A Personalized Health Behavior System to Promote Well-Being in Older Adults

摘要 65岁以上的人口将占美国人口的21%，到2040年将增加到约8000万， 而年龄最大的老年人(85岁以上)将达到1410万人。人口老龄化既带来了机遇，也带来了 对我们的医疗保健、经济和现有社会支持系统的挑战。尤其是许多老年人 年龄最大的老年人、少数民族和社会经济地位较低的人特别容易受到社会经济状况的影响 与世隔绝、饮食不佳和体力活动减少，每一项都会影响发病率和死亡率。 基于移动、基于平板电脑和居家的技术为投射行为提供了绝佳的机会- 以巨大的规模经济将干预和社会支持改变到老年人的日常生活中。这个 这项研究的目的是检查一种新的基于平板电脑的药物对不同的老年人的可用性和有效性 动态系统：菲特尔高级系统(FSS)将提供：(1)个性化的行为改变计划 用于改善饮食和增加体力活动以及(2)在线社交和来自小团队的支持 追求相似的目标。该系统建立在调查人员开发的两个基于技术的系统之上 小组：(1)以计算机为基础的PRISM系统，为老年人设计，以支持社会联系和 幸福感，以及(2)旨在通过以下方式支持积极健康行为改变的菲特尔+移动平台 基于人工智能(AI)的集成在线社交支持和个性化教练。这项研究将 分两个阶段进行。在第一阶段，我们将与代表一起开发和试运行FSS 老年人的样本。第二阶段将涉及一项两组随机试验，参与者将 随机到菲特尔高级系统(FSS)，这是一个使用移动设备的自适应教练和社会支持系统 技术)或在基线评估后的纸质心理教育(BPE)控制条件。 干预阶段的持续时间将包括12周的积极干预阶段，然后是12周的干预阶段 维护阶段。我们将招募和随机选择180名65岁以上的社区居住成年人 孤独，面临社会孤立的风险(每种情况下有90人--30名白人，30名黑人/非裔美国人 和30名拉美裔美国人)。我们将招募与性别比例相称的男性和女性 代表在这个年龄段，并努力确保我们有足够的代表从“最年长的老年人” 一群人。参与者将在基线、积极干预后3个月和维护后3个月进行评估 (积极干预后6个月)关于健康和健康行为的临床重要指标和 社会支持指数。我们还将收集有关潜在缓和的信息(例如，种族、年龄)和 中介变量(例如健康自我效能感)，将使用多水平建模技术进行检查 在当前行为改变和老年人接受和使用技术的理论指导下。

Abstract People aged 65+ will represent 21% of the U.S. population and increase to about 80 million by 2040, and the oldest old (age 85+) will number ~ 14.1 million. Population aging presents both opportunities and challenges for our healthcare, the economy, and existing social support systems. Many older adults especially the oldest old, minorities and those of lower Socio-Economic status (SES) are particularly vulnerable to social isolation, poor diet, and decreased levels of physical activity each of which influence morbidity and mortality. Mobile-based, tablet-based, and in-home technologies provide an excellent opportunity for projecting behavior- change interventions and social support into the everyday life of older adults at great economies of scale. The objectives of this study are to examine the usability and efficacy, for diverse older adults, of a new tablet-based dynamic system: the Fittle Senior System (FSS) that will provide: (1) personalized behavior-change programs for improved diet and increased physical activity and (2) online social interaction and support from small teams pursuing similar goals. The system builds on two technology-based systems developed by the investigative team: (1) the computer-based PRISM system, designed for older populations to support social connectivity and well-being, and (2) the Fittle+ mobile platform designed to support positive health behavior change through integrated online social support and personalized coaching based on artificial intelligence (AI). The study will be conducted in two phases. During Phase 1 we will develop and pilot test the FSS with representative samples of older adults. Phase 2 will involve a two group randomized trial where participants will be randomized to the Fittle Senior System (FSS, an adaptive coaching and social support system using mobile technology) or to a paper-based psycho-educational (BPE) control condition following a baseline assessment. The duration of the intervention phase will involve an active 12-week intervention phase followed by a 12-week maintenance phase. We will recruit and randomize 180 community dwelling adults aged 65+ years, who live alone and are at risk for social isolation (90 per condition - 30 White Caucasians, 30 Black/African Americans and 30 Hispanic Americans). We will recruit males and females commensurate to the gender proportions represented in this age group and work to ensure that we have sufficient representation from the “oldest old” cohort. Participants will be assessed at baseline, 3mths post active intervention and 3mths post maintenance (6mths following active intervention) on clinically significant measures of health and health behaviors and indices of social support. We will also gather information on potential moderating (e.g., ethnicity, age) and mediating variables (e.g., health self-efficacy), which will be examined using multilevel modeling techniques guided by current theories of behavior change and technology acceptance and use among older adults.