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

摘要 65岁以上的人将占美国人口的21%，到2040年将增加到约8000万， 最老的老年人（85岁以上）将达到1410万人。人口老龄化带来了机遇， 我们的医疗保健，经济和现有的社会支持系统面临的挑战。许多老年人，尤其是 年龄最大的老人、少数民族和社会经济地位较低的人特别容易受到社会影响， 与世隔绝、饮食不良和体力活动水平降低，每一项都会影响发病率和死亡率。 基于移动设备、平板电脑和家用技术为预测行为提供了绝佳的机会- 将干预措施和社会支持以巨大的规模经济融入老年人的日常生活。的 本研究的目的是检查新的基于平板电脑的 动态系统：Fittle老年人系统（FSS），将提供：（1）个性化的行为改变方案 改善饮食和增加身体活动，以及（2）在线社交互动和小团队的支持 追求相似的目标。该系统建立在调查部门开发的两个基于技术的系统之上 团队：（1）基于计算机的PRISM系统，为老年人设计，以支持社会联系， 健康，以及（2）Fittle+移动的平台，旨在通过以下方式支持积极的健康行为改变 基于人工智能（AI）的集成在线社交支持和个性化辅导。这项研究将 分两个阶段进行。在第一阶段，我们将开发和试点测试FSS与代表 老年人的样本。第2阶段将涉及一项两组随机试验，参与者将 随机分配到Fittle Senior System（FSS，一种使用移动的的自适应教练和社会支持系统 技术）或基于纸张的心理教育（BPE）控制条件后的基线评估。 干预阶段的持续时间将包括一个为期12周的积极干预阶段，随后是一个为期12周的 维护阶段。我们将招募并随机抽取180名年龄在65岁以上的社区居民， 孤独，并有社会孤立的风险（每种情况90例- 30例白色高加索人，30例黑人/非裔美国人 30名西班牙裔美国人）。我们将根据性别比例招募男性和女性 在这一年龄组的代表，并努力确保我们有足够的代表从“最古老的老年人” 队列。将在基线、主动干预后3个月和维持治疗后3个月对受试者进行评估 （积极干预后6个月）对健康和健康行为的临床重要指标， 社会支持指数。我们还将收集有关潜在调节的信息（例如，种族、年龄）和 中介变量（例如，健康自我效能），这将使用多层次建模技术进行检查 以当前老年人行为改变和技术接受与使用的理论为指导。

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.