Specific Aims:
- Describe older adults’ and their support persons’ perceptions of the usability and usefulness of VHAs;
- Describe the types of use and the frequency by which older adults and their support persons use VHAs over a period of 60 days;
- Explore older adults’ and support persons’ perceptions of current and new ways that VHAs could promote safe aging in place.
Background and Significance: Older adults in the U.S. prefer to remain in their own homes, a concept known as “aging in place” (Landers, et al., 2016). Harnessing emerging technology for the burgeoning population of adults with chronic conditions to safely age in place is critical to maintaining their independence and for balancing health and social care resources (Betts, Hill, & Gardner, 2017; Galambos, et al., 2017; Kim, Gollamudi, & Steinhubl, 2017). Technology facilitating aging in place for older adults exists for many uses, including social connectedness, safety, independent living, and entertainment (Holthe et al., 2018; Karki, Sallinen, & Kuusinen, 2015; Patomella, et al., 2018), but barriers to use persist. Technology use barriers include the age-related digital divide, cost, stigma, perceived lack of need for technology, concerns about privacy and trust, and general lack of technologic knowledge and aptitude (Kim, et al., 2017). Nevertheless, research findings suggest that older adults are interested in learning about and using technology to promote their independence, function, and ability to age in place (Holthe, et al., 2018; Patomella, et al, 2018). While current research suggests the usability of some technologies to aid in this process, such as smartphone apps and telehealth services, there is a paucity of research on emerging, commercially available technology, such as VHAs to promote aging in place (Karki, Sallinen, & Kuusinen, 2015; Holthe, et al., 2018). VHAs have a wide range of voice-activated capabilities allowing a single device to assist with functions of independent living, communication, and entertainment. Amazon Echo (hereafter referred to as “Alexa”) was selected as the VHA for this feasibility study because it has the majority of market share now and into the foreseeable future and, among voice-activated virtual home assistants, it has been rated as the easiest to use (emarketer Inc., 2018). This study provides a critical first step for gaining knowledge about potential benefits and challenges of using VHAs to facilitate aging in place among older adults.
Methods:
Design: Guided by the Unified Theory of Acceptance and Use of Technology (Venkatesh, Thong, & Xu, 2012), a mixed methods exploratory descriptive design will be used.
Sample: Inclusion criteria include adult participants, aged 70 years or older, who have at least one chronic condition, reside within 40 miles of the recruiting clinic, and have a support person who is willing to participate in the study who resides in a residence that is separate from the older adult, but also within 40 miles of the clinic. Exclusion criteria include cognitive impairment, severe hearing loss, inability to speak and/or read English, current use of a VHA by the older adult and/or their identified support person. A total of 5 dyads, 10 people—an older adult and their support person—will participate in this feasibility study.
Measures. Baseline measures include participant age, sex, race, ethnicity, educational level, and health-related measures (i.e., well-being, frailty, caregiver burden). Following 60 days of Alexa use, individual participants will be interviewed to obtain data about Alexa usability, usefulness, and ways that Alexa currently assists with aging in place, as well as ideas about ways in which Alexa could assist (i.e., new innovations) older adults who are aging in place. The Alexa app on the study-dedicated smart phone will enable the setup of each participant’s Alexa, and track the type and frequency by which participants use Alexa. The app automatically records participants’ commands to Alexa. For example, if the participant says, “Alexa, call Alice Jones,” the command is recorded on the app, and the research team can document the type of use as a phone call attempt. Importantly, only participants’ commands are recorded by the Alexa app. The phone conversation that follows the command is not recorded by the Alexa app.
Data Analysis: Consistent with the exploratory nature of this feasibility study, data analysis will be descriptive. Quantitative methods will be utilized to describe participants’ demographic and health-related characteristics. Descriptive statistics will be applied to describe the type and frequency by which participants used Alexa. Qualitative, low inference content analysis (Colorafi & Evans, 2016) is being completed to code interviews to determine participants’ perceptions about Alexa’s usability and usefulness and their ideas about current and new ways that Alexa can be employed to promote safe aging in place. Interviews of older adults and their support persons are being analyzed and coded separately, and will be compared to determine commonalities and divergent views.
Results: The feasibility study will be completed prior to the conference date and qualitative and quantitative data specific to each aim will be presented in poster format.
Conclusion: The population of older adults is expected to dramatically increase in the next twenty years (Joint Center for Housing Studies, 2016; Patomella, et al., 2018). Aging in place is associated with higher quality of life, lower cost, and less burden on federal resources (Landers, et al., 2016). Existing literature suggests that technology use can reduce feelings of isolation and increase safety and autonomy among older adults (Kim, et al., 2017). The ongoing study is consistent with recommendations to investigate emerging technology through feedback and insight from older adult populations and their support systems (Holthe, et al., 2018). Thus, findings will contribute knowledge about the usefulness of Alexa and other VHAs, generate information about improvements or innovations to VHAs that meet the specific needs of older adults, and provide preliminary data for further research that will implement more rigorous designs to evaluate the effects of this emerging technology.