@Article{info:doi/10.2196/68951,
author="Clemson, Veda
and Grey, Elisabeth
and Barnett, Julie
and Burfitt, Ella
and Gillison, Fiona",
title="Exploring Older Adult's Views of the Age-Inclusivity of Physical Activity Websites Using the Think Aloud Method: Qualitative Analysis",
journal="JMIR Aging",
year="2025",
month="Jun",
day="19",
volume="8",
pages="e68951",
keywords="ageism",
keywords="inclusivity",
keywords="digital literacy",
keywords="older adult",
keywords="physical activity",
abstract="Background: Older adults are the least active in our society and may face additional barriers to taking part in physical activity compared with those experienced by younger people because of factors such as lower digital literacy and negative stereotypes of aging. Objective: This study aimed to explore how older adults navigate websites that provide access to physical activity opportunities and facilities and make judgments about their suitability. Methods: Semistructured interviews were embedded within a think-aloud approach. Participants were shown a series of websites and asked to navigate through the websites as if they were going to take up what was on offer, articulating their thoughts and comments out loud as they progressed. Participants viewed up to 4 websites, rotated from a pool of 8, including leisure centers, exercise products, gyms, or community organizations. Additional questions were asked about perceptions of the inclusivity of the websites at the end of the interview. Digital recordings were made and transcribed verbatim, and analyzed using thematic analysis. Results: Nineteen participants (6 male and 13 female) aged between 65 and 84 years were recruited from southern England; one-third reported having poor digital ability prior to taking part. Three overarching themes relating to the research question were identified as follows: (1) signals of age-inclusivity, (2) limiting beliefs, and (3) confidence in making judgments. Older adults inferred a lot of information about how welcome they would be in physical activity settings from the images and language used on websites. They showed a preference for imagery that was inclusive of age, body shape, and physical ability, not only for those depicting older adults themselves. Some adults reported firm views about the type and intensity of physical activity that is appropriate for older adults, and many expressed a specific dislike of gyms, based on both the (young) age of most users and perceived emphasis towards aesthetic rather than health-related exercise. While most participants could navigate websites successfully, they preferred to visit venues and speak to staff to gain greater confidence that they would feel welcome and that the activities would be at a suitable level. Conclusions: Websites providing access to physical activity could be more inclusive of older adults by using more diverse imagery, providing clearer descriptions of the activities on offer, along with details of the level of fitness or ability needed to take part, and providing alternatives to web-based booking. Additional societal-level approaches to reducing age-limiting self-stereotyping may also be useful in expanding the opportunities for older adults to access mainstream provisions for physical activity. ",
doi="10.2196/68951",
url="https://aging.jmir.org/2025/1/e68951"
}


@Article{info:doi/10.2196/69321,
author="Nakanishi, Akito
and Ichikawa, Masao
and Sano, Yukie",
title="Public Discourse Toward Older Drivers in Japan Using Social Media Data From 2010 to 2022: Longitudinal Analysis",
journal="JMIR Infodemiology",
year="2025",
month="Jun",
day="16",
volume="5",
pages="e69321",
keywords="older driver",
keywords="older people",
keywords="ageism",
keywords="social media",
keywords="Twitter",
keywords="sentiment analysis",
keywords="topic modeling",
abstract="Background: As the global population ages, concerns about older drivers are intensifying. Although older drivers are not inherently more dangerous than other age groups, traditional surveys in Japan reveal persistent negative sentiments toward them. This discrepancy suggests the importance of analyzing discourse on social media, where public perceptions and societal attitudes toward older drivers are actively shaped. Objective: This study aimed to quantify long-term public discourse on older drivers in Japan through Twitter (subsequently rebranded X), a leading social media platform. The specific objectives were to (1) examine the sentiments toward older drivers in tweets, (2) identify the textual contents and topics discussed in the tweets, and (3) analyze how sentiments correlate with various variables. Methods: We collected Japanese tweets related to older drivers from 2010 to 2022. Each quarter, we (1) applied to the Japanese version of the Linguistic Inquiry and Word Count dictionary for sentiment analysis, (2) employed 2-layer nonnegative matrix factorization for dynamic topic modeling, and (3) applied correlation analyses to explore the relationships of sentiments with crash rates, data counts, and topics. Results: We obtained 2,625,807 tweets from 1,052,976 unique users discussing older drivers. The number of tweets has steadily increased, with significant peaks in 2016, 2019, and 2021, coinciding with high-profile traffic crashes. Sentiment analysis revealed a predominance of negative emotions (n=383,520, 62.42\%), anger (n=106,767, 17.38\%), anxiety (n=114,234, 18.59\%), and risk (n=357,311, 58.15\%). Topic modeling identified 29 dynamic topics, including those related to driving licenses, crash events, self-driving technology, and traffic safety. The crash events topic, which increased by 0.28\% per year, showed a strong correlation with negative emotion (r=0.76, P<.001) and risk (r=0.72, P<.001). Conclusions: This 13-year study quantified public discourse on older drivers using Twitter data, revealing a paradoxical increase in negative sentiment and perceived risk, despite a decline in the actual crash rate among older drivers. These findings underscore the importance of reconsidering licensing policies, promoting self-driving systems, and fostering a more balanced understanding to mitigate undue prejudice and support continued safe mobility for older adults. ",
doi="10.2196/69321",
url="https://infodemiology.jmir.org/2025/1/e69321"
}


@Article{info:doi/10.2196/67242,
author="Balki, Eric
and Hayes, Niall
and Holland, Carol",
title="Factors Influencing Older Adults' Perception of the Age-Friendliness of Their Environment and the Impact of Loneliness, Technology Use, and Mobility: Quantitative Analysis",
journal="JMIR Aging",
year="2025",
month="May",
day="6",
volume="8",
pages="e67242",
keywords="COVID-19",
keywords="age-friendliness of environments",
keywords="physical isolation",
keywords="digital communication technologies",
keywords="loneliness",
keywords="cross-sectional",
keywords="WHO",
keywords="World Health Organization",
keywords="older adults",
keywords="reduced mobility",
keywords="age friendliness of environments",
keywords="adult well-being",
keywords="social connections",
keywords="aging in place",
keywords="life-space mobility",
keywords="LSE",
keywords="functional mobility",
keywords="UCLA loneliness scale",
keywords="age-friendly environment assessment tool",
keywords="AFEAT",
abstract="Background: The World Health Organization's (WHO) publication on age-friendly environments (AFEs) imagines future cities to become more age-friendly to harness the latent potential of older adults, especially those who have restricted mobility. AFE has important implications for older adults in maintaining social connections, independence, and successful aging-in-place. However, technology is notably absent in the 8 intersecting domains of AFEs that the WHO imagines improve older adult well-being, and we investigated whether technology should form a ninth domain. While mobility was severely restricted, the COVID-19 pandemic provided an opportunity to test how older adults' perceptions of their AFE changed and what role technology was playing. Objective: This study examined how life-space mobility (LSM), a concept for assessing patterns of functional mobility over time, and loneliness impacted perceived AFEs and the moderating effect of technology. It also explores whether technology should play a greater role as the ninth domain of the WHO's imagination of the AFE of the future. Methods: In this cross-sectional quantitative observation study, data from 92 older adults aged 65-89 years were collected in England from March 2020 to June 2021 during the COVID-19 pandemic. The Life-space Questionnaire, Technology Experience Questionnaire, UCLA (University of California, Los Angeles) Loneliness Scale, and age-friendly environment assessment tool were used. Correlation and moderation analyses were used to investigate relationships between variables. Results: Most participants (86/92, 93\%) had not left their immediate town in the previous 4 weeks before the interview. Restricted LSM was positively correlated to the age-friendly environment assessment tool, that is, rising physical isolation was linked to a better perception of AFEs; however, we discovered this result was due to the moderating impact of increased use of technology, and that restricted LSM actually had a negative effect on AFEs. Loneliness was correlated negatively with the perception of AFEs, but technology use was found to moderate the impact of loneliness. Conclusions: Pandemic-related LSM restrictions impacted perceived AFEs and loneliness negatively, but technology played a moderating role. The findings demonstrate that technology could be considered as a ninth domain in the WHO's assessment of AFEs for older adults and that there is a need for its explicit acknowledgment. ",
doi="10.2196/67242",
url="https://aging.jmir.org/2025/1/e67242"
}


@Article{info:doi/10.2196/50856,
author="Glenn, Jordan
and Sarmadi, Parmoon
and Cristman, Paul
and Kim, Gabrielle
and Lin, Ting-Hsuan
and Kashyap, Vikram",
title="Using the TrueLoo Smart Device to Record Toileting Sessions in Older Adults: Retrospective Validation and Acceptance Study",
journal="JMIR Aging",
year="2024",
month="May",
day="27",
volume="7",
pages="e50856",
keywords="activities of daily living",
keywords="toileting habits",
keywords="bowel movements",
keywords="elder care",
keywords="smart toileting",
keywords="monitoring technology",
abstract="Background: Because of the relationship between independent living and activities of daily living, care teams spend significant time managing assisted living residents' toileting problems. Recently, the TrueLoo was developed as a connected toilet seat to automatically log and monitor toileting sessions. Objective: This study aimed to demonstrate the validity of the TrueLoo to (1) record and identify toileting sessions with regard to stool and urine events; (2) compare the results with the person-reported, standard-of-care methods; and (3) establish metrics of user acceptability and ease of use in a assisted living facility population. Methods: We used two phases: (1) initial development of the TrueLoo algorithms to accurately identify urine and stool events and (2) evaluation of the algorithms against person-reported, standard-of-care methods commonly used in assisted living facilities. Phase 2 analyzed data over a 3-day period from 52 devices. Participants' age ranged from 63 to 101 (mean 84, SD 9.35) years. Acceptability and ease-of-use data were also collected. Results: Regarding the development of the TrueLoo algorithm for urine assessment, sensitivity and specificity of 96\% and 85\% were observed when evaluating a gold-standard labeled data set, respectively (F1-score=0.95). For stool, sensitivity and specificity of 90\% and 79\% were observed, respectively (F1-score=0.85). Regarding the TrueLoo algorithm in assisted living settings, classification performance statistics for urine assessment revealed sensitivity and specificity of 84\% and 94\%, respectively (F1-score=0.90), and for stool, 92\% and 98\%, respectively (F1-score=0.91). Throughout the study, 46 person-reported instances of urine were documented, compared with 630 recorded by the TrueLoo. For stool events, 116 person-reported events were reported, compared with 153 by the TrueLoo. This indicates that person-reported events were captured 7\% (46/630) of the time for urine and 76\% (116/153) of the time for stool. Overall, 45\% (32/71) of participants said that the new toilet seat was better than their previous one, 84\% (60/71) reported that using the TrueLoo was easy, and 99\% (69/71) said that they believed the system could help aging adults. Over 98\% (69/71) of participants reported that they would find alerts related to their health valuable and would be willing to share this information with their doctor. When asked about sharing information with caregivers, 66\% (46/71) reported that they would prefer the TrueLoo to send information and alerts to their caregiver, as opposed to the participant having to personally communicate those details. Conclusions: The TrueLoo accurately recorded toileting sessions compared with standard-of-care methods, successfully establishing metrics of user acceptability and ease of use in assisted living populations. While additional validation studies are warranted, data presented in this paper support the use of the TrueLoo in assisted living settings as a model of event monitoring during toileting. ",
doi="10.2196/50856",
url="https://aging.jmir.org/2024/1/e50856",
url="http://www.ncbi.nlm.nih.gov/pubmed/38801659"
}


@Article{info:doi/10.2196/54128,
author="Roberts, Lynae R.
and Cherry, D. Katelin
and Mohan, P. Desh
and Statler, Tiffany
and Kirkendall, Eric
and Moses, Adam
and McCraw, Jennifer
and Brown III, E. Andrew
and Fofanova, Y. Tatiana
and Gabbard, Jennifer",
title="A Personalized and Interactive Web-Based Advance Care Planning Intervention for Older Adults (Koda Health): Pilot Feasibility Study",
journal="JMIR Aging",
year="2024",
month="May",
day="6",
volume="7",
pages="e54128",
keywords="advance care planning",
keywords="ACP",
keywords="digital health tools",
keywords="system usability",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="aging",
keywords="adoption",
keywords="acceptance",
keywords="usability",
keywords="digital health",
keywords="platform",
keywords="website",
keywords="websites",
abstract="Background: Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Digital applications may help facilitate this process, though their use in older adults has not been adequately studied. Objective: This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, a web-based patient-facing ACP platform, among older adults. Methods: Older adults (aged 50 years and older) who had an active Epic MyChart account at an academic health care system in North Carolina were recruited to participate. A total of 2850 electronic invitations were sent through MyChart accounts with an embedded hyperlink to the Koda platform. Participants who agreed to participate were asked to complete pre- and posttest surveys before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and System Usability Scale (SUS) scores. Exploratory outcomes included ACP knowledge and readiness. Results: A total of 161 participants enrolled in the study and created an account on the platform (age: mean 63, SD 9.3 years), with 80\% (129/161) of these participants going on to complete all steps of the intervention, thereby generating an advance directive. Participants reported minimal difficulty in using the Koda platform, with an overall SUS score of 76.2. Additionally, knowledge of ACP (eg, mean increase from 3.2 to 4.2 on 5-point scale; P<.001) and readiness (eg, mean increase from 2.6 to 3.2 on readiness to discuss ACP with health care provider; P<.001) significantly increased from before to after the intervention. Conclusions: This study demonstrated that the Koda Health platform is feasible, had above-average usability, and improved ACP documentation of preferences in older adults. Our findings indicate that web-based health tools like Koda may help older individuals learn about and feel more comfortable with ACP while potentially facilitating greater engagement in care planning. ",
doi="10.2196/54128",
url="https://aging.jmir.org/2024/1/e54128"
}


@Article{info:doi/10.2196/46522,
author="Money, Annemarie
and Hall, Alex
and Harris, Danielle
and Eost-Telling, Charlotte
and McDermott, Jane
and Todd, Chris",
title="Barriers to and Facilitators of Older People's Engagement With Web-Based Services: Qualitative Study of Adults Aged >75 Years",
journal="JMIR Aging",
year="2024",
month="Feb",
day="28",
volume="7",
pages="e46522",
keywords="digital exclusion",
keywords="digital inclusion",
keywords="older people",
keywords="technology",
keywords="aged",
keywords="web-based",
keywords="internet",
abstract="Background: 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. Objective: This study aims to explore the views of adults aged >75 years on accessing public services digitally. Methods: 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. Results: 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. Conclusions: 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. ",
doi="10.2196/46522",
url="https://aging.jmir.org/2024/1/e46522",
url="http://www.ncbi.nlm.nih.gov/pubmed/38416543"
}