A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VIII. DISCUSSIONS <s> The successful adoption of technology is becoming increasingly important to functional independence. The present article reports findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE) on the use of technology among communitydwelling adults. The sample included 1,204 individuals ranging in age from 18–91 years. All participants completed a battery that included measures of demographic characteristics, self-rated health, experience with technology, attitudes toward computers, and component cognitive abilities. Findings indicate that the older adults were less likely than younger adults to use technology in general, computers, and the World Wide Web. The results also indicate that computer anxiety, fluid intelligence, and crystallized intelligence were important predictors of the use of technology. The relationship between age and adoption of technology was mediated by cognitive abilities, computer self-efficacy, and computer anxiety. These findings are discussed in terms of training strategies to promote technology adoption. <s> BIB001 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VIII. DISCUSSIONS <s> The use of digital technologies is increasingly proposed in health and social care to address the aging population phenomenon but, in practice, the designers of these technologies are ill equipped to design for older people. We suggest participatory design as an approach to improving the quality of design for older people but, based on previous work and our own experiences, identify four central issues that participatory design approaches need to address. We describe an approach to early engagement in design with older people that address each of these issues and some of our experiences applying the approach in a variety of different design projects. We conclude by discussing some of the issues that have been highlighted when attempting apply this approach in different design contexts and the issues that have been raised when working with partners who are less committed to the idea of engaging with older adults in participatory design. <s> BIB002 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VIII. DISCUSSIONS <s> The introduction of the iPad and similar form-factor devices e.g. Samsung Galaxy Tab, Asus Eee Pad and Motorola Xoom has provided a unique opportunity for older adults to engage with mobile computing devices and platforms. Engagement with 'traditional' computing devices amongst older adults, including arguably mobile devices, such as laptop computers is low due to dexterity issues amongst this population Hertzum & Hornbaek, 2010. Whilst the iPad removes some of the traditional barriers to computer engagement, new barriers including weight and screen reflection are evident to an older user group. This paper provides an exploratory evaluation of how older adults in 11 UK care-home settings and the staff engaged in their care are using iPads to help improve communication, build physical social networks amongst residents, staff and family members, and map the most frequently used applications by an older population during a six-month pilot period. Results suggest that applications involving information searching for personally related and historical information were most valued by older adults. Further, older adults and care staff alike report mainly positive experiences of iPad use in care settings including the increased opportunities for social interaction and the enhancement of intergenerational communication. Additionally, the barriers to use e.g. device weight are often overcome by low-tech adaptations and adjustment when using the device. This paper argues that the portability and adaptive nature of the iPad combined with the increased social interaction afforded by device could increase quality of life in care settings. <s> BIB003 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VIII. DISCUSSIONS <s> Background: Reaction time, coordination, and cognition performance typically diminish in older adults, which may lead to gait impairments, falls, and injuries. Regular strength–balance exercises are highly recommended to reduce this problem and to improve health, well-being, and independence in old age. However, many older people face a lack of motivation in addition to other strong barriers to exercise. We developed ActiveLifestyle, an information technology (IT)-based system for active and healthy aging aiming at improving balance and strength. ActiveLifestyle is a training app that runs on a tablet and assists, monitors, and motivates older people to follow personalized training plans autonomously at home. Objective: The objectives were to (1) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people, (2) assess the impact of ActiveLifestyle on physical activity behavior change, and (3) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed. Methods: A total of 44 older adults followed personalized, 12-week strength and balance training plans. All participants performed the exercises autonomously at home. Questionnaires were used to assess the technological familiarity and stage of behavior change, as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle. Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study. Pretests and posttests were performed to evaluate gait speed of the participants before and after the study. Results: Participants were 75 years (SD 6), predominantly female (64%), held a trade or professional diploma (54%), and their past profession was in a sitting position (43%). Of the 44 participants who enrolled, 33 (75%) completed the study. The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength–balance exercises (median 6 on a 7-point Likert scale). Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan, as well as to change their behavior permanently toward a more physically active lifestyle. The exercises were effective to improve preferred and fast gait speed. Conclusions: ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength–balance exercises over 12 weeks and had low dropout rates. The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention. The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time. [J Med Internet Res 2013;15(8):e159] <s> BIB004
In this paper, we have individually reviewed tablet applications for each component of ''Successful Aging'' and summarized their limitations (Table 1 ). In addition, we have also highlighted the successes and challenges of tablet adoption among older adults. We found that older adults, in general, showed acceptance and satisfaction with the tablet technology and the studied applications, primarily because tablet applications were developed using an iterative user-centered design approach. Involving older adults in the design/development process bridges the gap between the target user (older adults) and the developer BIB002 , resulting in products that are perceived, by the target population, as being intrinsically useful BIB001 . Studies' focus on user-centered design process shows that currently this field is in its nascent stage. Researchers are still understanding older adults' tablet interactions and validating design choices for different types of tablet applications. These goals can be accomplished via short-term user studies with small sample sizes. However, to evaluate true impact and effectiveness, long-term studies with larger sample sizes are needed that can bring greater understanding around technology use starting from its adoption to its abandonment. Usually, there is an initial learning curve, which might be steeper for older adults who may be slow in adopting technology. Moreover, individuals tend to stop using technologies after a certain period of time because they are either bored or have mastered the focus area of the application  . Studies that do measure effectiveness are usually concerned with evaluating individual components of ''Successful Aging'' in isolation. For example, the study conducted for evaluating the effectiveness of ALICE  only studied its effect on medication adherence as it is a tablet-based medication management application. Although it is important to rigorously study application's impact on the area of focus, secondary outcomes should also be considered. For instance, the effect of social engagement could be considered as a secondary outcome for ALICE as the tablet itself is shown to increase interpersonal communication and promote social networking BIB003 . Similarly, ActiveLifestyle BIB004 , a tabletbased application for strength training, uses individual and group motivational strategies, and encourages group training that indirectly increase social engagement. However, the study does not evaluate this effect. Moreover, we did not find any studies that consider the synergistic effect of the different components, which is ultimately needed for ''Successful Aging''. Since different domains of ''Successful Aging'' are interlinked, it is important to understand whether improvement in one domain leads to improvement in another. For instance, medication non-adherence (poor management of chronic conditions) increases the risk for co-morbid chronic conditions, thereby resulting in a deterioration of physical health. This poor physical health often limits the individual's ability to perform daily activities which, in turn, sometimes restricts social engagement. The restricted mobility or social isolation increases risk for depression, thereby affecting one's cognitive ability. In fact, combination of medication adherence and healthy lifestyle (physical exercise and cognitive stimulation) will help reduce the risk for certain chronic conditions like diabetes and hypertension. Thus, it is required to build applications that integrates different domains (physical, cognitive, social, medication adherence) in one platform to truly achieve ''Successful Aging'' and to help the older adults stay independent as long as they can. However, it should be noted that in addition to being studied together, these individual applications should still be studied in isolation for evaluating the impact on the primary focus area.