Using technological innovations and data science to inform and improve health care services and health outcomes for older adults
Editor-in-Chief: Yun Jiang, PhD, MS, RN, FAMIA, Assistant Professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing
Jinjiao Wang, PhD, RN, MPhil, Assistant Professor, Postdoctoral Program Director, Elaine C. Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester
Impact Factor 2023
Yun Jiang, PhD, MS, RN, FAMIA, Assistant Professor, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing
JMIR Aging is an open-access journal that focuses on digital health, emerging technologies, health informatics applications, and patient education for preventative care, clinical care, home care, and self-management support for older adults. The journal also covers 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 datasets.
The target audience of JMIR Aging includes physicians, nurses, allied health professionals, advanced clinical practitioners, patients and caregivers. We publish original research, viewpoints, and reviews (both literature reviews and technology reviews). JMIR Aging is indexed in PubMed, PubMed Central, DOAJ, Scopus, and the Emerging Sources Citation Index (Clarivate).
Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments.
According to the 2022 Alzheimer’s Association Facts and Figures, more than 6 million Americans have Alzheimer disease and related dementias. They are cared for by millions of family members, friends, or other unpaid caregivers. Communication deficits are common among persons with Alzheimer disease and related dementias and pose challenges to caregiving and clinical care, which is already complex. An interdisciplinary team developed a mobile app prototype to improve communications between people living with dementia and their caregivers and providers and to promote person-centered care. This viewpoint paper provides a road map for how the interdisciplinary team worked together to develop and plan for the implementation and evaluation of a new evidence-based app. In our paper, we provide an 8-step process used by a team of clinicians, researchers, and software engineers to develop a new app to meet the needs of people living with dementia and their caregiver(s). The planned clinical trial has been registered at ClinicalTrials.gov (NCT04571502; https://clinicaltrials.gov/ct2/show/NCT04571502).
Internet of Things (IoT) technology enables physiological measurements to be recorded at home from people living with dementia and monitored remotely. However, measurements from people with dementia in this context have not been previously studied. We report on the distribution of physiological measurements from 82 people with dementia over approximately 2 years.
Successful adoption and sustained use of smart home technology can support the aging in place of older adults with frailty. However, the expansion of this technology has been limited, particularly by a lack of ethical considerations surrounding its application. This can ultimately prevent older adults and members of their support ecosystems from benefiting from the technology. This paper has 2 aims in the effort to facilitate adoption and sustained use: to assert that proactive and ongoing analysis and management of ethical concerns are crucial to the successful development, evaluation, and implementation of smart homes for older adults with frailty and to present recommendations to create a framework, resources, and tools to manage ethical concerns with the collaboration of older adults; members of their support ecosystems; and the research, technical development, clinical, and industry communities. To support our assertion, we reviewed intersecting concepts from bioethics, specifically principlism and ethics of care, and from technology ethics that are salient to smart homes in the management of frailty in older adults. We focused on 6 conceptual domains that can lead to ethical tensions and of which proper analysis is essential: privacy and security, individual and relational autonomy, informed consent and supported decision-making, social inclusion and isolation, stigma and discrimination, and equity of access. To facilitate the proactive and ongoing analysis and management of ethical concerns, we recommended collaboration to develop a framework with 4 proposed elements: a set of conceptual domains as discussed in this paper, along with a tool consisting of reflective questions to guide ethical deliberation throughout the project phases; resources comprising strategies and guidance for the planning and reporting of ethical analysis throughout the project phases; training resources to support leadership, literacy, and competency in project teams for the analysis and management of ethical concerns; and training resources for older adults with frailty, their support ecosystems, and the public to support their awareness and participation in teams and ethical analysis processes. Older adults with frailty require nuanced consideration when incorporating technology into their care because of their complex health and social status and vulnerability. Smart homes may have a greater likelihood of accommodating users and their contexts with committed and comprehensive analysis, anticipation, and management of ethical concerns that reflect the unique circumstances of these users. Smart home technology may then achieve its desired individual, societal, and economic outcomes and serve as a solution to support health; well-being; and responsible, high-quality care.
Various technological interventions have been proposed and studied to address the growing demand for care of residents in assisted living facilities, in which a preexisting shortage of professional caregivers has been exacerbated by the COVID-19 pandemic. Care robots are one such intervention with the potential to improve both the care of older adults and the work life of their professional caregivers. However, concerns about efficacy, ethics, and best practices in the applications of robotic technologies in care settings remain.
Digital technologies were implemented to address the disruption of long-term care facility residents’ socialization needs during the COVID-19 pandemic. A literature review regarding this topic is needed to inform public policy, facility managers, family caregivers, and nurses and allied health professionals involved in mediating the use of digital devices for residents’ social ties.
Older adults tend to have insufficient health literacy, which includes eHealth literacy—the ability to access, assess, and use digital health information. Interventions using methods such as collaborative learning (CL) and individualistic learning (IL) may be effective in addressing older adults’ low eHealth literacy, but little is known about the short- and long-term effects of CL versus IL on older adults’ eHealth literacy.
Assessing cognitive constructs affected by Alzheimer disease, such as processing speed (PS), is important to screen for potential disease and allow for early detection. Digital PS assessments have been developed to provide widespread, efficient cognitive testing, but all have been validated only based on the correlation between test scores. Best statistical practices dictate that concurrent validity should be assessed for agreement or equivalence rather than using correlation alone.