The Physical-Digital Divide: Exploring the Social Gap Between Digital Natives and Physical Natives

"I'm like something out of star wars": a qualitative investigation of the views of people with age-related macular degeneration regarding wearable electronic vision enhancement systems

PURPOSE

This study explores the initial views of people with age-related macular degeneration towards wearable electronic vision enhancement systems.

METHODS

Ten adults with age-related macular degeneration participated in semi-structured interviews, which were analysed using reflexive thematic analysis.

RESULTS

Four themes were identified. Firstly, participants spoke of the wide-ranging impact of sight loss and how current helpful coping strategies still had significant limitations, affecting their desire to seek new solutions. The second theme showed that "other people" offered welcomed support with existing electronic coping solutions and are needed to provide suitable advice and training. However, "other people" limited the acceptability of using new solutions in public places. The third theme captured participants' desire for a wearable aid providing image magnification and enhancement over a range of distances. The final theme covered the reality of some current wearable technology, perceived as heavy, enclosing, or strange in appearance. Appearance caused some to lose interest in use, although others reframed the devices' desired usefulness to solo and sedentary activities.

CONCLUSION

This population are interested in the potential benefits of wearable electronic vision enhancement systems. More work is needed to understand the suitability of current solutions due to participant concerns about training, appearance and performance.

Geriatric assessment for the practicing clinician: The why, what, and how

Older adults with cancer heterogeneously experience health care, treatment, and symptoms. Geriatric assessment (GA) offers a comprehensive evaluation of an older individual's health status and can predict cancer-related outcomes in individuals with solid tumors and those with hematologic malignancies. In the last decade, randomized controlled trials have demonstrated the benefits of GA and GA management (GAM), which uses GA information to provide tailored intervention strategies to address GA impairments (e.g., implementing physical therapy for impaired physical function). Multiple phase 3 clinical trials in older adults with solid tumors and hematologic malignancies have demonstrated that GAM improves treatment completion, quality of life, communication, and advance care planning while reducing treatment-related toxicity, falls, and polypharmacy. Nonetheless, implementation and uptake of GAM remain challenging. Various strategies have been proposed, including the use of GA screening tools, to identify patients most likely to benefit from GAM, the systematic engagement of the oncology workforce in the delivery of GAM, and the integration of technologies like telemedicine and mobile health to enhance the availability of GA and GAM interventions. Health inequities in minoritized groups persist, and systematic GA implementation has the potential to capture social determinants of health that are relevant to equitable care. Caregivers play an important role in cancer care and experience burden themselves. GA can guide dyadic supportive care interventions, ultimately helping both patients and caregivers achieve optimal health.

Exploring the mediating influence of acceptance of change: A study on gerontechnology acceptance, mental well-being, and urban-rural disparities among older adults

BACKGROUND

The global aging population necessitates leveraging technology for older adults' independence and mental well-being. Gerontechnology, tailored for older users, thrives when accessible and accepted, with the pivotal role of acceptance of change shaping its adoption.

AIMS

This study investigates the mediating role of acceptance of change in the relationship between gerontechnology acceptance and mental well-being among older adults and explores disparities in urban and rural settings DESIGN & METHODS: A cross-sectional, correlational design adhering to STROBE guidelines collected data through an interview survey from 802 older adults. Instruments included the Older Adult Structured Survey, Short Version of Senior Technology Acceptance, Acceptance of Change Scale, and the World Health Organization Well-Being Index.

RESULTS

The results underscore a significant correlation between technology adoption, adaptability, and mental well-being among 60-year-olds and older. Notably, an individual's openness to change significantly influences the technology-mental well-being relationship, emphasizing its impact on overall health. Urban areas exhibit a stronger positive correlation between technology acceptance and mental well-being, whereas rural regions demonstrate a more pronounced negative correlation.

CONCLUSION

This research contributes valuable knowledge for addressing the unique challenges older adults face in diverse geographic settings, paving the way for targeted and effective initiatives.

IMPLICATIONS

Nurses should prioritize understanding the nexus between gerontechnology acceptance, change adaptability, and mental wellness, integrating technology education and culturally sensitive interventions to enhance care strategies for older adults in diverse geographic settings. This study lays the groundwork for developing person-centered geriatric nursing care plans, underscoring the importance of harnessing technology for improved mental well-being.

Older Adults' Perceptions of the Technology Influence on Interpersonal Communication: A Cross-Sectional Study

This study aimed to understand the association between the online experience of older adults, their socio-demographic background, and their perceptions regarding the influence of the new technologies on their interpersonal communication. Technology familiarity and grey digital divide approaches served as the study's theoretical framework. The data were obtained from the 2020 Israel Social Survey and analyzed using multinomial logistic regression models. The sample included adults aged 60 years and older (N = 1,607). The findings show that online group participation and general Internet use, though to a varying extent, corresponded to more positive perceptions of influence of the new technologies on both family and peer communication. Female gender, tertiary education, and belonging to ethnic majority group were associated with more positive perceptions in the studied context. The results imply that online experience of older adults is more dominant than their background with respect to perceptions regarding the influence of new technologies on interpersonal communication. The findings imply that older adults should engage in various activities on the Internet, especially in the online group participation, in order to have better perceptions regarding the new technology influence on interpersonal communication.

Cyber Interpersonal Violence: Adolescent Perspectives and Digital Practices

BACKGROUND

The pervasive use of technology, especially among adolescents, has enabled cyber communication and brought many advantages but also led to potential violence. The issue of cyber interpersonal violence (CIV) impacting young individuals is increasingly recognized as a matter of public health; however, little is known about adolescents' perspectives of the phenomenon. This study explores adolescents' perspectives on CIV. It seeks to understand their interpretations of abuse, victim impact and reactions, violence escalation, gender issues, victimization and perpetration patterns, and bystander roles.

METHODS

This qualitative study used fifteen focus groups to gather elementary school participants' perspectives on cyber interpersonal violence. From four Portuguese schools, 108 participants (M = 12.87 and SD = 0.31) participated in the study. A thematic analysis uncovered three themes. The results evidenced adolescents' perspectives about CIV. Due to the amount of time spent online, adolescents regularly encounter cyber harassment and recognize the importance of help-seeking. Mental health problems and their influence on the social and educational lives of adolescents is arising as a CIV problem.

CONCLUSIONS

Parents play a crucial role in mitigating CIV as well as bystanders. Future programs should promote healthy relationships, raise CIV awareness, involve stakeholders, guide parents, integrate perpetrators into programs, and foster effective networking.

Assessing the Potential Role of Artificial Intelligence in Medication-Related Osteonecrosis of the Jaw Information Sharing

BACKGROUND

Artificial Intelligence, by answering questions about disease prevention strategies, can contribute to making diseases more treatable in their early stages.

PURPOSE

This study aims to evaluate the quality of patient information by assessing the responses of the Chat Generative Pretrained Transformer (ChatGPT, Open AI, USA) artificial intelligence model to questions related to medication-related osteonecrosis of the jaw (MRONJ).

STUDY DESIGN, SETTING, SAMPLE

The study was prospective cross-sectional design. The study was conducted within the Department of Oral and Maxillofacial Surgery. The study's questions were prepared by an experienced oral and maxillofacial surgeon and directed to the artificial intelligence platform. The responses were evaluated by oral and maxillofacial surgeons using the Global Quality Scale (GQS).

PREDICTOR VARIABLE

The predictor variable is question type. A total of 120 questions were categorized into six groups, which encompassed general information about MRONJ (Group 1), queries from patients about to initiate medication therapy (Group 2), questions from patients currently undergoing medication treatment (Group 3), inquiries from patients who had completed medication usage (Group 4), general treatment-related information (Group 5), and case scenarios (Group 6).

MAIN OUTCOME VARIABLES

The main variable is the GQS score. The GQS rates the quality of information and its utility for the patients. The scores are as follows: Score 1: Poor quality, Score 2: Generally poor quality, Score 3: Moderate quality, Score 4: Good quality, Score 5: Excellent quality.

COVARIATES

Not applicable.

ANALYSES

Kruskal-Wallis and Mann-Whitney U tests were applied for intragroup and intergroup analyses. The statistical significance level was determined as P < .05 and P < .01.

RESULTS

The average score for all questions was calculated to be 3.9 ± 0.8, which is above the "moderate quality" threshold. Group 1 had a mean score of 3.4 ± 1.1; group 2 had 4.1 ± 0.7; group 3 had 3.8 ± 0.8; group 4 had 4.3 ± 0.6; group 5 had 4.2 ± 0.7; and group 6 had 4.1 ± 0.5. The variations in mean scores among these groups did not exhibit statistical significance (P > .05).

CONCLUSION AND RELEVANCE

The artificial intelligence model has generated responses of moderate quality to questions about MRONJ. The use of the artificial intelligence platform may assist in patients gaining a fundamental understanding of MRONJ.

Age-related digital disparities, functional limitations, and social isolation: unraveling the grey digital divide between baby boomers and the silent generation in senior living facilities

OBJECTIVES

The onset of the digital age has sparked a significant age-related digital divide, detrimentally affecting older adults. The age-related digital disparities and the gray digital divide between the Baby Boomers and the Silent Generation in senior living facilities remains an exigent issue. This study explored the lived experiences of older adults as they confront the challenges posed by age-related digital disparities inherent in the gray digital divide in senior living facilities.

METHODS

In-depth, semi-structured interviews and observations were conducted with 28 older adults living in six senior living facilities in three urban locations. Moustakas's transcendental phenomenology was employed, and the Modified Stevick-Colaizzi-Keen method was used to analyze the data.

RESULTS

This study identified six main themes: barriers to connectivity, digital literacy, generational-rooted perceptions, navigating technology with functional limitations, social isolation, and end-of-life planning.

CONCLUSION

The gray digital divide disproportionately affects older adults in senior living facilities. The study emphasizes the need for tailored interventions and targeted support to address the specific needs of each cohort and reduce age-related disparities. Addressing these disparities has significant implications for academics, policy-makers, senior living accommodations, and technology developers.

Older Adults, Tablets, and Ambivalence: A Grounded Theory Study of a One-Tablet-Per Older Person, Public Program in Uruguay

This study used grounded theory to investigate older Uruguayans' use of tablets delivered through a public program called Plan Ibirapitá. This program was developed in 2015, by the leftist government that was in power at that time, to promote the digital inclusion of individuals considered to be excluded from the benefits of the information society, such as older adults. Through Plan Ibirapitá, older adults who receive a pension below approximately 900 USD, receive a tablet for free, training for its use, and 1 GB of monthly internet. According to the program's Fifth-Use Survey from 2019, almost 60% of those who received Plan Ibirapitá's tablet do not use it. To examine the relationship between older adults and the tablets, twenty-six participants were interviewed about their experiences with this device. Results suggest that the relationship they established with the tablets is ambivalent. On the one hand, the participants see information and communication technology (ICT) as modern tools that are useful for communicating with loved ones. On the other hand, they understood their lives as busy for which tablets were mostly unnecessary. These findings indicate that including older people into the digital world is more complex than distributing devices top-down.

Telehealth Consultation for Malaysian Citizens' Willingness to Pay Assessed by the Double-Bounded Dichotomous Choice Method

Background

Re-envisioning healthcare in technology tools includes robust utilisation of telehealth, improvement in access, quality, care efficiencies and cost-effectiveness of healthcare services. In reality, the technology's potential to transform healthcare may be limited by the ability to pay for it. This study aims to estimate Malaysian citizens' willingness to pay (WTP) for telehealth consultations and determine the factors contributing to it. This is vital to inform decision-making about expansion, preferences and deployment of a pricing strategy for telehealth services.

Methods

A random sample of 220 adult Malaysians was surveyed using social network services (SNS). Three different WTP bid arrays were identified and each respondent received a randomly drawn bid price. The WTP fee for using the telehealth consultation for 30 min was measured and estimated using a Double-Bounded Dichotomous Choice (DBDC) and the Random Utility Logit Model.

Result

The median WTP was estimated to be RM58 (JPY2,198), RM78 (JPY2,956) for 132 respondents' willingness to use telehealth consultation and RM26 (JPY985) for 51 respondents who were unwilling. Further analysis found that WTP is correlated with the perception and willingness of the respondents to use it.

Conclusion

Despite most respondents being willing to pay for telehealth consultations, sociodemographic characteristics and affordability influenced the process of making decisions about WTP for telehealth consultation. This finding suggests that the private sector can play a crucial role in the deployment of telehealth. However, there may be a need to consider affordability and how to increase access and use of telehealth services.

Evidence of How Physicians and Their Patients Adopt mHealth Apps in Germany: Exploratory Qualitative Study

BACKGROUND

The enactment of the "Act to Improve Healthcare Provision through Digitalisation and Innovation " (Digital Healthcare Act; Digitale-Versorgung-Gesetz [DVG]) in Germany has introduced a paradigm shift in medical practice, allowing physicians to prescribe mobile health (mHealth) apps alongside traditional medications. This transformation imposes a dual responsibility on physicians to acquaint themselves with qualifying apps and align them with patient diagnoses, while requiring patients to adhere to the prescribed app use, similar to pharmaceutical adherence. This transition, particularly challenging for older generations who are less skilled with technology, underscores a significant evolution in Germany's medical landscape.

OBJECTIVE

This study aims to investigate physicians' responses to this novel treatment option, their strategies for adapting to this form of prescription, and the willingness of patients to adhere to prescribed mHealth apps.

METHODS

Using an exploratory qualitative study design, we conducted semistructured interviews with 28 physicians and 30 potential patients aged 50 years and older from August 2020 to June 2021.

RESULTS

The findings reveal several factors influencing the adoption of mHealth apps, prompting a nuanced understanding of adoption research. Notably, both physicians and patients demonstrated a lack of information regarding mHealth apps and their positive health impacts, contributing to a deficiency in trust. Physicians' self-perceived digital competence and their evaluation of patients' digital proficiency emerge as pivotal factors influencing the prescription of mHealth apps.

CONCLUSIONS

Our study provides comprehensive insights into the prescription process and the fundamental factors shaping the adoption of mHealth apps in Germany. The identified information gaps on both the physicians' and patients' sides contribute to a trust deficit and hindered digital competence. This research advances the understanding of adoption dynamics regarding digital health technologies and highlights crucial considerations for the successful integration of digital health apps into medical practice.

Adolescent Popularity: Distinct Profiles and Associations with Excessive Internet Usage and Interpersonal Sensitivity

Peer popularity constitutes a pivotal developmental task to adolescents' current and future adaptation. This study identified distinct adolescent popularity profiles and explored their links with excessive Internet usage and interpersonal sensitivity. The sample included 2090 students attending Greek high schools (M_age = 16.16, SD = 0.91). Their popularity was measured via self-report and peer sociometric means. They also responded to the Internet Addiction Test (IAT) and the Interpersonal Sensitivity subscale of the Symptom Checklist-90-Revised (SCL-90-R). A sequence of latent profile analysis, ANOVAs and linear regression models were performed. Three distinct popularity profiles were revealed: the "Average Confident" (68.4%), the "Socially Vulnerable" (26.8%), and the "Insecure Bi-Strategic" (4.8%). These profiles did not significantly vary regarding their Internet usage and interpersonal sensitivity behaviours. Interestingly, lower self-perceived popularity predicted higher interpersonal sensitivity, whereas higher actual popularity predicted excessive Internet use. Findings have important implications for student-tailored mental health prevention and intervention practices.

Technological Utopias: Loneliness and Rural Contexts in Western Iberia

Background: Urbanisation and rural migration in some areas of Spain and Portugal have given rise to rural contexts largely defined by ageing and depopulation. Rural populations have suffered from increasing social isolation, with older people living alone in villages with very few inhabitants and limited access to services. The aim of this study is to analyse the extent to which technology serve as a strategy to improve social relations and how technology influences older adults’ loneliness, its uses, meanings, experiences, and perceptions. Methods: Ethnographic research is conducted in several locations in the border area between Spain and Portugal, supported by semi-structured interviews with 17 rural subjects aged 65 years and older. Results: The results underline two main points. Participants’ definitions point to loneliness as an experience built around nostalgia for those who are no longer there, where the disappearance of rituals in the community also leads to a lack of “social happiness”. Conclusions: We note low levels of digital literacy skills and competence among our participants, with most of them rejecting any technology beyond analogue devices.

The role of assistive technology in addressing social isolation, loneliness and health inequities among older adults during the COVID-19 pandemic

PURPOSE

Assistive technology (AT) is an effective tool to promote social connectedness among older adults affected by the COVID-19 pandemic; however, its role in reducing loneliness and health inequities is not well understood. The goal of this scoping review was to construct a model for how technologies may be deployed to mitigate the impact of the COVID-19 pandemic on social isolation, loneliness and health inequities for older adults.

METHODS

PubMed, SCOPUS and PsychINFO were searched from 2010 to 2020 for the following keywords: "social isolation," "loneliness," "social support," "resilience," "technology," "pandemic" and "health inequit*." Articles selected for full analysis attempted to understand how technology alleviates social isolation and/or loneliness among older adults.

RESULTS

Eighteen articles met the criteria for selection and data extraction. Six were review-type studies, seven were observational, three were randomized control trials, one opinion piece and one case study. ATs have been shown to reduce loneliness and social isolation, strengthen social support, and promote resilience among older adults. AT reduces loneliness both directly and indirectly, by affecting social isolation. There is insufficient evidence to determine technology's relationship to health inequities experienced by older adults.

CONCLUSIONS

The model we have proposed should help advance research on the relationship between ATs and health inequities among older adults that may be aggravated by the COVID-19 pandemic. We hypothesize that AT interventions for social support and functional competence should be sequenced to reduce health disparities.Implications for rehabilitationThe social distancing and quarantine measures as a result of the COVID-19 pandemic can be linked to adverse health outcomes among older adult populations.Technology is an effective tool to promote social connectedness among older adults affected by the pandemic.Assistive technology (AT) interventions for social support and functional competence should be sequenced in order to have best effects on reducing health disparities.

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.

Digital Ageism: Challenges and Opportunities in Artificial Intelligence for Older Adults

Artificial intelligence (AI) and machine learning are changing our world through their impact on sectors including health care, education, employment, finance, and law. AI systems are developed using data that reflect the implicit and explicit biases of society, and there are significant concerns about how the predictive models in AI systems amplify inequity, privilege, and power in society. The widespread applications of AI have led to mainstream discourse about how AI systems are perpetuating racism, sexism, and classism; yet, concerns about ageism have been largely absent in the AI bias literature. Given the globally aging population and proliferation of AI, there is a need to critically examine the presence of age-related bias in AI systems. This forum article discusses ageism in AI systems and introduces a conceptual model that outlines intersecting pathways of technology development that can produce and reinforce digital ageism in AI systems. We also describe the broader ethical and legal implications and considerations for future directions in digital ageism research to advance knowledge in the field and deepen our understanding of how ageism in AI is fostered by broader cycles of injustice.

The role of age and digital competence on the use of online health and social care services: A cross-sectional population-based survey

OBJECTIVE

Online health and social care services are getting widespread which increases the risk that less advantaged groups may not be able to access these services resulting in digital exclusion. We examined the combined effects of age and digital competence on the use of online health and social care services.

METHODS

We used a large representative population-based sample of 4495 respondents from Finland. Paper-based self-assessment questionnaire with an online response option was mailed to participants. The associations were analyzed using survey weighted logistic regression, exploring potential non-linear effects of age and controlling for potential sex differences.

RESULTS

Higher age, starting from around the age of 60 was associated with a lower likelihood of using online services for receiving test results, renewing prescriptions and scheduling appointments. Good digital competence was able to hinder the age-related decline in online services use, but only up to around the age of 80.

CONCLUSIONS

Our results suggest that older adults are at risk of digital exclusion, and not even good digital competence alleviates this risk among the oldest. We suggest that health and social care providers should consider older users' needs and abilities more thoroughly and offer easy to use online services. More digital support and training possibilities should be provided for older people. It is equally important that face-to-face and telephone services will be continued to be provided for those older people who are not able to use online services even when supported.

Exploration of ICT Appropriation by Disabled People and Its Effect on Self-Perceived Normalcy

Information and communication technologies (ICTs) are omnipresent and define the interactions in society. Within society, there are vulnerable groups of people for whom ICT use is more challenging. Disabled people are the most vulnerable ICT users. To identify the digital divides of access and impact of ICT on disabled users, an exploratory qualitative study was conducted. Relying on a French national association for disability that grants unique access to disabled ICT users, two focus groups and 10 in-depth interviews were carried. The study allows to propose a model of ICT use and effects for disabled people, integrating several types of disabilities. The results show that ICT appropriation by disabled users depends on their perceived self-efficacy in ICT. ICT use can lead to negative effects, including social exclusion and low perceived normalcy. To address societal interests and develop the literature, a research agenda is proposed.

Fully digital problem-based learning for undergraduate medical students during the COVID-19 period: Practical considerations

Digital problem-based learning (PBL) was originally introduced as a means to improve student engagement and increase flexibility. However, its use becomes mandatory during the coronavirus disease 2019 (COVID-19) period, accelerating changes in medical education. Few elaborated on the implementation details of digital PBL curricula. Technical guidance can be important but under-recognized prerequisite of a successful digital PBL session. In National Taiwan University College of Medicine, we established a digital PBL curriculum and previously validated a confidence questionnaire for surveying undergraduate students receiving digital PBL sessions. In this opinion piece, we gleaned multiple procedural details from our experiences based on students'/tutors' feedback, which we summarized in a 5″W″ recommendations (Who), timing/duration (When), location (Where), software/hardware/topics (What), and evaluation aspects (Why). Suggestions on how to optimally prepare for digital PBL session are also provided. We believe that these tips can further facilitate the wide adoption of digital PBL.

Benefits and barriers: a qualitative study on online social participation among widowed older adults in Southwest China

BACKGROUND

With the development of digital media, online activities are increasingly becoming part of the daily life of older adults. Widowed older adults generally would face changes in social interactions and activities due to widowhood; thus, the importance of online participation may be more prominent in this population. However, a detailed evidence on the experiences of online social participation among widowed older adults is relatively sparse. This study aimed to explore widowed older adults' perceptions regarding online social participation in southwestern China.

METHODS

This study adopted a qualitative approach. Semi-structured, in-depth individual interviews were conducted with 19 widowed older adults between September-December 2020. Thematic analysis was applied to analyse the data.

RESULTS

Two major themes, "benefits" and "barriers" were identified from the original data analysis. Subcategories concerning the theme "benefits" were "benefit perception (convenience, flexible time, supplementation)", "health promotion", "emotional comfort", and "social connection". Subcategories of "barriers" were "worries: personal economic loss", "concerns: security of digital device", "troubles: the diversity of online social participation", and "difficulties: using digital media".

CONCLUSIONS

Social participation of widowed older adults in southwestern China has begun to be integrated into the digital world; however, it remains at an early stage with the simple purpose of engagement. The older adults may face many challenges for online social participation. Although there are barriers and challenges in online social participation, widowed older adults can reap its benefits, which can be used as an important measure to facilitate a fulfilling life and successful ageing. There is no doubt that online social participation will become a trend within the foreseeable future. Family, friends and health care professionals should pay more attention to the needs of online social participation in widowed older adults and provide adequate support for them to achieve a meaningful life.

The link between social anxiety and intimate loneliness is stronger for older adults than for younger adults

OBJECTIVES

The current study focuses on the association between social anxiety (e.g. fear of social interactions or negative judgment by others) and intimate loneliness (lacking meaningful relationships, i.e. having low quantity/quality of intimate companionship) in older and younger adults. We assessed whether social anxiety, a factor which hampers intimacy, may be associated with intimate loneliness to a greater extent in older adults versus younger adults.

METHOD

Measures of loneliness (Revised UCLA loneliness scale) and social anxiety (Leibowitz social anxiety scale) were obtained from 342 participants (220 younger adults, age = 19-40, and 122 older adults, age = 61-89).

RESULTS

Age differences were evident for non-intimate types of loneliness but not for intimate loneliness. Further, older adults were less socially anxious. Critically, the strength of the social anxiety-intimate loneliness link was more robust among older adults. Effects remained significant after controlling for demographic and computer/social media variables.

CONCLUSIONS

Older adults with high levels of social anxiety displayed greater intimate loneliness relative to younger adults. On a theoretical level, the results reveal that the pruning mechanism of investing more in closer and more rewarding relationships among older adults may be challenged under high social anxiety. The results suggest that older adults with higher intimate loneliness may benefit from interventions aimed at decreasing their social anxiety.

Socioeconomic Disparities in Patient Use of Telehealth During the Coronavirus Disease 2019 Surge

Importance

The coronavirus disease 2019 (COVID-19) pandemic required the rapid transition to telehealth with the aim of providing patients with medical access and supporting clinicians while abiding by the stay-at-home orders.

Objective

To assess demographic and socioeconomic factors associated with patient participation in telehealth during the COVID-19 pandemic.

Design, Setting, and Participants

This cohort study included all pediatric and adult patient encounters at the Department of Otolaryngology-Head & Neck Surgery in a tertiary care, academic, multisubspecialty, multisite practice located in an early hot spot for the COVID-19 pandemic from March 17 to May 1, 2020. Encounters included completed synchronous virtual, telephone, and in-person visits as well as visit no-shows.

Main Outcomes and Measures

Patient demographic characteristics, insurance status, and 2010 Census block level data as a proxy for socioeconomic status were extracted. Univariate and multivariate logistic regression models were created for patient-level comparisons.

Results

Of the 1162 patients (604 females [52.0%]; median age, 55 [range, 0-97] years) included, 990 completed visits; of these, 437 (44.1%) completed a virtual visit. After multivariate adjustment, females (odds ratio [OR], 1.71; 95% CI, 1.11-2.63) and patients with preferred provider organization insurance (OR, 2.70; 95% CI, 1.40-5.20) were more likely to complete a virtual visit compared with a telephone visit. Increasing age (OR per year, 0.98; 95% CI, 0.98-0.99) and being in the lowest median household income quartile (OR, 0.60; 95% CI, 0.42-0.86) were associated with lower odds of completing a virtual visit overall. Those patients within the second (OR, 0.53; 95% CI, 0.28-0.99) and lowest (OR, 0.33; 95% CI, 0.17-0.62) quartiles of median household income by census block and those with Medicaid, no insurance, or other public insurance (OR, 0.47; 95% CI, 0.23-0.94) were more likely to complete a telephone visit. Finally, being within the lower 2 quartiles of proportion being married (OR for third quartile, 0.49 [95% CI, 0.29-0.86]; OR for lowest quartile, 0.39 [95% CI, 0.23-0.67]) was associated with higher likelihood of a no-show visit.

Conclusions and Relevance

These findings suggest that age, sex, median household income, insurance status, and marital status are associated with patient participation in telehealth. These findings identify vulnerable patient populations who may not engage with telehealth, yet still require medical care in a changing health care delivery landscape.

Can Online Communication Prevent Depression Among Older People? A Longitudinal Analysis

Evidence on the association between internet usage and incidence of depression remains mixed. We examined the associations between different categories of internet usage and developing clinical depression. We used data from the 2013 and 2016 waves of the Japan Gerontological Evaluation Study (JAGES) comprising 12,333 physically and cognitively independent adults aged ≥65 years. Participants were engaged in seven categories of internet usage: communication with friends/family, social media, information collection about health/medicine, searching for medical facilities, purchase of drugs and vitamins, shopping, and banking. We found that internet use for communication had a protective influence on the probability of developing clinical depression defined as the Geriatric Depression Scale scores ≥5 or self-reported diagnosed depression. Our findings support the role of online communication with friends/family in preventing clinical depression among older people. Online communication could be particularly useful in the COVID-19 crisis because many families are geographically dispersed and/or socially distanced.

Older People's Use and Nonuse of the Internet in Sweden

The use of the internet has considerably increased over recent years, and the importance of internet use has also grown as services have gone online. Sweden is largely an information society like other countries with high reported use amongst European countries. In line with digitalization development, society is also changing, and many activities and services today take place on the internet. This development could potentially lead to those older persons who do not use the internet or do not follow the development of services on the internet finding it difficult to take part in information and activities that no longer occur in the physical world. This has led to a digital divide between groups, where the older generations (60+), in particular, have been affected. In a large study of Sweden’s adult population in 2019, 95 percent of the overall population was said to be internet users, and the corresponding number for users over 66 years of age was 84%. This study shows that the numbers reported about older peoples’ internet use, most likely, are vastly overestimated and that real use is significantly lower, especially among the oldest age groups. We report that 62.4% of the study subjects are internet users and that this number most likely also is an overestimation. When looking at nonresponders to the questionnaire, we find that they display characteristics generally attributed to non-use, such as lower education, lower household economy, and lower cognitive functioning.

The complex geographies of telelactation and access to community breastfeeding support in the state of Ohio

The availability of breastfeeding support resources, including those provided by Baby-Friendly Hospitals, International Board Certified Lactation Consultants, breastfeeding counselors and educators, and volunteer-based mother-to-mother support organizations, such as La Leche League, are critically important for influencing breastfeeding initiation and continuation for the mother-child dyad. In addition, the emergence of community support options via information and communication technologies such as Skype and Facetime, social media (e.g., Facebook), and telelactation providers are providing mothers with a new range of support options that can help bridge geographic barriers to traditional community support. However, telelactation services that use information and communication technologies to connect breastfeeding mothers to remotely located breastfeeding experts require reliable, affordable, high-quality broadband connections to facilitate interaction between mothers and their support resources. The purpose of this paper is to explore the complex spatial landscape of virtual and face-to-face breastfeeding support options for mothers in the state of Ohio (U.S.), identifying barriers to support. Using a range of spatial and network analytics, the results suggest that a divide is emerging. While urban areas in Ohio benefit from both a density of face-to-face breastfeeding support resources and robust broadband options for engaging in telelactation, many rural areas of the state are lacking access to both. Policy implications and several potential strategies for mitigating these inequities are discussed.

Challenges for the evaluation of digital health solutions-A call for innovative evidence generation approaches

The field of digital health, and its meaning, has evolved rapidly over the last 20 years. For this article we followed the most recent definition provided by FDA in 2020. Emerging solutions offers tremendous potential to positively transform the healthcare sector. Despite the growing number of applications, however, the evolution of methodologies to perform timely, cost-effective and robust evaluations have not kept pace. It remains an industry-wide challenge to provide credible evidence, therefore, hindering wider adoption. Conventional methodologies, such as clinical trials, have seldom been applied and more pragmatic approaches are needed. In response, several academic centers such as researchers from the Institute of Global Health Innovation at Imperial College London have initiated a digital health clinical simulation test bed to explore new approaches for evidence gathering relevant to solution type and maturity. The aim of this article is to: (1) Review current research approaches and discuss their limitations; (2) Discuss challenges faced by different stakeholders in undertaking evaluations; and (3) Call for new approaches to facilitate the safe and responsible growth of the digital health sector.

Perceptions of the Self Versus One's Own Social Group: (Mis)conceptions of Older Women's Interest in and Competence With Technology

Our analysis investigates how gender, age, and technology stereotypes relate to one another and how this relationship reinforces or questions stereotypes. Based on intersectionality, stereotyping, and sense-making literature, our study explores how older women perceive their own interest in and competence with technology and that of their peers. We conducted qualitative in-depth interviews with women between 65 and 75 years of age in Germany. Our findings indicate that their evaluations of others are age and gender stereotyped. When explaining their own interest in technology, they refer to their individual preferences, and for explaining their own competence of technology, they refer to social categories. Plus, assumptions of technology usage seem to be gendered. On the basis of our findings, we discuss the need for taking social categories into account when evaluating inclusiveness with new technologies.

Impact of Age on Patients' Communication and Technology Preferences in the Era of Meaningful Use: Mixed Methods Study

BACKGROUND

Identifying effective means of communication between patients and their health care providers has a positive impact on patients' satisfaction, adherence, and health-related outcomes.

OBJECTIVE

This study aimed to identify the impact of patients' age on their communication and technology preferences when managing their health. We hypothesize that a patient's age affects their communication and technology preferences when interacting with clinicians and managing their health.

METHODS

A mixed methods study was conducted to identify the preferences of patients with cardiovascular diseases. Results were analyzed based on the patients' age. Grounded theory was used to analyze the qualitative data. Patients were recruited based on age, gender, ethnicity, and zip code.

RESULTS

A total of 104 patients were recruited: 34 young adults (19-39 years), 33 middle aged (40-64), and 37 senior citizens (>65). Young adults (mean 8.29, SD 1.66) reported higher computer self-efficacy than middle-aged participants (mean 5.56, SD 3.43; P<.05) and senior citizens (mean 47.55, SD 31.23; P<.05). Qualitative analysis identified the following three themes: (1) patient engagement (young adults favored mobile technologies and text messaging, middle-aged patients preferred phone calls, and senior citizens preferred direct interactions with the health care provider); (2) patient safety (young adults preferred electronic after-visit summaries [AVS] and medication reconciliation over the internet; middle-aged patients preferred paper-based or emailed AVS and medication reconciliation in person; senior citizens preferred paper-based summaries and in-person medication reconciliation); (3) technology (young adults preferred smartphones and middle-aged patients and senior citizens preferred tablets or PCs). Middle-aged patients were more concerned about computer security than any other group. A unique finding among senior citizens was the desire for caregivers to have access to their personal health record (PHR).

CONCLUSIONS

Patients of different ages have different communication and technology preferences and different preferences with respect to how they would like information presented to them and how they wish to interact with their provider. The PHR is one approach to improving patient engagement, but nontechnological options need to be sustained to support all patients.

The second information revolution: digitalization brings opportunities and concerns for public health

The spread of the written word, facilitated by the introduction of the printing press, was an information revolution with profound implications for European society. Now, a second information revolution is underway, a digital transformation that is shaping the way Europeans live and interact with each other and the world around them. We are confronted with an unprecedented expansion in ways to share and access information and experiences, to express ourselves and communicate. Yet while these changes have undoubtedly provided many benefits for health, from information sharing to improved surveillance and diagnostics, they also open up many potential threats. These come in many forms. Here we review some the pressing issues of concern; discrimination; breaches of privacy; iatrogenesis; disinformation and misinformation or 'fake news' and cyber-attacks. These have the potential to impact negatively on the health and wellbeing of individuals as well as entire communities and nations. We call for a concerted European response to maximize the benefits of the digital revolution while minimizing the harms, arguably one of the greatest challenges facing the public health community today.

Technology acceptance of older persons living in residential care

The social, psychological, physical, and financial benefits of digital inclusion are of increasing importance for older persons. However, older persons are often less inclined to utilise technological communication with reports of perceived poor technology acceptance. In this context, a study was conducted to investigate communication technology acceptance in older persons living in residential care. A cross sectional survey of residents (≥60 yrs) of four inner city residences in Durban, South Africa was conducted to assess communication technology access and technology acceptance defined as Usage Behaviour. A researcher-administered questionnaire was based on the Senior Technology Acceptance Model (STAM). Descriptive statistics of STAM factors and structural equation model (SEM) were conducted to test this model, to quantify the importance of various technology acceptance factors on Usage Behaviour among older persons living in residential care. The survey had a 72.1% response rate (n=277). Most of the respondents owned mobile phones (87.6%), although there was low smartphone ownership. Family desire to communicate and ease of use motivated mobile phone acquisition. Behaviour Intention, Facilitating Conditions, Attitude to Life and Satisfaction and education level were significantly associated with Usage Behaviour. Gerontechnology Anxiety and Age showed significant negative associations with Usage Behaviour. The acceptance of communication technology in this setting was low and predominantly influenced by Attitudinal and Technological Context factors together with age and education.