JMIR Publications

ABSTRACT

Background:

Out of necessity, dependent adults often ask proxies to help manage their digital accounts. However, data on the prevalence and predictors of digital proxy behaviour is scarce, and piecemeal.

Objective:

We aim to describe the prevalence and predictors of digital proxy behaviour among the US population, and associated demographic, behavior and care factors.

Methods:

We designed a cross-sectional online survey with a nationally representative adult cohort. 657 US residents completed the survey.

Results:

Our findings indicate that about 49% of the US population report having digital proxy duties, which are predicted by being male, younger, more educated, and helping with physical care. Of these, 59% handled both medical and financial duties, but each domain still has a few different predictors. Financial proxies are additionally predicted by having a higher income. In contrast, medical proxies are more likely to come from larger families and are less likely to be from an underrepresented ethnicity in the US. The most commonly given reasons for being a proxy are linked to low perceived usability of the interface and are less so about the cognitive and physical disabilities of the adult delegator. These results suggest that reducing usability challenges may reduce some of the need for proxies. Of all the digital proxies, about 2 in 3 report having formal access to the account. Hence, informal digital proxies are about one-third of all digital proxies, translating to about 18% of the adult caregiver population, or about 18 million people [23]. Of these informal digital proxies, 47.5% (medical) and 55.3% (financial) report knowing the login details, and 29.8% of (medical) 35.1% (financial) report using the accounts without the account owner present. The data indicates a higher than previously reported prevalence of proxy digital behavior, with an estimated 5.3 million people reporting risky login and independent use of digital accounts

Conclusions:

The profile of a digital proxy is often younger, male, and better educated. When helping with digital accounts, the financial and medical digital proxies were motivated by similar reasons (low perceived usability) and had similar helping patterns. In both groups, about 1 in 10 digital proxies were accessing and operating digital accounts without the presence of the account owner. We conclude this finding translates to an unacceptably high number of adults engaged in informal proxy tasks, which puts vulnerable owners at risk when they lack the capacity to manage their accounts. We call for the promotion of digital caregiver accounts with guardianship features. We further suggest that an initial intervention should educate users from lower-income groups while mitigating the barriers to formal digital proxy accounts. Clinical Trial: none.