Digital Engagement of Older Adults: Scoping Review

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.

Telemedicine home-based management in patients with chronic heart failure and diabetes type II: study protocol for a randomized controlled trial

BACKGROUND

Heart failure and type 2 diabetes are prevalent public health issues in Europe. These complex chronic conditions require extensive pharmacological management, ongoing self-care, and behavioral changes. Despite the known benefits of lifestyle changes, such as regular exercise and better control of blood sugar levels, patients may need help implementing the recommended changes. This study aims to assess the effectiveness of a telemedicine program for managing heart failure and type 2 diabetes at home. The program focuses on promoting lifestyle changes.

METHODS AND ANALYSIS

During scheduled outpatient cardiology evaluations, eligible patients are recruited and randomly assigned to either an intervention or control group in a 1:1 ratio. The intervention group receives support from a nursing case manager through a structured home-based teleassistance program and a trainer for daily physical activity stimulation. They also have access to teleconsultations with cardiologists and diabetes specialists as needed, telemonitoring of vital signs, and daily step tracking. An app records and monitors daily drug treatment, glycemia, blood pressure, heart rate, and other clinical parameters. Patients can also self-report symptoms and communicate via a chat and videoconference system with a Nurse Case Manager. The control group receives routine care. Data collection occurs before intervention and 6 months after baseline during a new outpatient cardiology evaluation. The primary outcome is to measure the difference in the distance walked during a 6-min walk test between baseline and after 6 months. The key secondary outcomes include improving the disease status and physical activity profile. Data will be analyzed according to the intention-to-treat principles.

DISCUSSION

This study will provide evidence on the efficacy of a telemedicine home-based management model to maintain correct lifestyles in patients with both heart failure and type 2 diabetes, improving self-management, their empowerment on the diseases, and increasing their knowledge and ability to recognize symptoms early.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05633784. Registered on November 30, 2022.

Digital Literacy Training for Low-Income Older Adults Through Undergraduate Community-Engaged Learning: Single-Group Pretest-Posttest Study

BACKGROUND

Digital technology is a social determinant of health that affects older people's ability to engage in health maintenance and disease prevention activities; connect with family and friends; and, more generally, age in place. Unfortunately, disparities in technology adoption and use exist among older adults compared with other age groups and are even greater among low-income older adults.

OBJECTIVE

In this study, we described the development and implementation of a digital literacy training program designed with the dual goals of training low-income older adults in the community and teaching students about aging using a community-engaged learning (CEL) approach.

METHODS

The training program was embedded within a 10-week CEL course that paired undergraduates (N=27) with low-income older adults (n=18) for 8 weeks of digital literacy training. Older adults and students met weekly at the local senior center for the training. Students also met in the classroom weekly to learn about aging and how to use design thinking to train their older adult trainees. Both older adults and students completed pre- and posttraining surveys.

RESULTS

Older adults demonstrated increased digital literacy skills and confidence in the use of digital technology. Loneliness did not change from pre to postassessment measurements; however, older adults showed improvements in their attitudes toward their own aging and expressed enthusiasm for the training program. Although students' fear of older adults did not change, their comfort in working with older adults increased. Importantly, older adults and students expressed positive feelings about the trainee-trainer relationship that they formed during the training program.

CONCLUSIONS

A CEL approach that brings together students and low-income older adults in the community has a strong potential to reduce the digital divide experienced by underserved older adults. Additional work is needed to explore the efficacy and scalability of this approach in terms of older adults' digital literacy as well as other potential benefits to both older and younger adults.

Changes in well-being among socially isolated older people during the COVID-19 pandemic: An outcome-wide analysis

Older adults experienced major changes during the COVID-19 pandemic and ensuing restrictions, and it might be expected that those who were already socially isolated before the pandemic were particularly vulnerable. We apply an outcome-wide longitudinal design on 4,636 participants (mean age 66.8 y) from the English Longitudinal Study of Ageing, observed in 2018/19 and early (June/July 2020) and later (November/December 2020) in the pandemic. Social isolation is defined using an index including marital status, social contact, and social participation in 2018/19. Using mixed models, we compare changes in well-being, health, health behaviors, financial well-being, and Internet use, between isolated and nonisolated participants. From before to during the pandemic, isolated participants (29%) experienced smaller declines in life satisfaction and quality of life and a smaller increase in loneliness. They showed greater declines in smoking and physical activity and were more likely to remain worried about their future financial situation. They also did not change in their likelihood of regular Internet use, contrasting with nonisolated participants who increased in this regard. The groups followed a similar trend for general health and sleep quality (no change), depression and anxiety (increase), and expectations of future financial difficulties (decrease). Although isolated older adults generally show poorer outcomes than their socially connected counterparts, they were somewhat protected during the pandemic on some fronts. Our findings highlight the need to continually care for isolated older adults but also to be attentive in times of unexpected crises to those experiencing extreme changes related to necessary policy responses.

A pioneering EMR-embedded digital health literacy tool reveals healthcare disparities for diverse older adults

BACKGROUND

The COVID-19 pandemic transformed healthcare delivery with the rapid adoption of telehealth and digital technologies to access healthcare. Interventions are needed to ensure that older people in underserved communities do not face new technology-driven healthcare disparities. This article describes pioneering electronic medical record (EMR) embedded tools to assess and support each diverse patient's digital health literacy.

METHODS

We designed and validated a rapid EMR-embedded Digital Health Engagement Tool (DHET) to assess each patient's digital literacy in English and Spanish. We built a separate, EMR-generated auto-scoring function to assess patient use of telehealth and healthcare navigation as recorded within the EMR. Combined, the tools created a complete digital literacy assessment for each patient. We then deployed the tools to conduct a pilot study to elucidate disparities.

RESULTS

A total of 112 ethnic/racial diverse older patients were enrolled (mean age was 78, ranging from 57 to 96) years (SD = 8.04). The female participants were 72.3%. Among the participants, non-Hispanic Whites were 47.3%; Hispanic 25.0%; non-Hispanic Asian 19.6%; non-Hispanic others (including multi-race and non-Hispanic Black/African Americans) 8.0%. Digital literacy disparities were revealed for older adults, particularly those over 70 years old, female gender, and those reporting relying on a helper.

CONCLUSION

New EMR-embedded tools enable healthcare systems to assess the ability of patients to navigate and utilize EMR capabilities, such as video telehealth appointments, messaging providers, reviewing labs/radiology reports, and requesting prescriptions. The study identified significant challenges for older patients in navigating EMRs and calls for healthcare systems to better support patient learning.

Experiences of a Community-Based Digital Intervention Among Older People Living in a Low-Income Neighborhood: Qualitative Study

BACKGROUND

Older adults worldwide experienced heightened risks of depression, anxiety, loneliness, and poor mental well-being during the COVID-19 pandemic. During this period, digital technology emerged as a means to mitigate social isolation and enhance social connectedness among older adults. However, older adults' behaviors and attitudes toward the adoption and use of digital technology are heterogeneous and shaped by factors such as age, income, and education. Few empirical studies have examined how older adults experiencing social and economic disadvantages perceive the learning of digital tools.

OBJECTIVE

This study aims to examine the motivations, experiences, and perceptions toward a community-based digital intervention among older adults residing in public rental flats in a low-income neighborhood. Specifically, we explored how their attitudes and behaviors toward learning the use of smartphones are shaped by their experiences related to age and socioeconomic challenges.

METHODS

This study adopted a qualitative methodology. Between December 2020 and March 2021, we conducted semistructured in-depth interviews with 19 participants aged ≥60 years who had completed the community-based digital intervention. We asked participants questions about the challenges encountered amid the pandemic, their perceived benefits of and difficulties with smartphone use, and their experiences with participating in the intervention. All interviews were audio recorded and analyzed using a reflexive thematic approach.

RESULTS

Although older learners stated varying levels of motivation to learn, most expressed ambivalence about the perceived utility and relevance of the smartphone to their current needs and priorities. While participants valued the social interaction with volunteers and the personalized learning model of the digital intervention, they also articulated barriers such as age-related cognitive and physical limitations and language and illiteracy that hindered their sustained use of these digital devices. Most importantly, the internalization of ageist stereotypes of being less worthy learners and the perception of smartphone use as being in the realm of the privileged other further reduced self-efficacy and interest in learning.

CONCLUSIONS

To improve learning and sustained use of smartphones for older adults with low income, it is essential to explore avenues that render digital tools pertinent to their daily lives, such as creating opportunities for social connections and relationship building. Future studies should investigate the relationships between older adults' social, economic, and health marginality and their ability to access digital technologies. We recommend that the design and implementation of digital interventions should prioritize catering to the needs and preferences of various segments of older adults, while working to bridge rather than perpetuate the digital divide.

Factors influencing older adults' acceptance of voice assistants

Introduction

Voice assistants (VAs) have the potential to uphold and enhance the quality of life for older adults. However, the extent to which older adults accept and benefit from VAs may be relatively modest.

Methods

This study developed a comprehensive model combined with product and personal characteristics to explain the acceptance of VAs among older adults, using semi-structured interviews (Study 1) and questionnaires (Study 2).

Results

Results revealed that in terms of product characteristics, perceived usefulness and perceived enjoyment significantly affect behavior intention. Regarding personal characteristics of older adults, technological self-efficacy and dispositional resistance to change significantly affect behavior intention. However, no direct impact of perceived ease of use and perceived trust on behavior intention. Additionally, perceived enjoyment influenced both perceived ease of use and perceived usefulness.

Discussion

Results suggested the significant role of technology self-efficacy and dispositional resistance to change in predicting the acceptance of VAs among older adults. Our newly developed model offers valuable insights for tailoring VAs to this demographic during design and implementation.

Factors influencing older adults' participation in telehealth interventions for primary prevention and health promotion: A rapid review

OBJECTIVE

To identify facilitators and barriers to older adults' participation in telehealth interventions for primary prevention and health promotion.

METHODS

Relevant articles were searched using keywords in Embase and MEDLINE. Study characteristics, type of telehealth interventions and technology involved, as well as facilitators and barriers to their use, were extracted from selected articles. The Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was used to organise data.

RESULTS

A total of 24 articles (pertaining to 20 studies) were included. Nine facilitators and 11 barriers influencing the participation in telehealth interventions for primary prevention and health promotion among older adults were identified. The most recurrent facilitators were related to the individual's performance expectancy and effort expectancy, as well as the presence of a social dimension associated with the intervention (i.e. having a good relationship with the other participants in the program). The two most prevalent barriers were also related to effort expectancy and performance expectancy, followed by barriers related to the inherent characteristics of the technology and older adults' health condition. Experience, age and gender were also found to moderate technology use and acceptance.

CONCLUSIONS

This rapid review highlights the importance of adopting a holistic perspective when designing telehealth interventions aimed at preventive and health promotion purposes among older adults.

Barriers to and Facilitators of Older People's Engagement With Web-Based Services: Qualitative Study of Adults Aged >75 Years

BACKGROUND

The COVID-19 pandemic has accelerated the shift toward the digital provision of many public services, including health and social care, public administration, and financial and leisure services. COVID-19 services including test appointments, results, vaccination appointments and more were primarily delivered through digital channels to the public. Many social, cultural, and economic activities (appointments, ticket bookings, tax and utility payments, shopping, etc) have transitioned to web-based platforms. To use web-based public services, individuals must be digitally included. This is influenced by 3 main factors: access (whether individuals have access to the internet), ability (having the requisite skills and confidence to participate over the web), and affordability (ability to pay for infrastructure [equipment] and data packages). Many older adults, especially those aged >75 years, are still digitally excluded.

OBJECTIVE

This study aims to explore the views of adults aged >75 years on accessing public services digitally.

METHODS

We conducted semistructured qualitative interviews with a variety of adults aged ≥75 years residing in Greater Manchester, United Kingdom. We also interviewed community support workers. Thematic analysis was used to identify the key themes from the data.

RESULTS

Overall, 24 older adults (mean age 81, SD 4.54 y; 14/24, 58% female; 23/24, 96% White British; and 18/24, 75% digitally engaged to some extent) and 2 support workers participated. A total of five themes were identified as key in understanding issues around motivation, engagement, and participation: (1) "initial motivation to participate digitally"-for example, maintaining social connections and gaining skills to be able to connect with family and friends; (2) "narrow use and restricted activity on the web"-undertaking limited tasks on the web and in a modified manner, for example, limited use of web-based public services and selected use of specific services, such as checking but never transferring funds during web-based banking; (3) "impact of digital participation on well-being"-choosing to go to the shops or general practitioner's surgery to get out of the house and get some exercise; (4) "the last generation?"-respondents feeling that there were generational barriers to adapting to new technology and change; and (5) "making digital accessible"-understanding the support needed to keep those engaged on the web.

CONCLUSIONS

As we transition toward greater digitalization of public services, it is crucial to incorporate the perspectives of older people. Failing to do so risks excluding them from accessing services they greatly rely on and need.

Reducing Loneliness and Improving Social Support among Older Adults through Different Modalities of Personal Voice Assistants

This study examines the potential of AI-powered personal voice assistants (PVAs) in reducing loneliness and increasing social support among older adults. With the aging population rapidly expanding, innovative solutions are essential. Prior research has indicated the effectiveness of various interactive communication technologies (ICTs) in mitigating loneliness, but studies focusing on PVAs, particularly considering their modality (audio vs. video), are limited. This research aims to fill this gap by evaluating how voice assistants, in both audio and video formats, influence perceived loneliness and social support. This study examined the impact of voice assistant technology (VAT) interventions, both audio-based (A-VAT) and video-based (V-VAT), on perceived loneliness and social support among 34 older adults living alone. Over three months, participants engaged with Amazon Alexa™ PVA through daily routines for at least 30 min. Using a hybrid natural language processing framework, interactions were analyzed. The results showed reductions in loneliness (Z = -2.99, p < 0.01; pre-study loneliness mean = 1.85, SD = 0.61; post-study loneliness mean = 1.65, SD = 0.57), increases in social support post intervention (Z = -2.23, p < 0.05; pre-study social support mean = 5.44, SD = 1.05; post-study loneliness mean = 5.65, SD = 1.20), and a correlation between increased social support and loneliness reduction when the two conditions are combined (ρ = -0.39, p < 0.05). In addition, V-VAT was more effective than A-VAT in reducing loneliness (U = 85.50, p < 0.05) and increasing social support (U = 95, p < 0.05). However, no significant correlation between changes in perceived social support and changes in perceived loneliness was observed in either intervention condition (V-VAT condition: ρ = -0.24, p = 0.37; A-VAT condition: ρ = -0.46, p = 0.06). This study's findings could significantly contribute to developing targeted interventions for improving the well-being of aging adults, addressing a critical global issue.

Enhancing access and impact of the Medicare Diabetes Prevention Program using telehealth: a narrative review

Background and Objective

Over 26 million older adults in the United States (US) have prediabetes, which is often a precursor to type 2 diabetes. The Medicare Diabetes Prevention Program (MDPP) is an evidence-based, lifestyle program for older-adult Medicare beneficiaries to prevent progression to diabetes. However, the MDPP has been drastically underutilized. Telehealth delivery may be a promising strategy to increase the reach and impact of the MDPP, including for underserved populations. The objective of this narrative review is to explore the role of telehealth on the accessibility and effectiveness of diabetes prevention programs (DPPs) for older adults.

Methods

We searched the online databases of MEDLINE, APA PsycInfo, CINAHL, and Academic Search Elite for studies that used telehealth to deliver DPPs to older adults through distance learning, i.e., live program delivery where participants join via phone- or video-conferencing. Relevant information from policy documents and related publications was also included.

Key Content and Findings

Three themes emerged from the literature on telehealth delivery of DPPs for older adults (I) clinical effectiveness for weight loss, (II) feasibility and acceptability of this format; and (III) policy considerations to support greater public health impact. There is a growing body of recent evidence to suggest that older adults achieve a clinically meaningful amount of weight loss from participation in telehealth DPPs. The literature suggests that telehealth program delivery is feasible, and older adults find it acceptable, with some specific accommodations. Effectiveness and acceptability of telehealth interventions were also noted for older adults from rural, ethnically-diverse, and low-income groups. Policy considerations include adjustments in rulemaking by the Centers for Medicare and Medicaid Services (CMS) to allow MDPP delivery via telehealth using distance learning, along with sufficient reimbursement rates.

Conclusions

The evidence indicates that delivery of the MDPP via telehealth is beneficial for increasing program reach and impact, including among underserved groups, as well as providing social support for older participants. Scalable delivery of the MDPP via telehealth is essential to make a national, population-level impact for older adults with prediabetes who receive Medicare benefits.

Connections and older adults

This editorial comments on the article by Neumann et al. in this issue.

Older Adults and New Technology: Mapping Review of the Factors Associated With Older Adults' Intention to Adopt Digital Technologies

BACKGROUND

Ongoing advancements in digital solutions support older adults' healthy aging and well-being. However, a unified synthesis of sociodemographic, cognitive, attitudinal, emotional, and environmental factors that influence older adults' intention to use these new digital technologies is still lacking. Understanding the salient factors that influence older adults' intention to use digital technologies will help to ensure that technology is developed appropriately and contextually. This understanding is also likely to contribute to developing technology acceptance models specifically for the aging generation, by reorganizing principles and constructing objectivity criteria for future research studies.

OBJECTIVE

This review aims to identify the key factors associated with older adults' intention to use digital technologies and to provide a comprehensive conceptual framework to describe the relationships between these key factors and older adults' intention to use digital technologies.

METHODS

A mapping review was conducted using 9 databases from inception to November 2022. Articles were selected for review if they had an evaluative component of older adults' intention to use digital technologies. Three researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review and quality appraisal was measured using 3 different tools based on each article's study design.

RESULTS

We identified a total of 59 articles investigating older adults' intention to use digital technologies. The majority (40/59, 68%) of articles did not use an existing framework or model for technology acceptance. Studies mostly adopted a quantitative research design (27/59, 46%). We found 119 unique factors reported to influence older adults' intention to use digital technologies. These were categorized into 6 distinct themes: Demographics and Health Status, Emotional Awareness and Needs, Knowledge and Perception, Motivation, Social Influencers, and Technology Functional Features.

CONCLUSIONS

Given the importance of global demographic change toward an aging society, there is surprisingly limited research on the factors that influence older adults' intention to use digital technologies. Our identification of the key factors across different types of digital technology and models supports the future integration of a comprehensive perspective encompassing environmental, psychological, and social determinants for older adults' intention to use digital technologies.

Ten Years of TeleHealth and Digital Healthcare: Where Are We?

Due to the development of the technological innovation of devices, availability of increasingly performing networks, improvement of the digitization processes, and the push to greater diffusion determined by the COVID-19 pandemic, Digital Healthcare (DH), also referred to as Digital Health [...]