Feasibility and Adoption of a Focused Digital Wellness Program in Older Adults

Digital health programs offer numerous psychological and physical health benefits. To date, digital programs have been aimed broadly at younger participants, yet older individuals may also benefit. Our study sought to demonstrate user feasibility and satisfaction in a digital wellness program for older adults. We conducted a retrospective analysis of 140 participants in a digital health wellness application that integrated guided exercises, nutrition planning and health education. Primary outcomes were active participant retention, engagement in the mobile program and user satisfaction as operationalized by NPS scores. Among 140 participants, median age was 59.82 (50–80), 61% female, in a sample taken in the United States. Engagement was high and sustained, with more than 65% participants engaged, operationalized as at least completing one task activity a month over 17 weeks. Participants were also satisfied with the program, reporting NPS scores of 43 on day 30 of the program. Secondary health outcomes included 3.44 pound weight change during the first month. User feasibility and satisfaction was demonstrated in a sample of older participants for this novel digital health wellness program. Future work focused on older adult users may result in improvements in patient health outcomes and improved preventive medicine strategies.

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Associations Between Self-Esteem With Diverse Deleterious Mental Health Outcomes Among Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.974 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 304-304

Author(s):

Marissa Pifer ◽

Daniel Segal ◽

Meghan Marty

Keyword(s):

Mental Health ◽

Older Adults ◽

Health Outcomes ◽

Sense Of Belonging ◽

Self Esteem ◽

Mental Health Outcomes ◽

Older Individuals ◽

Adult Participants ◽

Patient Health ◽

Meaningful Relationships

Abstract Research suggests meaningful relationships between self-esteem and various deleterious mental health outcomes. However, these relationships are less well understood in older adults, where age-specific models of self-esteem are lacking. In this study, older adult participants (N = 284, M age = 73.3 years) anonymously completed a series of questionnaires as part of a larger battery. Measures examined for this study included the Single-Item Self-Esteem Scale (SISE), Patient Health Questionnaire (PHQ-9), Beck Hopelessness Scale (BHS), Three-Item Loneliness Scale (3LS), Sense of Belonging Inventory – Psychological Subscale (SOBI-P), and the Geriatric Anxiety Scale (GAS). A multiple regression was conducted to examine how these mental health variables predict self-esteem. The model explained a significant 39% of the variance in self-esteem, F (5,234) = 29.68, p < .001, with two significant predictors. Specifically, lower scores on the PHQ-9 (β = -3.06, p < .01) predicted higher scores on the SISE, whereas higher scores SOBI-P (β = .27, p < .01) predicted higher scores on the SISE. Scores on the 3LS (β = -.09), BHS (β = -.03), and GAS (β = -.03) did not emerge as significant predictors in the model. Results from this study indicate that lower depression and higher sense of belonging have unique contributions to self-esteem for older adults, controlling for the shared variance from other mental health variables, such as loneliness, hopelessness, and anxiety. Although causality was not assessed, future prospective studies should examine whether interventions focusing on reducing depression or increasing feelings of belongingness enhance self-esteem for older individuals.

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Self-Reported Energy Trajectories Predict Adverse Health Outcomes in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.2880 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 794-795

Author(s):

Briana Sprague ◽

Xiaonan Zhu ◽

Rebecca Ehrenkranz ◽

Qu Tian ◽

Theresa Gmelin ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Mixed Models ◽

Single Item ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Observational Cohort ◽

Outcome Performance ◽

Future Work ◽

Mortality Hazard Ratio

Abstract Declining energy may indicate homeostatic dysregulation and predict adverse health outcomes. We hypothesized that declining energy would predict greater frailty (1-10), greater mortality, and faster mood (CES-D) and cognition (3MS) decline over time. This observational cohort studies included 2,443 older adults (mean age=74.6, 62.5% White, 47.8% men) from the Health ABC Study with up to eight years of data. Energy was assessed using a single-item question about prior month’s energy (baseline mean=6.7, SD=1.7, range=0–10, lower=less energy). We used linear mixed models to create energy change scores (mean=-.07 points/year, SD=.05, range=-0.32-0.21, negative=decreased energy). In regression models adjusting for baseline outcome performance and energy and demographics, declining energy predicted greater frailty (β=-2.72, 95%CI = -3.39,-2.06), greater mortality (hazard ratio=.07, p<.001), and faster CES-D (β=-.93, 95%CI=-1.10,-0.75) but not 3MS decline. Energy changes are easy to assess and predict clinically-relevant outcomes. Future work should consider mechanisms of declining energy on disability-related outcomes. Part of a symposium sponsored by Brain Interest Group.

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Digital Health Literacy: A Bibliometric Analysis (Preprint)

10.2196/preprints.35816 ◽

2021 ◽

Author(s):

Keng Yang ◽

Yekang Hu ◽

Hanying Qi

Keyword(s):

Health Literacy ◽

Health Outcomes ◽

Digital Divide ◽

Bibliometric Analysis ◽

Digital Health ◽

The United States ◽

Research Progress ◽

Future Research ◽

Scientific Publications ◽

Number Of Publications

BACKGROUND Digital health is growing at a rapid pace, and digital health literacy has tremendous potential to promote health outcomes, bridge the digital divide, and improve health inequalities. OBJECTIVE The purposes of this study are to conduct a systematic bibliometric analysis on the field of dig-ital health literacy and to understand the research context and trends in this field. METHODS A total of 1,955 scientific publications were collected from the Web of Science (WoS) core col-lection. Institutional cooperation, journal co-citation, theme bursting, keyword co-occurrence, author cooperation, author co-citation, literature co-citation and references in the field of digi-tal health literacy were analyzed using the VOSviewer and CiteSpace knowledge mapping tools. RESULTS The results demonstrated that the United States was the leader in number of publications and citations in this field. The University of California System was first in terms of institutional contributions. The Journal of Medical Internet Research led in number of publications, cita-tions and co-citations. Research areas in the field of digital health literacy mainly include the definition and scale of health literacy, health literacy and health outcomes, health literacy and the digital divide, and the influencing factors of health literacy. CONCLUSIONS We summarize research progress in the field of digital health literacy and reveal the context, trends, and trending topics of digital health literacy research through statistical analysis and network visualization. Our work can serve as a fundamental reference and directional guide for future research in this field.

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How Families Make Their Way Into Your Heart: Exploring the Associations Between Daily Experiences Involving Family Members and Cardiovascular Health

Annals of Behavioral Medicine ◽

10.1093/abm/kaab095 ◽

2021 ◽

Author(s):

Hye Won Chai ◽

David M Almeida

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Cardiovascular Health ◽

Family Members ◽

The United States ◽

Cardiovascular Outcomes ◽

National Study ◽

Public Health Issue ◽

Negative Experiences ◽

Daily Experiences

Abstract Background Cardiovascular disease is a critical public health issue and a growing body of literature on relationships and health point to individuals’ interactions and involvement with family members as significant correlates of cardiovascular outcomes. However, less is known about the implications of daily encounters with family members on cardiovascular health outcomes and how the associations vary across adulthood. Purpose The aims of this study were to examine the associations of positive and negative daily experiences with family members with comprehensive measures of cardiovascular health and to further explore how age moderates these associations. Methods This study used data from the Midlife in the United States (MIDUS) II and MIDUS Refresher. The sample was composed of respondents who participated in two subprojects of MIDUS, namely the National Study of Daily Experiences (NSDE) and Biomarker Project (N = 1,312). Indices of cardiovascular health included inflammatory markers, autonomic functioning, and Life’s Simple 7 scores. Results Results showed that the associations between daily family experiences and cardiovascular outcomes differed by age. Having more daily negative experiences with family members was associated with better cardiovascular health outcomes among young adults and worse cardiovascular outcomes among older adults. Having more daily positive experiences was also associated with lower heart rate variability for older adults. Conclusions Results revealed that contrary to the general assumption that negative experiences have health-damaging effects, frequent involvement with family members in daily life, even negative ones, may be indicative of active engagement in life that could be health promoting for younger adults.

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Meeting Geriatric Competencies: Are Internal Medicine Residency Programs in New Jersey Meeting Expectations for Quality Care in Older Adults

SAGE Open ◽

10.1177/2158244019827678 ◽

2019 ◽

Vol 9 (1) ◽

pp. 215824401982767

Author(s):

Ramy Sedhom ◽

Daniel Sedhom ◽

David Barile

Keyword(s):

Internal Medicine ◽

Older Adults ◽

New Jersey ◽

Palliative Medicine ◽

Training Programs ◽

Quality Care ◽

The United States ◽

Outpatient Setting ◽

Older Individuals ◽

Formal Curriculum

There has long been recognition for improved education and training in aging and geriatrics. As the number of older individuals in the United States increases, with 20% being older than 65 years by 2030, it will become increasingly important for internists and medical subspecialty trainees to have proper training in the care of older adults. A survey was developed and administered to Internal Medicine Program Directors, to perform an educational needs assessment. The survey was administered during the beginning of the 2015 academic year via email. The survey assessed general program characteristics, details regarding required geriatric and palliative medicine teaching, opportunities for electives, barriers encountered at each training site, and future recommendations for improving the structure of resident education. Analysis of survey responses indicated that geriatric and palliative care education is lacking. Although all training programs provided some aspect of geriatric and palliative medicine training to internal medicine residents, only 27% of training programs had a formal curriculum in geriatric and palliative medicine. The majority had an informal curriculum. Very few programs reported using a multimodality approach; most used isolated experiences in either an inpatient or an outpatient setting. Although all residency directors believed curricular developments in geriatric and palliative medicine were important, very few have available faculty needed to facilitate curricular improvements. Almost all identified that they would use a restructured curriculum if it were readily available. Investment in developing content and a standardized curriculum in geriatric and palliative medicine would be very valuable and well received in New Jersey.

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The Role of Immigration in the Health of Lesbian, Gay, Bisexual, and Transgender Older Adults in the United States

The International Journal of Aging and Human Development ◽

10.1177/0091415019842844 ◽

2019 ◽

Vol 89 (1) ◽

pp. 3-21

Author(s):

Jane J. Lee ◽

Hyun-Jun Kim ◽

Karen Fredriksen Goldsen

Keyword(s):

Older Adults ◽

Health Care ◽

Health Behaviors ◽

Health Outcomes ◽

Health Care Access ◽

Well Being ◽

The United States ◽

Foreign Born ◽

Care Access ◽

Bisexual And Transgender

Lesbian, gay, bisexual, and transgender (LGBT) aging research is growing around the globe. Yet, few studies have examined the interconnectedness of different populations and cultures. This study examines whether LGBT foreign-born older adults experience greater health disparities than their U.S.-born counterparts. We conducted a cross-sectional analysis of the National Health, Aging, and Sexuality/Gender Study: Aging with Pride from 2014, which assessed measures of health and well-being among LGBT adults aged 50 years and older ( n = 2,441). We compared sociodemographic characteristics, health-care access, health behaviors, and health outcomes between foreign-born and U.S.-born participants. Foreign-born LGBT older adults reported greater socioeconomic disadvantage and higher levels of experiencing barriers to health-care access than U.S.-born LGBT older adults. Groups did not significantly differ in health behaviors and health outcomes when controlling for sociodemographic factors. Greater understanding of the mechanisms that shape the relationship between migration and health among the LGBT population is warranted.

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Care Transitions, Patient Health, and System Performance in the United States

Encyclopedia of Social Work ◽

10.1093/acrefore/9780199975839.013.1059 ◽

2016 ◽

Author(s):

June Simmons ◽

Sandy Atkins ◽

Janice Lynch Schuster ◽

Melissa Jones

Keyword(s):

Health Outcomes ◽

Social Services ◽

Hospital Readmissions ◽

Care Transitions ◽

Transition Process ◽

The United States ◽

Institutional Setting ◽

Patient Health ◽

Barriers And Opportunities ◽

Services And Supports

Transitions in care occur when a patient moves from an institutional setting, such as a hospital or nursing home, to home or community, often with the hope or expectation of improving health status. At the very least, patients, clinicians, and caregivers aim to achieve stability and avoid complications that would precipitate a return to the emergency department (ED) or hospital. For some groups of vulnerable people, especially the very old and frail, such transitions often require specific, targeted coaching and supports that enable them to make the change successfully. Too often, as research indicates, these transitions are poorly executed and trigger a cycle of hospital readmissions and worsening health, even death. In recognizing these perils, organizations have begun to see that by improving the care transition process, they can improve health outcomes and reduce costs while ensuring safety, consistency, and continuity. While some of this improvement relies on medical care, coaching, social services and supports are often also essential. Lack of timely medical follow-up, transportation, inadequate nutrition, medication issues, low health literacy, and poverty present barriers to optimal health outcomes. By addressing social and environmental determinants of health and chronic disease self-management, social workers who make home visits or other proven timely interventions to assess and coach patients and their caregivers are demonstrating real results. This article describes care transitions interventions, research into barriers and opportunities, and specific programs aimed at improvement.

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Monitoring Older Adult Blood Pressure Trends at Home as a Proxy for Brain Health

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v13i3.11842 ◽

2021 ◽

Vol 13 (3) ◽

Author(s):

Nicole Cassarino ◽

Blake Bergstrom ◽

Christine Johannes ◽

Lisa Gualtieri

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Design Thinking ◽

Digital Health ◽

Primary Care Providers ◽

The United States ◽

Warning Signs ◽

Care Providers ◽

Brain Health ◽

At Home

Even when older adults monitor hypertension at home, it is difficult to understand trends and share them with their providers. MyHealthNetwork is a dashboard designed for patients and providers to monitor blood pressure readings to detect hypertension and ultimately warning signs of changes in brain health. A multidisciplinary group in a Digital Health course at Tufts University School of Medicine used Design Thinking to formulate a digital solution to promote brain health among older adults in the United States (US). Older adults (aged 65 and over) are a growing population in the US, with many having one or more chronic health conditions including hypertension. Nearly half of all American adults ages 50-64 worry about memory loss as they age and almost all (90%) wish to maintain independence and age in their homes. Given the well-studied association between hypertension and dementia, we designed a solution that would ultimately promote brain health among older adults by allowing them to measure and record their blood pressure readings at home on a regular basis. Going through each step in the Design Thinking process, we devised MyHealthNetwork, an application which connects to a smart blood pressure cuff and stores users’ blood pressure readings in a digital dashboard which will alert users if readings are outside of the normal range. The dashboard also has a physician view where users’ data can be reviewed by the physician and allow for shared treatment decisions. The authors developed a novel algorithm to visually display the blood pressure categories in the dashboard in a way straightforward enough that users with low health literacy could track and understand their blood pressure over time. Additional features of the dashboard include educational content about brain health and hypertension, a digital navigator to support users with application use and technical questions. Phase 1 in the development of our application includes a pilot study involving recruitment of Primary Care Providers with patients who are at risk of dementia to collect and monitor BP data with our prototype. Subsequent phases of development involve partnerships to provide primary users with a rewards program to promote continued use, additional connections to secondary users such as family members and expansion to capture other health metrics.

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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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Antifragile Behavior Change through Digital Behavior Change Interventions (Preprint)

10.2196/preprints.32571 ◽

2021 ◽

Author(s):

Benjamin T Kaveladze ◽

Sean D Young ◽

Stephen M Schueller

Keyword(s):

Mental Health ◽

Decision Making ◽

Behavior Change ◽

Health Outcomes ◽

Real World ◽

Change Process ◽

Digital Health ◽

Health Behavior Change ◽

Behavior Change Interventions ◽

Future Work

UNSTRUCTURED Digital health behavior change interventions (DHBCIs) are popular and widely-accessible tools for helping people to pursue behavior change goals. However, their effectiveness tends to be low in real-world settings. Drawing from Nassim Nicholas Taleb’s concept of antifragility, we introduce antifragile behavior change, a strategy that leverages user-specific characteristics to make the behavior change process more efficient. Next, we propose two principles for designing DHBCIs to support antifragile behavior change: first, DHBCIs should provide personalized guidance that accounts for user-specific circumstances and goals; second, DHBCIs should prioritize user agency by refraining from using nudges that might manipulate user decision-making. We hope this paper will encourage researchers and product developers to reconsider DHBCI design through the lens of antifragility. Future work can examine if DHBCIs that are consistent with our principles of designing for antifragile behavior change lead to better mental health outcomes than other DHBCIs.

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