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Journal Description

JMIR Aging (JA, Founding Editor-in-chief: Jing Wang, Professor and Vice Dean for Research, Hugh Roy Cullen Professor, UT Health San Antonio School of Nursing, San Antonio, TX, USA) is a new sister journal of JMIR (the leading open-access journal in health informatics (Impact Factor 2017: 4.671), focusing on technologies, medical devices, apps, engineering, informatics applications and patient education for medicine and nursing, education, preventative interventions and clinical care / home care for elderly populations. In addition, aging-focused big data analytics using data from electronic health record systems, health insurance databases, federal reimbursement databases (e.g. U.S. Medicare and Medicaid), and other large databases are also welcome.  

As open access journal we are read by clinicians, nurses/allied health professionals, informal caregivers and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).

During a limited period of time, there are no fees to publish in this journal. Articles are carfully copyedited and XML-tagged, ready for submission in PubMed Central.

Be a founding author of this new journal and submit your paper today!

 

Recent Articles:

  • An older adult with multiple long-term conditions. Source: Max Pixel; Copyright: Max Pixel; URL: https://www.maxpixel.net/Corridor-Elderly-Doctor-1461424; License: Public Domain (CC0).

    Understanding Care Navigation by Older Adults With Multimorbidity: Mixed-Methods Study Using Social Network and Framework Analyses

    Abstract:

    Background: Health and social care systems were designed to be used primarily by people with single and acute diseases. However, a growing number of older adults are diagnosed with multiple long-term conditions (LTCs). The process of navigating the intricacies of health and social care systems to receive appropriate care presents significant challenges for older people living with multiple LTCs, which in turn can negatively influence their well-being and quality of life. Objective: The long-term goal of this work is to design technology to assist people with LTCs in navigating health and social care systems. To do so, we must first understand how older people living with LTCs currently engage with and navigate their care networks. No published research describes and analyses the structure of formal and informal care networks of older adults with multiple LTCs, the frequency of interactions with each type of care service, and the problems that typically arise in these interactions. Methods: We conducted a mixed-methods study and recruited 62 participants aged ≥55 years who were living in England, had ≥2 LTCs, and had completed a social network analysis questionnaire. Semistructured interviews were conducted with roughly a 10% subsample of the questionnaire sample: 4 women and 3 men. On average, interviewees aged 70 years and had 4 LTCs. Results: Personal care networks were complex and adapted to each individual. The task of building and subsequently navigating one’s personal care network rested mainly on patients’ shoulders. It was frequently the patients’ task to bridge and connect the different parts of the system. The major factor leading to a satisfying navigation experience was found to be patients’ assertive, determined, and proactive approaches. Furthermore, smooth communication and interaction between different parts of the care system led to more satisfying navigation experiences. Conclusions: Technology to support care navigation for older adults with multiple LTCs needs to support patients in managing complex health and social care systems by effectively integrating the management of multiple conditions and facilitating communication among multiple stakeholders, while also offering flexibility to adapt to individual situations. Quality of care seems to be dependent on the determination and ability of patients. Those with less determination and fewer organization skills experience worse care. Thus, technology must aim to fulfill these coordination functions to ensure care is equitable across those who need it.

  • The VC Health program for improving the cognitive function and mental health of older adults with subjective. Source: Free Stock Photos; Copyright: CDC / Dawn Arlotta; URL: http://www.freestockphotos.biz/stockphoto/17511; License: Public Domain (CC0).

    The Impact of the Virtual Cognitive Health Program on the Cognition and Mental Health of Older Adults: Pre-Post 12-Month Pilot Study

    Abstract:

    Background: Face-to-face multidomain lifestyle interventions have shown to be effective for improving or maintaining cognitive function in older adults at risk for dementia. Remotely delivered interventions could increase access to such solutions but first require evidence to support that these programs can successfully impact health outcomes. Objective: The objective of this study was to evaluate the impact of a remotely delivered multidomain lifestyle intervention, the virtual cognitive health (VC Health) program, on the cognitive function and mental health of older adults with subjective cognitive decline (SCD). Methods: A 52-week, prospective, single-arm, pre-post, remote nationwide clinical trial was conducted to measure the change in cognitive function, depression, and anxiety levels for older adults at risk of developing dementia who participated in the VC Health program. A Web-based study platform was used to screen, consent, and enroll participants across the United States. Participants completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) test and Web-based assessments (which included the Patient Health Questionnaire [PHQ-9] and Generalized Anxiety Disorder [GAD-7] surveys) at baseline and weeks 12, 24, and 52; all data were collected remotely. Changes in RBANS, PHQ-9, and GAD-7 were assessed using 2-tailed paired t tests and nonparametric signed-rank tests. Results: Participants (N=82) were, on average, aged 64 years (range 60.0-74.9 years), 74% (61/82) female, 88% (72/82) white, and 67% (55/82) had a college degree or higher. At baseline, participants had a mean and median RBANS Total Index score of 95.9 (SD 11.1) and 95.5 (interquartile range, IQR=13). Participants experienced a mean and median increase of 5.8 (SD 7.4) and 6 (IQR=11) in RBANS Total Index score from baseline to week 52 (P<.001). Participants had a mean and median PHQ-9 score of 8.5 (SD 4.9) and 8 (IQR=6) at baseline and experienced a mean and median decrease of 3.8 (SD 4.1) and 4 (IQR=6) units in PHQ-9 score from baseline to week 52 (P<.001). At baseline, participants had a mean and median GAD-7 score of 6.2 (SD 4.5) and 5.5 (IQR=6) and experienced a mean and median decrease of 2.9 (SD 4.1) and 2 (IQR=5) units in GAD-7 score from baseline to week 52 (P<.001). Participants were engaged and very satisfied with various program components. Conclusions: In this study, older adults with SCD who were at risk for dementia experienced statistically significant improvements in their cognitive function, depression, and anxiety levels. These findings serve as initial evidence for the overall feasibility and effectiveness of the VC Health program to improve or maintain cognitive function in older adults who are experiencing SCD. Further research should be conducted to understand the degree to which the improvements are attributable to specific components of the intervention. Trial Registration: ClinicalTrials.gov NCT02969460; https://clinicaltrials.gov/ct2/show/NCT02969460 (Archived by WebCite at http://www.webcitation.org/73XOph9Qm)

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/smiling-young-woman-sitting-on-yellow-sofa-using-laptop_3090847.htm; License: Licensed by JMIR.

    Identifying Consumers Who Search for Long-Term Care on the Web: Latent Class Analysis

    Abstract:

    Background: Because the internet has become a primary means of communication in the long-term care (LTC) and health care industry, an elevated understanding of market segmentation among LTC consumers is an indispensable step to responding to the informational needs of consumers. Objective: This exploratory study was designed to identify underlying market segments of the LTC consumers who seek Web-based information. Methods: Data on US adult internet users (n=2018) were derived from 2010 Pew Internet and America Life Project. Latent class analysis was employed to identify underlying market segments of LTC Web-based information seekers. Results: Web-based LTC information seekers were classified into the following 2 subgroups: heavy and light Web-based information seekers. Overall, 1 in 4 heavy Web-based information seekers used the internet for LTC information, whereas only 2% of the light information seekers did so. The heavy information seekers were also significantly more likely than light users to search the internet for all other health information, such as a specific disease and treatment and medical facilities. The heavy Web-based information seekers were more likely to be younger, female, highly educated, chronic disease patients, caregivers, and frequent internet users in general than the light Web-based information seekers. Conclusions: To effectively communicate with their consumers, providers who target Web-based LTC information seekers can more carefully align their informational offerings with the specific needs of each subsegment of LTC markets.

  • Here, an elderly gentleman uses a second-hand stroller while attending a health fair. There is a high prevalence of falls in the elderly population; creativity abounds as patients attempt to compensate for disequilibrium. Source: Image created by the Authors; Copyright: The Authors; URL: http://aging.jmir.org/2018/2/e11772/; License: Creative Commons Attribution (CC-BY).

    Digital Media Recruitment for Fall Prevention Among Older Chinese-American Individuals: Observational, Cross-Sectional Study

    Abstract:

    Background: Research in fall prevention programs has increased in recent years in response to the aging demographics of the United States. To date, limited research and outreach programs have focused on ethnic minorities due to increased cost, language barriers, and cultural differences. Digital media platforms may be a cost-effective avenue to initiate fall prevention programs for minority populations. Objective: The objective of this study was to determine whether Facebook advertisements are a practical recruitment method for health education to the Chinese-speaking population. Methods: This was an observational, cross-sectional study. We uploaded a video on fall education on YouTube and initiated an advertisement campaign on Facebook that was linked to the video. The target population was older adults aged >45 years who used Facebook and were presented with the advertisement (N=1039). We recorded metrics such as the number of unique individuals reached, the number of views of the advertisement, the number of clicks, user gender and age, and traffic sources to the advertisement. Data were analyzed with descriptive statistics. Results: Our Facebook advertisement had 1087 views (1039 unique viewers). There were 121 link clicks with a click-through rate of 11.13% (121/1087). The cost per link click was approximately US $0.06. Among the viewers, 91.41% (936/1024) were females and 8.59% (88/1024) were males. In the 45-54 age group, the ad reached 50 people, with 1 link click (2.00%). In the 55-64 age group, the ad reached 572 people, with 57 link clicks (9.97%). In the ≥65 age group, the ad reached 417 people, with 63 link clicks (15.11%). Conclusions: Facebook was able to directly target the advertisement to the desired older ethnic population at a low cost. Engagement was highest among females and among those aged ≥65 years. Hence, our results suggest that Facebook can serve as an alternative platform for dissemination of health information to geriatric patients in addition to print-based and face-to-face communication.

  • Source: Flickr; Copyright: Langwitches; URL: https://www.flickr.com/photos/langwitches/4234062133/in/photolist-7s9Fag-5nzQZz-9xJrPo-7u1fpM-dNbShM-arHw5s-dNhsb1-hYedGs-5wLLAG-rumG5c-7HpcRk-9yyKUQ-9idkpF-7RRh3x-4erdVm-7HrtJw-7kqY5x-4dVikL-7Fh9eU-5iozoH-dU9sXN-7BDSTg-7ASVEn-8QQyYP-iVKWnJ-aANLSs-7VDKFg-; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

    Feasibility and Conceptualization of an e-Mental Health Treatment for Depression in Older Adults: Mixed-Methods Study

    Abstract:

    Background: Depression is one of the most common mental disorders in older adults. Unfortunately, it often goes unrecognized in the older population. Objective: The aim of this study was to identify how Web-based apps can recognize and help treat depression in older adults. Methods: Focus groups were conducted with mental health care experts. A Web-based survey of 56 older adults suffering from depression was conducted. Qualitative interviews were conducted with 2 individuals. Results: Results of the focus groups highlighted that there is a need for a collaborative care platform for depression in old age. Findings from the Web-based study showed that younger participants (aged 50 to 64 years) used electronic media more often than older participants (aged 65 years and older). The interviews pointed in a comparable direction. Conclusions: Overall, an e-mental (electronic mental) health treatment for depression in older adults would be well accepted. Web-based care platforms should be developed, evaluated, and in case of evidence for their effectiveness, integrated into the everyday clinic.

  • Source: Philips Lifeline; Copyright: The Authors; URL: http://aging.jmir.org/2018/2/e10254/; License: Creative Commons Attribution (CC-BY).

    Health Care Cost Analyses for Exploring Cost Savings Opportunities in Older Patients: Longitudinal Retrospective Study

    Abstract:

    Background: Half of Medicare reimbursement goes toward caring for the top 5% of the most expensive patients. However, little is known about these patients prior to reaching the top or how their costs change annually. To address these gaps, we analyzed patient flow and associated health care cost trends over 5 years. Objective: To evaluate the cost of health care utilization in older patients by analyzing changes in their long-term expenditures. Methods: This was a retrospective, longitudinal, multicenter study to evaluate health care costs of 2643 older patients from 2011 to 2015. All patients had at least one episode of home health care during the study period and used a personal emergency response service (PERS) at home for any length of time during the observation period. We segmented all patients into top (5%), middle (6%-50%), and bottom (51%-100%) segments by their annual expenditures and built cost pyramids based thereon. The longitudinal health care expenditure trends of the complete study population and each segment were assessed by linear regression models. Patient flows throughout the segments of the cost acuity pyramids from year to year were modeled by Markov chains. Results: Total health care costs of the study population nearly doubled from US $17.7M in 2011 to US $33.0M in 2015 with an expected annual cost increase of US $3.6M (P=.003). This growth was primarily driven by a significantly higher cost increases in the middle segment (US $2.3M, P=.003). The expected annual cost increases in the top and bottom segments were US $1.2M (P=.008) and US $0.1M (P=.004), respectively. Patient and cost flow analyses showed that 18% of patients moved up the cost acuity pyramid yearly, and their costs increased by 672%. This was in contrast to 22% of patients that moved down with a cost decrease of 86%. The remaining 60% of patients stayed in the same segment from year to year, though their costs also increased by 18%. Conclusions: Although many health care organizations target intensive and costly interventions to their most expensive patients, this analysis unveiled potential cost savings opportunities by managing the patients in the lower cost segments that are at risk of moving up the cost acuity pyramid. To achieve this, data analytics integrating longitudinal data from electronic health records and home monitoring devices may help health care organizations optimize resources by enabling clinicians to proactively manage patients in their home or community environments beyond institutional settings and 30- and 60-day telehealth services.

  • Source: Marine Corps Air Station Iwakuni; Copyright: US Marine Corps (Aaron Henson); URL: https://www.mcasiwakuni.marines.mil/News/Photos/igphoto/2001327755/; License: Public Domain (CC0).

    Association Between Advanced Care Management and Progression of Care Needs Level in Long-Term Care Recipients: Retrospective Cohort Study

    Abstract:

    Background: Long-term care insurance systems in Japan started a special senior care program overseen by qualified care managers (also known as advanced care managers). However, the relationship between advanced care management and outcomes in long-term care recipients remains unknown. Objective: We aimed to compare the outcome of long-term care recipients using facilities with advanced care management and conventional care management, in terms of care needs level progression. Methods: We conducted a retrospective cohort study using the Survey of Long-Term Care Benefit Expenditures in Japan. We identified those aged ≥65 years who were newly designated a care need level of 3, and received long-term care services between April 2009 and March 2014 in Tokyo. We compared survival without progression of care needs level between the groups, with and without advanced care management, using the Kaplan-Meier method. Factors affecting the outcomes were determined using a multivariable logistic regression model fitted with a generalized estimating equation. Results: Of 45,330 eligible persons, 12,903 (28.46%) received long-term care based on advanced care management. The average duration of progression-free survival was 17.4 (SD 10.2) months. The proportions of five-year cumulative progression-free survival were 41.2% and 32.8% in those with and without advanced care management, respectively. The group with advanced care management had significantly lower care needs levels (odds ratio 0.77, 95% CI, 0.72-0.82, P<.001). Conclusions: Advanced care management was significantly associated with improved care needs levels.

  • Blood pressure monitor. Source: Flickr; Copyright: Jason Cao; URL: https://www.flickr.com/photos/157887475@N08/42092137064/in/photolist-278xcT7-27AS6yS-9t9Juf-7GZHrT-22SZyB7-4nF7rP-pAxrSq-qsTk7f-hfLDF4-buqmAY-Kb3Fsb-kz6q7m-FgodPt-8rp7z9-cvppTC-eaESct-FbW4Ua-cm6Bub-7RnSmp-9rBZkK-aiFnMV-8Skw5i-eBQgpJ-7Lejnw-7d1JVz-sodfxu-p; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Usability and Acceptability of a Home Blood Pressure Telemonitoring Device Among Community-Dwelling Senior Citizens With Hypertension: Qualitative Study

    Abstract:

    Background: Hypertension is a major cause of cardiovascular disease in older individuals. To ensure that blood pressure (BP) levels are within the optimal range, accurate BP monitoring is required. Contemporary hypertension clinical practice guidelines strongly endorse the use of home BP measurement as a preferred method of BP monitoring for individuals with hypertension. The benefits of home BP monitoring may be optimized when measurements are telemonitored to care providers; however, this may be challenging for older individuals with less technological capabilities. Objective: The objective of this qualitative study was to examine the usability and acceptability of a home BP telemonitoring device among senior citizens. Methods: We conducted a qualitative descriptive study. Following a 1-week period of device use, individual, semistructured interviews were conducted. Interview audio recordings were anonymized, de-identified, and transcribed verbatim. We performed thematic analysis on interview transcripts. Results: Seven senior citizens participated in the usability testing of the home BP telemonitoring device. Participants comprised females (n=4) and males (n=3) with a mean age of 86 years (range, 70-95 years). Overall, eight main themes were identified from the interviews: (1) positive features of the device; (2) difficulties or problems with the device; (3) device was simple to use; (4) comments about wireless capability and components; (5) would recommend device to someone else; (6) would use device in future; (7) suggestions for improving the device; and (8) assistance to use device. Additional subthemes were also identified. Conclusions: Overall, the home BP telemonitoring device had very good usability and acceptability among community-dwelling senior citizens with hypertension. To enhance its long-term use, few improvements were noted that may mitigate some of the relatively minor challenges encountered by the target population.

  • Adult woman with diabetes visiting the DOC. Source: Shutterstock; Copyright: Natalie Board; URL: https://www.shutterstock.com/image-photo/professional-older-woman-working-desk-computer-687565183?src=LMcRGcAoAM8Cf6_vXaSI-w-1-58; License: Licensed by the authors.

    Understanding Why Older Adults With Type 2 Diabetes Join Diabetes Online Communities: Semantic Network Analyses

    Abstract:

    Background: As individuals age, chronic health difficulties may disrupt physical and social well-being. Individuals can turn to online communities to interact with similar peers, which may help buffer negative effects resulting from health difficulties. Objective: This study investigated the reasons that older adults join a diabetes online community to better understand the specific resources that are being sought. Methods: We used semantic network analyses to categorize the reasons participants provided for joining a community during the sign-up process. Results: The most frequent reasons for joining were to seek information about their health condition, to help with self-management of health difficulties, for feelings of informational and social support, and for having a community with whom to share. Women were more likely to go online for sharing and companionship as well as for information and social support reasons, whereas men were more likely to go online for general information and self-management reasons. Conclusions: This study shows the reasons older adults seek to join a diabetes online community: for increased information and support regarding chronic health difficulties. Practitioners may want to consider ways to promote access to online communities among their older patients as a source of health information and a resource to provide a sense of community.

  • Source: iStock by Getty Images; Copyright: vgajic; URL: https://www.istockphoto.com/ca/photo/mature-businessman-doing-blood-sugar-test-in-his-office-gm870234212-145307555; License: Licensed by the authors.

    Diabetes Online Community User Perceptions of Successful Aging With Diabetes: Analysis of a #DSMA Tweet Chat

    Abstract:

    Background: According to the American Diabetes Association, there are approximately 30.3 million Americans with diabetes, and the incidence is growing by nearly 1.5 million cases per year. These individuals are at particularly high risk of developing secondary comorbid conditions related to diabetes and aging. Nearly 45% of individuals aged 65 to 75 years use social media, and this number is steadily growing. The use of social media provides the opportunity to assess the perceptions and needs of this population. Objective: The purpose of this study was to examine stakeholder perceptions of successful aging with diabetes. Methods: This study presents a retrospective analysis of a tweet chat focused on aging with diabetes. Tweets were collected using Symplur Signals data analytics software (Symplur LLC) and analyzed for content analysis, sentiment, and participant demographics. Two authors reviewed discussion posts for accuracy of analysis. Results: A total of 59 individuals participated in this tweet chat generating 494 tweets and nearly 2 million impressions. Most (36/59, 63%) tweet chat participants were people living with diabetes; 25% (14/59) were caregivers and advocates. Seven countries were represented in the conversation. A majority (352/494, 71.3%) of the tweets indicated positive sentiment related to aging with diabetes. Five major themes emerged from the qualitative analysis: (1) personal decline now and in the future, (2) limited access to treatment, (3) inability to provide self-care, (4) health care provider capacity to support aging with diabetes, and (5) life-long online peer health support to facilitate diabetes management. Conclusions: Individuals with diabetes are living longer and want to be supported with specialized care and access to technology that will allow them to successfully age. Aging- and diabetes-related changes may complicate diabetes management into old age. People with diabetes desire options including aging in place; therefore, special training for care partners and health care providers who care for older adults is needed.

  • The McMaster Optimal Aging Portal web resource rating. Source: Image created by the Authors; Copyright: The McMaster Optimal Aging Portal; URL: http://aging.jmir.org/2018/1/e3/; License: Licensed by JMIR.

    A Tool That Assesses the Evidence, Transparency, and Usability of Online Health Information: Development and Reliability Assessment

    Abstract:

    Background: The internet is commonly used by older adults to obtain health information and this trend has markedly increased in the past decade. However, studies illustrate that much of the available online health information is not informed by good quality evidence, developed in a transparent way, or easy to use. Furthermore, studies highlight that the general public lacks the skills necessary to distinguish between online products that are credible and trustworthy and those that are not. A number of tools have been developed to assess the evidence, transparency, and usability of online health information; however, many have not been assessed for reliability or ease of use. Objective: The first objective of this study was to determine if a tool assessing the evidence, transparency, and usability of online health information exists that is easy and quick to use and has good reliability. No such tool was identified, so the second objective was to develop such a tool and assess it for reliability when used to assess online health information on topics of relevant to optimal aging. Methods: An electronic database search was conducted between 2002 and 2012 to identify published papers describing tools that assessed the evidence, transparency, and usability of online health information. Papers were retained if the tool described was assessed for reliability, assessed the quality of evidence used to create online health information, and was quick and easy to use. When no one tool met expectations, a new instrument was developed and tested for reliability. Reliability between two raters was assessed using the intraclass correlation coefficient (ICC) for each item at two time points. SPSS Statistics 22 software was used for statistical analyses and a one-way random effects model was used to report the results. The overall ICC was assessed for the instrument as a whole in July 2015. The threshold for retaining items was ICC>0.60 (ie, “good” reliability). Results: All tools identified that evaluated online health information were either too complex, took a long time to complete, had poor reliability, or had not undergone reliability assessment. A new instrument was developed and assessed for reliability in April 2014. Three items had an ICC<0.60 (ie, “good” reliability). One of these items was removed (“minimal scrolling”) and two were retained but reworded for clarity. Four new items were added that assessed the level of research evidence that informed the online health information and the tool was retested in July 2015. The total ICC score showed excellent agreement with both single measures (ICC=0.988; CI 0.982–0.992) and average measures (ICC=0.994; CI 0.991–0.996). Conclusions: The results of this study suggest that this new tool is reliable for assessing the evidence, transparency, and usability of online health information that is relevant to optimal aging.

  • Source: MyTools4Care / Placeit.net; Copyright: JMIR Publications; URL: http://aging.jmir.org/2018/1/e2/; License: Creative Commons Attribution (CC-BY).

    A Web-Based Intervention to Help Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: Qualitative Study

    Abstract:

    Background: Caregivers (ie, family members and friends) play a vital role in the ongoing care and well-being of community-living older persons with Alzheimer disease and related dementia in combination with multiple chronic conditions. However, they often do so to the detriment of their own physical, mental, and emotional health. Caregivers often experience multiple challenges in their caregiving roles and responsibilities. Recent evidence suggests that Web-based interventions have the potential to support caregivers by decreasing caregiver stress and burden. However, we know little about how Web-based supports help caregivers. Objective: The objectives of this paper were to describe (1) how the use of a self-administered, psychosocial, supportive, Web-based Transition Toolkit, My Tools 4 Care (MT4C), designed by atmist, Edmonton, Alberta, Canada, helped caregivers of older adults with Alzheimer disease and related dementia and multiple chronic conditions; (2) which features of MT4C caregivers found most and least beneficial; and (3) what changes would they would recommend making to MT4C. Methods: This study was part of a larger multisite mixed-methods pragmatic randomized controlled trial. The qualitative portion of the study and the focus of this paper used a qualitative descriptive design. Data collectors conducted semistructured, open-ended, telephone interviews with study participants who were randomly allocated to use MT4C for 3 months. All interviews were audio-taped and ranged from 20 to 40 min. Interviews were conducted at 1 and 3 months following a baseline interview. Qualitative content analysis was used to analyze collected data. Results: Fifty-six caregivers from Alberta and Ontario, Canada, participated in either one or both of the follow-up interviews (89 interviews in total). Caregivers explained that using MT4C (1) encouraged reflection; (2) encouraged sharing of caregiving experiences; (3) provided a source of information and education; (4) provided affirmation; and for some participants (5) did not help. Caregivers also described features of MT4C that they found most and least beneficial and changes they would recommend making to MT4C. Conclusions: Study results indicate that a self-administered psychosocial supportive Web-based resource helps caregivers of community-dwelling older adults with Alzheimer disease and related dementia and multiple chronic conditions with their complex caregiving roles and responsibilities. The use of MT4C also helped caregivers in identifying supports for caring, caring for self, and planning for future caregiving roles and responsibilities. Caregivers shared important recommendations for future development of Web-based supports.

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    Date Submitted: Oct 26, 2018

    Open Peer Review Period: Oct 27, 2018 - Dec 22, 2018

    Background: Older adults are the fastest growing age group worldwide and in Canada. Immigrants represent a significant proportion of older Canadians. Social isolation is common among older adults and...

    Background: Older adults are the fastest growing age group worldwide and in Canada. Immigrants represent a significant proportion of older Canadians. Social isolation is common among older adults and has many negative consequences including limiting community and civic participation, increasing income insecurity, and increasing the risk of elder abuse. Additional factors such as the social, cultural, and economic changes that accompany migration, language differences, racism, and ageism, heighten older immigrants' vulnerability to social isolation. Objective: This multi-methods, sequential (qualitative – quantitative) study seeks to clarify older immigrants' social needs, networks and support, and how these shape their capacity, resilience, and independence in aging well in Ontario. Methods: Theoretically, our research is informed by an intersectionality perspective and an ecological model, allowing us to critically examine the complexity surrounding multiple dimensions of social identity (e.g., gender, immigration) and how these interrelate at the micro (individual, family), meso (community), and macro (societal) levels in diverse geographical settings. Methodologically, the project is guided by a collaborative, community-based, mixed-methods approach to engaging a range of stakeholders in Toronto, Ottawa, Waterloo, and London, in generating knowledge. The four settings were strategically chosen for their diversity in level of urbanization, size of community, and the number of immigrants and immigrant serving organizations. Interviews will be conducted in Arabic, Mandarin and Spanish with older women, older men, family members, community leaders, and service providers. The study protocol has received ethics approval from the four participating universities. Results: Comparative analyses of qualitative and quantitative data within and across sites will provide insights about common and unique factors that contribute to the wellbeing of older immigrants in different regions of Ontario. Conclusions: Given the comprehensive approach to incorporating local knowledge and expert contributions from multi-level stakeholders, the empirical and theoretical findings will be highly relevant to our community partners, help facilitate practice change, and improve the wellbeing of older men and women in immigrant communities.

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    Date Submitted: Oct 24, 2018

    Open Peer Review Period: Oct 25, 2018 - Dec 20, 2018

    Background: Colorectal cancer (CRC) is the second leading cancer-related cause of death in the United States, however survivorship has been increasing. Both cancer survivors and underserved populatio...

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    Date Submitted: Oct 4, 2018

    Open Peer Review Period: Oct 6, 2018 - Dec 1, 2018

    Background: Novel and sustainable approaches to scale Home-Based Primary Care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the US. Telehealth m...

    Background: Novel and sustainable approaches to scale Home-Based Primary Care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the US. Telehealth may be a viable option for scaling HBPC programs. Objective: The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to scale the program. Methods: We collected qualitative data from HBPC staff (physicians, nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York Metropolitan area through 16 semi-structured interviews and 3 focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (relatedness, competence, and autonomy) as an analytical lens. Results: Four broad themes (work climate, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship) and multiple second-level themes emerged from the analysis. Within the theme of work climate, staff acknowledged the need to scale the program without diminishing effective patient-centered care. Within the theme of technology impact on staff autonomy, participants perceived alerts generated from patients and caregivers using telehealth as a potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. Regarding technology impact on competence in providing care, participants noted that it could increase efficiency and enable more informed care provision. Regarding technology impact on the patient-provider relationship, participants noted the opportunity to make caregivers part of the team through telehealth. Staff members, however, were concerned that patients or caregivers might unnecessarily over utilize the technology, and that some visits are more appropriate in-person rather than via telehealth. Conclusions: These findings suggest the importance of taking into account the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program is likely to facilitate the integration of telehealth innovations. Clinical Trial: Not applicable

  • Engaging Ageing Individuals in the Design of Technologies and Services to Support Health and Wellbeing: A Constructivist Grounded Theory Study

    Date Submitted: Oct 2, 2018

    Open Peer Review Period: Oct 6, 2018 - Dec 1, 2018

    Background: Changes noted within the ageing population are physical, cognitive as well as emotional. Social isolation and loneliness are also serious problems that the ageing population may encounter....

    Background: Changes noted within the ageing population are physical, cognitive as well as emotional. Social isolation and loneliness are also serious problems that the ageing population may encounter. As technology and applications become more accessible, many basic services, such as though offered by social services, wellbeing organisations and healthcare institutions have invested in the development of supportive devices, services and online interaction. Despite the perceived benefits that these offer, many ageing individuals choose not to engage, or engage in a limited manner. In order to explore this phenomena we developed a theory to describe the condition for engagement. Objective: The main objective of this study was to understand the perceptions of an ageing South African population regarding online services and technologies that could support ageing-in-place. Although the concept of ageing-in-place speaks to a great number of everyday activities, this paper explores aspects of health and wellbeing as being central to ageing in place. Methods: The study used a grounded theory methodology, relying on an iterative and simultaneous process of data collection, coding, category development and data comparisons. Data was collected through qualitative methods, including interviews (13 participants, between the ages of 64 and 85), two participatory workshops (15 participants) and observations. The study focused on Charmaz’s approach to grounded theory, which puts forward the premise that theory or knowledge cannot take shape in a purely objective manner. Instead, theory is constructed through the interaction of the researcher and research participant. Results: Coding and data analysis was supported with Atlas.ti. The study resulted in a substantive theory exploring the process of interaction and engaging factors, through user insights and experiences. The emerging design theory, AUDDE (Ageing User Decision Driven Engagement), explored the elements that support engagement with technology and supportive applications, which could offer access to required health and wellness services. Conclusions: In AUDDE the perceived value of the interaction is a crucial catalyst for engagement. Ageing users continuously make meaning of their experiences, which affects their current and future actions.

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