Predictors of computer use in community-dwelling, ethnically diverse older adults

Examining Ethnic Disparities in Digital Healthcare Services Utilization: Insights from Israel

Purpose

The purpose of this study was to examine ethnic disparities in the utilization of digital healthcare services (DHS) in Israel and explore the characteristics and factors influencing DHS use among the Arab minority and Jewish majority populations.

Methods

A cross-sectional correlational design was employed to collect data from 606 Israeli participants, 445 Jews, and 161 Arabs. Participants completed a digital questionnaire that assessed DHS utilization, digital health literacy, attitudes towards DHS, and demographic variables.

Results

The findings reveal significant disparities in DHS utilization and attitudes between these ethnic groups, with Jewish participants demonstrating higher rates of utilization and positive attitudes toward DHS. The study also explores the predictive role of digital health literacy and attitudes in DHS use while considering ethnicity as a potential moderator. Significant predicting factors related to DHS utilization among Jews include positive attitudes and high health literacy. Among the Arabs, only attitudes towards DHS significantly predict the extent of DHS use. Digital health literacy affects the extent of use through attitudes at the two groups of the moderator significantly, but it is stronger among the Arab group.

Conclusion

To improve healthcare outcomes and reduce disparities, efforts should focus on ensuring equitable access to DHS for the Arab minority population. Targeted interventions, including digital literacy education, removing technology access barriers, offering services in Arabic, and collaborating with community organizations, can help bridge the gap and promote equal utilization of DHS.

Validity of the NIH toolbox cognitive battery in a healthy oldest-old 85+ sample

OBJECTIVE

To evaluate the construct validity of the NIH Toolbox Cognitive Battery (NIH TB-CB) in the healthy oldest-old (85+ years old).

METHOD

Our sample from the McKnight Brain Aging Registry consists of 179 individuals, 85 to 99 years of age, screened for memory, neurological, and psychiatric disorders. Using previous research methods on a sample of 85 + y/o adults, we conducted confirmatory factor analyses on models of NIH TB-CB and same domain standard neuropsychological measures. We hypothesized the five-factor model (Reading, Vocabulary, Memory, Working Memory, and Executive/Speed) would have the best fit, consistent with younger populations. We assessed confirmatory and discriminant validity. We also evaluated demographic and computer use predictors of NIH TB-CB composite scores.

RESULTS

Findings suggest the six-factor model (Vocabulary, Reading, Memory, Working Memory, Executive, and Speed) had a better fit than alternative models. NIH TB-CB tests had good convergent and discriminant validity, though tests in the executive functioning domain had high inter-correlations with other cognitive domains. Computer use was strongly associated with higher NIH TB-CB overall and fluid cognition composite scores.

CONCLUSION

The NIH TB-CB is a valid assessment for the oldest-old samples, with relatively weak validity in the domain of executive functioning. Computer use's impact on composite scores could be due to the executive demands of learning to use a tablet. Strong relationships of executive function with other cognitive domains could be due to cognitive dedifferentiation. Overall, the NIH TB-CB could be useful for testing cognition in the oldest-old and the impact of aging on cognition in older populations.

A study on community older people's willingness to use smart home-an extended technology acceptance model with intergenerational relationships

Introduction

Despite the potential of smart home technology to promote sustainable lifestyles, the adoption rate among older adults remains relatively low. This study aims to investigate the influence of intergenerational relationships on the acceptance of smart home services among seniors.

Methods

A survey was conducted among 298 older adults in China, and data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). Ten predictor variables were examined to assess their impact on the willingness to use smart home services.

Results

Intergenerational relationships significantly influenced the utilization of smart home services among older adults. Specifically, intergenerational instrumental support had a direct positive effect on the behavioral intention to use smart homes. Additionally, intergenerational emotional and financial support affected life satisfaction, which subsequently influenced the behavioral intention to use smart homes.

Discussion

The assistance and guidance provided by younger generations play a crucial role in shaping the willingness of older adults to adopt smart home technology. Intergenerational support can contribute positively to enabling aging individuals to age in place through the utilization of technology.

A retrospective study of differences in patients’ anxiety and satisfaction between paper-based and computer-based tools for “Shared Decision-Making”

We aimed to investigate differences in patients’ anxiety and satisfaction between patients undergoing paper-based patient decision aid (PDA) for shared decision-making (SDM) and those receiving computer-based PDA. We retrospectively collected questionnaires before and after SDM. Basic demographic data as well as anxiety, satisfaction, knowledge acquisition, and participation in SDM were recorded. We divided our population into subgroups according to use of paper-based or computer-based PDA. In addition, Pearson correlation analysis was applied to assess the relationships among variables. In total, 304 patients who visited our Division of Nephrology were included in the final analysis. Overall, over half of the patients felt anxiety (n = 217, 71.4%). Near half of the patients felt a reduction in anxiety after SDM (n = 143, 47.0%) and 281 patients (92.4%) were satisfied with the whole process of SDM. When we divided all the patients based on use of paper-based or computer-based PDA, the reduction of anxiety level was greater in the patients who underwent paper-based PDA when compared with that of those who underwent computer-based PDA. However, there was no significant difference in satisfaction between the two groups. Paper-based PDA was as effective as computer-based PDA. Further studies comparing different types of PDA are warranted to fill the knowledge gaps in the literature.

A study on the quality evaluation index system of smart home care for older adults in the community --based on Delphi and AHP

BACKGROUND

In the context of the "silver wave" and "technology wave", smart home care for older adults in the community provide new ways for China and other countries to support ageing in place. Yet, only very few studies have focused on developing a quality index system of smart care. This study attempted to draw on the SERVQUAL model to establish a quality evaluation index system for smart senior care for older adults in the community.

METHODS

On the basis of the service quality model, this paper has integrated qualitative and quantitative analyses using the Delphi and Analytic Hierarchy Process (AHP) methods to construct the index system of smart home care in the community and obtain the weights. These were based on literature research and field interviews in Guangzhou and Shenzhen pilot districts.

RESULTS

A quality evaluation indexes system of smart home care for older adults in the community was developed, with 5 primary indices and 33 secondary indices. The weights of the 5 stair indices from high to low were smart emergency assistance 0.332, smart meal assistance 0.272, smart medical assistance 0.229, smart cleaning assistance 0.110 and smart amusement assistance 0.057.

CONCLUSION

The results from the weight allocation revealed smart emergency assistance, smart meal assistance, and smart medical care assistance were the most important and crucial aspects of community-based smart home care. The study also suggested that "timeliness", "reliability", and "ease of use" should be given more attention. It is recommended to use this index system as a regulatory benchmark to guide the government bodies, senior care enterprises and communities to take measures to enhance the quality.

Failure mode and effects analysis of telehealth service of minority elderly for sustainable digital transformation

BACKGROUND

Telehealth services are time- and cost-saving solutions for disease management for older adults. Minority older individuals with multiple risk factors have an increasing demand for telehealth services. There are insufficient data on patient safety in telehealth services. This study aimed to enhance the quality of telehealth services by reducing errors and creating a safe user environment for low-income older adults. Failure mode and effects analysis tool (FMEA) was adopted to manage potential risks for sustainable digital transformation.

METHOD

An eight-member multidisciplinary team conducted telehealth FMEA to determine risk priority numbers (RPNs). The process included identifying the potential cause and effect failure mode of each step; measuring severity, probability, and detectability scores for RPNs; and generating strategies to decrease potential failures.

RESULTS

This study identified 24 risk factors and 34 causes in four major phases with a mean RPN of 90.7: preparation to measure biosignals, measurement of biosignals following instructions from a personal device, confirmation of measurement results, and intervention based on disease or condition type. Risk prioritization revealed four high failure modes and a total RPN of 362.7. Based on fundamental causes, risks were categorized as oblivescence, economic issues, and technology literacy.

CONCLUSIONS

To correct these failure modes, stabilization of the platform, adding to the providers' manpower, and support for government policies are recommended. FMEA identifies and evaluates the potential risks of telehealth services. The selected priorities reduce the clinical risks of low-income elders who use telehealth services by weighting clinical actions.

Health and self-perceived barriers to internet use among older migrants: a population-based study

Background

In older adults, including those with a migrant background, ill health is associated with less internet use. However, it is not known what are the specific self-perceived barriers to internet use among older migrants with different health conditions. The aim of this study was to investigate the associations between different health conditions and self-perceived barriers to internet use among older migrants.

Methods

We used the Care, Health and Ageing of Russian-speaking Minority in Finland (CHARM) study, which is a nationally representative survey of community-dwelling Russian-speaking adults aged ≥50 years living in Finland (N=1082, 57% men, mean age 63.2 years, standard deviation 8.4 years, response rate 36%). Postal survey data were collected in 2019. Health indicators were self-rated health (SRH), depressive symptoms, cognitive functioning, and doctor-diagnosed conditions. Linear regression analyses were used to investigate the associations between health indicators and a summary scale consisting of the following barriers of internet use: (1) internet use is too complicated and hard to learn; (2) having concerns about safety issues; (3) internet use is too expensive; (4) physical limitations hinder the internet use; (5) memory problems hinder the internet use. In addition, the two most commonly reported barriers (the first two) were examined separately using logistic regression analyses. The analyses were adjusted for age, sex, education, marital status, local language proficiency, and income support, and the health conditions, and were performed with weights accounting for the survey design and non-response.

Results

After adjustments, spine/back problems (b=0.13; p=0.049), depressive symptoms (b=0.40; p=0.007), and problems in learning new things (b=0.60; p<0.0005) were associated with higher level of overall barriers to internet use. In addition, a number of health conditions were associated with individual barriers, albeit some health conditions appeared protective.

Conclusions

In general, older migrants with declining health experience more barriers to internet use than their counterparts with better health. To provide better access to healthcare for older adults, including older migrants, rapidly changing devices, software and apps need to be modified and adapted for those with specific health-related needs.

"Me Dieron Vida": The Effects of a Pilot Health Promotion Intervention to Reduce Cardiometabolic Risk and Improve Behavioral Health among Older Latinos with HIV

There are significant gaps in knowledge about the synergistic and disparate burden of health disparities associated with cardiovascular health issues, poorer mental health outcomes, and suboptimal HIV-care management on the health of older Latinos living with HIV (OLLWH). This pilot study sought to evaluate the feasibility and acceptability of an innovative application of an already established health-promotion intervention-Happy Older Latinos are Active (HOLA)-among this marginalized population. Eighteen self-identified Latino men with an undetectable HIV viral load and documented risk of cardiometabolic disease participated in this study. Although the attrition rate of 22% was higher than expected, participants attended 77% of the sessions and almost 95% of the virtual walks. Participants reported high satisfaction with the intervention, as evident by self-report quantitative (CSQ-8; M = 31, SD = 1.5) and qualitative metrics. Participants appreciated bonding with the community health worker and their peers to reduce social isolation. Results indicate that the HOLA intervention is an innovative way of delivering a health promotion intervention adapted to meet the diverse needs and circumstances of OLLWH, is feasible and acceptable, and has the potential to have positive effects on the health of OLLWH.

Urban/Rural Digital Divide Exists in Older Adults: Does It Vary by Racial/Ethnic Groups?

Despite the overall increase in older adults' internet use, the digital divide within older Americans remains substantial, particularly for those in rural areas and with racial/ethnic minority backgrounds. The current study examines how one's residential area and racial/ethnicity relate to internet access, both singularly and in concert. Data were from the 2016 Health and Retirement Study. The sample consisted of 17,372 Americans aged 50 and above. Logistic regression analyses were performed to test the direct effects of residence and race/ethnicity and their interaction effects on internet use. The odds of internet use were significantly lower for older adults living in suburban and rural residences as well as for Black and Hispanic individuals. Furthermore, rural living reduced the probability of using the internet more for Blacks than Whites. These findings underscore the need for targeted interventions to narrow the digital divide, with particular attention required for older Blacks in rural communities.

Have changes in Internet use during the COVID-19 pandemic affected older adults' self-rated health? A cross-sectional study of young-old and old-old populations in Korea

Disparities in Internet access are barriers to older populations' well-being. This study examined the association between changes in older adults' Internet usage during the coronavirus disease 2019 (COVID-19) pandemic and their self-rated health. Participants were adults aged 65 years and above, selected from the 2020 Digital Divide Survey conducted in Korea (n = 1150). Changes in Internet use among younger (aged 65-74 years) and older (aged 75 years and above) groups and the association between these changes and participants' self-rated health were examined. Internet usage remained similar or increased during the COVID-19 pandemic, particularly among the younger group. Increased Internet use was associated with better self-rated health of the participants. Other characteristics, including age, income, and education level, were also positively associated with their health. This study highlights the need for increasing older adults' access to online activities to enhance health equity in the digital era.

Efficacy of Mobile Health for Self-management of Cardiometabolic Risk Factors: A Theory-Guided Systematic Review

BACKGROUND

Although mobile health (mHealth) technologies are burgeoning in the research arena, there is a lack of mHealth interventions focused on improving self-management of individuals with cardiometabolic risk factors (CMRFs).

OBJECTIVE

The purpose of this article was to critically and systematically review the efficacy of mHealth interventions for self-management of CMRF while evaluating quality, limitations, and issues with disparities using the technology acceptance model as a guiding framework.

METHODS

PubMed, CINAHL, EMBASE, and Lilacs were searched to identify research articles published between January 2008 and November 2018. Articles were included if they were published in English, included adults, were conducted in the United States, and used mHealth to promote self-care or self-management of CMRFs. A total of 28 articles were included in this review.

RESULTS

Studies incorporating mHealth have been linked to positive outcomes in self-management of diabetes, physical activity, diet, and weight loss. Most mHealth interventions included modalities such as text messaging, mobile applications, and wearable technologies. There was a lack of studies that are (1) in resource-poor settings, (2) theoretically driven, (3) community-engaged research, (4) measuring digital/health literacy, (5) measuring and evaluating engagement, (6) measuring outcomes related to disease self-management, and (7) focused on vulnerable populations, especially immigrants.

CONCLUSION

There is still a lack of mHealth interventions created specifically for immigrant populations, especially within the Latino community-the largest growing minority group in the United States. In an effort to meet this challenge, more culturally tailored mHealth interventions are needed.

The Impact of an Internet Use Promotion Programme on Communication, Internet Use, and the Extent of Social Networks among Low-Income Older Adults

We examined whether an internet use promotion intervention influences low-income older adults’ communication modes, internet use, and social networks using existing data collected for an intervention. Participants living in public senior housing facilities in the United States (n = 77) completed surveys before and after a 12-week computer and internet training. The six-item Lubben Social Network Scale (LSNS-6) was used to measure the extent of older adults’ social networks. The primary mode of communication shifted from more traditional means to internet-based communications (p < .0005 in a Fisher’s exact test). The frequency of internet use significantly increased (p < .00005 in a one-sided Sign test). Overall, the LSNS-6 score increased by 4.1 points (p < .00005 in a Welch’s t-test). The LSNS-6 score increase was significantly larger among African Americans than Whites, controlling for gender (p < .05 in negative binomial regression). Moderate (p < .005) and frequent internet users (p < .05) had higher LSNS-6 scores than rare internet users at posttest when gender and race were controlled for in linear regression. Comparatively more improvement in the extent of social networks among African Americans suggests greater benefits of such interventions for population groups of disadvantaged backgrounds. Larger social networks among moderate and frequent internet users than rare users suggest positive impacts of internet communications on social networks.

Digital Information Technology Use, Self-Rated Health, and Depression: Population-Based Analysis of a Survey Study on Older Migrants

BACKGROUND

Previous studies have found that in general, poor health is associated with a lower likelihood of internet use in older adults, but it is not well known how different indicators of health are associated with different types of digital information technology (DIT) use. Moreover, little is known about the relationship between health and the types of DIT use in older ethnic minority and migrant populations.

OBJECTIVE

The aim of this study is to examine the associations among depressive symptoms and self-rated health (SRH) with different dimensions of DIT use in older migrants.

METHODS

We analyzed data from the Care, Health and Ageing of Russian-speaking Minority (CHARM) study, which is based on a nationally representative sample of community-dwelling, Russian-speaking adults aged 50 years or older residing permanently in Finland (men: 616/1082, 56.93%; age: mean 63.2 years, SD 8.4 years; response rate: 1082/3000, 36.07%). Data were collected in 2019 using a postal survey. Health was measured using depressive symptoms (measured using the Center for Epidemiologic Studies Depression Scale) and SRH. Binary logistic regression analyses were used to investigate the associations between the two health indicators and the following six outcomes: daily internet use, smartphone ownership, the use of the internet for messages and calls, social media use, the use of the internet for personal health data, and obtaining health information from the internet. A number of sociodemographic and socioeconomic factors were controlled for in the logistic regression regression analysis. Analyses were performed with weights accounting for the survey design and nonresponse.

RESULTS

After adjusting for sociodemographic and socioeconomic factors, depressive symptoms (odds ratio [OR] 2.68, 95% CI 1.37-5.24; P=.004) and poor SRH (OR 7.90, 95% CI 1.88-33.11; P=.005) were associated with a higher likelihood of not using the internet daily. Depressive symptoms (OR 1.88, 95% CI 1.06-3.35; P=.03) and poor SRH (OR 5.05, 95% CI 1.58-16.19; P=.006) also increased the likelihood of smartphone nonuse. Depressive symptoms were additionally associated with a lower likelihood of social media use, and poor SRH was associated with a lower likelihood of using the internet for messaging and calling.

CONCLUSIONS

Poor SRH and depressive symptoms are associated with a lower likelihood of DIT use in older adults. Longitudinal studies are required to determine the directions of these relationships.

Impact of the use of the internet on quality of life in older adults: review of literature

Aim:

Given the paucity of data on the use of internet and quality of life (QoL), this literature review aimed to identify the motivations and barriers for internet use and the impact on QoL on older adults using the internet.

Background:

Even though older adults are increasingly using information technology, the numbers remain quite small globally. Currently published research primarily focuses on the various ways and methods of information technology use by older adults and the factors influencing use rather than on the impact of information technology on QoL of older adults.

Methods:

The studies included in this literature review were searched in three databases: WEB of Science, GoogleScholar and PubMed. English language articles were searched using the terms ‘older’, ‘elderly’, ‘senior’, ‘well-being’, ‘life satisfaction’, ‘quality of life’, ‘internet’ and “computer”.

Findings:

The review demonstrated the association of internet use on QoL in older adults. The majority of the studies substantiate the advantages of internet use by older adults including the ability to communicate with family and friends, maintain a wide social network, have access to information and participate in online leisure activities. There are some studies, though less in number, which did not find a relationship between well-being and use of internet by older adults. The policy implications of this review advocate a multidimensional strategy to support internet use by the older people incorporating internet training and education, financial issues, technical support and access needs to be developed.

Older adults' technology use and its association with health and depressive symptoms: Findings from the 2011 National Health and Aging Trends Study

Background

Information and communication technology (ICT) provides older adults with access to information and resources that benefit their health.

Purpose

To explore ICT use among older adults and examine the influence of information technology (IT), communication technology (CT), or ICT use on older adults' self-rated health status and depressive symptoms.

Method

A sample of community-dwelling Medicare beneficiaries aged 65 and older in the United States (N = 4,976) from the 2011 National Health and Aging Trends Study.

Findings

Older adults who embraced ICT and used this technology for a variety of purposes were more likely to report better health status, and were less likely to experience major depressive symptoms than nonusers.

Discussion

In accordance with the Health Information Technology for Economic and Clinical Health Act, nursing professional can play an important role by responding to older adults' diverse technology preferences and effectively incorporating them into nursing practice.

The role of online communication among spousal caregivers of individuals with Alzheimer's disease

This study investigates (1) the importance of online communication for female caregivers (2) the impact of this form of maintaining social contact on well-being among 48 Polish spousal female caregivers of individuals with Alzheimer's disease. Data were collected using semi-structured interviews and self-completion questionnaires. Caregivers' online communication usage intensity was significantly associated with lower levels of depression and loneliness. Older women used online support groups to share their emotions related to the burden of providing care, to maintain a sense of social connection with other caregivers, and to access information about the disease. The results indicated Internet use has both positive and negative influences on the well-being of older women caregivers.

Trends in Internet Use Among Older Adults in the United States, 2011–2016

The present study examined the trends in internet use among older adults (60+ years) in the United States from 2011 to 2016 by considering not only the entire study sample as a whole but also specific subgroups by age, gender, race/ethnicity, and education. Using data from 107,500 older adults in the California Health Interview Survey between 2011 and 2016, the significance of linear trends was tested by including the survey year as a continuous variable in the logistic regression. Findings confirm the general knowledge that an increased number of the older U.S. population used the internet over the period of 2011–2016. Furthermore, closer inspection indicates that this upward trend does not apply to all, but specifically to those with advanced age, male gender, racial/ethnic minority background, and low educational attainment. Findings provide implications for identifying and prioritizing a target group for internet technology training.

Internet use and self-rated health among Swedish 70-year-olds: a cross-sectional study

Background

The Internet is increasingly becoming an infrastructure for a number of services, both commercial, public (including health related) and personal. Using the internet have the potential to promote social interaction and social connectedness by upholding social networks and social contacts. However, Internet use is lower in older adults compared to other age groups. This digital divide is considered a risk to the health of older adults since it limits their participation in society, access and use of relevant health related information and services. This study focuses on whether there is an association between Internet use and self-rated health.

Method

A cross-sectional population-based sample of 70-year-olds from The Gothenburg H70 Birth Cohort Study (n = 1136) was examined in 2014–16. All data was collected using structured interviews and questionnaires. Differences in proportions were tested with chi-square test and ordinary least square regression analysis was used to estimate the relationship between Internet use and self-rated health controlling for health factors, hearing and visual impairment, and social contacts.

Results

There is a relationship between more frequent Internet use and good self-rated health (unstandardized β 0.101 p < 0.001), and the effect remained after adjusting for all covariates (unstandardized β 0.082 p < 0.001). Our results also show that, in comparison to health factors, Internet use is of minor importance to the SRH of older adults, since adding these improved the explanatory power of the model by approximately 400% (from 0.04 to 0.18).

Conclusion

Although the direction of the relationship between more frequent interne use and better self-rated health is undetermined in the present study, it can be suggested that using the Internet informs and educates older adults, strengthening their position as active and engaged participants of society. It can also be suggested that those using the Internet report less loneliness and a possibility to establish new computer-mediated relationships within online communities. Further research needs to examine what aspects of Internet use, and in what contexts such positive perceptions arise.

The Social Context of Sedentary Behaviors and Their Relationships With Health in Later Life

This study examined sedentary behaviors among older adults and explored associations with social context and health measures using cross-sectional data from the National Health and Aging Trends Study (N = 1,687). Multivariate models were estimated to explore associations of time in six sedentary behaviors (i.e., television watching, sitting and talking, hobbies, computer use, driving, and resting) with sociodemographic characteristics and level of social engagement and with health status. Results indicated substantial variability in sedentary behaviors, with television watching being the most frequent and resting the least frequent activities. Sedentary behaviors varied by sociodemographic characteristics, including age, race/ethnicity, and education, as well as by level of social engagement. Television watching and resting, but not other behaviors, were associated with poorer health. These findings help to unpack the role of social context in sedentary behaviors and could inform public health interventions aimed at reducing time spent in behaviors that are adversely associated with health.

A Future Research Agenda for Digital Geriatric Mental Healthcare

The proliferation of mobile, online, and remote monitoring technologies in digital geriatric mental health has the potential to lead to the next major breakthrough in mental health treatments. Unlike traditional mental health services, digital geriatric mental health has the benefit of serving a large number of older adults, and in many instances, does not rely on mental health clinics to offer real-time interventions. As technology increasingly becomes essential in the everyday lives of older adults with mental health conditions, these technologies will provide a fundamental service delivery strategy to support older adults' mental health recovery. Although ample research on digital geriatric mental health is available, fundamental gaps in the scientific literature still exist. To begin to address these gaps, we propose the following recommendations for a future research agenda: 1) additional proof-of-concept studies are needed; 2) integrating engineering principles in methodologically rigorous research may help science keep pace with technology; 3) studies are needed that identify implementation issues; 4) inclusivity of people with a lived experience of a mental health condition can offer valuable perspectives and new insights; and 5) formation of a workgroup specific for digital geriatric mental health to set standards and principles for research and practice. We propose prioritizing the advancement of digital geriatric mental health research in several areas that are of great public health significance, including 1) simultaneous and integrated treatment of physical health and mental health conditions; 2) effectiveness studies that explore diagnostics and treatment of social determinants of health such as "social isolation" and "loneliness;" and 3) tailoring the development and testing of innovative strategies to minority older adult populations.

New Perspectives on User Participation in Technology Design Processes: An Interdisciplinary Approach

Background and Objectives

Technologies can enable older adults to participate in social life. These technologies need to be designed so that their benefits are obvious and older users are willing and able to use them. Although user participation has gained importance, participants are frequently not representative of the diversity of potential user groups, so that actual requirements are often not met. Thus, digital inequalities may increase. This problem arose at the beginning of an interdisciplinary research project to design a digital district platform that was to be codesigned with older residents. Here we report an approach to participatory development that takes into account the requirements of older adults, in diverse life situations.

Research Design and Methods

We performed a cluster analysis using data (N = 962) from a representative survey in the case study region. We then conducted semi-structured interviews with residents, as representatives of the different clusters, to explore their life situations and everyday lifestyles. We applied a case-related analysis.

Results

We identified nine life-situation clusters and conducted nine interviews with residents representing them. In an interdisciplinary team, we subsequently developed suggestions for possible technical solutions, based on the respective life situation, everyday life, habits, and challenges of each case.

Discussion and Implications

Although the process was time consuming, we were able to incorporate perspectives of heterogeneous life situations into the digital platform development. This approach, which raises awareness of user-centered requirements, could lead to more apposite and beneficial solutions-especially for those who are underprivileged. Nevertheless, additional strategies to overcome digital inequalities are essential.

Cognitive Function and Digital Device Use in Older Adults Attending a Memory Clinic

This study investigated cognitive function in relation to the use of a computer and a touchscreen device among older adults attending a memory clinic. The entire sample (n = 323) was categorized into four profiles, according to the frequency of digital device use (either daily or non-daily usage). Results showed that on a daily basis, 26% of the sample used both a computer and a touchscreen device, 26.9% used only a computer, 7.1% used only a touchscreen device, and 39.9% used neither type of digital device. There were significant group differences on age, education, and clinical diagnosis (p < .001). Non-daily users of digital devices had significantly lower performance, compared with daily users of both types of digital device, on measures of global cognitive function, processing speed, short-term memory, and several components of executive function (p < .001). Falling behind with regard to the use of digital devices might reflect underlying poor cognitive capacities.

Perceptions on technology for volunteer respite care for bedridden elders in Chile

PURPOSE

 Informal caregivers of bedridden elders need a respite. One form of obtaining a respite is through volunteers who are contacted by means of information and communication technology (ICT).

METHOD

 A qualitative study was carried out in a low-income district in Santiago, Chile, to learn about how caregivers of bedridden elders perceive the possibility of using ICT to access this respite. In-depth interviews were carried out and transcribed verbatim, then analysed using open coding. Results: The results reveal that caregivers are willing to receive a volunteer in their home and use ICT to communicate with them, although a discrepancy exists between the use of devices connected to the Internet and feature phones. Conclusion: This study concludes that informal caregivers of bedridden elders have a favourable disposition towards accessing a respite system by means of ICT based on a peer-to-peer economy.

Patient perspectives of the experience of a computerized cognitive assessment in a clinical setting

INTRODUCTION

Computerized assessments are becoming widely accepted in the clinical setting and as a potential outcome measure in clinical trials. To gain patient perspectives of this experience, the aim of the present study was to investigate patient attitudes and perceptions of the Cognigram [Cogstate], a computerized cognitive assessment.

METHODS

Semi-structured interviews were conducted with 19 older adults undergoing a computerized cognitive assessment at the University of British Columbia Hospital Clinic for Alzheimer Disease and Related Disorders. Thematic analysis was applied to identify key themes and relationships within the data.

RESULTS

The analysis resulted in three categories: attitudes toward computers in healthcare, the cognitive assessment process, and evaluation of the computerized assessment experience. The results show shared views on the need for balance between human and computer intervention, as well as room for improvement in test design and utility.

DISCUSSION

Careful design and user-testing should be made a priority in the development of computerized assessment interfaces, as well as reevaluating the cognitive assessment process to minimize patient anxiety and discomfort. Future research should move toward continuous data capture within clinical trials and ensuring instruments of high reliability to reduce variance.

Older Adults’ Internet Use for Health Information: Digital Divide by Race/Ethnicity and Socioeconomic Status

Building upon literature suggesting low Internet use among racial/ethnic minorities and socioeconomically disadvantaged groups, this study examined how race/ethnicity and socioeconomic status (SES) influence the Internet use for health information, addressing both independent and interactive effects. Using data from 17,704 older adults in the California Health Interview Survey, logistic regression models were estimated with race/ethnicity (Whites, African Americans, Latinos, and Asians), SES index, and the interaction between race/ethnicity and SES index. Overall, approximately 40% of participants were Internet-users for health information. Direct effects of race/ethnicity and SES—and their interactions—were all found to be significant. Minority status combined with the lowest levels of SES substantially reduced the odds of using Internet for health information. Findings suggest the combination of racial/ethnic minority status and low SES as a source of digital divide, and provide implications for Internet technology training for the target population.

Understanding Older Adult's Technology Adoption and Withdrawal for Elderly Care and Education: Mixed Method Analysis from National Survey

BACKGROUND

Elderly adults have comprised the fastest growing population adopting the Internet and computer technology over the past decade. However, how their experiences can shed light on elderly learning theory has not been examined much in the literature.

OBJECTIVE

This study investigated the factors and reasons associated with Internet adoption and withdrawal among older adults in Taiwan, and if any gender differences exist in this context.

METHODS

Data on participants aged 50 years and older from the nationally representative "Digital Opportunity Survey on Individuals and Households in Taiwan," who did not use the Internet in 2005 but adopted it in 2007 (n=1548), and those who reported using Internet in 2011 but then withdrew (n=1575), were analyzed. Factors and reasons associated with Internet adoption and withdrawal were examined using both quantitative and qualitative data.

RESULTS

Education level independently predicted Internet adoption behavior. With regard to the reasons for adoption, 66% (62/94) of participants indicated they started using the Internet to meet certain "needs"; for example, "keeping up with the world" (40.4%, 38/94) was listed as the most critical reason, followed by "job needs" (25.5%, 24/94). Older adults with a positive attitude toward the Internet with regard to increasing employment opportunities (OR 2.0, 95% CI 1.0-3.9, P=.04) and the amount of information obtained (OR 0.5, 95% CI 0.3-0.9, P=.01), as well as enriching recreation and entertainment (OR 0.6, 95% CI 0.4-0.9, P=.02), were less likely to withdraw from the Internet. The most common reason for Internet withdrawal was "psychological barriers" (eg, no available time, no meaningful use, or nothing worth reading/watching; 66.3%, 193/291), followed by "health barriers" (eg, eyes or body deteriorate with Internet use; 21.0%, 61/291). Although psychological barriers were the most important factor for Internet withdrawal for both men (72.5%, 100/138) and women (62%, 93/150), women were more likely than men to be affected by health barriers (26.0%, 39/150 vs 15.9%, 22/138; P=.004) and anthropic factors or accidental barriers (7.3%, 11/150 vs 2.9%, 4/138; P=.02).

CONCLUSIONS

Our findings that the need to keep up with the world associated with Internet adoption, and gender differences in reasons behind Internet withdrawal, such that women reported more health and anthropic factors or accidental barriers than man, may provide a new perspective that help health educators understand strategies that encourage older adults to keep learning, an important component of active aging.

Tablet-based support for older adults with severe mood disorders treated in an ambulatory geriatric psychiatry setting: Protocol of a feasibility study of the eCare@Home platform

INTRODUCTION

Although older adults are just as likely to benefit from e-mental health as their younger counterparts, there are virtually no applications specifically designed to accommodate the needs of older adults with recurrent depression or bipolar disorder. Recurrent mood disorders constitute a large and rising proportion of the global disease in older populations, indicating a need for more e-mental health applications targeting this group. This paper describes the theoretical background and methodology of a study examining the feasibility of a tablet-based self-management platform for older adults with recurrent mood disorders. The eCare@Home platform was designed to 1) improve patients' awareness and knowledge of recurrent mood disorders and their treatment, 2) promote self-management through the use of a simple daily monitoring tool, and 3) facilitate online contact with their clinician through videoconferencing.

METHODS

The design involves a single-group four-month pilot study, with measurements at baseline (T0), and at weeks 8 and 16 (T1 and T2). The target group consists of older outpatients (aged 60 or above) who are undergoing treatment for recurrent depressive or bipolar disorder (N = 50), and their clinicians (N = 10). Primary feasibility endpoints will be system acceptability, system usability, and client satisfaction with the platform. In addition, qualitative data from semi-structured interviews in N = 10 patients and N = 5 clinicians will be gathered to provide more insight into user experiences and evaluations of the platform's added value.

DISCUSSION

To the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a tablet-based e-mental health platform for older adults with severe mood disorders. If tablet-based support for this group is shown to be feasible, the intention is to proceed with the design of a large-scale process and outcome evaluation. The strengths and limitations of the methodology used are addressed in this article.Trial Registration: registration is pending.

Elderly and technology tools: a fuzzyset qualitative comparative analysis

The number of senior citizens is growing globally and governments are striving to find innovative solutions to deal with complex care demands of this part of the population. Technology has been an answer to this situation; however, it is very important that the elderly accept and actually use the technology. This paper empirically tests the senior technology acceptance model using the fsQCA method to analyse data with a sample of 811 seniors aged 60 and over living in Sweden. The results revealed that the necessary conditions for high "perceived ease of use" and "perceived usefulness" are gerontechnology self-efficacy, gerontechnology anxiety, and cognitive abilities; however, each of these is not sufficient on its own. Self-reported health conditions and physical function also play a peripheral role in achieving the desired outcome. Theoretical and managerial implications are discussed at the end of the paper.

Occupational Therapy Home Safety Intervention via Telehealth

Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist. In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety. After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions. Sessions were recorded and transcribed. Data were examined using content analysis. The content analysis identified the following themes: the value of photos to support learning; the value of narrative learning related to home safety education; and abstract versus concrete learners. Procedural findings are included to support future endeavors. Findings indicate that within a wellness context, home safety education for older adults can be delivered effectively via telehealth when using photography as a part of an occupational therapy intervention.

Are Virtual Rehabilitation Technologies Feasible Models to Scale an Evidence-Based Fall Prevention Program? A Pilot Study Using the Kinect Camera

Background

Falls in older adults are a significant public health issue. Interventions have been developed and proven effective to reduce falls in older adults, but these programs typically last several months and can be resource intensive. Virtual rehabilitation technologies may offer a solution to bring these programs to scale. Off-the-shelf and custom exergames have demonstrated to be a feasible adjunct to rehabilitation with older adults. However, it is not known if older adults will be able or willing to use a virtual rehabilitation technology to participate in an evidence-based fall prevention program. To have the greatest impact, virtual rehabilitation technologies need to be acceptable to older adults from different backgrounds and level of fall risk. If these technologies prove to be a feasible option, they offer a new distribution channel to disseminate fall prevention programs.

Objective

Stand Tall (ST) is a virtual translation of the Otago Exercise Program (OEP), an evidence-based fall prevention program. Stand Tall was developed using the Virtual Exercise Rehabilitation Assistant (VERA) software, which uses a Kinect camera and a laptop to deliver physical therapy exercise programs. Our purpose in this pilot study was to explore if ST could be a feasible platform to deliver the OEP to older adults from a variety of fall risk levels, education backgrounds, and self-described level of computer expertise.

Methods

Adults age 60 and over were recruited to participate in a one-time usability study. The study included orientation to the program, navigation to exercises, and completion of a series of strength and balance exercises. Quantitative analysis described participants and the user experience.

Results

A diverse group of individuals participated in the study. Twenty-one potential participants (14 women, 7 men) met the inclusion criteria. The mean age was 69.2 (± 5.8) years, 38% had a high school education, 24% had a graduate degree, and 66% classified as “at risk for falls”. Eighteen participants agreed they would like to use ST to help improve their balance, and 17 agreed or strongly agreed they would feel confident using the system in either the senior center or the home. Thirteen participants felt confident they could actually set up the system in their home. The mean System Usability Scale (SUS) score was 65.5 ± 21.2 with a range of 32.5 to 97.5. Ten participants scored ST as an above average usability experience compared to other technologies and 5 participants scored a less than optimal experience. Exploratory analysis revealed no significant relationships between user experience, education background, self-described computer experience, and fall risk.

Conclusions

Results support the virtual delivery of the OEP by a Kinect camera and an avatar may be acceptable to older adults from a variety of backgrounds. Virtual technologies, like Stand Tall, could offer an efficient and effective approach to bring evidence-based fall prevention programs to scale to address the problem of falls and fall-related injuries. Next steps include determining if similar or better outcomes are achieved by older adults using the virtual OEP, Stand Tall, compared to the standard of care.

Psychosocial Links Between Internet Use and Mental Health in Later Life: A Systematic Review of Quantitative and Qualitative Evidence

Research on the role of information and communication technology (ICT) use for active aging is limited. The aim of this systematic review is to investigate the link between Internet use and mental health among older adults. The review was conducted based on searches in 9 electronic databases (2002-2014). A meta-synthesis approach was applied, examining quantitative (18) and qualitative (14) studies. The findings from the synthesis of quantitative statistical data indicate an overall positive association between Internet use and mental health and its psychosocial covariates in later life. The psychosocial links between Internet use and mental health identified from the qualitative data were (a) enhanced interpersonal interaction at individual level, (b) increased access to resources within the community, and (c) empowered social inclusion at society level. The results highlight the multi-level psychosocial links between Internet use and mental health, which may be applied in initiatives targeting healthy aging in various settings.

Perceptions of Computer System Usefulness: Insights for Design from Experienced Older Users

Computer systems have the potential to assist older adults by supporting independence, enhancing social communication, and enabling healthcare activities. Yet older adults' adoption rates continue to lag behind younger and middle-aged adults. We report data from 249 older adult computer users (65-93 years of age) that identify the details of their perceptions of computer usefulness for a range of everyday activities. Participants rated the importance of activities to their quality of life and the usefulness of current computer systems for supporting those activities. These experienced computer users indicated that computers were meeting their needs for some activities (e.g., social communication, games) but not for other activities (e.g., calendaring, healthcare, recreation and learning). Our data provide guidance for (a) introducing the potential of computer systems to current non-users and (b) designing systems targeted to meet the needs of older adults and enhancing computing functionality for them.

Response rates for patient-reported outcomes using web-based versus paper questionnaires: comparison of two invitational methods in older colorectal cancer patients

BACKGROUND

Improving questionnaire response rates is an everlasting issue for research. Today, the Internet can easily be used to collect data quickly. However, collecting data on the Internet can lead to biased samples because not everyone is able to access or use the Internet. The older population, for example, is much less likely to use the Internet. The Patient-Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship (PROFILES) registry offers a platform to collect Web-based and paper questionnaires and to try different measures to improve response rates.

OBJECTIVE

In this study, our aim was to study the influence of two methods of invitation on the response rate. Our second aim was to examine the preference of questionnaire mode of administration (paper or Web-based) for the older patient in particular.

METHODS

To test these two invitational methods, 3406 colorectal cancer patients between ages 18 and 85 years received an invitation containing an access code for the Web-based questionnaire. They could also request a paper questionnaire with an included reply card (paper-optional group). In contrast, 179 randomly selected colorectal cancer patients received a paper questionnaire with the invitation (paper-included group). They could also choose to fill out the Web-based questionnaire with the included access code.

RESULTS

Response rates did not differ between the paper-optional and the paper-included groups (73.14%, 2491/3406 and 74.9%, 134/179, P=.57). In the paper-optional group, online response was significantly higher when compared to the paper-included group (41.23%, 1027/2491 vs 12.7%, 17/134, P<.001). The majority of online respondents responded after the first invitation (95.33%, 979/1027), which was significantly higher than the paper respondents (52.19%, 764/1464, P<.001). Respondents aged 70 years and older chose to fill out a paper questionnaire more often (71.0%, 677/954). In the oldest age group (≥80 years), 18.2% (61/336) of the respondents filled out a Web-based questionnaire.

CONCLUSIONS

The lack of difference in response rates between invitation modes implies that researchers can leave out a paper questionnaire at invitation without lowering response rates. It may be preferable not to include a paper questionnaire because more respondents then will fill out a Web-based questionnaire, which will lead to faster available data. However, due to respondent preference, it is not likely that paper questionnaires can be left out completely in the near future.

Computer Use and Computer Anxiety in Older Korean Americans

Responding to the limited literature on computer use in ethnic minority older populations, the present study examined predictors of computer use and computer anxiety in older Korean Americans. Separate regression models were estimated for computer use and computer anxiety with the common sets of predictors: (a) demographic variables (age, gender, marital status, and education), (b) physical health indicators (chronic conditions, functional disability, and self-rated health), and (c) sociocultural factors (acculturation and attitudes toward aging). Approximately 60% of the participants were computer-users, and they had significantly lower levels of computer anxiety than non-users. A higher likelihood of computer use and lower levels of computer anxiety were commonly observed among individuals with younger age, male gender, advanced education, more positive ratings of health, and higher levels of acculturation. In addition, positive attitudes toward aging were found to reduce computer anxiety. Findings provide implications for developing computer training and education programs for the target population.

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.

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).

Older Adults' Coping With the Stress Involved in the Use of Everyday Technologies

PURPOSE

This study was conducted to examine the frequency of reported use of everyday technologies (EDT) and its associations with self-efficacy, stress appraisal, and coping strategies.

DESIGN AND METHODS

Cross-sectional data were collected from 150 participants (aged ≥ 65 years), measuring use of EDT by means of self-report questionnaires and a computerized simulator of an automatic teller machine (ATM), and EDT-related self-efficacy, stress appraisal, and coping strategies questionnaires.

RESULTS

Structured equation modeling analysis showed that EDT-related self-efficacy was related to higher use of EDT, through the mediation of EDT-related stress and coping strategies. Logistic regression showed that use of ATM simulator was predicted by self-efficacy, younger age, and female gender.

IMPLICATIONS

Enhancing EDT-self efficacy is suggested to increase the use of EDT among elder adults. The use of simulators may be an efficient mean to promote EDT self-efficacy and use.

Predictors of older adults' technology use and its relationship to depressive symptoms and well-being

OBJECTIVE

To extend the empirical evidence regarding the predictors of older adults' use of information and communications technology (ICT) and to further examine its relationship to depressive symptoms and well-being.

METHOD

This cross-sectional study utilized a sample of community-dwelling older adults from the National Health and Aging Trends Study (N = 6,443). Structural equation modeling was used to estimate the effects of predictor variables on ICT use and the effects of use on depressive symptoms and well-being. Tests of moderation by demographic characteristics and level of ICT use were also performed.

RESULTS

Socioeconomic status (SES), age, and cognitive function accounted for approximately 60% of the variance in ICT use. SES was a stronger predictor for Blacks/African Americans, whereas cognitive function was a stronger predictor for Whites. ICT use was unrelated to depressive symptoms or well-being. However, it acted as a moderator, such that limitations in activities of daily living (ADLs) was a stronger predictor of depressive symptoms for high ICT users, whereas ill-health was a stronger predictor for non/limited users.

DISCUSSION

Findings do not support the claim that ICT use directly enhances mental health or well-being among older adults although it may protect against depressive symptoms for individuals coping with health conditions other than ADL impairments.

Use or non-use of gerontechnology--a qualitative study

This study employed a qualitative approach to explore the attitudes and experiences of older people towards using gerontechnology, and to determine the underlying reasons that might account for their use and non-use of gerontechnology. Four focus group discussions and 26 individual interviews were undertaken. Qualitative data were analyzed using NVivo software and were categorized using coding and grounded theory techniques. The result indicated that old people in Hong Kong had an overall positive attitude toward technology. Positive attitudes were most frequently related to enhanced convenience and advanced features. Negative attitudes were most frequently associated with health risks and social problems arising from using technology (e.g., social isolation and addiction). Usage of technology is driven by outcome expectations and social influences, and supported by facilitators, whereas non-use of gerontechnology relates to the personal (e.g., health and functional capacities), technological (e.g., cost and complexity), and environmental barriers experienced. Use of gerontechnology is a synthesis of person, technology, and environment. To encourage non-users to adopt technology, there is a need to remove barriers at personal, technological, and environmental levels.

Internet use among older adults: association with health needs, psychological capital, and social capital

BACKGROUND

Previous studies have identified socioeconomic status and health status as predictors of older adults' computer and Internet use, but researchers have not examined the relationships between older adults' health needs and psychological capital (emotional well-being and self-efficacy) and social capital (social integration/ties and support networks) to different types of Internet use.

OBJECTIVE

This study examined (1) whether older adults' health conditions and psychological and social capital differentiate Internet users from nonusers, and (2) whether the Internet users differed in their types of Internet use on the basis of their health conditions and psychological and social capital.

METHODS

Data for this study came from the National Health and Aging Trends Study, which is based on a nationally representative sample of US Medicare beneficiaries aged 65 years and older. The sample for this study were those who resided in the community in their own or others' homes (N=6680). Binary logistic regression analysis was used to compare health needs, psychological capital, and social capital among (1) any type of Internet users and nonusers, (2) Internet users who engaged in health-related tasks and Internet users who did not, (3) Internet users who engaged in shopping/banking tasks and Internet users who did not, and (4) Internet users only used the Internet for email/texting and all other Internet users.

RESULTS

Depressive and anxiety symptoms, measures of psychological capital, were negatively associated with Internet use among older adults (odds ratio [OR] 0.83, 95% CI 0.70-0.98, P=.03 and OR 0.79, 95% CI 0.65-0.97, P=.03, respectively), whereas most measures of social capital were positively associated with Internet use. Having more chronic medical conditions and engaging in formal volunteering increased the odds of Internet use for health-related tasks by 1.15 (95% CI 1.08-1.23, P<.001) and 1.28 (95% CI 1.05-1.57, P=.02), respectively, but anxiety symptoms decreased the odds (OR 0.74, 95% CI 0.55-0.99, P=.05). Religious service attendance was negatively associated with Internet use for shopping/banking activities (OR 0.75, 95% CI 0.62-0.91, P=.01). Anxiety symptoms increased the odds of using the Internet only for emails/texting (OR 1.75, 95% CI 1.12-2.75, P=.02), but formal volunteering decreased the odds (OR 0.63, 95% CI 0.43-0.92, P=.02). Other correlates of Internet use solely for emails/texting were older age (80-84 years and ≥85 years), a black or "other" racial/ethnic background, a high school education or less than high school, and lower income.

CONCLUSIONS

The findings point to the importance of social capital in facilitating older adults' learning and adoption of Internet technology. Older adults who used the Internet for email/texting purposes only were the most socially and economically disadvantaged group of Internet users. Computer/Internet training for older adults and computer/Internet use for various purposes need to consider the significant role their social capital can play.

The digital divide among low-income homebound older adults: Internet use patterns, eHealth literacy, and attitudes toward computer/Internet use

Background

Internet technology can provide a diverse array of online resources for low-income disabled and homebound older adults to manage their health and mental health problems and maintain social connections. Despite many previous studies of older adults’ Internet use, none focused on these most vulnerable older adults.

Objective

This study examined Internet use patterns, reasons for discontinued use, eHealth literacy, and attitudes toward computer/Internet use among low-income homebound individuals aged 60 and older in comparison to their younger counterparts—homebound adults under age 60.

Methods

Face-to-face or telephone surveys were conducted with 980 recipients of home-delivered meals in central Texas (78% were age 60 years and older and 22% under age 60). The eHealth Literacy Scale (eHEALS) and the efficacy and interest subscales of the Attitudes Toward Computer/Internet Questionnaire (ATC/IQ) were used to measure the respective constructs. Age groups were compared with chi-square tests and t tests. Correlates of Internet use were analyzed with multinomial logistic regression, and correlates of eHEALS and ATC/IQ scores were analyzed with OLS regression models.

Results

Only 34% of the under-60 group and 17% of the 60 years and older group currently used the Internet, and 35% and 16% of the respective group members reported discontinuing Internet use due to cost and disability. In addition to being older, never users were more likely to be black (OR 4.41; 95% CI 2.82-6.91, P<.001) or Hispanic (OR 4.69; 95% CI 2.61-8.44, P<.001), and to have lower incomes (OR 0.36; 95% CI 0.27-0.49, P<.001). Discontinued users were also more likely to be black or Hispanic and to have lower incomes. Among both age groups, approximately three-fourths of the current users used the Internet every day or every few days, and their eHEALS scores were negatively associated with age and positively associated with frequency of use. Among the 60 and older group, a depression diagnosis was also negatively associated with eHEALS scores. ATC/IQ efficacy among never users of all ages and among older adults was positively associated with living alone, income, and the number of medical conditions and inversely associated with age, Hispanic ethnicity, and Spanish as the primary language. Although ATC/IQ interest among older adults was also inversely associated with age, it was not associated with Hispanic ethnicity and Spanish as the primary language.

Conclusions

This study is the first to describe in detail low-income disabled and homebound adults’ and older adults’ Internet use. It shows very low rates of Internet use compared to the US population, either due to lack of exposure to computer/Internet technology; lack of financial resources to obtain computers and technology; or medical conditions, disabilities, and associated pain that restrict use. Recommendations to reduce the digital divide among these individuals are provided.

ICT activity in later life: Internet use and leisure activities amongst senior citizens in Finland

The article examines the relationship between the Internet use and leisure activities amongst Finnish seniors. Traditionally, the young have been the most active users of the Internet and other information and communication technologies (ICTs). In recent years, however, older age groups have increasingly become more interested in ICT, yet a significant proportion of Finnish seniors rarely log on. Using data from a nationally representative survey (N = 542) conducted in the summer of 2010, we explored the connection between the frequent Internet use and general leisure activity. The basic socio-demographic variables were controlled in the analysis. The findings indicate that the active Internet use in old age has a strong positive correlation with the number of different leisure activities amongst Finnish seniors. As most European societies continue to age, it is clear that future research should focus on the implications and the role the Internet and other new ICTs will play in the everyday life amongst the ageing citizens.