JMIR Publications

ABSTRACT

Background:

Ecological momentary assessment (EMA) is a method of investigating individuals’ real-time experiences, behaviors, and moods in their natural environment over time. Despite its general usability and clinical value for evaluating daily depressive mood, there are several methodological challenges when applying EMA to older adults.

Objective:

The aim of this integrative literature review was to examine possible uses of EMA methodology with older adults and to suggest strategies to increase the feasibility of its application in geriatric depression research and practice.

Methods:

Fifteen studies were selected from four electronic databases: MEDLINE, CINAHL, PsycINFO, and EMBASE; a hand search was also conducted. All database searches were limited to articles published in peer-reviewed journals from 2007 to 2018. Search terms consisted of “ecological momentary assessment,” “smartphone assessment,” “real time assessment,” “electronic daily diary,” “mHealth momentary assessment,” “mobile-based app,” and “experience sampling method” combined with the relevant term of depression. We included any studies that possibly enrolled adults aged 65 or more and reported depressive mood at least once a day for more than two days.

Results:

Only one study enrolled older adults aged 65 or older as the entire sample, while the remainder of the reviewed studies used mixed samples of both younger and older adults. Most of the analyzed studies (n=11, 73.33%) were quantitative, cross-sectional, and exploratory (descriptive, correlational, and predictive) in design. EMA was used to describe the fluctuating pattern of participants’ depressive moods and to examine the correlation between mood patterns and other health outcomes such as concurrent symptoms or predisposing conditions. We found four key methodological issues: (1) There was no consistency of operational definitions of momentary mood due to depression; (2) There was no consensus regarding the optimal protocol in terms of measurement scales, application devices, and observation frequency, duration, and timing to report in a day; (3) The cutoffs to decide nonadherence were too varied, and incomplete data affected a wide range of adherence or dropout rates; and (4) Significant subject burden was reported such as technical problems, aging-related health problems, or discomfort while using the device.

Conclusions:

EMA has been used for a comprehensive assessment of multiple mental health indicators in relation to depressive mood. Our study findings provide methodological considerations for further studies that may be implemented using EMA to assess daily depressive mood in older adults. Conducting more feasibility studies with older adults using standardized data-collection protocols and mixed-methods research is required to reflect users’ experiences. Further tele-psychiatric evaluation and diagnosis based on EMA data should involve standardized and sophisticated strategies to maximize the potential of EMA for older adults with depression in the community setting.