Non-use of information and communication technology as a predictor of frailty in postmenopausal midlife and older women

Highlights

• Frailty was found in 33.0% of our sample of 409 postmenopausal midlife and older women.

• Information and communication technology, including tablets, computers or smartphones, was used by 258 (63.1%) of the women.

• Social media, (WhatsApp or Facebook), were used by 223 (86.4%) of those 258 women.

• Non-use of information and communication technology was an independent predictor of frailty in our postmenopausal cohort.

Abstract

Background

Frailty is a clinically discernible state in which decreased physiological reserve and function result in a reduced ability to cope with stressors. Information and communication technology (ICT) has been proposed as an aid to help with frailty, yet the use of ICT by older people, particularly women, is an understudied area.

Aim

To analyze the association between use of ICT (specifically internet functions and social media) and frailty status in postmenopausal midlife and elderly women.

Methods

A cross-sectional study was designed to investigate whether frailty status is related to ICT use in postmenopausal midlife and older women. Community-dwelling women attending primary health care centers for health checks were invited to participate in the study. Postmenopausal status was the only inclusion criterion, whereas limitations that could interfere with use of ICT were exclusion criteria. The Fried phenotype was used to assess frailty. Four types of ICT use were examined: the internet for e-mail, the internet for other functions, and social media (WhatsApp or Facebook). Chi-square test and multivariate multinomial regression analysis were used to examine the association between frailty status and ICT use.

Results

We included 409 women (age = 67.45 ± 7.81 years, mean ± SD), who were frail (n = 135, 33.01%), pre-frail (n = 159, 38.87%), or robust (n  =  115, 28.11%). Frailty status was significantly and inversely associated with any ICT use, showing a strong association with use of WhatsApp (P < 0.001) and internet searches (P < 0.001). ICT non-use was a predictor of frailty, while ICT users were more likely to be robust (OR 10.62; 95% [CI], 5.34–21.10) or pre-frail (OR 9.03; [CI], 95% 5.18–15.74).

Conclusion

Postmenopausal midlife and older women not using ICT were more likely to be frail.

Introduction

Frailty is a clinically recognizable state in which the ability to cope with stressors is compromised by increased vulnerability brought on by decline in physiological reserve and function [1]. Attributes of this condition include increased risk of hospital admissions, falls, disability, institutionalization and mortality [2,3]. Ageing is a main determinant of frailty, although younger people may be frail as a result of the accumulation of specific deficits in organs or systems [4]. Frailty, therefore, has become a crucial variable in every strategy addressing healthy ageing. Moreover, the association of frailty with menopause has been recently shown [5].

The rapid development of information and communication technology (ICT) provides opportunities for end user empowerment and social connectedness, which are considered potent enablers to improve adherence to healthy lifestyle in several studies [6]. In parallel with this are efforts by institutions and governmental bodies to digitalize healthcare, such as the European Commission document “Transformation of Health and Care in the Digital Single Market”, in which citizen empowerment and person-centered care occupy a central position [7].

Implementing policy programs to extend the digital transformation of health care requires a series of conditions, of which the preparedness of the end user is pivotal. One initial limiting factor has been availability of the required technology on a wide scale, which has been largely overcome by widespread access to smartphones. Another important barrier has been digital illiteracy, which is not uniform across countries and certainly not across age groups, with older citizens significantly overrepresented in the illiterate group. Focusing on women, the so-called gender gap imposes an additional barrier due to social, economic and educational factors [8].

Of the multiple ICT-based opportunities, access to internet functions including e-mail and use of social media are the most popular. Social media in particular have further potential for promoting socialization, which is aligned with an increasing interest in social prescribing as an effective resource in medical practice [9]. Nonetheless, there is scant evidence about the prevalence of ICT use in the frail population, and even less so in women.

In this study, we explored a group of community-dwelling post-menopausal midlife and older women to gain knowledge on their use of ICT, which was defined by regular use of four types of internet options, i) access to the web, including general functions or e-mail, and ii) social media, either WhatsApp or Facebook. We investigated how ICT use related to condition of frailty. Other potentially relevant covariates were also included in the analysis.