@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/10.2196/63609,
author="Silva, Malpriya S. Sandun
and Wabe, Nasir
and Nguyen, D. Amy
and Seaman, Karla
and Huang, Guogui
and Dodds, Laura
and Meulenbroeks, Isabelle
and Mercado, Ibarra Crisostomo
and Westbrook, I. Johanna",
title="Development of a Predictive Dashboard With Prescriptive Decision Support for Falls Prevention in Residential Aged Care: User-Centered Design Approach",
journal="JMIR Aging",
year="2025",
month="Apr",
day="7",
volume="8",
pages="e63609",
keywords="falls prevention",
keywords="dashboard architecture",
keywords="predictive",
keywords="sustainability",
keywords="challenges",
keywords="decision support",
keywords="falls",
keywords="aged care",
keywords="geriatric",
keywords="older adults",
keywords="economic burden",
keywords="prevention",
keywords="electronic health record",
keywords="EHR",
keywords="intervention",
keywords="decision-making",
keywords="patient safety",
keywords="risks",
keywords="older people",
keywords="monitoring",
abstract="Background: Falls are a prevalent and serious health condition among older people in residential aged care facilities, causing significant health and economic burdens. However, the likelihood of future falls can be predicted, and thus, falls can be prevented if appropriate prevention programs are implemented. Current fall prevention programs in residential aged care facilities rely on risk screening tools with suboptimal predictive performance, leading to significant concerns regarding resident safety. Objective: This study aimed to develop a predictive, dynamic dashboard to identify residents at risk of falls with associated decision support. This paper provides an overview of the technical process, including the challenges faced and the strategies used to overcome them during the development of the dashboard. Methods: A predictive dashboard was co-designed with a major residential aged care partner in New South Wales, Australia. Data from resident profiles, daily medications, fall incidents, and fall risk assessments were used. A dynamic fall risk prediction model and personalized rule-based fall prevention recommendations were embedded in the dashboard. The data ingestion process into the dashboard was designed to mitigate the impact of underlying data system changes. This approach aims to ensure resilience against alterations in the data systems. Results: The dashboard was developed using Microsoft Power BI and advanced R programming by linking data silos. It includes dashboard views for those managing facilities and for those caring for residents. Data drill-through functionality was used to navigate through different dashboard views. Resident-level change in daily risk of falling and risk factors and timely evidence-based recommendations were output to prevent falls and enhance prescriptive decision support. Conclusions: This study emphasizes the significance of a sustainable dashboard architecture and how to overcome the challenges faced when developing a dashboard amid underlying data system changes. The development process used an iterative dashboard co-design process, ensuring the successful implementation of knowledge into practice. Future research will focus on the implementation and evaluation of the dashboard's impact on health processes and economic outcomes. International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1136/bmjopen-2021-048657 ",
doi="10.2196/63609",
url="https://aging.jmir.org/2025/1/e63609"
}


@Article{info:doi/10.2196/68061,
author="Lee, Man-Sin Maggie
and Yeoh, Eng-Kiong
and Wong, Lai-Yi Eliza",
title="Employers' Perspectives of Caregiver-Friendly Workplace Policies for Caregiver-Employees Caring for Older Adults in Hong Kong: Thematic Analysis",
journal="JMIR Aging",
year="2025",
month="Mar",
day="31",
volume="8",
pages="e68061",
keywords="caregiver",
keywords="aging",
keywords="burnout",
keywords="stress",
keywords="mental health",
keywords="employees",
abstract="Background: Caregiver-friendly workplace policies (CFWPs) are rare in Hong Kong. With Hong Kong facing a ``silver tsunami'' in the near future, it is important to understand the need for such policies and the views of employers for future facilitation. Objective: This study aimed to identify the support that is currently provided or that could be provided to caregiver-employees (CEs) caring for older adults in Hong Kong and assess the challenge and facilitative support for employers to adopt CFWPs in the specific context of Hong Kong. Methods: A qualitative research design with semistructured individual in-depth interviews with employers from Hong Kong was adopted for this study. A purposive snowball sampling method was used to recruit participants from the 7 primary industries mentioned in the Hong Kong census and from all 3 employer types (private, public, and nongovernmental organizations), which allowed the inclusion of participants sensitized to the idea and potential of CFWPs. Thematic framework analysis was used to evaluate the data collected during the interviews. Results: We interviewed 17 employers and managers from 7 major industries in Hong Kong (2.5 to 120,000 employees). There were 4 (24\%) male and 13 (76\%) female participants, and the participant age ranged from 30 to 50 years. All participants held managerial positions at the time of the interview. Of the 17 participants, 13 were from private companies, 2 were from public institutions, and 2 were from nongovernmental organizations. Four of the companies had a global presence. Four main themes were identified: (1) current support and potential support for CEs (which was limited to discretionary annual leave and unpaid leave when annual leave was exhausted), (2) challenges in adopting CFWPs, (3) facilitating support for adopting CFWPs, and (4) incentives for adopting CFWPs. The participants rated information and resources for CEs (mean 8.56, SD 0.37), bereavement leave (mean 8.47, SD 0.63), flexible working hours (mean 8.32, SD 0.48), and caregiver-inclusive corporate culture (mean 8.32, SD 0.48) as essential CFWPs for CEs in Hong Kong. Conclusions: While several studies have reported the types of CFWPs and their impacts on CEs, stakeholders' perspectives on CFWPs have been rarely investigated. This study found that although employers consider CFWPs as necessary and see them as a catalyst for a long-term win-win situation, the current support for CEs is discretionary and industry-specific. Government leadership is critical for formulating, piloting, and implementing CFWPs to create a friendly environment that encourages disclosure with trust and respect across industrial sectors in Hong Kong. This study identified the current unmet needs and demands of CEs from the employer's perspective, the barriers to large-scale adoption of CFWPs, and the path forward to inform further discourse and policy formulation in Hong Kong. ",
doi="10.2196/68061",
url="https://aging.jmir.org/2025/1/e68061"
}


@Article{info:doi/10.2196/67539,
author="Pettersson, Beatrice
and Lundin-Olsson, Lillemor
and Skelton, A. Dawn
and Liv, Per
and Zingmark, Magnus
and Rosendahl, Erik
and Sandlund, Marlene",
title="Effectiveness of the Safe Step Digital Exercise Program to Prevent Falls in Older Community-Dwelling Adults: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="31",
volume="27",
pages="e67539",
keywords="geriatric medicine",
keywords="aging",
keywords="accidental falls",
keywords="independent living",
keywords="exercise therapy",
keywords="fall prevention",
keywords="electronic health",
keywords="mobile health",
keywords="preventive medicine",
keywords="self-management",
keywords="effectiveness",
keywords="randomized controlled trial",
keywords="older adults",
keywords="digital technology",
abstract="Background: Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population. Objective: This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program. Methods: Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively. Results: In total, 1628 people were enrolled in the study, 79\% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95\% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11\%) in the exercise group compared to the control group (53\% vs 59.6\%; RR 0.89, 95\% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1\% in the exercise group, 37.1\% in the control group; RR 0.92, 95\% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20\%) participants from the exercise group and 63 (8\%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7\%, 13.4\%, 8.6\%, and 9.1\% at 3, 6, 9, and 12 months, respectively. Conclusions: Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population. Trial Registration: ClinicalTrials.gov NCT03963570; https://clinicaltrials.gov/study/NCT03963570 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-036194 ",
doi="10.2196/67539",
url="https://www.jmir.org/2025/1/e67539"
}


@Article{info:doi/10.2196/60547,
author="Salma, Jordana
and Au, Alesia
and Sayadi, Ghada
and Kleib, Manal",
title="Digital Competence of Arabic-Speaking Immigrant and Refugee Older Adults Enacting Agency and Navigating Barriers: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="25",
volume="27",
pages="e60547",
keywords="digital competence",
keywords="Arab",
keywords="older adult",
keywords="co-design",
keywords="migrant",
keywords="information and communications technology",
keywords="ICT",
abstract="Background: Canada's immigrant and refugee older adult population is projected to grow substantially, making equitable access to information and communications technologies (ICTs) vital for enhancing quality of life in older age. Strengthening the digital competence of immigrant and refugee older adults can improve their social connectedness and access to local information. Objective: This study explored the digital competence of Arabic-speaking immigrant and refugee older adults, focusing on how they engage with ICTs to meet their information and communication needs and the strategies they use to navigate digital barriers. Methods: A qualitative descriptive methodology within a social constructivist paradigm was adopted, incorporating triangulated data collection and iterative co-design cycles. The qualitative approach facilitated an in-depth exploration of participants' experiences, skills, and emotions and the contextual factors influencing their digital competence. Data were collected through storytelling approaches, qualitative interviews, and focus group discussions, which were effective in capturing the experiential aspects of aging and technology use. Co-design cycles informed 6 digital learning sessions tailored to participants' immediate learning needs, fostering motivation and engagement and allowing for observation of ICT use. Digital competence was mapped across the learning domains of the Digital Competence Framework for Citizens 2.2. Results: This study engaged 31 Arabic-speaking immigrant and refugee older adults residing in Canada. Most participants had limited formal education (19/31, 61\%), lived with family (22/31, 70\%), and reported a low income (21/31, 68\%). All participants (31/31, 100\%) used smartphones as their primary ICT device, whereas few (3/31, 10\%) had access to a computer. In total, 3 themes were identified from the analysis, grounded in Digital Competence Framework for Citizens 2.2 competencies on information and data literacy, communication and collaboration, and safety and problem-solving. The themes focused on agency, which is enhanced or constrained using ICTs, impacting older adults' desire and ability to use these technologies to independently meet their daily needs. Conclusions: Immigrant and refugee older adults require support to navigate digital barriers and gain digital competence. Smartphones serve as a critical tool for enhancing digital agency, which can lead to greater social connectedness and improved access to local resources in older age. The findings will inform the design of future digital competence programs for older migrants, emphasizing community partnership and reciprocal learning. ",
doi="10.2196/60547",
url="https://www.jmir.org/2025/1/e60547"
}


@Article{info:doi/10.2196/60582,
author="Rivas, Vincent Eric
and Lesley, Ulf
and Davoody, Nadia",
title="Health Care Professionals' Perspectives on Using eHealth Tools in Advanced Home Care: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="24",
volume="12",
pages="e60582",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="advanced home care",
keywords="content analysis",
keywords="nurse",
keywords="staff-patient relationship",
keywords="aging population",
keywords="patient engagement",
keywords="personalized care",
keywords="patient experience",
abstract="Background: The rising demand for advanced home care services, driven by an aging population and the preference for aging in place, presents both challenges and opportunities. While advanced home care can improve cost-effectiveness and patient outcomes, gaps remain in understanding how eHealth technologies can optimize these services. eHealth tools have the potential to offer personalized, coordinated care that increases patient engagement. However, research exploring health care professionals' (HCPs) perspectives on the use of eHealth tools in advanced home care and their impact on the HCP-patient relationship is limited. Objective: This study aims to explore HCPs' perspectives on using eHealth tools in advanced home care and these tools' impact on HCP-patient relationships. Methods: In total, 20 HCPs from 9 clinics specializing in advanced home care were interviewed using semistructured interviews. The discussions focused on their experiences with 2 eHealth tools: a mobile documentation tool and a mobile preconsultation form. The data were analyzed using content analysis to identify recurring themes. Results: The data analysis identified one main theme: optimizing health care with eHealth; that is, enhancing care delivery and overcoming challenges for future health care. Two subthemes emerged: (1) enhancing care delivery, collaboration, and overcoming adoption barriers and (2) streamlining implementation and advancing eHealth tools for future health care delivery. Five categories were also identified: (1) positive experiences and benefits, (2) interactions between HCPs and patients, (3) challenges and difficulties with eHealth tools, (4) integration into the daily workflow, and (5) future directions. Most HCPs expressed positive experiences with the mobile documentation tool, highlighting improved efficiency, documentation quality, and patient safety. While all found the mobile preconsultation form beneficial, patient-related factors limited its utility. Regarding HCP-patient relationships, interactions with patients remained unchanged with the implementation of both tools. HCPs successfully maintained their interpersonal skills and patient-centered approach while integrating eHealth tools into their practice. The tools allowed more focused, in-depth discussions, enhancing patient engagement without affecting relationships. Difficulties with the tools originated from tool-related issues, organizational challenges, or patient-related complexities, occasionally affecting the time available for direct patient interaction. Conclusions: The study underscores the importance of eHealth tools in enhancing advanced home care while maintaining the HCP-patient relationship. While eHealth tools modify care delivery techniques, they do not impact the core dynamics of the relationships between HCPs and patients. While most of the HCPs in the study had a positive attitude toward using the eHealth tools, understanding the challenges they encounter is crucial for improving user acceptance and success in implementation. Future development should focus on features that not only improve efficiency but also actively enhance HCP-patient relationships, such as facilitating more meaningful interactions and supporting personalized care in the advanced home care setting. ",
doi="10.2196/60582",
url="https://humanfactors.jmir.org/2025/1/e60582"
}


@Article{info:doi/10.2196/66248,
author="Peng, Yingchun
and Zhang, Zhiying
and Zhang, Ruyi
and Zhang, Yiyao
and Wang, Runying
and Zhang, Jiaying
and Zhai, Shaoqi
and Jin, Qilin
and Zhou, Jiaojiao
and Chen, Jingjing",
title="Multidimensional Evaluation of the Process of Constructing Age-Friendly Communities Among Different Aged Community Residents in Beijing, China: Cross-Sectional Questionnaire Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Mar",
day="21",
volume="11",
pages="e66248",
keywords="age-friendly",
keywords="positive living experience",
keywords="active aging",
keywords="healthy aging",
keywords="community residents",
keywords="older adults",
keywords="age-friendly communities",
keywords="multiple stakeholders",
keywords="evaluating age-friendliness",
keywords="urban and suburban areas",
abstract="Background: The World Health Organization (WHO) has made significant efforts to promote age-friendly community initiatives (AFCI) to address the challenges of population aging. Previous studies have discussed the construction of age-friendly communities (AFC) in urban cities, evaluating AFCs often rooted in the WHO's Checklist and focused on a single group, namely older adults, overlooking the role of other age groups in community development. Objective: This study aims to evaluate AFCs from multidimensional aspects, particularly the positive living experiences of older adults, summarize the deficiencies in both hardware and software aspects in the process of constructing AFCs in China, and provide some recommendations to promote AFCIs worldwide. Methods: Using a multistage sampling strategy, 470 community residents from urban and suburban areas participated in this study. A self-designed questionnaire was designed to use a standardized method to evaluate older adults' living experiences across five dimensions, including the degree of age-friendliness in the community, social support, sense of gain, sense of happiness, and sense of security. Respondents rated each dimension on a 10-point scale. This study defined community residents into 3 groups: residents younger than 45 years(Group 1: youth), those aged 45-59 years (Group 2: middle-aged), and those aged ?60 years (Group 3: old-age). Results: In this study, 382 (81.3\%) community residents were unaware of the relevant concepts of AFCs. Most participants highlighted the importance of community support and health services, followed by respect and social inclusion, and outdoor spaces and buildings. The findings showed that the highest-rated dimension was the sense of security. The mean scores for the degree of the sense of security in urban and suburban areas were 7.88 (SD 1.776) and 7.73 (SD 1.853), respectively. For Group 2, the mean scores were 7.60 (SD 2.070) and 8.03 (SD 1.662), while Group 3 had mean scores of 7.34 (SD 2.004) and 7.91 (SD 1.940). The lowest-rated dimension was social support; the mean scores for Group 1 for the degree of social support in urban and suburban areas were 7.63 (SD 1.835) and 7.48 (SD 1.918), respectively. For Group 2, the mean scores were 6.94 (SD 2.087) and 7.36 (SD 2.228), while those for Group 3 were 6.37 (SD 2.299) and 6.84 (SD 2.062). Further, there were significant differences in the scores of residents among different age groups in urban areas regarding age-friendliness (P<.001), social support, (P<.001), and sense of gain (P=.01). Conclusions: China is in the early stages of developing AFCs. We further highlight the importance of continued research on the collaboration and participation among multiple stakeholders. These outcomes have a direct and positive impact on the well?being of older adults. ",
doi="10.2196/66248",
url="https://publichealth.jmir.org/2025/1/e66248"
}


@Article{info:doi/10.2196/67632,
author="Li, Jiaying
and He, Rendong
and Hsu, Erh-Chi
and Li, Junxin",
title="Network Analysis of Key Instrumental Activities of Daily Living and Cognitive Domains for Targeted Intervention in US Older Adults Without Dementia: Cross-Sectional Study",
journal="JMIR Aging",
year="2025",
month="Mar",
day="19",
volume="8",
pages="e67632",
keywords="cognition function",
keywords="older adults",
keywords="intervention targets",
keywords="elder",
keywords="elderly",
keywords="cognitive impairment",
keywords="stimulating activity",
keywords="instrumental activities of daily living",
keywords="IADL",
keywords="daily living activity",
keywords="cognitive domain",
keywords="non-demented",
keywords="cognitive network",
keywords="holistic cognition",
keywords="holistic cognition function",
keywords="network comparison",
keywords="central variables",
keywords="bridge variables",
keywords="network analysis",
abstract="Background: Cognitive impairment in older adults reduces independence and raises health care costs but can be mitigated through stimulating activities. Based on network theory, intricate relationships within and between clusters of instrumental activities of daily living (IADLs) and cognitive domains suggest the existence of central IADLs and cognitive domains, as well as bridge IADLs. Modifying these can significantly enhance daily living activities and cognitive functions holistically. Objective: This study aims to identify central IADLs (key activities within the IADL network), central cognitive domains (key domains within the cognitive network), and bridge IADLs (linking IADL and cognitive networks). These insights will inform targeted interventions to effectively improve IADL and cognitive well-being in older adults. Methods: A cross-sectional analysis of adults aged 65 years and older in the United States focused on 5 IADLs and 6 cognitive domains from the National Health and Aging Trends Study (NHATS). Network analysis identified central and bridge variables. Nonparametric and case-dropping bootstrap methods checked network stability. Network comparison tests assessed sex differences with Benjamini-Hochberg adjustments. Results: Of the 2239 participants, 56.4\% were female (n=976). We computed and tested 3 networks: IADL, cognition, and bridge-with correlation stability coefficients of 0.67, 0.75, and 0.44, respectively (all>0.25). Meal preparation was identified as the central IADL, with a centrality index of 3.87, which was significantly higher than that of other IADLs (all P<.05). Visual attention emerged as the central cognition domain, with a centrality index of 0.86, which was significantly higher than that of other cognition domains (all P<.05). Shopping was determined to be the bridge IADL, with a centrality index of 0.41, which was significantly higher than that of other IADLs (all P<.05). Notably, gender differences emerged in the IADL network, with stronger associations between laundry and meal preparation in females (1.69 vs males: 0.74; P=.001) and higher centrality in meal preparation among females (difference=1.99; P=.007). Conclusions: While broad enhancements in all IADL and cognitive domains are beneficial, targeting meal preparation, visual attention, and shopping may leverage their within-network influence to yield a more pronounced improvement in holistic IADL, holistic cognition, and holistic cognition function through IADL interventions among older adults. Notably, meal preparation interventions may be less effective in males, requiring tailored approaches. ",
doi="10.2196/67632",
url="https://aging.jmir.org/2025/1/e67632"
}


@Article{info:doi/10.2196/63900,
author="Abu El Kheir-Mataria, Wafa
and Mahmoud Abdelraheem, Omnia
and Chun, Sungsoo",
title="Genetic, Socioecological, and Health Determinants of Extreme Longevity in Semi-Supercentenarians and Supercentenarians: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="5",
volume="14",
pages="e63900",
keywords="supercentenarians",
keywords="semi-supercentenarians",
keywords="extreme longevity",
keywords="genetic factors",
keywords="socioecological factors",
keywords="health determinants",
keywords="aging research",
keywords="scoping review",
keywords="cognitive performance",
keywords="data collection methods",
abstract="Background: The study of supercentenarians (individuals aged 110 years or older) offers valuable insights into aging, longevity, and the factors contributing to exceptional lifespans. These individuals often exhibit extraordinary cognitive and physical performance, which can inform strategies to improve the health of the general population. Research on centenarians (individuals aged 100 years or older), semi-supercentenarians (individuals aged 105-109 years), and supercentenarians covers themes like genetic factors, microbiome, inflammation, diet, lifestyle, and psychological aspects. These studies often focus on various aspects of extreme longevity, using varied objectives and methodologies, highlighting the need for a comprehensive synthesis to map the breadth of research and identify gaps in understanding this demographic. Objective: This scoping review aims to map and synthesize existing evidence on the determinants of extreme longevity, focusing on individuals living beyond 105 years. This review seeks to categorize genetic factors associated with semi-supercentenarians and supercentenarians; explore the range of socioecological factors contributing to their longevity; and identify common themes such as health, functional capacity, cognition, mental health, behaviors, social support, quality of life, personality traits, environmental factors, and religiosity. Additionally, it aims to examine and describe the methodologies and assessment tools used in studies on extreme longevity and provide an overview of global demographic trends and patterns among supercentenarians, including geographic distribution, gender prevalence, and socioeconomic characteristics. Methods: This scoping review follows the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 guidelines and the Population, Exposure, and Outcome framework. It includes observational and interventional, quantitative and qualitative studies on supercentenarians and semi-supercentenarians. Data will be sourced from databases like Scopus, PubMed, ProQuest, PsycINFO, and The Cochrane Library. The selection process involves abstract and full-text screening by two independent reviewers, with data extraction focusing on study characteristics, participant demographics, interventions or exposures, and key findings. A thematic analysis will identify patterns across various themes Results: As of October 2, 2024, five databases were searched, yielding 844 studies. After removing duplicates, 706 studies remained. Following the first and second screening stages, 135 studies were found to be eligible. The study is expected to be completed by the end of February 2025. Conclusions: By synthesizing evidence, this study will understand the global scope of supercentenarians, describe the main themes of research interest, and identify gaps. The findings are expected to contribute significantly to the body of knowledge on longevity, informing future research and public health policies. This scoping review aims to enhance the understanding of factors promoting healthy aging and extreme longevity, benefiting broader public health initiatives. Trial Registration: PROSPERO CRD42024512298; https://tinyurl.com/4cmux7h4 ",
doi="10.2196/63900",
url="https://www.researchprotocols.org/2025/1/e63900",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053776"
}


@Article{info:doi/10.2196/65075,
author="Fan, Huimin
and Yu, Weijie
and Rong, Hongguo
and Geng, Xiaokun",
title="Associations Between Sleep Duration and Activity of Daily Living Disability Among Older Adults in China: Cross-Sectional Study",
journal="Interact J Med Res",
year="2025",
month="Mar",
day="5",
volume="14",
pages="e65075",
keywords="sleep",
keywords="sleep duration",
keywords="activities of daily living",
keywords="CHARLS",
keywords="survey",
keywords="questionnaire",
keywords="self-reported",
keywords="gerontology",
keywords="geriatric",
keywords="older adult",
keywords="elder",
keywords="elderly",
keywords="aging",
keywords="ADL",
keywords="physical function",
keywords="physical functioning",
keywords="well-being",
keywords="association",
keywords="correlation",
keywords="China Health and Retirement Longitudinal Study",
abstract="Background: China has the largest elderly population globally; the growth rate of the aged tendency of the population was higher than that of Western countries. Given the distinctions in historical, ethnic, and economic status as well as socio-cultural background, Chinese adults had different sleep patterns compared with adults in other countries. Considering the heavy disease burden caused by activities of daily living (ADL) disability, we conducted a cross-sectional analysis using data from the China Health and Retirement Longitudinal Study (CHARLS) to test the hypothesis that individuals with short and longer sleep duration are more likely to have ADL disability. Objective: ADL disability is a common condition affecting the quality of life among older people. This study aimed to explore the associations between sleep duration and ADL disability among middle-aged and older adults in China. Methods: This cross-sectional study used data from 17,607 participants from the 2018 CHARLS (from 2018 to 2020), an ongoing representative survey of adults aged 45 years or older and their spouses. Self-reported sleep duration per night was obtained from face-to-face interviews. The ADL was measured using a 6-item summary assessed with an ADL scale that included eating, dressing, getting into or out of bed, bathing, using the toilet, and continence. Multiple generalized linear regression models---adjusted for age, sex, education, marital status, tobacco and alcohol use, depression, place of residence, sensory impairment, self-reported health status, life satisfaction, daytime napping, chronic disease condition, and sample weights---were used. Results: Data were analyzed from 17,607 participants, of whom 8375 (47.6\%) were men. The mean (SD) age was 62.7 (10.0) years. Individuals with 4 hours or less (odds ratio [OR] 1.91, 95\% CI 1.60?2.27; P<.001), 5 hours (OR 1.33, 95\% CI 1.09?1.62; P=.006), 9 hours (OR 1.48, 95\% CI 1.13?1.93; P<.001), and 10 hours or more (OR 1.88, 95\% CI 1.47?2.14; P<.001) of sleep per night had a higher risk of ADL disability than those in the reference group (7 hours per night) after adjusting for several covariates. Restricted cubic splines analysis suggested a U-shaped association between sleep duration and ADL disability. When sleep duration fell below 7 hours, an increased sleep duration was associated with a significantly low risk of ADL disability, which was negatively correlated with sleep duration until it fell below 7 hours (OR 0.83, 95\% CI 0.79?0.87; P<.001). When sleep duration exceeded 7 hours, the risk of ADL disability would increase facing prolonged sleep duration (OR 1.19, 95\% CI 1.12?1.27; P<.001). ADL disability should be monitored in individuals with insufficient (?4 or 5 hours per night) or excessive (9 or ?10 hours per night) sleep duration. Conclusions:: In this study, a U-shaped association between sleep duration and ADL disability was found. Future longitudinal studies are needed to establish temporality and examine the mechanisms of the associations between sleep duration and ADL disability. ",
doi="10.2196/65075",
url="https://www.i-jmr.org/2025/1/e65075"
}


@Article{info:doi/10.2196/59458,
author="Lochhead, Chris
and Fisher, B. Robert",
title="On the Necessity of Multidisciplinarity in the Development of at-Home Health Monitoring Platforms for Older Adults: Systematic Review",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="27",
volume="12",
pages="e59458",
keywords="multi-disciplinarity",
keywords="gait assessment",
keywords="machine learning",
keywords="at-home health monitoring",
keywords="older adults",
keywords="elderly",
keywords="artificial intelligence",
keywords="AI",
keywords="gait",
keywords="development",
keywords="health monitoring",
keywords="monitoring",
keywords="systematic review",
keywords="monitoring system",
keywords="barriers",
keywords="caregiver",
keywords="efficiency",
keywords="effectiveness",
abstract="Background: The growth of aging populations globally has increased the demand for new models of care. At-home, computerized health care monitoring is a growing paradigm, which explores the possibility of reducing workloads, lowering the demand for resource-intensive secondary care, and providing more precise and personalized care. Despite the potential societal benefit of autonomous monitoring systems when implemented properly, uptake in health care institutions is slow, and a great volume of research across disciplines encounters similar common barriers to real-world implementation. Objective: The goal of this systematic review was to construct an evaluation framework that can assess research in terms of how well it addresses already identified barriers to application and then use that framework to analyze the literature across disciplines and identify trends between multidisciplinarity and the likelihood of research being developed robustly. Methods: This paper introduces a scoring framework for evaluating how well individual pieces of research address key development considerations using 10 identified common barriers to uptake found during meta-review from different disciplines across the domain of health care monitoring. A scoping review is then conducted using this framework to identify the impact that multidisciplinarity involvement has on the effective development of new monitoring technologies. Specifically, we use this framework to measure the relationship between the use of multidisciplinarity in research and the likelihood that a piece of research will be developed in a way that gives it genuine practical application. Results: We show that viewpoints of multidisciplinarity; namely across computer science and medicine alongside public and patient involvement (PPI) have a significant positive impact in addressing commonly encountered barriers to application research and development according to the evaluation criteria. Using our evaluation metric, multidisciplinary teams score on average 54.3\% compared with 35\% for teams made up of medical experts and social scientists, and 2.68 for technical-based teams, encompassing computer science and engineering. Also identified is the significant effect that involving either caregivers or end users in the research in a co-design or PPI-based capacity has on the evaluation score (29.3\% without any input and between 48.3\% and 36.7\% for end user or caregiver input respectively, on average). Conclusions: This review recommends that, to limit the volume of novel research arbitrarily re-encountering the same issues in the limitations of their work and hence improve the efficiency and effectiveness of research, multidisciplinarity should be promoted as a priority to accelerate the rate of advancement in this field and encourage the development of more technology in this domain that can be of tangible societal benefit. ",
doi="10.2196/59458",
url="https://humanfactors.jmir.org/2025/1/e59458"
}


@Article{info:doi/10.2196/56584,
author="Madeira, Ricardo
and Esteves, Dulce
and Pinto, Nuno
and Vercelli, Alessandro
and Vaz Patto, Maria",
title="Acceptance Factors and Barriers to the Implementation of a Digital Intervention With Older Adults With Dementia or Caregivers: Protocol for an Umbrella Review",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="24",
volume="14",
pages="e56584",
keywords="dementia",
keywords="aging",
keywords="telemedicine",
keywords="implementation",
keywords="digital intervention",
keywords="older people",
keywords="elderly",
keywords="geriatrics",
keywords="mobile applications",
keywords="barriers",
keywords="adherence",
keywords="caregivers",
keywords="self-management",
keywords="acceptability",
abstract="Background: The increase in average life expectancy, aging, and the rise in the number of people living with dementia contribute to growing interest from the scientific community. As the disease progresses, people with dementia may need help with most daily activities and need to be supervised by their carer to ensure their safety. With the help of technology, health care provides new means of self-managing health that support active aging, allowing older people and people with dementia to live independently in their homes for a longer period of time. Although some systematic reviews have revealed some of the impacts of using digital interventions in this area, a broad systematic review that examines the overall results of the effect of this intervention type is mandatory. Objective: The aim of this review is to further investigate and understand the acceptability and barriers to using technology to monitor and manage health conditions of people living with dementia and their caregivers. Methods: A review of systematic reviews on acceptability factors and barriers for people with dementia and caregivers was carried out. Interventions that assessed acceptability factors and barriers to the use of technology by people with dementia or their carers were included. Each potentially relevant systematic review was assessed in full text by a member of a team of external experts. Results: The analysis of the results will be presented in the form of a detailed table of the characteristics of the reviews included. It will also describe the technologies used and factors of acceptability and barriers to their use. The search and preliminary analysis were carried out between May 5, 2023, and August 1, 2024. Conclusions: This review will play an important role as a comprehensive, evidence-based summary of the barriers and facilitators to the use of digital interventions. This review may help to establish effective policy and clinical guideline recommendations. ",
doi="10.2196/56584",
url="https://www.researchprotocols.org/2025/1/e56584"
}


@Article{info:doi/10.2196/64716,
author="Harvey, Philip
and Curiel-Cid, Rosie
and Kallestrup, Peter
and Mueller, Annalee
and Rivera-Molina, Andrea
and Czaja, Sara
and Crocco, Elizabeth
and Loewenstein, David",
title="Digital Migration of the Loewenstein Acevedo Scales for Semantic Interference and Learning (LASSI-L): Development and Validation Study in Older Participants",
journal="JMIR Ment Health",
year="2025",
month="Feb",
day="19",
volume="12",
pages="e64716",
keywords="mild cognitive impairment",
keywords="cognitive challenge tests",
keywords="elder",
keywords="aging",
keywords="amyloid biomarkers",
keywords="cognition",
keywords="cognitive decline",
keywords="deterioration",
keywords="semantic interference",
keywords="Alzheimer disease",
keywords="self-administered",
keywords="voice recognition",
keywords="technology",
keywords="assessment study",
keywords="accuracy",
keywords="artificial intelligence",
keywords="treatment",
keywords="medication",
keywords="mental health",
keywords="biomarkers",
keywords="amnesia",
keywords="neurodegeneration",
keywords="patient health",
keywords="health monitoring",
keywords="digital mental health",
keywords="neuroscience",
keywords="neurotechnology",
keywords="Loewenstein Acevedo Scales for Semantic Interference and Learning",
keywords="LASSI-L",
keywords="digital Loewenstein-Acevedo Scales for Semantic Interference",
keywords="LASSI-D",
abstract="Background: The early detection of mild cognitive impairment is crucial for providing treatment before further decline. Cognitive challenge tests such as the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) can identify individuals at highest risk for cognitive deterioration. Performance on elements of the LASSI-L, particularly proactive interference, correlate with the presence of critical Alzheimer disease biomarkers. However, in-person paper tests require skilled testers and are not practical in many community settings or for large-scale screening in prevention. Objective: This study reports on the development and initial validation of a self-administered computerized version of the Loewenstein-Acevedo Scales for Semantic Interference (LASSI), the digital LASSI (LASSI-D). A self-administered digital version, with an artificial intelligence--generated avatar assistant, was the migrated assessment. Methods: Cloud-based software was developed, using voice recognition technology, for English and Spanish versions of the LASSI-D. Participants were assessed with either the LASSI-L or LASSI-D first, in a sequential assessment study. Participants with amnestic mild cognitive impairment (aMCI; n=54) or normal cognition (NC; n=58) were also tested with traditional measures such as the Alzheimer Disease Assessment Scale-Cognition. We examined group differences in performance across the legacy and digital versions of the LASSI, as well as correlations between LASSI performance and other measures across the versions. Results: Differences on recall and intrusion variables between aMCI and NC samples on both versions were all statistically significant (all P<.001), with at least medium effect sizes (d>0.68). There were no statistically significant performance differences in these variables between legacy and digital administration in either sample (all P<.13). There were no language differences in any variables (P>.10), and correlations between LASSI variables and other cognitive variables were statistically significant (all P<.01). The most predictive legacy variables, proactive interference and failure to recover from proactive interference, were identical across legacy and migrated versions within groups and were identical to results of previous studies with the legacy LASSI-L. Classification accuracy was 88\% for NC and 78\% for aMCI participants. Conclusions: The results for the digital migration of the LASSI-D were highly convergent with the legacy LASSI-L. Across all indices of similarity, including sensitivity, criterion validity, classification accuracy, and performance, the versions converged across languages. Future studies will present additional validation data, including correlations with blood-based Alzheimer disease biomarkers and alternative forms. The current data provide convincing evidence of the use of a fully self-administered digitally migrated cognitive challenge test. ",
doi="10.2196/64716",
url="https://mental.jmir.org/2025/1/e64716"
}


@Article{info:doi/10.2196/59665,
author="Wong, Po Ka
and Teh, Pei-Lee
and Lim, Marc Weng
and Lee, Huey Shaun Wen",
title="Enhancing Older Adults' Lives Through Positive Aging Perception, Quality-of-Life Enhancement, and Social Support to Drive Acceptance and Readiness Toward Indoor Assistive Technology: Cross-Sectional Study",
journal="JMIR Aging",
year="2025",
month="Feb",
day="5",
volume="8",
pages="e59665",
keywords="indoor assistive technology",
keywords="positive aging perceptions",
keywords="quality of life",
keywords="social support",
keywords="technology acceptance",
keywords="technology readiness",
abstract="Background: The growing aging population faces increasing mobility limitations, highlighting the need for assistive technologies as potential solutions. These technologies support the independence and well-being of older adults and individuals with mobility challenges. Indoor mobility is essential for daily activities and significantly impacts their lives. Limited indoor mobility can reduce quality of life and heighten the risk of falls. Objective: This study explores how positive aging perceptions, quality-of-life enhancements, and social support influence the acceptance and readiness of indoor assistive technologies among older adults. Methods: A cross-sectional study was conducted at a gerontechnology laboratory, requiring participants to visit the facility in person. Each 60-minute session included demonstrations of various indoor assistive technologies and the completion of a questionnaire. The assistive technologies showcased encompassed a wide range of devices. Participants' positive aging perceptions, quality-of-life enhancements, social support, technology acceptance, and readiness were measured using validated scales. Data were analyzed with AMOS (version 28; IBM Corp) and SPSS (version 28; IBM Corp), using structural equation modeling and multivariate analysis of covariance to assess the effects of predictors while controlling for demographic factors. Results: A total of 104 older adults aged 60 years and older participated, with a mean age of 67.92 (SD 5.68) years. Structural equation modeling indicated that positive aging perception has a significant influence on older adults' control beliefs (P=.095), comfort (P=.047), and confidence (P<.001) in gerontechnology. Multivariate analysis revealed significant combined effects of quality-of-life enhancement (P=.01) and social support (P=.03) on technology acceptance and readiness, wherein quality-of-life enhancement (P=.001) and social support (P=.008) negatively impacted security perception. Among demographic variables, educational level significantly impacted gerontechnology confidence (P=.004) while ethnicity influenced optimism (P=.003). Conclusions: This study sheds light on key factors affecting older adults' acceptance and readiness to adopt indoor assistive technologies. Findings highlight the importance of fostering positive aging perceptions through these technologies. Addressing issues related to control beliefs, comfort, and confidence in gerontechnology is essential to enhance technology acceptance and readiness among older adults. Future research should investigate the underlying mechanisms and create targeted interventions to support successful technology adoption in this population. ",
doi="10.2196/59665",
url="https://aging.jmir.org/2025/1/e59665"
}


@Article{info:doi/10.2196/65141,
author="Hossain, Rubana Sheikh
and Samant, N. Akanksha
and Balsamo, C. Briana
and Hawley, E. Chelsea
and Zanchelli, C. Michael
and Zhu, Carolyn
and Venegas, D. Maria
and Robertson, Marina
and McCullough, B. Megan
and Beizer, L. Judith
and Boockvar, S. Kenneth
and Siu, L. Albert
and Moo, R. Lauren
and Hung, W. William",
title="Effect of Medication Management at Home via Pharmacist-Led Home Televisits: Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="5",
volume="14",
pages="e65141",
keywords="older adults",
keywords="medication management",
keywords="televisit",
keywords="polypharmacy",
keywords="adverse drug reaction",
abstract="Background: Older adults are more likely to have multiple chronic conditions, be prescribed multiple medications, and be more susceptible to adverse drug reactions (ADRs) to their medications. In addition, older adults often use over-the-counter medications and supplements, further complicating their medication regimens. Complex medication regimens are potentially harmful to older adults. Interventions aimed at reducing medication discrepancy in the ambulatory clinic setting, such as reviews of medication lists and the implementation of ``brown bag'' reconciliation, continue to be challenging, with limited success. Pharmacist-led interventions to improve appropriate medication use in older adults have demonstrated effectiveness in reducing ADRs. Video visits have the potential to provide direct visualization of medications in older adults' homes, thereby reducing medication discrepancy and increasing medication adherence. Pharmacist-led management of older adults' medication regimens may improve appropriate medication use in older adults. Objective: The objective of this study is to examine the effect of pharmacist-led medication through home televisits compared to usual care on appropriate medication use, medication discrepancies, medication adherence, and ADRs. Methods: We will conduct a 2-site cluster randomized controlled trial (RCT). The intervention will be a pharmacist-led home televisit including medication reconciliation and assessment of actual medication use. The cluster RCT was iteratively adapted after a pilot test. The primary outcome of medication appropriateness of the intervention will be measured using the STOPP (Screening Tool of Older Persons' Prescriptions) criteria for potentially inappropriate medications (PIMs) at 6 months. Medication lists obtained will be compared against electronic medical records (EMRs) by a clinician to establish discrepancies in medications. The clinician will review medications using the validated Medication Appropriateness Index (MAI). Results: This project has been peer-reviewed and selected for support by the Veterans Affairs (VA) Health Services Research Service. The pilot phase of the study was completed December 2021 with 20 veterans and was primarily informed by the Steinman model of the prescribing process adapted to include system- and provider-level factors. The last date of enrollment was August 6, 2021. We anticipate the completion of the ongoing trial in spring 2025. The first results are expected to be submitted for publication in 2025. Conclusions: The cluster RCT will provide evidence on medication management through televisits. If found effective in improving the use of medications, the intervention has the potential to impact older adults with multiple chronic conditions and polypharmacy. Trial Registration: ClinicalTrials.gov NCT04340570; https://clinicaltrials.gov/study/NCT04340570 International Registered Report Identifier (IRRID): PRR1-10.2196/65141 ",
doi="10.2196/65141",
url="https://www.researchprotocols.org/2025/1/e65141"
}


@Article{info:doi/10.2196/64763,
author="Shade, Marcia
and Yan, Changmin
and Jones, K. Valerie
and Boron, Julie",
title="Evaluating Older Adults' Engagement and Usability With AI-Driven Interventions: Randomized Pilot Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="24",
volume="9",
pages="e64763",
keywords="voice assistant",
keywords="interventions",
keywords="usability",
keywords="engagement",
keywords="personality",
keywords="older adults",
keywords="aging",
keywords="technology",
keywords="artificial intelligence",
keywords="AI",
keywords="self-management",
keywords="pilot trial",
keywords="chronic",
keywords="musculoskeletal pain",
keywords="AI assistant",
keywords="Alexa",
keywords="user experience",
keywords="digital health",
keywords="digital intervention",
keywords="mobile phone",
abstract="Background: Technologies that serve as assistants are growing more popular for entertainment and aiding in daily tasks. Artificial intelligence (AI) in these technologies could also be helpful to deliver interventions that assist older adults with symptoms or self-management. Personality traits may play a role in how older adults engage with AI technologies. To ensure the best intervention delivery, we must understand older adults' engagement with and usability of AI-driven technologies. Objective: This study aimed to describe how older adults engaged with routines facilitated by a conversational AI assistant. Methods: A randomized pilot trial was conducted for 12-weeks in adults aged 60 years or older, self-reported living alone, and having chronic musculoskeletal pain. Participants (N=50) were randomly assigned to 1 of 2 intervention groups (standard vs enhanced) to engage with routines delivered by the AI assistant Alexa (Amazon). Participants were encouraged to interact with prescribed routines twice daily (morning and evening) and as needed. Data were collected and analyzed on routine engagement characteristics and perceived usability of the AI assistant. An analysis of the participants' personality traits was conducted to describe how personality may impact engagement and usability of AI technologies as interventions. Results: The participants had a mean age of 79 years, with moderate to high levels of comfort and trust in technology, and were predominately White (48/50, 96\%) and women (44/50, 88\%). In both intervention groups, morning routines (n=62, 74\%) were initiated more frequently than evening routines (n=52, 62\%; z=?2.81, P=.005). Older adult participants in the enhanced group self-reported routine usability as good (mean 74.50, SD 11.90), and those in the standard group reported lower but acceptable usability scores (mean 66.29, SD 6.94). Higher extraversion personality trait scores predicted higher rates of routine initiation throughout the whole day and morning in both groups (standard day: B=0.47, P=.004; enhanced day: B=0.44, P=.045; standard morning: B=0.50, P=.03; enhanced morning: B=0.53, P=.02). Higher agreeableness (standard: B=0.50, P=.02; enhanced B=0.46, P=.002) and higher conscientiousness (standard: B=0.33, P=.04; enhanced: B=0.38, P=.006) personality trait scores predicted better usability scores in both groups. Conclusions: he prescribed interactive routines delivered by an AI assistant were feasible to use as interventions with older adults. Engagement and usability by older adults may be influenced by personality traits such as extraversion, agreeableness, and conscientiousness. While integrating AI-driven interventions into health care, it is important to consider these factors to promote positive outcomes. Trial Registration: ClinicalTrials.gov NCT05387447; https://clinicaltrials.gov/study/NCT05387447 ",
doi="10.2196/64763",
url="https://formative.jmir.org/2025/1/e64763"
}


@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/10.2196/63567,
author="Hultman, Lisa
and Eklund, Caroline
and von Heideken W{\aa}gert, Petra
and S{\"o}derlund, Anne
and Lind{\'e}n, Maria
and Elfstr{\"o}m, L. Magnus",
title="Development of an eHealth Intervention Including Self-Management for Reducing Sedentary Time in the Transition to Retirement: Participatory Design Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="20",
volume="9",
pages="e63567",
keywords="behavior change intervention",
keywords="adherence",
keywords="integrated behavior change model",
keywords="autonomous motivation",
keywords="affective determinants",
abstract="Background: Having a great amount of sedentary time is common among older adults and increases with age. There is a strong need for tools to reduce sedentary time and promote adherence to reduced sedentary time, for which eHealth interventions have the potential to be useful. Interventions for reducing sedentary time in older adults have been found to be more effective when elements of self-management are included. When creating new eHealth interventions, accessibility and effectiveness can be increased by including end users as co-designers in the development process. Objective: The aim was to explore the desired features of an eHealth intervention including self-management for reducing sedentary time and promoting adherence to reduced sedentary time in older adults transitioning from working life to retirement. Further, the aim was to develop a digital prototype of such an eHealth intervention. Methods: The study used the participatory design approach to include end users, researchers, and a web designer as equal partners. Three workshops were conducted with 6 older adults transitioning to retirement, 2 researchers, and 1 web designer. Thematic analysis was used to analyze the data from the workshops. Results: Participants expressed a desire for an easy-to-use eHealth intervention, which could be accessed from mobile phones, tablets, and computers, and could be individualized to the user. The most important features for reducing sedentary time were those involving finding joyful activities, setting goals, and getting information regarding reduced sedentary time. Participants expressed that the eHealth intervention would need to first provide the user with knowledge regarding sedentary time, then offer features for measuring sedentary time and for setting goals, and lastly provide support in finding joyful activities to perform in order to avoid being sedentary. According to the participants, an eHealth intervention including self-management for reducing sedentary time in older adults in the transition to retirement should be concise, accessible, and enjoyable. A digital prototype of such an eHealth intervention was developed. Conclusions: The developed eHealth intervention including self-management for reducing sedentary time in older adults transitioning to retirement is intended to facilitate behavior change by encouraging the user to participate in autonomously motivated activities. It uses several behavior change techniques, such as goal setting and action planning through mental contrasting and implementation intention, as well as shaping knowledge. Its active components for reducing sedentary time can be explained using the integrated behavior change model. Further research is needed to evaluate the feasibility and effectiveness of the eHealth intervention. ",
doi="10.2196/63567",
url="https://formative.jmir.org/2025/1/e63567"
}


@Article{info:doi/10.2196/63568,
author="Kwek, Peng Siong
and Leong, Ying Qiao
and Lee, Vien V.
and Lau, Yin Ni
and Vijayakumar, Smrithi
and Ng, Ying Wei
and Rai, Bina
and Raczkowska, Natalia Marlena
and Asplund, L. Christopher
and Remus, Alexandria
and Ho, Dean",
title="Exploring the General Acceptability and User Experience of a Digital Therapeutic for Cognitive Training in a Singaporean Older Adult Population: Qualitative Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="13",
volume="9",
pages="e63568",
keywords="older adults",
keywords="cognitive training",
keywords="digital therapeutic",
keywords="DTx",
keywords="remote",
keywords="usability",
keywords="acceptance",
keywords="interviews",
keywords="gerontology",
keywords="geriatric",
keywords="elderly",
keywords="experiences",
keywords="attitudes",
keywords="opinions",
keywords="perceptions",
keywords="perspectives",
keywords="interview",
keywords="cognition",
keywords="digital health",
keywords="qualitative",
keywords="thematic",
abstract="Background: Singapore's large aging population poses significant challenges for the health care system in managing cognitive decline, underscoring the importance of identifying and implementing effective interventions. Cognitive training delivered remotely as a digital therapeutic (DTx) may serve as a scalable and accessible approach to overcoming these challenges. While previous studies indicate the potential of cognitive training as a promising solution for managing cognitive decline, understanding the attitudes and experiences of older adults toward using such DTx platforms remains relatively unexplored. Objective: This study aimed to characterize the general acceptability and user experience of CURATE.DTx, a multitasking-based DTx platform that challenges the cognitive domains of attention, problem-solving, and executive function in the Singaporean older adult population. Methods: A total of 15 older adult participants (mean age 66.1, SD 3.5 years) were recruited for a 90-minute in-person session. This session included a 30-minute playtest of CURATE.DTx, followed by a 60-minute semistructured interview to understand their overall attitudes, experience, motivation, and views of the intervention. Interviews were audio-recorded and transcribed verbatim, then analyzed using an inductive approach. Thematic analysis was used to identify emerging patterns and insights. Results: A total of 3 main themes, and their respective subthemes, emerged from the interviews: comprehension, with subthemes of instruction and task comprehension; acceptability, with subthemes of tablet usability, engagement and enjoyment, and attitude and perceived benefits; and facilitators to adoption, with subthemes of framing and aesthetics, motivation recommendations and the role of medical professionals. Our findings revealed that participants encountered some challenges with understanding certain elements of CURATE.DTx. Nevertheless, they were still highly engaged with it, finding the challenge to be enjoyable. Participants also showed a strong awareness of the importance of cognitive training and expressed a keen interest in using CURATE.DTx for this purpose, especially if recommended by medical professionals. Conclusions: Given the positive engagement and feedback obtained from Singaporean older adults on CURATE.DTx, this study can serve as a basis for future platform iterations and strategies that should be considered during implementation. Future studies should continue implementing an iterative codesign approach to ensure the broader applicability and effectiveness of interventions tailored to this demographic. ",
doi="10.2196/63568",
url="https://formative.jmir.org/2025/1/e63568"
}


@Article{info:doi/10.2196/65065,
author="Jin, Hengjiang
and Qu, Ying",
title="Association Between Intergenerational Support, Technology Perception and Trust, and Intention to Seek Medical Care on the Internet Among Chinese Older Adults: Cross-Sectional Questionnaire Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="6",
volume="27",
pages="e65065",
keywords="intergenerational support",
keywords="older adults",
keywords="internet medical intentions",
keywords="perceived technology",
keywords="trust",
abstract="Background: Avoiding technological innovation does not simplify life. In fact, using internet-based medical services can enhance the quality of life for older adults. In the context of an aging population and the growing integration of information technology, the demand for internet-based medical services among older adults is gaining increased attention. While scholars have highlighted the important role of intergenerational support in promoting digital inclusion for older adults, research on the relationship between intergenerational support and older adults' intentions to seek online care remains limited. Objective: This study aims (1) to explore the association between intergenerational support, online medical information, and older adults' intention to seek medical care online, and (2) to examine the mediating role of technology perception and trust, as well as the moderating role of eHealth literacy. Methods: A cross-sectional survey was conducted in China, collecting 958 valid responses from older adults aged 60 years and above. A vast majority of participants were between the ages of 60 and 75 years (771/958, 80.5\%). Of the 958 participants, 559 (58.4\%) resided in rural areas, while 399 (41.6\%) lived in urban areas. The survey included questions on intergenerational support, perceived usefulness, perceived ease of use, trust, online medical information, eHealth literacy, and the intention to seek medical care online. Structural equation modeling and linear regression analysis were applied to explore the relationship between intergenerational support and the intention to seek medical care on the internet. Results: Intergenerational support was positively associated with perceived ease of use ($\beta$=.292, P<.001), perceived usefulness ($\beta$=.437, P<.001), trust ($\beta$=.322, P<.001), and the intention to seek medical care online ($\beta$=.354, P<.001). Online medical information also positively affected the intention to seek medical care online among older adults ($\beta$=.109, P<.001). Perceived ease of use ($\beta$=.029, 95\% CI 0.009-0.054), perceived usefulness ($\beta$=.089, 95\% CI 0.050-0.130), and trust ($\beta$=.063, 95\% CI 0.036-0.099) partially mediated the association between intergenerational support and the intention to seek medical care online. Further analysis found that perceived ease of use, perceived usefulness, and trust played a chain mediating role between intergenerational support and the intention to seek medical care online ($\beta$=.015, 95\% CI 0.008-0.027; $\beta$=.022, 95\% CI 0.012-0.036). Additionally, eHealth literacy played a moderating role in the relationship between intergenerational support and perceived ease of use ($\beta$=.177, P<.001), perceived usefulness ($\beta$=.073, P<.05), trust ($\beta$=.090, P<.01), and the intention to seek medical care online ($\beta$=.124, P<.001). Conclusions: An integrated model of health communication effects was constructed and validated, providing empirical support for the intention to seek medical care online and for the impact of health communication. This model also helps promote the role of technology in empowering the lives of seniors. ",
doi="10.2196/65065",
url="https://www.jmir.org/2025/1/e65065"
}


@Article{info:doi/10.2196/65690,
author="Husain, Laiba
and Greenhalgh, Trisha",
title="Examining Intersectionality and Barriers to the Uptake of Video Consultations Among Older Adults From Disadvantaged Backgrounds With Limited English Proficiency: Qualitative Narrative Interview Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="6",
volume="27",
pages="e65690",
keywords="digital health disparities",
keywords="video consultations",
keywords="intersectionality",
keywords="health inequity",
keywords="digital capital",
keywords="mobile phone",
abstract="Background: The rapid shift to video consultation services during the COVID-19 pandemic has raised concerns about exacerbating existing health inequities, particularly for disadvantaged populations. Intersectionality theory provides a valuable framework for understanding how multiple dimensions of disadvantage interact to shape health experiences and outcomes. Objective: This study aims to explore how multiple dimensions of disadvantage---specifically older age, limited English proficiency, and low socioeconomic status---intersect to shape experiences with digital health services, focusing on video consultations. Methods: Following familiarization visits and interviews with service providers, 17 older people with multiple markers of disadvantage (older age, low socioeconomic status, and limited English proficiency) were recruited in the Redbridge borough of London. Data collection included narrative interviews and ethnographic observations during home visits. Field notes captured participants' living conditions, family dynamics, and technological arrangements. Guided by intersectionality theory and digital capital concepts, interviews explored participants' experiences accessing health care remotely. Intersectional narrative analysis was used to identify key themes and examine how different forms of disadvantage interact. We developed theoretically informed narrative portraits and user personas to synthesize findings. Results: Analysis revealed that the digitalization of health care can exacerbate existing inequities, erode trust, compound oppression, and reduce patient agency for multiply disadvantaged patient populations. Examining intersectionality illuminated how age, language proficiency, and socioeconomic status interact to create unique barriers and experiences. Key themes included the following: weakened presence in digital interactions, erosion of therapeutic relationships, shift from relational to distributed continuity, increased complexity leading to disorientation, engagement shaped by previous experiences of discrimination, and reduced patient agency. Conclusions: This study provides critical insights into how the digitalization of health care can deepen disparities for older patients with low income and limited English proficiency. By applying intersectionality theory to digital health disparities, our findings underscore the need for multifaceted approaches to digital health equity that address the complex interplay of disadvantage. Recommendations include co-designing inclusive digital services, strengthening relational continuity, and developing targeted support to preserve agency and trust for marginalized groups in an increasingly digital health care landscape. ",
doi="10.2196/65690",
url="https://www.jmir.org/2025/1/e65690"
}


@Article{info:doi/10.2196/53205,
author="Zhang, Jinbao
and Prunty, E. Jonathan
and Charles, C. Alison
and Forder, Julien",
title="Association Between Digital Front Doors and Social Care Use for Community-Dwelling Adults in England: Cross-Sectional Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="2",
volume="27",
pages="e53205",
keywords="social care support",
keywords="long term care",
keywords="access",
keywords="front door",
keywords="easy-read",
keywords="self-assessment",
keywords="system navigation",
keywords="digital system",
keywords="digital technology",
keywords="internet",
abstract="Background: Requests for public social care support can be made through an online portal. These digital ``front doors'' can help people navigate complex social care systems and access services. These systems can be set up in different ways, but there is little evidence about the impact of alternative arrangements. Digital front-door systems should help people better access services, particularly low-intensity services (high-intensity care is likely to require a full in-person assessment). Objective: This study aimed to investigate the association between 2 primary digital front door arrangements, easy-read information, and self-assessment tools provided on official websites, and the type of social care support that is offered: ongoing low-level support (OLLS), short-term care (STC) and long-term care (LTC). Methods: Information on front door arrangements was collected from the official websites of 152 English local authorities in 2021. We conducted a cross-sectional analysis using aggregated service use data from official government returns at the local authority level. The independent variables were derived from the policy information collected, specifically focusing on the availability of online digital easy-read information and self-assessment tools for adults and caregivers through official websites. The dependent variables were the rates of using social care support, including OLLS, STC, and LTC, across different age groups: the adult population (aged 18 and older), younger population (aged between 18 and 64 years), and older population (aged 65 and older). Multivariate regression analysis was used to examine the association between digital front door arrangements and access to social care support, controlling for population size, dependency level, and financial need factors. Results: Less than 20\% (27/147) of local authorities provided an integrated digital easy-read format as part of their digital front door system with about 25\% (37/147) adopting digital self-assessment within their system. We found that local authorities that offered an integrated digital easy-read information format showed higher rates of using OLLS ($\beta$ coefficient=0.54; P=.03; but no statistically significant association with LTC and STC). The provision of an online self-assessment system was not associated with service use in the 1-year (2021) cross-sectional estimate, but when 2 years (2020 and 2021) of service-use data were analyzed, a significant positive association was found on OLLS rates ($\beta$ coefficient=0.41; P=.21). Notably, these findings were consistent across different age groups. Conclusions: These findings are consistent with our hypothesis that digital systems with built-in easy-read and self-assessment may make access to (low-intensity) services easier for people. Adoption of these arrangements could potentially help increase the uptake of support among those who are eligible, with expected benefits for their care-related well-being. Given the limited adoption of the digital front door by local authorities in England, expanding their use could improve care-related outcomes and save social care costs. ",
doi="10.2196/53205",
url="https://www.jmir.org/2025/1/e53205"
}


@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/10.2196/57622,
author="Probst, Freya
and Rees, Jessica
and Aslam, Zayna
and Mexia, Nikitia
and Molteni, Erika
and Matcham, Faith
and Antonelli, Michela
and Tinker, Anthea
and Shi, Yu
and Ourselin, Sebastien
and Liu, Wei",
title="Evaluating a Smart Textile Loneliness Monitoring System for Older People: Co-Design and Qualitative Focus Group Study",
journal="JMIR Aging",
year="2024",
month="Dec",
day="17",
volume="7",
pages="e57622",
keywords="loneliness",
keywords="smart textiles",
keywords="wearable technology",
keywords="health monitoring",
keywords="older people",
keywords="co-design",
keywords="design requirement",
keywords="mobile phone",
abstract="Background: Previous studies have explored how sensor technologies can assist in in the detection, recognition, and prevention of subjective loneliness. These studies have shown a correlation between physiological and behavioral sensor data and the experience of loneliness. However, little research has been conducted on the design requirements from the perspective of older people and stakeholders in technology development. The use of these technologies and infrastructural questions have been insufficiently addressed. Systems generally consist of sensors or software installed in smartphones or homes. However, no studies have attempted to use smart textiles, which are fabrics with integrated electronics. Objective: This study aims to understand the design requirements for a smart textile loneliness monitoring system from the perspectives of older people and stakeholders. Methods: We conducted co-design workshops with 5 users and 6 stakeholders to determine the design requirements for smart textile loneliness monitoring systems. We derived a preliminary product concept of the smart wearable and furniture system. Digital and physical models and a use case were evaluated in a focus group study with older people and stakeholders (n=7). Results: The results provided insights for designing systems that use smart textiles to monitor loneliness in older people and widen their use. The findings informed the general system, wearables and furniture, materials, sensor positioning, washing, sensor synchronization devices, charging, intervention, and installation and maintenance requirements. This study provided the first insight from a human-centered perspective into smart textile loneliness monitoring systems for older people. Conclusions: We recommend more research on the intervention that links to the monitored loneliness in a way that addresses different needs to ensure its usefulness and value to people. Future systems must also reflect on questions of identification of system users and the available infrastructure and life circumstances of people. We further found requirements that included user cooperation, compatibility with other worn medical devices, and long-term durability. ",
doi="10.2196/57622",
url="https://aging.jmir.org/2024/1/e57622",
url="http://www.ncbi.nlm.nih.gov/pubmed/39688889"
}


@Article{info:doi/10.2196/59504,
author="Blair, K. Cindy
and Brown-Glaberman, Ursa
and Walters, T. Scott
and Pestak, Claire
and Boyce, Tawny
and Barriga, Laura
and Burgess, Ellen
and Tawfik, Bernard
and Killough, Cynthia
and Kinney, Y. Anita
and Demark-Wahnefried, Wendy
and Meisner, L. Angela
and Wiggins, L. Charles
and Pankratz, Shane V.
and Davis, Sally",
title="A Remotely Delivered Light-Intensity Physical Activity Intervention for Older Cancer Survivors: Protocol for a Feasibility Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="13",
volume="13",
pages="e59504",
keywords="cancer survivor",
keywords="physical performance",
keywords="physical activity",
keywords="physical function",
keywords="older adults",
keywords="activity tracker",
keywords="mobile phone",
abstract="Background: Older cancer survivors face age- and treatment-related comorbidities, including physical functional impairment, which are exacerbated by physical inactivity and sedentary behavior. Regular physical activity can reduce this risk, yet less than 30\% of older cancer survivors meet the recommended guidelines for physical activity. Objective: This study aims to describe the design, methods, and rationale for a remotely delivered intervention that uses a whole-of-day approach to physical activity in older cancer survivors. This approach focuses on the accumulation of intermittent bouts of light-intensity activity throughout the entire day by disrupting and reducing sedentary activity. The intervention was guided by social cognitive and self-determination theories and incorporated motivational interviewing. Methods: The 12-week Move for Your Health trial randomly assigned 64 older cancer survivors to a theory-based physical activity intervention or a waitlist control. A Fitbit (Google) activity tracker and smartphone app were used to promote awareness of activity levels and enable self-monitoring of both activity and inactivity in tandem with health coaching phone calls. Motivational interviewing was used to engage participants and tailor strategies to achieve goals during the 12-week intervention. Data were collected at baseline, immediately after the intervention, and at longer-term follow-up (3 months thereafter). Feasibility outcomes included recruitment, retention, adherence, adverse events, and acceptability. Other outcomes included obtaining the parameter estimates for changes in physical function, physical performance, physical activity, sedentary behavior, and quality of life. Results: Recruitment for the Move for Your Health randomized controlled trial was completed in June 2023. Data collection was completed in March 2024. Data analyses are ongoing. Conclusions: The results of this trial will provide information on the feasibility of implementing this intervention in the target patient population, as well as data that will provide information about the potential impact of the intervention on the outcomes. Both of these outcomes will inform the design of a larger randomized controlled trial to more fully test a physical activity intervention in an older cancer survivor population. Trial Registration: ClinicalTrials.gov NCT05582889; https://clinicaltrials.gov/study/NCT05582889 International Registered Report Identifier (IRRID): DERR1-10.2196/59504 ",
doi="10.2196/59504",
url="https://www.researchprotocols.org/2024/1/e59504"
}


@Article{info:doi/10.2196/59584,
author="Green, R. Ariel
and Boyd, M. Cynthia
and Rosado, Quiles Rosalphie
and Daddato, E. Andrea
and Gleason, S. Kathy
and Taylor McPhail, E. Tobie
and Blinka, D. Marcela
and Schoenborn, L. Nancy
and Wolff, L. Jennifer
and Bayliss, A. Elizabeth
and Boxer, S. Rebecca",
title="Improving How Caregivers of People Living With Dementia Are Identified in the Electronic Health Record: Qualitative Study and Exploratory Chart Review",
journal="JMIR Aging",
year="2024",
month="Dec",
day="13",
volume="7",
pages="e59584",
keywords="dementia",
keywords="dementia care",
keywords="caregivers",
keywords="electronic health record",
keywords="patient record",
keywords="aging",
keywords="geriatrics",
keywords="memory",
abstract="Background: Family and unpaid caregivers play a crucial role in supporting people living with dementia; yet, they are not systematically identified and documented by health systems. Objective: The aims of the study are to determine the extent to which caregivers are currently identified and documented in the electronic health record (EHR) and to elicit the perspectives of caregivers and clinical staff on how to best identify, engage, and support caregivers of people living with dementia through the EHR. Methods: People with dementia were identified based on International Classification of Diseases, Tenth Revision (ICD-10) codes or dementia medications in the EHR. A chart review of people with dementia characterized how caregiver information was documented and whether caregivers had shared access to the patient portal. Caregivers of eligible people with dementia were then recruited through mailed letters and follow-up calls to the homes of people with dementia. We conducted semistructured interviews with caregivers, clinicians, and staff involved in the care of people with dementia within 2 health systems in Maryland and Colorado. Transcripts were analyzed using a mixed inductive and deductive approach. Results: Caregivers of people with dementia (N=22) were usually identified in the ``contact information'' or ``patient contacts'' tab (n=20, 91\%) by their name and relation to the people with dementia; this tab did not specify the caregiver's role. Caregivers were also mentioned, and their roles were described to a varying degree in clinical notes (n=21, 96\%). Of the 22 caregivers interviewed, the majority (n=17, 77\%) reported that the people with dementia had additional caregivers. The presence of multiple caregivers could be gleaned from most charts (n=16, 73\%); however, this information was not captured systematically, and caregivers' individual contributions were not explicitly recorded. Interviews with 22 caregivers and 16 clinical staff revealed two major themes: (1) caregiving arrangements are complex and not systematically captured or easy to locate in the EHR and (2) health systems should develop standardized processes to obtain and document caregiver information in the EHR. Conclusions: This exploratory chart review and qualitative interview study found that people with dementia frequently have multiple caregivers, whose roles and needs are captured inconsistently in the EHR. To address this concern, caregivers and clinical staff suggested that health systems should develop and test workflows to identify caregivers, assess their needs at multiple touchpoints, and record their information in extractable EHR fields. ",
doi="10.2196/59584",
url="https://aging.jmir.org/2024/1/e59584"
}


@Article{info:doi/10.2196/59588,
author="Gustafson Sr, H. David
and Mares, Marie-Louise
and Johnston, Darcie
and Vjorn, J. Olivia
and Curtin, J. John
and Landucci, Gina
and Pe-Romashko, Klaren
and Gustafson Jr, H. David
and Shah, V. Dhavan",
title="An eHealth Intervention to Improve Quality of Life, Socioemotional, and Health-Related Measures Among Older Adults With Multiple Chronic Conditions: Randomized Controlled Trial",
journal="JMIR Aging",
year="2024",
month="Dec",
day="6",
volume="7",
pages="e59588",
keywords="eHealth",
keywords="telemedicine",
keywords="aged",
keywords="geriatrics",
keywords="multiple chronic conditions",
keywords="social support",
keywords="quality of life",
keywords="primary care",
keywords="mobile phone",
keywords="smartphone",
abstract="Background: In the United States, over 60\% of adults aged 65 years or older have multiple chronic health conditions, with consequences that include reduced quality of life, increasingly complex but less person-centered treatment, and higher health care costs. A previous trial of ElderTree, an eHealth intervention for older adults, found socioemotional benefits for those with high rates of primary care use. Objective: This study tested the effectiveness of an ElderTree intervention designed specifically for older patients with multiple chronic conditions to determine whether combining it with primary care improved socioemotional and physical outcomes. Methods: In a nonblinded randomized controlled trial, 346 participants recruited from primary care clinics were assigned 1:1 to the ElderTree intervention or an attention control and were followed for 12 months. All participants were aged 65 years or older and had electronic health record diagnoses of at least three of 11 chronic conditions. Primary outcomes were mental and physical quality of life, psychological well-being (feelings of competence, connectedness, meaningfulness, and optimism), and loneliness. Tested mediators of the effects of the study arm (ElderTree vs active control) on changes in primary outcomes over time were 6-month changes in health coping, motivation, feelings of relatedness, depression, and anxiety. Tested moderators were sex, scheduled health care use, and number of chronic conditions. Data sources were surveys at baseline and 6 and 12 months comprising validated scales, and continuously collected ElderTree usage. Results: At 12 months, 76.1\% (134/176) of ElderTree participants were still using the intervention. There was a significant effect of ElderTree (vs control) on improvements over 12 months in mental quality of life (arm {\texttimes} timepoint interaction: b=0.76, 95\% CI 0.14-1.37; P=.02; 12-month ?d=0.15) but no such effect on the other primary outcomes of physical quality of life, psychological well-being, or loneliness. Sex moderated the effects of the study arm over time on mental quality of life (b=1.33, 95\% CI 0.09-2.58; P=.04) and psychological well-being (b=1.13, 95\% CI 0.13-2.12; P=.03), with stronger effects for women than men. The effect of the study arm on mental quality of life was mediated by 6-month improvements in relatedness ($\alpha$=1.25, P=.04; b=0.31, P<.001). Analyses of secondary and exploratory outcomes showed minimal effects of ElderTree. Conclusions: Consistent with the previous iteration of ElderTree, the current iteration designed for older patients with multiple chronic conditions showed signs of improving socioemotional outcomes but no impact on physical outcomes. This may reflect the choice of chronic conditions for inclusion, which need not have impinged on patients' physical quality of life. Two ongoing trials are testing more specific versions of ElderTree targeting older patients coping with (1) chronic pain and (2) greater debilitation owing to at least 5 chronic conditions. Trial Registration: ClinicalTrials.gov NCT03387735; https://clinicaltrials.gov/study/NCT03387735 International Registered Report Identifier (IRRID): RR2-10.2196/25175 ",
doi="10.2196/59588",
url="https://aging.jmir.org/2024/1/e59588"
}


@Article{info:doi/10.2196/64367,
author="Dermody, Gordana
and Wadsworth, Daniel
and Dunham, Melissa
and Glass, Courtney
and Fritz, Roschelle",
title="Factors Affecting Clinician Readiness to Adopt Smart Home Technology for Remote Health Monitoring: Systematic Review",
journal="JMIR Aging",
year="2024",
month="Dec",
day="5",
volume="7",
pages="e64367",
keywords="clinician",
keywords="provider",
keywords="health professional",
keywords="smart home",
keywords="remote monitoring",
keywords="technology",
keywords="readiness",
keywords="adoption",
keywords="preparedness",
abstract="Background: The population of older adults worldwide continues to increase, placing higher demands on primary health care and long-term care. The costs of housing older people in care facilities have economic and societal impacts that are unsustainable without innovative solutions. Many older people wish to remain independent in their homes and age in place. Assistive technology such as health-assistive smart homes with clinician monitoring could be a widely adopted alternative to aged-care facilities in the future. While studies have found that older persons have demonstrated a readiness to adopt health-assistive smart homes, little is known about clinician readiness to adopt this technology to support older adults to age as independently as possible. Objective: The purpose of this systematic review was to identify the factors that affect clinician readiness to adopt smart home technology for remote health monitoring. Methods: This review was conducted in accordance with the Joanna Briggs Institute methodology for systematic Reviews and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting. Results: Several factors affected clinicians' perspectives on their readiness to adopt smart home technology for remote health monitoring, including challenges such as patient privacy and dignity, data security, and ethical use of ``invasive'' technologies. Perceived benefits included enhancing the quality of care and outcomes. Conclusions: Clinicians, including nurses, reported both challenges and benefits of adopting smart home technology for remote health monitoring. Clear strategies and frameworks to allay fears and overcome professional concerns and misconceptions form key parts of the Readiness for Adoption Pathway proposed. The use of more rigorous scientific methods and reporting is needed to advance the state of the science. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020195989; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=195989 ",
doi="10.2196/64367",
url="https://aging.jmir.org/2024/1/e64367",
url="http://www.ncbi.nlm.nih.gov/pubmed/39012852"
}


@Article{info:doi/10.2196/58895,
author="White-Lewis, Sharon
and Lightner, Joseph
and Crowley, Julia
and Grimes, Amanda
and Spears, Kathleen
and Chesnut, Steven",
title="Disaster Preparedness Intervention for Older Adults (Seniors' Positive Involvement in Community Emergencies): Protocol for a Quasi-Experimental Study",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="4",
volume="13",
pages="e58895",
keywords="older adults",
keywords="disaster preparedness",
keywords="emergency preparedness",
keywords="disaster protocol",
keywords="disaster engagement",
keywords="disaster recovery",
keywords="personal preparedness",
keywords="community dwelling older adults",
keywords="elderly",
keywords="aging in place",
keywords="activities in daily life",
keywords="resiliency",
keywords="community health",
abstract="Background: Older adults comprise a substantial proportion of the US population requiring support during disaster events. Previous research demonstrates that older adults are resilient but deficient in disaster preparedness and lacking in community engagement. There is a gap in high-quality research in this area. Objective: This study aims to fill this gap by developing a 4-phase intervention to improve mobility and balance, decrease fall risks (mitigation), increase knowledge of disaster preparedness (preparedness), improve community emergency operation plans (response), and improve self-efficacy in disaster recovery (recovery) for older adults. Methods: This is a community-based, 10-month study in a large Midwestern urban and suburban location targeting community-dwelling older adults. The 4 phases of interventions address mitigation, preparedness, response, and recovery---aspects improving outcomes from disaster events. In total, 4 to 6 one-hour seminars each month are provided to community-dwelling older adults to improve disaster preparedness and recovery planning. A critical incident packet with resources on essential information such as medications, a communication plan, evacuation resources, and supplies was started and is being reviewed. Preintervention surveys are orally given, with research assistants aiding in any difficulties the participants have. After the surveys, 2 individual 20-minute presentations separated by a short break for snacks and initial completion of their disaster plan preserve the older adult's attention. Mitigation efforts to improve mobility and safety are offered with 10 visits to the older adults' residences, adapting physical activity and balance exercises to the individual's needs. To address response needs, the emergency operations plans for 2 of the major cities are being amended for specific functional needs and access guidelines. Measurements include accelerometers to assess improvement in mobility, fall risk assessments, an abbreviated Federal Emergency Management Association Household Survey, an assessment for disaster engagement with partners tool, a brief pain inventory assessment, and the General Self-Efficacy Scale. We analyze data descriptively and compare pre- and postintervention data for each phase with paired-samples t test and other nonparametric techniques (proportion tests and Wilcoxon signed-rank tests). Overarching objectives prioritized during this intervention include underscoring respect for the experience and resilience found in older adults and engaging them in specialized roles to support their communities during disaster events. Results: The intervention was funded in July 2023; enrollment began in November 2023 and is continuing. We will conclude data collection by July 2025. Published study results can be expected in early 2025. Conclusions: With improved disaster preparedness, mobility, recovery planning, and inclusion as a resource in community disasters, older adults are expected to be safer and be able to age in place. If successful, future studies will focus on outreach and sustainability. This study will serve as a model for older adult disaster preparedness and community involvement. International Registered Report Identifier (IRRID): DERR1-10.2196/58895 ",
doi="10.2196/58895",
url="https://www.researchprotocols.org/2024/1/e58895"
}


@Article{info:doi/10.2196/65730,
author="Kokorelias, M. Kristina
and Valentine, Dean
and Dove, M. Erica
and Brown, Paige
and McKinlay, Stuart
and Sheppard, L. Christine
and Singh, Hardeep
and Eaton, D. Andrew
and Jamieson, Laura
and Wasilewski, B. Marina
and Zhabokritsky, Alice
and Flanagan, Ashley
and Abdelhalim, Reham
and Zewude, Rahel
and Parpia, Rabea
and Walmsley, Sharon
and Sirisegaram, Luxey",
title="Exploring the Perspectives of Older Adults Living With HIV on Virtual Care: Qualitative Study",
journal="JMIR Aging",
year="2024",
month="Dec",
day="4",
volume="7",
pages="e65730",
keywords="HIV",
keywords="human immunodeficiency virus",
keywords="perspective",
keywords="telemedicine",
keywords="telehealth",
keywords="virtual care",
keywords="virtual health",
keywords="virtual medicine",
keywords="qualitative",
keywords="gerontology",
keywords="geriatrics",
keywords="older adult",
keywords="older people",
keywords="aging",
abstract="Background: As the population of individuals with HIV ages rapidly due to advancements in antiretroviral therapy, virtual care has become an increasingly vital component in managing their complex health needs. However, little is known about perceptions of virtual care among older adults living with HIV. Objective: This study aimed to understand the perceptions of older adults living with HIV regarding virtual care. Methods: Using an interpretive, qualitative, descriptive methodology, semistructured interviews were conducted with 14 diverse older adults living with HIV. The participants lived in Ontario, Canada, self-identified as HIV-positive, and were aged 50 years or older. Efforts were made to recruit individuals with varying experience with virtual health care. Reflexive thematic analysis was conducted with the interview transcripts to identify prevalent themes. Results: The identified themes included (1) the importance of relationships in virtual care for older adults living with HIV; (2) privacy and confidentiality in virtual care; and (3) challenges and solutions related to access and technological barriers in virtual care. These themes highlight the perceptions of diverse older adults living with HIV concerning virtual care, emphasizing the fundamental role of trust, privacy, and technology access. Conclusions: By embracing the unique perspectives and experiences of this population, we can work toward building more inclusive and responsive health care systems that meet the needs of all individuals, regardless of age, HIV status, or other intersecting identities. ",
doi="10.2196/65730",
url="https://aging.jmir.org/2024/1/e65730"
}


@Article{info:doi/10.2196/58051,
author="Naud{\'e}, B{\'e}rang{\`e}re
and Rigaud, Anne-Sophie
and Pino, Maribel",
title="Investigating the Acceptability of an Interactive Television Intervention Promoting Social Links Among Older Adults Living at Home and in Care Institutions: Qualitative Interview and Questionnaire Study",
journal="JMIR Hum Factors",
year="2024",
month="Dec",
day="2",
volume="11",
pages="e58051",
keywords="interactive television",
keywords="iTV",
keywords="acceptance",
keywords="older adults",
keywords="nursing home",
keywords="residential facility",
keywords="technology acceptance model",
keywords="TAM",
keywords="mobile phone",
abstract="Background: When older adults (OAs) can no longer live independently at home, they have the option to choose from various types of geriatric care institutions, such as residential facilities or nursing homes. For several years now, thanks to the development of interactive television (iTV), social link functions have been accessible directly on televisions, tools that are already integrated into residents' rooms. The acceptance of technologies specifically targeting older users, as well as iTV, has been widely documented in the literature, incorporating factors from the innovation resistance model. Objective: This research aims to enrich the acceptance of existing models of innovation by OAs living in different settings. Methods: User tests were carried out to evaluate OAs' experiences with iTV and identify the factors involved in its acceptance. A total of 32 OAs living at home, in nursing homes, or in residential facilities in France were interviewed between November 2022 and June 2023. iTV acceptance was examined using an interview grid based on the technology acceptance model and included the following factors: intention to use, perceived usefulness, perceived ease of use, user resistance, anxiety, facilitating conditions, and user characteristics. Results: The deductive qualitative analysis based on the technology acceptance model helped to identify 33 concepts. Conclusions: This study has contributed to the literature on the acceptance of iTV by OAs living at home and in geriatric institutions, particularly by enriching existing models and proposing new avenues for reflection. ",
doi="10.2196/58051",
url="https://humanfactors.jmir.org/2024/1/e58051"
}


@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/10.2196/59343,
author="Longcoy, Huang Li-Ting
and Li, Chien-Ching
and Tai, Chun-Yi
and Doorenbos, Ardith",
title="Applying the Multiphase Optimization Strategy for the Development of a Culturally Tailored Resilience-Building Intervention to Facilitate Advance Care Planning Discussions for Chinese Americans: Protocol for a Survey and Qualitative Study",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="26",
volume="13",
pages="e59343",
keywords="resilience",
keywords="Chinese Americans",
keywords="multiphase optimization strategy",
keywords="protocol",
keywords="advance care planning",
keywords="feasibility studies",
abstract="Background: Newly arrived Chinese Americans face difficulties engaging in advance care planning (ACP) discussions with their family caregivers. Avoiding such discussions and failing to complete advance directives can delay palliative and hospice care. Yet, timely palliative care is essential to maintaining the quality of life at the end of life. Currently, there is a lack of interventions to help Chinese Americans diagnosed with cancer or heart disease overcome the barriers to engaging in ACP discussions via effective use of resilience. Objective: This study aims to develop a culturally tailored, resilience-building intervention for Chinese Americans with cancer or heart disease. Methods: The development of this intervention will be guided by the 3-phase multiphase optimization strategy. In the first phase of preparation, we will examine the prespecified components of the intervention through pilot studies to understand the necessity of each component. First, a qualitative study will be conducted to understand the experiences of 10 religious or spiritual leaders who have provided pastoral or spiritual care to Chinese Americans in Chicago, United States. The interview findings will be categorized as facilitators and barriers and integrated into the development of the intervention's resilience-building guide. Second, a cross-sectional study will be conducted to assess the readiness of Chinese Americans to engage in ACP discussions with their family using surveys. Third, think-aloud interviews will be conducted to understand the experiences of 18 pairs of Chinese Americans and their family caregivers regarding the prototype of the culturally tailored, resilience-building intervention. Finally, we will examine the feasibility and acceptability of the intervention prototype along with issues related to the study's implementation process. Results: Recruitment for the qualitative study began in November 2023. As of October 2024, a total of 7 participants have been recruited, enabling a preliminary qualitative analysis to evaluate the analytical framework developed from the literature. Recruitment for the cross-sectional study began in April 2024, and as of October 2024, a total of 63 Chinese Americans have participated. The potential participant recruitment lists for the think-aloud interviews have been received, enabling recruitment to begin after the preliminary qualitative analysis is completed. Conclusions: The proposed culturally tailored, resilience-building intervention is an innovative way to facilitate ACP discussions among Chinese Americans, particularly those diagnosed with serious chronic diseases. The findings from all 3 study methods will inform the development of the proposed intervention and identify effective recruitment strategies for this underserved and hard-to-reach population to be used in future research. International Registered Report Identifier (IRRID): DERR1-10.2196/59343 ",
doi="10.2196/59343",
url="https://www.researchprotocols.org/2024/1/e59343"
}


@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/10.2196/58261,
author="Xie, Junan
and Li, Shilin
and Song, Zhen
and Shu, Lin
and Zeng, Qing
and Huang, Guozhi
and Lin, Yihuan",
title="Functional Monitoring of Patients With Knee Osteoarthritis Based on Multidimensional Wearable Plantar Pressure Features: Cross-Sectional Study",
journal="JMIR Aging",
year="2024",
month="Nov",
day="25",
volume="7",
pages="e58261",
keywords="knee osteoarthritis",
keywords="KOA",
keywords="40-m fast-paced walk test",
keywords="40mFPWT",
keywords="timed up-and-go test",
keywords="TUGT",
keywords="timed up and go",
keywords="TUG",
keywords="functional assessment",
keywords="monitoring",
keywords="wearable",
keywords="gait",
keywords="walk test",
keywords="plantar",
keywords="knee",
keywords="joint",
keywords="arthritis",
keywords="gait analysis",
keywords="regression model",
keywords="machine learning",
abstract="Background: Patients with knee osteoarthritis (KOA) often present lower extremity motor dysfunction. However, traditional radiography is a static assessment and cannot achieve long-term dynamic functional monitoring. Plantar pressure signals have demonstrated potential applications in the diagnosis and rehabilitation monitoring of KOA. Objective: Through wearable gait analysis technology, we aim to obtain abundant gait information based on machine learning techniques to develop a simple, rapid, effective, and patient-friendly functional assessment model for the KOA rehabilitation process to provide long-term remote monitoring, which is conducive to reducing the burden of social health care system. Methods: This cross-sectional study enrolled patients diagnosed with KOA who were able to walk independently for 2 minutes. Participants were given clinically recommended functional tests, including the 40-m fast-paced walk test (40mFPWT) and timed up-and-go test (TUGT). We used a smart shoe system to gather gait pressure data from patients with KOA. The multidimensional gait features extracted from the data and physical characteristics were used to establish the KOA functional feature database for the plantar pressure measurement system. 40mFPWT and TUGT regression prediction models were trained using a series of mature machine learning algorithms. Furthermore, model stacking and average ensemble learning methods were adopted to further improve the generalization performance of the model. Mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean squared error (RMSE) were used as regression performance metrics to evaluate the results of different models. Results: A total of 92 patients with KOA were included, exhibiting varying degrees of severity as evaluated by the Kellgren and Lawrence classification. A total of 380 gait features and 4 physical characteristics were extracted to form the feature database. Effective stepwise feature selection determined optimal feature subsets of 11 variables for the 40mFPWT and 10 variables for the TUGT. Among all models, the weighted average ensemble model using 4 tree-based models had the best generalization performance in the test set, with an MAE of 2.686 seconds, MAPE of 9.602\%, and RMSE of 3.316 seconds for the prediction of the 40mFPWT and an MAE of 1.280 seconds, MAPE of 12.389\%, and RMSE of 1.905 seconds for the prediction of the TUGT. Conclusions: This wearable plantar pressure feature technique can objectively quantify indicators that reflect functional status and is promising as a new tool for long-term remote functional monitoring of patients with KOA. Future work is needed to further explore and investigate the relationship between gait characteristics and functional status with more functional tests and in larger sample cohorts. ",
doi="10.2196/58261",
url="https://aging.jmir.org/2024/1/e58261"
}


@Article{info:doi/10.2196/59974,
author="Hackett, Katherine
and Xu, Shiyun
and McKniff, Moira
and Paglia, Lido
and Barnett, Ian
and Giovannetti, Tania",
title="Mobility-Based Smartphone Digital Phenotypes for Unobtrusively Capturing Everyday Cognition, Mood, and Community Life-Space in Older Adults: Feasibility, Acceptability, and Preliminary Validity Study",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="22",
volume="11",
pages="e59974",
keywords="digital phenotyping",
keywords="digital biomarkers",
keywords="monitoring",
keywords="mHealth",
keywords="cognition",
keywords="mobility",
keywords="life space",
keywords="depression",
keywords="location data",
keywords="Alzheimer disease",
keywords="aging",
keywords="mobile phone",
abstract="Background: Current methods of monitoring cognition in older adults are insufficient to address the growing burden of Alzheimer disease and related dementias (AD/ADRD). New approaches that are sensitive, scalable, objective, and reflective of meaningful functional outcomes are direly needed. Mobility trajectories and geospatial life space patterns reflect many aspects of cognitive and functional integrity and may be useful proxies of age-related cognitive decline. Objective: We investigated the feasibility, acceptability, and preliminary validity of a 1-month smartphone digital phenotyping protocol to infer everyday cognition, function, and mood in older adults from passively obtained GPS data. We also sought to clarify intrinsic and extrinsic factors associated with mobility phenotypes for consideration in future studies. Methods: Overall, 37 adults aged between 63 and 85 years with healthy cognition (n=31, 84\%), mild cognitive impairment (n=5, 13\%), and mild dementia (n=1, 3\%) used an open-source smartphone app (mindLAMP) to unobtrusively capture GPS trajectories for 4 weeks. GPS data were processed into interpretable features across categories of activity, inactivity, routine, and location diversity. Monthly average and day-to-day intraindividual variability (IIV) metrics were calculated for each feature to test a priori hypotheses from a neuropsychological framework. Validation measures collected at baseline were compared against monthly GPS features to examine construct validity. Feasibility and acceptability outcomes included retention, comprehension of study procedures, technical difficulties, and satisfaction ratings at debriefing. Results: All (37/37, 100\%) participants completed the 4-week monitoring period without major technical adverse events, 100\% (37/37) reported satisfaction with the explanation of study procedures, and 97\% (36/37) reported no feelings of discomfort. Participants' scores on the comprehension of consent quiz were 97\% on average and associated with education and race. Technical issues requiring troubleshooting were infrequent, though 41\% (15/37) reported battery drain. Moderate to strong correlations (r?0.3) were identified between GPS features and validators. Specifically, individuals with greater activity and more location diversity demonstrated better cognition, less functional impairment, less depression, more community participation, and more geospatial life space on objective and subjective validation measures. Contrary to predictions, greater IIV and less routine in mobility habits were also associated with positive outcomes. Many demographic and technology-related factors were not associated with GPS features; however, income, being a native English speaker, season of study participation, and occupational status were related to GPS features. Conclusions: Theoretically informed digital phenotypes of mobility are feasibly captured from older adults' personal smartphones and relate to clinically meaningful measures including cognitive test performance, reported functional decline, mood, and community activity. Future studies should consider the impact of intrinsic and extrinsic factors when interpreting mobility phenotypes. Overall, smartphone digital phenotyping is a promising method to unobtrusively capture relevant risk and resilience factors in the context of aging and AD/ADRD and should continue to be investigated in large, diverse samples. ",
doi="10.2196/59974",
url="https://humanfactors.jmir.org/2024/1/e59974"
}


@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/10.2196/64149,
author="Mace, A. Ryan
and Law, E. Makenna
and Cohen, E. Joshua
and Ritchie, S. Christine
and Okereke, I. Olivia
and Hoeppner, B. Bettina
and Brewer, A. Judson
and Bartels, J. Stephen
and Vranceanu, Ana-Maria
and ",
title="A Mindfulness-Based Lifestyle Intervention for Dementia Risk Reduction: Protocol for the My Healthy Brain Feasibility Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="21",
volume="13",
pages="e64149",
keywords="lifestyle",
keywords="cognitive decline",
keywords="brain health",
keywords="mindfulness",
keywords="mind-body therapies",
keywords="telemedicine",
keywords="digital health",
keywords="randomized clinical trial",
abstract="Background: Lifestyle behavior change and mindfulness have direct and synergistic effects on cognitive functioning and may prevent Alzheimer disease and Alzheimer disease--related dementias (AD/ADRD). We are iteratively developing and testing My Healthy Brain (MHB), the first mindfulness-based lifestyle group program targeting AD/ADRD risk factors in older adults with subjective cognitive decline. Our pilot studies (National Institutes of Health [NIH] stage 1A) have shown that MHB is feasible, acceptable, and associated with improvement in lifestyle behavior and cognitive outcomes. Objective: We will compare the feasibility of MHB versus an education control (health enhancement program [HEP]) in 50 older adults (aged ?60 y) with subjective cognitive decline and AD/ADRD risk factors. In an NIH stage 1B randomized controlled trial (RCT), we will evaluate feasibility benchmarks, improvements in cognitive and lifestyle outcomes, and engagement of hypothesized mechanisms. Methods: We are recruiting through clinics, flyers, web-based research platforms, and community partnerships. Participants are randomized to MHB or the HEP, both delivered in telehealth groups over 8 weeks. MHB participants learn behavior modification and mindfulness skills to achieve individualized lifestyle goals. HEP participants receive lifestyle education and group support. Assessments are repeated after the intervention and at a 6-month follow-up. Our primary outcomes are feasibility, acceptability, appropriateness, credibility, satisfaction, and fidelity benchmarks. The secondary outcomes are cognitive function and lifestyle (physical activity, sleep, nutrition, alcohol and tobacco use, and mental and social activity) behaviors. Data analyses will include the proportion of MHB and HEP participants who meet each benchmark (primary outcome) and paired samples 2-tailed t tests, Cohen d effect sizes, and the minimal clinically important difference for each measure (secondary outcomes). Results: Recruitment began in January 2024. We received 225 inquiries. Of these 225 individuals, 40 (17.8\%) were eligible. Of the 40 eligible participants, 21 (52.5\%) were enrolled in 2 group cohorts, 17 (42.5\%) were on hold for future group cohorts, and 2 (5\%) withdrew before enrollment. All participants have completed before the intervention assessments. All cohort 1 participants (9/21, 43\%) have completed either MHB or the HEP (?6 of 8 sessions) and after the intervention assessments. The intervention for cohort 2 (12/21, 57\%) is ongoing. Adherence rates for the Garmin Vivosmart 5 (128/147, 87.1\% weeks) and daily surveys (105/122, 86.1\% weeks) are high. No enrolled participants have dropped out. Enrollment is projected to be completed by December 2024. Conclusions: The RCT will inform the development of a larger efficacy RCT (NIH stage 2) of MHB versus the HEP in a more diverse sample of older adults, testing mechanisms of improvements through theoretically driven mediators and moderators. The integration of mindfulness with lifestyle behavior change in MHB has the potential to be an effective and sustainable approach for increasing the uptake of AD/ADRD risk reduction strategies among older adults. Trial Registration: ClinicalTrials.gov NCT05934136; https://www.clinicaltrials.gov/study/NCT05934136 International Registered Report Identifier (IRRID): DERR1-10.2196/64149 ",
doi="10.2196/64149",
url="https://www.researchprotocols.org/2024/1/e64149"
}


@Article{info:doi/10.2196/57352,
author="Wong, Ching Arkers Kwan
and Zhang, Qian Melissa
and Bayuo, Jonathan
and Chow, Sum Karen Kit
and Wong, Man Siu
and Wong, Po Bonnie
and Liu, Man Bob Chung
and Lau, Ho David Chi
and Kowatsch, Tobias",
title="The Effect of Young People--Assisted, Individualized, Motion-Based Video Games on Physical, Cognitive, and Social Frailty Among Community-Dwelling Older Adults With Frailty: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2024",
month="Nov",
day="20",
volume="12",
pages="e57352",
keywords="frailty",
keywords="gaming intervention",
keywords="motion-based",
keywords="video games",
keywords="older adults",
keywords="gerontology",
keywords="geriatrics",
keywords="randomized controlled trial",
keywords="RCT",
keywords="physical fitness",
keywords="adolescents",
keywords="young people--assisted",
keywords="eHealth literacy",
keywords="well-being",
keywords="therapists",
keywords="youth volunteers",
keywords="social support",
keywords="exergames",
keywords="gamification",
keywords="active games",
keywords="physical activity",
abstract="Background: The aging population highlights the need to maintain both physical and psychological well-being. Frailty, a multidimensional syndrome, increases vulnerability to adverse outcomes. Although physical exercise is effective, adherence among older adults with frailty is often low due to barriers. Motion-based video games (MBVGs) may enhance motivation and engagement. Objective: This study aims to evaluate the effect of individualized exercise programs that combine MBVGs, intergenerational support, and therapeutic frameworks on physical, cognitive, and social frailty outcomes in community-dwelling older adults. Methods: This randomized controlled trial was conducted from March 2022 to October 2023 across 6 community centers in Hong Kong. Participants aged 60 years and above with mild neurocognitive disorder were recruited, screened, and randomly assigned to either an intervention (n=101) or control group (n=101). The intervention included an 18-week program with 12 supervised exercise sessions utilizing motion-based technology, led by occupational therapists and assisted by youth volunteers. Data were collected at baseline (T1) and postintervention (T2), focusing on physical, cognitive, and social frailty outcomes, as well as client-related metrics. Statistical analyses were performed using SPSS, with significance set at P<.05. Results: A total of 202 participants were recruited, with a mean age of 78.8 years (SD 7.8). Both groups showed improvements in balance from T1 to T2, with a significant time effect ($\beta$=?0.63, P=.03). The intervention group demonstrated enhancements in hand strength and BMI, but no statistically significant between-group differences were observed. The intervention group also exhibited significant improvements in cognitive function ($\beta$=2.43, P<.001), while the control group's scores declined. Short-term memory improved for both groups, with no significant differences noted. Both groups experienced a reduction in depression levels, with a significant within-group effect at T2 ($\beta$=?1.16, P=.001). Improvements in social connectedness and eHealth literacy were observed in both groups, with the latter showing a significant within-group effect at T2 ($\beta$=3.56, P=.002). No significant effects were found for social isolation, physical activities, or quality of life. Conclusions: The growing aging population necessitates innovative strategies to support aging in place. Results indicated statistically significant improvements only in BMI and cognition, while other outcomes such as loneliness, balance, and eHealth literacy showed positive trends but lacked significance. Despite the limitations observed, particularly regarding the role of volunteer support and the diverse needs of community-dwelling older adults, the findings contribute to the foundation for future research aimed at enhancing biopsychosocial outcomes. Future studies should explore tailored interventions that consider individual preferences and abilities, as well as evaluate specific components of motion-based video games to optimize their effectiveness. Trial Registration: ClinicalTrials.gov NCT05267444; https://clinicaltrials.gov/study/NCT05267444 ",
doi="10.2196/57352",
url="https://games.jmir.org/2024/1/e57352"
}


@Article{info:doi/10.2196/56636,
author="Duan, Sainan
and Chen, Dongxu
and Wang, Jinping
and Paramboor, Sharooq Mohammed
and Xia, Zhen
and Xu, Wanting
and Han, Kun
and Zhu, Tao
and Jiang, Xiaoqin",
title="Digital Exclusion and Cognitive Function in Elderly Populations in Developing Countries: Insights Derived From 2 Longitudinal Cohort Studies",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="15",
volume="26",
pages="e56636",
keywords="digital exclusion",
keywords="cognition",
keywords="cohort study",
keywords="developing country",
keywords="China Health and Retirement Longitudinal Study",
keywords="CHARLS",
keywords="",
keywords="MHAS",
keywords="cognitive decline",
abstract="Background: Cognition disorders not only lead to adverse health consequences but also contribute to a range of socioeconomic challenges and diminished capacity for performing routine daily activities. In the digital era, understanding the impact of digital exclusion on cognitive function is crucial, especially in developing countries. Objective: This study aimed to evaluate the association between digital exclusion and cognitive function among elderly populations in developing countries. Methods: Using data from CHARLS (China Health and Retirement Longitudinal Study) from 2011 to 2020 and MHAS (Mexican Health \& Aging Study) from 2012 to 2021, we defined digital exclusion as self-reported absence from the internet. Cognitive function was assessed through 5 tests: orientation, immediate verbal recall, delayed verbal recall, serial 7s, and figure recall. Cognitive function was assessed in 2 categories: worse cognition (a categorical variable that classifies cognition as either better or worse compared to the entire cohort population) and cognitive scores (a continuous variable representing raw cognitive scores across multiple follow-up waves). Logistic regression analyses and generalized estimating equation (GEE) analyses were used to examine the relationship between cognitive function and digital exclusion, adjusting for potential confounders, including demographics, lifestyle factors, history of chronic diseases, basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and basic cognitive abilities. Results: After excluding participants with probable cognitive impairment at baseline and those who did not have a complete cognitive assessment in any given year (ie, all tests in the cognitive assessment must be completed in any follow-up wave), a total of 24,065 participants in CHARLS (n=11,505, 47.81\%) and MHAS (n=12,560, 52.19\%) were included. Of these, 96.78\% (n=11,135) participants in CHARLS and 70.02\% (n=8795) in MHAS experienced digital exclusion. Adjusted logistic regression analyses revealed that individuals with digital exclusion were more likely to exhibit worse cognitive performance in both CHARLS (odds ratio [OR] 2.04, 95\% CI 1.42-2.99; P<.001) and MHAS (OR 1.40, 95\% CI 1.26-1.55; P<.001). Gender and age did not significantly modify the relationship between digital exclusion and worse cognition (intervention P>.05). The fully adjusted mean differences in global cognitive scores between the 2 groups were 0.98 (95\% CI 0.70-1.28; P<.001) in CHARLS and 0.50 (95\% CI 0.40-0.59; P<.001) in MHAS. Conclusions: A substantial proportion of older adults, particularly in China, remain excluded from internet access. Our study examined longitudinal changes in cognitive scores and performed cross-sectional comparisons using Z-score standardization. The findings suggest that digital exclusion is linked to an increased risk of cognitive decline among older adults in developing countries. Promoting internet access may help mitigate this risk and support better cognitive health in these populations. ",
doi="10.2196/56636",
url="https://www.jmir.org/2024/1/e56636"
}


@Article{info:doi/10.2196/58175,
author="Guo, Hongzhi
and Cao, Jianwei
and He, Shichun
and Wei, Meiqi
and Meng, Deyu
and Yu, Ichen
and Wang, Ziyi
and Chang, Xinyi
and Yang, Guang
and Wang, Ziheng",
title="Quantifying the Enhancement of Sarcopenic Skeletal Muscle Preservation Through a Hybrid Exercise Program: Randomized Controlled Trial",
journal="JMIR Aging",
year="2024",
month="Nov",
day="15",
volume="7",
pages="e58175",
keywords="sarcopenia",
keywords="older adults",
keywords="physical exercise program",
keywords="explainable artificial intelligence",
keywords="tai chi",
abstract="Background: Sarcopenia is characterized by the loss of skeletal muscle mass and muscle function with increasing age. The skeletal muscle mass of older people who endure sarcopenia may be improved via the practice of strength training and tai chi. However, it remains unclear if the hybridization of strength exercise training and traditional Chinese exercise will have a better effect. Objective: We designed a strength training and tai chi exercise hybrid program to improve sarcopenia in older people. Moreover, explainable artificial intelligence was used to predict postintervention sarcopenic status and quantify the feature contribution. Methods: To assess the influence of sarcopenia in the older people group, 93 participated as experimental participants in a 24-week randomized controlled trial and were randomized into 3 intervention groups, namely the tai chi exercise and strength training hybrid group (TCSG; n=33), the strength training group (STG; n=30), and the control group (n=30). Abdominal computed tomography was used to evaluate the skeletal muscle mass at the third lumbar (L3) vertebra. Analysis of demographic characteristics of participants at baseline used 1-way ANOVA and $\chi$2 tests, and repeated-measures ANOVA was used to analyze experimental data. In addition, 10 machine-learning classification models were used to calculate if these participants could reverse the degree of sarcopenia after the intervention. Results: A significant interaction effect was found in skeletal muscle density at the L3 vertebra, skeletal muscle area at the L3 vertebra (L3 SMA), grip strength, muscle fat infiltration, and relative skeletal muscle mass index (all P values were <.05). Grip strength, relative skeletal muscle mass index, and L3 SMA were significantly improved after the intervention for participants in the TCSG and STG (all P values were <.05). After post hoc tests, we found that participants in the TCSG experienced a better effect on L3 SMA than those in the STG and participants in the control group. The LightGBM classification model had the greatest performance in accuracy (88.4\%), recall score (74\%), and F1-score (76.1\%). Conclusions: The skeletal muscle area of older adults with sarcopenia may be improved by a hybrid exercise program composed of strength training and tai chi. In addition, we identified that the LightGBM classification model had the best performance to predict the reversion of sarcopenia. Trial Registration: ClinicalTrials.gov NCT05694117; https://clinicaltrials.gov/study/NCT05694117 ",
doi="10.2196/58175",
url="https://aging.jmir.org/2024/1/e58175"
}


@Article{info:doi/10.2196/58186,
author="Mundada, Pallavi
and Makhija, Deepa
and Mata, Sunita
and Kachare, Kalpana
and Manathottathil, Aparna
and Sharma, Abha
and Rao, Sekhara Bhogavalli Chandra
and Rana, Rakesh
and Tripathi, Arunabh
and Rana, Kiran
and Joshi, Vandana
and Raturi, Ashish
and Singh, Anukampa
and Srikanth, N.
and Acharya, Rabinarayan",
title="Effectiveness of Ayush Rasayana A and B on the Quality of Life of Older Adults: Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="11",
volume="13",
pages="e58186",
keywords="Ayush Rasayana A",
keywords="Ayush Rasayana B",
keywords="cluster-randomized trial",
keywords="geriatrics",
keywords="Ayurveda",
keywords="quality of life",
keywords="complementary and alternative medicine",
abstract="Background: With advancing age among older adults, the associated debilities increase, indicating a deteriorating health status as there is a gradual loss of muscle mass, strength, and functionality. Ayush Rasayana A and B are coded Ayurvedic medicines developed from herbal extracts. This study has been planned to prevent debilitating conditions and improve the quality of life (QOL) in older adults. Objective: This study aimed to assess the effectiveness of Ayush Rasayana A and B on the QOL, quality of sleep, and functionality of older adults, along with the tolerability of the intervention. Methods: This was a multicenter, open-label, cluster randomized controlled trial conducted with 720 participants aged 60 to 75 years. The participants were divided into 2 groups (intervention and control), with both receiving Ayurvedic ancillary treatment for 3 months. The intervention group additionally received 10 g of Ayush Rasayana A orally once daily at bedtime for 6 days, followed by 1.5 g of Ayush Rasayana B orally twice daily before food for the remaining 84 days. The assessment criteria included the Older People's Quality of Life Questionnaire Brief, Katz Index of Independence in Activities of Daily Living, Pittsburgh Sleep Quality Index, Five Times Sit-to-Stand Test, and shoulder and scapular movements. Any change in hematological and biochemical parameters and occurrence of treatment-emergent adverse events were also assessed during the study period. Results: The recruitment of the participants started in December 2023, and the final follow-up was completed in April 2024. Out of the total 720 enrolled participants, 686 (95.3\%) completed the study up to the last follow-up. Conclusions: This study may provide evidence-based data to establish preventive treatment protocols for enhancing the QOL and functionality among older adults. The study results may also be helpful for the planning of interdisciplinary health policies for improving the health conditions of different populations International Registered Report Identifier (IRRID): DERR1-10.2196/58186 ",
doi="10.2196/58186",
url="https://www.researchprotocols.org/2024/1/e58186"
}


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


@Article{info:doi/10.2196/58196,
author="Abhari, Shahabeddin
and McMurray, Josephine
and Randhawa, Tanveer
and Bin Noon, Gaya
and Hanjahanja-Phiri, Thokozani
and McNeil, Heather
and Manning, Fiona
and Debergue, Patricia
and Teague, Jennifer
and Pelegrini Morita, Plinio",
title="Exploring the Landscape of Standards and Guidelines in AgeTech Design and Development: Scoping Review and Thematic Analysis",
journal="JMIR Aging",
year="2024",
month="Oct",
day="31",
volume="7",
pages="e58196",
keywords="aging in place",
keywords="technology",
keywords="gerontechnology",
keywords="AgeTech",
keywords="assistive technology",
keywords="older adult",
keywords="aging",
keywords="ambient assisted living",
keywords="active assisted living",
abstract="Background: AgeTech (technology for older people) offers digital solutions for older adults supporting aging in place, including digital health, assistive technology, Internet of Things, medical devices, robotics, wearables, and sensors. This study underscores the critical role of standards and guidelines in ensuring the safety and effectiveness of these technologies for the health of older adults. As the aging demographic expands, the focus on robust standards becomes vital, reflecting a collective commitment to improving the overall quality of life for older individuals through thoughtful and secure technology integration. Objective: This scoping review aims to investigate the current state of standards and guidelines applied in AgeTech design and development as reported in academic literature. We explore the existing knowledge of these standards and guidelines and identify key gaps in the design and development of AgeTech guidelines and standards in scholarly publications. Methods: The literature review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Searches were carried out across multiple databases, including Scopus, IEEE, PubMed, Web of Science, EBSCO, CINAHL, Cochrane, and Google Scholar, using a search string incorporating concepts such as ``older people,'' ``technology,'' and ``standards or guidelines.'' Alternative terms, Boolean operators, and truncation were used for comprehensive coverage in each database. The synthesis of results and data analysis involved both quantitative and qualitative methods. Results: Initially, 736 documents were identified across various databases. After applying specific inclusion and exclusion criteria and a screening process, 58 documents were selected for full-text review. The findings highlight that the most frequently addressed aspect of AgeTech standards or guidelines is related to ``design and development,'' constituting 36\% (21/58) of the literature; ``usability and user experience'' was the second most prevalent aspect, accounting for 19\% (11/58) of the documents. In contrast, ``privacy and security'' (1/58, 2\%) and ``data quality'' (1/58, 2\%) were the least addressed aspects. Similarly, ``ethics,'' ``integration and interoperability,'' ``accessibility,'' and ``acceptance or adoption'' each accounted for 3\% (2/58) of the documents. In addition, a thematic analysis identified qualitative themes that warrant further exploration of variables. Conclusions: This study investigated the available knowledge regarding standards and guidelines in AgeTech design and development to evaluate their current status in academic literature. The substantial focus on assistive technologies and ambient assisted living technologies confirmed their vital role in AgeTech. The findings provide valuable insights for interested parties and point to prioritized areas for further development and research in the AgeTech domain. ",
doi="10.2196/58196",
url="https://aging.jmir.org/2024/1/e58196"
}


@Article{info:doi/10.2196/56923,
author="Cotter, M. Lynne
and Shah, Dhavan
and Brown, Kaitlyn
and Mares, Marie-Louise
and Landucci, Gina
and Saunders, Sydney
and Johnston, C. Darcie
and Pe-Romashko, Klaren
and Gustafson, David
and Maus, Adam
and Thompson, Kasey
and Gustafson, H. David",
title="Decoding the Influence of eHealth on Autonomy, Competence, and Relatedness in Older Adults: Qualitative Analysis of Self-Determination Through the Motivational Technology Model",
journal="JMIR Aging",
year="2024",
month="Oct",
day="30",
volume="7",
pages="e56923",
keywords="self-determination theory",
keywords="usability",
keywords="mobile technology model",
keywords="aging",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="smart displays",
keywords="video calls",
keywords="older adult",
keywords="chronic conditions",
keywords="mobile phone",
abstract="Background: Older adults adopt and use eHealth systems to build autonomy, competence, and relatedness and engage in healthy behaviors. The motivational technology model posits that technology features, such as those on websites, smart displays, and mobile phones, must allow for navigability, interactivity, and customizability, which spur feelings of self-determination and intrinsic motivation. We studied ElderTree, an online system for older adults that provides on-demand videos of healthy living content, self-monitoring, and weekly researcher-hosted video meetings. Objective: We aimed to understand the theoretical crossover between the motivational technology model and self-determination theory using features of ElderTree to understand the usability of the technology and how it may support older adults' autonomy, competence, and relatedness. Methods: Drawing participants from a randomized controlled trial of a mobile health app for older adults with multiple chronic conditions, we conducted qualitative interviews with 22 older adults about their use of the app; the interviews were coded using qualitative thematic analysis. Results: Older adults did find that features within ElderTree such as content available on demand, good navigation, and weekly researcher-led video calls supported feelings of autonomy, competence, and relatedness, respectively. Individual differences such as a background using computers also influenced participants' experiences with the smart displays. Conclusions: Participants confirmed the features that increased internal motivation, such as interactivity correlating with feelings of relatedness, but they also found other ways to support autonomous health behavior change beyond narrow views of navigability, interactivity, and customization. ",
doi="10.2196/56923",
url="https://aging.jmir.org/2024/1/e56923"
}


@Article{info:doi/10.2196/56869,
author="Farapti, Farapti
and Putri, Amara Sheila
and Furqonia, Wulida Annisaa
and Rejeki, Sri Purwo
and Miftahussurur, Muhammad",
title="High Potassium Diet Rich in Spices and Herbs-Salt Substitution (HPSH-SS) for Blood Pressure Reduction in Older Adults: Protocol for Diet Concept and Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="29",
volume="13",
pages="e56869",
keywords="sodium",
keywords="potassium",
keywords="spices and herbs",
keywords="blood pressure",
keywords="hypertension",
keywords="elderly",
keywords="vascular",
keywords="kidney",
keywords="gerontology",
keywords="aging",
keywords="protocol study",
keywords="dietary",
keywords="phytochemical",
keywords="anti-hypertensive",
keywords="Indonesia",
keywords="molecular mechanism",
keywords="control group",
keywords="oxidative stress",
abstract="Background: Hypertension increases with age, often due to high sodium (Na) and low potassium (K) intake. Reducing salt and increasing K intake is challenging, especially for older adults due to taste preferences. Culinary herbs and spices, rich in K, offer a potential solution. The High Potassium Diet Rich in Spices and Herbs-Salt Substitution (HPSH-SS) diet has not yet been studied for its effectiveness in lowering blood pressure. Objective: This study aims to create an HPSH-SS diet, analyze its effects on blood pressure in older adults, and study the molecular mechanism occurring in the kidneys and blood vessels influenced by this diet. Methods: This study consists of 2 phases. The first phase involved formulating and assessing the HPSH-SS diet tailored for older adults. The intervention group (IG) received a diet of 1800 kcal/day, with 3500 mg K and 1500 mg Na, while the control group (CG) received 1500 mg K and 2000 mg Na. The diet was administered for 14 days and standardized using the NutriSurvey program and biochemistry analysis by atomic absorbance spectrophotometry (AAS). The second phase was a 14-day parallel randomized controlled trial (RCT) with the older adult participants divided into IG and CG. Primary outcomes included blood pressure; serum potassium; aldosterone; F2 isoprostane; nitric oxide plasma levels; and urine analysis of Na, K, and the Na/K ratio. Confounding variables were controlled through randomization and stratified analysis. Results: The menu formulation and organoleptic assessment of the HPSH-SS diet began in mid-2022 and was approved by the Ethics Committee of the Faculty of Public Health at Universitas Airlangga (78/EA/KEPK/2022) on May 11, 2022. The diet was standardized to achieve daily nutritional values of 1800 kcal energy, 3500 mg K, and 1500 mg Na. K and Na contents were analyzed using AAS from several participants' spice diet menus. Recruitment for the RCT started in March 2023, with approval from the Health Research Ethics Committee Universitas Airlangga School of Medicine, Surabaya (35/EC/KEPK/FKUA/2023). The study was registered from February 9, 2023, to February 9, 2024. Between March and June 2023, 64 participants were recruited, with 32 participants in the IG and CG. The intervention and data collection will take place over 1 year. Data management is in progress, and data analysis is yet to be performed. Conclusions: This RCT protocol hypothesizes that the diet will increase serum K, plasma aldosterone, and nitric oxide levels; decrease plasma F2 isoprostane; increase urinary Na and K levels; lower the urinary Na/K ratio; and reduce systolic and diastolic blood pressure. If effective, it will offer valuable insights into dietary strategies for blood pressure regulation in older adults. International Registered Report Identifier (IRRID): DERR1-10.2196/56869 ",
doi="10.2196/56869",
url="https://www.researchprotocols.org/2024/1/e56869",
url="http://www.ncbi.nlm.nih.gov/pubmed/39470696"
}


@Article{info:doi/10.2196/59818,
author="Wu, Yuting
and Gong, Cong
and Pi, Lifang
and Zheng, Meixin
and Liu, Weifang
and Wang, Yamei",
title="Interrelationships Among Individual Factors, Family Factors, and Quality of Life in Older Chinese Adults: Cross-Sectional Study Using Structural Equation Modeling",
journal="JMIR Aging",
year="2024",
month="Oct",
day="28",
volume="7",
pages="e59818",
keywords="quality of life",
keywords="older adults",
keywords="individual factor",
keywords="family factor",
keywords="structural equation modeling (SEM)",
abstract="Background: China's rapidly aging population necessitates effective strategies for ensuring older adults' quality of life (QOL). While individual factors (IF) and family factors (FF) are known to influence QOL, existing research often examines these factors in isolation or focuses on specific subpopulations, overlooking potential interactions and mediating pathways. Objective: This study aims to examine both direct and indirect pathways connecting IF and FF to older adults' QOL, focusing on the mediating roles of health risks (HR) and health care service demand (HSD). Methods: This study uses structural equation modeling (SEM) to analyze cross-sectional data from 8600 older participants in the 2015 China Health and Retirement Longitudinal Study (CHARLS), a nationally representative study using a multistage probability proportional to size sampling method. Results: Among the 8600 participants, the majority (5586/8502, 65.7\%) were aged 60-70 years, with a near-equal distribution of males and females at around 50\%. The average PCS score was 76.77, while the MCS score averaged 59.70. Both IF ($\beta$=0.165, P<.001) and FF ($\beta$=0.189, P<.001) had a direct positive effect on QOL. Furthermore, the indirect effects of IF ($\beta$=0.186, P<.001) and FF ($\beta$=0.211, P<.001) through HR and HSD were also significant. In the direct model, IF and FF had a greater impact on MCS ($\beta$=0.841) than on PCS ($\beta$=0.639). However, after including the 2 mediating factors, HR and HSD, the influence of IF and FF on MCS ($\beta$=0.739) became consistent with that on PCS ($\beta$=0.728). Subgroup analyses revealed that the direct effect of IF on QOL was significant in the 60-70 age group ($\beta$=0.151, P<.001) but not in those over 70 years old ($\beta$=0.122, P=.074). Comorbidity status significantly influenced the pathway from HR to HSD, with older adults having 2 or more chronic diseases ($\beta$=0.363) showing a greater impact compared to those with fewer than 2 chronic diseases ($\beta$=0.358). Conclusions: Both IF (education, per capita disposable income, and endowment insurance) and FF (satisfaction with a spouse and children) directly impact the QOL in older people. Meanwhile, IF and FF have equal influence on QOL through the mediating role of HR and HSD. Recognizing the interplay among these factors is crucial for targeted interventions to enhance the well-being of older adults in China. ",
doi="10.2196/59818",
url="https://aging.jmir.org/2024/1/e59818"
}


@Article{info:doi/10.2196/54839,
author="Wernli, Boris
and Verloo, Henk
and von Gunten, Armin
and Pereira, Filipa",
title="Using Existing Clinical Data to Measure Older Adult Inpatients' Frailty at Admission and Discharge: Hospital Patient Register Study",
journal="JMIR Aging",
year="2024",
month="Oct",
day="28",
volume="7",
pages="e54839",
keywords="frailty",
keywords="frailty assessment",
keywords="electronic patient records",
keywords="functional independence measure",
keywords="routinely collected data",
keywords="hospital register",
keywords="patient records",
keywords="medical records",
keywords="clinical data",
keywords="older adults",
keywords="cluster analysis",
keywords="hierarchical clustering",
abstract="Background: Frailty is a widespread geriatric syndrome among older adults, including hospitalized older inpatients. Some countries use electronic frailty measurement tools to identify frailty at the primary care level, but this method has rarely been investigated during hospitalization in acute care hospitals. An electronic frailty measurement instrument based on population-based hospital electronic health records could effectively detect frailty, frailty-related problems, and complications as well be a clinical alert. Identifying frailty among older adults using existing patient health data would greatly aid the management and support of frailty identification and could provide a valuable public health instrument without additional costs. Objective: We aim to explore a data-driven frailty measurement instrument for older adult inpatients using data routinely collected at hospital admission and discharge. Methods: A retrospective electronic patient register study included inpatients aged ?65 years admitted to and discharged from a public hospital between 2015 and 2017. A dataset of 53,690 hospitalizations was used to customize this data-driven frailty measurement instrument inspired by the Edmonton Frailty Scale developed by Rolfson et al. A 2-step hierarchical cluster procedure was applied to compute e-Frail-CH (Switzerland) scores at hospital admission and discharge. Prevalence, central tendency, comparative, and validation statistics were computed. Results: Mean patient age at admission was 78.4 (SD 7.9) years, with more women admitted (28,018/53,690, 52.18\%) than men (25,672/53,690, 47.81\%). Our 2-step hierarchical clustering approach computed 46,743 inputs of hospital admissions and 47,361 for discharges. Clustering solutions scored from 0.5 to 0.8 on a scale from 0 to 1. Patients considered frail comprised 42.02\% (n=19,643) of admissions and 48.23\% (n=22,845) of discharges. Within e-Frail-CH's 0-12 range, a score ?6 indicated frailty. We found a statistically significant mean e-Frail-CH score change between hospital admission (5.3, SD 2.6) and discharge (5.75, SD 2.7; P<.001). Sensitivity and specificity cut point values were 0.82 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.85. Comparing the e-Frail-CH instrument to the existing Functional Independence Measure (FIM) instrument, FIM scores indicating severe dependence equated to e-Frail-CH scores of ?9, with a sensitivity and specificity of 0.97 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.92. There was a strong negative association between e-Frail-CH scores at hospital discharge and FIM scores (rs=--0.844; P<.001). Conclusions: An electronic frailty measurement instrument was constructed and validated using patient data routinely collected during hospitalization, especially at admission and discharge. The mean e-Frail-CH score was higher at discharge than at admission. The routine calculation of e-Frail-CH scores during hospitalization could provide very useful clinical alerts on the health trajectories of older adults and help select interventions for preventing or mitigating frailty. ",
doi="10.2196/54839",
url="https://aging.jmir.org/2024/1/e54839"
}


@Article{info:doi/10.2196/60209,
author="Ding, Huitong
and Ho, Kristi
and Searls, Edward
and Low, Spencer
and Li, Zexu
and Rahman, Salman
and Madan, Sanskruti
and Igwe, Akwaugo
and Popp, Zachary
and Burk, Alexa
and Wu, Huanmei
and Ding, Ying
and Hwang, H. Phillip
and Anda-Duran, De Ileana
and Kolachalama, B. Vijaya
and Gifford, A. Katherine
and Shih, C. Ludy
and Au, Rhoda
and Lin, Honghuang",
title="Assessment of Wearable Device Adherence for Monitoring Physical Activity in Older Adults: Pilot Cohort Study",
journal="JMIR Aging",
year="2024",
month="Oct",
day="25",
volume="7",
pages="e60209",
keywords="physical activity",
keywords="remote monitoring",
keywords="wearable device",
keywords="adherence",
keywords="older adults",
abstract="Background: Physical activity has emerged as a modifiable behavioral factor to improve cognitive function. However, research on adherence to remote monitoring of physical activity in older adults is limited. Objective: This study aimed to assess adherence to remote monitoring of physical activity in older adults within a pilot cohort from objective user data, providing insights for the scalability of such monitoring approaches in larger, more comprehensive future studies. Methods: This study included 22 participants from the Boston University Alzheimer's Disease Research Center Clinical Core. These participants opted into wearing the Verisense watch as part of their everyday routine during 14-day intervals every 3 months. Eighteen continuous physical activity measures were assessed. Adherence was quantified daily and cumulatively across the follow-up period. The coefficient of variation was used as a key metric to assess data consistency across participants over multiple days. Day-to-day variability was estimated by calculating intraclass correlation coefficients using a 2-way random-effects model for the baseline, second, and third days. Results: Adherence to the study on a daily basis outperformed cumulative adherence levels. The median proportion of adherence days (wearing time surpassed 90\% of the day) stood at 92.1\%, with an IQR spanning from 86.9\% to 98.4\%. However, at the cumulative level, 32\% (7/22) of participants in this study exhibited lower adherence, with the device worn on fewer than 4 days within the requested initial 14-day period. Five physical activity measures have high variability for some participants. Consistent activity data for 4 physical activity measures might be attainable with just a 3-day period of device use. Conclusions: This study revealed that while older adults generally showed high daily adherence to the wearable device, consistent usage across consecutive days proved difficult. These findings underline the effectiveness of wearables in monitoring physical activity in older populations and emphasize the ongoing necessity to simplify usage protocols and enhance user engagement to guarantee the collection of precise and comprehensive data. ",
doi="10.2196/60209",
url="https://aging.jmir.org/2024/1/e60209"
}


@Article{info:doi/10.2196/59894,
author="Kim, Ga-Young
and Jo, Mini
and Cho, Sang Young
and Moon, Joon Il",
title="Over-the-Counter Hearing Aids Versus Traditional Hearing Aids in Patients With Mild-to-Moderate Hearing Loss: Protocol for a Noninferiority Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="25",
volume="13",
pages="e59894",
keywords="hearing aids",
keywords="over-the-counter hearing aids",
keywords="correction of hearing impairment",
keywords="randomized controlled trial",
keywords="evidence-based medicine",
keywords="hearing loss",
keywords="aging",
keywords="hearing sensitivity",
keywords="mobile phone",
abstract="Background: With the aging of society, the prevalence of hearing loss (HL) is increasing. Currently, approximately 5\% of the global population has HL, and this number is projected to reach 7 million by 2050. Although hearing aids (HAs) are the primary treatment for HL, their use is limited by barriers such as high costs and social stigma. To address these limitations, over-the-counter (OTC) HAs have been introduced, but their effectiveness and drawbacks require further investigation. Objective: This study aims to conduct a noninferiority randomized controlled trial comparing OTC HAs with traditional HAs to assess the clinical effectiveness of OTC HAs. Methods: We designed a noninferiority randomized controlled trial comparing OTC HAs and traditional HAs in adults with mild-to-moderate HL. A total of 64 participants (32 per group) will be recruited. Randomization will be performed using block randomization (block sizes of 2 or 4) with an equal allocation ratio. The study will include 2 types of HAs: an OTC HA (Jabra Enhance Pro) and a traditional HA (LiNX Quattro LE561-DRW) by GN ReSound A/S. OTC HAs will be self-fitted using a smartphone app, while traditional HAs will be fitted by a licensed audiologist using the National Acoustics Laboratories--Non-Linear Prescription, second generation. Assessments, including functional gain, real-ear measurement, speech audiometry, and questionnaires, will be conducted at 6-month intervals over the course of 3 visits. Statistical analysis will compare the 2 outcomes, focusing on functional gain, to determine noninferiority. Results: This study is scheduled to begin in August 2024 and has not yet recruited any participants. The study will be conducted over 2 years, from August 2024 to July 2026. Each participant will have 2 follow-up visits at 6-month intervals, making the total follow-up period 1 year. Conclusions: Since 2022, the introduction of OTC HAs has revolutionized access to these devices. Researchers, clinicians, and the general public are keen to evaluate the clinical effectiveness of OTC HAs, as more individuals will likely use them for HL. This increased usage will provide valuable real-world data to understand the benefits and limitations of OTC HAs. Monitoring the outcomes and user feedback will provide insights into their effectiveness and impact on hearing rehabilitation. International Registered Report Identifier (IRRID): PRR1-10.2196/59894 ",
doi="10.2196/59894",
url="https://www.researchprotocols.org/2024/1/e59894"
}


@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/10.2196/60056,
author="Rousaki, Anastasia
and Zamani, D. Efpraxia
and Sbaffi, Laura
and Hamblin, Kate
and Black, Rachael",
title="The Digitalization of Social Care in England and Implications for Older, Unpaid Carers: Constructionist Thematic Analysis",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="24",
volume="26",
pages="e60056",
keywords="social care",
keywords="England",
keywords="digitalization",
keywords="digital transformation",
keywords="unpaid care",
keywords="mobile phone",
abstract="Background: Globally, populations are aging, generating concerns about the sustainability of health and social care provision. In terms of the public provision of social care in particular, unpaid carers provide much of the support to people with disabilities and older people. In addition, there is an increased onus in many countries on digital transformation projects, in the hope that the digitalization of services can create efficiencies and savings in both costs and care labor. In England, the focus of this paper, the shift to digital services is also framed as a means to enhance choice and control for older unpaid carers, while being part of a broader offering that includes nondigital alternatives and support to mitigate digital exclusion. Objective: This study examines the impact of digitalization on older, unpaid carers---a group more likely to be both expected to engage digitally with services and at risk of digital exclusion---in England, focusing on their lived experiences in terms of caring and access to social care. Methods: We used a constructionist approach to thematic analysis, where data from 48 older unpaid carers collected through focus groups were analyzed using thematic analysis, resulting in 4 prevailing themes. Results: Our findings indicated that while unpaid carers largely acknowledge the benefits of digitalization, they also highlight several points of failure, whereby engagement with digital spaces is experienced as coercive and exacerbates feelings of exclusion. These are further worsened by government failures to address issues of connectivity, imposing additional financial burdens and complicating tasks such as benefit applications. Conclusions: In this study, we have highlighted the need for greater involvement in shaping both policy and technological solutions, which in turn will be more inclusive and aligned to the aspirations and circumstances of older carers. ",
doi="10.2196/60056",
url="https://www.jmir.org/2024/1/e60056"
}


@Article{info:doi/10.2196/58312,
author="Vald{\'e}s-Aragon{\'e}s, Myriam
and P{\'e}rez-Rodr{\'i}guez, Rodrigo
and Carnicero, Antonio Jos{\'e}
and Moreno-S{\'a}nchez, A. Pedro
and Oviedo-Briones, Myriam
and Villalba-Mora, Elena
and Abizanda-Soler, Pedro
and Rodr{\'i}guez-Ma{\~n}as, Leocadio",
title="Effects of Monitoring Frailty Through a Mobile/Web-Based Application and a Sensor Kit to Prevent Functional Decline in Frail and Prefrail Older Adults: FACET (Frailty Care and Well Function) Pilot Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="22",
volume="26",
pages="e58312",
keywords="frailty",
keywords="functional status",
keywords="older adults",
keywords="new technologies",
keywords="sensor",
keywords="monitoring system",
keywords="information and communication technologies",
keywords="mobile app",
keywords="sensor kit",
keywords="sensors",
keywords="technological ecosystem",
keywords="clinical intervention",
abstract="Background: Frailty represents a state of susceptibility to stressors and constitutes a dynamic process. Untreated, this state can progress to disability. Hence, timely detection of alterations in patients' frailty status is imperative to institute prompt clinical interventions and impede frailty progression. With this aim, the FACET (Frailty Care and Well Function) technological ecosystem was developed to provide clinically gathered data from the home to a medical team for early intervention. Objective: The aim of this study was to assess whether the FACET technological ecosystem prevents frailty progression and improves frailty status, according to the frailty phenotype criteria and Frailty Trait Scale-5 items (FTS-5) at 3 and 6 months of follow-up. Methods: This randomized clinical trial involved 90 older adults aged ?70 years meeting 2 or more Fried frailty phenotype criteria, having 4 or more comorbidities, and having supervision at home. This study was conducted between August 2018 and June 2019 at the geriatrics outpatient clinics in Getafe University Hospital and Albacete University Hospital. Participants were randomized into a control group receiving standard treatment and the intervention group receiving standard treatment along with the FACET home monitoring system. The system monitored functional tests at home (gait speed, chair stand test, frailty status, and weight). Outcomes were assessed using multivariate linear regression models for continuous response and multivariate logistic models for dichotomous response. P values less than .05 were considered statistically significant. Results: The mean age of the participants was 82.33 years, with 28\% (25/90) being males. Participants allocated to the intervention group showed a 74\% reduction in the risk of deterioration in the FTS-5 score (P=.04) and 92\% lower likelihood of worsening by 1 point according to Fried frailty phenotype criteria compared to the control group (P=.02) at 6 months of follow-up. Frailty status, when assessed through FTS-5, improved in the intervention group at 3 months (P=.004) and 6 months (P=.047), while when the frailty phenotype criteria were used, benefits were shown at 3 months of follow-up (P=.03) but not at 6 months. Conclusions: The FACET technological ecosystem helps in the early identification of changes in the functional status of prefrail and frail older adults, facilitating prompt clinical interventions, thereby improving health outcomes in terms of frailty and functional status and potentially preventing disability and dependency. Trial Registration: ClinicalTrials.gov NCT03707145; https://clinicaltrials.gov/study/NCT03707145 ",
doi="10.2196/58312",
url="https://www.jmir.org/2024/1/e58312",
url="http://www.ncbi.nlm.nih.gov/pubmed/39436684"
}


@Article{info:doi/10.2196/58242,
author="Kilaberia, R. Tina
and Hu, Yuanyuan
and Bell, F. Janice",
title="Habit and Help---Experiences of Technology Use During the COVID-19 Pandemic: Interview Study Among Older Adults",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="18",
volume="8",
pages="e58242",
keywords="pandemic",
keywords="older people",
keywords="technology habit",
keywords="subjective experience",
keywords="acceptance of technology",
abstract="Background: The COVID-19 pandemic compelled older adults to engage with technology to a greater extent given emergent public health observance and home-sheltering restrictions in the United States. This study examined subjective experiences of technology use among older adults as a result of unforeseen and widespread public health guidance catalyzing their use of technology differently, more often, or in new ways. Objective: This study aimed to explore whether older adults scoring higher on the Unified Theory of Acceptance and Use of Technology questionnaire fared better in aspects of technology use, and reported better subjective experiences, in comparison with those scoring lower. Methods: A qualitative study using prevalence and thematic analyses of data from 18 older adults (mean age 79 years) in 2 groups: 9 scoring higher and 9 scoring lower on the Unified Theory of Acceptance and Use of Technology questionnaire. Results: Older adults were fairly competent technology users across both higher- and lower-scoring groups. The higher-scoring group noted greater use of technology in terms of telehealth and getting groceries and household items. Cognitive difficulty was described only among the lower-scoring group; they used technology less to get groceries and household items and to obtain health information. Qualitative themes depict the role of habit in technology use, enthusiasm about technology buttressed by the protective role of technology, challenges in technology use, and getting help regardless of technology mastery. Conclusions: Whereas the pandemic compelled older adults to alter or increase technology use, it did not change their global outlook on technology use. Older adults' prepandemic habits of technology use and available help influenced the degree to which they made use of technology during the COVID-19 pandemic. ",
doi="10.2196/58242",
url="https://formative.jmir.org/2024/1/e58242",
url="http://www.ncbi.nlm.nih.gov/pubmed/39422990"
}


@Article{info:doi/10.2196/54916,
author="Pack, P. Allison
and Bailey, C. Stacy
and O'Conor, Rachel
and Velazquez, Evelyn
and Wismer, Guisselle
and Yeh, Fangyu
and Curtis, M. Laura
and Alcantara, Kenya
and Wolf, S. Michael",
title="Phenotyping Adherence Through Technology-Enabled Reports and Navigation (the PATTERN Study): Qualitative Study for Intervention Adaptation Using the Exploration, Preparation, Implementation, and Sustainment Framework",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="17",
volume="8",
pages="e54916",
keywords="older adults",
keywords="polypharmacy",
keywords="medication adherence",
keywords="intervention development",
keywords="qualitative research",
abstract="Background: Older adults with multiple chronic conditions (MCC) and polypharmacy often face challenges with medication adherence. Nonadherence can lead to suboptimal treatment outcomes, adverse drug events, and poor quality of life. Objective: To facilitate medication adherence among older adults with MCC and polypharmacy in primary care, we are adapting a technology-enabled intervention previously implemented in a specialty clinic. The objective of this study was to obtain multilevel feedback to inform the adaptation of the proposed intervention (Phenotyping Adherence Through Technology-Enabled Reports and Navigation [PATTERN]). Methods: We conducted a formative qualitative study among patients, clinicians, and clinic administrators affiliated with a large academic health center in Chicago, Illinois. Patient eligibility included being aged 65 years or older, living with MCC, and contending with polypharmacy. Eligibility criteria for clinicians and administrators included being employed by any primary care clinic affiliated with the participating health center. Individual semistructured interviews were conducted remotely by a trained member of the study team using interview guides informed by the Exploration, Preparation, Implementation, and Sustainment Framework. Thematic analysis of interview audio recordings drew from the Rapid Identification of Themes from Audio Recordings procedures. Results: In total, we conducted 25 interviews, including 12 with clinicians and administrators, and 13 with patients. Thematic analysis revealed participants largely found the idea of technology-based medication adherence monitoring to be acceptable and appropriate for the target population in primary care, although several concerns were raised; we discuss these in detail. Conclusions: Our medication adherence monitoring intervention, adapted from specialty care, will be implemented in primary care. Formative interviews, informed by the Exploration, Preparation, Implementation, and Sustainment Framework and conducted among patients, clinicians, and administrators, have identified intervention adaptation needs. Results from this study could inform other interventions using the patient portal with older adults. ",
doi="10.2196/54916",
url="https://formative.jmir.org/2024/1/e54916",
url="http://www.ncbi.nlm.nih.gov/pubmed/39418094"
}


@Article{info:doi/10.2196/52640,
author="Ch{\^a}tel, L. Bas D.
and Janssen, M. Jeroen H.
and Peeters, E. Geeske M. E.
and Corten, Rense
and Tieben, Rob
and Deen, Menno
and Hendriks, M. Elmy J.
and Olde Rikkert, M. Marcel G.",
title="Social Gaming to Decrease Loneliness in Older Adults: Recruitment Challenges and Attrition Analysis in a Digital Mixed Methods Feasibility Study",
journal="JMIR Serious Games",
year="2024",
month="Oct",
day="16",
volume="12",
pages="e52640",
keywords="loneliness",
keywords="digital health",
keywords="serious gaming",
keywords="older adults",
keywords="recruitment",
keywords="feasibility study",
abstract="Background: Digital mental health interventions could sustainably and scalably prevent and reduce loneliness in older adults. We designed an app containing 29 text-based games and a questionnaire-administering chatbot to stimulate intergenerational contact. Objective: This study aims to evaluate the feasibility of a social gaming app in reducing loneliness among older adults by evaluating recruitment strategies, data collection procedures, and gameplay activity. Methods: This mixed methods study recruited participants via newsletters, articles, and a social media campaign. We used semistructured interviews and descriptive analysis of questionnaire answers and game data to assess feasibility. Key measures included recruitment reach and efficiency, participant demographics, in-app activity, and app usability and engagement feedback. Results: The social media campaign reached 192,641 potential participants, resulting in 1363 game downloads. A total of 155 participants (aged 65 years and older: n=34, 21.9\% and aged less than 65 years: n=121, 78.1\%) provided informed consent, yielding a conversion rate of 0.08\%. The recruitment campaign focusing on distanced playful interaction had a significantly (P<.001) higher click-through rate (1.98\%) than a campaign focusing on research participation (click-through rate=0.51\%; P<.001). The overall conversion rate from advertisement exposure to research participation was 0.08\%. Participants had a mean age of 48 (SD 16) years. The 65 years and older group averaged 70 (SD 5) years, while the less 65 years group averaged 42 (SD 12) years. Additionally, 45.2\% (57/126) reported at least moderate levels of loneliness at baseline. Of the initial 554 players, 91 (16.4\%) remained active after the first week, and 32 (5.8\%) remained active for more than 90 days. Active participants tended to interact with those within their own age group, as indicated by a Pearson correlation of r=0.31 between the ages of the message sender and receiver. Interviews with 12 (48\%) participants (aged 65-79 years; female: n=12, 83\%) revealed barriers such as excessive chatbot questions and a mismatch between the target group and app design focus. Questionnaire completion rates dropped from 46\% at baseline to 10\% at follow-up. Conclusions: These findings underscore the challenges of recruitment and retention for older adults in a fully digital social gaming intervention. Effective recruitment strategies and targeted app design are crucial for engagement. Based on these insights, future interventions should focus on simplified interfaces, clear guidance for gameplay, and addressing the specific needs and preferences of older adults, thereby enhancing the effectiveness of digital mental health interventions. ",
doi="10.2196/52640",
url="https://games.jmir.org/2024/1/e52640",
url="http://www.ncbi.nlm.nih.gov/pubmed/39412863"
}


@Article{info:doi/10.2196/58888,
author="Wilkes, Matt
and Kramer, Annabel
and Pugmire, Juliana
and Pilkington, Christopher
and Zaniello, Benjamin
and Zahradka, Nicole",
title="Hospital Is Not the Home: Lessons From Implementing Remote Technology to Support Acute Inpatient and Transitional Care in the Home in the United States and United Kingdom",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="11",
volume="26",
pages="e58888",
keywords="telemedicine",
keywords="implementation science",
keywords="hospital-to-home transition",
keywords="remote patient monitoring",
keywords="digital health",
keywords="transition of care",
keywords="accuracy",
keywords="acceptability",
doi="10.2196/58888",
url="https://www.jmir.org/2024/1/e58888",
url="http://www.ncbi.nlm.nih.gov/pubmed/39331537"
}


@Article{info:doi/10.2196/54736,
author="Pani, Jasmine
and Lorusso, Letizia
and Toccafondi, Lara
and D'Onofrio, Grazia
and Ciccone, Filomena
and Russo, Sergio
and Giuliani, Francesco
and Sancarlo, Daniele
and Calamida, Novella
and Vignani, Gianna
and Pihl, Tarmo
and Rovini, Erika
and Cavallo, Filippo
and Fiorini, Laura",
title="How Time, Living Situation, and Stress Related to Technology Influence User Acceptance and Usability of a Socialization Service for Older Adults and Their Formal and Informal Caregivers: Six-Month Pilot Study",
journal="JMIR Aging",
year="2024",
month="Oct",
day="9",
volume="7",
pages="e54736",
keywords="active aging",
keywords="longitudinal study",
keywords="technostress",
keywords="technology usability and acceptance",
keywords="scaling up",
abstract="Background: Considering the growing population of older adults, addressing the influence of loneliness among this demographic group has become imperative, especially due to the link between social isolation and deterioration of mental and physical well-being. Technology has the potential to be used to create innovative solutions to increase socialization and potentially promote healthy aging. Objective: This 6-month study examined the usability and acceptability of a technology-based socialization service and explored how stress and living situation affect older adults' and their ecosystem's perceptions of technology, investigating cross-sectional and longitudinal differences among and across user groups. Methods: Participants were recruited in Tuscany and Apulia (Italy) through a network of social cooperatives and a research hospital, respectively. A total of 20 older adults were provided with the same technology installed on a tablet and on a smart television. The technology has three functionalities: video calling, playing games, and sharing news. Additionally, 20 informal caregivers (IC) and 13 formal caregivers (FC) connected to the older adults were included in the study. After both initial training in the use of the system (T0) and 6 months of using the system (T6), questionnaires on usability, acceptability, and technostress were filled in by older adults, IC, and FC. Nonparametric or parametric tests were conducted to investigate group differences at both time points and changes over time. Additional analyses on older adults were done to assess whether differences in usability and acceptability were related to living situation (ie, alone or with someone). Furthermore, correlation analyses were performed between usability, acceptability, and stress toward technology at T0 and T6. Results: At both T0 and T6, older adults had lower usability scores than IC and FC and higher anxiety than IC. Over time, there was a significant decrease in older adults' attitudes toward technology score, depicting a negative attitude over time (T0 median 4.2, IQR 0.5; T6 median 3.7, IQR 0.8; Cohen d=0.7), while there was no change for IC and FC. At T0, those living alone had lower acceptability than those living with someone but this difference disappeared at T6. People or participants living with someone had a decline in anxiety, attitudes toward technology, enjoyment, and perceived usefulness. Stress toward technology affected usability and acceptability in the older adult group entering the study ($\rho$=?.85) but this was not observed after 6 months. In the IC group, stress affected trust at T0 ($\rho$=?.23) but not at T6. Conclusions: At the start of the study, older adults judged the system to be less usable and more stressful than did the caregivers. Indeed, at first, technostress was correlated with usability and acceptability; however, with repeated use, technostress did not influence the perception of technology. Overall, getting accustomed to technology decreased anxiety and stress toward technology. ",
doi="10.2196/54736",
url="https://aging.jmir.org/2024/1/e54736"
}


@Article{info:doi/10.2196/60387,
author="Hill, Miranda
and Greene, Meredith
and Johnson, K. Julene
and Tan, Y. Judy",
title="United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="8",
volume="8",
pages="e60387",
keywords="HIV",
keywords="AIDS",
keywords="mental health",
keywords="loneliness",
keywords="older adults",
keywords="music-based interventions",
keywords="technology",
keywords="mobile phone",
abstract="Background: People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology. Objective: While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV. Methods: In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13). Results: The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording. Conclusions: Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV. ",
doi="10.2196/60387",
url="https://formative.jmir.org/2024/1/e60387",
url="http://www.ncbi.nlm.nih.gov/pubmed/39378071"
}


@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/10.2196/58110,
author="Merchant, Aziz Reshma
and Loke, Bernard
and Chan, Huak Yiong",
title="Ability of Heart Rate Recovery and Gait Kinetics in a Single Wearable to Predict Frailty: Quasiexperimental Pilot Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="3",
volume="8",
pages="e58110",
keywords="falls",
keywords="fall prevention",
keywords="wearables",
keywords="older adult",
keywords="community dwelling older adults",
keywords="gait",
keywords="gait kinetics",
keywords="gait analysis",
keywords="biomechanics",
keywords="sensors",
keywords="gerontology",
abstract="Background: Aging is a risk factor for falls, frailty, and disability. The utility of wearables to screen for physical performance and frailty at the population level is an emerging research area. To date, there is a limited number of devices that can measure frailty and physical performance simultaneously. Objective: The aim of this study is to evaluate the accuracy and validity of a continuous digital monitoring wearable device incorporating gait mechanics and heart rate recovery measurements for detecting frailty, poor physical performance, and falls risk in older adults at risk of falls. Methods: This is a substudy of 156 community-dwelling older adults ?60 years old with falls or near falls in the past 12 months who were recruited for a fall prevention intervention study. Of the original participants, 22 participants agreed to wear wearables on their ankles. An interview questionnaire involving demographics, cognition, frailty (FRAIL), and physical function questions as well as the Falls Risk for Older People in the Community (FROP-Com) was administered. Physical performance comprised gait speed, timed up and go (TUG), and the Short Physical Performance Battery (SPPB) test. A gait analyzer was used to measure gait mechanics and steps (FRAIL-functional: fatigue, resistance, and aerobic), and a heart rate analyzer was used to measure heart rate recovery (FRAIL-nonfunctional: weight loss and chronic illness). Results: The participants' mean age was 74.6 years. Of the 22 participants, 9 (41\%) were robust, 10 (46\%) were prefrail, and 3 (14\%) were frail. In addition, 8 of 22 (36\%) had at least one fall in the past year. Participants had a mean gait speed of 0.8 m/s, a mean SPPB score of 8.9, and mean TUG time of 13.8 seconds. The sensitivity, specificity, and area under the curve (AUC) for the gait analyzer against the functional domains were 1.00, 0.84, and 0.92, respectively, for SPPB (balance and gait); 0.38, 0.89, and 0.64, respectively, for FRAIL-functional; 0.45, 0.91, and 0.68, respectively, for FROP-Com; 0.60, 1.00, and 0.80, respectively, for gait speed; and 1.00, 0.94, and 0.97, respectively, for TUG. The heart rate analyzer demonstrated superior validity for the nonfunctional components of frailty, with a sensitivity of 1.00, specificity of 0.73, and AUC of 0.83. Conclusions: Agreement between the gait and heart rate analyzers and the functional components of the FRAIL scale, gait speed, and FROP-Com was significant. In addition, there was significant agreement between the heart rate analyzer and the nonfunctional components of the FRAIL scale. The gait and heart rate analyzers could be used in a screening test for frailty and falls in community-dwelling older adults but require further improvement and validation at the population level. ",
doi="10.2196/58110",
url="https://formative.jmir.org/2024/1/e58110",
url="http://www.ncbi.nlm.nih.gov/pubmed/39361400"
}


@Article{info:doi/10.2196/55322,
author="Zhu, Julia Shiyi
and Bennell, L. Kim
and Hinman, S. Rana
and Harrison, Jenny
and Kimp, J. Alexander
and Nelligan, K. Rachel",
title="Development of a 12-Week Unsupervised Online Tai Chi Program for People With Hip and Knee Osteoarthritis: Mixed Methods Study",
journal="JMIR Aging",
year="2024",
month="Sep",
day="30",
volume="7",
pages="e55322",
keywords="intervention development",
keywords="osteoarthritis",
keywords="Tai Chi",
keywords="web-based intervention",
keywords="online",
keywords="telehealth",
keywords="unsupervised exercise",
keywords="exercise",
keywords="physical activity",
keywords="arthritis",
keywords="development",
keywords="web based",
keywords="hip",
keywords="knee",
keywords="gerontology",
keywords="geriatric",
keywords="older adult",
keywords="aging",
keywords="bone",
keywords="workout",
keywords="digital health",
keywords="eHealth",
keywords="literature review",
keywords="telemedicine",
abstract="Background: Osteoarthritis is a leading contributor to global disability. While evidence supports the effectiveness of Tai Chi in improving symptoms for people with hip/knee osteoarthritis, access to in-person Tai Chi classes may be difficult for many people. An unsupervised online Tai Chi intervention for people with osteoarthritis can help overcome accessibility barriers. The Approach to Human-Centered, Evidence-Driven Adaptive Design (AHEAD) framework provides a practical guide for co-designing such an intervention. Objective: This study aims to develop an unsupervised online Tai Chi program for people with hip/knee osteoarthritis. Methods: An iterative process was conducted using the AHEAD framework. Initially, a panel of Tai Chi instructors and people with osteoarthritis was assembled. A literature review was conducted to inform the content of a survey (survey 1), which was completed by the panel and additional Australian Tai Chi instructors to identify Tai Chi movements for potential inclusion. Selection of Tai Chi movements was based on 3 criteria: those that were appropriate (for people with hip/knee osteoarthritis aged 45+ years), safe (to be performed at home unsupervised), and practical (to be delivered online using prerecorded videos). Movements that met these criteria were then ranked in a second survey (survey 2; using conjoint analysis methodology). Survey findings were discussed in a focus group, and the Tai Chi movements for program use were identified. A draft of the online Tai Chi program was developed, and a final survey (survey 3) was conducted with the panel to rate the appropriateness and safety of the proposed program. The final program was developed, and usability testing (think-aloud protocol) was conducted with people with knee osteoarthritis. Results: The panel consisted of 10 Tai Chi instructors and 3 people with osteoarthritis. The literature review identified Yang Style 24 as a common and effective Tai Chi style used in hip/knee osteoarthritis studies. Surveys 1 (n=35) and 2 (n=27) produced a ranked list of 24 Tai Chi movements for potential inclusion. This list was refined and informed by a focus group, with 10 Tai Chi movements being selected for inclusion (known as the Yang Style 10 form). Survey 3 (n=13) found that 92\% (n=12) of the panel members believed that the proposed draft Tai Chi program was appropriate and safe, resulting in its adoption. The final program was produced and hosted on a customized website, ``My Joint Tai Chi,'' which was further refined based on user feedback (n=5). ``My Joint Tai Chi'' is currently being evaluated in a randomized controlled trial. Conclusions: This study demonstrates the use of the AHEAD framework to develop an unsupervised online Tai Chi intervention (``My Joint Tai Chi'') for people with hip/knee osteoarthritis. This intervention is now being tested for effectiveness and safety in a randomized controlled trial. ",
doi="10.2196/55322",
url="https://aging.jmir.org/2024/1/e55322"
}


@Article{info:doi/10.2196/64196,
author="Kawaguchi, Kenjiro
and Nakagomi, Atsushi
and Ide, Kazushige
and Kondo, Katsunori",
title="Effects of a Mobile App to Promote Social Participation on Older Adults: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="30",
volume="26",
pages="e64196",
keywords="gerontology",
keywords="geriatrics",
keywords="older adults",
keywords="elderly",
keywords="older people",
keywords="community dwelling older adult",
keywords="aging",
keywords="social participation",
keywords="walking",
keywords="mHealth",
keywords="apps",
keywords="smartphone",
keywords="digital health",
keywords="digital technology",
keywords="digital interventions",
keywords="physical activity",
keywords="exercise",
abstract="Background: Social participation is crucial for healthy aging, improving physical and mental health, cognitive function, and quality of life among older adults. However, social participation tends to decline with age due to factors like loss of social networks and health issues. Mobile health apps show promise in promoting healthy behaviors among older adults, but their effectiveness in increasing social participation remains understudied. Objective: This randomized controlled trial aimed to evaluate the efficacy of a mobile app called Encouragement of Social Participation (ESP, ``Shakai Sanka no Susume;'' Hitachi) in promoting social participation and physical activity among community-dwelling older adults. Methods: The study recruited 181 community-dwelling adults aged 60 years or older from 2 municipalities in Japan and through a web-based research panel. Participants were randomly assigned to either the intervention group (n=87), which used the ESP app for 12 weeks, or the control group (n=94), which used only Google Fit. The ESP app incorporated features such as self-monitoring of social participation, personalized feedback, gamification elements, and educational content. Primary outcomes were changes in social participation frequency over the previous 2 months and changes in step counts, measured at baseline and week 12. Secondary outcomes included changes in specific types of social activities and subjective well-being. Data were analyzed using analysis of covariance and linear mixed-effects models. Results: The intervention group showed a significantly greater increase in social participation frequency compared with the control group (adjusted difference 3.03; 95\% CI 0.17-5.90; P=.04). Specifically, the intervention group demonstrated higher frequencies of participation in hobbies (adjusted difference: 0.82; 95\% CI 0.01-1.63) and cultural clubs (adjusted difference 0.65; 95\% CI 0.07-1.23) compared with the control group. However, there were no significant differences in weekly step counts between the groups. Subgroup analyses suggested potentially larger effects among participants who were older than 70 years, female, had lower educational attainment, and were recruited from community settings, although only females and the lower educational attainment subgroups demonstrated 95\% CIs that did not encompass zero. Conclusions: The ESP mobile app effectively promoted social participation among community-dwelling older adults, particularly in hobbies and cultural club activities. However, it did not significantly impact physical activity levels as measured by step counts. These findings suggest that mobile apps can be valuable tools for encouraging social engagement in older populations, potentially contributing to healthy aging. Future research should focus on optimizing app features to maintain long-term engagement and exploring strategies to enhance physical activity alongside social participation. Trial Registration: University Medical Information Network Clinical Trial Registry UMIN000049045; https://center6.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000055781 ",
doi="10.2196/64196",
url="https://www.jmir.org/2024/1/e64196",
url="http://www.ncbi.nlm.nih.gov/pubmed/39348180"
}


@Article{info:doi/10.2196/58316,
author="Bello, Oneyi Medina
and Mammino, Michael Kevin
and Vernon, Anthony Mark
and Wakeman, G. Daniel
and Denmon, Aerius Chanse
and Krishnamurthy, Crystal Lisa
and Krishnamurthy, Venkatagiri
and McGregor, Matthew Keith
and Novak, Samuel Thomas
and Nocera, Robert Joe",
title="Graded Intensity Aerobic Exercise to Improve Cerebrovascular Function and Performance in Older Veterans: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="26",
volume="13",
pages="e58316",
keywords="aerobic exercise",
keywords="exercise",
keywords="functional magnetic resonance imaging",
keywords="fMRI",
keywords="veterans",
keywords="quality of life",
keywords="sedentary lifestyle",
keywords="elderly",
keywords="geriatrics",
keywords="geriatric",
keywords="older adults",
keywords="cardiovascular disease",
keywords="health promotion",
keywords="aging",
keywords="cognitive",
keywords="cognitive health",
keywords="physical health",
abstract="Background: Growing health care challenges resulting from a rapidly expanding aging population necessitate examining effective rehabilitation techniques that mitigate age-related comorbidity and improve quality of life. To date, exercise is one of a few proven interventions known to attenuate age-related declines in cognitive and sensorimotor functions critical to sustained independence. Objective: This work aims to implement a multimodal imaging approach to better understand the mechanistic underpinnings of the beneficial exercise-induced adaptations to sedentary older adults' brains and behaviors. Due to the complex cerebral and vascular dynamics that encompass neuroplastic change with aging and exercise, we propose an imaging protocol that will model exercise-induced changes to cerebral perfusion, cerebral vascular reactivity (CVR), and cognitive and sensorimotor task-dependent functional magnetic resonance imaging (fMRI) after prescribed exercise. Methods: Sedentary older adults (aged 65-80 years) were randomly assigned to either a 12-week aerobic-based interval-based cycling intervention or a 12-week balance and stretching intervention. Assessments of cardiovascular fitness used the YMCA submaximal VO2 test, basal cerebral perfusion using arterial spin labeling (ASL), CVR using hypercapnic fMRI, and cortical activation using fMRI during verbal fluency and motor tapping tasks. A battery of cognitive-executive and motor function tasks outside the scanning environment will be performed before and after the interventions. Results: Our studies and others show that improved cardiovascular fitness in older adults results in improved outcomes related to physical and cognitive health as well as quality of life. A consistent but unexplained finding in many of these studies is a change in cortical activation patterns during task-based fMRI, which corresponds with improved task performance (cognitive-executive and motor). We hypothesize that the 12-week aerobic exercise intervention will increase basal perfusion and improve CVR through a greater magnitude of reactivity in brain areas susceptible to neural and vascular decline (inferior frontal and motor cortices) in previously sedentary older adults. To differentiate between neural and vascular adaptations in these regions, we will map changes in basal perfusion and CVR over the inferior frontal and the motor cortices---regions we have previously shown to be beneficially altered during fMRI BOLD (blood oxygen level dependent), such as verbal fluency and motor tapping, through improved cardiovascular fitness. Conclusions: Exercise is one of the most impactful interventions for improving physical and cognitive health in aging. This study aims to better understand the mechanistic underpinnings of improved health and function of the cerebrovascular system. If our hypothesis of improved perfusion and cerebrovascular reactivity following a 12-week aerobic exercise intervention is supported, it would add critically important insights into the potential of exercise to improve brain health in aging and could inform exercise prescription for older adults at risk for neurodegenerative disease brought on by cerebrovascular dysfunction. Trial Registration: ClinicalTrials.gov NCT05932069; https://clinicaltrials.gov/study/NCT05932069 International Registered Report Identifier (IRRID): DERR1-10.2196/58316 ",
doi="10.2196/58316",
url="https://www.researchprotocols.org/2024/1/e58316"
}


@Article{info:doi/10.2196/59900,
author="Spijker, A. Jeroen J.
and Barl?n, Hande
and Grad, Alecsandra Diana
and Gu, Yang
and Klavina, Aija
and Korkmaz Yaylagul, Nilufer
and Kulla, Gunilla
and Orhun, Eda
and {\vS}ev{\v c}{\'i}kov{\'a}, Anna
and Unim, Brigid
and Tofan, Maria Cristina",
title="The Impact of Digital Technology on the Physical Health of Older Workers: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="26",
volume="13",
pages="e59900",
keywords="digital tools",
keywords="digital technology",
keywords="digitalization",
keywords="physical health",
keywords="mobility",
keywords="vision loss",
keywords="musculoskeletal disorders",
keywords="migraine",
keywords="older workers",
keywords="older population",
keywords="aging",
keywords="scoping review",
keywords="mobile phone",
abstract="Background: Digital technologies have penetrated most workplaces. However, it is unclear how such digital technologies affect the physical health of older workers. Objective: This scoping review aims to examine and summarize the evidence from scientific literature concerning the impact of digital technology on the physical health of older workers. Methods: This scoping review will be conducted following recommendations outlined by Levac et al and will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines for reporting. Peer-reviewed papers written in English will be searched in the following databases: MEDLINE, Cochrane, ProQuest, Web of Science, Scopus, APA PsycInfo, and ERIH PLUS. The web-based systematic review platform Covidence will be used to create a data extraction template. It will cover the following items: study and participant characteristics, health measures, digital tool characteristics and usage, and research findings. Following the Population, Concept, and Context (PCC) framework, our review will focus on studies involving older workers aged 50 years or older, any form of digital technology (including teleworking and the use of digital tools at work), and how digital technologies affect physical health (such as vision loss, musculoskeletal disorders, and migraines). Studies that focus only on mental health will be excluded. Study selection based on title and abstract screening (first stage), full-text review (second stage), and data extraction (third stage) will be performed by a group of researchers, whereby each paper will be reviewed by at least 2 people. Any conflict regarding the inclusion or exclusion of a study and the data extraction will be resolved by discussion between the researchers who evaluated the papers; a third researcher will be involved if consensus is not reached. Results: A preliminary search of MEDLINE, Epistemonikos, Cochrane, PROSPERO, and JBI Evidence Synthesis was conducted, and no current or ongoing systematic reviews or scoping reviews on the topic were identified. The results of the study are expected in April 2025. Conclusions: Our scoping review will seek to provide an overview of the available evidence and identify research gaps regarding the effect of digital technology and the use of digital tools in the work environment on the physical health of older workers. International Registered Report Identifier (IRRID): PRR1-10.2196/59900 ",
doi="10.2196/59900",
url="https://www.researchprotocols.org/2024/1/e59900",
url="http://www.ncbi.nlm.nih.gov/pubmed/39325529"
}


@Article{info:doi/10.2196/56549,
author="Huang, Huei-Ling
and Chao, Yi-Ping
and Kuo, Chun-Yu
and Sung, Ya-Li
and Shyu, L. Yea-Ing
and Hsu, Wen-Chuin",
title="Development of a Dementia Case Management Information System App: Mixed Methods Study",
journal="JMIR Aging",
year="2024",
month="Sep",
day="23",
volume="7",
pages="e56549",
keywords="case management",
keywords="dementia",
keywords="health information systems",
keywords="mobile apps",
keywords="user needs",
keywords="mobile phone",
abstract="Background: Case managers for persons with dementia not only coordinate patient care but also provide family caregivers with educational material and available support services. Taiwan uses a government-based information system for monitoring the provision of health care services. Unfortunately, scheduling patient care and providing information to family caregivers continues to be paper-based, which results in a duplication of patient assessments, complicates scheduling of follow-ups, and hinders communication with caregivers, which limits the ability of case managers to provide cohesive, quality care. Objective: This multiphase study aimed to develop an electronic information system for dementia care case managers based on their perceived case management needs and what they would like included in an electronic health care app. Methods: Case managers were recruited to participate (N=63) by purposive sampling from 28 facilities representing two types of community-based dementia care centers in Taiwan. A dementia case management information system (DCMIS) app was developed in four phases. Phase 1 assessed what should be included in the app by analyzing qualitative face-to-face or internet-based interviews with 33 case managers. Phase 2 formulated a framework for the app to support case managers based on key categories identified in phase 1. During phase 3, a multidisciplinary team of information technology engineers and dementia care experts developed the DCMIS app: hardware and software components were selected, including platforms for messaging, data management, and security. The app was designed to eventually interface with a family caregiver app. Phase 4 involved pilot-testing the DCMIS app with a second group of managers (n=30); feedback was provided via face-to-face interviews about their user experience. Results: Findings from interviews in phase 1 indicated the DCMIS framework should include unified databases for patient reminder follow-up scheduling, support services, a health education module, and shared recordkeeping to facilitate teamwork, networking, and communication. The DCMIS app was built on the LINE (LY Corporation) messaging platform, which is the mobile app most widely used in Taiwan. An open-source database management system allows secure entry and storage of user information and patient data. Case managers had easy access to educational materials on dementia and caregiving for persons living with dementia that could be provided to caregivers. Interviews with case managers following pilot testing indicated that the DCMIS app facilitated the completion of tasks and management responsibilities. Some case managers thought it would be helpful to have a DCMIS desktop computer system rather than a mobile app. Conclusions: Based on pilot testing, the DCMIS app could reduce the growing challenges of high caseloads faced by case managers of persons with dementia, which could improve continuity of care. These findings will serve as a reference when the system is fully developed and integrated with the electronic health care system in Taiwan. ",
doi="10.2196/56549",
url="https://aging.jmir.org/2024/1/e56549"
}


@Article{info:doi/10.2196/53384,
author="Tajika, Atsuko
and Nakagomi, Atsushi
and Miyaguni, Yasuhiro
and Koga, Chie
and Kondo, Katsunori
and Ojima, Toshiyuki",
title="Internet Use and Higher-Level Functional Capacity Decline Suppression in Japanese Older Adults With Low Education: JAGES 2016-2019 Longitudinal Study",
journal="JMIR Aging",
year="2024",
month="Sep",
day="20",
volume="7",
pages="e53384",
keywords="functional capacity",
keywords="instrumental activities of daily living",
keywords="older adults' cognitive engagement",
keywords="older adults' social role",
keywords="internet impact on seniors",
keywords="educational attainment",
keywords="low education",
keywords="independent living",
keywords="older adults",
keywords="health disparities",
abstract="Background: Higher-level functional capacity (HLFC) is crucial for the independent living of older adults. While internet use positively impacts the health of older adults, its effect on HLFC and how this effect varies with educational attainment remains uncertain. Objective: This longitudinal study aimed to investigate whether internet use could mitigate the risk of HLFC decline and if this benefit extends to older adults with lower levels of education. Methods: The data were sourced from the Japan Gerontological Evaluation Study (JAGES), encompassing 8050 community-dwelling adults aged 65 years and older from 2016 to 2019. The study focused on those who remained self-sufficient from 2016 to 2019, identifying participants with independent HLFC in 2016. The Tokyo Metropolitan Institute of Gerontology Index of Competence defined HLFC operationally, consisting of 3 subscales, namely instrumental activities of daily living, intellectual activity, and social role. The primary variable was the frequency of internet use in 2016; participants who reported using the internet were classified as internet users, while those who answered ``No'' were identified as nonusers. The study compared the effects of internet use on HLFC decline across educational levels of ?9 years, 10-12 years, and ?13 years using Poisson regression analysis adjusted for robust SE to calculate the risk ratio (RR) and 95\% CI for HLFC decline in 2019. Results: After adjusting for demographic and health condition risk factors, internet use was significantly linked to a decreased risk of HLFC decline in older adults over 3 years, including those with lower educational levels. Internet users with ?9 years of educational attainment experienced a suppressed decline in the total score (RR 0.57, 95\% CI 0.43-0.76; P<.001); instrumental activities of daily living (RR 0.58, 95\% CI 0.38-0.91; P=.02), intellectual activity (RR 0.60, 95\% CI 0.41-0.89; P=.01), and social role (RR 0.74, 95\% CI 0.56-0.97; P=.03) compared with nonusers. Participants with 10-12 years of education showed suppression rates of 0.78 (95\% CI 0.63-0.98; P=.03), 0.59 (95\% CI 0.39-0.90; P=.01), 0.91 (95\% CI 0.63-1.31; P=.61), and 0.82 (95\% CI 0.68-1.00; P=.05), respectively, and those with ?13 years displayed suppression rates of 0.65 (95\% CI 0.51-0.85; P=.001), 0.55 (95\% CI 0.36-0.83; P=.01), 0.64 (95\% CI 0.37-1.10; P=.11), and 0.83 (95\% CI 0.64-1.08; P=.17), respectively. Conclusions: These findings indicate that internet use supports the maintenance of HLFC independence in older adults with higher education and those with lower educational levels. Encouraging internet use among older adults with lower levels of education through future policies could help narrow functional health disparities associated with educational attainment. ",
doi="10.2196/53384",
url="https://aging.jmir.org/2024/1/e53384"
}


@Article{info:doi/10.2196/63367,
author="Liu, Lu
and Wang, Xiu-Ling
and Cheng, Nuo
and Yu, Fu-Min
and Li, Hui-Jun
and Mu, Yang
and Yuan, Yonghui
and Dong, Jia-Xin
and Wu, Yu-Dan
and Gong, Da-Xin
and Wang, Shuang
and Zhang, Guang-Wei",
title="Development Trends and Prospects of Technology-Based Solutions for Health Challenges in Aging Over the Past 25 Years: Bibliometric Analysis",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="20",
volume="26",
pages="e63367",
keywords="bibliometrics",
keywords="CiteSpace",
keywords="VOSviewer",
keywords="visualization",
keywords="aging health",
keywords="technological innovations",
keywords="tech-based",
keywords="technology-based",
keywords="technology",
keywords="health challenges",
keywords="challenges",
keywords="trends",
keywords="older adults",
keywords="older adult",
keywords="ageing",
keywords="aging",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="remote",
keywords="remote monitoring",
keywords="monitoring",
keywords="surveillance",
keywords="artificial intelligence",
keywords="AI",
keywords="AI-driven",
keywords="innovation",
keywords="innovations",
keywords="health management",
keywords="telemedicine",
keywords="remote care",
abstract="Background: As the global population ages, we witness a broad scientific and technological revolution tailored to meet the health challenges of older adults. Over the past 25 years, technological innovations, ranging from advanced medical devices to user-friendly mobile apps, are transforming the way we address these challenges, offering new avenues to enhance the quality of life and well-being of the aging demographic. Objective: This study aimed to systematically review the development trends in technology for managing and caring for the health of older adults over the past 25 years and to project future development prospects. Methods: We conducted a comprehensive bibliometric analysis of literatures related to technology-based solutions for health challenges in aging, published up to March 18, 2024. The search was performed using the Web of Science Core Collection, covering a span from 1999 to 2024. Our search strategy was designed to capture a broad spectrum of terms associated with aging, health challenges specific to older adults, and technological interventions. Results: A total of 1133 publications were found in the Web of Science Core Collection. The publication trend over these 25 years showed a gradual but fluctuating increase. The United States was the most productive country and participated in international collaboration most frequently. The predominant keywords identified through this analysis included ``dementia,'' ``telemedicine,'' ``older-adults,'' ``telehealth,'' and ``care.'' The keywords with citation bursts included ``telemedicine'' and ``digital health.'' Conclusions: The scientific and technological revolution has significantly improved older adult health management, particularly in chronic disease monitoring, mobility, and social connectivity. The momentum for innovation continues to build, with future research likely to focus on predictive analytics and personalized health care solutions, further enhancing older adults' independence and quality of life. ",
doi="10.2196/63367",
url="https://www.jmir.org/2024/1/e63367",
url="http://www.ncbi.nlm.nih.gov/pubmed/39238480"
}


@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/10.2196/58714,
author="Happe, Lisa
and Sgraja, Marie
and Quinten, Vincent
and F{\"o}rster, Mareike
and Diekmann, Rebecca",
title="Requirement Analysis of Different Variants of a Measurement and Training Station for Older Adults at Risk of Malnutrition and Reduced Mobility: Focus Group Study",
journal="JMIR Aging",
year="2024",
month="Sep",
day="17",
volume="7",
pages="e58714",
keywords="gerontechnology",
keywords="physical activity",
keywords="diet",
keywords="technical assistance system",
keywords="health data",
keywords="qualitative research",
abstract="Background: Demographic change is leading to an increasing proportion of older people in the German population and requires new approaches for prevention and rehabilitation to promote the independence and health of older people. Technical assistance systems can offer a promising solution for the early detection of nutritional and physical deficits and the initiation of appropriate interventions. Such a system should combine different components, such as devices for assessing physical and nutritional status, educational elements on these topics, and training and feedback options. The concept is that the whole system can be used independently by older adults (aged ?70 years) for monitoring and early detection of problems in nutrition or physical function, as well as providing opportunities for intervention. Objective: This study aims to develop technical and digital elements for a measurement and training station (MuTs) with an associated app. Through focus group discussions, target group requirements, barriers, and favorable components for such a system were identified. Methods: Older adults (aged ?70 years) were recruited from a community-based setting as well as from a geriatric rehabilitation center. Focus group interviews were conducted between August and November 2022. Following a semistructured interview guideline, attitudes, requirements, preferences, and barriers for the MuTs were discussed. Discussions were stimulated by videos, demonstrations of measuring devices, and participants' ratings of the content presented using rankings. After conducting 1 focus group in the rehabilitation center and 2 in the community, the interview guide was refined, making a more detailed discussion of identified elements and aspects possible. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. Results: A total of 21 older adults (female participants: n=11, 52\%; mean age 78.5, SD 4.6 years) participated in 5 focus group discussions. There was a strong interest in the independent measurement of health parameters, such as pulse and hand grip strength, especially among people with health problems who would welcome feedback on their health development. Participants emphasized the importance of personal guidance and interaction before using the device, as well as the need for feedback mechanisms and personalized training for everyday use. Balance and coordination were mentioned as preferred training areas in a MuTs. New training options that motivate and invite people to participate could increase willingness to use the MuTs. Conclusions: The target group is generally open and interested in tracking and optimizing diet and physical activity. A general willingness to use a MuTs independently was identified, as well as a compelling need for guidance and feedback on measurement and training to be part of the station. ",
doi="10.2196/58714",
url="https://aging.jmir.org/2024/1/e58714"
}


@Article{info:doi/10.2196/57437,
author="Dong, Xing-Xuan
and Huang, Yueqing
and Miao, Yi-Fan
and Hu, Hui-Hui
and Pan, Chen-Wei
and Zhang, Tianyang
and Wu, Yibo",
title="Personality and Health-Related Quality of Life of Older Chinese Adults: Cross-Sectional Study and Moderated Mediation Model Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="12",
volume="10",
pages="e57437",
keywords="personality",
keywords="health-related quality of life",
keywords="older adults",
keywords="sleep quality",
keywords="quality of life",
keywords="old",
keywords="older",
keywords="Chinese",
keywords="China",
keywords="mechanisms",
keywords="psychology",
keywords="behavior",
keywords="analysis",
keywords="hypothesis",
keywords="neuroticism",
keywords="mediation analysis",
keywords="health care providers",
keywords="aging",
abstract="Background: Personality has an impact on the health-related quality of life (HRQoL) of older adults. However, the relationship and mechanisms of the 2 variables are controversial, and few studies have been conducted on older adults. Objective: The aim of this study was to explore the relationship between personality and HRQoL and the mediating and moderating roles of sleep quality and place of residence in this relationship. Methods: A total of 4123 adults 60 years and older were from the Psychology and Behavior Investigation of Chinese Residents survey. Participants were asked to complete the Big Five Inventory, the Brief version of the Pittsburgh Sleep Quality Index, and EQ-5D-5L. A backpropagation neural network was used to explore the order of factors contributing to HRQoL. Path analysis was performed to evaluate the mediation hypothesis. Results: As of August 31, 2022, we enrolled 4123 older adults 60 years and older. Neuroticism and extraversion were strong influencing factors of HRQoL (normalized importance >50\%). The results of the mediation analysis suggested that neuroticism and extraversion may enhance and diminish, respectively, HRQoL (index: $\beta$=?.262, P<.001; visual analog scale: $\beta$=?.193, P<.001) by increasing and decreasing brief version of the Pittsburgh Sleep Quality Index scores (neuroticism: $\beta$=.17, P<.001; extraversion: $\beta$=?.069, P<.001). The multigroup analysis suggested a significant moderating effect of the place of residence (EQ-5D-5L index: P<.001; EQ-5D-5L visual analog scale: P<.001). No significant direct effect was observed between extraversion and EQ-5D-5L index in urban older residents ($\beta$=.037, P=.73). Conclusions: This study sheds light on the potential mechanisms of personality and HRQoL among older Chinese adults and can help health care providers and relevant departments take reasonable measures to promote healthy aging. ",
doi="10.2196/57437",
url="https://publichealth.jmir.org/2024/1/e57437"
}


@Article{info:doi/10.2196/54467,
author="Guo, Ying
and Hong, Zixuan
and Cao, Chenglin
and Cao, Wenwen
and Chen, Ren
and Yan, Jing
and Hu, Zhi
and Bai, Zhongliang",
title="Urban-Rural Differences in the Association of eHealth Literacy With Medication Adherence Among Older People With Frailty and Prefrailty: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="11",
volume="10",
pages="e54467",
keywords="eHealth literacy",
keywords="medication adherence",
keywords="frailty",
keywords="older people",
keywords="China",
abstract="Background: With advances in science and technology and improvements in health literacy, more studies have focused on frailty prevention by promoting medication adherence, emphasizing the role of eHealth literacy. However, the association between eHealth literacy and medication adherence in frail older adults has not been well studied, and it is unknown whether urban-rural differences exist in this relationship. Objective: This study aims to examine the relationship between eHealth literacy and medication adherence in older people with different frailty statuses, emphasizing variations between rural and urban areas. Methods: Between November and December 2020, a total of 4218 urban and rural community members (aged ?60 years) in China were recruited as participants using a multistage random sampling method. A face-to-face structured questionnaire survey was conducted to collect information on demographic characteristics, eHealth literacy (consisting of application, evaluation, and decision dimensions), and medication adherence. eHealth literacy was assessed using the Chinese version of the eHealth Literacy Scale developed by Norman and Skinner, and medication adherence was measured using the 4-item Morisky scale. We used a general descriptive analysis and stratified logistic regression models to examine how eHealth literacy is linked to medication adherence and urban-rural differences. Results: There were 4218 respondents, of which 2316 (54.9\%) lived in urban areas and 1902 (45.1\%) in rural areas, respectively. After adjusting for potential confounders, among participants with prefrailty, eHealth literacy was associated with medication adherence in urban areas in terms of less application (adjusted odds ratio [AOR] 1.16, 95\% CI 0.82?1.63), less evaluation (AOR 1.29, 95\% CI 0.92?1.81), and less decision ability (AOR 1.20, 95\% CI 0.86?1.68); eHealth literacy was linked with medication adherence in the rural areas in terms of less application (AOR 1.10, 95\% CI 0.56?2.13), less evaluation (AOR 1.05, 95\% CI 0.61?1.79), and less decision ability (AOR 1.10, 95\% CI 0.64?1.90). Among frail participants, less eHealth literacy (AOR 0.85, 95\% CI 0.48?1.51), along with its dimensions, including less application (AOR 0.85, 95\% CI 0.47?1.54), evaluation (AOR 0.89, 95\% CI 0.50?1.57), and decision ability (AOR 0.99, 95\% CI 0.55?1.76), were associated with medication adherence in urban areas; less eHealth literacy (AOR 0.89, 95\% CI 0.48?1.65), along with its dimensions, including less application (AOR 1.23, 95\% CI 0.62?2.44), evaluation (AOR 0.98, 95\% CI 0.53?1.82), and decision ability (AOR 0.90, 95\% CI 0.49?1.67), were associated with medication adherence in rural areas. Conclusions: The results of this study suggest that there is an association between eHealth literacy and medication adherence among older people with frailty and prefrailty. To promote medication adherence, eHealth literacy can be helpful in tailoring interventions. ",
doi="10.2196/54467",
url="https://publichealth.jmir.org/2024/1/e54467"
}


@Article{info:doi/10.2196/57601,
author="Suffoletto, Brian
and Kim, David
and Toth, Caitlin
and Mayer, Waverly
and Glaister, Sean
and Cinkowski, Chris
and Ashenburg, Nick
and Lin, Michelle
and Losak, Michael",
title="Feasibility of Measuring Smartphone Accelerometry Data During a Weekly Instrumented Timed Up-and-Go Test After Emergency Department Discharge: Prospective Observational Cohort Study",
journal="JMIR Aging",
year="2024",
month="Sep",
day="4",
volume="7",
pages="e57601",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="aging",
keywords="gait",
keywords="balance",
keywords="fall",
keywords="falls",
keywords="functional decline",
keywords="fall risk",
keywords="fall risks",
keywords="mobility",
keywords="phone",
keywords="sensors",
keywords="patient monitoring",
keywords="monitoring",
keywords="emergency department",
keywords="emergency departments",
keywords="ED",
keywords="emergency room",
keywords="ER",
keywords="discharge",
keywords="mobile application",
keywords="mobile applications",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="digital interventions",
keywords="smartphone",
keywords="smartphones",
keywords="prediction",
keywords="mobile phone",
abstract="Background: Older adults discharged from the emergency department (ED) face elevated risk of falls and functional decline. Smartphones might enable remote monitoring of mobility after ED discharge, yet their application in this context remains underexplored. Objective: This study aimed to assess the feasibility of having older adults provide weekly accelerometer data from an instrumented Timed Up-and-Go (TUG) test over an 11-week period after ED discharge. Methods: This single-center, prospective, observational, cohort study recruited patients aged 60 years and older from an academic ED. Participants downloaded the GaitMate app to their iPhones that recorded accelerometer data during 11 weekly at-home TUG tests. We measured adherence to TUG test completion, quality of transmitted accelerometer data, and participants' perceptions of the app's usability and safety. Results: Of the 617 approached patients, 149 (24.1\%) consented to participate, and of these 149 participants, 9 (6\%) dropped out. Overall, participants completed 55.6\% (912/1639) of TUG tests. Data quality was optimal in 31.1\% (508/1639) of TUG tests. At 3-month follow-up, 83.2\% (99/119) of respondents found the app easy to use, and 95\% (114/120) felt safe performing the tasks at home. Barriers to adherence included the need for assistance, technical issues with the app, and forgetfulness. Conclusions: The study demonstrates moderate adherence yet high usability and safety for the use of smartphone TUG tests to monitor mobility among older adults after ED discharge. Incomplete TUG test data were common, reflecting challenges in the collection of high-quality longitudinal mobility data in older adults. Identified barriers highlight the need for improvements in user engagement and technology design. ",
doi="10.2196/57601",
url="https://aging.jmir.org/2024/1/e57601"
}


@Article{info:doi/10.2196/59168,
author="Knotnerus, R. Hanna
and Ngo, N. H{\`a} T.
and Maarsingh, R. Otto
and van Vugt, A. Vincent",
title="Understanding Older Adults' Experiences With a Digital Health Platform in General Practice: Qualitative Interview Study",
journal="JMIR Aging",
year="2024",
month="Aug",
day="30",
volume="7",
pages="e59168",
keywords="digital health care",
keywords="digital health platform",
keywords="general practice",
keywords="qualitative research",
keywords="older adults",
keywords="primary care",
keywords="mobile phone",
abstract="Background: In our aging population, primary care is under pressure to remain accessible to all. Effective use of digital health care could potentially lower general practitioners' (GPs) workload. Some general practices are already implementing a digital health platform as a primary method to contact their patients. However, it is unknown how older people experience this novel way to communicate with their GP. Objective: The aim of this study was to study the experiences of patients aged 65 years and older in general practices who use digital health as a primary communication tool. The secondary aims were to identify barriers and facilitators for the use of digital health care and whether a practice focus on digital health influences older patients' choice to enlist. Methods: We invited all patients aged 65 years and older at 2 general practices in Amsterdam that work with a novel digital health platform. We used purposive sampling to select a heterogeneous group of patients in terms of age, sex, level of education, digital literacy, and experiences with the digital app of their general practice. We conducted 18 semistructured interviews from May through July 2023. All interviews were audio-recorded, transcribed, coded, and thematically analyzed. Results: We generated three themes: (1) experiences of older people with digital health care in general practice, (2) impact of individual factors on digital health experiences, and (3) reasons for choosing a digitally oriented general practice. Participants reported both positive and negative experiences. The main perceived advantages of the digital health platform were increased accessibility, direct GP contact without an intermediary, and saving time through asynchronous communication. The disadvantages mentioned were log-in difficulties and problems with the automated explanatory questionnaire. Individual factors such as age, digital literacy, and expectations of general practice care seemed to impact people's experiences and could act as barriers or facilitators for using digital health. Reasons for older patients to enlist at a general practice were mainly practical. The digital orientation of the practice hardly played a role in this choice. Conclusions: Older patients in general practice see benefits to using a digital health platform that offers 2-way chat-based communication between the patient and GP. We found that individual factors such as skills, norms and values, attitudes toward digitalization, and expectations of general practice care impacted older patients' experiences with digital health care. For many older participants, the digital profile of the general practice did not play a role in their choice to enlist. Further improvement of digital health platforms will be necessary to ensure digital health for all in general practice. ",
doi="10.2196/59168",
url="https://aging.jmir.org/2024/1/e59168"
}


@Article{info:doi/10.2196/54800,
author="Quinn, Kelly
and Leiser Ransom, Sarah
and O'Connell, Carrie
and Muramatsu, Naoko
and Marquez, X. David
and Chin, Jessie",
title="Assessing the Feasibility and Acceptability of Smart Speakers in Behavioral Intervention Research With Older Adults: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="30",
volume="26",
pages="e54800",
keywords="smart speakers",
keywords="physical activity",
keywords="older adults",
keywords="behavioral health",
keywords="intervention",
keywords="smart device",
keywords="smart devices",
keywords="conversational agent",
keywords="physical activities",
keywords="behavioral intervention",
keywords="intervention research",
abstract="Background: Smart speakers, such as Amazon's Echo and Google's Nest Home, combine natural language processing with a conversational interface to carry out everyday tasks, like playing music and finding information. Easy to use, they are embraced by older adults, including those with limited physical function, vision, or computer literacy. While smart speakers are increasingly used for research purposes (eg, implementing interventions and automatically recording selected research data), information on the advantages and disadvantages of using these devices for studies related to health promotion programs is limited. Objective: This study evaluates the feasibility and acceptability of using smart speakers to deliver a physical activity (PA) program designed to help older adults enhance their physical well-being. Methods: Community-dwelling older adults (n=18) were asked to use a custom smart speaker app to participate in an evidence-based, low-impact PA program for 10 weeks. Collected data, including measures of technology acceptance, interviews, field notes, and device logs, were analyzed using a concurrent mixed analysis approach. Technology acceptance measures were evaluated using time series ANOVAs to examine acceptability, appropriateness, feasibility, and intention to adopt smart speaker technology. Device logs provided evidence of interaction with and adoption of the device and the intervention. Interviews and field notes were thematically coded to triangulate the quantitative measures and further expand on factors relating to intervention fidelity. Results: Smart speakers were found to be acceptable for administering a PA program, as participants reported that the devices were highly usable (mean 5.02, SE 0.38) and had strong intentions to continue their use (mean 5.90, SE 0.39). Factors such as the voice-user interface and engagement with the device on everyday tasks were identified as meaningful to acceptability. The feasibility of the devices for research activity, however, was mixed. Despite the participants rating the smart speakers as easy to use (mean 5.55, SE 1.16), functional and technical factors, such as Wi-Fi connectivity and appropriate command phrasing, required the provision of additional support resources to participants and potentially impaired intervention fidelity. Conclusions: Smart speakers present an acceptable and appropriate behavioral intervention technology for PA programs directed at older adults but entail additional requirements for resource planning, technical support, and troubleshooting to ensure their feasibility for the research context and for fidelity of the intervention. ",
doi="10.2196/54800",
url="https://www.jmir.org/2024/1/e54800"
}


@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/10.2196/45468,
author="Rahadiani, Pratiwi
and Kekalih, Aria
and Soemantri, Diantha
and Krisnamurti, Budi Desak Gede",
title="Exploring HTML5 Package Interactive Content in Supporting Learning Through Self-Paced Massive Open Online Courses on Healthy Aging: Mixed Methods Study",
journal="JMIR Med Educ",
year="2024",
month="Aug",
day="22",
volume="10",
pages="e45468",
keywords="HTML5 package",
keywords="H5P",
keywords="students' perspectives",
keywords="students' acceptance",
keywords="massive open online courses",
keywords="MOOCs",
keywords="healthy aging",
keywords="self-paced MOOC",
keywords="student",
keywords="perception",
keywords="acceptance",
keywords="opinion",
keywords="attitude",
keywords="MOOC",
keywords="self-paced",
keywords="self-guided",
keywords="online course",
keywords="online learning",
keywords="geriatric",
keywords="gerontology",
keywords="gerontological",
keywords="learning",
abstract="Background: The rapidly aging population and the growth of geriatric medicine in the field of internal medicine are not supported by sufficient gerontological training in many health care disciplines. There is rising awareness about the education and training needed to adequately prepare health care professionals to address the needs of the older adult population. Massive open online courses (MOOCs) might be the best alternative method of learning delivery in this context. However, the diversity of MOOC participants poses a challenge for MOOC providers to innovate in developing learning content that suits the needs and characters of participants. Objective: The primary outcome of this study was to explore students' perceptions and acceptance of HTML5 package (H5P) interactive content in self-paced MOOCs and its association with students' characteristics and experience in using MOOCs. Methods: This study used a cross-sectional design, combining qualitative and quantitative approaches. Participants, predominantly general practitioners from various regions of Indonesia with diverse educational backgrounds and age groups, completed pretests, engaged with H5P interactive content, and participated in forum discussions and posttests. Data were retrieved from the online questionnaire attached to a selected MOOC course. Students' perceptions and acceptance of H5P interactive content were rated on a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). Data were analyzed using SPSS (IBM Corp) to examine demographics, computer literacy, acceptance, and perceptions of H5P interactive content. Quantitative analysis explored correlations, while qualitative analysis identified recurring themes from open-ended survey responses to determine students' perceptions. Results: In total, 184 MOOC participants agreed to participate in the study. Students demonstrated positive perceptions and a high level of acceptance of integrating H5P interactive content within the self-paced MOOC. Analysis of mean (SD) value across all responses consistently revealed favorable scores (greater than 5), ranging from 5.18 (SD 0.861) to 5.45 (SD 0.659) and 5.28 (SD 0.728) to 5.52 (SD 0.627), respectively. This finding underscores widespread satisfaction and robust acceptance of H5P interactive content. Students found the H5P interactive content more satisfying and fun, easier to understand, more effective, and more helpful in improving learning outcomes than material in the form of common documents and learning videos. There is a significant correlation between computer literacy, students' acceptance, and students' perceptions. Conclusions: Students from various backgrounds showed a high level of acceptance and positive perceptions of leveraging H5P interactive content in the self-paced MOOC. The findings suggest potential new uses of H5P interactive content in MOOCs, such as interactive videos with pop-up questions, to substitute for synchronous learning. The study underscores the significance of tailored educational strategies in supporting the professional development of health care professionals. ",
doi="10.2196/45468",
url="https://mededu.jmir.org/2024/1/e45468",
url="http://www.ncbi.nlm.nih.gov/pubmed/39049507"
}


@Article{info:doi/10.2196/53513,
author="Gualtieri, Lisa
and Rigby, Mathilda
and Wang, Deelia
and Mann, Elaine",
title="Medication Management Strategies to Support Medication Adherence: Interview Study With Older Adults",
journal="Interact J Med Res",
year="2024",
month="Aug",
day="13",
volume="13",
pages="e53513",
keywords="home medication management",
keywords="medication adherence",
keywords="prescription drugs",
keywords="adherence devices",
keywords="adherence apps",
keywords="pill cases",
keywords="aging in place",
keywords="independent living",
keywords="aging",
keywords="medication",
keywords="older adults",
keywords="prescription",
keywords="interview",
keywords="interview design",
keywords="design",
keywords="app",
keywords="mobile phone",
abstract="Background: Home medication management has been insufficiently studied, including the factors that impact the development and effectiveness of adherence strategies under both routine and anomalous circumstances. Older adults are a particularly important population to study due to the greater likelihood of taking medication in combination with the desire to ``age in place.'' Objective: This interview study aims to understand how older adults develop medication management strategies, identify when and why such strategies succeed or fail, learn more about how older adults think about their medication, and explore interventions that increase medication adherence. Methods: This study used a qualitative, semistructured interview design to elicit older adults' experiences with home medication management. Overall, 22 participants aged ?50 years taking 1 to 3 prescription medications were recruited and interviewed. Interview responses were recorded, and thematic, qualitative analysis was performed by reviewing recordings and identifying recurring patterns and themes. Responses were systematically coded, which not only facilitated the identification of these themes but also allowed us to quantify the prevalence of behaviors and perceptions, providing a robust understanding of medication management and medication adherence. Results: Participants reported developing home medication management strategies on their own, with none of the participants receiving guidance from health care providers and 59\% (13/22) of the participants using trial and error. The strategies developed by study participants were all unique and generally encompassed prescription medication and vitamins or supplements, with no demarcation between what was prescribed or recommended by a physician and what they selected independently. Participants thought about their medications by their chemical name (10/22, 45\%), by the appearance of the pill (8/22, 36\%), by the medication's purpose (2/22, 9\%), or by the medication's generic name (2/22, 9\%). Pill cases (17/22, 77\%) were more popular than prescription bottles (5/22, 23\%) for storage of daily medication. Most participants (19/22, 86\%) stored their pill cases or prescription bottles in visible locations in the home, and those using pill cases varied in their refill routines. Participants used ?2 routines or objects as triggers to take their medication. Nonadherence was associated with a disruption to their routine. Finally, only 14\% (3/22) of the participants used a time-based reminder or alarm, and none of the participants used a medication adherence device or app. Conclusions: Participants in our study varied considerably in their home medication management strategies and developed unique routines to remember to take their medication as well as to refill their pill cases. To reduce trial and error in establishing a strategy, there are opportunities for physicians and pharmacists to provide adherence guidance to older adults. To minimize the impact of disruptions on adherence, there are opportunities to develop more durable strategies and to design aids to medication adherence that leverage established daily routines. ",
doi="10.2196/53513",
url="https://www.i-jmr.org/2024/1/e53513",
url="http://www.ncbi.nlm.nih.gov/pubmed/39137021"
}


@Article{info:doi/10.2196/52648,
author="Urien, Marie Jean
and Berthelot, Emmanuelle
and Raphael, Pierre
and Moine, Thomas
and Lopes, Emilie Marie
and Assayag, Patrick
and Jourdain, Patrick",
title="Evaluation of a New Telemedicine System for Early Detection of Cardiac Instability in Patients With Chronic Heart Failure: Real-Life Out-of-Hospital Study",
journal="JMIR Cardio",
year="2024",
month="Aug",
day="13",
volume="8",
pages="e52648",
keywords="telemedicine system",
keywords="follow-up",
keywords="detection",
keywords="heart failure",
keywords="chronic heart failure",
keywords="CHF",
keywords="heart disease",
keywords="ambulatory patient",
keywords="ambulatory patients",
keywords="home-based",
keywords="TwoCan Pulse",
keywords="telecardiology",
keywords="cardiology",
keywords="e-device",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="effectiveness",
keywords="real-life setting",
keywords="remote monitoring",
keywords="virtual monitoring",
keywords="France",
keywords="men",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older man",
keywords="ageing",
keywords="aging",
abstract="Background: For a decade, despite results from many studies, telemedicine systems have suffered from a lack of recommendations for chronic heart failure (CHF) care because of variable study results. Another limitation is the hospital-based architecture of most telemedicine systems. Some systems use an algorithm based on daily weight, transcutaneous oxygen measurement, and heart rate to detect and treat acute heart failure (AHF) in patients with CHF as early on as possible. Objective: The aim of this study is to determine the efficacy of a telemonitoring system in detecting clinical destabilization in real-life settings (out-of-hospital management) without generating too many false positive alerts. Methods: All patients self-monitoring at home using the system after a congestive AHF event treated at a cardiology clinic in France between March 2020 and March 2021 with at least 75\% compliance on daily measurements were included retrospectively. New-onset AHF was defined by the presence of at least 1 of the following criteria: transcutaneous oxygen saturation loss, defined as a transcutaneous oxygen measurement under 90\%; rise of cardiac frequency above 110 beats per minute; weight gain of at least 2 kg; and symptoms of congestive AHF, described over the phone. An AHF alert was generated when the criteria reached our definition of new-onset acute congestive heart failure (HF). Results: A total of 111 consecutive patients (n=70 men) with a median age of 76.60 (IQR 69.5-83.4) years receiving the telemonitoring system were included. Thirty-nine patients (35.1\%) reached the HF warning level, and 28 patients (25\%) had confirmed HF destabilization during follow-up. No patient had AHF without being detected by the telemonitoring system. Among incorrect AHF alerts (n=11), 5 patients (45\%) had taken inaccurate measurements, 3 patients (27\%) had supraventricular arrhythmia, 1 patient (9\%) had a pulmonary bacterial infection, and 1 patient (9\%) contracted COVID-19. A weight gain of at least 2 kg within 4 days was significantly associated with a correct AHF alert (P=.004), and a heart rate of more than 110 beats per minute was more significantly associated with an incorrect AHF alert (P=.007). Conclusions: This single-center study highlighted the efficacy of the telemedicine system in detecting and quickly treating cardiac instability complicating the course of CHF by detecting new-onset AHF as well as supraventricular arrhythmia, thus helping cardiologists provide better follow-up to ambulatory patients. ",
doi="10.2196/52648",
url="https://cardio.jmir.org/2024/1/e52648",
url="http://www.ncbi.nlm.nih.gov/pubmed/39137030"
}


@Article{info:doi/10.2196/52310,
author="Angonese, Giulia
and Buhl, Mareike
and Kuhlmann, Inka
and Kollmeier, Birger
and Hildebrandt, Andrea",
title="Prediction of Hearing Help Seeking to Design a Recommendation Module of an mHealth Hearing App: Intensive Longitudinal Study of Feature Importance Assessment",
journal="JMIR Hum Factors",
year="2024",
month="Aug",
day="12",
volume="11",
pages="e52310",
keywords="hearing loss",
keywords="mobile health",
keywords="mHealth",
keywords="older adults",
keywords="help seeking",
keywords="mobile study",
keywords="machine learning",
keywords="supervised classification",
keywords="feature importance",
keywords="profiling",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual's profile regarding the outcome of interest. Objective: This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions. Methods: In total, 185 (n=106, 57.3\% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, na{\"i}ve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis. Results: The algorithms correctly predicted action to seek help at study end in 65.9\% (122/185) to 70.3\% (130/185) of cases, reaching 74.8\% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income. Conclusions: This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps. ",
doi="10.2196/52310",
url="https://humanfactors.jmir.org/2024/1/e52310",
url="http://www.ncbi.nlm.nih.gov/pubmed/39133539"
}


@Article{info:doi/10.2196/57402,
author="Kim, Sunyoung
and Sivangula, Phaneendra",
title="Toward Safe and Confident Silver Drivers: Interview Study Investigating Older Adults' Driving Practices",
journal="JMIR Aging",
year="2024",
month="Aug",
day="12",
volume="7",
pages="e57402",
keywords="older adults",
keywords="driving",
keywords="transportation",
keywords="healthy aging",
keywords="aging in place",
keywords="quality of life",
abstract="Background: As the aging population in the United States continues to increase rapidly, preserving the mobility and independence of older adults becomes increasingly critical for enabling aging in place successfully. While personal vehicular transport remains a popular choice among this demographic due to its provision of independence and control over their lives, age-related changes may heighten the risk of common driving errors and diminish driving abilities. Objective: This study aims to investigate the driving practices of older adults and their efforts to maintain safe and confident driving habits. Specifically, we sought to identify the factors that positively and negatively influence older adults' driving performance and confidence, as well as the existing efforts put into sustaining their driving abilities. Methods: We recruited 20 adults aged ?65 years who remained active drivers during the recruitment from the greater New York area. Then, we conducted semistructured interviews with them to examine their perceptions, needs, and challenges regarding safe and confident driving. Results: Our findings uncovered a notable disparity between older adults' self-perceived driving skills and the challenges they face, particularly caused by age-related limitations and health conditions such as vision and memory declines and medication routines. Drawing on these findings, we proposed strategies to bridge this gap and empower older adults to drive safely and confidently, including fostering a realistic understanding of their capabilities, encouraging open dialogue regarding their driving, encouraging regular assessments, and increasing awareness of available resources. Conclusions: This study uncovered a noticeable disparity between the perceived driving competence of older adults and the actual challenges they confront while driving. This divergence underscores a significant need for better support beyond the existing aid available to preserve older adults' driving skills. We hope that our recommendations will offer valuable insights for practitioners and scholars committed to enhancing the overall well-being and quality of life for older adults as they age in their homes. ",
doi="10.2196/57402",
url="https://aging.jmir.org/2024/1/e57402",
url="http://www.ncbi.nlm.nih.gov/pubmed/39133531"
}


@Article{info:doi/10.2196/55507,
author="Jimenez, E. Daniel
and Ross, J. Emily
and Weinstein, Elliott
and Gouse, Hetta
and Pan, Yue
and Martinez Garza, David
and Burke, L. Shanna
and Joo, Hui Jin
and Behar-Zusman, Victoria",
title="Preventing Cognitive Decline in Older Latino Adults With HIV Through a Culturally Tailored Health Promotion Intervention: Protocol for a Single-Arm Pilot Trial",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="12",
volume="13",
pages="e55507",
keywords="Latinos",
keywords="HIV",
keywords="AIDS",
keywords="cognitive decline",
keywords="health promotion",
keywords="intervention",
keywords="protocol",
keywords="single-arm",
keywords="pilot trial",
keywords="prevention",
keywords="older",
keywords="cognitive impairment",
keywords="impairment",
keywords="treatment",
keywords="dementia",
keywords="psychosocial",
keywords="men",
keywords="women",
keywords="cohort",
abstract="Background: Older Latino adults with HIV are at increased risk for mild cognitive impairment and earlier onset of aging-related cognitive decline. Improvements in cognitive functioning and cognitive outcomes are possible among people with HIV who adopt health promotion behaviors. However, health promotion interventions for older Latino adults with HIV have not been extensively used or widely recognized as viable treatment options. Happy Older Latinos are Active (HOLA) is a multicomponent, health promotion intervention that is uniquely tailored for older Latino adults with HIV. Objective: This study aims to (1) determine the feasibility and acceptability of an adapted version of HOLA aimed at improving cognitive functioning among older Latino adults with HIV; (2) explore whether HOLA will produce changes in cognitive functioning; (3) explore whether HOLA will produce changes in activity, psychosocial functioning, or biomarkers of cognition; and (4) explore whether changes in activity, psychosocial functioning or cognitive biomarkers correlate with changes in cognition, while accounting for genetic risk for dementia. Methods: A single-arm pilot trial with 30 Latino (aged 50 years and older) men and women with HIV was conducted to assess feasibility, acceptability, and preliminary effects on cognition. Participants were assessed at 2 time points (baseline and postintervention) on measures of neurocognitive and psychosocial functioning. In addition, blood samples were collected to determine biomarkers of cognition at baseline and postintervention. Successful recruitment was defined as meeting 100\% of the targeted sample (N=30), with 20\% (n=6) or less of eligible participants refusing to participate. Adequate retention was defined as 85\% (n=25) or more of participants completing the postintervention assessment and acceptability was defined as 80\% (n=38) or more of sessions attended by participants. Results: Participant recruitment began on February 22, 2022, and was completed on August 15, 2022. The last study visit took place on February 20, 2023. Data analysis is currently ongoing. Conclusions: Encouraging findings from this exploratory study may provide a blueprint for scaling up the HOLA intervention to a larger cohort of older Latino adults with HIV who may be currently experiencing or are at risk for HIV-related cognitive challenges. Trial Registration: ClinicalTrials.gov NCT04791709; https://clinicaltrials.gov/study/NCT04791709 International Registered Report Identifier (IRRID): DERR1-10.2196/55507 ",
doi="10.2196/55507",
url="https://www.researchprotocols.org/2024/1/e55507",
url="http://www.ncbi.nlm.nih.gov/pubmed/39133532"
}


@Article{info:doi/10.2196/59705,
author="Attarha, Mouna
and de Figueiredo Pelegrino, Carolina Ana
and Toussaint, Paule-Joanne
and Grant, Sarah-Jane
and Van Vleet, Thomas
and de Villers-Sidani, Etienne",
title="Improving Neurological Health in Aging Via Neuroplasticity-Based Computerized Exercise: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="8",
volume="13",
pages="e59705",
keywords="brain training",
keywords="cognitive training",
keywords="healthy aging",
keywords="neuroplasticity",
keywords="acetylcholine",
keywords="FEOBV",
keywords="randomized controlled trial",
keywords="aging",
keywords="ageing",
keywords="elderly",
keywords="elder",
keywords="older adults",
keywords="older adult",
keywords="neurological health",
keywords="cognitive",
keywords="computerized brain training",
keywords="computerize",
keywords="cognition",
keywords="cognitive decline",
keywords="Canada",
abstract="Background: Our current understanding of how computerized brain training drives cognitive and functional benefits remains incomplete. This paper describes the protocol for Improving Neurological Health in Aging via Neuroplasticity-based Computerized Exercise (INHANCE), a randomized controlled trial in healthy older adults designed to evaluate whether brain training improves cholinergic signaling. Objective: INHANCE evaluates whether 2 computerized training programs alter acetylcholine binding using the vesicular acetylcholine transporter ligand [18F] fluoroethoxybenzovesamicol ([18F] FEOBV) and positron emission tomography (PET). Methods: In this phase IIb, prospective, double-blind, parallel-arm, active-controlled randomized trial, a minimum of 92 community-dwelling healthy adults aged 65 years and older are randomly assigned to a brain training program designed using the principles of neuroplasticity (BrainHQ by Posit Science) or to an active control program of computer games designed for entertainment (eg, Solitaire). Both programs consist of 30-minute sessions, 7 times per week for 10 weeks (35 total hours), completed remotely at home using either loaned or personal devices. The primary outcome is the change in FEOBV binding in the anterior cingulate cortex, assessed at baseline and posttest. Exploratory cognitive and behavioral outcomes sensitive to acetylcholine are evaluated before, immediately after, and 3 months following the intervention to assess the maintenance of observed effects. Results: The trial was funded in September 2019. The study received approval from the Western Institutional Review Board in October 2020 with Research Ethics Board of McGill University Health Centre and Health Canada approvals in June 2021. The trial is currently ongoing. The first participant was enrolled in July 2021, enrollment closed when 93 participants were randomized in December 2023, and the trial will conclude in June 2024. The study team will be unblinded to conduct analyses after the final participant exits the study. We expect to publish the results in the fourth quarter of 2024. Conclusions: There remains a critical need to identify effective and scalable nonpharmaceutical interventions to enhance cognition in older adults. This trial contributes to our understanding of brain training by providing a potential neurochemical explanation of cognitive benefit. Trial Registration: ClinicalTrials.gov NCT04149457; https://clinicaltrials.gov/ct2/show/NCT04149457 International Registered Report Identifier (IRRID): DERR1-10.2196/59705 ",
doi="10.2196/59705",
url="https://www.researchprotocols.org/2024/1/e59705"
}


@Article{info:doi/10.2196/57258,
author="Kokorelias, Marie Kristina
and Grigorovich, Alisa
and Harris, T. Maurita
and Rehman, Umair
and Ritchie, Louise
and Levy, M. AnneMarie
and Denecke, Kerstin
and McMurray, Josephine",
title="Longitudinal Coadaptation of Older Adults With Wearables and Voice-Activated Virtual Assistants: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="7",
volume="26",
pages="e57258",
keywords="older adults",
keywords="coadaptation",
keywords="voice recognition",
keywords="virtual assistant",
keywords="wearable",
keywords="artificial intelligence",
keywords="smart-assistive technology",
keywords="scoping review",
keywords="review methods",
keywords="review methodology",
keywords="knowledge synthesis",
keywords="synthesis",
keywords="scoping",
keywords="older adult",
keywords="gerontechnology",
keywords="technology",
keywords="smart technology",
keywords="smart technologies",
keywords="smart",
keywords="geriatrics",
keywords="older people",
keywords="geriatric",
keywords="scoping literature review",
keywords="protocol",
keywords="Internet of Things",
keywords="IoT",
keywords="aging",
keywords="PRISMA-ScR",
keywords="Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews",
keywords="user-centered design",
keywords="design",
keywords="user centered",
keywords="mobile phone",
abstract="Background: The integration of smart technologies, including wearables and voice-activated devices, is increasingly recognized for enhancing the independence and well-being of older adults. However, the long-term dynamics of their use and the coadaptation process with older adults remain poorly understood. This scoping review explores how interactions between older adults and smart technologies evolve over time to improve both user experience and technology utility. Objective: This review synthesizes existing research on the coadaptation between older adults and smart technologies, focusing on longitudinal changes in use patterns, the effectiveness of technological adaptations, and the implications for future technology development and deployment to improve user experiences. Methods: Following the Joanna Briggs Institute Reviewer's Manual and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, this scoping review examined peer-reviewed papers from databases including Ovid MEDLINE, Ovid Embase, PEDro, Ovid PsycINFO, and EBSCO CINAHL from the year 2000 to August 28, 2023, and included forward and backward searches. The search was updated on March 1, 2024. Empirical studies were included if they involved (1) individuals aged 55 years or older living independently and (2) focused on interactions and adaptations between older adults and wearables and voice-activated virtual assistants in interventions for a minimum period of 8 weeks. Data extraction was informed by the selection and optimization with compensation framework and the sex- and gender-based analysis plus theoretical framework and used a directed content analysis approach. Results: The search yielded 16,143 papers. Following title and abstract screening and a full-text review, 5 papers met the inclusion criteria. Study populations were mostly female participants and aged 73-83 years from the United States and engaged with voice-activated virtual assistants accessed through smart speakers and wearables. Users frequently used simple commands related to music and weather, integrating devices into daily routines. However, communication barriers often led to frustration due to devices' inability to recognize cues or provide personalized responses. The findings suggest that while older adults can integrate smart technologies into their lives, a lack of customization and user-friendly interfaces hinder long-term adoption and satisfaction. The studies highlight the need for technology to be further developed so they can better meet this demographic's evolving needs and call for research addressing small sample sizes and limited diversity. Conclusions: Our findings highlight a critical need for continued research into the dynamic and reciprocal relationship between smart technologies and older adults over time. Future studies should focus on more diverse populations and extend monitoring periods to provide deeper insights into the coadaptation process. Insights gained from this review are vital for informing the development of more intuitive, user-centric smart technology solutions to better support the aging population in maintaining independence and enhancing their quality of life. International Registered Report Identifier (IRRID): RR2-10.2196/51129 ",
doi="10.2196/57258",
url="https://www.jmir.org/2024/1/e57258"
}


@Article{info:doi/10.2196/49403,
author="Wong, Ching Arkers Kwan
and Bayuo, Jonathan
and Su, Jing Jing
and Chow, Sum Karen Kit
and Wong, Man Siu
and Wong, Po Bonnie
and Lee, Lam Athena Yin
and Wong, Yuet Frances Kam",
title="Exploring the Experiences of Community-Dwelling Older Adults on Using Wearable Monitoring Devices With Regular Support From Community Health Workers, Nurses, and Social Workers: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="7",
volume="26",
pages="e49403",
keywords="community-dwelling older adults",
keywords="focus group",
keywords="wearable monitoring devices",
keywords="mobile phone",
abstract="Background: The use of wearable monitoring devices (WMDs), such as smartwatches, is advancing support and care for community-dwelling older adults across the globe. Despite existing evidence of the importance of WMDs in preventing problems and promoting health, significant concerns remain about the decline in use after a period of time, which warrant an understanding of how older adults experience the devices. Objective: This study aims to explore and describe the experiences of community-dwelling older adults after receiving our interventional program, which included the use of a smartwatch with support from a community health workers, nurses, and social workers, including the challenges that they experienced while using the device, the perceived benefits, and strategies to promote their sustained use of the device. Methods: We used a qualitative descriptive approach in this study. Older adults who had taken part in an interventional study involving the use of smartwatches and who were receiving regular health and social support were invited to participate in focus group discussions at the end of the trial. Purposive sampling was used to recruit potential participants. Older adults who agreed to participate were assigned to focus groups based on their community. The focus group discussions were facilitated and moderated by 2 members of the research team. All discussions were recorded and transcribed verbatim. We used the constant comparison analytical approach to analyze the focus group data. Results: A total of 22 participants assigned to 6 focus groups participated in the study. The experiences of community-dwelling older adults emerged as (1) challenges associated with the use of WMDs, (2) the perceived benefits of using the WMDs, and (3) strategies to promote the use of WMDs. In addition, the findings also demonstrate a hierarchical pattern of health-seeking behaviors by older adults: seeking assistance first from older adult volunteers, then from social workers, and finally from nurses. Conclusions: Ongoing use of the WMDs is potentially possible, but it is important to ensure the availability of technical support, maintain active professional follow-ups by nurses and social workers, and include older adult volunteers to support other older adults in such programs. ",
doi="10.2196/49403",
url="https://www.jmir.org/2024/1/e49403",
url="http://www.ncbi.nlm.nih.gov/pubmed/39110493"
}


@Article{info:doi/10.2196/58174,
author="Shi, Beibei
and Li, Guangkai
and Wu, Shuang
and Ge, Hongli
and Zhang, Xianliang
and Chen, Si
and Pan, Yang
and He, Qiang",
title="Assessing the Effectiveness of eHealth Interventions to Manage Multiple Lifestyle Risk Behaviors Among Older Adults: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="31",
volume="26",
pages="e58174",
keywords="eHealth",
keywords="lifestyle risk behaviors",
keywords="older adults",
keywords="multiple health behavior change",
keywords="mobile phone",
abstract="Background: Developing adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors. Objective: The purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ?2 major lifestyle risk behaviors in people aged ?50 years. Methods: The literature search was conducted in 6 electronic databases---PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus---from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ?2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep. Results: A total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95\% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95\% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95\% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95\% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95\% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD --0.23, 95\% CI --0.33 to --0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. Conclusions: eHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult--oriented research is needed to develop eHealth interventions that can change multiple behaviors. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42023444418 ",
doi="10.2196/58174",
url="https://www.jmir.org/2024/1/e58174"
}


@Article{info:doi/10.2196/56433,
author="Herold, Fabian
and Theobald, Paula
and Gronwald, Thomas
and Kaushal, Navin
and Zou, Liye
and de Bruin, D. Eling
and Bherer, Louis
and M{\"u}ller, G. Notger",
title="The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions",
journal="JMIR Aging",
year="2024",
month="Jul",
day="31",
volume="7",
pages="e56433",
keywords="physical activity",
keywords="dementia prevention",
keywords="cognitive health",
keywords="hybrid: aging in place",
keywords="active",
keywords="exercises",
keywords="exercising",
keywords="healthy lifestyle",
keywords="dementia",
keywords="dementia onset",
keywords="dementia care",
keywords="preventive",
keywords="prevention",
keywords="cognition",
keywords="cognitive",
keywords="hybrid",
keywords="hybrid model",
doi="10.2196/56433",
url="https://aging.jmir.org/2024/1/e56433",
url="http://www.ncbi.nlm.nih.gov/pubmed/39083334"
}


@Article{info:doi/10.2196/58846,
author="Sweeting, Anna
and Warncken, A. Katie
and Patel, Martyn",
title="The Role of Assistive Technology in Enabling Older Adults to Achieve Independent Living: Past and Future",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="30",
volume="26",
pages="e58846",
keywords="assistive technology",
keywords="older adults",
keywords="users",
keywords="aging",
keywords="aging in place",
keywords="UK",
keywords="cocreation",
keywords="research trial",
keywords="independent living",
keywords="North Norfolk",
keywords="disability",
keywords="injury",
keywords="tool",
keywords="use",
keywords="design",
keywords="barrier",
doi="10.2196/58846",
url="https://www.jmir.org/2024/1/e58846"
}


@Article{info:doi/10.2196/57694,
author="Tung, Heng-Hsin
and Kuo, Chen-Yuan
and Lee, Pei-Lin
and Chang, Chih-Wen
and Chou, Kun-Hsien
and Lin, Ching-Po
and Chen, Liang-Kung",
title="Efficacy of Digital Dance on Brain Imagery, Cognition, and Health: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="30",
volume="26",
pages="e57694",
keywords="digital",
keywords="somatosensory dance",
keywords="somatosensory game",
keywords="cognitive performance",
keywords="physical function",
keywords="resilience",
keywords="demoralization",
keywords="quality of life",
keywords="dance",
keywords="dancer",
keywords="dancing",
keywords="movement",
keywords="sport",
keywords="sports",
keywords="cognitive",
keywords="cognition",
keywords="brain",
keywords="neuroscience",
keywords="image",
keywords="imagery",
keywords="imaging",
keywords="RCT",
keywords="randomized",
keywords="controlled trial",
keywords="controlled trials",
keywords="somatosensory",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="aging",
keywords="aged",
keywords="game",
keywords="games",
keywords="gaming",
abstract="Background: Multidomain interventions have demonstrable benefits for promoting healthy aging, but self-empowerment strategies to sustain long-term gains remain elusive. Objective: This study evaluated the effects of digital somatosensory dance game participation on brain imagery changes as primary outcomes and other physical and mental health measures as secondary outcomes related to healthy aging. Methods: Between August 31, 2020, and June 27, 2021, this randomized controlled trial recruited 60 eligible participants older than 55 years with no recent engagement in digital dance games. A computer-generated randomization sequence was used to allocate participants 1:1, without stratification, to an intervention group (n=30) who underwent digital somatosensory dance game training or a control group (n=30). An anonymized code masked the intervention allocations from the investigators, and individuals who assigned the interventions were not involved in analyzing the study data. The intervention entailed two 30-minute dance game sessions per week for 6 months, and the control group received healthy aging education. Primary outcomes were brain imagery changes. All variables were measured at baseline and the 6-month follow-up, and intervention effects were estimated using t tests with intention-to-treat analyses. Results: Compared with the control group, intervention participants had significantly different brain imagery in the gray matter volume (GMV) of the left putamen (estimate 0.016, 95\% CI 0.008 to 0.024; P<.001), GMV of the left pallidum (estimate 0.02, 95\% CI 0.006 to 0.034; P=.004), and fractional amplitude of low frequency fluctuations of the left pallidum (estimate 0.262, 95\% CI 0.084 to 0.439; P=.004). Additionally, the intervention group had different imagery in the cerebellum VI GMV (estimate 0.011, 95\% CI 0.003 to 0.02; P=.01). The intervention group also had improved total Montreal Cognitive Assessment scores (estimate 1.2, 95\% CI 0.27 to ?2.13; P<.01), quality of life (estimate 7.08, 95\% CI 2.35 to 11.82; P=.004), and time spent sitting on weekdays (estimate ?1.96, 95\% CI ?3.33 to ?0.60; P=.005). Furthermore, dance performance was significantly associated with cognitive performance (P=.003), health status (P=.14), resilience (P=.007), and demoralization (P<.001). Conclusions: Digital somatosensory dance game participation for 6 months was associated with brain imagery changes in multiple regions involving somatosensory, motor, visual, and attention functions, which were consistent with phenotypic improvements associated with healthy aging. Trial Registration: ClinicalTrials.gov NCT05411042; https://clinicaltrials.gov/study/NCT05411042 ",
doi="10.2196/57694",
url="https://www.jmir.org/2024/1/e57694",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078687"
}


@Article{info:doi/10.2196/53450,
author="Wu, Yi-Chen
and Shen, Shu-Fen
and Chen, Liang-Kung
and Tung, Heng-Hsin",
title="A Web-Based Resilience-Enhancing Program to Improve Resilience, Physical Activity, and Well-being in Geriatric Population: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="25",
volume="26",
pages="e53450",
keywords="geriatric population",
keywords="community-dwelling older adult",
keywords="web-based resilience-enhancing program",
keywords="resilience",
keywords="physical activity",
keywords="well-being",
keywords="pandemic.",
abstract="Background: Resilience is a protective factor in healthy aging, helping to maintain and recover physical and mental functions. The Resilience in Illness Model has proven effective in fostering resilience and well-being. Physical activity is crucial for older adults' independence and well-being, even as aging causes a progressive decline. Additionally, older adults face challenges such as spousal loss and physical disability, making preventive intervention strategies necessary. Objective: This study aims to develop and evaluate a web-based program to enhance resilience, physical activity, and well-being among community-dwelling older adults. Additionally, we aim to gather feedback on the program's strengths and limitations. Methods: A 4-week resilience-enhancing program was created, incorporating role-play and talk-in-interaction and focusing on 3 key skills: coping, control belief, and manageability. The program included scenarios such as becoming widowed and suffering a stroke, designed to engage older adults. A pilot test preceded the intervention. As a result of the COVID-19 pandemic, the program shifted from in-person to web-based sessions. A single-blind, parallel-group, randomized controlled trial was conducted. Participants aged over 65 years were recruited offline and randomly assigned to either an intervention or control group. A certified resilience practitioner delivered the program. Outcomes in resilience, physical activity, and well-being were self-assessed at baseline (T0), 4 weeks (T1), and 12 weeks (T2) after the program. A mixed methods approach was used to evaluate feedback. Results: A web-based participatory program enhancing 3 skills---coping, control belief, and manageability for resilience---was well developed. Among 96 participants, 63 were randomized into the intervention group (n=31) and the control group (n=32). The mean age in the intervention group was 69.27 (SD 3.08) years and 74.84 (SD 6.23) years in the control group. Significant between-group differences at baseline were found in age (t45.6=--4.53, P<.001) and physical activity at baseline (t61=2.92, P=.005). No statistically significant between-group differences over time were observed in resilience (SE 7.49, 95\% CI --10.74 to 18.61, P=.60), physical activity (SE 15.18, 95\% CI --24.74 to 34.74, P=.74), and well-being (SE 3.74, 95\% CI --2.68 to 11.98, P=.21) after controlling for baseline differences. The dropout rate was lower in the intervention group (2/31, 6\%) compared with the control group (5/32, 16\%). Moreover, 77\% (24/31) of participants in the intervention group completed the entire program. Program feedback from the participants indicated high satisfaction with the web-based format and mentorship support. Conclusions: This study demonstrated that a web-based resilience-enhancing program is appropriate, acceptable, feasible, and engaging for community-dwelling older adults. The program garnered enthusiasm for its potential to optimize resilience, physical activity, and well-being, with mentorship playing a crucial role in its success. Future studies should aim to refine program content, engagement, and delivery methods to effectively promote healthy aging in this population. Trial Registration: ClinicalTrials.gov NCT05808491; https://clinicaltrials.gov/ct2/show/NCT05808491 ",
doi="10.2196/53450",
url="https://www.jmir.org/2024/1/e53450"
}


@Article{info:doi/10.2196/52555,
author="Roquet, Ang{\'e}lique
and Martinelli, Paolo
and Lampraki, Charikleia
and Jopp, S. Daniela",
title="Internet Use as a Moderator of the Relationship Between Personal Resources and Stress in Older Adults: Cross-Sectional Study",
journal="JMIR Aging",
year="2024",
month="Jul",
day="19",
volume="7",
pages="e52555",
keywords="internet use",
keywords="aging",
keywords="stress",
keywords="personal resources",
keywords="technical resources",
keywords="Hobfoll's Conservation of Resources theory",
keywords="COR theory",
abstract="Background: Internet use has dramatically increased worldwide, with over two-thirds of the world's population using it, including the older adult population. Technical resources such as internet use have been shown to influence psychological processes such as stress positively. Following the Conservation of Resources theory by Hobfoll, stress experience largely depends on individuals' personal resources and the changes in these resources. While personal resource loss has been shown to lead to stress, we know little regarding the role that technical resources may play on the relationship between personal resources and stress. Objective: This study aims to investigate the moderating effect of technical resources (internet use) on the relationship between personal resources and stress in younger and older adults. Methods: A total of 275 younger adults (aged 18 to 30 years) and 224 older adults (aged ?65 years) indicated their levels of stress; change in personal resources (ie, cognitive, social, and self-efficacy resource loss and gain); and internet use. Variance analyses, multiple regression, and moderation analyses were performed to investigate the correlates of stress. Results: Results showed that older adults, despite experiencing higher levels of resource loss (questionnaire scores: 1.82 vs 1.54; P<.001) and less resource gain (questionnaire scores: 1.82 vs 2.31; P<.001), were less stressed than younger adults (questionnaire scores: 1.99 vs 2.47; P<.001). We observed that the relationship among resource loss, resource gain, and stress in older adults was moderated by their level of internet use ($\beta$=.09; P=.05). Specifically, older adults who used the internet more frequently were less stressed when they experienced high levels of both loss and gain compared to their counterparts who used internet the less in the same conditions. Furthermore, older adults with low resource gain and high resource loss expressed less stress when they used the internet more often compared to those with low internet use. Conclusions: These findings highlight the importance of internet use in mitigating stress among older adults experiencing resource loss and gain, emphasizing the potential of digital interventions to promote mental health in this population. ",
doi="10.2196/52555",
url="https://aging.jmir.org/2024/1/e52555",
url="http://www.ncbi.nlm.nih.gov/pubmed/39028547"
}


@Article{info:doi/10.2196/56608,
author="Miura, Watanabe Kumi
and Kudo, Takashi
and Otake-Matsuura, Mihoko",
title="Web-Based Group Conversational Intervention on Cognitive Function and Comprehensive Functional Status Among Japanese Older Adults: Protocol for a 6-Month Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="11",
volume="13",
pages="e56608",
keywords="randomized controlled trial",
keywords="web-based intervention",
keywords="communication technology",
keywords="cognitive health",
keywords="neural blood markers",
keywords="social isolation",
keywords="well-being",
abstract="Background: Social communication is a key factor in maintaining cognitive function and contributes to well-being in later life. Objective: This study will examine the effects of ``Photo-Integrated Conversation Moderated by Application version 2'' (PICMOA-2), which is a web-based conversational intervention, on cognitive performance, frailty, and social and psychological indicators among community-dwelling older adults. Methods: This study is a randomized controlled trial with an open-label, 2-parallel group trial and 1:1 allocation design. Community dwellers aged 65 years and older were enrolled in the trial and divided into the intervention and control groups. The intervention group receives the PICMOA-2 program, a web-based group conversation, once every 2 weeks for 6 months. The primary outcome is verbal fluency, including phonemic and semantic fluency. The secondary outcomes are other neuropsychiatric batteries, including the Mini-Mental State Examination, Logical Memory (immediate and delay), verbal paired associates, and comprehensive functional status evaluated by questionnaires, including frailty, social status, and well-being. The effect of the intervention will be examined using a mixed linear model. As a secondary aim, we will test whether the intervention effects vary with the covariates at baseline to examine the effective target attributes. Results: Recruitment was completed in July 2023. A total of 66 participants were randomly allocated to intervention or control groups. As of January 1, 2024, the intervention is ongoing. Participants are expected to complete the intervention at the end of February 2024, and the postintervention evaluation will be conducted in March 2024. Conclusions: This protocol outlines the randomized controlled trial study design evaluating the effect of a 6-month intervention with PICMOA-2. This study will provide evidence on the effectiveness of social interventions on cognitive function and identify effective target images for remote social intervention. Trial Registration: UMIN Clinical Trials UMIN000050877; https://tinyurl.com/5eahsy66 International Registered Report Identifier (IRRID): DERR1-10.2196/56608 ",
doi="10.2196/56608",
url="https://www.researchprotocols.org/2024/1/e56608",
url="http://www.ncbi.nlm.nih.gov/pubmed/38990615"
}


@Article{info:doi/10.2196/53289,
author="Tennant, Ryan
and Allana, Sana
and Mercer, Kate
and Burns, M. Catherine",
title="Capturing Home Care Information Management and Communication Processes Among Caregivers of Older Adults: Qualitative Study to Inform Technology Design",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="4",
volume="8",
pages="e53289",
keywords="aged",
keywords="caregivers",
keywords="patient safety",
keywords="communication",
keywords="patient care team",
keywords="information management",
keywords="digital technology",
keywords="human-centered design",
keywords="mobile phone",
abstract="Background: The demand for complex home care is increasing with the growing aging population and the ongoing COVID-19 pandemic. Family and hired caregivers play a critical role in providing care for individuals with complex home care needs. However, there are significant gaps in research informing the design of complex home care technologies that consider the experiences of family and hired caregivers collectively. Objective: The objective of this study was to explore the health documentation and communication experiences of family and hired caregivers to inform the design and adoption of new technologies for complex home care. Methods: The research involved semistructured interviews with 15 caregivers, including family and hired caregivers, each of whom was caring for an older adult with complex medical needs in their home in Ontario, Canada. Due to COVID-19--related protection measures, the interviews were conducted via Teams (Microsoft Corp). The interview guide was informed by the cognitive work analysis framework, and the interview was conducted using storytelling principles of narrative medicine to enhance knowledge. Inductive thematic analysis was used to code the data and develop themes. Results: Three main themes were developed. The first theme described how participants were continually updating the caregiver team, which captured how health information, including their communication motivations and intentions, was shared among family and hired caregiver participants. The subthemes included binder-based health documentation, digital health documentation, and communication practices beyond the binder. The second theme described how participants were learning to improve care and decision-making, which captured how they acted on information from various sources to provide care. The subthemes included developing expertise as a family caregiver and tailoring expertise as a hired caregiver. The third theme described how participants experienced conflicts within caregiver teams, which captured the different struggles arising from, and the causes of, breakdowns in communication and coordination between family and hired caregiver participants. The subthemes included 2-way communication and trusting the caregiver team. Conclusions: This study highlights the health information communication and coordination challenges and experiences that family and hired caregivers face in complex home care settings for older adults. Given the challenges of this work domain, there is an opportunity for appropriate digital technology design to improve complex home care. When designing complex home care technologies, it will be critical to include the overlapping and disparate perspectives of family and hired caregivers collectively providing home care for older adults with complex needs to support all caregivers in their vital roles. ",
doi="10.2196/53289",
url="https://formative.jmir.org/2024/1/e53289",
url="http://www.ncbi.nlm.nih.gov/pubmed/38963695"
}


@Article{info:doi/10.2196/51987,
author="Chien, Shao-Yun
and Zaslavsky, Oleg
and Berridge, Clara",
title="Technology Usability for People Living With Dementia: Concept Analysis",
journal="JMIR Aging",
year="2024",
month="Jul",
day="3",
volume="7",
pages="e51987",
keywords="usability",
keywords="dementia",
keywords="older adults",
keywords="technology",
keywords="concept analysis",
keywords="mobile phone",
abstract="Background: Usability is a key indicator of the quality of technology products. In tandem with technological advancements, potential use by individuals with dementia is increasing. However, defining the usability of technology for individuals with dementia remains an ongoing challenge. The diverse and progressive nature of dementia adds complexity to the creation of universal usability criteria, highlighting the need for focused deliberations. Technological interventions offer potential benefits for people living with dementia and caregivers. Amid COVID-19, technology's role in health care access is growing, especially among older adults. Enabling the diverse population of people living with dementia to enjoy the benefits of technologies requires particular attention to their needs, desires, capabilities, and vulnerabilities to potential harm from technologies. Successful technological interventions for dementia require meticulous consideration of technology usability. Objective: This concept analysis aims to examine the usability of technology in the context of individuals living with dementia to establish a clear definition for usability within this specific demographic. Methods: The framework by Walker and Avant was used to guide this concept analysis. We conducted a literature review spanning 1984 to 2024, exploring technology usability for people with dementia through the PubMed, Web of Science, and Google Scholar databases using the keywords ``technology usability'' and ``dementia.'' We also incorporated clinical definitions and integrated interview data from 29 dyads comprising individuals with mild Alzheimer dementia and their respective care partners, resulting in a total of 58 older adults. This approach aimed to offer a more comprehensive portrayal of the usability needs of individuals living with dementia, emphasizing practical application. Results: The evidence from the literature review unveiled that usability encompasses attributes such as acceptable learnability, efficiency, and satisfaction. The clinical perspective on dementia stages, subtypes, and symptoms underscores the importance of tailored technology usability assessment. Feedback from 29 dyads also emphasized the value of simplicity, clear navigation, age-sensitive design, personalized features, and audio support. Thus, design should prioritize personalized assistance for individuals living with dementia, moving away from standardized technological approaches. Synthesized from various sources, the defined usability attributes for individuals living with dementia not only encompass the general usability properties of effectiveness, efficiency, and satisfaction but also include other key factors: adaptability, personalization, intuitiveness, and simplicity, to ensure that technology is supportive and yields tangible benefits for this demographic. Conclusions: Usability is crucial for people living with dementia when designing technological interventions. It necessitates an understanding of user characteristics, dementia stages, symptoms, needs, and tasks, as well as consideration of varied physical requirements, potential sensory loss, and age-related changes. Disease progression requires adapting to evolving symptoms. Recommendations include versatile, multifunctional technology designs; accommodating diverse needs; and adjusting software functionalities for personalization. Product feature classification can be flexible based on user conditions. ",
doi="10.2196/51987",
url="https://aging.jmir.org/2024/1/e51987"
}


@Article{info:doi/10.2196/58503,
author="LoCastro, Marissa
and Wang, Ying
and Yu, Tristan
and Mortaz-Hedjri, Soroush
and Mendler, Jason
and Norton, Sally
and Bernacki, Rachelle
and Carroll, Thomas
and Klepin, Heidi
and Wedow, Lucy
and Goonan, Sean
and Erdos, Hannah
and Bagnato, Brenda
and Liesveld, Jane
and Huselton, Eric
and Kluger, Benzi
and Loh, Poh Kah",
title="Clinicians' Perspectives on the Telehealth Serious Illness Care Program for Older Adults With Myeloid Malignancies: Single-Arm Pilot Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="27",
volume="8",
pages="e58503",
keywords="serious illness conversations",
keywords="serious illness conversation",
keywords="SIC",
keywords="Serious Illness Care Program",
keywords="SICP",
keywords="hematologic malignancy",
keywords="geriatric oncology",
keywords="acute myeloid leukemia",
keywords="AML",
keywords="myelodysplastic syndrome",
keywords="MDS",
keywords="cancer",
keywords="oncology",
keywords="oncologist",
keywords="oncologists",
keywords="metastases",
keywords="telemedicine",
keywords="telehealth",
keywords="tele-medicine",
keywords="tele-health",
abstract="Background: Serious illness conversations may help patients avoid unwanted treatments. We previously piloted the telehealth Serious Illness Care Program (SICP) for older adults with acute myeloid leukemia and myelodysplastic syndrome. Objective: In this study, we aimed to understand the experience of the telehealth SICP from the clinician's perspective. Methods: We studied 10 clinicians who delivered the telehealth SICP to 20 older adults with acute myeloid leukemia or myelodysplastic syndrome. Quantitative outcomes included confidence and acceptability. Confidence was measured using a 22-item survey (range 1-7; a higher score is better). Acceptability was measured using an 11-item survey (5-point Likert scale). Hypothesis testing was performed at $\alpha$=.10 (2-tailed) due to the pilot nature and small sample size. Clinicians participated in audio-recorded qualitative interviews at the end of the study to discuss their experience. Results: A total of 8 clinicians completed the confidence measure and 7 clinicians completed the acceptability measure. We found a statistically significant increase in overall confidence (mean increase of 0.5, SD 0.6; P=.03). The largest increase in confidence was in helping families with reconciliation and goodbye (mean 1.4, SD 1.5; P=.04). The majority of clinicians agreed that the format was simple (6/7, 86\%) and easy to use (6/7, 86\%). Clinicians felt that the telehealth SICP was effective in understanding their patients' values about end-of-life care (7/7, 100\%). A total of three qualitative themes emerged: (1) the telehealth SICP deepened relationships and renewed trust; (2) each telehealth SICP visit felt unique and personal in a positive way; and (3) uninterrupted, unrushed time optimized the visit experience. Conclusions: The telehealth SICP increased confidence in having serious illness conversations while deepening patient-clinician relationships. Trial Registration: ClinicalTrials.gov NCT04745676; https://www.clinicaltrials.gov/study/NCT04745676 ",
doi="10.2196/58503",
url="https://formative.jmir.org/2024/1/e58503",
url="http://www.ncbi.nlm.nih.gov/pubmed/38935428"
}


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


@Article{info:doi/10.2196/54074,
author="Gomes, Cunha Mateus
and Castro, Robert
and Silva Serra, Willian
and Sagica de Vasconcelos, Jhak
and Parente, Andressa
and Botelho, Pinheiro Eli{\~a}
and Ferreira, Glenda
and Sousa, Fabianne",
title="Demographic Profile, Health, and Associated Factors of Family Caregivers and Functionality of Hospitalized Older Adults: Cross-Sectional, Exploratory, and Descriptive Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="21",
volume="8",
pages="e54074",
keywords="family caregiver",
keywords="older adult",
keywords="hospitalization",
keywords="functionality",
keywords="caregiver",
keywords="health",
abstract="Background: The longevity of the world population can contribute to an increase in hospitalizations and, consequently, to the emergence of functional limitations, resulting in the need for family caregivers. Hospitalized older adults may become dependent and require more care, increasing the burden on family caregivers. Thus, the nursing team in the hospital environment faces a new situation: an increase in the number of older adults occupying hospital beds and the presence of their family caregivers. Objective: We aimed to analyze the association between the demographic variables of interest and the self-rated health of family caregivers and to describe the functionality of older adults hospitalized in a university hospital in the Amazonian context. Methods: This cross-sectional, quantitative, exploratory, and descriptive study was carried out through individual interviews with 98 interviewees, divided into 49 family caregivers and 49 older adults hospitalized in the surgical clinic sector of a university hospital in Brazil between February and March 2023. Demographic data and health conditions were collected from family caregivers, and to describe the functionality of hospitalized older adults, the Barthel Index was applied. Descriptive (frequency and percentage) and inferential analyses were used, and the student t test was applied. The significance level of 5\% was adopted. Results: Among the 49 family caregivers, the majority were women (n=40, 81.6\%) with an average age of 46.9 (SD 13.3) years. Most were single (n=28, 57.1\%) and had completed an average level of education (n=26, 53.1\%). Additionally, 25 (51\%) caregivers were caring for their parents. Regarding health conditions, respondents self-assessed their health as good (25/49, 51\%; P=.01), and they considered that their health status was not affected by the provision of care (36/49, 73.5\%; P=.01). There was a significant association between demographic variables (ie, gender, age, and education) and self-assessment of family caregivers (P=.01, P=.01, and P=.04, respectively). Of the 49 older adults hospitalized, the majority (n=31, 63.2\%) were men, with a mean age of 69.2 (SD 7.12) years. Regarding the assessment of functionality, most older adults were classified as having mild dependence on care (n=23, 46.9\%), specifically in the age group between 60 and 69 years (21/49, 67.8\%). Conclusions: The data revealed that female gender, age, and education of family caregivers contributed favorably to the provision of care to hospitalized older adults with a lower degree of functional dependence. It is important to emphasize that during the older adult's hospitalization, the family caregiver should not be seen as a delegation of responsibilities or as a complement of human resources to assist in their recovery. Health professionals need to implement assertive interventions so that the family caregiver functions as a therapeutic resource. ",
doi="10.2196/54074",
url="https://formative.jmir.org/2024/1/e54074"
}


@Article{info:doi/10.2196/53607,
author="Chan, Wing Colette Sze
and Kan, Pui Mandy Ming
and Wong, Ching Arkers Kwan",
title="Effects of Peer- or Professional-Led Support in Enhancing Adherence to Wearable Monitoring Devices Among Community-Dwelling Older Adults: Systematic Review of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="20",
volume="26",
pages="e53607",
keywords="wearable monitoring device",
keywords="older adults",
keywords="adherence",
keywords="systematic review",
keywords="healthy aging",
keywords="peer support",
keywords="professional help",
keywords="support",
keywords="peers",
keywords="peer",
keywords="professionals",
keywords="wearable",
keywords="monitoring devices",
keywords="monitoring device",
keywords="community-dwelling",
keywords="older adult",
keywords="aging",
keywords="elderly",
abstract="Background: Despite the well-documented health benefits associated with wearable monitoring devices (WMDs), adherence among community-dwelling older adults remains low. By providing guidance on the purpose and benefits of using WMDs, facilitating goal-setting aligned with the device's features, promoting comprehension of the health data captured by the device, and assisting in overcoming technological challenges, peers and health care professionals can potentially enhance older adults' adherence to WMDs. However, the effectiveness of such support mechanisms in promoting adherence to WMDs among older adults remains poorly understood. Objective: The aims of this systematic review were to examine the effects of peer- or professional-led intervention programs designed to improve adherence to WMDs among community-dwelling older adults and to identify the intervention components that may positively influence the effects of the intervention. Methods: We conducted a comprehensive search across 7 electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], PubMed, EMBASE, PsycINFO, British Nursing Index, Web of Science, and CINAHL) to identify articles published between January 1, 2010, and June 26, 2023. We specifically targeted randomized controlled trials that examined the impact of peer- or professional-led interventions on enhancing adherence to WMDs among individuals aged 60 years and older residing in the community. Two independent reviewers extracted data from the included studies and assessed the potential risk of bias in accordance with the Cochrane Risk of Bias tool for randomized trials, version 2. Results: A total of 10,511 studies were identified through the database search. Eventually, we included 3 randomized controlled trials involving 154 community-dwelling older adults. The participants had a mean age of 65 years. Our review revealed that increasing awareness of being monitored and implementing the SystemCHANGE approach, a habit change tool focusing on personal goals and feedback, were effective strategies for enhancing adherence to WMDs among older adults. All of the included studies exhibited a low risk of bias. Conclusions: By collaboratively designing specific goals related to WMDs with health care professionals, including nurses and physicians, older adults exhibited a higher likelihood of adhering to the prescribed use of WMDs. These goal-setting tools provided a framework for structure and motivation, facilitating the seamless integration of WMDs into their daily routines. Researchers should prioritize interventions that target awareness and goal-setting as effective approaches to enhance adherence to WMDs among older adults, thereby maximizing the realization of associated health benefits. ",
doi="10.2196/53607",
url="https://www.jmir.org/2024/1/e53607",
url="http://www.ncbi.nlm.nih.gov/pubmed/38900546"
}


@Article{info:doi/10.2196/59294,
author="Pickett, C. Andrew
and Valdez, Danny
and Sinclair, L. Kelsey
and Kochell, J. Wesley
and Fowler, Boone
and Werner, E. Nicole",
title="Social Media Discourse Related to Caregiving for Older Adults Living With Alzheimer Disease and Related Dementias: Computational and Qualitative Study",
journal="JMIR Aging",
year="2024",
month="Jun",
day="19",
volume="7",
pages="e59294",
keywords="caregiving",
keywords="dementia",
keywords="social support",
keywords="social media",
keywords="Reddit",
abstract="Background: In the United States, caregivers of people living with Alzheimer disease and Alzheimer disease--related dementias (AD/ADRD) provide >16 billion hours of unpaid care annually. These caregivers experience high levels of stress and burden related to the challenges associated with providing care. Social media is an emerging space for individuals to seek various forms of support. Objective: We aimed to explore the primary topics of conversation on the social media site Reddit related to AD/ADRD. We then aimed to explore these topics in depth, specifically examining elements of social support and behavioral symptomology discussed by users. Methods: We first generated an unsupervised topic model from 6563 posts made to 2 dementia-specific subreddit forums (r/Alzheimers and r/dementia). Then, we conducted a manual qualitative content analysis of a random subset of these data to further explore salient themes in the corpus. Results: The topic model with the highest overall coherence score (0.38) included 10 topics, including caregiver burden, anxiety, support-seeking, and AD/ADRD behavioral symptomology. Qualitative analyses provided added context, wherein users sought emotional and informational support for many aspects of the care experience, including assistance in making key care-related decisions. Users expressed challenging and complex emotions on Reddit, which may be taboo to express in person. Conclusions: Reddit users seek many different forms of support, including emotional and specific informational support, from others on the internet. Users expressed a variety of concerns, challenges, and behavioral symptoms to manage as part of the care experience. The unique (ie, anonymous and moderated) nature of the forum allowed for a safe space to express emotions free from documented caregiver stigma. Additional support structures are needed to assist caregivers of people living with AD/ADRD. ",
doi="10.2196/59294",
url="https://aging.jmir.org/2024/1/e59294",
url="http://www.ncbi.nlm.nih.gov/pubmed/38896462"
}


@Article{info:doi/10.2196/52069,
author="Steinman, Lesley
and Chadwick, Kelly
and Chavez Santos, Erica
and Sravanam, Sruthi
and Johnson, Snowy Selisha
and Rensema, Elspeth
and Mayotte, Caitlin
and Denison, Paige
and Lorig, Kate",
title="Remote Evidence-Based Programs for Health Promotion to Support Older Adults During the COVID-19 Pandemic and Beyond: Mixed Methods Outcome Evaluation",
journal="JMIR Aging",
year="2024",
month="Jun",
day="13",
volume="7",
pages="e52069",
keywords="older adults",
keywords="health equity",
keywords="rural",
keywords="chronic disease",
keywords="outcome evaluation",
keywords="behavior change",
keywords="technology",
keywords="community based",
keywords="evidence based",
keywords="health promotion",
keywords="mobile phone",
abstract="Background: Evidence-based programs (EBPs) for health promotion were developed to reach older adults where they live, work, pray, and play. When the COVID-19 pandemic placed a disproportionate burden on older adults living with chronic conditions and the community-based organizations that support them, these in-person programs shifted to remote delivery. While EBPs have demonstrated effectiveness when delivered in person, less is known about outcomes when delivered remotely. Objective: This study evaluated changes in remote EBP participants' health and well-being in a national mixed methods outcome evaluation in January 1, 2021, to March 31, 2022. Methods: We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for equity framework to guide the evaluation. We purposively sampled for diverse remote EBP delivery modes and delivery organizations, staff, and traditionally underserved older adults, including people of color and rural dwellers. We included 5 EBPs for self-management, falls prevention, and physical activity: videoconferencing (Chronic Disease Self-Management Program, Diabetes Self-Management Program, and EnhanceFitness), telephone plus mailed materials (Chronic Pain Self-Management Program), and enhanced self-directed mailed materials (Walk With Ease). Participant and provider data included validated surveys, in-depth interviews, and open-ended survey questions. We used descriptive statistics to characterize the sample and the magnitude of change and paired t tests (2-tailed) and the Fisher exact test to test for change in outcomes between enrollment and 6-month follow-up. Thematic analysis was used to identify similarities and differences in outcomes within and across programs. Joint display tables facilitated the integration of quantitative and qualitative findings. Results: A total of 586 older adults, 198 providers, and 37 organizations providing EBPs participated in the evaluation. Of the 586 older adults, 289 (49.3\%) provided follow-up outcome data. The mean age of the EBP participants was 65.4 (SD 12.0) years. Of the 289 EBP participants, 241 (83.4\%) were female, 108 (37.3\%) were people of color, 113 (39.1\%) lived alone, and 99 (34.3\%) were experiencing financial hardship. In addition, the participants reported a mean of 2.5 (SD 1.7) chronic conditions. Overall, the remote EBP participants showed statistically significant improvements in health, energy, sleep quality, loneliness, depressive symptoms, and technology anxiety. Qualitatively, participants shared improvements in knowledge, attitudes, and skills for healthier living; reduced their social isolation and loneliness; and gained better access to programs. Three-fourths of the providers (149/198, 75.2\%) felt that effectiveness was maintained when switching from in-person to remote delivery. Conclusions: The findings suggest that participating in remote EBPs can improve health, social, and technological outcomes of interest for older adults and providers, with benefits extending to policy makers. Future policy and practice can better support remote EBP delivery as one model for health promotion, improving access for all older adults. ",
doi="10.2196/52069",
url="https://aging.jmir.org/2024/1/e52069",
url="http://www.ncbi.nlm.nih.gov/pubmed/38869932"
}


@Article{info:doi/10.2196/58205,
author="Miguel-Cruz, Antonio
and Perez, Hector
and Choi, Yoojin
and Rutledge, Emily
and Daum, Christine
and Liu, Lili",
title="The Prevalence of Missing Incidents and Their Antecedents Among Older Adult MedicAlert Subscribers: Retrospective Descriptive Study",
journal="JMIR Aging",
year="2024",
month="Jun",
day="10",
volume="7",
pages="e58205",
keywords="dementia",
keywords="Alzheimer disease",
keywords="memory loss",
keywords="cognitive impairment",
keywords="missing incident",
keywords="wandering",
keywords="critical wandering",
keywords="older adults",
keywords="retrospective design",
abstract="Background: With the population aging, the number of people living with dementia is expected to rise, which, in turn, is expected to lead to an increase in the prevalence of missing incidents due to critical wandering. However, the estimated prevalence of missing incidents due to dementia is inconclusive in some jurisdictions and overlooked in others. Objective: The aims of the study were to examine (1) the demographic, psychopathological, and environmental antecedents to missing incidents due to critical wandering among older adult MedicAlert Foundation Canada (hereinafter MedicAlert) subscribers; and (2) the characteristics and outcomes of the missing incidents. Methods: This study used a retrospective descriptive design. The sample included 434 older adult MedicAlert subscribers involved in 560 missing incidents between January 2015 and July 2021. Results: The sample was overrepresented by White older adults (329/425, 77.4\%). MedicAlert subscribers reported missing were mostly female older adults (230/431, 53.4\%), living in urban areas with at least 1 family member (277/433, 63.8\%). Most of the MedicAlert subscribers (345/434, 79.5\%) self-reported living with dementia. MedicAlert subscribers went missing most frequently from their private homes in the community (96/143, 67.1\%), traveling on foot (248/270, 91.9\%) and public transport (12/270, 4.4\%), during the afternoon (262/560, 46.8\%) and evening (174/560, 31.1\%). Most were located by first responders (232/486, 47.7\%) or Good Samaritans (224/486, 46.1\%). Of the 560 missing incidents, 126 (22.5\%) were repeated missing incidents. The mean time between missing incidents was 11 (SD 10.8) months. Finally, the majority of MedicAlert subscribers were returned home safely (453/500, 90.6\%); and reports of harm, injuries (46/500, 9.2\%), and death (1/500, 0.2\%) were very low. Conclusions: This study provides the prevalence of missing incidents from 1 database source. The low frequency of missing incidents may not represent populations that are not White. Despite the low number of missing incidents, the 0.2\% (1/500) of cases resulting in injuries or death are devastating experiences that may be mitigated through prevention strategies. ",
doi="10.2196/58205",
url="https://aging.jmir.org/2024/1/e58205",
url="http://www.ncbi.nlm.nih.gov/pubmed/38857069"
}


@Article{info:doi/10.2196/50107,
author="Goerss, Doreen
and K{\"o}hler, Stefanie
and Rong, Eleonora
and Temp, Gesine Anna
and Kilimann, Ingo
and Bieber, Gerald
and Teipel, Stefan",
title="Smartwatch-Based Interventions for People With Dementia: User-Centered Design Approach",
journal="JMIR Aging",
year="2024",
month="Jun",
day="7",
volume="7",
pages="e50107",
keywords="assistive technology",
keywords="user-centered design",
keywords="usability",
keywords="dementia",
keywords="smartwatch",
keywords="mobile phone",
abstract="Background: Assistive technologies can help people living with dementia maintain their everyday activities. Nevertheless, there is a gap between the potential and use of these materials. Involving future users may help close this gap, but the impact on people with dementia is unclear. Objective: We aimed to determine if user-centered development of smartwatch-based interventions together with people with dementia is feasible. In addition, we evaluated the extent to which user feedback is plausible and therefore helpful for technological improvements. Methods: We examined the interactions between smartwatches and people with dementia or people with mild cognitive impairment. All participants were prompted to complete 2 tasks (drinking water and a specific cognitive task). Prompts were triggered using a smartphone as a remote control and were repeated up to 3 times if participants failed to complete a task. Overall, 50\% (20/40) of the participants received regular prompts, and 50\% (20/40) received intensive audiovisual prompts to perform everyday tasks. Participants' reactions were observed remotely via cameras. User feedback was captured via questionnaires, which included topics like usability, design, usefulness, and concerns. The internal consistency of the subscales was calculated. Plausibility was also checked using qualitative approaches. Results: Participants noted their preferences for particular functions and improvements. Patients struggled with rating using the Likert scale; therefore, we assisted them with completing the questionnaire. Usability (mean 78 out of 100, SD 15.22) and usefulness (mean 9 out of 12) were rated high. The smartwatch design was appealing to most participants (31/40, 76\%). Only a few participants (6/40, 15\%) were concerned about using the watch. Better usability was associated with better cognition. The observed success and self-rated task comprehension were in agreement for most participants (32/40, 80\%). In different qualitative analyses, participants' responses were, in most cases, plausible. Only 8\% (3/40) of the participants were completely unaware of their irregular task performance. Conclusions: People with dementia can have positive experiences with smartwatches. Most people with dementia provided valuable information. Developing assistive technologies together with people with dementia can help to prioritize the future development of functional and nonfunctional features. ",
doi="10.2196/50107",
url="https://aging.jmir.org/2024/1/e50107",
url="http://www.ncbi.nlm.nih.gov/pubmed/38848116"
}


@Article{info:doi/10.2196/53261,
author="Szczepocka, Ewa
and Mokros, ?ukasz
and Kazmierski, Jakub
and Nowakowska, Karina
and ?ucka, Anna
and Antoszczyk, Anna
and Oltra-Cucarella, Javier
and Werzowa, Walter
and Hellevik, Moum Martin
and Skouras, Stavros
and Bagger, Karsten",
title="The Effectiveness of Virtual Reality--Based Training on Cognitive, Social, and Physical Functioning in High-Functioning Older Adults (CoSoPhy FX): 2-Arm, Parallel-Group Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="5",
volume="13",
pages="e53261",
keywords="cognitive functions",
keywords="head-mounted-display",
keywords="healthy seniors",
keywords="virtual reality",
keywords="well-being",
keywords="mobile phone",
abstract="Background: Virtual reality (VR) has emerged as a promising technology for enhancing the health care of older individuals, particularly in the domains of cognition, physical activity, and social engagement. However, existing VR products and services have limited availability and affordability; hence, there is a need for a scientifically validated and personalized VR service to be used by older adults in their homes, which can improve their overall physical, cognitive, and social well-being. Objective: The main purpose of the CoSoPhy FX (Cognitive, Social, and Physical Effects) study was to analyze the effects of a VR-based digital therapeutics app on the cognitive, social, and physical performance abilities of healthy (high-functioning) older adults. This paper presents the study protocol and the results from the recruitment phase. Methods: A group of 188 healthy older adults aged 65-85 years, recruited at the Medical University of Lodz, Poland, were randomly allocated to the experimental group (VR dual-task training program) or to the control group (using a VR headset app showing nature videos). A total of 3 cognitive exercises were performed in various 360{\textdegree} nature environments delivered via a VR head-mounted display; the participants listened to their preferred music genre. Each patient received 3 sessions of 12 minutes per week for 12 weeks, totaling a minimum of 36 sessions per participant. Attention and working memory (Central Nervous System Vital Signs computerized cognitive battery) were used as primary outcomes, while other cognitive domains in the Central Nervous System Vital Signs battery, quality of life (World Health Organization--5 Well-Being Index), health-related quality of life (EQ-5D-5L), and anxiety (General Anxiety Disorder 7-item questionnaire) were the secondary outcomes. The group-by-time interaction was determined using linear mixed models with participants' individual slopes. Results: In total, 122 (39\%) of the initial 310 participants failed to meet the inclusion criteria, resulting in a recruitment rate of 61\% (188/310). Among the participants, 68 successfully completed the intervention and 62 completed the control treatment. The data are currently being analyzed, and we plan to publish the results by the end of September 2024. Conclusions: VR interventions have significant potential among healthy older individuals. VR can address various aspects of well-being by stimulating cognitive functions, promoting physical activity, and facilitating social interaction. However, challenges such as physical discomfort, technology acceptance, safety concerns, and cost must be considered when implementing them for older adults. Further research is needed to determine the long-term effects of VR-based interventions, optimal intervention designs, and the specific populations that would benefit most. Trial Registration: ClinicalTrials.gov NCT05369897; https://clinicaltrials.gov/study/NCT05369897 International Registered Report Identifier (IRRID): DERR1-10.2196/53261 ",
doi="10.2196/53261",
url="https://www.researchprotocols.org/2024/1/e53261",
url="http://www.ncbi.nlm.nih.gov/pubmed/38837194"
}


@Article{info:doi/10.2196/53141,
author="Cohen Elimelech, Ortal
and Rosenblum, Sara
and Tsadok-Cohen, Michal
and Meyer, Sonya
and Ferrante, Simona
and Demeter, Naor",
title="Three Perspectives on Older Adults' Daily Performance, Health, and Technology Use During COVID-19: Focus Group Study",
journal="JMIR Aging",
year="2024",
month="May",
day="30",
volume="7",
pages="e53141",
keywords="daily activity",
keywords="health",
keywords="technology use",
keywords="older adult",
keywords="qualitative study",
keywords="focus group",
keywords="COVID-19",
abstract="Background: During COVID-19 lockdowns, older adults' engagement in daily activities was severely affected, causing negative physical and mental health implications. Technology flourished as a means of performing daily activities in this complex situation; however, older adults often struggled to effectively use these opportunities. Despite the important role of older adults' social environments---including their families and health professionals---in influencing their technology use, research into their unique perspectives is lacking. Objective: This study aimed to explore the daily activity performance, health, and technology use experiences of healthy independent Israeli adults (aged ?65 years) during COVID-19 from a 3-dimensional perspective: older adults, older adults' family members, and health professionals. Methods: Nine online focus groups, averaging 6-7 participants per group, were conducted with older adults, family members, and health professionals (N=59). Data were analyzed using thematic analysis and constant comparative methods. Results: The intertwining of daily activity performance and health emerged as a central theme, with differences between the groups. Older adults prioritized their self-fulfilling routines based on motivation and choice, especially in social-familial activities. In contrast, family members and health professionals focused on serious physical and mental health COVID-19--related consequences. A consensus among all three groups revealed the meaningful role of technology use during this period in bridging functional limitations. Participants delved into technology's transformative power, focusing on the need for technology to get engaged in daily activities. Conclusions: This study illustrates the profound interplay between daily activity performances, physical and mental health, and technology use, using a 3-dimensional approach. Its focus on technology's uses and benefits sheds light on what older adults need to increase their technology use. Interventions for improving digital activity performance can be tailored to meet older adults' needs and preferences by focusing on motivational and preference-related activities. ",
doi="10.2196/53141",
url="https://aging.jmir.org/2024/1/e53141"
}


@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/10.2196/53192,
author="Au-Yeung, M. Wan-Tai
and Liu, Yan
and Hanna, Remonda
and Gothard, Sarah
and Rodrigues, Nathaniel
and Leon Guerrero, Cierra
and Beattie, Zachary
and Kaye, Jeffrey",
title="Feasibility of Deploying Home-Based Digital Technology, Environmental Sensors, and Web-Based Surveys for Assessing Behavioral Symptoms and Identifying Their Precipitants in Older Adults: Longitudinal, Observational Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="8",
volume="8",
pages="e53192",
keywords="neuropsychiatric symptoms",
keywords="mild cognitive impairment",
keywords="dementia",
keywords="unobtrusive monitoring",
keywords="digital biomarkers",
keywords="environmental precipitants",
keywords="mobile phone",
abstract="Background: Apathy, depression, and anxiety are prevalent neuropsychiatric symptoms experienced by older adults. Early detection, prevention, and intervention may improve outcomes. Objective: We aim to demonstrate the feasibility of deploying web-based weekly questionnaires inquiring about the behavioral symptoms of older adults with normal cognition, mild cognitive impairment, or early-stage dementia and to demonstrate the feasibility of deploying an in-home technology platform for measuring participant behaviors and their environment. Methods: The target population of this study is older adults with normal cognition, mild cognitive impairment, or early-stage dementia. This is an observational, longitudinal study with a study period of up to 9 months. The severity of participant behavioral symptoms (apathy, depression, and anxiety) was self-reported weekly through web-based surveys. Participants' digital biomarkers were continuously collected at their personal residences and through wearables throughout the duration of the study. The indoor physical environment at each residence, such as light level, noise level, temperature, humidity, or air quality, was also measured using indoor environmental sensors. Feasibility was examined, and preliminary correlation analysis between the level of symptoms and the digital biomarkers and between the level of symptoms and the indoor environment was performed. Results: At 13 months after recruitment began, a total of 9 participants had enrolled into this study. The participants showed high adherence rates in completing the weekly questionnaires (response rate: 275/278, 98.9\%), and data collection using the digital technology appeared feasible and acceptable to the participants with few exceptions. Participants' severity of behavioral symptoms fluctuated from week to week. Preliminary results show that the duration of sleep onset and noise level are positively correlated with the anxiety level in a subset of our participants. Conclusions: This study is a step toward more frequent assessment of older adults' behavioral symptoms and holistic in situ monitoring of older adults' behaviors and their living environment. The goal of this study is to facilitate the development of objective digital biomarkers of neuropsychiatric symptoms and to identify in-home environmental factors that contribute to these symptoms. ",
doi="10.2196/53192",
url="https://formative.jmir.org/2024/1/e53192",
url="http://www.ncbi.nlm.nih.gov/pubmed/38717798"
}


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


@Article{info:doi/10.2196/57878,
author="Xiao, Yan
and Fulda, G. Kimberley
and Young, A. Richard
and Hendrix, Noah Z.
and Daniel, M. Kathryn
and Chen, Yut Kay
and Zhou, Yuan
and Roye, L. Jennifer
and Kosmari, Ludmila
and Wilson, Joshua
and Espinoza, M. Anna
and Sutcliffe, M. Kathleen
and Pitts, I. Samantha
and Arbaje, I. Alicia
and Chui, A. Michelle
and Blair, Somer
and Sloan, Dawn
and Jackson, Masheika
and Gurses, P. Ayse",
title="Patient Partnership Tools to Support Medication Safety in Community-Dwelling Older Adults: Protocol for a Nonrandomized Stepped Wedge Clinical Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="29",
volume="13",
pages="e57878",
keywords="primary care",
keywords="medication safety",
keywords="communication",
keywords="patient engagement",
keywords="human factors",
keywords="medication",
keywords="safety",
keywords="engagement",
keywords="support",
keywords="community dwelling",
keywords="older adults",
keywords="elderly",
keywords="protocol",
keywords="patient safety",
keywords="self-management",
keywords="ambulatory",
keywords="medications",
keywords="tool",
keywords="tools",
keywords="effective",
keywords="data collection",
keywords="decision",
keywords="decision making",
keywords="care",
keywords="self-efficacy",
keywords="engagement tool",
abstract="Background: Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with community resources. Objective: This study aims to assess the impact of a set of patient partnership tools that redesign primary care encounters to encourage and empower patients to make more effective use of those encounters to improve medication safety. Methods: The study is a nonrandomized, cross-sectional stepped wedge cluster-controlled trial with 1 private family medicine clinic and 2 public safety-net primary care clinics each composing their own cluster. There are 2 intervention sequences with 1 cluster per sequence and 1 control sequence with 1 cluster. Cross-sectional surveys will be taken immediately at the conclusion of visits to the clinics during 6 time periods of 6 weeks each, with a transition period of no data collection during intervention implementation. The number of visits to be surveyed will vary by period and cluster. We plan to recruit patients and professionals for surveys during 405 visits. In the experimental periods, visits will be conducted with two partnership tools and associated clinic process changes: (1) a 1-page visit preparation guide given to relevant patients by clinic staff before seeing the provider, with the intention to improve communication and shared decision-making, and (2) a library of short educational videos that clinic staff encourage patients to watch on medication safety. In the control periods, visits will be conducted with usual care. The primary outcome will be patients' self-efficacy in medication use. The secondary outcomes are medication-related issues such as duplicate therapies identified by primary care providers and assessment of collaborative work during visits. Results: The study was funded in September 2019. Data collection started in April 2023 and ended in December 2023. Data was collected for 405 primary care encounters during that period. As of February 15, 2024, initial descriptive statistics were calculated. Full data analysis is expected to be completed and published in the summer of 2024. Conclusions: This study will assess the impact of patient partnership tools and associated process changes in primary care on medication use self-efficacy and medication-related issues. The study is powered to identify types of patients who may benefit most from patient engagement tools in primary care visits. Trial Registration: ClinicalTrials.gov NCT05880368; https://clinicaltrials.gov/study/NCT05880368 International Registered Report Identifier (IRRID): DERR1-10.2196/57878 ",
doi="10.2196/57878",
url="https://www.researchprotocols.org/2024/1/e57878",
url="http://www.ncbi.nlm.nih.gov/pubmed/38684080"
}


@Article{info:doi/10.2196/52898,
author="Rantakokko, Merja
and Matikainen-Tervola, Emmi
and Aartolahti, Eeva
and Sihvonen, Sanna
and Chichaeva, Julija
and Finni, Taija
and Cronin, Neil",
title="Gait Features in Different Environments Contributing to Participation in Outdoor Activities in Old Age (GaitAge): Protocol for an Observational Cross-Sectional Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="29",
volume="13",
pages="e52898",
keywords="walking",
keywords="aging",
keywords="environment",
keywords="biomechanics",
keywords="kinematics",
keywords="spatiotemporal",
keywords="gait",
keywords="GaitAge",
keywords="observational cross-sectional study",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="health disparities",
keywords="health disparity",
keywords="assessment",
keywords="assessments",
keywords="physical test",
keywords="physical tests",
keywords="interview",
keywords="interviews",
keywords="biomechanic",
keywords="activities",
keywords="outdoor",
keywords="activity",
keywords="movement analysis",
keywords="analysis of walk",
keywords="posture",
keywords="free living",
abstract="Background: The ability to walk is a key issue for independent old age. Optimizing older peoples' opportunities for an autonomous and active life and reducing health disparities requires a better understanding of how to support independent mobility in older people. With increasing age, changes in gait parameters such as step length and cadence are common and have been shown to increase the risk of mobility decline. However, gait assessments are typically based on laboratory measures, even though walking in a laboratory environment may be significantly different from walking in outdoor environments. Objective: This project will study alterations in biomechanical features of gait by comparing walking on a treadmill in a laboratory, level outdoor, and hilly outdoor environments. In addition, we will study the possible contribution of changes in gait between these environments to outdoor mobility among older people. Methods: Participants of the study were recruited through senior organizations of Central Finland and the University of the Third Age, Jyv{\"a}skyl{\"a}. Inclusion criteria were community-dwelling, aged 70 years and older, able to walk at least 1 km without assistive devices, able to communicate, and living in central Finland. Exclusion criteria were the use of mobility devices, severe sensory deficit (vision and hearing), memory impairment (Mini-Mental State Examination ?23), and neurological conditions (eg, stroke, Parkinson disease, and multiple sclerosis). The study protocol included 2 research visits. First, indoor measurements were conducted, including interviews (participation, health, and demographics), physical performance tests (short physical performance battery and Timed Up and Go), and motion analysis on a treadmill in the laboratory (3D Vicon and next-generation inertial measurement units [NGIMUs]). Second, outdoor walking tests were conducted, including walking on level (sports track) and hilly (uphill and downhill) terrain, while movement was monitored via NGIMUs, pressure insoles, heart rate, and video data. Results: A total of 40 people (n=26, 65\% women; mean age 76.3, SD 5.45 years) met the inclusion criteria and took part in the study. Data collection took place between May and September 2022. The first result is expected to be published in the spring of 2024. Conclusions: This multidisciplinary study will provide new scientific knowledge about how gait biomechanics are altered in varied environments, and how this influences opportunities to participate in outdoor activities for older people. International Registered Report Identifier (IRRID): RR1-10.2196/52898 ",
doi="10.2196/52898",
url="https://www.researchprotocols.org/2024/1/e52898",
url="http://www.ncbi.nlm.nih.gov/pubmed/38684085"
}


@Article{info:doi/10.2196/52292,
author="Lu, Yinn Si
and Yoon, Sungwon
and Yee, Qi Wan
and Heng Wen Ngiam, Nerice
and Ng, Yi Kennedy Yao
and Low, Leng Lian",
title="Experiences of a Community-Based Digital Intervention Among Older People Living in a Low-Income Neighborhood: Qualitative Study",
journal="JMIR Aging",
year="2024",
month="Apr",
day="25",
volume="7",
pages="e52292",
keywords="digital divide",
keywords="digital learning",
keywords="smartphones",
keywords="social gerontology",
keywords="older adults",
keywords="COVID-19 pandemic",
keywords="technology adoption",
abstract="Background: Older adults worldwide experienced heightened risks of depression, anxiety, loneliness, and poor mental well-being during the COVID-19 pandemic. During this period, digital technology emerged as a means to mitigate social isolation and enhance social connectedness among older adults. However, older adults' behaviors and attitudes toward the adoption and use of digital technology are heterogeneous and shaped by factors such as age, income, and education. Few empirical studies have examined how older adults experiencing social and economic disadvantages perceive the learning of digital tools. Objective: This study aims to examine the motivations, experiences, and perceptions toward a community-based digital intervention among older adults residing in public rental flats in a low-income neighborhood. Specifically, we explored how their attitudes and behaviors toward learning the use of smartphones are shaped by their experiences related to age and socioeconomic challenges. Methods: This study adopted a qualitative methodology. Between December 2020 and March 2021, we conducted semistructured in-depth interviews with 19 participants aged ?60 years who had completed the community-based digital intervention. We asked participants questions about the challenges encountered amid the pandemic, their perceived benefits of and difficulties with smartphone use, and their experiences with participating in the intervention. All interviews were audio recorded and analyzed using a reflexive thematic approach. Results: Although older learners stated varying levels of motivation to learn, most expressed ambivalence about the perceived utility and relevance of the smartphone to their current needs and priorities. While participants valued the social interaction with volunteers and the personalized learning model of the digital intervention, they also articulated barriers such as age-related cognitive and physical limitations and language and illiteracy that hindered their sustained use of these digital devices. Most importantly, the internalization of ageist stereotypes of being less worthy learners and the perception of smartphone use as being in the realm of the privileged other further reduced self-efficacy and interest in learning. Conclusions: To improve learning and sustained use of smartphones for older adults with low income, it is essential to explore avenues that render digital tools pertinent to their daily lives, such as creating opportunities for social connections and relationship building. Future studies should investigate the relationships between older adults' social, economic, and health marginality and their ability to access digital technologies. We recommend that the design and implementation of digital interventions should prioritize catering to the needs and preferences of various segments of older adults, while working to bridge rather than perpetuate the digital divide. ",
doi="10.2196/52292",
url="https://aging.jmir.org/2024/1/e52292",
url="http://www.ncbi.nlm.nih.gov/pubmed/38662423"
}


@Article{info:doi/10.2196/50219,
author="Bults, Marloes
and van Leersum, Margaretha Catharina
and Olthuis, Josef Theodorus Johannes
and Siebrand, Egbert
and Malik, Zohrah
and Liu, Lili
and Miguel-Cruz, Antonio
and Jukema, Seerp Jan
and den Ouden, Maria Marjolein Elisabeth",
title="Acceptance of a Digital Assistant (Anne4Care) for Older Adult Immigrants Living With Dementia: Qualitative Descriptive Study",
journal="JMIR Aging",
year="2024",
month="Apr",
day="19",
volume="7",
pages="e50219",
keywords="assistive technology",
keywords="technology acceptance",
keywords="immigrant",
keywords="dementia",
keywords="marginalized older adults",
abstract="Background: There is a need to develop and coordinate dementia care plans that use assistive technology for vulnerable groups such as immigrant populations. However, immigrant populations are seldom included in various stages of the development and implementation of assistive technology, which does not optimize technology acceptance. Objective: This study aims to gain an in-depth understanding of the acceptance of a digital personal assistant, called Anne4Care, by older adult immigrants living with dementia in their own homes. Methods: This study used a qualitative descriptive research design with naturalistic inquiry. A total of 13 older adults participated in this study. The participants were invited for 2 interviews. After an introduction of Anne4Care, the first interview examined the lives and needs of participants, their expectations, and previous experiences with assistive technology in daily life. Four months later, the second interview sought to understand facilitators and barriers, suggestions for modifications, and the role of health care professionals. Three semistructured interviews were conducted with health care professionals to examine the roles and challenges they experienced in the use and implementation of Anne4Care. Content analysis, using NVivo11, was performed on all transcripts. Results: All 13 participants had an immigration background. There were 10 male and 3 female participants, with ages ranging from 52 to 83 years. Participants were diagnosed with an early-stage form of dementia or acquired brain injury. None of the older adult participants knew or used digital assistive technology at the beginning. They obtained assistance from health care professionals and family caregivers who explained and set up the technology. Four themes were found to be critical aspects of the acceptance of the digital personal assistant Anne4Care: (1) use of Anne4Care, (2) positive aspects of Anne4Care, (3) challenges with Anne4Care, and (4) expectations. Assistance at first increased the burden on health care professionals and families. After the initial effort, most health care professionals and families experienced that Anne4Care reduced their tasks and stress. Contributions of Anne4Care included companionship, help with daily tasks, and opportunities to communicate in multiple languages. On the other hand, some participants expressed anxiety toward the use of Anne4Care. Furthermore, the platform required an internet connection at home and Anne4Care could not be used outside the home. Conclusions: Although older adult immigrants living with dementia had no previous experience with digital assistive technology specifically, the acceptance of the digital personal assistant, called Anne4Care, by older adult immigrants living with dementia was rather high. The digital assistant can be further developed to allow for interactive conversations and for use outside of one's home. Participation of end users during various stages of the development, refinement, and implementation of health technology innovations is of utmost importance to maximize technology acceptance. ",
doi="10.2196/50219",
url="https://aging.jmir.org/2024/1/e50219",
url="http://www.ncbi.nlm.nih.gov/pubmed/38639994"
}


@Article{info:doi/10.2196/55192,
author="Kvalsvik, Fifi
and Larsen, Hamre Bente
and Eilertsen, Grethe
and Falkenberg, K. Helle
and Dalen, Ingvild
and Haaland, Stine
and Storm, Marianne",
title="Health Needs Assessment in Home-Living Older Adults: Protocol for a Pre-Post Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="18",
volume="13",
pages="e55192",
keywords="assessment",
keywords="frailty",
keywords="healthy aging",
keywords="health care",
keywords="home-living older adults",
keywords="pre-post study",
keywords="protocol",
abstract="Background: Conducting a health needs assessment for older adults is important, particularly for early detection and management of frailty. Such assessments can help to improve health outcomes, maintain overall well-being, and support older adults in retaining their independence as they age at home. Objective: In this study, a systematic approach to health needs assessment is adopted in order to reflect real-world practices in municipal health care and capture the nuances of frailty. The aim is to assess changes in frailty levels in home-living older adults over 5 months and to examine the observable functional changes from a prestudy baseline (t1) to a poststudy period (t2). Additionally, the study explores the feasibility of conducting the health needs assessment from the perspective of home-living older adults and their informal caregivers. Methods: Interprofessional teams of registered nurses, physiotherapists, and occupational therapists will conduct 2 health needs assessments covering physical, cognitive, psychological, social, and behavioral domains. The study includes 40 home-living older adults of 75 years of age or older, who have applied for municipal health and care services in Norway. A quantitative approach will be applied to assess changes in frailty levels in home-living older adults over 5 months. In addition, we will examine the observable functional changes from t1 to t2 and how these changes correlate to frailty levels. Following this, a qualitative approach will be used to examine the perspectives of participants and their informal caregivers regarding the health needs assessment and its feasibility. The final sample size for the qualitative phase will be determined based on the participant's willingness to be interviewed. The quantitative data consist of descriptive statistics, simple tests, and present plots and correlation coefficients. For the qualitative analysis, we will apply thematic analysis. Results: The initial baseline assessments were completed in July 2023, and the second health needs assessments are ongoing. We expect the results to be available for analysis in the spring of 2024. Conclusions: This study has potential benefits for not only older adults and their informal caregivers but also health care professionals. Moreover, it can be used to inform future studies focused on health needs assessments of this specific demographic group. The study also provides meaningful insights for local policy makers, with potential future implications at the national level. Trial Registration: ClinicalTrials.gov NCT05837728; https://clinicaltrials.gov/study/NCT05837728 International Registered Report Identifier (IRRID): DERR1-10.2196/55192 ",
doi="10.2196/55192",
url="https://www.researchprotocols.org/2024/1/e55192",
url="http://www.ncbi.nlm.nih.gov/pubmed/38635319"
}


@Article{info:doi/10.2196/46287,
author="Sheng, Yiyang
and Bond, Raymond
and Jaiswal, Rajesh
and Dinsmore, John
and Doyle, Julie",
title="Augmenting K-Means Clustering With Qualitative Data to Discover the Engagement Patterns of Older Adults With Multimorbidity When Using Digital Health Technologies: Proof-of-Concept Trial",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="28",
volume="26",
pages="e46287",
keywords="aging",
keywords="digital health",
keywords="multimorbidity",
keywords="chronic disease",
keywords="engagement",
keywords="k-means clustering",
abstract="Background: Multiple chronic conditions (multimorbidity) are becoming more prevalent among aging populations. Digital health technologies have the potential to assist in the self-management of multimorbidity, improving the awareness and monitoring of health and well-being, supporting a better understanding of the disease, and encouraging behavior change. Objective: The aim of this study was to analyze how 60 older adults (mean age 74, SD 6.4; range 65-92 years) with multimorbidity engaged with digital symptom and well-being monitoring when using a digital health platform over a period of approximately 12 months. Methods: Principal component analysis and clustering analysis were used to group participants based on their levels of engagement, and the data analysis focused on characteristics (eg, age, sex, and chronic health conditions), engagement outcomes, and symptom outcomes of the different clusters that were discovered. Results: Three clusters were identified: the typical user group, the least engaged user group, and the highly engaged user group. Our findings show that age, sex, and the types of chronic health conditions do not influence engagement. The 3 primary factors influencing engagement were whether the same device was used to submit different health and well-being parameters, the number of manual operations required to take a reading, and the daily routine of the participants. The findings also indicate that higher levels of engagement may improve the participants' outcomes (eg, reduce symptom exacerbation and increase physical activity). Conclusions: The findings indicate potential factors that influence older adult engagement with digital health technologies for home-based multimorbidity self-management. The least engaged user groups showed decreased health and well-being outcomes related to multimorbidity self-management. Addressing the factors highlighted in this study in the design and implementation of home-based digital health technologies may improve symptom management and physical activity outcomes for older adults self-managing multimorbidity. ",
doi="10.2196/46287",
url="https://www.jmir.org/2024/1/e46287",
url="http://www.ncbi.nlm.nih.gov/pubmed/38546724"
}


@Article{info:doi/10.2196/53402,
author="Sharma, Nikita
and Grotenhuijs, Karen
and Gemert-Pijnen, van J. E. W. C.
and Oinas-Kukkonen, Harri
and Braakman-Jansen, A. L. M.",
title="Low-Fidelity Prototype of a Sensor-Dependent Interaction Platform: Formative Evaluation With Informal Caregivers of Older Adults With Cognitive Impairment",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="22",
volume="8",
pages="e53402",
keywords="older adult care",
keywords="informal caregivers",
keywords="cognitive impairment",
keywords="sensing solutions",
keywords="information communication platform",
keywords="low-fidelity",
keywords="lo-fi prototype",
abstract="Background: Unobtrusive sensing technologies developed for monitoring deviant behaviors in older adult care require integration with an interaction platform to facilitate the flow of information between older adults and their caregivers. However, the continuous monitoring capabilities generate a considerable amount of data that must be interpreted, filtered, and personalized before being communicated to the informal caregivers based on their specific care needs and requirements. Objective: For the effective implementation of unobtrusive sensing solutions (USSs) in the care of older adults with cognitive impairment, we aimed to explore the expectations and preconditions regarding the implementation of USSs from the perspective of informal caregivers. Subsequently, we designed and evaluated a low-fidelity prototype of an interaction platform for its conceptual workflow and usability, incorporating persuasive system design features based on the needs and requirements of informal caregivers. Methods: Overall, 6 informal caregivers of older adults with cognitive impairment living alone participated in this qualitative interview study. We explored the expectation and preconditions regarding implementation through open-ended questions and conducted a formative evaluation (usability study with a think-aloud approach) to evaluate the conceptual workflow and used persuasive system design features in the interaction platform. Overall, a combination of inductive and thematic analyses was used to analyze the interviews. Results: The results of this study present both positive and negative outcome expectations regarding the implementation of USSs, highlighting benefits such as objective decision-making and peace of mind and concerns about information overload and the potential substitution of human contact. Strategic information communication agreements between informal and formal caregivers were deemed crucial for the successful implementation of USSs in care. Overall, informal caregivers had a positive experience with the low-fidelity prototype of the interaction platform, particularly valuing the personalization feature. Conclusions: In conclusion, to achieve successful implementation, a holistic design approach is necessary, and equal consideration should be given to the personalization-privacy paradox to balance users' needs and privacy. ",
doi="10.2196/53402",
url="https://formative.jmir.org/2024/1/e53402",
url="http://www.ncbi.nlm.nih.gov/pubmed/38517461"
}


@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/10.2196/49462,
author="Chou, Ya-Hsin
and Lin, Chemin
and Lee, Shwu-Hua
and Lee, Yen-Fen
and Cheng, Li-Chen",
title="User-Friendly Chatbot to Mitigate the Psychological Stress of Older Adults During the COVID-19 Pandemic: Development and Usability Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="13",
volume="8",
pages="e49462",
keywords="geriatric psychiatry",
keywords="mental health",
keywords="loneliness",
keywords="chatbot",
keywords="user experience",
keywords="health promotion",
keywords="older adults",
keywords="technology-assisted interventions",
keywords="pandemic",
keywords="lonely",
keywords="gerontology",
keywords="elderly",
keywords="develop",
keywords="design",
keywords="development",
keywords="conversational agent",
keywords="geriatric",
keywords="geriatrics",
keywords="psychiatry",
abstract="Background: To safeguard the most vulnerable individuals during the COVID-19 pandemic, numerous governments enforced measures such as stay-at-home orders, social distancing, and self-isolation. These social restrictions had a particularly negative effect on older adults, as they are more vulnerable and experience increased loneliness, which has various adverse effects, including increasing the risk of mental health problems and mortality. Chatbots can potentially reduce loneliness and provide companionship during a pandemic. However, existing chatbots do not cater to the specific needs of older adult populations. Objective: We aimed to develop a user-friendly chatbot tailored to the specific needs of older adults with anxiety or depressive disorders during the COVID-19 pandemic and to examine their perspectives on mental health chatbot use. The primary research objective was to investigate whether chatbots can mitigate the psychological stress of older adults during COVID-19. Methods: Participants were older adults belonging to two age groups (?65 years and <65 years) from a psychiatric outpatient department who had been diagnosed with depressive or anxiety disorders by certified psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. The participants were required to use mobile phones, have internet access, and possess literacy skills. The chatbot's content includes monitoring and tracking health data and providing health information. Participants had access to the chatbot for at least 4 weeks. Self-report questionnaires for loneliness, depression, and anxiety were administered before and after chatbot use. The participants also rated their attitudes toward the chatbot. Results: A total of 35 participants (mean age 65.21, SD 7.51 years) were enrolled in the trial, comprising 74\% (n=26) female and 26\% (n=9) male participants. The participants demonstrated a high utilization rate during the intervention, with over 82\% engaging with the chatbot daily. Loneliness significantly improved in the older group ?65 years. This group also responded positively to the chatbot, as evidenced by changes in University of California Los Angeles Loneliness Scale scores, suggesting that this demographic can derive benefits from chatbot interaction. Conversely, the younger group, <65 years, exhibited no significant changes in loneliness after the intervention. Both the older and younger age groups provided good scores in relation to chatbot design with respect to usability (mean scores of 6.33 and 6.05, respectively) and satisfaction (mean scores of 5.33 and 5.15, respectively), rated on a 7-point Likert scale. Conclusions: The chatbot interface was found to be user-friendly and demonstrated promising results among participants 65 years and older who were receiving care at psychiatric outpatient clinics and experiencing relatively stable symptoms of depression and anxiety. The chatbot not only provided caring companionship but also showed the potential to alleviate loneliness during the challenging circumstances of a pandemic. ",
doi="10.2196/49462",
url="https://formative.jmir.org/2024/1/e49462",
url="http://www.ncbi.nlm.nih.gov/pubmed/38477965"
}


@Article{info:doi/10.2196/52996,
author="Shin, Jung-hye
and Shields, Rachael
and Lee, Jenny
and Skrove, Zachary
and Tredinnick, Ross
and Ponto, Kevin
and Fields, Beth",
title="Quality and Accessibility of Home Assessment mHealth Apps for Community Living: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Mar",
day="11",
volume="12",
pages="e52996",
keywords="mobile app",
keywords="mobile applications",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="mobile phone",
keywords="mobile app rating system",
keywords="occupational therapy",
keywords="home assessment",
keywords="web accessibility",
keywords="aging in place",
keywords="accessible",
keywords="accessibility",
keywords="quality",
keywords="rating",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="aging",
keywords="systematic",
keywords="synthesis",
keywords="syntheses",
keywords="PRISMA",
keywords="Google Play",
keywords="content analysis",
keywords="functionality",
keywords="WCAG",
abstract="Background: Home assessment is a critical component of successful home modifications, enabling individuals with functional limitations to age in place comfortably. A high-quality home assessment tool should facilitate a valid and reliable assessment involving health care and housing professionals, while also engaging and empowering consumers and their caregivers who may be dealing with multiple functional limitations. Unlike traditional paper-and-pencil assessments, which require extensive training and expert knowledge and can be alienating to consumers, mobile health (mHealth) apps have the potential to engage all parties involved, empowering and activating consumers to take action. However, little is known about which apps contain all the necessary functionality, quality appraisal, and accessibility. Objective: This study aimed to assess the functionality, overall quality, and accessibility of mHealth home assessment apps. Methods: mHealth apps enabling home assessment for aging in place were identified through a comprehensive search of scholarly articles, the Apple (iOS) and Google Play (Android) stores in the United States, and fnd.io. The search was conducted between November 2022 and January 2023 following a method adapted from PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Reviewers performed a content analysis of the mobile app features to evaluate their functionality, overall quality, and accessibility. The functionality assessment used a home assessment component matrix specifically developed for this study. For overall quality, the Mobile Application Rating Scale (MARS) was used to determine the apps' effectiveness in engaging and activating consumers and their caregivers. Accessibility was assessed using the Web Content Accessibility Guidelines (WCAG) 2.1 (A and AA levels). These 3 assessments were synthesized and visualized to provide a comprehensive evaluation. Results: A total of 698 apps were initially identified. After further screening, only 6 apps remained. Our review revealed that none of the apps used thoroughly tested assessment tools, offered all the functionality required for reliable home assessment, achieved the ``good'' quality threshold as measured by the MARS, or met the accessibility criteria when evaluated against WCAG 2.1. However, DIYModify received the highest scores in both the overall quality and accessibility assessments. The MapIt apps also showed significant potential due to their ability to measure the 3D environment and the inclusion of a desktop version that extends the app's functionality. Conclusions: Our review revealed that there are very few apps available within the United States that possess the necessary functionality, engaging qualities, and accessibility to effectively activate consumers and their caregivers for successful home modification. Future app development should prioritize the integration of reliable and thoroughly tested assessment tools as the foundation of the development process. Furthermore, efforts should be made to enhance the overall quality and accessibility of these apps to better engage and empower consumers to take necessary actions to age in place. ",
doi="10.2196/52996",
url="https://mhealth.jmir.org/2024/1/e52996",
url="http://www.ncbi.nlm.nih.gov/pubmed/38466987"
}


@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/10.2196/45492,
author="Elavsky, Steriani
and Knapova, Lenka
and Jani{\vs}, Kamil
and Cimler, Richard
and Kuhnova, Jitka
and Cernicky, Tomas",
title="Multiple Perspectives on the Adoption of SMART Technologies for Improving Care of Older People: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="7",
volume="26",
pages="e45492",
keywords="adults",
keywords="older",
keywords="technologies",
keywords="technological",
keywords="caregivers",
keywords="SMART",
keywords="mobile phone",
abstract="Background: Despite the ever-increasing offering of SMART technologies (ie, computer-controlled devices acting intelligently and capable of monitoring, analyzing or reporting), a wide gap exists between the development of new technological innovations and their adoption in everyday care for older adults. Objective: This study aims to explore the barriers and concerns related to the adoption of SMART technologies among different groups of stakeholders. Methods: Data from 4 sources were used: semistructured in-person or internet-based interviews with professional caregivers (n=12), structured email interviews with experts in the area of aging (n=9), a web-based survey of older adults (>55 years) attending the Virtual University of the Third Age (n=369), and a case study on the adoption of new technology by an older adult care facility. Results: Although all stakeholders noted the potential of SMART technologies to improve older adult care, multiple barriers to their adoption were identified. Caregivers perceived older adults as disinterested or incompetent in using technology, reported preferring known strategies over new technologies, and noted own fears of using technology. Experts viewed technologies as essential but expressed concerns about cost, low digital competency of older adults, and lack of support or willingness to implement technologies in older adult care. Older adults reported few concerns overall, but among the mentioned concerns were lack of ability or interest, misuse of data, and limited usefulness (in specific subgroups or situations). In addition, older adults' ratings of the usefulness of different technologies correlated with their self-rating of digital competency (r=0.258; P<.001). Conclusions: Older adults appeared to have more positive views of various technologies than professional caregivers; however, their concerns varied by the type of technology. Lack of competence and lack of support were among the common themes, suggesting that educationally oriented programs for both older adults and their caregivers should be pursued. ",
doi="10.2196/45492",
url="https://www.jmir.org/2024/1/e45492",
url="http://www.ncbi.nlm.nih.gov/pubmed/38324345"
}


@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/10.2196/50286,
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/10.2196/50548,
author="Groulx, Mark
and Freeman, Shannon
and Gourlay, Keone
and Hemingway, Dawn
and Rossnagel, Emma
and Chaudhury, Habib
and Nouri, Mohammadjavad",
title="Monitoring and Evaluation of Dementia-Friendly Neighborhoods Using a Walkshed Approach: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Jan",
day="3",
volume="13",
pages="e50548",
keywords="dementia-friendly",
keywords="neighborhood",
keywords="persons living with dementia",
keywords="walkability",
keywords="walkshed",
abstract="Background: The number of people in society living with dementia is growing. In Canada, most people who live with dementia live at home, often in a neighborhood setting. Neighborhood environments can be a source of independence, social engagement, and well-being. They can also contain barriers that limit physical activity, social engagement, and well-being. A dementia-friendly neighborhood includes assets that support persons living with dementia and their caregivers in multiple life domains, including those that support walking within the neighborhood environment. Objective: The objectives for this scoping review are twofold. First, focusing on walkshed analysis, we aim to extend scholarly understandings of methodological practices used in the monitoring and evaluation of dementia-friendly neighborhoods. Second, we aim to provide clear and practical guidance for those working in planning, design, and public health fields to assess the neighborhood context in support of evidence-based action to improve the lives of persons living with dementia. Methods: The study design follows Arksey and O'Malley's scoping review framework and PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. We will conduct a search of peer-reviewed studies in 6 electronic databases to identify the use of Geographic Information System analysis to measure the walkshed of persons living with dementia in a community setting. As age is a primary risk factor associated with dementia, we will also include studies that focus more broadly on community-dwelling older adults aged 65 years and older. Data will be extracted, analyzed, and represented according to 3 domains. This includes study details, walkshed analysis methods, and criteria and indicators used to measure dementia-friendly neighborhoods. Results: The results of the study and the submission of a manuscript for peer review are expected in June 2024. The results of the review are expected to contribute to an understanding of methods for monitoring and evaluating dementia-friendly neighborhoods. Expected findings will include a detailed breakdown of current parameters and routines used to conduct walkshed analysis. Findings will also convey criteria that can be operationalized in a Geographic Information System as indicators to assess barriers and facilitators to walking in a neighborhood setting. Conclusions: As far as we are aware, the proposed scoping review will be the first to provide comprehensive methodological or technical guidance for conducting walkshed analysis specific to persons living with dementia. Both the scalability and objective nature of walkshed analysis are likely to be of direct interest to public health practitioners, planners, and allied professionals. Clearly documenting methods used in walkshed analysis can spur increased collaboration across these disciplines to enable an evidence-informed approach to improving neighborhood environments for persons living with dementia. International Registered Report Identifier (IRRID): PRR1-10.2196/50548 ",
doi="10.2196/50548",
url="https://www.researchprotocols.org/2024/1/e50548",
url="http://www.ncbi.nlm.nih.gov/pubmed/38170573"
}


@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/10.2196/47510,
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/10.2196/53150,
author="Guay-B{\'e}langer, Sabrina
and Aubin, Emmanuelle
and Cimon, Marie
and Archambault, Patrick
and Blanchette, Virginie
and Giguere, Anik
and Gogovor, Am{\'e}d{\'e}
and Morin, Mich{\`e}le
and Ben Charif, Ali
and Ben Gaied, Nouha
and Bickerstaff, Julie
and Ch{\'e}nard, Nancy
and Emond, Julie
and Gilbert, Julie
and Violet, Isabelle
and L{\'e}gar{\'e}, France",
title="Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="20",
volume="12",
pages="e53150",
keywords="shared decision making",
keywords="patient-centered care",
keywords="home care",
keywords="older adults",
keywords="caregivers",
keywords="decision aids",
keywords="scalability assessment",
keywords="innovation scalability self-administered questionnaire",
keywords="interprofessional",
keywords="team based",
abstract="Background: Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture. Objective: This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system. Methods: This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria. Results: This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024. Conclusions: This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec. International Registered Report Identifier (IRRID): PRR1-10.2196/53150 ",
doi="10.2196/53150",
url="https://www.researchprotocols.org/2023/1/e53150",
url="http://www.ncbi.nlm.nih.gov/pubmed/37889512"
}


@Article{info:doi/10.2196/47586,
author="de Ruiter, Hans-Peter
and Clisbee, David
and Houston, Rebecca
and Sk{\"a}rs{\"a}ter, Ingela",
title="The Ethical, Care, and Client-Caregiver Relationship Impacts Resulting From Introduction of Digital Communication and Surveillance Technologies in the Home Setting: Qualitative Inductive Study",
journal="JMIR Hum Factors",
year="2023",
month="Nov",
day="3",
volume="10",
pages="e47586",
keywords="home care",
keywords="caregivers",
keywords="ethical implications",
keywords="communication technology",
keywords="surveillance technology",
keywords="public health nursing practices",
keywords="digital vulnerability",
keywords="care of the elderly",
abstract="Background: Embedding communication and surveillance technology into the home health care setting has demonstrated the capacity for increased data efficiency, assumptions of convenience, and smart solutions to pressing problems such as caregiver shortages amid a rise in the aging population. The race to develop and implement these technologies within home care and public health nursing often leaves several ethical questions needing to be answered. Objective: The aim of this study was to understand the ethical and care implications of implementing digital communication and surveillance technologies in the home setting as perceived by health caregivers practicing in the region of Halland in Sweden with clients receiving home care services. Methods: A questionnaire was completed by 1260 home health caregivers and the written responses were evaluated by qualitative inductive content analysis. The researchers reviewed data independently and consensus was used to determine themes. Results: This study identified three main themes that illustrate ethical issues and unintended effects as perceived by caregivers of introducing digital communication and surveillance technologies in the home: (1) digital dependence vulnerability, (2) moral distress, and (3) interruptions to caregiving. This study highlights the consequences of technology developers and health systems leaders unintentionally ignoring the perspectives of caregivers who practice the intuitive artistry of providing care to other humans. Conclusions: Beyond the obtrusiveness of devices and impersonal data collection designed to emphasize health care system priorities, this study discovered a multifaceted shadow side of unintended consequences that arise from misalignment between system priorities and caregiver expertise, resulting in ethical issues. To develop communication and surveillance technologies that meet the needs of all stakeholders, it is important to involve caregivers who work with clients in the development process of new health care technology to improve both the quality of life of clients and the services offered by caregivers. ",
doi="10.2196/47586",
url="https://humanfactors.jmir.org/2023/1/e47586",
url="http://www.ncbi.nlm.nih.gov/pubmed/37921843"
}


@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/10.2196/41035,
author="Stara, Vera
and Soraci, Luca
and Takano, Eiko
and Kondo, Izumi
and M{\"o}ller, Johanna
and Maranesi, Elvira
and Luzi, Riccardo
and Riccardi, Renato Giovanni
and Browne, Ryan
and Dacunha, S{\'e}bastien
and Palmier, Cecilia
and Wieching, Rainer
and Ogawa, Toshimi
and Bevilacqua, Roberta",
title="Intrinsic Capacity and Active and Healthy Aging Domains Supported by Personalized Digital Coaching: Survey Study Among Geriatricians in Europe and Japan on eHealth Opportunities for Older Adults",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="12",
volume="25",
pages="e41035",
keywords="intrinsic capacity",
keywords="functional ability, active and healthy aging",
keywords="digital coaching",
keywords="eHealth interventions",
keywords="older adults",
abstract="Background: The worldwide aging trend requires conceptually new prevention, care, and innovative living solutions to support human-based care using smart technology, and this concerns the whole world. Enabling access to active and healthy aging through personalized digital coaching services like physical activity coaching, cognitive training, emotional well-being, and social connection for older adults in real life could offer valuable advantages to both individuals and societies. A starting point might be the analysis of the perspectives of different professionals (eg, geriatricians) on such technologies. The perspectives of experts in the sector may allow the individualization of areas of improvement of clinical interventions, supporting the positive perspective pointed out by the intrinsic capacity framework. Objective: The overall aim of this study was to explore the cross-national perspectives and experiences of different professionals in the field of intrinsic capacity, and how it can be supported by eHealth interventions. To our knowledge, this is the first study to explore geriatric care providers' perspectives about technology-based interventions to support intrinsic capacity. Methods: A survey involving 20 geriatricians or clinical experts in the fields of intrinsic capacity and active and healthy aging was conducted in Italy, France, Germany, and Japan between August and September 2021. Results: The qualitative findings pointed out relevant domains for eHealth interventions and provided examples for successful practices that support subjective well-being under the intrinsic capacity framework (the benefits offered by personalized interventions, especially by promoting health literacy but avoiding intrusiveness). Moreover, eHealth interventions could be used as a bridge that facilitates and enables social engagement; an instrument that facilitates communication between doctors and patients; and a tool to enrich the monitoring actions of medical staff. Conclusions: There is an unexplored and significant role for such geriatric perspectives to help the development process and evaluate the evidence-based results on the effectiveness of technologies for older people. This is possible only when clinicians collaborate with data scientists, engineers, and developers in order to match the complex daily needs of older adults. ",
doi="10.2196/41035",
url="https://www.jmir.org/2023/1/e41035",
url="http://www.ncbi.nlm.nih.gov/pubmed/37824183"
}


@Article{info:doi/10.2196/45876,
author="Muurling, Marijn
and Au-Yeung, M. Wan-Tai
and Beattie, Zachary
and Wu, Chao-Yi
and Dodge, Hiroko
and Rodrigues, K. Nathaniel
and Gothard, Sarah
and Silbert, C. Lisa
and Barnes, L. Lisa
and Steele, S. Joel
and Kaye, Jeffrey",
title="Differences in Life Space Activity Patterns Between Older Adults With Mild Cognitive Impairment Living Alone or as a Couple: Cohort Study Using Passive Activity Sensing",
journal="JMIR Aging",
year="2023",
month="Oct",
day="11",
volume="6",
pages="e45876",
keywords="passive monitoring",
keywords="in-home sensor",
keywords="mild cognitive impairment",
keywords="2-person home",
keywords="life space activity",
keywords="sensor",
keywords="older adult",
keywords="aging",
keywords="elder",
keywords="gerontology",
keywords="geriatric",
keywords="cognition",
keywords="cognitive impairment",
keywords="activity pattern",
keywords="at home",
keywords="daily activities",
keywords="activities of daily living",
keywords="digital health",
keywords="old age",
keywords="technology",
abstract="Background: Measuring function with passive in-home sensors has the advantages of real-world, objective, continuous, and unobtrusive measurement. However, previous studies have focused on 1-person homes only, which limits their generalizability. Objective: This study aimed to compare the life space activity patterns of participants living alone with those of participants living as a couple and to compare people with mild cognitive impairment (MCI) with cognitively normal participants in both 1- and 2-person homes. Methods: Passive infrared motion sensors and door contact sensors were installed in 1- and 2-person homes with cognitively normal residents or residents with MCI. A home was classified as an MCI home if at least 1 person in the home had MCI. Time out of home (TOOH), independent life space activity (ILSA), and use of the living room, kitchen, bathroom, and bedroom were calculated. Data were analyzed using the following methods: (1) daily averages over 4 weeks, (2) hourly averages (time of day) over 4 weeks, or (3) longitudinal day-to-day changes. Results: In total, 129 homes with people living alone (n=27, 20.9\%, MCI and n=102, 79.1\%, no-MCI homes) and 52 homes with people living as a couple (n=24, 46.2\%, MCI and n=28, 53.8\%, no-MCI homes) were included with a mean follow-up of 719 (SD 308) days. Using all 3 analysis methods, we found that 2-person homes showed a shorter TOOH, a longer ILSA, and shorter living room and kitchen use. In MCI homes, ILSA was higher in 2-person homes but lower in 1-person homes. The effects of MCI status on other outcomes were only found when using the hourly averages or longitudinal day-to-day changes over time, and they depended on the household type (alone vs residing as a couple). Conclusions: This study shows that in-home behavior is different when a participant is living alone compared to when they are living as a couple, meaning that the household type should be considered when studying in-home behavior. The effects of MCI status can be detected with in-home sensors, even in 2-person homes, but data should be analyzed on an hour-to-hour basis or longitudinally. ",
doi="10.2196/45876",
url="https://aging.jmir.org/2023/1/e45876",
url="http://www.ncbi.nlm.nih.gov/pubmed/37819694"
}


@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/10.2196/46269,
author="Kwok, Ian
and Lattie, Gardiner Emily
and Yang, Dershung
and Summers, Amanda
and Grote, Veronika
and Cotten, Paul
and Moskowitz, Tedlie Judith",
title="Acceptability and Feasibility of a Socially Enhanced, Self-Guided, Positive Emotion Regulation Intervention for Caregivers of Individuals With Dementia: Pilot Intervention Study",
journal="JMIR Aging",
year="2023",
month="Sep",
day="6",
volume="6",
pages="e46269",
keywords="dementia",
keywords="caregiving",
keywords="eHealth",
keywords="digital interventions",
keywords="positive emotion",
keywords="stress",
keywords="coping",
abstract="Background: The responsibilities of being a primary caregiver for a loved one with dementia can produce significant stress for the caregiver, leading to deleterious outcomes for the caregiver's physical and psychological health. Hence, researchers are developing eHealth interventions to provide support for caregivers. Members of our research team previously developed and tested a positive emotion regulation intervention that we delivered through videoconferencing, in which caregiver participants would meet one-on-one with a trained facilitator. Although proven effective, such delivery methods have limited scalability because they require significant resources in terms of cost and direct contact hours. Objective: This study aimed to conduct a pilot test of a socially enhanced, self-guided version of the positive emotion regulation intervention, Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF). Studies have shown that social presence or the perception of others in a virtual space is associated with enhanced learning and user satisfaction. Hence, the intervention leverages various social features (eg, discussion boards, podcasts, videos, user profiles, and social notifications) to foster a sense of social presence among participants and study team members. Methods: Usability, usefulness, feasibility, and acceptability data were collected from a pilot test in which participants (N=15) were given full access to the SAGE LEAF intervention over 6 weeks and completed preintervention and postintervention assessments (10/15, 67\%). Preliminary outcome measures were also collected, with an understanding that no conclusions about efficacy could be made, because our pilot study did not have a control group and was not sufficiently powered. Results: The results suggest that SAGE LEAF is feasible, with participants viewing an average of 72\% (SD 42\%) of the total available intervention web pages. In addition, acceptability was found to be good, as demonstrated by participants' willingness to recommend the SAGE LEAF program to a friend or other caregiver. Applying Pearson correlational analyses, we found moderate, positive correlation between social presence scores and participants' willingness to recommend the program to others (r9=0.672; P=.03). We also found positive correlation between social presence scores and participants' perceptions about the overall usefulness of the intervention (r9=0.773; P=.009). This suggests that participants' sense of social presence may be important for the feasibility and acceptability of the program. Conclusions: In this pilot study, the SAGE LEAF intervention demonstrates potential for broad dissemination for dementia caregivers. We aim to incorporate participant feedback about how the social features may be improved in future iterations to enhance usability and to further bolster a sense of social connection among participants and study staff members. Next steps include partnering with dementia clinics and other caregiver-serving organizations across the United States to conduct a randomized controlled trial to evaluate the effectiveness of the intervention. ",
doi="10.2196/46269",
url="https://aging.jmir.org/2023/1/e46269",
url="http://www.ncbi.nlm.nih.gov/pubmed/37672311"
}


@Article{info:doi/10.2196/47577,
author="Fan, Qiping
and DuBose, Logan
and Ory, G. Marcia
and Lee, Shinduk
and Hoang, Minh-Nguyet
and Vennatt, Jeswin
and Kew, Lin Chung
and Doyle, David
and Falohun, Tokunbo",
title="Financial, Legal, and Functional Challenges of Providing Care for People Living With Dementia and Needs for a Digital Platform: Interview Study Among Family Caregivers",
journal="JMIR Aging",
year="2023",
month="Sep",
day="5",
volume="6",
pages="e47577",
keywords="family caregiver",
keywords="Alzheimer disease",
keywords="dementia",
keywords="caregiving challenges",
keywords="digital health",
keywords="community-based participatory research",
keywords="mobile phone",
abstract="Background: Alzheimer disease and Alzheimer disease--related dementia represent complex neuropathologies directly challenging individuals, their families, and communities in the United States. To support persons living with dementia, family or informal caregivers often encounter complex financial, psychological, and physical challenges. A widely used solution such as a consolidated web-based assistance or guidance platform is missing, compounding care challenges. Objective: In preparation for designing an internet-based artificial intelligence--driven digital resource platform, a qualitative interview study was conducted to characterize the challenges and needs of family caregivers in the United States. Methods: A semistructured interview topic guide in English was developed by engaging community partners and research partnerships. Family caregiver participants were purposefully recruited via various means, such as word of mouth, local dementia community service providers, digital recruitment emails, flyers, and social media. Interested individuals were first invited to complete an eligibility screening survey, and eligible individuals were then contacted to arrange a web-based in-depth interview via Zoom (Zoom Video Communications) from January 1, 2022, to May 31, 2022. A follow-up survey was administered in May 2022 to provide an overview of the participants' demographics, socioeconomic characteristics, and caregiving information. Thematic analysis in a framework approach was used to identify and organize themes and the study findings. Results: Following the prescreening of 150 eligible respondents, 20\% (30/150) individuals completed both the interviews and follow-up survey, allowing for an in-depth look into the challenges, experiences, and expectations of primary caregivers of people living with dementia. Most participants (20/30, 67\%) were primary caregivers of persons with dementia, and 93\% (28/30) had provided care for at least a year. Most participants were aged >50 years (25/30, 83\%), female (23/30, 77\%), White (25/30, 83\%), and non-Hispanic (27/30, 90\%) and held a bachelor's or graduate degree (22/30, 73\%). Collectively, all participants acknowledged challenges in caring for people living with dementia. Thematic analyses elicited the challenges of caregiving related to functional care needs and financial and legal challenges. In addition, participants identified the need for an integrative digital platform where information could be supplied to foster education, share resources, and provide community support, enabling family caregivers to improve the quality of care and reducing caregiver burden. Conclusions: This study emphasized the difficulties associated with the family caregiver role and the expectations and potential for a supportive web-based platform to mitigate current challenges within the caregiving role. ",
doi="10.2196/47577",
url="https://aging.jmir.org/2023/1/e47577",
url="http://www.ncbi.nlm.nih.gov/pubmed/37526513"
}


@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/10.2196/49933,
author="Sathyan, Sanish
and Ayers, Emmeline
and Blumen, Helena
and Weiss, F. Erica
and Adhikari, Dristi
and Stimmel, Marnina
and Abdulsalam, Kizhakkaniyakath
and Noone, Mohan
and George, K. Roy
and Ceide, Mirnova
and Ambrose, Felicia Anne
and Wang, Cuiling
and Narayanan, Poornima
and Sureshbabu, Sachin
and Shaji, S. Kunnukatil
and Sigamani, Alben
and Mathuranath, S. Pavagada
and Pradeep, G. Vayyattu
and Verghese, Joe",
title="Epidemiology of Motoric Cognitive Risk Syndrome in the Kerala Einstein Study: Protocol for a Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2023",
month="Aug",
day="17",
volume="12",
pages="e49933",
keywords="motoric cognitive risk",
keywords="Kerala",
keywords="India",
keywords="dementia",
keywords="cognitive decline",
keywords="neuroimaging",
abstract="Background: The southern India state of Kerala has among the highest proportion of older adults in its population in the country. An increase in chronic age-related diseases such as dementia is expected in the older Kerala population. Identifying older individuals early in the course of cognitive decline offers the best hope of introducing preventive measures early and planning management. However, the epidemiology and pathogenesis of predementia syndromes at the early stages of cognitive decline in older adults are not well established in India. Objective: The Kerala Einstein Study (KES) is a community-based cohort study that was established in 2008 and is based in the Kozhikode district in Kerala state. KES aims to establish risk factors and brain substrates of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of slow gait and subjective cognitive concerns in individuals without dementia or disability. This protocol describes the study design and procedures for this KES project. Methods: KES is proposing to enroll a sample of 1000 adults\thinspace?60 years old from urban and rural areas in the Kozhikode district of Kerala state: 200 recruited in the previous phase of KES and 800 new participants to be recruited in this project. MCR is the cognitive phenotype of primary interest. The associations between previously established risk factors for dementia as well as novel risk factors (apathy and traumatic brain injury) and MCR will be examined in KES. Risk factor profiles for MCR will be compared between urban and rural residents as well as with individuals who meet the criteria for mild cognitive impairment (MCI). Cognitive and physical function, medical history and medications, sociodemographic characteristics, lifestyle patterns, and activities of daily living will be evaluated. Participants will also undergo magnetic resonance imaging and electrocardiogram investigations. Longitudinal follow-up is planned in a subset of participants as a prelude to future longitudinal studies. Results: KES (2R01AG039330-07) was funded by the US National Institutes of Health in September 2019 and received approval from the Indian Medical Council of Research to start the study in June 2021. We had recruited 433 new participants from urban and rural sites in Kozhikode as of May 2023: 41.1\% (178/433) women, 67.7\% (293/433) rural residents, and 13.4\% (58/433) MCR cases. Enrollment is actively ongoing at all the KES recruitment sites. Conclusions: KES will provide new insights into risk factors and brain substrates associated with MCR in India and will help guide future development of regionally specific preventive interventions for dementia. International Registered Report Identifier (IRRID): DERR1-10.2196/49933 ",
doi="10.2196/49933",
url="https://www.researchprotocols.org/2023/1/e49933",
url="http://www.ncbi.nlm.nih.gov/pubmed/37590054"
}


@Article{info:doi/10.2196/50231,
author="Powell, R. Kimberly
and Popescu, Mihail
and Lee, Suhwon
and Mehr, R. David
and Alexander, L. Gregory",
title="Examining the Use of Text Messages Among Multidisciplinary Care Teams to Reduce Avoidable Hospitalization of Nursing Home Residents with Dementia: Protocol for a Secondary Analysis",
journal="JMIR Res Protoc",
year="2023",
month="Aug",
day="9",
volume="12",
pages="e50231",
keywords="age-friendly health systems",
keywords="Alzheimer disease",
keywords="communication",
keywords="dementia",
keywords="nursing homes",
keywords="older adults",
abstract="Background: Reducing avoidable nursing home (NH)--to-hospital transfers of residents with Alzheimer disease or a related dementia (ADRD) has become a national priority due to the physical and emotional toll it places on residents and the high costs to Medicare and Medicaid. Technologies supporting the use of clinical text messages (TMs) could improve communication among health care team members and have considerable impact on reducing avoidable NH-to-hospital transfers. Although text messaging is a widely accepted mechanism of communication, clinical models of care using TMs are sparsely reported in the literature, especially in NHs. Protocols for assessing technologies that integrate TMs into care delivery models would be beneficial for end users of these systems. Without evidence to support clinical models of care using TMs, users are left to design their own methods and protocols for their use, which can create wide variability and potentially increase disparities in resident outcomes. Objective: Our aim is to describe the protocol of a study designed to understand how members of the multidisciplinary team communicate using TMs and how salient and timely communication can be used to avert poor outcomes for NH residents with ADRD, including hospitalization. Methods: This project is a secondary analysis of data collected from a Centers for Medicare \& Medicaid Services (CMS)--funded demonstration project designed to reduce avoidable hospitalizations for long-stay NH residents. We will use two data sources: (1) TMs exchanged among the multidisciplinary team across the 7-year CMS study period (August 2013-September 2020) and (2) an adapted acute care transfer tool completed by advanced practice registered nurses to document retrospective details about NH-to-hospital transfers. The study is guided by an age-friendly model of care called the 4Ms (What Matters, Medications, Mentation, and Mobility) framework. We will use natural language processing, statistical methods, and social network analysis to generate a new ontology and to compare communication patterns found in TMs occurring around the time NH-to-hospital transfer decisions were made about residents with and without ADRD. Results: After accounting for inclusion and exclusion criteria, we will analyze over 30,000 TMs pertaining to over 3600 NH-to-hospital transfers. Development of the 4M ontology is in progress, and the 3-year project is expected to run until mid-2025. Conclusions: To our knowledge, this project will be the first to explore the content of TMs exchanged among a multidisciplinary team of care providers as they make decisions about NH-to-hospital resident transfers. Understanding how the presence of evidence-based elements of high-quality care relate to avoidable hospitalizations among NH residents with ADRD will generate knowledge regarding the future scalability of behavioral interventions. Without this knowledge, NHs will continue to rely on ineffective and outdated communication methods that fail to account for evidence-based elements of age-friendly care. International Registered Report Identifier (IRRID): DERR1-10.2196/50231 ",
doi="10.2196/50231",
url="https://www.researchprotocols.org/2023/1/e50231",
url="http://www.ncbi.nlm.nih.gov/pubmed/37556199"
}


@Article{info:doi/10.2196/46617,
author="Tobis, Slawomir
and Piasek-Skupna, Joanna
and Neumann-Podczaska, Agnieszka
and Suwalska, Aleksandra
and Wieczorowska-Tobis, Katarzyna",
title="The Effects of Stakeholder Perceptions on the Use of Humanoid Robots in Care for Older Adults: Postinteraction Cross-Sectional Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="4",
volume="25",
pages="e46617",
keywords="older adult",
keywords="care robot",
keywords="stakeholder",
keywords="perception",
keywords="needs and requirements",
keywords="user need",
keywords="patient need",
keywords="elder",
keywords="gerontology",
keywords="geriatric",
keywords="caregiver",
keywords="attitude",
keywords="opinion",
keywords="home care",
keywords="caregiving",
keywords="robot",
abstract="Background: Efficient use of humanoid social robots in the care for older adults requires precise knowledge of expectations in this area. There is little research in this field that includes the interaction of stakeholders with the robot. Even fewer studies have compared the perceptions of older people (as care recipients) and professional caregivers (representing those taking care of older adults in teams with robots). Objective: The aim of this study was to analyze whether specific aspects of the perceptions about humanoid robots influence attitudes after interacting with the robot and to compare the opinions of different stakeholders (older people and their professional caregivers) on this topic. We analyzed the potential impact of the differences in perception of the robot between stakeholder groups with respect to how the robot should be designed and tailored to fit the specific needs of future users. We also attempted to define areas where targeted educational activities could bring the attitudes of the two groups of stakeholders closer to each other. Methods: The studied group was a conveniently available sample of individuals who took part in the presentation of and interaction with a humanoid social robot. Among them, there were 48 community-dwelling older adults (aged ?60 years), who were participants of day care units (which may signal the presence of self-care needs), and 53 professional caregivers. The participants were asked to express their views after an interaction with a humanoid social robot (TIAGo) using the Users' Needs, Requirements and Abilities Questionnaire (UNRAQ) and the Godspeed Questionnaire Series (GQS). Results: Compared to the caregivers, older adults not only assessed the robot more positively with respect to its roles as a companion and assistant (P=.009 and P=.003, respectively) but also had higher scores on their need to increase their knowledge about the robot (P=.049). Regarding the robot's functions, the greatest differences between groups were observed for the social aspects on the UNRAQ, including decreasing the sense of loneliness (P=.003) and accompanying the user in everyday activities (P=.005). As for the GQS, the mean scores of the Animacy, Likeability, and Perceived Intelligence scales were significantly higher for older participants than for caregivers (P=.04, P<.001, and P<.001, respectively). The only parameter for which the caregivers' scores were higher than those of the older adults was the Artificial-Lifelike item from the Anthropomorphism scale of the GQS (P=.03). Conclusions: The acceptance of the social functions of a humanoid robot is related to its perception in all analyzed aspects, whereas the expected usefulness of a care robot is not linked to aspects of anthropomorphism. Successful implementation of robots in the care for older people thus depends on considering not only the fears, needs, and requirements of various stakeholders but also on the perceptions of the robot. Given the differences between the stakeholders, targeted and properly structured educational and training activities for caregivers and prospective users may enable a seamless integration of robotic technologies in care provision. ",
doi="10.2196/46617",
url="https://www.jmir.org/2023/1/e46617",
url="http://www.ncbi.nlm.nih.gov/pubmed/37540548"
}


@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/10.2196/41535,
author="Balki, Eric
and Holland, Carol
and Hayes, Niall",
title="Use and Acceptance of Digital Communication Technology by Older Adults for Social Connectedness During the COVID-19 Pandemic: Mixed Methods Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="2",
volume="25",
pages="e41535",
keywords="aging in place",
keywords="technology acceptance",
keywords="technology adoption",
keywords="information and communication technologies",
keywords="qualitative research",
keywords="COVID-19 pandemic, Facebook, Meta",
keywords="WhatsApp",
keywords="Zoom, generative artificial intelligence, AI",
abstract="Background: Older adults are at higher risk for health issues, including mental health problems. This was especially apparent during the COVID-19 pandemic, where older adults were simultaneously more vulnerable to the disease and the mental health concerns created by social distancing. Subsequently, the use of digital communication technology (DCT) became a critical option for maintaining social connectedness in older adults. Prior to the pandemic, the low uptake and use of technology by older adults was an established problem, known as the digital divide. However, not much is known about how this may have changed as a result of the pandemic. Objective: This study aims to explore how older adults maintained social connectedness through DCT during the pandemic and to understand factors influencing the use and acceptance of DCT. Methods: A mixed methods explorative field study was set up, involving surveys and interviews of 25 community-dwelling older adults (65-88 years old) living in the United Kingdom. The surveys included the internet acceptance questionnaire (based on the Technology Acceptance Model [TAM]); COVID-19 dysfunctional anxiety was captured using the COVID-19 Anxiety Scale (CAS). Background information (demographics, use of technology) was gathered before conducting semistructured interviews. We hypothesized that CAS would affect constructs of TAM and that predictive constructs of TAM would have remained valid during the pandemic. We also posited that there would be unidentified themes outside TAM that impacted the acceptance and use of DCT. We used the quantitative data to guide the semistructured interviews, which were then analyzed through thematic analysis to identify additional themes. Results: Correlational analysis showed that CAS influences all constructs of TAM. We also saw that the predictive constructs of TAM, especially the perceived ease of use (PEU) and perceived usefulness (PU), remained valid during the pandemic. Common acceptance-influencing themes were encountered in both quantitative and qualitative analyses, with 3 matching the known constructs of TAM (PU, PEU, and behavioral intention). We identified 2 additional themes affecting acceptance, namely influence of the pandemic (situational context) and privacy and security concerns. DCT use (especially email and videoconferencing use) increased during the pandemic, but the results related to social networking sites were mixed. Conclusions: The COVID-19 pandemic impacted technology acceptance and use by older adults, encouraging their use of certain DCT apps (email and videoconferencing apps, such as WhatsApp). These apps helped insulate them from adverse effects (social isolation and loneliness). Other social networking apps, however, exerted a negative influence, increasing anxiety and a general feeling of negativity. Future studies should maximize older adult agency related to design, privacy, security, and user requirements for development. We also recommend that when studying DCT acceptance for older adults, our additional identified themes should be considered alongside the existing TAM constructs. ",
doi="10.2196/41535",
url="https://www.jmir.org/2023/1/e41535",
url="http://www.ncbi.nlm.nih.gov/pubmed/37531187"
}


@Article{info:doi/10.2196/47568,
author="Schmidt, M. Steven
and Iwarsson, Susanne
and Hansson, {\AA}sa
and Dahlgren, David
and Kyl{\'e}n, Maya",
title="Homeownership While Aging---How Health and Economic Factors Incentivize or Disincentivize Relocation: Protocol for a Mixed Methods Project",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="10",
volume="12",
pages="e47568",
keywords="housing market",
keywords="aging-in-place",
keywords="housing policy",
keywords="healthy aging",
keywords="mobility",
keywords="housing preferences",
abstract="Background: Many factors influence housing choices among older adults, but far from all have been identified. There is little systematic analysis that has included economic factors and virtually no knowledge about the interplay among perceived costs of moving, health status, and the mobility rate of older homeowners. It is currently unclear whether economic factors influence older adults' willingness to move, and the effects of economic policies on their actual behavior in the housing market are largely unknown. Objective: The overarching objective of the AGE-HERE project is to develop knowledge of the relationship between health and economic factors that incentivize or disincentivize relocation during the process of aging. Methods: This project uses a mixed methods convergent design across 4 studies. The initial quantitative register study and subsequent qualitative focus group study will nurture the evidence base and the development of a national survey. The final study will synthesize and integrate the results of the entire project. Results: Ethical approval for the register study (DNR 2022-04626-01) and focus group study (DNR 2023-01887-01) has been obtained. As of July 2023, data analyses (register study) and data collection (focus group study) are currently being conducted. The first paper based on the register data is expected to be submitted after the summer of 2023. Three meetings have been held with the nonacademic reference group. The qualitative data will be analyzed in the autumn. Based on the results of these studies, a survey questionnaire will be developed and distributed nationally during the spring of 2024, followed by data analyses in the autumn. Finally, the results from all studies will be synthesized in 2025. Conclusions: Results from AGE-HERE will add to the knowledge base for research on aging, health, and housing and can play a critical role in guiding future policy decisions aiming to balance the housing market. Such developments may lower related social costs and support older adults to maintain active, independent, and healthy lives. International Registered Report Identifier (IRRID): DERR1-10.2196/47568 ",
doi="10.2196/47568",
url="https://www.researchprotocols.org/2023/1/e47568",
url="http://www.ncbi.nlm.nih.gov/pubmed/37428548"
}


@Article{info:doi/10.2196/42283,
author="Darwich, S. Adam
and Bostr{\"o}m, Anne-Marie
and Guidetti, Susanne
and Raghothama, Jayanth
and Meijer, Sebastiaan",
title="Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2023",
month="Jun",
day="30",
volume="10",
pages="e42283",
keywords="aging",
keywords="intervention",
keywords="health policy",
keywords="health services administration and management",
keywords="health care intervention",
keywords="home care",
keywords="home support",
keywords="in-home assistance",
keywords="personal care",
keywords="policy",
keywords="reablement",
keywords="rehabilitation",
keywords="rehabilitation medicine",
keywords="social support",
keywords="stress",
keywords="support",
keywords="systems thinking",
keywords="user",
abstract="Background: Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use. Objective: The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems. Methods: The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods. Results: The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements ``workload'' and ``distress'' were important determinants of home care staff health, provision, and quality of care. Conclusions: The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored. ",
doi="10.2196/42283",
url="https://humanfactors.jmir.org/2023/1/e42283",
url="http://www.ncbi.nlm.nih.gov/pubmed/37389904"
}


@Article{info:doi/10.2196/47855,
author="Skolarus, Lesli
and Thrash-Sall, Erica
and Hellem, Katherine Abby
and Giacalone Jr, Michael
and Burke, James
and Lin, Chieh Chun
and Bailey, Sarah
and Corches, Casey
and Dinh, Mackenzie
and Casetti, Amanda
and Mansour, Maria
and Bowie, Kaitlyn
and Roth, Rylyn
and Whitfield, Candace
and Sales, Anne",
title="Community-Led, Cross-Sector Partnership of Housing and Health Care to Promote Aging in Place (Unite Health Project): Protocol for a Prospective Observational Study",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="29",
volume="12",
pages="e47855",
keywords="aging in place",
keywords="stroke prevention",
keywords="hypertension",
keywords="blood pressure",
keywords="social determinants of health",
keywords="affordable housing",
keywords="older adults",
keywords="community-based participatory research",
keywords="implementation evaluation",
abstract="Background: For many older Americans, aging in place is their preferred living arrangement. Minoritized and socioeconomically disadvantaged older adults are up to 3 times more likely to experience disability than other groups, which increases their likelihood of being unable to age in place. Bold ideas to facilitate aging in place, particularly among vulnerable populations, are needed. One such idea is the Unite care model, a community-initiated, academic-supported, cross-sector initiative that combines 2 sectors: housing and health care. The Unite care model colocates a federally qualified health center clinic on an older adult affordable housing campus in Flint, Michigan. Objective: There are two aims to this study. Aim 1 is to evaluate the implementation of the Unite care model in terms of acceptability, adoption, and penetration. Aim 2 is to determine which older adults use the care model and whether the care model promotes aging in place through risk factor reduction and improvement in the physical and social environment. Methods: We will assess the care model using a concurrent, exploratory mixed methods design. For aim 1, acceptability will be assessed through semistructured interviews with key stakeholder groups; adoption and penetration will be assessed using housing and health care records. For aim 2, residents residing in the Unite clinic building will participate in structured outcome assessments at 6 and 12 months. Risk factor reduction will be measured by change in systolic blood pressure from baseline to 12 months and change in the physical and social environment (item counts) will also be assessed from baseline to 12 months. Results: Data collection for aim 1 began in July 2021 and is anticipated to end in April 2023. Data collection for aim 2 began in June 2021 and concluded in November 2022. Data analysis for aim 1 is anticipated to begin in the summer of 2023 and analysis for aim 2 will begin in the spring of 2023. Conclusions: If successful, the Unite care model could serve as a new care model to promote aging in place among older adults living in poverty and older Black Americans. The results of this proposal will inform whether larger scale testing of this new model of care is warranted. International Registered Report Identifier (IRRID): DERR1-10.2196/47855 ",
doi="10.2196/47855",
url="https://www.researchprotocols.org/2023/1/e47855",
url="http://www.ncbi.nlm.nih.gov/pubmed/37384383"
}


@Article{info:doi/10.2196/46014,
author="Wang, Jingjing
and Liang, Yiqing
and Cao, Songmei
and Cai, Peixuan
and Fan, Yimeng",
title="Application of Artificial Intelligence in Geriatric Care: Bibliometric Analysis",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="23",
volume="25",
pages="e46014",
keywords="artificial intelligence",
keywords="older adults",
keywords="geriatric care",
keywords="bibliometric analysis",
abstract="Background: Artificial intelligence (AI) can improve the health and well-being of older adults and has the potential to assist and improve nursing care. In recent years, research in this area has been increasing. Therefore, it is necessary to understand the status of development and main research hotspots and identify the main contributors and their relationships in the application of AI in geriatric care via bibliometric analysis. Objective: Using bibliometric analysis, this study aims to examine the current research hotspots and collaborative networks in the application of AI in geriatric care over the past 23 years. Methods: The Web of Science Core Collection database was used as a source. All publications from inception to August 2022 were downloaded. The external characteristics of the publications were summarized through HistCite and the Web of Science. Keywords and collaborative networks were analyzed using VOSviewers and Citespace. Results: We obtained a total of 230 publications. The works originated in 499 institutions in 39 countries, were published in 124 journals, and were written by 1216 authors. Publications increased sharply from 2014 to 2022, accounting for 90.87\% (209/230) of all publications. The United States and the International Journal of Social Robotics had the highest number of publications on this topic. The 1216 authors were divided into 5 main clusters. Among the 230 publications, 4 clusters were modeled, including Alzheimer disease, aged care, acceptance, and the surveillance and treatment of diseases. Machine learning, deep learning, and rehabilitation had also become recent research hotspots. Conclusions: Research on the application of AI in geriatric care has developed rapidly. The development of research and cooperation among countries/regions and institutions are limited. In the future, strengthening the cooperation and communication between different countries/regions and institutions may further drive this field's development. This study provides researchers with the information necessary to understand the current state, collaborative networks, and main research hotspots of the field. In addition, our results suggest a series of recommendations for future research. ",
doi="10.2196/46014",
url="https://www.jmir.org/2023/1/e46014",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351923"
}


@Article{info:doi/10.2196/45557,
author="Hung, Yeow Ho
and Azman, Azlinda
and Jamir Singh, Singh Paramjit",
title="The Impact of Counseling on the Dignity of Older People: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="23",
volume="12",
pages="e45557",
keywords="counseling",
keywords="dignity",
keywords="elderly",
keywords="emotional management",
keywords="psychological",
keywords="Singapore",
abstract="Background: Psychological counseling is perceived as a treatment that could significantly improve older individuals' psychological and behavioral functioning. There is a dearth of information on the impact of psychological counseling on preserving dignity and facilitating good aging among older people in Singapore. Objective: The objectives of this study are as follows: (1) to assess advance care planning among older people and their perception of life and health, end of life, and end-of-life care; (2) to explore older people's accessibility and receptiveness toward counseling; (3) elucidate older people's perspectives on counseling and its impact on emotional management and decision-making; (4) to assess older people's competencies in emotional management; and (5) to propose an intervention model for enhancing older people's well-being and dignity through psychological counseling in Singapore. Methods: A mixed method study design involving quantitative and qualitative methods will be used. Older individuals receiving some form of preventive, primary, or long-term care in the community through voluntary welfare organizations from the senior activity centers located in eastern Singapore participated in the qualitative phase. Six older individuals from each senior activity center have been enrolled for the interview phase to explore 6 components: the Advanced Care Planning (ACP) booklet, Trait Meta Mood Scale (TMMS), accessibility and receptiveness toward counseling, and emotional management and decision-making. The ACP, an instrument designed to assess advanced care planning among older individuals, and the TMMS, an instrument developed to measure meta-mood experience and emotional management, were used in the quantitative phase among 100 participants. The data will be analyzed thematically using NVivo version 12, whereas descriptive statistics and a 2-tailed, 1-sample t test will be conducted in SPSS (version 25; IBM Corp) for empirical data analyses. Results: The qualitative phase, which involves a semistructured interview, has been completed among 20 older individuals aged 66-86 years. Thematic analysis of the data is still ongoing. Meanwhile, the quantitative phase commenced on March 22, 2022, with 100 participants providing signed informed consent to participate in the study. The study is expected to be completed by March 2023. Conclusions: The mixed methods study will document the current awareness of ACP, accessibility and receptiveness toward counseling, and the potential use of psychological counseling in enhancing well-being and dignity among older people in Singapore. The research findings will benefit policy makers in their decision-making when attempting to mitigate the potential barriers to seeking counseling assistance among older people. International Registered Report Identifier (IRRID): DERR1-10.2196/45557 ",
doi="10.2196/45557",
url="https://www.researchprotocols.org/2023/1/e45557",
url="http://www.ncbi.nlm.nih.gov/pubmed/37272062"
}


@Article{info:doi/10.2196/44439,
author="Ghorayeb, Abir
and Comber, Rob
and Gooberman-Hill, Rachael",
title="Development of a Smart Home Interface With Older Adults: Multi-Method Co-Design Study",
journal="JMIR Aging",
year="2023",
month="Jun",
day="16",
volume="6",
pages="e44439",
keywords="data visualization",
keywords="digital health",
keywords="smart homes",
keywords="older people",
keywords="technology acceptance",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: Smart home technologies have the potential to support aging in place; however, older people's perceptions of the value of smart homes may be influenced by their access to the information gathered by the technology. This information is needed to support their informed decision-making. Limited research has been conducted on how best to design visualizations of smart home data in keeping with the needs and wishes of older people. Objective: We aimed to investigate the design options that impact the usefulness of smart home systems, older people's information needs, their perceptions of data visualization, and the ways they would like information displayed to them. Methods: We used a qualitative approach to empower the participants as co-designers. Data collection comprised a sequence of methods such as interviews, observation, focus groups, scenario design, probes, and design workshops. Each phase informed the next. Overall, 13 older adults (n=8, 62\% female and n=5, 38\% male; aged 65-89 years) consented to participate. A thematic approach was used to analyze the data set, and participants were actively involved in designing the in-home interface, which enabled them to better conceptualize their needs. Results: The information collected was clustered into 5 themes: enabling home, health, and self-monitoring; enabling opportunities for social inclusion and engagement; enhancing cognitive abilities; customizability of the display; and promoting inclusion in recreation and leisure activities. These themes informed 5 design sessions in which participants co-designed visual metaphors for the themes based on their own experiences in an age-inclusive manner. Together, the participants produced a user-friendly prototype, which they chose to call My Buddy. They found it useful to receive social and cognitive triggers, as well as recommendations for special diets or activities based on their mood, health, and social status. Conclusions: Smart home data visualization is much more than a nice-to-have option. Visualization is a must-have feature because it deepens the understanding of the information collected and means that technology provides information of value and relevance to older people. This may improve the acceptability and perceived utility of in-home technology. By understanding what older people want to know from smart home technology and considering how to visualize data in ways that work for them, we can provide an appropriate in-home interface. Such an interface would suggest ways or opportunities to connect and socialize; stimulate contact with close friends or family members; maintain awareness of health and well-being; provide support in decision-making, cognitive tasks, and daily life activities; and monitor health status. Older adults are the best co-designers for the development of visual metaphors that resonate with their own experiences. Our findings promote the development of technologies that foreground and reflect the information needs of older people and engage them as designers of the display. ",
doi="10.2196/44439",
url="https://aging.jmir.org/2023/1/e44439",
url="http://www.ncbi.nlm.nih.gov/pubmed/37327037"
}


@Article{info:doi/10.2196/45231,
author="Budak, Beliz K{\"u}bra
and Laporte Uribe, Franziska
and Meiland, Franka
and Felding, Anna Simone
and Teupen, Sonja
and Bergmann, Michael Johannes
and Mueller-Widmer, Rene
and Roes, Martina",
title="Implementing Active Assisted Living Technology in the Long-term Care of People Living With Dementia to Address Loneliness: European Survey",
journal="JMIR Aging",
year="2023",
month="Jun",
day="14",
volume="6",
pages="e45231",
keywords="loneliness",
keywords="social isolation",
keywords="active assisted living technology",
keywords="long-term care",
keywords="dementia",
keywords="Alzheimer",
keywords="implementation",
keywords="CFIR",
abstract="Background: In the lives of people with dementia, loneliness is an important issue with psychological and physical consequences. Active assisted living (AAL) technology has been gaining visibility in the care of persons living with dementia, including addressing loneliness. However, to the best of our knowledge, there is a lack of evidence concerning the factors influencing the implementation of AAL technology within the context of dementia, loneliness, and long-term care (LTC). Objective: We aimed to identify the familiarity with AAL technology that is promising for addressing loneliness in persons living with dementia in LTC in Europe and the factors influencing AAL technology implementation. Methods: A web-based survey was developed based on findings from our previous literature review. The Consolidated Framework for Implementation Research guided the development and analysis of the survey. Participants included 24 representatives of Alzheimer Europe member associations from 15 European countries. The data were analyzed using basic statistical methods (descriptive statistics). Results: The baby seal robot Paro was reported to be the most familiar AAL technology by 19 of 24 participants addressing loneliness in people with dementia living in LTC. Participants from Norway (n=2) reported familiarity with 14 AAL technologies, and participants from Serbia (n=1) reported zero familiarity. It seems that countries that invest less in LTC facilities are familiar with fewer AAL technologies. At the same time, these countries report a more positive attitude toward AAL technology, express a higher need for it, and see more advantages than disadvantages than those countries that invest more in LTC. However, a country's investment in LTC facilities does not seem to be linked to other implementation aspects such as costs, planning, and the impact of infrastructure. Conclusions: Implementation of AAL technology to address loneliness in dementia seems to be linked to familiarity with the technology in a country as well as national investment in LTC facilities. This survey confirms the literature on higher investment countries' critical stance in regard to AAL technology implementation to address loneliness in persons living with dementia living in LTC. Further research is needed to clarify the potential reasons why familiarity with more AAL technology does not seem to be directly linked with acceptance, positive attitude, or satisfaction with AAL technology addressing loneliness in persons living with dementia. ",
doi="10.2196/45231",
url="https://aging.jmir.org/2023/1/e45231",
url="http://www.ncbi.nlm.nih.gov/pubmed/37314840"
}


@Article{info:doi/10.2196/40953,
author="Kelly, M. Ryan
and Xing, Yushan
and Baker, Steven
and Waycott, Jenny",
title="Video Calls as a Replacement for Family Visits During Lockdowns in Aged Care: Interview Study With Family Members",
journal="JMIR Aging",
year="2023",
month="Jun",
day="12",
volume="6",
pages="e40953",
keywords="aged care",
keywords="COVID-19 pandemic",
keywords="lockdowns",
keywords="older adults",
keywords="video calls",
keywords="videoconferencing",
keywords="mobile phone",
keywords="COVID-19",
abstract="Background: Lockdowns have been used to prevent the spread of transmissible illnesses such as influenza, norovirus, and COVID-19 in care homes. However, lockdowns deny care home residents supplemental care and the socioemotional enrichment that comes from seeing family members. Video calling has the potential to enable ongoing contact between residents and family members during lockdowns. However, video calls can be considered by some as a poor substitute for in-person visits. It is important to understand family members' experiences with video calling during lockdowns to ensure the effective use of this technology in the future. Objective: This study aimed to understand how family members use video calls to communicate with relatives living in aged care during lockdowns. We focused on experiences during the COVID-19 pandemic, which involved extensive lockdowns in aged care homes. Methods: We conducted semistructured interviews with 18 adults who had been using video calls with relatives living in aged care during pandemic lockdowns. The interviews focused on how participants had been using video calls, what benefits they gained from video-based interactions, and what challenges they encountered when using the technology. We analyzed the data using the 6-phase reflexive approach to thematic analysis by Braun and Clarke. Results: We developed 4 themes through our analysis. Theme 1 interprets video calling as a medium for the continuation of care during lockdowns. Using video calls, family members were able to provide social enrichment for residents and engaged in health monitoring to uphold residents' welfare. Theme 2 highlights how video calling extended care by supporting frequent contact, transmitting nonverbal cues that were essential for communication, and negating the need for face masks. Theme 3 interprets organizational issues such as the lack of technology and staff time as impediments to the continuation of familial care through video. Finally, theme 4 highlights the need for 2-way communication, interpreting residents' unfamiliarity with video calling and their health conditions as further barriers to the continuation of care. Conclusions: This study suggests that, during restrictions arising from the COVID-19 pandemic, video calls became a medium for enabling family members to continue participating in the care of their relatives. The use of video calls to continue care illustrates their value for families during times of mandatory lockdown and supports the use of video to complement face-to-face visits at other times. However, better support is needed for video calling in aged care homes. This study also revealed a need for video calling systems that are designed for the aged care context. ",
doi="10.2196/40953",
url="https://aging.jmir.org/2023/1/e40953",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191951"
}


@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/10.2196/41942,
author="Oyibo, Kiemute
and Wang, Kang
and Morita, Pelegrini Plinio",
title="Using Smart Home Technologies to Promote Physical Activity Among the General and Aging Populations: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="May",
day="12",
volume="25",
pages="e41942",
keywords="smart home",
keywords="physical activity",
keywords="aging population",
keywords="activity of daily living",
keywords="remote health care monitoring",
keywords="health monitoring",
keywords="health promotion",
keywords="smart home technology",
keywords="assisted living",
keywords="mobile phone",
abstract="Background: Health-monitoring smart homes are becoming popular, with experts arguing that 9-to-5 health care services might soon become a thing of the past. However, no review has explored the landscape of smart home technologies that aim to promote physical activity and independent living among a wide range of age groups. Objective: This review aims to map published studies on smart home technologies aimed at promoting physical activity among the general and aging populations to unveil the state of the art, its potential, and the research gaps and opportunities. Methods: Articles were retrieved from 6 databases (PubMed, CINAHL, Scopus, IEEE Xplore, ACM Library, and Web of Science). The criteria for inclusion were that the articles must be user studies that dealt with smart home or Active Assisted Living technologies and physical activity, were written in English, and were published in peer-reviewed journals. In total, 3 researchers independently and collaboratively assessed the eligibility of the retrieved articles and elicited the relevant data and findings using tables and charts. Results: This review synthesized 20 articles that met the inclusion criteria, 70\% (14/20) of which were conducted between 2018 and 2020. Three-quarters of the studies (15/20, 75\%) were conducted in Western countries, with the United States accounting for 25\% (5/20). Activities of daily living were the most studied (9/20, 45\%), followed by physical activity (6/20, 30\%), therapeutic exercise (4/20, 20\%), and bodyweight exercise (1/20, 5\%). K-nearest neighbor and na{\"i}ve Bayes classifier were the most used machine learning algorithms for activity recognition, with at least 10\% (2/20) of the studies using either algorithm. Ambient and wearable technologies were equally studied (8/20, 40\% each), followed by robots (3/20, 15\%). Activity recognition was the most common goal of the evaluated smart home technologies, with 55\% (11/20) of the studies reporting it, followed by activity monitoring (7/20, 35\%). Most studies (8/20, 40\%) were conducted in a laboratory setting. Moreover, 25\% (5/20) and 10\% (2/20) were conducted in a home and hospital setting, respectively. Finally, 75\% (15/20) had a positive outcome, 15\% (3/20) had a mixed outcome, and 10\% (2/20) had an indeterminate outcome. Conclusions: Our results suggest that smart home technologies, especially digital personal assistants, coaches, and robots, are effective in promoting physical activity among the young population. Although only few studies were identified among the older population, smart home technologies hold bright prospects in assisting and aiding older people to age in place and function independently, especially in Western countries, where there are shortages of long-term care workers. Hence, there is a need to do more work (eg, cross-cultural studies and randomized controlled trials) among the growing aging population on the effectiveness and acceptance of smart home technologies that aim to promote physical activity. ",
doi="10.2196/41942",
url="https://www.jmir.org/2023/1/e41942",
url="http://www.ncbi.nlm.nih.gov/pubmed/37171839"
}


@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/10.2196/40762,
author="Thomas, Missy
and Henderson, Dean
and Trudel, Chantal
and Thomas, Neil",
title="Usability of a Community-Based Dementia Resource Website: Mixed Methods Study",
journal="JMIR Aging",
year="2023",
month="Apr",
day="20",
volume="6",
pages="e40762",
keywords="dementia",
keywords="caregivers",
keywords="eHealth",
keywords="community resources",
abstract="Background: Many individuals living with dementia want to live in their own homes for as long as possible. To do so, they frequently require assistance with activities of daily living, which is often provided by friends and relatives acting as informal care partners. In Canada, many informal care partners are currently overworked and overwhelmed. Although community-based dementia-inclusive resources are available to support them, care partners often struggle to find them. Dementia613.ca was created to make the process of finding community dementia-inclusive resources simpler and more straightforward by bringing them together in one eHealth website. Objective: The objective of our study was to determine if dementia613.ca is meeting the goal of connecting care partners and persons living with dementia to dementia-inclusive resources in their community. Methods: A review and assessment of the website was conducted using 3 evaluation methods: web analytics, questionnaires, and task analysis. Google Analytics was used to collect data related to website use over a 9-month period. Data on site content and user characteristics were collected. Furthermore, 2 web-based self-administered questionnaires were developed: one intended for care partners and persons living with dementia, and the other intended for businesses and organizations interested in serving persons living with dementia. Both gathered data on user characteristics and included standard questions used in website evaluations. Responses were collected over a 6-month period. Scenarios, tasks, and questions were developed for the moderated, remote, and task-analysis sessions. These tasks and questions determined how effectively persons living with dementia and their care partners can use dementia613.ca. Overall, 5 sessions were held with persons experiencing moderate cognitive decline and with care partners of persons living with dementia. Results: This evaluation showed that the idea behind dementia613.ca is strong and appeals to persons living with dementia, their care partners, and the businesses and organizations serving this market. Participants indicated that it is a useful community resource that meets a previously unfulfilled need in the area, and highlighted the benefits of bringing community resources together on 1 website. In our questionnaire, >60\% (19/29, 66\%) of people living with dementia and their care partners and 70\% (7/10) of businesses and organizations agreed that the website made it easier to find relevant dementia-inclusive resources. There is room for improvement; participants indicated that the navigation and search features could be further developed. Conclusions: We believe that the dementia613.ca model could be used to inspire and guide the creation of dementia resource websites in other regions in Ontario and beyond. The framework behind it is generalizable and could be replicated to help care partners and persons living with dementia find local resources more easily. ",
doi="10.2196/40762",
url="https://aging.jmir.org/2023/1/e40762",
url="http://www.ncbi.nlm.nih.gov/pubmed/37079355"
}


@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/10.2196/43538,
author="Juhl, Haase Marie
and Soerensen, Lykkegaard Ann
and Kristensen, Kolding Jette
and Johnsen, Paaske S{\o}ren
and Olesen, Estrup Anne",
title="Safe Medication in Nursing Home Residents Through the Development and Evaluation of an Intervention (SAME): Protocol for a Fully Integrated Mixed Methods Study With a Cocreative Approach",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="31",
volume="12",
pages="e43538",
keywords="protocols and guidelines",
keywords="medication safety",
keywords="cocreation",
keywords="user involvement",
keywords="health and safety within primary care",
keywords="research in nursing home care",
keywords="mixed methods",
abstract="Background: Medication safety is increasingly challenging patient safety in growing aging populations. Developing positive patient safety cultures is acknowledged as a primary goal to improve patient safety, but evidence on the interventions to do so is inconclusive. Nursing home residents are often cognitively and physically impaired and are therefore highly reliant on frontline health care providers. Thus, interventions to improve medication safety of nursing home residents through patient safety culture among providers are needed. Using cocreative partnerships, integrating knowledge of residents and their relatives, and ensuring managerial support could be beneficial. Objective: The primary aim of the Safe Medication of Nursing Home Residents Through Development and Evaluation of an Intervention (SAME) study is to improve medication safety for nursing home residents through developing an intervention by gaining experiential knowledge of patient safety culture in cocreative partnerships, integrating knowledge of residents and their relatives, and ensuring managerial support. Methods: The fully integrated mixed method study will be conducted using an integrated knowledge translation approach. Patient safety culture within nursing homes will first be explored through qualitative focus groups (stage 1) including nursing home residents, their relatives, and frontline health care providers. This will inform the development of an intervention in a multidisciplinary panel (stage 2) including cocreators representing the medication management process across the health care system. Evaluation of the intervention will be done in a randomized controlled trial set at nursing homes (stage 3). The primary outcome will be changes in the mean scale score of an adapted version of the Danish ``Safety Attitudes Questionnaire'' (SAQ-DK) for use in nursing homes. Patient safety--related outcomes will be collected through Danish health registers to assess safety issues and effects, including medication, contacts to health care, diagnoses, and mortality. Finally, a mixed methods analysis on patient safety culture in nursing homes will be done (stage 4), integrating qualitative data (stage 1) and quantitative data (stage 3) to comprehensively understand patient safety culture as a key to medication safety. Results: The SAME study is ongoing. Focus groups were carried out from April 2021 to September 2021 and the workshop in September 2021. Baseline SAQ-DK data were collected in January 2022 with expected follow-up in January 2023. Final data analysis is expected in spring 2024. Conclusions: The SAME study will help not only to generate evidence on interventions to improve medication safety of nursing home residents through patient safety culture but also to give insight into possible impacts of using cocreativity to guide the development. Thus, findings will address multiple gaps in evidence to guide future patient safety improvement efforts within primary care settings of political and scientific scope. Trial Registration: ClinicalTrials.gov NCT04990986; https://clinicaltrials.gov/ct2/show/NCT04990986 International Registered Report Identifier (IRRID): DERR1-10.2196/43538 ",
doi="10.2196/43538",
url="https://www.researchprotocols.org/2023/1/e43538",
url="http://www.ncbi.nlm.nih.gov/pubmed/37000508"
}


@Article{info:doi/10.2196/41692,
author="Drazich, F. Brittany
and Lee, Won Ji
and Bowles, H. Kathryn
and Taylor, L. Janiece
and Shah, Shivani
and Resnick, Barbara
and Kim, Nayeon
and Szanton, L. Sarah",
title="Pandemic-Related Changes in Technology Use Among a Sample of Previously Hospitalized Older Adult New Yorkers: Observational Study",
journal="JMIR Aging",
year="2023",
month="Mar",
day="29",
volume="6",
pages="e41692",
keywords="older adults",
keywords="technology",
keywords="COVID-19",
keywords="well-being",
keywords="elderly population",
keywords="technology use",
keywords="physical disability",
keywords="virtual health",
keywords="social interaction",
keywords="digital gaming",
keywords="digital learning",
abstract="Background: The COVID-19 pandemic increased the importance of technology for all Americans, including older adults. Although a few studies have indicated that older adults might have increased their technology use during the COVID-19 pandemic, further research is needed to confirm these findings, especially among different populations, and using validated surveys. In particular, research on changes in technology use among previously hospitalized community-dwelling older adults, especially those with physical disability, is needed because older adults with multimorbidity and hospital associated deconditioning were a population greatly impacted by COVID-19 and related distancing measures. Obtaining knowledge regarding previously hospitalized older adults' technology use, before and during the pandemic, could inform the appropriateness of technology-based interventions for vulnerable older adults. Objective: In this paper, we 1) described changes in older adult technology-based communication, technology-based phone use, and technology-based gaming during the COVID-19 pandemic, compared to before the COVID-19 pandemic and 2) tested whether technology use moderated the association between changes in in-person visits and well-being, controlling for covariates. Methods: Between December 2020 and January 2021 we conducted a telephone-based objective survey with 60 previously hospitalized older New Yorkers with physical disability. We measured technology-based communication through three questions pulled from the National Health and Aging Trends Study COVID-19 Questionnaire. We measured technology-based smart phone use and technology-based video gaming through the Media Technology Usage and Attitudes Scale. We used paired t tests and interaction models to analyze survey data. Results: This sample of previously hospitalized older adults with physical disability consisted of 60 participants, 63.3\% of whom identified as female, 50.0\% of whom identified as White, and 63.8\% of whom reported an annual income of \$25,000 or less. This sample had not had physical contact (such as friendly hug or kiss) for a median of 60 days and had not left their home for a median of 2 days. The majority of older adults from this study reported using the internet, owning smart phones, and nearly half learned a new technology during the pandemic. During the pandemic, this sample of older adults significantly increased their technology-based communication (mean difference=.74, P=.003), smart phone use (mean difference=2.9, P=.016), and technology-based gaming (mean difference=.52, P=.030). However, this technology use during the pandemic did not moderate the association between changes in in-person visits and well-being, controlling for covariates. Conclusions: These study findings suggest that previously hospitalized older adults with physical disability are open to using or learning technology, but that technology use might not be able to replace in-person social interactions. Future research might explore the specific components of in-person visits that are missing in virtual interactions, and if they could be replicated in the virtual environment, or through other means. ",
doi="10.2196/41692",
url="https://aging.jmir.org/2023/1/e41692",
url="http://www.ncbi.nlm.nih.gov/pubmed/36881528"
}


@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/10.2196/44201,
author="Sari, Wulan Dianis
and Aurizki, Ekapuja Gading
and Indarwati, Retno
and Farapti, Farapti
and Rekawati, Etty
and Takaoka, Manami",
title="The Provision of Texture-Modified Foods in Long-term Care Facilities by Health Professionals: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="17",
volume="12",
pages="e44201",
keywords="aged",
keywords="diet",
keywords="dysphagia",
keywords="health professional",
keywords="texture-modified foods",
keywords="residential care",
abstract="Background: Malnutrition among older adults with dysphagia is common. Texture-modified foods (TMFs) are an essential part of dysphagia management. In long-term care (LTC) facilities, health professionals have implemented TMFs, but their application has not been fully elucidated, making them heterogeneous. Objective: We aim to explore the implementation of TMFs in LTC facilities, particularly focusing on the role of health professionals in nutritional care involving TMFs (eg, deciding the type of food, preparing and giving the food, and evaluating the outcomes). Methods: A scoping review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodological approach will be performed. A comprehensive search for published literature will be systematically performed in PubMed, CINAHL, MEDLINE, ProQuest, PsycINFO, and Science Citation Index (Web of Science). Data screening and extraction will be performed by 2 reviewers independently. The studies included will be synthesized, summarized, and reported, following the preferred reporting items of the Mixed Methods Appraisal Tool. Our review will consider the following study designs: mixed methods, quantitative, and qualitative. Studies with patients who are not older adults will be excluded. Results: Data extraction will be completed by February 2023. Data presentation and analyses will be completed by April 2023, and the final outcomes will be completed by June 2023. The study findings will be published in a peer-reviewed journal. Conclusions: Our scoping review will consider studies related to TMF interventions for older adults in LTC residential facilities, with no exclusion restrictions based on country, gender, or comorbidities. Studies on interventions that address TMF-related issues, such as deciding the type of food, preparing and giving the food, and evaluating the outcomes, are qualified for inclusion. Trial Registration: OSF Registries 79AFZ; https://osf.io/79afz International Registered Report Identifier (IRRID): PRR1-10.2196/44201 ",
doi="10.2196/44201",
url="https://www.researchprotocols.org/2023/1/e44201",
url="http://www.ncbi.nlm.nih.gov/pubmed/36930183"
}


@Article{info:doi/10.2196/44007,
author="Brown, L. Ellen
and Ruggiano, Nicole
and Allala, Chaithra Sai
and Clarke, J. Peter
and Davis, Debra
and Roberts, Lisa
and Framil, Victoria C.
and Mu{\~n}oz, Hernandez Mar{\'i}ateresa Teri
and Hough, Strauss Monica
and Bourgeois, S. Michelle",
title="Developing a Memory and Communication App for Persons Living With Dementia: An 8-Step Process",
journal="JMIR Aging",
year="2023",
month="Mar",
day="15",
volume="6",
pages="e44007",
keywords="health technology",
keywords="interdisiplinary team",
keywords="older adults",
keywords="dementia",
keywords="communication",
keywords="communication aids for disabled persons",
keywords="communication boards",
keywords="app",
keywords="Alzheimer disease",
keywords="family",
keywords="caregiver",
keywords="clinical care",
keywords="development",
keywords="speech",
keywords="psychosocial intervention",
keywords="software design",
abstract="International Registered Report Identifier (IRRID): RR2-10.3928/19404921-20210825-02 ",
doi="10.2196/44007",
url="https://aging.jmir.org/2023/1/e44007",
url="http://www.ncbi.nlm.nih.gov/pubmed/36920462"
}


@Article{info:doi/10.2196/44918,
author="May, T. Jennifer
and Harris, Louise Melissa",
title="Health Experiences of Sexual and Gender Minority People Living With Dementia and Their Care Partners: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="13",
volume="12",
pages="e44918",
keywords="lesbian, gay, bisexual, transgender, and queer",
keywords="LGBTQ",
keywords="dementia",
keywords="caregiver",
keywords="identity",
keywords="gender minority",
keywords="health inequity",
keywords="vulnerable population",
keywords="health care",
keywords="health disparity",
keywords="scoping review protocol",
keywords="sexual minority",
abstract="Background: People living with dementia and their care partners who identify as a sexual and gender minority (SGM) often experience specific health inequities and disparities due to discrimination related to age, cognitive impairment, and being SGM. Objective: The purpose of this scoping review is to identify, explore, and synthesize the state of the science regarding the health and health care experiences of SGM people living with dementia and their care partners. This review also aims to identify gaps in research and set forth key recommendations to improve the health and health care experiences of SGM people living with dementia and their care partners by advancing health equity through research, policy, and practice. Methods: The protocol follows the guidelines set forth by Joanna Briggs Institute protocol for scoping reviews. Steps of this framework that will be followed include (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consultation. This scoping review will explore several electronic databases, including MEDLINE, Embase, CINAHL, AgeLine, PsychINFO, and Scopus. Health librarians will conduct the initial search for articles that are in English, include people living with dementia who identify as SGM, SGM people living with dementia and their care partners, or SGM care partners caring for people with dementia. Studies must be peer reviewed and focus on the phenomenon of interest, which is the health and health care experiences of participants. Covidence will be used to review abstracts and full-text articles and to screen articles. After the search has been completed, 2 independent reviewers will screen article titles and abstracts to identify eligibility. Discrepancies will be discussed and decided upon by the 2 reviewers. Relevant studies will be collected, and data will be extracted and charted to summarize key findings. Key findings will be presented to a community stakeholder group of SGM care partners and people living with dementia, and a listening session will be convened. Results: This scoping review will identify the state of the science of health and health care experiences of people living with dementia and their care partners who identify as SGM. We will identify gaps and provide recommendations to inform future research, policy, and practice to improve health and health care experiences of SGM people living with dementia and their care partners. Conclusions: Little is known about people living with dementia and their care partners who identify as SGM. This scoping review will be one of the first to identify the health and health care experiences of people living with dementia and their care partners who identify as SGM. The results of this review will be used to guide future interventions and to inform future policy and practice to improve health care and reduce health disparities in this population. International Registered Report Identifier (IRRID): PRR1-10.2196/44918 ",
doi="10.2196/44918",
url="https://www.researchprotocols.org/2023/1/e44918",
url="http://www.ncbi.nlm.nih.gov/pubmed/36757411"
}


@Article{info:doi/10.2196/42340,
author="Mart{\'i}n-Carbonell, Marta
and Espejo, Bego{\~n}a
and Castro-Melo, Patricia Greys
and Sequeira-Daza, Doris
and Checa, Irene",
title="Psychometric Properties of and Measurement Invariance in the Questionnaire of Stereotypes Toward Older Adulthood in Health Care College Students and Health Professionals of Colombia: Psychometric Study",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="9",
volume="25",
pages="e42340",
keywords="psychometric properties",
keywords="structural equation modeling",
keywords="older adulthood",
keywords="geriatric",
keywords="gerontology",
keywords="health care college students",
keywords="health care professionals",
keywords="questionnaire",
keywords="stereotype",
keywords="agism",
abstract="Background: In health professionals, negative stereotypes toward older adulthood have been associated with the difficulty in recognizing pathological processes and the refusal to care for older patients because of assuming that communication with them will be uncomfortable and frustrating. For these reasons, research on stereotypes in these groups has acquired growing importance. The usual strategy to identify and evaluate agist stereotypes is to use scales and questionnaires. Although multiple scales are currently used, in Latin America, the Questionnaire for the Evaluation of Negative Stereotypes Toward Older Adulthood (Cuestionario de Estereotipos Negativos sobre la Vejez [CENVE]), developed in Spain, is widely used but without evidence of construct validity in our context. In addition, although in the original version, a factorial structure of 3 factors was found, in later studies, a unifactorial structure was obtained. Objective: The objective is to study the construct validity of the CENVE in a sample of Colombian health personnel to clarify its factorial structure and concurrent validity. Likewise, the measurement invariance according to gender and age was studied. Methods: A nonprobabilistic sample of 877 Colombian health professionals and intern health students was obtained. The data were collected online using the LimeSurvey tool. To study the factor structure of the CENVE, 2 confirmatory factor analysis (CFA) models were carried out, one to test a single factor and the other to test the 3-related-factor structure. The factor measurement reliability was evaluated with the composite reliability index (CRI) and the average variance extracted (AVE). The measurement invariance was studied according to gender (men and women) and age (emerging adults, 18-29 years old, and adults, 30 years old or older). Using a structural equation model, the relationship between age and the latent CENVE total score was studied to obtain evidence of concurrent validity, since studies indicate that the younger the age, the greater the number of stereotypes. Results: The 1-factor structure was confirmed. The reliability results indicated that both indices show adequate values. Likewise, the existence of a strong invariance in measurement by gender and age group was verified. After contrasting the means of the groups, the results showed that men show more negative stereotypes toward old age than women. Likewise, emerging adults also showed more stereotypes than adults. We also verified that age is inversely related to the latent score of the questionnaire, such that the younger the age, the greater the stereotype. These results are in agreement with those obtained by other authors. Conclusions: The CENVE shows good construct and concurrent validity, as well as good reliability, and it can be used to assess stereotypes toward older adulthood in Colombian health professionals and health sciences college students. This will allow us to better understand the effect of stereotypes on agism. ",
doi="10.2196/42340",
url="https://www.jmir.org/2023/1/e42340",
url="http://www.ncbi.nlm.nih.gov/pubmed/36892936"
}


@Article{info:doi/10.2196/43777,
author="David, B. Michael C.
and Kolanko, Magdalena
and Del Giovane, Martina
and Lai, Helen
and True, Jessica
and Beal, Emily
and Li, M. Lucia
and Nilforooshan, Ramin
and Barnaghi, Payam
and Malhotra, A. Paresh
and Rostill, Helen
and Wingfield, David
and Wilson, Danielle
and Daniels, Sarah
and Sharp, J. David
and Scott, Gregory",
title="Remote Monitoring of Physiology in People Living With Dementia: An Observational Cohort Study",
journal="JMIR Aging",
year="2023",
month="Mar",
day="9",
volume="6",
pages="e43777",
keywords="dementia",
keywords="remote monitoring",
keywords="physiology",
keywords="Internet of Things",
keywords="alerts",
keywords="monitoring",
keywords="technology",
keywords="detection",
keywords="blood pressure",
keywords="support",
keywords="feasibility",
keywords="system",
keywords="quality of life",
abstract="Background: Internet of Things (IoT) technology enables physiological measurements to be recorded at home from people living with dementia and monitored remotely. However, measurements from people with dementia in this context have not been previously studied. We report on the distribution of physiological measurements from 82 people with dementia over approximately 2 years. Objective: Our objective was to characterize the physiology of people with dementia when measured in the context of their own homes. We also wanted to explore the possible use of an alerts-based system for detecting health deterioration and discuss the potential applications and limitations of this kind of system. Methods: We performed a longitudinal community-based cohort study of people with dementia using ``Minder,'' our IoT remote monitoring platform. All people with dementia received a blood pressure machine for systolic and diastolic blood pressure, a pulse oximeter measuring oxygen saturation and heart rate, body weight scales, and a thermometer, and were asked to use each device once a day at any time. Timings, distributions, and abnormalities in measurements were examined, including the rate of significant abnormalities (``alerts'') defined by various standardized criteria. We used our own study criteria for alerts and compared them with the National Early Warning Score 2 criteria. Results: A total of 82 people with dementia, with a mean age of 80.4 (SD 7.8) years, recorded 147,203 measurements over 958,000 participant-hours. The median percentage of days when any participant took any measurements (ie, any device) was 56.2\% (IQR 33.2\%-83.7\%, range 2.3\%-100\%). Reassuringly, engagement of people with dementia with the system did not wane with time, reflected in there being no change in the weekly number of measurements with respect to time (1-sample t-test on slopes of linear fit, P=.45). A total of 45\% of people with dementia met criteria for hypertension. People with dementia with $\alpha$-synuclein--related dementia had lower systolic blood pressure; 30\% had clinically significant weight loss. Depending on the criteria used, 3.03\%-9.46\% of measurements generated alerts, at 0.066-0.233 per day per person with dementia. We also report 4 case studies, highlighting the potential benefits and challenges of remote physiological monitoring in people with dementia. These include case studies of people with dementia developing acute infections and one of a person with dementia developing symptomatic bradycardia while taking donepezil. Conclusions: We present findings from a study of the physiology of people with dementia recorded remotely on a large scale. People with dementia and their carers showed acceptable compliance throughout, supporting the feasibility of the system. Our findings inform the development of technologies, care pathways, and policies for IoT-based remote monitoring. We show how IoT-based monitoring could improve the management of acute and chronic comorbidities in this clinically vulnerable group. Future randomized trials are required to establish if a system like this has measurable long-term benefits on health and quality of life outcomes. ",
doi="10.2196/43777",
url="https://aging.jmir.org/2023/1/e43777",
url="http://www.ncbi.nlm.nih.gov/pubmed/36892931"
}


@Article{info:doi/10.2196/41322,
author="Wang, H. Rosalie
and Tannou, Thomas
and Bier, Nathalie
and Couture, M{\'e}lanie
and Aubry, R{\'e}gis",
title="Proactive and Ongoing Analysis and Management of Ethical Concerns in the Development, Evaluation, and Implementation of Smart Homes for Older Adults With Frailty",
journal="JMIR Aging",
year="2023",
month="Mar",
day="9",
volume="6",
pages="e41322",
keywords="ethics",
keywords="older adults",
keywords="frailty",
keywords="smart home",
keywords="assistive technology",
keywords="aging in place",
keywords="ethical concerns",
keywords="implementation",
keywords="bioethics",
keywords="technology ethics",
keywords="autonomy",
keywords="privacy",
keywords="security",
keywords="informed consent",
keywords="support ecosystem",
doi="10.2196/41322",
url="https://aging.jmir.org/2023/1/e41322",
url="http://www.ncbi.nlm.nih.gov/pubmed/36892912"
}


@Article{info:doi/10.2196/42231,
author="Mali, Namrata
and Restrepo, Felipe
and Abrahams, Alan
and Sands, Laura
and Goldberg, M. David
and Gruss, Richard
and Zaman, Nohel
and Shields, Wendy
and Omaki, Elise
and Ehsani, Johnathon
and Ractham, Peter
and Kaewkitipong, Laddawan",
title="Safety Concerns in Mobility-Assistive Products for Older Adults: Content Analysis of Online Reviews",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="2",
volume="25",
pages="e42231",
keywords="injury prevention",
keywords="consumer-reported injuries",
keywords="older adults",
keywords="online reviews",
keywords="mobility-assistive devices",
keywords="product failures",
abstract="Background: Older adults who have difficulty moving around are commonly advised to adopt mobility-assistive devices to prevent injuries. However, limited evidence exists on the safety of these devices. Existing data sources such as the National Electronic Injury Surveillance System tend to focus on injury description rather than the underlying context, thus providing little to no actionable information regarding the safety of these devices. Although online reviews are often used by consumers to assess the safety of products, prior studies have not explored consumer-reported injuries and safety concerns within online reviews of mobility-assistive devices. Objective: This study aimed to investigate injury types and contexts stemming from the use of mobility-assistive devices, as reported by older adults or their caregivers in online reviews. It not only identified injury severities and mobility-assistive device failure pathways but also shed light on the development of safety information and protocols for these products. Methods: Reviews concerning assistive devices were extracted from the ``assistive aid'' categories, which are typically intended for older adult use, on Amazon's US website. The extracted reviews were filtered so that only those pertaining to mobility-assistive devices (canes, gait or transfer belts, ramps, walkers or rollators, and wheelchairs or transport chairs) were retained. We conducted large-scale content analysis of these 48,886 retained reviews by coding them according to injury type (no injury, potential future injury, minor injury, and major injury) and injury pathway (device critical component breakage or decoupling; unintended movement; instability; poor, uneven surface handling; and trip hazards). Coding efforts were carried out across 2 separate phases in which the team manually verified all instances coded as minor injury, major injury, or potential future injury and established interrater reliability to validate coding efforts. Results: The content analysis provided a better understanding of the contexts and conditions leading to user injury, as well as the severity of injuries associated with these mobility-assistive devices. Injury pathways---device critical component failures; unintended device movement; poor, uneven surface handling; instability; and trip hazards---were identified for 5 product types (canes, gait and transfer belts, ramps, walkers and rollators, and wheelchairs and transport chairs). Outcomes were normalized per 10,000 posting counts (online reviews) mentioning minor injury, major injury, or potential future injury by product category. Overall, per 10,000 reviews, 240 (2.4\%) described mobility-assistive equipment--related user injuries, whereas 2318 (23.18\%) revealed potential future injuries. Conclusions: This study highlights mobility-assistive device injury contexts and severities, suggesting that consumers who posted online reviews attribute most serious injuries to a defective item, rather than user misuse. It implies that many mobility-assistive device injuries may be preventable through patient and caregiver education on how to evaluate new and existing equipment for risk of potential future injury. ",
doi="10.2196/42231",
url="https://www.jmir.org/2023/1/e42231",
url="http://www.ncbi.nlm.nih.gov/pubmed/36862459"
}


@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/10.2196/44627,
author="Jin, Haomiao
and Junghaenel, U. Doerte
and Orriens, Bart
and Lee, Pey-Jiuan
and Schneider, Stefan",
title="Developing Early Markers of Cognitive Decline and Dementia Derived From Survey Response Behaviors: Protocol for Analyses of Preexisting Large-scale Longitudinal Data",
journal="JMIR Res Protoc",
year="2023",
month="Feb",
day="21",
volume="12",
pages="e44627",
keywords="dementia",
keywords="mild cognitive impairment",
keywords="early markers",
keywords="survey response behaviors",
keywords="epidemiology",
abstract="Background: Accumulating evidence shows that subtle alterations in daily functioning are among the earliest and strongest signals that predict cognitive decline and dementia. A survey is a small slice of everyday functioning; nevertheless, completing a survey is a complex and cognitively demanding task that requires attention, working memory, executive functioning, and short- and long-term memory. Examining older people's survey response behaviors, which focus on how respondents complete surveys irrespective of the content being sought by the questions, may represent a valuable but often neglected resource that can be leveraged to develop behavior-based early markers of cognitive decline and dementia that are cost-effective, unobtrusive, and scalable for use in large population samples. Objective: This paper describes the protocol of a multiyear research project funded by the US National Institute on Aging to develop early markers of cognitive decline and dementia derived from survey response behaviors at older ages. Methods: Two types of indices summarizing different aspects of older adults' survey response behaviors are created. Indices of subtle reporting mistakes are derived from questionnaire answer patterns in a number of population-based longitudinal aging studies. In parallel, para-data indices are generated from computer use behaviors recorded on the backend server of a large web-based panel study known as the Understanding America Study (UAS). In-depth examinations of the properties of the created questionnaire answer pattern and para-data indices will be conducted for the purpose of evaluating their concurrent validity, sensitivity to change, and predictive validity. We will synthesize the indices using individual participant data meta-analysis and conduct feature selection to identify the optimal combination of indices for predicting cognitive decline and dementia. Results: As of October 2022, we have identified 15 longitudinal ageing studies as eligible data sources for creating questionnaire answer pattern indices and obtained para-data from 15 UAS surveys that were fielded from mid-2014 to 2015. A total of 20 questionnaire answer pattern indices and 20 para-data indices have also been identified. We have conducted a preliminary investigation to test the utility of the questionnaire answer patterns and para-data indices for the prediction of cognitive decline and dementia. These early results are based on only a subset of indices but are suggestive of the findings that we anticipate will emerge from the planned analyses of multiple behavioral indices derived from many diverse studies. Conclusions: Survey response behaviors are a relatively inexpensive data source, but they are seldom used directly for epidemiological research on cognitive impairment at older ages. This study is anticipated to develop an innovative yet unconventional approach that may complement existing approaches aimed at the early detection of cognitive decline and dementia. International Registered Report Identifier (IRRID): DERR1-10.2196/44627 ",
doi="10.2196/44627",
url="https://www.researchprotocols.org/2023/1/e44627",
url="http://www.ncbi.nlm.nih.gov/pubmed/36809337"
}


@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/10.2196/40858,
author="Wu, Jingsong
and Tu, Jingnan
and Liu, Zhizhen
and Cao, Lei
and He, Youze
and Huang, Jia
and Tao, Jing
and Wong, K. Mabel N.
and Chen, Lidian
and Lee, C. Tatia M.
and Chan, H. Chetwyn C.",
title="An Effective Test (EOmciSS) for Screening Older Adults With Mild Cognitive Impairment in a Community Setting: Development and Validation Study",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="30",
volume="25",
pages="e40858",
keywords="mild cognitive impairment",
keywords="digital assessment",
keywords="digital health",
keywords="community dwelling",
keywords="screening test",
keywords="older adults",
keywords="aging",
abstract="Background: Early detection of mild cognitive impairment (MCI) symptoms is an important step to its diagnosis and intervention. We developed a new screening test called ``Efficient Online MCI Screening System'' (EOmciSS) for use in community-dwelling older adults. It is a self-paced cognitive test to be completed within 10 minutes on tablets or smartphones in homes or care centers for older adults. Objective: This study aims to test the validity of EOmciSS for identifying community-dwelling older adults with MCI risks. Methods: Participants (N=827) completed EOmciSS and other screening tests for MCI. The psychometric properties tested were ``subscale item difficulty,'' ``discriminative index,'' ``internal consistency,'' and ``construct validity.'' We also tested between-group discrimination using the cross-validation method in an MCI group and a normal cognitive function (NCF) group. Results: A total of 3 accuracy factors and 1 reaction time factor explained the structure of the 20 item factors. The difficulty level of accuracy factors (ie, ``trail making,'' ``clock drawing,'' ``cube copying,'' ``delayed recall'') was 0.63-0.99, whereas that of the reaction time factor was 0.77-0.95. The discriminative index of the medium-to-high-difficulty item factors was 0.39-0.97. The internal consistency (Cronbach $\alpha$) ranged from .41 (for few item factors) to .96. The training data set contained 9 item factors (CC-Acc1, P<.001; CD-Acc1, P=.07; CD-Acc2, P=.06; CD-Acc3, P<.001; TM-Acc4, P=.07; DR-Acc1, P=.03; RS, P=.06; DR-RT1, P=.02; and DR-RT2, P=.05) that were significant predictors for an MCI classification versus NCF classification. Depressive symptoms were identified as significant factors (P<.001) influencing the performance of participants, and were an integral part of our test system. Age (P=.15), number of years of education (P=.18), and proficiency in using an electronic device (P=.39) did not significantly influence the scores nor classification of participants. Application of the MCI/NCF cutoff score (7.90 out of 9.67) to the validation data set yielded an area under the curve of 0.912 (P<.001; 95\% CI 0.868-0.955). The sensitivity was 84.9\%, specificity was 85.1\%, and the Youden index was 0.70. Conclusions: EOmciSS was valid and reliable for identifying older adults with significant risks of MCI. Our results indicate that EOmciSS has higher sensitivity and specificity than those of the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment and the Computerized Cognitive Screen. The user interface, online operation, and self-paced format allowed the test system to be operated by older adults or their caregivers in different settings (eg, home or care centers for older adults). Depressive symptoms should be an integral part in future MCI screening systems because they influence the test performance and, hence, MCI risk. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000039411; http://www.chictr.org.cn/showprojen.aspx?proj=62903 ",
doi="10.2196/40858",
url="https://www.jmir.org/2023/1/e40858",
url="http://www.ncbi.nlm.nih.gov/pubmed/36716081"
}


@Article{info:doi/10.2196/37785,
author="Wegener, Kauffeldt Emilie
and Bergsch{\"o}ld, M. Jenny
and Whitmore, Carly
and Winters, Marjolein
and Kayser, Lars",
title="Involving Older People With Frailty or Impairment in the Design Process of Digital Health Technologies to Enable Aging in Place: Scoping Review",
journal="JMIR Hum Factors",
year="2023",
month="Jan",
day="27",
volume="10",
pages="e37785",
keywords="eHealth",
keywords="cognitive decline",
keywords="frail",
keywords="aging",
keywords="cocreation",
keywords="user involvement",
keywords="mobile phone",
abstract="Background: With an increase in life expectancy globally, the focus on digital health technologies that can enhance physical and mental health among older people with frailty and impairment has increased. Similarly, research interest in how digital health technology can promote well-being and self-management of health in older age has increased, including an increased focus on methods for designing digital health technologies that meet the various medical, psychological, and social needs of older population. Despite the increased focus, there remains a necessity to further understand the needs of this population group to ensure uptake and to avoid introduction of additional challenges when introducing technologies, for example, because of poor technological design. The scope is limited to digital health technologies meant to enable older people with frailty and impairment to age in place. Objective: In this study, we aimed to explore how older people with frailty and impairment are involved in various parts of the design processes of digital health technologies and identify gaps or neglected steps in a user-involving design process. This included a focus on recruitment strategies, contributions, and methods used to address the perspectives, needs, and desires of older people with frailty and impairment in the development of digital health technologies. Methods: A scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting from February 2021 to April 2021. Literature searches were conducted in PubMed, Scopus, Embase, and IEEE using a search string covering the concepts of health technology, older people, frailty and impairment, user-centered design, and self-management. Results: In total, 1891 studies were imported for screening from the initial search. A total of 22 studies were included in this review after full-text screening and manual search. Invitation through partners was the most reported recruitment strategy to involve older people with frailty and impairment in the design process of digital health technologies. Furthermore, they were commonly involved in the final evaluation of the development process. Three main gaps identified were the use of outreach approaches to recruit older people with frailty and impairment in the design process of digital health technologies, description of the value of involvement and outcome of the contribution of participants, and knowledge regarding involvement in all parts of the design process. Conclusions: Although there is literature on methods for involving older people with frailty and impairment in the design of digital health technology, there is little methodological dialogue on the nuances of how different methods for involvement relate to and shape the outcome of the development process. ",
doi="10.2196/37785",
url="https://humanfactors.jmir.org/2023/1/e37785",
url="http://www.ncbi.nlm.nih.gov/pubmed/36705959"
}


@Article{info:doi/10.2196/39130,
author="Pereira, Filipa
and Dixe, Anjos Maria dos
and Gon{\c{c}}alves Pereira, S{\'o}nia
and Meyer-Massetti, Carla
and Verloo, Henk",
title="An Intervention Program to Reduce Medication-Related Problems Among Polymedicated Home-Dwelling Older Adults (OptiMed): Protocol for a Pre-Post, Multisite, Pilot, and Feasibility Study",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="25",
volume="12",
pages="e39130",
keywords="protocol",
keywords="pilot study",
keywords="feasibility",
keywords="medication safety",
keywords="medication-related problems",
keywords="medication management",
keywords="home-dwelling older adults",
keywords="informal caregivers",
keywords="interprofessional collaboration",
keywords="patient-centered care",
keywords="quasi-experimental",
keywords="pre-post study",
keywords="polypharmacy",
abstract="Background: Effective medication management is one of the essential preconditions for enabling polymedicated home-dwelling older adults with multiple chronic conditions to remain at home and preserve their quality of life and autonomy. Lack of effective medication management predisposes older adults to medication-related problems (MRPs) and adverse health outcomes, which can lead to the degradation of a patient's acute clinical condition, physical and cognitive decline, exacerbation of chronic medical conditions, and avoidable health care costs. Nonetheless, it has been shown that MRPs can be prevented or reduced by using well-coordinated, patient-centered, interprofessional primary care interventions. Objective: This study aimed to explore the feasibility and acceptability of an evidence-based, multicomponent, interprofessional intervention program supported by informal caregivers to decrease MRPs among polymedicated home-dwelling older adults with multiple chronic conditions. Methods: This quasi-experimental, pre-post, multisite pilot, and feasibility study will use an open-label design, with participants knowing the study's objectives and relevant information, and it will take place in primary health care settings in Portugal and Switzerland. The research population will comprise 30 polymedicated, home-dwelling adults, aged ?65 years at risk of MRPs and receiving community-based health care, along with their informal caregivers and health care professionals. Results: Before a projected full-scale study, this pilot and feasibility study will focus on recruiting and ensuring the active collaboration of its participants and on the feasibility of expanding this evidence-based, multicomponent, interprofessional intervention program throughout both study regions. This study will also be essential to projected follow-up research programs on informal caregivers' multiple roles, enhancing their coordination tasks and their own needs. Results are expected at the end of 2024. Conclusions: Designing, establishing, and exploring the feasibility and acceptability of an intervention program to reduce the risks of MRPs among home-dwelling older adults is an underinvestigated issue. Doing so in collaboration with all the different actors involved in that population's medication management and recording the first effects of the intervention will make this pilot and feasibility study's findings very valuable as home care becomes an ever more common solution. Trial Registration: Swiss National Clinical Trials Portal 000004654; https://tinyurl.com/mr3yz8t4 ",
doi="10.2196/39130",
url="https://www.researchprotocols.org/2023/1/e39130",
url="http://www.ncbi.nlm.nih.gov/pubmed/36696165"
}


@Article{info:doi/10.2196/42223,
author="Wang, Zixin
and Fang, Yuan
and Chan, Shing-Fong Paul
and Yu, Yuen Fuk
and Sun, Fenghua",
title="The Changes in Levels and Barriers of Physical Activity Among Community-Dwelling Older Adults During and After the Fifth Wave of COVID-19 Outbreak in Hong Kong: Repeated Random Telephone Surveys",
journal="JMIR Aging",
year="2023",
month="Jan",
day="23",
volume="6",
pages="e42223",
keywords="COVID-19",
keywords="physical activity",
keywords="older adults",
keywords="barriers",
keywords="changes",
keywords="repeated random telephone survey",
keywords="China",
keywords="aging",
keywords="elderly population",
keywords="community-dwelling older adults",
keywords="health promotion",
keywords="telehealth",
abstract="Background: COVID-19 has had an impact on physical activity (PA) among older adults; however, it is unclear whether this effect would be long-lasting, and there is a dearth of studies assessing the changes in barriers to performing PA among older adults before and after entering the ``postpandemic era.'' Objective: The aim of this study was to compare the levels and barriers of PA among a random sample of community-dwelling older adults recruited during (February to April 2022) and after the fifth wave of the COVID-19 outbreak (May to July 2022) in Hong Kong. In addition, we investigated factors associated with a low PA level among participants recruited at different time points. Methods: This study involved two rounds of random telephone surveys. Participants were community-dwelling Chinese-speaking individuals aged 65 years or above and having a Hong Kong ID card. Household telephone numbers were randomly selected from the most updated telephone directories. Experienced interviewers carried out telephone interviews between 6 PM and 10 PM on weekdays and between 2 PM and 9 PM on Saturdays to avoid undersampling of working individuals. We called 3900 and 3840 households in the first and second round, respectively; for each round, 640 and 625 households had an eligible older adult and 395 and 370 completed the telephone survey, respectively. Results: As compared to participants in the first round, fewer participants indicated a low level of PA in the second round (28.6\% vs 45.9\%, P<.001). Participants in the second round had higher metabolic equivalent of tasks-minutes/week (median 1707.5 vs 840, P<.001) and minutes of moderate-to-vigorous PA per week (median 240 vs 105, P<.001) than those in the first round. After adjustment for significant background characteristics, participants who perceived a lack of physical capacity to perform PA (first round: adjusted odds ratio [AOR] 3.34, P=.001; second round: 2.92, P=.002) and believed that PA would cause pain and discomfort (first round: AOR 2.04, P=.02; second round: 2.82, P=.001) were more likely to have a low level of PA in both rounds. Lack of time (AOR 4.19, P=.01) and concern about COVID-19 infection during PA (AOR 1.73, P=.02) were associated with a low level of PA among participants in the first round, but not in the second round. A perceived lack of space and facility to perform PA at home (AOR 2.03, P=.02) and unable to find people to do PA with (AOR 1.80, P=.04) were associated with a low PA level in the second round, but not in the first round. Conclusions: The level of PA increased significantly among older adults after Hong Kong entered the ``postpandemic era.'' Different factors influenced older adults' PA level during and after the fifth wave of the COVID-19 outbreak. Regular monitoring of the PA level and its associated factors should be conducted to guide health promotion and policy-making. ",
doi="10.2196/42223",
url="https://aging.jmir.org/2023/1/e42223",
url="http://www.ncbi.nlm.nih.gov/pubmed/36599172"
}


@Article{info:doi/10.2196/42195,
author="Du, Yan
and Roberts, Penny
and Liu, Wei",
title="Facilitators and Barriers of Tai Chi Practice in Community-Dwelling Older Adults: Qualitative Study",
journal="Asian Pac Isl Nurs J",
year="2023",
month="Jan",
day="23",
volume="7",
pages="e42195",
keywords="facilitators",
keywords="barriers",
keywords="older adults",
keywords="practice",
keywords="adherence",
keywords="Tai Chi",
keywords="qualitative study",
keywords="health outcomes",
keywords="martial arts",
keywords="exercise",
keywords="gerontology",
keywords="muscle strengthening",
abstract="Background: Numerous studies have documented the beneficial effects of Tai Chi on a variety of health outcomes, especially in older adults. However, only few studies have examined how to improve the practice and adherence of this Asian-originated exercise among older adults in Western countries. Objective: This study aimed to identify facilitators and barriers to Tai Chi practice and adherence in community-dwelling older adults. Methods: This study analyzed the qualitative data collected from 13 participants (mean age 62.0, SD 10.3) at the end of a 15-week randomized controlled trial conducted at a day activity senior center. Semistructured interviews were conducted, recorded, and transcribed; and the data were analyzed using inductive thematic analysis. Results: Four themes emerged: perceived benefit, threats, facilitators, and barriers. Perceived threats (eg, aging and side effects of medications) and perceived benefits of Tai Chi (eg, balance) inspired participants' engagement in Tai Chi exercise. On the other hand, barriers to Tai Chi practice and adherence included instructor's teaching style, the complexity of Tai Chi postures and movements, and existing health conditions (eg, hip problems). In essence, factors like Tai Chi class availability, family and peer support, as well as practicing Tai Chi with music may facilitate Tai Chi exercise adherence. Conclusions: The study findings could provide valuable information to health professionals, such as nurses and physical therapists, in developing and implementing effective Tai Chi programs in care plans. Considering health conditions, tailoring Tai Chi exercise instruction styles, encouraging social and peer support, and incorporating music may promote Tai Chi practice and adherence. ",
doi="10.2196/42195",
url="https://apinj.jmir.org/2023/1/e42195",
url="http://www.ncbi.nlm.nih.gov/pubmed/36720122"
}


@Article{info:doi/10.2196/43106,
author="Fakhfakh, Maya
and Blanchette, Virginie
and Plourde, V. Karine
and Gadio, Souleymane
and Elf, Marie
and Jones, Allyson C.
and Meijering, Louise
and Gigu{\`e}re, Anik
and L{\'e}gar{\'e}, France",
title="Canadian Older Adults' Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey",
journal="JMIR Aging",
year="2023",
month="Jan",
day="18",
volume="6",
pages="e43106",
keywords="aged",
keywords="intention",
keywords="decision aid",
keywords="decision support techniques",
keywords="housing",
keywords="unified theory of acceptance and use of technology",
keywords="UTAUT",
keywords="information technology",
keywords="internet",
keywords="shared decision-making",
abstract="Background: Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision. Objective: We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention. Methods: We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ?65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA. Results: Of the 11,972 invited panelists, 1176 (9.82\%) met the eligibility criteria, and 1000 (85.03\%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8\%), White (906/1000, 90.6\%), English speakers (629/1000, 62.9\%), and lived in Ontario or Quebec (628/1000, 62.8\%) and in urban areas (850/1000, 85\%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue ($\beta$=.30; P<.001), objective eHealth literacy ($\beta$=--.06; P=.03), performance expectancy ($\beta$=.55; P<.001), social influence ($\beta$=.37; P<.001), and facilitating conditions ($\beta$=.15; P<.001). Conclusions: Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA. ",
doi="10.2196/43106",
url="https://aging.jmir.org/2023/1/e43106",
url="http://www.ncbi.nlm.nih.gov/pubmed/36566499"
}


@Article{info:doi/10.2196/43098,
author="Harris, Melissa
and Van Houtven, Courtney
and Hastings, Susan",
title="Development of a Home-Based Stress Management Toolkit for Dementia Caring Dyads: Protocol for a Pilot Intervention Development and Feasibility Study",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="14",
volume="11",
number="12",
pages="e43098",
keywords="dementia",
keywords="stress",
keywords="caregiver",
keywords="dyad",
keywords="intervention",
keywords="nonpharmacologic",
abstract="Background: People living with dementia (PLWD) and their care partners (dementia caring dyads) are at a heightened risk of experiencing stress-related symptoms and conditions. Yet, many dyadic stress management interventions have had limited uptake by health care systems and in the community. An intervention that combines simple, safe, easy-to-use, nonpharmacologic tools (eg, animatronic social pets, weighted blankets and garments, aromatherapy and bright light therapy devices, acupressure, and massage tools) that can be used in the home may be a promising approach to promote stress management among dementia caring dyads. Objective: The proposed study aims to develop and user test a dyadic toolkit intervention composed of simple, tangible stress management tools for community-dwelling PLWD and their care partners. This study will also explore the feasibility of collecting several stress-related outcome measures to inform measurement selection for future studies. Methods: A human-centered design (HCD) approach will be used to increase the likelihood of developing an intervention that will be translatable to real-world settings. This study consists of 2 phases. The first phase will address the discover, define, and design stages of HCD using qualitative focus groups with dementia caring dyads (N=12-16 dyads). Dyadic focus groups (3-4 groups anticipated) will be convened to understand participants' stress experiences and to co-design a stress management toolkit prototype. Rapid qualitative analysis will be used to analyze focus group data. In phase 2, the toolkit prototype will be user tested for 2 weeks in a new sample to address the validation step of HCD. A within-subjects (n=10 dyads), pre-post design will be used with measures of usability (frequency of toolkit use), feasibility (enrollment and withdrawal rates, adverse events/injuries), and acceptability (satisfaction, benefit) collected via questionnaires (at the end of weeks 1 and 2 of user testing) and focus groups (n=3-4 dyads/group at the end of week 2). The feasibility of collecting participant-reported, stress-related outcomes (neuropsychiatric symptoms of dementia, caregiver stress, dyadic relationship strain) and salivary cortisol as a physiologic measure of stress will be assessed at baseline and after user testing. Results: This study will yield a working prototype of a stress management toolkit for dementia caring dyads, as well as preliminary data to support the feasibility and acceptability of the intervention. User testing will elucidate areas to refine the prototype and provide data to inform preliminary testing of the intervention. As of September 2022, this study has received institutional ethics board approval with phase 1 recruitment anticipated to begin January 2023. Conclusions: Few interventions have focused on combining simple, safe, low burden tools to promote stress management among community-dwelling dementia caring dyads. By involving families and exploring feasibility and acceptability at the onset of development, this intervention will have greater potential to be implemented and sustained in the future. Trial Registration: ClinicalTrials.gov NCT05465551; https://clinicaltrials.gov/ct2/show/NCT05465551 International Registered Report Identifier (IRRID): PRR1-10.2196/43098 ",
doi="10.2196/43098",
url="https://www.researchprotocols.org/2022/12/e43098",
url="http://www.ncbi.nlm.nih.gov/pubmed/36399169"
}


@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/10.2196/29675,
author="Nunes-Da-Silva, Catarina
and Victorino, Andr{\'e}
and Lemos, Marta
and Porojan, Ludmila
and Costa, Andreia
and Arriaga, Miguel
and Greg{\'o}rio, Jo{\~a}o Maria
and de Sousa, Dinis Rute
and Rodrigues, Maria Ana
and Canh{\~a}o, Helena",
title="A Video-Based Mobile App as a Health Literacy Tool for Older Adults Living at Home: Protocol for a Utility Study",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="7",
volume="11",
number="12",
pages="e29675",
keywords="mobile app",
keywords="technology",
keywords="treatment adherence",
keywords="health literacy",
keywords="seniors",
keywords="older adults",
abstract="Background: People aged ?65 years are more likely to have health problems related to aging, polypharmacy, and low treatment adherence. Moreover, health literacy levels decrease with increasing age. Objective: The aim of this study is to assess an app's utility in promoting health-related knowledge in people aged ?65 years. Methods: We developed a simple, intuitive, and video-based app (DigiAdherence) that presents a recipe, nutritional counseling, and content on physical activity, cognitive exercise, motivation to adhere to treatment, fall prevention, and health literacy. A convenience sample of 25 older adults attending the Personalized Health Care Unit of Portim{\~a}o or the Family Health Unit of Portas do Arade (ACeS Algarve II -- Barlavento, ARS Algarve, Portugal) will be recruited. Subjects must be aged ?65 years, own a smartphone or tablet, be willing to participate, and consent to participate. Those who do not know how to use or do not have a smartphone/tablet will be excluded. Likewise, people with major cognitive or physical impairment as well as those living in a long-term care center will not be included in this study. Participants will have access to the app for 4 weeks and will be evaluated at 3 different timepoints (V0, before they start using the app; V1, after using it for 30 days; and V2, 60 days after stopping using it). After using the app for 30 days, using a 7-point Likert scale, participants will be asked to score the mobile tool's utility in encouraging them to take their medications correctly, improving quality of life, increasing their health-related knowledge, and preventing falls. They will also be asked to assess the app's ease of use and visual esthetics, their motivation to use the app, and their satisfaction with the app. Subjects will be assessed in a clinical interview with a semistructured questionnaire, including questions regarding user experience, satisfaction, the utility of the app, quality of life (EQ-5D-3L instrument), and treatment adherence (Morisky scale). The proportion of participants who considered the app useful for their health at V1 and V2 will be analyzed. Regarding quality of life and treatment adherence perceptions, comparisons will be made between V0 and V1, using the t test for dependent samples. The same comparisons will be made between V0 and V2. Results: This study was funded in December 2019 and authorized by the Executive Board of ACeS Algarve II -- Barlavento and by the Ethics Committee of NOVA Medical School (99/2019/CEFCM, June 2020). This protocol was also approved by the Ethics Committee for Health (16/2020, September 2020) and the Executive Board (December 2020) of the Regional Health Administration of the Algarve, IP (Instituto P{\'u}blico). Recruitment was completed in June 2021. Conclusions: Since the next generation of older adults may have higher digital literacy, information and communication technologies could potentially be used to deliver health-related content to improve lifestyles among older adults. International Registered Report Identifier (IRRID): PRR1-10.2196/29675 ",
doi="10.2196/29675",
url="https://www.researchprotocols.org/2022/12/e29675",
url="http://www.ncbi.nlm.nih.gov/pubmed/36476754"
}


@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/10.2196/39199,
author="Ahmed, Mona
and Mar{\'i}n, Mayca
and How, Daniella
and Judica, Elda
and Tropea, Peppino
and Bentlage, Ellen
and J Ferreira, Joaquim
and Bou{\c{c}}a-Machado, Raquel
and Brach, Michael",
title="End Users' and Other Stakeholders' Needs and Requirements in the Development of a Personalized Integrated Care Platform (PROCare4Life) for Older People With Dementia or Parkinson Disease: Mixed Methods Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="30",
volume="6",
number="11",
pages="e39199",
keywords="neurodegenerative",
keywords="Parkinson disease",
keywords="dementia",
keywords="chronic diseases",
keywords="health care technologies",
keywords="integrated care",
keywords="information and communication technology",
keywords="ICT",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: With what has been known as the ``triple-win effect'', introducing information and communication technologies (ICTs) in the health care of neurodegenerative diseases is beneficial in delaying the need for institutional care, reducing the associated health care costs, reducing the caregiving burden, and improving individuals' quality of life. Nevertheless, the mismatch between the users' expectations and their actual needs remains one of the main challenges that can reduce the usability of technology solutions. Therefore, the European project Personalized Integrated Care Promoting Quality of Life for Older People (PROCare4Life), which aimed to develop an ICT-based platform for all parties involved in the health care of neurodegenerative diseases, adopted a user-centered design approach, where all users are involved from the inception and throughout the platform development and implementation to integrate their needs and requirements in the proposed platform. Objective: This paper presents the results of a study on the needs and requirements of the potential end users (older people with neurodegenerative diseases, caregivers, and health care professionals) and other key stakeholders in the development of the PROCare4Life platform. Methods: A mixed qualitative and quantitative study design was used, including 2 web-based surveys, 40 interviews, and 4 workshops. The study was conducted between April and September 2020 in 5 European countries: Germany, Italy, Portugal, Romania, and Spain. Both data types were analyzed separately and then merged and interpreted, with greater priority placed on qualitative research. Results: A total of 217 participants were recruited; 157 (72.4\%) of them completed the web-based surveys (n=85, 54.1\% patients and n=72, 45.9\% caregivers), and 60 (27.6\%) individuals participated in the qualitative research (20/60, 33\% health care professionals; 5/60, 8\% patients; 5/60, 8\% caregivers; and 30/60, 50\% key stakeholders). We identified 3 main themes (T): (T1) experiences associated with illness, (T2) thoughts about the platform technology, and (T3) desired properties. Alerts for adverse events, communication tools, reminders, and monitoring are constantly needed functionalities, whereas ease of use, personalization, and user-friendliness are foreseen as necessary features. Conclusions: This paper identified the key personal, social, and health factors that influence the daily lives of the potential end users and reflected on their needs and expectations regarding the design of the proposed PROCare4Life platform. The collected data were useful for the development of the PROCare4Life platform. Although the combination and collection of features for diverse user groups are typical for integrated care platforms, it results in exponential complexity for designers, developers, and users. Contradicting opinions and several concerns in this study demonstrate that an ICT-integrated care platform should not promise too much for too many. Instead, selection, focus, and, sometimes, restriction to essentials are necessary. Users and other stakeholders should be involved in these decisions. International Registered Report Identifier (IRRID): RR2-10.2196/22463 ",
doi="10.2196/39199",
url="https://formative.jmir.org/2022/11/e39199",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449340"
}


@Article{info:doi/10.2196/37827,
author="Brodbeck, Jeannette
and Jacinto, Sofia
and Gouveia, Afonso
and Mendon{\c{c}}a, Nuno
and Mad{\"o}rin, Sarah
and Brandl, Lena
and Schokking, Lotte
and Rodrigues, Maria Ana
and Gon{\c{c}}alves, Judite
and Mooser, Bettina
and Marques, M. Marta
and Isaac, Joana
and Nogueira, Vasco
and Matos Pires, Ana
and van Velsen, Lex",
title="A Web-Based Self-help Intervention for Coping With the Loss of a Partner: Protocol for Randomized Controlled Trials in 3 Countries",
journal="JMIR Res Protoc",
year="2022",
month="Nov",
day="30",
volume="11",
number="11",
pages="e37827",
keywords="bereavement",
keywords="cognitive behavioral therapy",
keywords="CBT",
keywords="cost-effectiveness",
keywords="electronic mental health",
keywords="grief",
keywords="technology acceptance",
abstract="Background: The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content. Objective: This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study. Methods: The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n?85), the Netherlands (n?40), and Portugal (n?80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention's clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20). Results: The trials started in March 2022 and are expected to end in December 2022 or when the needed sample size is achieved. The first results are expected by January 2023. Conclusions: The trials will provide insights into the efficacy and acceptance of a web-based self-help intervention among older adults who have recently lost a partner. Results will extend the knowledge on the role of self-tailoring, working alliance, and satisfaction in the effects of the intervention. Finally, the study will suggest adaptations to improve the acceptance of web-based self-help interventions for older mourners and explore the cost-effectiveness of this intervention. Limitations include a self-selective sample and the lack of cross-cultural comparisons. Trial Registration: Switzerland: ClinicalTrials.gov NCT05280041; https://clinicaltrials.gov/ct2/show/NCT05280041; Portugal: ClinicalTrials.gov NCT05156346; https://clinicaltrials.gov/ct2/show/NCT05156346 International Registered Report Identifier (IRRID): PRR1-10.2196/37827 ",
doi="10.2196/37827",
url="https://www.researchprotocols.org/2022/11/e37827",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449341"
}


@Article{info:doi/10.2196/40079,
author="Chan, Andrew
and Cohen, Rachel
and Robinson, Katherine-Marie
and Bhardwaj, Devvrat
and Gregson, Geoffrey
and Jutai, W. Jeffrey
and Millar, Jason
and R{\'i}os Rinc{\'o}n, Adriana
and Roshan Fekr, Atena",
title="Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review",
journal="JMIR Aging",
year="2022",
month="Nov",
day="28",
volume="5",
number="4",
pages="e40079",
keywords="smart homes",
keywords="concerns",
keywords="user-centered frameworks",
keywords="clinical evidence",
keywords="home health monitoring",
keywords="gerontechnology",
keywords="telemonitoring",
keywords="older adults",
abstract="Background: Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies. Objective: This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks. Methods: A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented. Results: The scoping review found 822 systematic reviews, of which 94 (11\%) were included and of those, 23 (24\%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57\%) and hospitalizations (5/6, 83\%); improved hemoglobin A1c (1/2, 50\%); improved safety for older adults at home and detected changing cognitive status (2/3, 66\%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100\%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63\%), autonomy (12/19, 63\%), and control (10/19, 53\%) being the most common. An additional 7 user-centered frameworks were studied. Conclusions: Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users. ",
doi="10.2196/40079",
url="https://aging.jmir.org/2022/4/e40079",
url="http://www.ncbi.nlm.nih.gov/pubmed/36441572"
}


@Article{info:doi/10.2196/39185,
author="Pech, Marion
and Gbessemehlan, Antoine
and Dupuy, Lucile
and Sauz{\'e}on, H{\'e}l{\`e}ne
and Lafitte, St{\'e}phane
and Bachelet, Philippe
and Amieva, H{\'e}l{\`e}ne
and P{\'e}r{\`e}s, Karine",
title="Lessons Learned From the SoBeezy Program for Older Adults During the COVID-19 Pandemic: Experimentation and Evaluation",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="24",
volume="6",
number="11",
pages="e39185",
keywords="voice assistance",
keywords="social isolation",
keywords="healthy aging",
keywords="living in place",
keywords="acceptability",
keywords="technologies",
keywords="digital divide",
keywords="older adults",
keywords="aging",
keywords="elderly population",
keywords="voice assistant",
keywords="COVID-19",
abstract="Background: The SoBeezy program is an innovative intervention aimed at promoting and fostering healthy aging and aging in place by proposing to older adults concrete solutions to face daily life, tackle loneliness, promote social participation, and reduce the digital divide, thanks to a specific, easy-to-use voice assistant (the BeeVA smart display). Objective: This study aims to assess the acceptability of the SoBeezy program and its voice assistant and to identify potential areas of improvement. Methods: A 12-month experimentation of the program was deployed in real-life conditions among older adults living in the community in 4 pilot cities of France. Launched during the first lockdown of the COVID-19 crisis, this multisite study aimed to assess acceptability using questionnaires and interviews conducted at baseline and at the end of the experimentation. In addition, a series of meetings were conducted with SoBeezy staff members to obtain direct feedback from the ground. Results: In total, 109 older individuals were equipped with BeeVA to use the SoBeezy program; of these, 32 (29.4\%) left the experimentation before its end and 69 (63.3\%) completed the final questionnaires. In total, 335 interventions were conducted and 27 (39\%) of the participants requested services, mainly for supportive calls and visits and assistance with shopping, transportation, and crafting-gardening. Of the whole sample, 52 (75\%) considered BeeVA as a reassuring presence, and few persons (15/69, 22\%) reported a negative opinion about the program. Among the participants, the voice assistant appeared easy to use (n=57, 82\%) and useful (n=53, 77\%). They also were positive about the BeeVA smart display and the SoBeezy intervention. Conclusions: This multisite study conducted in real-life conditions among more than 100 older adults living in the community provides enlightening results of the reality from the ground of digital tools designed for the aging population. The COVID-19 context appeared both as an opportunity, given the massive needs of the older adults during this crisis, and as limiting due to sanitary constraints. Nevertheless, the experimentation showed overall good acceptability of the voice assistant and a high level of satisfaction of the participants among those who really used the system and could be a way of improving the autonomy and well-being of older adults and their families. However, the findings also highlighted resistance to change and difficulties for the users to ask for help. The experimentation also emphasized levers for next deployments and future research. The next step will be the experimentation of the activity-sharing component that could not be tested due to the COVID-19 context. ",
doi="10.2196/39185",
url="https://formative.jmir.org/2022/11/e39185",
url="http://www.ncbi.nlm.nih.gov/pubmed/36355629"
}


@Article{info:doi/10.2196/42555,
author="van Cooten, C. Vivette J.
and Gielissen, M. Marieke F.
and van Mastrigt, G. Ghislaine A. P.
and den Hollander, Wouter
and Evers, A. Silvia M. A.
and Smeets, Odile
and Smit, Filip
and Boon, Brigitte",
title="Smart Continence Care for People With Profound Intellectual and Multiple Disabilities: Protocol for a Cluster Randomized Trial and Trial-Based Economic Evaluation",
journal="JMIR Res Protoc",
year="2022",
month="Nov",
day="22",
volume="11",
number="11",
pages="e42555",
keywords="care technology",
keywords="implementation",
keywords="disability care",
keywords="profound intellectual and multiple disabilities",
keywords="economic evaluation",
keywords="continence care",
keywords="smart diaper",
abstract="Background: People with profound intellectual and multiple disabilities (PIMD) cannot communicate the need to change their incontinence products. The smart continence care (SCC) product Abena Nova signals caregivers when change is needed. This provides the opportunity for more person-centered care, increased quality of life, and a decreased number of leakages. However, there is a need for evidence of the effectiveness and cost-effectiveness of such technology compared with regular continence care (RCC) for people with PIMD. Objective: This paper presents the research protocol for an effectiveness and cost-effectiveness study with people with PIMD living in long-term care facilities in the Netherlands. Methods: A cluster randomized trial will be conducted in 3 consecutive waves across 6 long-term care providers for people with disabilities and 160 participants with PIMD. Long-term care providers are randomized at a 1:1 ratio, resulting in an intervention group and a group continuing RCC. The intervention group will receive implementation guidance and use SCC for 3 months; the other group will continue their RCC as usual and then switch to SCC. This study consists of three components: effectiveness study, economic evaluation, and process evaluation. The primary outcome will be a change in the number of leakages. The secondary outcomes are quality of life, the difference in the number of changes, the work perception of caregivers, cost-effectiveness, and cost utility. Data collection will occur at T0 (baseline), T1 (6 weeks), T2 (12 weeks), and T3 (9-month follow-up) for the first 2 intervention groups. An intention-to-treat analysis will be performed. The economic evaluation will be conducted alongside the trial from the societal and long-term care provider perspectives. Qualitative data collection through interviews and field notes will complement these quantitative results and provide input for the process evaluation. Results: This research was funded in December 2019 by ZonMw, the Netherlands Organization for Health Research and Development. As of June 2022, we enrolled 118 of the 160 participants. The enrollment of participants will continue in the third and fourth quarters of 2022. Conclusions: This study will provide insights into the effectiveness and cost-effectiveness of SCC for people with PIMD, allowing long-term care providers to make informed decisions about implementing such a technology. This is the first time that such a large-scale study is being conducted for people with PIMD. Trial Registration: ClinicalTrials.gov NCT05481840; https://clinicaltrials.gov/ct2/show/NCT05481840 International Registered Report Identifier (IRRID): DERR1-10.2196/42555 ",
doi="10.2196/42555",
url="https://www.researchprotocols.org/2022/11/e42555",
url="http://www.ncbi.nlm.nih.gov/pubmed/36413389"
}


@Article{info:doi/10.2196/37617,
author="Mills, Marie Christine
and Parniak, Simone
and Hand, Carri
and McGrath, Colleen
and Laliberte Rudman, Debbie
and Chislett, Cassandra
and Giberson, Mariah
and White, Lauren
and DePaul, Vincent
and Donnelly, Catherine",
title="The Impact of a Naturally Occurring Retirement Community Supportive Services Program on Older Adult Participants' Social Networks: Semistructured Interview Study",
journal="JMIR Aging",
year="2022",
month="Nov",
day="21",
volume="5",
number="4",
pages="e37617",
keywords="aging in place",
keywords="naturally occurring retirement communities",
keywords="social networks",
keywords="social networking",
keywords="social capital",
keywords="aged",
abstract="Background: Most older adults want to age in place, in their homes and communities. However, this can be challenging for many, frequently owing to lack of supports that allow for aging in place. Naturally occurring retirement community supportive services programs (NORC-SSPs) offer an approach to help older adults age in place. Although qualitative studies have examined the experiences of NORC-SSP participants, little is known about how participation in NORC-SSP programming affects participants' social networks. Objective: This study aimed to explore the experiences of 13 NORC-SSP residents who participated in Oasis Senior Supportive Living (Oasis) and how participating in NORC-SSP programming, specifically based on the Oasis model, influenced their social networks. Methods: Participants were recruited, using convenience sampling, from 4 naturally occurring retirement communities (NORCs) in Ontario, Canada. All participants (13/13, 100\%) had participated in Oasis programming. Semistructured qualitative interviews were conducted with participants. Social network theory informed the interview guide and thematic analysis. Results: In total, 13 participants (n=12, 92\% women and n=1, 8\% men) were interviewed. These participants were from 4 different NORCs where Oasis had been implemented, comprising 2 midrise apartment buildings, 1 low-rise apartment building, and 1 mobile home community. Overall, 3 main themes were identified from the interviews with Oasis participants: expansion and deepening of social networks, Oasis activities (something to do, someone to do it with), and self-reported impact of Oasis on mental health and well-being (feeling and coping with life better). Participants noted that Oasis provided them with opportunities to meet new people and broaden their social networks, both within and outside their NORCs. They also indicated that Oasis provided them with meaningful ways to spend their time, including opportunities to socialize and try new activities. Participants stated that participating in Oasis helped to alleviate loneliness and improved their quality of life. They noted that Oasis provided them with a reason to get up in the morning. However, the experiences described by participants may not be reflective of all Oasis members. Those who had positive experiences may have been more likely to agree to be interviewed. Conclusions: On the basis of the participants' interviews, Oasis is an effective aging-in-place model that has been successfully implemented in low-rise apartment buildings, midrise apartment buildings, and mobile home communities. Participating in Oasis allowed participants to expand their social networks and improve their mental health and well-being. Therefore, NORCs may offer an ideal opportunity to build strong communities that provide deep, meaningful social connections that expand social networks. NORC-SSPs, such as Oasis, can support healthy aging and allow older adults to age in place. ",
doi="10.2196/37617",
url="https://aging.jmir.org/2022/4/e37617",
url="http://www.ncbi.nlm.nih.gov/pubmed/36409533"
}


@Article{info:doi/10.2196/41015,
author="Jose, Ambily
and Sasseville, Maxime
and Dequanter, Samantha
and Gorus, Ellen
and Gigu{\`e}re, Anik
and Bourbonnais, Anne
and Abbasgholizadeh Rahimi, Samira
and Buyl, Ronald
and Gagnon, Marie-Pierre",
title="Existing eHealth Solutions for Older Adults Living With Neurocognitive Disorders (Mild and Major) or Dementia and Their Informal Caregivers: Protocol for an Environmental Scan",
journal="JMIR Res Protoc",
year="2022",
month="Nov",
day="4",
volume="11",
number="11",
pages="e41015",
keywords="dementia",
keywords="eHealth solutions",
keywords="mild cognitive impairment (MCI)",
keywords="environmental scan",
keywords="digital health",
abstract="Background: Dementia is one of the main public health priorities for current and future societies worldwide. Over the past years, eHealth solutions have added numerous promising solutions to enhance the health and wellness of people living with dementia-related cognitive problems and their primary caregivers. Previous studies have shown that an environmental scan identifies the knowledge-to-action gap meaningfully. This paper presents the protocol of an environmental scan to monitor the currently available eHealth solutions targeting dementia and other neurocognitive disorders against selected attributes. Objective: This study aims to identify the characteristics of currently available eHealth solutions recommended for older adults with cognitive problems and their informal caregivers. To inform the recommendations regarding eHealth solutions for these people, it is important to obtain a comprehensive view of currently available technologies and document their outcomes and conditions of success. Methods: We will perform an environmental scan of available eHealth solutions for older adults with cognitive impairment or dementia and their informal caregivers. Potential solutions will be initially identified from a previous systematic review. We will also conduct targeted searches for gray literature on Google and specialized websites covering the regions of Canada and Europe. Technological tools will be scanned based on a preformatted extraction grid. The relevance and efficiency based on the selected attributes will be assessed. Results: We will prioritize relevant solutions based on the needs and preferences identified from a qualitative study among older adults with cognitive impairment or dementia and their informal caregivers. Conclusions: This environmental scan will identify eHealth solutions that are currently available and scientifically appraised for older adults with cognitive impairment or dementia and their informal caregivers. This knowledge will inform the development of a decision support tool to assist older adults and their informal caregivers in their search for adequate eHealth solutions according to their needs and preferences based on trustable information. International Registered Report Identifier (IRRID): DERR1-10.2196/41015 ",
doi="10.2196/41015",
url="https://www.researchprotocols.org/2022/11/e41015",
url="http://www.ncbi.nlm.nih.gov/pubmed/36331531"
}


@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/10.2196/39386,
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/10.2196/32453,
author="Frechette, Mikaela
and Fanning, Jason
and Hsieh, Katherine
and Rice, Laura
and Sosnoff, Jacob",
title="The Usability of a Smartphone-Based Fall Risk Assessment App for Adult Wheelchair Users: Observational Study",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="16",
volume="6",
number="9",
pages="e32453",
keywords="usability testing",
keywords="mobile health",
keywords="wheeled device user",
keywords="fall risk",
keywords="telehealth",
keywords="mHealth",
keywords="mobile device",
keywords="smartphone",
keywords="health applications",
keywords="older adults",
keywords="elderly population",
keywords="device usability",
abstract="Background: Individuals who use wheelchairs and scooters rarely undergo fall risk screening. Mobile health technology is a possible avenue to provide fall risk assessment. The promise of this approach is dependent upon its usability. Objective: We aimed to determine the usability of a fall risk mobile health app and identify key technology development insights for aging adults who use wheeled devices. Methods: Two rounds (with 5 participants in each round) of usability testing utilizing an iterative design-evaluation process were performed. Participants completed use of the custom-designed fall risk app, Steady-Wheels. To quantify fall risk, the app led participants through 12 demographic questions and 3 progressively more challenging seated balance tasks. Once completed, participants shared insights on the app's usability through semistructured interviews and completion of the Systematic Usability Scale. Testing sessions were recorded and transcribed. Codes were identified within the transcriptions to create themes. Average Systematic Usability Scale scores were calculated for each round. Results: The first round of testing yielded 2 main themes: ease of use and flexibility of design. Systematic Usability Scale scores ranged from 72.5 to 97.5 with a mean score of 84.5 (SD 11.4). After modifications were made, the second round of testing yielded 2 new themes: app layout and clarity of instruction. Systematic Usability Scale scores improved in the second iteration and ranged from 87.5 to 97.5 with a mean score of 91.9 (SD 4.3). Conclusions: The mobile health app, Steady-Wheels, has excellent usability and the potential to provide adult wheeled device users with an easy-to-use, remote fall risk assessment tool. Characteristics that promoted usability were guided navigation, large text and radio buttons, clear and brief instructions accompanied by representative illustrations, and simple error recovery. Intuitive fall risk reporting was achieved through the presentation of a single number located on a color-coordinated continuum that delineated low, medium, and high risk. ",
doi="10.2196/32453",
url="https://formative.jmir.org/2022/9/e32453",
url="http://www.ncbi.nlm.nih.gov/pubmed/36112405"
}


@Article{info:doi/10.2196/34872,
author="Hechinger, Mareike
and Hentschel, Diana
and Aumer, Christine
and Rester, Christian",
title="A Conceptual Model of Experiences With Digital Technologies in Aging in Place: Qualitative Systematic Review and Meta-synthesis",
journal="JMIR Aging",
year="2022",
month="Sep",
day="9",
volume="5",
number="3",
pages="e34872",
keywords="older adults",
keywords="old age",
keywords="assistive device",
keywords="aging in place",
keywords="home modification",
keywords="independent living",
keywords="telemedicine",
keywords="assistive technology",
keywords="ambient assisted living",
keywords="assisted living",
keywords="community living",
keywords="chronic disease",
keywords="chronic condition",
keywords="chronic illness",
keywords="elder",
keywords="older adult",
keywords="systematic review",
keywords="meta-synthesis",
keywords="digital technology",
keywords="mobile phone",
abstract="Background: Older adults with chronic illnesses or dependency on care who strive to age in place need support and care depending on their illness. Digital technology has enabled the possibility of supporting older adults in their wishes to age in place. However, current studies have mainly focused on the solitary evaluation of individual technologies or on evaluating technologies for specific illnesses. Objective: This study aimed to synthesize research on the experiences of older people from the Western culture with chronic illnesses or care needs and their families with digital technology for aging in place. From the meta-synthesis, a model was derived that can be useful for the development of assistive devices in old age and that can support health care providers and professionals in their work with affected individuals. Methods: A systematic review and qualitative meta-synthesis was performed using an inductive approach, as proposed by Sandelowski and Barroso. We performed a systematic literature search in 6 databases from 2000 to 2019, with an update in 2021 and, in addition, conducted a hand search in 2 databases, relevant journals, and reference lists. The results of each study were analyzed using initial and axial coding, followed by theoretical coding. A conceptual model was derived. Results: A total of 7776 articles were identified. Articles were screened independently by 2 authors based on the eligibility criteria. Finally, of the 7776 studies, 18 (0.23\%) were included in the meta-synthesis. The derived conceptual model describes older adults with chronic illnesses or dependency on care and their family members in an individual process of reflection and decision-making, starting with the use of a digital device. Older adults live in times of change. They experience stable and unstable times of illness as they are part of a changing digital world. Hence, older adults and their families consider digital technology a solution to their current situation. As they become familiar with a specific digital technology, they refine their needs and demands, gain confidence in its use, and note its advantages and disadvantages. They weigh hopes, needs, demands, and experiences in a process of reflection to decide on convenience and inconvenience. Independent of their decision, they achieve peace of mind either with or without digital technology. This process can restart repeatedly during the illness trajectory of older adults. Conclusions: This study promotes a differentiated understanding of older adults' experiences with digital technology. The conceptual model can be useful for the development of assistive technology in old age. Moreover, it can guide health care professionals in their work with older adults and their families to provide individual counseling to find the appropriate digital technology for their respective situations. ",
doi="10.2196/34872",
url="https://aging.jmir.org/2022/3/e34872",
url="http://www.ncbi.nlm.nih.gov/pubmed/36083625"
}


@Article{info:doi/10.2196/40387,
author="Belmin, Jo{\"e}l
and Villani, Patrick
and Gay, Mathias
and Fabries, St{\'e}phane
and Havreng-Th{\'e}ry, Charlotte
and Malvoisin, St{\'e}phanie
and Denis, Fabrice
and Veyron, Jacques-Henri",
title="Real-world Implementation of an eHealth System Based on Artificial Intelligence Designed to Predict and Reduce Emergency Department Visits by Older Adults: Pragmatic Trial",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="8",
volume="24",
number="9",
pages="e40387",
keywords="emergency department visits",
keywords="home care aides",
keywords="community-dwelling older adults",
keywords="smartphone",
keywords="mobile phone",
keywords="predictive tool",
keywords="health intervention",
keywords="machine learning",
keywords="predict",
keywords="risk",
keywords="algorithm",
keywords="model",
keywords="user experience",
keywords="alert",
keywords="monitoring",
abstract="Background: Frail older people use emergency services extensively, and digital systems that monitor health remotely could be useful in reducing these visits by earlier detection of worsening health conditions. Objective: We aimed to implement a system that produces alerts when the machine learning algorithm identifies a short-term risk for an emergency department (ED) visit and examine health interventions delivered after these alerts and users' experience. This study highlights the feasibility of the general system and its performance in reducing ED visits. It also evaluates the accuracy of alerts' prediction. Methods: An uncontrolled multicenter trial was conducted in community-dwelling older adults receiving assistance from home aides (HAs). We implemented an eHealth system that produces an alert for a high risk of ED visits. After each home visit, the HAs 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 ED visit within 14 days. In case of risk, the eHealth system alerted a coordinating nurse who could then inform the family carer and the patient's nurses or general practitioner. The primary outcomes were the rate of ED visits and the number of deaths after alert-triggered health interventions (ATHIs) and users' experience with the eHealth system; the secondary outcome was the accuracy of the eHealth system in predicting ED visits. Results: We included 206 patients (mean age 85, SD 8 years; 161/206, 78\% women) who received aid from 109 HAs, and the mean follow-up period was 10 months. The HAs monitored 2656 visits, which resulted in 405 alerts. Two ED visits were recorded following 131 alerts with an ATHI (2/131, 1.5\%), whereas 36 ED visits were recorded following 274 alerts that did not result in an ATHI (36/274, 13.4\%), corresponding to an odds ratio of 0.10 (95\% IC 0.02-0.43; P<.001). Five patients died during the study. All had alerts, 4 did not have an ATHI and were hospitalized, and 1 had an ATHI (P=.04). In terms of overall usability, the digital system was easy to use for 90\% (98/109) of HAs, and response time was acceptable for 89\% (98/109) of them. Conclusions: The eHealth system has been successfully implemented, was appreciated by users, and produced relevant alerts. ATHIs were associated with a lower rate of ED visits, suggesting that the eHealth system might be effective in lowering the number of ED visits in this population. Trial Registration: clinicaltrials.gov NCT05221697; https://clinicaltrials.gov/ct2/show/NCT05221697. ",
doi="10.2196/40387",
url="https://www.jmir.org/2022/9/e40387",
url="http://www.ncbi.nlm.nih.gov/pubmed/35921685"
}


@Article{info:doi/10.2196/38130,
author="Hackett, Katherine
and Giovannetti, Tania",
title="Capturing Cognitive Aging in Vivo: Application of a Neuropsychological Framework for Emerging Digital Tools",
journal="JMIR Aging",
year="2022",
month="Sep",
day="7",
volume="5",
number="3",
pages="e38130",
keywords="digital phenotyping",
keywords="neuropsychology",
keywords="aging",
keywords="dementia",
keywords="smartphone",
keywords="neurological",
keywords="psychological",
keywords="older adults",
doi="10.2196/38130",
url="https://aging.jmir.org/2022/3/e38130",
url="http://www.ncbi.nlm.nih.gov/pubmed/36069747"
}


@Article{info:doi/10.2196/39005,
author="Kim, Daejin
and Bian, Hongyi
and Chang, K. Carl
and Dong, Liang
and Margrett, Jennifer",
title="In-Home Monitoring Technology for Aging in Place: Scoping Review",
journal="Interact J Med Res",
year="2022",
month="Sep",
day="1",
volume="11",
number="2",
pages="e39005",
keywords="in-home monitoring",
keywords="aging in place",
keywords="ambient assisted living",
keywords="home modification",
keywords="monitoring",
keywords="aging",
keywords="technology",
keywords="intervention",
keywords="older adult",
keywords="wellness",
keywords="independence",
keywords="monitor",
keywords="research",
keywords="sensor",
keywords="activity",
keywords="behavior",
keywords="cognitive",
keywords="sleep",
abstract="Background: For successful aging-in-place strategy development, in-home monitoring technology is necessary as a new home modification strategy. Monitoring an older adult's daily physical activity at home can positively impact their health and well-being by providing valuable information about functional, cognitive, and social health status. However, it is questionable how these in-home monitoring technologies have changed the traditional residential environment. A comprehensive review of existing research findings should be utilized to characterize recent relative technologies and to inform design considerations. Objective: The main purpose of this study was to classify recent smart home technologies that monitor older adults' health and to architecturally describe these technologies as they are used in older adults' homes. Methods: The scoping review method was employed to identify key characteristics of in-home monitoring technologies for older adults. In June 2021, four databases, including Web of Science, IEEE Xplore, ACM Digital Library, and Scopus, were searched for peer-reviewed articles pertaining to smart home technologies used to monitor older adults' health in their homes. We used two search strings to retrieve articles: types of technology and types of users. For the title, abstract, and full-text screening, the inclusion criteria were original and peer-reviewed research written in English, and research on monitoring, detecting, recognizing, analyzing, or tracking human physical, emotional, and social behavior. The exclusion criteria included theoretical, conceptual, or review papers; studies on wearable systems; and qualitative research. Results: This scoping review identified 30 studies published between June 2016 and 2021 providing overviews of in-home monitoring technologies, including (1) features of smart home technologies and (2) sensor locations and sensor data. First, we found six functions of in-home monitoring technology among the reviewed papers: daily activities, abnormal behaviors, cognitive impairment, falls, indoor person positioning, and sleep quality. Most of the research (n=27 articles) focused on functional monitoring and analysis, such as activities of daily living, instrumental activities of daily living, or falls among older adults; a few studies (n=3) covered social interaction monitoring. Second, this scoping review also found 16 types of sensor technologies. The most common data types encountered were passive infrared motion sensors (n=21) and contact sensors (n=19), which were used to monitor human behaviors such as bodily presence and time spent on activities. Specific locations for each sensor were also identified. Conclusions: This wide-ranging synthesis demonstrates that in-home monitoring technologies within older adults' homes play an essential role in aging in place, in that the technology monitors older adults' daily activities and identifies various health-related issues. This research provides a key summarization of in-home monitoring technologies that can be applied in senior housing for successful aging in place. These findings will be significant when developing home modification strategies or new senior housing. ",
doi="10.2196/39005",
url="https://www.i-jmr.org/2022/2/e39005",
url="http://www.ncbi.nlm.nih.gov/pubmed/36048502"
}


@Article{info:doi/10.2196/37315,
author="Lavoie, Audrey
and Dub{\'e}, V{\'e}ronique",
title="Web-Based Interventions to Promote Healthy Lifestyles for Older Adults: Scoping Review",
journal="Interact J Med Res",
year="2022",
month="Aug",
day="23",
volume="11",
number="2",
pages="e37315",
keywords="aged",
keywords="behavior change",
keywords="components",
keywords="effects",
keywords="healthy lifestyle",
keywords="web-based intervention",
abstract="Background: With the aging of the population and rising rates of chronic diseases, web-based interventions could be considered to support older adults in adopting healthy lifestyles. To date, published knowledge syntheses have focused on quantitative studies among older adults aged ?50 years. However, those aged ?65 years may have different needs to be met by these interventions because of the biological and physiological changes associated with aging, and qualitative studies could help advance knowledge in this field. Objective: The objective of this scoping review is to explore the extent of the literature on web-based interventions aimed at promoting healthy lifestyles among people aged ?65 years. Methods: A scoping review was conducted based on the framework proposed by Levac et al. Six databases (ie, MEDLINE, CINAHL, PsycINFO, Web of Science, the Cochrane Database of Systematic Reviews, and the Joanna Briggs Library) and gray literature (ie, Google Scholar and OpenGrey) were searched. The final search was conducted on June 23, 2021. The studies were selected by 2 persons (AL and ML) independently. The included studies were systematic reviews and qualitative and quantitative studies focusing on web-based interventions to promote healthy lifestyles in people aged ?65 years that were published in French or English between 1990 and 2021. Data were extracted in a table and synthesized based on the conceptualization of web-based interventions (ie, according to the use parameters, behavior change techniques, delivery modes, and theories). A thematic analysis was performed. Results: In total, 20 articles were included in this review, which represents studies focused on 11 distinct interventions. All of the interventions (11/11, 100\%) aimed to promote physical activity among older adults. The number of intervention sessions varied from 5 to 16, with a frequency from daily to once every 2 weeks. Diverse delivery modes such as electronic diary, video, and phone call were found. The most used behavior change techniques were instruction, feedback, and self-monitoring. Few interventions (6/11, 55\%) were based on a theory. A favorable trend was observed in increasing physical activity, and 5 themes emerged that appeared to be central to behavior change among older adults: motivation, support, tailoring, barriers, and perceptions. Conclusions: This scoping review provides a better understanding of the components of web-based interventions and their outcomes on the healthy lifestyles of people aged ?65 years. These findings could provide important guidance for the design and development of future web-based interventions in this field. Further research is needed to continue the development and evaluation of innovative and accessible interventions to promote healthy lifestyles among older adults. International Registered Report Identifier (IRRID): RR2-10.2196/23207 ",
doi="10.2196/37315",
url="https://www.i-jmr.org/2022/2/e37315",
url="http://www.ncbi.nlm.nih.gov/pubmed/35998024"
}


@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/10.2196/39032,
author="Schmidt, M. Steven
and Chiatti, Carlos
and Ekstam, Lisa
and Haak, Maria
and Heller, Christina
and Nilsson, H. Maria
and Slaug, Bj{\"o}rn",
title="Enabling Long-term Predictions and Cost-benefit Analysis Related to Housing Adaptation Needs for a Population Aging in Place: Protocol for a Simulation Study",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="12",
volume="11",
number="8",
pages="e39032",
keywords="accessibility",
keywords="activities of daily living",
keywords="age-friendly housing",
keywords="aging in place",
keywords="demographic aging",
keywords="functional limitations",
keywords="housing adaptations",
keywords="housing policies",
keywords="person-environment fit",
keywords="simulation models",
abstract="Background: Policies that promote aging in place are common in Sweden and many other countries. However, the current housing stock cannot sufficiently accommodate a population aging in place considering how functional capacity and housing needs change as people age. To be suitable for all regardless of their functional ability, housing should be designed or adapted to facilitate the performance of activities of daily living. Long-term planning and plausible projections of development 20 to 30 years into the future are needed. Objective: The overall aim is to develop simulation models that enable long-term predictions and analysis of potential consequences in terms of societal gains and costs for different large-scale measures and interventions in the ordinary housing stock. Methods: This study is designed as a simulation study and will broadly apply health impact assessment methods in collaboration with five municipalities in Sweden. Individual interviews and research circles were used to identify current and prioritize potential new policies to improve the accessibility of the housing stock. We will run a series of simulations based on an estimated willingness to pay from discussions with the municipalities. Two to three different prioritized policies will be compared simultaneously using Markov cohort analysis to estimate the potential costs and health impact on the population. Using data from a systematic review and existing population-based data sets with individual-level data on home and health variables, we will calculate parameter estimates for the relations between housing accessibility and health outcomes. The potential impact of selected policy interventions will be estimated in several microsimulations representing people living in the community. Sensitivity analyses will be conducted for each simulation. Results: As of April 2022, open access data was collected, and a systematic review was underway and expected to be completed by November 2022. Collaboration with five municipalities was established in autumn 2020. In spring 2021, the municipalities developed a list of prioritized policy interventions to be tested and used in the simulation models. Inventories of barrier frequencies in ordinary housing started in spring 2022 and are expected to be completed in autumn 2022. Data gathering and analyses for simulation inputs will be completed during 2022 followed by the simulation modeling analyses to be completed in 2023. Conclusions: Improved accessibility of the ordinary housing stock has the potential to maintain or improve the health of the aging population. This study will generate tools that enable long-term predictions and reliable cost-benefit estimates related to the housing adaptation needs for a population aging in place, thus providing support for the best-informed policy decisions. International Registered Report Identifier (IRRID): DERR1-10.2196/39032 ",
doi="10.2196/39032",
url="https://www.researchprotocols.org/2022/8/e39032",
url="http://www.ncbi.nlm.nih.gov/pubmed/35969445"
}


@Article{info:doi/10.2196/35072,
author="Dixon, Emma
and Anderson, Jesse
and Blackwelder, C. Diana
and Radnofsky, L. Mary
and Lazar, Amanda",
title="The Human Need for Equilibrium: Qualitative Study on the Ingenuity, Technical Competency, and Changing Strategies of People With Dementia Seeking Health Information",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="11",
volume="24",
number="8",
pages="e35072",
keywords="dementia",
keywords="health information behavior",
keywords="action research",
keywords="equilibrium",
keywords="postdiagnostic experience",
keywords="mobile phone",
abstract="Background: Prior research on health information behaviors of people with dementia has primarily focused on examining the types of information exchanged by people with dementia using various web-based platforms. A previous study investigated the information behaviors of people with dementia within a month of their diagnosis. There is an empirical gap in the literature regarding the evolution of health information needs and behaviors of people with dementia as their condition progresses. Objective: Our work primarily investigated the information behaviors of people with dementia who have been living with the condition for several (4 to 26) years. We also aimed to identify their motivations for changing their information behaviors over time. Our primary research questions were as follows: how do people with dementia get informed about their condition, and why do people with dementia seek information about their condition? Methods: We adopted an action research approach by including 2 people with dementia as members of our research team. Collaboratively, we conducted 16 remote 1-hour contextual inquiry sessions with people living with mild to moderate dementia. During the study sessions, the first 40 minutes included semistructured interviews with participants concerning their information behaviors, followed by a 20-minute demonstration of their information-seeking strategies. Data from these interviews were analyzed using a constructivist grounded theory approach. Results: Participants described their information needs in terms of managing the disrupted physiological, emotional, and social aspects of their lives following a diagnosis of dementia. They used various information behaviors, including active search, ongoing search, monitoring, proxy search, information avoidance, and selective exposure. These information behaviors were not stagnant; however, they were adapted to accommodate the changing circumstances of their dementia and their lives as they worked to re-establish equilibrium to continue to engage in life while living with a degenerative neurological condition. Conclusions: Our research revealed the motivations, changing abilities, and chosen strategies of people with dementia in their search for information as their condition evolves. This knowledge can be used to develop and improve person-centered information and support services for people with dementia so that they can more easily re-establish equilibrium and continue to engage in life. ",
doi="10.2196/35072",
url="https://www.jmir.org/2022/8/e35072",
url="http://www.ncbi.nlm.nih.gov/pubmed/35969426"
}


@Article{info:doi/10.2196/36975,
author="Boutilier, J. Justin
and Loganathar, Priya
and Linden, Anna
and Scheer, Eleanore
and Noejovich, Sofia
and Elliott, Christian
and Zuraw, Matthew
and Werner, E. Nicole",
title="A Web-Based Platform (CareVirtue) to Support Caregivers of People Living With Alzheimer Disease and Related Dementias: Mixed Methods Feasibility Study",
journal="JMIR Aging",
year="2022",
month="Aug",
day="4",
volume="5",
number="3",
pages="e36975",
keywords="Alzheimer disease and related dementias",
keywords="mHealth",
keywords="caregivers",
keywords="dementia caregiving",
keywords="eHealth",
keywords="telehealth",
abstract="Background: People living with Alzheimer disease and related dementias (ADRD) require prolonged and complex care that is primarily managed by informal caregivers who face significant unmet needs regarding support for communicating and coordinating across their informal care network. To address this unmet need, we developed CareVirtue, which provides (1) the ability to invite care network members; (2) a care guide detailing the care plan; (3) a journal where care network members can document, communicate, and coordinate; (4) a shared calendar; and (5) vetted geolocated caregiver resources. Objective: This study aims to evaluate CareVirtue's feasibility based on: (1) Who used CareVirtue? (2) How did caregivers use CareVirtue? (3) How did caregivers perceive the acceptability of CareVirtue? (4) What factors were associated with CareVirtue use? Methods: We conducted a feasibility study with 51 care networks over a period of 8 weeks and used a mixed methods approach that included both quantitative CareVirtue usage data and semistructured interviews. Results: Care networks ranged from 1 to 8 members. Primary caregivers were predominantly female (38/51, 75\%), White (44/51, 86\%), married (37/51, 73\%), college educated (36/51, 71\%), and were, on average, 60.3 (SD 9.8) years of age, with 18\% (9/51) living in a rural area. CareVirtue usage varied along 2 axes (total usage and type of usage), with heterogeneity in how the most engaged care networks interacted with CareVirtue. Interviews identified a range of ways CareVirtue was useful, including practically, organizationally, and emotionally. On the Behavioral Intention Scale, 72\% (26/36) of primary caregivers reported an average score of at least 3, indicating an above average intention to use. The average was 81.8 (SD 12.8) for the System Usability Scale score, indicating ``good'' usability, and 3.4 (SD 1.0) for perceived usefulness, suggesting above average usefulness. The average confidence score increased significantly over the study duration from 7.8 in week 2 to 8.9 in week 7 (P=.005; r=0.91, 95\% CI 0.84-0.95). The following sociodemographic characteristics were associated with posting in the journal: retired (mean 59.5 posts for retired caregivers and mean 16.9 for nonretired caregivers), income (mean 13 posts for those reporting >US \$100K and mean 55.4 for those reporting <US \$100K), relationship to care recipient (mean 18.7 posts for child and mean 56.4 for partners/spouses), and living situation (mean 44.7 for those who live with the care recipient and mean 13.1 for those who do not). Older care recipients were associated with fewer posts (r=--0.33, 95\% CI --0.55 to --0.06). Conclusions: This study establishes the acceptability and feasibility of CareVirtue among ADRD care networks and highlights the importance of designing flexible, multicomponent interventions that allow care networks to tailor their engagement according to their needs. The results will be used to improve CareVirtue feasibility and acceptability in preparation for a subsequent randomized trial to test CareVirtue's effectiveness in improving caregiver outcomes. ",
doi="10.2196/36975",
url="https://aging.jmir.org/2022/3/e36975",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925654"
}


@Article{info:doi/10.2196/39335,
author="Berridge, Clara
and Turner, R. Natalie
and Liu, Liu
and Karras, W. Sierramatice
and Chen, Amy
and Fredriksen-Goldsen, Karen
and Demiris, George",
title="Advance Planning for Technology Use in Dementia Care: Development, Design, and Feasibility of a Novel Self-administered Decision-Making Tool",
journal="JMIR Aging",
year="2022",
month="Jul",
day="27",
volume="5",
number="3",
pages="e39335",
keywords="Alzheimer disease",
keywords="advance care planning",
keywords="dyadic intervention",
keywords="technology",
keywords="remote monitoring",
keywords="artificial intelligence",
keywords="older adult",
keywords="seniors",
keywords="human-computer interaction",
keywords="aging",
keywords="elderly population",
keywords="digital tool",
keywords="educational tool",
keywords="dementia care",
keywords="ethics",
keywords="informed consent",
abstract="Background: Monitoring technologies are used to collect a range of information, such as one's location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult's dignity and wishes. Objective: We designed, developed, and piloted a communication and education tool in the form of a web application called Let's Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention's motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners. Methods: We surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants' experiences and recommendations to improve the intervention. Results: The study enrolled 33 people living with AD and their care partners, and 29 (88\%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90\%), having the right amount of information (>84\%), being very clearly worded (>74\%), and presenting information in a balanced way (>90\%). Most felt the tool was easy to use and helpful, and would likely recommend it to others. Conclusions: This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits. ",
doi="10.2196/39335",
url="https://aging.jmir.org/2022/3/e39335",
url="http://www.ncbi.nlm.nih.gov/pubmed/35896014"
}


@Article{info:doi/10.2196/33085,
author="Garnett, Anna
and Northwood, Melissa
and Ting, Justine
and Sangrar, Ruheena",
title="mHealth Interventions to Support Caregivers of Older Adults: Equity-Focused Systematic Review",
journal="JMIR Aging",
year="2022",
month="Jul",
day="8",
volume="5",
number="3",
pages="e33085",
keywords="caregivers",
keywords="older adults",
keywords="mobile health",
keywords="social determinants of health",
keywords="intervention",
keywords="mobile phone",
abstract="Background: Informal caregivers, hereafter referred to as caregivers, provide support to older adults so that they can age safely at home. The decision to become a caregiver can be influenced by individual factors, such as personal choice, or societal factors such as social determinants of health, including household income, employment status, and culture-specific gender roles. Over time, caregivers' health can be negatively affected by their caregiving roles. Although programs exist to support caregivers, the availability and appropriateness of services do not match caregivers' expressed needs. Research suggests that supportive interventions offered through mobile health (mHealth) technologies have the potential to increase caregivers' access to supportive services. However, a knowledge gap remains regarding the extent to which social determinants of health are considered in the design, implementation, and evaluation of mHealth interventions intended to support the caregivers of older adults. Objective: This study aimed to conduct a systematic review to determine how health equity is considered in the design, implementation, and evaluation of mHealth interventions for caregivers of older adults using Cochrane Equity's PROGRESS-Plus (place of residence, race, ethnicity, culture, language, occupation, gender, religion, education, social capital, socioeconomic status--plus age, disability, and sexual orientation) framework and synthesize evidence of the impacts of the identified caregiver-focused mHealth interventions. Methods: A systematic review was conducted using 5 databases. Articles published between January 2010 and June 2021 were included if they evaluated or explored the impact of mHealth interventions on the health and well-being of informal caregivers of older adults. mHealth interventions were defined as supportive services, for example, education, that caregivers of older adults accessed via mobile or wireless devices. Results: In total, 28 articles met the inclusion criteria and were included in the review. The interventions evaluated sought to connect caregivers with services, facilitate caregiving, and promote caregivers' health and well-being. The PROGRESS-Plus framework factors were mainly considered in the results, discussion, and limitations sections of the included studies. Some PROGRESS-Plus factors such as sexual orientation, religion, and occupation, received little to no consideration across any phase of the intervention design, implementation, or evaluation. Overall, the findings of this review suggest that mHealth interventions were positively received by study participants. Such interventions have the potential to reduce caregiver burden and positively affect caregivers' physical and mental health while supporting them as caregivers. The study findings highlight the importance of making support available to help facilitate caregivers' use of mHealth interventions, as well as in the use of appropriate language and text. Conclusions: The successful uptake and spread of mHealth interventions to support caregivers of older adults will depend on creating opportunities for the inclusive involvement of a broad range of stakeholders at all stages of design, implementation, and evaluation. ",
doi="10.2196/33085",
url="https://aging.jmir.org/2022/3/e33085",
url="http://www.ncbi.nlm.nih.gov/pubmed/35616514"
}


@Article{info:doi/10.2196/36370,
author="Morgan, Catherine
and Tonkin, L. Emma
and Craddock, Ian
and Whone, L. Alan",
title="Acceptability of an In-home Multimodal Sensor Platform for Parkinson Disease: Nonrandomized Qualitative Study",
journal="JMIR Hum Factors",
year="2022",
month="Jul",
day="7",
volume="9",
number="3",
pages="e36370",
keywords="sensor",
keywords="Parkinson disease",
keywords="wearables",
keywords="cameras",
keywords="acceptability",
keywords="smart home",
keywords="behavior change",
keywords="multimodal home-based",
keywords="qualitative",
abstract="Background: Parkinson disease (PD) symptoms are complex, gradually progressive, and fluctuate hour by hour. Home-based technological sensors are being investigated to measure symptoms and track disease progression. A smart home sensor platform, with cameras and wearable devices, could be a useful tool to use to get a fuller picture of what someone's symptoms are like. High-resolution video can capture the ground truth of symptoms and activities. There is a paucity of information about the acceptability of such sensors in PD. Objective: The primary objective of our study was to explore the acceptability of living with a multimodal sensor platform in a naturalistic setting in PD. Two subobjectives are to identify any suggested limitations and to explore the sensors' impact on participant behaviors. Methods: A qualitative study was conducted with an inductive approach using semistructured interviews with a cohort of PD and control participants who lived freely for several days in a home-like environment while continuously being sensed. Results: This study of 24 participants (12 with PD) found that it is broadly acceptable to use multimodal sensors including wrist-worn wearables, cameras, and other ambient sensors passively in free-living in PD. The sensor that was found to be the least acceptable was the wearable device. Suggested limitations on the platform for home deployment included camera-free time and space. Behavior changes were noted by the study participants, which may have related to being passively sensed. Recording high-resolution video in the home setting for limited periods of time was felt to be acceptable to all participants. Conclusions: The results broaden the knowledge of what types of sensors are acceptable for use in research in PD and what potential limitations on these sensors should be considered in future work. The participants' reported behavior change in this study should inform future similar research design to take this factor into account. Collaborative research study design, involving people living with PD at every stage, is important to ensure that the technology is acceptable and that the data outcomes produced are ecologically valid and accurate. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-041303 ",
doi="10.2196/36370",
url="https://humanfactors.jmir.org/2022/3/e36370",
url="http://www.ncbi.nlm.nih.gov/pubmed/35797101"
}


@Article{info:doi/10.2196/24376,
author="Latulippe, Karine
and Giroux, Dominique
and Guay, Manon
and Kairy, Dahlia
and Vincent, Claude
and Boivin, Katia
and Morales, Ernesto
and Obradovic, Natasa
and Provencher, V{\'e}ronique",
title="Mobile Videoconferencing for Occupational Therapists' Assessments of Patients' Home Environments Prior to Hospital Discharge: Mixed Methods Feasibility and Comparative Study",
journal="JMIR Aging",
year="2022",
month="Jul",
day="5",
volume="5",
number="3",
pages="e24376",
keywords="caregivers",
keywords="feasibility",
keywords="mixed methods",
keywords="mobile videoconferencing",
keywords="mobile phone",
keywords="occupational therapy",
keywords="discharge planning",
keywords="home assessment",
abstract="Background: Occupational therapists who work in hospitals need to assess patients' home environment in preparation for hospital discharge in order to provide recommendations (eg, technical aids) to support their independence and safety. Home visits increase performance in everyday activities and decrease the risk of falls; however, in some countries, home visits are rarely made prior to hospital discharge due to the cost and time involved. In most cases, occupational therapists rely on an interview with the patient or a caregiver to assess the home. The use of videoconferencing to assess patients' home environments could be an innovative solution to allow better and more appropriate recommendations. Objective: The aim of this study was (1) to explore the added value of using mobile videoconferencing compared with standard procedure only and (2) to document the clinical feasibility of using mobile videoconferencing to assess patients' home environments. Methods: Occupational therapists assessed home environments using, first, the standard procedure (interview),  and then, videoconferencing (with the help of a family caregiver located in patients' homes, using an electronic tablet). We used a concurrent mixed methods design. The occupational therapist's responsiveness to telehealth, time spent on assessment, patient's occupational performance and satisfaction, and major events influencing the variables were collected as quantitative data. The perceptions of occupational therapists and family caregivers regarding the added value of using this method and the nature of changes made to recommendations as a result of the videoconference (if any) were collected as qualitative data, using questionnaires and semistructured interviews. Results: Eight triads (6 occupational therapists, 8 patients, and 8 caregivers) participated. The use of mobile videoconferencing generally led occupational therapists to modify the initial intervention plan (produced after the standard interview). Occupational therapists and caregivers perceived benefits in using mobile videoconferencing (eg, the ability to provide real-time comments or feedback), and they also perceived disadvantages (eg, videoconferencing requires additional time and greater availability of caregivers). Some occupational therapists believed that mobile videoconferencing added value to assessments, while others did not. Conclusions: The use of mobile videoconferencing in the context of hospital discharge planning has raised questions of clinical feasibility. Although mobile videoconferencing provides multiple benefits to hospital discharge, including more appropriate occupational therapist recommendations, time constraints made it more difficult to perceive the added value. However, with smartphone use, interdisciplinary team involvement, and patient participation in the videoconference visit, mobile videoconferencing can become an asset to hospital discharge planning. International Registered Report Identifier (IRRID): RR2-10.2196/11674 ",
doi="10.2196/24376",
url="https://aging.jmir.org/2022/3/e24376",
url="http://www.ncbi.nlm.nih.gov/pubmed/35787486"
}


@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/10.2196/33894,
author="Provencher, Veronique
and Baillargeon, Dany
and Abdulrazak, Bessam
and Boissy, Patrick
and Levasseur, M{\'e}lanie
and Delli-Colli, Nathalie
and Pigot, H{\'e}l{\`e}ne
and Audet, M{\'e}lisa
and Bahrampoor Givi, Sara
and Girard, Catherine",
title="Developing a One-Stop Platform Transportation Planning Service to Help Older Adults Move Around in Their Community Where, When, and How They Wish: Protocol for a Living Lab Study",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="9",
volume="11",
number="6",
pages="e33894",
keywords="aged",
keywords="mobility limitation",
keywords="transportation",
keywords="community-based",
keywords="participatory research",
keywords="information system",
keywords="mobility",
keywords="older adults",
abstract="Background: ?Multiple mobility-related challenges frequently appear with aging. As a result, many older adults have difficulty getting around, to go, for example, to doctors' appointments or leisure activities. Although various means of transportation are currently available, older adults do not necessarily use them, partly because they do not know which ones are adapted to their needs and preferences. To foster older adults' autonomy and freedom in their decision-making about transportation, it is crucial to help them make informed decisions about the means that suit them best. Objective: Our aim is to develop Mobilain{\'e}s, a one-stop platform transportation planning service combining different transport modes and services to help older adults move around in their community where, when, and how they wish. More specifically, we aim to (1) define older adults' mobility needs and preferences in order to conceptualize a one-stop platform; (2) cocreate a prototype of the one-stop platform; and (3) test the prototype with users in a real-life context. Methods: This ongoing study uses a ``Living Lab'' co-design approach. This approach differs from traditional research on aging by facilitating intersectoral knowledge sharing and innovative solutions by and with older adults themselves. A steering committee of 8 stakeholders from the public, scientific, and private sectors, as well as older citizens, will meet quarterly throughout the study. The design comprises three phases, each with several iterative subphases. Phase 1 is exploration: through co-design workshops and literature reviews, members of the intersectoral committee will define older adults' mobility needs and preferences to support the conceptualization of the one-stop platform. Phase 2 is experimentation: 4 personas will be produced that reflect the different needs and preferences of typical older adult end users of the platform; for development of a prototype, scenarios and mockups (static designs of the web application) will be created through co-design sessions with older adults (N=12) embodying these personas. Phase 3 is evaluation: we will test the usability of the prototype and document changes in mobility, such as the ability to move around satisfactorily and to participate in meaningful activities, by and with older adults (N=30) who use the prototype. The steering committee will identify ways to support the adoption, implementation, and scaling up of Mobilain{\'e}s to ensure its sustainability. Qualitative and quantitative data will be triangulated according to each subphase objective. Results: ?The first phase began in September 2019. The study is scheduled for completion by mid-2023. Conclusions: ?This innovative transportation planning service will merge existing transportation options in one place. By meeting a wide variety of older adults' needs and preferences, Mobilain{\'e}s will help them feel comfortable and safe when moving around, which should increase their participation in meaningful activities and reduce the risk of social isolation. International Registered Report Identifier (IRRID): DERR1-10.2196/33894 ",
doi="10.2196/33894",
url="https://www.researchprotocols.org/2022/6/e33894",
url="http://www.ncbi.nlm.nih.gov/pubmed/35679116"
}


@Article{info:doi/10.2196/38456,
author="Brijnath, Bianca
and Baruah, Upasana
and Antoniades, Josefine
and Varghese, Mathew
and Cooper, Claudia
and Dow, Briony
and Kent, Mike
and Loganathan, Santosh",
title="Using Digital Media to Improve Dementia Care in India: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="2",
volume="11",
number="6",
pages="e38456",
keywords="dementia",
keywords="care",
keywords="India",
keywords="digital health",
keywords="film",
abstract="Background: India is undergoing a demographic transition characterized by population aging and is witnessing a high dementia rate. Although nearly 7 million people live with dementia in India, dementia awareness is poor, and current resources addressing dementia care are basic and often incomplete, duplicated, or conflicting. To address this gap, this study aims to use digital media, which has had a massive technological uptake in India, to improve dementia care in India. Objective: The objective of this paper is to describe an intervention study design that examines the feasibility and acceptability of Moving Pictures India, a digital media resource to improve dementia care in India. Methods: This study employs a mixed methods design and is divided into 4 phases: (1) video interviews with Indian caregivers and health professionals; (2) coproduction of resources; (3) pilot randomized controlled trial (RCT); and (4) dissemination and analytics. The pilot RCT will follow an experimental parallel group design with 2 arms aiming to assess the impact, feasibility, and acceptability of the developed resources. The primary outcome measures for the pilot RCT will be feasibility and acceptability, while the secondary outcome measures will be caregiver burden, mood, and quality of life. Results: This study received funding from the Alzheimer's Association in the United States in July 2021. In 2023, we will enroll 60 dementia caregivers (40 caregivers in the intervention arm and 20 in the control) for the pilot RCT. The study has been approved by the National Institute of Mental Health and Neuro Sciences Ethics Committee (26th IEC (BEH.SC.DIV.)/2020-21 dated November 11, 2020); the Health Ministry's Screening Committee, India (proposal ID 2020-10137); the Curtin University Human Research Ethics Committee (approval number HRE2020-0735); and the NARI Research Governance Office (site-specific approval dated March 17, 2021). Conclusions: This protocol is designed to deliver unique, coproduced, and evidence-based media resources to support caregivers of persons with dementia in India and other countries aiming to utilize digital media for dementia care. If the intervention is found feasible and acceptable, postpiloting analytics and qualitative feedback will be used to develop an implementation trial to evaluate the effectiveness of the potential low-risk high-benefit intervention in practice. Trial Registration: Clinical Trials Registry-India CTRI/2021/01/030403; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=50794 International Registered Report Identifier (IRRID): DERR1-10.2196/38456 ",
doi="10.2196/38456",
url="https://www.researchprotocols.org/2022/6/e38456",
url="http://www.ncbi.nlm.nih.gov/pubmed/35653168"
}


@Article{info:doi/10.2196/35929,
author="Singh, Hardeep
and Tang, Terence
and Steele Gray, Carolyn
and Kokorelias, Kristina
and Thombs, Rachel
and Plett, Donna
and Heffernan, Matthew
and Jarach, M. Carlotta
and Armas, Alana
and Law, Susan
and Cunningham, V. Heather
and Nie, Xin Jason
and Ellen, E. Moriah
and Thavorn, Kednapa
and Nelson, LA Michelle",
title="Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review",
journal="JMIR Aging",
year="2022",
month="May",
day="19",
volume="5",
number="2",
pages="e35929",
keywords="transitions",
keywords="health",
keywords="medical informatics",
keywords="aged",
keywords="mobile phone",
abstract="Background: Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective: To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods: This 2-phase rapid review involved a selective review of providers' roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults' hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results: In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients' status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions: This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045596 ",
doi="10.2196/35929",
url="https://aging.jmir.org/2022/2/e35929",
url="http://www.ncbi.nlm.nih.gov/pubmed/35587874"
}


@Article{info:doi/10.2196/31352,
author="Alley, J. Stephanie
and van Uffelen, Jannique
and Schoeppe, Stephanie
and Parkinson, Lynne
and Hunt, Susan
and Power, Deborah
and Waterman, Natasha
and Waterman, Courtney
and To, G. Quyen
and Duncan, J. Mitch
and Schneiders, Anthony
and Vandelanotte, Corneel",
title="The Effectiveness of a Computer-Tailored Web-Based Physical Activity Intervention Using Fitbit Activity Trackers in Older Adults (Active for Life): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="May",
day="12",
volume="24",
number="5",
pages="e31352",
keywords="internet",
keywords="online",
keywords="activity trackers",
keywords="activity monitors",
keywords="wearables",
keywords="physical activity",
keywords="mobile phone",
abstract="Background: Physical activity is an integral part of healthy aging; yet, most adults aged ?65 years are not sufficiently active. Preliminary evidence suggests that web-based interventions with computer-tailored advice and Fitbit activity trackers may be well suited for older adults. Objective: The aim of this study was to examine the effectiveness of Active for Life, a 12-week web-based physical activity intervention with 6 web-based modules of computer-tailored advice to increase physical activity in older Australians. Methods: Participants were recruited both through the web and offline and were randomly assigned to 1 of 3 trial arms: tailoring+Fitbit, tailoring only, or a wait-list control. The computer-tailored advice was based on either participants' Fitbit data (tailoring+Fitbit participants) or self-reported physical activity (tailoring-only participants). The main outcome was change in wrist-worn accelerometer (ActiGraph GT9X)--measured moderate to vigorous physical activity (MVPA) from baseline to after the intervention (week 12). The secondary outcomes were change in self-reported physical activity measured by means of the Active Australia Survey at the midintervention point (6 weeks), after the intervention (week 12), and at follow-up (week 24). Participants had a face-to-face meeting at baseline for a demonstration of the intervention and at baseline and week 12 to return the accelerometers. Generalized linear mixed model analyses were conducted with a $\gamma$ distribution and log link to compare MVPA and self-reported physical activity changes over time within each trial arm and between each of the trial arms. Results: A total of 243 participants were randomly assigned to tailoring+Fitbit (n=78, 32.1\%), tailoring only (n=96, 39.5\%), and wait-list control (n=69, 28.4\%). Attrition was 28.8\% (70/243) at 6 weeks, 31.7\% (77/243) at 12 weeks, and 35.4\% (86/243) at 24 weeks. No significant overall time by group interaction was observed for MVPA (P=.05). There were no significant within-group changes for MVPA over time in the tailoring+Fitbit group (+3\%, 95\% CI --24\% to 40\%) or the tailoring-only group (--4\%, 95\% CI --24\% to 30\%); however, a significant decline was seen in the control group (--35\%, 95\% CI --52\% to --11\%). The tailoring+Fitbit group participants increased their MVPA 59\% (95\% CI 6\%-138\%) more than those in the control group. A significant time by group interaction was observed for self-reported physical activity (P=.02). All groups increased their self-reported physical activity from baseline to week 6, week 12, and week 24, and this increase was greater in the tailoring+Fitbit group than in the control group at 6 weeks (+61\%, 95\% CI 11\%-133\%). Conclusions: A computer-tailored physical activity intervention with Fitbit integration resulted in improved MVPA outcomes in comparison with a control group in older adults. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000646246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000646246 ",
doi="10.2196/31352",
url="https://www.jmir.org/2022/5/e31352",
url="http://www.ncbi.nlm.nih.gov/pubmed/35552166"
}


@Article{info:doi/10.2196/31486,
author="Read, A. Emily
and Gagnon, A. Danie
and Donelle, Lorie
and Ledoux, Kathleen
and Warner, Grace
and Hiebert, Brad
and Sharma, Ridhi",
title="Stakeholder Perspectives on In-home Passive Remote Monitoring to Support Aging in Place in the Province of New Brunswick, Canada: Rapid Qualitative Investigation",
journal="JMIR Aging",
year="2022",
month="May",
day="11",
volume="5",
number="2",
pages="e31486",
keywords="aging in place",
keywords="home care",
keywords="older adults",
keywords="passive remote monitoring",
abstract="Background: The province of New Brunswick (NB) has one of the oldest populations in Canada, providing an opportunity to develop and test innovative strategies to address the unique health challenges faced by older adults. Passive remote monitoring technology has the potential to support independent living among older adults. Limited research has examined the benefits of and barriers to the adoption of this technology among community-dwelling older adults. Objective: This study aimed to explore perceptions of in-home passive remote monitoring technology designed to support aging in place from the perspective of older adults, their family or friend caregivers, social workers, and government decision-makers in the province of NB, Canada. Methods: Between October 2018 and March 2020, a rapid qualitative investigation of 28 one-on-one interviews was conducted in person or via telephone. Participants included 2 home support services clients and 11 family or friend caregivers who had used passive remote monitoring technology in their homes; 8 social workers who had worked as case managers for home support services clients; and 7 individuals who were key government decision-makers in the adoption, policy development, and use of the technology in the province of NB. The interviews focused on the following topics: decision to adopt the passive remote monitoring system, barriers to adopting the passive remote monitoring system, benefits of the passive remote monitoring system, impact on client health outcomes, and privacy concerns. The interviews were audio recorded, transcribed, and analyzed by a team of 6 researchers. Data analysis was conducted using a rapid assessment process approach that included matrix analysis. Results: Participants reported that the use of the remote monitoring system allowed older adults to live at home longer and provided caregiver relief. Stakeholders were invested in meeting the home support (home care) needs of older adults. However, when it came to the use of remote monitoring, there was a lack of consensus about which clients it was well-suited for and the role that social workers should play in informing clients and caregivers about the service (role ambiguity, gatekeeping, and perceived conflicts of interest). Conclusions: Our findings highlight many benefits and challenges of the adoption of passive remote monitoring for clients, their family or friend caregivers, and public provincial health and social services systems. Passive remote monitoring is a valuable tool that can provide support to older adults and their family or friend caregivers when it is a good fit with client needs. Further work is needed in NB to increase public and social workers' awareness of the service and its benefits. ",
doi="10.2196/31486",
url="https://aging.jmir.org/2022/2/e31486",
url="http://www.ncbi.nlm.nih.gov/pubmed/35544304"
}


@Article{info:doi/10.2196/36768,
author="Kleschnitzki, Marina Jana
and Grossmann, Inga
and Beyer, Reinhard
and Beyer, Luzi",
title="Modification in the Motor Skills of Seniors in Care Homes Using Serious Games and the Impact of COVID-19: Field Study",
journal="JMIR Serious Games",
year="2022",
month="May",
day="10",
volume="10",
number="2",
pages="e36768",
keywords="serious games",
keywords="motor skills",
keywords="motor",
keywords="long-term care",
keywords="exercise",
keywords="movement",
keywords="coronavirus effects",
keywords="eHealth",
keywords="seniors",
keywords="older adult",
keywords="elder",
keywords="senior population",
keywords="aged",
keywords="care home",
keywords="intervention effects analysis",
keywords="COVID-19",
keywords="pandemic",
keywords="digital game",
keywords="digital health",
keywords="physical activity",
abstract="Background: The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. At the beginning of 2020, the COVID-19 pandemic led to many restrictions, which affected seniors in care facilities in the form of severe isolation. The isolation led, among other things, to a lack of exercise, which has led to a multitude of negative effects for this target group. Serious games can potentially help by being used anywhere at any time to strengthen skills with few resources. Objective: The aim of this study is to evaluate the effectiveness of a serious game to strengthen motor skills (study 1) and the influence of pandemic restrictions (study 2) on seniors in care facilities. Methods: The data on motor skills (measured by the Tinetti test) originated from an intervention study with repeated measurements that was interrupted by the pandemic conditions. Data were collected 4 times every 3 months with an intervention group (IG, training 3 times for 1 hour per week) and a control group (CG, no intervention). There were 2 substudies. The first considered the first 6 months until the pandemic restrictions, while the second considered the influence of the restrictions on motor skills. Results: The sample size was 70. The IG comprised 31 (44\%) participants, with 22 (71\%) female and 9 (29\%) male seniors with an average age of 85 years. The CG comprised 39 (56\%) participants, with 31 (79\%) female and 8 (21\%) male seniors with an average age of 87 years. In study 1, mixed-design ANOVA showed no significant interaction between measurement times and group membership for the first measurements (F2.136=1.414, P<.25, partial $\eta$2=.044), but there was a significant difference between the CG (mean 16.23, SD 1.1) and the IG (mean 19.81, SD 1.2) at the third time of measurement (P=.02). In study 2 the mixed-design ANOVA (used to investigate motor skills before and after the pandemic conditions between the 2 groups) couldn't reveal any significant interaction between measurement times and group membership: F1.67=2.997, P<.09, partial $\eta$2=.043. However, there was a significant main effect of the time of measurement: F1.67=5.44, P<.02, partial $\eta${\texttwosuperior}=.075. Conclusions: During the first 6 months, the IG showed increased motor skills, whereas the motor skills of the CG slightly deteriorated and showed a statistically significant difference after 6 months. The pandemic restrictions leveled the difference and showed a significant negative effect on motor skills over 3 months. As our results show, digital games have the potential to break down access barriers and promote necessary maintenance for important skills. The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. This potentially great benefit for the challenges of tomorrow shows the relevance of the topic and demonstrates the urgent need for action and research. Trial Registration: Deutsches Register klinischer Studien DRKS00016633; https://tinyurl.com/yckmj4px ",
doi="10.2196/36768",
url="https://games.jmir.org/2022/2/e36768",
url="http://www.ncbi.nlm.nih.gov/pubmed/35536610"
}


@Article{info:doi/10.2196/32006,
author="Coley, Nicola
and Andre, Laurine
and Hoevenaar-Blom, P. Marieke
and Ngandu, Tiia
and Beishuizen, Cathrien
and Barbera, Mariagnese
and van Wanrooij, Lennard
and Kivipelto, Miia
and Soininen, Hilkka
and van Gool, Willem
and Brayne, Carol
and Moll van Charante, Eric
and Richard, Edo
and Andrieu, Sandrine
and ",
title="Factors Predicting Engagement of Older Adults With a Coach-Supported eHealth Intervention Promoting Lifestyle Change and Associations Between Engagement and Changes in Cardiovascular and Dementia Risk: Secondary Analysis of an 18-Month Multinational Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="May",
day="9",
volume="24",
number="5",
pages="e32006",
keywords="aging",
keywords="eHealth",
keywords="disparities",
keywords="engagement",
keywords="prevention",
keywords="cardiovascular",
keywords="lifestyle",
keywords="risk factors",
abstract="Background: Digital health interventions could help to prevent age-related diseases, but little is known about how older adults engage with such interventions, especially in the long term, or whether engagement is associated with changes in clinical, behavioral, or biological outcomes in this population. Disparities in engagement levels with digital health interventions may exist among older people and be associated with health inequalities. Objective: This study aimed to describe older adults' engagement with an eHealth intervention, identify factors associated with engagement, and examine associations between engagement and changes in cardiovascular and dementia risk factors (blood pressure, cholesterol, BMI, physical activity, diet, and cardiovascular and dementia risk scores). Methods: This was a secondary analysis of the 18-month randomized controlled Healthy Ageing Through Internet Counselling in the Elderly trial of a tailored internet-based intervention encouraging behavior changes, with remote support from a lifestyle coach, to reduce cardiovascular and cognitive decline risk in 2724 individuals aged ?65 years, recruited offline in the Netherlands, Finland, and France. Engagement was assessed via log-in frequency, number of lifestyle goals set, measurements entered and messages sent to coaches, and percentage of education materials read. Clinical and biological data were collected during in-person visits at baseline and 18 months. Lifestyle data were self-reported on a web-based platform. Results: Of the 1389 intervention group participants, 1194 (85.96\%) sent at least one message. They logged in a median of 29 times, and set a median of 1 goal. Higher engagement was associated with significantly greater improvement in biological and behavioral risk factors, with evidence of a dose-response effect. Compared with the control group, the adjusted mean difference (95\% CI) in 18-month change in the primary outcome, a composite z-score comprising blood pressure, BMI, and cholesterol, was ?0.08 (?0.12 to ?0.03), ?0.04 (?0.08 to 0.00), and 0.00 (?0.08 to 0.08) in the high, moderate, and low engagement groups, respectively. Low engagers showed no improvement in any outcome measures compared with the control group. Participants not using a computer regularly before the study engaged much less with the intervention than those using a computer up to 7 (adjusted odds ratio 5.39, 95\% CI 2.66-10.95) or ?7 hours per week (adjusted odds ratio 6.58, 95\% CI 3.21-13.49). Those already working on or with short-term plans for lifestyle improvement at baseline, and with better cognition, engaged more. Conclusions: Greater engagement with an eHealth lifestyle intervention was associated with greater improvement in risk factors in older adults. However, those with limited computer experience, who tended to have a lower level of education, or who had poorer cognition engaged less. Additional support or forms of intervention delivery for such individuals could help minimize potential health inequalities associated with the use of digital health interventions in older people. ",
doi="10.2196/32006",
url="https://www.jmir.org/2022/5/e32006",
url="http://www.ncbi.nlm.nih.gov/pubmed/35385395"
}


@Article{info:doi/10.2196/33498,
author="McCloud, Rachel
and Perez, Carly
and Bekalu, Awoke Mesfin
and Viswanath, K.",
title="Using Smart Speaker Technology for Health and Well-being in an Older Adult Population: Pre-Post Feasibility Study",
journal="JMIR Aging",
year="2022",
month="May",
day="9",
volume="5",
number="2",
pages="e33498",
keywords="technology",
keywords="older adults",
keywords="communication inequalities",
keywords="digital health",
keywords="elderly population",
keywords="smart technology",
keywords="smart speaker",
keywords="well-being",
keywords="health technology",
keywords="mobile phone",
abstract="Background: Although smart speaker technology is poised to help improve the health and well-being of older adults by offering services such as music, medication reminders, and connection to others, more research is needed to determine how older adults from lower socioeconomic position (SEP) accept and use this technology. Objective: This study aimed to investigate the feasibility of using smart speakers to improve the health and well-being of low-SEP older adults. Methods: A total of 39 adults aged between 65 and 85 years who lived in a subsidized housing community were recruited to participate in a 3-month study. The participants had a smart speaker at their home and were given a brief orientation on its use. Over the course of the study, participants were given weekly check-in calls to help assist with any problems and newsletters with tips on how to use the speaker. Participants received a pretest and posttest to gauge comfort with technology, well-being, and perceptions and use of the speaker. The study staff also maintained detailed process notes of interactions with the participants over the course of the study, including a log of all issues reported. Results: At the end of the study period, 38\% (15/39) of the participants indicated using the speaker daily, and 38\% (15/39) of the participants reported using it several times per week. In addition, 72\% (28/39) of the participants indicated that they wanted to continue using the speaker after the end of the study. Most participants (24/39, 62\%) indicated that the speaker was useful, and approximately half of the participants felt that the speaker gave them another voice to talk to (19/39, 49\%) and connected them with the outside world (18/39, 46\%). Although common uses were using the speaker for weather, music, and news, fewer participants reported using it for health-related questions. Despite the initial challenges participants experienced with framing questions to the speaker, additional explanations by the study staff addressed these issues in the early weeks of the study. Conclusions: The results of this study indicate that there is promise for smart speaker technology for low-SEP older adults, particularly to connect them to music, news, and reminders. Future studies will need to provide more upfront training on query formation as well as develop and promote more specific options for older adults, particularly in the area of health and well-being. ",
doi="10.2196/33498",
url="https://aging.jmir.org/2022/2/e33498",
url="http://www.ncbi.nlm.nih.gov/pubmed/35532979"
}


@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/10.2196/35277,
author="Timon, M. Claire
and Heffernan, Emma
and Kilcullen, M. Sophia
and Lee, Hyowon
and Hopper, Louise
and Quinn, Joe
and McDonald, David
and Gallagher, Pamela
and Smeaton, F. Alan
and Moran, Kieran
and Hussey, Pamela
and Murphy, Catriona",
title="Development of an Internet of Things Technology Platform (the NEX System) to Support Older Adults to Live Independently: Protocol for a Development and Usability Study",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="5",
volume="11",
number="5",
pages="e35277",
keywords="independent living",
keywords="older adults",
keywords="Internet of Things",
keywords="wearable electronic devices",
keywords="activities of daily living",
keywords="mobile phone",
abstract="Background: In a rapidly aging population, new and efficient ways of providing health and social support to older adults are required that not only preserve independence but also maintain quality of life and safety. Objective: The NEX project aims to develop an integrated Internet of Things system coupled with artificial intelligence to offer unobtrusive health and wellness monitoring to support older adults living independently in their home environment. The primary objective of this study is to develop and evaluate the technical performance and user acceptability of the NEX system. The secondary objective is to apply machine learning algorithms to the data collected via the NEX system to identify and eventually predict changes in the routines of older adults in their own home environment. Methods: The NEX project commenced in December 2019 and is expected to be completed by August 2022. Mixed methods research (web-based surveys and focus groups) was conducted with 426 participants, including older adults (aged ?60 years), family caregivers, health care professionals, and home care workers, to inform the development of the NEX system (phase 1). The primary outcome will be evaluated in 2 successive trials (the Friendly trial [phase 2] and the Action Research Cycle trial [phase 3]). The secondary objective will be explored in the Action Research Cycle trial (phase 3). For the Friendly trial, 7 older adult participants aged ?60 years and living alone in their own homes for a 10-week period were enrolled. A total of 30 older adult participants aged ?60 years and living alone in their own homes will be recruited for a 10-week data collection period (phase 3). Results: Phase 1 of the project (n=426) was completed in December 2020, and phase 2 (n=7 participants for a 10-week pilot study) was completed in September 2021. The expected completion date for the third project phase (30 participants for the 10-week usability study) is June 2022. Conclusions: The NEX project has considered the specific everyday needs of older adults and other stakeholders, which have contributed to the design of the integrated system. The innovation of the NEX system lies in the use of Internet of Things technologies and artificial intelligence to identify and predict changes in the routines of older adults. The findings of this project will contribute to the eHealth research agenda, focusing on the improvement of health care provision and patient support in home and community environments. International Registered Report Identifier (IRRID): DERR1-10.2196/35277 ",
doi="10.2196/35277",
url="https://www.researchprotocols.org/2022/5/e35277",
url="http://www.ncbi.nlm.nih.gov/pubmed/35511224"
}


@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/10.2196/34764,
author="Lim, A. Haikel
and Lee, Win Joanne Sze
and Lim, Han Meng
and Teo, Zhen Lynn Pei
and Sin, Wen Natalene Siew
and Lim, Wei Rou
and Chua, Min Si
and Yeo, Qi Jia
and Ngiam, Wen Nerice Heng
and Tey, Jie-Yin Angeline
and Tham, Xin Celine Yi
and Ng, Yi Kennedy Yao
and Low, Leng Lian
and Tang, Aaron Kai Wen",
title="Bridging Connectivity Issues in Digital Access and Literacy: Reflections on Empowering Vulnerable Older Adults in Singapore",
journal="JMIR Aging",
year="2022",
month="May",
day="3",
volume="5",
number="2",
pages="e34764",
keywords="COVID-19",
keywords="digital literacy",
keywords="digital literacy training",
keywords="digital disparities",
keywords="digital divide",
keywords="social construction of health technologies",
keywords="health technology",
keywords="COVID-19 pandemic",
keywords="pandemic",
keywords="COVID",
keywords="social isolation",
keywords="elder",
keywords="older adult",
keywords="Asia",
keywords="access",
keywords="barrier",
keywords="empower",
keywords="volunteer",
keywords="vulnerable",
keywords="digital skill",
keywords="low income",
doi="10.2196/34764",
url="https://aging.jmir.org/2022/2/e34764",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503520"
}


@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/10.2196/35625,
author="Perales-Puchalt, Jaime
and Acosta-Rull{\'a}n, Mariola
and Ram{\'i}rez-Mantilla, Mariana
and Espinoza-Kissell, Paul
and Vidoni, Eric
and Niedens, Michelle
and Ellerbeck, Edward
and Hinton, Ladson
and Loera, Linda
and Ram{\'i}rez, Susana A.
and Lara, Esther
and Watts, Amber
and Williams, Kristine
and Resendez, Jason
and Burns, Jeffrey",
title="A Text Messaging Intervention to Support Latinx Family Caregivers of Individuals With Dementia (CuidaTEXT): Development and Usability Study",
journal="JMIR Aging",
year="2022",
month="Apr",
day="28",
volume="5",
number="2",
pages="e35625",
keywords="Latinx individuals",
keywords="mHealth",
keywords="dementia",
keywords="caregiving",
abstract="Background: Latinx family caregivers of individuals with dementia face many barriers to caregiver support access. Interventions to alleviate these barriers are urgently needed. Objective: This study aimed to describe the development of CuidaTEXT, a tailored SMS text messaging intervention to support Latinx family caregivers of individuals with dementia. Methods: CuidaTEXT is informed by the stress process framework and social cognitive theory. We developed and refined CuidaTEXT using a mixed methods approach that included thematic analysis and descriptive statistics. We followed 6 user-centered design stages, namely, the selection of design principles, software vendor collaboration, evidence-based foundation, caregiver and research and clinical advisory board guidance, sketching and prototyping, and usability testing of the prototype of CuidaTEXT among 5 Latinx caregivers. Results: CuidaTEXT is a bilingual 6-month-long SMS text messaging--based intervention tailored to caregiver needs that includes 1-3 daily automatic messages (n=244) about logistics, dementia education, self-care, social support, end of life, care of the person with dementia, behavioral symptoms, and problem-solving strategies; 783 keyword-driven text messages for further help with the aforementioned topics; live chat interaction with a coach for further help; and a 19-page reference booklet summarizing the purpose and functions of the intervention. The 5 Latinx caregivers who used the prototype of CuidaTEXT scored an average of 97 out of 100 on the System Usability Scale. Conclusions: CuidaTEXT's prototype demonstrated high usability among Latinx caregivers. CuidaTEXT's feasibility is ready to be tested. ",
doi="10.2196/35625",
url="https://aging.jmir.org/2022/2/e35625",
url="http://www.ncbi.nlm.nih.gov/pubmed/35482366"
}


@Article{info:doi/10.2196/34606,
author="Gooch, Daniel
and Mehta, Vikram
and Stuart, Avelie
and Katz, Dmitri
and Bennasar, Mohamed
and Levine, Mark
and Bandara, Arosha
and Nuseibeh, Bashar
and Bennaceur, Amel
and Price, Blaine",
title="Designing Tangibles to Support Emotion Logging for Older Adults: Development and Usability Study",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="27",
volume="9",
number="2",
pages="e34606",
keywords="older adults",
keywords="health",
keywords="emotion",
keywords="affect",
keywords="well-being",
keywords="tangible interaction",
keywords="TUI",
abstract="Background: The global population is aging, leading to shifts in health care needs. In addition to developing technology to support physical health, there is an increasing recognition of the need to consider how technology can support emotional health. This raises the question of how to design devices that older adults can interact with to log their emotions. Objective: We designed and developed 2 novel tangible devices, inspired by existing paper-based scales of emotions. The findings from a field trial of these devices with older adults are reported. Methods: Using interviews, field deployment, and fixed logging tasks, we assessed the developed devices. Results: Our results demonstrate that the tangible devices provided data comparable with standardized psychological scales of emotion. The participants developed their own patterns of use around the devices, and their experience of using the devices uncovered a variety of design considerations. We discuss the difficulty of customizing devices for specific user needs while logging data comparable to psychological scales of emotion. We also highlight the value of reflecting on sparse emotional data. Conclusions: Our work demonstrates the potential for tangible emotional logging devices. It also supports further research on whether such devices can support the emotional health of older adults by encouraging reflection of their emotional state. ",
doi="10.2196/34606",
url="https://humanfactors.jmir.org/2022/2/e34606",
url="http://www.ncbi.nlm.nih.gov/pubmed/35475781"
}


@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/10.2196/28222,
author="Puthusseryppady, Vaisakh
and Morrissey, Sol
and Aung, Hane Min
and Coughlan, Gillian
and Patel, Martyn
and Hornberger, Michael",
title="Using GPS Tracking to Investigate Outdoor Navigation Patterns in Patients With Alzheimer Disease: Cross-sectional Study",
journal="JMIR Aging",
year="2022",
month="Apr",
day="21",
volume="5",
number="2",
pages="e28222",
keywords="Alzheimer disease",
keywords="dementia",
keywords="spatial disorientation",
keywords="getting lost",
keywords="outdoor navigation",
keywords="risk factors",
keywords="environmental",
keywords="GPS tracking",
keywords="community",
keywords="mobile phone",
abstract="Background: Spatial disorientation is one of the earliest and most distressing symptoms seen in patients with Alzheimer disease (AD) and can lead to them getting lost in the community. Although it is a prevalent problem worldwide and is associated with various negative consequences, very little is known about the extent to which outdoor navigation patterns of patients with AD explain why spatial disorientation occurs for them even in familiar surroundings. Objective: This study aims to understand the outdoor navigation patterns of patients with AD in different conditions (alone vs accompanied; disoriented vs not disoriented during the study) and investigate whether patients with AD experienced spatial disorientation when navigating through environments with a high outdoor landmark density and complex road network structure (road intersection density, intersection complexity, and orientation entropy). Methods: We investigated the outdoor navigation patterns of community-dwelling patients with AD (n=15) and age-matched healthy controls (n=18) over a 2-week period using GPS tracking and trajectory mining analytical techniques. Here, for the patients, the occurrence of any spatial disorientation behavior during this tracking period was recorded. We also used a spatial buffer methodology to capture the outdoor landmark density and features of the road network in the environments that the participants visited during the tracking period. Results: The patients with AD had outdoor navigation patterns similar to those of the controls when they were accompanied; however, when they were alone, they had significantly fewer outings per day (total outings: P<.001; day outings: P=.003; night outings: P<.001), lower time spent moving per outing (P=.001), lower total distance covered per outing (P=.009), lower walking distance per outing (P=.02), and lower mean distance from home per outing (P=.004). Our results did not identify any mobility risk factors for spatial disorientation. We also found that the environments visited by patients who experienced disorientation versus those who maintained their orientation during the tracking period did not significantly differ in outdoor landmark density (P=.60) or road network structure (road intersection density: P=.43; intersection complexity: P=.45; orientation entropy: P=.89). Conclusions: Our findings suggest that when alone, patients with AD restrict the spatial and temporal extent of their outdoor navigation in the community to successfully reduce their perceived risk of spatial disorientation. Implications of this work highlight the importance for future research to identify which of these individuals may be at an actual high risk for spatial disorientation as well as to explore the implementation of health care measures to help maintain a balance between patients' right to safety and autonomy when making outings alone in the community. ",
doi="10.2196/28222",
url="https://aging.jmir.org/2022/2/e28222",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451965"
}


@Article{info:doi/10.2196/34326,
author="Mao, Alice
and Tam, Lydia
and Xu, Audrey
and Osborn, Kim
and Sheffrin, Meera
and Gould, Christine
and Schillinger, Erika
and Martin, Marina
and Mesias, Matthew",
title="Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment",
journal="JMIR Aging",
year="2022",
month="Apr",
day="19",
volume="5",
number="2",
pages="e34326",
keywords="telemedicine",
keywords="barriers to access to care",
keywords="older adults",
keywords="eHealth",
keywords="e-visit",
keywords="access",
keywords="accessibility",
keywords="barrier",
keywords="elder",
keywords="gerontology",
keywords="geriatric",
keywords="need assessment",
keywords="mixed method",
keywords="cross-sectional",
keywords="telehealth",
keywords="community care",
keywords="independent living",
abstract="Background: Despite the increasing availability of telemedicine video visits during the COVID-19 pandemic, older adults have greater challenges in getting care through telemedicine. Objective: We aim to better understand the barriers to telemedicine in community-dwelling older adults to improve the access to and experience of virtual visits. Methods: We conducted a mixed methods needs assessment of older adults at two independent living facilities (sites A and B) in Northern California between September 2020 and March 2021. Voluntary surveys were distributed. Semistructured interviews were then conducted with participants who provided contact information. Surveys ascertained participants' preferred devices as well as comfort level, support, and top barriers regarding telephonic and video visits. Qualitative analysis of transcribed interviews identified key themes. Results: Survey respondents' (N=249) average age was 84.6 (SD 6.6) years, and 76.7\% (n=191) of the participants were female. At site A, 88.9\% (111/125) had a bachelor's degree or beyond, and 99.2\% (124/125) listed English as their preferred language. At site B, 42.9\% (51/119) had a bachelor's degree or beyond, and 13.4\% (16/119) preferred English, while 73.1\% (87/119) preferred Mandarin. Regarding video visits, 36.5\% (91/249) of all participants felt comfortable connecting with their health care team through video visits. Regarding top barriers, participants at site A reported not knowing how to connect to the platform (30/125, 24\%), not being familiar with the technology (28/125, 22.4\%), and having difficulty hearing (19/125, 15.2\%), whereas for site B, the top barriers were not being able to speak English well (65/119, 54.6\%), lack of familiarity with technology and the internet (44/119, 36.9\%), and lack of interest in seeing providers outside of the clinic (42/119, 35.3\%). Three key themes emerged from the follow-up interviews (n=15): (1) the perceived limitations of video visits, (2) the overwhelming process of learning the technology for telemedicine, and (3) the desire for in-person or on-demand help with telemedicine. Conclusions: Substantial barriers exist for older adults in connecting with their health care team through telemedicine, particularly through video visits. The largest barriers include difficulty with technology or using the video visit platform, hearing difficulty, language barriers, and lack of desire to see providers virtually. Efforts to improve telemedicine access for older adults should take into account patient perspectives. ",
doi="10.2196/34326",
url="https://aging.jmir.org/2022/2/e34326",
url="http://www.ncbi.nlm.nih.gov/pubmed/35438648"
}


@Article{info:doi/10.2196/34577,
author="Parniak, Simone
and DePaul, G. Vincent
and Frymire, Clare
and DePaul, Samuel
and Donnelly, Catherine",
title="Naturally Occurring Retirement Communities: Scoping Review",
journal="JMIR Aging",
year="2022",
month="Apr",
day="14",
volume="5",
number="2",
pages="e34577",
keywords="naturally occurring retirement communities",
keywords="NORC",
keywords="NORC supportive service programs",
keywords="aging in place",
keywords="older adults",
keywords="scoping review",
abstract="Background: As Canada's population ages, there is a need to explore community-based solutions to support older adults. Naturally occurring retirement communities (NORCs), defined in 1986 as buildings or areas not specifically designed for, but which attract, older adults and associated NORC supportive service programs (NORC-SSPs) have been described as potential resources to support aging in place. Though the body of literature on NORCs has been growing since the 1980s, no synthesis of this work has been conducted to date. Objective: The goal of this scoping review is to highlight the current state of NORC literature to inform future research and offer a summarized description of NORCs and how they have supported, and can support, older adults to age in place. Methods: Using a published framework, a scoping review was conducted by searching 13 databases from earliest date of coverage to January 2022. We included English peer- and non--peer-reviewed scholarly journal publications that described, critiqued, reflected on, or researched NORCs. Aging-in-place literature with little to no mention of NORCs was excluded, as were studies that recruited participants from NORCs but did not connect findings to the setting. A qualitative content analysis of the literature was conducted, guided by a conceptual framework, to examine the promise of NORC programs to promote aging in place. Results: From 787 publications, we included 64 (8.1\%) articles. All publications were North American, and nearly half used a descriptive research approach (31/64, 48\%). A little more than half provided a specific definition of a NORC (33/64, 52\%); of these, 13 (39\%) used the 1986 definition; yet, there were discrepancies in the defined proportions of older adults that constitute a NORC (eg, 40\% or 50\%). Of the 64 articles, 6 (9\%) described processes for identifying NORCs and 39 (61\%) specifically described NORC-SSPs and included both external partnerships with organizations for service delivery (33/39, 85\%) and internal resources such as staff, volunteers, or neighbors. Identified key components of a NORC-SSP included activities fostering social relationships (25/64, 39\%) and access to resources and services (26/64, 41\%). Sustainability and funding of NORC-SSPs were described (27/64, 42\%), particularly as challenges to success. Initial outcomes, including self-efficacy (6/64, 9\%) and increased access to social and health supports (14/64, 22\%) were cited; however, long-term outcomes were lacking. Conclusions: This review synthesizes the NORC literature to date and demonstrates that NORC-SSPs have potential as an alternative model of supporting aging in place. Longitudinal research exploring the impacts of both NORCs and NORC-SSPs on older adult health and well-being is recommended. Future research should also explore ways to improve the sustainability of NORC-SSPs. ",
doi="10.2196/34577",
url="https://aging.jmir.org/2022/2/e34577",
url="http://www.ncbi.nlm.nih.gov/pubmed/35436204"
}


@Article{info:doi/10.2196/33165,
author="Ho, Vanda
and Merchant, A. Reshma",
title="The Acceptability of Digital Technology and Tele-Exercise in the Age of COVID-19: Cross-sectional Study",
journal="JMIR Aging",
year="2022",
month="Apr",
day="13",
volume="5",
number="2",
pages="e33165",
keywords="senior",
keywords="telehealth",
keywords="digital exercise",
keywords="acceptability",
keywords="telemedicine",
keywords="elderly",
keywords="older adults",
keywords="outcome",
keywords="isolation",
keywords="decline",
keywords="function",
keywords="adoption",
keywords="perception",
keywords="exercise",
keywords="physical activity",
keywords="questionnaire",
keywords="COVID-19",
abstract="Background: With the COVID-19 pandemic, telehealth has been increasingly used to offset the negative outcomes of social isolation and functional decline in older adults. Crucial to the success of telehealth is end user adoption. Objective: This study aims to investigate perception and acceptability of digital technology among Asian older adults. Methods: The Healthy Ageing Promotion Program for You (HAPPY) dual-task exercise was conducted virtually to participants aged ?60 years. Questionnaires were administered digitally and collected data on demographics, perceptions of digital technology and evaluation of HAPPY, the 6-item Lubben Social Network Scale, intrinsic capacity using the Integrated Care for Older People tool, and a functional screening with the FRAIL scale and five chair rises. Descriptive analysis was used. Results: A total of 42 participants were digitally interviewed. The mean age was 69.1 (4.7) years. Hearing, vision, and 3-item recall difficulty were present in 14\% (n=6), 12\% (n=5), and 24\% (n=10) of participants, respectively. Of the participants, 29\% (n=12) had possible sarcopenia and 14\% (n=6) were prefrail. Around 24\% (n=10) were at risk of social isolation. Most of the participants (n=38, 91\%) agreed that technology is good, and 79\% (n=33) agreed that technology would allow them to be independent for longer. Over three-quarters of participants (n=33, 79\%) agreed that they have the necessary knowledge, and 91\% (n=38) had technological assistance available. However, 57\% (n=24) were still apprehensive about using technology. Despite 71\% (n=30) of older adults owning their devices, 36\% (n=15) felt finances were limiting. Through digital HAPPY, 45\% (n=19) of participants reported feeling stronger, 48\% (n=20) had improved spirits, and 40\% (n=17) and 38\% (n=16) had improved mood and memory, respectively. Conclusions: The majority of older adults in this study believed in digital technology and had the necessary knowledge and help, but almost half still felt apprehensive and had financial barriers to adopting technology. A digitally administered exercise program especially in a group setting is a feasible option to enhance intrinsic capacity in older adults. However, more work is needed in elucidating sources of apprehension and financial barriers to adopting technology. ",
doi="10.2196/33165",
url="https://aging.jmir.org/2022/2/e33165",
url="http://www.ncbi.nlm.nih.gov/pubmed/35294921"
}


@Article{info:doi/10.2196/28260,
author="Shahid, Khais Zahraa
and Saguna, Saguna
and {\AA}hlund, Christer",
title="Detecting Anomalies in Daily Activity Routines of Older Persons in Single Resident Smart Homes: Proof-of-Concept Study",
journal="JMIR Aging",
year="2022",
month="Apr",
day="11",
volume="5",
number="2",
pages="e28260",
keywords="Activities of daily living",
keywords="smart homes",
keywords="elderly care",
keywords="anomaly detection",
keywords="IoT devices",
keywords="smart device",
keywords="elderly",
keywords="sensors",
keywords="digital sensors",
keywords="Internet of things",
abstract="Background: One of the main challenges of health monitoring systems is the support of older persons in living independently in their homes and with relatives. Smart homes equipped with internet of things devices can allow older persons to live longer in their homes. Previous surveys used to identify sensor-based data sets in human activity recognition systems have been limited by the use of public data set characteristics, data collected in a controlled environment, and a limited number of older participants. Objective: The objective of our study is to build a model that can learn the daily routines of older persons, detect deviations in daily living behavior, and notify these anomalies in near real-time to relatives. Methods: We extracted features from large-scale sensor data by calculating the time duration and frequency of visits. Anomalies were detected using a parametric statistical approach, unusually short or long durations being detected by estimating the mean ($\mu$) and standard deviation ($\sigma$) over hourly time windows (80 to 355 days) for different apartments. The confidence level is at least 75\% of the tested values within two ($\sigma$) from the mean. An anomaly was triggered where the actual duration was outside the limits of 2 standard deviations ($\mu$?2$\sigma$, $\mu$+2$\sigma$), activity nonoccurrence, or absence of activity. Results: The patterns detected from sensor data matched the routines self-reported by users. Our system observed approximately 1000 meals and bathroom activities and notifications sent to 9 apartments between July and August 2020. A service evaluation of received notifications showed a positive user experience, an average score of 4 being received on a 1 to 5 Likert-like scale. One was poor, two fair, three good, four very good, and five excellent. Our approach considered more than 75\% of the observed meal activities were normal. This figure, in reality, was 93\%, normal observed meal activities of all participants falling within 2 standard deviations of the mean. Conclusions: In this research, we developed, implemented, and evaluated a real-time monitoring system of older participants in an uncontrolled environment, with off-the-shelf sensors and internet of things devices being used in the homes of older persons. We also developed an SMS-based notification service and conducted user evaluations. This service acts as an extension of the health/social care services operated by the municipality of Skellefte{\aa} provided to older persons and relatives. ",
doi="10.2196/28260",
url="https://aging.jmir.org/2022/2/e28260",
url="http://www.ncbi.nlm.nih.gov/pubmed/35404260"
}


@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/10.2196/19641,
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/10.2196/35221,
author="Yu, Ellie
and Hagens, Simon",
title="Socioeconomic Disparities in the Demand for and Use of Virtual Visits Among Senior Adults During the COVID-19 Pandemic: Cross-sectional Study",
journal="JMIR Aging",
year="2022",
month="Mar",
day="22",
volume="5",
number="1",
pages="e35221",
keywords="virtual care",
keywords="virtual visit",
keywords="COVID-19",
keywords="survey",
keywords="virtual care demand",
keywords="virtual care use",
keywords="older adults",
keywords="elderly care",
keywords="aging",
keywords="digital health",
keywords="pandemic",
abstract="Background: The COVID-19 pandemic has limited the provision of in-person care and accelerated the need for virtual care. Older adults (65+ years) were 1 of the highest user groups of in-person health care services prior to the pandemic. Social distancing guidelines and high rates of mortality from coronavirus infections among older adults made receiving in-person health care services challenging for older adults. The provision of virtual care technologies can help to ensure continuity of care and provide essential health care services during the pandemic to those at high risk of contracting the COVID-19 coronavirus, including older adults. It is also essential to understand and address potential socioeconomic, demographic, and health disparities in the demand for and use of virtual care technologies among older adults. Objective: The objective of this study is to investigate socioeconomic disparities in the demand for and use of virtual visits during the COVID-19 pandemic among older adults in Canada. Methods: A cross-sectional web survey was conducted with 12,052 Canadians over the age of 16 years, selected from Leger's L{\'e}ger Opinion panel from July 14 to August 6, 2021. Associations between socioeconomic factors and the demand for and use of virtual visits were tested using $\chi$2 tests and logistic regression models for telephone visits, video visits, and secure messaging. Weighting was applied using the 2016 census reference variables to render a representative sample of the Canadian population. Results: A total of 2303 older adults were surveyed. Older adults expressed the highest demand for and use of telephone visits, following by video visits and secure messaging. eHealth literacy was positively associated with the use of all 3 virtual care modalities. Higher income was negatively associated with the use of video visits (odds ratio [OR] 0.65, 95\% CI 0.428-0.974, P=.03). Having no private insurance coverage was negatively associated with use of secure messaging (OR 0.73, 95\% CI 0.539-0.983, P=.04), but living in a rural community (OR 0.172, 95\% CI 1.12-2.645, P=.01) and being born outside of Canada (OR 0.150, 95\% CI 1.041-2.173, P=.03) were positively associated with the use of secure messaging. Higher education (OR 0.078, 95\% CI 0.633-0.97, P=.02) and being non-White (OR=0.054, 95\% CI 0.312-0.92, P=.02) were negatively associated with the use of the telephone. Conclusions: This study found that compared to video visits and secure messaging, the demand for and use of telephone visits were more prevalent among older adults during the pandemic. The gaps between the demand for and use of video and secure messaging services remain substantial. Our results highlight socioeconomic disparities among older adults that could potentially explain this trend. Lower income and a lower education level may act as barriers for older adults in acquiring the skills and technologies necessary to use more complex solutions, such as video and secure messaging. In addition, higher eHealth literacy was found to be critical for older adults to successfully navigate all types of virtual visit technologies. ",
doi="10.2196/35221",
url="https://aging.jmir.org/2022/1/e35221",
url="http://www.ncbi.nlm.nih.gov/pubmed/35134746"
}


@Article{info:doi/10.2196/31552,
author="Albers, A. Elizabeth
and Mikal, Jude
and Millenbah, Ashley
and Finlay, Jessica
and Jutkowitz, Eric
and Mitchell, Lauren
and Horn, Brenna
and Gaugler, E. Joseph",
title="The Use of Technology Among Persons With Memory Concerns and Their Caregivers in the United States During the COVID-19 Pandemic: Qualitative Study",
journal="JMIR Aging",
year="2022",
month="Mar",
day="17",
volume="5",
number="1",
pages="e31552",
keywords="social isolation",
keywords="dementia",
keywords="caregiving - informal",
keywords="aging in place",
keywords="caregivers",
keywords="aging",
keywords="elderly",
keywords="pandemic",
keywords="COVID-19",
keywords="mental health",
keywords="technology use",
keywords="health technology",
abstract="Background: Stay-at-home orders and other public health measures designed to mitigate the spread of COVID-19 have increased isolation among persons with memory concerns (PWMCs: individuals diagnosed with cognitive impairment or Alzheimer disease or related dementias). The pandemic has also exacerbated challenges for family members who care for PWMCs. Although technology has demonstrated the potential to improve the social connections and mental health of PWMCs and their family caregivers (CGs), previous research shows that older adults may be reluctant to adopt new technologies. Objective: We aimed to understand why and how some PWMCs and their CGs altered their use of mainstream technology, such as smartphones and fitness trackers, and assistive technology to adapt to lifestyle changes (eg, increased isolation) during the COVID-19 pandemic. Methods: Using data collected in 20 qualitative interviews from June to August 2020 with 20 PWMCs and family CG dyads, we assessed changes in and barriers to everyday technology use following the implementation of COVID-19 mitigation strategies in the United States. Zoom videoconferencing was utilized to conduct the interviews to protect the health of the participants who were primarily older adults. Results: Using qualitative thematic analysis, we identified 3 themes that explained motivations for using technology during a pandemic: (1) maintaining social connections, (2) alleviating boredom, and (3) increasing CG respite. Results further revealed lingering barriers to PWMC and CG adoption of technologies, including: (1) PWMC dependence upon CGs, (2) low technological literacy, and (3) limitations of existing technology. Conclusions: This in-depth investigation suggests that technology can provide PWMCs with more independence and offer CGs relief from CG burden during periods of prolonged isolation. ",
doi="10.2196/31552",
url="https://aging.jmir.org/2022/1/e31552",
url="http://www.ncbi.nlm.nih.gov/pubmed/35134748"
}


@Article{info:doi/10.2196/32957,
author="Kim, Sunyoung
and Yao, Willow
and Du, Xiaotong",
title="Exploring Older Adults' Adoption and Use of a Tablet Computer During COVID-19: Longitudinal Qualitative Study",
journal="JMIR Aging",
year="2022",
month="Mar",
day="8",
volume="5",
number="1",
pages="e32957",
keywords="older adults",
keywords="tablet computer",
keywords="technology acceptance",
keywords="mental model",
keywords="longitudinal study",
keywords="COVID-19",
abstract="Background: As mobile computing technology evolves, such as smartphones and tablet computers, it increasingly offers features that may be particularly beneficial to older adults. However, the digital divide exists, and many older adults have been shown to have difficulty using these devices. The COVID-19 pandemic has magnified how much older adults need but are excluded from having access to technologies to meet essential daily needs and overcome physical distancing restrictions. Objective: This study sought to understand how older adults who had never used a tablet computer learn to use it, what they want to use it for, and what barriers they experience as they continue to use it during social isolation caused by the COVID-19 pandemic. Methods: We conducted a series of semistructured interviews with eight people aged 65 years and older for 16 weeks, investigating older novice users' adoption and use of a tablet computer during the nationwide lockdown due to COVID-19. Results: Participants were gradually yet successfully accustomed to using a tablet computer to serve various daily needs, including entertainment, social connectedness, and information-seeking. However, this success was not achieved through developing sufficient digital skills but rather by applying the methods they were already familiar with in its operation, such as taking and referring to instruction notes. Conclusions: Our findings imply that older adults without digital literacy can still benefit from a digital device for quality of later life if proper traditional methods they are already familiar with are offered in its use. ",
doi="10.2196/32957",
url="https://aging.jmir.org/2022/1/e32957",
url="http://www.ncbi.nlm.nih.gov/pubmed/35134747"
}


@Article{info:doi/10.2196/28333,
author="Ferrario, Andrea
and Luo, Minxia
and Polsinelli, J. Angelina
and Moseley, A. Suzanne
and Mehl, R. Matthias
and Yordanova, Kristina
and Martin, Mike
and Demiray, Burcu",
title="Predicting Working Memory in Healthy Older Adults Using Real-Life Language and Social Context Information: A Machine Learning Approach",
journal="JMIR Aging",
year="2022",
month="Mar",
day="8",
volume="5",
number="1",
pages="e28333",
keywords="cognitive aging",
keywords="language complexity",
keywords="social context",
keywords="machine learning",
keywords="natural language processing",
keywords="Electronically Activated Recorder (EAR)",
keywords="behavioral indicators",
abstract="Background: Language use and social interactions have demonstrated a close relationship with cognitive measures. It is important to improve the understanding of language use and behavioral indicators from social context to study the early prediction of cognitive decline among healthy populations of older adults. Objective: This study aimed at predicting an important cognitive ability, working memory, of 98 healthy older adults participating in a 4-day-long naturalistic observation study. We used linguistic measures, part-of-speech (POS) tags, and social context information extracted from 7450 real-life audio recordings of their everyday conversations. Methods: The methods in this study comprise (1) the generation of linguistic measures, representing idea density, vocabulary richness, and grammatical complexity, as well as POS tags with natural language processing (NLP) from the transcripts of real-life conversations and (2) the training of machine learning models to predict working memory using linguistic measures, POS tags, and social context information. We measured working memory using (1) the Keep Track test, (2) the Consonant Updating test, and (3) a composite score based on the Keep Track and Consonant Updating tests. We trained machine learning models using random forest, extreme gradient boosting, and light gradient boosting machine algorithms, implementing repeated cross-validation with different numbers of folds and repeats and recursive feature elimination to avoid overfitting. Results: For all three prediction routines, models comprising linguistic measures, POS tags, and social context information improved the baseline performance on the validation folds. The best model for the Keep Track prediction routine comprised linguistic measures, POS tags, and social context variables. The best models for prediction of the Consonant Updating score and the composite working memory score comprised POS tags only. Conclusions: The results suggest that machine learning and NLP may support the prediction of working memory using, in particular, linguistic measures and social context information extracted from the everyday conversations of healthy older adults. Our findings may support the design of an early warning system to be used in longitudinal studies that collects cognitive ability scores and records real-life conversations unobtrusively. This system may support the timely detection of early cognitive decline. In particular, the use of a privacy-sensitive passive monitoring technology would allow for the design of a program of interventions to enable strategies and treatments to decrease or avoid early cognitive decline. ",
doi="10.2196/28333",
url="https://aging.jmir.org/2022/1/e28333",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258457"
}


@Article{info:doi/10.2196/34221,
author="Thangavel, Gomathi
and Memedi, Mevludin
and Hedstr{\"o}m, Karin",
title="Customized Information and Communication Technology for Reducing Social Isolation and Loneliness Among Older Adults: Scoping Review",
journal="JMIR Ment Health",
year="2022",
month="Mar",
day="7",
volume="9",
number="3",
pages="e34221",
keywords="social isolation",
keywords="loneliness",
keywords="review",
keywords="ICT",
keywords="older adults",
keywords="customization",
keywords="mobile phone",
abstract="Background: Advancements in science and various technologies have resulted in people having access to better health care, a good quality of life, and better economic situations, enabling humans to live longer than ever before. Research shows that the problems of loneliness and social isolation are common among older adults, affecting psychological and physical health. Information and communication technology (ICT) plays an important role in alleviating social isolation and loneliness. Objective: The aim of this review is to explore ICT solutions for reducing social isolation or loneliness among older adults, the purpose of ICT solutions, and the evaluation focus of these solutions. This study particularly focuses on customized ICT solutions that either are designed from scratch or are modifications of existing off-the-shelf products that cater to the needs of older adults. Methods: A scoping literature review was conducted. A search across 7 databases, including ScienceDirect, Association for Computing Machinery, PubMed, IEEE Xplore, PsycINFO, Scopus, and Web of Science, was performed, targeting ICT solutions for reducing and managing social isolation and loneliness among older adults. Articles published in English from 2010 to 2020 were extracted and analyzed. Results: From the review of 39 articles, we identified 5 different purposes of customized ICT solutions focusing on reducing social isolation and loneliness. These were social communication, social participation, a sense of belonging, companionship, and feelings of being seen. The mapping of purposes of ICT solutions with problems found among older adults indicates that increasing social communication and social participation can help reduce social isolation problems, whereas fulfilling emotional relationships and feeling valued can reduce feelings of loneliness. In terms of customized ICT solution types, we found the following seven different categories: social network, messaging services, video chat, virtual spaces or classrooms with messaging capabilities, robotics, games, and content creation and management. Most of the included studies (30/39, 77\%) evaluated the usability and acceptance aspects, and few studies (11/39, 28\%) focused on loneliness or social isolation outcomes. Conclusions: This review highlights the importance of discussing and managing social isolation and loneliness as different but related concepts and emphasizes the need for future research to use suitable outcome measures for evaluating ICT solutions based on the problem. Even though a wide range of customized ICT solutions have been developed, future studies need to explore the recent emerging technologies, such as the Internet of Things and augmented or virtual reality, to tackle social isolation and loneliness among older adults. Furthermore, future studies should consider evaluating social isolation or loneliness while developing customized ICT solutions to provide more robust data on the effectiveness of the solutions. ",
doi="10.2196/34221",
url="https://mental.jmir.org/2022/3/e34221",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254273"
}


@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/10.2196/29224,
author="Koh, Qi Wei
and Whelan, Sally
and Heins, Pascale
and Casey, Dympna
and Toomey, Elaine
and Dr{\"o}es, Rose-Marie",
title="The Usability and Impact of a Low-Cost Pet Robot for Older Adults and People With Dementia: Qualitative Content Analysis of User Experiences and Perceptions on Consumer Websites",
journal="JMIR Aging",
year="2022",
month="Feb",
day="22",
volume="5",
number="1",
pages="e29224",
keywords="social robot",
keywords="pet robots",
keywords="low-cost robot",
keywords="dementia",
keywords="older adults",
keywords="qualitative research",
keywords="qualitative content analysis",
abstract="Background: Worldwide, populations are aging exponentially. Older adults and people with dementia are especially at risk of social isolation and loneliness. Social robots, including robotic pets, have had positive impacts on older adults and people with dementia by providing companionship, improving mood, reducing agitation, and facilitating social interaction. Nevertheless, the issue of affordability can hinder technology access. The Joy for All (JfA) robotic pets have showed promise as examples of low-cost alternatives. However, there has been no research that investigated the usability and impact of such low-cost robotic pets based on perceptions and experiences of its use with older adults and people with dementia. Objective: The aim of our study was to explore the usability and impact of the JfA robotic cat, as an example of a low-cost robot, based on perceptions and experiences of using the JfA cat for older adults and people with dementia. Methods: We used a novel methodology of analyzing a large volume of information that was uploaded by reviewers of the JfA cat onto online consumer review sites. Data were collected from 15 consumer websites. This provided a total of 2445 reviews. Next, all reviews were screened. A total of 1327 reviews that contained information about use of the JfA cat for older adults or people with dementia were included for analysis. These were reviews that contained terms relating to ``older adults,'' ``dementia,'' and ``institutional care'' and were published in the English language. Descriptive statistics was used to characterize available demographic information, and textual data were qualitatively analyzed using inductive content analysis. Results: Most reviews were derived from consumer sites in the United States, and most reviewers were family members of users (ie, older adults and people with dementia). Based on the qualitative content analysis, 5 key themes were generated: prior expectations, perceptions, meaningful activities, impacts, and practicalities. Reviewers had prior expectations of the JfA cat, which included circumstantial reasons that prompted them to purchase this technology. Their perceptions evolved after using the technology, where most reported positive perceptions about their appearance and interactivity. The use of the robot provided opportunities for users to care for it and incorporate it into their routine. Finally, reviewers also shared information about the impacts of device and practicalities related to its use. Conclusions: This study provides useful knowledge about the usability and impact of a low-cost pet robot, based on experiences and perceptions of its use. These findings can help researchers, robot developers, and clinicians understand the viability of using low-cost robotic pets to benefit older adults and people with dementia. Future research should consider evaluating design preferences for robotic pets, and compare the effects of low-cost robotic pets with other more technologically advanced robotic pets. ",
doi="10.2196/29224",
url="https://aging.jmir.org/2022/1/e29224",
url="http://www.ncbi.nlm.nih.gov/pubmed/35191844"
}


@Article{info:doi/10.2196/29541,
author="Garcia, P. Angely
and De La Vega, F. Shelley
and Mercado, P. Susan",
title="Health Information Systems for Older Persons in Select Government Tertiary Hospitals and Health Centers in the Philippines: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="14",
volume="24",
number="2",
pages="e29541",
keywords="health information systems",
keywords="the Philippines",
keywords="aged",
keywords="hospitals",
keywords="community health centers",
keywords="database",
keywords="geriatric assessment",
keywords="elderly",
keywords="digital health",
keywords="medical records",
keywords="health policy",
abstract="Background: The rapid aging of the world's population requires systems that support health facilities' provision of integrated care at multiple levels of the health care system. The use of health information systems (HISs) at the point of care has shown positive effects on clinical processes and patient health in several settings of care. Objective: We sought to describe HISs for older persons (OPs) in select government tertiary hospitals and health centers in the Philippines. Specifically, we aimed to review the existing policies and guidelines related to HISs for OPs in the country, determine the proportion of select government hospitals and health centers with existing health information specific for OPs, and describe the challenges related to HISs in select health facilities. Methods: We utilized the data derived from the findings of the Focused Interventions for Frail Older Adults Research and Development Project (FITforFrail), a cross-sectional and ethics committee--approved study. A facility-based listing of services and human resources specific to geriatric patients was conducted in purposively sampled 27 tertiary government hospitals identified as geriatric centers and 16 health centers across all regions in the Philippines. We also reviewed the existing policies and guidelines related to HISs for OPs in the country. Results: Based on the existing guidelines, multiple agencies were involved in the provision of services for OPs, with several records containing health information of OPs. However, there is no existing HIS specific for OPs in the country. Only 14 (52\%) of the 27 hospitals and 4 (25\%) of the 16 health centers conduct comprehensive geriatric assessment (CGA). All tertiary hospitals and health centers are able to maintain medical records of their patients, and almost all (26/27, 96\%) hospitals and all (16/16, 100\%) health centers have data on top causes of morbidity and mortality. Meanwhile, the presence of specific disease registries varied per hospitals and health centers. Challenges to HISs include the inability to update databases due to inadequately trained personnel, use of an offline facility--based HIS, an unstable internet connection, and technical issues and nonuniform reporting of categories for age group classification. Conclusions: Current HISs for OPs are characterized by fragmentation, multiple sources, and inaccessibility. Barriers to achieving appropriate HISs for OPs include the inability to update HISs in hospitals and health centers and a lack of standardization by age group and disease classification. Thus, we recommend a 1-person, 1-record electronic medical record system for OPs and the disaggregation and analysis across demographic and socioeconomic parameters to inform policies and programs that address the complex needs of OPs. CGA as a required routine procedure for all OPs and its integration with the existing HISs in the country are also recommended. ",
doi="10.2196/29541",
url="https://www.jmir.org/2022/2/e29541",
url="http://www.ncbi.nlm.nih.gov/pubmed/35156927"
}


@Article{info:doi/10.2196/27355,
author="Hu, Lu
and Trinh-Shevrin, Chau
and Islam, Nadia
and Wu, Bei
and Cao, Shimin
and Freeman, Jincong
and Sevick, Ann Mary",
title="Mobile Device Ownership, Current Use, and Interest in Mobile Health Interventions Among Low-Income Older Chinese Immigrants With Type 2 Diabetes: Cross-sectional Survey Study",
journal="JMIR Aging",
year="2022",
month="Feb",
day="2",
volume="5",
number="1",
pages="e27355",
keywords="technology use",
keywords="Chinese immigrants",
keywords="type 2 diabetes",
keywords="mHealth",
keywords="health disparities",
keywords="immigrant health",
keywords="diabetes",
keywords="mobile health",
keywords="intervention",
keywords="smartphone",
keywords="immigrant",
abstract="Background: Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D. Objective: This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D. Methods: In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant's preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use. Results: The sample (N=91) was predominantly female (n=57, 63\%), married (n=68, 75\%), and had a high school education or less (n=58, 64\%); most participants had an annual household income of less than US \$25,000 (n=63, 69\%) and had limited English proficiency (n=78, 86\%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99\%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91\%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71\%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69\%) reported health care providers, followed by 13 who reported the internet (14\%), and 10 who reported family, friends, and coworkers (11\%). Less than one-quarter (21/91, 23\%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37\%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76\%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management. Conclusions: Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group. ",
doi="10.2196/27355",
url="https://aging.jmir.org/2022/1/e27355",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107426"
}


@Article{info:doi/10.2196/15413,
author="Egan, J. Kieren
and Clark, Patricia
and Deen, Zahid
and Paputa Dutu, Carmen
and Wilson, Graham
and McCann, Lisa
and Lennon, Marilyn
and Maguire, Roma",
title="Understanding Current Needs and Future Expectations of Informal Caregivers for Technology to Support Health and Well-being: National Survey Study",
journal="JMIR Aging",
year="2022",
month="Jan",
day="27",
volume="5",
number="1",
pages="e15413",
keywords="caregiving",
keywords="technology",
keywords="health",
keywords="well-being",
keywords="digital health",
keywords="co-design",
keywords="mobile phone",
abstract="Background: There are approximately 6.5 million informal (unpaid) caregivers in the United Kingdom. Each caregiver plays a critical role in the society, supporting the health and well-being of those who are ill, disabled, or older and who need frequent support. Digital technologies are becoming a ubiquitous part of everyday life for many, but little is known about the real-world impact of technology for those in a caring role, including the abilities of technologies to address the mental and physical impacts of caregiving. Objective: This study aims to understand the current and future technology use of caregivers, including digital technologies used to care for themselves and the person they look after. Methods: We codeveloped a wide range of questions with caregivers and care professionals and delivered this survey both on the web and in paper format (eg, using social networks such as Twitter alongside in-person events). Questions were focused on providing care and looking after caregiver health and well-being. Analyses focused on both quantitative outcomes (frequency counts and Likert questions) and explored free text entries (thematic analysis). Results: From 356 respondents, we identified that caregivers were receptive to, and largely positive about current and future use of technology both for their own care and their caring role (eg, checking in from distance). There were notable concerns, including the risk that technology could replace human contact. We identified several key areas for future work, including communication with health and social care professionals, and the potential for technology to help caregivers with their own health. We also identified several stakeholders (eg, care workers, pharmacy staff, and general practitioners) who could act as suitable points for technology signposting and support. Conclusions: Caregivers are a transient, often difficult to reach population, and this work has collated a large body of knowledge across a diverse group of individuals. Many caregivers, like the rest of society, are realizing the benefits of using everyday technology to help deliver care. It is clear that there is already a high level of dependency on technologies, where future expectations will grow. However, many barriers to digital technology use remain, including a lack of ongoing technology support. Preventive measures linked to technology that can help look after a caregiver's own health appear acceptable, particularly for communicative tools. This collated caregiver knowledge is a call for all stakeholders---academics, policy makers, and practitioners---to take note of these specific challenges, and to ensure that caregiver voices are both heard and fully integrated within the emerging digital health agenda. ",
doi="10.2196/15413",
url="https://aging.jmir.org/2022/1/e15413",
url="http://www.ncbi.nlm.nih.gov/pubmed/35084339"
}


@Article{info:doi/10.2196/26652,
author="Domingos, C{\'e}lia
and Costa, Patr{\'i}cio
and Santos, Correia Nadine
and P{\^e}go, Miguel Jos{\'e}",
title="Usability, Acceptability, and Satisfaction of a Wearable Activity Tracker in Older Adults: Observational Study in a Real-Life Context in Northern Portugal",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="26",
volume="24",
number="1",
pages="e26652",
keywords="user experience",
keywords="Technology Acceptance Model",
keywords="health monitoring",
keywords="fitness trackers",
keywords="aging",
keywords="seniors",
abstract="Background: The use of activity trackers has significantly increased over the last few years. This technology has the potential to improve the levels of physical activity and health-related behaviors in older adults. However, despite the potential benefits, the rate of adoption remains low among older adults. Therefore, understanding how technology is perceived may potentially offer insight to promote its use. Objective: This study aimed to (1) assess acceptability, usability, and user satisfaction with the Xiaomi Mi Band 2 in Portuguese community-dwelling older adults in a real-world context; (2) explore the mediating effect of the usability on the relationship between user characteristics and satisfaction; and (3) examine the moderating effect of user characteristics on the relationship between usability and user satisfaction. Methods: Older adults used the Xiaomi Mi Band 2 over 15 days. The user experience was evaluated through the Technology Acceptance Model 3, System Usability Scale, and User Satisfaction Evaluation Questionnaire. An integrated framework for usability and user satisfaction was used to explore user experience. Statistical data analysis included descriptive data analysis, reliability analysis, confirmatory factor analysis, and mediation and moderation analyses. Results: A sample of 110 older adults with an average age of 68.41 years (SD 3.11) completed the user experience questionnaires. Mean user acceptance was very high---perceived ease of use: 6.45 (SD 0.78); perceptions of external control: 6.74 (SD 0.55); computer anxiety: 6.85 (SD 0.47); and behavioral intention: 6.60 (SD 0.97). The usability was excellent with an average score of 92.70 (SD 10.73), and user satisfaction was classified as a good experience 23.30 (SD 2.40). The mediation analysis confirmed the direct positive effect of usability on satisfaction ($\beta$=.530; P<.01) and the direct negative effect of depression on usability ($\beta$=--.369; P<.01). Lastly, the indirect effect of usability on user satisfaction was higher in individuals with lower Geriatric Depression Scale levels. Conclusions: Findings demonstrate that the Xiaomi Mi Band 2 is suitable for older adults. Furthermore, the results confirmed usability as a determinant of satisfaction with the technology and extended the existing knowledge about wearable activity trackers in older adults. ",
doi="10.2196/26652",
url="https://www.jmir.org/2022/1/e26652",
url="http://www.ncbi.nlm.nih.gov/pubmed/35080503"
}


@Article{info:doi/10.2196/25760,
author="Yu, Xinyue
and Mu, Aruhan
and Wu, Xiang
and Zhou, Liqin",
title="Impact of Internet Use on Cognitive Decline in Middle-Aged and Older Adults in China: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="24",
volume="24",
number="1",
pages="e25760",
keywords="internet use",
keywords="cognitive decline",
keywords="China",
keywords="fixed-effects analysis",
abstract="Background: Given that cognitive decline lacks effective treatment options and has severe implications for healthy aging, internet use may achieve nonpharmacological relief of cognitive decline through cognitive stimulation and social engagement. Objective: This longitudinal study aimed to investigate the relationship between the diversity, frequency, and type of internet use and cognitive decline, and to provide theoretical support and suggestions for mitigating cognitive decline in middle-aged and older adults. Methods: Data were obtained from a total of 10,532 survey respondents from the China Family Panel Studies database from wave 3 (2014) and wave 5 (2018) of the survey. Cognitive function was measured using vocabulary tests, and internet use was categorized into five aspects: study, work, socializing, entertainment, and commercial-related activities. Associations between the diversity, frequency, and type of internet use and cognitive decline were estimated by controlling for demographic variables and health status risk factors through fixed-effects models. Results: After controlling for demographic and health status risk factors, the type and frequency of internet use were found to be associated with cognitive functioning during the subsequent 4-year period, and different types of internet use had different effects on cognitive decline. Frequency of internet use of at least once a week for study ($\beta$=0.620, 95\% CI 0.061 to 1.180; P=.04), work ($\beta$=0.896, 95\% CI 0.271 to 1.520; P=.01), and entertainment ($\beta$=0.385, 95\% CI --0.008 to 0.778; P=.06), as well as less than once a week for social purposes ($\beta$=0.860, 95\% CI 0.074 to 1.650; P=.06), were associated with better cognitive function. Frequency of internet use of less than once a week for commercial-related activities ($\beta$=--0.906, 95\% CI --1.480 to --0.337; P=.005) was associated with poorer cognitive function. Using the internet for more than one type of activity ($\beta$=0.458, 95\% CI 0.065 to 0.850; P=.03) and at least once a week ($\beta$=0.436, 95\% CI 0.066 to 0.806; P=.02) was associated with better cognitive function. Conclusions: This study shows that breadth and depth of internet use are positively associated with cognitive function and that different types of internet use have different roles in cognitive decline. The importance of the internet as a nonpharmacological intervention pathway for cognitive decline is emphasized. Future research could explore specific mechanisms of influence. ",
doi="10.2196/25760",
url="https://www.jmir.org/2022/1/e25760",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072642"
}


@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/10.2196/29987,
author="Mu{\~n}oz, John
and Mehrabi, Samira
and Li, Yirou
and Basharat, Aysha
and Middleton, E. Laura
and Cao, Shi
and Barnett-Cowan, Michael
and Boger, Jennifer",
title="Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic",
journal="JMIR Serious Games",
year="2022",
month="Jan",
day="19",
volume="10",
number="1",
pages="e29987",
keywords="virtual reality",
keywords="exergames",
keywords="persons living with dementia",
keywords="physical activity",
keywords="head mounted displays",
keywords="participatory design",
keywords="co-development",
keywords="gaming",
keywords="older adults",
keywords="elderly",
keywords="design",
keywords="dementia",
keywords="VR",
keywords="user-centered",
keywords="exercise",
keywords="COVID-19",
abstract="Background: Advancements in supporting personalized health care and well-being using virtual reality (VR) have created opportunities to use immersive games to support a healthy lifestyle for persons living with dementia and mild cognitive impairment (MCI). Collaboratively designing exercise video games (exergames) as a multistakeholder team is fundamental to creating games that are attractive, effective, and accessible. Objective: This research extensively explores the use of human-centered design methods that involve persons living with dementia in long-term care facilitates, exercise professionals, content developers, game designers, and researchers in the creation of VR exergames targeting physical activity promotion for persons living with dementia/MCI. Methods: Conceptualization, collaborative design, and playtesting activities were carried out to design VR exergames to engage persons living with dementia in exercises to promote upper limb flexibility, strength, and aerobic endurance. We involved a total of 7 persons living with dementia/MCI, 5 exercise professionals, 5 community-dwelling older adults, a VR company for content creation, and a multidisciplinary research team with game designers, engineers, and kinesiology experts. Results: An immersive VR exergame called Seas the Day was jointly designed and developed and it is freely available to be played in state-of-the-art VR headsets (Oculus Quest 1, 2). A model for the triadic interaction (health care institution, industry partner, academia) is also presented to illustrate how different stakeholders contribute to the design of VR exergames that consider/complement complex needs, preferences, and motivators of an underrepresented group of end users. Conclusions: This study provides evidence that a collaborative multistakeholder design results in more tailored and context-aware VR games for persons living with dementia. The insights and lessons learned from this research can be used by others to co-design games, including remote engagement techniques that were used during the COVID-19 pandemic. ",
doi="10.2196/29987",
url="https://games.jmir.org/2022/1/e29987",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044320"
}


@Article{info:doi/10.2196/33118,
author="Wu, Xi Vivien
and Dong, Yanhong
and Tan, Choo Poh
and Gan, Peiying
and Zhang, Di
and Chi, Yuchen
and Chao, Ting Felicia Fang
and Lu, Jinhua
and Teo, Dennis Boon Heng
and Tan, Qian Yue",
title="Development of a Community-Based e-Health Program for Older Adults With Chronic Diseases: Pilot Pre-Post Study",
journal="JMIR Aging",
year="2022",
month="Jan",
day="17",
volume="5",
number="1",
pages="e33118",
keywords="eHealth",
keywords="self-management",
keywords="older adults",
keywords="chronic disease",
keywords="community care",
keywords="elderly",
keywords="community",
keywords="innovation",
keywords="development",
keywords="pilot",
keywords="evaluation",
keywords="health literacy",
keywords="empowerment",
keywords="feasibility",
keywords="engagement",
abstract="Background: Chronic diseases may impact older adults' health outcomes, health care costs, and quality of life. Self-management is expected to encourage individuals to make autonomous decisions, adhere to treatment plans, deal with emotional and social consequences, and provide choices for healthy lifestyle. New eHealth solutions significantly increase the health literacy and empower patients in self-management of chronic conditions. Objective: This study aims to develop a Community-Based e-Health Program (CeHP) for older adults with chronic diseases and conduct a pilot evaluation. Methods: A pilot study with a 2-group pre- and posttest repeated measures design was adopted. Community-dwelling older adults with chronic diseases were recruited from senior activity centers in Singapore. A systematic 3-step process of developing CeHP was coupled with a smart-device application. The development of the CeHP intervention consists of theoretical framework, client-centric participatory action research process, content validity assessment, and pilot testing. Self-reported survey questionnaires and health outcomes were measured before and after the CeHP. The instruments used were the Self-care of Chronic Illness Inventory (SCCII), Healthy Aging Instrument (HAI), Short-Form Health Literacy Scale, 12 Items (HLS-SF 12), Patient Empowerment Scale (PES), and Social Support Questionnaire, 6 items. The following health outcomes were measured: Montreal Cognitive Assessment, Symbol Digit Modalities Test, total cholesterol (TC), high-density lipoproteins, low-density lipoproteins/very-low-density lipoproteins (LDL/VLDL), fasting glucose, glycated hemoglobin (HbA1c), and BMI. Results: The CeHP consists of health education, monitoring, and an advisory system for older adults to manage their chronic conditions. It is an 8-week intensive program, including face-to-face and eHealth (Care4Senior App) sessions. Care4Senior App covers health education topics focusing on the management of hypertension, hyperlipidemia, and diabetes, brain health, healthy diet, lifestyle modification, medication adherence, exercise, and mindfulness practice. Content validity assessment indicated that the content of the CeHP is valid, with a content validity index (CVI) ranging 0.86-1 and a scale-CVI of 1. Eight participants in the CeHP group and 4 in the control group completed both baseline and post intervention assessments. Participants in the CeHP group showed improvements in fasting glucose, HbA1c, TC, LDL/VLDL, BMI, SCCII indices (Maintenance, Monitoring, and Management), HAI, and PES scores post intervention, although these changes were not significant. For the participants in the control group, the scores for SCCII (management and confidence) and HLS-SF 12 decreased post intervention. Conclusions: The CeHP is feasible, and it engages and empowers community-dwelling older adults to manage their chronic conditions. The rigorous process of program development and pilot evaluation provided valid evidence to expand the CeHP to a larger-scale implementation to encourage self-management, reduce debilitating complications of poorly controlled chronic diseases, promote healthy longevity and social support, and reduce health care costs. ",
doi="10.2196/33118",
url="https://aging.jmir.org/2022/1/e33118",
url="http://www.ncbi.nlm.nih.gov/pubmed/35037882"
}


@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/10.2196/29876,
author="Pham, Quynh
and El-Dassouki, Noor
and Lohani, Raima
and Jebanesan, Aravinth
and Young, Karen",
title="The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="7",
volume="24",
number="1",
pages="e29876",
keywords="virtual care",
keywords="digital health",
keywords="health equity",
keywords="cultural equity",
keywords="chronic disease",
keywords="caregivers",
keywords="ethnocultural minority",
keywords="older adults",
keywords="ethnicity",
keywords="ethnic patients",
keywords="technology-mediated care",
keywords="equity",
keywords="diversity",
keywords="family",
doi="10.2196/29876",
url="https://www.jmir.org/2022/1/e29876",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994707"
}


@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/10.2196/26767,
author="Edwards, J. Katie
and Jones, B. Ray
and Shenton, Deborah
and Page, Toni
and Maramba, Inocencio
and Warren, Alison
and Fraser, Fiona
and Kri?aj, Tanja
and Coombe, Tristan
and Cowls, Hazel
and Chatterjee, Arunangsu",
title="The Use of Smart Speakers in Care Home Residents: Implementation Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="20",
volume="23",
number="12",
pages="e26767",
keywords="voice-activated technology",
keywords="smart speaker",
keywords="care home",
keywords="technology-enabled care",
keywords="older people",
keywords="learning disability",
keywords="digital technology",
keywords="consumer device",
keywords="smart device",
abstract="Background: The use of smart speakers to improve well-being had been trialed in social care by others; however, we were not aware of their implementation in most care homes across a region in the Southwest of the United Kingdom. For the widespread adoption of new technology, it must be locally demonstrable and become normalized. Objective: The aim of this study was to install smart speakers in care homes in a rural and coastal region and to explore if and how the devices were being used, the barriers to their implementation, and their potential benefits. Methods: Email, workshops, drop-in sessions, phone, and cold calling was used to contact all 230 care homes, offering a free smart speaker and some advisory support. Care homes accepting the devices were asked to complete a feedback diary. Nonresponse rate for diary completion was high and was thus supplemented with a telephone survey. Results: Over the course of 7 months, we installed 156 devices in 92 care homes for older people, 50 devices for people with physical or mental health needs, and 8 for others. The devices were used mainly for music but also for poetry, recipes, light controls, jokes, and video calls. Care home managers reported the benefits for the residents, including enhanced engagement with home activities, enjoyment, calming effects, and the acquisition of new skills. Implementation problems included internet connectivity, staff capacity, and skills. Conclusions: Affordable consumer devices such as smart speakers should be installed in all care homes to benefit residents. Voice-activated technologies are easy to use and promote interaction. This study indicates that implementation in care homes was possible and that smart speakers had multifaceted benefits for residents and staff. Most care homes in this region now use smart speakers for their residents, thereby normalizing this practice. ",
doi="10.2196/26767",
url="https://www.jmir.org/2021/12/e26767",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932010"
}


@Article{info:doi/10.2196/19543,
author="Davies, Karen
and Cheraghi-Sohi, Sudeh
and Ong, Nio Bie
and Perryman, Katherine
and Sanders, Caroline",
title="Co-designing an Adaption of a Mobile App to Enhance Communication, Safety, and Well-being Among People Living at Home With Early-Stage Dementia: Protocol for an Exploratory Multiple Case Study",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="20",
volume="10",
number="12",
pages="e19543",
keywords="design research",
keywords="co-design",
keywords="dementia",
keywords="mobile app",
keywords="communication",
keywords="safety",
keywords="mobile phone",
abstract="Background: There is a growing interest in using mobile apps to support communication, safety, and well-being. Evidence directly from people with dementia regarding the usability, usefulness, and relevance of mobile apps is limited. Objective: This paper describes the protocol of a study that will evaluate an app designed for supporting communication, safety, and well-being among people living with dementia. The study aims to understand if the app can enhance safety through improved communication among users. Methods: The study will use participatory qualitative methods over 3 cycles of evaluation with co-designers (service users, their families, and care practitioners). The study will be developed in partnership with a specialist home care service in England. Purposive case selection will be performed to ensure that the cases exemplify differences in experiences. The app will be evaluated in a walk-through workshop by people living with early-stage dementia and then trialed at home by up to 12 families in a try-out cycle. An amended version will be evaluated in a final walk-through workshop during cycle 3. Data will be collected from at least 4 data sources during the try-out phase and analyzed thematically. An explanatory multiple case study design will be used to synthesize and present the evidence from the three cycles, drawing on the Normalization Process Theory to support the interpretation of the findings. Results: The study is ready to be implemented, but it was paused to protect vulnerable individuals during the COVID-19 pandemic in 2020. The findings will be particularly relevant for understanding how to support vulnerable people living in the community during social distancing and the period following the pandemic as well as for providing insight into the challenges of social isolation that arise from living with dementia. Conclusions: Evaluating a mobile app for enhancing communication, safety, and well-being among people living with dementia contributes to the key ambitions enshrined in policy and practice---championing the use of digital technology and supporting people with dementia to live safely in their own homes. The study will involve co-designers living with dementia, so that the voices of service users can be used to highlight the benefits and challenges of assistive technology and shape the future development of apps that enhance safety by improving communication. International Registered Report Identifier (IRRID): PRR1-10.2196/19543 ",
doi="10.2196/19543",
url="https://www.researchprotocols.org/2021/12/e19543",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932011"
}


@Article{info:doi/10.2196/30135,
author="Hsu, Yu-Cheng
and Wang, Hailiang
and Zhao, Yang
and Chen, Frank
and Tsui, Kwok-Leung",
title="Automatic Recognition and Analysis of Balance Activity in Community-Dwelling Older Adults: Algorithm Validation",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="20",
volume="23",
number="12",
pages="e30135",
keywords="fall risk",
keywords="balance",
keywords="activity recognition",
keywords="automatic framework",
keywords="community-dwelling elderly",
abstract="Background: Clinical mobility and balance assessments identify older adults who have a high risk of falls in clinics. In the past two decades, sensors have been a popular supplement to mobility and balance assessment to provide quantitative information and a cost-effective solution in the community environment. Nonetheless, the current sensor-based balance assessment relies on manual observation or motion-specific features to identify motions of research interest. Objective: The objective of this study was to develop an automatic motion data analytics framework using signal data collected from an inertial sensor for balance activity analysis in community-dwelling older adults. Methods: In total, 59 community-dwelling older adults (19 males and 40 females; mean age = 81.86 years, SD 6.95 years) were recruited in this study. Data were collected using a body-worn inertial measurement unit (including an accelerometer and a gyroscope) at the L4 vertebra of each individual. After data preprocessing and motion detection via a convolutional long short-term memory (LSTM) neural network, a one-class support vector machine (SVM), linear discriminant analysis (LDA), and k-nearest neighborhood (k-NN) were adopted to classify high-risk individuals. Results: The framework developed in this study yielded mean accuracies of 87\%, 86\%, and 89\% in detecting sit-to-stand, turning 360{\textdegree}, and stand-to-sit motions, respectively. The balance assessment classification showed accuracies of 90\%, 92\%, and 86\% in classifying abnormal sit-to-stand, turning 360{\textdegree}, and stand-to-sit motions, respectively, using Tinetti Performance Oriented Mobility Assessment-Balance (POMA-B) criteria by the one-class SVM and k-NN. Conclusions: The sensor-based approach presented in this study provided a time-effective manner with less human efforts to identify and preprocess the inertial signal and thus enabled an efficient balance assessment tool for medical professionals. In the long run, the approach may offer a ?exible solution to relieve the community's burden of continuous health monitoring. ",
doi="10.2196/30135",
url="https://www.jmir.org/2021/12/e30135",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932008"
}


@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/10.2196/30353,
author="Anderson, Smith Martha
and Bankole, Azziza
and Homdee, Nutta
and Mitchell, A. Brook
and Byfield, E. Grace
and Lach, John",
title="Dementia Caregiver Experiences and Recommendations for Using the Behavioral and Environmental Sensing and Intervention System at Home: Usability and Acceptability Study",
journal="JMIR Aging",
year="2021",
month="Dec",
day="6",
volume="4",
number="4",
pages="e30353",
keywords="dementia",
keywords="agitation",
keywords="sensors",
keywords="smart health",
keywords="wearable technology",
keywords="just-in-time notifications",
keywords="caregiver",
keywords="dyad",
keywords="home-based",
keywords="qualitative",
abstract="Background: Caregiver burden associated with dementia-related agitation is one of the most common reasons for a community-dwelling person living with dementia to transition to a care facility. The Behavioral and Environmental Sensing and Intervention (BESI) for the Dementia Caregiver Empowerment system uses sensing technology, smartwatches, tablets, and data analytics to detect and predict agitation in persons living with dementia and to provide just-in-time notifications and dyad-specific intervention recommendations to caregivers. The BESI system has shown that there is a valid relationship between dementia-related agitation and environmental factors and that caregivers prefer a home-based monitoring system. Objective: The aim of this study is to obtain input from caregivers of persons living with dementia on the value, usability, and acceptability of the BESI system in the home setting and obtain their insights and recommendations for the next stage of system development. Methods: A descriptive qualitative design with thematic analysis was used to analyze 10 semistructured interviews with caregivers. The interviews comprised 16 questions, with an 80\% (128/160) response rate. Results: Postdeployment caregiver feedback about the BESI system and the overall experience were generally positive. Caregivers acknowledged the acceptability of the system by noting the ease of use and saw the system as a fit for them. Functionality issues such as timeliness in agitation notification and simplicity in the selection of agitation descriptors on the tablet interface were identified, and caregivers indicated a desire for more word options to describe agitation behaviors. Agitation intervention suggestions were well received by the caregivers, and the resulting decrease in the number and severity of agitation events helped confirm that the BESI system has good value and acceptability. Thematic analysis suggested several subjective experiences and yielded the themes of usefulness and helpfulness. Conclusions: This study determined preferences for assessing caregiver strain and burden, explored caregiver acceptance of the technology system (in-home sensors, actigraph or smart watch technology, and tablet devices), discerned caregiver insights on the burden and stress of caring for persons living with dementia experiencing agitation in dementia, and solicited caregiver input and recommendations for system changes. The themes of usefulness and helpfulness support the use of caregiver knowledge and experience to inform further development of the technology. ",
doi="10.2196/30353",
url="https://aging.jmir.org/2021/4/e30353",
url="http://www.ncbi.nlm.nih.gov/pubmed/34874886"
}


@Article{info:doi/10.2196/23804,
author="Airola, Ella",
title="Learning and Use of eHealth Among Older Adults Living at Home in Rural and Nonrural Settings: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="2",
volume="23",
number="12",
pages="e23804",
keywords="aged",
keywords="barrier",
keywords="digital competence",
keywords="deinstitutionalization",
keywords="eHealth",
keywords="home care",
keywords="learning",
keywords="older adult",
keywords="rural health",
abstract="Background: Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim. However, there is a need to better understand older adults' needs for eHealth services, and thus, these health solutions require further exploration. Objective: The purpose of this systematic literature review is to appraise, synthesize, and summarize the literature on older adults' (aged ?60 years) eHealth learning and use in real home settings, particularly in rural and remote areas, with a focus on the social and cultural context. Methods: A systematic search was conducted in January 2020 using 4 academic databases. The studies by means of qualitative thematic analysis to identify the barriers, enablers, and support practices involved in the domestication process were examined. In addition, we identified the various meanings attached to eHealth technologies for older adults living in rural and remote areas. Results: In total, 31 empirical studies published between 2010 and 2020 were included in this review. A total of 17 articles included participants from rural and remote areas. The most regularly reported barriers related to older adults' learning to use and use of eHealth were health-related difficulties, such as cognitive impairment or impaired hearing. The most reported enabler was the support provided for older adults in learning and use of eHealth. Support mainly comprised older adults' own digital competences, which were distributed with their social network. It was found that eHealth technology is needed for rural and remote areas to facilitate access and reduce logistical barriers to health care services. Conclusions: The literature review provided information and practical implications for designers, health care providers, and policy makers. On the basis of these findings, eHealth technologies should be easy to use, and adequate support should be provided to older adults for use. ",
doi="10.2196/23804",
url="https://www.jmir.org/2021/12/e23804",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860664"
}


@Article{info:doi/10.2196/28652,
author="Goodridge, Donna
and Reis, Nathan
and Neiser, Jenna
and Haubrich, Tim
and Westberg, Bev
and Erickson-Lumb, Laura
and Storozinski, Jo
and Gonzales, Cesar
and Michael, Joanne
and Cammer, Allison
and Osgood, Nathaniel",
title="An App-Based Mindfulness-Based Self-compassion Program to Support Caregivers of People With Dementia: Participatory Feasibility Study",
journal="JMIR Aging",
year="2021",
month="Nov",
day="26",
volume="4",
number="4",
pages="e28652",
keywords="virtual support programs",
keywords="caregivers",
keywords="dementia",
keywords="mindfulness",
keywords="self-compassion",
keywords="mobile health",
keywords="mobile applications",
keywords="elderly",
keywords="older adults",
keywords="usability",
keywords="feasibility",
keywords="smartphone app",
keywords="mobile phone",
abstract="Background: The number of persons with dementia is steadily growing, as is the number of individuals supporting persons with dementia. Primary caregivers of persons with dementia are most often family members or spouses of the persons with dementia, and they are more likely to experience increased stress and other negative effects than individuals who are not primary caregivers. Although in-person support groups have been shown to help buffer the negative impacts of caregiving, some caregivers live in isolated or rural communities and are unable to make the burdensome commitment of traveling to cities. Using an interdisciplinary approach, we developed a mobile smartphone support app designed for primary caregivers of persons with dementia, with the goal of reducing caregiver burden and easing stress. The app features a 12-week intervention, largely rooted in mindfulness-based self-compassion (MBSC), because MBSC has been linked to minimizing stress, depression, and anxiety. Objective: The primary objectives of our program are twofold: to explore the feasibility of a 12-week mobile support program and to conduct an initial efficacy evaluation of changes in perceived caregiver burden, coping styles, and emotional well-being of caregivers before and after the program. Methods: Our feasibility study used a 2-phase participatory pretest and posttest design, focusing on acceptability, demand, practicality, implementation, and efficacy. At phase I, we recruited 57 primary caregivers of persons with dementia (mean age 76.3, SD 12.9 years), comprising spouses (21/57, 37\%), children (21/57, 37\%), and friends or relatives (15/57, 26\%) of persons with dementia, of whom 29 (51\%) completed all measures at both pre- and postprogram. The content of the program featured a series of MBSC podcasts. Our primary outcome measure was caregiver burden, with secondary outcome measures including coping styles and emotional well-being. Daily ecological momentary assessments enabled us to ask participants, ``How are you feeling today?'' Phase II of our study involved semistructured follow-up interviews with most participants (n=21) who completed phase I. Results: Our findings suggest that our app or program meets the feasibility criteria examined. Notably, participants generally accepted the program and believed it could be a useful resource. Emotional well-being increased significantly (P=.04), and emotion-based coping significantly decreased (P=.01). Participants generally considered the app or program to be a helpful resource. Conclusions: Although there were no significant changes in caregiver burden, we were encouraged by the increased emotional well-being of our participants following the completion of our program. We also conclude that our app or program demonstrated feasibility (ie, acceptability, practicality, implementation, and efficacy) and can provide a much-needed resource for primary caregivers of persons with dementia. In the subsequent version of the program, we will respond to participant feedback by incorporating web-based weekly sessions and incorporating an outcome measure of self-compassion. ",
doi="10.2196/28652",
url="https://aging.jmir.org/2021/4/e28652",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842530"
}


@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/10.2196/16824,
author="Lasrado, Reena
and Bielsten, Therese
and Hann, Mark
and Schumm, James
and Reilly, Theresa Siobhan
and Davies, Linda
and Swarbrick, Caroline
and Dowlen, Robyn
and Keady, John
and Hellstr{\"o}m, Ingrid",
title="Developing a Management Guide (the DemPower App) for Couples Where One Partner Has Dementia: Nonrandomized Feasibility Study",
journal="JMIR Aging",
year="2021",
month="Nov",
day="16",
volume="4",
number="4",
pages="e16824",
keywords="dementia guide",
keywords="self-management for couples with dementia",
keywords="dementia self-help",
keywords="dementia app",
keywords="dementia resource",
keywords="feasibility study",
keywords="nonrandomized study",
keywords="dementia intervention",
abstract="Background: Promoting the health and well-being of couples where one partner has dementia is an overlooked area of care practice. Most postdiagnostic services currently lack a couple-centered approach and have a limited focus on the couple relationship. To help address this situation, we developed a tablet-based self-management guide (DemPower) focused on helping couples enhance their well-being and relationship quality. Objective: The aim of this study is to investigate the feasibility and acceptability of the DemPower app. Methods: A nonrandomized feasibility design was used to evaluate the DemPower intervention over 3 months among couples where a partner had a diagnosis of dementia. The study recruited 25 couples in the United Kingdom and 19 couples in Sweden. Outcome measures were obtained at baseline and postintervention. The study process and interventions were evaluated at various stages. Results: The study was completed by 48\% (21/44) of couples where one partner had dementia, of whom 86\% (18/21) of couples accessed all parts of the DemPower app. Each couple spent an average of 8 hours (SD 3.35 hours) using the app during the study period. In total, 90\% (19/21) of couples reported that all sections of DemPower were useful in addressing various aspects of daily life and helped to focus on how they interacted in their relationship. Of the 4 core subjects on which the DemPower app was structured, home and neighborhood received the highest number of visits. Couples used activity sections more often than the core subject pages. The perception of DemPower's utility varied with each couple's lived experience of dementia, geographic location, relationship dynamics, and opportunities for social interaction. A 5.2-point increase in the dementia quality of life score for people with dementia and a marginal increase in the Mutuality scale (+1.23 points) for caregiver spouses were found. Design and navigational challenges were reported in the DemPower app. Conclusions: The findings suggest that the DemPower app is a useful resource for couples where one partner has dementia and that the implementation of the app requires the support of memory clinics to reach couples at early diagnosis. Trial Registration: ISRCTN Registry ISRCTN10122979; http://www.isrctn.com/ISRCTN10122979 ",
doi="10.2196/16824",
url="https://aging.jmir.org/2021/4/e16824",
url="http://www.ncbi.nlm.nih.gov/pubmed/34783666"
}


@Article{info:doi/10.2196/29788,
author="Kim, Ben
and Ghasemi, Peyman
and Stolee, Paul
and Lee, Joon",
title="Clinicians and Older Adults' Perceptions of the Utility of Patient-Generated Health Data in Caring for Older Adults: Exploratory Mixed Methods Study",
journal="JMIR Aging",
year="2021",
month="Nov",
day="5",
volume="4",
number="4",
pages="e29788",
keywords="mobile health",
keywords="mHealth",
keywords="older adults",
keywords="wearables",
keywords="patient generated health data",
keywords="chronic disease management",
keywords="home care",
keywords="self-care",
keywords="activities of daily living",
keywords="sleep",
abstract="Background: Many people are motivated to self-track their health and optimize their well-being through mobile health apps and wearable devices. The diversity and complexity of these systems have evolved over time, resulting in a large amount of data referred to as patient-generated health data (PGHD), which has recently emerged as a useful set of data elements in health care systems around the world. Despite the increased interest in PGHD, clinicians and older adults' perceptions of PGHD are poorly understood. In particular, although some clinician barriers to using PGHD have been identified, such as concerns about data quality, ease of use, reliability, privacy, and regulatory issues, little is known from the perspectives of older adults. Objective: This study aims to explore the similarities and differences in the perceptions of older adults and clinicians with regard to how various types of PGHD can be used to care for older adults. Methods: A mixed methods study was conducted to explore clinicians and older adults' perceptions of PGHD. Focus groups were conducted with older adults and health care providers from the Greater Toronto area and the Kitchener-Waterloo region. The participants were asked to discuss their perceptions of PGHD, including facilitators and barriers. A questionnaire aimed at exploring the perceived usefulness of a range of different PGHD was also embedded in the study design. Focus group interviews were transcribed for thematic analysis, whereas the questionnaire results were analyzed using descriptive statistics. Results: Of the 9 participants, 4 (44\%) were clinicians (average age 38.3 years, SD 7 years), and 5 (56\%) were older adults (average age 81.0 years, SD 9.1 years). Four main themes were identified from the focus group interviews: influence of PGHD on patient-provider trust, reliability of PGHD, meaningful use of PGHD and PGHD-based decision support systems, and perceived clinical benefits and intrusiveness of PGHD. The questionnaire results were significantly correlated with the frequency of PGHD mentioned in the focus group interviews (r=0.42; P=.03) and demonstrated that older adults and clinicians perceived blood glucose, step count, physical activity, sleep, blood pressure, and stress level as the most useful data for managing health and delivering high-quality care. Conclusions: This embedded mixed methods study generated several important findings about older adults and clinicians' perceptions and perceived usefulness of a range of PGHD. Owing to the exploratory nature of this study, further research is needed to understand the concerns about data privacy, potential negative impact on the trust between older adults and clinicians, data quality and quantity, and usability of PGHD-related technologies for older adults. ",
doi="10.2196/29788",
url="https://aging.jmir.org/2021/4/e29788",
url="http://www.ncbi.nlm.nih.gov/pubmed/34738913"
}


@Article{info:doi/10.2196/26181,
author="Hill, R. Jordan
and Brown, C. Janetta
and Campbell, L. Noll
and Holden, J. Richard",
title="Usability-In-Place---Remote Usability Testing Methods for Homebound Older Adults: Rapid Literature Review",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="2",
volume="5",
number="11",
pages="e26181",
keywords="mobile usability testing",
keywords="usability inspection",
keywords="methods",
keywords="aging",
keywords="literature synthesis",
keywords="usability study",
keywords="mobile usability",
keywords="elderly",
keywords="older adults",
keywords="remote usability",
keywords="mobility restriction",
abstract="Background: Technology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, self-quarantined and sheltered in place during the COVID-19 pandemic, the importance of usability-in-place became clear. To understand the remote use of technology in an ecologically valid manner, researchers and others must be able to test usability remotely. Objective: Our objective was to review practical approaches for and findings about remote usability testing, particularly remote usability testing with older adults. Methods: We performed a rapid review of the literature and reported on available methods, their advantages and disadvantages, and practical recommendations. This review also reported recommendations for usability testing with older adults from the literature. Results: Critically, we identified a gap in the literature---a lack of remote usability testing methods, tools, and strategies for older adults, despite this population's increased remote technology use and needs (eg, due to disability or technology experience). We summarized existing remote usability methods that were found in the literature as well as guidelines that are available for conducting in-person usability testing with older adults. Conclusions: We call on the human factors research and practice community to address this gap to better support older adults and other homebound or mobility-restricted individuals. ",
doi="10.2196/26181",
url="https://formative.jmir.org/2021/11/e26181",
url="http://www.ncbi.nlm.nih.gov/pubmed/34726604"
}


@Article{info:doi/10.2196/29755,
author="Ginsburg, Sarah Amy
and Kinshella, Woo Mai-Lei
and Naanyu, Violet
and Rigg, Jessica
and Chomba, Dorothy
and Coleman, Jesse
and Hwang, Bella
and Ochieng, Roseline
and Ansermino, Mark J.
and Macharia, M. William",
title="Multiparameter Continuous Physiological Monitoring Technologies in Neonates Among Health Care Providers and Caregivers at a Private Tertiary Hospital in Nairobi, Kenya: Feasibility, Usability, and Acceptability Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="28",
volume="23",
number="10",
pages="e29755",
keywords="infants",
keywords="Africa",
keywords="medical technology design",
keywords="user perspectives",
keywords="in-depth interviews",
keywords="direct observations",
abstract="Background: Continuous physiological monitoring technologies are important for strengthening hospital care for neonates, particularly in resource-constrained settings, and understanding user perspectives is critical for informing medical technology design, development, and optimization. Objective: This study aims to assess the feasibility, usability, and acceptability of 2 noninvasive, multiparameter, continuous physiological monitoring technologies for use in neonates in an African health care setting. Methods: We assessed 2 investigational technologies from EarlySense and Sibel, compared with the reference Masimo Rad-97 technology through in-depth interviews and direct observations. A purposive sample of health care administrators, health care providers, and caregivers at Aga Khan University Hospital, a tertiary, private hospital in Nairobi, Kenya, were included. Data were analyzed using a thematic approach in NVivo 12 software. Results: Between July and August 2020, we interviewed 12 health care providers, 5 health care administrators, and 10 caregivers and observed the monitoring of 12 neonates. Staffing and maintenance of training in neonatal units are important feasibility considerations, and simple training requirements support the feasibility of the investigational technologies. Key usability characteristics included ease of use, wireless features, and reduced number of attachments connecting the neonate to the monitoring technology, which health care providers considered to increase the efficiency of care. The main factors supporting acceptability included caregiver-highlighted perceptions of neonate comfort and health care respondent technology familiarity. Concerns about the side effects of wireless connections, electromagnetic fields, and mistrust of unfamiliar technologies have emerged as possible acceptability barriers to investigational technologies. Conclusions: Overall, respondents considered the investigational technologies feasible, usable, and acceptable for the care of neonates at this health care facility. Our findings highlight the potential of different multiparameter continuous physiological monitoring technologies for use in different neonatal care settings. Simple and user-friendly technologies may help to bridge gaps in current care where there are many neonates; however, challenges in maintaining training and ensuring feasibility within resource-constrained health care settings warrant further research. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-035184 ",
doi="10.2196/29755",
url="https://www.jmir.org/2021/10/e29755",
url="http://www.ncbi.nlm.nih.gov/pubmed/34709194"
}


@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/10.2196/29074,
author="Raj, Minakshi
and Iott, Bradley",
title="Evaluation of Family Caregivers' Use of Their Adult Care Recipient's Patient Portal From the 2019 Health Information National Trends Survey: Secondary Analysis",
journal="JMIR Aging",
year="2021",
month="Oct",
day="4",
volume="4",
number="4",
pages="e29074",
keywords="informal caregivers",
keywords="family caregivers",
keywords="patient portal",
keywords="electronic health record",
keywords="telehealth",
keywords="aging in place",
keywords="web-based medical record",
abstract="Background: Patient engagement is critical for realizing the value of telehealth modalities such as the patient portal. Family caregiver engagement may also be critical for facilitating the use of the patient portal among adult patients, including older adults. Objective: This study aims to analyze the 2019 Health Information National Trends Survey to characterize family caregivers' use of their care recipient's patient portal in terms of sociodemographic, health, and caregiving characteristics and caregivers' use of their own portal. Methods: We conducted a secondary analysis of cross-sectional data from the National Cancer Institute's Health Information National Trends Survey 5 Cycle 3. This survey was administered to 5438 US adults between January and May 2019. We analyzed data from 320 respondents who were identified as family caregivers. We created measures to reflect family caregivers' use of their care recipient's and their own portal, caregiver demographic and caregiving characteristics, and care recipient health characteristics. Results: Over half of the caregivers (179/320, 55.9\%) reported using their own portal at least once, whereas only one-third (105/320, 32.8\%) reported using their care recipient's record in the previous 12 months. Caregivers using their own portal were significantly more likely to use their care recipient's portal (odds ratio 11.18; P<.001). Conclusions: Policies should enable patients to designate family caregivers who can access their patient portal. Providers could screen caregivers for challenges in their caregiving responsibilities that may be addressed through the portal so they can better support their adult relatives. Interventions to support family caregivers, especially older caregivers, in using their own portal may facilitate their use of their care recipient's portal. ",
doi="10.2196/29074",
url="https://aging.jmir.org/2021/4/e29074",
url="http://www.ncbi.nlm.nih.gov/pubmed/34605766"
}


@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/10.2196/30802,
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/10.2196/29031,
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/10.2196/27047,
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/10.2196/25671,
author="Rottenberg, Shelley
and Williams, Allison",
title="Web-Based Delivery of the Caregiving Essentials Course for Informal Caregivers of Older Adults in Ontario: Mixed Methods Evaluation Study",
journal="JMIR Aging",
year="2021",
month="Jun",
day="15",
volume="4",
number="2",
pages="e25671",
keywords="informal caregivers",
keywords="family caregivers",
keywords="older adults",
keywords="elder care",
keywords="web-based intervention",
keywords="online intervention",
keywords="online course",
keywords="health education",
keywords="eHealth",
keywords="evaluation",
abstract="Background: Many informal caregivers of older adults have limited time because of the number of responsibilities that their caregiving role entails. This population often experiences high levels of burden due to the stressful nature of their work and are vulnerable to developing negative psychological health outcomes. Easily accessible and flexible knowledge interventions are needed to alleviate the burden and stress experienced by this group. Objective: This study aims to evaluate the acceptability of the web-based delivery of the Caregiving Essentials course for informal caregivers of older adults. Both the strengths and limitations of using a web-based platform to provide information and resources were explored to see whether the method of delivery enhanced or hindered the overall course experience for participants. Methods: A mixed methodology of web-based pre- (n=111) and postcourse surveys (n=39) and telephone interviews (n=26) was used to collect both qualitative and quantitative data from participants. Individual interviews were also conducted with key stakeholders (n=6), and a focus group was conducted with nursing students (n=5) who were involved in the project. Results: The web-based delivery of the course provided participants with greater accessibility to the course because it allowed them to work independently through the modules at their own pace wherever and whenever. The discussion boards were also identified as a major strength because of the opportunity for social interaction and the sense of community that many felt through sharing their experiences. Some barriers to participation included age-related factors, issues with navigating aspects of the course, and concerns about privacy and anonymity. Some key suggestions included more engaging methods of web-based communication and the reorganization of the module content to reduce the amount of text and streamline information. Conclusions: The web-based delivery of Caregiving Essentials appeared to enhance the overall course experience by increasing accessibility and allowing participants to interact with the learning materials and other caregivers. The findings from this evaluation can be used to create and improve the web-based delivery of both the current and emerging interventions for caregivers. ",
doi="10.2196/25671",
url="https://aging.jmir.org/2021/2/e25671",
url="http://www.ncbi.nlm.nih.gov/pubmed/34128815"
}


@Article{info:doi/10.2196/24728,
author="Daniels, Helen
and Hollinghurst, Joe
and Fry, Richard
and Clegg, Andrew
and Hillcoat-Nall{\'e}tamby, Sarah
and Nikolova, Silviya
and Rodgers, E. Sarah
and Williams, Neil
and Akbari, Ashley",
title="The Value of Routinely Collected Data in Evaluating Home Assessment and Modification Interventions to Prevent Falls in Older People: Systematic Literature Review",
journal="JMIR Aging",
year="2021",
month="Apr",
day="23",
volume="4",
number="2",
pages="e24728",
keywords="falls",
keywords="aged",
keywords="routinely collected data",
keywords="evaluation research",
keywords="systematic review",
abstract="Background: Falls in older people commonly occur at home. Home assessment and modification (HAM) interventions can be effective in reducing falls; however, there are some concerns over the validity of evaluation findings. Routinely collected data could improve the quality of HAM evaluations and strengthen their evidence base. Objective: The aim of this study is to conduct a systematic review of the evidence of the use of routinely collected data in the evaluations of HAM interventions. Methods: We searched the following databases from inception until January 31, 2020: PubMed, Ovid, CINAHL, OpenGrey, CENTRAL, LILACS, and Web of Knowledge. Eligible studies were those evaluating HAMs designed to reduce falls involving participants aged 60 years or more. We included study protocols and full reports. Bias was assessed using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. Results: A total of 7 eligible studies were identified in 8 papers. Government organizations provided the majority of data across studies, with health care providers and third-sector organizations also providing data. Studies used a range of demographic, clinical and health, and administrative data. The purpose of using routinely collected data spanned recruiting and creating a sample, stratification, generating independent variables or covariates, and measuring key study-related outcomes. Nonhome-based modification interventions (eg, in nursing homes) using routinely collected data were not included in this study. We included two protocols, which meant that the results of those studies were not available. MeSH headings were excluded from the PubMed search because of a reduction in specificity. This means that some studies that met the inclusion criteria may not have been identified. Conclusions: Routine data can be used successfully in many aspects of HAM evaluations and can reduce biases and improve other important design considerations. However, the use of these data in these studies is currently not widespread. There are a number of governance barriers to be overcome to allow these types of linkage and to ensure that the use of routinely collected data in evaluations of HAM interventions is exploited to its full potential. ",
doi="10.2196/24728",
url="https://aging.jmir.org/2021/2/e24728",
url="http://www.ncbi.nlm.nih.gov/pubmed/33890864"
}


@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/10.2196/20196,
author="Aung, Nyein Myo
and Moolphate, Saiyud
and Yuasa, Motoyuki
and Aung, Nyein Thin Nyein
and Koyanagi, Yuka
and Supakankunti, Siripen
and Ahmad, Ishtiaq
and Kayano, Ryoma
and Ong, Paul",
title="Community-Integrated Intermediary Care (CIIC) Service Model to Enhance Family-Based, Long-Term Care for Older People: Protocol for a Cluster Randomized Controlled Trial in Thailand",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="24",
volume="10",
number="3",
pages="e20196",
keywords="aging",
keywords="Asia",
keywords="care prevention",
keywords="health promotion",
keywords="long-term care",
keywords="implementation research",
abstract="Background: Thailand is one of the most rapidly aging countries in Asia. Traditional family-based care, which has been the basis of most care for older people, is becoming unsustainable as families become smaller. In addition, women tend to be adversely affected as they still form the bulk of caregivers for older people, and many are likely to exit the labor market in order to provide care. Many family caregivers also have no or minimal training, and they may be called upon to provide quite complex care, increasing the proportion of older people receiving suboptimal care if they rely only on informal care that is provided by families and friends. Facing the increasing burden of noncommunicable diseases and age-related morbidity, Thai communities are increasingly in need of community-integrated care models for older persons that can link existing health systems and reduce the burden upon caring families. This need is common to many countries in the Association of Southeast Asian Nations (ASEAN). Objective: In this study, we aimed to assess the effectiveness of a community-integrated intermediary care (CIIC) model to enhance family-based care for older people. Methods: This paper describes a cluster randomized controlled trial comprised of 6 intervention clusters and 6 control clusters that aim to recruit 2000 participants in each arm. This research protocol has been approved by the World Health Organization Ethics Review Committee. The intervention clusters will receive an integrated model of care structured around (1) a community respite service, (2) the strengthening of family care capacity, and (3) an exercise program that aims to prevent entry into long-term care for older people. Control group clusters receive usual care (ie, the current system of long-term care common to all provinces in Thailand), consisting principally of a volunteer-assisted home care service. The trial will be conducted over a period of 2 years. The primary outcome is family caregiver burden measured at a 6-month follow-up, as measured by the Caregiver Burden Inventory. Secondary outcomes consist of biopsychosocial indicators including functional ability, as measured using an activity of daily living scale; depression, as measured by the Geriatric Depression Scale; and quality of life of older people, as measured by the EuroQol 5-dimensions 5-levels scale. Intention-to-treat analysis will be followed. Results: The CIIC facility has been established. Community care prevention programs have been launched at the intervention clusters. Family caregivers are receiving training and assistance. However, the COVID-19 pandemic delayed the intervention. Conclusions: Since ASEAN and many Asian countries share similar traditional family-based, long-term care systems, the proposed CIIC model and the protocol for its implementation and evaluation may benefit other countries wishing to adopt similar community-integrated care models for older people at risk of needing long-term care. Trial Registration: Thai Clinical Trials Registry TCTR20190412004; http://www.thaiclinicaltrials.org/\# International Registered Report Identifier (IRRID): DERR1-10.2196/20196 ",
doi="10.2196/20196",
url="https://www.researchprotocols.org/2021/3/e20196",
url="http://www.ncbi.nlm.nih.gov/pubmed/33759787"
}


@Article{info:doi/10.2196/24006,
author="Biehl, Verena
and Becker, Heidrun
and Ogrin, Alenka
and Reissner, Alenka
and Burger, Johannes
and Glaessel, Andrea",
title="User-Centered Development of a Web Platform Supporting Community-Based Health Care Organizations for Older Persons in Need of Support: Qualitative Focus Group Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="10",
volume="23",
number="3",
pages="e24006",
keywords="community-based health care services",
keywords="older persons in need of support",
keywords="user-centered design",
keywords="focus groups",
keywords="qualitative research",
keywords="web platform",
abstract="Background: The ongoing changes in population demographics increase the relevance of dignified aging across Europe. Community-based health care (CBHC) organizations are necessary to provide sustainable strategies for organizing care for older persons in need of support. To support the digitalization of these organizations, new business models and suitable web platforms are necessary. Objective: This study, which is part of the European Active and Assisted Living (AAL) project called ``ICareCoops'', aimed to explore concepts, approaches, and workflows of CBHC organizations to achieve a comprehensive understanding of extant services offered and relevant requirements to support these services with information and computer technology (ICT) solutions. Methods: A qualitative study with six focus groups (FGs) with 40 participants was conducted in Switzerland and Slovenia to identify potential stakeholders' needs and requirements for the user-centered development of a web platform. Data were collected from three different stakeholder groups: (1) older persons in need of support as care receivers, (2) significant others of older persons in need of support, and (3) managers or care providers of CBHC organizations. A semistructured interview guide with open questions was used for data collection. FG sessions were audio-recorded and transcribed verbatim. Thematic content analysis was used to analyze the content of the FG sessions. To assist with further web platform development, the responses of the FG participants were translated into user stories to describe technical requirements. Results: By analyzing the transcripts, five main categories were identified: (1) ICT usage behavior of users, (2) challenges of web platform usage, (3) content and technical requirements for the web platform, (4) form and services of CBHC organizations, and (5) rationales of CBHC organizations. The main issues identified were the need for seniors to have individual contact with the CBHC organization and the possibility to coordinate routine services via the web platform, such as ordering meals-on-wheels or booking a caregiver to accompany an older person to the doctor. Conclusions: The majority of participants showed a lack of familiarity with the usage of ICT. Nevertheless, they were open-minded regarding web platform usage to facilitate workflows and to benefit CBHC organizations. Cooperatives as an organizational model demonstrate a high potential to address users' needs. Therefore, the web platform offers an essential tool for innovative health care models in the future. Searching for care services, contacting care providers, and communicating with care providers was preferred via personal contact and seemed to be the key element for user acceptance and for the successful implementation of a web platform like ``ICareCoops'' to support CBHC organizations. ",
doi="10.2196/24006",
url="https://www.jmir.org/2021/3/e24006",
url="http://www.ncbi.nlm.nih.gov/pubmed/33688837"
}


@Article{info:doi/10.2196/24363,
author="S{\"u}lz, Sandra
and van Elten, J. Hilco
and Askari, Marjan
and Weggelaar-Jansen, Marie Anne
and Huijsman, Robbert",
title="eHealth Applications to Support Independent Living of Older Persons: Scoping Review of Costs and Benefits Identified in Economic Evaluations",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="9",
volume="23",
number="3",
pages="e24363",
keywords="cost",
keywords="benefit",
keywords="eHealth",
keywords="aged",
keywords="economic evaluation",
abstract="Background: eHealth applications are constantly increasing and are frequently considered to constitute a promising strategy for cost containment in health care, particularly if the applications aim to support older persons. Older persons are, however, not the only major eHealth stakeholder. eHealth suppliers, caregivers, funding bodies, and health authorities are also likely to attribute value to eHealth applications, but they can differ in their value attribution because they are affected differently by eHealth costs and benefits. Therefore, any assessment of the value of eHealth applications requires the consideration of multiple stakeholders in a holistic and integrated manner. Such a holistic and reliable value assessment requires a profound understanding of the application's costs and benefits. The first step in measuring costs and benefits is identifying the relevant costs and benefit categories that the eHealth application affects. Objective: The aim of this study is to support the conceptual phase of an economic evaluation by providing an overview of the relevant direct and indirect costs and benefits incorporated in economic evaluations so far. Methods: We conducted a systematic literature search covering papers published until December 2019 by using the Embase, Medline Ovid, Web of Science, and CINAHL EBSCOhost databases. We included papers on eHealth applications with web-based contact possibilities between clients and health care providers (mobile health apps) and applications for self-management, telehomecare, telemedicine, telemonitoring, telerehabilitation, and active healthy aging technologies for older persons. We included studies that focused on any type of economic evaluation, including costs and benefit measures. Results: We identified 55 papers with economic evaluations. These studies considered a range of different types of costs and benefits. Costs pertained to implementation activities and operational activities related to eHealth applications. Benefits (or consequences) could be categorized according to stakeholder groups, that is, older persons, caregivers, and health care providers. These benefits can further be divided into stakeholder-specific outcomes and resource usage. Some cost and benefit types have received more attention than others. For instance, patient outcomes have been predominantly captured via quality-of-life considerations and various types of physical health status indicators. From the perspective of resource usage, a strong emphasis has been placed on home care visits and hospital usage. Conclusions: Economic evaluations of eHealth applications are gaining momentum, and studies have shown considerable variation regarding the costs and benefits that they include. We contribute to the body of literature by providing a detailed and up-to-date framework of cost and benefit categories that any interested stakeholder can use as a starting point to conduct an economic evaluation in the context of independent living of older persons. ",
doi="10.2196/24363",
url="https://www.jmir.org/2021/3/e24363",
url="http://www.ncbi.nlm.nih.gov/pubmed/33687335"
}


@Article{info:doi/10.2196/18164,
author="Abrantes, Diogo
and Teles, Soraia
and Tavares de Sousa, Rita
and Freitas, Alberto
and Vieira-Marques, Pedro
and Ferreira, Ana",
title="A Multipurpose Platform for Ambient Assisted Living (ActiveAdvice): Usability Study",
journal="JMIR Aging",
year="2021",
month="Mar",
day="1",
volume="4",
number="1",
pages="e18164",
keywords="aging",
keywords="ambient assisted living",
keywords="elderly",
keywords="usability testing",
keywords="user-centered design",
abstract="Background: Aging of the global population is slowly paving the way for new markets for care products and services. The desire of older people to maintain their independence while remaining at home is boosting the development of ambient assisted living (AAL) solutions. Lack of user awareness of AAL solutions paired with an insufficient use of user-centered and participatory design approaches in the development of these products has hindered the uptake of these solutions by end users. Objective: This study aims to describe the usability and users' experiences within a novel platform, ActiveAdvice, aimed at offering advice and a holistic market overview of AAL products and services. Methods: Usability tests were performed on the developed platform among identified prospective end users, with 32 older adults and informal carers from 4 European countries being part of the user tests. The usability and appeal of the web interface design, information flow, and information architecture were analyzed by collecting both objective and subjective measures. These would include pretest and posttest surveys, along with a series of think-aloud tasks to be performed within the platform. Results: The outcomes suggest that the ActiveAdvice platform's objectives and functionalities are mostly aligned with the needs and expectations of end users, who demonstrated interest in using it, stressing its purpose along with its simple and intuitive interaction. Task completion rates were high, and participants had good satisfaction rates when navigating the platform. However, the tests still advocate for an improved design at some points and better disclosure of information. Conclusions: Our findings shed light on a few peculiarities of interface design, information architecture, user needs, and preferred functionalities, which should be applied to future developments of similar platforms with related services. The AAL field could benefit from tools supporting the dissemination of available AAL solutions and how they can improve one's quality of life. These tools may benefit not only older adults but also caregivers, business owners, and governmental employees. ",
doi="10.2196/18164",
url="https://aging.jmir.org/2021/1/e18164",
url="http://www.ncbi.nlm.nih.gov/pubmed/33646134"
}


@Article{info:doi/10.2196/23767,
author="Hoang, Peter
and Whaley, Colin
and Thompson, Karen
and Ho, Venus
and Rehman, Uzma
and Boluk, Karla
and Grindrod, A. Kelly",
title="Evaluation of an Intergenerational and Technological Intervention for Loneliness: Protocol for a Feasibility Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="17",
volume="10",
number="2",
pages="e23767",
keywords="seniors",
keywords="communication technology",
keywords="social isolation",
keywords="computers",
keywords="intergenerational",
keywords="older adults",
keywords="mobile phone",
abstract="Background: Social integration and mental health are vital aspects of healthy aging. However, close to half of Canadians older than 80 years report feeling socially isolated. Research has shown that social isolation leads to increased mortality and morbidity, and various interventions have been studied to alleviate loneliness among older adults. This proposal presents an evaluation of an intervention that provides one-on-one coaching, is intergenerational, provides both educational and socialization experiences, and increases technology literacy of older adults to overcome loneliness. Objective: This paper describes the protocol of a randomized, mixed-methods study that will take place in Ontario, Canada. The purpose of this study is to evaluate if an intergenerational technology literacy program can reduce social isolation and depression in older adults via quantitative and qualitative outcome measures. Methods: This study is a randomized, mixed-methods, feasibility trial with 2 conditions. Older adults in the intervention condition will receive 1 hour of weekly technological assistance to send an email to a family member, for 8 weeks, with the assistance of a volunteer. Participants in the control condition will not receive any intervention. The primary outcomes are loneliness, measured using the University of California, Los Angeles Loneliness Scale, and depression, measured using the Center for Epidemiologic Studies Depression scale, both of which are measured weekly. Secondary outcomes are quality of life, as assessed using the Older People's Quality of Life-Brief version, and technological literacy, evaluated using the Computer Proficiency Questionnaire-12, both of which will be administered before and after the intervention. Semistructured interviews will be completed before and after the intervention to assess participants' social connectedness, familiarity with technology, and their experience with the intervention. The study will be completed in a long-term care facility in Southwestern Ontario, Canada. Significance was set at P<.05. Results: This study was funded in April 2019 and ethical approval was obtained in August 2019. Recruitment for the study started in November 2019. The intervention began in February 2020 but was halted due to the COVID-19 pandemic. The trial will be restarted when safe. As of March 2020, 8 participants were recruited. Conclusions: Information and communication technology interventions have shown varying results in reducing loneliness and improving mental health among older adults. Few studies have examined the role of one-on-one coaching for older adults in addition to technology education in such interventions. Data from this study may have the potential to provide evidence for other groups to disseminate similar interventions in their respective communities. International Registered Report Identifier (IRRID): DERR1-10.2196/23767 ",
doi="10.2196/23767",
url="http://www.researchprotocols.org/2021/2/e23767/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33595443"
}


@Article{info:doi/10.2196/25340,
author="Koh, Qi Wei
and Ang, Hui Faith Xin
and Casey, Dympna",
title="Impacts of Low-cost Robotic Pets for Older Adults and People With Dementia: Scoping Review",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Feb",
day="12",
volume="8",
number="1",
pages="e25340",
keywords="social robot",
keywords="assistive technology",
keywords="robotic animals",
keywords="pet robots",
keywords="older adults",
keywords="dementia",
keywords="low-cost robot",
keywords="psychosocial intervention",
keywords="intervention",
keywords="robot",
keywords="review",
abstract="Background: Older adults and people with dementia are particularly vulnerable to social isolation. Social robots, including robotic pets, are promising technological interventions that can benefit the psychosocial health of older adults and people with dementia. However, issues such as high costs can lead to a lack of equal access and concerns about infection control. Although there are previous reviews on the use of robotic pets for older adults and people with dementia, none have included or had a focus on low-cost and familiarly and realistically designed pet robots. Objective: The aim of this review is to synthesize evidence on the delivery and impact of low-cost, familiarly and realistically designed interactive robotic pets for older adults and people with dementia. Methods: The Arksey and O'Malley framework was used to guide this review. First, the research question was identified. Second, searches were conducted on five electronic databases and Google Scholar. Studies were selected using a two-phase screening process, where two reviewers independently screened and extracted data using a standardized data extraction form. Finally, the results were discussed, categorized, and presented narratively. Results: A total of 9 studies were included in the review. Positive impacts related to several psychosocial domains, including mood and affect, communication and social interaction, companionship, and other well-being outcomes. Issues and concerns associated with its use included misperceptions of the robotic pets as a live animal, ethical issues of attachment, negative reactions by users, and other pragmatic concerns such as hygiene and cost. Conclusions: Overall, the findings resonate with previous studies that investigated the effectiveness of other social robots, demonstrating the promise of these low-cost robotic pets in addressing the psychosocial needs of older adults and people with dementia. The affordability of these robotic pets appeared to influence the practicalities of real-world use, such as intervention delivery and infection control, which are especially relevant in light of COVID-19. Moving forward, studies should also consider comparing the effects of these low-cost robots with other robotic pets. ",
doi="10.2196/25340",
url="http://rehab.jmir.org/2021/1/e25340/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33497349"
}


@Article{info:doi/10.2196/14781,
author="Stanyon, Miriam
and Streater, Amy
and Coleston-Shields, Maria Donna
and Yates, Jennifer
and Challis, David
and Dening, Tom
and Hoe, Juanita
and Lloyd-Evans, Brynmor
and Mitchell, Shirley
and Moniz-Cook, Esme
and Poland, Fiona
and Prothero, David
and Orrell, Martin",
title="Development of an Evidence-Based Best Practice Model for Teams Managing Crisis in Dementia: Protocol for a Qualitative Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="27",
volume="10",
number="1",
pages="e14781",
keywords="dementia",
keywords="caregivers",
keywords="crisis",
keywords="mental health",
keywords="home management",
abstract="Background: Teams working in the community to manage crisis in dementia currently exist, but with widely varying models of practice, it is difficult to determine the effectiveness of such teams. Objective: The aim of this study is to develop a ``best practice model'' for dementia services managing crisis, as well as a set of resources to help teams implement this model to measure and improve practice delivery. These will be the best practice tool and toolkit to be utilized by teams to improve the effectiveness of crisis teams working with older people with dementia and their caregivers. This paper describes the protocol for a prospective study using qualitative methods to establish an understanding of the current practice to develop a ``best practice model.'' Methods: Participants (people with dementia, caregivers, staff members, and stakeholders) from a variety of geographical areas, with a broad experience of crisis and noncrisis work, will be purposively selected to participate in qualitative approaches including interviews, focus groups, a consensus workshop, and development and field testing of both the best practice tool and toolkit. Results: Data were collected between October 2016 and August 2018. Thematic analysis will be utilized to establish the current working of teams managing crisis in dementia in order to draw together elements of the best practice. Conclusions: This is the first study to systematically explore the requirements needed to fulfill effective and appropriate home management for people with dementia and their caregivers at the time of mental health crisis, as delivered by teams managing crisis in dementia. This systematic approach to development will support greater acceptability and validity of the best practice tool and toolkit and lay the foundation for a large scale trial with teams managing crisis in dementia across England to investigate the effects on practice and impact on service provision, as well as the associated experiences of people with dementia and their caregivers. International Registered Report Identifier (IRRID): RR1-10.2196/14781 ",
doi="10.2196/14781",
url="http://www.researchprotocols.org/2021/1/e14781/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33502333"
}


@Article{info:doi/10.2196/19244,
author="Sturge, Jodi
and Meijering, Louise
and Jones, Allyson C.
and Garvelink, Mirjam
and Caron, Danielle
and Nordin, Susanna
and Elf, Marie
and L{\'e}gar{\'e}, France",
title="Technology to Improve Autonomy and Inform Housing Decisions for Older Adults With Memory Problems Who Live at Home in Canada, Sweden, and the Netherlands: Protocol for a Multipronged Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="21",
volume="10",
number="1",
pages="e19244",
keywords="aging in place",
keywords="co-design",
keywords="cross-country comparison",
keywords="electronic decision support intervention",
keywords="housing decisions",
keywords="memory problems",
keywords="mixed methods",
keywords="mobility patterns",
keywords="shared decision making",
keywords="technology",
abstract="Background: Understanding the mobility patterns and experiences of older adults with memory problems living at home has the potential to improve autonomy and inform shared decision making (SDM) about their housing options. Objective: We aim to (1) assess the mobility patterns and experiences of older adults with memory problems, (2) co-design an electronic decision support intervention (e-DSI) that integrates users' mobility patterns and experiences, (3) explore their intention to use an e-DSI to support autonomy at home, and (4) inform future SDM processes about housing options. Methods: Informed by the Good Reporting of A Mixed Methods Study (GRAMMS) reporting guidelines, we will conduct a 3-year, multipronged mixed methods study in Canada, Sweden, and the Netherlands. For Phase 1, we will recruit a convenience sample of 20 older adults living at home with memory problems from clinical and community settings in each country, for a total of 60 participants. We will ask participants to record their mobility patterns outside their home for 14 days using a GPS tracker and a travel diary; in addition, we will conduct a walking interview and a final debrief interview after 14 days. For Phase 2, referring to results from the first phase, we will conduct one user-centered co-design process per country with older adults with memory issues, caregivers, health care professionals, and information technology representatives informed by the Double Diamond method. We will ask participants how personalized information about mobility patterns and experiences could be added to an existing e-DSI and how this information could inform SDM about housing options. For Phase 3, using online web-based surveys, we will invite 210 older adults with memory problems and/or their caregivers, split equally across the three countries, to use the e-DSI and provide feedback on its strengths and limitations. Finally, in Phase 4, we will triangulate and compare data from all phases and countries to inform a stakeholder meeting where an action plan will be developed. Results: The study opened for recruitment in the Netherlands in November 2018 and in Canada and Sweden in December 2019. Data collection will be completed by April 2021. Conclusions: This project will explore how e-DSIs can integrate the mobility patterns and mobility experiences of older adults with memory problems in three countries, improve older adults' autonomy, and, ultimately, inform SDM about housing options. Trial Registration: ClinicalTrials.gov NCT04267484; https://clinicaltrials.gov/ct2/show/NCT04267484 International Registered Report Identifier (IRRID): DERR1-10.2196/19244 ",
doi="10.2196/19244",
url="http://www.researchprotocols.org/2021/1/e19244/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33475512"
}


@Article{info:doi/10.2196/24157,
author="Hunter, Inga
and Elers, Phoebe
and Lockhart, Caroline
and Guesgen, Hans
and Singh, Amardeep
and Whiddett, Dick",
title="Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Dec",
day="2",
volume="8",
number="12",
pages="e24157",
keywords="smart home",
keywords="home monitoring technology",
keywords="aging in place",
keywords="information governance",
keywords="information management",
keywords="older people",
keywords="support network",
keywords="aging",
keywords="elderly health",
abstract="Background: Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. Objective: The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people's health and well-being. Methods: Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. Results: The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was ``access to technology and systems,'' which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was ``collecting and sharing of information,'' which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients' social environment. The third theme was that all respondents identified similar ``barriers to uptake'': cost and funding issues, usability of systems by older people, and information security and privacy concerns. Conclusions: The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people's unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required. ",
doi="10.2196/24157",
url="https://mhealth.jmir.org/2020/12/e24157",
url="http://www.ncbi.nlm.nih.gov/pubmed/33263551"
}


@Article{info:doi/10.2196/16012,
author="Li, Laiyou
and Sun, Ning
and Yu, Libo
and Dong, Xiaoxin
and Zhao, Jing
and Ying, Yuchen",
title="The Needs of Older Adults With Disabilities With Regard to Adaptation to Aging and Home Care: Questionnaire Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Oct",
day="26",
volume="7",
number="2",
pages="e16012",
keywords="community",
keywords="disability",
keywords="older people",
keywords="adaptation to aging",
keywords="influence factor",
abstract="Background: The home environment is an important means of support in home-based care services for older people. A home environment that facilitates healthy aging can help older adults maximize their self-care abilities and integrate and utilize care resources. However, some home environments fail to meet the needs of older adults with disabilities. Objective: This paper aimed to study the needs of older adults with disabilities with respect to adaptation to aging, and to analyze the associations of individual factors and dysfunction with those needs. Methods: A questionnaire survey was administered to 400 older adults with disabilities from 10 communities in Ningbo City, Zhejiang Province, China. The survey was conducted from August 2018 to February 2019. Results: A total of 370 participants completed the survey. The proportion of participants with mild dysfunction was the highest (128/370, 34.59\%), followed by those with extremely mild (107/370, 28.92\%), moderate (72/370, 19.46\%), and severe (63/370, 17.03\%) dysfunction. The care needs of older adults with extremely mild and mild dysfunction pertained primarily to resting, a supportive environment, and transformation of indoor activity spaces. The care needs of older adults with moderate dysfunction pertained mainly to resting and renovation of bathing and toilet spaces. Factors influencing the needs of older adults with disabilities were dysfunction (P=.007), age (P=.006), monthly income (P=.005), and living conditions (P=.04). Conclusions: The needs of older adults with disabilities varied by the degree of dysfunction, and many factors influenced these needs in the community. These findings may provide a scientific basis for developing community-specific aging-related adaptation services for older adults with disabilities in the future. ",
doi="10.2196/16012",
url="http://rehab.jmir.org/2020/2/e16012/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33104000"
}


@Article{info:doi/10.2196/20938,
author="Piera-Jim{\'e}nez, Jordi
and Daugbjerg, Signe
and Stafylas, Panagiotis
and Meyer, Ingo
and M{\"u}ller, Sonja
and Lewis, Leo
and da Col, Paolo
and Folkvord, Frans
and Lupi{\'a}{\~n}ez-Villanueva, Francisco",
title="BeyondSilos, a Telehealth-Enhanced Integrated Care Model in the Domiciliary Setting for Older Patients: Observational Prospective Cohort Study for Effectiveness and Cost-Effectiveness Assessments",
journal="JMIR Med Inform",
year="2020",
month="Oct",
day="6",
volume="8",
number="10",
pages="e20938",
keywords="integrated care",
keywords="telemedicine",
keywords="telecare",
keywords="digital health",
keywords="cost-effectiveness",
keywords="clinical effectiveness",
keywords="chronic disease",
abstract="Background: Information and communication technology may provide domiciliary care programs with continuity of care. However, evidence about the effectiveness and cost-effectiveness of information and communication technology in the context of integrated care models is relatively scarce. Objective: The objective of our study was to provide evidence on the clinical effectiveness and cost-effectiveness of the BeyondSilos project for patients enrolled in the Badalona city pilot site in Spain. Methods: A quasi-experimental study was used to assess the cost-effectiveness of information and communication technology--enhanced integration of health and social care, including the third sector (intervention), compared to basic health and social care coordination (comparator). The study was conducted in Badalona between 2015 and 2016. Participants were followed for 8 months. Results: The study included 198 patients: 98 in the intervention group and 100 in the comparator group. The mean Barthel index remained unchanged in the intervention group (mean change 0.14, 95\% CI --4.51 to 4.78; P=.95) but decreased in the comparator group (mean change --3.23, 95\% CI --5.34 to --1.11; P=.003). Instrumental Activities of Daily Living significantly decreased in both groups: mean changes of --0.23 (95\% CI --0.44 to --0.02; P=.03) and --0.33 (95\% CI --0.46 to --0.20; P<.001) in the intervention and comparator groups, respectively. No differences were found in the Geriatric Depression Scale (intervention: mean change 0.28, 95\% CI --0.44 to 1.01, P=.44; comparator: mean change --0.29, 95\% CI --0.59 to 0.01, P=.06). The intervention showed cost-effectiveness (incremental cost-effectiveness ratio {\texteuro}6505.52, approximately US \$7582). Conclusions: The information and communication technology--enhanced integrated domiciliary care program was cost-effective. The beneficial effects of this approach strongly rely upon the commitment of the professional staff involved. Trial Registration: ClinicalTrials.gov NCT03111004; http://clinicaltrials.gov/ct2/show/ NCT03111004 ",
doi="10.2196/20938",
url="https://medinform.jmir.org/2020/10/e20938",
url="http://www.ncbi.nlm.nih.gov/pubmed/33021490"
}


@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/10.2196/16175,
author="Guay, Manon
and Latulippe, Karine
and Auger, Claudine
and Giroux, Dominique
and S{\'e}guin-Tremblay, No{\'e}mie
and Gauthier, Jos{\'e}e
and Genest, Catherine
and Morales, Ernesto
and Vincent, Claude",
title="Self-Selection of Bathroom-Assistive Technology: Development of an Electronic Decision Support System (Hygiene 2.0)",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="10",
volume="22",
number="8",
pages="e16175",
keywords="hygiene",
keywords="activities of daily living",
keywords="decision aids",
keywords="occupational therapy",
keywords="aging",
keywords="self-help devices",
keywords="universal design",
keywords="accidental falls",
keywords="mobile phone",
abstract="Background: A clinical algorithm (Algo) in paper form is used in Quebec, Canada, to allow health care workers other than occupational therapists (OTs) to make bathroom adaptation recommendations for older adults. An integrated knowledge transfer process around Algo suggested an electronic version of this decision support system (electronic decision support system [e-DSS]) to be used by older adults and their caregivers in search of information and solutions for their autonomy and safety in the bathroom. Objective: This study aims to (1) create an e-DSS for the self-selection of bathroom-assistive technology by community-dwelling older adults and their caregivers and (2) assess usability with lay users and experts to improve the design accordingly. Methods: On the basis of a user-centered design approach, the process started with content identification for the prototype through 7 semistructured interviews with key informants of various backgrounds (health care providers, assistive technology providers, and community services) and 4 focus groups (2 with older adults and 2 with caregivers). A thematic content transcript analysis was carried out and used during the creation of the prototype. The prototype was refined iteratively using think-aloud and observation methods with a clinical expert (n=1), researchers (n=3), OTs (n=3), older adults (n=3), and caregivers (n=3), who provided information on the usability of the e-DSS. Results: Overall, 4 themes served as the criteria for the prototype of the electronic Algo (Hygiene 2.0 [H2.0]): focus (safety, confidentiality, well-being, and autonomy), engage, facilitate (simplify, clarify, and illustrate), and access. For example, users first pay attention to the images (engage and illustrate) that can be used to depict safe postures (safety), illustrate questions embedded in the decision support tool (clarify and illustrate), and demonstrate the context of the use of assistive technology (safety and clarify). Conclusions: The user-centered design of H2.0 allowed the cocreation of an e-DSS in the form of a website, in line with the needs of community-dwelling older adults and their caregivers seeking bathroom-assistive technology that enables personal hygiene. Each iteration improved usability and brought more insight into the users' realities, tailoring the e-DSS to the implementation context. ",
doi="10.2196/16175",
url="https://www.jmir.org/2020/8/e16175",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773380"
}


@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/10.2196/15600,
author="Guisado-Fernandez, Estefania
and Blake, Catherine
and Mackey, Laura
and Silva, Alexandra Paula
and Power, Dermot
and O'Shea, Diarmuid
and Caulfield, Brian",
title="A Smart Health Platform for Measuring Health and Well-Being Improvement in People With Dementia and Their Informal Caregivers: Usability Study",
journal="JMIR Aging",
year="2020",
month="Jul",
day="23",
volume="3",
number="2",
pages="e15600",
keywords="Connected Health",
keywords="dementia",
keywords="informal caregiver",
keywords="home care",
keywords="home monitoring",
abstract="Background: Dementia is a neurodegenerative chronic condition characterized by a progressive decline in a person's memory, thinking, learning skills, and the ability to perform activities of daily living. Previous research has indicated that there are many types of technology interventions available in the literature that have shown promising results in improving disease progression, disease management, and the well-being of people with dementia (PwD) and their informal caregiver, thus facilitating dementia care and living. Technology-driven home care interventions, such as Connected Health (CH), could offer a convenient and low-cost alternative to traditional home care, providing an informal caregiver with the support they may need at home while caring for a PwD, improving their physical and mental well-being. Objective: This study aimed (1) to create a multidimensional profile for evaluating the well-being progression of the PwD--informal caregiver dyad for a year during their use of a CH platform, designed for monitoring PwD and supporting their informal caregivers at home, and (2) to conduct a long-term follow-up using the proposed well-being profile at different time-interval evaluations. Methods: The PwD--informal caregiver well-being profile was created based on the World Health Organization International Classification of Functioning considering the following outcomes: functional status, cognitive status, and quality of life for the PwD and mental well-being, sleeping quality, and burden for the informal caregiver. Over a year, comprehensive assessments of these outcomes were conducted every 3 months to evaluate the well-being of PwD--informal caregivers, using international and standardized validated questionnaires. Participants' demographic information was analyzed using descriptive statistics and presented as means and SDs. A nonparametric Friedman test was used to analyze the outcome changes and the progression in the PwD-caregiver dyads and to determine if those changes were statistically significant. Results: There were no significant changes in the well-being of PwD or their caregivers over the year of follow-up, with the majority of the PwD-caregiver dyads remaining stable. The only instances in which significant changes were observed were the functional status in the PwD and sleep quality in their caregivers. In each of these measures, post hoc pairwise comparisons did not indicate that the changes observed were related to the deployment of the CH platform. Conclusions: The follow-up of this population of PwD and their informal caregivers has shown that disease progression and physical and mental well-being do not change significantly during the time, being a slow and gradual process. The well-being profile created to analyze the potential impact of the CH platform on the PwD--informal caregiver dyad well-being, once validated, could be used as a future tool to conduct the same analyses with other CH technologies for this population. International Registered Report Identifier (IRRID): RR2-10.2196/13280 ",
doi="10.2196/15600",
url="http://aging.jmir.org/2020/2/e15600/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706650"
}


@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/10.2196/17930,
author="Verloo, Henk
and Kampel, Thomas
and Vidal, Nicole
and Pereira, Filipa",
title="Perceptions About Technologies That Help Community-Dwelling Older Adults Remain at Home: Qualitative Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="4",
volume="22",
number="6",
pages="e17930",
keywords="technology",
keywords="gerontechnology",
keywords="photo-elicitation",
keywords="informal caregivers",
keywords="cognitive impairment",
keywords="professional caregivers",
keywords="interviews",
keywords="focus groups",
keywords="content analysis",
keywords="physical impairment",
keywords="frailty",
abstract="Background: The population of Europe is aging rapidly. Most community-dwelling older adults (CDOAs) want to remain in their homes, particularly those experiencing functional decline. Politicians and academics repeatedly praise technological instruments for being the preferred solution for helping older adults with deteriorating health to remain at home. Objective: This study aimed to understand the perceptions of CDOAs and their informal caregivers (ICs) and professional caregivers (PCs) about technologies that can help keep older adults at home. Methods: This qualitative study used personal interviews, focus groups, and photo-elicitation interviews to better understand the perceptions of a convenience sample of 68 CDOAs, 21 ICs, and 32 PCs. Results: A fraction of CDOAs did not perceive technological instruments to be a very useful means of helping them remain at home. However, the ICs and PCs were more positive. The CDOAs preferred and were more willing to adopt technologies related to their mobility and safety and those that would help slow down their cognitive decline. The ICs preferred technological aids that assist in the activities of daily living as well as safety-related technologies for detecting falls and helping to locate disoriented older adults. The PCs preferred integrated communication and information systems to improve collaboration between all stakeholders, housing equipped with technologies to manage complex care, high-performance ancillary equipment to transfer people with reduced mobility, and surveillance systems to ensure safety at home. Conclusions: Although our study reports that CDOAs have limited interest in innovative technologies to help them remain at home, their technological skills will undoubtedly improve in the future, as will those of ICs and PCs. Technological tools will play an increasingly important role in home health care. ",
doi="10.2196/17930",
url="http://www.jmir.org/2020/6/e17930/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32496197"
}


@Article{info:doi/10.2196/15976,
author="Chen, Chien-I Sonia
and Liu, Chenglian
and Wang, Zhenyuan
and McAdam, Rodney
and Brennan, Michael
and Davey, Shirley
and Cheng, Yuan Teng",
title="How Geographical Isolation and Aging in Place Can Be Accommodated Through Connected Health Stakeholder Management: Qualitative Study With Focus Groups",
journal="J Med Internet Res",
year="2020",
month="May",
day="27",
volume="22",
number="5",
pages="e15976",
keywords="connected health care",
keywords="remote areas",
keywords="business strategy",
keywords="Taiwan",
keywords="population aging",
keywords="knowledge sharing",
abstract="Background: In remote areas, connected health (CH) is needed, but as local resources are often scarce and the purchasing power of residents is usually poor, it is a challenge to apply CH in these settings. In this study, CH is defended as a technological solution for reshaping the direction of health care to be more proactive, preventive, and precisely targeted---and thus, more effective. Objective: The objective of this study was to explore the identity of CH stakeholders in remote areas of Taiwan and their interests and power in order to determine ideal strategies for applying CH. We aimed to explore the respective unknowns and discover insights for those facing similar issues. Methods: Qualitative research was conducted to investigate and interpret the phenomena of the aging population in a remote setting. An exploratory approach was employed involving semistructured interviews with 22 participants from 8 remote allied case studies. The interviews explored perspectives on stakeholder arrangements, including the power and interests of stakeholders and the needs of all the parties in the ecosystem. Results: Results were obtained from in-depth interviews and focus groups that included identifying the stakeholders of remote health and determining how they influence its practice, as well as how associated agreements bring competitive advantages. Stakeholders included people in government sectors, industrial players, academic researchers, end users, and their associates who described their perspectives on their power and interests in remote health service delivery. Specific facilitators of and barriers to effective delivery were identified. A number of themes, such as government interests and power of decision making, were corroborated across rural and remote services. These themes were broadly grouped into the disclosure of conflicts of interest, asymmetry in decision making, and data development for risk assessment. Conclusions: This study contributes to current knowledge by exploring the features of CH in remote areas and investigating its implementation from the perspectives of stakeholder management. It offers insights into managing remote health through a CH platform, which can be used for preliminary quantitative research. Consequently, these findings could help to more effectively facilitate diverse stakeholder engagement for health information sharing and social interaction. ",
doi="10.2196/15976",
url="http://www.jmir.org/2020/5/e15976/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459181"
}


@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/10.2196/14583,
author="Della Mea, Vincenzo
and Popescu, Horia Mihai
and Gonano, Dario
and Petaros, Toma?
and Emili, Ivo
and Fattori, Grazia Maria",
title="A Communication Infrastructure for the Health and Social Care Internet of Things: Proof-of-Concept Study",
journal="JMIR Med Inform",
year="2020",
month="Feb",
day="25",
volume="8",
number="2",
pages="e14583",
keywords="health services for the aged",
keywords="remote sensing technology",
keywords="sensors and actuators",
keywords="embedded systems",
keywords="Internet of Things",
keywords="LoRaWAN",
abstract="Background: Increasing life expectancy and reducing birth rates indicate that the world population is becoming older, with many challenges related to quality of life for old and fragile people, as well as their informal caregivers. In the last few years, novel information and communication technology techniques generally known as the Internet of Things (IoT) have been developed, and they are centered around the provision of computation and communication capabilities to objects. The IoT may provide older people with devices that enable their functional independence in daily life by either extending their own capacity or facilitating the efforts of their caregivers. LoRa is a proprietary wireless transmission protocol optimized for long-range, low-power, low--data-rate applications. LoRaWAN is an open stack built upon LoRa. Objective: This paper describes an infrastructure designed and experimentally developed to support IoT deployment in a health care setup, and the management of patients with Alzheimer's disease and dementia has been chosen for a proof-of-concept study. The peculiarity of the proposed approach is that it is based on the LoRaWAN protocol stack, which exploits unlicensed frequencies and allows for the use of very low-power radio devices, making it a rational choice for IoT communication. Methods: A complete LoRaWAN-based infrastructure was designed, with features partly decided in agreement with caregivers, including outdoor patient tracking to control wandering; fall recognition; and capability of collecting data for further clinical studies. Further features suggested by caregivers were night motion surveillance and indoor tracking for large residential structures. Implementation involved a prototype node with tracking and fall recognition capabilities, a middle layer based on an existing network server, and a Web application for overall management of patients and caregivers. Tests were performed to investigate indoor and outdoor capabilities in a real-world setting and study the applicability of LoRaWAN in health and social care scenarios. Results: Three experiments were carried out. One aimed to test the technical functionality of the infrastructure, another assessed indoor features, and the last assessed outdoor features. The only critical issue was fall recognition, because a slip was not always easy to recognize. Conclusions: The project allowed the identification of some advantages and restrictions of the LoRaWAN technology when applied to the health and social care sectors. Free installation allows the development of services that reach ranges comparable to those available with cellular telephony, but without running costs like telephony fees. However, there are technological limitations, which restrict the scenarios in which LoRaWAN is applicable, although there is room for many applications. We believe that setting up low-weight infrastructure and carefully determining whether applications can be concretely implemented within LoRaWAN limits might help in optimizing community care activities while not adding much burden and cost in information technology management. ",
doi="10.2196/14583",
url="http://medinform.jmir.org/2020/2/e14583/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130158"
}


@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/10.2196/15381,
author="Martin-Hammond, Aqueasha
and Vemireddy, Sravani
and Rao, Kartik",
title="Exploring Older Adults' Beliefs About the Use of Intelligent Assistants for Consumer Health Information Management: A Participatory Design Study",
journal="JMIR Aging",
year="2019",
month="Dec",
day="11",
volume="2",
number="2",
pages="e15381",
keywords="intelligent assistants",
keywords="artificial intelligence",
keywords="chatbots",
keywords="conversational agents",
keywords="digital health",
keywords="elderly",
keywords="aging in place",
keywords="participatory design",
keywords="co-design",
keywords="health information seeking",
abstract="Background: Intelligent assistants (IAs), also known as intelligent agents, use artificial intelligence to help users achieve a goal or complete a task. IAs represent a potential solution for providing older adults with individualized assistance at home, for example, to reduce social isolation, serve as memory aids, or help with disease management. However, to design IAs for health that are beneficial and accepted by older adults, it is important to understand their beliefs about IAs, how they would like to interact with IAs for consumer health, and how they desire to integrate IAs into their homes. Objective: We explore older adults' mental models and beliefs about IAs, the tasks they want IAs to support, and how they would like to interact with IAs for consumer health. For the purpose of this study, we focus on IAs in the context of consumer health information management and search. Methods: We present findings from an exploratory, qualitative study that investigated older adults' perspectives of IAs that aid with consumer health information search and management tasks. Eighteen older adults participated in a multiphase, participatory design workshop in which we engaged them in discussion, brainstorming, and design activities that helped us identify their current challenges managing and finding health information at home. We also explored their beliefs and ideas for an IA to assist them with consumer health tasks. We used participatory design activities to identify areas in which they felt IAs might be useful, but also to uncover the reasoning behind the ideas they presented. Discussions were audio-recorded and later transcribed. We compiled design artifacts collected during the study to supplement researcher transcripts and notes. Thematic analysis was used to analyze data. Results: We found that participants saw IAs as potentially useful for providing recommendations, facilitating collaboration between themselves and other caregivers, and for alerts of serious illness. However, they also desired familiar and natural interactions with IAs (eg, using voice) that could, if need be, provide fluid and unconstrained interactions, reason about their symptoms, and provide information or advice. Other participants discussed the need for flexible IAs that could be used by those with low technical resources or skills. Conclusions: From our findings, we present a discussion of three key components of participants' mental models, including the people, behaviors, and interactions they described that were important for IAs for consumer health information management and seeking. We then discuss the role of access, transparency, caregivers, and autonomy in design for addressing participants' concerns about privacy and trust as well as its role in assisting others that may interact with an IA on the older adults' behalf. International Registered Report Identifier (IRRID): RR2-10.1145/3240925.3240972 ",
doi="10.2196/15381",
url="http://aging.jmir.org/2019/2/e15381/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31825322"
}


@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/10.2196/13280,
author="Guisado-Fernandez, Estefania
and Caulfield, Brian
and Silva, Alexandra Paula
and Mackey, Laura
and Singleton, David
and Leahy, Daniel
and Dossot, S{\'e}bastien
and Power, Dermot
and O'Shea, Diarmuid
and Blake, Catherine",
title="Development of a Caregivers' Support Platform (Connected Health Sustaining Home Stay in Dementia): Protocol for a Longitudinal Observational Mixed Methods Study",
journal="JMIR Res Protoc",
year="2019",
month="Aug",
day="28",
volume="8",
number="8",
pages="13280",
keywords="connected health",
keywords="dementia",
keywords="caregivers",
keywords="home care",
keywords="home monitoring",
abstract="Background: Dementia disease is a chronic condition that leads a person with dementia (PwD) into a state of progressive deterioration and a greater dependence in performing their activities of daily living (ADL). It is believed nowadays that PwDs and their informal caregivers can have a better life when provided with the appropriate services and support. Connected Health (CH) is a new technology-enabled model of chronic care delivery where the stakeholders are connected through a health portal, ensuring continuity and efficient flow of information. CH has demonstrated promising results regarding supporting informal home care and Aging in Place, and it has been increasingly considered by researchers and health care providers as a method for dementia home care management. Objective: This study aims to describe the development and implementation protocol of a CH platform system to support informal caregivers of PwDs at home. Methods: This is a longitudinal observational mixed methods study where quantitative and qualitative data will be combined for determining the utility of the CH platform for dementia home care. Dyads, consisting of a PwD and their informal caregiver living in the community, will be divided into 2 groups: the intervention group, which will receive the CH technology package at home, and the usual care group, which will not have any CH technology at all. Dyads will be followed up for 12 months during which they will continue with their traditional care plan, but in addition, the intervention group will receive the CH package for their use at home during 6 months (months 3 to 9 of the yearly follow-up). Further comprehensive assessments related to the caregiver's and PwD's emotional and physical well-being will be performed at the initial assessment and at 3, 6, 9, and 12 months using international and standardized validated questionnaires and semistructured individual interviews. Results: This 3-year funded study (2016-2019) is currently in its implementation phase and is expected to finish by December 2019. We believe that CH can potentially change the PwD current care model, facilitating a proactive and preventive model, utilizing self-management--based strategies, and enhancing caregivers' involvement in the management of health care at home for PwDs. Conclusions: We foresee that our CH platform will provide knowledge and promote autonomy for the caregivers, which may empower them into greater control of the care for PwDs, and with it, improve the quality of life and well-being for the person they are caring for and for themselves through a physical and cognitive decline predictive model. We also believe that facilitating information sharing between all the PwDs' care stakeholders may enable a stronger relationship between them, facilitate a more coordinated care plan, and increase the feelings of empowerment in the informal caregivers. International Registered Report Identifier (IRRID):   DERR1-10.2196/13280 ",
doi="10.2196/13280",
url="http://www.researchprotocols.org/2019/8/e13280/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31464187"
}


@Article{info:doi/10.2196/13228,
author="Daniele, Katia
and Marcucci, Maura
and Cattaneo, Cesarina
and Borghese, Alberto Nunzio
and Zannini, Lucia",
title="How Prefrail Older People Living Alone Perceive Information and Communications Technology and What They Would Ask a Robot for: Qualitative Study",
journal="J Med Internet Res",
year="2019",
month="Aug",
day="06",
volume="21",
number="8",
pages="e13228",
keywords="frail elders",
keywords="independent living",
keywords="attitude",
keywords="technology",
keywords="information technology",
keywords="robotics",
keywords="qualitative research",
keywords="interview",
abstract="Background: In the last decade, the family system has changed significantly. Although in the past, older people used to live with their children, nowadays, they cannot always depend on assistance of their relatives. Many older people wish to remain as independent as possible while remaining in their homes, even when living alone. To do so, there are many tasks that they must perform to maintain their independence in everyday life, and above all, their well-being. Information and communications technology (ICT), particularly robotics and domotics, could play a pivotal role in aging, especially in contemporary society, where relatives are not always able to accurately and constantly assist the older person. Objective: The aim of this study was to understand the needs, preferences, and views on ICT of some prefrail older people who live alone. In particular, we wanted to explore their attitude toward a hypothetical caregiver robot and the functions they would ask for. Methods: We designed a qualitative study based on an interpretative phenomenological approach. A total of 50 potential participants were purposively recruited in a big town in Northern Italy and were administered the Fried scale (to assess the participants' frailty) and the Mini-Mental State Examination (to evaluate the older person's capacity to comprehend the interview questions). In total, 25 prefrail older people who lived alone participated in an individual semistructured interview, lasting approximately 45 min each. Overall, 3 researchers independently analyzed the interviews transcripts, identifying meaning units, which were later grouped in clustering of themes, and finally in emergent themes. Constant triangulation among researchers and their reflective attitude assured trustiness. Results: From this study, it emerged that a number of interviewees who were currently using ICT (ie, smartphones) did not own a computer in the past, or did not receive higher education, or were not all young older people (aged 65-74 years). Furthermore, we found that among the older people who described their relationship with ICT as negative, many used it in everyday life. Referring to robotics, the interviewees appeared quite open-minded. In particular, robots were considered suitable for housekeeping, for monitoring older people's health and accidental falls, and for entertainment. Conclusions: Older people's use and attitudes toward ICT does not always seem to be related to previous experiences with technological devices, higher education, or lower age. Furthermore, many participants in this study were able to use ICT, even if they did not always acknowledge it. Moreover, many interviewees appeared to be open-minded toward technological devices, even toward robots. Therefore, proposing new advanced technology to a group of prefrail people, who are self-sufficient and can live alone at home, seems to be feasible. ",
doi="10.2196/13228",
url="https://www.jmir.org/2019/8/e13228/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31389341"
}


@Article{info:doi/10.2196/12415,
author="Kozikowski, Andrzej
and Shotwell, Jillian
and Wool, Eve
and Slaboda, C. Jill
and Abrashkin, A. Karen
and Rhodes, Karin
and Smith, L. Kristofer
and Pekmezaris, Renee
and Norman, J. Gregory",
title="Care Team Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: Qualitative Study",
journal="JMIR Aging",
year="2019",
month="Jun",
day="2",
volume="2",
number="1",
pages="e12415",
keywords="home-based primary care",
keywords="homebound patients",
keywords="telehealth technology",
abstract="Background: Novel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs. Objective: The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to increase the reach of HBPC to more homebound patients. Methods: We collected qualitative data from HBPC staff (ie, physicians, registered nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York metropolitan area through 16 semistructured interviews and three focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (ie, relatedness, competence, and autonomy) as an analytical lens. Results: Four broad themes---pros and cons of scaling, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship---and multiple second-level themes emerged from the analysis. Staff acknowledged the need to scale the program without diminishing effective patient-centered care. Participants perceived alerts generated from patients and caregivers using telehealth as potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. However, they also noted that telehealth could increase efficiency and enable more informed care provision. Telehealth could enhance the patient-provider relationship by enabling caregivers to be an integral part of the patient's care team. Staff members raised the concern that patients or caregivers might unnecessarily overutilize the technology, and that some home visits are more appropriate in person rather than via telehealth. Conclusions: These findings suggest the importance of considering the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program will hopefully facilitate the optimal integration of telehealth innovations. ",
doi="10.2196/12415",
url="http://aging.jmir.org/2019/1/e12415/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518266"
}


@Article{info:doi/10.2196/12153,
author="Yang, Yang
and Hirdes, P. John
and Dubin, A. Joel
and Lee, Joon",
title="Fall Risk Classification in Community-Dwelling Older Adults Using a Smart Wrist-Worn Device and the Resident Assessment Instrument-Home Care: Prospective Observational Study",
journal="JMIR Aging",
year="2019",
month="Jun",
day="07",
volume="2",
number="1",
pages="e12153",
keywords="falls",
keywords="elderly",
keywords="wearable devices",
keywords="machine learning",
keywords="interRAI",
abstract="Background: ?Little is known about whether off-the-shelf wearable sensor data can contribute to fall risk classification or complement clinical assessment tools such as the Resident Assessment Instrument-Home Care (RAI-HC). Objective: ?This study aimed to (1) investigate the similarities and differences in physical activity (PA), heart rate, and night sleep in a sample of community-dwelling older adults with varying fall histories using a smart wrist-worn device and (2) create and evaluate fall risk classification models based on (i) wearable data, (ii) the RAI-HC, and (iii) the combination of wearable and RAI-HC data. Methods: ?A prospective, observational study was conducted among 3 faller groups (G0, G1, G2+) based on the number of previous falls (0, 1, ?2 falls) in a sample of older community-dwelling adults. Each participant was requested to wear a smart wristband for 7 consecutive days while carrying out day-to-day activities in their normal lives. The wearable and RAI-HC assessment data were analyzed and utilized to create fall risk classification models, with 3 supervised machine learning algorithms: logistic regression, decision tree, and random forest (RF). Results: ?Of 40 participants aged 65 to 93 years, 16 (40\%) had no previous falls, whereas 8 (20\%) and 16 (40\%) had experienced 1 and multiple (?2) falls, respectively. Level of PA as measured by average daily steps was significantly different between groups (P=.04). In the 3 faller group classification, RF achieved the best accuracy of 83.8\% using both wearable and RAI-HC data, which is 13.5\% higher than that of using the RAI-HC data only and 18.9\% higher than that of using wearable data exclusively. In discriminating between \{G0+G1\} and G2+, RF achieved the best area under the receiver operating characteristic curve of 0.894 (overall accuracy of 89.2\%) based on wearable and RAI-HC data. Discrimination between G0 and \{G1+G2+\} did not result in better classification performance than that between \{G0+G1\} and G2+. Conclusions: ?Both wearable data and the RAI-HC assessment can contribute to fall risk classification. All the classification models revealed that RAI-HC outperforms wearable data, and the best performance was achieved with the combination of 2 datasets. Future studies in fall risk assessment should consider using wearable technologies to supplement resident assessment instruments. ",
doi="10.2196/12153",
url="http://aging.jmir.org/2019/1/e12153/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518278"
}


@Article{info:doi/10.2196/13864,
author="Wang, Jing
and Du, Yan
and Coleman, Deidra
and Peck, Michelle
and Myneni, Sahiti
and Kang, Hong
and Gong, Yang",
title="Mobile and Connected Health Technology Needs for Older Adults Aging in Place: Cross-Sectional Survey Study",
journal="JMIR Aging",
year="2019",
month="May",
day="15",
volume="2",
number="1",
pages="e13864",
keywords="mobile health",
keywords="connected health",
keywords="wearable technology",
keywords="remote monitoring",
keywords="independent living",
keywords="aging in place",
abstract="Background: An increasing number of mobile and wearable devices are available in the market. However, the extent to which these devices can be used to assist older adults to age in place remains unclear. Objective: This study aimed to assess older adults' perceptions of using mobile and connected health technologies. Methods: Using a cross-sectional design, a total of 51 participants were recruited from a senior community center. Demographics and usage of mobile or wearable devices and online health communities were collected using a survey questionnaire. Descriptive statistics assessed usage of devices and online health communities. The Fisher exact test was used to examine the relationship between technology usage and having access to a smartphone. Results: The sample was primarily comprised non-Hispanic white (35/51, 69\%), educated (39/51, 76\% any college), and female (36/51, 71\%) participants, with an average age of 70 (SD 8) years. All participants were insured and nearly all lived at home (49/51, 94\%). A total of 86\% (44/51) of the participants had heard of wearable health devices, but only 18 out of 51 (35\%) had ever used them. Over 80\% (42/51) expressed interest in using such devices and were interested in tracking exercise and physical activity (46/51, 90\%), sleep (38/51, 75\%), blood pressure (34/51, 67\%), diet (31/51, 61\%), blood sugar (28/51, 55\%), weight (26/51, 51\%), and fall risk (23/51, 45\%). The greatest concerns about using wearable devices were cost (31/51, 61\%), safety (14/51, 28\%), and privacy (13/51, 26\%); one-fourth (12/51) reported having no concerns. They were mostly interested in sharing data from mobile and connected devices with their health care providers followed by family, online communities, friends, and no one. About 41\% (21/51) of the older adults surveyed reported having ever heard of an online health community, and roughly 40\% (20/51) of the participants reported being interested in joining such a community. Most participants reported having access to a smartphone (38/51, 74\%), and those with such access were significantly more likely to show interest in using a wearable health device (P<.001) and joining an online health community (P=.05). Conclusions: Our findings suggest that, although few older adults are currently using mobile and wearable devices and connected health technologies for managing health, they are open to this idea and are mostly interested in sharing such data with their health care providers. Further studies are warranted to explore strategies to balance the data sharing preference of older adults and how to best integrate mobile and wearable device data with clinical workflow for health care providers to promote healthy aging in place. ",
doi="10.2196/13864",
url="http://aging.jmir.org/2019/1/e13864/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518283"
}


@Article{info:doi/10.2196/12447,
author="Norell Pejner, Margaretha
and Ourique de Morais, Wagner
and Lundstr{\"o}m, Jens
and Laurell, H{\'e}l{\`e}ne
and Sk{\"a}rs{\"a}ter, Ingela",
title="A Smart Home System for Information Sharing, Health Assessments, and Medication Self-Management for Older People: Protocol for a Mixed-Methods Study",
journal="JMIR Res Protoc",
year="2019",
month="Apr",
day="30",
volume="8",
number="4",
pages="e12447",
keywords="assessments",
keywords="medication",
keywords="mixed methods",
keywords="older people",
keywords="self-management",
keywords="smart homes",
abstract="Background: Older adults often want to stay in a familiar place, such as their home, as they get older. This so-called aging in place, which may involve support from relatives or care professionals, can promote older people's independence and well-being. The combination of aging and disease, however, can lead to complex medication regimes and difficulties for care providers in correctly assessing the older person's health. In addition, the organization of health care is fragmented, which makes it difficult for health professionals to encourage older people to participate in their own care. It is also a challenge to perform adequate health assessments and to engage in appropriate communication between health care professionals. Objective: The purpose of this paper is to describe the design for an integrated home-based system that can acquire and compile health-related evidence for guidance and information-sharing among care providers and care receivers in order to support and promote medication self-management among older people. Methods: The authors used a participatory design approach for this mixed-methods project, which was divided into four phases. Phase I, Conceptualization, consists of the conceptualization of a system to support medication self-management, objective health assessments, and communication between health care professionals. Phase II, Development of a System, consists of building and bringing together the conceptualized systems from Phase I. Phase III, Pilot Study, and Phase IV, Full-Scale Intervention, are described briefly. Results: Participants in Phase I were people who were involved in some way in the care of older adults and included older adults themselves, relatives of older adults, care professionals, and industrial partners. With input from Phase I participants, we identified two relevant concepts for promoting medication self-management, both of which related to systems that participants believed could provide guidance for the older adults themselves, relatives of older adults, and care professionals. The systems will also encourage information-sharing between care providers and care receivers. The first is the concept of the Intelligent Age-Friendly Home (IAFH), defined as an integrated residential system that evolves to sense, reason, and act in response to individuals' needs, preferences, and behaviors as these change over time. The second concept is the Medication safety, Objective assessments of health-related behaviors, and Personalized medication reminders (MedOP) system, a system that would be supported by the IAFH, and which consists of three related components: one that assesses health behaviors, another that communicates health data, and a third that promotes medication self-management. Conclusions: The participants in this project were older adults, relatives of older adults, care professionals, and our industrial partners. With input from the participants, we identified two main concepts that could comprise a system for health assessment, communication, and medication self-management: the IAFH and the MedOP system. These concepts will be tested in this study to determine whether they can facilitate and promote medication self-management among older people. International Registered Report Identifier (IRRID): DERR1-10.2196/12447 ",
doi="10.2196/12447",
url="http://www.researchprotocols.org/2019/4/e12447/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31038459"
}


@Article{info:doi/10.2196/12393,
author="Du Preez, Vikki
and De La Harpe, Retha",
title="Engaging Aging Individuals in the Design of Technologies and Services to Support Health and Well-Being: Constructivist Grounded Theory Study",
journal="JMIR Aging",
year="2019",
month="Mar",
day="20",
volume="2",
number="1",
pages="e12393",
keywords="technology",
keywords="healthy aging",
keywords="grounded theory",
keywords="qualitative research",
abstract="Background: Changes noted within the aging population are physical, cognitive, as well as emotional. Social isolation and loneliness are also serious problems that the aging population may encounter. As technology and apps become more accessible, many basic services, such as those offered by social services, well-being organizations, and health care institutions, have invested in the development of supportive devices, services, and Web-based interactions. Despite the perceived benefits that these devices and services offer, many aging individuals choose not to engage, or engage in a limited manner. To explore this phenomenon, we developed a theory to describe the condition for engagement. Objective: The main objective of this study was to understand the perceptions of an aging South African population regarding Web-based services and technologies that could support aging in place (AiP). Although the concept of AiP speaks to a great number of everyday activities, this paper explores aspects of health and well-being as being central to AiP. Methods: The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, category development, and data comparisons. Data were collected through qualitative methods, including interviews (13 participants aged between 64 and 85 years), 2 participatory workshops (15 participants), and observations. The study focused on Charmaz's approach to constructivist GT, which puts forward the premise that theory or knowledge cannot take shape in a purely objective manner. Instead, theory is constructed through the interaction of the researcher and research participant. Coding and data analysis were supported with ATLAS.ti (ATLAS.ti Scientific Software Development GmbH). Results: The study resulted in a substantive theory exploring the process of interaction and engaging factors through user insights and experiences. The emerging design theory, Ageing User Decision-Driven Engagement (AUDDE), explored the elements that support engagement with technology and supportive apps, which could offer access to required health and wellness services. Conclusions: In AUDDE, the perceived value of the interaction is a crucial catalyst for engagement. Aging users continuously make meaning of their experiences, which affects their current and future actions. ",
doi="10.2196/12393",
url="http://aging.jmir.org/2019/1/e12393/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518258"
}


@Article{info:doi/10.2196/10476,
author="Cabrita, Miriam
and Tabak, Monique
and Vollenbroek-Hutten, MR Miriam",
title="Older Adults' Attitudes Toward Ambulatory Technology to Support Monitoring and Coaching of Healthy Behaviors: Qualitative Study",
journal="JMIR Aging",
year="2019",
month="Mar",
day="12",
volume="2",
number="1",
pages="e10476",
keywords="wearable technology",
keywords="telemedicine",
keywords="independent living",
keywords="healthy aging",
keywords="nutritional status",
keywords="cognitive function",
keywords="physical activity",
abstract="Background: Prevention of functional decline demands a holistic perspective of health management. Older adults are becoming avid users of technology; however, technology is not yet largely used in supporting self-management of health in daily life. Previous research suggests that the low adherence to these technologies is likely to be associated with the fact that opinions and wishes of the older population are not always taken into consideration when designing new technology. Objective: The aim of this study was to investigate the attitudes of older adults living independently regarding technology to support healthy behaviors, addressing nutrition, physical and cognitive function, and well-being. Methods: In-depth semistructured interviews were performed with 12 older adults addressing 4 themes: (1) current practices in health management, (2) attitudes toward using technology to support health management, (3) wishes from technology, and (4) change in attitudes after actual use of technology. The fourth theme was investigated with a follow-up interview after participants had used a step counter, a smart scale, and a mobile app for 1 month. Data collected were analyzed using inductive thematic analysis. Results: Participants were active in self-managing their health and foresaw an added value on using technology to support them in adopting healthier behaviors in everyday life. Attitudes and wishes differed considerably per health domain, with cognitive function being the most sensitive topic. Fears from technology mentioned were attention theft, replacement of human touch, and disuse of existing abilities. Poststudy interviews suggest that attitudes toward technology improve after a short period of use. Conclusions: Technology to support aging in place must target health literacy, allow personalization in the design but also in the use of the technology, and tackle existing fears concerning technology. Further research should investigate the effect of these strategies on the adherence to technology to be used in daily life. We outline a set of recommendations of interest to those involved in developing and implementing technology to support aging in place, focusing on acceptance, barriers, and ethical concerns. ",
doi="10.2196/10476",
url="http://aging.jmir.org/2019/1/e10476/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518252"
}


@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/10.2196/10952,
author="van den Kieboom, CP Robin
and Bongers, MB Inge
and Mark, E. Ruth
and Snaphaan, JAE Liselore",
title="User-Driven Living Lab for Assistive Technology to Support People With Dementia Living at Home: Protocol for Developing Co-Creation--Based Innovations",
journal="JMIR Res Protoc",
year="2019",
month="Jan",
day="28",
volume="8",
number="1",
pages="e10952",
keywords="dementia",
keywords="family caregivers",
keywords="longitudinal studies",
keywords="technology",
abstract="Background: Owing to no cure for dementia currently, there is an urgent need to look for alternative ways to support these people and their informal caregivers. Carefully designed interventions can answer the unmet needs of both people with dementia and their informal caregivers in the community. However, existing products, systems, and services are often too complex or unsuitable. Objective: This study aims to identify, longitudinally, the changing needs (as dementia progresses) of people with dementia living at home and their informal caregivers. By developing co-creation-based innovations, these changing needs will hopefully be met. Methods: A user-driven Living Lab design is used to structurally explore the needs over time of people with dementia (and their informal caregivers) living in the community in the North Brabant region of the Netherlands. In addition, co-creation-based innovations will be developed, tested, and evaluated by these people and their caregivers at home. All participants will complete complaints-oriented questionnaires at 3 time-points---at the baseline, 1 year, and 2 years after they start participating. Home interviews are scheduled to explore if and how these complaints translate into participants' specific needs or wishes. Focus groups meet on a monthly basis to further identify the needs of people with dementia and their informal caregivers and provide feedback to the stakeholders. In the context field, participants have an opportunity to actually test the products at home and provide feedback. Quantitative outcome measurements include neuropsychiatric symptoms, cognitive decline, independence in activities of daily living, safety, and caregiver burden. Qualitative outcome measurements include feedback to the stakeholders regarding the needs of people with dementia and their informal caregivers and how these needs change over time, as well as user experiences about the specific innovations. Results: Participant recruitment will start in September 2018 and is ongoing. The first results of data analyses are expected in the spring of 2019. Conclusions: The overall aim of Innovate Dementia 2.0 is to facilitate person-centered innovations developed for people with dementia and their informal caregivers at all stages as dementia progresses. This should lead to newly designed concepts and innovations, which are better able to answer the needs of people with dementia and their caregivers in the community. International Registered Report Identifier (IRRID): DERR1-10.2196/10952 ",
doi="10.2196/10952",
url="http://www.researchprotocols.org/2019/1/e10952/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30688653"
}


@Article{info:doi/10.2196/11955,
author="VanRavenstein, Kathy
and Davis, H. Boyd",
title="When More Than Exercise Is Needed to Increase Chances of Aging in Place: Qualitative Analysis of a Telehealth Physical Activity Program to Improve Mobility in Low-Income Older Adults",
journal="JMIR Aging",
year="2018",
month="Dec",
day="21",
volume="1",
number="2",
pages="e11955",
keywords="older adults",
keywords="low income",
keywords="physical activity",
keywords="aging in place",
keywords="social isolation",
keywords="qualitative research",
abstract="Background: A telehealth-delivered physical activity program was implemented within two low-income older adult housing properties utilizing the Otago exercise program, a physical therapy program endorsed by the Centers for Disease Control and Prevention to improve balance and strengthening in community dwelling older adults and by the National Council on Aging as the highest level of evidence for fall prevention programs. Participants were also given Fitbit activity monitors to help track their activity. Objective: The goal of this project was to increase older adults' daily physical activity in hopes of decreasing chronic disease morbidity, disability, and falls, and decrease social isolation. Methods: The Otago exercise program was conducted via telehealth twice weekly for 12 weeks. Participants also wore Fitbit activity trackers to encourage physical activity outside of the group classes. Postintervention qualitative interviews were conducted, recorded, transcribed, and analyzed using discourse analysis. Results: Twenty-one older adult participants from two low-income properties in Charleston, SC, participated in the 12-week telehealth physical therapy program. Postintervention qualitative interviews revealed that the two sites were very different in their participation in the program and their main concerns surrounding aging in place. One site had a community-oriented outlook and enjoyed participating in physical activity together; whereas, the other site had very few participants and referenced depression and social isolation as main concerns. Conclusions: A telehealth physical therapy-led intervention to increase physical activity in low-income older adults aging in place was successfully implemented and attended; however, it became clear in postintervention qualitative interviews that social isolation and depression were prevalent and mental health needs to be addressed along with physical health to encourage successful aging in place. ",
doi="10.2196/11955",
url="http://aging.jmir.org/2018/2/e11955/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518250"
}


@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/10.2196/10054,
author="Stokke, Randi",
title="Older People Negotiating Independence and Safety in Everyday Life Using Technology: Qualitative Study",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="19",
volume="20",
number="10",
pages="e10054",
keywords="welfare technology",
keywords="patient care",
keywords="the social alarm",
keywords="caring practices",
keywords="home care services",
keywords="science and technology studies",
keywords="public service innovation",
keywords="co-production",
abstract="Background: Due to demographic changes with an aging population, there is a demand for technology innovations in care services. However, technology innovations have proven difficult to implement in regular use. To understand the complexity of technology innovations in care practices, we need a knowledge base of the complex and diverse experiences of people interacting with established technologies. Objective: This paper addresses the research gap in relation to understanding the microcontext of co-production of care involving established technologies integrated into care practices. The paper also aims to provide a framework for exploring what really happens when different actors use technology in care practices. Methods: Participant observations and 22 interviews with actors using social alarms were conducted employing the critical incident technique. A stepwise deductive-inductive analysis was then performed. Results: The results reveal how co-production of care assumes different meanings according to how actors use the technology. The results also show how technology innovation changes the dynamics between the actors and rearranges care practices. Independent and safe living is co-produced through performing bricolages and optimizing practice. Additionally, this opens up for unexpected results and bricolages as an integrated part of technology innovations. Conclusions: This study illustrates how care services are always co-produced between the actors involved. By using aspects from science and technology studies, this paper provides a framework for exploring technology in use in care practices. The framework provides tools to unpack and articulate the process of co-producing services. ",
doi="10.2196/10054",
url="http://www.jmir.org/2018/10/e10054/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30341049"
}


@Article{info:doi/10.2196/jmir.9460,
author="Cavallo, Filippo
and Esposito, Raffaele
and Limosani, Raffaele
and Manzi, Alessandro
and Bevilacqua, Roberta
and Felici, Elisa
and Di Nuovo, Alessandro
and Cangelosi, Angelo
and Lattanzio, Fabrizia
and Dario, Paolo",
title="Robotic Services Acceptance in Smart Environments With Older Adults: User Satisfaction and Acceptability Study",
journal="J Med Internet Res",
year="2018",
month="Sep",
day="21",
volume="20",
number="9",
pages="e264",
keywords="social robotics",
keywords="active and healthy aging",
keywords="acceptability models",
abstract="Background: In Europe, the population of older people is increasing rapidly. Many older people prefer to remain in their homes but living alone could be a risk for their safety. In this context, robotics and other emerging technologies are increasingly proposed as potential solutions to this societal concern. However, one-third of all assistive technologies are abandoned within one year of use because the end users do not accept them. Objective: The aim of this study is to investigate the acceptance of the Robot-Era system, which provides robotic services to permit older people to remain in their homes. Methods: Six robotic services were tested by 35 older users. The experiments were conducted in three different environments: private home, condominium, and outdoor sites. The appearance questionnaire was developed to collect the users' first impressions about the Robot-Era system, whereas the acceptance was evaluated through a questionnaire developed ad hoc for Robot-Era. Results: A total of 45 older users were recruited. The people were grouped in two samples of 35 participants, according to their availability. Participants had a positive impression of Robot-Era robots, as reflected by the mean score of 73.04 (SD 11.80) for DORO's (domestic robot) appearance, 76.85 (SD 12.01) for CORO (condominium robot), and 75.93 (SD 11.67) for ORO (outdoor robot). Men gave ORO's appearance an overall score higher than women (P=.02). Moreover, participants younger than 75 years understood more readily the functionalities of Robot-Era robots compared to older people (P=.007 for DORO, P=.001 for CORO, and P=.046 for ORO). For the ad hoc questionnaire, the mean overall score was higher than 80 out of 100 points for all Robot-Era services. Older persons with a high educational level gave Robot-Era services a higher score than those with a low level of education (shopping: P=.04; garbage: P=.047; reminding: P=.04; indoor walking support: P=.006; outdoor walking support: P=.03). A higher score was given by male older adults for shopping (P=.02), indoor walking support (P=.02), and outdoor walking support (P=.03). Conclusions: Based on the feedback given by the end users, the Robot-Era system has the potential to be developed as a socially acceptable and believable provider of robotic services to facilitate older people to live independently in their homes. ",
doi="10.2196/jmir.9460",
url="http://www.jmir.org/2018/9/e264/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30249588"
}


@Article{info:doi/10.2196/10741,
author="Elers, Phoebe
and Hunter, Inga
and Whiddett, Dick
and Lockhart, Caroline
and Guesgen, Hans
and Singh, Amardeep",
title="User Requirements for Technology to Assist Aging in Place: Qualitative Study of Older People and Their Informal Support Networks",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jun",
day="06",
volume="6",
number="6",
pages="e10741",
keywords="aging in place",
keywords="informal support",
keywords="smart home",
keywords="home monitoring technology",
abstract="Background: Informal support is essential for enabling many older people to age in place. However, there is limited research examining the information needs of older adults' informal support networks and how these could be met through home monitoring and information and communication technologies. Objective: The purpose of this study was to investigate how technologies that connect older adults to their informal and formal support networks could assist aging in place and enhance older adults' health and well-being. Methods: Semistructured interviews were conducted with 10 older adults and a total of 31 members of their self-identified informal support networks. They were asked questions about their information needs and how technology could support the older adults to age in place. The interviews were transcribed and thematically analyzed. Results: The analysis identified three overarching themes: (1) the social enablers theme, which outlined how timing, informal support networks, and safety concerns assist the older adults' uptake of technology, (2) the technology concerns theme, which outlined concerns about cost, usability, information security and privacy, and technology superseding face-to-face contact, and (3) the information desired theme, which outlined what information should be collected and transferred and who should make decisions about this. Conclusions: Older adults and their informal support networks may be receptive to technology that monitors older adults within the home if it enables aging in place for longer. However, cost, privacy, security, and usability barriers would need to be considered and the system should be individualizable to older adults' changing needs. The user requirements identified from this study and described in this paper have informed the development of a technology that is currently being prototyped. ",
doi="10.2196/10741",
url="http://mhealth.jmir.org/2018/6/e10741/"
}


@Article{info:doi/10.2196/humanfactors.8319,
author="Dijkstra, Elske Nienke
and Sino, Maria Carolina Geertruida
and Heerdink, Rob Eibert
and Schuurmans, Joanna Marieke",
title="Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study",
journal="JMIR Hum Factors",
year="2018",
month="Mar",
day="07",
volume="5",
number="1",
pages="e10",
keywords="primary care",
keywords="home care",
keywords="eHealth",
keywords="mHealth",
abstract="Background: Home care patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, home care could add to the multidisciplinary expertise of general practitioners (GPs) and pharmacists. The home care observation of medication-related problems by home care employees (HOME)-instrument is paper-based and assists home care workers in reporting potential DRPs. To facilitate the multiprofessional consultation, a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between home care and general practices and pharmacies is desired. Objective: The objective of this study was to develop an electronic HOME system (eHOME), a mobile version of the HOME-instrument that includes a monitoring and a consulting system for primary care. Methods: The development phase of the Medical Research Council (MRC) framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi round for the context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by 2 series of pilots for testing the usability and redesign. Results: By using an iterative design approach and by involving home care workers, GPs, and pharmacists throughout the process as informants, design partners, and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report webpage interface, which includes the adjusted content of the HOME-instrument and added home care practice--based problems, home care workers can digitally report observed DRPs. Furthermore, it was found that the monitoring and consulting webpage interfaces enable digital consultation between home care and general practices and pharmacies. The webpages were considered convenient, clear, easy, and usable. Conclusions: By employing an HCD approach, the eHOME-instrument was found to be an easy-to-use system. The systematic approach promises a valuable contribution for the future development of digital mobile systems of paper-based tools. ",
doi="10.2196/humanfactors.8319",
url="http://humanfactors.jmir.org/2018/1/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29514771"
}


@Article{info:doi/10.2196/aging.9025,
author="Dale, Jeremy
and Loew, Joelle
and Nanton, Veronica
and Grason Smith, Gillian",
title="Coproduction of a Theory-Based Digital Resource for Unpaid Carers (The Care Companion): Mixed-Methods Study",
journal="JMIR Aging",
year="2018",
month="Feb",
day="28",
volume="1",
number="1",
pages="e1",
keywords="family caregivers",
keywords="caregivers",
keywords="self efficacy",
keywords="information technology",
keywords="frailty",
keywords="Internet",
abstract="Background: Family and other unpaid carers are crucial to supporting the growing population of older people that are living outside residential care with frailty and comorbidities. The burden associated with caring affects carers' well-being, thus limiting the sustainability of such care. There is a need for accessible, flexible, and responsive interventions that promote carers' coping and resilience, and hence support maintenance of the health, well-being, and independence of the cared-for person. Objective: This study aimed to coproduce a digital program for carers to promote resilience and coping through supporting effective use of information and other Web-based resources. Its overlapping stages comprised the following: understanding the ways in which Web-based interventions may address challenges faced by carers, identifying target behaviors for the intervention, identifying intervention components, and developing the intervention prototype. Methods: The study was informed by person-based theories of coproduction and involved substantial patient and public involvement. It drew on the Behavior Change Wheel framework to support a systematic focus on behavioral issues relevant to caring. It comprised scoping literature reviews, interviews, and focus groups with carers and organizational stakeholders, and an agile, lean approach to information technology development. Qualitative data were analyzed using a thematic approach. Results: Four behavioral challenges were identified: burden of care, lack of knowledge, self-efficacy, and lack of time. Local health and social care services for carers were only being accessed by a minority of carers. Carers appreciated the potential value of Web-based resources but described difficulty identifying reliable information at times of need. Key aspects of behavior change relevant to addressing these challenges were education (increasing knowledge and understanding), enablement (increasing means and reducing barriers for undertaking caring roles), and persuasion (changing beliefs and encouraging action toward active use of the intervention). In collaboration with carers, this was used to define requirements for the program. A resources library was created to link to websites, Web-based guidance, videos, and other material that addressed condition-specific and generic information. Each resource was classified according to a taxonomy itemizing over 30 different subcategories of need under the headings Care Needs (of the cared-for person), General Information and Advice, and Sustaining the Carer. In addition, features such as a journal and mood monitor were incorporated to address other enablement challenges. The need for proactive, personalized prompts emerged; the program regularly prompts the carer to revisit and update their profile, which, together with their previous use of the intervention, drives notifications about resources and actions that may be of value. Conclusions: The person-based approach allowed an in-depth understanding of the biopsychosocial context of caring to inform the production of an engaging, relevant, applicable, and feasible Web-based intervention. User acceptance and feasibility testing is currently underway. ",
doi="10.2196/aging.9025",
url="http://aging.jmir.org/2018/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518238"
}


@Article{info:doi/10.2196/resprot.8744,
author="Wallack, M. Elizabeth
and Harris, Chelsea
and Ploughman, Michelle
and Butler, Roger",
title="Telegerontology as a Novel Approach to Address Health and Safety by Supporting Community-Based Rural Dementia Care Triads: Randomized Controlled Trial Protocol",
journal="JMIR Res Protoc",
year="2018",
month="Feb",
day="22",
volume="7",
number="2",
pages="e56",
keywords="Aging",
keywords="Remote Assessment",
keywords="Monitoring",
abstract="Background: Telegerontology is an approach using videoconferencing to connect an interdisciplinary team in a regional specialty center to patients in rural communities, which is becoming increasingly practical for addressing current limitations in rural community-based dementia care. Objective: Using the remotely-delivered expertise of the Telegerontology dementia care team, we aim to enhance the caregiver/patient/physician triad and thereby provide the necessary support for the person with dementia to ``age in place.'' Methods: This is a cluster randomized feasibility trial with four rural regions in the province of Newfoundland and Labrador, Canada (2 regions randomly assigned to ``intervention'' and 2 to ``control''). The study population includes 22 ``dementia triads'' that consist of a community-dwelling older Canadian with moderate to late dementia, their family caregivers, and their Primary Care Physician (PCP). Over the 6-month active study period, all participants will be provided an iPad. The intervention is intended as an adjunct to existing PCP care, consisting of weekly Skype-based videoconferencing calls with the Telegerontology physician, and other team members as needed (occupational therapist, physical therapist etc). Control participants receive usual community-based dementia care with their PCP. A baseline (pre-) assessment will be performed during a home visit with the study team. Post intervention, 6- and 12-month follow-up assessments will be collected remotely using specialized dementia monitoring applications and Skype calls. Primary outcomes include admission to long-term care, falls, emergency room visits, hospital stays, and caregiver burden. Results: Results will be available in March of 2018. Conclusions: Results from this study will demonstrate a novel approach to dementia care that has the potential to impact both rural PCPs, family caregivers, and people with dementia, as well as provide evidence for the utility of Telegerontology in models of eHealth-based care. ",
doi="10.2196/resprot.8744",
url="http://www.researchprotocols.org/2018/2/e56/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29472178"
}


@Article{info:doi/10.2196/iproc.8601,
author="Wang, Jing
and Branson, Sandra
and Boss, Lisa",
title="Attitudes Toward Aging in Place Using Wearable and Remote Monitoring Technology Among Underserved Homebound Seniors",
journal="iproc",
year="2017",
month="Sep",
day="22",
volume="3",
number="1",
pages="e39",
keywords="aging in place",
keywords="homebound",
keywords="wearable",
keywords="remote monitoring",
abstract="Background: Wearable and remote monitoring technology have great potential to support homebound seniors aging in place. However, the seniors' adoption of new technology has been slow, and current research has focused primarily on the rich and the motivated. Objective: The purpose of this study was to investigate underserved homebound seniors' attitudes, including their current use, interests, preferences, and potential concerns toward aging in place using wearable and remote monitoring technology. Methods: A cross sectional survey study was conducted with 181 seniors who were participants of the Meals on Wheels program. In order to be eligible for this program, clients must be disabled adults who are homebound and over 60 years of age. Results: The sample had an average age of 77 years. The group of participants was 66\% female, 36\% African American, and 49\% White. Nearly 51\% of the residents sampled in this study reported that they lived alone; 22.7\% lived with a spouse; and 22.7\% lived with family. More than half the sample (54.7\%) reported having ever used a health-monitoring device at home, such as a blood pressure monitor or a blood glucose meter. More than half of the resident had access to electronic devices such as a television (92.8\%), regular cell phone (58.0\%), DVD player (56.9\%), or a landline telephone (53.6\%). A smaller percentage had more popular electronic devices, such as a smartphone (21.0\%), laptop computer (18.8\%), desktop computer (12.7\%), or tablet (12.2\%). Only 1\% of the residents sampled reported having no access to any type of electronic device. Nearly 50\% of the residents surveyed had never heard of wearable health devices; most had never used such devices (84.0\%). Sixty-one percent of the residents reported that they would be interested in using a wearable device. Well over half of the residents (68.5\%) would prefer to wear the device on their wrist. This sample reported an interest in tracking the following with wearable devices: blood pressure (51.4\%), heart rate (44.8\%), exercise and physical activity (35.4\%), blood sugar (34.3\%), fall risk (32.6\%), hours and quality of sleep (32.6\%), weight 27.6\%, diet (27.1\%), body posture (19.3\%), mood (17.7\%), and other (9.9\%). When asked about what concerns residents had about using wearable devices, 55.2\% reported cost to be a concern. Other concerns were related to safety (20.4\%), privacy (16.0\%), fraud (14.4\%), and overwhelming information (11.0\%). Twenty-five percent of the residents reported having no concerns. Conclusions: While the majority of the underserved homebound seniors had never used any wearable or remote monitoring technology to support aging in place, and half had never heard of them, there is a great amount of interest in using such technology in this underserved population. Cost is the primary barrier to their adoption. Additional studies are needed to examine cost-effectiveness of using such technology to prevent expensive emergency room and other health services due to poor management of chronic conditions in this underserved population. ",
doi="10.2196/iproc.8601",
url="http://www.iproc.org/2017/1/e39/"
}


@Article{info:doi/10.2196/iproc.6246,
author="Stutman, Steve",
title="Enhancing Video Chat Applications for Home Health Care",
journal="iproc",
year="2016",
month="Dec",
day="29",
volume="2",
number="1",
pages="e22",
keywords="video chat",
keywords="patient-physician interaction",
keywords="age in place",
abstract="Background: Estimates show that up to 87\% of seniors would like to ``age in place.'' Often, such people are remote from their families and health care providers. Acquisition and telemetry of data and bio-signals from personal health care instrumentation is of great value, but we feel that this does not tell the complete story, because we are dealing with humans. A brief video chat, via personal computer, can usually provide a great deal of information concerning a person's well-being. An individual's mood, physical status, and energy level and the state of their surroundings can frequently be determined in a one-minute video chat. While these evaluations are qualitative, they can be very useful in answering the simple, important question ``Is this person OK?'' A video chat can also help build constructive social bonds between patients and providers because the telecommunication is no longer ``faceless.'' People who are aging in place are generally not the best computer users. Even if a person is proficient with the use of computers, issues with vision and manual dexterity can present obstacles to the use of video chat applications such as Skype. We have designed and implemented a low-cost system, comprised of a small ``helper'' program and a wired keypad, which operates with a personal computer and obviates the difficulties experienced by many less experienced and older users. Very simply, this system makes it easier for many people to communicate with their families and healthcare providers. Objective: Our goal was to simplify the use of video chat applications. A conventional desktop is often visually cluttered or has one application window obscuring another. Navigation with a mouse or other pointing device can be difficult for people with impaired vision and those with tremors, arthritis, or other dexterity limiting factors. We designed and built a ``helper'' program that, in conjunction with a dedicated large symbol keypad, lets a user initiate a video chat just by pressing a couple of buttons. Methods: At present we have conducted a small pilot study (N=8) with na{\"i}ve computer users who want to video chat with family members. Participants in the study were chosen because they had difficulty initiating video chats. We asked this group to use our system and measured time required to initiate a video chat. Results: All subjects were able to initiate video chats in <30 seconds. The users were all able to terminate the chats when desired. In simple terms, the na{\"i}ve users were able to start and end calls when they wanted to. Users expressed satisfaction at being able to control this aspect of their computers without technical support from others and enjoyed chat interactions. Conclusions: Video chat applications can be made simpler and easier to use, empowering a person who is aging in place to engage with family and healthcare providers. ",
doi="10.2196/iproc.6246",
url="http://www.iproc.org/2016/1/e22/"
}


@Article{info:doi/10.2196/jmir.5253,
author="Peek, Micha{\"e}l Sebastiaan Theodorus
and Wouters, JM Eveline
and Luijkx, G. Katrien
and Vrijhoef, JM Hubertus",
title="What it Takes to Successfully Implement Technology for Aging in Place: Focus Groups With Stakeholders",
journal="J Med Internet Res",
year="2016",
month="May",
day="03",
volume="18",
number="5",
pages="e98",
keywords="aged",
keywords="independent living",
keywords="technology",
keywords="eHealth",
keywords="health services for the elderly",
keywords="project and people management",
keywords="implementation management",
keywords="qualitative research",
keywords="focus groups",
abstract="Background: There is a growing interest in empowering older adults to age in place by deploying various types of technology (ie, eHealth, ambient assisted living technology, smart home technology, and gerontechnology). However, initiatives aimed at implementing these technologies are complicated by the fact that multiple stakeholder groups are involved. Goals and motives of stakeholders may not always be transparent or aligned, yet research on convergent and divergent positions of stakeholders is scarce. Objective: To provide insight into the positions of stakeholder groups involved in the implementation of technology for aging in place by answering the following questions: What kind of technology do stakeholders see as relevant? What do stakeholders aim to achieve by implementing technology? What is needed to achieve successful implementations? Methods: Mono-disciplinary focus groups were conducted with participants (n=29) representing five groups of stakeholders: older adults (6/29, 21\%), care professionals (7/29, 24\%), managers within home care or social work organizations (5/29, 17\%), technology designers and suppliers (6/29, 21\%), and policy makers (5/29, 17\%). Transcripts were analyzed using thematic analysis. Results: Stakeholders considered 26 different types of technologies to be relevant for enabling independent living. Only 6 out of 26 (23\%) types of technology were mentioned by all stakeholder groups. Care professionals mentioned fewer different types of technology than other groups. All stakeholder groups felt that the implementation of technology for aging in place can be considered a success when (1) older adults' needs and wishes are prioritized during development and deployment of the technology, (2) the technology is accepted by older adults, (3) the technology provides benefits to older adults, and (4) favorable prerequisites for the use of technology by older adults exist. While stakeholders seemed to have identical aims, several underlying differences emerged, for example, with regard to who should pay for the technology. Additionally, each stakeholder group mentioned specific steps that need to be taken to achieve successful implementation. Collectively, stakeholders felt that they need to take the leap (ie, change attitudes, change policies, and collaborate with other organizations); bridge the gap (ie, match technology with individuals and stimulate interdisciplinary education); facilitate technology for the masses (ie, work on products and research that support large-scale rollouts and train target groups on how to use technology); and take time to reflect (ie, evaluate use and outcomes). Conclusions: Stakeholders largely agree on the direction in which they should be heading; however, they have different perspectives with regard to the technologies that can be employed and the work that is needed to implement them. Central to these issues seems to be the tailoring of technology or technologies to the specific needs of each community-dwelling older adult and the work that is needed by stakeholders to support this type of service delivery on a large scale. ",
doi="10.2196/jmir.5253",
url="http://www.jmir.org/2016/5/e98/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27143097"
}