The proportion of the global population aged above 60 years old is growing more rapidly than any other age group creating several socio-economic challenges. Finding strategies to preserve functional independence for as long as possible is a priority to reduce the burden on the healthcare sector and enhance quality-of-life for the older population. In 2015, the World Health Organization defined Healthy Ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age”. As such, Healthy Ageing places the individuals as active participants in managing their own health, focusing on the importance of healthy behaviors as strategies to preserve functional ability in older age. Telemedicine systems and services – often interchangeably referred to as telehealth or eHealth systems – concern the use of ICT in the prevention, diagnosis and/or treatment of diseases from a distance. For Active and Healthy Ageing, telemedicine services can provide support in monitoring, diagnosis and treatment in several life domains, such as physical and mental health, mobility, social connectedness, everyday activities and leisure.
The main aim of this Thesis is to explore how technology can be utilized in the support of Active and Healthy Ageing in daily life, by promoting physical activity and emotional wellbeing in everyday life.
In Chapter 1 we introduce the research on Active and Pleasant Ageing, which gives title to this PhD Thesis, as emerging in the overlapping area between three topics: Active & Healthy Ageing, physical activity and emotional wellbeing. The first topic was already introduced: Active & Healthy Ageing. The second topic is physical activity, one of the focal points in strategies to support Active & Healthy Ageing. Physical activity, referred in this work as the total of voluntary movement produced by skeletal muscles during everyday functioning, has well-established benefits for physical health and to preserve functional independence. Despite the well-known benefits of an active lifestyle for physical health, most older adults do not reach the recommended activity levels. When asked about the barriers to engage in regular physical activity, older adults mention poor health, but also provide reasons such as lack of interest, lack of time and not enjoying the activities. Within this Thesis, we look at approaches to promote physical activity in the daily lives of older adults to support Active and Pleasant Ageing. The third topic is emotional wellbeing, and concerns the presence of positive emotions (e.g. joy and calmness), the absence of negative emotions (e.g. sadness and anger), and satisfaction with life. Positive emotions are influenced by daily contexts and situations and are thus prone to fluctuations in daily life.
In Chapter 2 we present the results of a systematic review of the literature on the relation between positive emotions and functional ability of older adults living independently, including only empirical studies. There is solid evidence that being physically active plays an important role in the prevention of functional decline. But how do positive emotions contribute to the preservation, or decline, of these functional abilities? The results of the systematic review presented in this chapter suggest that there is evidence supporting a relation between functional ability and the intensity and frequency of experience of positive emotions, although the direction of this relation remains unclear. Particularly, there is some, but limited, evidence suggesting that more frequent experience of positive emotions relates to better functional status and to delay of functional decline. A cohesive conclusion could not be drawn from our review due to the limited number of studies meeting the inclusion criteria, as well as disparities among design methods and sample populations. Nevertheless, the results presented are in line with theories of positive psychology suggesting that frequent experience of positive emotions supports a variety of resilience resources, such as environmental mastery and social support, which might enhance the ability to adopt strategies to cope in moments of adversity at later age. In conclusion, the review of empirical studies, combined with the theoretical models, suggest that emotional wellbeing has positive implications on the functional abilities of the older adults, and in this way, should be addressed when defining strategies for the support of Active and Healthy Ageing.
In Chapter 3 we present the results of a longitudinal study that investigates the social and physical context of daily physical activity (e.g. location, social companionship and type of activity) and corresponding pleasure in the daily life of older adults. Using an intensive longitudinal study design with ambulatory assessment, consisting of continuous monitoring of physical activity with an accelerometer and repeated measurements in a smartphone application to assess daily activities and their contexts, we observed the contribution of outdoor activities and social relations to the daily physical activity of older adults. Our results indicate that, when engaged in leisure activities, more physical activity is associated with higher experience of positive emotions (in this case pleasure), but not when engaged in basic activities of daily living (e.g. commuting or eating). The results of our study support the hypothesis that identification and promotion of pleasurable activities, i.e. daily activities that contribute simultaneously for to both daily physical activity and emotional wellbeing of the older adults, might be a good strategy to support Active and Healthy Ageing.
In the next step, we investigated how older adults experience health technology in their daily life and what their expectations are before and after use. This study was divided into two parts. In the first part, we investigated current practices in managing health in daily life, attitudes towards using technology and expectations from technology, by performing semi-structured interviews with twelve older adults. This study analyzed four health domains: physical function, cognitive function, nutrition and wellbeing. The results presented in Chapter 4 suggest that the level of engagement of older adults in self-managing their health depends on various factors, such as medical history of themselves or close relatives. Furthermore, we see that older adults have a positive attitude towards technology to support managing their health, as long as this technology is integrated in daily life, targeted to personal needs and preferences, empathetic and not replacing existing human contact. To sum up, the older adults participating in the study recognize the potential added value of technology to support the self-management of their health as well as achieving and maintaining healthy behaviors, ultimately supporting Active and Healthy Ageing.
In a second part of the study, after assessing expectations of technology, we provided the same older adults with a short intervention – consisting of goal-setting and feedback – to coach physical activity and monitor emotional wellbeing in daily life. The data collected through step counters and experience sampling method was analyzed, and compared to the data acquired through semi-structured interviews, in order to investigate how older adults perceived the use of health technology in daily life for a period of 4 weeks. The results of this study, reported in Chapter 5, suggest that the attitude towards technology remains positive, or improves, after using technology to promote physical activity. However, most participants did not experience an added value of monitoring positive emotions in daily life. At the end of this chapter, we discuss the reasons underlining the dissatisfaction of the older adults with monitoring of emotional well-being, in particular, in relation to various challenges associated to research with ambulatory assessment.
Chapter 6 presents an overview of the literature on technology aiming to support Active and Healthy Ageing, focusing on four components – sensing, reasoning, coaching and applications – with physical activity and emotional wellbeing as core parameters. For each one of these components we explore the past and state-of-the-art, incorporating the lessons learned from the literature study and empirical studies. The chapter ends by providing a glimpse at future trends on the field of technologies supporting Active and Healthy Ageing.
Finally, in Chapter 7 we discuss the results of the research and look at several challenges and opportunities associated with the adoption of technology. Furthermore, we discuss how the lessons learnt in this Thesis can be applied in a wider context, for example, supporting self-management of chronic diseases.