JMIR Publications

ABSTRACT

Background:

Maintaining functional health, or the ability to live independently, is a primary goal of individuals as they age, but most older adults develop chronic conditions that threaten this goal. Physical activity is a key aspect of self-care that can improve functional health, and digital interventions offering guidance in appropriate exercise can help. However, older adults with multiple morbidities may be unable to use laptop or smartphone-based eHealth because poor vision, dexterity, mobility, or other physical challenges make typing or touch navigation difficult. A smart display platform—comprising a smart speaker plus a small visual screen—has the potential to remove these barriers because it is voice activated.

Objective:

Compare usage patterns of an eHealth intervention for older adults when delivered via a voice-based smart display versus a typing-based laptop, and assess whether the smart display outperforms the laptop in improving functional health and its specific physical and mental aspects.

Methods:

A minimum of 356 adults age 60 and older with at least 5 chronic health conditions are to be recruited from primary care clinics and community organizations. Participants will be randomized 1:1 to 12 months of access to an evidence-based intervention, ElderTree, delivered on either a smart display or a touchscreen laptop, with a post-intervention follow-up at 18 months. The primary outcome is differences between groups on a comprehensive measure of physical and mental functional health. Secondary outcomes are between-group differences in separate aspects of functional health (eg, physical function, depression), as well as health distress, loneliness, unscheduled healthcare, and falls. We will also examine mediators and moderators of effects of ElderTree on both platforms. Participants will complete surveys at baseline, 6, 12, and 18 months, and ElderTree use data will be collected continuously during the intervention period in system logs. We will use linear mixed effect models to evaluate outcomes over time, with treatment condition and timepoint as between-subjects factors. Separate analyses will be conducted for each outcome.

Results:

Recruitment began in July 2023 and was completed in May 2024, with 387 participants enrolled. The 12-month intervention period will end May 2025; data collection will end November 2025. Findings will be disseminated via peer-reviewed publications.

Conclusions:

Voice-activated digital health interventions have theoretical but untested advantages over typing-based technologies for older adults with physical limitations. As the population ages, and as multiple morbidities threaten the functional health of the majority of older adults, innovations in self-management are a matter of public health as well as individual quality of life. Clinical Trial: clinicaltrials.gov NCT05240534