Digital-Human Public Community Care Integration for Chronic Pain in Low-Income Older Adults in a 6-Week Living Lab Setting: Quasi-Experimental Feasibility Study

초록

Background: Digital health technologies offer promising solutions for managing chronic pain and depression in older adults, yet low-income populations with limited digital literacy face substantial barriers to access. Community-based approaches that leverage existing care infrastructure may bridge this digital divide, but evidence remains limited on effective integration strategies for digitally excluded populations. Objective: We evaluated a multimodal digital health monitoring platform for this underserved population through 6-week living lab trials with 86 low-income Korean older adults (43 intervention and 43 age-and gender-matched controls) and 25 community caregivers. Methods: Participants were recruited offline from recipients of government-supported community care services. The platform integrated chatbot surveys, smartwatch monitoring, and motion sensors, generating personalized traffic-light alerts when health indicators deviated from individual baselines and triggering real-time caregiver notifications for persistent declines. Mobile apps for older adult users and caregivers, along with a centralized monitoring system for community center managers, were provided to the intervention group, while controls received standard community care. Pre-and posttest surveys assessed changes in pain-related functional limitations, depressive symptoms, sleep quality, and system usability through face-to-face assessments. Caregivers documented platform-triggered interventions. Results: Following attrition due to illness (n=3) and participation burden (n=4), weanalyzed 1318 days of continuous monitoring data from 35 intervention participants (mean 37.7, SD 8.8 days per participant), with 77 participants (35 intervention and 42 control) completing pre-post assessments. Distinct patterns emerged in 24-hour heart rate profiles: participants experiencing higher-than-usual pain demonstrated elevated heart rates during early morning (5-8 AM) and late evening (10-11 PM) hours compared to their low-pain days. Multilevel modeling revealed significant within-person associations between digital biomarkers and symptoms. Heart rate variability (P=.02) and moderate physical activity (P=.05) were associated with same-day pain. Heart rate variability (P=.03) and long wake episodes during sleep (P=.03) predicted next-day pain. Shorter sleep duration (P=.03) and lower sleep efficiency (P=.05) were associated with same-day depressive symptoms. A significant group-by-time interaction was observed for pain-related functional limitations (P=.03): the intervention group maintained baseline levels while the comparison group reported increased functional limitations. Depressive symptoms, sleep quality, and platform usability did not show significant changes. Community caregivers successfully conducted 37 health decline-triggered interventions during regular service hours (25 hours per week), demonstrating integration of digital monitoring with existing care workflows. Conclusions:Integrating digital health monitoring within existing community care infrastructure may be a feasible approach to supporting vulnerable older adults. The intervention was associated with maintained pain-related functional limitations, while depressive symptoms and sleep quality showed no significant changes, possibly due to the 6-week duration. This feasibility study provides preliminary support for digital-human integration models to address health equity, though randomized controlled trials are needed to establish causal relationships and isolate active intervention components. Trial Registration: ClinicalTrials.gov NCT06270121; https://clinicaltrials.gov/study/NCT06270121

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