O ri g i n a l
D e c e m b e r 2 0 0 5 , Vo l 4 , N o 3
Pe rs onalD igitalA s s is tants (PD A s ) as
M e dication R e m inding Tool
s:
Expl
oring A ge D iffe re nce s in Us ab il
ity
w w w . g e r o n te c h jo u r n a l. n e t
128
Ch ris toph e r B. M ayh orn
Vince nt R. Lanz ol
l
a
M ich ae lS. W ogal
te r
A aron M . W ats on
D e partm e nt of Ps ych ol
ogy, North Carol
ina State Unive rs ity,
Ral
e igh , North Carol
ina, USA
E: Ch ris _M ayh orn@ ncs u .e du
C.B. Mayh orn, V.R. Lanz ol
l
a, M.S. W ogal
te r, A.M. W ats on, Pe rs onalD igitalAs s is tants
(PD As ) as Me dication Re m inding Tool
s : Expl
oring Age D iffe re nce s in Us ab il
ity.
Ge ronte ch nol
ogy 2005; 4(3):128-140. Purpos e M e dication adh e re nce b y ol
de r
adu l
ts can b e im portant in re tu rning to and m aintaining h e al
th . Ne w te ch nol
ogie s
m ay b e h e l
pfu lin facil
itating adh e re nce . Th is articl
e e xam ine s age diffe re nce s in
u s ab il
ity for one de vice : th e pe rs onaldigitalas s is tant (PD A ). D e s ign and M e th od In
th e e xpe rim e nt re porte d h e re , 25 ol
de r and 26 you nge r adu l
ts w e re as k e d to l
e arn
to u s e m e dication adh e re nce s oftw are s u pporte d b y a PD A . In addition to
com pl
e ting a b atte ry of cognitive te s ts and a s u rve y de s igne d to as s e s s pe rce ive d
PD A u s ab il
ity, e ach participant’s PD A s k il
lacq u is ition w as as s e s s e d ove r tim e (i.e .,
du ring training, im m e diate l
y fol
l
ow ing training, and afte r a de l
ay). R e s ul
ts
Cons is te nt w ith pre viou s re s e arch , ol
de r adu l
ts re q u ire d l
onge r to l
e arn to u s e th e
PD A and com m itte d m ore e rrors com pare d to you nge r adu l
ts . O ve r tim e , age
diffe re nce s in PD A pe rform ance w e re re du ce d s u gge s ting th at ol
de r adu l
ts m igh t
b e ne fit from PD A s as pros pe ctive m e m ory aids du ring m e dication adh e re nce .
Im pl
ications Pote ntialdire ctions for PD A training cu rricu l
a, h ardw are de s ign, and
fu tu re re s e arch are dis cu s s e d.
K e yw ords : aging, te ch nol
ogy, us ab il
ity, m e dication adh e re nce , cognitive s upport
Ol
de r adu l
ts , age d 60+ , are b e com ing incre as ingl
y aw are of th e b e ne fits of u s ing
com pu te riz e d te ch nol
ogy to e nh ance
th e ir dail
yl
ive s 1,2. W h il
e a com m on m is conce ption is th at ol
de r adu l
ts are
ave rs e to ch ange and u nw il
l
ing to u s e
ne w te ch nol
ogy s u ch as com pu te rs or
th e inte rne t, re ce nt as s e s s m e nts of
ol
de r adu l
ts ge ne ral
l
y s h ow th at th e y
pos s e s s pos itive attitu de s and e xpre s s a
w il
l
ingne s s to l
e arn to u s e th e s e
de vice s 3,4. A l
th ou gh th e s e re s u l
ts are e ncou raging b e cau s e th e y s u gge s t th at
ol
de r adu l
ts are adopting de s k top com -
pu ting te ch nol
ogy, th e findings m ay not
b e appl
icab l
e to ne w e r te ch nol
ogy th at
is b e com ing avail
ab l
e to th e pu b l
ic. Cu rre nt tre nds in de vice de s ign are trans itioning from traditionalde s k top w ork s tations to m ob il
e , h andh e l
d de vice s
s u ch
as pe rs onal digital as s is tants
(PD A s ) and ce l
l
ul
ar te l
e ph one s 5. It is u ncl
e ar w h e th e r th e s e ne w e r, m iniatu riz e d
de vice s w ou l
d b e of b e ne fit to ol
de r
adu l
ts give n w e l
l
-docu m e nte d pe rce ptu al
, m otor, and cognitive de cl
ine s 6,7.
O w ne rs h ip of h andh e l
d de vice s is b e -
O ne are a w ith in th e re al
m of h e al
th care
th at is particu l
arl
y prob l
e m atic for ol
de r
adu l
ts is m e dication adh e re nce w h ich
h as b e e n de fine d as a patie nt u s ing doctor pre s crib e d m e dication as dire cte d 11.
Corre ct adh e re nce e ntail
s tak ing th e
m e dication at th e corre ct tim e s , at th e indicate d dos age , and fol
l
ow ing any s pe cialins tru ctions as dire cte d on th e l
ab e l
(w h ich can b e q u ite com pl
icate d). D u e
to th e ons e t of ch ronic conditions s u ch
as os te oarth ritis and h ype rte ns ion, th e
ave rage ol
de r adu l
t u s e s 4-5 pre s cription m e dications concu rre ntl
y and it is
not u ncom m on for s om e ol
de r adu l
ts to
u s e as m any as 10 or m ore 12,13.
Th e cons e q u e nce s of im prope r m e dication u s age can b e s e ve re , and are in fact
s tagge ring. In te rm s of h u m an s u ffe ring, one re ce nt s tu dy indicate d th at
m ore th an 2.2 m il
l
ion pe opl
e are h os pital
iz e d e ach ye ar for s e riou s adve rs e
dru g re actions and th at approxim ate l
y
106,000 pe opl
e l
os e th e ir l
ive s du e to
m e dication e rror e ach ye ar14. Th e annu ale conom ic cos t of m e dication-re l
ate d
e rrors in th e Unite d State s al
one h as
b e e n e s tim ate d at ne arl
y US$85 m il
l
ion15. W h il
e a nu m b e r of variab l
e s s u ch
as il
l
ne s s re pre s e ntation, patie nt-doctor
com m u nication, m e dication l
ab e l
ing,
and patie nt m otivation h ave b e e n e xpl
ore d to e xpl
ain th e cau s e s of m e dication-re l
ate d e rror, th e cognitive as pe cts
of th e m e dication adh e re nce tas k h ave
b e e n th e focu s of nu m e rou s s tu die s 16.
Cognitive factors s u ch as com pl
e xity of
s ch e du l
e , nu m b e r of pre s crib ing ph ys icians , and nu m b e r of m e dications al
l
te nd to corre l
ate w ith non-adh e re nce 13.
A n e s tim ate d 71% of non-adh e re nce is
u nde r u s e of th e m e dication, in l
arge
part du e to forge tfu l
ne s s 17.
Re m e m b e ring to tak e m e dication re q u ire s th e u s e of pros pe ctive m e m ory
w h ich can b e de fine d as re m e m b e ring
to pe rform an action s om e tim e in th e
fu tu re 13. O ne w ay to as s is t in th e accom pl
is h m e nt of pros pe ctive m e m ory tas k s
is to provide cognitive s u pport. H e re ,
cognitive s u pport re fe rs to th e as s is tive
as pe cts of te ch nol
ogy th at e nh ance th e
m e ntalcapab il
itie s (and avoid th e l
im itations ) of u s e rs . For ins tance , active s u pports s u ch as al
arm cl
ock s cal
latte ntion
to th e m s e l
ve s and h ave b e e n s h ow n to
b e e ffe ctive in facil
itating pros pe ctive
m e m ory18.
Give n th e s e findings , PD A s h ave th e pote ntialto b e ne fit individu al
s of al
lage s
w h o h ave com pl
icate d m e dication s ch e dul
e s . Th e s e de vice s can re l
ie ve th e individu alof h aving to re l
y on m e m ory to re tain de tail
s of h is or h e r s ch e du l
e and
oth e r pe rtine nt m e dication-re l
ate d inform ation (e .g., tak e w ith m il
k , afte r dinne r) as w e l
las s e rving as a s ou rce of active s u pport b y activating an al
arm to
annou nce a s ch e du l
e d dos age . A rgu ab l
y, a nu m b e r of e xis ting e xte rnal
m e m ory aids s u ch as voice m ailre m ind-
129
w w w . g e r o n te c h jo u r n a l. n e t
com ing incre as ingl
y u b iq u itou s am ong
u s e rs of al
lage grou ps 8, ye t th e u s ab il
ity ne e ds of ol
de r adu l
ts h ave re ce ive d
ve ry l
ittl
e atte ntion. Cons ide r th e re ce nt
tre nd in com b ining th e b as ic fu nctional
ity of ce l
l
ul
ar te l
e ph one s w ith th e advance d com pu ting attrib u te s of PD A s .
PD A s are h andh e l
d com pu te rs th at pos s e s s m ul
tipl
e fe atu re s s u ch as addre s s
b ook s , to-do-l
is ts , and cal
e ndars th at
can s e rve a m ne m onic fu nction. Be cau s e
PD A s are b e com ing incre as ingl
y affordab l
e and al
l
ow portab l
e acce s s to inform ation, th e l
ik e l
ih ood th at ol
de r adu l
ts
can b e ne fit from adopting th e u s e of
th e s e ne w de vice s is prom is ing. For ins tance , PD A s m igh t re du ce th e ris k of inju ry to ol
de r adu l
ts b y is s u ing w arnings
th at cal
latte ntion to th e m s e l
ve s and de l
ive r s afe ty inform ation w h e n and w h e re
it is ne e de d 9 . For th e s e re as ons , advance s in w ire l
e s s te ch nol
ogy h ave b e e n
h ail
e d as one approach to m e e ting th e
h e al
th care ne e ds of ol
de r adu l
ts in th e
ne w m il
l
e nniu m 10.
D e c e m b e r 2 0 0 5 , Vo l 4 , N o 3
PD A s a n d O ld e r A d u lts
D e c e m b e r 2 0 0 5 , Vo l 4 , N o 3
PD A s a n d O ld e r A d u lts
w w w . g e r o n te c h jo u r n a l. n e t
130
ing s ys te m s , vib rating w ris tw atch e s , and
s pe cialpil
ldis pe ns e rs are com m e rcial
l
y
avail
ab l
e and l
ik e l
y to im prove m e dication adh e re nce 11,13. H ow e ve r, s e ve rall
im itations of th e s e de vice s m ay m ak e
th e m l
e s s e ffe ctive at m e dication re m inding th an PD A s . For ins tance , th e voice m ailre m inding s ys te m w il
lonl
y b e e ffe ctive if pe opl
e re m ain in cl
os e proxim ity
to a te l
e ph one and m ay not b e cos t e ffe ctive in te rm s of s e tu p. Vib rating w ris tw atch e s m ay provide an active re m inde r
al
arm th at s om e th ing h as to b e done at
a particu l
ar tim e b u t pe rtine nt m e dication-re l
ate d inform ation (i.e ., w h at m e dication m u s t b e tak e n; prope r dos age ,
e tc.) is not avail
ab l
e . Lik e w is e , s pe cial
pil
ldis pe ns e rs m ay provide th e ne e de d
m e dication-re l
ate d inform ation b u t l
ack
th e active al
arm s ys te m . Th u s , PD A s
m igh t b e m ore s u cce s s fu l th an th e s e
oth e r de vice s b e cau s e th e y com b ine th e
fe atu re s of affordab il
ity (as th e de vice s
b e com e m ore w ide l
y dis s e m inate d), portab il
ity, acce s s to m e dication-re l
ate d inform ation, and active al
arm s ys te m s .
you nge r and ol
de r adu l
ts on a PD A b as e d m e dication s ch e du l
ing tas k on
th re e s e parate occas ions . Tas k pe rform ance data s u ch as tim e to com pl
e te th e
tas k s and e rror produ ction w e re s u ppl
em e nte d w ith s u b je ctive m e as u re s of pe rce ive d u s ab il
ity. Th e goalw as to de te rm ine w h e th e r age diffe re nce s in
pe rform ance infl
u e nce d th e l
ik e l
ih ood
to u s e th e s e de vice s in th e fu tu re .
O b viou s l
y th e pote ntial financial and
h e al
th b e ne fits of PD A u s age b y ol
de r
adu l
ts are gre at, ye t th e re al
iz ation of
th is pote ntialis de pe nde nt on th e ir u s ab il
ity w ith re s pe ct to th is s pe cialpopu l
ation. For ins tance , cu rre nt PD A s u til
iz e
s m al
lLCD dis pl
ays th at h ave l
e s s ab il
ity
to dis pl
ay s h arp contras ts th an l
arge r
m onitors do. Scre e n s iz e , and th e re fore
font, icon, and control s iz e is l
im ite d
m ak ing for gre ate r difficu l
ty in re ading
and m anipu l
ating th e inte rface . W h il
e it
h as b e e n re porte d th at ol
de r adu l
ts
h ave difficu l
ty w ith
te xt e ntry on
PD A s 19 , oth e r as pe cts incl
u ding th e ove ral
lu s ab il
ity of th e s e de vice s w ith ol
de r
adu l
t s am pl
e s h ave not b e e n inve s tigate d. A l
th ou gh ol
de r adu l
ts h ave appare ntl
y adopte d traditionalde s k top com pu te rs , th is s tu dy w il
lfocu s on h ow w e l
l
th e y can l
e arn to u s e h andh e l
d de vice s .
Th u s , th e pu rpos e of th e pre s e nt s tu dy
w as to com pare th e pe rform ance of
Tw e nty-s ix you nge r (m e an age of 18.6
ye ars , SD = 1.36, range = 18-23) and 25
ol
de r (m e an age of 67.3 ye ars , SD =
5.24, range = 60-76) adu l
ts participate d. Th e you nge r participants w e re re cru ite d from an u nde rgradu ate re s e arch
participant pool and re ce ive d partial
cou rs e cre dit. Th e ol
de r participants
w e re com m u nity-dw e l
l
ing adu l
ts w h o
w e re re cru ite d from com pu te r e du cation
cl
as s e s at a l
ocals e nior ce nte r and paid
for th e ir participation. O nl
y participants
w ith s om e com pu te r e xpe rie nce and no
PD A e xpe rie nce w e re al
l
ow e d to participate . Th is w as done to e ns u re at l
e as t
m inim alcom pu te r l
ite racy and ye t not introdu ce th e confou nding variab l
e of
prior PD A e xpe rie nce . Te s ting w as divide d into tw o e xpe rim e ntal s e s s ions
s u ch th at D ay 1 w as com pris e d of grou padm inis te re d de m ograph ics and ab il
itie s te s ts w h e re as D ay 2 w as com pos e d
of individu alPD A ins tru ction and te s ting.
M ETH
OD
D e s ign and Participants
A 2 (age : you nge r vs . ol
d) X 3 (tim e of
as s e s s m e nt: practice , im m e diate as s e s s m e nt,
de l
aye d
as s e s s m e nt) m ixe d
factorialde s ign w as u s e d. A ge w as th e
b e tw e e n s u b je cts grou ping variab l
e and
tim e of as s e s s m e nt w as a w ith in s u b je ct
variab l
e . Th e de pe nde nt variab l
e s w e re
tim e on tas k and nu m b e r of e rrors
m ade . Each de pe nde nt variab l
e h ad
th re e m e as u re s s u ch th at th e re w as one
for e ach ph as e of th e training: practice ,
im m e diate as s e s s m e nt, and de l
aye d as s e s s m e nt.
PD A s a n d O ld e r A d u lts
A b atte ry of cognitive te s ts w as adm inis te re d to al
lparticipants and incl
u de d
m e as u re s of vocab u l
ary21, re ading com pre h e ns ion22, s patialab il
itie s 23, w ork ing
24
m e m ory , and pe rce ptu al s pe e d 25.
M e an pe rform ance for e ach age grou p is
l
is te d in Tab l
e 1. O l
de r participants pe rform e d s ignificantl
y b e tte r th an you nge r
participants on th e vocab u l
ary te s t,
t(49 ) = 3.09 , p < .01. H ow e ve r, you nge r
adu l
ts pe rform e d s ignificantl
y b e tte r
th an th e ol
de r adu l
ts on th e m e as u re s
of w ork ing m e m ory, re ading com pre h e ns ion, s patial ab il
ity, and pe rce ptu al
s pe e d; t(49 ) = 2.20, p < .05, t(49 ) =
3.12, p < .01, t(49 ) = 6.44, p < .001,
t(49 ) = 8.46, p < .001, re s pe ctive l
y. Col
l
e ctive l
y, th e s e patte rns of re s u l
ts indicate d th at th e s am pl
e s w e re re pre s e ntative of th e ir re s pe ctive popu l
ations .
D e c e m b e r 2 0 0 5 , Vo l 4 , N o 3
pu te r te ch nol
ogy.
131
Stim ul
us M ate rial
s
Participants w e re as k e d to e nte r inform ation into a com m e rcial
l
y avail
ab l
e m e dication track ing s oftw are pack age on a
PD A . Th e PD A s w e re th e Pal
m Z ire , u til
iz ing th e Pal
m ope rating s ys te m , w ith a
160x160 pixe l m onoch rom e dis pl
ay.
Th e O n-Tim e Rx s oftw are w as u s e d b e cau s e it w as adve rtis e d b y th e m anu factu re r as ‘intu itive and e as y to u s e ’ 26.
Tab l
e 1. Group Me ans (Standard D e viations in pare nth e s e s ) for Te ch nol
ogy Expe rie nce and Cognitive Me as ure s ;a TotalScore from th e Sh ipl
e y Vocab ul
ary Te s t21;b Num b e r of trial
s corre ctl
y re cal
l
e d on th e Al
ph ab e t Span Te s t24;c TotalScore from th e Ne l
s on-D e nne y Re ading Com pre h e ns ion Te s t22;d Num b e r of trial
s corre ctl
y com pl
e te d on
th e Pape r Fol
ding Te s t23;e TotalScore on th e D igit Sym b olSub s titution Te s t25
Variab l
e
Younge r (n = 26)
Ol
de r (n = 25)
TCEQ - Com pu te r Expe rie nce
TCEQ -W e b Us e
TCEQ -W e b Expe rie nce
Vocab u l
arya
W ork ing M e m oryb
Re ading Com pre h e ns ionc
SpatialA b il
ityd
Pe rce ptu alSpe e d e
35.5
13.4
20.2
28.8
36.0
31.9
13.8
70.3
30.1 (11.5)
9 .5 (4.8)
13.9 (8.9 )
32.7 (4.7)
29 .1 (9 .2)
25.2 (9 .3)
7.8 (3.6)
49 .5 (8.8)
(3.4)
(1.4)
(6.2)
(4.5)
(12.9 )
(5.5)
(3.0)
(8.8)
w w w . g e r o n te c h jo u r n a l. n e t
D e m ograph ic and ab il
itie s inform ation
w as col
l
e cte d for th e pu rpos e of de s crib ing th e tw o s am pl
e s . W h e n participants
e val
u ate d th e ir ge ne ralh e al
th on a s cal
e
of 1 (‘Poor’) to 5 (‘Exce l
l
e nt’), m e an re s pons e s from b oth age grou ps approxim ate d 4 (‘Ve ry Good’) s u ch th at no age -re l
ate d diffe re nce s in pe rce ive d h e al
th
e m e rge d, p = .36. To de s crib e th e l
e ve l
of e du cation th at th e y h ad com pl
e te d,
participants u s e d a s cal
e of 1 (‘Le s s
th an h igh s ch ool
’) to 7 (‘M D , JD , Ph D ,
oth e r advance d de gre e ’). Th e m e an re s pons e for th e you nge r adu l
ts approxim ate d 3 (‘Som e col
l
e ge ’) w h il
e th at of th e
ol
de r adu l
ts w as s ignificantl
y h igh e r and
approxim ate d 4 (‘Bach e l
or’s de gre e ’);
t(49 ) = 4.33, p < .001. A s il
l
u s trate d in
Tab l
e 1, th e te ch nol
ogy e xpe rie nce and
u s age q u e s tionnaire (TCEQ )20 w as u s e d
to as s e s s participants ’ e xpe rie nce w ith
and u s age of com pu te rs and th e w orl
d
w ide w e b . O l
de r adu l
ts re porte d s ignificantl
y l
e s s e xpe rie nce w ith com pu te rs
and th e w orl
d w ide w e b th an you nge r
adu l
ts ; t(49 ) = 2.32, p < .05, t(49 ) =
2.89 , p < .01, re s pe ctive l
y. O l
de r adu l
ts
al
s o re porte d u s ing th e w orl
d w ide w e b
l
e s s th an you nge r adu l
ts , t(49 ) = 3.9 4, p
< .001. Th u s , th e s am pl
e s w e re ge ne ral
l
y h e al
th y, b u t varie d s ignificantl
y in
te rm s of th e ir e du cation and re porte d
u s age /e xpe rie nce w ith de s k top com -
PD A s a n d O ld e r A d u lts
D e c e m b e r 2 0 0 5 , Vo l 4 , N o 3
Th e on-s cre e n k e yb oard w as u s e d as it
is O n-Tim e Rx’s de fau l
t m e th od of data
e ntry.
w w w . g e r o n te c h jo u r n a l. n e t
132
Bas e d on pil
ot te s ting w ith ol
de r adu l
ts ,
th e m anu alprovide d b y th e O n-Tim e Rx
s oftw are m anu factu re r w as de e m e d inade q u ate for u s e b y participants . To cl
arify, th e com m e rcial
l
y avail
ab l
e m anu al
l
ack e d proce du ralde tail
, provide d onl
y
ab b re viate d te xt-b as e d ins tru ctions for
s oftw are u s age , and did not provide
s te p-b y-s te p il
l
u s trations to gu ide pe rform ance . To addre s s th e s e is s u e s , a
tas k anal
ys is w as condu cte d. Bas e d on
th e re s u l
ts of th e tas k anal
ys is , an il
l
us trate d m anu al(avail
ab l
e from th e firs t au th or u pon re q u e s t) w as cons tru cte d to
te ach th e participants to u s e th e O nTim e Rx s oftw are . Th e m anu al il
l
us trate d e ve ry s te p ne ce s s ary to e nte r a
m e dication’s inform ation. Participants
l
e arne d to u s e th e PD A and s oftw are b y
fol
l
ow ing th e ins tru ctions in th e m anu al
to pe rform a m e dication e ntry tas k du ring th e practice ph as e of training. Th is
active l
e arning m e th od, w h ich pairs ins tru ction w ith h ands -on action, h as
b e e n s h ow n to b e m ore e ffe ctive th an
s im pl
y re ading ins tru ctions for ol
de r
adu l
ts 27.
Be cau s e m e dication e ntry w as accom pl
is h e d th rou gh th e u s e of th e PD A
s tyl
u s , a s tyl
u s te s te r program w as de ve l
ope d b y th e e xpe rim e nte rs to e ns u re
a m inim u m l
e ve lof com pe te ncy w ith th e
s tyl
u s and th e tap-s cre e n inte rface . Th e
program random l
y pl
ace d a b ox on th e
s cre e n and th e participants h ad to tap
th e inte rior of th e b ox w ith in tw o
s e conds . Th is w as re pe ate d 20 tim e s .
A n 85% s u cce s s rate w as cons ide re d m inim u m com pe te ncy. Participants w e re
give n th re e atte m pts to re ach m inim u m
com pe te ncy. A l
lparticipants w e re ab l
e
to attain th e m inim all
e ve lof com pe te ncy.
Proce dure
O n D ay 1 of te s ting, grou ps of u p to 10
participants com pl
e te d a de m ograph ic
q u e s tionnaire and th e cognitive b atte ry
du ring an e xpe rim e ntals e s s ion th at l
as te d for approxim ate l
y tw o h ou rs . O n
D ay 2 (non-cons e cu tive ), participants
w e re individu al
l
y te s te d for ne ar-norm al
vis ion (de fine d as 20/40 corre cte d), and
th e ab il
ity to accu rate l
y u s e a s tyl
us .
Th e y w e re th e n te s te d for th e ir ab il
ity to
l
e arn th e proce du re s ne ce s s ary for m e dication e ntry on th e PD A program .
Participants w e re give n th e ins tru ction
m anu aland as k e d to fol
l
ow th e m anu al
s te p b y s te p to practice e nte ring a m e dication (practice as s e s s m e nt). Th e y w e re
th e n as k e d to e nte r a s e cond m e dication (initial as s e s s m e nt). Th e Eve ryday
Cognition Batte ry Re as oning Q u e s tionnaire 28, w as th e n give n as a dis tracte r
tas k , for a pe riod of 25-30 m inu te s to re du ce th e l
ik e l
ih ood of re h e ars alof th e
PD A proce du re du ring th e inte rve ning
pe riod. H aving com pl
e te d th e dis tracte r
tas k , participants w e re as k e d to e nte r a
th ird m e dication (de l
aye d as s e s s m e nt).
A s ins tru ction u s e is not m andatory in
re all
ife , u s e of th e ins tru ction m anu al
w as optionalfor th e initialand de l
aye d
as s e s s m e nts . Th is w as done to m ak e
th e tas k as natu ral
is tic as pos s ib l
e . An
e xpe rim e nte r w as pre s e nt at al
ltim e s ,
th ou gh th e participants w e re e ncou rage d to pe rform as m u ch of th e w ork on
th e ir ow n as pos s ib l
e w ith ou t as k ing th e
e xpe rim e nte r for as s is tance .
To e nte r a m e dication, participants
e nte re d th e nam e of th e m e dication, th e
dos age , nu m b e r of dos e s pe r day and
th e ir adm inis tration tim e s , fre q u e ncy
(dail
y, w e e k l
y, m onth l
y), and any s pe cial
adm inis tration ins tru ctions (e .g., afte r
m e al
s , at b e dtim e ). Th e y w e re th e n to re vie w th e dail
y s ch e du l
e s cre e n to ve rify
th e accu racy of th e ir w ork . For e ach
trial
, th e e xpe rim e nte r w atch e d and re corde d tim e on tas k and e rror produ c-
PD A s a n d O ld e r A d u lts
1) O ve ral
l
, I am s atis fie d w ith h ow e as y
it is to u s e th e PD A .
2) Th e PD A w as s im pl
e to u s e .
3) I cou l
d e ffe ctive l
y e nte r m e dication inform ation into th e PD A .
4) It w as e as y to l
e arn to u s e th e PD A .
5) W h e ne ve r I m ade a m is tak e u s ing th e
PD A , I cou l
d re cove r e as il
y and
q u ick l
y.
6) I am l
ik e l
y to u s e a PD A in th e fu tu re .
Each s tate m e nt w as accom panie d b y a
Lik e rt-type s cal
e w ith w h ol
e -nu m b e r anch ors ranging from one to s e ve n. O n
th e s cal
e , 1 w as l
ab e l
l
e d ‘s trongl
y dis agre e ’, 4 w as l
ab e l
l
e d ‘ne u tral
’, and 7
w as l
ab e l
l
e d ‘s trongl
y agre e ’.
1) D e s crib e one th ing you cons ide r b e s t
ab ou t th is PD A .
2) D e s crib e one th ing you cons ide r
w ors t ab ou t th is PD A .
3) D e s crib e s om e th ing ne w you w ou l
d
m os t w is h to s e e in a fu tu re ve rs ion
of a PD A .
A fte r participants com pl
e te d th e q u e s tionnaire , th e y w e re paid for th e ir tim e ,
de b rie fe d, and e xcu s e d.
R ESULTS
To as s e s s age diffe re nce s in PD A pe rform ance , a s e rie s of anal
ys e s w e re condu cte d. Firs t, tas k pe rform ance in te rm s
of tim e on tas k and e rror produ ction
w as anal
yz e d. Se cond, z e ro-orde r corre l
ations w e re u s e d to de te rm ine th e re l
ations h ip b e tw e e n tas k pe rform ance and
s pe cific cognitive ab il
itie s du ring th e
de l
aye d as s e s s m e nt. Th ird, b as e d on
th e corre l
ational anal
ys e s , a s e rie s of
h ie rarch icalre gre s s ions w e re condu cte d
to de te rm ine w h ich pre dictor variab l
es
w e re m os t im portant in produ cing PD A
pe rform ance du ring th e de l
aye d as s e s s m e nt. Fou rth , th e re s u l
ts of th e pe rce ive d u s ab il
ity s u rve y w e re e xam ine d
to de te rm ine w h e th e r th e age grou ps
h el
d diffe ring opinions on PD A u s ab il
ity.
Al
ph a l
e ve l
s of al
lanal
ys e s w e re s e t to
.05.
A nal
ys e s of PD A Tas k Pe rform ance
Th re e 2 (A ge ) X 3 (Tim e of A s s e s s m e nt)
re pe ate d m e as u re s anal
ys e s of variance
w e re pe rform e d on th e de pe nde nt variab l
e s of (1) tim e on tas k , (2) nu m b e r of
cognitive e rrors , and (3) nu m b e r of
m otor controle rrors . A nal
ys is of tim e
on tas k re ve al
e d a m ain e ffe ct of age ,
F(1, 49 ) = 56.82, p < .001. A l
s o s ignificant w e re th e m ain e ffe ct of tim e of as s e s s m e nt, F(2, 9 8) = 141.5, p < .001,
and th e inte raction of age and tim e of
D e c e m b e r 2 0 0 5 , Vo l 4 , N o 3
To s u ppl
e m e nt th e pe rform ance data de rive d from th e e xpe rim e ntals e s s ion, participants com pl
e te d a s u rve y de s igne d
to as s e s s th e pe rce ive d u s ab il
ity of th e
PD A . Th e s u rve y incl
u de d s ix u s ab il
ity
agre e m e nt ratings and th re e ope ne nde d q u e s tions re garding PD A fe atu re
u til
ity. To as s e s s th e pe rce ive d u s ab il
ity
of th e PD A h ardw are , participants w e re
as k e d to rate th e ir agre e m e nt on s tate m e nts conce rning: (i) ove ral
l s atis faction, (ii) s im pl
icity of ope ration, (iii) e as e
of m e dication inform ation e ntry, (iv)
e as e of l
e arning, (v) e rror re cove ry, and
(vi) l
ik e l
ih ood of fu tu re u s e . Th e s pe cific
s tate m e nts w e re :
Ne xt, participants w e re as k e d to com pl
e te th e fol
l
ow ing ope n-e nde d q u e s tions re garding u til
ity ju dgm e nts of th e
‘b e s t’, ‘w ors t’, and ‘fu tu re ’ PD A fe atu re s :
133
w w w . g e r o n te c h jo u r n a l. n e t
tion. Errors w e re cl
as s ifie d as e ith e r cognitive or m otor control
. Som e e xam pl
es
of cognitive e rrors are forge tting to incl
u de a s te p (e .g. not s e tting th e s ch e dul
e to re pe at), adding a s te p (e .g. ch anging th e fre q u e ncy w h e n th e de fau l
t is
corre ct), re pe ating a s te p, or e vide ncing
s e arch e rrors (e .g., re pe ate dl
y re tu rning
to th e s am e page s in th e m e nu ). M otor
controle rrors occu rre d w h e n th e participant m is s e d a targe t, m ove d th e s tyl
us
off th e targe t du ring s e l
e ction, or fail
ed
to pre s s h ard e nou gh to activate th e targe t.
D e c e m b e r 2 0 0 5 , Vo l 4 , N o 3
PD A s a n d O ld e r A d u lts
w w w . g e r o n te c h jo u r n a l. n e t
134
as s e s s m e nt, F(2, 9 8) = 12.9 7, p < .001.
Th e s e re s u l
ts il
l
u s trate th at th e you nge r
adu l
ts w e re fas te r at com pl
e ting th e m e dication e ntry tas k th an ol
de r adu l
ts
acros s trial
s (Tab l
e 2). Tu k e y’s H SD te s t
indicate d th at participants of b oth age
grou ps took m ore tim e in th e practice as s e s s m e nt (M = 465.9 1 s ), th an in initial
(M = 284.53 s ) w h ich in tu rn w as gre ate r
th an th e am ou nt of tim e s pe nt on th e
de l
aye d as s e s s m e nt (M = 165.9 1 s ).
Th e pre s e nce of th e inte raction s h ow e d
th at th e ge ne ral
iz e d de cre as e in tim e
w as not as cons is te nt for th e you nge r
adu l
ts as for th e ol
de r adu l
ts . Th is patte rn of m e ans is l
ik e l
y du e to a fl
oor e ffe ct. Th e you nge r adu l
ts s e e m e d to
re ach a point of dim inis h ing re tu rns on
practice , w h il
e th e ol
de r adu l
ts continu e d to im prove . It s h ou l
d b e note d th at
e ach age grou p m ade s ignificant im prove m e nt
acros s
as s e s s m e nts ;
h ow e ve r, th e ol
de r adu l
ts fail
e d to ob tain th e s am e l
e ve lof proficie ncy as th e
you nge r adu l
ts .
rors m ade in th e initialas s e s s m e nt th an
in practice or de l
aye d as s e s s m e nt. Th is
finding is cons is te nt w ith th e e col
ogical
l
y val
id natu re of th e tas k b e cau s e u s e
of th e ins tru ctions w as m andatory in
practice , b u t optionalfor th e oth e r trial
s.
A nal
ys is of m otor controle rrors s h ow e d
a m ain e ffe ct of age , F(1, 49 ) = 13.06, p
= .001. Th e re w as al
s o a m ain e ffe ct of
tim e of as s e s s m e nt, F(2,9 8) = 3.16, p =
.05; b u t no inte raction of age and tim e
of as s e s s m e nt, F(2,9 8) = 1.66, p > .05.
Th e ol
de r grou p h ad a m u ch l
arge r variance , b u t th e m e ans of th e l
as t tw o as s e s s m e nts are q u ite s im il
ar. Both age
grou ps ’ m otor control e rrors de cl
ine d
acros s trial
s (Tab l
e 2).
Corre l
ation A nal
ys e s
A s e rie s of z e ro-orde r corre l
ations w e re
pe rform e d on de m ograph ic variab l
es
s u ch as age and pre viou s com pu ting e xpe rie nce , cognitive m e as u re s from th e
ab il
itie s te s ts , and th e de pe nde nt variab l
e s (i.e ., tim e on tas k , cognitive e rrors
and m otor-control e rrors ) du ring th e
de l
aye d as s e s s m e nt. Th e focu s on th e
de l
aye d as s e s s m e nt re fl
e cts an e ffort to
de te rm ine th e re l
ations h ip b e tw e e n th e
variou s cognitive factors th at m igh t infl
u e nce PD A pe rform ance afte r l
e arning
h as occu rre d.
A nal
ys is of th e cognitive e rrors s h ow e d
a m ain e ffe ct of age , F(1, 49 ) = 19 .75, p
< .001, and tim e of as s e s s m e nt, F(2, 9 8)
= 54.61, p < .001, ye t th e inte raction of
age and tim e of as s e s s m e nt fail
e d to
re ach s ignificance , F(2, 9 8) = 2.55, p >
.05. Th e you nge r adu l
ts m ade fe w e r cognitive e rrors acros s trial
s (Tab l
e 2). Each
age grou p dis pl
aye d a s im il
ar patte rn of
pe rform ance , in th at th e re w e re m ore e r-
Th e re s u l
ts il
l
u s trate d in Tab l
e 3 s u gge s te d th at th e re w as a com pl
e x re l
ation-
Tab l
e 2. Group Me ans (M) and Standard D e viations (SD ) for Tim e on Tas k , Cognitive
and Motor Errors
Tim e of
A s s e s s m e nt
Practice
Initial
Del
aye d
Group
You nge r
Ol
d
You nge r
Ol
d
You nge r
Ol
d
Tim e on Tas k in
s e conds
M
308
623
152
416
97
234
SD
63
216
54
19 1
15
106
Cognitive Errors
M
0.9 2
4.52
3.31
5.76
1.9 2
3.60
SD
1.3
4.39
2.35
3.62
1.16
2.00
M otor Errors
M
1.27
4.04
1.12
3.38
1.04
2.64
SD
1.34
3.88
1.37
3.50
2.4
2.83
PD A s a n d O ld e r A d u lts
Tim e on tas k
In th e de l
aye d as s e s s m e nt; age , w e b
u s e , com pu te r e xpe rie nce , pe rce ptu al
s pe e d, and w e b e xpe rie nce al
ladde d s ignificantl
y to th e m ode l
, accou nting for
al
m os t 85% of th e variance , R 2= .845,
F(1,48) = 4.9 6, p < .01. Th e s e re s u l
ts
im pl
y th at k now l
e dge trans fe rs from th e
PC e nvironm e nt to tim e l
y PD A tas k pe rform ance ; w e b u s e , com pu te r u s e and
w e b e xpe rie nce w e re e ach s ignificant inde pe nde nt of ch ronol
ogical age . Th e
onl
y s ignificant cognitive pre dictor, pe rce ptu als pe e d, s u gge s ts th at th e ab il
ity
to trans pos e inform ation from th e ins tru ction m anu al to th e PD A inte rface
q u ick e ne d s pe e d of pe rform ance .
Cognitive e rrors
H ie rarch icalre gre s s ion for th e nu m b e r
of cognitive e rrors ob s e rve d du ring th e
de l
aye d as s e s s m e nt indicate d th at age
and re ading com pre h e ns ion e ach contrib u te d s ignificantl
y to th e m ode land
accou nte d for approxim ate l
y 35% of th e
variance , R 2= .354, F(1, 48) = 7.82, p <
.01. Th e infl
u e nce of re ading com pre h e ns ion on l
ate r PD A pe rform ance
m igh t re pre s e nt an e ffe ct of diffe re ntial
re te ntion of th e k now l
e dge gl
e ane d
from practice s u ch th at th os e w h o s u cce s s fu l
l
y com pre h e nde d th e ins tru ctions
l
ocate d in th e m anu alw e re m ore l
ik e l
y
Tab l
e 3. Z e ro-orde r Corre l
ations of Pre dictors and O utcom e Me as ure s during D e l
aye d
As s e s s m e nt;* p < .05. ** p < .01
Variab l
es
A ge
Del
aye d
Tim e
A ge
Pe rce ptu alSpe e d
SpatialA b il
ity
Re ading Com pre h e ns ion
W ork ing M e m ory
TCEQ -W e b Us e
TCEQ -W e b Expe rie nce
TCEQ -Com pu te r Expe rie nce
1.0
-.77**
-.67**
-.41**
-.32*
-.43**
-.34*
-.26
.65**
-.70**
-.59 **
-.57**
-.42**
-.79 **
-.63**
-.76**
Del
aye d Cognitive
Errors
.5**
-.41**
-.44**
-.50**
-.34*
-.30*
-.22
-.13
Del
aye d M otor
Errors
.36**
-.22
-.18
-.19
-.25
-.30*
-.25
-.03
D e c e m b e r 2 0 0 5 , Vo l 4 , N o 3
R e gre s s ion A nal
ys e s
A s e rie s of h ie rarch icalre gre s s ions w e re
pe rform e d on e ach of th e ou tcom e m e as u re s of tim e on tas k and cognitive e rrors du ring th e de l
aye d as s e s s m e nt. Be cau s e
th e
s tandard pre dictors
of
com pu te r pe rform ance h ave not ye t
b e e n as s e s s e d in th e PD A e nvironm e nt,
th e nu m b e r of pre dictor variab l
e s and
th e ir orde ring in e ach h ie rarch icalre gre s s ion w e re gu ide d b y th e corre l
ational
anal
ys e s . A s none of th e cognitive or e xpe rie nce variab l
e s s trongl
y corre l
ate d
w ith th e occu rre nce of m otor controle rrors du ring th e de l
aye d as s e s s m e nt, th e
occu rre nce of m otor controle rrors w il
l
not b e dis cu s s e d fu rth e r. To controlfor
ch ronol
ogical age , th is variab l
e w as
e nte re d firs t in al
lre gre s s ions fol
l
ow e d
b y th e re m aining cognitive and e xpe rie nce variab l
e s th at corre l
ate d w ith e ach
crite rion variab l
e (i.e ., tim e on tas k and
cognitive e rrors ).
135
w w w . g e r o n te c h jo u r n a l. n e t
s h ip b e tw e e n de m ograph ic variab l
e s,
cognitive fu nction, and PD A pe rform ance . Cons is te nt w ith pre viou s anal
ys e s ,
age w as corre l
ate d w ith al
lof th e cognitive and de m ograph ic variab l
e s. Al
l of
th e de m ograph ic and cognitive m e as u re s w e re s ignificantl
y corre l
ate d w ith
tim e on tas k w h e re as onl
y cognitive
m e as u re s corre l
ate d w ith cognitive e rror
produ ction. Inte re s tingl
y, s e l
f-re porte d
w e b -u s e (r = -.3) w as corre l
ate d w ith th e
nu m b e r of m otor control e rrors ob s e rve d, h ow e ve r, none of th e cognitive
m e as u re s w e re re l
ate d.
D e c e m b e r 2 0 0 5 , Vo l 4 , N o 3
PD A s a n d O ld e r A d u lts
w w w . g e r o n te c h jo u r n a l. n e t
136
to avoid cognitive e rrors du ring th e
de l
aye d as s e s s m e nt. Bas e d on th e corre l
ationalanal
ys e s , th e cognitive variab l
es
for w ork ing m e m ory, s patialab il
ity, and
pe rce ptu als pe e d w e re e nte re d into s u cce s s ive s te ps of th e re gre s s ion proce du re b u t e ach fail
e d to e xpl
ain a s ignificant am ou nt of variance and w il
lnot b e
dis cu s s e d fu rth e r in th is re port.
Us ab il
ity Surve y A nal
ys e s
Us ab il
ity agre e m e nt ratings
Th e m e an u s ab il
ity agre e m e nt ratings
for e ach age grou p are pre s e nte d in
Tab l
e 4. For al
lite m s , th e m e an agre e m e nt rating w as ab ove 4.80 w h ich indicate s th at e ach age grou p on ave rage
h el
d pos itive attitu de s re garding th e ir
firs t e xpe rie nce w ith PD A s . T-te s t com paris ons re ve al
e d age diffe re nce s in pe rce ive d u s ab il
ity for five of th e s ix s tate m e nts . You nge r adu l
ts rate d th e PD A s
as s ignificantl
y e as ie r and s im pl
e r to
u s e and rate d th e e as e of l
e arning to
u s e th e de vice s as h igh e r th an th at re porte d b y th e ol
de r adu l
ts ; t(49 ) = 2.80, p
<.01, t (49 ) = 3.42, p <.01, and t (49 ) =
2.46, p <.01, re s pe ctive l
y. Fu rth e rm ore ,
you nge r adu l
ts al
s o rate d th e ir e ffe ctive ne s s at e nte ring m e dication s ch e du l
ing
inform ation and e rror re cove ry as h igh e r th an th at of th e ol
de r adu l
ts ; t(49 ) =
2.69 , p <.01 and t (49 ) = 4.65, p <.01, re s pe ctive l
y. Com paris ion of th e re m aining finalm e an ratings re ve al
e d no age
diffe re nce s on th e s tate m e nt re garding
th e l
ik e l
ih ood of fu tu re u s e . Inte re s tingl
y, th e ol
de r adu l
ts (M = 5.24) rate d
th e ir l
ik e l
ih ood of fu tu re u s e as s l
igh tl
y,
b u t not s ignificantl
y h igh e r th an th at re porte d b y th e you nge r adu l
ts (M =
5.15).
Re s pons e s to ope n-e nde d q ue s tions
Re s pons e s to th e ope n-e nde d q u e s tions
w e re trans crib e d and code d b y tw o inde pe nde nt rate rs . Pe rce ntage agre e m e nt
b e tw e e n th e ratings of th e code rs w as
cal
cu l
ate d to de te rm ine inte r-rate r re l
iab il
ity. Th e h igh pe rce ntage agre e m e nt
w h ich w as 9 7.6% indicate d th at th e coding s ch e m e w as ade q u ate l
y de fine d and
re l
iab l
e.
W h e n as k e d for th e BEST ‘th ing’ ab ou t
th e PD A , th e you nge r adu l
ts gave th e fol
l
ow ing re s pons e s : 15 (58%) s tate d th at
th e de vice w as ge ne ral
l
y e as y to u s e , 12
(46%) note d th e s m al
l
/portab l
e s iz e of
th e de vice , and 4 (15%) m ade re fe re nce
to its pote ntialu s e for pe rs onalorganiz ation. Th e ol
de r adu l
ts gave th e fol
l
ow ing re s pons e s to th e s am e q u e s tion: 11
(44%) note d th e s m al
l
/portab l
e s iz e , 6
(24%) s tate d th at th e dis pl
ay w as e as y to
re ad, and 3 (12%) note d th at th e q u al
ity
of th e m e nu /s cre e n organiz ation m ade
th e de vice e as y to u s e . Th u s , you nge r
and ol
de r adu l
ts w e re ge ne ral
l
y in agre e m e nt re garding th e ir opinion of th e
‘b e s t’ fe atu re s of th e PD A : portab il
ity
and e as e of u s e .
W h e n as k e d for th e W O RST ‘th ing’ ab ou t
th e PD A , you nge r adu l
ts gave th e fol
l
ow ing re s pons e s : 9 (35%) dis l
ik e d th e
s m al
ldis pl
ay s cre e n, 5 (19 %) com m e nte d on th e m onoch rom e dis pl
ay, w h il
e
Tab l
e 4. Me an us ab il
ity agre e m e nt ratings ;Standard D e viations in pare nth e s e s ;
*
p < .01
Q ue s tion
Younge r
O ve ral
ls atis faction
Sim pl
icity of ope ration
Eas e of inform ation e ntry
Eas e of l
e arning
Error re cove ry
Lik e l
ih ood of fu tu re u s e
6.42
6.50
6.62
6.46
6.31
5.15
(.64)
(.71)
(.50)
(.65)
(.84)
(1.9 1)
Ol
de r
5.72
5.68
5.9 6
5.9 2
4.80
4.24
(1.10)*
(.9 9 )*
(1.14)*
(.9 1)*
(1.41)*
(1.48)
W h e n as k e d to de s crib e ‘s om e th ing
NEW ’ in fu tu re ve rs ions of th e PD A , 6
(23%) you nge r participants m ainl
y e xpre s s e d re vis ions to th e vis u al l
ayou t
(e .g., s h ape , col
or, b u tton configu ation)
of th e de vice , w h e re as 5 (19 %) e xpre s s e d a pre fe re nce for a col
or s cre e n.
By contras t, 3 (12%) ol
de r adu l
ts w ante d
voice inte raction, 2 (8%) w ante d an e m e rge ncy b u tton (e .g., 9 11) for rapid-as s is tance com m u nication, and 2 (8%) re q u e s te d a l
arge r, col
or s cre e n. Le s s fre q u e nt
re s pons e s incl
u de d: b ack l
igh ting of th e
dis pl
ay, privacy m e as u re s for m e dication inform ation, and b e tte r s ou nd fe atu re s . Th u s , oth e r th an b oth age grou ps
e xpre s s ing inte re s t in a col
or s cre e n,
th e tw o grou ps diffe re d in th e ir pre fe re nce for fu tu re de s ign. Th e you nge r
adu l
ts w ante d ch ange s to th e vis u all
ayou t w h e re as ol
de r adu l
ts w ante d fu tu re
PD A s to incl
u de voice inte raction and an
e m e rge ncy b u tton.
D ISCUSSIO N
Col
l
e ctive l
y, th e re s u l
ts from th e cu rre nt
e xpe rim e nt il
l
u s trate th at ol
de r adu l
ts
can l
e arn to u s e PD A -b as e d m e dication
adh e re nce appl
ications if give n th e appropriate training. Fu rth e rm ore , th e s e
findings indicate d th at m any of th e
tre nds ob s e rve d in pre viou s s tu die s th at
inve s tigate d de s k top com pu te r s k il
lacq u is ition29 w ith ol
de r adu l
ts w e re al
so
pre s e nt w h e n PD A s k il
lacq u is ition w as
e xpl
ore d. Firs t, ol
de r adu l
ts re q u ire d
m ore tim e to com pl
e te th e PD A -b as e d
m e dication e ntry tas k and com m itte d
m ore cognitive and m otor e rrors th an
you nge r adu l
ts . Se cond, th e PD A pe rform ance of ol
de r adu l
ts im prove d in
te rm s of re du ce d tim e on tas k and e rror
com m is s ion ove r tim e ye t th e y fail
e d to
re ach th e s am e l
e ve l of proficie ncy
de m ons trate d b y th e you nge r adu l
ts . Final
l
y, th e q u al
itative re s pons e s from th e
s u rve y of PD A u s ab il
ity indicate d th at
de s pite age diffe re nce s in pe rce ive d u s ab il
ity b e tw e e n you ng and ol
de r adu l
ts ,
th e ol
de r adu l
ts re taine d th e ir ge ne ral
l
y
pos itive
attitu de s
re garding de vice
u s age .
A prim ary m otivation for th is re s e arch
w as to de te rm ine w h e th e r u s ab il
ity-re l
ate d is s u e s m igh t act as b arrie rs to re du ce or e l
im inate th e pote ntialb e ne fits
of u s ing PD A s to e nh ance m e dication adh e re nce . A l
th ou gh m e dication adh e re nce w as not te s te d dire ctl
y in th is e xpe rim e nt, th e pe rform ance of th e ol
de r
adu l
ts w as e ncou raging b e cau s e th e y
continu e d to im prove ove r tim e w ith
practice . Spe cifical
l
y, ol
de r adu l
ts com pl
e te d th e m e dication e ntry tas k m ore
q u ick l
y and w ith fe w e r cognitive and
m otor e rrors as th e ir e xpe rtis e w ith th e
PD A gre w . Im portantl
y, th e re s u l
ts of
th e re gre s s ion anal
ys e s h igh l
igh te d th e
ne e d for e ffe ctive training program s to
m axim iz e th e u s ab il
ity of th e s e h andh el
d de vice s . Be cau s e pe rce ptu als pe e d
and re ading com pre h e ns ion e xpl
aine d a
portion of th e variance in th e de pe nde nt
variab l
e s of tim e on tas k and cognitive
e rror produ ction, re s pe ctive l
y, a nu m b e r
of training de s ign re com m e ndations
m igh t b e cons ide re d to m e e t th e ne e ds
of ol
de r adu l
ts . For ins tance , it is im pe rative th at ins tru ction doe s not progre s s
at a rate too fas t for ol
de r adu l
ts give n
th e ir re du ce d proce s s ing s pe e d 1. Lik e -
137
w w w . g e r o n te c h jo u r n a l. n e t
oth e rs 2 (8%) de s crib e d prob l
e m s u s ing
th e s tyl
u s and 2 (8%) e xpre s s e d difficu l
ty re ading th e s cre e n b e cau s e of
gl
are . Th e ol
de r adu l
ts gave th e fol
l
ow ing re s pons e s to th e s am e q u e s tion: 5
(20%) dis l
ik e d th e s m al
ls cre e n dis pl
ay,
4 (16%) e xpre s s e d annoyance at th e
ide a of k e e ping th e de vice w ith th e m ,
and 4 (16%) de s crib e d difficu l
ty w ith th e
s tyl
u s . Le s s fre q u e nt re s pons e s incl
u de d: s m al
lb u tton s iz e , u nappe al
ing
appe arance of th e PD A , and poor s cre e n
contras t m ak ing th e de vice dis pl
ay difficu l
t to re ad. Th u s , th e age grou ps w e re
ge ne ral
l
y in agre e m e nt th at th e s m al
ldis pl
ay s iz e and difficu l
ty m anipu l
ating th e
s tyl
u s re du ce d pe rce ive d PD A u s ab il
ity.
D e c e m b e r 2 0 0 5 , Vo l 4 , N o 3
PD A s a n d O ld e r A d u lts
D e c e m b e r 2 0 0 5 , Vo l 4 , N o 3
PD A s a n d O ld e r A d u lts
w w w . g e r o n te c h jo u r n a l. n e t
138
w is e , re ading com pre h e ns ion of ins tru ctions m igh t b e facil
itate d b y th e u s e of
el
ab orative m e m ory s trate gie s and th e
u s e of e xpl
icit s ignal
s th at h igh l
igh t th e
m ain ide as and re l
ations in th e te xt1,3.
M ore ove r, th e finding th at pre viou s
de s k top com pu ting e xpe rie nce is pre dictive of PD A s k il
l acq u is ition s u gge s ts
th at it m ay b e u s e fu l
l
y appl
ie d to th e de ve l
opm e nt of training cu rricu l
a. A s ne w
inform ation is u s u al
l
y inte rpre te d in th e
conte xt of th e pre -e xis ting k now l
e dge
b as e , ins tru ctionalm ate rial
s s h ou l
d be
pre s e nte d u s ing fam il
iar te rm inol
ogy
th at capital
iz e s on th e pre viou s de s k top
e xpe rie nce s of ol
de r adu l
ts to facil
itate
l
e arning9 ,30.
O f cou rs e , th e s u cce s s of any te ch nol
ogy-re l
ate d training program w il
lh inge
on th e attitu de s of th e ol
de r adu l
ts u nde rgoing training30,31. Be cau s e pre viou s
re s e arch s u gge s ts th at ol
de r adu l
ts w h o
vie w com pu te r te ch nol
ogy as b e ing u s e fu lto th e m are al
s o m ore l
ik e l
y to u s e
th e s e de vice s 32, th e findings from th e u s ab il
ity s u rve y are particu l
arl
y ins igh tfu l
in de te rm ining w h e th e r ol
de r adu l
ts are
l
ik e l
y to u s e PD A s ou ts ide of th e l
ab oratory. A nal
ys is of th e s u rve y data re ve al
ed
th at al
th ou gh th e m e an u s ab il
ity ratings
for five of th e s ix s tate m e nts did vary b y
age , ol
de r adu l
ts re taine d ge ne ral
l
y pos itive attitu de s in s pite of difficu l
tie s e xpe rie nce d du ring th e m e dication e ntry tas k .
M os t s u rpris ing w as th e finding th at
ol
de r adu l
ts e xpre s s e d a l
arge r m e an
agre e m e nt th an you nge r adu l
ts to th e
l
ik e l
ih ood of u s ing PD A s in th e fu tu re .
A ne cdotal
l
y, th e s e findings w e re fu rth e r
s u b s tantiate d b y s e ve ralof th e ol
de r participants u s ing th e m one y e arne d from
s tu dy participation to pu rch as e th e ir
ow n PD A s .
W h e n as k e d to m ak e u til
ity ju dgm e nts
of PD A fe atu re s , opinions of th e ‘b e s t’
and ‘w ors t’ fe atu re s w e re ge ne ral
l
y cons is te nt acros s age grou ps . H ow e ve r, th e
patte rn of re s u l
ts for ‘fu tu re ’ fe atu re s
are s u gge s tive . W h il
e th e you nge r participants appe are d to b e inte re s te d in al
te ring th e appe arance of PD A s for m ore
ae s th e tic pu rpos e s , th e ide as of th e
ol
de r adu l
ts w e re m ore as s ociate d w ith
im proving fu nction to com pe ns ate for re du ce d u s ab il
ity. A l
th ou gh b oth age
grou ps de s crib e d difficu l
ty w ith u s ing
th e s tyl
u s as one of th e ‘W ors t’ fe atu re s
of th e PD A , onl
y th e ol
de r adu l
t s u gge s tion of voice inte ractivity approxim ate s
a de s ign s ol
u tion. Lik e w is e , th e re q u e s t
for an e m e rge ncy as s is tance b u tton s u gge s ts th at ol
de r adu l
ts are aw are of
th e ir pote ntialne e d to u s e s u ch a fe atu re to com pe ns ate for ph ys icalvu l
ne rab il
ity. M ore ove r, th e s e data il
l
u s trate
th e val
u e of u s ing ol
de r adu l
ts to te s t
th e u s ab il
ity of de vice s s u ch as PD A s b e cau s e u s e rs in oth e r age grou ps m ay
al
s o b e ne fit from th e incl
u s ion of fe atu re s th at incre as e s afe ty and privacy
fu nctional
ity33,34.
W h il
e th e re s u l
ts of th is s tu dy are pote ntial
l
y inform ative for fu tu re PD A training
cu rricu l
a and h ardw are de s ign, a nu m b e r of l
im itations m u s t b e m e ntione d.
Firs t, th is s tu dy w as a b e s t-cas e s ce nario— onl
y re l
ative l
y wel
l e du cate d and
h e al
th y ol
de r adu l
ts participate d in th is
s tu dy. Th e ave rage ol
de r adu l
t w il
ll
ik e l
y
m ak e m ore e rrors , and h ave gre ate r difficu l
ty w h ich cou l
d re s u l
t in cl
inical
l
y s ignificant re du ctions in m e dication adh e re nce . Se cond, th e b e h avior of a
re l
ative l
y s m al
l s am pl
e of individu al
s
from e ach age grou p w as ob s e rve d du ring a re l
ative l
y b rie f pe riod. Th e incl
us ion of a PD A s k il
las s e s s m e nt s e ve ral
w e e k s afte r th e com pl
e tion of training
s h ou l
d b e inform ative in de te rm ining
h ow w e l
ls u ch s k il
l
s are m aintaine d ove r
tim e . Th u s , cau tion m u s t b e u s e d in inte rpre ting tre nds in th e data. Th ird, PD A
u s e m e as u re s and pe rce ive d u s ab il
ity
ratings w e re col
l
e cte d in th e control
l
ed
e nvironm e nt of th e l
ab oratory w h e re al
l
of th e participants w e re aw are th at th e y
w e re b e ing ob s e rve d. To addre s s th e s e
PD A s a n d O ld e r A d u lts
R e fe re nce s
1. M ayh orn CB, Stronge A J, M cLau gh l
in A C, Roge rs W R. O l
de r adu l
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and th e s ys te m s approach : A form u l
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2. Roge rs W A , M ayh orn CB, Fis k A D . Te ch noK w on S, Bu rdick D , e ditors , Ge rote ch nol
ogy:
Re s e arch and practice in te ch nol
ogy and
Be cau s e ol
de r adu l
ts com m onl
y e xpre s s
th e de s ire to re tain th e ir fu nctionalinde pe nde nce 35, it is cl
e ar th at one approach
to as s is ting th e m to ach ie ve th is goalis
th rou gh th e de ve l
opm e nt of te ch nol
ogy
tail
ore d to m e e t th e ir s pe cific ne e ds .
W h e th e r th e prom is e of e nh ance d m e dication adh e re nce can b e re al
iz e d b y ove rcom ing th e u s ab il
ity b arrie rs th at ol
de r
adu l
ts e ncou nte r w ith PD A s is an e m piricalq u e s tion ripe for fu rth e r re s e arch . Fu tu re w ork in th is are a w il
lfocu s on e fforts to re du ce e rror produ ction b y
is ol
ating
pe rce ptu al and
cognitive
factors as s ociate d w ith diffe re nt type s
of e rrors . Th rou gh th e ide ntification of
u s ab il
ity is s u e s cou pl
e d w ith k now l
e dge
of de s ign re com m e ndations b as e d on
pre viou s cognitive aging and h u m an
factors re s e arch , th e de s ign of ne w and
e m e rging te ch nol
ogie s s u ch as PD A s
m ay offe r an opportu nity to prom ote s u cce s s fu laging, im prove d s afe ty, and pe rs onal e m pow e rm e nt th rou gh m u ndane
tas k s s u ch as m e dication adh e re nce .
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de r
adu l
ts : D e s ign ch al
l
e nge s and opportu nitie s .
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de r adu l
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l
ul
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iz e d w ire l
e s s indu s try re s ul
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h ttp://fil
e s .ctia.org/ pdf/CTIA Ye ar-
A ck now l
e dge m e nts
Th is w ork w as s u pporte d b y a Facu l
ty Re s e arch and D e ve l
opm e nt Grant to th e
firs t au th or from North Carol
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Unive rs ity. Portions of th is w ork w e re
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d cons ide r ob s e rving th e natu ral
is tic b e h avior of l
arge r, m ore dive rs e s am pl
e s s u ch as s pe cial ne e ds
popu l
ations w ith in th e ol
de r de m ograph ic w h e re actu al m e dication adh e re nce
data is col
l
e cte d ove r tim e to provide a
m ore accu rate as s e s s m e nt of s k il
lre te ntion and com pl
iance .
PD A s a n d O ld e r A d u lts
Law re nce Erl
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m an, D . M anu alfor K it of Factor Re fe re nce d
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