BackgroundFalls and fall-related injuries are a serious public health issue. Exercise programs can effectively reduce fall risk in older people. The iStoppFalls project developed an Information and Communication Technology-based system to deliver an unsupervised exercise program in older people’s homes. The primary aims of the iStoppFalls randomized controlled trial were to assess the feasibility (exercise adherence, acceptability and safety) of the intervention program and its effectiveness on common fall risk factors.MethodsA total of 153 community-dwelling people aged 65+ years took part in this international, multicentre, randomized controlled trial. Intervention group participants conducted the exercise program for 16 weeks, with a recommended duration of 120 min/week for balance exergames and 60 min/week for strength exercises. All intervention and control participants received educational material including advice on a healthy lifestyle and fall prevention. Assessments included physical and cognitive tests, and questionnaires for health, fear of falling, number of falls, quality of life and psychosocial outcomes.ResultsThe median total exercise duration was 11.7 h (IQR = 22.0) over the 16-week intervention period. There were no adverse events. Physiological fall risk (Physiological Profile Assessment, PPA) reduced significantly more in the intervention group compared to the control group (F1,127 = 4.54, p = 0.035). There was a significant three-way interaction for fall risk assessed by the PPA between the high-adherence (>90 min/week; n = 18, 25.4 %), low-adherence (<90 min/week; n = 53, 74.6 %) and control group (F2,125 = 3.12, n = 75, p = 0.044). Post hoc analysis revealed a significantly larger effect in favour of the high-adherence group compared to the control group for fall risk (p = 0.031), postural sway (p = 0.046), stepping reaction time (p = 0.041), executive functioning (p = 0.044), and quality of life (p for trend = 0.052).ConclusionsThe iStoppFalls exercise program reduced physiological fall risk in the study sample. Additional subgroup analyses revealed that intervention participants with better adherence also improved in postural sway, stepping reaction, and executive function.Trial registrationAustralian New Zealand Clinical Trials Registry Trial ID: ACTRN12614000096651International Standard Randomised Controlled Trial Number: ISRCTN15932647

The World Health Organization (WHO) strives to assist and inspire cities to become more “age-friendly”, and the fundamentals are included in the Global Age-Friendly Cities Guide. An age-friendly city enables residents to grow older actively within their families, neighbourhoods and civil society, and offers extensive opportunities for the participation of older people in the community. Over the decades, technology has become essential for contemporary and future societies, and even more imperative as the decades move on, given we are nearly in our third decade of the twenty-first century. Yet, technology is not explicitly considered in the 8-domain model by the WHO, which describes an age-friendly city. This paper discusses the gaps in the WHO’s age-friendly cities model in the field of technology and provides insights and recommendations for expansion of the model for application in the context of countries with a high human development index that wish to be fully age-friendly. This work is distinctive because of the proposed new age-friendly framework, and the work presented in this paper contributes to the fields of gerontology, geography urban and development, computer science, and gerontechnology.

Technology is entwined in 21st Century society, and within the lives of people across all ages. The Technology In Later Life (TILL) study is the first piece of work contributing to the impact, behavior, and perception of technology use, by adults aged ≥70 years, residing in rural and suburban areas. TILL is an international, multi-centred, multi-methods study investigating and conceptualizing how various technologies impact the lives of older adults; residing in urban and rural locations in the United Kingdom (UK) and Canada. This in-depth study recruited 37 participants via a multi-methods approach. Analysis of the findings ascertained two overarching themes: facilitators of technology use (i.e., sharing of information and feeling secure), and detractors of technology (i.e., feelings of apprehension of use). Proposed recommendations include promotion of technology from a strengths-based perspective focusing on positive opportunities technology to improve health and wellbeing, creating a peer support network to assist with learning of new technology, and the need to examine further how intergenerational relationships may be enhanced through the use of technology. The distinction of these themes narrates to the originality of this initial study and milieu of recruited participants, intersecting across the fields of gerontology, geography, social sciences, and gerontechnology.

BackgroundFalls are common in older adults and can result in serious injuries. Due to demographic changes, falls and related healthcare costs are likely to increase over the next years. Participation and motivation of older adults in fall prevention measures remain a challenge. The iStoppFalls project developed an information and communication technology (ICT)-based system for older adults to use at home in order to reduce common fall risk factors such as impaired balance and muscle weakness. The system aims at increasing older adults’ motivation to participate in ICT-based fall prevention measures. This article reports on usability, user-experience and user-acceptance aspects affecting the use of the iStoppFalls system by older adults.MethodsIn the course of a 16-week international multicenter study, 153 community-dwelling older adults aged 65+ participated in the iStoppFalls randomized controlled trial, of which half used the system in their home to exercise and assess their risk of falling. During the study, 60 participants completed questionnaires regarding the usability, user experience and user acceptance of the iStoppFalls system. Usability was measured with the System Usability Scale (SUS). For user experience the Physical Activity Enjoyment Scale (PACES) was applied. User acceptance was assessed with the Dynamic Acceptance Model for the Re-evaluation of Technologies (DART). To collect more detailed data on usability, user experience and user acceptance, additional qualitative interviews and observations were conducted with participants.ResultsParticipants evaluated the usability of the system with an overall score of 62 (Standard Deviation, SD 15.58) out of 100, which suggests good usability. Most users enjoyed the iStoppFalls games and assessments, as shown by the overall PACES score of 31 (SD 8.03). With a score of 0.87 (SD 0.26), user acceptance results showed that participants accepted the iStoppFalls system for use in their own home. Interview data suggested that certain factors such as motivation, complexity or graphical design were different for gender and age.ConclusionsThe results suggest that the iStoppFalls system has good usability, user experience and user acceptance. It will be important to take these along with factors such as motivation, gender and age into consideration when designing and further developing ICT-based fall prevention systems.

COVID-19 has impacted not only the health of citizens, but also the various factors that make up our society, living environments, and ecosystems. This pandemic has shown that future living will need to be agile and flexible to adapt to the various changes in needs of societal populations. Digital technology has played an integral role during COVID-19, assisting various sectors of the community, and demonstrating that smart cities can provide opportunities to respond to many future societal challenges. In the decades ahead, the rise in aging populations will be one of these challenges, and one in which the needs and requirements between demographic cohorts will vary greatly. Although we need to create future smart age-friendly ecosystems to meet these needs, technology still does not feature in the WHO eight domains of an age-friendly city. This paper extends upon Marston and van Hoof’s ‘Smart Age-friendly Ecosystem’ (SAfE) framework, and explores how digital technology, design hacking, and research approaches can be used to understand a smart age-friendly ecosystem in a post-pandemic society. By exploring a series of case studies and using real-life scenarios from the standpoint of COVID-19, we propose the ‘Concept of Age-friendly Smart Ecologies (CASE)’ framework. We provide an insight into a myriad of contemporary multi-disciplinary research, which are capable to initiate discussions and bring various actors together with a positive impact on future planning and development of age-friendly ecosystems. The strengths and limitations of this framework are outlined, with advantages evident in the opportunity for towns, regions/counties, provinces, and states to take an agile approach and work together in adopting and implement improvements for the greater benefits of residents and citizens.