JMIR Publications

ABSTRACT

Background:

Digital solutions such as mobile applications or telemonitoring devices are frequently pointed out as a facilitator in the process of empowering older adults, but they can also act as a source of digital exclusion and/or disempowerment if they are not adequate for older adults’ needs and characteristics.

Objective:

To synthesize and critically evaluate existing evidence on the effectiveness of integrated digital solutions for empowering older adults in aspects related to their health.

Methods:

A systematic search was carried out in Pubmed, ScienceDirect, SCOPUS, EBSCO, and Scielo, using a combination of terms informed by previous reviews on empowerment. Screening of references was performed against pre-defined inclusion criteria. Data extraction and the methodological quality of included studies using the PEDro scale were performed by two authors. The certainty of evidence was graded for the main comparisons and outcomes of the review using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). When at least three studies were available within the same domain of empowerment (knowledge, support by others, capacities, and behaviors) and comparison group, a meta-analysis was performed.

Results:

A total of 30 manuscripts were included in the present review. Knowledge: there was very low certainty of evidence of a medium effect size favoring the digital intervention group (k=5, es=0.40; 95% CI=0.07; 0.73, I2=79%). Capacities: there was low certainty of evidence of no between-group differences (k=5; d=0.13; 95% CI=-0.02; 0.29, I2=0%) when comparing digital solutions against no intervention; low certainty of evidence of a medium effect size favoring the digital intervention group (k=13; d=0.29; 95% CI=0.07; 0.52, I2=79%) when comparing digital solutions against usual care; very low certainty of evidence of no between-group differences (k=4, d=0.97; 95% CI=-0.62; 2.56, I2=97%) when comparing digital interventions to face-to-face interventions. Social support and behaviors: no meta-analysis was possible and existing evidence is conflicting.

Conclusions:

There is very low to low certainty of evidence that using integrated digital solutions results in increased knowledge and increased capacities (mainly self-efficacy) when compared to usual care and impacts capacities to an extent similar to face-to-face interventions at post-intervention. Interestingly, results also suggest, with low certainty of evidence, that there are no differences between using digital solutions and no intervention for improving capacities. Included studies and technologies were diverse and meta-analysis showed high heterogeneity which limits the confidence in the results and suggests that further research might affect the conclusions of this review.