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

Exploring factors affecting the acceptance of fall detection technology among older adults and their families: a content analysis

BACKGROUND

This study conducted in-depth interviews to explore the factors that influence the adoption of fall detection technology among older adults and their families, providing a valuable evaluation framework for healthcare providers in the field of fall detection, with the ultimate goal of assisting older adults immediately and effectively when falls occur.

METHODS

The method employed a qualitative approach, utilizing semi-structured interviews with 30 older adults and 29 families, focusing on their perspectives and expectations of fall detection technology. Purposive sampling ensured representation from older adults with conditions such as Parkinson's, dementia, and stroke.

RESULTS

The results reveal key considerations influencing the adoption of fall-detection devices, including health factors, reliance on human care, personal comfort, awareness of market alternatives, attitude towards technology, financial concerns, and expectations for fall detection technology.

CONCLUSIONS

This study identifies seven key factors influencing the adoption of fall detection technology among older adults and their families. The conclusion highlights the need to address these factors to encourage adoption, advocating for user-centered, safe, and affordable technology. This research provides valuable insights for the development of fall detection technology, aiming to enhance the safety of older adults and reduce the caregiving burden.

Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study

BACKGROUND

The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps.

OBJECTIVE

The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers.

METHODS

We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads.

RESULTS

Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three- and bottom three-rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t15=4.087, P<.001), this may not be a significant determinant of the app's perceived impact.

CONCLUSIONS

The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app.

Elderly people's perceptions on the use of mobile phones to support the self-management of long-term illnesses at Kiruddu National Referral Hospital

Introduction

The global estimate of the aging population is progressively increasing in low and middle-income countries and this is accompanied by the limitations associated with the need for equitable and efficient healthcare delivery among this dire population. Unfortunately, despite the increasing numbers, the adoption of mobile phones is not balanced in the different populations with research showing young persons' adoption rate is higher than that of elderly persons.

Objective

This current study was conducted to identify elderly people's perceptions of the use of mobile phones to support the self-management of long-term illnesses at Kiruddu National Referral Hospital.

Methods

This descriptive-cross-sectional design study was conducted on a sample population of 30 elderly individuals older than 60 years admitted at the outpatient department of Kiruddu National Referral Hospital, Kampala, Uganda. We conducted face-to-face interviews following an interview guide and one focus group discussion. We later used a feature mobile phone and a tablet mobile phone to assess the individual ease of use of each device. The audio recordings were professionally transcribed and transcripts were coded into NVIVO version 12 analysis software for thematic analysis.

Results

Almost all of the respondents who visited the facility had an ailment that hindered their full utilization of the mobile phone to support their self-care. This together with other factors like financial constraints, lack of support from the health workers on how to use mobile phones to support health, inadequate support from the facility, and cost of mobile data among others.

Background and Conclusion

This study provides empirical evidence that there is hardly a known mobile phone adoption model to enable policymakers, systems developers, and health workers to promote the elderly population's use of mobile phones to manage their long-term illnesses in Uganda.

How to adopt technologies in home care: a mixed methods study on user experiences and change of home care in Finland

BACKGROUND

There is a need for better adoption of technology to meet the needs of home care professionals, older people, and informal caregivers.

METHODS

Mixed methods were used to describe and analyse quantitative and qualitative data in a Finnish governmental programme called KATI. The study was three-fold: it 1) listed what kinds of technologies were piloted and deployed in a national study, 2) provided information from the perspectives of home care professionals about requirements to use technology by using focus-group interviews, and 3) assessed experiences of how the adoption of technology changes work and work processes over time by using repeated surveys. Informants in interviews (n = 25) and surveys (n = 90) were home care professionals, who also described the perspectives of older people and informal caregivers. The conceptual models framing the study were adapted from the Technology Acceptance Model and DirVA PROVE-IT.

RESULTS

There were 80 technology pilots, in which variety of technologies were followed in home care. Familiarity with, commitment to and understanding of technology benefits were considered to be requirements for the technology to be used. The adoption of technology provided new skills and information about older people's wellbeing, realisation of treatment and new possibilities in home care. It developed new procedures to focus on older people's needs and motivated professionals by gained concrete aid. It enabled them to leave out some concrete procedures as unnecessary. On the other hand, there were also pessimistic and negative experiences when technology use provided nothing new or did not change anything.

CONCLUSIONS

The adoption of technology is dependent on the technology and its integration into the prevailing service practice. When they both work, it is possible to leave out unnecessary procedures in care, allocate resources and save time. It is possible to be aware of older people's safety and how they cope at home, find new ways to get involved in older people's lives, gain insight, and make changes at work. Continuous on-site training, modifications in service practices and communication throughout organisations is needed.

Understanding the influencing factors and mechanism of social compensation for Chinese older adults using social media in the context of smart home: a qualitative analysis

As a new generation of necessary terminals for future homes, smart homes have become one of the essential mediums for smart aging at home. This paper aims to explore how older adults who age at home can overcome the digital divide of the new medium and achieve social participation in the home context to realize active aging. Based on the theory of social compensation, we select the smart-home smart screen, a representative new medium product in China, and carry out open coding, spindle coding, selective coding, and theoretical construction of the original interview data through the grounded theory research method. The results show that the main factors affecting the social compensation of older adults to smart home social media include user interface quality, interaction quality, content quality, and service quality, and these four factors are used as external variables to compensate older adults socially, thereby stimulating the emotional experience and perception changes at the cognitive level of older adults and then affecting the adoption and acceptance of smart home social media by older adults. This study refines the factors influencing the older adults' use of smart home social media from the perspective of social compensation. It explains the mechanism of acceptable behavior of older adults, bridging the gap in previous literature on the influencing factors and behavioral mechanisms of older adults of smart home social media. This paper provides a theoretical basis and guidance for the subsequent academic research and software development practice of social media under new technological devices to further help older adults in China achieve active and healthy aging.

Ethical Imperatives for Working With Diverse Populations in Digital Research

Digital research methodologies are driving a revolution in health technology but do not yet fully engage diverse and historically underrepresented populations. In this paper, we explore the ethical imperative for such engagement alongside accompanying challenges related to recruitment, appreciation of risk, and confidentiality, among others. We critically analyze existing research ethics frameworks and find that their reliance on individualistic and autonomy-focused models of research ethics does not offer adequate protection in the context of the diversity imperative. To meet the requirements of justice and inclusivity in digital research, methods will benefit from a reorientation toward more participatory practices.

Agreement with COVID-19 disinformation among Portuguese-speaking older adults: an international study

OBJECTIVES

to assess agreement with COVID-19 disinformation among Portuguese-speaking individuals aged 50 years or older.

METHODS

a descriptive and analytical study involving 1,214 older adults born in Portuguese-speaking countries. Data collection occurred through online information mining to recognize COVID-19 and disinformation content, and the application of a structured questionnaire.

RESULTS

agreement with disinformation content was 65.2%. Residing outside Brazil is a protective factor for agreement with disinformation content, and those who believe in the truthfulness of the information sources they receive were 31% more likely to agree with disinformation content.

CONCLUSIONS

there is a high prevalence of disinformation among the older population in two Portuguese-speaking countries, which should raise the attention of healthcare professionals and guide coping strategies.

Practices of Care in Participatory Design With Older Adults During the COVID-19 Pandemic: Digitally Mediated Study

BACKGROUND

Participatory Design (PD), albeit an established approach in User-Centered Design, comes with specific challenges when working with older adults as research participants. Addressing these challenges relates to the reflection and negotiation of the positionalities of the researchers and research participants and includes various acts of giving and receiving help. During the COVID-19 pandemic, facets of positionalities and (mutual) care became particularly evident in qualitative and participatory research settings.

OBJECTIVE

The aim of this paper was to systematically analyze care practices of participatory (design) research, which are to different extents practices of the latter. Using a multiyear PD project with older people that had to take place remotely over many months, we specify different practices of care; how they relate to collaborative work in the design project; and represent foundational practices for sustainable, long-term co-design. Our research questions were "How can digitally-mediated PD work during COVID-19 and can we understand such digital PD as 'care'?"

METHODS

Our data comes from the Joint Programming Initiative "More Years, Better Lives" (JPI MYBL), a European Union project that aims to promote digital literacy and technology appropriation among older adults in domestic settings. It targeted the cocreation, by older adults and university researchers, of a mobile demo kit website with cocreated resources, aimed at improving the understanding of use options of digital tools. Through a series of workshops, a range of current IT products was explored by a group of 21 older adults, which served as the basis for joint cocreative work on generating design ideas and prototypes. We reflect on the PD process and examine how the actors enact and manifest care.

RESULTS

The use of digital technology allowed the participatory project to continue during the COVID-19 pandemic and accentuated the digital skills of older adults and the improvement of digital literacy as part of "care." We provide empirically based evidence of PD with older adults developing digital literacy and sensitizing concepts, based on the notion of care by Tronto for differentiating aspects and processes of care. The data suggest that it is not enough to focus solely on the technologies and how they are used; it is also necessary to focus on the social structures in which help is available and in which technologies offer opportunities to do care work.

CONCLUSIONS

We document that the cocreation of different digital media tools can be used to provide a community with mutual care. Our study demonstrates how research participants effectively enact different forms of care and how such "care" is a necessary basis for a genuinely participatory approach, which became especially meaningful as a form of support during COVID-19. We reflect on how notions of "care" and "caring" that were central to the pandemic response are also central to PD.

Testing a Model of Human Spatial Navigation Attitudes towards Global Navigation Satellite Systems

Global navigation satellite systems (GNSS) can provide better data quality for different purposes; however, some age groups might lie outside its use. Understanding the barriers to its adoption is of interest in different fields. This work aims at developing a measurement instrument of the adoption attitudes towards this technology and examining the relationship of variables such as age and gender. A UTAUT model was tested on 350 participants. The main results can be summarised as follows: (i) the proposed GNSS scale on human spatial navigation attitudes towards geopositioning technology showed optimal psychometric properties; (ii) although statistically significant differences were found in the Wayfinding Questionnaire (WQ) between men and women, these did not reach the level of statistical significance for the scores on attitudes towards GNSS; (iii) by testing a model on human spatial navigation attitudes towards geopositioning technology, it was possible to show a higher relationship with age in women.

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

Background

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

Methods

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

Results

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

Conclusions

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

Age-Related Digital Divide during the COVID-19 Pandemic in China

China has adopted a variety of digital technologies to effectively combat the unprecedented COVID-19 pandemic. The massive utilisation of digital technologies, however, to a great extent, magnifies the age-related digital divide. This paper aims to examine the impacts of the age-related digital divide on older adults in the context of the COVID-19 pandemic. Cases of three age-related digital divide scenarios, including older people taking public transportation, seeking medical care, as well as conducting digital transactions, are collected from Chinese official news outlets. The results indicate that the COVID-19 pandemic accelerates the pace of digital technology utilisation but exacerbates the age-related digital divide. Such an age-related digital divide has largely excluded older adults from both the real society and the virtual society. Older adults' personal attitudes and motivations, as well as education and income, governmental policies, and family and social supports, are all major contributors to the severe impacts of the age-related digital divide on old adults during the pandemic. More measures should be adopted to bridge the age-related digital divide and build a senior-friendly e-society.

Ethics and acceptance of smart homes for older adults

Societal challenges associated with caring for the physical and mental health of older adults worldwide have grown at an unprecedented pace, increasing demand for health-care services and technologies Despite the development of several assistive systems tailored to older adults, the rate of adoption of health technologies is low. This review discusses the ethical and acceptability challenges resulting in low adoption of health technologies specifically focused on smart homes for older adults. The findings have been structured in two categories: Ethical Considerations (Privacy, Social Support, and Autonomy) and Technology Aspects (User Context, Usability, and Training). The findings conclude that older adults community is more likely to adopt assistive systems when four key criteria are met. The technology should: be personalized toward their needs, protect their dignity and independence, provide user control, and not be isolating. Finally, we recommend researchers and developers working on assistive systems to: (1) provide interfaces via smart devices to control and configure the monitoring system with feedback for the user, (2) include various sensors/devices to architect a smart home solution in a way that is easy to integrate in daily life, and (3) define policies about data ownership.

Needs and Preferences of Middle-Aged and Older Adults in Taiwan for Companion Robots and Pets: Survey Study

Background

In recent years, robots have been considered a new tech industry that can be used to solve the shortage in human resources in the field of health care. Also, animal-assisted therapy has been used to provide assistance, companionship, and interaction among the elderly and has been shown to have a positive impact on their emotional and psychological well-being. Both pets and robots can provide dynamic communication and positive interaction patterns. However, preferences for middle-aged and older adults in this regard are not clear.

Objective

This study explored the degree of acceptance of robots and pets as partners in later life and to determine the needs and preferences of elderly individuals related to companion robots.

Methods

A total of 273 middle-aged and older adults aged ≥45 years and living in the community were invited to answer a structured questionnaire after watching a companion robot video. Sociodemographic data, physical health status and activities, experience with technology, eHealth literacy, and acceptance and attitude toward robots and pets were recorded and analyzed using multinomial logistic regression analysis.

Results

Age, level of education, type of dwelling, occupation, retirement status, number of comorbidities, experience with pets, experience using apps, and eHealth literacy were significantly associated with acceptance of robots and pets. Middle-aged and older women preferred robots with an animal-like appearance, while men preferred robots that resembled a human adult. In terms of robot functions, participants preferred a companion robot with dancing, singing, storytelling, or news-reporting functions. Participants’ marital status and whether or not they lived alone affected their preference of functions in the companion robot.

Conclusions

Findings from this study inform the development of social robots with regard to their appearance and functions to address loneliness in later life in fast-aging societies.

Comparing the Effectiveness of a Wearable Activity Tracker in Addition to Counseling and Counseling Only to Reinforce Leisure-Time Physical Activity among Breast Cancer Patients: A Randomized Controlled Trial

This randomized controlled trial aimed to compare the effectiveness of a wearable activity tracker (WAT) in addition to counseling (WAT+counseling) and counseling only for reinforcing leisure-time physical activity (LTPA) among breast cancer patients during radiotherapy (RT). A total of 152 breast cancer patients who were planning to undergo radiation therapy (RT) after surgery participated in the study. The WAT+counseling group (n = 76) underwent physical activity (PA) self-monitoring using a WAT and participated in counseling. The counseling-only group (n = 76) received telephone counseling once a week during RT and did not receive WAT. The WAT+counseling group had increased relative change in self-reported LTPA (102.8) compared with the counseling-only group (57.8) immediately after RT compared to baseline. Although the relative changes of self-reported LTPA of the WAT+counseling group were higher at three and six months after the end of RT compared to in the counseling-only group, the results were not significant. The mean average daily step count of the WAT+counseling group was 9351.7, which increased to 11,592.2 during RT and 12,240.1 after RT. In the subgroup analysis, patients who did not perform regular PA before cancer diagnosis had significantly increased step counts. This study shows the feasibility of WAT with counseling to reinforce PA among breast cancer patients.

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.

Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population. In this narrative review, we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients: People of diverse ethnic background and color, children with disabilities, sexual and gender minorities, pregnant women, mature adults, and those patients living in urban and rural communities. The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression, anxiety and posttraumatic stress disorder symptoms. Those psychiatric patients who are ethnic minorities display barriers to care, including collective trauma and structural racism. Sexual and gender minorities with mental illness face discrimination and limited access to treatment. Pregnant women with psychiatric diagnoses show higher exposure to domestic violence. Children with disabilities face a higher risk of worsening behavior. Mature adults with psychiatric problems show depression due to social isolation. Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities, which face limited access to telehealth services. We suggest that social programs that decrease discrimination, enhance communal resilience, and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.

[The role of gratifications in the process of adopting new media in higher age : Results of a qualitative study with very old users of digital media]

Hintergrund

Eine verbreitete Annahme geht davon aus, dass Menschen im Laufe der Jugend und des Erwachsenenlebens bestimmte Dispositionen des Umgangs mit Medien erlernen, die es ihnen später erschweren, neue mediale Nutzungsmuster zu entwickeln. Jenseits theoretischer Annahmen besteht bislang ein Mangel an explorierenden Untersuchungen, die der Frage nachgehen, unter welchen Bedingungen ältere Menschen digitale, ihnen bislang nicht vertraute Medien aufgreifen und in ihren Alltag einbeziehen.

Material und Methoden

Zwischen Oktober 2019 und März 2020 wurden 16 halbstandardisierte Einzelinterviews mit Personen zwischen 80 und 92 Jahren geführt, die sich in den letzten Jahren ein digitales Medium neu erschlossen und in ihren Alltag integriert haben.

Ergebnisse

Die Interviewten haben sich neue Medien zielgerichtet angeeignet. Dabei fällt auf, dass Aneignungsprozesse maßgeblich durch gravierende Veränderungen der Lebensumstände angestoßen wurden. Die Intention der Aneignung eines internetfähigen Mediums lag bei den meisten Interviewten im Wunsch begründet, wenige ausgewählte Funktionen nutzen zu wollen. Erst mit einiger Verzögerung sind neue Möglichkeiten der Onlinenutzung ausgekundschaftet worden. Im Hinblick auf die Motive und Gratifikationen der Aneignung wurden folgende Muster identifiziert: Neue Medien als … 1) Hobbyerweiterung, 2) Hilfsnetz, 3) Kompensationsinstrument, 4) Anschlussmöglichkeit, 5) Ausbruch aus dem Alltag.

Diskussion

Soweit gewinnbringende, alltagsnahe Nutzungspotenziale wahrgenommen werden, zeigen ältere Menschen ein hohes Maß an Anpassungsfähigkeit in Bezug auf neue Medien. Vor diesem Hintergrund erscheint ein gratifikationsorientiertes Modell als vielversprechender Ausgangspunkt, um Voraussetzungen für die Medienaneignung anhand von Motiven zu erklären, die sinnhafte Anreize schaffen, den Umgang mit neuen Medien im höheren Lebensalter zu erlernen.

The efficacy of microlearning in improving self-care capability: a systematic review of the literature

OBJECTIVE

To determine the effectiveness of microlearning in improving an individual's capability for self-care.

STUDY DESIGN

Systematic review of the literature.

BACKGROUND

The routine adoption of health seeking self-care behaviours can prevent or delay the appearance of various lifestyle diseases including type 2 diabetes and cardiovascular disease. Microlearning delivers complex knowledge in fragments or bite-size 'nuggets' of information and has been applied as a novel intervention to improve individual's self-care capabilities. The aim of this research was to systematically review the literature to determine the effectiveness of microlearning in improving individual self-care capability.

METHODS

A search was conducted on 15 July 2019 across five electronic bibliographic databases: EMBASE, MEDLINE, PsycINFO, CINAHL and Scopus. Randomised and non-randomised controlled trials, controlled before-after studies and interrupted time series studies, published between 1 January 1990 and 15 July 2019 and looking at individuals of all ages were included in the search. The search strategy included a keyword search and a string of "(modality) AND (learning) AND (micro)", which broadly described microlearning to cover all available articles that have used microformat learning interventions. The search was combined with keywords and Medical Subject Headings (MeSH) terms for self-care to identify studies of interests. Studies were screened by two reviewers independently and reported using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. Data from included articles were extracted using Cochran Data Collection Form. Risk of bias was assessed using Version 2 of the Cochrane Risk-of-bias or Risk Of Bias In Non-Randomised Studies of Interventions (ROBINS-I).

RESULTS

1310 articles were identified in the initial search. A total of 26 manuscripts were included in the narrative synthesis after title and abstract and full text screening was performed by two reviewers. Outcomes of studies were categorised. A total of 23 studies measured cognitive level self-care capabilities-related changes, and 91% showed statistically significant improvements. Only 11 studies measured actual self-care behaviour changes, from which only 36% showed statistically significant results. From the 26 manuscripts included, 25 articles were evaluated as having moderate-to-high risk of bias.

CONCLUSION

Under certain conditions, or when combined with monitoring such as tracking daily medicine intake, microlearning can be effective in improving actual self-care behaviours. Microlearning can also positively influence individuals' cognitive self-care capabilities but was largely ineffective in triggering actual self-care behaviour change. More studies are needed to investigate the effectiveness of microlearning in improving self-care capabilities amongst the general population at scale.

Access to an Electronic Health Record: A Polish National Survey

In Poland, as in many countries around the world, e-health services are becoming more and more popular. Obligatory e-sick leave was implemented, followed by e-prescriptions and e-referrals. Therefore, it is worth considering the introduction of a complete electronic health record (EHR) that can be accessed by doctors and patients. The main aim of the study is to find out whether patients want to have access to their EHRs and if they would agree to pay for such a service. The research was based on three surveys conducted among 1000 Polish adults in 2007, 2012, and 2018. The sample collection was carried out by the national opinion poll agency, with the use of computer-assisted telephone interviews. Over 60% of respondents were interested in the possibility of accessing EHRs in general, and almost 50% of them were ready to pay for it. Nevertheless, when analyzing all the year-on-year trends, they were subject to a gradual decrease. The youngest age group was the one most interested in EHRs, while the group comprising respondents in middle age was the one most willing to pay for it. There is still great potential in implementing EHRs on a bigger scale.

Variety, frequency, and type of Internet use and its association with risk of depression in middle- and older-aged Chinese: A cross-sectional study

BACKGROUND

Internet use is beneficial to mental health has been acknowledged, but its specific patterns await further investigation in China's context of urban-rural disparity. Therefore, we aimed to understand the patterns of Internet use and measure their associations with risk of depression in China from three dimensions: variety, frequency and type.

METHODS

We selected 18,492 urban and rural Chinses respondents aged 45 years and older from China Health and Retirement Longitudinal Study (CHARLS) 2015 dataset. Risk of depression was measured by 10-item Centre for Epidemiologic Studies (CES-D 10). Internet use was measured from three dimensions: variety, frequency and type, whereas its relationship with risk of depression was examined by multivariate logistic regression model.

RESULTS

In the whole sample, 67.2% of respondents had no risk of depression, and approximately 7% used Internet, which was inversely associated with risk of depression (AOR=0.617, 95% CI=0.444, 0.858). Rural respondents had higher risk of depression (37.1% VS 26.2%) and lower prevalence of Internet use (2.6% VS 13%). Among rural respondents, using Internet occasionally (AOR=0.338; 95% CI=0.130, 0.881), using one type of device (AOR=0.293; 95% CI=0.113, 0.760), especially mobile phone (AOR=0.427; 95% CI=0.187, 0.978) were associated with lower odds of depression. No significant associations were observed in urban respondents.

LIMITATIONS

The causal relationship between variables awaits further investigation with a longitudinal design.

CONCLUSION

Internet use was negatively associated with risks of depression, especially in rural but not in urban participants. Rural-urban disparities should be considered when designing strategies to encourage moderate Internet use.

Impact of New Technologies for Middle-Aged and Older Patients: In-Depth Interviews With Type 2 Diabetes Patients Using Continuous Glucose Monitoring

Background

Continuous glucose monitoring (CGM) uses subcutaneous sensors and records the average interstitial sensor current every 5 min in the recorder; data are subsequently exported to a computer 4 to 7 days later when calibration with self-measured blood glucose is made retrospectively. How middle-aged and older patients perceive the added technology intervention is not clear.

Objective

The study aimed to understand the factors associated with the adoption of new technology in diabetes care, to understand the feelings and behaviors while using it, and to determine the changes in attitudes and behavior after completing the use of the new technology at the 3-month follow-up.

Methods

Middle-aged and older type 2 diabetes patients who had received professional continuous glucose monitoring (iPro 2 [Medtronic]) were invited for semistructured in-depth interviews on the day of the CGM sensor removal and at 3 months after CGM-based counseling. A phenomenography approach was used to analyze the interview data.

Results

A total of 20 type 2 diabetes patients (aged 53 to 72 years, 13 males and 7 females, 4 to 40 years duration of diabetes, mean glycated hemoglobin 8.54% [SD 0.71%]) completed 2 sections of semistructured in-depth interviews. Physician guidance and participant motivation toward problem solving were found to be factors associated with adoption of the device. Participants indicated that technology can be a reminder, a supervisor, and a visualizer of blood glucose, all of which are helpful for disease management. However, CGM is somewhat inconvenient, and some participants also reported that the provision of this new technology might be a hint of disease progression. There was a higher percentage of women compared with men who reported that CGM can be a reminder or a supervisor to help them with diet control.

Conclusions

Physician guidance and participants’ degree of motivation are keys to adopting new technology in the case of middle-aged and older adults. Although the CGM sensor may cause inconvenience to patients on their limited body movement when wearing the device, it is helpful for diet control and is an effective behavioral modification tool that offers support, especially in the case of women.

Relationship Between Internet Behaviors and Social Engagement in Middle-Aged and Older Adults in Taiwan

Aim: To examine older adults’ Internet use patterns and its relationship with social engagement. Methods: Telephonic interview data of older Internet users from two urban and two rural areas were analyzed (N = 248). Cluster analysis was used to identify their Internet use patterns. Multinomial logistic regression identified characteristics associated with the Internet usage groups, and the multiple regression was used to examine if the Internet usage pattern was associated with social engagement in real life. Results: The majority of older adults in Taiwan using the Internet were considered Leisure users (32%). Others were Sporadic (26%), Instrumental (21%), and Eager users (21%). Leisure and Eager users, but not Instrumental users, had significantly higher scores on social engagement compared with Sporadic users after controlling for sociodemographic and behavioral covariates. Eager Internet users were associated with 22.8% increase in the social engagement level, and Leisure users were associated with 31.2% increase in the social engagement level. Conclusions: Older adults with different Internet behaviors were associated with distinct sociodemographic and social engagement behaviors. Causal relationship is warranted for further investigation.

Digital Pathways to Positive Health Perceptions: Does Age Moderate the Relationship Between Medical Satisfaction and Positive Health Perceptions Among Middle-Aged and Older Internet Users?

Objectives

We explored the influence of e-trust, e-health literacy, e-health information seeking, and e-health information consumerism on medical satisfaction and positive health perceptions.

Methods

Our sample consisted of 499 randomly selected panel members aged 40–93. We employed hierarchical ordinary least squares (OLS) regression analyses and structural equation modeling (SEM). We examined the moderating role of age on the relationship between medical satisfaction and positive health perceptions.

Results

A significant interaction was found between age and medical satisfaction in predicting positive health perceptions in the OLS regression models. Medical satisfaction has a stronger association with self-care, health-related quality of life, and health status in the older adult sample as compared with the middle-aged sample. SEM analyses revealed that e-health information seeking has an indirect effect on both medical satisfaction and positive health perceptions through its significant direct effect on e-health information consumerism. Both e-trust and e-health consumerism were significant predictors. The e-health literacy and e-trust measures were significant predictors of the positive health perception index in the OLS regression models.

Discussion

The results contribute to our understanding of the potential benefits information technologies have for the health and well-being of computer-connected aging adults.

Electronic Health Literacy Across the Lifespan: Measurement Invariance Study

Background

Electronic health (eHealth) information is ingrained in the healthcare experience to engage patients across the lifespan. Both eHealth accessibility and optimization are influenced by lifespan development, as older adults experience greater challenges accessing and using eHealth tools as compared to their younger counterparts. The eHealth Literacy Scale (eHEALS) is the most popular measure used to assess patient confidence locating, understanding, evaluating, and acting upon online health information. Currently, however, the factor structure of the eHEALS across discrete age groups is not well understood, which limits its usefulness as a measure of eHealth literacy across the lifespan.

Objective

The purpose of this study was to examine the structure of eHEALS scores and the degree of measurement invariance among US adults representing the following generations: Millennials (18-35-year-olds), Generation X (36-51-year-olds), Baby Boomers (52-70-year-olds), and the Silent Generation (71-84-year-olds).

Methods

Millennials (N=281, mean 26.64 years, SD 5.14), Generation X (N=164, mean 42.97 years, SD 5.01), and Baby Boomers/Silent Generation (N=384, mean 62.80 years, SD 6.66) members completed the eHEALS. The 3-factor (root mean square error of approximation, RMSEA=.06, comparative fit index, CFI=.99, Tucker-Lewis index, TLI=.98) and 4-factor (RMSEA=.06, CFI=.99, TLI=.98) models showed the best global fit, as compared to the 1- and 2-factor models. However, the 4-factor model did not have statistically significant factor loadings on the 4th factor, which led to the acceptance of the 3-factor eHEALS model. The 3-factor model included eHealth Information Awareness, Search, and Engagement. Pattern invariance for this 3-factor structure was supported with acceptable model fit (RMSEA=.07, Δχ²=P>.05, ΔCFI=0). Compared to Millennials and members of Generation X, those in the Baby Boomer and Silent Generations reported less confidence in their awareness of eHealth resources (P<.001), information seeking skills (P=.003), and ability to evaluate and act on health information found on the Internet (P<.001).

Results

Young (18-48-year olds, N=411) and old (49-84-year olds, N=419) adults completed the survey. A 3-factor model had the best fit (RMSEA=.06, CFI=.99, TLI=.98), as compared to the 1-factor, 2-factor, and 4-factor models. These 3-factors included eHealth Information Awareness (2 items), Information Seeking (2 items), and Information and Evaluation (4 items). Pattern invariance was supported with the acceptable model fit (RMSEA=.06, Δχ²=P>.05, ΔCFI=0). Compared with younger adults, older adults had less confidence in eHealth resource awareness (P<.001), information seeking skills (P<.01), and ability to evaluate and act upon online health information (P<.001).

Conclusions

The eHEALS can be used to assess, monitor uniquely, and evaluate Internet users’ awareness of eHealth resources, information seeking skills, and engagement abilities. Configural and pattern invariance was observed across all generation groups in the 3-factor eHEALS model. To meet gold the standards for factor interpretation (ie, 3 items or indicators per factor), future research is needed to create and assess additional eHEALS items. Future research is also necessary to identify and test items for a fourth factor, one that captures the social nature of eHealth.

E-health for active ageing; A systematic review

Enabling successful active ageing is an international priority to meet the challenges of increasing life expectancy. Digital strategies, such as telemedicine and e-health, offer the potential to deliver active ageing in a cost-effective manner at scale. This article aims to establish the extent to which the research literature considers e-health-based and telemedicine-based active ageing interventions. A systematic review was conducted according to PRISMA standards. Independently, two authors searched the Cochrane, EMBASE & CINAHL databases, with subsequent independent extraction and semi-quantitative analysis. We report a considerable breadth in digital active ageing research, which is truly international in its scope. There is a diverse range of both interventions and technologies, including a reassuring focus on community-based interventions. Whilst there are a number of quantitative studies, sample sizes are small, with a limited amount of statistical testing of the results. There is significant variation in the outcome measures reported and little consensus as to the most effective intervention strategies. Overall, whilst there is considerable breadth to the research published in the literature, there is a clear restriction in the depth of this research. There is little overall consensus. This lack of depth and consensus may be due to the need to recognize the important role of technical research elements alongside more traditional research methodologies, such as randomized controlled trials. Enabling both technical and clinical research methods to be recognized, in tandem, has enormous potential to support individuals, communities, clinicians and policy makers to make more informed decisions in relation to active ageing.