Cannabis Use is Associated with Greater Total Sleep Time in Middle-Aged and Older Adults with and without HIV: A Preliminary Report Utilizing Digital Health Technologies

Abstract BackgroundDigital health technologies are being increasingly developed with the aim of allowing older adults to maintain functional independence throughout the old age, a process known as healthy ageing. Such digital health technologies for healthy ageing are expected to mitigate the socio-economic effects of population ageing and improve the quality of life of older people. However, little is known regarding the views and needs of older people regarding these technologies. AimThe aim of this study is to explore the views, needs and perceptions of community-dwelling older adults regarding the use of digital health technologies for healthy ageing. MethodFace-to-face, in-depth qualitative interviews were conducted with community-dwelling older adults (median age 79.6 years). The interview process involved both abstract reflections and practical demonstrations. The interviews were transcribed verbatim and analyzed according to inductive content analysis. ResultsThree main themes and twelve sub-themes emerged. The three main themes revolved around the following thematic areas: favorable views and perceptions on technology-assisted living, usability evaluations and ethical considerations. ConclusionsOur study reveals a generally positive attitude towards digital health technologies as participants believed digital tools could positively contribute to improving their overall wellbeing, especially if designed in a patient-centered manner. Safety concerns and ethical issues related to privacy, empowerment and lack of human contact also emerged as key considerations.

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Consumer-Grade Wearable Device for Predicting Frailty in Canadian Home Care Service Clients: Prospective Observational Proof-of-Concept Study

Journal of Medical Internet Research ◽

10.2196/19732 ◽

2020 ◽

Vol 22 (9) ◽

pp. e19732

Author(s):

Ben Kim ◽

Sandra M McKay ◽

Joon Lee

Keyword(s):

Older Adults ◽

Heart Rate ◽

Logistic Regression ◽

Home Care ◽

Total Sleep Time ◽

Care Service ◽

Sleep Time ◽

Wearable Devices ◽

Wearable Device ◽

Deep Sleep

Background Frailty has detrimental health impacts on older home care clients and is associated with increased hospitalization and long-term care admission. The prevalence of frailty among home care clients is poorly understood and ranges from 4.0% to 59.1%. Although frailty screening tools exist, their inconsistent use in practice calls for more innovative and easier-to-use tools. Owing to increases in the capacity of wearable devices, as well as in technology literacy and adoption in Canadian older adults, wearable devices are emerging as a viable tool to assess frailty in this population. Objective The objective of this study was to prove that using a wearable device for assessing frailty in older home care clients could be possible. Methods From June 2018 to September 2019, we recruited home care clients aged 55 years and older to be monitored over a minimum of 8 days using a wearable device. Detailed sociodemographic information and patient assessments including degree of comorbidity and activities of daily living were collected. Frailty was measured using the Fried Frailty Index. Data collected from the wearable device were used to derive variables including daily step count, total sleep time, deep sleep time, light sleep time, awake time, sleep quality, heart rate, and heart rate standard deviation. Using both wearable and conventional assessment data, multiple logistic regression models were fitted via a sequential stepwise feature selection to predict frailty. Results A total of 37 older home care clients completed the study. The mean age was 82.27 (SD 10.84) years, and 76% (28/37) were female; 13 participants were frail, significantly older (P<.01), utilized more home care service (P=.01), walked less (P=.04), slept longer (P=.01), and had longer deep sleep time (P<.01). Total sleep time (r=0.41, P=.01) and deep sleep time (r=0.53, P<.01) were moderately correlated with frailty. The logistic regression model fitted with deep sleep time, step count, age, and education level yielded the best predictive performance with an area under the receiver operating characteristics curve value of 0.90 (Hosmer-Lemeshow P=.88). Conclusions We proved that a wearable device could be used to assess frailty for older home care clients. Wearable data complemented the existing assessments and enhanced predictive power. Wearable technology can be used to identify vulnerable older adults who may benefit from additional home care services.

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Digital Predictors of Morbidity, Hospitalization, and Mortality Among Older Adults: A Systematic Review and Meta-Analysis

Frontiers in Digital Health ◽

10.3389/fdgth.2020.602093 ◽

2021 ◽

Vol 2 ◽

Author(s):

Sofia Daniolou ◽

Andreas Rapp ◽

Celina Haase ◽

Alfred Ruppert ◽

Marlene Wittwer ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Health Outcomes ◽

Digital Health ◽

Meta Analysis ◽

Design Development ◽

Clinical Implementation ◽

Care Needs ◽

Health Technologies ◽

Improve Health

The widespread adoption of digital health technologies such as smartphone-based mobile applications, wearable activity trackers and Internet of Things systems has rapidly enabled new opportunities for predictive health monitoring. Leveraging digital health tools to track parameters relevant to human health is particularly important for the older segments of the population as old age is associated with multimorbidity and higher care needs. In order to assess the potential of these digital health technologies to improve health outcomes, it is paramount to investigate which digitally measurable parameters can effectively improve health outcomes among the elderly population. Currently, there is a lack of systematic evidence on this topic due to the inherent heterogeneity of the digital health domain and the lack of clinical validation of both novel prototypes and marketed devices. For this reason, the aim of the current study is to synthesize and systematically analyse which digitally measurable data may be effectively collected through digital health devices to improve health outcomes for older people. Using a modified PICO process and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework, we provide the results of a systematic review and subsequent meta-analysis of digitally measurable predictors of morbidity, hospitalization, and mortality among older adults aged 65 or older. These findings can inform both technology developers and clinicians involved in the design, development and clinical implementation of digital health technologies for elderly citizens.

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ProACT - A Digital Platform to Support Self-Management of Multiple Chronic Conditions: Findings in Relation to Engagement during a one-year Proof-of-Concept Trial (Preprint)

10.2196/preprints.22672 ◽

2020 ◽

Author(s):

Julie Doyle ◽

Emma Murphy ◽

Shane Gavin ◽

Alessandra Pascale ◽

Stephane Deparis ◽

...

Keyword(s):

Older Adults ◽

Chronic Conditions ◽

Digital Health ◽

Self Management ◽

Multiple Chronic Conditions ◽

User Engagement ◽

Proof Of Concept ◽

Structured Interviews ◽

Health Technologies ◽

Care Approach

BACKGROUND Self-management, a core activity for older adults living with multiple chronic conditions (multimorbidity), is challenging, requiring the person to engage in multiple tasks such as symptom monitoring, recognition of exacerbations, medication adherence and inter-stakeholder communication. A digital, integrated care approach is a critical part of the solution, however, there is a dearth of literature on this topic. Furthermore, there is little research on older adults’ acceptability, usage and experiences of engaging with digital health technologies, particularly over long periods of time. OBJECTIVE The objectives were to (1) co-design and develop a digital health platform, called ProACT, to facilitate older adults self-managing multimorbidity, with support from their care network (CN); (2) evaluate end user engagement and experiences with the platform through a 12-month trial. METHODS The ProACT digital health platfrom is presented. The platform was evaluated in a year-long proof-of-concept (PoC) action research trial with 120 older persons with multimorbidity (PwMs) in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts, and a technical helpdesk. Interactions with the platform during the PoC trial were logged to determine engagement, semi-structured interviews were conducted with participants and analysed using inductive thematic analysis methods, while usability and user burden were examined using validated questionnaires. RESULTS This article presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who took part, 24 withdrew before the end of the study while three passed away. The remaining 93 participants actively used the platform until the end of the trial, on average taking two or three health readings daily over the course of the trial, in Ireland and Belgium respectively. Participants reported ProACT to be usable and of low burden. Findings from interviews outline that participants experienced multiple benefits as a result of using ProACT, including improved self-management, improved health and wellbeing and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology didn’t work as expected. CONCLUSIONS This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multiple chronic conditions. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for this include a strong focus on user-centred design and engagement throughout the project lifecycle, resulting in a platform that met user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. INTERNATIONAL REGISTERED REPORT RR2-10.2196/preprints.22125

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Associations between probable anxiety and mood disorder and measures of alcohol and cannabis use in young, middle-aged and older adults.

Journal of Concurrent Disorders ◽

10.54127/tklt6639 ◽

2019 ◽

Vol 1 (2) ◽

pp. 9-19

Author(s):

Robert E. Mann ◽

Wah Lap Cheung ◽

Gina Stoduto ◽

Christine M. Wickens ◽

Anca R. Ialomiteanu ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression ◽

General Health Questionnaire ◽

Age Groups ◽

Alcohol Problems ◽

Cannabis Use ◽

Religious Service Attendance ◽

Middle Aged ◽

Cross Sectional ◽

The Impact

This study examined the associations of cannabis use, alcohol use and alcohol problems with probable anxiety and mood disorders (AMD) in young, middle-aged and older adults. Method: Data are based on the CAMH Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 years and older. For the purposes of the current study, a merged dataset from the years 2001 through 2009 inclusive was separated into three individual datasets: 18-34 year olds (n=4,211), 35-54 year olds (n=7,874), and 55 years of age and older (n=6,778). The survey included the 12-item version of the General Health Questionnaire, which provides a measure of probable AMD for the general population. Logistic regression analyses examined the odds of probable AMD in three age groups associated with alcohol measures (number of drinks per day and alcohol problems (AUDIT 8+)) and cannabis use, while controlling for self-reported physical health, religious service attendance, and demographic factors. Due to listwise deletion, the logistic regression models were based on reduced samples. Results: Lifetime cannabis use and past year cannabis use predicted probable AMD in young and middle-aged adults, but only lifetime cannabis use predicted probable AMD among older adults. Alcohol problems predicted probable AMD among middle aged and older adults, but not among younger adults. No consistent link between recent alcohol consumption and probable AMD was observed. Conclusion: These analyses suggest that the impact of alcohol and cannabis use and problems on probable AMD may differ across age groups.

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Caudate Volume Mediates the Interaction between Total Sleep Time and Executive Function after Acute Exercise in Healthy Older Adults

Brain Plasticity ◽

10.3233/bpl-190087 ◽

2019 ◽

Vol 5 (1) ◽

pp. 69-82 ◽

Cited By ~ 2

Author(s):

Junyeon Won ◽

Alfonso J. Alfini ◽

Lauren R. Weiss ◽

Casandra C. Nyhuis ◽

Adam P. Spira ◽

...

Keyword(s):

Older Adults ◽

Executive Function ◽

Acute Exercise ◽

Total Sleep Time ◽

Sleep Time ◽

Healthy Older Adults

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Sleep continuity and total sleep time are associated with task-switching and preparation in young and older adults

Journal of Sleep Research ◽

10.1111/jsr.12148 ◽

2014 ◽

Vol 23 (5) ◽

pp. 508-516 ◽

Cited By ~ 13

Author(s):

Kristine A. Wilckens ◽

Sarah G. Woo ◽

Kirk I. Erickson ◽

Mark E. Wheeler

Keyword(s):

Older Adults ◽

Task Switching ◽

Total Sleep Time ◽

Sleep Time ◽

Sleep Continuity

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Home-Based Sleep Sensor Measurements in an Older Australian Population: Before and during a Pandemic

Sensors ◽

10.3390/s21185993 ◽

2021 ◽

Vol 21 (18) ◽

pp. 5993

Author(s):

Mahnoosh Kholghi ◽

Claire M. Ellender ◽

Qing Zhang ◽

Yang Gao ◽

Liesel Higgins ◽

...

Keyword(s):

Older Adults ◽

Time Course ◽

Total Sleep Time ◽

Sleep Onset ◽

Sleep Time ◽

Community Dwelling ◽

Sleep Efficiency ◽

Sleep Onset Latency ◽

Onset Latency ◽

Short Sleep Duration

Older adults are susceptible to poor night-time sleep, characterized by short sleep duration and high sleep disruptions (i.e., more frequent and longer awakenings). This study aimed to longitudinally and objectively assess the changes in sleep patterns of older Australians during the 2020 pandemic lockdown. A non-invasive mattress-based device, known as the EMFIT QS, was used to continuously monitor sleep in 31 older adults with an average age of 84 years old before (November 2019–February 2020) and during (March–May 2020) the COVID-19, a disease caused by a form of coronavirus, lockdown. Total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, time to bed, and time out of bed were measured across these two periods. Overall, there was no significant change in total sleep time; however, women had a significant increase in total sleep time (36 min), with a more than 30-min earlier bedtime. There was also no increase in wake after sleep onset and sleep onset latency. Sleep efficiency remained stable across the pandemic time course between 84–85%. While this sample size is small, these data provide reassurance that objective sleep measurement did not deteriorate through the pandemic in older community-dwelling Australians.

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Older Adults Engage With Personalized Digital Coaching Programs at Rates That Exceed Those of Younger Adults

Frontiers in Digital Health ◽

10.3389/fdgth.2021.642818 ◽

2021 ◽

Vol 3 ◽

Author(s):

Sarah A. Graham ◽

Natalie Stein ◽

Fjori Shemaj ◽

OraLee H. Branch ◽

Jason Paruthi ◽

...

Keyword(s):

Older Adults ◽

Technology Use ◽

Chronic Conditions ◽

Digital Health ◽

Cost Effective ◽

Health Programs ◽

Care Providers ◽

Younger Adults ◽

Health Technologies ◽

Healthcare Needs

Background: The US population is aging and has an expanding set of healthcare needs for the prevention and management of chronic conditions. Older adults contribute disproportionately to US healthcare costs, accounting for 34% of total healthcare expenditures in 2014 but only 15% of the population. Fully automated, digital health programs offer a scalable and cost-effective option to help manage chronic conditions. However, the literature on technology use suggests that older adults face barriers to the use of digital technologies that could limit their engagement with digital health programs. The objective of this study was to characterize the engagement of adults 65 years and older with a fully automated digital health platform called Lark Health and compare their engagement to that of adults aged 35–64 years.Methods: We analyzed data from 2,169 Lark platform users across four different coaching programs (diabetes prevention, diabetes care, hypertension care, and prevention) over a 12-month period. We characterized user engagement as participation in digital coaching conversations, meals logged, and device measurements. We compared engagement metrics between older and younger adults using nonparametric bivariate analyses.Main Results: Aggregate engagement across all users during the 12-month period included 1,623,178 coaching conversations, 588,436 meals logged, and 203,693 device measurements. We found that older adults were significantly more engaged with the digital platform than younger adults, evidenced by older adults participating in a larger median number of coaching conversations (514 vs. 428) and logging more meals (174 vs. 89) and device measurements (39 vs. 28) all p ≤ 0.01.Conclusions: Older adult users of a commercially available, fully digital health platform exhibited greater engagement than younger adults. These findings suggest that despite potential barriers, older adults readily adopted digital health technologies. Fully digital health programs may present a widely scalable and cost-effective alternative to traditional telehealth models that still require costly touchpoints with human care providers.

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