Ethics in Evaluating a Sociotechnical Intervention With Socially Isolated Older Adults.

The purpose of this article is to consider how ethical principles can inform the effective design and implementation of technology-based interventions that aim to promote the well-being of socially isolated older adults. We evaluated a new iPad application with small groups of older adults. In this article, we reflect on the ethical issues encountered at each stage of the research process. Drawing on the ethical principles of beneficence, research merit and integrity, justice, and respect, we identify key issues to consider in the future design and implementation of social isolation interventions that use new technologies. Key issues include (a) providing sufficient support to facilitate ongoing social interactions, (b) managing older adults' expectations, (c) providing encouragement without coercion, and (d) responding to individual needs. We conclude that it is important to report on ethical challenges incurred when evaluating social isolation interventions to inform future research in this important area.

Weaving Social Connectivity into the Community Fabric: Exploring Older Adult's Relationships to Technology and Place.

The wellbeing of older adults is positively impacted by ease of access to social networks and opportunities. In urban fringe communities, longer geographical distances, combined with mobility and health issues, can lead to decreased access to community life. Technology can facilitate socialisation opportunities for older adults living in more geographically isolated locations, but we need to work with communities to better understand how technology can fit into their existing social tapestry and community infrastructure. We conducted an explorative, qualitative study consisting of in-depth semi-structured interviews with members of an urban fringe community (n = 2), and a community mapping focus group (n = 14). Transcripts and mapping materials were analysed thematically, and also the method's suitability explored. The community mapping proved suitable to uncover the complexity of technology use to support social connectivity. We found that while technology was perceived as valuable by our participants, there were also significant fears and concerns surrounding its use related to the abstract concept of online friendship and the steep learning curve required to master some platforms. Inclusive communities connected by technology require tailored and customised community-led technology initiatives in order to accommodate for the unique social and geographical contexts in which they live. We outline the next steps for future research on technology-supported social connectivity within urban fringe communities.

Technology for societal change: Evaluating a mobile app addressing the emotional needs of people experiencing homelessness.

New technology that aims to tackle the systemic and societal problems face challenges bringing together diverse stakeholder perspectives effectively. We evaluate how an emotion-led approach, with a Living Lab process may be effective in these situations. We discuss findings and their implications for this in the context of the development and ongoing maintenance of a web app called "Ask Izzy". Ask Izzy supports people who are homeless or are otherwise disadvantaged by providing information and consequently improving their everyday life and wellbeing. We present a mixed-method evaluation of the web app: firstly, we evaluate impact of key design decisions upon engagement. Secondly, we conducted semi-structured interviews with 30 participants who are either homeless, ex-homeless or service providers and used content analysis. Then we demonstrate that our emotion-led approach brings a novel perspective on concerns from key actors influencing the refinement of the app. The results section outlines emotional goals such as a feeling of control that were important to consider in order to meet the needs of both end users and the wider service provision network. Our study provides recommendations and an approach that may inform others in developing and delivering similar health care and related systems and services.

Using the Double Diamond model to co-design a dementia caregivers telehealth peer support program.

We aimed to develop a telehealth peer support program for isolated dementia caregivers. This paper reports the co-design process by telehealth and the impact and experiences of participants. The Double Diamond model guided the co-design process, which has four phases, with participants reflecting on their caregiving experiences. Group meetings were recorded, notes compiled with inductive thematic analysis undertaken for phases one to three. Each phase findings were presented to the group for verification and refinement. Semi-structured interviews with participants were completed at the end of the project. Six dementia caregivers were recruited from dispersed locations with diverse characteristics. The process identified eight key topics to be included in a program to be delivered by telehealth. Participants reported the technology did not detract from the co-design and at times aided it, despite some technical problems. All reported high levels of group connectedness, feeling supported and transfer of knowledge and skills. One participant would have liked more understanding of the process. The group continued to meet without professional input for 2.5 years following the completion of the project. Telehealth can be a mechanism to support diverse populations in participating in co-design projects.

Combining the Digital, Social and Physical Layer to Create Age-Friendly Cities and Communities.

This qualitative investigation makes suggestions about creating age-friendly cities for older adults focusing on three domains of the World Health Organization (WHO) age-friendly city framework namely "Communication and Information", "Outdoor Spaces and Buildings" and "Social Participation". The authors present two case studies, the first one focusing on older adults using activity wearables for health self-management in the neighborhood, and the second one focusing on older adults engaged in social prescribing activities in the community. The authors then reflect on the relationships of the domains and future opportunities for age-friendly cities. These case studies apply a co-design and citizen-based approach focusing within these larger frameworks on emotions, values and motivational goals of older adults. Results suggest how the convergence of the often siloed age-friendly city components based on older adults' goals and input can lead to better social participation and longer-term health outcomes. The authors propose that the digital, physical and social aspects need to be considered in all domains of age-friendly cities to achieve benefits for older adults. Further work involving older adults in the future shaping of age-friendly neighborhoods and cities, and identifying barriers and opportunities is required.

Gait Assessment Using Wearable Sensor-Based Devices in People Living with Dementia: A Systematic Review.

The ability of people living with dementia to walk independently is a key contributor to their overall well-being and autonomy. For this reason, understanding the relationship between dementia and gait is significant. With rapidly emerging developments in technology, wearable devices offer a portable and affordable alternative for healthcare experts to objectively estimate kinematic parameters with great accuracy. This systematic review aims to provide an updated overview and explore the opportunities in the current research on wearable sensors for gait analysis in adults over 60 living with dementia. A systematic search was conducted in the following scientific databases: PubMed, Cochrane Library, and IEEE Xplore. The targeted search identified 1992 articles that were potentially eligible for inclusion, but, following title, abstract, and full-text review, only 6 articles were deemed to meet the inclusion criteria. Most studies performed adequately on measures of reporting, in and out of a laboratory environment, and found that sensor-derived data are successful in their respective objectives and goals. Nevertheless, we believe that additional studies utilizing standardized protocols should be conducted in the future to explore the impact and usefulness of wearable devices in gait-related characteristics such as fall prognosis and early diagnosis in people living with dementia.

Discrepancies Between Community-Dwelling Individuals with Dementia and Their Proxies in Completing the Cornell Scale for Depression in Dementia: A Secondary Data Analysis.

BACKGROUND: Depressive symptoms are common in people with dementia. PURPOSE: This study examined the discrepancies in the ratings of depressive symptoms between people with dementia and their family caregivers, and the extent to which these discrepancies varied according to the functional status of people with dementia. PARTICIPANTS AND METHODS: This study is a cross-sectional secondary analysis. Twenty-five people living with dementia ("participants") and their family caregivers ("proxies") participated as pairs in the study (participant mean age = 71.36, SD = 8.63; proxy mean age = 67.54, SD = 11.46). Data were collected in Victoria, Australia between May 2018 and May 2019. Participants were administered a semi-structured interview comprising the Cornell Scale for Depression in Dementia (CSDD). Proxies independently completed the CSDD and the Functional Activities Questionnaire (FAQ). A paired sample t-test was used to investigate differences in CSDD scores between participants and proxies. Kendall's tau-b correlation was used to examine the relationship between FAQ scores and discrepancy scores of CSDD. Participants were then classified into either low or high functional impairment. Mann-Whitney U-test was used to examine whether the discrepancy scores of CSDD were similar between these two groups. Intraclass correlation coefficients were calculated to indicate the level of agreement between participants and proxies in each group. RESULTS: The CSDD scores of participants were significantly lower than proxies. The size of the discrepancy in CSDD scores was positively correlated with FAQ scores. The "high functional impairment" group had larger discrepancy scores and a lower level of agreement than the "low functional impairment" group. CONCLUSION: The findings highlighted that relying on proxy CSDD scores may not reflect estimates of depressive symptoms by people with dementia. Hence, both perspectives need to be taken into account, particularly when the level of functional impairment in dementia is advanced.

Subverting the Narrative: Alternate Technology Approaches for Active Ageing.

This chapter presents two case studies where the dominant narrative was subverted, one by citizen participants and one by researchers. Subversion, as a questioning and challenging stance, in the context of co-creation supports the discovery of new pathways for healthy behaviours even in modest projects. We also illustrate how emotion-led and interest-based design is used to increase adoption by end-users. Here we explore the development of an active ageing portal for a local council and the use of 'Kira' the robot to promote social interaction between older adults living with dementia.

Young Children's Indiscriminate Helping Behavior Toward a Humanoid Robot.

Young children help others in a range of situations, relatively indiscriminate of the characteristics of those they help. Recent results have suggested that young children's helping behavior extends even to humanoid robots. However, it has been unclear how characteristics of robots would influence children's helping behavior. Considering previous findings suggesting that certain robot features influence adults' perception of and their behavior toward robots, the question arises of whether young children's behavior and perception would follow the same principles. The current study investigated whether two key characteristics of a humanoid robot (animate autonomy and friendly expressiveness) would affect children's instrumental helping behavior and their perception of the robot as an animate being. Eighty-two 3-year-old children participated in one of four experimental conditions manipulating a robot's ostensible animate autonomy (high/low) and friendly expressiveness (friendly/neutral). Helping was assessed in an out-of-reach task and animacy ratings were assessed in a post-test interview. Results suggested that both children's helping behavior, as well as their perception of the robot as animate, were unaffected by the robot's characteristics. The findings indicate that young children's helping behavior extends largely indiscriminately across two important characteristics. These results increase our understanding of the development of children's altruistic behavior and animate-inanimate distinctions. Our findings also raise important ethical questions for the field of child-robot interaction.

Caring for Carers of People with Dementia: A Protocol for Harnessing Innovation Through Deploying Leading Edge Technologies to Enable Virtual Support Groups and Services.

In rural Australia, knowledge and utilisation of support by informal carers is lacking. During the caregiving period, socioemotional support from family and friends plays an important role in sustaining caregiving activities. Post-care, these social networks facilitate adjustment to role change and dealing with grief. Developing and improving access to peer support to enable carers to effectively cope with the challenges of caring may positively influence their caring experience. The primary objective of this project is to examine the response of isolated rural carers for older people with dementia to a videoconference (VC) based peer support and information program. Will participation in the program improve self-efficacy, quality of life, and mental health? Secondary objectives are to develop a VC based peer support program for isolated rural carers for older people with dementia, using a co-design approach; and to assess the feasibility of VC technology for enhancing social support to family caregivers in their homes. This project will collaboratively co-design and evaluate a facilitated VC peer support and information program to carers of people with dementia within rural areas. Carers will be recruited through community health and care providers. Program development will use an information sharing approach to facilitate social interaction. A focus of the project is to use off-the-shelf technology which will be more accessible than specialised bespoke solutions that are currently popular in this area of research. A mixed methods repeated measures randomized wait list design will be used to evaluate the project. The primary outcomes are self-efficacy, quality of life, and mental health. Secondary outcomes are perceived social support and user satisfaction with the technology, and intention to continue VC interaction.