Digital engagement preferences of individuals aged 65 and older with cancer.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 289-289
Author(s):  
Matthew Allison ◽  
Jonathan Patterson ◽  
Stephen Burton ◽  
Dhiren Patel ◽  
Kelly Jean Brassil
Keyword(s):  
Older Adults ◽  
Patient Engagement ◽  
Digital Health ◽  
Text Message ◽  
Geriatric Oncology ◽  
Patient Characteristics ◽  
Demographic Differences ◽  
Chi Square ◽  
Facilitators And Barriers ◽  
Digital Engagement

289 Background: Recent reviews suggest that digital solutions play a prominent role in the context of geriatric oncology. While interventions ranging from remote monitoring to nutrition and physical activity support have demonstrated feasibility in older adults (aged 65 and older), little is known about facilitators and barriers to eHealth uptake in older adults diagnosed with cancer. Insights into the digital engagement preferences of older adults with cancer may help to inform which platforms may be best aligned to optimal engagement and outcomes. Methods: A retrospective analysis was conducted to examine patient engagement preferences (phone, text and/or email) among older adults with cancer enrolled in a digital health coaching program. Descriptive statistics were used to summarize patient characteristics. Chi-square tests were used to evaluate differences in patient engagement preferences by race. Results: Of 513 individuals, the majority (n = 308; 60%) preferred information be provided by phone, email and text, while 20% (n = 105) requested content by phone and text only. Less than 10% of the sample requested content via phone only (n = 45; 8%), phone and email, (n = 31; 6%), email only (n = 11, 2%), or by email and text (n = 9; 2%). Interestingly, adults aged 65 and older had a significant predisposition to phone only communication (8.77%) compared to 2.25% in the general oncology population (p < 0.001). Among adults aged 65 and older with a phone preference, there were on average 8.39 calls over the course of the program with an average of 9.51 minutes per call over the course of 12-weeks. For those with text message preference, there were an average of 14.17 outbound and 8.30 inbound texts over the 12-week engagement, and for those with email preference a 62.38% open rate was observed. Retention over a three month coaching period was highest among those engaged via phone, text and email (56.17%), and email only (54.55%). Race was significantly related to engagement preference, with black members twice as likely (p < 0.001) to choose phone and text, and three times as likely (p < 0.001) to choose phone only compared with white members. However, no differences emerged between race and retention. Conclusions: Engagement preference was associated with differences in retention and race. Our results highlight the importance of offering different mechanisms for patient engagement and the need for attention to specific demographic differences such as race, which may impact access to and preference for engagement types when employing digital health solutions for older adults with cancer.

scholarly journals Protocol for a scoping review of digital health for older adults with cancer and their families

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038876
Author(s):  
Karis Kin-Fong Cheng ◽  
Rosalind Chiew-Jiat Siah ◽  
Emma Ream ◽  
Ravindran Kanesvaran ◽  
Jo Armes
Keyword(s):  
Older Adults ◽  
Scoping Review ◽  
Digital Health ◽  
Grey Literature ◽  
Geriatric Oncology ◽  
Flow Diagram ◽  
Published Data ◽  
Cochrane Central Register ◽  
Scientific Journals ◽  
Scoping Reviews

IntroductionThe potential for digital medicine and healthcare in geriatric oncology settings has received much attention. This scoping review will summarise the nature and extent of the existing literature that describes and examines digital health development, implementation, evaluation, outcome and experience for older adults with cancer, their families and their healthcare providers.Methods and analysisArksey and O'Malley’s six stages of scoping review methodology framework will be used. Searches will be conducted in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase via OvidSP, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus via EBSCO, Scopus and PsycINFO via OvidSP for published articles in peer-reviewed scientific journals from year 2000 onwards. In addition, we will screen databases for all prospectively registered trials. Research articles using quantitative or qualitative study design or reviews will be included if they describe or report the design, development or usability of digital health interventions in the treatment and care of patients 65 years of age or older with cancer and their families before, during and after cancer treatment. Grey literature will not be searched and included. Two investigators will independently perform the literature search, eligibility assessments and study selection. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for the scoping reviews (PRISMA-ScR) will be used to delineate the search decision process. For included articles, the extracted results will be synthesised both quantitatively and qualitatively and reported under key conceptual categories of this scoping review. Research gaps and opportunities will be identified and summarised.Ethics and disseminationSince this review will only include published data, ethics approval will not be sought. The results of the review will be published in peer-reviewed scientific journals. We will also engage with relevant stakeholders within research team’s networks to determine suitable approaches for dissemination.

Digital Health for Geriatric Oncology

2018 ◽  
pp. 1-12 ◽  
Author(s):  
Ramin Fallahzadeh ◽  
Seyed Ali Rokni ◽  
Hassan Ghasemzadeh ◽  
Enrique Soto-Perez-de-Celis ◽  
Armin Shahrokni
Keyword(s):  
Older Adults ◽  
State Of The Art ◽  
Digital Health ◽  
Unmet Need ◽  
Geriatric Oncology ◽  
Symptom Assessment ◽  
Health Technologies ◽  
Cancer Management ◽  
Study Protocols ◽  
Health Related

In this review, we describe state-of-the-art digital health solutions for geriatric oncology and explore the potential application of emerging remote health-monitoring technologies in the context of cancer care. We also discuss the benefits and motivations behind adopting technology for symptom monitoring of older adults with cancer. We provide an overview of common symptoms and of the digital solutions–designed remote symptom assessment. We describe state-of-the-art systems for this purpose and highlight the limitations and challenges for the full-scale adoption of such solutions in geriatric oncology. With rapid advances in Internet-of-things technologies, many remote assessment systems have been developed in recent years. Despite showing potential in several health care domains and reliable functionality, few of these solutions have been designed for or tested in older patients with cancer. As a result, the geriatric oncology community lacks a consensus understanding of a possible correlation between remote digital assessments and health-related outcomes. Although the recent development of digital health solutions has been shown to be reliable and effective in many health-related applications, there exists an unmet need for development of systems and clinical trials specifically designed for remote cancer management of older adults with cancer, including developing advanced remote technologies for cancer-related symptom assessment and psychological behavior monitoring at home and developing outcome-oriented study protocols for accurate evaluation of existing or emerging systems. We conclude that perhaps the clearest path to future large-scale use of remote digital health technologies in cancer research is designing and conducting collaborative studies involving computer scientists, oncologists, and patient advocates.

Measures of polypharmacy and chemotherapy toxicity in older adults with cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9545-9545 ◽  
Author(s):  
Ronald John Maggiore ◽  
Tao Feng ◽  
William Dale ◽  
Cary Philip Gross ◽  
William P. Tew ◽  
...  
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Geriatric Oncology ◽  
Stage Iv ◽  
The Elderly ◽  
Chi Square ◽  
Chemotherapy Toxicity ◽  
Chi Square Test ◽  
Grade 3

9545 Background: Polypharmacy is common and associated with adverse clinical outcomes in older adults. Potentially inappropriate medication (PIM) use serves as an adjunctive assessment of polypharmacy. The goals of this study in an outpatient population of older adults with cancer (CA) were: 1) to estimate the prevalence of polypharmacy using multiple measures; and 2) to determine the relationship between polypharmacy and chemotherapy (chemo) toxicity. Methods: Medication use was evaluated in 500 patients (pts) age ≥65 years with invasive CA who were starting a new chemo regimen. Polypharmacy was defined by number of daily medications (meds), including non-prescription meds. PIM use was defined by 4 indices: Beers (2003 and 2012 update), Zhan, and HEDIS Drugs to Avoid in the Elderly (DAE) criteria. Prevalence of polypharmacy, PIM, and their association with grade 3-5 chemo toxicity [NCI Common Toxicity Criteria (v. 3.0)] were analyzed using chi square test and unconditional logistic regression. Results: All 500 pts were evaluable [mean age, 73 years (range 65-91); 56% female; 61% stage IV]. The mean number of daily meds was 5 (range 0-23); 38% used ≤3 daily meds, 51% used 4-9 meds, and 11% using ≥10 meds. Using 0-3 daily meds as the referent group, no association was found between daily meds and chemo tox: 4-9 meds, OR 1.34 (95% CI: 0.92-1.97); ≥10, OR 0.82 (95% CI: 0.45-1.49). PIM use was identified in 87 (17%), 147 (29%), 54 (11%), and 69 (13%) patients utilizing the 2003 Beers, 2012 Beers, Zhan, and HEDIS DAE criteria, respectively. There was no association between each PIM use index and chemo toxicity (p>0.10 for all). Conclusions: Polypharmacy and PIM use were common in the geriatric oncology population. Although polypharmacy did not increase the risk of chemotherapy toxicity in this sample, further studies of polypharmacy’s impact on additional outcomes, including non-chemotherapy adverse drug events, in older persons with cancer are warranted.

Comparison of older adult symptom occurrence rates in a geriatric-oncology clinic with meta-analysis for adults receiving chemotherapy.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 102-102
Author(s):  
Marie Anne Flannery ◽  
Allison Magnuson ◽  
Joseph John Guido ◽  
Luke Joseph Peppone ◽  
William Dale ◽  
...  
Keyword(s):  
Older Adults ◽  
Older Patients ◽  
Meta Analysis ◽  
Geriatric Oncology ◽  
Psychological Status ◽  
Published Data ◽  
Limited Information ◽  
Symptom Experience ◽  
Chi Square ◽  
Significant Difference

102 Background: The majority of cancers occur in older adults, yet there is limited information on their symptom experience because they are under-represented in studies. To address this gap we examined registry data from two partnered geriatric oncology clinics, our aims are to: 1) identify older patients’ symptom occurrence rates and 2) compare symptom occurrence rates to published norms for adults with cancer. Methods: At presentation, patients completed the MD Anderson Symptom Inventory with symptoms coded as present or absent. Prevalence rates were compared to rates from a meta-analysis (Reilly et al., 2013) of adult cancer patients receiving chemotherapy which included pooled data from 21 studies (age M = 58 years, Range 118 = 97 years.) Differences were tested with Chi-Square. Results: As compared to published data, older patients (N = 291, M = 80.6 years, SD = 6.47, 52% > 80 yrs.) reported higher rates for the following symptoms: drowsiness (65% vs. 43%), trouble remembering (60% vs. 44%), distress (50% vs. 41%), sadness (49% vs.34%) (p’s < .01), and dry mouth (55% vs. 48%, p = .03). Lower rates were reported for nausea/vomiting (23% vs 40%/ 13 vs 27%, p’s < .001). There was no significant difference for the rates of fatigue (60%), difficulty sleeping (52%), pain (50%), decreased appetite (49%), dyspnea (48%), and numbness/tingling (38%). Conclusions: Older adults referred to specialized geriatric oncology clinic present with multiple symptoms. These patients had a mean age of eighty, may reflect the frail and vulnerable and were not often receiving active treatment. Results reinforce that it is especially important to assess and intervene on cognitive and psychological status in older patients. Nausea/Vomiting were less common in older adults perhaps due to lower chemotherapy rates. Limitations exist as we were not able to control for other factors affecting symptoms in the analysis. Nonetheless, results are consistent with older adults reporting many symptoms at a similar or higher rate than prior studies including all adults receiving chemotherapy. Increased study of the symptom experience in older oncology patients is critical to advance palliative care and symptom science.

The Impact of an Automated Patient Digital Engagement Application on Revisit Reduction (Preprint)

2020 ◽  
Author(s):  
Pothik Chatterjee ◽  
Adam Michael Beck ◽  
Jenna Ashley Levenson Brager ◽  
Daniel James Durand
Keyword(s):  
Health System ◽  
Patient Engagement ◽  
Information Exchange ◽  
Digital Health ◽  
General Medicine ◽  
Inpatient Setting ◽  
Hospital Inpatient ◽  
Digital Engagement ◽  
The Impact ◽  
Improve Patient

BACKGROUND Revisits within 30-days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continue to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system’s finances in a value based care or global budget environment. LifeBridge Health, a community health system in Maryland, implemented an automated patient digital engagement application as part of the overall organization’s digital health strategy to improve patient engagement and reduce revisits to the ED. OBJECTIVE To evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to reduce 30-day revisits after home discharge from an ED or hospital inpatient setting. METHODS The LifeBridge Health Innovation Department and ED staff from two participating health system hospitals collaborated with the GetWell Network to customize their patient engagement application (GetWell Loop) with automated check-in questions and resources. An application link was e-mailed to adult patients discharged home from the ED. A retrospective study of ED visits for patients treated for general medicine and cardiology conditions between 8/1/2018 through 7/31/2019 was conducted using CRISP, Maryland’s state-designated health information exchange. We also used data within GetWell Loop to track patient activation and engagement. The primary endpoint was a comparison of ED patients that experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary end points included overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the application. Statistical significance was calculated using the Fisher’s exact test with a P-value < 0.05. RESULTS Patients discharged from the ED who were treated for general medicine conditions (n=2087) and activated their GetWell Loop account experienced a 30-day revisit rate of 17.3% compared to 24.6% who did not activate their account (P<.001). For patients treated for cardiology conditions (n = 1779), 12.8% of patients who activated their GetWell account experienced a 30-day revisit compared to 17.7% not activating their account (P=.01). During this one-year study, 25% of all emergency patients receiving an invite to use the digital application activated their account (n=4125), logged in a total of 8935 times, generated 1911 alerts, and submitted 771 open ended comments/questions. CONCLUSIONS These results indicate the potential value of digital health applications to reduce 30-day revisit rates. The results also indicate patients are willing to utilize a digital application post-discharge to proactively engage in their own care. LifeBridge Health’s experience demonstrates that healthcare systems can leverage automated mobile applications to improve patient engagement and successfully impact clinical outcomes at scale.

scholarly journals Toward Modernization of Geriatric Oncology by Digital Health Technologies

2020 ◽  
pp. 209-215 ◽  
Author(s):  
Armin Shahrokni ◽  
Kah Poh Loh ◽  
William A. Wood
Keyword(s):  
Older Adults ◽  
Wireless Sensors ◽  
Patient Reported Outcomes ◽  
Digital Health ◽  
Geriatric Oncology ◽  
Proper Selection ◽  
Health Technologies ◽  
The Past ◽  
Oncology Research ◽  
Patient Reported

The number of older adults with cancer is increasing. Over the past 3 decades, geriatric oncology research has focused on improving the assessment of frailty and fitness of older adults with cancer as well as methods of improving their outcomes. At the same time, advances in digital health technologies have opened new frontiers for reaching this goal. Digital health technologies encompass a variety of solutions, from electronic patient-reported outcomes (ePROs) to big data and wireless sensors. These solutions have the potential to further advance our understanding of patients’ experiences during cancer treatment. Whereas the data on the feasibility and utility of such solutions in the care of older adults with cancer are limited, interest from digital health oncology researchers to further explore the benefits of these products is increasing. In this article, we describe the focus of geriatric oncology, the rationale behind the need to explore digital health technologies in this setting, and emerging data and ongoing studies, as well as provide guidelines for proper selection, implementation, and testing of digital health solutions in the context of geriatric oncology.

scholarly journals Dual Decline in Gait and Cognition Is Associated With Future Dementia: Evidence for a Phenotype

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 264-264
Author(s):  
Manuel Montero Odasso ◽  
Mark Speechley ◽  
Richard Camicioli ◽  
Nellie Kamkar ◽  
Qu Tian ◽  
...  
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Regression Models ◽  
Community Dwelling ◽  
Hierarchical Regression ◽  
Chi Square ◽  
Cox Models ◽  
Incident Dementia ◽  
Risk Of Progression ◽  
Community Dwelling Older Adults

Abstract BACKGROUND: The concurrent decline in gait speed and cognition are associated with future dementia. However, the clinical profile of those who present with dual-decline has not yet been described. We aimed to describe the phenotype and risk for incident dementia of individuals who present a dual-decline in comparison with non dual-decliners. METHODS: Prospective cohort of community-dwelling older adults free of dementia at baseline. We evaluated participants’ gait speed, cognition, medical status, functionality, incidence of adverse events, and dementia biannually over 7 years. Gait speed was assessed with a 6-meter electronic-walkway, and global cognition was assessed using the MoCA test. We compared characteristics between dual-decliners and non dual-decliners using t-test, Chi-square, and hierarchical regression models. We estimated incident dementia using Cox models. RESULTS: Among 144 participants (mean age 74.23 ± 6.72 years, 54% women), 17% progressed to dementia. Dual-decliners had a three-fold risk (HR: 3.12, 95%CI:1.23-7.93, p=0.017) of progression to dementia compared with non dual-decliners. Dual-decliners were significantly older with a higher prevalence of hypertension and dyslipidemia (p=0.002). Hierarchical regression models show that age and sex alone explained 3% of the variation in the dual-decliners group, while adding hypertension and dyslipidemia increased the explained variation to 8% and 10 %, respectively. The risk of becoming a dual-decliner was 4-fold if hypertension was present. CONCLUSION: Older adults with concurrent decline in gait speed and cognition represent a group at the highest risk of progression to dementia. These dual-decliners have a distinct phenotype with a higher prevalence of hypertension, a potentially treatable condition.

scholarly journals Orthostatic Hypotension and Falls in Hospitalized Older Adults

2021 ◽  
pp. 105477382098668
Author(s):  
Kathleen Schell ◽  
Denise Lyons ◽  
Barry Bodt
Keyword(s):  
Older Adults ◽  
Orthostatic Hypotension ◽  
Electronic Medical Records ◽  
Fall Prevention ◽  
Medical Records ◽  
The Elderly ◽  
Chi Square ◽  
Convenience Sample ◽  
Chi Square Test ◽  
Hospitalized Older Adults

The aim of this retrospective study was to determine the prevalence of orthostatic hypotension (OH) among a convenience sample of older adults on two Acute Care of the Elderly (ACE) units of the ChristianaCare™ in Delaware. Another aim was to determine if subjects with documented OH experienced falls. Retrospective de-identified data was obtained from electronic medical records for the years 2015 to 2018. Among all patients who had valid first orthostatic vital sign (OVS) readings ( n = 7,745), 39.2% had orthostatic hypotension on the first reading. Among the patients, 42.8% were found to be hypotensive during OVS. Thirty-one (0.9%) of those with OH fell at some point during their stay. The odds ratio for falls in the presence of OH was 1.34 with a 95% confidence interval (0.82, 2.21), but a chi-square test failed to find significance ( p = .2494). The results could not determine if OVS should be mandatory in fall prevention protocols.

scholarly journals Codesign of a cardiovascular disease prevention text message bank for older adults

2021 ◽  
Author(s):  
Jessica Ardo ◽  
Jung-Ah Lee ◽  
Janett A. Hildebrand ◽  
Diana Guijarro ◽  
Hassan Ghasemazadeh ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Disease Prevention ◽  
Text Message ◽  
Cardiovascular Disease Prevention

scholarly journals Promoting Problem Solving About Health Management: A Mixed-Methods Pilot Evaluation of a Digital Health Intervention for Older Adults With Pre-Frailty and Frailty

2021 ◽  
Vol 7 ◽  
pp. 233372142098568
Author(s):  
Annie T. Chen ◽  
Frances Chu ◽  
Andrew K. Teng ◽  
Soojeong Han ◽  
Shih-Yin Lin ◽  
...  
Keyword(s):  
Older Adults ◽  
Mixed Methods ◽  
Health Literacy ◽  
Problem Solving ◽  
Self Efficacy ◽  
Health Management ◽  
Digital Health ◽  
Post Intervention ◽  
Problem Solving Skills ◽  
Health Related

Background: There is a need for interventions to promote health management of older adults with pre-frailty and frailty. Technology poses promising solutions, but questions exist about effective delivery. Objectives: We present the results of a mixed-methods pilot evaluation of Virtual Online Communities for Older Adults (VOCALE), an 8-week intervention conducted in the northwestern United States, in which participants shared health-related experiences and applied problem solving skills in a Facebook group. Methods: We performed a mixed-methods process evaluation, integrating quantitative and qualitative data, to characterize the intervention and its effects. We focus on four areas: health-related measures (health literacy and self-efficacy), participation, problem solving skills enacted, and subjective feedback. Results: Eight older adults with pre-frailty and frailty (age = 82.7 ± 6.6 years) completed the study. There was an upward trend in health literacy and health self-efficacy post-intervention. Participants posted at least two times per week. Content analysis of 210 posts showed participants were able to apply the problem solving skills taught, and exit interviews showed participants’ increased awareness of the need to manage health, and enjoyment in learning about others. Conclusion: This mixed-methods evaluation provides insight into feasibility and design considerations for online interventions to promote health management among vulnerable older adults.

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