JMIR Publications

ABSTRACT

Background:

With the rising prevalence of aging worldwide, there is a necessity for reliable and frequent assessments of older individuals’ health status, for managing and potentially preventing age-related complications. Digital health technologies (DHTs) provide the opportunity to gather objective, continuous, and unobtrusive measurements, enabling effective health management in everyday life.

Objective:

We remotely monitored older individuals with different DHTs, and here we evaluate the relationship between digital endpoints with frailty, nutritional status, and patient reported outcomes (PROs), and quantified compliance and comfort with DHTs.

Methods:

In two cross-sectional studies, namely the Geriatric Anorexia Studies (NCT04858932, NCT05211973), including 3 in-clinic visits and 2 to 3 weeks of at-home monitoring with DHTs, 94 participants (mean±sd age: 72.98±6.28 years) were stratified based on their frailty status (39 non-frail, 45 pre-frail, and 10 frail) and nutritional status (70 with normal nutrition, 24 at-risk of malnutrition), as assessed in a clinical setting via Fried Frailty Score (FFS), and Simplified Nutritional Appetite Questionnaire (SNAQ), respectively. At-home, participants were monitored with wrist accelerometer for physical activity, continuous glucose monitoring (CGM) for glucose concentration, digital body scale for weight and body composition, and digital nutritional scale for meals tracking. Compliance with DHTs was assessed via wear time and correct usage at-home, while comfort was evaluated using questionnaires. The association between digital endpoints and frailty/nutritional status was investigated via linear regression followed by ANOVA, and the relationship between digital endpoints collected at-home and PROs was evaluated via Spearman’s ρ. Weight and body composition were also assessed in-clinic with a research-grade scale, used to validate the at-home digital body scale measurements, via intraclass correlation coefficient (ICC), Pearson’s R, and Bland-Altman with mean bias.

Results:

Physical activity digital endpoints collected at-home, such as mean daily activity in the maximum 60-min of activity (M60min) and moderate to vigorous physical activity (MVPA), were significantly different across frailty and nutritional groups, and significantly correlated with PROs of appetite, fatigue, and physical function (for M60min, ρ=0.28, -0.23, 0.47, respectively). More than 80% of participants reported all DHTs to be mostly-to-very acceptable to wear/use and would wear them for more than one week. Compliance ranged between 60% of the monitoring days for the digital nutrition scale to 90% for the wrist accelerometer.

Conclusions:

Physical activity digital endpoints show clear prognostic significance for frailty and malnutrition in older individuals, and reflect self-reported measures. DHTs can reliably be deployed at-home in older individuals, to measure physical activity, weight and body composition, glucose concentration and meal intakes, thus enabling patient-centric and data-centric clinical trials. Clinical Trial: NCT04858932, NCT05211973