Background Swallowing difficulties (ie, dysphagia) are common among older adults, with a 13% to 54% prevalence. Adequate interventions to improve the swallowing function of older adults would reduce morbidity and enhance health-related quality of life outcomes. Mobile health (mHealth) apps may help alleviate dysphagia symptoms by providing programs that maximize the intensity and frequency of training without requiring high costs or regular clinic visits. Objective The aim of this pilot study was to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults’ self-reported data, taking into consideration their educational levels and exposure to mobile technology. We conducted surveys and brief interviews while the participants used a swallowing intervention app we developed. We subsequently identified and resolved individual-specific usability issues to improve future implementation of the app protocol for older persons with swallowing difficulties. Methods A total of 11 participants (10 women, 91%; mean age 75.7 years, SD 3.93) from two district-run senior welfare centers took part in this study. The participants were divided into a high-potential group and a low-potential group based on their total number of years of education and smart device usage. To investigate the usability of the app twice (ie, in the second week of the intervention and the postintervention stage), we used mixed methods consisting of both quantitative approaches, namely the System Usability Scale (SUS) and modified Computer Self-Efficacy Scale (mCSES) surveys, and qualitative approaches (ie, interviews). Results The quantitative results of the SUS and mCSES surveys revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. Specifically, within the high-potential group, a Wilcoxon signed-rank test indicated that the postintervention mCSES scores (median 65.50) were significantly higher than those in the second week of intervention (median 54.00; z=–2.023, P=.04). Additionally, the usability scores in the low-potential group were within the “marginal acceptability” range even after completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional responses, and learning experience. Conclusions To the best of the authors’ knowledge, this usability and feasibility study is the first report of a swallowing training app designed to improve the swallowing function of older adults. Future research should consider several issues, such as user characteristics, pretraining education, and the intensity and innate characteristics of the intervention program.
Objectives: A decline in vocal function due to aging interferes with successful communication in daily life, and negatively affects the quality of life. As part of an appropriate intervention for presbyphonia, adherence to regular voice exercise benefits and improves therapeutic effectiveness. The purpose of this study was to investigate the efficacy of oral and pharyngolaryngeal strength training on voice using a mobile healthcare application in elderly women. Methods: Eleven participants performed 'A Successful Swallowing with Effortful Training (ASSET)' at home for eight weeks using a mobile health application. A significant training effect was identified in seven participants (7 women, mean age= 74.6± 5.7 years) who performed the protocol appropriately. The effects of the training were measured by voice function evaluation and voice-related questionnaire assessment. Results: The post-training results showed significant increases in maximum phonation time, average fundamental frequency, and cepstral peak prominence smoothed, and significant decreases in jitter local, shimmer local, and noise to harmonic ratio (NHR) (p < .05). Furthermore, a significant improvement was observed in the participants' voice-related quality of life. The long-term post-intervention evaluation showed that the improvement of NHR observed in the short-term efficacy was maintained for 12-weeks post-intervention (p < .05). Conclusion:After the oral and pharyngolaryngeal strengthening training using a mobile application, voice function and voice-related quality of life in elderly women were improved and the improvement of voice function was maintained in the long term follow-up. This training protocol can be of use as an effective voice therapy for presbyphonia.
BACKGROUND Swallowing difficulties (i.e., dysphagia) are common among older adults, with a 13%-54% prevalence rate. Adequate interventional efforts to improve the swallowing function of the elderly would reduce morbidity and improve their health-related quality of life outcomes. Mobile health (mHealth) apps may alleviate dysphagia symptoms by providing the maximum intensity and frequency of training programs without the high costs and the need for regular clinic visits. OBJECTIVE This pilot study aimed to assess the usability of swallowing training apps by quantitatively and qualitatively evaluating older adults’ self-reported data, taking into consideration their educational attainment and exposure to mobile technology. For this purpose, we conducted surveys and brief interviews while utilizing a swallowing intervention app developed by us. By doing so, we could identify and resolve individual-specific usability issues in order to improve future implementation of the app protocol for older persons with swallowing difficulties. METHODS A total of 11 participants (10 women; aged 75.7±3.93 years) from two district-run senior welfare centers took part in this study. Based on their total number of years of education and smart device usage, the participants were divided into two groups: the high-potential group and low-potential group. To investigate the usability of the app at initial- and post-intervention stages, we used mixed methods, consisting of both quantitative (i.e., System Usability Scale (SUS), modified Computer Self-Efficacy Scale (mCSES) surveys) and qualitative (i.e., interview) approaches. RESULTS Quantitative results of the SUS and mCSES revealed that the high-potential group was more inclined to adopt and learn new technology than the low-potential group. In addition, the low-potential group’s usability scores were within the “marginal acceptability” range even after the completion of an 8-week intervention program. Qualitative analyses via semi-structured interviews yielded promising outcomes regarding app acceptability, training program utilization, emotional response, and learning experience. CONCLUSIONS To the best of the authors’ knowledge, this usability and feasibility study is the first on swallowing training apps to improve the swallowing function of older adults. Considering several issues, such as user characteristics, pre-training education, and the intensity and innate characteristics of the intervention program, future research is warranted.
Objectives: Normal older persons often experience presbyphagia due to aging. This study utilized the 18-item self-reported questionnaire of the Swallowing Monitoring & Assessment Protocol (SMAP) to identify swallowing difficulties that might appear during natural aging. Methods: After excluding those with neurological disorders, dysphagia-related disorders, and/or cognitive problems, a total of 822 healthy older adults aged 65 or older (mean age= 76.88± 5.60; men:women= 277:545) were surveyed by the self-reported swallowing function questionnaire of the SMAP. The total score of the 18-item questionnaire (5-point Likert scale: 0, 1, 2, 3, 4) was extracted and the ranking was determined based on the mean score of each item. Ranking among two age groups (aged 65-74 and aged 75≤ ) was compared with a Spearman rank correlation, and the difference in total scores by age group was examined with the Mann-Whitney test. Results: The mean total score was 7.81± 7.63 (range 0-58). Swallowing problems related to 'dry mouth' , 'meal volume' , 'mealtime' , and 'choking on water or liquid' were regarded as chief complaints. There was a significant correlation between the ranking of questions by age group. The mean total score was significantly higher for groups aged 75 or older (n = 494; mean age = 80.46 ± 3.98) than those aged 65 to 74 (n= 328; mean age= 71.49± 2.51) (p < .01). Conclusion: The chief complaints for swallowing reported by older adults can be considered as main swallowing problems caused by aging. By identifying precise swallowing difficulties that appear during normal aging, we should be able to alleviate presbyphagia via early detection and intervention.
Tongue pressure is one of the effective indices of swallowing function, which decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue strengthening therapy on tongue function. Tongue exercises utilizing mobile Health (mHealth) technologies may have tremendous potential in advancing healthcare in the digital age to be more efficient for people with limited resources, especially for older adults. The purpose of this study was to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention program aimed at improving the swallowing tongue pressure in older adults. We developed a mobile health (mHealth) app for intervention which was utilized for 8 weeks (3 times/day, 5 days/week, a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age: 75.7 years) who complained of swallowing difficulties. The app was used for three therapy maneuvers: effortful prolonged swallowing (EPS), effortful pitch glide (EPG), and effortful tongue rotation (ETR). Pre-intervention and post-intervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument (IOPI). We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12-week post-intervention. Eight out of 11 participants adhered to the home-based 8-week app therapy program with optimal intervention dosage. At the main trial endpoint (i.e., 8-week) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median = 17.5 kPa at pre-intervention and 26.5 kPa at post-intervention; P < .05). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12-week post-intervention were not observed. Since swallowing tongue pressure is closely related with dysphagia symptoms, the combined methods of EPS, EPG, and ETR training have positively affected swallowing tongue pressure with their use as indirect and direct exercises. The mHealth app is a promising platform which can be used to deliver effective therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size as well as long-term effects of the intervention program, further studies are warranted. RR2-10.2196/19585
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