Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations (Preprint)

Abstract

BACKGROUND Digital health technologies have been proposed to support hospital to home transitions for older adults. The COVID-19 pandemic and associated physical distancing guidelines propelled a shift to digital health technologies. However, the characteristics of older adults who participated in digital health interventions to support hospital to home transitions remain unclear. This information is needed to assess whether current digital health technologies are generalizable to the needs of broader older adult populations. OBJECTIVE We conducted a rapid review of the existing literature to: i) identify the characteristics of the populations targeted by studies testing the implementation of digital health interventions that are designed to support hospital to home transitions, ii) identify the characteristics of the samples included within studies testing digital health interventions used to support hospital to home transitions, and iii) create recommendations for enhancing the diversity of samples within future digital health interventions. METHODS A rapid review methodology informed by Arksey and O’Malley’s (2005) scoping review guidelines was conducted. A search for peer-reviewed literature published between (2010-2021) on digital health solutions that support hospital to home transitions for older adults was conducted through MEDLINE, EMBASE and CINAHL. Data were analyzed using descriptive statistics and qualitative content analysis. The Sex-and Gender-Based Analysis Plus (SGBA+) lens theoretically guided the study design, analysis and interpretation. RESULTS 34 papers met inclusion criteria. Our findings indicate that many groups of older adults were excluded from these interventions and remain understudied. Specifically, the “oldest old” and those living with cognitive impairments were excluded from studies included in this review. In addition, very few studies described characteristics related to gender diversity, education, race, ethnicity and culture. No study commented on the sexual orientation of participants. CONCLUSIONS This is the first review, to our knowledge, that has mapped the literature focusing on the inclusion of older adults in digital hospital to home interventions. Findings suggest that the literature on digital health interventions tends to operationalize older adults as a homogenous group, ignoring the heterogeneity in older age definitions. Inconsistency in the literature surrounding the characteristics of included participants suggests a need for further study to understand better how digital technologies to support hospital to home transitions can be inclusive. CLINICALTRIAL N/A