Health Information Technology and Older Adults

Background and Purpose: Many people suffer from chronic disease; however, incidence of chronic condition and comorbity increases with age.  Although social workers regularly engage with chronically ill older adults, they are not noticeably involved with the research and development of chronic disease management.  As such, with the recent expansion of health information technologies (HIT), the efficacy of technology-based chronic disease management is not well established for marginalized populations, specifically older adults.  Informed by theories of self-management, human development, and technology design, this research investigated lifespan differences of technology engagement, self-management processes, and health outcomes of a specific HIT intervention, web-based chronic disease self-management.

Methods: This study involves a sub-analysis of data from a randomized control trial of a HIT diabetes specific web-based self-management intervention (n=462). Following a sequential mixed methods design, this study used discriminant function analysis, survival analysis, and multivariate analysis of covariance.  Based on the quantitative results, a theoretically driven content analysis of five focus groups with 40 older intervention participants followed.  The quantitative and qualitative data were then then mixed using merging and expansion techniques for overall interpretation. 

Results: Older adults used a computer less frequently (X²(5) = 14.09, p < .01) and were less likely to participate in the HIT web-based self-management intervention trial (Λ = .94, X²(3, N=2,604) = 168.22, p < .001) because they were not interested or lacked internet access.  Negative perceptions about technology were identified by older focus group participants, indicating that older adults may not have the interest or access to participate in HIT interventions.  However, once enrolled, technology utilization did not differ by age (λ, F(2,328) = .72, p = .486, partial ƞ² = .004, n.s.), and older participants were found to use technologies that were user-friendly, entertaining, and simplified everyday tasks.  Older participants were healthier than younger participants, had superior medication adherence (r = .249, p <.001), yet self-monitoring was lower among older participants (F(1,255) = 4.13, p < .05, partial ƞ² = .016), indicating the need for improved tools for activities of interest to older adults, specifically healthful eating.  Although biopsychosocial outcomes did not differ by age, with the exception of increased use of supportive resources among older intervention participants (F(1,363) = 4.57, p < .01, partial ƞ² = .025), the inclusion of subjective outcomes relevant to older adults was highlighted by qualitative findings.

Conclusions: With a rich history of promoting healthcare services and improving public health conditions, social workers have the unique knowledge and skills to assist in the management of chronic disease among older adults, particularly when combined with HIT.  It is time for social work to reemerge in the research and development literature of chronic disease management.  Without examining issues important to the social work profession, the impacts of chronic disease prevention and treatment on vulnerable populations will continually be disregarded.  Due to social work’s distinctive understanding of aging issues and digital disparities, social workers must take a leadership role in the evaluation, design, and implementation of HIT for older adults.