scholarly journals DO OLDER ADULTS AND THEIR CHILDREN AGREE ABOUT THE USE OF LOCATION TRACKING, IN-HOME SENSORS, AND WEB-CAMERAS?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S371-S371
Author(s):  
Clara Berridge
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Adult Children ◽  
Remote Monitoring ◽  
Social Life ◽  
Adult Women ◽  
Location Tracking ◽  
Structured Interviews ◽  
Meals On Wheels ◽  
Monitoring Technologies

Abstract On the dyad and aggregate level, we compare preferences of older adult women and their adult children for three remote monitoring technologies: location tracking, in-home sensors, and Web-cameras. Their assessments of each technology’s impact on privacy, safety, independence, freedom, relationship with family member, social life, and identity are also compared. Twenty-eight individual, in-depth structured interviews were conducted with 18 women who are Meals on Wheels clients and 10 of their adult children. Adult children preferred each technology more than their mothers did and underestimated both their mothers’ ability to comprehend the functions of the technologies and the importance of engaging them fully in decision making. For both groups, privacy was the most-cited concern, and participants perceived significant overlap between values of privacy, independence, identity, and freedom. Shared decision-making tools are needed to promote remote monitoring use consistent with older adults’ values and to prevent conflict and caregiver overreach.

scholarly journals Why Older Adults and Their Children Disagree About In-Home Surveillance Technology, Sensors, and Tracking

2019 ◽  
Vol 60 (5) ◽  
pp. 926-934 ◽  
Author(s):  
Clara Berridge ◽  
Terrie Fox Wetle
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Adult Children ◽  
Remote Monitoring ◽  
Social Life ◽  
Multiple Chronic Conditions ◽  
Adult Women ◽  
Structured Interviews ◽  
Meals On Wheels ◽  
Monitoring Technologies

Abstract Background and Objectives Despite the surveilling nature of technologies that allow caregivers to remotely monitor location, movements, or activities, the potential differences in comfort with remote monitoring between caregivers and care recipients have not been examined in depth. On the dyad and aggregate level, we compare preferences of older adult women and their adult children for three remote monitoring technologies. Their assessments of each technology’s impact on privacy, safety, independence, freedom, relationship with family member, social life, and identity are also compared. Research Design and Methods This dyadic study used cognitive-based interview probing and value-centered design methods. Twenty-eight individual, in-depth, structured interviews were conducted with 18 women who are Meals on Wheels clients and 10 of their adult children. Results Meals on Wheels participants reported multiple chronic conditions and an average of 1.7 ADL and 3.3 IADL difficulties; two thirds were enrolled in Medicaid. Adult children preferred each technology more than their mothers did and underestimated both their mothers’ ability to comprehend the functions of the technologies and the importance of engaging them fully in decision making. Most were confident that they could persuade their mothers to adopt. For both groups, privacy was the most-cited concern, and participants perceived significant overlap between values of privacy, independence, identity, and freedom. Discussion and Implications Studying privacy in isolation overlooks privacy’s instrumental role in enabling other values. Shared decision-making tools are needed to promote remote monitoring use consistent with older adults’ values and to prevent conflict and caregiver overreach.

scholarly journals Medicaid Becomes the First Third-Party Payer to Cover Passive Remote Monitoring for Home Care: Policy Analysis (Preprint)

2017 ◽  
Author(s):  
Clara Berridge
Keyword(s):  
Older Adults ◽  
Remote Monitoring ◽  
Activity Monitoring ◽  
The State ◽  
Community Dwelling ◽  
Third Party ◽  
Location Tracking ◽  
Medicaid Program ◽  
Party Payer ◽  
Monitoring Technologies

BACKGROUND Recent years have seen an influx of location-tracking, activity-monitoring sensors, and Web-cameras to remotely monitor the safety of older adults in their homes and to reduce reliance on in-person assistance. The state of research on these monitoring technologies leaves open crucial financial, social, and ethical cost-benefit questions, which have prevented widespread use. Medicaid is now the first large third-party payer in the United States to pay for these technologies, and their use is likely to increase as states transition to managed long-term services and supports (MLTSS). OBJECTIVES This is the first study to examine how state Medicaid programs are treating passive remote monitoring technologies. This study identifies (1) which states allow location tracking, sensor systems, and cameras; (2) what policies are in place to track their use; (3) what implementation processes and program monitoring mechanisms are in place; and (4) what related insights Medicaid program stakeholders would like to learn from researchers. METHODS Interviews were conducted with 43 state, federal, and managed care organization (MCO) Medicaid program stakeholders about how these technologies are used in state waivers serving community-dwelling older adults in 15 states, and what policies are in place to regulate them. The interviews were analyzed by the research team using the framework analysis method for applied policy research. RESULTS Two-thirds of the states cover location tracking and activity-monitoring sensors and one-third cover cameras, but only 3 states have specific service categories that allow them to track when they are paying for any of these technologies, impeding regulation and understanding of their use at the state and federal level. Consideration of ethical and social risks is limited, and states struggle to understand which circumstances warrant use. They are further challenged by extreme resource restrictions and transitions to MLTSS by MCOs inexperienced in serving this growing “high-need, high-cost” population. CONCLUSIONS Decisions about Medicaid reimbursement of technologies that have the potential to dramatically alter the way older adults receive supportive services are being made without research on their use, social and ethical implications, or outcomes. At a minimum, new service categories are needed to enable oversight. Participants prioritized 3 research aims to inform practice: (1) determine cost-effectiveness; (2) identify what type of information beneficiaries want to be generated and whom they want it to be shared with; and (3) understand how to support ethical decision making for beneficiaries with cognitive impairment. These findings provide direction for future research and reveal that greater interaction between policy makers and researchers in this field is needed.

scholarly journals General practitioners’ attitudes and decision making regarding admission for older adults with infection: a UK qualitative interview study

2018 ◽  
Vol 36 (4) ◽  
pp. 493-500 ◽  
Author(s):  
Abigail Moore ◽  
Caroline Croxson ◽  
Sara McKelvie ◽  
Dan Lasserson ◽  
Gail Hayward
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
General Practitioners ◽  
Older Patients ◽  
Ageing Population ◽  
Structured Interviews ◽  
Suspected Infection ◽  
Qualitative Interview Study ◽  
System Factors ◽  
The Uk

Abstract Background The world has an ageing population. Infection is common in older adults; serious infection has a high mortality rate and is associated with unplanned admissions. In the UK, general practitioners (GPs) must identify which older patients require admission to hospital and provide appropriate care and support for those staying at home. Objectives To explore attitudes of UK GPs towards referring older patients with suspected infection to hospital, how they weigh up the decision to admit against the alternatives and how alternatives to admission could be made more effective. Methods. Qualitative study using semi-structured interviews. GPs were purposively sampled from across the UK to achieve maximum variation in terms of GP role, experience and practice population. Interview transcripts were coded and analysed using a modified framework approach. Results GPs’ key influences on decision making were grouped into patient, GP and system factors. Patient factors included clinical factors, social factors and shared decision making. GP factors included gut instinct, risk management and acknowledging an associated personal emotional burden. System factors involved weighing up the pressure on secondary care beds against increasing GP workload. GPs described that finding an alternative to admission could be more time consuming, complex to arrange or were restricted by lack of capacity. Conclusion GPs need to be empowered to make safe decisions about place of care for older adults with suspected infection. This may mean developing strategies to support decision making as well as improving the ease of access to, and capacity of, any alternatives to admission.

scholarly journals Sensor-Based Passive Remote Monitoring and Discordant Values: Qualitative Study of the Experiences of Low-Income Immigrant Elders in the United States (Preprint)

2018 ◽  
Author(s):  
Clara Berridge ◽  
Keith T Chan ◽  
Youngjun Choi
Keyword(s):  
United States ◽  
Older Adults ◽  
Social Workers ◽  
Low Income ◽  
Remote Monitoring ◽  
Elder Care ◽  
The United States ◽  
Passive Monitoring ◽  
Senior Housing ◽  
Monitoring Technologies

BACKGROUND Remote monitoring technologies are positioned to mitigate the problem of a dwindling care workforce and disparities in access to care for the growing older immigrant population in the United States. To achieve these ends, designers and providers need to understand how these supports can be best provided in the context of various sociocultural environments that shape older adults’ expectations and care relationships, yet few studies have examined how the same remote monitoring technologies may produce different effects and uses depending on what population is using them in a particular context. OBJECTIVE This study aimed to examine the experiences and insights of low-income, immigrant senior residents, family contacts, and staff of housing that offered a sensor-based passive monitoring system designed to track changes in movement around the home and trigger alerts for caregivers. The senior housing organization had been offering the QuietCare sensor system to its residents for 6 years at the time of the study. We are interested in adoption and discontinuation decisions and use over time, rather than projected acceptance. Our research question is how do cultural differences influence use and experiences with this remote monitoring technology? The study does not draw generalizable conclusions about how cultural groups interact with a given technology, but rather, it examines how values are made visible in elder care technology interactions. METHODS A total of 41 participants (residents, family, and staff) from 6 large senior housing independent living apartment buildings were interviewed. Interviews were conducted in English and Korean with these participants who collectively had immigrated to the United States from 10 countries. RESULTS The reactions of immigrant older adults to the passive monitoring system reveal that this tool offered to them was often mismatched with their values, needs, and expectations. Asian elders accepted the intervention social workers offered largely to appease them, but unlike their US-born counterparts, they adopted reluctantly without hope that it would ameliorate their situation. Asian immigrants discontinued use at the highest rate of all residents, and intergenerational family cultural conflict contributed to this termination. Social workers reported that none of the large population of Russian-speaking residents agreed to use QuietCare. Bilingual and bicultural social workers played significant roles as cultural navigators in the promotion of QuietCare to residents. CONCLUSIONS This research into the interactions of culturally diverse people with the same monitoring technology reveals the significant role that social values and context play in shaping how people and families interact with and experience elder care interventions. If technology-based care services are to reach their full potential, it will be important to identify the ways in which cultural values produce different uses and responses to technologies intended to help older adults live independently.

Timing of onset and self-management of multiple chronic conditions: A qualitative examination taking a lifespan perspective

2018 ◽  
Vol 16 (3) ◽  
pp. 173-189 ◽  
Author(s):  
Allison R Heid ◽  
Andrew R Gerber ◽  
David S Kim ◽  
Stefan Gillen ◽  
Seran Schug ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Life ◽  
Chronic Conditions ◽  
Self Management ◽  
Multiple Chronic Conditions ◽  
Older Individuals ◽  
Structured Interviews ◽  
Targeted Interventions ◽  
Timing Of Onset ◽  
Management Behaviors

Objectives Over two-thirds of older individuals live with multiple chronic conditions, yet chronic diseases are often studied in silos. Taking a lifespan approach to understanding the development of multiple chronic conditions in the older population helps to further elucidate opportunities for targeted interventions that address the complexities of multiple chronic conditions. Methods Semi-structured interviews were conducted with 38 older adults (age 64+) diagnosed with at least two chronic health conditions. Content analysis was used to build understanding of how older adults discuss the timing of diagnoses and subsequent self-management of multiple chronic conditions. Results Findings highlight the complex process by which illnesses unfold in the context of individuals’ lives and the subsequent engagement and/or disengagement in self-management behaviors. Two primary themes were evident regarding timing of illnesses: illnesses were experienced within the context of social life events and/or health events, and illnesses were not predominantly seen as connected to one another by patients. Self-management behaviors were described in response to onset of each illness. Discussion Findings provide insight into how older adults understand their experience of multiple chronic conditions and change in self-management behaviors over time. In order for practitioners to ignite behavioral changes, a person’s history and life experiences must be considered.

scholarly journals The shared decision making of older adults in healthcare

2019 ◽  
Vol 23 (2) ◽  
pp. 77-86
Author(s):  
Emilia Pusey ◽  
Anthea Tinker ◽  
Federica Lucivero
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Research Question ◽  
Healthcare Setting ◽  
Shared Decision ◽  
Structured Interviews ◽  
Content Type ◽  
The Family

Purpose The research question is: what are older adults’ experiences of shared decision making (SDM) in a healthcare setting? This involved exploring older adults’ experiences and opinions of decision making in a healthcare setting, and understanding what SDM means to older adults. The paper aims to discuss this issue. Design/methodology/approach A qualitative study using face-to-face, semi-structured interviews with adults over 65 years was conducted. Thematic analysis was used. Findings Three broad themes were identified which ascribed roles to individuals involved in decision making. This includes the way in which older adults felt they should be involved actively: by asking questions and knowing their own body. The doctors’ role was described as assistive by facilitating discussion, giving options and advice. The role of the family was also explored; older adults felt the family could impact on their decisions in both a direct and indirect way. There was some confusion about what constituted a decision. Research limitations/implications This was a small qualitative study in a market town in England. Practical implications Clinicians should facilitate the involvement of older adults in SDM and consider how they can increase awareness of this. They should also involve the family in decision making. Originality/value There are limited studies which look at this issue in depth.

Forms of trust and polypharmacy among older adults

2020 ◽  
pp. 1-16
Author(s):  
Alison Ross ◽  
James Gillett
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Decision Making ◽  
Social Networks ◽  
Health Care Professionals ◽  
Communicative Action ◽  
Medication Use ◽  
Modern Society ◽  
Structured Interviews ◽  
Life World

Abstract This article examines how older adults make decisions about their medications through interconnected axes of trust that operate across social networks. Trust is negotiated by older adults enrolled in a deprescribing programme which guides them through the process of reducing medications to mitigate risks associated with polypharmacy. Habermas’ work on the significance of communicative action in negotiating trust within social relationships informs our analysis, specifically in-depth semi-structured interviews with older adults about their medication use and the role of social networks in managing their health. Participants were age 70+ and experiencing polypharmacy. Our analysis discusses the social nature of medication practices and the importance of social networks for older adults’ decision-making. Their perspective reflects the critique of late-modern society put forward by Habermas. Negotiating trust in pharmaceutical decision-making requires navigating tensions across and between system networks (health-care professionals) and life-world networks (family and friends). This study contributes to our knowledge of how distinct forms of trust operate in different social spheres, setting the context for the way health-care decisions are made across social networks. Our analysis reinforces the need for older adults to engage meaningfully in health-care decision-making such that a convergence between system-world and life-world structures is encouraged. This would improve deprescribing programmes’ efficacy as older adults optimise their medication use and improve overall quality of life.

scholarly journals Remote Monitoring Technologies in Dementia Care: An Interpretative Phenomenological Analysis of Family Caregivers’ Experiences

2020 ◽  
Author(s):  
Martha Snyder ◽  
Laurie Dringus ◽  
Manon Maitland Schladen ◽  
Ronald Chenail ◽  
Elizabeth Oviawe
Keyword(s):  
Family Caregivers ◽  
Remote Monitoring ◽  
Interpretative Phenomenological Analysis ◽  
Wearable Sensors ◽  
Family Care ◽  
Phenomenological Analysis ◽  
Structured Interviews ◽  
Home Based ◽  
Integral Role ◽  
Monitoring Technologies

The desire to maintain an independent lifestyle is one shared by an increasing number of older adults. Adult children, spouses, siblings, and other relatives, also known as family caregivers, play an integral role in helping their loved ones maintain independence. Remote monitoring technologies (RMTs) such as wearable sensors, mobile emergency devices, smartphone apps, and webcams can be used to monitor, sense, record, and communicate a person’s daily activities. However, understanding is limited of the family caregiver’s needs and perceptions of RMTs used in a home-based setting. The purpose was to explore how family caregivers perceive RMTs and their use for monitoring and supporting their care recipients who choose to live independently. We used a survey to capture some basic characteristics of family caregivers, what they know about RMTs, and to recruit interview participants. We conducted semi-structured interviews with four participants who shared the commonality of caring for a relative with dementia. We reported the survey data using descriptive statistics and we applied interpretative phenomenological analysis (IPA) to analyze and report results from the interviews. Four themes emerged including the unique relationships that exist in family care, the risk-benefit conundrum that accompanies benefits and tradeoffs of RMT use, human-technology interaction and usability, and the importance of creating tailored solutions to facilitate RMT adoption and use. Our findings provide insight into factors impacting adoption and use.

Functional disability and the role of children in U.S. older adults’ core discussion networks

2021 ◽  
pp. 1-19
Author(s):  
Markus H. Schafer ◽  
Laura Upenieks
Keyword(s):  
Older Adults ◽  
Adult Children ◽  
Social Life ◽  
Functional Disability ◽  
Functional Health ◽  
Older Parents ◽  
Core Networks ◽  
Egocentric Network ◽  
Advanced Stages

Abstract This study considered the role of adult children in the core networks of U.S. older adults with varying levels of functional health. Taking a multidimensional perspective of the ego network system, we considered (a) presence of child(ren) in the network, (b) contact with children network members, and (c) embeddedness of children within the network. We observed older parents from three waves of the National Social Life, Health, and Aging Project (NSHAP). The common ‘important matters’ name generator was used to construct egocentric network variables, while self-reported difficulty with activities of daily life was used to measure disablement transitions. Parameters were estimated with Generalized Estimating Equations (GEE). Though child turnover was common in parents’ core networks, there was no evidence linking disablement transitions to systematic forms of child reshuffling. Children that remained in parents’ networks, however, showed increased contact with parents and with other members of the network when the parent underwent disability progression. Disability onset was not significantly linked to either outcome. There was limited evidence of gender variation in these patterns. Overall, results strengthen the view that children are distinctive members of older adults’ core networks. Further, the role of adult children shifts most noticeably at advanced stages of the disablement process.

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