Development and Evaluation of the Mobile Tech Support Questionnaire for Older Adults

IntroductionAlthough Information and Communication Technology (ICT) has great potential to help older adults cope with challenges associated with aging, the intended benefits of ICT are not always realized in this population due to access barriers and low digital literacy. During the COVID-19 pandemic, numerous tech support initiatives for older adults got underway. However, evaluation of the effectiveness of these initiatives is less common. This research partnered with a large, multi-service organization in New York City that gave some groups of their clients ICT devices, unlimited broadband, and access to technology training in response to COVID-19 lockdowns. This study investigates older adults’ experiences with ICT and ICT support services to better inform the existing and emerging tech support for older adults during and beyond the pandemic.MethodsData were obtained from interviewer-administered surveys of 35 older adult recipients of ICT devices, connectivity, and training in New York City. The average age was 74 years (range = 55–90 years). The group was diverse regarding race/ethnicity (Black 29%, Latino 19%, White 43%). All had low incomes. Surveys consisted of multiple-choice items and open-ended responses.ResultsThe study found that one size does not fit all when it comes to ICT training and support for older adults. While connection to devices and services and tech support led to a degree of ICT adoption, the newly learned skills did not always lead to expanded device usage. The readily available tech support training and support do not guarantee service utilization, as success with tech services is related to one’s pre-existing ICT competence.DiscussionThe study concludes that customized training based on individuals’ skills rather than age is needed. Tech support training should start by understanding an individual’s interests and incorporate tech education to help users identify a wide range of existing and emerging online services that can meet their needs. Service organizations should consider including an assessment of ICT access, use, and skills into their standard intake protocols to ensure effective service delivery.

BackgroundAlthough family technical support seems intuitive, there is very little research exploring this topic.ObjectiveThe objective of this study was to conduct a subanalysis of data collected from a large-scale qualitative project regarding older adults’ experiences in using health information technology. Specifically, the subanalysis explored older adults’ experiences with technology support from family members to inform strategies for promoting older adults’ engagement with new health technologies. Although the primary analysis of the original study was theoretically driven, this paper reports results from an inductive, open-coding analysis.MethodsThis is a subanalysis of a major code identified unexpectedly from a qualitative study investigating older adults’ use experience of a widespread health technology, the patient portal. A total of 24 older patients (≥65 years) with multiple chronic conditions (Charlson Comorbidity Index >2) participated in focus groups conducted at the patients’ primary clinic. While conducting the primary theoretically driven analysis, coders utilized an open-coding approach to ensure important ideas not reflected in the theoretical code book were captured. Open coding resulted in 1 code: family support. This subanalysis further categorized family support by who provided tech support, how tech support was offered, and the opinions of older participants about receiving family tech support.ResultsThe participants were not specifically asked about family support, yet themes around family assistance and encouragement for technology emerged from every focus group. Participants repeatedly mentioned that they called their grandchildren and adult children if they needed help with technology. Participants also reported that family members experienced difficulty when teaching technology use. Family members struggled to explain simple technology tasks and were frustrated by the slow teaching process.ConclusionsThe results suggest that older adults ask their family members, particularly grandchildren, to support them in the use of new technologies. However, family may experience difficulties in providing this support. Older adults will be increasingly expected to use health technologies, and family members may help with tech support. Providers and health systems should consider potential family support and engagement strategies to foster adoption and use among older patients.

The extant literature demonstrates that the age‐related digital divide prevents older adults from enhancing their quality of life. To bridge this gap and promote active aging, this study explores the interplay between social networks and older adults' use of information and communication technology (ICT). Using an action‐oriented field research approach, we offered technical help (29 help sessions) to older adult participants recruited from western China. Then, we conducted content analysis to examine the obtained video, audio, and text data. Our results show that, first, different types of social networks significantly influence older adults' ICT use in terms of digital skills, engagement, and attitudes; however, these effects vary from person to person. In particular, our results highlight the crucial role of a stable and long‐term supportive social network in learning and mastering ICT for older residents. Second, technical help facilitates the building and reinforcing of such a social network for the participants. Our study has strong implications in that policymakers can foster the digital inclusion of older people through supportive social networks.

Older adults comprise a highly heterogeneous group that engages with digital media in varying ways, therefore a large variation in technology support needs is likely. This study examines the nature of support for using digital media among older adults. We conducted in-depth qualitative interviews with older adults (age 59+) in Hungary, the Netherlands, and Switzerland (N=58) in 2019 exploring: (1) whether and how older adults receive support in using digital media; and (2) older adults’ perceptions of whether the support they receive meets their needs. We began with open coding, then conducted consensus meetings to identify themes and coding schemes, and wrote memos to share findings and ensure reliability across coders. We find that older adults voice a highly varying range of need for technical support as well as varying instances of both receiving and not receiving technical help. Participants report receiving help from different informal (e.g. spouses) and formal (e.g. computer classes) sources. However, support may not be immediate, posing challenges for older adults who depend on the availability of their support sources. Importantly, we also find that there are older adults who are quite self-sufficient in the ways they use digital technology. For older adults needing support, greater access to community-based support may help those without satisfactory options in their own social circle. Given our findings that older adults can have great ease with solving technology-related problems, peer-driven support networks where older adults can offer support to others may be an effective approach to providing digital technology guidance.

In day-to-day life, older adults prefer getting tech support from loved ones, rather than relying on instruction manuals or institutional support. But asking for help, frequently or repeatedly for similar issues, can strain relations between older adults and their helpers. This paper examines how relationships are maintained when younger helpers give and older adults get tech support—across three different cultures: North American, South Asian, and Middle Eastern. Our deductive application of the relational maintenance strategies framework to 40 in-depth, semi-structured, and cross-cultural interviews identify challenges in tech caregiving, like avoiding the topic or interaction, and mitigation efforts, like directly or indirectly assuring each other of their skills and abilities. We discuss how social interactions are managed around tech support, how individual constraints, like time, place, or abilities are respected, and how self-conscious emotions, like guilt, embarrassment, or empathy are handled.

The COVID-19 pandemic and resultant restrictions on social gatherings significantly impacted many peoples' sense of social connectedness, defined as an individual's subjective sense of having close relationships with others. Older adults living in long-term care homes (LTCHs) experienced extreme restrictions on social gatherings, which negatively impacted their physical and mental health as well as the health and well-being of their family caregivers. Their experiences highlighted the need to reconceptualize social connectedness. In particular, the pandemic highlighted the need to explore novel ways to attain fulfilling relationships with others in the absence of physical gatherings such as through the use of a hybridized system of web-based and in-person presence. Given the potential benefits and challenges of web-based presence technology within LTCHs, the proposed research objectives are to (1) explore experiences regarding the use of web-based presence technology (WPT) in support of social connectedness between older adults in LTCHs and their family members, and (2) identify the contextual factors that must be addressed for successful WPT implementation within LTCHs. This study will take place in south western Ontario, Canada, and be guided by a qualitative multimethod research design conducted in three stages: (1) qualitive description with in-depth qualitative interviews guided by the Technology Acceptance Model (TAM) and analyzed using content analysis; (2) qualitative description and document analysis methodologies, informed by content and thematic analysis methods; and (3) explicit between-methods triangulation of study findings from stages 1 and 2, interpretation of findings and development of a guiding framework for technology implementation within LTCHs. Using a purposeful, maximum variation sampling approach, stage 1 will involve recruiting approximately 45 participants comprising a range of older adults, family members (30 participants) and staff (15 participants) within several LTCH settings. In stage 2, theoretical sampling will be used to recruit key LTCH stakeholders (directors, administrators, and IT support). In stage 3, the findings from stages 1 and 2 will be triangulated and interpreted to develop a working framework for WPT usage within LTCHs. Data collection will begin in fall 2023. The findings emerging from this study will provide insights and understanding about how the factors, barriers, and facilitators to embedding and spreading WPT in LTCHs may benefit or negatively impact older adults in LTCHs, family caregivers, and staff and administrators of LTCHs. The results of this research study will provide a greater understanding of potential approaches that could be used to successfully integrate WPTs in LTCHs. Additionally, benefits as well as challenges for older adults in LTCHs, family caregivers, and staff and administrators of LTCHs will be identified. These findings will help increase knowledge and understanding of how WPT may be used to support social connectedness between older adults in LTCHs and their family members. PRR1-10.2196/50137.

Predictors of health-promoting behaviour among older adults with hypertension in Indonesia

Lighthouse for Older Adults, an innovative public-private partnership, was developed in response to COVID-19 as a means of advancing telehealth for low-income older adults living in affordable housing communities. Residents of these communities often don’t have reliable access to devices, sufficient bandwidth for telehealth, or adequate social services, further complicated by the need for multi-lingual and culturally sensitive programs. This presentation will share program implementation strategies and outcomes, including the essential role telehealth services play in the care and wellbeing of older adults during and beyond COVID-19. This session will review evidence-based components of a telehealth intervention, including digital literacy training and technology support. Key drivers for successful implementation (e.g., peer led training, user input into technology selection) as well as barriers to implementation (e.g., broad band installation, internet service availability/cost, tech support) will be reviewed. Lessons learned through program replication and scaling of Lighthouse telehealth services will be discussed.

Physical activity positively influences and improves motor ability, increases desirable behavior, promotes brain activity, and increases marginal memory and thinking among older adults with mild cognitive impairments. This systematic review explored current trends and the effectiveness of digital health (eHealth) interventions to promote physical activity among older adults with mild cognitive impairment. We used the PRISMA guidelines and the PICO framework to search for literature in five electronic databases (PubMed, Embase, CINAHL, and Web of Sciences). The search outcome was transferred to Endnotes software and independently screened based on title, abstract, and full text using predetermined eligibility criteria. The screening resulted in 10 articles for extraction using a self-developed matrix. The JBI quality appraisal tool was used for quality appraisals and the conventional thematic data synthesis method of analysis was used. The strategy used was diverse and multiple technological platforms for the implementation of digital interventions, and included hardware technology like tablets, smartphones, smartwatches, Bluetooth devices, earpieces, computers, or durable covers, while, software techniques like promoting, customization, multimedia, multisensory, hands-on practice, demonstration, cueing, tech support, user manual or in the training of care practitioners were used. The use of digital-based health interventions for people with mild cognitive impairment to improve physical activity is still rudimentary even though the potential influence of such interventions is enormous. Interventions that use digital methods focusing on promoting physical activity among older adults with mild cognitive impairments should provide detailed information on the types of interventions, implementation, development process, and the resultant improvements.

Background: Heart rate variability (HRV) has been suggested as an indicator of capacity to adapt effectively to physiological or environmental challenges and of physical and psychological health in old age. Aims: The study assessed levels of high-frequency HRV (HF-HRV) among older adults in relation to positive and negative affect and the mediating role of positive and negative affect in the association between coping resources (perceived social support and sense of mastery) and HF-HRV.Method: Participants were 187 men and women in three assisted-living residences who were independent in activities of daily living (93.4% participation rate). The participants completed sense of mastery, multidimensional scale of perceived social support, and positive and negative affect questionnaires. HF-HRV was derived from electrocardiography data measured by a Holter monitoring device for 15 minutes.Results: The empirical model showed good fit indices indicating that higher HF-HRV was associated with lower negative affect, and negative affect mediated the association between perceived social support and HF-HRV. In addition, perceived social support and sense of mastery were associated with higher positive affect and lower negative affect.Conclusions: Although this was a cross-sectional study, it suggests that HF-HRV may be a link between affect and health in old age. It also suggests the importance of identification and intervention with older adults and their support systems to reduce negative affect.

BackgroundOlder cancer survivors are at risk of the development or worsening of both age- and treatment-related morbidity. Sedentary behavior increases the risk of or exacerbates these chronic conditions. Light-intensity physical activity (LPA) is more common in older adults and is associated with better health and well-being. Thus, replacing sedentary time with LPA may provide a more successful strategy to reduce sedentary time and increase physical activity.ObjectiveThis study primarily aims to evaluate the feasibility, acceptability, and preliminary efficacy of a home-based mobile health (mHealth) intervention to interrupt and replace sedentary time with LPA (standing and stepping). The secondary objective of this study is to examine changes in objective measures of physical activity, physical performance, and self-reported quality of life.MethodsOverall, 54 cancer survivors (aged 60-84 years) were randomized in a 1:1:1 allocation to the tech support intervention group, tech support plus health coaching intervention group, or waitlist control group. Intervention participants received a Jawbone UP2 activity monitor for use with their smartphone app for 13 weeks. Tech support and health coaching were provided via 5 telephone calls during the 13-week intervention. Sedentary behavior and physical activity were objectively measured using an activPAL monitor for 7 days before and after the intervention.ResultsParticipants included survivors of breast cancer (21/54, 39%), prostate cancer (16/54, 30%), and a variety of other cancer types; a mean of 4.4 years (SD 1.6) had passed since their cancer diagnosis. Participants, on average, were 70 years old (SD 4.8), 55% (30/54) female, 24% (13/54) Hispanic, and 81% (44/54) overweight or obese. Malfunction of the Jawbone trackers occurred in one-third of the intervention group, resulting in enrollment stopping at 54 rather than the initial goal of 60 participants. Despite these technical issues, the retention in the intervention was high (47/54, 87%). Adherence was high for wearing the tracker (29/29, 100%) and checking the app daily (28/29, 96%) but low for specific aspects related to the sedentary features of the tracker and app (21%-25%). The acceptability of the intervention was moderately high (81%). There were no significant between-group differences in total sedentary time, number of breaks, or number of prolonged sedentary bouts. There were no significant between-group differences in physical activity. The only significant within-group change occurred within the health coaching group, which increased by 1675 daily steps (95% CI 444-2906; P=.009). This increase was caused by moderate-intensity stepping rather than light-intensity stepping (+15.2 minutes per day; 95% CI 4.1-26.2; P=.008).ConclusionsA home-based mHealth program to disrupt and replace sedentary time with stepping was feasible among and acceptable to older cancer survivors. Future studies are needed to evaluate the optimal approach for replacing sedentary behavior with standing and/or physical activity in this population.Trial RegistrationClinicalTrials.gov NCT03632694; https://clinicaltrials.gov/ct2/show/NCT03632694

As technologies aimed at enhancing older adults’ quality of life continue to advance, so does the optimism surrounding their potential to improve care. This framing appears in state policy documents that address technology and aging, but relatively few studies have examined them. Our study addresses this gap by analyzing age tech policy documents published over the past decade by major institutional actors in U.S. aging policy (e.g., Office of Science and Technology Policy; Department of Health and Human Services). Our analyses revealed that age tech is framed not only as providing older adults with better care, defined as more effective, more efficient, and safer care, but also as reducing care providers’ work by making it less time-intensive and demanding. Critical analysis of these framings, however, revealed that age tech, especially digital forms centering on monitoring and surveillance, can have the opposite effect. It expands the work of care providers, paid and unpaid, by creating new tasks, like “tech support,” and reduces time spent in more emotionally rewarding aspects of carework, like providing support in face-to-face interactions. Age tech also creates new forms of “self-care work” for older adults, like collecting and tracking biometric health data. These shifts can diminish rather than improve quality of care. We interpret these intertwined illusions of better care and less work through an analysis of the political economic underpinnings of technology’s application to carework, which reveals how it contributes to the exploitation, alienation, and commodification of care workers, as well as care recipients.

Many older adults, particularly those with mobility disabilities, experience barriers to participation in exercise classes, including lack of accessibility and transportation. Tele-technologies (e.g., Zoom) provide an opportunity to facilitate both physical and social wellness through remote group classes. We developed the TechSAge Telewellness tool to provide guidelines for designing wellness classes delivered via video-conferencing for older adults with and without disabilities. The protocols and guidelines presented within it have been tested for usability and acceptance with older adults with long-term mobility disabilities. Throughout the tool, we present examples from the TechSAge Tele Tai Chi study as a case study to provide helpful insights on developing a Telewellness program. The tool includes guidance on selecting a software, safety considerations, class organization and logistics, social time, and tech support. The contents of the tool provide insights for research and design regarding telehealth technology, as well as health and wellness interventions.

Smart healthcare systems are being designed to provide medical services to and improve the daily lives of older adults. However, most research has been focused on technical issues, despite a need to conduct in-depth studies on related ethical issues. Therefore, this study aimed to examine ethical issues in smart healthcare for older adults. We reviewed published literature using PubMed. In total, 292 documents were analyzed by applying the scoping review method. Finally, 29 articles were selected from the 292 articles. Ethical issues in smart healthcare for older adults were analyzed in terms of the themes of responsibility/autonomy (n=10), privacy (n=9), and digital divide (n=10). Technical help provided by smart healthcare may infringe on the autonomy of tacit choice for older adults. This pose a potential ethical issue as the subject of responsibility here is unclear. Privacy is a concern as smart technology may intrude the personal life of the user. The digital divide is a challenge because of low responsiveness from older adults to technological changes. The future development and application of smart healthcare systems must take these ethical aspects into account to enable their efficient and effective use in supplementing healthcare for older adults. Critical discussions to identify ethical issues and customize ethical requirements for specific user needs are necessary among smart healthcare providers.

ObjectiveAge-related hearing loss is one of the leading causes of disability in older adults. This cross-sectional study investigated the association between untreated hearing loss, social (perception of quality and quantity of social network) and emotional loneliness (perception of limited emotional support), social isolation (size of the social network), social support (actual or perceived availability of resources from the social network) and psychological discomfort (depression, anxiety, and stress) in older adults.Study DesignCross-sectional study design.MethodsA total of 202 community derived sample of volunteers, age range 40–89 years, mean age (M) = 65.3 ± 11.0 years were recruited. Of these 115 were females (M = 63.2 ± 12.0 years) and 87 were males (M = 68.2 ± 8.9 years). All participants completed a hearing assessment, social interaction and support questionnaire and a social and emotional loneliness questionnaire.ResultsHearing loss significantly contributed to both moderate [P < 0.001, B (95% CI): 0.01 (0.99–1.02)] and intense levels [P < 0.001, 0.02 (1.00–1.04)] of emotional loneliness. Depression was significantly associated with satisfaction with social support [P < 0.001; −0.17 (−0.23 to −0.11), social interaction [P = 0.01; −0.07 (−0.12 to −0.01)], and moderate [P < 0.001; 0.31 (1.22–1.53)] and intense [P < 0.001; 0.29 (1.20–1.50)] levels of emotional loneliness and intense levels of social loneliness [P = 0.01; 0.12 (1.05–1.21)].ConclusionUntreated hearing loss significantly increases the odds of being emotionally lonely. Depression significantly contributes to social and emotional loneliness, satisfaction with social support and social loneliness. Given the higher prevalence of loneliness and psychological discomfort and their associations with untreated hearing loss, hearing-impaired older adults are at significant risk of developing loneliness and psychological discomfort. Therefore, hearing health professionals should be aware of the psychosocial burden that may accompany hearing loss, in order to provide appropriate advice and support.