Everyday Challenges for Individuals Aging With Vision Impairment: Technology Implications.

BACKGROUND AND OBJECTIVES: There are growing numbers of older adults with long-term vision impairment who are likely to experience everyday activity challenges from their impairment in conjunction with age-related changes. Technology has potential to support activity engagement. To develop effective technologies and interventions, we need to understand the context of activity challenges and identify unmet support needs. RESEARCH DESIGN AND METHODS: The Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study is a mixed-method approach to explore everyday challenges of people aging with long-term disabilities. Participants included 60 adults aging with long-term vision impairment (63% female; M age = 67, SD = 4.6) who completed in-depth, structured interviews exploring the nature of everyday challenges and their unmet support needs for activity engagement. We conducted a content analysis using a deductive and inductive approach to build a detailed coding scheme of challenge codes and subcodes. RESULTS: The analyses provided detailed insights about the nature of challenges people aging with vision impairment experience when performing specific instrumental activities of daily living (IADLs) in the context of home maintenance, transportation, shopping/finance, and managing health. Vision-related challenges and participation restrictions were identified for several activities that require reading, navigation, and identification (e.g., shopping, medication management, public transportation). Emergent challenge themes for performing IADLs included personal limitations (e.g., physical, cognitive, financial) and environmental barriers (e.g., accessibility, technology, transportation). DISCUSSION AND IMPLICATIONS: Contextual examples of IADL challenges among individuals aging with vision impairment highlight opportunities for technology design and innovation to support participation in everyday activities.

Research-Driven Guidelines for Delivering Group Exercise Programs via Videoconferencing to Older Adults.

Telehealth holds much potential for supporting older adults' physical and social health. In particular, telewellness interventions to support the physical and social wellness of older adults are needed to overcome participation barriers with in-person programs. This paper presents guidelines for delivering telewellness interventions to older adults, which were informed by a human factors approach to developing a Tele Tai Chi intervention for older adults with mobility disabilities, including reviewing user needs literature and conducting user-centered needs assessment research. From these findings, we developed a protocol and support materials for delivering a telewellness intervention and conducted a feasibility study. We also established an adaptation committee to provide recommendations on the intervention. The outcome of our human factors approach was the establishment of research-driven design guidelines for delivering group exercise programs to older adults using videoconferencing. The guidelines provide direction for designing a telewellness protocol, supporting remote participation, and promoting socialization and engagement. These guidelines can be used to deliver interventions that increase access to socially-engaging, physical activity programs for older adults, which can ultimately help support their physical health, mental health, and quality of life.

Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) for adults aging with a long-term mobility disability.

BACKGROUND: There are growing numbers of adults aging with long-term mobility disabilities. Very little is known about the challenges this population experiences with everyday activities, and such challenges are likely to be greater and more complex than those of older adults who experience mobility declines later in life. OBJECTIVES: The current manuscript presents in-depth insights on the specific activity challenges experienced by older adults with long-term mobility disabilities, and the response strategies they employ to overcome those challenges. METHODS: In-depth, structured interviews designed to assess challenges and response strategies for a range of daily activities were conducted with sixty older adult participants (ages 60-79) who self-identified as having a mobility disability for a minimum of 10 years. A coding scheme was developed to classify emerging themes. We identify the most common challenges and responses reported across all 6 broad categories as well as for a single activity category as an exemplar of an in-depth activity analysis. RESULTS: A needs taxonomy revealed challenges and response themes in relation to the most difficult activities identified by the participants. Frequently reported challenges included physical limitations and accessibility challenges. Common response strategies (e.g., utilizing tools or technologies, obtaining assistance from others, or modifying the approach to the task) were successfully mapped onto the Selection, Optimization, and Compensation model. CONCLUSIONS: Findings reveal the unique challenges individuals face when engaging in everyday activities, and the potential of affordable and effective supports to promote aging-in-place, functional independence, and community engagement for adults aging with long-term mobility disability.

The TechSAge Minimum Battery: A multidimensional and holistic assessment of individuals aging with long-term disabilities.

BACKGROUND: People with disabilities acquired in early to mid-life are living longer, contributing to growing numbers of older adults who are aging with disability, an understudied population likely to be underserved. OBJECTIVES: This paper demonstrates the usefulness of the TechSAge Minimum Battery as a holistic assessment of health for people aging with disabilities. METHODS: Survey data of socio-demographic and health characteristics were collected from 176 older adults with long-term vision, hearing, and/or mobility disabilities. A series of descriptive and bivariate analyses were conducted to illustrate the heterogeneity of the sample. An in-depth analysis of the subsample with vision difficulty was conducted to highlight the tool's value in assessing detailed contextual information for a specific disability. RESULTS: Prevalence of health conditions (M = 4.1; SD = 2.5), prescription medications (M = 4.1; SD = 3.9), and serious functional difficulties (M = 1.6; SD = 0.85) indicated a fair degree of comorbidity, but with considerable variation in number and type among individuals. Subjective health ratings were high overall, but lower scores were correlated with additional comorbidities (r = -0.31-0.40, p =<.001). Analyses of the subsample with vision difficulty demonstrated heterogeneity in functional capacity, degree of impairment, duration, and use of supportive aids. CONCLUSIONS: Findings highlighted the heterogeneity among people aging with disability and demonstrated the importance of capturing multi-dimensional factors inclusive of an individual's capacity, context, and personal factors, which the Minimum Battery provides in an integrated assessment. Potential healthcare applications of the tool are discussed with implications for bridging aging and disability services.

Understanding the use and non-use of social communication technologies by older adults: A qualitative test and extension of the UTAUT model.

Technology has the ability to foster social engagement, but a sizable divide exists between older and younger adults in the use of social communication technologies. The goal of the current study was to gain a better understanding of older adults' perspectives on social communication technologies, including those with higher adoption rates such as email and those with lower adoption rates such as social networking sites (e.g., Facebook, Instagram). Semi-structured group interviews were conducted with either users or non-users of social networking sites to gain insight into issues of adoption and non-adoption of social communication technologies. The Unified Theory of Acceptance and Use of Technology model (UTAUT) was adapted and used to categorize the interview content. We found support for a benefit-driven account of social communication technology acceptance and usage, with participants most frequently discussing the degree social communication technologies would or would not help them attain gains in social connectedness, entertainment, and/or information sharing. However, the UTAUT was not sufficient in fully capturing the group-interview content, with additional categories being necessary. For instance, trust in social networking sites (privacy and security concerns) was frequently discussed by both users and non-users. The current results broaden theories of technology acceptance by identifying facilitators and barriers to technology use in the older adult population.

Everyday technology use among older deaf adults.

PURPOSE: Technology holds great potential to support Deaf individuals as they age into older adulthood. However, it is unclear to what extent Deaf seniors are using technology in everyday life or whether they experience challenges in using technology. The current study explored technology use among older Deaf adults with regard to attitudes, adoption style, and frequency of use for a wide range of technologies, including assistive technologies (ATs) for persons with hearing loss and general, everyday technologies. MATERIALS AND METHODS: We developed a questionnaire that assessed older Deaf adults' use of and experiences with technology. The questionnaire was made available in online and paper versions. Participants (N = 109) were recruited from national conferences and organizations for the Deaf. RESULTS: Overall, we found that the older Deaf adults were technology adopters and regularly use and feel comfortable with a variety of devices. However, we also identified a number of technologies that are not being used by this population, including an AT that appears to have become obsolete and technologies that use sound-based alerts. CONCLUSIONS: Insights on how older Deaf adults are embracing technology and which devices they are actually using can help policy makers, technology developers, and a range of aging services professionals, better meet the needs of this understudied population. Implications for Rehabilitation: Older Deaf adults use a variety of assistive and everyday technologies and must be considered as consumers and included in the design process. Older Deaf adults are generally positive in their attitudes towards technologies but they are infrequent users of potentially beneficial health technologies, highlighting opportunities for future research and development. Assistive technology for the Deaf (TTY/TTD) appears to have become obsolete with advances in modern communication technologies, which has implications for policy decisions.

Technology Adoption by Older Adults: Findings From the PRISM Trial.

Background and Objectives: There is growing evidence of the benefits of computers for older adults. Yet, adoption rates are lower compared with younger adults. Extant theoretical models of technology acceptance are limited in their application to older adults-studies on which these models are based included a limited sample of older adults or none at all; none assessed use of a technology specifically designed for older adults; and most only measured intention to use a technology or short-term use, rather than longer-term use (i.e., adoption). We assessed adoption of a computer system specifically designed for older users, for a diverse sample, over an extended period of time. Research Design and Methods: We analyzed archival data from 150 ethnically diverse older adults (65-98 years of age) who participated in the Personal Reminder Information and Social Management (PRISM) randomized controlled trial (Czaja SJ, Boot WR, Charness N, Rogers WA, Sharit J, Fisk AD,…Nair SN. The personalized reminder information and social management system (PRISM) trial: Rationale, methods and baseline characteristics. Contemp Clin Trials. 2015;40:35-46; Czaja SJ, Boot WR, Charness N, Rogers WA, Sharit J. Improving social support for older adults through technology: Findings from the PRISM randomized controlled trial. Gerontologist. 2017;58:467-477). We examined the extent to which attitudes, personal characteristics (e.g., age, gender, and personality), and cognitive abilities predicted mid-term and long-term adoption of a computer system designed for older adults. Results: There were individual differences in PRISM use over time. Regression analyses indicated that individual differences in earlier use of the system, executive functioning, and computer efficacy predicted long-term use. Discussion and Implications: These data provide insights for broader-based models of technology acceptance to guide design, instruction, and deployment of products for older adults. Specifically, the provision of opportunities to foster efficacy and gain positive experience with computer technologies may play a critical role in the likelihood that older adults adopt such technologies. Trial Registration: NCT01497613.

Exploring Older Adults' Video Game Use in the PRISM Computer System.

BACKGROUND AND OBJECTIVE: As part of the PRISM (Personal Reminder Information & Social Management) randomized field trial, a large group of older adults (N = 150) received a computer system in their home that presented them with the opportunity to play eleven different video games. While researchers have often assessed older adults' gaming preferences and habits through survey data and focus groups, this trial represented a unique opportunity to study gaming behavior "in the wild" over an entire year. RESEARCH DESIGN AND METHODS: We present an exploration of game usage data, individual differences in game preferences and gaming habits, and individual difference predictors of game use. RESULTS: Although few individual difference variables consistently predicted game use and preferences, there were clear favorites among the different games, and results demonstrate that given the opportunity and training many older adults may become active and long-term gamers. DISCUSSION AND IMPLICATIONS: Findings have implications for designing video games that older adults enjoy, supporting enjoyable and meaningful interactions with video games across the life span, and for designing cognitive, social, and health interventions involving games.

Closing the Capacity-Ability Gap: Using Technology to Support Aging With Disability.

There is a critical need to develop supports for older adults who have a wide range of abilities, including those aging with long-term impairments. Without appropriate support, many individuals will be functioning below optimal levels and will face participation barriers. Technology holds great promise to provide individualized support for a wide range of abilities and for a variety of domains. To ensure technology interventions are designed well and meet research-documented user requirements, we need more specific, actionable models to provide guidance for those developing and designing interventions. In this paper, we present the TechSAge Aging and Disability Model to bridge models from the aging and disability literatures and to disambiguate the population of individuals aging into disability from those aging with disability (i.e., pre-existing impairments). We also present the TechSAge Technology Intervention Model to support aging with pre-existing impairments, which provides direction and touch points for technology interventions. These models reflect the complex and dynamic interaction between age-related changes and an individual's prior capabilities and limitations. We describe the need for these models with respect to filling a gap in the disability and aging literature by highlighting the importance of differentiating between age-related changes and long-term impairments when designing interventions. We also show the need for quantitative and qualitative data to refine the models given complexities of the current state of the literature and survey data. The TechSAge Technology Intervention Model can be used to drive and inform technology redesign and development.

Understanding healthcare providers' perceptions of a personal assistant robot.

To successfully deploy a robot into a healthcare setting, it must be accepted by the end users. This study explored healthcare providers' perceptions of a mobile manipulator class personal robot assisting with caregiving tasks for older adult patients. Participants were 14 healthcare providers with an average of 12 years of continuous work experience with older patients. Quantitative and qualitative methods were used. Participants indicated a willingness to use a mobile manipulator robot as an assistant, yet they expressed discretion in their acceptance for different tasks. Benefits of robot assistance noted by participants included saving time, being accurate when conducting medical tasks, and enabling them to be more productive. Participants expressed concern about robots being unreliable, hazardous to patients, and inappropriate for performing some tasks (e.g., those that involve close patient contact). These findings provide insights into healthcare providers' attitudes and preferences for assistance from a mobile manipulator robot.

Medication Management Apps: Usable by Older Adults?

For older adults, managing medications can be a burden and could lead to medication non-adherence. To decrease risks associated with medication non-adherence, healthcare providers may recommend medication reminder apps as an assistive tool. However, these apps are often not designed with consideration of older adults' needs, capabilities, and limitations. To identify whether available apps are suitable for older adults, we conducted an in-depth cognitive walkthrough and a heuristic evaluation of the most commonly downloaded medication reminder app. Findings revealed three main issues: 1) difficulty in navigation, 2) poor visibility, and 3) a lack of transparency. We also selected the top five downloaded medication reminder apps and categorized user reviews to assess app functionality and usability problems. The results of our analysis provide guidance for app design for older adult users to provide effective tools for managing medications and supporting patient/user health.

How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR's Rehabilitation Engineering Research Centers.

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a "total approach to rehabilitation", combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970's, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.

Understanding the Potential of PARO for Healthy Older Adults.

As the population ages, there is an increasing need for socio-emotional support for older adults. A potential way to meet this need is through interacting with pet-type robots such as the seal robot, PARO. There was a need to extend research on PARO's potential benefits beyond cognitively impaired and dependently living older adults. Because independently living, cognitively intact older adults may also have socio-emotional needs, the primary goal of this study was to investigate their attitudes, emotions, and engagement with PARO to identify its potential applicability to this demographic. Thirty older adults participated in an interaction period with PARO, and their attitudes and emotions toward PARO were assessed before and after using a multi-method approach. Video of the interaction was coded to determine the types and frequency of engagements participants initiated with PARO. Overall, there were no pre-post interaction differences on these measures. However, semi-structured interviews suggested that these older adults had positive attitudes towards PARO's attributes, thought it would be easy to use, and perceived potential uses for both themselves and others. Participants varied in their frequency of engagement with PARO. A novel finding is that this active engagement frequency uniquely predicted post-interaction period positive affect. This study advances understanding of healthy older adults' attitudes, emotions, and engagement with PARO and of possible ways in which PARO could provide social and emotional support to healthy older adults. The results are informative for future research and design of pet-type robots.

Envisioning the Future for Older Adults: Autonomy, Health, Well-being, and Social Connectedness with Technology Support.

Envisioning the future of older adults of 2050 is a challenging task given the heterogeneity of the older adult population. We consider primarily the domains of home, health, and social participation for individuals over age 65 and the potential role of information, communication, and robotic technology for enhanced independence, maintenance of autonomy, and enriched quality of life. We develop several scenarios to illustrate the diversity of circumstances, health, and living situations for older adults in the future. We discuss possible negative outcomes resulting from the proliferation of technology, including increased social isolation and a widening digital divide. However, we focus primarily on envisioning desired situations wherein older adults have autonomy and independence; are easily able to manage their health and wellness needs; have rich and rewarding opportunities for social connectedness, personal growth, continued life purpose, and overall high quality of life. To attain this future, we must be acting now: designing the technology with involvement by today's older adults who represent the needs and capabilities of tomorrow's older adults; developing the necessary infrastructure to support widespread availability and deployment of these technologies; and supporting the integration of technology into people's lives at younger ages with adaptive functionality to support changing needs and preferences.

Older Adults' Acceptance of Activity Trackers.

OBJECTIVE: To assess the usability and acceptance of activity tracking technologies by older adults. METHOD: First in our multimethod approach, we conducted heuristic evaluations of two activity trackers that revealed potential usability barriers to acceptance. Next, questionnaires and interviews were administered to 16 older adults ( Mage = 70, SDage = 3.09, rangeage = 65-75) before and after a 28-day field study to understand facilitators and additional barriers to acceptance. These measurements were supplemented with diary and usage data and assessed whether and why users overcame usability issues. RESULTS: The heuristic evaluation revealed usability barriers in System Status Visibility, Error Prevention, and Consistency and Standards. The field study revealed additional barriers (e.g., accuracy, format) and acceptance-facilitators (e.g., goal tracking, usefulness, encouragement). DISCUSSION: The acceptance of wellness management technologies, such as activity trackers, may be increased by addressing acceptance-barriers during deployment (e.g., providing tutorials on features that were challenging, communicating usefulness).

Older Users' Acceptance of an Assistive Robot: Attitudinal Changes Following Brief Exposure.

INTRODUCTION: Many older adults wish to age-in-place. Robot assistance at home may be beneficial for older adults who are experiencing limitations in performing home activities. In this study we investigate older Americans' robot acceptance before and after exposure to a domestic mobile manipulator, with an emphasis on understanding trialability (i.e., "trying out" a robot for a short time period) and result demonstrability (i.e., observing the results of the robot's functionality). METHOD: Older adult participants observed a mobile manipulator robot autonomously demonstrating three tasks: delivering medication, learning to turn off a light switch, and organizing home objects. We administered pre and post exposure questionnaires about participants' opinions and attitudes toward the robot, as well as a semi-structured interview about each demonstration. RESULTS: We found that demonstration of a mobile manipulator assistive robot did, in fact, influence older adults' acceptance. There was a significant increase, pre vs. post, in positive perceptions of robot usefulness and ease of use for 8 of the 12 Robot Opinions Questionnaire items. Furthermore, in the Assistance Preference Checklist, eighteen tasks significantly differed between pre and post exposure, with older adults showing a greater openness to robot assistance after exposure to the robot. CONCLUSION: Thus, demonstration of robot capability positively affected older adults' preferences for robot assistance for tasks in the home. Interview data suggest that the robot's capability and reliability influenced older adults' first impressions of the robot.

Acceptance of televideo technology by adults aging with a mobility impairment for health and wellness interventions.

Televideo technology (e.g., Skype) has potential to support adults as they age by facilitating their interactions with people remotely; this potential may be even greater for adults aging with pre-existing mobility impairments, who face challenges interacting with others in person due to lack of transportation or accessibility. Our research employed questionnaire and interview methodologies to investigate this understudied population about their attitudes toward televideo technology for supporting social engagement, healthcare provider access, and physical activity. Participants were 14 adults aging with self-reported mobility impairments (50-70 years of age). Overall, participants were open to accepting televideo technology for social engagement, healthcare provider access, and physical activity. Participants perceived these technologies to be useful and perceived additional benefits, including the feeling of "being there" by enabling the viewing of facial expressions and the environment of the other person. Concerns included perceptions that televideo technologies lack security and privacy. Participants also expressed concerns that these technologies are difficult to use and are difficult to learn to use. The findings have implications for education, training, and deployment of televideo technology for home-based interventions for adults aging with pre-existing mobility impairments.

Understanding older adults' perceptions of and attitudes towards exergames.

PURPOSE: Maintaining physical activity is a key component of successful aging and has benefits for both physical and cognitive functioning in the older adult population. One promising method for engaging in physical activity is through exergames, which are video games designed to promote exercise. Exergames have the potential to be used by a wide range of people, including older adults, in a variety of settings, such as at home, in community living environments, or senior centers. However, exergames have not been designed for older adults (e.g., with respect to their attitudes, needs). Thus, older adults may not adopt these systems if they perceive them as not useful or relevant to them. METHOD: Twenty older adults (aged 60-79) interacted with two exergames, and were then interviewed about their perceptions of the system's ease of use and usefulness, as well as their general attitudes towards the system. RESULTS: Participants identified the potential for exergames' usefulness for various goals, such as to increase their physical activity. However, they also reported negative attitudes concerning the system, including perceiving barriers to system use. Overall, participants said they would use the system in the future and recommend it to other people at their age for improving health, despite these use challenges. CONCLUSION: The older adults were open to adopting exergames, which could provide opportunities to increase physical activity. Given the participants' overall positive perceptions of the usefulness of exergames, designers must address the perceived challenges of using these systems. Understanding barriers and facilitators for older adults' use of exergames can guide design, training, and adoption of these systems.

Predicting Older Adults' Perceptions about a Computer System Designed for Seniors.

PURPOSE: Although computer technology may be particularly useful for older adults (e.g., for communication, information access), they have been slower adopters than their younger counterparts. Perceptions about computers such as perceived usefulness and perceived ease of use can pose barriers to acceptance and universal access [1]. Therefore, understanding the precursors to these perceptions for older adult non-computer users may provide insight into the reasons for their non-adoption. METHODS: We examined the relationship between perceived usefulness and perceived ease of use of a computer interface designed for older users and demographic, technology experience, cognitive abilities, personality, and attitudinal variables in a sample of 300 non-computer using adults between the ages of 64 and 98, selected for being at high risk for social isolation. RESULTS: The strongest correlates of perceived usefulness and perceived ease of use were: technology experience, personality dimensions of agreeableness and openness to experience, and attitudes. The emotional stability personality dimension was significantly correlated with perceived ease of use but not perceived usefulness. Hierarchical regression analysis revealed that attitudes (i.e., self-efficacy, comfort, interest) remained predictive of perceptions of usefulness and ease of use when technology experience and personality variables were accounted for. CONCLUSION: Given that attitudes are more malleable than other variables, such as demographic and cognitive abilities, these findings highlight the potential to increase technology acceptance through positive experiences, appropriate training, and educational campaigns about the benefits of computers and other technologies.

Perceptions of Computer System Usefulness: Insights for Design from Experienced Older Users.

Computer systems have the potential to assist older adults by supporting independence, enhancing social communication, and enabling healthcare activities. Yet older adults' adoption rates continue to lag behind younger and middle-aged adults. We report data from 249 older adult computer users (65-93 years of age) that identify the details of their perceptions of computer usefulness for a range of everyday activities. Participants rated the importance of activities to their quality of life and the usefulness of current computer systems for supporting those activities. These experienced computer users indicated that computers were meeting their needs for some activities (e.g., social communication, games) but not for other activities (e.g., calendaring, healthcare, recreation and learning). Our data provide guidance for (a) introducing the potential of computer systems to current non-users and (b) designing systems targeted to meet the needs of older adults and enhancing computing functionality for them.