Article

Computer and Internet Access for Long-Term Care Residents: Perceived Benefits and Barriers

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Abstract

In this study, the authors examined residents' computer and Internet access, as well as benefits and barriers to access in nursing homes. Administrators of 64 nursing homes in a national chain completed surveys. Fourteen percent of the nursing homes provided computers for residents to use, and 11% had Internet access. Some residents owned personal computers in their rooms. Administrators perceived the benefits of computer and Internet use for residents as facilitating direct communication with family and providing mental exercise, education, and enjoyment. Perceived barriers included cost and space for computer equipment and residents' cognitive and physical impairments. Implications of residents' computer activities were discussed for nursing care. Further research is warranted to examine therapeutic effects of computerized activities and their cost effectiveness.

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... While technology use in healthy and functioning older adults is a major theme in international gerontology (Schulz et al., 2015), the situation differs for those with multiple morbidities and functional impairments and for those in advanced old age (Cotten, 2020;Hunsaker & Hargittai, 2018). This situation is unfortunate, as the internet and wearables, such as smartphones, may also be an important resource for groups of vulnerable older adults (Fang et al., 2018;Kononova et al., 2019;Rosales & Fernández-Ardèvol, 2019;Sims et al., 2016;Tak et al., 2007). From the vantage point of established concepts of successful adaptation, such as the model of selection and optimization with compensation (Baltes & Baltes, 1990), ICT usage may be important in maintaining health, functional competence, autonomy, and social participation, particularly among very old and more frail older adults (Hofer, 2017;Schlomann et al., 2020;Van der Goot et al., 2015). ...
... Another interesting finding is that although previous studies have often found health level to significantly predict technology use (Dobransky & Hargittai, 2006;König et al., 2018;Tak et al., 2007), and our bivariate analyses also showed the same significant patterns, our multivariate findings showed no significant relation with care level for smartphone, tablet, and internet use in the full models. Instead, these models showed that predictors such as interest in technology were more important for distinguishing between users/nonusers. ...
... This finding reveals multiple uses of ICT devices within LTC settings, which should draw researchers' attention to the need for diverse trainings within long-term facilities for different ICT devices (Cotten et al., 2017). This situation also speaks to the need for diverse competences among support staff in LTC settings to aid older adults in using different technologies (Moyle et al., 2018;Tak et al., 2007). ...
Article
Although information and communication technologies (ICTs), such as smartphones, tablets, and the internet, have all become increasingly important in modern society, available studies on the adoption of ICTs have mostly focused on healthy and community-dwelling “young-old” adults. Relatively little is known about ICT use among long-term care residents, such as “old-old” adults, who often have various functional impairments and live in institutionalized settings. The study includes data on ICT use (TV, radio, computers, smartphones, tablets, and internet) among a large sample of 940 residents (mean age: 87.6 years) living in 20 retirement homes in Zurich, Switzerland. Twenty-one percent of residents reported using the internet, 13% used a smartphone, and 5% used a tablet. Younger older adults, those with more education, those with lower nursing-care levels, and those who reported being particularly interested in technology were more likely to own more than one ICT device. Compared with nonusers, internet users were more likely to be younger, better educated, and more interested in technology in general. Modern ICT usage has reached the long-term care sector and appears to play a significant role in many residents’ lives. Researchers should continue to examine the role of ICTs in the lives of older adults in general and for residents in long-term care in particular, given that this population is often ignored in studies of older adults and ICT use.
... To date, there has not been research from nursing homes' view related to cognitively intact resident's usage of computers. Tak, Beck, and McMahon (2007) surveyed nursing homes with a dementia unit and found that administrators think there is the potential for increased family contact when residents have computers available to them. Two studies have found none to minimal Internet access in nursing homes (Abramson, Stone, & Bollinger, 2001;Tak et al., 2007). ...
... Tak, Beck, and McMahon (2007) surveyed nursing homes with a dementia unit and found that administrators think there is the potential for increased family contact when residents have computers available to them. Two studies have found none to minimal Internet access in nursing homes (Abramson, Stone, & Bollinger, 2001;Tak et al., 2007). Barriers to computer accessibility at nursing homes are unknown. ...
... Barriers to computer accessibility at nursing homes are unknown. Administrators perceive barriers to be due to lack of Internet access, limited computer access for nursing homes that have Internet access, or the potential for staff to use computers inappropriately (Tak et al., 2007). Research is needed to understand how or whether computers are currently utilized in nursing homes. ...
Article
Limited research exists examining video communication among cognitively intact nursing home residents to connect with family. This scoping review evaluated existing literature for video communication usage with nursing home residents, family, and nursing homes. A comprehensive search was completed using PubMed and EBSCOhost (including AgeLine, CINAHL, and PsycINFO) between 1972 and 2016 to locate English-language articles. The analysis identified five eligible studies (four involved an intervention, one assessed family views) meeting inclusion criteria. Findings included, seeing family members separated by distance, seeing other parts of their life, and visually monitoring resident’s health. Participants described frustration with technology limitations, such as video or audio lag. Current literature does not show a comprehensive assessment of video communication usage for residents, family, and nursing homes. Future studies should address the complexity of the intersection of the person, nursing home, and families in terms of potential benefits and capability of video communication use with residents.
... For example, nursing homes are federally mandated to provide telephone access for each resident and are required to provide internet access if it is available at the facility [14]. In addition to following federal regulations, some LTC facilities have also started to incorporate information and communication technologies (ICTs) for residents' use in the facility [15][16][17]. ICTs are devices and applications that provide the potential for unlimited connectivity and communication through technology such as desktop computers, laptops, tablets, smartphones, the internet, social media platforms, and videoconferencing [16,18]. Some segment of LTC residents can use ICTs, although residents' age, education level, interest in technology, and level of care may influence ICT use (Seifert ...
... This study is unique in that it presents an institutional perspective regarding how LTC facilities attempted to use ICTs to help address the socioemotional needs of their residents during the COVID-19 pandemic. Although there were some LTC facilities that, prior to the pandemic, provided ICTs for residents' use, corroborating the findings from other prior studies [15,17,19], the advent of the lockdowns led many of the South Carolina facilities in this study to purchase ICTs. ...
Article
Background: The prevalence of COVID-19 in the U.S. led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs in order to use them. Objective: This study explored ICT access and use in LTC institutions and how LTC institutions adapted to try to enhance social connections for their residents during COVID-19. Methods: LTC administrators in South Carolina were invited to complete an online survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of COVID-19. Results: LTC administrators (N=70, 12 nursing homes, 58 assisted living facilities) completed the online survey. Since March 2020, 53% (37/70) of the LTC facilities have purchased ICTs for residents' use. ICTs have mainly been used for video conferencing with family members (31/36, 86%), friends (25/36, 69%), and/or healthcare providers (26/36, 72%). Nursing homes were 10.23 times more likely to purchase ICTs for residents' use during COVID-19 compared to assisted living facilities (OR 11.23, 95% CI 1.12-113.02; P = .04). Benefits of ICT use included residents' feeling connected to their family members, friends, and/or other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, broken technology, and residents who do not want to share technology. Conclusions: Results of this exploratory study suggest that over half of the LTC institutions in this study were able to acquire ICTs for their residents to use during COVID-19. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and/or adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents' engagement and communication opportunities, such as another pandemic. Clinicaltrial:
... While Internet use in healthy and well-functioning older adults has developed as a major theme in international gerontology (e.g., Chen & Persson, 2002;Czaja & Lee, 2007;Doh et al., 2015;Schulz et al., 2015;Seifert & Schelling, 2016), the situation differs in those with multimorbidity and functional impairments and in advanced old age. This is unfortunate as the A c c e p t e d M a n u s c r i p t 4 Internet may also become an important resource for groups of vulnerable older adults (Tak, Beck & McMahon, 2007). Seen from the vantage point of established concepts of successful adaptation, such as the model of selection, optimization with compensation (Baltes & Baltes, 1990), media use may gain an important role in maintaining health, functional competence, autonomy, education and social participation, particularly in very old and more frail older adults (Wittkämper, 2013). ...
... Regarding gender and age, the study from Seifert and Schelling (2015a) conducted in Switzerland as well as other international studies (Lengsfeld, 2011;Olson et al., 2010;Brandtzaeg, Heim & Karahasnovic, 2011) have reported age and gender as significant predictors for Internet use. Internet use has repeatedly been found to be lower in the situation of higher care needs and lowered care health (Dobransky, 2006;Tak, Beck & McMahon, 2007). In the present study, higher subjective autonomy and higher life satisfaction remained significant predictors of Internet use in our multivariate model. ...
Article
Full-text available
The Internet has gained much importance as a resource for older adults during recent years, e.g. as a resource for maintain lifelong learning. However, available studies targeting the adoption of the Internet have mostly focused on young-old, healthy, and community-dwelling adults. To our knowledge, no study has yet examined Internet use among individuals living in residential care facilities (RCF), i.e., old-old adults with a range of functional impairments. We provide data on the Internet use in a large sample of 1,212 residents (mean age, 87.9 years) living in 24 RCFs in Zurich, Switzerland. We found that 14% of residents used the Internet, a very similar proportion as previously reported in a Swiss survey of older adults in private households. However, when stratified according to age, individuals aged 65–84 years in RCFs had lower Internet use compared with community-dwelling older adults (21% versus 65%, respectively). No difference was observed among individuals aged ≥85 years. Compared with non-users, Internet users were more likely to be younger, male, living for a shorter duration in RCF, not living alone in the institution, and healthier and functionally unimpaired. Internet users also described themselves as having higher autonomy and satisfaction with life. In conclusion, Internet use has reached (at least in Switzerland) the long-term care sector and appears to play a significant role in the lives of a considerable portion of RCF residents. http://dx.doi.org/10.1080/03601277.2017.1326224
... This technology seems to have been embraced by mental health experts as they can retrieve and disseminate information by email, videoconferencing, websites, online journals and newsletters. Supervision of practising mental health professionals through the use of the internet has also been undertaken (McMahon, 2002;Myrick & Sabella, 1995). In addition, some mental health practitioners were also using the Internet to communicate effectively with diverse and troubled clients (Guanipa, 2001). ...
Article
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Mental health professionals especially those working in the Northwest and Southwest communities in Cameroon are confronted with a plethora of challenges that impinge on their service delivery. Today, the use of information and communication technologies (ICT) has the potential to improve the provision of mental healthcare services through greater access and coverage, effectiveness and efficiency, and quality. Thus, the purpose of this study was to investigate the effect of ICT utilization on mental healthcare service provision in the Northwest and Southwest communities of Cameroon during Covid-19 pandemic and the Anglophone Crisis. More specifically, the study sought to ascertain the extent to which computer utilization, and internet utilization affects mental healthcare service provision. The employed the survey research design with a mix of both quantitative and qualitative techniques. Quantitative data was collected through questionnaires while a semi-structured interview guide and an observational checklist was used to obtain qualitative data from a sample of 150 mental healthcare workers. Data was analyzed with the aid of the Statistical Package for Social Sciences (SPSS) version 23.0 for Windows. Descriptive statistics such as simple percentages, mean scores and standard deviation, and inferential statistics such as the one sample t-test, one-way analysis of variance (ANOVA's F-test) and the Pearson Correlation test were used to analyze quantitative data while qualitative data was analyzed using content analysis with the support of ATLAS.ti software version 8.0. Based on the findings, recommendations were made to mental healthcare trainers who were advised to make efforts to effectively use information and communication technologies to improve the quality and effectiveness of mental healthcare services in Cameroon secondary schools.
... The issues of involvement of older people in the digital environment, caused by the desire of society to integrate them into community, has been actively discussed in recent years in many countries [1][2][3]. Meanwhile, older people are often associated with distancing from computers, smartphones and other digital innovations, as well as with weak learning ability. ...
... Using computers and the Internet may provide a cognitive and intellectual challenging activity, which is intrinsically rewarding, because Internet-based services may have particular benefits for older persons (Amichai-Hamburger, McKenna, & Tal, 2008;Cody, Dunn, Hoppin, & Wendt, 1999;Tak, Beck, & McMahon, 2007;White et al., 2002). Moreover, using computers and the Internet may even improve autonomy, because in order to use Internet services such as Web surfing or e-mail, many of the cognitive abilities that are intensively drawn upon, are also essential in everyday functioning. ...
... The USA was the setting for around two-fifths of the work (114 studies). 26,[30][31][32]36,42,[46][47][48][49]64,[67][68][69][70]74,75,77,82,[87][88][89]91,[93][94][95]97,98,[103][104][105][106][107][108][110][111][112]117,120,121,128,129,133,134,[136][137][138]140,141,143,[151][152][153]155,156,159,172,175,176,178,181,184,189,190,192,[196][197][198]212,217,218,221,222,224,[226][227][228][229][230][231][232][233][239][240][241]243,244,250,252,255,257,[260][261][262][263][264]266,272,276,[278][279][280][281][282]285,286 A further 94 (33%) studies were from high-income countries outside the USA and Europe. 19,[23][24][25]33,[37][38][39][40][41][50][51][52]61,62,66,73,78,81,[84][85][86]90,92,101,114,116,122,125,[130][131][132]142,[144][145][146][147][148][149][150]154,157,[164][165][166][167][168]171,174,177,179,180,182,[185][186][187][201][202][203][204][205][209][210][211]216,219,220,225,[235][236][237][238]245,249,251,253,256,258,259,265,[268][269][270][273][274][275]283,[289][290][291]293,295 A minority of studies were conducted in Europe (n = 78, 28%), half of these in the UK. ...
Article
Full-text available
Background Flexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme. Aim To conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation. Objectives (1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes? Data sources Searches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search. Design Mapping review and rapid, systematic evidence syntheses. Setting Care homes with and without nursing in high-income countries. Review methods Published literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses. Results Seven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising. Limitations This review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded. Conclusions This review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation. Future work Future work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context. Study registration This study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938. Funding The National Institute for Health Research Health Services and Delivery Research programme.
... A systematic review of the effects of communication technology on reducing social isolation in older adults revealed a significant reduction of loneliness when consistently using information communication technologies (i.e., smartphones, iPads, emailing, and online chat rooms or forums), and use of high-technology apps (e.g., Wii, the TV gaming system, virtual pet companions) to alleviate loneliness (Chen & Schulz, 2016). Unfortunately, internet access in LTC is limited, leaving some areas of the building and residents' rooms without Wi-fi (Moyle et al., 2018;Saskatchewan Health Authority, 2019;Tak et al., 2007), and many homes only offer a limited number of desktop computers in a communal area available for resident use (Powell et al., 2019;Seifert et al., 2017). Access to and use of technological innovations, such as stable and reliable Wi-Fi access for communication technology, fosters greater independence (Christophorou et al., 2016), and helps address residents' psychosocial needs by enabling them to communicate and remain connected with friends and family. ...
Article
The COVID-19 pandemic has exposed persistent inequities in the long-term care sector and brought strict social/physical distancing distancing and public health quarantine guidelines that inadvertently put long-term care residents at risk for social isolation and loneliness. Virtual communication and technologies have come to the forefront as the primary mode for residents to maintain connections with their loved ones and the outside world; yet, many long-term care homes do not have the technological capabilities to support modern day technologies. There is an urgent need to replace antiquated technological infrastructures to enable person-centered care and prevent potentially irreversible cognitive and psychological declines by ensuring residents are able to maintain important relationships with their family and friends. To this end, we provide five technological recommendations to support the ethos of person-centered care in residential long-term care homes during the pandemic and in a post-COVID-19 pandemic world.
... A systematic review of the effects of communication technology on reducing social isolation in older adults revealed a significant reduction of loneliness when consistently using information communication technologies (i.e., smartphones, iPads, emailing, and online chat rooms or forums), and use of high-technology apps (e.g., Wii, the TV gaming system, virtual pet companions) to alleviate loneliness (Chen & Schulz, 2016). Unfortunately, internet access in LTC is limited, leaving some areas of the building and residents' rooms without Wi-fi (Moyle et al., 2018;Saskatchewan Health Authority, 2019;Tak et al., 2007), and many homes only offer a limited number of desktop computers in a communal area available for resident use (Powell et al., 2019;Seifert et al., 2017). Access to and use of technological innovations, such as stable and reliable Wi-Fi access for communication technology, fosters greater independence (Christophorou et al., 2016), and helps address residents' psychosocial needs by enabling them to communicate and remain connected with friends and family. ...
Article
The COVID-19 pandemic has exposed persistent inequities in the long-term care sector and brought strict social/physical distancing distancing and public health quarantine guidelines that inadvertently put long-term care residents at risk for social isolation and loneliness. Virtual communication and technologies have come to the forefront as the primary mode for residents to maintain connections with their loved ones and the outside world; yet, many long-term care homes do not have the technological capabilities to support modern day technologies. There is an urgent need to replace antiquated technological infrastructures to enable person-centered care and prevent potentially irreversible cognitive and psychological declines by ensuring residents are able to maintain important relationships with their family and friends. To this end, we provide five technological recommendations to support the ethos of person centered care in residential long-term care homes during the pandemic and in a post-COVID-19 pandemic world.
Article
Much research has focused on the introduction of information and communication technology (ICTs) into the lives of older people, but it has generally understood them as external factors who act as a sort of independent variable that impacts the seniors’ lives. There remains a dearth of empirical research into how aging and technology are co-constructed, namely, research that focuses on older people’s relationship to technology as a socio-technical network. We therefore contribute to this field by analyzing the development and establishment of a network in a geriatric hospital in Montevideo, Uruguay. Uruguay has been developing a one-tablet computer-per low-income-senior policy since 2015. In this research, we deployed a qualitative ethnographic research comprised of semi-structured interviews, jottings, and field notes where we explore the adoption of tablets within the corresponding actor network. Our findings suggest that objectively, not only was the establishment of the sociotechnical network rife with complexities, disruptions, and fissures, but subjectively, seniors in the hospital were heavily influenced by their self perception of the potentialities of ICTs.
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Die Expertise gibt einen umfassenden Überblick zum Umgang älterer Menschen mit Informations- und Kommunikationstechnologien (IKT), mit Fokus auf das Internet. Die Befunde basieren auf empirischen Studien größtenteils aus repräsentativen IKT- und Medien-Surveys, wie dem D21-Digital-Index, Eurostat und den ARD/ZDF-Onlinestudien sowie IKT-Daten aus SHARE. Ein weiterer Schwerpunkt der verwendeten Daten beruht auf eigenen Forschungsprojekten (SAMS-Studie, FUTA) und Untersuchungen (Zürich-Studie zu Heimbewohner*innen). Speziell für die Expertise konnten zu fast allen Studien eigene, aktuelle Analysen berechnet werden (siehe Kapitel 2). Inhalt-lich sind die Befunde in zwei Bereiche unterteilt: Kapitel 3 und 4 umfasst Berechnungen zur Entwicklung der Internetdiffusion in Europa und Deutschland nach Altersgruppen und weiterer sozio-demographischer Merkmale. Zur Darstellung der Entwicklung der „digitalen Kluft“ in Deutschland wurde ein Index entwickelt. In Kapitel 5 erfolgen aktuelle Ergebnisse zum Umgang mit Internet und IKT im Alter (u. a. Haushaltsausstattung und Nutzungsverhalten) und zu Digitalen Kompetenzen. Gesondert werden drei spezifische Aspekte beleuchtet: Personen, die in Einrichtungen der Altenhilfe leben sowie Befunde zu Gesundheit und Selbstwirksamkeit. Im Anschluss an den empirischen Teil werden zwei Strategien bzw. Konzepte zur digitalen Inklusion und zur sozialen Teilhabe im Alter vorgestellt: der Peer-to-Peer-Ansatz im Bereich der digitalen Freiwilligenarbeit und Online-Nachbarschaftsplattformen, die als „Digitale Nachbarschaften“ beschrieben werden können (siehe Kapitel 6). Daraus ableitend erfolgen in Kapitel 7 Handlungsempfehlungen.
Article
Objective: The objective of this review was to chart the literature on assistive technologies (excluding robots) that support social interaction of older adults in long-term care homes, and to advance a definition of socially assistive technologies. Introduction: Loneliness and social isolation have adverse effects on the health and well-being of older adults. Many long-term care homes provide recreational programming intended to entertain or distract residents, yet the evidence of their effectiveness is limited. Absent from the literature are comprehensive reviews of assistive technologies (other than robots) that are used to support social interaction in long-term care homes. Inclusion criteria: The review considered research studies as well as gray literature that included older adults (≥65 years) living in long-term care homes. The concept of interest was the use of assistive technologies (excluding robots) that support social interaction in long-term care homes. Methods: The databases were searched on June 26, 2019 and included CINAHL Full Text (EBSCOhost), MEDLINE (Ovid), PsycINFO (EBSCOhost), Sociological Abstracts (ProQuest), Embase (Elsevier), and Web of Science (Clarivate). The search for gray literature was conducted in ProQuest Dissertations and Theses Databases and across 11 websites during September and October 2019. The recommended JBI approach to study selection, data extraction, and data synthesis was used. Results: Twenty-five articles were included in this review, with comparable numbers of quantitative (n = 6), qualitative (n = 9), and mixed methods (n = 7) studies, with the remaining articles employing non-empirical designs (n = 3). Technologies were categorized as low (easily recognizable to everyone), medium (more electronics), or high (involves internet). Two studies reported on low-assistive technologies, including videotapes, and the telephone. Medium-assistive technologies were identified in nine studies and included videophones; Nintendo Wii; tablet-based games; picture- and video-viewing tools; and CRDL (pronounced "cradle"), a special instrument that translates touch into sound. More than half (n = 14) of the included articles utilized high-assistive technologies, such as computer labs/kiosks, tablet-based applications, social media (eg, Facebook), videoconferencing, and multi-functional systems. Five studies measured whether assistive technologies had an impact on the quantity of long-term care residents' social interaction levels. On the other hand, qualitative themes were related to residents' social connections and experiences after using various technologies. Four studies systematically incorporated a framework/model, and Social Structuration Theory was considered the most comprehensive. In the absence of a definition of socially assistive technologies, the definition advanced from this review is: Socially assistive technologies are user-appropriate devices and tools that enable real-time connectivity to enhance social interaction. Conclusions: Included literature reported benefits of technology use, with considerable variability in engagement and no cost estimates. We recommend that future research continue to advance our definition of socially assistive technologies, make promising assistive technologies available in long-term care homes after studies are completed, report the costs of assistive technologies, and include participants with dementia and culturally and linguistically diverse backgrounds.
Article
Computers offer new activities that are easily accessible, cognitively stimulating, and enjoyable for individuals with dementia. The current descriptive study examined preferred computer activities among nursing home residents with different severity levels of dementia. A secondary data analysis was conducted using activity observation logs from 15 study participants with dementia (severe = 115 logs, moderate = 234 logs, and mild = 124 logs) who participated in a computer activity program. Significant differences existed in preferred computer activities among groups with different severity levels of dementia. Participants with severe dementia spent significantly more time watching slideshows with music than those with both mild and moderate dementia (F [2,12] = 9.72, p = 0.003). Preference in playing games also differed significantly across the three groups. It is critical to consider individuals' interests and functional abilities when computer activities are provided for individuals with dementia. A practice guideline for tailoring computer activities is detailed. [Journal of Gerontological Nursing, xx(xx), xx-xx.].
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Introduction: Nursing home residents with dementia need cognitively stimulating and enjoyable activities, and computer technology offers them a means of engaging in such activities. This study therefore examined the feasibility of providing a 12-week computer activity program (CAP) for nursing homes residents with dementia. Methods: Fourteen participants completed the CAP, and 462 observational logs of CAP sessions were analyzed. Results: On average, participants completed 33 sessions amounting to 936.5 minutes over 12 weeks. Participants with mild and moderate dementia preferred playing a cognitively challenging game such as solitaire, while those with severe dementia enjoyed watching slideshows with music. Conclusion: The findings suggest that it is important to match computer activities to interests and cognitive ability in order to increase participation and satisfaction of NH residents with dementia.
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Objectives To describe methodological approaches to population targeting and sampling and to summarize limitations of Internet-based questionnaires in older adults.DesignSystematic literature review.SettingStudies using online questionnaires in older adult populations.ParticipantsEnglish-language articles using search terms for geriatric, age 65 and over, Internet survey, online survey, Internet questionnaire, and online questionnaire in PubMed and EBSCO host between 1984 and July 2012. Inclusion criteria were study population mean age 65 and older and use of an online questionnaire for research. Review of 336 abstracts yielded 14 articles for full review by two investigators; 11 articles met inclusion criteria.MeasurementsArticles were extracted for study design and setting, participant characteristics, recruitment strategy, country, and study limitations.ResultsEleven articles were published after 2001. Studies had populations with a mean age of 65 to 78, included descriptive and analytical designs, and were conducted in the United States, Australia, and Japan. Recruiting methods varied widely from paper fliers and personal e-mails to use of consumer marketing panels. Investigator-reported study limitations included the use of small convenience samples and limited generalizability.Conclusion Online questionnaires are a feasible method of surveying older adults in some geographic regions and for some subsets of older adults, but limited Internet access constrains recruiting methods and often limits study generalizability.
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This study applies the concept of "negative symptoms," previously used in schizophrenia, to dementia of the Alzheimer type (DAT) and examines the relationship of negative symptoms to cognitive deficits and depression. The negative symptom subscale of the Positive and Negative Symptom Scale (PANSS-N), the Hamilton Depression Scale (Ham-D), and the Mini-Mental State Examination (MMSE) were administered to 26 patients with DAT and to 13 normal control subjects. The mean PANSS-N score in DAT patients was significantly higher than in control subjects. DAT patients demonstrated significant correlation between negative symptoms and cognitive deficits. Ham-D scores did not significantly correlate with MMSE or PANSS-N scores. These results indicate that negative symptoms are prevalent in DAT and do not result from depression. Copyright (C) 1995 American Association for Geriatric Psychiatry
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Computers play an important role in modern society by allowing people to communicate and be connected with sources of activities whether social, political, recreational, and so forth. However, elderly persons residing in long-term care facilities are often removed from these ubiquitous and virtually omnipotent sources of interface. This project included 24 elderly persons in a long-term care setting who participated in the activities of a computer-class designed specifically to teach them to become independent in operating a computer. After 15 months, only five residents remained in the class, and they used computers several times a week for a variety of reasons (e.g., access e-mail, write letters, work on special projects, search the Web for special issues/items, and play games). The article discusses the five categories of obstacles that may have caused the discontinuation of participation: physical and cognitive, personal, hardware/software/technological, organizational, and environmental.
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Institutionalization often presents an unstimulating environment, in addition to requiring a surrender of autonomy. Research has shown that people quickly come to respond to the world in a limited and rigid fashion when their choices and activities are limited. This decline is frequently associated with a corresponding decline in psychological health and, consequently, an increase in depression. According to Seligman (1981), changing depressed individuals’ environment for the better and enhancing their sense of control should serve as an antidepressive. Thus the purpose of this study was to evaluate the effects of a psychoeducational model making use of computer interaction for the therapy, education, and recreation of a group of institutionalized older adults. The results indicated that the computer interaction was an effective tool for increasing these older adults’ cognitive abilities and daily living skills and decreasing their levels of depression.
Article
The Simple Pleasures research team investigated the effects of 30 handmade recreational items on the behavior of nursing home residents with dementia. The impact on family visits, staff knowledge, and volunteer involvement also was examined during the course of this study. Twenty-three items were found therapeutically valuable and acceptable for nursing home use. Family visits, use of recreational items, and satisfaction with visits significantly improved during the intervention. Residents were significantly less agitated at one nursing home and slightly less agitated at the other nursing home. More than 540 volunteers of all ages were trained and made Simple Pleasures recreational items during this project.
Article
Background: Developers of Interactive Health Communication (IHC) are capable of providing great benefit by creating interactive programs that serve to protect and improve health. Conducting proper evaluation of these programs will ensure that they achieve these goals more successfully. Conclusions: This article seeks to inform developers of IHC about which types of evaluation are most important to include as a part of the development process and to examine the ways in which such evaluation can be implemented to benefit the producers—and ultimately, the consumers—of IHC.
Article
Correlated short- and long-term measurements to determine the impact of a computer instructional program on the quality of life of 8 senior citizens who participated. The program was comprised of 2 15-wk sessions (each followed by an assessment), separated by a 15-wk waiting period in order to determine the residual effects of outcomes. In the short-term, results showed that participants moved from reluctance to enthusiasm toward using the computer and showed a slow progression in functional skills. In the long-term, participants showed a change in level of independence, more interest in other activities, a shift in mood toward a more positive temperament, and some transfer of physical skills to other areas. There were 3 patterns noticed in the qualitative/clinical assessment, in terms of how seniors adapted to using the computer. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Microcomputers have great potential in therapeutic environments, but, if they are to achieve this potential, they need appropriate software (programs). This paper examines the ideas behind games software and the relevance of commercially available software to therapy. It recommends that specially designed programs are needed and lays down some guidelines for the design and development of such software.
Article
The benefits of computer use by the elderly are named in this article. Described here is a project instigated to determine feasibility of computer use with frail institutionalized elderly. The four games used in this project are presented, as are participant reactions to these games. Computer use was found to be not only valuable as a learning tool, but a diagnostic one as well The author looks to practitioners in the future to investigate the possibilities of using computer games in their work with the elderly.
Article
Lonely older adults are frequently hesitant to reach out for help because they fear forced institutionalization or other loss of control over their lives. The utilization of a time-limited holiday hotline for outreach to lonely older persons is examined. There were 306 calls from aged persons. Grief and bereavement were the primary themes of these calls. Trained professionals and supervised students staffed the telephone bank and provided such services as responsive listening and community referrals.
Article
To assess the association of past use of computer games and parallel-processing skills as measured by tests of discrimination perception using computers 46 boys and girls in kindergarten, aged 4 to 6 years, were classified into 17 player and 17 nonplayer groups by their enthusiasm for computer games. There were no significant differences between the two groups in correct responses; however, RTs of players were significantly faster than those of nonplayers. RTs were different to color and shape. Experiences with computer games might develop information-processing skills.
Article
A 3-month observational study of 24 agitated and severely cognitively impaired nursing home residents was conducted to document the typical ways in which residents spend their time and how time use relates to the manifestation of agitated behaviors. We found that these residents were involved in no activity during 63% of the observations. In addition, residents spent little time in structured activities (e.g., music therapy) or social activities (e.g., receiving visitors). Yet data analysis revealed that residents manifested a greater number of agitated behaviors when they were unoccupied and fewer agitated behaviors when involved in structured or social activities. We discuss implications for caregivers.
Article
The purpose of this study was to test whether an intervention combining increased daytime physical activity with improvement in the nighttime environment improves sleep and decreases agitation in nursing home residents. A randomized trial. One community nursing home in the Los Angeles, California area. Twenty-nine incontinent residents (mean age 88.3 years, 90% female). Subjects were randomized to receive either (1) an intervention combining increased daytime physical activity (14 weeks in duration) plus a nighttime program (5 nights in duration) to decrease noise and sleep-disruptive nursing care practices (intervention group), or (2) the nighttime program alone (control group). Daytime physical activity monitors and structured physical function assessments; nighttime wrist activity monitors to estimate nighttime sleep; and timed daytime behavioral observations of sleep versus wakefulness, either in or out of bed, and agitation. Physical function measures did not change significantly (MANOVA for repeated measures, group by time effect). Wrist actigraphy estimation of nighttime percent sleep (time asleep over time monitored in bed at night) increased in intervention subjects from 51.7% at baseline to 62.5% at follow-up compared with 67.0% at baseline to 66.3% at follow-up in controls (MANOVA, group by time, F = 4.42, P = .045, df = 27). At follow-up, intervention subjects averaged a 32% decrease in the percent of daytime observations in bed compared with baseline, with essentially no change in controls (MANOVA, group by time, F = 5.31, P = .029, df = 27). Seven of 15 intervention subjects had a decrease in observed agitation at follow-up, compared with baseline, versus only 1 of 14 controls with a decrease in observed agitation. This study provides preliminary evidence that an intervention combining increased physical activity with improvement in the nighttime nursing home environment improves sleep and decreases agitation in nursing home residents.
Article
The risk factors for mistreatment of older people include age, race, low income, functional or cognitive impairment, a history of violence, and recent stressful events. There is little information in the literature concerning the clinical profile of mistreated older people. To describe the characteristics of abused or neglected patients and to compare the prevalence of depression and dementia in neglected patients with that of patients referred for other reasons. A case control study. Baylor College of Medicine Geriatrics Clinic at the Harris County Hospital District (Houston, Texas). Forty-seven older persons referred for neglect and 97 referred for other reasons. Comprehensive geriatric assessment. Standard geriatric assessment tools. There was a statistically significant higher prevalence of depression (62% vs 12%) and dementia (51% vs 30%) in victims of self-neglect compared to patients referred for other reasons. This is the first primary data study that highlights a high prevalence of depression as well as dementia in mistreated older people. Geriatric clinicians should rule out elder neglect or abuse in their depressed or demented patients.
Article
Computer technology has become an integral part of health care, yet there have been few studies exploring the use of multimedia technology in the prevention of cancer, especially targeting children. The aims of this study were to develop and evaluate a new multimedia computer program for the primary prevention of skin cancer among a childhood population. An interactive CD-ROM program was developed, then pilot tested in a public elementary school in rural North Carolina. This intervention trial involved 8 third- and fourth-grade classes (N = 209 students), randomized into 3 groups: computer intervention, standard teacher-led intervention, and controls. Students were tested using pre- and postintervention surveys that measured knowledge, attitudes, and self-reported behaviors. A 7-month follow-up survey was performed. There was a significant increase in postintervention knowledge for the computer group when compared to either the teacher-led or control groups (mean scores out of 100: 75.2, 59.5, 55.0, respectively; p < 0.001). Attitudes about suntanning demonstrated a significant difference between the 3 groups (mean scores out of 100: 64.0, 53.0, 48.6, respectively; p = 0.002). There were slight improvements in the behavioral scores, especially among the computer group, but the overall differences were not significant. Similar overall results were found for the long-term follow-up survey, except that attitudes about suntanning no longer demonstrated a significant difference. These results indicate that this new educational tool is an effective way to introduce health education programs for young children in typical classroom settings. This prototype may serve as a model for the development of future preventive school-based programs, including applications to other conditions associated with high-risk behaviors among children.
Article
The authors describe characteristics, treatment, and acute service use associated with agitation and depression in dementia. Authors used retrospective chart review of symptoms, physician-level prescribing, and acute service use over 3 months for 2,487 physically frail older residents, including 1,836 with dementia, (mean age: 79.8 years) in 109 long-term care facilities, describing differences between uncomplicated dementia and three mutually exclusive subgroups of complicated dementia, including dementia with agitation-only, dementia with depression-only, and dementia with mixed agitation and depression. Compared with the other subgroups, frail elderly patients with dementia complicated by mixed agitation and depression have the highest rate of hospitalization, the greatest number of medical diagnoses, and the greatest medical severity, and they receive the greatest number of psychiatric medications. Depression in dementia (either alone or mixed with agitation) was associated with greater prevalence of pain. Dementia complicated by mixed agitation and depression accounts for over one-third of complicated dementia and is associated with multiple psychiatric and medical needs, intensive pharmacological treatment, and use of high-cost services. Research should target this complex, high-risk group to develop appropriate diagnostic criteria and effective treatment interventions.
Article
To examine the effect of staffing level on time observed in bed during the daytime in nursing home (NH) residents. Descriptive, cross-sectional study. Thirty-four southern California NHs. A total of 882 NH residents: 837 had hourly observation data, 777 had mealtime observations, 837 completed interviews, and 817 completed a physical performance test. Cross-sectional data collected from participants at each NH site included direct observations (hourly and mealtime), resident interviews, medical record review, and physical performance tests. In multivariate analyses, staffing level remained the strongest predictor of time observed in bed after controlling for resident functional measures (odds ratio=4.89; P=.042). Residents observed in bed during the daytime in more than 50% of hourly observations were observed also to experience increased daytime sleeping (P<.001) and less social engagement (P=.026) and consumed less food and fluids during mealtimes than those observed in bed in less than 50% of observations, after adjusting for resident function (P<.001). In this sample of NHs, resident functional measures and NH staffing level predicted observed time in bed according to hourly observations, with staffing level the most powerful predictor. Neither of these predictors justifies the excessive in-bed times observed in this study. Staff care practices relevant to encouraging residents to be out of bed and resident preferences for being in bed should be examined and improved. Practice recommendations regarding in-bed time should be considered, and further research should seek to inform the development of such recommendations.
Article
Agitation and passivity are behavioral symptoms exhibited by 90% of nursing home residents with dementia. They account for many poor health outcomes, caregiver burden, and increased costs of long-term care. This study tested the efficacy of recreational activities derived from the Need-driven Dementia-compromised Behavior (NDB) model: activities matched to skill level only; activities matched to style of interest only; and a combination of both (NDB-derived) for responding to the behavioral symptoms of dementia. Thirty participants were randomly assigned to 1 of 6 possible order-of-condition presentations in this crossover experimental design with repeated measures of dependent variables. Trained research assistants, blind to condition match, implemented each condition for 12 consecutive days. Measures of engagement (time on task and participation), affect, and behavioral symptoms (agitation and passivity) were taken from videotape recordings of each session. Mood was measured with the Dementia Mood Picture Test. The primary analysis method was mixed-model analysis of variance. Significantly more time on task, greater participation, more positive affect, and less passivity were found under NDB-derived and matched to interest only treatments compared with the matched to skill level only treatment or baseline. Agitation and negative affect improved under all treatments compared with baseline. There was no significant change in mood. The NDB-derived activities are tailored to meet individual needs and improve behavioral symptoms associated with dementia. These findings help to explain factors that produce behavioral symptoms and the mechanisms that underlie their successful treatment.
Article
The aim of the present pilot study was to investigate the effects of computer-assisted cognitive training on aging-associated memory deficits, information processing speed, learning, and interference tendency in older people. Residents of a home for older people (15 women, four men; mean age 83.5; range 75-91) participated in a 14-week computer-assisted cognitive training program. The Niirnberg Aging Inventory and the California Verbal Learning Test were administered prior to the program, immediately after the program and after a period of five months to assess the effectiveness of the cognitive training. After the cognitive training program there were significant improvements in primary working memory and also secondary working memory (for verbal and visual stimuli), on parameters of information processing speed, learning and interference tendency. Improvements in the last two cognitive parameters were maintained five months after completion of the training program. The present study indicates that computerized cognitive training programs can be used in older people to achieve long-term improvements in some important aspects of fluid intelligence. It is suggested that computers could be employed more extensively to prevent and treat cognitive deficits in older people.
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