Benefits and Barriers to Emerging Technologies to Promote Health, Well-Being, and Independence of Older Adults

Emerging technologies, such as voice assistant systems and artificial companion robots, hold a great deal of promise for improving the health, wellbeing, and independence of older adults. However, these solutions will likely be ineffective in the absence of research to understand barriers to the adoption and use of these technologies and without an exploration of the needs and preferences of older adults. This symposium focuses on both the potential of such technologies and factors that may affect their success. H. Spangler will present a detailed analysis of privacy concerns of older adults, with and without cognitive impairment, related to the use of Voice Assistant Systems (VAS). R. Nicholson will discuss the potential of a VAS app for promoting exercise among older adults and their caregivers to enhance mobility independence, with a focus on perceived benefits and dislikes about the app that may impact use. Finally, C. Berridge will present an exploration of perceptions of and attitudes toward artificial companion (AC) robots across the lifespan, before and after the start of the COVID-19 pandemic, including concerns about privacy. Together, these talks will highlight novel methods through which emerging technologies can support older adults and issues to consider if these methods are to produce meaningful change.

Psychometric validation and meaningful change thresholds of the Worst Itching Intensity Numerical Rating Scale for assessing itch in patients with chronic kidney disease-associated pruritus

Background Chronic kidney disease-associated pruritus (CKD-aP) is characterized by persistent itch that often leads to substantially impaired quality of life. The Worst Itching Intensity Numerical Rating Scale (WI-NRS) is a single-item patient-reported outcome measure in which patients indicate the intensity of the worst itching they experienced over the past 24 h. Here, we evaluated the content validity and psychometric properties of the WI-NRS and confirmed the threshold of meaningful change in hemodialysis patients with moderate-to-severe CKD-aP. Methods Content validity interviews were conducted in 23 patients. Psychometric properties of the WI-NRS were assessed using data from one phase 2 (N = 174) and two phase 3 (N = 848) clinical trials investigating an anti-pruritic treatment. Anchor-based methods were used to confirm meaningful within-patient change score thresholds in the phase 3 trial patients and mixed-method exit interviews (N = 70) contributed further insight. Results Content validity interviews indicated patients considered the WI-NRS to be straightforward, comprehensive, and relevant. Test–retest reliability was strong in both trial cohorts (intraclass correlation coefficients > 0.75). Construct validity analyses indicated high correlation between the WI-NRS and other measures of itch. Anchor-based analyses showed a reduction of ≥ 3 points from baseline score represented an appropriate clinically meaningful within-patient change on the WI-NRS. In the exit interviews, all patients with a reduction ≥ 3 points considered the change meaningful. Conclusions The WI-NRS is a reliable, valid, and responsive measure of itch intensity for patients with moderate-to-severe CKD-aP. These results support its use to assess treatment efficacy and in clinical evaluation and management of pruritus in hemodialysis patients.

Will Business and Human Rights regulation help Rajasthan's bonded labourers who mine sandstone?

Some of the worst human rights conditions globally are found in Rajasthan’s sandstone quarries. This paper asks if state-based regulation in the economic-North advanced under the Business and Human Rights agenda: disclosure-based regimes, due diligence compliance regimes and trade-based regimes, could advance efforts to improve respect for human rights in this sector. It adopts fields of struggle lens and global value chain theoretical approaches to business power and governance to understand the challenging political and economic dynamics that entrench harm within sandstone quarrying in Rajasthan. This analysis suggests that company-based disclosure and due diligence regimes will struggle to ameliorate these dynamics whilst trade-based approaches hold some potential to generate meaningful change.

The psychometric properties of the King's Brief Interstitial Lung Disease questionnaire and thresholds for meaningful treatment response in patients with progressive fibrosing interstitial lung diseases

There is a lack of fully validated patient-reported outcome measures for progressive fibrosing interstitial lung disease (PF-ILD). We aimed to validate the King's Brief Interstitial Lung Disease questionnaire (KBILD) for measuring health-related quality of life (HRQoL) in these patients. We also estimated the meaningful change threshold for interpreting stabilisation of HRQoL as a clinical endpoint in PF-ILD, where the current goal of treatment is disease stability and slowing progression. This analysis evaluated data from 663 patients with PF-ILD other than idiopathic pulmonary fibrosis from the INBUILD trial. Validation of the measurement properties was assessed for internal consistency, test-retest reliability, construct validity, known-groups validity, and responsiveness. We calculated meaningful change thresholds for treatment response using anchor-based (within-patient) and distribution-based methods. The KBILD had strong internal consistency (Cronbach alpha was 0.94 for total score, 0.88 for KBILD domain breathlessness and activities, 0.91 for psychological and 0.79 for chest symptoms). Test-retest reliability intraclass correlation coefficient was 0.74 for KBILD total score. The KBILD demonstrated weak correlations with forced vital capacity (FVC)% predicted. Known-groups validity showed significant differences in KBILD scores for patient groups with different disease severity based on use of supplemental oxygen or baseline FVC% predicted (<70 or >70%). We estimated a meaningful change threshold of ≥–2 for the KBILD total score for defining patients who remain stable/improved versus those with progressive deterioration. Our results validate the KBILD as a tool for assessing HRQoL in patients with PF-ILD and set a meaningful change threshold of ≥–2 for KBILD total score.