Understanding changes and stability in the long-term use of technologies by seniors who are aging in place: a dynamical framework.

BACKGROUND: If technologies are to support aging in place, then it is important to develop fundamental knowledge on what causes stability and changes in the use of technologies by seniors. However, longitudinal studies on the long-term use of technologies that have been accepted into the home (i.e., post-implementation use) are very scarce. Many factors potentially could influence post-implementation use, including life events, age-related decline, changes in personal goal orientation, and various types of social influences. The aforementioned factors are likely to be interrelated, adding to the complexity. The goal of this study is to better understand changes and stability in the use of technologies by independent-living seniors, by using a dynamical systems theory approach. METHODS: A longitudinal qualitative field study was conducted involving home visits to 33 community-dwelling seniors in the Netherlands, on three occasions (2012-2014). Interviews were held on technology usage patterns, including reasons for stable, increased, declined and stopped use. Technologies were included if they required electric power in order to function, were intended to be used in or around the home, and could support activities of daily living, personal health or safety, mobility, communication, and physical activity. Thematic analysis was employed, using constant case comparison to better understand dynamics and interplay between factors. In total, 148 technology use patterns by 33 participants were analyzed. RESULTS: A core of six interrelated factors was closely linked to the frequency of technology use: emotional attachment, need compatibility, cues to use, proficiency to use, input of resources, and support. Additionally, disruptive forces (e.g., social influences, competition with alternative means, changes of personal needs) could induce change by affecting these six factors. Furthermore, long-term technology use was in some cases more resilient to disruption than in other cases. Findings were accumulated in a new framework: Dynamics In Technology Use by Seniors (DITUS). CONCLUSIONS: Similar to aging, the use of technologies by older people is complex, dynamic and personal. Periods of stability and change both occur naturally. The DITUS framework can aid in understanding stability and instability of technology use, and in developing and implementing sustainable technological solutions for aging in place.

Origins and consequences of technology acquirement by independent-living seniors: towards an integrative model.

BACKGROUND: Living independently can be challenging for seniors. Technologies are expected to help older adults age in place, yet little empirical research is available on how seniors develop a need for technologies, how they acquire these technologies, and how these subsequently affect their lives. Aging is complex, dynamic and personal. But how does this translate to seniors' adoption and acceptance of technology? To better understand origins and consequences of technology acquirement by independent-living seniors, an explorative longitudinal qualitative field study was set up. METHODS: Home visits were made to 33 community-dwelling seniors living in the Netherlands, on three occasions (2012-2014). Semi-structured interviews were conducted on the timeline of acquirements, and people and factors involved in acquirements. Additionally, participants were interviewed on experiences in using technologies since acquirement. Thematic analysis was employed to analyze interview transcripts, using a realist approach to better understand the contexts, mechanisms and outcomes of technology acquirements. RESULTS: Findings were accumulated in a new conceptual model: The Cycle of Technology Acquirement by Independent-Living Seniors (C-TAILS), which provides an integrative perspective on why and how technologies are acquired, and why these may or may not prove to be appropriate and effective, considering an independent-living senior's needs and circumstances at a given point in time. We found that externally driven and purely desire-driven acquirements led to a higher risk of suboptimal use and low levels of need satisfaction. CONCLUSIONS: Technology acquirement by independent-living seniors may be best characterized as a heterogeneous process with many different origins, pathways and consequences. Furthermore, technologies that are acquired in ways that are not congruent with seniors' personal needs and circumstances run a higher risk of proving to be ineffective or inappropriate. Yet, these needs and circumstances are subject to change, and the C-TAILS model can be employed to better understand contexts and mechanisms that come into play.

Exploring Innovative Solutions for Quality of Life and Care of Bed-Ridden Nursing Home Residents through Codesign Sessions.

Bed-ridden nursing home residents are in need of environments which are homelike and facilitate the provision of care. Design guidance for this group of older people is limited. This study concerned the exploration and generation of innovative environmental enrichment scenarios for bed-ridden residents. This exploration was conducted through a combination of participatory action research with user-centred design involving 56 professional stakeholders in interactive work sessions. This study identified numerous design solutions, both concepts and products that are available on the marketplace and that on a higher level relate to improvements in resident autonomy and the supply of technological items and architectural features. The methodology chosen can be used to explore the creative potential of stakeholders from the domain of healthcare in product innovation.

Stress induces increases in IL-6 production by leucocytes of patients with the chronic inflammatory disease juvenile rheumatoid arthritis: a putative role for alpha(1)-adrenergic receptors.

Juvenile rheumatoid arthritis (JRA) is characterized by chronic inflammation of the joints. In the present study we demonstrate that exposure of JRA patients to a noradrenergic stressor (cold pressor test) results in enhanced LPS-induced IL-6 production by peripheral blood cells of these patients. Healthy, age-matched controls had the same rise in norepinephrine, but do not respond with changes in IL-6 production after exposure to the cold pressor test. Moreover, PBMC of patients with JRA express mRNA encoding alpha(1)-adrenergic receptors (AR), predominantly of the alpha(1d)-AR subtype. In contrast, we could not detect mRNA encoding for alpha(1)-AR in PBMC of healthy controls. The results of this study suggest that expression of alpha(1)-AR mRNA in PBMC during chronic inflammation is associated with altered responses of the immune system to stress.

Noradrenaline induces phosphorylation of ERK-2 in human peripheral blood mononuclear cells after induction of alpha(1)-adrenergic receptors.

alpha(1)-Adrenergic receptors (ARs) are not expressed by peripheral blood mononuclear cells (PBMCs) of healthy human individuals. However, in the present study we show that alpha(1)-ARs can be induced in lymphocytes after culturing with either the mitogen PHA or the glucocorticoid dexamethasone. Moreover, incubation of these activated PBMCs with noradrenaline (NA) results in enhanced phosphorylation of ERK-2, a kinase involved in the activation of many immune functions. Similar induction of alpha(1)-AR mRNA with concomitant NA-induced activation of ERK-2 occurs in monocytes after culture with LPS. Our results demonstrate that functional alpha(1)-ARs can be induced on PBMCs and that these alpha(1)-ARs mediate NA-induced activation of ERK-2.

Naturally induced secretions of the potato cyst nematode co-stimulate the proliferation of both tobacco leaf protoplasts and human peripheral blood mononuclear cells.

Naturally induced secretions from infective juveniles of the potato cyst nematode Globodera rostochiensis co-stimulate the proliferation of tobacco leaf protoplasts in the presence of the synthetic phytohormones alpha-naphthaleneacetic acid (NAA) and 6-benzylaminopurine (BAP). With the use of a protoplast-based bioassay, a low-molecular-weight peptide(s) (< 3 kDa) was shown to be responsible for the observed effect. This mitogenic oligopeptide(s) is functionally dissimilar to auxin and cytokinin and, in addition, it does not change the sensitivity of the protoplasts toward these phytohormones. In combination with the mitogen phytohemagglutinin (PHA), cyst nematode secretions also co-stimulated mitogenesis in human peripheral blood mononuclear cells (PBMC). The stimulation of plant cells isolated from nontarget tissue--these nematodes normally invade the roots of potato plants--suggests the activation of a general signal transduction mechanism(s) by an oligopeptide(s) secreted by the nematode. Whether a similar oligopeptide-induced mechanism underlies human PBMC activation remains to be investigated. Reactivation of the cell cycle is a crucial event in feeding cell formation by cyst nematodes. The secretion of a mitogenic low-molecular-weight peptide(s) by infective juveniles of the potato cyst nematode could contribute to the redifferentiation of plant cells into such a feeding cell.

Neuroendocrine mediators up-regulate alpha1b- and alpha1d-adrenergic receptor subtypes in human monocytes.

Beta2- and alpha2-adrenergic receptors (AR) are thought to be the main AR subtypes to exert the effects of catecholamines on the immune system. However, in the present study, we demonstrate that another subtype of AR can be induced in human monocytes. Expression of alpha1b- and alpha1d-AR mRNA can be obtained by culturing freshly isolated human peripheral blood monocytes with the neuroendocrine mediators dexamethasone or the beta2-AR agonist terbutaline. Using the human monocytic cell line THP-1, we demonstrate that increased levels of alpha1b- and alpha1d-mRNA are accompanied by increased levels of receptor protein as determined by Western blot analysis and radioligand binding assays. This study describes for the first time regulated expression of alpha1-AR subtypes in human monocytes.

Functional alpha 1-adrenergic receptors on leukocytes of patients with polyarticular juvenile rheumatoid arthritis.

During the last decade it has been shown that the central nervous system can influence the immune system. In healthy individuals, catecholamines can inhibit the production of pro-inflammatory cytokines like interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) via interaction with beta 2-adrenergic receptors. In contrast, we show here that catecholamines can stimulate the production of the interleukin-6 (IL-6) in children with the chronic inflammatory disease polyarticular juvenile rheumatoid arthritis (JRA). The induction of IL-6 is mediated by triggering of alpha 1-adrenergic receptors on peripheral blood leucocytes of the patients with polyarticular JRA. Functional alpha 1-adrenergic receptors are absent on leukocytes of normal donors and on leukocytes of patients with the oligoarticular form of the disease.