Technology, aging, and mental health: opportunities and challenges

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AgeTech refers to the use of existing and emerging technologies (e.g. digital media, information and communication technologies [ICTs], big data and AI, mobile technologies, wearables, and smart home systems) to keep older adults connected and to deliver health and community services. In recent years AgeTech has emerged as a key area for research, innovation, policy and practice to meet the needs of increasing numbers of older people, improve health outcomes and to support them to live independently and well. Worldwide, major initiatives have been established to accelerate the development and implementation of technology-based solutions that make a meaningful difference to older people, including the European AAL-Program (www.aal-europe.eu) and the AGE-WELL Network of Centres of Excellence in Canada (www.agewell-nce.ca). Despite this increasing attention, the primary focus of AgeTech initiatives has been on physical health conditions, while the application of technology to support the mental health and well-being of older adults has received much less attention.

Technology-based solutions for mental health may help older adults to remain happy, healthy, and independent, while reducing demands on healthcare services. The COVID-19 pandemic and lockdown in particular laid bare many of the mental health challenges associated with social isolation and loneliness. We are becoming increasingly aware of the negative long-term effects of stress and anxiety on healthy aging. At a global level we are witnessing social and economic megatrends such as climate change, rapid urbanisation, international migration and conflict and displacement, all of which have mental health implications, while at the same time occurring within the context of an increasingly technology-mediated world. It is also important to recognise that health services worldwide are struggling to meet the needs of growing numbers of older people within populations, along with increasing demands to be able to continue living within their own homes and communities, rather than admission to long-term care facilities.

The goal of this special issue is to provide a benchmark publication relevant to an interdisciplinary community of researchers. The 10 papers represent a wide range of topics and geographic spread, and taken together the papers have important implications for policy-makers and research funders.

The article by Sun and Ye (2023) addresses a major research gap in our understanding of older people’s relationship with technology. They examined technophobia- a fear or dislike of technology- amongst older adults in China. Contrary to prevailing age stereotypes, their research showed that most older people are not technophobic. However, many still have concerns over personal data privacy, while a minority could be classed as ‘technophobic’, with implications for using and accessing technology-based services.

Caring for people living with dementia can stressful and isolating for caregivers. Castillo et al. (2024) identify and evaluate the effectiveness of 16 mobile apps for informal caregivers of people living with dementia. While apps have potential to enhance the delivery and access to supports, the results suggest that the range of features in currently available apps may not be sufficient to address the complex needs of caregivers, limiting their effectiveness in improving outcomes.

Cohn-Schwartz et al. (2024) evaluated a tablet-based digital intervention program with aging Holocaust survivors, who are an especially vulnerable group due to their old age and past traumas. The intervention resulted in increased use of communications technologies by participants, such as video chat with family. These participants also showed positive mental health benefits, including fewer post-traumatic stress episodes.

The article by Wilson et al. (2023) highlights the central role of smart devices in the lives of people with dementia and mild cognitive impairment. Qualitative interviews showed that these devices are seen as essential aids to meaningful activities and social engagement at earlier stages of cognitive impairment. Contrary to the common view that they would struggle with technology, the research indicates a strong desire for greater support to learn to use smart devices to facilitate living well with cognitive impairment.

Alfaro et al. (2023) investigate the impact of distributing video-enabled tablets to older veterans with alcohol use disorder (AUD) to enhance their access to mental health services. Revealing a notable shift from phone-based to video-based mental health consultations post-tablet distribution, the likelihood of using video visits also varied among participants: older, male veterans with numerous physical health issues were less inclined to use video services, whereas those who were married, lived in urban areas, had unstable housing histories, and suffered from multiple mental health conditions showed a higher propensity for video consultations. The study underscores the potential of video-enabled tablets in mitigating access barriers to mental health care for older veterans with AUD, though it also highlights the need for tailored support for certain demographic groups to maximize the benefits of this technological intervention.

The article by Tran et al. (2022) reports on the implementation and evaluation of a tablet-based pain assessment checklist for older people with limited communication abilities. The study used a mixed methods evaluation approach in 11 long-term care facilities and builds on a previous validation of the app to demonstrate its clinical utility. The study demonstrates various quality improvements in care practice, while care professionals preferred the tablet-based app over article versions of the pain assessment protocol.

Delving into the inequities in access and use of technology, particularly the disparities between Baby Boomers and the Silent Generation in senior living facilities, Chee (2023) highlights an issue that has become increasingly prominent in the digital age. Aiming to understand the lived experiences of older adults facing the challenges of this ‘gray digital divide’, Chee highlights the importance of addressing these disparities for a range of stakeholders, including academics, policymakers, senior living facilities, and technology developers, to improve the quality of life and inclusion of older adults in the digital world.

Wang et al. discuss (2023) CATCH-ON Connect, a cellular-enabled tablet program, that aims to reduce loneliness among older adults. Utilizing a single-group pre-post evaluation, their work focuses on the program’s influence on social isolation and loneliness, highlighting the potential benefits of tablet programs coupled with technical assistance for older adults and point to the necessity of further research to discern the individual and combined impacts of internet access and technical support. This study underscores the value of integrating technology-based interventions for older adults, suggesting new directions for healthcare providers and policymakers in developing effective, user-friendly technological solutions.

Focusing on the reluctance of older adults to adopt new computer technology, Ferguson et al. (2023) examine factors that may restrict their access to essential online resources, including healthcare, and potentially affect their cognitive abilities, well-being, and mental health. The project findings, while preliminary, are encouraging and suggest that further research could help shape public health and policy initiatives aimed at overcoming barriers to technology access for older adults, potentially enhancing their psychological health and overall quality of life.

Nature-based virtual reality (VR) with heart rate variability biofeedback (HRVBF) is a promising new avenue for reducing pain and anxiety in patients undergoing total knee arthroplasty (TKA). Girishan Prabhu et al. (2023) conducted a randomized control trial examining pain and anxiety using visual analogue scales and the State-Trait Anxiety Inventory, alongside monitoring physiological signals like heart rate variability. Their results suggest that VR with HRVBF could be a useful approach to manage post-surgical pain and anxiety in TKA patients.

What implications for research funders and policy-makers can we draw from the various articles included this special issue? Firstly, they should be aware that the use of technology-based interventions can have real and tangible benefits for older people ranging from clinical applications, as discussed by Girishan Prabhu et al. (2023) and Tran et al. (2022) to technologies that have benefits for the overall well-being of older people, such as Wang et al. (2023) CATCH-ON Connect program to reduce loneliness among older adults. Technology may be particularly valuable in supporting those people who may have particular characteristics or needs or are isolated, for example Holocaust survivors as discussed by Cohn-Schwartz et al. (2023) and Alfaro et al. (2023) use of video-enabled tablets to support older veterans with alcohol use disorder.

Contrary to the stereotypical view, older adults are not technophobic and are receptive to technology, with key implications for policy and practice. The article by Wilson et al. (2023) highlights the central role of smart devices in their lives, and the need to move beyond small-scale pilot studies and the rehearsal of what is needed to practical development and implementation. However, as Sun and Ye (2023) argue, many still have concerns over privacy, while a substantial minority will be resistant to tech-mediated health services. Technology should not be seen as a solution for everyone, or a quick fix for failing health services. As discussed by Ferguson et al. (2023), policy and practice should pay attention to the barriers that many older people face when using technology and to avoid the social and economic disparities of the digital divide highlighted by Chee (2023).

The articles chosen for this special issue are drawn from different countries and funding sources, and reflects a growing and wide range of research within AgeTech for mental health. However, much of this remains piecemeal and it is important that funders and policy makers develop a more coherent strategy going forward. The mental health needs of older adults and caregivers are complex and multifaceted and this needs to be reflected in research priorities and agendas of funding programs. Many of the applications discussed make use of everyday technologies such as smart phones, tablets and internet, while the mainstreaming of technologies such as AI and smart-home technologies offer huge opportunities for digital services to support older people in the community. In this context, research needs to be about practical implementation and providing evidence to support adoption, as highlighted by Castillo et al. (2023). Key to this are co-production approaches that involve technology users in all stages of development to make technologies more useful, engaging and ethically responsible.

Andrew Sixsmith
Department of Gerontology, Simon Fraser University, Vancouver, Canada
[email protected]
T. D.Cosco
Department of Gerontology, Simon Fraser University, Vancouver, Canada
School of Public Policy, Simon Fraser University, Vancouver, Canada
Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom
[email protected]

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The guest editors acknowledge the AGE-WELL Network of Centres of Excellence for their support (AW-SD-2015). T.D. Cosco is a Michael Smith Health Research BC Scholar (SCH-2020-0490).