 at cognitive and memory deterioration. We also compiled and reported 5 categories of persuasive features: reminders, social features, game elements, personalized interventions, and health education.

DISCUSSION

Only 5 studies included design elements that were based on theories. Moreover, the majority of the included studies evaluated the application as a whole without examining end-user perceptions and the effectiveness of each single design feature. Finally, most studies had methodological limitations, and better research designs are needed to quantify the effectiveness of the application designs rigorously.

CONCLUSIONS

This review synthesizes elderly-friendly interface and persuasive feature design recommendations for mobile health applications from the existing literature and provides recommendations for future research in this area and guidelines for designers.

The importance of knowing and listening to all those involved in the design and use of nutrition mobile apps. Getting to know the Great GApp

Introduction

Almost every country worldwide suffers from one or more types of malnutrition. Mobile technology (mHealth) interventions seem to represent a promising approach to this problem because they help share information about healthy eating patterns, offer motivation for behavioral change, etc. From this perspective we introduce a theoretical model that attempts to explain the gap that currently prevails between the elements involved in the development of nutritional mHealth strategies (which we have called the Great GApp). Evidence tells us that it is necessary to consider all the parts involved to ensure positive outcomes of an mHealth-based nutritional intervention: patients, health care providers, and stakeholders (technological companies). If these elements are not considered in the design of mHealth strategies a Great GApp arises, which may lead to lack of adherence to the proposed change, and decrease the potential for improving the quality of health outcomes.

Older Adults' Engagement in Technology-Mediated Self-Monitoring of Diet: A Mixed-Method Study

Purpose

This feasibility study explored older adults’ use of a nutrition app called Appetitus (https://apps.apple.com/us/app/appetitt/id1001936854?ign‐mpt=uo%3D2; https://play.google.com/store/apps/details?id=no.nr.appetitt&hl=e) and addressed their engagement in technology‐mediated self‐monitoring of diet. Undernutrition is a significant challenge among older adults and is associated with poorer health experiences. Digital health for self‐monitoring of diet has the potential to increase awareness of personal nutrition, and the scarcity of research reporting older adults’ ability and willingness to engage in technology‐mediated dietary self‐monitoring warranted this study.

Design and Methods

An explorative mixed‐methods design combining descriptive analysis of log data with qualitative analysis of interviews with Appetitus users was implemented.

Findings

Twenty‐five older adults self‐monitored their diet using Appetitus over an 8‐week trial period. Eighty percent of the participants used the app regularly in the trial period. The most engaged users recorded their food consumption daily for 8 weeks. Personal interest in nutrition and commitment to the project facilitated regular use of Appetitus. Poor health and the perception that using a nutrition app lacked personal relevance contributed to irregular self‐monitoring. For inexperienced technology users, participation in this project became a springboard to using tablet technology and the Internet beyond the Appetitus app.

Conclusions

The majority of the participants regularly used Appetitus for self‐monitoring of diet; they found the tablet technology and Appetitus app easy to use.

Clinical Relevance

Older adults are able and willing to use self‐monitoring tools. Nutrition apps can empower older adults to make better informed decisions about their diet. Patients’ self‐monitoring can provide valuable and detailed health‐related information to healthcare professionals and mediate patient‐centered care practices.