Can Changes in Older Adults' Technology Use Patterns be Used to Detect Cognitive Decline?

BACKGROUND AND OBJECTIVES: The number of older adults diagnosed with dementia is expected to more than double by mid-century. Monitoring older adults' cognitive functioning is essential for the early detection of dementia, which can increase treatment efficacy and slow the disease progression. Current approaches to detect preclinical dementia are expensive, invasive, and are not accessible to everyone. This study aimed to determine whether technology use patterns could be used as an indicator of cognitive change. RESEARCH DESIGN AND METHODS: Using six waves (2015 - 2020) from the National Health and Aging Trends Study (NHATS), we examined within-person and between-person effects of stopping four types of technology use on four cognitive outcomes. RESULTS: Our analyses showed that stopping the use of the Internet, computers, tablets, and sending texts and emails were related to cognitive decline. DISCUSSION AND IMPLICATIONS: These results suggest that monitoring technology use patterns may be an innovative approach that is economical and efficient to identify individuals at risk of cognitive decline.

Social Media Use May Not Be As Bad As Some Suggest: Implication for Older Adults.

Background and Objectives: Social media use (SMU) has increased over the past decade among older adults. Cross-sectional studies report SMU is related to negative mental health outcomes (i.e., depression). Given depression is the most common mental health issue for older adults and increases the risk of morbidity and mortality, determining longitudinally whether SMU is related to increased depression is critical. This study examined the longitudinal relationship between SMU and depression. Research Design and Methods: Data from 6 waves (2015-20) of the National Health and Aging Trends Study (NHATS) were analyzed. Participants included a nationally representative sample of U.S. older adults, aged 65 years and older (N = 7,057). We used a Random Intercept Cross-Lagged Panel Modeling (RI-CLPM) framework to examine the relationship between primary outcomes of SMU and depression symptoms. Results: No pattern was found of SMU predicting depression symptoms, or depression symptoms predicting SMU. The major driver of SMU in each wave was SMU in the previous wave. On average, our model accounted for 3.03% of the variance in SMU. The major predictor of depression in each wave was the pre-existing depression. Our model accounted for an average of 22.81% of the variance in depressive symptoms. Discussion and Implications: The results suggest that SMU and depressive symptoms are driven by the previous patterns of SMU and depression, respectively. We did not find any patterns of SMU and depression influencing each other. NHATS measures SMU with a binary instrument. Future longitudinal research should employ measures that account for SMU duration, type, and purpose. These findings suggest that SMU may not be related to negative health outcomes, in this case, depression, for older adults.

Online health information seeking and the association with anxiety among older adults.

Introduction: The Internet supplies users with endless access to a wealth of information and is generally the first source searched by U.S. adults (18 years and older) when seeking health information. Age and anxiety are associated with online health information seeking (OHIS). Older adults (65 years and older) are increasing their OHIS. Importantly, OHIS can potentially lead to improved health outcomes for older adults. The relationship between OHIS and anxiety is less clear. Studies report those with more symptoms of anxiety are more likely to be OHIS, while other studies find the reverse pattern or no association. Generalized anxiety disorder affects up to 11% of older adults and is oftentimes unrecognized and untreated. Methods: To address the mixed findings in the literature, we analyzed six waves (2015-2020) of data from the National Health and Aging Trends Study to assess the causal relationship between anxiety and OHIS using a Random Intercept Cross-lagged Panel Model framework. Results: We found that while anxiety symptoms lead to OHIS in the next wave, OHIS was not associated with anxiety symptoms in the next wave. Discussion: This suggests that for this sample of older adults, OHIS does not reduce or exacerbate older adults' symptoms of anxiety.

Active and passive social media use are differentially related to depressive symptoms in older adults.

OBJECTIVES: Previous research on social media use (SMU) and mental health has focused on younger individuals. For example, in young adults active SMU (e.g. posting content) has been related to decreased depressive symptoms, whereas passive SMU (e.g. browsing content) has been related to increased depressive symptoms. These relationships have not yet been investigated in older adults, however, even though SMU and poor mental health are common. METHODS: We collected data from adults aged 65 years and older, and categorized SMU into active and passive dimensions with a principal component analysis. Next, we conducted t-tests and logistic regressions to assess whether older adults' SMU was associated with depressive symptoms. RESULTS: Our analysis revealed that active SMU was associated with increased odds for depressive symptoms, whereas passive SMU was associated with decreased odds for depressive symptoms. CONCLUSION: Our results suggest that the relationships between active and passive SMU and depressive symptoms in older adults are different from previous literature focusing on younger individuals. We theorize that these findings may be due to older adults' engaging in fewer social comparisons overall, and hence experiencing fewer negative feelings while passively viewing others' social media posts.

Established Adults, Who Self-Identify as Smartphone and/or Social Media Overusers, Struggle to Balance Smartphone Use for Personal and Work Purposes.

Smartphone ownership and use continues to proliferate, allowing people to easily access online communication, entertainment, and information. Importantly, individuals can perceive that they overuse their smartphone and/or the social media applications (apps) they access on their devices. Much of the research on smartphone overuse has focused on youth and emerging adults, with little research focusing on individuals in the established adulthood stage of life. This study examines smartphone use among established adults who perceive that they overuse their smartphone and/or social media. As part of a larger study, we conducted in-depth interviews with 21 individuals (30-45 years old) who self-identified as smartphone and/or social media overusers. Data were collected through a pre-survey, 1-hour interview, and smartphone use screenshots. Audio-recorded interviews were transcribed and then coded using NVivo software. Participants' average age was 35.9 years (SD = 4.1). The majority of the sample were female (67%), White (76%), and had a master's degree or higher (76%). Participants spent an average of 215 min on their smartphone daily, primarily using social media, video conferencing, and texting apps. Issues with smartphone use occurred when there was an unclear separation between work and personal use. Participants felt pressure to always respond quickly to work emails. An effort was made to limit smartphone use for work and during family time to be present for their family. Established adults strive to balance smartphone use for personal and work purposes. Creating boundaries for how and when established adults use their smartphone may help them find this balance.

The effect of an mHealth intervention for adolescents with Type 1 diabetes and their parents.

BACKGROUND: Past research has demonstrated that adolescents with Type 1 diabetes (T1D) typically have a decline in health outcomes as they begin to assume more self-management activities. Mobile app interventions have been suggested as one possible way to improve this behavior. PURPOSE: The primary aim of this study was to address declines in health outcomes by pilot testing the satisfaction, use and feasibility of an app-based family communication intervention aimed to assist in adolescent self-management of T1D. METHODS: Thirty-three adolescent-parent pairs were enrolled in and completed the 12-week pilot study. Participants were randomized 2:1 to intervention (app use) or control group. Pre/post quantitative and qualitative data were collected, including HbA1c and surveys. Paired-sample t-tests and ANOVA statistics were conducted. RESULTS: The parents and adolescents reported high satisfaction with the app, and that it was easy to use. Results showed HbA1c stability in the intervention group and significant worsening in the control group. There were also significant improvements in adherence to diabetes management and quality of life for the parents in the intervention group. The adolescents did not show any improvement in quality-of-life measures. CONCLUSION: This study suggests that the app intervention is acceptable, shows promise for improving health outcomes for adolescents with T1D, and may improve family communication. The public health implications of this work are that app interventions have a potential role in positively influencing chronic disease outcomes. Additional research with a more extensive and diverse sample is needed to determine generalizability.

A mobile application-based home assessment tool for patients undergoing joint replacement surgery: A qualitative feasibility study.

BACKGROUND: Most adults prefer to age in place. However, the majority of homes are not designed to support resident needs, especially for adults undergoing joint replacement surgeries such as total knee arthroplasty (TKA) or total hip arthroplasty (THA). It is of paramount importance to proactively assess and modify the homes of adults undergoing TKA/THA such that they can safely transition home following surgery. Several tools utilize emerging technology like virtual reality, augmented reality, or teleconferencing to assess home environments. These are meant to be used by professionals like occupational therapists. However, the acceptance and uptake of simple technology like mobile applications for assessing homes proactively by residents has not been explored. OBJECTIVE: A qualitative exploratory study was conducted to evaluate the feasibility and potential acceptance of a mobile application for resident-initiated home assessment. METHODS: Semi-structured interviews were conducted with 22 patient-care partner dyads before and after THA/TKA to understand the perceived usefulness, likelihood of using a mobile application-based home assessment tool, and perceived barriers and facilitators of using the tool. RESULTS: About 68% of the patient-care partner dyads interviewed for this study perceived benefits of using a mobile application-based tool. All the participants who perceived the tool to be useful showed high likelihood of using it. A comparison of responses between pre-and post-surgery interviews revealed that around 50% of participants showed an increased intention of using an assessment tool after experiencing challenges in their homes post-surgery. Participants provided recommendations for key content, potential features to include in the assessment tool, and preferred formats (e.g., checklists, visuals, and videos). CONCLUSIONS: To increase acceptance of a mobile application-based home assessment tool, it is crucial that residents are made aware of the home environment challenges and the importance of an assessment tool to improve their safety and independence. The content, features, formats, and usability suggestions from the participants in this study provide a framework for health mobile application and interface developers to design a home assessment tool.

Social media use and well-being among older adults.

While older adults (aged 65 years and older) are increasingly using social media, their usage rates still lag those of younger age groups. Social media use has been observed to have some positive effects on older adults' well-being; however, divergent findings exist depending upon the sample, measures, and methodological approach. This review highlights what is currently known about social media use and well-being among older adults, identifies strengths and weaknesses of current research on this topic, and argues that methodological and content-related research gaps must be closed before researchers can confirm a positive overall effect of social media use in everyday situations for older adults.

COVID-19's Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators.

BACKGROUND: The prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them. OBJECTIVE: This study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic. METHODS: LTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic. RESULTS: LTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53% (37/70) of the LTC facilities have purchased ICTs for residents' use. ICTs have mainly been used for videoconferencing with family members (31/36, 86%), friends (25/36, 69%), and health care providers (26/36, 72%). NHs were 10.23 times more likely to purchase ICTs for residents' use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology. CONCLUSIONS: Our results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents' engagement and communication opportunities, such as another pandemic.

An mHealth-Based Intervention for Adolescents With Type 1 Diabetes and Their Parents: Pilot Feasibility and Efficacy Single-Arm Study.

BACKGROUND: Type 1 diabetes (T1D) affects more than 165,000 individuals younger than 20 years in the United States of America. The transition from parent management to parent-child team management, with the child taking on increased levels of self-care, can be stressful and is associated with a deterioration in self-management behaviors. Therefore, a mobile app intervention, MyT1DHero, was designed to facilitate diabetes-specific positive parent-adolescent communication and improve diabetes-related outcomes. The MyT1DHero intervention links an adolescent with T1D and their parent through 2 separate app interfaces and is designed to promote positive communication regarding T1D management. OBJECTIVE: The aim of this pilot study was to determine (1) the initial efficacy of the MyT1DHero intervention in improving diabetes outcomes in adolescents, specifically the hemoglobin A1c (HbA1c) levels, diabetes care adherence, and quality of life, and (2) the adolescents' overall satisfaction with this intervention. METHODS: This pilot study included 30 adolescent-parent pairs who used the MyT1DHero app in a 12-week single-arm clinical trial. Participants were recruited from the local pediatric endocrinology subspecialty clinic via snowball sampling. HbA1c levels, diabetes care adherence, quality of life, family conflict, and satisfaction levels were measured and analyzed using paired sample two-sided t tests and linear regression analyses. RESULTS: The final analysis included 25 families. The mean age of the adolescents was 12.28 (SD 1.62) years. Half of the participants (13/25) reported a diabetes diagnosis of less than 5 years. After 12 weeks of the intervention, diabetes care adherence significantly improved (before the study: mean 3.87 [SD 0.59]; after the study: mean 4.19 [SD 0.65]; t21=-2.52, P=.02, d=0.52) as did quality of life (before the study: mean 4.02 [SD 0.84]; after the study: mean 4.27 [SD 0.73]; t24=2.48, P=.01, d=0.32). HbA1c levels (before the study: mean 8.94 [SD 1.46]; after the study: mean 8.87 [SD 1.29]; t24=0.67, P=.51, d=0.04) and family conflict (before the study: mean 2.45 [SD 0.55]; after the study: mean 2.61 [SD 0.45]; t23=0.55, P=.14, d=0.32) changed in the hypothesized direction, but the change was not significant. However, higher use of the mobile app was associated with more improvement in HbA1c levels (F1,20=9.74, P<.005; R2=0.33). Overall, the adolescents were satisfied with the app intervention. CONCLUSIONS: In a 12-week pilot study of the mobile app intervention designed to facilitate parent-adolescent communication for improving diabetes outcomes, significant benefits were demonstrated in self-care adherence and quality of life. A randomized controlled trial with a longer intervention is needed to replicate these findings and to determine the stability of the intervention effects. TRIAL REGISTRATION: ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628.

Willingness to Use Automated Vehicles: Results From a Large and Diverse Sample of U.S. Older Adults.

The diffusion of fully automated vehicles (AVs), or self-driving vehicles, is expected to provide many affordances for older adults. If older adults are not willing to use AVs, they will not be able to reap these affordances. Understanding factors related to older adults' willingness to use AVs is key to ensuring that successful strategies can be devised to promote their utilization in the future. In this study, we investigate U.S. older adults' willingness to use AVs among a large and diverse sample (N = 1,231). We assessed sociodemographic, population density, health, and attitudinal determinants of willingness to use AVs. Our binary logistic regression results showed that older adults with higher levels of educational attainment, transportation limitations, and positive attitudes toward new technology adoption were more likely to be willing to use AVs. Our study indicates that older adults' willingness to use AVs are complex and vary among U.S. older adults. Practical implications and study limitations are discussed.

Mobility challenges and perceptions of autonomous vehicles for individuals with physical disabilities.

BACKGROUND: Individuals with physical disabilities face many challenges, especially with mobility. Transportation plays a key role in an individual's health as it provides the access to critical services such as medical visits. Autonomous vehicles (AVs) can be one possible solution to increase transportation accessibility. However, there is currently limited information detailing the obstacles individuals with disabilities face when it comes to mobility, or research regarding perceptions of this population toward autonomous vehicles. OBJECTIVE: The goals of this study were twofold: 1) to identify the accessibility needs associated with transportation for individuals with a physical disability and 2) to understand the initial perceptions of this population towards autonomous vehicles to meet these needs. METHODS: A survey with multiple choice and short-answer questions was developed to gather data on transportation issues and experiences from individuals with physical disabilities. This survey was distributed to disability networks. RESULTS: Our results illustrate the many challenges that individuals with physical disabilities experience related to transportation, such as cost, time for planning, and convenience of use. We also found that individuals with physical disabilities had an overall positive attitude towards AVs and would be willing to pay the same price as private transportation or possibly more to use AVs if it had the proper accessibility and safety features. CONCLUSIONS: Overall, this work can be used to inform decisions surrounding accessibility of current transportation as well as guide the planning and design of autonomous vehicles for a population with physical disabilities.

A Double Burden of Exclusion? Digital and Social Exclusion of Older Adults in Times of COVID-19.

The COVID-19 pandemic has excluded older adults from a society based on physical social contact. Vulnerable populations like older adults also tend to be excluded from digital services because they opt not to use the internet, lack necessary devices and network connectivity, or inexperience using the technology. Older adults who are frail and are not online, many of whom are in long-term care facilities, struggle with the double burden of social and digital exclusion. This paper discusses the potential outcomes of this exclusion and provides recommendations for rectifying the situation, with a particular focus on older adults in long-term care facilities.

Problematic Social Media Use and Perceived Social Isolation in Older Adults: A Cross-Sectional Study.

BACKGROUND: Social isolation in older adults is associated with numerous adverse health outcomes. In today's digital society, if individuals perceive themselves to be socially isolated, they can take steps to interact with others on social media platforms. Research with younger adults indicates that social media use is positively linked to social isolation. However, less is known about social media use and social isolation in older adults. OBJECTIVE: The objective of this study was to investigate the possible association between social isolation and degree of social media use in older adults. METHODS: Using Internet sources, we recruited 213 participants (79.8% female; mean age 62.6 years, SD 8.3) who responded to an online survey focusing on living situation, depression, social isolation, and 2 measures of social media use: estimated daily time on social media and problematic social media use. Next, using binary logistic regression, we assessed associations between social isolation and social media use. RESULTS: Our analyses failed to identify a relationship between perceived social isolation and estimated daily time on social media; however, higher problematic social media use was associated with higher perceived social isolation (OR 1.17). DISCUSSION AND CONCLUSION: Although no causal attribution can be made, our findings demonstrate an association between problematic social media use and perceived social isolation in older adults. Researchers conducting social media interventions in older adults should note this potential and monitor maladaptive use of these platforms. Overall, our results provide an important starting point for future studies on social media use and social isolation in older adults.

Factors Associated with Older Adults' Long-Term Use of Wearable Activity Trackers.

Background: Wearable activity trackers (WATs) have the potential to improve older adults' health; yet, many adopters of WATs are not able to use them on a long-term basis. Methods: A survey was conducted with an online panel of adults 65 and older (N = 214) to explore factors associated with long-term use of WATs, including initial adoption motivations, usage patterns, as well as differences in sociodemographic factors, health status, and activity levels. Results: Results from the logistic regression analysis indicated that being a long-term WAT user was significantly associated with using a wider variety of WAT functions, wearing WAT every day, being female, exercising more frequently, having higher education, not engaging in step count competition, and not having chronic conditions. Conclusions: Understanding long-term use of WATs among older adults is important given that this technology is prone to be abandoned quickly after initial adoption and such abandonment negates its potential in supporting long-term health behavior change. Findings of this study will inform innovative WAT designs that afford long-term use and offer helpful strategies for future interventions using WATs among older adults.

Using User-Feedback to Develop a Website: MyT1DHope, for Parents of Children with T1D.

Effectively caring for a child with type-1 diabetes (T1D) can be extremely demanding and stressful for the entire family. The difficulties of caring for a child with T1D impact the psychological and physical well-being of the parents. Interventions aimed at reducing stress and increasing coping may improve parental outcomes. This project sought to develop a resource to be used as a preliminary intervention step for these parents. This research was conducted in two parts. Part 1 includes three stages of formative evaluation, including a focus group, interviews, and a survey with parents to examine the current landscape of diabetes websites as a resource. Using data from Part 1, Part 2 of the study included the identification of a theory to guide the design of a website, the development of the website, and an 8-week pilot study of the website with parents with a child with T1D. Significant improvements were found in diabetes knowledge and caregivers' satisfaction of life. No changes were found in social support, self-efficacy, or quality of life. Overall, the data show that the parents were generally satisfied with the website. Through this work, researchers were able to develop a deeper understanding of the needs of parents caring for a child with T1D to develop the initial component of a larger intervention.

Workplace Bullying Among Nurses: Developing a Model for Intervention.

Workplace bullying is endemic to the nursing profession and it threatens nurses' health and ability to work safely. However, effective interventions to prevent workplace bullying are lacking. A sample of hospital nurses (n = 15) explored experiences of bullying and ideas for intervention via four focus groups in 2016. Four main themes emerged from the qualitative content analysis: (a) characteristics that define bullying behavior; (b) facilitators of bullying; (c) consequences of bullying; and (d) possible interventions. Although personal characteristics played a role, bullying was primarily facilitated by workplace and organizational factors that hindered the establishment of collegiality and team trust among nurses. Findings have informed a conceptual model for prevention of nurse-to-nurse bullying with ethical leadership and communication, trust, and social cohesion in work teams as key elements.

A Pilot Study Examining the Effects of Educational Setting and Stress on Multitasking Among Medical Students.

This study examines multitasking with media and technology among medical students across four learning contexts (lecture, lab, team-based learning, and homework) and whether stress moderates the relationship between multitasking and academic performance. The proliferation of technology simultaneously used for learning, entertainment, and socialization facilitates multitasking in learning environments. There is comparatively little research on multitasking behavior among medical students. Data were collected using a survey distributed online to four cohorts of an allopathic medical school to examine the relationship of multitasking and academic performance using both descriptive and correlational analyses of multitasking behavior in each of the four learning contexts. A moderation analysis was used to investigate the role of stress in this relationship. Lower multitasking was reported as learning contexts became more active (e.g., lecture versus lab). Some respondents, however, appeared resilient to the changing environment, maintaining high levels of multitasking. In the low multitasking environment of lab, respondents with high levels of stress, who multitasked heavily, reported better academic performance. Approaches to multitasking must account for learning environments and the individual propensities of students. Additionally, some forms of multitasking may not be counterproductive to learning, but the boundaries between productive and counterproductive multitasking are difficult to distinguish.

The Physical-Digital Divide: Exploring the Social Gap Between Digital Natives and Physical Natives.

Older adults are the most digitally divided demographic group. The present study explores how older adults perceive the physical use of information and communication technologies (ICTs), particularly across generations and contexts. Data for the present study come from nine focus groups. Seniors acknowledge that ICTs help them connect with geographically distant social ties, but that they lead to feelings of disconnection with geographically close social ties. We label this phenomenon the "physical-digital divide," which exists when a group feels ostracized or offended when those around them engage with ICTs while they themselves are not or cannot engage with ICTs. Younger generations are often referred to as "digital natives" and older generations as "digital immigrants." A more apt label for older adults may be "physical natives," as their preferred method of communication involves physical face-to-face interactions and traditional codes of etiquette. Suggestions are made for reducing the physical-digital divide.