Use and benefit of information, communication, and assistive technology among community-dwelling older adults - a cross-sectional study.

BACKGROUND: Technology can support healthy aging and empower older adults to live independently. However, technology adoption by older adults, particularly assistive technology (AT), is limited and little is known about the types of AT used among older adults. This study explored the use of key information and communication technologies (ICT) and AT among community-dwelling adults aged ≥ 65. METHODS: A cross-sectional study was conducted among community-dwelling adults aged ≥ 65 in southern Germany using a paper-based questionnaire. The questionnaire included questions on the three domains sociodemographic aspects, health status, and technology use. Technology use was considered separately for key ICT (smartphone, computer/laptop, and tablet) and a range of 31 different AT. Data were analyzed using descriptive statistics, univariate analyses, and Bernoulli Naïve Bayes modelling. RESULTS: The questionnaire was answered by 616 participants (response rate: 24.64%). ICT were used by 497 (80.68%) participants and were associated with lower age, higher level of education, living together with someone, availability of internet connection, higher interest in technology, and better health status (p < .05). No association was found with sex and size of the hometown. The most frequently owned AT were a landline phone, a body scale, and a blood pressure monitor. Several AT related to functionality, (instrumental) activities of daily living- (IADL), and morbidity were used more frequently among non-ICT users compared to ICT-users: senior mobile phone (19.33% vs. 3.22%), in-house emergency call (13.45% vs. 1.01%), hearing aid (26.89% vs. 16.7%), personal lift (7.56% vs. 1.61%), electronic stand-up aid (4.2% vs. 0%). Those with higher interest in technology reported higher levels of benefit from technology use. CONCLUSIONS: Despite the benefits older adults can gain from technology, its use remains low, especially among those with multimorbidity. Particularly newer, more innovative and (I)ADL-related AT appear underutilized. Considering the potential challenges in providing adequate care in the future, it may be crucial to support the use of these specific AT among older and frailer populations. To focus scientific and societal work, AT with a high impact on autonomy ((I)ADL/disease-related) should be distinguished from devices with a low impact on autonomy (household-/ comfort-related).

Perceived Benefit and Satisfaction With a Tablet Computer and an Emergency Smartwatch by Older Adults and Their Relatives: Prospective Real-World Pilot Study.

Background: Assistive technologies (ATs) have the potential to promote the quality of life and independent living of older adults and, further, to relieve the burden of formal and informal caregivers and relatives. Technological developments over the last decades have led to a boost of available ATs. However, evidence on the benefits and satisfaction with ATs in real-world applications remains scarce. Objective: This prospective, real-world, pilot study tested the perceived benefit and satisfaction with different ATs in the real-world environment. Methods: Community-dwelling adults aged ≥65 and their relatives tested a tablet computer with a simplified interface or a smartwatch with programmable emergency contacts for 8 weeks in their everyday life. Perceived benefits and satisfaction with ATs were assessed by all older adults and their relatives using different assessment tools before and after the intervention. Outcome measures included the Technology Usage Inventory, Quebec User Evaluation of Satisfaction with Assistive Technology 2.0, and Canadian Occupational Performance Measure. Results: A total of 17 older adults (tablet computer: n=8, 47% and smartwatch: n=9, 53%) and 16 relatives (tablet computer: n=7, 44% and smartwatch: n=9, 56%) were included in the study. The number of participants that were frail (according to the Clinical Frailty Scale) and received care was higher in the smartwatch group than in the tablet computer group. Older adults of the smartwatch group reported higher technology acceptance (Technology Usage Inventory) and satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0) scores than those of the tablet computer group, although the differences were not significant (all P>.05). In the tablet computer group, relatives had significantly higher ratings on the item intention to use than older adults (t12.3=3.3, P=.006). Identified everyday issues with the Canadian Occupational Performance Measure included contact/communication and entertainment/information for the tablet computer, safety and getting help in emergency situations for the smartwatch, and the usability of the AT for both devices. While the performance (t8=3.5, P=.008) and satisfaction (t8=3.2, P=.01) in these domains significantly improved in the smartwatch group, changes in the tablet computer group were inconsistent (all P>.05). Conclusions: This study highlights the remaining obstacles for the widespread and effective application of ATs in the everyday life of older adults and their relatives. While the results do not provide evidence for a positive effect regarding communication deficits, perceived benefits could be shown for the area of safety. Future research and technical developments need to consider not only the preferences, problems, and goals of older adults but also their relatives and caregivers to improve the acceptability and effectiveness of ATs.

[Functionality and everyday suitability of commercially wristwear products for frail older people - a comparative product testing]. / Funktionalität und Alltagstauglichkeit kommerziell erhältlicher Wristwear-Produkte für gebrechliche ältere Menschen : Ein vergleichender Produkttest.

BACKGROUND AND AIM: There is a wide range of smartwatches and emergency watches on the market that are specifically designed for older people. The products are freely available, which is why there is an urgent need for information about the reliability and functionality of the products among potential users, but also health professionals and decision-makers. As part of a systematic product comparison test, the functionality and quality of seven smartwatches were investigated. METHOD: Four watches for seniors, one watch for adults and two watches for children, but with comparable functionalities, were included in the test. For the test, real-life situations were simulated and, in addition to emergency calls, GPS tracking, fall detection and geofencing, the battery life, call quality, stability/robustness of the products and service/support were evaluated. From the total number of points, a grade was determined based on the German school grading system (1 = very good to 6 = insufficient). RESULTS: All smartwatches evaluated were rated at least "3-satisfactory". The two best-rated watches received a score of 1.8. The differences were particularly evident in the emergency call functionality, battery life, precision of the tracking function, and service/support. The call quality, with one exception, and the stability/robustness were consistently rated as "1-very good". Three watches in the test were able to detect falls with variable results. CONCLUSION: The functionality and usability of the tested products differed considerably. A focus on a few main functions can even provide added value for older, frail people. Continuous comparative testing of products for this target group with new and updated products is desirable.

The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials.

BACKGROUND: The use of assistive technologies (ATs) to support older people has been fueled by the demographic change and technological progress in many countries. These devices are designed to assist seniors, enable independent living at home or in residential facilities, and improve quality of life by addressing age-related difficulties. OBJECTIVE: We aimed to evaluate the effectiveness of ATs on relevant outcomes with a focus on frail older adults. METHODS: A systematic literature review of randomized controlled trials evaluating ATs was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Ovid Medline, PsycINFO, SocIndex, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CENTRAL (Cochrane Central Register of Controlled Trials), and IEEEXplore databases were searched from January 1, 2009, to March 15, 2019. ATs were included when aiming to support the domains autonomy, communication, or safety of older people with a mean age ≥65 years. Trials performed within a laboratory setting were excluded. Studies were retrospectively categorized according to the physical frailty status of participants. RESULTS: A total of 19 trials with a high level of heterogeneity were included in the analysis. Six device categories were identified: mobility, personal disease management, medication, mental support, hearing, and vision. Eight trials showed significant effectiveness in all or some of the primary outcome measures. Personal disease management devices seem to be the most effective, with four out of five studies showing significant improvement of disease-related outcomes. Frailty could only be assessed for seven trials. Studies including participants with significant or severe impairment showed no effectiveness. CONCLUSIONS: Different ATs show some promising results in well-functioning but not in frail older adults, suggesting that the evaluated ATs might not (yet) be suitable for this subgroup. The uncertainty of the effectiveness of ATs and the lack of high-quality research for many promising supportive devices were confirmed in this systematic review. Large studies, also including frail older adults, and clear standards are needed in the future to guide professionals, older users, and their relatives. TRIAL REGISTRATION: PROSPERO CRD42019130249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130249.

Invasion and destruction of a murine fibrosarcoma by Salmonella-induced effector CD8 T cells as a therapeutic intervention against cancer.

We have developed a new vaccination strategy by using the Salmonella type III secretion system (T3SS) to translocate heterologous antigens into the cytosol of host cells. This leads to an efficient antigen-specific CD8 T cell induction. Recently, we have demonstrated the use of Salmonella's T3SS for the immunoprophylaxis of a solid tumor. The murine fibrosarcoma WEHI 164 was transfected with the DNA sequence encoding the MHC class I-peptide p60(217-225) from Listeria monocytogenes. In the present study, we used this tumor model to investigate the potential of vaccination with recombinant Salmonella in a therapeutic setting. BALB/c mice were subcutaneously challenged with WEHI-p60 cells. Simultaneously or 4 days later, these mice received either an orogastric or intravenous immunization with Salmonella translocating p60. Interestingly, 71-80% of the intravenously and 50-52% of the orogastrically immunized mice showed a complete tumor regression after 14 days. In addition, the distribution of tetramer-positive p60(217-225)-specific CD8 T cell subpopulations in blood and tumor tissue was analyzed. Co-staining with CD62L and CD127 revealed that the frequencies of p60(217-225)-specific effector and effector memory CD8 T cells in blood and in fibrosarcoma tissue were related to the kinetics of tumor regression. In summary, our study demonstrates that therapeutic vaccination with Salmonella leads to efficient induction of tumor-invading effector CD8 T cells that may result in significant tumor regression.

Obstacles to Using Assistive Technology for Older Adults - Results from a Focus Group Analysis.

Much hope is placed in the use of assistive technologies (AT) to support older adults and retain their independence and quality of life. AT could also be a way to help fulfill the increasing requirements of caring for an aging population. While many devices are freely available, successful and broad adoption is progressing slowly. In a qualitative analysis, we investigated the popularity of AT and the willingness to and obstacles for use. Eleven older adults aged 62-85 participated in three groups, each focusing on a specific age-related case example. Using content analysis, statements have been categorized into three levels: the affected person, their surroundings, and supportive devices. Information (knowledge, consultation) was the topic spoken about the most (n=101), followed by statements focusing on everyday life and the use of assistive devices (n=99). Comments on economic topics carried the least weight (n=28). The biggest obstacles for the reluctant adoption of AT don't seem to be acceptance issues but rather a lack of knowledge of AT and where to get counseling. Thus, the provision and promotion of coherent information material and accessible consultation for users and relatives should be prioritized. AT training for healthcare professionals can provide further opportunities.

Alternative endogenous protein processing via an autophagy-dependent pathway compensates for Yersinia-mediated inhibition of endosomal major histocompatibility complex class II antigen presentation.

Extracellular Yersinia pseudotuberculosis employs a type III secretion system (T3SS) for translocating virulence factors (Yersinia outer proteins [Yops]) directly into the cytosol of eukaryotic cells. Recently, we used YopE as a carrier molecule for T3SS-dependent secretion and translocation of listeriolysin O (LLO) from Listeria monocytogenes. We demonstrated that translocation of chimeric YopE/LLO into the cytosol of macrophages by Yersinia results in the induction of a codominant antigen-specific CD4 and CD8 T-cell response in orally immunized mice. In this study, we addressed the requirements for processing and major histocompatibility complex (MHC) class II presentation of chimeric YopE proteins translocated into the cytosol of macrophages by the Yersinia T3SS. Our data demonstrate the ability of Yersinia to counteract exogenous MHC class II antigen presentation of secreted hybrid YopE by the action of wild-type YopE and YopH. In the absence of exogenous MHC class II antigen presentation, an alternative pathway was identified for YopE fusion proteins originating in the cytosol. This endogenous antigen-processing pathway was sensitive to inhibitors of phagolysosomal acidification and macroautophagy, but it did not require the function either of the proteasome or of transporters associated with antigen processing. Thus, by an autophagy-dependent mechanism, macrophages are able to compensate for the YopE/YopH-mediated inhibition of the endosomal MHC class II antigen presentation pathway for exogenous antigens. This is the first report demonstrating that autophagy might enable the host to mount an MHC class II-restricted CD4 T-cell response against translocated bacterial virulence factors. We provide critical new insights into the interaction between the mammalian immune system and a human pathogen.

Superior protective immunity against murine listeriosis by combined vaccination with CpG DNA and recombinant Salmonella enterica serovar typhimurium.

Preexisting antivector immunity can severely compromise the ability of Salmonella enterica serovar Typhimurium live vaccines to induce protective CD8 T-cell frequencies after type III secretion system-mediated heterologous protein translocation in orally immunized mice. To circumvent this problem, we injected CpG DNA admixed to the immunodominant p60(217-225) peptide from Listeria monocytogenes subcutaneously into BALB/c mice and coadministered a p60-translocating Salmonella strain by the orogastric route. The distribution of tetramer-positive p60(217-225)-specific effector and memory CD8 T cells was analyzed by costaining of lymphocytes with CD62L and CD127. In contrast to the single oral application of recombinant Salmonella or single immunization with CpG and p60, in the spleens from mice immunized with a combination of both vaccine types a significantly higher level of p60-specific CD8 T cells with a predominance of the effector memory T-cell subset was detected. In vivo protection studies revealed that this CD8 T-cell population conferred sterile protective immunity against a lethal infection with L. monocytogenes. However, p60-specific central memory CD8 T cells induced by single vaccination with CpG and p60 were not able confer effective protection against rapidly replicating intracellular Listeria. In conclusion, we provide compelling evidence that the combination of Salmonella type III-mediated antigen delivery and CpG immunization is an attractive novel vaccination strategy to modulate CD8 differentiation patterns toward distinct antigen-specific T-cell subsets with favorable protective capacities.