Computer Use and Computer Anxiety in Older Korean Americans

Associations Between Everyday ICT Usage and (Self-)Ageism: A Systematic Literature Review

BACKGROUND AND OBJECTIVES

Both rapid technological changes and (self-)ageism are pervasive challenges of the 21st century, potentially affecting older adults' everyday functioning, health, and well-being. This systematic literature review aimed to synthesize scholarly evidence to determine the associations between everyday information and communication technology (EICT) usage and (self-)ageism as well as potential moderators.

RESEARCH DESIGN AND METHODS

A systematic search was performed in 8 academic databases, covering the time frame from January 1995 to January 2021. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a total of 15 articles met the inclusion criteria and were involved in the analysis. The standardized National Heart, Lung, and Blood Institute's quality assessment tools were used for risk bias.

RESULTS

Several studies demonstrated significant associations between EICT usage and stereotype embodiment (n = 8), stereotype threat (n = 2), and age discrimination (n = 3). Age (group), gender, and motivation were examined as potential moderators.

DISCUSSION AND IMPLICATIONS

This review provides initial evidence on the associations between (self-)ageism and EICT usage. It highlights the importance of positive subjective aging perceptions for active EICT usage in older adults, but also emphasizes the detrimental consequences of ageism in EICT learning settings and technology design on older persons' willingness and ability to use EICT. Further ecologically valid and methodologically sound research is needed to better understand both the nature and direction of the association between EICT usage and (self-)ageism.

Digital technology usage among older adults with cognitive frailty: A survey during COVID-19 pandemic

Objective

The research aimed to study digital divide by determining the usage of digital technology among older adults with cognitive frailty (CF) in Malaysia.

Methods

The dataset was obtained from the AGELESS trial screening phase conducted from October 2021 to March 2022, involving 476 community-dwelling Malaysian older adults (67.7 years old ± 6.1). Digital technology usage was assessed and CF was determined using Fried's criteria and Clinical Dementia Rating. A binary logistic regression was used to determine the sociodemographic factors associated with digital technology use among older adults with CF.

Results

The findings suggest a digital divide between older adults with CF and robust in Malaysia. CF individuals (72.1%) were less likely to utilise digital technology, mainly smartphone than robust older adults (89.6%). More than 70% of older people owned social media on their smartphones, namely, WhatsApp. The most frequent online activities in both groups were family interaction and obtaining current news. CF older adults were less likely to play games on their smart devices. Usage of digital technology was more common among male, younger age, attained formal education more than 6 years, had a higher monthly household income, and robust participants.

Conclusions

The usage of digital technology was inversely related to CF status. CF older adults were less likely to integrate digital technology into their daily living compared to robust even though they were familiar with it. The use of digital technology should be reinforced among female, advanced age, widowers/divorcees without formal education and those from lower- or middle-income statuses, and cognitively frail older people.

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.

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.

Measurement of Digital Literacy Among Older Adults: Systematic Review

Background

Numerous instruments are designed to measure digital literacy among the general population. However, few studies have assessed the use and appropriateness of these measurements for older populations.

Objective

This systematic review aims to identify and critically appraise studies assessing digital literacy among older adults and to evaluate how digital literacy instruments used in existing studies address the elements of age-appropriate digital literacy using the European Commission’s Digital Competence (DigComp) Framework.

Methods

Electronic databases were searched for studies using validated instruments to assess digital literacy among older adults. The quality of all included studies was evaluated using the Crowe Critical Appraisal Tool (CCAT). Instruments were assessed according to their ability to incorporate the competence areas of digital literacy as defined by the DigComp Framework: (1) information and data literacy, (2) communication and collaboration, (3) digital content creation, (4) safety, and (5) problem-solving ability, or attitudes toward information and communication technology use.

Results

Searches yielded 1561 studies, of which 27 studies (17 cross-sectional, 2 before and after, 2 randomized controlled trials, 1 longitudinal, and 1 mixed methods) were included in the final analysis. Studies were conducted in the United States (18/27), Germany (3/27), China (1/27), Italy (1/27), Sweden (1/27), Canada (1/27), Iran (1/27), and Bangladesh (1/27). Studies mostly defined older adults as aged ≥50 years (10/27) or ≥60 years (8/27). Overall, the eHealth Literacy Scale (eHEALS) was the most frequently used instrument measuring digital literacy among older adults (16/27, 59%). Scores on the CCAT ranged from 34 (34/40, 85%) to 40 (40/40, 100%). Most instruments measured 1 or 2 of the DigComp Framework’s elements, but the Mobile Device Proficiency Questionnaire (MDPQ) measured all 5 elements, including “digital content creation” and “safety.”

Conclusions

The current digital literacy assessment instruments targeting older adults have both strengths and weaknesses, relative to their study design, administration method, and ease of use. Certain instrument modalities like the MDPQ are more generalizable and inclusive and thus, favorable for measuring the digital literacy of older adults. More studies focusing on the suitability of such instruments for older populations are warranted, especially for areas like “digital content creation” and “safety” that currently lack assessment. Evidence-based discussions regarding the implications of digitalization for the treatment of older adults and how health care professionals may benefit from this phenomenon are encouraged.

Older Black Adults' Satisfaction and Anxiety Levels After Completing Alternative Versus Traditional Cognitive Batteries

OBJECTIVE

The objective of this study was to examine satisfaction, test anxiety, and performance using computer-based cognitive batteries versus a paper-and-pencil neuropsychological battery among older Blacks.

METHOD

Self-identified Black adults (n = 87, age range: 55-86; mean education = 14) completed two computer-based tests (CogState and Joggle) and a paper-and-pencil neuropsychological battery. After each battery, participants reported their testing anxiety and satisfaction using the batteries. Descriptive, correlational, and regression analyses compared satisfaction, anxiety, and performance across the batteries.

RESULTS

Majority of the participants reported more satisfaction with the computer-based (Joggle: 66%; CogState: 77%) than the neuropsychological (52%) battery. Participants also reported less testing anxiety after completing the computer-based batteries than the neuropsychological battery, F(2, 172) = 22.96, p < .001. Older adults' familiarity and comfort level with the computer were not associated with their performance on the computer-based tests (p > .05). Although testing anxiety was not associated with performance across the batteries, age and education quality were uniquely associated with performance on the CogState and neuropsychological batteries.

CONCLUSIONS

Computer-based cognitive batteries appear to be less intimidating than the commonly used paper-and-pencil neuropsychological tests for Black adults. Thus, these cognitive batteries may be useful tools for monitoring older Blacks' cognitive status.

Stability of neuropsychological test performance in older adults serving as normative controls for a study on postoperative cognitive dysfunction

OBJECTIVE

Studies of postoperative cognitive dysfunction (POCD) rely on repeat neuropsychological testing. The stability of the applied instruments, which are affected by natural variability in performance and measurement imprecision, is often unclear. We determined the stability of a neuropsychological test battery using a sample of older adults from the general population. Forty-five participants aged 65 to 89 years performed six computerized and non-computerized neuropsychological tests at baseline and again at 7 day and 3 months follow-up sessions. Mean scores on each test were compared across time points using repeated measures analyses of variance (ANOVA) with pairwise comparison. Two-way mixed effects, absolute agreement analyses of variance intra-class correlation coefficients (ICC) determined test-retest reliability.

RESULTS

All tests had moderate to excellent test-retest reliability during 7-day (ICC range 0.63 to 0.94; all p < 0.01) and 3-month intervals (ICC range 0.60 to 0.92; all p < 0.01) though confidence intervals of ICC estimates were large throughout. Practice effects apparent at 7 days eased off by 3 months. No substantial differences between computerized and non-computerized tests were observed. We conclude that the present six-test neuropsychological test battery is appropriate for use in POCD research though small sample size of our study needs to be recognized as a limitation. Trial registration ClinicalTrials.gov Identifier NCT02265263 (15th October 2014).

"You get old. You get invisible": Social isolation and the challenge of communicating with aging women

Social isolation is a problem facing many older women. Isolation can contribute to poor health as adults age without social support. Increased and tailored communication offers service organizations more opportunities to provide social support to these adults. This research examines perceptions of aging to explore communication behaviors, barriers, and opportunities for improved communication and service provision for aging women. Using data from focus groups and interviews, this study finds that participants from community organizations rely on word of mouth and traditional media to communicate with their aging constituents, despite opportunities to use digital communication and to develop communication plans for this population.

Rationale and study protocol for a multi-component Health Information Technology (HIT) screening tool for depression and post-traumatic stress disorder in the primary care setting

The prevalence rate of depression in primary care is high. Primary care providers serve as the initial point of contact for the majority of patients with depression, yet, approximately 50% of cases remain unrecognized. The under-diagnosis of depression may be further exacerbated in limited English-language proficient (LEP) populations. Language barriers may result in less discussion of patients' mental health needs and fewer referrals to mental health services, particularly given competing priorities of other medical conditions and providers' time pressures. Recent advances in Health Information Technology (HIT) may facilitate novel ways to screen for depression and other mental health disorders in LEP populations. The purpose of this paper is to describe the rationale and protocol of a clustered randomized controlled trial that will test the effectiveness of an HIT intervention that provides a multi-component approach to delivering culturally competent, mental health care in the primary care setting. The HIT intervention has four components: 1) web-based provider training, 2) multimedia electronic screening of depression and PTSD in the patients' primary language, 3) Computer generated risk assessment scores delivered directly to the provider, and 4) clinical decision support. The outcomes of the study include assessing the potential of the HIT intervention to improve screening rates, clinical detection, provider initiation of treatment, and patient outcomes for depression and post-traumatic stress disorder (PTSD) among LEP Cambodian refugees who experienced war atrocities and trauma during the Khmer Rouge. This technology has the potential to be adapted to any LEP population in order to facilitate mental health screening and treatment in the primary care setting.