A Scoping Review of Nutrition Health for Older Adults: Does Technology Help?

The technological developments in healthcare may help facilitate older adult nutritional care. This scoping review includes research in technology and nutrition to (1) explain how technology is used to manage nutrition needs and (2) describe the forms of technology used to manage nutrition. Five major databases were the foundation for papers published from January 2000 to December 2020. The most common type of technology used is software to (1) “track, plan, and execute” nutrition management and for (2) “assessing” technology use. “Track, plan, and execute” includes tracking food intake, planning for changes, and executing a plan. “Assessing” technology use is collecting nutrition data from a provider’s or an older adult’s self-use of technology to understand dietary intake. Hardware is the second most type of technology used, with tablet computers for software and internet access. The findings reveal that software for older adults lacks standardization, the Internet of Things is a promising area, the current device emphasis is the tablet computer, and broadband internet access is essential for nutrition care. Only 38 studies were published in the last five years, indicating that nutrition management for older adults with hardware or software has not reached a significant research mass.


Introduction
The percentage of older adults aged 65 and older increases daily [1]; however, not all older adults are able to access technology.Ten percent of the United States (U.S.) population does not use the internet; 25 percent are 65 years and older [2].Yet, studies show that computer-based touch-screen assessment systems [3] and robots with specific responsiveness to diet [4] improve nutrition awareness among older adults.Older adults navigate technology differently compared with other age groups [5], and consideration for this difference should be considered in helping this population adopt new technology to improve their quality of life (QOL).Including older adults in the mainstream inclusion of technology and new designs could help decrease the risk of age-related health conditions, such as weight loss from inadequate nutritional intake [6].

Biological Aging and Nutrition
Physiological changes in the cardiovascular, neurological, respiratory, and musculoskeletal systems are a natural part of biological aging and are a primary factor of agerelated chronic illness [7].These age-related conditions increase an older adult's risk for poor nutritional status [8].Age-related changes in appetite, ability to taste and smell, and level of food involvement [9] can further worsen nutrition status, chronic diseases, disabilities, and QOL [10].Optimal dietary intake can increase lifespan [7, [11][12][13][14] and independence and minimize healthcare costs [15,16].Therefore, health status can vary widely among older adults, and technology may help better manage variability among older adults as they age and optimize diet quality [17].A registered dietitian nutritionist (RDN), an expert in food and nutrition, can provide evidence-based nutrition recommendations and guidance to address barriers older adults may face in achieving optimal dietary intake.

The Nutrition Care Process
The nutrition care process (NCP) is a systematic framework that RDNs use to provide individualized, high-quality medical nutrition therapy and is composed of four interconnected steps: (1) assessment (document nutrition and medical history; biochemical data; medical tests; anthropometrics; and nutrition-focused physical examination); (2) diagnosis (use the collected data to make a diagnosis), ( 3) intervention (select targeted interventions and goals); and (4) monitoring/evaluation (ensure goal completion [8]).An RDN can work with an older adult to detect and treat nutrient deficiencies, improve or maintain body composition, manage diet-related health conditions, and enroll in food assistance programs [18].Technology can enhance the management of this framework.

Accessing Nutrition Professionals and Services
The exponential increase in the aging population has encouraged "aging in place", a practice where older adults live in their community homes independently, safely, and comfortably [19].Up to 98% of older adults are community-dwelling and live outside nursing homes [20].Healthy dietary patterns can facilitate "aging in place" by helping to prevent and/or manage chronic diseases while also helping to optimize physical and cognitive functioning [15,16,21].Efforts to address nutritional status among older adults include government-funded meal support and health support programs [22,23].Additionally, RDNs can help older adults optimize their nutrition status.However, older adults face barriers in accessing an RDN and nutrition services, which include residing in rural areas, disabilities and mobility issues, low socioeconomic status, and accessibility to transportation or health care services [24,25].Some older adults lack knowledge of unintended weight loss's negative consequences on their health [26,27].Others face psychosocial barriers, like loneliness and isolation, which can affect their desire to eat, and some older adults are unwilling to be screened for malnutrition [28].In the U.S., federal medical insurance for older adults covers nutrition therapy and group education classes only for specific diseases [29,30].As a result, one-on-one nutrition counseling sessions and education programs are limited to subsets of older adults [31,32].Technology-based interventions are promising strategies to overcome barriers older adults face and help them access nutrition services [23].The technology could bring value to conducting nutrition assessments, promoting healthy eating, and improving dietary quality and nutritional status [33][34][35].As a result, incorporating technology in the care of older adults may enhance nutrition care and status, promote "aging in place", and improve QOL [6,23].

Technology for Aging
Caregivers have introduced technologies to assess, track, and manage older adults' health [36,37] along with promoting "aging in place" [38].These technologies incorporate digital health, which helps people manage and monitor their health [39].Both older adults and their healthcare clinicians can use digital health technologies, including sensors found in wearable devices, smart homes, mobile and video communications, and social networks [36,37].Telehealth, a video communication technology, allows healthcare providers to deliver medical care and education to people in remote rural areas [24].These technologies may help improve health outcomes and increase access to nutrition information; nevertheless, use among older adults to provide routine nutrition care is limited [23,40].
Learned as an outcome of the COVID-19 pandemic, technologies can become a routine part of healthcare practice [41] and can support health management.In response, U.S. Medicare expanded coverage of telehealth services and agreed to temporarily reimburse RDNs for telephone assessments and services [42].Some reimbursements continue as a new norm for coverage [43].However, in the U.S., Medicare only covers medical nutri-tion therapy for older adults with diabetes, kidney disease, or those 36 months after a kidney transplant [23,40].The pandemic has also reinforced older adults' desire to "age in place" [38], which can be feasible with technology adoption.

Research Objective
Providing older adults with healthcare services using technology is efficient, convenient, and cost-effective.Technology reduces patient wait time, and research shows older adults find using technology to access healthcare services acceptable [24].Exploring older adults' technology use to manage their nutrition would be advantageous to better incorporate existing and new technologies into the older adults' nutrition care plan.The primary objective of this scoping review is to assess the extant research on using technology to manage nutrition for and by older adults.The secondary objective is to describe the technology used and nutrition areas of focus of the extant research.
The remainder of this paper provides a detailed methodology of the search strategy, inclusion and exclusion criteria for studies, and how the articles were analyzed.The authors then describe the types of research studies extracted, the technology utilized, and the areas of nutrition the technology seeks to address.This paper closes with an interpretation and synthesis of the extracted studies, implication for practice, and recommendations for future research.

Materials and Methods
The Preferred Reporting Item for Systematic Reviews and Meta-analysis for Scoping Review (PRISMA-ScR) guidelines [44] and the PRISMA (http://www.prisma-statement.org/?AspxAutoDetectCookieSupport=1, accessed on 11 October 2023) (Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA)) model [45] were used to perform a scoping review of the literature.Steps for conducting this review were adopted from the 5-step approach [46].A scoping review methodology was selected based on the need to identify the type and extent of the research evidence [47], mainly to map out the type and nature of the technology used to manage older adults' nutrition [48].

Research Methods
To build a foundation, we searched several nutritional science and business databases for peer-reviewed journal papers.At first, we assumed that if our research topic was an emerging phenomenon, research would exist in the top journals of our disciplines in nutrition and information systems (IS).The paper search began with prominent nutrition and IS journals.Table 1 summarizes the selected journals in alphabetical order.The IS journals chosen to be included in the preliminary search are considered prominent because they are included in the top eight journals as determined by the senior scholars of the Association for Information Systems [49].Of the six nutrition journals selected, all but one are considered Quartile 1 or 2 journals based on the Clarivate Analytics Journal Citation Report [50].The nutrition journals selected also frequently cover topics related to nutrition interventions, nutrition assessment, education, aging, and utilizing technology to manage nutrition.The one journal considered a Quartile 3 journal is the Journal of Nutrition in Gerontology and Geriatrics since the journal is dedicated to covering papers related to nutrition and aging.
Next, we researched prominent nutritional science and business databases.Our nutrition-focused databases were PubMed and Web of Science.The business databases for IS research were Business Source Elite, Abstracted Business Information/INFORM (ABI/INFORM) Collection, and ScienceDirect.Finally, we considered secondary source papers.These papers surfaced through references within the papers retrieved from the databases or suggested by colleagues.While not comprehensive, this list represents a measure of older adult technology use of nutrition found in the nutrition, IS, and gerontology disciplines.

Eligibility Criteria
Papers about older adults that addressed technology to manage nutrition were included.All papers were published between 1 January 2000 and 31 December 2020 and were written in English.Papers included qualitative and quantitative studies, mixed methods studies, randomized controlled trials, interventions, literature reviews, future research designs, and commentaries.Papers that did not include older adults or examine technology usage to manage nutrition were excluded.Additionally, we excluded studies of older adults that addressed only nutrition or technology, conference abstracts, and poster sessions.

Study Selection
We created a data extract for each database and journal search to record the citation and the paper's PDF file.To understand how each study framed the search terms, we conducted an initial screening by examining the title, abstract, and keywords.We sought to understand whether our search word combination explained an older adult's use of technology for nutrition care.Our abstract review examined how researchers referenced older adults.If terms such as elderly, seniors, and senior citizens were used, the paper was included.If the extant research included participants by age group and older adults were among them, the paper was included.We separately completed a full-text review of the retained articles against our inclusion criteria.We then met to discuss and resolve disagreements related to study inclusion.In a final evaluation of the remaining full-text articles, we excluded additional articles after further discussion.

Data Charting
We extracted the following information for each paper: authorship, type of study, study population, type of technology used, country, study purpose, and nutrition/medical outcomes.Data from each article were sorted into a summary table (Table 2, forthcoming) and synthesized.After that, the studies were characterized and described based on technology (Table 3) and nutrition (Table 4) areas of interest.Additionally, the two researchers further categorized the use of technology to manage and care for older adults' nutritional needs into three domains-hardware, software, and various information and communications technology (ICT).For nutrition, the high-level categories were nutrition areas of focus and study setting.
Technology type data used in each study were recorded into the following categories: home-based sensors, smart devices (TV, smart scale, adaptive kitchenware), mobile device sensors, fitness devices, assistive robots, tablet computers, computers, smartphones, telephones, webcams (photos, video monitoring), internet access, videoconferencing (personal and health-related), and software (applications, web-specific resources) (Table 3).Additional information was extracted from each article to identify the technology used to manage nutrition, the nutrition focus, the specific end-users of interest, and the study setting (community vs. institutional) (Table 4).These categories were determined a priori and post hoc by the second author, an expert in IS, and finalized with the first author.
Data on each study's nutrition area of focus were recorded and placed into the following categories and subcategories: assessment, monitoring, and/or tracking; weight and body composition; nutrition status; education/counseling; diet intake/diet quality; and activities of daily living (ADL).The first author, an RDN, identified these categories and finalized them with the second author.Each retained article was reviewed to understand who the end user was.We then noted the "distinction of end-user based on three types we created and defined as follows: (1) self-use of technology (SUT, where older adults use technology to manage nutrition and health); (2) provider use of technology to support older adults (PUT, where providers use technology to optimize or enhance the care of older adults); and (3) ability or readiness to use technology (ART, where older adults or providers received technology education or training, [51]".Studies were characterized and described based on technology and nutrition areas of interest.After reviewing findings, integration of technology, and nutrition characterization, the two researchers further analyzed and integrated the nutrition and technology characterizations of interest into three domains.Rural upstate New York, U.S.
Understand the use of telemedicine for setting goals to address behavior change; examine progress toward these goals in underserved rural older adults with diabetes.
Telemedicine is an acceptable tool for consistent diabetes education, nutrition counseling, and diabetes monitoring.It offers access to diabetes support, resources, and feedback from the convenience of their home.Overall, 68% of behavioral goals set during the intervention were rated as "met" or "improved".

Results
From the initial search, 254 papers were extracted, and 52 were added as identified with other sources for 306 papers.A review of the remaining full-text articles was where additional articles were excluded from this study based on a lack of discussion of nutrition, technology, or aging, resulting in the removal of 165 papers.Duplicates were removed from the 141, leaving the full-text analysis of 79 papers.For the first round of analysis, we removed 25 papers since they did not fully cover the topic areas.In a second round of review, 11 papers were removed as a meticulous final review required that papers be excluded.Debate and agreement on the inclusion or exclusion of a paper ensued between the authors to develop the final list of papers.Forty-four full-text peerreviewed papers met the research criteria and were retained, as shown in Figure 1: process of identification, and inclusion in this study: PRISMA diagram flow.

Results
From the initial search, 254 papers were extracted, and 52 were added as identified with other sources for 306 papers.A review of the remaining full-text articles was completed, where additional articles were excluded from this study based on a lack of discussion of nutrition, technology, or aging, resulting in the removal of 165 papers.Duplicates were removed from the 141, leaving the full-text analysis of 79 papers.For the first round of analysis, we removed 25 papers since they did not fully cover the topic areas.In a second round of review, 11 papers were removed as a meticulous final review required that papers be excluded.Debate and agreement on the inclusion or exclusion of a paper ensued between the authors to develop the final list of papers.Forty-four full-text peer-reviewed papers met the research criteria and were retained, as shown in Figure 1: process of identification, and inclusion in this study: PRISMA diagram flow.

Study Characterization
The final papers fit within eight categories: commentary, (2) future research, (3) intervention, (4) randomized, (5) literature review, (6) qualitative, (7) mixed methods, and (8) quantitative.Some retained papers fit into multiple study categories, yet only the first category associated with the study was summarized.Most studies examined the early stages of using technology to manage nutrition, including older adults' and providers' technology preferences, research protocols, and pilot/feasibility interventions.Mixed methods and qualitative studies explored the end users' experiences and the cocreation of digital nutrition interventions.Quantitative studies compared digital technologies with traditional methods for collecting nutrition data [3,6,64,65].

Study Characterization
The final papers fit within eight categories: (1) commentary, (2) future research, (3) intervention, (4) randomized, (5) literature review, (6) qualitative, (7) mixed methods, and (8) quantitative.Some retained papers fit into multiple study categories, yet only the first category associated with the study was summarized.Most studies examined the early stages of using technology to manage nutrition, including older adults' and providers' technology preferences, research protocols, and pilot/feasibility interventions.Mixed methods and qualitative studies explored the end users' experiences and the cocreation of digital nutrition interventions.Quantitative studies compared digital technologies with traditional methods for collecting nutrition data [3,6,64,65].

Technology Characterization
Our results revealed that most studies included multiple technologies, particularly a combination of hardware and software (Table 3).

Technology Characterization
Our results revealed that most studies included multiple technologies, particularly a combination of hardware and software (Table 3).
Notable mention technologies: To a lesser extent, the following technological devices or software were found in the analysis: sensors and smart devices, robots/assistive devices, desktop/laptop, mobile or smartphone, webcam, telephone, video conferencing, and internet access.Nineteen studies explored the utilization of sensors and smart devices; this included home-based sensors (n = 6 studies), mobile sensors (n = 5 studies), and fitness devices (n = 8 studies).Ten studies utilize internet access as a core component of delivering nutrition or health information.
Integration of technology and nutrition characterization: The use of technology is the integration of "software and hardware [in] three domains as it relates to nutrition management and the nutrition care process: (1) "track, plan, and execute" (track dietary intake, plan changes, and execute nutrition plans); (2) "assess" (health data collection); and (3) build knowledge (promote clinicians' and older adults' nutrition understanding [51]).
Nutrition assessment and monitoring: Many studies focused on nutrition assessment, monitoring, or tracking dietary behaviors.In some studies, self-monitoring was assessed, where older adults tracked dietary intake and nutrition-related markers, such as weight and laboratory values [3,23,40,59,61,[64][65][66][67]73,77,82,85,89].Other studies focused on passive monitoring, where technology was used to monitor and track older adults' movement and behaviors using wearable devices, sensors, and robots [4,6,53,60,68,81].In several studies, health professionals performed assessments and monitoring with videoconferencing [24,56,87,88].One study had older adults use a tablet application to collect data, these data were used to identify environmental facilitators and food barriers to healthy living [79].
Nutrition education and counseling: Studies that focused on nutrition education included remote nutrition counseling and self-directed education, along with articles that outline how technology can be used to improve dietary intake and nutritional status.Several studies focused on webinars and "live" nutrition counseling [57,76,83,88] as ways to provide nutrition information.Two papers used telephone sessions with an RDN [8,80].One study trained long-term care staff to enhance their knowledge around nutrition related topics [73].One study educated providers on enhanced caregiver knowledge of dysphagia in long-term care settings [73].
Studies that focused on self-directed nutrition education provided older adults nutrition information.Two studies blended education sessions and self-directed learning [58,73].Studies on self-directed nutrition education typically had older adults receive nutrition information, such as recommendations, recipes, or patient-oriented feedback and messaging.Afterward, older adults set personal nutrition goals to improve self-care, usually using an application [23,40,52,54,56,[59][60][61]67,77,84,85].Most studies focused on self-directed nutrition education were pilot studies, protocol papers, or formative studies that examined older adults' preferences and acceptability after interacting with the application.Chiu et al. [58] and Ploeg et al. [73] utilized a combination of live-nutrition education sessions and self-directed learning.Participants attended nutrition lectures and received a device with nutrition-related films and applications downloaded [58].Ploeg et al. [73] conducted home visits, where older adults set goals with their healthcare providers.The health data were stored on personal health records that both older adults and their providers could access, and older adults could message their providers using their personal health records.Some studies examined older adults' preferences to better understand how to provide nutrition information [4,70,71].One study found that older adults and their caregivers thought it would be helpful if a robot provided nutrition advice.Two studies synthesized the literature and provided the best nutrition and health education practices using technology [24,81].
Other studies provided tailored meal plans to improve nutrition [60,67,77].Two papers focused on how caregivers could improve older adults' dietary intake [69,74].Other studies obtained older adults' views on how technology could improve their nutrition [4] or synthesized the previous literature [78,81].For example, Lukasik et al. [4] collected formative data on how robots may help offer nutrition support to older adults and caregivers.Their findings reveal that older adults accepted that a robot could remind them to eat and drink for optimum food and fluid intake.Finally, one study looked at older adults who participated in online communities and found that older adults' posts related to "dietary nutrition" often revolved around certain dietary nutrients of concern, such as vitamins, fats, and protein [75].
Other nutrition areas: Less frequently considered nutrition topics included: nutritional status (n = 12 studies), weight and body composition (n = 12 studies), and ADL (n = 7 studies).Several studies used technology to improve nutrition status for those older adults that presented with malnutrition or that were at nutritional risk [40,54,67,84,85]; these studies explicitly addressed frailty and sarcopenia and optimizing weight status among older adults.Other studies assessed malnutrition but without technology [60,61,77].Three studies examined how technology can promote weight loss [55,56,86].One study described how caregivers could help treat and prevent protein-energy malnutrition.Two studies examined the existing research on how technology can help prevent and manage malnutrition [70,81].Specifically, Marx et al. [70] completed a systematic review assessing how malnutrition-focused telehealth interventions could improve protein intake among older adults and QOL.Several studies addressed how technology can help older adults maintain their independence by completing food-related ADLs, including buying, preparing, and eating food safely and reminding them to consume meals and snacks.

Discussion
This scoping review examined the existing technologies used to support older adults in managing their nutrition and food intake.It also described the areas of the NCP in which technology can better serve older adults.Software applications were the most common form of software mentioned in the literature.Tablet computers were the most used hardware device.Figure 3, prominent uses of software application and tablet computers, summarizes the areas of technology used to manage nutrition by software applications and tablet computers.The primary nutrition areas of focus included: nutrition assessment, monitoring, and/or tracking, nutrition education/counseling, and diet intake and quality.These categories are integral pieces of the four steps of the NCP.Many of the nutrition interventions sought to address age-related nutrition concerns that are well-documented among this population and include: malnutrition, sarcopenia, frailty, and chronic conditions with dietary implications.Additionally, the findings reveal that while telenutrition is a feasible way to manage nutrition, more extensive studies are needed to ensure practical utility and effectiveness in utilizing various software and applications, such as telenutrition, to manage nutrition in this population.among older adults.Other studies assessed malnutrition but without technology [60,61,77].Three studies examined how technology can promote weight loss [55,56,86].One study described how caregivers could help treat and prevent protein-energy malnutrition.Two studies examined the existing research on how technology can help prevent and manage malnutrition [70,81].Specifically, Marx et al. [70] completed a systematic review assessing how malnutrition-focused telehealth interventions could improve protein intake among older adults and QOL.Several studies addressed how technology can help older adults maintain their independence by completing food-related ADLs, including buying, preparing, and eating food safely and reminding them to consume meals and snacks.

Discussion
This scoping review examined the existing technologies used to support older adults in managing their nutrition and food intake.It also described the areas of the NCP in which technology can better serve older adults.Software applications were the most common form of software mentioned in the literature.Tablet computers were the most used hardware device.Figure 3, prominent uses of software application and tablet computers, summarizes the areas of technology used to manage nutrition by software applications and tablet computers.The primary nutrition areas of focus included: nutrition assessment, monitoring, and/or tracking, nutrition education/counseling, and diet intake and quality.These categories are integral pieces of the four steps of the NCP.Many of the nutrition interventions sought to address age-related nutrition concerns that are well-documented among this population and include: malnutrition, sarcopenia, frailty, and chronic conditions with dietary implications.Additionally, the findings reveal that while telenutrition is a feasible way to manage nutrition, more extensive studies are needed to ensure practical utility and effectiveness in utilizing various software and applications, such as telenutrition, to manage nutrition in this population.

Software Applications Dominance
The prominent area of technology found in the extant research reviewed was software.Sixty-eight percent (n = 31) of the studies used some form of software.The use of software falls within four areas that we label as (1) track, plan, and execute; (2) assessment; (3) build knowledge; and (4) social media.First, 45.16% of the studies use track, plan, and execute as the use of software to track dietary intake, plan for any changes, and execute

Software Applications Dominance
The prominent area of technology found in the extant research reviewed was software.Sixty-eight percent (n = 31) of the studies used some form of software.The use of software falls within four areas that we label as (1) track, plan, and execute; (2) assessment; (3) build knowledge; and (4) social media.First, 45.16% of the studies use track, plan, and execute as the use of software to track dietary intake, plan for any changes, and execute actions in the plan.The software used was a mix of existing and existing software with modifications and custom development.All the software was for niche use, including a limited population and functional features.None of the articles included in this scoping review utilized commercially available software popular with everyday consumers.In the U.S., these software applications include Lose It! [90], Fooducate [91], and MyPlate [92].In many cases, these apps are free; however, there is usually a cost for tracking important dietary intake goals for older adults, such as fluid, protein, and sodium intake.Of concern, the typical app promotion is for weight loss [93,94], which could create some confusion for older adults since, in some older adults, weight gain is most important.Nevertheless, using software to track, plan, and execute a nutrition program is essential.
The second area of software used in the studies is assessment, at 35.48% of the studies.Assessment involves obtaining data through a provider's use of technology to support an older adult or an older adult's self-use of technology.In this study's papers, many researchers converted existing forms to apps or web pages, which may be a future mandate for nutritionists as data collection requirements expand.Government legislation and regulation required the wholesale collection and sharing of health care data, as seen in the U.S. HITECH Act, 2009 [95].In that act, electronic medical records (EMRs) are a clinical understanding of health care information between health care systems, networks, and providers and are widely used.Electronic health records (EHRs) include medical history, medications, treatment plans, etc., and are not as common in day-to-day use today.Nutrition assessment, monitoring, and evaluation are essential components of the nutrition care process to detect and treat poor nutritional status among older adults and understand intervention efficacy [8].
Our findings reveal that technology may be a promising way to expand healthcare providers' ability to identify older adults with poor nutritional status or at nutritional risk [61,77].
More research is needed to understand how utilizing these applications to track nutritional status and diet can help reduce the number of adults at nutritional risk with undetected malnutrition and how technology can help improve nutritional status.
However, collecting and addressing the requirements for older adult data is no small task with or without EHRs.That said, sixty percent of older adults have two or more chronic medical conditions [96].They often receive transition care for their needs [8], which creates a perpetual necessity to update data for many healthcare needs.Today's remedies for collecting these data include an ongoing requirement for older adults to answer questions for those filling out or completing manual and electronic forms themselves.The Academy of Nutrition and Dietetics recommends that nutrition practitioners improve evidence-based outcomes to advance the relevance of nutrition programs [18].Likewise, the NCP provides a systematic framework for tailored, high-quality nutrition care that considers clients' values, needs, and evidenced-based recommendations [97].The ongoing need rests in understanding that older adults have individualized diets based on nutrition needs, weight, chronic illness, medical complexities, and involvement in their diet plans [8].Against this background, apps for evidence-based assessment will expand and need to be standardized.Third, 16.13% of the studies use software to build knowledge, which is software to develop a provider or older adult's understanding of nutrition.The intent is to increase an older adult's learning on how nutrition can positively affect QOL.However, a health improvement may not be seen; underlying hindrances may be due to nutrition-related health issues, such as appetite loss and eating difficulties [61].Yet, new visual techniques may help build knowledge for older adults and providers.Three-dimensional animation software has shown early promise to replace printed material for older adults [52].Access to snips of information, video, and text helps caregivers remedy dysphagia [74].Many of these software applications recognized the heterogeneity in our aging population and the vital need for personalized dietary guidance and messaging to improve outcomes [54,59,60].As a result, while standardization of app interfaces may be needed to enhance usability for older adult end users, the nutrition content should be tailored to meet their health needs.While software to build knowledge was not prominent, future research may show that knowledge-building is inherent in tracking, planning, and executing software.
Finally, at 3.23% of the studies using software, social media uses electronic networks to support a healthy life.Online social communities for older adults are a venue for discussing nutrition, exercise, and mental health.Research has indicated that in nutrition, online communities promote topic discussion on aging where issues with diet develop [75].Applications for sharing views and information, such as in social media committed to older adult health, safety, and welfare, are of value to those more information technology-minded.

Tablet Computers Dominance
The second dominant area of technology used was a tablet computer; of the studies reviewed, that number was 52.27% (n = 23).The primary use of tablets was for older adults' SUT.Following in structure with the areas of software we labeled earlier, a tablet was used to track, plan, and execute within nine studies.Additionally, using a tablet for assessment was included in nine studies and to build knowledge was a part of three studies.Based on software as the predominant technology, it is unsurprising that the tablet computer was number one in the hardware category.The final use for a tablet computer was webcam capabilities for taking pictures of food before and after dining and videoconferencing.Photographing a meal allows an older adult to record the nutrition and calories consumed in the track, plan, and execute nutrition program.A tablet webcam was used for videoconferencing by older adults to complete support calls regarding nutrition follow-up or assistance.In one specific study, providers used a tablet with specialty software to build knowledge supporting older adults.Video and 3D knowledge-building resources for providers and older adults are a ready interactive opportunity.
Given the user-friendliness of tablets as well as the extensive device features, this type of hardware holds promise to assist with various steps of the NCP, including connecting older adults with providers for nutrition assessment and counseling, actively tracking health information, and allowing older adults to set and strive to achieve tailored dietary goals.Previous research has also noted that tablet computers are the most intuitive and user-friendly for older adults [98].

Notable Mention Technologies
Our findings reveal that researchers used hardware including tablets, desktops, laptops, and mobile or smartphones in 88.64% of the studies.This finding is significant because the legacy technologies of desktop, laptop, mobile, or even smartphones are not the leading technologies in current research.Based on the discussion above, tablet computers are the most-used hardware when conducting recent research with older adults.Previous research has noted that tablet computers are the most intuitive and user-friendly for older adults [96].User-friendly acceptance indicates that investigations should be open to understanding the effects of newer technology and its adoption by older adults in the future since tablets may not continue as the prevailing technology.As technology changes, large-screen smartphones may prevail so that older adults maintain one device for voice, video, and internet application engagement.
Regarding the Internet of Things (IoT) family, they appeared in 56.82% of the studies."IoT consists of objects embedded with technology that can sense or capture information, communicate over the internet, and interact with its features or outside influences [51]."The breakdown of studies extracted is as follows: home-based sensors (13.64%), smart devices (13.64%), mobile device sensors (11.36%), and fitness devices (18.18%).There seems to be a movement toward conducting more research on the IoT, such as fitness and sensors; this is evident in current studies conducted from 2018 to 2020.The disciplines-IS, nutrition, and gerontology-are likely to conduct more research on the value of sensors in supporting older adults.Tracking and monitoring bring value by automatically assessing and reporting care and QOL measures [6,76].
We have seen the importance of the internet in day-to-day life across different age groups.While most of these studies did not explicitly mention internet use, internet use is pervasive.It will be integral in any investigation where two or more people are linked to complete a task or transact using digital services.The pandemic has highlighted the lack of broadband internet access to homes and small businesses nationwide.In particular, older adults living in rural areas lack digital services [99].And proper internet access has become a necessity that U.S. legislators are interested in solving, as is evident in current federal law considerations [100].Increasing broadband internet access for older adults can help offer digital nutrition services and help decrease social isolation in both communitydwelling older adults and those residing in long-term care communities experienced during the COVID-19 pandemic [101].Research in videoconferencing will help bridge how telemedicine, telenutrition, and socialization enhance an older adult's QOL.

Implications
Our scoping review reveals that nutrition and technology are needed to support an older adult's QOL.The literature shows that software standardization is an essential initial step to being able to track, plan, and execute nutrition programs.Practitioners may not see existing software as transparent or simple enough for older adults to log and photograph food as a clear intake record.The value of standardization is making software use habitual as older adults maintain their nutrition across day-to-day and transition care for rehabilitation.Second, under the topic of software is the standardization of assessment software.When evident-based programs are needed, and the reporting values of a track, plan, and execute software are not detailed enough, standardized assessment software would be of value.The software input must be straightforward for the provider's assessment evidence area and simplistic for older adult entry.
This current study's findings rest within four areas: (1) software for track, plan, and execute and assessment functions lack standardization; (2) the family of the IoT is a promising area for new research for older adults; (3) personal device use by older adults appears to be evolving to the tablet computer; and (4) broadband internet is a technology source to health and nutrition care.Researchers in countries on continents worldwide, such as Australia, Asia, Europe, and North America, were involved in the findings revealed.As the world population ages, research is needed to build knowledge on older adults' nutrition needs.Like innovation in any field, technology will be a part; however, how the end user responds to a technology's capabilities is imperative to the innovation's success.
Against this background, we find that only 51.1% of the older adult end users are engaged in the self-use of technology (see SUT percentage in Figure 3).The remaining use of technology, found in this scoping review, is the provider use of technology in support of the older adult, a combination of old adult self-users and provider users together, and providing for older adults' ability or readiness to use technology.The expectations are that while the use of technology by providers of older adults is routine during their care, additional effort is necessary to place technology in the hands of the older adults.While these implications are significant in their own right, considering this research's practical utility and effectiveness is also due for discussion.

Implications for Practical Utility and Effectiveness
Society has become aware of the daily effectiveness of technology for almost all of life's matters to enhance the average person's QOL.Effectiveness with technology is ubiquitous in a world of all devices, always on, with multiple modality access to the internet.That said, technology integration is its users adopting the technology designed and deployed by hardware and software companies.However, older adults and those with disabilities adapt to technology since change is often required for older adults to use some hardware and software.
Regarding older adults, in an ad hoc analysis of the practical utility and effectiveness of nutrition and technology, we found in the papers for this study that most of the extant research was formative.We analyzed 12 studies where outcome data were reported from an intervention or randomized control trial to assess digital health's practical utility and effectiveness for managing nutrition in our aging population.Only 11 (25%) of the retained studies were interventions [52,[56][57][58][59]61,67,[82][83][84]86], and one (2.27%) was a randomized control trial [88].Eight studies examined used specially designed, proprietary software (customized software), rather than software readily available to the public, to assess or monitor nutrition status or provide nutrition education [52,58,59,61,67,80,82,85]. The other four studies used videoconferencing with older adults to provide education and counseling [56,57,86,88].Overall, the primary outcomes of these 12 studies also varied, ranging from feasibility, acceptability, adherence, or changes in health markers pre-and post-intervention, which included weight status, nutrition knowledge, and lab values.While most studies support using technology to manage health, generalizing these findings is limited by the small sample sizes in the 11 intervention studies, ranging from 6 to 94 participants.Therefore, capturing the effectiveness of videoconferencing and customized software applications in improving older adults' nutrition markers is difficult.Additionally, interventions are needed to assess adopted versus adaptive technology use, as well as to explore other hardware devices to manage health.Of these 12 studies extracted, only 4 examined fitness devices in conjunction with videoconferencing or software applications [56,57,59,80].
The practical utility of hardware and software is evident in the expanding integration into nutrition and healthcare management.As a result, more studies and support services research will help older adults benefit from these technologies and ensure practical utility in this population.Studies and services are time-sensitive since access to a hardware device connected to the internet is required to take advantage of certain services, including government-funded programs.For example, older adults were a priority to receive the COVID-19 vaccine first; however, registration was only mainly online when the vaccines were first rolled out to the public.Many older adults did not have the digital competency to schedule an appointment at a vaccine site [102], highlighting gaps in the digital divide between younger (adopters of technology) and older adults (adaptors of technology) and how this divide can result in health inequities [102].Finally, some older adults have reported forced adoption to utilize the patient portal by their physicians [103].It is imperative that further research is conducted to ensure the practical utility, adoption, and effectiveness of technology to manage nutrition and promote health among older adults and those who provide care for our aging population.

Future Research and Limitations
Further research is needed, because of COVID-19, to realize better the movement to videoconference technology for health care digital information and support.The studies reviewed were pre-pandemic, and videoconferencing was considered a worldwide business technology and became an emerging healthcare technology.With advancements in technology and its use in health care, videoconferencing is destined to be the omnipresent software in one's browser.Similar to tablet hardware, this popular consumer-voted software will become the leader.It will be best for older adults to follow where younger family members lead on videoconferencing as with the tablet computer.Our search also reveals that few studies addressed the use of social media by older adults; however, the new generation of aging adults is technology-aware of the many personal devices, hardware, software, and social media available.This next generation of older adults will likely not submit to aging out of technology yet demand more age-specific technology.The use of social media is a promising area to introduce future older adults to videos, 3D experiences, and new learning to build knowledge.
How technology could assess dietary intake, improve diet quality, and food provision was also studied to a lesser extent.Only one study examined the efficacy of protein-enforced home-delivered meals selected from a tablet and monitoring intake for patients discharged from the hospital [67].Scott et al.'s [78] findings reveal that smartphone applications can be used to access food delivery services.Given that the COVID-19 pandemic has disrupted how we traditionally purchase food in the grocery store [104], future studies should examine how to train older adults to use online grocery shopping to buy nutritious foods that meet their unique nutritional needs.Whether or not purchasing groceries online impacts diet quality among older adults should also be examined.Digital technology for food provisioning has increased the utilization of meal delivery kits (delivery of preportioned, fresh ingredients and recipes); how these kits among older adults improve diet quality with the help of an RDN should also be explored [105].Additionally, since a critical contributor to inadequate dietary intake among older adults is decreased food enjoyment and food involvement (desire to prioritize food [9]), how these services improve these risk factors should be examined.
Future studies involving any new investigation should be considered open to various research methods.Further research should include a focus on increasing the number of participants.While data are more obtainable when using secondary data sources, participant group size can be an issue for new face-to-face studies.Older adults are susceptible to exclusion from studies for reasons not typically found in younger age groups, such as corrective eyesight limitations, increased chronic illness, and loneliness due to social isolation [106].These limited population studies are critical since older adults have similarities yet are very heterogeneous in their medical and nutrition needs.
Findings from this research can be incorporated into the Theory of Andragogy [107] to help inform the design of technologies and telenutrition programs for older adults and healthcare providers.The Theory of Andragogy recognizes adult learners as mutual partners in learning, acknowledging that their prior experience can help them learn a new skill.When educating older adults and health professionals on using technology to manage nutrition, we suggest training sessions based on learning objectives that fulfill the end user's requests, interests, and digital competence levels.

Conclusions
Our scoping review provides valuable evidence of the extant literature in the discipline of technology, nutrition, and geriatrics.The time frame of the literature search was the last 21 years; however, the search results show that 86% (n = 38) of the studies are within the five years from 2016 to 2020.This study time frame reveals the broader understanding that research interlocked in technology, nutrition, and geriatrics is new.And during this period, the critical analysis of the findings reveals that software for older adults to track, plan, execute, and assess evidence-based nutrition programs needs standardization.The IoT is a promising area for new research in QOL, and personal device use appears to evolve to the tablet computer.Finally, broadband internet is a vital nutrition care technology source.The results suggest that research on older adults' nutrition using technology is not yet a formable research area; however, building knowledge is underway.

Figure 1 .
Figure 1.Process of identification and inclusion in this study: PRISMA diagram flow.

Figure 1 .
Figure 1.Process of identification and inclusion in this study: PRISMA diagram flow.

Figure 2 .
Figure 2. Target end users of technology.

Figure 2 .
Figure 2. Target end users of technology.

Figure 3 .
Figure 3. Prominent uses of software applications and tablet computers.

Figure 3 .
Figure 3. Prominent uses of software applications and tablet computers.

Table 1 .
List of nutrition and information systems (IS) journals included in the initial search.

Table 2 .
Summary of studies using technology for managing nutrition for older adults.

Table 3 .
Forms of technology used to manage nutrition for older adults.

Table Legend :
ART = ability or readiness to use technology; ICT = information and communication technology; PUT = provider use of technology in support; SUT = self-use technology [51].

Table 4 .
Nutrition area of focus and study setting to manage nutrition for older adults.