Examining Internet and eHealth Practices and Preferences: Survey Study of Australian Older Adults With Subjective Memory Complaints, Mild Cognitive Impairment, or Dementia

Haley M LaMonica, Amelia English, Ian B Hickie, Jerome Ip, Catriona Ireland, Stacey West, Tim Shaw, Loren Mowszowski, Nick Glozier, Shantel Duffy, Alice A Gibson, Sharon L Naismith, Haley M LaMonica, Amelia English, Ian B Hickie, Jerome Ip, Catriona Ireland, Stacey West, Tim Shaw, Loren Mowszowski, Nick Glozier, Shantel Duffy, Alice A Gibson, Sharon L Naismith

Abstract

Background: Interest in electronic health (eHealth) technologies to screen for and treat a variety of medical and mental health problems is growing exponentially. However, no studies to date have investigated the feasibility of using such e-tools for older adults with mild cognitive impairment (MCI) or dementia.

Objective: The objective of this study was to describe patterns of Internet use, as well as interest in and preferences for eHealth technologies among older adults with varying degrees of cognitive impairment.

Methods: A total of 221 participants (mean age=67.6 years) attending the Healthy Brain Ageing Clinic at the University of Sydney, a specialist mood and memory clinic for adults ≥50 years of age, underwent comprehensive clinical and neuropsychological assessment and completed a 20-item self-report survey investigating current technology use and interest in eHealth technologies. Descriptive statistics and Fisher exact tests were used to characterize the findings, including variability in the results based on demographic and diagnostic factors, with diagnoses including subjective cognitive impairment (SCI), MCI, and dementia.

Results: The sample comprised 27.6% (61/221) SCI, 62.0% (137/221) MCI, and 10.4% (23/221) dementia (mean Mini-Mental State Examination=28.2). The majority of participants reported using mobile phones (201/220, 91.4%) and computers (167/194, 86.1%) routinely, with most respondents having access to the Internet at home (204/220, 92.6%). Variability was evident in the use of computers, mobile phones, and health-related websites in relation to sociodemographic factors, with younger, employed respondents with higher levels of education being more likely to utilize these technologies. Whereas most respondents used email (196/217, 90.3%), the use of social media websites was relatively uncommon. The eHealth intervention of most interest to the broader sample was memory strategy training, with 82.7% (172/208) of participants reporting they would utilize this form of intervention. Preferences for other eHealth interventions varied in relation to educational level, with university-educated participants expressing greater interest in interventions related to mood (P=.01), socialization (P=.02), memory (P=.01), and computer-based exercises (P=.046). eHealth preferences also varied in association, with diagnosis for interventions targeting sleep (P=.01), nutrition (P=.004), vascular risk factors (P=.03), and memory (P=.02).

Conclusions: Technology use is pervasive among older adults with cognitive impairment, though variability was noted in relation to age, education, vocational status, and diagnosis. There is also significant interest in Web-based interventions targeting cognition and memory, as well as other risk factors for cognitive decline, highlighting the urgent need for the development, implementation, and study of eHealth technologies tailored specifically to older adults, including those with MCI and early dementia. Strategies to promote eHealth use among older adults who are retired or have lower levels of education will also need to be considered.

Keywords: Alzheimer disease; Internet; dementia; eHealth; mild cognitive impairment.

Conflict of interest statement

Conflicts of Interest: Professor Ian Hickie has been a Commissioner in Australia’s National Mental Health Commission since 2012. He is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC) University of Sydney. The BMC operates early-intervention youth services at Camperdown under contract to headspace. Professor Hickie has previously led community-based and pharmaceutical industry-supported (Wyeth, Eli Lily, Servier, Pfizer, and AstraZeneca) projects focused on the identification and better management of anxiety and depression. He is a member of the Medical Advisory Panel for Medibank Private, a Board Member of Psychosis Australia Trust, and a member of Veterans Mental Health Clinical Reference group. He is the Chief Scientific Advisor to, and an equity shareholder in, Innowell. Innowell has been formed by the University of Sydney and PwC to deliver the $30 million Australian Government–funded Project Synergy. Project Synergy is a 3-year program for the transformation of mental health services through the use of innovative technologies. No other disclosures to declare.

©Haley M LaMonica, Amelia English, Ian B Hickie, Jerome Ip, Catriona Ireland, Stacey West, Tim Shaw, Loren Mowszowski, Nick Glozier, Shantel Duffy, Alice A Gibson, Sharon L Naismith. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.10.2017.

Figures

Figure 1
Figure 1
Interest in electronic health (eHealth) technologies varies with diagnosis. Abbreviations: SCI: subjective cognitive impairment, MCI: mild cognitive impairment, ^eg, outings, public talks and seminars, groups, etc, and *eg, high blood pressure, cholesterol, etc.

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