JMIR Publications

ABSTRACT

Background:

Population aging is associated with a growing prevalence of cognitive impairment among adults aged 65 years and older. Digital health technologies offer promising opportunities to support cognitive health and well-being in this population. However, their effectiveness largely depends on users’ level of engagement. Despite the recognized importance of engagement in digital health, limited evidence exists on how engagement is conceptualized, measured, and related to intervention outcomes among older adults living with cognitive impairment.

Objective:

This scoping review aimed to describe how engagement with digital health technologies among older adults with cognitive impairment is conceptualized and measured, to examine the relationship between engagement and the effectiveness of digital health interventions, and to identify factors that facilitate or hinder engagement.

Methods:

A scoping review was conducted following the Joanna Briggs Institute methodological guidance and reported in accordance with the PRISMA-ScR checklist. A comprehensive search strategy, developed in collaboration with an information specialist, was applied to MEDLINE, Embase, CINAHL, Web of Science, and Google Scholar, without date restrictions. Empirical studies involving adults aged 65 years and older living with cognitive impairment and using digital health technologies were included. Study selection and data extraction were performed independently by at least two reviewers. Results were synthesized narratively.

Results:

Of the 1,665 records identified after duplicate removal, two studies met the inclusion criteria. One study examined computerized cognitive stimulation and cognitive engagement programs among community-dwelling older adults with mild cognitive impairment, while the other explored the use of a personalized digital reminiscence application in long-term care settings among individuals with major cognitive impairment. No study used a validated instrument to directly measure engagement. However, observable indicators and markers related to the behavioral, cognitive, and affective components of engagement were reported. Both studies also documented concurrent cognitive or psychosocial outcomes. Factors facilitating engagement included professional support, content personalization, and involvement of informal caregivers, whereas limiting factors included cognitive fluctuations, fatigue, technical complexity, and reliance on external support.

Conclusions:

TThis scoping review highlights a significant gap in the literature regarding the explicit conceptualization and standardized measurement of engagement with digital health technologies among older adults living with cognitive impairment. The findings underscore the need to develop and apply multidimensional, context-sensitive engagement measurement tools tailored to this population to better understand and optimize digital health interventions.