the role of technology in supporting the health and well-being of older adults: opportunities and...

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


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



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

http://www.medicare.gov/

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


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



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?


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



“…“…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

the role of technology in supporting the health and well-being of older adults: opportunities and...

Documents

healthcare slide

supplies slide

pdf slide

healthcare information

technology use

health care delivery

health care professionals

role of technology