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Using Mobile Health Technology to Support Health-related Quality of Life: From the Perspective of Older Adults with Cognitive Impairment
Blekinge Institute of Technology, Faculty of Engineering, Department of Health. (BTH Health Technology Research Lab)ORCID iD: 0000-0002-5135-0452
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The prevalence of cognitive impairment and illness increases with age. For older adults, maintaining or improving health-related quality of life (HRQoL) in the early stages of cognitive impairment is important to prevent consequences related to the progression of the condition. This thesis aims to identify factors affecting HRQoL and describe how mHealth technology can support HRQoL in older adults with cognitive impairment.

Four studies were conducted using quantitative and qualitative approaches. A cross-sectional design was used to identify factors affecting older adults’ HRQoL (Study I) and investigate the relationship between mHealth technology use and self-rated quality of life (QoL) (Study III). A phenomenographical design was used to describe variations in older adults’ perceptions of mHealth technology and its impact on HRQoL (Study II). A prospective longitudinal design was used to examine older adults’ HRQoL changes over time (Study IV).

Participants were selected from two longitudinal population studies using a purposive sampling strategy to include those aged 55 years and above with mild cognitive impairment or mild dementia. Data were obtained from questionnaires and semi-structured interviews. Data from the quantitative studies were analysed using statistical analysis, including descriptive and comparative analysis and regression analysis, while data from the qualitative study were examined using phenomenographical analysis in consecutive steps.

The results showed that most older adults experienced good HRQoL with regard to both physical and mental health. The likelihood of having good-to-excellent QoL increased with age and was higher among males and those with higher education levels. Those diagnosed with dementia reported poorer HRQoL. Factors associated with low HRQoL included dependency in activities of daily living, receiving informal care and feelings of loneliness and pain. The use of mHealth technology was perceived as supportive in maintaining social interactions and facilitating independent living. The technology literacy levels among the study sample varied significantly. Those who reported having moderate-to-high technical skills and using the internet regularly via mHealth technology had higher odds of experiencing good-to-excellent QoL. No significant changes were observed in the older adults’ HRQoL over time in relation to the non-use and use of a customized mHealth application.

The indicators of HRQoL are clinically relevant for the secondary prevention of dementia to help maintain good HRQoL in older adults with incipient cognitive impairment. The technology-related differences reflect the risk of digital exclusion. To improve preconditions for being digitally involved in society, societal initiatives that aim to empower the technology literacy level of older adults are needed.

Place, publisher, year, edition, pages
Karlskrona: Blekinge Tekniska Högskola, 2022.
Series
Blekinge Institute of Technology Doctoral Dissertation Series, ISSN 1653-2090 ; 2022:01
Keywords [en]
Aging, Cognitive Impairment, Cohort Studies, Dementia, Gerontechnology, Health-related Quality of Life, Independent Living, Mental Health, Mobile Health, Phenomenography, Quality of Life, Telemedicine
National Category
Nursing
Research subject
Applied Health Technology
Identifiers
URN: urn:nbn:se:bth-22553ISBN: 978-91-7295-435-9 (print)OAI: oai:DiVA.org:bth-22553DiVA, id: diva2:1626698
Public defence
2022-02-25, J1630, Valhallavägen 1, 371 41 Karlskrona, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2022-01-12 Created: 2022-01-11 Last updated: 2022-01-26Bibliographically approved
List of papers
1. Health-related quality of life and related factors among a sample of older people with cognitive impairment
Open this publication in new window or tab >>Health-related quality of life and related factors among a sample of older people with cognitive impairment
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2019 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 3, p. 849-859Article in journal (Refereed) Published
Abstract [en]

Aim: This study aimed to identify factors affecting health-related quality of life (HRQoL) of older adults with cognitive impairment and to describe the association of these factors with different components of HRQoL. Design: A cross-sectional, descriptive research design was used. Methods: Data were collected from 247 individuals aged 60 years and older from a Swedish longitudinal cohort study. The Short-Form Health Survey-12 (SF-12) and EuroQol (EQ-5D) were used to assess HRQoL. The data were analysed using descriptive and comparative statistics. Results: The present study identified several factors that influenced HRQoL of older adults with cognitive impairment. The results of a multiple logistic regression analysis revealed that the following factors were associated with physical and mental HRQoL: dependency in activities of daily living (ADL), receiving informal care and feelings of loneliness and pain. © 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Ltd, 2019
Keywords
ageing, cognitive impairment, EuroQol, health-related quality of life, Short-Form Health Survey-12
National Category
Nursing
Identifiers
urn:nbn:se:bth-18618 (URN)10.1002/nop2.265 (DOI)000476917700022 ()2-s2.0-85069794910 (Scopus ID)
Note

open access

Available from: 2019-09-10 Created: 2019-09-10 Last updated: 2022-01-11Bibliographically approved
2. Using Mobile Health and the Impact on Health-Related Quality of Life: Perceptions of Older Adults with Cognitive Impairment
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2020 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 8, article id 2650Article in journal (Refereed) Published
Abstract [en]

Digital health technologies such as mobile health (mHealth) are considered to have the potential to support the needs of older adults with cognitive impairment. However, the evidence for improving health with the use of mHealth applications is of limited quality. Few studies have reported on the consequences of technology use concerning the older adults' quality of life. The purpose of this study was to describe perceptions of mHealth and its impact on health-related quality of life (HRQoL) among older adults with cognitive impairment. The study was conducted using a qualitative design with a phenomenographic approach. A total of 18 older participants with cognitive impairment were interviewed. The interviews were analyzed in order to apply phenomenography in a home-care context. The results showed variations in the older adults' perceptions that were comprised within three categories of description; Require technology literacy, Maintain social interaction, and Facilitate independent living. In conclusion, the development and design of mHealth technologies need to be tailored based on older adults´ needs in order to be understood and perceived as useful in a home-care context. For mHealth to support HRQoL, healthcare should be provided in a way that encourages various forms of communication and interaction.

Place, publisher, year, edition, pages
MDPI, 2020
Keywords
aging, cognitive impairment, health technology use, health-related quality of life, phenomenography
National Category
Nursing
Identifiers
urn:nbn:se:bth-19423 (URN)10.3390/ijerph17082650 (DOI)000535744100035 ()32294911 (PubMedID)2-s2.0-85083407856 (Scopus ID)
Note

Open access

Available from: 2020-05-03 Created: 2020-05-03 Last updated: 2022-01-11Bibliographically approved
3. Associations Between Mobile Health Technology use and Self-rated Quality of Life: A Cross-sectional Study on Older Adults with Cognitive Impairment
Open this publication in new window or tab >>Associations Between Mobile Health Technology use and Self-rated Quality of Life: A Cross-sectional Study on Older Adults with Cognitive Impairment
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2021 (English)In: Gerontology and geriatric medicine, E-ISSN 2333-7214, Vol. 7Article in journal (Refereed) Published
Abstract [en]

Background: Quality of life (QoL) is affected even at early stages in older adults with cognitive impairment. The use of mobile health (mHealth) technology can offer support in daily life and improve the physical and mental health of older adults. However, a clarification of how mHealth technology can be used to support the QoL of older adults with cognitive impairment is needed. Objective: To investigate factors affecting mHealth technology use in relation to self-rated QoL among older adults with cognitive impairment. Methods: A cross-sectional research design was used to analyse mHealth technology use and QoL in 1,082 older participants. Baseline data were used from a multi-centered randomized controlled trial including QoL, measured by the Quality of Life in Alzheimer's Disease (QoL-AD) Scale, as the outcome variable. Data were analyzed using logistic regression models. Results: Having moderately or high technical skills in using mHealth technology and using the internet via mHealth technology on a daily or weekly basis was associated with good to excellent QoL in older adults with cognitive impairment. Conclusions: The variation in technical skills and internet use among the participants can be interpreted as an obstacle for mHealth technology to support QoL.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC, 2021
Keywords
aging, cognitive impairment, gerontechnology, mobile health, quality of life
National Category
Nursing Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:bth-21586 (URN)10.1177/23337214211018924 (DOI)000656404000001 ()34104685 (PubMedID)2-s2.0-85106937241 (Scopus ID)
Projects
SMART4MD
Funder
EU, Horizon 2020, 643399
Note

open access

Available from: 2021-06-10 Created: 2021-06-10 Last updated: 2022-01-11Bibliographically approved

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