"There's Not Enough Knowledge Out There": Examining Older Adults' Perceptions of Digital Technology Use and Digital Inclusion Classes

Can a "Pandemic Life Adaptation" Digital Technology Curriculum Reduce the Digital Disadvantage of Older Adults During COVID-19? An Intervention Study from Shanghai

Older adults are at a digital disadvantage because of social stereotypes and a lack of social support; however, smartphones have become a necessary technology to cope with crises and daily life in China, especially during the pandemic. This study aimed to help marginalized older adults take on new tasks by developing digital technology education that used a framework of social cognitive theory in social work. The study followed a quasi-experimental design in which 153 elderly people were recruited from three community service centers; 90 of the participants received 6-weekly intervention. Intent-to-treat analysis, effect size calculations, and sensitivity analysis were conducted. The findings show that digital education significantly enhanced two domains of digital life adaptation abilities: general digital life adaptation abilities [g = .50, 95% CI (.70, 2.69)] and pandemic digital life adaptation abilities [g = .89, 95% CI (.96, 2.07)]. The intervention also improved three domains of digital self-efficacy: sharing and communication [g = .55, 95% CI (.04, .48)], verification [g = .34, 95% CI (.01, .59)], and influencing others [g = .53, 95% CI (.13, .77)]. The study showed that the new intervention approach reduced the harm to vulnerable older adults in the digital wave, especially during the pandemic.

User profiles in digitalized healthcare: active, potential, and rejecting - a cross-sectional study using latent class analysis

BACKGROUND

There is evidence of different use by different groups of people for general health-related applications. Yet, these findings are lacking for digitalized healthcare services. It is also unclear whether typical use patterns can be found and how user types can be characterized.

METHODS

The analyses are based on data from 1 821 respondents to the Health Related Beliefs and Health Care Experiences in Germany panel (HeReCa). Digitalized healthcare services, that were used to determine the user types, include for example sick notes before/after examination and disease related training. User types were determined by latent class analysis. Individual groups were characterized using multinomial logistic regressions, taking into account socioeconomic and demographic factors as well as individual attitudes towards digitalization in the healthcare system.

RESULTS

Three types were identified: rejecting (27.9%), potential (53.8%) and active (18.3%). Active participants were less likely to be employed, less likely to be highly educated and less skeptical of digital technologies. Potential users were the youngest, most highly-educated and most frequently employed group, with less skepticism than those who rejected. Rejecters were the oldest group, more likely to be female and of higher socio-economic status.

CONCLUSIONS

Socio-demographic and socio-economic differences were identified among three user types. It can therefore be assumed that not all population groups will benefit from the trend towards digitalization in healthcare. Steps should be taken to enhance access to innovations and ensure that everyone benefits from them.

"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.

The Value of a Virtual Assistant to Improve Engagement in Computerized Cognitive Training at Home: Exploratory Study

BACKGROUND

Impaired cognitive function is observed in many pathologies, including neurodegenerative diseases such as Alzheimer disease. At present, the pharmaceutical treatments available to counter cognitive decline have only modest effects, with significant side effects. A nonpharmacological treatment that has received considerable attention is computerized cognitive training (CCT), which aims to maintain or improve cognitive functioning through repeated practice in standardized exercises. CCT allows for more regular and thorough training of cognitive functions directly at home, which represents a significant opportunity to prevent and fight cognitive decline. However, the presence of assistance during training seems to be an important parameter to improve patients' motivation and adherence to treatment. To compensate for the absence of a therapist during at-home CCT, a relevant option could be to include a virtual assistant to accompany patients throughout their training.

OBJECTIVE

The objective of this exploratory study was to evaluate the interest of including a virtual assistant to accompany patients during CCT. We investigated the relationship between various individual factors (eg, age, psycho-affective functioning, personality, personal motivations, and cognitive skills) and the appreciation and usefulness of a virtual assistant during CCT. This study is part of the THERADIA (Thérapies Digitales Augmentées par l'Intelligence Artificielle) project, which aims to develop an empathetic virtual assistant.

METHODS

A total of 104 participants were recruited, including 52 (50%) young adults (mean age 21.2, range 18 to 27, SD 2.9 years) and 52 (50%) older adults (mean age 67.9, range 60 to 79, SD 5.1 years). All participants were invited to the laboratory to answer several questionnaires and perform 1 CCT session, which consisted of 4 cognitive exercises supervised by a virtual assistant animated by a human pilot via the Wizard of Oz method. The participants evaluated the virtual assistant and CCT at the end of the session.

RESULTS

Analyses were performed using the Bayesian framework. The results suggest that the virtual assistant was appreciated and perceived as useful during CCT in both age groups. However, older adults rated the assistant and CCT more positively overall than young adults. Certain characteristics of users, especially their current affective state (ie, arousal, intrinsic relevance, goal conduciveness, and anxiety state), appeared to be related to their evaluation of the session.

CONCLUSIONS

This study provides, for the first time, insight into how young and older adults perceive a virtual assistant during CCT. The results suggest that such an assistant could have a beneficial influence on users' motivation, provided that it can handle different situations, particularly their emotional state. The next step of our project will be to evaluate our device with patients experiencing mild cognitive impairment and to test its effectiveness in long-term cognitive training.

Honoring the Care Experiences of Chinese Canadian Survivors of Prostate Cancer to Cultivate Cultural Safety and Relationality in Digital Health: Exploratory-Descriptive Qualitative Study

BACKGROUND

Prostate cancer (PCa) is the most commonly diagnosed nonskin cancer for Canadian men and has one of the highest 5-year survival rates, straining systems to provide care. Virtual care can be one way to relieve this strain, but survivors' care needs and technology use are influenced by intersecting social and cultural structures. Cultural adaptation has been posited as an effective method to tailor existing interventions to better serve racialized communities, including Chinese men. However, cultural adaptations may inadvertently draw attention away from addressing structural inequities.

OBJECTIVE

This study used qualitative methods to (1) explore the perceptions and experiences of Chinese Canadian PCa survivors with follow-up and virtual care, and (2) identify implications for the cultural adaptation of a PCa follow-up care app, the Ned (no evidence of disease) Clinic.

METHODS

An axiology of relational accountability and a relational paradigm underpinned our phenomenologically informed exploratory-descriptive qualitative study design. A community-based participatory approach was used, informed by cultural safety and user-centered design principles, to invite Chinese Canadian PCa survivors and their caregivers to share their stories. Data were inductively analyzed to explore their unmet needs, common experiences, and levels of digital literacy.

RESULTS

Unmet needs and technology preferences were similar to broader trends within the wider community of PCa survivors. However, participants indicated that they felt uncomfortable, unable to, or ignored when expressing their needs. Responses spoke to a sense of isolation and reflected a reliance on culturally informed coping mechanisms, such as "eating bitterness," and familial assistance to overcome systemic barriers and gaps in care. Moreover, virtual care was viewed as "better than nothing;" it did not change a perceived lack of focus on improving quality of life or care continuity in survivorship care. Systemic changes were identified as likely to be more effective in improving care delivery and well-being rather than the cultural adaptation of Ned for Chinese Canadians. Participants' desires for care reflected accessibility issues that were not culturally specific to Chinese Canadians.

CONCLUSIONS

Chinese Canadian survivors are seeking to strengthen their connections in a health care system that provides privacy and accessibility, protects relationality, and promotes transparency, accountability, and responsibility. Designing "trickle-up" adaptations that address structural inequities and emphasize accessibility, relationality, and privacy may be more effective and efficient at improving care than creating cultural adaptations of interventions.

Improving older adults' telehealth through a novel community-academic partnership: Preliminary data

BACKGROUND

The COVID-19 pandemic increased the use of telehealth, which posed unique challenges for the provision of care to older adults who face numerous barriers to accessing and using technology. To improve older adults' online health-related abilities, the UCSF Geriatrics Workforce Enhancement Program (UCSF-GWEP) partnered with Little Brothers Friends of the Elderly-San Francisco (LBFE-SF) to develop a model telehealth training intervention.

METHODS

LBFE-SF recruited older adults from their members with wi-fi and paired each one with a new device and volunteer trainer to cover seven lessons and four key tasks (emailing providers, video visits, accessing health information, and using patient portals). Older adults completed surveys to self-assess their skill level after training, and their confidence before, immediately after, and 3 months post training. A subset of trainees were also interviewed about their program goals and experiences. UCSF-GWEP conducted statistical analyses of survey data, and coded interview transcripts to identify aspects of the model supportive to learning and success.

RESULTS

Of 43 participants, 31 completed training. Their median age was 75; 48% were non-white; 45% had no more than a high school education; and 63% reported yearly income below U.S. $20,000. Three months after completing the program, more than 50% of trainees reported that they needed little or no help performing all four key tasks, and confidence with video visits, online searches, and patient portals showed significant improvement. Additionally, in interviews participants reported improved health, social benefits, and explained that learning was facilitated by self-pacing, repetition, and longitudinal support from volunteer trainers.

CONCLUSIONS

Older adults with various barriers to learning technology showed online independence and increased confidence with some telehealth tasks after a novel training intervention. Key characteristics of the model included a tablet device, one-on-one longitudinal support from volunteers, comprehensive learning materials, and community-academic partnership.

Changed Digital Technology Perceptions and Influencing Factors among Older Adults during the COVID-19 Pandemic

This correlational study aimed to identify factors that contribute to changes in perceptions of digital technology among older adults during the COVID-19 pandemic. This study utilized raw data from "The 2021 Report on the Digital Divide," a nationwide survey conducted in South Korea. Data were collected from 1171 older adults (aged ≥ 65 years) from September to December 2021. Multiple regression analyses were performed to examine the factors influencing changes in the perception of digital technology. Over one-third of the participants reported positive changes in their perceptions of digital technology during the pandemic. Key factors included self-efficacy for digital devices (β = 0.35, p < 0.001), digital networking (β = 0.11, p < 0.001), accessibility to digital devices (β = 0.10, p = 0.002), and perceived health (β = 0.08, p = 0.003). The expansion of digital technology owing to the pandemic has served as a catalyst for changes in older adults' perceptions. Healthcare providers and caregivers should consider digital technology perceptions and influencing factors when providing digital healthcare services. The results can be utilized to identify vulnerable older adults with negative perceptions of digital technology, thus minimizing disparities in access to digital healthcare services.

Educational Concepts of Digital Competence Development for Older Adults-A Scoping Review

The digital transformation of healthcare and nursing is becoming increasingly important due to demographic change and the growing shortage of skilled workers. In order to ensure the participation of senior citizens in digital assistive technologies, educational concepts and support services are needed to promote digital skills in older adults. Therefore, the specific needs and prerequisites of this target group have to be taken into consideration. This paper asks how educational programs for the support of digital competences of older adults are designed and implemented. A scoping review was conducted to systematically extract existing findings from the literature. Four databases (Cinahl, PubMed, Web of Science Social Sciences Citation Index (SSCI), ERIC) were searched using an exploratory strategy to identify studies that address educational concepts promoting digital competences for older adults. A total of 47 publications were included in the qualitative analysis and show a variety of strategies to deal with the promotion of digital competences for elderly people. In conclusion, programs dealing with the promotion of digital competences for elderly people should be flexibly adapted to the target group with its specific needs and challenges such as fears, lack of previous experience, or physical limitations. For successful implementation, social support is of outstanding importance.

On the triple exclusion of older adults during COVID-19: Technology, digital literacy and social isolation

During the COVID-19 pandemic, the relationship between older adults and digital technology became complicated. Prior to the pandemic, some older adults may have faced a double exclusion due to a lack of digital literacy and social interaction, and the pandemic-imposed transition to nearly all aspects of life being online magnified the requirement for people to be increasingly digitally literate. This paper presents an exploratory analysis to understand how the increased online nature of the world during the pandemic may have impacted older adults’ relationship with digital technology by conducting an expansion on a prior study of older adults who, pre-pandemic, self-identified as occasional or non-users of digital technology. Follow-up interviews were conducted with 12 of these people during the pandemic. Our findings demonstrate the ways that their risk of precarity became heightened and how they began to use digital technology more frequently, strengthening and applying their digital literacy skills to remain virtually connected with friends and family. Further, the paper advances the concept of a triple exclusion for older adults who are non-users of digital technology and describes how digital literacy and remaining virtually connected can work in tandem, helping older adults to remain included in society.

Screen time, phone usage, and social media usage: Before and during the COVID-19 pandemic

Objective

Technology use has increased in the past several years, especially among younger generations. The COVID-19 pandemic drastically changed how people work, learn, and interact, with many utilizing technology for daily tasks and socializing.

Methods

The current study investigated a sample of college students using a cross-sectional design to determine whether there was a change in how much time students spent on screens, phones, and social media.

Results

Findings indicated that time on screens and phones was significantly higher during the pandemic; however, time spent on social media did not differ significantly.

Conclusion

These findings suggest that students are spending more time working and socializing on their screens and phones, yet social media may not be the platform in which students are doing this. Future studies should further explore technology usage and whether these trends during the COVID-19 pandemic will be lasting.

Digital Engagement of Older Adults: Scoping Review

BACKGROUND

Digital technologies facilitate everyday life, social connectedness, aging at home, well-being, and dignified care. However, older adults are disproportionately excluded from these benefits. Equal digital opportunities, access, and meaningful engagement require an understanding of older adults' experience across different stages of the technological engagement life cycle from nonuse and initial adoption to sustained use, factors influencing their decisions, and how the experience changes over time.

OBJECTIVE

Our objectives were to identify the extent and breadth of existing literature on older adults' perspective on digital engagement and summarize the barriers to and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement.

METHODS

We used the Arksey and O'Malley framework for the scoping review process. We searched MEDLINE, PsycINFO, CINAHL, Web of Science, and ACM digital library for primary studies published between 2005 and 2021. The inclusion and exclusion criteria were developed based on the Joanna Briggs Institute (participants, content, and context) framework. Studies that investigated the digital engagement experience as well as barriers to and facilitators of older adults' digital technology engagement were included. The characteristics of the study, types of digital technology, and digital engagement levels were analyzed descriptively. Content analysis was used to generate tentative elements using a congruent theme, and barriers and facilitators were mapped over the capability, opportunity, and motivation behavior change model (COM-B) and the theoretical domain framework. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews).

RESULTS

In total, 96 publications were eligible for the final charting and synthesis. Most of the studies were published over the past 5 years, investigated the initial adoption stage of digital engagement, and focused on everyday technologies. The most cited barriers and facilitators across the engagement stages from each COM-B component were capability (eg, physical and psychological changes and lack of skill), opportunity (eg, technological features, environmental context, and resources), and motivation (eg, optimism from perceived usefulness and beliefs about capability).

CONCLUSIONS

The COM-B model and theoretical domain framework provide a guide for identifying multiple and intertwined barriers and facilitators at each stage of digital engagement. There are limited studies looking into the whole spectrum of older adults' digital technology experience; in particular, studies on technological nonuse and sustained use stages are rare. Future research and practice should focus on tailored interventions accounting for the barriers to older adults' digital engagement and addressing capabilities, motivation, and opportunities; affordable, usable, and useful digital technologies, which address the changes and capability requirements of older adults and are cocreated with a value framework; and lifelong learning and empowerment to develop older adults' knowledge and skills to cope with digital technology development.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/25616.

Providing community services for persons with disabilities during the COVID-19 pandemic: A scoping review

Community organisations and municipalities support people with disabilities by providing resources and services that are essential for their engagement in the community. Their services were particularly impacted by restrictions related to the COVID-19 pandemic. The aim of the study is to identify scientific literature that examines how community organisations and municipalities adapted services and resources provided to people with disabilities as a result of the COVID-19 pandemic. A scoping review was conducted by searching the databases Medline, Embase, CINAHL, PsycINFO and Web of Science Core Collection in January 2021. Fifteen studies were included from the initial search strategy of 7651 individual studies. Most of the studies were quantitative studies (73.3%; n = 11) and aimed at describing the adaptations put in place during the COVID-19 pandemic (66.7%; n = 10). Most services and resources involved some form of preventive healthcare (66.7%; n = 10). The adaptation of modalities for delivering resources and services varied widely across organisations (e.g. online or a combination of online and in-person) but mostly led to an improvement of the studied outcome (e.g. social skills, quality of life). Barriers (e.g. need for a reliable internet connection, lack of technology literacy from the member) and facilitators (e.g. flexibility and planning from the organisations) for these adaptations have been identified, but there is little information surrounding their cost. The results highlight that the delivery of online services has increased since the inception of the COVID-19 pandemic with valuable outcomes. However, further research is needed to better identify the barriers, facilitators and outcomes of remote services to better face future large-scale disasters like the COVID-19 pandemic and to better support individuals who cannot reach in-person services.

Translational Potential of High-Resistance Inspiratory Muscle Strength Training

Age-associated cardiovascular (CV) dysfunction increases the risk for CV diseases. Aerobic exercise training can improve CV function, but only a minority of adults meet aerobic exercise guidelines. High-resistance inspiratory muscle strength training is a time-efficient lifestyle intervention that may promote adherence and improve CV function. However, further investigation is needed to translate inspiratory muscle strength training into the public health domain.

A codesigned web platform for reducing social isolation and loneliness in older people: a feasibility study

Social isolation and loneliness are associated with negative health outcomes, physical as well as cognitive. Information and communication technology (ICT) can be effective tools for preventing and tackling social isolation and loneliness among older people. Our objective was to evaluate the feasibility of the Fik@ room, a web platform for social interaction designed for older people. A mixed methods design was applied, where both quantitative and qualitative data were collected during a 12-week period (n = 28, Md age 74). Experiences of loneliness were reduced using the Fik@ room. The results highlight the feasibility issues surrounding the recruitment process, adoption, pattern of use, usability, support service, and technical infrastructure. In particular, the importance of offering ICT solutions with few technical issues, and to provide easily accessible and appropriate support. The Fik@ room is a feasible tool for older people to develop new friendships, reduce loneliness, and grow their social networks. However, it is not a communication option that fits all. The results offer a compilation of feasibility issues that can serve as an inspirational guide in the design and implementation of similar technologies.

Effectiveness of Instructional Strategies Designed for Older Adults in Learning Digital Technologies: A Systematic Literature Review

An ageing population is a universal phenomenon experienced worldwide. In parallel with these demographic changes, a significant breakthrough in digital devices has also influenced this digital age. Designing instructional strategies to promote meaningful learning among older adult learners has been a long-standing challenge. To enhance older adults’ life-long learning experiences, implementing instructional strategies in the process through which such adults learn can help to improve effective learning. Despite significant calls for research in this area, there is still insufficient research that systematically reviews the existing literature on older adult learning needs and preferences. Hence, in the present article, a systematic literature review was conducted of the effectiveness of instructional strategies designed for older adult learners through the use of digital technologies. The review was guided by the publication standard, which is ROSES (Reporting Standard for Systematic Evidence Syntheses). This study involves articles selected from two established databases, Web of Science and Scopus. Data from the articles were then analysed using the thematic analysis, which resulted in six main themes: (1) collaborative learning; (2) informal learning setting; (3) teaching aids; (4) pertinence; (5) lesson design; and (6) obtaining and providing feedback. The six main themes produced a further 15 sub-themes. The results from this study make significant contributions in the areas of instructional design and gerontology. The findings from this study highlight several important strategies of teaching digital technology, particularly for older adults, as follows: (1) to enhance instructional design use in teaching digital technology based on the needs and preferences of older adult learners; and (2) to highlight the factors for, and impact of, learning digital technologies among older adults.

Factors Influencing Intention to Technological Use in Older Adults. The TAM Model Aplication

The use of digital technology by older adults has improved in recent years in response to the need for their functional adaptation to an increasingly technological social context. Understanding this type of technological adaptation has recently become an important field of inquiry in both social and gerontological studies. Working within this framework, the aim of this study is to identify the main determinants that influence the intention of older people to use digital technology in their daily lives, using the Technological Acceptance Model. A study was carried out with the participation of 1155 people over 65 years of age in Spain. Confirmatory Factor Analysis and structural equation models (SEM) were performed. The results show that the TAM is a useful model to explain the intention of older adults to use Digital Technology, showing a high predictive power, highlighting Perceived Usefulness and Perceived Ease of Use as the main predictor variables.

Social Disconnection in Late Life Suicide: An NIMH Workshop on State of the Research in Identifying Mechanisms, Treatment Targets, and Interventions

Both social disconnection and suicide are significant public health concerns among older adults, and social disconnection is associated with greater risk for suicide-related thoughts and behaviors in late life. We present a synthesis of research discussed during a workshop hosted by the National Institute of Mental Health on social disconnection and late-life suicide. Social disconnection is related to suicide risk in late life via a variety of mechanisms, including biological, behavioral, and psychological correlates. Researchers in several scientific fields have begun to establish these connections and identify targets for interventions to reduce risk in late life. While research has demonstrated that social connection is amenable to change, there is little research to date on the most evidence-based interventions to mitigate social disconnection or the related risks. However, there are several promising biological, behavioral, and psychological interventions that may target various mechanisms, as well as social disconnection itself. With a relative paucity of research in this area, these lines of study are ripe for innovative investigation. In order to most effectively advance the field, we must establish more consistent definitions of social connection and disconnection; more accurately measure and assess older adults' social needs; examine the most effective approaches and modalities for assessment and intervention; take into account important contextual factors; and apply a translational, convergent scientific approach.

The use of a bespoke website developed for people with dementia and carers: Users' experiences, perceptions and support needs

Background: Current policy emphasises the role of digital technologies in facilitating the management of long-term conditions. While digital resources have been developed for carers, there has been little attention to their development for people with dementia. The Caregiverspro-MMD website was developed as a joint resource for people with dementia and carers, delivering access to information, informal content, games and peer support. Research Design and Methods: This study explored the experiences of dyads consisting of people with dementia and carers of using the website. Interviews and focus groups were conducted with 43 participants. Findings: Thematic analysis identified 10 subthemes grouped under three superordinate themes which highlight participants' experiences of and responses to the website functions; important aspects of the website design and delivery; and barriers to use. Discussion: Findings highlight the value of a credible information source which negated the need for arduous online searches, the pleasure associated with playing games and interacting with others online. However, participants were reluctant to share personal information online, preferring to create 'informal content' which celebrated everyday life, and were reluctant to 'friend' people online who they had not met in person. The importance of training and support to use the website was highlighted. Health problems, lack of interest or difficulties using technology, and time were all identified as barriers to use.

Promoting Information Communication Technology Adoption and Acceptance for Aging-in-Place: A Randomized Controlled Trial

The prevailing digital divide along with barriers to information communication technology (ICT) adoption among older adults is well elucidated. To contribute evidence on ICT education, a 2-year randomized controlled trial verified the long-term effect of a novel individualized ICT training program for older adults in demographic cohorts who are known to underutilize ICT (n = 42 in the training and n = 43 in a control group). Mixed-model repeated measures analysis of data was conducted from baseline and 6-month intervals (df = 4, 1) post training. Older adults in the training group engaged in a wide range of leisure (p = .03), health management (p = .006), and instrumental activities of daily living (p = .02) significantly more than those in the control group. They also reported significantly enhanced technology acceptance and sustained sense of independence in key ICT-based activities. The study supports the implementation of one-on-one ICT training programs to promote access and utilization of digital resources for aging-in-place.

Virtual Home Assistant Use and Perceptions of Usefulness by Older Adults and Support Person Dyads

AIM

Describe virtual home assistant use and usefulness from the perspective of older adults and their support persons.

METHODS

This was a mixed-methods study with older adults and their support persons (n = 10 dyads). Virtual home assistant (VHA) equipment was installed in participants' homes, and its use was documented for 60 days. Participants received protocol-guided telephone calls to address their VHA questions or problems. The type and frequency of VHA use were summarized with descriptive statistics. End-of-study interviews about VHA use were conducted with dyad participants. Qualitative content analyses were used to describe the interview findings about the dyad's perceptions of using the VHA, how it was used, any difficulties experienced, and suggestions for future VHA uses.

RESULTS

Participant dyads reported positive VHA perceptions, including the potential for VHAs to promote aging in place. Participants discussed the challenges learning the technology and replacing old habits with new ones. Participants offered recommendations for future VHA skills and for more education and training about using the VHA.

CONCLUSIONS

The study findings suggest that VHAs may be useful for older adults as they age in place and offer reassurance for support persons.

Adequacy of Web-Based Activities as a Substitute for In-Person Activities for Older Persons During the COVID-19 Pandemic: Survey Study

BACKGROUND

Senior centers and other types of clubs provide activities for older adults to address boredom, social isolation, and loneliness. Due to the COVID-19 pandemic, most of these activities have been cancelled. A limited range of web-based activities have been offered as alternatives. However, the effectiveness of these web-based group activities for older adults has scarcely been researched.

OBJECTIVE

We aimed to understand the extent to which web-based activities for older adults provide an adequate substitute for in-person activities.

METHODS

In this telephone survey, we interviewed 105 older adults in Israel who had been offered the opportunity to participate in web-based activities after routine activities closed due to the COVID-19 pandemic. Of the total sample, 49/105 (46.7%) participated in the activities and 56/105 (53.3%) did not. We inquired about the respondents' background characteristics, satisfaction with the activities, and reasons for participation or nonparticipation.

RESULTS

The respondents who participated in the web-based activities tended to be highly satisfied with at least some of them. They rated the enjoyment derived from the content of the activity as the most important motivator, followed by maintaining a routine and by enjoying the group and the presence of others. Over 50% of the participants (28/49, 57%) wished to continue with the exercise programming after the end of the COVID-19 pandemic, and 41% (20/49) wished to continue with the web-based lectures. Participants were more likely to report partaking in alternative activities than nonparticipants (P=.04). The most common reasons cited by nonparticipants were being unaware of the web-based program (24/56, 43%) despite a notification having been sent to the entire sample, lack of interest in the content (18/56, 32%), and technical issues (13/56, 23%), such as not owning or being able to fully use a computer. Both participants and nonparticipants were interested in a wide range of topics, with many being very particular about the topics they wished to access. Approximately half expressed willingness to pay for access; those who were willing to pay tended to have more years of education (P=.03).

CONCLUSIONS

Our findings suggest a need for web-based activities for countering boredom and feelings of isolation. The main factors that influence the use, efficacy, and sustainability of online activities are access, motivational and need-fulfilling factors, and whether the activities are sufficiently tailored to individuals' preferences and abilities. Challenges in substituting in-person services are promoting social relationships that are currently not sufficiently incorporated into most web-based programs, accommodating a wider range of topics, and increasing the accessibility of current programs to older adults, especially those who are homebound, both during and after the COVID-19 pandemic.

Promoting Problem Solving About Health Management: A Mixed-Methods Pilot Evaluation of a Digital Health Intervention for Older Adults With Pre-Frailty and Frailty

Background: There is a need for interventions to promote health management of older adults with pre-frailty and frailty. Technology poses promising solutions, but questions exist about effective delivery. Objectives: We present the results of a mixed-methods pilot evaluation of Virtual Online Communities for Older Adults (VOCALE), an 8-week intervention conducted in the northwestern United States, in which participants shared health-related experiences and applied problem solving skills in a Facebook group. Methods: We performed a mixed-methods process evaluation, integrating quantitative and qualitative data, to characterize the intervention and its effects. We focus on four areas: health-related measures (health literacy and self-efficacy), participation, problem solving skills enacted, and subjective feedback. Results: Eight older adults with pre-frailty and frailty (age = 82.7 ± 6.6 years) completed the study. There was an upward trend in health literacy and health self-efficacy post-intervention. Participants posted at least two times per week. Content analysis of 210 posts showed participants were able to apply the problem solving skills taught, and exit interviews showed participants' increased awareness of the need to manage health, and enjoyment in learning about others. Conclusion: This mixed-methods evaluation provides insight into feasibility and design considerations for online interventions to promote health management among vulnerable older adults.

DigiCraft: A Pedagogical Innovative Proposal for the Development of the Digital Competence in Vulnerable Children

The integration of citizens in the society of information and knowledge is a pillar in social cohesiveness. The digital gap, a direct consequence of socioeconomic inequality among citizens enables e-exclusion, which is a new way of social exclusion that excludes people from different economic, social and economic backgrounds out of the society of information and knowledge. The aim of this paper is to present an educational programme lead by the Foundation Vodafone Spain with the assessment of educators and experts at university. The objective is focused on the development of the digital competence centred on vulnerable childhood. This program uses a method based on learning-by-doing and the “maker” movement. The majority of educators who have participated have underlined that children have improved their digital competence and also some transversal competencies and have defined it as an innovative and creative programme. DigiCraft contributes to the acquisition and development of digital competence from a social perspective. The proposal avoids discrimination of children depending on their sociable heterogeneous factors in their education.

Age is negatively associated with upper limb recovery after conventional but not robotic rehabilitation in patients with stroke: a secondary analysis of a randomized-controlled trial

BACKGROUND

There is consistent evidence that robotic rehabilitation is at least as effective as conventional physiotherapy for upper extremity (UE) recovery after stroke, suggesting to focus research on which subgroups of patients may better respond to either intervention. In this study, we evaluated which baseline variables are associated with the response after the two approaches.

METHODS

This is a secondary analysis of a randomized-controlled trial comparing robotic and conventional treatment for the UE. After the assigned intervention, changes of the Fugl-Meyer Assessment UE score by ≥ 5 points classified patients as responders to treatment. Variables associated with the response were identified in a univariate analysis. Then, variables independently associated with recovery were investigated, in the whole group, and the two groups separately.

RESULTS

A sample of 190 patients was evaluated after the treatment; 121 were responders. Age, baseline impairment, and neglect were significantly associated with worse response to the treatment. Age was the only independently associated variable (OR 0.967, p = 0.023). Considering separately the two interventions, age remained negatively associated with recovery (OR 0.948, p = 0.013) in the conventional group, while none of the variables previously identified were significantly associated with the response to treatment in the robotic group.

CONCLUSIONS

We found that, in our sample, age is significantly associated with the outcome after conventional but not robotic UE rehabilitation. Possible explanations may include an enhanced positive attitude of the older patients towards technological training and reduced age-associated fatigue provided by robotic-assisted exercise. The possibly higher challenge proposed by robotic training, unbiased by the negative stereotypes concerning very old patients' expectations and chances to recover, may also explain our findings.

TRIAL REGISTRATION NUMBER

NCT02879279.

Gamification for Older Adults: A Systematic Literature Review

BACKGROUND AND OBJECTIVES

During past years, gamification has become a major trend in technology, and promising results of its effectiveness have been reported. However, prior research has predominantly focused on examining the effects of gamification among young adults, while other demographic groups such as older adults have received less attention. In this review, we synthesize existing scholarly work on the impact of gamification for older adults.

RESEARCH DESIGN AND METHODS

A systematic search was conducted using 4 academic databases from inception through January 2019. A rigorous selection process was followed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Twelve empirical peer-reviewed studies written in English, focusing on older adults aged ≥55, including a gameful intervention, and assessing subjective or objective outcomes were identified. Eleven of the 12 studies were conducted in the health domain. Randomized controlled study settings were reported in 8 studies. Positively oriented results were reported in 10 of 12 studies on visual attention rehabilitation, diabetes control, increasing positive emotions for patients with subthreshold depression, cognitive training and memory tests, engagement in training program, perceptions of self-efficacy, motivation and positive emotions of social gameplay conditions, increased physical activity and balancing ability, and increased learning performance and autonomy experiences. The results are, however, mostly weak indications of positive effects.

DISCUSSION AND IMPLICATIONS

Overall, the studies on gameful interventions for older adults suggest that senior users may benefit from gamification and game-based interventions, especially in the health domain. However, due to methodological shortcomings and limited amount of research available, further work in the area is called for.

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.

Review of the Content and Quality of Mobile Applications About Alzheimer's Disease and Related Dementias

This study reviewed the content of mobile applications (apps) providing Alzheimer's disease or related dementias (ADRD) information and assessed quality of the apps. Characteristics, content, and technical aspects of 36 apps in the U.S. Google Play Store and App Store were coded, and quality of the apps was evaluated using the Mobile Application Rating Scale. Caregiving (62.1%) and disease management (55.6%) content was frequently provided. Few apps had an app community (8.3%) or a reminder function (8.3%). Overall, quality of the apps was acceptable; apps by health care-related developers had higher quality scores than those by non-health care-related developers. This analysis showed that ADRD-related apps provide a range of content and have potential to benefit caregivers, individuals with ADRD, health care providers, and the general public. Collaboration of ADRD experts and technology experts is needed to provide evidence-based information using effective technical functions that make apps to meet users' needs.