the role of technology in supporting the health and well-being of older adults: opportunities and...
Post on 21-Dec-2015
217 views
TRANSCRIPT
The Role of Technology in Supporting The Role of Technology in Supporting the Health and Well-Being of Older the Health and Well-Being of Older
Adults: Opportunities and ChallengesAdults: Opportunities and Challenges
The Role of Technology in Supporting The Role of Technology in Supporting the Health and Well-Being of Older the Health and Well-Being of Older
Adults: Opportunities and ChallengesAdults: Opportunities and Challenges
Sara J. Czaja Ph.D. Sara J. Czaja Ph.D.
Department of Psychiatry and Behavioral Department of Psychiatry and Behavioral SciencesSciences
Center on AgingCenter on Aging
University of Miami Miller School of MedicineUniversity of Miami Miller School of Medicine
Research presented in this paper is supported by National Institute on Aging/ National Institutes of Health (Grants # U01AG20274; P01AG17211-0252) and the Langeloth Foundation, AT&T, Cisco, Administration on Aging
Prepared for the 19th Annual Cellar Conference on Technology and Aging
Case Western Reserve UniversityApril 8th, 2011
CollaboratorsCollaboratorsCollaboratorsCollaborators Joseph SharitJoseph Sharit
Shih Hua FuShih Hua Fu
Mario HernandezMario Hernandez
Chin Chin LeeChin Chin Lee
David LoewensteinDavid Loewenstein
Sankaran NairSankaran Nair
Dolores PerdomoDolores Perdomo
Halley PoliftaHalley Polifta
Andreina Sala-GuerreroAndreina Sala-Guerrero
Jessica TahaJessica Taha
Focus of PresentationFocus of PresentationFocus of PresentationFocus of Presentation Discuss ways in which technology can be used Discuss ways in which technology can be used
to promote the physical and emotional well-to promote the physical and emotional well-being of older adultsbeing of older adults
Discuss existing barriers that hinder the Discuss existing barriers that hinder the successful use of technology for health care successful use of technology for health care deliverydelivery
Discuss recent findings regarding technology Discuss recent findings regarding technology and agingand aging
Present examples of on-going research at Present examples of on-going research at CREATE /the University of Miami Miller School CREATE /the University of Miami Miller School of Medicineof Medicine
Significance of the IssueSignificance of the Issue
Projected increase in the elderly Projected increase in the elderly population especially population especially ““oldest oldoldest old”” who require more care and long who require more care and long term assistanceterm assistance
Dramatic increase in healthcare expenditures within the United States and most other countries
Trend from in-patient to out-Trend from in-patient to out-patient care and increased reliance patient care and increased reliance on family members to provide on family members to provide needed care and supportneeded care and support
Rapid diffusion of technology in Rapid diffusion of technology in healthcarehealthcare
Examples of Telemedicine/ Examples of Telemedicine/ E-Health Applications E-Health Applications
Examples of Telemedicine/ Examples of Telemedicine/ E-Health Applications E-Health Applications
Diagnosis and treatment of patients Diagnosis and treatment of patients at distant locationsat distant locations
Monitoring of patients with chronic Monitoring of patients with chronic illness/diseaseillness/disease
Automated message reminders Automated message reminders (e.g., medications, appointments)(e.g., medications, appointments)
Physician consultationsPhysician consultations Patient portals of EHR systemsPatient portals of EHR systems
Examples of Telemedicine/ Examples of Telemedicine/ E-Health Applications E-Health ApplicationsExamples of Telemedicine/ Examples of Telemedicine/ E-Health Applications E-Health Applications
On-line peer support systemsOn-line peer support systems Health websites that provide health-Health websites that provide health-
care information and resources and care information and resources and servicesservices
Prescription drug salePrescription drug sale Sale of medical equipment and Sale of medical equipment and
suppliessupplies
Potential Advantages of Technology
Eliminates the need for patients and health Eliminates the need for patients and health care professionals to travelcare professionals to travel
Permits more flexible appointment schedulingPermits more flexible appointment scheduling Permits easier access to a wider array of Permits easier access to a wider array of
information and services especially for rural information and services especially for rural and underserved patientsand underserved patients
Permits increased access to specialistsPermits increased access to specialists Permits asynchronous communicationPermits asynchronous communication Patient empowerment (e.g., well-informed Patient empowerment (e.g., well-informed
questions; information on treatment options)questions; information on treatment options)
Potential Disadvantages of Technology
Proliferation of incorrect or inappropriate Proliferation of incorrect or inappropriate informationinformation
Proliferation of too much informationProliferation of too much information Potential disruptions in physician/patient Potential disruptions in physician/patient
relationshipsrelationships Privacy issuesPrivacy issues Technology breakdowns/failuresTechnology breakdowns/failures Promotes false sense of securityPromotes false sense of security Potential for increasing health care disparitiesPotential for increasing health care disparities
Will older people be able to Will older people be able to access and successfully adapt access and successfully adapt to and use telemedicine and e-to and use telemedicine and e-health tools?health tools?
Critical QuestionCritical QuestionCritical QuestionCritical Question
Aging and Technology UseAging and Technology UseAging and Technology UseAging and Technology Use Although older adults are Although older adults are
increasingly using technology there increasingly using technology there still remains an age-related “digital still remains an age-related “digital divide”divide”
http://www.pewinternet.org/pdfs/PIP_Digital_Divisions_Oct_5_2005.pdf
•Source: http://www.pewinternet.org/pdfs/PIP_Digital_Divisions_Oct_5_2005.pdf
Disparities in Internet Disparities in Internet Access Speed Access Speed
Requirements of Requirements of Meaningful Access to Meaningful Access to
Health ITHealth IT
Requirements of Requirements of Meaningful Access to Meaningful Access to
Health ITHealth IT Awareness of technologyAwareness of technology
Access to technology and technical Access to technology and technical supportsupport
Requisite knowledge and skills to use the Requisite knowledge and skills to use the technology technology
Able to comprehend and integrate the Able to comprehend and integrate the information and use the information information and use the information appropriatelyappropriately
Use of the Internet is complex and Use of the Internet is complex and places demands on cognitive places demands on cognitive processes and involves special processes and involves special knowledge and skills:knowledge and skills:
Use of the Internet is complex and Use of the Internet is complex and places demands on cognitive places demands on cognitive processes and involves special processes and involves special knowledge and skills:knowledge and skills:
Domain ExpertiseDomain Expertise: Basic knowledge of the : Basic knowledge of the problem domain (e.g., diabetes) problem domain (e.g., diabetes)
System ExpertiseSystem Expertise: Facility with the : Facility with the interface to the search system (basic interface to the search system (basic computer skills)computer skills)
Information-Seeking ExpertiseInformation-Seeking Expertise: : Knowledge about the configuration of Knowledge about the configuration of information and of information seeking information and of information seeking methods (use of links, search boxes)methods (use of links, search boxes)
Information ExpertiseInformation Expertise: Knowledge of : Knowledge of credible websites, ability to comprehend credible websites, ability to comprehend and integrate informationand integrate information
Barriers to Use of Healthcare Barriers to Use of Healthcare TechnologiesTechnologies
Barriers to Use of Healthcare Barriers to Use of Healthcare TechnologiesTechnologies
Limited knowledge of potential Limited knowledge of potential uses/benefits of technologyuses/benefits of technology
CostCost
Rapid developments and changes in Rapid developments and changes in technical systemstechnical systems
Interface issuesInterface issues
Use of most telemedicine and E-health tools Use of most telemedicine and E-health tools require at least adequate levels of health require at least adequate levels of health literacyliteracy
Barriers to Use of Healthcare Barriers to Use of Healthcare TechnologiesTechnologies
Barriers to Use of Healthcare Barriers to Use of Healthcare TechnologiesTechnologies
Older adults especially minority older adults have lower health literacy than other segments of the populations
Human-technology interaction involves Human-technology interaction involves information processing and places demands information processing and places demands on memory and other cognitive abilitieson memory and other cognitive abilities
Age is associated with declines in some Age is associated with declines in some aspects of cognitionaspects of cognition
Age-Related Cognitive Age-Related Cognitive ChangesChanges
-1.5
-1
-0.5
0
0.5
1
1.5
20's 30's 40's 50's 60's 70's 80's
Perceptual Speed
Spatial Ability
Working Memory
Memory - Recall
Verbal Ability
Age Groups
Z-s
core
s
Park Lab n = 350
Unless problems with meaningful Unless problems with meaningful access are addressed with access are addressed with minority older adult populations minority older adult populations healthcare disparities will healthcare disparities will increase and there will be a wider increase and there will be a wider gap between the “haves’ and gap between the “haves’ and “have nots”!“have nots”!
How can we Maximize the How can we Maximize the Design Solutions for Older Design Solutions for Older
Adults?Adults?
How can we Maximize the How can we Maximize the Design Solutions for Older Design Solutions for Older
Adults?Adults? Knowledge about user characteristicsKnowledge about user characteristics
Knowledge about user needs and Knowledge about user needs and preferencespreferences
Knowledge about technology demands Knowledge about technology demands and contexts in which the technology will and contexts in which the technology will be usedbe used
Use of ecologically valid research Use of ecologically valid research protocolsprotocols
Multidisciplinary teams and approachesMultidisciplinary teams and approaches
Involving users in the design processInvolving users in the design process
Center for Research and Center for Research and Education on Aging and Education on Aging and
Technology EnhancementTechnology Enhancement
Center for Research and Center for Research and Education on Aging and Education on Aging and
Technology EnhancementTechnology Enhancement
Sara J. Czaja & Joseph SharitSara J. Czaja & Joseph Sharit
University of MiamiUniversity of Miami
Neil Charness & Walter BootNeil Charness & Walter Boot
Florida State UniversityFlorida State University
Arthur D. Fisk & Wendy A. RogersArthur D. Fisk & Wendy A. Rogers
Georgia Institute of TechnologyGeorgia Institute of Technology
CREATE IIICREATE IIICREATE IIICREATE III
Aims of CREATE IIIAims of CREATE III Examine issues regarding technology use in diverse Examine issues regarding technology use in diverse
samples of adults.samples of adults. Gather systematic data on the impact of technology use Gather systematic data on the impact of technology use
on the well-being and quality of life of older adults.on the well-being and quality of life of older adults. Develop guidelines for technology design and Develop guidelines for technology design and
implementation to foster technology adoption among implementation to foster technology adoption among older people.older people.
Further our understanding on the relationship between Further our understanding on the relationship between individual characteristics and technology adoption.individual characteristics and technology adoption.
Develop a comprehensive database on the need and Develop a comprehensive database on the need and preferences of older people for a range of technologies.preferences of older people for a range of technologies.
Introduction to CREATE IIIIntroduction to CREATE IIIIntroduction to CREATE IIIIntroduction to CREATE III
Aims of CREATE IIIAims of CREATE III Promote collaborations between researchers, Promote collaborations between researchers,
community agencies and business/industry.community agencies and business/industry.
Foster the training of students and junior Foster the training of students and junior investigators.investigators.
Promote new areas of research in aging and Promote new areas of research in aging and technology.technology.
Disseminate the findings and products from Disseminate the findings and products from CREATE to a broad audience.CREATE to a broad audience.
CREATE IIICREATE IIICREATE IIICREATE III
FocusFocus Living environmentsLiving environments Work settingsWork settings Health Care arenaHealth Care arena
Research programs at each siteResearch programs at each site 2 RO1 type research projects2 RO1 type research projects 2 Collaborative projects 2 Collaborative projects
Cross-site field trialCross-site field trial Pilot Research ProgramPilot Research Program
Georgia Tech Research: Georgia Tech Research: Advancing Health and Well-Being in Living Advancing Health and Well-Being in Living
Environments through TechnologyEnvironments through Technology
Georgia Tech Research: Georgia Tech Research: Advancing Health and Well-Being in Living Advancing Health and Well-Being in Living
Environments through TechnologyEnvironments through Technology
Wendy A. Rogers & Arthur Wendy A. Rogers & Arthur D. Fisk D. Fisk
Research ProjectsResearch ProjectsResearch ProjectsResearch Projects
Current studies focused on Current studies focused on supporting successful supporting successful interactions of humans and interactions of humans and collaborative machine collaborative machine assistants (CMAs)assistants (CMAs)
» Analysis of perceived usefulness of Analysis of perceived usefulness of a CMA a CMA
» Understanding attitudes, beliefs, Understanding attitudes, beliefs, and knowledge about CMAs and knowledge about CMAs
» Perception of emotions displayed Perception of emotions displayed by synthetic faces and robotsby synthetic faces and robots
FSU Research ProjectsFSU Research ProjectsFSU Research ProjectsFSU Research Projects
Neil Charness & Walter BootNeil Charness & Walter Boot
Projects: Theoretically-Projects: Theoretically-OrientedOriented
Projects: Theoretically-Projects: Theoretically-OrientedOriented
Older GOMS toolboxOlder GOMS toolbox Improve modeling of technology task Improve modeling of technology task
completion times using GOMS parameterscompletion times using GOMS parameters• add missing parameters via meta-analysisadd missing parameters via meta-analysis• extend GOMS to predict errorsextend GOMS to predict errors
Cognitive Training toolboxCognitive Training toolbox Assess effects of videogames on cognition Assess effects of videogames on cognition
using Nintendo DS platformusing Nintendo DS platform Design games to improve specific Design games to improve specific
cognitive abilities cognitive abilities
CREATE III: Cross-Site CREATE III: Cross-Site ProjectProject
CREATE III: Cross-Site CREATE III: Cross-Site ProjectProject
A Personal Reminder A Personal Reminder Information and Social Information and Social Management System Management System (PRISM) for Seniors(PRISM) for Seniors
Study OverviewStudy OverviewStudy OverviewStudy Overview
Cross-site Randomized Field TrialCross-site Randomized Field Trial PRISM conditionPRISM condition Control conditionControl condition
Target PopulationTarget Population Older adults aged 65 + yrs. who live Older adults aged 65 + yrs. who live
alone and at risk for isolationalone and at risk for isolation 100 participants per site100 participants per site
Specific AimsSpecific AimsSpecific AimsSpecific Aims
Obtain information on the usefulness Obtain information on the usefulness and usability of the PRISM system and and usability of the PRISM system and interface design issues among a diverse interface design issues among a diverse sample of older adults.sample of older adults.
Examine the impact of access to the Examine the impact of access to the PRISM system on:PRISM system on: Social isolationSocial isolation Social supportSocial support Well-beingWell-being
Examine the impact of access to the Examine the impact of access to the system on:system on: Computer attitudesComputer attitudes Computer self-efficacyComputer self-efficacy Technology adoptionTechnology adoption
Specific AimsSpecific AimsSpecific AimsSpecific Aims
Gather longitudinal data on the impact Gather longitudinal data on the impact of access to the system on measures of access to the system on measures of social isolation, quality of life, well-of social isolation, quality of life, well-being and technology adoption.being and technology adoption.
Gather usage patterns over time.Gather usage patterns over time.
Gather data on system features that Gather data on system features that are useful to older people.are useful to older people.
Gather data on the relationship Gather data on the relationship between individual characteristics and between individual characteristics and system use.system use.
PRISM SystemPRISM SystemPRISM SystemPRISM System
FeaturesFeatures Email: family/friends; “PRISM buddies”Email: family/friends; “PRISM buddies” Resource guide: local and national resourcesResource guide: local and national resources Instructional/educational features: menu of Instructional/educational features: menu of
information related to topics; monthly information related to topics; monthly recommendations for videos (e.g., NIH recommendations for videos (e.g., NIH Seniorhealth)Seniorhealth)
Calendar and personal reminder featureCalendar and personal reminder feature InternetInternet PhotosPhotos GamesGames
Research at the University Research at the University of Miamiof Miami
Research at the University Research at the University of Miamiof Miami
Health Information SeekingHealth Information Seeking Factors influencing information seeking Factors influencing information seeking
performanceperformance• Age, cognition, knowledge, health literacyAge, cognition, knowledge, health literacy
Impact on patient/physician interactionsImpact on patient/physician interactions Usability of health websitesUsability of health websites Factors influencing trust in e-health informationFactors influencing trust in e-health information Training and cognitive aiding toolsTraining and cognitive aiding tools
Health IT ApplicationsHealth IT ApplicationsHealth IT ApplicationsHealth IT Applications
Internet-based Health ApplicationsInternet-based Health Applications Training and design interventions to enhance Training and design interventions to enhance
“meaningful access” (e.g., cognitive aiding tools)“meaningful access” (e.g., cognitive aiding tools) Impact of access on patient/physician interactionsImpact of access on patient/physician interactions Impact of access on health outcomesImpact of access on health outcomes
Patient Portals of Electronic Medical Patient Portals of Electronic Medical RecordsRecords
Telemedicine for adults with hypertension in Telemedicine for adults with hypertension in rural locationsrural locations
Use of the Medicare.gov Use of the Medicare.gov WebsiteWebsite
Use of the Medicare.gov Use of the Medicare.gov WebsiteWebsite
Czaja, Sharit & Nair Czaja, Sharit & Nair JAMAJAMA, 2008, 2008
Study GoalsStudy GoalsStudy GoalsStudy Goals
Examine the ability of older adults to: Examine the ability of older adults to: Search for health information on the InternetSearch for health information on the Internet Integrate that information and make a choice Integrate that information and make a choice
or decisionor decision Obtain information regarding Obtain information regarding
perceptions of the usability of Internet perceptions of the usability of Internet health information and factors health information and factors influencing trust in Internet health influencing trust in Internet health informationinformation
One focus of the study is on the One focus of the study is on the Medicare and Medicare Part D websites Medicare and Medicare Part D websites given the importance of these given the importance of these applicationsapplications
Study ProtocolStudy ProtocolStudy ProtocolStudy Protocol
Pre-Screening (vision, hearing, MMSE Pre-Screening (vision, hearing, MMSE ≥27≥27))
Pre-TaskPre-Task Background questionnaire Background questionnaire Technology and computer experience questionnaireTechnology and computer experience questionnaire Health literacy questionnaire (STOFHLA)Health literacy questionnaire (STOFHLA) Knowledge testKnowledge test Computer and Internet trainingComputer and Internet training
Post-TaskPost-Task Internet health information questionnaireInternet health information questionnaire Usability questionnaireUsability questionnaire Knowledge testKnowledge test
Task DescriptionTask DescriptionTask DescriptionTask Description
Part A: General Health Information Part A: General Health Information SearchSearch
Participants are asked to provide Participants are asked to provide answers to questions related to answers to questions related to dementia and caregiving based on dementia and caregiving based on information they find on the Internetinformation they find on the Internet
““Please use the Internet to find Please use the Internet to find information about things you can do information about things you can do as a caregiver to help manage as a caregiver to help manage behavioral agitation and wandering”behavioral agitation and wandering”
Task DescriptionTask DescriptionTask DescriptionTask Description
Part B: Medicare QuestionsPart B: Medicare Questions Participants must use the Participants must use the
www.medicare.gov website website 2 questions relate to:2 questions relate to:
• Eligibility for Medicare coverageEligibility for Medicare coverage• Selection of home health agenciesSelection of home health agencies
6 questions relate to Medicare Part-D:6 questions relate to Medicare Part-D:• EnrollmentEnrollment• Plan selectionPlan selection• Determination of deductibles, “out-of-pocket” Determination of deductibles, “out-of-pocket”
expensesexpenses
Sample Description (N=112)Sample Description (N=112) Sample Description (N=112)Sample Description (N=112)
GenderGender 31 Males 31 Males 81 Females81 Females
Age Age mean=65.1 yrs. mean=65.1 yrs. Std. Dev.=10.2 Std. Dev.=10.2 Range=50-85Range=50-85
EthnicityEthnicity Hispanic: 41%Hispanic: 41% Non Hispanic White/Caucasian: Non Hispanic White/Caucasian:
40%40% Non Hispanic Black/African Non Hispanic Black/African
American: 17%American: 17% Other: 2%Other: 2%
Education High school: 7%
Some college: 41% Bachelor’s degree: 23%
Post-graduate: 29%
STOFHLA mean = 34.12
Std. Dev. = 2.51 Range = 22-36
MeasuresMeasuresMeasuresMeasures
Completeness and accuracy of Completeness and accuracy of responses to task problemsresponses to task problems
Navigational efficiencyNavigational efficiency Response timeResponse time Search history (Weblogger)Search history (Weblogger) Actual search behavior (Weblogger)Actual search behavior (Weblogger) Ratings of usabilityRatings of usability Rating of trustRating of trust Change in knowledgeChange in knowledge
Quit problemQuit problemQuit problemQuit problem
All participants completed the All participants completed the problem on finding information on problem on finding information on agitation/wandering (first problem) agitation/wandering (first problem)
19% quit at least one problem19% quit at least one problem 10% quit the Medicare Part-D Cost 10% quit the Medicare Part-D Cost
Computation problemComputation problem 10% quit the Medicare Part-D Plan 10% quit the Medicare Part-D Plan
Selection problemSelection problem
Performance Sample Performance Sample Problems*Problems*
Performance Sample Performance Sample Problems*Problems*
MeanMean SDSD RangeRange
Finding information on Finding information on agitation/ wandering (Max = agitation/ wandering (Max = 10)10)
1.271.27 1.131.13 0-40-4
Issues to consider when Issues to consider when selecting home healthcare selecting home healthcare provider (Max = 10)provider (Max = 10)
2.422.42 2.072.07 0-80-8
Medicare eligibility for home Medicare eligibility for home healthcare aide (Max = 4)healthcare aide (Max = 4)
1.601.60 1.841.84 0-40-4
•* Completeness and accuracy of response
MeaMeann
SDSD RangeRange
Navigational score (Max = Navigational score (Max = 14)14)
7.497.49 4.924.92 0-140-14
Procedural score (Max = 13)Procedural score (Max = 13) 5.465.46 4.434.43 0-130-13
Interpretation score (Max = Interpretation score (Max = 5)5)
1.751.75 1.571.57 0-50-5
Percent overall correctnessPercent overall correctness 41%41% -- --
Performance Measures – Performance Measures – Medicare Part-D ProblemMedicare Part-D ProblemPerformance Measures – Performance Measures – Medicare Part-D ProblemMedicare Part-D Problem
Usability Rating of Medicare Usability Rating of Medicare SiteSite
% % AgreAgre
ee
% % NeutraNeutra
ll
% % DisagreDisagre
ee
I found it difficult to locate the I found it difficult to locate the information that I needed.information that I needed.
5555 1515 3030
I found the information difficult to I found the information difficult to understand.understand.
4242 1818 4040
I found it difficult to navigate within the I found it difficult to navigate within the site.site.
6161 1212 2727
I found the language confusing.I found the language confusing. 3232 2222 4646
I found the organization of the website I found the organization of the website confusing.confusing.
4747 2222 3131
The amount of information in the The amount of information in the website made it difficulty to search for website made it difficulty to search for information.information.
3939 2323 3838
I became frustrated using the website to I became frustrated using the website to search for information.search for information.
6161 1414 2525
Overall, I found the website difficult to Overall, I found the website difficult to use.use.
4949 1616 3535
Trust in Internet Information (N=112)
Trust in Internet Information (N=112)
Agree%
Neutral%
Disagree%
Trust information if associated with a government agency
81% 14% 5%
Trust information if associated with a company
35% 33% 32%
Trust information if associated with a consumer group
47% 36% 17%
Author’s name would increase my trust 42% 42% 16%
Date of information would increase my trust
77% 18% 5%
“Seal of approval” would increase my trust
43% 37% 20%
Less likely to trust information websites with a lot of advertisements
64% 28% 8%
Trust information if the website was well designed and professional
69% 21% 10%
Perceived Value of Internet Health Information (N=111)
Perceived Value of Internet Health Information (N=111)
% Agree% Agree NeutralNeutral%%
DisagreDisagreee%%
Internet is a valuable tool for finding health Internet is a valuable tool for finding health informationinformation 9595 44 11
Use Internet to find information about a Use Internet to find information about a prescribed medicationprescribed medication 8989 88 33
Use Internet to find information about an illnessUse Internet to find information about an illness 9797 33 00
Use the Internet to find health-related Use the Internet to find health-related informationinformation 9595 33 22
Discuss internet health information with a Discuss internet health information with a healthcare professionalhealthcare professional 9393 44 33
Substitute internet health information about a Substitute internet health information about a diagnosis for information given to me by my diagnosis for information given to me by my doctordoctor
1010 2525 6565
Substitute internet health information about Substitute internet health information about medical treatment for information given to me medical treatment for information given to me by my doctorby my doctor
77 2828 6565
Trust internet health information as much as I Trust internet health information as much as I trust information from my doctortrust information from my doctor 2525 3131 4444
Investigating the Role of Knowledge Investigating the Role of Knowledge and Cognitive Abilities in Older Adult and Cognitive Abilities in Older Adult
Information Seeking on the WebInformation Seeking on the Web
Investigating the Role of Knowledge Investigating the Role of Knowledge and Cognitive Abilities in Older Adult and Cognitive Abilities in Older Adult
Information Seeking on the WebInformation Seeking on the Web
Study ObjectivesStudy Objectives To examine Internet information seeking To examine Internet information seeking
performance among older adultsperformance among older adults
To examine the degree to which Internet-To examine the degree to which Internet-related information-seeking performancerelated information-seeking performance
To examine the influence of To examine the influence of cognitive cognitive abilitiesabilities on information-seeking performance on information-seeking performance
((Sharit, Hernandez, Czaja & Pirolli, Sharit, Hernandez, Czaja & Pirolli, TOCHI,2008TOCHI,2008; ; Czaja et al., 2010)
Study ParticipantsStudy ParticipantsStudy ParticipantsStudy Participants
40 older adults40 older adults 20 “younger-old” people 60-70 years of 20 “younger-old” people 60-70 years of
age (age (MM = 65.2) = 65.2) 20 “older-old” people 71-85 years of age 20 “older-old” people 71-85 years of age
((MM = 76.7) = 76.7)
10 younger adults (comparison group)10 younger adults (comparison group)18-39 years of age (18-39 years of age (MM = 27.9) = 27.9)
All participants had at least some All participants had at least some minimal Web-based search minimal Web-based search experienceexperience
Study Protocol Study Protocol Study Protocol Study Protocol
Cognitive Ability TestsCognitive Ability Tests: 21 measures of : 21 measures of component cognitive abilities component cognitive abilities
QuestionnairesQuestionnaires:: Demographic and healthDemographic and health Technology and computer experienceTechnology and computer experience Web experienceWeb experience
Internet Information-seeking task performance: Internet Information-seeking task performance: Participants performed 6 health-related problemsParticipants performed 6 health-related problems
Structured interview -- knowledge test: Assessed Structured interview -- knowledge test: Assessed declarative and procedural knowledge related to declarative and procedural knowledge related to Internet information seeking Internet information seeking
Problem 3 (Flu Shot)Problem 3 (Flu Shot)Problem 3 (Flu Shot)Problem 3 (Flu Shot)
Flu season is coming around and you’re Flu season is coming around and you’re
interested in getting a flu shot. However, interested in getting a flu shot. However,
you want to be sure you don’t belong to the you want to be sure you don’t belong to the
group of people who should not receive this group of people who should not receive this
shot. Find information on at least 3 types ofshot. Find information on at least 3 types of
people who should not get a flu shot.people who should not get a flu shot.
Key Dependent MeasuresKey Dependent MeasuresKey Dependent MeasuresKey Dependent Measures Information seeking task performance scoresInformation seeking task performance scores
A composite score was computed for each problem based on A composite score was computed for each problem based on completion time, correctness (incorrect/no answer, partially completion time, correctness (incorrect/no answer, partially correct, correct), and problem difficulty correct, correct), and problem difficulty
These scores were then aggregated across all problems, and These scores were then aggregated across all problems, and across the simple and complex problem subsetsacross the simple and complex problem subsets
Total knowledge score Total knowledge score Individual knowledge domain scores Individual knowledge domain scores
Internet, web browsers, simple search, and advanced searchInternet, web browsers, simple search, and advanced search
Pathfinder similarity scoresPathfinder similarity scores Each individual’s network of relationships was compared to a Each individual’s network of relationships was compared to a
referent “expert” networkreferent “expert” network
Cognitive ability test scoresCognitive ability test scores
Age Group Differences in Task Age Group Differences in Task PerformancePerformance
Age Group Differences in Task Age Group Differences in Task PerformancePerformance
Younger-old (Younger-old (nn = 20) vs. older-old ( = 20) vs. older-old (nn = = 20): 20): No significant differences on performance of No significant differences on performance of
simple, complex, or all problemssimple, complex, or all problems
Younger (Younger (n n = 10) vs. older (= 10) vs. older (nn = 40) = 40) adults:adults: The younger adults had significantly higher The younger adults had significantly higher
scores than the older adults on all problemsscores than the older adults on all problems
Other FindingsOther FindingsOther FindingsOther Findings
Internet knowledge and cognitive Internet knowledge and cognitive abilities were significant predictors of abilities were significant predictors of performanceperformance
Differences in cognitive abilities Differences in cognitive abilities differentiated the high performing and differentiated the high performing and low performing older adultslow performing older adults
Older adult with high cognitive abilities Older adult with high cognitive abilities performed at the same level as younger performed at the same level as younger adultsadults
Dependent Variable: All Problems (N = 40)
Model Step
Variable R2 β t-score p
1Total
Knowledge.292 .541 3.86 <.001
2Total
Knowledge.292 .313 2.18 .037
Reasoning .405 .305 2.07 .046
Working Memory
.474 .268 2.19 .035
Perceptual Speed
.537 .253 2.11 .042
3 Age* .537 .021 0.16 .874
Hierarchical Regression Hierarchical Regression ModelingModeling
Younger-Old Participants: Performance on all Problems
Variable β t-score p
Total Knowledge .560 2.55 .022
Reasoning .203 .938 .363
Working Memory .306 1.66 .117
Older-Old Participants: Performance on all Problems
Variable β t-score p
Total Knowledge.381
1.75 .097
Reasoning .834 5.15 .001
Working Memory .417 3.41. .004.
Hierarchical Regression Hierarchical Regression ModelingModeling
Effects of the InternetEffects of the Internet on Older Adult Health on Older Adult Health
Information Needs Information Needs
Effects of the InternetEffects of the Internet on Older Adult Health on Older Adult Health
Information Needs Information Needs
Taha, Sharit and Czaja, 2009
Key Study QuestionsKey Study QuestionsKey Study QuestionsKey Study Questions
How useful do older adults perceive various How useful do older adults perceive various information sources (including the Internet) to information sources (including the Internet) to be with respect to satisfying their health be with respect to satisfying their health information needs? information needs?
Do Internet users and non-users differ in their Do Internet users and non-users differ in their use of health information sources?use of health information sources?
Do these two groups differ with respect to how Do these two groups differ with respect to how access to health information influences their access to health information influences their health care behaviors?health care behaviors?
ParticipantsParticipantsParticipantsParticipants
53 adults, 51-85 years of age (53 adults, 51-85 years of age (MM = 68.9, = 68.9, SDSD = 8.5) = 8.5)
Participants were recruited into two Participants were recruited into two groups:groups: A non-Internet group:A non-Internet group: Reported little or no Reported little or no
experience looking for health information experience looking for health information online (online (NN = 26, = 26, MM = 70.7 years; 9 males, 17 = 70.7 years; 9 males, 17 females)females)
An Internet group:An Internet group: Reported using the Internet Reported using the Internet often for obtaining health information (often for obtaining health information (NN = 27, = 27, MM = 67.3 years; 11 males, 16 females) = 67.3 years; 11 males, 16 females)
Results: Health Information Results: Health Information Seeking and Technology Seeking and Technology
Experience QuestionnairesExperience Questionnaires
Results: Health Information Results: Health Information Seeking and Technology Seeking and Technology
Experience QuestionnairesExperience Questionnaires
Reasons given for never having been online:Reasons given for never having been online: Never having learned to use the Internet (48%)Never having learned to use the Internet (48%) It’s too complicated (22%)It’s too complicated (22%) It’s too expensive (15%)It’s too expensive (15%) Friends or family go online for them (11%)Friends or family go online for them (11%) Belief that information online is not correct (7%)Belief that information online is not correct (7%) Being too busy (4%)Being too busy (4%)
52% of the participants in the Internet group had 52% of the participants in the Internet group had been using the Internet for more than 5 years:been using the Internet for more than 5 years: 44% learned to use the Internet by attending a class44% learned to use the Internet by attending a class 33% reported using it frequently for finding health information33% reported using it frequently for finding health information
Sources Used “Most of the Time” or “Always” for health information
Non-Internet Group
(N = 25)
Internet Group
(N = 27)
Doctors or other health care providers 68% 67%
Pharmacists 20% 19%
Newspapers 32% 15%
Popular Magazines 28% 7%
Medical Journals 12% 4%
Popular Books 20% 11%
Medical Books 16% 4%
Internet 0% 58%
Television 24% 11%
Radio 12% 15%
Friends or family 36% 15%
Results
Feelings about Internet Health Information (Internet Group Participants)
Internet Users in
Agreement (N = 27)
Communication with my doctor improved when I discussed the health information that I found
82%
The health information that I found helps me become more knowledgeable
96%
The health information that I found helps me discuss alternative treatments with my doctor
93%
The health information that I found helps me make decisions with my doctor
82%
The health information that I found saves time when I have an appointment with my doctor
74%
The health information that I found improves the quality of the visit with my doctor
85%
The health information that I found increases my ability to take better care of myself
96%
Results
Purpose of this StudyPurpose of this StudyPurpose of this StudyPurpose of this Study
Explore the perceptions of physicians Explore the perceptions of physicians regarding patient-acquired Internet regarding patient-acquired Internet health information and the impact on health information and the impact on the physician-patient relationshipthe physician-patient relationship
Identify possible ways to assist older Identify possible ways to assist older patients in preparing for office visits to patients in preparing for office visits to maximize the efficiency of the visit and maximize the efficiency of the visit and improve their ability to communicate improve their ability to communicate with their physicianswith their physicians
Sample DemographicsSample DemographicsSample DemographicsSample Demographics
33 physicians from local hospitals:33 physicians from local hospitals: University of Miami/Jackson HospitalUniversity of Miami/Jackson Hospital Mt. SinaiMt. Sinai BaptistBaptist South MiamiSouth Miami
19 males (30-78 years)19 males (30-78 years)
14 females (25-56 years)14 females (25-56 years)
Areas of Areas of Practice/DepartmentsPractice/Departments
Areas of Areas of Practice/DepartmentsPractice/Departments
Adult PsychologyAdult Psychology
AnesthesiologyAnesthesiology
DermatologyDermatology
Facial Plastic SurgeryFacial Plastic Surgery
Family MedicineFamily Medicine
GastroenterologyGastroenterology
Geriatric PsychiatryGeriatric Psychiatry
GeriatricsGeriatrics
Hepatology Hepatology
HospitalistsHospitalists
Internal MedicineInternal Medicine
NephrologyNephrology
NeurologyNeurology
OB/GYNOB/GYN
OphthalmologyOphthalmology
PsychiatryPsychiatry
PulmonaryPulmonary
Radiation OncologyRadiation Oncology
Methodology – Structured Methodology – Structured Interview 10 QuestionsInterview 10 Questions
Methodology – Structured Methodology – Structured Interview 10 QuestionsInterview 10 Questions
How often patients bring in information to How often patients bring in information to discuss or have them look atdiscuss or have them look at
Whether physicians feel that online health Whether physicians feel that online health information provides opportunities for patients information provides opportunities for patients to improve their healthto improve their health
Whether physicians feel that the Internet Whether physicians feel that the Internet enables patients to make informed decisions enables patients to make informed decisions regarding health choicesregarding health choices
Whether access to online health information has Whether access to online health information has improved or degraded physicians’ relationships improved or degraded physicians’ relationships with patientswith patients
Whether physicians suggest websites for Whether physicians suggest websites for patients to visitpatients to visit
Methodology – Structured Methodology – Structured Interview 10 QuestionsInterview 10 Questions
Methodology – Structured Methodology – Structured Interview 10 QuestionsInterview 10 Questions
Whether physicians find more patients requesting Whether physicians find more patients requesting procedures, tests, or medications now that this procedures, tests, or medications now that this information is available onlineinformation is available online
Whether patients use information found online to Whether patients use information found online to improve communication or challenge their expertiseimprove communication or challenge their expertise
What benefits physicians have seen patients What benefits physicians have seen patients experience as a result of using online health experience as a result of using online health informationinformation
What negative outcomes physicians have seen What negative outcomes physicians have seen patients experience as a result of using online patients experience as a result of using online health informationhealth information
How physicians think that patients could better How physicians think that patients could better prepare for office visitsprepare for office visits
The Internet enables patients to make The Internet enables patients to make
more informed decisionsmore informed decisions The Internet enables patients to make The Internet enables patients to make
more informed decisionsmore informed decisions Majority (59%) of physicians felt the Majority (59%) of physicians felt the
Internet enables patients to make more Internet enables patients to make more informed decisions regarding health informed decisions regarding health choiceschoices Helps patient understand their condition and Helps patient understand their condition and
their medicationstheir medications Helps patient in asking questions during the visitHelps patient in asking questions during the visit Allows patient to find out about more options Allows patient to find out about more options
than what was discussed by their providerthan what was discussed by their provider Allows patient to be their own advocateAllows patient to be their own advocate
The Internet enables patients to make The Internet enables patients to make more informed decisionsmore informed decisions
The Internet enables patients to make The Internet enables patients to make more informed decisionsmore informed decisions
21% of physicians thought that 21% of physicians thought that the Internet the Internet cancan help, but it help, but it depends upon:depends upon:
The individualThe individual The condition/disease with which they The condition/disease with which they
are dealingare dealing The online source that is usedThe online source that is used How the information is usedHow the information is used
How can patients better prepare How can patients better prepare for office visits?for office visits?
How can patients better prepare How can patients better prepare for office visits?for office visits?
If using the Internet to get information, If using the Internet to get information, use major sites and stay away from use major sites and stay away from commercial promotions; check the source commercial promotions; check the source and weigh the information accordinglyand weigh the information accordingly
To improve communication, patients should To improve communication, patients should not think that they have all of the answers not think that they have all of the answers based upon what they read online and be based upon what they read online and be open to discussion with their physicianopen to discussion with their physician
How can patients better prepare How can patients better prepare for office visits?for office visits?
How can patients better prepare How can patients better prepare for office visits?for office visits?
“…“…you can’t expect to do medical school you can’t expect to do medical school and residency training online in front of and residency training online in front of your computer in an evening before you go your computer in an evening before you go in to see your doctor… [use] what in to see your doctor… [use] what information you gather in order to spark information you gather in order to spark discussion and [gain] information but discussion and [gain] information but [don’t come] to too many conclusions on [don’t come] to too many conclusions on something that is probably quite something that is probably quite complicated.”complicated.”
Electronic Medical RecordsElectronic Medical RecordsElectronic Medical RecordsElectronic Medical Records
Examining the ability of older adults Examining the ability of older adults to use patient portals of EMRs to to use patient portals of EMRs to perform routine tasks and identify perform routine tasks and identify usability problemsusability problems
Also gathering information on issues Also gathering information on issues related to privacy and trustrelated to privacy and trust
Focus on lower SES populations with Focus on lower SES populations with low health literacylow health literacy
Clearly, our results suggest Clearly, our results suggest that information technology that information technology holds a promising role in holds a promising role in health care delivery for older health care delivery for older adults and in providing adults and in providing support for their families but:support for their families but:
Clearly, our results suggest Clearly, our results suggest that information technology that information technology holds a promising role in holds a promising role in health care delivery for older health care delivery for older adults and in providing adults and in providing support for their families but:support for their families but:
Currently, there are barriers to access and use of
technology among both consumers and providers