E-Health for Older People: The Use of Technology in Health Promotion.

E-Health for Older People: The Use of Technology
in Health Promotion
MIMI M. Y. TSE, Ph.D., R.N., 1 KIM C. Y. CHOI, B.S.N., R.N.,2 and RINCY S.W. LEUNG, B.S.N., R.N.3
ABSTRACT
To meet the needs of frail older people and to promote functional longevity, providing health
education and disease prevention to the elderly is important. The present study describes the
development, implementation, and evaluation of an e-health program for older persons. The
objective of the 4-week e-health program was to improve elders’ autonomous access to and
use of health-related information in the form of physical exercise videography from a government-
sponsored Web site. The content of the program included participants’ mastery of
basic computing skills and accessing and enhancing participants’ interest in seeking healthrelated
knowledge and information via the Internet. Data were collected in weeks 1 (pretest)
and 4 (posttest) using questionnaires and open-ended questions. Thirty older people participated
in the study (9 males, 21 females, aged 65–80 years, with the mean age of 72). Participants’
mastery of basic computer operating skills increased significantly (p ? 0.05); they were
able to access health information via the Internet and had gained health-related knowledge
by week 4 posttest (p ? 0.05). The overall learning experience was positive. In conclusion, the
collaboration of community partners in sponsoring a technology-based e-health program
would be an effective way to provide health education to older people.
電子健康老年人：該技術使用
健康促進
我的軍事工業化謝，博士，註冊護士，1金賽揚財，學士學位進修，註冊護士，2和RINCY西南梁，B.S.N.，R.N.3
摘要
為了滿足需求，老年人和體弱促進長壽功能，提供健康
教育和預防疾病的老人非常重要。本研究介紹
開發，實施和評價的電子保健方案的老年人。該
目標 4週電子保健方案，以改善老年人的自主利用和
使用健康有關的信息的形式的體育鍛煉錄像從政府
贊助網站。該計劃內容包括學員精通
基本的計算機技能和獲取，提高參與者的興趣，尋求健康相關
知識和信息通過因特網。資料收集在1週（前測）
和4（後測）通過問卷調查和開放式問題。 30老年人參加
在研究中（9男21女，年齡 65-80歲，平均年齡 72）。參加者
掌握基本的電腦操作技能明顯提高（P？0.05）;他們
能夠獲得健康信息，並通過互聯網獲得的與健康有關的知識
通過 4週後測性（P？0.05）。整體的學習經驗是積極的。最後，
社區合作夥伴贊助的技術為基礎的電子健康計劃
將是一個有效的方式提供健康教育，老年人。

INTRODUCTION
TO MEET THE NEEDS of frail older people and to promote
functional longevity, it is important for
older people to receive health education for developing
healthy habits, maintaining health, and preventing
disease. The growth and implementation of
Web-enabled communication and patient services, as
well as e-health initiatives, enable patients, their families,
and their caregivers to access useful information
and resources;1 thus, the quality of services and
care can be improved. E-health is the use of Internet
technology and electronic communication to support
the delivery and management of health care services.
1–2 Internet users represent a large population
seeking information, and many are seeking healthrelated
information. Approximately 60 million adults
sought health-related information in 2000.1,3
Despite the advantages of the Internet and advances
in electronic communication, utilization of
the Internet among older adults in Chinese societies
is relatively low; only 2% of adults aged 65 or older
in Hong Kong and 0.8% of adults aged 60 or older
in mainland China are Internet users.4 One of the
reasons may be the low literacy level among older
people in Hong Kong and China; also, they have
limited access to computers, making them a difficult-
access group in terms of Internet and computer
usage.5 It was therefore the aim of the present study
to attempt to collaborate with a community center
for the elderly, using an e-health education program
to provide health education to older people. The objectives
of the present study include (a) mastery of
basic computer skills for older people; (b) enabling
older people to access health information via the Internet;
and (c) improving elderly people’s health-related
knowledge.
引言
以滿足需要的體弱老人和促進
長壽功能，它是重要的
老年人接受健康教育的發展
健康的生活習慣，保持健康，預防
疾病。的成長和實施
支持Web的通訊和病人服務，
以及電子保健措施，讓病人，家屬，
和他們的照顧者，以獲取有用信息
和資源; 1因此，質量和服務
護理可以改善。電子健康是使用互聯網
技術和電子通信支持
交付和管理的衛生保健服務。
1-2互聯網用戶佔人口眾多
尋求信息，許多人尋求健康相關
信息。大約 60萬成年人
尋求與健康有關的信息，2000.1,3
儘管互聯網的優勢和墊款
在電子通訊，利用
在互聯網中老年人在華人社會
比較低，只有2％的成年人65歲以上的老年人
在香港和0.8％的成年人60歲以上的老年人
大陸中國是互聯網 users.4之一
原因可能是老年人文化水平低
人在香港和中國，也有
限制使用電腦，使他們難以
訪問組中的條款，互聯網和電腦
usage.5因此在本研究的目的
嘗試與社區合作中心
老人，使用電子健康教育計劃
提供健康教育，老年人。的目標
本研究包括：（1）精通
基本的計算機技能的老年人;（二）使
老年人獲得保健信息通過互聯網;
及（c）改善老人的健康相關
知識。

METHODS
Sample
This was an illustrative case study. Thirty older
people attending community centers were invited
to participate in an e-health education program. The
inclusion criteria were (a) being an older person
who scored 24 or above on the Mini Mental Status
Examination and (b) being able to speak, understand,
and read Cantonese. Those with severe visual
impairment and functional deficits that would
hinder learning and operating the computer were
excluded.
E-health program: Objectives, implementation,
and evaluation
The 4-week e-health program (1.5 hrs per week)
was held in the activity room of an elderly center.
The objective of the e-health program was to improve
elders’ autonomous access to and use of
health-related information in the form of physical
exercise videography from a government-sponsored
Web site. The content of the e-health program
included mastery of basic computing skills and accessing
government health Web sites that provide
health information regarding exercise. Participants
were invited to perform exercise as recommended
on the Web sites, and the process was videotaped
and subsequently viewed on video compact disc
(VCD). The contents and expected outcomes of the
program are itemized in Table 1.
Pre- and post-questionnaires about the e-health
program, a knowledge test, and focus group interviews
were used. Participants were asked to complete
a questionnaire in week 1 (pretest) and in week
4 (posttest). A 5-point Likert scale (1, not very much;
5, a great deal) was used. Knowledge gained after
browsing the Web site was accessed using true and
false questions. The face validity of the questionnaires
and true and false questions were established
by the research team. Also, the test–retest reliability
was established (r 0.93) by repeat testing
among five older people.
Focus groups were conducted at the end of the
e-health program for participants and staff working
in the elderly center. Data collection ceased when
saturation was achieved. The interviews were audiotaped
and transcribed. Related content was clustered
by themes and further analyzed into categories
for comparison and discussion.
方法
樣本
這是一個典型案例研究。 30老
人被邀請參加社區中心
參與電子健康教育計劃。該
納入標準分別為：（1）作為一個老年人
誰得分24或以上的迷你精神狀態
考試及（b）能夠說話，理解，
並宣讀粵語。那些有嚴重視覺
損害和功能缺損，將
妨礙學習和操作電腦的
排除在外。
電子保健方案：目標，執行，
和評價
4週電子保健方案（每週 1.5小時）
在舉行活動室的老人中心。
客觀的電子保健方案，以改善
長者自主獲取和利用
與健康有關的資料，實物的形式
演習錄像從政府資助
網站。內容的電子保健方案
包括掌握基本的計算機技能和獲取
政府衛生網站提供
關於衛生信息工作。與會者
被邀請的建議做運動
在這些網站上，整個過程進行了錄像
並隨後觀看視頻光盤
（光碟）。內容和預期成果的
分項計劃是在表1。
前和後的問卷對電子保健
方案，知識測試，焦點小組訪談
使用了。參與者被要求完成
本週一在一份調查問卷（預試）和週
4（後測）。阿五點李克特尺度（1，沒有多大;
5，一個偉大的交易）的使用。後獲得的知識
瀏覽該網站被訪問使用真實
虛假的問題。表面效度的問卷
和真正的和虛假的問題，建立
由研究團隊。此外，可靠性測試Etest法
成立（註冊商標 0.93）的重複測試
其中5老年人。
焦點小組進行，最後的
電子保健方案的參與者和工作人員的工作
在老人中心。數據收集時停止
飽和度達到了。在訪談錄音
和轉錄。相關內容是群集
按主題進行分類，並進一步分析
進行比較和討論。


RESULTS
Demographic data
Thirty older people (9 males, 21 females) participated
in the study (Table 2).
Mastery of computer skills, interest, and health-related
knowledge gained via the e-heath program
Table 3 shows a significant increase in mastery of
computer skills and interest in accessing health information
via the Internet after the 4-week e-health
program; knowledge of health information in the
area of physical exercise also increased significantly
(p ? 0.05). Participants were able to operate the
computer and access health information via the Internet,
and they expressed confidence in their ability
to do so. Participants were also found to have
increased their knowledge after reading information
on the Web sites, with a significant increase in
giving correct answers to health-related questions.
Focus group interview
Focus group interviews revealed that elderly center
staff were impressed by the active involvement
of the older persons in the e-health program. Staff
felt that providing such programs through elderly
centers would be useful. The following comments,
made by participants during the focus group interviews,
highlight their reactions to the e-health program
and their concerns about using technology.
Explore the technology. “It provides an opportunity
to explore technology that we had not imagined
before.” “I could obtain health information.
There is a lot of information out there, and I was
able to use it.”
Language barrier and lower education level. “We
don’t know many words.” “People think we are oldfashioned,
so there’s no need to learn about computers.”
“We can’t even type. How are we supposed
to manage Chinese typing?”
Physical disabilities. “Poor eye–hand coordination
makes it difficult for us to use the mouse.” “When
sitting for a period of time, I get severe low back
pain. It annoys me.”
Limited resources. “We live alone and on CSSA
[Comprehensive Social Security Assistance]. How
can we get a computer?”
Lack of guidance. “I don’t know where to get help;
my friends don’t know about computers, and they
cannot discuss computer use with me.” “I don’t
know the addresses of these Web sites.”
結果
人口統計數據
30老年人（男9例，女21）參加
在研究中（表2）。
掌握計算機技能，興趣，以及與健康有關
獲得的知識通過電子健康計劃
表3顯示了顯著增加精通
計算機技能和興趣在獲取衛生信息
通過互聯網後 4週的電子健康
方案;知識的健康信息在
面積也顯著增加體育鍛煉
（P值0.05）。參加者能夠操作
計算機和獲得保健信息通過互聯網，
他們表示，相信他們有能力
這樣做的。與會者還發現有
增加他們的知識在閱讀信息
在這些網站上，有顯著增加
給予正確的答案與健康有關的問題。
焦點團體訪談
焦點小組訪談發現，老人中心
工作人員留下深刻印象的積極參與
對老年人在電子保健方案。員工
認為，這種方案通過提供長者
中心將是有益的。以下評論，
與會者提出，在焦點團體訪談，
他們的反應突出的電子保健方案
他們的關注和使用技術。
探索這一技術。 “它提供了一個機會
探索技術，我們沒有想到
前。“”我可以得到健康的信息。
有很多信息在那裡，而我
可以使用它。“
語言障礙和教育程度較低。 “我們
不知道很多的話。“”人們認為我們是老式，
因此沒有必要學習電腦。“
“我們甚至不能類型。我們應該如何
管理中文打字？“
身體殘疾。 “可憐的手眼協調
使我們難以用鼠標“。”當
坐在一期的時候，我得到嚴厲的腰背
疼痛。這讓我很煩。“
有限的資源。 “我們獨居及領取綜援
[綜合社會保障援助]。如何
我們可以得到一台電腦？“
缺乏指導。 “我不知道在哪裡可以得到幫助;
我的朋友們不知道的電腦，他們
不能討論計算機使用我。“”我不
知道了這些網站的地址。“

DISCUSSION
The present study demonstrated an innovative
way of using the Internet to search for health information
and improve health promotion among
community-dwelling older adults. With the collaboration
of community services, the use of technology
in the form of an e-health program would be
an effective tool in providing health education to
older people. Computer skills, interest in accessing
health information, and health knowledge gained
were found among the 30 participants. It is suggested
that attending the e-health program helped
to build their confidence in searching health-related
Web sites and that they benefited from information
obtained from these Web sites. Therefore, the ehealth
program and the use of Internet technology
will be a new trend in health promotion and health
education among the older population.6
As older populations and their vulnerability to
health problems increase, e-health education can
help to enhance their health status.7 The use of ehealth
education can help promote healthy habits
and lifestyles and increase health knowledge among
older people. Continual and regular provision of ehealth
programs for older people will bring positive
health outcomes to older adults and to society as a
whole.
討論
目前的研究表明一種創新
使用互聯網的方式來搜索健康資訊
健康促進和改善中
社區中居住的老年人。隨著合作
社區服務，使用的技術
在表格的電子保健方案將
一個有效的工具，提供健康教育
老年人。計算機技能，興趣訪問
衛生信息，健康知識獲得
發現其中30人參加。這是建議
，出席電子保健方案幫助
建立自己的信心，查找與健康有關
網站，他們從信息中受益
從這些網站獲得。因此，電子衛生保健
方案和互聯網技術的使用
將是一個新趨勢，健康促進和健康
教育的老population.6
隨著老年人口和易受
健康問題的增加，電子健康教育能
有助於提高他們的健康status.7電子衛生保健的使用
教育可以幫助促進健康的生活習慣
和生活方式，提高健康知識調查
老年人。持續和定期提供電子衛生保健
方案將帶來積極的老年人
對老年人健康的成果和社會作為一個
整體。


REFERENCES
1. Nazi KM. The journey to e-health: VA Healthcare Network
Upstate New York (VISN 2). Journal of Medical
Systems 2003; 27:35–45.
2. Oh H, Rizo C, Enkin M, et al. What is eHealth? A systematic
review of published definitions. Journal of
Medical Internet Research 2005; 7:e9.
3. Moody LE. E-health Web portals: delivering holistic
healthcare and making home the point of care. Holistic
Practice 2005; 19:156–60.
4. Census and Statistics Department. (2003) Hong Kong as
an information society. Hong Kong: HKSAR Government
Census & Statistics Department.
5. Lai CKY, Arthur DG, Chau WWH. Implication of Internet
growth on enhancing health of disadvantaged
groups in China: a global perspective. International
Journal of Older People Nursing and Journal of Clinical
Nursing 2004; 13:68–73.
6. Oermann MH, Hamilton J, Shook ML. Using the Web
to improve seniors’ awareness of their role in preventing
medical errors. Journal of Nursing Care Quality
2003; 18:122–8.
7. Nahm ES, Preece J, Resnick B, et al. Usability of health
Web sites for older adults: a preliminary study. Computers,
Informatics, Nursing 2004; 22:326–34.

ICT-based health information services for elderly people: Past experiences, current trends, and future strategies

Author(s): Marschollek M (Marschollek, Michael)1, Mix S (Mix, Stefan)2, Wolf KH (Wolf, Klaus-H.)1, Effertz B (Effertz, Beate)2, Haux R (Haux, Reinhold)1, Steinhagen-Thiessen E (Steinhagen-Thiessen, Elisabeth)2
Source: MEDICAL INFORMATICS AND THE INTERNET IN MEDICINE Volume: 32 Issue: 4 Pages: 251-261 Published: DEC 2007
Times Cited: 4 References: 60 Citation Map
Abstract: Although health information is readily available on the Internet and has changed the way people deal with their health in many ways, the retrieval of relevant information remains problematic, especially for elderly people. With a focus on elderly people, this paper summarizes current trends in consumer health informatics, discusses past and present intiatives providing health-information services, and proposes a future strategy for the design of sustainable services. A systematic literature review and a review of past German and EU projects concerned with health information services for elderly people are given. Many publications focus on health information services for specific diseases and on their quality and semantic accessibility, yet few deal with presenting and customizing health information for elderly and disabled people. Past experiences from Germany suggest that very often the specific needs of this target group are not met, and therefore accessibility remains largely hypothetical. We propose a strategy with five key points for the design of sustainable health-information services for elderly people. More research is needed to customize web-based health information services to the needs of the user group that needs them most urgently-elderly and disabled people.
儘管衛生信息，隨時可在因特網上，並改變了人們處理他們的健康在許多方面，檢索相關信息仍然是個問題，尤其適用於老年人。重點在老人，本文總結了當前的趨勢，消費者的健康信息，探討過去和現在 intiatives提供衛生信息服務，並提出了未來戰略的設計可持續的服務。有系統的文獻回顧和檢討過去的德國和歐盟的項目涉及衛生信息服務的老人給予。許多出版物集中在衛生信息服務的特定疾病，其質量和語義可及性，但很少提出處理信息和定制健康老人和殘疾人。從以往的經驗表明，很多時候德國的具體需要這一目標的群體是沒有達到，因此在很大程度上無障礙假設。我們提出了一個戰略，5個關鍵點的設計可持續的健康信息服務的老人。需要更多的研究來定制網絡為基礎的衛生信息服務的需求的用戶組，他們最迫切需要的長者及殘疾人士。
Document Type: Article
Language: English
Author Keywords: elderly people; health information services; consumer health informatics; telematics; telemedicine
KeyWords Plus: WORLD-WIDE-WEB; MEDICO-LEGAL MODEL; BIOMEDICAL INFORMATICS; OLDER-ADULTS; EDUCATION SYSTEM; BREAST-CANCER; INTERNET; QUALITY; SUSTAINABILITY; INSTRUMENTS
Reprint Address: Marschollek, M (reprint author), Tech Univ Carolo Wilhelmina Braunschweig, Inst Med Informat, Muehlenpfordstr 23, D-38106 Braunschweig, Germany
Addresses:
1. Tech Univ Carolo Wilhelmina Braunschweig, Inst Med Informat, D-38106 Braunschweig, Germany
2. Charite Univ Med Berlin, Res Grp Geriatr, Evangel Geriatriezentrum, Berlin, Germany
E-mail Addresses: m.marschollek@mi.tu-bs.de
Publisher: TAYLOR & FRANCIS LTD, 4 PARK SQUARE, MILTON PARK, ABINGDON OX14 4RN, OXON, ENGLAND
Subject Category: Computer Science, Information Systems; Health Care Sciences & Services; Medical Informatics
IDS Number: 256QD
ISSN: 1463-9238
DOI: 10.1080/14639230701692736

1. Introduction
The availability of information and communication technologies and information services has revolutionized our lives in many aspects and has affected many different areas of life.
Health as one fundamental topic of universal interest is no exception.
Health-information websites on the Internet such as MedlinePlus are accessed by millions of people: MedlinePlus reported 215 million page views and 24.2 million unique visitors just in the second quarter of the year 2006 [1].
Many persons gather extensive information about diseases as well as diagnostic and
therapeutic procedures and alternatives before or in addition to consulting a physician [2].
In 2004, the SeniorNet organization conducted a survey on its members’ interests when using the Internet and reported that ‘searching for health information’ (37%) is only seconded by ‘sending emails or photos’ [3].
該供應信息和通信技術和信息服務在我們的生活發生了革命性的許多方面，並已影響到許多不同領域的生活。
健康作為一項基本議題的普遍興趣也不例外。
衛生信息網站在互聯網上，如一個存放被訪問數以百萬計的人：一個存放報導頁面瀏覽量 2.15億和24.2萬獨立訪客只是在第二季度的2006年[1]。
許多人收集的大量信息，以及對疾病的診斷和
治療前的程序和辦法或除了諮詢醫師 [2]。
2004年，SeniorNet組織進行的一項調查其成員的利益時，使用互聯網，並報告說'尋找健康信息'（37％）是唯一由借調'發送電子郵件或照片'[3]。
Along with the obvious advantages of the availability of extensive health information on the Internet come the inherent drawbacks and problems:
1.Quality of information: The majority of health information resources on the Internet are not run professionally and do not contain materials peer-reviewed by independent health professionals.
Though most offers are certainly well meant and informative, several cases of misleading or severely biased information have been reported [4 – 6].
Different initiatives have been started to ensure the quality of health-related electronic sources [7].
One prominent example is the Health On the Net (HON) foundation (http://www.hon.ch)
which introduced the HONcode, a code of conduct that defines a set of rules to be abided by developers of websites with health-related content.
The code has been followed for more than 120,000 websites (as of April 2006 [8]).
In Germany, many health websites are Afgis-certified (aktionsforum gesundheitsinformationssystem e.V., http://www.logo.afgis.de), providing additional data about the source of information, aims, authors, etc.
2. Information overload and retrieval problems: As there is an abundance as well as a rapid change in health information on the Internet [9], it becomes difficult first to find the
relevant information and second to interpret and understand it.
This holds true especially for people who are not familiar with different search strategies.
3. Unconsidered consumer needs: Health information services are accessed by groups of different characteristics as far as age, education, and informational needs are concerned.
Many services do not consider these differences and lack psychologically elaborated and target-group-oriented offers of information [10].
4. The access problem: There are still people who either do not have access to IT-based healthinformation resources or do not know how to use them.
Although, for example, in Germany 68.6% of the households own a PC and 54.6% of all households have access to the Internet, despite numerous efforts for many elderly people, the ‘digital barrier’ remains [11].
In the first quarter of 2005, 27% of people aged 55 or older have accessed the
Internet [12].
The older people are, the less likely they are to use the Internet [13,14], despite the growing demand for health-information services.
伴隨著明顯的優勢，提供廣泛的健康信息在互聯網上出現固有的缺點和問題：
一，質量信息：大部分衛生信息資源在互聯網上是無法運行的專業，不包含材料同行審查由獨立的衛生專業人員。
雖然大多數優惠肯定善意和知識性，幾起案件或嚴重偏見的誤導信息的報導 [4 - 6]。
不同的舉措已經開始，以確保質量與健康有關的電子來源 [7]。
一個突出的例子是在網絡上的健康（漢）基礎（http://www.hon.ch）
其中介紹了HONcode認證，一個行為準則，它定義一組規則得到遵守發展商的網站與健康相關的內容。
該代碼一直沿用超過 12萬網站（截至2006年4月[8]）。
在德國，許多健康網站 Afgis認證（aktionsforum gesundheitsinformationssystem電子伏特，http://www.logo.afgis.de），提供額外的數據信息的來源，目的，作者等
2。信息超載和檢索問題：由於是豐富以及快速變化的健康信息在互聯網上[9]，它變得困難首先找到
有關資料，二來解釋和理解。
這也是如此，尤其是人誰不熟悉的不同的搜索策略。
3。未被考慮消費者的需求：衛生信息服務進行訪問的群體不同特點，在年齡，教育和信息需求的關注。
許多服務不認為這些分歧和缺乏心理上的闡述和目標群為導向提供信息[10]。
4。訪問問題：誰還有人既沒有機會接觸資訊科技為基礎的healthinformation資源或不知道如何使用它們。
雖然，例如，在德國 68.6％的家庭擁有個人電腦和54.6％的家庭已經上網，儘管多次努力，對許多老人，'數字障礙的遺體 [11]。
在2005年第一季度，27％的人已年滿 55歲或以上的訪問
互聯網 [12]。
年長的人，越有可能是他們使用互聯網 [13,14]，儘管不斷增長的需求對衛生信息服務。

The aims of the research presented in this paper—with a focus on elderly people—are:
1. to summarize current trends in consumer health informatics (section 3.1);
2. to show—by means of presenting exemplary initiatives and projects from Germany—a
critical survey of past activities in using ICT for health-information services (section 3.2);
3. to present an example of a German health-information portal (section 3.3); and
4. to discuss the results and give a prospect of and propose a strategy for future developments in geriatric health-information services (section 4).
該研究的目標，本文提出，重點在長者人是：
1。總結目前的趨勢，消費者的健康信息學（第3.1）;
2。顯示由手段提出的倡議和示範項目，從德國 1
關鍵的調查活動中利用信息通信技術來為衛生信息服務（第3.2）;
3。提出一個例子，一個德國醫療信息門戶（第3.3）;及
4。討論的結果，並給予展望，並提出今後發展的戰略中老年保健信息服務（第4條）。

2. Methods
In section 3.1, a systematic literature review of articles related to consumer health informatics for elderly people is conducted.
The basis of this review is, first, a literature review of peerreviewed and PubMed-listed medical informatics and medical journals conducted in the context of the investigations for the section ‘education and consumer health informatics’ of the International Medical Informatics Association’s (IMIA) Yearbook of Medical Informatics for the years 2005 – 2007 [15 – 17], thus including papers published between 1 April 2003 and 31July 2006.
The papers found in the search were reviewed for their significance for healthinformation
services for elderly people.
The review process for the IMIA Yearbook of Medical Informatics and the evaluation criteria used are described in detail elsewhere [18,19].
Second, an additional systematic literature search was done in PubMed/Medline on 14 September 2006 for the period from 1 January 2000 to 31 July 2006 using the search term ((‘consumer’ OR ‘health’) AND ‘informatics’) OR ‘Internet’ OR ‘website’ OR ‘portal’ OR ‘web’) AND ((‘health’ OR ‘medical’) AND (‘information’ OR ‘resource’)) AND (‘elderly’ OR ‘senior’ OR ‘age’ OR ‘older’).
Thus, altogether, 706 papers were found and their abstracts subsequently reviewed and summarized.
Complying with rules for good scientific practice (e.g. [20]), all literature review data recorded by the authors as the basis for this publication have been stored.
Copies of the files can be requested from the authors.
In section 3.2, we provide examples from our own experiences with IT-based halthinformation services and telemedicine projects in Germany, and in section 3.3, we present an example of a German health-information portal for elderly people.
2。方法
在第3.1節，有系統的文獻回顧的文章涉及消費者健康信息為老人進行。
依據這項檢討是，第一，文學審查 peerreviewed和PubMed上市的醫療信息和醫學期刊進行上下文的調查為部分教育和消費者的健康信息'國際醫學信息協會（伊米亞）年鑑醫學信息學 252米Marschollek等。年2005 - 2007 [15 - 17]，從而包括論文發表的2003年四月一日至31July 2006。
這些論文，發現在搜索進行了審查其意義 healthinformation
為老人服務。
審查進程的伊米亞醫學年鑑
信息學和所用的評價標準中作了詳細介紹 [18,19]。二，
另外系統的文獻檢索做醫學 / Medline 9月14日
2006年期間從 2000年1月至2006年7月31日使用搜索詞（（'消費者'
或'健康'）和'信息'）或'互聯網'或'網站'或'門戶'或'網'）和
（（'健康'或'醫生'）和（'信息'或'資源'））和（'老人'或'高級'或
'時代'或'老'）。因此，總共有706份文件後發現及其摘要
回顧和總結。遵守規則，好的科學的做法（如[20]），所有
文獻資料記錄了作者作為依據本刊物已
儲存。這些文件的副本可從作者的要求。
在3.2節中，我們提供的例子從我們自己的經驗與資訊科技為基礎的healthinformation
服務和遠程醫療項目在德國，在第3.3節，我們提出了一個
例如一個德國醫療信息門戶的老人。


3. Health-information services for elderly people
3.1. Current trends in consumer health informatics for elderly people
In the 1990s, a trend towards research in education and information systems for health
professionals could be observed.
The focus now seems to have shifted towards work that aims to provide systems for conveying high-quality health-information and educative materials to consumers or patients, respectively, in order to empower them to make informed decisions and to deal more actively with their health, e.g. by taking preventive measures and changing their lifestyle.
Very often, specific health conditions or diseases are addressed, e.g. genetic diseases [21,22], prostate cancer [23], asthma [24], or diabetes [25], some of which have a high prevalence in—though are not exclusive to—elderly people.
Liu et al. present a pharmaceutical education system for patients that accounts for the patient’s individual informational needs by making use of personal information taken from a hospital information system and by tailoring the information given to the patient accordingly [26].
3。衛生信息服務的老人
3.1。目前的趨勢，消費者的健康信息學的老人
在20世紀 90年代，這一趨勢對教育研究和信息系統的健康
專業人士可以觀察到。
現在的重點似乎已經轉向工作，其目的是提供系統輸送高質量的衛生信息和教育材料，以消費者或患者，分別以使他們能夠作出明智的決定，並更積極地處理與他們的健康，例如：通過採取預防措施，改變他們的生活方式。
很多時候，具體的健康狀況或疾病得到解決，例如：遺傳性疾病[21,22]，前列腺癌[23]，哮喘[24]，或糖尿病[25]，其中一些具有較高的患病率，但並不排斥到老人。
劉等人。目前的教育體系製藥病人佔病人的個人信息需要通過利用個人信息取自醫院信息系統和信息剪裁的病人給予相應 [26]。

A considerable amount of research work has recently been done on criteria and methods to assess the quality and usability of health-related websites—e.g. [27 – 29]—and in a large number of articles, the results, when searching for specific diseases or conditions, are presented and evaluated [30 – 33].
The problem of how relevant health information can be found by laypersons—e.g. by matching consumer queries with controlled vocabularies [34 –36] or by providing assistance in query formulation [37]—is also the focus of some research
groups.
Proactive services are emerging, e.g. in the shape of automated email or phone
messages [38,39].
有相當數量的研究工作最近已完成的標準和方法，評估的質量和可用性與健康有關的網站，例如： [27 - 29]，並在大量的文章，結果，在尋找特定疾病或情況，是介紹和評價 [30 - 33]。
問題是如何相關的健康信息可以找到居士，如：消費者的查詢相匹配的受控詞表[34 -36]或在查詢的制定提供援助[37]，也是一些研究重點
組。
主動服務不斷湧現，例如在形狀自動發送的電子郵件或電話

Another major trend is the emergence of specialized [21] or general health-information
portals.
The most prominent example certainly is the MedlinePlus website by the National
Library of Medicine [40].
It also features a portal especially designed for elderly people, NIHSeniorHealth (http://www.nihseniorhealth.org) which had 1.8 million page-views from 125,000 unique visitors in August 2006 (personal contact: R. Tyler, US National Library of
Medicine).
另一個主要趨勢是出現了專門的[21]或一般健康信息
門戶網站。
最突出的例子當然是一個存放網站由全國
醫學圖書館 [40]。
它還具有一個門戶網站是專為老年人，NIHSeniorHealth（http://www.nihseniorhealth.org），其中有180萬頁的意見，從 125,000獨立訪客 2006年8月（個人聯繫方式：河泰勒，美國國家圖書館
醫學）。

Pervasive and ubiquitous health services is another field of intensive research activity [41],
though the current developments are aimed mainly at gathering information about an
individual (monitoring) and subsequently transferring the original or processed information
to health professionals.
Little research work is being done on interactive user interfaces for the persons concerned—e.g. [42,43]—much less on specific pervasive interfaces for elderly
people.
無孔不入，無處不在的衛生服務是另一個領域的深入研究活動 [41]
雖然目前的事態發展的目的主要是收集信息1
個人（監察），隨後轉移的原件或處理的信息
衛生專業人員。
小的研究工作正在開展交互式用戶界面的有關人士，例如[42,43]，更具體的普遍接口的老人。

The following conclusions can be drawn from the referenced work:
. A considerable amount of research work is done on health-information services for specific diseases, though few original papers deal with health-information services for elderly people.
. The quality and semantic accessibility of website content is a major issue and is addressed by several prominent research groups.
Little work is being done on interface design for elderly people or those with functional impairments.
. There is little research on the implications of ICT-based health-information services and communication on the relationship between patients and health professionals, e.g. [44], where the authors report positive attitudes towards Web-based communication but also technological limitations in practice.
. Proactive systems aiming to motivate healthy behaviour are emerging, though primary
prevention does not seem to be a major issue yet.
At present, pervasive and ubiquitous systems are mainly used in health care for monitoring purposes, not as informationbrokerage tools.
下面可以得出結論從被引用的工作：
。有相當數量的研究工作已經完成對衛生信息服務的特定疾病，雖然一些原始文件處理與衛生信息服務的老人。
。無障礙的質量和語義內容的網站是一個主要問題，是解決一些突出的研究小組。
小的工作正在做的界面設計為老年人或那些與功能障礙。
。很少有研究的影響的信息和通信技術為基礎的衛生信息服務和溝通之間的關係，患者和衛生專業人員，如： [44]，其中提交報告的積極態度對基於網絡通訊技術的限制，而且在實踐中。
。積極主動的系統，以推動健康行為正在出現，雖然主要
預防似乎沒有成為一個大問題呢。
目前，普遍的，無所不在的系統，主要用於衛生保健監測目的，而不是信息經紀工具。

3.2. Past initiatives in Germany
Following the fast-paced progress of ICT for home consumers in the 1990s, there were
intensive endeavours to allow elderly people to participate in this development.
Three motives for this can be identified: first, industry was interested in opening up new markets; second, new ICT was to be used to convey knowledge and information and to empower elderly people to enhance their communication; and third, there was the political intention not to ignore but to include older persons in the technological development in order to prevent social isolation and the consolidation of a ‘digital divide’.
In Germany, associations were set up—e.g. ‘Seniors in the knowledge society e.V.’ (1998 – 2001)—with the aims of promoting media competence, minimizing barriers for seniors to access products and services of the ICT economy, and developing strategies that allow them to inform themselves about and selectively use new technologies.
This resulted in quite a few national initiatives and associations which trained elderly people in the use of computers and provided a forum for those interested in new
technologies [45,46].
While the German initiatives were directed primarily to reduce the barriers for seniors to use ICT, European support programmes within the Fourth Research and Technological Development (RTD) Framework Programme (FP4) aimed to facilitate the access for disabled and chronically ill elderly people [47,48].
Most of these projects, however, failed to demonstrate a lasting telematics-based integration of the target group.
Among the 224 projects within the Fifth Framework Programme (FP5) with the support agenda ‘The Ageing Population and disabilities’ (1998 – 2002), no project attended intensively to this topic.
FP6 at first did not have a support focus on the use of telematics for the elderly, though
at the end of 2005 the strategic objective ‘Ambient Assisted Living (AAL) for the Ageing
Society’ was issued ‘to extend the time during which elderly people can live independently in their preferred environment with the support of ICTs’ [49].
3.2。過去在德國的倡議
隨著快節奏的信息和通信技術的進步為家庭消費者在20世紀 90年代，有
密集的努力，讓老人參與這方面的發展。
這三種動機可以查明：第一，行業有興趣開拓新市場;第二，新的信息和通信技術是用來傳遞知識和信息，並授權老人加強溝通;第三，有政治意圖不要忽視，而是包括老年人在科技發展，以防止社會隔離和鞏固一個'數字鴻溝'。
在德國，協會分別成立，無。 '老人在知識社會伏特'（1998 - 2001），旨在促進與媒體的能力，最大限度地減少障礙老年人獲得的產品和服務的信息和通信技術的經濟和發展戰略，讓他們了解並使用新的選擇性技術。
這導致不少國家倡議和協會培訓老人在使用電腦，並提供一個論壇，為有志於新
技術 [45,46]。
儘管德國的倡議主要是針對老年人的障礙減少使用信息和通信技術，歐洲的支持方案，在第四次的研究和技術發展（RTD）的框架計劃（FP4）旨在促進殘疾人獲得老人和慢性病患者[47， 48]。
大部分這些項目，但是，未能表現出持久的遠程信息處理為基礎的一體化的目標群體。
其中224第五框架內的項目方案（FP5）與支持議程'的人口老齡化和殘疾人'（1998 - 2002），沒有項目參加了深入討論這一議題。
第六框架起初沒有一個支持重點放在利用遠程信息處理老人，雖然
在2005年年底的戰略目標'環境輔助生活（AAL的）的老齡化
社會'發出'，延長期間，老人可獨立生活在他們喜歡的環境信息和通信技術的支持'[49]。

Whereas the majority of German projects were aimed at promoting general knowledge
transfer—partly for health related topics—in some projects video phones were installed in elderly peoples’ homes with the intention of improving communication facilities with service centres.
The first of these projects was the ‘Home Tele-Service Frankfurt’ in which a conventional TV set was used [50].
The ‘TeleReha’ project of the Geriatrics Research Group in Berlin expanded this approach by installing specialized ICT equipment at home with a touch-screen user interface that provided a connection to a professional gerontological service centre as well as a health-information service customized to elderly peoples’ needs [51,52].
In addition to this, the patients’ relatives were also included in the communication network (Figure 1).
The evaluation of the TeleReha study clearly proved the need for such a communication network but also revealed that customized interfaces for disabled people, individual support, and reasonable costs are vital factors for its usage and acceptance.
鑑於大多數德國項目旨在促進一般知識
轉移部分健康相關議題，在一些項目視頻電話安裝在老人的家中，意圖改善通訊設施與服務中心。
這些項目的第一個是'家庭遠程服務法蘭克福中一名普通的電視機是使用[50]。
在'TeleReha'項目的老年醫學研究小組在柏林擴大這種方法通過安裝專門的信息通信技術設備在國內具有觸摸屏用戶界面，提供一個連接到服務中心，老年醫學的專業以及衛生信息服務定制老人人民的需要[51,52]。
除了這個，病人的親屬，還包括在通信網絡（圖 1）。
該評價 TeleReha研究清楚證明了這樣一個需要溝通網絡，而且還透露，為殘疾人定制接口，個人支持和合理的成本是至關重要的因素，其使用和接受。


Attempts to establish ICT-based rehabilitation programmes for seniors with motor disabilities (e.g. following an apoplectic stroke) and their relatives on the basis of these experiences have so far been unsuccessful in Germany.
The reasons for this are manifold.
First of all, there is the German health-care system, with its lasting separation between ambulatory and stationary care.
Besides, economic reasons have to be mentioned, as the costly provision of service concept failed to be funded by individual licence fees yet, and funding by the social insurance system has not been an option because the preventive efficiency of these services so far remains to be proven.
Finally, the lack of adjustment of technology to the needs of the extremely heterogenous group of elderly people was—and
remains to this day—a major reason for the failures.
嘗試建立信息和通信技術為基礎的康復方案，老年人肢體殘疾（如中風中風後 1）和他們的親屬對這些經驗的基礎上迄今已成功在德國。
這個的原因是多方面的。
首先，有德國的醫療保健制度，其持久的分離與動態和固定的照顧。
另外，由於經濟原因，不可不提的，因為昂貴的提供服務的概念沒有得到應有的資助個別牌照費未定，資金由社會保險制度不是一項選擇，因為這些服務的效率，預防迄今仍是證明。
最後，缺乏技術調整的需要極異質組的老人是和
仍然是這一天，一個重要原因失敗。

While there are still no sustainable concepts to integrate seniors into individual care networks, the number of health-related Internet portals is rising.
The impact of these portals is substantial because of their dissemination, but their accessibility for the target group of elderly or disabled people often remains hypothetical.
User statistics of health-related websites neither necessarily reflect their use by the elderly nor allow conclusions on the users’ health status or social situation.
From the experience with outreach clinics’ utilization and own statistics data (cf. chapter 3.3) it can be assumed that a significant proportion of younger relatives look for specific health information in these portals, and not the elderly persons themselves.
On the basis of the experiences resulting from the ‘TeleReha’ project, in particular with the knowledge that the information service component was perceived to be very useful, a new German information service portal—‘Vitanet’—was set up [53].
雖然目前還沒有可持續的概念融入到個人的老人照顧網絡，這個數字與健康有關的互聯網門戶網站正在上升。
這些門戶網站的衝擊是巨大的，因為他們的傳播，但它們的可利用為目標的長者或殘疾人士往往是假設的。
用戶統計與健康有關的網站，他們也不一定能反映老年人使用的結論，也不讓使用者的健康狀況或社會狀況。
從經驗推廣衛生所的利用率和自己的統計數據（參見第3.3章）我們可以假設，一個顯著比例的年輕親人尋找具體的健康信息，這些門戶網站，而不是自己的長者。
在此基礎上產生的經驗，從'TeleReha'項目，特別是與知識，信息服務組件被認為是非常有益的，一個新的德國信息服務門戶 'Vitanet'，成立[53]。

3.3. Vitanet portal for elderly people
Vitanet [53] was launched in 2001 in collaboration with some of the authors of the Research Group on Geriatrics at Charite´ and is an example of a Web portal that on the one hand offers comprehensive information about a wide range of different health problems and disease conditions particularly common in the elderly population (e.g. arteriosclerosis, cardiac diseases, dementia or common metabolic diseases such as diabetes) and likewise for other
age-related questions concerning, for example, sexual problems or fitness to drive.
On the other hand, it contains practical advice for both the elderly people and their relatives for different home and outpatient-care problems (e.g. how to bed a patient with hemiparesis after
stroke correctly; see Figure 2).
They also can find information and professional advice about the benefits of the different types of health insurance, e.g. the coverage of the three care levels:
short- and long-term care, home care, and institutional care).
3.3。 Vitanet門戶老人
Vitanet [53] 2001年啟動了合作與一些作詞老年醫學研究小組在沙裡泰'，是一個例子，一個 Web門戶，一方面提供全面的信息範圍廣泛的不同的健康問題和疾病條件，特別是常見的老年人口（如動脈硬化，心髒病，老年癡呆症或常見的代謝疾病，如糖尿病），同樣為其他
與年齡有關的問題有關，例如，性問題或健身駕駛。
另一方面，它包含了實用的建議為老人和他們的親屬對不同家庭和門診護理問題（例如如何與偏癱病人床後
中風正確;見圖 2）。
他們還可以找到有關的資料和專業意見的利益不同類型的醫療保險，例如覆蓋面三個服務層次：
短期和長期護理，家庭護理和住院）。

Economic analyses for ICT in elderly healthcare: questions and challenges

Economic analyses for ICT in elderly healthcare: questions and challenges
Vivian Vimarlund
Economic Information Systems, Department of Computer and Information Science, Linköping University, S-581 83 Linköping, Sweden, vivvi@ida.liu.se

Nils-Göran Olve

Economic Information Systems, Department of Computer and Information Science, Linköping University, S-581 83 Linköping, Sweden

Elderly healthcare is a likely arena for extensive change in years to come, and information and communication technology (ICT) will be an important enabler of such change.
老年醫療保健是一個可能的領域進行廣泛的變化在今後幾年，信息和通信技術（ICT）將是一個重要的推動者的這種變化。
Before investing in new systems and practices, there will be a call for evaluations.
在新系統之前，投資和做法，將有要求的評價。
To date, economic evaluations of ICT applications in healthcare have been rare, and a literature review did not turn up any examples of such evaluations of elderly care.
迄今為止，經濟評價的信息通信技術應用在醫療保健已日漸稀少，而文獻未有出現任何例子這種評價的老人照顧。
The options for elderly care will often have to transcend organization boundaries, as the point of many ICT initiatives now being discussed is to make healthcare institutions, home care, and self-administered care interact in new ways.
該方案將照顧老人往往要超越組織邊界，許多信息和通信技術的一點現在正在討論的倡議是使醫療機構，家庭護理，自我管理的醫療互動的新途徑。
Analysts performing evaluations of such complex changes will have to be very specific about such classic issues in economic analysis as defining alternatives, the basis for comparison, and combining different indicators into an overall evaluation.
分析家們表演的評價如此複雜的變化，是非常具體的問題，對這些經典的經濟分析，確定方案，進行比較的基礎上，結合不同的指標納入全面評估。
Key Words: economic evaluations • elderly healthcare • information and communication technology • Sweden
此篇論文概要論述在醫療照顧的ICT是需要進行投資評估，但現在已愈來愈少人這樣做，而真對高齡者的ICT照顧的投資更是在文獻上少見，而像醫療機構、家庭護理及自我管理的互動的新途徑，已超出機構的邊界，而這樣的評估與傳統上的經濟分析是不同的，它納入了許多不同指標以全面評估。
在ICT投入高齡者的照顧若是以傳統的經濟評估方式，是沒辦法評估其真正的效益，必須納入各方面的指標才能真正的評估其效益，這與我目前的研究有何關連，其關連在於如果高齡者ICT素養足夠，使用的恰當，這樣的投資效益才會增加，應要查閱全文了解其評估指標到底有那些。
。