Recent Articles:

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  Aging with Chronic Disease

  Sep 11, 2019

  Understanding Comorbidities and Their Contribution to Predictors of Medical Resource Utilization for an Age- and Sex-Matched Patient Population Living With...

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  • Michelle Odlum  
  • Sunmoo Yoon  

  Abstract:

  • JMIR Aging 2019;2(2):e13865

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  Mobile Devices and Apps for Seniors...

  Aug 23, 2019

  Social Support Patterns of Middle-Aged and Older Adults Within a Physical Activity App: Secondary Mixed Method Analysis

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  • Zakkoyya H Lewis  
  • Maria C Swartz  
  • Eloisa Martinez  
  • Elizabeth J Lyons  

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  • JMIR Aging 2019;2(2):e12496

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  Supporting Informal Care and Caregivers

  Aug 22, 2019

  Promoting Identification and Use of Aid Resources by Caregivers of Seniors: Co-Design of an Electronic Health Tool

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  Authors List:

  • Dominique Giroux  
  • Mélanie Tremblay  
  • Karine Latulippe  
  • Véronique Provencher  
  • Valérie Poulin  
  • Anik Giguere  
  • Véronique Dubé  
  • Andrée Sévigny  
  • Manon Guay  
  • Sophie Ethier  
  • Maude Carignan  

  Abstract:

  Background: The importance of supporting caregivers is recognized in home care for older persons, and facilitating their help-seeking process is a way to meet that need. The use of electronic health (eHealth) is a potentially promising solution to facilitate caregivers’ help-seeking process. Objective: The aim of this research was to develop, in partnership with community organizations, health and social service professionals and caregivers, an eHealth tool promoting the earlier identification of needs of older persons and an optimal use of available resources. Methods: To design the tool, 8 co-design sessions (CoDs) were conducted and 3 advisory committees were created (in 11 regions) in Quebec between May 2017 and May 2018. A variety of methods were used, including the sorting method, the use of personas, eHealth tool analysis, brainstorming, sketching, prototyping, and pretesting. Results: A total of 74 co-designers (women n=64 and men n=10) were recruited to participate in the CoDs or the advisory committees. This number allowed for the identification of needs to which the tool must respond and for the identification of its requirements (functionalities and content), as well as for the development of the information architecture. Throughout the study, adjustments were made to the planning of CoD, notably because certain steps required more sessions than expected. Among others, this was true for the identification of functionalities. Conclusions: This study led to the development of an eHealth tool for caregivers of functionally dependent older persons to help them identify their needs and the resources available to meet them. International Registered Report Identifier (IRRID): RR2-10.2196/11634

  • JMIR Aging 2019;2(2):e12314

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  Supporting Informal Care and Caregivers

  Aug 20, 2019

  Exploring the Perceived Usefulness and Ease of Use of a Personalized Web-Based Resource (Care Companion) to Support Informal Caring: Qualitative Descriptive...

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  • Amadea Turk  
  • Emma Fairclough  
  • Gillian Grason Smith  
  • Benjamin Lond  
  • Veronica Nanton  
  • Jeremy Dale  

  Abstract:

  Background: Informal carers play an increasingly vital role in supporting the older population and the sustainability of health care systems. Care Companion is a theory-based and coproduced Web-based intervention to help support informal carers’ resilience. It aims to provide personalized access to information and resources that are responsive to individuals’ caring needs and responsibilities and thereby reduce the burdens associated with caregiving roles. Following the development of a prototype, it was necessary to undertake user acceptability testing to assess its suitability for wider implementation. Objective: This study aimed to undertake user acceptance testing to investigate the perceived usefulness and ease of use of Care Companion. The key objectives were to (1) explore how potential and actual users perceived its usefulness, (2) explore the barriers and facilitators to its uptake and use and (3) gather suggestions to inform plans for an area-wide implementation. Methods: We conducted user acceptance testing underpinned by principles of rapid appraisal using a qualitative descriptive approach. Focus groups, observations, and semistructured interviews were used in two phases of data collection. Participants were adult carers who were recruited through local support groups. Within the first phase, think-aloud interviews and observations were undertaken while the carers familiarized themselves with and navigated through the platform. In the second phase, focus group discussions were undertaken. Interested participants were then invited to trial Care Companion for up to 4 weeks and were followed up through semistructured telephone interviews exploring their experiences of using the platform. Thematic analysis was applied to the data, and a coding framework was developed iteratively with each phase of the study, informing subsequent phases of data collection and analysis. Results: Overall, Care Companion was perceived to be a useful tool to support caregiving activities. The key themes were related to its appearance and ease of use, the profile setup and log-in process, concerns related to the safety and confidentiality of personal information, potential barriers to use and uptake and suggestions for overcoming them, and suggestions for improving Care Companion. More specifically, these related to the need for personalized resources aimed specifically at the carers (instead of care recipients), the benefits of incorporating a Web-based journal, the importance of providing transparency about security and data usage, minimizing barriers to initial registration, offering demonstrations to support uptake by people with low technological literacy, and the need to develop a culturally sensitive approach. Conclusions: The findings identified ways of improving the ease of use and usefulness of Care Companion and demonstrated the importance of undertaking detailed user acceptance testing when developing an intervention for a diverse population, such as informal carers of older people. These findings have informed the further refinement of Care Companion and the strategy for its full implementation.

  • JMIR Aging 2019;2(2):e13875

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  Internet Access and Digital...

  Aug 9, 2019

  An Intergenerational Information and Communications Technology Learning Project to Improve Digital Skills: User Satisfaction Evaluation

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  • Francesc López Seguí  
  • Marc de San Pedro  
  • Eva Aumatell Verges  
  • Salvador Simó Algado  
  • Francesc Garcia Cuyàs  

  Abstract:

  Background: “Digital Partners” is an intergenerational information and communications technology learning project carried out in the municipalities of Vic and Centelles (Catalonia) from April to May 2018. Within the framework of the introduction of community service as a subject in secondary education, the Centre for Health and Social Studies (University of Vic) created a training space with 38 intergenerational partners (aged 14-15 years and >65 years), with the aim of improving the senior users’ digital skills in terms of use of smartphones and tablets, thus helping reduce the digital divide in the territory. Objective: The aim of this paper is to evaluate the satisfaction of both junior and senior participants toward the intervention and to explore its main drivers. Methods: Participants who volunteered to participate in the study were interviewed. Quantitative and qualitative data gathered in paper-based ad hoc surveys were used to assess participants’ satisfaction. Results: The experience shows a broad satisfaction of both junior and senior users. The project’s strengths include the format of working in couples; randomly pairing individuals by operating system; the ability to practice with the device itself; individuals’ free choice 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 that could be improved, there is a need to review the timetabling flexibility of meetings to avoid hurrying the elderly and to extend the project’s duration, if necessary. Conclusions: This 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.

  • JMIR Aging 2019;2(2):e13939

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  Preventing Social Isolation and...

  Jul 24, 2019

  Attrition in an Online Loneliness Intervention for Adults Aged 50 Years and Older: Survival Analysis

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  • Tamara Bouwman  
  • Theo van Tilburg  
  • Marja Aartsen  

  Abstract:

  Background: Online interventions can be as effective as in-person interventions. However, attrition in online intervention is high and potentially biases the results. More importantly, high attrition rates might reduce the effectiveness of online interventions. Therefore, it is important to discover the extent to which factors affect adherence to online interventions. The setting for this study is the online Friendship Enrichment Program, a loneliness intervention for adults aged 50 years and older. Objective: This study examined the contribution of severity of loneliness, coping preference, activating content, and engagement in attrition within an online intervention. Methods: Data were collected from 352 participants in an online loneliness intervention for Dutch people aged 50 years and older. Attrition was defined as not completing all 10 intervention lessons. The number of completed lessons was assessed through the management system of the intervention. We tested 4 hypotheses on attrition by applying survival analysis (Cox regression). Results: Of the 352 participants who subscribed to the intervention, 46 never started the introduction. The remaining 306 participants were divided into 2 categories: 73 participants who did not start the lessons of the intervention and 233 who started the lessons of the intervention. Results of the survival analysis (n=233) showed that active coping preference (hazard ratio [HR]=0.73), activating content (HR=0.71), and 2 indicators of engagement (HR=0.94 and HR=0.79) lowered attrition. Severity of loneliness was not related to attrition. Conclusions: To reduce attrition, developers of online (loneliness) interventions may focus on stimulating active behavior within the intervention.

  • JMIR Aging 2019;2(2):e13638

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  Preventing Social Isolation and...

  Jun 18, 2019

  A Web-Based Mobile App With a Smartwatch to Support Social Engagement in Persons With Memory Loss: Pilot Randomized Controlled Trial

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  Authors List:

  • Hayley R McCarron  
  • Rachel Zmora  
  • Joseph E Gaugler  

  Abstract:

  Background: It is estimated that the number of individuals living with dementia worldwide will increase from 50 million in 2017 to 152 million by 2050. Assistive technology has been recognized as a promising tool to improve the lives of persons living with memory loss and their caregivers. The use of assistive technology in dementia care is expanding, although it is most often intended to manage care and promote safety. There is a lack of assistive technology designed to aid persons with memory loss in participating in meaningful activities. The Social Support Aid (SSA) is a mobile phone-based app that employs facial recognition software. It was designed to assist persons with memory loss remember the names and relationships of the people they interact with to promote social engagement. Methods: Persons with memory loss were randomized to the SSA (n=20) or the usual care control group (n=28). Quantitative data were collected at three timepoints (baseline, 3 months, and 6 months). Participants in the intervention group participated in qualitative interviews following completion of their 6-month survey. Results: Participant eligibility, willingness to be randomized, and retention were not barriers to conducting a full-scale RCT; however, recruitment strategies should be addressed before doing so. Feasibility and utility scores indicated that participants felt neutral about the technology. Use of the SSA was not significantly associated with changes in quality of social interactions or quality of life measures over the 6 months of follow-up (P>.05). The qualitative analysis revealed three themes that described how and why the SSA worked or not: (1) outcomes, (2) reasons why it was or was not useful, and (3) recommendations. Conclusions: There is a need to develop effective assistive technology that improves the quality of life of persons with memory loss. Assistive technology that allows persons living with memory loss to maintain some level of autonomy should be a priority for future research. This study suggests reasons why the SSA facial recognition software did not appear to improve the quality of social interaction and quality of life of people with memory loss. Results also provide recommendations for future assistive technology development and evaluation.

  • JMIR Aging 2019;2(1):e13378

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  Aging in Place

  Jun 11, 2019

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

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  • Andrzej Kozikowski  
  • Jillian Shotwell  
  • Eve Wool  
  • Jill C Slaboda  
  • Karen A Abrashkin  
  • Karin Rhodes  
  • Kristofer L Smith  
  • Renee Pekmezaris  
  • Gregory J Norman  

  Abstract:

  Background: Novel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs. Methods: We collected qualitative data from HBPC staff (ie, physicians, registered nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York metropolitan area through 16 semistructured interviews and three focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (ie, relatedness, competence, and autonomy) as an analytical lens. Results: Four broad themes—pros and cons of scaling, 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. Staff acknowledged the need to scale the program without diminishing effective patient-centered care. Participants perceived alerts generated from patients and caregivers using telehealth as potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. However, they also noted that telehealth could increase efficiency and enable more informed care provision. Telehealth could enhance the patient-provider relationship by enabling caregivers to be an integral part of the patient’s care team. Staff members raised the concern that patients or caregivers might unnecessarily overutilize the technology, and that some home visits are more appropriate in person rather than via telehealth. Conclusions: These findings suggest the importance of considering 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 will hopefully facilitate the optimal integration of telehealth innovations.

  • JMIR Aging 2019;2(1):e12415

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  Supporting Informal Care and Caregivers

  Jun 7, 2019

  Requirements for an Electronic Health Tool to Support the Process of Help Seeking by Caregivers of Functionally Impaired Older Adults: Co-Design Approach

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  Authors List:

  • Mélanie Tremblay  
  • Karine Latulippe  
  • Anik MC Giguere  
  • Véronique Provencher  
  • Valérie Poulin  
  • Véronique Dubé  
  • Manon Guay  
  • Sophie Ethier  
  • Andrée Sévigny  
  • Maude Carignan  
  • Dominique Giroux  

  Abstract:

  Background: In Quebec, Canada, many public, community, and private organizations provide resources to caregivers of functionally impaired older adults. Nevertheless, these resources may be difficult for caregivers to find. A co-design study was conducted to address the gap between caregivers and access to resources. The purpose of this study was to support the process of help seeking by caregivers of functionally impaired older adults through electronic health (eHealth). Objective: The purpose of this study was to focus on the identification of functional and content requirements for an eHealth tool to support the help-seeking process of caregivers of functionally impaired older adults. Methods: This study uses a co-design process based on qualitative action research approach to develop an eHealth tool with health and social service professionals (HSSPs), community workers, and caregivers. The participants acted as co-designers in identifying requirements for the tool. A total of 4 design workshops and 1 advisory committee session were held in different locations in Quebec, Canada. Activities were videotaped and analyzed with a conceptual framework of user experience. Results: A total of 11 caregivers, 16 community workers, and 11 HSSPs participated in identifying the requirements for the eHealth tool. Several functional and content requirements were identified for each user need (19). Content requirements differed depending on the category of participant, corresponding to the concept of user segmentation in the design of information and communication technology. Nevertheless, there were disagreements among co-designers about specific functionalities, which included (1) functionalities related to the social Web, (2) functionalities related to the evaluation of resources for caregivers, and (3) functionalities related to the emerging technologies. Several co-design sessions were required to resolve disagreements. Conclusions: Co-designers (participants) were able to identify functional and content requirements for each of the previously identified needs; however, several discussions were required to achieve consensus. Decision making was influenced by identity, social context, and participants’ knowledge, and it is a challenge to reconcile the different perspectives. The findings stressed the importance of allowing more time to deal with the iterative aspect of the design activity, especially during the identification of requirements of an eHealth tool. International Registered Report Identifier (IRRID): RR2-10.2196/11634

  • JMIR Aging 2019;2(1):e12327

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  Falls and Emergency Detection with...

  Jun 7, 2019

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

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  Authors List:

  • Yang Yang  
  • John P Hirdes  
  • Joel A Dubin  
  • Joon Lee  

  Abstract:

  Background:  Little is known about whether off-the-shelf wearable sensor data can contribute to fall risk classification or complement clinical assessment tools such as the Resident Assessment Instrument-Home Care (RAI-HC). Methods:  A prospective, observational study was conducted among 3 faller groups (G0, G1, G2+) based on the number of previous falls (0, 1, ≥2 falls) in a sample of older community-dwelling adults. Each participant was requested to wear a smart wristband for 7 consecutive days while carrying out day-to-day activities in their normal lives. The wearable and RAI-HC assessment data were analyzed and utilized to create fall risk classification models, with 3 supervised machine learning algorithms: logistic regression, decision tree, and random forest (RF). Results:  Of 40 participants aged 65 to 93 years, 16 (40%) had no previous falls, whereas 8 (20%) and 16 (40%) had experienced 1 and multiple (≥2) falls, respectively. Level of PA as measured by average daily steps was significantly different between groups (P=.04). In the 3 faller group classification, RF achieved the best accuracy of 83.8% using both wearable and RAI-HC data, which is 13.5% higher than that of using the RAI-HC data only and 18.9% higher than that of using wearable data exclusively. In discriminating between {G0+G1} and G2+, RF achieved the best area under the receiver operating characteristic curve of 0.894 (overall accuracy of 89.2%) based on wearable and RAI-HC data. Discrimination between G0 and {G1+G2+} did not result in better classification performance than that between {G0+G1} and G2+. Conclusions:  Both wearable data and the RAI-HC assessment can contribute to fall risk classification. All the classification models revealed that RAI-HC outperforms wearable data, and the best performance was achieved with the combination of 2 datasets. Future studies in fall risk assessment should consider using wearable technologies to supplement resident assessment instruments.

  • JMIR Aging 2019;2(1):e12153

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  Supporting Informal Care and Caregivers

  Jun 6, 2019

  “Call a Teenager… That’s What I Do!” - Grandchildren Help Older Adults Use New Technologies: Qualitative Study

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  Authors List:

  • Jennifer Dickman Portz  
  • Christine Fruhauf  
  • Sheana Bull  
  • Rebecca S Boxer  
  • David B Bekelman  
  • Alejandra Casillas  
  • Kathy Gleason  
  • Elizabeth A Bayliss  

  Abstract:

  Background: Although family technical support seems intuitive, there is very little research exploring this topic. Objective: The objective of this study was to conduct a subanalysis of data collected from a large-scale qualitative project regarding older adults’ experiences in using health information technology. Specifically, the subanalysis explored older adults’ experiences with technology support from family members to inform strategies for promoting older adults’ engagement with new health technologies. Although the primary analysis of the original study was theoretically driven, this paper reports results from an inductive, open-coding analysis. Methods: This is a subanalysis of a major code identified unexpectedly from a qualitative study investigating older adults’ use experience of a widespread health technology, the patient portal. A total of 24 older patients (≥65 years) with multiple chronic conditions (Charlson Comorbidity Index >2) participated in focus groups conducted at the patients’ primary clinic. While conducting the primary theoretically driven analysis, coders utilized an open-coding approach to ensure important ideas not reflected in the theoretical code book were captured. Open coding resulted in 1 code: family support. This subanalysis further categorized family support by who provided tech support, how tech support was offered, and the opinions of older participants about receiving family tech support. Results: The 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 needed 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: The results suggest that older adults ask their family members, particularly grandchildren, to support them in the use of new technologies. However, family may experience difficulties in providing this support. Older adults will be increasingly expected to use health technologies, and family members may help with tech support. Providers and health systems should consider potential family support and engagement strategies to foster adoption and use among older patients.

  • JMIR Aging 2019;2(1):e13713

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  Mental Health Issues in Elderly...

  May 28, 2019

  Weekly, Seasonal, and Geographic Patterns in Health Contemplations About Sundown Syndrome: An Ecological Correlational Study

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  Authors List:

  • Kenneth Michael Madden  
  • Boris Feldman  

  Abstract:

  Background: Sundown syndrome (ie, agitation later in the day) is common in older adults with dementia. The underlying etiology for these behaviors is unclear. Possibilities include increased caregiver fatigue at the end of the day and disruption of circadian rhythms by both age and neurodegenerative illness. Objective: This study sought to examine circumseptan (weekly) patterns in search volumes related to sundown syndrome, in order to determine if such searches peaked at the end of the weekend, a time when caregiver supports are least available. We also sought to examine both seasonal differences and associations of state-by-state search activity with both state latitude and yearly sun exposure. Methods: Daily Internet search query data was obtained from Google Trends (2005-2017 inclusive). Circumseptan patterns were determined by wavelet analysis, and seasonality was determined by the difference in search volumes between winter (December, January, and February) and summer (June, July, and August) months. Geographic associations between percent sunny days and latitude were done on a state-by-state basis. Results: “Sundowning” searches showed a significant increase at the end of the weekend with activity being 10.9% (SD 4.0) higher on Sunday as compared to the rest of the week. Search activity showed a seasonal pattern with search activity significantly highest in the winter months (36.6 [SD 0.6] vs 13.7 [SD 0.2], P<.001). State-by-state variations in “sundowning” searches showed a significant negative association with increasing mean daily sunlight (R2=.16, β=-.429 [SD .149], P=.006) and showed a positive association with increasing latitude (R2=.38, β=.648 [SD .122], P<.001). Conclusions: Interest in “sundowning” is highest after a weekend, which is a time when external caregiver support is reduced. Searches related to sundown syndrome also were highest in winter, in states with less sun, and in states at more northerly latitudes, supporting disrupted circadian rhythms as another contributing factor to these behaviors.

  • JMIR Aging 2019;2(1):e13302

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