@Article{info:doi/10.2196/71030, author="Li, Xueqin and Liu, Jin and Huang, Ning and Zhao, Wanyu and He, Hongbo", title="Association Between Internet Use and Sleep Health Among Middle-Aged and Older Chinese Individuals: Nationwide Longitudinal Study", journal="J Med Internet Res", year="2025", month="Apr", day="16", volume="27", pages="e71030", keywords="internet use", keywords="sleep", keywords="Chinese middle-aged and older adults", keywords="internet frequency", keywords="cohort study", abstract="Background: Sleep disorders are common among older adults and have a bidirectional impact on their emotional well-being. While some studies suggest that internet use may offer mental health benefits to this population, the relationship between internet use and sleep outcomes remains underexplored. Objective: This study investigates the association between internet use (including use frequency) and sleep quality and duration in middle-aged and older Chinese adults. Methods: A longitudinal analysis was conducted using the China Health and Retirement Longitudinal Study data from 2015 to 2018. Sleep quality was assessed using the sleep item from the Centre for Epidemiologic Studies Depression Scale, categorized as ``good'' (<1 day; reference), ``fair'' (1-4 days), or ``poor'' (5-7 days). Sleep duration was classified as short (<6 hours), medium (6-9 hours; reference), or long (>9 hours). Adjusted multinomial logistic regressions were used to examine the associations between internet use or frequency in 2015 and sleep quality or duration in 2018, controlling for age, sex, residence, diseases, smoking, drinking, and napping time and further exploring sex and age group variations. Results: The baseline analysis included 18,460 participants aged 45 years and older, with 1272 (6.9\%) internet users, 8825 (48.1\%) participants had fair or poor sleep, and 6750 (37.2\%) participants had abnormal sleep duration. Internet users, particularly those who used it almost daily, were less likely to report poor sleep quality (relative risk [RR] 0.71, 95\% CI 0.54-0.94) and longer sleep duration (RR 0.22, 95\% CI 0.11-0.44) than nonusers. In the longitudinal analysis, baseline internet users had a significantly reduced risk of fair (RR 0.66, 95\% CI 0.51-0.86) and poor sleep quality (RR 0.60, 95\% CI 0.44-0.81), as well as short (RR 0.73, 95\% CI 0.53-1.00) and long sleep duration (RR 0.39, 95\% CI 0.21-0.72) during the follow-up period than nonusers. These associations remained significant for almost daily internet use (RR 0.32, 95\% CI 0.15-0.69). Subgroup analyses by sex revealed a positive relationship between internet use and sleep quality, with a stronger effect in female (poor sleep: RR 0.57, 95\% CI 0.36-0.89) than male (poor sleep: RR 0.61, 95\% CI 0.40-0.92) participants. The effect on sleep duration was significant only in daily male users, showing a reduced risk of long sleep duration (RR 0.30, 95\% CI 0.11-0.78). In the age subgroup analysis, most internet users were in the 45- to 59-year age group, with results consistent with the overall findings. Conclusions: This study suggests that internet use is associated with a reduced risk of sleep problems in middle-aged and older adults. The findings indicate that moderate, regular internet engagement---such as daily use---may promote better sleep health in this population. ", doi="10.2196/71030", url="https://www.jmir.org/2025/1/e71030" } @Article{info:doi/10.2196/64324, author="Panzavolta, Andrea and Arighi, Andrea and Guido, Emanuele and Lavorgna, Luigi and Di Lorenzo, Francesco and Dodich, Alessandra and Cerami, Chiara", title="Patient-Related Barriers to Digital Technology Adoption in Alzheimer Disease: Systematic Review", journal="JMIR Aging", year="2025", month="Apr", day="10", volume="8", pages="e64324", keywords="digital technology", keywords="digital e-health", keywords="accessibility", keywords="user-friendliness", keywords="neurocognitive disorders", keywords="Alzheimer disease", keywords="dementia", abstract="Background: Digital technology in dementia is an area of great development with varying experiences across countries. However, novel digital solutions often lack a patient-oriented perspective, and several relevant barriers prevent their use in clinics. Objective: In this study, we reviewed the existing literature on knowledge, familiarity, and competence in using digital technology and on attitude and experiences with digital tools in Alzheimer disease. The main research question is whether digital competence and attitudes of patients and caregivers may affect the adoption of digital technology. Methods: Following the PRISMA guidelines, a literature search was conducted by two researchers in the group. Inter-rater reliability was calculated with Cohen $\kappa$ statistics. The risk of bias assessment was also recorded. Results: Of 597 initial records, only 18 papers were considered eligible. Analyses of inter-rater reliability showed good agreement levels. Significant heterogeneity in study design, sample features, and measurement tools emerged across studies. Quality assessment showed a middle-high overall quality of evidence. The main factors affecting the adoption of digital technology in patients and caregivers are severity of cognitive deficits, timing of adoption, and the availability of training and support. Additional factors are age, type of digital device, and ease of use of the digital solution. Conclusions: Adoption of digital technology in dementia is hampered by many patient-related barriers. Improving digital competence in patient-caregiver dyads and implementing systematic, patient-oriented strategies for the development and use of digital tools are needed for a successful incorporation of digital technology in memory clinics. ", doi="10.2196/64324", url="https://aging.jmir.org/2025/1/e64324" } @Article{info:doi/10.2196/64449, author="Gustafson Sr, H. David and Mares, Marie-Louise and Johnston, C. Darcie and Curtin, J. John and Pe-Romashko, Klaren and Landucci, Gina", title="Comparison of Smart Display Versus Laptop Platforms for an eHealth Intervention to Improve Functional Health for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Clinical Trial", journal="JMIR Res Protoc", year="2025", month="Apr", day="3", volume="14", pages="e64449", keywords="eHealth", keywords="aged", keywords="geriatrics", keywords="functional health", keywords="multiple chronic conditions", keywords="smart display", keywords="smart speaker", keywords="primary care", keywords="quality of life", abstract="Background: Maintaining functional health, or the ability to live independently, is a primary goal of individuals as they age, but most older adults develop chronic conditions that threaten this goal. Physical activity is a key aspect of self-care that can improve functional health, and digital interventions offering guidance on appropriate exercise can help. However, older adults with multiple morbidities may be unable to use a laptop or smartphone-based eHealth because poor vision, dexterity, mobility, or other physical challenges make typing or touch navigation difficult. A smart display platform---comprising a smart speaker plus a small visual screen---has the potential to remove these barriers because it is voice-activated. Objective: The study aims to compare usage patterns of an eHealth intervention for older adults when delivered via a voice-based smart display versus a typing-based laptop, and assess whether the smart display outperforms the laptop in improving functional health and its specific physical and mental aspects. Methods: A minimum of 356 adults aged 60 years and older with at least 5 chronic health conditions are to be recruited from primary care clinics and community organizations. Participants will be randomized 1:1 to 12 months of access to an evidence-based intervention, ElderTree, delivered on either a smart display or a touchscreen laptop, with a postintervention follow-up at 18 months. The primary outcome is differences between groups on a comprehensive measure of physical and mental functional health. Secondary outcomes are between-group differences in the subscales of functional health (eg, physical function and depression), as well as measures of health distress, loneliness, unscheduled health care, and falls. We will also examine mediators and moderators of the effects of ElderTree on both platforms. Participants will complete surveys at baseline, 6, 12, and 18 months, and ElderTree use data will be collected continuously during the intervention period in system logs. We will use linear mixed-effect models to evaluate outcomes over time, with treatment condition and time point as between-subjects factors. Separate analyses will be conducted for each outcome. Results: Recruitment began in July 2023 and was completed in May 2024, with 387 participants enrolled. The 12-month intervention period will end in May 2025; data collection will end in November 2025. Findings will be disseminated via peer-reviewed publications. Conclusions: Voice-activated digital health interventions have theoretical but untested advantages over typing-based technologies for older adults with physical limitations. As the population ages, and as multiple morbidities threaten the functional health of the majority of older adults, innovations in self-management are a matter of public health as well as individual quality of life. Trial Registration: ClinicalTrials.gov NCT05240534; https://clinicaltrials.gov/study/NCT05240534 International Registered Report Identifier (IRRID): DERR1-10.2196/64449 ", doi="10.2196/64449", url="https://www.researchprotocols.org/2025/1/e64449", url="http://www.ncbi.nlm.nih.gov/pubmed/40080672" } @Article{info:doi/10.2196/63168, author="Park, Yoonseo and Kim, Eun-Ji and Park, Sewon and Lee, Munjae", title="Digital Health Intervention Effect on Older Adults With Chronic Diseases Living Alone: Systematic Review and Meta-Analysis of Randomized Controlled Trials", journal="J Med Internet Res", year="2025", month="Mar", day="31", volume="27", pages="e63168", keywords="digital health", keywords="chronic diseases", keywords="older adults", keywords="independent living", keywords="aging", keywords="chronic disease", keywords="living alone", keywords="self-management", keywords="medical cost", keywords="cost management", keywords="health promotion", keywords="effectiveness", keywords="quality of life", keywords="physical activity", keywords="health care", keywords="health informatics", keywords="systematic review", keywords="meta-analysis", keywords="PRISMA", abstract="Background: The incidence of chronic diseases is increasing owing to the aging population; in particular, older adults living alone struggle with self-management and medical expenses. Digital health can contribute to medical cost management and health promotion, but its effectiveness for older adults living alone remains unclear. In a rapidly aging society, it is important to demonstrate the effect of digital health on improving the lives of older adults living alone and reducing the burden of chronic diseases. Objective: This study aims to examine the intervention effects of digital health on self-management, quality of life, and medical factors for older adults living alone with common chronic diseases such as cardiovascular disease, respiratory disease, and musculoskeletal disorders through a systematic literature review and meta-analysis. Methods: We searched the literature using 3 databases, including PubMed, CINAHL, and Cochrane CENTRAL, for literature published in overseas academic journals up to October 2024. The final 11 papers were used for analysis based on selection and exclusion criteria. Meta-analysis was used to calculate the mean difference and standardized mean difference (SMD) for the selected literature using RevMan (version 5.4; Cochrane). The effect size and heterogeneity were calculated through 95\% CI. Results: As a result of conducting a meta-analysis of 8 of 11 documents, there was a significant effect of self-management factors on moderate-to-vigorous physical activity (SMD=0.08; z=2.07; P=.04). However, among self-management factors, low-density lipoprotein cholesterol (SMD=--0.04; z=0.91; P=.36) did not show statistically significant results. Among the medical factors, general quality of life (SMD=0.11; z=0.93; P=.35), depression (SMD=--3.95; z=1.59; P=.11), and hospital days (SMD=--1.57; z=0.91; P=.36) also did not show statistically significant results. However, it was confirmed that they improved after a digital health intervention. Conclusions: This study demonstrated that digital health interventions are effective in improving physical activity in older adults with chronic diseases living alone. However, owing to the characteristics of older adults living alone, there is a need to further expand digital health to combine care services that can manage diseases at home. ", doi="10.2196/63168", url="https://www.jmir.org/2025/1/e63168" } @Article{info:doi/10.2196/65269, author="Yang, Jun Hyo and Lee, Ji-Hyun and Lee, Wonjae", title="Factors Influencing Health Care Technology Acceptance in Older Adults Based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology: Meta-Analysis", journal="J Med Internet Res", year="2025", month="Mar", day="28", volume="27", pages="e65269", keywords="technology adoption", keywords="older adults", keywords="health care technology", keywords="technology acceptance model", keywords="unified theory of acceptance and use of technology", keywords="meta-analysis", abstract="Background: The technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT) are widely used to examine health care technology acceptance among older adults. However, existing literature exhibits considerable heterogeneity, making it difficult to determine consistent predictors of acceptance and behavior. Objective: We aimed to (1) determine the influence of perceived usefulness (PU), perceived ease of use (PEOU), and social influence (SI) on the behavioral intention (BI) to use health care technology among older adults and (2) assess the moderating effects of age, gender, geographic region, type of health care technology, and presence of visual demonstrations. Methods: A systematic search was conducted across Google Scholar, Web of Science, Scopus, IEEE Xplore, and ProQuest databases on March 15, 2024, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Of the 1167 initially identified studies, 41 studies (11,574 participants; mean age 67.58, SD 4.76 years; and female:male ratio=2.00) met the inclusion criteria. The studies comprised 12 mobile health, 12 online or telemedicine, 9 wearable, and 8 home or institution hardware investigations, with 23 studies from Asia, 7 from Europe, 7 from African-Islamic regions, and 4 from the United States. Studies were eligible if they used the TAM or UTAUT, examined health care technology adoption among older adults, and reported zero-order correlations. Two independent reviewers screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale, evaluating selection, comparability, and outcome assessment with 34\% (14/41) of studies rated as good quality and 66\% (27/41) as satisfactory. Results: Random-effects meta-analysis revealed significant positive correlations for PU-BI (r=0.607, 95\% CI 0.543-0.665; P<.001), PEOU-BI (r=0.525, 95\% CI 0.462-0.583; P<.001), and SI-BI (r=0.551, 95\% CI 0.468-0.624; P<.001). High heterogeneity was observed across studies (I{\texttwosuperior}=95.9\%, 93.6\%, and 95.3\% for PU-BI, PEOU-BI, and SI-BI, respectively). Moderator analyses revealed significant differences based on geographic region for PEOU-BI (Q=8.27; P=.04), with strongest effects in Europe (r=0.628) and weakest in African-Islamic regions (r=0.480). Technology type significantly moderated PU-BI (Q=8.08; P=.04) and SI-BI (Q=14.75; P=.002), with home or institutional hardware showing the strongest effects (PU-BI: r=0.736; SI-BI: r=0.690). Visual demonstrations significantly enhanced PU-BI (r=0.706 vs r=0.554; Q=4.24; P=.04) and SI-BI relationships (r=0.670 vs r=0.492; Q=4.38; P=.04). Age and gender showed no significant moderating effects. Conclusions: The findings indicate that PU, PEOU, and SI significantly impact the acceptance of health care technology among older adults, with heterogeneity influenced by geographic region, type of technology, and presence of visual demonstrations. This suggests that tailored strategies for different types of technology and the use of visual demonstrations are important for enhancing adoption rates. Limitations include varying definitions of older adults across studies and the use of correlation coefficients rather than controlled effect sizes. Results should therefore be interpreted within specific contexts and populations. ", doi="10.2196/65269", url="https://www.jmir.org/2025/1/e65269" } @Article{info:doi/10.2196/66058, author="Zhang, Chenglin and Mohamad, Emma and Azlan, Anis Arina and Wu, Anqi and Ma, Yilian and Qi, Yihan", title="Social Media and eHealth Literacy Among Older Adults: Systematic Literature Review", journal="J Med Internet Res", year="2025", month="Mar", day="26", volume="27", pages="e66058", keywords="eHealth literacy", keywords="digital health literacy", keywords="older adults", keywords="social media", keywords="health information", keywords="systematic review", abstract="Background: The advent of social media has significantly transformed health communication and the health-related actions of older adults, offering both obstacles and prospects for this generation to embrace eHealth developments. Objective: We aimed to investigate the correlation between social media and eHealth literacy in older individuals and answer four research questions: (1) What are the specific social media behaviors (including general use behaviors and health behaviors) of older adults on social media? (2) How do these behaviors impact their eHealth literacy? (3) How does eHealth literacy influence older adults' social media behaviors? and (4) What factors influence older adults' use of social media for health-related purposes? Methods: Using predetermined keywords and inclusion criteria, we searched Scopus, Web of Science, and PubMed databases for English-language journal articles published from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles. The initial search identified 1591 publications, and after removing duplicates, 48.21\% (767/1591) of publications remained. Ultimately, 1\% (16/1591) of studies met the inclusion criteria. A research question--driven manual qualitative thematic analysis was conducted, guided by the categorization of social media use behaviors, the definition of eHealth literacy, and the social-ecological model to provide direction for coding and thematic analysis. In addition, attention was given to identifying unanticipated behaviors or phenomena during the coding process, and these were subsequently incorporated into the analytical framework. Results: The results indicated that older adults' general social media use behaviors are primarily characterized by social media preferences, with 2 subthemes identified. Their social media health behaviors revealed 5 main themes and 14 subthemes. Among the primary themes, health information behavior appeared most frequently (12/16, 75\%), followed by self-management (8/16, 50\%). Other themes included health decision-making (4/16, 25\%), telemedicine (3/16, 19\%), and health interventions (2/16, 13\%). Cross-thematic analysis confirmed that older adults' social media use behaviors and their eHealth literacy had a reciprocal relationship. Finally, the study revealed that the use of social media to improve eHealth literacy among older adults was influenced by individual, interpersonal, institutional or organizational, and social factors. Conclusions: The reciprocal relationship between older adults' social media use and eHealth literacy highlights the importance of establishing a long-term positive mechanism that mutually reinforces social media health practices and eHealth literacy. Based on the findings, this review proposes key directions for efforts to achieve this goal: (1) leveraging postpandemic momentum to enhance eHealth literacy among older adults through social media, (2) reconsidering the dimensions of eHealth literacy among older adults in the context of Web 2.0, (3) actively developing age-friendly integrated social media health service platforms, (4) optimizing social media for engaging and reliable health information for older adults, and (5) integrating social support systems to foster lifelong eHealth learning for older adults. ", doi="10.2196/66058", url="https://www.jmir.org/2025/1/e66058" } @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/10.2196/60936, author="Tan, Siow-Hooi and Yap, Yee-Yann and Tan, Siow-Kian and Wong, Chee-Kuan", title="Determinants of Telehealth Adoption Among Older Adults: Cross-Sectional Survey Study", journal="JMIR Aging", year="2025", month="Mar", day="24", volume="8", pages="e60936", keywords="telehealth services adoption", keywords="survey", keywords="questionnaire", keywords="telehealth", keywords="older adult population", keywords="subjective well-being", keywords="transition cost", keywords="technology acceptance model", keywords="importance-performance map analysis", keywords="IPMA", abstract="Background: The aging population and the accompanying rise in chronic diseases have intensified the need to study the adoption of telehealth services. However, the success of telehealth services depends not only on their ease and usefulness but also on addressing broader concerns. Despite being a substantial user group in traditional health services, older adults may encounter barriers to adopting telehealth services. Increasing the adoption of telehealth among the older adult population is crucial for enhancing their access to care and managing the challenges of aging effectively. Objective: We aimed to explore factors influencing the adoption of telehealth services among older adults in Malaysia, going beyond the conventional framework by incorporating transition cost and subjective well-being as additional constructs. Methods: A cross-sectional survey was conducted among 119 adults aged ?60 years in Malaysia, using 39 survey items adapted from existing studies. Data analysis was performed using partial least squares structural equation modeling, with both the measurement model and structural model being evaluated. To determine the predictive relevance of the model, PLSpredict was applied. In addition, importance-performance map analysis was conducted to further expand on the structural model results by assessing the performance of each variable. Results: Of the 119 participants, 52 (43.7\%) were women and 67 (56.3\%) were men. The study found that subjective well-being ($\beta$=0.448; P<.001) was the most significant factor, followed by attitude ($\beta$=0.242; P<.001), transition cost ($\beta$=?0.163; P<.001), and perceived usefulness ($\beta$=0.100, P=.02) in influencing telehealth service intention. Furthermore, perceived ease of use ($\beta$=0.271; P<.001), availability ($\beta$=0.323; P<.001), subjective well-being ($\beta$=0.261; P<.001), and trust ($\beta$=0.156, P=.004) positively influenced perceived usefulness, while inertia ($\beta$=0.024, P=.22) did not. In addition, availability ($\beta$=0.420; P<.001) and subjective well-being ($\beta$=0.260; P<.001) were positively related to perceived ease of use, with inertia ($\beta$=?0.246; P<.001) having a negative impact. The importance-performance map analysis results showed that subjective well-being (importance=0.532) was the most crucial factor for older adult users, while availability (importance=70.735) had the highest performance in telehealth services. Conclusions: This research underscores the importance of catering to the subjective well-being of older adults and optimizing the availability of telehealth services to encourage adoption, ultimately advancing health care accessibility and quality for this vulnerable demographic. ", doi="10.2196/60936", url="https://aging.jmir.org/2025/1/e60936", url="http://www.ncbi.nlm.nih.gov/pubmed/40126531" } @Article{info:doi/10.2196/64193, author="Wang, Xinxin and Zhang, Chengrui and Qi, Yue and Xing, Ying and Liu, Yawen and Sun, Jiayi and Luan, Wei", title="Digital Health Literacy Questionnaire for Older Adults: Instrument Development and Validation Study", journal="J Med Internet Res", year="2025", month="Mar", day="19", volume="27", pages="e64193", keywords="digital health literacy", keywords="digital literacy", keywords="older adults", keywords="instruments", keywords="reliability", keywords="psychological measures", keywords="questionnaire", keywords="China", abstract="Background: The integration of digital technology into older adult health and care has enhanced the intelligence of health and older adult care products and services while also transforming how seniors acquire and share health information. Assessing older adults' digital health literacy (DHL) is crucial for developing targeted interventions. Objective: This study aims to develop and validate a DHL assessment questionnaire for older adults. It also seeks to evaluate the questionnaire's scientific validity and feasibility among community-dwelling older adults in China, providing a reliable tool for assessing their level of DHL. Methods: A literature review, focus group discussions, and the Delphi method were used to construct the questionnaire item pool and perform item screening. Item analysis was conducted for comprehensive evaluation, and questionnaire validity was assessed through construct validity (exploratory factor analysis, confirmatory factor analysis, convergent validity, and discriminant validity), content validity, and criterion-related validity. Reliability was analyzed using Cronbach alpha coefficient, split-half reliability, and test-retest reliability. Results: The study included 710 participants. Item analysis indicated that the questionnaire had strong discriminant validity. Correlation coefficient analysis showed that the item-total correlation coefficients ranged from 0.497 to 0.920 (P<.01). After multiple exploratory factor analyses, 6 common factors were extracted, with a cumulative variance contribution rate of 73.745\%. Confirmatory factor analysis demonstrated a good model fit ($\chi$2/df=2.803, root-mean-square error of approximation=0.071, comparative fit index=0.907, goodness-of-fit index=0.773, incremental fit index=0.908, Tucker-Lewis index=0.901, normed fit index=0.863). The questionnaire demonstrated favorable convergent validity, content validity, and criterion-related validity. The total Cronbach $\alpha$ coefficient was 0.976, with dimension-specific Cronbach $\alpha$ coefficients ranging from 0.819 to 0.952, indicating satisfactory internal consistency. Additionally, the test-retest reliability coefficient for the total questionnaire was 0.925, demonstrating good stability over time. Conclusions: This study developed a questionnaire specifically designed to assess DHL in older adults through a scientifically rigorous and systematic process. The questionnaire demonstrates strong psychometric properties and can serve as an empirical tool for health professionals to design personalized intervention policies and enhance health service delivery. ", doi="10.2196/64193", url="https://www.jmir.org/2025/1/e64193" } @Article{info:doi/10.2196/65776, author="Wolfe, H. Brooke and Oh, Jung Yoo and Choung, Hyesun and Cui, Xiaoran and Weinzapfel, Joshua and Cooper, Amanda R. and Lee, Hae-Na and Lehto, Rebecca", title="Caregiving Artificial Intelligence Chatbot for Older Adults and Their Preferences, Well-Being, and Social Connectivity: Mixed-Method Study", journal="J Med Internet Res", year="2025", month="Mar", day="13", volume="27", pages="e65776", keywords="older adults", keywords="technology use", keywords="AI chatbots", keywords="artificial intelligence", keywords="well-being", keywords="social connectedness", keywords="mobile phone", abstract="Background: The increasing number of older adults who are living alone poses challenges for maintaining their well-being, as they often need support with daily tasks, health care services, and social connections. However, advancements in artificial intelligence (AI) technologies have revolutionized health care and caregiving through their capacity to monitor health, provide medication and appointment reminders, and provide companionship to older adults. Nevertheless, the adaptability of these technologies for older adults is stymied by usability issues. This study explores how older adults use and adapt to AI technologies, highlighting both the persistent barriers and opportunities for potential enhancements. Objective: This study aimed to provide deeper insights into older adults' engagement with technology and AI. The technologies currently used, potential technologies desired for daily life integration, personal technology concerns faced, and overall attitudes toward technology and AI are explored. Methods: Using mixed methods, participants (N=28) completed both a semistructured interview and surveys consisting of health and well-being measures. Participants then participated in a research team--facilitated interaction with an AI chatbot, Amazon Alexa. Interview transcripts were analyzed using thematic analysis, and surveys were evaluated using descriptive statistics. Results: Participants' average age was 71 years (ranged from 65 years to 84 years). Most participants were familiar with technology use, especially using smartphones (26/28, 93\%) and desktops and laptops (21/28, 75\%). Participants rated appointment reminders (25/28, 89\%), emergency assistance (22/28, 79\%), and health monitoring (21/28, 75\%). Participants rated appointment reminders (25/28, 89.3\%), emergency assistance (22/28, 78.6\%), and health monitoring (21/28, 75\%) as the most desirable features of AI chatbots for adoption. Digital devices were commonly used for entertainment, health management, professional productivity, and social connectivity. Participants were most interested in integrating technology into their personal lives for scheduling reminders, chore assistance, and providing care to others. Challenges in using new technology included a commitment to learning new technologies, concerns about lack of privacy, and worries about future technology dependence. Overall, older adults' attitudes coalesced into 3 orientations, which we label as technology adapters, technologically wary, and technology resisters. These results illustrate that not all older adults were resistant to technology and AI. Instead, older adults are aligned with categories on a spectrum between willing, hesitant but willing, and unwilling to use technology and AI. Researchers can use these findings by asking older adults about their orientation toward technology to facilitate the integration of new technologies with each person's comfortability and preferences. Conclusions: To ensure that AI technologies effectively support older adults, it is essential to foster an ongoing dialogue among developers, older adults, families, and their caregivers, focusing on inclusive designs to meet older adults' needs. ", doi="10.2196/65776", url="https://www.jmir.org/2025/1/e65776" } @Article{info:doi/10.2196/56692, author="Chien, Shuo-Chen and Yen, Chia-Ming and Chang, Yu-Hung and Chen, Ying-Erh and Liu, Chia-Chun and Hsiao, Yu-Ping and Yang, Ping-Yen and Lin, Hong-Ming and Yang, Tsung-En and Lu, Xing-Hua and Wu, I-Chien and Hsu, Chih-Cheng and Chiou, Hung-Yi and Chung, Ren-Hua", title="Use of Artificial Intelligence, Internet of Things, and Edge Intelligence in Long-Term Care for Older People: Comprehensive Analysis Through Bibliometric, Google Trends, and Content Analysis", journal="J Med Internet Res", year="2025", month="Mar", day="4", volume="27", pages="e56692", keywords="bibliometric analysis", keywords="Google Trends", keywords="content analysis", keywords="long-term care", keywords="older adults", keywords="artificial intelligence", keywords="Internet of Things", keywords="edge intelligence", abstract="Background: The global aging population poses critical challenges for long-term care (LTC), including workforce shortages, escalating health care costs, and increasing demand for high-quality care. Integrating artificial intelligence (AI), the Internet of Things (IoT), and edge intelligence (EI) offers transformative potential to enhance care quality, improve safety, and streamline operations. However, existing research lacks a comprehensive analysis that synthesizes academic trends, public interest, and deeper insights regarding these technologies. Objective: This study aims to provide a holistic overview of AI, IoT, and EI applications in LTC for older adults through a comprehensive bibliometric analysis, public interest insights from Google Trends, and content analysis of the top-cited research papers. Methods: Bibliometric analysis was conducted using data from Web of Science, PubMed, and Scopus to identify key themes and trends in the field, while Google Trends was used to assess public interest. A content analysis of the top 1\% of most-cited papers provided deeper insights into practical applications. Results: A total of 6378 papers published between 2014 and 2023 were analyzed. The bibliometric analysis revealed that the United States, China, and Canada are leading contributors, with strong thematic overlaps in areas such as dementia care, machine learning, and wearable health monitoring technologies. High correlations were found between academic and public interest, in key topics such as ``long-term care'' ($\tau$=0.89, P<.001) and ``caregiver'' ($\tau$=0.72, P=.004). The content analysis demonstrated that social robots, particularly PARO, significantly improved mood and reduced agitation in patients with dementia. However, limitations, including small sample sizes, short study durations, and a narrow focus on dementia care, were noted. Conclusions: AI, IoT, and EI collectively form a powerful ecosystem in LTC settings, addressing different aspects of care for older adults. Our study suggests that increased international collaboration and the integration of emerging themes such as ``rehabilitation,'' ``stroke,'' and ``mHealth'' are necessary to meet the evolving care needs of this population. Additionally, incorporating high-interest keywords such as ``machine learning,'' ``smart home,'' and ``caregiver'' can enhance discoverability and relevance for both academic and public audiences. Future research should focus on expanding sample sizes, conducting long-term multicenter trials, and exploring broader health conditions beyond dementia, such as frailty and depression. ", doi="10.2196/56692", url="https://www.jmir.org/2025/1/e56692", url="http://www.ncbi.nlm.nih.gov/pubmed/40053718" } @Article{info:doi/10.2196/66636, author="Werts-Pelter, J. Samantha and Chen, Zhao and Bea, W. Jennifer and Sokan, E. Amanda and Thomson, A. Cynthia", title="Analysis of the Relationship Between Rural-Urban Status and Use of Digital Health Technology Among Older Cancer Survivors Based on the Health Information National Trends Survey: Cross-Sectional Analysis", journal="JMIR Cancer", year="2025", month="Mar", day="4", volume="11", pages="e66636", keywords="cancer", keywords="non-metropolitan", keywords="disparities", keywords="digital divide", keywords="health research", keywords="aging", keywords="rural-urban", keywords="digital health technology", keywords="cross-sectional", keywords="health behaviors", keywords="mobile phone", abstract="Background: Though telehealth has been a promising avenue for engaging cancer survivors with health care and lifestyle programming, older and rural-dwelling cancer survivors may have additional challenges in accessing digital devices and tools that have not yet been described. This study aimed to use a robust, nationally representative sample collected in 2022 to provide an updated view of digital technology use and the use of technology for health in this population. Objective: This study aimed to examine the prevalence of digital technology use for health-related activities among older cancer survivors in both rural and urban settings. The primary outcomes of interest included (1) internet access and use for health-related activities, (2) digital device ownership and use as a tool for health behaviors, (3) use of social media for health, and (4) use of telehealth. Methods: A cross-sectional analysis of the National Cancer Institute's Health Information National Trends Survey Cycle 6 (HINTS 6) was completed to examine the prevalence of digital technology use among older cancer survivors. For analysis, the sample was restricted to cancer survivors over the age of 60 years (n=710). Unadjusted and adjusted logistic regression models were used to test the association between rurality and digital health tool use. Results: Overall, 17\% (125/710) of the sample lived in a rural area of the United States and the mean sample age was 73 (SD 8.2) years. Older cancer survivors, regardless of rural-urban status, reported a high prevalence of internet usage (n=553, 79.9\%), digital device ownership (n=676, 94.9\%), and social media use (n=448, 66.6\%). In unadjusted models, rural survivors were less likely than urban survivors to report that they had used a health or wellness application in the previous year (odds ratio [OR] 0.56, 95\% CI 0.32-0.97; P=.04). In adjusted models, rural survivors were more likely to report that they had shared personal health information on social media (OR 2.64, 95\% CI 1.13-6.19; P=.03). There were no differences in the proportion of rural and urban respondents who reported receiving health services through telehealth in the previous year. Conclusions: Regardless of the residential status, older cancer survivors report high internet and technology use for health-related activities. These results show promise for the feasibility of using digital technologies to implement supportive care and wellness programming with older cancer survivors. ", doi="10.2196/66636", url="https://cancer.jmir.org/2025/1/e66636" } @Article{info:doi/10.2196/49507, author="van der Smissen, Doris and Schreijer, A. Maud and van Gemert-Pijnen, C. Lisette J. E. W. and Verdaasdonk, M. Rudolf and van der Heide, Agnes and Korfage, J. Ida and Rietjens, C. Judith A.", title="Implementation of a Web-Based Program for Advance Care Planning and Evaluation of its Complexity With the Nonadoption, Abandonment, Scale-Up, Spread, And Sustainability (NASSS) Framework: Qualitative Evaluation Study", journal="JMIR Aging", year="2025", month="Mar", day="4", volume="8", pages="e49507", keywords="eHealth", keywords="web-based intervention", keywords="implementation", keywords="sustainability", keywords="advance care planning", keywords="NASSS framework", keywords="nonadoption, abandonment, scale-up, spread, and sustainability framework", keywords="health communication", keywords="patient education", keywords="patient-centered care", abstract="Background: The implementation of eHealth applications often fails. The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework aims to identify complexities in eHealth applications; the more complex, the more risk of implementation failure. Objective: This study aimed to analyze the implementation of the web-based advance care planning (ACP) program ``Explore Your Preferences for Treatment and Care'' using the NASSS framework. Methods: The NASSS framework enables a systematic approach to improve the implementation of eHealth tools. It is aimed at generating a rich and situated analysis of complexities in multiple domains, based on thematic analysis of existing and newly collected data. It also aims at supporting individuals and organizations to handle these complexities. We used 6 of 7 domains of the NASSS framework (ie, condition, technology, value proposition, adopters, external context, and embedding and adaptation over time) leaving out ``organization,'' and analyzed the multimodal dataset of a web-based ACP program, its development and evaluation, including peer-reviewed publications, notes of stakeholder group meetings, and interviews with stakeholders. Results: This study showed that the web-based ACP program uses straightforward technology, is embedded in a well-established web-based health platform, and in general appears to generate a positive value for stakeholders. A complexity is the rather broad target population of the program. A potential complexity considers the limited insight into the extent to which health care professionals adopt the program. Awareness of the relevance of the web-based ACP program may still be improved among target populations of ACP and among health care professionals. Furthermore, the program may especially appeal to those who value individual autonomy, self-management, and an explicit and direct communicative approach. Conclusions: Relatively few complexities were identified considering the implementation of the web-based ACP program ``Explore Your Preferences for Treatment and Care.'' The program is evidence-based, freestanding, and well-maintained, with straightforward, well-understood technology. The program is expected to generate a positive value for different stakeholders. Complexities include the broad target population of the program and sociocultural factors. People with limited digital literacy may need support to use the program. Its uptake might be improved by increasing awareness of ACP and the program among a wider population of potential users and among health care professionals. Addressing these issues may guide future use and sustainability of the program. ", doi="10.2196/49507", url="https://aging.jmir.org/2025/1/e49507", url="http://www.ncbi.nlm.nih.gov/pubmed/40053753" } @Article{info:doi/10.2196/66804, author="Yan, Mengyao and Sun, Wendi and Tan, Cheng and Wu, Yibo and Liu, Yuanli", title="Analysis of Factors Influencing the Willingness of Chinese Older Adults to Use mHealth Devices: Nationwide Cross-Sectional Survey Study", journal="J Med Internet Res", year="2025", month="Mar", day="4", volume="27", pages="e66804", keywords="older adults", keywords="mobile health devices", keywords="health management", keywords="medical services", keywords="mobile phone", abstract="Background: In addition to standard older adult care services, mobile medical devices have proved to be an effective tool for controlling the health of older adults. However, little is known about the variables driving the acceptance of these gadgets and the willingness of older adults in China to use them. Objective: This study aims to explore the factors that affect the use of mobile health (mHealth) devices by older adults in China, focusing on individual, social, and family influences. Methods: The Psychology and Behavior Investigation of Chinese Residents survey database provided the data for this study. The survey was conducted in 148 Chinese cities between June 20 and August 31, 2022. The parameters linked to older persons' desire to use mobile medical devices were determined by this study using a combination model of multiple stepwise linear regression and a classification and regression tree decision tree. Results: In total, 4085 older adults took part in the poll. On a scale of 0 to 100, the average score for willingness to adopt mHealth devices was 63.70 (SD 25.11). The results of the multiple stepwise linear regression showed that having a postgraduate degree and higher ($\beta$=.040; P=.007), being unemployed ($\beta$=.037; P=.02), having a high social status ($\beta$=.085; P<.001), possessing high health literacy ($\beta$=.089; P<.001), demonstrating high self-efficacy ($\beta$=.043; P=.02), not living with children ($\beta$=.0340; P=.02), having a household per capita monthly income of >Y4000 (US \$550) ($\beta$=.048; P=.002), experiencing high perceived social support ($\beta$=.096; P<.001), reporting a high quality of life ($\beta$=.149; P<.001), having higher levels of family communication ($\beta$=--.071; P<.001), having an identity bubble ($\beta$=.085; P<.001), not having chronic diseases ($\beta$=.049; P=.001), and experiencing mild depression ($\beta$=--.035; P=.02) were associated with older adults' willingness to use mHealth devices. The classification and regression tree decision tree model's findings demonstrated that the primary determinants of older adults' desire to use mHealth devices are quality of life, identity bubble, social status, health literacy, family health, and perceived social support. Conclusions: This study uses the Andersen Healthcare Utilization Model to investigate the effects of demand variables, enabling resources, and predisposing traits on older persons' propensity to use mHealth devices. These results offer reference data for the marketing and use of mHealth devices for older individuals in the future. The ultimate goal of this strategy is to create a balanced and harmonious integration of technology and humanistic care. ", doi="10.2196/66804", url="https://www.jmir.org/2025/1/e66804", url="http://www.ncbi.nlm.nih.gov/pubmed/40053781" } @Article{info:doi/10.2196/64661, author="Connelly, Jenni and Swingler, Kevin and Rodriguez-Sanchez, Nidia and Whittaker, C. Anna", title="Identifying Food Preferences and Malnutrition in Older Adults in Care Homes: Co-Design Study of a Digital Nutrition Assessment Tool", journal="JMIR Aging", year="2025", month="Mar", day="3", volume="8", pages="e64661", keywords="ageing", keywords="digital technology", keywords="dietary measurement", keywords="care homes", keywords="co-design", keywords="dietary intake", keywords="food diary", abstract="Background: Malnutrition is a challenge among older adults and can result in serious health consequences. However, the dietary intake monitoring needed to identify malnutrition for early intervention is affected by issues such as difficulty remembering or needing a dietitian to interpret the results. Objective: This study aims to co-design a tool using automated food classification to monitor dietary intake and food preferences, as well as food-related symptoms and mood and hunger ratings, for use in care homes. Methods: Participants were 2 separate advisory groups and 2 separate sets of prototype testers. The testers for the first prototype were 10 community-dwelling older adults based in the Stirlingshire area in Scotland who noted their feedback on the tool over 2 weeks in a food diary. The second set of testers consisted of 14 individuals (staff: n=8, 57\%; and residents: n=6, 43\%) based in 4 care homes in Scotland who provided feedback via interview after testing the tool for a minimum of 3 days. In addition, 130 care home staff across the United Kingdom completed the web-based survey on the tool's needs and potential routes to pay for it; 2 care home managers took part in follow-up interviews. Data were collected through food diaries, a web-based survey, audio recordings and transcriptions of focus groups and interviews, and research notes. Systematic text condensation was used to describe themes across the different types of data. Results: Key features identified included ratings of hunger, mood, and gastrointestinal symptoms that could be associated with eating specific foods, as well as a traffic light system to indicate risk. Issues included staff time, Wi-Fi connectivity, and the accurate recognition of pureed food and fortified meals. Different models for potential use and commercialization were identified, including peer support among residents to assist those considered less able, staff-only use of the tool, care home--personalized database menus for easy meal photo selection, and targeted monitoring of residents considered to be at the highest risk using the traffic light system. Conclusions: The tool was deemed useful for monitoring dietary habits and associated symptoms, but necessary design improvements were identified. These should be incorporated before formal evaluation of the tool as an intervention in this setting. Co-design was vital to help make the tool fit for the intended setting and users. ", doi="10.2196/64661", url="https://aging.jmir.org/2025/1/e64661", url="http://www.ncbi.nlm.nih.gov/pubmed/40053797" } @Article{info:doi/10.2196/59391, author="Newton, Lorelei and Monkman, Helen and Fullerton, Claire", title="Exploring Older Adult Cancer Survivors' Digital Information Needs: Qualitative Pilot Study", journal="JMIR Cancer", year="2025", month="Feb", day="27", volume="11", pages="e59391", keywords="older adults", keywords="cancer survivors", keywords="digital health literacy", keywords="digital health technologies", keywords="aging", keywords="qualitative", keywords="pilot study", keywords="semistructured interview", abstract="Background: Older adults (aged >65 years) are disproportionately affected by cancer at a time when Canadians are surviving cancer in an unprecedented fashion. Contrary to persistent ageist assumptions, not only do the majority of older adult cancer survivors use digital health technologies (DHTs) regularly, such technologies also serve as important sources of their health information. Although older adults' transition to cancer survivorship is connected to the availability and provision of relevant and reliable information, little evidence exists as to how they use DHTs to supplement their understanding of their unique situation to manage, and make decisions about, their ongoing cancer-related concerns. Objective: This pilot study, which examined older adult cancer survivors' use of DHTs, was conducted to support a larger study designed to explore how digital health literacy dimensions might affect the management of cancer survivorship sequelae. Understanding DHT use is also an important consideration for digital health literacy. Thus, we sought to investigate older adult cancer survivors' perceptions of DHTs in the context of accessing information about their health, health care systems, and health care providers. Methods: A qualitative pilot study, which involved semistructured interviews with older adult cancer survivors (N=5), was conducted to explore how participants interacted with, accessed, and searched for information, as well as how DHT use related to their cancer survivorship. Institutional ethics approval (\#21?0421) was obtained. Interpretive description inquiry---a practice-based approach suitable for generating applied knowledge---supported exploration of the research question. Thematic analysis was used to examine the transcripts for patterns of meaning (themes). Results: Assessing the credibility of digital information remains challenging for older adult cancer survivors. Identified benefits of DHTs included improved access to meet health information needs, older adult cancer survivors feeling empowered to make informed decisions regarding their health trajectory, and the ability to connect with interdisciplinary teams for care continuity. Additionally, participants described feeling disconnected when DHTs seemed to be used as substitutes for human interaction. The results of this pilot study were used to create 12 additional questions to supplement a digital health literacy survey, through which we will seek a more fulsome account of the relationship between digital health literacy and DHTs for older adult cancer survivors. Conclusions: Overall, this pilot study confirmed the utility of DHTs in enhancing the connection of older adult cancer survivors to their health care needs. Importantly, this connection exists on a continuum, and providing greater access to technologies, in combination with human support, leads to feelings of empowerment. DHTs are an important aspect of contemporary health care; yet, these technologies must be seen as complementary and not as replacements for human interaction. Otherwise, we risk dehumanizing patients and disconnecting them from the care that they need and deserve. ", doi="10.2196/59391", url="https://cancer.jmir.org/2025/1/e59391" } @Article{info:doi/10.2196/57730, author="Luz, Sara and Nogueira, Paulo and Costa, Andreia and Henriques, Adriana", title="Psychometric Analysis of the eHealth Literacy Scale in Portuguese Older Adults (eHEALS-PT24): Instrument Development and Validation", journal="J Med Internet Res", year="2025", month="Feb", day="26", volume="27", pages="e57730", keywords="eHealth", keywords="health literacy", keywords="older adults", keywords="psychometric properties", keywords="public health", abstract="Background: In this era of digitalization, eHealth interventions are used to engage patients in health care and help them manage their health. Previous studies showed that this can be particularly interesting for chronic disease self-management and self-care in older adults. Despite older adults becoming increasingly active on the internet, they continue to struggle in using eHealth information due to inadequate eHealth literacy. Thus, assessing and monitoring eHealth literacy is critical to support eHealth interventions. Objective: This study aimed to describe the translation, adaptation, and validation process of the eHealth Literacy Scale (eHEALS) in Portuguese older adults. Methods: The cross-cultural adaption followed the steps of forward and blinded backward translations, evaluation of the translations by a committee of judges, pilot-testing, and full psychometric testing. We tested the psychometric properties of the eHEALS by carrying out two studies: general psychometric analysis (study 1) and confirmatory factor analysis (study 2). Study 1 included 80 older adults conveniently selected from a Health Family Unit. Data were collected by in-person questionnaires between May and July 2022. Study 2 included 301 older adults randomly selected from two distinct Health Family Units. Data were collected by in-person questionnaires between May and July 2023. Results: We tested stability, reliability, construct validity (exploratory and confirmatory factor analyses and known groups), and model fit. Study 1 had 58.8\% (47/80) male and 41.3\% (33/80) female respondents (mean age 71.20, SD 5.26 years). Study 2 had 56.5\% (170/301) male and 43.5\% (131/301) female respondents (mean age 71.77, SD 5.15 years). Moderate and strong correlations were identified in the scale items (study 1: 0.42?r?0.91 and study 2: 0.81?r?0.96; P<.001). The scale showed good internal consistency for study 1 ($\alpha$=.92) and study 2 ($\alpha$=.98), with high correlations between items. The exploratory factor analysis yielded a single-factor structure, explaining 58.3\% of the variance in study 1 and 86.4\% in study 2. In the confirmatory analysis (study 2), the model fit was mixed ($\chi${\texttwosuperior}20=265, P<.001; comparative fit index=0.94; Tucker-Lewis Index=0.91; root mean square error of approximation=0.20). Thus, we compared 1-, 2-, and 3-factor structures, deciding on the unidimensional one. In study 1, the eHEALS-PT24 (Portuguese version of the eHealth Literacy Scale for older adults) mean score was 27.25 (SD 5.61), with 43.8\% (35/80) and 11.3\% (9/80) of participants showing low and high eHealth literacy levels, respectively. In study 2, the eHEALS-PT24 mean score was 23.31 (SD 9.53), with 38.2\% (115/301) and 23.6\% (71/301) of participants showing low and high eHealth literacy levels, respectively. The known-groups analysis showed statistically significant differences between eHealth literacy and demographic variables (P<.001). Conclusions: The findings suggest that the eHEALS-PT24 is a reliable and valid tool to assess eHealth literacy in Portuguese older adults. Therefore, this instrument can be integrated to support the implementation process of eHealth interventions. ", doi="10.2196/57730", url="https://www.jmir.org/2025/1/e57730" } @Article{info:doi/10.2196/55082, author="Min, Deborah and Yun, Ji-Young and Parslow, Chad and Jajodia, Anushka and Han, Hae-Ra", title="Online-Based Recruitment Methods for Community-Dwelling Older Adults: Scoping Review and Lessons Learned From the PLAN Trial", journal="J Med Internet Res", year="2025", month="Feb", day="25", volume="27", pages="e55082", keywords="older adults", keywords="online", keywords="online recruitment", keywords="community-dwelling", keywords="strategies", keywords="America", keywords="Americans", keywords="technology adoption", keywords="digital technologies", keywords="COVID-19", keywords="pandemic", keywords="digital health", keywords="dementia", keywords="caregivers", keywords="healthcare system", keywords="community health workers", keywords="consultants", keywords="mobile phone", abstract="Background: Despite rapid technological advancement and a considerably aging US population, there remains a gap in the literature pertaining to online-based recruitment strategies for older adults. Objective: This study aimed to describe the lessons learned from the authors' experience of recruiting a sample for PLAN (Preparing successful aging through dementia Literacy education And Navigation), an ongoing, community-based randomized controlled trial designed to promote the transition of community-dwelling Korean American older adults with probable dementia and their caregivers into the health care system. The authors also present online-based recruitment strategies focused on older adults reported in relevant published studies to compare with their experiences. Methods: Data sources included PLAN recruitment tracking files, study team meeting minutes, and interviews with community consultants. We also conducted a scoping review of published studies, searching PubMed in July 2021, and updated our search in September 2023. Eligibility criteria included (1) focus on older adults aged more than 65 years, (2) sample recruited from a community setting, and (3) inclusion and description of online-based recruitment strategies. Exclusion criteria (1) did not focus on adults older than 65 years in a community setting, (2) did not include or describe online-based recruitment strategies, or (3) used online-based methods but not for the purpose of recruitment. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Information was extracted using a data charting table and synthesized by conducting a thematic analysis. Results: In total, 8 articles were included in the scoping review and primarily addressed health promotion and recruitment strategy evaluation. When compared with PLAN data sources, five key themes emerged as relevant to the online-based recruitment of community-dwelling older adults: (1) unfamiliarity with technology---limited digital literacy, (2) differences in internet access and use across older age groups, (3) providing technological support to promote recruitment, (4) successful and unsuccessful recruitment using social media, and (5) other diverse online-based methods of recruitment. In particular, direct quotes from multiple sources for the PLAN trial revealed technological challenges that were common among immigrant older adults as the study team used various online-based recruitment activities. Conclusions: The literature was limited in the discussion of online-based recruitment among older participants. Data sources revealed the digital divide and limited digital literacy, particularly among non--English-speaking immigrant older adults and their caregivers. The usefulness of online-based recruitment of older adults is uncertain due, in large part, to limited sociodemographic diversity noted in the samples recruited in the included studies. Future research should explore the role of race and ethnicity and other characteristics, such as socioeconomic status, sex, education, access to technology, and digital literacy, in relation to online-based recruitment for adequate representation of diverse older adults in research. Trial Registration: ClinicalTrials.gov NCT03909347; https://clinicaltrials.gov/study/NCT03909347 ", doi="10.2196/55082", url="https://www.jmir.org/2025/1/e55082", url="http://www.ncbi.nlm.nih.gov/pubmed/39998873" } @Article{info:doi/10.2196/65379, author="Deng, Cheng and Shen, Na and Li, Guangzhou and Zhang, Ke and Yang, Shijun", title="Digital Isolation and Dementia Risk in Older Adults: Longitudinal Cohort Study", journal="J Med Internet Res", year="2025", month="Feb", day="19", volume="27", pages="e65379", keywords="dementia", keywords="digital isolation", keywords="cognitive decline", keywords="older adults", keywords="elderly", keywords="geriatric", keywords="longitudinal cohort study", keywords="cognitive impairment", keywords="aging", keywords="social isolation", keywords="risk", keywords="digital engagement", abstract="Background: Dementia poses a significant global health challenge, characterized by progressive cognitive decline and functional impairment. With the aging global population, dementia prevalence is projected to surge, reaching an estimated 153 million cases by 2050. While the impact of traditional social isolation on dementia risk has been extensively studied, the influence of digital isolation, a phenomenon unique to the digital age, remains underexplored. Objective: This study aimed to investigate the association between digital isolation and dementia risk among older adults, hypothesizing that higher levels of digital isolation significantly increase the risk of developing dementia. Methods: We conducted a longitudinal cohort study using data from the National Health and Aging Trends Study (NHATS), analyzing 8189 participants aged 65 years and older from the 3rd (2013) to the 12th wave (2022). Digital isolation was quantified using a composite digital isolation index, derived from participants' usage of digital devices, electronic communication, internet access, and engagement in online activities. Participants were stratified into low isolation and moderate to high isolation groups. Dementia incidence was assessed using cognitive tests and proxy reports. Cox proportional hazards models were used to estimate the association between digital isolation and dementia risk, adjusting for potential confounders including sociodemographic factors, baseline health conditions, and lifestyle variables. Results: The moderate to high isolation group demonstrated a significantly elevated risk of dementia compared with the low isolation group. In the discovery cohort, the adjusted hazard ratio (HR) was 1.22 (95\% CI 1.01-1.47, P=.04), while the validation cohort showed an HR of 1.62 (95\% CI 1.27-2.08, P<.001). The pooled analysis across both cohorts revealed an adjusted HR of 1.36 (95\% CI 1.16-1.59, P<.001). Kaplan-Meier curves corroborated a higher incidence of dementia in the moderate to high isolation group. Conclusions: Our findings indicate that digital isolation is a significant risk factor for dementia among older adults. This study underscores the importance of digital engagement in mitigating dementia risk and suggests that promoting digital literacy and access to digital resources should be integral components of public health strategies aimed at dementia prevention. ", doi="10.2196/65379", url="https://www.jmir.org/2025/1/e65379", url="http://www.ncbi.nlm.nih.gov/pubmed/39969956" } @Article{info:doi/10.2196/57122, author="Shin, Jiyoung and Kang, Hun and Choi, Seongmi and Chu, Hui Sang and Choi, JiYeon", title="Identifying Profiles of Digital Literacy Among Community-Dwelling Korean Older Adults: Latent Profile Analysis", journal="J Med Internet Res", year="2025", month="Feb", day="19", volume="27", pages="e57122", keywords="digital literacy", keywords="digital divide", keywords="older adults", keywords="South Korea", keywords="latent profile analysis", abstract="Background: The digital divide is apparent not only between older and younger generations but also within the older adult population itself. Identifying digital literacy profiles among older adults is crucial for developing targeted strategies to narrow this divide. Objective: This study aimed to identify profiles of digital literacy among community-dwelling older adults and to examine factors associated with these profiles. Methods: Data were collected from community-dwelling older adults in South Korea through a nationwide cross-sectional survey that assessed digital literacy and related factors. Digital literacy was evaluated across 3 domains: information and communication (9 items), content creation and management (4 items), and safety and security (9 items). Latent profile analysis was used to identify profiles of digital literacy among community-dwelling older adults, and multinomial logistic regression was used to identify predictors of profile membership. Results: A total of 1016 older adults completed structured questionnaires (average age 68, SD 6.5 years; 486/1016, 47.8\% men). Three digital literacy profiles were identified (P<.001): ``low level'' (346/1016, 34.1\%), ``middle level'' (374/1016, 36.8\%), and ``high level'' (296/1016, 29.1\%). With the ``middle-level'' digital literacy group as the reference group, older adult participants (odds ratio [OR] 1.11, 95\% CI 1.07-1.15) with less than a middle school education (vs with a college degree or higher; OR 7.22, 95\% CI 2.31-22.54), who needed help with one of the 10 instrumental daily activities (vs ?2 activities; OR 3.06, 95\% CI 1.11-8.40) and who did not engage in in-person social activities (OR 1.81, 95\% CI 1.07-3.07), were more likely to be in the ``low-level'' group. Women were less likely to be in the ``high-level'' digital literacy group than men (OR 0.45, 95\% CI 0.25-0.80). Participants with less than a college education were also less likely to be in the ``high-level'' group, with those having less than a middle school education showing the lowest OR (OR 0.17, 95\% CI 0.07-0.41). Those who had never worked (OR 0.23, 95\% CI 0.06-0.90) and those not engaging in regular physical exercise (OR 0.58, 95\% CI 0.40-0.84) were also less likely to be in the ``high-level'' digital literacy group. Participants with greater social support were more likely to be in the ``high-level'' digital literacy group (OR 1.70, 95\% CI 1.22-2.37). Conclusions: These findings underscore the characteristics linked to lower digital literacy and suggest a tailored approach to meet the needs of diverse groups of older adults in a digitalizing society. To promote digital literacy among older adults, potential strategies include improving access to and guidance for using digital devices, specifically designed for this demographic, as well as promoting social support and encouraging participation in social activities. ", doi="10.2196/57122", url="https://www.jmir.org/2025/1/e57122", url="http://www.ncbi.nlm.nih.gov/pubmed/39969960" } @Article{info:doi/10.2196/72007, author="Vordenberg, E. Sarah and Nichols, Julianna and Marshall, D. Vincent and Weir, Rebecca Kristie and Dorsch, P. Michael", title="Authors' Reply: Enhancing the Clinical Relevance of Al Research for Medication Decision-Making", journal="J Med Internet Res", year="2025", month="Feb", day="18", volume="27", pages="e72007", keywords="older adults", keywords="artificial intelligence", keywords="vignette", keywords="pharmacology", keywords="medication", keywords="decision-making", keywords="aging", keywords="attitude", keywords="perception", keywords="perspective", keywords="electronic heath record", doi="10.2196/72007", url="https://www.jmir.org/2025/1/e72007", url="http://www.ncbi.nlm.nih.gov/pubmed/39964740" } @Article{info:doi/10.2196/70657, author="Wang, Qi and Chen, Mingxian", title="Enhancing the Clinical Relevance of Al Research for Medication Decision-Making", journal="J Med Internet Res", year="2025", month="Feb", day="18", volume="27", pages="e70657", keywords="older adults", keywords="artificial intelligence", keywords="medication", keywords="decision-making", keywords="data security", keywords="patient trust", doi="10.2196/70657", url="https://www.jmir.org/2025/1/e70657", url="http://www.ncbi.nlm.nih.gov/pubmed/39964744" } @Article{info:doi/10.2196/60107, author="Snow, Martha and Silva-Ribeiro, Wagner and Baginsky, Mary and Di Giorgio, Sonya and Farrelly, Nicola and Larkins, Cath and Poole, Karen and Steils, Nicole and Westwood, Joanne and Malley, Juliette", title="Best Practices for Implementing Electronic Care Records in Adult Social Care: Rapid Scoping Review", journal="JMIR Aging", year="2025", month="Feb", day="14", volume="8", pages="e60107", keywords="digital care records", keywords="adult social care", keywords="digitization", keywords="domiciliary care", keywords="care homes", keywords="electronic care records", keywords="PRISMA", abstract="Background: In the past decade, the use of digital or electronic records in social care has risen worldwide, capturing key information for service delivery. The COVID-19 pandemic accelerated digitization in health and social care. For example, the UK government created a fund specifically for adult social care provider organizations to adopt digital social care records. These developments offer valuable learning opportunities for implementing digital care records in adult social care settings. Objective: This rapid scoping review aimed to understand what is known about the implementation of digital care records in adult social care and how implementation varies across use cases, settings, and broader contexts. Methods: A scoping review methodology was used, with amendments made to enable a rapid review. Comprehensive searches based on the concepts of digital care records, social care, and interoperability were conducted across the MEDLINE, EmCare, Web of Science Core Collection, HMIC Health Management Information Consortium, Social Policy and Practice, and Social Services Abstracts databases. Studies published between 2018 and 2023 in English were included. One reviewer screened titles and abstracts, while 2 reviewers extracted data. Thematic analysis mapped findings against the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. Results: Our search identified 2499 references. After screening titles and abstracts, 71 records were selected for full-text review, resulting in 31 references from 29 studies. Studies originated from 11 countries, including 1 multicountry study, with the United Kingdom being the most represented (10/29, 34\%). Studies were most often conducted in nursing homes or facilities (7/29, 24\%) with older people as the target population (6/29, 21\%). Health records were the most investigated record type (12/29, 41\%). We identified 45 facilitators and 102 barriers to digital care record implementation across 28 studies, spanning 6 of the 7 NASSS framework domains and aligning with 5 overarching themes that require greater active management regarding implementation. Intended or actual implementation outcomes were reported in 17 (59\%) of the 29 studies. Conclusions: The findings suggest that implementation is complex due to a lack of consensus on what digital care records and expected outcomes and impacts should look like. The literature often lacks clear definitions and robust study designs. To be successful, implementation should consider complexity, while studies should use robust frameworks and mixed methods or quantitative designs where appropriate. Future research should define the target population, gather data on carer or service user experiences, and focus on digital care records specifically used in social care. ", doi="10.2196/60107", url="https://aging.jmir.org/2025/1/e60107" } @Article{info:doi/10.2196/59023, author="Yang, Lu and Lynch, Chris and Lee, Tayu John and Oldenburg, Brian and Haregu, Tilahun", title="Understanding the Association Between Home Broadband Connection and Well-Being Among Middle-Aged and Older Adults in China: Nationally Representative Panel Data Study", journal="J Med Internet Res", year="2025", month="Feb", day="10", volume="27", pages="e59023", keywords="digital divide", keywords="health inequity", keywords="China", keywords="longitudinal study", keywords="broadband", keywords="internet connection", keywords="internet", keywords="well-being", keywords="psychosocial", keywords="middle age", keywords="older adult", keywords="inequality", keywords="digital connectivity", keywords="logistic regression", keywords="questionnaire", keywords="survey", keywords="panel data approach", abstract="Background: Access to digital technology is among the major social determinants of health, and digital divide impacts health inequality. Yet, the impact of digital connectivity on the well-being and psychosocial outcomes in adults has not been fully studied. Objective: The aim of this study was to investigate the association of home broadband connection with health and well-being of middle-aged adults and adults older than 45 years in China. Methods: A panel data study design of the national sample of China Health and Retirement Longitudinal Study (CHARLS) was conducted in 2015, 2018, and 2020. This study included 16,185 participants older than 45 years. The associations between digital connectivity (home broadband connection), loneliness, social participation, and life satisfaction were assessed using mixed effects logistic regression models, adjusting for socioeconomic factors, behavioral factors, and locality. Broadband internet connectivity, feelings of loneliness, social participation, and satisfaction with life were measured using the self-reported CHARLS questionnaire. Results: We observed a substantial increase in digital connectivity from 29.5\% in 2015 to 59.8\% in 2020. Broadband internet connection at home was positively correlated with social participation (adjusted odds ratio [AOR] 1.34, 95\% CI 1.28-1.41) and life satisfaction (AOR 1.30, 95\% CI 1.20-1.40), after adjusting for confounding factors, while the absence of broadband internet connection was associated with increased loneliness (AOR 0.81, 95\% CI 0.77-0.86). These associations were consistent across age, gender, socioeconomic groups, and geographic areas. Conclusions: This study highlights the potential additional health benefits of digital connectivity beyond the known advantages. Our results suggest the importance of expanding broadband access to enhance social inclusion and life satisfaction. Further research is needed to understand the broader implications and digital determinants of health associated with digital connectivity. ", doi="10.2196/59023", url="https://www.jmir.org/2025/1/e59023" } @Article{info:doi/10.2196/62936, author="Bergh, Sverre and Benth, {\vS}altyt? J?rat? and H{\o}gset, Dyrendal Lisbeth and Rydjord, Britt and Kayser, Lars", title="Assessment of Technology Readiness in Norwegian Older Adults With Long-Term Health Conditions Receiving Home Care Services: Cross-Sectional Questionnaire Study", journal="JMIR Aging", year="2025", month="Feb", day="7", volume="8", pages="e62936", keywords="eHealth literacy", keywords="digital health services", keywords="technology readiness", keywords="Readiness and Enablement Index for Health Technology", keywords="READHY", keywords="chronic conditions", abstract="Background: With the increasing number of older adults globally, there is a constant search for new ways to organize health care services. Digital health services are promising and may reduce workload and at the same time improve patient well-being. A certain level of eHealth literacy is needed to be able to use digital health services. However, knowledge of technology readiness in this target group of older adults is unclear. Objective: The aim of this study was to understand the technology readiness level of a group of older adults who were provided home care services in order to address the present and future needs of this group in relation to the implementation of digital health care services. Methods: This quantitative cross-sectional study included 149 older adults from Norway receiving home care services. The participants completed the Readiness and Enablement Index for Health Technology (READHY) instrument, assessments of well-being (World Health Organization-Five Well-Being Index [WHO-5]), and assessments of demographic and clinical variables (sex, age, education, living situation, comorbidity, use of digital devices, and use of IT). Cluster analyses were used to group the users according to their technology readiness. Results: The mean participant age was 78.6 (SD 8.0) years, and 55.7\% (83/149) were women. There was good consistency within the assumed READHY scales (Cronbach $\alpha$=.61-.91). The participants were grouped into 4 clusters, which differed in terms of READHY scores, demographic variables, and the use of IT in daily life. Participants in cluster 1 (n=40) had the highest scores on the READHY scales, were younger, had a larger proportion of men, had higher education, and had better access to digital devices and IT. Participants in cluster 4 (n=16) scored the lowest on eHealth literacy knowledge. Participants in cluster 1 had relatively high levels of eHealth literacy knowledge and were expected to benefit from digital health services, while participants in cluster 4 had the lowest level of eHealth literacy and would not easily be able to start using digital health services. Conclusions: The technology readiness level varied in our cohort of Norwegian participants receiving home care. Not all elderly people have the eHealth literacy to fully benefit from digital health services. Participants in cluster 4 (n=16) had the lowest scores in the eHealth Literacy Questionnaire scales in the READHY instrument and should be offered nondigital services or would need extensive management support. The demographic differences between the 4 clusters may inform stakeholders about which older people need the most training and support to take advantage of digital health care services. ", doi="10.2196/62936", url="https://aging.jmir.org/2025/1/e62936", url="http://www.ncbi.nlm.nih.gov/pubmed/39918862" } @Article{info:doi/10.2196/68163, author="Jung, Hyein and Lee, Hocheol and Nam, Woo Eun", title="Mediating Effect of Social Capital on the Association Between Digital Literacy and Life Satisfaction Among Older Adults in South Korea: Cross-Sectional Study", journal="JMIR Form Res", year="2025", month="Feb", day="6", volume="9", pages="e68163", keywords="digital literacy", keywords="digital access", keywords="digital competency", keywords="digital utilization", keywords="life satisfaction", keywords="older adults", keywords="social capital", keywords="mediating effect", keywords="aging", abstract="Background: As Korea rapidly transforms into a super-aged society, research indicates that digital literacy among older adults enhances their life satisfaction. Digital literacy refers to the ability to efficiently use digital technologies, encompassing access, competency, and utilization. It reflects the capacity to navigate and benefit from digital environments effectively. Furthermore, social capital positively influences the quality of life, and digital literacy facilitates social capital formation. However, since most studies have only focused on the direct relationship between digital literacy and life satisfaction, research on the mediating role of social capital remains limited. Objective: To analyze the effect of digital literacy on the life satisfaction of older adults in South Korea and to verify whether social capital acts as a mediating factor in this process. Methods: This descriptive cross-sectional study used data from the 2023 Report on the Digital Divide---an annual survey conducted by the Korean Ministry of Science and Information and Communications Technology. The study targeted individuals aged 65 years or older. Descriptive statistics, the Pearson correlation analyses, and the 3-step multiple regression analysis proposed by Baron and Kenny were performed. The bootstrap method was employed, and all analyses were conducted using R, version 4.4.1. Results: The study included 869 participants. Digital literacy had a significant positive effect on their life satisfaction ($\beta$=0.103; P=.008). Social capital was also positively associated with life satisfaction ($\beta$=0.337; P<.001). Mediation analysis showed that digital literacy influenced life satisfaction both directly ($\beta$=0.103; P=.006) and indirectly through social capital ($\beta$=0.037; P=.03). Bootstrapping confirmed the significance of the indirect effect ($\beta$=0.037, 95\% CI 0.005?0.070; P=.03). The total effect of digital literacy on life satisfaction was also significant ($\beta$=0.140, 95\% CI 0.058?0.230; P=.002). Conclusions: This study analyzed the association between digital literacy, social capital, and life satisfaction among older adults in Korea. We identified that social capital mediates the association between digital literacy and life satisfaction among older adults. These findings indicate that tailored digital literacy programs and support policies that promote social capital formation could help bridge the digital divide and foster social inclusion. These measures would enable older adults to access essential services, reduce social isolation, and enhance health and well-being, ultimately improving the overall quality of life. ", doi="10.2196/68163", url="https://formative.jmir.org/2025/1/e68163" } @Article{info:doi/10.2196/65492, author="Kim, SungMin and Park, Choonghee and Park, Sunghyeon and Kim, Dai-Jin and Bae, Ye-Seul and Kang, Jae-Heon and Chun, Ji-Won", title="Measuring Digital Health Literacy in Older Adults: Development and Validation Study", journal="J Med Internet Res", year="2025", month="Feb", day="5", volume="27", pages="e65492", keywords="digital health care", keywords="older adults", keywords="digital health literacy", keywords="exploratory factor analysis", keywords="confirmatory factor analysis", keywords="mobile phone", abstract="Background: New health care services such as smart health care and digital therapeutics have greatly expanded. To effectively use these services, digital health literacy skills, involving the use of digital devices to explore and understand health information, are important. Older adults, requiring consistent health management highlight the need for enhanced digital health literacy skills. To address this issue, it is imperative to develop methods to assess older adults' digital health literacy levels. Objective: This study aimed to develop a tool to measure digital health literacy. To this end, it reviewed existing literature to identify the components of digital health literacy, drafted preliminary items, and developed a scale using a representative sample. Methods: We conducted a primary survey targeting 600 adults aged 55-75 years and performed an exploratory factor analysis on 74 preliminary items. Items with low factor loadings were removed, and their contents were modified to enhance their validity. Then, we conducted a secondary survey with 400 participants to perform exploratory and confirmatory factor analyses. Results: A digital health literacy scale consisting of 25 items was developed, comprising 4 subfactors: use of digital devices, understanding health information, use and decision regarding health information, and use intention. The model fit indices indicated excellent structural validity (Tucker-Lewis Index=0.924, comparative fit index=0.916, root-mean-square error of approximation=0.088, standardized root-mean-square residual=0.044). High convergent validity (average variance extracted>0.5) and reliability (composite reliability>0.7) were observed within each factor. Discriminant validity was also confirmed as the square root of the average variance extracted was greater than the correlation coefficients between the factors. This scale demonstrates high reliability and excellent structural validity. Conclusions: This study is a significant first step toward enhancing digital health literacy among older adults by developing an appropriate tool for measuring digital health literacy. We expect this study to contribute to the future provision of tailored education and treatment based on individual literacy levels. ", doi="10.2196/65492", url="https://www.jmir.org/2025/1/e65492" } @Article{info:doi/10.2196/65399, author="Guo, Lin and Li, Yunwei and Cheng, Kai and Zhao, Ying and Yin, Wenqiang and Liu, Ying", title="Impact of Internet Usage on Depression Among Older Adults: Comprehensive Study", journal="J Med Internet Res", year="2025", month="Jan", day="31", volume="27", pages="e65399", keywords="internet usage", keywords="depression", keywords="older people", keywords="mechanism", keywords="heterogeneity", keywords="mobile phone", abstract="Background: Depression is a widespread mental health issue affecting older adults globally, with substantial implications for their well-being. Although digital interventions have proven effective in high-income countries, research on the potential of internet usage to alleviate depression among older adults in high-income countries remains limited. Objective: This study aimed to examine the impact of internet usage on depression among older adults in high-income countries by developing a comprehensive theoretical framework and testing key hypotheses. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), a 2-stage instrumental variable approach was applied to address endogeneity and estimate causal relationships between internet usage and depression. Results: The findings indicate that internet usage results in a 1.41\% reduction in depression levels among older adults. This effect is mediated by four primary mechanisms: (1) enhanced social interaction, (2) increased physical activity, (3) improved intergenerational contact, and (4) expanded access to educational opportunities. A heterogeneity analysis revealed that these effects are more pronounced in urban areas, eastern regions, and regions with superior internet infrastructure. Conclusions: Internet usage plays a crucial role in alleviating depression among older adults in high-income countries, with regional variations. The findings highlight the need for targeted policy interventions to improve internet access and digital literacy, which can mitigate depression and enhance the mental health of older adults. ", doi="10.2196/65399", url="https://www.jmir.org/2025/1/e65399" } @Article{info:doi/10.2196/60506, author="Wang, Yingxuan Dorothy and Wong, Lai-Yi Eliza and Cheung, Wai-Ling Annie and Tang, Kam-Shing and Yeoh, Eng-Kiong", title="A Comparison of Patient and Provider Perspectives on an Electronic Health Record--Based Discharge Communication Tool: Survey Study", journal="JMIR Aging", year="2025", month="Jan", day="29", volume="8", pages="e60506", keywords="older adult", keywords="gerontology", keywords="geriatric", keywords="old", keywords="older", keywords="elderly", keywords="aging", keywords="aged", keywords="post-acute care", keywords="communication", keywords="satisfaction", keywords="medication information", keywords="patient-provider comparison", keywords="technology-based intervention", keywords="technology acceptance model", keywords="discharge", keywords="EHR", keywords="record", keywords="portal", keywords="cross-sectional", keywords="survey", keywords="questionnaire", keywords="experience", keywords="attitude", keywords="opinion", keywords="perception", keywords="perspective", keywords="acceptance", keywords="adoption", keywords="design", keywords="user experience", abstract="Background: Hospital discharge for older adult patients carries risks. Effective patient-provider communication is crucial for postacute care. Technology-based communication tools are promising in improving patient experience and outcomes. However, there is limited evidence comparing patient and provider user experiences on a large-scale basis, hindering the exploration of true patient-provider shared understanding. Objective: This study aimed to evaluate an electronic health record--based discharge communication tool by examining and comparing patient and provider perspectives. Methods: This study comprised a cross-sectional self-administered staff survey and a pre-post cross-sectional patient survey. Physicians, nurses, and older adult patients aged 65 years and older discharged from 4 public hospitals were included. Patient-provider comparison items focused on 3 aspects of the design quality of the tool (information clarity, adequacy, and usefulness) and overall satisfaction with the tool. In addition, patients' experience of discharge information and their medication-taking behaviors before and after the program implementation were compared based on a validated local patient experience survey instrument. Providers' perceived usefulness of this tool to their work and implementation intentions were measured based on the technology acceptance model to enhance understanding of their experiences by conducting structural equation modeling analysis. Results: A total of 1375 and 2353 valid responses were received from providers and patients, respectively. Patients' overall satisfaction with this communication tool is significantly higher than providers', and patients rated the information clarity and usefulness presented by this tool higher as well (P<.001). However, patients rated information adequacy significantly lower than providers (P<.001). Meanwhile, patients reported a significant improvement in their experience of discharge medication information, and fewer patients reported side effects encounters after the program implementation (126/1083, 11.6\% vs 111/1235, 9\%; P=.04). However, providers showed inconsistent implementation fidelity. Providers' perceived quality of the tool design ($\beta$ coefficient=0.24, 95\% CI 0.08-0.40) and perceived usefulness to their work ($\beta$ coefficient=0.57, 95\% CI 0.43-0.71) significantly impacted their satisfaction. Satisfaction can significantly impact implementation intentions ($\beta$ coefficient=0.40, 95\% CI 0.17-0.64), which further impacts implementation behaviors ($\beta$ coefficient=0.16, 95\% CI 0.10-0.23). Conclusions: A notable disparity exists between patients and health care providers. This may hinder the achievement of the tool's benefits. Future research should aim for a comprehensive overview of implementation barriers and corresponding strategies to enhance staff performance and facilitate patient-provider shared understanding. ", doi="10.2196/60506", url="https://aging.jmir.org/2025/1/e60506" } @Article{info:doi/10.2196/69554, author="Gu, Chenyu and Qian, Liquan and Zhuo, Xiaojie", title="Mindfulness Intervention for Health Information Avoidance in Older Adults: Mixed Methods Study", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="28", volume="11", pages="e69554", keywords="health information avoidance", keywords="cyberchondria", keywords="self-determination theory", keywords="mindfulness", keywords="elderly", abstract="Background: The global aging population and rapid development of digital technology have made health management among older adults an urgent public health issue. The complexity of online health information often leads to psychological challenges, such as cyberchondria, exacerbating health information avoidance behaviors. These behaviors hinder effective health management; yet, little research examines their mechanisms or intervention strategies. Objective: This study investigates the mechanisms influencing health information avoidance among older adults, emphasizing the mediating role of cyberchondria. In addition, it evaluates the effectiveness of mindfulness meditation as an intervention strategy to mitigate these behaviors. Methods: A mixed methods approach was used, combining quantitative and qualitative methodologies. Substudy 1 developed a theoretical model based on self-determination theory to explore internal (positive metacognition and health self-efficacy) and external (subjective norms and health information similarity) factors influencing health information avoidance, with cyberchondria as a mediator. A cross-sectional survey (N=236) was conducted to test the proposed model. Substudy 2 involved a 4-week mindfulness meditation intervention (N=94) to assess its impact on reducing health information avoidance behaviors. Results: Study 1 showed that positive metacognition ($\beta$=.26, P=.002), health self-efficacy ($\beta$=.25, P<.001), and health information similarity ($\beta$=.29, P<.001) significantly predicted health information avoidance among older adults. Cyberchondria mediated these effects: positive metacognition (effect=0.106, 95\% CI 0.035-0.189), health self-efficacy (effect=0.103, 95\% CI 0.043-0.185), and health information similarity (effect=0.120, 95\% CI 0.063-0.191). Subjective norms did not significantly predict health information avoidance ($\beta$=?.11, P=.13), and cyberchondria did not mediate this relationship (effect=?0.045, 95\% CI ?0.102 to 0.016). Study 2 found that after the 4-week mindfulness intervention, the intervention group (group 1: n=46) exhibited significantly higher mindfulness levels than the control group (group 2: n=48; Mgroup1=4.122, Mgroup2=3.606, P<.001) and higher levels compared with preintervention (Mt2=4.122, Mt1=3.502, P<.001, where t1=preintervention and t2=postintervention). However, cyberchondria levels did not change significantly (Mt1=2.848, Mt2=2.685, P=.18). Nevertheless, the results revealed a significant interaction effect between mindfulness and cyberchondria on health information avoidance (effect=?0.357, P=.002, 95\% CI ?0.580 to ?0.131), suggesting that mindfulness intervention effectively inhibited the transformation of cyberchondria into health information avoidance behavior. Conclusions: This study reveals the role of cyberchondria in health information avoidance and validates mindfulness meditation as an effective intervention for mitigating such behaviors. Findings offer practical recommendations for improving digital health information delivery and health management strategies for older adults. ", doi="10.2196/69554", url="https://publichealth.jmir.org/2025/1/e69554" } @Article{info:doi/10.2196/59663, author="Xiao, Yi and Zhang, Sirui and Ma, Yuanzheng and Wang, Shichan and Li, Chunyu and Liang, Yan and Shang, Huifang", title="Long-Term Impact of Using Mobile Phones and Playing Computer Games on the Brain Structure and the Risk of Neurodegenerative Diseases: Large Population-Based Study", journal="J Med Internet Res", year="2025", month="Jan", day="28", volume="27", pages="e59663", keywords="electronic device", keywords="parkinsonism", keywords="dementia", keywords="aging", keywords="brain MRI", keywords="magnetic resonance imaging", abstract="Background: Despite the increasing popularity of electronic devices, the longitudinal effects of daily prolonged electronic device usage on brain health and the aging process remain unclear. Objective: The aim of this study was to investigate the impact of the daily use of mobile phones/computers on the brain structure and the risk of neurodegenerative diseases. Methods: We used data from the UK Biobank, a longitudinal population-based cohort study, to analyze the impact of mobile phone use duration, weekly usage time, and playing computer games on the future brain structure and the future risk of various neurodegenerative diseases, including all-cause dementia (ACD), Alzheimer disease (AD), vascular dementia (VD), all-cause parkinsonism (ACP), and Parkinson disease (PD). All the characteristics of using mobile phones and playing computer games were collected through face-to-face interviews at baseline, and outcomes were extracted from the algorithmic combinations of self-reported medical conditions, hospital admissions, and death registries. In addition, a group of participants underwent magnetic resonance imaging (MRI) at follow-up. Cox regression and linear regression were performed. Results: The study included over 270,000 participants for risk analysis, with a mean baseline age of approximately 55.85 (SD 8.07) years. The average follow-up duration was approximately 13.9 (SD 1.99) years. Lengthy mobile phone use was associated with a reduced risk of ACD (2-4 years: hazard ratio [HR] 0.815, 95\% CI 0.729-0.912, P<.001; 5-8 years: HR 0.749, 95\% CI 0.677-0.829, P<.001; >8 years: HR 0.830, 95\% CI 0.751-0.918, P<.001), AD (5-8 years: HR 0.787, 95\% CI 0.672-0.922, P=.003), and VD (2-4 years: HR 0.616, 95\% CI 0.477-0.794, P<.001; 5-8 years: HR 0.729, 95\% CI 0.589-0.902, P=.004; >8 years: HR 0.750, 95\% CI 0.605-0.930, P=.009) compared to rarely using mobile phones. Additionally, lengthy mobile phone use was linked to a decreased risk of ACP (5-8 years: HR 0.747, 95\% CI 0.637-0.875, P<.001; >8 years: HR 0.774, 95\% CI 0.663-0.904, P=.001) and PD (5-8 years: HR 0.760, 95\% CI 0.644-0.897, P=.001; >8 years: HR 0.777, 95\% CI 0.660-0.913, P=.002) in participants older than 60 years. However, higher weekly usage time did not confer additional risk reduction compared to lower weekly usage of mobile phones. The neuroimaging analysis involved 35,643 participants, with an average duration of approximately 9.0 years between baseline and neuroimaging scans. Lengthy mobile phone use was related to a thicker cortex in different areas of the brain. Conclusions: Lengthy mobile phone use is associated with a reduced risk of neurodegenerative diseases and improved brain structure compared to minimal usage. Our research provides valuable background knowledge for future studies on the impact of modern electronic devices on brain health. ", doi="10.2196/59663", url="https://www.jmir.org/2025/1/e59663" } @Article{info:doi/10.2196/69080, author="Nakagomi, Atsushi and Ide, Kazushige and Kondo, Katsunori and Shiba, Koichiro", title="Digital Gaming and Subsequent Health and Well-Being Among Older Adults: Longitudinal Outcome-Wide Analysis", journal="J Med Internet Res", year="2025", month="Jan", day="27", volume="27", pages="e69080", keywords="digital gaming", keywords="older adults", keywords="flourishing", keywords="well-being", keywords="physical activity", keywords="social engagement", keywords="mobile phone", abstract="Background: Digital gaming has become increasingly popular among older adults, potentially offering cognitive, social, and physical benefits. However, its broader impact on health and well-being, particularly in real-world settings, remains unclear. Objective: This study aimed to evaluate the multidimensional effects of digital gaming on health and well-being among older adults, using data from the Japan Gerontological Evaluation Study conducted in Matsudo City, Chiba, Japan. Methods: Data were drawn from 3 survey waves (2020 prebaseline, 2021 baseline, and 2022 follow-up) of the Japan Gerontological Evaluation Study, which targets functionally independent older adults. The exposure variable, digital gaming, was defined as regular video game play and was assessed in 2021. In total, 18 outcomes across 6 domains were evaluated in 2022; domain 1---happiness and life satisfaction, domain 2---physical and mental health, domain 3---meaning and purpose, domain 4---character and virtue, domain 5---close social relationships, and domain 6---health behavior. Furthermore, 10 items from the Human Flourishing Index were included in domains 1-5, with 2 items for each domain. Overall flourishing was defined as the average of the means across these 5 domains. In addition, 7 items related to domains 2, 5, and 6 were assessed. The final sample consisted of 2504 participants aged 65 years or older, with questionnaires containing the Human Flourishing Index randomly distributed to approximately half of the respondents (submodule: n=1243). Consequently, we used 2 datasets for analysis. We applied targeted maximum likelihood estimation to estimate the population average treatment effects, with Bonferroni correction used to adjust for multiple testing. Results: Digital gaming was not significantly associated with overall flourishing or with any of the 5 domains from the Human Flourishing Index. Although initial analyses indicated associations between digital gaming and participation in hobby groups (mean difference=0.12, P=.005) as well as meeting with friends (mean difference=0.076, P=.02), these associations did not remain significant after applying the Bonferroni correction for multiple testing. In addition, digital gaming was not associated with increased sedentary behavior or reduced outdoor activities. Conclusions: This study provides valuable insights into the impact of digital gaming on the health and well-being of older adults in a real-world context. Although digital gaming did not show a significant association with improvements in flourishing or in the individual items across the 5 domains, it was also not associated with increased sedentary behavior or reduced outdoor activities. These findings suggest that digital gaming can be part of a balanced lifestyle for older adults, offering opportunities for social engagement, particularly through hobby groups. Considering the solitary nature of gaming, promoting social gaming opportunities may be a promising approach to enhance the positive effects of digital gaming on well-being. ", doi="10.2196/69080", url="https://www.jmir.org/2025/1/e69080" } @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/10.2196/50669, author="Chang, Chien-Hsiang and Wei, Chun-Chun and Lien, Wei-Chih and Yang, Tai-Hua and Liu, Bo and Lin, Yimo and Tan, Thong Poh and Lin, Yang-Cheng", title="The Usability and Effect of a Novel Intelligent Rehabilitation Exergame System on Quality of Life in Frail Older Adults: Prospective Cohort Study", journal="JMIR Serious Games", year="2025", month="Jan", day="21", volume="13", pages="e50669", keywords="frailty", keywords="exergame", keywords="older adults", keywords="intelligent rehabilitation", keywords="reminiscence therapy", keywords="eHealth care", abstract="Background: Aging in older adults results in a decline in physical function and quality of daily life. Due to the COVID-19 pandemic, the exercise frequency among older adults decreased, further contributing to frailty. Traditional rehabilitation using repetitive movements tends not to attract older adults to perform independently. Objective: Intelligent Rehabilitation Exergame System (IRES), a novel retro interactive exergame that incorporates real-time surface electromyography, was developed and evaluated. Methods: Frail older adults were invited to use the IRES for rehabilitation using lower limb training twice per week for 4 weeks. Participants were required to have no mobility or communication difficulties and be willing to complete the 4-week study. The enrolled cohort had baseline scores ranging from 1 to 5 on the Clinical Frailty Scale, as described by Rockwood et al. Three major lower limb movements (knee extension, plantar flexion, and dorsiflexion) were performed 20 times for each leg within 30 minutes. The surface electromyography collected and analyzed muscle potential signals for review by health care professionals to customize the protocol for the next training. The System Usability Scale (SUS) and Taiwanese version of the EuroQol-5 Dimensions (EQ-5D) were administered after completing the first (week 1, baseline) and last training (week 4, one-month follow-up) to evaluate the usability of the IRES and its effects on the quality of life of participants. Results: A total of 49 frail older adults (mean age 74.6 years) were included in the analysis. The usability of the IRES improved according to the mean SUS score, from 82.09 (good) at baseline to 87.14 (good+) at 1-month follow-up. The willingness to use (t96=?4.51; P<.001), learnability (t96=?4.83; P<.001), and confidence (t96=?2.27; P=.02) in working with the IRES increased. After using the IRES for 1 month, significant improvements were observed in the ease of use (t47=2.05; P=.04) and confidence (t47=2.68; P<.001) among participants without previous rehabilitation experience. No sex-based differences in the SUS scores were found at baseline or 1-month follow-up. The quality of life, as assessed by the EQ-5D, improved significantly after 1 month of IRES training compared to that at baseline (t96=6.03; P<.001). Conclusions: The novel IRES proposed in this study received positive feedback from frail older adults. Integrating retro-style exergame training into rehabilitation not only improved their rehabilitation motivation but also increased their learning, system operability, and willingness to continue rehabilitation. The IRES provides an essential tool for the new eHealth care service in the post--COVID-19 era. ", doi="10.2196/50669", url="https://games.jmir.org/2025/1/e50669" } @Article{info:doi/10.2196/62645, author="Wu, Mengqiu and Xue, Yongxi and Ma, Chengyu", title="The Association Between the Digital Divide and Health Inequalities Among Older Adults in China: Nationally Representative Cross-Sectional Survey", journal="J Med Internet Res", year="2025", month="Jan", day="15", volume="27", pages="e62645", keywords="older adults", keywords="digital divide", keywords="internet use", keywords="internet access", keywords="health inequalities", abstract="Background: Health inequalities among older adults become increasingly pronounced as aging progresses. In the digital era, some researchers argue that access to and use of digital technologies may contribute to or exacerbate these existing health inequalities. Conversely, other researchers believe that digital technologies can help mitigate these disparities. Objective: This study aimed to investigate the relationship between the digital divide and health inequality among older adults and to offer recommendations for promoting health equity. Methods: Data were obtained from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) scale, the Instrumental Activities of Daily Living scale, the Mini-Mental State Examination scale, and a 5-point self-rated health scale, respectively. The chi-square and rank sum tests were used to explore whether internet use and access were associated with health inequality status. After controlling for confounders, multiple linear regression models were used to further determine this association. Sensitivity analysis was conducted using propensity score matching, and heterogeneity was analyzed for different influencing factors. Results: The 2018 analysis highlighted widening health disparities among older adults due to internet access and use, with statistically significant increases in inequalities in self-rated health (3.9\%), ADL score (5.8\%), and cognition (7.5\%). Similarly, internet use widened gaps in self-rated health (7.5\%) and cognition (7.6\%). Conversely, the 2020 analysis demonstrated that internet access improved health disparities among older adults, reducing gaps in self-rated health (3.8\%), ADL score (2.1\%), instrumental ADL score (3.5\%), and cognition (7.5\%), with significant results, except for ADL. Internet use also narrowed disparities, with significant effects on self-rated health (4.8\%) and cognition (12.8\%). The robustness of the results was confirmed through propensity score--matching paired tests. In addition, the study found heterogeneity in the effects of internet access and use on health inequalities among older adults, depending on sex, age, education, and region. Conclusions: The impact of internet access and use on health inequalities among older adults showed different trends in 2018 and 2020. These findings underscore the importance of addressing the challenges and barriers to internet use among older adults, particularly during the early stages of digital adoption. It is recommended to promote equitable access to the health benefits of the internet through policy interventions, social support, and technological advancements. ", doi="10.2196/62645", url="https://www.jmir.org/2025/1/e62645" } @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/10.2196/62730, author="Wang, Wei and Wang, Hui and Hu, Xinru and Yu, Qian and Chen, Fangyi and Qiu, Xirui and Wang, Xiaoxiao", title="The Association Between Posting WeChat Moments and the Risk of Depressive Symptoms Among Middle-Aged and Older Chinese Adults: Prospective National Cohort Study", journal="JMIR Public Health Surveill", year="2025", month="Jan", day="13", volume="11", pages="e62730", keywords="cohort study", keywords="depression", keywords="depressive symptoms", keywords="mental health", keywords="middle-aged adults", keywords="modified Poisson regression", keywords="older adults", keywords="WeChat", abstract="Background: The association between social media usage and the risk of depressive symptoms has attracted increasing attention. WeChat is a popular social media software in China. The impact of using WeChat and posting WeChat moments on the risk of developing depressive symptoms among community-based middle-aged and older adults in China is unknown. Objective: The objective was to assess the association between using WeChat and posting WeChat moments and the risk of depressive symptoms among middle-aged and older adults in China. Methods: A prospective national cohort study was designed based on the data obtained from the fourth and fifth waves of the China Health and Retirement Longitudinal Study (CHARLS). The strength of association between using WeChat and posting WeChat moments and the risk of depressive symptoms was estimated by modified Poisson regressions. Depressive symptoms were determined using the 10-item Center for Epidemiologic Studies Depression Scale. Meanwhile, the heterogeneity of the associations was explored through multiple subgroup analyses. Moreover, multiple sensitivity analyses were performed to verify the robustness of the associations between the exposures and depressive symptoms. Results: A total of 9670 eligible participants were included in the cohort study, and the incidence rate of depressive symptoms was 19.08\% (1845/9670, 95\% CI 19.07\%?19.09\%) from the fourth to fifth waves of the CHARLS. Using WeChat (adjusted relative risk [aRR] 0.691, 95\% CI 0.582?0.520) and posting WeChat moments (aRR 0.673, 95\% CI 0.552?0.821) reduced the risk of depressive symptoms among middle-aged and older Chinese adults. The association between the exposures and depressive symptoms was robust, proved through multiple sensitivity analyses (all P<.05). However, the associations were heterogeneous in certain subgroup catagories, such as solitude, duration of sleep at night, nap after lunch, physical activity, and having multiple chronic conditions. Conclusions: Using WeChat and especially posting WeChat moments can mitigate the risk of depressive symptoms among community-based middle-aged and older Chinese adults. However, there is likely a need for a longer follow-up period to explore the impact of the exposures on the risk of long-term depressive outcomes. ", doi="10.2196/62730", url="https://publichealth.jmir.org/2025/1/e62730" } @Article{info:doi/10.2196/54466, author="Martins, Isabel Ana and Ribeiro, {\'O}scar and Santinha, Gon{\c{c}}alo and Silva, Telmo and Rocha, P. Nelson and Silva, G. Anabela", title="Effectiveness of Integrated Digital Solutions to Empower Older Adults in Aspects Related to Their Health: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2025", month="Jan", day="9", volume="27", pages="e54466", keywords="empowerment", keywords="older adults", keywords="digital health", keywords="digital solutions", keywords="effectiveness", keywords="health related", keywords="outcomes", keywords="systematic review", keywords="meta-analysis", keywords="synthesize", keywords="evaluate", keywords="apps", keywords="mHealth", keywords="mobile health", abstract="Background: Digital solutions, such as mobile apps or telemonitoring devices, are frequently considered facilitators in the process of empowering older adults, but they can also act as a source of digital exclusion or disempowerment if they are not adequate for older adults' needs and characteristics. Objective: This study aimed to synthesize and critically evaluate existing evidence on the effectiveness of integrated digital solutions that enable interaction for empowering older adults in aspects related to their health and to explore potential factors (eg, type of technology, participants' characteristics) impacting effectiveness. Methods: A systematic search was carried out in PubMed, ScienceDirect, SCOPUS, EBSCO, and SciELO using a combination of terms informed by previous reviews on empowerment. Screening of references was performed against predefined inclusion criteria. Data extraction and the methodological quality of included studies using the PEDro (Physiotherapy Evidence Database) scale were performed by 2 authors. The certainty of evidence was graded for the main comparisons and outcomes of the review using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. When at least 3 studies were available within the same domain of empowerment (knowledge, support by others, capacities, and behaviors) and comparison group, a meta-analysis was performed. Results: A total of 30 manuscripts were included in the review. Regarding knowledge, there was very low certainty of evidence of a medium effect size (ES) favoring the digital intervention group (k=5, ES=0.40, 95\% CI 0.07-0.73, I2=79\%). Regarding capacities, there was low certainty of evidence of no between-group differences (k=5, d=0.13, 95\% CI --0.02 to 0.29, I2=0\%) when comparing digital solutions against no intervention, low certainty of evidence of a medium ES favoring the digital intervention group (k=13, d=0.29, 95\% CI 0.07-0.52, I2=79\%) when comparing digital solutions against usual care, and very low certainty of evidence of no between-group differences (k=4, d=0.97, 95\% CI --0.62 to 2.56, I2=97\%) when comparing digital interventions to face-to-face interventions. Regarding social support and behaviors, no meta-analysis was possible, and existing evidence is conflicting. Conclusions: There is very-low-to-low certainty of evidence that using integrated digital solutions results in increased knowledge and increased capacities (mainly self-efficacy) when compared to usual care and impacts capacities to an extent similar to face-to-face interventions at postintervention. Interestingly, results also suggest, with low certainty of evidence, that there are no differences between using digital solutions and no intervention for improving capacities. Included studies and technologies were diverse, and meta-analysis showed high heterogeneity, which limits the confidence in the results and suggests that further research might affect the conclusions of this review. Trial Registration: PROSPERO CRD42022346823; https://tinyurl.com/39k29pzc ", doi="10.2196/54466", url="https://www.jmir.org/2025/1/e54466" } @Article{info:doi/10.2196/62824, author="Valla, Guido Luca and Rossi, Michele and Gaia, Alessandra and Guaita, Antonio and Rolandi, Elena", title="The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study", journal="J Med Internet Res", year="2025", month="Jan", day="9", volume="27", pages="e62824", keywords="older adults", keywords="information and communication technology", keywords="ICT", keywords="ICT use", keywords="COVID-19", keywords="social capital", keywords="health", keywords="mental health", keywords="digital divide", abstract="Background: During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. Objective: This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. Methods: We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. Results: COVID-19 had a significant impact on social relationships ($\beta$=--4.35, 95\% CI 6.38 to --2.32; P<.001), cultural activities ($\beta$=--.55, 95\% CI --0.75 to --0.35; P<.001), cognitive functioning ($\beta$=--1.00, 95\% CI --1.28 to --0.72; P<.001), depressive symptoms ($\beta$=.42, 95\% CI 0.10-0.74; P=.009), physical health ($\beta$=.07, 95\% CI 0.04-0.10; P<.001), and ICT use ($\beta$=--.11, 95\% CI --0.18 to --0.03; P=.008). Internet use predicts reduced depressive symptoms ($\beta$=--.56, 95\% CI --1.07 to --0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities ($\beta$=--.73, 95\% CI --1.22 to --0.24; P=.003) and cognitive functioning ($\beta$=1.36, 95\% CI 0.67-2.05; P<.001). Conclusions: The pandemic had adverse effects on older adults' health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. Trial Registration: ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110 ", doi="10.2196/62824", url="https://www.jmir.org/2025/1/e62824" } @Article{info:doi/10.2196/50329, author="Valkonen, Paula and Kujala, Sari and Savolainen, Kaisa and Helminen, Riina-Riitta", title="Exploring Older Adults' Needs for a Healthy Life and eHealth: Qualitative Interview Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="8", volume="12", pages="e50329", keywords="older adults", keywords="eHealth", keywords="needs", keywords="retirement", keywords="well-being", keywords="cultural probes", keywords="sentence completion", keywords="human-computer interaction", abstract="Background: Aging brings physical and life changes that could benefit from eHealth services. eHealth holistically combines technology, tasks, individuals, and contexts, and all these intertwined elements should be considered in eHealth development. As users' needs change with life situations, including aging and retirement, it is important to identify these needs at different life stages to develop eHealth services for well-being and active, healthy lives. Objective: This study aimed to (1) understand older adults' everyday lives in terms of well-being and health, (2) investigate older adults' needs for eHealth services, and (3) create design recommendations based on the findings. Methods: A total of 20 older adults from 2 age groups (55 to 74 years: n=12, 60\%; >75 years: n=8, 40\%) participated in this qualitative interview study. The data were collected remotely using a cultural probes package that included diary-based tasks, sentence completion tasks, and 4 background questionnaires; we also performed remote, semistructured interviews. The data were gathered between the fall of 2020 and the spring of 2021 in Finland as a part of the Toward a Socially Inclusive Digital Society: Transforming Service Culture (DigiIN) project (2019 to 2025). Results: In the daily lives of older adults, home-based activities, such as exercising (72/622, 11.6\% of mentions), sleeping (51/622, 8.2\% of mentions), and dining and cooking (96/622, 15.4\% of mentions), promoted well-being and health. When discussing their needs for eHealth services, participants highlighted a preference for a chat function. However, they frequently mentioned barriers and concerns such as the lack of human contact, inefficiency, and difficulties using eHealth systems. Older adults value flexibility; testing possibilities (eg, trial versions); support for digital services; and relevant, empathetically offered content with eHealth services on short-term and long-term bases in their changing life situations. Conclusions: Many older adults value healthy routines and time spent at home. The diversity of older adults' needs should be considered by making it possible for them to manage their health safely and flexibly on different devices and channels. eHealth services should adapt to older adults' life changes through motivation, personalized content, and appropriate functions. Importantly, older adults should still have the option to not use eHealth services. ", doi="10.2196/50329", url="https://humanfactors.jmir.org/2025/1/e50329" } @Article{info:doi/10.2196/63856, author="DeLange Martinez, Pauline and Tancredi, Daniel and Pavel, Misha and Garcia, Lorena and Young, M. Heather", title="Adapting the Technology Acceptance Model to Examine the Use of Information Communication Technologies and Loneliness Among Low-Income, Older Asian Americans: Cross-Sectional Survey Analysis", journal="JMIR Aging", year="2025", month="Jan", day="8", volume="8", pages="e63856", keywords="social isolation", keywords="loneliness", keywords="aged", keywords="older adults", keywords="Asian American", keywords="immigrant", keywords="vulnerable populations", keywords="internet", keywords="information and communication technologies", keywords="ICTs", keywords="digital divide", keywords="technology acceptance model", keywords="mobile phone", abstract="Background: Loneliness is a significant issue among older Asian Americans, exacerbated by the COVID-19 pandemic. Older age, lower income, limited education, and immigrant status heighten loneliness risk. Information communication technologies (ICTs) have been associated with decreased loneliness among older adults. However, older Asian Americans are less likely to use ICTs, particularly if they are immigrants, have limited English proficiency, or are low income. The Technology Acceptance Model posits that perceived usefulness (PU), and perceived ease of use (PEOU) are key factors in predicting technology use. Objective: This study aimed to examine associations between PU, PEOU, ICT use, and loneliness among low-income, older Asian Americans. Methods: Cross-sectional survey data were gathered from predominately older Asian Americans in affordable senior housing (N=401). Using exploratory factor analysis and Horn parallel analysis, we examined 12 survey items to identify factors accounting for variance in ICT use. We deployed structural equation modeling to explore relationships among the latent factors and loneliness, adjusting for demographic and cognitive factors. Results: Exploratory factor analysis and Horn parallel analysis revealed 3 factors that accounted for 56.48\% (6.78/12) total variance. PEOU combined items from validated subscales of tech anxiety and comfort, accounting for a 28.44\% (3.41/12) variance. ICT use combined years of technological experience, computer, tablet, and smartphone use frequency, accounting for 15.59\% (1.87/12) variance. PU combined 2 items assessing the usefulness of technology for social connection and learning and accounted for a 12.44\% (1.49/12) variance. The 3-factor structural equation modeling revealed reasonable fit indexes ($\chi$2133=345.132; P<.001, chi-square minimum (CMIN)/df = 2595, comparative fit index (CFI)=0.93, Tucker-Lewis Index (TLI)=0.88). PEOU was positively associated with PU ($\beta$=.15; P=.01); PEOU and PU were positive predictors of ICT use (PEOU $\beta$=.26, P<.001; PU $\beta$=.18, P=.01); and ICT use was negatively associated with loneliness ($\beta$=--.28, P<.001). Demographic and health covariates also significantly influenced PU, PEOU, ICT use, and loneliness. English proficiency and education positively predicted PEOU (r=0.25, P<.001; r=0.26, P<.001) and ICT use ($\beta$=1.66, P=.03; $\beta$=.21, P<.001), while subjective cognitive decline and Asian ethnicity were positively associated with loneliness ($\beta$=.31, P<.001; $\beta$=.25, P<.001). Conclusions: This study suggests that targeted interventions enhancing PU or PEOU could increase ICT acceptance and reduce loneliness among low-income Asian Americans. Findings also underscore the importance of considering limited English proficiency and subjective cognitive decline when designing interventions and in future research. ", doi="10.2196/63856", url="https://aging.jmir.org/2025/1/e63856" } @Article{info:doi/10.2196/65684, author="Weir, Rebecca Kristie and Maitah, Yehya and Vordenberg, E. Sarah", title="Older Adults' Experiences With an Online Survey", journal="JMIR Hum Factors", year="2025", month="Jan", day="8", volume="12", pages="e65684", keywords="older adults", keywords="gerontology", keywords="geriatric", keywords="older", keywords="aging", keywords="online", keywords="internet", keywords="survey", keywords="questionnaire", keywords="research engagement", keywords="engagement", keywords="study subject", keywords="participant", keywords="medication decisions", doi="10.2196/65684", url="https://humanfactors.jmir.org/2025/1/e65684" } @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/10.2196/53205, 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/10.2196/60483, author="Chadwick, Helen and Laverty, Louise and Finnigan, Robert and Elias, Robert and Farrington, Ken and Caskey, J. Fergus and van der Veer, N. Sabine", title="Engagement With Digital Health Technologies Among Older People Living in Socially Deprived Areas: Qualitative Study of Influencing Factors", journal="JMIR Form Res", year="2024", month="Dec", day="26", volume="8", pages="e60483", keywords="aged", keywords="digital health", keywords="health equity", keywords="intersectionality, qualitative research", keywords="social deprivation", abstract="Background: The potential benefits of incorporating digital technologies into health care are well documented. For example, they can improve access for patients living in remote or underresourced locations. However, despite often having the greatest health needs, people who are older or living in more socially deprived areas may be less likely to have access to these technologies and often lack the skills to use them. This puts them at risk of experiencing further health inequities. In addition, we know that digital health inequities associated with older age may be compounded by lower socioeconomic status. Yet, there is limited research on the intersectional barriers and facilitators for engagement with digital health technology by older people who are particularly marginalized. Objective: This study aimed to explore factors influencing engagement with digital health technologies among people at the intersection of being older and socially deprived. Methods: We conducted semistructured interviews with people who were 70 years or older, living in a socially deprived area, or both. Chronic kidney disease was our clinical context. We thematically analyzed interview transcripts using the Unified Theory of Acceptance and Use of Technology as a theoretical framework. Results: We interviewed 26 people. The majority were White British (n=20) and had moderate health and digital literacy levels (n=10 and n=11, respectively). A total of 13 participants were 70 years of age or older and living in a socially deprived area. Across participants, we identified 2 main themes from the interview data. The first showed that some individuals did not use digital health technologies due to a lack of engagement with digital technology in general. The second theme indicated that people felt that digital health technologies were ``not for them.'' We identified the following key engagement factors, with the first 2 particularly impacting participants who were both older and socially deprived: lack of opportunities in the workplace to become digitally proficient; lack of appropriate support from family and friends; negative perceptions of age-related social norms about technology use; and reduced intrinsic motivation to engage with digital health technology because of a perceived lack of relevant benefits. Participants on the intersection of older age and social deprivation also felt significant anxiety around using digital technology and reported a sense of distrust toward digital health care. Conclusions: We identified factors that may have a more pronounced negative impact on the health equity of older people living in socially deprived areas compared with their counterparts who only have one of these characteristics. Successful implementation of digital health interventions therefore warrants dedicated strategies for managing the digital health equity impact on this group. Future studies should further develop these strategies and investigate their effectiveness, as well as explore the influence of related characteristics, such as educational attainment and ethnicity. ", doi="10.2196/60483", url="https://formative.jmir.org/2024/1/e60483" } @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/10.2196/60794, author="Vordenberg, E. Sarah and Nichols, Julianna and Marshall, D. Vincent and Weir, Rebecca Kristie and Dorsch, P. Michael", title="Investigating Older Adults' Perceptions of AI Tools for Medication Decisions: Vignette-Based Experimental Survey", journal="J Med Internet Res", year="2024", month="Dec", day="16", volume="26", pages="e60794", keywords="older adults", keywords="survey", keywords="decisions", keywords="artificial intelligence", keywords="vignette", keywords="drug", keywords="pharmacology", keywords="pharmaceutic", keywords="medication", keywords="decision-making", keywords="geriatric", keywords="aging", keywords="surveys", keywords="attitude", keywords="perception", keywords="perspective", keywords="recommendation", keywords="electronic heath record", abstract="Background: Given the public release of large language models, research is needed to explore whether older adults would be receptive to personalized medication advice given by artificial intelligence (AI) tools. Objective: This study aims to identify predictors of the likelihood of older adults stopping a medication and the influence of the source of the information. Methods: We conducted a web-based experimental survey in which US participants aged ?65 years were asked to report their likelihood of stopping a medication based on the source of information using a 6-point Likert scale (scale anchors: 1=not at all likely; 6=extremely likely). In total, 3 medications were presented in a randomized order: aspirin (risk of bleeding), ranitidine (cancer-causing chemical), or simvastatin (lack of benefit with age). In total, 5 sources of information were presented: primary care provider (PCP), pharmacist, AI that connects with the electronic health record (EHR) and provides advice to the PCP (``EHR-PCP''), AI with EHR access that directly provides advice (``EHR-Direct''), and AI that asks questions to provide advice (``Questions-Direct'') directly. We calculated descriptive statistics to identify participants who were extremely likely (score 6) to stop the medication and used logistic regression to identify demographic predictors of being likely (scores 4-6) as opposed to unlikely (scores 1-3) to stop a medication. Results: Older adults (n=1245) reported being extremely likely to stop a medication based on a PCP's recommendation (n=748, 60.1\% [aspirin] to n=858, 68.9\% [ranitidine]) compared to a pharmacist (n=227, 18.2\% [simvastatin] to n=361, 29\% [ranitidine]). They were infrequently extremely likely to stop a medication when recommended by AI (EHR-PCP: n=182, 14.6\% [aspirin] to n=289, 23.2\% [ranitidine]; EHR-Direct: n=118, 9.5\% [simvastatin] to n=212, 17\% [ranitidine]; Questions-Direct: n=121, 9.7\% [aspirin] to n=204, 16.4\% [ranitidine]). In adjusted analyses, characteristics that increased the likelihood of following an AI recommendation included being Black or African American as compared to White (Questions-Direct: odds ratio [OR] 1.28, 95\% CI 1.06-1.54 to EHR-PCP: OR 1.42, 95\% CI 1.17-1.73), having higher self-reported health (EHR-PCP: OR 1.09, 95\% CI 1.01-1.18 to EHR-Direct: OR 1.13 95\%, CI 1.05-1.23), having higher confidence in using an EHR (Questions-Direct: OR 1.36, 95\% CI 1.16-1.58 to EHR-PCP: OR 1.55, 95\% CI 1.33-1.80), and having higher confidence using apps (EHR-Direct: OR 1.38, 95\% CI 1.18-1.62 to EHR-PCP: OR 1.49, 95\% CI 1.27-1.74). Older adults with higher health literacy were less likely to stop a medication when recommended by AI (EHR-PCP: OR 0.81, 95\% CI 0.75-0.88 to EHR-Direct: OR 0.85, 95\% CI 0.78-0.92). Conclusions: Older adults have reservations about following an AI recommendation to stop a medication. However, individuals who are Black or African American, have higher self-reported health, or have higher confidence in using an EHR or apps may be receptive to AI-based medication recommendations. ", doi="10.2196/60794", url="https://www.jmir.org/2024/1/e60794" } @Article{info:doi/10.2196/52834, author="Choukou, Mohamed-Amine and Banihani, Jasem and Azizkhani, Sarah", title="Exploring Older Adults' Perspectives on Digital Home Care Interventions and Home Modifications: Focus Group Study", journal="JMIR Form Res", year="2024", month="Dec", day="13", volume="8", pages="e52834", keywords="agetech", keywords="attitude", keywords="opinion", keywords="perception", keywords="perspective", keywords="home based", keywords="community based", keywords="research", keywords="strategic planning", keywords="gerontechnology", keywords="geriatric", keywords="older adults", keywords="aging", keywords="co-construction", keywords="workshop", keywords="inductive analysis", keywords="development", keywords="aging-in-place", keywords="independent", abstract="Background: Emerging gerontechnology seeks to enable older adults (OAs) to remain independently and safely in their homes by connecting to health and social support and services. There are increasing attempts to develop gerontechnology, but successful implementations are more likely limited because of the uncertainty of developers about the needs and priorities of OAs. As the global population ages, the challenges faced by older OAs in maintaining independence and well-being within their homes have become increasingly important. With the proportion of OAs expected to triple by 2068, addressing the needs of this demographic has become a pressing social and public health priority. OAs often encounter various challenges related to physical, cognitive, and social well-being, including reduced mobility, memory impairments, and social isolation, which can compromise their ability to age in place and maintain a high quality of life. Objective: The goals of this qualitative research study are to (1) determine the best strategies for promoting aging well in the community with the support of gerontechnology, (2) establish the top priorities for implementing gerontechnology with OAs and their families, and (3) create a road map for the creation and application of gerontechnology for aging well in Manitoba. Methods: A total of 14 OAs participated in a qualitative research study conducted through a coconstruction workshop format, including a presentation of novel research facilities and a demonstration of research and development products. This activity was followed by an interactive discussion focused on revisiting the ongoing research and innovation programs and planning for a new research and innovation agenda. The workshop contents, notes, and recorded conversation underwent a data-driven inductive analysis. Results: Emerging themes included home design, accessibility, and safety for OAs, particularly those with memory impairments. The participants also underlined the need for digital reminders and ambient technologies in current homes as a priority. Participants stressed the importance of including OAs in gerontechnology development programs and the need to consider dignity and independence as the guiding values for future research. Conclusions: This study presents a tentative road map for the development of gerontechnology in Manitoba. The main principles of our road map are the inclusion of OAs as early as possible in gerontechnology development and the prioritization of independence and dignity. Applying these principles would contribute to combatting digital ageism and the marginalization of OAs in technology development because of the perceived lack of technological skills and the stereotypes associated with this presumption. ", doi="10.2196/52834", url="https://formative.jmir.org/2024/1/e52834" } @Article{info:doi/10.2196/62689, author="Klein, Melina and von Bosse, Alexa and Kunze, Christophe", title="The Needs and Experiences of People With Early-Stage Dementia Using an Application for Cognitive and Physical Activation in Germany: Qualitative Study", journal="JMIR Aging", year="2024", month="Dec", day="10", volume="7", pages="e62689", keywords="touch-based digital technology", keywords="gerontology", keywords="geriatric", keywords="older", keywords="elderly", keywords="aging", keywords="aged", keywords="tablet-based technology", keywords="tablet", keywords="digital care application", keywords="mHealth", keywords="mobile health", keywords="app", keywords="health app", keywords="home care setting", keywords="caring relatives", keywords="dementia", keywords="MCI", keywords="Alzheimer", keywords="mild cognitive impairment", keywords="cognition", keywords="prototype", keywords="digital health", keywords="telehealth", keywords="memory loss", keywords="patient care", keywords="patient health", keywords="patient support", abstract="Background: The demand for support among people with dementia is increasing, while caregiving capacity is declining. As the trend of aging at home continues, technologies can help maintain the autonomy of people with dementia, enabling them to live independently for as long as possible. Furthermore, digital applications can have numerous positive biopsychosocial effects on the health of people with dementia, enhancing their physical, cognitive, and social functioning. Objective: This study aims to investigate the needs and experiences of people with dementia regarding a prototype tablet-based application designed to promote cognitive and physical activity. Methods: We conducted a methodical triangulation by combining semistructured interviews with people with dementia and external overt participant observation while testing a tablet-based application. A qualitative content analysis, as outlined by Kuckartz, was used to analyze the data. Results: Participants demonstrated varying levels of ability and prior experience with technology. While most were initially hesitant to use the tablet independently, they were more willing to try it after receiving encouragement. Some individuals required more assistance than others, indicating the need for individualized adjustments. Personal relevance to the content appeared to be crucial for cognitive tasks, as it helped to minimize overload for people with dementia. The participants appreciated social interaction with researchers and direct communication. Therefore, it is important to consider the role of personal support when developing and implementing technology. Conclusions: The successful implementation and use of technology requires acceptance and an effective interaction between people with dementia, technology, and caregivers or caring relatives providing personal support. The acceptance of the application was found to be less influenced by the types and presentation of tasks and more by content relevance and social interaction. Ideally, one-on-one support will be provided during use, though this requires additional time and financial resources, which are often limited in caregiving settings. ", doi="10.2196/62689", url="https://aging.jmir.org/2024/1/e62689" } @Article{info:doi/10.2196/63907, author="Jeon, Sangha and Charles, Turk Susan", title="Internet-Based Social Activities and Cognitive Functioning 2 Years Later Among Middle-Aged and Older Adults: Prospective Cohort Study", journal="JMIR Aging", year="2024", month="Dec", day="10", volume="7", pages="e63907", keywords="online social interaction", keywords="cognitive health", keywords="age differences", keywords="Health and Retirement Study", keywords="social activity", keywords="internet use", keywords="isolation", abstract="Background: A number of studies document the benefits of face-to-face social interactions for cognitive functioning among middle-aged and older adults. Social activities in virtual worlds may confer similar if not enhanced cognitive benefits as face-to-face social activities, given that virtual interactions require the additional cognitive tasks of learning and navigating communicative tools and technology platforms. Yet, few studies have examined whether social activities in internet-based settings may have synergistic effects on cognitive functioning beyond those of face-to-face interactions. Objective: This study examined whether internet-based social activity participation is associated with concurrent and later cognitive functioning, after adjusting for face-to-face social activity participation and sociodemographic covariates. Methods: For cross-sectional analyses, we included 3650 adults aged 50 years and older who completed questions in the 2020 Health and Retirement Study about social activity participation, including specific internet-based social activities such as emailing or accessing social networks. Cognitive functioning was measured using the standardized cognitive tasks assessing working memory, episodic memory, and attention and processing speed. The longitudinal analyses included the 2034 participants who also completed follow-up cognitive assessments in 2022. Results: Our results revealed that those with higher levels of internet-based social activity participation had higher levels of concurrent cognitive functioning than those with low levels of internet-based social activity participation, after adjusting for demographic and health-related factors and face-to-face social activity participation (b=0.44, SE 0.07; P<.001). More internet-based social activity participation also predicted better cognitive functioning 2 years later, even when adjusting for baseline cognitive functioning and other covariates (b=0.35, SE 0.09; P<.001). Conclusions: Our findings suggest that greater engagement in internet-based social activities is associated with higher levels of concurrent cognitive functioning and slower cognitive decline in middle-aged and older adults. ", doi="10.2196/63907", url="https://aging.jmir.org/2024/1/e63907" } @Article{info:doi/10.2196/58729, author="Takesue, Atsuhide and Hiratsuka, Yoshimune and Kondo, Katsunori and Aida, Jun and Nakagomi, Atsushi and Nakao, Shintaro", title="Association Between Visual Impairment and Daily Internet Use Among Older Japanese Individuals: Cross-Sectional Questionnaire Study", journal="JMIR Form Res", year="2024", month="Dec", day="9", volume="8", pages="e58729", keywords="visual impairment", keywords="visually impaired", keywords="internet", keywords="internet use", keywords="internet usage", keywords="older adults", keywords="digital divide", keywords="telemedicine", keywords="mobile phone", abstract="Background: Older adults might not use computers due to psychological barriers, environmental barriers such as not owning a computer or lack of internet access, and health-related barriers such as difficulties with fine motor skills, low cognitive function, or low vision. Given the health benefits of internet use among older adults, inadequate use of the internet is an urgent public health issue in many countries. Objective: We aimed to determine whether visual impairment is associated with internet use in a population-based sample of older adults. Methods: This cross-sectional study sourced data for the year 2016 from the Japan Gerontological Evaluation Study. It included functionally independent community-dwelling individuals aged ?65 years (N=19,452) in Japan. The respondents reported their visual status by answering the question, ``Is your eyesight (without or with usual glasses or corrective lenses) excellent, very good, good, fair, or poor?'' We defined ``internet user'' as a person who uses the internet ``almost daily.'' We used multivariate logistic regression with multiple imputations to analyze visual status, daily internet use, and any correlations between them. Results: We observed that 23.6\% (4599/19,452) of respondents used the internet almost daily. Respondents with good visual status notably tended to use the internet more frequently than those with poor visual status. Specifically, 13\% and 31\% of respondents with poor and excellent vision, respectively, used the internet almost daily. In contrast, 66\% and 45\% of respondents with poor and excellent vision, respectively, did not use the internet. Even after adjusting for several covariates (age, sex, equivalized income, years of education, marital status, depression, history of systemic comorbidities, frequency of meeting friends, and total social participation score), significant associations persisted between visual status and daily internet usage. The odds ratios (ORs) tended to increase as visual status improved (P for trend <.001). The adjusted ORs for individuals with excellent and very good visual status who used the internet almost daily were 1.38 (95\% CI 1.22-1.56) and 1.25 (95\% CI 1.15-1.36), respectively. Conversely, the adjusted OR for those with fair or poor visual status was 0.73 (95\% CI 0.62-0.86). Conclusions: In this study, we reaffirmed what several previous studies have pointed out using a very large dataset; visual impairment negatively impacted daily internet use by older adults. This highlights the need to address visual impairments to promote web use as health care services become more easily accessed on the web. ", doi="10.2196/58729", url="https://formative.jmir.org/2024/1/e58729" } @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/10.2196/65541, author="Qiu, Yuanbo and Huang, Huang and Gai, Junjie and De Leo, Gianluca", title="The Effects of the COVID-19 Pandemic on Age-Based Disparities in Digital Health Technology Use: Secondary Analysis of the 2017-2022 Health Information National Trends Survey", journal="J Med Internet Res", year="2024", month="Dec", day="4", volume="26", pages="e65541", keywords="age-based disparities", keywords="health equity", keywords="digital health technology use", keywords="digital divide", keywords="health policy", keywords="COVID-19", keywords="mobile phone", abstract="Background: The COVID-19 pandemic accelerated the adoption of digital health technology, but it could also impact age-based disparities as existing studies have pointed out. Compared with the pre-pandemic period, whether the rapid digitalization of the health care system during the pandemic widened the age-based disparities over a long period remains unclear. Objective: This study aimed to analyze the long-term effects of the COVID-19 pandemic on the multifaceted landscape of digital health technology used across diverse age groups among US citizens. Methods: We conducted the retrospective observational study using the 2017-2022 Health Information National Trends Survey to identify the influence of the COVID-19 pandemic on a wide range of digital health technology use outcomes across various age groups. The sample included 15,505 respondents, which were categorized into 3 age groups: adults (18-44 years), middle-aged adults (45-64 years), and older adults (more than 65 years). We also designated the time point of March 11, 2020, to divide the pre- and post-pandemic periods. Based on these categorizations, multivariate linear probability models were used to assess pre-post changes in digital health technology use, controlling for demographic, socioeconomic, and health-related variables among different age groups. Results: Essentially, older adults were found to be significantly less likely to use digital health technology compared with adults, with a 26.28\% lower likelihood of using the internet for health information (P<.001) and a 32.63\% lower likelihood of using health apps (P<.001). The usage of digital health technology for all age groups had significantly increased after the onset of the pandemic, and the age-based disparities became smaller in terms of using the internet to look for health information. However, the disparities have widened for older adults in using the internet to look up test results (11.21\%, P<.001) and make appointments (10.03\%, P=.006) and using wearable devices to track health (8.31\%, P=.01). Conclusions: Our study reveals a significant increase in the use of digital health technology among all age groups during the pandemic. However, while the disparities in accessing online information have narrowed, age-based disparities, particularly for older adults, have widened in most areas such as looking up test results and making appointments with doctors. Therefore, older adults are more likely left behind by the rapidly digitalized US health care system during the pandemic. Policy makers and health care providers should focus on addressing these disparities to ensure equitable access to digital health resources for US baby boomers. ", doi="10.2196/65541", url="https://www.jmir.org/2024/1/e65541" } @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/10.2196/57009, author="DeLange Martinez, Pauline and Tancredi, Daniel and Pavel, Misha and Garcia, Lorena and Young, M. Heather", title="The Role of Health in the Technology Acceptance Model Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis", journal="JMIR Form Res", year="2024", month="Dec", day="3", volume="8", pages="e57009", keywords="aged", keywords="older adults", keywords="Asian American", keywords="immigrant", keywords="vulnerable populations", keywords="internet", keywords="information and communications technology", keywords="ICT", keywords="digital divide", keywords="technology acceptance model", keywords="mobile phone", abstract="Background: Self-rated health is associated with information and communications technology (ICT) use among older adults. Non--US born, older Asian American individuals are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the technology acceptance model for low-income, Asian American older adults, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of ICT use. However, the association between health and technology acceptance has not been explored among Asian American older adults. Objective: This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of ICTs among low-income, Asian American older adults. Methods: This cross-sectional survey included Asian American individuals aged ?62 years living in affordable housing for older adults (N=392). Using hierarchical multiple regression, we explored the association between self-rated health and ICT use and technology acceptance model mediators (PU and PEOU) while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association between age and subjective cognitive decline and the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines, revealing that the relationship between subjective cognitive decline and ICT use varied in 3 age segments, which led to updating our analysis to estimate differences in ICT use among age categories with and without subjective cognitive decline. Results: Self-rated health was not significantly associated with ICT use ($\beta$=.087; P=.13), PU ($\beta$=.106; P=.10), or PEOU ($\beta$=.062; P=.31). However, the interaction terms of subjective cognitive decline and age significantly improved the model fit for ICT use ($\Delta$R2=0.011; P=.04). In reviewing scatterplots, we determined that, in the youngest age group (62-74 years), ICT use increased with subjective cognitive decline, whereas in the older age groups (75-84 and ?85 years), ICT use decreased with subjective cognitive decline, more so in the oldest age category. Through regression analysis, among participants with subjective cognitive decline, ICT use significantly decreased in the middle and older age groups as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant. Conclusions: This study contributes to the understanding of the complex relationship between health and ICT acceptance among low-income, Asian American older adults and suggests the need for tailored interventions to promote digital engagement and quality of life for this population. ", doi="10.2196/57009", url="https://formative.jmir.org/2024/1/e57009", url="http://www.ncbi.nlm.nih.gov/pubmed/39625744" } @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/10.2196/60949, author="Hammarberg, Karin and Bandyopadhyay, Mridula and Nguyen, Hau and Cicuttini, Flavia and Stanzel, Andrea Karin and Brown, Helen and Hickey, Martha and Fisher, Jane", title="Development and Evaluation of 4 Short, Animated Videos for Women in Midlife Promoting Positive Health Behaviors: Survey Study", journal="Interact J Med Res", year="2024", month="Dec", day="2", volume="13", pages="e60949", keywords="health promotion", keywords="healthy aging", keywords="self-management", keywords="midlife", keywords="menopause", keywords="internet", keywords="video", keywords="animation", keywords="survey", keywords="questionnaire", keywords="education", keywords="women", keywords="gynecology", abstract="Background: Health and health behaviors in midlife are important determinants of healthy aging. There is evidence of unmet needs for health-promoting information for women from culturally and linguistically diverse backgrounds and women with low literacy. Objective: This study aimed to (1) develop accessible short, animated videos viewable and downloadable from YouTube aimed at promoting positive health behaviors in women in midlife and (2) evaluate their accessibility, acceptability, understanding, and usability and whether this was influenced by the level of education or socioeconomic disadvantage. Methods: In collaboration with a video production company, a multidisciplinary team of academics and health professionals developed 2 short, animated videos on self-management of menopause health and 2 promoting joint health. Their accessibility, acceptability, understanding, and usability to women were evaluated in an anonymous web-based survey. Results: A total of 490 women viewed the videos and responded to the survey. Of these, 353 (72\%) completed all questions. Almost all (from 321/353, 91\% to 334/363, 92\%) agreed that the information in the videos was ``very easy to understand.'' The proportions reporting that all or some of the information in the video was new to them varied between videos from 36\% (137/386) to 66\% (233/353), the reported likelihood of using the practical tips offered in the videos varied from 70\% (271/386) to 89\% (331/373), and between 61\% (235/386) and 70\% (263/373) of respondents stated that they would recommend the videos to others. Education-level group comparisons revealed few differences in opinions about the videos, except that women with lower education were more likely than those with higher education to state that they would recommend the 2 joint health videos to others (36/45, 80\% vs 208/318, 65\%; P=.051 for video 3; and 36/44, 80\% vs 197/309, 64\%; P=.04 for video 4). There were no differences between women living in the least advantaged areas (Socioeconomic Indexes for Areas quintile areas 1 and 2) and those living in the most advantaged areas (Socioeconomic Indexes for Areas quintile areas 3, 4, and 5) in their responses to any of the questions about the 4 videos. Conclusions: Most women found the videos easy to understand, learned something new from watching them, planned to use the practical tips they offered, and were likely to recommend them to other women. This suggests that short, animated videos about health self-management strategies in midlife to improve the chance of healthy aging are perceived as accessible, acceptable, easy to understand, and useful by women. ", doi="10.2196/60949", url="https://www.i-jmr.org/2024/1/e60949", url="http://www.ncbi.nlm.nih.gov/pubmed/39621404" } @Article{info:doi/10.2196/57301, author="Chen, Bowen and Yang, Chun and Ren, Shanshan and Li, Penggao and Zhao, Jin", title="Relationship Between Internet Use and Cognitive Function Among Middle-Aged and Older Chinese Adults: 5-Year Longitudinal Study", journal="J Med Internet Res", year="2024", month="Dec", day="2", volume="26", pages="e57301", keywords="aging", keywords="cognitive function", keywords="internet use", keywords="longitudinal study", keywords="fixed effects model", abstract="Background: Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the older adult population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet use among middle-aged and older adults. Objective: This study aims to explore the association between internet use and age-related cognitive decline among middle-aged and older Chinese adults. To gain a more comprehensive understanding of the effects of internet use, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet use on cognitive function for characteristics significantly linked to cognition in stratified analysis. Methods: We analyzed data based on 12,770 dementia-free participants aged ?45 years from the China Health and Retirement Longitudinal Study. We used a fixed effects model to assess the relationship between internet use and cognitive decline and further validated it using multiple linear regression analysis, generalized estimating equations, propensity score matching, inverse probability of treatment weighting, and overlap weighting. We further examined the varying effects of internet device type and frequency on cognitive function using fixed effects models and Spearman rank correlations. The Karlson-Holm-Breen method was used to estimate the mediating role of internet use in the urban-rural cognitive gap. Results: Participants using the internet (n=1005) were younger, more likely to be male, more educated, married, retired and living in an urban area and had higher cognitive assessment scores than nonusers (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function ($\beta$=0.551, 95\% CI 0.391-0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases, at 2.2\% (15/671), compared with nonusers, at 5.3\% (379/7099; P<.001). The negative impact of aging (>50 years) on cognitive function was consistently less pronounced among internet users than among nonusers. Furthermore, increased frequency of internet use was associated with greater cognitive benefits for middle-aged and older adults (rs=0.378, P<.001). Among digital devices used for internet access, cell phones ($\beta$=0.398, 95\% CI 0.283-0.495) seemed to have a higher level of cognitive protection than computers ($\beta$=0.147, 95\% CI 0.091-0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2\% of the total effect, P<.001). Conclusions: This study revealed that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet use?has the potential to be a viable, cost-effective, nonpharmacological intervention for?cognitive decline among middle-aged and older adults. ", doi="10.2196/57301", url="https://www.jmir.org/2024/1/e57301", url="http://www.ncbi.nlm.nih.gov/pubmed/39539034" } @Article{info:doi/10.2196/59684, author="Li, Yumeng and Liu, Chen and Sun, Jiaqing and Zhang, Junying and Li, Xin and Zhang, Zhanjun", title="The Digital Divide and Cognitive Disparities Among Older Adults: Community-Based Cohort Study in China", journal="J Med Internet Res", year="2024", month="Nov", day="27", volume="26", pages="e59684", keywords="digital divide", keywords="internet use", keywords="cognitive aging", keywords="mild cognitive impairment", keywords="socioeconomic status", keywords="resource inequality", keywords="cognitive disparities", keywords="cognitive function", keywords="elderly", keywords="older adult", keywords="aging", keywords="community-based", keywords="cohort study", keywords="China", keywords="ANCOVA", keywords="mixed linear model", keywords="Cox proportional hazards", keywords="mental health", keywords="internet", keywords="digital health", keywords="information and communication technologies", keywords="ICT", keywords="mHealth", abstract="Background: The widespread adoption of information and communication technologies (ICTs) further deepens disparities in resource access, particularly among the aging population. However, the relationship between these factors and their resulting impact on cognitive abilities remains uncertain. Objective: This study aims to investigate the potential impact of the digital divide on individuals' cognitive function and its association with the development and reversion of mild cognitive impairment (MCI). Methods: This cohort study used data from Beijing Aging Brain Rejuvenation (BABRI) study applying a multistage cluster sampling design between 2008 and 2020. The digital divide was quantified by the frequency of using ICTs. Analysis of covariance (ANCOVA), mixed linear models, and Cox proportional hazards models were used to model the association of digital divide and multidomain cognition. Results: Among the 10098 participants, nearly half (n=4941, 48.9\%) faced the digital divide, which was associated with a worse performance in processing speed (F10096=10.67; P<.001; effect size r=0.42), rather than memory, executive function, and language. The model indicated that individuals' physical and mental health, combined with their educational and occupational prestige, influenced the resources they attained, which ultimately caused the digital divide. Moreover, longitudinal data revealed that older adults who successfully crossed the digital divide during the tracking process and those who had already done so prior to tracking showed significantly slower rates of decline in processing speed (B=--1.98, P<.05; B=--2.62, P<.01) and general cognitive function (B=3.50, P<.001; B=3.13, P<.01). Additionally, overcoming the digital divide was also associated with a lower risk of developing MCI (hazard ratio [HR] 0.5, 95\% CI 0.34-0.74; HR 0.43, 95\% CI 0.29-0.62) and a greater probability of reversion from MCI to normal cognition (HR 6, 95\% CI 3.77-9.56; HR 9.22, 95\% CI 5.63-15.11). Conclusions: Overcoming the digital divide was significantly associated with improved cognitive function, a slower aging rate in cognitive performance, a reduced risk of developing MCI, and a higher likelihood of reverting from MCI to normal cognition. ", doi="10.2196/59684", url="https://www.jmir.org/2024/1/e59684" } @Article{info:doi/10.2196/65111, author="Nabelsi, Veronique and Leclerc, Chantal Marie and Plouffe, V{\'e}ronique", title="Nurses' and Nursing Assistants' Experiences With Teleconsultation in Small Rural Long-Term Care Facilities: Semistructured Interview Pilot Study", journal="JMIR Aging", year="2024", month="Nov", day="27", volume="7", pages="e65111", keywords="teleconsultation", keywords="long-term care facilities", keywords="nursing", keywords="nursing practices", keywords="workflow optimization", keywords="residents", keywords="rural", keywords="telehealth", keywords="Quebec", abstract="Background: In Quebec, the shortage of nurses during night shifts compromises the safety and quality of resident care, particularly in small residential and long-term care centers (``Centres d'h{\'e}bergement et de soins de longue dur{\'e}e''; CHSLDs) located in rural areas. The need to ensure the continuous presence of nurses 24 hours a day in CHSLDs has become more pressing, forcing some facilities to implement exceptional measures such as on-call telephone services to ensure access to a nurse. In light of these challenging circumstances, the Direction nationale des soins et des services infirmiers of Quebec's Minist{\`e}re de la Sant{\'e} et des Services sociaux has rolled out a teleconsultation pilot project. Objective: This study aims to explore nurses' and nursing assistants' experience of integrating teleconsultation during night shifts in rural CHSLDs with ?50 residents. Methods: The 6-month pilot project was rolled out sequentially in 3 rural CHSLDs located in 2 administrative regions of Quebec between July 2022 and March 2023. A total of 18 semistructured interviews were conducted with 9 nurses and nursing assistants between February and July 2023. Results: Participants' experiences revealed that teleconsultation provided significant added value by improving clinical, administrative, and organizational practices. Some practices remained unchanged, indicating stable workflows. Workflow optimization through an expanded scope of practice ensured efficient and safe continuity of care. Enhanced collaboration between nurses and nursing assistants led to improved care coordination and communication. The leadership played a significant role in clarifying professionals' roles and in supporting effective adaptation to teleconsultation. Conclusions: This pilot project represents a significant step forward in improving care for CHSLD residents in Quebec. Teleconsultation not only makes it possible to overcome recruitment challenges and ensure the continuous presence of nurses during night shifts but also optimizes professional practices while ensuring the safety and quality of care provided to residents. ", doi="10.2196/65111", url="https://aging.jmir.org/2024/1/e65111" } @Article{info:doi/10.2196/60574, author="Charles, Lesley and Tang, Eileen and Tian, Jaminal Peter George and Chan, Karenn and Br{\'e}mault-Phillips, Suzette and Dobbs, Bonnie and Vokey, Camelia and Polard, Sharna and Parmar, Jasneet", title="Characteristics, Barriers, and Facilitators of Virtual Decision-Making Capacity Assessments During the COVID-19 Pandemic: Online Survey", journal="JMIR Form Res", year="2024", month="Nov", day="25", volume="8", pages="e60574", keywords="decision making capacity", keywords="mental competency", keywords="aged", keywords="mobile applications", keywords="mobile phone", keywords="Canada", keywords="covid-19", keywords="pandemics", keywords="dementia", keywords="survey", keywords="virtual capacity assessment", keywords="characteristics", keywords="barriers", keywords="facilitators", keywords="virtual decision making", keywords="assessment", abstract="Background: With a growing older adult population, the number of persons with dementia is expected to rise. Consequently, the number of persons needing decision-making capacity assessments (DMCA) will increase. The COVID-19 pandemic has impacted how we deliver patient care including DMCAs with a much more rapid shift to virtual assessments. Virtual DMCAs offer patients and health care professionals distinct advantages over in-person delivery by improving reach, access, and timely provision of health care. However, questions have arisen as to whether DMCAs can be effectively conducted virtually. Objective: This study aimed to determine the characteristics, barriers, and facilitators of conducting virtual DMCA during the COVID-19 pandemic. Methods: We conducted an online survey among health care providers who perform DMCAs in Alberta from March 2022 to February 2023. The survey consisted of 25 questions on demographics, preferences, and experience in conducting DMCAs virtually, and risks and barriers to doing virtual DMCAs. The data were analyzed using descriptive statistics. Results: There were 31 respondents with a mean age of 51.1 (SD 12.7) years. The respondents consisted of physicians (45.2\%, 14/31), occupational therapists (29\%, 9/31), and social workers (16.1\%, 5/31), with a majority (93.6\%, 29/31) based in Edmonton. The mean number of years of experience conducting DMCAs was 12.3 (SD 10.7), with a median of 8 DMCAs (IQR 18.5) conducted per year. Most respondents conduct capacity interviews, with a majority (55.2\%, 16/29) being associated primarily with acute care services. Furthermore, 54.8\% (17/31) were interested in conducting DMCAs virtually; however, only 25.8\% (8/31) had administered DMCAs virtually. Barriers and facilitators to virtual DMCAs relate to patients' characteristics and environment (such as communication difficulties, hearing or visual impairment, language barriers, ease of use of technology, or cognitive impairment), technology and technical support (need for technical support in both the client's and assessor's sides, the unreliability of internet connection in rural settings, and the availability of high-fidelity equipment), and assessors' ability to perform DMCA's virtually (ability to observe body language, interact with the client physically when needed, and build rapport can all be affected when conducting a DMCA virtually). In terms of implications for clinical practice, it is recommended that the patient or caregiver be familiar with technology, have a stable internet connection, use a private room, not be recorded, use a standardized assessment template, and have a backup plan in case of technical difficulties. Conclusions: Conducting DMCAs virtually is a relatively infrequent undertaking. Barriers and facilitators to adequate assessment need to be addressed given that virtual assessments are time-saving and expand reach. ", doi="10.2196/60574", url="https://formative.jmir.org/2024/1/e60574", url="http://www.ncbi.nlm.nih.gov/pubmed/39585735" } @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/10.2196/57352, 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/10.2196/67749, author="Fahey, C. Margaret", title="Author's Reply: Expanding the Scope: Reflections on Digital Smoking Cessation Strategies for Diverse Age Groups", journal="J Med Internet Res", year="2024", month="Nov", day="18", volume="26", pages="e67749", keywords="digital smoking cessation", keywords="age group comparisons", keywords="behavioral health intervention", keywords="older adult", keywords="cigarette", keywords="tobacco", keywords="quitting", keywords="telehealth", keywords="behavioral health", keywords="public health", doi="10.2196/67749", url="https://www.jmir.org/2024/1/e67749" } @Article{info:doi/10.2196/65929, author="Wei, Bin and Hu, Xin and Wu, XiaoRong", title="Expanding the Scope: Reflections on Digital Smoking Cessation Strategies for Diverse Age Groups", journal="J Med Internet Res", year="2024", month="Nov", day="18", volume="26", pages="e65929", keywords="digital smoking cessation", keywords="age group comparisons", keywords="behavioral health interventions", keywords="older adults", keywords="digital cessation treatment", keywords="cigarettes", keywords="tobacco", keywords="quit", keywords="telehealth", keywords="behavioral health", keywords="public health", doi="10.2196/65929", url="https://www.jmir.org/2024/1/e65929" } @Article{info:doi/10.2196/52435, author="Wong, Ching Arkers Kwan and Bayuo, Jonathan and Su, Jing Jing and Wong, Yuet Frances Kam and Chow, Sum Karen Kit and Wong, Po Bonnie and Wong, Man Siu and Hui, Vivian", title="Effectiveness of the Support From Community Health Workers and Health Care Professionals on the Sustained Use of Wearable Monitoring Devices Among Community-Dwelling Older Adults: Feasibility Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Nov", day="18", volume="26", pages="e52435", keywords="wearable monitoring device", keywords="lay worker", keywords="smartwatch", keywords="older adult", keywords="nurse", keywords="engagement", keywords="attrition", keywords="wearable", keywords="user experience", abstract="Background: The wearable monitoring device (WMD) is emerging as a promising tool for community-dwelling older adults to monitor personal health, enhance awareness of their activities, and promote healthy behaviors. However, the sustained use of WMDs among this population remains a significant challenge. Objective: This study aims to implement an interventional program that promotes and motivates the continued use of WMDs among older adults through a peer and professional support approach. This program will facilitate the integration of WMDs into their daily lives. Methods: This feasibility trial examined the following: (1) the usability of the WMD from the users' perspectives; (2) the feasibility of the Live With Wearable Monitoring Device program; and (3) the effectiveness of the Live With Wearable Monitoring Device program among community-dwelling older adults. The intervention, based on Self-Determination Theory, involved using the Live With Wearable Monitoring Device program over a 3-month period, with ongoing professional and peer support provided by community health workers, aided by a nurse and social workers. This support included 1 home visit and biweekly communication via WhatsApp. Data were collected at baseline and at 1, 3, and 6 months. Results: A total of 39 participants were enrolled in the intervention group, while 37 participants were in the control group. The recruitment rate was high (76/89, 85\%), and the attrition rate was low (8/76, 11\%), indicating that the program is feasible for older adults. Participants in the intervention group exhibited higher self-efficacy, lower anxiety levels, and used the smartwatch more frequently, in terms of both days and hours, compared with the control group. A between-group difference was observed in self-efficacy between the intervention and control groups ($\beta$=3.31, 95\% CI 0.36-6.25, P=.03), with statistically significant higher mean values recorded at all 4 time points. Conclusions: It is clear that merely providing a WMD to older adults does not guarantee its usage, particularly for those unfamiliar with how to utilize its health-related functions in their daily routines. This study implemented a theory-based program aimed at enhancing the ongoing use of WMDs among older adults, suggesting that continuous professional and peer support may significantly influence WMD usage. Trial Registration: ClinicalTrials.gov NCT05269303; https://clinicaltrials.gov/ct2/show/NCT05269303 ", doi="10.2196/52435", url="https://www.jmir.org/2024/1/e52435" } @Article{info:doi/10.2196/60453, author="Ding, Huitong and Gifford, Katherine and Shih, C. Ludy and Ho, Kristi and Rahman, Salman and Igwe, Akwaugo and Low, Spencer and Popp, Zachary and Searls, Edward and Li, Zexu and Madan, Sanskruti and Burk, Alexa and Hwang, H. Phillip and Anda-Duran, De Ileana and Kolachalama, B. Vijaya and Au, Rhoda and Lin, Honghuang", title="Exploring the Perspectives of Older Adults on a Digital Brain Health Platform Using Natural Language Processing: Cohort Study", journal="JMIR Form Res", year="2024", month="Nov", day="18", volume="8", pages="e60453", keywords="digital brain health", keywords="older adults", keywords="perspectives", keywords="semistructured interviews", keywords="natural language processing", keywords="mobile phone", abstract="Background: Although digital technology represents a growing field aiming to revolutionize early Alzheimer disease risk prediction and monitoring, the perspectives of older adults on an integrated digital brain health platform have not been investigated. Objective: This study aims to understand the perspectives of older adults on a digital brain health platform by conducting semistructured interviews and analyzing their transcriptions by natural language processing. Methods: The study included 28 participants from the Boston University Alzheimer's Disease Research Center, all of whom engaged with a digital brain health platform over an initial assessment period of 14 days. Semistructured interviews were conducted to collect data on participants' experiences with the digital brain health platform. The transcripts generated from these interviews were analyzed using natural language processing techniques. The frequency of positive and negative terms was evaluated through word count analysis. A sentiment analysis was used to measure the emotional tone and subjective perceptions of the participants toward the digital platform. Results: Word count analysis revealed a generally positive sentiment toward the digital platform, with ``like,'' ``well,'' and ``good'' being the most frequently mentioned positive terms. However, terms such as ``problem'' and ``hard'' indicated certain challenges faced by participants. Sentiment analysis showed a slightly positive attitude with a median polarity score of 0.13 (IQR 0.08-0.15), ranging from --1 (completely negative) to 1 (completely positive), and a median subjectivity score of 0.51 (IQR 0.47-0.53), ranging from 0 (completely objective) to 1 (completely subjective). These results suggested an overall positive attitude among the study cohort. Conclusions: The study highlights the importance of understanding older adults' attitudes toward digital health platforms amid the comprehensive evolution of the digitalization era. Future research should focus on refining digital solutions to meet the specific needs of older adults, fostering a more personalized approach to brain health. ", doi="10.2196/60453", url="https://formative.jmir.org/2024/1/e60453" } @Article{info:doi/10.2196/54200, author="Chen, Xing-Ling and Li, Jin and Sun, Shu-Ning and Zhao, Qiang-Qiang and Lin, Sheng-Rong and Wang, Ling-Jun and Yang, Zhong-Qi and Ni, Shi-Hao and Lu, Lu", title="Association Between Daily Internet Use and Intrinsic Capacity Among Middle-Aged and Older Adults in China: Large Prospective Cohort Study", journal="J Med Internet Res", year="2024", month="Nov", day="12", volume="26", pages="e54200", keywords="daily internet use", keywords="intrinsic capacity", keywords="IC", keywords="middle-aged and older adult", keywords="healthy aging", keywords="social participation", abstract="Background: Intrinsic capacity (IC), as a comprehensive measure of an individual's functional ability, has gained prominence in the framework for healthy aging introduced by the World Health Organization (WHO). As internet usage continues to integrate into daily life, it is imperative to scrutinize the association between internet use and IC to effectively promote healthy aging among the middle-aged and older population. Objective: This study aimed to investigate whether daily internet use in middle-aged and older adults delays or accelerates the decline in IC. Methods: Participants included in the China Health and Retirement Longitudinal Study (CHARLS) comprised individuals aged ?45 years residing in China. We analyzed 4 years of CHARLS data from the first wave (May 2011-March 2012) to the third wave (July 2015-January 2016). Data from the first and third waves were used for longitudinal studies. Self-reported data encompassed internet use, frequency of use, and demographic baseline characteristics. In addition, the IC evaluation involved physical examination and blood test data. Initially, linear regression was used to assess the relationship between daily internet use and IC, followed by regression splines to explore potential nonlinear associations. Subgroup and sensitivity analyses were used to investigate the heterogeneity of IC in specific conditions and the robustness of our results. Mediation effect analysis was conducted to identify the factors that mediate the relationship between daily internet use and IC, focusing on social participation, physical activity, and health status. Results: Among the 12,826 participants included in the longitudinal analyses, 12,305 (95.9\%) did not use the internet, while 521 (4.1\%) reported daily internet use with a mean age of 52.62 (SD 7.67) years. After adjusting for demographic variables, socioeconomic factors, lifestyle behaviors, and health conditions and examining the impact of daily internet use and frequency on changes in IC, our findings indicated important associations. Specifically, daily internet use is significantly linked to a slower decline in IC over time (marginal effect 1.58, 95\% CI 1.03-2.12; P<.001). Individuals with moderate and regular internet use frequency exhibit higher levels of maintenance in IC (marginal effect 0.74, 95\% CI 0.45-1.03, P<.001). In addition, the relationship between IC changes and internet use frequency demonstrated a nonlinear inverted U-shaped curve (nonlinear P=.003). Subgroup analysis further revealed that improvements in IC vary based on age and gender. Furthermore, mediation analysis denoted that more than 28.78\% (95\% CI 21.24-40.33) of the observed association is mediated by social participation (P<.001). Conclusions: The findings of our research underscore the potential benefits of consistent and moderate internet use in promoting and preserving IC, particularly in cognitive capacity, sensory, vitality, and locomotion. The observed effects may be related to social participation. These insights offer valuable guidance for crafting strategies aimed at fostering healthy aging within the middle-aged and older adult demographics. ", doi="10.2196/54200", url="https://www.jmir.org/2024/1/e54200" } @Article{info:doi/10.2196/58641, author="Leong, Ying Qiao and Lee, Vien V. and Ng, Ying Wei and Vijayakumar, Smrithi and Lau, Yin Ni and Mauritzon, Ingela and Blasiak, Agata and Ho, Dean", title="Older Adults' Perspectives and Experiences With Digital Health in Singapore: Qualitative Study", journal="JMIR Hum Factors", year="2024", month="Nov", day="11", volume="11", pages="e58641", keywords="digital health", keywords="gerontology", keywords="geriatrics", keywords="elder", keywords="aging", keywords="Singapore", keywords="qualitative", keywords="mHealth", keywords="mobile health", keywords="experience", keywords="technology use", keywords="interview", keywords="perspective", keywords="acceptance", keywords="technology adoption", abstract="Background: Technology use among older adults is increasingly common. Even though there is potential in leveraging technology to help them manage their health, only a small fraction of them use it for health-related purposes. Objective: This study seeks to understand the perspectives of and experiences with digital health (DH) among older adults in Singapore. Methods: A total of 16 participants (age range 60-80 years; n=11, 69\% female) were interviewed for approximately an hour (range 27-64 minutes) about their health, DH use, and DH experiences. The interviews were recorded, transcribed verbatim, and thematically analyzed. Results: Five main themes emerged from the interview: support in developing DH literacy, credibility, cost and benefit considerations, intrinsic drive to be healthy, and telehealth. Older adults need support in familiarizing themselves with DH. When considering DH options, older adults often relied on credible sources and preferred DH to be free. Monetary incentives were brought up as motivators. The intrinsic drive to live longer and healthily was expressed to be a huge encouragement to use DH to help obtain health-related knowledge and achieve healthy living goals. The idea of telehealth was also appealing among older adults but was seen to be more suited for individuals who have issues accessing a physical clinic. Conclusions: Our findings offer insights into the various aspects that matter to older adults in the adoption of DH, which in turn can help reshape their health-seeking behavior and lifestyle. As such, policy makers and DH implementors are encouraged to take these into consideration and align their strategies accordingly. ", doi="10.2196/58641", url="https://humanfactors.jmir.org/2024/1/e58641" } @Article{info:doi/10.2196/63814, author="Gordon, P. Nancy and Yin, Chelsea and Lo, C. Joan", title="Examining Whether Patient Portal and Video Visit Use Differs by Race and Ethnicity Among Older Adults in a US Integrated Health Care Delivery System: Cross-Sectional Electronic Health Record and Survey-Based Study", journal="JMIR Aging", year="2024", month="Nov", day="7", volume="7", pages="e63814", keywords="patient portal use", keywords="video visit use", keywords="older adults", keywords="racial and ethnic differences", keywords="telehealth", keywords="mobile phone", abstract="Background: Health care systems are increasingly encouraging patients to use patient portals and participate in video visits. However, there is limited information about how portal use differs among older adults. Objective: This study aimed to understand how patient portal and video visit use differed by age, race, and ethnicity among older adult patients with access to the same digital health resources. Methods: This cross-sectional study used electronic health record and survey data for adults aged 65 to 85 years who were members of a large Northern California health care delivery system throughout 2019 and 2020. The electronic health record cohort (N=471,152) included 320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8473 South Asian, 6716 Japanese, 2930 Vietnamese, and 2015 Korean adults. Racial and ethnic group and age group (65 to 75 years vs 76 to 85 years) differences in having a patient portal account by December 2020, the performance of 2 portal activities (sending ?1 message to a clinician in 2019 or 2020 and viewing ?1 laboratory test result in 2020), and having ?1 video visit during 2020 were examined. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit use, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Data from a 2020 member survey were used to compare internet use factors among 2867 White, 306 Black, 343 Latino, 225 Chinese, and 242 Filipino adults. Results: Black, Latino, and Filipino adults were less likely to have a patient portal account than White adults, and Filipino adults were less likely to have a patient portal account than Chinese adults. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have sent messages and viewed test results than White adults, while Chinese and Japanese adults' use of these features was similar to that of White adults. Filipino, Vietnamese, and Korean adults were less likely to have performed the aforementioned activities than Chinese adults. Video visit use was lower among Black and Latino adults and higher among Chinese and South Asian adults compared with White adults (aged 76 to 85 years) and lower among Filipino, Korean, and Vietnamese adults compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain the lower use of messaging by Black, Latino, and Filipino adults compared with White and Chinese adults. Conclusions: Patient portal and video visit use differed by race, ethnicity, and age group among older adult patients with access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscore the importance of disaggregating use data by Asian ethnicity. ", doi="10.2196/63814", url="https://aging.jmir.org/2024/1/e63814" } @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/10.2196/60209, 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/10.2196/54210, 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/10.2196/63832, author="Wegener, Kauffeldt Emilie and Bergsch{\"o}ld, M. Jenny and Bergh, Sverre and van Berlo, Ad and Schmidt, Wong Camilla and Konidari, Afroditi and Kayser, Lars", title="Considerations When Designing Inclusive Digital Health Solutions for Older Adults Living With Frailty or Impairments", journal="JMIR Form Res", year="2024", month="Oct", day="21", volume="8", pages="e63832", keywords="digital health services", keywords="frameworks", keywords="sociotechnical ecosystem", keywords="older adults", keywords="co-design", doi="10.2196/63832", url="https://formative.jmir.org/2024/1/e63832" } @Article{info:doi/10.2196/54709, author="Miller, M. Lyndsey and Kaye, Jeffrey and Lindauer, Allison and Au-Yeung, M. Wan-Tai and Rodrigues, K. Nathaniel and Czaja, J. Sara", title="Remote Passive Sensing of Older Adults' Activities and Function: User-Centered Design Considerations for Behavioral Interventions Conducted in the Home Setting", journal="J Med Internet Res", year="2024", month="Oct", day="18", volume="26", pages="e54709", keywords="user-centered design", keywords="remote passive sensing", keywords="remote monitoring", keywords="behavioral interventions", keywords="caregiving", keywords="dementia", keywords="Alzheimer", keywords="monitoring", keywords="gerontology", keywords="geriatrics", keywords="older adult", keywords="aging", keywords="usability", keywords="acceptability", keywords="trust", keywords="behavioral", doi="10.2196/54709", url="https://www.jmir.org/2024/1/e54709", url="http://www.ncbi.nlm.nih.gov/pubmed/39423003" } @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/10.2196/60712, author="Peng, Wei and Lee, Rin Hee and Lim, Sue", title="Leveraging Chatbots to Combat Health Misinformation for Older Adults: Participatory Design Study", journal="JMIR Form Res", year="2024", month="Oct", day="11", volume="8", pages="e60712", keywords="chatbot", keywords="conversational agent", keywords="older adults", keywords="health misinformation", keywords="participatory design", abstract="Background: Older adults, a population particularly susceptible to misinformation, may experience attempts at health-related scams or defrauding, and they may unknowingly spread misinformation. Previous research has investigated managing misinformation through media literacy education or supporting users by fact-checking information and cautioning for potential misinformation content, yet studies focusing on older adults are limited. Chatbots have the potential to educate and support older adults in misinformation management. However, many studies focusing on designing technology for older adults use the needs-based approach and consider aging as a deficit, leading to issues in technology adoption. Instead, we adopted the asset-based approach, inviting older adults to be active collaborators in envisioning how intelligent technologies can enhance their misinformation management practices. Objective: This study aims to understand how older adults may use chatbots' capabilities for misinformation management. Methods: We conducted 5 participatory design workshops with a total of 17 older adult participants to ideate ways in which chatbots can help them manage misinformation. The workshops included 3 stages: developing scenarios reflecting older adults' encounters with misinformation in their lives, understanding existing chatbot platforms, and envisioning how chatbots can help intervene in the scenarios from stage 1. Results: We found that issues with older adults' misinformation management arose more from interpersonal relationships than individuals' ability to detect misinformation in pieces of information. This finding underscored the importance of chatbots to act as mediators that facilitate communication and help resolve conflict. In addition, participants emphasized the importance of autonomy. They desired chatbots to teach them to navigate the information landscape and come to conclusions about misinformation on their own. Finally, we found that older adults' distrust in IT companies and governments' ability to regulate the IT industry affected their trust in chatbots. Thus, chatbot designers should consider using well-trusted sources and practicing transparency to increase older adults' trust in the chatbot-based tools. Overall, our results highlight the need for chatbot-based misinformation tools to go beyond fact checking. Conclusions: This study provides insights for how chatbots can be designed as part of technological systems for misinformation management among older adults. Our study underscores the importance of inviting older adults to be active co-designers of chatbot-based interventions. ", doi="10.2196/60712", url="https://formative.jmir.org/2024/1/e60712" } @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/10.2196/53384, 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/10.2196/48654, author="Wang, Ning and Zhou, Siyu and Liu, Zhuo and Han, Ying", title="Perceptions and Satisfaction With the Use of Digital Medical Services in Urban Older Adults of China: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Sep", day="20", volume="26", pages="e48654", keywords="digital medical services", keywords="older adults", keywords="Technology Acceptance Model", keywords="perception", keywords="behavioral intention", keywords="satisfaction", abstract="Background: In an aging and information-driven society, older adults have distinct perceptions of and specific demands for digital medical services. It is essential for society to understand these needs and develop a more thoughtful approach to digital health care. Objective: This study aims to evaluate the behavioral intention and satisfaction of older adults with digital medical services by identifying the perceived factors and the pathways through which these factors influence their behavior. Methods: This study used a mixed methods approach, combining qualitative and quantitative analyses. A focus group interview was conducted with 30 randomly selected older adults, and the interviews were transcribed verbatim and coded using grounded theory. In addition, 876 valid questionnaires were collected to describe older adults' perceptions of and satisfaction with digital medical care. Then, t tests and ANOVA were used to explore differences among various demographic groups, while hierarchical multiple regression was conducted to identify the factors most closely related to satisfaction. Structural equation modeling was used to identify multiple mediating effects. Results: The qualitative study identified the core category of ``medical service relief and transformation paths for older adults in the context of digital reform.'' Quantitative analysis revealed that more than half of the older adults were satisfied with digital medical services, and behavioral intentions were higher among those with higher incomes and education levels. Structural equation modeling confirmed that external variables, such as digital skills training, positively influenced perceived ease of use ($\beta$=.594, P<.001), perceived usefulness ($\beta$=.544, P<.001), and promoted digital medical behavioral intentions ($\beta$=.256, P<.001), while also reducing perceived risk ($\beta$=--.295, P<.001). Additionally, perceived ease of use ($\beta$=.168, P<.001) and perceived usefulness ($\beta$=.508, P<.001) positively impacted behavioral intention, whereas perceived risk ($\beta$=--.05, P=.037) exerted a negative influence. Furthermore, behavioral intention ($\beta$=.641, P<.001) significantly and positively affected older adults' satisfaction with digital medical care. The mediation test identified 4 significant paths: (1) external variables {\textrightarrow} perceived ease of use {\textrightarrow} behavioral intention (effect size of 13.9\%); (2) external variables {\textrightarrow} perceived usefulness {\textrightarrow} behavioral intention (effect size of 38.4\%); (3) external variables {\textrightarrow} perceived ease of use {\textrightarrow} perceived usefulness {\textrightarrow} behavioral intention (effect size of 10.1\%); and (4) a direct effect (35.5\%) from external variables to behavioral intention. Conclusions: Based on the study's findings, addressing the needs of older adults and enhancing perceived usefulness are the most effective ways to encourage the use of digital health care devices. Community support plays a crucial role in helping older adults integrate into digital health care, and adapting the design of services and products to suit their needs improves their perceptions of digital health care. This, in turn, promotes usage behavior and satisfaction, while the negative impact of perceived risk remains minimal. ", doi="10.2196/48654", url="https://www.jmir.org/2024/1/e48654" } @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/10.2196/55384, author="Tuitert, Inge and Marinus, D. Jesse and Dalenberg, R. Jelle and van 't Veer, TB Job", title="Digital Health Technology Use Across Socioeconomic Groups Prior to and During the COVID-19 Pandemic: Panel Study", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="13", volume="10", pages="e55384", keywords="digital divide", keywords="vulnerable groups", keywords="digital health apps", keywords="adoption", keywords="socioeconomics", keywords="health technology", keywords="digital health", keywords="longitudinal", keywords="surveys", keywords="technology use", abstract="Background: Digital technologies have become more important in the health care sector in the past decades. This transition from conventional to digital health care has been accelerated by the impact of the COVID-19 pandemic, which poses the risk of creating a ``digital divide,'' inadvertently placing those who are older, economically disadvantaged, and have a lower level of education at a disadvantage. Objective: This study focuses on the influence of socioeconomic factors on the adoption of digital health technology in the Frisian population and how this relation is affected by the COVID-19 pandemic. Methods: In 2019 and 2020, a panel study was conducted on digital health in the Frisian population in the Netherlands. In the survey, the use of digital health technology was operationalized in a broad sense, going beyond the care context by also including preventative health-promoting solutions generally available on the consumer market, such as wearables and lifestyle apps. First, to assess the influence of socioeconomic factors on the total use of digital health apps, a generalized linear model was fitted with use of digital health app as the dependent variable and socioeconomic factors as between-subject factors on the 2019 data. Second, to analyze whether the use of separate health apps increased from 2019 to 2020, we conducted chi-square tests on different digital health app types. Third, to examine the influence of COVID-19 on the use of digital health apps, a generalized linear mixed model was fitted with the use of digital health apps as the dependent variable, COVID-19 as the within-subject variable, and socioeconomic factors as between-subject factors. Results: The results indicated that prior to the COVID-19 pandemic, digital health technology use was higher in women, younger people, and those who are well educated and economically more privileged. Moreover, the percentage of people who reported using digital health technology rose from 70\% (1580/2258) to 82.5\% (1812/2197) due to the COVID-19 pandemic. This increase was significant for all separate types of digital health technology (all P<.001). In addition, we found the interaction effects of COVID-19 with age and education attainment, indicating that the lower total use among older people and people with lower education attainment became slightly less apparent from 2019 to 2020. Conclusions: These findings on the influence of the COVID-19 pandemic on the digital divide indicated that the use of all types of digital health apps increased and that older individuals and people with a lower level of education caught up a little during COVID-19. Future research should gain more insight into this effect and examine whether it persists beyond the COVID-19 pandemic. Additionally, future endeavors should focus on vulnerable groups, ensuring they receive adequate attention to guarantee access to health care, preventative health-promoting solutions, and social services. ", doi="10.2196/55384", url="https://publichealth.jmir.org/2024/1/e55384" } @Article{info:doi/10.2196/49688, author="Fu, Liping and Liu, Caiping and Dong, Yongqing and Ma, Xiaodong and Cai, Quanling and Li, Dongli and Di, Kaisheng", title="Mediating Effects of Information Access on Internet Use and Multidimensional Health Among Middle-Aged and Older Adults: Nationwide Cross-Sectional Study", journal="J Med Internet Res", year="2024", month="Sep", day="9", volume="26", pages="e49688", keywords="internet use", keywords="health", keywords="middle-aged and older adults", keywords="information access", keywords="mediation analysis", abstract="Background: With the exacerbation of population aging, the health issues of middle-aged and older adults have increasingly become a focus of attention. The widespread use of the internet has created conditions for promoting the health of this demographic. However, little is known about the effects of information access in promoting the relationship between internet use and the health of middle-aged and older adults. Objective: This study aims to examine the relationship between internet use and multidimensional health in middle-aged and older adults, as well as the mediating effect of information access. Moreover, this study will explore the relationship between other dimensions of internet use (purposes and frequency) and health. Methods: Data were sourced from the China General Social Survey conducted in 2018. Health outcomes, including self-rated, physical, and mental health, were assessed using the 5-level self-rated health scale, the 5-level basic activities of daily living scale, and the 5-level depression scale, respectively. The ordinal logistic regression model was used to examine the relationship between internet use and health among middle-aged and older adults. Additionally, the Karlson-Holm-Breen decomposition method was used to examine the mediation effect of information access. To address endogeneity issues, the two-stage least squares approach was applied. Results: In our sample, nearly half (n=3036, 46.3\%) of the respondents use the internet. Regression analyses revealed that internet use was positively associated with self-rated health (odds ratio [OR] 1.55, 95\% CI 1.39-1.74; P<.001), physical health (OR 1.39, 95\% CI 1.25-1.56; P<.001), and mental health (OR 1.33, 95\% CI 1.19-1.49; P<.001) of middle-aged and older adults. Various dimensions of internet use positively contribute to health. In addition, information access significantly mediated the relationship between internet use and self-rated health ($\beta$=.28, 95\% CI 0.23-0.32), physical health ($\beta$=.40, 95\% CI 0.35-0.45), and mental health ($\beta$=.16, 95\% CI 0.11-0.20). Furthermore, there were significant differences in the relationship between internet use and health among advantaged and disadvantaged groups. Conclusions: The study showed that different dimensions of internet use are associated with better self-rated health, better physical health, and better mental health in middle-aged and older adults. Information access mediates the relationship between internet use and health. This result emphasizes the significance of promoting internet access as a means to enhance the health of middle-aged and older adults in China. ", doi="10.2196/49688", url="https://www.jmir.org/2024/1/e49688" } @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/10.2196/52919, author="Fahey, C. Margaret and Carpenter, J. Mathew and O'Neal, Riley and Pebley, Kinsey and Schick, R. Melissa and Ware, Emily and Toll, A. Benjamin and Dahne, Jennifer", title="Expectations and Preferences for Digital Cessation Treatment: Multimethods Study Among Older Adults Who Smoke Cigarettes", journal="J Med Internet Res", year="2024", month="Aug", day="28", volume="26", pages="e52919", keywords="older adults", keywords="digital health", keywords="digital cessation treatment", keywords="smoking cessation", keywords="digital cessation", keywords="treatment", keywords="smoke", keywords="cigarettes", keywords="cigarette", keywords="tobacco", keywords="adults", keywords="elderly", keywords="older person", keywords="older people", keywords="aging", keywords="smoking", keywords="quit", keywords="quitting", keywords="questionnaire", keywords="telehealth", keywords="treatments", keywords="behavioral health", keywords="public health", keywords="mobile phone", abstract="Background: To address enduring age-related tobacco disparities, it is critical to promote cessation treatment among older adults (aged 65+ years). Digital health platforms offer opportunities for wide dissemination of evidence-based behavioral cessation support. However, existing digital cessation treatments are not tailored to unique aging-related needs and preferences, resulting in low uptake. Detailed information is needed about how to best adapt these treatments for this age group. Objective: We aimed to collect detailed, hypothesis-generating information about expectations and preferences for cessation digital treatment among older adults who smoke cigarettes. Methods: Semistructured interviews were conducted with adults aged 65+ years currently smoking or who had quit within the past month. Interviews included open-ended questions regarding prior experiences with digital health platforms and expectations and preferences for cessation treatment via various modalities (app-delivered, texting-based, or videoconferencing counseling). Interviews also elicited questions regarding digital modalities that integrated social components (app-delivered social forums and group videoconferencing counseling). Using an iterative, team-based approach, the thematic analysis identified meaningful themes. Interviews were supplemented with quantitative measures assessing sociodemographics, digital literacy, and physical health symptoms. Results: Participants (12/20, 60\% men; 15/20, 75\% White; 4/20, 20\% Black or African American; 1/20, 5\% Asian) were currently smoking (17/20, 85\%) or had recently quit (3/20, 15\%). Thematic analysis identified 3 meaningful themes across all digital modalities: convenience, accessibility, and personalization. Expected benefits of digital platforms included convenient treatment access, without reliance on transportation. Participants preferred treatments to be personalized and deliver content or strategies beyond standard education. Most (17/20, 85\%) were unfamiliar with cessation apps but found them appealing given the potential for offering a novel quitting strategy. App ease of use (eg, easy navigation) was preferred. Half (10/20, 50\%) would try a texting-based intervention, with many preferring texting with a counselor rather than automated messaging. Most (17/20, 85\%) would use videoconferencing and expected this modality to deliver better quality counseling than via telephone. Expected videoconferencing challenges included looking presentable onscreen, technological difficulties, and privacy or security. Videoconferencing was regarded as the most personalized digital treatment, yet benefits unique to app-delivered and texting-based treatments included anonymity and access to treatment 24/7. Participants expected integrating social components into digital treatment to be useful for quit success and social connection, yet were concerned about possible interpersonal challenges. Conclusions: Because a long history of quit attempts and familiarity with standard quitting advice is common among older adults who smoke cigarettes, digital platforms might offer appealing and novel strategies for cessation that are accessible and convenient. Overall, this population was open to trying digital cessation treatments and would prefer that these platforms prioritize ease of use and personalized content. These findings challenge the bias that older adults are uninterested or unwilling to engage with digital treatments for behavioral health. ", doi="10.2196/52919", url="https://www.jmir.org/2024/1/e52919", url="http://www.ncbi.nlm.nih.gov/pubmed/39196628" } @Article{info:doi/10.2196/58594, author="Fealy, Shanna and McLaren, Suzanne and Seaman, Ellen Claire and Nott, Melissa and Jones, Donovan and Irwin, Pauletta and Logan, Patricia and Rossiter, Rachel and McDonald, Simon", title="Exploring the Sociodemographic and Health-Related Determinants of Telehealth Use Among a Cohort of Older Australians During the COVID-19 Pandemic: Repeated Cross-Sectional Study", journal="JMIR Aging", year="2024", month="Aug", day="23", volume="7", pages="e58594", keywords="telehealth", keywords="telemedicine", keywords="aging", keywords="older people", keywords="COVID-19", keywords="Australia", keywords="45 and Up Study", keywords="health-related determinates", keywords="Technology Acceptance Model", keywords="mobile phone", abstract="Background: During the COVID-19 pandemic, there was a rapid adoption of telehealth care services as a public health strategy to maintain access to essential health care. In Australia, there has been increasing optimism for the expansion of telehealth services. However, little is known about the patterns and determinants of telehealth adoption among older adults, with concerns that an expansion of telehealth services may only be of benefit to those who already have better access to health care. Objective: Leveraging data collected by The Sax Institute's 45 and Up COVID Insights study between November 2020 and April 2022, the objective of this study was to identify and describe the sociodemographic and health-related determinants of telehealth adoption and use among a cohort of older Australians. We hypothesized that health-related factors would be key determinants of telehealth adoption for Australians aged ?65 years during the COVID-19 pandemic. Methods: A repeated cross-sectional design was used. The relationships between telehealth use (classified as low, moderate, or high) and selected sociodemographic and health-related characteristics were assessed using logistic regression techniques. Variable selection and findings were situated within the Technology Acceptance Model, the Unified Theory of Acceptance, and the Use of Technology theoretical frameworks. Results: Of the 21,830 participants aged ?65 years, the proportion who indicated adopting telehealth ranged from 50.77\% (11,082/21,830) at survey 1 in 2020 to 39.4\% (7401/18,782) at survey 5 in 2022. High levels of telehealth use were associated with being female, aged <85 years, living in a major city, cohabiting with others, and being from the most socioeconomically disadvantaged areas (deciles 1-3). Individuals with a disability, chronic disease, multimorbidity, and lower perceived quality of life and those experiencing missed or delayed care were significantly more likely to use telehealth across all levels (P<.001). A temporal association was observed, whereby participants who engaged with telehealth services before or early in the pandemic (as assessed in survey 1) were more likely to continue telehealth use when assessed in survey 5 in 2022 (P<.001). Conclusions: This research contributes to the broader understanding of telehealth adoption and use among older adults. As telehealth models of care expand, there is an opportunity to tailor these services to the needs of older adults, particularly those living with chronic diseases and multimorbidity, by using targeted strategies that overcome barriers to accessing specialized health care services. ", doi="10.2196/58594", url="https://aging.jmir.org/2024/1/e58594", url="http://www.ncbi.nlm.nih.gov/pubmed/39178035" } @Article{info:doi/10.2196/56061, author="Kyaw, Yadana Myat and Aung, Nyein Myo and Koyanagi, Yuka and Moolphate, Saiyud and Aung, Nyein Thin Nyein and Ma, Carol Hok Ka and Lee, Hocheol and Nam, Hae-Kweun and Nam, Woo Eun and Yuasa, Motoyuki", title="Sociodigital Determinants of eHealth Literacy and Related Impact on Health Outcomes and eHealth Use in Korean Older Adults: Community-Based Cross-Sectional Survey", journal="JMIR Aging", year="2024", month="Aug", day="13", volume="7", pages="e56061", keywords="eHealth literacy", keywords="eHEALS", keywords="electronic health information", keywords="eHealth information", keywords="health literacy", keywords="health education", keywords="eHealth education", keywords="health training", keywords="eHealth training", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="digital interventions", keywords="gray digital divide", keywords="healthy aging", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="older person", keywords="older people", keywords="aging", keywords="eHealth Literacy Scale", abstract="Background: eHealth literacy is an essential skill for pursuing electronic health information, particularly for older people whose health needs increase with age. South Korea is now at the intersection of a rapidly digitalizing society and an increasingly aged population. eHealth literacy enables older people to maximize the effective use of emerging digital technology for their health and quality of life. Understanding the eHealth literacy of Korean older adults is critical to eliminating the gray digital divide and inequity in health information access. Objective: This study aims to investigate factors influencing eHealth literacy in older Korean adults and its impact on health outcomes and eHealth use. Methods: This was a cross-sectional survey. Community-dwelling older adults 65 years and older in 2 urban cities in South Korea were included. eHealth literacy was measured by the eHealth Literacy Scale. Ordinal logistic regression was used to analyze factors associated with eHealth literacy and multivariate ANOVA for the impact of eHealth literacy on health outcomes and eHealth use. Results: In total, 434 participants were analyzed. A total of 22.3\% (97/434) of participants had high eHealth literacy skills. Increasing age, higher monthly income, and time spent on the internet were significantly associated with eHealth literacy (P<.001), and social media users were 3.97 times (adjusted odds ratio 3.97, 95\% CI 1.02?15.43; P=.04) more likely to have higher skill. Higher eHealth literacy was associated with better self-perceived health and frequent use of digital technologies for accessing health and care services (P<.001). Conclusions: Disparity in socioeconomic status and engagement on the internet and social media can result in different levels of eHealth literacy skills, which can have consequential impacts on health outcomes and eHealth use. Tailored eHealth interventions, grounded on the social and digital determinants of eHealth literacy, could facilitate eHealth information access among older adults and foster a digitally inclusive healthy aging community. ", doi="10.2196/56061", url="https://aging.jmir.org/2024/1/e56061" } @Article{info:doi/10.2196/55693, author="Clohessy, Sophie and Kempton, Christian and Ryan, Kate and Grinbergs, Peter and Elliott, T. Mark", title="Exploring Older Adults' Perceptions of Using Digital Health Platforms for Self-Managing Musculoskeletal Health Conditions: Focus Group Study", journal="JMIR Aging", year="2024", month="Aug", day="1", volume="7", pages="e55693", keywords="musculoskeletal", keywords="digital health platform", keywords="physiotherapy self-management", keywords="digital triaging", keywords="phone app", keywords="qualitative", keywords="focus group", keywords="mobile phone", abstract="Background: Digital technologies can assist and optimize health care processes. This is increasingly the case in the musculoskeletal health domain, where digital platforms can be used to support the self-management of musculoskeletal conditions, as well as access to services. However, given a large proportion of the population with musculoskeletal conditions are older adults (aged ?60 years), it is important to consider the acceptability of such platforms within this demographic. Objective: This study aims to explore participants' opinions and perceptions on the use of digital platforms for supporting the self-management of musculoskeletal conditions within older adult (aged ?60 years) populations and to gather their opinions on real examples. Methods: A total of 2 focus groups (focus group 1: 6/15, 40\%; focus group 2: 9/15, 60\%) were conducted, in which participants answered questions about their thoughts on using digital health platforms to prevent or manage musculoskeletal conditions. Participants were further presented with 2 example scenarios, which were then discussed. Interviews were audio recorded, transcribed, and analyzed thematically. Participants were aged ?60 years and with or without current musculoskeletal conditions. Prior experience of using smartphone apps or other digital health platforms for musculoskeletal conditions was not required. Focus groups took place virtually using the Teams (Microsoft Corp) platform. Results: A total of 6 themes were identified across both focus groups: ``experiences of digital health platforms,'' ``preference for human contact,'' ``barriers to accessing clinical services,'' ``individual differences and digital literacy,'' ``trust in technology,'' and ``features and benefits of digital health technologies.'' Each theme is discussed in detail based on the interview responses. The findings revealed that most participants had some existing experience with digital health platforms for preventing or managing musculoskeletal conditions. Overall, there was a lack of trust in and low expectations of quality for digital platforms for musculoskeletal health within this age group. While there was some concern about the use of digital platforms in place of in-person health consultations, several benefits were also identified. Conclusions: Results highlighted the need for better communication on the benefits of using digital platforms to support the self-management of musculoskeletal conditions, without the platforms replacing the role of the health care professionals. The concerns about which apps are of suitable quality and trustworthiness lead us to recommend raising public awareness around the role of organizations that verify and assess the quality of digital health platforms. ", doi="10.2196/55693", url="https://aging.jmir.org/2024/1/e55693" } @Article{info:doi/10.2196/51355, author="Kepper, M. Maura and Fowler, A. Lauren and Kusters, S. Isabelle and Davis, W. Jean and Baqer, Manal and Sagui-Henson, Sara and Xiao, Yunyu and Tarfa, Adati and Yi, C. Jean and Gibson, Bryan and Heron, E. Kristin and Alberts, M. Nicole and Burgermaster, Marissa and Njie-Carr, PS Veronica and Klesges, M. Lisa", title="Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity", journal="J Med Internet Res", year="2024", month="Aug", day="1", volume="26", pages="e51355", keywords="digital health", keywords="health equity", keywords="mobile health", keywords="mHealth", keywords="health care access", keywords="digital divide", keywords="behavioral medicine", keywords="implementation", keywords="mobile phone", doi="10.2196/51355", url="https://www.jmir.org/2024/1/e51355", url="http://www.ncbi.nlm.nih.gov/pubmed/39088246" } @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/10.2196/48126, author="Palmier, C{\'e}cilia and Rigaud, Anne-Sophie and Ogawa, Toshimi and Wieching, Rainer and Dacunha, S{\'e}bastien and Barbarossa, Federico and Stara, Vera and Bevilacqua, Roberta and Pino, Maribel", title="Identification of Ethical Issues and Practice Recommendations Regarding the Use of Robotic Coaching Solutions for Older Adults: Narrative Review", journal="J Med Internet Res", year="2024", month="Jun", day="18", volume="26", pages="e48126", keywords="robotic coaching solutions", keywords="ethical issues", keywords="ethical recommendations", keywords="older adults", keywords="geriatrics", keywords="guidelines", abstract="Background: Technological advances in robotics, artificial intelligence, cognitive algorithms, and internet-based coaches have contributed to the development of devices capable of responding to some of the challenges resulting from demographic aging. Numerous studies have explored the use of robotic coaching solutions (RCSs) for supporting healthy behaviors in older adults and have shown their benefits regarding the quality of life and functional independence of older adults at home. However, the use of RCSs by individuals who are potentially vulnerable raises many ethical questions. Establishing an ethical framework to guide the development, use, and evaluation practices regarding RCSs for older adults seems highly pertinent. Objective: The objective of this paper was to highlight the ethical issues related to the use of RCSs for health care purposes among older adults and draft recommendations for researchers and health care professionals interested in using RCSs for older adults. Methods: We conducted a narrative review of the literature to identify publications including an analysis of the ethical dimension and recommendations regarding the use of RCSs for older adults. We used a qualitative analysis methodology inspired by a Health Technology Assessment model. We included all article types such as theoretical papers, research studies, and reviews dealing with ethical issues or recommendations for the implementation of these RCSs in a general population, particularly among older adults, in the health care sector and published after 2011 in either English or French. The review was performed between August and December 2021 using the PubMed, CINAHL, Embase, Scopus, Web of Science, IEEE Explore, SpringerLink, and PsycINFO databases. Selected publications were analyzed using the European Network of Health Technology Assessment Core Model (version 3.0) around 5 ethical topics: benefit-harm balance, autonomy, privacy, justice and equity, and legislation. Results: In the 25 publications analyzed, the most cited ethical concerns were the risk of accidents, lack of reliability, loss of control, risk of deception, risk of social isolation, data confidentiality, and liability in case of safety problems. Recommendations included collecting the opinion of target users, collecting their consent, and training professionals in the use of RCSs. Proper data management, anonymization, and encryption appeared to be essential to protect RCS users' personal data. Conclusions: Our analysis supports the interest in using RCSs for older adults because of their potential contribution to individuals' quality of life and well-being. This analysis highlights many ethical issues linked to the use of RCSs for health-related goals. Future studies should consider the organizational consequences of the implementation of RCSs and the influence of cultural and socioeconomic specificities of the context of experimentation. We suggest implementing a scalable ethical and regulatory framework to accompany the development and implementation of RCSs for various aspects related to the technology, individual, or legal aspects. ", doi="10.2196/48126", url="https://www.jmir.org/2024/1/e48126", url="http://www.ncbi.nlm.nih.gov/pubmed/38888953" } @Article{info:doi/10.2196/55471, author="Martin, Tobias and Veldeman, Sarah and Gro{\ss}mann, Heidrun and Fuchs-Frohnhofen, Paul and Czaplik, Michael and Follmann, Andreas", title="Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study", journal="JMIR Aging", year="2024", month="Jun", day="6", volume="7", pages="e55471", keywords="telemedicine", keywords="televisits", keywords="telehealth", keywords="eHealth", keywords="electronic health", keywords="older adult care", keywords="nursing homes", keywords="change management", keywords="implementation science", keywords="technology transfer", keywords="innovation transfer", keywords="long-term adoption", keywords="COVID-19 crisis", keywords="postpandemic", keywords="coronavirus", keywords="digitalization", abstract="Background: There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis. Objective: This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses' workload and their nursing practice. Methods: A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements. Results: In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs. Conclusions: Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine. ", doi="10.2196/55471", url="https://aging.jmir.org/2024/1/e55471", url="http://www.ncbi.nlm.nih.gov/pubmed/38842915" } @Article{info:doi/10.2196/52457, author="Cai, Wenfei and Liang, Wei and Liu, Huaxuan and Zhou, Rundong and Zhang, Jie and Zhou, Lin and Su, Ning and Zhu, Hanxiao and Yang, Yide", title="Electronic Health Literacy Scale-Web3.0 for Older Adults with Noncommunicable Diseases: Validation Study", journal="J Med Internet Res", year="2024", month="Jun", day="3", volume="26", pages="e52457", keywords="eHealth literacy", keywords="measurement", keywords="Web 3.0", keywords="psychometric properties", keywords="NCD", keywords="older adults", keywords="noncommunicable diseases", keywords="Electronic Health Literacy", keywords="health literacy", keywords="eHealth", keywords="reliability", keywords="validity", abstract="Background: In the current digital era, eHealth literacy plays an indispensable role in health care and self-management among older adults with noncommunicable diseases (NCDs). Measuring eHealth literacy appropriately and accurately ensures the successful implementation and evaluation of pertinent research and interventions. However, existing eHealth literacy measures focus mainly on individuals' abilities of accessing and comprehending eHealth information (Web1.0), whereas the capabilities for web-based interaction (Web2.0) and using eHealth information (Web3.0) have not been adequately evaluated. Objective: This study aimed to examine the reliability, validity, and measurement invariance of the eHealth Literacy Scale-Web3.0 (eHLS-Web3.0) among older adults with NCDs. Methods: A total of 642 Chinese older adults with NCDs (mean age 65.78, SD 3.91 years; 55.8\% female) were recruited in the baseline assessment, of whom 134 (mean age 65.63, SD 3.99 years; 58.2\% female) completed the 1-month follow-up assessment. Baseline measures included the Chinese version of the 24-item 3D eHLS-Web3.0, the Chinese version of the 8-item unidimensional eHealth Literacy Scale (eHEALS), and demographic information. Follow-up measures included the 24-item eHLS-Web3.0 and accelerometer-measured physical activity and sedentary behavior. A series of statistical analyses, for example, Cronbach $\alpha$, composite reliability coefficient (CR), confirmatory factor analysis (CFA), and multigroup CFA, were performed to examine the internal consistency and test-retest reliabilities, as well as the construct, concurrent, convergent, discriminant, and predictive validities, and the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence. Results: Cronbach $\alpha$ and CR were within acceptable ranges of 0.89-0.94 and 0.90-0.97, respectively, indicating adequate internal consistency of the eHLS-Web3.0 and its subscales. The eHLS-Web3.0 also demonstrated cross-time stability, with baseline and follow-up measures showing a significant intraclass correlation of 0.81-0.91. The construct validity of the 3D structure model of the eHLS-Web3.0 was supported by confirmatory factor analyses. The eHLS-Web3.0 exhibited convergent validity with an average variance extracted value of 0.58 and a CR value of 0.97. Discriminant validity was supported by CFA results for a proposed 4-factor model integrating the 3 eHLS-Web3.0 subscales and eHEALS. The predictive validity of the eHLS-Web3.0 for health behaviors was supported by significant associations of the eHLS-Web3.0 with light physical activity ($\beta$=.36, P=.004), moderate to vigorous physical activity ($\beta$=.49, P<.001), and sedentary behavior ($\beta$=--.26, P=.002). Finally, the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence was supported by the establishment of configural, metric, strong, and strict invariances. Conclusions: The present study provides timely empirical evidence on the reliability, validity, and measurement invariance of the eHLS-Web3.0, suggesting that the 24-item 3D eHLS-Web3.0 is an appropriate and valid tool for measuring eHealth literacy among older adults with NCDs within the Web3.0 sphere. ", doi="10.2196/52457", url="https://www.jmir.org/2024/1/e52457", url="http://www.ncbi.nlm.nih.gov/pubmed/38830207" } @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/10.2196/56653, author="Murabito, M. Joanne and Faro, M. Jamie and Zhang, Yuankai and DeMalia, Angelo and Hamel, Alexander and Agyapong, Nakesha and Liu, Hongshan and Schramm, Eric and McManus, D. David and Borrelli, Belinda", title="Smartphone App Designed to Collect Health Information in Older Adults: Usability Study", journal="JMIR Hum Factors", year="2024", month="May", day="30", volume="11", pages="e56653", keywords="mobile application surveys", keywords="mixed methods", keywords="electronic data collection", keywords="mHealth", keywords="mobile health", 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="usability", keywords="usable", keywords="usableness", keywords="usefulness", keywords="utility", keywords="health information", abstract="Background: Studies evaluating the usability of mobile-phone assessments in older adults are limited. Objective: This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting. Methods: We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40\% women; 15/15, 100\% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47\% women; 3/15, 20\% Hispanic; and 8/15, 53\% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent). Results: In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test. Conclusions: Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences. ", doi="10.2196/56653", url="https://humanfactors.jmir.org/2024/1/e56653", url="http://www.ncbi.nlm.nih.gov/pubmed/38815261" } @Article{info:doi/10.2196/53098, author="Greeley, Brian and Chung, Seohyeon Sally and Graves, Lorraine and Song, Xiaowei", title="Combating Barriers to the Development of a Patient-Oriented Frailty Website", journal="JMIR Aging", year="2024", month="May", day="28", volume="7", pages="e53098", keywords="frailty", keywords="frailty website", keywords="patient-oriented assessment", keywords="community-dwelling older adults", keywords="internet security", keywords="privacy", keywords="barrier", keywords="barriers", keywords="development", keywords="implementation", keywords="patient-oriented", keywords="internet", keywords="virtual health resource", keywords="community dwelling", keywords="older adult", keywords="older adults", keywords="health care professional", keywords="caregiver", keywords="caregivers", keywords="technology", keywords="real-time", keywords="monitoring", keywords="aging", keywords="ageing", doi="10.2196/53098", url="https://aging.jmir.org/2024/1/e53098" } @Article{info:doi/10.2196/56474, author="Groeneveld, Sjors and Bin Noon, Gaya and den Ouden, M. Marjolein E. and van Os-Medendorp, Harmieke and van Gemert-Pijnen, C. J. E. W. and Verdaasdonk, M. Rudolf and Morita, Pelegrini Plinio", title="The Cooperation Between Nurses and a New Digital Colleague ``AI-Driven Lifestyle Monitoring'' in Long-Term Care for Older Adults: Viewpoint", journal="JMIR Nursing", year="2024", month="May", day="23", volume="7", pages="e56474", keywords="artificial intelligence", keywords="data", keywords="algorithm", keywords="nurse", keywords="nurses", keywords="health care professional", keywords="health care professionals", keywords="health professional", keywords="health professionals", keywords="health technology", keywords="digital health", keywords="smart home", keywords="smart homes", keywords="health monitoring", keywords="health promotion", keywords="aging in place", keywords="assisted living", keywords="ambient assisted living", keywords="aging", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adults", keywords="independent living", keywords="machine learning", doi="10.2196/56474", url="https://nursing.jmir.org/2024/1/e56474", url="http://www.ncbi.nlm.nih.gov/pubmed/38781012" } @Article{info:doi/10.2196/51675, author="Miller, Soederberg Lisa M. and Callegari, A. Rachel and Abah, Theresa and Fann, Helen", title="Digital Literacy Training for Low-Income Older Adults Through Undergraduate Community-Engaged Learning: Single-Group Pretest-Posttest Study", journal="JMIR Aging", year="2024", month="May", day="14", volume="7", pages="e51675", keywords="community-engaged learning", keywords="digital divide", keywords="underserved older adults", keywords="digital literacy training", keywords="intergenerational programs", abstract="Background: Digital technology is a social determinant of health that affects older people's ability to engage in health maintenance and disease prevention activities; connect with family and friends; and, more generally, age in place. Unfortunately, disparities in technology adoption and use exist among older adults compared with other age groups and are even greater among low-income older adults. Objective: In this study, we described the development and implementation of a digital literacy training program designed with the dual goals of training low-income older adults in the community and teaching students about aging using a community-engaged learning (CEL) approach. Methods: The training program was embedded within a 10-week CEL course that paired undergraduates (N=27) with low-income older adults (n=18) for 8 weeks of digital literacy training. Older adults and students met weekly at the local senior center for the training. Students also met in the classroom weekly to learn about aging and how to use design thinking to train their older adult trainees. Both older adults and students completed pre- and posttraining surveys. Results: Older adults demonstrated increased digital literacy skills and confidence in the use of digital technology. Loneliness did not change from pre to postassessment measurements; however, older adults showed improvements in their attitudes toward their own aging and expressed enthusiasm for the training program. Although students' fear of older adults did not change, their comfort in working with older adults increased. Importantly, older adults and students expressed positive feelings about the trainee-trainer relationship that they formed during the training program. Conclusions: A CEL approach that brings together students and low-income older adults in the community has a strong potential to reduce the digital divide experienced by underserved older adults. Additional work is needed to explore the efficacy and scalability of this approach in terms of older adults' digital literacy as well as other potential benefits to both older and younger adults. ", doi="10.2196/51675", url="https://aging.jmir.org/2024/1/e51675", url="http://www.ncbi.nlm.nih.gov/pubmed/38599620" } @Article{info:doi/10.2196/53163, author="Sien, Sang-Wha and Kobekyaa, Kyerepagr Francis and Puts, Martine and Currie, Leanne and Tompson, Margaret and Hedges, Penelope and McGrenere, Joanna and Mariano, Caroline and Haase, R. Kristen", title="Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing", journal="JMIR Aging", year="2024", month="May", day="8", volume="7", pages="e53163", keywords="cancer", keywords="aging", keywords="self-management", keywords="usability testing", keywords="design thinking", keywords="design", keywords="oncology", keywords="develop", keywords="development", keywords="usability", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="ageing", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="symptom", keywords="symptoms", keywords="comorbidity", keywords="comorbidities", keywords="comorbid", keywords="multimorbidity", keywords="multimorbidities", keywords="co-design", abstract="Background: Globally, cancer predominates in adults aged older than 60 years, and 70\% of older adults have ?1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake. Objective: We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity. Methods: This study used Grey's self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses. Results: In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy. Conclusions: This app has the potential to support the complex health care needs of older adults with cancer, creating a ``home base'' for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation. ", doi="10.2196/53163", url="https://aging.jmir.org/2024/1/e53163", url="http://www.ncbi.nlm.nih.gov/pubmed/38717806" } @Article{info:doi/10.2196/53019, author="Aguirre, Alyssa and Hilsabeck, Robin and Smith, Tawny and Xie, Bo and He, Daqing and Wang, Zhendong and Zou, Ning", title="Assessing the Quality of ChatGPT Responses to Dementia Caregivers' Questions: Qualitative Analysis", journal="JMIR Aging", year="2024", month="May", day="6", volume="7", pages="e53019", keywords="Alzheimer's disease", keywords="information technology", keywords="social media", keywords="neurology", keywords="dementia", keywords="Alzheimer disease", keywords="caregiver", keywords="ChatGPT", abstract="Background: Artificial intelligence (AI) such as ChatGPT by OpenAI holds great promise to improve the quality of life of patients with dementia and their caregivers by providing high-quality responses to their questions about typical dementia behaviors. So far, however, evidence on the quality of such ChatGPT responses is limited. A few recent publications have investigated the quality of ChatGPT responses in other health conditions. Our study is the first to assess ChatGPT using real-world questions asked by dementia caregivers themselves. Objectives: This pilot study examines the potential of ChatGPT-3.5 to provide high-quality information that may enhance dementia care and patient-caregiver education. Methods: Our interprofessional team used a formal rating scale (scoring range: 0-5; the higher the score, the better the quality) to evaluate ChatGPT responses to real-world questions posed by dementia caregivers. We selected 60 posts by dementia caregivers from Reddit, a popular social media platform. These posts were verified by 3 interdisciplinary dementia clinicians as representing dementia caregivers' desire for information in the areas of memory loss and confusion, aggression, and driving. Word count for posts in the memory loss and confusion category ranged from 71 to 531 (mean 218; median 188), aggression posts ranged from 58 to 602 words (mean 254; median 200), and driving posts ranged from 93 to 550 words (mean 272; median 276). Results: ChatGPT's response quality scores ranged from 3 to 5. Of the 60 responses, 26 (43\%) received 5 points, 21 (35\%) received 4 points, and 13 (22\%) received 3 points, suggesting high quality. ChatGPT obtained consistently high scores in synthesizing information to provide follow-up recommendations (n=58, 96\%), with the lowest scores in the area of comprehensiveness (n=38, 63\%). Conclusions: ChatGPT provided high-quality responses to complex questions posted by dementia caregivers, but it did have limitations. ChatGPT was unable to anticipate future problems that a human professional might recognize and address in a clinical encounter. At other times, ChatGPT recommended a strategy that the caregiver had already explicitly tried. This pilot study indicates the potential of AI to provide high-quality information to enhance dementia care and patient-caregiver education in tandem with information provided by licensed health care professionals. Evaluating the quality of responses is necessary to ensure that caregivers can make informed decisions. ChatGPT has the potential to transform health care practice by shaping how caregivers receive health information. ", doi="10.2196/53019", url="https://aging.jmir.org/2024/1/e53019" } @Article{info:doi/10.2196/50759, author="Lee, Shinduk and Ory, G. Marcia and Vollmer Dahlke, Deborah and Smith, Lee Matthew", title="Technology Use Among Older Adults and Their Caregivers: Cross-Sectional Survey Study", journal="JMIR Aging", year="2024", month="May", day="1", volume="7", pages="e50759", keywords="technology", keywords="caregiving", keywords="social determinants of health", keywords="health disparities", keywords="disparity", keywords="disparities", keywords="caregiver", keywords="caregivers", keywords="carers", keywords="technology use", keywords="usage", 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="cross-sectional", keywords="survey", keywords="surveys", keywords="computer use", keywords="device", keywords="devices", keywords="adoption", keywords="dyad", keywords="dyads", abstract="Background: Informal caregivers are called upon to provide substantial care, but more needs to be known about technology use among older adult and caregiver dyads. Objective: This study described technology use among older adults and their caregivers, explored potential correlates of technology use, and highlighted implications for practice. Methods: A cross-sectional survey was conducted among unpaid caregivers of older adults (n=486). Primary outcomes were self-reported technology (devices and functions) use among caregivers and their oldest care recipient. The concordance of technology use among caregivers and care recipients was also examined. Multivariable regression models were conducted separately for caregivers and care recipients. Results: Greater proportions of caregivers used all examined technologies, except for the medication alerts or tracking function, than care recipients. Caregivers used an average of 3.4 devices and 4.2 functions, compared to 1.8 devices and 1.6 functions used by their care recipients. Among caregivers, younger age, higher income, and higher education were associated with more technology use (P<.05). Among care recipients, younger age, not having cognitive dysfunction, and caregiver's technology use were associated with more technology use (P<.05). Conclusions: Understanding technology use patterns and device adoption across diverse caregiver and care recipient populations is increasingly important for enhancing geriatric care. Findings can guide recommendations about appropriate technology interventions and help providers communicate and share information more effectively with patients and their caregivers. ", doi="10.2196/50759", url="https://aging.jmir.org/2024/1/e50759" } @Article{info:doi/10.2196/54120, author="Ausserhofer, Dietmar and Piccoliori, Giuliano and Engl, Adolf and Mahlknecht, Angelika and Plagg, Barbara and Barbieri, Verena and Colletti, Nicoletta and Lombardo, Stefano and G{\"a}rtner, Timon and Tappeiner, Waltraud and Wieser, Heike and Wiedermann, Josef Christian", title="Community-Dwelling Older Adults' Readiness for Adopting Digital Health Technologies: Cross-Sectional Survey Study", journal="JMIR Form Res", year="2024", month="Apr", day="30", volume="8", pages="e54120", keywords="frail older adults", keywords="Italy", keywords="Italian", keywords="Europe", keywords="European", keywords="digital health", keywords="health technologies", keywords="health technology", keywords="telemedicine", keywords="telehealth", keywords="eHealth", keywords="e-health", keywords="adoption", keywords="readiness", keywords="usage", keywords="survey", keywords="surveys", keywords="questionnaire", keywords="questionnaires", keywords="robotics", keywords="cross-sectional study", keywords="population-based survey", keywords="stratified probabilistic sampling", 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", abstract="Background: Digital health technologies offer the potential to improve the daily lives of older adults, maintain their health efficiently, and allow aging in place. Despite increasing evidence of benefits and advantages, readiness for adopting digital interventions among older people remains underexplored. Objective: This study aims to explore the relationships between sociodemographic-, health-, and lifestyle-related factors and technology use in everyday life and community-dwelling older adults' readiness to adopt telemedicine, smartphones with texting apps, wearables, and robotics. Methods: This was a cross-sectional, population-based survey study with a stratified probabilistic sample of adults aged 75 years or older living in South Tyrol (autonomous province of Bolzano/Bozen, Italy). A random sample of 3600 community-dwelling older adults living at home was invited to complete a questionnaire including single items (older adults' readiness to use health technology) and scales (PRISMA-7; Program of Research on Integration of Services for the Maintenance of Autonomy). Descriptive and logistic regression analyses were performed to analyze the data. Results: In total, 1695 community-dwelling older adults completed the survey (for a response rate of 47\%). In terms of potential digital health technology adoption, wearable devices were favored by 33.7\% (n=571), telemedicine by 30.1\% (n=510), smartphones and texting apps by 24.5\% (n=416), and assistant robots by 13.7\% (n=232). Sociodemographic-, health- and lifestyle-related factors, as well as the use of technology in everyday life, played a significant role in explaining readiness to adopt digital health technologies. For telemedicine, age ?85 years (odds ratio [OR] 0.74, 95\% CI 0.56-0.96), financial constraints (OR 0.68, 95\% CI 0.49-0.95), and less than 2 hours of physical activity per week (OR 0.75, 95\% CI 0.58-0.98) were associated with nonreadiness, while Italian-speaking participants (OR 1.54, 95\% CI 1.16-2.05) and those regularly using computers (OR 1.74, 95\% CI 1.16-2.60), smartphones (OR 1.69, 95\% CI 1.22-2.35), and the internet (OR 2.26, 95\% CI 1.47-3.49) reported readiness for adoption. Conclusions: Community-dwelling older adults display varied readiness toward the adoption of digital health technologies, influenced by age, mother tongue, living situation, financial resources, physical activity, and current use of technology. The findings underscore the need for tailored interventions and educational programs to boost digital health technology adoption among community-dwelling older adults. ", doi="10.2196/54120", url="https://formative.jmir.org/2024/1/e54120", url="http://www.ncbi.nlm.nih.gov/pubmed/38687989" } @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/10.2196/52317, author="Haimi, Motti and Sergienko, Ruslan", title="Adoption and Use of Telemedicine and Digital Health Services Among Older Adults in Light of the COVID-19 Pandemic: Repeated Cross-Sectional Analysis", journal="JMIR Aging", year="2024", month="Apr", day="24", volume="7", pages="e52317", keywords="telemedicine", keywords="digital health", keywords="older adults", keywords="COVID-19", keywords="use", keywords="digital divide", keywords="usability", keywords="pandemic", keywords="telehealth", keywords="Israel", keywords="working-hours telehealth visits", keywords="after-hours consultation", keywords="teleconsultation", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="wearables", keywords="mobile phone", abstract="Background: As the population ages and the prevalence of long-term diseases rises, the use of telecare is becoming increasingly frequent to aid older people. Objective: This study aims to explore the use and adoption of 3 types of telehealth services among the older population in Israel before, during, and after the COVID-19 pandemic. Methods: We explored the use characteristics of older adults (aged ?65 years) belonging to Clalit Health Services in several aspects in the use of 3 types of telehealth services: the use of digital services for administrative tasks; the use of synchronous working-hours telehealth visits with the patient's personal physician during clinic business hours; and the use of after-hours consultations during evenings, nights, and weekends when the clinics are closed. The data were collected and analyzed throughout 3 distinct periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic, and following the COVID-19 peak. Results: Data of 618,850 patients who met the inclusion criteria were extracted. Telehealth services used for administrative purposes were the most popular. The most intriguing finding was that the older population significantly increased their use of all types of telehealth services during the COVID-19 pandemic, and in most types, this use decreased after the COVID-19 peak, but to a level that was higher than the baseline level before the COVID-19 pandemic. Before the COVID-19 pandemic, 23.1\% (142,936/618,850) of the study population used working-hours telehealth visits, and 2.2\% (13,837/618,850) used after-hours consultations at least once. The percentage of use for these services increased during the COVID-19 pandemic to 59.2\% (366,566/618,850) and 5\% (30,777/618,850) and then decreased during the third period to 39.5\% (244,572/618,850) and 2.4\% (14,584/618,850), respectively (P<.001). Multiple patient variables have been found to be associated with the use of the different telehealth services in each period. Conclusions: Despite the limitations and obstacles, the older population uses telehealth services and can increase their use when they are needed. These people can learn how to use digital health services effectively, and they should be given the opportunity to do so by creating suitable and straightforward telehealth solutions tailored to this population and enhancing their usability. ", doi="10.2196/52317", url="https://aging.jmir.org/2024/1/e52317", url="http://www.ncbi.nlm.nih.gov/pubmed/38656768" } @Article{info:doi/10.2196/50938, author="Neumann, Ariana and K{\"o}nig, Hans-Helmut and Hajek, Andr{\'e}", title="Determinants of Telemedicine Service Use Among Middle-Aged and Older Adults in Germany During the COVID-19 Pandemic: Cross-Sectional Survey Study", journal="JMIR Aging", year="2024", month="Apr", day="23", volume="7", pages="e50938", keywords="telemedicine", keywords="telehealth", keywords="digital health", keywords="service use", keywords="COVID-19", abstract="Background: The occurrence of the COVID-19 pandemic demanded fast changes in the delivery of health care. As a result, significant growth in the use of telemedicine services occurred. Research, especially from nationally representative German samples, is needed to better understand determinants of telemedicine use. Objective: The purpose of this study was to identify determinants of telemedicine service use among middle-aged and older adults during the COVID-19 pandemic in Germany. Methods: Cross-sectional, nationally representative data were taken from the German sample of the Survey of Health, Ageing and Retirement in Europe (SHARE). The German Corona Survey 2 (n=2039), which was conducted between June and August 2021, was used for this study. Reporting experience with remote medical consultations during the COVID-19 pandemic served as the outcome measure. Associations with socioeconomic, psychological, social, health-related, and COVID-19--related determinants were examined using multiple Firth logistic regressions. Results: Psychological factors including feeling nervous, anxious, or on edge (odds ratio [OR] 1.61, 95\% CI 1.04-2.50; P=.03), feeling sad or depressed (OR 1.62, 95\% CI 1.05-2.51; P=.03) and feelings of loneliness (OR 1.66, 95\% CI 1.07-2.58; P=.02) were positively associated with telemedicine use. Moreover, forgoing medical treatment because of being afraid of being infected by SARS-CoV-2 (OR 1.81, 95\% CI 1.10-2.97; P=.02) and describing limitations because of a health problem as severe were positively associated with the outcome (OR 2.11, 95\% CI 1.12-4.00; P=.02). Socioeconomic and social factors were not significantly associated with telemedicine use in our sample. Conclusions: Middle-aged and older individuals in Germany seem to use telemedicine services according to psychological needs and health limitations. Especially when psychological symptoms are experienced, telemedicine seems to be a promising service option in this age group. Future research is needed to confirm these initial findings in postpandemic circumstances. ", doi="10.2196/50938", url="https://aging.jmir.org/2024/1/e50938" } @Article{info:doi/10.2196/47943, author="Zarling, Amie and Kim, Joseph and Russell, Daniel and Cutrona, Carolyn", title="Increasing Older Adults' Social Connectedness: Development and Implementation of a Web-Assisted Acceptance and Commitment Therapy--Based Intervention", journal="JMIR Aging", year="2024", month="Apr", day="22", volume="7", pages="e47943", keywords="acceptance and commitment therapy", keywords="psychotherapy", keywords="loneliness", keywords="technology", keywords="lonely", keywords="older adults", keywords="older adult", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="emotion regulation", keywords="mental health", keywords="elder", keywords="elderly", keywords="isolation", keywords="aging", keywords="mHealth", keywords="digital health", keywords="digital mental health", keywords="online health", keywords="online support", keywords="eHealth", keywords="internet", keywords="depression", doi="10.2196/47943", url="https://aging.jmir.org/2024/1/e47943" } @Article{info:doi/10.2196/49130, author="Ashraf, Nabila Mir and Gallant, L. Natasha and Bradley, Cara", title="Digital Health Interventions in Older Adult Populations Living With Chronic Disease in High-Income Countries: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Mar", day="28", volume="13", pages="e49130", keywords="chronic disease", keywords="high-income countries", keywords="digital health", keywords="interventions", keywords="older adults", keywords="quality of life", abstract="Background: Globally, around 80\% percent of adults aged 65 years or older are living with at least 1 chronic disease, and 68\% percent have 2 or more chronic diseases. Older adults living with chronic diseases require greater health care services, but these health care services are not always easily accessible. Furthermore, the COVID-19 pandemic has resulted in unprecedented changes in the provision of health care services for older adults. During the COVID-19 pandemic, digital health interventions for chronic disease management were developed out of necessity, but the evidence regarding these and developed interventions is lacking. Objective: In this scoping review, we aim to identify available digital health interventions such as emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms for chronic disease management for older adults in high-income countries. Methods: We will follow the Arksey and O'Malley framework to conduct the scoping review. Our full search strategy was developed following a preliminary search on MEDLINE. We will include studies where older adults are at least 65 years of age, living with at least 1 chronic disease (eg, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes), and residing in high-income countries. Digital health interventions will be broadly defined to include emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms. Results: This scoping review is currently ongoing. As of March 2023, our full search strategy has resulted in a total of 9901 records. We completed the screening of titles and abstracts and obtained 442 abstracts for full-text review. We are aiming to complete our full-text review in October 2024, data extraction in November 2024, and data synthesis in December 2024. Conclusions: This scoping review will generate evidence that will contribute to the further development of digital health interventions for future chronic disease management among older adults in high-income countries. More evidence-based research is needed to better understand the feasibility and limitations associated with the use of digital health interventions for this population. These evidence-based findings can then be disseminated to decision-makers and policy makers in other high-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/49130 ", doi="10.2196/49130", url="https://www.researchprotocols.org/2024/1/e49130", url="http://www.ncbi.nlm.nih.gov/pubmed/38546710" } @Article{info:doi/10.2196/50880, author="Mu, Aruhan and Liu, Zhiyong", title="Assessing the Impact of Internet Skills on Depressive Symptoms Among Chinese Middle-Aged and Older Adults: Cross-Sectional Instrumental Variables Analysis", journal="JMIR Aging", year="2024", month="Mar", day="21", volume="7", pages="e50880", keywords="internet skills", keywords="depression", keywords="second-level digital divide", keywords="instrumental variables", abstract="Background: The potential benefits of IT for the well-being of older adults have been widely anticipated. However, findings regarding the impact of internet use on depressive symptoms are inconsistent. As a result of IT's exponential growth, internet skills have supplanted internet access as the source of the digital divide. Objective: This study evaluates the effect of internet skills on depressive symptoms through an instrumental variables (IV) approach. Methods: Data from the China Health and Retirement Longitudinal Study's wave 4 (2018) were used. This included 16,949 community residents aged 45 years and older. To overcome the endogeneity issue, we used an IV approach. Results: Our results reveal the emergence of a second-level digital divide, the disparity in internet skills, among Chinese middle-aged and older adults. Liner regression suggests that a 1\% increase in internet skills is associated with a 0.037\% decrease in depressive symptoms ($\beta$=?.037, SE 0.009), which underestimates the causal effect. As expected, internet skills are an endogenous variable (F test P value <.001). IV regressions indicate that a 1\% increase in internet skills reduces 1.135\% (SE 0.471) to 1.741\% (SE 0.297) of depressive symptoms. These 2 IV are neither weak (F--1=16.7 and 28.5; both >10) nor endogenous (Wu-Hausman test P value of .10; >.05 or >.01). Conclusions: Better mental health is predicted through improved and higher internet skills. Consequently, residents and policy makers in China should focus on bridging the digital divide in internet skills among middle-aged and older adults. ", doi="10.2196/50880", url="https://aging.jmir.org/2024/1/e50880" } @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/10.2196/48292, author="Kirby, Pippa and Lai, Helen and Horrocks, Sophie and Harrison, Matthew and Wilson, Danielle and Daniels, Sarah and Calvo, A. Rafael and Sharp, J. David and Alexander, M. Caroline", title="Patient and Public Involvement in Technology-Related Dementia Research: Scoping Review", journal="JMIR Aging", year="2024", month="Mar", day="4", volume="7", pages="e48292", keywords="dementia", keywords="technology", keywords="patient and public involvement and engagement", keywords="co-design", keywords="coproduction", abstract="Background: Technology-related research on people with dementia and their carers often aims to enable people to remain living at home for longer and prevent unnecessary hospital admissions. To develop person-centered, effective, and ethical research, patient and public involvement (PPI) is necessary, although it may be perceived as more difficult with this cohort. With recent and rapid expansions in health and care--related technology, this review explored how and with what impact collaborations between researchers and stakeholders such as people with dementia and their carers have taken place. Objective: This review aims to describe approaches to PPI used to date in technology-related dementia research, along with the barriers and facilitators and impact of PPI in this area. Methods: A scoping review of literature related to dementia, technology, and PPI was conducted using MEDLINE, PsycINFO, Embase, and CINAHL. Papers were screened for inclusion by 2 authors. Data were then extracted using a predesigned data extraction table by the same 2 authors. A third author supported the resolution of any conflicts at each stage. Barriers to and facilitators of undertaking PPI were then examined and themed. Results: The search yielded 1694 papers, with 31 (1.83\%) being analyzed after screening. Most (21/31, 68\%) did not make clear distinctions between activities undertaken as PPI and those undertaken by research participants, and as such, their involvement did not fit easily into the National Institute for Health and Care Research definition of PPI. Most of this mixed involvement focused on reviewing or evaluating technology prototypes. A range of approaches were described, most typically using focus groups or co-design workshops. In total, 29\% (9/31) described involvement at multiple stages throughout the research cycle, sometimes with evidence of sharing decision-making power. Some (23/31, 74\%) commented on barriers to or facilitators of effective PPI. The challenges identified often regarded issues of working with people with significant cognitive impairments and pressures on time and resources. Where reported, the impact of PPI was largely reported as positive, including the experiences for patient and public partners, the impact on research quality, and the learning experience it provided for researchers. Only 4 (13\%) papers used formal methods for evaluating impact. Conclusions: Researchers often involve people with dementia and other stakeholders in technology research. At present, involvement is often limited in scope despite aspirations for high levels of involvement and partnership working. Involving people with dementia, their carers, and other stakeholders can have a positive impact on research, patient and public partners, and researchers. Wider reporting of methods and facilitative strategies along with more formalized methods for recording and reporting on meaningful impact would be helpful so that all those involved---researchers, patients, and other stakeholders---can learn how we can best conduct research together. ", doi="10.2196/48292", url="https://aging.jmir.org/2024/1/e48292", url="http://www.ncbi.nlm.nih.gov/pubmed/38437014" } @Article{info:doi/10.2196/46522, author="Money, Annemarie and Hall, Alex and Harris, Danielle and Eost-Telling, Charlotte and McDermott, Jane and Todd, Chris", title="Barriers to and Facilitators of Older People's Engagement With Web-Based Services: Qualitative Study of Adults Aged >75 Years", journal="JMIR Aging", year="2024", month="Feb", day="28", volume="7", pages="e46522", keywords="digital exclusion", keywords="digital inclusion", keywords="older people", keywords="technology", keywords="aged", keywords="web-based", keywords="internet", abstract="Background: The COVID-19 pandemic has accelerated the shift toward the digital provision of many public services, including health and social care, public administration, and financial and leisure services. COVID-19 services including test appointments, results, vaccination appointments and more were primarily delivered through digital channels to the public. Many social, cultural, and economic activities (appointments, ticket bookings, tax and utility payments, shopping, etc) have transitioned to web-based platforms. To use web-based public services, individuals must be digitally included. This is influenced by 3 main factors: access (whether individuals have access to the internet), ability (having the requisite skills and confidence to participate over the web), and affordability (ability to pay for infrastructure [equipment] and data packages). Many older adults, especially those aged >75 years, are still digitally excluded. Objective: This study aims to explore the views of adults aged >75 years on accessing public services digitally. Methods: We conducted semistructured qualitative interviews with a variety of adults aged ?75 years residing in Greater Manchester, United Kingdom. We also interviewed community support workers. Thematic analysis was used to identify the key themes from the data. Results: Overall, 24 older adults (mean age 81, SD 4.54 y; 14/24, 58\% female; 23/24, 96\% White British; and 18/24, 75\% digitally engaged to some extent) and 2 support workers participated. A total of five themes were identified as key in understanding issues around motivation, engagement, and participation: (1) ``initial motivation to participate digitally''---for example, maintaining social connections and gaining skills to be able to connect with family and friends; (2) ``narrow use and restricted activity on the web''---undertaking limited tasks on the web and in a modified manner, for example, limited use of web-based public services and selected use of specific services, such as checking but never transferring funds during web-based banking; (3) ``impact of digital participation on well-being''---choosing to go to the shops or general practitioner's surgery to get out of the house and get some exercise; (4) ``the last generation?''---respondents feeling that there were generational barriers to adapting to new technology and change; and (5) ``making digital accessible''---understanding the support needed to keep those engaged on the web. Conclusions: As we transition toward greater digitalization of public services, it is crucial to incorporate the perspectives of older people. Failing to do so risks excluding them from accessing services they greatly rely on and need. ", doi="10.2196/46522", url="https://aging.jmir.org/2024/1/e46522", url="http://www.ncbi.nlm.nih.gov/pubmed/38416543" } @Article{info:doi/10.2196/43999, author="Fritz, Johanna and von Heideken W{\aa}gert, Petra and Gusdal, K. Annelie and Johansson-Pajala, Rose-Marie and Eklund, Caroline", title="Determinants of Implementing an Information and Communication Technology Tool for Social Interaction Among Older People: Qualitative Content Analysis of Social Services Personnel Perspectives", journal="JMIR Aging", year="2024", month="Feb", day="26", volume="7", pages="e43999", keywords="information and communication technology", keywords="implementation", keywords="determinants", keywords="social isolation", keywords="loneliness", keywords="organization", keywords="digitalization", keywords="facilitators", keywords="barriers", keywords="older people", abstract="Background: Older people are particularly vulnerable to social isolation and loneliness, which can lead to ill-health, both mentally and physically. Information and communication technology (ICT) can supplement health and social care and improve health among the vulnerable, older adult population. When ICT is used specifically for communication with others, it is associated with reduced loneliness in older populations. Research is sparse on how the implementation of ICT, used specifically for communication among older people in social services, can be performed. It is recommended to consider the determinants of implementation, that is, barriers to and facilitators of implementation. Determinants related to older people using ICT tools are reported in several studies. To the best of our knowledge, studies investigating the determinants related to the social services perspective are lacking. Objective: This study aims to explore the determinants of implementing the Fik@ room, a new, co-designed, and research-based ICT tool for social interaction among older people, from a social services personnel perspective. Methods: This study used an exploratory, qualitative design. An ICT tool called the Fik@ room was tested in an intervention study conducted in 2021 in 2 medium-sized municipalities in Sweden. Informants in this study were municipal social services personnel with experience of implementing this specific ICT tool in social services. We conducted a participatory workshop consisting of 2 parts, with 9 informants divided into 2 groups. We analyzed the data using qualitative content analysis with an inductive approach. Results: The results included 7 categories of determinants for implementing the ICT tool. Being able to introduce the ICT tool in an appropriate manner concerns the personnel's options for introducing and supporting the ICT tool, including their competencies in using digital equipment. Organizational structure concerns a structure for communication within the organization. Leadership concerns engagement and enthusiasm as driving forces for implementation. The digital maturity of the social services personnel concerns the personnel's skills and attitudes toward using digital equipment. Resources concern time and money. IT support concerns accessibility, and legal liability concerns possibilities to fulfill legal responsibilities. Conclusions: The results show that implementation involves an entire organization at varying degrees. Regardless of how much each level within the organization comes into direct contact with the ICT tool, all levels need to be involved to create the necessary conditions for successful implementation. The prerequisites for the implementation of an ICT tool will probably change depending on the digital maturity of future generations. As this study only included 9 informants, the results should be handled with care. The study was performed during the COVID-19 pandemic, which has probably affected the results. ", doi="10.2196/43999", url="https://aging.jmir.org/2024/1/e43999", url="http://www.ncbi.nlm.nih.gov/pubmed/38407955" } @Article{info:doi/10.2196/48526, author="Percy Campbell, Jessica and Buchan, Jacob and Chu, H. Charlene and Bianchi, Andria and Hoey, Jesse and Khan, S. Shehroz", title="User Perception of Smart Home Surveillance Among Adults Aged 50 Years and Older: Scoping Review", journal="JMIR Mhealth Uhealth", year="2024", month="Feb", day="9", volume="12", pages="e48526", keywords="smart homes", keywords="privacy", keywords="surveillance", keywords="ambient assisted living", keywords="smart speakers", keywords="Internet of Things", keywords="sensors", keywords="sensor", keywords="smart home", keywords="perception", keywords="perceptions", keywords="elderly", keywords="older adult", keywords="older adults", keywords="review methods", keywords="review methodology", keywords="home monitoring", keywords="security", keywords="safety", keywords="ageing", keywords="ageing-in-place", keywords="integrative review", keywords="integrative reviews", abstract="Background: Smart home technology (SHT) can be useful for aging in place or health-related purposes. However, surveillance studies have highlighted ethical issues with SHTs, including user privacy, security, and autonomy. Objective: As digital technology is most often designed for younger adults, this review summarizes perceptions of SHTs among users aged 50 years and older to explore their understanding of privacy, the purpose of data collection, risks and benefits, and safety. Methods: Through an integrative review, we explored community-dwelling adults' (aged 50 years and older) perceptions of SHTs based on research questions under 4 nonmutually exclusive themes: privacy, the purpose of data collection, risk and benefits, and safety. We searched 1860 titles and abstracts from Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, Scopus, Web of Science Core Collection, and IEEE Xplore or IET Electronic Library, resulting in 15 included studies. Results: The 15 studies explored user perception of smart speakers, motion sensors, or home monitoring systems. A total of 13 (87\%) studies discussed user privacy concerns regarding data collection and access. A total of 4 (27\%) studies explored user knowledge of data collection purposes, 7 (47\%) studies featured risk-related concerns such as data breaches and third-party misuse alongside benefits such as convenience, and 9 (60\%) studies reported user enthusiasm about the potential for home safety. Conclusions: Due to the growing size of aging populations and advances in technological capabilities, regulators and designers should focus on user concerns by supporting higher levels of agency regarding data collection, use, and disclosure and by bolstering organizational accountability. This way, relevant privacy regulation and SHT design can better support user safety while diminishing potential risks to privacy, security, autonomy, or discriminatory outcomes. ", doi="10.2196/48526", url="https://mhealth.jmir.org/2024/1/e48526", url="http://www.ncbi.nlm.nih.gov/pubmed/38335026" } @Article{info:doi/10.2196/46824, author="Yu, Chuen Chou and Tou, Xiang Nien and Low, Alvin James", title="Internet Use and Effects on Mental Well-being During the Lockdown Phase of the COVID-19 Pandemic in Younger Versus Older Adults: Observational Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Feb", day="6", volume="8", pages="e46824", keywords="COVID-19", keywords="digital divide", keywords="well-being", keywords="older adults", keywords="information and communication technology", keywords="internet of things", keywords="online", keywords="mental health", keywords="lockdown", keywords="depression", keywords="stress", keywords="anxiety", keywords="digital technology", keywords="pandemic", abstract="Background: Majority of individuals, including both younger and older adults, had to adapt to digital means to cope with lockdown measures and pandemic-induced lifestyle changes during the COVID-19 pandemic. While internet accessibility was beneficial during the pandemic, existing literature suggests that excessive use could lead to the rise of problematic internet use in adolescents and younger adults. However, the effects on older adults remain unclear. Objective: This study aimed to examine differences in internet use during the lockdown phase of the COVID-19 pandemic and explore how age differences in mental health could be explained by time spent on the internet. Methods: A door-to-door survey of a nationally representative sample of 602 adults in Singapore was carried out using computer-assisted personal interviewing during the early phase of the COVID-19 pandemic (October to November 2020). Participants were categorized into younger (21-59 years old) and older (60 years or above) age groups. We assessed self-reported measures of depression, anxiety, and stress; psychosocial adaptability; ability to perform essential activities; social support; health status; digital media use patterns, and time spent on the internet. Procedures complied with existing safe distancing measures. Results: Older adults reported being less able to use digital platforms to meet needs and acquire information updates compared with younger adults during the lockdown period of the pandemic. Older adults spent significantly less time on the internet for both work and personal uses per day (mean 146.00 min, SD 9.18 min) compared with younger adults (mean 433.27 min, SD 14.32 min). Significant age differences in depression, anxiety, and stress were found, with younger adults showing poorer mental health. Mediation analysis showed that age differences in depression, anxiety, and stress were partially explained by time spent on the internet. These variables together explained 43\%, 40\%, and 40\% of the variances in depression, anxiety, and stress scores, respectively. Conclusions: The findings showed that younger adults spent significantly more time on the internet compared with older adults during the lockdown phase of the pandemic. They were also ahead in their ability to use digital resources to meet needs and engage socially compared with older adults. Despite this, the mental health of younger adults was poor, and this was partially accounted for by the amount of time spent on the internet. Since past research suggests that excessive time spent on the internet could lead to disordered use, the benefits brought by digital technologies could have been attenuated during the lockdown phase of the pandemic. Considering this potential negative effect, it is imperative to educate both young and old adults in the appropriate use of information and communication technology. ", doi="10.2196/46824", url="https://formative.jmir.org/2024/1/e46824", url="http://www.ncbi.nlm.nih.gov/pubmed/38319700" } @Article{info:doi/10.2196/47908, author="Sen, Keya and Laheji, Nida and Ramamonjiarivelo, Zo and Renick, Cecil and Osborne, Randall and Beauvais, Brad", title="Examining the Effect of Contactless Intergenerational Befriending Intervention on Social Isolation Among Older Adults and Students' Attitude Toward Companionship: Content Analysis", journal="JMIR Aging", year="2024", month="Jan", day="30", volume="7", pages="e47908", keywords="intergenerational befriending", keywords="social isolation", keywords="boredom", keywords="contactless socialization", keywords="service learning", keywords="internal motivation", keywords="mobile phone", abstract="Background: Intergenerational friendship, a mechanism of social support, is an effective intervention to reduce the increasing risk of social isolation (SI) and develop companionship in the older adult population. The COVID-19 pandemic provided a unique opportunity to examine the psychosocial intervention of befriending via technology use as a primary form of contactless socialization. Objective: The study aims to explore the effectiveness of the befriending intervention through a contactless, intergenerational service-learning project on older adult emotions, especially boredom and loneliness as the key attributes of SI, and on students' attitude toward companionship. Methods: During the months of January to April 2022 , undergraduate students enrolled in a health administration course with a special focus on culture were asked to be involved in a contactless, intergenerational service-learning project (n=46). In this study, contactless intervention meant communication using the telephone and apps such as FaceTime and Zoom. Students were paired with older adults to have at least a 30-minute weekly conversation, for 8 weeks, via telephone or an internet-based app such as FaceTime. Students were asked to write a half-page diary after each interaction and a 1-page reflection at the end of the fourth week and at the end of the service-learning project. At the completion of the project, the researchers also surveyed the older adults to assess the impact of the project using a 5-item open-ended questionnaire. Following a heuristic approach and content analysis, student artifacts (110,970 words; 118-page, single-spaced Microsoft Word document) and the older adult surveys were analyzed using MAXQDA, (VERBI GmbH). Qualitative data were extracted to assess the impact of service learning on SI by measuring the attributes of boredom and loneliness among 46 older adults. Students' attitudes toward companionship were also assessed using data from their diaries and reflections. Results: Overall, three major constructs were identified: (1) meaningful engagement, defined as feeling safe, having increased confidence, and having reduced boredom; (2) internal motivation to participate in the weekly interaction, defined as discussion about daily life experience, level of happiness, and ability to exert personal control over the situation; and (3) intergenerational befriending, defined as perceived benefits from the friendly nature of the interaction, ability to comfortably connect with students, and positive feeling and attitude toward the student. Conclusions: The contactless, intergenerational befriending intervention reduced boredom and loneliness among older adults and enhanced positive attitude and confidence among university students. Students helped older adults to develop digital skills for the use of apps and social media. Older adults showed interest in the intervention and shared their daily life experiences with the students, which helped to reduce the gap between generations. Findings indicate the effectiveness of an intergenerational service-learning intervention on SI reduction and increased positive attitude among college students. ", doi="10.2196/47908", url="https://aging.jmir.org/2024/1/e47908", url="http://www.ncbi.nlm.nih.gov/pubmed/38175944" } @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/10.2196/40172, author="Chen, Weichao and Ding, Mengjun and Wang, Xiaoyan", title="The Contribution of the Internet to Promoting Mental Health for Older Adults: Cross-Sectional Survey in China", journal="J Med Internet Res", year="2023", month="Dec", day="19", volume="25", pages="e40172", keywords="older adults", keywords="internet use", keywords="mental health", keywords="influence mechanism", keywords="participation in voluntary activities", keywords="subjective age", keywords="mobile phone", abstract="Background: Health is an important topic for everyone and essential to high-quality economic and social development. Recently, some researchers have suggested that older adults' internet use may have a health effect. Objective: This study specifically aims to clarify the relationship between internet use and the mental health of older adults, for which other surveys present contradictory results. Methods: Data were obtained from the China Longitudinal Aging Social Survey conducted in 2018. A total of 6648 participants were included. Mental health was assessed by the 12-item Center for Epidemiological Studies Depression Scale. Ordinary least squares regression was adopted to explore the relationship between internet use (independent variable) and the mental health of older adults. Robustness analysis, sensitivity analysis, and heterogeneity analysis were conducted in detail to verify the empirical result. A mediating effect analysis was further conducted to discover the effect mechanism between the dependent and independent variables. Results: It was found that internet use and smartphone use can significantly improve the mental health of older adults (ordinary least squares, $\beta$=.075; P<.001). After endogenous and robustness tests were conducted, the aforementioned conclusion remained robust. In particular, participation in voluntary activities played a mediating role in the relationship between internet use and the mental health of older adults. In addition, younger subjective age enhanced the positive effect of internet use on the mental health of older adults. Conclusions: Internet users showed higher levels of mental health among Chinese older adults. To improve the mental health of older adults, the government should not only cultivate the ability to use the internet but also encourage greater participation in voluntary activities among older adults. ", doi="10.2196/40172", url="https://www.jmir.org/2023/1/e40172", url="http://www.ncbi.nlm.nih.gov/pubmed/38113096" } @Article{info:doi/10.2196/50990, author="Faisal, Sadaf and Samoth, Devine and Aslam, Yusra and Patel, Hawa and Park, SooMin and Baby, Bincy and Patel, Tejal", title="Key Features of Smart Medication Adherence Products: Updated Scoping Review", journal="JMIR Aging", year="2023", month="Dec", day="19", volume="6", pages="e50990", keywords="technology", keywords="medication", keywords="aging", keywords="adherence", keywords="smart medication", keywords="digital technology", keywords="self-management", keywords="older adult", keywords="mobile health", keywords="mHealth", keywords="apps", keywords="digital health", keywords="geriatrics", keywords="older adults", keywords="mHealth app", keywords="application", keywords="management", keywords="scoping review", keywords="medication adherence", keywords="consumer", keywords="use", keywords="mobile phone", abstract="Background: Older adults often face challenges in self-managing their medication owing to physical and cognitive limitations, complex medication regimens, and packaging of medications. Emerging smart medication dispensing and adherence products (SMAPs) offer the options of automated dispensing, tracking medication intake in real time, and reminders and notifications. A 2021 review identified 51 SMAPs owing to the rapid influx of digital technology; an update to this review is required. Objective: This review aims to identify new products and summarize and compare the key features of SMAPs. Methods: Gray and published literature and videos were searched using Google, YouTube, PubMed, Embase, and Scopus. The first 10 pages of Google and the first 100 results of YouTube were screened using 4 and 5 keyword searches, respectively. SMAPs were included if they were able to store and allowed for the dispensation of medications, tracked real-time medication intake data, and could automatically analyze data. Products were excluded if they were stand-alone software applications, not marketed in English, not for in-home use, or only used in clinical trials. In total, 5 researchers independently screened and extracted the data. Results: This review identified 114 SMAPs, including 80 (70.2\%) marketed and 34 (29.8\%) prototypes, grouped into 15 types. Among the marketed products, 68\% (54/80) were available for consumer purchase. Of these products, 26\% (14/54) were available worldwide and 78\% (42/54) were available in North America. There was variability in the hardware, software, data collection and management features, and cost of the products. Examples of hardware features include battery life, medication storage capacity, availability of types and number of alarms, locking features, and additional technology required for use of the product, whereas software features included reminder and notification capabilities and availability of manufacturer support. Data capture methods included the availability of sensors to record the use of the product and data-syncing capabilities with cloud storage with short-range communications. Data were accessible to users via mobile apps or web-based portals. Some SMAPs provided data security assurance with secure log-ins (use of personal identification numbers or facial recognition), whereas other SMAPs provided data through registered email addresses. Although some SMAPs were available at set prices or free of cost to end users, the cost of other products varied based on availability, shipping fees, and subscription fees. Conclusions: An expanding market for SMAPs with features specific to at-home patient use is emerging. Health care professionals can use these features to select and suggest products that meet their patients' unique requirements. ", doi="10.2196/50990", url="https://aging.jmir.org/2023/1/e50990", url="http://www.ncbi.nlm.nih.gov/pubmed/38113067" } @Article{info:doi/10.2196/47997, author="Fothergill, Lauren and Holland, Carol and Latham, Yvonne and Hayes, Niall", title="Understanding the Value of a Proactive Telecare System in Supporting Older Adults' Independence at Home: Qualitative Interview Study Among Key Interest Groups", journal="J Med Internet Res", year="2023", month="Dec", day="14", volume="25", pages="e47997", keywords="older adults", keywords="telecare", keywords="independent living", keywords="health and well-being", abstract="Background: Telecare is claimed to support people to live in their own homes for longer by providing monitoring services that enable responses to emergencies at home. Although most telecare technologies commissioned in the United Kingdom predominantly supply reactive services, there has been recent interest among policy makers to develop proactive telecare services to provide additional understanding of older adults' health and well-being needs to provide a means for more preventive interventions. Proactive telecare refers to providing regular well-being calls or encouraging users to regularly confirm their well-being to anticipate and prevent crises through an increased understanding of individuals' needs and by building social relationships with older adults. Such technologies have already begun to be introduced, yet little research has explored the potential value of proactive telecare. Objective: This study explores the perceptions of different interest groups to understand the extent to which using a proactive telecare service can support older adults to live independently, what potential health and well-being benefits may be elicited from its use, and what the limitations are. Methods: Semistructured interviews were conducted with older people (those with experience in using proactive telecare and those without), family members of proactive telecare users, and proactive telecare staff regarding their perceptions and opinions about the value of a proactive telecare service. Data were analyzed using inductive thematic analysis. Results: A total of 30 individuals participated in this study. Older adults described the value of proactive telecare in feeling safe and in control and appreciated feeling connected. Family members and staff valued the potential to detect early health deterioration in older adults, and all participants highlighted the benefit of strengthening access to social networks, particularly for socially isolated older people. However, telecare is often viewed as a last resort, and therefore, anticipatory care may not suit all populations, as demonstrated by the mixed acceptance of the technology among older adults who did not have experience using it. Participants also reported limitations, including the requirement for family, friends, or neighbors to assist older adults during an emergency and the need for financial resources to fund the service. Conclusions: This study presents the first known qualitative inquiry about a proactive telecare system, which provides rich and detailed insights from different perspectives into the potential benefits of this intervention. Proactive telecare may promote and facilitate the accumulation of social and technological resources as individuals prepare to cope with age-related challenges, thus helping to avoid negative outcomes prematurely. However, similar to reactive telecare, proactive telecare must be matched to individual preferences and existing financial and social resources. ", doi="10.2196/47997", url="https://www.jmir.org/2023/1/e47997", url="http://www.ncbi.nlm.nih.gov/pubmed/38096023" } @Article{info:doi/10.2196/46430, author="Esmaeilzadeh, Pouyan", title="Older Adults' Perceptions About Using Intelligent Toilet Seats Beyond Traditional Care: Web-Based Interview Survey", journal="JMIR Mhealth Uhealth", year="2023", month="Dec", day="1", volume="11", pages="e46430", keywords="older adults", keywords="age tech", keywords="intelligent toilet seat", keywords="survey interview", keywords="qualitative study", keywords="mobile phone", abstract="Background: In contemporary society, age tech (age technology) represents a significant advancement in health care aimed at enhancing patient engagement, ensuring sustained independence, and promoting quality of life for older people. One innovative form of age tech is the intelligent toilet seat, which is designed to collect, analyze, and provide insights based on toileting logs and excreta data. Understanding how older people perceive and interact with such technology can offer invaluable insights to researchers, technology developers, and vendors. Objective: This study examined older adults' perspectives regarding the use of intelligent toilet seats. Through a qualitative methodology, this research aims to unearth the nuances of older people's opinions, shedding light on their preferences, concerns, and potential barriers to adoption. Methods: Data were collected using a web-based interview survey distributed on Amazon Mechanical Turk. The analyzed data set comprised 174 US-based individuals aged ?65 years who voluntarily participated in this study. The qualitative data were carefully analyzed using NVivo (Lumivero) based on detailed content analysis, ensuring that emerging themes were coded and classified based on the conceptual similarities in the respondents' narratives. Results: The analysis revealed 5 dominant themes encompassing the opinions of aging adults. The perceived benefits and advantages of using the intelligent toilet seat were grouped into 3 primary themes: health-related benefits including the potential for early disease detection, continuous health monitoring, and seamless connection to health care insights. Technology-related advantages include the noninvasive nature of smart toilet seats and leveraging unique and innovative data collection and analysis technology. Use-related benefits include ease of use, potential for multiple users, and cost reduction owing to the reduced need for frequent clinical visits. Conversely, the concerns and perceived risks were classified into 2 significant themes: psychological concerns, which included concerns about embarrassment and aging-related stereotypes, and the potential emotional impact of constant health monitoring. Technical performance risks include concerns centered on privacy and security, device reliability, data accuracy, potential malfunctions, and the implications of false positives or negatives. Conclusions: The decision of older adults to incorporate intelligent toilet seats into their daily lives depends on myriad factors. Although the potential health and technological benefits are evident, valid concerns that need to be addressed remain. To foster widespread adoption, it is imperative to enhance the advantages while simultaneously addressing and mitigating the identified risks. This balanced approach will pave the way for a more holistic integration of smart health care devices into the routines of the older population, ensuring that they reap the full benefits of age tech advancements. ", doi="10.2196/46430", url="https://mhealth.jmir.org/2023/1/e46430", url="http://www.ncbi.nlm.nih.gov/pubmed/38039065" } @Article{info:doi/10.2196/47729, author="Balki, Eric and Hayes, Niall and Holland, Carol", title="The Indirect Impact of Educational Attainment as a Distal Resource for Older Adults on Loneliness, Social Isolation, Psychological Resilience, and Technology Use During the COVID-19 Pandemic: Cross-Sectional Quantitative Study", journal="JMIR Aging", year="2023", month="Nov", day="24", volume="6", pages="e47729", keywords="pandemic", keywords="educational attainment", keywords="isolation", keywords="loneliness", keywords="socioemotional needs", keywords="social engagement", keywords="technology use", keywords="older adults", keywords="psychological resilience", abstract="Background: During the COVID-19 pandemic, government-mandated social distancing prevented the spread of the disease but potentially exacerbated social isolation and loneliness for older people, especially those already vulnerable to isolation. Older adults may have been able to draw from their personal resources such as psychological resilience (PR) and technology use (TU) to combat such effects. Educational attainment (EA) or early-life EA may potentially shape later-life personal resources and their impact on the effects of the pandemic lockdown on outcomes such as loneliness. The developmental adaptation model allows for the supposition that social isolation, TU, and PR may be affected by early EA in older adults. Objective: This study examined the indirect impact of EA on pandemic-linked loneliness in a sample of older adults. The developmental adaptation model was used as the conceptual framework to view EA as a distal influence on loneliness, social isolation, PR, and TU. We hypothesized that EA would predict TU and PR and have a moderating impact on social isolation and loneliness. We also hypothesized that PR and TU would mediate the effect of EA on loneliness. Methods: This was a cross-sectional observational study, in which data were gathered from 92 older adults aged ?65 years in the United Kingdom from March 2020 to June 2021, when the country was under various pandemic-linked social mobility restrictions. The data captured demographic information including age, gender, ethnicity, and the highest degree of education achieved. The University of California Los Angeles Loneliness Scale, Connor--Davidson Resilience Scale, Lubben Social Network Index, and Technology Experience Questionnaire were used as standardized measures. Pearson correlation, moderation, and mediation regression analyses were conducted to investigate the hypotheses. Results: We found a higher prevalence of loneliness in older adults than in prepandemic norms. EA was correlated with greater TU and PR and moderated the impact of social isolation on loneliness. PR mediated and TU partially mediated the relationship between EA and loneliness. Conclusions: Early-life EA was confirmed as a distal resource for older adults and played an indirect role in affecting loneliness levels during the pandemic. It has an impact on present-day personal resources, such as PR and TU, which affect loneliness and also moderate the impact of social isolation on loneliness. Policymakers should be aware that older adults with low levels of EA may be more vulnerable to the harmful impacts of loneliness when isolated by choice. ", doi="10.2196/47729", url="https://aging.jmir.org/2023/1/e47729", url="http://www.ncbi.nlm.nih.gov/pubmed/37999938" } @Article{info:doi/10.2196/41539, author="Liu, Yuxin and Arnaert, Antonia and da Costa, Daniel and Sumbly, Pia and Debe, Zoumanan and Charbonneau, Sylvain", title="Experiences of Patients With Chronic Obstructive Pulmonary Disease Using the Apple Watch Series 6 Versus the Traditional Finger Pulse Oximeter for Home SpO2 Self-Monitoring: Qualitative Study Part 2", journal="JMIR Aging", year="2023", month="Nov", day="2", volume="6", pages="e41539", keywords="Apple Watch", keywords="chronic obstructive pulmonary disease", keywords="pulse oximeter", keywords="qualitative descriptive", keywords="self-monitoring", keywords="smartwatch", abstract="Background: Amid the rise in mobile health, the Apple Watch now has the capability to measure peripheral blood oxygen saturation (SpO2). Although the company indicated that the Watch is not a medical device, evidence suggests that SpO2 measurements among patients with chronic obstructive pulmonary disease (COPD) are accurate in controlled settings. Yet, to our knowledge, the SpO2 function has not been validated for patients with COPD in naturalistic settings. Objective: This qualitative study explored the experiences of patients with COPD using the Apple Watch Series 6 versus a traditional finger pulse oximeter for home SpO2 self-monitoring. Methods: We conducted individual semistructured interviews with 8 female and 2 male participants with moderate to severe COPD, and transcripts were qualitatively analyzed. All received a watch to monitor their SpO2 for 5 months. Results: Due to respiratory distress, the watch was unable to collect reliable SpO2 measurements, as it requires the patient to remain in a stable position. However, despite the physical limitations and lack of reliable SpO2 values, participants expressed a preference toward the watch. Moreover, participants' health needs and their unique accessibility experiences influenced which device was more appropriate for self-monitoring purposes. Overall, all shared the perceived importance of prioritizing their physical COPD symptoms over device selection to manage their disease. Conclusions: Differing results between participant preferences and smartwatch limitations warrant further investigation into the reliability and accuracy of the SpO2 function of the watch and the balance among self-management, medical judgment, and dependence on self-monitoring technology. ", doi="10.2196/41539", url="https://aging.jmir.org/2023/1/e41539", url="http://www.ncbi.nlm.nih.gov/pubmed/37917147" } @Article{info:doi/10.2196/50137, author="Garnett, Anna and Yurkiv, Halyna and Booth, Richard and Connelly, Denise and Donelle, Lorie", title="Web-Based Presence for Social Connectedness in Long-Term Care: Protocol for a Qualitative Multimethods Study", journal="JMIR Res Protoc", year="2023", month="Oct", day="27", volume="12", pages="e50137", keywords="social connectedness", keywords="web-based presence technology", keywords="long-term care homes", keywords="older adults", keywords="research protocol", keywords="mobile devices", keywords="social interaction", keywords="social interactions", keywords="connectedness", keywords="lonely", keywords="loneliness", keywords="older adult", keywords="gerontology", keywords="ageing", keywords="geriatric", keywords="geriatrics", keywords="elder", keywords="elderly", keywords="nursing home", keywords="assisted living", keywords="web-based presence", keywords="conceptual", keywords="isolation", keywords="mobile phone", abstract="Background: The COVID-19 pandemic and resultant restrictions on social gatherings significantly impacted many peoples' sense of social connectedness, defined as an individual's subjective sense of having close relationships with others. Older adults living in long-term care homes (LTCHs) experienced extreme restrictions on social gatherings, which negatively impacted their physical and mental health as well as the health and well-being of their family caregivers. Their experiences highlighted the need to reconceptualize social connectedness. In particular, the pandemic highlighted the need to explore novel ways to attain fulfilling relationships with others in the absence of physical gatherings such as through the use of a hybridized system of web-based and in-person presence. Objective: Given the potential benefits and challenges of web-based presence technology within LTCHs, the proposed research objectives are to (1) explore experiences regarding the use of web-based presence technology (WPT) in support of social connectedness between older adults in LTCHs and their family members, and (2) identify the contextual factors that must be addressed for successful WPT implementation within LTCHs. Methods: This study will take place in south western Ontario, Canada, and be guided by a qualitative multimethod research design conducted in three stages: (1) qualitive description with in-depth qualitative interviews guided by the Technology Acceptance Model (TAM) and analyzed using content analysis; (2) qualitative description and document analysis methodologies, informed by content and thematic analysis methods; and (3) explicit between-methods triangulation of study findings from stages 1 and 2, interpretation of findings and development of a guiding framework for technology implementation within LTCHs. Using a purposeful, maximum variation sampling approach, stage 1 will involve recruiting approximately 45 participants comprising a range of older adults, family members (30 participants) and staff (15 participants) within several LTCH settings. In stage 2, theoretical sampling will be used to recruit key LTCH stakeholders (directors, administrators, and IT support). In stage 3, the findings from stages 1 and 2 will be triangulated and interpreted to develop a working framework for WPT usage within LTCHs. Results: Data collection will begin in fall 2023. The findings emerging from this study will provide insights and understanding about how the factors, barriers, and facilitators to embedding and spreading WPT in LTCHs may benefit or negatively impact older adults in LTCHs, family caregivers, and staff and administrators of LTCHs. Conclusions: The results of this research study will provide a greater understanding of potential approaches that could be used to successfully integrate WPTs in LTCHs. Additionally, benefits as well as challenges for older adults in LTCHs, family caregivers, and staff and administrators of LTCHs will be identified. These findings will help increase knowledge and understanding of how WPT may be used to support social connectedness between older adults in LTCHs and their family members. International Registered Report Identifier (IRRID): PRR1-10.2196/50137 ", doi="10.2196/50137", url="https://www.researchprotocols.org/2023/1/e50137", url="http://www.ncbi.nlm.nih.gov/pubmed/37889518" } @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/10.2196/44777, author="Zaidi, Maryum and Gazarian, Priscilla and Mattie, Heather and Sheldon, Kennedy Lisa and Gakumo, Ann C.", title="Examining the Impact of Selected Sociodemographic Factors and Cancer-Related Fatalistic Beliefs on Patient Engagement via Health Information Technology Among Older Adults: Cross-Sectional Analysis", journal="JMIR Aging", year="2023", month="Oct", day="20", volume="6", pages="e44777", keywords="health information technology", keywords="patient portals", keywords="older adults", keywords="digital health", keywords="self-management", keywords="mobile phone", abstract="Background: Despite the role of health information technology (HIT) in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults with a high burden of chronic diseases such as cancer. This study examines the role of selected sociodemographic factors and cancer-related fatalistic beliefs on patient engagement expressed through HIT use for patient engagement in adults aged ?65 years. We controlled for cancer diagnosis to account for its potential influence on patient engagement. Objective: This study has 2 aims: to investigate the role of sociodemographic factors such as race, education, poverty index, and psychosocial factors of cancer fatalistic beliefs in accessing and using HIT in older adults and to examine the association between access and use of HIT in the self-management domain of patient activation that serves as a precursor to patient engagement. Methods: This is a secondary data analysis of a subset of the Health Information National Trend Survey (Health Information National Trend Survey 4, cycle 3). The subset included individuals aged ?65 years with and without a cancer diagnosis. The relationships between access to and use of HIT to several sociodemographic variables and psychosocial factors of fatalistic beliefs were analyzed. Logistic and linear regression models were fit to study these associations. Results: This study included 180 individuals aged ?65 years with a cancer diagnosis and 398 without a diagnosis. This analysis indicated that having less than a college education level (P=<.001), being an individual from an ethnic and minority group (P=<.001), and living in poverty (P=.001) were significantly associated with decreased access to HIT. Reduced HIT use was associated with less than a college education (P=.001) and poverty(P=.02). This analysis also indicated that fatalistic beliefs about cancer were significantly associated with lower HIT use (P=.03). Specifically, a 1-point increase in the cancer fatalistic belief score was associated with a 36\% decrease in HIT use. We found that controlling for cancer diagnosis did not affect the outcomes for sociodemographic variables or fatalistic beliefs about cancer. However, patients with access to HIT had a self-management domain of patient activation (SMD) score of 0.21 points higher (P=.003) compared with patients who did not have access. SMD score was higher by 0.28 points (P=.002) for individuals who used HIT and 0.14 points higher (P=.04) who had a prior diagnosis of cancer. Conclusions: Sociodemographic factors (education, race, poverty, and cancer fatalistic beliefs) impact HIT access and use in older adults, regardless of prior cancer diagnosis. Among older adults, HIT users report higher self-management, which is essential for patient activation and engagement. ", doi="10.2196/44777", url="https://aging.jmir.org/2023/1/e44777", url="http://www.ncbi.nlm.nih.gov/pubmed/37655786" } @Article{info:doi/10.2196/45173, author="Janssen, Jeroen and Ch{\^a}tel, Bas and Den Heijer, Nora and Tieben, Rob and Deen, Menno and Corten, Rense and Peeters, Geeske and Olde Rikkert, Marcel", title="A Digital Gaming Intervention to Strengthen the Social Networks of Older Dutch Adults: Mixed Methods Process Evaluation of a Digitally Conducted Randomized Controlled Trial", journal="JMIR Form Res", year="2023", month="Oct", day="20", volume="7", pages="e45173", keywords="eHealth", keywords="gerontology", keywords="loneliness", keywords="mixed methods", keywords="mobile games", keywords="qualitative research", keywords="serious games", abstract="Background: Digital loneliness interventions for older adults are promising, yet conclusive evidence is lacking due to a lack of randomized controlled trials (RCTs) and difficulties with recruitment. Process evaluation of performed RCTs is essential to inform future interventions. Still, it is rarely carried out, resulting in an overly optimistic view of the impact of eHealth interventions on loneliness in older adults and options to conduct such research entirely remotely. Objective: We describe a mixed methods process evaluation of a digitally conducted RCT assessing the effectiveness of a mobile social gaming app to facilitate meaningful social interactions in older adults. Methods: We analyzed the questionnaire and game data of the RCT participants to evaluate recruitment and onboarding, intervention adherence, and intervention acceptability. The RCT participants were allocated either to the main group of older adults (aged 65 years or older) or the side group (aged between 18 and 64 years). The side group used networking to play with the older adults. We also conducted 6 post-RCT evaluation interviews and 1 focus group with a total of 4 RCT participants and 5 welfare organization representatives that aided in RCT recruitment. Results: In total, 371 people aged 18 years or older signed up for the RCT, of which 64\% (238/371) were aged 65 years or older. Of the total sample, 20\% (76/371) installed the app and signed informed consent, showing a large dropout during onboarding. The high number of questions was a relevant barrier for participants. Both questionnaire and gameplay adherence were low. Participants indicated that the games elicited contact and a feeling of togetherness and proposed challenging and competitive games with increasing difficulty levels. They suggested focusing on enjoying the games rather than administering questionnaires. Conclusions: Conducting a remote digital trial of a social gaming intervention for older adults is a great challenge. Remote recruitment and informed consent acquisition may often not result in sufficient participation. Personal engagement with fellow participants and researchers might be essential for adherence and enjoyment. Future digital gaming interventions should start with small-scale studies with in-person contact, repeated instructions, and fewer questionnaires. ", doi="10.2196/45173", url="https://formative.jmir.org/2023/1/e45173", url="http://www.ncbi.nlm.nih.gov/pubmed/37862093" } @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/10.2196/51129, author="Kokorelias, Marie Kristina and Grigorovich, Alisa and Harris, T. Maurita and Rehman, Umair and Ritchie, Louise and Levy, AnneMarie and Denecke, Kerstin and McMurray, Josephine", title="Coadaptation Between Smart Technologies and Older Adults Over Time: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2023", month="Oct", day="9", volume="12", pages="e51129", keywords="scoping review", keywords="review methods", keywords="review methodology", keywords="knowledge synthesis", keywords="scoping", keywords="coadaptation", keywords="older adults", keywords="older adult", keywords="gerontechnology", keywords="technology", keywords="smart technology", keywords="smart technologies", keywords="smart", keywords="geriatrics", keywords="elderly", keywords="elder", keywords="geriatric", keywords="scoping literature review", keywords="protocol", keywords="internet of things", keywords="IoT", keywords="ageing", keywords="aging", keywords="PRISMA-ScR", keywords="user-centered design", abstract="Background: The Internet of Things (IoT) has gained significant attention due to advancements in technology and has potential applications in meeting the needs of an aging population. Smart technologies, a subset of IoT, can support older adults in aging in place, promoting independent living and improving their quality of life. However, there is a lack of research on how older adults and smart technologies coadapt over time to maximize their benefits and sustain adoption. Objective: We will aim to comprehensively review and analyze the existing scientific literature pertaining to the coadaptation between smart technologies and older adults. The primary focus will be to investigate the extent and nature of this coadaptation process and explore how older adults and technology coevolve over time to enhance older adults' experience with technology. Methods: This scoping review will follow the methodology outlined in the Joanna Briggs Institute Reviewer's Manual and adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews) guidelines for reporting. Peer-reviewed articles will be searched in databases like Ovid MEDLINE, OVID Embase, PEDro, OVID PsycINFO, EBSCO CINAHL, the Cochrane Library, Scopus, IEEE Xplore, Web of Science, and Global Index Medicus. The research team will create a data extraction form covering study characteristics, participant characteristics, underlying models and frameworks, research findings, implications for technology coadaptation, and any identified study limitations. A directed content analysis approach will be used, incorporating the Selection, Optimization, and Compensation framework and Sex- and Gender-Based Analysis Plus theoretical framework. Results: The results of this study are expected in January 2024. Conclusions: This scoping review endeavors to present a thorough overview of the available evidence concerning how smart technologies interact with older adults over an extended period. The insights gained from this review will lay the groundwork for a research program that explores how older adults adapt to and use smart technologies throughout their lives, ultimately leading to improved user satisfaction and experience and facilitating aging in place with tailored support and user-centered design principles. International Registered Report Identifier (IRRID): PRR1-10.2196/51129 ", doi="10.2196/51129", url="https://www.researchprotocols.org/2023/1/e51129", url="http://www.ncbi.nlm.nih.gov/pubmed/37812466" } @Article{info:doi/10.2196/45343, author="Liu, Jing and Peng, Junwei and Chen, Minyan and Zhang, Tao", title="Mediating and Moderating Effects of Internet Use on Urban-Rural Disparities in Health Among Older Adults: Nationally Representative Cross-Sectional Survey in China", journal="J Med Internet Res", year="2023", month="Sep", day="28", volume="25", pages="e45343", keywords="internet use", keywords="cognitive function", keywords="depressive symptoms", keywords="functional disability", keywords="mediation analysis", keywords="mobile phone", abstract="Background: The urban-rural disparities in health outcomes in China are remarkable. The internet has shown the potential to reduce the likelihood of contracting a disease by increasing disease knowledge. However, little is known about the effects of internet use in alleviating health inequities between urban and rural areas. Objective: This study aimed to examine the mediation and moderation of health disparities between urban and rural older adults through internet use. Methods: A total of 8223 respondents were selected from the China Health and Retirement Longitudinal Study 2018 data set. Basic activities of daily living, a brief Community Screening Instrument for Dementia, and the Centre for Epidemiologic Studies Depression Scale were used to measure functional disability, cognitive function, and depressive symptoms, respectively. Logistic regressions testing ``internet use{\texttimes}urban-rural status'' interactions for moderation and Karlson-Holm-Breen decomposition for mediation were performed. Results: Internet use moderated the urban-rural disparities in cognitive function (odds ratio 7.327, 95\% CI 3.011-17.832) and depressive symptoms (odds ratio 1.070, 95\% CI 1.037-1.787), but the moderating effects were significant only for those using the internet daily. Karlson-Holm-Breen results showed the suppression effects of using the internet daily ($\beta$=.012, 95\% CI .002-.021) on the association between urban-rural status and cognitive function. The urban-rural inequality in depressive symptoms was partially attributed to the disparity in internet use ($\beta$=?.027, 95\% CI ?.043 to ?.009). Conclusions: The urban-rural inequalities in mental health are partially attributable to disparities in the prevalence of internet use between the 2 groups. However, using the internet is more beneficial for the psychological health of rural users, thereby alleviating the urban-rural disparities in health. Providing convenient channels for rural older adults to use the internet, improving the ability of rural users to effectively use the internet, and promoting internet popularity in rural areas are effective approaches to reducing urban-rural health inequalities. ", doi="10.2196/45343", url="https://www.jmir.org/2023/1/e45343", url="http://www.ncbi.nlm.nih.gov/pubmed/37768721" } @Article{info:doi/10.2196/45433, author="Napetschnig, Alina and Brixius, Klara and Deiters, Wolfgang", title="Development of a Core Set of Quality Criteria for Virtual Reality Applications Designed for Older Adults: Multistep Qualitative Study", journal="Interact J Med Res", year="2023", month="Sep", day="27", volume="12", pages="e45433", keywords="virtual reality", keywords="older adults", keywords="quality criteria", keywords="user-centered", abstract="Background: Virtual reality (VR) applications are gaining growing significance, particularly among older adults. These applications can provide valuable support to older adults by offering immersive VR content that positively influences various aspects of their daily lives, including activities of daily living. Furthermore, VR applications can contribute to the enhancement of cognitive and motor skills, ultimately leading to an improved quality of life for older individuals. Nevertheless, to ensure a positive impact, it is crucial to develop VR experiences that are tailored to the needs and preferences of the users. Objective: This study aims to develop a core set of quality criteria and guidelines for the development of user-centered VR applications specifically designed for older adults (target group). Methods: The multistep qualitative study design comprised several key stages, beginning with a systematic literature search. This was followed by a framework analysis aimed at identifying a core set of criteria. Subsequently, these criteria underwent validation through expert workshops. The outcomes achieved through this iterative process were organized and categorized into criteria, accompanied by explanations detailing the underlying categories or codes. Results: The quality criteria core set for older adults--friendly VR applications has been developed through an iterative process. It is divided into 2 distinct parts, each containing criteria categorized into specific areas. The first part includes the following categories: (1) quality assurance of medical/health content, (2) data protection provisions, (3) quality requirements, (4) consumer protection, and (5) interoperability. The second part includes the following categories: (1) graphic/quality, (2) 3D character/avatar, (3) providing in-game instructions and prompts, (4) interaction, (5) navigation, and (6) promotion of user motivation and loyalty to use. The results imply a differentiated scope as well as a differentiated granularity of the criteria. Conclusions: Considering the ongoing advancement of VR technology and the diverse needs within the older adult demographic, it is essential to assess the quality criteria core set results on an individual basis. ", doi="10.2196/45433", url="https://www.i-jmr.org/2023/1/e45433", url="http://www.ncbi.nlm.nih.gov/pubmed/37756112" } @Article{info:doi/10.2196/46002, author="Tewary, Sweta and Cook, Nicole and Dezine, Marie and Shnayder, Oksana and Pandya, Naushira", title="Supporting Vulnerable Older Adults With Telehealth Through Wellness Calls and Tablet Distribution During COVID-19: Quality Improvement Project", journal="JMIR Form Res", year="2023", month="Sep", day="11", volume="7", pages="e46002", keywords="COVID-19", keywords="telehealth", keywords="older adults", keywords="isolation", keywords="health education", keywords="mental wellness", keywords="telemedicine", keywords="health literacy", keywords="digital health", keywords="mental health", keywords="social isolation", abstract="Background: Loneliness, social isolation, and lack of technical literacy are associated with poorer health outcomes. To help improve social connection during the COVID-19 pandemic, Nova Southeastern University's South Florida Geriatric Workforce Enhancement Program partnered with a community-based organization to provide educational resources to promote telehealth services. Objective: This study aimed to provide educational resources to older adults with limited resources and promote the use of telehealth services in this population. Methods: Through this pilot project, we contacted 66 vulnerable older adults who expressed interest in telehealth support through wellness calls, with 44 participants moving on to participate in tablet usage. All tablets were preloaded with educational information on using the device, COVID-19 resources, and accessing telehealth services for patients, caregivers, and families. Results: Feedback from wellness assessments suggested a significant need for telehealth support. Participants used the tablets mainly for telehealth (n=6, 15\%), to connect with friends and family (n=10, 26\%), and to connect with faith communities (n=3, 8\%). Conclusions: The findings from the pilot project suggest that wellness calls and telehealth education are beneficial to support telehealth usage among older adults. ", doi="10.2196/46002", url="https://formative.jmir.org/2023/1/e46002", url="http://www.ncbi.nlm.nih.gov/pubmed/37695647" } @Article{info:doi/10.2196/44514, author="Du, Xiwang and Liao, Jiazhi and Ye, Qing and Wu, Hong", title="Multidimensional Internet Use, Social Participation, and Depression Among Middle-Aged and Elderly Chinese Individuals: Nationwide Cross-Sectional Study", journal="J Med Internet Res", year="2023", month="Aug", day="30", volume="25", pages="e44514", keywords="internet use", keywords="depression", keywords="social participation", keywords="middle-aged and elderly Chinese", keywords="RIDL", abstract="Background: There is growing evidence that the internet has beneficial effects on the mental health of middle-aged and older people (?45 years), but the evidence is inconclusive, and the underlying mechanisms are less known. Objective: This study aims to explore the relationship between multidimensional (devices, frequency, and purpose) internet use and depression in middle-aged and elderly Chinese, as well as the mediating effect of social participation. Moreover, this study will explore the moderating effect of the regional informatization development level (RIDL) on the relationships between individual internet use, social participation, and depression. Methods: Data on 17,676 participants aged 45 years or older were obtained from the China Health and Retirement Longitudinal Study (CHARLS) 2018 data set. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to identify the presence of depression. Logistic regression was used to explore the relationship between each dimension of internet use and depression. Multiple linear regression was used to explore the mediating effect of social participation and the moderating effect of the RIDL. Results: The results showed that 28.33\% (5008/17,676) of the total population had depression. In terms of regional subgroups, respondents living in the western region exhibited the highest proportion of depression (2041/5884, 34.69\%). Internet use was negatively associated with depression (odds ratio 0.613, 95\% CI 0.542-0.692; P<.001). Various dimensions of internet use positively contributed to individual social participation and reduced individual depression (devices: $\beta$=--.170, 95\% CI --0.209 to --0.127; frequency: $\beta$=--.065, 95\% CI --0.081 to --0.047; and purpose: $\beta$=--.043, 95\% CI --0.053 to --0.031). In addition, the RIDL weakened the relationship between individual-level internet use and social participation (internet use: F74.12,9.82=7.55, P<.001; devices: F51.65/9.88=5.23, P=.005; frequency: F66.74/10.08=6.62, P=.001; and purpose: F66.52/9.78=6.80, P=.001), and negatively moderated the relationship between the frequency of internet use and depression (frequency: F662.67/188.79=3.51, P=.03). Conclusions: This study found that different dimensions of internet use are associated with lower levels of depression. Social participation partially mediates the association between multidimensional internet use and depression in the eastern, central, and western regions, respectively. Additionally, the RIDL helps individuals further their internet use and social participation, reducing the impact of depression. However, this effect weakens sequentially from the western region to the central region and then to the eastern region. ", doi="10.2196/44514", url="https://www.jmir.org/2023/1/e44514", url="http://www.ncbi.nlm.nih.gov/pubmed/37647119" } @Article{info:doi/10.2196/48618, author="Tan, Kelvin Cheng Kian and Lou, Q. Vivian W. and Cheng, Man Clio Yuen and He, Chu Phoebe and Mor, Ying Yan", title="Technology Acceptance of a Social Robot (LOVOT) Among Single Older Adults in Hong Kong and Singapore: Protocol for a Multimethod Study", journal="JMIR Res Protoc", year="2023", month="Aug", day="17", volume="12", pages="e48618", keywords="gerontechnology", keywords="older people", keywords="senior technology acceptance", keywords="single people", keywords="social robot", abstract="Background: Given the rapidly aging nature of our global population, policy makers around the world are now emphatically promoting active aging. To address the psychosocial needs of older persons and support active aging, researchers are exploring the use of assistive technologies, specifically social robots as companions. However, there is limited evidence on the efficacy of social robots in promoting active aging for older people in the Hong Kong and Singapore contexts. Objective: This study presents the protocol of a study that investigates the acceptance and quality of interaction between a Japanese social robot, LOVOT, and single older adults in Hong Kong and Singapore. Methods: We used a baseline assessment to measure the primary outcome, participants' acceptance of technology, and a sense of loneliness, namely, the participants' differences in responses to LOVOT before and following their interaction with the social robot in this multimethod study design. The baseline assessment consisted of the Qualtrics survey, which measures senior technology acceptance, loneliness, older people's quality of life, subjective happiness, cultural values, willingness to pay, and demographic characteristics, along with the LOVOT's sociability and system usability. In the study, participants interacted with LOVOT in 3 sessions before being surveyed to measure the older people's acceptance and attitudes toward LOVOT. A pre--social robot intervention also occurred in the first session. The study was conducted in both Hong Kong and Singapore. A total of 15 single older adults (ie, individuals who live alone) from Hong Kong and another 15 from Singapore were recruited. Participants were 60-75 years of age, lived by themselves, and had no known cognitive or mental issues. Results: The study began recruiting in March 2022, and recruitment was completed at the end of October 2022. Data collection and data set construction were completed at the end of January 2023. Analysis of the data is currently being conducted, and we plan to publish the results by mid-2023. Conclusions: At an individual level, the study will clarify if LOVOT influences single older adults' psychosocial well-being by reducing their loneliness. At a community level, the study's findings will illustrate whether LOVOT can provide increased social connectedness while decreasing individual loneliness. Last, this study's conclusions can inform policy makers to provide social robots to older people to improve their quality of life. Findings can also inform gerontechnology developers on which aspects and cultural considerations to take into account for future inventions. International Registered Report Identifier (IRRID): DERR1-10.2196/48618 ", doi="10.2196/48618", url="https://www.researchprotocols.org/2023/1/e48618", url="http://www.ncbi.nlm.nih.gov/pubmed/37590084" } @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/10.2196/41535, 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/10.2196/46298, author="Li, Peiyi and Zhang, Chenyang and Gao, Shuanliang and Zhang, Yanbo and Liang, Xiaolong and Wang, Chengdi and Zhu, Tao and Li, Weimin", title="Association Between Daily Internet Use and Incidence of Chronic Diseases Among Older Adults: Prospective Cohort Study", journal="J Med Internet Res", year="2023", month="Jul", day="17", volume="25", pages="e46298", keywords="daily internet use", keywords="chronic disease", keywords="disease prevention", keywords="middle-aged and older adult", keywords="usage", keywords="internet use", keywords="technology use", keywords="chronic illness", keywords="association", keywords="incidence", keywords="middle age", keywords="older adult", keywords="gerontology", keywords="geriatric", keywords="aging", keywords="elder", keywords="national survey", abstract="Background: Chronic disease incidence among the elderly is increasing, which is correlated with the acceleration of population aging. Evolving internet technologies may help prevent and provide interventions for chronic diseases in an accelerating aging process. However, the impact of daily internet use on the incidence of chronic diseases is not well understood. Objective: This study aims to investigate whether daily internet use by middle-aged and older adults may inhibit or promote the occurrence of chronic diseases. Methods: We included participants from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal survey of Chinese residents aged ?45 years. We assessed 8-year data from wave 1 (June 2011-March 2012) to wave 4 (July-September 2018) in CHARLS. Data from wave 4 were used for a cross-sectional study, and data from all 4 waves were used for a longitudinal study. Self-reported data were used to track variables, including internet use, use frequency, and the incidence of different chronic diseases. Cox proportional hazards modeling was applied in the longitudinal study to examine the relationship between daily internet use and chronic diseases among middle-aged and older adults, while adjusting for sociodemographic characteristics and health behaviors. In addition, longitudinal data were used to analyze internet usage trends, and cross-sectional data were used to analyze the factors influencing internet use. Results: Among the 20,113 participants included in the longitudinal analyses, internet use increased significantly, from 2\% to 12.3\%, between 2011 and 2018. The adjusted model found statistically significant relationships between daily internet use and a lower incidence of the following chronic diseases: hypertension (hazard ratio [HR] 0.78, 95\% CI 0.65-0.95, P=.01), chronic lung disease (HR 0.74, 95\% CI 0.57-0.97, P=.03), stroke (HR 0.69, 95\% CI 0.50-0.94, P=.02), digestive disease (HR 0.73, 95\% CI 0.58-0.91, P=.005), memory-related disorders (HR 0.58, 95\% CI 0.37-0.91, P=.02), arthritis or rheumatism (HR 0.60, 95\% CI 0.48-0.76, P<.001), asthma (HR 0.52, 95\% CI 0.33-0.84, P=.007), depression (HR 0.80, 95\% CI 0.71-0.89, P<.001), and vision impairment (HR 0.83, 95\% CI 0.74-0.93, P=.004). Moreover, our study also showed that with increasing frequency of internet use, the risk of some chronic diseases decreases. Conclusions: This study found that middle-aged and older adults who use the internet have a reduced risk of developing chronic diseases versus those who do not use the internet. The increasing prevalence of daily internet use among middle-aged and older adults may stimulate contemplation of the potential role of internet platforms in future research on chronic disease prevention. ", doi="10.2196/46298", url="https://www.jmir.org/2023/1/e46298", url="http://www.ncbi.nlm.nih.gov/pubmed/37459155" } @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/10.2196/46721, author="Zhou, Weijiao and Cho, Youmin and Shang, Shaomei and Jiang, Yun", title="Use of Digital Health Technology Among Older Adults With Cancer in the United States: Findings From a National Longitudinal Cohort Study (2015-2021)", journal="J Med Internet Res", year="2023", month="May", day="31", volume="25", pages="e46721", keywords="digital health", keywords="technology", keywords="older adults", keywords="cancer", keywords="survivorship", keywords="cancer survivor", keywords="older cancer survivors", keywords="digital health technology", abstract="Background: Despite the benefits of digital health technology use, older adults with cancer (ie, aged 65 years) have reported challenges to technology adoption. However, there has been a lack of a good understanding of their digital health technology use patterns and the associated influential factors in the past few years. Objective: This study aimed to examine the trends in and factors associated with digital health technology use among older adults with cancer. Methods: The National Health and Aging Trends Study (NHATS) data set is a national longitudinal cohort study with annual survey waves of Medicare beneficiaries 65 years and older. Participants were community-dwelling older adults who self-reported previous or current cancer diagnoses in each round. The study sample size of each round ranged from 1996 (2015) to 1131 (2021). Digital health technology use was defined as using the internet or online in the last month to order or refill prescriptions, contact medical providers, handle Medicare or other insurance matters, or get information about their health conditions. The association of sociodemographics, clinical factors (self-rated health, chronic conditions, difficulties in activities of daily living, dementia, anxiety, and depression), and physical function (Short Physical Performance Battery and grip strength) with digital health technology use was examined using design-based logistic regression. All statistical analyses accounted for the complex sample design. Results: The prevalence of any digital health technology use increased from 36\% in 2015 to 45\% in 2019. In 2020-2021, which was amid the COVID-19 pandemic, it ranged from 51\% to 52\%. In terms of each digital health technology use behavior, in 2015, overall, 28\% of older cancer survivors used digital health technology to obtain health information, followed by contacting clinicians (19\%), filling prescriptions (14\%), and handling insurance (11\%). Greater use of digital health technology was associated with younger age, being White, having a college or higher education, having a higher income, having more comorbidities, nondementia, and having a higher gait speed. Conclusions: Digital health technology use in older adults with cancer has gradually increased, particularly during the COVID-19 pandemic. However, socioeconomic and racial disparities have remained in older cancer survivors. Additionally, older adults with cancer may have some unique features associated with digital health technology use; for example, their use of digital health may be increased by their comorbidities (ie, health care needs) and reduced by their frailty. ", doi="10.2196/46721", url="https://www.jmir.org/2023/1/e46721", url="http://www.ncbi.nlm.nih.gov/pubmed/37256672" } @Article{info:doi/10.2196/45641, author="Judson, J. Timothy and Subash, Meera and Harrison, D. James and Yeager, Jan and Williams, M. Aim{\'e}e and Grouse, K. Carrie and Byron, Maria", title="Patient Perceptions of e-Visits: Qualitative Study of Older Adults to Inform Health System Implementation", journal="JMIR Aging", year="2023", month="May", day="26", volume="6", pages="e45641", keywords="e-visit", keywords="patient portal message", keywords="digital health tool", keywords="patient portal", keywords="perception", keywords="attitude", keywords="qualitative", keywords="e-consult", keywords="remote care", keywords="remote visit", keywords="remote consult", keywords="vulnerable", keywords="messaging", keywords="telehealth", keywords="telemedicine", keywords="eHealth", abstract="Background: Electronic visits (e-visits) are billable, asynchronous patient-initiated messages that require at least five minutes of medical decision-making by a provider. Unequal use of patient portal tools like e-visits by certain patient populations may worsen health disparities. To date, no study has attempted to qualitatively assess perceptions of e-visits in older adults. Objective: In this qualitative study, we aimed to understand patient perceptions of e-visits, including their perceived utility, barriers to use, and care implications, with a focus on vulnerable patient groups. Methods: We conducted a qualitative study using in-depth structured individual interviews with patients from diverse backgrounds to assess their knowledge and perceptions surrounding e-visits as compared with unbilled portal messages and other visit types. We used content analysis to analyze interview data. Results: We conducted 20 interviews, all in adults older than 65 years. We identified 4 overarching coding categories or themes. First, participants were generally accepting of the concept of e-visits and willing to try them. Second, nearly two-thirds of the participants voiced a preference for synchronous communication. Third, participants had specific concerns about the name ``e-visit'' and when to choose this type of visit in the patient portal. Fourth, some participants indicated discomfort using or accessing technology for e-visits. Financial barriers to the use of e-visits was not a common theme. Conclusions: Our findings suggest that older adults are generally accepting of the concept of e-visits, but uptake may be limited due to their preference for synchronous communication. We identified several opportunities to improve e-visit implementation. ", doi="10.2196/45641", url="https://aging.jmir.org/2023/1/e45641", url="http://www.ncbi.nlm.nih.gov/pubmed/37234031" } @Article{info:doi/10.2196/40213, author="Paquet, Catherine and Whitehead, Jocelyne and Shah, Rishabh and Adams, Mary Alayne and Dooley, Damion and Spreng, Nathan R. and Aunio, Anna-Liisa and Dub{\'e}, Laurette", title="Social Prescription Interventions Addressing Social Isolation and Loneliness in Older Adults: Meta-Review Integrating On-the-Ground Resources", journal="J Med Internet Res", year="2023", month="May", day="17", volume="25", pages="e40213", keywords="social prescription", keywords="social isolation", keywords="loneliness", keywords="intervention", keywords="older adults", keywords="knowledge mobilization", keywords="database management", keywords="ontology", abstract="Background: Social prescription programs represent a viable solution to linking primary care patients to nonmedical community resources for improving patient well-being. However, their success depends on the integration of patient needs with local resources. This integration could be accelerated by digital tools that use expressive ontology to organize knowledge resources, thus enabling the seamless navigation of diverse community interventions and services tailored to the needs of individual users. This infrastructure bears particular relevance for older adults, who experience a range of social needs that impact their health, including social isolation and loneliness. An essential first step in enabling knowledge mobilization and the successful implementation of social prescription initiatives to meet the social needs of older adults is to incorporate the evidence-based academic literature on what works, with on-the-ground solutions in the community. Objective: This study aims to integrate scientific evidence with on-the-ground knowledge to build a comprehensive list of intervention terms and keywords related to reducing social isolation and loneliness in older adults. Methods: A meta-review was conducted using a search strategy combining terms related to older adult population, social isolation and loneliness, and study types relevant to reviews using 5 databases. Review extraction included intervention characteristics, outcomes (social [eg, loneliness, social isolation, and social support] or mental health [eg, psychological well-being, depression, and anxiety]), and effectiveness (reported as consistent, mixed, or not supported). Terms related to identified intervention types were extracted from the reviewed literature as well as descriptions of corresponding community services in Montr{\'e}al, Canada, available from web-based regional, municipal, and community data sources. Results: The meta-review identified 11 intervention types addressing social isolation and loneliness in older adults by either increasing social interactions, providing instrumental support, promoting mental and physical well-being, or providing home and community care. Group-based social activities, support groups with educational elements, recreational activities, and training or use of information and communication technologies were the most effective in improving outcomes. Examples of most intervention types were found in community data sources. Terms derived from the literature that were the most commonly congruent with those describing existing community services were related to telehealth, recreational activities, and psychological therapy. However, several discrepancies were observed between review-based terms and those addressing the available services. Conclusions: A range of interventions found to be effective at addressing social isolation and loneliness or their impact on mental health were identified from the literature, and many of these interventions were represented in services available to older residents in Montr{\'e}al, Canada. However, different terms were occasionally used to describe or categorize similar services across data sources. Establishing an efficient means of identifying and structuring such sources is important to facilitate referrals and help-seeking behaviors of older adults and for strategic planning of resources. ", doi="10.2196/40213", url="https://www.jmir.org/2023/1/e40213", url="http://www.ncbi.nlm.nih.gov/pubmed/37195738" } @Article{info:doi/10.2196/44564, author="Schroeder, Tanja and Dodds, Laura and Georgiou, Andrew and Gewald, Heiko and Siette, Joyce", title="Older Adults and New Technology: Mapping Review of the Factors Associated With Older Adults' Intention to Adopt Digital Technologies", journal="JMIR Aging", year="2023", month="May", day="16", volume="6", pages="e44564", keywords="technology adoption", keywords="digital technology", keywords="older adults", keywords="seniors", keywords="intention to use digital technologies", abstract="Background: Ongoing advancements in digital solutions support older adults' healthy aging and well-being. However, a unified synthesis of sociodemographic, cognitive, attitudinal, emotional, and environmental factors that influence older adults' intention to use these new digital technologies is still lacking. Understanding the salient factors that influence older adults' intention to use digital technologies will help to ensure that technology is developed appropriately and contextually. This understanding is also likely to contribute to developing technology acceptance models specifically for the aging generation, by reorganizing principles and constructing objectivity criteria for future research studies. Objective: This review aims to identify the key factors associated with older adults' intention to use digital technologies and to provide a comprehensive conceptual framework to describe the relationships between these key factors and older adults' intention to use digital technologies. Methods: A mapping review was conducted using 9 databases from inception to November 2022. Articles were selected for review if they had an evaluative component of older adults' intention to use digital technologies. Three researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review and quality appraisal was measured using 3 different tools based on each article's study design. Results: We identified a total of 59 articles investigating older adults' intention to use digital technologies. The majority (40/59, 68\%) of articles did not use an existing framework or model for technology acceptance. Studies mostly adopted a quantitative research design (27/59, 46\%). We found 119 unique factors reported to influence older adults' intention to use digital technologies. These were categorized into 6 distinct themes: Demographics and Health Status, Emotional Awareness and Needs, Knowledge and Perception, Motivation, Social Influencers, and Technology Functional Features. Conclusions: Given the importance of global demographic change toward an aging society, there is surprisingly limited research on the factors that influence older adults' intention to use digital technologies. Our identification of the key factors across different types of digital technology and models supports the future integration of a comprehensive perspective encompassing environmental, psychological, and social determinants for older adults' intention to use digital technologies. ", doi="10.2196/44564", url="https://aging.jmir.org/2023/1/e44564", url="http://www.ncbi.nlm.nih.gov/pubmed/37191976" } @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/10.2196/42287, author="Heponiemi, Tarja and Kainiemi, Emma and Virtanen, Lotta and Saukkonen, Petra and Sainio, P{\"a}ivi and Koponen, P{\"a}ivikki and Koskinen, Seppo", title="Predicting Internet Use and Digital Competence Among Older Adults Using Performance Tests of Visual, Physical, and Cognitive Functioning: Longitudinal Population-Based Study", journal="J Med Internet Res", year="2023", month="May", day="5", volume="25", pages="e42287", keywords="internet services", keywords="digital exclusion", keywords="digital skills", keywords="older adults", keywords="physical and cognitive decline", keywords="mobile phone", abstract="Background: The rapidly increasing role of the internet in obtaining basic services poses challenges, especially for older adults' capabilities of getting the services they need. Research on the predictors of older adults' internet use and digital competence is especially relevant given that people are living longer than before, and the age profile of many societies is changing rapidly. Objective: We aimed to examine the associations of objective measures of physical and cognitive impairment with the nonuse of the internet for services and low digital competence among older adults. Methods: A longitudinal population-based design was used that combined data from performance tests and self-rated questionnaires. Data were gathered in 2017 and 2020 among 1426 older adults aged between 70 and 100 years in Finland. Logistic regression analyses were used to examine the associations. Results: Those who had poor near (odds ratio [OR] 1.90, 95\% CI 1.36-2.66) or distant vision (OR 1.81, 95\% CI 1.21-2.71), restricted or failed abduction of upper arms (OR 1.81, 95\% CI 1.28-2.85), and poor results from the word list memory (OR 3.77, 95\% CI 2.65-5.36) or word list delayed recall (OR 2.12, 95\% CI 1.48-3.02) tests had greater odds for nonuse of the internet for services than their counterparts. Moreover, those who had poor near (OR 2.18, 95\% CI 1.57-3.02) or distant vision (OR 2.14, 95\% CI 1.43-3.19), poor results from the chair stand test (OR 1.57, 95\% CI 1.06-2.31), restricted or failed abduction of upper arms (OR 1.74, 95\% CI 1.10-2.76), and poor results from the word list memory (OR 3.41, 95\% CI 2.32-5.03) or word list delayed recall (OR 2.05, 95\% CI 1.39-3.04) tests had greater odds of low digital competence than their counterparts. Conclusions: According to our results, older adults' impaired physical and cognitive functioning may hamper their possibilities of accessing internet services such as digital health care services. Our results should be considered when planning digital health care services intended to be used by older adults; that is, digital solutions should also be suitable for older adults with impairments. Furthermore, face-to-face services should be provided for those who cannot use digital services, even if they are assisted properly. ", doi="10.2196/42287", url="https://www.jmir.org/2023/1/e42287", url="http://www.ncbi.nlm.nih.gov/pubmed/37145836" } @Article{info:doi/10.2196/43709, author="Zhang, Yichi and Lee, J. Edmund W. and Teo, Wei-Peng", title="Health-Seeking Behavior and Its Associated Technology Use: Interview Study Among Community-Dwelling Older Adults", journal="JMIR Aging", year="2023", month="May", day="4", volume="6", pages="e43709", keywords="health", keywords="health-seeking behavior", keywords="aging", keywords="technology", keywords="telehealth", keywords="mobile health", keywords="mHealth", keywords="eHealth", keywords="health access", keywords="qualitative study", keywords="mobile phone", abstract="Background: Understanding older people's health-seeking behavior (HSB) is crucial for uncovering their health needs and priorities and developing appropriate policies to address them and avert their disease progression. Technologies play an active role in our daily lives and have been incorporated into health activities to support the older population and facilitate their HSB. However, previous studies of HSB have mainly focused on behaviors during illness, and there are limited studies on how technologies have been used in older people's health-seeking activities. Objective: This study aimed to investigate HSB and the associated technology use among the older population, ultimately proposing implications for practice to address their unmet health needs. Methods: This paper presents partial data from a large qualitative study, which has been approved by the institutional review board and used a phenomenological approach. Semistructured interviews were conducted between April 2022 and July 2022, either via Zoom (Zoom Video Communications Inc) or face-to-face sessions. Inclusion criteria were being aged ?50 years, long-term residence in Singapore, and being able to speak English or Mandarin. The interviews were manually transcribed verbatim, and thematic analysis was performed, with the individual as the unit of analysis to understand the patterns of behaviors. Results: In total, 15 interviews were conducted to reach thematic saturation. We identified 5 main consequences of HSB, which were aligned with the original HSB model. Regarding technology use in health seeking, 4 themes were extracted: the most widely used digital technologies are the mobile health apps and wearable devices with the associated wellness programs launched by the government and local companies, and they have the potential to enhance health communication, promote health maintenance, and increase access to health services; information communication technologies and social media, though not primarily designed for health purposes, play a substantial role in easing the process of seeking health information and managing symptoms. Although the outbreak of the COVID-19 pandemic has resulted in some alterations to older adults' well-being, it has catalyzed the adoption of telehealth as a complement to access health care services, and older adults have different considerations when selecting technologies to facilitate their health seeking and fulfill their health needs. Moreover, 4 archetypes were proposed based on our findings and the insights gained from our participants' observations in their social networks. These findings led to several implications for practice regarding health communication and promotion, health education, technology design and improvement, telemonitoring service implementation, and solutions to address the needs of each proposed archetype. Conclusions: Unlike the commonly held belief that older adults resist technologies and lack technological proficiency, our findings showed that technologies could play a promising role in facilitating older adults' health seeking. Our findings have implications for the design and implementation of health services and policies. ", doi="10.2196/43709", url="https://aging.jmir.org/2023/1/e43709", url="http://www.ncbi.nlm.nih.gov/pubmed/36996003" } @Article{info:doi/10.2196/38169, author="Cinalioglu, Karin and Elbaz, Sasha and Sekhon, Kerman and Su, Chien-Lin and Rej, Soham and Sekhon, Harmehr", title="Exploring Differential Perceptions of Artificial Intelligence in Health Care Among Younger Versus Older Canadians: Results From the 2021 Canadian Digital Health Survey", journal="J Med Internet Res", year="2023", month="Apr", day="28", volume="25", pages="e38169", keywords="artificial intelligence", keywords="telehealth", keywords="telemedicine", keywords="older adult", keywords="perception", keywords="technology", keywords="public opinion", keywords="national survey", keywords="Canada", keywords="Canadian", keywords="attitude", keywords="adoption", keywords="trust", keywords="satisfaction", abstract="Background: The changing landscape of health care has led to the incorporation of powerful new technologies like artificial intelligence (AI) to assist with various services across a hospital. However, despite the potential outcomes that this tool may provide, little work has examined public opinion regarding their use. Objective: In this study, we aim to explore differences between younger versus older Canadians with regard to the level of comfort and perceptions around the adoption and use of AI in health care settings. Methods: Using data from the 2021 Canadian Digital Health Survey (n=12,052), items related to perceptions about the use of AI as well as previous experience and satisfaction with health care were identified. We conducted Mann-Whitney U tests to compare the level of comfort of younger versus older Canadians regarding the use of AI in health care for a variety of purposes. Multinomial logistic regression was used to predict the comfort ratings based on categorical indicators. Results: Younger Canadians had greater knowledge of AI, but older Canadians were more comfortable with AI applied to monitoring and predicting health conditions, decision support, diagnostic imaging, precision medicine, drug and vaccine development, disease monitoring at home, tracking epidemics, and optimizing workflow to save time. Additionally, for older respondents, higher satisfaction led to higher comfort ratings. Only 1 interaction effect was identified between previous experience, satisfaction, and comfort with AI for drug and vaccine development. Conclusions: Older Canadians may be more open to various applications of AI within health care than younger Canadians. High satisfaction may be a critical criterion for comfort with AI, especially for older Canadians. Additionally, in the case of drug and vaccine development, previous experience may be an important moderating factor. We conclude that gaining a greater understanding of the perceptions of all health care users is integral to the implementation and sustainability of new and cutting-edge technologies in health care settings. ", doi="10.2196/38169", url="https://www.jmir.org/2023/1/e38169", url="http://www.ncbi.nlm.nih.gov/pubmed/37115588" } @Article{info:doi/10.2196/37329, author="Sweeney, Megan and Barton, William and Nebeker, Camille", title="Evaluating Mobile Apps Targeting Older Adults: Descriptive Study", journal="JMIR Form Res", year="2023", month="Apr", day="27", volume="7", pages="e37329", keywords="older adults", keywords="mobile apps", keywords="privacy", keywords="data management, research ethics", keywords="app", keywords="aging", keywords="environment", keywords="safety", keywords="smartphone", keywords="personal information", keywords="user knowledge", keywords="user", keywords="data", keywords="data collection", keywords="storage", abstract="Background: Smartphone use has increased dramatically and, in parallel, a market for mobile apps, including health apps, has emerged. The business model of targeted mobile app advertisements allows for the collection of personal and potentially sensitive information, often without user knowledge. Older adults comprise a rapidly growing demographic that is potentially vulnerable to exploitation by those accessing data collected via these apps. Objective: This research examined apps that claimed to be useful to older adults with a goal of (1) classifying the functionality of each app, (2) identifying whether a privacy policy existed and was accessible, and (3) evaluating evidence that could support claims of value to older adults. Methods: An environmental scan was conducted using the Google search engine and typing ``apps for older adults.'' The first 25 sites that this search returned comprised the primary data for this study. Data were organized by descriptive features of purpose (eg, health, finance, and utility), the existence of an electronically accessible privacy policy, price, and evidence supporting each recommended mobile app. Results: A total of 133 mobile apps were identified and promoted as being the best ``apps for older adults.'' Of these 133 mobile apps, 83\% (n=110) included a privacy policy. Fewer apps designated in the ``medical'' category included a privacy policy than those classified otherwise. Conclusions: The results suggest that most mobile apps targeting older adults include a privacy policy. Research is needed to determine whether these privacy policies are readable, succinct, and incorporate accessible data use and sharing practices to mitigate potential risks, particularly when collecting potentially sensitive health information. ", doi="10.2196/37329", url="https://formative.jmir.org/2023/1/e37329", url="http://www.ncbi.nlm.nih.gov/pubmed/37103995" } @Article{info:doi/10.2196/40004, author="Brainin, Esther and Neter, Efrat", title="Refined Analysis of Older eHealth Users From an Agency Perspective: Quantitative Telephone Interview Study", journal="JMIR Aging", year="2023", month="Apr", day="26", volume="6", pages="e40004", keywords="eHealth", keywords="health", keywords="internet", keywords="structuration theory", keywords="agency", keywords="digital divide", keywords="age", keywords="gender", keywords="education", keywords="information", keywords="health condition", keywords="self-rated health", keywords="SRH", keywords="health care services", keywords="surrogate", keywords="older adults", keywords="users", keywords="patient", keywords="Giddens", keywords="Archer", keywords="Bourdieu", keywords="capital", abstract="Background: Most studies on the eHealth divide among older people have compared users to nonusers and found that age, gender, and education were associated with eHealth misuse. They assumed that these characteristics were structural barriers to eHealth adoption. Furthermore, eHealth practices have been examined in a narrow and incomplete way, and the studies disagree about the association between health conditions and eHealth use. Using a more dynamic theoretical lens, we investigated the potential motivations driving older adults' agential adoption of eHealth practices despite their advanced age. Objective: This study aimed to obtain a complete and detailed description of eHealth uses among older adults; examine whether demographic characteristics such as age, gender, and education (previously related to eHealth misuse) are still associated with the various eHealth clusters; and determine whether contextual factors such as changes in the health condition of older eHealth users or their loved ones are associated with older adult eHealth use. Methods: We conducted a 30-minute telephone interview with a representative sample of 442 Israeli adults (aged ?50 years) with a sampling error of 2.04\%. The interviews were conducted in Hebrew, Arabic, and Russian. Using factor analysis with 21 eHealth use questions, we identified 4 eHealth clusters: instrumental and administrative information seeking, information sharing, seeking information from peers, and web-based self-tracking. In addition to age, gender, education, internet experience, frequency of internet use, perceived eHealth literacy, and self-rated health, we asked respondents to indicate how much they had used offline health services because of a health crisis in the past year. Results: We found differences in the number of older eHealth users in the various clusters. They used instrumental and administrative information (420/442, 95\%) and obtained information from peers (348/442, 78.7\%) the most; followed by web-based self-tracking related to health issues (305/442, 69\%), and only a few (52/442, 11.3\%) uploaded and shared health information on the web. When controlling for personal attributes, age, gender, and education were no longer predictors of eHealth use, nor was a chronic ailment. Instead, internet experience, frequency of internet use, and perceived eHealth literacy were associated with 3 eHealth clusters. Looking for health information for family and friends predicted all 4 eHealth clusters. Conclusions: Many older adults can overcome structural barriers such as age, gender, and education. The change in their or their loved ones' circumstances encouraged them to make deliberate efforts to embrace the new practices expected from today's patients. Seeking health information for family and friends and dealing with unexpected health crises motivates them to use eHealth. We suggest that health professionals ignore their tendency to label older people as nonusers and encourage them to benefit from using eHealth and overcome stereotypical ways of perceiving these patients. ", doi="10.2196/40004", url="https://aging.jmir.org/2023/1/e40004", url="http://www.ncbi.nlm.nih.gov/pubmed/37121572" } @Article{info:doi/10.2196/40460, author="Zhang, Yichi and Leuk, Siew-Pin Jessie and Teo, Wei-Peng", title="Domains, Feasibility, Effectiveness, Cost, and Acceptability of Telehealth in Aging Care: Scoping Review of Systematic Reviews", journal="JMIR Aging", year="2023", month="Apr", day="18", volume="6", pages="e40460", keywords="telehealth", keywords="telemedicine", keywords="telecare", keywords="telemonitoring", keywords="aging care", keywords="health care access", keywords="scoping review", keywords="digital health", keywords="mobile health", keywords="mHealth", keywords="eHealth", abstract="Background: Aging is becoming a major global challenge. Compared with younger adults, the older population has greater health needs but faces inadequate access to appropriate, affordable, and high-quality health care. Telehealth can remove geographic and time boundaries, as well as enabling socially isolated and physically homebound people to access a wider range of care options. The impacts of different telehealth interventions in terms of their effectiveness, cost, and acceptability in aging care are still unclear. Objective: This scoping review of systematic reviews aimed to provide an overview of the domains of telehealth implemented in aging care; synthesize evidence of telehealth's feasibility, effectiveness, cost benefits, and acceptability in the context of aging care; identify gaps in the literature; and determine the priorities for future research. Methods: Guided by the methodological framework of the Joanna Briggs Institute, we reviewed systematic reviews concerning all types of telehealth interventions involving direct communication between older users and health care providers. In total, 5 major electronic databases, PubMed, Embase (Ovid), Cochrane Library, CINAHL, and PsycINFO (EBSCO), were searched on September 16, 2021, and an updated search was performed on April 28, 2022, across the same databases as well as the first 10 pages of the Google search. Results: A total of 29 systematic reviews, including 1 post hoc subanalysis of a previously published large Cochrane systematic review with meta-analysis, were included. Telehealth has been adopted in various domains in aging care, such as cardiovascular diseases, mental health, cognitive impairment, prefrailty and frailty, chronic diseases, and oral health, and it seems to be a promising, feasible, effective, cost-effective, and acceptable alternative to usual care in selected domains. However, it should be noted that the generalizability of the results might be limited, and further studies with larger sample sizes, more rigorous designs, adequate reporting, and more consistently defined outcomes and methodologies are needed. The factors affecting telehealth use among older adults have been categorized into individual, interpersonal, technological, system, and policy levels, which could help direct collaborative efforts toward improving the security, accessibility, and affordability of telehealth as well as better prepare the older population for digital inclusion. Conclusions: Although telehealth remains in its infancy and there is a lack of high-quality studies to rigorously prove the feasibility, effectiveness, cost benefit, and acceptability of telehealth, mounting evidence has indicated that it could play a promising complementary role in the care of the aging population. ", doi="10.2196/40460", url="https://aging.jmir.org/2023/1/e40460", url="http://www.ncbi.nlm.nih.gov/pubmed/37071459" } @Article{info:doi/10.2196/41915, author="Kim, Seungmo and Chow, Chu Bik and Park, Sanghyun and Liu, Huaxuan", title="The Usage of Digital Health Technology Among Older Adults in Hong Kong and the Role of Technology Readiness and eHealth Literacy: Path Analysis", journal="J Med Internet Res", year="2023", month="Apr", day="12", volume="25", pages="e41915", keywords="older adults", keywords="elderly", keywords="digital health technology", keywords="health technology", keywords="digital health", keywords="technology readiness", keywords="eHealth literacy", keywords="continuous usage intention", keywords="usage intention", keywords="intention-to-use", keywords="attitude", keywords="technology use", keywords="elder", keywords="digital literacy", keywords="adoption", keywords="acceptance", keywords="readiness", keywords="gerontology", keywords="aging", abstract="Background: Although digital health technologies (DHTs) help many people maintain a healthy life, including those of advanced age, these technologies are of little use to older adult populations if they are not being adopted in daily life. Thus, it is critical to identify ways to help older adults recognize and try new technologies and maintain their use of them to maximize the benefits of these technologies in a digital-based society. Objective: Our study aimed (1) to assess the current usage of DHT among older adults in Hong Kong and (2) to examine how high and low levels of eHealth literacy in this group affects the relationship between the Technology Readiness and Acceptance Model (TRAM) and attitudes and intention toward DHT. Methods: A total of 306 adults over 60 years of age in Hong Kong participated in this study. After conducting confirmatory factor analysis to validate the measurement model, the hypothesized model was tested using structural equation modeling. Results: Optimism was significantly related to perceived usefulness, while optimism, innovativeness, and discomfort were significantly associated with perceived ease of use. Both perceived usefulness and perceived ease of use were significantly linked to attitude toward the use of DHTs. Meanwhile, attitude significantly predicted usage intention. Additionally, the results revealed the differences in the relationships of the TRAM between participants with high and low levels of eHealth literacy. The influence of optimism and innovativeness on perceived ease of use was stronger for the higher-level group than for the lower-level group, and the influence of discomfort for the higher-level group was much weaker. Conclusions: The findings provided partial support for the impact of eHealth literacy on encouraging older adults to use DHT and obtain health benefits from it. This study also suggests providing assistance and guidelines for older adults to narrow the aging-related technology gap and to further explore the associations of eHealth literacy, the TRAM, and actual behaviors. ", doi="10.2196/41915", url="https://www.jmir.org/2023/1/e41915", url="http://www.ncbi.nlm.nih.gov/pubmed/37043274" } @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/10.2196/43542, author="De Santis, Karolina Karina and Mergenthal, Lea and Christianson, Lara and Busskamp, Annalena and Vonstein, Claudia and Zeeb, Hajo", title="Digital Technologies for Health Promotion and Disease Prevention in Older People: Scoping Review", journal="J Med Internet Res", year="2023", month="Mar", day="23", volume="25", pages="e43542", keywords="digital technology", keywords="health technology", keywords="digital public health", keywords="health promotion", keywords="disease prevention", keywords="healthy aging", keywords="elderly population", keywords="older adult", keywords="older population", keywords="scoping review", abstract="Background: Digital technologies have the potential to contribute to health promotion and disease prevention in the aging world. Objective: This study aims to identify digital technologies for health promotion and disease prevention that could be used independently by older people in nonclinical settings using a scoping review. Methods: Through database (MEDLINE, PsycINFO, CINAHL, and SCOPUS; to March 3, 2022) and manual searches (to June 14, 2022), 90 primary studies and 8 systematic reviews were included in this scoping review. The eligibility was based on the PCC (Population, Concept, and Context) criteria: (1) people aged 50 years or older (population), (2) any digital (health) technology (eg, smartphone apps, websites, virtual reality; concept), and (3) health promotion and disease prevention in daily life in nonclinical and noninstitutional settings (context). Data items included study characteristics, PCC criteria, opportunities versus challenges, and evidence gaps. Data were synthesized using descriptive statistics or narratively described by identifying common themes. Results: The studies were published in 2005-2022 and originated predominantly from North America and Europe. Most primary studies were nonrandomized, reported quantitative data, and investigated effectiveness or feasibility (eg, acceptance or usability) of digital technologies in older people. The participants were aged 50 years to 99 years, predominantly female, affluent (ie, with high income, education, and digital competence), and intended to use or used digital technologies for a median of 3 months independently at home or in community settings. The digital technologies included mobile or nonmobile technologies or virtual reality. The studies used ``modern devices'' (eg, smartphones, wearables, or gaming consoles) or modern and ``older devices'' (eg, computers or mobile phones). The users interacted with digital technologies via websites, emails, text messages, apps, or virtual reality. Health targets of digital technologies were mobility, mental health, nutrition, or cognition. The opportunities versus challenges of digital technologies were (1) potential health benefits versus unclear or no benefits for some outcomes, (2) monitoring of health versus ethical issues with data collection and management, (3) implications for functioning in daily life (ie, potential to prolong independent living) versus unclear application for clinical management or care, (4) tailoring of technical properties and content toward older users versus general use, (5) importance of human support for feasibility versus other factors required to improve feasibility, (6) reduction of social isolation versus access to digital technologies, and (7) improvement in digital competence versus digital divide. Conclusions: Various digital technologies were independently used by people aged 50 years or older for health promotion and disease prevention. Future studies should focus on (1) more diverse populations of older people, (2) new digital technologies, (3) other (clinical and care) settings, and (4) outcome evaluation to identify factors that could enhance any health benefits of digital technologies. International Registered Report Identifier (IRRID): RR2-10.2196/37729 ", doi="10.2196/43542", url="https://www.jmir.org/2023/1/e43542", url="http://www.ncbi.nlm.nih.gov/pubmed/36951896" } @Article{info:doi/10.2196/40956, author="Wen, Wen and Zhang, Yaru and Shi, Wenjie and Li, Jiajia", title="Association Between Internet Use and Physical Health, Mental Health, and Subjective Health in Middle-aged and Older Adults: Nationally Representative Cross-sectional Survey in China", journal="J Med Internet Res", year="2023", month="Mar", day="21", volume="25", pages="e40956", keywords="internet use", keywords="health status", keywords="middle-aged and older adults", keywords="China", abstract="Background: Internet use is an important means of accessing health-related information. Identifying the associations between internet use and health outcomes could provide insight into strategies for improving public health among middle-aged and older adults (45 years and up). Objective: This study aimed to examine the relationship between internet use and health outcomes in middle-aged and older adults. Methods: Data were obtained from the 2018 China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) Scale, the 10-item Center for Epidemiologic Studies Depression Scale, and the 3-level Self-Rated Health Scale, respectively. The chi-square test and rank sum test were used to explore whether internet use was associated with health status. A multivariate logistic regression model was used to determine this association further after controlling for the confounding factors. Results: Overall, 13\% (1752/13,474) of the participants used the internet. Regression analyses revealed that the prevalence of depression (odds ratio [OR] 0.59, 95\% CI 0.52-0.68; P<.001), negative self-rated health (OR 0.68, 95\% CI 0.61-0.76; P<.001), and difficulty with ADL (OR 0.48, 95\% CI 0.39-0.60; P<.001) in the participating middle-aged and older adult was lower in those using the internet than nonusers. After controlling for confounding factors, internet use was found to be negatively associated with difficulty with ADL (urban: OR 0.44, 95\% CI 0.32-0.61; P<.001 vs rural: OR 0.55, 95\% CI 0.41-0.75; P<.001), depression (urban: OR 0.69, 95\% CI 0.57-0.84; P<.001 vs rural: OR 0.52, 95\% CI: 0.43-0.63; P<.001), and self-rated health status (urban: OR 0.70, 95\% CI 0.61-0.81; P<.001 vs rural: OR 0.67, 95\% CI 0.57-0.78; P<.001) among middle-aged and older adults in both urban and rural areas. Conclusions: Internet use had a positive effect on the physical and mental health of middle-aged and older adults who participated in this study. However, the internet usage rate remains low among older Chinese people. Therefore, the internet penetration rate should be a priority. ", doi="10.2196/40956", url="https://www.jmir.org/2023/1/e40956", url="http://www.ncbi.nlm.nih.gov/pubmed/36943368" } @Article{info:doi/10.2196/43197, author="Garcia Reyes, Paola Elsy and Kelly, Ryan and Buchanan, George and Waycott, Jenny", title="Understanding Older Adults' Experiences With Technologies for Health Self-management: Interview Study", journal="JMIR Aging", year="2023", month="Mar", day="21", volume="6", pages="e43197", keywords="older adults", keywords="technology", keywords="health self-management", keywords="motivator", keywords="enabler", keywords="barrier", abstract="Background: Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments. Objective: This study aimed to understand the types of technologies that older adults use to support their health and the factors that motivate them to use their chosen technologies to support their health. In addition, we aimed to understand the factors that enable the effective use of technologies for health self-management and to identify the barriers that can negatively affect the adoption of technologies. Methods: A total of 22 older adults participated in semistructured interviews regarding their experiences of using technologies for health self-management. Interview transcripts were analyzed through an in-depth thematic analysis. Results: The interviews revealed that a range of technologies, such as videoconferencing software, fitness trackers, and other devices, were being used by older adults to support their health. Interviews showed that participants were motivated to use technologies to monitor health issues, to stay active and connected, and to record and change their behavior in the light of foreseen risks related to their future health status. Enablers that facilitated the effective use of technologies include social and organizational influence, convenient access to health care and safety provided by the technology, and easy setup and low cost of the technology. Barriers include information overload and a sense of futility about future health decline; telehealth being an inadequate substitute for in-person consultation; concerns about trust related to privacy and accuracy; and technologies being stigmatizing, uncomfortable to use, expensive, and unfamiliar. Conclusions: This study suggested that older adults were using a variety of technologies to prevent or prepare for future health decline, evidencing a resilient attitude toward health and aging. In addition, older adults were willing to continue using the technology when there was a perceived need. The enabler mentioned by most participants was the social and organizational influence that included health care staff, family, friends, and organizations. This analysis provides a better understanding of how older adults use technologies to support their health and can guide the provision of appropriate health technologies for them. ", doi="10.2196/43197", url="https://aging.jmir.org/2023/1/e43197", url="http://www.ncbi.nlm.nih.gov/pubmed/36943333" } @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/10.2196/38593, author="Lemaire, C{\'e}lia and Humbert, Christophe and Sueur, C{\'e}dric and Racin, C{\'e}line", title="Use of Digital Technologies to Maintain Older Adults' Social Ties During Visitation Restrictions in Long-Term Care Facilities: Scoping Review", journal="JMIR Aging", year="2023", month="Feb", day="10", volume="6", pages="e38593", keywords="social isolation", keywords="COVID-19 pandemic", keywords="remote care", keywords="nursing homes", keywords="social ties", keywords="digital devices", keywords="older adults", abstract="Background: Digital technologies were implemented to address the disruption of long-term care facility residents' socialization needs during the COVID-19 pandemic. A literature review regarding this topic is needed to inform public policy, facility managers, family caregivers, and nurses and allied health professionals involved in mediating the use of digital devices for residents' social ties. Objective: Our study outlines key concepts, methodologies, results, issues, and gaps in articles published during pandemic-related visitation restrictions. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) protocol, a scoping review was conducted by searching 3 database aggregator platforms (EBSCO, ProQuest, and PubMed) for studies published in peer-reviewed journals from early 2020 to the end of June 2021, when the most stringent restrictions were in place. We included qualitative and quantitative studies, reviews, commentaries, viewpoints, and letters to the editors in French or English focusing on digital technologies aiming to support the social contact of residents in long-term care facilities during pandemic-related visitation restrictions. Results: Among 763 screened articles, 29 met our selection criteria. For each study, we characterized the (1) authors, title, and date of the publication; (2) country of the first author; (3) research fields; (4) article type; and (5) type of technology mentioned. The analysis distinguished 3 main themes emerging from the literature: (1) impact and expectations of remote social contact on the physical and mental health and well-being of the residents (n=12), (2) with whom or what the social contact took place (n=17), and (3) limitations and barriers to significant social contact related to digital technologies (n=14). The results first underlined the highly positive impact expected by the authors of the digital technologies on health and quality of life of residents of long-term care facilities. Second, they highlighted the plurality of ties to consider, since social contact takes place not only with family caregivers to maintain contact but also for other purposes (end-of-life videoconferences) and with other types of contact (eg, with staff and robots). Third, they exposed the limitations and barriers to significant contact using digital technologies and outlined the required conditions to enable them. Conclusions: The review demonstrated the opportunities and risks outlined by the literature about the implementation of digital technologies to support remote social contact. It showed the plurality of ties to consider and revealed the need to evaluate the positive impact of remote contact from the residents' perspectives. Therefore, to go beyond the risk of digital solutionism, there is a need for studies considering the holistic impact on health regarding the implementation of digital technologies, including the meaning residents give to interpersonal exchanges and the organizational constraints. Trial Registration: OSF Registries osf.io/yhpx3; https://osf.io/yhpx3 ", doi="10.2196/38593", url="https://aging.jmir.org/2023/1/e38593", url="http://www.ncbi.nlm.nih.gov/pubmed/36599164" } @Article{info:doi/10.2196/40582, author="Shu, Sara and Woo, P. Benjamin K.", title="Pioneering the Metaverse: The Role of the Metaverse in an Aging Population", journal="JMIR Aging", year="2023", month="Jan", day="20", volume="6", pages="e40582", keywords="metaverse", keywords="older adult", keywords="aging in place", keywords="dementia", keywords="gerontology", keywords="geriatric", keywords="digital health", keywords="digital technology", keywords="computer generated", keywords="artificial intelligence", keywords="virtual reality", keywords="mixed reality", keywords="augmented reality", keywords="aging", keywords="mental health", doi="10.2196/40582", url="https://aging.jmir.org/2023/1/e40582", url="http://www.ncbi.nlm.nih.gov/pubmed/36662547" } @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/10.2196/39848, author="Phang, Kie Jie and Kwan, Heng Yu and Yoon, Sungwon and Goh, Hendra and Yee, Qi Wan and Tan, Seng Chuen and Low, Leng Lian", title="Digital Intergenerational Program to Reduce Loneliness and Social Isolation Among Older Adults: Realist Review", journal="JMIR Aging", year="2023", month="Jan", day="4", volume="6", pages="e39848", keywords="aged", keywords="loneliness", keywords="older people", keywords="review", keywords="social isolation", abstract="Background: There is a compelling need for an innovative and creative approach to promote social connectedness among older adults to optimize their well-being and quality of life. One possible solution may be through a digital intergenerational program. Objective: This realist review aimed to identify existing digital intergenerational programs that were used to reduce loneliness or social isolation among older adults and analyze them in terms of strategy, context, mechanisms, and outcomes. Methods: We performed a realist review with an extensive search of published and gray literature. For scholarly literature, we searched PubMed, Embase, CINAHL, PsycINFO (Ovid), and Social Sciences Citation Index databases for articles published between January 2000 to August 2020. A grey literature search was performed using the Google search engine, and the search was completed in May 2021. We included programs that evaluated digital intergenerational programs for older adults, which described outcomes of loneliness or social isolation. We included quantitative, mixed methods, and qualitative studies, as well as relevant theoretical papers, policy documents, and implementation documents. The studies were appraised based on their relevance and rigor. We synthesized the available evidence from the literature into Strategy-Context-Mechanism-Outcome (S-C-M-O) configurations to better understand what, when, and how programs work. Results: A total of 31 documents reporting 27 digital intergenerational programs were reviewed. Our final results identified 4 S-C-M-O configurations. For S-C-M-O configuration 1, we found that for community-dwelling older adults, provision of access to and training in digital technology may increase older adults' self-efficacy in digital devices and therefore increase the use of digital communication with family. In S-C-M-O configuration 2, digital psychosocial support and educational interventions from nurses were found to be useful in reducing loneliness among community-dwelling older adults. In S-C-M-O configuration 3, a video call with a student or family was found to reduce loneliness among older adults residing in long-term residential care facilities. Finally, for S-C-M-O configuration 4, we found that behavioral activation provided through videoconferencing by a lay coach may be useful in reducing loneliness among older adults who are lonely. However, as almost half (11/27, 41\%) of the included programs only reported quantitative results, this review focused on screening the discussion section of publications to identify author opinions or any qualitative information to elucidate the mechanisms of how programs work. Conclusions: This review identified the key strategy, context, and mechanism influencing the success of programs that promote intergenerational interaction through digital means. This review revealed that different strategies should be adopted for different groups of older adults (eg, older adults who are lonely, older adults who reside in long-term residential care facilities, and community-dwelling older adults). The S-C-M-O configurations should be considered when designing and implementing digital intergenerational programs for older adults. ", doi="10.2196/39848", url="https://aging.jmir.org/2023/1/e39848", url="http://www.ncbi.nlm.nih.gov/pubmed/36598801" } @Article{info:doi/10.2196/41317, author="Foster, Marva and Xiong, Wei and Quintiliani, Lisa and Hartmann, W. Christine and Gaehde, Stephan", title="Preferences of Older Adult Veterans With Heart Failure for Engaging With Mobile Health Technology to Support Self-care: Qualitative Interview Study Among Patients With Heart Failure and Content Analysis", journal="JMIR Form Res", year="2022", month="Dec", day="20", volume="6", number="12", pages="e41317", keywords="qualitative research", keywords="heart failure", keywords="self-care", keywords="mobile health", keywords="mobile health technology", keywords="older adults", keywords="elderly", keywords="perceptions", keywords="mhealth intervention", keywords="veteran health", keywords="mHealth technology", keywords="elderly health care", keywords="elderly self-care", abstract="Background: Heart failure (HF) affects approximately 6.5 million adults in the United States, disproportionately afflicting older adults. Mobile health (mHealth) has emerged as a promising tool to empower older adults in HF self-care. However, little is known about the use of this approach among older adult veterans. Objective: The goal of this study was to explore which features of an app were prioritized for older adult veterans with HF. Methods: Between January and July 2021, we conducted semistructured interviews with patients with heart failure aged 65 years and older at a single facility in an integrated health care system (the Veterans Health Administration). We performed content analysis and derived themes based on the middle-range theory of chronic illness, generating findings both deductively and inductively. The qualitative questions captured data on the 3 key themes of the theory: self-care maintenance, self-care monitoring, and self-care management. Qualitative responses were analyzed using a qualitative data management platform, and descriptive statistics were used to analyze demographic data. Results: Among patients interviewed (n=9), most agreed that a smartphone app for supporting HF self-care was desirable. In addition to 3 a priori themes, we identified 7 subthemes: education on daily HF care, how often to get education on HF, support of medication adherence, dietary restriction support, goal setting for exercises, stress reduction strategies, and prompts of when to call a provider. In addition, we identified 3 inductive themes related to veteran preferences for app components: simplicity, ability to share data with caregivers, and positive framing of HF language. Conclusions: We identified educational and tracking app features that can guide the development of HF self-care for an older adult veteran population. Future research needs to be done to extend these findings and assess the feasibility of and test an app with these features. ", doi="10.2196/41317", url="https://formative.jmir.org/2022/12/e41317", url="http://www.ncbi.nlm.nih.gov/pubmed/36538348" } @Article{info:doi/10.2196/43192, author="Borghouts, Judith and Eikey, V. Elizabeth and De Leon, Cinthia and Schueller, M. Stephen and Schneider, Margaret and Stadnick, A. Nicole and Zheng, Kai and Wilson, Lorraine and Caro, Damaris and Mukamel, B. Dana and Sorkin, H. Dara", title="Understanding the Role of Support in Digital Mental Health Programs With Older Adults: Users' Perspective and Mixed Methods Study", journal="JMIR Form Res", year="2022", month="Dec", day="13", volume="6", number="12", pages="e43192", keywords="older adults", keywords="mental health", keywords="digital mental health intervention", keywords="human support", abstract="Background: Digital mental health interventions have the potential to increase mental health support among isolated older adults. However, the older adult population can experience several barriers to accessing and using digital health resources and may need extra support to experience its benefits. Objective: This paper aimed to understand what older adults experience as an important aspect of support during engagement in a digital mental health program. The program entailed 3 months of staff support to participate in digital literacy training and engage with the digital mental health platform myStrength, which offers support for a range of mental health challenges, including depression and anxiety. Methods: A total of 30 older adults participated in surveys and interviews to assess their experience of participating in a digital mental health program provided by county mental health services. As part of the program, participants attended 4 classes of digital literacy training, had access to the digital mental health platform myStrength for 2 months with staff support (and 10 months after the program without support), and received support from program staff during the entire 3-month program. Survey data were analyzed using descriptive statistics, and interview data were analyzed using thematic analysis. Results: A thematic analysis of the interview data revealed that participants valued ongoing support in 3 main areas: technical support to assist them in using technology, guided support to remind them to use myStrength and practice skills they had learned, and social support to enable them to connect with others through the program. Furthermore, participants reported that social connections was the most important aspect of the program and that they were mainly motivated to participate in the program because it was recommended to them by trusted others such as a community partner or because they believed it could potentially help others. Conclusions: Our findings can be used to inform the design of future digital mental health programs for older adults who may have unique support needs in terms of dedicated technical support and ongoing guided support to use technology and social support to increase social connectedness. ", doi="10.2196/43192", url="https://formative.jmir.org/2022/12/e43192", url="http://www.ncbi.nlm.nih.gov/pubmed/36512387" } @Article{info:doi/10.2196/40192, author="Kebede, Sahilemichael Abraham and Ozolins, Lise-Lotte and Holst, Hanna and Galvin, Kathleen", title="Digital Engagement of Older Adults: Scoping Review", journal="J Med Internet Res", year="2022", month="Dec", day="7", volume="24", number="12", pages="e40192", keywords="digital divide", keywords="digital engagement", keywords="older adults", keywords="older people", keywords="sustained engagement", keywords="technology acceptance", keywords="technological nonuse", abstract="Background: Digital technologies facilitate everyday life, social connectedness, aging at home, well-being, and dignified care. However, older adults are disproportionately excluded from these benefits. Equal digital opportunities, access, and meaningful engagement require an understanding of older adults' experience across different stages of the technological engagement life cycle from nonuse and initial adoption to sustained use, factors influencing their decisions, and how the experience changes over time. Objective: Our objectives were to identify the extent and breadth of existing literature on older adults' perspective on digital engagement and summarize the barriers to and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement. Methods: We used the Arksey and O'Malley framework for the scoping review process. We searched MEDLINE, PsycINFO, CINAHL, Web of Science, and ACM digital library for primary studies published between 2005 and 2021. The inclusion and exclusion criteria were developed based on the Joanna Briggs Institute (participants, content, and context) framework. Studies that investigated the digital engagement experience as well as barriers to and facilitators of older adults' digital technology engagement were included. The characteristics of the study, types of digital technology, and digital engagement levels were analyzed descriptively. Content analysis was used to generate tentative elements using a congruent theme, and barriers and facilitators were mapped over the capability, opportunity, and motivation behavior change model (COM-B) and the theoretical domain framework. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Results: In total, 96 publications were eligible for the final charting and synthesis. Most of the studies were published over the past 5 years, investigated the initial adoption stage of digital engagement, and focused on everyday technologies. The most cited barriers and facilitators across the engagement stages from each COM-B component were capability (eg, physical and psychological changes and lack of skill), opportunity (eg, technological features, environmental context, and resources), and motivation (eg, optimism from perceived usefulness and beliefs about capability). Conclusions: The COM-B model and theoretical domain framework provide a guide for identifying multiple and intertwined barriers and facilitators at each stage of digital engagement. There are limited studies looking into the whole spectrum of older adults' digital technology experience; in particular, studies on technological nonuse and sustained use stages are rare. Future research and practice should focus on tailored interventions accounting for the barriers to older adults' digital engagement and addressing capabilities, motivation, and opportunities; affordable, usable, and useful digital technologies, which address the changes and capability requirements of older adults and are cocreated with a value framework; and lifelong learning and empowerment to develop older adults' knowledge and skills to cope with digital technology development. International Registered Report Identifier (IRRID): RR2-10.2196/25616 ", doi="10.2196/40192", url="https://www.jmir.org/2022/12/e40192", url="http://www.ncbi.nlm.nih.gov/pubmed/36477006" } @Article{info:doi/10.2196/39890, author="Moxley, Jerad and Sharit, Joseph and Czaja, J. Sara", title="The Factors Influencing Older Adults' Decisions Surrounding Adoption of Technology: Quantitative Experimental Study", journal="JMIR Aging", year="2022", month="Nov", day="23", volume="5", number="4", pages="e39890", keywords="aging", keywords="technology", keywords="design", keywords="older adult", keywords="application", keywords="independence", keywords="relationship", keywords="adopt", keywords="transportation", keywords="leisure", keywords="health", keywords="learning", keywords="adoption", keywords="cognition", keywords="cognitive", keywords="willingness", keywords="marketing", keywords="consumer", keywords="mobile phone", abstract="Background: The rapid diffusion of technology apps may support older adults' independence and improve the quality of their lives. Models for predicting technology acceptance in older adults are sparse, based on broad questions related to general technology acceptance, and largely not grounded in theories of aging. Objective: This study aimed to use a mixed methods approach involving 5 technologies to comprehensively assess the causal relationships among factors that influence older adults' willingness to adopt the technologies. Methods: In total, 187 men and women aged 65 to 92 years participated in the study. Participants were given presentations on 5 different technologies spanning domains that included transportation, leisure, health, and new learning and provided ratings of each technology on various measures hypothesized to influence adoption. They were also administered other instruments to collect data on their actual and self-assessed cognitive abilities, rates of discounting of the technologies with respect to willingness to invest time to attain higher skills in the technologies, general technology experience, and attitudes toward technology. We used the machine learning technique of k-fold cross-validated regressions to select variables that predicted participants' willingness to adopt the technologies. Results: Willingness to adopt technologies was most impacted by 3 variables: perceived value of the technologies ($\beta$=.54), perceived improvement in quality of life attainable from the technologies ($\beta$=.24), and confidence in being able to use the technologies ($\beta$=.15). These variables, in turn, were mostly facilitated or inhibited by the perceived effort required to learn to use the technologies, a positive attitude toward technology as reflected in the optimism component of the technology readiness scale, the degree to which technologies were discounted, and the perceived help needed to learn to use the technologies. Conclusions: Our findings demonstrate that participants' willingness to adopt technologies is mainly determined by perceptions of 3 aspects of the technologies; these aspects possibly mediate many relationships with willingness to adopt. We discuss the implications of these findings for the design and marketing of technology products for older consumers. ", doi="10.2196/39890", url="https://aging.jmir.org/2022/4/e39890", url="http://www.ncbi.nlm.nih.gov/pubmed/36416885" } @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/10.2196/40125, author="Balki, Eric and Hayes, Niall and Holland, Carol", title="Effectiveness of Technology Interventions in Addressing Social Isolation, Connectedness, and Loneliness in Older Adults: Systematic Umbrella Review", journal="JMIR Aging", year="2022", month="Oct", day="24", volume="5", number="4", pages="e40125", keywords="information and communications technology", keywords="interventions", keywords="loneliness", keywords="older adults", keywords="social connectedness", keywords="social isolation", keywords="technology interventions", abstract="Background: The global population of older adults (aged >60 years) is expected to triple to 2 billion by 2050. Proportionate rises in older adults affected by loneliness and social isolation (or social connectedness) are expected. Rapid deployability and social changes have increased the availability of technological devices, creating new opportunities for older adults. Objective: This study aimed to identify, synthesize, and critically appraise the effectiveness of technology interventions improving social connectedness in older adults by assessing the quality of reviews, common observations, and derivable themes. Methods: Following the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), 4 databases (PsycINFO, PubMed, Embase, and MEDLINE) were searched between February 2020 and March 2022. We identified reviews with adults aged ?50 years in community and residential settings, reporting outcomes related to the impact of technologies on social disconnectedness with inclusion criteria based on the population, intervention, context, outcomes, and study schema---review-type articles (systematic, meta-analyses, integrative, and scoping)---and with digital interventions included. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to measure the strength of outcome recommendations including the risk of bias. The reviews covered 326 primary studies with 79,538 participants. Findings were extracted, synthesized, and organized according to emerging themes. Results: Overall, 972 publications met the initial search criteria, and 24 met our inclusion criteria. Revised Assessment of Multiple Systematic Reviews was used to assess the quality of the analysis. Eligible reviews (3/24, 12\%) were excluded because of their low Revised Assessment of Multiple Systematic Reviews scores (<22). The included reviews were dedicated to information and communications technology (ICT; 11/24, 46\%), videoconferencing (4/24, 17\%), computer or internet training (3/24, 12\%), telecare (2/24, 8\%), social networking sites (2/24, 8\%), and robotics (2/27, 8\%). Although technology was found to improve social connectedness, its effectiveness depended on study design and is improved by shorter durations, longer training times, and the facilitation of existing relationships. ICT and videoconferencing showed the best results, followed by computer training. Social networking sites achieved mixed results. Robotics and augmented reality showed promising results but lacked sufficient data for informed conclusions. The overall quality of the studies based on GRADE was medium low to very low. Conclusions: Technology interventions can improve social connectedness in older adults. The specific effectiveness rates favor ICT and videoconferencing, but with limited evidence, as indicated by low GRADE ratings. Future intervention and study design guidelines should carefully assess the methodological quality of studies and the overall certainty of specific outcome measures. The lack of randomized controlled trials in underlying primary studies (<28\%) and suboptimal methodologies limited our findings. Robotics and augmented or virtual reality warrant further research. Low GRADE scores highlight the need for high-quality research in these areas. Trial Registration: PROSPERO CRD42022363475; https://tinyurl.com/mdd6zds ", doi="10.2196/40125", url="https://aging.jmir.org/2022/4/e40125", url="http://www.ncbi.nlm.nih.gov/pubmed/36279155" } @Article{info:doi/10.2196/41536, author="Balki, Eric and Hayes, Niall and Holland, Carol", title="The Impact of Social Isolation, Loneliness, and Technology Use During the COVID-19 Pandemic on Health-Related Quality of Life: Observational Cross-sectional Study", journal="J Med Internet Res", year="2022", month="Oct", day="19", volume="24", number="10", pages="e41536", keywords="health-related quality of life", keywords="healthy aging", keywords="older adult", keywords="elder", keywords="older person", keywords="older population", keywords="geriatric", keywords="gerontology", keywords="technology intervention", keywords="COVID-19", keywords="pandemic", keywords="loneliness", keywords="social isolation", keywords="isolation", keywords="isolated", keywords="lonely", keywords="cross-sectional", keywords="technology use", keywords="digital literacy", keywords="acceptance", doi="10.2196/41536", url="https://www.jmir.org/2022/10/e41536", url="http://www.ncbi.nlm.nih.gov/pubmed/36260401" } @Article{info:doi/10.2196/39584, author="Fjells{\aa}, Hunsbedt Hilde Marie and Huseb{\o}, Lunde Anne Marie and Storm, Marianne", title="eHealth in Care Coordination for Older Adults Living at Home: Scoping Review", journal="J Med Internet Res", year="2022", month="Oct", day="18", volume="24", number="10", pages="e39584", keywords="eHealth", keywords="care coordination", keywords="older adults", keywords="primary health care", keywords="mobile phone", abstract="Background: The population of older adults is projected to increase, potentially resulting in more older adults living with chronic illnesses or multimorbidity. Living with chronic illnesses increases the need for coordinated health care services. Older adults want to manage their illnesses themselves, and many are positive about using eHealth for care coordination (CC). CC can help older adults navigate the health care system and improve information sharing. Objective: This study aimed to map the research literature on eHealth used in CC for older adults living at home. This study assessed CC activities, outcomes, and factors influencing the use of eHealth in CC reported by older adults and health care professionals. Methods: We used a scoping review methodology. We searched four databases---MEDLINE, CINAHL, Academic Scoping Premier, and Scopus---from 2009 to 2021 for research articles. We screened 630 records using the inclusion criteria (older adults aged >65 years, primary health care setting, description of an eHealth program or intervention or measure or experiences with the use of eHealth, and inclusion of CC or relevant activities as described in the Care Coordination Atlas). The analysis of the included articles consisted of both a descriptive and thematic analysis. Results: A total of 16 studies were included in this scoping review. Of these 16 studies, 12 (75\%) had a quantitative design, and the samples of the included studies varied in size. The categories of eHealth used for CC among older adults living at home were electronic health records and patient portals, telehealth monitoring solutions, and telephone only. The CC activity communication was evident in all studies (16/16, 100\%). The results on patient- and system-level outcomes were mixed; however, most studies (7/16, 44\%) reported improved mental and physical health and reduced rehospitalization and hospital admission rates. Observing changes in patients' health was a facilitator for health care professionals using eHealth in CC. When using eHealth in CC, available support to the patient, personal continuity, and a sense of security and safety were facilitators for older adults. Individual characteristics and lack of experience, confidence, and knowledge were barriers to older adults' use of eHealth. Health care professionals reported barriers such as increased workload and hampered communication. Conclusions: We mapped the research literature on eHealth-enabled CC for older adults living at home. We did not map the gray literature as we aimed to map the research literature (peer-reviewed research articles published in academic journals). The study results showed that using eHealth to coordinate care for older adults who live at home is promising. To ensure the successful use of eHealth in CC, we recommend customized eHealth-enabled health care services for older adults, including individualized education and support. ", doi="10.2196/39584", url="https://www.jmir.org/2022/10/e39584", url="http://www.ncbi.nlm.nih.gov/pubmed/36256831" } @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/10.2196/39681, author="Lapp, Linda and Egan, Kieren and McCann, Lisa and Mackenzie, Moira and Wales, Ann and Maguire, Roma", title="Decision Support Tools in Adult Long-term Care Facilities: Scoping Review", journal="J Med Internet Res", year="2022", month="Sep", day="6", volume="24", number="9", pages="e39681", keywords="decision support", keywords="care home", keywords="nursing home", keywords="digital health", abstract="Background: Digital innovations are yet to make real impacts in the care home sector despite the considerable potential of digital health approaches to help with continued staff shortages and to improve quality of care. To understand the current landscape of digital innovation in long-term care facilities such as nursing and care homes, it is important to find out which clinical decision support tools are currently used in long-term care facilities, what their purpose is, how they were developed, and what types of data they use. Objective: The aim of this review was to analyze studies that evaluated clinical decision support tools in long-term care facilities based on the purpose and intended users of the tools, the evidence base used to develop the tools, how the tools are used and their effectiveness, and the types of data the tools use to contribute to the existing scientific evidence to inform a roadmap for digital innovation, specifically for clinical decision support tools, in long-term care facilities. Methods: A review of the literature published between January 1, 2010, and July 21, 2021, was conducted, using key search terms in 3 scientific journal databases: PubMed, Cochrane Library, and the British Nursing Index. Only studies evaluating clinical decision support tools in long-term care facilities were included in the review. Results: In total, 17 papers were included in the final review. The clinical decision support tools described in these papers were evaluated for medication management, pressure ulcer prevention, dementia management, falls prevention, hospitalization, malnutrition prevention, urinary tract infection, and COVID-19 infection. In general, the included studies show that decision support tools can show improvements in delivery of care and in health outcomes. Conclusions: Although the studies demonstrate the potential of positive impact of clinical decision support tools, there is variability in results, in part because of the diversity of types of decision support tools, users, and contexts as well as limited validation of the tools in use and in part because of the lack of clarity in defining the whole intervention. ", doi="10.2196/39681", url="https://www.jmir.org/2022/9/e39681", url="http://www.ncbi.nlm.nih.gov/pubmed/36066928" } @Article{info:doi/10.2196/39851, author="Boucher, Eliane and Honomichl, Ryan and Ward, Haley and Powell, Tyler and Stoeckl, Elizabeth Sarah and Parks, Acacia", title="The Effects of a Digital Well-being Intervention on Older Adults: Retrospective Analysis of Real-world User Data", journal="JMIR Aging", year="2022", month="Sep", day="2", volume="5", number="3", pages="e39851", keywords="mobile apps", keywords="mental health", keywords="older adults", keywords="technology adoption", keywords="digital health", keywords="mobile phone", abstract="Background: Digital interventions have been shown to be effective for a variety of mental health disorders and problems. However, few studies have examined the effects of digital interventions in older adults; therefore, little is known about how older adults engage with or benefit from these interventions. Given that adoption rates for technology among people aged ?65 years remain substantially lower than in the general population and that approximately 20\% of older adults are affected by mental health disorders, research exploring whether older adults will use and benefit from digital interventions is needed. Objective: This study aimed to examine the extent to which older adults engaged with a digital well-being intervention (Happify) and whether engaging with this program led to improvements in both subjective well-being and anxiety symptoms. Methods: In this retrospective analysis, we analyzed data from 375 real-world Happify users aged ?65 years who signed up for the platform between January 1, 2019, and December 23, 2021. Changes in well-being and anxiety symptoms across 42 to 182 days were assessed using responses to the in-app assessment, which users were prompted to take every 2 weeks, and were compared among users who engaged with the program at the recommended level (ie, 2 or more activities per week) or below the recommended level. Results: In all, 30\% (113/375) of the sample engaged with the platform at the recommended level (ie, completed an average of 2 or more activities per week), and overall, users completed an average of 43.35 (SD 87.80) activities, ranging from 1 to 786, between their first and last assessment. Users were also active on the platform for an average of 19.36 (SD 27.16) days, ranging from 1 to 152 days. Moreover, older adults who engaged at the recommended level experienced significantly greater improvements in subjective well-being (P=.002) and anxiety symptoms (P<.001) relative to those who completed fewer activities. Conclusions: These data provide preliminary evidence that older adults engage with and benefit from digital well-being interventions. We believe that these findings highlight the importance of considering older adult populations in digital health research. More research is needed to understand potential barriers to using digital interventions among older adults and whether digital interventions should be modified to account for this population's particular needs (eg, ensuring that the intervention is accessible using a variety of devices). However, these results are an important step in demonstrating the feasibility of such interventions in a population that is assumed to be less inclined toward digital approaches. ", doi="10.2196/39851", url="https://aging.jmir.org/2022/3/e39851", url="http://www.ncbi.nlm.nih.gov/pubmed/36053569" } @Article{info:doi/10.2196/37482, author="Alexander, L. Gregory and Liu, Jianfang and Powell, R. Kimberly and Stone, W. Patricia", title="Examining Structural Disparities in US Nursing Homes: National Survey of Health Information Technology Maturity", journal="JMIR Aging", year="2022", month="Aug", day="23", volume="5", number="3", pages="e37482", keywords="nursing homes", keywords="health information technology", keywords="policy", keywords="nursing informatics", keywords="electronic health record", keywords="electronic data", keywords="data sharing", keywords="care providers", keywords="resident", keywords="care", keywords="quality of care", keywords="structural disparity", keywords="clinical support", keywords="administration", abstract="Background: There are 15,632 nursing homes (NHs) in the United States. NHs continue to receive significant policy attention due to high costs and poor outcomes of care. One strategy for improving NH care is use of health information technology (HIT). A central concept of this study is HIT maturity, which is used to identify adoption trends in HIT capabilities, use and integration within resident care, clinical support, and administrative activities. This concept is guided by the Nolan stage theory, which postulates that a system such as HIT moves through a series of measurable stages. HIT maturity is an important component of the rapidly changing NH landscape, which is being affected by policies generated to protect residents, in part because of the pandemic. Objective: The aim of this study is to identify structural disparities in NH HIT maturity and see if it is moderated by commonly used organizational characteristics. Methods: NHs (n=6123, >20\%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. Results: Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7\%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. Conclusions: NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes. ", doi="10.2196/37482", url="https://aging.jmir.org/2022/3/e37482", url="http://www.ncbi.nlm.nih.gov/pubmed/35998030" } @Article{info:doi/10.2196/37315, 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/10.2196/34952, author="Chen, Wenwen and Flanagan, Ashley and Nippak, MD Pria and Nicin, Michael and Sinha, K. Samir", title="Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Mixed Methods Study", journal="JMIR Aging", year="2022", month="Aug", day="10", volume="5", number="3", pages="e34952", keywords="telemedicine", keywords="virtual care visit", keywords="geriatric care professionals", keywords="aging population", keywords="Consolidated Framework for Implementation Research", keywords="geriatric care", keywords="older adults", keywords="elderly care", keywords="telehealth", keywords="digital health", keywords="COVID-19", keywords="pandemic", keywords="technology usability", abstract="Background: Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be used to meet the needs of geriatric care professionals in providing care to frail older patients, their caregivers, and their families. Objective: This study aims to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and their families and how to maximize the benefits of this method of providing care. Methods: This was a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine technologies and participate in a semistructured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). Results: Quantitative and qualitative data were obtained from 30 practicing geriatric care professionals (22, 73\%, geriatricians, 5, 17\%, geriatric psychiatrists, and 3, 10\%, geriatric nurse practitioners) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (complexity, design quality and packaging, patient needs and resources, readiness for implementation, and culture) and 13 CFIR contextual facilitators (relative advantage, adaptability, tension for change, available resources, access to knowledge, networks and communications, compatibility, knowledge and beliefs, self-efficacy, champions, external agents, executing, and reflecting and evaluating). The CFIR concept of external policy and incentives was found to be a neutral construct. Conclusions: This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of Ontario geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person but is less useful in providing specific aspects of geriatric care to frail older patients, their caregivers, and their families. ", doi="10.2196/34952", url="https://aging.jmir.org/2022/3/e34952", url="http://www.ncbi.nlm.nih.gov/pubmed/35830331" } @Article{info:doi/10.2196/36515, author="Lippke, Sonia and Ratz, Tiara and Keller, Maria Franziska and Juljugin, Dennis and Peters, Manuela and Pischke, Claudia and Voelcker-Rehage, Claudia", title="Mitigating Feelings of Loneliness and Depression by Means of Web-Based or Print-Based Physical Activity Interventions: Pooled Analysis of 2 Community-Based Intervention Trials", journal="JMIR Aging", year="2022", month="Aug", day="9", volume="5", number="3", pages="e36515", keywords="physical activity", keywords="older adults", keywords="intervention", keywords="loneliness", keywords="depression", keywords="eHealth", keywords="mobile health", keywords="mHealth", abstract="Background: Physical activity (PA) is associated with benefits, such as fewer depressive symptoms and loneliness. Web- and print-based PA interventions can help older individuals accordingly. Objective: We aimed to test the following research questions: Do PA interventions delivered in a web- or print-based mode improve self-reported PA stage of change, social-cognitive determinants of PA, loneliness, and symptoms of depression? Is subjective age a mediator and stage of change a moderator of this effect? Methods: Overall, 831 adults aged ?60 years were recruited and either allocated to a print-based or web-based intervention group or assigned to a wait-list control group (WLCG) in 2 community-based PA intervention trials over 10 weeks. Missing value imputation using an expectation-maximization algorithm was applied. Frequency analyses, multivariate analyses of variance, and moderated mediation analyses were conducted. Results: The web-based intervention outperformed (47/59, 80\% of initially inactive individuals being adopters, and 396/411, 96.4\% of initially active individuals being maintainers of the recommended PA behavior) the print-based intervention (20/25, 80\% of adopters, and 63/69, 91\% of maintainers) and the WLCG (5/7, 71\% of adopters; 141/150, 94\% of maintainers). The pattern regarding adopters was statistically significant (web vs print Z=--1.94; P=.02; WLCG vs web Z=3.8367; P=.01). The pattern was replicated with stages ($\chi$24=79.1; P<.001; contingency coefficient 0.314; P<.001); in the WLCG, 40.1\% (63/157) of the study participants moved to or remained in action stage. This number was higher in the groups receiving web-based (357/470, 76\%) or print-based interventions (64/94, 68.1\%). A significant difference was observed favoring the 2 intervention groups over and above the WLCG (F19, 701=4.778; P<.001; $\eta$2=0.098) and a significant interaction of time and group (F19, 701=2.778; P<.001; $\eta$2=0.070) for predictors of behavior. The effects of the interventions on subjective age, loneliness, and depression revealed that both between-group effects (F3, 717=8.668; P<.001; $\eta$2=0.018) and the interaction between group and time were significant (F3, 717=6.101; P<.001; $\eta$2=0.025). In a moderated mediation model, both interventions had a significant direct effect on depression in comparison with the WLCG (web-based: c{\textasciiacutex} path ?0.86, 95\% CI ?1.58 to ?0.13, SE 0.38; print-based: c{\textasciiacutex} path ?1.96, 95\% CI ?2.99 to ?0.92, SE 0.53). Furthermore, subjective age was positively related to depression (b path 0.14, 95\% CI 0.05-0.23; SE 0.05). An indirect effect of the intervention on depression via subjective age was only present for participants who were in actor stage and received the web-based intervention (ab path ?0.14, 95\% CI ?0.34 to ?0.01; SE 0.09). Conclusions: Web-based interventions appear to be as effective as print-based interventions. Both modes might help older individuals remain or become active and experience fewer depression symptoms, especially if they feel younger. Trial Registration: German Registry of Clinical Trials DRKS00010052 (PROMOTE 1); https://tinyurl.com/nnzarpsu and DRKS00016073 (PROMOTE 2); https://tinyurl.com/4fhcvkwy International Registered Report Identifier (IRRID): RR2-10.2196/15168 ", doi="10.2196/36515", url="https://aging.jmir.org/2022/3/e36515", url="http://www.ncbi.nlm.nih.gov/pubmed/35943790" } @Article{info:doi/10.2196/35425, author="Gerritzen, Vera Esther and Lee, Rebecca Abigail and McDermott, Orii and Coulson, Neil and Orrell, Martin", title="Online Peer Support for People With Parkinson Disease: Narrative Synthesis Systematic Review", journal="JMIR Aging", year="2022", month="Jul", day="27", volume="5", number="3", pages="e35425", keywords="Parkinson disease", keywords="web-based health community", keywords="online peer support", keywords="narrative synthesis", keywords="systematic review", abstract="Background: Parkinson disease (PD) significantly impacts the lives of people with the diagnosis and their families. In addition to the physical symptoms, living with PD also has an emotional impact. This can result in withdrawal from social roles, increasing the risk for social isolation and loneliness. Peer support is a way to stay socially connected, share experiences, and learn new coping skills. Peer support can be provided both in person and on the internet. Some of the advantages of online peer support are that it overcomes geographical barriers and provides a form of anonymity; moreover, support can be readily available when needed. However, the psychosocial impact of PD is still underresearched, and there is no systematic synthesis of online peer support for people with PD. Objective: This review aims to explore the benefits and challenges of online peer support and identify successful elements of online peer support for people with PD. Methods: The method selected for this systematic review is narrative synthesis. A total of 6 databases were systematically searched in April 2020 for articles published between 1989 and 2020. The quality of the included studies was assessed using the Critical Appraisal Skills Programme qualitative research checklist and the Downs and Black quality checklist. Results: A total of 10,987 unique articles were identified through a systematic database search. Of these 10,987 articles, 8 (0.07\%) were included in this review. Of the 8 studies, 5 (63\%) were of good or high quality, 2 (25\%) were of medium or fair quality, and 1 (13\%) study was of poor quality. Web-based platforms included discussion forums, a web-based virtual world, and Facebook groups. Most papers reported on text-based communication. The included studies reported on sharing social support and personal experiences. Successful elements included increasing similarity between members and offering the opportunity to directly ask questions to a physician. Challenges included members leaving without a warning and PD symptoms hindering the use of technology. Conclusions: Peer support can improve social support and help people with PD in living meaningful and satisfying lives. Peer support is unique and cannot be replaced by family members, friends, or health care professionals. Online peer support can be a solution for those who do not have access to an in-person support group or whose PD symptoms restrict them from travelling. However, research on the personal experiences of those who engage in online peer support and potential barriers in accessing it remains limited. Future research could use qualitative methods to explore these fields further. ", doi="10.2196/35425", url="https://aging.jmir.org/2022/3/e35425", url="http://www.ncbi.nlm.nih.gov/pubmed/35896025" } @Article{info:doi/10.2196/35028, author="Ufholz, Kelsey and Sheon, Amy and Bhargava, Daksh and Rao, Goutham", title="Telemedicine Preparedness Among Older Adults With Chronic Illness: Survey of Primary Care Patients", journal="JMIR Form Res", year="2022", month="Jul", day="27", volume="6", number="7", pages="e35028", keywords="telemedicine", keywords="seniors", keywords="primary care", keywords="chronic illness", keywords="health equities", keywords="telehealth", keywords="older adult", keywords="healthcare", keywords="health care", keywords="digital health", keywords="senior health", abstract="Background: Older adults are a high priority for telemedicine given their elevated COVID-19 risk and need for frequent provider contact to manage chronic illnesses. It seems that many older adults now use smartphones but few studies have examined their overall readiness for telemedicine. Objective: The aim of this study is to survey older primary care patients about their telemedicine preparedness, including internet usage, internet-capable devices, telemedicine experiences and concerns, and perceived barriers. Results were used to inform a telemedicine preparedness training program. Methods: Community-dwelling older adult patients (aged 65-81 years; N=30) with a chronic health condition that could be managed remotely who were present at a family medicine clinic that primarily serves an urban African American population for a prescheduled in-person appointment were asked to complete a brief survey written for this study. Data were collected February-June 2021 at a large, urban, Midwestern hospital. To minimize patient burden, the survey was limited to 10 questions, focused on the most critical topics. Results: Most participants (21/30, 70\%) reported having a device that could be used for telemedicine and using the internet. However, about half had only a single connected device, and messaging and video calling were the most commonly used applications. Few used email and none used online shopping or banking. Only 7 patients had had telemedicine appointments. Telemedicine users were younger than nonusers and used more internet functions than nonusers. Only 2 people reported problems with their telemedicine visits (technology and privacy). Nearly all respondents recognized avoiding travel and COVID-19 exposure as telemedicine benefits. The most common concerns were loss of the doctor-patient connection and inability to be examined. Conclusions: Most older adults reported having devices that could be used for telemedicine, but their internet use patterns did not confirm the adequacy of their devices or skills for telemedicine. Doctor-patient conversations could be helpful in addressing telemedicine concerns but device and skill gaps must be addressed as well. ", doi="10.2196/35028", url="https://formative.jmir.org/2022/7/e35028", url="http://www.ncbi.nlm.nih.gov/pubmed/35896013" } @Article{info:doi/10.2196/37729, author="De Santis, Karolina Karina and Mergenthal, Lea and Christianson, Lara and Zeeb, Hajo", title="Digital Technologies for Health Promotion and Disease Prevention in Older People: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2022", month="Jul", day="21", volume="11", number="7", pages="e37729", keywords="digital technology", keywords="health technology", keywords="digital public health", keywords="health promotion", keywords="disease prevention", keywords="healthy aging", keywords="elderly population", keywords="older adult", keywords="older population", keywords="scoping review", abstract="Background: Digital technologies could contribute to health promotion and disease prevention. It is unclear if and how such digital technologies address the health needs of older people in nonclinical settings (ie, daily life). Objective: This study aims to identify digital technologies for health promotion and disease prevention that target the needs of older people in nonclinical settings by performing a scoping review of the published literature. The scoping review is guided by the framework of Arksey and O'Malley. Methods: Our scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The information sources are bibliographic databases (MEDLINE, PsycINFO, CINAHL, and SCOPUS) and bibliographies of any included systematic reviews. Manual searches for additional studies will be performed in Google Scholar and most relevant journals. The electronic search strategy was developed in collaboration with a librarian who performed the search for studies on digital technologies for health promotion and disease prevention targeting the needs of older people. Study selection and data coding will be performed independently by 2 authors. Consensus will be reached by discussion. Eligibility is based on the PCC (Population, Concept, and Context) criteria as follows: (1) older people (population); (2) any digital (health) technology, such as websites, smartphone apps, or wearables (concept); and (3) health promotion and disease prevention in nonclinical (daily life, home, or community) settings (context). Primary studies with any design or reviews with a systematic methodology published in peer-reviewed academic journals will be included. Data items will address study designs, PCC criteria, benefits or barriers related to digital technology use by older people, and evidence gaps. Data will be synthesized using descriptive statistics or narratively described by identifying common themes. Quality appraisal will be performed for any included systematic reviews, using a validated instrument for this study type (A Measurement Tool to Assess Systematic Reviews, version 2 [AMSTAR2]). Results: Following preliminary literature searches to test and calibrate the search syntax, the electronic literature search was performed in March 2022 and manual searches were completed in June 2022. Study selection based on titles and abstracts was completed in July 2022, and the full-text screen was initiated in July 2022. Conclusions: Our scoping review will identify the types of digital technologies, health targets in the context of health promotion and disease prevention, and health benefits or barriers associated with the use of such technologies for older people in nonclinical settings. This knowledge could guide further research on how digital technologies can support healthy aging. International Registered Report Identifier (IRRID): PRR1-10.2196/37729 ", doi="10.2196/37729", url="https://www.researchprotocols.org/2022/7/e37729", url="http://www.ncbi.nlm.nih.gov/pubmed/35862187" } @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/10.2196/34793, author="Savage, D. Rachel and Di Nicolo, Sophia and Wu, Wei and Li, Joyce and Lawson, Andrea and Grieve, Jim and Goel, Vivek and Rochon, A. Paula", title="The Factors Associated With Nonuse of Social Media or Video Communications to Connect With Friends and Family During the COVID-19 Pandemic in Older Adults: Web-Based Survey Study", journal="JMIR Aging", year="2022", month="Jun", day="6", volume="5", number="2", pages="e34793", keywords="digital technology", keywords="loneliness", keywords="older adults", keywords="COVID-19", keywords="elderly", keywords="lonely", keywords="mental health", keywords="factor", keywords="usage", keywords="social media", keywords="video", keywords="communication", keywords="connection", keywords="connect", keywords="family", keywords="friend", keywords="age", keywords="support", abstract="Background: Digital technologies have enabled social connection during prolonged periods of physical distancing and travel restrictions throughout the COVID-19 pandemic. These solutions may exclude older adults, who are at higher risk for social isolation, loneliness, and severe outcomes if infected with SARS-CoV-2. Objective: This study investigated factors associated with nonuse of social media or video communications to connect with friends and family among older adults during the pandemic's first wave. Methods: A web-based, cross-sectional survey was administered to members of a national retired educators' organization based in Ontario, Canada, between May 6 and 19, 2020. Respondents (N=4879) were asked about their use of social networking websites or apps to communicate with friends and family, their internet connection and smartphone access, loneliness, and sociodemographic characteristics. Factors associated with nonuse were evaluated using multivariable logistic regression. A thematic analysis was performed on open-ended survey responses that described experiences with technology and virtual connection. Results: Overall, 15.4\% (751/4868) of respondents did not use social networking websites or apps. After adjustment, male gender (odds ratio [OR] 1.60, 95\% CI 1.33-1.92), advanced age (OR 1.88, 95\% CI 1.38-2.55), living alone (OR 1.68, 95\% CI 1.39-2.02), poorer health (OR 1.33, 95\% CI 1.04-1.71), and lower social support (OR 1.44, 95\% CI 1.20-1.71) increased the odds of nonuse. The reliability of internet connection and access to a smartphone also predicted nonuse. Many respondents viewed these technologies as beneficial, especially for maintaining pre--COVID-19 social contacts and routines, despite preferences for in-person connection. Conclusions: Several factors including advanced age, living alone, and low social support increased the odds of nonuse of social media in older adults to communicate with friends and family during COVID-19's first wave. Our findings identified socially vulnerable subgroups who may benefit from intervention (eg, improved access, digital literacy, and telephone outreach) to improve social connection. ", doi="10.2196/34793", url="https://aging.jmir.org/2022/2/e34793", url="http://www.ncbi.nlm.nih.gov/pubmed/35344502" } @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/10.2196/34628, author="Wolff, L. Jennifer and Dukhanin, Vadim and Burgdorf, G. Julia and DesRoches, M. Catherine", title="Shared Access to Patient Portals for Older Adults: Implications for Privacy and Digital Health Equity", journal="JMIR Aging", year="2022", month="May", day="4", volume="5", number="2", pages="e34628", keywords="patient portal", keywords="electronic health record", keywords="care partners", keywords="proxy", keywords="health equity", keywords="health informatics", keywords="health services", keywords="elderly", keywords="older adults", keywords="aging", keywords="cognition", keywords="health system", keywords="care delivery", keywords="elderly care", doi="10.2196/34628", url="https://aging.jmir.org/2022/2/e34628", url="http://www.ncbi.nlm.nih.gov/pubmed/35507405" } @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/10.2196/32169, author="Gudala, Meghana and Ross, Trail Mary Ellen and Mogalla, Sunitha and Lyons, Mandi and Ramaswamy, Padmavathy and Roberts, Kirk", title="Benefits of, Barriers to, and Needs for an Artificial Intelligence--Powered Medication Information Voice Chatbot for Older Adults: Interview Study With Geriatrics Experts", journal="JMIR Aging", year="2022", month="Apr", day="28", volume="5", number="2", pages="e32169", keywords="medication information", keywords="chatbot", keywords="older adults", keywords="technology capabilities", keywords="mobile phone", abstract="Background: One of the most complicated medical needs of older adults is managing their complex medication regimens. However, the use of technology to aid older adults in this endeavor is impeded by the fact that their technological capabilities are lower than those of much of the rest of the population. What is needed to help manage medications is a technology that seamlessly integrates within their comfort levels, such as artificial intelligence agents. Objective: This study aimed to assess the benefits, barriers, and information needs that can be provided by an artificial intelligence--powered medication information voice chatbot for older adults. Methods: A total of 8 semistructured interviews were conducted with geriatrics experts. All interviews were audio-recorded and transcribed. Each interview was coded by 2 investigators (2 among ML, PR, METR, and KR) using a semiopen coding method for qualitative analysis, and reconciliation was performed by a third investigator. All codes were organized into the benefit/nonbenefit, barrier/nonbarrier, and need categories. Iterative recoding and member checking were performed until convergence was reached for all interviews. Results: The greatest benefits of a medication information voice-based chatbot would be helping to overcome the vision and dexterity hurdles experienced by most older adults, as it uses voice-based technology. It also helps to increase older adults' medication knowledge and adherence and supports their overall health. The main barriers were technology familiarity and cost, especially in lower socioeconomic older adults, as well as security and privacy concerns. It was noted however that technology familiarity was not an insurmountable barrier for older adults aged 65 to 75 years, who mostly owned smartphones, whereas older adults aged >75 years may have never been major users of technology in the first place. The most important needs were to be usable, to help patients with reminders, and to provide information on medication side effects and use instructions. Conclusions: Our needs analysis results derived from expert interviews clarify that a voice-based chatbot could be beneficial in improving adherence and overall health if it is built to serve the many medication information needs of older adults, such as reminders and instructions. However, the chatbot must be usable and affordable for its widespread use. ", doi="10.2196/32169", url="https://aging.jmir.org/2022/2/e32169", url="http://www.ncbi.nlm.nih.gov/pubmed/35482367" } @Article{info:doi/10.2196/35925, author="Kokorelias, Marie Kristina and Nelson, LA Michelle and Tang, Terence and Steele Gray, Carolyn and Ellen, Moriah and Plett, Donna and Jarach, Micaela Carlotta and Xin Nie, Jason and Thavorn, Kednapa and Singh, Hardeep", title="Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations", journal="JMIR Aging", year="2022", month="Apr", day="27", volume="5", number="2", pages="e35925", keywords="older adults", keywords="digital technology", keywords="transitions", keywords="older adult population", keywords="digital health", keywords="Digital Hospital", keywords="health intervention", keywords="aging", keywords="gender diversity", keywords="home transition", keywords="epidemiology", abstract="Background: Digital health technologies have been proposed to support hospital-to-home transition for older adults. The COVID-19 pandemic and the associated physical distancing guidelines have propelled a shift toward digital health technologies. However, the characteristics of older adults who participated in digital health research interventions to support hospital-to-home transitions remain unclear. This information is needed to assess whether current digital health interventions are generalizable to the needs of the broader older adult population. Objective: This rapid review of the existing literature aimed to identify the characteristics of the populations targeted by studies testing the implementation of digital health interventions designed to support hospital-to-home transitions, identify the characteristics of the samples included in studies testing digital health interventions used to support hospital-to-home transitions, and create recommendations for enhancing the diversity of samples within future hospital-to-home digital health interventions. Methods: A rapid review methodology based on scoping review guidelines by Arksey and O'Malley was developed. A search for peer-reviewed literature published between 2010 and 2021 on digital health solutions that support hospital-to-home transitions for older adults was conducted using MEDLINE, Embase, and CINAHL databases. The data were analyzed using descriptive statistics and qualitative content analysis. The Sex- and Gender-Based Analysis Plus lens theoretically guided the study design, analysis, and interpretation. Results: A total of 34 studies met the inclusion criteria. Our findings indicate that many groups of older adults were excluded from these interventions and remain understudied. Specifically, the oldest old and those living with cognitive impairments were excluded from the studies included in this review. In addition, very few studies have described the characteristics related to gender diversity, education, race, ethnicity, and culture. None of the studies commented on the sexual orientation of the participants. Conclusions: This is the first review, to our knowledge, that has mapped the literature focusing on the inclusion of older adults in digital hospital-to-home interventions. The findings suggest that the literature on digital health interventions tends to operationalize older adults as a homogenous group, ignoring the heterogeneity in older age definitions. Inconsistency in the literature surrounding the characteristics of the included participants suggests a need for further study to better understand how digital technologies to support hospital-to-home transitions can be inclusive. ", doi="10.2196/35925", url="https://aging.jmir.org/2022/2/e35925", url="http://www.ncbi.nlm.nih.gov/pubmed/35475971" } @Article{info:doi/10.2196/32473, author="Boumans, Roel and van de Sande, Yana and Thill, Serge and Bosse, Tibor", title="Voice-Enabled Intelligent Virtual Agents for People With Amnesia: Systematic Review", journal="JMIR Aging", year="2022", month="Apr", day="25", volume="5", number="2", pages="e32473", keywords="intelligent virtual agent", keywords="amnesia", keywords="dementia", keywords="Alzheimer", keywords="systematic review", keywords="mobile phone", abstract="Background: Older adults often have increasing memory problems (amnesia), and approximately 50 million people worldwide have dementia. This syndrome gradually affects a patient over a period of 10-20 years. Intelligent virtual agents may support people with amnesia. Objective: This study aims to identify state-of-the-art experimental studies with virtual agents on a screen capable of verbal dialogues with a target group of older adults with amnesia. Methods: We conducted a systematic search of PubMed, SCOPUS, Microsoft Academic, Google Scholar, Web of Science, and CrossRef on virtual agent and amnesia on papers that describe such experiments. Search criteria were (Virtual Agent OR Virtual Assistant OR Virtual Human OR Conversational Agent OR Virtual Coach OR Chatbot) AND (Amnesia OR Dementia OR Alzheimer OR Mild Cognitive Impairment). Risk of bias was evaluated using the QualSyst tool (University of Alberta), which scores 14 study quality items. Eligible studies are reported in a table including country, study design type, target sample size, controls, study aims, experiment population, intervention details, results, and an image of the agent. Results: A total of 8 studies was included in this meta-analysis. The average number of participants in the studies was 20 (SD 12). The verbal interactions were generally short. The usability was generally reported to be positive. The human utterance was seen in 7 (88\%) out of 8 studies based on short words or phrases that were predefined in the agent's speech recognition algorithm. The average study quality score was 0.69 (SD 0.08) on a scale of 0 to 1. Conclusions: The number of experimental studies on talking about virtual agents that support people with memory problems is still small. The details on the verbal interaction are limited, which makes it difficult to assess the quality of the interaction and the possible effects of confounding parameters. In addition, the derivation of the aggregated data was difficult. Further research with extended and prolonged dialogues is required. ", doi="10.2196/32473", url="https://aging.jmir.org/2022/2/e32473", url="http://www.ncbi.nlm.nih.gov/pubmed/35468084" } @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/10.2196/33165, 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/10.2196/28724, author="Pang, Ning-Qi and Lau, Jerrald and Fong, Si-Ying and Wong, Yu-Hui Celine and Tan, Ker-Kan", title="Telemedicine Acceptance Among Older Adult Patients With Cancer: Scoping Review", journal="J Med Internet Res", year="2022", month="Mar", day="29", volume="24", number="3", pages="e28724", keywords="older adult patients", keywords="cancer", keywords="telemedicine", keywords="acceptability", keywords="satisfaction", abstract="Background: Cancer is likely to remain the most prevalent noncommunicable disease in high-income countries with an older population. Interestingly, no review of attitudes toward telemedicine among older adults has been performed. This is likely to be the group most affected by both cancer and the increasing use of technology in health care. Objective: We aimed to map research on the acceptance of telemedicine among older adults who are cancer patients. Methods: We conducted a scoping review. PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to September 2020. Articles were included if the study population had a mean or median age ?65 years, with cancer diagnoses and if the study assessed patients' acceptance of a telemedicine intervention. Quantitative, qualitative, and mixed method studies were included. Results: Out of a total of 887 articles that were identified, 19 were included in the review. Interventions were delivered via telephone, videoconference, web portal, mobile app, wearable technology, and text messaging and included teleconsultation, monitoring and follow-up, psychosocial support and nursing care, and prompts. The most often cited facilitating factor was convenience. Other facilitators included an increase in telemedicine care accessibility, previous positive experiences of telemedicine, appropriate technical knowledge and support, decreased cost, physician recommendations, and privacy conferred by the telemedicine intervention. Barriers include a preference for conventional care along with negative perceptions of telemedicine, concerns about technical difficulties, and confidentiality concerns in the adoption of telemedicine. Conclusions: None of the studies explored the ability of tailored interventions to address facilitators and barriers of the acceptance of telemedicine in order to increase its adoption by older adults. Facilitators and barriers will likely differ across different cultural contexts and by type of telemedicine; however, this is a gap in current knowledge. In-depth studies are necessary to determine if interventions could potentially address the barriers identified in this review, to increase acceptability. ", doi="10.2196/28724", url="https://www.jmir.org/2022/3/e28724", url="http://www.ncbi.nlm.nih.gov/pubmed/35348462" } @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/10.2196/31912, author="Wong, Ching Arkers Kwan and Bayuo, Jonathan and Wong, Yuet Frances Kam and Yuen, Shan Wing and Lee, Lam Athena Yin and Chang, King Pui and Lai, Chui Jojo Tsz", title="Effects of a Nurse-Led Telehealth Self-care Promotion Program on the Quality of Life of Community-Dwelling Older Adults: Systematic Review and Meta-analysis", journal="J Med Internet Res", year="2022", month="Mar", day="21", volume="24", number="3", pages="e31912", keywords="telehealth", keywords="meta-analysis", keywords="self-care", keywords="community-dwelling older adult", keywords="nurse", abstract="Background: In recent years, telehealth has become a common channel for health care professionals to use to promote health and provide distance care. COVID-19 has further fostered the widespread use of this new technology, which can improve access to care while protecting the community from exposure to infection by direct personal contact, and reduce the time and cost of traveling for both health care users and providers. This is especially true for community-dwelling older adults who have multiple chronic diseases and require frequent hospital visits. Nurses are globally recognized as health care professionals who provide effective community-based care to older adults, facilitating their desire to age in place. However, to date, it is unclear whether the use of telehealth can facilitate their work of promoting self-care to community-dwelling older adults. Objective: This review aims to summarize findings from randomized controlled trials on the effect of nurse-led telehealth self-care promotion programs compared with the usual on-site or face-to-face services on the quality of life (QoL), self-efficacy, depression, and hospital admissions among community-dwelling older adults. Methods: A search of 6 major databases was undertaken of relevant studies published from May 2011 to April 2021. Standardized mean differences (SMDs) and their 95\% CIs were calculated from postintervention outcomes for continuous data, while the odds ratio was obtained for dichotomous data using the Mantel--Haenszel test. Results: From 1173 possible publications, 13 trials involving a total of 4097 participants were included in this meta-analysis. Compared with the control groups, the intervention groups of community-dwelling older adults significantly improved in overall QoL (SMD 0.12; 95\% CI 0.03 to 0.20; P=.006; I2=21\%), self-efficacy (SMD 0.19; 95\% CI 0.08 to 0.30; P<.001; I2=0\%), and depression level (SMD --0.22; 95\% CI --0.36 to --0.08; P=.003; I2=89\%). Conclusions: This meta-analysis suggests that employing telehealth in nurse-led self-care promotion programs may have a positive impact on older adults, although more studies are needed to strengthen the evidence base, particularly regarding organization and delivery. Trial Registration: PROSPERO (Prospective International Register of Systematic Reviews) CRD42021257299; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=257299 ", doi="10.2196/31912", url="https://www.jmir.org/2022/3/e31912", url="http://www.ncbi.nlm.nih.gov/pubmed/35311680" } @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/10.2196/34221, 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/10.2196/34790, author="Zhao, Chris Yuxiang and Zhao, Mengyuan and Song, Shijie", title="Online Health Information Seeking Behaviors Among Older Adults: Systematic Scoping Review", journal="J Med Internet Res", year="2022", month="Feb", day="16", volume="24", number="2", pages="e34790", keywords="older adults", keywords="online health information seeking", keywords="health information behavior", keywords="aging technology", keywords="systematic scoping review", abstract="Background: With the world's population aging, more health-conscious older adults are seeking health information to make better-informed health decisions. The rapid growth of the internet has empowered older adults to access web-based health information sources. However, research explicitly exploring older adults' online health information seeking (OHIS) behavior is still underway. Objective: This systematic scoping review aims to understand older adults' OHIS and answer four research questions: (1) What types of health information do older adults seek and where do they seek health information on the internet? (2) What are the factors that influence older adults' OHIS? (3) What are the barriers to older adults' OHIS? (4) How can we intervene and support older adults' OHIS? Methods: A comprehensive literature search was performed in November 2020, involving the following academic databases: Web of Science; Cochrane Library database; PubMed; MEDLINE; CINAHL Plus; APA PsycINFO; Library and Information Science Source; Library, Information Science and Technology Abstracts; Psychology and Behavioral Sciences Collection; Communication \& Mass Media Complete; ABI/INFORM; and ACM Digital Library. The initial search identified 8047 publications through database search strategies. After the removal of duplicates, a data set consisting of 5949 publications was obtained for screening. Among these, 75 articles met the inclusion criteria. Qualitative content analysis was performed to identify themes related to the research questions. Results: The results suggest that older adults seek 10 types of health information from 6 types of internet-based information sources and that 2 main categories of influencing factors, individual-related and source-related, impact older adults' OHIS. Moreover, the results reveal that in their OHIS, older adults confront 3 types of barriers, namely individual, social, and those related to information and communication technologies. Some intervention programs based on educational training workshops have been created to intervene and support older adults' OHIS. Conclusions: Although OHIS has become increasingly common among older adults, the review reveals that older adults' OHIS behavior is not adequately investigated. The findings suggest that more studies are needed to understand older adults' OHIS behaviors and better support their medical and health decisions in OHIS. Based on the results, the review proposes multiple objectives for future studies, including (1) more investigations on the OHIS behavior of older adults above 85 years; (2) conducting more longitudinal, action research, and mixed methods studies; (3) elaboration of the mobile context and cross-platform scenario of older adults' OHIS; (4) facilitating older adults' OHIS by explicating technology affordance; and (5) promoting and measuring the performance of OHIS interventions for older adults. ", doi="10.2196/34790", url="https://www.jmir.org/2022/2/e34790", url="http://www.ncbi.nlm.nih.gov/pubmed/35171099" } @Article{info:doi/10.2196/31920, author="Yu, Jiyeon and de Antonio, Angelica and Villalba-Mora, Elena", title="Design of an Integrated Acceptance Framework for Older Users and eHealth: Influential Factor Analysis", journal="J Med Internet Res", year="2022", month="Jan", day="28", volume="24", number="1", pages="e31920", keywords="eHealth", keywords="older people", keywords="older user", keywords="health technology", keywords="acceptance factors", keywords="adoption", keywords="acceptance framework", keywords="systematic review", keywords="thematic analysis", keywords="influential factor analysis", keywords="mobile phone", abstract="Background: eHealth and telehealth play a crucial role in assisting older adults who visit hospitals frequently or who live in nursing homes and can benefit from staying at home while being cared for. Adapting to new technologies can be difficult for older people. Thus, to better apply these technologies to older adults' lives, many studies have analyzed the acceptance factors for this particular population. However, there is not yet a consensual framework that can be used in further development and to search for solutions. Objective: This paper aims to present an integrated acceptance framework (IAF) for older users' acceptance of eHealth based on 43 studies selected through a systematic review. Methods: We conducted a 4-step study. First, through a systematic review in the field of eHealth from 2010 to 2020, the acceptance factors and basic data for analysis were extracted. Second, we conducted a thematic analysis to group the factors into themes to propose an integrated framework for acceptance. Third, we defined a metric to evaluate the impact of the factors addressed in the studies. Finally, the differences among the important IAF factors were analyzed according to the participants' health conditions, verification time, and year. Results: Through a systematic review, 731 studies were found in 5 major databases, resulting in 43 (5.9\%) selected studies using the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) methodology. First, the research methods and acceptance factors for eHealth were compared and analyzed, extracting a total of 105 acceptance factors, which were grouped later, resulting in an IAF. A total of 5 dimensions (ie, personal, user--technology relational, technological, service-related, and environmental) emerged, with a total of 23 factors. In addition, we assessed the quality of evidence and then conducted a stratification analysis to reveal the more appropriate factors depending on the health condition and assessment time. Finally, we assessed the factors and dimensions that have recently become more important. Conclusions: The result of this investigation is a framework for conducting research on eHealth acceptance. To elaborately analyze the impact of the factors of the proposed framework, the criteria for evaluating the evidence from the studies that have the extracted factors are presented. Through this process, the impact of each factor in the IAF has been presented, in addition to the framework proposal. Moreover, a meta-analysis of the current status of research is presented, highlighting the areas where specific measures are needed to facilitate eHealth acceptance. ", doi="10.2196/31920", url="https://www.jmir.org/2022/1/e31920", url="http://www.ncbi.nlm.nih.gov/pubmed/35089155" } @Article{info:doi/10.2196/34616, author="Lama, Yuki and Davidoff, J. Amy and Vanderpool, C. Robin and Jensen, E. Roxanne", title="Telehealth Availability and Use of Related Technologies Among Medicare-Enrolled Cancer Survivors: Cross-sectional Findings From the Onset of the COVID-19 Pandemic", journal="J Med Internet Res", year="2022", month="Jan", day="25", volume="24", number="1", pages="e34616", keywords="cancer survivor", keywords="Medicare", keywords="telehealth", keywords="COVID-19", keywords="availability", keywords="use", keywords="elderly", keywords="older adults", keywords="cancer", keywords="sociodemographic", keywords="internet", keywords="communication", keywords="population", keywords="access", abstract="Background: There has been rapid integration of telehealth into care delivery during the COVID-19 pandemic. However, little is known about technology ownership, internet access and use for communication, and telehealth availability among cancer survivors, particularly those enrolled in Medicare. Objective: This study aims to identify sociodemographic associations with technology ownership, internet access and use for communication, and telehealth availability in a population-based sample of Medicare-enrolled cancer survivors. Methods: Data are from the Medicare Current Beneficiary Survey COVID-19 Summer 2020 Supplement administered between June 10 and July 15, 2020. Analyses were restricted to beneficiaries who reported a prior (nonskin) cancer diagnosis and a usual source of care (N=2044). Dichotomous outcomes included technology ownership, internet access, internet use for communication, and telehealth availability from providers. Sociodemographic correlates included sex, age, race/ethnicity, Medicare/Medicaid dual enrollment, rurality, census region, and self-reported comorbidities. Results: Over half (957/2044, 53\%) of cancer survivors reported using the internet for communication purposes, and 62\% (1218/2044) reported that their usual provider had telehealth services available. Using the internet for communication purposes was reported less frequently for rural compared to urban survivors (adjusted probability of 28\% vs 46\%; P<.001) and for Hispanic and Black survivors compared to non-Hispanic White survivors (29\%, 31\%, and 44\%, respectively; all P<.01). Rural survivors reported lower telehealth availability (53\% vs 63\%; P<.001); no significant differences in telehealth availability were identified by race/ethnicity. Conclusions: During the COVID-19 pandemic, study findings highlight a complex digital divide among Medicare beneficiaries with a history of cancer related to device ownership necessary for telehealth, internet access and use for communication, and reports of providers having telehealth available. Multilevel approaches are needed to increase equitable telehealth availability and use for cancer survivors. Suggested strategies include increasing broadband internet access to providers and patients in at-risk communities, supporting telehealth implementation among providers that serve populations with known health disparities, raising awareness of providers' available telehealth services among patients, and screening for technology use and provision of telehealth-related technical assistance among older and historically underserved cancer survivors. ", doi="10.2196/34616", url="https://www.jmir.org/2022/1/e34616", url="http://www.ncbi.nlm.nih.gov/pubmed/34978531" } @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/10.2196/28113, author="Stargatt, Jennifer and Bhar, Sunil and Bhowmik, Jahar and Al Mahmud, Abdullah", title="Digital Storytelling for Health-Related Outcomes in Older Adults: Systematic Review", journal="J Med Internet Res", year="2022", month="Jan", day="12", volume="24", number="1", pages="e28113", keywords="digital storytelling", keywords="mental health", keywords="aging", keywords="dementia", keywords="reminiscence", keywords="memory", keywords="systematic review", keywords="older adults", abstract="Background: Older adults face a unique set of challenges and may experience a range of psychological comorbidities. Digital storytelling is an emerging tool for sharing and recording lived experiences and may have the potential to support well-being but is yet to be systematically reviewed for use among older adults. Objective: The aim of this review is to examine the methods for creating digital stories, the health-related outcomes associated with creating digital stories, and the potential for implementing digital storytelling with older adults. Methods: We systematically searched electronic databases to identify articles published in English that reported on at least one health-related outcome of digital storytelling for participants aged ?60 years. Data were extracted and synthesized using qualitative content analysis and summarized in tables. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool. Results: A total of 8 studies were included in the review. Participants were primarily community-dwelling older adults living with dementia, involving family caregivers and professional care staff. Studies have taken various approaches to digital storytelling and reported diverse benefits associated with digital storytelling, including improvements in mood, memory, social engagement, and quality of relationships. Although the potential for implementation was not widely examined, some studies have presented evidence for acceptability and feasibility. Generally, studies were of high quality, despite the absence of comparator groups and confounder analyses. Conclusions: The evidence reviewed suggests that despite the various approaches taken, digital storytelling shows promise as an effective approach for supporting well-being in older adults. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019145922; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42019145922 International Registered Report Identifier (IRRID): RR2-10.2196/15512 ", doi="10.2196/28113", url="https://www.jmir.org/2022/1/e28113", url="http://www.ncbi.nlm.nih.gov/pubmed/35019845" } @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/10.2196/30807, author="Senoo, Keitaro and Miki, Tomonori and Ohkura, Takashi and Iwakoshi, Hibiki and Nishimura, Tetsuro and Shiraishi, Hirokazu and Teramukai, Satoshi and Matoba, Satoaki", title="A Smartphone App to Improve Oral Anticoagulation Adherence in Patients With Atrial Fibrillation: Prospective Observational Study", journal="JMIR Mhealth Uhealth", year="2022", month="Jan", day="7", volume="10", number="1", pages="e30807", keywords="atrial fibrillation", keywords="smartphone app", keywords="anticoagulants", keywords="drug adherence", keywords="education", keywords="patient involvement", abstract="Background: Poor adherence to oral anticoagulation in elderly patients with atrial fibrillation (AF) has been shown to negatively impact health care costs, morbidity, and mortality. Although various methods such as automated reminders, counseling, telephone support, and patient education have been effective in improving medication adherence, the burden on health care providers has been considerable. Recently, an attempt has been made to improve medication adherence without burdening health care providers by using smartphone apps; however, the use of the app for elderly patients with AF is still limited. Objective: The purpose of this study was to determine whether the newly developed smartphone app for patients with AF (the Smart AF), which integrates education, automatic reminder, and patient engagement strategies with a simple user interface, can improve medication adherence in elderly patients with AF. Methods: Patient enrollment was carried out by obtaining informed consent from patients with AF attending Kyoto Prefectural University of Medicine hospital between May 2019 and September 2020. Follow-up was planned at 1, 3, and 6 months after enrollment, and questionnaire reminders were automatically sent to patient apps at designated follow-up time points. A questionnaire-based survey of medication adherence was performed electronically using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) as the survey tool. Results: A total of 136 patients with AF were enrolled in this study. During the follow-up period, 112 (82\%) patients underwent follow-up at 1 month, 107 (79\%) at 3 months, and 96 (71\%) at 6 months. The mean age of the enrolled patients was 64.3 years (SD 9.6), and male participants accounted for 79.4\% (108/136) of the study population. The mean CHADS2 (congestive heart failure, hypertension, age, diabetes, previous stroke, or transient ischemic attack) score was 1.2, with hypertension being the most common comorbidity. At the time of enrollment, 126 (93\%) and 10 (7\%) patients were taking direct oral anticoagulants and warfarin, respectively. For medication adherence as measured according to the MMAS-8, MMAS scores at 1 month, 3 months, and 6 months were significantly improved compared with baseline MMAS scores (all P values less than .01). The overall improvement in medication adherence achieved by the 6-month intervention was as follows: 77.8\% (14/18) of the patients in the high adherence group (score=8) at baseline remained in the same state, 45.3\% (24/53) of the patients in the medium adherence group (score=6 to <8) at baseline moved to the high adherence group, and 72\% (18/25) of the patients in the low adherence group (score <6) moved to either the medium or high adherence group. Conclusions: The Smart AF app improved medication adherence among elderly patients with AF. In the realm of medication management, an approach using a mobile health technology that emphasizes education, automatic reminder, and patient engagement may be helpful. ", doi="10.2196/30807", url="https://mhealth.jmir.org/2022/1/e30807", url="http://www.ncbi.nlm.nih.gov/pubmed/34894626" } @Article{info:doi/10.2196/25251, author="Zaman, Bin Sojib and Khan, Kabir Raihan and Evans, G. Roger and Thrift, G. Amanda and Maddison, Ralph and Islam, Shariful Sheikh Mohammed", title="Exploring Barriers to and Enablers of the Adoption of Information and Communication Technology for the Care of Older Adults With Chronic Diseases: Scoping Review", journal="JMIR Aging", year="2022", month="Jan", day="7", volume="5", number="1", pages="e25251", keywords="older adults", keywords="gerontechnology", keywords="usability challenges", keywords="chronic disease", keywords="information technology", keywords="mobile phone", abstract="Background: Information and communication technology (ICT) offers considerable potential for supporting older adults in managing their health, including chronic diseases. However, there are mixed opinions about the benefits and effectiveness of ICT interventions for older adults with chronic diseases. Objective: We aim to map the use of ICT interventions in health care and identified barriers to and enablers of its use among older adults with chronic disease. Methods: A scoping review was conducted using 5 databases (Ovid MEDLINE, Embase, Scopus, PsycINFO, and ProQuest) to identify eligible articles from January 2000 to July 2020. Publications incorporating the use of ICT interventions, otherwise known as eHealth, such as mobile health, telehealth and telemedicine, decision support systems, electronic health records, and remote monitoring in people aged ?55 years with chronic diseases were included. We conducted a strengths, weaknesses, opportunities, and threats framework analysis to explore the implied enablers of and barriers to the use of ICT interventions. Results: Of the 1149 identified articles, 31 (2.7\%; n=4185 participants) met the inclusion criteria. Of the 31 articles, 5 (16\%) mentioned the use of various eHealth interventions. A range of technologies was reported, including mobile health (8/31, 26\%), telehealth (7/31, 23\%), electronic health record (2/31, 6\%), and mixed ICT interventions (14/31, 45\%). Various chronic diseases affecting older adults were identified, including congestive heart failure (9/31, 29\%), diabetes (7/31, 23\%), chronic respiratory disease (6/31, 19\%), and mental health disorders (8/31, 26\%). ICT interventions were all designed to help people self-manage chronic diseases and demonstrated positive effects. However, patient-related and health care provider--related challenges, in integrating ICT interventions in routine practice, were identified. Barriers to using ICT interventions in older adults included knowledge gaps, a lack of willingness to adopt new skills, and reluctance to use technologies. Implementation challenges related to ICT interventions such as slow internet connectivity and lack of an appropriate reimbursement policy were reported. Advantages of using ICT interventions include their nonpharmacological nature, provision of health education, encouragement for continued physical activity, and maintenance of a healthy diet. Participants reported that the use of ICT was a fun and effective way of increasing their motivation and supporting self-management tasks. It gave them reassurance and peace of mind by promoting a sense of security and reducing anxiety. Conclusions: ICT interventions have the potential to support the care of older adults with chronic diseases. However, they have not been effectively integrated with routine health care. There is a need to improve awareness and education about ICT interventions among those who could benefit from them, including older adults, caregivers, and health care providers. More sustainable funding is required to promote the adoption of ICT interventions. We recommend involving clinicians and caregivers at the time of designing ICT interventions. ", doi="10.2196/25251", url="https://aging.jmir.org/2022/1/e25251", url="http://www.ncbi.nlm.nih.gov/pubmed/34994695" } @Article{info:doi/10.2196/20466, author="Silva, Patr{\'i}cia and Delerue Matos, Alice and Martinez-Pecino, Roberto", title="The Contribution of the Internet to Reducing Social Isolation in Individuals Aged 50 Years and Older: Quantitative Study of Data From the Survey of Health, Ageing and Retirement in Europe", journal="J Med Internet Res", year="2022", month="Jan", day="3", volume="24", number="1", pages="e20466", keywords="social isolation", keywords="internet", keywords="50+ individuals", keywords="e-inclusion", keywords="SHARE", abstract="Background: Social isolation has a negative impact on the quality of life of older people; therefore, studies have focused on identifying its sociodemographic, economic, and health determinants. In view of the growing importance of the internet as a means of communication, it is essential to assess whether internet use interferes with social isolation. Objective: This study specifically aims to clarify the relationship between internet use and social isolation of individuals aged ?50 years, for which other surveys present contradictory results. Methods: We performed logistic regression analysis with social isolation as the dependent variable, internet use as the interest variable, and several other sociodemographic, economic, and health characteristics of the individuals as control variables. The sample size was 67,173 individuals aged 50 years and older from 17 European countries (Portugal, Greece, Italy, Spain, Denmark, Sweden, Austria, Belgium, France, Germany, Switzerland, Luxemburg, Poland, Czech Republic, Slovenia, Estonia, and Croatia) plus Israel, who were interviewed in the Survey of Health, Ageing and Retirement in Europe (SHARE), wave 6. Results: The results show that countries differ in the level of social isolation and rate of internet use by individuals aged 50 years and older. They also evidence that in most of the countries analyzed, social isolation of internet users was lower compared to that of nonusers after controlling for a set of sociodemographic, economic, and health characteristics of the individuals that have been previously described in the literature as determinants of social isolation. Indeed, on average, although 31.4\% of individuals in the nonuser group experienced high social isolation, only 12.9\% of individuals who used the internet experienced this condition. Conclusions: Internet users show lower social isolation. This result underlines the importance of promoting e-inclusion in Europe as a way to counter social isolation of individuals aged 50 years and older. ", doi="10.2196/20466", url="https://www.jmir.org/2022/1/e20466", url="http://www.ncbi.nlm.nih.gov/pubmed/34982040" } @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/10.2196/30558, author="Jacobson, L. Claire and Foster, C. Lauren and Arul, Hari and Rees, Amanda and Stafford, S. Randall", title="A Digital Health Fall Prevention Program for Older Adults: Feasibility Study", journal="JMIR Form Res", year="2021", month="Dec", day="23", volume="5", number="12", pages="e30558", keywords="older adults", keywords="accidental falls", keywords="fall prevention", keywords="digital health", keywords="technology", keywords="exercise", keywords="longevity and healthy aging", keywords="program evaluation", keywords="aging", keywords="elderly", keywords="health strategy", abstract="Background: About 1 in 3 adults aged 65 and older falls annually. Exercise interventions are effective in reducing the fall risk and fall rate among older adults. In 2020, startup company Age Bold Inc. disseminated the Bold Fall Prevention Program, aiming to reduce falls among older adults through a remotely delivered, digital exercise program. Objective: We conducted a feasibility study to assess the delivery of the Bold Fall Prevention Program remotely and evaluate the program's impact on 2 primary outcomes---annualized fall rate and weekly minutes of physical activity (PA)---over 6 months of follow-up. Methods: Older adults at high risk of falling were screened and recruited for the feasibility study via nationwide digital advertising strategies. Self-reported outcomes were collected via surveys administered at the time of enrollment and after 3 and 6 months. Responses were used to calculate changes in the annualized fall rate and minutes of PA per week. Results: The remote delivery of a progressive digital fall prevention program and associated research study, including remote recruitment, enrollment, and data collection, was deemed feasible. Participants successfully engaged at home with on-demand video exercise classes, self-assessments, and online surveys. We enrolled 65 participants, of whom 48 (74\%) were women, and the average participant age was 72.6 years. Of the 65 participants, 54 (83\%) took at least 1 exercise class, 40 (62\%) responded to at least 1 follow-up survey at either 3 or 6 months, 20 (31\%) responded to both follow-up surveys, and 25 (39\%) were lost to follow-up. Among all participants who completed at least 1 follow-up survey, weekly minutes of PA increased by 182\% (ratio change=2.82, 95\% CI 1.26-6.37, n=35) from baseline and annualized falls per year decreased by 46\% (incidence rate ratio [IRR]=0.54, 95\% CI 0.32-0.90, n=40). Among only 6-month survey responders (n=31, 48\%), weekly minutes of PA increased by 206\% (ratio change=3.06, 95\% CI 1.43-6.55) from baseline to 6 months (n=30, 46\%) and the annualized fall rate decreased by 28\% (IRR=0.72, 95\% CI 0.42-1.23) from baseline to 6 months. Conclusions: The Bold Fall Prevention Program provides a feasible strategy to increase PA and reduce the burden of falls among older adults. ", doi="10.2196/30558", url="https://formative.jmir.org/2021/12/e30558", url="http://www.ncbi.nlm.nih.gov/pubmed/34837492" } @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/10.2196/25887, author="Kunonga, Patience Tafadzwa and Spiers, Frances Gemma and Beyer, R. Fiona and Hanratty, Barbara and Boulton, Elisabeth and Hall, Alex and Bower, Peter and Todd, Chris and Craig, Dawn", title="Effects of Digital Technologies on Older People's Access to Health and Social Care: Umbrella Review", journal="J Med Internet Res", year="2021", month="Nov", day="24", volume="23", number="11", pages="e25887", keywords="digital health", keywords="social care", keywords="access", keywords="older adults", keywords="review of reviews", keywords="umbrella review", abstract="Background: The 2020 COVID-19 pandemic prompted the rapid implementation of new and existing digital technologies to facilitate access to health and care services during physical distancing. Older people may be disadvantaged in that regard if they are unable to use or have access to smartphones, tablets, computers, or other technologies. Objective: In this study, we synthesized evidence on the impact of digital technologies on older adults' access to health and social services. Methods: We conducted an umbrella review of systematic reviews published from January 2000 to October 2019 using comprehensive searches of 6 databases. We looked for reviews in a population of adults aged ?65 years in any setting, reporting outcomes related to the impact of technologies on access to health and social care services. Results: A total of 7 systematic reviews met the inclusion criteria, providing data from 77 randomized controlled trials and 50 observational studies. All of them synthesized findings from low-quality primary studies, 2 of which used robust review methods. Most of the reviews focused on digital technologies to facilitate remote delivery of care, including consultations and therapy. No studies examined technologies used for first contact access to care, such as online appointment scheduling. Overall, we found no reviews of technology to facilitate first contact access to health and social care such as online appointment booking systems for older populations. Conclusions: The impact of digital technologies on equitable access to services for older people is unclear. Research is urgently needed in order to understand the positive and negative consequences of digital technologies on health care access and to identify the groups most vulnerable to exclusion. ", doi="10.2196/25887", url="https://www.jmir.org/2021/11/e25887", url="http://www.ncbi.nlm.nih.gov/pubmed/34821564" } @Article{info:doi/10.2196/16006, author="Seckin, Gul and Hughes, Susan", title="Patient-Reported Outcomes in a Nationally Representative Sample of Older Internet Users: Cross-sectional Survey", journal="JMIR Aging", year="2021", month="Nov", day="24", volume="4", number="4", pages="e16006", keywords="internet", keywords="information", keywords="health", keywords="communication", keywords="strain", keywords="education", keywords="eHealth literacy", abstract="Background: The rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients' ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy. Objective: We explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes. Methods: Our study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age?60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms. Results: Age ($\beta$=--.17; P=.02), gender ($\beta$=--.22; P=.01), and medical satisfaction ($\beta$=--.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender ($\beta$=.13; P=.05) and satisfaction with medical encounters ($\beta$=.34; P<.001) but negatively predicted by education ($\beta$=--.18; P=.03) and eHealth literacy ($\beta$=--.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education ($\beta$=--.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress ($\beta$=--.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress ($\beta$=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem ($\beta$=--.22; P=.01). Conclusions: This study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals. ", doi="10.2196/16006", url="https://aging.jmir.org/2021/4/e16006", url="http://www.ncbi.nlm.nih.gov/pubmed/34822340" } @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/10.2196/26181, 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/10.2196/32729, author="Henrique, Bazzanello Patr{\'i}cia Paula and Perez, Pelle Fabr{\'i}zzio Martin and Becker, Cemin Osvaldo Henrique and Bellei, Andrei Ericles and Biduski, Daiana and Korb, Arthiese and Pochmann, Daniela and Dani, Caroline and Elsner, Rostirola Viviane and De Marchi, Bertoletti Ana Carolina", title="Kinesiotherapy With Exergaming as a Potential Modulator of Epigenetic Marks and Clinical Functional Variables of Older Women: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Oct", day="13", volume="10", number="10", pages="e32729", keywords="elderly women", keywords="exergame", keywords="epigenome", keywords="cognition", keywords="kinesiotherapy", abstract="Background: Kinesiotherapy is an option to mitigate worsening neuropsychomotor function due to human aging. Moreover, exergames are beneficial for the practice of physical therapy by older patients. Physical exercise interventions are known to alter the epigenome, but little is known about their association with exergames. Objective: We aim to evaluate the effects of kinesiotherapy with exergaming on older women's epigenetic marks and cognitive ability, as well as on their clinical functional variables. Our hypothesis states that this kind of therapy can elicit equal or even better outcomes than conventional therapy. Methods: We will develop a virtual clinic exergame with 8 types of kinesiotherapy exercises. Afterward, we will conduct a 1:1 randomized clinical trial to compare the practice of kinesiotherapy with exergames (intervention group) against conventional kinesiotherapy (control group). A total of 24 older women will be enrolled for 1-hour sessions performed twice a week, for 6 weeks, totaling 12 sessions. We will assess outcomes using epigenetic blood tests, the Montreal Cognitive Assessment test, the Timed Up and Go test, muscle strength grading in a hydraulic dynamometer, and the Game Experience Questionnaire at various stages. Results: The project was funded in October 2019. Game development took place in 2020. Patient recruitment and a clinical trial are planned for 2021. Conclusions: Research on this topic is likely to significantly expand the understanding of kinesiotherapy and the impact of exergames. To the best of our knowledge, this may be one of the first studies exploring epigenetic outcomes of exergaming interventions. Trial Registration: Brazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Cl{\'i}nicos (ReBEC) RBR-9tdrmw; https://ensaiosclinicos.gov.br/rg/RBR-9tdrmw. International Registered Report Identifier (IRRID): DERR1-10.2196/32729 ", doi="10.2196/32729", url="https://www.researchprotocols.org/2021/10/e32729", url="http://www.ncbi.nlm.nih.gov/pubmed/34643543" } @Article{info:doi/10.2196/25616, author="Kebede, Sahilemichael Abraham and Ozolins, Lise-Lotte and Holst, Hanna and Galvin, Kathleen", title="The Digital Engagement of Older People: Systematic Scoping Review Protocol", journal="JMIR Res Protoc", year="2021", month="Jul", day="5", volume="10", number="7", pages="e25616", keywords="digital divide", keywords="digital engagement", keywords="digital inclusion", keywords="initial adoption", keywords="older people", keywords="older users", keywords="sustained engagement", keywords="technological nonuse", keywords="older adults", abstract="Background: There is an ongoing negative narrative about aging that portrays older people as a socioeconomic burden on society. However, increased longevity and good health will allow older adults to contribute meaningfully to society and maximize their well-being. As such, a paradigm shift toward healthy and successful aging can be potentially facilitated by the growing digital technology use for mainstream (day-to-day activities) and assisted living (health and social care). Despite the rising digital engagement trend, digital inequality between the age groups persists. Objective: The aims of this scoping review are to identify the extent and breadth of existing literature of older people's perspectives on digital engagement and summarize the barriers and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement. Methods: This review will be based on the Arksey and O'Malley framework for scoping reviews. The 6-stage framework includes: identifying research questions, identifying relevant studies, study selection, charting the data, summarizing and reporting the results, and a consultation exercise. Published literature will be searched on primary electronic databases such as the Association of Computing Machinery, Web of Science, MEDLINE, PsycINFO, CINAHL, and ScienceDirect. Common grey literature sources will complement the database search on the topic. A two-stage (title/abstract and full article) screening will be conducted to obtain eligible studies for final inclusion. A standardized data extraction tool will be used to extract variables such as the profile of the study population, technologies under investigation, stage of digital engagement, and the barriers and facilitators. Identified and eligible studies will be analyzed using a quantitative (ie, frequency analysis) and qualitative (ie, content analysis) approach suitable for comparing and evaluating literature to provide an evaluation of the current state of the older person's digital engagement. Inclusion will be based on the Joanna Briggs Institute--recommended participant, concept, and context framework. Articles on older people (65 years and older), on digital technology engagement, and from a global context will be included in our review. Results: The results of this review are expected in July 2021. Conclusions: The findings from this review will identify the extent and nature of empirical evidence on how older people digitally engage and the associated barriers and facilitators. International Registered Report Identifier (IRRID): PRR1-10.2196/25616 ", doi="10.2196/25616", url="https://www.researchprotocols.org/2021/7/e25616", url="http://www.ncbi.nlm.nih.gov/pubmed/36260392" } @Article{info:doi/10.2196/23471, author="Chiu, Ching-Ju and Hsieh, Shiuan and Li, Chia-Wei", title="Needs and Preferences of Middle-Aged and Older Adults in Taiwan for Companion Robots and Pets: Survey Study", journal="J Med Internet Res", year="2021", month="Jun", day="11", volume="23", number="6", pages="e23471", keywords="middle-aged adults", keywords="older adults", keywords="companionship demand", keywords="robot", keywords="pet", keywords="acceptance", abstract="Background: In recent years, robots have been considered a new tech industry that can be used to solve the shortage in human resources in the field of health care. Also, animal-assisted therapy has been used to provide assistance, companionship, and interaction among the elderly and has been shown to have a positive impact on their emotional and psychological well-being. Both pets and robots can provide dynamic communication and positive interaction patterns. However, preferences for middle-aged and older adults in this regard are not clear. Objective: This study explored the degree of acceptance of robots and pets as partners in later life and to determine the needs and preferences of elderly individuals related to companion robots. Methods: A total of 273 middle-aged and older adults aged ?45 years and living in the community were invited to answer a structured questionnaire after watching a companion robot video. Sociodemographic data, physical health status and activities, experience with technology, eHealth literacy, and acceptance and attitude toward robots and pets were recorded and analyzed using multinomial logistic regression analysis. Results: Age, level of education, type of dwelling, occupation, retirement status, number of comorbidities, experience with pets, experience using apps, and eHealth literacy were significantly associated with acceptance of robots and pets. Middle-aged and older women preferred robots with an animal-like appearance, while men preferred robots that resembled a human adult. In terms of robot functions, participants preferred a companion robot with dancing, singing, storytelling, or news-reporting functions. Participants' marital status and whether or not they lived alone affected their preference of functions in the companion robot. Conclusions: Findings from this study inform the development of social robots with regard to their appearance and functions to address loneliness in later life in fast-aging societies. ", doi="10.2196/23471", url="https://www.jmir.org/2021/6/e23471/", url="http://www.ncbi.nlm.nih.gov/pubmed/34347621" } @Article{info:doi/10.2196/26242, author="Okoye, M. Safiyyah and Mulcahy, F. John and Fabius, D. Chanee and Burgdorf, G. Julia and Wolff, L. Jennifer", title="Neighborhood Broadband and Use of Telehealth Among Older Adults: Cross-sectional Study of National Survey Data Linked With Census Data", journal="J Med Internet Res", year="2021", month="Jun", day="14", volume="23", number="6", pages="e26242", keywords="aging", keywords="broadband internet", keywords="neighborhood", keywords="telehealth", abstract="Background: The COVID-19 pandemic has amplified the role of telehealth in health care delivery. Regional variation in internet access and telehealth use are well-documented, but the effect of neighborhood factors, including the pervasiveness of broadband internet, on older adults' telehealth usage in the context of internet access is not known. Objective: This study aimed to investigate how individual and neighborhood characteristics, including the pervasiveness of neighborhood broadband internet subscription, are associated with engagement in telehealth among older adults with internet access. Methods: In this cross-sectional study, we included 5117 community-living older adults aged ?65 years, who participated in the 2017 National Health and Aging Trends Study with census tract--level data for participants' places of residence from the American Community Survey. Results: Of an estimated 35.3 million community-living older adults, 21.1 million (59.7\%) were internet users, and of this group, more than one-third (35.8\%) engaged in telehealth. In a multivariable regression model adjusted for individual- and neighborhood-level factors, age, education, income, and the pervasiveness of neighborhood broadband internet subscription were associated with engagement in telehealth, while race, health, county metropolitan status, and neighborhood social deprivation were not. Among internet users, living in a neighborhood at the lowest (versus highest) tertile of broadband internet subscription was associated with being 40\% less likely to engage in telehealth (adjusted odds ratio 0.61, 95\% CI 0.42-0.87), all else equal. Conclusions: Neighborhood broadband internet stands out as a mutable characteristic that is consequential to engagement in telehealth. ", doi="10.2196/26242", url="https://www.jmir.org/2021/6/e26242", url="http://www.ncbi.nlm.nih.gov/pubmed/34125071" } @Article{info:doi/10.2196/25236, author="Kolotylo-Kulkarni, Malgorzata and Seale, E. Deborah and LeRouge, M. Cynthia", title="Personal Health Information Management Among Older Adults: Scoping Review", journal="J Med Internet Res", year="2021", month="Jun", day="7", volume="23", number="6", pages="e25236", keywords="personal health information management", keywords="health information management", keywords="scoping review", keywords="information management", keywords="consumer health informatics", keywords="medical informatics", keywords="patient participation", abstract="Background: Older adults face growing health care needs and could potentially benefit from personal health information management (PHIM) and PHIM technology. To ensure effective PHIM and to provide supportive tools, it is crucial to investigate the needs, challenges, processes, and tools used by this subpopulation. The literature on PHIM by older adults, however, remains scattered and has not provided a clear picture of what we know about the elements that play a role in older adults' PHIM. Objective: The goal of our review was to provide a comprehensive overview of extant knowledge on PHIM by older adults, establish the status quo of research on this topic, and identify research gaps. Methods: We carried out a scoping review of the literature from 1998 to 2020, which followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework. First, we executed a broad and structured search. We then carried out a qualitative analysis of papers pertinent to the topic taking into consideration the five elements of the patient work system as follows: (1) personal-level factors, (2) PHIM tasks, (3) tools used, (4) physical settings of PHIM activities, and (5) socio-organizational aspects. Results: The review included 22 studies. Consolidated empirical evidence was related to all elements of the patient work system. Multiple personal factors affected PHIM. Various types of personal health information were managed (clinical, patient-generated, and general) and tools were used (electronic, paper-based, and others). Older adults' PHIM was intertwined with their surroundings, and various individuals participated. The largest body of evidence concerned personal factors, while findings regarding the physical environment of PHIM were scarce. Most research has thus far examined older adults as a single group, and scant attention has been paid to age subgroups. Conclusions: Opportunities for further PHIM studies remain across all elements of the patient work system in terms of empirical, design science, or review work. ", doi="10.2196/25236", url="https://www.jmir.org/2021/6/e25236", url="http://www.ncbi.nlm.nih.gov/pubmed/34096872" } @Article{info:doi/10.2196/23591, author="Anderberg, Peter and Abrahamsson, Linda and Berglund, Sanmartin Johan", title="An Instrument for Measuring Social Participation to Examine Older Adults' Use of the Internet as a Social Platform: Development and Validation Study", journal="JMIR Aging", year="2021", month="May", day="17", volume="4", number="2", pages="e23591", keywords="internet", keywords="older people", keywords="social participation", keywords="aging", keywords="instrument", keywords="elderly", keywords="social platform", keywords="perception", keywords="connectedness", abstract="Background: Older people's use of the internet is increasingly coming into focus with the demographic changes of a growing older population. Research reports several benefits of older people's internet use and highlights problems such as various forms of inequality in use within the group. There is a need for consistent measurements to follow the development and use of the internet in this group and to be able to compare groups both within and between countries, as well as follow the changes over time. Objective: The aim of this study was to create an instrument to measure an older person's perception of the benefits of their online social participation, unconnected to specific applications and services. The instrument to measure internet social participation proposed in this paper builds on social participation factors and is a multidimensional construct incorporating both social relations and societal connectedness. Methods: A short instrument for measuring social participation over the internet was created. An exploratory factor analysis (EFA) was conducted in a random selection of persons aged 65 years or older (n=193) on 10 initial items. Further validation was made by confirmatory factor analysis (CFA) in the remaining group (n=193). Results: A 1-factor solution for the social internet score was decided upon after exploratory factor analysis (EFA; based on a random sample of half the data set). None of the questionnaire items were excluded based on the EFA, as they all had high loadings, the lowest being 0.61. The Cronbach $\alpha$ coefficient was .92. The 1-factor solution explained 55\% of the variance. CFA was performed and included all 10 questionnaire items in a 1-factor solution. Indices of goodness of fit of the model showed room for improvement. Removal of 4 questions in a stepwise procedure resulted in a 6-item model ($\chi$26=13.985; $\chi$2/degrees of freedom=1.554; comparative fit index=0.992; root mean square error of approximation=0.054; standardized root mean square residual=0.025). Conclusions: The proposed instrument can be used to measure digital social participation and coherence with society. The factor analysis is based on a sufficient sample of the general population of older adults in Sweden, and overall the instrument performed as expected. ", doi="10.2196/23591", url="https://aging.jmir.org/2021/2/e23591", url="http://www.ncbi.nlm.nih.gov/pubmed/33999004" } @Article{info:doi/10.2196/27005, author="Terp, Rikke and Kayser, Lars and Lindhardt, Tove", title="Older Patients' Competence, Preferences, and Attitudes Toward Digital Technology Use: Explorative Study", journal="JMIR Hum Factors", year="2021", month="May", day="14", volume="8", number="2", pages="e27005", keywords="eHealth literacy", keywords="eHealth", keywords="self-management", keywords="older patients", keywords="explorative study", abstract="Background: Malnutrition is prevalent in older patients, which is associated with severe consequences such as a decline in functional status, increased risk of readmission, and increased mortality. A tablet-based eHealth solution (Food`n'Go) was recently developed and introduced at our clinic to support older patients' involvement in nutritional interventions during their hospitalization, thereby enhancing their awareness and motivation for choosing the right food to obtain sufficient calorie and protein intake. To reap the full benefits from the eHealth solution, the technology should be introduced and accompanied by support that targets the end users' competence level and needs. Objective: In this study, we aimed to explore older patients' readiness (ie, competence, preferences, and attitudes) toward the use of information and communication technology (ICT), and to identify the factors that may act as barriers or facilitators for their engagement with health technology. Methods: A descriptive and explorative study was performed using triangulation of data derived from semistructured interviews and questionnaires (based on the Readiness and Enablement Index for Health Technology [READHY] instrument). Older hospitalized patients (age ?65 years; N=25) were included from two hospitals in Denmark. Results: The majority (16/25, 64\%) of the older patients (median age 81 years) were users of ICT. The qualitative findings revealed that their experiences of benefits related to the use of ICT facilitated usage. Barriers for use of ICT were health-related challenges, limited digital literacy, and low self-efficacy related to ICT use due to age-related prejudices by their relatives and themselves. The qualitative findings were also reflected in the low median scores on the eHealth Literacy Questionnaire (eHLQ) READHY scales within dimensions addressing the user's knowledge and skills (eHLQ1:1.8; eHLQ3: 2.0), and the user experience (eHLQ6: 2.0; eHLQ7: 1.5). Conclusions: Older patients are potential users of ICT, but experience a variety of barriers for using eHealth. When introducing older patients to eHealth, it is important to emphasize the possible benefits, and to offer support targeting their knowledge, skills, and motivation. ", doi="10.2196/27005", url="https://humanfactors.jmir.org/2021/2/e27005", url="http://www.ncbi.nlm.nih.gov/pubmed/33988512" } @Article{info:doi/10.2196/22549, author="Cross, A. Dori and Levin, Zachary and Raj, Minakshi", title="Patient Portal Use, Perceptions of Electronic Health Record Value, and Self-Rated Primary Care Quality Among Older Adults: Cross-sectional Survey", journal="J Med Internet Res", year="2021", month="May", day="10", volume="23", number="5", pages="e22549", keywords="patient portals", keywords="electronic health records", keywords="primary care", keywords="older adults", keywords="patient satisfaction", abstract="Background: Older adults are increasingly accessing information and communicating using patient-facing portals available through their providers' electronic health record (EHR). Most theories of technology acceptance and use suggest that patients' overall satisfaction with care should be independent of their chosen level of portal engagement. However, achieving expected benefits of portal use depends on demonstrated support from providers to meet these expectations. This is especially true among older adults, who may require more guidance. However, little is known about whether misalignment of expectations around technology-facilitated care is associated with lower perceptions of care quality. Objective: The aims of this study were to analyze whether older adults' assessment of primary care quality differs across levels of patient portal engagement and whether perceptions of how well their provider uses the EHR to support care moderates this relationship. Methods: We conducted a cross-sectional survey analysis of 158 older adults over the age of 65 (average age 71.4 years) across Michigan using a 13-measure composite of self-assessed health care quality. Portal use was categorized as none, moderate (use of 1-3 functionalities), or extensive (use of 4-7 functionalities). EHR value perception was measured by asking respondents how they felt their doctor's EHR use improved the patient--provider relationship. Results: Moderate portal users, compared to those who were extensive users, had lower estimated care quality (--0.214 on 4-point scale; P=.03). Differences between extensive portal users and nonportal users were not significant. Quality perception was only particularly low among moderate portal users with low EHR value perception; those with high EHR value perception rated quality similarly to other portal user groups. Conclusions: Older adults who are moderate portal users are the least satisfied with their care, and the most sensitive to perceptions of how well their provider uses the EHR to support the relationship. Encouraging portal use without compromising perceptions of quality requires thinking beyond patient-focused education. Achieving value from use of patient-facing technologies with older adults is contingent upon matched organizational investments that support technology-enabled care delivery. Providers and staff need policies and practices that demonstrate technology adeptness. Older adults may need more tailored signaling and accommodation for technology to be maximally impactful. ", doi="10.2196/22549", url="https://www.jmir.org/2021/5/e22549", url="http://www.ncbi.nlm.nih.gov/pubmed/33970111" } @Article{info:doi/10.2196/21864, author="Cosco, D. Theodore and Fortuna, Karen and Wister, Andrew and Riadi, Indira and Wagner, Kevin and Sixsmith, Andrew", title="COVID-19, Social Isolation, and Mental Health Among Older Adults: A Digital Catch-22", journal="J Med Internet Res", year="2021", month="May", day="6", volume="23", number="5", pages="e21864", keywords="social isolation", keywords="mental health", keywords="COVID-19", keywords="technology", keywords="older adult", keywords="psychology", keywords="digital health", doi="10.2196/21864", url="https://www.jmir.org/2021/5/e21864", url="http://www.ncbi.nlm.nih.gov/pubmed/33891557" } @Article{info:doi/10.2196/25706, author="Neter, Efrat and Chachashvili-Bolotin, Svetlana and Erlich, Bracha and Ifrah, Kfir", title="Benefiting From Digital Use: Prospective Association of Internet Use With Knowledge and Preventive Behaviors Related to Alzheimer Disease in the Israeli Survey of Aging", journal="JMIR Aging", year="2021", month="Apr", day="30", volume="4", number="2", pages="e25706", keywords="Alzheimer disease", keywords="digital benefits", keywords="digital divide", keywords="digital skills", keywords="internet use", keywords="health behaviors", keywords="social capital", abstract="Background: Previous work documented the beneficial association between internet use and improved cognition, functional capacity, and less cognitive decline among people in late adulthood. This work focused on potential mechanisms of such an association: knowledge on Alzheimer disease (AD) and preventive behaviors related to AD. Objective: The aim of this study was to examine prospective associations of internet use and perceived computer skills with knowledge on AD and preventive behaviors related to AD. Methods: The sample included 1232 older adults (mean age 71.12 [SD 9.07]) drawn from the Israeli branch of the Survey of Health, Aging, and Retirement in Europe (SHARE-Israel). The sample is representative of Israeli households of adults aged 50 or older and their spouses. Data analyzed were collected in person during 2015 (Wave 6), and in a drop-off questionnaire following the in-person 2017 data collection (Wave 7). Results: Although both internet use and perceived computer skills were prospectively associated with knowledge and behaviors related to AD in bivariate analyses, after controlling for sociodemographics, only internet use was associated with more such knowledge ($\beta$=.13, P<.001) and behaviors ($\beta$=.22, P<.001). Conclusions: Internet use emerged as a prospective predictor of protective factors against AD. Policymakers should advance digital engagement so as to enhance knowledge on AD and preventive behaviors among older adults. ", doi="10.2196/25706", url="https://aging.jmir.org/2021/2/e25706", url="http://www.ncbi.nlm.nih.gov/pubmed/33929331" } @Article{info:doi/10.2196/28010, author="Haase, R. Kristen and Cosco, Theodore and Kervin, Lucy and Riadi, Indira and O'Connell, E. Megan", title="Older Adults' Experiences With Using Technology for Socialization During the COVID-19 Pandemic: Cross-sectional Survey Study", journal="JMIR Aging", year="2021", month="Apr", day="23", volume="4", number="2", pages="e28010", keywords="older adults", keywords="social isolation", keywords="COVID-19", keywords="technology use", keywords="eHealth", abstract="Background: Technology use has become the most critical approach to maintaining social connectedness during the COVID-19 pandemic. Older adults (aged >65 years) are perceived as the most physiologically susceptible population to developing COVID-19 and are at risk of secondary mental health challenges related to the social isolation that has been imposed by virus containment strategies. To mitigate concerns regarding sampling bias, we analyzed a random sample of older adults to understand the uptake and acceptance of technologies that support socialization during the pandemic. Objective: We aimed to conduct a population-based assessment of the barriers and facilitators to engaging in the use of technology for web-based socialization among older adults in the Canadian province of British Columbia during the COVID-19 pandemic. Methods: We conducted a cross-sectional, population-based, regionally representative survey by using the random-digit dialing method to reach participants aged >65 years who live in British Columbia. Data were analyzed using SPSS (IBM Corporation), and open-text responses were analyzed via thematic analysis. Results: Respondents included 400 older adults aged an average of 72 years, and 63.7\% (n=255) of respondents were female. Most respondents (n=358, 89.5\%) were aware of how to use technology to connect with others, and slightly more than half of the respondents (n=224, 56\%) reported that, since the beginning of the pandemic, they used technology differently to connect with others during the pandemic. Additionally, 55.9\% (n=223) of respondents reported that they adopted new technology since the beginning of the pandemic. Older adults reported the following key barriers to using technology: (1) a lack of access (including finance-, knowledge-, and age-related issues); (2) a lack of interest (including a preference for telephones and a general lack of interest in computers); and (3) physical barriers (resultant of cognitive impairments, stroke, and arthritis). Older adults also reported the following facilitators: (1) a knowledge of technologies (from self-teaching or external courses); (2) reliance on others (family, friends, and general internet searches); (3) technology accessibility (including appropriate environments, user-friendly technology, and clear instructions); and (4) social motivation (everyone else is doing it). Conclusions: Much data on older adults' use of technology are limited by sampling biases, but this study, which used a random sampling method, demonstrated that older adults used technology to mitigate social isolation during the pandemic. Web-based socialization is the most promising method for mitigating potential mental health effects that are related to virus containment strategies. Providing telephone training; creating task lists; and implementing the facilitators described by participants, such as facilitated socialization activities, are important strategies for addressing barriers, and these strategies can be implemented during and beyond the pandemic to bolster the mental health needs of older adults. ", doi="10.2196/28010", url="https://aging.jmir.org/2021/2/e28010", url="http://www.ncbi.nlm.nih.gov/pubmed/33739929" } @Article{info:doi/10.2196/26232, author="Mannheim, Ittay and Wouters, M. Eveline J. and van Boekel, C. Leonieke and van Zaalen, Yvonne", title="Attitudes of Health Care Professionals Toward Older Adults' Abilities to Use Digital Technology: Questionnaire Study", journal="J Med Internet Res", year="2021", month="Apr", day="21", volume="23", number="4", pages="e26232", keywords="ageism", keywords="attitudes", keywords="stereotype activation", keywords="digital technology", abstract="Background: Digital technologies (DTs) for older adults focus mainly on health care and are considered to have the potential to improve the well-being of older adults. However, adoption rates of these DTs are considered low. Although previous research has investigated possible reasons for adoption and acceptance of DT, age-based stereotypes (eg, those held by health care professionals) toward the abilities of older adults to use DTs have yet to be considered as possible barriers to adoption. Objective: The aim of this study was to investigate the influencing role of ageism in the context of health care professionals attitudes toward older adults' abilities to use health care DT. A further goal was to examine if social comparison and stereotype activation affect and moderate this association. Methods: A new measurement to assess health care professionals' attitudes toward older adults using technology (ATOAUT-10) was developed and used in 2 studies. Study 1 involved the development of the ATOAUT-10 scale using a principal component analysis and further examined health care professionals' attitudes toward the use of health care DTs and correlations with ageism. Study 2 further explored the correlation between ageism and ATOAUT in an experimental design with health care professionals. Results: In study 1, physiotherapists (N=97) rated older adults as young as 50 years as less able to use health care DT compared to younger adults (P<.001). A multiple regression analysis revealed that higher levels of ageism, beyond other predictors, were predictive of more negative ATOAUT, ($\beta$=.36; t=3.73; P<.001). In study 2, the salience of age was manipulated. Health care professionals (N=93) were randomly assigned to rate the abilities of a young or old person to use health care DT. Old age salience moderated the correlation between ageism and ATOAUT (R2=0.19; F6,85=3.35; P=.005), such that higher levels of ageism correlated with more negative ATOAUT in the old age salient condition, but not the young condition. Stereotype activation accounted for health care professionals' attitudes more than did the experience of working with older patients or the professionals' age. Conclusions: Negative and ageist attitudes of health care professionals can potentially affect how older adults are viewed in relation to DT and consequently might influence actual use and adoption of technology-based treatment. Future studies should broaden the validation of the ATOAUT-10 scale on more diverse samples and focus on the discriminatory aspect of ageism and self-ageism of older adults. This study calls for a focus on ageism as a determinant of adoption of DT. ", doi="10.2196/26232", url="https://www.jmir.org/2021/4/e26232", url="http://www.ncbi.nlm.nih.gov/pubmed/33881408" } @Article{info:doi/10.2196/25928, author="LaMonica, M. Haley and Roberts, E. Anna and Davenport, A. Tracey and Hickie, B. Ian", title="Evaluation of the Usability and Acceptability of the InnoWell Platform as Rated by Older Adults: Survey Study", journal="JMIR Aging", year="2021", month="Apr", day="21", volume="4", number="2", pages="e25928", keywords="older adults", keywords="mental health", keywords="technology", keywords="community-based participatory research", keywords="stakeholder participation", keywords="smartphone", keywords="mobile phone", abstract="Background: As the global population ages, there is increased interest in developing strategies to promote health and well-being in later life, thus enabling continued productivity, social engagement, and independence. As older adults use technologies with greater frequency, proficiency, and confidence, health information technologies (HITs) now hold considerable potential as a means to enable broader access to tools and services for the purposes of screening, treatment, monitoring, and ongoing maintenance of health for this group. The InnoWell Platform is a digital tool co-designed with lived experience to facilitate better outcomes by enabling access to a comprehensive multidimensional assessment, the results of which are provided in real time to enable consumers to make informed decisions about clinical and nonclinical care options independently or in collaboration with a health professional. Objective: This study aims to evaluate the usability and acceptability of a prototype of the InnoWell Platform, co-designed and configured with and for older adults, using self-report surveys. Methods: Participants were adults 50 years and older who were invited to engage with the InnoWell Platform naturalistically (ie, at their own discretion) for a period of 90 days. In addition, they completed short web-based surveys at baseline regarding their background, health, and mental well-being. After 90 days, participants were asked to complete the System Usability Scale to evaluate the usability and acceptability of the prototyped InnoWell Platform, with the aim of informing the iterative redesign and development of this digital tool before implementation within a health service setting. Results: A total of 19 participants consented to participate in the study; however, only the data from the 16 participants (mean age 62.8 years, SD 7.5; range 50-72) who completed at least part of the survey at 90 days were included in the analyses. Participants generally reported low levels of psychological distress and good mental well-being. In relation to the InnoWell Platform, the usability scores were suboptimal. Although the InnoWell Platform was noted to be easy to use, participants had difficulty identifying the relevance of the tool for their personal circumstances. Ease of use, the comprehensive nature of the assessment tools, and the ability to track progress over time were favored features of the InnoWell Platform, whereas the need for greater personalization and improved mobile functionality were cited as areas for improvement. Conclusions: HITs such as the InnoWell Platform have tremendous potential to improve access to cost-effective and low-intensity interventions at scale to improve and maintain mental health and well-being in later life. However, to promote adoption of and continued engagement with such tools, it is essential that these HITs are personalized and relevant for older adult end users, accounting for differences in background, clinical profiles, and levels of need. ", doi="10.2196/25928", url="https://aging.jmir.org/2021/2/e25928", url="http://www.ncbi.nlm.nih.gov/pubmed/33881410" } @Article{info:doi/10.2196/21726, author="Davies, R. Alisha and Honeyman, Matthew and Gann, Bob", title="Addressing the Digital Inverse Care Law in the Time of COVID-19: Potential for Digital Technology to Exacerbate or Mitigate Health Inequalities", journal="J Med Internet Res", year="2021", month="Apr", day="7", volume="23", number="4", pages="e21726", keywords="COVID-19", keywords="digital divide", keywords="digital exclusion", keywords="digital health", keywords="health inequality", keywords="population health", doi="10.2196/21726", url="https://www.jmir.org/2021/4/e21726", url="http://www.ncbi.nlm.nih.gov/pubmed/33735096" } @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/10.2196/23588, author="Casanova, Georgia and Zaccaria, Daniele and Rolandi, Elena and Guaita, Antonio", title="The Effect of Information and Communication Technology and Social Networking Site Use on Older People's Well-Being in Relation to Loneliness: Review of Experimental Studies", journal="J Med Internet Res", year="2021", month="Mar", day="1", volume="23", number="3", pages="e23588", keywords="review", keywords="aging", keywords="loneliness", keywords="older people's well-being", keywords="ICTs", keywords="social network sites", abstract="Background: In the last decades, the relationship between social networking sites (SNSs) and older people's loneliness is gaining specific relevance. Studies in this field are often based on qualitative methods to study in-depth self-perceived issues, including loneliness and well-being, or quantitative surveys to report the links between information and communication technologies (ICTs) and older people's well-being or loneliness. However, these nonexperimental methods are unable to deeply analyze the causal relationship. Moreover, the research on older people's SNS use is still scant, especially regarding its impact on health and well-being. In recent years, the existing review studies have separately focused their attention on loneliness and social isolation of older people or on the use of ICTs and SNSs in elderly populations without addressing the relationship between the former and the latter. This thorough qualitative review provides an analysis of research performed using an experimental or quasi-experimental design that investigates the causal effect of ICT and SNS use on elderly people's well-being related to loneliness. Objective: The aims of this review are to contrast and compare research designs (sampling and recruitment, evaluation tools, interventions) and the findings of these studies and highlight their limitations. Methods: Using an approach that integrates the methodological framework for scoping studies and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews, we identified 11 articles that met our inclusion criteria. A thematic and content analysis was performed based on the ex post categorization of the data on the selected studies, and the data were summarized in tables. Results: The analysis of the selected articles showed that: (1) ICT use is positively but weakly related to the different measures of older people's well-being and loneliness, (2) overall, the studies under review lack a sound experimental design, (3) the main limitations of these studies lie in the lack of rigor in the sampling method and in the recruitment strategy. Conclusions: The analysis of the reviewed studies confirms the existence of a beneficial effect of ICT use on the well-being of older people in terms of reduced loneliness. However, the causal relationship is often found to be weak. This review highlights the need to study these issues further with adequate methodological rigor. ", doi="10.2196/23588", url="https://www.jmir.org/2021/3/e23588", url="http://www.ncbi.nlm.nih.gov/pubmed/33439127" } @Article{info:doi/10.2196/23826, author="Han, Madeline and Tan, Yi Xin and Lee, Rachael and Lee, Kyu Jeong and Mahendran, Rathi", title="Impact of Social Media on Health-Related Outcomes Among Older Adults in Singapore: Qualitative Study", journal="JMIR Aging", year="2021", month="Feb", day="17", volume="4", number="1", pages="e23826", keywords="aging", keywords="social media", keywords="health", keywords="qualitative research", keywords="communication", keywords="mobile phone", abstract="Background: The worldwide spread of digitalization has led to the harnessing of technology to improve health outcomes. Paying attention to older adults' social needs via social media is one way to promote healthy aging. Although 56\% of older adults are smartphone users, little is known about their use patterns of social media. Objective: This exploratory study aims to determine the experiences of social media apps' use among older adults in Singapore and understand their perceptions of its impact on health-related outcomes. Methods: This study used a qualitative research design with an interpretative approach. Using maximum variation purposive sampling, normal aging older adults (N=16) who were aged between 60 and 80 years and experienced in the use of internet-enabled technology were recruited from an existing community study. Semistructured, in-depth interviews were conducted. Employing a thematic analysis, interviews were transcribed verbatim and analyzed for codes inductively. Results: The following themes and subthemes were identified as key moderators of older adults' experiences on social media apps: (1) personal attitudes: participants were encouraged to use social media due to the increased accessibility, which enabled the ease of contact, but perceptions that the quality of interactions was compromised and its associated risks reduced their use; and (2) social influences: the desire to bond with co-users and the availability of support increased use. In addition, use of social media apps was perceived to positively impact health through its ability to keep older adults cognitively engaged, improve health communication, and increase social connectedness. However, opinions remained mixed on older adults' vulnerability to social media addiction. Conclusions: Personal and social contexts determine older adults' social media use. This study's findings provide practical insights into how social media can be deployed to improve health-related outcomes in older adults. ", doi="10.2196/23826", url="http://aging.jmir.org/2021/1/e23826/", url="http://www.ncbi.nlm.nih.gov/pubmed/33595437" } @Article{info:doi/10.2196/24092, author="McLean, Bianca and Hossain, Nazia and Donison, Valentina and Gray, Mikaela and Durbano, Sara and Haase, Kristen and Alibhai, Husayn Shabbir Muhammad and Puts, Martine", title="Providing Medical Information to Older Adults in a Web-Based Environment: Systematic Review", journal="JMIR Aging", year="2021", month="Feb", day="9", volume="4", number="1", pages="e24092", keywords="eHealth", keywords="systematic review", keywords="geriatric assessment", keywords="geriatric oncology", abstract="Background: Cancer is a disease that predominantly affects older adults, and several organizations recommend the completion of a geriatric assessment to help with cancer treatment decision-making. Owing to a shortage of geriatric teams and the vast number of older adults diagnosed with cancer each year, a web-based geriatric assessment may improve access to geriatric assessment for older adults. We systematically reviewed the literature to obtain the latest evidence for the design of our web-based geriatric assessment tool Comprehensive Health Assessment for My Plan. Objective: This review aimed to probe the following questions: what is the impact of providing health test results to older adults in a web-based environment without the presence of a health care provider for patient-centered outcomes, including satisfaction, perceived harm, empowerment, quality of life, and health care use (eg, hospitalization, physician visits, emergency room visits, and costs), and what recommendations do older adults and developers have for designing future apps or websites for older adults? Methods: This systematic review was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement. Studies were limited to publications in English that examined a web-based tool that provided test results to older adults (aged ?65 years) without the presence of a health care provider. A health sciences librarian performed the search on November 29, 2019, on the following electronic databases: MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Library. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool Version 2018. The findings are summarized narratively and in tabular format. Results: A total of 26,898 titles and abstracts were screened by 2 independent reviewers, of which 94 studies were selected for a full-text review, and 9 studies were included in this review. There were only 2 randomized controlled trials of high quality that explored the effects of receiving health care results on the web via eHealth tools for older adults or provided evidence-based recommendations for designing such tools. Older adults were generally satisfied with receiving screening results via eHealth tools, and several studies suggested that receiving health screening results electronically improved participants' quality of life. However, user interfaces that were not designed with older adults in mind and older adults' lack of confidence in navigating eHealth tools proved challenging to eHealth uptake and use. All 9 studies included in this systematic review made recommendations on how to design eHealth tools that are intuitive and useful for older adults. Conclusions: eHealth tools should incorporate specific elements to ensure usability for older adults. However, more research is required to fully elucidate the impact of receiving screening and results via eHealth tools without the presence of a health care provider for patient-centered outcomes in this target population. ", doi="10.2196/24092", url="https://aging.jmir.org/2021/1/e24092", url="http://www.ncbi.nlm.nih.gov/pubmed/33560228" } @Article{info:doi/10.2196/22463, author="Ahmed, Mona and Mar{\'i}n, Mayca and Bou{\c{c}}a-Machado, Raquel and How, Daniella and Judica, Elda and Tropea, Peppino and Bentlage, Ellen and Brach, Michael", title="Investigating Users' and Other Stakeholders' Needs in the Development of a Personalized Integrated Care Platform (PROCare4Life) for Older People with Dementia or Parkinson Disease: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Jan", day="12", volume="10", number="1", pages="e22463", keywords="dementia", keywords="older adults", keywords="neurodegenerative diseases", keywords="integrated care", keywords="health care technologies", keywords="user-centered design", abstract="Background: Dementias---including Alzheimer disease---and Parkinson disease profoundly impact the quality of life of older population members and their families. PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older Adults) is a European project that recognizes the benefit of technology-based integrated care models in improving the care coordination and the quality of life of these target groups. This project proposes an integrated, scalable, and interactive care platform targeting older people suffering from neurodegenerative diseases, their caregivers, and socio-health professionals. PROCare4Life adopts a user-centered design approach from the early stage and throughout platform development and implementation, during which the platform is designed and adapted to the needs and requirements of all the involved users. Objective: This paper presents the study protocol for investigating users' needs and requirements regarding the design of the proposed PROCare4Life platform. Methods: A mixed qualitative and quantitative study design is utilized, including online surveys, interviews, and workshops. The study aimed to recruit approximately 200 participants, including patients diagnosed with dementia or Parkinson disease, caregivers, socio-health professionals, and other stakeholders, from five different European countries: Germany, Italy, Portugal, Romania, and Spain. Results: The study took place between April and September 2020. Recruitment is now closed, and all the data have been collected and analyzed in order to be used in shaping the large-scale pilot phase of the PROCare4Life project. Results of the study are expected to be published in spring 2021. Conclusions: This paper charts the protocol for a user-centered design approach at the early stage of the PROCare4Life project in order to shape and influence an integrated health platform suitable for its intended target group and purpose. International Registered Report Identifier (IRRID): DERR1-10.2196/22463 ", doi="10.2196/22463", url="https://www.researchprotocols.org/2021/1/e22463", url="http://www.ncbi.nlm.nih.gov/pubmed/33433394" } @Article{info:doi/10.2196/21461, author="LaMonica, M. Haley and Davenport, A. Tracey and Roberts, E. Anna and Hickie, B. Ian", title="Understanding Technology Preferences and Requirements for Health Information Technologies Designed to Improve and Maintain the Mental Health and Well-Being of Older Adults: Participatory Design Study", journal="JMIR Aging", year="2021", month="Jan", day="6", volume="4", number="1", pages="e21461", keywords="aging", keywords="mental health", keywords="technology", keywords="mobile phone", keywords="community-based participatory research", keywords="health care reform", keywords="stakeholder participation", abstract="Background: Worldwide, the population is aging rapidly; therefore, there is a growing interest in strategies to support and maintain health and well-being in later life. Although familiarity with technology and digital literacy are increasing among this group, some older adults still lack confidence in their ability to use web-based technologies. In addition, age-related changes in cognition, vision, hearing, and perception may be barriers to adoption and highlight the need for digital tools developed specifically to meet the unique needs of older adults. Objective: The aim of this study is to understand the use of technology by older adults in general and identify the potential barriers to and facilitators of the adoption of health information technologies (HITs) to support the health and well-being of older adults to facilitate implementation and promote user uptake. In addition, this study aims to co-design and configure the InnoWell Platform, a digital tool designed to facilitate better outcomes for people seeking mental health services, to meet the needs of adults 50 years and older and their supportive others (eg, family members, caregivers) to ensure the accessibility, engagement, and appropriateness of the technology. Methods: Participants were adults 50 years and older and those who self-identified as a supportive other (eg, family member, caregiver). Participants were invited to participate in a 3-hour participatory design workshop using a variety of methods, including prompted discussion, creation of descriptive artifacts, and group-based development of user journeys. Results: Four participatory design workshops were conducted, including a total of 21 participants, each attending a single workshop. Technology use was prevalent, with a preference indicated for smartphones and computers. Factors facilitating the adoption of HITs included personalization of content and functionality to meet and be responsive to a consumer's needs, access to up-to-date information from reputable sources, and integration with standard care practices to support the relationship with health professionals. Concerns regarding data privacy and security were the primary barriers to the use of technology to support mental health and well-being. Conclusions: Although HITs have the potential to improve access to cost-effective and low-intensity interventions at scale for improving and maintaining mental health and well-being, several strategies may improve the uptake and efficacy of technologies by the older adult community, including the use of co-design methodologies to ensure usability, acceptability, and appropriateness of the technology; support in using and understanding the clinical applications of the technology by a digital navigator; and ready availability of education and training materials. ", doi="10.2196/21461", url="https://aging.jmir.org/2021/1/e21461", url="http://www.ncbi.nlm.nih.gov/pubmed/33404509" } @Article{info:doi/10.2196/20691, author="Mascret, Nicolas and Delbes, Lisa and Voron, Am{\'e}lie and Temprado, Jean-Jacques and Montagne, Gilles", title="Acceptance of a Virtual Reality Headset Designed for Fall Prevention in Older Adults: Questionnaire Study", journal="J Med Internet Res", year="2020", month="Dec", day="14", volume="22", number="12", pages="e20691", keywords="technology acceptance model", keywords="acceptability", keywords="acceptance", keywords="virtual reality", keywords="elderly", keywords="fall", keywords="eHealth", keywords="self-efficacy", keywords="achievement goals", abstract="Background: Falls are a common phenomenon among people aged 65 and older and affect older adults' health, quality of life, and autonomy. Technology-based intervention programs are designed to prevent the occurrence of falls and their effectiveness often surpasses that of more conventional programs. However, to be effective, these programs must first be accepted by seniors. Objective: Based on the technology acceptance model, this study aimed to examine the acceptance among older adults before a first use of a virtual reality headset (VRH) used in an intervention program designed to prevent falls. Methods: A sample of 271 French older adults (mean age 73.69 years, SD 6.37 years) voluntarily and anonymously filled out a questionnaire containing the focal constructs (perceived usefulness, perceived enjoyment, perceived ease of use, intention to use, fall-related self-efficacy, and self-avoidance goals) adapted to the VRH, which was designed to prevent falls. Results: The results of the structural equation modeling analysis showed that intention to use the VRH was positively predicted by perceived usefulness, perceived enjoyment, and perceived ease of use. Perceived usefulness of the VRH was also negatively predicted by fall-related self-efficacy (ie, the perceived level of confidence of an individual when performing daily activities without falling) and positively predicted by self-avoidance goals (ie, participating in a physical activity to avoid physical regression). Conclusions: A better understanding of the initial acceptance among older adults of this VRH is the first step to involving older adults in intervention programs designed to prevent falls using this kind of device. ", doi="10.2196/20691", url="http://www.jmir.org/2020/12/e20691/", url="http://www.ncbi.nlm.nih.gov/pubmed/33315019" } @Article{info:doi/10.2196/15543, author="Quittschalle, Janine and Stein, Janine and Luppa, Melanie and Pabst, Alexander and L{\"o}bner, Margrit and Koenig, Hans-Helmut and Riedel-Heller, G. Steffi", title="Internet Use in Old Age: Results of a German Population-Representative Survey", journal="J Med Internet Res", year="2020", month="Nov", day="23", volume="22", number="11", pages="e15543", keywords="internet use", keywords="epidemiology", keywords="old age", keywords="health services", keywords="eHealth", abstract="Background: The internet has the potential to foster healthy lifestyles and to support chronic disease management. Older adults could benefit from using the internet and other information and communication technology to access health-related information and interventions available online. Objective: The aim of this study was to investigate factors influencing internet use in older and oldest age groups and to determine the frequency of internet use for health-related purposes. Methods: Using data from a nationally representative telephone survey of older adults aged 75 years and over, a sample of 999 people was assessed using structured clinical interviews. Descriptive and binary logistic regression analyses were performed. Results: Overall, 42.6\% (418/999) of participants used the internet. Among those, 55.7\% (233/417) searched the internet for health-related information. Regression analyses revealed that internet use was significantly associated with younger age (odds ratio [OR] 0.89, 95\% CI 0.85-0.92; P<.001), male gender (OR 2.84, 95\% CI 2.02-4.00; P<.001), higher education levels (OR 6.69, 95\% CI 4.48-9.99; P<.001), a wider social network (OR 1.04, 95\% CI 1.01-1.07; P=.01), higher health-related quality of life (OR 1.02, 95\% CI 1.00-1.03; P=.006), lower levels of depressive symptoms (OR 0.89, 95\% CI 0.80-0.99; P=.04), and higher rates of chronic illness (OR 1.12, 95\% CI 1.04-1.21; P<.004). Conclusions: This study provides population-representative data on internet use in old age in Germany. People in the older and oldest age groups participate in online activities. Understanding the factors that are associated with older adults internet use can contribute to developing tailored interventions and eHealth (electronic health) services to improve well-being in older adults. ", doi="10.2196/15543", url="https://www.jmir.org/2020/11/e15543", url="http://www.ncbi.nlm.nih.gov/pubmed/33226351" } @Article{info:doi/10.2196/18312, author="Kim, Sunyoung and Choudhury, Abhishek", title="Comparison of Older and Younger Adults' Attitudes Toward the Adoption and Use of Activity Trackers", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="22", volume="8", number="10", pages="e18312", keywords="older adults", keywords="technology acceptance", keywords="activity tracker", keywords="fitness tracker", keywords="mHealth", keywords="health care", keywords="quality of life", abstract="Background: Activity tracking devices have significant potential in assisting older adults' health care and quality of life, but this population lags behind in the adoption of these devices. While theoretical frameworks have been introduced to explain and increase the adoption of this technology by older adults, little effort has been made to validate the frameworks with people in other age groups. Objective: The goal of this study was to validate the theoretical framework of technology acceptance by older adults that we previously proposed through a direct comparison of the attitudes to and experiences of activity trackers in older and younger users. Methods: Semistructured interviews were conducted with 2 groups of 15 participants to investigate their experiences of using activity trackers. The recruitment criteria included age (between 18 years and 24 years for the younger participant group or 65 years and older for the older participant group) and prior experiences of using mobile devices or apps for activity tracking for 2 months and longer. Results: Our findings showed that the phase of perceived ease of learning as a significant influencer of the acceptance of activity trackers existed only in the older participant group, but this phase never emerged in the younger participant group. In addition, this study confirmed that other phases exist in both age groups, but 2 distinct patterns emerged according to age groups: (1) the social influence construct influenced the older participants positively but the younger participants negatively and (2) older participants' exploration in the system experiment phase was purpose-driven by particular needs or benefits but for younger participants, it was a phase to explore a new technology. Conclusions: This study confirms the validity of the proposed theoretical framework to account for the unique aspect of older adults' technology adoption. This framework can provide theoretical guidelines when designing technology for older adults as well as when generating new investigations and experiments for older adults and technology use. ", doi="10.2196/18312", url="https://mhealth.jmir.org/2020/10/e18312", url="http://www.ncbi.nlm.nih.gov/pubmed/33090116" } @Article{info:doi/10.2196/22443, author="Chandrasekaran, Ranganathan and Katthula, Vipanchi and Moustakas, Evangelos", title="Patterns of Use and Key Predictors for the Use of Wearable Health Care Devices by US Adults: Insights from a National Survey", journal="J Med Internet Res", year="2020", month="Oct", day="16", volume="22", number="10", pages="e22443", keywords="wearable healthcare devices", keywords="mobile health", keywords="HINTS", keywords="health technology adoption and use", keywords="smart wearables", abstract="Background: Despite the growing popularity of wearable health care devices (from fitness trackes such as Fitbit to smartwatches such as Apple Watch and more sophisticated devices that can collect information on metrics such as blood pressure, glucose levels, and oxygen levels), we have a limited understanding about the actual use and key factors affecting the use of these devices by US adults. Objective: The main objective of this study was to examine the use of wearable health care devices and the key predictors of wearable use by US adults. Methods: Using a national survey of 4551 respondents, we examined the usage patterns of wearable health care devices (use of wearables, frequency of their use, and willingness to share health data from a wearable with a provider) and a set of predictors that pertain to personal demographics (age, gender, race, education, marital status, and household income), individual health (general health, presence of chronic conditions, weight perceptions, frequency of provider visits, and attitude towards exercise), and technology self-efficacy using logistic regression analysis. Results: About 30\% (1266/4551) of US adults use wearable health care devices. Among the users, nearly half (47.33\%) use the devices every day, with a majority (82.38\% weighted) willing to share the health data from wearables with their care providers. Women (16.25\%), White individuals (19.74\%), adults aged 18-50 years (19.52\%), those with some level of college education or college graduates (25.60\%), and those with annual household incomes greater than US \$75,000 (17.66\%) were most likely to report using wearable health care devices. We found that the use of wearables declines with age: Adults aged >50 years were less likely to use wearables compared to those aged 18-34 years (odds ratios [OR] 0.46-0.57). Women (OR 1.26, 95\% CI 0.96-1.65), White individuals (OR 1.65, 95\% CI 0.97-2.79), college graduates (OR 1.05, 95\% CI 0.31-3.51), and those with annual household incomes greater than US \$75,000 (OR 2.6, 95\% CI 1.39-4.86) were more likely to use wearables. US adults who reported feeling healthier (OR 1.17, 95\% CI 0.98-1.39), were overweight (OR 1.16, 95\% CI 1.06-1.27), enjoyed exercise (OR 1.23, 95\% CI 1.06-1.43), and reported higher levels of technology self-efficacy (OR 1.33, 95\% CI 1.21-1.46) were more likely to adopt and use wearables for tracking or monitoring their health. Conclusions: The potential of wearable health care devices is under-realized, with less than one-third of US adults actively using these devices. With only younger, healthier, wealthier, more educated, technoliterate adults using wearables, other groups have been left behind. More concentrated efforts by clinicians, device makers, and health care policy makers are needed to bridge this divide and improve the use of wearable devices among larger sections of American society. ", doi="10.2196/22443", url="http://www.jmir.org/2020/10/e22443/", url="http://www.ncbi.nlm.nih.gov/pubmed/33064083" } @Article{info:doi/10.2196/19223, author="Wang, Hailiang and Zhao, Yang and Yu, Lisha and Liu, Jiaxing and Zwetsloot, Maria Inez and Cabrera, Javier and Tsui, Kwok-Leung", title="A Personalized Health Monitoring System for Community-Dwelling Elderly People in Hong Kong: Design, Implementation, and Evaluation Study", journal="J Med Internet Res", year="2020", month="Sep", day="30", volume="22", number="9", pages="e19223", keywords="telehealth monitoring", keywords="personalized health", keywords="technology acceptance", keywords="digital biomarkers", keywords="digital phenotyping", keywords="wearables", keywords="falls detection", keywords="fitness tracker", keywords="sensors", keywords="elderly population", abstract="Background: Telehealth is an effective means to assist existing health care systems, particularly for the current aging society. However, most extant telehealth systems employ individual data sources by offline data processing, which may not recognize health deterioration in a timely way. Objective: Our study objective was two-fold: to design and implement an integrated, personalized telehealth system on a community-based level; and to evaluate the system from the perspective of user acceptance. Methods: The system was designed to capture and record older adults' health-related information (eg, daily activities, continuous vital signs, and gait behaviors) through multiple measuring tools. State-of-the-art data mining techniques can be integrated to detect statistically significant changes in daily records, based on which a decision support system could emit warnings to older adults, their family members, and their caregivers for appropriate interventions to prevent further health deterioration. A total of 45 older adults recruited from 3 elderly care centers in Hong Kong were instructed to use the system for 3 months. Exploratory data analysis was conducted to summarize the collected datasets. For system evaluation, we used a customized acceptance questionnaire to examine users' attitudes, self-efficacy, perceived usefulness, perceived ease of use, and behavioral intention on the system. Results: A total of 179 follow-up sessions were conducted in the 3 elderly care centers. The results of exploratory data analysis showed some significant differences in the participants' daily records and vital signs (eg, steps, body temperature, and systolic blood pressure) among the 3 centers. The participants perceived that using the system is a good idea (ie, attitude: mean 5.67, SD 1.06), comfortable (ie, self-efficacy: mean 4.92, SD 1.11), useful to improve their health (ie, perceived usefulness: mean 4.99, SD 0.91), and easy to use (ie, perceived ease of use: mean 4.99, SD 1.00). In general, the participants showed a positive intention to use the first version of our personalized telehealth system in their future health management (ie, behavioral intention: mean 4.45, SD 1.78). Conclusions: The proposed health monitoring system provides an example design for monitoring older adults' health status based on multiple data sources, which can help develop reliable and accurate predictive analytics. The results can serve as a guideline for researchers and stakeholders (eg, policymakers, elderly care centers, and health care providers) who provide care for older adults through such a telehealth system. ", doi="10.2196/19223", url="http://www.jmir.org/2020/9/e19223/", url="http://www.ncbi.nlm.nih.gov/pubmed/32996887" } @Article{info:doi/10.2196/18080, author="Askari, Marjan and Klaver, Sabine Nicky and van Gestel, Johannes Thimon and van de Klundert, Joris", title="Intention to use Medical Apps Among Older Adults in the Netherlands: Cross-Sectional Study", journal="J Med Internet Res", year="2020", month="Sep", day="4", volume="22", number="9", pages="e18080", keywords="Senior Technology Acceptance Model", keywords="intention to use", keywords="elderly", keywords="older adults", keywords="medical apps", keywords="mHealth", keywords="adoption", abstract="Background: The increasing health service demand driven by the aging of the global population calls for the development of modes of health service delivery that are less human resource--intensive. Electronic health (eHealth) and medical apps are expected to play an important role in this development. Although evidence shows mobile medical apps might be effective in improving the care, self-management, self-efficacy, health-related behavior, and medication adherence of older adults, little is known about older adults' intention to use these technologies when needed, or the factors influencing this intention. Objective: The objective of this study was to investigate the relationship of technology acceptance factors and intention to use mobile medical apps among community-dwelling older adults. Methods: Data was collected using questionnaires. The factors selected from the literature have been validated using Cronbach $\alpha$ and tested for significance using logistic regressions. Results: Almost half (49.7\%) of the included older adults reported no intention to use medical apps. Adjusted logistic regression analysis per factor showed that the factors Attitude toward use (odds ratio [OR] 8.50), Perceived usefulness (OR 5.25), Perceived ease of use (OR 4.22), Service availability (OR 3.46), Sense of control (OR 3.40), Self-perceived effectiveness (OR 2.69), Facilities (OR 2.45), Personal innovativeness (OR 2.08), Social relationships (OR 1.79), Subjective norm (OR 1.48), and Feelings of anxiety (OR 0.62) significantly influenced the intention to use mobile medical apps among older adults, whereas the factor Finance (OR 0.98) did not. When considered together, a controlled multivariate logistic regression yielded high explained variances of 0.542 (Cox-Snell R2) and 0.728 (Nagelkerke R2). Conclusions: The high odds ratios and explained variance indicate that the factors associated with the intention to use medical apps are largely understood and the most important factors have been identified. To advance the evidence base, experimental controlled research should investigate the causality between the factors, intention to use, and actual use. For this purpose, our evidence suggests that policies designed to improve Attitude toward use appear most effective, followed by policies addressing Perceived usefulness, Perceived ease of use, Service availability, and Sense of control. ", doi="10.2196/18080", url="https://www.jmir.org/2020/9/e18080", url="http://www.ncbi.nlm.nih.gov/pubmed/32624465" } @Article{info:doi/10.2196/20359, author="Kruse, Clemens and Fohn, Joanna and Wilson, Nakia and Nunez Patlan, Evangelina and Zipp, Stephanie and Mileski, Michael", title="Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review", journal="JMIR Med Inform", year="2020", month="Aug", day="12", volume="8", number="8", pages="e20359", keywords="telehealth", keywords="telemedicine", keywords="older adults", keywords="barriers", keywords="health outcomes", abstract="Background: Rising telehealth capabilities and improving access to older adults can aid in improving health outcomes and quality of life indicators. Telehealth is not being used ubiquitously at present. Objective: This review aimed to identify the barriers that prevent ubiquitous use of telehealth and the ways in which telehealth improves health outcomes and quality of life indicators for older adults. Methods: This systematic review was conducted and reported in accordance with the Kruse protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviewers queried the following four research databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE), Web of Science, and Embase (Science Direct). Reviewers analyzed 57 articles, performed a narrative analysis to identify themes, and identified barriers and reports of health outcomes and quality of life indicators found in the literature. Results: Reviewers analyzed 57 studies across the following five interventions of telehealth: eHealth, mobile health (mHealth), telemonitoring, telecare (phone), and telehealth video calls, with a Cohen $\kappa$ of 0.75. Reviewers identified 14 themes for barriers. The most common of which were technical literacy (25/144 occurrences, 17\%), lack of desire (19/144 occurrences, 13\%), and cost (11/144 occurrences, 8\%). Reviewers identified 13 medical outcomes associated with telehealth interventions. The most common of which were decrease in psychological stress (21/118 occurrences, 18\%), increase in autonomy (18/118 occurrences, 15\%), and increase in cognitive ability (11/118 occurrences, 9\%). Some articles did not report medical outcomes (18/57, 32\%) and some did not report barriers (19/57, 33\%). Conclusions: The literature suggests that the elimination of barriers could increase the prevalence of telehealth use by older adults. By increasing use of telehealth, proximity to care is no longer an issue for access, and thereby care can reach populations with chronic conditions and mobility restrictions. Future research should be conducted on methods for personalizing telehealth in older adults before implementation. Trial Registration: PROSPERO CRD42020182162; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42020182162. International Registered Report Identifier (IRRID): RR2-10.2196/15490 ", doi="10.2196/20359", url="http://medinform.jmir.org/2020/8/e20359/", url="http://www.ncbi.nlm.nih.gov/pubmed/32784177" } @Article{info:doi/10.2196/15683, author="Lam, Man Sabrina Sze and Jivraj, Stephen and Scholes, Shaun", title="Exploring the Relationship Between Internet Use and Mental Health Among Older Adults in England: Longitudinal Observational Study", journal="J Med Internet Res", year="2020", month="Jul", day="28", volume="22", number="7", pages="e15683", keywords="internet", keywords="socioeconomic factors", keywords="mental health", keywords="life satisfaction", keywords="depression", keywords="effect modifier", abstract="Background: There is uncertainty about the impact of internet use on mental health in older adults. Moreover, there is very little known specifically about the impact of particular purposes of internet use. Objective: This study aims to investigate the longitudinal relationship between two distinct concepts of mental health with the frequency of internet use among older adults: the moderating role of socioeconomic position (SEP) and the association between specific purposes of internet use. Methods: Longitudinal fixed and random effects (27,507 person-years) models were fitted using waves 6-8 of the English Longitudinal Study of Ageing to examine the relationship between different aspects of internet use (frequency and purpose) and two mental health outcomes (depression and life satisfaction). The potential moderating effect of SEP on these associations was tested using interaction terms. Results: Infrequent internet use (monthly or less vs daily) was predictive of deteriorating life satisfaction ($\beta$=?0.512; P=.02) but not depression. Education and occupational class had a moderating effect on the association between frequency of internet use and mental health. The associations were stronger in the highest educational group in both depression (P=.09) and life satisfaction (P=.02), and in the highest occupational group in life satisfaction (P=.05) only. Using the internet for communication was associated with lower depression ($\beta$=?0.24; P=.002) and better life satisfaction ($\beta$=.97; P<.001), whereas those using the internet for information access had worse life satisfaction ($\beta$=?0.86; P<.001) compared with those who did not. Conclusions: Policies to improve mental health in older adults should encourage internet use, especially as a tool to aid communication. ", doi="10.2196/15683", url="https://www.jmir.org/2020/7/e15683", url="http://www.ncbi.nlm.nih.gov/pubmed/32718913" } @Article{info:doi/10.2196/17703, author="Cornet, Philip Victor and Toscos, Tammy and Bolchini, Davide and Rohani Ghahari, Romisa and Ahmed, Ryan and Daley, Carly and Mirro, J. Michael and Holden, J. Richard", title="Untold Stories in User-Centered Design of Mobile Health: Practical Challenges and Strategies Learned From the Design and Evaluation of an App for Older Adults With Heart Failure", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="21", volume="8", number="7", pages="e17703", keywords="user-centered design", keywords="research methods", keywords="mobile health", keywords="digital health", keywords="mobile apps", keywords="usability", keywords="technology", keywords="evaluation", keywords="human-computer interaction", keywords="mobile phone", abstract="Background: User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. Objective: This study aims to characterize the practical challenges encountered and propose strategies when implementing UCD for mHealth. Methods: Our multidisciplinary team implemented a UCD process to design and evaluate a mobile app for older adults with heart failure. During and after this process, we documented the challenges the team encountered and the strategies they used or considered using to address those challenges. Results: We identified 12 challenges, 3 about UCD as a whole and 9 across the UCD stages of formative research, design, and evaluation. Challenges included the timing of stakeholder involvement, overcoming designers' assumptions, adapting methods to end users, and managing heterogeneity among stakeholders. To address these challenges, practical recommendations are provided to UCD researchers and practitioners. Conclusions: UCD is a gold standard approach that is increasingly adopted for mHealth projects. Although UCD methods are well-described and easily accessible, practical challenges and strategies for implementing them are underreported. To improve the implementation of UCD for mHealth, we must tell and learn from these traditionally untold stories. ", doi="10.2196/17703", url="http://mhealth.jmir.org/2020/7/e17703/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706745" } @Article{info:doi/10.2196/16341, author="Orr, Casey L. and Graham, K. Andrea and Mohr, C. David and Greene, J. Carolyn", title="Engagement and Clinical Improvement Among Older Adult Primary Care Patients Using a Mobile Intervention for Depression and Anxiety: Case Studies", journal="JMIR Ment Health", year="2020", month="Jul", day="8", volume="7", number="7", pages="e16341", keywords="mobile health", keywords="older adults", keywords="depression", keywords="anxiety", keywords="primary care", keywords="smartphone", keywords="mobile phone", keywords="text messaging", abstract="Background: Technology-based mental health interventions are an increasingly attractive option for expanding access to mental health services within the primary care system. Older adults are among the groups that could potentially benefit from the growing ubiquity of technology-based mental health interventions; however, older adults are perceived to be averse to using technology and have reported barriers to use. Objective: The aim of this paper is to present a case study of 3 participants from a clinical trial evaluating IntelliCare, an evidence-based mobile intervention for depression and anxiety, among adults recruited from primary care clinics. Our report of these 3 participants, who were aged 60 years or older, focuses on their engagement with the IntelliCare service (ie, app use, coach communication) and clinical changes in depression or anxiety symptoms over the intervention period. Methods: The 3 case study participants were offered IntelliCare with coaching for 8 weeks. The intervention consisted of 5 treatment intervention apps that support a variety of psychological skills, a Hub app that contained psychoeducational content and administered weekly assessments, and coaching for encouragement, accountability, and technical assistance as needed. The 3 case study participants were selected to reflect the overall demographics of participants within the trial and because their interactions with IntelliCare provided a good illustration of varied experiences regarding engagement with the intervention. Results: The 3 participants' unique experiences with the intervention are described. Despite potential barriers and experiencing some technical glitches, the participants showed proficient ability to use the apps, high levels of participation through frequent app use and coach interaction, and decreased depression and anxiety scores. At the end of the 8-week intervention, each of these 3 participants expressed great enthusiasm for the benefit of this program through feedback to their coach, and they each identified a number of ways they had seen improvements in themselves. Conclusions: These 3 cases provide examples of older individuals who engaged with and benefitted from the IntelliCare service. Although the results from these 3 cases may not generalize to others, they provide an important, informed perspective of the experiences that can contribute to our understanding of how older adults use and overcome barriers to mental health technologies. The findings also contribute toward the ultimate goal of ensuring that the IntelliCare intervention is appropriate for individuals of all ages. ", doi="10.2196/16341", url="https://mental.jmir.org/2020/7/e16341", url="http://www.ncbi.nlm.nih.gov/pubmed/32673236" } @Article{info:doi/10.2196/15099, author="Weber, Winja and Reinhardt, Anne and Rossmann, Constanze", title="Lifestyle Segmentation to Explain the Online Health Information--Seeking Behavior of Older Adults: Representative Telephone Survey", journal="J Med Internet Res", year="2020", month="Jun", day="12", volume="22", number="6", pages="e15099", keywords="older adults", keywords="online health information seeking", keywords="lifestyle", keywords="segmentation", keywords="cluster analysis", abstract="Background: As a result of demographic changes, the number of people aged 60 years and older has been increasing steadily. Therefore, older adults have become more important as a target group for health communication efforts. Various studies show that online health information sources have gained importance among younger adults, but we know little about the health-related internet use of senior citizens in general and in particular about the variables explaining their online health-related information--seeking behavior. Media use studies indicate that in addition to sociodemographic variables, lifestyle factors might play a role in this context. Objective: The aim of this study was to examine older people's health-related internet use. Our study focused on the explanatory potential of lifestyle types over and above sociodemographic variables to predict older adults' internet use for health information. Methods: A telephone survey was conducted with a random sample of German adults aged 60 years and older (n=701) that was quota-allocated by gender, age, educational status, and degree of urbanity of their place of residence. Results: The results revealed that participants used the internet infrequently (mean 1.82 [SD 1.07]), and medical personnel (mean 2.89 [SD 1.11]), family and friends (mean 2.86 [SD 1.21]), and health brochures (mean 2.85 [SD 1.21]) were their main sources of health information. A hierarchical cluster analysis based on values, interests, and leisure time activities revealed three different lifestyle types for adults aged over 60 years: the Sociable Adventurer, the Average Family Person, and the Uninterested Inactive. After adding these types as second-step predictors in a hierarchical regression model with sociodemographic variables (step 1), the explained variance increased significantly (R2=.02, P=.001), indicating that the Average Family Person and the Sociable Adventurer use the internet more often for health information than the Uninterested Inactive, over and above their sociodemographic attributes. Conclusions: Our findings indicate that the internet still plays only a minor role in the health information--seeking behavior of older German adults. Nevertheless, there are subgroups including younger, more active, down-to-earth and family-oriented males that may be reached with online health information. Our findings suggest that lifestyle types should be taken into account when predicting health-related internet use behavior. ", doi="10.2196/15099", url="http://www.jmir.org/2020/6/e15099/", url="http://www.ncbi.nlm.nih.gov/pubmed/32530433" } @Article{info:doi/10.2196/17884, author="Poli, Arianna and Kelfve, Susanne and Klompstra, Leonie and Str{\"o}mberg, Anna and Jaarsma, Tiny and Motel-Klingebiel, Andreas", title="Prediction of (Non)Participation of Older People in Digital Health Research: Exergame Intervention Study", journal="J Med Internet Res", year="2020", month="Jun", day="5", volume="22", number="6", pages="e17884", keywords="technology", keywords="exclusion", keywords="recruitment", keywords="self-selection", keywords="nonparticipation", abstract="Background: The use of digital technologies is increasing in health care. However, studies evaluating digital health technologies can be characterized by selective nonparticipation of older people, although older people represent one of the main user groups of health care. Objective: We examined whether and how participation in an exergame intervention study was associated with age, gender, and heart failure (HF) symptom severity. Methods: A subset of data from the HF-Wii study was used. The data came from patients with HF in institutional settings in Germany, Italy, the Netherlands, and Sweden. Selective nonparticipation was examined as resulting from two processes: (non)recruitment and self-selection. Baseline information on age, gender, and New York Heart Association Functional Classification of 1632 patients with HF were the predictor variables. These patients were screened for HF-Wii study participation. Reasons for nonparticipation were evaluated. Results: Of the 1632 screened patients, 71\% did not participate. The nonrecruitment rate was 21\%, and based on the eligible sample, the refusal rate was 61\%. Higher age was associated with lower probability of participation; it increased both the probabilities of not being recruited and declining to participate. More severe symptoms increased the likelihood of nonrecruitment. Gender had no effect. The most common reasons for nonrecruitment and self-selection were related to physical limitations and lack of time, respectively. Conclusions: Results indicate that selective nonparticipation takes place in digital health research and that it is associated with age and symptom severity. Gender effects cannot be proven. Such systematic selection can lead to biased research results that inappropriately inform research, policy, and practice. Trial Registration: ClinicalTrial.gov NCT01785121, https://clinicaltrials.gov/ct2/show/NCT01785121 ", doi="10.2196/17884", url="http://www.jmir.org/2020/6/e17884/", url="http://www.ncbi.nlm.nih.gov/pubmed/32501275" } @Article{info:doi/10.2196/15491, author="Merkel, Sebastian and Hess, Moritz", title="The Use of Internet-Based Health and Care Services by Elderly People in Europe and the Importance of the Country Context: Multilevel Study", journal="JMIR Aging", year="2020", month="Jun", day="3", volume="3", number="1", pages="e15491", keywords="eHealth", keywords="Europe", keywords="elderly people", abstract="Background: Digital health care is becoming increasingly important, but it has the risk of further increasing the digital divide, as not all individuals have the opportunity, skills, and knowledge to fully benefit from potential advantages. In particular, elderly people have less experience with the internet, and hence, they are in danger of being excluded. Knowledge on the influences of the adoption of internet-based health and care services by elderly people will help to develop and promote strategies for decreasing the digital divide. Objective: This study examined if and how elderly people are using digital services to access health and social care. Moreover, it examined what personal characteristics are associated with using these services and if there are country differences. Methods: Data for this study were obtained from the Special Eurobarometer 460 (SB 460), which collected data on Europeans' handling of and attitudes toward digital technologies, robots, and artificial intelligence, including data on the use of internet-based health and social care services, among 27,901 EU citizens aged 15 years or older. Multilevel logistic regression models were adopted to analyze the association of using the internet for health and social care services with several individual and country-level variables. Results: At the individual level, young age, high education, high social class, and living in an urban area were positively associated with a high probability of using internet-based health and social services. At the country level, the proportion of elderly people who participated in any training activity within the last month was positively associated with the proportion of elderly people using these services. Conclusions: The probability of using internet-based health and social services and their accompanying advantages strongly depend on the socioeconomic background. Training and educational programs might be helpful to mitigate these differences. ", doi="10.2196/15491", url="http://aging.jmir.org/2020/1/e15491/", url="http://www.ncbi.nlm.nih.gov/pubmed/32490837" } @Article{info:doi/10.2196/18073, author="Patel, Tejal and Ivo, Jessica and Faisal, Sadaf and McDougall, Aidan and Carducci, Jillian and Pritchard, Sarah and Chang, Feng", title="A Prospective Study of Usability and Workload of Electronic Medication Adherence Products by Older Adults, Caregivers, and Health Care Providers", journal="J Med Internet Res", year="2020", month="Jun", day="2", volume="22", number="6", pages="e18073", keywords="electronic medication adherence", keywords="usability", keywords="workload", keywords="geriatrics", keywords="older adults", keywords="mobile phone", abstract="Background: A decreased capacity to self-manage medications results in nonadherence, medication errors, and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products available to assist patients with self-management of medications. Unfortunately, the usability and workload of these products are unknown. Objective: This study aimed to examine the usability and workload of a sample of electronic medication adherence products. Methods: In a prospective, mixed methods study, a sample of older adults, health care professionals, and caregivers tested the usability and workload of 21 electronic medication adherence products. Each participant tested 5 products, one at a time, after which they completed the system usability scale (SUS) and NASA-task load index (NASA-TLX), instruments that measure the usability and workload involved in using a product. Higher SUS scores indicate more user-friendliness, whereas lower NASA-TLX raw scores indicate less workload when using a product. Results: Electronic medication adherence products required a mean of 12.7 steps (range 5-20) for the appropriate use and took, on average, 15.19 min to complete the setup tasks (range 1-56). Participants were able to complete all steps without assistance 55.3\% of the time (103 out of the 186 tests were completed by 39 participants; range 0\%-100\%). The mean SUS and NASA-TLX raw scores were 52.8 (SD 28.7; range 0-100) and 50.0 (SD 25.7; range 4.2-99.2), respectively, revealing significant variability among the electronic medication adherence products. The most user-friendly products were found to be TimerCap travel size (mean 78.67, SD 15.57; P=.03) and eNNOVEA Weekly Planner with Advanced Auto Reminder (mean 78.13, SD 14.13; P=.049) as compared with MedReady 1700 automated medication dispenser (mean 28.63, SD 21.24). Similarly, MedReady (72.92, SD 18.69) was found to be significantly more work intensive when compared with TimerCap (29.35, SD 20.35; P=.03), e-pill MedGlider home medication management system (28.43, SD 20.80; P=.02), and eNNOVEA (28.65, SD 14.97; P=.03). The e-pill MedTime Station automatic pill dispenser with tipper (71.77, SD 21.98) had significantly more workload than TimerCap (P=.04), MedGlider (P=.03), and eNNOVEA (P=.04). Conclusions: This study demonstrated that variability exists in the usability and workload of different electronic medication adherence products among older adults, caregivers, and clinicians. With few studies having investigated the usability and workload of electronic medication adherence products, no benchmarks exist to compare the usability and workload of these products. However, our study highlights the need to assess the usability and workload of different products marketed to assist with medication taking and provides guidance to clinicians regarding electronic medication adherence product recommendations for their patients. Future development of electronic medication adherence products should ensure that the target populations of patients are able to use these products adequately to improve medication management. ", doi="10.2196/18073", url="https://www.jmir.org/2020/6/e18073", url="http://www.ncbi.nlm.nih.gov/pubmed/32348292" } @Article{info:doi/10.2196/17331, author="Dermody, Gordana and Whitehead, Lisa and Wilson, Graham and Glass, Courtney", title="The Role of Virtual Reality in Improving Health Outcomes for Community-Dwelling Older Adults: Systematic Review", journal="J Med Internet Res", year="2020", month="Jun", day="1", volume="22", number="6", pages="e17331", keywords="virtual reality", keywords="aged", keywords="aged, 80 and over", keywords="outcome assessment, health care", keywords="independent living", keywords="systematic review", abstract="Background: Virtual reality (VR) delivered through immersive headsets creates an opportunity to deliver interventions to improve physical, mental, and psychosocial health outcomes. VR app studies with older adults have primarily focused on rehabilitation and physical function including gait, balance, fall prevention, pain management, and cognition. Several systematic reviews have previously been conducted, but much of the extant literature is focused on rehabilitation or other institutional settings, and little is known about the effectiveness of VR apps using immersive headsets to target health outcomes among community-dwelling older adults. Objective: The objective of this review was to evaluate the effectiveness of VR apps delivered using commercially available immersive headsets to improve physical, mental, or psychosocial health outcomes in community-dwelling older adults. Methods: Peer-reviewed publications that included community-dwelling older adults aged ?60 years residing in residential aged care settings and nursing homes were included. This systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness evidence. The title of this review was registered with JBI, and the systematic review protocol was registered with the International Prospective Register of Systematic Reviews. Results: In total, 7 studies that specifically included community-dwelling older adults were included in this review. VR apps using a head-mounted display led to improvements in a number of health outcomes, including pain management, posture, cognitive functioning specifically related to Alzheimer disease, and a decreased risk of falls. A total of 6 studies reported a statistically significant difference post VR intervention, and 1 study reported an improvement in cognitive function to reduce navigational errors. Only one study reported on the usability and acceptability of the interventions delivered through VR. While one study used a distraction mechanism for pain management, none of the studies used gaming technology to promote enjoyment. Conclusions: Interventions to improve health outcomes through VR have demonstrated potential; however, the ability to synthesize findings by primary outcome for the older adult population is not possible. A number of factors, especially related to frailty, usability, and acceptability, also need to be explored before more substantial recommendations on the effectiveness of VR interventions for older adults can be made. Trial Registration: PROSPERO CRD42019143504; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=143504 ", doi="10.2196/17331", url="https://www.jmir.org/2020/6/e17331", url="http://www.ncbi.nlm.nih.gov/pubmed/32478662" } @Article{info:doi/10.2196/14670, author="Knapova, Lenka and Klocek, Adam and Elavsky, Steriani", title="The Role of Psychological Factors in Older Adults' Readiness to Use eHealth Technology: Cross-Sectional Questionnaire Study", journal="J Med Internet Res", year="2020", month="May", day="28", volume="22", number="5", pages="e14670", keywords="eHealth", keywords="information technology", keywords="need for cognitive closure", keywords="elderly", abstract="Background: Information and communication technology (ICT) use among older adults has been on the rise in recent years. However, the predictors and mechanisms behind older adults' acceptance and use of ICT are not clear. Objective: This study aimed to systematically describe ICT usage among Czech older adults and to evaluate the factors influencing their ICT use and readiness to use digital technology to promote health (eHealth readiness). The primary focus was on psychological factors and the role of persons close to older adults. Methods: The research utilized cross-sectional survey data from a quota-based sample of Czech older adults (>50 years) and persons close to them further referred to as close persons (N=250 dyads). A structural equation modeling framework was used to evaluate relationships between psychological factors, ICT use, and eHealth readiness. Results: Czech older adults' use of ICT is low with the exception of cell phone usage (cell phone usage by 173/250, 69.2\%; other devices used by 50/250, 20.0\% of older adults or less). Apart from age ($\beta$=?.21; P<.001), eHealth readiness was predicted by ICT use ($\beta$=.65; P<.001). eHealth readiness was also indirectly affected by the need for cognitive closure (NFCC): individuals with a high need for closure perceived more barriers to ICT ($\beta$=.23; P=.01) and more reported barriers were linked to lower ICT usage ($\beta$=?.21; P=.001). The expected positive relationships between eHealth readiness of persons close to older adults and ICT use and eHealth readiness of older adults were not significant, but the total effect of eHealth readiness of persons close to older adults on eHealth readiness of older adults was positive and significant ($\beta$=.18; P=.01), indicating some level of influence of persons close to them on older adults' attitudes and behaviors. Conclusions: This study provided the first systematic examination of Czech older adults' ICT usage and eHealth readiness. Novel predictors (NFCC and close persons' variables) were evaluated and yielded actionable results. More research is needed to clarify the role of persons close to older adults. ", doi="10.2196/14670", url="http://www.jmir.org/2020/5/e14670/", url="http://www.ncbi.nlm.nih.gov/pubmed/32348251" } @Article{info:doi/10.2196/13726, author="Stra{\ss}mann, Carolin and Kr{\"a}mer, C. Nicole and Buschmeier, Hendrik and Kopp, Stefan", title="Age-Related Differences in the Evaluation of a Virtual Health Agent's Appearance and Embodiment in a Health-Related Interaction: Experimental Lab Study", journal="J Med Internet Res", year="2020", month="Apr", day="23", volume="22", number="4", pages="e13726", keywords="virtual health advisor", keywords="age-related differences", keywords="human-agent interaction", keywords="appearance", keywords="embodiment", abstract="Background: Assistive technologies have become more important owing to the aging population, especially when they foster healthy behaviors. Because of their natural interface, virtual agents are promising assistants for people in need of support. To engage people during an interaction with these technologies, such assistants need to match the users{\textasciiacute} needs and preferences, especially with regard to social outcomes. Objective: Prior research has already determined the importance of an agent's appearance in a human-agent interaction. As seniors can particularly benefit from the use of virtual agents to maintain their autonomy, it is important to investigate their special needs. However, there are almost no studies focusing on age-related differences with regard to appearance effects. Methods: A 2{\texttimes}4 between-subjects design was used to investigate the age-related differences of appearance effects in a human-agent interaction. In this study, 46 seniors and 84 students interacted in a health scenario with a virtual agent, whose appearance varied (cartoon-stylized humanoid agent, cartoon-stylized machine-like agent, more realistic humanoid agent, and nonembodied agent [voice only]). After the interaction, participants reported on the evaluation of the agent, usage intention, perceived presence of the agent, bonding toward the agent, and overall evaluation of the interaction. Results: The findings suggested that seniors evaluated the agent more positively (liked the agent more and evaluated it as more realistic, attractive, and sociable) and showed more bonding toward the agent regardless of the appearance than did students. In addition, interaction effects were found. Seniors reported the highest usage intention for the cartoon-stylized humanoid agent, whereas students reported the lowest usage intention for this agent. The same pattern was found for participant bonding with the agent. Seniors showed more bonding when interacting with the cartoon-stylized humanoid agent or voice only agent, whereas students showed the least bonding when interacting with the cartoon-stylized humanoid agent. Conclusions: In health-related interactions, target group--related differences exist with regard to a virtual assistant's appearance. When elderly individuals are the target group, a humanoid virtual assistant might trigger specific social responses and be evaluated more positively at least in short-term interactions. ", doi="10.2196/13726", url="http://www.jmir.org/2020/4/e13726/", url="http://www.ncbi.nlm.nih.gov/pubmed/32324146" } @Article{info:doi/10.2196/15704, author="Keogh, Alison and Dorn, F. Jonas and Walsh, Lorcan and Calvo, Francesc and Caulfield, Brian", title="Comparing the Usability and Acceptability of Wearable Sensors Among Older Irish Adults in a Real-World Context: Observational Study", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="20", volume="8", number="4", pages="e15704", keywords="wearable technology", keywords="usability", keywords="mixed methods", keywords="user satisfaction", abstract="Background: Wearable devices are valuable assessment tools for patient outcomes in contexts such as clinical trials. To be successfully deployed, however, participants must be willing to wear them. Another concern is that usability studies are rarely published, often fail to test devices beyond 24 hours, and need to be repeated frequently to ensure that contemporary devices are assessed. Objective: This study aimed to compare multiple wearable sensors in a real-world context to establish their usability within an older adult (>50 years) population. Methods: Eight older adults wore seven devices for a minimum of 1 week each: Actigraph GT9x, Actibelt, Actiwatch, Biovotion, Hexoskin, Mc10 Biostamp\_RC, and Wavelet. Usability was established through mixed methods using semistructured interviews and three questionnaires, namely, the Intrinsic Motivation Inventory (IMI), the System Usability Scale (SUS), and an acceptability questionnaire. Quantitative data were reported descriptively and qualitative data were analyzed using deductive content analysis. Data were then integrated using triangulation. Results: Results demonstrated that no device was considered optimal as all scored below average in the SUS (median, IQR; min-max=57.5, 12.5; 47.5-63.8). Hexoskin was the lowest scored device based on the IMI (3.6; 3.4-4.5), while Biovotion, Actibelt, and Mc10 Biostamp\_RC achieved the highest median results on the acceptability questionnaire (3.6 on a 6-point Likert scale). Qualitatively, participants were willing to accept less comfort, less device discretion, and high charging burdens if the devices were perceived as useful, namely through the provision of feedback for the user. Participants agreed that the purpose of use is a key enabler for long-term compliance. These views were particularly noted by those not currently wearing an activity-tracking device. Participants believed that wrist-worn sensors were the most versatile and easy to use, and therefore, the most suitable for long-term use. In particular, Actiwatch and Wavelet stood out for their comfort. The convergence of quantitative and qualitative data was demonstrated in the study. Conclusions: Based on the results, the following context-specific recommendations can be made: (1) researchers should consider their device selection in relation to both individual and environmental factors, and not simply the primary outcome of the research study; (2) if researchers do not wish their participants to have access to feedback from the devices, then a simple, wrist-worn device that acts as a watch is preferable; (3) if feedback is allowed, then it should be made available to help participants remain engaged; this is likely to apply only to people without cognitive impairments; (4) battery life of 1 week should be considered as a necessary feature to enhance data capture; (5) researchers should consider providing additional information about the purpose of devices to participants to support their continued use. ", doi="10.2196/15704", url="http://mhealth.jmir.org/2020/4/e15704/", url="http://www.ncbi.nlm.nih.gov/pubmed/32310149" } @Article{info:doi/10.2196/18398, author="Neil-Sztramko, E. Sarah and Coletta, Giulia and Dobbins, Maureen and Marr, Sharon", title="Impact of the AGE-ON Tablet Training Program on Social Isolation, Loneliness, and Attitudes Toward Technology in Older Adults: Single-Group Pre-Post Study", journal="JMIR Aging", year="2020", month="Apr", day="20", volume="3", number="1", pages="e18398", keywords="technology", keywords="older adults", keywords="tablet training", keywords="education", abstract="Background: The internet and technology can help older adults connect with family and friends. However, many older adults face obstacles to internet and technology use, such as lack of knowledge or self-efficacy. Objective: The purpose of this study was to explore the impact of the AGE-ON tablet training program on social isolation, loneliness, and quality of life. Methods: Adults aged >60 years took part in a series of 6 weekly workshops covering the basic features of a tablet. Before and after the program, social isolation, loneliness, social support, and quality of life were assessed. In addition, data on current tablet use and attitudes toward technology use were collected. Satisfaction with the program was also assessed at the end of the study using 6 Likert scale questions. Results: The participants (N=32; mean age 76.3, SD 8.6 years) were predominantly female (n=20, 63\%) and retired (n=30, 94\%). The participants reported that they were highly satisfied with the program. After completing the program, no differences in social isolation, loneliness, social support, or quality of life were found. Frequency of tablet use increased and the attitudes of the participants toward technology improved. Conclusions: The AGE-ON program resulted in increased tablet use frequency and may improve comfort and attitudes toward tablet use among older adults. This program may assist older adults in overcoming obstacles to internet and technology use to better connect with family and friends; however, further work targeting older adults who are socially isolated or at risk of social isolation is needed to more fully understand whether tablet training programs are beneficial in this population. Trial Registration: ClinicalTrials.gov NCT03472729; https://clinicaltrials.gov/ct2/show/NCT03472729 ", doi="10.2196/18398", url="http://aging.jmir.org/2020/1/e18398/", url="http://www.ncbi.nlm.nih.gov/pubmed/32310146" } @Article{info:doi/10.2196/16614, author="Lee, Heayon and Park, Rang Yu and Kim, Hae-Reong and Kang, Young Na and Oh, Gahee and Jang, Il-Young and Lee, Eunju", title="Discrepancies in Demand of Internet of Things Services Among Older People and People With Disabilities, Their Caregivers, and Health Care Providers: Face-to-Face Survey Study", journal="J Med Internet Res", year="2020", month="Apr", day="15", volume="22", number="4", pages="e16614", keywords="Internet of Things", keywords="older adults", keywords="disability", keywords="health care", keywords="mobile phone", abstract="Background: Home Internet of Things (IoT) services and devices have the potential to aid older adults and people with disabilities in their living environments. IoT services and devices can also aid caregivers and health care providers in conveniently providing care to those in need. However, real-world data on the IoT needs of vulnerable people are lacking. Objective: The objective of this study is to conduct a face-to-face survey on the demand for IoT services among older people and people with disabilities, their caregivers, and health care providers in a real-world setting and to see if there are any differences in the aspects of need. Methods: We conducted a face-to-face survey with 500 participants between January 2019 and March 2019. A total of 300 vulnerable people (200 older adults aged ?65 years and 100 physically disabled people aged 30-64 years) were randomly sampled from either a population-based, prospective cohort study of aging---the Aging Study of Pyeongchang Rural Area (ASPRA)---or from the outpatient clinics at the Asan Medical Center, Seoul, South Korea. Simultaneously, their caregivers (n=150) and health care providers (n=50) participated in the survey. Detailed socioeconomic status, digital literacy, health and physical function, and home IoT service needs were determined. Among all commercially available IoT services, 27 services were classified into five categories: emergency and security, safety, health care, convenience (information), and convenience (operation). The weighted-ranking method was used to rank the IoT needs in different groups. Results: There were discrepancies in the demand of IoT services among the vulnerable groups, their caregivers, and health care providers. The home IoT service category that was required the most by the vulnerable groups and their caregivers was emergency and security. However, health care providers indicated that the safety category was most needed by the older adults and disabled people. Home IoT service requirements differed according to the different types of disabilities among the vulnerable groups. Participants with fewer disabilities were more willing to use IoT services than those with more disabilities. Conclusions: Our survey study shows that there were discrepancies in the demand of IoT services among the vulnerable groups, their caregivers, and health care providers. IoT service requirements differed according to the various types of disabilities. Home IoT technology should be established by combining patients' priorities and individualized functional assessments among vulnerable people. Trial Registration: Clinical Research Information Service (CRIS; KCT0004157); https://tinyurl.com/r83eyva ", doi="10.2196/16614", url="http://www.jmir.org/2020/4/e16614/", url="http://www.ncbi.nlm.nih.gov/pubmed/32293575" } @Article{info:doi/10.2196/15906, author="Sedrak, S. Mina and Soto-Perez-De-Celis, Enrique and Nelson, A. Rebecca and Liu, Jennifer and Waring, E. Molly and Lane, S. Dorothy and Paskett, D. Electra and Chlebowski, T. Rowan", title="Online Health Information--Seeking Among Older Women With Chronic Illness: Analysis of the Women's Health Initiative", journal="J Med Internet Res", year="2020", month="Apr", day="9", volume="22", number="4", pages="e15906", keywords="online health information--seeking", keywords="digital health", keywords="technology", keywords="chronic disease", keywords="internet", abstract="Background: Understanding how older patients with chronic illnesses use the internet to obtain health information is relevant for the design of digital interventions aimed at improving the health and well-being of adults aged 65 years and older; this cohort represents the sickest, most expensive, and fastest-growing segment of the US population. Objective: The objective of our study was to describe online health information--seeking behavior among older patients with chronic illnesses and to compare the characteristics of patients who report using the internet to obtain health information with those who do not. Methods: The study population included 72,806 women aged 65 years and older enrolled in the Women's Health Initiative (WHI), a national cohort study, who completed a 2014 supplemental questionnaire assessing everyday technology use and internet use for researching health conditions. Comparisons were made between participants with and without a history of chronic illness and between users and nonusers of online sources for health information. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95\% CIs. Results: Of the total, 59\% (42,887/72,806) of older women used the internet for health information. Compared with women who did not use the internet to obtain health information, those who used the internet were younger (median age: 76 vs 81 years), more likely to be non-Hispanic white (90\% [38,481/42,887] vs 87\% [26,017/29,919]), earned a higher income (over \$US 50,000: 55\% [23,410/42,887] vs 33\% [9991/29,919]), achieved a higher educational level (more than high school: 87\% [37,493/42,887] vs 75\% [22,377/29,919]), and were more likely to live with a partner (52\% [22,457/42,887] vs 36\% [10,759/29,919]) (all P<.001). Women with Alzheimer disease were least likely to report online health information--seeking compared to those without the disease (OR 0.41, 95\% CI 0.38-0.43). In contrast, women with a recent diagnosis of cancer, within the previous 2 years (OR 1.23, 95\% CI 1.11-1.36) or 2-5 years ago (OR 1.09, 95\% CI 1.00-1.19), were most likely to use the internet for health information. Conclusions: Nearly 6 in 10 older women participating in the WHI reported using the internet to obtain health information. Patients recently diagnosed with cancer are more likely to be looking for health information online, even after adjustment for age, suggesting that these patients may have a greater need for digital health resources. ", doi="10.2196/15906", url="http://www.jmir.org/2020/4/e15906/", url="http://www.ncbi.nlm.nih.gov/pubmed/32271152" } @Article{info:doi/10.2196/13077, author="Herrmann, Maximilian and Boehme, Philip and Hansen, Arne and Jansson, Katharina and Rebacz, Patrick and Ehlers, P. Jan and Mondritzki, Thomas and Truebel, Hubert", title="Digital Competencies and Attitudes Toward Digital Adherence Solutions Among Elderly Patients Treated With Novel Anticoagulants: Qualitative Study", journal="J Med Internet Res", year="2020", month="Jan", day="24", volume="22", number="1", pages="e13077", keywords="medication adherence", keywords="eHealth", keywords="mHealth", keywords="digital health", keywords="smartphone", keywords="elderly patients", keywords="compliance", keywords="digital device", keywords="digital competencies", keywords="grounded theory", keywords="delivery of health care", keywords="diffusion of innovation", abstract="Background: Nonadherence to medication is a driver of morbidity and mortality, and complex medication regimens in patients with chronic diseases foster the problem. Digital technology might help, but despite numerous solutions being developed, none are currently widely used, and acceptance rates remain low, especially among the elderly. Objective: This study aimed to better understand and operationalize how new digital solutions can be evaluated. Particularly, the goal was to identify factors that help digital approaches targeting adherence to become more widely accepted. Methods: A qualitative study using a conceptual grounded theory approach was conducted. We included patients aged 65 years and older who routinely took new oral anticoagulants. To generate theses about the digital competencies of the target group with daily medication intake, face-to-face interviews were conducted, recorded, and anonymized. After coding the interviews, categories were generated, discussed, and combined with several theses until saturation of the statements was reached. Results: The methodological approach led to the finding that after interviews in 20 of 77 potentially available patients, a saturation of statements was reached. The average patient's age was 75 years, and 50\% (10/20) of the subjects were female. The data identified five main coding categories---Diseases and medicine, Technology, Autonomy, Patient narrative, and Attitude toward technologies---each including positive and negative subcategories. Main categories and subcategories were summarized as Adherence Radar, which can be considered as a framework to assess the potential of adherence solutions in the process of prototyping and can be applied to all adherence tools in a holistic manner. Conclusions: The Adherence Radar can be used to increase the acceptance rate of digital solutions targeting adherence. For a patient-centric design, an app should be adapted to the individual patient's needs. According to our results, this application should be based on gender and educational background as well as the individual physician-patient relationship. If used in a proper, individualized manner, digital adherence solutions could become a new cornerstone for the treatment of chronically ill individuals. ", doi="10.2196/13077", url="http://www.jmir.org/2020/1/e13077/", url="http://www.ncbi.nlm.nih.gov/pubmed/32012049" } @Article{info:doi/10.2196/14241, author="Bender, L. Jacqueline and Feldman-Stewart, Deb and Tong, Christine and Lee, Karen and Brundage, Michael and Pai, Howard and Robinson, John and Panzarella, Tony", title="Health-Related Internet Use Among Men With Prostate Cancer in Canada: Cancer Registry Survey Study", journal="J Med Internet Res", year="2019", month="Nov", day="19", volume="21", number="11", pages="e14241", keywords="prostate cancer", keywords="internet", keywords="health decision making", keywords="digital divide", abstract="Background: After a prostate cancer diagnosis, men want information about their disease and treatment options. The internet offers a convenient means to deliver health information to patients with prostate cancer. However, there are concerns about the use of the internet among this largely senior population. Objective: This study aimed to determine the patterns and factors associated with the use of the internet as a source of health information among Canadian men with prostate cancer and the features and information required in a website. Methods: Population surveys were conducted in four Canadian provinces (British Columbia, Alberta, Saskatchewan, and Ontario) in 2014-2015. Data analyses included descriptive, bivariable, and multivariable analyses. The Pearson Chi-square and univariable regression were used to examine associations between independent variables and health-related internet use. Correlates of health-related internet use were analyzed using multivariable logistic regression. Results: A total of 1362 patients responded across the four provinces. The mean age of respondents was 69 years (SD 8.2). In addition, 82\% (n=1071) were internet users and 71\% (n=910) used the internet daily. Further, 65\% (n=784) used the internet as a source of prostate cancer information, and 40\% (n=521) were confident about using information obtained from the internet to make health decisions. Men who used the internet to obtain prostate cancer information were more likely to be active information seekers (odds ratio [OR]: 4.5, 95\% CI 2.6-7.8), be confident using information from the internet to make health decisions (OR: 3.6, 95\% CI 2.3-5.7), have broadband internet access (OR: 1.8, 95\% CI 1.2-2.7), and have more unmet supportive care needs (OR: 1.05, 95\% CI 1.0-1.1). Top features wanted in a website, reported by more than 50\% of respondents, were a library of resources (n=893, 65.6\%), tools to support treatment decision making (n=815, 59.8\%), and tools to help navigate the prostate cancer journey (n=698, 51.2\%). Top three topics of information wanted in such a website were treatment options (n=916, 67.3\%), disease progression (n=904, 66.4\%), and management of side effects (n=858, 63\%). Conclusions: Over two-thirds of Canadian patients with prostate cancer surveyed use the internet as a source of health information about prostate cancer, but over half did not feel confident using information from the internet to make health decisions. Being an active information seeker, having confidence in using information from the internet to make health decisions, having broadband internet, and having more unmet supportive care needs were significantly associated with health-related internet use. Future work should examine electronic health literacy interventions as a means to boost men's confidence in using information from the internet and design websites that include information and features that help men navigate the prostate cancer journey and support treatment decision making and management of side effects. ", doi="10.2196/14241", url="http://www.jmir.org/2019/11/e14241/", url="http://www.ncbi.nlm.nih.gov/pubmed/31742561" } @Article{info:doi/10.2196/15320, author="Waring, E. Molly and Hills, T. Mellanie and Lessard, M. Darleen and Saczynski, S. Jane and Libby, A. Brooke and Holovatska, M. Marta and Kapoor, Alok and Kiefe, I. Catarina and McManus, D. David", title="Characteristics Associated With Facebook Use and Interest in Digital Disease Support Among Older Adults With Atrial Fibrillation: Cross-Sectional Analysis of Baseline Data From the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) Cohort", journal="JMIR Cardio", year="2019", month="Nov", day="14", volume="3", number="2", pages="e15320", keywords="atrial fibrillation", keywords="social media", keywords="information seeking behavior", abstract="Background: Online support groups for atrial fibrillation (AF) and apps to detect and manage AF exist, but the scientific literature does not describe which patients are interested in digital disease support. Objective: The objective of this study was to describe characteristics associated with Facebook use and interest in digital disease support among older patients with AF who used the internet. Methods: We used baseline data from the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF), a prospective cohort of older adults (?65 years) with AF at high stroke risk. Participants self-reported demographics, clinical characteristics, and Facebook and technology use. Online patients (internet use in the past 4 weeks) were asked whether they would be interested in participating in an online support AF community. Mobile users (owns smartphone and/or tablet) were asked about interest in communicating with their health care team about their AF-related health using a secure app. Logistic regression models identified crude and multivariable predictors of Facebook use and interest in digital disease support. Results: Online patients (N=816) were aged 74.2 (SD 6.6) years, 47.8\% (390/816) were female, and 91.1\% (743/816) were non-Hispanic white. Roughly half (52.5\%; 428/816) used Facebook. Facebook use was more common among women (adjusted odds ratio [aOR] 2.21, 95\% CI 1.66-2.95) and patients with mild to severe depressive symptoms (aOR 1.50, 95\% CI 1.08-2.10) and less common among patients aged ?85 years (aOR 0.27, 95\% CI 0.15-0.48). Forty percent (40.4\%; 330/816) reported interest in an online AF patient community. Interest in an online AF patient community was more common among online patients with some college/trade school or Bachelors/graduate school (aOR 1.70, 95\% CI 1.10-2.61 and aOR 1.82, 95\% CI 1.13-2.92, respectively), obesity (aOR 1.65, 95\% CI 1.08-2.52), online health information seeking at most weekly or multiple times per week (aOR 1.84, 95\% CI 1.32-2.56 and aOR 2.78, 95\% CI 1.86-4.16, respectively), and daily Facebook use (aOR 1.76, 95\% CI 1.26-2.46). Among mobile users, 51.8\% (324/626) reported interest in communicating with their health care team via a mobile app. Interest in app-mediated communication was less likely among women (aOR 0.48, 95\% CI 0.34-0.68) and more common among online patients who had completed trade school/some college versus high school/General Educational Development (aOR 1.95, 95\% CI 1.17-3.22), sought online health information at most weekly or multiple times per week (aOR 1.86, 95\% CI 1.27-2.74 and aOR 2.24, 95\% CI 1.39-3.62, respectively), and had health-related apps (aOR 3.92, 95\% CI 2.62-5.86). Conclusions: Among older adults with AF who use the internet, technology use and demographics are associated with interest in digital disease support. Clinics and health care providers may wish to encourage patients to join an existing online support community for AF and explore opportunities for app-mediated patient-provider communication. ", doi="10.2196/15320", url="http://cardio.jmir.org/2019/2/e15320/", url="http://www.ncbi.nlm.nih.gov/pubmed/31758791" } @Article{info:doi/10.2196/13939, author="L{\'o}pez Segu{\'i}, Francesc and de San Pedro, Marc and Aumatell Verges, Eva and Sim{\'o} Algado, Salvador and Garcia Cuy{\`a}s, Francesc", title="An Intergenerational Information and Communications Technology Learning Project to Improve Digital Skills: User Satisfaction Evaluation", journal="JMIR Aging", year="2019", month="Aug", day="09", volume="2", number="2", pages="e13939", keywords="active aging", keywords="digital inclusion", keywords="ICT program", keywords="intergenerational relationships", keywords="civic participation", keywords="community service", abstract="Background: ``Digital Partners'' is an intergenerational information and communications technology learning project carried out in the municipalities of Vic and Centelles (Catalonia) from April to May 2018. Within the framework of the introduction of community service as a subject in secondary education, the Centre for Health and Social Studies (University of Vic) created a training space with 38 intergenerational partners (aged 14-15 years and >65 years), with the aim of improving the senior users' digital skills in terms of use of smartphones and tablets, thus helping reduce the digital divide in the territory. Objective: The aim of this paper is to evaluate the satisfaction of both junior and senior participants toward the intervention and to explore its main drivers. Methods: Participants who volunteered to participate in the study were interviewed. Quantitative and qualitative data gathered in paper-based ad hoc surveys were used to assess participants' satisfaction. Results: The experience shows a broad satisfaction of both junior and senior users. The project's strengths include the format of working in couples; randomly pairing individuals by operating system; the ability to practice with the device itself; individuals' free choice to decide what they wish to learn, develop, or practice; and the availability of voluntary practice material that facilitates communication and learning. With regard to aspects that could be improved, there is a need to review the timetabling flexibility of meetings to avoid hurrying the elderly and to extend the project's duration, if necessary. Conclusions: This activity can serve to create mutual learning through the use of mobile devices and generate security and motivation on the part of the seniors, thus reducing the digital divide and improving social inclusion. ", doi="10.2196/13939", url="http://aging.jmir.org/2019/2/e13939/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518276" } @Article{info:doi/10.2196/11604, author="Portz, Dickman Jennifer and Bayliss, A. Elizabeth and Bull, Sheana and Boxer, S. Rebecca and Bekelman, B. David and Gleason, Kathy and Czaja, Sara", title="Using the Technology Acceptance Model to Explore User Experience, Intent to Use, and Use Behavior of a Patient Portal Among Older Adults With Multiple Chronic Conditions: Descriptive Qualitative Study", journal="J Med Internet Res", year="2019", month="Apr", day="08", volume="21", number="4", pages="e11604", keywords="multiple chronic conditions", keywords="personal health record", keywords="patient portals", keywords="aging", keywords="health information technology", abstract="Background: Patient portals offer modern digital tools for older adults with multiple chronic conditions (MCC) to engage in their health management. However, there are barriers to portal adoption among older adults. Understanding portal user interface and user experience (UI and UX) preferences of older adults with MCC may improve the accessibility, acceptability, and adoption of patient portals. Objective: The aim of this study was to use the Technology Acceptance Model (TAM) as a framework for qualitatively describing the UI and UX, intent to use, and use behaviors among older patients with MCC. Methods: We carried out a qualitative descriptive study of Kaiser Permanente Colorado's established patient portal, My Health Manager. Older patients (N=24; mean 78.41 (SD 5.4) years) with MCC participated in focus groups. Stratified random sampling was used to maximize age and experience with the portal among participants. The semistructured focus groups used a combination of discussion and think-aloud strategies. A total of 2 coders led the theoretically driven analysis based on the TAM to determine themes related to use behavior, portal usefulness and ease of use, and intent to use. Results: Portal users commonly used email, pharmacy, and lab results sections of the portal. Although, generally, the portal was seen to be easy to use, simple, and quick, challenges related to log-ins, UI design (color and font), and specific features were identified. Such challenges inhibited participants' intent to use the portal entirely or specific features. Participants indicated that the portal improved patient-provider communication, saved time and money, and provided relevant health information. Participants intended to use features that were beneficial to their health management and easy to use. Conclusions: Older adults are interested in using patient portals and are already taking advantage of the features available to them. We have the opportunity to better engage older adults in portal use but need to pay close attention to key considerations promoting usefulness and ease of use. ", doi="10.2196/11604", url="https://www.jmir.org/2019/4/e11604/", url="http://www.ncbi.nlm.nih.gov/pubmed/30958272" } @Article{info:doi/10.2196/12243, author="Gordon, P. Nancy and Crouch, Elizabeth", title="Digital Information Technology Use and Patient Preferences for Internet-Based Health Education Modalities: Cross-Sectional Survey Study of Middle-Aged and Older Adults With Chronic Health Conditions", journal="JMIR Aging", year="2019", month="Apr", day="04", volume="2", number="1", pages="e12243", keywords="internet", keywords="health status disparities", keywords="aged", keywords="health informatics", keywords="information technology", keywords="health education", abstract="Background: Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education. Objective: The objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic health conditions. Methods: The study used cross-sectional survey data for 9005 Kaiser Permanente Northern California members aged 45 to 85 years who responded to a mailed and Web-based health survey conducted during 2014 and 2015 and indicated having at least 1 chronic health condition. Bivariate analyses and logistic regression models with weighted data were used to estimate and compare the prevalence of digital information technology use, past-year use of internet-based health information and advice resources, and preferences for using internet-based, mHealth, and traditional health information and advice modalities for adults aged 45 to 65 years, 66 to 75 years, and 76 to 85 years. Results: The percentages of adults who used digital information technologies (computers, smartphones, internet, email, and apps), had obtained health information and advice from an internet-based resource in the past year, and who were interested in using internet-based and mHealth modalities for obtaining health information and advice declined with age. Within age group, prevalence of digital information technologies use and interest in internet-based and mHealth modalities was lower among adults with no college education versus college graduates. Differences in preferences for internet-based health information and advice modalities between the oldest and younger groups and those with lower versus higher education were substantially diminished when we restricted analyses to internet users. Conclusions: Health care providers and organizations serving middle-aged and older adults with chronic health conditions should not assume that patients, especially those who are older and less educated, want to engage with internet-based and mHealth resources. In addition, increasing the engagement of nonutilizers of digital devices and the internet with internet-based health information and advice and mHealth apps might require both instrumental (eg, providing digital information technology devices, internet, and skills training) and social support. As part of patient-centered care, it is important for providers to ascertain their patients' use of digital information technologies and preferences for obtaining health information and patient education rather than routinely referring them to internet-based resources. It is also important for health care providers and consumer health organizations to user test their Web-based resources to make sure they are easy for older and less educated adults to use and to make sure that it remains easy for adults with chronic conditions to obtain health information and patient education using offline resources. ", doi="10.2196/12243", url="http://aging.jmir.org/2019/1/e12243/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518291" } @Article{info:doi/10.2196/11451, author="Crouch, Elizabeth and Gordon, P. Nancy", title="Prevalence and Factors Influencing Use of Internet and Electronic Health Resources by Middle-Aged and Older Adults in a US Health Plan Population: Cross-Sectional Survey Study", journal="JMIR Aging", year="2019", month="Mar", day="26", volume="2", number="1", pages="e11451", keywords="digital divide", keywords="patient portal", keywords="information-seeking behavior", keywords="health education", keywords="patient preference", keywords="patient surveys", abstract="Background: Health care organizations are increasingly using electronic health (eHealth) platforms to provide and exchange health information and advice (HIA). There is limited information about how factors beyond internet access affect use of eHealth resources by middle-aged and older adults. Objective: We aimed to estimate prevalence of use of the internet, health plan patient portal, and Web-based HIA among middle-aged and older adults; investigate whether similar sociodemographic-related disparities in eHealth resource use are found among middle-aged and older adults; and examine how sociodemographic and internet access factors drive disparities in eHealth resource use among adults who use the internet. Methods: We analyzed cross-sectional survey data for 10,920 Northern California health plan members aged 45 to 85 years who responded to a mailed and Web-based health survey (2014-2015). We used bivariate and multivariable analyses with weighted data to estimate prevalence of and identify factors associated with internet use and self-reported past year use of the health plan's patient portal and Web-based HIA resources by middle-aged adults (aged 45 to 65 years; n=5520), younger seniors (aged 65 to 75 years; n=3014), and older seniors (aged 76 to 85 years; n=2389). Results: Although approximately 96\% of middle-aged adults, 92\% of younger seniors, and 76\% of older seniors use the internet to obtain information, about 4\%, 9\%, and 16\%, respectively, require someone's help to do so. The percentages who used the patient portal and Web-based HIA resources were similar for middle-aged adults and younger seniors but lower among older seniors (59.6\%, 61.4\%, and 45.0\% and 47.9\%, 48.4\%, and 37.5\%, respectively). Disparities in use of the internet, patient portal, and Web-based HIA across levels of education and between low and higher income were observed in all age groups, with wider disparities between low and high levels of education and income among seniors. Multivariable analyses showed that for all 3 age groups, educational attainment, ability to use the internet without help, and having 1 or more chronic condition were significant predictors of patient portal and Web-based HIA use after controlling for gender, race/ethnicity, and internet use. Conclusions: Internet use, and especially use without help, significantly declines with age, even within a middle-aged group. Educational attainment is significantly associated with internet use, ability to use the internet without help, and use of patient portal and Web-based HIA resources by middle-aged and older adults. Even among middle-aged and older adult internet users, higher educational attainment and ability to use the internet without help are positively associated with patient portal and Web-based HIA use. Organizations serving middle-aged and older adults should take into account target population characteristics when developing and evaluating uptake of eHealth resources and should consider offering instruction and support services to boost patient engagement. ", doi="10.2196/11451", url="http://aging.jmir.org/2019/1/e11451/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518256" } @Article{info:doi/10.2196/11449, author="Powell, Ryan Kimberly and Alexander, Lynn Gregory and Madsen, Richard and Deroche, Chelsea", title="A National Assessment of Access to Technology Among Nursing Home Residents: A Secondary Analysis", journal="JMIR Aging", year="2019", month="Mar", day="05", volume="2", number="1", pages="e11449", keywords="nursing homes", keywords="health information technology", keywords="patient access", keywords="patient portals", keywords="personal health records", keywords="patient engagement", keywords="person-centered care", abstract="Background: According to the National Center for Health Statistics, there are over 1.7 million nursing home residents in the United States. Nursing home residents and their family members have unique needs and stand to benefit from using technology empowering them to be more informed and engaged health care consumers. Although there is growing evidence for benefits of patient-facing technologies like electronic patient portals on patient engagement in acute and outpatient settings, little is known about use of this technology in nursing homes. Objective: The purpose of this study was to report findings from a secondary analysis of data from a national nursing home study of information technology (IT) adoption, called IT sophistication. We describe the extent to which nursing homes (n=815) allow residents or their representatives to access technology including electronic health records, patient portals, and health information-exchange systems as well as the ability of the residents or representatives to self-report data directly into the electronic health record. Methods: We used descriptive statistics and regression techniques to explore relationships between information technology adoption (IT sophistication) and residents' or their representatives' access to technology. Covariates of location, bed size, and ownership were added to the model to understand their potential influence on the relationship between IT sophistication and resident access to technology. Results: Findings revealed that resident access to technology was a significant predictor of the nursing home IT sophistication (P<.001). The inclusion of covariates---nursing home location, bed size, and ownership---with their interactions produced a nonsignificant effect in the model. Residents' or their representatives' use of electronic health records and personal health records were both significant predictors of overall IT sophistication (P<.001). Conclusions: As nursing homes continue to progress in technological capabilities, it is important to understand how increasing IT sophistication can be leveraged to create opportunities to engage residents in their care. Understanding the impact of health information technology on outcomes and which technologies make a difference will help nursing home administrators make more informed decisions about adoption and implementation. ", doi="10.2196/11449", url="http://aging.jmir.org/2019/1/e11449/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518285" } @Article{info:doi/10.2196/11280, author="Jin, Yinzi and Jing, Mingxia and Zhang, Luyu and Song, Suhang and Ma, Xiaochen", title="Internet Access and Hypertension Management Among the Elderly Population: A Nationally Representative Cross-Sectional Survey in China", journal="J Med Internet Res", year="2019", month="Jan", day="31", volume="21", number="1", pages="e11280", keywords="China", keywords="health disparity", keywords="hypertension", keywords="internet", abstract="Background: Hypertension is a rapidly growing epidemic in China. Yet, it remains inadequately controlled, especially in rural areas. The internet has shown potential for better health management in different settings; however, few studies have investigated its role in hypertension management in China. Objective: This study aims to examine the association between internet access and hypertension awareness, treatment, and control among elderly Chinese adults and to investigate whether the association between internet access and hypertension management differed between those living in urban and rural areas. Methods: We obtained data from the nationally representative survey of the China Health and Retirement Longitudinal Study in 2011. Hypertension was defined as (1) average systolic blood pressure of ?140 mm Hg or average diastolic blood pressure of ?90 mm Hg or (2) currently taking antihypertensive medications. The outcome assessed included hypertension awareness, treatment, and control. The key independent variable was defined as whether one had internet access at home. We performed multivariate logistic regressions for each of the 3 outcomes. Results: Among 5135 hypertensive respondents (age 62.4 [SD 9.9] years; 2351/5135, 45.78\% men), 12.89\% (662/5135) had internet access at home. Compared with those who had no internet access, internet access was positively associated with hypertension awareness (odds ratio [OR] 1.36, 95\% CI 1.07-1.73) and treatment (OR 1.38, 95\% CI 1.09-1.75), but not with control (OR 1.19, 95\% CI 0.90-1.58). Internet access reduced urban-rural disparity in hypertension awareness by 9.6\% (P=.02), treatment by 8.3\% (P=.05), but not in control. In addition, the moderating effect of internet access on urban-rural disparities in hypertension management was larger among females. The decreased urban-rural disparities were primarily driven by that internet access improved the management level in rural areas. Conclusions: Despite the low rate of internet access among the elderly population, the internet shows its potential as a platform for achieving better hypertension management in China. Strategies for reducing the disparities in hypertension management and overall disease burden of hypertension among the elderly population might consider the internet as a platform. ", doi="10.2196/11280", url="http://www.jmir.org/2019/1/e11280/", url="http://www.ncbi.nlm.nih.gov/pubmed/30702439" } @Article{info:doi/10.2196/10049, author="Raven, C. Maria and Kaplan, M. Lauren and Rosenberg, Marina and Tieu, Lina and Guzman, David and Kushel, Margot", title="Mobile Phone, Computer, and Internet Use Among Older Homeless Adults: Results from the HOPE HOME Cohort Study", journal="JMIR Mhealth Uhealth", year="2018", month="Dec", day="10", volume="6", number="12", pages="e10049", keywords="homelessness", keywords="internet", keywords="cell phone", keywords="smartphone", keywords="aged and middle aged", abstract="Background: The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. Access to mobile phones and the internet could help lower the barriers to social support, social services, and medical care; however, little is known about access to and use of these by older homeless adults. Objective: This study aimed to describe the access to and use of mobile phones, computers, and internet among a cohort of 350 homeless adults over the age of 50 years. Methods: We recruited 350 participants who were homeless and older than 50 years in Oakland, California. We interviewed participants at 6-month intervals about their health status, residential history, social support, substance use, depressive symptomology, and activities of daily living (ADLs) using validated tools. We performed clinical assessments of cognitive function. During the 6-month follow-up interview, study staff administered questions about internet and mobile technology use. We assessed participants' comfort with and use of multiple functions associated with these technologies. Results: Of the 343 participants alive at the 6-month follow-up, 87.5\% (300/343) completed the mobile phone and internet questionnaire. The median age of participants was 57.5 years (interquartile range 54-61). Of these, 74.7\% (224/300) were male, and 81.0\% (243/300) were black. Approximately one-fourth (24.3\%, 73/300) of the participants had cognitive impairment and slightly over one-third (33.6\%, 100/300) had impairments in executive function. Most (72.3\%, 217/300) participants currently owned or had access to a mobile phone. Of those, most had feature phones, rather than smartphones (89, 32.1\%), and did not hold annual contracts (261, 94.2\%). Just over half (164, 55\%) had ever accessed the internet. Participants used phones and internet to communicate with medical personnel (179, 64.6\%), search for housing and employment (85, 30.7\%), and to contact their families (228, 82.3\%). Those who regained housing were significantly more likely to have mobile phone access (adjusted odds ratio [AOR] 3.81, 95\% CI 1.77-8.21). Those with ADL (AOR 0.53, 95\% CI 0.31-0.92) and executive function impairment (AOR 0.49; 95\% CI 0.28-0.86) were significantly less likely to have mobile phones. Moderate to high risk amphetamine use was associated with reduced access to mobile phones (AOR 0.27, 95\% CI 0.10-0.72). Conclusions: Older homeless adults could benefit from portable internet and phone access. However, participants had a lower prevalence of smartphone and internet access than adults aged over 65 years in the general public or low-income adults. Participants faced barriers to mobile phone and internet use, including financial barriers and functional and cognitive impairments. Expanding access to these basic technologies could result in improved outcomes. ", doi="10.2196/10049", url="http://mhealth.jmir.org/2018/12/e10049/", url="http://www.ncbi.nlm.nih.gov/pubmed/30530464" } @Article{info:doi/10.2196/10763, author="Liu, Darren and Yamashita, Takashi and Burston, Betty", title="Identifying Consumers Who Search for Long-Term Care on the Web: Latent Class Analysis", journal="JMIR Aging", year="2018", month="Nov", day="02", volume="1", number="2", pages="e10763", keywords="internet", keywords="information seeking behavior", keywords="consumer health information", keywords="marketing of health services", keywords="public reporting", abstract="Background: Because the internet has become a primary means of communication in the long-term care (LTC) and health care industry, an elevated understanding of market segmentation among LTC consumers is an indispensable step to responding to the informational needs of consumers. Objective: This exploratory study was designed to identify underlying market segments of the LTC consumers who seek Web-based information. Methods: Data on US adult internet users (n=2018) were derived from 2010 Pew Internet and America Life Project. Latent class analysis was employed to identify underlying market segments of LTC Web-based information seekers. Results: Web-based LTC information seekers were classified into the following 2 subgroups: heavy and light Web-based information seekers. Overall, 1 in 4 heavy Web-based information seekers used the internet for LTC information, whereas only 2\% of the light information seekers did so. The heavy information seekers were also significantly more likely than light users to search the internet for all other health information, such as a specific disease and treatment and medical facilities. The heavy Web-based information seekers were more likely to be younger, female, highly educated, chronic disease patients, caregivers, and frequent internet users in general than the light Web-based information seekers. Conclusions: To effectively communicate with their consumers, providers who target Web-based LTC information seekers can more carefully align their informational offerings with the specific needs of each subsegment of LTC markets. ", doi="10.2196/10763", url="https://aging.jmir.org/2018/2/e10763/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518237" } @Article{info:doi/10.2196/cardio.8903, author="Sak, Gabriele and Schulz, Johannes Peter", title="Exploring Health Information-Seeking Preferences of Older Adults With Hypertension: Quasi-Experimental Design", journal="JMIR Cardio", year="2018", month="May", day="30", volume="2", number="1", pages="e12", keywords="desire for health information", keywords="assisted computer-based information search", keywords="decision self-efficacy", keywords="medical decision making", keywords="senior hypertensive patients", keywords="quasi-experimental design", keywords="Switzerland", abstract="Background: Patients' engagement in health care decision making is constituted by at least two behaviors: health information seeking and active involvement in medical decisions. Previous research reported that older adults desire a lot of information, but want to participate in decision making to a lesser degree. However, there is only limited evidence on the effect of desire for health information on seniors' perceived confidence in making an informed choice (ie, decision self-efficacy). Objective: The goal of this study was to investigate the role desire for health information has for older patients. More specifically, it tested whether decision self-efficacy increases as a function of an assisted computer-based information search. Additionally, the study allowed insights into the sources seniors with hypertension prefer to consult. Methods: A sample of 101 senior citizens (aged ?60 years) with high blood pressure in the Italian-speaking part of Switzerland answered a questionnaire before and after an informational intervention was applied. The intervention consisted of offering additional information on hypertension from five different sources and of providing the information the participant desired. Preference for receiving this information was the major independent variable. The main outcome measure was decision self-efficacy (assessed at baseline and posttest). Analyses of covariance were conducted to detect differences between and within who desired additional hypertension-related content (intervention group) and ``information avoiders'' (control group). Results: Health care professionals firmly remain the preferred and most trusted source of health information for senior patients. The second most consulted source was the internet (intervention group only). However, among the total sample, the internet obtained the lowest credibility score. A significant increase in decision self-efficacy occurred in seniors consulting additional information compared to information avoiders (F1,93=28.25, P<.001). Conclusions: Consulting health information on a computer screen, and assistance by a computer-savvy person, may be a helpful activity to increase perceived confidence in making treatment decisions in seniors with hypertension. ", doi="10.2196/cardio.8903", url="http://cardio.jmir.org/2018/1/e12/", url="http://www.ncbi.nlm.nih.gov/pubmed/31758784" } @Article{info:doi/10.2196/jmir.8203, author="Shim, Hyunju and Ailshire, Jennifer and Zelinski, Elizabeth and Crimmins, Eileen", title="The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points", journal="J Med Internet Res", year="2018", month="May", day="25", volume="20", number="5", pages="e200", keywords="health information technology", keywords="health services", keywords="disease management", keywords="chronic disease", keywords="geriatrics", abstract="Background: The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known. Objective: This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions. Methods: The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested. Results: A total of 48.0\% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times. Conclusions: The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions. ", doi="10.2196/jmir.8203", url="http://www.jmir.org/2018/5/e200/", url="http://www.ncbi.nlm.nih.gov/pubmed/29802088" } @Article{info:doi/10.2196/jmir.3749, author="Medlock, Stephanie and Eslami, Saeid and Askari, Marjan and Arts, L. Derk and Sent, Danielle and de Rooij, E. Sophia and Abu-Hanna, Ameen", title="Health Information--Seeking Behavior of Seniors Who Use the Internet: A Survey", journal="J Med Internet Res", year="2015", month="Jan", day="08", volume="17", number="1", pages="e10", keywords="aged", keywords="aged, 80 and over", keywords="information-seeking behavior", keywords="Internet", keywords="patient education", keywords="empowerment", abstract="Background: The Internet is viewed as an important source for health information and a medium for patient empowerment. However, little is known about how seniors use the Internet in relation to other sources for health information. Objective: The aim was to determine which information resources seniors who use the Internet use and trust for health information, which sources are preferred, and which sources are used by seniors for different information needs. Methods: Questions from published surveys were selected based on their relevance to the study objectives. The Autonomy Preference Index was used to assess information needs and preferences for involvement in health decisions. Invitation to participate in this online survey was sent to the email list of a local senior organization (298 addresses) in the Netherlands. Results: There were 118 respondents with a median age of 72 years (IQR 67-78 years). Health professionals, pharmacists, and the Internet were the most commonly used and trusted sources of health information. Leaflets, television, newspapers, and health magazines were also important sources. Respondents who reported higher use of the Internet also reported higher use of other sources (P<.001). Use of health professionals, pharmacists, leaflets, telephone, television, and radio were not significantly different; use of all other resources was significantly higher in frequent Internet users. When in need of health information, preferred sources were the Internet (46/105, 43.8\%), other sources (eg, magazines 38/105, 36.2\%), health professionals (18/105, 17.1\%), and no information seeking (3/105, 2.8\%). Of the 51/107 respondents who indicated that they had sought health information in the last 12 months, 43 sought it after an appointment, 23 were preparing for an appointment, and 20 were deciding if an appointment was needed. The source used varied by the type of information sought. The Internet was used most often for symptoms (27/42, 64\%), prognosis (21/31, 68\%), and treatment options (23/41, 62\%), whereas health professionals were asked for additional information on medications (20/36, 56\%), side effects (17/36, 47\%), coping (17/31, 55\%), practical care (12/14, 86\%), and nutrition/exercise (18/30, 60\%). Conclusions: For these seniors who use the Internet, the Internet was a preferred source of health information. Seniors who report higher use of the Internet also report higher use of other information resources and were also the primary consumers of paper-based resources. Respondents most frequently searched for health information after an appointment rather than to prepare for an appointment. Resources used varied by health topic. Future research should seek to confirm these findings in a general elderly population, investigate how seniors seek and understand information on the Internet, and investigate how to reach seniors who prefer not to use the Internet for health information. ", doi="10.2196/jmir.3749", url="http://www.jmir.org/2015/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/25574815" }