Technology to

Purpose Osteoarthritis (OA) of the hip and knee is among the most common and rapidly increasing chronic diseases.Guidelines recommend a stepped-care strategy: starting with nonsurgical treatments including self-care, education and behavioral and rehabilitative components prior to more expensive joint-replacement.However, there is an underuse of self-care, exercises and weight management and an overuse of surgical treatments 1 .The SMART app aims to empower people throughout their entire OA journey by using self-administered data and AI-algorithms to provide just-in-time guidance in optimal selfmanagement.Guidance that can be provided by the app consist of selfcare modules on physical activity, weight management or sleep, general information on OA, information on relevant (healthcare) professionals or positive reinforcement.To determine at what time people could benefit from which type of guidance, the (potential) determinants of a worsening in pain, physical functioning and participation were determined with a systematic review 2 and a focus group with experts and interviews with patients.As a first step in the development of the AI-algorithm in the SMART app, this study aimed to develop a theory-driven model to predict at what time people might benefit from what guidance.Method For this developmental study, researchers with a background in the medical field and computer science worked closely together.First, (potential) determinants were screened on feasibility for self-measurement via an app or wearable and listed: age, gender, educational level, alcohol usage, pain medication usage, duration of complaints, BMI, comorbidities, tiredness, support, pain, stiffness, job satisfaction, coping, self-efficacy, anxiety and depression, kinesiophobia and physical functioning.Second, for each determinant the most appropriate measurement instrument was chosen.Third, in a 2-hour pressure cooker with 10 researchers, cut-off points for each measurement instrument were determined using available interpretations and minimal clinical important difference scores.Thereafter, the authors intensively discussed how the combination of determinants that should led to guidance in general.Lastly, based on clinical expertise, criteria were formulated to decide which type of guidance would be the most optimal guidance for which patient.All these decisions together were summarized in a rule-based model.Results and discussion Input from literature, patients, clinical experts and researchers resulted in theory-based model with rules that describe which patient, at what time (i.e. for what changes in which number of determinants) receives which guidance in the SMART app.Characteristics of the individual patient at baseline will be taken in account to assure that more complex patients will receive their guidance earlier than less complex people.Also, threshold scores for the main OA symptoms were determined, to assure that extreme scores directly result in guidance.Since a lot of choices in this study had to be made based on consensus instead of available theory, this study stresses the need for data-driven decision models.The theory-based model will now be integrated in the SMART-app and used in the SMART e-cOAch cohort to collect continuous data in a large group of patients (n=600) over a period of 1 year.In the next years, a data-driven model will be created based on the cohort data, compared and possibly combined with the theory-based model and, finally, evaluated in an RCT study to compare AI-supported selfmanagement with usual care in patients with hip or knee OA.

This study examines the effectiveness of Online-Kayoinoba, an online community-based initiative launched in Oita Prefecture during the COVID-19 pandemic (2021 to present).The initiative aims to promote social participation, support independent living, and extend the healthy life expectancy of older people, including those living alone.It utilizes the Nou-Waka 365 chat communication system (Somelight Ltd.) on LINE SNS to connect seniors with their local communities and facilitate activities that prevent nursing care needs.Daily mass messages in the morning with personalized responses are transmitted to participants, who can reply voluntarily.The research aims to determine if Nou-Waka 365 can mitigate the risk of communication loss for older people living alone during a pandemic and to develop a method for creating personalized messages based on detailed changes in their responses.Methods involved analyzing reply data from 79 consenting participants using word co-occurrence analysis (KH-coder) and sentiment analysis (AI analysis based on JIWC dictionary, then manual correction).Key findings reveal that older people living alone exhibited a significantly higher reply rate than those who did not.Co-occurrence analysis highlighted changes in participants' interests and activities.Sentiment analysis indicated a trend of increasing positive emotions following expressions of sadness.In conclusion, Online-Kayoinoba has the potential to contribute to the social participation and mental well-being of older people, underscoring the importance of continuous, personalized communication.Future research should focus on long-term effects and advanced personalization techniques.

Purpose Digital tools are currently being developed to help with the diagnosis of neurocognitive disorder (NCD).Their use in primary care as screening tools could optimize referral to specialized teams.We aimed to develop a simple, easy-to-use neurocognitive screening tool on a touchscreen tablet to distinguish between people with major NCD, those with mild NCD and those with no NCD.We hypothesize that, depending on cognitive impairment, differences in correct responses and response times differ significantly.Method We implemented selfquestionnaires and tasks for touch-screen tablets self-questionnaires inspired from conventional cognitive tools relevant to screen cognitive impairment.They comprised simple cognitive tasks like immediate and delayed recall of 3 words, temporal orientation questions, categorizations.Response times for tasks were also recorded.The screens have been designed to be used by the participant alone or with the help of a supervisor.Finally, we composed a battery of self-questionnaires and cognitive tasks that can be completed in 10-15 minutes.This battery was offered to 77 consecutive patients from a memory clinic and 28 volunteers without cognitive complaints recruited from a citizens' association.Cognitive diagnoses were based on DSM-5 criteria.Variables were compared using the Kruskal-Wallis test and Pearson's chi2 test and the level of significance was 0.05.Results and Discussion Among the 105 participants, there were 79 women (75%) and 26 men (25%) and aged 79.9 +/-7.5 years; 40 were free from NCD, 40 had a major NCD and 25 a mild NCD.All the participants realized the full battery of tests on tablets.Success for each task and response times are shown in Table 1.Four variables were found to discriminate cognitive patient and will be combined to the battery.The feasibility of our digital tablet battery for older adults is excellent, and initial results show promising aspects for cognitive screening.

Purpose To systematically review the literature of gerontechnologies tested in community-dwelling older adults living with dementia and their family caregivers from 2012 to 2022.This information is crucial to help researchers, scientists, clinicians, and the industry to understand the advantages, limitations, and opportunities of their use among dyads of family caregivers and older adults with unimpaired cognition (Moreno et al., 2024a) and individuals with dementia (Moreno et al., 2024b).Method A systematic literature search was conducted in five different databases (CINAHL, Medline, PsycINFO, AgeLine, and Web of Science) and validated by two independent librarians with backgrounds in Psychology and Geriatrics.Using COVIDENCE software, two independent reviewers screened records available in English, French, and Spanish from 2012 to 2022.We included records addressing the use of technology-assisted home support simultaneously in community-dwelling older adults living with dementia and their family caregivers following a qualitative, quantitative, or mixed methods design.Results and Discussion There were 1563 references published between 2012 and 2022.After removing the duplicates, 877 titles and abstracts were screened and the full text of 132 studies was assessed for eligibility, with only 20 studies testing 17 different gerontechnologies for home support in community-dwelling older adults living with dementia and their family caregivers.The results of the independent assessment of the quality of the studies using the Mixed Methods Appraisal Tool (MMAT) indicated that most were relatively good studies in terms of quality standards with a mean MMAT score of 4.2 (SD = 0.6).Gerontechnologies with overlapping functionalities included: a) behavioral monitoring focusing on tracking the behavior of an individual at home, b) health monitoring to better manage the illness and motivate people with dementia to get more involved in their own wellbeing by increasing the feeling of being connected with healthcare providers, c) caregiver education about dementia and advice about daily care, d) communication technologies to facilitate interaction between community-dwelling older adults living with dementia and their family caregivers, e) tracking devices when wandering events occur or to easily locate the person living with dementia when they are out of their usual geographic boundaries, and e) reminders, emergency warnings, and solutions for social isolation and daily activities support using digital prompters or conversational agents.Based on the analysis of these 17 gerontechnologies tested to assist community-dwelling older adults living with dementia and their family caregivers to age in place, we provide recommendations.In clinical practice, we advocate for education and accessibility early in the disease process as families are looking for creative technological alternatives to alleviate their caregiving tasks and increase peace of mind.We also provide research recommendations, such as testing these technologies with specific severities of dementia throughout the disease process considering the clinical heterogeneity of dementia.In addition, we recommend that technological development for dementia must include personalization and technical support because needs change in the dementia continuum and technical problems can lead to abandonment.Finally, we provide recommendations for public policy to promote collaboration with specific partners in the community to anticipate and facilitate implementation, to develop clearer privacy policies to protect users' data and to avoid commercializing a technology without evidence of its efficacy.Taking into account these recommendations, we can foster the responsible and evidence-driven development of gerontechnologies for home support.

Purpose Worldwide healthcare faces major challenges.Digital health technology can potentially be part of a solution for the problem, but implementing and upscaling digital health technology remains challenging.One of the main barriers of healthcare professionals seem to be related to not having sufficient information or knowledge about the available technology and to make an educated decision to use a specific technology for a specific patient.This lack of knowledge can be translated into not knowing what technology is available and not knowing what the quality of technology is.Meanwhile several assessment frameworks are being developed, but these frameworks are specifically developed to assess one type of technology (i.e.mobile apps) or can only be executed with support from the developer 1 .Therefore we aimed to develop a quality assessment framework for digital health technologies from the perspectives of experts in the field.Method: A national e-Delphi procedure was conducted 2 .Thirty experts were included with expertise in physical therapy, research, health technology development, teaching (in physical therapy) and policy advisors.The Delphi consisted of four rounds and each round consisted of a questionnaire and an anonymized report.The first three rounds consisted of questions regarding (1) Information framework (2) Proposed criteria for the quality assessment framework and (3) Presentation.The fourth round a conceptual rubric was proposed.Consensus was reached when >70% of the experts agreed or a 7.0 or higher was scored on a criterium.Results and discussion: After four rounds, this Delphi study resulted in an information framework, a quality assessment framework, a presentation label and a rubric.The information framework includes 15 items that describe functions, goals, costs and available scientific literature of the technology (2) a quality assessment framework consisting of 15 criteria that assess the technology in three categories: Healthy & Safe, Usability and Data safety.The experts found it important to present an overall score, a subscore per category and user-reviews.The experts also agreed on the proposed rubric which results in a five-star scoring system.This study showed what experts found important to assess before using digital technology in practice.Nevertheless, it remains important to consider whether the technology suits the digital literacy, health literacy of the patient and healthcare professional and whether technology supports in reaching the treatment goals.Additionally, technologies are rapidly evolving and therefore scores can change quickly, so keeping the scores up to date is challenging.Because of the rapidly changing technology landscapes it is also important to regularly reflect on the relevance of the included criteria in the framework and to maybe add new important criteria to it.

PurposeThe HelpAge global network and the International Society for Gerontechnology (ISG) are exploring opportunities for collaboration.On the one hand, ISG members may share learning from ageing and gerontechnology explorations, design, innovations, and interventions while members of the HelpAge global network share their views and experiences on what technological innovations can be introduced into Low-and Middle-Income countries (LMICs) and how to make these more accessible and affordable in low-resource settings and enhance older people's participation in its design.Method In April 2024, HelpAge invited a sample of its Network Members to respond to a short online survey to capture their experiences, lessons, and challenges in using Gerontechnology in their work with older people in LMICs.Eight organizations from 7 countries responded, all of whom are happy to continue engaging on this topic (see Table 1).The survey comprises three questions: experience with technology (Q1), challenges to adapting technologies for older people (Q2), and views on key gaps in the availability and suitability of technologies for ageing populations (Q3).In addition, on May 15, 2024, a webinar was hosted by the HelpAge Global network together with ISG to have more in-depth discussions and explore potential benefits.Results and Discussion Results related to Q1 are: that there are significant opportunities for the use of technology for ageing people.There are mobile apps to promote self-management and well-being by monitoring health data and offering services and resources.Also, digital literacy programs can be used to empower older people to engage with technology confidently through training, basic smartphone usage, and more.Technological innovations for older people offer exciting possibilities for a more independent and fulfilling life when ageing.Findings regarding Q2 are: user-related challenges are reported including physical limitations (reduced dexterity, vision impairments), cognitive challenges (memory issues), lack of habit in using technology, and information overload.Technological solutions do use smartphones as an interface which requires digital skills and access to the internet and data storage.The former can be lacking or low while the latter could be absent or not affordable in LMICs.Key gaps coming from Q3 are that technology products are often designed without sufficient attention to expected age-related declines in dexterity or vision, hindering user interaction.Many technologies have complex interfaces and technical terminology which pose challenges for users with varying levels of technological literacy.In addition, there is a need to provide personalization and tailoring of technological innovations to better fit older people's capabilities (Castro et.al., 2020).There is also a need to consider cultural nuances and linguistic preferences.Technological innovations usually cater to higher socioeconomic classes and neglect older people with limited resources.The work of Jess-Azabal et.al. 2023 also presented at the webinar though showed that it is possible to design technological solutions for older people with limited resources and access to the Internet.Charness showed that it pays off to include older people from the start of the design of technological innovation (Charness, et.al., 2022) while Costa-Castro presented that a commercial party in Brazil targets the needs of older people providing tailored services in health diagnostics at home.In Gerontechnology students are educated to design user-friendly, easy-to-use, robust technological solutions for older people.Mainstream industry though is not familiar yet with gerontechnology.In this roundtable, further collaboration will be explored as well as a discussion of how to reach mainstream industry designing technologies for older people.