Bridging the Technological Divide: Stigmas and Challenges With Technology in Digital Brain Health Studies of Older Adults

Abstract

The COVID-19 pandemic has increased adoption of remote assessments in clinical research. However, longstanding stereotypes persist regarding older adults' technology familiarity and their willingness to participate in technology-enabled remote studies. We examined the validity of these stereotypes using a novel technology familiarity assessment (n = 342) and with a critical evaluation of participation factors from an intensive smartphone study of cognition in older adults (n = 445). The technology assessment revealed that older age was strongly associated with less technology familiarity, less frequent engagement with technology, and higher difficulty ratings. Despite this, the majority (86.5%) of older adults elected to participate in the smartphone study and showed exceptional adherence (85.7%). Furthermore, among those enrolled, neither technology familiarity, knowledge, perceived difficulty, nor gender, race, or education were associated with adherence. These results suggest that while older adults remain significantly less familiar with technology than younger generations, with thoughtful study planning that emphasizes participant support and user-centered design, they are willing and capable participants in technology-enabled studies. And once enrolled, they are remarkably adherent.

Neuroscience from the comfort of your home: Repeated, self-administered wireless dry EEG measures brain function with high fidelity

“…These results are consistent with previous findings from McWilliams and colleagues who deployed the same dry EEG technology in a separate cohort of 89 healthy older adults and reported high adherence and usability scores (e.g., mean adherence of 82% and mean SUS score of 78.7) (52). Our compliance levels are also slightly higher than those observed in purely cognitive remote studies using smartphone for repeated testing [e.g., adherence of 85.7% (32)]. As discussed by Moore et al, it is likely that our older participants' high adherence rate is due to a combination of extrinsic factors including the ease-of-use of the technology, and intrinsic factors such as personal motivation (the older cohort self-referred into our study) (63).…”

“…No clear evidence of usability barrier in the older cohort was found as attested by the lack of differences in usability scores between the two groups. This result is in agreement with findings from Nicosia and colleagues who reported that, while older age is associated with less technology familiarity, older adults are willing and able to participate in technology-enabled studies (32). The high percentage of successful sessions in the older cohort also underlines that the ease-of-use of the platform was satisfactory and enabled populations who were not digital natives to use the system.…”

“…One challenge with repeated neurocognitive testing protocols is maintaining participant engagement over extended periods (25,26), as has been investigated more extensively in purely behavioral testing (27)(28)(29)(30)(31)(32). Neurocognitive tasks used in EEG research often require participants to respond to simple geometric stimuli presented on a uniform background, with deliberately little variation among trials over several minutes.…”

Unsupervised high-frequency smartphone-based cognitive assessments are reliable, valid, and feasible in older adults at risk for Alzheimer’s disease

“…Technology familiarity was assessed with a novel measure described in Nicosia et al (2021). Briefly, the assessment combined objective measurements of technology knowledge (technology-related icon recognition) and self-reported ratings of (1) the frequency with which they perform certain smartphone tasks and (2) how difficult it would be for them to perform various technology-related tasks.…”

“…demand characteristics, “white coat” testing effects), bolster sample size and diversity, and make participation more accessible and inclusive for individuals who may otherwise be unable to come into the laboratory or clinic. Indeed, interest in smartphone studies is growing, and several studies have demonstrated the feasibility and validity of smartphone-based assessments for use in older adults and individuals with preclinical AD (Güsten et al, 2021; Hassenstab et al, 2020; Lancaster et al, 2020; Mackin et al, 2018; Nicosia et al, 2021; Öhman et al, 2021; Papp et al, 2021; Wilks et al, 2021), as well as the potential for high-frequency in-home monitoring to substantially increase the statistical power of therapeutic trials (Dodge et al, 2015).…”