Abstract Objective Across two summers self-report surveys were completed by a total of 130 older adults who were trialling a digital heat early warning system in Southeast Queensland. The purpose of the project was to assess participants’ access to (accessibility), and willingness to use (acceptability) commonly promoted cooling strategies, and to further explore the reasons for reluctance to use. Results Most participants reported access to all strategies (93–100%). Acceptability (mean response [95%CI]) was high for opening/closing windows or blinds (97 [94–100]%), fans, drinking cool water, sitting quietly, removing excess clothing (all 96 [93–99]%), cold showers (92 [87–96]%), and air-conditioning (90 [84–95] %). Conversely, hand/forearm baths (76 [69–84]%), icepacks (68 [60–76]%), dampened clothing (64 [56–72]%), foot baths (63 [54–71]%), and cold baths (49 [39–60]%) were less acceptable. Key reported barriers included messiness (n = 48), physical discomfort (n = 47), and preference for other strategies (n = 47). Among this sample of older adults, several widely promoted water-based cooling strategies were reported as unacceptable despite high accessibility. These findings highlight an implementation gap between public health recommendations and self-reported willingness to use such strategies, underscoring the need for co-designed heat-health interventions.

OBJECTIVE:Digital technology increasingly plays an important role in supporting older adults to live longer and healthier lives. However, research consistently identifies barriers to technology usage for some older adults, particularly as they age. This study draws on data from a survey of older adults (aged 65 years and older) to improve our understanding of the role that confidence with technology plays in older adults' technology acceptance. METHODS:We analysed technology usage and acceptance data from 547 Queensland older adults (53% male, 47% female) gathered as part of a larger survey examining how technology may assist the development of an in-home heat early warning system for older Queenslanders. Respondents fell within five age range groups, 65-69 years (24%), 70-74 years (29%), 75-79 years (28%), 80-84 years (12%) and 85+ (7%). RESULTS:Respondents from the highest age range groups were more apprehensive about, and were slower to adopt, new technologies. Moreover, overall use of technology also declined with age, implying the need to consider ageing cohorts when considering technology acceptance. When looking at digital confidence, our results highlight that age was the only independent variable that predicted (inversely) digital confidence, and somewhat counterintuitively, frustration with technology. This may suggest that older cohorts avoid using new technology to avoid the risk of frustration. CONCLUSIONS:Results from the survey data add to our knowledge of the patterns of technology usage and acceptance by older adults. Our analysis underscores the need to consider variables such as confidence or frustration with technology when considering whether cutting-edge technologies will benefit older users.

Extreme heat poses a growing threat to vulnerable urban populations, and the existing heat early warning system usually operates at population level. Pairing emerging individualized and population early warning systems could directly and meaningfully extend protection to those most in need.

Extreme heat events lead to considerable health burden and are becoming more severe and frequent, calling for the development of effective population-based and individualised heat early warning systems. We developed an individualised heat early warning system and tested it in 78 older adults’ ( ≥ 65 years) homes in Southeast Queensland, Australia. Quantitative and qualitative data from this proof-of-concept testing study showed that the Ethos system performed well on a standard usability scale (mean score of 78 on the System Usability Scale). Following a summer-time use of this early warning system, there were increases in heat preparedness (P < 0.001, marginal homogeneity tests) but no significant increases in heat health risk perception or the uptake of low-cost cooling measures (e.g., hand/forearm bath, fans). This proof-of-concept research demonstrated the usability of this tailored, actionable, real-time digital heat early warning system, although the effectiveness of the system remains to be evaluated in a robust trial design.

Video calls are increasingly being adopted to enable older adults living in long-term residential care (aged care homes) to remain socially connected with friends and family. However, care home residents often require extensive support to participate effectively in video calls. Despite growing interest in examining the work involved in facilitating technology use in care homes, the role of caregivers---comprising family members and staff---in facilitating video calls has received limited attention. Drawing on data from a study of family members' experiences in Australia, we analysed the essential work activities required to make video calls function in residential aged care. We show how video calling is underpinned by the development of relationships between families and staff, and how video calling requires considerable work in preparation, facilitation, and troubleshooting. We discuss how video calling systems for care homes might be designed to alleviate unwanted work, lowering the burden of call participation for residents, families, and care staff.

Background: Heatwave warnings provide crucial information about the nature of the event and the steps that can be taken to mitigate its impact. It is well known that heat events disproportionately impact the health of older adults. Therefore, it’s critical that heatwave warnings reach this population. However, our current understanding of the effectiveness of heatwave warning messages among older Queenslanders is limited. Methods: A Queensland wide survey was conducted in 2022 among 547 older adults (≥65 years), aiming to collect information on their perception of heat-related health risk, their knowledge of the existing heatwave warnings, and if they had ever heard of a heatwave warning. Chi-square analysis followed by multinomial or binomial logistic regression was utilized to understand various socio-economic and personal factors that impact the heatwave warning reach to older Queenslanders. Results: Only 43% of the respondents had heard a heatwave warning and only 49% of those who heard a warning(s) changed their behavior as a result. The results showed 20% of respondents perceived themselves to be at heat-related health risk, and these individuals were 1.98 times more likely to have heard heatwave warnings. Further, individuals who perceived themselves to be at heat-related health risk were 3.62 times more likely to adopt adaptive measures in response to heatwave warnings. Implications: This study suggests that in older adults, higher knowledge and perception of heat-related health risk are associated with higher likelihoods of attention to heatwave warnings and adoption of cooling measures.

Previous studies of Virtual Reality (VR) in aged care settings have demonstrated that the benefits can be multiple, including improved social connection and engagement and reduced social isolation in later life. However, there remains a lack of widespread uptake of VR in aged care facilities. This prompts an important question: Given the potential benefits, why is there such poor engagement in VR by aged care facilities? The aim of this qualitative study is to investigate the experience of introducing VR into an aged care facility. Our innovative approach supported care staff to introduce VR into aged care facilities. Fieldwork diaries and focus group discussions were used to document experiences of introducing VR, including the obstacles, challenges and benefits and the adaptations to aged care environments that were required to accommodate new VR activities. Thematic analysis of the data revealed that VR can be an important medium to support the wellbeing of older residents. However, our findings also indicate that there are significant challenges associated with introducing VR, including substantial costs in time, money and institutional resources and attention. This study concludes that, to be successful, VR requires substantive care and relational resources from both staff and residents that are only visible when paying attention to the contextual adjustments required to introduce the technology to a new setting. This suggests that other research on gerontechnologies would likely also benefit from further attention to the role of the broader social context - including care and relational resources - in ensuring their successful design and implementation.

Background: Lockdowns have been used to prevent the spread of transmissible illnesses such as influenza, norovirus, and COVID-19 in care homes. However, lockdowns deny care home residents supplemental care and the socioemotional enrichment that comes from seeing family members. Video calling has the potential to enable ongoing contact between residents and family members during lockdowns. However, video calls can be considered by some as a poor substitute for in-person visits. It is important to understand family members' experiences with video calling during lockdowns to ensure the effective use of this technology in the future.Objective: This study aimed to understand how family members use video calls to communicate with relatives living in aged care during lockdowns. We focused on experiences during the COVID-19 pandemic, which involved extensive lockdowns in aged care homes.Methods: We conducted semistructured interviews with 18 adults who had been using video calls with relatives living in aged care during pandemic lockdowns. The interviews focused on how participants had been using video calls, what benefits they gained from video-based interactions, and what challenges they encountered when using the technology. We analyzed the data using the 6-phase reflexive approach to thematic analysis by Braun and Clarke.Results: We developed 4 themes through our analysis. Theme 1 interprets video calling as a medium for the continuation of care during lockdowns. Using video calls, family members were able to provide social enrichment for residents and engaged in health monitoring to uphold residents' welfare. Theme 2 highlights how video calling extended care by supporting frequent contact, transmitting nonverbal cues that were essential for communication, and negating the need for face masks. Theme 3 interprets organizational issues such as the lack of technology and staff time as impediments to the continuation of familial care through video. Finally, theme 4 highlights the need for 2-way communication, interpreting residents' unfamiliarity with video calling and their health conditions as further barriers to the continuation of care.Conclusions: This study suggests that, during restrictions arising from the COVID-19 pandemic, video calls became a medium for enabling family members to continue participating in the care of their relatives. The use of video calls to continue care illustrates their value for families during times of mandatory lockdown and supports the use of video to complement face-to-face visits at other times. However, better support is needed for video calling in aged care homes. This study also revealed a need for video calling systems that are designed for the aged care context.

OBJECTIVES:Virtual reality (VR) is not a common leisure activity in aged care, despite pilot studies demonstrating its value as a tool to combat inactivity and loneliness. This study investigated the organisational enablers and barriers to sustained uptake of VR among aged care staff and organisations, who may lack familiarity or confidence with the technology.METHODS:Creative methods were adopted to co-design and develop a VR implementation toolkit tailored specifically for aged care staff. Three aged care homes in South-East Queensland participated, with 15 residents and seven staff engaging in up to four VR sessions facilitated by the research team. Participant observation of the VR sessions was complemented by interviews with aged care staff and residents.RESULTS:Guided by Normalisation Process Theory, a reflexive thematic analysis identified four key themes: (1) Positively Appreciating the VR Experience, (2) Staff VR Champions and the Importance of Personal Use and Experimentation with VR, (3) Management Support and (4) Technical Challenges.CONCLUSIONS:Our results indicate benefits and challenges of VR use in aged care, offering valuable insights into the factors that can lead to the long-term success of VR-based leisure activities for aged care. Providing time and resources for a VR champion to experiment and learn about the technology is critical. The development of an online implementation toolkit, based on our learning from this project, also provides aged care stakeholders with the evidence-based resources needed to ensure the successful implementation of VR-based leisure programs.

Objective: To evaluate the association between capillary refill time (CRT) measured by a medical device and sepsis among patients presenting to the Emergency Department (ED).Methods: This prospective observational study enrolled adult and pediatric patients during ED triage when sepsis was considered a potential diagnosis by the triage nurse. Patients were enrolled at an academic medical center between December 2020 and June 2022. CRT was measured by a research assistant using an investigational med-ical device. The outcomes included sepsis and septic shock defined using sep-3 criteria, septic shock defined as IV antibiotics and a vasopressor requirement, ICU admission, and hospital mortality. Other measures included pa-tient demographics and vital signs at ED triage. We evaluated univariate associations between CRT and sepsis outcomes.Results: We enrolled 563 patients in the study, 48 met Sep-3 criteria, 5 met Sep-3 shock criteria, and 11 met prior septic shock criteria (IV antibiotics and vasopressors to maintain mean arterial pressure of 65). Sixteen patients were admitted to the ICU. The mean age was 49.1 years, and 51% of the cohort was female. The device measured CRT was significantly associated with the diagnosis of sepsis by sep-3 criteria (OR 1.23, 95% CI 1.06-1-43), septic shock by sep-3 criteria (OR 1.57, 95% CI 1.02-2.40), and septic shock defined as receipt of IV antibiotics and a va-sopressor requirement (OR 1.37, 95% CI 1.03-1.82). Patients with CRT >3.5 s measured by the DCR device had an odds ratio of 4.67 (95%CI 1.31-16.1) of septic shock (prior definition), and an odds ratio of 3.97 (95% CI 1.99-7.92) of ICU admission, supporting the potential for the 3.5-s cutoff of the DCR measurement.Conclusions: CRT measured by a medical device at ED triage was associated with the diagnosis of sepsis. Objective CRT measurement using a medical device may be a relatively simple way to improve sepsis diagnosis during ED triage. (c) 2023 Elsevier Inc. All rights reserved.

Immersive virtual reality (VR) is being used as an enriching experience for people living in residential aged care, or nursing homes, where care staff play a critical role supporting clients to use VR. In HCI research concerned with technology use in aged care, however, the role of formal caregivers has received limited attention. We conducted interviews with 11 caregivers working in care homes that have implemented VR as part of the social program offered to residents. Our findings highlight tensions between the opportunities created by the immersive VR experience and the risks and challenges full immersion presents for people in aged care. In this paper, we draw on an ethics of care framework to make visible the care practices involved in facilitating VR in aged care homes, highlighting the care required to ensure that older adults experience benefits when using immersive VR, while risks and challenges are carefully managed.

As virtual environments—in the form of videogames and augmented and virtual reality experiences—become more popular, it is important to ensure that they are accessible to all. Previous research has identified echolocation as a useful interaction approach to enable people with visual impairment to access virtual environments. In this article, we further investigate the usefulness of echolocation to explore virtual environments. We follow a participatory design approach that comprised a focus group session coupled with two fast prototyping and evaluation iterations. During the focus group session, expert echolocators produced a series of seven design recommendations, of which we implemented and trialed four. Our trials revealed that the use of ambient sounds, the ability to place landmarks, directional control, and the ability to use pre-recorded mouth-clicks produced by expert echolocators improved the overall experience of our participants by facilitating the detection of openings and obstacles. The recommendations presented and evaluated in this article may help to develop virtual environments that support a broader range of users while recognising the value of the lived experience of people with disability as a source of knowledge.

Elementary portfolio theory implies that environmentalists optimally hold more shares of polluting firms than non-environmentalists, and that polluting firms attract more investment capital than otherwise identical non-polluting firms through a hedging channel. Pigouvian taxation can reverse the aggregate investment results, but environmentalists still overweight polluters. We introduce countervailing motives for environmentalists to underweight polluters, comparing the implications when environmentalists coordinate to internalize pollution, or have nonpecuniary disutility from holding polluter stock. With nonpecuniary disutility, introducing a green derivative may dramatically alter who invests most in polluters, but has no impact on aggregate pollution.

Background: Monitoring of capillary refill time (CRT) is a common bedside assessment used to ascertain peripheral perfusion in a patient for a vast array of conditions. The literature has shown that a change in CRT can be used to recognize life-threatening conditions that cause decreased perfusion, such as sepsis, and aid in resuscitation. The current practice for calculating CRT invites subjectivity and produces a highly variable result. Innovative technology may be able to standardize this process and provide a reliable and accurate value for use in diagnostics and treatment. This study aimed to assess a new technology (DCR by ProMedix Inc.) for rapid, bedside, and noninvasive detection of CRT. Methods: This was a secondary analysis of a prospective observational study evaluating the accuracy of new technology towards CRT-guided diagnosis of sepsis. It was carried out in the adult emergency departments (ED) of an academic tertiary care medical center. Patients seeking care in the ED were determined eligible if they were > 18 years in age and exhibited chief complaints suggestive of possible sepsis. The CRT produced by the technology was compared to the gold standard manual waveform assessment. Results: 218 consecutive subject enrollments were included and multiple measurements were made on each patient. Data with irregular waveforms were excluded. A total of 692 waveforms were evaluated for CRT values by a pair of trained PhD biomedical engineers. The average age of the cohort was 50.62 and 51.4% female. Results showed a Pearson correlation coefficient of 0.91 for the device CRT compared to the CRT gold standard. The Pearson correlation coefficient for the two independent engineering review of the waveform data was 0.98. This device produces accurate, consistent results and eliminates the subjectivity of CRT measurements that is in practice currently.

Heart rate variability (HRV) evaluates beat-to-beat interval (BBI) differences and is a suggested marker of the autonomic nervous system with diagnostic/monitoring capabilities in mental health; especially parasympathetic measures. The standard duration for short-term HRV analysis ranges from 24 h down to 5-min. However, wearable technology, mainly wrist devices, have large amounts of motion at times resulting in need for shorter duration of monitoring. The objective of this study was to evaluate the correlation between 1 and 5 min segments of continuous HRV data collected simultaneously on the same patient. Subjects wore a patch electrocardiograph (Cardea Solo, Inc.) over a 1–7 day period. For every consecutive hour the patch was worn, we selected a 5-min, artifact-free electrocardiogram segment. HRV metric calculation was performed to the entire 5-min segment and the first 1-min from this same 5-min segment. There were 492 h of electrocardiogram data collected allowing calculation of 492 5 min and 1 min segments. 1 min segments of data showed good correlation to 5 min segments in both time and frequency domains: root mean square of successive difference (RMSSD) (R = 0.92), high frequency component (HF) (R = 0.90), low frequency component (LF) (R = 0.71), and standard deviation of NN intervals (SDNN) (R = 0.63). Mental health research focused on parasympathetic HRV metrics, HF and RMSSD, may be accomplished through smaller time windows of recording, making wearable technology possible for monitoring.

Objective Suicide is the 2nd leading cause of death in adolescence, and acute pediatric mental health emergency department (ED) visits have doubled in the past decade. The objective of this study was to evaluate physiologic parameters relationship to suicide severity. Methods This was a prospective, observational study from April 2018 thru November 2019 in a tertiary care pediatric emergency department (ED) and inpatient pediatric psychiatric unit enrolling acutely suicidal adolescent patients. Patients wore a wrist device that used photoplethysmography for 7 days during their acute hospitalization to measure heart rate variability (HRV). During that time, Columbia Suicide Severity Scores (CSSRS) were assessed at 3 time points. Results There was complete device data and follow-up for 51 patients. There was an increase in the high frequency (HF) component of HRV in patients that had a 25% or greater decrease in their CSSRS (mean difference 11.89 ms/HZ; p-value 0.005). Patients with a CSSRS≥15 on day of enrollment had a lower, although not statistically significant, HF component (mean difference -8.34 ms/HZ; p-value 0.071). Conclusion We found an inverse correlation between parasympathetic activity measured through the HF component and suicidality in an acutely suicidal population of adolescents. Wearable technology may have the ability to improve outpatient monitoring for earlier detection and intervention.

While HCI researchers have begun designing personalised VR experiences for older adults, there has been limited research examining the use of social VR - where users interact via avatars in a virtual environment. Avatar-mediated communication (AMC) is a crucial component of the social VR experience, but older users’ experience with AMC is poorly understood. We conducted a five-month study with 16 older adults evaluating a co-designed social VR prototype. Results show that AMC in social VR was seen as medium that supported introverted users to express themselves and was viewed as offering advantages when discussing sensitive topics. Our study provides new insights into how older adults view AMC in social VR as a communication medium and we contribute six design reflections, based on our results, that highlight the steps that can be taken to ensure that AMC in social VR can meet the communication needs of older users.