Article Archive
January/February 2021

The Last Word: Digital Decision Making and Safety in the COVID World
By Erin Smith; Malcolm P. Forbes, MBBS, MPM; Sandra B. Chapman, PhD; Ian H. Robertson, PhD; and Harris A. Eyre, MBBS, PhD
Today’s Geriatric Medicine
Vol. 14 No. 1 P. 34

A recent study in the American Journal of Geriatric Psychiatry found that more frequent late-life cognitive activity may maintain and improve decision making among older persons.1 These are helpful findings from a public health perspective. In this article, we extend the implications of this study by noting the ubiquity and complexity of digital decision making in a time of pandemic. We then consider the impacts of these digital services on late-life cognitive activity and propose digital safety strategies for clinicians, researchers, public health practitioners, and regulators.

Digital safety strategies are considered approaches to optimize digital decision making and protect late-life users of digital technologies. In the accompanying table online, we provide an overview of this topic.

We recently reviewed the effects of computers, the internet, and social media on the daily decision making of people living with brain health conditions.2 Teaching older adults to use social media has been found to significantly improve executive functioning as measured by their inhibitory control and overall cognition.3 Social media use among older adults may also positively boost health by increasing social connectedness, which is critical with social and physical distancing imposed by COVID-19.

Social media may also have adverse brain health affects for older adults. Loneliness and social isolation in older adults can dramatically alter cognitive performance, decision making, and emotional regulation.4 Lonely older adults have more difficulty maintaining vigilance and self-regulating, demonstrate a heightened awareness of social threats, and pay greater attention to negative social stimuli.2

These findings—combined with social media algorithms that are intended to keep users on the platforms as long as possible—may help explain recent reports showing that individuals older than age 65 are seven times more likely to share and disseminate fake news domains on social media than are their younger counterparts.5 These findings may have societal implications, notably with the increased numbers of aging adults on social media and the fact that political and policy decisions are now often shaped by information that is publicly available on these platforms.

Geriatric health care providers will have to increasingly contend with technology use in their day-to-day practice. For example, ubiquitous smartphones are being used to collect data that can be used in the clinic. Wearable technology has the benefit of capturing real-time biometric data on autonomic nervous system activity, voice analytics, sleep quality and quantity, physical activity, and social activity, all of which can assist in diagnosis.

Data obtained by technology can be used as an adjunct to enhance the physician-patient connection and therapeutic alliance. Geriatric health care providers have a role in supporting their patients in navigating the potential minefield of technology, cutting through marketing claims and evaluating the benefit of new technologies. They should be cognizant of technologies on the market and appraise their utility, caution their patients about privacy and security implications, and help their patients evaluate the positives and negatives. Digital literacy workshops, such as those provided by Senior Planet (, are an increasingly important consideration in the primary care setting and may be able to reduce cyber-exploitation and the negative health consequences of engaging with fake news. These workshops teach older adults how to use fact-checking resources such as Snopes ( and

Understanding the decision-making implications of cognitive decline, especially within the digital realm, and enacting subsequent clinical and policy measures is critical. Existing issues are likely to be amplified due to the current effects and long-term repercussions of COVID, making these measures an urgent global priority.

Erin Smith is a brain health executive and an associate at The PRODEO Institute in Palo Alto, California.

Malcolm P. Forbes, MBBS, MPM, is a principal psychiatry trainee at Royal Melbourne Hospital and a senior lecturer in the department of psychiatry at the University of Melbourne in Australia.

Sandra B. Chapman, PhD, is a professor in and founder and chief director of the Center for BrainHealth, as well as the Dee Wyly Distinguished University Chair at The University of Texas at Dallas.

Ian H. Robertson, PhD, is the T. Boone Pickens Distinguished Scientist at the Center for BrainHealth at The University of Texas at Dallas and codirector of the Global Brain Health Institute, a collaboration of Trinity College Dublin and the University of California, San Francisco.

— Harris A. Eyre, MBBS, PhD, is a brain health executive, cofounder of The PRODEO Institute, and President of PRODEO in San Francisco.


Digital Care in the COVID World

Daily activities increasingly digital Benefits of digital activities Risks of digital activities Impacts of COVID on brain health Approaches to building brain health




Health care services

Entertainment services

Financial, legal, and administrative services

Increased health literacy

Social engagement


Reduced cognitive decline

Technology fatigue

Individuals gravitate toward “echo chambers” on social medial


Dissemination of fake news

Reduced depth of offline social connection


Loss of control

Caregiver burden




Postintensive care syndrome

COVID infection-based inflammation-induced neuropsychiatric symptoms

Cognitive activity

Physical activity

Social activity

Management of chronic disease


Healthy diet


Clinical and research-based digital safety strategies Regulatory, public health, and policy-based digital safety strategies

Clinical strategies:
Careful assessment of COVID effects on brain health

Build brain health to optimize decision making

Engage social worker in assessing digital safety optimization

Optimize digital literacy for consumer protection

Research strategies:
Rigorously assess the impact of brain health on digital decision making and digital safety

Continue to refine the personalization of brain health programs (eg, The BrainHealth Project)

Regulatory strategies:
Responsible innovation framework used in digital service and product development (including assessing the individual’s capacity to consent, and data privacy provisions)

Public health and policy strategies:
Optimize the use and adherence to scalable brain health programs (eg, Cleveland Clinic Brain Health Initiative)

Cybersecurity education for consumer employment
Increased cybersecurity resources (public and not-for-profit) for consumer protection

Broadband internet access

Develop Brain Health Innovation Diplomacy workforce


1. Glover CM, et al. The association of late life cognitive activity with healthcare and financial decision-making in community-dwelling, nondemented older adults [published online June 16, 2020]. Am J Geriatr Psychiatry. doi: 10.1016/j.jagp.2020.06.010.

2. Ternes K, Iyengar V, Lavretsky H, et al. Brain health INnovation Diplomacy: a model binding diverse disciplines to manage the promise and perils of technological innovation. Int Psychogeriatr. 2020;32(8):955-979.

3. Quinn K. Cognitive effects of social media use: a case of older adults. Soc Media Soc. 2018;4(3):2056305118787203.

4. Cacioppo JT, Hawkley LC. Perceived social isolation and cognition. Trends Cogn Sci. 2009;13(10):447-454.

5. Guess A, Nagler J, Tucker J. Less than you think: prevalence and predictors of fake news dissemination on Facebook. Sci Adv. 2019;5(1):eaau4586.