The participation of hard-to-reach older people in the research and development process of health technologies from the perspective of multipliers-A qualitative analysis.

Introduction: The participation of older people in research and development processes has long been called for but has not been sufficiently put into practice. In addition, participation is often late and not particularly intensive, so that certain older groups of people are underrepresented in the development of health technologies (HT). Heterogeneity, e.g., between urban and rural populations, in access to and motivation for participation is also rarely taken into account. The aim of this study was to investigate form and phases of participation for hard-to-reach older people in the research and development process of HT. Methods: The qualitative study among multipliers was conducted using focus groups and telephone interviews and took place in a city and an adjacent rural area in northwestern Lower Saxony, Germany. A content analysis of the data was undertaken using deductive-inductive category formation. Results: Seventeen participants (13 female) took part in the study (median age 61, 33-73). Participants from both areas identified particular forms and phases of participation in the research and development process. Longer forms of participation for hard-to-reach groups and the development process of technologies for older people from the rural area were viewed as challenges. Passive and active access strategies are needed to achieve sufficient heterogeneity in the research and development process. Trusted multipliers can play an important role in gaining access to hard-to-reach older people, but also during the research process. Apart from facilitating factors (e.g., age-specific study materials), inhibiting factors such as contact anxieties are also indicated. Only urban participants mention financial/material incentives and community as possible motivations. Conclusions: The results provide important insights from the perspective of multipliers. They show specificities in access and participation for rural areas and for hard-to-reach older people. Many older people may have uncertainties about research projects and HT. Multipliers can assume a key role to help reduce these uncertainties in the future.

[The Perspectives of Stakeholders on Users of Care Robotics at the Intersection of Age and Gender - Results of a Qualitative Analysis]. / Die Perspektive von Stakeholdern auf Nutzende von Pflegerobotik an der Intersektion Alter und Geschlecht ­ Ergebnisse einer qualitativen Analyse.

Having to face the challenges posed by a shortage of skilled care workers and an increasing number of older people in need of care, policy makers and economic enterprises perceive care robotics as a promising solution. However, studies have shown that potential users have little interest in technology and that technology developers have little knowledge about the needs and wishes of potential users. Against this background, this paper explores, based on 16 qualitative interviews with stakeholders from the area of technology development, marketing, and nursing care (science), which assumptions and expectations regarding age and gender of users are relevant in this field. The results revealed three perspectives of the stakeholders regarding the users of care robotics: 1) the need to take age and gender in development and implementation of care robotics was acknowledged, 2) the relevance of other social categories, such as education, culture and illness, was mentioned, and 3) the relevance of social categories was rejected altogether. These results are discussed in the context of discourses about diversity in care-robotics and conclusions are drawn for user-centred and diversity-sensitive technology development and implementation.

[Motivational Reasons and Perceptions about Future Participation of Older People in the Research and Development Process of Health Technologies: a Mixed Methods Study]. / Motivationsgründe und Vorstellungen über eine zukünftige Beteiligung älterer Menschen im Forschungs- und Entwicklungsprozess von Gesundheitstechnologien ­ eine Mixed Methods-Studie.

BACKGROUND: Although digital approaches for disease prevention in older people have a high potential and are being used more often, there are still inequalities in access and use. One reason could be that in technology development future users are insufficiently taken into consideration, or involved very late in the process using inappropriate methods. The aim of this work was to analyze the motivation of older people participating, and their perceptions of future participation in the research and development process of health technologies aimed at health care for older people. METHODOLOGY: Quantitative and qualitative data from one needs assessment and two evaluation studies were analyzed. The quantitative data were analyzed descriptively and the qualitative data were analyzed content-analytically with inductive-deductive category formation. RESULTS: The median age of the 103 participants (50 female) was 75 years (64-90), most of whom were interested in using technology and had prior experience of study participation. Nine categories for participation motivation were derived. A common motivation for participation was to promote and support their own health. Respondents were able to envision participation both at the beginning of the research process and at its end. In terms of technique development, different ideas were expressed, but there was a general interest in technological development. Methods that would enable exchange with others were favored most. CONCLUSIONS: Differences in motivation to participate and ideas about participation were identified. The results provide important information from the perspective of older people and complement the existing state of research.

Designing and applying technology for prevention-Lessons learned in AEQUIPA and its implications for future research and practice.

Almost all Western societies are facing the challenge that their population structure is changing very dynamically. Already in 2019, ten countries had a population share of at least 20 percent in the age group of 64 years and older. Today's society aims to improve population health and help older people live active and independent lives by developing, establishing, and promoting safe and effective interventions. Modern technological approaches offer tremendous opportunities but pose challenges when preventing functional decline. As part of the AEQUIPA Prevention Research Network, the use of technology to promote physical activity in older people over 65 years of age was investigated in different settings and from various interdisciplinary perspectives, including technology development and evaluation for older adults. We present our findings in three main areas: (a) design processes for developing technology interventions, (b) older adults as a user group, and (c) implications for the use of technology in interventions. We find that cross-cutting issues such as time and project management, supervision of participants, ethics, and interdisciplinary collaboration are of vital importance to the success of the work. The lessons learned are discussed based on the experiences gained in the overall AEQUIPA network while building, particularly on the experiences from the AEQUIPA sub-projects TECHNOLOGY and PROMOTE. Our experiences can help researchers of all disciplines, industries, and practices design, study and implement novel technology-based interventions for older adults to avoid pitfalls and create compelling and meaningful solutions.

Gender and Age Stereotypes in Robotics for Eldercare: Ethical Implications of Stakeholder Perspectives from Technology Development, Industry, and Nursing.

Social categorizations regarding gender or age have proven to be relevant in human-robot interaction. Their stereotypical application in the development and implementation of robotics in eldercare is even discussed as a strategy to enhance the acceptance, well-being, and quality of life of older people. This raises serious ethical concerns, e.g., regarding autonomy of and discrimination against users. In this paper, we examine how relevant professional stakeholders perceive and evaluate the use of social categorizations and stereotypes regarding gender and age in robotics for eldercare. Based on 16 semi-structured interviews with representatives from technology development, industry, and nursing science as well as practice, we explore the subjects' awareness, evaluations, and lines of argument regarding the corresponding moral challenges. Six different approaches of dealing with categorizations and stereotypes regarding gender and age in care robotics for older people are identified: negation, functionalistic relativization, explanation, neutralization, stereotyping, and queering. We discuss the ethical implications of these approaches with regard to professional responsibility and draw conclusions for responsible age tech in pluralistic societies.

Measurement System for Unsupervised Standardized Assessments of Timed Up and Go Test and 5 Times Chair Rise Test in Community Settings-A Usability Study.

Comprehensive measurements are needed in older populations to detect physical changes, initiate prompt interventions, and prevent functional decline. While established instruments such as the Timed Up and Go (TUG) and 5 Times Chair Rise Test (5CRT) require trained clinicians to assess corresponding functional parameters, the unsupervised screening system (USS), developed in a two-stage participatory design process, has since been introduced to community-dwelling older adults. In a previous article, we investigated the USS's measurement of the TUG and 5CRT in comparison to conventional stop-watch methods and found a high sensitivity with significant correlations and coefficients ranging from 0.73 to 0.89. This article reports insights into the design process and evaluates the usability of the USS interface. Our analysis showed high acceptance with qualitative and quantitative methods. From participant discussions, suggestions for improvement and functions for further development could be derived and discussed. The evaluated prototype offers a high potential for early detection of functional limitations in elderly people and should be tested with other target groups in other locations.

[Family as a Health-Maintaining Resource for Late Repatriates? A Qualitative Study of Health Attitudes in Old Age]. / Familie als gesundheitserhaltende Ressource bei Spätaussiedler/innen?! Eine qualitative Studie zu Gesundheitsvorstellungen im Alter.

BACKGROUND: In the context of demographic changes in Germany, it can be observed that the number of older people among the second largest migrant group - the so-called late repatriates - is on the rise. The health and utilisation behaviour of preventive measures by this group differs from that of the German population or people with a different migration background. An essential prerequisite for the design of target group-specific prevention measures is the knowledge of health expectations of the late repatriates. GOAL OF THE STUDY: The goal of this study was to show the importance of the family and the predominant role models of late repatriates in health attitudes. METHOD: Guided interviews were conducted with 13 late repatriates in Russian and evaluated using the documentary method. RESULTS: The family and the care for (grand-)children was a central element of the preservation of health of the respondents. The traditional role models brought from the Soviet Union were partly preserved and partly (regardless the gender) expanded by the care for the (grand-)children. CONCLUSION: The involvement of (grand-)children has a health-promoting effect on maintaining health in late repatriates and can encourage their use of preventive measures.

"I can do that on my own!" On the relevance of subjective factors to the use of formal support, from the perspective of people with dementia.

Our aim was to reach a better insight of the disposition of people living alone with dementia toward the use of care and support services. In biographical narrative interviews, women and men with dementia communicated to us their opinions, needs, and subjectively perceived level of resources regarding their everyday life and care. Both individual and gender-specific differences concerning the use of formal support become evident in their narrations. We offer indications for a future healthcare practice that is specific to dementia. To fully exploit the potential of participatory research, study designs specific to dementia should be developed further.

Requirements for (web-based) physical activity interventions targeting adults above the age of 65 years - qualitative results regarding acceptance and needs of participants and non-participants.

BACKGROUND: It remains unclear how physical activity (PA) interventions need to be designed to reach older adults and to be widely accepted in this target group. The aim of this study was to assess the acceptance of a web-based PA program, including individual intervention components as well as relevant contextual factors, and to specify requirements for future interventions. METHODS: Two hundred sixty-six participants of a PA intervention completed a questionnaire covering individual program components (content, structure, and context). Further, 25 episodic guided interviews focusing on reasons for (non-) participation were conducted with 8 participants and 17 non-participants. Following qualitative content analysis, different requirements were identified and organized based on the social-ecological model, resulting in a profile of requirements. RESULTS: Based on the participants' and non-participants' statements, six different levels of requirements affecting acceptance of and successful participation in a web-based PA intervention were identified. The individual fit was influenced by an interaction of different factors at the intrapersonal, sociocultural, content, spatial, digital and organizational levels. Several age- and gender-specific requirements were noted in the interviewed older adults. Men and women, as well as younger (< 70 years) and older (≥70 years) adults differed in terms of perceived enjoyment and benefits of socializing while exercising together, the time expenditure perceived to be acceptable, previous digital skills, as well as in perceptions that ambience and accessibility of exercise facilities in the neighborhood were important. CONCLUSIONS: To motivate older adults to engage in PA and address different needs in terms of life circumstances and quality of life as well as differences in technical affinity, different requirement profiles should be included in the process of intervention development and implementation. Participatory development loops and modular offer formats are recommended for this.

[Experiences with health technologies to support physical activity in people over the age of 65: A qualitative survey of the requirements for the development of preventive technologies for a heterogeneous target group]. / Erfahrungen mit Gesundheitstechnologien zur Unterstützung der körperlichen Aktivität bei Menschen ab 65 Jahren ­ Eine qualitative Erhebung der Anforderungen für die Entwicklung präventiver Technologien für eine heterogene Zielgruppe.

BACKGROUND: For elderly people, physical activity (PA) is an important prerequisite for a healthy and self-determined life and provides preventive protection against many chronic diseases. Since a high proportion of this group does not exercise sufficiently in everyday life, new preventive strategies have been developed. In recent years, health technologies have also become increasingly important and offer a potential for primary prevention to promote PA. The aim of this study was to analyze experience with and acceptance of the use of technologies to support PA and to monitor health parameters in people over the age of 65. In addition to identifying concerns, uncertainties and subjective ideas about technologies, requirements for preventive technology should be derived. METHOD: Guided (semi-structured) interviews were conducted. Interviewing topics included "PA" and "technology". Recruitment took place through a public call and the distribution of flyers. The evaluation was carried out by content analysis with inductive and deductive category formation. In addition, an interdisciplinary requirements analysis was performed on the basis of the transcripts in order to derive needs and requirements for preventive technologies. RESULTS: The interviews were conducted with 33 persons (19 female). The average age was 75 years. Nine participants with a migration background originated from four countries. All participants were active in everyday life. The barriers identified included a lack of motivation and weather conditions. Many participants used health technologies in their everyday lives and were quite open to these developments. However, concern was expressed regarding topics such as data protection and security. CONCLUSION: Experience and acceptance in dealing with future preventive technologies as well as concerns, ideas and requirements could be inferred from discussions with the heterogeneous target group. General strategies (e.g. notices, press) as well as specific strategies (e.g. multipliers) and sufficient time are important to ensure a target group-specific access to different groups of people.

[Mental disorders of working age : Evaluation of the administrative incidence and prevalence as well as regional differences in Lower Saxony on the basis of secondary data from a statutory health insurance provider]. / Psychische Störungen im Erwerbsalter : Ermittlung der administrativen Inzidenz und Prävalenz sowie regionaler Unterschiede in Niedersachsen anhand von Sekundärdaten einer gesetzlichen Krankenkasse.

BACKGROUND: Mental disorder is the subject of ever-increasing attention in the field of public health. However, the actual number of such cases is difficult to determine owing to the lack of comprehensive longitudinal studies. OBJECTIVES: The administrative incidence and prevalence of mental disorders were estimated on the basis of data from 2010 to 2013 provided by the health insurance company AOK, Lower Saxony, and were assessed according to age and gender. Additionally, possible correlations between local conditions and the occurrence of diagnosed mental disorders were examined for both urban and rural districts. MATERIALS AND METHODS: Analyses were conducted using the secondary datasets of 1.5 million persons born between 1940 and 1994 who had been continuously insured throughout the period specified. Only documented diagnoses from outpatient care were taken into account. RESULTS: One third of the insured persons showed at least one documented diagnosis of a mental disorder within a 12-month period. In approximately 11 out of 100 cases, there was a newly documented diagnosis in 2012. With the exception of cases relating to psychotropic substance use, women were significantly more frequently affected than men. Age-specific differences were also determined. At a regional level, in relation to administrative prevalence, mental disorders showed positive correlations in the density of doctors and psychotherapists. Moreover, regions with a high rate of unemployment generally show a higher prevalence of mental disorders. CONCLUSION: Despite certain limitations, the use of administrative incidence and prevalence data is a viable approach to assessing gender- and age-specific, and regional differences. Our regional analyses suggest a correlation between the local job situation and the level of regional administrative prevalence.

Development and evaluation of two web-based interventions for the promotion of physical activity in older adults: study protocol for a community-based controlled intervention trial.

BACKGROUND: Regular physical activity (PA) is a key contributor to healthy ageing. However, despite known health benefits, only one third of older adults in Germany reach the PA levels recommended for persons aged 65 years and above by the World Health Organization. The aim of the current study is to evaluate the effectiveness of two web-based interventions for the initiation and maintenance of regular PA (i.e., intervention groups 1 and 2) compared to a delayed intervention control group of older adults aged 65 to 75 years. METHODS/DESIGN: Study participants will be randomly assigned to one of three study arms in five communities in the Bremen-Oldenburg metropolitan region: a) Participants in the first arm will receive access to a web-based intervention for 10 weeks allowing them to track their weekly PA (subjective self-monitoring, intervention group 1); b) participants in the second arm will receive access to the web-based intervention for 10 weeks and, in addition, track PA using Fitbit Zips (objective self-monitoring, intervention group 2); c) participants in the delayed intervention control group will receive access to the intervention implemented in the first study arm after completion of the 12-week follow-up in the other two groups within each community. In addition, weekly group meetings in the communities will be offered to study participants in the intervention groups providing the opportunity to address questions related to the use of the website and to practice PA in groups (e.g., neighborhood walks, strength and balance exercises). To evaluate short-term effects of the intervention on physical and psychological health, PA, physical fitness, and cognitive and psychological variables will be assessed at baseline and 12-week follow-up. DISCUSSION: This study will provide answers regarding acceptance and effectiveness of web-based interventions promoting uptake and maintenance of regular PA in persons aged 65-75 years. Study findings will contribute to a growing body of evidence in Germany concerning the role of community-based interventions for the promotion of PA and healthy ageing in older adults. TRIAL REGISTRATION: German Clinical Trials Register DRKS00010052 (Date of registration 07-11-2016).

How to Tackle Key Challenges in the Promotion of Physical Activity among Older Adults (65+): The AEQUIPA Network Approach.

The paper introduces the theoretical framework and methods/instruments used by the Physical Activity and Health Equity: Primary Prevention for Healthy Ageing (AEQUIPA) prevention research network as an interdisciplinary approach to tackle key challenges in the promotion of physical activity among older people (65+). Drawing on the social-ecological model, the AEQUIPA network developed an interdisciplinary methodological design including quantitative/qualitative studies and systematic reviews, while combining expertise from diverse fields: public health, psychology, urban planning, sports sciences, health technology and geriatrics. AEQUIPA tackles key challenges when promoting physical activity (PA) in older adults: tailoring of interventions, fostering community readiness and participation, strengthening intersectoral collaboration, using new technological devices and evaluating intervention generated inequalities. AEQUIPA aims to strengthen the evidence base for age-specific preventive PA interventions and to yield new insights into the explanatory power of individual and contextual factors. Currently, the empirical work is still underway. First experiences indicate that thenetwork has achieved a strong regional linkage with communities, local stakeholders and individuals. However, involving inactive persons and individuals from minority groups remained challenging. A review of existing PA intervention studies among the elderly revealed the potential to assess equity effects. The results will add to the theoretical and methodological discussion on evidence-based age-specific PA interventions and will contribute to the discussion about European and national health targets.

[Dementia in the focus of health research : A comparative analysis of current ageing studies]. / Demenz im Fokus der Gesundheitsforschung : Eine vergleichende Analyse aktueller Altersstudien.

Health research on an increasingly aging population calls for careful consideration of aging-associated phenomena, such as dementia. Accounting for such diseases is a necessary step for gaining a view of health in the elderly. It is moreover imperative to gather data on subjects' mental limitations in surveys to better evaluate the validity of answers disclosed by elderly participants. This article discusses the availability of data on individuals suffering from dementia in national studies on aging. It centers on the question of how surveys respond to the challenge of diagnosing dementia. The analysis is based on a literature review, which focuses on national studies on aging that were conducted no later than 2005, and that enforced an upper age limit of at least 79 years old for their subjects. By evaluating these published studies, and analyzing their data descriptively, it was determined how many subjects suffering from dementia were part of each sample, and which methods were applied to diagnose such illnesses. Overall, the availability of data on age and aging is satisfactory in Germany. The literature review discovered seven studies on aging, as well as five that lend themselves to a framework oriented toward research on aging. The number of subjects suffering from dementia in the samples is between 0 and 14% - over half of the studies reach less than 1.5% of those affected. These results thus point out problems in surveying individuals suffering from dementia. They highlight the limitations of studies on aging that do not account for dementia in their subjects. The following discussion aims to contribute to the debate on relevant research methodology, and to the development of methodological approaches that consider dementia as a crucial factor.