Abstract
Background: The US population is aging and has an expanding set of healthcare needs for the prevention and management of chronic conditions. Older adults contribute disproportionately to US healthcare costs, accounting for 34% of total healthcare expenditures in 2014 but only 15% of the population. Fully automated, digital health programs offer a scalable and cost-effective option to help manage chronic conditions. However, the literature on technology use suggests that older adults face barriers to the use of digital technologies that could limit their engagement with digital health programs. The objective of this study was to characterize the engagement of adults 65 years and older with a fully automated digital health platform called Lark Health and compare their engagement to that of adults aged 35-64 years. Methods: We analyzed data from 2,169 Lark platform users across four different coaching programs (diabetes prevention, diabetes care, hypertension care, and prevention) over a 12-month period. We characterized user engagement as participation in digital coaching conversations, meals logged, and device measurements. We compared engagement metrics between older and younger adults using nonparametric bivariate analyses. Main Results: Aggregate engagement across all users during the 12-month period included 1,623,178 coaching conversations, 588,436 meals logged, and 203,693 device measurements. We found that older adults were significantly more engaged with the digital platform than younger adults, evidenced by older adults participating in a larger median number of coaching conversations (514 vs. 428) and logging more meals (174 vs. 89) and device measurements (39 vs. 28) all p ≤ 0.01. Conclusions: Older adult users of a commercially available, fully digital health platform exhibited greater engagement than younger adults. These findings suggest that despite potential barriers, older adults readily adopted digital health technologies. Fully digital health programs may present a widely scalable and cost-effective alternative to traditional telehealth models that still require costly touchpoints with human care providers.