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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:

  • 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.

  • Source: Freepik; Copyright: pressfoto; URL: https://www.freepik.com/free-photo/man-with-stomachache_857942.htm; License: Public Domain (CC0).

    Coproduction of a Theory-Based Digital Resource for Unpaid Carers (The Care Companion): Mixed-Methods Study

    Abstract:

    Background: Family and other unpaid carers are crucial to supporting the growing population of older people that are living outside residential care with frailty and comorbidities. The burden associated with caring affects carers’ well-being, thus limiting the sustainability of such care. There is a need for accessible, flexible, and responsive interventions that promote carers’ coping and resilience, and hence support maintenance of the health, well-being, and independence of the cared-for person. Objective: This study aimed to coproduce a digital program for carers to promote resilience and coping through supporting effective use of information and other Web-based resources. Its overlapping stages comprised the following: understanding the ways in which Web-based interventions may address challenges faced by carers, identifying target behaviors for the intervention, identifying intervention components, and developing the intervention prototype. Methods: The study was informed by person-based theories of coproduction and involved substantial patient and public involvement. It drew on the Behavior Change Wheel framework to support a systematic focus on behavioral issues relevant to caring. It comprised scoping literature reviews, interviews, and focus groups with carers and organizational stakeholders, and an agile, lean approach to information technology development. Qualitative data were analyzed using a thematic approach. Results: Four behavioral challenges were identified: burden of care, lack of knowledge, self-efficacy, and lack of time. Local health and social care services for carers were only being accessed by a minority of carers. Carers appreciated the potential value of Web-based resources but described difficulty identifying reliable information at times of need. Key aspects of behavior change relevant to addressing these challenges were education (increasing knowledge and understanding), enablement (increasing means and reducing barriers for undertaking caring roles), and persuasion (changing beliefs and encouraging action toward active use of the intervention). In collaboration with carers, this was used to define requirements for the program. A resources library was created to link to websites, Web-based guidance, videos, and other material that addressed condition-specific and generic information. Each resource was classified according to a taxonomy itemizing over 30 different subcategories of need under the headings Care Needs (of the cared-for person), General Information and Advice, and Sustaining the Carer. In addition, features such as a journal and mood monitor were incorporated to address other enablement challenges. The need for proactive, personalized prompts emerged; the program regularly prompts the carer to revisit and update their profile, which, together with their previous use of the intervention, drives notifications about resources and actions that may be of value. Conclusions: The person-based approach allowed an in-depth understanding of the biopsychosocial context of caring to inform the production of an engaging, relevant, applicable, and feasible Web-based intervention. User acceptance and feasibility testing is currently underway.

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  • Staff Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: A Qualitative Study

    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.

  • Review of Commercially Available Mobile Apps for Caregivers of People with Alzheimer’s Disease or Other Related Dementias

    Date Submitted: Sep 20, 2018

    Open Peer Review Period: Sep 24, 2018 - Nov 19, 2018

    Background: More than 15 million Americans provide unpaid care for persons with Alzheimer’s disease or other related dementias (ADRD). While there is good evidence to suggest that caregivers benefit...

    Background: More than 15 million Americans provide unpaid care for persons with Alzheimer’s disease or other related dementias (ADRD). While there is good evidence to suggest that caregivers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group-formats. Alternatively, offering eHealth interventions may assist them in providing quality care while remaining in good health. Research to date has generated little knowledge about what app features support ADRD caregivers behaviour change and how developers might optimize features over the long term. Objective: There is an evident knowledge gap in the current landscape of commercially available apps, their integration of behavioural techniques, content focus, and compliance with usability recommendations. This paper systematically reviews and inventories the apps caregivers might typically be exposed to and determines the supports integrated into the apps and their functionality for older adults. Methods: The search strategy was designed to mimic typical online health information-seeking behaviour for adults. Apps were included based on their explicit focus on ADRD caregiver knowledge and skill improvement. Two coders with expertise in behavioural interventions and eHealth pilot tested the data extraction. One coder retained app characteristics and design features. Techniques used to promote change were determined and two questions from the Mobile App Rating Scale were used to assess app credibility and evidence-base. Content topics were evaluated using a thematic framing technique and each app was assessed using a usability heuristic checklist. Results: The search results generated 18 unique apps that met inclusion criteria. Some apps were unavailable and only 8 unique apps were reviewed. Seven apps (88%) did not state which scientific orientation was followed to develop their content. None of the apps made clinical claims of improving caregivers’ and care recipients’ overall health. All apps relied on textual information to disseminate their contents. None of the apps were trialed and evidence-based. Apps included on average 7 out of 10 behavioural change techniques, 5 out of 10 C.A.R.E. features, and 10 out of 18 features on the usability heuristics checklist. Conclusions: Our findings suggest that caregivers are likely to discover apps that are not actually accessible and have low-no evidence base. Apps were found to be largely static, text-based informational resources and few supported behaviours needed to maintain caregivers’ health. While apps may be providing high-volume of information, caregivers must still navigate what resources they need with limited guidance. Finally, the commercial marketplace is addressing some of the major usability elements, but there are many design elements that are not addressed.

  • Digital Information Technology Use and eHealth Education Modality Preferences Differ by Age and Education Among Middle-aged and Older Adults with Chronic Health Conditions: A Cross-sectional Survey Study

    Date Submitted: Sep 17, 2018

    Open Peer Review Period: Sep 21, 2018 - Nov 16, 2018

    Background: Health information, patient education, and self-management (HIA) tools are increasingly being made available to adults with chronic health conditions through eHealth and mHealth modalities...

    Background: Health information, patient education, and self-management (HIA) tools are increasingly being made available to adults with chronic health conditions through eHealth and mHealth modalities. However, there is limited information about patient preferences for using specific types of ehealth and mHealth resources and how this differs by age and education. Objective: The objective of this study was to examine how current use of digital information technologies (DITs) and preferred methods for obtaining HIA varies by age and education among middle-aged and older adults with chronic health conditions. Methods: The study used cross-sectional survey data for 9,005 Kaiser Permanente Northern California members aged 45-85 who responded to a mailed/online health survey conducted 2014-2015 and indicated having ≥1 chronic health condition. Bivariate analyses and logistic regression models with weighted data were used to estimate and compare prevalence of DIT use, past-year use of online HIA resources, and preferences for using ehealth, mHealth, and traditional HIA modalities for adults aged 45-65, 66-75, and 76-85. Results: The percentages of adults who used DITs (computers, smartphones, internet, email, apps), had obtained HIA from an online resource in the past year, and who were interested in using eHealth and mHealth modalities for obtaining HIA declined with age group. Within age group, prevalence of DIT use and interest in ehealth and mHealth modalities was lower among adults who had not attended any college compared to college graduates. Differences between the oldest and younger groups and those with lower versus higher education in preferences for eHIA modalities were substantially diminished when we restricted analyses to internet users. Conclusions: Healthcare providers and other organizations serving middle-aged and older adults with chronic health conditions should not assume that patients will want to engage with ehealth and mHealth resources. This is especially true among those who are older and less educated. Since these groups are also less likely to be using digital devices and the internet, increasing their engagement with online HIA and health apps may require both instrumental (e.g., providing DIT devices, internet, and skills training) and social support. As part of patient-centered care, it is important for providers to ascertain their patients’ use of digital technologies and preferences for obtaining health information and patient education rather than routinely referring them to online resources. It is also important for healthcare providers and consumer health organizations to user-test their online resources to make sure they are easy for older and less educated adults to use and to make sure that it remains easy for adults with chronic conditions to obtain health information and patient education using off-line resources.

  • Fall Risk Classification in Community-Dwelling Older Adults Using a Smart Wrist-Worn Device and the Resident Assessment Instrument-Home Care

    Date Submitted: Sep 16, 2018

    Open Peer Review Period: Sep 20, 2018 - Nov 15, 2018

    Background: Little is known about whether off-the-shelf wearable sensor data can contribute to fall risk classification or complement clinical assessment tools like the Resident Assessment Instrument-...

    Background: Little is known about whether off-the-shelf wearable sensor data can contribute to fall risk classification or complement clinical assessment tools like the Resident Assessment Instrument-Home Care (RAI-HC). Objective: This study aimed to: 1) investigate the similarities and differences in physical activity, heart rate, and night sleep in a sample of community-dwelling older adults with varying fall histories, using a smart wrist-worn device; and 2) create and evaluate fall risk classification models based on: i) wearable data, ii) the RAI-HC, and iii) the combination of wearable and RAI-HC data. Methods: A prospective, observational study was conducted among three faller groups (G0, G1, G2+) based on the number of previous falls (0, 1, ≥2 falls) in a sample of older community-dwelling adults. The wearable and RAI-HC assessment data were analyzed and utilized to create fall risk classification models, with three supervised machine learning algorithms: logistic regression, decision tree, and random forest (RF). Results: Of 40 participants aged 65-93, 16 (40%) had no previous falls, while 8 (20%) and 16 (40%) had experienced one and multiple (≥2) falls, respectively. Level of physical activity as measured by average daily steps was significantly different between groups (p = .036). In the three faller group classification, RF achieved the best accuracy of 70.0% using both wearable and RAI-HC data. In discriminating between G0 and G1+G2+, RF achieved the best area under the receiver operating characteristic curve of 0.816 based on wearable data only. Discrimination between G0+G1 and G2+ did not result in better classification performance than that between G0 and G1+G2+. Conclusions: Both wearable data and the RAI-HC assessment can contribute to fall risk classification. Future studies in fall risk assessment should consider using wearable technologies to supplement resident assessment instruments.

  • Feasibility and Acceptability of Technology-based Exercise and Posture Training in Older Adults with Age-related Hyperkyphosis: A Pilot Trial

    Date Submitted: Sep 13, 2018

    Open Peer Review Period: Sep 17, 2018 - Nov 12, 2018

    Background: Background: Hyperkyphosis is common among older adults, and is associated with multiple adverse health outcomes. A kyphosis-specific exercise and posture training program improves hyperkyp...

    Background: Background: Hyperkyphosis is common among older adults, and is associated with multiple adverse health outcomes. A kyphosis-specific exercise and posture training program improves hyperkyphosis, but in-person programs are expensive to implement and maintain over longer-periods of time. It is unknown if a technology-based posture training program disseminated through a smartphone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis. Objective: Objective: The primary purpose of this study was to assess the feasibility of subject recruitment, retention and adherence, and the acceptability of a technology-based exercise and postural training program disseminated as video clip links and text messaging prompts via a smartphone. The secondary purpose was to explore the potential efficacy of this program on kyphosis, physical function and health-related quality of life in older adults with hyperkyphosis Methods: Methods: This was a 6-week pre-post design pilot trial. We recruited community-dwelling adults ≥65 years with hyperkyphosis ≥40 degrees and access to a smartphone. The intervention had two parts: 1) exercise and posture training via video clips sent to participants daily via text messaging which included 6 weekly video clip links to be viewed on the participant’s smartphone and 2) text messaging prompts to practice good posture. We determined subject recruitment, adherence, retention and acceptability of the intervention. Outcomes included change in kyphometer-measured kyphosis, occiput to wall (OTW), Short Physical Performance Battery (SPPB), Scoliosis Research Society SRS-30, Center for Epidemiological Studies Depression (CESD) and Physical Activity Scale for the Elderly (PASE). Results: Results: 64 potential participants were recruited, 17 participants were enrolled and 12 completed post-intervention testing at 6-weeks. Average age was 71.6 (SD=4.8) years and 53% were female. Median adherence to daily video viewing was 100%, (range 14 to 100) and to practicing good posture three times or more per day was 71%, (range 0 to 100). Qualitative evaluation of acceptability of the intervention revealed the smartphone screen was too small for participants to view the videos well and daily prompts to practice posture were too frequent. Kyphosis, OTW and physical activity significantly improved after the 6-week intervention. Kyphosis decreased by -8.4 (95% CI: -11.8, -5.0) degrees (p<0.001), OTW decreased -1.9 (95% CI: -3.3, -0.7) cm (p=0.007), and physical activity measured by PASE increased 29 (95% CI: 3, 54) points (p=0.03). The health-related quality of life SRS-30 score increased 0.11 (SD=0.19) points, but it was not statistically significant, p=0.09. Conclusions: Conclusions: Technology-based exercise and posture training using video clip viewing and text messaging reminders is feasible and acceptable in a small cohort of older adults with hyperkyphosis. Technology-based exercise and posture training warrants further study as a potential self-management program for age-related hyperkyphosis that may be more easily disseminated than in-person training.

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