Aging is associated with a decline in the ability to carry out daily tasks. Physical activity can delay or diminish the decline and increase the ability of older adults to live independently at home. Performing home-based exercises can help older adults achieve the recommended levels of physical activity. Technology allows exercise programs to be tailored to individual needs. This thesis describes a blended intervention that was developed and evaluated according to the Medical Research Council framework. The principal findings are that older adults are motivated to perform technology-supported home-based exercises if they help them maintain self-reliance and there is sufficient guidance, safety is taken into account, and adherence is stimulated. To meet those conditions, a blended intervention was developed that was based on functional exercises, behavior change theory and human guidance. A custom-made tablet application appears to be usable by the target audience. A process evaluation has shown that the tablet as well as the coach support older adults in the various phases of self-regulating their exercise behavior. The blended intervention stimulates intrinsic motivation by supporting the autonomy of participants, fostering competence and, for some, meeting the need for relatedness by offering emotional support. Data derived from the tablet demonstrate that older adults participating in the intervention exhibit exercise behavior that is in line with WHO guidelines and that engagement with the tablet was a contributing factor. Future work should include assessment of intervention fidelity and explore which aspects of coaching can and cannot be further automated.
MULTIFILE
(A) BACKGROUND: Home-based cardiac rehabilitation (CR) is an attractive alternative for frail older patients who are unable to participate in hospital-based CR. Yet, the feasibility of home-based CR provided by primary care physiotherapists (PTs) to these patients remains uncertain.(B) OBJECTIVE: To investigate physiotherapists' (PTs) clinical experience with a guideline-centered, home-based CR protocol for frail older patients.(C) METHODS: A qualitative study examined the home-based CR protocol of a randomized controlled trial. Observations and interviews of the CR-trained primary care PTs providing home-based CR were conducted until data saturation. Two researchers separately coded the findings according to the theoretical framework of Gurses.(D) RESULTS: The enrolled PTs (n = 8) had a median age of 45 years (IQR 27-57), and a median work experience of 20 years (IQR 5-33). Three principal themes were identified that influence protocol-adherence by PTs and the feasibility of protocol-implementation: 1) feasibility of exercise testing and the exercise program; 2) patients' motivation and PTs' motivational techniques; and 3) interdisciplinary collaboration with other healthcare providers in monitoring patients' risks.(E) CONCLUSION: Home-based CR for frail patients seems feasible for PTs. Recommendations on the optimal intensity, use of home-based exercise tests and measurement tools, and interventions to optimize self-regulation are needed to facilitate home-based CR.
Expectations are high with regards to smart home technology. In particular, smart home technology is expected to support or enable independent living by older adults. This raises the question: can smart home technology contribute to independent living, according to older adults themselves? This chapter aims to answer this question by reviewing and discussing older adults’ perspectives on independence and their views on smart home technology. Firstly, older adults’ opinions on independence and aging in place are discussed. Secondly, this chapter will review to what extent smart home technology can support older adults’ independence. Thirdly, it will be explained how community-dwelling older adults’ concept of independence entails three distinct types or modes, and how these modes are related to their perceptions and acceptance of technology. In the last section of this chapter, an overview of key points is presented, and recommendations for technology designers, policy makers, and care providers are postulated.
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