https://aging.jmir.org/issue/feedJMIR Aging2023-01-04T09:45:03-05:00JMIR Publicationseditor@jmir.orgOpen Journal Systems This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published JMIR Aging, is properly cited. The complete bibliographic information, a link to the original publication on https://aging.jmir.org/, as well as this copyright and license information must be included. Using technological innovations and data science to inform and improve health care services and health outcomes for older adults. https://aging.jmir.org/2024/1/e53975/ Phase Angle and Impedance Ratio as Indicators of Physical Function and Fear of Falling in Older Adult Women: Cross-Sectional Analysis2024-03-05T15:00:16-05:00Danielle A SternerJeffrey R StoutKworweinski LafontantJoon-Hyuk ParkDavid H FukudaLadda ThiamwongBackground: Older adults experience a significant decline in muscle integrity and function with aging. Early detection of decreased muscle quality can pave a way for interventions that may mitigate the progression of age-related physical declines. Phase angle (PhA) and impedance ratio (IR) are measures of muscle integrity, can be assessed quickly via bioelectrical impedance analysis (BIA), and may be indicative of physical function. Objective: This study aimed to characterize the relationships between hand grip strength (HGS), sit-to-stand (STS), BTrackS balance scores, fear of falling (Short FES-I), and IR among community-dwelling older adult women classified as having low or high PhA. Methods: A cross-sectional analysis was conducted in 85 older women with a mean age of 75.0 (SD 7.2) years, weight of 71.0 (SD 15.0) kg, and height of 162.6 (SD 6.1) cm. To examine the influence of PhA on performance measures, participants were divided into two PhA groups, high (>4.1°; n=56) and low (≤4.1°; n=29). Data were non-normative, so Mann-Whitney U test was used to evaluate between-group differences and Kendall’s tau coefficients were utilized to determine the partial correlations. Results: The low PhA group had significantly higher IR (mean 0.85, SD 0.03; P<.001, rrb=0.92) compared to the high PhA group (mean 0.81, SD 0.03). The high PhA group had superior HGS (mean 21.4kg, SD 6.2kg; P=.007, rrb=0.36), BTrackS balance scores (mean 26.6cm, SD 9.5cm; P =.03, rrb=0.30), and STS scores (mean 16.0, SD 5.5; P<.001, rrb=0.49) compared to the low PhA group (HGS mean 17.6kg, SD 4.7kg; BTrackS mean 37.1cm, SD 21.1cm; STS mean 10.7, SD 6.2). Both PhA and IR were significantly correlated with HGS, BTrackS balance scores, STS, and Short FES-I (P<.05). However, when adjusted for age among the whole sample, only PhA was strongly correlated with HGS (τb=0.75, P=.003) and STS scores (τb=0.76, P=.002). Short FES-I scores were moderately correlated with IR (τb=0.46, P=.07) after controlling for age. No significant between group differences were observed for height, weight, or body mass index. Conclusions: PhA and IR are associated with physical function and the fear of falling in older women. However, PhA and not IR, was significantly associated with physical function (HGS and STS) independent of age. Conversely, only IR was significantly associated with the fear of falling. Diminished physical function and increased IR appear to be characteristics of older women with a PhA ≤4.1°. These findings suggest that PhA and IR measured through BIA together may serve as a valuable tool for early identification of older women at risk of functional decline and heightened fear of falling. Clinical Trial: ClinicalTrials.gov (NCT06063187) 2024-03-05T15:00:16-05:00 https://aging.jmir.org/2024/1/e48292/ Patient and Public Involvement in Technology-Related Dementia Research: Scoping Review2024-03-04T09:45:03-05:00Pippa KirbyHelen LaiSophie HorrocksMatthew HarrisonDanielle WilsonSarah DanielsRafael A CalvoDavid J SharpCaroline M Alexander<strong>Background:</strong> Technology-related research on people with dementia and their carers often aims to enable people to remain living at home for longer and prevent unnecessary hospital admissions. To develop person-centered, effective, and ethical research, patient and public involvement (PPI) is necessary, although it may be perceived as more difficult with this cohort. With recent and rapid expansions in health and care–related technology, this review explored how and with what impact collaborations between researchers and stakeholders such as people with dementia and their carers have taken place. <strong>Objective:</strong> This review aims to describe approaches to PPI used to date in technology-related dementia research, along with the barriers and facilitators and impact of PPI in this area. <strong>Methods:</strong> A scoping review of literature related to dementia, technology, and PPI was conducted using MEDLINE, PsycINFO, Embase, and CINAHL. Papers were screened for inclusion by 2 authors. Data were then extracted using a predesigned data extraction table by the same 2 authors. A third author supported the resolution of any conflicts at each stage. Barriers to and facilitators of undertaking PPI were then examined and themed. <strong>Results:</strong> The search yielded 1694 papers, with 31 (1.83%) being analyzed after screening. Most (21/31, 68%) did not make clear distinctions between activities undertaken as PPI and those undertaken by research participants, and as such, their involvement did not fit easily into the National Institute for Health and Care Research definition of PPI. Most of this mixed involvement focused on reviewing or evaluating technology prototypes. A range of approaches were described, most typically using focus groups or co-design workshops. In total, 29% (9/31) described involvement at multiple stages throughout the research cycle, sometimes with evidence of sharing decision-making power. Some (23/31, 74%) commented on barriers to or facilitators of effective PPI. The challenges identified often regarded issues of working with people with significant cognitive impairments and pressures on time and resources. Where reported, the impact of PPI was largely reported as positive, including the experiences for patient and public partners, the impact on research quality, and the learning experience it provided for researchers. Only 4 (13%) papers used formal methods for evaluating impact. <strong>Conclusions:</strong> Researchers often involve people with dementia and other stakeholders in technology research. At present, involvement is often limited in scope despite aspirations for high levels of involvement and partnership working. Involving people with dementia, their carers, and other stakeholders can have a positive impact on research, patient and public partners, and researchers. Wider reporting of methods and facilitative strategies along with more formalized methods for recording and reporting on meaningful impact would be helpful so that all those involved—researchers, patients, and other stakeholders—can learn how we can best conduct research together. 2024-03-04T09:45:03-05:00 https://aging.jmir.org/2024/1/e46522/ Barriers to and Facilitators of Older People’s Engagement With Web-Based Services: Qualitative Study of Adults Aged >75 Years2024-02-28T09:15:04-05:00Annemarie MoneyAlex HallDanielle HarrisCharlotte Eost-TellingJane McDermottChris Todd<strong>Background:</strong> The COVID-19 pandemic has accelerated the shift toward the digital provision of many public services, including health and social care, public administration, and financial and leisure services. COVID-19 services including test appointments, results, vaccination appointments and more were primarily delivered through digital channels to the public. Many social, cultural, and economic activities (appointments, ticket bookings, tax and utility payments, shopping, etc) have transitioned to web-based platforms. To use web-based public services, individuals must be digitally included. This is influenced by 3 main factors: access (whether individuals have access to the internet), ability (having the requisite skills and confidence to participate over the web), and affordability (ability to pay for infrastructure [equipment] and data packages). Many older adults, especially those aged >75 years, are still digitally excluded. <strong>Objective:</strong> This study aims to explore the views of adults aged >75 years on accessing public services digitally. <strong>Methods:</strong> We conducted semistructured qualitative interviews with a variety of adults aged ≥75 years residing in Greater Manchester, United Kingdom. We also interviewed community support workers. Thematic analysis was used to identify the key themes from the data. <strong>Results:</strong> Overall, 24 older adults (mean age 81, SD 4.54 y; 14/24, 58% female; 23/24, 96% White British; and 18/24, 75% digitally engaged to some extent) and 2 support workers participated. A total of five themes were identified as key in understanding issues around motivation, engagement, and participation: (1) “initial motivation to participate digitally”—for example, maintaining social connections and gaining skills to be able to connect with family and friends; (2) “narrow use and restricted activity on the web”—undertaking limited tasks on the web and in a modified manner, for example, limited use of web-based public services and selected use of specific services, such as checking but never transferring funds during web-based banking; (3) “impact of digital participation on well-being”—choosing to go to the shops or general practitioner’s surgery to get out of the house and get some exercise; (4) “the last generation?”—respondents feeling that there were generational barriers to adapting to new technology and change; and (5) “making digital accessible”—understanding the support needed to keep those engaged on the web. <strong>Conclusions:</strong> As we transition toward greater digitalization of public services, it is crucial to incorporate the perspectives of older people. Failing to do so risks excluding them from accessing services they greatly rely on and need. 2024-02-28T09:15:04-05:00 https://aging.jmir.org/2024/1/e43999/ Determinants of Implementing an Information and Communication Technology Tool for Social Interaction Among Older People: Qualitative Content Analysis of Social Services Personnel Perspectives2024-02-26T09:30:04-05:00Johanna FritzPetra von Heideken WågertAnnelie K GusdalRose-Marie Johansson-PajalaCaroline Eklund<strong>Background:</strong> Older people are particularly vulnerable to social isolation and loneliness, which can lead to ill-health, both mentally and physically. Information and communication technology (ICT) can supplement health and social care and improve health among the vulnerable, older adult population. When ICT is used specifically for communication with others, it is associated with reduced loneliness in older populations. Research is sparse on how the implementation of ICT, used specifically for communication among older people in social services, can be performed. It is recommended to consider the determinants of implementation, that is, barriers to and facilitators of implementation. Determinants related to older people using ICT tools are reported in several studies. To the best of our knowledge, studies investigating the determinants related to the social services perspective are lacking. <strong>Objective:</strong> This study aims to explore the determinants of implementing the Fik@ room, a new, co-designed, and research-based ICT tool for social interaction among older people, from a social services personnel perspective. <strong>Methods:</strong> This study used an exploratory, qualitative design. An ICT tool called the Fik@ room was tested in an intervention study conducted in 2021 in 2 medium-sized municipalities in Sweden. Informants in this study were municipal social services personnel with experience of implementing this specific ICT tool in social services. We conducted a participatory workshop consisting of 2 parts, with 9 informants divided into 2 groups. We analyzed the data using qualitative content analysis with an inductive approach. <strong>Results:</strong> The results included 7 categories of determinants for implementing the ICT tool. <i>Being able to introduce the ICT tool in an appropriate manner</i> concerns the personnel’s options for introducing and supporting the ICT tool, including their competencies in using digital equipment<i>. Organizational structure</i> concerns a structure for communication within the organization. <i>Leadership</i> concerns engagement and enthusiasm as driving forces for implementation. <i>The digital maturity of the social services personnel</i> concerns the personnel’s skills and attitudes toward using digital equipment. <i>Resources</i> concern time and money. <i>IT support</i> concerns accessibility, and <i>legal liability</i> concerns possibilities to fulfill legal responsibilities<i>.</i> <strong>Conclusions:</strong> The results show that implementation involves an entire organization at varying degrees. Regardless of how much each level within the organization comes into direct contact with the ICT tool, all levels need to be involved to create the necessary conditions for successful implementation. The prerequisites for the implementation of an ICT tool will probably change depending on the digital maturity of future generations. As this study only included 9 informants, the results should be handled with care. The study was performed during the COVID-19 pandemic, which has probably affected the results. 2024-02-26T09:30:04-05:00 https://aging.jmir.org/2024/1/e53025/ The #SeePainMoreClearly Phase II Pain in Dementia Social Media Campaign: Implementation and Evaluation Study2024-02-08T09:45:22-05:00Louise I R CastilloVivian TranMary BrachaniecChristine T ChambersKelly ChessieAlec CourosAndre LeRuyetCharmayne LeRuyetLilian ThorpeJaime WilliamsSara WheelwrightThomas Hadjistavropoulos<strong>Background:</strong> Social media platforms have been effective in raising awareness of the underassessment and undertreatment of pain in dementia. <strong>Objective:</strong> After a successful pilot campaign, we aimed to scale our pain-in-dementia knowledge mobilization pilot initiative (ie, #SeePainMoreClearly) to several social media platforms with the aid of a digital media partner. The goal of the initiative was to increase awareness of the challenges in the assessment and management of pain among people with dementia. A variety of metrics were implemented to evaluate the effort. Through this work, we endeavored to highlight key differences between our pilot initiative (which was a grassroots initiative), focusing largely on Twitter and YouTube, and the current science-media partnership. We also aimed to generate recommendations suitable for other social media campaigns related to health or aging. <strong>Methods:</strong> Evidence-based information about pain in dementia was summarized into engaging content (eg, videos) tailored to the needs of various knowledge users (eg, health professionals, families, and policy makers). We disseminated information using Facebook (Meta Platforms), Twitter (X Corp), YouTube (Alphabet Inc), Instagram (Meta Platforms), and LinkedIn (LinkedIn Corp) and measured the success of the initiative over a 12-month period (2020 to 2021). The evaluation methods focused on web analytics and questionnaires related to social media content. Knowledge users’ web responses about the initiative and semistructured interviews were analyzed using thematic analysis. <strong>Results:</strong> During the course of the campaign, >700 posts were shared across all platforms. Web analytics showed that we drew >60,000 users from 82 countries to our resource website. Of the social media platforms used, Facebook was the most effective in reaching knowledge users (ie, over 1,300,000 users). Questionnaire responses from users were favorable; interview responses indicated that the information shared throughout the initiative increased awareness of the problem of pain in dementia and influenced respondent behavior. <strong>Conclusions:</strong> In this investigation, we demonstrated success in directing knowledge users to a resource website with practical information that health professionals could use in patient care along with pain assessment and management information for caregivers and people living with dementia. The evaluation metrics suggested no considerable differences between our pilot campaign and broader initiative when accounting for the length of time of each initiative. The limitations of large-scale health campaigns were noted, and recommendations were outlined for other researchers aiming to leverage social media as a knowledge mobilization tool. <strong>Trial Registration:</strong> 2024-02-08T09:45:22-05:00 https://aging.jmir.org/2024/1/e53010/ Experiences of Older Adults, Physiotherapists, and Aged Care Staff in the TOP UP Telephysiotherapy Program: Interview Study of the TOP UP Interventions2024-02-07T09:45:23-05:00Rik DawsonHeidi GilchristMarina PinheiroKarn NelsonNina BowesCathie SherringtonAbby Haynes<strong>Background:</strong> Telehealth provides opportunities for older adults to access health care. However, limited research exists on the use of telehealth within aged care services, particularly regarding physiotherapy-led fall prevention and mobility programs. Understanding the experiences and interactions of older adults, physiotherapists, and aged care service providers is crucial for the scale-up and sustainability of such essential programs. The TOP UP study, a hybrid type 1 effectiveness-implementation randomized controlled trial in aged care, used a supported multidisciplinary telephysiotherapy model to motivate older adults to engage in exercises to improve mobility and reduce falls. <strong>Objective:</strong> This qualitative substudy aims to achieve 2 primary objectives: to describe the experiences and acceptability of the TOP UP intervention for older people, physiotherapists, and aged care support workers and managers and to gain an in-depth understanding of program implementation. <strong>Methods:</strong> A purposive recruitment strategy was used to select 18 older adults who participated in the TOP UP intervention, ensuring variation in age, gender, residential status (home or residential aged care), geographic location, and cognitive levels. In addition, 7 physiotherapists, 8 aged care support workers, and 6 managers from 7 different aged care provider partners participated in this study. Semistructured interviews were conducted to explore stakeholders’ experiences with the TOP UP program, gather suggestions for improvement, and obtain insights for the future implementation of similar telephysiotherapy programs. The interview framework and coding processes were informed by behavior changes and implementation frameworks. Data were analyzed using an abductive approach, informed by 2 behavioral change theories (Capability, Opportunity, Motivation, and Behavior Model and Self-Determination Theory) and the Nonadoption, Abandonment and Challenges to the Scale-Up, Spread and Sustainability of Health and Care Technologies framework. <strong>Results:</strong> All participants (n=39) reported high levels of acceptability for the TOP UP program and cited multiple perceived benefits. The thematic analysis generated 6 main themes: telephysiotherapy expands opportunity; tailored physiotherapy care with local support enhances motivation; engaging, older adult–friendly educational resources build capability; flexible reablement approach fosters autonomy; telephysiotherapy is safe, effective, and acceptable for many; and organizational commitment is required to embed telehealth. The motivation to exercise was enhanced by Zoom’s convenience, use of tailored web-based exercise resources, and companionable local support. <strong>Conclusions:</strong> This study highlights the inherent value of telephysiotherapy in aged care, emphasizing the need for investment in staff training, local support, and older adult–friendly resources in future telephysiotherapy iterations. TOP UP represents a convenient and flexible web-based care model that empowers many older adults to receive sustainable, high-quality care precisely when and where they need it. <strong>Trial Registration:</strong> Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN 1261000734864; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000734864 2024-02-07T09:45:23-05:00 https://aging.jmir.org/2024/1/e48132/ Expectation, Attitude, and Barriers to Receiving Telehomecare Among Caregivers of Homebound or Bedridden Older Adults: Qualitative Study2024-02-07T09:45:04-05:00Pansiree OnsengWichuda JiraporncharoenSasiwimon MoonkayaowPimchai VeerasirikulNutchar WiwatkunupakarnChaisiri AngkurawaranonKanokporn Pinyopornpanish<strong>Background:</strong> In recent years, telehomecare has become an increasingly important option for health care providers to deliver continuous care to their patients. <strong>Objective:</strong> This study aims to explore the expectations, attitudes, and barriers to telehomecare among caregivers of homebound or bedridden older adults. <strong>Methods:</strong> This qualitative study used semistructured interviews to explore caregivers’ perspectives on telehomecare for homebound or bedridden older adults. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines. Participants were selected using convenience sampling from caregivers of homebound or bedridden older adults with experience in both in-person home visits and telehomecare services provided by the Department of Family Medicine at Chiang Mai University, in an urban area of Chiang Mai Province in Northern Thailand. Semistructured interviews were conducted. The interviews were audio recorded with participant consent and transcribed verbatim. The framework method was used, involving multiple readings of transcripts to facilitate familiarization and accuracy checking. The study used the technology acceptance model and comprehensive geriatric assessment as the analytical framework. <strong>Results:</strong> The study included 20 caregivers of older adult patients. The patients were predominantly female (15/20, 75%), with an average age of 86.2 years. Of these patients, 40% (n=8) of patients were bedridden, and 60% (n=12) of patients were homebound. Caregivers expressed generally positive attitudes toward telehomecare. They considered it valuable for overall health assessment, despite recognizing certain limitations, particularly in physical assessments. Psychological assessments were perceived as equally effective. While in-person visits offered more extensive environmental assessments, caregivers found ways to make telehomecare effective. Telehomecare facilitated multidisciplinary care, enabling communication with specialists. Caregivers play a key role in care planning and adherence. Challenges included communication issues due to low volume, patient inattention, and faulty devices and internet signals. Some caregivers helped overcome these barriers. The loss of information was mitigated by modifying signaling equipment. Technology use was a challenge for some older adult caregivers. Despite these challenges, telehomecare offered advantages in remote communication and resolving scheduling conflicts. Caregivers varied in their preferences. Some preferred in-person visits for a broader view, while others favored telehomecare for its convenience. Some had no strong preference, appreciating both methods, while others considered the situation and patient conditions when choosing between them. Increased experience with telehomecare led to more confidence in its use. <strong>Conclusions:</strong> Caregivers have positive attitudes and high expectations for telehomecare services. Although there may be barriers to receiving care through this mode, caregivers have demonstrated the ability to overcome these challenges, which has strengthened their confidence in telehomecare. However, it is important to enhance the skills of caregivers and health care teams to overcome barriers and optimize the use of telehomecare. 2024-02-07T09:45:04-05:00 https://aging.jmir.org/2024/1/e47908/ Examining the Effect of Contactless Intergenerational Befriending Intervention on Social Isolation Among Older Adults and Students’ Attitude Toward Companionship: Content Analysis2024-01-30T09:30:03-05:00Keya SenNida LahejiZo RamamonjiariveloCecil RenickRandall OsborneBrad Beauvais<strong>Background:</strong> Intergenerational friendship, a mechanism of social support, is an effective intervention to reduce the increasing risk of social isolation (SI) and develop companionship in the older adult population. The COVID-19 pandemic provided a unique opportunity to examine the psychosocial intervention of befriending via technology use as a primary form of contactless socialization. <strong>Objective:</strong> The study aims to explore the effectiveness of the befriending intervention through a contactless, intergenerational service-learning project on older adult emotions, especially boredom and loneliness as the key attributes of SI, and on students’ attitude toward companionship. <strong>Methods:</strong> During the months of January to April 2022 , undergraduate students enrolled in a health administration course with a special focus on culture were asked to be involved in a contactless, intergenerational service-learning project (n=46). In this study, contactless intervention meant communication using the telephone and apps such as FaceTime and Zoom. Students were paired with older adults to have at least a 30-minute weekly conversation, for 8 weeks, via telephone or an internet-based app such as FaceTime. Students were asked to write a half-page diary after each interaction and a 1-page reflection at the end of the fourth week and at the end of the service-learning project. At the completion of the project, the researchers also surveyed the older adults to assess the impact of the project using a 5-item open-ended questionnaire. Following a heuristic approach and content analysis, student artifacts (110,970 words; 118-page, single-spaced Microsoft Word document) and the older adult surveys were analyzed using MAXQDA, (VERBI GmbH). Qualitative data were extracted to assess the impact of service learning on SI by measuring the attributes of boredom and loneliness among 46 older adults. Students’ attitudes toward companionship were also assessed using data from their diaries and reflections. <strong>Results:</strong> Overall, three major constructs were identified: (1) meaningful engagement, defined as feeling safe, having increased confidence, and having reduced boredom; (2) internal motivation to participate in the weekly interaction, defined as discussion about daily life experience, level of happiness, and ability to exert personal control over the situation; and (3) intergenerational befriending, defined as perceived benefits from the friendly nature of the interaction, ability to comfortably connect with students, and positive feeling and attitude toward the student. <strong>Conclusions:</strong> The contactless, intergenerational befriending intervention reduced boredom and loneliness among older adults and enhanced positive attitude and confidence among university students. Students helped older adults to develop digital skills for the use of apps and social media. Older adults showed interest in the intervention and shared their daily life experiences with the students, which helped to reduce the gap between generations. Findings indicate the effectiveness of an intergenerational service-learning intervention on SI reduction and increased positive attitude among college students. 2024-01-30T09:30:03-05:00 https://aging.jmir.org/2024/1/e51544/ The Implementation Success of Technology-Based Counseling in Dementia Care: Scoping Review2024-01-25T09:15:20-05:00Dorothee BauernschmidtJanina WittmannJulian HirtGabriele MeyerAnja Bieber<strong>Background:</strong> Implementing technology-based counseling as a complex intervention in dementia care poses challenges such as adaptation to stakeholders’ needs and limited resources. While studies have examined the effectiveness of technology-based counseling, its successful implementation remains largely unexplored. <strong>Objective:</strong> We aimed to review the knowledge about the implementation success of technology-based counseling interventions for people with dementia and their informal caregivers. <strong>Methods:</strong> We conducted a scoping review and systematically searched CINAHL, the Cochrane Library including the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and Web of Science Core Collection databases (April 2021) in combination with citation searching and web searching (November 2021). Studies reporting on technology-based counseling interventions for people with dementia or their informal caregivers were included, irrespective of the design. We used the conceptual framework for implementation outcomes to operationalize <i>implementation success</i> and applied the outcomes acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability as categories to inform data extraction. We identified dimensions within the categories and synthesized results narratively and graphically. <strong>Results:</strong> We included 52 publications reporting on 27 technology-based counseling interventions. The studies were conducted in 9 countries and published between 1993 and 2021. As the design of the included studies varied, the number of participants and the type of data reported varied as well. The intervention programs were heterogeneous and ranged from single counseling interventions (such as helpline services) to counseling as part of a multicomponent program. Telephone, email, videoconferencing, social media (respectively chats), and web-based platforms were used for delivering counseling. We found data on appropriateness for all interventions and data on acceptability for most interventions, describing aspects such as consumer-perceived usefulness and helpfulness of services, as well as satisfaction. Information on the other categories of adoption, feasibility, fidelity, implementation cost, penetration, and sustainability was fragmented. <strong>Conclusions:</strong> The scope and depth of information on conceptual categories of the implementation success of technology-based counseling for people with dementia and informal caregivers varied. The data only partially covered the concept of <i>implementation success</i>, which highlights the need for a systematic evaluation accompanying the implementation. The application of theoretical approaches for implementation and adherence to the framework for developing and evaluating complex interventions are required to promote the implementation of complex interventions and to comprehensively assess implementation success. <strong>Trial Registration:</strong> PROSPERO CRD42021245473; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=245473 2024-01-25T09:15:20-05:00 https://aging.jmir.org/2024/1/e51264/ Development and Usability Testing of a Mobile App–Based Clinical Decision Support System for Delirium: Randomized Crossover Trial2024-01-24T17:18:45-05:00Jiamin WangMeihua JiYuan HanYing WuBackground: The 3-minute Diagnostic Interview for CAM-Defined Delirium (3D-CAM) is an instrument specially developed for the assessment of delirium in the general wards, with identified high sensitivity and specificity. However, the use of the 3D-CAM by bedside nurses in routine practice showed relatively poor usability with multiple human errors during assessment. Objective: To develop a mobile-based delirium assessment tool based on the 3D-CAM and evaluate its usability among older patients by bedside nurses. Methods: The 3D-DST (delirium assessment tool with decision support based on the 3D-CAM) was developed to address existing issues of the 3D-CAM and optimized the assessment process. Following a randomized cross-over design, questionnaires were used to evaluate the usability of the 3D-DST among older adults by bedside nurses. Meanwhile, the performance of both the 3D-DST and the 3D-CAM paper version, including the assessment completion rate, time required for completing the assessment, and the number of human errors made by nurses during assessment, were recorded and their differences were compared. Results: The 3D-DST included 3 assessment modules, 9 evaluation interfaces and 16 results interfaces, with built-in reminders to guide nurses in completing delirium assessment. In the usability testing, a total of 432 delirium assessments (216 pairs) on 148 older adults were performed by 72 bedside nurses with the 3D-CAM paper version and the 3D-DST. Compared to the paper version, the mean usability score was significantly higher when using the 3D-DST (4.35 vs 3.41, P<.001). The median scores of the six domains of the satisfactory evaluation questionnaire for nurses using the paper version and the 3D-DST were above 2.83 points and 4.33 point, respectively (P<.001). The average time in completing the assessment reduced by 2.10 minutes (4.4 vs 2.3 min, P<.001) when the 3D-DST was used. Conclusions: This study demonstrated that the 3D-DST significantly improved the efficiency of delirium assessment and was considered highly acceptable by bedside nurses. Clinical Trial: Chinese Clinical Trial Registry ChiCTR-IOR-17,010,368; https://www.chictr.org.cn/showproj.html?proj= 17671 2024-01-24T17:18:45-05:00