Table 2.

Examples and Limitations of Using Technology for Interventions in Older Adults

Construct	Summary of current intervention techniques and limitations
Physical activity	Telephone delivery, web-based programs, smartphone applications, and virtual advisors can implement behavioral strategies from face-to-face interventions.35 Limited research has tested these approaches in older adults. Previous studies used feedback from participants to develop and test different phone apps and smartphone platforms for intervention delivery.36,37 Text messaging interventions increased PA in older adults.38 Furthermore, in a recent review of the literature, seven of eight in-home telephone-based interventions showed improvement in older adults, four of four home-based pedometer/accelerometer-based interventions provided evidence of effectiveness, and two of four web-based intervention studies showed effectiveness.39 In inactive older adults, a 3-month web-based PA intervention, which delivered monitoring and feedback by accelerometry and digital coaching, effectively increased PA and improved metabolic health.37 Studies using mHealth with minimal behavioral support are not as effective as those interventions that integrate mHealth with multiple behavioral change techniques; however, evidence from larger RCTs with older adults is needed.40
Posture/sitting	Several published pilot studies in older adults effectively reduced sitting time and used activPAL-derived feedback, with several larger RCTs underway including wearables and phone counseling.6,16–20 Jawbone UP is easy to use for older adults, and regular vibrations remind individuals to break up their sitting.41 Consumer wearables do not detect sitting accurately, as these devices focus on movement rather than posture.42,43 The activPAL device does not yet provide real-time feedback. Some apps are available (e.g., Rise & Recharge) but do not specifically target older adults.
Gait, balance, frailty, or mobility	Balance and gait can be improved using body motion sensors and virtual sensory feedback in adults with stroke, Parkinson disease, multiple sclerosis, and cerebral palsy and in those with age-related gait deficits.44 Various mHealth devices provide immediate biofeedback in visual, auditory, vibrotactile, or electrotactile formats. Previous research using motion capture with auditory biofeedback (using plantar force sensors) found an improvement in gait symmetry, speed, and balance in stroke survivors.45 Additionally, wearable sensors can improve static balance, dynamic balance, or both immediately after intervention or on follow-up.46 A tablet-based strength—balance training program that allowed monitoring of and assistance to autonomous-living older adults was more effective in improving gait and physical performance compared to a brochure-based program.47 Future studies need to assess gait during single tasks as well as dual-task conditions, specifically including both arithmetic and verbal fluency tasks, to fully measure gait characteristics as related to frailty. Furthermore, previous RCTs included older adult samples with balance disorders (Parkinson disease, diabetes with peripheral neuropathy, stroke)46; therefore, future RCTs need to include healthy older adults to further evaluate interventions targeting balance, gait, and mobility.
Falls	Previous research used virtual reality to increase physical activity and reduce falls risk48,49 (Wii and Kinetics games50). Intervention types mostly focus on reducing functional ability deficits, improving balance, and bolstering cognitive function to prevent falls. Participants may like using video games because of the immediate feedback and stimulating environment. Using video games at home can also reach a larger sector of the older populations (those who cannot go to medical centers to receive treatment). Few interventions have used smartphone apps to prevent falls, even though smartphones may be more popular than video consoles within the older adult population. The majority of pre-fall prevention interventions employ 3D technology and games to bolster evidence-based exercises focusing on intrinsic fall risk factors (i.e., functional ability deficits and balance impairments). Most are deployed within the home to increase adherence and reduce traveling costs.
Life space	Passively measured GPS is promising, but there are issues related to battery life and participants’ privacy concerns in having their locations revealed. Few interventions have explored using these methods to improve life space mobility, but feasibility studies show that older adults are amenable to using devices. 21,22,27,51,52
Eating and hydration	Interventions using technology to improve dietary intake and hydration are expanding. For hydration, watches will beep or signal fluid intake at intervals optimal for older adults based on age and physical condition. Another app enables shoppers to scan the barcode of food they intend to purchase or eat and receive immediate feedback regarding sodium levels, including suggestions for lower-sodium alternatives. Alternatively, logging food using spoken language utterances could be an easy way for older adults to keep track of food intake instead of relying on their memories. This utterance via the spoken language voice recording could be linked to food databases, and nutrient intakes could be calculated. A number of barriers specific to older adults make these types of interventions more challenging. For example, dementia, diminishing taste and smell, altered living conditions, or not having caregiver assistance make both dietary intake and collection of accurate information challenging for interventions targeting healthy eating.

PA, physical activity.