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Information and communication technology (ICT) offers considerable potential for supporting older adults in managing their health, including chronic diseases. However, there are mixed opinions about the benefits and effectiveness of ICT interventions for older adults with chronic diseases.
We aim to map the use of ICT interventions in health care and identified barriers to and enablers of its use among older adults with chronic disease.
A scoping review was conducted using 5 databases (Ovid MEDLINE, Embase, Scopus, PsycINFO, and ProQuest) to identify eligible articles from January 2000 to July 2020. Publications incorporating the use of ICT interventions, otherwise known as eHealth, such as mobile health, telehealth and telemedicine, decision support systems, electronic health records, and remote monitoring in people aged ≥55 years with chronic diseases were included. We conducted a
Of the 1149 identified articles, 31 (2.7%; n=4185 participants) met the inclusion criteria. Of the 31 articles, 5 (16%) mentioned the use of various eHealth interventions. A range of technologies was reported, including mobile health (8/31, 26%), telehealth (7/31, 23%), electronic health record (2/31, 6%), and mixed ICT interventions (14/31, 45%). Various chronic diseases affecting older adults were identified, including congestive heart failure (9/31, 29%), diabetes (7/31, 23%), chronic respiratory disease (6/31, 19%), and mental health disorders (8/31, 26%). ICT interventions were all designed to help people self-manage chronic diseases and demonstrated positive effects. However, patient-related and health care provider–related challenges, in integrating ICT interventions in routine practice, were identified. Barriers to using ICT interventions in older adults included knowledge gaps, a lack of willingness to adopt new skills, and reluctance to use technologies. Implementation challenges related to ICT interventions such as slow internet connectivity and lack of an appropriate reimbursement policy were reported. Advantages of using ICT interventions include their nonpharmacological nature, provision of health education, encouragement for continued physical activity, and maintenance of a healthy diet. Participants reported that the use of ICT was a fun and effective way of increasing their motivation and supporting self-management tasks. It gave them reassurance and peace of mind by promoting a sense of security and reducing anxiety.
ICT interventions have the potential to support the care of older adults with chronic diseases. However, they have not been effectively integrated with routine health care. There is a need to improve awareness and education about ICT interventions among those who could benefit from them, including older adults, caregivers, and health care providers. More sustainable funding is required to promote the adoption of ICT interventions. We recommend involving clinicians and caregivers at the time of designing ICT interventions.
Chronic diseases represent a significant public health challenge worldwide and are the predominant cause of death among older adults [
Information and communication technology (ICT) has been used in several settings to help individuals diagnose, treat, and manage chronic diseases better [
The current high use of ICT among young people shows that ICT could be a future intervention model in health care, enhancing the number of people in need who are reached [
In this review, we aim to identify (1) the available ICT interventions that have been used for managing older adults with chronic diseases and (2) the barriers to and enablers of using ICT interventions among older adults with chronic diseases.
This scoping review was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews) guidelines [
A literature search was performed using 4 databases: Ovid MEDLINE, Embase, Scopus, and PsycINFO. We also used the ProQuest database to include eligible papers and proceedings published in association with computer science and technology conferences. We included articles and conference papers published from January 2000 to July 2020, which had full text in English and were peer reviewed. We selected the time frame of the past 2 decades to identify recent work undertaken on ICT interventions among older adults with chronic diseases. The population of older adults with chronic diseases could benefit from targeted health education interventions. We defined older adults as those ≥aged 55 years [
A total of 2 reviewers (SBZ and RKK) screened the titles and abstracts of the selected articles and identified duplicates. In cases of conflicting opinions regarding the eligibility of specific articles, the reviewers discussed their views with a third reviewer (SMSI) to reach a consensus. If inclusion was unclear from the title, the abstract was screened. Similarly, if inclusion was unclear from the abstract, the reviewer read the full text. We included original articles, all types of reviews, and conference papers (
Our definition of ICT interventions in health care, otherwise known as eHealth, includes the following: mHealth, electronic health records (EHRs), clinical decision support systems (CDSSs), telehealth and telemedicine, virtual reality in health care, and information technology systems used in health care settings. mHealth includes the use of mobile phones, mobile apps, PDAs, and PDA phones (eg, smartphones and handheld and ultraportable computers such as tablet devices) [
We use the following ICT terminology in this paper:
ICT device: refers to hardware only
ICT intervention: refers to a specific program of research or implementation of ICT (eg, computer, mobile phone or tablet apps, and telehealth)
We considered older adults living with chronic diseases, their caregivers or family members, and health care providers as end users of ICT interventions.
SBZ, RK, and SMSI developed a data extraction form based on the aims of this review. SBZ and RK extracted data on the article title, names of first authors, publication year, study types or methods, setting, sample size, findings or recommendations, and expected or experienced barriers for all selected articles. Outcomes related to the use of ICT interventions were presented as
Second, we described and identified various ICT interventions—mHealth, EHR and CDSS, telemedicine, and remote monitoring—that were used for older adults with chronic diseases. Third, we reviewed articles to identify challenges in using ICT interventions among older adults with chronic diseases. For example, factors such as lack of motivation, comorbidities, poor adherence to treatment following ICT interventions, and absence of prior experience in the operation of ICT devices for older adults were considered as challenges. Issues related to costs of implementation, infrastructure, data security, and delays in making a decision were considered in the implementation category. Finally, we conducted a strengths, weaknesses, opportunities, and threats (SWOT) [
A total of 1149 articles, including conference papers (863/1149, 75.12%), were identified. Of the 1149 articles, 44 (3.83%) were duplicates (
Flowchart of the literature search used for the selection of articles. This flowchart provides information regarding the various phases of the investigation, including the number of articles identified and the number included and excluded following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews) guidelines. ICT: information and communication technology.
The characteristics of the included articles are presented in
Characteristics of included articles.
Study | Country | Study design or type of article | ICTa |
Instrument | Sample or articles | Target condition | Findings or |
Limitations or challenges of ICT interventions |
Miguel et al, 2013 [ |
Australia | RCTb (6-month study period) | Telehealth intervention | Face-to-face interviews | 80 | COPDc |
The telehealth group had comparatively fewer hospital admissions and a reduced length of stay than the control group. |
Maintenance cost (high) |
Barbera et al, 2018 [ |
Finland, France, and the Netherlands | RCT | Internet-based approaches | N/Ad | 2725 | Dementia, CHFe, DMf, and dyslipidemia |
Participants in the intervention arm were motivated to access information, advice, and motivational support throughout the intervention. |
High cost and country-specific adaptation were major limitations |
Barron et al, 2014 [ |
United States | Qualitative | Patient portal (EHRg) | Cognitive walkthrough | 14 | COPD and CHF |
Patients with chronic diseases and caregivers were satisfied using the patient portal. |
Assistance required for portal use Medical terms (unfamiliar) |
Bhattarai et al, 2020 [ |
Australia | Qualitative | App for self-management of pain | Semistructured interviews | 6 | Arthritic pain |
Apps for self-management of pain were potentially valuable for older patients App’s content and usability features should be relevant to the users |
Apps were required to meet the user’s needs Pain self-management app might not be helpful if not designed to be used friendly |
Chang et al, 2017 [ |
Taiwan | Qualitative | Telehealth | Semistructured (technology acceptance model) | 18 | DM |
Participants with diabetes self-managed their disease with the help of telehealth |
Mixed feelings regarding dependence on others for telehealth related problem solving |
Coley et al, 2019 [ |
Finland, France, and the Netherlands | Mixed | eHealth intervention or internet counseling | Web-based questionnaire and semistructured interviews | 343 | CVDsh and diabetes |
Altruism and personal benefits were motivations for older adults’ use of telehealth Prevention of functional dependency on caregivers was a main underlying motivation |
Internet-based health information perceived as unreliable by older adults Specific practical advice and encouragement was required for making lifestyle changes |
Kim et al, 2019 [ |
United States | Mixed | Telehealth | Web-based surveys and in-depth interviews | 20 | Depression care |
Telehealth was perceived as useful for managing symptoms and reducing costs. |
Reimbursement and cost-related factors Patient home environment (not suitable) Agency-related characteristic (not well equipped) |
Zettel-Watson et al, 2016 [ |
United States | Cross-sectional- exploratory study | Web-based health management tools | Web-based survey | 169 | Chronic diseases |
Most users (89%) were satisfied with web-based health management tools Users were more likely to be younger, female, and married |
Privacy or security was a concern among participants Users were not adequately aware of the exact benefits of web-based health management tools |
Lee et al, 2016 [ |
United States | Pilot study | Android tablet with an installed app | A mobile-based health technology intervention | 18 | CVDs and CHF |
Knowledge of self-management (anticoagulation) significantly improved from baseline to follow-up Participants were satisfied with the simplicity of the app |
Some health care providers were not receptive to their patients using mHealthi apps Privacy and security of information was a concerned |
Mirza et al, 2008 [ |
New Zealand | Pilot study (qualitative nature) | mHealth initiative (through SMS text messaging) | Semistructured interviews | 18 | Diabetes and heart disease |
High acceptability and recognition of the advantages of mHealth Issues affecting mHealth adoption, such as social issues, technical issues, economic issues, clinical or organizational issues |
Patients’ access to their EHR was recommended by the health care providers Impaired abilities to cope with technology |
Radhakrishnan et al, 2016 [ |
United States | Qualitative | Telehealth | Semistructured interviews | 23 | Cardiac disease, pulmonary disease, and DM |
Positive impact on cost-effectiveness and patient-centered outcomes Home health management culture was important Establishment of patient–clinician and interprofessional communication was required |
Factors negatively affected the telehealth program: Financial challenges Technical issues Management and communication-related issues |
Nymberg et al, 2019 [ |
Sweden | Qualitative | eHealth (EMRj, telehealth, and mHealth) | Focus group interviews | 15 | Hypertension, diabetes, and COPD |
Mixed feelings toward eHealth by the older adults Participants reported dissatisfaction in accessing health care |
Lack of will, skills, self-trust, or mistrust in the new technology Organizational barriers (poor ITk systems) |
Rocha et al, 2019 [ |
N/A | Systematic review | mHealth | A systematic review of reviews and meta-analyses | 66 reviews | DM, mental illness, cancer, COPD, and CVDs |
mHealth interventions had positive effects on various health-related outcomes, including medication adherence No adverse impact of mHealth was identified |
More research-based evidence was recommended for the incorporation of mHealth in clinical practices |
Searcy et al, 2019 [ |
N/A | Narrative review | mHealth technologies | —l | — | CVDs |
mHealth interventions for older adults with cardiovascular disease yielded mixed results |
Physical limitations and cognitive challenges were identified as limitations |
Peek ST et al, 2014 [ |
N/A | Systematic review | Electronic technologies | — | 16 articles | Chronic diseases |
Apparent benefits of using mHealth were recommended for widespread acceptance |
Lack of security in using mHealth was a concern |
Vollenbroek-Hutten et al, 2017 [ |
N/A | Narrative review | Various ICT platforms | — | 673 | Chronic pain, COPD |
Patients were satisfied with ICT-supported services |
Real-time contact and safe monitoring of patients in an emergency was challenging |
Wildenbos et al, 2018 [ |
N/A | Scoping review | mHealth | Framework analysis | — | Chronic diseases |
A total of 4 critical categories of aging barriers influencing usability of mHealth were cognition, motivation, physical ability, and perception |
Obstacles related to cognitive and physical ability to use mHealth was difficult for older adults to overcome |
Blass et al, 2006 [ |
United States | Narrative | Telehealth | Ethics and public policy (ethical challenges) | — | Physical or psychiatric illness |
Ethical challenges with homebound older patients were unique because of patient characteristics and features of the treatment environment. |
Protecting the confidentiality of personal information of users could be challenging |
Bostrom et al, 2020 [ |
N/A | Narrative review | Various mHealth technology | mHealth cardiac rehabilitation | — | CVD, hypertension, arrhythmia, and CHF |
mHealth: cardiac rehabilitation represented a particularly attractive area compared with traditional barriers to facility-based cardiac rehabilitation Improved accessibility to patients unable to attend traditional cardiac rehabilitation |
Safety of mHealth-based cardiac rehabilitation Physical limitations (eyesight and fine motor skills) might limit use in older adults Hesitance from older adults to adopt technology |
Christensen et al, 2020 [ |
N/A | Systematic review | Video consultations | Different survey instruments | 21 studies | Mental health practice (unipolar depression) |
Video consultations were found to be a viable option for delivering mental health care Video consultations allowed patients to receive treatment at their home |
Incorrect diagnosis Required trained health care providers |
Gilbert et al, 2015 [ |
United States | Narrative | Gerontechnology: mHealth | Applications of gerontechnology by stakeholders | — | Chronic diseases |
A digital divide was developed between older adults and younger adults Gerontechnology was found to be an essential limb of mHealth unique to older adults |
Without focusing on user-centered design, it would be difficult to widen the accessibility and engagement of older adults in the long run |
Henriquez-Camacho et al, 2014 [ |
N/A | Narrative review | eHealth technologies | Problems related to age and technology | — | Chronic diseases |
eHealth technologies were found to have the potential to improve access to health care by empowering patients |
Difficulty in accessing eHealth care because of limited resources, lack of literacy, large geographical areas, and physical, cognitive, and visual impairment |
Harerimana et al, 2019 [ |
N/A | Systematic review | Telehealth interventions | Users’ perceptions of a telehealth intervention | 13 articles | Chronic diseases |
Use of telehealth reduced emergency visits, hospital admissions, and depressive symptoms and improved cognitive functioning of the patients |
Obstacles for using telehealth were levels of education, cognitive function, living arrangement, and negative experience with the clinics |
Jimison et al, 2008 [ |
N/A | Narrative review | Health IT | Barriers and drivers to the use of health IT | 129 articles | Chronic diseases |
Rapid and frequent interactions from a clinician improved use and user satisfaction |
It was critical that data entry does not feel cumbersome and that the intervention fit into the user’s daily routine. |
Matthew-Maich et al, 2016 [ |
N/A | Scoping review | mHealth | Designing, implementing, and evaluating mHealth technologies | 42 articles | Chronic diseases |
The implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. |
A user-centered and interdisciplinary approach is imperative to enhance the feasibility and acceptability of mHealth innovations |
D’Haeseleer et al, 2019 [ |
Italy | Conference paper | Various ICT platforms for self-monitoring services | Focus group interview | 12 | Chronic diseases |
The skills to use computers were heterogeneous among the older adults They perceived the use of health technologies as a threat to social interaction |
Health technologies are not ready for adoption by older adults yet, and further research on making them more accessible is required |
Hosseinpour et al, 2019 [ |
Iran | Conference paper | Telecare | Medical records | 38 | Acute coronary syndrome |
An innovative telecare system based on artificial intelligence is presented for the early diagnosis of acute cardiac syndrome |
Improving the accuracy of the telecare system by using real-time information of users was challenging |
Lorenz et al, 2007 [ |
Germany | Conference paper | mHealth | Semistructured interviews | 8 | Chronic diseases |
Older adults prefer the advanced interface, characterized by displays of graphical symbols and animations, of devices They also preferred the basic interface with simple navigation over 2 different screens |
Participants preferred a device like the shape of a wristwatch, equipped with an unobtrusive system It was challenging to develop a tool for all such older versus younger patients and persons with computer experience versus no computer experience instances |
Pikna et al, 2018 [ |
Slovakia | Conference paper | ICT | Semistructured interviews | 5 | Chronic diseases |
Older adults usually use a mobile phone or a computer to share their experiences with others on different social networks |
The use of ICT can be a difficult challenge for seniors. |
Termeh et al, 2015 [ |
Iran | Conference paper | Smart-watches and sensors | Implementation of a U-Healthm system | — | Heart failure and arterial fibrillation |
U-Health approach is relatively low cost, can be implemented using simple equipment, and does not limit the movement of the patient. |
To get the notification patient has to have the watch on his or her wrist. |
Wang et al, 2018 [ |
United States | Conference paper | ICT | Semistructured interviews | 12 | Chronic diseases |
Older adults were positively influenced for using new technologies |
Difficulty in accessing ICT care due to limited resources and lack of literacy |
aICT: information and communication technology.
bRCT: randomized controlled trial.
cCOPD: chronic obstructive pulmonary disorder.
dN/A: not applicable.
eCHF: chronic heart failure.
fDM: diabetes mellitus.
gEHR: electronic health record.
hCVD: cardiovascular disease.
imHealth: mobile health.
jEMR: electronic medical record.
kIT: information technology.
lNot available.
mU-Health: ubiquitous health.
Multilayered donut chart shows the distribution of information and communication technology interventions used in health care. This figure shows various information and communication technology interventions that have been primarily described in the included studies or reviews in our scoping review. The total number of studies or reviews that mentioned various information and communication technology interventions is included in the bracket. mHealth: mobile health.
In total, the systematic reviews used in the current synthesis included 122 independent studies. We did not include studies already reported in the systematic reviews as individual studies to avoid duplication. Clinical trial intervention studies (RCTs and non-RCTs) were conducted in Finland, France, the Netherlands [
All articles provided evidence that ICT interventions are beneficial for health care among older adults with chronic diseases (
All the included articles reported a positive outcome for supporting the management of chronic diseases such as CVDs (eg, chronic heart failure, atrial fibrillation, and hypertension) [
In many cases, identified in 48% (15/31) of articles, participants reported that the use of an ICT intervention was a fun or effective way for improving health [
One of the biggest advantages of ICT interventions that was identified was their nonpharmacological nature [
The most common limiting factor, identified in 35% (11/31) of articles, was the lack of confidence in computer skills [
Only a few weaknesses were reported for health care provider–related factors. Health care providers reported that some older adults with chronic diseases were dependent on family members or friends for using their ICT devices [
The authors of 58% (18/31) of articles reported that ICT interventions supported older adults in maintaining regular medical checkups [
A range of operational factors was identified in relation to the use of hardware and software related to ICT interventions. Most of the investigators reported that the local context should be considered during the development of an ICT intervention [
In 48% (15/31) of articles, providers reported that they were satisfied that the ICT interventions allowed them to give special care to older adults with cognitive or sensory dysfunction [
The authors of 32% (10/31) of articles reported that some older adults had hearing and sight impairment and that these disabilities restricted communication with health care providers [
The authors of 23% (7/31) of the articles reported that providers were influential in motivating their patients to use or stop the use of ICT interventions [
Overall, findings from this scoping review highlight the potential benefit of ICT interventions or eHealth (eg, mHealth and mobile apps, EHR, remote monitoring, CDSS, and telemedicine) for supporting older adults in self-managing chronic diseases. The review highlighted a range of operational and technical barriers to using these ICT interventions for older adults. Our review highlighted age-related barriers to using ICT interventions, including cognition, motivation, physical limitations (eyesight and fine motor skills), and perception, which limited the use of ICT interventions among older adults with chronic diseases. In this case, personalized learning may meet the unique needs, interests, and capacities of individual users to mitigate these limitations [
Our results indicate that some older adults with chronic diseases might have reservations when it comes to engaging with ICT interventions. We found operational and technical challenges, including a lack of willingness to adopt new skills, poor confidence, and the lack of necessary skills to operate ICT devices. These findings are consistent with the results of other studies where older people expressed no interest in using novel technology and struggled to think of the need for such an application in their own lives [
We found strong motivation and desire to use ICT interventions among older adults with chronic diseases because of the nonpharmacological nature of the intervention. Self-management of chronic diseases includes the maintenance of a healthy lifestyle and adherence to medication. However, older adults seem to require specific motivation to make practical changes, such as eating a healthy diet and being physically active, even if they are already aware of their value [
It is imperative to understand the duration that people require to achieve a cost-effective outcome from ICT interventions. Findings from this scoping review suggest that older adults living with chronic diseases and caregivers were unwilling to pay for the use of ICT interventions, although they were happy with the service. Most participants only offered to pay partially. An explanation for this result is that all participants in the studies we reviewed were from high-income countries and frequently reported the lack of an appropriate insurance scheme and reimbursement for procuring devices required for ICT interventions. Without addressing the payment model, it will be challenging to ensure the proper use of ICT interventions in health care, even if older adults desire to use them. Chen and Chan [
In addition to the financial factors discussed above, this review highlights workload as an additional determinant of the adoption of ICT interventions. Managing life-threatening events, such as arrhythmia or heart attack, requires an immediate response from health care providers, and such a rapid response can be challenging to execute in many places, particularly in hard-to-reach areas. Failure to react to patients immediately may exacerbate the health risks of older adults with chronic diseases and render health care providers susceptible to accusations of negligence [
Future app developers should consider involving end users in the design and development process for ICT interventions. We reported that clinicians’ involvement in the recruitment process appeared to influence the decision of participants to take part in the trials or studies. Hence, their involvement will be crucial for motivating patients to use ICT interventions. The authors also point out the necessity of ensuring that health care providers are encouraged and committed to recommending ICT interventions for their patients [
Management of chronic diseases may require the engagement of multiple health care service providers [
There are opportunities for implementing ICT interventions in LMICs to support the care of older adults with chronic diseases. Approximately 6.5 billion people reside in LMICs, and the proportion of older adults within this population will increase in the near future in these countries [
To the best of our knowledge, this is the first review of its type to use the SWOT framework to identify strengths, weaknesses, opportunities, and threats for the use of ICT interventions to support the care of older adults with chronic diseases. A potential limitation of our approach is that we did not consult external experts during the review process. Nevertheless, by conducting a scoping review on this topic, we have defined the nature, extent, and range of research activities on ICT interventions for older adults with chronic diseases. Although we searched the literature exhaustively using 4 academic databases, in addition to ProQuest, there is a possibility that we missed some important studies. In this scoping review, we focused on providing an overview of the available research evidence on the use of ICT interventions in older adults with chronic diseases. Therefore, we included a good range of original studies, systematic reviews, and conference papers to help answer our research question. Importantly, none of the studies included in these reviews overlapped. We did not perform a critical appraisal of the literature, which was beyond the scope of our objectives (PRISMA-ScR checklist is given in
ICT interventions might help support the care of older adults with chronic diseases by increasing adherence to treatment and healthy lifestyles. However, the incorporation of ICT interventions into medical practice is still challenging. The involvement of clinicians is crucial for motivating people with chronic diseases to adopt ICT interventions to support self-management. There is a need to improve awareness and training in the available and effective ICT interventions among older adults and health care providers. Widespread implementation of ICT interventions will also require more sustainable approaches to funding and reimbursement. We recommend involving clinicians and caregivers when designing ICT interventions and integrating them into routine medical care.
Search strategies for Ovid MEDLINE, Embase, Scopus, and PsycInfo databases.
Framework analysis of strengths, weaknesses, opportunities, and threats on the use of information and communication technology in health care among older adults.
List of barriers to and challenges for the use of information and communication technology.
PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist.
clinical decision support system
chronic obstructive pulmonary disorder
cardiovascular disease
electronic health record
information and communication technology
low- to middle-income country
mobile health
Preferred Reporting Items for Systematic Reviews and Meta-Analysis
randomized controlled trial
strengths, weaknesses, opportunities, and threats
The authors are grateful to Zubair Ahmed Ratan, Mulugeta Birhanu, Lana Coleman, and Rajshree Thapa for their help in preparing the manuscript. SBZ received a scholarship from the Australian Government Research Training Program to support his academic career. SMSI is funded by the National Heart Foundation of Australia (102112) and the National Health and Medical Research Council Emerging Leadership Fellowship (GNT1195406).
SBZ, RGE, and SMSI conceived and designed the review. SBZ, RKK, and SMSI performed the literature searches and analyzed the data. SBZ, AGT, RGE, RKK, RM, and SMSI wrote the paper.
RGE reports grants from the National Health and Medical Research Council (Australia) and the National Heart Foundation of Australia outside the submitted work. RGE has also received consulting fees from Medtronic Australasia in relation to work other than that described in this manuscript. AGT reports grants from Monash University during the conduct of the study and grants from the National Health and Medical Research Council (Australia) outside the submitted work.