Older Adults' Experience with a Novel Fall Detection Device.

BACKGROUND: Falls are a significant concern for the older adult (OA) population, many of whom are unable to get up following a fall. INTRODUCTION: While many devices exist designed to detect a fall, little work has been conducted to evaluate the usability of such devices. We present a longitudinal usability study of a fall detection (FD) device tested with OAs in real-world settings. MATERIALS AND METHODS: OAs were recruited and asked to use a wearable FD device for up to 4 months. Participants were interviewed at baseline and 2 and 4 months and encouraged to provide direct feedback on their experience. RESULTS: In total, 18 OAs participated in the study. Eight completed the 4-month trial. We conducted a total of 38 interviews (16 baseline, 7 midpoint, and 15 final) and logged a total of 78 comments. While participants enjoyed the GPS and automatic detection features of the device, they were unhappy with the volume of false alarms and obtrusiveness of the device. Many also did not see a great need for having the device or were embarrassed by the device. DISCUSSION: Engineers must work to better develop this technology so that it is accessible to people with hearing loss, limited dexterity, and low vision. Utilizing age-appropriate design techniques will help make such informatics tools more user friendly. CONCLUSION: We explored the usability of a particular FD device with OAs and provide design recommendations to help future device manufacturers create more age-appropriate devices.

The use of think-aloud and instant data analysis in evaluation research: Exemplar and lessons learned.

While health information technologies have become increasingly popular, many have not been formally tested to ascertain their usability. Traditional rigorous methods take significant amounts of time and manpower to evaluate the usability of a system. In this paper, we evaluate the use of instant data analysis (IDA) as developed by Kjeldskov et al. to perform usability testing on a tool designed for older adults and caregivers. The IDA method is attractive because it takes significantly less time and manpower than the traditional usability testing methods. In this paper we demonstrate how IDA was used to evaluate usability of a multifunctional wellness tool, discuss study results and lessons learned while using this method. We also present findings from an extension of the method which allows the grouping of similar usability problems in an efficient manner. We found that the IDA method is a quick, relatively easy approach to identifying and ranking usability issues among health information technologies.

Tree testing of hierarchical menu structures for health applications.

To address the need for greater evidence-based evaluation of Health Information Technology (HIT) systems we introduce a method of usability testing termed tree testing. In a tree test, participants are presented with an abstract hierarchical tree of the system taxonomy and asked to navigate through the tree in completing representative tasks. We apply tree testing to a commercially available health application, demonstrating a use case and providing a comparison with more traditional in-person usability testing methods. Online tree tests (N=54) and in-person usability tests (N=15) were conducted from August to September 2013. Tree testing provided a method to quantitatively evaluate the information structure of a system using various navigational metrics including completion time, task accuracy, and path length. The results of the analyses compared favorably to the results seen from the traditional usability test. Tree testing provides a flexible, evidence-based approach for researchers to evaluate the information structure of HITs. In addition, remote tree testing provides a quick, flexible, and high volume method of acquiring feedback in a structured format that allows for quantitative comparisons. With the diverse nature and often large quantities of health information available, addressing issues of terminology and concept classifications during the early development process of a health information system will improve navigation through the system and save future resources. Tree testing is a usability method that can be used to quickly and easily assess information hierarchy of health information systems.

Examining health information-seeking behaviors of older adults.

This study aims to examine which resources older adults utilize for their health information needs, how trustworthy and reliable they find these resources, and the difficulties they face in obtaining health-related information. A 41-item survey designed to understand the information-seeking characteristics of older adults was developed and distributed to retirement communities. Some items were taken from the Health Information National Trends Survey. Of 1520 surveys, 403 were returned completed (26.6%). Respondents' mean age was 77.65 years. Average scores indicated respondents trusted particular sources of health information in the following order (highest to lowest): health care providers, pharmacists, friends and relatives, retirement community staff, newspapers, the Internet, television, and the radio. In conclusion, older adults have a greater amount of trust in a person with whom they are able to actively discuss their health as opposed to a nonliving source, which they have to access or manipulate, such as the Internet. Efforts must be made to help older adults better navigate and utilize the Internet and recognize dependable online sources so that they may increase their trust in its use, thereby increasing satisfaction with their own ability to seek and use sources of health information.

Understanding Older Adult Use of Data Visualizations as a Resource for Maintaining Health and Wellness.

To better understand how older adults use health visualizations and the potential barriers that impact utility, we conducted semistructured interviews with 21 older adults. Within these sessions, we presented participants with two interactive visualizations for exploration. Through an affinity mapping exercise, we extracted five key themes associated with how older adults utilize health visualizations and provide corresponding recommendations as points of consideration for designers developing older adult focused health visualizations. By examining how older adults perceive the utility of health visualizations, we lay the groundwork for design choices that impact eventual use and adoption of systems that generate data for such visualizations.

Older Adults' Perceptions of Fall Detection Devices.

A third of adults over the age of 65 are estimated to fall at least once a year. Perhaps as dangerous as the fall itself is the time spent after a fall if the person is unable to move. Although there are many devices available to detect when a person has fallen, little is known about the opinions of older adults regarding these fall detection devices (FDDs). We conducted five focus groups with 27 older adults. Transcripts from sessions were coded to generate themes that captured participants' perceptions. Themes were identified that related to two topics of interest: (a) personal influences on the participants' desire to have a FDD, including perceived need, participant values, and cost, and (b) participant recommendations regarding specific features and functionalities of these devices such as automation, wearable versus non-wearable devices, and device customization. Together, these themes suggest ways in which FDDs may be improved so that they are suitable for their intended population.

Older adults' attitudes and preferences regarding a multifunctional wellness tool: A pilot study.

OBJECTIVE: To examine older adults' attitudes toward multifunctional technology tools and specific preferences and expectations that would maximize their utility and usability. METHODS: We held three focus group sessions for this pilot study to determine perceptions of older adults toward multifunctional wellness tools, including usefulness and barriers to use. Areas discussed included features that would be wanted or unwanted, form factor and context of use. Recordings were transcribed and qualitative content analysis was performed. RESULTS: Fourteen older adults participated in the focus group sessions. Participants viewed potential uses for wellness tools with regard to their health and health information positively, as they felt currently available tools were lacking. In addition, participants felt that a single-user, smaller, portable device would be more useful than a non-portable multi-user device. Concerns were expressed toward technologies that were difficult to use with aging-related changes, privacy and perceptions of technology. CONCLUSIONS: Participants felt generally positively toward a multifunctional wellness tool and would be willing to use one if it were portable, intuitive and had reliable health-related information on the device.

The Online Availability of Multilingual Health Promotion Materials Produced by Local Health Departments: an Information Assessment.

OBJECTIVES: Local Health Departments (LHDs) are a key source of health promotion information. For ethnically and culturally diverse communities, it becomes important to provide minorities with language appropriate health information. This project sought to assess the availability of multilingual health promotion materials on LHD websites in Washington State (WA), USA. METHODS: We performed a cross-sectional study of all 34 LHD websites in WA. We collected and classified health promotion documents available to the public, specifically, whether translated versions were available. We also assessed the extent of document sharing between LHDs. RESULTS: We identified 1,624 documents across 34 LHDs. Topics most frequently covered were communicable diseases and emergency preparedness. Fewer than 10% of documents were available in non-English languages. We found little evidence of document sharing between LHDs; only 5% of all documents were shared between LHDs. CONCLUSIONS: WA LHDs provide a variety of health promotion materials for the public, but few multilingual materials are available online. New technologies for facilitating document sharing and machine translation may improve the present landscape.

Integrating Patient-Reported Outcomes into Spine Surgical Care through Visual Dashboards: Lessons Learned from Human-Centered Design.

INTRODUCTION: The collection of patient-reported outcomes (PROs) draws attention to issues of importance to patients-physical function and quality of life. The integration of PRO data into clinical decisions and discussions with patients requires thoughtful design of user-friendly interfaces that consider user experience and present data in personalized ways to enhance patient care. Whereas most prior work on PROs focuses on capturing data from patients, little research details how to design effective user interfaces that facilitate use of this data in clinical practice. We share lessons learned from engaging health care professionals to inform design of visual dashboards, an emerging type of health information technology (HIT). METHODS: We employed human-centered design (HCD) methods to create visual displays of PROs to support patient care and quality improvement. HCD aims to optimize the design of interactive systems through iterative input from representative users who are likely to use the system in the future. Through three major steps, we engaged health care professionals in targeted, iterative design activities to inform the development of a PRO Dashboard that visually displays patient-reported pain and disability outcomes following spine surgery. FINDINGS: Design activities to engage health care administrators, providers, and staff guided our work from design concept to specifications for dashboard implementation. Stakeholder feedback from these health care professionals shaped user interface design features, including predefined overviews that illustrate at-a-glance trends and quarterly snapshots, granular data filters that enable users to dive into detailed PRO analytics, and user-defined views to share and reuse. Feedback also revealed important considerations for quality indicators and privacy-preserving sharing and use of PROs. CONCLUSION: Our work illustrates a range of engagement methods guided by human-centered principles and design recommendations for optimizing PRO Dashboards for patient care and quality improvement. Engaging health care professionals as stakeholders is a critical step toward the design of user-friendly HIT that is accepted, usable, and has the potential to enhance quality of care and patient outcomes.

Fall detection devices and their use with older adults: a systematic review.

BACKGROUND: Falls represent a significant threat to the health and independence of adults aged 65 years and older. As a wide variety and large number of passive monitoring systems are currently and increasingly available to detect when individuals have fallen, there is a need to analyze and synthesize the evidence regarding their ability to accurately detect falls to determine which systems are most effective. OBJECTIVES: The purpose of this literature review is to systematically assess the current state of design and implementation of fall-detection devices. This review also examines to what extent these devices have been tested in the real world as well as the acceptability of these devices to older adults. DATA SOURCES: A systematic literature review was conducted in PubMed, CINAHL, EMBASE, and PsycINFO from their respective inception dates to June 25, 2013. STUDY ELIGIBILITY CRITERIA AND INTERVENTIONS: Articles were included if they discussed a project or multiple projects involving a system with the purpose of detecting a fall in adults. It was not a requirement for inclusion in this review that the system targets persons older than 65 years. Articles were excluded if they were not written in English or if they looked at fall risk, fall detection in children, fall prevention, or a personal emergency response device. STUDY APPRAISAL AND SYNTHESIS METHODS: Studies were initially divided into those using sensitivity, specificity, or accuracy in their evaluation methods and those using other methods to evaluate their devices. Studies were further classified into wearable devices and nonwearable devices. Studies were appraised for inclusion of older adults in sample and if evaluation included real-world settings. RESULTS: This review identified 57 projects that used wearable systems and 35 projects using nonwearable systems, regardless of evaluation technique. Nonwearable systems included cameras, motion sensors, microphones, and floor sensors. Of the projects examining wearable systems, only 7.1% reported monitoring older adults in a real-world setting. There were no studies of nonwearable devices that used older adults as subjects in either a laboratory or a real-world setting. In general, older adults appear to be interested in using such devices although they express concerns over privacy and understanding exactly what the device is doing at specific times. LIMITATIONS: This systematic review was limited to articles written in English and did not include gray literature. Manual paper screening and review processes may have been subject to interpretive bias. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: There exists a large body of work describing various fall-detection devices. The challenge in this area is to create highly accurate unobtrusive devices. From this review it appears that the technology is becoming more able to accomplish such a task. There is a need now for more real-world tests as well as standardization of the evaluation of these devices.

Trust in health information sources differs between young/middle and oldest old.

PURPOSE: Examine differences in trust of health information sources between the oldest old and young/middle old. DESIGN: Cross-sectional survey using convenience sampling. SETTING: Eleven retirement communities. SUBJECTS: Older adults ≥65 years (N = 353). MEASURES: Self-rated trust in health information sources. ANALYSIS: Mann-Whitney U-test or Fisher exact test to compare trust between age groups; multinomial ordered logistic regression analyses to model trust in Internet information sources. RESULTS: The overall survey response rate was 26.6%. Differences in trust were identified between oldest old (n = 108) and young/middle old (n = 245) for pharmacist (p < .05), Internet (p < .001), television (p < .05), radio (p < .001), and newspaper (p < .05) sources. In the oldest old, we found associations between levels of trust in Internet sources and frequency of Internet use (ß = 4.13, p < .001). CONCLUSION: Understanding where differences in trust arise can inform the design of resources to support the information-seeking process. When planning widespread distribution of health information to these distinct groups, program developers need to consider these differences.

Older adults' acceptance of a community-based telehealth wellness system.

The development of ongoing assessment tools to monitor older adult health and wellness can support improved quality of life and independence. These technologies have often been employed within private residences. Our work describes a telehealth kiosk system implemented within a community setting, which reduces the costs of installing and maintaining individual systems. Though user acceptance of telehealth systems has been studied within the context of home residences, this has yet to be addressed for community-based systems. Older adults in a retirement community were recruited to use a telehealth system including assessment of vital signs and cognitive performance. With a series of focus groups (N = 12, average age 79.3 years), we examined user perceptions of the telehealth kiosk, addressing issues of usability, effectiveness and privacy. Older adults were favorable towards the collection of health monitoring information, recognizing the utility of these data sources. There were issues of usability, especially regarding ergonomics of the telehealth kiosk. We found no concerns over privacy, with some participants expressing increased preference for the social interactions afforded through the community setting. Understanding the social, technical and human factors involved with a community-based telehealth system can inform the design of cost-effective health monitoring systems.

Framing the evidence for health smart homes and home-based consumer health technologies as a public health intervention for independent aging: a systematic review.

INTRODUCTION: There is a critical need for public health interventions to support the independence of older adults as the world's population ages. Health smart homes (HSH) and home-based consumer health (HCH) technologies may play a role in these interventions. METHODS: We conducted a systematic review of HSH and HCH literature from indexed repositories for health care and technology disciplines (e.g., MEDLINE, CINAHL, and IEEE Xplore) and classified included studies according to an evidence-based public health (EBPH) typology. RESULTS: One thousand, six hundred and thirty-nine candidate articles were identified. Thirty-one studies from the years 1998-2011 were included. Twenty-one included studies were classified as emerging, 10 as promising and 3 as effective (first tier). CONCLUSION: The majority of included studies were published in the period beginning in the year 2005. All 3 effective (first tier) studies and 9 of 10 of promising studies were published during this period. Almost all studies included an activity sensing component and most of them used passive infrared motion sensors. The three effective (first tier) studies all used a multicomponent technology approach that included activity sensing, reminders and other technologies tailored to individual preferences. Future research should explore the use of technology for self-management of health by older adults; social support; and self-reported health measures incorporated into personal health records, electronic medical records, and community health registries.