Non-use of information and communication technology as a predictor of frailty in postmenopausal midlife and older women
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.
Section snippets
Participants
Our target population comprised community-dwelling post-menopausal women attending primary care centers for health checks. Primary care centers in the catchment area covered by our institution are engaged in an integrated care program in which the tertiary hospital provides services beyond basic health check measures when required. Women attending three specific centers between January 2018 and February 2020 were invited to enroll in a research program aimed at exploring the relationship
Descriptive data
A total of 587 women were screened, but only 409 women were enrolled, following application of exclusion criteria and omission of women with missing values. The mean age of participants was 67.45 years, with a range of 40-90 years. The mean number of years since menopause was 19.91 years, range 2-46 years. Women were slightly overweight, with an overall BMI of 27.13 ± 5.12 kg/m2 (mean ± SD), and on average had a low-medium educational level, with only 14.91% of women with university education
Discussion
Our study has shown that ICT use was inversely associated with frailty status in a cohort of postmenopausal midlife/older women. This finding was evidenced after adjusting for a list of clinical and socio-economic covariates. As a strength of our study, the frailty status of our participants was assessed by direct clinical evaluation. We found that ICT use was confirmed by 63.10% of women, a reasonable percentage considering their age and gender.
This is key information for several reasons.
Conclusion
In conclusion, we found that non-use of ICT was an independent predictor of frailty in a cohort of midlife and older postmenopausal women. Information was obtained on use of internet functions, including e-mail, and social media, specifically WhatsApp and Facebook. Both internet and social media use were consistently more frequent in robust women.
Contributors
Alicia García-Vigara participated in data collection, building the database, and the literature search, and contributed to the writing of the manuscript.
Antonio Cano participated in designing the study, the literature search, and analysis, and contributed to the writing of the manuscript.
Julio Fernández-Garrido participated in designing the study and data analysis, and contributed to the writing of the manuscript.
JA Carbonell-Asíns contributed to statistical and data analysis and interpretation
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
This work was supported by grant number 664367 FOCUS, from the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) of the European Commission, under the European Union Health Programme (20142020).
Ethical approval
This study was approved by the Comité Ético de Investigación en Humanos de la Comisión de Ética en Investigación Experimental de le Universitat de València, HI475670749430.
Provenance and peer review
This article was not commissioned and was externally peer reviewed.
Research data (data sharing and collaboration)
There are no linked research data sets for this paper. Data will be made available on request.
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