The Acceptability of Technology in Health Care Among Older Korean Adults With Multiple Chronic Conditions

Abstract Background: Although there are benefits in utilizing ICT in health care, older adults have challenges in employ technologies in their health care management due to the changes in cognitive and physical functions, low motivation to use technology, and low computer/internet literacy (Adebayo et al, 2017; Wildenbos et al, 2018). The purpose of this study is to investigate the acceptance of technology among older Korean adults with multiple chronic conditions and examine factors associating with the acceptance of the technology. Method: The participants were 226 community-dwelling older adults who have more than two chronic conditions. Directed by the senior technology acceptance model (Chen & Chan, 2014), demographics, gerontechnology self-efficacy, gerontechnology anxiety, facilitating conditions, self-reported health conditions, cognitive ability, social relationship, attitude to life and satisfaction, physical functioning, and acceptance of technology were surveyed using a self-reported questionnaire. Findings: Older Korean adults with multiple chronic conditions showed a moderately high technology acceptance score (M = 25.35, SD = 5.28). There were significant differences in the acceptance of technology depending on age (r=-0.241, p<.01), cognitive ability (r=0.225, p<.01), gerontechnology self-efficacy (r=0.323, p<.0001), and facilitating conditions (r=0.288, p<.0001). Conclusion: While older age were associated to the acceptance of technology, gerontechnology self-efficacy which is one’s judgment of their ability to perform a task successfully using gerontechnology and facilitating conditions which are environmental factors that help older adults use gerontechnology easier were positively associated with the acceptance of technology among older Korean adults with multiple chronic conditions.

Download Full-text

A Web-Based eHealth Intervention to Improve the Quality of Life of Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/25175 ◽

2021 ◽

Vol 10 (2) ◽

pp. e25175

Author(s):

David H Gustafson Sr ◽

Marie-Louise Mares ◽

Darcie C Johnston ◽

Jane E Mahoney ◽

Randall T Brown ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Primary Care ◽

Health Care ◽

Chronic Conditions ◽

Health Care Use ◽

Multiple Chronic Conditions ◽

Secondary Outcomes ◽

Ehealth Intervention

Background Multiple chronic conditions (MCCs) are common among older adults and expensive to manage. Two-thirds of Medicare beneficiaries have multiple conditions (eg, diabetes and osteoarthritis) and account for more than 90% of Medicare spending. Patients with MCCs also experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on laboratory results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving these patients’ lives. Objective This study aims to assess the effects of ElderTree (ET), an eHealth intervention for older adults with MCCs, on quality of life and related measures. Methods In this unblinded study, 346 adults aged 65 years and older with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, and BMI ≥30 kg/m2) were recruited from primary care clinics and randomized in a ratio of 1:1 to one of 2 conditions: usual care (UC) plus laptop computer, internet service, and ET or a control consisting of UC plus laptop and internet but no ET. Patients with ET have access for 12 months and will be followed up for an additional 6 months, for a total of 18 months. The primary outcomes of this study are the differences between the 2 groups with regard to measures of quality of life, psychological well-being, and loneliness. The secondary outcomes are between-group differences in laboratory scores, falls, symptom distress, medication adherence, and crisis and long-term health care use. We will also examine the mediators and moderators of the effects of ET. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; laboratory data are collected from eHealth records; health care use and chronic conditions are collected from health records and patient surveys; and ET use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. Results Recruitment was conducted from January 2018 to December 2019, and 346 participants were recruited. The intervention period will end in June 2021. Conclusions With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ET may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. Trial Registration ClinicalTrials.gov NCT03387735; https://www.clinicaltrials.gov/ct2/show/NCT03387735. International Registered Report Identifier (IRRID) DERR1-10.2196/25175

Download Full-text

Association between patterns of multiple chronic conditions and cognitive impairment in community‐dwelling older adults in Taiwan

Alzheimer s & Dementia ◽

10.1002/alz.054751 ◽

2021 ◽

Vol 17 (S10) ◽

Author(s):

Pei‐Iun Hsieh ◽

Yen‐Ching Chen ◽

Jeng‐Min Chiou ◽

Ta‐Fu Chen ◽

Su‐Ling Yeh ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Chronic Conditions ◽

Community Dwelling ◽

Multiple Chronic Conditions ◽

Community Dwelling Older Adults

Download Full-text

Outcome Goals and Health Care Preferences of Older Adults With Multiple Chronic Conditions

JAMA Network Open ◽

10.1001/jamanetworkopen.2021.1271 ◽

2021 ◽

Vol 4 (3) ◽

pp. e211271 ◽

Cited By ~ 1

Author(s):

Mary E. Tinetti ◽

Darcé M. Costello ◽

Aanand D. Naik ◽

Claire Davenport ◽

Kizzy Hernandez-Bigos ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Chronic Conditions ◽

Multiple Chronic Conditions ◽

Outcome Goals ◽

Health Care Preferences

Download Full-text

Research Priorities to Advance the Health and Health Care of Older Adults with Multiple Chronic Conditions

Journal of the American Geriatrics Society ◽

10.1111/jgs.14943 ◽

2017 ◽

Vol 65 (7) ◽

pp. 1549-1553 ◽

Cited By ~ 17

Author(s):

Mayra Tisminetzky ◽

Elizabeth A. Bayliss ◽

Jay S. Magaziner ◽

Heather G. Allore ◽

Kathryn Anzuoni ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Chronic Conditions ◽

Research Priorities ◽

Multiple Chronic Conditions

Download Full-text

Self-Regulation Strategies as Predictors: Managing Multimorbidities Among Community-Dwelling People Aging with Arthritis

Western Journal of Nursing Research ◽

10.1177/0193945919893679 ◽

2020 ◽

Vol 42 (9) ◽

pp. 698-707 ◽

Cited By ~ 1

Author(s):

Wenhui Zhang ◽

Kavita Radhakrishnan ◽

Heather Becker ◽

Gayle J. Acton ◽

Carole K. Holahan

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Self Efficacy ◽

Self Regulation ◽

Health Resources ◽

Physical Symptoms ◽

Community Dwelling ◽

Care Utilization ◽

Multiple Chronic Conditions ◽

Regulation Strategies

Self-regulation (SR) has been defined as consisting of three basic strategies: selection, optimization, and compensation. This study investigates these three SR strategies as predictors of arthritis self-efficacy, quality of life (QOL), and health-care utilization in community-dwelling people aging with arthritis and comorbidities. One hundred forty individuals over age 50 years provided demographic characteristics and completed surveys on comorbidities, health resources, use of SR strategies, symptoms, arthritis self-efficacy, QOL, and health-care utilization. Multivariate hierarchical stepwise regressions were used to examine SR strategies as predictors for arthritis self-efficacy, and together with arthritis self-efficacy as predictors for health-care utilization, and QOL. Physical symptoms; SR strategies, especially optimization; and income adequacy significantly predicted arthritis self-efficacy. Arthritis self-efficacy and mental and physical symptoms significantly predicted QOL. This study adds evidence to support the role of SR strategies, especially optimization, in building arthritis self-efficacy for better self-management and QOL in persons with arthritis and multiple chronic conditions.

Download Full-text

Video Consultations for Older Adults With Multimorbidity During the COVID-19 Pandemic: Protocol for an Exploratory Qualitative Study

JMIR Research Protocols ◽

10.2196/22679 ◽

2020 ◽

Vol 9 (10) ◽

pp. e22679

Author(s):

Eng Sing Lee ◽

Poay Sian Sabrina Lee ◽

Evelyn Ai Ling Chew ◽

Gayathri Muthulingam ◽

Hui Li Koh ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Qualitative Methodology ◽

Scale Up ◽

Improve Patient Care ◽

Risk Groups ◽

Community Dwelling ◽

Alternative Form ◽

Multiple Chronic Conditions ◽

Two Phases

Background Multimorbidity, the coexistence of multiple chronic conditions in an individual, is a growing public health challenge. Amidst the COVID-19 pandemic, physical distancing remains an indispensable measure to limit the spread of the virus. This pertains especially to those belonging to high-risk groups, namely older adults with multimorbidity. In-person visits are discouraged for this cohort; hence, there is a need for an alternative form of consultation such as video consultations to continue the provision of care. Objective The potential of video consultations has been explored in several studies. However, the emergence of COVID-19 presents us with an unprecedented opportunity to explore the use of this technological innovation in a time when physical distancing is imperative. This study will evaluate the sustainability of video consultations on a micro-, meso-, and macro-level by assessing the views of patients, physicians, and organizational and national policymakers, respectively. Methods The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework was designed as a guide for the development of health care technologies. In this study, the implementation of and experiences related to video consultations will be studied using the NASSS framework. Individual in-depth interviews or focus group discussions will be conducted with participants using the Zoom platform. Data will be analyzed by at least two investigators trained in qualitative methodology, organized thematically, and coded in two phases—an initial phase and a focused selective phase. All disagreements will be resolved by consulting the larger research team until consensus is reached. Results This study was approved for funding from the Geriatric Education and Research Institute. Ethics approval was obtained from the National Healthcare Group Domain Specific Review Board (reference #2020/00760). Study recruitment commenced in July 2020. The results of the data analysis are expected to be available by the end of the year. Conclusions This study aims to evaluate the adoption and sustainability of video consultations for older adults with multimorbidity during the pandemic as well as post COVID-19. The study will yield knowledge that will challenge the current paradigm on how care is being delivered for community-dwelling older adults with multimorbidity. Findings will be shared with administrators in the health care sector in order to enhance the safety and quality of these video consultations to improve patient care for this group of population. International Registered Report Identifier (IRRID) DERR1-10.2196/22679

Download Full-text

Video Consultations for Older Adults With Multimorbidity During the COVID-19 Pandemic: Protocol for an Exploratory Qualitative Study (Preprint)

10.2196/preprints.22679 ◽

2020 ◽

Author(s):

Eng Sing Lee ◽

Poay Sian Sabrina Lee ◽

Evelyn Ai Ling Chew ◽

Gayathri Muthulingam ◽

Hui Li Koh ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Qualitative Methodology ◽

Scale Up ◽

Improve Patient Care ◽

Risk Groups ◽

Community Dwelling ◽

Alternative Form ◽

Multiple Chronic Conditions ◽

Two Phases

BACKGROUND Multimorbidity, the coexistence of multiple chronic conditions in an individual, is a growing public health challenge. Amidst the COVID-19 pandemic, physical distancing remains an indispensable measure to limit the spread of the virus. This pertains especially to those belonging to high-risk groups, namely older adults with multimorbidity. In-person visits are discouraged for this cohort; hence, there is a need for an alternative form of consultation such as video consultations to continue the provision of care. OBJECTIVE The potential of video consultations has been explored in several studies. However, the emergence of COVID-19 presents us with an unprecedented opportunity to explore the use of this technological innovation in a time when physical distancing is imperative. This study will evaluate the sustainability of video consultations on a micro-, meso-, and macro-level by assessing the views of patients, physicians, and organizational and national policymakers, respectively. METHODS The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework was designed as a guide for the development of health care technologies. In this study, the implementation of and experiences related to video consultations will be studied using the NASSS framework. Individual in-depth interviews or focus group discussions will be conducted with participants using the Zoom platform. Data will be analyzed by at least two investigators trained in qualitative methodology, organized thematically, and coded in two phases—an initial phase and a focused selective phase. All disagreements will be resolved by consulting the larger research team until consensus is reached. RESULTS This study was approved for funding from the Geriatric Education and Research Institute. Ethics approval was obtained from the National Healthcare Group Domain Specific Review Board (reference #2020/00760). Study recruitment commenced in July 2020. The results of the data analysis are expected to be available by the end of the year. CONCLUSIONS This study aims to evaluate the adoption and sustainability of video consultations for older adults with multimorbidity during the pandemic as well as post COVID-19. The study will yield knowledge that will challenge the current paradigm on how care is being delivered for community-dwelling older adults with multimorbidity. Findings will be shared with administrators in the health care sector in order to enhance the safety and quality of these video consultations to improve patient care for this group of population. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/22679

Download Full-text

Illness perceptions and health outcomes among community-dwelling older adults with multiple chronic conditions

Innovation in Aging ◽

10.1093/geroni/igab046.2339 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 615-616

Author(s):

Ayo Bankole

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Chronic Conditions ◽

Illness Perceptions ◽

Community Dwelling ◽

Multiple Chronic Conditions ◽

Targeted Interventions ◽

Self Rated Health ◽

The Past ◽

The Relationship

Abstract Illness perceptions (IP) has been associated with self-management and health outcomes in individuals with chronic diseases such as heart disease and diabetes; however, there is less research on the relationship between IP and health outcomes in individuals with multiple chronic conditions (MCC). Older adults with MCC are more likely to experience poor outcomes such as hospitalizations and poor self-rated health yet, there is less understanding of the processes associated with these outcomes. The purpose of this study was to (1) explore the relationship between IP and self-rated health among older adults with MCC (2) explore the relationship between IP and the number of hospitalization within the past year among older adults with MCC. Understanding these relationships may be instrumental to designing targeted interventions to improve health outcomes for this population. 116 participants (ages 65-90) completed the illness perception of multimorbidity scale, modified general health subscale of the SF-36 questionnaire, and self-reported number of hospitalizations within the past year. Ordinal logistic regression was used for analysis. Older adults who reported negative IP were likely to report worse self-rated health and this relationship remained significant after controlling for age and number of chronic conditions {-0.032 (95% CI (-0.050 to 0.014) p< 0.05}. There was no significant relationship between IP and the number of hospitalization within the past year. The study results study suggest that IP is associated with self-rated health in older adults with MCC. IP may be useful to design targeted interventions to improve self-rated health in this population.

Download Full-text

Chronic disease burden predicts food insecurity among older adults

Public Health Nutrition ◽

10.1017/s1368980017004062 ◽

2018 ◽

Vol 21 (9) ◽

pp. 1737-1742 ◽

Cited By ~ 18

Author(s):

Jane Jih ◽

Irena Stijacic-Cenzer ◽

Hilary K Seligman ◽

W John Boscardin ◽

Tung T Nguyen ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Chronic Disease ◽

Food Insecurity ◽

Chronic Conditions ◽

Disease Burden ◽

Health Care Expenditures ◽

Multiple Chronic Conditions ◽

Increased Risk ◽

Chronic Disease Burden

AbstractObjectiveIncreased out-of-pocket health-care expenditures may exert budget pressure on low-income households that leads to food insecurity. The objective of the present study was to examine whether older adults with higher chronic disease burden are at increased risk of food insecurity.DesignSecondary analysis of the 2013 Health and Retirement Study (HRS) Health Care and Nutrition Study (HCNS) linked to the 2012 nationally representative HRS.SettingUSA.SubjectsRespondents of the 2013 HRS HCNS with household incomes <300 % of the federal poverty line (n 3552). Chronic disease burden was categorized by number of concurrent chronic conditions (0–1, 2–4, ≥5 conditions), with multiple chronic conditions (MCC) defined as ≥2 conditions.ResultsThe prevalence of food insecurity was 27·8 %. Compared with those having 0–1 conditions, respondents with MCC were significantly more likely to report food insecurity, with the adjusted odds ratio for those with 2–4 conditions being 2·12 (95 % CI 1·45, 3·09) and for those with ≥5 conditions being 3·64 (95 % CI 2·47, 5·37).ConclusionsA heavy chronic disease burden likely exerts substantial pressure on the household budgets of older adults, creating an increased risk for food insecurity. Given the high prevalence of food insecurity among older adults, screening those with MCC for food insecurity in the clinical setting may be warranted in order to refer to community food resources.

Download Full-text

Self-Management of Multiple Chronic Conditions by Community-Dwelling Older Adults: A Concept Analysis

SAGE Open Nursing ◽

10.1177/2377960817752471 ◽

2018 ◽

Vol 4 ◽

pp. 237796081775247 ◽

Cited By ~ 6

Author(s):

Anna Garnett ◽

Jenny Ploeg ◽

Maureen Markle-Reid ◽

Patricia H. Strachan

Keyword(s):

Older Adults ◽

Disease Management ◽

Chronic Conditions ◽

Concept Analysis ◽

Community Dwelling ◽

Self Management ◽

Multiple Chronic Conditions ◽

Complex Process ◽

Health And Disease ◽

Community Dwelling Older Adults

The proportion of the aging population living with multiple chronic conditions (MCC) is increasing. Self-management is valuable in helping individuals manage MCC. The purpose of this study was to conduct a concept analysis of self-management in community-dwelling older adults with MCC using Walker and Avant’s method. The review included 30 articles published between 2000 and 2017. The following attributes were identified: (a) using financial resources for chronic disease management, (b) acquiring health- and disease-related education, (c) making use of ongoing social supports, (d) responding positively to health changes, (e) ongoing engagement with the health system, and (f) actively participating in sustained disease management. Self-management is a complex process; the presence of these attributes increases the likelihood that an older adult will be successful in managing the symptoms of MCC.

Download Full-text