A Tablet-Based Application to Enhance Social Connectedness for Individuals With a Cognitive Impairment: Results From the PRISM-CI Pilot Study

Abstract

Social engagement is fundamental to successful aging and linked to better emotional, physical, and cognitive health. Maintaining social engagement is challenging for many older adults but especially for those with a cognitive impairment (CI). Information and communication technologies (ICT) can provide enhanced opportunities for social and cognitive engagement for older adults with a CI via increased information, education, and social connectivity access. This study used a pre-test post-test design to evaluate the feasibility, acceptability, and preliminary efficacy of the PRISM-CI software system, a tablet-based application designed to enhance access to resources, information, and social engagement, in 52 individuals with a CI between the ages of 65–88 years who had access to PRISM-CI for five months. Findings show that social isolation, loneliness, and depressive symptoms significantly decreased, and mobile device proficiency significantly increased, from baseline to follow-up. Results highlight ICTs potential to foster social engagement among older adults with a CI.

Keywords

technology loneliness social support cognitive impairment

Get full access to this article

View all access options for this article.

References

Administration on Aging (2020). A profile of older Americans, 2020.

Anderson

N. D.

(2019). State of the science on mild cognitive impairment (MCI). CNS Spectrums, 24(1), 78–87. https://doi.org/10.1017/s1092852918001347

Antonucci

T. C.

Ajrouch

K. J.

Manalel

J. A.

(2017). Social relations and technology: Continuity, context, and change. Innovation in Aging, 1(3), igx029. https://doi.org/10.1093/geroni/igx029

Boot

Charness

Czaja

S. J.

Rogers

W. A.

(2020). Designing for older adults: Case studies, methods, and tools. CRC Press.

Borg

Boulet

Smith

Bragge

(2019). Digital inclusion & health communication: A rapid review of literature. Health Communication, 34(11), 1320–1328. https://doi.org/10.1080/10410236.2018.1485077

Brandt

Spencer

Folstein

(1988). The telephone interview for cognitive status. Cognitive and Behavioral Neurology, 1(2), 111–117.

Charness

Kelley

C. L.

Bosman

E. A.

Mottram

(2001). Word-processing training and retraining: effects of adult age, experience, and interface. Psychology and Aging, 16(1), 110–127. https://doi.org/10.1037/0882-7974.16.1.110

Cook

S. E.

Marsiske

McCoy

K. J.

(2009). The use of the Modified Telephone Interview for Cognitive Status (TICS-M) in the detection of amnestic mild cognitive impairment. Journal of Geriatric Psychiatry and Neurology, 22(2), 103–109. https://doi.org/10.1177/0891988708328214

Cotten

S. R.

Anderson

W. A.

McCullough

B. M.

(2013). Impact of internet use on loneliness and contact with others among older adults: Cross-sectional analysis. Journal of Medical Internet Research, 15(2), Article e39. https://doi.org/10.2196/jmir.2306

10.

Czaja

S. J.

Boot

W. R.

Charness

A Rogers

Sharit

Fisk

A. D.

Lee

C. C.

Nair

S. N.

(2015). The personalized reminder information and social management system (PRISM) trial: Rationale, methods and baseline characteristics. Contemporary Clinical Trials, 40, 35–46. https://doi.org/10.1016/j.cct.2014.11.004

11.

Czaja

S. J.

Boot

W. R.

Charness

Rogers

W. A.

Sharit

(2018). Improving Social support for older adults through technology: Findings from the PRISM randomized controlled trial. The Gerontologist, 58(3), 467–477. https://doi.org/10.1093/geront/gnw249

12.

Czaja

S. J.

Kallestrup

Harvey

P. D.

(2020). Evaluation of a novel technology-based program designed to assess and train everyday skills in older adults. Innovation in Aging, 4(6), igaa052. https://doi.org/10.1093/geroni/igaa052

13.

Davis

F. D.

(1985). A technology acceptance model for empirically testing new end-user information systems: Theory and results. Doctoral dissertation, Massachusetts Institute of Technology.

14.

Davis

F. D.

(1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13(3), 319–340. https://doi.org/10.2307/249008

15.

Delello

J. A.

McWhorter

R. R.

(2017). Reducing the digital divide: Connecting older adults to iPad technology. Journal of Applied Gerontology, 36(1), 3–28. https://doi.org/10.1177/0733464815589985

16.

Demiris

Thompson

H. J.

Lazar

Lin

S.-Y.

(2016). Evaluation of a digital companion for older adults with mild cognitive impairment. AMIA Annual Symposium Proceedings, Chicago, IL, USA, November 12-16, 2016.

17.

Dequanter

Gorus

Van Laere

De Witte

Verté

Steenhout

Fobelets

Buyl

(2022). Internet use and cognitive frailty in older adults: A large-scale multidimensional approach. European Journal of Ageing, 19(4), 1135–1144. https://doi.org/10.1007/s10433-022-00686-2

18.

Fankhauser

Maercker

Forstmeier

(2017). Social network and cognitive functioning in old age. Zeitschrift fur Gerontologie und Geriatrie, 50(2), 123–131. https://doi.org/10.1007/s00391-016-1178-y

19.

Faverio

(2022). Share of those 65 and older who are tech users has grown in the past decade. Pew Research Center. Retrieved August 16, 2022 from.https://www.pewresearch.org/fact-tank/2022/01/13/share-of-those-65-and-older-who-are-tech-users-has-grown-in-the-past-decade/

20.

Feise

R. J.

(2002). Do multiple outcome measures require p-value adjustment? BMC Medical Research Methodology, 2(8), 1–4. https://doi.org/10.1186/1471-2288-2-8

21.

Folstein

M. F.

Folstein

S. E.

McHugh

P. R.

(1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6

22.

Francis

Ball

Kadylak

Cotten

S. R.

(2019). Aging in the digital age: Conceptualizing technology adoption and digital inequalities. In Ageing and digital technology (pp. 35–49). Springer.

23.

Gadbois

E. A.

Jimenez

Brazier

J. F.

Davoodi

N. M.

Nunn

A. S.

Mills

W. L.

Dosa

Thomas

K. S.

(2022). Findings from talking tech: A technology training pilot intervention to reduce loneliness and social isolation among homebound older adults. Innovation in Aging, 6(5), igac040. https://doi.org/10.1093/geroni/igac040

24.

Zhu

McConnell

E. S.

(2018). Technology-based cognitive training and rehabilitation interventions for individuals with mild cognitive impairment: A systematic review. BMC Geriatrics, 18(1), 1–19. https://doi.org/10.1186/s12877-018-0893-1

25.

Hamer

Stamatakis

(2014). Prospective study of sedentary behavior, risk of depression, and cognitive impairment. Medicine & Science in Sports & Exercise, 46(4), 718–723. https://doi.org/10.1249/MSS.0000000000000156

26.

Hargittai

Piper

A. M.

Morris

M. R.

(2019). From internet access to internet skills: Digital inequality among older adults. Universal Access in the Information Society, 18(4), 881–890. https://doi.org/10.1007/s10209-018-0617-5

27.

Hartanto

Yong

J. C.

Toh

W. X.

Lee

S. T.

Tng

G. Y.

Tov

(2020). Cognitive, social, emotional, and subjective health benefits of computer use in adults: A 9-year longitudinal study from the midlife in the United States (MIDUS). Computers in Human Behavior, 104, Article 106179. https://doi.org/10.1016/j.chb.2019.106179

28.

Hawthorne

(2006). Measuring social isolation in older adults: Development and initial validation of the friendship scale. Social Indicators Research, 77(3), 521–548. https://doi.org/10.1007/s11205-005-7746-y

29.

Hertzog

Kramer

A.F.

Wilson

R.S.

Lindenberger

(2008). Enrichment effects on adult cognitive development: can the functional capacity of older adults be preserved and enhanced? Psychological Science in the Public Interest, 9(1), 1–65. https://doi.org/10.1111/j.1539-6053.2009.01034.x

30.

Holt-Lunstad

(2017). The potential public health relevance of social isolation and loneliness: Prevalence, epidemiology, and risk factors. Public Policy & Aging Report, 27(4), 127–130. https://doi.org/10.1093/ppar/prx030

31.

Hülür

Macdonald

(2020). Rethinking social relationships in old age: Digitalization and the social lives of older adults. American Psychologist, 75(4), 554–566. https://doi.org/10.1037/amp0000604

32.

Jay

G. M.

Willis

S. L.

(1992). Influence of direct computer experience on older adults' attitudes toward computers. Journal of Gerontology, 47(4), P250–P257. https://doi.org/10.1093/geronj/47.4.p250

33.

Jeste

D. V.

Lee

E. E.

Cacioppo

(2020). Battling the modern behavioral epidemic of loneliness: Suggestions for research and interventions. JAMA Psychiatry, 77(6), 553–554. https://doi.org/10.1001/jamapsychiatry.2020.0027

34.

Jun

H. J.

Kim

M.-Y.

(2017). What accounts for the relationship between internet use and suicidal ideation of Korean older adults? A mediation analysis. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 72(5), 846–855. https://doi.org/10.1093/geronb/gbw163

35.

Jung

A.-R.

Kim

Park

E.-A.

(2021). Cognitive intervention using information and communication technology for older adults with mild cognitive impairment: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18(21), Article 11535. https://doi.org/10.3390/ijerph182111535

36.

Knopman

D. S.

Roberts

R. O.

Geda

Y. E.

Pankratz

V. S.

Christianson

T. J.

Petersen

R. C.

Rocca

W. A.

(2010). Validation of the telephone interview for cognitive status-modified in subjects with normal cognition, mild cognitive impairment, or dementia. Neuroepidemiology, 34(1), 34–42. https://doi.org/10.1159/000255464

37.

Kotwal

A. A.

Kim

Waite

Dale

(2016). Social function and cognitive status: Results from a US nationally representative survey of older adults. Journal of General Internal Medicine, 31(8), 854–862. https://doi.org/10.1007/s11606-016-3696-0

38.

Lacruz

Emeny

Bickel

Linkohr

Ladwig

(2013). Feasibility, internal consistency and covariates of TICS-m (telephone interview for cognitive status-modified) in a population-based sample: Findings from the KORA-Age study. International Journal of Geriatric Psychiatry, 28(9), 971–978. https://doi.org/10.1002/gps.3916

39.

Lam

J. C.

Lee

M. K.

(2006). Digital inclusiveness--Longitudinal study of Internet adoption by older adults. Journal of Management Information Systems, 22(4), 177–206. https://doi.org/10.2753/MIS0742-1222220407

40.

Larner

A. J.

(2017). MMSE variants and subscores. In Cognitive screening instruments (pp. 49–66). Springer.

41.

Leone

Lim

J. S. L.

Stern

Charles

Black

Baecker

(2018). Communication technology adoption among older adult veterans: The interplay of social and cognitive factors. Aging & Mental Health, 22(12), 1666–1677. https://doi.org/10.1080/13607863.2017.1381946

42.

Yue

Xiao

(2022). Association between internet use, cognitive function, and globus pallidus volumes: A study among the elderly in Chinese communities. Frontiers in Public Health, 10, Article 886974. https://doi.org/10.3389/fpubh.2022.886974

43.

Lifshitz

Nimrod

Bachner

Y. G.

(2018). Internet use and well-being in later life: A functional approach. Aging & Mental Health, 22(1), 85–91. https://doi.org/10.1080/13607863.2016.1232370

44.

Livingston

(2019). On average, older adults spend over half their waking hours alone. Pew Research Center. Retrieved August 16, 2022 from.https://www.pewresearch.org/fact-tank/2019/07/03/on-average-older-adults-spend-over-half-their-waking-hours-alone/

45.

Lydon

E. A.

Nguyen

L. T.

Nie

Rogers

W. A.

Mudar

R. A.

(2022). An integrative framework to guide social engagement interventions and technology design for persons with mild cognitive impairment. Frontiers in Public Health, 9, Article 750340. https://doi.org/10.3389/fpubh.2021.750340

46.

Moxley

Sharit

Czaja

S. J.

(2022). The factors influencing older adults’ decisions surrounding adoption of technology: Quantitative experimental study. JMIR Aging, 5(4), Article e39890. https://doi.org/10.2196/39890

47.

Mubarak

Suomi

(2022). Elderly forgotten? Digital exclusion in the information age and the rising grey digital divide. Inquiry, 59, Article 469580221096272. https://doi.org/10.1177/00469580221096272

48.

Murthy

(2023). Our epidemic of loneliness and isolation: The U.S. Surgeon’s general’s advisory on the healing effects of social connection and community. U. S. Department of Public Health Services. https://www.hhs.gov

49.

Parasuraman

Colby

C. L.

(2015). An updated and streamlined technology readiness index: TRI 2.0. Journal of Service Research, 18(1), 59–74. https://doi.org/10.1177/1094670514539730

50.

Perrin

Atske

(2021). 7% of Americans don’t use the internet. Who are they? Pew Research Center. Retrieved August 16, 2022 from.https://www.pewresearch.org/fact-tank/2021/04/02/7-of-americans-dont-use-the-internet-who-are-they/

51.

Radloff

L. S.

(1977). The CES-D scale a self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306

52.

Raina

K. D.

Rittenberger

J. C.

Holm

M. B.

Callaway

C. W.

(2015). Functional outcomes: One year after a cardiac arrest. BioMed Research International, 2015, Article 283608. https://doi.org/10.1155/2015/283608

53.

Roque

N. A.

Boot

W. R.

(2018). A new tool for assessing mobile device proficiency in older adults: The mobile device proficiency Questionnaire. Journal of Applied Gerontology, 37(2), 131–156. https://doi.org/10.1177/0733464816642582

54.

Roth

A. R.

(2020). Social networks and health in later life: A state of the literature. Sociology of Health & Illness, 42(7), 1642–1656. https://doi.org/10.1111/1467-9566.13155

55.

Rothman

K. J.

(1990). No adjustments are needed for multiple comparisons. Epidemiology, 1(1), 43–46. https://doi.org/10.1097/00001648-199001000-00010

56.

Russell

Peplau

L. A.

Cutrona

C. E.

(1980). The revised UCLA loneliness scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472–480. https://doi.org/10.1037/0022-3514.39.3.472

57.

Seifert

Cotten

S. R.

Xie

(2021). A double burden of exclusion? Digital and social exclusion of older adults in times of COVID-19. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 76(3), e99–e103. https://doi.org/10.1093/geronb/gbaa098

58.

Sherbourne

C. D.

Stewart

A. L.

(1991). The MOS social support survey. Social Science & Medicine, 32(6), 705–714. https://doi.org/10.1016/0277-9536(91)90150-B

59.

Szabo

Allen

Stephens

Alpass

(2019). Longitudinal analysis of the relationship between purposes of internet use and well-being among older adults. The Gerontologist, 59(1), 58–68. https://doi.org/10.1093/geront/gny036

60.

Venkatesh

Thong

J. Y.

(2016). Unified theory of acceptance and use of technology: A synthesis and the road ahead. Journal of the Association for Information Systems, 17(5), 328–376. https://doi.org/10.17705/1jais.00428

61.

Vogels

E. A.

(2021). Digital divide persists even as Americans with lower incomes make gains in tech adoption. Pew Research Center. Retrieved August 16, 2022 from. https://www.pewresearch.org/fact-tank/2021/06/22/digital-divide-persists-even-as-americans-with-lower-incomes-make-gains-in-tech-adoption/

62.

Wan

Lighthall

N. R.

Paulson

(2022). Subjective markers of successful aging and change in Internet use among older adults: The distinctive role of subjective health. Computers in Human Behavior, 127, Article 107064. https://doi.org/10.1016/j.chb.2021.107064

63.

Wang

Zhang

Feng

Wang

(2019). Does internet use affect levels of depression among older adults in China? A propensity score matching approach. BMC Public Health, 19(1), 1–10. https://doi.org/10.1186/s12889-019-7832-8

64.

Xue

Xiao

Luo

(2021). The effect of a game training intervention on cognitive functioning and depression symptoms in the elderly with mild cognitive impairment: A randomized controlled trial. International Journal of Methods in Psychiatric Research, 30(4), Article e1887. https://doi.org/10.1002/mpr.1887

65.

Zhou

(2022). Impact of internet use on cognitive decline in middle-aged and older adults in China: Longitudinal observational study. Journal of Medical Internet Research, 24(1), Article e25760. https://doi.org/10.2196/25760