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

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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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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Strategies to Improve Health Technologies for Older Adults With Cognitive Impairment and Dementia

Innovation in Aging ◽

10.1093/geroni/igaa057.3179 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 862-862

Author(s):

Stacey Schepens Niemiec ◽

Elissa Lee ◽

Jeanine Blanchard ◽

Adam Strizich

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Older People ◽

Cognitive Deficits ◽

Technology Use ◽

Community Organization ◽

Digital Health ◽

Health Technologies ◽

Partner Involvement ◽

Improve Health

Abstract Technology may improve health self-management of older people with cognitive deficits, yet these individuals may have unique needs influencing its utility. This study’s purpose was to gather current strategies described in the literature and by expert stakeholders for utilizing digital health technologies in older adults with cognitive impairment (CI) or dementia. We conducted a rapid literature review to identify articles that featured digital health technology use in persons with CI/dementia. Additionally, we conducted interviews (n=12) with expert stakeholders who were identified through online academic, professional, and community organization biographies and snowball referral. Qualitative-based thematic analysis was used to identify emergent themes from selected literature and transcribed interviews. Recommended strategies addressed instructional methods (e.g., reducing distractions), technology adaptations (e.g., simplified interface), care partner involvement, and dosage/exposure. Findings are applicable to development of technology-driven interventions and products, with the aim of improving the effectiveness of such technology for older people with CI/dementia.

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Digital Health Interventions for Healthy Aging: A Qualitative User Evaluation and Ethical Assessment

10.21203/rs.3.rs-121871/v1 ◽

2020 ◽

Author(s):

Marcello Ienca ◽

Christophe Schneble ◽

Reto Kressig ◽

Tenzin Wangmo

Keyword(s):

Older Adults ◽

Older People ◽

Healthy Aging ◽

Ethical Issues ◽

Digital Health ◽

Functional Independence ◽

Community Dwelling ◽

Healthy Ageing ◽

Health Technologies ◽

Community Dwelling Older Adults

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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Evaluating the potential costs and impact of digital health technologies for tuberculosis treatment support

European Respiratory Journal ◽

10.1183/13993003.01363-2018 ◽

2018 ◽

Vol 52 (5) ◽

pp. 1801363 ◽

Cited By ~ 11

Author(s):

Ntwali Placide Nsengiyumva ◽

Benjamin Mappin-Kasirer ◽

Olivia Oxlade ◽

Mayara Bastos ◽

Anete Trajman ◽

...

Keyword(s):

Digital Health ◽

Cost Savings ◽

Cost Effective ◽

Multidrug Resistant ◽

Potential Cost ◽

Health Technologies ◽

Life Years ◽

Message Service ◽

Latent Tb ◽

Latent Tb Infection

Ensuring adherence and support during treatment of tuberculosis (TB) is a major public health challenge. Digital health technologies could help improve treatment outcomes. We considered their potential cost and impact on treatment for active or latent TB in Brazil.Decision analysis models simulated two adult cohorts with 1) drug-susceptible active TB, and 2) multidrug-resistant TB, and two cohorts treated with isoniazid for latent TB infection (LTBI): 1) close contacts of persons with active TB, and 2) others newly diagnosed with LTBI. We evaluated four digital support strategies: two different medication monitors, synchronous video-observed therapy (VOT), and two-way short message service (SMS). Comparators were standard directly observed treatment for active TB and self-administered treatment for LTBI. Projected outcomes included costs (2016 US dollars), plus active TB cases and disability-adjusted life years averted among persons with LTBI.For individuals with active TB, medication monitors and VOT are projected to lead to substantial (up to 58%) cost savings, in addition to alleviating inconvenience and cost to patients of supervised treatment visits. For LTBI treatment, SMS and medication monitors are projected to be the most cost-effective interventions. However, all projections are limited by the scarcity of published estimates of clinical effect for the digital technologies.

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OP348 Assessing The Potential Value Of Wearable Digital Health Technologies In Chronic Kidney Disease Using Early Health Technology Assessment Methods

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462321001033 ◽

2021 ◽

Vol 37 (S1) ◽

pp. 15-16

Author(s):

Vijay S. Gc ◽

Andrea Manca ◽

Alexander J. Casson ◽

Steven Antrobus ◽

Cynthia Iglesias

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Digital Health ◽

Qualitative Interviews ◽

Cost Effective ◽

Health Technology ◽

Self Management ◽

Health Technologies ◽

Early Health Technology Assessment ◽

Early Health

IntroductionWearable digital health technologies (WDHTs) offer several solutions in terms of disease monitoring, management and delivery of specific interventions. In chronic conditions, WDHTs can be used to support individuals’ self-management efforts, potentially improving adherence to (and outcomes resulting from) interventions. Early health technology assessment (HTA) methods can inform considerations about the potential clinical and economic benefits of technology in the initial phases of the product's lifecycle, facilitating identification of those Research & Development (R&D) investments with the greatest potential stakeholders’ payoff. We report our experience of using early HTA methods to support R&D decisions relating to novel WDHT being designed to support self-management of chronic kidney disease (CKD).MethodsWe performed a literature review, focus-group interviews with patients, and qualitative interviews with the prototype development team to understand the relevant characteristics of WDHTs, quantify relevant clinical indications and existing technological constraints. An early economic evaluation was used to identify the key drivers of value for money, and a discrete choice experiment shed light onto patient preferences towards what key features the WDHT should have for the users to adopt it. Then a model-based cost-effectiveness analysis was undertaken incorporating headroom analysis, return on investment, one-way sensitivity analysis and scenario analyses using data from secondary sources.ResultsThe review of the literature, focus groups with CKD patients, and qualitative interviews with technology developers helped to understand relevant characteristics of WDHT and user preferences helped inform the next R&D iteration. Compared to the standard care, WDHT that support stage ≥3 CKD patients self-management at home by measuring blood pressure and monitor mobility has the potential to be cost-effective at conventional cost-effectiveness threshold levels. From the headroom analysis, novel WDHT can be priced up to GBP280 (EUR315, USD360) and still be cost-effective compared to standard home blood pressure monitoring.ConclusionsOur study provides valuable information for the further development of the WDHT, such as defining a go/no-go decision, as well as providing a template for performing early HTA of Digital Health Interventions.

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EXPLORING THE POWER OF COMBINATORIAL HEALTH TECHNOLOGIES TO SUPPORT SELF-MANAGEMENT OF COPD AMONG OLDER PEOPLE

Innovation in Aging ◽

10.1093/geroni/igz038.1662 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S443-S443

Author(s):

Sandra Varey ◽

Mandy Dixon ◽

Alejandra Hernandez ◽

Ceu Mateus ◽

Tom Palmer ◽

...

Keyword(s):

Older People ◽

Large Scale ◽

Digital Health ◽

Self Management ◽

Chronic Obstructive ◽

Test Bed ◽

Long Term Conditions ◽

Health Technologies ◽

Healthcare Needs ◽

The Impact

Abstract Ways to address the increasing healthcare needs of older people are a priority for the National Health Service (NHS) in England. The NHS England Test Bed programme was designed to trial new models of care that are supported by digital health technologies. This paper reports on findings from one Test Bed programme, the Lancashire and Cumbria Innovation Alliance (LCIA) – a partnership between NHS England, industry and Lancaster University, which ran from 2016 to 2018. A key aim of the LCIA Test Bed was to explore the extent to which supported self-care telehealth technology helped older people with long-term conditions to better self-manage their own care, promoting independence and enabling them to remain at home for longer. Each patient received a combination of health technologies over a six-month period. This paper presents results from the qualitative data that formed part of a large-scale mixed-methods evaluation. Specifically it draws on the analysis of 34 observational interviews with 17 participants with chronic obstructive pulmonary disease (COPD) to understand the role of these technologies in the self-management of their care. The data revealed that the majority of participants felt more confident about self-managing COPD as a result of their participation in the programme. These increases in confidence were the result of participants’ increased knowledge and skills in managing their COPD. The paper demonstrates how patients learned to better manage their respiratory condition, the impact of this learning on their daily lives and that of their family carers, and the implications for healthcare practice.

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The Digital Health Revolution and People with Disabilities: Perspective from the United States

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020381 ◽

2020 ◽

Vol 17 (2) ◽

pp. 381 ◽

Cited By ~ 4

Author(s):

Mike Jones ◽

Frank DeRuyter ◽

John Morris

Keyword(s):

United States ◽

Mobile Health ◽

Chronic Conditions ◽

Digital Health ◽

Wearable Sensors ◽

Healthcare Delivery ◽

People With Disabilities ◽

The United States ◽

Models Of Care ◽

Health Technologies

This article serves as the introduction to this special issue on Mobile Health and Mobile Rehabilitation for People with Disabilities. Social, technological and policy trends are reviewed. Needs, opportunities and challenges for the emerging fields of mobile health (mHealth, aka eHealth) and mobile rehabilitation (mRehab) are discussed. Healthcare in the United States (U.S.) is at a critical juncture characterized by: (1) a growing need for healthcare and rehabilitation services; (2) maturing technological capabilities to support more effective and efficient health services; (3) evolving public policies designed, by turns, to contain cost and support new models of care; and (4) a growing need to ensure acceptance and usability of new health technologies by people with disabilities and chronic conditions, clinicians and health delivery systems. Discussion of demographic and population health data, healthcare service delivery and a public policy primarily focuses on the U.S. However, trends identified (aging populations, growing prevalence of chronic conditions and disability, labor shortages in healthcare) apply to most countries with advanced economies and others. Furthermore, technologies that enable mRehab (wearable sensors, in-home environmental monitors, cloud computing, artificial intelligence) transcend national boundaries. Remote and mobile healthcare delivery is needed and inevitable. Proactive engagement is critical to ensure acceptance and effectiveness for all stakeholders.

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MANAGING MULTIPLE CHRONIC CONDITIONS: EXPERIENCES OF OLDER ADULTS, CAREGIVERS, AND CARE PROVIDERS

Innovation in Aging ◽

10.1093/geroni/igx004.303 ◽

2017 ◽

Vol 1 (suppl_1) ◽

pp. 73-73

Author(s):

J. Ploeg ◽

N. Matthew-Maich ◽

K. Fraser ◽

S. Dufour ◽

C.A. McAiney ◽

...

Keyword(s):

Older Adults ◽

Chronic Conditions ◽

Multiple Chronic Conditions ◽

Care Providers

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Comparison of Mobile Health Technology Use for Self-Tracking Between Older Adults and the General Adult Population in Canada: Cross-Sectional Survey

JMIR mhealth and uhealth ◽

10.2196/24718 ◽

2020 ◽

Vol 8 (11) ◽

pp. e24718

Author(s):

Mirou Jaana ◽

Guy Paré

Keyword(s):

Older Adults ◽

Health Care ◽

Technology Use ◽

Chronic Conditions ◽

Mobile Apps ◽

Adult Population ◽

Smart Devices ◽

Cross Sectional Survey ◽

Cross Sectional ◽

General Adult Population

Background The burden of population aging and chronic conditions has been reported worldwide. Older adults, especially those with high needs, experience social isolation and have high rates of emergency visits and limited satisfaction with the care they receive. Mobile health (mHealth) technologies present opportunities to address these challenges. To date, limited information is available on Canadian older adults’ attitudes toward and use of mHealth technologies for self-tracking purposes—an area that is increasingly important and relevant during the COVID-19 era. Objective This study presents contributions to an underresearched area on older adults and mHealth technology use. The aim of this study was to compare older adults’ use of mHealth technologies to that of the general adult population in Canada and to investigate the factors that affect their use. Methods A cross-sectional survey on mHealth and digital self-tracking was conducted. A web-based questionnaire was administered to a national sample of 4109 Canadian residents who spoke either English or French. The survey instrument consisted of 3 sections assessing the following items: (1) demographic characteristics, health status, and comorbidities; (2) familiarity with and use of mHealth technologies (ie, mobile apps, consumer smart devices/wearables such as vital signs monitors, bathroom scales, fitness trackers, intelligent clothing); and (3) factors influencing the continued use of mHealth technologies. Results Significant differences were observed between the older adults and the general adult population in the use of smart technologies and internet (P<.001). Approximately 47.4% (323/682) of the older adults in the community reported using smartphones and 49.8% (340/682) indicated using digital tablets. Only 19.6% (91/463) of the older adults using smartphones/digital tablets reported downloading mobile apps, and 12.3% (47/383) of the older adults who heard of smart devices/wearables indicated using them. The majority of the mobile apps downloaded by older adults was health-related; interestingly, their use was sustained over a longer period of time (P=.007) by the older adults compared to that by the general population. Approximately 62.7% (428/682) of the older adults reported tracking their health measures, but the majority did so manually. Older adults with one or more chronic conditions were mostly nontrackers (odds ratio 0.439 and 0.431 for traditional trackers and digital trackers, respectively). No significant differences were observed between the older adults and the general adult population with regard to satisfaction with mHealth technologies and their intention to continue using them. Conclusions Leveraging mHealth technologies in partnership with health care providers and sharing of health/well-being data with health care professionals and family members remain very limited. A culture shift in the provision of care to older adults is deemed necessary to keep up with the development of mHealth technologies and the changing demographics and expectations of patients and their caregivers.

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Proposing an Ecosystem of Digital Health Solutions for Teens With Chronic Conditions Transitioning to Self-Management and Independence: Exploratory Qualitative Study (Preprint)

10.2196/preprints.10285 ◽

2018 ◽

Author(s):

Emre Sezgin ◽

Monica Weiler ◽

Anthony Weiler ◽

Simon Lin

Keyword(s):

Health Care Providers ◽

Chronic Conditions ◽

Access To Health Care ◽

Environmental Changes ◽

Digital Health ◽

Chronically Ill ◽

Care Providers ◽

Component Solution ◽

Access To Health ◽

Transition To Independence

BACKGROUND Chronic disease management is critical to quality of life for both teen patients with chronic conditions and their caregivers. However, current literature is largely limited to a specific digital health tool, method, or approach to manage a specific disease. Guiding principles on how to use digital tools to support the transition to independence are rare. Considering the physiological, psychological, and environmental changes that teens experience, the issues surrounding the transition to independence are worth investigating to develop a deeper understanding to inform future strategies for digital interventions. OBJECTIVE The purpose of this study was to inform the design of digital health solutions by systematically identifying common challenges among teens and caregivers living with chronic diseases. METHODS Chronically ill teens (n=13) and their caregivers (n=13) were interviewed individually and together as a team. Verbal and projective techniques were used to examine teens’ and caregivers’ concerns in-depth. The recorded and transcribed responses were thematically analyzed to identify and organize the identified patterns. RESULTS Teens and their caregivers identified 10 challenges and suggested technological solutions. Recognized needs for social support, access to medical education, symptom monitoring, access to health care providers, and medical supply management were the predominant issues. The envisioned ideal transition included a 5-component solution ecosystem in the transition to independence for teens. CONCLUSIONS This novel study systematically summarizes the challenges, barriers, and technological solutions for teens with chronic conditions and their caregivers as teens transition to independence. A new solution ecosystem based on the 10 identified challenges would guide the design of future implementations to test and validate the effectiveness of the proposed 5-component ecosystem.

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