Supporting Well-Being: Exploring the Value of a Digital Coach for Older Adults in the Transition from Work to Retirement.

Supporting older adults' health and well-being in the transition from work to retirement requires a holistic perspective and needs to address physical, mental, and social aspects of life. In a field study, applying a mixed-methods approach, we investigated to what extent the prototype of a digital coach can support older adults in this sensitive phase. We aim at answering the central research question: How can a digital coach support older adults in the transition from work to retirement to establish and maintain a healthy lifestyle? Overall, 32 participants from Austria and Belgium took part in an eight-week trial. App-based interventions in different domains (physical, mental, social) were provided and aimed at motivating the target group to become and/or stay active. The study shows that the digital coach has potential to support health and well-being on various levels. In particular, the mental activities proofed valuable and supported older adults' well-being.

The Impact of Digital Coaching Intervention for Improving Healthy Ageing Dimensions among Older Adults during Their Transition from Work to Retirement.

Retirement is a critical step in older adults' lives, so it is important to motivate them to stay physically active, mentally healthy, and socially connected in the transition from work to retirement, including through digital health coaching programs. This study aims to: evaluate the impact of a digital coaching intervention to enhance three healthy ageing dimensions, i.e., physical activity, mental well-being, and socialization of a group of adults near retirement; understand the users' experience; and identify the system strengths and weaknesses. This longitudinal mixed-methods study, carried out in 2021 in Italy and the Netherlands, enrolled 62 individuals. In the first 5 weeks of the trial, participants used a digital coach with the support of human coaches, and then they continued autonomously for another 5 weeks. The use of the digital coach improved the participants' physical activity, mental well-being and self-efficacy during the first period and only the physical activity in the second. An effective coaching system should be flexible and attractive. High levels of personalization remain the golden key to aligning the health program to the physical, cognitive and social status of the intended target, thus increasing the user-system interaction, usability, and acceptability, as well as enhancing adherence to the intervention.

Cocreating a Harmonized Living Lab for Big Data-Driven Hybrid Persona Development: Protocol for Cocreating, Testing, and Seeking Consensus.

BACKGROUND: Living Labs are user-centered, open innovation ecosystems based on a systematic user cocreation approach, which integrates research and innovation processes in real-life communities and settings. The Horizon 2020 Project VITALISE (Virtual Health and Wellbeing Living Lab Infrastructure) unites 19 partners across 11 countries. The project aims to harmonize Living Lab procedures and enable effective and convenient transnational and virtual access to key European health and well-being research infrastructures, which are governed by Living Labs. The VITALISE consortium will conduct joint research activities in the fields included in the care pathway of patients: rehabilitation, transitional care, and everyday living environments for older adults. This protocol focuses on health and well-being research in everyday living environments. OBJECTIVE: The main aim of this study is to cocreate and test a harmonized research protocol for developing big data-driven hybrid persona, which are hypothetical user archetypes created to represent a user community. In addition, the use and applicability of innovative technologies will be investigated in the context of various everyday living and Living Lab environments. METHODS: In phase 1, surveys and structured interviews will be used to identify the most suitable Living Lab methods, tools, and instruments for health-related research among VITALISE project Living Labs (N=10). A series of web-based cocreation workshops and iterative cowriting processes will be applied to define the initial protocols. In phase 2, five small-scale case studies will be conducted to test the cocreated research protocols in various real-life everyday living settings and Living Lab infrastructures. In phase 3, a cross-case analysis grounded on semistructured interviews will be conducted to identify the challenges and benefits of using the proposed research protocols. Furthermore, a series of cocreation workshops and the consensus seeking Delphi study process will be conducted in parallel to cocreate and validate the acceptance of the defined harmonized research protocols among wider Living Lab communities. RESULTS: As of September 30, 2021, project deliverables Ethics and safety manual and Living lab standard version 1 have been submitted to the European Commission review process. The study will be finished by March 2024. CONCLUSIONS: The outcome of this research will lead to harmonized procedures and protocols in the context of big data-driven hybrid persona development among health and well-being Living Labs in Europe and beyond. Harmonized protocols enable Living Labs to exploit similar research protocols, devices, hardware, and software for interventions and complex data collection purposes. Economies of scale and improved use of resources will speed up and improve research quality and offer novel possibilities for open data sharing, multidisciplinary research, and comparative studies beyond current practices. Case studies will also provide novel insights for implementing innovative technologies in the context of everyday Living Lab research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34567.

User Requirements Analysis of an Embodied Conversational Agent for Coaching Older Adults to Choose Active and Healthy Ageing Behaviors during the Transition to Retirement: A Cross-National User Centered Design Study.

BACKGROUND: Retirement is recognized as a factor influencing the ageing process. Today, virtual health coaching systems can play a pivotal role in supporting older adults' active and healthy ageing. This study wants to answer two research questions: (1) What are the user requirements of a virtual coach (VC) based on an Embodied Conversational Agent (ECA) for motivating older adults in transition to retirement to adopt a healthy lifestyle? (2) How could a VC address the active and healthy ageing dimensions, even during COVID-19 times? METHODS: Two-wave focus-groups with 60 end-users aged 55 and over and 27 follow-up telephone interviews were carried out in Austria, Italy and the Netherlands in 2019-2020. Qualitative data were analysed by way of framework analysis. RESULTS: End-users suggest the VC should motivate older workers and retirees to practice physical activity, maintain social contacts and emotional well-being. The ECA should be reactive, customizable, expressive, sympathetic, not directive nor patronizing, with a pleasant and motivating language. The COVID-19 outbreak increased the users' need for functions boosting community relationships and promoting emotional well-being. CONCLUSIONS: the VC can address the active and healthy ageing paradigm by increasing the chances of doing low-cost healthy activities at any time and in any place.

Technically Representing Clinical Knowledge for Rehabilitation Care.

Providing a suitable rehabilitation after an acute episode or a chronic disease helps people to live independently and enhance their quality of life. However, the continuity of care is often interrupted in the transition from hospital to home. Virtual coaches (VCs) could help these patients to engage in personalized home rehabilitation programs. These coaching systems need also to be fed with procedural precepts in order to work as intended. This, in turn, relates both to properly represent the clinical knowledge (as the VC somehow replaces the formal caregivers that cannot be fully present) as well guide the patient correctly (in order to follow the medically desired procedures given the need for personalisation according to individual needs). Therefore, we outline our technical approach to deal with this. In particular, clinical pathways in terms of semi-formal procedure models in combination with machine learning components processing and powerful user interfaces providing these pathway information and feeding the VC are presented. The system is currently under testing in a participatory design phase called Living Lab. Thus, initial user feedback for further improvements is about to come.

Correction: Digital Health Coaching Programs Among Older Employees in Transition to Retirement: Systematic Literature Review.

[This corrects the article DOI: 10.2196/17809.].

Digital Health Coaching Programs Among Older Employees in Transition to Retirement: Systematic Literature Review.

BACKGROUND: The rapid increase of the aging population is pushing many national governments to reshape retirement legislation in order to extend older adults' working life. Once retired, older adults can be invaluable resources for the community as family carers, as volunteers, or by returning to work. Healthy aging is one of the main conditions for being able to work longer and being active after retirement. The latter, indeed, represents a very sensitive life transition, which can entail psychological and social difficulties. Interventions for promoting older workers' health and well-being and supporting the transition to retirement are on the top of the policy agenda of most European countries. Recently, computer-based and digital health interventions have been seen as promising means to reach this purpose. OBJECTIVE: This systematic literature review aimed to explore studies on digital health coaching programs for older workers that followed a user-centered design approach and evaluated their effectiveness in providing older adults with guidance for adopting a healthy lifestyle and being active in the community. METHODS: The search identified 1931 papers, and 2 relevant articles were selected by applying specific eligibility criteria. RESULTS: To our knowledge, only few digital health coaching programs have targeted the population of older workers to date; there is an insufficient number of studies on the efficacy of such programs. The results show the difficulties of assessing the efficacy of digital coaching itself and with respect to older employees. The 2 studies suggest that digital health programs for workplaces can improve various aspects of older employees' well-being; however, they considered health mainly from a physical perspective and neglected contextual, social, psychological, and cultural factors that can influence older workers' health and general well-being. Future digital health coaching programs should adopt the healthy aging paradigm as a multidimensional lens for interpreting the impact of eHealth technology on aging and retirement. The literature around this issue remains at an embryonic state, and this gap needs to be filled by further investigations that apply a user-centered approach for designing the technology, test innovative research methodologies, and adopt new technical solutions for high-quality interaction design. CONCLUSIONS: Further digital health coaching programs aimed at supporting healthy and active living for older workers and retirees are necessary. The user-centered design approach is recommended in order to fully address the users' health needs and the technological requirements throughout development. Moreover, the healthy aging perspective allows inclusion of physical, social, and psychological factors influencing the transition from work to retirement, as well as the experiences and interactions of individuals with the technology.

Assistive Solutions in Practice: Experiences from AAL Pilot Regions in Austria.

Since 2012 six AAL pilot regions were launched in Austria. The main goal of these pilot regions is to evaluate the impact of AAL technologies in daily use considering the entire value chain. Additionally, go-to market strategies for assistive technologies based on an involvement of all relevant stakeholders are developed. Within this paper an overview of the specific objectives, approaches and the status of all Austrian AAL pilot regions is given. Taking into account the different experiences of the different pilot regions, specific challenges in establishing, implementing and sustaining pilot region projects are discussed and lessons-learned are presented. Results show that a careful planning of all project phases taking into account available resources is crucial for the successful implementation of an AAL pilot region. In particular, this applies to all activities related to the active involvement of end-users.

Development of and Adherence to a Computer-Based Gamified Environment Designed to Promote Health and Wellbeing in Older People with Mild Cognitive Impairment.

BACKGROUND: The older population of Europe is increasing and there has been a corresponding increase in long term care costs. This project sought to promote active ageing by delivering tasks via a tablet computer to participants aged 65-80 with mild cognitive impairment. OBJECTIVES: An age-appropriate gamified environment was developed and adherence to this solution was assessed through an intervention. METHODS: The gamified environment was developed through focus groups. Mixed methods were used in the intervention with the time spent engaging with applications recorded supplemented by participant interviews to gauge adherence. There were two groups of participants: one living in a retirement village and the other living separately across a city. RESULTS: The retirement village participants engaged in more than three times the number of game sessions compared to the other group possibly because of different social arrangements between the groups. CONCLUSION: A gamified environment can help older people engage in computer-based applications. However, social community factors influence adherence in a longer term intervention.

Reasoning and Data Representation in a Health and Lifestyle Support System.

Case-based reasoning and data interpretation is an artificial intelligence approach that capitalizes on past experience to solve current problems and this can be used as a method for practical intelligent systems. Case-based data reasoning is able to provide decision support for experts and clinicians in health systems as well as lifestyle systems. In this project we were focusing on developing a solution for healthy ageing considering daily activities, nutrition as well as cognitive activities. The data analysis of the reasoner followed state of the art guidelines from clinical practice. Guidelines provide a general framework to guide clinicians, and require consequent background knowledge to become operational, which is precisely the kind of information recorded in practice cases; cases complement guidelines very well and helps to interpret them. It is expected that the interest in case-based reasoning systems in the health.

YouDo - we help! - An Open Information and Training Platform for Informal Caregivers.

The number of people in need of care increases constantly, and in the coming few years many seniors will depend on their close relatives for their care needs. These relatives very often need support to fulfill their role as informal caregivers. The YouDo prototype presented in this paper aims to provide special training programs for informal caregivers in order to help them to improve the quality of their nursing. This work illustrates first development concepts, used methods and techniques towards a modular, extensible and user adaptable multimodal information and training platform.

Evaluation of a modular scalable system for silver-ager located in assisted living homes in Austria--study protocol of the ModuLAAr ambient assisted living project.

BACKGROUND: To cope with the upcoming demographic change, economic efforts in the European Union are undertaken to promote activities in research and development of Ambient Assisted Living (AAL) solutions. As a result, a large variety of AAL products will be available in the next years. Only very few of these products are comprehensively evaluated regarding different aspects of quality of life in the target population. The aim of this study is to examine the effects of AAL on quality of life, health and technology acceptance of people at advanced age living in assisted living homes providing them the ModuLAAr Ambient Assisted Living system. METHODS/DESIGN: A treatment group of adults aged 60 years and older will be recruited within the participating assisted living homes. At baseline, the participating volunteers will report on quality of life, subjective health and sociodemographic conditions. After system installation, prospective follow-up (1, 4, 12 and 18 months) with additional reporting on technology acceptance and usability of the system will be conducted. Mixed methods data collection, linking quantitative data to interview-gathered qualitative data will be applied. Primary outcome measure will be the change in quality of life and subjective health across study duration. DISCUSSION: As there is currently very little evidence that AAL solutions can contribute to improved health and the particular dimensions of quality of life in elderly persons, there is a need to assess these technologies and services more carefully. This field trial seeks to investigate the most relevant aspects connected to advanced information and communication technologies and their impact on daily life of residents in assisted living conditions. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02130102.

Oscillometric estimation of aortic pulse wave velocity: comparison with intra-aortic catheter measurements.

OBJECTIVES: Recently, a novel method to estimate aortic pulse wave velocity (aPWV) noninvasively from an oscillometric single brachial cuff waveform reading has been introduced. We investigated whether this new approach provides acceptable estimates of aPWV compared with intra-aortic catheter measurements. METHODS: Estimated values of aPWV obtained from brachial cuff readings were compared with those obtained using an intra-aortic catheter in 120 patients (mean age 61.8±10.8 years) suspected for coronary artery disease undergoing cardiac catheterization. Differences between aPWV values obtained from the test device and those obtained from catheter measurements were estimated using Bland-Altman analysis. RESULTS: The mean difference±SD between brachial cuff-derived values and intra-aortic values was 0.43±1.24 m/s. Comparison of aPWV measured by the two methods showed a significant linear correlation (Pearson's R=0.81, P<0.0001). The mean difference for repeated oscillometric measurements of aPWV was 0.05 m/s, with 95% confidence interval limits from -0.47 to 0.57 m/s. CONCLUSION: aPWV can be obtained using an oscillometric device with brachial cuffs with acceptable accuracy compared with intra-aortic readings.

Wave reflection quantification based on pressure waveforms alone--methods, comparison, and clinical covariates.

Within the last decade the quantification of pulse wave reflections mainly focused on measures of central aortic systolic pressure and its augmentation through reflections based on pulse wave analysis (PWA). A complementary approach is the wave separation analysis (WSA), which quantifies the total amount of arterial wave reflection considering both aortic pulse and flow waves. The aim of this work is the introduction and comparison of aortic blood flow models for WSA assessment. To evaluate the performance of the proposed modeling approaches (Windkessel, triangular and averaged flow), comparisons against Doppler measurements are made for 148 patients with preserved ejection fraction. Stepwise regression analysis between WSA and PWA parameters are performed to provide determinants of methodological differences. Against Doppler measurement mean difference and standard deviation of the amplitudes of the decomposed forward and backward pressure waves are comparable for Windkessel and averaged flow models. Stepwise regression analysis shows similar determinants between Doppler and Windkessel model only. The results indicate that the Windkessel method provides accurate estimates of wave reflection in subjects with preserved ejection fraction. The comparison with waveforms derived from Doppler ultrasound as well as recently proposed simple triangular and averaged flow waves showed that this approach may reduce variability and provide realistic results.

Validation of a brachial cuff-based method for estimating central systolic blood pressure.

The prognostic value of central systolic blood pressure has been established recently. At present, its noninvasive assessment is limited by the need of dedicated equipment and trained operators. Moreover, ambulatory and home blood pressure monitoring of central pressures are not feasible. An algorithm enabling conventional automated oscillometric blood pressure monitors to assess central systolic pressure could be of value. We compared central systolic pressure, calculated with a transfer-function like method (ARCSolver algorithm), using waveforms recorded with a regular oscillometric cuff suitable for ambulatory measurements, with simultaneous high-fidelity invasive recordings, and with noninvasive estimations using a validated device, operating with radial tonometry and a generalized transfer function. Both studies revealed a good agreement between the oscillometric cuff-based central systolic pressure and the comparator. In the invasive study, composed of 30 patients, mean difference between oscillometric cuff/ARCSolver-based and invasive central systolic pressures was 3.0 mm Hg (SD: 6.0 mm Hg) with invasive calibration of brachial waveforms and -3.0 mm Hg (SD: 9.5 mm Hg) with noninvasive calibration of brachial waveforms. Results were similar when the reference method (radial tonometry/transfer function) was compared with invasive measurements. In the noninvasive study, composed of 111 patients, mean difference between oscillometric cuff/ARCSolver-derived and radial tonometry/transfer function-derived central systolic pressures was -0.5 mm Hg (SD: 4.7 mm Hg). In conclusion, a novel transfer function-like algorithm, using brachial cuff-based waveform recordings, is suited to provide a realistic estimation of central systolic pressure.