Inclusion of Older Adults in the Research and Design of Digital Technology

Nurse-led remote digital support for adults with chronic conditions: A systematic synthesis without meta-analysis

AIM

The systematic review aims to synthesize the literature examining the effectiveness of nurse-led remote digital support on health outcomes in adults with chronic conditions.

BACKGROUND

Adults with chronic diseases have increased rates of mortality and morbidity and use health care resources at a higher intensity than those without chronic conditions-placing strain on the patient, their caregivers and health systems. Nurse-led digital health disease self-management interventions have potential to improve outcomes for patients with chronic conditions by facilitating care in environments other that the hospital setting.

DESIGN AND METHODS

We searched PubMed/MEDLINE, Embase, PsycINFO and Cochrane Central databases from inception to 7 December 2022. We included randomized controlled trials assessing the impact of nurse-led remote digital support interventions compared to usual care on health-related outcomes in adults with chronic illness. The Cochrane risk-of-bias tool was used to assess bias in studies. Outcomes were organized into four categories: self-management, clinical outcomes, health care resource use and satisfaction with care. Results are presented narratively based on statistical significance.

RESULTS

Forty-four papers pertaining to 40 unique studies were included. Interventions most targeted diabetes (n = 11) and cardiovascular disease (n = 8). Websites (n = 10) and mobile applications (n = 10) were the most used digital modalities. Nurses supported patients either in response to incoming patient health data (n = 14), virtual appointment (n = 8), virtual health education (n = 5) or through a combination of these approaches (n = 13). Positive impacts of nurse-led digital chronic disease support were identified in each outcome category. Mobile applications were the most effective digital modality.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

Results show that nurse-led remote digital support interventions significantly improve self-management capacity, clinical health outcomes, health care resource use and satisfaction with care. Such interventions have potential to support overall health for adults with chronic conditions in their home environments.

Unlocking engagement: exploring the drivers of elderly participation in digital backfeeding through community education

Amid China's rapid aging and digitalization, elderly individuals face a "digital refugee" dilemma, making community education a vital channel for enhancing their digital participation. To address this, the study investigates how community education influences elderly engagement in digital backfeeding-a process where younger generations assist older adults with digital skills-by examining the interplay of personal, technological, and community factors in promoting technology acceptance. Using an integrated framework of the UTAUT, TTF, and TAM models, the research surveyed 482 elderly participants in community centers in Taiyuan, China, focusing on variables such as task and technology characteristics, social influence, facilitating conditions, perceived usefulness, ease of use, and technology anxiety. Analysis through AMOS and SPSS Process macro revealed that task characteristics significantly enhance engagement willingness, although technology characteristics introduce certain challenges. Furthermore, social influence and facilitating conditions were found to positively affect willingness and behavior, mediated by perceived usefulness, ease of use, and technology anxiety. Notably, participatory digital skills exhibited a stronger moderating effect on engagement willingness compared to receptive skills. These findings underscore the pivotal role of community education in fostering digital inclusion among the elderly. Practical recommendations include simplifying technology interfaces, creating supportive environments, and prioritizing participatory skills development to enhance technology acceptance, offering valuable insights for the design of age-friendly digital tools that bridge the digital divide.

'Such a lot of bother': Qualitative results of a home trial of a wearable electronic vision enhancement system for people with age-related macular degeneration

PURPOSE

Wearable electronic low vision enhancement systems (wEVES) improve visual function but are not widely adopted by people with vision impairment. Here, qualitative research methods were used to investigate the usefulness of wEVES for people with age-related macular degeneration (AMD) after an extended home trial.

METHODS

Following a 12-week non-masked randomised crossover trial, semi-structured interviews were completed with 34 participants with AMD, 64.7% female, mean age 80.2 (±6.0) years, mean distance visual acuity 0.81logMAR (±0.32). Reflexive thematic analysis was used to analyse the data.

RESULTS

Four themes were developed: (i) early positivity and potential; (ii) you're not good enough: performance barriers of the device; (iii) you're annoying: practicality barriers of the device and (iv) we can fix this together. First, participants expressed joy in an aesthetically appealing device perceived as potentially enabling, different and complementary to their current solutions. Imagined usefulness included not only reading, shopping and television but also resuming abandoned hobbies. The second theme captured performance barriers that restricted numerous activities but were most acutely noted with manipulation tasks. Barriers included image quality, screen size and short-lived adverse effects. The third theme conveyed the multiple practical challenges that caused annoyance, preventing imagined usage even when performance appeared superior to other solutions. Slow start-up times and the inability to use wEVES dynamically prevented integration within users' lifestyles. The final theme reflected that wEVES remained a desirable concept, but future iterations require inclusive design methodology to ensure development is directed by consumers' needs.

CONCLUSIONS

Performance and practicality barriers limit the usefulness of a device initially seen as desirable. Current devices do not align with users' requirements for flexible use, even when performance is good. Improvements in technology may solve performance barriers, but these changes must be inclusively designed and evaluated to ensure the device integrates more successfully into the lives of users with AMD.

Exploring Older Adults' Needs for a Healthy Life and eHealth: Qualitative Interview Study

BACKGROUND

Aging brings physical and life changes that could benefit from eHealth services. eHealth holistically combines technology, tasks, individuals, and contexts, and all these intertwined elements should be considered in eHealth development. As users' needs change with life situations, including aging and retirement, it is important to identify these needs at different life stages to develop eHealth services for well-being and active, healthy lives.

OBJECTIVE

This study aimed to (1) understand older adults' everyday lives in terms of well-being and health, (2) investigate older adults' needs for eHealth services, and (3) create design recommendations based on the findings.

METHODS

A total of 20 older adults from 2 age groups (55 to 74 years: n=12, 60%; >75 years: n=8, 40%) participated in this qualitative interview study. The data were collected remotely using a cultural probes package that included diary-based tasks, sentence completion tasks, and 4 background questionnaires; we also performed remote, semistructured interviews. The data were gathered between the fall of 2020 and the spring of 2021 in Finland as a part of the Toward a Socially Inclusive Digital Society: Transforming Service Culture (DigiIN) project (2019 to 2025).

RESULTS

In the daily lives of older adults, home-based activities, such as exercising (72/622, 11.6% of mentions), sleeping (51/622, 8.2% of mentions), and dining and cooking (96/622, 15.4% of mentions), promoted well-being and health. When discussing their needs for eHealth services, participants highlighted a preference for a chat function. However, they frequently mentioned barriers and concerns such as the lack of human contact, inefficiency, and difficulties using eHealth systems. Older adults value flexibility; testing possibilities (eg, trial versions); support for digital services; and relevant, empathetically offered content with eHealth services on short-term and long-term bases in their changing life situations.

CONCLUSIONS

Many older adults value healthy routines and time spent at home. The diversity of older adults' needs should be considered by making it possible for them to manage their health safely and flexibly on different devices and channels. eHealth services should adapt to older adults' life changes through motivation, personalized content, and appropriate functions. Importantly, older adults should still have the option to not use eHealth services.

Frailism: a scoping review exploring discrimination against people living with frailty

People living with frailty can experience discrimination, but unlike the characteristics of age and disability, frailty is not protected by law. Frailty is a clinical syndrome associated with ageing in which health deficits increase a person's vulnerability to illness, disability, and death. This scoping review, conducted by a team of methodologists, clinicians, lawyers, and patients, aimed to investigate the extent of discrimination against people living with frailty described in health-care literature. We searched five health-care databases from inception up to June, 2022, and grey literature, to identify 144 texts. The texts were classified by the types of discrimination (direct discrimination, indirect discrimination, harassment, and victimisation) and inductively developed into contextual themes. The median age of the participants was 77 years (IQR 69·9-82·0), and 65·4% were women. The most common types of discrimination were direct (in 90 [63%]), indirect (in 66 [46%]), and harassment (in one [1%]) of the 144 texts, with no instances of victimisation reported. Nine themes of discriminatory actions were developed. Discrimination against people living with frailty overlapped with discrimination based on established protected characteristics, including age, disability, race, and sex. Evidence indicated that frailty discrimination replaces, mediates, masks, and potentiates age discrimination. Discrimination against people with frailty seemed to be both an independent event and one that interacts with established protected characteristics. Future research should focus on preventing frailty-based discrimination and establishing whether frailty should be considered a new protected characteristic by law.

Nonparticipation in a Digital Health Intervention Study Among Older Adults: Uneven Involvement, Biased Outcomes, and the Effect of Weighting

BACKGROUND

The involvement of older adults in research on digital health is uneven with respect to, for example, age, gender, health status, and digital skills. However, little is known regarding the effect of the uneven involvement of older adults in digital health research on researched outcomes. This study helps to fill this knowledge gap, identifies the effects of uneven involvement of older adults in digital health research on researched outcomes, and also develops a correction for this.

METHODS

Data are retrieved from a digital health intervention for postoperative monitoring of people who underwent day surgery in Sweden. Based on field information on the recruitment process and researched outcomes for the intervention, this study (i) tested intervention effects by using 2 standard unweighted procedures in a sample of 281 individuals aged 50 years or older, and then (ii) used the information on participants, nonparticipants, and their respective probabilities to be involved in the intervention study to perform a weighting of the intervention effects for each step of selection and for the study group membership.

RESULTS

The intervention effects were found to be overestimated due to overrepresentation of groups that gained from receiving the intervention. No intervention effects were found after adjustment for participation bias.

CONCLUSIONS

Selective participation of older adults in digital health research biases research outcomes and can lead to overestimation of intervention effects. Weighting allows researchers to correct and describe the effect of selective participation on researched outcomes.

Detangling experiences of agency in welfare technology use by home care recipients and their staff

Welfare technology (WT), defined as digital technology enabling individuals to live securely, actively and independently at home, is often viewed as a solution to care resource shortages. This solution discourse has increasingly been problematised, and ethical issues specifically connected to WT have emerged, e.g., regarding quality of care. The existing array of WT is developed with limited user involvement; primary user perspectives are thus inadequately voiced in research. This study aimed to disentangle how older adults and their homecare staff experience and influence WT use in homecare situations. The qualitative approach encompassed individual semi-structured interviews with homecare staff (n = 26) and older adults (n = 26) receiving homecare as well as utilising WT. Interviews were conducted in five Swedish municipalities, transcribed verbatim and analysed using thematic analysis. Three main themes were developed: (1) Lack of agency in WT obtainment, in which a lack of influence in the receiving of WT is illustrated. (2) Contradictory user perspectives regarding WT and agency, in which staffs' perceptions of specific WT are contrasted to older adults', highlighting how WT perceived positively by staff often detract from older adults' agency. (3) Agency and WT use inextricably linked with time, in which it is illustrated how influence over time is intricately connected to experienced agency in WT use. Our findings demonstrate a problematic lack of agency in WT use. Further improvements to current WT, aided by stronger user involvement, as well as certain municipal routines, are necessary if user agency is to be strengthened in relation to WT use.

Navigating Challenges and Opportunities in Community-Based Interventions for Promoting Active Aging: A Systematic Review of the Roles of Technology

Background and Objectives

Researchers from different fields are increasingly interested in incorporating technology into community-based interventions that promote active aging. Yet, there lacks a comprehensive understanding of technology roles, posing challenges for designers seeking to maximize the intended impacts of such interventions. This systematic review aims to fill the gap by examining existing community-based interventions that integrate digital technologies to promote active aging.

Research Design and Methods

Thirteen studies were screened, with a total of 14 interventions examined, following the PRISMA Guideline.

Results

The challenges in designing and operating community-based interventions, the roles of technology in the interventions, and the caveats of utilizing technology during the process were identified. The review emphasizes the importance of overcoming challenges in community-based interventions and leveraging technology to enhance the intended impacts.

Discussion and Implications

The findings underscore the need to understand technology's nuanced roles in community-based interventions for active aging. The article provides a starting point for accumulating knowledge and practice in utilizing technology to navigate the challenges and opportunities encountered in such interventions. It also sheds light on a notable gap: the lack of innovative and strategic approaches that harness digital interventions appropriately in community-based interventions. This emphasizes a crucial requirement for guidelines to assist designers, policymakers, and community staff in integrating technology appropriately into community-based interventions or implementing interventions that incorporate digital technologies at the community level.

Perspectives and Experiences on eHealth Solutions for Coping With Chronic Pain: Qualitative Study Among Older People Living With Chronic Pain

BACKGROUND

Chronic noncancer pain (CNCP) is a major health issue among the older population, affecting multiple aspects of individual functioning. Recently, the use of eHealth solutions has been proposed in supporting chronic pain self-management even among older adults, although some barriers have emerged. Few qualitative studies, with none conducted in Mediterranean countries, have explored older people's experiences and perceptions regarding the types of strategies used to cope with chronic pain and eHealth tools for chronic pain management.

OBJECTIVE

This study's objectives were to explore the perspectives and experiences of older adults regarding the coping strategies used to manage chronic pain, the use of digital technologies in everyday life, and the potentiality and barriers in using those technologies for health and pain management.

METHODS

A multimethod approach (ie, self-report questionnaires and a semistructured interview) has been adopted targeting older adults (ie, those who are aged 65 to 80 years and presenting different types of CNCP) who are attending a pain therapy center in Italy. Qualitative answers were analyzed using thematic analysis.

RESULTS

Overall, participants reported using a variety of pain coping strategies; however, they showed an attitude of resignation to their CNCP condition. Nearly 70% (12/18) of the interviewees referred to using digital technologies for purposes related to health and pain management, mostly involving very basic management activities. The participants' opinions on the useful functions that need to be incorporated in eHealth tools for chronic pain management have been categorized into four themes: (1) specific pain self-management skills, (2) support in organizing various health-related aspects, (3) sharing experiences with others, and (4) increasing pain-related personal knowledge. Conversely, the following potential barriers to adopting eHealth tools emerged: (1) computer illiteracy, (2) negative effects or risks, (3) impersonal interaction, and (4) physical limitations.

CONCLUSIONS

The use of eHealth solutions still seems low, often being accompanied by a perceived lack of digital skills or attitude among a sample of older adults from Italy with CNCP. Before introducing innovative eHealth solutions, it would be of primary importance to take action to enhance, on the one hand, self-efficacy in pain management and, on the other, the digital literacy level among older people.

Ageism and (Successful) Digital Engagement: A Proposed Theoretical Model

Recently, scholars have highlighted the detrimental consequences of technology-based ageism. Digital technology (DT) is commonly discoursed as an opportunity to promote Successful Aging. Nevertheless, the theoretical implications of ageism, DT, and Successful Aging are underexplored. This paper presents a new theoretical model of Digital Engagement and Ageism (D-EngAge), which elaborates on the potential impacts of ageism on digital engagement and participation in later life and explains how ageism may pose a threat to realizing the potential of DT to promote Successful Aging. The D-EngAge model was developed based on a synthesis of findings from 12 recent studies we conducted on the intersection of ageism and DT. Findings were synthesized through Iversen's clasification of four dimensions of ageism, demonstrating how ageism as a multifaceted construct has a reciprocal relationship with digital engagement on the micro- (individual), meso- (social interaction), and macro-levels (discourses and societal practices). Consequently, digital engagement on these levels may exacerbate or reduce technology-based ageism. This forum paper identifies ageism as a barrier to utilizing DT, critically discusses power imbalances, and deconstructs Successful Aging discourses regarding digital engagement. Theoretical implications and recommendations for future interventions and policy measures to mitigate ageism and promote digital engagement and participation in later life are presented.

Public Health Challenges and Responses to the Growing Ageing Populations

Background

Human populations are rapidly ageing worldwide due to declining birth rates and rising life expectancies. This profound demographic shift presents complex public health challenges. Synthesizing evidence on key public health issues impacting ageing populations and policy strategies is required to address these needs.

Methods

The study employs narrative literature review based on the PubMed database. Data have been extracted on public health challenges to ageing populations and its recommended policy solutions.

Results

The key public health challenges identified include rising chronic disease burden, risks for preventable multi‐morbidities and co‐morbidities, disability and dependencies, mental health issues, caregiving gaps, long‐term care system deficiencies, health inequities, healthcare access barriers, end‐of‐life care needs, financial instability, ageism/elder abuse, adverse built environments, climate/disaster threats, and social isolation. Evidence‐based policy responses span interventions in healthcare, social services, urban planning, emergency preparedness, economics, technology, anti‐ageism advocacy and so on.

Conclusions

Proactively addressing the array of public health challenges faced by rapidly growing ageing populations globally requires implementing collaborative, multisectoral policy solutions focused on promoting healthy, equitable, and socially engaged ageing. Healthcare systems, communities, and policies must be optimized to meet the needs of elderly people and tap into their strengths.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Person-centred quality indicators for Australian aged care assessment services: a mixed methods study

BACKGROUND

Aged Care Assessment Teams are the assessment component of the Australian aged care system. Their purpose is to undertake needs-based assessments to determine an older person's eligibility for, and access to Commonwealth-funded aged care services. There are no measures that tell us if the aged care assessment service is of high quality from the perspective of the person being assessed. Quality measures have been developed and introduced in Australian residential aged care facilities. These however, have not considered the perspectives of those living in this setting. Quality measures for home care services have also been recommended. This research aims to address the gap in person-centred quality measures by asking current and future service users of aged care assessment services to vote on the importance of 24 person-centred quality indicators (PC-QIs), that were developed in a previous study using a modified Delphi method approach supported by engagement with a consumer led Advisory Board.

METHODS

This mixed methods study used the RAND/UCLA Appropriateness Method to reach consensus on a final set of PC-QIs. Twenty-five community-dwelling older people in Brisbane, Australia, voted on the importance of 24 PC-QIs using a five-point Likert scale. A consensus statement for PC-QI elimination was determined prior to participants voting. Voting was undertaken with participants individually either face-to-face or via telephone, in their homes. To capture any narrative provided by participants regarding each PC-QI, participant voting sessions were audio-recorded and subsequently transcribed verbatim. Quantitative data from participant votes for each PC-QI were calculated and statistically described by median, interquartile range, consensus met, percentile, percentile rank, rank order, median and standard deviation. PC-QIs were then assessed against the consensus statement for elimination and rank ordered according to importance to participants. Content analysis of qualitative data from audio transcriptions was conducted to determine the presence of certain words supporting participant votes for each PC-QI.

RESULTS

No PC-QIs were eliminated during voting. Variation existed among participants' ratings of importance for each PC-QI. Final quality domains, their respective title, quality indicator descriptor and supporting qualitative data are presented. Five PC-QIs had a median of five, no votes recorded below four, an interquartile range of zero, and a rank order score of one, two and four, out of a possible ten, indicating they were of highest importance to participants.

CONCLUSION

Participants reached consensus on 24 evidence-based PC-QIs that represent measures of quality of aged care assessment services from the perspectives of current and future service users.

eHealth-Integrated Psychosocial and Physical Interventions for Chronic Pain in Older Adults: Scoping Review

BACKGROUND

Chronic noncancer pain (CNCP) is highly present among older adults, affecting their physical, psychological, and social functioning. A biopsychosocial multimodal approach to CNCP management is currently extensively suggested by international clinical practice guidelines. Recently, the growing development and application of eHealth within pain management has yielded encouraging results in terms of effectiveness and feasibility; however, its use among the older population remains underexamined.

OBJECTIVE

The overall aim of this scoping review was to systematically map existing literature about eHealth multimodal interventions (including both physical and psychosocial components) targeting older adults with CNCP.

METHODS

This review adhered to the JBI methodology, a protocol was a priori registered as a preprint on the medRxiv platform, and the results were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO) were systematically searched for relevant articles. Studies were included if they reported on multimodal interventions (including both physical and psychosocial components) delivered through any eHealth modality to an older population with any type of CNCP. Two reviewers selected the studies: first by screening titles and abstracts and second by screening full-text articles. The quality of the included studies was evaluated using the Quality Assessment Tool for Studies with Diverse Designs. The results of the studies were summarized narratively.

RESULTS

A total of 9 studies (n=6, 67% published between 2021 and 2023) with quality rated as medium to high were included, of which 7 (78%) were randomized controlled trials (n=5, 71% were pilot and feasibility studies). All the included studies evaluated self-management interventions, most of them (n=7, 78%) specifically designed for older adults. The participants were aged between 65 and 75 years on average (mean 68.5, SD 3.5 y) and had been diagnosed with different types of CNCP (eg, osteoarthritis and chronic low back pain). Most of the included studies (5/9, 56%) involved the use of multiple eHealth modalities, with a higher use of web-based programs and video consulting. Only 1 (11%) of the 9 studies involved a virtual reality-based intervention. The evaluated interventions showed signs of effectiveness in the targeted biopsychosocial outcomes, and the participants' engagement and ratings of satisfaction were generally positive. However, several research gaps were identified and discussed.

CONCLUSIONS

Overall, of late, there has been a growing interest in the potential that eHealth multimodal interventions offer in terms of improving pain, physical, and psychosocial outcomes in older adults with CNCP. However, existing literature on this topic still seems scarce and highly heterogeneous, with few proper randomized controlled trials, precluding robust conclusions. Several gaps emerged in terms of the older population considered and the lack of evaluation of comorbidities.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1101/2023.07.27.23293235.

The participation of hard-to-reach older people in the research and development process of health technologies from the perspective of multipliers-A qualitative analysis

Introduction

The participation of older people in research and development processes has long been called for but has not been sufficiently put into practice. In addition, participation is often late and not particularly intensive, so that certain older groups of people are underrepresented in the development of health technologies (HT). Heterogeneity, e.g., between urban and rural populations, in access to and motivation for participation is also rarely taken into account. The aim of this study was to investigate form and phases of participation for hard-to-reach older people in the research and development process of HT.

Methods

The qualitative study among multipliers was conducted using focus groups and telephone interviews and took place in a city and an adjacent rural area in northwestern Lower Saxony, Germany. A content analysis of the data was undertaken using deductive-inductive category formation.

Results

Seventeen participants (13 female) took part in the study (median age 61, 33-73). Participants from both areas identified particular forms and phases of participation in the research and development process. Longer forms of participation for hard-to-reach groups and the development process of technologies for older people from the rural area were viewed as challenges. Passive and active access strategies are needed to achieve sufficient heterogeneity in the research and development process. Trusted multipliers can play an important role in gaining access to hard-to-reach older people, but also during the research process. Apart from facilitating factors (e.g., age-specific study materials), inhibiting factors such as contact anxieties are also indicated. Only urban participants mention financial/material incentives and community as possible motivations.

Conclusions

The results provide important insights from the perspective of multipliers. They show specificities in access and participation for rural areas and for hard-to-reach older people. Many older people may have uncertainties about research projects and HT. Multipliers can assume a key role to help reduce these uncertainties in the future.

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

BACKGROUND

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

PURPOSE

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

STUDY DESIGN, SETTING, SAMPLE

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

PREDICTOR VARIABLE

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

MAIN OUTCOME VARIABLES

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

COVARIATES

Not applicable.

ANALYSES

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

RESULTS

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

CONCLUSION AND RELEVANCE

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

Smart Speaker and ICT Use in Relationship With Social Connectedness During the Pandemic: Loneliness and Social Isolation Found in Older Adults in Low-Income Housing

BACKGROUND AND OBJECTIVES

Social well-being of older adults living in low-income housing was disproportionately affected by the coronavirus disease 2019 pandemic. We explored low-income residents' experiences of social isolation and loneliness and strategies to remain socially connected during the pandemic.

RESEARCH DESIGN AND METHODS

As part of a larger, 3-phase user-centered design study, we conducted a qualitative study using focus groups to gain insights into social isolation experiences and the role of information and communication technologies (ICTs), including smart speakers, in social connectedness (N = 25, 76% African American). We also collected survey data to describe social isolation, loneliness, and current ICT use in the sample. Participants included both smart speaker users and nonusers.

RESULTS

Experiences of social isolation and loneliness varied by participants' sociodemographic characteristics and previous experiences with smart speakers. Qualitative analysis showed participants demonstrated coping strategies developed during the pandemic to adapt to new norms of connecting with others, including technology-enabled social interactions. Participants expressed a strong desire to build community together in their facilities and highlighted the potential role of smart speakers in making meaningful social connections, encompassing safety checks to have a means for emergencies, and providing a virtual companion. Access, digital literacy, training, security, and privacy issues were discussed as factors affecting their adoption of new ICT for enhanced social connectedness.

DISCUSSION AND IMPLICATIONS

This study highlights the importance of understanding the unique social isolation experience, demographics, and social determinants of health of low-income residents to develop ICT-based interventions for social connectedness.

Geriatric Assessment in CKD Care: An Implementation Study

Rationale & Objective

Older people with progressive chronic kidney disease (CKD) have complex health care needs. Geriatric evaluation preceding decision making for kidney replacement is recommended in guidelines, but implementation is lacking in routine care. We aimed to evaluate implementation of geriatric assessment in CKD care.

Study Design

Mixed methods implementation study.

Setting & Participants

Dutch nephrology centers were approached for implementation of geriatric assessment in patients aged ≥70 years and with an estimated glomerular filtration rate of ≤20 mL/min/1.73 m2.

Quality Improvement Activities/Exposure

We implemented a consensus-based nephrology-tailored geriatric assessment: a patient questionnaire and professionally administered test set comprising 16 instruments covering functional, cognitive, psychosocial, and somatic domains and patient-reported outcome measures.

Outcomes

We aimed for implementation in 10 centers and 200 patients. Implementation was evaluated by (i) perceived enablers and barriers of implementation, including integration in work routines (Normalization Measure Development Tool) and (ii) relevance of the instruments to routine care for the target population.

Analytical Approach

Variations in implementation practices were described based on field notes. The postimplementation survey among health care professionals was analyzed descriptively, using an explanatory qualitative approach for open-ended questions.

Results

Geriatric assessment was implemented in 10 centers among 191 patients. Survey respondents (n = 71, 88% response rate) identified determinants that facilitated implementation, ie, multidisciplinary collaboration (with geriatricians) -meetings and reports and execution of assessments by nurses. Barriers to implementation were patient illiteracy or language barrier, time constraints, and patient burden. Professionals considered geriatric assessment sufficiently integrated into work routines (mean, 6.7/10 ± 2.0 [SD]) but also subject to improvement. Likewise, the relevance of geriatric assessment for routine care was scored as 7.8/10 ± 1.2. The Clinical Frailty Score and Montreal Cognitive Assessment were perceived as the most relevant instruments.

Limitations

Selection bias of interventions' early adopters may limit generalizability.

Conclusions

Geriatric assessment could successfully be integrated in CKD care and was perceived relevant to health care professionals.

An Iterative Participatory Design Approach to Develop Collaborative Augmented Reality Activities for Older Adults in Long-Term Care Facilities

Over four million older adults living in long-term care (LTC) communities experience loneliness, adversely impacting their health. Increased contact with friends and family is an evidence-based intervention to reduce loneliness, but in-person visits are not always possible. Augmented Reality (AR)-based telepresence activities can offer viable alternatives with increased immersion and presence compared to video calls. However, its feasibility as an interaction technology for older adults is not known. In this paper, we detail the design of two dyadic collaborative AR activities that accommodate diminished physical and cognitive abilities of older adults. The findings include a general design framework based on an iterative participatory design focusing on preferred activities, modes of interaction, and overall AR experience of eight older adults, two family members, and five LTC staff. Results demonstrate the potential of collaborative AR as an effective means of interaction for older adults with their family, if designed to cater to their needs.

Assessment of a digital intervention program with Holocaust survivors

OBJECTIVE

This study evaluated a digital intervention program with aging Holocaust survivors. Participants received a tablet device and were coupled with a volunteer who assisted them to use the tablet. The study aimed to assess which characteristics of the Holocaust survivors are linked with more frequent use of digital communication at the end of the program.

METHODS

Information was collected by telephone interviews with 91 survivors before and 54 after participating in the program. We combined this data with digital usage data from the tablets. Regression models examined the characteristics of Holocaust survivors that were related to higher frequency of using digital communication technologies during the intervention.

RESULTS

The Holocaust survivors expressed high satisfaction with the program. They increased their frequency of using digital communication technologies-text correspondence and video chats with friends and family. Regressions showed that Holocaust survivors who reported increased digital communication were characterized at the start of the intervention by having fewer post-traumatic stress symptoms, higher levels of flourishing (reflecting a more meaningful life and higher well-being), being lonelier, and were also more satisfied with the program at follow-up.

CONCLUSION

The pilot program benefited the aging Holocaust survivors. Further programs should be developed to increase the digital communication of vulnerable older populations, such as trauma survivors.

Exploring the impact of information and communication technologies on loneliness and social isolation in community-dwelling older adults: a scoping review of reviews

BACKGROUND

Recognizing the escalating public health concerns of loneliness and social isolation in aging populations, this study seeks to comprehensively explore the potential of information and communication technology (ICT)-based interventions to address these issues among older adults. This scoping review of reviews aims to map and synthesize existing evidence on the effectiveness and scope of ICT interventions targeting loneliness and social isolation in community-dwelling older adults, elucidating types of technology, impacts, facilitators, barriers, and research gaps.

METHODS

Following the Joanna Briggs Institute framework, we systematically searched eight diverse databases identifying relevant published reviews. We included English-written, peer-reviewed reviews of all types, with no limits regarding time of publication about ICTs targeting loneliness and/or social isolation for community-dwelling older adults. Eligible reviews were analysed and summarized, offering a holistic narrative of the reported types of ICTs and their impact, the identified facilitators and barriers influencing the implementation and adoption of ICT interventions, and the research gaps identified in the literature.

RESULTS

The review included 39 publications published between 2012 and 2024, spanning systematic, scoping, and reviews of reviews. Various ICTs were reported, primarily social media virtual communities, followed by video-mediated friendly visits, conversational agents, social robots, exergames and online gameplay. Predominantly positive impacts on mitigating social isolation and loneliness were evident for these ICTs, although methodological diversity and contradictory findings complicated definite conclusions. Facilitators and barriers encompassed individual competencies, access and usage, and intervention design and implementation. Research gaps involved targeting specific subgroups, exploring innovative technologies, incorporating diverse study designs, improving research methodologies, and addressing usability and accessibility. Future research should focus on identifying elderly individuals who can benefit the most from ICT use, exploring novel technologies, using a wider range of study designs, and enhancing usability and accessibility considerations.

CONCLUSIONS

This review sheds light on the diverse range of ICTs, their impact, and the facilitators and barriers associated with their use. Future investigations should prioritize refining outcome measures, addressing gender differences, and enhancing the usability and accessibility of interventions. The involvement of older adults in the design process and the exploration of technological training interventions hold promise in overcoming barriers.

Digital Literacy and Associated Factors in Older Adults Living in Urban South Korea: A Qualitative Study

This study aimed to explore digital literacy among community-dwelling older adults in urban South Korea. A semistructured interview guide was developed using the Digital Competence ( 2.0 framework, which emphasizes the competencies for full digital participation in five categories: information and data literacy, communication and collaboration, content creation, safety, and problem-solving. The data were analyzed using combined inductive and deductive content analysis. Inductive analysis identified three main categories: perceived ability to use digital technology, responses to digital technology, and contextual factors. In the results of deductive analysis, participants reported varying abilities in using digital technologies for information and data literacy, communication or collaboration, and problem-solving. However, their abilities were limited in handling the safety or security of digital technology and lacked in creating digital content. Responses to digital technology contain subcategories of perception (positive or negative) and behavior (trying or avoidance). Regarding contextual factors, aging-related physical and cognitive changes were identified as barriers to digital literacy. The influence of families or peers was viewed as both a facilitator and a barrier. Our participants recognized the importance of using digital devices to keep up with the trend of digitalization, but their digital literacy was mostly limited to relatively simple levels.

Digital Care Pathway for Patients With Sleep Apnea in Specialized Care: Mixed Methods Study

BACKGROUND

Sleep apnea is a significant public health disorder in Finland, with a prevalence of 3.7%. Continuous positive airway pressure (CPAP) therapy is the first-line treatment for moderate or severe sleep apnea. From November 18, 2019, all patients who started their CPAP therapy at Oulu University Hospital were attached to a sleep apnea digital care pathway (SA-DCP) and were instructed on its use. Some patients still did not use the SA-DCP although they had started their CPAP therapy.

OBJECTIVE

We aimed to study health care professionals' (HCPs') perspectives on the SA-DCP and its usefulness for their work; whether the main targets of SA-DCP can be reached: shortening the initial guiding sessions of CPAP therapy, reducing patient calls and contact with HCPs, and improving patients' adherence to CPAP therapy; and patients' perspectives on the SA-DCP and its usefulness to them.

METHODS

Overall, 6 HCPs were interviewed in May and June 2021. The survey for SA-DCP users (58/91, 64%) and SA-DCP nonusers (33/91, 36%) was conducted in 2 phases: from May to August 2021 and January to June 2022. CPAP device remote monitoring data were collected from SA-DCP users (80/170, 47.1%) and SA-DCP nonusers (90/170, 52.9%) in May 2021. The registered phone call data were collected during 2019, 2020, and 2021. Feedback on the SA-DCP was collected from 446 patients between February and March 2022.

RESULTS

According to HCPs, introducing the SA-DCP had not yet significantly improved their workload and work practices, but it had brought more flexibility in some communication situations. A larger proportion of SA-DCP users familiarized themselves with prior information about CPAP therapy before the initial guiding session than nonusers (43/58, 74% vs 16/33, 49%; P=.02). Some patients still had not received prior information about CPAP therapy; therefore, most of the sessions were carried out according to their needs. According to the patient survey and remote monitoring data of CPAP devices, adherence to CPAP therapy was high for both SA-DCP users and nonusers. The number of patients' phone calls to HCPs did not decrease during the study. SA-DCP users perceived their abilities to use information and communications technology to be better than nonusers (mean 4.2, SD 0.8 vs mean 3.2, SD 1.2; P<.001).

CONCLUSIONS

According to this study, not all the goals set for the introduction of the SA-DCP have been achieved. Despite using the SA-DCP, some patients still wanted to communicate with HCPs by phone. The most significant factors explaining the nonuse of the SA-DCP were lower digital literacy and older age of the patients. In the future, more attention should be paid to these user groups when designing and introducing upcoming digital care pathways.

Conversation for change: engaging older adults as partners in research on gerotechnology

There is increasing research and public policy investment in the development of technologies to support healthy aging and age-friendly services in Canada. Yet adoption and use of technologies by older adults is limited and rates of abandonment remain high. In response to this, there is growing interest within the field of gerotechnology in fostering greater participation of older adults in research and design. The nature of participation ranges from passive information gathering to more active involvement in research activities, such as those informed by participatory design or participatory action research (PAR). However, participatory approaches are rare with identified barriers including ageism and ableism. This stigma contributes to the limited involvement of older adults in gerotechnology research and design, which in turn reinforces negative stereotypes, such as lack of ability and interest in technology. While the full involvement of older adults in gerotechnology remains rare, the Older Adults' Active Involvement in Ageing & Technology Research and Development (OA-INVOLVE) project aims to develop models of best practice for engaging older adults in these research projects. In this comment paper, we employ an unconventional, conversational-style format between academic researchers and older adult research contributors to provide new perspectives, understandings, and insights into: (i) motivations to engage in participatory research; (ii) understandings of roles and expectations as research contributors; (iii) challenges encountered in contributing to gerotechnology research; (iv) perceived benefits of participation; and (v) advice for academic researchers.

Affordance trajectories and the usefulness of online records access among older adults in Sweden

Objective

The current understanding of the breadth of individual differences in how eHealth technologies are perceived as useful for different purposes is incomprehensive. The aim/purpose of the study is to improve the understanding of diverse perceptions of the usefulness of technologies by exploring older adults' use of their patient-accessible electronic health records (PAEHRs).

Methods

The study applies and extends Affordance Theory based on an empirical analysis of data from the NORDeHEALTH 2022 Patient Survey on attitudes toward PAEHR in Norway, Sweden, Finland, and Estonia. Responses from 3964 participants in Sweden, aged 65 + years were analysed. Data included demographics and agreement ratings to reasons for using PAEHR. To analyse variation in the reasons for using PAEHR, group comparisons were conducted based on gender (male/female), age group (65-74, 75-84 and 85+) and earlier encouragement to use PAEHR.

Results

Overall, the findings suggest that PAEHRs have multiple parallel affordance trajectories and affordance potencies that actualise differently depending on needs. The top reasons, pointing to both orientational and goal-oriented affordances for using PAEHR, were improving understanding of health issues, getting an overview of medical history/treatment and ensuring understanding of what the doctor said. Men reported more often sharing information with relatives or friends as a reason to access PAEHR. Women were more inclined, albeit similarly to men less frequently, to read their PAEHR for detecting errors. Age had little influence on reasons for using PAEHR.

Conclusions

The study applies and extends Affordance Theory in the context of older adults' PAEHR use based on findings from the largest national investigation of reasons for older users to access PAEHR in Sweden demonstrating the applicability of the theory in improving the understanding of the diversity of individual perceptions on eHealth technologies.

Navigating the crossroads of aging, caregiving and technology: Insights from a southern Spain about video-based technology in the care context

Objective

As the world faces an aging population, the complexities of care management become increasingly pronounced. While technological solutions hold promise in addressing the dynamic demands of care, many nuances are to be considered in the design and implementation of active and assisted living technologies (AAL) for older adult care. This qualitative study, set in southern Spain, is positioned at the crossroads of healthcare challenges, as seen by the different actors involved in the care process and the technological solutions developed in response to these challenges. By investigating the complex landscape of caregiving and by examining the experiences and challenges faced by caregivers, healthcare professionals, and older adults, we aim to guide the development of vision-based AAL technologies that are responsive to the genuine needs of older adults and those requiring care.

Methods

A qualitative research methodology was used in the study. In total15 in-depth interviews and five focus groups were conducted with a diverse group of stakeholders involved in the process of care provision and reception.

Results

While the results demonstrate that there is a readiness for technological solutions, concerns over privacy and trust highlight the need for a carefully integrated, human-centric approach to technology in caregiving.

Conclusion

This research serves as a compass, guiding future discussions on the intersection of aging, technology, and care, with the ultimate goal of transforming caregiving into a collaborative and enriching journey for all stakeholders involved.

Inequality persists in a large citizen science programme despite increased participation through ICT innovations

Biological recording is a prominent and widely practised form of citizen science, but few studies explore long-term demographic trends in participation and knowledge production. We studied long-term demographic trends of age and gender of participants reporting to a large online citizen science multi-taxon biodiversity platform ( www.artportalen.se ). Adoption by user communities and continually developing Information and Communications Technologies (ICTs) greatly increased the number of participants reporting data, but profound long-term imbalances in gender contribution across species groups persisted over time. Reporters identifying as male dominated in numbers, spent more days in the field reporting and reported more species on each field day. Moreover, an age imbalance towards older participants amplified over time. As the first long-term study of citizen participation by age and gender, our results show that it is important for citizen science project developers to account for cultural and social developments that might exclude participants, and to engage with underrepresented and younger participants. This could facilitate the breadth of engagement and learning across a larger societal landscape, ensure project longevity and biodiversity data representation (e.g. mitigate gender bias influence on the number of reports of different species groups).

Home-based exercise interventions delivered by technology in older adults: A scoping review of technological tools usage

BACKGROUND

Despite technology-based systems being considered promising tools to stimulate and increase physical function at home, most older adults are unfamiliar with technology, which may pose some difficulties. Technology-related parameters, such as adherence, acceptance, and acceptability, are crucial to achieving higher efficacy levels of home-based exercise interventions delivered by technology. In this scoping review, we aimed to revise the use of home-based technological tools to improve physical function in the older population, focusing on the user's experience and perspective. Methods This scoping review was conducted following PRISMA guidelines. The search was conducted in April 2022 and updated in April 2023. A total of 45 studies were included in the review. Results Most studies (95.5%) met the technology usage levels defined by the research team or reported satisfactory technology usage levels. Positive health-related outcomes were reported in 80% of studies. Although the existence of guidelines to correctly define and use measures associated with technology use, including adherence, acceptance and acceptability, some terms are still being used interchangeably. Some concerns related to the lack of an international consensus regarding technology usage measures and the exclusion of older adults who did not own or have previous experience with technology in a large percentage of the included studies may have limited the results obtained. Conclusions Altogether, home-based exercise interventions delivered through technology were associated with positive health-related outcomes in older adults, and technology usage levels are considered satisfactory. Older adults are willing and able to use technology autonomously if adequate support is provided.

The Impact of a Multicomponent Platform Intervention on the Daily Lives of Older Adults

Gerontechnology is an interdisciplinary field of research involving gerontology and technology in order to help older adults identify and slow down the effects of age-related physical and cognitive decline. It has enormous potential to allow individuals to remain in their own homes and improve their quality of life. This study aims to assess the impact of a multicomponent platform, consisting of an ambient sensor, wearable devices, and a cloud application, as an intervention in terms of usability and acceptance as primary outcomes and well-being, quality of life, and self-efficacy as secondary outcomes in a sample of 25 older adults aged over 65 after 21 days of non-supervised usage at home. This research involved the use of a mixed-methods approach, in which both qualitative and quantitative data were collected in three different measurements. Overall, the participants shared good engagement with the integrated platform. The system achieved positive results in terms of both usability and acceptance, especially the smartwatch. The state of complete well-being slightly improved over the period, whereas self-efficacy remained stable. This study demonstrates the ability of target users to use technology independently in their home environment: it strengthens the idea that this technology is ready for mainstream use and offers food for thought for developers who create products for the aging population.

Incorporating technology in research with older bereaved adults: Lessons learned from conducting an internet-based randomized controlled trial

Objective

Digital health interventions (DHI) involve multiple interactions between the user, technology platform, and study team, posing challenges for implementation. This paper describes the lessons learned while implementing an internet-based randomized controlled trial (RCT) for reducing depression symptom burden in older acutely-bereaved adults.

Methods

The RCT was entitled "Widowed Elders' Lifestyle after Loss" (or WELL), which compared the efficacy of a DHI to an enhanced usual care (EUC) for reducing depression symptoms in adults 60+ years who lost their spouse/life partner within the previous 12 months. Participants randomized to the DHI used their own tablet, smartphone, or pc to record the timing and regularity of sleep, meals, and physical activity twice daily, for 12 weeks. The also received weekly health coaching sessions from a clinician certified in motivational interviewing. Participants randomized to the EUC arm received weekly calls from research staff and were assessed on the same schedule as intervention participants. All study procedures were conducted virtually. Methodological and procedural challenges were discussed weekly with study staff and the primary investigator.

Results

Many challenges can be categorized as follows recruiting virtually, obtaining informed consent, training older adults to use technology, and establishing rapport with older adults. Solutions required researcher and interventionist flexibility in adapting to new strategies. For instance, we redesigned the informed consent process to include a user-friendly brochure that enhanced participants' understanding of the RCT and improved our enrollment rate. We also utilized user-engagement in refining an intervention protocol.

Conclusion

We resolved implementation challenges without compromising internal validity via interdisciplinary collaborations with mobile programmers to ensure our technology met the unique and varied needs of aging users. The solutions from this study may promote the recruitment and retainment of older adults in research studies that use technology-based interventions.

Older adults in the digital health era: insights on the digital health related knowledge, habits and attitudes of the 65 year and older population

BACKGROUND

The COVID-19 pandemic has increased internet use by older age groups to an unprecedented level in Hungary mirroring the general tendency in the total population. Nevertheless, international trends indicate that this group is less likely to use digital health technologies than younger ones. The aging population raises the question of successfully integrating elderly people into the digital health ecosystem. Our research aim is to investigate the digital health usage patterns and attitudes of the population aged 65 and over through a representative sample.

METHODS

A national representative questionnaire survey was conducted by telephone (CATI), interviewing 1723 respondents. Within this sample we examined 428 people in the over-65 age group, 246 in the 65-74 age group and 182 in the over-75 age group. Predictors of demand for digital solutions were tested using binary logistic regression model.

RESULTS

50.8% of people aged 65-74 and 37.1. % of people aged 75 + use the internet for health-related purposes, mostly to access websites. 85% of respondents in 65-74 and 74% in 75 + age group have used more than one digital health device and around 70% of both age groups have a need for more than one digital solution. 90.2% (64-75 age group) and 85.7% (75 + age group) of respondents are familiar with e-prescription, 86.4% and 81.4% of them use it. 77.1% of 65-74-year-olds have heard of and nearly half 45.5% have used online appointment. More than half (52.7%) of the respondents in this age group have heard of and used electronic transmission of medical records and data. A similar proportion has heard about and used apps: 54.3% has heard of them, but only 17.3% has used them. The multivariate analyses emphasized that the need for digital solutions increases with the level of education and the more benefits one perceives in using digital solutions.

CONCLUSION

Our research has shown that the senior age group has measurable needs in the field of digital health, so helping them on this journey is in the interest of the whole health ecosystem. Their high level of interest is indicated by the fact that more than a fifth of older adults would like to have access to between 7 and 10 of the maximum number of digital devices available. The differences between the two age groups - with younger people being more open to digital solutions and using them more - and the fact that the under 65s are better adapted digitally in all respects, raises the possibility that the specific trends in digital health for older people may virtually disappear in 10 years' time (when the under 65s now enter this age group).

Mobilizing Patient and Public Involvement in the Development of Real-World Digital Technology Solutions: Tutorial

Although the value of patient and public involvement and engagement (PPIE) activities in the development of new interventions and tools is well known, little guidance exists on how to perform these activities in a meaningful way. This is particularly true within large research consortia that target multiple objectives, include multiple patient groups, and work across many countries. Without clear guidance, there is a risk that PPIE may not capture patient opinions and needs correctly, thereby reducing the usefulness and effectiveness of new tools. Mobilise-D is an example of a large research consortium that aims to develop new digital outcome measures for real-world walking in 4 patient cohorts. Mobility is an important indicator of physical health. As such, there is potential clinical value in being able to accurately measure a person's mobility in their daily life environment to help researchers and clinicians better track changes and patterns in a person's daily life and activities. To achieve this, there is a need to create new ways of measuring walking. Recent advancements in digital technology help researchers meet this need. However, before any new measure can be used, researchers, health care professionals, and regulators need to know that the digital method is accurate and both accepted by and produces meaningful outcomes for patients and clinicians. Therefore, this paper outlines how PPIE structures were developed in the Mobilise-D consortium, providing details about the steps taken to implement PPIE, the experiences PPIE contributors had within this process, the lessons learned from the experiences, and recommendations for others who may want to do similar work in the future. The work outlined in this paper provided the Mobilise-D consortium with a foundation from which future PPIE tasks can be created and managed with clearly defined collaboration between researchers and patient representatives across Europe. This paper provides guidance on the work required to set up PPIE structures within a large consortium to promote and support the creation of meaningful and efficient PPIE related to the development of digital mobility outcomes.

Use and benefit of information, communication, and assistive technology among community-dwelling older adults - a cross-sectional study

BACKGROUND

Technology can support healthy aging and empower older adults to live independently. However, technology adoption by older adults, particularly assistive technology (AT), is limited and little is known about the types of AT used among older adults. This study explored the use of key information and communication technologies (ICT) and AT among community-dwelling adults aged ≥ 65.

METHODS

A cross-sectional study was conducted among community-dwelling adults aged ≥ 65 in southern Germany using a paper-based questionnaire. The questionnaire included questions on the three domains sociodemographic aspects, health status, and technology use. Technology use was considered separately for key ICT (smartphone, computer/laptop, and tablet) and a range of 31 different AT. Data were analyzed using descriptive statistics, univariate analyses, and Bernoulli Naïve Bayes modelling.

RESULTS

The questionnaire was answered by 616 participants (response rate: 24.64%). ICT were used by 497 (80.68%) participants and were associated with lower age, higher level of education, living together with someone, availability of internet connection, higher interest in technology, and better health status (p < .05). No association was found with sex and size of the hometown. The most frequently owned AT were a landline phone, a body scale, and a blood pressure monitor. Several AT related to functionality, (instrumental) activities of daily living- (IADL), and morbidity were used more frequently among non-ICT users compared to ICT-users: senior mobile phone (19.33% vs. 3.22%), in-house emergency call (13.45% vs. 1.01%), hearing aid (26.89% vs. 16.7%), personal lift (7.56% vs. 1.61%), electronic stand-up aid (4.2% vs. 0%). Those with higher interest in technology reported higher levels of benefit from technology use.

CONCLUSIONS

Despite the benefits older adults can gain from technology, its use remains low, especially among those with multimorbidity. Particularly newer, more innovative and (I)ADL-related AT appear underutilized. Considering the potential challenges in providing adequate care in the future, it may be crucial to support the use of these specific AT among older and frailer populations. To focus scientific and societal work, AT with a high impact on autonomy ((I)ADL/disease-related) should be distinguished from devices with a low impact on autonomy (household-/ comfort-related).

Ageing, the digital and everyday life during and since the Covid-19 pandemic

Introduction

During and since the Covid-19 pandemic there has been an intensified integration of digital technologies into the everyday lives of older people. We do, however, know little about the ways in which older people incorporate digital technologies and communications into their daily lives and their own meanings, embodiment and experiences of the digital during and since the Covid-19 pandemic.

Method

The aim of our research was to explore the use of digital devices during and since the Covid-19 pandemic and to identify facilitators and barriers to incorporating digital devices into everyday life. The research involved a series of online focus groups with people aged between 63 and 86 years living in the United Kingdom and were conducted in 2022. Each focus group lasted around 90 min and data was audio-recorded and transcribed. The data was analysed thematically.

Results

From the analysis, three interconnecting whilst analytically distinct themes around the meaning and experiences of using digital devices in everyday life during and since the pandemic, are thematically presented as: (1) Incorporating the digital into everyday life; (2) Social and digital connectivity; and (3) Challenges and limitations of the digital in everyday life.

Discussion

The research has provided insights into the way digital devices were used by older people during and since the Covid-19 pandemic. In particular, we highlight the increasing importance of digital connectivity and the ways in which older people actively engage (and resist) technologies of communication in their daily lives; and the significance of embodied co-presence and the immediacy of shared space and/or time is highlighted.

Co-designing an interactive artificial intelligent system with post-stroke patients and caregivers to augment the lost abilities and improve their quality of life: a human-centric approach

Objectives

The motor disability due to stroke compromises the autonomy of patients and caregivers. To support autonomy and other personal and social needs, trustworthy, multifunctional, adaptive, and interactive assistive devices represent optimal solutions. To fulfill this aim, an artificial intelligence system named MAIA would aim to interpret users' intentions and translate them into actions performed by assistive devices. Analyzing their perspectives is essential to develop the MAIA system operating in harmony with patients' and caregivers' needs as much as possible.

Methods

Post-stroke patients and caregivers were interviewed to explore the impact of motor disability on their lives, previous experiences with assistive technologies, opinions, and attitudes about MAIA and their needs. Interview transcripts were analyzed using inductive thematic analysis.

Results

Sixteen interviews were conducted with 12 post-stroke patients and four caregivers. Three themes emerged: (1) Needs to be satisfied, (2) MAIA technology acceptance, and (3) Perceived trustfulness. Overall, patients are seeking rehabilitative technology, contrary to caregivers needing assistive technology to help them daily. An easy-to-use and ergonomic technology is preferable. However, a few participants trust a system based on artificial intelligence.

Conclusion

An interactive artificial intelligence technology could help post-stroke patients and their caregivers to restore motor autonomy. The insights from participants to develop the system depends on their motor ability and the role of patients or caregiver. Although technology grows exponentially, more efforts are needed to strengthen people's trust in advanced technology.

Examining Public Awareness of Ageist Terms on Twitter: Content Analysis

Background

The World Health Organization, the Centers for Disease Control and Prevention, and the Gerontological Society of America have made efforts to raise awareness on ageist language and propose appropriate terms to denote the older adult population. The COVID-19 pandemic and older adults' vulnerability to the disease have perpetuated hostile ageist discourse on social media. This is an opportune time to understand the prevalence and use of ageist language and discuss the ways forward.

Objective

This study aimed to understand the prevalence and situated use of ageist terms on Twitter.

Methods

We collected 60.32 million tweets between March and July 2020 containing terms related to COVID-19. We then conducted a mixed methods study comprising a content analysis and a descriptive quantitative analysis.

Results

A total of 58,930 tweets contained the ageist terms "old people" or "elderly." The more appropriate term "older adult" was found in 11,328 tweets. Twitter users used ageist terms (eg, "old people" and "elderly") to criticize ageist messages (17/60, 28%), showing a lack of understanding of appropriate terms to describe older adults. Highly hostile ageist content against older adults came from tweets that contained the derogatory terms "old people" (22/30, 73%) or "elderly" (13/30, 43%).

Conclusions

The public discourse observed on Twitter shows a continued lack of understanding of appropriate terms to use when referring to older adults. Effort is needed to eliminate the perpetuation of ageist messages that challenge healthy aging. Our study highlights the need to inform the public about appropriate language use and ageism.

Ageism in the Discourse and Practice of Designing Digital Technology for Older Persons: A Scoping Review

BACKGROUND AND OBJECTIVES

Involving older persons in the design process of digital technology (DT) promotes the development of technologies that are appealing, beneficial, and used. However, negative discourse on aging and ageism are potential underlying factors that could influence which and how DTs are designed and how older persons are involved in the design process. This scoping review investigates the explicit and implicit manifestations of ageism in the design process of DT.

RESEARCH DESIGN AND METHODS

Seven databases were screened for studies reporting on the design of DT with older persons between January 2015 and January 2020. Data regarding study and DT characteristics, discourse about older persons, and their involvement in the design process were extracted, coded, and analyzed using critical discourse analysis.

RESULTS

Sixty articles met the inclusion criteria and were included in the analysis. Various forms of exclusion of older persons from the design process were identified, such as no or low involvement, upper-age limits, and sample biases toward relatively "active," healthy and "tech-savvy" older persons. Critical discourse analysis revealed the use of outdated language, stereotypical categorizations, and/or design decisions based on ageism in 71.7% of the studies.

DISCUSSION AND IMPLICATIONS

A discrepancy was found between an "ideal" discourse regarding the involvement of older persons throughout the design process and actual practice. Manifestations of ageism, errors, and biases of designing DT with older persons are discussed. This article calls for more authentic inclusion of older persons and higher awareness toward the implications of ageism in the design process of DT.

Associations Between Everyday ICT Usage and (Self-)Ageism: A Systematic Literature Review

BACKGROUND AND OBJECTIVES

Both rapid technological changes and (self-)ageism are pervasive challenges of the 21st century, potentially affecting older adults' everyday functioning, health, and well-being. This systematic literature review aimed to synthesize scholarly evidence to determine the associations between everyday information and communication technology (EICT) usage and (self-)ageism as well as potential moderators.

RESEARCH DESIGN AND METHODS

A systematic search was performed in 8 academic databases, covering the time frame from January 1995 to January 2021. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a total of 15 articles met the inclusion criteria and were involved in the analysis. The standardized National Heart, Lung, and Blood Institute's quality assessment tools were used for risk bias.

RESULTS

Several studies demonstrated significant associations between EICT usage and stereotype embodiment (n = 8), stereotype threat (n = 2), and age discrimination (n = 3). Age (group), gender, and motivation were examined as potential moderators.

DISCUSSION AND IMPLICATIONS

This review provides initial evidence on the associations between (self-)ageism and EICT usage. It highlights the importance of positive subjective aging perceptions for active EICT usage in older adults, but also emphasizes the detrimental consequences of ageism in EICT learning settings and technology design on older persons' willingness and ability to use EICT. Further ecologically valid and methodologically sound research is needed to better understand both the nature and direction of the association between EICT usage and (self-)ageism.

Defeating diabetes in the desert: A community-based mHealth diabetes screening intervention in Jodhpur Rajasthan

Background

There is a paucity of demonstrated models for mHealth-based diabetes screening and coordinated care in India, especially in western Rajasthan, which is the part of Thar desert.

Materials and Methods

JSPH collaboratively developed and implemented an easy-to-use, noninvasive, mobile phone-based screening interview, to identify adults at high risk for diabetes. The high risk for diabetes was defined using multiple clinical and epidemiologic criteria, all based on the evidence for India and globally. Since participants above 35 years or older were only considered in the screening, the application was designed to categorize the participants as high and low risk.

Results

Out of 4000 screened participants, the percentage of males and females were 51% and 50%, respectively. Participants found to be at high risk and low risk were n = 3600 (90%) and 400 (10%). The mean age of high- and low-risk participants was 52.2 (+12.8) and 36.2 (+4.2), respectively. Of the 3600 high-risk individuals who have been given a follow-up interview, 90.50% of high-risk individuals obtained diabetes testing, and of these, 65.67% had a written report showing they test positive for diabetes or prediabetes, requiring ongoing clinical care.

Conclusions

JSPH mHealth application provided a novel noninvasive way to better identify those at high diabetes risk in the community and demonstrated how to optimize the use of mobile health methods in diabetes prevention and care services.

Enhancing Community Participation through Age-Friendly Ecosystems: A Rapid Realist Review

This rapid realist review explored the key components of age-friendly ecosystems that promote community participation among older adults. The study (undertaken in 2021 and updated in 2023) synthesized evidence from 10 peer-reviewed and grey literature databases to identify the underlying mechanisms and contextual factors that shape why, under what circumstances, and for whom an age-friendly ecosystems might be effective as well as the intervention outcomes. A total of 2823 records were initially identified after deduplication. Title and abstract screening produced a potential dataset of 126 articles, reducing to 14 articles after full text screening. Data extraction focused on the contexts, mechanisms, and outcomes of ecosystems for older adults' community participation. Analysis suggested that age-friendly ecosystems that aim to promote community participation are characterized by the provision of accessible and inclusive physical environments, the availability of supportive social networks and services, and the creation of opportunities for meaningful engagement in community life. The review also highlighted the importance of recognizing the diverse needs and preferences of older adults and involving them in the design and implementation of age-friendly ecosystems. Overall, the study has provided valuable insights into the mechanisms and contextual factors that contribute to the success of age-friendly ecosystems. Ecosystem outcomes were not well discussed in the literature. The analysis has important implications for policy and practice, emphasizing the need to develop interventions that are tailored to the specific needs and contexts of older adults, and that promote community participation as a means of enhancing health, wellbeing, and quality of life in later life.

An "ultimate partnership": Older persons' perspectives on age-stereotypes and intergenerational interaction in co-designing digital technologies

AIM

There is often a gap between the ideal of involving older persons iteratively throughout the design process of digital technology, and actual practice. Until now, the lens of ageism has not been applied to address this gap. The goals of this study were: to voice the perspectives and experiences of older persons who participated in co-designing regarding the design process; their perceived role in co-designing and intergenerational interaction with the designers; and apparent manifestations of ageism that potentially influence the design of digital technology.

METHODS

Twenty-one older persons participated in three focus groups. Five themes were identified using thematic analysis which combined a critical ageism 'lens' deductive approach and an inductive approach.

RESULTS

Ageism was experienced by participants in their daily lives and interactions with the designers during the design process. Negative images of ageing were pointed out as a potential influencing factor on design decisions. Nevertheless, positive experiences of inclusive design pointed out the importance of "partnership" in the design process. Participants defined the "ultimate partnership" in co-designing as processes in which they were involved from the beginning, iteratively, in a participatory approach. Such processes were perceived as leading to successful design outcomes, which they would like to use, and reduced intergenerational tension.

CONCLUSIONS

This study highlights the potential role of ageism as a detrimental factor in how digital technologies are designed. Viewing older persons as partners in co-designing and aspiring to more inclusive design processes may promote designing technologies that are needed, wanted and used.

The Role of Ageism in the Acceptance and Use of Digital Technology

Technology acceptance models associate older age with lower intention to use digital technology although this assumption is often stereotypically-based and not sufficiently tested with older persons. This study investigated the association of ageism (rather than chronological age) with behavioral intention and actual use of technology within the theoretical framework of the Unified Theory of Acceptance and Use of Technology (UTAUT-2) model. 374 Dutch-speaking participants aged 50-97 completed the UTAUT-2 questionnaire, Expectations Regarding Aging, Attitudes Toward Older Adults Using Technology (ATOAUT-11) and experienced ageism scales. A path analysis found that expectations regarding aging partially mediated the association of age with negative attitudes. Mixed results were found regarding the fit of the new UTAUT-2-Ageism model. Negative ATOAUT moderated the associations of Effort Expectancy, Facilitating Conditions, and Habit with Behavioral Intention to use technology, and the explained variance increased. Further research is warranted to fully identify the potential role of ageism in technology acceptance.

The Hospital to Home study (H2H): smartwatch technology-enabled rehabilitation following hip fracture in older adults, a feasibility non-randomised trial

Introduction

Hip fractures are associated with significant morbidity and mortality. This study assessed the feasibility of smartwatches supporting rehabilitation post-surgical fixation.

Methods

This UK-based non-randomised intervention study recruited patients who had sustained a hip fracture (age ≥65 and Abbreviated Mental Test Score ≥8/10), following surgical fixation, at one hospital to the intervention group, and at a second hospital to a usual care group. The intervention group received a smartwatch (Fitbit Charge 4) and app (CUSH Health©). Feasibility measures included retention and completion of outcome measures.

Results

Between November 2020 and November 21, 66 participants were recruited (median age 78 (IQR 74-84)). The intervention cohort were younger, with no significant differences in frailty or multi-morbidity between the cohorts. Hospital stay was shorter in the intervention cohort (10 days (7-16) versus 12 (10-18), p=0.05). There were 15 falls-related readmissions in the control cohort, including 11 fractures, with none in the intervention cohort (p=0.016). In the intervention group, median daily step counts increased from 477 (320-697) in hospital, to 931 (505-1238) 1 week post-discharge, to 5,352 (3,552-7,944) at 12-weeks (p=0.001). Of the intervention cohort, 12 withdrew.

Conclusion

This study found that smartwatch-supported rehabilitation was feasible in this cohort. A significant proportion of patients either chose not to participate or withdrew; such a decrease in participants must be addressed to avoid digital exclusion. Falls and fracture-related readmissions were more frequent at the control site compared with the intervention site.

Needs assessment in community-dwelling older adults toward digital interventions to promote physical activity: Cross-sectional survey study

Background

Tackling physical inactivity represents a key global public health challenge. Strategies to increase physical activity (PA) are therefore warranted. Despite the rising availability of digital interventions (DIs), which offer tremendous potential for PA promotion, there has been inadequate attention to the special needs of older adults.

Objective

The aim was to investigate community-dwelling older adults' needs, requirements, and preferences toward DIs to promote PA.

Methods

The target population of this cross-sectional study was community-dwelling older adults (≥60 years old) within German-speaking Switzerland. Potential respondents were informed about the study and sent a link to a self-developed and self-administered online survey by our cooperating institutions.

Results

Overall, 922 respondents who completed the online survey were included in the final analysis. The mean age of the sample was 72 years (SD 6.4, range 60-98). The preferred delivery mode of DIs to promote PA was a website (428/922, 46.4%) and 80.3% (740/922) preferred video-based structures. Most respondents expressed the need for personal access, personal goals, personal messages, and a personal contact in case of problems or questions (585/817, 71.6%; 546/811, 67.3%; 536/822, 65.2%; 536/822, 65.2%). Memory training, psychological wellbeing, and nutrition were mainly rated as relevant additional content of DIs to promote PA (690/849, 81.2%; 661/845, 78.2%, 619/849, 72.9%).

Conclusion

Community-dwelling older adults may be willing to use DIs to promote PA in the long term, but this study identified particular needs and requirements in terms of design, technological realization, delivery mode, support, and individualization/personalization among the sample. Our results can inform future developments of DIs to promote PA specifically tailored to older adults. However, caution is warranted in interpreting the findings due to the sample's high PA and education levels.

Aging in Place: Connections, Relationships, Social Participation and Social Support in the Face of Crisis Situations

OBJECTIVES

We seek to identify active coping strategies used by older adults to face the pandemic and to deal with daily stressors, and to clarify which factors had an effect on stress, positive emotions and depression in active and healthy community-dwelling older adults in the first and second year of the pandemic in Costa Rica.

METHODS

Participants were living in their own homes in Costa Rica (n = 218, mean age 69.96, 82.1% women). Participants were interviewed by phone and answered an online survey, which included socio-demographic information, mental health variables such as stressors (perceived health and fear of COVID-19, illness, perception of pandemic gravity), loneliness (whether they felt lonely and how often they felt lonely), access to Information and Communication Technologies, socio-emotional coping variables, social participation and physical activity level during the pandemic.

RESULTS

Positive socio-emotional indicators related to well-being such as self-efficacy, social support, perceived health and proactive behavior were high. Negative well-being indicators such as perceived stress, emotional COVID-19 fear and loneliness showed low values in the sample studied during both years. We found significant relations across the dependent variables (perceived stress, positive emotions and depression) by studying the psychological well-being coping strategies.

CONCLUSIONS

Findings highlight the importance of coping strategies and social participation in the capacity of older adults to mitigate the negative psychological consequences of crisis situations and provide evidence of "aging in place".

A Technology-Based Intervention to Support Older Adults in Living Independently: Protocol for a Cross-National Feasibility Pilot

Innovative technologies can support older adults with or without disabilities, allowing them to live independently in their environment whilst monitoring their health and safety conditions and thereby reducing the significant burden on caregivers, whether family or professional. This paper discusses the design of a study protocol to evaluate the acceptance, usability, and efficiency of the SAVE system, a custom-developed information technology-based elderly care system. The study will involve older adults (aged 65 or older), professional and lay caregivers, and care service decision-makers representing all types of users in a care service scenario. The SAVE environmental sensors, smartwatches, smartphones, and Web service application will be evaluated in people's homes situated in Romania, Italy, and Hungary with a total of 165 users of the three types (cares, elderly, and admin). The study design follows the mixed method approach, using standardized tests and questionnaires with open-ended questions and logging all the data for evaluation. The trial is registered to the platform ClinicalTrials.gov with the registration number NCT05626556. This protocol not only guides the participating countries but can be a feasibility protocol suitable for evaluating the usability and quality of similar systems.

eHealth Platforms to Promote Autonomous Life and Active Aging: A Scoping Review

New technologies, namely eHealth platforms, are being used more than ever before. These platforms enable older people to have a more independent lifestyle, enhance their participation, and improve their well-being. Information and communication technologies are expected to be linked to the triad of aging, social inclusion, and active participation, which is in line with the implementation of Smart Healthy and Age-Friendly Environments. This scoping review aimed to map eHealth platforms designed to promote autonomous life and active aging. The Joanna Briggs Institute methodology and the PRISMA-ScR checklist were used. A search was conducted on MEDLINE (via PubMed), CINAHL Complete (via EBSCOhost), Scopus, Cochrane Database of Systematic Reviews (via EBSCOhost), SciELO, DART-Europe, CAPES, and MedNar databases. Fourteen studies were included. This scoping review synthesized information on eHealth platforms designed to promote active living, their domains of intervention, and the outcomes assessed in those studies that have implemented and evaluated these eHealth platforms.

Digital health in older adults for the prevention and management of cardiovascular diseases and frailty. A clinical consensus statement from the ESC Council for Cardiology Practice/Taskforce on Geriatric Cardiology, the ESC Digital Health Committee and the ESC Working Group on e-Cardiology

Digital health technology is receiving increasing attention in cardiology. The rise of accessibility of digital health tools including wearable technologies and smart phone applications used in medical practice has created a new era in healthcare. The coronavirus pandemic has provided a new impetus for changes in delivering medical assistance across the world. This Consensus document discusses the potential implementation of digital health technology in older adults, suggesting a practical approach to general cardiologists working in an ambulatory outpatient clinic, highlighting the potential benefit and challenges of digital health in older patients with, or at risk of, cardiovascular disease. Advancing age may lead to a progressive loss of independence, to frailty, and to increasing degrees of disability. In geriatric cardiology, digital health technology may serve as an additional tool both in cardiovascular prevention and treatment that may help by (i) supporting self-caring patients with cardiovascular disease to maintain their independence and improve the management of their cardiovascular disease and (ii) improving the prevention, detection, and management of frailty and supporting collaboration with caregivers. Digital health technology has the potential to be useful for every field of cardiology, but notably in an office-based setting with frequent contact with ambulatory older adults who may be pre-frail or frail but who are still able to live at home. Cardiologists and other healthcare professionals should increase their digital health skills and learn how best to apply and integrate new technologies into daily practice and how to engage older people and their caregivers in a tailored programme of care.