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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: Flickr; Copyright: Travis Jon Allison; URL: https://www.flickr.com/photos/whybesubtle/3131513044/in/photolist-5LHPJd-9ZX5mx-arfebo-9rWeym-6fSPhy-6fNAWB-Jjqf3-5pviTW-6FmDdw-a7hA6H-9uyq4m-dBLRZP-ruhNM7-9AtMaK-exQtz6-exQtzB-exTDos-6fNDEP-6fSPFQ-mDNhtx-dMs1Ym-neWe2b-cybcD1-7j7rt1-E3DsU-4bekg2-6CfUsX-7n; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

    Mentalizing Imagery Therapy Mobile App to Enhance the Mood of Family Dementia Caregivers: Feasibility and Limited Efficacy Testing

    Abstract:

    Background: Family caregivers of patients with Alzheimer disease and related dementias (AD and ADRD) often experience high stress and are at high risk for depression. Technologically delivered therapy is attractive for AD and ADRD caregivers because of the time demands associated with in-person participation. Objective: We aimed to study the feasibility and conduct limited efficacy testing of a mobile app intervention delivering mentalizing imagery therapy (MIT) for family caregivers. Methods: A 4-week trial of the MIT app for family AD and ADRD caregivers was conducted to assess the feasibility of use and investigate changes in depression symptoms, mood, and caregiving experience. Semistructured interviews were conducted to characterize participants’ perceived feasibility and benefits. Results: A total of 17 of the 21 (80%) consented participants (mean age 67 years, range 54-79) utilized the app at least once and were further analyzed. Average usage of audio recordings was on 14 (SD 10) days out of 28 possible and comprised 29 (SD 28) individual sessions. There were improvements in depression with a large effect size for those who used the app at least moderately (P=.008), increases in positive mood postintervention (P<.05), and acute increases in mood following daily guided imagery practice (Stretching and Breathing, P<.001; Eye in the Center, P<.001; Nesting Doll, P=.002; Situation Solver, P=.003; and Life Globe, P=.006). Semistructured interviews revealed perceived benefits such as greater ability to remain “centered” despite caregiving challenges and positive reframing of the caregiver experience. Conclusions: App delivery of MIT is feasible for family AD and ADRD caregivers, including aging seniors. Results showed moderate to high usage of the app for a majority of users. Limited efficacy testing provides justification for studying the MIT app for AD and ADRD caregivers to improve mood and reduce depression in larger, controlled trials.

  • A study subject completing one of BrainCheck's assessments on an iPad. Source: Image created by the Authors; Copyright: The Authors; URL: http://aging.jmir.org/2019/1/e12615/; License: Creative Commons Attribution (CC-BY).

    A Rapid, Mobile Neurocognitive Screening Test to Aid in Identifying Cognitive Impairment and Dementia (BrainCheck): Cohort Study

    Abstract:

    Background: The US population over the age of 65 is expected to double by the year 2050. Concordantly, the incidence of dementia is projected to increase. The subclinical stage of dementia begins years before signs and symptoms appear. Early detection of cognitive impairment and/or cognitive decline may allow for interventions to slow its progression. Furthermore, early detection may allow for implementation of care plans that may affect the quality of life of those affected and their caregivers. Objective: We sought to determine the accuracy and validity of BrainCheck Memory as a diagnostic aid for age-related cognitive impairment, as compared against physician diagnosis and other commonly used neurocognitive screening tests, including the Saint Louis University Mental Status (SLUMS) exam, the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). Methods: We tested 583 volunteers over the age of 49 from various community centers and living facilities in Houston, Texas. The volunteers were divided into five cohorts: a normative population and four comparison groups for the SLUMS exam, the MMSE, the MoCA, and physician diagnosis. Each comparison group completed their respective assessment and BrainCheck Memory. Results: A total of 398 subjects were included in the normative population. A total of 84 participants were in the SLUMS exam cohort, 51 in the MMSE cohort, 35 in the MoCA cohort, and 18 in the physician cohort. BrainCheck Memory assessments were significantly correlated to the SLUMS exam, with coefficients ranging from .5 to .7. Correlation coefficients for the MMSE and BrainCheck and the MoCA and BrainCheck were also significant. Of the 18 subjects evaluated by a physician, 9 (50%) were healthy, 6 (33%) were moderately impaired, and 3 (17%) were severely impaired. A significant difference was found between the severely and moderately impaired subjects and the healthy subjects (P=.02). We derived a BrainCheck Memory composite score that showed stronger correlations with the standard assessments as compared to the individual BrainCheck assessments. Receiver operating characteristic (ROC) curve analysis of this composite score found a sensitivity of 81% and a specificity of 94%. Conclusions: BrainCheck Memory provides a sensitive and specific metric for age-related cognitive impairment in older adults, with the advantages of a mobile, digital, and easy-to-use test. Trial Registration: ClinicalTrials.gov NCT03608722; https://clinicaltrials.gov/ct2/show/NCT03608722 (Archived by WebCite at http://www.webcitation.org/76JLoYUGf)

  • Source: Flickr; Copyright: European Parliament; URL: https://www.flickr.com/photos/european_parliament/13559193964; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    An Intervention to Promote Medication Understanding and Use Self-Efficacy: Design of Video Narratives for Aging Patients at Risk of Recurrent Stroke

    Abstract:

    Background: The debilitating effects of recurrent stroke among aging patients have urged researchers to explore medication adherence among these patients. Video narratives built upon Health Belief Model (HBM) constructs have displayed potential impact on medication adherence, adding an advantage to patient education efforts. However, its effect on medication understanding and use self-efficacy have not been tested. Objective: The researchers believed that culturally sensitive video narratives, which catered to a specific niche, would reveal a personalized impact on medication adherence. Therefore, this study aimed to develop and validate video narratives for this purpose. Methods: This study adapted the Delphi method to develop a consensus on the video scripts’ contents based on learning outcomes and HBM constructs. The panel of experts comprised 8 members representing professional stroke disease experts and experienced poststroke patients in Malaysia. The Delphi method involved 3 rounds of discussions. Once the consensus among members was achieved, the researchers drafted the initial scripts in English, which were then back translated to the Malay language. A total of 10 bilingual patients, within the study’s inclusion criteria, screened the scripts for comprehension. Subsequently, a neurologist and poststroke patient narrated the scripts in both languages as they were filmed, to add to the realism of the narratives. Then, the video narratives underwent a few cycles of editing after some feedback on video engagement by the bilingual patients. Few statistical analyses were applied to confirm the validity and reliability of the video narratives. Results: Initially, the researchers proposed 8 learning outcomes and 9 questions based on HBM constructs for the video scripts’ content. However, following Delphi rounds 1 to 3, a few statements were omitted and rephrased. The Kendall coefficient of concordance, W, was about 0.7 (P<.001) for both learning outcomes and questions which indicated good agreement between members. Each statement’s Cronbach alpha was above .8 with SD values within a range below 1.5 that confirmed satisfactory content and construct validity. Approximately 75% (6/8) of members agreed that all chosen statements were relevant and suitable for video script content development. Similarly, more than 80% (8/10) of patients scored video engagement above average, intraclass correlation coefficient was above 0.7, whereas its Kendall W was about 0.7 with significance (P<.001), which indicated average agreement that the video narratives perceived realism. Conclusions: The Delphi method was proven to be helpful in conducting discussions systematically and providing precise content for the development of video narratives, whereas the Video Engagement Scale was an appropriate measurement of video realism and emotions, which the researchers believed could positively impact medication understanding and use self-efficacy among patients with stroke. A feasibility and acceptability study in an actual stroke care center is needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000174280; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=373554&isReview=true

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://aging.jmir.org/2019/1/e12393/; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Engaging Aging Individuals in the Design of Technologies and Services to Support Health and Well-Being: Constructivist Grounded Theory Study

    Abstract:

    Background: Changes noted within the aging population are physical, cognitive, as well as emotional. Social isolation and loneliness are also serious problems that the aging population may encounter. As technology and apps become more accessible, many basic services, such as those offered by social services, well-being organizations, and health care institutions, have invested in the development of supportive devices, services, and Web-based interactions. Despite the perceived benefits that these devices and services offer, many aging individuals choose not to engage, or engage in a limited manner. To explore this phenomenon, we developed a theory to describe the condition for engagement. Objective: The main objective of this study was to understand the perceptions of an aging South African population regarding Web-based services and technologies that could support aging in place (AiP). Although the concept of AiP speaks to a great number of everyday activities, this paper explores aspects of health and well-being as being central to AiP. Methods: The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, category development, and data comparisons. Data were collected through qualitative methods, including interviews (13 participants aged between 64 and 85 years), 2 participatory workshops (15 participants), and observations. The study focused on Charmaz’s approach to constructivist GT, 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. Coding and data analysis were supported with ATLAS.ti (ATLAS.ti Scientific Software Development GmbH). Results: The study resulted in a substantive theory exploring the process of interaction and engaging factors through user insights and experiences. The emerging design theory, Ageing User Decision-Driven Engagement (AUDDE), explored the elements that support engagement with technology and supportive apps, 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. Aging users continuously make meaning of their experiences, which affects their current and future actions.

  • Source: iStock by Getty Images; Copyright: mediaphotos; URL: https://www.istockphoto.com/ca/photo/taking-pulse-gm601391472-103429713; License: Licensed by the authors.

    Mobilizing mHealth Data Collection in Older Adults: Challenges and Opportunities

    Abstract:

    Worldwide, there is an unprecedented and ongoing expansion of both the proportion of older adults in society and innovations in digital technology. This rapidly increasing number of older adults is placing unprecedented demands on health care systems, warranting the development of new solutions. Although advancements in smart devices and wearables present novel methods for monitoring and improving the health of aging populations, older adults are currently the least likely age group to engage with such technologies. In this commentary, we critically examine the potential for technology-driven data collection and analysis mechanisms to improve our capacity to research, understand, and address the implications of an aging population. Alongside unprecedented opportunities to harness these technologies, there are equally unprecedented challenges. Notably, older adults may experience the first-level digital divide, that is, lack of access to technologies, and/or the second-level digital divide, that is, lack of use/skill, alongside issues with data input and analysis. To harness the benefits of these innovative approaches, we must first engage older adults in a meaningful manner and adjust the framework of smart devices to accommodate the unique physiological and psychological characteristics of the aging populace. Through an informed approach to the development of technologies with older adults, the field can leverage innovation to increase the quality and quantity of life for the expanding population of older adults.

  • Coauthor's mother listening to a story about how they used to go Huckleberry picking. Source: Image Created by Authors; Copyright: The Authors; URL: http://aging.jmir.org/2019/1/e11599/; License: Licensed by JMIR.

    Evaluating the Impact of Music & Memory’s Personalized Music and Tablet Engagement Program in Wisconsin Assisted Living Communities: Pilot Study

    Abstract:

    Background: Individuals with Alzheimer disease or related dementia represent a significant and growing segment of the older adult (aged 65 years and above) population. In addition to physical health concerns, including comorbid medical conditions, these individuals often exhibit behavioral and psychological symptoms of dementia (BPSD). The presence of BPSD in long-term care residential facilities can disrupt resident’s care and impact staff. Nonpharmacological interventions such as personalized music and tablet engagement maintain cognitive function, improve quality of life (QOL), and mitigate BPSD for older adults with dementia. Evidence of the impact of such interventions in assisted living communities (ALCs) is needed for widespread adoption and sustainment of these technologies. Objective: The aim of this study was to assess the impact of Music & Memory’s personalized music and tablet engagement (PMATE) program on QOL, agitation, and medication use for residents living in 6 Wisconsin ALCs. Methods: The data collected were on the utilization of iPods and iPads by the residents. Residents’ outcomes were assessed using the Pittsburgh Agitation Scale, the Quality of Life in Late Stage Dementia scale, and self-reported medication use. A mixed-methods approach was utilized to examine the impact of the PMATE program on these outcomes. Descriptive statistics were calculated. A paired t test explored changes in residents’ QOL. A 1-way analysis of variance was utilized to examine changes in resident’s agitation and QOL based on the resident’s utilization of the PMATE program. Qualitative interviews were conducted with the individuals responsible for PMATE implementation in the ALC. Residents excluded from the analysis were those who passed away, were discharged, or refused to participate. Results: A total of 5 apps, based on average times used by residents, were identified. In all, 4 of the 5 apps were rated as being useful to promote residents’ engagement. PMATE utilization was not associated with changes in the residents’ agitation levels or antipsychotic medication use over time. Over a 3-month period, the change in residents’ QOL was significant (P=.047), and the differences across ALCs were also significant (F25=3.76, P=.02). High utilizers of the PMATE program (>2500 min over 3 months) showed greater improvements in QOL as compared with low utilizers (a change of −5.90 points vs an increase of 0.43 points). The difference was significant (P=.03). Similar significant findings were found between the high- and midutilizers. Conclusions: The study is one of the first to explore the impact of Music & Memory’s PMATE program on residents living in ALCs. Findings suggest that higher utilization over time improves residents’ QOL. However, a more comprehensive study with improved data collection efforts across multiple ALCs is needed to confirm these preliminary findings.

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/senior-woman-glasses-browsing-tablet_2177215.htm; License: Licensed by JMIR.

    Older Adults’ Attitudes Toward Ambulatory Technology to Support Monitoring and Coaching of Healthy Behaviors: Qualitative Study

    Abstract:

    Background: Prevention of functional decline demands a holistic perspective of health management. Older adults are becoming avid users of technology; however, technology is not yet largely used in supporting self-management of health in daily life. Previous research suggests that the low adherence to these technologies is likely to be associated with the fact that opinions and wishes of the older population are not always taken into consideration when designing new technology. Objective: The aim of this study was to investigate the attitudes of older adults living independently regarding technology to support healthy behaviors, addressing nutrition, physical and cognitive function, and well-being. Methods: In-depth semistructured interviews were performed with 12 older adults addressing 4 themes: (1) current practices in health management, (2) attitudes toward using technology to support health management, (3) wishes from technology, and (4) change in attitudes after actual use of technology. The fourth theme was investigated with a follow-up interview after participants had used a step counter, a smart scale, and a mobile app for 1 month. Data collected were analyzed using inductive thematic analysis. Results: Participants were active in self-managing their health and foresaw an added value on using technology to support them in adopting healthier behaviors in everyday life. Attitudes and wishes differed considerably per health domain, with cognitive function being the most sensitive topic. Fears from technology mentioned were attention theft, replacement of human touch, and disuse of existing abilities. Poststudy interviews suggest that attitudes toward technology improve after a short period of use. Conclusions: Technology to support aging in place must target health literacy, allow personalization in the design but also in the use of the technology, and tackle existing fears concerning technology. Further research should investigate the effect of these strategies on the adherence to technology to be used in daily life. We outline a set of recommendations of interest to those involved in developing and implementing technology to support aging in place, focusing on acceptance, barriers, and ethical concerns.

  • Source: Pixabay; Copyright: Susanne Pälmer; URL: https://pixabay.com/photos/pair-seniors-pensioners-age-2914879/; License: Licensed by the authors.

    Relevance of Activity Tracking With Mobile Devices in the Relationship Between Physical Activity Levels and Satisfaction With Physical Fitness in Older...

    Abstract:

    Background: Physical activity has been shown to positively affect many aspects of life, and the positive relationship between physical activity levels and health is well established. Recently, research on the interrelationship between physical activity levels and subjective experiences has gained attention. However, the underlying mechanisms that link physical activity levels with subjective experiences of physical fitness have not been sufficiently explained. Objective: This study aimed to explore the role of physical activity tracking (PAT) in the relationship between physical activity levels and satisfaction with physical fitness in older adults. It is hypothesized that higher levels of physical activity are associated with a higher satisfaction with physical fitness in older adults and that this positive association is stronger for older people who use mobile devices for PAT. Methods: As part of this study, 1013 participants aged 50 years or older and living in Switzerland were interviewed via computer-assisted telephone interviews. Bivariate and multivariate analyses were applied. The interaction effects between physical activity levels and PAT were evaluated using multiple linear regression analysis. Results: Descriptive analyses showed that 719 participants used at least 1 mobile device and that 136 out of 719 mobile device users (18.9%) used mobile devices for PAT. In the multivariate regression analysis, frequent physical activity was found to have a positive effect on satisfaction with physical fitness (beta=.24, P<.001). A significant interaction effect between physical activity levels and PAT (beta=.30, P=.03) provides some first evidence that the positive effects of physical activity on satisfaction with physical fitness can be enhanced by PAT. Conclusions: The results indicate the potential of PAT to enhance the physical fitness of older adults. However, the results also raise new issues in this context. Recommendations for further research and practice include the acquisition of longitudinal data, a more detailed observation of durations of use, and the development of devices for PAT considering health psychology and gerontology theories.

  • Source: Free Digital Photos; Copyright: Ambro; URL: http://www.freedigitalphotos.net/images/Couplespartners_g216-Elderly_Couple_With_Laptop_p41091.html; License: Licensed by the authors.

    A National Assessment of Access to Technology Among Nursing Home Residents: A Secondary Analysis

    Abstract:

    Background: According to the National Center for Health Statistics, there are over 1.7 million nursing home residents in the United States. Nursing home residents and their family members have unique needs and stand to benefit from using technology empowering them to be more informed and engaged health care consumers. Although there is growing evidence for benefits of patient-facing technologies like electronic patient portals on patient engagement in acute and outpatient settings, little is known about use of this technology in nursing homes. Objective: The purpose of this study was to report findings from a secondary analysis of data from a national nursing home study of information technology (IT) adoption, called IT sophistication. We describe the extent to which nursing homes (n=815) allow residents or their representatives to access technology including electronic health records, patient portals, and health information-exchange systems as well as the ability of the residents or representatives to self-report data directly into the electronic health record. Methods: We used descriptive statistics and regression techniques to explore relationships between information technology adoption (IT sophistication) and residents’ or their representatives’ access to technology. Covariates of location, bed size, and ownership were added to the model to understand their potential influence on the relationship between IT sophistication and resident access to technology. Results: Findings revealed that resident access to technology was a significant predictor of the nursing home IT sophistication (P<.001). The inclusion of covariates—nursing home location, bed size, and ownership—with their interactions produced a nonsignificant effect in the model. Residents’ or their representatives’ use of electronic health records and personal health records were both significant predictors of overall IT sophistication (P<.001). Conclusions: As nursing homes continue to progress in technological capabilities, it is important to understand how increasing IT sophistication can be leveraged to create opportunities to engage residents in their care. Understanding the impact of health information technology on outcomes and which technologies make a difference will help nursing home administrators make more informed decisions about adoption and implementation.

  • An older adult engaging in an intergenerational activity, a form of social participation that may be lost in busy postmigration life contexts. Source: Pexels; Copyright: icon0.com; URL: https://www.pexels.com/photo/adult-aged-care-caucasian-226620/; License: Licensed by the authors.

    Understanding Social Network and Support for Older Immigrants in Ontario, Canada: Protocol for a Mixed-Methods Study

    Abstract:

    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 limited community and civic participation, increased income insecurity, and increased 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 mixed-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 (eg, gender and immigration) and how these interrelate at the micro (individual and 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 4 settings were strategically chosen for their diversity in the 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 4 participating universities. Results: Quantitative and qualitative data collection is ongoing. The project is funded by the Social Sciences and Humanities Council of Canada. Conclusions: Comparative analyses of qualitative and quantitative data within and across sites will provide insights about common and unique factors that contribute to the well-being of older immigrants in different regions of Ontario. Given the comprehensive approach to incorporating local knowledge and expert contributions from multilevel stakeholders, the empirical and theoretical findings will be highly relevant to our community partners, help facilitate practice change, and improve the well-being of older men and women in immigrant communities. International Registered Report Identifier (IRRID): DERR1-10.2196/12616

  • 'Maintain Your Brain': an entirely online prevention trial for cognitive decline in older adults (montage). Source: The Authors / Placeit; Copyright: JMIR Publications; URL: https://aging.jmir.org/2019/1/e13135/; License: Creative Commons Attribution (CC-BY).

    Design and Development of the Brain Training System for the Digital “Maintain Your Brain” Dementia Prevention Trial

    Abstract:

    Background: Dementia is the leading cause of disability worldwide, and interventions aimed at reducing the prevalence and burden of the disease are urgently needed. Maintain Your Brain (MYB) is a randomized controlled trial of a multimodal digital health intervention targeting modifiable dementia risk factors to combat cognitive decline and potentially prevent dementia. In addition to behavioral modules targeting mood, nutrition, and physical exercise, a new Brain Training System (BTS) will deliver computerized cognitive training (CCT) throughout the trial to provide systematic, challenging, and personally adaptive cognitive activity. Objective: This paper aimed to describe the design and development of BTS. Methods: BTS has been designed with a central focus on the end user. Raw training content is provided by our partner NeuroNation and delivered in several innovative ways. A baseline cognitive profile directs selection and sequencing of exercises within and between sessions and is updated during the 10-week 30-session module. Online trainers are available to provide supervision at different levels of engagement, including face-to-face share-screen coaching, a key implementation resource that is triaged by a “red flag” system for automatic tracking of user adherence and engagement, or through user-initiated help requests. Individualized and comparative feedback is provided to aid motivation and, for the first time, establish a social support network for the user based on their real-world circle of friends and family. Results: The MYB pilot was performed from November 2017 to March 2018. We are currently analyzing data from this pilot trial (n=100), which will make up a separate research paper. The main trial was launched in June 2018. Process and implementation data from the first training module (September to November 2018) are expected to be reported in 2019 and final trial outcomes are anticipated in 2022. Conclusions: The BTS implemented in MYB is focused on maximizing adherence and engagement with CCT over the short and long term in the setting of a fully digital trial, which, if successful, could be delivered economically at scale. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000851268; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=370631&isReview=true

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/portrait-of-senior-woman-texting-on-cell-phone-at-home_3115584.htm; License: Licensed by JMIR.

    Feasibility and Acceptability of Technology-Based Exercise and Posture Training in Older Adults With Age-Related Hyperkyphosis: Pre-Post Study

    Abstract:

    Background: Hyperkyphosis is common among older adults and is associated with multiple adverse health outcomes. Kyphosis-specific exercise and posture training programs improve hyperkyphosis, but in-person programs are expensive to implement and maintain over long periods. It is unclear if a technology-based posture training program disseminated through a mobile phone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis. Objective: The primary purpose was to assess the feasibility of subject recruitment, short-term retention and adherence, and acceptability of a technology-based exercise and posture training program disseminated as video clip links and text messaging prompts via a mobile phone. The secondary purpose was to explore the potential efficacy of this program for kyphosis, physical function, and health-related quality of life in older adults with hyperkyphosis. Methods: In this 6-week pre-post design pilot trial, we recruited community-dwelling adults aged ≥65 years with hyperkyphosis ≥40° (±5°) and access to a mobile phone. The intervention had two parts: (1) exercise and posture training via video clips sent to participants daily via text messaging, including 6 weekly video clip links to be viewed on the participant’s mobile phone, and (2) text messaging prompts to practice good posture. We analyzed the subject recruitment, adherence, retention, and acceptability of the intervention. Outcomes included change in kyphometer-measured kyphosis, occiput-to-wall (OTW) distance, Short Physical Performance Battery score, Scoliosis Research Society (SRS-30) score, Center for Epidemiological Studies Depression score, and Physical Activity Scale for the Elderly (PASE) score. Results: A total of 64 potential participants were recruited, 17 were enrolled, and 12 completed postintervention testing at 6 weeks. The average age was 71.6 (SD 4.9) years, and 50% were women. The median adherence to daily video viewing was 100% (range, 14%-100%) and to practicing good posture at least three times per day was 71% (range, 0%-100%). Qualitative evaluation of intervention acceptability revealed that the mobile phone screen was too small for participants to view the videos well and daily prompts to practice posture were too frequent. Kyphosis, OTW distance, and physical activity significantly improved after the 6-week intervention. Kyphosis decreased by 8° (95% CI –12 to –5; P<.001), OTW decreased by 1.9 cm (95% CI –3.3 to –0.7; P=.007), and physical activity measured by PASE increased by 29 points (95% CI 3 to 54; P=.03). The health-related quality of life SRS-30 score increased by 0.11 point (SD 0.19), but this increase was not statistically significant (P=.09). Conclusions: Technology-based exercise and posture training using video clip viewing and text messaging reminders is feasible and acceptable for 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, which may be more easily disseminated than in-person training.

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  • Evaluation of an intergenerational learning experience to improve digital skills in the use of mobile devices

    Date Submitted: Mar 7, 2019

    Open Peer Review Period: Mar 12, 2019 - May 7, 2019

    Background: "Digital Partners" is an intergenerational learning project involving digital competences carried out in the municipalities of Vic and Centelles (Catalonia). Within the framework of the in...

    Background: "Digital Partners" is an intergenerational learning project involving digital competences carried out in the municipalities of Vic and Centelles (Catalonia). Within the framework of the introduction of community service as a subject in compulsory secondary education, the ICT Health Chair and the University of Vic’s Centre for Health and Social Studies created a training space with intergenerational partners (14-15 year-olds and those aged over 65) with the aim of improving the senior users digital skills in respect to the use of mobile devices (smartphones and tablets) and raising awareness among young people as to the positive effects of carrying out community service, helping to reduce the digital divide in the territory and fostering a committed, participative attitude within society. Objective: The project forms intergenerational partners with a double objective: on the one hand, to improve digital skills in the use of mobile devices (smartphones and tablets) in the over-65s (henceforth, seniors), thus improving their quality of life and preventing isolation and exclusion, and on the other hand, raising awareness among young people as to the positive effects of participating in voluntary work by providing them with a community service experience, thus contributing to reducing the digital divide in the territory and fostering a committed and participative attitude towards society. Methods: The intervention proposed in the "UVIC-UCC Digital Partners" project is based on Collaborative Learning methodology defined as "an educational approach to teaching and learning which involves groups of students working together to solve a problem, complete a task or create a product". Results: The project’s strengths include the format of working in pairs, pairing individuals by operating system, the ability to practice with the device itself, individuals free to decide what they wish to learn, develop or practice, and the availability of voluntary practice material that facilitates communication and learning. With regard to aspects which could be improved, there is a need to review the timetabling of meetings and the possibility of extending the project’s duration. The paper highlights the broad satisfaction of both its junior and senior users and providing evidence in favour of the effectiveness of the intervention. Conclusions: It has been shown that the activity can serve to create mutual learning through the use of mobile devices and generate security and motivation on the part of the seniors, thus reducing the digital divide and improving social inclusion

  • Understanding Comorbidities and their Contribution to Medical Resource Utilization for an Age and Sex Matched Patient Population Living with HIV: A Cross-Sectional Study

    Date Submitted: Feb 28, 2019

    Open Peer Review Period: Mar 4, 2019 - Apr 29, 2019

    Background: Over 60% of people aging with HIV are observed to have multiple comorbidities; attributed to a variety of factors (e.g., biological, environmental), with sex differences observed. However,...

    Background: Over 60% of people aging with HIV are observed to have multiple comorbidities; attributed to a variety of factors (e.g., biological, environmental), with sex differences observed. However, understanding these differences and their contribution to medical resource utilization remains challenging. Objective: For further insight, we analyzed HIV patient data matched by sex. Methods: ICD9/10 diagnostic codes that comprise the Electronic Health Records from a clinical data warehouse of male (N=229) and female (N=229) patients were categorized by individual characteristics, chronic and mental health conditions, treatment, high risk behaviors and infections, and used as predictors of medical resource utilization represented by Charlson Comorbidity scores. Results: Significant contributors to high Charlson scores in males were age (β =2.37; 1.45, 3.29), longer hospital stay (β=0.046; 0.009, 0.083), malnutrition (β=2.96; 1.72, 4.20) kidney failure (β=2.23; 0.934, 3.52); chemotherapy (β= 3.58; 2.16, 5.002), prior tobacco use (β= 1.40; 0.200, 2.61) and Hepatitis C (β= 1.49; 0.181, 2.79). For females, age (β=1.37; 0.361, 2.38), longer hospital stay (β=0.042; 0.005, 0.078), heart failure (β= 2.41; 0.833, 3.98); chemotherapy (β= 3.48; 1.626, 5.33) and substance abuse (β= 1.94; 0.180, 3.702). Conclusions: Our findings identified sex-based differences in medical resource utilization. Increased prevalence of comorbidities in aging people with HIV has the potential to overburden global health systems; the development of narrower HIV sex-based phenotypes with greater clinical validity will support intervention efficacy and successful aging.

  • Exploring the value and usability of a personalised online resource (the Care Companion) to support informal caring: a qualitative study

    Date Submitted: Mar 4, 2019

    Open Peer Review Period: Mar 4, 2019 - Apr 29, 2019

    Background: The Care Companion is a theory-based online intervention, co-produced to promote informal carers’ coping and resilience. It provides personalised access to information and resources that...

    Background: The Care Companion is a theory-based online intervention, co-produced to promote informal carers’ coping and resilience. It provides personalised access to information and resources that are responsive to individuals’ caring needs and responsibilities, and thereby aims to reduce the burdens associated with caregiving roles and the impact these have on carers’ well-being. Objective: User acceptance testing was undertaken to investigate the value and usability of the Care Companion. Key objectives were to explore 1) how its value was perceived by potential and actual users; 2) the barriers and facilitators to its uptake and use; 3) and gather suggestions to inform plans for an area-wide implementation. Methods: A qualitative descriptive study was conducted using focus groups, observations and semi-structured interviews. Within the first phase, semi-structured interviews were undertaken whilst carers familiarised themselves with the Care Companion and we observed how they navigated the website. In the second phase, focus group discussions were undertaken with participants trialling the Care Companion for two-week periods, followed by semi-structured interviews which explored their experiences of using the platform. Thematic analysis was applied to the data and a coding framework was developed iteratively with each phase of work informing the subsequent phases of data collection and analysis. Results: From the synthesis of the data analysis, the key themes that emerged related to: the value and usefulness of the Care Companion; its appearance and ease of use; the profile set-up and logging-in process; the safety and confidentiality of personal information; barriers to use and uptake, and suggestions for overcoming them; and suggestions for improving the Care Companion. Overall, participants perceived it to be a valuable and useful tool to support their caregiving activities. Themes that had been identified during the previous co-production phase of the Care Companion were validated, including the need for resources aimed specifically at carers (instead of care recipients); the importance of personalised information; and the value of having a journal. In addition, issues that had not previously been identified included the importance of providing transparency about security and data usage; minimising barriers to initial registration; offering demonstrations to support a wider uptake by people with low technological literacy; and the need to develop a culturally sensitive approach that reflects the diversity of the target population. Conclusions: The findings from this study demonstrate the importance of undertaking detailed user acceptance testing when developing an intervention for a diverse population, such as caregivers of older people. They have informed the further refinement of the Care Companion, as well as the strategy for its full implementation. This will be evaluated in future research.

  • “Call a Teenager… that’s what I do!”: Grandchildren Help Older Adults Use New Technologies

    Date Submitted: Feb 14, 2019

    Open Peer Review Period: Feb 19, 2019 - Apr 16, 2019

    Background: As older adults increasingly show interest in technology for their well-being, families will play an important role in promoting the adoption and use of beneficial health technologies. Obj...

    Background: As older adults increasingly show interest in technology for their well-being, families will play an important role in promoting the adoption and use of beneficial health technologies. Objective: The purpose of this study was to conduct a sub-analysis of data collected from a large-scale qualitative project regarding older adults’ experiences using health information technology. Specifically, the sub-analysis explored older adults’ experiences with technology support from family members to inform strategies for promoting older adult engagement with new health technologies. While the primary analysis of the original study was theoretically driven, this paper reports results from the inductive, open-coding analysis. Methods: This is a sub-analysis of a major theme identified from a qualitative study investigating older adults’ use-experience of a widespread health technology, the patient portal. Twenty-four older patients (≥65 years) with multiple chronic conditions (Charlson Comorbidity Index > 2) participated in focus groups conducted at patients’ primary clinic. While conducting the primary theoretically driven analysis, coders also utilized an open-coding approach to ensure important ideas not reflected in the theoretical code-book were captured. Open-coding resulted in a primary theme, “family support”, that was furthered categorized by who and how the tech-support was provided. Results: Participants were not specifically asked about family support, yet themes around family assistance and encouragement for technology emerged from every focus group. Participants repeatedly mentioned that they called their grandchildren and adult children if they need help with technology. Participants also reported that family members experienced difficulty when teaching technology use. Family members struggled to explain simple technology tasks and were frustrated by the slow teaching process. Conclusions: Family support, specifically via grandchildren, may have a key role in the successful adoption and use of emerging health technologies. While family tech-support seems intuitive, there is very little research exploring this topic. Older adults will be increasingly expected to use health technologies. Providers and health systems should consider potential family support and engagement strategies to foster adoption and use among older patients. Clinical Trial: NA

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