@Article{info:doi/10.2196/60297, author="Post, Dannielle and Whitson, Kathleen and Parfitt, Gaynor", title="Implementation of New Technologies in an Aged Care Social Day Program: Mixed Methods Evaluation", journal="JMIR Aging", year="2025", month="May", day="12", volume="8", pages="e60297", keywords="aged care", keywords="older adults", keywords="interactive robots", keywords="social engagement", keywords="evaluation", keywords="geriatric", keywords="robot", keywords="day program", keywords="perception", abstract="Background: Australia's aging population is looking to age in place, accessing care alternatives external to the traditional model of residential aged care facilities. This evaluation is situated in a Social Day Program, delivered by an aged care organization. It is designed to cater for people living with dementia, located in an environment equipped with new technologies including age-specific interactive computer gaming, social robots, sensory stimulation, and virtual reality. The technologies are designed to support older adults, enabling them to stay connected and maintain physical and cognitive functioning, independence, and quality of life. Objective: This project aimed to undertake a multifaceted evaluation of the implementation of the new technologies, including an exploration of the barriers and enablers to uptake. The key issue is how to enhance the potential for optimizing the use of these technologies in the Social Day Program environment, to help inform decision-making regarding the implementation of these technologies at the organization's other sites, and future investment in such technologies by aged care organizations generally. Methods: Observation of technology use within the organization was conducted over a 16-week period. Surveys and semistructured interviews were used to collect information from staff related to their experiences with the technology. Thematic analysis was used to analyze the interviews. Data were triangulated across the sample. Results: Forty-eight observation periods were completed, totaling 126.5 observation hours. Technology use by clients was observed on 24 occasions, for 22 (17.4\% of the observation time) hours. Nineteen staff completed surveys. Nearly three-quarters (n=14) of the staff perceived there to be barriers to the clients' use of technology, and 18 (95\%) staff reported that they assisted clients to use the technology. Ten (53\%) staff reported receiving training to use the technology and feeling confident in their knowledge of the technology to assist clients in using it. Twelve staff members participated in an interview. Key themes identified from the interview data were: technology has potential but is not for everyone, incorporating the subtheme technology as a placation tool, staff knowledge and confidence, and technology functionality and support. Conclusions: This evaluation identified that technology was not being used for the purposes of enrichment or experience enhancement, nor extensively. Multiple barriers to the implementation and sustained use of the technology items were identified. Recommendations to improve implementation and promote sustained use of technology, based on the findings of this evaluation and evidence from the literature, may apply to other organizations seeking to implement these technologies in similar programs. ", doi="10.2196/60297", url="https://aging.jmir.org/2025/1/e60297" } @Article{info:doi/10.2196/71950, author="Nabelsi, Veronique and Plouffe, V{\'e}ronique and Leclerc, Chantal Marie", title="Barriers to and Facilitators of Implementing Overnight Nursing Teleconsultation in Small, Rural Long-Term Care Facilities: Qualitative Interview Study", journal="JMIR Aging", year="2025", month="May", day="7", volume="8", pages="e71950", keywords="teleconsultation", keywords="long-term facilities", keywords="nursing", keywords="barriers and facilitators", keywords="rural", keywords="telehealth", keywords="qualitative", keywords="pilot study", keywords="Quebec", abstract="Background: Teleconsultation has expanded rapidly in recent years, especially during the COVID-19 pandemic, and has become standard practice among physicians. The benefits of teleconsultation, namely, improving access to care, ensuring continuity and quality of care, increasing patient satisfaction, and reducing costs and wait times, are well documented. However, its use in nursing practice, especially in long-term care settings, remains underresearched despite its significant transformative potential, particularly in resource-limited and rural settings, where it could address major challenges such as nursing shortages and access to care. Objective: This study aimed to identify barriers to and facilitators of implementing overnight nursing teleconsultation in rural residential and long-term care centers in Quebec, Canada (centres d'h{\'e}bergement et de soins de longue dur{\'e}e [CHSLDs]), with ?50 beds. Methods: A 6-month pilot project was rolled out sequentially in 3 rural CHSLDs in 2 administrative regions of Quebec between July 2022 and March 2023. A total of 38 semistructured interviews were conducted with managers (n=27, 71\%), nursing staff members (n=9, 24\%), and resident committee presidents (n=2, 5\%) between February 2023 and July 2023. Results: The study identified several barriers to the implementation of teleconsultation. The main barriers reported included union opposition (managers: 23/27, 85\%), network instability (resident committee presidents: 2/2, 100\%), limited technology skills (nursing staff members: 7/9, 78\%), a perceived increase in workload (nursing staff members: 8/9, 89\%; resident committee presidents: 2/2, 100\%), and a low volume of teleconsultations (nursing staff members: 8/9, 89\%). Despite the barriers, participants also identified key facilitators. These included the care setting (nursing staff members: 9/9, 100\%; managers: 21/27, 78\%), buy-in from senior management and managers (managers: 27/27, 100\%; resident committee presidents: 2/2, 100\%), collaboration between the departments (nursing staff members: 9/9, 100\%), nursing staff motivation (nursing staff members: 9/9, 100\%), and improvements in professional practices (nursing staff members: 8/9, 89\%). Finally, the relative benefits of teleconsultation, such as enhanced mutual vision, faster assessment of clinical situations, improved resident care management quality, and greater flexibility and safety, were unanimously recognized (38/38, 100\%) as contributing to its acceptability and potential for success. Conclusions: This study provides an in-depth understanding of the barriers to and facilitators of implementing overnight nursing teleconsultation in small rural CHSLDs. This constitutes a sound basis for developing tailored strategies aimed at overcoming identified barriers and optimizing facilitators. The results also provide practical guidelines for decision makers, highlighting the need to adapt implementation approaches to the unique context of each facility. Furthermore, this study highlights the importance of further research to broaden our knowledge on the dissemination and scale-up of health care innovations. This includes the development of learning health systems capable of responding in an agile and effective way to the needs of rural and vulnerable populations both in Quebec and elsewhere. ", doi="10.2196/71950", url="https://aging.jmir.org/2025/1/e71950" } @Article{info:doi/10.2196/63700, author="Havreng-Th{\'e}ry, Charlotte and Fouchard, Arnaud and Denis, Fabrice and Veyron, Jacques-Henri and Belmin, Jo{\"e}l", title="Cost-Effectiveness Analysis of a Machine Learning--Based eHealth System to Predict and Reduce Emergency Department Visits and Unscheduled Hospitalizations of Older People Living at Home: Retrospective Study", journal="JMIR Form Res", year="2025", month="Apr", day="11", volume="9", pages="e63700", keywords="monitoring", keywords="older adult", keywords="predictive tool", keywords="home care aide", keywords="emergency department visit", keywords="cost-effectiveness", keywords="artificial intelligence", keywords="electronic health", keywords="eHealth", keywords="emergency department", keywords="unscheduled hospitalization", keywords="aging", keywords="retrospective study", keywords="medico-economic", keywords="living at home", keywords="nursing home", keywords="emergency visit", keywords="Brittany", keywords="France", keywords="machine learning", keywords="remote monitoring", keywords="digital health", keywords="health informatics", abstract="Background: Dependent older people or those losing their autonomy are at risk of emergency hospitalization. Digital systems that monitor health remotely could be useful in reducing these visits by detecting worsening health conditions earlier. However, few studies have assessed the medico-economic impact of these systems, particularly for older people. Objective: The objective of this study was to compare the clinical and economic impacts of an eHealth device in real life compared with the usual monitoring of older people living at home. Methods: This study was a comparative, retrospective, and controlled trial on data collected between May 31, 2021, and May 31, 2022, in one health care and home nursing center located in Brittany, France. Participants had to be aged >75 years, living at home, and receiving assistance from the home care service for at least 1 month. We implemented among the intervention group an eHealth system that produces an alert for a high risk of emergency department visits or hospitalizations. After each home visit, the home care aides completed a questionnaire on participants' functional status using a smartphone app, and the information was processed in real time by a previously developed machine learning algorithm that identifies patients at risk of an emergency visit within 7 to 14 days. In the case of predicted risk, the eHealth system alerted a coordinating nurse who could then inform the family carer and the patient's nurses or general practitioner. Results: A total of 120 patients were included in the study, with 60 in the control group and 60 in the intervention group. Among the 726 visits from the intervention group that were not followed by an alert, only 4 (0.6\%) resulted in hospitalizations (P<.001), confirming the relevance of the system's alerts. Over the course of the study, 37 hospitalizations were recorded for 25 (20.8\%) of the 120 patients. Additionally, of the 120 patients, 9 (7.5\%) were admitted to a nursing home, and 7 (5.8\%) died. Patients in the intervention group (56/60, 93\%) remained at home significantly more often than those in the control group (48/60, 80\%; P=.03). The total cost of primary care and hospitalization during the study was {\texteuro}167,000 ({\texteuro}1=US \$1.09), with {\texteuro}108,000 (64.81\%) attributed to the intervention group (P=.20). Conclusions: This study presents encouraging results on the impact of a remote medical monitoring system for older adults, demonstrating a reduction in both emergency department visits and hospitalization costs. Trial Registration: ClinicalTrials.gov NCT05221697; https://clinicaltrials.gov/study/NCT05221697 ", doi="10.2196/63700", url="https://formative.jmir.org/2025/1/e63700", url="http://www.ncbi.nlm.nih.gov/pubmed/40215100" } @Article{info:doi/10.2196/67538, author="van Bree, M. Egid and Snijder, E. Lynn and Ossebaard, C. Hans and Brakema, A. Evelyn", title="Environmental Impact of Physical Visits and Telemedicine in Nursing Care at Home: Comparative Life Cycle Assessment", journal="J Med Internet Res", year="2025", month="Apr", day="4", volume="27", pages="e67538", keywords="carbon footprint", keywords="eHealth", keywords="telemedicine", keywords="telehealth", keywords="sustainable health care", keywords="digital health care", keywords="environmental impact", keywords="environment", keywords="physical visits", keywords="nursing", keywords="life cycle assessment", keywords="life cycle", keywords="ecology", keywords="sustainability", keywords="footprint", keywords="planetary health", abstract="Background: The health care sector contributes notably to environmental harms, impacting human and ecosystem health. Hence, countries increasingly set ambitions to transition to environmentally sustainable health care, focusing on resource use, energy consumption, and patient travel. Telemedicine is often considered a promising solution to reduce travel-related carbon emissions. However, underlying environmental impact assessments lack important components such as staff travel and fail to adhere to standardized conduct and reporting. Moreover, assessments of telemedicine use in primary care are scarce. Objective: This study aims to quantify and compare the environmental impact of physical visits and telemedicine visits in the context of domiciliary care and home nursing. Methods: We conducted a life cycle assessment following international ISO-14040/44 standards of all resources required per individual patient visit, either in person at the patient's home or via video calling with a dedicated user-friendly tablet. We collected anonymous user data in collaboration with a telemedicine service company, complemented by consulting staff members of four nursing organizations. Telemedicine visits were elementary in nature, such as supporting patients in taking their medication or structuring their daily agenda. We quantified average environmental impacts from cradle to grave, using the Environmental Footprint method, and verified the robustness of the comparison via uncertainty analysis. The variability of environmental impacts in different settings was explored using scenario analyses for the available minimum to maximum ranges. Results: Compared to a single physical visit in the studied setting, a telemedicine visit contributed less to global warming (0.1 vs 0.3 kg of carbon dioxide equivalents [kgCO2eq]; --60\%), particulate matter formation (6.2 * 10--9 vs 1.8 * 10--8 disease incidence; --60\%), and fossil resource use (1.8 vs 4.4 megajoules; --60\%). Mineral/metal resource use was higher for telemedicine than for physical visits (1.1 * 10--5 vs 4.0 * 10--6 kg antimony equivalent; +180\%). Only water use was not consistently different in the uncertainty analysis. Scenario analyses indicated that telemedicine's environmental impact could become similar to physical visits only in urban settings (1-3 km of travel distance) with 50\%-100\% car commuting (0.1-0.4 vs 0.2-0.7 kgCO2eq). In rural settings (5-15 km of travel distance, 80\%-100\% car commute), physical visits' environmental impact was higher (1.0-3.5 kgCO2eq), mostly even for mineral/metal resource use. Conclusions: Using telemedicine for domiciliary care and home nursing mostly reduces its environmental impact compared to physical visits. Benefits are larger in rural settings, where travel distances between patients are larger, and apply to multiple environmental impacts but not always to mineral/metal resource use. In urban settings, factors that influence the degree to which telemedicine is environmentally beneficial are whether staff are working from home versus at the office, commuting to the office by bicycle versus by car, and reusing video-calling devices. Accordingly, considerate application of telemedicine is important to support care for both human and planetary health. ", doi="10.2196/67538", url="https://www.jmir.org/2025/1/e67538", url="http://www.ncbi.nlm.nih.gov/pubmed/40184167" } @Article{info:doi/10.2196/66338, author="Keefe, M. Janice and McCloskey, Rose and Hodgins, J. Marilyn and McArthur, Caitlin and MacKenzie, Adrian and Weeks, E. Lori and Estabrooks, A. Carole", title="Examining Quality of Work Life in Atlantic Canadian Long-Term Care Homes: Protocol for a Cross-Sectional Survey Study", journal="JMIR Res Protoc", year="2025", month="Mar", day="31", volume="14", pages="e66338", keywords="residential long-term care", keywords="care staff", keywords="Atlantic Canada", keywords="quality of work life", keywords="work environment", keywords="health and well-being", abstract="Background: The Canadian long-term care (LTC) workforce cares for increasingly complex residents. With greater care needs come greater demands. Despite this, LTC staffing and resources are largely unchanged and underresearched over the last decade. The Atlantic provinces are home to the oldest population in Canada, indicating a high need for LTC. The health and well-being of the LTC workforce are critical components of care quality, yet only in Western Canada are such data routinely and systematically collected. Translating Research in Elder Care is a 2-decade research program studying the LTC work environment and has found strong links between the working conditions of LTC staff and resident outcomes. We draw upon their success to generate the evidence needed to understand, support, and manage the LTC workforce in Canada's four Atlantic provinces. Objective: This study aims (1) to assess the quality of work life among staff in LTC homes in Atlantic Canada; (2) to examine the effects of the work environment on the quality of work life; and (3) to build capacity for research in the LTC sector in Atlantic Canada among knowledge users, researchers, and trainees. The objective of this paper is to describe the approach needed to examine the quality of work life and health of care staff in LTC homes. Methods: Stratified random sampling will be used to recruit homes in Atlantic Canada. The sampling frame was designed to recruit 25\% of the LTC homes in each of the 4 provinces with proportional representation by size; ownership model; and, if applicable, region or language. Key outcome variables include measures of mental health and well-being, quality of work life, intention to leave, workplace context, and missed or rushed care. Primary data will be obtained through structured interviews with care aides and web-based surveys from registered nurses, licensed practical nurses, managers, and allied health providers. Eligible participants were from an LTC home with at least 25 residents, 90\% of whom were aged 65 years or older, and had worked in the home for at least 3 months. Multivariate analyses include regression analysis for explaining predictors of quality of work-life outcomes and multilevel modeling for more complex relationships of staff outcomes by provinces and LTC home characteristics. Results: Data collection and cleaning are complete as of October 2024 (N=2305). Care aides (n=1338), nurses (n=724), allied health providers (n=154), and managers (n=89) from 53 homes make up the sample. Data analysis is ongoing. Initially, individual reports will present descriptive data for each participating LTC home. Concurrent analysis is planned for publication in peer-reviewed journals. Conclusions: This peer-reviewed research protocol lays the foundation for a comprehensive analysis of the effects of the work environment on the quality of work life of LTC staff in Atlantic Canada. International Registered Report Identifier (IRRID): DERR1-10.2196/66338 ", doi="10.2196/66338", url="https://www.researchprotocols.org/2025/1/e66338" } @Article{info:doi/10.2196/64074, author="van Gaans-Riteco, Dani{\"e}lle and Stoop, Annerieke and Wouters, Eveline", title="Values of Stakeholders Involved in Applying Surveillance Technology for People With Dementia in Nursing Homes: Scoping Review", journal="JMIR Aging", year="2025", month="Mar", day="20", volume="8", pages="e64074", keywords="surveillance technology", keywords="nursing home", keywords="stakeholders", keywords="values", keywords="dementia", keywords="safety", abstract="Background: Due to the progressive nature of dementia, concerns about the safety of nursing home residents are frequently raised. Surveillance technology, enabling visual and auditory monitoring, is often seen as a solution for ensuring safe and efficient care. However, tailoring surveillance technology to individual needs is challenging due to the complex and dynamic care environment involving multiple formal and informal stakeholders, each with unique perspectives. Objective: This study aims to explore the scientific literature on the perspectives and values of stakeholders involved in applying surveillance technology for people with dementia in nursing homes. Methods: We conducted a scoping review and systematically searched 5 scientific databases. We identified 31 articles published between 2005 and 2024. Stakeholder characteristics were extracted and synthesized according to the theory of basic human values by Schwartz. Results: In total, 12 stakeholder groups were identified, with nursing staff, residents, and informal caregivers being the most frequently mentioned. Among stakeholder groups close to residents, values related to benevolence, security, conformity, and tradition were most commonly addressed. Furthermore, values such as self-direction, power, and achievement seemed important to most stakeholder groups. Conclusions: Several stakeholder groups emphasized the importance of being and feeling involved in the application of surveillance technologies. In addition, they acknowledged the necessity of paying attention to stakeholders' perspectives and values. Across these stakeholder groups, values related to benevolence, security, and self-direction were represented, although various stakeholders assigned different meanings to these values. Awareness of stakeholders' perspectives demands a willingness to acknowledge each other's values and bridge differences. ", doi="10.2196/64074", url="https://aging.jmir.org/2025/1/e64074", url="http://www.ncbi.nlm.nih.gov/pubmed/39899267" } @Article{info:doi/10.2196/64388, author="Skjelvik, Alvhild and West, Nicholas and G{\"o}rges, Matthias", title="Identifying Contextual Factors That Shape Cybersecurity Risk Perception for Assisted Living and Health Care Technologies and Wearables: Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Mar", day="19", volume="27", pages="e64388", keywords="digital health", keywords="health care technology", keywords="cybersecurity", keywords="risk perception", keywords="health care stakeholders", keywords="contextual factors", abstract="Background: Over the last decade, the health care technology landscape has expanded significantly, introducing new and innovative solutions to address health care needs. The implications of cybersecurity incidents in the health care context extend beyond data breaches to potentially harming individuals' health and safety. Risk perception is influenced by various contextual factors, contributing to cybersecurity concerns that technological safeguards alone cannot address. Thus, it is imperative to study risk perceptions, contextual factors, and technological benefits to guide policy development, risk management, education, and implementation strategies. Objective: This study aims to investigate the differences in cybersecurity risk perception among various stakeholders in the health care sector in Norway and British Columbia (BC), Canada, and identify specific contextual factors that shape these perceptions. We expect to identify differences in risk perceptions for the explored health care technologies. Methods: We used a mixed methods approach comprising surveys and semistructured interviews to sample health care--related wearable technology stakeholders, including health care workers, patients (adults and adolescents) and their families, health authorities and hospital staff (biomedical engineers, information technology support, research staff), and device vendors/industry professionals in Norway and BC. Surveys explored information security scenarios based on the Behavioral-Cognitive Internet Security Questionnaire (BCISQ), risk perception, and contextualizing variables. We analyzed both survey data sets to summarize participants' characteristics and responses to questions related to the BCISQ (behavior and attitude) and risk perception. Interviews were analyzed thematically using an inductive-deductive approach to explore risk perception and contextual factors. Results: Data from 274 survey respondents were available for analysis: 185 from Norway, including 139 (75.1\%) females, and 89 from BC, including 57 (64\%) females. A total of 45 respondents (31 in Norway and 14 in BC) participated in interviews. The BCISQ showed minor differences between locations; respondents demonstrated generally low-risk behavior and robust information security awareness. However, password simulation demonstrated discrepancies between self-assessed and ``real'' behavior by sharing or willingness to share passwords. Perceived risk is generally considered low, yet consequences of cybersecurity risks were evaluated as major but unlikely. Risk perception was stronger for assisted living and diabetes technologies than for smartwatches. The most important contextual factors shaping risk perceptions are human factors encompassing knowledge, competence, familiarity, feelings of dread, perceived benefit, and trust, as well as the technological factor of device functionality. Organizational and technological factors had lesser effects. Conclusions: We found minimal differences in behavior and risk perception among Norwegian and BC participants. Human factors and device functionality were most influential in shaping cybersecurity risk perceptions. Considering the rising need for assisted living technologies and wearables, insights into risk perceptions can strengthen risk management, awareness, and competence building. Further, it can address potential concerns among stakeholders to enable quicker technology adoption. ", doi="10.2196/64388", url="https://www.jmir.org/2025/1/e64388" } @Article{info:doi/10.2196/63572, author="Walzer, Stefan and Sch{\"o}n, Isabel and Pfeil, Johanna and Merz, Nicola and Marx, Helga and Ziegler, Sven and Kunze, Christophe", title="Experiences With an In-Bed Real-Time Motion Monitoring System on a Geriatric Ward: Mixed Methods Study", journal="JMIR Form Res", year="2025", month="Mar", day="4", volume="9", pages="e63572", keywords="nurses", keywords="geriatric patients", keywords="cognitive impairment", keywords="technology", keywords="fall prevention", keywords="hospital", keywords="mixed methods", keywords="patient", keywords="learning process", keywords="assessment", keywords="autonomy", keywords="impairment", keywords="real-time motion", keywords="university", keywords="geriatric ward", keywords="survey", keywords="anxiety", keywords="willingness", keywords="patient privacy", keywords="effectiveness", keywords="monitoring system", keywords="health care practice", abstract="Background: Older adults now make up about two-thirds of hospital admissions, with up to 50\% experiencing cognitive impairments such as dementia. These patients often struggle with adherence to care plans and maintaining regular day or night cycles, presenting challenges for nurses. Hospitals are typically unprepared to manage this patient population, resulting in increased nurse workload and challenges like managing motor agitation, which can lead to falls or accidental removal of medical devices. Objective: This study aimed to (1) assess how an in-bed real-time motion monitoring system (IRMS) impacts nurses' perceptions of physical and mental stress, (2) evaluate the IRMS's effect on the care process, (3) explore ethical implications like patient autonomy and privacy, and (4) understand how nurses acquire knowledge about the technology and how this affects their assessment of the IRMS. Methods: The IRMS, which provides real-time motion monitoring and bed edge or exit information, was implemented in the geriatric ward of a university medical center. The study followed a monocentric, explorative evaluation design using a mixed methods approach. It lasted 24 weeks and had two phases. In Phase 0 (6 weeks), patients received standard care. In Phase 1 (18 weeks), the IRMS was introduced. Initial data were gathered through focus groups and participant observations during manufacturer training sessions. At the end of the intervention, a survey, a second focus group, and an interview were conducted to capture nurses' experiences. The study follows the Good Reporting of a Mixed Method Study (GRAMMS) checklist for reporting. Results: Initial training sessions with 12 participants (10 nurses and 2 physiotherapists) showed varying levels of engagement, with the second session demonstrating more optimism and interprofessional collaboration. A total of 10 questionnaires were completed (10/21, 48\%). Survey results showed that 80\% (8/10) of nurses found the IRMS valuable for assessing the quality of work, and 90\% (9/10) were willing to continue using it. The system was regarded as reliable for monitoring bed edge and exit events. Usability was positively rated, with minimal concerns about documentation burden. Focus group discussions (n=3 per session) indicated that nurses viewed the system as reliable and appreciated its role in reducing anxiety related to fall prevention. However, concerns about patient privacy and monitoring were raised. Nurses expressed a willingness to continue using the IRMS but reaffirmed their ability to care for patients without it. Conclusions: Nurses had a generally positive attitude toward the IRMS, recognizing its benefits, particularly for nighttime monitoring. Although its effectiveness in preventing falls remains inconclusive, the system helps reduce nurses' fear of falls and enhances their responsiveness. The study highlights the broader impact of the IRMS beyond fall prevention and stresses the importance of thoughtful integration into health care practice. ", doi="10.2196/63572", url="https://formative.jmir.org/2025/1/e63572", url="http://www.ncbi.nlm.nih.gov/pubmed/40053780" } @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/10.2196/57911, author="Hacking, Coen and de Boer, Bram and Verbeek, Hilde and Hamers, Jan and Aarts, Sil", title="Developing an App for Real-Time Daily Life Observations in a Nursing Home Setting: Qualitative User-Centered Co-Design Approach", journal="JMIR Hum Factors", year="2025", month="Feb", day="27", volume="12", pages="e57911", keywords="co-design", keywords="user-centered design", keywords="app development", keywords="nursing home", keywords="user-centered", keywords="design", keywords="efficiency", keywords="usability", keywords="tablet", keywords="mobile phone", abstract="Background: Assessing the daily lives of older adults, including their activities, social interactions, and well-being is essential, particularly in nursing homes, as it gains insights into their quality of life. Methods such as the Microsoft Excel-based Maastricht Electronic Daily Life Observation (MEDLO) tool are time-consuming and require extensive manual input, making them difficult to use. Objective: This study aimed to develop an app-based version of the MEDLO using a user-centered design (UCD) and co-design approach to enhance efficiency and usability. We looked to actively involve researchers and care professionals who have used the MEDLO before, throughout the development process. Methods: Participants included a diverse group of researchers and care professionals experienced in using the MEDLO tool. The UCD approach involved multiple iterative phases including semistructured interviews, user research sessions, and application development. Data were analyzed using a qualitative (thematic) approach of UCD and user research sessions. The app, which was preferred to the traditional Excel-based MEDLO, underwent multiple iterations. This method primed the continuous iterative development of the app, aimed for a minimum viable product (MVP). Results: This study included 14 participants, primarily female, from diverse professional backgrounds. Their feedback highlighted the need for efficiency improvements in tool preparation and data management. Key improvements included automated data handling, an intuitive tablet interface, and functionalities such as randomization and offline data syncing. Conclusions: The iterative development process led to an app that aligns with end-user needs, indicating potential for improved usability. Early and continuous user involvement was key in enhancing the application's usability, demonstrating the importance of user feedback in the development process. ", doi="10.2196/57911", url="https://humanfactors.jmir.org/2025/1/e57911" } @Article{info:doi/10.2196/66706, author="Hall, Alex and Aguilera-Mu{\~n}oz, Johanna and McGarrigle, Lisa and Eost-Telling, Charlotte and Denison-Day, James and Cabral, Christie and Willcox, Merlin and Todd, Chris", title="Adapting the Germ Defence Web-Based Intervention to Improve Infection Prevention and Control in Care Homes: Interview Study Among Care Home Staff", journal="JMIR Form Res", year="2025", month="Feb", day="19", volume="9", pages="e66706", keywords="care homes", keywords="long-term care", keywords="nursing homes", keywords="infection prevention and control", keywords="behavioral intervention development", keywords="person-based approach", keywords="qualitative", abstract="Background: Infection prevention and control (IPC) is vital in care homes as it can reduce morbidity and mortality by 30\%. Ensuring good IPC practice is a perennial challenge in the varied and complex context of care homes. Behavior change interventions delivered via digital technology may be effective in improving IPC among care home staff. Objective: This study aimed to evaluate how an evidence-based, digital behavior change intervention called Germ Defence can be rapidly adapted to meet the needs of care homes. Methods: This study applied the person-based approach, which emphasizes iterative approaches to optimizing interventions via individual user feedback. Phase 1 involved initial edits to the website by the research team to create Germ Defence for Care Homes (GDCH) version 1. Phase 2 consisted of stakeholder consultation on GDCH version 1 followed by edits to create GDCH version 2. The formal research (phases 3 and 4) involved individual think-aloud interviews with 21 staff members from management, care, and ancillary positions in 4 care homes providing real-time feedback as they worked through GDCH. Edits were made to create GDCH version 3 between phases 3 and 4. During the development of GDCH versions 2 and 3, it became clear that the intervention would need more fundamental changes beyond the pragmatic, incremental changes that would be possible within the scope of this study. Analysis was completed via a rapid, qualitative descriptive approach to develop a high-level summary of key findings from the interview data. Results: There were mixed results about the attractiveness of GDCH and its suitability to the care home context. Participants felt that the images needed to be aligned much more closely with the meaning of adjacent text. Many participants felt that they would not have time to read a text-based website, and some suggested that more engaging content, including audio and video, may be preferable. Most participants felt that the overall concept of Germ Defence was clearly relevant to their context. Some felt that it might be a useful introduction for new staff members or a refresher for current staff, but others felt that it did not add anything to their existing IPC training. There were mixed opinions about the level of detail provided in the information offered by the site. While the goal-setting behavior change mechanism may have potential, the findings suggested that it may be unsuitable for care homes and more work is needed to refine it. Conclusions: Much more work needs to be done to make Germ Defence more engaging, accessible, and relevant to the care home workforce. Our study highlights the challenges of rapidly adapting an existing intervention to a new context. Future research in this area will require a pragmatic methodological approach with a focus on implementation. ", doi="10.2196/66706", url="https://formative.jmir.org/2025/1/e66706" } @Article{info:doi/10.2196/60107, author="Snow, Martha and Silva-Ribeiro, Wagner and Baginsky, Mary and Di Giorgio, Sonya and Farrelly, Nicola and Larkins, Cath and Poole, Karen and Steils, Nicole and Westwood, Joanne and Malley, Juliette", title="Best Practices for Implementing Electronic Care Records in Adult Social Care: Rapid Scoping Review", journal="JMIR Aging", year="2025", month="Feb", day="14", volume="8", pages="e60107", keywords="digital care records", keywords="adult social care", keywords="digitization", keywords="domiciliary care", keywords="care homes", keywords="electronic care records", keywords="PRISMA", abstract="Background: In the past decade, the use of digital or electronic records in social care has risen worldwide, capturing key information for service delivery. The COVID-19 pandemic accelerated digitization in health and social care. For example, the UK government created a fund specifically for adult social care provider organizations to adopt digital social care records. These developments offer valuable learning opportunities for implementing digital care records in adult social care settings. Objective: This rapid scoping review aimed to understand what is known about the implementation of digital care records in adult social care and how implementation varies across use cases, settings, and broader contexts. Methods: A scoping review methodology was used, with amendments made to enable a rapid review. Comprehensive searches based on the concepts of digital care records, social care, and interoperability were conducted across the MEDLINE, EmCare, Web of Science Core Collection, HMIC Health Management Information Consortium, Social Policy and Practice, and Social Services Abstracts databases. Studies published between 2018 and 2023 in English were included. One reviewer screened titles and abstracts, while 2 reviewers extracted data. Thematic analysis mapped findings against the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. Results: Our search identified 2499 references. After screening titles and abstracts, 71 records were selected for full-text review, resulting in 31 references from 29 studies. Studies originated from 11 countries, including 1 multicountry study, with the United Kingdom being the most represented (10/29, 34\%). Studies were most often conducted in nursing homes or facilities (7/29, 24\%) with older people as the target population (6/29, 21\%). Health records were the most investigated record type (12/29, 41\%). We identified 45 facilitators and 102 barriers to digital care record implementation across 28 studies, spanning 6 of the 7 NASSS framework domains and aligning with 5 overarching themes that require greater active management regarding implementation. Intended or actual implementation outcomes were reported in 17 (59\%) of the 29 studies. Conclusions: The findings suggest that implementation is complex due to a lack of consensus on what digital care records and expected outcomes and impacts should look like. The literature often lacks clear definitions and robust study designs. To be successful, implementation should consider complexity, while studies should use robust frameworks and mixed methods or quantitative designs where appropriate. Future research should define the target population, gather data on carer or service user experiences, and focus on digital care records specifically used in social care. ", doi="10.2196/60107", url="https://aging.jmir.org/2025/1/e60107" } @Article{info:doi/10.2196/58528, author="Lee, Man-Sin Maggie and Yeoh, Eng-kiong and Wong, Lai-Yi Eliza and Bai, Xue and Yeung, Chun-Yiu Nelson and French, Catherine and Taddese, Henock", title="Perceptions and Experiences of Caregiver-Employees, Employers, and Health Care Professionals With Caregiver-Friendly Workplace Policy in Hong Kong: Thematic Analysis", journal="Interact J Med Res", year="2025", month="Feb", day="10", volume="14", pages="e58528", keywords="caregiver employees", keywords="workplace", keywords="discrimination", keywords="dual roles", keywords="caregiver burden", abstract="Background: Caregiver-employees (CEs) for older adults experience a high burden to fulfill their dual roles. Caregiver-friendly workplace policy (CFWP) has been used in many countries to balance employment and caregiving duties, but it is a relatively new concept in Hong Kong. Objective: This study explored the views and experiences of CEs, employers, and health care professionals regarding CFWP (specifically for older adult caregivers) in Hong Kong. Methods: This study explored the CFWP-related views and experiences in Hong Kong using 15 in-depth interviews with purposively sampled CEs for older adults, employers, and health care professionals. Results: Two context-related themes (``lacking leadership'' and ``unfavorable culture'') were identified with thematic analysis. They explain the absence of CFWP in Hong Kong due to the lack of governmental and organizational leadership, and the additional burden experienced by CEs because of the working culture that underpins work-life separation, overprizing business interest, and unsympathetic corporate attitude. Implicit voice theory was applicable in explaining CEs' nondisclosure about their status at work due to potential risks. In addition, the two facilitation-related themes (``role struggle'' and ``inadequate support'') identified in this study exhibit how the dual role had positive and negative spillover effects on each other and the inadequacy of social welfare and health care support systems. Conclusions: We strongly recommend exploring and adopting potential CFWP in Hong Kong, considering the complexity of factors identified in this study. ", doi="10.2196/58528", url="https://www.i-jmr.org/2025/1/e58528" } @Article{info:doi/10.2196/57768, author="Kohta, Masushi and Takahashi, Mayumi and Koyanagi, Hiroe and Sugama, Junko", title="Evaluating the Knowledge Level, Practice, and Behavioral Change Potential of Care Managers in Pressure Injury Prevention Using a Mobile App Prototyping Model in the Home-Care Setting: Single-Arm, Pre-Post Pilot Study", journal="JMIR Form Res", year="2025", month="Feb", day="7", volume="9", pages="e57768", keywords="behavioral change", keywords="home care", keywords="knowledge", keywords="mobile application", keywords="pressure injury", keywords="mHealth", keywords="mobile health", keywords="apps", keywords="practice", keywords="injury", keywords="prevention", keywords="prototype", keywords="effectiveness", keywords="care manager", keywords="Japan", keywords="Pips-Map", keywords="questionnaire", keywords="wound care", keywords="pilot study", keywords="women", abstract="Background: The use of mobile apps to promote knowledge level, practice, and behavioral change potential has become increasingly common. However, studies on apps targeting social welfare employees working in the home-care setting to prevent pressure injury (PI) are lacking. The care manager (CM) plays a key role in connecting the demand and supply of home-care services. PI is more prevalent in the home-care setting, where resources are limited, than in acute settings. Objective: The research hypothesis was that CMs who use a mobile app will have improved general knowledge and heightened practice for PI prevention, compared to that before using the app. This study aimed to assess the effectiveness of a PI prevention support mobile app prototyping model (Pips-Map) in improving the knowledge level, practice, and behavioral change potential of CMs in PI prevention in the home-care setting. Methods: This was conducted between December 2021 and December 2023 as a single-arm, pre-post pilot study including 27 CMs who worked in a Japanese city. Pips-Map was used for 6 months in daily practice, and a self-administered test questionnaire was used to assess participants' knowledge and practice in PI prevention before or after using Pips-Map. At the end of the posttest, a validated App Behavior Change Scale was used to analyze behavioral change potential. This study followed the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials. Results: In total, 19 participants were analyzed. Out of 55 points, the total mean knowledge score significantly increased from 30.9 (SD 5.9) in the pretest group to 36.1 (SD 5.9) in the posttest group (P=.0003). The number of participants with a total score of >70\% (adequate knowledge level) increased from 2 (11\%) to 7 (36.8\%), but the difference was not statistically significant (P=.07). For the level of practice, out of 21 points, the total score increased from 15.2 (SD 3.1) in the pretest group to 16.2 (SD 3.0) in the posttest group, but no statistically significant differences were observed (P=.16). The behavior change scale revealed that participants positively evaluated the Pips-Map to provide information on PI prevention guidelines but had concerns regarding inadequate usability and financial incentives of Pips-Map. Conclusions: The use of Pips-Map for 6 months in actual practice increased the knowledge level of Japanese CMs in PI prevention, but it did not change the level of practice. Considering the need for updating apps that aim to promote behavioral change, this study identified some limitations of Pips-Map. Thus, revisions must be made to adapt Pips-Map to home-based care needs. Trial Registration: UMIN Clinical Trial Registry UMIN000048904; https://tinyurl.com/5bt6zv7t ", doi="10.2196/57768", url="https://formative.jmir.org/2025/1/e57768" } @Article{info:doi/10.2196/59921, author="Lu, Wei and Silvera-Tawil, David and Yoon, Hwan-Jin and Higgins, Liesel and Zhang, Qing and Karunanithi, Mohanraj and Bomke, Julia and Byrnes, Joshua and Hewitt, Jennifer and Smallbon, Vanessa and Freyne, Jill and Prabhu, Deepa and Varnfield, Marlien", title="Impact of the Smarter Safer Homes Solution on Quality of Life and Health Outcomes in Older People Living in Their Own Homes: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Jan", day="22", volume="27", pages="e59921", keywords="randomized controlled trial", keywords="digital health", keywords="eHealth", keywords="smart home", keywords="sensor", keywords="health monitoring", keywords="home monitoring", keywords="aged care", keywords="aging in place", keywords="older adult", keywords="quality of life", abstract="Background: An increasingly aging population, accompanied by a shortage of residential aged care homes and workforce and consumer feedback, has driven a growing interest in enabling older people to age in place through home-based care. In this context, smart home technologies for remote health monitoring have gained popularity for supporting older people to live in their own homes. Objective: This study aims to investigate the impact of smart home monitoring on multiple outcomes, including quality of life, activities of daily living, and depressive symptoms among older people living in their own homes over a 12-month period. Methods: We conducted an open-label, parallel-group randomized controlled trial. The control group continued to receive their existing care from aged care service providers. Meanwhile, the intervention group, in addition to receiving their usual aged care services, had their activities of daily living monitored using a smart home platform. Surveys including the Adult Social Care Outcomes Toolkit (ASCOT), EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), Katz Index of Independence in Activities of Daily Living (Katz ADL), Lawton Instrumental Activities of Daily Living Scale (IADL), and Geriatric Depression Scale (GDS) were conducted at baseline and 6 and 12 months from baseline. Linear mixed-effects models were used to compare the difference between the intervention and control groups, with the ASCOT as the primary outcome measure. Results: Data from 130 participants were used in the analysis, with no significant differences in baseline characteristics between the control group (n=61) and the intervention group (n=69). In comparison to the control group, the intervention group had a higher ASCOT score at the 6-month assessment (mean difference 0.045, 95\% CI 0.001 to 0.089; Cohen d=0.377). However, this difference did not persist at the 12-month assessment (mean difference 0.031, 95\% CI --0.014 to 0.076; Cohen d=0.259). There were no significant differences in EQ-5D-5L, Katz ADL, IADL, and GDS observed between the intervention and control groups at the 6-month and 12-month assessments. Conclusions: The study demonstrates that smart home monitoring can improve social care--related quality of life for older people living in their own homes. However, the improvement was not sustained over the long term. The lack of statistically significant findings and diminished long-term improvements may be attributed to the influence of the COVID-19 pandemic during the later stage of the trial. Further research with a larger sample size is needed to evaluate the effect of smart home monitoring on broader quality-of-life measures. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000829213; https://tinyurl.com/2n6a75em International Registered Report Identifier (IRRID): RR2-10.2196/31970 ", doi="10.2196/59921", url="https://www.jmir.org/2025/1/e59921" } @Article{info:doi/10.2196/55042, author="Khatib, Sewar and Palgi, Yuval and Ashar, K. Yoni and Polyvyannaya, Natalya and Goldstein, Pavel", title="The Combined Effect of Multisensory Stimulation and Therapist Support on Physical and Mental Health of Older Adults Living in Nursing Homes: Pilot Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Jan", day="14", volume="27", pages="e55042", keywords="Snoezelen room", keywords="mental health", keywords="sensory stimulation environment", keywords="social support", keywords="nursing homes", keywords="older adults", abstract="Background: Increasing life expectancy has led to a rise in nursing home admissions, a context in which older adults often experience chronic physical and mental health conditions, chronic pain, and reduced well-being. Nonpharmacological approaches are especially important for managing older adults' chronic pain, mental health conditions (such as anxiety and depression), and overall well-being, including sensory stimulation (SS) and therapist support (TS). However, the combined effects of SS and TS have not been investigated. Objective: This randomized controlled trial examines the specific and combined effects of brief SS and TS interventions on older adults' physical and mental health and pain intensity levels, among individuals living in nursing homes. Methods: A total of 96 patients aged 65-99 years from a nursing home were randomly assigned to 3 groups: SS, TS, and combined SS+TS interventions, each delivered as four 20-minute sessions. SS was implemented using a multisensory Snoezelen room. Pain intensity levels (per a Visual Analog Scale), blood pressure, heart rate, blood oxygen saturation, and hand grip strength (using a Jamar hand dynamometer) were measured before and after each of the 4 weekly therapeutic sessions. In addition, life satisfaction (per the Satisfaction with Life Scale) and anxiety (per the 7-item General Anxiety Disorder Scale) were evaluated before and after the whole intervention. Mixed model analyses tested the relative efficacy of the 3 interventions, applying simple slope analysis with Tukey correction. Study rationale and analytical plans were preregistered. Results: The combined intervention of SS and TS (SS+TS) resulted in reduced pain levels compared with SS (B=0.209, P=.006) and TS alone (B=0.23, P=.002) over 4 sessions (F6,266=2.62; P=.017; R2=0.23). Further, the combined SS+TS intervention resulted in reduced systolic blood pressure versus SS (B=0.09, P=.01) and TS alone (B=0.016, P<.001) groups (F6,272=5.42; P<.001; R2=0.29). In addition, the combined SS+TS intervention resulted in an increased grip strength versus SS (B=--0.35, P=.003) and TS alone (B=--0.032, P=.008) groups (F6,273=2.25; P=.04; R2=0.19). Moreover, combined SS+TS resulted in an improvement in life satisfaction (B=--4.29, P<.0001) compared with SS (B=--2.38, P=.0042) and TS alone (B=--1.20, P=.13) groups (F2,39=3.47; P=.04). Finally, SS+TS demonstrated greater improvement in symptoms of general anxiety disorder (B=10.64, P<.0001) compared with SS (B=3.30 P=.01) and TS alone (B=1.13, P=.37) (F2,38=13.5; P<.001) groups. No differences between the interventions were shown for blood oxygen saturation (F6,273=2.06; P=.06), diastolic blood pressure (F6,272=1.12; P=.35), and heart rate (F6,273=1.33; P=.23). Conclusions: The combined intervention of SS and TS showed therapeutic benefits for pain management and physical and mental health of older adults living in nursing homes, relative to each therapeutic component in isolation. This brief intervention can be readily implemented to improve well-being and optimize therapeutic resources in nursing home settings. Trial Registration: ClinicalTrials.gov NCT05394389; https://clinicaltrials.gov/ct2/show/NCT05394389 ", doi="10.2196/55042", url="https://www.jmir.org/2025/1/e55042", url="http://www.ncbi.nlm.nih.gov/pubmed/39808474" } @Article{info:doi/10.2196/55673, author="Merkel, Sebastian and Schorr, Sabrina", title="Identification of Use Cases, Target Groups, and Motivations Around Adopting Smart Speakers for Health Care and Social Care Settings: Scoping Review", journal="JMIR AI", year="2025", month="Jan", day="13", volume="4", pages="e55673", keywords="conversational agents", keywords="smart speaker", keywords="health care", keywords="social care", keywords="digitalization", keywords="scoping review", keywords="mobile phone", abstract="Background: Conversational agents (CAs) are finding increasing application in health and social care, not least due to their growing use in the home. Recent developments in artificial intelligence, machine learning, and natural language processing have enabled a variety of new uses for CAs. One type of CA that has received increasing attention recently is smart speakers. Objective: The aim of our study was to identify the use cases, user groups, and settings of smart speakers in health and social care. We also wanted to identify the key motivations for developers and designers to use this particular type of technology. Methods: We conducted a scoping review to provide an overview of the literature on smart speakers in health and social care. The literature search was conducted between February 2023 and March 2023 and included 3 databases (PubMed, Scopus, and Sociological Abstracts), supplemented by Google Scholar. Several keywords were used, including technology (eg, voice assistant), product name (eg, Amazon Alexa), and setting (health care or social care). Publications were included if they met the predefined inclusion criteria: (1) published after 2015 and (2) used a smart speaker in a health care or social care setting. Publications were excluded if they met one of the following criteria: (1) did not report on the specific devices used, (2) did not focus specifically on smart speakers, (3) were systematic reviews and other forms of literature-based publications, and (4) were not published in English. Two reviewers collected, reviewed, abstracted, and analyzed the data using qualitative content analysis. Results: A total of 27 articles were included in the final review. These articles covered a wide range of use cases in different settings, such as private homes, hospitals, long-term care facilities, and outpatient services. The main target group was patients, especially older users, followed by doctors and other medical staff members. Conclusions: The results show that smart speakers have diverse applications in health and social care, addressing different contexts and audiences. Their affordability and easy-to-use interfaces make them attractive to various stakeholders. It seems likely that, due to technical advances in artificial intelligence and the market power of the companies behind the devices, there will be more use cases for smart speakers in the near future. ", doi="10.2196/55673", url="https://ai.jmir.org/2025/1/e55673", url="http://www.ncbi.nlm.nih.gov/pubmed/39804689" } @Article{info:doi/10.2196/58094, author="Strauven, Hannelore and Wang, Chunzhuo and Hallez, Hans and Vanden Abeele, Vero and Vanrumste, Bart", title="Unobtrusive Nighttime Movement Monitoring to Support Nursing Home Continence Care: Algorithm Development and Validation Study", journal="JMIR Nursing", year="2024", month="Dec", day="24", volume="7", pages="e58094", keywords="nursing home", keywords="agitation", keywords="incontinence", keywords="accelerometer", keywords="unobtrusive", keywords="enuresis", keywords="sensor technology", abstract="Background: The rising prevalence of urinary incontinence (UI) among older adults, particularly those living in nursing homes (NHs), underscores the need for innovative continence care solutions. The implementation of an unobtrusive sensor system may support nighttime monitoring of NH residents' movements and, more specifically, the agitation possibly associated with voiding events. Objective: This study aims to explore the application of an unobtrusive sensor system to monitor nighttime movement, integrated into a care bed with accelerometer sensors connected to a pressure-redistributing care mattress. Methods: A total of 6 participants followed a 7-step protocol. The obtained dataset was segmented into 20-second windows with a 50\% overlap. Each window was labeled with 1 of the 4 chosen activity classes: in bed, agitation, turn, and out of bed. A total of 1416 features were selected and analyzed with an XGBoost algorithm. At last, the model was validated using leave one subject out cross-validation (LOSOCV). Results: The trained model attained a trustworthy overall F1-score of 79.56\% for all classes and, more specifically, an F1-score of 79.67\% for the class ``Agitation.'' Conclusions: The results from this study provide promising insights in unobtrusive nighttime movement monitoring. The study underscores the potential to enhance the quality of care for NH residents through a machine learning model based on data from accelerometers connected to a viscoelastic care mattress, thereby driving progress in the field of continence care and artificial intelligence--supported health care for older adults. ", doi="10.2196/58094", url="https://nursing.jmir.org/2024/1/e58094" } @Article{info:doi/10.2196/63710, author="Albers, W. Charlotte A. and Wieland-Jorna, Yvonne and de Bruijne, C. Martine and Smalbrugge, Martin and Joling, J. Karlijn and de Boer, E. Marike", title="Enhancing Standardized and Structured Recording by Elderly Care Physicians for Reusing Electronic Health Record Data: Interview Study", journal="JMIR Med Inform", year="2024", month="Dec", day="13", volume="12", pages="e63710", keywords="electronic health records", keywords="health information interoperability", keywords="health information exchange", keywords="reference standards", keywords="long-term care", keywords="nursing homes", keywords="medical records", keywords="attitude of health personnel", keywords="qualitative research", keywords="digital health", abstract="Background: Elderly care physicians (ECPs) in nursing homes document patients' health, medical conditions, and the care provided in electronic health records (EHRs). However, much of these health data currently lack structure and standardization, limiting their potential for health information exchange across care providers and reuse for quality improvement, policy development, and scientific research. Enhancing this potential requires insight into the attitudes and behaviors of ECPs toward standardized and structured recording in EHRs. Objective: This study aims to answer why and how ECPs record their findings in EHRs and what factors influence them to record in a standardized and structured manner. The findings will be used to formulate recommendations aimed at enhancing standardized and structured data recording for the reuse of EHR data. Methods: Semistructured interviews were conducted with 13 ECPs working in Dutch nursing homes. We recruited participants through purposive sampling, aiming for diversity in age, gender, health care organization, and use of EHR systems. Interviews continued until we reached data saturation. Analysis was performed using inductive thematic analysis. Results: ECPs primarily use EHRs to document daily patient care, ensure continuity of care, and fulfill their obligation to record specific information for accountability purposes. The EHR serves as a record to justify their actions in the event of a complaint. In addition, some respondents also mentioned recording information for secondary purposes, such as research and quality improvement. Several factors were found to influence standardized and structured recording. At a personal level, it is crucial to experience the added value of standardized and structured recording. At the organizational level, clear internal guidelines and a focus on their implementation can have a substantial impact. At the level of the EHR system, user-friendliness, interoperability, and guidance were most frequently mentioned as being important. At a national level, the alignment of internal guidelines with overarching standards plays a pivotal role in encouraging standardized and structured recording. Conclusions: The results of our study are similar to the findings of previous research in hospital care and general practice. Therefore, long-term care can learn from solutions regarding standardized and structured recording in other health care sectors. The main motives for ECPs to record in EHRs are the daily patient care and ensuring continuity of care. Standardized and structured recording can be improved by aligning the recording method in EHRs with the primary care process. In addition, there are incentives for motivating ECPs to record in a standardized and structured way, mainly at the personal, organizational, EHR system, and national levels. ", doi="10.2196/63710", url="https://medinform.jmir.org/2024/1/e63710" } @Article{info:doi/10.2196/55460, author="Veyron, Jacques-Henri and Deparis, Fran{\c{c}}ois and Al Zayat, Noel Marie and Belmin, Jo{\"e}l and Havreng-Th{\'e}ry, Charlotte", title="Postimplementation Evaluation in Assisted Living Facilities of an eHealth Medical Device Developed to Predict and Avoid Unplanned Hospitalizations: Pragmatic Trial", journal="J Med Internet Res", year="2024", month="Dec", day="10", volume="26", pages="e55460", keywords="digital technology", keywords="unplanned hospitalization", keywords="machine learning", keywords="predictive tool", keywords="assisted living facility", keywords="eHealth", keywords="pragmatic trial", keywords="artificial intelligence", keywords="AI", keywords="gerontology", keywords="older people", keywords="aging", keywords="quality of life", keywords="uncontrolled multicenter trial", keywords="France", keywords="smartphone", keywords="app", keywords="telehealth", keywords="telemonitoring", keywords="remote monitoring of patients", keywords="electronic patient-reported outcome measure", keywords="ePROM", abstract="Background: The proportion of very old adults in the population is increasing, representing a significant challenge. Due to their vulnerability, there is a higher frequency of unplanned hospitalizations in this population, leading to adverse events. Digital tools based on artificial intelligence (AI) can help to identify early signs of vulnerability and unfavorable health events and can contribute to earlier and optimized management. Objective: This study aims to report the implementation in assisted living facilities of an innovative monitoring system (Presage Care) for predicting the short-term risk of emergency hospitalization. We describe its use and assess its performance. Methods: An uncontrolled multicenter intervention study was conducted between March and August 2022 in 7 assisted living facilities in France that house very old and vulnerable adults. The monitoring system was set up to provide alerts in cases of a high risk of emergency hospitalization. Nurse assistants (NAs) at the assisted living facilities used a smartphone app to complete a questionnaire on the functional status of the patients, comprising electronic patient-reported outcome measures (ePROMs); these were analyzed in real time by a previously designed machine learning algorithm. This remote monitoring of patients using ePROMs allowed notification of a coordinating nurse or a coordinating NA who subsequently informed the patient's nurses or physician. The primary outcomes were the acceptability and feasibility of the monitoring system in the context and confirmation of the effectiveness and efficiency of AI in risk prevention and detection in practical, real-life scenarios. The secondary outcome was the hospitalization rate after alert-triggered interventions. Results: In this study, 118 of 194 (61\%) eligible patients were included who had at least 1 follow-up visit. A total of 38 emergency hospitalizations were documented. The system generated 92 alerts for 47 of the 118 (40\%) patients. Of these 92 alerts, 46 (50\%) led to 46 health care interventions for 14 of the 118 (12\%) patients and resulted in 4 hospitalizations. The other 46 of the 92 (50\%) alerts did not trigger a health care intervention and resulted in 25 hospitalizations (P<.001). Almost all hospitalizations were associated with a lack of alert-triggered interventions (P<.001). System performance to predict hospitalization had a high specificity (96\%) and negative predictive value (99.4\%). Conclusions: The Presage Care system has been implemented with success in assisted living facilities. It was well accepted by coordinating nurses and performed well in predicting emergency hospitalizations. However, its use by NAs was less than expected. Overall, the system performed well in terms of performance and clinical impact in this setting. Nevertheless, further work is needed to improve the moderate use rate by NAs. Trial Registration: ClinicalTrials.gov NCT05221697; https://clinicaltrials.gov/study/NCT05221697 ", doi="10.2196/55460", url="https://www.jmir.org/2024/1/e55460" } @Article{info:doi/10.2196/57320, author="Chan, Andrew and Cai, Joanne and Qian, Linna and Coutts, Brendan and Phan, Steven and Gregson, Geoff and Lipsett, Michael and R{\'i}os Rinc{\'o}n, M. Adriana", title="In-Home Positioning for Remote Home Health Monitoring in Older Adults: Systematic Review", journal="JMIR Aging", year="2024", month="Dec", day="2", volume="7", pages="e57320", keywords="gerontology", keywords="geriatrics", keywords="older adult", keywords="elderly", keywords="aging", keywords="aging-in-place", keywords="localization", keywords="ambient sensor", keywords="wearable sensor", keywords="acceptability", keywords="home monitor", keywords="health monitor", keywords="technology", keywords="digital health", keywords="e-health", keywords="telehealth", keywords="clinical studies", keywords="cognitive impairment", keywords="neuro", keywords="cognition", abstract="Background: With the growing proportion of Canadians aged >65 years, smart home and health monitoring technologies may help older adults manage chronic disease and support aging in place. Localization technologies have been used to support the management of frailty and dementia by detecting activities in the home. Objective: This systematic review aims to summarize the clinical evidence for in-home localization technologies, review the acceptability of monitoring, and summarize the range of technologies being used for in-home localization. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was followed. MEDLINE, Embase, CINAHL, and Scopus were searched with 2 reviewers performing screening, extractions, and quality assessments. Results: A total of 1935 articles were found, with 36 technology-focused articles and 10 articles that reported on patient outcomes being included. From moderate- to high-quality studies, 2 studies reported mixed results on identifying mild cognitive dementia or frailty, while 4 studies reported mixed results on the acceptability of localization technology. Technologies included ambient sensors; Bluetooth- or Wi-Fi--received signal strength; localizer tags using radio frequency identification, ultra-wideband, Zigbee, or GPS; and inertial measurement units with localizer tags. Conclusions: The clinical utility of localization remains mixed, with in-home sensors not being able to differentiate between older adults with healthy cognition and older adults with mild cognitive impairment. However, frailty was detectable using in-home sensors. Acceptability is moderately positive, particularly with ambient sensors. Localization technologies can achieve room detection accuracies up to 92\% and linear accuracies of up to 5-20 cm that may be promising for future clinical applications. Trial Registration: PROSPERO CRD42022339845; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=339845 ", doi="10.2196/57320", url="https://aging.jmir.org/2024/1/e57320" } @Article{info:doi/10.2196/56951, author="Turley, Kate and Rafferty, Joseph and Bond, Raymond and Mulvenna, Maurice and Ryan, Assumpta and Crawford, Lloyd", title="Evaluating the Impact of a Daylight-Simulating Luminaire on Mood, Agitation, Rest-Activity Patterns, and Social Well-Being Parameters in a Care Home for People With Dementia: Cohort Study", journal="JMIR Mhealth Uhealth", year="2024", month="Nov", day="29", volume="12", pages="e56951", keywords="digital health", keywords="dementia", keywords="dynamic lighting", keywords="sensors", keywords="circadian rhythm", keywords="daylight", keywords="wellbeing", keywords="mood", keywords="agitation", keywords="sleep", keywords="social wellbeing", keywords="care home", keywords="older adults", keywords="elderly", keywords="cardiac", keywords="psychological", keywords="monitoring", abstract="Background: Living with a diagnosis of dementia can involve managing certain behavioral and psychological symptoms. Alongside cognitive decline, this cohort expresses a suppression in melatonin production which can negatively influence their alignment of sleep or wake timings with the 24 hour day and night cycle. As a result, their circadian rhythms become disrupted. Since daylight has the capacity to stimulate the circadian rhythm and humans spend approximately 90\% of their time indoors, research has shifted toward the use of indoor lighting to achieve this same effect. This type of lighting is programmed in a daylight-simulating manner; mimicking the spectral changes of the sun throughout the day. As such, this paper focuses on the use of a dynamic lighting and sensing technology used to support the circadian rhythm, behavioral and psychological symptoms, and well-being of people living with dementia. Objective: This study aimed to understand how dynamic lighting, as opposed to static lighting, may impact the well-being of those who are living with dementia. Methods: An ethically approved trial was conducted within a care home for people with dementia. Data were collected in both quantitative and qualitative formats using environmentally deployed radar sensing technology and the validated QUALIDEM (Quality of Life for People With Dementia) well-being scale, respectively. An initial 4 weeks of static baseline lighting was used before switching out for 12 weeks of dynamic lighting. Metrics were collected for 11 participants on mood, social interactions, agitation, sense of feeling, and sleep and rest-activity over a period of 16 weeks. Results: Dynamic lighting showed significant improvement with a moderate effect size in well-being parameters including positive affect (P=.03), social isolation (P=.048), and feeling at home (P=.047) after 5?10 weeks of dynamic lighting exposure. The results also highlight statistically significant improvements in rest-activity--related parameters of interdaily stability (P<.001), intradaily variation (P<.001), and relative amplitude (P=.03) from baseline to weeks 5?10, with the effect propagating for interdaily stability at weeks 10?16 as well (P<.001). Nonsignificant improvements are also noted for sleep metrics with a small effect size; however, the affect in agitation does not reflect this improvement. Conclusions: Dynamic lighting has the potential to support well-being in dementia, with seemingly stronger influence in earlier weeks where the dynamic lighting initially follows the static lighting contrast, before proceeding to aggregate as marginal gains over time. Future longitudinal studies are recommended to assess the additional impact that varying daylight availability throughout the year may have on the measured parameters. ", doi="10.2196/56951", url="https://mhealth.jmir.org/2024/1/e56951" } @Article{info:doi/10.2196/57050, author="Matos Queir{\'o}s, Alcina and von Gunten, Armin and Rosselet Amoussou, Jo{\"e}lle and Lima, Maria Andreia and Martins, Manuela Maria and Verloo, Henk", title="Relationship Between Depression and Falls Among Nursing Home Residents: Integrative Review", journal="Interact J Med Res", year="2024", month="Nov", day="28", volume="13", pages="e57050", keywords="depression", keywords="falls", keywords="nursing home", keywords="nursing home resident", keywords="cross-sectional study", keywords="cohort study", keywords="integrative review", keywords="fall risk", keywords="older adults", abstract="Background: Depression is a highly prevalent psychopathological condition among older adults, particularly those institutionalized in nursing homes (NHs). Unfortunately, it is poorly identified and diagnosed. NH residents are twice as likely to fall as community-dwelling older adults. There is a need for more knowledge about the mechanisms and relationships between depression and falls. Objective: This study aims to identify, analyze, and synthesize research on the relationships between depression and falls among NH residents. Methods: A literature search was conducted in October 2023 in the following bibliographic databases: MEDLINE ALL Ovid, Embase, CINAHL with Full Text EBSCO, APA PsycInfo Ovid, Web of Science Core Collection, the Cochrane Database of Systematic Reviews Wiley, and ProQuest Dissertations \& Theses A\&I. Clinical trials were searched for in the Cochrane Central Register of Controlled Trials Wiley, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. Additional searches were performed using Google Scholar, the DART-Europe E-theses Portal, and backward citation tracking. The Newcastle-Ottawa Scale and the Appraisal tool for Cross-Sectional Studies were used to evaluate study quality. Results: The review included 7 quantitative studies published in 7 different countries from 3 continents; of these, 6 (86\%) were cross-sectional studies, and 1 (14\%) was a prospective cohort study. Results suggested high frequencies of depressive symptoms and falls among older adults living in NHs, and depressive symptoms were considered a risk factor for falls. The 15-item and 10-item versions of the Geriatric Depression Scale were the most commonly used measurement tools, followed by the Cornell Scale for Depression in Dementia and the Resident Assessment Instrument-Minimum Data Set 2.0. The prevalence of depression was heterogeneous, varying from 21.5\% to 47.7\% of NH residents. The studies used heterogeneous descriptions of a fall, and some considered the risk of falls, recurrent fallers, and near falls in their data. The prevalence of fallers was disparate, varying from 17.2\% to 63.1\%. Of the 7 retained studies, 6 (86\%) reported a relationship between depression and falls or the risk of falls. Among the 19 other risk factors identified in the review as being associated with falls among NH residents were a history of falls in the last 180 days, >1 fall in the past 12 months, and respiratory illnesses. Conclusions: There is a paucity of research examining falls among older adults with depressive symptoms in NHs. These findings should alert nurses to the need to consider depression as a risk factor in their work to prevent falls. More research is needed to gain a comprehensive understanding of fall risk among NH residents with depressive symptoms. International Registered Report Identifier (IRRID): RR2-10.2196/46995 ", doi="10.2196/57050", url="https://www.i-jmr.org/2024/1/e57050", url="http://www.ncbi.nlm.nih.gov/pubmed/39608784" } @Article{info:doi/10.2196/63092, author="Vagnetti, Roberto and Camp, Nicola and Story, Matthew and Ait-Belaid, Khaoula and Mitra, Suvobrata and Fowler Davis, Sally and Meese, Helen and Zecca, Massimiliano and Di Nuovo, Alessandro and Magistro, Daniele", title="Social Robots and Sensors for Enhanced Aging at Home: Mixed Methods Study With a Focus on Mobility and Socioeconomic Factors", journal="JMIR Aging", year="2024", month="Nov", day="25", volume="7", pages="e63092", keywords="older adults", keywords="motor difficulties", keywords="socioeconomic status", keywords="social assistive robots", keywords="monitoring technologies", keywords="mixed methods", abstract="Background: Population aging affects society, with a profound impact on daily activities for those of a low socioeconomic status and with motor impairments. Social assistive robots (SARs) and monitoring technologies can improve older adults' well-being by assisting with and monitoring home activities. Objective: This study explored the opinions and needs of older adults, including those with motor difficulties and of a low socioeconomic status, regarding SARs and monitoring technologies at home to promote daily activities and reduce sedentary behaviors. Methods: A mixed methods approach was used, with 31 older adults divided into 3 groups: those of a low socioeconomic status, those with motor difficulties, and healthy individuals. Focus groups were conducted, and they were analyzed using thematic analysis. Perceived mental and physical well-being were assessed using the 12-Item Short Form Health Survey, and attitudes toward robots were evaluated using the Multidimensional Robot Attitude Scale. Results: The results identified 14 themes in four key areas: (1) technology use for supporting daily activities and reducing sedentary behaviors, (2) perceived barriers, (3) suggestions and preferences, and (4) actual home technology use. Lower perceived physical well-being was associated with higher levels of familiarity, interest, perceived utility, and control related to SARs. Lower perceived psychological well-being was linked to a more negative attitude, increased concerns about environmental fit, and a preference for less variety. Notably, older adults from the low--socioeconomic status group perceived less control over SARs, whereas older adults with motor difficulties expressed higher perceived utility compared to other groups, as well as higher familiarity and interest compared to the low--socioeconomic status group. Conclusions: Participants indicated that SARs and monitoring technologies could help reduce sedentary behaviors by assisting in the management of daily activities. The results are discussed in the context of these outcomes and the implementation of SARs and monitoring technologies at home. This study highlights the importance of considering the functional and socioeconomic characteristics of older adults as future users of SARs and monitoring technologies to promote widespread adoption and improve well-being within this population. ", doi="10.2196/63092", url="https://aging.jmir.org/2024/1/e63092" } @Article{info:doi/10.2196/59285, author="Bavngaard, Vinther Martin and Lund, Anne and Thordardottir, Bj{\"o}rg and Rasmussen, B{\o}rve Erik", title="The Uses and Experiences of Synchronous Communication Technology for Home-Dwelling Older Adults in a Home Care Services Context: Qualitative Systematic Review", journal="J Med Internet Res", year="2024", month="Nov", day="22", volume="26", pages="e59285", keywords="systematic review", keywords="qualitative", keywords="thematic synthesis", keywords="communication technology", keywords="relatives", keywords="home care services", keywords="aging in place", keywords="home-dwelling", keywords="older adult", keywords="aging", keywords="gerontology", keywords="European", keywords="effectiveness", keywords="information", keywords="technology", keywords="health care provider", keywords="cross-disciplinary", keywords="telehealth", keywords="telemonitoring", abstract="Background: European health care systems regard information and communication technology as a necessity in supporting future health care provision by community home care services to home-dwelling older adults. Communication technology enabling synchronous communication between 2 or more human actors at a distance constitutes a significant component of this ambition, but few reviews have synthesized research relating to this particular type of technology. As evaluations of information and communication technology in health care services favor measurements of effectiveness over the experiences and dynamics of putting these technologies into use, the nuances involved in technology implementation processes are often omitted. Objective: This review aims to systematically identify and synthesize qualitative findings on the uses and experiences of synchronous communication technology for home-dwelling older adults in a home care services context. Methods: The review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist for reporting. We conducted a cross-disciplinary search in 5 databases for papers published between 2011 and 2023 that yielded 4210 citations. A total of 13 studies were included after 4 screening phases and a subsequent appraisal of methodological quality guided by the Critical Appraisal Skills Programme tool. From these, prespecified data were extracted and incorporated in a 3-stage thematic synthesis producing 4 analytical themes. Results: The first theme presented the multiple trajectories that older users' technology acceptance could take, namely straightforward, gradual, partial, and resistance laden, notwithstanding outright rejection. It also emphasized both instrumental and emotional efforts by the older adults' relatives in facilitating acceptance. Moving beyond acceptance, the second theme foregrounded the different types of work involved in attempts to integrate the technology by older users, their relatives, and health care providers. Theme 3 highlighted how the older users' physical and cognitive conditions formed a contextual backdrop challenging this integration work, together with challenges related to spatial context. Finally, consequences derived from taking the technology into use could be of a both enabling and complicating nature as integration reconfigured the way users related to themselves and each other. Conclusions: The acceptance and integration of synchronous communication technology for older adults involves multiple user groups in work tending to the technology, to the users themselves, and to each other through intergroup negotiations. This review's original contribution consists of its attention to the dynamics across different user groups in deriving consequences from using the technology in question, in addition to its assertion that such consequences may be both intentional and unintentional. We argue that our findings may be used to provide nuance to policies addressing---and practices taking place in---contexts that involve similar user technology constellations to the ones explored in this paper. Trial Registration: PROSPERO CRD42023414243; https://tinyurl.com/wrha6j3f ", doi="10.2196/59285", url="https://www.jmir.org/2024/1/e59285" } @Article{info:doi/10.2196/64248, author="Mira, Joaqu{\'i}n Jos{\'e} and Garc{\'i}a-Torres, Daniel and Bonell-Guerrero, Mar Mar{\'i}a del and C{\'a}ceres-Sevilla, Isabel Ana and Ramirez-Sanz, Martina and Mart{\'i}nez-Lleo, Rosa and Carratal{\'a}, Concepci{\'o}n", title="Patient Profile and Cost Savings of Long-Term Care in a Spanish Hospital: Retrospective Observational Study", journal="Interact J Med Res", year="2024", month="Nov", day="19", volume="13", pages="e64248", keywords="chronicity", keywords="length of stay", keywords="hospital", keywords="chronic", keywords="long-term care", keywords="demographics", keywords="gerontology", keywords="Hospitals for Acute and Chronic Long-Term Extended Stay", keywords="HACLES", keywords="healthcare economics", keywords="cost savings", abstract="Background: Long-term care hospitals have been considered an efficient response to the health care needs of an increasingly aging population. These centers are expected to contribute to better hospital bed management and more personalized care for patients needing continuous care. The evaluation of their outcomes is necessary after a sufficient period to assess their impact. Hospitals for Acute and Chronic Long-Term Extended Stay (HACLES) emerged in Spain in the late 20th century as a response to the aging population and the increase in chronic diseases. Objective: This study aimed to analyze the profile of patients treated in a HACLES, particularly analyzing gender differences, and evaluate the cost savings associated with using these centers. Methods: A retrospective study was conducted based on data from patients 65 years old or older admitted to a HACLES between 2022 and 2023. Gender, age, household cohabitation data, diagnosis and comorbidity, daily medication intake, and degree of dependency were obtained to describe the profile of patients who attended the HACLES. Data coded in SIA-Abucasis (version 37.00.03; Conseller{\'i}a Sanitat, Generalitat Valenciana; a digital medical record system used in the Valencian region) were reviewed, and descriptive statistics and comparison tests were used. The direct cost savings of HACLES admissions were calculated by comparing the daily cost of a general hospital bed with that of a HACLES bed. Results: Data from 123 patients with a mean age of 77 years were analyzed. Most (n=81, 65.9\%) had a cohabiting family member as their primary caregiver. Palliative care was the most frequent reason for admission (n=75, 61\%). The mortality rate (odds ratio [OR] 61.8, 95\% CI 53.2-70.5) was similar between men and women (OR 54.1, 95\% CI 47.8-71.5 vs OR 59.7, 95\% CI 42.2-66.0; P=.23). The cognitive assessment, using the Pfeiffer scale, improved at discharge (mean 3.2, SD 3.2 vs mean 2.5, SD 3.1; P=.003). The length of stay was significantly larger for patients who returned home compared with patients discharged to other facilities (mean 89.8, SD 58.2 versus mean 33.1, SD 43.1 days; P<.001). The direct cost savings were estimated at US \$42,614,846 per 1000 admissions. Conclusions: Patients typically treated in HACLES are older, with a high level of cognitive impairment and physical dependency, and a significant proportion are in palliative care, highlighting the importance of adapting care to the individual needs of the admitted patients. The HACLES model contributes to the sustainability of the public health system. ", doi="10.2196/64248", url="https://www.i-jmr.org/2024/1/e64248" } @Article{info:doi/10.2196/58190, author="Beer, Thomas and Hirt, Julian and Adlbrecht, Laura and Lindwedel, Ulrike and Dammert, Matthias and Maurer, Carola and Kliegel, Matthias and K{\"o}nig, Peter and Bleses, M. Helma", title="Exploring the Experiences of Times Without Care and Encounters in Persons With Dementia in the Swiss and German Nursing Home and Domiciliary Care Settings: Protocol for an Ethnographic Multimethods Study", journal="JMIR Res Protoc", year="2024", month="Nov", day="18", volume="13", pages="e58190", keywords="dementia", keywords="nursing homes", keywords="home nursing", keywords="home care services", keywords="nursing", keywords="ethnography", keywords="formal caregivers", keywords="informal caregivers", abstract="Background: Persons with dementia spend a large part of the day without care and encounters, often without activity, as confirmed by numerous studies. However, no scientific analysis has examined how persons with dementia experience these periods. Such knowledge would be highly relevant for health care professionals and relatives to develop adequate strategies for dealing with times without care. Objective: We aim to reconstruct times without care and encounters in persons with dementia in the nursing home and domiciliary care settings and develop a typology. This typology will address the lifeworld understandings of time and the ways of arranging the time of persons with dementia. Methods: Our study is designed as an explorative, sequential multimethods investigation. We aim to systematically reconstruct times without care and encounters over a period of 36 months using ethnographic methods. Afterward, we will examine the resulting typology using a survey. To describe different social and caring cultures, practices, and arrangements, we will analyze time periods across all phases of dementia in (1) institutions exclusively caring for persons with dementia, (2) institutions where persons with dementia and those without live together, and (3) domiciliary care. For each type of care, our target is 10 intensive case observations. These observations will occur in both participatory and nonparticipatory ways. We video record selected situations and conduct situational conversations and interviews with persons with dementia and nurses. We are aiming for a minimum sample of 30 persons with dementia plus their caregivers (ie, relatives of people with dementia and professional caregivers). We will analyze data according to grounded theory methodology. Furthermore, we will perform a hermeneutic sequence analysis of selected text passages. To interpret the video material, we will conduct a video interaction analysis. To obtain complementary information about the newly developed typology, we will survey approximately 400 formal and 150 informal caregivers. We will summarize the ethnography and survey findings into an overall concept of times without care and encounters in persons with dementia. To fulfill the research objectives, our cross-disciplinary and cross-country team comprises researchers with expertise in nursing sciences, gerontology, sociology, psychology, and ethnography. Results: Our approach allows formulating statements about the nature, frequency, and prevalence of times without care and encounters in people with dementia across countries and types of care. Thus, we will contribute to making visible the lifeworld of persons with dementia. Our study commenced in March 2022 and will conclude in May 2025. The results are expected to be published in the fall of 2025. Conclusions: Our research offers points of departure for the representative investigation of times without care and encounters in persons with dementia, for the development of diagnostic instruments, and for dealing critically with possibilities of interruption (eg, by developing targeted interventions). International Registered Report Identifier (IRRID): DERR1-10.2196/58190 ", doi="10.2196/58190", url="https://www.researchprotocols.org/2024/1/e58190" } @Article{info:doi/10.2196/53447, author="Chung, Jane and Pretzer-Aboff, Ingrid and Parsons, Pamela and Falls, Katherine and Bulut, Eyuphan", title="Using a Device-Free Wi-Fi Sensing System to Assess Daily Activities and Mobility in Low-Income Older Adults: Protocol for a Feasibility Study", journal="JMIR Res Protoc", year="2024", month="Nov", day="12", volume="13", pages="e53447", keywords="Wi-Fi sensing", keywords="dementia", keywords="mild cognitive impairment", keywords="older adults", keywords="health disparities", keywords="in-home activities", keywords="mobility", keywords="machine learning", abstract="Background: Older adults belonging to racial or ethnic minorities with low socioeconomic status are at an elevated risk of developing dementia, but resources for assessing functional decline and detecting cognitive impairment are limited. Cognitive impairment affects the ability to perform daily activities and mobility behaviors. Traditional assessment methods have drawbacks, so smart home technologies (SmHT) have emerged to offer objective, high-frequency, and remote monitoring. However, these technologies usually rely on motion sensors that cannot identify specific activity types. This group often lacks access to these technologies due to limited resources and technology experience. There is a need to develop new sensing technology that is discreet, affordable, and requires minimal user engagement to characterize and quantify various in-home activities. Furthermore, it is essential to explore the feasibility of developing machine learning (ML) algorithms for SmHT through collaborations between clinical researchers and engineers and involving minority, low-income older adults for novel sensor development. Objective: This study aims to examine the feasibility of developing a novel channel state information--based device-free, low-cost Wi-Fi sensing system, and associated ML algorithms for localizing and recognizing different patterns of in-home activities and mobility in residents of low-income senior housing with and without mild cognitive impairment. Methods: This feasibility study was conducted in collaboration with a wellness care group, which serves the healthy aging needs of low-income housing residents. Prior to this feasibility study, we conducted a pilot study to collect channel state information data from several activity scenarios (eg, sitting, walking, and preparing meals) using the proposed Wi-Fi sensing system continuously over a week in apartments of low-income housing residents. These activities were videotaped to generate ground truth annotations to test the accuracy of the ML algorithms derived from the proposed system. Using qualitative individual interviews, we explored the acceptability of the Wi-Fi sensing system and implementation barriers in the low-income housing setting. We use the same study protocol for the proposed feasibility study. Results: The Wi-Fi sensing system deployment began in November 2022, with participant recruitment starting in July 2023. Preliminary results will be available in the summer of 2025. Preliminary results are focused on the feasibility of developing ML models for Wi-Fi sensing--based activity and mobility assessment, community-based recruitment and data collection, ground truth, and older adults' Wi-Fi sensing technology acceptance. Conclusions: This feasibility study can make a contribution to SmHT science and ML capabilities for early detection of cognitive decline among socially vulnerable older adults. Currently, sensing devices are not readily available to this population due to cost and information barriers. Our sensing device has the potential to identify individuals at risk for cognitive decline by assessing their level of physical function by tracking their in-home activities and mobility behaviors, at a low cost. International Registered Report Identifier (IRRID): DERR1-10.2196/53447 ", doi="10.2196/53447", url="https://www.researchprotocols.org/2024/1/e53447" } @Article{info:doi/10.2196/57036, author="Desai, Chaitali and Dove, Erica and Nanthakumar, Jarshini and Main, Emilia and Colquhoun, Heather and Astell, Arlene and Mihailidis, Alex and Layton, Natasha and Burhan, M. Amer and Chan, Brian and Wang, H. Rosalie", title="Assistive Technology to Support Dementia Management: Protocol for a Scoping Review of Reviews", journal="JMIR Res Protoc", year="2024", month="Nov", day="11", volume="13", pages="e57036", keywords="assistive technology", keywords="assistive products", keywords="dementia", keywords="care partners", keywords="caregivers", keywords="elderly", abstract="Background: In Canada, more than 60\% of persons living with dementia reside in their own homes, and over 25\% rely heavily on their care partners (ie, family members or friends) for assistance with daily activities such as personal hygiene, eating, and walking. Assistive technology (AT) is a key dementia management strategy, helping to maintain health and social support in home and community settings. AT comprises assistive products and services required for safe and effective use. Persons living with dementia and their care partners often require multiple types of AT to maintain their needs, dignity, and autonomy. AT for dementia management is rapidly developing with abundant scientific literature, which can present a challenge to efficiently navigate and extract insights?for policy and personal decision-making. Objective: This scoping review aims to synthesize review-level evidence from published scientific literature on AT to support dementia management for persons living with dementia and their care partners in their homes and communities. Research gaps in knowledge and areas for further investigation into the use and access of AT will be identified. This review will provide an overview of AT types and characteristics and chart the outcomes and conclusions in review-level evidence. Methods: This review will follow the Joanna Briggs Institute's framework for conducting scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. In total, 6 electronic databases will be searched. Articles will be screened according to the ``Population-Concept-Context (PCC)'' framework for eligible studies. Population includes persons living with dementia, their care partners, and health care professionals (eg, therapists or others who recommend AT). Concept includes AT and self-help devices of many types. Context includes homes and communities. A data charting template will guide data extraction, charting, and summarization. A descriptive numerical summary and an overview of the findings will be presented. Data, such as (1) article information (eg, author and year), (2) article characteristics (eg, review type), (3) AT types and characteristics, (4) setting and population characteristics, and (5) key review outcomes and conclusions, will be extracted. Results: A total of 10,978 unique citations were identified across the 6 electronic databases. This review is in the full-text screening stage, which is expected to be completed by October 2024. Conclusions: This review will provide a comprehensive understanding and documentation of the published scientific literature on AT to support dementia management. Findings from this review are expected to provide evidence-based insights on the complexities of AT types, uses, availability, and access. The author group's diverse national and international perspectives may contribute to knowledge exchange and influence standards to improve the daily function, safety, and well-being of persons living with dementia. Trial Registration: Open Science Framework DKSM9; https://osf.io/dksm9 International Registered Report Identifier (IRRID): PRR1-10.2196/57036 ", doi="10.2196/57036", url="https://www.researchprotocols.org/2024/1/e57036" } @Article{info:doi/10.2196/54210, author="Timon, M. Claire and Heffernan, Emma and Kilcullen, Sophia and Hopper, Louise and Lee, Hyowon and Gallagher, Pamela and Smeaton, F. Alan and Moran, Kieran and Hussey, Pamela and Murphy, Catriona", title="Developing Independent Living Support for Older Adults Using Internet of Things and AI-Based Systems: Co-Design Study", journal="JMIR Aging", year="2024", month="Oct", day="24", volume="7", pages="e54210", keywords="independent living", keywords="gerontology", keywords="geriatric", keywords="older adult", keywords="elderly", keywords="aging", keywords="Internet of Things", keywords="IoT", keywords="wearable electronic device", keywords="medical device", keywords="daily living activities", keywords="quality of life", keywords="QoL", keywords="artificial intelligence", keywords="AI", keywords="algorithm", keywords="predictive model", keywords="predictive analytics", keywords="predictive system", keywords="practical model", abstract="Background: The number of older people with unmet health care and support needs is increasing substantially due to the challenges facing health care systems worldwide. There are potentially great benefits to using the Internet of Things coupled with artificial intelligence to support independent living and the measurement of health risks, thus improving quality of life for the older adult population. Taking a co-design approach has the potential to ensure that these technological solutions are developed to address specific user needs and requirements. Objective: The aim of this study was to investigate stakeholders' perceptions of independent living and technology solutions, identify stakeholders' suggestions on how technology could assist older adults to live independently, and explore the acceptability and usefulness of a prototype Internet of Things solution called the NEX system to support independent living for an older adult population. Methods: The development of the NEX system was carried out in 3 key phases with a strong focus on diverse stakeholder involvement. The initial predesign exploratory phase recruited 17 stakeholders, including older adults and family caregivers, using fictitious personas and scenarios to explore initial perceptions of independent living and technology solutions. The subsequent co-design and testing phase expanded this to include a comprehensive web-based survey completed by 380 stakeholders, encompassing older adults, family caregivers, health care professionals, and home care support staff. This phase also included prototype testing at home by 7 older adults to assess technology needs, requirements, and the initial acceptability of the system. Finally, in the postdesign phase, workshops were held between academic and industry partners to analyze data collected from the earlier stages and to discuss recommendations for the future development of the system. Results: The predesign phase revealed 3 broad themes: loneliness and technology, aging and technology, and adopting and using technology. The co-design phase highlighted key areas where technology could assist older adults to live independently: home security, falls and loneliness, remote monitoring by family members, and communication with clients. Prototype testing revealed that the acceptability aspects of the prototype varied across technology types. Ambient sensors and voice-activated assistants were described as the most acceptable technology by participants. Last, the postdesign analysis process highlighted that ambient sensors have the potential for automatic detection of activities of daily living, resulting in key recommendations for future developments and deployments in this area. Conclusions: This study demonstrates the significance of incorporating diverse stakeholder perspectives in developing solutions that support independent living. Additionally, it emphasizes the advantages of prototype testing in home environments, offering crucial insights into the real-world experiences of users interacting with technological solutions. International Registered Report Identifier (IRRID): RR2-10.2196/35277 ", doi="10.2196/54210", url="https://aging.jmir.org/2024/1/e54210" } @Article{info:doi/10.2196/54977, author="Juhl, Haase Marie and Soerensen, Lykkegaard Ann and Vardinghus-Nielsen, Henrik and Mortensen, Sinding Lea and Kolding Kristensen, Jette and Olesen, Estrup Anne", title="Designing an Intervention to Improve Medication Safety for Nursing Home Residents Based on Experiential Knowledge Related to Patient Safety Culture at the Nursing Home Front Line: Cocreative Process Study", journal="JMIR Form Res", year="2024", month="Oct", day="9", volume="8", pages="e54977", keywords="intervention development", keywords="nursing home", keywords="frontline professionals", keywords="medication safety", keywords="quality improvement", keywords="patient safety culture", keywords="experiential knowledge", keywords="cocreation", keywords="resilient health care systems", keywords="safety II perspective", keywords="human resources", keywords="integrated knowledge translation", abstract="Background: Despite years of attention, avoiding medication-related harm remains a global challenge. Nursing homes provide essential health care for frail older individuals, who often experience multiple chronic diseases and polypharmacy, increasing their risk of medication errors. Evidence of effective interventions to improve medication safety in these settings is inconclusive. Focusing on patient safety culture is a potential key to intervention development as it forms the foundation for overall patient safety and is associated with medication errors. Objective: This study aims to develop an intervention to improve medication safety for nursing home residents through a cocreative process guided by integrated knowledge translation and experience-based codesign. Methods: This study used a cocreative process guided by integrated knowledge translation and experience-based co-design principles. Evidence on patient safety culture was used as an inspirational source for exploration of medication safety. Data collection involved semistructured focus groups to generate experiential knowledge (stage 1) to inform intervention design in a multidisciplinary workshop (stage 2). Research validation engaging different types of research expertise and municipal managerial representatives in finalizing the intervention design was essential. Acceptance of the final intervention for evaluation was aimed for through contextualization focused on partnership with a municipal advisory board. An abductive, rapid qualitative analytical approach to data analysis was chosen using elements from analyzing in the present, addressing the time-dependent, context-bound aspects of the cocreative process. Results: Experiential knowledge was represented by three main themes: (1) closed systems and gaps between functions, (2) resource interpretation and untapped potential, and (3) community of medication safety and surveillance. The main themes informed the design of preliminary intervention components in a multidisciplinary workshop. An intervention design process focused on research validation in addition to contextualization resulted in the Safe Medication in Nursing Home Residents (SAME) intervention covering (1) campaign material visualizing key roles and responsibilities regarding medication for nursing home residents and (2) ``Medication safety reflexive spaces'' focused on social and health care assistants. Conclusions: The cocreative process successfully resulted in the multifaceted SAME intervention, grounded in lived experiences shared by some of the most important (but often underrepresented in research) stakeholders: frontline health care professionals and representatives of nursing home residents. This study brought attention toward closed systems related to functions in medication management and surveillance, not only informing the SAME intervention design but as opportunities for further exploration in future research. Evaluation of the intervention is an important next step. Overall, this study represents an important contribution to the complex field of medication safety. International Registered Report Identifier (IRRID): RR2-10.2196/43538 ", doi="10.2196/54977", url="https://formative.jmir.org/2024/1/e54977" } @Article{info:doi/10.2196/56278, author="Li, Yijun and Shiyanov, Irina and Muschalla, Beate", title="Older Adults' Acceptance of a Virtual Reality Group Intervention in Nursing Homes: Pre-Post Study Under Naturalistic Conditions", journal="JMIR Hum Factors", year="2024", month="Oct", day="4", volume="11", pages="e56278", keywords="virtual reality", keywords="VR", keywords="computer-generated simulation", keywords="simulation", keywords="technology acceptance", keywords="nursing home", keywords="nursing facility", keywords="long-term care center", keywords="long-term care facility", keywords="older adult", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="senior", keywords="understanding human behavior", keywords="meaningful activity", keywords="group intervention", keywords="human behavior", abstract="Background: Virtual reality (VR) group activities can act as interventions against inactivity and lack of meaningful activities in nursing homes. The acceptance of VR among older adults has been explored from different perspectives. However, research on the impact of older adults' individual characteristics on the acceptance of VR group activities in nursing homes is necessary. Objective: This study investigates the impact of individual characteristics (eg, psychosocial capacities) on VR acceptance among older adults in nursing homes, as well as this group's perceptions of VR after participating in a VR intervention. Methods: In this pre-post study conducted in nursing homes, we applied a VR group intervention with 113 older adult participants. These participants were categorized into two groups based on their naturalistic choice to join the intervention: a higher VR acceptance group (n=90) and a lower VR acceptance group (n=23). We compared the two groups with respect to their sociodemographic characteristics, psychosocial capacities, and attitudes toward new technologies. Additionally, we examined the participants' perceptions of VR. Results: The results show that those with lower acceptance of VR initially reported higher capacities in organizing daily activities and stronger interpersonal relationships compared to older adults with higher VR acceptance. The VR group activity might hold limited significance for the latter group, but it offers the chance to activate older adults with lower proactivity. Openness to new technology was associated with a favorable perception of VR. After the VR intervention, the acceptance of VR remained high. Conclusions: This study investigates the acceptance of VR group events as meaningful activities for older adults in nursing homes under naturalistic conditions. The results indicate that the VR group intervention effectively addressed low proactivity and interpersonal relationship issues among older adults in nursing homes. Older adults should be encouraged to experience VR if the opportunity to participate is offered, potentially facilitated by caregivers or trusted individuals. ", doi="10.2196/56278", url="https://humanfactors.jmir.org/2024/1/e56278" } @Article{info:doi/10.2196/41093, author="Yoo, In-jin and Park, Do-Hyung and Lee, EunKyoung Othelia and Park, Albert", title="Investigating Older Adults' Use of a Socially Assistive Robot via Time Series Clustering and User Profiling: Descriptive Analysis Study", journal="JMIR Form Res", year="2024", month="Sep", day="19", volume="8", pages="e41093", keywords="socially assistive robot", keywords="older adults", keywords="robot use pattern", keywords="time series clustering", keywords="profiling analysis", abstract="Background: The aging population and the shortage of geriatric care workers are major global concerns. Socially assistive robots (SARs) have the potential to address these issues, but developing SARs for various types of users is still in its infancy. Objective: This study aims to examine the characteristics and use patterns of SARs. Methods: This study analyzed log data from 64 older adults who used a SAR called Hyodol for 60 days to understand use patterns and their relationship with user characteristics. Data on user interactions, robot-assisted content use, demographics, physical and mental health, and lifestyle were collected. Time series clustering was used to group users based on use patterns, followed by profiling analysis to relate these patterns to user characteristics. Results: Overall, 4 time series clusters were created based on use patterns: helpers, friends, short-term users, and long-term users. Time series and profiling analyses revealed distinct patterns for each group. We found that older adults use SARs differently based on factors beyond demographics and health. This study demonstrates a data-driven approach to understanding user needs, and the findings can help tailor SAR interventions for specific user groups. Conclusions: This study extends our understanding of the factors associated with the long-term use of SARs for geriatric care and makes methodological contributions. ", doi="10.2196/41093", url="https://formative.jmir.org/2024/1/e41093" } @Article{info:doi/10.2196/60099, author="Garc{\'i}a-Sangen{\'i}s, Ana and Modena, Daniela and Jensen, Nygaard Jette and Chalkidou, Athina and Antsupova, S. Valeria and Marloth, Tina and Theut, Marie Anna and Gonz{\'a}lez L{\'o}pez-Valc{\'a}rcel, Beatriz and Raynal, Fabiana and Vallejo-Torres, Laura and Lykkegaard, Jesper and Hansen, Plejdrup Malene and S{\o}ndergaard, Jens and Olsen, Kanstrup Jonas and Munck, Anders and Balint, Andr{\'a}s and Benko, Ria and Petek, Davorina and Sodja, Nina and Kowalczyk, Anna and Godycki-Cwirko, Maciej and Glasov{\'a}, Helena and Glasa, Jozef and Radzeviciene Jurgute, Ruta and Jaruseviciene, Lina and Lionis, Christos and Anastasaki, Marilena and Angelaki, Agapi and Petelos, Elena and Alvarez, Laura and Ricart, Marta and Briones, Sergi and Ruppe, Georg and Monf{\`a}, Ramon and Bjerrum, Anders and Llor, Carl", title="Improving Antibiotic Use in Nursing Homes by Infection Prevention and Control and Antibiotic Stewardship (IMAGINE): Protocol for a Before-and-After Intervention and Implementation Study", journal="JMIR Res Protoc", year="2024", month="Sep", day="16", volume="13", pages="e60099", keywords="antimicrobial stewardship", keywords="medical audit", keywords="hygiene", keywords="antibacterial agents", keywords="quality improvement", keywords="nursing homes", keywords="health personnel", keywords="drug resistance, microbial", keywords="frail elderly", abstract="Background: Despite the extensive use of antibiotics and the growing challenge of antimicrobial resistance, there has been a lack of substantial initiatives aimed at diminishing the prevalence of infections in nursing homes and enhancing the detection of urinary tract infections (UTIs). Objective: This study aims to systematize and enhance efforts to prevent health care--associated infections, mainly UTIs and reduce antibiotic inappropriateness by implementing a multifaceted intervention targeting health care professionals in nursing homes. Methods: A before-and-after intervention study carried out in a minimum of 10 nursing homes in each of the 8 European participating countries (Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain). A team of 4 professionals consisting of nurses, doctors, health care assistants, or health care helpers are actively involved in each nursing home. Over the initial 3-month period, professionals in each nursing home are registering information on UTIs as well as infection and prevention control measures by means of the Audit Project Odense method. The audit will be repeated after implementing a multifaceted intervention. The intervention will consist of feedback and discussion of the results from the first registration, training on the implementation of infection and prevention control techniques provided by experts, appropriateness of the diagnostic approach and antibiotic prescribing for UTIs, and provision of information materials on infection control and antimicrobial stewardship targeted to staff, residents, and relatives. We will compare the pre- and postintervention audit results using chi-square test for prescription appropriateness and Student t test for implemented hygiene elements. Results: A total of 109 nursing homes have participated in the pilot study and the first registration audit. The results of the first audit registration are expected to be published in autumn of 2024. The final results will be published by the end of 2025. Conclusions: This is a European Union--funded project aimed at contributing to the battle against antimicrobial resistance through improvement of the quality of management of common infections based on evidence-based interventions tailored to the nursing home setting and a diverse range of professionals. We expect the intervention to result in a significant increase in the number of hygiene activities implemented by health care providers and residents. Additionally, we anticipate a marked reduction in the number of inappropriately managed UTIs, as well as a substantial decrease in the overall incidence of infections following the intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/60099 ", doi="10.2196/60099", url="https://www.researchprotocols.org/2024/1/e60099", url="http://www.ncbi.nlm.nih.gov/pubmed/39284176" } @Article{info:doi/10.2196/58629, author="Trainum, Katie and Liu, Jiaying and Hauser, Elliott and Xie, Bo", title="Nursing Staff's Perspectives of Care Robots for Assisted Living Facilities: Systematic Literature Review", journal="JMIR Aging", year="2024", month="Sep", day="16", volume="7", pages="e58629", keywords="robots", keywords="nursing staff", keywords="nursing home", keywords="senior living", keywords="systematic review", keywords="aging", keywords="older adults", keywords="gerontology", keywords="participatory design", keywords="user needs", keywords="nurses", keywords="nursing", keywords="retirement", keywords="long-term care", keywords="geriatrics", keywords="elderly", keywords="older people", keywords="syntheses", keywords="review methods", keywords="review methodology", keywords="searches", keywords="searching", keywords="systematic", keywords="experiences", keywords="attitudes", keywords="opinions", keywords="perceptions", keywords="perspectives", keywords="preferences", keywords="needs", keywords="preference", abstract="Background: Care robots have been proposed in response to nursing shortages in assisted living facilities (ALFs) and the growing population of older adults. While the use of care robots may improve the general health and well-being of older adults, their introduction changes the work of nursing staff fundamentally, and it has implications for the entire health care system. In developing such technology, it is important to include end users, but so far, the nursing staff's perspectives have largely been ignored. Objective: This study aims to examine the literature on nursing staff's attitudes, needs, and preferences related to the use of care robots in ALFs, in order to discover gaps in the literature and guide future research. Methods: This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 protocol. On May 12, 2023, we searched PubMed, CINAHL Plus with Full Text, PsycINFO, the IEEE Xplore Digital Library, and the ACM Digital Library using predetermined search terms. Included publications, written in English, focused on the predevelopment phase, in which information was gathered on nursing staff's attitudes, needs, and preferences regarding care robots for ALFs. Publications were excluded if they did not provide peer-reviewed empirical data. The studies' findings were summarized, coded, and analyzed into major themes using thematic analysis and narrative synthesis. Their quality was assessed using McGill University's Mixed Methods Appraisal Tool and the Joanna Briggs Institute's critical appraisal tools. Results: The final sample included 15 studies. Most of the studies (n=11, 73\%) were rated as good quality; however, there was a general lack of reporting on important methodological decisions and sample characteristics. Nursing staff desired care robots that could assist with physically demanding tasks and reduce their workload but had mixed feelings on whether robots could or should assist with social tasks. In addition, nursing staff are concerned about the ethics of care robots, as well as about their safety, accessibility, and operability. The nursing staff's culture, qualification, and role in the facility may influence their perspectives of care robots. The studies lacked theory-driven designs and large sample sizes. Eight (53\%) studies mentioned using a participatory design approach, but a lack of established criteria for what constitutes participatory design leads to varying degrees of methodological quality. Conclusions: There was consensus among nursing staff that care robots should serve as nursing assistants to reduce workload. Whether robots could or should assist with social tasks remains a question. Further research is needed to mitigate nursing staff's concerns and understand the socioecological factors that influence their perspectives of care robots and their adoption in ALFs. In addition, theory-driven and large sample size study designs are necessary, as well as work to develop clear criteria for related participatory design research. ", doi="10.2196/58629", url="https://aging.jmir.org/2024/1/e58629" } @Article{info:doi/10.2196/60896, author="Hoben, Matthias and Maxwell, J. Colleen and Ubell, Andrea and Doupe, B. Malcolm and Goodarzi, Zahra and Allana, Saleema and Beleno, Ron and Berta, Whitney and Bethell, Jennifer and Daly, Tamara and Ginsburg, Liane and Rahman, -. Atiqur SM and Nguyen, Hung and Tate, Kaitlyn and McGrail, Kimberlyn", title="EXploring Patterns of Use and Effects of Adult Day Programs to Improve Trajectories of Continuing Care (EXPEDITE): Protocol for a Retrospective Cohort Study", journal="JMIR Res Protoc", year="2024", month="Aug", day="30", volume="13", pages="e60896", keywords="adult day care centers", keywords="aged", keywords="program evaluation", keywords="cohort studies", keywords="routinely collected health data", abstract="Background: Adult day programs provide critical supports to older adults and their family or friend caregivers. High-quality care in the community for as long as possible and minimizing facility-based continuing care are key priorities of older adults, their caregivers, and health care systems. While most older adults in need of care live in the community, about 10\% of newly admitted care home residents have relatively low care needs that could be met in the community with the right supports. However, research on the effects of day programs is inconsistent. The methodological quality of studies is poor, and we especially lack robust, longitudinal research. Objective: Our research objectives are to (1) compare patterns of day program use (including nonuse) by province (Alberta, British Columbia, and Manitoba) and time; (2) compare characteristics of older adults by day program use pattern (including nonuse), province, and time; and (3) assess effects of day programs on attendees, compared with a propensity score--matched cohort of older nonattendees in the community. Methods: In this population-based retrospective cohort study, we will use clinical and health administrative data of older adults (65+ years of age) who received publicly funded continuing care in the community in the Canadian provinces of Alberta, British Columbia, and Manitoba between January 1, 2012, and December 31, 2024. We will compare patterns of day program use between provinces and assess changes over time. We will then compare characteristics of older adults (eg, age, sex, physical or cognitive disability, area-based deprivation indices, and caregiver availability or distress) by pattern of day program use or nonuse, province, and time. Finally, we will create a propensity score--matched comparison group of older adults in the community, who have not attended a day program. Using time-to-event models and general estimating equations, we will assess whether day program attendees compared with nonattendees enter care homes later; use emergency, acute, or primary care less frequently; experience less cognitive and physical decline; and have better mental health. Results: This will be a 3-year study (July 1, 2024, to June 30, 2027). We received ethics approvals from the relevant ethics boards. Starting on July 1, 2024, we will work with the 3 provincial health systems on data access and linkage, and we expect data analyses to start in early 2025. Conclusions: This study will generate robust Canadian evidence on the question whether day programs have positive, negative, or no effects on various older adult and caregiver outcomes. This will be a prerequisite to improving the quality of care provided to older adults in day programs, ultimately improving the quality of life of older adults and their caregivers. Trial Registration: ClinicalTrials.gov NCT06440447; https://clinicaltrials.gov/study/NCT06440447 International Registered Report Identifier (IRRID): PRR1-10.2196/60896 ", doi="10.2196/60896", url="https://www.researchprotocols.org/2024/1/e60896" } @Article{info:doi/10.2196/56055, author="Cannings, Madeleine and Brookman, Ruth and Parker, Simon and Hoon, Leonard and Ono, Asuka and Kawata, Hiroaki and Matsukawa, Hisashi and Harris, B. Celia", title="Optimizing Technology-Based Prompts for Supporting People Living With Dementia in Completing Activities of Daily Living at Home: Experimental Approach to Prompt Modality, Task Breakdown, and Attentional Support", journal="JMIR Aging", year="2024", month="Aug", day="23", volume="7", pages="e56055", keywords="assistive technology", keywords="accessible technology", keywords="accessibility technology", keywords="assistive technologies", keywords="accessible technologies", keywords="assistive device", keywords="assistive devices", keywords="dementia", keywords="people living with dementia", keywords="dementia care", keywords="person-centered technology", keywords="patient-centered technology", keywords="person-centered technologies", keywords="patient-centered technologies", keywords="memory support", keywords="prompting", keywords="user-computer interface", keywords="user interface", keywords="UI", keywords="app", keywords="apps", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="digital interventions", keywords="mobile phone", abstract="Background: Assistive technology is becoming increasingly accessible and affordable for supporting people with dementia and their care partners living at home, with strong potential for technology-based prompting to assist with initiation and tracking of complex, multistep activities of daily living. However, there is limited direct comparison of different prompt features to guide optimal technology design. Objective: Across 3 experiments, we investigated the features of tablet-based prompts that best support people with dementia to complete activities of daily living at home, measuring prompt effectiveness and gaining feedback from people with dementia and their care partners about their experiences. Methods: Across experiments, we developed a specialized iPad app to enable data collection with people with dementia at home over an extended experimental period. In experiment 1, we varied the prompts in a 3 (visual type: text instruction, iconic image, and photographic image) {\texttimes} 3 (audio type: no sound, symbolic sound, and verbal instruction) experimental design using repeated measures across multiple testing sessions involving single-step activities. In experiment 2, we tested the most effective prompt breakdown for complex multistep tasks comparing 3 conditions (1-prompt, 3-prompt, and 7-prompt conditions). In experiment 3, we compared initiation and maintenance alerts that involved either an auditory tone or an auditory tone combined with a verbal instruction. Throughout, we asked people with dementia and their care partners to reflect on the usefulness of prompting technology in their everyday lives and what could be developed to better meet their needs. Results: First, our results showed that audible verbal instructions were more useful for task completion than either tone-based or visual prompts. Second, a more granular breakdown of tasks was generally more useful and increased independent use, but this varied across individuals. Third, while a voice or text maintenance alert enabled people with dementia to persist with a multistep task for longer when it was more frequent, task initiation still frequently required support from a care partner. Conclusions: These findings can help inform developers of assistive technology about the design features that promote the usefulness of home prompting systems for people with dementia as well as the preferences and insights of people with dementia and their care partners regarding assistive technology design. ", doi="10.2196/56055", url="https://aging.jmir.org/2024/1/e56055" } @Article{info:doi/10.2196/52676, author="Reicherzer, Leah and Scheermesser, Mandy and Kl{\"a}y, Adrian and Duarte, E. Jaime and Graf, S. Eveline", title="Barriers and Facilitators to the Use of Wearable Robots as Assistive Devices: Qualitative Study With Older Adults and Physiotherapists", journal="JMIR Rehabil Assist Technol", year="2024", month="Aug", day="9", volume="11", pages="e52676", keywords="assistive device", keywords="barriers", keywords="facilitators", keywords="mobility", keywords="older adults", keywords="wearable robots", abstract="Background: Light wearable robots have the potential to assist older adults with mobility impairments in daily life by compensating for age-related decline in lower extremity strength. Physiotherapists may be the first point of contact for older adults with these devices. Objective: The aims of this study were to explore views of older adults and physiotherapists on wearable robots as assistive devices for daily living and to identify the barriers and facilitators to their use. Methods: Six older adults (aged 72?88 years) tested a wearable robot (Myosuit) and participated in semistructured interviews. A focus group with 6 physiotherapists who had a minimum of 5 years of professional experience and specialized in geriatrics was conducted. Data were analyzed using thematic qualitative text analysis. Results: Older adults perceived benefits and had positive use experiences, yet many saw no need to use the technology for themselves. Main barriers and facilitators to its use were the perception of usefulness, attitudes toward technology, ease of use, and environmental factors such as the support received. Physiotherapists named costs, reimbursement schemes, and complexity of the technology as limiting factors. Conclusions: A light wearable robot---the Myosuit---was found to be acceptable to study participants as an assistive device. Although characteristics of the technology are important, the use and acceptance by older adults heavily depend on perceived usefulness and need. ", doi="10.2196/52676", url="https://rehab.jmir.org/2024/1/e52676" } @Article{info:doi/10.2196/47072, author="Traulsen, Pia and Kitschke, Lisa and Steinh{\"a}user, Jost", title="Perceptions Toward Telemedicine of Health Care Staff in Nursing Homes in Northern Germany: Cross-Sectional Study", journal="JMIR Aging", year="2024", month="Aug", day="7", volume="7", pages="e47072", keywords="eHealth", keywords="telemedicine", keywords="nursing home", keywords="pandemic", keywords="Germany", abstract="Background: Digitalization in the German health care system is progressing slowly, even though it offers opportunities for improvement of care. In nursing homes, most of the staff's work is paper based. Following the pandemic, there has been a decrease in the use of telemedicine applications. To ensure long-term implementation, the views of users, in this case nurses, are of interest. Objective: This cross-sectional study was conducted to describe which digital applications are already being used at inpatient care facilities, the attitude of nurses toward telemedicine, and for which areas the use of telemedicine in the facilities is considered appropriate by the participants. Methods: All inpatient care facility staff in Schleswig-Holstein were invited to participate in the survey from August 1 to October 31, 2022. The questionnaire consists of 17 determinants that ask about the attitude, use, and possible applications of telemedicine. In addition to a descriptive analysis, the influence of the general attitude toward telemedicine on various determinants was examined using the Fisher exact test for nominal variables and Spearman correlation coefficient for metric variables. Results: A total of 425 caregivers participated in the survey. Of these respondents, 10.7\% (n=41) currently used video consultations, and 76.1\% (n=321) of the respondents were in favor of video consultations being practiced in training. Furthermore, 74.8\% (n=312) of the respondents would attend a training on telephone medical consultation. Respondents indicated that video consultations have a small added value compared to asynchronous telemedicine (eg, sending photos). However, video consultations were perceived as somewhat less time-consuming than other communication channels. Video consultations are perceived as most useful for clarifying urgent problems. The respondents estimated that one in five paramedic calls at their facilities could be reduced through telemedicine approaches. It was important to the participants that telemedicine is as simple as possible and that there is a high level of data security. Conclusions: Although many caregivers have a positive attitude toward telemedicine and perceive its advantages, communication channels such as video consultation are still used infrequently in care facilities. To promote the use of telemedicine applications, it is important to emphasize their benefits. The presumed saving of paramedic calls thus represents a benefit, and it is crucial to train caregivers in the use of telemedicine to avoid uncertainties in dealing with the newer technologies. It is important to give them enough time and repetitions of the training. ", doi="10.2196/47072", url="https://aging.jmir.org/2024/1/e47072" } @Article{info:doi/10.2196/53811, author="Wiegel, Patrick and Fotteler, Liselotte Marina and Kohn, Brigitte and Mayer, Sarah and Verri, Maria Filippo and Dallmeier, Dhayana and Denkinger, Michael", title="Perceived Benefit and Satisfaction With a Tablet Computer and an Emergency Smartwatch by Older Adults and Their Relatives: Prospective Real-World Pilot Study", journal="JMIR Hum Factors", year="2024", month="Aug", day="2", volume="11", pages="e53811", keywords="assistive technology", keywords="older adults", keywords="caregiver", keywords="benefits", keywords="usability", keywords="gerontechnology", abstract="Background: Assistive technologies (ATs) have the potential to promote the quality of life and independent living of older adults and, further, to relieve the burden of formal and informal caregivers and relatives. Technological developments over the last decades have led to a boost of available ATs. However, evidence on the benefits and satisfaction with ATs in real-world applications remains scarce. Objective: This prospective, real-world, pilot study tested the perceived benefit and satisfaction with different ATs in the real-world environment. Methods: Community-dwelling adults aged ?65 and their relatives tested a tablet computer with a simplified interface or a smartwatch with programmable emergency contacts for 8 weeks in their everyday life. Perceived benefits and satisfaction with ATs were assessed by all older adults and their relatives using different assessment tools before and after the intervention. Outcome measures included the Technology Usage Inventory, Quebec User Evaluation of Satisfaction with Assistive Technology 2.0, and Canadian Occupational Performance Measure. Results: A total of 17 older adults (tablet computer: n=8, 47\% and smartwatch: n=9, 53\%) and 16 relatives (tablet computer: n=7, 44\% and smartwatch: n=9, 56\%) were included in the study. The number of participants that were frail (according to the Clinical Frailty Scale) and received care was higher in the smartwatch group than in the tablet computer group. Older adults of the smartwatch group reported higher technology acceptance (Technology Usage Inventory) and satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0) scores than those of the tablet computer group, although the differences were not significant (all P>.05). In the tablet computer group, relatives had significantly higher ratings on the item intention to use than older adults (t12.3=3.3, P=.006). Identified everyday issues with the Canadian Occupational Performance Measure included contact/communication and entertainment/information for the tablet computer, safety and getting help in emergency situations for the smartwatch, and the usability of the AT for both devices. While the performance (t8=3.5, P=.008) and satisfaction (t8=3.2, P=.01) in these domains significantly improved in the smartwatch group, changes in the tablet computer group were inconsistent (all P>.05). Conclusions: This study highlights the remaining obstacles for the widespread and effective application of ATs in the everyday life of older adults and their relatives. While the results do not provide evidence for a positive effect regarding communication deficits, perceived benefits could be shown for the area of safety. Future research and technical developments need to consider not only the preferences, problems, and goals of older adults but also their relatives and caregivers to improve the acceptability and effectiveness of ATs. ", doi="10.2196/53811", url="https://humanfactors.jmir.org/2024/1/e53811" } @Article{info:doi/10.2196/47565, author="Ansaldo, In{\'e}s Ana and Masson-Trottier, Mich{\`e}le and Delacourt, Barbara and Dubuc, Jade and Dub{\'e}, Catherine", title="Efficacy of COMPAs, an App Designed to Support Communication Between Persons Living With Dementia in Long-Term Care Settings and Their Caregivers: Mixed Methods Implementation Study", journal="JMIR Aging", year="2024", month="Jul", day="4", volume="7", pages="e47565", keywords="dementia", keywords="communication", keywords="caregivers", keywords="technology", keywords="burden", keywords="mixed methods design", keywords="quality of life", keywords="mobile phone", keywords="tablet", abstract="Background: Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills, leading to fewer interactions and isolation for both people living with dementia and their caregivers, negatively impacting the quality of life for both members of the dyad. The resulting stress and burden on caregivers make them particularly susceptible to burnout. Objective: This study aims to examine the efficacy of Communication Proches Aidants (COMPAs), an app designed following the principles of person-centered and emotional communication, which is intended to improve well-being in persons living with dementia and caregivers and reduce caregiver burden. Methods: In this implementation study, volunteer caregivers in 2 long-term care facilities (n=17) were trained in using COMPAs and strategies to improve communication with persons living with dementia. Qualitative and quantitative analyses, semistructured interviews, and questionnaires were completed before and after 8 weeks of intervention with COMPAs. Results: Semistructured interviews revealed that all caregivers perceived a positive impact following COMPAs interventions, namely, improved quality of communication and quality of life among persons living with dementia and caregivers. Improved quality of life was also supported by a statistically significant reduction in the General Health Questionnaire-12 scores (caregivers who improved: 9/17, 53\%; z=2.537; P=.01). COMPAs interventions were also associated with a statistically significant increased feeling of personal accomplishment (caregivers improved: 11/17, 65\%; t15=2.430; P=.03; d=0.61 [medium effect size]). Conclusions: COMPAs intervention improved well-being in persons living with dementia and their caregivers by developing person-centered communication within the dyad, increasing empathy, and reducing burden in caregivers although most caregivers were unfamiliar with technology. The results hold promise for COMPAs interventions in long-term care settings. Larger group-controlled studies with different populations, in different contexts, and at different stages of dementia will provide a clearer picture of the benefits of COMPAs interventions. ", doi="10.2196/47565", url="https://aging.jmir.org/2024/1/e47565", url="http://www.ncbi.nlm.nih.gov/pubmed/38963691" } @Article{info:doi/10.2196/37625, author="Hsiao, Hsun Kai and Quinn, Emma and Johnstone, Travers and Gomez, Maria and Ingleton, Andrew and Parasuraman, Arun and Najjar, Zeina and Gupta, Leena", title="A Novel Web-Based Application for Influenza and COVID-19 Outbreak Detection and Response in Residential Aged Care Facilities", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="24", volume="10", pages="e37625", keywords="web application", keywords="digital health", keywords="communicable disease control", keywords="outbreak", keywords="surveillance", keywords="influenza", keywords="aged care", keywords="aged care homes", doi="10.2196/37625", url="https://publichealth.jmir.org/2024/1/e37625" } @Article{info:doi/10.2196/55471, author="Martin, Tobias and Veldeman, Sarah and Gro{\ss}mann, Heidrun and Fuchs-Frohnhofen, Paul and Czaplik, Michael and Follmann, Andreas", title="Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study", journal="JMIR Aging", year="2024", month="Jun", day="6", volume="7", pages="e55471", keywords="telemedicine", keywords="televisits", keywords="telehealth", keywords="eHealth", keywords="electronic health", keywords="older adult care", keywords="nursing homes", keywords="change management", keywords="implementation science", keywords="technology transfer", keywords="innovation transfer", keywords="long-term adoption", keywords="COVID-19 crisis", keywords="postpandemic", keywords="coronavirus", keywords="digitalization", abstract="Background: There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis. Objective: This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses' workload and their nursing practice. Methods: A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements. Results: In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs. Conclusions: Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine. ", doi="10.2196/55471", url="https://aging.jmir.org/2024/1/e55471", url="http://www.ncbi.nlm.nih.gov/pubmed/38842915" } @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/10.2196/56474, author="Groeneveld, Sjors and Bin Noon, Gaya and den Ouden, M. Marjolein E. and van Os-Medendorp, Harmieke and van Gemert-Pijnen, C. J. E. W. and Verdaasdonk, M. Rudolf and Morita, Pelegrini Plinio", title="The Cooperation Between Nurses and a New Digital Colleague ``AI-Driven Lifestyle Monitoring'' in Long-Term Care for Older Adults: Viewpoint", journal="JMIR Nursing", year="2024", month="May", day="23", volume="7", pages="e56474", keywords="artificial intelligence", keywords="data", keywords="algorithm", keywords="nurse", keywords="nurses", keywords="health care professional", keywords="health care professionals", keywords="health professional", keywords="health professionals", keywords="health technology", keywords="digital health", keywords="smart home", keywords="smart homes", keywords="health monitoring", keywords="health promotion", keywords="aging in place", keywords="assisted living", keywords="ambient assisted living", keywords="aging", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adults", keywords="independent living", keywords="machine learning", doi="10.2196/56474", url="https://nursing.jmir.org/2024/1/e56474", url="http://www.ncbi.nlm.nih.gov/pubmed/38781012" } @Article{info:doi/10.2196/53587, author="Shashidhara, N. Y. and Raghavendra, G. and P Kundapur, Poornima and Binil, V.", title="Effectiveness of Gerontechnology Empowerment Program on Awareness and Use of Mobile Apps Among Older Adults for Instrumental Activities of Daily Living: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="May", day="13", volume="13", pages="e53587", keywords="gerontechnology", keywords="older adults", keywords="awareness", keywords="older people", keywords="instrumental activities of daily living", keywords="iADLs", keywords="mobile apps", keywords="mobile phone", keywords="empowerment", abstract="Background: Instrumental activities of daily living (iADLs) are crucial for older adults to live independently. Health care and technological advancements will increase the older adult population and life expectancy globally. Difficulties with iADLs impact older adults' quality of life. Mobile apps can assist older adults, but many require help due to limited awareness. Lack of awareness is a barrier to app use. Existing literature mainly covers health care and app design, needing more focus on iADL apps for older adults. Objective: The study objectives encompass 2 main aspects: first, to evaluate the awareness, use, and factors influencing the use of apps among older adults for iADLs; and second, to create and assess the effectiveness of a gerontechnology empowerment program (GEP) for older adults on the awareness and use of apps for iADLs. Methods: This research uses a quantitative approach divided into 2 distinct phases. In phase 1, we conduct a descriptive survey to assess the level of awareness and use of mobile apps for iADLs and identify the factors that influence the use of such apps among older adults. To ensure clarity and comprehension among participants, we provide them with a subject information sheet in both Kannada and English. The data collected during this phase enable us to gain insights into awareness levels, use patterns, and factors that shape older adults' use of apps for iADLs. The results serve as the foundation for designing the GEP. In phase 2, a cluster randomization method will be used to select older adults aged 60 to 75 years in Udupi district, Karnataka, India, who are active smartphone users. These participants will be divided into 2 groups: the experimental and the control groups. The experimental group will join the GEP. The sample size for phase 1 is 554, and phase 2 is 50. To assess the effectiveness of this program, we will measure the outcomes before and after its implementation using the same assessment tools used in phase 1. Results: This study is funded by the Indian Council of Medical Research (Adhoc/193/2022/SBHSR on November 18, 2022). Phase 1 data collection is expected to be completed by November 2023, and phase 2 is scheduled to commence in the upcoming months. Phase 1 and 2 findings will be analyzed and discussed in the main paper, which we intend to submit to a high-quality peer-reviewed journal for publication. The research protocol, informed consent forms, and associated documentation received approval from institutional ethics committees (214/2020). Conclusions: Upon the successful testing of the GEP, it can be recommended that welfare departments encourage older adults to use mobile apps for iADLs and establish training programs to provide support to older adults in using these apps. Trial Registration: Clinical Trials Registry - India CTRI/2020/09/027977; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDUxMzM=\&Enc=\&userName=027977 International Registered Report Identifier (IRRID): DERR1-10.2196/53587 ", doi="10.2196/53587", url="https://www.researchprotocols.org/2024/1/e53587", url="http://www.ncbi.nlm.nih.gov/pubmed/38739442" } @Article{info:doi/10.2196/47229, author="Tokunaga, Seiki and Sekiguchi, Takuya and Watanabe Miura, Kumi and Sugimoto, Hikaru and S Abe, Masato and Tamura, Kazuhiro and Kishimoto, Taishiro and Kudo, Takashi and Otake-Matsuura, Mihoko", title="Home-Based Cognitive Intervention for Healthy Older Adults Through Asking Robots Questions: Randomized Controlled Trial", journal="JMIR Aging", year="2024", month="Apr", day="22", volume="7", pages="e47229", keywords="cognitive intervention", keywords="home-based experiment", keywords="robots", keywords="older adults", keywords="technology adoption", keywords="digital health", abstract="Background: Asking questions is common in conversations, and while asking questions, we need to listen carefully to what others say and consider the perspective our questions adopt. However, difficulties persist in verifying the effect of asking questions on older adults' cognitive function due to the lack of a standardized system for conducting experiments at participants' homes. Objective: This study examined the intervention effect of cognitive training moderated by robots on healthy older adults. A focus on the feasibility of the intervention at participants' homes was also maintained. Feasibility was evaluated by considering both the dropout rate during the intervention and the number of questions posed to each participant during the experiment. Methods: We conducted a randomized controlled trial with 81 adults older than 65 years. Participants were recruited through postal invitations and then randomized into 2 groups. The intervention group (n=40) received sessions where participants listened to photo-integrated stories and posed questions to the robots. The control group (n=41) received sessions where participants listened to photo-integrated stories and only thanked the robots for confirming participation. The participants participated in 12 dialogue sessions for 2-3 weeks. Scores of global cognitive functioning tests, recall tests, and verbal fluency tasks measured before and after the intervention were compared between the 2 groups. Results: There was no significant intervention effect on the Telephone Interview for Cognitive Status-Japanese scores, recall tests, and verbal fluency tasks. Additionally, our study successfully concluded with no participant dropouts at follow-up, confirming the feasibility of our approach. Conclusions: There was no statistically significant evidence indicating intervention benefits for cognitive functioning. Although the feasibility of home-based interventions was demonstrated, we identified areas for improvement in the future, such as setting up more efficient session themes. Further research is required to identify the effectiveness of an improved cognitive intervention involving the act of asking questions. Trial Registration: University Hospital Medical Information Network Center UMIN000039489; https://center6.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000045027 ", doi="10.2196/47229", url="https://aging.jmir.org/2024/1/e47229" } @Article{info:doi/10.2196/52443, author="Otaka, Eri and Osawa, Aiko and Kato, Kenji and Obayashi, Yota and Uehara, Shintaro and Kamiya, Masaki and Mizuno, Katsuhiro and Hashide, Shusei and Kondo, Izumi", title="Positive Emotional Responses to Socially Assistive Robots in People With Dementia: Pilot Study", journal="JMIR Aging", year="2024", month="Apr", day="11", volume="7", pages="e52443", keywords="dementia care", keywords="robotics", keywords="emotion", keywords="facial expression", keywords="expression intensity", keywords="long-term care", keywords="sensory modality", keywords="gerontology", keywords="gerontechnology", abstract="Background: Interventions and care that can evoke positive emotions and reduce apathy or agitation are important for people with dementia. In recent years, socially assistive robots used for better dementia care have been found to be feasible. However, the immediate responses of people with dementia when they are given multiple sensory modalities from socially assistive robots have not yet been sufficiently elucidated. Objective: This study aimed to quantitatively examine the immediate emotional responses of people with dementia to stimuli presented by socially assistive robots using facial expression analysis in order to determine whether they elicited positive emotions. Methods: This pilot study adopted a single-arm interventional design. Socially assistive robots were presented to nursing home residents in a three-step procedure: (1) the robot was placed in front of participants (visual stimulus), (2) the robot was manipulated to produce sound (visual and auditory stimuli), and (3) participants held the robot in their hands (visual, auditory, and tactile stimuli). Expression intensity values for ``happy,'' ``sad,'' ``angry,'' ``surprised,'' ``scared,'' and ``disgusted'' were calculated continuously using facial expression analysis with FaceReader. Additionally, self-reported feelings were assessed using a 5-point Likert scale. In addition to the comparison between the subjective and objective emotional assessments, expression intensity values were compared across the aforementioned 3 stimuli patterns within each session. Finally, the expression intensity value for ``happy'' was compared between the different types of robots. Results: A total of 29 participants (mean age 88.7, SD 6.2 years; n=27 female; Japanese version of Mini-Mental State Examination mean score 18.2, SD 5.1) were recruited. The expression intensity value for ``happy'' was the largest in both the subjective and objective assessments and increased significantly when all sensory modalities (visual, auditory, and tactile) were presented (median expression intensity 0.21, IQR 0.09-0.35) compared to the other 2 patterns (visual alone: median expression intensity 0.10, IQR 0.03-0.22; P<.001; visual and auditory: median expression intensity 0.10, IQR 0.04-0.23; P<.001). The comparison of different types of robots revealed a significant increase when all stimuli were presented by doll-type and animal-type robots, but not humanoid-type robots. Conclusions: By quantifying the emotional responses of people with dementia, this study highlighted that socially assistive robots may be more effective in eliciting positive emotions when multiple sensory stimuli, including tactile stimuli, are involved. More studies, including randomized controlled trials, are required to further explore the effectiveness of using socially assistive robots in dementia care. Trial Registration: UMIN Clinical Trials Registry UMIN000046256; https://tinyurl.com/yw37auan ", doi="10.2196/52443", url="https://aging.jmir.org/2024/1/e52443" } @Article{info:doi/10.2196/45978, author="Haslam-Larmer, Lynn and Grigorovich, Alisa and Shum, Leia and Bianchi, Andria and Newman, Kristine and Iaboni, Andrea and McMurray, Josephine", title="Factors That Influence Successful Adoption of Real-Time Location Systems for Use in a Dementia Care Setting: Mixed Methods Study", journal="JMIR Aging", year="2024", month="Apr", day="8", volume="7", pages="e45978", keywords="remote sensing technologies", keywords="dementia", keywords="real-time location systems", keywords="Fit between Individuals, Tasks, and Technology framework", keywords="FITT framework", keywords="technology implementation", abstract="Background: Technology has been identified as a potential solution to alleviate resource gaps and augment care delivery in dementia care settings such as hospitals, long-term care, and retirement homes. There has been an increasing interest in using real-time location systems (RTLS) across health care settings for older adults with dementia, specifically related to the ability to track a person's movement and location. Objective: In this study, we aimed to explore the factors that influence the adoption or nonadoption of an RTLS during its implementation in a specialized inpatient dementia unit in a tertiary care rehabilitation hospital. Methods: The study included data from a brief quantitative survey and interviews from a convenience sample of frontline participants. Our deductive analysis of the interview used the 3 categories of the Fit Between Individuals, Task, and Technology framework as follows: individual and task, individual and technology, and task and technology. The purpose of using this framework was to assess the quality of the fit between technology attributes and an individual's self-reported intentions to adopt RTLS technology. Results: A total of 20 health care providers (HCPs) completed the survey, of which 16 (80\%) participated in interviews. Coding and subsequent analysis identified 2 conceptual subthemes in the individual-task fit category, including the identification of the task and the perception that participants were missing at-risk patient events. The task-technology fit category consisted of 3 subthemes, including reorganization of the task, personal control in relation to the task, and efficiency or resource allocation. A total of 4 subthemes were identified in the individual-technology fit category, including privacy and personal agency, trust in the technology, user interfaces, and perceptions of increased safety. Conclusions: By the end of the study, most of the unit's HCPs were using the tablet app based on their perception of its usefulness, its alignment with their comfort level with technology, and its ability to help them perform job responsibilities. HCPs perceived that they were able to reduce patient search time dramatically, yet any improvements in care were noted to be implied, as this was not measured. There was limited anecdotal evidence of reduced patient risk or adverse events, but greater reported peace of mind for HCPs overseeing patients' activity levels. ", doi="10.2196/45978", url="https://aging.jmir.org/2024/1/e45978", url="http://www.ncbi.nlm.nih.gov/pubmed/38587884" } @Article{info:doi/10.2196/50796, author="Li, Yijun and Wilke, Carlotta and Shiyanov, Irina and Muschalla, Beate", title="Impact of Virtual Reality--Based Group Activities on Activity Level and Well-Being Among Older Adults in Nursing Homes: Longitudinal Exploratory Study", journal="JMIR Serious Games", year="2024", month="Mar", day="29", volume="12", pages="e50796", keywords="virtual reality", keywords="group activity", keywords="aging care", keywords="older adults", keywords="meaningful activity", keywords="mental health", keywords="well-being", keywords="social interaction", keywords="psychosocial capacities", keywords="activity of daily living", abstract="Background: In addition to illness, inactivity is a risk factor for high mortality in nursing homes. Using innovative technology, such as virtual reality (VR), for meaningful group activities could provide new opportunities for solving this problem. VR interventions have already been approved as a promising method for enhancing the health of older adults. Objective: In this study, we examined whether VR-based group activities can have a positive impact on activity level and group interaction among older adults living in nursing homes. Methods: We conducted a longitudinal study and provided VR interventions as a group activity once a week for 4 consecutive weeks in nursing homes. Participants were recruited based on the experience of the nursing staff members and the natural decisions of the older adults. Within a virtual cottage, designed according to the needs of the target group, older adults were able to perform daily tasks that they were no longer able to do in real life, such as gardening and making pizza. Overall, 2 psychologists measured the psychosocial capacities, activities of daily life, and well-being before and after the interventions using standardized instruments. Results: The results focus on a total of 84 older adults from 14 nursing homes who completed at least 3 VR interventions. The results indicate that several psychosocial capacities among the older adults improved, including adherence to regulations (P<.001; $\eta${\texttwosuperior}=0.122), flexibility (P<.001; $\eta${\texttwosuperior}=0.109), and group integration (P<.001; $\eta${\texttwosuperior}=0.141). Problems related to competence also showed a slight decrease (P=.04; $\eta${\texttwosuperior}=0.039). In addition, the VR intervention promoted their proactivity (P<.001; $\eta${\texttwosuperior}=0.104) and mobility (P=.04; $\eta${\texttwosuperior}=0.039). During the VR group intervention, older adults' well-being could be maintained at a high level. The results highlight the beneficial effects of VR intervention as a meaningful activity in nursing homes, showcasing the potential of VR applications in this setting. Conclusions: This study provides a novel and naturalistic perspective, offering new insights into the use of VR in nursing homes. The VR intervention was well accepted and fulfilled the aim of enhancing capacity and well-being. It could be a meaningful group activity in nursing homes to improve social group interaction. To provide stronger evidence, randomized controlled trials are necessary. ", doi="10.2196/50796", url="https://games.jmir.org/2024/1/e50796", url="http://www.ncbi.nlm.nih.gov/pubmed/38551635" } @Article{info:doi/10.2196/52049, author="Gately, Elizabeth Megan and Waller, E. Dylan and Metcalf, E. Emily and Moo, R. Lauren", title="Caregivers' Role in In-Home Video Telehealth: National Survey of Occupational Therapy Practitioners", journal="JMIR Rehabil Assist Technol", year="2024", month="Mar", day="14", volume="11", pages="e52049", keywords="telemedicine", keywords="caregivers", keywords="occupational therapy", keywords="caregiver", keywords="care worker", keywords="telehealth", keywords="older adults", keywords="older adult", keywords="geriatric", keywords="rural", keywords="remote", keywords="OT practitioner", keywords="web-based", keywords="national survey", keywords="role", keywords="home care", keywords="clinical support", keywords="mobile phone", abstract="Background: Older adults face barriers to specialty care, such as occupational therapy (OT), and these challenges are worse for rural older adults. While in-home video telehealth may increase access to OT, older adults' health- and technology-related challenges may necessitate caregiver assistance. Objective: This study examines caregiver assistance with in-home OT video telehealth visits from the perspectives of OT practitioners at Veterans Health Administration (VHA). Methods: A web-based national survey of VHA OT practitioners about caregivers' role in video telehealth was conducted between January and February 2022. Survey items were developed with input from subject matter experts in geriatrics and OT and identified patient factors that necessitate caregiver participation; the extent to which caregivers assist with different types of tasks (technological and clinical tasks); and the perceived facilitators of, benefits of, and barriers to caregiver involvement. Results: Of approximately 1787 eligible VHA OT practitioners, 286 (16\% response rate) participated. Not all survey items required completion, resulting in different denominators. Most respondents were female (183/226, 81\%), White (163/225, 72.4\%), and occupational therapists (275/286, 96.2\%). Respondents were from 87 VHA medical centers, the catchment areas of which served a patient population that was 34\% rural, on average (SD 0.22). Most participants (162/232, 69.8\%) had >10 years of OT experience serving a patient cohort mostly aged ?65 years (189/232, 81.5\%) in primarily outpatient rehabilitation (132/232, 56.9\%). The top patient factors necessitating caregiver involvement were lack of technical skills, cognitive impairment, and advanced patient age, with health-related impairments (eg, hearing or vision loss) less frequent. Technological tasks that caregivers most frequently assisted with were holding, angling, moving, repositioning, or operating the camera (136/250, 54.4\%) and enabling and operating the microphone and setting the volume (126/248, 50.8\%). Clinical tasks that caregivers most frequently assisted with were providing patient history (143/239, 59.8\%) and assisting with patient communication (124/240, 51.7\%). The top facilitator of caregiver participation was clinician-delivered caregiver education about what to expect from video telehealth (152/275, 55.3\%), whereas the top barrier was poor connectivity (80/235, 34\%). Increased access to video telehealth (212/235, 90.2\%) was the top-rated benefit of caregiver participation. Most respondents (164/232, 70.7\%) indicated that caregivers were at least sometimes unavailable or unable to assist with video telehealth, in which case the appointment often shifted to phone. Conclusions: Caregivers routinely assist VHA patients with in-home OT video visits, which is invaluable to patients who are older and have complex medical needs. Barriers to caregiver involvement include caregivers' challenges with video telehealth or inability to assist, or lack of available caregivers. By elucidating the caregiver support role in video visits, this study provides clinicians with strategies to effectively partner with caregivers to enhance older patients' access to video visits. ", doi="10.2196/52049", url="https://rehab.jmir.org/2024/1/e52049", url="http://www.ncbi.nlm.nih.gov/pubmed/38483462" } @Article{info:doi/10.2196/52284, author="Lussier, Maxime and Couture, M{\'e}lanie and Giroux, Sylvain and Aboujaoud{\'e}, Aline and Ngankam, Kenfack Hubert and Pigot, H{\'e}l{\`e}ne and Gaboury, S{\'e}bastien and Bouchard, Kevin and Bottari, Carolina and Belchior, Patricia and Par{\'e}, Guy and Bier, Nathalie", title="Codevelopment and Deployment of a System for the Telemonitoring of Activities of Daily Living Among Older Adults Receiving Home Care Services: Protocol for an Action Design Research Study", journal="JMIR Res Protoc", year="2024", month="Feb", day="29", volume="13", pages="e52284", keywords="action design research", keywords="protocol", keywords="activities of daily living", keywords="older adults", keywords="cognitive deficits", keywords="telemonitoring", keywords="public health care system", keywords="home care services", abstract="Background: Telemonitoring of activities of daily living (ADLs) offers significant potential for gaining a deeper insight into the home care needs of older adults experiencing cognitive decline, particularly those living alone. In 2016, our team and a health care institution in Montreal, Quebec, Canada, sought to test this technology to enhance the support provided by home care clinical teams for older adults residing alone and facing cognitive deficits. The Support for Seniors' Autonomy program (SAPA [Soutien {\`a} l'autonomie des personnes {\^a}g{\'e}es]) project was initiated within this context, embracing an innovative research approach that combines action research and design science. Objective: This paper presents the research protocol for the SAPA project, with the aim of facilitating the replication of similar initiatives in the future. The primary objectives of the SAPA project were to (1) codevelop an ADL telemonitoring system aligned with the requirements of key stakeholders, (2) deploy the system in a real clinical environment to identify specific use cases, and (3) identify factors conducive to its sustained use in a real-world setting. Given the context of the SAPA project, the adoption of an action design research (ADR) approach was deemed crucial. ADR is a framework for crafting practical solutions to intricate problems encountered in a specific organizational context. Methods: This project consisted of 2 cycles of development (alpha and beta) that involved cyclical repetitions of stages 2 and 3 to develop a telemonitoring system for ADLs. Stakeholders, such as health care managers, clinicians, older adults, and their families, were included in each codevelopment cycle. Qualitative and quantitative data were collected throughout this project. Results: The first iterative cycle, the alpha cycle, took place from early 2016 to mid 2018. The first prototype of an ADL telemonitoring system was deployed in the homes of 4 individuals receiving home care services through a public health institution. The prototype was used to collect data about care recipients' ADL routines. Clinicians used the data to support their home care intervention plan, and the results are presented here. The prototype was successfully deployed and perceived as useful, although obstacles were encountered. Similarly, a second codevelopment cycle (beta cycle) took place in 3 public health institutions from late 2018 to late 2022. The telemonitoring system was installed in 31 care recipients' homes, and detailed results will be presented in future papers. Conclusions: To our knowledge, this is the first reported ADR project in ADL telemonitoring research that includes 2 iterative cycles of codevelopment and deployment embedded in the real-world clinical settings of a public health system. We discuss the artifacts, generalization of learning, and dissemination generated by this protocol in the hope of providing a concrete and replicable example of research partnerships in the field of digital health in cognitive aging. International Registered Report Identifier (IRRID): RR1-10.2196/52284 ", doi="10.2196/52284", url="https://www.researchprotocols.org/2024/1/e52284", url="http://www.ncbi.nlm.nih.gov/pubmed/38422499" } @Article{info:doi/10.2196/48132, author="Onseng, Pansiree and Jiraporncharoen, Wichuda and Moonkayaow, Sasiwimon and Veerasirikul, Pimchai and Wiwatkunupakarn, Nutchar and Angkurawaranon, Chaisiri and Pinyopornpanish, Kanokporn", title="Expectation, Attitude, and Barriers to Receiving Telehomecare Among Caregivers of Homebound or Bedridden Older Adults: Qualitative Study", journal="JMIR Aging", year="2024", month="Feb", day="7", volume="7", pages="e48132", keywords="telehomecare", keywords="telemedicine", keywords="telehealth", keywords="caregivers", keywords="older adults", keywords="attitudes", abstract="Background: In recent years, telehomecare has become an increasingly important option for health care providers to deliver continuous care to their patients. Objective: This study aims to explore the expectations, attitudes, and barriers to telehomecare among caregivers of homebound or bedridden older adults. Methods: 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. Results: 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. Conclusions: 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. ", doi="10.2196/48132", url="https://aging.jmir.org/2024/1/e48132", url="http://www.ncbi.nlm.nih.gov/pubmed/38324373" } @Article{info:doi/10.2196/51544, author="Bauernschmidt, Dorothee and Wittmann, Janina and Hirt, Julian and Meyer, Gabriele and Bieber, Anja", title="The Implementation Success of Technology-Based Counseling in Dementia Care: Scoping Review", journal="JMIR Aging", year="2024", month="Jan", day="25", volume="7", pages="e51544", keywords="implementation success", keywords="implementation outcomes", keywords="counseling", keywords="technology", keywords="dementia", abstract="Background: 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. Objective: We aimed to review the knowledge about the implementation success of technology-based counseling interventions for people with dementia and their informal caregivers. Methods: 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 implementation success 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. Results: 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. Conclusions: 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 implementation success, 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. Trial Registration: PROSPERO CRD42021245473; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=245473 ", doi="10.2196/51544", url="https://aging.jmir.org/2024/1/e51544", url="http://www.ncbi.nlm.nih.gov/pubmed/38271050" } @Article{info:doi/10.2196/50286, author="Bergsch{\"o}ld, M. Jenny and Gunnes, Mari and Eide, H. Arne and Lassemo, Eva", title="Characteristics and Range of Reviews About Technologies for Aging in Place: Scoping Review of Reviews", journal="JMIR Aging", year="2024", month="Jan", day="22", volume="7", pages="e50286", keywords="aging in place", keywords="technology", keywords="gerontechnology", keywords="assistive technology", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="aging", keywords="scoping", keywords="review methods", keywords="review methodology", keywords="older people", keywords="evidence map", keywords="evidence mapping", abstract="Background: It is a contemporary and global challenge that the increasing number of older people requiring care will surpass the available caregivers. Solutions are needed to help older people maintain their health, prevent disability, and delay or avoid dependency on others. Technology can enable older people to age in place while maintaining their dignity and quality of life. Literature reviews on this topic have become important tools for researchers, practitioners, policy makers, and decision makers who need to navigate and access the extensive available evidence. Due to the large number and diversity of existing reviews, there is a need for a review of reviews that provides an overview of the range and characteristics of the evidence on technology for aging in place. Objective: This study aimed to explore the characteristics and the range of evidence on technologies for aging in place by conducting a scoping review of reviews and presenting an evidence map that researchers, policy makers, and practitioners may use to identify gaps and reviews of interest. Methods: The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Literature searches were conducted in Web of Science, PubMed, and Scopus using a search string that consisted of the terms ``older people'' and ``technology for ageing in place,'' with alternate terms using Boolean operators and truncation, adapted to the rules for each database. Results: A total of 5447 studies were screened, with 344 studies included after full-text screening. The number of reviews on this topic has increased dramatically over time, and the literature is scattered across a variety of journals. Vocabularies and approaches used to describe technology, populations, and problems are highly heterogeneous. We have identified 3 principal ways that reviews have dealt with populations, 5 strategies that the reviews draw on to conceptualize technology, and 4 principal types of problems that they have dealt with. These may be understood as methods that can inform future reviews on this topic. The relationships among populations, technologies, and problems studied in the reviews are presented in an evidence map that includes pertinent gaps. Conclusions: Redundancies and unexploited synergies between bodies of evidence on technology for aging in place are highly likely. These results can be used to decrease this risk if they are used to inform the design of future reviews on this topic. There is a need for an examination of the current state of the art in knowledge on technology for aging in place in low- and middle-income countries, especially in Africa. ", doi="10.2196/50286", url="https://aging.jmir.org/2024/1/e50286", url="http://www.ncbi.nlm.nih.gov/pubmed/38252472" } @Article{info:doi/10.2196/48031, author="Tanner, Alexandra and Urech, Andreas and Schulze, Hartmut and Manser, Tanja", title="Older Adults' Engagement and Mood During Robot-Assisted Group Activities in Nursing Homes: Development and Observational Pilot Study", journal="JMIR Rehabil Assist Technol", year="2023", month="Dec", day="25", volume="10", pages="e48031", keywords="human-robot interaction", keywords="social robot", keywords="nursing home", keywords="observational research", keywords="group activity", keywords="observational", keywords="pilot study", keywords="robot", keywords="engagement", keywords="mood", keywords="well-being", keywords="cognitive", keywords="elderly", keywords="nursing", keywords="aging", abstract="Background: Promoting the well-being of older adults in an aging society requires new solutions. One resource might be the use of social robots for group activities that promote physical and cognitive stimulation. Engaging in a robot-assisted group activity may help in the slowdown of physical and cognitive decline in older adults. Currently, our knowledge is limited on whether older adults engage in group activities with humanlike social robots and whether they experience a positive affect while doing so. Both are necessary preconditions to achieve the intended effects of a group activity. Objective: Our pilot study has 2 aims. First, we aimed to develop and pilot an observational coding scheme for robot-assisted group activities because self-report data on engagement and mood of nursing home residents are often difficult to obtain, and the existing observation instruments do have limitations. Second, we aimed to investigate older adults' engagement and mood during robot-assisted group activities in 4 different nursing care homes in the German-speaking part of Switzerland. Methods: We developed an observation system, inspired by existing tools, for a structured observation of engagement and mood of older adults during a robot-assisted group activity. In this study, 85 older adult residents from 4 different care homes in Switzerland participated in 5 robot-assisted group activity sessions, and they were observed using our developed system. The data were collected in the form of video clips that were assessed by 2 raters regarding engagement (direction of gaze, posture as well as body expression, and activity) and mood (positive and negative affects). Both variables were rated on a 5-point rating scale. Results: Our pilot study findings show that the engagement and mood of older adults can be assessed reliably by using the proposed observational coding scheme. Most participants actively engaged in robot-assisted group activities (mean 4.19, SD 0.47; median 4.0). The variables used to measure engagement were direction of gaze (mean 4.65, SD 0.49; median 5.0), posture and body expression (mean 4.03, SD 0.71; median 4.0), and activity (mean 3.90, SD 0.65; median 4.0). Further, we observed mainly positive affects in this group. Almost no negative affect was observed (mean 1.13, SD 0.20; median 1.0), while the positive affect (mean 3.22, SD 0.55; median 3.2) was high. Conclusions: The developed observational coding system can be used and further developed in future studies on robot-assisted group activities in the nursing home context and potentially in other settings. Additionally, our pilot study indicates that cognitive and physical stimulation of older adults can be promoted by social robots in a group setting. This finding encourages future technological development and improvement of social robots and points to the potential of observational research to systematically evaluate such developments. ", doi="10.2196/48031", url="https://rehab.jmir.org/2023/1/e48031", url="http://www.ncbi.nlm.nih.gov/pubmed/38145484" } @Article{info:doi/10.2196/47997, author="Fothergill, Lauren and Holland, Carol and Latham, Yvonne and Hayes, Niall", title="Understanding the Value of a Proactive Telecare System in Supporting Older Adults' Independence at Home: Qualitative Interview Study Among Key Interest Groups", journal="J Med Internet Res", year="2023", month="Dec", day="14", volume="25", pages="e47997", keywords="older adults", keywords="telecare", keywords="independent living", keywords="health and well-being", abstract="Background: Telecare is claimed to support people to live in their own homes for longer by providing monitoring services that enable responses to emergencies at home. Although most telecare technologies commissioned in the United Kingdom predominantly supply reactive services, there has been recent interest among policy makers to develop proactive telecare services to provide additional understanding of older adults' health and well-being needs to provide a means for more preventive interventions. Proactive telecare refers to providing regular well-being calls or encouraging users to regularly confirm their well-being to anticipate and prevent crises through an increased understanding of individuals' needs and by building social relationships with older adults. Such technologies have already begun to be introduced, yet little research has explored the potential value of proactive telecare. Objective: This study explores the perceptions of different interest groups to understand the extent to which using a proactive telecare service can support older adults to live independently, what potential health and well-being benefits may be elicited from its use, and what the limitations are. Methods: Semistructured interviews were conducted with older people (those with experience in using proactive telecare and those without), family members of proactive telecare users, and proactive telecare staff regarding their perceptions and opinions about the value of a proactive telecare service. Data were analyzed using inductive thematic analysis. Results: A total of 30 individuals participated in this study. Older adults described the value of proactive telecare in feeling safe and in control and appreciated feeling connected. Family members and staff valued the potential to detect early health deterioration in older adults, and all participants highlighted the benefit of strengthening access to social networks, particularly for socially isolated older people. However, telecare is often viewed as a last resort, and therefore, anticipatory care may not suit all populations, as demonstrated by the mixed acceptance of the technology among older adults who did not have experience using it. Participants also reported limitations, including the requirement for family, friends, or neighbors to assist older adults during an emergency and the need for financial resources to fund the service. Conclusions: This study presents the first known qualitative inquiry about a proactive telecare system, which provides rich and detailed insights from different perspectives into the potential benefits of this intervention. Proactive telecare may promote and facilitate the accumulation of social and technological resources as individuals prepare to cope with age-related challenges, thus helping to avoid negative outcomes prematurely. However, similar to reactive telecare, proactive telecare must be matched to individual preferences and existing financial and social resources. ", doi="10.2196/47997", url="https://www.jmir.org/2023/1/e47997", url="http://www.ncbi.nlm.nih.gov/pubmed/38096023" } @Article{info:doi/10.2196/46430, author="Esmaeilzadeh, Pouyan", title="Older Adults' Perceptions About Using Intelligent Toilet Seats Beyond Traditional Care: Web-Based Interview Survey", journal="JMIR Mhealth Uhealth", year="2023", month="Dec", day="1", volume="11", pages="e46430", keywords="older adults", keywords="age tech", keywords="intelligent toilet seat", keywords="survey interview", keywords="qualitative study", keywords="mobile phone", abstract="Background: In contemporary society, age tech (age technology) represents a significant advancement in health care aimed at enhancing patient engagement, ensuring sustained independence, and promoting quality of life for older people. One innovative form of age tech is the intelligent toilet seat, which is designed to collect, analyze, and provide insights based on toileting logs and excreta data. Understanding how older people perceive and interact with such technology can offer invaluable insights to researchers, technology developers, and vendors. Objective: This study examined older adults' perspectives regarding the use of intelligent toilet seats. Through a qualitative methodology, this research aims to unearth the nuances of older people's opinions, shedding light on their preferences, concerns, and potential barriers to adoption. Methods: Data were collected using a web-based interview survey distributed on Amazon Mechanical Turk. The analyzed data set comprised 174 US-based individuals aged ?65 years who voluntarily participated in this study. The qualitative data were carefully analyzed using NVivo (Lumivero) based on detailed content analysis, ensuring that emerging themes were coded and classified based on the conceptual similarities in the respondents' narratives. Results: The analysis revealed 5 dominant themes encompassing the opinions of aging adults. The perceived benefits and advantages of using the intelligent toilet seat were grouped into 3 primary themes: health-related benefits including the potential for early disease detection, continuous health monitoring, and seamless connection to health care insights. Technology-related advantages include the noninvasive nature of smart toilet seats and leveraging unique and innovative data collection and analysis technology. Use-related benefits include ease of use, potential for multiple users, and cost reduction owing to the reduced need for frequent clinical visits. Conversely, the concerns and perceived risks were classified into 2 significant themes: psychological concerns, which included concerns about embarrassment and aging-related stereotypes, and the potential emotional impact of constant health monitoring. Technical performance risks include concerns centered on privacy and security, device reliability, data accuracy, potential malfunctions, and the implications of false positives or negatives. Conclusions: The decision of older adults to incorporate intelligent toilet seats into their daily lives depends on myriad factors. Although the potential health and technological benefits are evident, valid concerns that need to be addressed remain. To foster widespread adoption, it is imperative to enhance the advantages while simultaneously addressing and mitigating the identified risks. This balanced approach will pave the way for a more holistic integration of smart health care devices into the routines of the older population, ensuring that they reap the full benefits of age tech advancements. ", doi="10.2196/46430", url="https://mhealth.jmir.org/2023/1/e46430", url="http://www.ncbi.nlm.nih.gov/pubmed/38039065" } @Article{info:doi/10.2196/47510, author="Ferreira, Moraes P{\^a}mela and Gomes, Cunha Mateus and de Araujo, Nascimento Lucianne and Oliveira, de Tain{\'a} Sayuri Onuma and Ferreira, Glenda and Aben-Athar, Cintia and da Silva, Dias Silvio Eder and Cruz Ramos, P. Aline M. and Rodrigues, Pereira Diego and Sousa, Fabianne", title="Sociodemographic Profile, Health Conditions, and Burden of Informal Caregivers of Older Adults in Brazil During the COVID-19 Pandemic: Cross-Sectional, Exploratory, Noninterventional, Descriptive Study", journal="JMIR Form Res", year="2023", month="Nov", day="23", volume="7", pages="e47510", keywords="informal caregivers", keywords="older adult", keywords="caregiver", keywords="caregivers", keywords="caregiving", keywords="burden", keywords="informal care", keywords="cross-sectional", keywords="gerontology", keywords="older adults", keywords="hospitalized", keywords="overload", keywords="burnout", abstract="Background: Demographic changes in the world population have resulted in an increasingly aging society, with a progressive increase in the number of people in situations of dependence, who require assistance from family members to meet their basic needs. Caring for older adults involves performing diverse activities, resulting in reduced free time and tiredness, and fulfilling the demands and expectations related to personal, family, physical, and social life, consequently compromising the quality of life of the caregiver. In this context, the informal caregiver of hospitalized older adults emerges as the focus of attention. Objective: The aim of this study was to describe the sociodemographic profile, health conditions, and burden of informal caregivers of older adults admitted to a university hospital in Brazil during the COVID-19 pandemic period. Methods: This is a cross-sectional, descriptive, and analytical study that was conducted with 25 informal caregivers of hospitalized older adults in a university hospital in Brazil between August and September 2022. Three instruments were applied: Caregiver Burden Inventory, sociodemographic questionnaire, and health conditions questionnaire. The data were analyzed using SPSS version 28.0. Descriptive (frequency and percentage) and inferential analyses were performed using 2-sided Student t test with 95\% CIs. Results: Of the 25 interviewees, 18 (72\%) were females, 17 (46\%) were married or in a stable union, 14 (56\%) completed secondary education, and 11 (44\%) lived with the older adults who needed care. The average age of the participants was 44 (SD 12.8) years. Regarding their health conditions, most caregivers self-reported it as good (12/25, 48\%). They provided care to their father or mother older than 70 years (14/25, 56\%). The Caregiver Burden Inventory analysis showed that the caregivers were the most negatively impacted in the domains of personal life overload (mean 10.8, SD 3.46; P=.047) and physical overload (mean 10.6, SD 2.32; P=.02). Conclusions: In recent years, there has been an increase in the burden on informal caregivers of hospitalized older adults in Brazil, thereby impacting their personal and physical lives. The findings of our study show that health care professionals should be trained to promote health guidelines and actions to improve the personal and physical lives of the caregiver population in Brazil. ", doi="10.2196/47510", url="https://formative.jmir.org/2023/1/e47510", url="http://www.ncbi.nlm.nih.gov/pubmed/37995120" } @Article{info:doi/10.2196/45875, author="Davoodi, Mansoor and Batista, Ana and Mertel, Adam and Senapati, Abhishek and Abdussalam, Wildan and Vyskocil, Jiri and Barbieri, Giuseppe and Fan, Kai and Schlechte-Welnicz, Weronika and M Calabrese, Justin", title="A Web-Based COVID-19 Tool for Testing Residents in Retirement Homes: Development Study", journal="JMIR Form Res", year="2023", month="Nov", day="21", volume="7", pages="e45875", keywords="application", keywords="COVID-19", keywords="optimized testing", keywords="pandemic", keywords="retirement home", keywords="web application", abstract="Background: Long-term care facilities have been widely affected by the COVID-19 pandemic. Empirical evidence demonstrated that older people are the most impacted and are at higher risk of mortality after being infected. Regularly testing care facility residents is a practical approach to detecting infections proactively. In many cases, the care staff must perform the tests on the residents while also providing essential care, which in turn causes imbalances in their working time. Once an outbreak occurs, suppressing the spread of the virus in retirement homes (RHs) is challenging because the residents are in contact with each other, and isolation measures cannot be widely enforced. Regular testing strategies, on the other hand, have been shown to effectively prevent outbreaks in RHs. However, high-frequency testing may consume substantial staff working time, which results in a trade-off between the time invested in testing and the time spent providing essential care to residents. Objective: We developed a web application (Retirement Home Testing Optimizer) to assist RH managers in identifying effective testing schedules for residents. The outcome of the app, called the ``testing strategy,'' is based on dividing facility residents into groups and then testing no more than 1 group per day. Methods: We created the web application by incorporating influential factors such as the number of residents and staff, the average rate of contacts, the amount of time spent to test, and constraints on the test interval and size of groups. We developed mixed integer nonlinear programming models for balancing staff workload in long-term care facilities while minimizing the expected detection time of a probable infection inside the facility. Additionally, by leveraging symmetries in the problem, we proposed a fast and efficient local search method to find the optimal solution. Results: Considering the number of residents and staff and other practical constraints of the facilities, the proposed application computes the optimal trade-off testing strategy and suggests the corresponding grouping and testing schedule for residents. The current version of the application is deployed on the server of the Where2Test project and is accessible on their website. The application is open source, and all contents are offered in English and German. We provide comprehensive instructions and guidelines for easy use and understanding of the application's functionalities. The application was launched in July 2022, and it is currently being tested in RHs in Saxony, Germany. Conclusions: Recommended testing strategies by our application are tailored to each RH and the goals set by the managers. We advise the users of the application that the proposed model and approach focus on the expected scenarios, that is, the expected risk of infection, and they do not guarantee the avoidance of worst-case scenarios. ", doi="10.2196/45875", url="https://formative.jmir.org/2023/1/e45875", url="http://www.ncbi.nlm.nih.gov/pubmed/37988136" } @Article{info:doi/10.2196/36324, author="Moon, Hui-Woun and Park, Me Da Som and Jung, Young Se", title="Use of the Smart Excretion Care System Linked to Electronic Medical Records to Alleviate Nursing Burden and Enhance Patient Convenience: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Oct", day="30", volume="7", pages="e36324", keywords="care", keywords="caregiving", keywords="instrument development", keywords="elderly", keywords="quality of life", keywords="ergonomics", keywords="focus groups", keywords="musculoskeletal", keywords="usability", keywords="feasibility", keywords="digital health intervention", keywords="digital health", keywords="health intervention", keywords="nursing", keywords="electronic medical record", abstract="Background: The surge in older demographics has inevitably resulted in a heightened demand for health care, and a shortage of nursing staff is impending. Consequently, there is a growing demand for the development of nursing robots to assist patients with urinary and bowel elimination. However, no study has examined nurses' opinions of smart devices that provide integrated nursing for patients' urinary and bowel elimination needs. Objective: This study aimed to evaluate the feasibility of the Smart Excretion Care System tethered to electronic medical records in a tertiary hospital and community care setting and discuss the anticipated reductions in the burden of nursing care. Methods: Focus group interviews were conducted using the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The interviews were conducted in March 2021 and involved 67 nurses who had worked at Seoul National University Bundang Hospital for more than 1 year and had experience in assisting patients with excretion care. Data were collected using purposive and snowball sampling methods. Results: A total of four themes relevant to the Smart Excretion Care System were found: (1) expected reductions in the burden of nursing care, (2) applicable indications (by departments and diseases), (3) preferred features/functions, and (4) expected benefits of using the Smart Excretion Care System in clinical facilities. Nurses from comprehensive nursing care wards had the highest burden when it came to excretion care. It was a common opinion that the Smart Excretion Care System would be very useful in intensive care units and should be applied first to patients with stroke or dementia. Conclusions: Excretion care is one of the most burdensome tasks for nurses, increasing their workload. The development of the Smart Excretion Care System as a digital health intervention could help improve nurses' work efficiency, reduce their burden, and extend to caregivers and guardians. ", doi="10.2196/36324", url="https://formative.jmir.org/2023/1/e36324", url="http://www.ncbi.nlm.nih.gov/pubmed/37902820" } @Article{info:doi/10.2196/49500, author="Aclan, Roslyn and George, Stacey and Laver, Kate", title="A Digital Tool for the Self-Assessment of Homes to Increase Age-Friendliness: Validity Study", journal="JMIR Aging", year="2023", month="Oct", day="26", volume="6", pages="e49500", keywords="age-friendliness", keywords="aging", keywords="home environment", keywords="self-assessment", keywords="digital", keywords="tool", abstract="Background: Age-friendly environments in homes and communities play an important role in optimizing the health and well-being of society. Older people have strong preferences for remaining at home as they age. Home environment assessment tools that enable older people to assess their homes and prepare for aging in place may be beneficial. Objective: This study aims to establish the validity of a digital self-assessment tool by assessing it against the current gold standard, an occupational therapy home assessment. Methods: A cohort of adults aged ?60 years living in metropolitan Adelaide, South Australia, Australia, assessed their homes using a digital self-assessment tool with 89 questions simultaneously with an occupational therapist. Adults who were living within their homes and did not have significant levels of disabilities were recruited. Cohen $\kappa$ and Gwet AC1 were used to assess validity. Results: A total of 61 participants (age: mean 71.2, SD 7.03 years) self-assessed their own homes using the digital self-assessment tool. The overall levels of agreement were high, supporting the validity of the tool in identifying potential hazards. Lower levels of agreement were found in the following domains: steps (77\% agreement, Gwet AC1=0.56), toilets (56\% agreement, $\kappa$=0.10), bathrooms (64\% agreement, $\kappa$=0.46), and backyards (55\% agreement, $\kappa$=0.24). Conclusions: Older people were able to self-assess their homes using a digital self-assessment tool. Digital health tools enable older people to start thinking about their future housing needs. Innovative tools that can identify problems and generate solutions may improve the age-friendliness of the home environment. ", doi="10.2196/49500", url="https://aging.jmir.org/2023/1/e49500", url="http://www.ncbi.nlm.nih.gov/pubmed/37883134" } @Article{info:doi/10.2196/49319, author="Sharma, Nikita and Braakman-Jansen, A. Louise M. and Oinas-Kukkonen, Harri and Croockewit, Hendrik Jan and Gemert-Pijnen, van JEWC", title="Exploring the Needs and Requirements of Informal Caregivers of Older Adults With Cognitive Impairment From Sensor-Based Care Solutions: Multimethod Study", journal="JMIR Aging", year="2023", month="Oct", day="25", volume="6", pages="e49319", keywords="informal caregiving", keywords="cognitive impairment", keywords="unobtrusive sensing solutions", keywords="in-home care", keywords="aging in place", keywords="assistive technologies", abstract="Background: With the increase in the older adult population, sensor-based care solutions that can monitor the deviations in physical, emotional, and physiological activities in real-time from a distance are demanded for prolonging the stay of community-dwelling older adults with cognitive impairment. To effectively develop and implement these care solutions, it is important to understand the current experiences, future expectations, perceived usefulness (PU), and communication needs of the informal caregivers of older adults with cognitive impairment regarding such solutions. Objective: This comprehensive study with informal caregivers of older adults with cognitive impairment aims to (1) highlight current experiences with (if any) and future expectations from general sensor-based care solutions, (2) explore PU specifically toward unobtrusive sensing solutions (USSs), (3) determine the information communication (IC) needs and requirements for communicating the information obtained through USSs in different care scenarios (fall, nocturnal unrest, agitation, and normal daily life), and (4) elicit the design features for designing the interaction platform in accordance with the persuasive system design (PSD) model. Methods: A multimethod research approach encompassing a survey (N=464) and in-depth interviews (10/464, 2.2\%) with informal caregivers of older adults with cognitive impairment was used. The insights into past experiences with and future expectations from the sensor-based care solutions were obtained through inductive thematic analysis of the interviews. A convergent mixed methods approach was used to explore PU and gather the IC needs from USSs by using scenario-specific questions in both survey and interviews. Finally, the design features were elicited by using the PSD model on the obtained IC needs and requirements. Results: Informal caregivers expect care infrastructure to consider centralized and empathetic care approaches. Specifically, sensor-based care solutions should be adaptable to care needs, demonstrate trust and reliability, and ensure privacy and safety. Most informal caregivers found USSs to be useful for emergencies (mean 4.09, SD 0.04) rather than for monitoring normal daily life activities (mean 3.50, SD 0.04). Moreover, they display variations in information needs including mode, content, time, and stakeholders involved based on the care scenario at hand. Finally, PSD features, namely, reduction, tailoring, personalization, reminders, suggestions, trustworthiness, and social learning, were identified for various care scenarios. Conclusions: From the obtained results, it can be concluded that the care scenario at hand drives PU and IC design needs and requirements toward USSs. Therefore, future technology developers are recommended to develop technology that can be easily adapted to diverse care scenarios, whereas designers of such sensor-driven platforms are encouraged to go beyond tailoring and strive for strong personalization while maintaining the privacy of the users. ", doi="10.2196/49319", url="https://aging.jmir.org/2023/1/e49319", url="http://www.ncbi.nlm.nih.gov/pubmed/37878353" } @Article{info:doi/10.2196/46995, author="Matos Queir{\'o}s, Alcina and von Gunten, Armin and Rosselet Amoussou, Jo{\"e}lle and Martins, Manuela Maria and Verloo, Henk", title="Relationship Between Depression and Falls Among Nursing Home Residents: Protocol for an Integrative Review", journal="JMIR Res Protoc", year="2023", month="Oct", day="19", volume="12", pages="e46995", keywords="depression", keywords="falls", keywords="nursing homes", keywords="nursing home residents", keywords="older adults", keywords="fall risk", keywords="intervention", abstract="Background: Aging exposes individuals to new health disorders and debilitating chronic diseases, yet most older adults, even in functional decline, do not want to leave their homes. Nevertheless, for many, institutionalization in a nursing home (NH) may become essential to ensure their continued safety and health. Depression is one of the most common psychiatric disorders among older adults, especially among those who are institutionalized. Depressed NH residents face a high risk of future functional decline and falls, decreasing their quality of life. The relationship between depression and falls is complex and bidirectional. Previous reviews have focused on home-dwelling older adults or explored the relationship between antidepressant drugs and falls. To the best of our knowledge, no integrative literature reviews have explored the relationship between depression and falls among NH residents. Objective: Analyze studies on the relationship between depression and falls among NH residents. Methods: We will conduct an integrative literature review of published articles in relevant scientific journals on the relationship between depression and depressive symptomatology and falls among NH residents. As usually defined, we will consider NH residents to be people aged 65 years and older who can no longer live safely and independently in their homes. We will also consider older adults on short-term stays in an NH for rehabilitation after hospital discharge. Retrieved articles will be screened for eligibility and analyzed following previously reported steps. The most pertinent bibliographical databases will be examined for qualitative, quantitative, and mixed methods studies, from inception until August 31, 2023, thus ensuring that all relevant literature is included. We will also hand-search the bibliographies of all the relevant articles found and search for unpublished studies in any language. If appropriate, we will consider conducting a meta-analysis of the studies retrieved. Results: A first round of data collection was completed in March 2023. We retrieved a total of 2276 references. A supplementary literature search to ensure the most up-to-date evidence is ongoing. We anticipate that the review will be completed in late September 2023, and we expect to publish results at the end of December 2023. Conclusions: This integrative review will increase knowledge and understanding of the complex relationship between depression and falls in NH environments. Its findings will be important for developing integrated, multidisciplinary models and care recommendations, adaptable to each NH resident's situation and health status, and for creating preventive interventions to help them maintain or recover optimal health stability. International Registered Report Identifier (IRRID): DERR1-10.2196/46995 ", doi="10.2196/46995", url="https://www.researchprotocols.org/2023/1/e46995", url="http://www.ncbi.nlm.nih.gov/pubmed/37856175" } @Article{info:doi/10.2196/45442, author="Randall, Natasha and Kamino, Waki and Joshi, Swapna and Chen, Wei-Chu and Hsu, Long-Jing and Tsui, M. Katherine and {\vS}abanovi{\'c}, Selma", title="Understanding the Connection Among Ikigai, Well-Being, and Home Robot Acceptance in Japanese Older Adults: Mixed Methods Study", journal="JMIR Aging", year="2023", month="Oct", day="4", volume="6", pages="e45442", keywords="ikigai", keywords="meaning in life", keywords="purpose", keywords="well-being", keywords="eudaimonic", keywords="hedonic", keywords="happiness", keywords="home robots", keywords="social robots", keywords="human-robot interaction", keywords="Japan", abstract="Background: Ikigai (meaning or purpose in life) is a concept understood by most older adults in Japan. The term has also garnered international attention, with recent academic attempts to map it to concepts in the Western well-being literature. In addition, efforts to use social and home robots to increase well-being have grown; however, they have mostly focused on hedonic well-being (eg, increasing happiness and decreasing loneliness) rather than eudaimonic well-being (eg, fostering meaning or purpose in life). Objective: First, we explored how Japanese older adults experience ikigai and relate these to concepts in the Western well-being literature. Second, we investigated how a home robot meant to promote ikigai is perceived by older adults. Methods: We used a mixed methods research design---including 20 interviews with older adults, a survey of 50 older adults, and 10 interviews with family caregivers. For interviews, we asked questions about older adults' sources of ikigai, happiness, and social support, along with their perception of the robot (QT). For surveys, a number of well-being scales were used, including 2 ikigai scales---ikigai-9 and K-1---and 6 Patient-Reported Outcomes Measurement Information System scales, measuring meaning and purpose, positive affect, satisfaction with participation in social roles, satisfaction with participation in discretionary social activities, companionship, and emotional support. Questions related to the perception and desired adoption of the robot and older adults' health status were also included. Results: Our results suggest that health is older adults' most common source of ikigai. Additionally, although self-rated health correlated moderately with ikigai and other well-being measures, reported physical limitation did not. As opposed to social roles (work and family), we found that ikigai is more strongly related to satisfaction with discretionary social activities (leisure, hobbies, and friends) for older adults. Moreover, we found that older adults' sources of ikigai included the eudaimonic aspects of vitality, positive relations with others, contribution, accomplishment, purpose, and personal growth, with the first 3 being most common, and the hedonic aspects of positive affect, life satisfaction, and lack of negative affect, with the first 2 being most common. However, the concept of ikigai was most related to eudaimonic well-being, specifically meaning in life, along the dimension of significance. Finally, we found that Japanese older adults have high expectations of a home robot for well-being, mentioning that it should support them in a multitude of ways before they would likely adopt it. However, we report that those with the highest levels of meaning, and satisfaction with their leisure life and friendships, may be most likely to adopt it. Conclusions: We outline several ways to improve the robot to increase its acceptance, such as improving its voice, adding functional features, and designing it to support multiple aspects of well-being. ", doi="10.2196/45442", url="https://aging.jmir.org/2023/1/e45442", url="http://www.ncbi.nlm.nih.gov/pubmed/37792460" } @Article{info:doi/10.2196/48753, author="Kanninen, Carita Jonna and Holm, Anu and Koivisto, Anna-Liisa and Hietasalo, Pauliina and Heikkil{\"a}, Anna-Maija and Kunvik, Susanna and Bergman, Jussi and Airaksinen, Marja and Puustinen, Juha", title="Development of a Preventive Health Screening Procedure Enabling Supportive Service Planning for Home-Dwelling Older Adults (PORI75): Protocol for an Action Research Study", journal="JMIR Res Protoc", year="2023", month="Oct", day="3", volume="12", pages="e48753", keywords="health screening", keywords="older adults", keywords="community health care", keywords="secondary use", keywords="Finland", keywords="screening", keywords="supportive service", keywords="clinical patient data", keywords="community", keywords="develop", keywords="primary care", keywords="self-assessment", keywords="pilot test", keywords="testing", keywords="planning", keywords="data collection", abstract="Background: In Finland, at least 1 in 4 residents will be >75 years of age in 2030. The national aging policy has emphasized the need to improve supportive services to enable older people to live in their own homes for as long as possible. Objective: This study aimed to develop a preventive health screening procedure for home-dwelling older adults aged 75 years to enable the use of clinical patient data for purposes of strategic planning of supportive services in primary care. Methods: The action research method was applied to develop the health screening procedure with selected validated health measures in cooperation with the local practicing interprofessional health care teams from 10 primary care centers in the Social Security Center of Pori, Western Finland (99,485 residents, n=11,938, 12\% of them >75 years). The selection of evidence-based validated health measures was based on the national guide to screen factors increasing fall risk and the national functioning measures database. The cut-off points of the selected health measures and laboratory tests were determined in consecutive consensus meetings with the local primary care physicians, with decisions based on internationally validated measures, national current care guidelines, and local policies in clinical practice. Results: The health screening procedure for 75-year-old residents comprised 30 measures divided into three categories: (1) validated self-assessments (9 measures), (2) nurse-conducted screenings (14 measures), and (3) laboratory tests (7 measures). The procedure development process comprised the following steps: (1) inventory and selection of the validated health measures and laboratory tests, (2) training of practical nurses to perform screenings for the segment of 75-year-old residents and to guide them to possible further medical actions, (3) creation of research data from clinical patient data for secondary use purposes, (4) secondary data analysis, and (5) consensus meeting after the pilot test of the health screening procedure for 75-year-old residents procedure in 2019 based on the experiences of health care professionals and collected research data. Conclusions: The developed preventive health screening procedure for 75-year-old residents enables the use of clinical patient data for purposes of strategic planning of supportive services in primary care if the potential bias by a low participation rate is controlled. International Registered Report Identifier (IRRID): DERR1-10.2196/48753 ", doi="10.2196/48753", url="https://www.researchprotocols.org/2023/1/e48753", url="http://www.ncbi.nlm.nih.gov/pubmed/37788079" } @Article{info:doi/10.2196/46480, author="Krafft, Jelena and Barisch-Fritz, Bettina and Krell-Roesch, Janina and Trautwein, Sandra and Scharpf, Andrea and Woll, Alexander", title="A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study", journal="JMIR Aging", year="2023", month="Aug", day="22", volume="6", pages="e46480", keywords="dementia", keywords="individualized physical exercise", keywords="tailored exercise", keywords="physical activity", keywords="older adults", keywords="app", keywords="mobile health", keywords="mHealth", keywords="usability", keywords="mobile phone", abstract="Background: The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia. Objective: This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach. Methods: Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively. Results: A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93\% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as ``good.'' The main usability issues concerned navigation logic and comprehensibility of app content. Conclusions: The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ?50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study. ", doi="10.2196/46480", url="https://aging.jmir.org/2023/1/e46480", url="http://www.ncbi.nlm.nih.gov/pubmed/37606974" } @Article{info:doi/10.2196/46753, author="Beogo, Idrissa and Sia, Drissa and Collin, Stephanie and Phaelle Gedeon, Andi and Louism{\'e}, Micha{\"e}l-Christopher and Ramd{\'e}, Jean and Gagnon, Marie-Pierre and Tchouaket Nguemeleu, Eric", title="Strengthening Social Capital to Address Isolation and Loneliness in Long-Term Care Facilities During the COVID-19 Pandemic: Systematic Review of Research on Information and Communication Technologies", journal="JMIR Aging", year="2023", month="Aug", day="14", volume="6", pages="e46753", keywords="information and communication technology", keywords="ICT", keywords="long-term care facilities", keywords="COVID-19", keywords="social isolation", keywords="loneliness", keywords="pandemic", keywords="implementation sciences", keywords="protocol", keywords="nursing home", keywords="mobile phone", abstract="Background: The COVID-19 pandemic has disproportionately and severely affected older adults, namely those living in long-term care facilities (LTCFs). Aside from experiencing high mortality rates, survivors were critically concerned by social isolation and loneliness (SIL). To address this serious public health concern and stay connected with LTCF residents, information and communication technology (ICT) platforms (eg, video calls) were used as an alternative to maintaining social interactions amid the visiting restriction policy. Objective: This paper aimed to synthesize the effects of ICT-related communication interventions using SMS text messaging or chat, video, voice mail, or photo to address SIL in LTCF residents during the COVID-19 pandemic. Methods: In total, 2793 references published in English and French in 2019 and onward were obtained from 10 relevant databases: PsycINFO-Ovid, Ovid-MEDLINE, CINAHL-EBSCO, Cochrane Library, Web of Science, Scopus, DirectScience, Communication \& Mass Media Complete, IEEE Xplore, and ACM Digital Library. A 2-person screening approach was used, and the studies were screened independently and blindly. A narrative synthesis was performed to interpret the results of the included studies, and their quality was appraised. Results: In total, 4 studies were included in the review. ICT-related applications were used to ensure connectedness to address SIL. ICT interventions consisted mainly of videoconferencing, intergroup video call sessions between residents, and chatting (SMS text messages and phone calls). Roughly 3 classes of mediating ICT tools were used: video calls using software applications (eg, Skype); robot systems embedding video telephones; and ordinary telecommunication such as telephone, internet, social media platforms, and videoconferencing. This review has included the role of humanoid robots in LTCFs as an innovation avenue because of their multipurpose use (eg, communication tools and remotely operable). Conclusions: Remote social capitalization through ICT applications has become an avenue to reduce SIL among LTCF residents. This review examined a social connection approach that will remain relevant and even be fostered after the COVID-19 pandemic. As families remain the main stakeholders of LTCFs, this study's findings could inform policy makers and frontline managers to better shape programs and initiatives to prevent or reduce SIL in LTCFs. International Registered Report Identifier (IRRID): RR2-10.2196/36269 ", doi="10.2196/46753", url="https://aging.jmir.org/2023/1/e46753", url="http://www.ncbi.nlm.nih.gov/pubmed/37578824" } @Article{info:doi/10.2196/45602, author="Zhang, Jinghui and Peng, Sha and Hou, Jianmei and Ma, Guiyuan and Liu, Yanhui and Fan, Yuhua and Luo, Lingxia and Shi, Zhengkun", title="Nurses' Willingness and Demand for Internet+Home Care Services and the Associated Factors in Municipal Hospitals in China: Cross-Sectional Survey", journal="J Med Internet Res", year="2023", month="Aug", day="4", volume="25", pages="e45602", keywords="Internet+home care services", keywords="willingness", keywords="demand", keywords="clinical nurses", keywords="municipal hospitals", abstract="Background: Developing Internet+home care (IHC) services is a promising way to address the problems related to population aging, which is an important global issue. However, IHC services are in their infancy in China. Limited studies have investigated the willingness and demand of nurses in municipal hospitals to provide IHC services. Objective: This study aims to investigate the willingness and demand of nurses in municipal hospitals in China to provide IHC services and analyze the factors to promote IHC development in China. Methods: This cross-sectional study used multistage sampling to recruit 9405 nurses from 10 hospitals in 5 regions of China. A self-designed questionnaire with good reliability and validity was used to measure nurses' willingness and demand for providing IHC services. Data analysis used the chi-square test, Welch t test, binary logistic regression analysis, and multiple linear regression analysis. Results: Nurses were highly willing to provide IHC services and preferred service distances of <5 km and times from 8 AM to 6 PM. An individual share >60\% was the expected service pay sharing. Job title, educational level, monthly income, and marital status were associated with nurses' willingness to provide IHC services in binary logistic regression analysis. Supervising nurses were 1.177 times more likely to express a willingness to provide IHC services than senior nurses. Nurses with a bachelor's degree had a 1.167 times higher likelihood of expressing willingness to provide IHC services than those with a junior college education or lower. Married nurses were 1.075 times more likely to express a willingness than unmarried nurses. A monthly income >{\textyen}10,000 increased the likelihood of nurses' willingness to provide IHC services, by 1.187 times, compared with an income <{\textyen}5000. Nurses' total mean demand score for IHC services was 17.38 (SD 3.67), with the highest demand being privacy protection. Multiple linear regression analysis showed that job title, monthly income, and educational level were associated with nurses' demand for IHC services. Supervising nurses (B=1.058, P<.001) and co-chief nurses or those with higher positions (B=2.574, P<.001) reported higher demand scores than senior nurses. Monthly incomes of {\textyen}5000 to {\textyen}10,000 (B=0.894, P<.001) and >{\textyen}10,000 (B=1.335, P<.001), as well as a bachelor's degree (B=0.484, P=.002) and at least a master's degree (B=1.224, P=.02), were associated with higher demand scores compared with a monthly income <{\textyen}5000 and junior college education or lower, respectively. Conclusions: Nurses in municipal hospitals showed a high willingness and demand to provide IHC services, with differences in willingness and demand by demographic characteristics. Accordingly, government and hospitals should regulate the service period, service distance, and other characteristics according to nurses' willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of IHC services. ", doi="10.2196/45602", url="https://www.jmir.org/2023/1/e45602", url="http://www.ncbi.nlm.nih.gov/pubmed/37540546" } @Article{info:doi/10.2196/41810, author="Stawarz, Katarzyna and Liang, Ju Ian and Alexander, Lyndsay and Carlin, Angela and Wijekoon, Anjana and Western, J. Max", title="Exploring the Potential of Technology to Promote Exercise Snacking for Older Adults Who Are Prefrail in the Home Setting: User-Centered Design Study", journal="JMIR Aging", year="2023", month="May", day="24", volume="6", pages="e41810", keywords="physical activity", keywords="older adults", keywords="Internet of Things", keywords="user-centered design", keywords="qualitative research", keywords="mobile phone", abstract="Background: Older adults are at increased risk of falls, injury, and hospitalization. Maintaining or increasing participation in physical activity during older age can prevent some of the age-related declines in physical functioning that contribute to loss of independence and low reported quality of life. Exercise snacking may overcome some commonly cited barriers to exercise and encourage older adults to engage in muscle strength and balance activity, but the best way to deliver and support this novel format remains unknown. Objective: Our aim was to explore how the novel exercise snacking approach, that is, incorporating short bouts of strength and balance activities into everyday routines, could be supported by technology within a home setting and what types of technologies would be acceptable for older adults who are prefrail. Methods: Following a user-centered design process, 2 design workshops (study 1) were conducted first to understand older adults' (n=11; aged 69-89 years) attitudes toward technology aimed at supporting exercise snacking at home and to inform the design of 2 prototypes. Next, based on the findings of study 1, an exploratory pilot study (study 2) was conducted over 1 day with 2 prototypes (n=5; aged 69-80 years) at the participants' homes. Participants were interviewed over the telephone afterward about their experience. Transcripts were analyzed using framework analysis. Results: The results showed that the participants were positive toward using technology at home to support exercise snacking, but both exercises and technology would need to be simple and match the participants' everyday routines. Workshop discussions (study 1) led to the design of 2 prototypes using a pressure mat to support resistance and balance exercises. The exploratory pilot study (study 2) participants reported the potential in using smart devices to support exercise snacking, but the design of the initial prototypes influenced the participants' attitudes toward them. It also hampered the acceptability of these initial versions and highlighted the challenges in fitting exercise snacking into everyday life. Conclusions: Older adults were positive about using technology in their homes to support strength and balance exercise snacking. However, although promising, the initial prototypes require further refinement and optimization before feasibility, acceptability, and efficacy testing. Technologies to support exercise snacking need to be adaptable and personalized to individuals, to ensure that users are snacking on balance and strengthening exercises that are appropriate for them. ", doi="10.2196/41810", url="https://aging.jmir.org/2023/1/e41810", url="http://www.ncbi.nlm.nih.gov/pubmed/37223992" } @Article{info:doi/10.2196/40606, author="Bin Noon, Gaya and Hanjahanja-Phiri, Thokozani and Dave, Harishree and Fadrique, Laura and Teague, Jennifer and Morita, P. Plinio", title="Exploring the Role of Active Assisted Living in the Continuum of Care for Older Adults: Thematic Analysis", journal="JMIR Aging", year="2023", month="May", day="22", volume="6", pages="e40606", keywords="ambient assisted living", keywords="active assisted living", keywords="AAL", keywords="internet of things", keywords="aging well", keywords="aging in place", keywords="older adults", keywords="geriatrics", keywords="standards", keywords="policies", keywords="health care", abstract="Background: Active assisted living (AAL) refers to systems designed to improve the quality of life, aid in independence, and create healthier lifestyles for those who need assistance at any stage of their lives. As the population of older adults in Canada grows, there is a pressing need for nonintrusive, continuous, adaptable, and reliable health monitoring tools to support aging in place and reduce health care costs. AAL has great potential to support these efforts with the wide variety of solutions currently available; however, additional work is required to address the concerns of care recipients and their care providers with regard to the integration of AAL into care. Objective: This study aims to work closely with stakeholders to ensure that the recommendations for system-service integrations for AAL aligned with the needs and capacity of health care and allied health systems. To this end, an exploratory study was conducted to understand the perceptions of, and concerns with, AAL technology use. Methods: A total of 18 semistructured group interviews were conducted with stakeholders, with each group comprising several participants from the same organization. These participant groups were categorized into care organizations, technology development organizations, technology integration organizations, and potential care recipient or patient advocacy groups. The results of the interviews were coded using a thematic analysis to identify future steps and opportunities regarding AAL. Results: The participants discussed how the use of AAL systems may lead to improved support for care recipients through more comprehensive monitoring and alerting, greater confidence in aging in place, and increased care recipient empowerment and access to care. However, they also raised concerns regarding the management and monetization of data emerging from AAL systems as well as general accountability and liability. Finally, the participants discussed potential barriers to the use and implementation of AAL systems, especially addressing the question of whether AAL systems are even worth it considering the investment required and encroachment on privacy. Other barriers raised included issues with the institutional decision-making process and equity. Conclusions: Better definition of roles is needed in terms of who can access the data and who is responsible for acting on the gathered data. It is important for stakeholders to understand the trade-off between using AAL technologies in care settings and the costs of AAL technologies, including the loss of patient privacy and control. Finally, further work is needed to address the gaps, explore the equity in AAL access, and develop a data governance framework for AAL in the continuum of care. ", doi="10.2196/40606", url="https://aging.jmir.org/2023/1/e40606", url="http://www.ncbi.nlm.nih.gov/pubmed/37213201" } @Article{info:doi/10.2196/44692, author="Chang, Fangyuan and {\"O}stlund, Britt and Kuoppam{\"a}ki, Sanna", title="Domesticating Social Alarm Systems in Nursing Homes: Qualitative Study of Differences in the Perspectives of Assistant Nurses", journal="J Med Internet Res", year="2023", month="May", day="5", volume="25", pages="e44692", keywords="technology implementation", keywords="nursing care", keywords="social alarm system", keywords="domestication", keywords="nursing home", keywords="technology integration", keywords="long-term care", keywords="social alarm", keywords="nursing", keywords="elder", keywords="older adult", keywords="aging", keywords="gerontology", keywords="geriatric", keywords="interview", keywords="qualitative", abstract="Background: New social alarm solutions are viewed as a promising approach to alleviate the global challenge of an aging population and a shortage of care staff. However, the uptake of social alarm systems in nursing homes has proven both complex and difficult. Current studies have recognized the benefits of involving actors such as assistant nurses in advancing these implementations, but the dynamics by which implementations are created and shaped in their daily practices and relations have received less attention. Objective: Based on domestication theory, this paper aims to identify the differences in the perspectives of assistant nurses when integrating a social alarm system into daily practices. Methods: We interviewed assistant nurses (n=23) working in nursing homes to understand their perceptions and practices during the uptake of social alarm systems. Results: During the four domestication phases, assistant nurses were facing different challenges including (1) system conceptualization; (2) spatial employment of social alarm devices; (3) treatment of unexpected issues; and (4) evaluation of inconsistent competence in technology use. Our findings elaborate on how assistant nurses have distinct goals, focus on different facets, and developed diverse coping strategies to facilitate the system domestication in different phases. Conclusions: Our findings reveal a divide among assistant nurses in terms of domesticating social alarm systems and stress the potential of learning from each other to facilitate the whole process. Further studies could focus on the role of collective practices during different domestication phases to enhance the understanding of technology implementation in the contexts of complex interactions within a group. ", doi="10.2196/44692", url="https://www.jmir.org/2023/1/e44692", url="http://www.ncbi.nlm.nih.gov/pubmed/37145835" } @Article{info:doi/10.2196/45297, author="Mujirishvili, Tamara and Maidhof, Caterina and Florez-Revuelta, Francisco and Ziefle, Martina and Richart-Martinez, Miguel and Cabrero-Garc{\'i}a, Julio", title="Acceptance and Privacy Perceptions Toward Video-based Active and Assisted Living Technologies: Scoping Review", journal="J Med Internet Res", year="2023", month="May", day="1", volume="25", pages="e45297", keywords="video-based active assisted living technologies", keywords="video monitoring", keywords="life logging", keywords="user acceptance", keywords="privacy", keywords="older adults", keywords="disability", keywords="eHealth", keywords="virtual assistance", keywords="technology", keywords="assistive technology", keywords="virtual assistant", keywords="virtual reality", abstract="Background: The aging society posits new socioeconomic challenges to which a potential solution is active and assisted living (AAL) technologies. Visual-based sensing systems are technologically among the most advantageous forms of AAL technologies in providing health and social care; however, they come at the risk of violating rights to privacy. With the immersion of video-based technologies, privacy-preserving smart solutions are being developed; however, the user acceptance research about these developments is not yet being systematized. Objective: With this scoping review, we aimed to gain an overview of existing studies examining the viewpoints of older adults and/or their caregivers on technology acceptance and privacy perceptions, specifically toward video-based AAL technology. Methods: A total of 22 studies were identified with a primary focus on user acceptance and privacy attitudes during a literature search of major databases. Methodological quality assessment and thematic analysis of the selected studies were executed and principal findings are summarized. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines were followed at every step of this scoping review. Results: Acceptance attitudes toward video-based AAL technologies are rather conditional, and are summarized into five main themes seen from the two end-user perspectives: caregiver and care receiver. With privacy being a major barrier to video-based AAL technologies, security and medical safety were identified as the major benefits across the studies. Conclusions: This review reveals a very low methodological quality of the empirical studies assessing user acceptance of video-based AAL technologies. We propose that more specific and more end user-- and real life--targeting research is needed to assess the acceptance of proposed solutions. ", doi="10.2196/45297", url="https://www.jmir.org/2023/1/e45297", url="http://www.ncbi.nlm.nih.gov/pubmed/37126390" } @Article{info:doi/10.2196/43408, author="Waters, Bryony and Orrell, Martin and McDermott, Orii", title="The Development of a UK Culturally Adapted and Modified Version of the Person Attuned Musical Interactions Manual: Protocol for a 2-Phase Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Apr", day="18", volume="12", pages="e43408", keywords="psychosocial intervention", keywords="music", keywords="dementia", keywords="interactions", keywords="care homes", keywords="care staff training tool", keywords="tool", keywords="research", keywords="impairment", keywords="training", keywords="communication", keywords="intervention", keywords="quality of life", keywords="care", keywords="development", keywords="language", abstract="Background: Previous research has suggested that care home interactions need significant improvements, especially those between staff and residents with dementia. Reasons for the lack of interactions are staff time pressures and residents' language impairments. Although residents may experience reduced language abilities, they can continue to communicate through other forms, including nonverbal communication and music. Person Attuned Musical Interactions (PAMI) is a staff training tool that provides staff with music therapy skill-sharing to promote high-quality interactions between staff and residents using nonverbal communication and music. The tool was originally developed in Denmark. To ensure that the tool is appropriate for UK care homes, a team of researchers in the United Kingdom have modified and culturally adapted the tool. Objective: This study aims to investigate the appropriateness of the adapted and modified manual for UK care homes and to explore the impact of PAMI on residents with dementia and care staff. Methods: The project consists of 2 phases, a qualitative field-testing study and a mixed methods evaluation study, which have been developed following the Medical Research Council's guidelines for complex interventions. Care staff and residents with dementia will be recruited from care homes in Lincolnshire, where the care staff will be trained in the PAMI intervention before implementing the intervention in their daily routines. Fortnightly reflective sessions will be provided throughout the phases to provide supervision and monitoring. The qualitative methods include interviews, reflective session transcripts, diary entries, and resident experience questionnaires. The quantitative outcome measures are residents' music engagement, staff's dementia competence, residents' quality of life, and staff burden. The resident's music engagement will be administered at 9 fortnightly time points. Staff's dementia competence, resident's quality of life, and staff burden will be administered at preintervention and postintervention time points. Results: The study has been funded by The Music Therapy Charity as part of a PhD studentship. The study began recruiting in September 2021. The research team aims to publish the results of the first phase in July to September 2023 and those of the second phase in October to December 2023. Conclusions: This study will be the first to investigate the modified version of PAMI. Therefore, it will provide feedback on the appropriateness of the manual for UK care homes. The PAMI intervention has the potential to offer high-quality music intervention training to a larger population of care homes who may currently be restricted by finances, the availability of time, and a lack of training opportunities. International Registered Report Identifier (IRRID): DERR1-10.2196/43408 ", doi="10.2196/43408", url="https://www.researchprotocols.org/2023/1/e43408", url="http://www.ncbi.nlm.nih.gov/pubmed/37071461" } @Article{info:doi/10.2196/41935, author="Shin, Ri Hye and Um, Rang Sa and Yoon, Jeong Hee and Choi, Young Eun and Shin, Chul Won and Lee, Yun Hee and Kim, Sun Young", title="Comprehensive Senior Technology Acceptance Model of Daily Living Assistive Technology for Older Adults With Frailty: Cross-sectional Study", journal="J Med Internet Res", year="2023", month="Apr", day="10", volume="25", pages="e41935", keywords="senior technology acceptance model", keywords="daily living assistive technologies", keywords="frailty", keywords="older adults", abstract="Background: There are considerable gaps between the need for assistive technologies and the actual adoption of these technologies among older adults, although older adults are among the groups that most need assistive technologies. Consequently, research is needed in this area because older adults' technology acceptance and influencing factors may differ depending on their level of frailty. Objective: The objective of this study was to compare frail, prefrail, and robust groups of South Korean adults regarding their behavioral intention to use daily living assistive technologies and the affecting factors---namely, technological context factors, health contexts and abilities, and attitudinal factors---based on a comprehensive senior technology acceptance model. Methods: A nationwide sample of 500 older South Korean adults (aged 55-92 years) was analyzed, and multivariate linear regression analyses of the robust, prefrail, and frail groups were performed. The independent and dependent variables consisted of 3 factors based on previous studies. First, technological context factors consisted of gerontechnology self-efficacy, gerontechnology anxiety, and facilitating conditions. Second, health contexts and abilities consisted of self-reported health conditions, cognitive ability, social relationships, psychological function, and physical function. Third and last, attitudinal factors consisted of behavioral intention to use assistive technologies, attitude toward use, perceived usefulness (PU), and perceived ease of use (PEOU). Results: The results of the analyses showed that technological context factors such as gerontechnology self-efficacy, health contexts and abilities such as self-reported health conditions and psychological function, and attitudinal factors such as attitude toward use, PU, and PEOU had significant effects on behavioral intention to use daily living assistive technologies. In particular, gerontechnology self-efficacy had a significant relationship with behavioral intention to use these technologies in the robust (r=0.120; P=.03) and prefrail (r=0.331; P<.001) groups. Psychological function (life satisfaction) had a significant relationship with behavioral intention to use these technologies in the robust group (r=--0.040; P=.02). Self-reported health conditions had a significant relationship with behavioral intention to use these technologies in the prefrail group (r=--0.169; P=.01). Although each group had a different significant relationship with the variables, attitudinal factors such as attitude toward use affected all groups (robust group: r=0.190; P=.03; prefrail group: r=0.235; P=.006; and frail group: r=0.526; P=.002). In addition, PU and PEOU in the attitudinal factors had a significant relationship with behavioral intention to use assistive technologies in the robust (PU: r=0.160; P=.01; and PEOU: r=0.350; P<.001) and prefrail (PU: r=0.265; P<.001; and PEOU: r=0.120; P=.04) groups. Conclusions: This study found that the comprehensive senior technology acceptance model of daily living assistive technologies had different associations according to the frailty group. These findings provided insights into the consideration of interventions with daily living assistive technologies for older adults with varying levels of frailty. ", doi="10.2196/41935", url="https://www.jmir.org/2023/1/e41935", url="http://www.ncbi.nlm.nih.gov/pubmed/37036760" } @Article{info:doi/10.2196/39967, author="Troeung, Lakkhina and Tshering, Gap and Walton, Rebecca and Martini, Angelita and Roberts, Martin", title="Optimizing the Quality of Clinical Data in an Australian Aged Care and Disability Service to Improve Care Delivery and Clinical Outcomes: Protocol for an Agile Lean Six Sigma Study", journal="JMIR Res Protoc", year="2023", month="Mar", day="27", volume="12", pages="e39967", keywords="aged care", keywords="disability", keywords="information technology", keywords="data", keywords="quality", keywords="health services", abstract="Background: In Australia, aged care and disability service providers are legally required to maintain comprehensive and accurate clinical documentation to meet regulatory and funding requirements and support safe and high-quality care provision. However, evidence suggests that poor-quality clinical data and documentation are widespread across the sector and can substantially affect clinical decision-making and care delivery and increase business costs. Objective: In the Optimizing the Quality of Clinical Data in an Australian Aged Care and Disability Service to Improve Care Delivery and Clinical Outcomes (OPTIMISE) study, we aim to use an Agile Lean Six Sigma framework to identify opportunities for the optimization of clinical documentation processes and clinical information systems, implement and test optimization solutions, and evaluate postoptimization outcomes in a large postacute community-based health service providing aged care and disability services in Western Australia. Methods: A 3-stage prospective optimization study will be conducted. Stage 1 (baseline [T0]) will measure existing clinical data quality, identify root causes of data quality issues across services, and generate optimization solutions. Stage 2 (optimization) will implement and test changes to clinical documentation processes and information systems using incremental Agile sprints. Stage 3 (evaluation) will evaluate changes in primary and secondary outcomes from T0 to 12 months after optimization. The primary outcome is the data quality measured in terms of defects per unit, defects per million opportunities, and Sigma level. The secondary outcomes are care delivery (direct care time), clinical incidents, business outcomes (cost of quality and workforce productivity), and user satisfaction. Case studies will be analyzed to understand the impact of optimization on clinical outcomes and business processes. Results: As of June 1, 2022, stage 1 commenced with T0 data quality audits conducted to measure current data quality. T0 data quality audits will be followed by user consultations to identify root causes of data quality issues. Optimization solutions will be developed by May 2023 to inform optimization (stage 2) and evaluation (stage 3). Results are expected to be published in June 2023. Conclusions: The study findings will be of interest to individuals and organizations in the health care sector seeking novel solutions to improve the quality of clinical data, support high-quality care delivery, and reduce business costs. International Registered Report Identifier (IRRID): DERR1-10.2196/39967 ", doi="10.2196/39967", url="https://www.researchprotocols.org/2023/1/e39967", url="http://www.ncbi.nlm.nih.gov/pubmed/36622197" } @Article{info:doi/10.2196/38080, author="Quinn, Emma and Hsiao, Hsun Kai and Johnstone, Travers and Gomez, Maria and Parasuraman, Arun and Ingleton, Andrew and Hirst, Nicholas and Najjar, Zeina and Gupta, Leena", title="Protecting Older Adult Residents in Care Facilities Against Influenza and COVID-19 Using the Influenza Communication, Advice and Reporting (FluCARE) App: Prospective Cohort Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Mar", day="13", volume="7", pages="e38080", keywords="web app", keywords="digital health", keywords="influenza", keywords="COVID-19", keywords="outbreak", keywords="monitoring", keywords="disease control", keywords="infection spread", keywords="infection control", keywords="detect", keywords="aged care", keywords="elderly", keywords="elderly population", keywords="older adult", keywords="long term care", keywords="care home", keywords="AFC", keywords="LTC", keywords="nursing home", keywords="retirement home", keywords="mobile application", keywords="health application", keywords="mHealth", keywords="care facility", keywords="online training", keywords="health impact", keywords="feasibility", keywords="efficacy", keywords="satisfaction", keywords="prevention", keywords="disease spread", keywords="notification", abstract="Background: Early detection and response to influenza and COVID-19 outbreaks in aged care facilities (ACFs) are critical to minimizing health impacts. The Sydney Local Health District (SLHD) Public Health Unit (PHU) has developed and implemented a novel web-based app with integrated functions for online line listings, detection algorithms, and automatic notifications to responders, to assist ACFs in outbreak response. The goal of the Influenza Outbreak Communication, Advice and Reporting (FluCARE) app is to reduce time delays to notifications, which we hope will reduce the spread, duration, and health impacts of an influenza or COVID-19 outbreak, as well as ease workload burdens on ACF staff. Objective: The specific aims of the study were to (1) evaluate the acceptability and user satisfaction of the implementation and use of FluCARE in helping ACFs recognize, notify, and manage influenza and COVID-19 outbreaks in their facility; (2) identify the safety of FluCARE and any potential adverse outcomes of using the app; and (3) identify any perceived barriers or facilitators to the implementation and use of FluCARE from the ACF user perspective. Methods: The FluCARE app was piloted from September 2019 to December 2020 in the SLHD. Associated implementation included promotion and engagement, user training, and operational policies. Participating ACF staff were invited to complete a posttraining survey. Staff were also invited to complete a postpilot evaluation survey that included the user Mobile Application Rating Scale (uMARS) measuring app acceptance, utility, and barriers and facilitators to use. An issues log was also prospectively maintained to assess safety. Survey data were analyzed descriptively or via content analysis where appropriate. Results: Surveys were completed by 31 consenting users from 27 ACFs. FluCARE was rated 3.91 of 5 overall on the uMARS. Of the 31 users, 25 (80\%) would definitely use FluCARE for future outbreaks, and all users agreed that the app was useful for identifying influenza and COVID-19 outbreaks at their facilities. There were no reported critical issues with incorrect or missed outbreak detection. User training, particularly online training modules, and technical support were identified as key facilitators to FluCARE use. Conclusions: FluCARE is an acceptable, useful, and safe app to assist ACF staff with early detection and response to influenza and COVID-19 outbreaks. This study supports feasibility for ongoing implementation and efficacy evaluation, followed by scale-up into other health districts in New South Wales. ", doi="10.2196/38080", url="https://formative.jmir.org/2023/1/e38080", url="http://www.ncbi.nlm.nih.gov/pubmed/36763638" } @Article{info:doi/10.2196/42652, author="Trainum, Katie and Tunis, Rachel and Xie, Bo and Hauser, Elliott", title="Robots in Assisted Living Facilities: Scoping Review", journal="JMIR Aging", year="2023", month="Mar", day="6", volume="6", pages="e42652", keywords="robotics", keywords="long-term care", keywords="nursing home", keywords="residential care", keywords="scoping review", keywords="review method", keywords="robot", keywords="aging", keywords="elder", keywords="older adult", keywords="gerontology", keywords="geriatric", keywords="senior living", abstract="Background: Various technological interventions have been proposed and studied to address the growing demand for care of residents in assisted living facilities, in which a preexisting shortage of professional caregivers has been exacerbated by the COVID-19 pandemic. Care robots are one such intervention with the potential to improve both the care of older adults and the work life of their professional caregivers. However, concerns about efficacy, ethics, and best practices in the applications of robotic technologies in care settings remain. Objective: This scoping review aimed to examine the literature on robots used in assisted living facilities and identify gaps in the literature to guide future research. Methods: On February 12, 2022, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, we searched PubMed, CINAHL Plus with Full Text, PsycINFO, IEEE Xplore digital library, and ACM Digital Library using predetermined search terms. Publications were included if they were written in English and focused on the use of robotics in assisted living facilities. Publications were excluded if they did not provide peer-reviewed empirical data, focused on user needs, or developed an instrument to study human-robot interaction. The study findings were then summarized, coded, and analyzed using the Patterns, Advances, Gaps, Evidence for practice, and Research recommendations framework. Results: The final sample included 73 publications from 69 unique studies on the use of robots in assisted living facilities. The findings of studies on older adults were mixed, with some studies suggesting positive impacts of robots, some expressing concerns about robots and barriers to their use, and others being inconclusive. Although many therapeutic benefits of care robots have been identified, methodological limitations have weakened the internal and external validity of the findings of these studies. Few studies (18/69, 26\%) considered the context of care: most studies (48/69, 70\%) collected data only on recipients of care, 15 studies collected data on staff, and 3 studies collected data on relatives or visitors. Theory-driven, longitudinal, and large sample size study designs were rare. Across the authors' disciplines, a lack of consistency in methodological quality and reporting makes it difficult to synthesize and assess research on care robotics. Conclusions: The findings of this study call for more systematic research on the feasibility and efficacy of robots in assisted living facilities. In particular, there is a dearth of research on how robots may change geriatric care and the work environment within assisted living facilities. To maximize the benefits and minimize the consequences for older adults and caregivers, future research will require interdisciplinary collaboration among health sciences, computer science, and engineering as well as agreement on methodological standards. ", doi="10.2196/42652", url="https://aging.jmir.org/2023/1/e42652", url="http://www.ncbi.nlm.nih.gov/pubmed/36877560" } @Article{info:doi/10.2196/42160, author="Harnett, Tove and J{\"o}nson, H{\aa}kan and F{\"a}ldtman, Alexander", title="Home Care in the Daily Lives of Older People: Protocol for an Ethnographic Two-Year Longitudinal Study", journal="JMIR Res Protoc", year="2023", month="Mar", day="1", volume="12", pages="e42160", keywords="eldercare", keywords="user perspective", keywords="home care", keywords="theory of care use", abstract="Background: Research on eldercare has been dominated by a provider-oriented perspective, concerned with the conditions and views of care providers. There are striking differences compared with the field of disability studies, where help is framed as part of a larger project of having a daily life and being included in society. Pilot interviews indicate that older people develop active strategies to make care work. These include practical preparations, emotional activities such as showing an interest in staff members' lives, or rhetorical skills in asking for help. Objective: The aim of this project is to develop empirical and theoretical knowledge of eldercare as a relational practice, accomplished by older people in their daily lives. This perspective will also offer an alternative to ongoing attempts to reduce the user perspective to an issue about older people acting as customers in a market. Methods: The project will map, investigate, and follow up on care use from the perspective of care users. The project has an ethnographic 2-year longitudinal approach. Data consist of interviews and participant observations with 35 persons (home care users and cohabitating partners) and a diary study with additional 10 care users. Inclusion criteria are people 65 years or older with home care provided by needs assessors. It is preferred that they have had home care between 6 months and 2 years in order to follow a progression in roles, identities, and strategies within home care use. Results: Between May and October 2022, 25 interviews with home care users were conducted. Data collection with follow-up interviews and observations, analysis, and reporting of findings will be completed by December 2024. Conclusions: By studying care use in the context of older people's lives the project will add important knowledge about the strategies and adjustments older people apply to make care arrangements work. A user-oriented perspective will further the understanding of how power relations play out in home care over time in relation to the formal rights, categorical belongings, and established norm systems that place the user in superior or subordinate positions. International Registered Report Identifier (IRRID): PRR1-10.2196/42160 ", doi="10.2196/42160", url="https://www.researchprotocols.org/2023/1/e42160", url="http://www.ncbi.nlm.nih.gov/pubmed/36857122" } @Article{info:doi/10.2196/38593, author="Lemaire, C{\'e}lia and Humbert, Christophe and Sueur, C{\'e}dric and Racin, C{\'e}line", title="Use of Digital Technologies to Maintain Older Adults' Social Ties During Visitation Restrictions in Long-Term Care Facilities: Scoping Review", journal="JMIR Aging", year="2023", month="Feb", day="10", volume="6", pages="e38593", keywords="social isolation", keywords="COVID-19 pandemic", keywords="remote care", keywords="nursing homes", keywords="social ties", keywords="digital devices", keywords="older adults", abstract="Background: Digital technologies were implemented to address the disruption of long-term care facility residents' socialization needs during the COVID-19 pandemic. A literature review regarding this topic is needed to inform public policy, facility managers, family caregivers, and nurses and allied health professionals involved in mediating the use of digital devices for residents' social ties. Objective: Our study outlines key concepts, methodologies, results, issues, and gaps in articles published during pandemic-related visitation restrictions. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) protocol, a scoping review was conducted by searching 3 database aggregator platforms (EBSCO, ProQuest, and PubMed) for studies published in peer-reviewed journals from early 2020 to the end of June 2021, when the most stringent restrictions were in place. We included qualitative and quantitative studies, reviews, commentaries, viewpoints, and letters to the editors in French or English focusing on digital technologies aiming to support the social contact of residents in long-term care facilities during pandemic-related visitation restrictions. Results: Among 763 screened articles, 29 met our selection criteria. For each study, we characterized the (1) authors, title, and date of the publication; (2) country of the first author; (3) research fields; (4) article type; and (5) type of technology mentioned. The analysis distinguished 3 main themes emerging from the literature: (1) impact and expectations of remote social contact on the physical and mental health and well-being of the residents (n=12), (2) with whom or what the social contact took place (n=17), and (3) limitations and barriers to significant social contact related to digital technologies (n=14). The results first underlined the highly positive impact expected by the authors of the digital technologies on health and quality of life of residents of long-term care facilities. Second, they highlighted the plurality of ties to consider, since social contact takes place not only with family caregivers to maintain contact but also for other purposes (end-of-life videoconferences) and with other types of contact (eg, with staff and robots). Third, they exposed the limitations and barriers to significant contact using digital technologies and outlined the required conditions to enable them. Conclusions: The review demonstrated the opportunities and risks outlined by the literature about the implementation of digital technologies to support remote social contact. It showed the plurality of ties to consider and revealed the need to evaluate the positive impact of remote contact from the residents' perspectives. Therefore, to go beyond the risk of digital solutionism, there is a need for studies considering the holistic impact on health regarding the implementation of digital technologies, including the meaning residents give to interpersonal exchanges and the organizational constraints. Trial Registration: OSF Registries osf.io/yhpx3; https://osf.io/yhpx3 ", doi="10.2196/38593", url="https://aging.jmir.org/2023/1/e38593", url="http://www.ncbi.nlm.nih.gov/pubmed/36599164" } @Article{info:doi/10.2196/43130, author="Yap, L. Tracey and Horn, D. Susan and Sharkey, D. Phoebe and Brooks, R. Katie and Kennerly, Susan", title="The Nursing Home Severity Index and Application to Pressure Injury Risk: Measure Development and Validation Study", journal="JMIR Aging", year="2023", month="Feb", day="9", volume="6", pages="e43130", keywords="geriatrics", keywords="nursing homes", keywords="pressure ulcer", keywords="propensity scores", keywords="severity of illness index", keywords="development", keywords="validation", keywords="clinical", keywords="treatment", keywords="pressure injury", keywords="injury", keywords="risk", keywords="prevention", abstract="Background: An assessment tool is needed to measure the clinical severity of nursing home residents to improve the prediction of outcomes and provide guidance in treatment planning. Objective: This study aims to describe the development of the Nursing Home Severity Index, a clinical severity measure targeted for nursing home residents with the potential to be individually tailored to different outcomes, such as pressure injury. Methods: A retrospective nonexperimental design was used to develop and validate the Nursing Home Severity Index using secondary data from 9 nursing homes participating in the 12-month preintervention period of the Turn Everyone and Move for Ulcer Prevention (TEAM-UP) pragmatic clinical trial. Expert opinion and clinical literature were used to identify indicators, which were grouped into severity dimensions. Index performance and validation to predict risk of pressure injury were accomplished using secondary data from nursing home electronic health records, Minimum Data Sets, and Risk Management Systems. Logistic regression models including a resident's Worst-Braden score with/without severity dimensions generated propensity scores. Goodness of fit for overall models was assessed using C statistic; the significance of improvement of fit after adding severity components to the model was determined using the likelihood ratio chi-square test. The significance of each component was assessed with odds ratios. Validation based on randomly selected 65\% training and 35\% validation data sets was used to confirm the reliability of the severity measure. Finally, the discriminating ability of models was evaluated using propensity stratification to evaluate which model best discriminated between residents with/without pressure injury. Results: Data from 1015 residents without pressure injuries on admission were used for the Nursing Home Severity Index--Pressure Injury and included laboratory, weights/vitals/pain, underweight, and locomotion severity dimensions. Logistic regression C statistic measuring predictive accuracy increased by 19.3\% (from 0.627 to 0.748; P<.001) when adding four severity dimensions to Worst-Braden scores. Significantly higher odds of developing pressure injuries were associated with increasing dimension scores. The use of the three highest propensity deciles predicting the greatest risk of pressure injury improved predictive accuracy by detecting 21 more residents who developed pressure injury (n=58, 65.2\% vs n=37, 42.0\%) when both severity dimensions and Worst-Braden score were included in prediction modeling. Conclusions: The clinical Nursing Home Severity Index--Pressure Injury was successfully developed and tested using the outcome of pressure injury. Overall predictive capacity was enhanced when using severity dimensions in combination with Worst-Braden scores. This index has the potential to significantly impact the quality of care decisions aimed at improving individual pressure injury prevention plans. Trial Registration: ClinicalTrials.gov NCT02996331; http://clinicaltrials.gov/ct2/show/NCT02996331 ", doi="10.2196/43130", url="https://aging.jmir.org/2023/1/e43130", url="http://www.ncbi.nlm.nih.gov/pubmed/36757779" } @Article{info:doi/10.2196/40604, author="Boucaud-Maitre, Denis and Villeneuve, Roxane and Simo-Tabu{\'e}, Nadine and Dartigues, Jean-Fran{\c{c}}ois and Amieva, Helene and Tabu{\'e}-Teguo, Maturin", title="The Health Care Trajectories of Older People in Foster Families: Protocol for an Observational Study", journal="JMIR Res Protoc", year="2023", month="Feb", day="8", volume="12", pages="e40604", keywords="older people", keywords="foster family", keywords="hospitalization", keywords="geriatric syndromes", keywords="mortality", keywords="quality of life", abstract="Background: With aging of the population, the search for alternative models of care adapted to older people with dependency is necessary. In this setting, foster families (1-3 older people per family) could be an alternative to nursing homes, residential care facilities, or community- and home-based care. Objective: The KArukera Study of Ageing in Foster Families is a prospective cohort study designed to investigate the care pathways of older people with dependency in foster care over a year. The 1-year hospitalization rate (main objective), cost of hospitalization, incidence of mortality, prevalence of geriatric syndromes, and quality of life of residents will be assessed. Quality of life and burnout of their respective foster caregivers will also be studied. Methods: This study cohort will include 250 older people living in foster families in Guadeloupe (French West Indies), as well as their respective foster caregivers. Both older people and caregivers will be interviewed concurrently on site at three time points: (1) at baseline, (2) at 6 months, and (3) at 12 months. For older people, we will collect anthropometric measures, cognitive impairment, depressive and anxiety symptoms, functional abilities, physical frailty, information on general health status, quality of life, and care pathways (hospitalization, mortality, and medical and paramedical consultations). We will also assess the quality of life and burnout symptoms of family caregivers at each follow-up. A phone update of vital status (alive or death) and care pathways of residents will be carried out at 3 and 9 months after the baseline examination. Results: Recruitment opened in September 2020 and ended in May 2021, with 109 older people recruited and 56 respective foster caregivers. The 1-year follow-up was ended in June 2022. Data analyses are ongoing and the first results are expected to be published in May 2023. Conclusions: Foster families are a potentially innovative way to accommodate dependent older people. This study could help define the clinical profile of older people adapted to foster families in the transition from frailty to dependency. The effectiveness of foster families, in terms of hospitalizations and mortality, will be compared with other models of care, particularly nursing homes. In this setting, a twin study carried out in nursing homes in Guadeloupe with similar aims and outcomes will be conducted. Beyond mortality and morbidity, the numerous outcomes will allow us to assess the evolution of geriatric syndromes over time. Trial Registration: ClinicalTrials.gov NCT04545775; https://clinicaltrials.gov/ct2/show/NCT04545775 International Registered Report Identifier (IRRID): DERR1-10.2196/40604 ", doi="10.2196/40604", url="https://www.researchprotocols.org/2023/1/e40604", url="http://www.ncbi.nlm.nih.gov/pubmed/36753315" } @Article{info:doi/10.2196/42496, author="Omar, Noraida and Shafiee, Illyani Shazli and Nor'hisham, Hazimah Siti and Ibrahim, Zuriati and Jamaluddin, Rosita and Rahamat, Syafiqah and Mohd Yusof, Nisak Barakatun and Minhat, Sakdiah Halimatus and Sallehuddin, Hakimah and Mazlan, Syazwani Nur", title="A Logical Framework (MYGERYFS) for Hospital Foodservice to Prevent Malnutrition Among Geriatric Patients in Hospitals, Malaysia: Protocol for a Feasibility Study", journal="JMIR Res Protoc", year="2023", month="Jan", day="31", volume="12", pages="e42496", keywords="hospital foodservice satisfaction", keywords="hospital meals satisfaction", keywords="elderly", keywords="nutrition", keywords="malnutrition in elderly", keywords="malnutrition", keywords="geriatric", keywords="patient", keywords="prevention", keywords="nutrient", keywords="feasibility", abstract="Background: Geriatric malnutrition in hospitals is common and can be affected by many things, including poor satisfaction toward hospital foodservice. Hospital foodservice plays an important role in a patient's recovery process by providing adequate nutrients. On top of that, patients' foodservice satisfaction can easily be afflicted by the quality of food served and the overall foodservice experience. Furthermore, malnutrition can occur from poor foodservice quality, especially among geriatric patients. Objective: This study aims to assess the effectiveness of the Malaysian Geriatric Patients' Hospital Foodservice Protocol (MYGERYFS). Methods: The protocol comprises 3 phases. Phase One is a cross-sectional study that took place at public hospitals with geriatric wards in the Klang Valley. Univariate data from Phase One were analyzed descriptively. Pearson correlation and chi-square were conducted to find factors associated with foodservice satisfaction. Phase Two involves the collaboration of health care professionals in the geriatric field. In Phase Three, a feasibility study will be conducted to determine the feasibility of the MYGERYFS protocol in a hospital among 60 geriatric patients. These patients will be randomized into control and intervention groups, respectively. Intervention care will be done to ensure the safety of the protocol. Results: Data collection for Phase One of the study has been completed. A total of 233 geriatric respondents with the mean age of 71.39 (SD 7.99) years were gathered. Approximately 51.5\% (n=120) of the respondents were female, while 48.5\% (n=113) were male, with a mean BMI of 24.84 (SD 6.05) kg/m2. Their mean energy and protein intakes were 1006.20 kcal (SD 462.03 kcal) and 42.60 (SD 22.20) grams, respectively. Based on the Mini Nutritional Assessment, older patients who scored 12-14 (normal) were 27.9\% (n=65), those who scored 8-11 (at risk) were 54.9\% (n=128), and those who scored 0-7, which is the lowest (malnutrition), were 17.2\% (n=40) of the study population. Hence, most patients were at risk of malnutrition. Although a majority of the patients claimed to have good foodservice satisfaction 26.2\% (n=61), they also experienced at least 3 barriers during mealtimes. It was found that dietary intake and mealtime barriers were significantly associated with the respondent's foodservice satisfaction. Data for Phase Two and Phase Three are yet to be collected and analyzed. Conclusions: This study protocol could potentially benefit the hospital foodservice system and aid in improving geriatric nutritional status. Trial Registration: ClinicalTrials.gov NCT04858165; https://clinicaltrials.gov/ct2/show/NCT04858165 International Registered Report Identifier (IRRID): RR1-10.2196/42496 ", doi="10.2196/42496", url="https://www.researchprotocols.org/2023/1/e42496", url="http://www.ncbi.nlm.nih.gov/pubmed/36719732" } @Article{info:doi/10.2196/38929, author="Wieland-Jorna, Yvonne and Verheij, A. Robert and Francke, L. Anneke and Tomassen, Marit and Houtzager, Max and Joling, J. Karlijn and Oosterveld-Vlug, G. Mariska", title="Setting up a Governance Framework for Secondary Use of Routine Health Data in Nursing Homes: Development Study Using Qualitative Interviews", journal="J Med Internet Res", year="2023", month="Jan", day="25", volume="25", pages="e38929", keywords="electronic health records", keywords="routinely recorded health data", keywords="learning health system", keywords="data governance", keywords="governance framework", keywords="nursing homes", abstract="Background: In the nursing home sector, reusing routinely recorded data from electronic health records (EHRs) for knowledge development and quality improvement is still in its infancy. Trust in appropriate and responsible reuse is crucial for patients and nursing homes deciding whether to share EHR data for these purposes. A data governance framework determines who may access the data, under what conditions, and for what purposes. This can help obtain that trust. Although increasing attention is being paid to data governance in the health care sector, little guidance is available on development and implementation of a data governance framework in practice. Objective: This study aims to describe the development process of a governance framework for the ``Registry Learning from Data in Nursing Homes,'' a national registry for EHR data on care delivered by nursing home physicians (in Dutch: specialist ouderengeneeskunde) in Dutch nursing homes---to allow data reusage for research and quality improvement of care. Methods: Relevant stakeholders representing practices, policies, and research in the nursing home sector were identified. Semistructured interviews were conducted with 20 people from 14 stakeholder organizations. The main aim of the interviews was to explore stakeholders' perspectives regarding the Registry's aim, data access criteria, and governing bodies' tasks and composition. Interview topics and analyses were guided by 8 principles regarding governance for reusing health data, as described in the literature. Interview results, together with legal advice and consensus discussions by the Registry's consortium partners, were used to shape the rules, regulations, and governing bodies of the governance framework. Results: Stakeholders valued the involvement of nursing home residents and their representatives, nursing home physicians, nursing homes' boards of directors, and scientists and saw this as a prerequisite for a trustworthy data governance framework. For the Registry, involvement of these groups can be achieved through a procedure in which residents can provide their consent or objection to the reuse of the data, transparency about the decisions made, and providing them a position in a governing body. In addition, a data request approval procedure based on predefined assessment criteria indicates that data reuse by third parties aligns with the aims of the Registry, benefits the nursing home sector, and protects the privacy of data subjects. Conclusions: The stakeholders' views, expertise, and knowledge of other frameworks and relevant legislation serve to inform the application of governance principles to the contexts of both the nursing home sector and the Netherlands. Many different stakeholders were involved in the development of the Registry Learning from Data in Nursing Homes' governance framework and will continue to be involved. Engagement of the full range of stakeholders in an early stage of governance framework development is important to generate trust in appropriate and responsible data reuse. ", doi="10.2196/38929", url="https://www.jmir.org/2023/1/e38929", url="http://www.ncbi.nlm.nih.gov/pubmed/36696162" } @Article{info:doi/10.2196/38081, author="Savira, Feby and Gupta, Adyya and Gilbert, Cecily and Huggins, E. Catherine and Browning, Colette and Chapman, Wendy and Haines, Terry and Peeters, Anna", title="Virtual Care Initiatives for Older Adults in Australia: Scoping Review", journal="J Med Internet Res", year="2023", month="Jan", day="18", volume="25", pages="e38081", keywords="virtual care", keywords="older adults", keywords="Australia", keywords="mobile phone", abstract="Background: There has been a rapid shift toward the adoption of virtual health care services in Australia. It is unknown how widely virtual care has been implemented or evaluated for the care of older adults in Australia. Objective: We aimed to review the literature evaluating virtual care initiatives for older adults across a wide range of health conditions and modalities and identify key challenges and opportunities for wider adoption at both patient and system levels in Australia. Methods: A scoping review of the literature was conducted. We searched MEDLINE, Embase, PsycINFO, CINAHL, AgeLine, and gray literature (January 1, 2011, to March 8, 2021) to identify virtual care initiatives for older Australians (aged ?65 years). The results were reported according to the World Health Organization's digital health evaluation framework. Results: Among the 6296 documents in the search results, we identified 94 that reported 80 unique virtual care initiatives. Most (69/80, 89\%) were at the pilot stage and targeted community-dwelling older adults (64/79, 81\%) with chronic diseases (52/80, 65\%). The modes of delivery included videoconference, telephone, apps, device or monitoring systems, and web-based technologies. Most initiatives showed either similar or better health and behavioral outcomes compared with in-person care. The key barriers for wider adoption were physical, cognitive, or sensory impairment in older adults and staffing issues, legislative issues, and a lack of motivation among providers. Conclusions: Virtual care is a viable model of care to address a wide range of health conditions among older adults in Australia. More embedded and integrative evaluations are needed to ensure that virtually enabled care can be used more widely by older Australians and health care providers. ", doi="10.2196/38081", url="https://www.jmir.org/2023/1/e38081", url="http://www.ncbi.nlm.nih.gov/pubmed/36652291" } @Article{info:doi/10.2196/37587, author="Ishigaki, Yo and Yokogawa, Shinji and Minamoto, Yuki and Saito, Akira and Kitamura, Hiroko and Kawauchi, Yuto", title="Pilot Evaluation of Possible Airborne Transmission in a Geriatric Care Facility Using Carbon Dioxide Tracer Gas: Case Study", journal="JMIR Form Res", year="2022", month="Dec", day="30", volume="6", number="12", pages="e37587", keywords="nursing home", keywords="care home", keywords="airborne transmission", keywords="ventilation frequency", keywords="air change rate", keywords="ACR", keywords="computational fluid dynamics", keywords="CFD", keywords="mobile phone", abstract="Background: Although several COVID-19 outbreaks have occurred in older adult care facilities throughout Japan, no field studies focusing on airborne infections within these settings have been reported. Countermeasures against airborne infection not only consider the air change rate (ACR) in a room but also the airflow in and between rooms. However, a specific method has not yet been established by Japanese public health centers or infectious disease--related organizations. Objective: In April 2021, 59 COVID-19 cases were reported in an older adult care facility in Miyagi, Japan, and airborne transmission was suspected. The objective of this study was to simultaneously reproduce the ACR and aerosol advection in this facility using the carbon dioxide (CO2) tracer gas method to elucidate the specific location and cause of the outbreak. These findings will guide our recommendations to the facility to prevent recurrence. Methods: In August 2021, CO2 sensors were placed in 5 rooms where airborne infection was suspected, and the CO2 concentration was intentionally increased using dry ice, which was subsequently removed. The ACR was then estimated by applying the Seidel equation to the time-series changes in the CO2 concentration due to ventilation. By installing multiple sensors outside the room, advection outside the room was monitored simultaneously. Aerosol advection was verified using computer simulations. Although the windows were closed at the time of the outbreak, we conducted experiments under open-window conditions to quantify the effects of window opening. Results: The ACR values at the time of the outbreak were estimated to be 2.0 to 6.8 h?1 in the rooms of the facility. A low-cost intervention of opening windows improved the ventilation frequency by a factor of 2.2 to 5.7. Ventilation depended significantly on the window-opening conditions (P values ranging from .001 to .03 for all rooms). Aerosol advection was detected from the private room to the day room in agreement with the simulation results. Considering that the individual who initiated the infection was in the private room on the day of infection, and several residents, who later became secondarily infected, were gathered in the day room, it was postulated that the infectious aerosol was transmitted by this air current. Conclusions: The present results suggest that secondary infections can occur owing to aerosol advection driven by large-scale flow, even when the building design adheres to the ventilation guidelines established in Japan. Moreover, the CO2 tracer gas method facilitates the visualization of areas at a high risk of airborne infection and demonstrates the effectiveness of window opening, which contributes to improved facility operations and recurrence prevention. ", doi="10.2196/37587", url="https://formative.jmir.org/2022/12/e37587", url="http://www.ncbi.nlm.nih.gov/pubmed/36583933" } @Article{info:doi/10.2196/43564, author="Khalili-Mahani, Najmeh and Sawchuk, Kim", title="Double-Bind of Recruitment of Older Adults Into Studies of Successful Aging via Assistive Information and Communication Technologies: Mapping Review", journal="JMIR Aging", year="2022", month="Dec", day="23", volume="5", number="4", pages="e43564", keywords="information and communication technologies", keywords="successful aging", keywords="healthy aging", keywords="independent living", keywords="agism", keywords="research methods", keywords="double-bind theory", keywords="mobile phone", abstract="Background: Two fields of research and development targeting the needs of the aging population of the world are flourishing, successful aging and assistive information and communication technologies (A-ICTs). The risks of ageist stereotypes emerging from how we communicate in both discourses are long known. This raises questions about whether using specific age criteria in the context of ``aging deficits'' can bias participation in, or compliance with, the research process by older adults who try to avoid age-related stigma. Objective: This study aimed to examine subject recruitment, study designs (based on age >65 years criteria), as well as discourses in research objectives and conclusions in health research on affordances of A-ICTs for older adults. Methods: A systematic mapping approach was used to characterize rationales, methods, stated objectives, and expected outcomes of studies indexed in PubMed and retrieved through the search logic ([``Older Adults'' OR Seniors OR Elderly] AND [ICT OR gerontechnology OR ``Assistive Technology'')] AND (``Healthy Aging'' OR ``Successful Aging'' OR ``healthy ageing'' OR ``successful ageing''). Inclusion criteria were as follows: the study should have recruited older participants (aged >65 years), been qualitative or quantitative research, and involved the introduction of at least one A-ICT for health-related improvements. Exclusion criteria were as follows: reviews, viewpoints, surveys, or studies that used information and communication technology for data collection instead of lifestyle interventions. Content, thematic, and discourse analyses were used to map the study characteristics and synthesize results with respect to the research question. Results: Of 180 studies that passed the search logic, 31 (17.2\%) satisfied the inclusion criteria (6 randomized controlled trials, 4 purely quantitative studies, 9 focus groups, 2 observational studies, and 10 mixed methods studies). In all but one case, recruitment was pragmatic and nonrandom. Thematic analysis of rationales revealed a high likelihood of emphasis on the burdens of aging, such as rising costs of care (12/31, 39\%) and age-related deficits (14/31, 45\%). The objectives of the research fell under 4 categories: promotion of physical activity, acceptance and feasibility of robots and remote health monitoring systems, risk detection, and the future of A-ICTs in health care for older adults. Qualitative studies were more attentive to the nonageist research guidelines. Heterogeneity in the study results (both qualitative and quantitative) was not related to age but to individual agency, acceptance, and adherence. A combination of research strategies (participatory, longitudinal, playful, flexible, and need-based designs) proved successful in characterizing variations in study outcomes. Studies that documented recruitment dynamics revealed that fear of stigma was a factor that biased participants' engagement. Conclusions: This review indicates that age is not an informative criterion for recruitment and retention of participants. Charting the dynamics of adoption of, and interaction with, A-ICTs is critical for advancing research and technology development. ", doi="10.2196/43564", url="https://aging.jmir.org/2022/4/e43564", url="http://www.ncbi.nlm.nih.gov/pubmed/36563033" } @Article{info:doi/10.2196/39148, author="Zougar, Mohammad and Todd, Chris and McGarrigle, Lisa and Stanmore, Emma", title="MIRA Rehab Exergames for Older Male Residents in a Care Home Center in Saudi Arabia: Protocol for a Feasibility Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Dec", day="20", volume="11", number="12", pages="e39148", keywords="exergame", keywords="balance", keywords="older adults", keywords="telerehabilitation", keywords="feasibility", keywords="elderly care", keywords="aging", keywords="elderly population", keywords="rehabilitation", keywords="virtual therapy", keywords="digital rehabilitation", keywords="physical activity", abstract="Background: Physical activity leads to improvements in morbidity, mortality, and quality of life, especially when it is progressive, challenging, and regular. There is strong evidence that strength and balance exercises decrease the risk of falling. However, traditional exercises may be tedious and not very motivating for participants. Exergames have been found to increase engagement and enjoyment for older users. Objective: This study will conduct a feasibility randomized controlled trial (RCT) on the use of MIRA Rehab Exergames among older male residents in a care home setting in Saudi Arabia. A sample of 30 eligible participants will be recruited to meet feasibility study requirements. Methods: We will recruit 38 residents in the care home who will be randomly allocated to either an intervention or a control group. The intervention participants will perform gamified exercises using the MIRA telerehabilitation platform (30 minutes 3 times per week for 6 weeks). The control group will receive educational advice based on booklets of the Otago exercise program and be encouraged to exercise (30 minutes 3 times per week for 6 weeks). Participants will be assessed at weeks 0, 6, and 12. Assessments will include feasibility measures (eligibility, recruitment and attrition rates, and practicalities of data collection methods) and participant outcome measures (balance, strength, mobility, adherence, quality of life, fear of falling, depression, acceptability, and usability). Results: Data collection started in November 2021 and ended in March 2022. The study is currently in the data analysis stage, which commenced in May 2022. The findings from this feasibility RCT will be used to design a definitive RCT to test whether the MIRA Rehab Exergame program benefits older people in Saudi Arabia who may not like participating in traditional exercise programs and may be unwilling or unable to leave their homes. Conclusions: This study will contribute to our understanding of how to recruit in this specific population and provide information to inform the design of a future RCT. International Registered Report Identifier (IRRID): DERR1-10.2196/39148 ", doi="10.2196/39148", url="https://www.researchprotocols.org/2022/12/e39148", url="http://www.ncbi.nlm.nih.gov/pubmed/36538360" } @Article{info:doi/10.2196/42731, author="Garnett, Anna and Connelly, Denise and Yous, Marie-Lee and Hung, Lillian and Snobelen, Nancy and Hay, Melissa and Furlan-Craievich, Cherie and Snelgrove, Shannon and Babcock, Melissa and Ripley, Jacqueline and Hamilton, Pam and Sturdy-Smith, Cathy and O'Connell, Maureen", title="Nurse-Led Virtual Delivery of PIECES in Canadian Long-Term Care Homes to Support the Care of Older Adults Experiencing Responsive Behaviors During COVID-19: Qualitative Descriptive Study", journal="JMIR Nursing", year="2022", month="Dec", day="13", volume="5", number="1", pages="e42731", keywords="long-term care", keywords="older adults", keywords="families", keywords="responsive behaviors", keywords="qualitative", keywords="COVID-19", keywords="PIECES", keywords="nurse(s)", keywords="care home", keywords="infection", keywords="therapeutic", keywords="anxiety", keywords="depression", keywords="cognitive", keywords="fear", keywords="death", keywords="dementia", keywords="communication", keywords="technology", abstract="Background: Worldwide, the COVID-19 pandemic has resulted in profound loss of life among older adults living in long-term care (LTC) homes. As a pandemic response, LTC homes enforced infection control processes, including isolating older adults in their rooms, canceling therapeutic programs, and restricting family member visits. Social isolation negatively impacts older adults in LTC, which may result in increased rates of anxiety, depression, physical and cognitive decline, disorientation, fear, apathy, and premature death. Isolation of older adults can also cause an increase in responsive behaviors (eg, yelling, hitting, calling out) to express frustration, fear, restricted movement, and boredom. To respond to the challenges in LTC and support frontline staff, older adults, and family members, a novel registered practical nurse (RPN)-led delivery of the PIECES approach for addressing responsive behaviors among older adults with dementia using virtual training/mentoring was implemented in Canadian LTC homes. PIECES employs a person- and family/care partner--centered collaborative team-based approach to provide education and capacity-building for nurses; engages families as active participants in care; and embeds evidence-informed practices to provide person- and family-centered care to older adults with complex needs, including dementia. Objective: The aim of this study was to describe the experiences of LTC staff, family/care partners, and older adult research partners with implementation of a novel RPN-led virtual adaptation of the PIECES care-planning approach for responsive behaviors in two Canadian LTC homes during the COVID-19 pandemic. Methods: Using a qualitative descriptive design, two focus groups were held with three to four staff members (eg, RPNs, managers) per LTC home in Ontario. A third focus group was held with three PIECES mentors. Individual semistructured interviews were conducted with RPN champions, family/care partners, and older adult research partners. Research team meeting notes provided an additional source of data. Content analysis was performed. Results: A total of 22 participants took part in a focus group (n=11) or an in-depth individual interview (n=11). Participant experiences suggest that implementation of RPN-led virtual PIECES fostered individualized care, included family as partners in care, increased interdisciplinary collaboration, and improved staff practices. However, virtual PIECES, as delivered, lacked opportunities for family member feedback on older adult outcomes. Implementation facilitators included the provision of mentorship and leadership at all levels of implementation and suitable technological infrastructure. Barriers were related to availability and use of virtual communication technology (family members) and older adults became upset due to lack of comprehension during virtual care conferences. Conclusions: These findings offer promising support to adopting virtual PIECES, a team approach to gather valuable family input and engagement to address residents' unmet needs and responsive behaviors in LTC. Future research should investigate a hybridized communication format to foster sustainable person- and family-centered care-planning practices to include active collaboration of families in individualized care plans. ", doi="10.2196/42731", url="https://nursing.jmir.org/2022/1/e42731", url="http://www.ncbi.nlm.nih.gov/pubmed/36446050" } @Article{info:doi/10.2196/40360, author="Seah, L. Cassandra E. and Zhang, Zheyuan and Sun, Sijin and Wiskerke, Esther and Daniels, Sarah and Porat, Talya and Calvo, A. Rafael", title="Designing Mindfulness Conversational Agents for People With Early-Stage Dementia and Their Caregivers: Thematic Analysis of Expert and User Perspectives", journal="JMIR Aging", year="2022", month="Dec", day="6", volume="5", number="4", pages="e40360", keywords="mindfulness", keywords="dyadic", keywords="dementia", keywords="caregivers", keywords="user needs", keywords="intervention", keywords="user", keywords="feedback", keywords="design", keywords="accessibility", keywords="relationships", keywords="mindset", keywords="essential", abstract="Background: The number of people with dementia is expected to grow worldwide. Among the ways to support both persons with early-stage dementia and their caregivers (dyads), researchers are studying mindfulness interventions. However, few studies have explored technology-enhanced mindfulness interventions for dyads and the needs of persons with dementia and their caregivers. Objective: The main aim of this study was to elicit essential needs from people with dementia, their caregivers, dementia experts, and mindfulness experts to identify themes that can be used in the design of mindfulness conversational agents for dyads. Methods: Semistructured interviews were conducted with 5 dementia experts, 5 mindfulness experts, 5 people with early-stage dementia, and 5 dementia caregivers. Interviews were transcribed and coded on NVivo (QSR International) before themes were identified through a bottom-up inductive approach. Results: The results revealed that dyadic mindfulness is preferred and that implementation formats such as conversational agents have potential. A total of 5 common themes were also identified from expert and user feedback, which should be used to design mindfulness conversational agents for persons with dementia and their caregivers. The 5 themes included enhancing accessibility, cultivating positivity, providing simplified tangible and thought-based activities, encouraging a mindful mindset shift, and enhancing relationships. Conclusions: In essence, this research concluded with 5 themes that mindfulness conversational agents could be designed based on to meet the needs of persons with dementia and their caregivers. ", doi="10.2196/40360", url="https://aging.jmir.org/2022/4/e40360", url="http://www.ncbi.nlm.nih.gov/pubmed/36472897" } @Article{info:doi/10.2196/37590, author="Pfisterer, Kaylen and Amelard, Robert and Boger, Jennifer and Keller, Heather and Chung, Audrey and Wong, Alexander", title="Enhancing Food Intake Tracking in Long-term Care With Automated Food Imaging and Nutrient Intake Tracking (AFINI-T) Technology: Validation and Feasibility Assessment", journal="JMIR Aging", year="2022", month="Nov", day="17", volume="5", number="4", pages="e37590", keywords="long-term care", keywords="automated nutrient intake", keywords="convolutional neural network", keywords="food segmentation", keywords="food classification", keywords="depth imaging", keywords="deep learning", keywords="collaborative design", keywords="aging", keywords="food intake", abstract="Background: Half of long-term care (LTC) residents are malnourished, leading to increased hospitalization, mortality, and morbidity, with low quality of life. Current tracking methods are subjective and time-consuming. Objective: This paper presented the automated food imaging and nutrient intake tracking technology designed for LTC. Methods: A needs assessment was conducted with 21 participating staff across 12 LTC and retirement homes. We created 2 simulated LTC intake data sets comprising modified (664/1039, 63.91\% plates) and regular (375/1039, 36.09\% plates) texture foods. Overhead red-green-blue-depth images of plated foods were acquired, and foods were segmented using a pretrained food segmentation network. We trained a novel convolutional autoencoder food feature extractor network using an augmented UNIMIB2016 food data set. A meal-specific food classifier was appended to the feature extractor and tested on our simulated LTC food intake data sets. Food intake (percentage) was estimated as the differential volume between classified full portion and leftover plates. Results: The needs assessment yielded 13 nutrients of interest, requirement for objectivity and repeatability, and account for real-world environmental constraints. For 12 meal scenarios with up to 15 classes each, the top-1 classification accuracy was 88.9\%, with mean intake error of ?0.4 (SD 36.7) mL. Nutrient intake estimation by volume was strongly linearly correlated with nutrient estimates from mass (r2=0.92-0.99), with good agreement between methods ($\sigma$=?2.7 to ?0.01; 0 within each of the limits of agreement). Conclusions: The automated food imaging and nutrient intake tracking approach is a deep learning--powered computational nutrient sensing system that appears to be feasible (validated accuracy against gold-standard weighed food method, positive end user engagement) and may provide a novel means for more accurate and objective tracking of LTC residents' food intake to support and prevent malnutrition tracking strategies. ", doi="10.2196/37590", url="https://aging.jmir.org/2022/4/e37590", url="http://www.ncbi.nlm.nih.gov/pubmed/36394940" } @Article{info:doi/10.2196/40528, author="Isabet, Baptiste and Rigaud, Anne-Sophie and Li, Wanji and Pino, Maribel", title="Telepresence Robot Intervention to Reduce Loneliness and Social Isolation in Older Adults Living at Home (Project DOMIROB): Protocol for a Clinical Nonrandomized Study", journal="JMIR Res Protoc", year="2022", month="Oct", day="31", volume="11", number="10", pages="e40528", keywords="older adults", keywords="telepresence robot", keywords="feeling of loneliness", keywords="social isolation", keywords="home", keywords="acceptability", keywords="usability", abstract="Background: There is a growing prevalence of loneliness and social isolation among older adults (OAs). These problems are often associated with depressive states, cognitive decline, sleep disorders, addictions, and increased mortality. To limit loneliness and social isolation in OAs, some authors recommend the use of new communication technologies to maintain a social link with family members as well as with health and social care professionals. Among these communication tools, telepresence robots (TRs) seem to be a promising solution. These robots offer users the possibility of making video calls with their relatives, social workers, and health care professionals, to maintain social contact and access to support services while living at home. Nevertheless, TRs have been relatively unstudied in real-life environments. Objective: The main objective of this study is to measure the impact of a 12-week intervention using a TR on the feeling of loneliness and on social isolation of OAs living at home. Its secondary objective is to establish recommendations for the implementation of TRs in the studied context. Methods: A nonrandomized study will be conducted among 60 OAs living at home who will participate in the study for 24 weeks. During this period, they will host a TR for 12 weeks to use it in their home. After the end of the intervention a 12-week follow-up ensues. In total, 4 evaluations will be performed over the entire experimental phase for each participant at weeks 0, 6, 12, and 24. A multidimensional assessment of the impact of the robot will be performed using a multimethod approach including standardized scales and a semistructured interview. This assessment will also help to identify the ergonomic aspects that influence the robot's usability and acceptability among OAs. Results: Data collection started in September 2020 and is expected to be completed in early 2023. In August 2022, 56 participants were recruited for the study. Data analysis will take place between August 2022 and is expected to be completed in early 2023. Conclusions: The DOMIROB study will provide new knowledge on the impact of social TRs in OAs living at home. The results will make it possible to suggest technological, ethical, and organizational recommendations for the use and implementation of TRs for OAs in real-life settings. Trial Registration: ClinicalTrials.gov NCT04767100; https://clinicaltrials.gov/ct2/show/NCT04767100 International Registered Report Identifier (IRRID): DERR1-10.2196/40528 ", doi="10.2196/40528", url="https://www.researchprotocols.org/2022/10/e40528", url="http://www.ncbi.nlm.nih.gov/pubmed/36315231" } @Article{info:doi/10.2196/33351, author="Sauz{\'e}on, H{\'e}l{\`e}ne and Edjolo, Arlette and Amieva, H{\'e}l{\`e}ne and Consel, Charles and P{\'e}r{\`e}s, Karine", title="Effectiveness of an Ambient Assisted Living (HomeAssist) Platform for Supporting Aging in Place of Older Adults With Frailty: Protocol for a Quasi-Experimental Study", journal="JMIR Res Protoc", year="2022", month="Oct", day="26", volume="11", number="10", pages="e33351", keywords="ambient assisted living technology", keywords="AAL", keywords="Internet-of-Things", keywords="IoT", keywords="aging and frailty", keywords="independent living", keywords="effectiveness study", abstract="Background: Ambient assisted living (AAL) technologies are viewed as a promising way to prolong aging in place, particularly when they are designed as closely as possible to the needs of the end users. However, very few evidence-based results have been provided to support its real value, notably for frail older adults who have a high risk of autonomy loss as well as entering a nursing home. Objective: We hypothesized that the benefit from an AAL with a user-centered design is effective for aging in place for frail older adults in terms of everyday functioning (instrumental activities of daily-life scale). In addition, our secondary hypotheses are that such an AAL decreases or neutralizes the frailty process and reduces the rates of institutionalization and hospitalization and that it improves the psychosocial health of participants and their caregivers when compared with the control condition. We also assume that a large proportion of equipped participants will have a satisfactory experience and will accept a subscription to an internet connection to prolong their participation. Methods: HomeAssist (HA) is an AAL platform offering a large set of apps for 3 main age-related need domains (activities of daily-living, safety, and social participation), relying on a basic set of entities (sensors, actuators, tablets, etc). The HA intervention involves monitoring based on assistive services to support activities related to independent living at home. The study design is quasi-experimental with a duration of 12 months, optionally extensible to 24 months. Follow-up assessments occurred at 0, 12, and 24 months. The primary outcome measures are related to everyday functioning. Secondary outcome measures include indices of frailty, cognitive functioning, and psychosocial health of the participants and their caregivers. Every 6 months, user experience and attitudes toward HA are also collected from equipped participants. Concomitantly, data on HA use will be collected. All measures of the study will be tested based on an intention-to-treat approach using a 2-tailed level of significance set at $\alpha$=.05, concerning our primary and secondary efficacy outcomes. Results: Descriptive analyses were conducted to characterize the recruited equipped participants compared with the others (excluded and refusals) on the data available at the eligibility visit, to describe the characteristics of the recruited sample at baseline, as well as those of the dropouts. Finally, recruitment at 12 months included equipped participants (n=73), matched with control participants (n=474, from pre-existing cohorts). The results of this study will be disseminated through scientific publications and conferences. This will provide a solid basis for the creation of a start-up to market the technology. Conclusions: This trial will inform the real-life efficacy of HA in prolonging aging in place for frail older adults and yield an informed analysis of AAL use and adoption in frail older individuals. International Registered Report Identifier (IRRID): DERR1-10.2196/33351 ", doi="10.2196/33351", url="https://www.researchprotocols.org/2022/10/e33351", url="http://www.ncbi.nlm.nih.gov/pubmed/36287595" } @Article{info:doi/10.2196/38546, author="Abdallah, Lama and Stolee, Paul and Lopez, J. Kimberly and Whate, Alexandra and Boger, Jennifer and Tong, Catherine", title="The Impact of COVID-19 on Older Adults' Perceptions of Virtual Care: Qualitative Study", journal="JMIR Aging", year="2022", month="Oct", day="20", volume="5", number="4", pages="e38546", keywords="virtual care", keywords="older adult", keywords="qualitative", keywords="COVID-19", keywords="elderly population", keywords="aging", keywords="telehealth", keywords="digital care", keywords="technology usability", keywords="patient perspective", keywords="technology access", abstract="Background: In response to the COVID-19 pandemic, older adults worldwide have increasingly received health care virtually, and health care organizations and professional bodies have indicated that virtual care is ``here to stay.'' As older adults are the highest users of the health care system, virtual care implementation can have a significant impact on them and may pose a need for additional support. Objective: This research aims to understand older adults' perspectives and experiences of virtual care during the pandemic. Methods: As part of a larger study on older adults' technology use during the pandemic, we conducted semistructured interviews with 20 diverse older Canadians (mean age 76.9 years, SD 6.5) at 2 points: summer of 2020 and winter/early spring of 2021. Participants were asked about their technology skills, experiences with virtual appointments, and perspectives on this type of care delivery. Interviews were digitally recorded and transcribed. A combination of team-based and framework analyses was used to interpret the data. Results: Participants described their experiences with both in-person and virtual care during the pandemic, including issues with accessing care and long gaps between appointments. Overall, participants were generally satisfied with the virtual care they received during the pandemic. Participants described the benefits of virtual care (eg, increased convenience, efficiency, and safety), the limitations of virtual care (eg, need for physical examination and touch, lack of nonverbal communication, difficulties using technology, and systemic barriers in access), and their perspectives on the future of virtual care. Half of our participants preferred a return to in-person care after the COVID-19 pandemic, while the other half preferred a combination of in-person and virtual services. Many participants who preferred to access in-person services were not opposed to virtual care options, as needed; however, they wanted virtual care as an option alongside in-person care. Participants emphasized a need for training and support to be meaningfully implemented to support both older adults and providers in using virtual care. Conclusions: Overall, our research identified both perceived benefits and perceived limitations of virtual care, and older adult participants emphasized their wish for a hybrid model of virtual care, in which virtual care is viewed as an addendum, not a replacement for in-person care. We recognize the limitations of our sample (small, not representative of all older Canadians, and more likely to use technology); this body of literature would greatly benefit from more research with older adults who do not/cannot use technology to receive care. Findings from this study can be mobilized as part of broader efforts to support older patients and providers engaged in virtual and in-person care, particularly post--COVID-19. ", doi="10.2196/38546", url="https://aging.jmir.org/2022/4/e38546", url="http://www.ncbi.nlm.nih.gov/pubmed/36054599" } @Article{info:doi/10.2196/41255, author="Granbom, Marianne and J{\"o}nson, H{\aa}kan and Kottorp, Anders", title="Older Adults Living in Disadvantaged Areas: Protocol for a Mixed Methods Baseline Study on Homes, Quality of Life, and Participation in Transitioning Neighborhoods", journal="JMIR Res Protoc", year="2022", month="Oct", day="12", volume="11", number="10", pages="e41255", keywords="aging", keywords="housing", keywords="neighborhood", keywords="quality of life", keywords="participation", keywords="rural areas", keywords="disadvantaged areas", keywords="aging-in-place", keywords="relocation", keywords="socioeconomic status", keywords="older adults", keywords="elderly", keywords="mental health", keywords="physical health", keywords="social participation", keywords="health dynamics", abstract="Background: Swedish policy states that older adults should be able to age safely with continued independence and lead active lives. However, this plays out differently in different Swedish municipalities depending upon degree of demographic change, globalization, and urbanization. Internationally, older adults living in disadvantaged areas have worse physical and mental health, activity restrictions, and reduced life expectancy. In Sweden, research on how disadvantaged areas impact older adults' quality of life is virtually nonexistent. We argue that disadvantaged areas exist in both urban and rural contexts. Objective: We aimed to investigate how older adults' homes and neighborhoods influence their community participation, quality of life, identity, and belonging in urban and rural disadvantaged areas in Sweden, and how these person--context dynamics are experienced by older adults in transitioning neighborhoods. Methods: The study has a mixed methods design and includes 3 phases. Adults 65 years and older living in certain urban and rural disadvantaged areas in the south of Sweden will be included. Phase 1 is an interview study in which qualitative data are collected on neighborhood attachment, identity, and belonging through semistructured interviews and photo-elicitation interviews with 40 subjects. A variety of qualitative data analysis procedures are used. In phase 2, a survey study will be conducted to explore associations between observable and self-rated aspects of housing and neighborhood (physical, social, and emotional), participation, and quality of life; 400 subjects will be recruited and added to the 40 phase-1 subjects for a total of 440. The survey will include standardized measures and study-specific questions. Survey data will be analyzed with mainstream statistical analyses and structural equation modeling to understand the interactions between quality of life, home and neighborhood factors, and sociodemographic factors. In phase 3, the integration study, survey data from the 40 participants who participated in both data collections will be analyzed together with qualitative data with a mixed methods analysis approach. Results: As of the submission of this protocol (August 2022), recruitment for the interview study is complete (N=39), and 267 participants have been recruited and have completed data collection in the survey study. We expect recruitment and data collection to be finalized by December 2022. Conclusions: With an increasing proportion of older adults, an increasing number of disadvantaged areas, and an increasing dependency ratio in more than 50\% of Swedish municipalities, these municipalities are transforming and becoming increasingly segregated. This study will add unique knowledge on what it is like to be older in a disadvantaged area and deepen knowledge on housing and health dynamics in later life. Further, the design of the current study will allow future follow-up studies to facilitate longitudinal analysis (if funding is granted) on aging in a transforming societal context. International Registered Report Identifier (IRRID): DERR1-10.2196/41255 ", doi="10.2196/41255", url="https://www.researchprotocols.org/2022/10/e41255", url="http://www.ncbi.nlm.nih.gov/pubmed/36222809" } @Article{info:doi/10.2196/34927, author="Ma, Huiting and Yiu, Y. Kristy C. and Baral, D. Stefan and Fahim, Christine and Moloney, Gary and Darvin, Dariya and Landsman, David and Chan, K. Adrienne and Straus, Sharon and Mishra, Sharmistha", title="COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study", journal="JMIR Public Health Surveill", year="2022", month="Oct", day="4", volume="8", number="10", pages="e34927", keywords="long-term care", keywords="nursing home", keywords="staff", keywords="essential worker", keywords="retirement home", keywords="shelter", keywords="congregate living", keywords="COVID-19", keywords="observational", keywords="risk", keywords="transmission", keywords="elderly", keywords="older adults", keywords="retirement", keywords="nurse", keywords="health care worker", keywords="congregate", keywords="trend", keywords="geography", keywords="Canada", keywords="Toronto", abstract="Background: Disproportionate risks of COVID-19 in congregate care facilities including long-term care homes, retirement homes, and shelters both affect and are affected by SARS-CoV-2 infections among facility staff. In cities across Canada, there has been a consistent trend of geographic clustering of COVID-19 cases. However, there is limited information on how COVID-19 among facility staff reflects urban neighborhood disparities, particularly when stratified by the social and structural determinants of community-level transmission. Objective: This study aimed to compare the concentration of cumulative cases by geography and social and structural determinants across 3 mutually exclusive subgroups in the Greater Toronto Area (population: 7.1 million): community, facility staff, and health care workers (HCWs) in other settings. Methods: We conducted a retrospective, observational study using surveillance data on laboratory-confirmed COVID-19 cases (January 23 to December 13, 2020; prior to vaccination rollout). We derived neighborhood-level social and structural determinants from census data and generated Lorenz curves, Gini coefficients, and the Hoover index to visualize and quantify inequalities in cases. Results: The hardest-hit neighborhoods (comprising 20\% of the population) accounted for 53.87\% (44,937/83,419) of community cases, 48.59\% (2356/4849) of facility staff cases, and 42.34\% (1669/3942) of other HCW cases. Compared with other HCWs, cases among facility staff reflected the distribution of community cases more closely. Cases among facility staff reflected greater social and structural inequalities (larger Gini coefficients) than those of other HCWs across all determinants. Facility staff cases were also more likely than community cases to be concentrated in lower-income neighborhoods (Gini 0.24, 95\% CI 0.15-0.38 vs 0.14, 95\% CI 0.08-0.21) with a higher household density (Gini 0.23, 95\% CI 0.17-0.29 vs 0.17, 95\% CI 0.12-0.22) and with a greater proportion working in other essential services (Gini 0.29, 95\% CI 0.21-0.40 vs 0.22, 95\% CI 0.17-0.28). Conclusions: COVID-19 cases among facility staff largely reflect neighborhood-level heterogeneity and disparities, even more so than cases among other HCWs. The findings signal the importance of interventions prioritized and tailored to the home geographies of facility staff in addition to workplace measures, including prioritization and reach of vaccination at home (neighborhood level) and at work. ", doi="10.2196/34927", url="https://publichealth.jmir.org/2022/10/e34927", url="http://www.ncbi.nlm.nih.gov/pubmed/35867901" } @Article{info:doi/10.2196/39386, author="Adisso, Lionel {\'E}v{\`e}hou{\'e}nou and Taljaard, Monica and Stacey, Dawn and Bri{\`e}re, Nathalie and Zomahoun, Vignon Herv{\'e} Tchala and Durand, Jacob Pierre and Rivest, Louis-Paul and L{\'e}gar{\'e}, France", title="Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial", journal="JMIR Aging", year="2022", month="Sep", day="20", volume="5", number="3", pages="e39386", keywords="shared decision-making", keywords="home care", keywords="nursing homes", keywords="patient engagement", abstract="Background: Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams. Objective: We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making. Methods: We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis. Results: A total of 311 frail older adults were included in the analysis, including 208 (66.9\%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5\%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3\% (95\% CI --5.8\% to 12.4\%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1\% (95\% CI -11.2\% to 23.4\%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults' perception of how much health professionals involved them in decision-making increased by 5.4 (95\% CI ?0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5\% (95\% CI ?16.5\% to 1.6\%, P=.10). Conclusions: Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making. Trial Registration: ClinicalTrials.gov NCT02592525; https://clinicaltrials.gov/show/NCT02592525 ", doi="10.2196/39386", url="https://aging.jmir.org/2022/3/e39386", url="http://www.ncbi.nlm.nih.gov/pubmed/35759791" } @Article{info:doi/10.2196/38864, author="Bradwell, Hannah and Edwards, J. Katie and Winnington, Rhona and Thill, Serge and Allgar, Victoria and Jones, B. Ray", title="Implementing Affordable Socially Assistive Pet Robots in Care Homes Before and During the COVID-19 Pandemic: Stratified Cluster Randomized Controlled Trial and Mixed Methods Study", journal="JMIR Aging", year="2022", month="Aug", day="24", volume="5", number="3", pages="e38864", keywords="social robots", keywords="companion robots", keywords="well-being", keywords="older adults", keywords="dementia", keywords="robot pets", keywords="COVID-19", abstract="Background: Robot pets may assist in the challenges of supporting an aging population with growing dementia prevalence. Prior work has focused on the impacts of the robot seal Paro on older adult well-being, but recent studies have suggested the good acceptability and implementation feasibility of more affordable devices (Joy for All [JfA] cats and dogs). Objective: We aimed to address the limited effectiveness research on JfA devices. Methods: We conducted an 8-month, stratified, cluster randomized controlled trial in 8 care homes in Cornwall, United Kingdom. Over 4 months, 4 care homes each received 2 JfA devices (1 cat and 1 dog; intervention group), and 4 homes received care as usual (control group). Psychometrics were collected before and after the intervention to compare the change from baseline to follow-up between the groups. In the final 4 months, all 8 care homes received devices, but only qualitative data were collected owing to COVID-19 and reduced capacity. The primary outcome was neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI] Nursing Home version). Care provider burden was a secondary outcome (occupational disruptiveness NPI subscale), alongside the Challenging Behavior scale, the Holden communication scale, the Campaign to End Loneliness questionnaire, and medication use. Qualitative data were collected through care staff observation calendars and end-of-study interviews to understand use, experience, and impact. We also collected demographic data and assessed dementia severity. In total, 253 residents had robot interaction opportunities, and 83 were consented for direct data collection. Results: There was a significant difference in the total change from baseline to follow-up between the intervention and control groups for NPI (P<.001) and occupational disruptiveness (P=.03). Neuropsychiatric symptoms increased in the control group and decreased in the intervention group. No significant difference was seen for communication issues or challenging behavior. For NPI subdomains, there were significant differences from baseline to follow-up in delusions (P=.03), depression (P=.01), anxiety (P=.001), elation (P=.02), and apathy (P=.009), all of which decreased in the intervention group and increased slightly in the control group. The summative impact results suggested that most residents (46/54, 85\%) who interacted with robots experienced a positive impact. Those who interacted had significantly higher dementia severity scores (P=.001). The qualitative results suggested good adoption, acceptability, and suitability for subjectively lonely individuals and lack of a novelty effect through sustained use, and demonstrated that the reasons for use were entertainment, anxiety, and agitation. Conclusions: Affordable robot pets hold potential for improving the well-being of care home residents and people with dementia, including reducing neuropsychiatric symptoms and occupational disruptiveness. This work suggests no novelty effect and contributes toward understanding robot pet suitability. Moreover, interactions were more common among residents with more moderate/severe dementia and those subjectively lonely. Trial Registration: ClinicalTrials.gov NCT04168463; https://www.clinicaltrials.gov/ct2/show/NCT04168463 ", doi="10.2196/38864", url="https://aging.jmir.org/2022/3/e38864", url="http://www.ncbi.nlm.nih.gov/pubmed/35830959" } @Article{info:doi/10.2196/37482, author="Alexander, L. Gregory and Liu, Jianfang and Powell, R. Kimberly and Stone, W. Patricia", title="Examining Structural Disparities in US Nursing Homes: National Survey of Health Information Technology Maturity", journal="JMIR Aging", year="2022", month="Aug", day="23", volume="5", number="3", pages="e37482", keywords="nursing homes", keywords="health information technology", keywords="policy", keywords="nursing informatics", keywords="electronic health record", keywords="electronic data", keywords="data sharing", keywords="care providers", keywords="resident", keywords="care", keywords="quality of care", keywords="structural disparity", keywords="clinical support", keywords="administration", abstract="Background: There are 15,632 nursing homes (NHs) in the United States. NHs continue to receive significant policy attention due to high costs and poor outcomes of care. One strategy for improving NH care is use of health information technology (HIT). A central concept of this study is HIT maturity, which is used to identify adoption trends in HIT capabilities, use and integration within resident care, clinical support, and administrative activities. This concept is guided by the Nolan stage theory, which postulates that a system such as HIT moves through a series of measurable stages. HIT maturity is an important component of the rapidly changing NH landscape, which is being affected by policies generated to protect residents, in part because of the pandemic. Objective: The aim of this study is to identify structural disparities in NH HIT maturity and see if it is moderated by commonly used organizational characteristics. Methods: NHs (n=6123, >20\%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. Results: Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7\%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. Conclusions: NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes. ", doi="10.2196/37482", url="https://aging.jmir.org/2022/3/e37482", url="http://www.ncbi.nlm.nih.gov/pubmed/35998030" } @Article{info:doi/10.2196/34997, author="Li, S. Karen and Nagallo, Nathan and McDonald, Erica and Whaley, Colin and Grindrod, Kelly and Boluk, Karla", title="Implementing Technology Literacy Programs in Retirement Homes and Residential Care Facilities: Conceptual Framework", journal="JMIR Aging", year="2022", month="Aug", day="19", volume="5", number="3", pages="e34997", keywords="older adult", keywords="technology", keywords="retirement home", keywords="long-term care", keywords="social connections", keywords="technology literacy program", keywords="retirement", keywords="elderly", keywords="literacy", keywords="implementation", keywords="concept", keywords="framework", keywords="knowledge translation", abstract="Background: The COVID-19 pandemic caused widespread societal disruption, with governmental stay-at-home orders resulting in people connecting more via technology rather than in person. This shift had major impacts on older adult residents staying in retirement homes and residential care facilities, where they may lack the technology literacy needed to stay connected. The enTECH Computer Club from the University of Waterloo in Ontario, Canada created a knowledge translation toolkit to support organizations interested in starting technology literacy programs (TLPs) by providing guidance and practical tips. Objective: This paper aimed to present a framework for implementing TLPs in retirement homes and residential care facilities through expanding on the knowledge translation toolkit and the framework for person-centered care. Methods: Major concepts relating to the creation of a TLP in retirement homes and residential care facilities were extracted from the enTECH knowledge translation toolkit. The domains from the framework for person-centered care were modified to fit a TLP context. The concepts identified from the toolkit were sorted into the three framework categories: ``structure,'' ``process,'' and ``outcome.'' Information from the knowledge translation toolkit were extracted into the three categories and synthesized to form foundational principles and potential actions. Results: All 13 domains from the framework for person-centered care were redefined to shift the focus on TLP implementation, with 7 domains under ``structure,'' 4 domains under ``process,'' and 2 domains under ``outcome.'' Domains in the ``structure'' category focus on developing an organizational infrastructure to deliver a successful TLP; 10 foundational principles and 25 potential actions were identified for this category. Domains in the ``process'' category focus on outlining procedures taken by stakeholders involved to ensure a smooth transition from conceptualization into action; 12 foundational principles and 9 potential actions were identified for this category. Domains in the ``outcome'' category focus on evaluating the TLP to consider making any improvements to better serve the needs of older adults and staff; 6 foundational principles and 6 potential actions were identified for this category. Conclusions: Several domains and their foundational principles and potential actions from the TLP framework were found to be consistent with existing literatures that encourage taking active steps to increase technology literacy in older adults. Although there may be some limitations to the components of the framework with the current state of the pandemic, starting TLPs in the community can yield positive outcomes that will be beneficial to both older adult participants and the organization in the long term. ", doi="10.2196/34997", url="https://aging.jmir.org/2022/3/e34997", url="http://www.ncbi.nlm.nih.gov/pubmed/35984689" } @Article{info:doi/10.2196/37434, author="Mahmoudi Asl, Aysan and Molinari Ulate, Mauricio and Franco Martin, Manuel and van der Roest, Henri{\"e}tte", title="Methodologies Used to Study the Feasibility, Usability, Efficacy, and Effectiveness of Social Robots For Elderly Adults: Scoping Review", journal="J Med Internet Res", year="2022", month="Aug", day="1", volume="24", number="8", pages="e37434", keywords="aged", keywords="dementia", keywords="social robots", keywords="pet-bots", keywords="community settings", keywords="long-term care", keywords="methods", keywords="scoping review", abstract="Background: New research fields to design social robots for older people are emerging. By providing support with communication and social interaction, these robots aim to increase quality of life. Because of the decline in functioning due to cognitive impairment in older people, social robots are regarded as promising, especially for people with dementia. Although study outcomes are hopeful, the quality of studies on the effectiveness of social robots for the elderly is still low due to many methodological limitations. Objective: We aimed to review the methodologies used thus far in studies evaluating the feasibility, usability, efficacy, and effectiveness of social robots in clinical and social settings for elderly people, including persons with dementia. Methods: Dedicated search strings were developed. Searches in MEDLINE (PubMed), Web of Science, PsycInfo, and CINAHL were performed on August 13, 2020. Results: In the 33 included papers, 23 different social robots were investigated for their feasibility, usability, efficacy, and effectiveness. A total of 8 (24.2\%) studies included elderly persons in the community, 9 (27.3\%) included long-term care facility residents, and 16 (48.5\%) included people with dementia. Most of the studies had a single aim, of which 7 (21.2\%) focused on efficacy and 7 (21.2\%) focused on effectiveness. Moreover, forms of randomized controlled trials were the most applied designs. Feasibility and usability were often studied together in mixed methods or experimental designs and were most often studied in individual interventions. Feasibility was often assessed with the Unified Theory of the Acceptance and Use of Technology model. Efficacy and effectiveness studies used a range of psychosocial and cognitive outcome measures. However, the included studies failed to find significant improvements in quality of life, depression, and cognition. Conclusions: This study identified several shortcomings in methodologies used to evaluate social robots, resulting in ambivalent study findings. To improve the quality of these types of studies, efficacy/effectiveness studies will benefit from appropriate randomized controlled trial designs with large sample sizes and individual intervention sessions. Experimental designs might work best for feasibility and usability studies. For each of the 3 goals (efficacy/effectiveness, feasibility, and usability) we also recommend a mixed method of data collection. Multiple interaction sessions running for at least 1 month might aid researchers in drawing significant results and prove the real long-term impact of social robots. ", doi="10.2196/37434", url="https://www.jmir.org/2022/8/e37434", url="http://www.ncbi.nlm.nih.gov/pubmed/35916695" } @Article{info:doi/10.2196/37688, author="Tennant, Ryan and Allana, Sana and Mercer, Kate and Burns, M. Catherine", title="Caregiver Expectations of Interfacing With Voice Assistants to Support Complex Home Care: Mixed Methods Study", journal="JMIR Hum Factors", year="2022", month="Jun", day="30", volume="9", number="2", pages="e37688", keywords="caregivers", keywords="children", keywords="communication", keywords="digital", keywords="home care", keywords="information management", keywords="interaction", keywords="older adult", keywords="technology acceptance", keywords="voice assistant", abstract="Background: Providing care in home environments is complex, and often the pressure is on caregivers to document information and ensure care continuity. Digital information management and communication technologies may support care coordination among caregivers. However, they have yet to be adopted in this context, partly because of issues with supporting long-term disease progression and caregiver anxiety. Voice assistant (VA) technology is a promising method for interfacing with digital health information that may aid in multiple aspects of being a caregiver, thereby influencing adoption. Understanding the expectations for VAs to support caregivers is fundamental to inform the practical development of this technology. Objective: This study explored caregivers' perspectives on using VA technology to support caregiving and inform the design of future digital technologies in complex home care. Methods: This study was part of a larger study of caregivers across North America on the design of digital health technologies to support health communication and information management in complex home care. Caregivers included parents, guardians, and hired caregivers such as personal support workers and home care nurses. Video interviews were conducted with caregivers to capture their mental models on the potential application of VAs in complex home care and were theoretically analyzed using the technology acceptance model. Interviews were followed up with Likert-scale questions exploring perspectives on other VA applications beyond participants' initial perceptions. Results: Data were collected from 22 caregivers, and 3 themes were identified: caregivers' perceived usefulness of VAs in supporting documentation, care coordination, and person-centered care; caregivers' perceived ease of use in navigating information efficiently (they also had usability concerns with this interaction method); and caregivers' concerns, excitement, expected costs, and previous experience with VAs that influenced their attitudes toward use. From the Likert-scale questions, most participants (21/22, 95\%) agreed that VAs should support prompted information recording and retrieval, and all participants (22/22, 100\%) agreed that they should provide reminders. They also agreed that VAs should support them in an emergency (18/22, 82\%)---but only for calling emergency services---and guide caregivers through tasks (21/22, 95\%). However, participants were less agreeable on VAs expressing a personality (14/22, 64\%)---concerned they would manipulate caregivers' perceptions---and listening ambiently to remind caregivers about their documentation (16/22, 73\%). They were much less agreeable about VAs providing unprompted assistance on caregiving tasks (9/22, 41\%). Conclusions: The interviews and Likert-scale results point toward the potential for VAs to support family caregivers and hired caregivers by easing their information management and health communication at home. However, beyond information interaction, the potential impact of VA personality traits on caregivers' perceptions of the care situation and the passive collection of audio data to improve user experience through context-specific interactions are critical design considerations that should be further examined. ", doi="10.2196/37688", url="https://humanfactors.jmir.org/2022/2/e37688", url="http://www.ncbi.nlm.nih.gov/pubmed/35771594" } @Article{info:doi/10.2196/34239, author="Cao, Yuanyuan and Erdt, Mojisola and Robert, Caroline and Naharudin, Binte Nurhazimah and Lee, Qi Shan and Theng, Yin-Leng", title="Decision-making Factors Toward the Adoption of Smart Home Sensors by Older Adults in Singapore: Mixed Methods Study", journal="JMIR Aging", year="2022", month="Jun", day="24", volume="5", number="2", pages="e34239", keywords="aging in place", keywords="health care systems and management", keywords="telehealth", keywords="assistive technology", keywords="assisted living facilities", abstract="Background: An increasing aging population has become a pressing problem in many countries. Smart systems and intelligent technologies support aging in place, thereby alleviating the strain on health care systems. Objective: This study aims to identify decision-making factors involved in the adoption of smart home sensors (SHS) by older adults in Singapore. Methods: The study involved 3 phases: as an intervention, SHS were installed in older adults' homes (N=42) for 4 to 5 weeks; in-depth semistructured interviews were conducted with 18 older adults, 2 center managers, 1 family caregiver, and 1 volunteer to understand the factors involved in the decision-making process toward adoption of SHS; and follow-up feedback was collected from 42 older adult participants to understand the reasons for adopting or not adopting SHS. Results: Of the 42 participants, 31 (74\%) adopted SHS after the intervention, whereas 11 (26\%) did not adopt SHS. The reasons for not adopting SHS ranged from privacy concerns to a lack of family support. Some participants did not fully understand SHS functionality and did not perceive the benefits of using SHS. From the interviews, we found that the decision-making process toward the adoption of SHS technology involved intrinsic factors, such as understanding the technology and perceiving its usefulness and benefits, and more extrinsic factors, such as considering affordability and care support from the community. Conclusions: We found that training and a strong support ecosystem could empower older adults in their decision to adopt technology. We advise the consideration of human values and involvement of older adults in the design process to build user-centric assistive technology. ", doi="10.2196/34239", url="https://aging.jmir.org/2022/2/e34239", url="http://www.ncbi.nlm.nih.gov/pubmed/35749213" } @Article{info:doi/10.2196/34550, author="Verstraeten, F. Helma M. and Ziylan, Canan and Gerritsen, L. Debby and Huijsman, Robbert and Nakanishi, Miharu and Smalbrugge, Martin and van der Steen, T. Jenny and Zuidema, U. Sytse and Achterberg, P. Wilco and Bakker, M. Ton J. E.", title="Implementing a Personalized Integrated Stepped-Care Method (STIP-Method) to Prevent and Treat Neuropsychiatric Symptoms in Persons With Dementia in Nursing Homes: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2022", month="Jun", day="22", volume="11", number="6", pages="e34550", keywords="dementia", keywords="neuropsychiatric symptoms", keywords="caregiver", keywords="implementation", keywords="psychosocial intervention", keywords="nursing homes", abstract="Background: Neuropsychiatric symptoms occur frequently in many nursing home residents with dementia. Despite the availability of multidisciplinary guidelines, neuropsychiatric symptoms are often inadequately managed. Three proven effective methods for managing neuropsychiatric symptoms were integrated into a single intervention method: the STIP-Method, a personalized integrated stepped-care method to prevent and treat neuropsychiatric symptoms. The STIP-Method comprises 5 phases of clinical reasoning to neuropsychiatric symptoms and 4 stepped-care interventions and is supported with a web application. Objective: This study aims to identify the facilitators and barriers in the implementation of the STIP-Method in nursing homes. Methods: A mixed methods design within a participatory action research was used to implement the STIP-Method in 4 facilities of 2 Dutch nursing home organizations. In total, we aimed at participation of 160-200 persons with dementia and expected an intervention fidelity of 50\% or more, based on earlier studies regarding implementation of effective psychosocial interventions to manage neuropsychiatric symptoms. All involved managers and professionals were trained in the principles of the STIP-Method and in using the web application. An advisory board of professionals, managers, and informal caregivers in each facility supported the implementation during 21 months, including an intermission of 6 months due to the COVID-19 pandemic. In these 6-weekly advisory board meetings, 2 researchers stimulated the members to reflect on progress of the implementation by making use of available data from patient records and the web application. Additionally, the 2 researchers invited the members to suggest how to improve the implementation. Data analysis will involve (1) analysis of facilitators and barriers to the implementation derived from verbatim text reports of advisory board meetings to better understand the implementation process; (2) analysis of patient records in accordance with multidisciplinary guidelines to neuropsychiatric symptoms: personalized, interdisciplinary, and proactive management of neuropsychiatric symptoms; (3) evaluation of the web application in terms of usability scores; (4) pre- and postimplementation analysis of patient records and the web application to evaluate the impact of the STIP-Method, such as changes in neuropsychiatric symptoms and informal caregiver burden. Results: We enrolled 328 persons with dementia. Data collection started in July 2019 and ended in December 2021. The first version of this manuscript was submitted in October 2021. The first results of data analysis are expected to be published in December 2022 and final results in June 2023. Conclusions: Our study may increase understanding of facilitators and barriers to the prevention and treatment of neuropsychiatric symptoms in nursing home residents with dementia by implementing the integrated STIP-Method. The need for well-designed implementation studies is of importance to provide nursing homes with optimal tools to prevent and treat neuropsychiatric symptoms. International Registered Report Identifier (IRRID): DERR1-10.2196/34550 ", doi="10.2196/34550", url="https://www.researchprotocols.org/2022/6/e34550", url="http://www.ncbi.nlm.nih.gov/pubmed/35731558" } @Article{info:doi/10.2196/33023, author="Wilding, Clare and Morgan, Debra and Greenhill, Jennene and Perkins, David and O'Connell, E. Megan and Bauer, Michael and Farmer, Jane and Morley, Catherine and Blackberry, Irene", title="Web-Based Technologies to Support Carers of People Living With Dementia: Protocol for a Mixed Methods Stepped-Wedge Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="May", day="19", volume="11", number="5", pages="e33023", keywords="virtual", keywords="dementia", keywords="community", keywords="rural", keywords="carer", keywords="caregiver", keywords="mobile phone", abstract="Background: Informal carers play a significant role in supporting people living with dementia; however, carers in rural areas are often isolated, with limited access to support services. Although dementia-friendly communities provide valued support for carers, access to them is limited as they are few and geographically dispersed. Objective: This study's aim was to increase support and services for rural informal carers of people living with dementia by using information and communication technologies accessed through an integrated website and mobile app---the Verily Connect app. The objective of this protocol is to detail the research design used in a complex study that was situated in a challenging real-world setting integrating web-based and on-ground technology and communication. Therefore, it is anticipated that this protocol will strengthen the research of others exploring similar complex concepts. Methods: A stepped-wedge, open-cohort cluster randomized controlled trial was conducted to implement Verily Connect across 12 rural Australian communities. The Verily Connect intervention delivered web-based, curated information about dementia, a localized directory of dementia services and support, group and individual chat forums, and peer support through videoconference. During the implementation phase of 32 weeks, Verily Connect was progressively implemented in four 8-weekly waves of 3 communities per wave. Usual care, used as a comparator, was available to carers throughout the study period. Participants and researchers were unblinded to the intervention. There were 3 cohorts of participants: carers, volunteers, and staff; participants were recruited from their communities. The primary outcome measure was perceived carer social support measured using the Medical Outcomes Study-Social Support Survey. Volunteers and staff provided feedback on their participation in Verily Connect as qualitative data. Qualitative data were collected from all cohorts of participants through interviews and focus groups. Process evaluation data were collected through interviews and memos written by research staff. Data on the costs of implementing Verily Connect were collected by the research team members and evaluated by a health economist. Results: Between August 2018 and September 2019, a total of 113 participants were recruited. There were 37 (32.7\%) carers, 39 (34.5\%) volunteers, and 37 (32.7\%) health service staff. The study was complex because of the involvement of multiple and varied communities of carers, volunteers, health service staff, and research team members originating from 5 universities. Web-based technologies were used as intervention strategies to support carers and facilitate the process of undertaking the study. Conclusions: The Verily Connect trial enabled the testing and further development of a web-based approach to increasing support for carers of people living with dementia across a diverse rural landscape in Australia. This protocol provides an example of how to conduct a pragmatic evaluation of a complex and co-designed intervention involving multiple stakeholders. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001213235; https://tinyurl.com/4rjvrasf International Registered Report Identifier (IRRID): RR1-10.2196/33023 ", doi="10.2196/33023", url="https://www.researchprotocols.org/2022/5/e33023", url="http://www.ncbi.nlm.nih.gov/pubmed/35588366" } @Article{info:doi/10.2196/37521, author="Miguel Cruz, Antonio and Lopez Portillo, Perez Hector and Daum, Christine and Rutledge, Emily and King, Sharla and Liu, Lili", title="Technology Acceptance and Usability of a Mobile App to Support the Workflow of Health Care Aides Who Provide Services to Older Adults: Pilot Mixed Methods Study", journal="JMIR Aging", year="2022", month="May", day="18", volume="5", number="2", pages="e37521", keywords="usability", keywords="technology acceptance", keywords="Unified Theory of Acceptance and Use of Technology", keywords="UTAUT", keywords="older adults", keywords="caregivers", keywords="health care aides", keywords="mobile phone", abstract="Background: Health care aides are unlicensed support personnel who provide direct care, personal assistance, and support to people with health conditions. The shortage of health care aides has been attributed to recruitment challenges, high turnover, an aging population, the COVID-19 pandemic, and low retention rates. Mobile apps are among the many information communication technologies that are paving the way for eHealth solutions to help address this workforce shortage by enhancing the workflow of health care aides. In collaboration with Clinisys EMR Inc, we developed a mobile app (Mobile Smart Care System [mSCS]) to support the workflow of health care aides who provide services to older adult residents of a long-term care facility. Objective: The purpose of this study was to investigate the technology acceptance and usability of a mobile app in a real-world environment, while it is used by health care aides who provide services to older adults. Methods: This pilot study used a mixed methods design: sequential mixed methods (QUANTITATIVE, qualitative). Our study included a pre-- and post--paper-based questionnaire with no control group (QUAN). Toward the end of the study, 2 focus groups were conducted with a subsample of health care aides (qual, qualitative description design). Technology acceptance and usability questionnaires used a 5-point Likert scale ranging from disagree (1) to agree (5). The items included in the questionnaires were validated in earlier research as having high levels of internal consistency for the Unified Theory of Acceptance and Use of Technology constructs. A total of 60 health care aides who provided services to older adults as part of their routine caseloads used the mobile app for 1 month. Comparisons of the Unified Theory of Acceptance and Use of Technology constructs' summative scores at pretest and posttest were calculated using a paired t test (2-tailed). We used the partial least squares structural regression model to determine the factors influencing mobile app acceptance and usability for health care aides. The $\alpha$ level of significance for all tests was set at P?.05 (2-tailed). Results: We found that acceptance of the mSCS was high among health care aides, performance expectancy construct was the strongest predictor of intention to use the mSCS, intention to use the mSCS predicted usage behavior. The qualitative data support the quantitative findings and showed health care aides' strong belief that the mSCS was useful, portable, and reliable, although there were still opportunities for improvement, especially with regard to the mSCS user interface. Conclusions: Overall, these results support the assertion that mSCS technology acceptance and usability are high among health care aides. In other words, health care aides perceived that the mSCS assisted them in addressing their workflow issues. ", doi="10.2196/37521", url="https://aging.jmir.org/2022/2/e37521", url="http://www.ncbi.nlm.nih.gov/pubmed/35583930" } @Article{info:doi/10.2196/33714, author="Camp, Nicola and Johnston, Julie and Lewis, C. Martin G. and Zecca, Massimiliano and Di Nuovo, Alessandro and Hunter, Kirsty and Magistro, Daniele", title="Perceptions of In-home Monitoring Technology for Activities of Daily Living: Semistructured Interview Study With Community-Dwelling Older Adults", journal="JMIR Aging", year="2022", month="May", day="5", volume="5", number="2", pages="e33714", keywords="aging", keywords="wearable sensors", keywords="environmental sensors", keywords="social robots", keywords="activities of daily living", keywords="older adults", keywords="elderly", keywords="robots", keywords="wearables", abstract="Background: Many older adults prefer to remain in their own homes for as long as possible. However, there are still questions surrounding how best to ensure that an individual can cope with autonomous living. Technological monitoring systems are an attractive solution; however, there is disagreement regarding activities of daily living (ADL) and the optimal technologies that should be used to monitor them. Objective: This study aimed to understand older adults' perceptions of important ADL and the types of technologies they would be willing to use within their own homes. Methods: Semistructured interviews were conducted on the web with 32 UK adults, divided equally into a younger group (aged 55-69 years) and an older group (?70 years). Results: Both groups agreed that ADL related to personal hygiene and feeding were the most important and highlighted the value of socializing. The older group considered several activities to be more important than their younger counterparts, including stair use and foot care. The older group had less existing knowledge of monitoring technology but was more willing to accept wearable sensors than the younger group. The younger group preferred sensors placed within the home but highlighted that they would not have them until they felt that daily life was becoming a struggle. Conclusions: Overall, technological monitoring systems were perceived as an acceptable method for monitoring ADL. However, developers and carers must be aware that individuals may express differences in their willingness to engage with certain types of technology depending on their age and circumstances. ", doi="10.2196/33714", url="https://aging.jmir.org/2022/2/e33714", url="http://www.ncbi.nlm.nih.gov/pubmed/35511248" } @Article{info:doi/10.2196/35847, author="Cha, Jinhee and Peterson, M. Colleen and Millenbah, N. Ashley and Louwagie, Katie and Baker, G. Zachary and Shah, Ayush and Jensen, J. Christine and Gaugler, E. Joseph", title="Delivering Personalized Recommendations to Support Caregivers of People Living With Dementia: Mixed Methods Study", journal="JMIR Aging", year="2022", month="May", day="3", volume="5", number="2", pages="e35847", keywords="caregivers", keywords="caregiving", keywords="Alzheimer", keywords="dementia", keywords="intervention", keywords="COVID-19", abstract="Background: Estimates suggest that 6.2 million Americans aged ?65 years are living with Alzheimer dementia in 2021, and by 2060, this number could more than double to 13.8 million. As a result, public health officials anticipate a greater need for caregivers of persons with Alzheimer disease or related dementia and support resources for both people living with dementia and their caregivers. Despite the growing need for dementia caregiver support services, there is a lack of consensus regarding how to tailor these services to best meet the heterogeneous needs of individual caregivers. To fill this gap, Care to Plan (CtP), a web-based tool for caregivers of people living with dementia, was developed to provide tailored support recommendations to dementia caregivers. Objective: The aim of this study is to formally explore the feasibility, acceptability, and utility of CtP for 20 family members of people living with dementia within a health system over a 1-month time period using a mixed methods parallel convergent design. Methods: A moderately sized health system in the mid-Atlantic region was selected as the site for CtP implementation, where 20 caregivers who were family members of people living with dementia were enrolled. The web-based CtP tool was used by caregivers and facilitated by a health care professional (ie, a senior care navigator [SCN]). Caregivers were given a 21-item review checklist to assess barriers and facilitators associated with reviewing CtP with an SCN. Following the 21-item review checklist, semistructured telephone interviews, which included 18 open-ended questions, focused on the facilitators of and barriers to CtP implementation and recommendations for future implementation. Results: Quantitative results suggested that 85\% (17/20) of caregivers indicated that CtP was helpful and 90\% (18/20) would recommend CtP to someone in a similar situation. The qualitative analysis identified 4 themes regarding facilitators of and barriers to implementation: caregiver factors, SCN factors, CtP tool system factors, and recommendations and resources factors. Conclusions: CtP was found to be not only feasible but also a valuable tool for caregivers seeking resources for themselves and their people living with dementia. Long-term evaluation findings aim to generate results on how CtP can be integrated into care plans for caregivers and how SCNs can provide additional support for caregivers of people living with dementia over an extended period. ", doi="10.2196/35847", url="https://aging.jmir.org/2022/2/e35847", url="http://www.ncbi.nlm.nih.gov/pubmed/35503650" } @Article{info:doi/10.2196/32322, author="Shin, H. Marlena and McLaren, Jaye and Ramsey, Alvin and Sullivan, L. Jennifer and Moo, Lauren", title="Improving a Mobile Telepresence Robot for People With Alzheimer Disease and Related Dementias: Semistructured Interviews With Stakeholders", journal="JMIR Aging", year="2022", month="May", day="3", volume="5", number="2", pages="e32322", keywords="mild cognitive impairment", keywords="socially assistive robot", keywords="robot technology", keywords="caregiver support", keywords="gerontology", keywords="aging in place", keywords="qualitative research", keywords="mobile phone", abstract="Background: By 2050, nearly 13 million Americans will have Alzheimer disease and related dementias (ADRD), with most of those with ADRD or mild cognitive impairment (MCI) receiving home care. Mobile telepresence robots may allow persons with MCI or ADRD to remain living independently at home and ease the burden of caregiving. The goal of this study was to identify how an existing mobile telepresence robot can be enhanced to support at-home care of people with MCI or ADRD through key stakeholder input. Objective: The specific aims were to assess what applications should be integrated into the robot to further support the independence of individuals with MCI or ADRD and understand stakeholders' overall opinions about the robot. Methods: We conducted in-person interviews with 21 stakeholders, including 6 people aged >50 years with MCI or ADRD living in the community, 9 family caregivers of people with MCI or ADRD, and 6 clinicians who work with the ADRD population. Interview questions about the robot focused on technology use, design and functionality, future applications to incorporate, and overall opinions. We conducted a thematic analysis of the data obtained and assessed the patterns within and across stakeholder groups using a matrix analysis technique. Results: Overall, most stakeholders across groups felt positively about the robot's ability to support individuals with MCI or ADRD and decrease caregiver burden. Most ADRD stakeholders felt that the greatest benefits would be receiving help in emergency cases and having fewer in-person visits to the doctor's office. Caregivers and clinicians also noted that remote video communication with their family members using the robot was valuable. Adding voice commands and 1-touch lifesaving or help buttons to the robot were the top suggestions offered by the stakeholders. The 4 types of applications that were suggested included health-related alerts; reminders; smart-home--related applications; and social, entertainment, or well-being applications. Stakeholders across groups liked the robot's mobility, size, interactive connection, and communication abilities. However, stakeholders raised concerns about their physical stability and size for individuals living in smaller, cluttered spaces; screen quality for those with visual impairments; and privacy or data security. Conclusions: Although stakeholders generally expressed positive opinions about the robot, additional adaptations were suggested to strengthen functionality. Adding applications and making improvements to the design may help mitigate concerns and better support individuals with ADRD to live independently in the community. As the number of individuals living with ADRD in the United States increases, mobile telepresence robots are a promising way to support them and their caregivers. Engaging all 3 stakeholder groups in the development of these robots is a critical first step in ensuring that the technology matches their needs. Integrating the feedback obtained from our stakeholders and evaluating their effectiveness will be important next steps in adapting telepresence robots. ", doi="10.2196/32322", url="https://aging.jmir.org/2022/2/e32322", url="http://www.ncbi.nlm.nih.gov/pubmed/35503518" } @Article{info:doi/10.2196/32169, author="Gudala, Meghana and Ross, Trail Mary Ellen and Mogalla, Sunitha and Lyons, Mandi and Ramaswamy, Padmavathy and Roberts, Kirk", title="Benefits of, Barriers to, and Needs for an Artificial Intelligence--Powered Medication Information Voice Chatbot for Older Adults: Interview Study With Geriatrics Experts", journal="JMIR Aging", year="2022", month="Apr", day="28", volume="5", number="2", pages="e32169", keywords="medication information", keywords="chatbot", keywords="older adults", keywords="technology capabilities", keywords="mobile phone", abstract="Background: One of the most complicated medical needs of older adults is managing their complex medication regimens. However, the use of technology to aid older adults in this endeavor is impeded by the fact that their technological capabilities are lower than those of much of the rest of the population. What is needed to help manage medications is a technology that seamlessly integrates within their comfort levels, such as artificial intelligence agents. Objective: This study aimed to assess the benefits, barriers, and information needs that can be provided by an artificial intelligence--powered medication information voice chatbot for older adults. Methods: A total of 8 semistructured interviews were conducted with geriatrics experts. All interviews were audio-recorded and transcribed. Each interview was coded by 2 investigators (2 among ML, PR, METR, and KR) using a semiopen coding method for qualitative analysis, and reconciliation was performed by a third investigator. All codes were organized into the benefit/nonbenefit, barrier/nonbarrier, and need categories. Iterative recoding and member checking were performed until convergence was reached for all interviews. Results: The greatest benefits of a medication information voice-based chatbot would be helping to overcome the vision and dexterity hurdles experienced by most older adults, as it uses voice-based technology. It also helps to increase older adults' medication knowledge and adherence and supports their overall health. The main barriers were technology familiarity and cost, especially in lower socioeconomic older adults, as well as security and privacy concerns. It was noted however that technology familiarity was not an insurmountable barrier for older adults aged 65 to 75 years, who mostly owned smartphones, whereas older adults aged >75 years may have never been major users of technology in the first place. The most important needs were to be usable, to help patients with reminders, and to provide information on medication side effects and use instructions. Conclusions: Our needs analysis results derived from expert interviews clarify that a voice-based chatbot could be beneficial in improving adherence and overall health if it is built to serve the many medication information needs of older adults, such as reminders and instructions. However, the chatbot must be usable and affordable for its widespread use. ", doi="10.2196/32169", url="https://aging.jmir.org/2022/2/e32169", url="http://www.ncbi.nlm.nih.gov/pubmed/35482367" } @Article{info:doi/10.2196/35925, author="Kokorelias, Marie Kristina and Nelson, LA Michelle and Tang, Terence and Steele Gray, Carolyn and Ellen, Moriah and Plett, Donna and Jarach, Micaela Carlotta and Xin Nie, Jason and Thavorn, Kednapa and Singh, Hardeep", title="Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations", journal="JMIR Aging", year="2022", month="Apr", day="27", volume="5", number="2", pages="e35925", keywords="older adults", keywords="digital technology", keywords="transitions", keywords="older adult population", keywords="digital health", keywords="Digital Hospital", keywords="health intervention", keywords="aging", keywords="gender diversity", keywords="home transition", keywords="epidemiology", abstract="Background: Digital health technologies have been proposed to support hospital-to-home transition for older adults. The COVID-19 pandemic and the associated physical distancing guidelines have propelled a shift toward digital health technologies. However, the characteristics of older adults who participated in digital health research interventions to support hospital-to-home transitions remain unclear. This information is needed to assess whether current digital health interventions are generalizable to the needs of the broader older adult population. Objective: This rapid review of the existing literature aimed to identify the characteristics of the populations targeted by studies testing the implementation of digital health interventions designed to support hospital-to-home transitions, identify the characteristics of the samples included in studies testing digital health interventions used to support hospital-to-home transitions, and create recommendations for enhancing the diversity of samples within future hospital-to-home digital health interventions. Methods: A rapid review methodology based on scoping review guidelines by Arksey and O'Malley was developed. A search for peer-reviewed literature published between 2010 and 2021 on digital health solutions that support hospital-to-home transitions for older adults was conducted using MEDLINE, Embase, and CINAHL databases. The data were analyzed using descriptive statistics and qualitative content analysis. The Sex- and Gender-Based Analysis Plus lens theoretically guided the study design, analysis, and interpretation. Results: A total of 34 studies met the inclusion criteria. Our findings indicate that many groups of older adults were excluded from these interventions and remain understudied. Specifically, the oldest old and those living with cognitive impairments were excluded from the studies included in this review. In addition, very few studies have described the characteristics related to gender diversity, education, race, ethnicity, and culture. None of the studies commented on the sexual orientation of the participants. Conclusions: This is the first review, to our knowledge, that has mapped the literature focusing on the inclusion of older adults in digital hospital-to-home interventions. The findings suggest that the literature on digital health interventions tends to operationalize older adults as a homogenous group, ignoring the heterogeneity in older age definitions. Inconsistency in the literature surrounding the characteristics of the included participants suggests a need for further study to better understand how digital technologies to support hospital-to-home transitions can be inclusive. ", doi="10.2196/35925", url="https://aging.jmir.org/2022/2/e35925", url="http://www.ncbi.nlm.nih.gov/pubmed/35475971" } @Article{info:doi/10.2196/31162, author="Waycott, Jenny and Zhao, Wei and Kelly, M. Ryan and Robertson, Elena", title="Technology-Mediated Enrichment in Aged Care: Survey and Interview Study", journal="JMIR Aging", year="2022", month="Apr", day="12", volume="5", number="2", pages="e31162", keywords="aged care", keywords="older adults", keywords="technology", keywords="social enrichment", keywords="virtual reality", keywords="robots", keywords="videoconferencing", keywords="care providers", abstract="Background: Digital technologies such as virtual reality (VR), humanoid robots, and digital companion pets have the potential to provide social and emotional enrichment for people living in aged care. However, there is currently limited knowledge about how technologies are being used to provide enrichment, what benefits they provide, and what challenges arise when deploying these technologies in aged care settings. Objective: This study aims to investigate how digital technologies are being used for social and emotional enrichment in the Australian aged care industry and identify the benefits and challenges of using technology for enrichment in aged care. Methods: A web-based survey (N=20) was distributed among people working in the Australian aged care sector. The survey collected information about the types of technologies being deployed and their perceived value. The survey was followed by semistructured interviews (N=12) with aged care workers and technology developers to investigate their experiences of deploying technologies with older adults living in aged care. Survey data were analyzed using summary descriptive statistics and categorizing open-ended text responses. Interview data were analyzed using reflexive thematic analysis. Results: The survey revealed that a range of commercial technologies, such as VR, tablet devices, and mobile phones, are being used in aged care to support social activities and provide entertainment. Respondents had differing views about the value of emerging technologies, such as VR, social robots, and robot pets, but were more united in their views about the value of videoconferencing. Interviews revealed 4 types of technology-mediated enrichment experiences: enhancing social engagement, virtually leaving the care home, reconnecting with personal interests, and providing entertainment and distraction. Our analysis identified 5 barriers: resource constraints, the need to select appropriate devices and apps, client challenges, limited staff and organizational support, and family resistance. Conclusions: This study demonstrates that technologies can be used in aged care to create personally meaningful enrichment experiences for aged care clients. To maximize the effectiveness of technology-mediated enrichment, we argue that a person-centered care approach is crucial. Although enrichment experiences can be created using available technologies, they must be carefully selected and co-deployed with aged care clients. However, significant changes may be required within organizations to allow caregivers to facilitate individual technology-based activities for enrichment. ", doi="10.2196/31162", url="https://aging.jmir.org/2022/2/e31162", url="http://www.ncbi.nlm.nih.gov/pubmed/34975014" } @Article{info:doi/10.2196/31916, author="Fotteler, Liselotte Marina and M{\"u}hlbauer, Viktoria and Brefka, Simone and Mayer, Sarah and Kohn, Brigitte and Holl, Felix and Swoboda, Walter and Gaugisch, Petra and Risch, Beate and Denkinger, Michael and Dallmeier, Dhayana", title="The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials", journal="JMIR Aging", year="2022", month="Apr", day="4", volume="5", number="2", pages="e31916", keywords="assistive technology", keywords="older adults", keywords="systematic review", keywords="frailty", abstract="Background: The use of assistive technologies (ATs) to support older people has been fueled by the demographic change and technological progress in many countries. These devices are designed to assist seniors, enable independent living at home or in residential facilities, and improve quality of life by addressing age-related difficulties. Objective: We aimed to evaluate the effectiveness of ATs on relevant outcomes with a focus on frail older adults. Methods: A systematic literature review of randomized controlled trials evaluating ATs was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Ovid Medline, PsycINFO, SocIndex, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CENTRAL (Cochrane Central Register of Controlled Trials), and IEEEXplore databases were searched from January 1, 2009, to March 15, 2019. ATs were included when aiming to support the domains autonomy, communication, or safety of older people with a mean age ?65 years. Trials performed within a laboratory setting were excluded. Studies were retrospectively categorized according to the physical frailty status of participants. Results: A total of 19 trials with a high level of heterogeneity were included in the analysis. Six device categories were identified: mobility, personal disease management, medication, mental support, hearing, and vision. Eight trials showed significant effectiveness in all or some of the primary outcome measures. Personal disease management devices seem to be the most effective, with four out of five studies showing significant improvement of disease-related outcomes. Frailty could only be assessed for seven trials. Studies including participants with significant or severe impairment showed no effectiveness. Conclusions: Different ATs show some promising results in well-functioning but not in frail older adults, suggesting that the evaluated ATs might not (yet) be suitable for this subgroup. The uncertainty of the effectiveness of ATs and the lack of high-quality research for many promising supportive devices were confirmed in this systematic review. Large studies, also including frail older adults, and clear standards are needed in the future to guide professionals, older users, and their relatives. Trial Registration: PROSPERO CRD42019130249; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=130249 ", doi="10.2196/31916", url="https://aging.jmir.org/2022/2/e31916", url="http://www.ncbi.nlm.nih.gov/pubmed/35377322" } @Article{info:doi/10.2196/33169, author="Kleschnitzki, Marina Jana and Beyer, Luzi and Beyer, Reinhard and Gro{\ss}mann, Inga", title="The Effectiveness of a Serious Game (MemoreBox) for Cognitive Functioning Among Seniors in Care Facilities: Field Study", journal="JMIR Serious Games", year="2022", month="Apr", day="1", volume="10", number="2", pages="e33169", keywords="serious game", keywords="cognitive function", keywords="mental health", keywords="seniors", keywords="care facilities", keywords="aging", keywords="cognitive impairments", keywords="health technology", abstract="Background: Serious games have been found to have enhancing and preventative effects on cognitive abilities in healthy older adults. Yet, there are few results on the effects in older seniors with age-related low cognitive impairments. Their special needs were considered when designing and using innovate technology in the area of prevention, which is especially relevant owing to the continuously aging population. Objective: The objective of this study was to evaluate the impact of a serious game on the cognitive abilities of seniors in order to potentially implement innovative resource-oriented technological interventions that can help to meet future challenges. Methods: In this controlled trial, we tested the serious game MemoreBox, which features modules specifically designed for seniors in nursing homes. Over a period of 1 year, we tested the cognitive abilities of 1000 seniors at 4 time points using the Mini-Mental Status Test. Only half of the participating seniors engaged with the serious game. Results: The study included an intervention group (n=56) and a control group (did not play; n=55). Based on the in-game data collection, a second intervention group (n=38) was identified within the original intervention group, which exactly followed the planned protocol. There were no noteworthy differences between the demographic and main variables of the overall sample. The large reduction in the sample size was due to the effects of the COVID-19 pandemic (drop-out rate: 88.9\%). The CI was set at 5\%. Mixed analysis of variance (ANOVA) between the cognitive abilities of the intervention and control groups did not show a statistically significant difference between time and group (F2.710,295.379=1.942; P=.13; partial $\eta${\texttwosuperior}=0.018). We noted approximately the same findings for mixed ANOVA between the cognitive abilities of the second intervention and control groups (F3,273=2.574; P=.054; partial $\eta${\texttwosuperior}=0.028). However, we did observe clear tendencies and a statistically significant difference between the 2 groups after 9 months of the intervention (t88.1=?2.394; P=.02). Conclusions: The results of this study show similarities with the current research situation. Moreover, the data indicate that the intervention can have an effect on the cognitive abilities of seniors, provided that they regularly play the serious game of MemoreBox. The small sample size means that the tendency toward improvement cannot be proven as statistically significant. However, the tendency shown warrants further research. Establishing an effective prevention tool as part of standard care in nursing homes by means of an easy-to-use serious game would be a considerable contribution to the weakened health care system in Germany as it would offer a means of activating senior citizens in partially and fully inpatient care facilities. Trial Registration: German Clinical Trials Register DRKS00016633; https://tinyurl.com/2e4765nj ", doi="10.2196/33169", url="https://games.jmir.org/2022/2/e33169", url="http://www.ncbi.nlm.nih.gov/pubmed/35172959" } @Article{info:doi/10.2196/35373, author="Thapa, Rahul and Garikipati, Anurag and Shokouhi, Sepideh and Hurtado, Myrna and Barnes, Gina and Hoffman, Jana and Calvert, Jacob and Katzmann, Lynne and Mao, Qingqing and Das, Ritankar", title="Predicting Falls in Long-term Care Facilities: Machine Learning Study", journal="JMIR Aging", year="2022", month="Apr", day="1", volume="5", number="2", pages="e35373", keywords="vital signs", keywords="machine learning", keywords="blood pressure", keywords="skilled nursing facilities", keywords="independent living facilities", keywords="assisted living facilities", keywords="fall prediction", keywords="elderly care", keywords="elderly population", keywords="older adult", keywords="aging", abstract="Background: Short-term fall prediction models that use electronic health records (EHRs) may enable the implementation of dynamic care practices that specifically address changes in individualized fall risk within senior care facilities. Objective: The aim of this study is to implement machine learning (ML) algorithms that use EHR data to predict a 3-month fall risk in residents from a variety of senior care facilities providing different levels of care. Methods: This retrospective study obtained EHR data (2007-2021) from Juniper Communities' proprietary database of 2785 individuals primarily residing in skilled nursing facilities, independent living facilities, and assisted living facilities across the United States. We assessed the performance of 3 ML-based fall prediction models and the Juniper Communities' fall risk assessment. Additional analyses were conducted to examine how changes in the input features, training data sets, and prediction windows affected the performance of these models. Results: The Extreme Gradient Boosting model exhibited the highest performance, with an area under the receiver operating characteristic curve of 0.846 (95\% CI 0.794-0.894), specificity of 0.848, diagnostic odds ratio of 13.40, and sensitivity of 0.706, while achieving the best trade-off in balancing true positive and negative rates. The number of active medications was the most significant feature associated with fall risk, followed by a resident's number of active diseases and several variables associated with vital signs, including diastolic blood pressure and changes in weight and respiratory rates. The combination of vital signs with traditional risk factors as input features achieved higher prediction accuracy than using either group of features alone. Conclusions: This study shows that the Extreme Gradient Boosting technique can use a large number of features from EHR data to make short-term fall predictions with a better performance than that of conventional fall risk assessments and other ML models. The integration of routinely collected EHR data, particularly vital signs, into fall prediction models may generate more accurate fall risk surveillance than models without vital signs. Our data support the use of ML models for dynamic, cost-effective, and automated fall predictions in different types of senior care facilities. ", doi="10.2196/35373", url="https://aging.jmir.org/2022/2/e35373", url="http://www.ncbi.nlm.nih.gov/pubmed/35363146" } @Article{info:doi/10.2196/19641, author="Itoh, Sakiko and Tan, Hwee-Pink and Kudo, Kenichi and Ogata, Yasuko", title="Comparison of the Mental Burden on Nursing Care Providers With and Without Mat-Type Sleep State Sensors at a Nursing Home in Tokyo, Japan: Quasi-Experimental Study", journal="JMIR Aging", year="2022", month="Mar", day="23", volume="5", number="1", pages="e19641", keywords="long-term care", keywords="caregiver burden", keywords="nursing homes", keywords="aged", keywords="information technology", keywords="sensors", abstract="Background: Increasing need for nursing care has led to the increased burden on formal caregivers, with those in nursing homes having to deal with exhausting labor. Although research activities on the use of internet of things devices to support nursing care for older adults exist, there is limited evidence on the effectiveness of these interventions among formal caregivers in nursing homes. Objective: This study aims to investigate whether mat-type sleep state sensors for supporting nursing care can reduce the mental burden of formal caregivers in a nursing home. Methods: This was a quasi-experimental study at a nursing home in Tokyo, Japan. The study participants were formal caregivers who cared for residents in private rooms on the fourth and fifth floors of the nursing home. In the intervention group, formal caregivers took care of residents who used sleep state sensors on the fourth floor of the nursing home. The sleep state sensors were mat types and designed to detect body motion such as the frequency of toss and turning and to measure heartbeat and respiration. One sensor was placed on a bed in a private room. When body motion is detected, the information is instantly displayed on a monitor at a staff station. In addition, the mental condition of the formal caregivers was measured using a validated self-reported outcome measure---the Profile of Mood States (POMS), Short-Form, 2nd edition. Formal caregivers in both groups received the POMS at baseline, midpoint (week 4), and endpoint (week 8) to identify changes in these domains. The primary outcome was the difference in total mood disturbance (TMD) of the POMS at baseline and week 8. Results: Of the 22 eligible formal caregivers, 12 (intervention group) utilized sleep state sensors for 8 weeks. The remaining 10 formal caregivers (control group) provided nursing care as usual. As for the primary outcome of the difference between TMD at baseline and week 8, TMD in the intervention group improved by --3.67 versus 4.70 in the control group, resulting in a mean difference of --8.37 (95\% CI --32.02 to 15.29; P=.48) in favor of the intervention. Conclusions: The present 8-week study showed that sleep state sensing for elderly residents might not be associated with reduced mental burdens on formal caregivers in nursing homes. ", doi="10.2196/19641", url="https://aging.jmir.org/2022/1/e19641", url="http://www.ncbi.nlm.nih.gov/pubmed/35319474" } @Article{info:doi/10.2196/32516, author="Gilson, Aaron and Gassman, Michele and Dodds, Debby and Lombardo, Robin and Ford II, H. James and Potteiger, Michael", title="Refining a Digital Therapeutic Platform for Home Care Agencies in Dementia Care to Elicit Stakeholder Feedback: Focus Group Study With Stakeholders", journal="JMIR Aging", year="2022", month="Mar", day="2", volume="5", number="1", pages="e32516", keywords="dementia", keywords="technology", keywords="mobile app", keywords="home care", keywords="focus groups", keywords="qualitative research", keywords="digital therapeutics", keywords="value-based care", keywords="aging in place", keywords="caregiving", abstract="Background: Persons living with dementia require increasing levels of care, and the care model has evolved. The Centers for Medicare and Medicaid Services is transitioning long-term care services from institutional care to home- or community-based services, including reimbursement for nonclinical services. Although home care companies are positioned to handle this transition, they need innovative solutions to address the special challenges posed by caring for persons living with dementia. To live at home longer, these persons require support from formal caregivers (FCGs; ie, paid professionals), who often lack knowledge of their personal histories and have high turnover, or informal caregivers (eg, family or friends), who may have difficulty coping with behavioral and psychological symptoms of dementia. The Generation Connect platform was developed to support these individuals and their formal and informal caregivers. In preliminary studies, the platform improved mood and influenced caregiver satisfaction. To enhance platform effectiveness, Generation Connect received a grant from the National Institutes of Health Small Business Innovation Research to improve clinical outcomes, reduce health care costs, and lower out-of-pocket costs for persons living with dementia who receive care through home care agencies. Objective: This study aims to evaluate information elicited from a series of stakeholder focus groups to understand existing processes, needs, barriers, and goals for the use of the Generation Connect platform by home care agencies and formal and informal caregivers. Methods: A series of focus groups were conducted with home care agency corporate leadership, home care agency franchise owners, home care agency FCGs, and informal caregivers of persons living with dementia. The qualitative approach allowed for unrestricted idea generation that best informed the platform development to enable home care providers to differentiate their dementia care services, involve informal caregivers, improve FCG well-being, and extend the ability of persons living with dementia to age in place. Using the Technology-Enabled Caregiving in the Home framework, an inductive and iterative content analysis was conducted to identify thematic categories from the transcripts. Results: Overall, 39 participants participated across the 6 stakeholder focus groups. The following five overarching themes were identified: technology related; care services; data, documentation, and outcomes; cost, finance, and resources; and resources for caregivers. Within each theme, the most frequent subthemes were identified. Exemplar stakeholder group statements provided support for each of the identified themes. Conclusions: The focus group results will inform the further development of the Generation Connect platform to reduce the burden of caregiving for persons living with dementia, evaluate changes in cognition, preserve functional independence, and promote caregiver engagement between these individuals. The next step is to evaluate the effectiveness of the revised platform in the National Institutes of Health Small Business Innovation Research phase 2 clinical trial to assess the efficacy of its evidence-based interventions and market viability. ", doi="10.2196/32516", url="https://aging.jmir.org/2022/1/e32516", url="http://www.ncbi.nlm.nih.gov/pubmed/35234657" } @Article{info:doi/10.2196/29623, author="Cristiano, Alessia and Musteata, Stela and De Silvestri, Sara and Bellandi, Valerio and Ceravolo, Paolo and Cesari, Matteo and Azzolino, Domenico and Sanna, Alberto and Trojaniello, Diana", title="Older Adults' and Clinicians' Perspectives on a Smart Health Platform for the Aging Population: Design and Evaluation Study", journal="JMIR Aging", year="2022", month="Feb", day="28", volume="5", number="1", pages="e29623", keywords="smart health", keywords="remote monitoring", keywords="requirement elicitation", keywords="older population", keywords="age-related chronic conditions", keywords="healthy aging", keywords="Internet of Things", keywords="mobile phone", abstract="Background: Over recent years, interest in the development of smart health technologies aimed at supporting independent living for older populations has increased. The integration of innovative technologies, such as the Internet of Things, wearable technologies, artificial intelligence, and ambient-assisted living applications, represents a valuable solution for this scope. Designing such an integrated system requires addressing several aspects (eg, equipment selection, data management, analytics, costs, and users' needs) and involving different areas of expertise (eg, medical science, service design, biomedical and computer engineering). Objective: The objective of this study is 2-fold; we aimed to design the functionalities of a smart health platform addressing 5 chronic conditions prevalent in the older population (ie, hearing loss, cardiovascular diseases, cognitive impairments, mental health problems, and balance disorders) by considering both older adults' and clinicians' perspectives and to evaluate the identified smart health platform functionalities with a small group of older adults. Methods: Overall, 24 older adults (aged >65 years) and 118 clinicians were interviewed through focus group activities and web-based questionnaires to elicit the smart health platform requirements. Considering the elicited requirements, the main functionalities of smart health platform were designed. Then, a focus group involving 6 older adults was conducted to evaluate the proposed solution in terms of usefulness, credibility, desirability, and learnability. Results: Eight main functionalities were identified and assessed---cognitive training and hearing training (usefulness: 6/6, 100\%; credibility: 6/6, 100\%; desirability: 6/6, 100\%; learnability: 6/6, 100\%), monitoring of physiological parameters (usefulness: 6/6, 100\%; credibility: 6/6, 100\%; desirability: 6/6, 100\%; learnability: 5/6, 83\%), physical training (usefulness: 6/6, 100\%; credibility: 6/6, 100\%; desirability: 5/6, 83\%; learnability: 2/6, 33\%), psychoeducational intervention (usefulness: 6/6, 100\%; credibility: 6/6, 100\%; desirability: 4/6, 67\%; learnability: 2/6, 33\%), mood monitoring (usefulness: 4/6, 67\%; credibility: 4/6, 67\%; desirability: 3/6, 50\%; learnability: 5/6, 50\%), diet plan (usefulness: 5/6, 83\%; credibility: 4/6, 67\%; desirability: 1/6, 17\%; learnability: 2/6, 33\%), and environment monitoring and adjustment (usefulness: 1/6, 17\%; credibility: 1/6, 17\%; desirability: 0/6, 0\%; learnability: 0/6, 0\%). Most of them were highly appreciated by older participants, with the only exception being environment monitoring and adjustment. The results showed that the proposed functionalities met the needs and expectations of users (eg, improved self-management of patients' disease and enhanced patient safety). However, some aspects need to be addressed (eg, technical and privacy issues). Conclusions: The presented smart health platform functionalities seem to be able to meet older adults' needs and desires to enhance their self-awareness and self-management of their medical condition, encourage healthy and independent living, and provide evidence-based support for clinicians' decision-making. Further research with a larger and more heterogeneous pool of stakeholders in terms of demographics and clinical conditions is needed to assess system acceptability and overall user experience in free-living conditions. ", doi="10.2196/29623", url="https://aging.jmir.org/2022/1/e29623", url="http://www.ncbi.nlm.nih.gov/pubmed/35225818" } @Article{info:doi/10.2196/31970, author="Zhang, Qing and Varnfield, Marlien and Higgins, Liesel and Smallbon, Vanessa and Bomke, Julia and O'Dwyer, John and Byrnes, M. Joshua and Sum, Melissa and Hewitt, Jennifer and Lu, Wei and Karunanithi, Mohanraj", title="The Smarter Safer Homes Solution to Support Older People Living in Their Own Homes Through Enhanced Care Models: Protocol for a Stratified Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Jan", day="24", volume="11", number="1", pages="e31970", keywords="smart home", keywords="aged care", keywords="objective activity of daily living", keywords="randomized trial", keywords="wireless sensor network", keywords="older adults", keywords="care", keywords="methodology", keywords="platform", keywords="benefit", keywords="utilization", keywords="support", keywords="self-management", keywords="digital health", abstract="Background: An aging population, accompanied by the prevalence of age-related diseases, presents a significant burden to health systems. This is exacerbated by an increasing shortage of aged care staff due to the existing workforce entering their retirement and fewer young people being attracted to work in aged care. In line with consumer preferences and potential cost-efficiencies, government and aged care providers are increasingly seeking options to move care and support to the community or home as opposed to residential care facilities. However, compared to residential care, home environments may provide limited opportunity for monitoring patients' progression/decline in functioning and therefore limited opportunity to provide timely intervention. To address this, the Smarter Safer Homes (SSH) platform was designed to enable self-monitoring and/or management, and to provide aged care providers with support to deliver their services. The platform uses open Internet of Things communication protocols to easily incorporate commercially available sensors into the system. Objective: Our research aims to detail the benefits of utilizing the SSH platform as a service in its own right as well as a complementary service to more traditional/historical service offerings in aged care. This work is anticipated to validate the capacity and benefits of the SSH platform to enable older people to self-manage and aged care service providers to support their clients to live functionally and independently in their own homes for as long as possible. Methods: This study was designed as a single-blinded, stratified, 12-month randomized controlled trial with participants recruited from three aged care providers in Queensland, Australia. The study aimed to recruit 200 people, including 145 people from metropolitan areas and 55 from regional areas. Participants were randomized to the intervention group (having the SSH platform installed in their homes to assist age care service providers in monitoring and providing timely support) and the control group (receiving their usual aged care services from providers). Data on community care, health and social-related quality of life, health service utilization, caregiver burden, and user experience of both groups were collected at the start, middle (6 months), and end of the trial (12 months). Results: The trial recruited its first participant in April 2019 and data collection of the last participant was completed in November 2020. The trial eventually recruited 195 participants, with 98 participants allocated to the intervention group and 97 participants allocated to the control group. The study also received participants' health service data from government data resources in June 2021. Conclusions: A crisis is looming to support the aging population. Digital solutions such as the SSH platform have the potential to address this crisis and support aged care in the home and community. The outcomes of this study could improve and support the delivery of aged care services and provide better quality of life to older Australians in various geographical locations. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000829213; https://tinyurl.com/2n6a75em International Registered Report Identifier (IRRID): DERR1-10.2196/31970 ", doi="10.2196/31970", url="https://www.researchprotocols.org/2022/1/e31970", url="http://www.ncbi.nlm.nih.gov/pubmed/35072640" } @Article{info:doi/10.2196/32442, author="Schuster, M. Amy and Cotten, R. Shelia", title="COVID-19's Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators", journal="JMIR Aging", year="2022", month="Jan", day="12", volume="5", number="1", pages="e32442", keywords="COVID-19", keywords="pandemic", keywords="socioemotional needs", keywords="long-term care", keywords="nursing home facility", keywords="assisted living facility", keywords="elderly", keywords="older adults", keywords="information and communication technologies", keywords="support", keywords="emotion", keywords="needs", keywords="access", keywords="connection", keywords="communication", keywords="engagement", abstract="Background: The prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them. Objective: This study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic. Methods: LTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic. Results: LTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53\% (37/70) of the LTC facilities have purchased ICTs for residents' use. ICTs have mainly been used for videoconferencing with family members (31/36, 86\%), friends (25/36, 69\%), and health care providers (26/36, 72\%). NHs were 10.23 times more likely to purchase ICTs for residents' use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95\% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology. Conclusions: Our results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents' engagement and communication opportunities, such as another pandemic. ", doi="10.2196/32442", url="https://aging.jmir.org/2022/1/e32442", url="http://www.ncbi.nlm.nih.gov/pubmed/34878989" } @Article{info:doi/10.2196/28022, author="Latikka, Rita and Rubio-Hern{\'a}ndez, Rosana and Lohan, Simona Elena and Rantala, Juho and Nieto Fern{\'a}ndez, Fernando and Laitinen, Arto and Oksanen, Atte", title="Older Adults' Loneliness, Social Isolation, and Physical Information and Communication Technology in the Era of Ambient Assisted Living: A Systematic Literature Review", journal="J Med Internet Res", year="2021", month="Dec", day="30", volume="23", number="12", pages="e28022", keywords="loneliness", keywords="social isolation", keywords="older adults", keywords="physical information and communication technology", keywords="systematic literature review", abstract="Background: Loneliness and social isolation can have severe effects on human health and well-being. Partial solutions to combat these circumstances in demographically aging societies have been sought from the field of information and communication technology (ICT). Objective: This systematic literature review investigates the research conducted on older adults' loneliness and social isolation, and physical ICTs, namely robots, wearables, and smart homes, in the era of ambient assisted living (AAL). The aim is to gain insight into how technology can help overcome loneliness and social isolation other than by fostering social communication with people and what the main open-ended challenges according to the reviewed studies are. Methods: The data were collected from 7 bibliographic databases. A preliminary search resulted in 1271 entries that were screened based on predefined inclusion criteria. The characteristics of the selected studies were coded, and the results were summarized to answer our research questions. Results: The final data set consisted of 23 empirical studies. We found out that ICT solutions such as smart homes can help detect and predict loneliness and social isolation, and technologies such as robotic pets and some other social robots can help alleviate loneliness to some extent. The main open-ended challenges across studies relate to the need for more robust study samples and study designs. Further, the reviewed studies report technology- and topic-specific open-ended challenges. Conclusions: Technology can help assess older adults' loneliness and social isolation, and alleviate loneliness without direct interaction with other people. The results are highly relevant in the COVID-19 era, where various social restrictions have been introduced all over the world, and the amount of research literature in this regard has increased recently. ", doi="10.2196/28022", url="https://www.jmir.org/2021/12/e28022", url="http://www.ncbi.nlm.nih.gov/pubmed/34967760" } @Article{info:doi/10.2196/29744, author="Pech, Marion and Sauzeon, Helene and Yebda, Thinhinane and Benois-Pineau, Jenny and Amieva, Helene", title="Falls Detection and Prevention Systems in Home Care for Older Adults: Myth or Reality?", journal="JMIR Aging", year="2021", month="Dec", day="9", volume="4", number="4", pages="e29744", keywords="elderly people", keywords="new technologies", keywords="fall", keywords="acceptability", keywords="digital divide", keywords="aging", keywords="falls", keywords="fall prevention", keywords="detection", keywords="geriatrics", keywords="barriers", keywords="technology acceptance", keywords="home care", keywords="seniors", doi="10.2196/29744", url="https://aging.jmir.org/2021/4/e29744", url="http://www.ncbi.nlm.nih.gov/pubmed/34889755" } @Article{info:doi/10.2196/27645, author="Gell, Nancy and Hoffman, Elise and Patel, Kushang", title="Technology Support Challenges and Recommendations for Adapting an Evidence-Based Exercise Program for Remote Delivery to Older Adults: Exploratory Mixed Methods Study", journal="JMIR Aging", year="2021", month="Dec", day="9", volume="4", number="4", pages="e27645", keywords="tele-exercise", keywords="technology", keywords="older adults", keywords="adult learning theory", keywords="knee osteoarthritis", keywords="mobile phone", abstract="Background: Tele-exercise has emerged as a means for older adults to participate in group exercise during the COVID-19 pandemic. However, little is known about the technology support needs of older adults for accessing tele-exercise. Objective: This study aims to examine the needs of older adults for transition to tele-exercise, identify barriers to and facilitators of tele-exercise uptake and continued participation, and describe technology support challenges and successes encountered by older adults starting tele-exercise. Methods: We used an exploratory, sequential mixed methods study design. Participants were older adults with symptomatic knee osteoarthritis (N=44) who started participating in a remotely delivered program called Enhance Fitness. Before the start of the classes, a subsample of the participants (n=10) completed semistructured phone interviews about their technology support needs and the barriers to and facilitators for technology adoption. All of the participants completed the surveys including the Senior Technology Acceptance Model scale and a technology needs assessment. The study team recorded the technology challenges encountered and the attendance rates for 48 sessions delivered over 16 weeks. Results: Four themes emerged from the interviews: participants desire features in a tele-exercise program that foster accountability, direct access to helpful people who can troubleshoot and provide guidance with technology is important, opportunities to participate in high-value activities motivate willingness to persevere through the technology concerns, and belief in the ability to learn new things supersedes technology-related frustration. Among the participants in the tele-exercise classes (mean age 74, SD 6.3 years; 38/44, 86\% female; mean 2.5, SD 0.9 chronic conditions), 71\% (31/44) had a computer with a webcam, but 41\% (18/44) had little or no experience with videoconferencing. The initial technology orientation sessions lasted on average 19.3 (SD 10.3) minutes, and 24\% (11/44) required a follow-up assistance call. During the first 2 weeks of tele-exercise, 47\% of participants (21/44) required technical assistance, which decreased to 12\% (5/44) during weeks 3 to 16. The median attendance was 100\% for the first 6 sessions and 93\% for the subsequent 42 sessions. Conclusions: With appropriate support, older adults can successfully participate in tele-exercise. Recommendations include individualized technology orientation sessions, experiential learning, and availability of standby technical assistance, particularly during the first 2 weeks of classes. Continued development of best practices in this area may allow previously hard-to-reach populations of older adults to participate in health-enhancing, evidence-based exercise programs. ", doi="10.2196/27645", url="https://aging.jmir.org/2021/4/e27645", url="http://www.ncbi.nlm.nih.gov/pubmed/34889743" } @Article{info:doi/10.2196/27630, author="Xiang, Xiaoling and Kayser, Jay and Sun, Yihang and Himle, Joseph", title="Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants' Experiences", journal="JMIR Aging", year="2021", month="Nov", day="22", volume="4", number="4", pages="e27630", keywords="internet-based cognitive behavioral therapy", keywords="homebound older adults", keywords="home care", keywords="direct care workers", keywords="depression", keywords="qualitative study", abstract="Background: Depression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities. Objective: This study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression. Methods: The participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research. Results: Three themes and various subthemes emerged related to participants' experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants' perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement. Conclusions: iCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence. Trial Registration: ClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289 ", doi="10.2196/27630", url="https://aging.jmir.org/2021/4/e27630", url="http://www.ncbi.nlm.nih.gov/pubmed/34813491" } @Article{info:doi/10.2196/30337, author="Bradwell, Louise Hannah and Edwards, Katie and Shenton, Deborah and Winnington, Rhona and Thill, Serge and Jones, B. Ray", title="User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="1", volume="8", number="4", pages="e30337", keywords="companion robots", keywords="social robots", keywords="Paro", keywords="older adults", keywords="dementia", keywords="care homes", keywords="engagement", keywords="acceptability", keywords="gerontology", keywords="Joy for All", keywords="social care", keywords="user-centered design", abstract="Background: Globally, pressure is increasing on health and social care resources due to the aging population and growing prevalence of dementia. Companion robots, such as Paro, demonstrate strong potential for helping reduce this pressure through reported benefits including reduced agitation, depression, loneliness, care provider burden, and medication use. However, we previously identified that user-centered design of robot pets is both essential and understudied. We observed that commonly used robot pets are poorly matched to end-user requirements, and that end users and developers of robot pets differ significantly in their perception of appropriate design. This may explain some of the contradictory outcome research and variance in results for robot pets, such as Paro. Objective: In response to the literature gap, we aimed to provide user-centered insights into the design of robot pets from key stakeholders to inform future robot development and the choice of robots for real-world implementation and research. We focused on understanding user requirements. Methods: We conducted a qualitative study with 65 participants from 5 care homes (26 care home residents, 29 staff members. and 10 family members). Care home residents formed groups of between 3 and 4 individuals and experienced free interactions with a range of 8 companion robots and toys, including Paro and more affordable alternatives. The robots provided had a range of esthetics, shell types, interactivity levels, and designs for comparison. Care staff and family members observed the interactions. All participants then engaged in focus groups within their stakeholder category to discuss preferences and user requirements in companion robot design. Both free interactions and focus groups were video and audio recorded, transcribed, and subjected to thematic analysis. Results: Care home residents, family members, and staff were open and accepting of the use of companion robot pets, with the majority suggesting that they would keep a device for themselves or the residents. The most preferred device was the Joy for All cat, followed by the Joy for All dog. In discussions, the preferred design features included familiar animal embodiment (domestic pet), soft fur, interactivity, big appealing eyes, simulated breathing, and movements. Unfamiliar devices were more often seen as toy-like and suitable for children, producing some negative responses. Conclusions: This work provides important and user-centered insights into future robot designs for care home residents by means of a comprehensive comparison with key stakeholders. This work strongly supports the use of familiar embodiment in future robot pet designs, with domestic cat and dog morphologies appearing most acceptable. The results have implications for future robot designs and the selection of robot pets for both research and real-world implementations. ", doi="10.2196/30337", url="https://rehab.jmir.org/2021/4/e30337", url="http://www.ncbi.nlm.nih.gov/pubmed/34723825" } @Article{info:doi/10.2196/30841, author="Bastoni, Sofia and Wrede, Christian and da Silva, Cristina Marcia and Sanderman, Robbert and Gaggioli, Andrea and Braakman-Jansen, Annemarie and van Gemert-Pijnen, Lisette", title="Factors Influencing Implementation of eHealth Technologies to Support Informal Dementia Care: Umbrella Review", journal="JMIR Aging", year="2021", month="Oct", day="8", volume="4", number="4", pages="e30841", keywords="eHealth", keywords="assistive technologies", keywords="dementia", keywords="informal care", keywords="home care", keywords="implementation", abstract="Background: The worldwide increase in community-dwelling people with dementia underscores the need for innovative eHealth technologies that aim to provide support to both patients and their informal caregivers in the home setting. However, sustainable implementation of eHealth technologies within this target group can be difficult. Objective: The goal of this study was to gain a thorough understanding of why it is often difficult to implement eHealth technologies in practice, even though numerous technologies are designed to support people with dementia and their informal caregivers at home. In particular, our study aimed to (1) provide an overview of technologies that have been used and studied in the context of informal dementia care and (2) explore factors influencing the implementation of these technologies. Methods: Following an umbrella review design, five different databases were searched (PubMed, PsycINFO, Medline, Scopus, and Cochrane) for (systematic) reviews. Among 2205 reviews retrieved, 21 were included in our analysis based on our screening and selection procedure. A combination of deductive and inductive thematic analyses was performed, using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework for organizing the findings. Results: We identified technologies designed to be used ``by informal caregivers,'' ``by people with dementia,'' and ``with people with dementia.'' Within those groups, most of the represented technologies included, respectively: (i) devices for in-home monitoring of lifestyle, health, and safety; (ii) technologies for supporting memory, orientation, and day structure; and (iii) technologies to facilitate communication between the informal caregiver and person with dementia. Most of the identified factors influencing implementation related to the condition of dementia, characteristics of the technology, expected/perceived value of users, and characteristics of the informal caregiver. Considerably less information has been reported on factors related to the implementing organization and technology supplier, wider institutional and sociocultural context of policy and regulations, and continued adaptation of technology over time. Conclusions: Our study offers a comprehensive overview of eHealth technologies in the context of informal dementia care and contributes to gaining a better understanding of a broad range of factors influencing their implementation. Our results uncovered a knowledge gap regarding success factors for implementation related to the organizational and broader context and continuous adaptation over the long term. Although future research is needed, the current findings can help researchers and stakeholders in improving the development and implementation of eHealth technologies to support informal dementia care. ", doi="10.2196/30841", url="https://aging.jmir.org/2021/4/e30841", url="http://www.ncbi.nlm.nih.gov/pubmed/34623314" } @Article{info:doi/10.2196/27862, author="Sharma, Nikita and Brinke, Klein Jeroen and Gemert-Pijnen, Van J. E. W. C. and Braakman-Jansen, A. L. M.", title="Implementation of Unobtrusive Sensing Systems for Older Adult Care: Scoping Review", journal="JMIR Aging", year="2021", month="Oct", day="6", volume="4", number="4", pages="e27862", keywords="elderly care", keywords="unobtrusive", keywords="sensing system", keywords="caregiving", keywords="implementation", keywords="mobile phone", keywords="older adults", abstract="Background: The continuous growth of the older adult population will have implications for the organization of health and social care. Potentially, in-home monitoring unobtrusive sensing systems (USSs) can be used to support formal or informal caregivers of older adults, as they can monitor deviant physical and physiological behavior changes. Most existing USSs are not specific to older adult care. Hence, to facilitate the implementation of existing USSs in older adult care, it is important to know which USSs would be more suitable for older adults. Objective: This scoping review aims to examine the literature to identify current USSs for monitoring human activities and behaviors and assess their implementation readiness for older adult care. Methods: We conducted a structured search in the Scopus, Web of Science, and ACM Digital Library databases. Predefined inclusion criteria included studies on unobtrusive sensor-based technology; experimental in nature; aimed at monitoring human social, emotional, physical, and physiological behavior; having the potential to be scalable in in-home care; and having at least 5 adults as participants. Using these criteria, we screened studies by title, abstract, and full text. A deductive thematic analysis based on the Proctor implementation framework along with an additional outcome of external validity was applied to the included studies to identify the factors contributing to successful implementation. Finally, the identified factors were used to report the implementation readiness of the included studies for older adult care. Results: In this review, 52 studies were included. Deductive analysis using the implementation framework by Proctor resulted in six factors that can contribute to the successful implementation of USSs in older adult care: study settings, age of participants, activities monitored, sensor setup, sensing technology used, and usefulness of USSs. These factors were associated with the implementation outcomes as follows: study settings and age of participants contributed to external validity, sensor setup contributed to acceptability, usefulness of USSs contributed to adoption, activities monitored contributed to appropriateness, and sensing technology used contributed to implementation cost. Furthermore, the implementation assessment of the included 52 studies showed that none of the studies addressed all the identified factors. This assessment was useful in highlighting studies that have addressed multiple factors; thus, these studies represent a step ahead in the implementation process. Conclusions: This review is the first to scope state-of-the-art USSs suitable for older adult care. Although the included 52 USS studies fulfilled the basic criteria to be suitable for older adult care, systems leveraging radio frequency technology in a no-contact sensor setup for monitoring life risk or health wellness activities are more suitable for older adult care. Finally, this review has extended the discussion about unobtrusiveness as a property of systems that cannot be measured in binary because it varies greatly with user perception and context. ", doi="10.2196/27862", url="https://aging.jmir.org/2021/4/e27862", url="http://www.ncbi.nlm.nih.gov/pubmed/34612822" } @Article{info:doi/10.2196/31137, author="Zingmark, Magnus and Bj{\"o}rk, Jonas and Granbom, Marianne and Gefenaite, Giedre and Nordestr{\"o}m, Frida and Schmidt, M. Steven and Rantanen, Taina and Slaug, Bj{\"o}rn and Iwarsson, Susanne", title="Exploring Associations of Housing, Relocation, and Active and Healthy Aging in Sweden: Protocol for a Prospective Longitudinal Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Sep", day="21", volume="10", number="9", pages="e31137", keywords="accessibility", keywords="activity", keywords="age-friendly housing", keywords="aging-in-place", keywords="housing preferences", keywords="life-space", keywords="mobility", keywords="moving expectations", keywords="neighborhood", keywords="participation", abstract="Background: While housing and neighborhood features have the potential to impact opportunities for active aging, there is a lack of knowledge related to how older people reason regarding their housing situation and how housing and fulfillment of relocation are associated with active and healthy aging. Objective: The objectives of Prospective RELOC-AGE are to study housing choices and relocation and explore effects on active and healthy aging among men and women aged 55 years and older in Sweden considering relocation. Methods: The estimated sample (2800) will include people aged 55 years and older being listed for relocation at either of two housing companies: a local public housing company in Southern Sweden and a national condominium provider. Prospective RELOC-AGE has a 2-level longitudinal mixed methods design and includes quantitative surveys (implemented by a professional survey company) and a telephone interview for baseline data collection in 2021, with follow-ups with the same procedures in 2022 and 2023. The survey and interviews include questions related to present housing and neighborhood, relocation plans and expectations, a range of perspectives on active and healthy aging, and demographics. Linking to national registers will provide additional data on home help and health care use, objective housing, and neighborhood characteristics. To explore what housing attributes older adults considering relocation find important and to what extent when making their decisions on housing, we will develop a discrete choice experiment to be implemented with a subsample of participants. Further, a grounded theory approach will be applied to collect in-depth interview data from participants who have moved to another dwelling, within 6 months of the move. A follow-up interview 12 months later will focus on participants' deepened experience over time in terms of fulfilled expectations and relocation experiences. Results: As of submission of this protocol (June 2021), recruitment has commenced with approximately 960 respondents to the survey and ongoing telephone interviews. We anticipate recruitment and data collection based on surveys and interviews to continue during 2021. Conclusions: Prospective RELOC-AGE has the capacity to generate new policy-relevant knowledge on associations of housing, relocation, and active and healthy aging. Such knowledge is relevant for the development of proactive approaches to housing in old age on the individual, group, and societal levels. Trial Registration: ClinicalTrials.gov NCT04765696; https://clinicaltrials.gov/ct2/show/NCT04765696 International Registered Report Identifier (IRRID): DERR1-10.2196/31137 ", doi="10.2196/31137", url="https://www.researchprotocols.org/2021/9/e31137", url="http://www.ncbi.nlm.nih.gov/pubmed/34546172" } @Article{info:doi/10.2196/29210, author="Saredakis, Dimitrios and Keage, AD Hannah and Corlis, Megan and Ghezzi, S. Erica and Loffler, Helen and Loetscher, Tobias", title="The Effect of Reminiscence Therapy Using Virtual Reality on Apathy in Residential Aged Care: Multisite Nonrandomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Sep", day="20", volume="23", number="9", pages="e29210", keywords="reminiscence", keywords="head-mounted display", keywords="apathy", keywords="cognitive aging", keywords="dementia", keywords="residential facilities", keywords="virtual reality", abstract="Background: Apathy is a frequent and underrecognized neurological disorder symptom. Reduced goal-directed behavior caused by apathy is associated with poor outcomes for older adults in residential aged care. Recommended nonpharmacological treatments include person-centered therapy using information and communication technology. Virtual reality (VR) in the form of head-mounted displays (HMDs) is a fully immersive technology that provides access to a wide range of freely available content. The use of VR as a therapy tool has demonstrated promise in the treatment of posttraumatic stress disorder and anxiety. In addition, VR has been used to improve conditions including depression, anxiety, cognitive function, and balance in older adults with memory deficits, Alzheimer disease, and Parkinson disease. Research using VR for the symptoms of apathy in older adults living in residential aged care facilities is limited. Objective: This study aims to examine whether using HMDs as a tool for reminiscence therapy improves the symptoms of apathy compared with using a laptop computer and physical items with older adults living in residential aged care. Methods: In this multisite trial, 43 participants were allocated to one of three groups: reminiscence therapy intervention using VR in the form of HMDs, reminiscence therapy using a laptop computer supplemented by physical items if required (active control), and a usual care (passive control) group. The primary outcome was apathy, and the secondary outcomes included cognition and depression. The side effects of using HMDs were also measured in the VR group. Results: Mixed model analyses revealed no significant group interaction over time in outcomes between the VR and laptop groups (estimate=?2.24, SE 1.89; t40=?1.18; P=.24). Pooled apathy scores in the two intervention groups compared with the passive control group also revealed no significant group interaction over time (estimate=?0.26, SE 1.66; t40=?0.16; P=.88). There were no significant secondary outcomes. Most participants in the VR group stated that they would prefer to watch content in VR than on a flat screen ($\Chi$22=11.2; P=.004), side effects from HMD use were negligible to minimal according to the Simulator Sickness Questionnaire cutoff scores. Conclusions: Although there were no significant results in outcome measures, this study found that participants engaged in the research and enjoyed the process of reminiscing using both forms of technology. It was found that VR can be implemented in an aged care setting with correct protocols in place. Providing residents in aged care with a choice of technology may assist in increasing participation in activities. We cannot dismiss the importance of immediate effects while the therapy was in progress, and this is an avenue for future research. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001510134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378564. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-046030 ", doi="10.2196/29210", url="https://www.jmir.org/2021/9/e29210", url="http://www.ncbi.nlm.nih.gov/pubmed/34542418" } @Article{info:doi/10.2196/30802, author="Beogo, Idrissa and Ramd{\'e}, Jean and Nguemeleu Tchouaket, Eric and Sia, Drissa and Bationo, Jean-Claude Nebila and Collin, Stephanie and Anne, Abdoulaye and Gagnon, Marie-Pierre", title="Co-Development of a Web-Based Hub (eSocial-hub) to Combat Social Isolation and Loneliness in Francophone and Anglophone Older People in the Linguistic Minority Context (Quebec, Manitoba, and New Brunswick): Protocol for a Mixed Methods Interventional Study", journal="JMIR Res Protoc", year="2021", month="Sep", day="15", volume="10", number="9", pages="e30802", keywords="older people", keywords="nursing facility", keywords="nursing home", keywords="long-term care home", keywords="linguistic minority", keywords="digital health", keywords="COVID-19", keywords="social isolation", keywords="loneliness", keywords="older adults", keywords="development", keywords="isolation", keywords="minority", keywords="community", abstract="Background: The first wave of the COVID-19 pandemic has severely hit Canadian nursing facilities (81\% of deaths). To this toll, public health measures (eg, visitation restriction) have subsequently deepened the social isolation and loneliness of residents in nursing facilities (NFs), especially those in linguistic minority settings: Anglophone institutions in Quebec and Francophone institutions outside Quebec. However, very few COVID-19 initiatives targeting these populations specifically have been documented. Given the limited number of NFs serving linguistic minorities in Canadian populations, families and loved ones often live far from these facilities, sometimes even in other provinces. This context places the digital solutions as particularly relevant for the present COVID-19 pandemic as well as in the post--COVID-19 era. Objective: This project aims to co-develop a virtual community of practice through a web-based platform (eSocial-hub) to combat social isolation and loneliness among the older people in linguistic minority settings in Canada. Methods: An interventional study using a sequential mixed methods design will be conducted. Four purposely selected NFs will be included, 2 among facilities in Manitoba and 2 in New Brunswick; and 2 Anglophone NFs in Quebec will serve as knowledge users. The development of eSocial-hub will include an experimental 4-month phase involving the following end users: (1) older people (n=3 per NF), (2) families of the participating older people (n=3 per NF), and (3) frontline staff (nurse and health care aid; n=2 per NF). Results: Activities and solutions aiming at reducing social isolation and loneliness will be implemented and then evaluated with the project stakeholders, and the best practices generated. The assessment will be conducted using indicators derived from the 5 domains of the Consolidated Framework for Implementation Research. The project will be led by an interdisciplinary team and will involve a multisectoral partnership. Conclusions: The project will develop a promising and generalizable solution that uses virtual technology to help reduce social isolation and loneliness among the older people. International Registered Report Identifier (IRRID): PRR1-10.2196/30802 ", doi="10.2196/30802", url="https://www.researchprotocols.org/2021/9/e30802", url="http://www.ncbi.nlm.nih.gov/pubmed/34464326" } @Article{info:doi/10.2196/23539, author="Miyatake, Hirotomo and Kosaka, Makoto and Arita, Satoshi and Tsunetoshi, Chie and Masunaga, Hidehisa and Kotera, Yasuhiro and Nishikawa, Yoshitaka and Ozaki, Akihiko and Beniya, Hiroyuki", title="Videoconferencing for Home Care Delivery in Japan: Observational Study", journal="J Med Internet Res", year="2021", month="Sep", day="1", volume="23", number="9", pages="e23539", keywords="telehome care", keywords="videoconference", keywords="home care", keywords="caregiver", keywords="telepresenter", keywords="mobile phone", abstract="Background: Telemedicine has been increasingly used in many health care fields, including home care, where patients receive medical care at home. Owing to the current COVID-19 crisis, the value of telemedicine via videoconferencing is more recognized, particularly in allowing immobile patients to continue receiving care. However, the efficacy of telemedicine in home care settings in Japan remains to be fully appraised. Objective: This study aims to identify the use and impact of telemedicine in a singular home care delivery setting in Japan. Methods: A retrospective observational study was conducted using patient and other administrative records from a home care clinic. We considered patients who were involved in videoconferencing with home care physicians and telepresenters serving patients during 2018 and 2019. We extracted sociodemographic data of the patients and details of the videoconferencing and descriptively illustrated some specific cases. Results: In a home care clinic in Japan, videoconferencing was conducted in 17 cases (involving 14 patients) over a 2-year period. Of all the cases, 12\% (2/17) required emergency transfers and were hospitalized. A total of 88\% (15/17) of cases remained; 71\% (12/17) of cases were found to need extra medication or to go to a medical facility for consultation, whereas 18\% (3/17) of cases were found not to be in need of urgent attention and were asked to rest. Problematic symptoms subsequently improved in 82\% (14/17) of cases, and only 6\% (1/17) of cases were later hospitalized. Conclusions: Telemedicine was deemed effective for assessing patients' conditions in the home care setting in situations where home visits by a physician cannot be carried out. Our findings indicate that consultations via videoconferencing are safe and effective, suggesting more active use of videoconferencing in other clinical contexts. ", doi="10.2196/23539", url="https://www.jmir.org/2021/9/e23539", url="http://www.ncbi.nlm.nih.gov/pubmed/34468333" } @Article{info:doi/10.2196/29031, author="Verloo, Henk and Lorette, Adrien and Rosselet Amoussou, Jo{\"e}lle and Gill{\`e}s de P{\'e}lichy, Estelle and Matos Queir{\'o}s, Alcina and von Gunten, Armin and Perruchoud, Elodie", title="Using Living Labs to Explore Needs and Solutions for Older Adults With Dementia: Scoping Review", journal="JMIR Aging", year="2021", month="Aug", day="19", volume="4", number="3", pages="e29031", keywords="living lab", keywords="aged", keywords="dementia", keywords="cognitive dysfunction", keywords="long-term care", keywords="primary health care", keywords="technology", keywords="mobile phone", abstract="Background: Numerous living labs have established a new approach for studying the health, independent living, and well-being of older adults with dementia. Living labs interact with a broad set of stakeholders, including students, academic institutions, private companies, health care organizations, and patient representative bodies and even with other living labs. Hence, it is crucial to identify the types of cocreations that should be attempted and how they can be facilitated through living labs. Objective: This study aims to scope publications that examine all types of living lab activities, exploring the needs and expectations of older adults with dementia and seeking solutions, whether they live in the community or long-term health care facilities (LTHFs). Methods: This scoping review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations for the extension of scoping reviews. We searched six bibliographic databases for publications up to March 2020, and a forward-backward citation chasing was performed. Additional searches were conducted using Google Scholar. The quality of the selected papers was assessed. Results: Of the 5609 articles identified, we read 58 (1.03\%) articles and retained 12 (0.21\%) articles for inclusion and final analysis. All 12 articles presented an innovative product, developed in 4 main living labs, to assist older adults with cognitive disorders or dementia living in the community or LTHFs. The objectives of these studies were to optimize health, quality of life, independent living, home care, and safety of older adults with cognitive disorders or dementia, as well as to support professional and family caregivers or reduce their burdens. The overall methodological quality of the studies ranged from poor to moderate. Conclusions: This scoping review identified several living labs playing a pivotal role in research aimed at older adults with dementia living in the community or LTHFs. However, it also revealed that living labs should conduct more better-quality interventional research to prove the effectiveness of their technological products or service solutions. International Registered Report Identifier (IRRID): RR2-10.2147/SHTT.S233130 ", doi="10.2196/29031", url="https://aging.jmir.org/2021/3/e29031", url="http://www.ncbi.nlm.nih.gov/pubmed/34420916" } @Article{info:doi/10.2196/22316, author="Rostad, Marie Hanne and Stokke, Randi", title="Integrating Welfare Technology in Long-term Care Services: Nationwide Cross-sectional Survey Study", journal="J Med Internet Res", year="2021", month="Aug", day="16", volume="23", number="8", pages="e22316", keywords="ambient assisted living", keywords="cross-sectional survey", keywords="home care services", keywords="innovation", keywords="long-term care", keywords="nursing homes", keywords="telecare", keywords="welfare technology", keywords="mobile phone", abstract="Background: Welfare technologies are often described as a solution to the increasing pressure on primary health care services. However, despite initiating welfare technology projects in the health care sector and different government incentives, research indicates that it is difficult to integrate welfare technology innovations in a complex and varying setting, such as long-term care. Objective: We aim to describe the types of welfare technology and the extent to which welfare technology is provided in long-term care (ie, nursing homes and home care services); examine whether the extent of welfare technology provision differs on the basis of municipal characteristics (ie, population size, centrality, the proportion of older inhabitants, and income); and identify how local governments (ie, municipalities) describe their efforts toward integrating welfare technologies in long-term care. Methods: Quantitative and qualitative data about welfare technology from a larger cross-sectional survey about the provision of long-term care services in Norwegian municipalities were combined with registry data. Representatives of 422 Norwegian municipalities were invited to participate in the survey. Frequencies were used to describe the distribution of the types and extent of welfare technologies, whereas the Fisher exact test and Kruskal-Wallis one-way analysis of variance were used to determine the association between the extent of welfare technology and municipal characteristics. Free-form text data were analyzed using thematic analysis. Results: A total of 277 municipalities were surveyed. Technology for safety was the most widespread type of welfare technology, whereas technology for social contact was the least prevalent. Two-thirds of the sample (183/277, 66.1\%) in nursing home and (197/277, 71.1\%) in home care services reported providing one or two different types of welfare technology. There was a statistically significant association between the extent of welfare technology and population size (in both nursing homes and home care services: P=.01), centrality (nursing homes: P=.01; home care services: P<.001), and municipal income (nursing homes: P=.02; home care services: P<.001). The extent of welfare technology was not associated with the proportion of older adults. The municipalities described being in a piloting phase and committing to future investment in welfare technology. Monetary resources were allocated, competency development among staff was initiated, and the municipalities were concerned about establishing collaborations within and between municipalities. Home care services seem to have a more person-centered approach in their efforts toward integrating welfare technologies, whereas nursing homes seem to have a more technology-centered approach. Conclusions: Many municipalities provide welfare technologies; however, their extent is limited and varies according to municipal characteristics. Municipal practices still seem dominated by piloting, and welfare technologies are not fully integrated into long-term care services. Innovation with welfare technology appears top-down and is influenced by national policy but also reflects creating a window of opportunity through the organization of municipal efforts toward integrating welfare technology through, for example, collaborations and committing personnel and financial resources. ", doi="10.2196/22316", url="https://www.jmir.org/2021/8/e22316", url="http://www.ncbi.nlm.nih.gov/pubmed/34398791" } @Article{info:doi/10.2196/27047, author="Tiersen, Federico and Batey, Philippa and Harrison, C. Matthew J. and Naar, Lenny and Serban, Alina-Irina and Daniels, C. Sarah J. and Calvo, A. Rafael", title="Smart Home Sensing and Monitoring in Households With Dementia: User-Centered Design Approach", journal="JMIR Aging", year="2021", month="Aug", day="11", volume="4", number="3", pages="e27047", keywords="assistive technology", keywords="independent living", keywords="internet of things", keywords="remote monitoring", keywords="dementia", keywords="human centered design", keywords="user-centered design", keywords="patient-centered care", keywords="smart home", keywords="digital health", abstract="Background: As life expectancy grows, so do the challenges of caring for an aging population. Older adults, including people with dementia, want to live independently and feel in control of their lives for as long as possible. Assistive technologies powered by artificial intelligence and internet of things devices are being proposed to provide living environments that support the users' safety, psychological, and medical needs through remote monitoring and interventions. Objective: This study investigates the functional, psychosocial, and environmental needs of people living with dementia, their caregivers, clinicians, and health and social care service providers toward the design and implementation of smart home systems. Methods: We used an iterative user-centered design approach comprising 9 substudies. First, semistructured interviews (9 people with dementia, 9 caregivers, and 10 academic and clinical staff) and workshops (35 pairs of people with dementia and caregivers, and 12 health and social care clinicians) were conducted to define the needs of people with dementia, home caregivers, and professional stakeholders in both daily activities and technology-specific interactions. Then, the spectrum of needs identified was represented via patient--caregiver personas and discussed with stakeholders in a workshop (14 occupational therapists; 4 National Health Service pathway directors; and 6 researchers in occupational therapy, neuropsychiatry, and engineering) and 2 focus groups with managers of health care services (n=8), eliciting opportunities for innovative care technologies and public health strategies. Finally, these design opportunities were discussed in semistructured interviews with participants of a smart home trial involving environmental sensors, physiological measurement devices, smartwatches, and tablet-based chatbots and cognitive assessment puzzles (10 caregivers and 2 people with dementia). A thematic analysis revealed factors that motivate household members to use these technologies. Results: Outcomes of these activities include a qualitative and quantitative analysis of patient, caregiver, and clinician needs and the identification of challenges and opportunities for the design and implementation of remote monitoring systems in public health pathways. Conclusions: Participatory design methods supported the triangulation of stakeholder perspectives to aid the development of more patient-centered interventions and their translation to clinical practice and public health strategy. We discuss the implications and limitations of our findings, the value and the applicability of our methodology, and directions for future research. ", doi="10.2196/27047", url="https://aging.jmir.org/2021/3/e27047", url="http://www.ncbi.nlm.nih.gov/pubmed/34383672" } @Article{info:doi/10.2196/27884, author="S{\'a}pi, Mariann and Feh{\'e}r-Kiss, Anna and Csern{\'a}k, Krisztina and Domj{\'a}n, Andrea and Pint{\'e}r, S{\'a}ndor", title="The Effects of Exergaming on Sensory Reweighting and Mediolateral Stability of Women Aged Over 60: Usability Study", journal="JMIR Serious Games", year="2021", month="Jul", day="21", volume="9", number="3", pages="e27884", keywords="exergaming", keywords="sensory reweighting", keywords="older women", keywords="mediolateral sway", keywords="vestibular", abstract="Background: Older adults tend to experience difficulties in switching quickly between various reliable sensory inputs, which ultimately may contribute to an increased risk of falls and injuries. Sideward falls are the most frequent cause of hip fractures among older adults. Recently, exergame programs have been confirmed as beneficial tools for enhancing postural control, which can reduce the risk of falls. However, studies to explore more precisely which mechanism of exergaming directly influences older women's ability to balance are still needed. Objective: Our aim was to evaluate, in a single-group pretest/posttest/follow-up usability study, whether Kinect exergame balance training might have a beneficial impact on the sensory reweighting in women aged over 60. Methods: A total of 14 healthy women (mean age 69.57 [SD 4.66] years, mean body mass index 26.21 [SD 2.6] kg/m2) participated in the study. The volunteers trained with the commercially available games of Kinect for Xbox?360 console 3 times (30 minutes/session) a week over a 6-week period (total of 18 visits). Participants' postural sway in both the anteroposterior (AP) and mediolateral (ML) directions was recorded with NeuroCom Balance Master 6.0. To assess and measure postural sensory reweighting, the Modified Clinical Test of Sensory Interaction in Balance was used, where volunteers were exposed to various changes in visual (eyes open or eyes closed) and surface conditions (firm or foam surface). Results: In the ML direction, the Kinect exergame training caused a significant decrease in the sway path on the firm surface with the eyes open (P<.001) and eyes closed (P=.001), and on the foam surface with the eyes open (P=.001) and eyes closed (P<.001) conditions compared with baseline data. The follow-up measurements when compared with the baseline data showed a significant change in the sway path on the firm surface with the eyes open (P<.001) and eyes closed (P<.001) conditions, as well as on the foam surface with the eyes open (P=.003) and eyes closed (P<.001) conditions. Besides, on the firm surface, there were no significant differences in sway path values in the AP direction between the baseline and the posttraining measurements (eyes open: P=.49; eyes closed: P=.18). Likewise, on the foam surface, there were no significant differences in sway path values in the AP direction under both eyes open (P=.24) and eyes closed (P=.84) conditions. Conclusions: The improved posturography measurements of the sway path in the ML direction might suggest that the Kinect exergame balance training may have effects on sensory reweighting, and thus on the balance of women aged over 60. Based on these results, Kinect exergaming may provide a safe and potentially useful tool for improving postural stability in the crucial ML direction, and thus it may help reduce the risk of falling. ", doi="10.2196/27884", url="https://games.jmir.org/2021/3/e27884", url="http://www.ncbi.nlm.nih.gov/pubmed/34287215" } @Article{info:doi/10.2196/23516, author="Pimentel, B. Camilla and Clark, Valerie and Baughman, W. Amy and Berlowitz, R. Dan and Davila, Heather and Mills, L. Whitney and Mohr, C. David and Sullivan, L. Jennifer and Hartmann, W. Christine", title="Health Care Providers and the Public Reporting of Nursing Home Quality in the United States Department of Veterans Affairs: Protocol for a Mixed Methods Pilot Study", journal="JMIR Res Protoc", year="2021", month="Jul", day="21", volume="10", number="7", pages="e23516", keywords="nursing homes", keywords="public reporting", keywords="quality", abstract="Background: In June 2018, the United States Department of Veterans Affairs (VA) began the public reporting of its 134 Community Living Centers' (CLCs) overall quality by using a 5-star rating system based on data from the national quality measures captured in CLC Compare. Given the private sector's positive experience with report cards, this is a seminal moment for stimulating measurable quality improvements in CLCs. However, the public reporting of CLC Compare data raises substantial and immediate implications for CLCs. The report cards, for example, facilitate comparisons between CLCs and community nursing homes in which CLCs generally fare worse. This may lead to staff anxiety and potentially unintended consequences. Additionally, CLC Compare is designed to spur improvement, yet the motivating aspects of the report cards are unknown. Understanding staff attitudes and early responses is a critical first step in building the capacity for public reporting to spur quality. Objective: We will adapt an existing community nursing home public reporting survey to reveal important leverage points and support CLCs' quality improvement efforts. Our work will be grounded in a conceptual framework of strategic orientation. We have 2 aims. First, we will qualitatively examine CLC staff reactions to CLC Compare. Second, we will adapt and expand upon an extant community nursing home survey to capture a broad range of responses and then pilot the adapted survey in CLCs. Methods: We will conduct interviews with staff at 3 CLCs (1 1-star CLC, 1 3-star CLC, and 1 5-star CLC) to identify staff actions taken in response to their CLCs' public data; staff's commitment to or difficulties with using CLC Compare; and factors that motivate staff to improve CLC quality. We will integrate these findings with our conceptual framework to adapt and expand a community nursing home survey to the current CLC environment. We will conduct cognitive interviews with staff in 1 CLC to refine survey items. We will then pilot the survey in 6 CLCs (2 1-star CLCs, 2 3-star CLCs, and 2 5-star CLCs) to assess the survey's feasibility, acceptability, and preliminary psychometric properties. Results: We will develop a brief survey for use in a future national administration to identify system-wide responses to CLC Compare; evaluate the impact of CLC Compare on veterans' clinical outcomes and satisfaction; and develop, test, and disseminate interventions to support the meaningful use of CLC Compare for quality improvement. Conclusions: The knowledge gained from this pilot study and from future work will help VA refine how CLC Compare is used, ensure that CLC staff understand and are motivated to use its quality data, and implement concrete actions to improve clinical quality. The products from this pilot study will also facilitate studies on the effects of public reporting in other critical VA clinical areas. International Registered Report Identifier (IRRID): DERR1-10.2196/23516 ", doi="10.2196/23516", url="https://www.researchprotocols.org/2021/7/e23516", url="http://www.ncbi.nlm.nih.gov/pubmed/34287218" } @Article{info:doi/10.2196/17551, author="Bayen, Eleonore and Nickels, Shirley and Xiong, Glen and Jacquemot, Julien and Subramaniam, Raghav and Agrawal, Pulkit and Hemraj, Raheema and Bayen, Alexandre and Miller, L. Bruce and Netscher, George", title="Reduction of Time on the Ground Related to Real-Time Video Detection of Falls in Memory Care Facilities: Observational Study", journal="J Med Internet Res", year="2021", month="Jun", day="17", volume="23", number="6", pages="e17551", keywords="artificial intelligence", keywords="video monitoring", keywords="real-time video detection", keywords="fall", keywords="time on the ground", keywords="Alzheimer disease", keywords="dementia", keywords="memory care facilities", abstract="Background: Lying on the floor for a long period of time has been described as a critical determinant of prognosis following a fall. In addition to fall-related injuries due to the trauma itself, prolonged immobilization on the floor results in a wide range of comorbidities and may double the risk of death in elderly. Thus, reducing the length of Time On the Ground (TOG) in fallers seems crucial in vulnerable individuals with cognitive disorders who cannot get up independently. Objective: This study aimed to examine the effect of a new technology called SafelyYou Guardian (SYG) on early post-fall care including reduction of Time Until staff Assistance (TUA) and TOG. Methods: SYG uses continuous video monitoring, artificial intelligence, secure networks, and customized computer applications to detect and notify caregivers about falls in real time while providing immediate access to video footage of falls. The present observational study was conducted in 6 California memory care facilities where SYG was installed in bedrooms of consenting residents and families. Fall events were video recorded over 10 months. During the baseline installation period (November 2017 to December 2017), SYG video captures of falls were not provided on a regular basis to facility staff review. During a second period (January 2018 to April 2018), video captures were delivered to facility staff on a regular weekly basis. During the third period (May 2018 to August 2018), real-time notification (RTN) of any fall was provided to facility staff. Two digital markers (TUA, TOG) were automatically measured and compared between the baseline period (first 2 months) and the RTN period (last 4 months). The total number of falls including those happening outside of the bedroom (such as common areas and bathrooms) was separately reported by facility staff. Results: A total of 436 falls were recorded in 66 participants suffering from Alzheimer disease or related dementias (mean age 87 years; minimum 65, maximum 104 years). Over 80\% of the falls happened in bedrooms, with two-thirds occurring overnight (8 PM to 8 AM). While only 8.1\% (22/272) of falls were scored as moderate or severe, fallers were not able to stand up alone in 97.6\% (247/253) of the cases. Reductions of 28.3 (CI 19.6-37.1) minutes in TUA and 29.6 (CI 20.3-38.9) minutes in TOG were observed between the baseline and RTN periods. The proportion of fallers with TOG >1 hour fell from 31\% (8/26; baseline) to zero events (RTN period). During the RTN period, 76.6\% (108/141) of fallers received human staff assistance in less than 10 minutes, and 55.3\% (78/141) of them spent less than 10 minutes on the ground. Conclusions: SYG technology is capable of reducing TOG and TUA while efficiently covering the area (bedroom) and time zone (nighttime) that are at highest risk. After 6 months of SYG monitoring, TOG was reduced by a factor of 3. The drastic reduction of TOG is likely to decrease secondary comorbid complications, improve post-fall prognosis, and reduce health care costs. ", doi="10.2196/17551", url="https://www.jmir.org/2021/6/e17551", url="http://www.ncbi.nlm.nih.gov/pubmed/34137723" } @Article{info:doi/10.2196/25705, author="Wang, Gubing and Albayrak, Armagan and Kortuem, Gerd and van der Cammen, JM Tischa", title="A Digital Platform for Facilitating Personalized Dementia Care in Nursing Homes: Formative Evaluation Study", journal="JMIR Form Res", year="2021", month="May", day="28", volume="5", number="5", pages="e25705", keywords="human-centered design", keywords="data visualizations", keywords="person-centered care", keywords="people with dementia", keywords="assistive technology", keywords="health care design", keywords="care management", keywords="internet of things", keywords="data-driven design", keywords="data-enabled design", abstract="Background: Care personalization is key to the well-being of people with dementia according to person-centered care. With the development of the internet of things, a large quantity of personal data can be collected securely and reliably, which has the potential to facilitate care personalization for people with dementia. Yet, there are limited assistive technologies developed for this purpose, and the user acceptance of assistive technologies is low in nursing homes. Therefore, through a data-enabled design approach, a digital platform was developed for helping the care team in a nursing home to personalize dementia care, specifically in the management of behavioral and psychological dementia symptoms. Objective: This study aimed to evaluate the digital platform in a real-life context with potential users from the following two aspects: (1) to explore if the digital platform could help with generating insights on the current state of each person with dementia and (2) to gather feedback on the digital platform from the care team. Methods: The digital platform was deployed in the nursing home for 7 weeks and the data collected were visualized and presented to the care team via the digital platform. The visualizations were analyzed by the researchers for pattern detection. Meanwhile, the care team was asked to examine the visualizations and were interviewed for the following: (1) if any insights and actions were generated from the examination, (2) the usefulness of the digital platform, and (3) the improvements they would like to see. Results: The data collected on the digital platform demonstrated its potential for pattern detection. Insights were generated by the care team and categorized into ``client level,'' ``ward level,'' and ``team level.'' The corresponding actions taken by the care team were classified into ``investigation'' and ``implementation.'' User acceptance varied across the care team, and three aspects of improvement for the digital platform were identified. Conclusions: By evaluating the digital platform, this study gained insights on applying data-enabled design for personalizing dementia care; besides, it offers future researchers some recommendations on how to integrate assistive technologies in the nursing home context. ", doi="10.2196/25705", url="https://formative.jmir.org/2021/5/e25705", url="http://www.ncbi.nlm.nih.gov/pubmed/34047703" } @Article{info:doi/10.2196/26875, author="Wrede, Christian and Braakman-Jansen, Annemarie and van Gemert-Pijnen, Lisette", title="Requirements for Unobtrusive Monitoring to Support Home-Based Dementia Care: Qualitative Study Among Formal and Informal Caregivers", journal="JMIR Aging", year="2021", month="Apr", day="12", volume="4", number="2", pages="e26875", keywords="in-home monitoring", keywords="ambient assisted living", keywords="assistive technologies", keywords="dementia", keywords="home care", keywords="informal care", keywords="aging in place", abstract="Background: Due to a growing shortage in residential care, people with dementia will increasingly be encouraged to live at home for longer. Although people with dementia prefer extended independent living, this also puts more pressure on both their informal and formal care networks. To support (in)formal caregivers of people with dementia, there is growing interest in unobtrusive contactless in-home monitoring technologies that allow caregivers to remotely monitor the lifestyle, health, and safety of their care recipients. Despite their potential, these solutions will only be viable if they meet the expectations and needs of formal and informal caregivers of people with dementia. Objective: The objective of this study was to explore the expected benefits, barriers, needs, and requirements toward unobtrusive in-home monitoring from the perspective of formal and informal caregivers of community-dwelling people with dementia. Methods: A combination of semistructured interviews and focus groups was used to collect data among informal (n=19) and formal (n=16) caregivers of people with dementia. Both sets of participants were presented with examples of unobtrusive in-home monitoring followed by questions addressing expected benefits, barriers, and needs. Relevant in-home monitoring goals were identified using a previously developed topic list. Interviews and focus groups were transcribed and inductively analyzed. Requirements for unobtrusive in-home monitoring were elicited based on the procedure of van Velsen and Bergvall-K{\aa}reborn. Results: Formal and informal caregivers saw unobtrusive in-home monitoring as a support tool that should particularly be used to monitor (the risk of) falls, day and night rhythm, personal hygiene, nocturnal restlessness, and eating and drinking behavior. Generally, (in)formal caregivers reported cross-checking self-care information, extended independent living, objective communication, prevention and proactive measures, emotional reassurance, and personalized and optimized care as the key benefits of unobtrusive in-home monitoring. Main concerns centered around privacy, information overload, and ethical concerns related to dehumanizing care. Furthermore, 16 requirements for unobtrusive in-home monitoring were generated that specified desired functions, how the technology should communicate with the user, which services surrounding the technology were seen as needed, and how the technology should be integrated into the existing work context. Conclusions: Despite the presence of barriers, formal and informal caregivers of people with dementia generally saw value in unobtrusive in-home monitoring, and felt that these systems could contribute to a shift from reactive to more proactive and less obtrusive care. However, the full potential of unobtrusive in-home monitoring can only unfold if relevant concerns are considered. Our requirements can inform the development of more acceptable and goal-directed in-home monitoring technologies to support home-based dementia care. ", doi="10.2196/26875", url="https://aging.jmir.org/2021/2/e26875", url="http://www.ncbi.nlm.nih.gov/pubmed/33843596" } @Article{info:doi/10.2196/22613, author="Jaschinski, Christina and Ben Allouch, Somaya and Peters, Oscar and Cachucho, Ricardo and van Dijk, M. Jan A. G.", title="Acceptance of Technologies for Aging in Place: A Conceptual Model", journal="J Med Internet Res", year="2021", month="Mar", day="31", volume="23", number="3", pages="e22613", keywords="ambient assisted living", keywords="assistive technology", keywords="healthy aging", keywords="technology adoption", keywords="theory of planned behavior", keywords="structural equation modeling", abstract="Background: Older adults want to preserve their health and autonomy and stay in their own home environment for as long as possible. This is also of interest to policy makers who try to cope with growing staff shortages and increasing health care expenses. Ambient assisted living (AAL) technologies can support the desire for independence and aging in place. However, the implementation of these technologies is much slower than expected. This has been attributed to the lack of focus on user acceptance and user needs. Objective: The aim of this study is to develop a theoretically grounded understanding of the acceptance of AAL technologies among older adults and to compare the relative importance of different acceptance factors. Methods: A conceptual model of AAL acceptance was developed using the theory of planned behavior as a theoretical starting point. A web-based survey of 1296 older adults was conducted in the Netherlands to validate the theoretical model. Structural equation modeling was used to analyze the hypothesized relationships. Results: Our conceptual model showed a good fit with the observed data (root mean square error of approximation 0.04; standardized root mean square residual 0.06; comparative fit index 0.93; Tucker-Lewis index 0.92) and explained 69\% of the variance in intention to use. All but 2 of the hypothesized paths were significant at the P<.001 level. Overall, older adults were relatively open to the idea of using AAL technologies in the future (mean 3.34, SD 0.73). Conclusions: This study contributes to a more user-centered and theoretically grounded discourse in AAL research. Understanding the underlying behavioral, normative, and control beliefs that contribute to the decision to use or reject AAL technologies helps developers to make informed design decisions based on users' needs and concerns. These insights on acceptance factors can be valuable for the broader field of eHealth development and implementation. ", doi="10.2196/22613", url="https://www.jmir.org/2021/3/e22613", url="http://www.ncbi.nlm.nih.gov/pubmed/33787505" } @Article{info:doi/10.2196/25779, author="Daly, R. Jessica and Depp, Colin and Graham, A. Sarah and Jeste, V. Dilip and Kim, Ho-Cheol and Lee, E. Ellen and Nebeker, Camille", title="Health Impacts of the Stay-at-Home Order on Community-Dwelling Older Adults and How Technologies May Help: Focus Group Study", journal="JMIR Aging", year="2021", month="Mar", day="22", volume="4", number="1", pages="e25779", keywords="aging", keywords="quarantine", keywords="mental health", keywords="physical health", keywords="social isolation", keywords="COVID-19 pandemic", keywords="continued care senior housing community", keywords="CCSHC", keywords="qualitative research", keywords="videoconferencing", keywords="older adults", keywords="gerontechnology", keywords="loneliness", keywords="housing for the elderly", keywords="independent living", abstract="Background: As of March 2021, in the USA, the COVID-19 pandemic has resulted in over 500,000 deaths, with a majority being people over 65 years of age. Since the start of the pandemic in March 2020, preventive measures, including lockdowns, social isolation, quarantine, and social distancing, have been implemented to reduce viral spread. These measures, while effective for risk prevention, may contribute to increased social isolation and loneliness among older adults and negatively impact their mental and physical health. Objective: This study aimed to assess the impact of the COVID-19 pandemic and the resulting ``Stay-at-Home'' order on the mental and physical health of older adults and to explore ways to safely increase social connectedness among them. Methods: This qualitative study involved older adults living in a Continued Care Senior Housing Community (CCSHC) in southern California, USA. Four 90-minute focus groups were convened using the Zoom Video Communications platform during May 2020, involving 21 CCSHC residents. Participants were asked to describe how they were managing during the ``stay-at-home'' mandate that was implemented in March 2020, including its impact on their physical and mental health. Transcripts of each focus group were analyzed using qualitative methods. Results: Four themes emerged from the qualitative data: (1) impact of the quarantine on health and well-being, (2) communication innovation and technology use, (3) effective ways of coping with the quarantine, and (4) improving access to technology and training. Participants reported a threat to their mental and physical health directly tied to the quarantine and exacerbated by social isolation and decreased physical activity. Technology was identified as a lifeline for many who are socially isolated from their friends and family. Conclusions: Our study findings suggest that technology access, connectivity, and literacy are potential game-changers to supporting the mental and physical health of older adults and must be prioritized for future research. ", doi="10.2196/25779", url="https://aging.jmir.org/2021/1/e25779", url="http://www.ncbi.nlm.nih.gov/pubmed/33690146" } @Article{info:doi/10.2196/26340, author="Mansbach, E. William and Mace, A. Ryan and Tanner, A. Melissa", title="A New Tool for Detecting COVID-19 Psychological Burden Among Postacute and Long-term Care Residents (Mood-5 Scale): Observational Study", journal="JMIR Aging", year="2021", month="Mar", day="10", volume="4", number="1", pages="e26340", keywords="nursing homes", keywords="long-term care", keywords="COVID-19", keywords="depression", keywords="stress", keywords="coping", keywords="burden", keywords="mental health", keywords="elderly", keywords="older adults", keywords="risk", keywords="telehealth", keywords="self-assessment", keywords="scale", keywords="mood", abstract="Background: Older adults are at high risk for developing serious somatic and psychological symptoms associated with COVID-19. Currently available instruments may not be sensitive to the concerns about COVID-19 in postacute and long-term care and their applications in telehealth remain to be clarified. Objective: We investigated the psychometric properties of the Mood-5 Scale (M5) as a rapid self-assessment of the COVID-19 psychological burden among postacute and long-term care residents. Methods: Residents (N=131), aged 50 years and above, from 20 postacute and long-term care facilities in Maryland, USA, were evaluated in-person or via telehealth (43/131, 32.8\%) across a 4-week period (May 11 to June 5, 2020) during the COVID-19 pandemic. The COVID-19 psychological burden experienced by the residents was rated by geriatric psychologists who independently reviewed their clinical documentation. Psychometric analyses were performed on the M5 in relation to psychological tests, COVID-19 psychological burden, and diagnostic data collected during the evaluation. Results: The M5 demonstrated acceptable internal consistency (Cronbach $\alpha$=.77). M5 scores were not confounded by demographic variables or telehealth administration (P>.08). Convergent validity for the M5 was established via positive associations with anxiety (r=0.56, P<.001) and depressive (r=0.49, P<.001) symptoms. An M5 cutoff score of 3 demonstrated strong sensitivity (0.92) and adequate specificity (0.75) for identifying COVID-19 psychological distress among postacute and long-term care residents (area under the curve of 0.89, positive predictive value=0.79, negative predictive value=0.91). Conclusions: The M5 is a reliable and valid tool for self-assessment of mood that can help identify postacute and long-term care residents with significant psychological burden associated with COVID-19. It can be completed in less than 1 minute and is appropriate for use in both in-person and virtual visits. ", doi="10.2196/26340", url="https://aging.jmir.org/2021/1/e26340", url="http://www.ncbi.nlm.nih.gov/pubmed/33640866" } @Article{info:doi/10.2196/22370, author="Chu, H. Charlene and Biss, K. Ren{\'e}e and Cooper, Lara and Quan, Linh Amanda My and Matulis, Henrique", title="Exergaming Platform for Older Adults Residing in Long-Term Care Homes: User-Centered Design, Development, and Usability Study", journal="JMIR Serious Games", year="2021", month="Mar", day="9", volume="9", number="1", pages="e22370", keywords="user-centered design", keywords="aged", keywords="long-term care", keywords="nursing homes", abstract="Background: Older adults (OAs) residing in long-term care (LTC) homes are often unable to engage in adequate amounts of physical activity because of multiple comorbidities, including frailty and severe cognitive impairments. This level of physical inactivity is associated with declines in cognitive and functional abilities and can be further compounded by social isolation. Exergaming, defined as a combination of exercise and gaming, has the potential to engage OAs in exercise and encourage social interaction. However, previously used systems such as the Nintendo Wii are no longer commercially available, and the physical design of other exergames is not suitable for OAs (ie, fall risks, accessibility issues, and games geared toward a younger population) with diverse physical and cognitive impairments. Objective: This study aims to design and develop a novel, user-centered, evidence-based exergaming system for use among OAs in LTC homes. In addition, we aim to identify facilitators and barriers to the implementation of our exergaming intervention, the MouvMat, into LTC homes according to staff input. Methods: This study used a user-centered design (UCD) process that consisted of 4 rounds of usability testing. The exergame was developed and finalized based on existing evidence, end user and stakeholder input, and user testing. Semistructured interviews and standardized and validated scales were used iteratively to evaluate the acceptability, usability, and physical activity enjoyment of the MouvMat. Results: A total of 28 participants, 13 LTC residents, and 15 staff and family members participated in the UCD process for over 18 months to design and develop the novel exergaming intervention, the MouvMat. The iterative use of validated scales (System Usability Scale, 8-item Physical Activity Enjoyment Scale, and modified Treatment Evaluation Inventory) indicated an upward trend in the acceptability, usability, and enjoyment scores of MouvMat over 4 rounds of usability testing, suggesting that identified areas for refinement and improvement were appropriately addressed by the team. A qualitative analysis of semistructured interview data found that residents enjoyed engaging with the prototype and appreciated the opportunity to increase their PA. In addition, staff and stakeholders were drawn to MouvMat's ability to increase residents' autonomous PA. The intended and perceived benefits of MouvMat use, that is, improved physical and cognitive health, were the most common facilitators of its use identified by study participants. Conclusions: This study was successful in applying UCD to collaborate with LTC residents, despite the high number of physical and sensory impairments that this population experiences. By following a UCD process, an exergaming intervention that meets diverse requirements (ie, hardware design features and motivation) and considers environmental barriers and residents' physical and cognitive needs was developed. The effectiveness of MouvMat in improving physical and cognitive abilities should be explored in future multisite randomized controlled trials. ", doi="10.2196/22370", url="https://games.jmir.org/2021/1/e22370", url="http://www.ncbi.nlm.nih.gov/pubmed/33687337" } @Article{info:doi/10.2196/22974, author="Ausserhofer, Dietmar and Favez, Lauriane and Simon, Michael and Z{\'u}{\~n}iga, Franziska", title="Electronic Health Record Use in Swiss Nursing Homes and Its Association With Implicit Rationing of Nursing Care Documentation: Multicenter Cross-sectional Survey Study", journal="JMIR Med Inform", year="2021", month="Mar", day="2", volume="9", number="3", pages="e22974", keywords="electronic health records", keywords="nursing homes", keywords="nursing care", keywords="health care rationing", keywords="rationing of nursing care", keywords="unfinished care", keywords="documentation", keywords="patient care planning", keywords="mobile phone", abstract="Background: Nursing homes (NHs) are increasingly implementing electronic health records (EHRs); however, little information is available on EHR use in NH settings. It remains unclear how care workers perceive its safety, quality, and efficiency, and whether EHR use might ease the burden of documentation, thereby reducing its implicit rationing. Objective: This study aims to describe nurses' perceptions regarding the usefulness of the EHR system and whether sufficient numbers of computers are available in Swiss NHs, and to explore the system's association with implicit rationing of nursing care documentation. Methods: This was a multicenter cross-sectional study using survey data from the Swiss Nursing Homes Human Resources Project 2018. It includes a convenience sample of 107 NHs, 302 care units, and 1975 care workers (ie, registered nurses and licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the level of implicit rationing of nursing care documentation, their perceptions of the EHR system's usefulness and of how sufficient the number of available computers was, staffing and resource adequacy, leadership ability, and teamwork and safety climate. For analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics. Results: Overall, the care workers perceived the EHR systems as useful; ratings ranged from 69.42\% (1362/1962; guarantees safe care and treatment) to 78.32\% (1535/1960; allows quick access to relevant information on the residents). However, less than half (914/1961, 46.61\%) of the care workers reported sufficient computers on their unit to allow timely documentation. Half of the care workers responded that they sometimes or often had to ration the documentation of care. After adjusting for work environment factors and safety and teamwork climate, both higher care worker ratings of the EHR system's usefulness ($\beta$=?.12; 95\% CI ?0.17 to ?0.06) and sufficient numbers of computers ($\beta$=?.09; 95\% CI ?0.12 to ?0.06) were consistently associated with lower implicit rationing of nursing care documentation. Conclusions: Both the usefulness of the EHR system and the number of computers available were important explanatory factors for care workers leaving care activities (eg, developing or updating nursing care plans) unfinished. NH managers should carefully select and implement their information technology infrastructure with greater involvement and attention to the needs of their care workers and residents. Further research is needed to develop and implement user-friendly information technology infrastructure in NHs and to evaluate their impact on care processes as well as resident and care worker outcomes. ", doi="10.2196/22974", url="https://medinform.jmir.org/2021/3/e22974", url="http://www.ncbi.nlm.nih.gov/pubmed/33650983" } @Article{info:doi/10.2196/24280, author="So, Hong Kei and Ting, Wun Cheuk and Lee, Ping Chui and Lam, Tai-Ning Teddy and Chiang, Chu Sau and Cheung, Ting Yin", title="Medication Management Service for Old Age Homes in Hong Kong Using Information Technology, Automation Technology, and the Internet of Things: Pre-Post Interventional Study", journal="JMIR Med Inform", year="2021", month="Feb", day="10", volume="9", number="2", pages="e24280", keywords="medication management", keywords="old age homes", keywords="information technology", keywords="automation", keywords="Internet of Things", abstract="Background: Innovation in technology and automation has been increasingly used to improve conventional medication management processes.?In Hong Kong, the current practices of medication management in old age homes (OAHs) are time consuming, labor intensive, and error prone. To address this problem, we initiated an integrated medication management service combining information technology, automation technology, and the Internet of Things in a cluster network of OAHs. Objective: This pilot study aimed to evaluate the impact of the medication management program on (1) medication management efficiency, (2) medication safety, and (3) drug wastage in OAHs. We compared the time efficiency and the reductions in medication errors and medication wastage in OAHs before and at least 2 weeks after the implementation of the program. Methods: From November 2019 to February 2020, we recruited 2 OAHs (serving 178 residents) in Hong Kong into the prospective, pre-post interventional study. The interventional program consisted of electronic medication profiles, automated packaging, and electronic records of medication administration. Using 3-way analysis of variance, we compared the number of doses prepared and checked in 10-minute blocks before and after implementation. We received anonymous reports of medication errors from OAH staff and analyzed the results with the Fisher exact test. We also calculated the quantity and cost of wasted medications from drug disposal reports. Results: The number of doses prepared and checked in 10-minute blocks significantly increased postimplementation (pre: 41.3, SD 31.8; post: 70.6, SD 22.8; P<.001). There was also a significant reduction in medication errors (pre: 10/9504 doses, 0.1\%; post: 0/5731 doses; P=.02). The total costs of wasted medications during January 2020 in OAH 1 (77 residents) and OAH 2 (101 residents) were HK \$2566.03 (US \$328.98) and HK \$5249.48 (US \$673.01), respectively. Conclusions: Our pilot study suggested that an innovative medication management program with information technology, automation technology, and Internet of Things components improved the time efficiency of medication preparation and medication safety for OAHs. It is a promising solution to address the current limitations in medication management in OAHs in Hong Kong. ", doi="10.2196/24280", url="http://medinform.jmir.org/2021/2/e24280/", url="http://www.ncbi.nlm.nih.gov/pubmed/33565993" } @Article{info:doi/10.2196/22831, author="Grigorovich, Alisa and Kulandaivelu, Yalinie and Newman, Kristine and Bianchi, Andria and Khan, S. Shehroz and Iaboni, Andrea and McMurray, Josephine", title="Factors Affecting the Implementation, Use, and Adoption of Real-Time Location System Technology for Persons Living With Cognitive Disabilities in Long-term Care Homes: Systematic Review", journal="J Med Internet Res", year="2021", month="Jan", day="20", volume="23", number="1", pages="e22831", keywords="assistive technology", keywords="real-time location system", keywords="long-term care", keywords="implementation science", keywords="dementia", keywords="Alzheimer disease", keywords="ambulatory monitoring", keywords="wearable technology", keywords="qualitative research", abstract="Background: As the aging population continues to grow, the number of adults living with dementia or other cognitive disabilities in residential long-term care homes is expected to increase. Technologies such as real-time locating systems (RTLS) are being investigated for their potential to improve the health and safety of residents and the quality of care and efficiency of long-term care facilities. Objective: The aim of this study is to identify factors that affect the implementation, adoption, and use of RTLS for use with persons living with dementia or other cognitive disabilities in long-term care homes. Methods: We conducted a systematic review of the peer-reviewed English language literature indexed in MEDLINE, Embase, PsycINFO, and CINAHL from inception up to and including May 5, 2020. Search strategies included keywords and subject headings related to cognitive disability, residential long-term care settings, and RTLS. Study characteristics, methodologies, and data were extracted and analyzed using constant comparative techniques. Results: A total of 12 publications were included in the review. Most studies were conducted in the Netherlands (7/12, 58\%) and used a descriptive qualitative study design. We identified 3 themes from our analysis of the studies: barriers to implementation, enablers of implementation, and agency and context. Barriers to implementation included lack of motivation for engagement; technology ecosystem and infrastructure challenges; and myths, stories, and shared understanding. Enablers of implementation included understanding local workflows, policies, and technologies; usability and user-centered design; communication with providers; and establishing policies, frameworks, governance, and evaluation. Agency and context were examined from the perspective of residents, family members, care providers, and the long-term care organizations. Conclusions: There is a striking lack of evidence to justify the use of RTLS to improve the lives of residents and care providers in long-term care settings. More research related to RTLS use with cognitively impaired residents is required; this research should include longitudinal evaluation of end-to-end implementations that are developed using scientific theory and rigorous analysis of the functionality, efficiency, and effectiveness of these systems. Future research is required on the ethics of monitoring residents using RTLS and its impact on the privacy of residents and health care workers. ", doi="10.2196/22831", url="http://www.jmir.org/2021/1/e22831/", url="http://www.ncbi.nlm.nih.gov/pubmed/33470949" } @Article{info:doi/10.2196/18806, author="Wild, Katherine and Sharma, Nicole and Mattek, Nora and Karlawish, Jason and Riley, Thomas and Kaye, Jeffrey", title="Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study", journal="J Med Internet Res", year="2021", month="Jan", day="13", volume="23", number="1", pages="e18806", keywords="technology", keywords="remote sensing technology", keywords="care transition", abstract="Background: Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data. Objective: This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions. Methods: Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes. Results: During the study period, 30 of the 95 residents (32\%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44\%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use. Conclusions: Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use. ", doi="10.2196/18806", url="https://www.jmir.org/2021/1/e18806", url="http://www.ncbi.nlm.nih.gov/pubmed/33439144" } @Article{info:doi/10.2196/23014, author="Carolan, Kelsi and Grabowski, C. David and Mehrotra, Ateev and Hatfield, A. Laura", title="Use of Telemedicine for Emergency Triage in an Independent Senior Living Community: Mixed Methods Study", journal="J Med Internet Res", year="2020", month="Dec", day="17", volume="22", number="12", pages="e23014", keywords="telemedicine", keywords="telehealth", keywords="independent senior living communities", keywords="emergency care", keywords="first responders", abstract="Background: Older, chronically ill individuals in independent living communities are frequently transferred to the emergency department (ED) for acute issues that could be managed in lower-acuity settings. Triage via telemedicine could deter unnecessary ED transfers. Objective: We examined the effectiveness of a telemedicine intervention for emergency triage in an independent living community. Methods: In the intervention community, a 950-resident independent senior living community, when a resident called for help, emergency medical technician--trained staff could engage an emergency medicine physician via telemedicine to assist with management and triage. We compared trends in the proportion of calls resulting in transport to the ED (ie, primary outcome) in the intervention community to two control communities. Secondary outcomes were telemedicine use and posttransport disposition. Semistructured focus groups of residents and staff were conducted to examine attitudes toward the intervention. Qualitative data analysis used thematic analysis. Results: Although the service was offered at no cost to residents, use was low and we found no evidence of fewer ED transfers. The key barrier to program use was resistance from frontline staff members, who did not view telemedicine triage as a valuable tool for emergency response, instead perceiving it as time-consuming and as undermining their independent judgment. Conclusions: Engagement of, and acceptance by, frontline providers is a key consideration in using telemedicine triage to reduce unnecessary ED transfers. ", doi="10.2196/23014", url="http://www.jmir.org/2020/12/e23014/", url="http://www.ncbi.nlm.nih.gov/pubmed/33331827" } @Article{info:doi/10.2196/20215, author="Lussier, Maxime and Aboujaoud{\'e}, Aline and Couture, M{\'e}lanie and Moreau, Maxim and Lalibert{\'e}, Catherine and Giroux, Sylvain and Pigot, H{\'e}l{\`e}ne and Gaboury, S{\'e}bastien and Bouchard, K{\'e}vin and Belchior, Patricia and Bottari, Carolina and Par{\'e}, Guy and Consel, Charles and Bier, Nathalie", title="Using Ambient Assisted Living to Monitor Older Adults With Alzheimer Disease: Single-Case Study to Validate the Monitoring Report", journal="JMIR Med Inform", year="2020", month="Nov", day="13", volume="8", number="11", pages="e20215", keywords="activities of daily living", keywords="aging", keywords="Alzheimer disease", keywords="ambient assisted living", keywords="health care", keywords="technology assessment", keywords="health", keywords="remote sensing technology", abstract="Background: Many older adults choose to live independently in their homes for as long as possible, despite psychosocial and medical conditions that compromise their independence in daily living and safety. Faced with unprecedented challenges in allocating resources, home care administrators are increasingly open to using monitoring technologies known as ambient assisted living (AAL) to better support care recipients. To be effective, these technologies should be able to report clinically relevant changes to support decision making at an individual level. Objective: The aim of this study is to examine the concurrent validity of AAL monitoring reports and information gathered by care professionals using triangulation. Methods: This longitudinal single-case study spans over 490 days of monitoring a 90-year-old woman with Alzheimer disease receiving support from local health care services. A clinical nurse in charge of her health and social care was interviewed 3 times during the project. Linear mixed models for repeated measures were used to analyze each daily activity (ie, sleep, outing activities, periods of low mobility, cooking-related activities, hygiene-related activities). Significant changes observed in data from monitoring reports were compared with information gathered by the care professional to explore concurrent validity. Results: Over time, the monitoring reports showed evolving trends in the care recipient's daily activities. Significant activity changes occurred over time regarding sleep, outings, cooking, mobility, and hygiene-related activities. Although the nurse observed some trends, the monitoring reports highlighted information that the nurse had not yet identified. Most trends detected in the monitoring reports were consistent with the clinical information gathered by the nurse. In addition, the AAL system detected changes in daily trends following an intervention specific to meal preparation. Conclusions: Overall, trends identified by AAL monitoring are consistent with clinical reports. They help answer the nurse's questions and help the nurse develop interventions to maintain the care recipient at home. These findings suggest the vast potential of AAL technologies to support health care services and aging in place by providing valid and clinically relevant information over time regarding activities of daily living. Such data are essential when other sources yield incomplete information for decision making. ", doi="10.2196/20215", url="https://medinform.jmir.org/2020/11/e20215", url="http://www.ncbi.nlm.nih.gov/pubmed/33185555" } @Article{info:doi/10.2196/19002, author="Lin, Tsung-Yi and Huang, Chiu-Mieh and Hsu, Hsiao-Pei and Liao, Jung-Yu and Cheng, Ya-Wen Vivian and Wang, Shih-Wen and Guo, Jong-Long", title="Effects of a Combination of Three-Dimensional Virtual Reality and Hands-on Horticultural Therapy on Institutionalized Older Adults' Physical and Mental Health: Quasi-Experimental Design", journal="J Med Internet Res", year="2020", month="Nov", day="2", volume="22", number="11", pages="e19002", keywords="horticultural therapy", keywords="3D VR", keywords="older adults", keywords="long-term care facility", keywords="mental health", abstract="Background: Institutionalized older adults have limited ability to engage in horticultural activities that can improve their physical and mental health. Objective: This study explored the effects of a combination of 3D virtual reality and horticultural therapy on institutionalized older adults' physical and mental health. Methods: The study used a quasi-experimental design. A total of 106 older adults from 2 long-term care facilities were recruited and assigned to the experimental (n=59) or control (n=47) group. The experimental participants received a 9-week intervention. Both groups completed 3 assessments: at baseline, after the intervention, and 2 months later. The outcome variables included health status, meaning in life, perceived mattering, loneliness, and depression. Results: The experimental group demonstrated significantly improved health status (P<.001), meaning in life (P<.001), and perceived mattering (P<.001) as well as significantly reduced depression (P<.001) and loneliness (P<.001) compared to the control group immediately after the intervention; these effects persisted for up to 2 months. Conclusions: This study verified the beneficial effects of a combination of 3D virtual reality and hands-on horticultural therapy on older adults' health. These results could support the future successful implementation of similar programs for institutionalized older adults on a larger scale. ", doi="10.2196/19002", url="https://www.jmir.org/2020/11/e19002", url="http://www.ncbi.nlm.nih.gov/pubmed/33135666" } @Article{info:doi/10.2196/21845, author="Sacco, Guillaume and Ll{\'e}onart, S{\'e}bastien and Simon, Romain and Noublanche, Fr{\'e}d{\'e}ric and Annweiler, C{\'e}dric and ", title="Communication Technology Preferences of Hospitalized and Institutionalized Frail Older Adults During COVID-19 Confinement: Cross-Sectional Survey Study", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="18", volume="8", number="9", pages="e21845", keywords="video communication", keywords="telephone", keywords="older adults", keywords="nursing home", keywords="hospital", keywords="confinement", keywords="elderly", keywords="COVID-19", keywords="communication", keywords="technology", keywords="social isolation", keywords="loneliness", abstract="Background: Technological communication methods such as telephone calls and video calls can help prevent social isolation and loneliness in frail older adults during confinement. Objective: Our objectives were to determine which virtual communication method (ie, telephone call or video call) was preferred by confined older hospital patients and nursing home residents and the variables influencing this preference. Methods: The TOVID (Telephony Or Videophony for Isolated elDerly) study was a cross-sectional study that was designed to examine the preference between telephone calls and video calls among frail older adults who were either hospitalized in a geriatric acute care unit or institutionalized in a long-term care and nursing home during the COVID-19 confinement period. Results: A total of 132 older people were surveyed between March 25 and May 11, 2020 (mean age 88.2 years, SD 6.2); 79 (59.8\%) were women. Patients hospitalized in the geriatric acute care unit were more able to establish communication independently than residents institutionalized in the long-term care and nursing home (P=.03) and were more satisfied with their communication experiences (P=.02). Overall, older people tended to favor telephone calls (73/132, 55.3\%) over video calls (59/132, 44.7\%); however, their satisfaction degree was similar regardless of the chosen method (P=.1), with no effect of age (P=.97) or gender (P=.2). In the geriatric acute care unit, the satisfaction degrees were similar for telephone calls (40/41, 98\%) and video calls (33/38, 87\%) in older patients (P=.10). Conversely, in the long-term care and nursing home, residents were more satisfied with the use of video calls to communicate with their relatives (14/15, 93\%) versus the use of telephone calls (6/12, 50\%; P=.02). Conclusions: Older people confined to health care settings were able to complete telephone calls more independently than video calls, and they tended to use telephone calls more often than video calls. The satisfaction degrees were similar with both modalities and even greater with video calls among long-term care and nursing home residents when they were given assistance to establish communication. Trial Registration: ClinicalTrials.gov NCT04333849: https://www.clinicaltrials.gov/ct2/show/NCT04333849. ", doi="10.2196/21845", url="http://mhealth.jmir.org/2020/9/e21845/", url="http://www.ncbi.nlm.nih.gov/pubmed/32896832" } @Article{info:doi/10.2196/19554, author="Wilmink, Gerald and Dupey, Katherine and Alkire, Schon and Grote, Jeffrey and Zobel, Gregory and Fillit, M. Howard and Movva, Satish", title="Artificial Intelligence--Powered Digital Health Platform and Wearable Devices Improve Outcomes for Older Adults in Assisted Living Communities: Pilot Intervention Study", journal="JMIR Aging", year="2020", month="Sep", day="10", volume="3", number="2", pages="e19554", keywords="health technology", keywords="artificial intelligence", keywords="AI", keywords="preventive", keywords="senior technology", keywords="assisted living", keywords="long-term services", keywords="long-term care providers", abstract="Background: Wearables and artificial intelligence (AI)--powered digital health platforms that utilize machine learning algorithms can autonomously measure a senior's change in activity and behavior and may be useful tools for proactive interventions that target modifiable risk factors. Objective: The goal of this study was to analyze how a wearable device and AI-powered digital health platform could provide improved health outcomes for older adults in assisted living communities. Methods: Data from 490 residents from six assisted living communities were analyzed retrospectively over 24 months. The intervention group (+CP) consisted of 3 communities that utilized CarePredict (n=256), and the control group (--CP) consisted of 3 communities (n=234) that did not utilize CarePredict. The following outcomes were measured and compared to baseline: hospitalization rate, fall rate, length of stay (LOS), and staff response time. Results: The residents of the +CP and --CP communities exhibit no statistical difference in age (P=.64), sex (P=.63), and staff service hours per resident (P=.94). The data show that the +CP communities exhibited a 39\% lower hospitalization rate (P=.02), a 69\% lower fall rate (P=.01), and a 67\% greater length of stay (P=.03) than the --CP communities. The staff alert acknowledgment and reach resident times also improved in the +CP communities by 37\% (P=.02) and 40\% (P=.02), respectively. Conclusions: The AI-powered digital health platform provides the community staff with actionable information regarding each resident's activities and behavior, which can be used to identify older adults that are at an increased risk for a health decline. Staff can use this data to intervene much earlier, protecting seniors from conditions that left untreated could result in hospitalization. In summary, the use of wearables and AI-powered digital health platform can contribute to improved health outcomes for seniors in assisted living communities. The accuracy of the system will be further validated in a larger trial. ", doi="10.2196/19554", url="http://aging.jmir.org/2020/2/e19554/", url="http://www.ncbi.nlm.nih.gov/pubmed/32723711" } @Article{info:doi/10.2196/19732, author="Kim, Ben and McKay, M. Sandra and Lee, Joon", title="Consumer-Grade Wearable Device for Predicting Frailty in Canadian Home Care Service Clients: Prospective Observational Proof-of-Concept Study", journal="J Med Internet Res", year="2020", month="Sep", day="3", volume="22", number="9", pages="e19732", keywords="frailty", keywords="mobile health", keywords="wearables", keywords="physical activity", keywords="home care", keywords="prediction", keywords="predictive modeling, older adults", keywords="activities of daily living, sleep", abstract="Background: Frailty has detrimental health impacts on older home care clients and is associated with increased hospitalization and long-term care admission. The prevalence of frailty among home care clients is poorly understood and ranges from 4.0\% to 59.1\%. Although frailty screening tools exist, their inconsistent use in practice calls for more innovative and easier-to-use tools. Owing to increases in the capacity of wearable devices, as well as in technology literacy and adoption in Canadian older adults, wearable devices are emerging as a viable tool to assess frailty in this population. Objective: The objective of this study was to prove that using a wearable device for assessing frailty in older home care clients could be possible. Methods: From June 2018 to September 2019, we recruited home care clients aged 55 years and older to be monitored over a minimum of 8 days using a wearable device. Detailed sociodemographic information and patient assessments including degree of comorbidity and activities of daily living were collected. Frailty was measured using the Fried Frailty Index. Data collected from the wearable device were used to derive variables including daily step count, total sleep time, deep sleep time, light sleep time, awake time, sleep quality, heart rate, and heart rate standard deviation. Using both wearable and conventional assessment data, multiple logistic regression models were fitted via a sequential stepwise feature selection to predict frailty. Results: A total of 37 older home care clients completed the study. The mean age was 82.27 (SD 10.84) years, and 76\% (28/37) were female; 13 participants were frail, significantly older (P<.01), utilized more home care service (P=.01), walked less (P=.04), slept longer (P=.01), and had longer deep sleep time (P<.01). Total sleep time (r=0.41, P=.01) and deep sleep time (r=0.53, P<.01) were moderately correlated with frailty. The logistic regression model fitted with deep sleep time, step count, age, and education level yielded the best predictive performance with an area under the receiver operating characteristics curve value of 0.90 (Hosmer-Lemeshow P=.88). Conclusions: We proved that a wearable device could be used to assess frailty for older home care clients. Wearable data complemented the existing assessments and enhanced predictive power. Wearable technology can be used to identify vulnerable older adults who may benefit from additional home care services. ", doi="10.2196/19732", url="https://www.jmir.org/2020/9/e19732", url="http://www.ncbi.nlm.nih.gov/pubmed/32880582" } @Article{info:doi/10.2196/20828, author="Wilmink, Gerald and Summer, Ilyssa and Marsyla, David and Sukhu, Subhashree and Grote, Jeffrey and Zobel, Gregory and Fillit, Howard and Movva, Satish", title="Real-Time Digital Contact Tracing: Development of a System to Control COVID-19 Outbreaks in Nursing Homes and Long-Term Care Facilities", journal="JMIR Public Health Surveill", year="2020", month="Aug", day="25", volume="6", number="3", pages="e20828", keywords="COVID-19", keywords="SARS-CoV-2", keywords="contact tracing", keywords="nursing homes", keywords="long term care", keywords="care homes", keywords="digital contact tracing", abstract="Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can spread rapidly in nursing homes and long-term care (LTC) facilities. Symptoms-based screening and manual contact tracing have limitations that render them ineffective for containing the viral spread in LTC facilities. Symptoms-based screening alone cannot identify asymptomatic people who are infected, and the viral spread is too fast in confined living quarters to be contained by slow manual contact tracing processes. Objective: We describe the development of a digital contact tracing system that LTC facilities can use to rapidly identify and contain asymptomatic and symptomatic SARS-CoV-2 infected contacts. A compartmental model was also developed to simulate disease transmission dynamics and to assess system performance versus conventional methods. Methods: We developed a compartmental model parameterized specifically to assess the coronavirus disease (COVID-19) transmission in LTC facilities. The model was used to quantify the impact of asymptomatic transmission and to assess the performance of several intervention groups to control outbreaks: no intervention, symptom mapping, polymerase chain reaction testing, and manual and digital contact tracing. Results: Our digital contact tracing system allows users to rapidly identify and then isolate close contacts, store and track infection data in a respiratory line listing tool, and identify contaminated rooms. Our simulation results indicate that the speed and efficiency of digital contact tracing contributed to superior control performance, yielding up to 52\% fewer cases than conventional methods. Conclusions: Digital contact tracing systems show promise as an effective tool to control COVID-19 outbreaks in LTC facilities. As facilities prepare to relax restrictions and reopen to outside visitors, such tools will allow them to do so in a surgical, cost-effective manner that controls outbreaks while safely giving residents back the life they once had before this pandemic hit. ", doi="10.2196/20828", url="http://publichealth.jmir.org/2020/3/e20828/", url="http://www.ncbi.nlm.nih.gov/pubmed/32745013" } @Article{info:doi/10.2196/18003, author="?ukasik, Sylwia and Tobis, S?awomir and Kropi?ska, Sylwia and Suwalska, Aleksandra", title="Role of Assistive Robots in the Care of Older People: Survey Study Among Medical and Nursing Students", journal="J Med Internet Res", year="2020", month="Aug", day="12", volume="22", number="8", pages="e18003", keywords="assistive robots", keywords="older adults", keywords="acceptance", keywords="medical students", keywords="nursing students", abstract="Background: Populations are aging at an alarming rate in many countries around the world. There has been not only a decrease in the number of births and an increase in the percentage of older people, but also an increase in the number of people living alone. There is growing demand for specialist medical care and daily care with the number of people who can act as caregivers reducing. The use of assistive robots can, at least partially, solve these problems. Objective: The purpose of this study was to examine the opinions of future health care professionals (medical and nursing students) regarding the use of assistive robots in the care of older people. Methods: The study was conducted with a group of 178 students from Poznan University of Medical Sciences, Pozna?, Poland (110 nursing students and 68 medical students), using the Users' Needs, Requirements, and Abilities Questionnaire. Results: The participants of this study believed that assistive robots should, first of all, remind older people to take medication regularly, ensure their safety, monitor their health status and environment, provide cognitive training, and encourage them to maintain physical activity. In the students' opinion, the robot should not be an older person's companion but only act as an assistant. Nursing students had significantly higher scores than medical students in several statements concerning everyday use of robots, including reminding about meals (P=.03), monitoring the environment (P=.001), providing advice about a healthy diet (P=.04), monitoring the intake of food and fluids (P=.02), and automatic ``switch on'' function (P=.02). Nursing students were more focused on the social functions of robots, including encouraging contact with friends (P=.003) and reducing the sense of loneliness and improving mood (P=.008). Medical students were more aware of privacy issues in the statement concerning the possibility of switching off the robot in specific situations (P=.01). Conclusions: Our study revealed a generally positive attitude of future doctors and nurses toward assistive robots, which can have an impact on their acceptance by older adults. In the future, medical professionals could help their patients to choose the right robots (and necessary functions) that are best suited to their needs. However, this would require expanding the curriculum to include the issues of gerontechnology. ", doi="10.2196/18003", url="https://www.jmir.org/2020/8/e18003", url="http://www.ncbi.nlm.nih.gov/pubmed/32784187" } @Article{info:doi/10.2196/17286, author="Abdi, Sarah and de Witte, Luc and Hawley, Mark", title="Emerging Technologies With Potential Care and Support Applications for Older People: Review of Gray Literature", journal="JMIR Aging", year="2020", month="Aug", day="11", volume="3", number="2", pages="e17286", keywords="artificial intelligence", keywords="internet of things", keywords="mobile phone", keywords="robotics", keywords="emerging technologies", keywords="older people", keywords="care and support", abstract="Background: The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care systems. Emerging technological developments have the potential to address some of the care and support challenges of older people. However, limited work has been done to identify emerging technological developments with the potential to meet the care and support needs of the aging population. Objective: This review aimed to gain an overview of emerging technologies with potential care and support applications for older people, particularly for those living at home. Methods: A scoping gray literature review was carried out by using the databases of 13 key organizations, hand searching reference lists of included documents, using funding data, and consulting technology experts. A narrative synthesis approach was used to analyze and summarize the findings of the literature review. Results: A total of 39 documents were included in the final analysis. From the analysis, 8 emerging technologies were identified that could potentially be used to meet older people's needs in various care and support domains. These emerging technologies were (1) assistive autonomous robots; (2) self-driving vehicles; (3) artificial intelligence--enabled health smart apps and wearables; (4) new drug release mechanisms; (5) portable diagnostics; (6) voice-activated devices; (7) virtual, augmented, and mixed reality; and (8) intelligent homes. These emerging technologies were at different levels of development, with some being trialed for care applications, whereas others being in the early phases of development. However, only a few documents mentioned including older people during the process of designing and developing these technologies. Conclusions: This review has identified key emerging technologies with the potential to contribute to the support and care needs of older people. However, to increase the adoption of these technologies by older people, there is a need to involve them and other stakeholders, such as formal and informal carers, in the process of designing and developing these technologies. ", doi="10.2196/17286", url="http://aging.jmir.org/2020/2/e17286/", url="http://www.ncbi.nlm.nih.gov/pubmed/32780020" } @Article{info:doi/10.2196/16928, author="Lai, Rhoda and Tensil, Maria and Kurz, Alexander and Lautenschlager, T. Nicola and Diehl-Schmid, Janine", title="Perceived Need and Acceptability of an App to Support Activities of Daily Living in People With Cognitive Impairment and Their Carers: Pilot Survey Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="31", volume="8", number="7", pages="e16928", keywords="Aged", keywords="dementia", keywords="memory disorders", keywords="carers", keywords="mobile apps", abstract="Background: Modern technologies, including smartphone apps, have the potential to assist people with cognitive impairment with activities of daily living, allowing them to maintain their independence and reduce carer burden. However, such tools have seen a slow rate of uptake in this population, and data on the acceptability of assistive technologies in this population are limited. Objective: This pilot study included older adults with cognitive impairment and their carers, and explored the perceived needs for and acceptability of an app that was designed to be a simple assistive tool for activities of daily living. In particular, this study aimed to assess the acceptability of common app functions such as communication, reminder, navigation, and emergency tools in this population, and to compare patients' and carers' responses to them. Methods: A total of 24 German participants with mild cognitive impairment or dementia and their family carers separately completed two short questionnaires. The first questionnaire asked the participants with cognitive impairment and their carers to self-rate the patients' cognitive impairment levels and affinity to technology. Following a demonstration of the app, participants rated the usability and acceptability of the app and its functions in a second questionnaire. Results: Participants rated themselves as much less cognitively impaired than their carers did (P=.01), and insight into the level of support they received was low. The majority of the participants (19/24, 79\%) and their carers (20/24, 83\%) had low affinity to technology, and even after the demonstration, 63\% (15/24) of the participants had low interest in using the app. A breakdown of acceptability responses by app function revealed that participants were more amenable to the reminder function, the emergency feature, and a wearable form of the app. Features that centered around carers monitoring participants' movements were reported to be less acceptable to participants. Conclusions: This study highlights the importance of focusing on acceptability and the consumer's perceptions in the development of assistive technology for older adults with cognitive impairment. Participants showed an aversion to functions they perceived as eroding their independence, while functions that more closely aligned with independence and autonomy were perceived as more acceptable. ", doi="10.2196/16928", url="http://mhealth.jmir.org/2020/7/e16928/", url="http://www.ncbi.nlm.nih.gov/pubmed/32735223" } @Article{info:doi/10.2196/15472, author="Chang, Ernest Shuchih and Chen, YiChian and Lu, MingFang and Luo, Louis Hueimin", title="Development and Evaluation of a Smart Contract--Enabled Blockchain System for Home Care Service Innovation: Mixed Methods Study", journal="JMIR Med Inform", year="2020", month="Jul", day="28", volume="8", number="7", pages="e15472", keywords="home care service", keywords="trust", keywords="innovation", keywords="blockchain", keywords="smart contract", keywords="automation", abstract="Background: In the home care industry, the assignment and tracking of care services are controlled by care centers that are centralized in nature and prone to inefficient information transmission. A lack of trust among the involved parties, information opaqueness, and large manual manipulation result in lower process efficiency. Objective: This study aimed to explore and demonstrate the application of blockchain and smart contract technologies to innovate/renovate home care services for harvesting the desired blockchain benefits of process transparency, traceability, and interoperability. Methods: An object-oriented analysis/design combined with a unified modeling language tool was used to construct the architecture of the proposed home care service system. System feasibility was evaluated via an implementation test, and a questionnaire survey was performed to collect opinions from home care service respondents knowledgeable about blockchain and smart contracts. Results: According to the comparative analysis results, the proposed design outperformed the existing system in terms of traceability, system efficiency, and process automation. Moreover, for the questionnaire survey, the quantitative analysis results showed that the proposed blockchain-based system had significantly (P<.001) higher mean scores (when compared with the existing system) in terms of important factors, including timeliness, workflow efficiency, automatic notifications, insurance functionality, and auditable traceability. In summary, blockchain-based home care service participants will be able to enjoy improved efficiency, better transparency, and higher levels of process automation. Conclusions: Blockchain and smart contracts can provide valuable benefits to the home care service industry via distributed data management and process automation. The proposed system enhances user experiences by mitigating human intervention and improving service interoperability, transparency/traceability, and real-time response to home care service events. Efforts in exploring and integrating blockchain-based home care services with emerging technologies, such as the internet of things and artificial intelligence, are expected to provide further benefits and therefore are subject to future research. ", doi="10.2196/15472", url="https://medinform.jmir.org/2020/7/e15472", url="http://www.ncbi.nlm.nih.gov/pubmed/32720903" } @Article{info:doi/10.2196/16644, author="Huang, Rendong and Xu, Mei and Li, Xiuting and Wang, Yinping and Wang, Bin and Cui, Naixue", title="Internet-Based Sharing Nurse Program and Nurses' Perceptions in China: Cross-Sectional Survey", journal="J Med Internet Res", year="2020", month="Jul", day="22", volume="22", number="7", pages="e16644", keywords="sharing nurse", keywords="home visiting", keywords="internet plus nursing program", keywords="perception", keywords="China", abstract="Background: China is currently piloting a ``Sharing Nurse'' program that aims to increase the accessibility of nursing services to at-home patients by enabling patients to order nursing services using mobile apps or online platforms. Objective: This study aims to assess nurses' perceptions of the Sharing Nurse program, including their acceptance, concerns, needs, and willingness to take part in the program. Methods: A total of 694 nurses participated in the questionnaire survey. The survey collected their sociodemographic and work-related information and their perceptions of the Sharing Nurse program using a self-developed questionnaire. Results: The 694 respondents agreed that?the Sharing Nurse program?could provide patients with better access to nursing care (n=483, 69.6\%). Their main concerns about the program were unclear?liability division when medical disputes occur (n=637, 90.3\%)?and potential personal safety issues (n=604, 87\%). They reported that insurance (n=611, 88\%), permits from their affiliated hospital (n=562, 81.0\%), clear instructions concerning rights and duties (n=580, 83.6\%), real time positioning while delivering the service (n=567, 81.7\%), and one-key alarm equipment (n=590, 85.0\%) were necessary for better implementation of the program. More than half of the respondents (n=416, 60\%) had an optimistic attitude toward the development of the Sharing Nurse program in China. However, only 19.4\% (n=135) of the respondents expressed their willingness to be a ``shared nurse.'' Further analyses found that nurses with a master's degree or above ($\chi$23=28.835, P<.001) or from tertiary hospitals ($\chi$23=18.669, P<.001) were more likely to be aware of the Sharing Nurse program and that male nurses were more willing to be shared nurses (Z=--2.275, P=.02). Conclusions: The Chinese Sharing Nurse program is still in its infancy and many refinements are needed before it can be implemented nationwide. Generally, Chinese nurses are positive about the Sharing Nurse program and are willing to participate if the program is thoroughly regulated and supervised. ", doi="10.2196/16644", url="http://www.jmir.org/2020/7/e16644/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706711" } @Article{info:doi/10.2196/16979, author="Garvelink, Marjolein Mirjam and Agbadj{\'e}, Tatiana Titilayo and Freitas, Adriana and Bergeron, Lysa and Petitjean, Thomas and Dugas, Mich{\`e}le and Blair, Louisa and Archambault, Patrick and Roy, No{\'e}mie and Jones, Allyson and L{\'e}gar{\'e}, France", title="Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="22", volume="8", number="7", pages="e16979", keywords="internet-based intervention", keywords="frail elderly", keywords="caregivers", keywords="decision making", keywords="personal autonomy", keywords="housing for the elderly", abstract="Background: Older adults desire to stay independent at home for as long as possible. We developed an interactive website to inform older adults and caregivers about ways to achieve this. Objective: This study aimed to perform an in-depth exploration among potential end users about how to improve the interactive website to better inform older adults and caregivers about ways to stay independent at home. Methods: To complement the results of a quantitative survey on the usability and acceptability of the website before implementation, we conducted a qualitative descriptive study. Using multiple recruitment strategies, we recruited a purposeful sample of older adults (aged ?65 years) and caregivers of older adults struggling to stay independent at home. We conducted face-to-face or telephonic interviews in either English or French. In addition, we collected sociodemographic characteristics, other characteristics of participants (eg, health, digital profile, and perception of retirement homes), and experiences with using the website (factors facilitating the use of the website, barriers to its use, and suggestions for improvement). Interviews were audio recorded, transcribed verbatim, and thematically analyzed by two researchers. Results: We recruited 15 participants, including 5 older adults (mean age 75 years, SD 6) and 10 caregivers (mean age 57 years, SD 14). The mean interview time was 32 min (SD 14). Most older adults had either mobility or health problems or both, and many of them were receiving home care services (eg, blood pressure measurement and body care). Overall, participants found the website easy to navigate using a computer, reassuring, and useful for obtaining information. Barriers were related to navigation (eg, difficult to navigate with a cellphone), relevance (eg, no specific section for caregivers), realism (eg, some resources presented are not state funded), understandability (eg, the actors' accents were difficult to understand), and accessibility (eg, not adapted for low digital literacy). Suggestions for improvement included a needs assessment section to direct users to the support appropriate to their needs, addition of information about moving into residential care, a section for caregivers, distinction between state-provided and private support services, simpler language, expansion of content to be relevant to all of Canada, and video subtitles for the hearing impaired. Conclusions: Users provided a wealth of information about the needs of older adults who were facing a loss of autonomy and about what such a website could usefully provide. The request for less generic and more personalized information reflects the wide range of needs that electronic health innovations, such as our interactive website, need to address. After integrating the changes suggested, the new website---Support for Older Adults to Stay Independent at Home (SUSTAIN)---will be implemented and made available to better assist older adults and caregivers in staying independent at home. ", doi="10.2196/16979", url="https://mhealth.jmir.org/2020/7/e16979", url="http://www.ncbi.nlm.nih.gov/pubmed/32412908" } @Article{info:doi/10.2196/15923, author="Fadrique, X. Laura and Rahman, Dia and Vaillancourt, H{\'e}l{\`e}ne and Boissonneault, Paul and Donovska, Tania and Morita, P. Plinio", title="Overview of Policies, Guidelines, and Standards for Active Assisted Living Data Exchange: Thematic Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="22", volume="8", number="6", pages="e15923", keywords="ambient assisted living", keywords="active assisted living", keywords="AAL", keywords="Internet of Things", keywords="aging well", keywords="aging in place", keywords="elderly", keywords="geriatrics", keywords="standards", keywords="policies", keywords="health care", keywords="ambient intelligence", keywords="domotics", keywords="ubiquitous health", keywords="wearable", abstract="Background: A primary concern for governments and health care systems is the rapid growth of the aging population. To provide a better quality of life for the elderly, researchers have explored the use of wearables, sensors, actuators, and mobile health technologies. The term AAL can be referred to as active assisted living or ambient assisted living, with both sometimes used interchangeably. AAL technologies describes systems designed to improve the quality of life, aid in independence, and create healthier lifestyles for those who need assistance at any stage of their lives. Objective: The aim of this study was to understand the standards and policy guidelines that companies use in the creation of AAL technologies and to highlight the gap between available technologies, standards, and policies and what should be available for use. Methods: A literature review was conducted to identify critical standards and frameworks related to AAL. Interviews with 15 different stakeholders across Canada were carried out to complement this review. The results from interviews were coded using a thematic analysis and then presented in two workshops about standards, policies, and governance to identify future steps and opportunities regarding AAL. Results: Our study showed that the base technology, standards, and policies necessary for the creation of AAL technology are not the primary problem causing disparity between existing and accessible technologies; instead nontechnical issues and integration between existing technologies present the most significant issue. A total of five themes have been identified for further analysis: (1) end user and purpose; (2) accessibility; (3) interoperability; (4) data sharing; and (5) privacy and security. Conclusions: Interoperability is currently the biggest challenge for the future of data sharing related to AAL technology. Additionally, the majority of stakeholders consider privacy and security to be the main concerns related to data sharing in the AAL scope. Further research is necessary to explore each identified gap in detail. ", doi="10.2196/15923", url="https://mhealth.jmir.org/2020/6/e15923", url="http://www.ncbi.nlm.nih.gov/pubmed/32568090" } @Article{info:doi/10.2196/16039, author="Rasmussen, N{\o}rregaard Charlotte Diana and H{\o}jberg, Helene and Larsen, Konring Anne and Munch, Kold Pernille and Osborne, Richard and Kwak, Lydia and Jensen, Irene and Linnan, Laura and J{\o}rgensen, Birk Marie", title="Evaluation and Dissemination of a Checklist to Improve Implementation of Work Environment Initiatives in the Eldercare Sector: Protocol for a Prospective Observational Study", journal="JMIR Res Protoc", year="2020", month="May", day="13", volume="9", number="5", pages="e16039", keywords="RE-AIM", keywords="implementation", keywords="workplace", keywords="digital", abstract="Background: To measure sustainable improvements in the work environment, a flexible and highly responsive tool is needed that will give important focus to the implementation process. A digital checklist was developed in collaboration with key stakeholders to document the implementation of changes in eldercare sector workplaces. Objective: This paper describes the study protocol of a dissemination study that aims to examine when, why, and how the digital checklist is spread to the Danish eldercare sector following a national campaign particularly targeting nursing homes and home care. Methods: This prospective observational study will use quantitative data from Google Analytics describing use of the checklist as documented website engagement, a survey among members in the largest union in the sector, information from a central business register, and monitoring of campaign activities. The evaluation will be guided by the five elements of the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance. Results: The study was approved in June 2016 and began in October 2018. The campaign that is the foundation for the evaluation began in 2017 and ended in 2018. However, the webpage where we collect data is still running. Results are expected in 2020. Conclusions: This protocol provides a working example of how to evaluate dissemination of a checklist to improve implementation of work environment initiatives in the eldercare sector in Denmark. To our knowledge, implementation in a nationwide Danish work environment has not been previously undertaken. Given that the checklist is sector-specific for work environment initiatives and developed through systematic collaboration between research and practice, it is likely to have high utility and impact; however, the proposed evaluation will determine this. This study will advance dissemination research and, in particular, the evaluation of the impact of these types of studies. Finally, this study advances the field through digital tools that can be used for evaluation of dissemination efforts (eg, Google Analytics associated with website) in the context of a rigorous research design activity. International Registered Report Identifier (IRRID): DERR1-10.2196/16039 ", doi="10.2196/16039", url="https://www.researchprotocols.org/2020/5/e16039", url="http://www.ncbi.nlm.nih.gov/pubmed/32401212" } @Article{info:doi/10.2196/17710, author="Arnold, Helene Sif and Jensen, Nygaard Jette and Kousgaard, Brostr{\o}m Marius and Siersma, Volkert and Bjerrum, Lars and Holm, Anne", title="Reducing Antibiotic Prescriptions for Urinary Tract Infection in Nursing Homes Using a Complex Tailored Intervention Targeting Nursing Home Staff: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2020", month="May", day="8", volume="9", number="5", pages="e17710", keywords="urinary tract infection", keywords="nursing home", keywords="antibiotics", keywords="antibiotic resistance", keywords="drug prescription", keywords="communication", keywords="communication barriers", keywords="interprofessional relationship", keywords="elderly", abstract="Background: Urinary tract infection (UTI) is the most common reason for antibiotic prescription in nursing homes. Overprescription causes antibiotic-related harms in those who are treated and others residing within the nursing home. The diagnostic process in nursing homes is complicated with both challenging issues related to the elderly population and the nursing home setting. A physician rarely visits a nursing home for suspected UTI. Consequently, the knowledge of UTI and communication skills of staff influence the diagnosis. Objective: The objective of this study is to describe a cluster randomized controlled trial with a tailored complex intervention for improving the knowledge of UTI and communication skills of nursing home staff in order to decrease the number of antibiotic prescriptions for UTI in nursing home residents, without changing hospitalization and mortality. Methods: The study describes an open-label cluster randomized controlled trial with two parallel groups and a 1:1 allocation ratio. Twenty-two eligible nursing homes are sampled from the Capital Region of Denmark, corresponding to 1274 nursing home residents. The intervention group receives a dialogue tool, and all nursing home staff attend a workshop on UTI. The main outcomes of the study are the antibiotic prescription rate for UTI, all-cause hospitalization, all-cause mortality, and suspected UTI during the trial period. Results: The trial ended in April 2019. Data have been collected and are being analyzed. We expect the results of the trial to be published in a peer-reviewed journal in the fall of 2020. Conclusions: The greatest strengths of this study are the randomized design, tailored development of the intervention, and access to medical records. The potential limitations are the hierarchy in the prescription process, Hawthorne effect, and biased access to data on signs and symptoms through a UTI diary. The results of this trial could offer a strategy to overcome some of the challenges of increased antibiotic resistance and could have implications in terms of how to handle cases of suspected UTI. Trial Registration: ClinicalTrials.gov NCT03715062; https://clinicaltrials.gov/ct2/show/NCT03715062 International Registered Report Identifier (IRRID): DERR1-10.2196/17710 ", doi="10.2196/17710", url="https://www.researchprotocols.org/2020/5/e17710", url="http://www.ncbi.nlm.nih.gov/pubmed/32383679" } @Article{info:doi/10.2196/16854, author="Rawtaer, Iris and Mahendran, Rathi and Kua, Heok Ee and Tan, Pink Hwee and Tan, Xian Hwee and Lee, Tih-Shih and Ng, Pin Tze", title="Early Detection of Mild Cognitive Impairment With In-Home Sensors to Monitor Behavior Patterns in Community-Dwelling Senior Citizens in Singapore: Cross-Sectional Feasibility Study", journal="J Med Internet Res", year="2020", month="May", day="5", volume="22", number="5", pages="e16854", keywords="dementia", keywords="neurocognitive disorder", keywords="pattern recognition, automated/methods", keywords="internet of things", keywords="early diagnosis", abstract="Background: Dementia is a global epidemic and incurs substantial burden on the affected families and the health care system. A window of opportunity for intervention is the predementia stage known as mild cognitive impairment (MCI). Individuals often present to services late in the course of their disease and more needs to be done for early detection; sensor technology is a potential method for detection. Objective: The aim of this cross-sectional study was to establish the feasibility and acceptability of utilizing sensors in the homes of senior citizens to detect changes in behaviors unobtrusively. Methods: We recruited 59 community-dwelling seniors (aged >65 years who live alone) with and without MCI and observed them over the course of 2 months. The frequency of forgetfulness was monitored by tagging personal items and tracking missed doses of medication. Activities such as step count, time spent away from home, television use, sleep duration, and quality were tracked with passive infrared motion sensors, smart plugs, bed sensors, and a wearable activity band. Measures of cognition, depression, sleep, and social connectedness were also administered. Results: Of the 49 participants who completed the study, 28 had MCI and 21 had healthy cognition (HC). Frequencies of various sensor-derived behavior metrics were computed and compared between MCI and HC groups. MCI participants were less active than their HC counterparts and had more sleep interruptions per night. MCI participants had forgotten their medications more times per month compared with HC participants. The sensor system was acceptable to over 80\% (40/49) of study participants, with many requesting for permanent installation of the system. Conclusions: We demonstrated that it was both feasible and acceptable to set up these sensors in the community and unobtrusively collect data. Further studies evaluating such digital biomarkers in the homes in the community are needed to improve the ecological validity of sensor technology. We need to refine the system to yield more clinically impactful information. ", doi="10.2196/16854", url="https://www.jmir.org/2020/5/e16854", url="http://www.ncbi.nlm.nih.gov/pubmed/32369031" } @Article{info:doi/10.2196/17108, author="Zahid, Mahnoor and Gallant, L. Natasha and Hadjistavropoulos, Thomas and Stroulia, Eleni", title="Behavioral Pain Assessment Implementation in Long-Term Care Using a Tablet App: Case Series and Quasi-Experimental Design", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="22", volume="8", number="4", pages="e17108", keywords="pain measurement", keywords="long-term care", keywords="nursing", keywords="technology Alzheimer disease", keywords="mHealth", abstract="Background: Pain is often underassessed and undertreated among long-term care (LTC) residents living with dementia. When used regularly, the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC) scales have been shown to have beneficial effects on pain assessment and management practices and stress and burnout levels in frontline staff in LTC facilities. Such scales, however, are not utilized as often as recommended, which is likely to be related to additional record-keeping and tracking over time involved with their paper-and-pencil administration. Objective: Using implementation science principles, we assessed the introduction of the PACSLAC-II scale by comparing two methods of administration---a newly developed tablet app version and the original paper-and-pencil version---with respect to the frequency of pain assessment and facility staff feedback. Methods: Using a case series approach, we tracked pain-related quality indicators at baseline, implementation, and follow-up periods. A quasi-experimental design was used to evaluate the effect of the method of administration (ie, paper-and-pencil only [n=18], tablet only [n=12], paper-and-pencil followed by tablet app [n=31], and tablet app followed by paper-and-pencil [n=31]) on pain assessment frequency and frontline staff stress and burnout levels. Finally, semistructured interviews were conducted with frontline staff to obtain perspectives on each method of administration. Results: The implementation effort resulted in a great increase in pain assessment frequency across 7 independent LTC units, although these increases were not maintained during the follow-up period. Frontline staff reported lower levels of workload in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P<.001) and tablet app followed by paper-and-pencil (P<.001) conditions. Frontline staff also reported lower levels of workload in the tablet-only condition than those in the paper-and-pencil only condition (P=.05). Similarly, lower levels of emotional exhaustion were reported by frontline staff in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P=.002) and tablet app followed by paper-and-pencil (P=.002) conditions. Finally, frontline staff reported higher levels of depersonalization in the paper-and-pencil only condition than those in the tablet app only (P=.008), paper-and-pencil followed by tablet app (P<.001), and tablet app followed by paper-and-pencil (P<.001) conditions. Furthermore, narrative data from individual interviews with frontline staff revealed a preference for the tablet app over the paper-and-pencil method of administration. Conclusions: This study provides support for the use of either the tablet app or the paper-and-pencil version of the PACSLAC-II to improve pain-related quality indicators, but a reported preference for and lower levels of stress and burnout with the use of the tablet app method of administration suggests that the use of the tablet app may have more advantages compared with the paper-and-pencil method of administration. ", doi="10.2196/17108", url="http://mhealth.jmir.org/2020/4/e17108/", url="http://www.ncbi.nlm.nih.gov/pubmed/32319955" } @Article{info:doi/10.2196/17136, author="Wilson, Rozanne and Cochrane, Diana and Mihailidis, Alex and Small, Jeff", title="Mobile Apps to Support Caregiver-Resident Communication in Long-Term Care: Systematic Search and Content Analysis", journal="JMIR Aging", year="2020", month="Apr", day="8", volume="3", number="1", pages="e17136", keywords="mobile apps", keywords="communication barrier", keywords="dementia", keywords="caregivers", keywords="long-term care", keywords="patient-centered care", abstract="Background: In long-term residential care (LTRC), caregivers' attempts to provide person-centered care can be challenging when assisting residents living with a communication disorder (eg, aphasia) and/or a language-cultural barrier. Mobile communication technology, which includes smartphones and tablets and their software apps, offers an innovative solution for preventing and overcoming communication breakdowns during activities of daily living. There is a need to better understand the availability, relevance, and stability of commercially available communication apps (cApps) that could support person-centered care in the LTRC setting. Objective: This study aimed to (1) systematically identify and evaluate commercially available cApps that could support person-centered communication (PCC) in LTRC and (2) examine the stability of cApps over 2 years. Methods: We conducted systematic searches of the Canadian App Store (iPhone Operating System platform) in 2015 and 2017 using predefined search terms. cApps that met the study's inclusion criteria underwent content review and quality assessment. Results: Although the 2015 searches identified 519 unique apps, only 27 cApps were eligible for evaluation. The 2015 review identified 2 augmentative and alternative cApps and 2 translation apps as most appropriate for LTRC. Despite a 205\% increase (from 199 to 607) in the number of augmentative and alternative communication and translation apps assessed for eligibility in the 2017 review, the top recommended cApps showed suitability for LTRC and marketplace stability. Conclusions: The recommended existing cApps included some PCC features and demonstrated marketplace longevity. However, cApps that focus on the inclusion of more PCC features may be better suited for use in LTRC, which warrants future development. Furthermore, cApp content and quality would improve by including research evidence and experiential knowledge (eg, nurses and health care aides) to inform app development. cApps offer care staff a tool that could promote social participation and person-centered care. International Registered Report Identifier (IRRID): RR2-10.2196/10.2196/17136 ", doi="10.2196/17136", url="http://aging.jmir.org/2020/1/e17136/", url="http://www.ncbi.nlm.nih.gov/pubmed/32267236" } @Article{info:doi/10.2196/16252, author="Ali, Haneen and Li, Huiyang", title="Use of Notification and Communication Technology (Call Light Systems) in Nursing Homes: Observational Study", journal="J Med Internet Res", year="2020", month="Mar", day="27", volume="22", number="3", pages="e16252", keywords="communication systems", keywords="nursing home", keywords="response time", keywords="safety", keywords="quality of health care", keywords="observational study", abstract="Background: The call light system is one of the major communication technologies that link nursing home staff to the needs of residents. By providing residents the ability to request assistance, the system becomes an indispensable resource for patient-focused health care. However, little is known about how call light systems are being used in nursing homes and how the system contributes to safety and quality of care for seniors. Objective: This study aimed to understand the experiences of nursing home staff who use call light systems and to uncover usability issues and challenges associated with the implemented systems. Methods: A mix of 150 hours of hypothetico-deductive (unstructured) task analysis and 90 hours of standard procedure (structured) task analysis was conducted in 4 different nursing homes. The data collected included insights into the nursing home's work system and the process of locating and responding to call lights. Results: The data showed that the highest alarm rate is before and after mealtimes. The staff exceeded the administration's expectations of time to respond 50\% of the time. In addition, the staff canceled 10.0\% (20/201) of call lights and did not immediately assist residents because of high workload. Furthermore, the staff forgot to come back to assist residents over 3\% of the time. Usability issues such as broken parts, lack of feedback, lack of prioritization, and low or no discriminability also contributed to the long response time. More than 8\% of the time, residents notified the staff about call lights after they waited for a long time, and eventually, these residents were left unattended. Conclusions: Nursing homes that are still using old call light systems risk the continuation of usability issues that can affect the performance of the staff and contribute to declining staff and resident outcomes. By incorporating feedback from nurses, nursing home management will better understand the influence that the perceptions and usability of technology have on the quality of health care for their residents. In this study, it has been observed that the call light system is perceived to be an important factor affecting the outcomes of the care process and satisfaction of both residents and staff as well as the staff's performance. It is important to recognize that communication and notification technology contributes to the challenges the staff faced during their work, making their working conditions more difficult and challenging. ", doi="10.2196/16252", url="http://www.jmir.org/2020/3/e16252/", url="http://www.ncbi.nlm.nih.gov/pubmed/32217497" } @Article{info:doi/10.2196/12797, author="Gjestsen, Therese Martha and Wiig, Siri and Testad, Ingelin", title="Health Care Personnel's Perspective on Potential Electronic Health Interventions to Prevent Hospitalizations for Older Persons Receiving Community Care: Qualitative Study", journal="J Med Internet Res", year="2020", month="Jan", day="2", volume="22", number="1", pages="e12797", keywords="health services research", keywords="community health services", keywords="hospitalization", keywords="health services for the aged", keywords="qualitative research", keywords="focus groups", keywords="eHealth", keywords="technology", abstract="Background: The use of electronic health (eHealth) interventions is suggested to help monitor and treat degenerative and chronic diseases through the use of sensors, alarms, and reminders and can potentially prevent hospitalizations for home-dwelling older persons receiving community care. It is increasingly recognized that the health care personnel's acceptance of a technological application remains a key challenge in adopting an intervention, thus interventions must be perceived to be useful and fit for purpose by the actual users. Objective: The aim of this study was to identify and explore the perspectives of managers and health care personnel in community care regarding the use of eHealth interventions in terms of prevention of hospitalizations for home-dwelling older persons receiving community care. Methods: A case study with a qualitative approach was carried out in community care in a Norwegian municipality, comprising individual interviews and focus group interviews. A total of 5 individual interviews and 2 focus group interviews (n=12) were undertaken to provide the health care personnel's and managers' perspective regarding the use of eHealth interventions, which could potentially prevent hospitalizations for home-dwelling older persons receiving community care. Data were analyzed by way of systematic text condensation, as described by Malterud. Results: The data analysis of focus group interviews and individual interviews resulted in 2 categories: potential technological applications and potential patient groups. Discussions in the focus groups generated several suggestions and wishes related to technical applications that they could make use of in their day-to-day practice. The health care personnel warranted tools and measures to enhance and document their clinical observations in contact with patients. They also identified patient groups, such as patients with chronic obstructive pulmonary disease or dehydration or urinary tract infections, for whom hospitalizations could potentially have been prevented. Conclusions: We have shown that the health care personnel in community care warrant various technological applications that have the potential to improve quality of care and resource utilization in the studied municipality. We have identified needs and important matters in practice, which are paramount for acceptance and adoption of an intervention in community care. ", doi="10.2196/12797", url="https://www.jmir.org/2020/1/e12797", url="http://www.ncbi.nlm.nih.gov/pubmed/31895045" } @Article{info:doi/10.2196/15429, author="Sapci, Hasan A. and Sapci, Aylin H.", title="Innovative Assisted Living Tools, Remote Monitoring Technologies, Artificial Intelligence-Driven Solutions, and Robotic Systems for Aging Societies: Systematic Review", journal="JMIR Aging", year="2019", month="Nov", day="29", volume="2", number="2", pages="e15429", keywords="innovative assisted living tools for aging society", keywords="artificially intelligent home monitoring", keywords="older adults", keywords="robotic technologies", keywords="smart home", abstract="Background: The increase in life expectancy and recent advancements in technology and medical science have changed the way we deliver health services to the aging societies. Evidence suggests that home telemonitoring can significantly decrease the number of readmissions, and continuous monitoring of older adults' daily activities and health-related issues might prevent medical emergencies. Objective: The primary objective of this review was to identify advances in assistive technology devices for seniors and aging-in-place technology and to determine the level of evidence for research on remote patient monitoring, smart homes, telecare, and artificially intelligent monitoring systems. Methods: A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature Plus, MEDLINE, EMBASE, Institute of Electrical and Electronics Engineers Xplore, ProQuest Central, Scopus, and Science Direct. Publications related to older people's care, independent living, and novel assistive technologies were included in the study. Results: A total of 91 publications met the inclusion criteria. In total, four themes emerged from the data: technology acceptance and readiness, novel patient monitoring and smart home technologies, intelligent algorithm and software engineering, and robotics technologies. The results revealed that most studies had poor reference standards without an explicit critical appraisal. Conclusions: The use of ubiquitous in-home monitoring and smart technologies for aged people's care will increase their independence and the health care services available to them as well as improve frail elderly people's health care outcomes. This review identified four different themes that require different conceptual approaches to solution development. Although the engineering teams were focused on prototype and algorithm development, the medical science teams were concentrated on outcome research. We also identified the need to develop custom technology solutions for different aging societies. The convergence of medicine and informatics could lead to the development of new interdisciplinary research models and new assistive products for the care of older adults. ", doi="10.2196/15429", url="http://aging.jmir.org/2019/2/e15429/", url="http://www.ncbi.nlm.nih.gov/pubmed/31782740" } @Article{info:doi/10.2196/12633, author="Chiu, Ching-Ju and Wu, Hui Chi", title="Information and Communications Technology as a Health Promotion Method for Older Adults in Assisted-Living Facilities: Three-Arm Group-Randomized Trial", journal="JMIR Aging", year="2019", month="May", day="06", volume="2", number="1", pages="e12633", keywords="information and computer technology", keywords="quality of life", keywords="social support", keywords="psychological well-being", keywords="long-term care facilities", keywords="disabled", keywords="elderly", keywords="disability", keywords="assisted living", keywords="seniors", keywords="geriatrics", abstract="Background: The application of technology is an important and growing aspect in the field of long-term care. Growing evidence shows the positive impact of technology aids in helping the lives of the elderly. However, it is not known which aspects of information and communications technology (ICT) are preferred by older adults living in long-term care facilities. Objective: The goal of the research was to compare the impact of ICT-communication, ICT-entertainment, and conventional care on older adults' health and psychological change after interventions among older adults in assisted-living facilities. Methods: A three-arm group-randomized trial design was used to evaluate participants who resided in three different but comparable assisted-living facilities and received different aspects of the ICT interventions. A total of 54 older adults with disabilities received one of the three interventions over 12 weeks and completed pre- and postevaluations on quality of life, social support, and psychological well-being. Results: Participants completing this study had a mean age of 73 (SD 11.4) years, and 50\% (27/54) were male. Both the ICT-communication and ICT-entertainment groups showed significant improvement in the mental component of quality of life (4.11, P=.012 and 37.32, P<.001, respectively), family/friend--related social support (0.05, P=.001 and 0.04, P<.001, respectively), happiness (0.79, P=.038 and 3.72, P=.001, respectively), and depressive symptoms (--2.74, P=.001 and --7.33, P<.001, respectively). Importantly, participants in the ICT-entertainment group improved significantly more than the other two groups. The ICT-entertainment group also showed improvement in the physical component of quality of life (20.49, P<.001) and health care worker--related social support (0.1, P=.008). Conclusions: Results suggest that the entertainment but not the communication part of ICT is the most effective health promotion method for improving the health and psychological well-being of older adults in assisted-living facilities. ", doi="10.2196/12633", url="http://aging.jmir.org/2019/1/e12633/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518261" } @Article{info:doi/10.2196/11526, author="Mathews, Rebecca and O'Malley, Chris and Hall, M. Jenny and Macaden, Leah and MacRury, Sandra", title="Diabetes, Care Homes, and the Influence of Technology on Practice and Care Delivery in Care Homes: Systematic Review and Qualitative Synthesis", journal="JMIR Diabetes", year="2019", month="Apr", day="22", volume="4", number="2", pages="e11526", keywords="diabetes mellitus", keywords="technology", keywords="residential facilities", keywords="nursing homes", abstract="Background: Diabetes is increasing in prevalence and complexity in the care home setting, affecting up to a quarter of care home residents. Health outcomes for these residents are impacted by management of the disease, health care professionals (HCPs)' decision-making skills within the care home setting, and access to specialist services. The use of technology has the potential to recognize opportunities for early intervention that enables efficient responsive care, taking a fundamental role in linking the care home community to wider multidisciplinary teams for support. Objective: The aim of this paper was to identify evidence that explores factors relevant to the use of technology in and around the care home setting to aid in the management of diabetes. Methods: Databases searched using a structured prespecified approach included: PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), OVID Nursing database, Scopus, MEDLINE, the Cochrane Library, and the King's Fund from 2012 to 2017: handsearching was undertaken additionally for any gray literature. Preferred Reporting Items for Systematic review and Meta-Analysis Protocol was used as protocol with Risk of Bias in Systematic reviews a tool to assess the risk of bias across studies. Studies had to include interventions that combined technology to or from the care home setting to support residents living with diabetes. Results: The combined search strategy identified a total of 493 electronic records. Of these, 171 papers were screened for eligibility, 66 full papers were accessed, and 13 have been included in this study. Qualitative synthesis has identified different strands of research evidence in what and how technology is currently being used in and around care homes to enhance diabetes management. New initiatives and implementations of technology and emerging models of care that included the use of technology have also been included. Conclusions: By triangulating the perspectives of HCPs, practitioners, specialists, and members of the care home community, the authors anticipate that this review will represent an up-to-date, evidence-based overview of the potential for using technology within the care home setting for diabetes management as well as stimulate research in this area. ", doi="10.2196/11526", url="http://diabetes.jmir.org/2019/2/e11526/", url="http://www.ncbi.nlm.nih.gov/pubmed/31008705" } @Article{info:doi/10.2196/11516, author="Berridge, Clara and Chan, T. Keith and Choi, Youngjun", title="Sensor-Based Passive Remote Monitoring and Discordant Values: Qualitative Study of the Experiences of Low-Income Immigrant Elders in the United States", journal="JMIR Mhealth Uhealth", year="2019", month="Mar", day="25", volume="7", number="3", pages="e11516", keywords="immigrants", keywords="ubiquitous sensing", keywords="acculturation", keywords="passive monitoring", keywords="independent living", keywords="family caregiving", keywords="culturally appropriate technology", abstract="Background: Remote monitoring technologies are positioned to mitigate the problem of a dwindling care workforce and disparities in access to care for the growing older immigrant population in the United States. To achieve these ends, designers and providers need to understand how these supports can be best provided in the context of various sociocultural environments that shape older adults' expectations and care relationships, yet few studies have examined how the same remote monitoring technologies may produce different effects and uses depending on what population is using them in a particular context. Objective: This study aimed to examine the experiences and insights of low-income, immigrant senior residents, family contacts, and staff of housing that offered a sensor-based passive monitoring system designed to track changes in movement around the home and trigger alerts for caregivers. The senior housing organization had been offering the QuietCare sensor system to its residents for 6 years at the time of the study. We are interested in adoption and discontinuation decisions and use over time, rather than projected acceptance. Our research question is how do cultural differences influence use and experiences with this remote monitoring technology? The study does not draw generalizable conclusions about how cultural groups interact with a given technology, but rather, it examines how values are made visible in elder care technology interactions. Methods: A total of 41 participants (residents, family, and staff) from 6 large senior housing independent living apartment buildings were interviewed. Interviews were conducted in English and Korean with these participants who collectively had immigrated to the United States from 10 countries. Results: The reactions of immigrant older adults to the passive monitoring system reveal that this tool offered to them was often mismatched with their values, needs, and expectations. Asian elders accepted the intervention social workers offered largely to appease them, but unlike their US-born counterparts, they adopted reluctantly without hope that it would ameliorate their situation. Asian immigrants discontinued use at the highest rate of all residents, and intergenerational family cultural conflict contributed to this termination. Social workers reported that none of the large population of Russian-speaking residents agreed to use QuietCare. Bilingual and bicultural social workers played significant roles as cultural navigators in the promotion of QuietCare to residents. Conclusions: This research into the interactions of culturally diverse people with the same monitoring technology reveals the significant role that social values and context play in shaping how people and families interact with and experience elder care interventions. If technology-based care services are to reach their full potential, it will be important to identify the ways in which cultural values produce different uses and responses to technologies intended to help older adults live independently. ", doi="10.2196/11516", url="http://mhealth.jmir.org/2019/3/e11516/", url="http://www.ncbi.nlm.nih.gov/pubmed/30907741" } @Article{info:doi/10.2196/11599, author="Ford II, H. James and Dodds, Debby and Hyland, Julie and Potteiger, Michael", title="Evaluating the Impact of Music \& Memory's Personalized Music and Tablet Engagement Program in Wisconsin Assisted Living Communities: Pilot Study", journal="JMIR Aging", year="2019", month="Mar", day="14", volume="2", number="1", pages="e11599", keywords="Music \& Memory", keywords="assisted living facilities", keywords="quality of life", keywords="agitation", keywords="medication adherance", keywords="iPod", keywords="iPad", keywords="implementation science", keywords="patient participation", abstract="Background: Individuals with Alzheimer disease or related dementia represent a significant and growing segment of the older adult (aged 65 years and above) population. In addition to physical health concerns, including comorbid medical conditions, these individuals often exhibit behavioral and psychological symptoms of dementia (BPSD). The presence of BPSD in long-term care residential facilities can disrupt resident's care and impact staff. Nonpharmacological interventions such as personalized music and tablet engagement maintain cognitive function, improve quality of life (QOL), and mitigate BPSD for older adults with dementia. Evidence of the impact of such interventions in assisted living communities (ALCs) is needed for widespread adoption and sustainment of these technologies. Objective: The aim of this study was to assess the impact of Music \& Memory's personalized music and tablet engagement (PMATE) program on QOL, agitation, and medication use for residents living in 6 Wisconsin ALCs. Methods: The data collected were on the utilization of iPods and iPads by the residents. Residents' outcomes were assessed using the Pittsburgh Agitation Scale, the Quality of Life in Late Stage Dementia scale, and self-reported medication use. A mixed-methods approach was utilized to examine the impact of the PMATE program on these outcomes. Descriptive statistics were calculated. A paired t test explored changes in residents' QOL. A 1-way analysis of variance was utilized to examine changes in resident's agitation and QOL based on the resident's utilization of the PMATE program. Qualitative interviews were conducted with the individuals responsible for PMATE implementation in the ALC. Residents excluded from the analysis were those who passed away, were discharged, or refused to participate. Results: A total of 5 apps, based on average times used by residents, were identified. In all, 4 of the 5 apps were rated as being useful to promote residents' engagement. PMATE utilization was not associated with changes in the residents' agitation levels or antipsychotic medication use over time. Over a 3-month period, the change in residents' QOL was significant (P=.047), and the differences across ALCs were also significant (F25=3.76, P=.02). High utilizers of the PMATE program (>2500 min over 3 months) showed greater improvements in QOL as compared with low utilizers (a change of ?5.90 points vs an increase of 0.43 points). The difference was significant (P=.03). Similar significant findings were found between the high- and midutilizers. Conclusions: The study is one of the first to explore the impact of Music \& Memory's PMATE program on residents living in ALCs. Findings suggest that higher utilization over time improves residents' QOL. However, a more comprehensive study with improved data collection efforts across multiple ALCs is needed to confirm these preliminary findings. ", doi="10.2196/11599", url="http://aging.jmir.org/2019/1/e11599/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518259" } @Article{info:doi/10.2196/11449, author="Powell, Ryan Kimberly and Alexander, Lynn Gregory and Madsen, Richard and Deroche, Chelsea", title="A National Assessment of Access to Technology Among Nursing Home Residents: A Secondary Analysis", journal="JMIR Aging", year="2019", month="Mar", day="05", volume="2", number="1", pages="e11449", keywords="nursing homes", keywords="health information technology", keywords="patient access", keywords="patient portals", keywords="personal health records", keywords="patient engagement", keywords="person-centered care", abstract="Background: According to the National Center for Health Statistics, there are over 1.7 million nursing home residents in the United States. Nursing home residents and their family members have unique needs and stand to benefit from using technology empowering them to be more informed and engaged health care consumers. Although there is growing evidence for benefits of patient-facing technologies like electronic patient portals on patient engagement in acute and outpatient settings, little is known about use of this technology in nursing homes. Objective: The purpose of this study was to report findings from a secondary analysis of data from a national nursing home study of information technology (IT) adoption, called IT sophistication. We describe the extent to which nursing homes (n=815) allow residents or their representatives to access technology including electronic health records, patient portals, and health information-exchange systems as well as the ability of the residents or representatives to self-report data directly into the electronic health record. Methods: We used descriptive statistics and regression techniques to explore relationships between information technology adoption (IT sophistication) and residents' or their representatives' access to technology. Covariates of location, bed size, and ownership were added to the model to understand their potential influence on the relationship between IT sophistication and resident access to technology. Results: Findings revealed that resident access to technology was a significant predictor of the nursing home IT sophistication (P<.001). The inclusion of covariates---nursing home location, bed size, and ownership---with their interactions produced a nonsignificant effect in the model. Residents' or their representatives' use of electronic health records and personal health records were both significant predictors of overall IT sophistication (P<.001). Conclusions: As nursing homes continue to progress in technological capabilities, it is important to understand how increasing IT sophistication can be leveraged to create opportunities to engage residents in their care. Understanding the impact of health information technology on outcomes and which technologies make a difference will help nursing home administrators make more informed decisions about adoption and implementation. ", doi="10.2196/11449", url="http://aging.jmir.org/2019/1/e11449/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518285" } @Article{info:doi/10.2196/12425, author="Kang, Hyo-Jin and Han, Jieun and Kwon, Hyun Gyu", title="An Ecological Approach to Smart Homes for Health Care Services: Conceptual Framework of a Smart Servicescape Wheel", journal="JMIR Mhealth Uhealth", year="2019", month="Feb", day="08", volume="7", number="2", pages="e12425", keywords="health care information management", keywords="system analysis, smart homes for health care services", keywords="ecological approach", keywords="conceptual framework", keywords="smart servicescape wheel", abstract="Background: Smart homes are considered effective solutions for home health care for the elderly, as smart home technologies can reduce care costs and improve elderly residents' independence. To develop a greater understanding of smart homes for health care services (SHHSs), this study accentuated the necessity of ecological approaches with an emphasis on environmental constraints. This study was based on 2 rationales: (1) users are inclined to perceive the service quality and service experience from environments (ie, servicescape) owing to the intangibility of health care and the pervasiveness of smart home technologies, and (2) both service domains are complex adaptive systems in which diversified and undefined service experiences---not only a few intended service flows---can be generated by complex combinations of servicescape elements. Objective: This study proposed the conceptual framework of a Smart Servicescape Wheel (SSW) as an ecological approach delineating the extensive spectrum of environmental constraints in SHHSs. Methods: The SSW framework was established based on a literature review. Results: Generally divided by perceptible and imperceptible servicescapes, the SSW consists of the perceptible Physical scape (ie, hardware components, environmental cues, and human states) and Social scape (ie, service relationships and social relationships) as well as the imperceptible Datascape (ie, computing intelligence, databases, and communication networks). Following the ecological approach, each category of the SSW is subdivided and defined at the level of components or functions. Conclusions: The SSW's strengths lie in the various application opportunities for SHHSs. In terms of service planning and development, the SSW can be utilized to (1) establish the requirements for SHHS development, (2) associate with work domain analysis by defining component layers, and (3) understand the real contexts of SHHSs for the enhanced prediction of diverse service experiences. Regarding service management, it can be applied to develop measurement items for the operation and evaluation of SHHSs. ", doi="10.2196/12425", url="http://mhealth.jmir.org/2019/2/e12425/", url="http://www.ncbi.nlm.nih.gov/pubmed/30735145" } @Article{info:doi/10.2196/mhealth.9892, author="Steven, Alison and Wilson, Gemma and Young-Murphy, Lesley", title="The Implementation of an Innovative Hydration Monitoring App in Care Home Settings: A Qualitative Study", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="29", volume="7", number="1", pages="e9892", keywords="education", keywords="frail elderly", keywords="mobile apps", keywords="patient safety", keywords="residential facilities", keywords="water-electrolyte balance", abstract="Background: In response to marked concern regarding inadequate fluid intake recording in care homes, an innovative mobile hydration app was collaboratively developed. ``Hydr8'' aimed to facilitate accurate recording and communication of residents' fluid intake and ultimately increase care quality and patient safety. Objective: The aim of this study was to examine the implementation of Hydr8 in a sample of care homes in one area in England. Methods: The principles of Realist Evaluation and Action research were drawn upon throughout the study. Overall, 5 care homes participated in this study, 3 interview-only sites and 2 case-study sites, where interviews and observations were conducted at 3 time-points. Furthermore, 28 staff members participated, including care staff, management, a registered nurse, and administrative staff. Results: Findings suggest that Hydr8 benefits practice, enhancing the understanding of hydration and person-centered care and improving staff communication. However, technical glitches hindered the seamless embedding of Hydr8 into everyday practice, and enthusiasm for long-term use was dependent on the resolution of issues. In addition, Hydr8 heightened perceptions of personal accountability, and while managers viewed this as positive, some staff members were apprehensive. However, individuals were enthusiastic about the long-term use and potential of Hydr8. Conclusions: Utilizing the findings of this study to further develop and adapt Hydr8 indicates the long-term use of Hydr8 as promising. Although perceptions of Hydr8 were primarily positive, setbacks in its implementation and use created difficulties in normalizing the solution into everyday practice. This study highlights the need for education related to hydration practice and a change of infrastructure in care home settings to implement technical solutions and changes to care. ", doi="10.2196/mhealth.9892", url="http://mhealth.jmir.org/2019/1/e9892/", url="http://www.ncbi.nlm.nih.gov/pubmed/30694207" } @Article{info:doi/10.2196/11825, author="Biermann, Hannah and Offermann-van Heek, Julia and Himmel, Simon and Ziefle, Martina", title="Ambient Assisted Living as Support for Aging in Place: Quantitative Users' Acceptance Study on Ultrasonic Whistles", journal="JMIR Aging", year="2018", month="Dec", day="12", volume="1", number="2", pages="e11825", keywords="ambient assisted living", keywords="technology acceptance", keywords="user diversity", keywords="ultrasonic whistles", keywords="aging in place", abstract="Background: Given the fact of an aging society, new supply measures and living concepts are needed, especially as health impairments along with care dependency increase with age. As many elderly people wish to stay at home for as long as possible, ambient assisted living (AAL) represents a support for aging in place. Objective: AAL combines medical and care technology within living environments and is, therefore, a promising approach to cope with demographic change in terms of fast-growing care needs and fewer skilled workers. Ultrasonic whistles represent one innovative technical possibility for such supportive housing solutions. Central fields of application are home automation, emergency service, and positioning. As AAL technologies affect sensitive areas of life, it is of great interest under which conditions they are accepted or rejected, taking individual user requirements into account. Hence, the aim of this study was to investigate users' perception and evaluation of ultrasonic whistles. Methods: In this study, we examined the acceptance of ultrasonic whistles in home care by function and room using a Web-based questionnaire. Besides an evaluation of the overall usefulness, we focused on the intention to use ultrasonic whistles; 270 participants assessed home automation, emergency service, and positioning as specific functions of ultrasonic whistles. Furthermore, bathroom, bedroom, and living room were evaluated as specific usage locations (rooms). With regard to the user's perspective, the focus was set on age and attitudes toward aging of care receivers. Results: This study revealed a significant influence of function (F2,269=60.444; P<.001), room (F2,269=41.388; P<.001), and the interaction of function and room (F4,269=8.701; P<.001) on the acceptance of ultrasonic whistles. The use of emergency services within the bathroom represented the most accepted alternative, whereas positioning within the living room received the comparably lowest evaluations. Although user diversity played a minor role for acceptance overall, the assessment of single applications differed among user groups, particularly with regard to age differences (F20,500=1.988; P<.01) in the evaluation of specific installation options such as automated doors. Conclusions: The study revealed profound insights into the user-centered assessment of ultrasonic whistles in home care and discovered function and room as influencing acceptance parameters. Concerning user characteristics, age, and attitude toward aging partly affected these evaluations, forming the basis for and showing the importance of further investigations in this context. ", doi="10.2196/11825", url="http://aging.jmir.org/2018/2/e11825/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518245" } @Article{info:doi/10.2196/11875, author="Au, Yunghan and Laforet, Marcon and Talbot, Kirsten and Wang, C. Sheila", title="Skin and Wound Map From 23,453 Nursing Home Resident Records: Relative Prevalence Study", journal="JMIR Dermatol", year="2018", month="Oct", day="09", volume="1", number="2", pages="e11875", keywords="mobile health", keywords="wounds and injuries", keywords="skin", keywords="skilled nursing facilities", keywords="smartphone", abstract="Background: The overall distribution of all skin and wound problems experienced by residents in skilled nursing facilities, with respect to the location on the body, is poorly understood. Previous studies focused largely on one disease type, rather than all possible skin lesions. Hence, the relative distribution of skin and wound problems as mapped on the body has not previously been reported. In addition, existing data come mainly from clinical studies and voluntarily reported statistics; unbiased real-world evidence is lacking. Objective: The aim of this study was to understand the type and location of skin and wound lesions found in skilled nursing facilities and to map these on the body. Methods: Data from 23,453 wounds were used to generate heat maps to identify the most common areas of skin and wound lesions, as well as the most common wound types at different body locations. Results: The most common wound types were abrasion (8792/23,453, 37.49\%), pressure ulcers (4089/23,453, 17.43\%), surgical wounds (3107/23,453, 13.25\%), skin tears (2206/23,453, 9.41\%), and moisture-associated skin damage (959/23,453, 4.09\%). The most common skin and wound locations were the coccyx (962/23,453, 4.10\%), right (853/23,453, 3.64\%) and left (841/23,453, 3.59\%) forearms, and sacrum (818/23,453, 3.49\%). Conclusions: Here, we present the body location hot spots of skin and wound lesions experienced by residents of skilled nursing facilities. In addition, the relative prevalence of these conditions is presented. We believe that identifying areas on the body prone to preventable wounds can help direct actions by care workers and improve the quality of care for skilled nursing residents. This study represents an example of how analysis of specialized electronic medical records can be used to generate insights to educate and inform facility managers where to focus their efforts to prevent these injuries from occurring, not only from retrospective database analysis but also in near real time. ", doi="10.2196/11875", url="https://derma.jmir.org/2018/2/e11875/" } @Article{info:doi/10.2196/10424, author="Offermann-van Heek, Julia and Ziefle, Martina", title="They Don't Care About Us! Care Personnel's Perspectives on Ambient Assisted Living Technology Usage: Scenario-Based Survey Study", journal="JMIR Rehabil Assist Technol", year="2018", month="Sep", day="24", volume="5", number="2", pages="e10424", keywords="Ambient Assisted Living technologies", keywords="assistive technologies", keywords="care professionals", keywords="diverse care contexts", keywords="web-based survey", keywords="quantitative scenario-based approach", keywords="technology acceptance", keywords="user diversity", abstract="Background: Demographic change represents enormous burdens for the care sectors, resulting in high proportions of (older) people in need of care and a lack of care staff. Ambient Assisted Living (AAL) technologies have the potential to support the bottlenecks in care supply but are not yet in widespread use in professional care contexts. Objective: The objective of our study was to investigate professional caregivers' AAL technology acceptance and their perception regarding specific technologies, data handling, perceived benefits, and barriers. In particular, this study focuses on the perspectives on AAL technologies differing between care professionals working in diverse care contexts to examine the extent to which the care context influences the acceptance of assistive technologies. Methods: A Web-based survey (N=170) was carried out focusing on professional caregivers including medical, geriatric, and disabled people's caregivers. Based on a scenario, the participants were asked for their perceptions concerning specific technologies, specific types of gathered data, and potential benefits of and barriers to AAL technology usage. Results: The care context significantly impacted the evaluations of AAL technologies (F14,220=2.514; P=.002). Professional caregivers of disabled people had a significantly more critical attitude toward AAL technologies than medical and geriatric caregivers, indicated (1) by being the only caregiver group that rejected evaluations of AAL technology acceptance (F2,118=4.570; P=.01) and specific technologies (F2,118=11.727; P<.001) applied for gathering data and (2) by the comparatively lowest agreements referring to the evaluations of data types (F2,118=4.073, P=.02) that are allowed to be gathered. Conclusions: AAL technology acceptance is critical because of technology implementation reasons, especially in the care of people with disabilities. AAL technologies in care contexts have to be tailored to care professional's needs and concerns (``care about us''). The results contribute to a broader understanding of professional caregivers' needs referring to specific data and technology configurations and enclose major differences concerning diverse care contexts. Integrating these findings into user group-tailored technology concepts and communication strategies will support a sustainable adoption of AAL systems in professional care contexts. ", doi="10.2196/10424", url="http://rehab.jmir.org/2018/2/e10424/", url="http://www.ncbi.nlm.nih.gov/pubmed/30249592" } @Article{info:doi/10.2196/jmir.9638, author="Donnelly, Susie and Reginatto, Brenda and Kearns, Oisin and Mc Carthy, Marie and Byrom, Bill and Muehlhausen, Willie and Caulfield, Brian", title="The Burden of a Remote Trial in a Nursing Home Setting: Qualitative Study", journal="J Med Internet Res", year="2018", month="Jun", day="19", volume="20", number="6", pages="e220", keywords="mHealth", keywords="patient burden", keywords="remote trial", keywords="clinical trial methodology", keywords="wearable technology", keywords="activity monitors", abstract="Background: Despite an aging population, older adults are typically underrecruited in clinical trials, often because of the perceived burden associated with participation, particularly travel associated with clinic visits. Conducting a clinical trial remotely presents an opportunity to leverage mobile and wearable technologies to bring the research to the patient. However, the burden associated with shifting clinical research to a remote site requires exploration. While a remote trial may reduce patient burden, the extent to which this shifts burden on the other stakeholders needs to be investigated. Objective: The aim of this study was to explore the burden associated with a remote trial in a nursing home setting on both staff and residents. Methods: Using results from a grounded analysis of qualitative data, this study explored and characterized the burden associated with a remote trial conducted in a nursing home in Dublin, Ireland. A total of 11 residents were recruited to participate in this trial (mean age: 80 years; age range: 67-93 years). To support research activities, we also recruited 10 nursing home staff members, including health care assistants, an activities co-ordinator, and senior nurses. This study captured the lived experience of this remote trial among staff and residents and explored the burden associated with participation. At the end of the trial, a total of 6 residents and 8 members of staff participated in semistructured interviews (n=14). They reviewed clinical data generated by mobile and wearable devices and reflected upon their trial-related experiences. Results: Staff reported extensive burden in fulfilling their roles and responsibilities to support activities of the trial. Among staff, we found eight key characteristics of burden: (1) comprehension, (2) time, (3) communication, (4) emotional load, (5) cognitive load, (6) research engagement, (7) logistical burden, and (8) product accountability. Residents reported comparatively less burden. Among residents, we found only four key characteristics of burden: (1) comprehension, (2) adherence, (3) emotional load, and (4) personal space. Conclusions: A remote trial in a nursing home setting can minimize the burden on residents and enable inclusive participation. However, it arguably creates additional burden on staff, particularly where they have a role to play in locally supporting and maintaining technology as part of data collection. Future research should examine how to measure and minimize the burden associated with data collection in remote trials. ", doi="10.2196/jmir.9638", url="http://www.jmir.org/2018/6/e220/", url="http://www.ncbi.nlm.nih.gov/pubmed/29921563" } @Article{info:doi/10.2196/medinform.5587, author="Burleson, Winslow and Lozano, Cecil and Ravishankar, Vijay and Lee, Jisoo and Mahoney, Diane", title="An Assistive Technology System that Provides Personalized Dressing Support for People Living with Dementia: Capability Study", journal="JMIR Med Inform", year="2018", month="May", day="01", volume="6", number="2", pages="e21", keywords="Alzheimer disease", keywords="disorders, neurocognitive", keywords="image processing, computer-assisted", abstract="Background: Individuals living with advancing stages of dementia (persons with dementia, PWDs) or other cognitive disorders do not have the luxury of remembering how to perform basic day-to-day activities, which in turn makes them increasingly dependent on the assistance of caregivers. Dressing is one of the most common and stressful activities provided by caregivers because of its complexity and privacy challenges posed during the process. Objective: In preparation for in-home trials with PWDs, the aim of this study was to develop and evaluate a prototype intelligent system, the DRESS prototype, to assess its ability to provide automated assistance with dressing that can afford independence and privacy to individual PWDs and potentially provide additional freedom to their caregivers (family members and professionals). Methods: This laboratory study evaluated the DRESS prototype's capacity to detect dressing events. These events were engaged in by 11 healthy participants simulating common correct and incorrect dressing scenarios. The events ranged from donning a shirt and pants inside out or backwards to partial dressing---typical issues that challenge a PWD and their caregivers. Results: A set of expected detections for correct dressing was prepared via video analysis of all participants' dressing behaviors. In the initial phases of donning either shirts or pants, the DRESS prototype missed only 4 out of 388 expected detections. The prototype's ability to recognize other missing detections varied across conditions. There were also some unexpected detections such as detection of the inside of a shirt as it was being put on. Throughout the study, detection of dressing events was adversely affected by the relatively smaller effective size of the markers at greater distances. Although the DRESS prototype incorrectly identified 10 of 22 cases for shirts, the prototype preformed significantly better for pants, incorrectly identifying only 5 of 22 cases. Further analyses identified opportunities to improve the DRESS prototype's reliability, including increasing the size of markers, minimizing garment folding or occlusions, and optimal positioning of participants with respect to the DRESS prototype. Conclusions: This study demonstrates the ability to detect clothing orientation and position and infer current state of dressing using a combination of sensors, intelligent software, and barcode tracking. With improvements identified by this study, the DRESS prototype has the potential to provide a viable option to provide automated dressing support to assist PWDs in maintaining their independence and privacy, while potentially providing their caregivers with the much-needed respite. ", doi="10.2196/medinform.5587", url="http://medinform.jmir.org/2018/2/e21/", url="http://www.ncbi.nlm.nih.gov/pubmed/29716885" } @Article{info:doi/10.2196/jmir.9650, author="Berridge, Clara", title="Medicaid Becomes the First Third-Party Payer to Cover Passive Remote Monitoring for Home Care: Policy Analysis", journal="J Med Internet Res", year="2018", month="Feb", day="21", volume="20", number="2", pages="e66", keywords="policy making", keywords="Medicaid", keywords="long-term care", keywords="aging", keywords="information technology", keywords="passive remote monitoring", keywords="sensing", keywords="ethics", keywords="technology implementation", abstract="Background: Recent years have seen an influx of location-tracking, activity-monitoring sensors, and Web-cameras to remotely monitor the safety of older adults in their homes and to reduce reliance on in-person assistance. The state of research on these monitoring technologies leaves open crucial financial, social, and ethical cost-benefit questions, which have prevented widespread use. Medicaid is now the first large third-party payer in the United States to pay for these technologies, and their use is likely to increase as states transition to managed long-term services and supports (MLTSS). Objectives: This is the first study to examine how state Medicaid programs are treating passive remote monitoring technologies. This study identifies (1) which states allow location tracking, sensor systems, and cameras; (2) what policies are in place to track their use; (3) what implementation processes and program monitoring mechanisms are in place; and (4) what related insights Medicaid program stakeholders would like to learn from researchers. Methods: Interviews were conducted with 43 state, federal, and managed care organization (MCO) Medicaid program stakeholders about how these technologies are used in state waivers serving community-dwelling older adults in 15 states, and what policies are in place to regulate them. The interviews were analyzed by the research team using the framework analysis method for applied policy research. Results: Two-thirds of the states cover location tracking and activity-monitoring sensors and one-third cover cameras, but only 3 states have specific service categories that allow them to track when they are paying for any of these technologies, impeding regulation and understanding of their use at the state and federal level. Consideration of ethical and social risks is limited, and states struggle to understand which circumstances warrant use. They are further challenged by extreme resource restrictions and transitions to MLTSS by MCOs inexperienced in serving this growing ``high-need, high-cost'' population. Conclusions: Decisions about Medicaid reimbursement of technologies that have the potential to dramatically alter the way older adults receive supportive services are being made without research on their use, social and ethical implications, or outcomes. At a minimum, new service categories are needed to enable oversight. Participants prioritized 3 research aims to inform practice: (1) determine cost-effectiveness; (2) identify what type of information beneficiaries want to be generated and whom they want it to be shared with; and (3) understand how to support ethical decision making for beneficiaries with cognitive impairment. These findings provide direction for future research and reveal that greater interaction between policy makers and researchers in this field is needed. ", doi="10.2196/jmir.9650", url="http://www.jmir.org/2018/2/e66/", url="http://www.ncbi.nlm.nih.gov/pubmed/29467120" } @Article{info:doi/10.2196/resprot.8772, author="McMurray, Josephine and Strudwick, Gillian and Forchuk, Cheryl and Morse, Adam and Lachance, Jessica and Baskaran, Arani and Allison, Lauren and Booth, Richard", title="The Importance of Trust in the Adoption and Use of Intelligent Assistive Technology by Older Adults to Support Aging in Place: Scoping Review Protocol", journal="JMIR Res Protoc", year="2017", month="Nov", day="02", volume="6", number="11", pages="e218", keywords="assistive technology", keywords="trust", keywords="older adult", keywords="adoption", keywords="technology", keywords="aging in place", keywords="artificial intelligence", keywords="scoping review", abstract="Background: Intelligent assistive technologies that complement and extend human abilities have proliferated in recent years. Service robots, home automation equipment, and other digital assistant devices possessing artificial intelligence are forms of assistive technologies that have become popular in society. Older adults (>55 years of age) have been identified by industry, government, and researchers as a demographic who can benefit significantly from the use of intelligent assistive technology to support various activities of daily living. Objective: The purpose of this scoping review is to summarize the literature on the importance of the concept of ``trust'' in the adoption of intelligent assistive technologies to assist aging in place by older adults. Methods: Using a scoping review methodology, our search strategy will examine the following databases: ACM Digital Library, Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PsycINFO, Scopus, and Web of Science. Two reviewers will independently screen the initial titles obtained from the search, and these results will be further inspected by other members of the research team for inclusion in the review. Results: This review will provide insights into how the concept of trust is actualized in the adoption of intelligent assistive technology by older adults. Preliminary sensitization to the literature suggests that the concept of trust is fluid, unstable, and intimately tied to the type of intelligent assistive technology being examined. Furthermore, a wide range of theoretical lenses that include elements of trust have been used to examine this concept. Conclusions: This review will describe the concept of trust in the adoption of intelligent assistive technology by older adults, and will provide insights for practitioners, policy makers, and technology vendors for future practice. ", doi="10.2196/resprot.8772", url="http://www.researchprotocols.org/2017/11/e218/", url="http://www.ncbi.nlm.nih.gov/pubmed/29097354" } @Article{info:doi/10.2196/jmir.6841, author="Meekes, Wytske and Stanmore, Kate Emma", title="Motivational Determinants of Exergame Participation for Older People in Assisted Living Facilities: Mixed-Methods Study", journal="J Med Internet Res", year="2017", month="Jul", day="06", volume="19", number="7", pages="e238", keywords="technology", keywords="aged", keywords="accidental falls", keywords="rehabilitation", keywords="motivation", abstract="Background: Exergames (exercise-based videogames) for delivering strength and balance exercise for older people are growing in popularity with the emergence of new Kinect-based technologies; however, little is known about the factors affecting their uptake and usage by older people. Objective: The aim of this study was to determine the factors that may influence the motivation of older people to use exergames to improve their physical function and reduce fall risk. Methods: Mixed methods were employed in which 14 semistructured interviews were conducted with older people (n=12, aged 59-91 years) from 2 assisted living facilities in the North West of the United Kingdom. The older people participated in a 6-week trial of exergames along with one manager and one physiotherapist; 81 h of observation and Technology Acceptance Model questionnaires were conducted. Results: The findings suggest that the participants were intrinsically motivated to participate in the exergames because of the enjoyment experienced when playing the exergames and perceived improvements in their physical and mental health and social confidence. The social interaction provided in this study was an important extrinsic motivator that increased the intrinsic motivation to adhere to the exergame program. Conclusions: The findings of this study suggest that exergames may be a promising tool for delivering falls prevention exercises and increasing adherence to exercise in older people. Understanding the motivation of older people to use exergames may assist in the process of implementation. ", doi="10.2196/jmir.6841", url="http://www.jmir.org/2017/7/e238/", url="http://www.ncbi.nlm.nih.gov/pubmed/28684385" } @Article{info:doi/10.2196/iproc.4700, author="Burleson, Winslow and Lozano, Cecil and Ravishankar, Vijay and Rowe, Jeremy and Mahoney, Edward and Mahoney, Diane", title="Assistive Dressing System: A Capabilities Study for Personalized Support of Dressing Activities for People Living with Dementia", journal="iProc", year="2015", month="Oct", day="27", volume="1", number="1", pages="e13", keywords="User-centered design", keywords="Assistive technologies for persons with disabilities", keywords="Human Factors, Performance", keywords="Dementia", keywords="Context Aware Computing", keywords="Ubiquitous Computing", keywords="Sensing Systems", keywords="Image recognition.", doi="10.2196/iproc.4700", url="http://www.iproc.org/2015/1/e13/" } @Article{info:doi/10.2196/mhealth.2536, author="Aztiria, Asier and Farhadi, Golnaz and Aghajan, Hamid", title="User Behavior Shift Detection in Ambient Assisted Living Environments", journal="JMIR Mhealth Uhealth", year="2013", month="Jun", day="18", volume="1", number="1", pages="e6", keywords="shift detection", keywords="intelligent environments", keywords="disease detection", doi="10.2196/mhealth.2536", url="http://mhealth.jmir.org/2013/1/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/25100679" }