@Article{info:doi/10.2196/70291,
author="Chan, Chi-Fung Raffy
and Zhou, Hao-Shen Joson
and Cao, Yuan
and Lo, Kenneth
and Ng, Hiu-Fung Peter
and Shum, Ho-Keung David
and Wong, Yu-Lok Arnold",
title="Nonpharmacological Multimodal Interventions for Cognitive Functions in Older Adults With Mild Cognitive Impairment: Scoping Review",
journal="JMIR Aging",
year="2025",
month="May",
day="12",
volume="8",
pages="e70291",
keywords="mild cognitive impairment",
keywords="multimodal intervention",
keywords="prevention",
keywords="randomized controlled trial",
keywords="cognitive decline",
abstract="Background: As the global population ages, the prevalence of dementia is expected to rise significantly. To alleviate the burden on health care systems and the economy, it is essential to develop effective strategies to enhance cognitive function in older adults. Previous studies have shown that combined nonpharmacological interventions can improve cognition across various domains in older individuals. However, there is no established gold standard for the exact combination and duration of these interventions, which makes it challenging to assess their overall effectiveness. Objective: Given the diversity of nonpharmacological multimodal interventions aimed at preventing cognitive decline in older adults with mild cognitive impairment (MCI), this scoping review sought to identify and summarize the characteristics and outcomes of these interventions. Methods: We adhered to the Arksey and O'Malley methodological framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and searched 4 electronic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science) systematically on July 6, 2023, and updated the search on April 17, 2024, using specific terms and keywords. Results: This review included 45 studies from 18 countries with 4705 participants from 2014 to 2024 encompassing different combinations of physical training (PT), cognitive training (CT), nutrition intervention, psychosocial intervention, social activities, and electrical stimulation. There is a growing numbers of studies combining PT and CT for MCI treatment, with additional modalities often added to address various aspects of the condition. Compared to single-modal interventions and usual care, multimodal approaches demonstrated significantly better improvements in cognition domains such as attention, global cognition, executive function, memory, processing speed, and verbal fluency. Technology has been instrumental in delivering these interventions and enhancing the effects of PT and CT. Multimodal interventions also show promise in terms of acceptability and user experience, which can improve treatment adherence. Conclusions: Research is limited regarding the cost-effectiveness and optimal dosage of these interventions, making it difficult to assess the additional benefits of incorporating more modalities. Future research should examine the long-term effects of incorporating multiple modalities, using standardized MCI criteria and outcome measures. ",
doi="10.2196/70291",
url="https://aging.jmir.org/2025/1/e70291"
}


@Article{info:doi/10.2196/65213,
author="Lee, Li-Yun
and Tung, Heng-Hsin
and Liao, George
and Liu, Su-Ju
and Chen, Zi-Yu
and Yang, Yea-Ru",
title="Multihealth Promotion Programs on Physical Health and Quality of Life in Older Adults: Quasi-Experimental Study",
journal="Interact J Med Res",
year="2025",
month="May",
day="1",
volume="14",
pages="e65213",
keywords="older adult",
keywords="body composition",
keywords="physical activity",
keywords="health promotion",
keywords="exercise",
keywords="nutrition",
keywords="diet",
keywords="well-being",
keywords="quality-of-life",
keywords="QoL",
keywords="gerontology",
keywords="geriatrics",
abstract="Background: Physical activity and appropriate nutrition are essential for older adults. Improving physical health and quality of life can lead to healthy aging. Objective: This study aims to investigate the long-term effects of multihealth promotion programs on the physical and mental health of older adults in communities. Methods: A quasi-experimental method was used to recruit 112 older adults voluntarily from a pharmacy in central Taiwan between April 2021 and February 2023. Participants were divided into an experimental group receiving a multihealth promotion program and a control group with no specific intervention. The study measured frailty, nutritional status, well-being, and quality of life using standardized tools such as the Clinical Frailty Scale (CFS), Mini-Nutritional Assessment-Short Form (MNA-SF), Well-being Scale for Elders, and the EQ-5D-3L. Data were analyzed using descriptive statistics, independent t tests, Pearson correlation, and generalized estimating equations. Results: A total of 112 participants were recruited. There were 64 (57.1\%) in the experimental group and 48 (42.9\%) in the control group. The experimental group exhibited significantly better quality of life (EQ-5D index) at weeks 12 ($\beta$=--.59; P=.01) and 24 ($\beta$=--.44; P=.04) compared to the control group. The experimental group muscle mass significantly increased at weeks 24 ($\beta$=4.29; P<.01) and 36 ($\beta$=3.03; P=.01). Upper limb strength improved significantly at weeks 12 ($\beta$=3.4; P=.04) and 36 ($\beta$=5; P=.01), while core strength showed significant gains at weeks 12 ($\beta$=4.43; P=.01) and 36 ($\beta$=6.99; P<.01). Lower limb strength increased significantly only at week 12 ($\beta$=4.15; P=.01). Overall physical performance improved significantly at weeks 12 ($\beta$=5.47; P<.01), 24 ($\beta$=5.17; P<.01), and 36 ($\beta$=8.79; P<.01). Conclusions: The study's findings highlight the practical benefits of interventions, including physical and social activities and nutritional support, in enhancing the quality of life and general physical health of older adults. This study's findings have significant implications for clinical practice. These findings can aid in the establishment of effective interventions for older adults. Trial Registration: ClinicalTrials.gov NCT05412251; https://clinicaltrials.gov/study/NCT05412251 ",
doi="10.2196/65213",
url="https://www.i-jmr.org/2025/1/e65213",
url="http://www.ncbi.nlm.nih.gov/pubmed/40310677"
}


@Article{info:doi/10.2196/66298,
author="Halicki-Asakawa, Aman{\'e}
and Mocci, Julia
and Libben, Maya",
title="Mobile App--Delivered Motivational Interviewing for Women on Eating Disorder Treatment Waitlists (MI-Coach: ED): Protocol for an App Development and Pilot Evaluation",
journal="JMIR Res Protoc",
year="2025",
month="Apr",
day="10",
volume="14",
pages="e66298",
keywords="eating disorders",
keywords="motivational interviewing",
keywords="treatment barriers",
keywords="digital interventions",
keywords="pilot test",
keywords="protocol",
keywords="eating disorder",
keywords="eating",
keywords="woman",
keywords="women",
keywords="female",
keywords="Canada",
keywords="Canadian",
keywords="mobile apps",
keywords="mobile health",
keywords="mHealth",
keywords="app development",
keywords="app-based",
keywords="mental health",
keywords="pilot evaluation",
keywords="waitlists",
keywords="mixed methods",
keywords="feasibility",
keywords="acceptability",
keywords="service delivery",
abstract="Background: A significant increase in eating disorder (ED) service waitlists has been observed in the past several years, exacerbating existing barriers to care (eg, long waitlists, scarcity of treatment centers, and positive beliefs surrounding pathology). Given that treatment delays have important clinical correlates (eg, entrenchment of ED pathology), exploring new methods of mental health service delivery for this population is of critical concern. App-based motivational interviewing (MI) delivered prior to the start of treatment has the potential to improve accessibility by simultaneously addressing structural (eg, travel costs) and individual (eg, low motivation) barriers to care. Despite the potential benefits, there remains a lack of empirically validated, ED-specific MI-based mobile apps. Evaluating the feasibility and acceptability of such interventions is a crucial first step before progressing to full-scale efficacy trials. Objective: This multiphasic mixed methods study aims to develop and assess the feasibility and acceptability of MI-Coach: ED, a novel app designed to increase motivation among women waitlisted for ED treatment. Specifically, this study seeks to determine participant engagement levels, user satisfaction, and perceived usability of the app, as well as to explore preliminary trends in motivation and ED-related symptoms following app use. Methods: Phase I adapted the content and interface of an existing app based on evidence-based principles (MI-Coach) for an ED population. Phase II pilot tested the app through a pre-post evaluation. Participants (n=30) aged 18 years and older were recruited from ED treatment waitlists in British Columbia, Canada. After completing baseline assessments evaluating demographic and clinical variables (eg, motivation, eating pathology, depression, and anxiety symptoms), participants were provided access to MI-Coach: ED for 1 month. Participants completed postintervention assessments and provided both quantitative and qualitative feedback on the app. Feasibility will be evaluated through the total number of participants recruited, study dropout rates, and engagement indicators (eg, modules completed) within the app. Acceptability will be assessed through self-report measures and semistructured exit interviews, which will explore user experiences, perceived benefits, and barriers to app engagement. Additionally, exploratory analyses will examine changes in motivation and ED symptoms before and after the intervention. Results: The MI-Coach: ED app has been developed, and recruitment was initiated in November 2022 and terminated in May 2024. Results are being analyzed and will be submitted for publication in May 2025. Conclusions: This study has the potential to transform ED service delivery and mitigate the impacts of existing treatment barriers for this population. By leveraging a digital MI-based intervention, MI-Coach: ED could serve as a scalable and accessible pretreatment tool, helping to bridge the gap between initial help-seeking and formal ED treatment. Findings from this study will inform the refinement of the intervention and recruitment strategies for future large-scale efficacy trials. International Registered Report Identifier (IRRID): DERR1-10.2196/66298 ",
doi="10.2196/66298",
url="https://www.researchprotocols.org/2025/1/e66298"
}


@Article{info:doi/10.2196/64661,
author="Connelly, Jenni
and Swingler, Kevin
and Rodriguez-Sanchez, Nidia
and Whittaker, C. Anna",
title="Identifying Food Preferences and Malnutrition in Older Adults in Care Homes: Co-Design Study of a Digital Nutrition Assessment Tool",
journal="JMIR Aging",
year="2025",
month="Mar",
day="3",
volume="8",
pages="e64661",
keywords="ageing",
keywords="digital technology",
keywords="dietary measurement",
keywords="care homes",
keywords="co-design",
keywords="dietary intake",
keywords="food diary",
abstract="Background: Malnutrition is a challenge among older adults and can result in serious health consequences. However, the dietary intake monitoring needed to identify malnutrition for early intervention is affected by issues such as difficulty remembering or needing a dietitian to interpret the results. Objective: This study aims to co-design a tool using automated food classification to monitor dietary intake and food preferences, as well as food-related symptoms and mood and hunger ratings, for use in care homes. Methods: Participants were 2 separate advisory groups and 2 separate sets of prototype testers. The testers for the first prototype were 10 community-dwelling older adults based in the Stirlingshire area in Scotland who noted their feedback on the tool over 2 weeks in a food diary. The second set of testers consisted of 14 individuals (staff: n=8, 57\%; and residents: n=6, 43\%) based in 4 care homes in Scotland who provided feedback via interview after testing the tool for a minimum of 3 days. In addition, 130 care home staff across the United Kingdom completed the web-based survey on the tool's needs and potential routes to pay for it; 2 care home managers took part in follow-up interviews. Data were collected through food diaries, a web-based survey, audio recordings and transcriptions of focus groups and interviews, and research notes. Systematic text condensation was used to describe themes across the different types of data. Results: Key features identified included ratings of hunger, mood, and gastrointestinal symptoms that could be associated with eating specific foods, as well as a traffic light system to indicate risk. Issues included staff time, Wi-Fi connectivity, and the accurate recognition of pureed food and fortified meals. Different models for potential use and commercialization were identified, including peer support among residents to assist those considered less able, staff-only use of the tool, care home--personalized database menus for easy meal photo selection, and targeted monitoring of residents considered to be at the highest risk using the traffic light system. Conclusions: The tool was deemed useful for monitoring dietary habits and associated symptoms, but necessary design improvements were identified. These should be incorporated before formal evaluation of the tool as an intervention in this setting. Co-design was vital to help make the tool fit for the intended setting and users. ",
doi="10.2196/64661",
url="https://aging.jmir.org/2025/1/e64661",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053797"
}


@Article{info:doi/10.2196/65182,
author="Brassard, Didier
and Presse, Nancy
and Chevalier, St{\'e}phanie",
title="Estimating the Effect of Adhering to the Recommendations of the 2019 Canada's Food Guide on Health Outcomes in Older Adults: Protocol for a Target Trial Emulation",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="23",
volume="14",
pages="e65182",
keywords="aged",
keywords="Canada's Food Guide",
keywords="diet",
keywords="dietary guidelines",
keywords="target trial emulation",
keywords="hypothetical trial",
keywords="Healthy Eating Food Index-2019",
keywords="HEFI-2019",
abstract="Background: The 2019 Canada's Food Guide provides universal recommendations to individuals aged ?2 years. However, the extent to which these recommendations are appropriate for older adults is unknown. Although ideal, conducting a large randomized controlled trial is unrealistic in the short term. An alternative is the target trial emulation framework for causal inference, a novel approach to improve the analysis of observational data. Objective: This study aims to describe the protocol for a target trial emulation in older adults, with an emphasis on key aspects of a hypothetical sustained diet and physical activity intervention. Methods: To emulate the target trial, nonexperimental data from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge; N=1753 adults aged ?67 years) will be used. NuAge includes 4 yearly measurements of dietary intakes, covariates, and outcomes. The per-protocol causal contrast will be the primary causal contrast of interest to account for nonadherence. The sustained intervention strategy will be modeled using the parametric g-formula. In the hypothetical trial, participants will be instructed to meet sex-specific minimal intakes for vegetables and fruits, whole grains, animal- and plant-based protein foods, milk and plant-based beverages, and unsaturated fats. The eligibility criteria, follow-up, intervention, outcomes, and causal contrast in the emulation will closely align with those of the target trial, with only minor modifications. We will attempt to emulate the randomization of treatment by adjusting for baseline covariates and prebaseline dietary habits. Results: Data collection for NuAge was completed in June 2008. For this study, the main analysis was started in May 2024. Submission of the manuscript is expected by February 2025. Conclusions: Emulating a target trial will provide the first evidence of the adequacy of the 2019 Canada's Food Guide recommendations for older adults in relation to health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/65182 ",
doi="10.2196/65182",
url="https://www.researchprotocols.org/2025/1/e65182",
url="http://www.ncbi.nlm.nih.gov/pubmed/39847422"
}


@Article{info:doi/10.2196/48323,
author="van Dam, Lotte
and Christensen, H{\o}jlund Sine
and Tetens, Inge
and Riley III, William
and Timmer, Mari{\"e}lle
and Suciu Jr, George
and Marin, Iuliana
and De Groot, Lisette
and Grootswagers, Pol",
title="Developing a Digital Tool to Calculate Protein Quality in Plant-Based Meals of Older Adults: User Engagement Design Approach With End Users",
journal="J Particip Med",
year="2024",
month="Dec",
day="19",
volume="16",
pages="e48323",
keywords="digital tool",
keywords="protein quality",
keywords="user engagement design approach",
keywords="plant-based diets",
keywords="healthy ageing",
keywords="mobile phone",
abstract="Background: The global shift toward plant-based diets has been increasing, with more people making the transition for various reasons. In vulnerable subgroups such as older adults, the transition to plant-based diets deserves attention due to the potentially detrimental consequences of lower protein quantity and quality. Objective: We aimed to develop a digital tool that ensures adequate protein quality in plant-based meals for older adults experiencing low protein intake through an interdisciplinary collaboration and user engagement with potential end users. Methods: Three focus group interviews of Dutch and Danish dietitians and older adults as potential end users were conducted to identify their needs, preferences, and deal-breakers. Focus group interviews were based on a user-task-environment analysis, the Walt Disney method, the brainwriting method, and a cognitive walkthrough. The interview transcripts were analyzed with a thematic analysis. The front end and backend development of a potential tool took place in parallel and was well-synced to the focus group interviews. Results: Both dietitians and older adults from Dutch and Danish sites expressed high interest in a tool that provides feedback and background information on protein quality, sustainability, and nutrients or micronutrients. The user-task-environment analysis delivered input among others that dietitians and older adults are good potential users, the tool should be functional as an app as well as a website and the tool should provide preprogrammed meals or recipes. The Walt Disney method delivered usable and realistic solutions to the 4 challenges presented. Thirty-two percent of the solutions on all themes presented with the brainwriting method appeared to be highly feasible and relevant, having the potential to be implemented in a tool. The cognitive walkthrough identified certain screens as unclear, necessitating revisions for improved understandability, for example, the need for explanation in selecting food item filters is shown in screenshot 2, with an overall usability score of 59\%. Conclusions: Our user engagement design approach resulted in a prototype that ensured end users' wishes and needs, with a finetuned output tested in focus groups. We conclude that our user engagement design approach was a suitable and meaningful stepwise approach to ensure the relevance of the tool and identify potential barriers. The focus group results indicate that dietitians have a clear understanding and need for a tool to aid in meal planning for enhanced protein quality, highlighting its absence in their current resources despite increasing demands arising from the protein transition. Conversely, for older adults, the introduction of a digital tool appears less appropriate; instead, there is a necessity for foundational education on protein quality before such a tool can be effectively used. Future studies are needed to further implement the prototype into practice. ",
doi="10.2196/48323",
url="https://jopm.jmir.org/2024/1/e48323"
}


@Article{info:doi/10.2196/13723,
author="de Vette, Frederiek
and Ruiz-Rodriguez, Aurora
and Tabak, Monique
and Oude Nijeweme-d'Hollosy, Wendy
and Hermens, Hermie
and Vollenbroek-Hutten, Miriam",
title="Developing Game-Based Design for eHealth in Practice: 4-Phase Game Design Process",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="8",
volume="8",
pages="e13723",
keywords="game based",
keywords="gamification",
keywords="game",
keywords="eHealth",
keywords="telemedicine",
keywords="development",
keywords="design",
keywords="engagement",
keywords="game preferences",
keywords="older adults",
keywords="self-management",
keywords="prototyping",
keywords="evaluations",
keywords="creative",
abstract="Background: Games are increasingly used in eHealth as a strategy for user engagement. There is an enormous diversity of end users and objectives targeted by eHealth. Hence, identifying game content that drives and sustains engagement is challenging. More openness in the game design process and motivational strategies could aid researchers and designers of future game-based apps. Objective: This study aims to provide insights into our approach to develop game-based eHealth in practice with a case study (Personalised ICT Supported Services for Independent Living and Active Ageing [PERSSILAA]). PERSSILAA is a self-management platform that aims to counter frailty by offering training modules to older adults in the domains of healthy nutrition and physical and cognitive training to maintain a healthy lifestyle. We elaborate on the entire game design process and show the motivational strategies applied. Methods: We introduce four game design phases in the process toward game-based eHealth: (1) end-user research, (2) conceptualization, (3) creative design, and (4) refinement (ie, prototyping and evaluations). Results: First, 168 participants participated in end-user research, resulting in an overview of their preferences for game content and a set of game design recommendations. We found that conventional games popular among older adults do not necessarily translate well into engaging concepts for eHealth. Recommendations include focusing game concepts on thinking, problem-solving, variation, discovery, and achievement and using high-quality aesthetics. Second, stakeholder sessions with development partners resulted in strategies for long-term engagement using indicators of user performance on the platform's training modules. These performance indicators, for example, completed training sessions or exercises, form the basis for game progression. Third, results from prior phases were used in creative design to create the game ``Stranded!'' The user plays a person who is shipwrecked who must gather parts for a life raft by completing in-game objectives. Finally, iterative prototyping resulted in the final prototype of the game-based app. A total of 35 older adults participated using simulated training modules. End users scored appreciation (74/100), ease of use (73/100), expected effectivity and motivation (62/100), fun and pleasantness of using the app (75/100), and intended future use (66/100), which implies that the app is ready for use by a larger population. Conclusions: The study resulted in a game-based app for which the entire game design process within eHealth was transparently documented and where engagement strategies were based on extensive user research. Our user evaluations indicate that the strategies for long-term engagement led to game content that was perceived as engaging by older adults. As a next step, research is needed on the user experience and actual engagement with the game to support the self-management of older adults, followed by clinical studies on its added value. ",
doi="10.2196/13723",
url="https://formative.jmir.org/2024/1/e13723"
}


@Article{info:doi/10.2196/55572,
author="Ghabashi, Adil Mai
and Azzeh, Sultan Firas",
title="Factors Influencing Malnutrition Among Older Adult Residents in the Western Region of Saudi Arabia: Sex Differential Study",
journal="JMIR Aging",
year="2024",
month="Sep",
day="16",
volume="7",
pages="e55572",
keywords="Elderly",
keywords="Makkah",
keywords="Malnutrition",
keywords="Mini Nutritional Assessment Short Form",
keywords="Risk factors",
abstract="Background: The global population of older adults is on the rise. As people age, their physical functions gradually decline, leading to a decrease in the overall functioning of different organ systems. Due to these changes, older individuals are at a higher risk of encountering various adverse health outcomes and complications, such as malnutrition. Objective: This study aims to investigate the prevalence of malnutrition and its associated factors among older adults dwelling in the western region of Saudi Arabia. We have analyzed these factors separately for both men and women to understand any potential sex differences. Methods: A nonrandomized cross-sectional study was conducted for older adults aged ?60 years in the western region of Saudi Arabia. Personal information was obtained through a closed questionnaire. The Mini Nutritional Assessment Short Form was used to determine the malnutrition status of older adults. Consequently, the individuals were divided into 2 groups: normal and malnourished. To assess the risk factors related to malnutrition, the odds ratio (OR) and 95\% CI were determined using a binary logistic regression. Results: The prevalence of malnutrition in men and women was around 7\% and 5\%, respectively. Potential risk factors related to malnutrition in men were higher age (OR 1.263, 95\% CI 1.086-1.468; P=.002), being widowed (OR 8.392, 95\% CI 1.002-70.258; P=.049), and having dental problems (OR 9.408, 95\% CI 1.863-47.514; P=.007). On the other hand, risk factors associated with malnutrition in women were lower BMI (OR 0.843, 95\% CI 0.747-0.952; P=.006) and being disabled (OR 18.089, 95\% CI 0.747-0.952; P=.006). Conclusions: The findings of this study provide important insights into the risk factors for malnutrition among older adults in the western region of Saudi Arabia. While the overall prevalence of malnutrition was relatively low, the analysis revealed distinct risk factors for older men and women. Interventions developed based on the identified risk factors may prove effective in addressing the issue of malnutrition within this population. ",
doi="10.2196/55572",
url="https://aging.jmir.org/2024/1/e55572"
}


@Article{info:doi/10.2196/56714,
author="Mills, Marie Christine
and Boyar, Liza
and O'Flaherty, A. Jessica
and Keller, H. Heather",
title="Social Factors Associated With Nutrition Risk in Community-Dwelling Older Adults in High-Income Countries: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="25",
volume="13",
pages="e56714",
keywords="community",
keywords="malnutrition risk",
keywords="nutrition risk",
keywords="older adults",
keywords="social factors",
keywords="geriatric",
keywords="geriatrics",
keywords="malnutrition",
keywords="community-dwelling",
keywords="older adult",
keywords="elderly",
keywords="HIC",
keywords="high-income countries",
keywords="diet",
keywords="dietary intake",
keywords="nutritional status",
keywords="Canada",
keywords="nutritional risk",
keywords="social",
keywords="intervention",
keywords="public health",
keywords="community-based intervention",
keywords="health promotion",
abstract="Background: In high-income countries (HICs), between 65\% and 70\% of community-dwelling adults aged 65 and older are at high nutrition risk. Nutrition risk is the risk of poor dietary intake and nutritional status. Consequences of high nutrition risk include frailty, hospitalization, death, and reduced quality of life. Social factors (such as social support and commensality) are known to influence eating behavior in later life; however, to the authors' knowledge, no reviews have been conducted examining how these social factors are associated with nutrition risk specifically. Objective: The objective of this scoping review is to understand the extent and type of evidence concerning the relationship between social factors and nutrition risk among community-dwelling older adults in HICs and to identify social interventions that address nutrition risk in community-dwelling older adults in HICs. Methods: This review will follow the scoping review methodology as outlined by the JBI Manual for Evidence Synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search will include MEDLINE (Ovid), CINAHL, PsycINFO, and Web of Science. There will be no date limits placed on the search. However, only resources available in English will be included. EndNote (Clarivate Analytics) and Covidence (Veritas Health Innovation Ltd) will be used for reference management and removal of duplicate studies. Articles will be screened, and data will be extracted by at least 2 independent reviewers using Covidence. Data to be extracted will include study characteristics (country, methods, aims, design, and dates), participant characteristics (population description, inclusion and exclusion criteria, recruitment method, total number of participants, and demographics), how nutrition risk was measured (including the tool used to measure nutrition risk), social factors or interventions examined (including how these were measured or determined), the relationship between nutrition risk and the social factors examined, and the details of social interventions designed to address nutrition risk. Results: The scoping review was started in October 2023 and will be finalized by August 2024. The findings will describe the social factors commonly examined in the nutrition risk literature, the relationship between these social factors and nutrition risk, the social factors that have an impact on nutrition risk, and social interventions designed to address nutrition risk. The results of the extracted data will be presented in the form of a narrative summary with accompanying tables. Conclusions: Given the high prevalence of nutrition risk in community-dwelling older adults in HICs and the negative consequences of nutrition risk, it is essential to understand the social factors associated with nutrition risk. The results of the review are anticipated to aid in identifying individuals who should be screened proactively for nutrition risk and inform programs, policies, and interventions designed to reduce the prevalence of nutrition risk. International Registered Report Identifier (IRRID): DERR1-10.2196/56714 ",
doi="10.2196/56714",
url="https://www.researchprotocols.org/2024/1/e56714",
url="http://www.ncbi.nlm.nih.gov/pubmed/38696645"
}


@Article{info:doi/10.2196/52170,
author="Xu, Zidu
and Gu, Yaowen
and Xu, Xiaowei
and Topaz, Maxim
and Guo, Zhen
and Kang, Hongyu
and Sun, Lianglong
and Li, Jiao",
title="Developing a Personalized Meal Recommendation System for Chinese Older Adults: Observational Cohort Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="30",
volume="8",
pages="e52170",
keywords="knowledge graph",
keywords="personalized food recommendation",
keywords="geriatric nutrition",
keywords="community",
keywords="ubiquitous computing",
abstract="Background: China's older population is facing serious health challenges, including malnutrition and multiple chronic conditions. There is a critical need for tailored food recommendation systems. Knowledge graph--based food recommendations offer considerable promise in delivering personalized nutritional support. However, the integration of disease-based nutritional principles and preference-related requirements needs to be optimized in current recommendation processes. Objective: This study aims to develop a knowledge graph--based personalized meal recommendation system for community-dwelling older adults and to conduct preliminary effectiveness testing. Methods: We developed ElCombo, a personalized meal recommendation system driven by user profiles and food knowledge graphs. User profiles were established from a survey of 96 community-dwelling older adults. Food knowledge graphs were supported by data from websites of Chinese cuisine recipes and eating history, consisting of 5 entity classes: dishes, ingredients, category of ingredients, nutrients, and diseases, along with their attributes and interrelations. A personalized meal recommendation algorithm was then developed to synthesize this information to generate packaged meals as outputs, considering disease-related nutritional constraints and personal dietary preferences. Furthermore, a validation study using a real-world data set collected from 96 community-dwelling older adults was conducted to assess ElCombo's effectiveness in modifying their dietary habits over a 1-month intervention, using simulated data for impact analysis. Results: Our recommendation system, ElCombo, was evaluated by comparing the dietary diversity and diet quality of its recommended meals with those of the autonomous choices of 96 eligible community-dwelling older adults. Participants were grouped based on whether they had a recorded eating history, with 34 (35\%) having and 62 (65\%) lacking such data. Simulation experiments based on retrospective data over a 30-day evaluation revealed that ElCombo's meal recommendations consistently had significantly higher diet quality and dietary diversity compared to the older adults' own selections (P<.001). In addition, case studies of 2 older adults, 1 with and 1 without prior eating records, showcased ElCombo's ability to fulfill complex nutritional requirements associated with multiple morbidities, personalized to each individual's health profile and dietary requirements. Conclusions: ElCombo has shown enhanced potential for improving dietary quality and diversity among community-dwelling older adults in simulation tests. The evaluation metrics suggest that the food choices supported by the personalized meal recommendation system surpass autonomous selections. Future research will focus on validating and refining ElCombo's performance in real-world settings, emphasizing the robust management of complex health data. The system's scalability and adaptability pinpoint its potential for making a meaningful impact on the nutritional health of older adults. ",
doi="10.2196/52170",
url="https://formative.jmir.org/2024/1/e52170",
url="http://www.ncbi.nlm.nih.gov/pubmed/38814702"
}


@Article{info:doi/10.2196/50922,
author="French, Chloe
and Burden, Sorrel
and Stanmore, Emma",
title="Digital Intervention (Keep-On-Keep-Up Nutrition) to Improve Nutrition in Older Adults: Protocol for a Feasibility Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="30",
volume="13",
pages="e50922",
keywords="feasibility",
keywords="usability",
keywords="digital health",
keywords="diet",
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="dietary",
keywords="nutrition",
keywords="hydration",
keywords="community dwelling",
keywords="RCT",
keywords="randomized",
keywords="controlled trial",
keywords="controlled trials",
abstract="Background: Digital health tools can support behavior change and allow interventions to be scalable at a minimal cost. Keep-on-Keep-up Nutrition (KOKU-Nut) is a free, tablet-based app that focuses on increasing physical activity and improving the dietary intake of older adults based on UK guidelines. The intervention targets an important research area identified as a research priority reported by the James Lind Alliance priority setting partnership for malnutrition. Objective: This study aims to assess the feasibility of using the digital health tool KOKU-Nut among community-dwelling older adults to inform a future randomized controlled trial. The secondary aims are to determine the acceptability, usability, preliminary effect sizes, and safety of the study and the intervention (KOKU-Nut). Methods: This is a feasibility randomized controlled trial. We plan to recruit a total of 36 community-dwelling older adults using purposive sampling. Participants will be randomized 1:1 to either the intervention or the control group. The intervention group will be asked to engage with KOKU-Nut 3 times a week for 12 weeks. Participants in the control group will receive a leaflet promoting a healthy lifestyle. All study participants will complete questionnaires at baseline and the end of the 12 weeks. A sample of participants will be asked to participate in an optional interview. The study will collect a range of data including anthropometry (height and weight), dietary intake (3-day food diary), physical function (grip strength and 5-times sit-to-stand), perceived quality of life (EQ-5D), usability (System Usability Scale), and safety (adverse events). Results: Data collection commenced in March 2024, and the results will be ready for publication by January 2025. Feasibility will be determined on the basis of participants' self-reported engagement with the intervention, and recruitment and retention rates and will be summarized descriptively. We will also consider the amount of missing data and assess how outcomes are related to group assignment. Acceptability will be measured using the modified treatment evaluation inventory and one-to-one semistructured interviews. Transcripts from the interviews will be analyzed using NVivo (version 12; QSR International) software using framework analysis to understand any barriers to the recruitment process, the suitability of the assessment measures, and the acceptability of the intervention and study design. Conclusions: The study aligns with guidelines developed by the Medical Research Council for developing a complex intervention by using qualitative and quantitative research to examine the barriers of the intervention and identify potential challenges around recruitment and retention. We anticipate that these results will inform the development of a future powered randomized controlled design trial to test the true effectiveness of KOKU-Nut. Trial Registration: ClinicalTrials.gov NCT05943366; https://classic.clinicaltrials.gov/ct2/show/NCT05943366 International Registered Report Identifier (IRRID): PRR1-10.2196/50922 ",
doi="10.2196/50922",
url="https://www.researchprotocols.org/2024/1/e50922",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687981"
}


@Article{info:doi/10.2196/47196,
author="He, Qian
and Wu, Hei Kevin Chun
and Bennett, N. Adam
and Zhang, Yue Jia
and Chan, Katie Kei Hang",
title="Nutritional Interventions for the Prevention of Cognitive Decline in Patients With Mild Cognitive Impairment and Alzheimer Disease: Protocol for a Network Meta-Analysis of Randomized Controlled Trials",
journal="JMIR Res Protoc",
year="2024",
month="Feb",
day="28",
volume="13",
pages="e47196",
keywords="network meta-analysis",
keywords="cognitive impairment",
keywords="Alzheimer disease",
keywords="Alzheimer",
keywords="neurodegenerative disorders",
keywords="geriatric care",
keywords="nutritional interventions",
keywords="older patient",
keywords="geriatric",
keywords="cognitive decline",
keywords="aging",
keywords="older people",
keywords="nutrition",
keywords="cognitive",
keywords="intervention",
keywords="dementia",
keywords="acute confusional senile dementia",
keywords="Elder Nutritional Physiological Phenomena",
keywords="Nutrition Physiology",
keywords="meta-analysis",
keywords="meta-analyses",
keywords="systematic review",
keywords="systematic reviews",
abstract="Background: Mild cognitive impairment (MCI) is the stage between cognitive decline due to physiological aging and the severity of decline seen in neurodegenerative disorders like Alzheimer disease (AD), which is among the most prevalent neurodegenerative disorders characterized by cognitive impairment. People with MCI are at increased risk of developing AD. Although MCI and AD are incurable, nutritional interventions can potentially delay or prevent their onset. Consequently, effective interventions used to decelerate or alleviate the progress of cognitive impairment in older people are a significant focus in geriatric care. Given the synergistic effects of nutrition on health, assessing the effectiveness of nutritional supplements or dietary composition in preventing MCI or AD is essential for developing interventional strategies. Objective: Our study aims to assess the effectiveness of various nutritional interventions, including special dietary types, dietary patterns, specific foods, nutritional intake, and nutritional supplements, in preventing cognitive decline among patients diagnosed with MCI or AD. To achieve this, we will use a comprehensive approach, including network meta-analysis, pairwise meta-analysis, and systematic review of randomized controlled trials (RCTs). Methods: The review will follow the Population, Intervention, Comparison, Outcome (PICO) model and the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Two investigators will independently search PubMed electronically. Data extraction will follow the inclusion criteria, and data will be assessed for risk of bias using a revised tool. Additionally, evidence quality will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. The outcomes of interest are assessing the cognitive outcomes in patients with MCI or AD. A systematic literature search will be conducted, identifying randomized controlled trials that investigate the impact of these nutritional interventions on cognitive function decline in individuals with MCI and AD. Network meta-analyses (random-effects model) and pairwise meta-analyses will then estimate the relative effectiveness of different nutritional interventions. Results: We included 51 studies, published between 1999 and 2023 (27 studies for AD and 24 studies for MCI) and involving 8420 participants. We completed data extraction for all 51 studies by December 2023. Currently, we are actively engaged in data analysis and manuscript preparation. We plan to finalize the manuscript and publish the comprehensive results by the end of 2024. Conclusions: Our study holds significant clinical relevance given the rising prevalence of AD and the potential influence of nutritional interventions on cognitive function in individuals with MCI and AD. By investigating this relationship, our research aims to inform evidence-based decision-making in the development of prevention strategies for MCI and AD. The outcomes are expected to contribute to the establishment of reliable recommendations for MCI or AD management, providing substantial support in the field. Trial Registration: PROSPERO CRD42022331173; http://tinyurl.com/3snjp7a4 International Registered Report Identifier (IRRID): PRR1-10.2196/47196 ",
doi="10.2196/47196",
url="https://www.researchprotocols.org/2024/1/e47196",
url="http://www.ncbi.nlm.nih.gov/pubmed/38416536"
}


@Article{info:doi/10.2196/49322,
author="Salas-Groves, Emily
and Alcorn, Michelle
and Childress, Allison
and Galyean, Shannon",
title="The Effect of Web-Based Culinary Medicine to Enhance Protein Intake on Muscle Quality in Older Adults: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="13",
volume="8",
pages="e49322",
keywords="older adults",
keywords="culinary medicine",
keywords="protein",
keywords="muscle mass",
keywords="muscle strength",
keywords="physical activity",
keywords="nutrition intervention",
keywords="online",
abstract="Background: The most common age-related musculoskeletal disorder is sarcopenia. Sarcopenia is the progressive and generalized loss of muscle mass, strength, and function. The causes of sarcopenia can include insufficient nutritional status, which may be due to protein-energy malnutrition, anorexia, limited food access and eating ability, or malabsorption. In the United States, 15.51\% of older adults have been diagnosed with sarcopenia. Culinary medicine (CM) is a novel evidence-based medical field that combines the science of medicine with food and cooking to prevent and treat potential chronic diseases. CM helps individuals learn and practice culinary skills while tasting new recipes. Therefore, this program could successfully reduce barriers to protein intake, enabling older adults to enhance their diet and muscle quality. Objective: This study aimed to examine how a web-based CM intervention, emphasizing convenient ways to increase lean red meat intake, could improve protein intake with the promotion of physical activity to see how this intervention could affect older adults' muscle strength and mass. Methods: A 16-week, single-center, parallel-group, randomized controlled trial was conducted to compare a web-based CM intervention group (CMG) with a control group (CG) while monitoring each group's muscle strength, muscle mass, and physical activity for muscle quality. The CMG received weekly web-based cooking demonstrations and biweekly nutrition education videos about enhancing protein intake, whereas the CG just received the recipe handout. Anthropometrics, muscle mass, muscle strength, dietary habits, physical activity, and cooking effectiveness were established at baseline and measured after the intervention. The final number of participants for the data analysis was 24 in the CMG and 23 in the CG. Results: No between-group difference in muscle mass (P=.88) and strength (dominant P=.92 and nondominant P=.72) change from the prestudy visit was detected. No statistically significant difference in protein intake was seen between the groups (P=.50). A nonsignificant time-by-intervention interaction was observed for daily protein intake (P=.08). However, a statistically significant time effect was observed (P?.001). Post hoc testing showed that daily protein intake was significantly higher at weeks 1 to 16 versus week 0 (P<.05). At week 16, the intake was 16.9 (95\% CI 5.77-27.97) g higher than that at the prestudy visit. Conclusions: This study did not affect protein intake and muscle quality. Insufficient consistent protein intake, low physical activity, intervention adherence, and questionnaire accuracy could explain the results. These studies could include an interdisciplinary staff, different recruitment strategies, and different muscle mass measurements. Future research is needed to determine if this intervention is sustainable in the long term and should incorporate a follow-up to determine program efficacy on several long-term behavioral and health outcomes, including if the participants can sustain their heightened protein intake and how their cooking skills have changed. Trial Registration: ClinicalTrials.gov NCT05593978; https://clinicaltrials.gov/ct2/show/NCT05593978 ",
doi="10.2196/49322",
url="https://formative.jmir.org/2024/1/e49322",
url="http://www.ncbi.nlm.nih.gov/pubmed/38349721"
}


@Article{info:doi/10.2196/50870,
author="Su, Yan
and Wu, Kuan-Ching
and Chien, Shao-Yun
and Naik, Aishwarya
and Zaslavsky, Oleg",
title="A Mobile Intervention Designed Specifically for Older Adults With Frailty to Support Healthy Eating: Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="15",
volume="7",
pages="e50870",
keywords="frailty",
keywords="healthy eating",
keywords="mobile",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="clinical trial",
keywords="Mediterranean diet",
keywords="metabolic health",
keywords="diet",
keywords="dietary",
keywords="RCT",
keywords="randomized controlled trial",
keywords="randomized",
keywords="controlled trial",
keywords="controlled trials",
keywords="frail",
keywords="eating",
keywords="food",
keywords="nutrition",
keywords="adherence",
abstract="Background: Frailty, a common geriatric syndrome, predisposes older adults to functional decline. No medications can alter frailty's trajectory, but nutritional interventions may aid in supporting independence. Objective: This paper presents a pilot randomized controlled trial to investigate the feasibility and efficacy of a mobile health intervention, ``Olitor,'' designed to enhance adherence to the Mediterranean diet among older adults with frailty, requiring no external assistance. Methods: The study sample consisted of 15 participants aged 66-77 (mean 70.5, SD 3.96) years randomized into intervention (n=8; 8 females; mean 72.4, SD 4.8 years) and control groups (n=7; 6 females, 1 male; mean 70.0, SD 3.9 years). The intervention involved a patient-facing mobile app called ``Olitor'' and a secure web-based administrative dashboard. Participants were instructed to use the app at least weekly for 3 months, which provided feedback on their food choices, personalized recipe recommendations, and an in-app messaging feature. Using Mann-Whitney tests to compare change scores and Hedges g statistics to estimate effect sizes, the primary efficacy outcomes were adherence to the Mediterranean diet score and insulin resistance measures. Secondary outcomes included retention as a measure of feasibility, engagement level and user app quality ratings for acceptability, and additional metrics to evaluate efficacy. Models were adjusted for multiple comparisons. Results: The findings demonstrated a significant improvement in the Mediterranean diet adherence score in the intervention group compared to the control (W=50.5; adjusted P=.04) with median change scores of 2 (IQR 2-4.25) and 0 (IQR --0.50 to 0.50), respectively. There was a small and insignificant reduction in homeostasis model assessment of insulin resistance measure (W=23; adjusted P=.85). Additionally, there were significant increases in legume intake (W=54; adjusted P<.01). The intervention's effect size was large for several outcomes, such as Mediterranean diet adherence (Hedges g=1.58; 95\% CI 0.34-2.67) and vegetable intake (Hedges g=1.14; 95\% CI 0.08-2.21). The retention rate was 100\%. The app's overall quality rating was favorable with an average interaction time of 12 minutes weekly. Conclusions: This pilot study revealed the potential of the mobile intervention ``Olitor'' in promoting healthier eating habits among older adults with frailty. It demonstrated high retention rates, significant improvement in adherence to the Mediterranean diet, and increased intake of recommended foods. Insulin resistance showed a minor nonsignificant improvement. Several secondary outcomes, such as lower extremity function and Mediterranean diet knowledge, had a large effect size. Although the app's behavior change features were similar to those of previous digital interventions, the distinctive focus on theory-informed mechanistic measures involved in behavioral change, such as self-regulation, self-efficacy, and expected negative outcomes, may have enhanced its potential. Further investigations in a more diverse and representative population, focusing on individuals with impaired insulin sensitivity, are warranted to validate these preliminary findings. Trial Registration: ClinicalTrials.gov NCT05236712; https://clinicaltrials.gov/study/NCT05236712 ",
doi="10.2196/50870",
url="https://formative.jmir.org/2023/1/e50870",
url="http://www.ncbi.nlm.nih.gov/pubmed/37966877"
}


@Article{info:doi/10.2196/26871,
author="Gomes, Antunes Lu{\'i}s
and Greg{\'o}rio, Jo{\~a}o Maria
and Iakovleva, A. Tatiana
and Sousa, de Rute Dinis
and Bessant, John
and Oliveira, Pedro
and Branco, C. Jaime
and Canh{\~a}o, Helena
and Rodrigues, Maria Ana",
title="A Home-Based eHealth Intervention for an Older Adult Population With Food Insecurity: Feasibility and Acceptability Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="31",
volume="23",
number="8",
pages="e26871",
keywords="food insecurity",
keywords="eHealth",
keywords="television app",
keywords="elderly people",
keywords="vulnerable population",
keywords="cognitive behavioral strategy",
keywords="health innovation",
keywords="multidisciplinary program",
abstract="Background: Food insecurity is a global public health challenge, affecting predominately the most vulnerable people in society, including older adults. For this population, eHealth interventions represent an opportunity for promoting healthy lifestyle habits, thus mitigating the consequences of food insecurity. However, before their widespread dissemination, it is essential to evaluate the feasibility and acceptability of these interventions among end users. Objective: This study aims to explore the feasibility and acceptability of a home-based eHealth intervention focused on improving dietary and physical activity through an interactive television (TV) app among older adults with food insecurity. Methods: A pilot noncontrolled quasi-experimental study was designed with baseline and 3-month follow-up assessments. Older adult participants with food insecurity were recruited from 17 primary health care centers in Portugal. A home-based intervention program using an interactive TV app aimed at promoting healthy lifestyle behaviors was implemented over 12 weeks. Primary outcomes were feasibility (self-reported use and interest in eHealth) and acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy), which were evaluated using a structured questionnaire with a 7-point Likert scale. Secondary outcomes were changes in food insecurity (Household Food Insecurity Scale), quality of life (European Quality of Life Questionnaire with five dimensions and three levels and Functional Assessment of Chronic Illness Therapy-Fatigue), physical function (Health Assessment Questionnaire, Elderly Mobility Scale, grip strength, and regularity of exercise), and nutritional status (adherence to the Mediterranean diet). Results: A sample of 31 older adult individuals with food insecurity was enrolled in the 12-week intervention program with no dropouts. A total of 10 participants self-reported low use of the TV app. After the intervention, participants were significantly more interested in using eHealth to improve food insecurity (baseline median 1.0, IQR 3.0; 3-month median 5.0, IQR 5.0; P=.01) and for other purposes (baseline median 1.0, IQR 2.0; 3-month median 6.0, IQR 2.0; P=.03). High levels of acceptability were found both before and after (median range 7.0-7.0, IQR 2.0-0.0 and 5.0-7.0, IQR 2.0-2.0, respectively) the intervention, with no significant changes for most constructs. Clinically, there was a reduction of 40\% in food insecurity (P=.001), decreased fatigue (mean ?3.82, SD 8.27; P=.02), and improved physical function (Health Assessment Questionnaire: mean ?0.22, SD 0.38; P=.01; Elderly Mobility Scale: mean ?1.50, SD 1.08; P=.01; regularity of exercise: baseline 10/31, 32\%; 3 months 18/31, 58\%; P=.02). No differences were found for the European Quality of Life Questionnaire with five dimensions and three levels, grip strength, or adherence to the Mediterranean diet. Conclusions: The home-based eHealth intervention was feasible and highly acceptable by participants, thus supporting a future full-scale trial. The intervention program not only reduced the proportion of older adults with food insecurity but also improved participants' fatigue and physical function. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6626 ",
doi="10.2196/26871",
url="https://www.jmir.org/2021/8/e26871",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463638"
}


@Article{info:doi/10.2196/25327,
author="Benavides, Lynn Heidi
and Meireles, Lumachi Christiane
and Benavente, Viola
and Mays, Helen Mary
and Wang, Jing",
title="Decreasing COVID-19 Risk Factors for Older Adults by Using Digital Technology to Implement a Plant-Based-Diet: An Opinion",
journal="JMIR Aging",
year="2021",
month="Jul",
day="5",
volume="4",
number="3",
pages="e25327",
keywords="COVID-19",
keywords="coronavirus",
keywords="older adult",
keywords="plant-based diet",
keywords="eating patterns",
keywords="whole foods",
keywords="Mediterranean diet",
keywords="obesity",
keywords="pandemic",
keywords="ethnic minorities",
keywords="telehealth",
keywords="digital technology",
keywords="racial disparities",
keywords="aging",
doi="10.2196/25327",
url="https://aging.jmir.org/2021/3/e25327",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081595"
}


@Article{info:doi/10.2196/15649,
author="Robert, Caroline
and Erdt, Mojisola
and Lee, James
and Cao, Yuanyuan
and Naharudin, Binte Nurhazimah
and Theng, Yin-Leng",
title="Effectiveness of eHealth Nutritional Interventions for Middle-Aged and Older Adults: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="May",
day="17",
volume="23",
number="5",
pages="e15649",
keywords="eHealth",
keywords="mHealth",
keywords="nutritional intervention",
keywords="nutrition apps",
keywords="middle-aged",
keywords="older adults",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: The risk of development of chronic diseases related to poor nutrition increases with age. In the face of an aging population, it is important for health care sectors to find solutions in delivering health services efficiently and effectively to middle-aged and older adults. Objective: The aim of this systematic review and meta-analysis was to consolidate the literature that reported the effectiveness of eHealth apps in delivering nutritional interventions for middle-aged and older adults. Methods: A literature search from five databases (PubMed, CINAHL, Cochrane, Web of Science, and Global Health) from the past 5 years was performed. Studies were selected for inclusion that used eHealth to deliver nutritional interventions to adults aged 40 years and above, and reported health and behavioral outcomes. Two independent reviewers searched for research articles and assessed the eligibility of studies to be included in the review. A third reviewer resolved disagreements on study inclusion. We also assessed the quality of the included studies using the CONSORT 2010 checklist. Results: A total of 70 studies were included for analysis. The study quality ranged from 44\% to 85\%. The most commonly used eHealth intervention type was mobile apps (22/70, 31\%). The majority of studies (62/70, 89\%) provided multicomponent health interventions, which aimed to improve nutrition and other health behaviors (eg, exercise, smoking cessation, medication adherence). Meta-analysis results indicated high and significant heterogeneity; hence, conclusions based on these results should be considered with caution. Nonetheless, the results generally showed that eHealth interventions improved anthropometric and clinical outcomes, but not behavioral outcomes such as fruit and vegetable consumption. Conclusions: The use of eHealth apps to deliver health interventions has been increasing in recent years, and these apps have the potential to deliver health services to a larger group of people. Our findings showed that the effectiveness of eHealth apps to deliver health interventions for middle-aged to older adults was supported by the improvement of anthropometric and clinical outcomes. Future work could aim to develop research frameworks in administering eHealth interventions to address heterogeneity in this field of research. ",
doi="10.2196/15649",
url="https://www.jmir.org/2021/5/e15649",
url="http://www.ncbi.nlm.nih.gov/pubmed/33999005"
}


@Article{info:doi/10.2196/22186,
author="Kramer, L. Lean
and Mulder, C. Bob
and van Velsen, Lex
and de Vet, Emely",
title="Use and Effect of Web-Based Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="6",
volume="10",
number="1",
pages="e22186",
keywords="embodied conversational agent",
keywords="health behavior change",
keywords="loneliness",
keywords="eating behavior",
keywords="older adults",
abstract="Background: An unhealthy eating pattern and loneliness negatively influence quality of life in older age. Embodied conversational agents (ECAs) are a promising way to address these health behaviors in an engaging manner. Objective: We aim to (1) identify whether ECAs can persuade community-dwelling older adults to change their dietary behavior and whether ECA use can decrease loneliness, (2) test these pathways to effects, and (3) understand the use of an ECA. Methods: The web-based eHealth app PACO is a fully automated 8-week intervention in which 2 ECAs engage older adults in dialogue to motivate them to change their dietary behavior and decrease their loneliness. PACO was developed via a human-centered and stakeholder-inclusive design approach and incorporates Self-determination Theory and various behavior change techniques. For this study, an unblinded randomized controlled trial will be performed. There will be 2 cohorts, with 30 participants per cohort. Participants in the first cohort will immediately receive the PACO app for 8 weeks, while participants in the second cohort receive the PACO app after a waiting-list condition of 4 weeks. Participants will be recruited via social media, an online panel, flyers, and advertorials. To be eligible, participants must be at least 65 years of age, must not be in paid employment, and must live alone independently at home. Primary outcomes will be self-assessed via online questionnaires at intake, control, after 4 weeks, and after 8 weeks, and will include eating behavior and loneliness. In addition, the primary outcome---use---will be measured via data logs. Secondary outcomes will be measured at the same junctures, via either validated, self-assessed, online questionnaires or an optional interview. Results: As of July 2020, we have begun recruiting participants. Conclusions: By unraveling the mechanisms behind the use of a web-based intervention with ECAs, we hope to gain a fine-grained understanding of both the effectiveness and the use of ECAs in the health context. Trial Registration: ClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883 International Registered Report Identifier (IRRID): PRR1-10.2196/22186 ",
doi="10.2196/22186",
url="https://www.researchprotocols.org/2021/1/e22186",
url="http://www.ncbi.nlm.nih.gov/pubmed/33404513"
}