A Scoping Review Exploration of the Intended and Unintended Consequences of eHealth on Older People:A Health Equity Impact Assessment

eHealth is one perceived mechanism to extend the range and reach of limited health-care resources for older adults. A decade-scoping review (2007–2017) was conducted to systematically search and synthesize evidence to understand the intended and unintended consequences of eHealth initiatives, informed by a health equity impact assessment framework. Scoping review sources included international academic and grey literature on eHealth initiatives (e.g., eHealth records, telemedicine/telecare, and mobile eHealth application) focused on the varying needs of older adults (aged 60+), particularly individuals experiencing sociocultural and economic difficulties. Findings suggest that eHealth has several potential benefits for older adults, but also the possibility of further excluding already marginalized groups, thereby exacerbating existing health disparities. Ongoing evaluation of eHealth initiatives for older adults is necessary and requires attention to unique individual-level, socioeconomic, and cultural characteristics to heighten benefits and better capture both the intended and unintended outcomes of advanced eHealth systems.peerReviewe

Exploring Privilege in the Digital Divide:Implications for Theory, Policy, and Practice

Background and Objectives: The digital revolution has resulted in innovative solutions and technologies that can support the well-being, independence, and health of seniors. Yet, the notion of the “digital divide” presents significant inequities in terms of who accesses and benefits from the digital landscape. To better understand the social and structural inequities of the digital divide, a realist synthesis was conducted to: inform theoretical understandings of information and communication technologies (ICTs); understand the practicalities of access and use inequities; uncover practices that facilitate digital literacy and participation; and recommend policies to mitigate the digital divide.Research Design and Methods : A systematic search yielded 55 articles published between 2006 and 2016. Synthesis of existing knowledge, combined with user-experience elicited through a deliberative dialogue session with community stakeholders (n=35), made visible a pattern of privilege that determined individual agency in ICT access and use.Results: Though age is consistently centralized as the key determinant of the digital divide, our analyses, which encompassed both van Dijk’s resources and appropriation theory and intersectionality, appraised this notion and revealed that age is not the sole determinant. Findings highlight the role of other factors that contribute to digital inequity among community-dwelling middle-aged (45-64) and older (65+) adults, including education, income, gender, and generational status.Discussion and Implications: Informed by results of a realist synthesis that was guided by intersectional perspectives, a conceptual framework was developed outlining implications for theory, policy, and practice to address the wicked problem that is the digital divide

Contextual factors for aging well:Creating socially engaging spaces through the use of deliberative dialogues

Purpose of the Study: Home and community engagement are key contextual factors for aging well, particularly for older adults in vulnerable social positions. A community-based participatory action research project conducted in Western Canada examined how to best use the shared amenity spaces in a low-income seniors' apartment complex in order to connect services and programs with tenants and to provide opportunities for service providers and local stakeholders to build upon and create new relationships toward collaboration and service delivery. Design and Methods: Pre-move deliberative dialogue workshops (n = 4) were conducted with stakeholders (e.g., service providers, developers, and municipal government employees). Workshop participants (n = 24) generated ideas and plans on how physical and social environments can contribute to the social engagement of senior tenants. Results: Shared dialogue led to community investment and asset sharing by integrating the knowledge and experiences of multiple stakeholder groups into the planning process. This article highlights how collaborative planning approaches for the effective use of the social environment (e.g., social programming), within the physical environment (e.g., amenity and community spaces), can generate rich and illuminating data for informing enhancements in the social environment of apartment dwelling low-income seniors. Contextual challenges to service provision are discussed, including the need for communication about and coordination of on-site programming, culturally diverse and responsive programming, and longterm funding. Implications: Prolonging independent community living with the assistance of support services should be a goal to both delay premature relocation into institutional care and meet the preferences of older adults.</p