A home-based individualized information communication technology training program for older adults: a demonstration of effectiveness and value

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.

Social Prescription Interventions Addressing Social Isolation and Loneliness in Older Adults: Meta-Review Integrating On-the-Ground Resources

BACKGROUND

Social prescription programs represent a viable solution to linking primary care patients to nonmedical community resources for improving patient well-being. However, their success depends on the integration of patient needs with local resources. This integration could be accelerated by digital tools that use expressive ontology to organize knowledge resources, thus enabling the seamless navigation of diverse community interventions and services tailored to the needs of individual users. This infrastructure bears particular relevance for older adults, who experience a range of social needs that impact their health, including social isolation and loneliness. An essential first step in enabling knowledge mobilization and the successful implementation of social prescription initiatives to meet the social needs of older adults is to incorporate the evidence-based academic literature on what works, with on-the-ground solutions in the community.

OBJECTIVE

This study aims to integrate scientific evidence with on-the-ground knowledge to build a comprehensive list of intervention terms and keywords related to reducing social isolation and loneliness in older adults.

METHODS

A meta-review was conducted using a search strategy combining terms related to older adult population, social isolation and loneliness, and study types relevant to reviews using 5 databases. Review extraction included intervention characteristics, outcomes (social [eg, loneliness, social isolation, and social support] or mental health [eg, psychological well-being, depression, and anxiety]), and effectiveness (reported as consistent, mixed, or not supported). Terms related to identified intervention types were extracted from the reviewed literature as well as descriptions of corresponding community services in Montréal, Canada, available from web-based regional, municipal, and community data sources.

RESULTS

The meta-review identified 11 intervention types addressing social isolation and loneliness in older adults by either increasing social interactions, providing instrumental support, promoting mental and physical well-being, or providing home and community care. Group-based social activities, support groups with educational elements, recreational activities, and training or use of information and communication technologies were the most effective in improving outcomes. Examples of most intervention types were found in community data sources. Terms derived from the literature that were the most commonly congruent with those describing existing community services were related to telehealth, recreational activities, and psychological therapy. However, several discrepancies were observed between review-based terms and those addressing the available services.

CONCLUSIONS

A range of interventions found to be effective at addressing social isolation and loneliness or their impact on mental health were identified from the literature, and many of these interventions were represented in services available to older residents in Montréal, Canada. However, different terms were occasionally used to describe or categorize similar services across data sources. Establishing an efficient means of identifying and structuring such sources is important to facilitate referrals and help-seeking behaviors of older adults and for strategic planning of resources.

Older adults' needs and requirements for a comprehensive exergame-based telerehabilitation system: A focus group study

Introduction

Telerehabilitation in older adults using information and communication technologies (ICTs) provides therapy, which is potentially equally effective as traditional rehabilitation, yet more accessible. This study aimed to analyze the needs and requirements of older adults (OA) and healthcare-professionals (HP) toward ICTs and telerehabilitation in general as well as toward a specific novel exergame-based telerehabilitation system (COCARE system, Dividat).

Materials and methods

The COCARE telerehabilitation system enables individual training based on exergames, as well as an assessment system and a digital centralized case management. Six focus groups with in total 34 participants were conducted. A mixed-methods approach was used comprising questionnaires and semi-structured interviews.

Results

Both OA and HP would engage to an exergame-based telerehabilitation program. Major motivating factors are the relevance of such a training for health and the entertainment component of exergames. Main requirements are simplification of the system, variety, a personalized training, a constantly available contact person, and comprehensive instructions for use. Besides, HP praised the system's motivational effect, but remained concerned about risk of falls and social isolation.

Conclusion

ICTs for telerehabilitation are accepted by OA and HP but should be adapted hardware- and software-wise to address OA' age-stemming vulnerabilities (e.g., risk of falls) and low ICT literacy.

The association between information and communication technologies, loneliness and social connectedness: A scoping review

Older adults are at a higher risk of loneliness, compared to other demographics. The use of Internet Communication and Technologies (ICTs) among older adults is steadily increasing and given ICTs provide a means of enhancing social connectedness suggests they may have positive effects on reducing loneliness. Therefore, the aim of this scoping review was to examine the research that explores how ICTs may be implicated in mitigating loneliness and increasing social connectedness among older adults. After the examination of 54 articles, we identified three major themes within the literature: (1) ICTs were associated with a reduction in loneliness and increase in wellbeing. (2) ICTs promoted social connectedness by facilitating conversations. (3) Factors such as training, self-efficacy, self-esteem, autonomy, and the design/features, or affordances, of ICTs contribute toward the associations between ICT use and wellbeing. The heterogeneity of methodologies, statistical reporting, the small sample sizes of interventional and observational studies, and the diversity of the experimental contexts underline the challenges of quantitative research in this field and highlights the necessity of tailoring ICT interventions to the needs and contexts of the older users.

What's behind the Dashboard? Intervention Mapping of a Mobility Outcomes Monitoring System for Rehabilitation

Training and follow-up for older adults who received new assistive technology can improve device use adoption and function, but there is a lack of systematic and coordinated services. To address this gap, the Internet-based MOvIT+™ was designed to provide remote monitoring and support for assistive technology users and their caregivers. This paper presents the intervention mapping approach that was used. In step 1, we established a project governance structure and a logic model emerged from interviews with stakeholders and a systematic review of literature. In step 2, a modified TRIAGE consensus process led to the prioritization of thirty-six intervention components. In step 3, we created use cases for all intervention end users. In step 4, the intervention interface was created through iterative lab testing, and we gathered training resources. In step 5, a two-stage implementation plan was devised with the recruited rehabilitation sites. In step 6, we proposed an evaluation protocol. This detailed account of the development of MOvIT+™ demonstrates how the combined use of an intervention mapping approach and participatory processes with end users can help linking evidence-based, user-centered, and pragmatic reasoning. It makes visible the complexities behind the development of Internet-based interventions, while guiding future program developers.

Training Resources Targeting Social Media Skills to Inform Rehabilitation for People Who Have an Acquired Brain Injury: Scoping Review

BACKGROUND

In 2020 and 2021, people increasingly used the internet to connect socially and professionally. However, people with an acquired brain injury (ABI) experience challenges in using social media, and rehabilitation professionals have reported feeling underprepared to support them in its use. To date, no review of social media skills training to inform ABI rehabilitation has been conducted.

OBJECTIVE

This scoping review aimed to examine research on interventions addressing social media skills and safety, with a focus on people living with health conditions; free web-based resources for the general public on social media skills training; and currently available online support groups for people with ABI.

METHODS

An integrative scoping review was conducted, with a systematic search strategy applied in March and November 2020 across OvidSP (MEDLINE, AMED, PsycINFO, and Embase), Scopus, Web of Science, CINAHL, Google Scholar, Google, and Facebook. The data collected were critically appraised and synthesized to describe the key content and features of social media training resources.

RESULTS

This review identified 47 peer-reviewed academic articles, 48 social media training websites, and 120 online support groups for people with ABI. A key recommendation was interactive training with practical components addressing cybersafety, how to use platforms, and how to connect with others. However, no social media training resources that were relevant and accessible for people with ABI were identified.

CONCLUSIONS

Training resources to support people with ABI in safely using social media are limited. The key content to be addressed and the features to be incorporated into web-based social media training were determined, including the need for interactive training that is co-designed and safe and incorporates practical components that support people with ABI. These findings can be used to inform the development of web-based evidence-based support for people with ABI who may be vulnerable when participating in social media.

Aspects of ICT connectivity among older adults living in rural subsidized housing: reassessing the digital divide

Purpose

This article examines aspects of information communication technology (ICT) connectivity among the understudied population of low-income older adults living in rural and peri-urban subsidized housing. We aim to investigate if variations exist in access and connectivity when economic and housing conditions are constant and use data from northern New England.

Design/methodology/approach

The multidisciplinary, mixed-methods approach involved administering structured surveys using iPads with senior residents (n = 91) from five housing sites, qualitative observations by field researchers and an ecological assessment of ICT resources at housing, community and state levels.

Findings

All subsidized housing sites were broadband accessible and nearby libraries. Fewer sites had Wi-Fi freely available to residents, and individual residents disparately accessed the Internet. Age and education demonstrably influenced ICT use of social media and email. Technology in the form of iPads used for surveys posed functional challenges for some older adults, but these technology-mediated interactions were also perceived as important sites of sociability.

Originality/value

Older adults disparately access and use ICT relative to socioeconomic status even as housing conditions remain constant, and access and use influences frequency of social connections with friends and family. The findings reveal factors that contribute to the existing digital divide facing older adults and broader lack of digital equity.

The Effects of Technological Interventions on Social Participation of Community-Dwelling Older Adults with and without Dementia: A Systematic Review

Social isolation in community-dwelling older adults with dementia is a growing health issue that can negatively affect health and well-being. To date, little attention has been paid to the role of technology in improving their social participation. This systematic review aims to provide a systematic overview of the effects of technological interventions that target social participation in community-dwelling older adults with and without dementia. The scientific databases Medline (PubMed), PsycINFO, CINAHL, Web of Science, and the Cochrane Library were systematically searched and independently screened by two reviewers. Results were synthesized narratively. The methodological quality of included studies was independently assessed by two reviewers. In total, 36 studies of varying methodological quality were identified. Most studies evaluated social networking technology and ICT training programs. Three studies focused on people with dementia. Quantitative findings showed limited effects on loneliness, social isolation, and social support. Nevertheless, several benefits related to social participation were reported qualitatively. Social interaction, face-to-face contact, and intergenerational engagement were suggested to be successful elements of technological interventions in improving the social participation of community-dwelling older adults. Rigorous studies with larger sample sizes are highly needed to evaluate the long-term effects of technology on the multidimensional concept of social participation.

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.

Analyzing Older Adults' Perceived Values of Using Smart Bracelets by Means-End Chain

To cope with the demands for medical care in an aging society, smart healthcare wearable devices that can measure physiological signals are being regarded as the primary tools in medical care programs, allowing the users to acquire basic health data. Although the smart healthcare wearable devices could be applied to disease management and prevention that could help older adults control their health, older adults must be willing and able to use and continue to use them. In this research, interviews conducted through means–end chain (MEC) and laddering were used to guide the older adults step-by-step by explaining abstract ideas and emphasizing value in their perceptions of specific attributes. A “hierarchical value map” was further constructed to confirm the perceived value of smart healthcare wearable devices to older adults. The research results showed that, in terms of attribute functions, seniors believed that smart bracelets in mobile health devices should have the attributes of safe use, real-time information feedback, correct data, comfortable wear, and clear screen. In terms of consequent benefits, older adults can use smart bracelets in mobile health devices to gain benefits in learning about smart products, understanding technology applications, increasing health awareness and relaxation, and satisfying curiosity. In terms of value goals, older adults want to achieve the value goals of a sense of social belonging, improved quality of life, and healthier bodies. Health is the most important thing for older adults, but previous research has often focused on the use of equipment for physical examinations; relatively few studies have allowed older adults to experience the equipment personally. The device can provide the ultimate value of long-term health promotion for older adults.

Assistive technology for communication of older adults: a systematic review

OBJECTIVE

Describe the use of assistive technology to enhance communication opportunities for older adults.

METHODS

A systematic review was conducted in two databases, PubMed and Web of Science, by using two different searches in each. The search was limited to original articles, in English language, including people aged 60 years and older that used any type of assistive technology for communication. The articles found in the initial search were filtered by title, abstracts and the remaining articles were fully read.

RESULTS

Eighteen studies were included in this review after the reading of full-texts. Most of the studies included apparently healthy participants with communication limitations due to aging related changes and the others included people with some pathology that prevent them from normal communication.

CONCLUSION

Four categories of assistive technology were identified: assistive technology for people with speech problems; robot or videoconferencing systems; Information and Communication Technologies and, other types of assistive technology for communication, such as hearing aids and scrapbooks. Assistive technology for communication of older adults is not only used by people with disabilities that prevent them from usual communication. They are mostly for older adults without a pathological communication problem.

Cardiac Rehabilitees' Technology Experiences Before Remote Rehabilitation: Qualitative Study Using a Grounded Theory Approach

Background

Even though technology is becoming increasingly common in rehabilitation programs, insufficient data are as yet available on rehabilitees’ perceptions and experiences. It is important to understand their abilities when using technology for remote rehabilitation.

Objective

This is a qualitative study on technology experiences of persons affected by cardiovascular disease assessed before remote rehabilitation. The aim of the study was to explore rehabilitees’ experiences and attitudes toward technology before 12 months of remote rehabilitation.

Methods

Qualitative interviews were conducted with 39 rehabilitees in four focus groups. The subjects were aged 34 to 77 years (average age 54.8 years) and 74% (29/39) of them were male. They had been diagnosed with coronary artery disease and were undergoing treatment in a rehabilitation center. The interviews were conducted between September 2015 and November 2016. Data were analyzed using Glaser’s mode of the grounded theory approach.

Results

The result of the study was an “identifying e-usage” experience category, which refers to the rehabilitees’ notions of the use of information and communication technologies (e-usage) in the process of behavior change. The main category comprises four subcategories that define the rehabilitees’ technology experience. These subcategories are “feeling outsider,” “being uninterested,” “reflecting benefit,” and “enthusiastic using.” All rehabilitees expected that technology should be simple, flexible, and easy to use and learn. The results reflecting their technology experience can be used in e-rehabilitation programs. Rehabilitees who feel like outsiders and are not interested in technology need face-to-face communication for the major part of rehabilitation, while rehabilitees who reflect benefit and are enthusiastic about the use of technology need incrementally less face-to-face interaction and feel that Web-based coaching could offer sufficient support for rehabilitation.

Conclusions

The findings show that persons affected by heart disease had different experiences with technology and expectations toward counseling, while all rehabilitees expected technology to be easy to use and their experiences to be smooth and problem-free. The results can be used more widely in different contexts of social and health care for the planning of and training in remote rehabilitation counseling and education.

Trial Registration

ISRCTN Registry ISRCTN61225589; http://www.isrctn.com/ISRCTN61225589 (Archived by WebCite at http://www.webcitation.org/74jmrTXFD)

Multi-stakeholder perspectives on information communication technology training for older adults: implications for teaching and learning

Objectives: The objective of this research was to identify and conceptualize barriers and strategies for effective implementation of information communication technology (ICT) training for older adults. Methods: A grounded theory approach was used to collect and analyze qualitative data from 61 participants in three stakeholder groups: older-adult ICT trainees, care providers and ICT trainers. Results: Care providers expressed older adults' reluctance, lack of affinity, fears and socio-contextual attributes as barriers to overcome with ICT training. ICT trainers highlighted motivation, trainer-trainee relationship, patience, self-reliance and mutual value as strategic themes. ICT trainees elucidated occupational accomplishment, challenges and a sense of competence as themes from their experience with training. Discussion: While digital literacy and skill building have traditionally been the key focus of ageing-centred ICT training, a deeper approach to address internal (personal) and external (socio-contextual) barriers, as conceptualized in the study finding, is vital in yielding successful outcomes. Implications for rehabilitation Information communication technology (ICT) is a vital resource for older adults to age-in-place and for health professionals in delivery of tele-rehabilitation. Family members and care providers realize the scope of ICT for ageing-in-place but raise doubts on the inherent motivation and abilities of older adults to adopt ICT. On the other hand, older adults who engage in one-on-one ICT training value their new-found sense of accomplishment and competence in using the Internet and social media. Graduate students who provided the training greatly appreciate their own learning experience, and stress the need for mutual trust, patience and simplicity in teaching ICT. A major precursor to imparting digital literacy and skills in older adults who lack ICT exposure is to help them overcome deep-seated attitudinal and socio-contextual barriers through a one-on-one approach.

Assessment of the Apple iPad as a low-vision reading aid

PurposeLow-vision clients frequently report having problems with reading. Using magnification, reading performance (as measured by reading speed) can be improved by up to 200%. Current magnification aids can be expensive or bulky; therefore, we explored if the Apple iPad offers comparable performance in improving reading speeds, in comparison with a closed-circuit television (CCTV) video magnifier, or other magnification devices.MethodsWe recruited 100 participants between the ages of 24-97 years, with low vision who were literate and cognitively capable, of whom 57 had age-related macular degeneration. To assess reading, participants read standardized iReST texts and were tested for comprehension. We compared reading speed on the Apple iPad (10 inch) with that of the CCTV, home magnification devices, and baseline measures.ResultsAll assistive devices improved reading rates in comparison to baseline (P<0.001, Hedge's g>1), however, there was no difference in improvement across devices (P>0.05, Hedge's g<0.1). When experience was taken into account, those with iPad experience read, on average, 30 words per minute faster than first time iPad users, whereas CCTV experience did not influence reading speed.ConclusionsIn our sample, the Apple iPad was as effective as currently used technologies for improving reading rates. Moreover, exposure to, and experience with the Apple iPad might increase reading speed with that device. A larger sample size, however, is needed to do subgroup analysis on who would optimally benefit from each type of magnification device.

Feasibility study of an attention training application for older adults

BACKGROUND

Technology-based attention training has demonstrated promise in its potential to improve cognitive functioning in older people. Developing mobile applications, with older users specifically in mind, may support future dissemination of these interventions and integration into daily life.

AIMS AND OBJECTIVES

The purpose of this pilot study was to test the feasibility of an Attention Training Application (ATA) for community-dwelling older adults using mobile technology.

DESIGN

A descriptive, mixed-methods design was used to capture older adults' feedback on the usability and acceptability of the ATA.

METHODS

A convenience sample of older adults (n = 9) from two independent living facilities participated in a 2-hour training and practice session with the ATA. Participants were given personally tailored instructions for using the mobile device and the ATA specifically. Following a practice session, participants provided ratings on multiple components of the ATA and completed an audio-recorded, semi-structured interview to provide detailed descriptions of their experience and perceptions. An iterative process of content analysis was used to characterise the open-ended responses.

RESULTS

Participants rated the ATA favourably overall on several 0-10 scales including likeability [8.5 (1.6)], interest [8.8 (2.3)] and satisfaction [8.2 (1.9)]. The qualitative analyses revealed several issues relevant to the feasibility of the ATA among older people including the importance of the technological background of the user, limiting negative feedback, challenges with the touch screen interface, personal preferences for challenge, extending the practice period and the difficulty of the dual-task condition.

CONCLUSIONS

The use of the ATA is feasible in the older adult population. Future development should specifically consider personal characteristics as well as preferences to maximise usability and acceptability among older people.

IMPLICATIONS FOR PRACTICE

Older adults enjoyed the ATA. This opens doors to user-friendly technological interventions that may be effective in assisting older adults maintain and possibly even improve their cognitive function.