Digital interventions for healthy ageing and cognitive health in older adults: a systematic review of mixed method studies and meta-analysis

Abstract

Background: Currently, there is no systematic review to investigate the effectiveness of digital interventions for healthy ageing and cognitive health of older adults. This study aimed to conduct a systematic review to evaluate the effectiveness of digital intervention studies for facilitating healthy ageing and cognitive health and further identify the considerations of its application to older adults.

Methods: A systematic review and meta-analysis of literature were conducted across CINAHL, Medline, ProQuest, Cochrane, Scopus, and PubMed databases following the PRISMA guideline. All included studies were appraised using the Mixed Methods Appraisal Tool Checklist by independent reviewers. Meta-analyses were performed using JBI SUMARI software to compare quantitative studies. Thematic analyses were used for qualitative studies and synthesised into the emerging themes.

Results: Thirteen studies were included. Quantitative results showed no statistically significant pooled effect between health knowledge and healthy behaviour (I² =76, p=0.436, 95% CI [-0.32,0.74]), and between cardiovascular-related health risks and care dependency I²=0, p=0.426, 95% CI [0.90,1.29]). However, a statistically significant cognitive function preservation was found in older adults who had long-term use of laptop/cellphone devices and had engaged in the computer-based physical activity program (I²=0, p<0.001, 95% CI [0.01, 0.21]). Qualitative themes for the considerations of digital application to older adults were digital engagement, communication, independence, human connection, privacy, and cost.

Conclusions: Digital interventions used in older adults to facilitate healthy ageing were not always effective. Health knowledge improvement does not necessarily result in health risk reduction in that knowledge translation is key. Factors influencing knowledge translation (i.e., digital engagement, human coaching etc) were identified to determine the intervention effects. However, using digital devices appeared beneficial to maintain older adults' cognitive functions in the longer term. Therefore, the review findings suggest that the expanded meaning of a person-centred concept (i.e., from social, environmental, and healthcare system aspects) should be pursued in future practice. Privacy and cost concerns of technologies need ongoing scrutiny from policy bodies. Future research looking into the respective health benefits can provide more understanding of the current digital intervention applied to older adults.

Study registration: PROSPERO record ID: CRD42023400707 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=400707 .

Keywords: Ageing; Dementia risk; Digital engagement; Health knowledge; Technology.

Fig. 1

Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) flow chart for literature search [30]

Fig. 2

Types of digital technology and the targeted health areas. ˅ = Improved by the digital intervention. ˟ = No improvement by the digital intervention. * = Significant improvement p<0.001 in meta-analysis . % = Number of technology types used in the studies converted into percentage

Fig. 3

Continuous data for health knowledge to successful ageing

Fig. 4

Dichotomous data for cardiovascular risks and care dependency

Fig. 5

Dichotomous data for two studies on cognition

Fig. 6

Continuous data for three studies on cognition