@Article{info:doi/10.2196/65515, author="Da, Romaric Si{\'e} Mathieu Aymar and Sasseville, Maxime and Hardy, Marie-Soleil and Beogo, Idrissa and Gogovor, Am{\'e}d{\'e} and Amil, Samira and Yameogo, R. Achille and Bergeron, Fr{\'e}d{\'e}ric and Giguere, Anik and LeBlanc, Annie and Plaisimond, James and Rivard-Lacroix, Carole and Gagnon, Marie-Pierre", title="Engaging Older Adults With Cognitive Impairment in Digital Health Technologies: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2025", month="Jun", day="3", volume="14", pages="e65515", keywords="engagement", keywords="older adults", keywords="cognitive disorders", keywords="digital health technologies", keywords="scoping review", abstract="Background: The aging of the population is a major issue in Canada, particularly in Quebec. For people older than the age of 65 years, aging is often associated with both mild and severe cognitive impairment. The management of these disorders increases the pressure on health care systems. Digital health technologies could be used to promote the cognitive health of older people living with cognitive disorders. However, to reap the full benefits of using digital health technologies, it is critical that older people with cognitive disorders engage with these technologies. A dose-response relationship has been demonstrated between the level of engagement with digital health technologies and the effectiveness of interventions in older people. It is thus important to understand how older people with cognitive impairment engage with digital health technologies and how this engagement can influence the success of digital health interventions. Objective: This study aims to describe how the engagement of older adults with cognitive impairment with digital health technologies is conceptualized and assessed, and how this engagement relates to the effectiveness of digital health interventions. Methods: We will use the scoping review method outlined by Arksey and O'Malley. We will apply a systematic approach following the Joanna Briggs Institute guidelines and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist to ensure reproducibility of the scoping review. A search strategy, created with a medical information specialist, will be applied to MEDLINE, Embase, CINAHL, Web of Science, and Google Scholar, without time restrictions. Two reviewers will independently select titles, abstracts, and full texts. Data extraction will be conducted by the research team and validated by a senior member, resolving disagreements by consensus or a third party if necessary. Descriptive analyses will be done using concept mapping for a narrative synthesis of the results by themes related to the research questions. Results: The development of the search strategy and the completion of the selection phases of the review were completed in July 2024. Data extraction and analysis began in August 2024, and results are expected to be available in November 2024. Conclusions: The results of this scoping review will provide a comprehensive overview of the different conceptualizations of engagement with digital health technologies in older people with cognitive impairment, as well as the tools to measure it. This will contribute to a better understanding of the relationships between levels of engagement and the effectiveness of digital health interventions in older people living with neurocognitive disorders. International Registered Report Identifier (IRRID): PRR1-10.2196/65515 ", doi="10.2196/65515", url="https://www.researchprotocols.org/2025/1/e65515" } @Article{info:doi/10.2196/66610, author="Tabira, Kento and Oguma, Yuko and Yoshihara, Shota and Shibuya, Megumi and Nakamura, Manabu and Doihara, Natsue and Hirata, Akihiro and Manabe, Tomoki and Yamashita, Takashi", title="A 12-Month Digital Peer-Supported App Intervention to Promote Physical Activity Among Community-Dwelling Older Adults: Follow-Up Study of a Nonrandomized Controlled Trial", journal="JMIR Aging", year="2025", month="May", day="28", volume="8", pages="e66610", keywords="physical activity", keywords="exercise", keywords="exercising", keywords="physical function", keywords="older adult", keywords="aging", keywords="eHealth", keywords="peer support", keywords="mobile phone", keywords="mHealth", keywords="mobile health", keywords="mobile app", keywords="app", keywords="application", keywords="smartphone", keywords="digital", abstract="Background: Mobile apps and peer support are known to effectively promote physical activity in older adults, which, in turn, improves physical function. Previously, we investigated the feasibility and impact of using digital peer-supported apps (DPSAs) to increase physical activity among older adults over a 3-month period. However, the long-term feasibility and impact on sustainable behavior change remain unknown. Objective: This study aims to evaluate the 12-month feasibility of the DPSA and to obtain preliminary estimates of its effects on physical activity and physical function among older Japanese adults. Methods: This nonrandomized controlled trial recruited older adults aged 65 years or older from 2 physical activity programs. Participants chose either the intervention (app program + exercise instruction) group or the control (exercise instruction only) group. Only those participants who had completed the 3-month intervention and wished to continue in the 12-month follow-up intervention study were included. DPSA feasibility was assessed using retention and adherence rates. Physical activity was assessed using accelerometers, capturing daily step count, light-intensity activity, moderate to vigorous intensity activity, and sedentary behavior. Physical function was evaluated using grip strength and the 30-second chair stand test (CS-30). Accelerometer measurements were collected every 3 months over 12 months (5 time points, including baseline), whereas physical function was measured at baseline, 3 months, and 12 months. Results: The follow-up study included 44 of 66 participants from the 3-month intervention study, with 26 participants in the intervention group and 18 participants in the control group. The 12-month retention rate for participants in the DPSA intervention group was 73\% (19/26), whereas the retention rate among all 41 participants, including those who chose not to participate in the follow-up study, was 46\% (19/41). The adherence rate was 85.9\%. The average number of steps per day (95\% CI) in the intervention group changed before and after DPSA use (P=.048). We observed an increase of 1736 ($\beta$=1736, 95\% CI 232-3241) steps per day compared with baseline. No significant change was observed in the control group. There were significant within-group differences in CS-30 scores for both intervention (P<.001) and control (P=.03) groups over the 12-month period. Specifically, there was a significant change in CS-30 scores (95\% CI) between the baseline and 12-month assessments for the intervention ($\beta$=6.5, 95\% CI 3.8-9.1; P<.001) and control ($\beta$=3.8, 95\% CI 0.6-7.1; P=.02) groups. Conclusions: Participants with long-term DPSA use observed increases in average daily steps and CS-30 scores before and after DPSA use, although only a limited number of older adults had long-term access to the DPSA. Identifying ways to expand long-term DPSA use among older adults is necessary. Additionally, randomized controlled trials should be conducted to determine the long-term effects of DPSAs on physical activity and function in older adults. Trial Registration: University Hospital Medical Information Network UMIN000050618; https://center6.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000057008 ", doi="10.2196/66610", url="https://aging.jmir.org/2025/1/e66610" } @Article{info:doi/10.2196/73135, author="Huang, Xin and Ali, Mohamad Nazlena and Sahrani, Shafrida", title="Haptic-Driven Serious Card Games for Older Adults: User Preferences Study", journal="JMIR Serious Games", year="2025", month="May", day="27", volume="13", pages="e73135", keywords="serious games", keywords="older adults", keywords="haptic feedback", keywords="mobile card games", keywords="cognitive abilities", abstract="Background: Haptic feedback technology is widely used, including in serious games. It is an additional sensory method that supplements audio and vision, provides a novel user experience through a physical control layer, and enhances the immersion of virtual reality, thereby improving the user's cognitive state while alleviating dependence on visual information. However, there is limited research on haptic feedback preferences for mobile serious card games designed for older adults. Objective: The study aims to investigate older adults' preferences for haptic feedback in mobile serious card games. Methods: This study recruited a total of 250 participants from Dangtu County, Anhui Province, China, with an average age of 64.78 (SD 4.23) years. A descriptive survey was conducted among older adults, structured questionnaires were distributed, and data were collected via the Wenjuanxing (Changsha Ranxing Information Technology Co Ltd) mobile app. Reliability and validity analyses were performed using SPSS (IBM Corp) software. The questionnaire investigated older adults' basic understanding of card games and serious games, the integration of card games with mobile devices, the potential impact of combining card games with haptic feedback technology, as well as suggestions and opinions. Results: The results showed that 63.2\% (158/250) of the older adults liked the slight haptic feedback mode, and 78.4\% (196/250) of the participants believed that combining haptic feedback technology with mobile card games would help improve cognitive abilities. The study found that 73.6\% (184/250) of the older adults believed that this technology could reduce their reliance on visual information. This confirms that the combination of serious card games and haptic feedback can alleviate sensory impairments in older adults. Qualitative analysis revealed the potential of haptic feedback to reduce visual fatigue and provide an engaging cognitive training experience. Conclusions: Older adults have shown great interest in incorporating haptic feedback into mobile serious card games, believing that this could enhance their cognitive abilities while reducing their reliance on visual information. However, limitations include sample size and geographic restrictions, differences in digital literacy, self-reported data, and lack of longitudinal assessment. Longitudinal studies are recommended to evaluate the long-term effects of mobile serious card games with haptic feedback on cognitive abilities. Such investigations could provide valuable insights for game developers, rehabilitation institutions, and the development of cognitive training tools for older adults. ", doi="10.2196/73135", url="https://games.jmir.org/2025/1/e73135" } @Article{info:doi/10.2196/58142, author="Cho, Eunhee and Hwang, Sinwoo and Heo, Seok-Jae and Lim, Bokman and Lee, Jewoo and Lee, Younbaek", title="Feasibility and Effects of a Gait Assistance and Gait Resistance Training Program Using a Walking-Assist Wearable Robot for Community-Dwelling Older Adults: Single-Group, Pre-, and Posttest Study", journal="JMIR Mhealth Uhealth", year="2025", month="May", day="26", volume="13", pages="e58142", keywords="older adult", keywords="exercise", keywords="wearable robot", keywords="walking speed", keywords="physical functional performance", keywords="muscle strength", abstract="Background: Two-thirds of people aged 65 years and older may require help with daily activities such as eating, bathing, and getting in and out of bed or a chair. Walking-assist wearable robots have shown significant improvements in physical function in controlled settings for patients. Objective: In this study, we aimed to assess the feasibility and the effect of a gait assistance and gait resistance training program using a walking-assist wearable robot for community-dwelling older adults. Methods: A total of 23 community-dwelling older adults aged 65 years and older (30 participants recruited, 7 dropped out) enrolled in a 12-session, 6-week gait assistance and gait resistance training program using a walking-assist wearable robot. A single-group, pre- and posttest design was employed to evaluate the feasibility based on program adherence and effectiveness. The primary and secondary outcomes for evaluating effectiveness were walking speed and functional performance, respectively. Results: Regarding the feasibility, the average number of sessions attended was 11.7 out of 12, indicating a mean adherence rate of 97.8\%. Linear mixed model analysis revealed significant improvements in walking speed and functional performance at the end of the program compared with baseline. Specifically, the walking speed measured using the 10-Meter Walk Test, which includes self-selected velocity and fastest safe velocity, improved by a mean of 0.15??(SD 0.13)?m/s (P<.001) and 0.15?(SD?0.17)?m/s (P<.001), respectively. Functional performance also improved, with faster performance in Timed Up-and-Go (mean ?0.63, SD 0.92 s; P=.003) and Four Square Step Test (mean ?1.71, SD 1.64 s; P?.001). Leg muscle strength increased across all measured domains, including plantarflexion (mean +7.29, SD 4.92; P=.004), hip adduction (mean +3.03, SD 2.73; P?.001), hip extension (mean +2.63, SD 2.50; P?.001), knee extension (mean +2.33, SD 3.12; P?.001), knee flexion (mean +2.19, SD 2.17; P?.001), dorsiflexion (mean +2.10, SD 3.06; P?.001), hip abduction (mean +1.59, SD 1.92; P=.002), and hip flexion (mean +0.90, SD 1.56; P?.001). Conclusions: This study stands out for applying gait assistance and resistance training across various terrains, unlike previous studies that only tested gait assistance in controlled environments. The results demonstrated significant improvements in walking speed and functional performance in older adults, suggesting the effectiveness of preventive health care services using a walking-assist wearable robot as an intervention that can contribute to improving independent functioning and frailty among community-dwelling older adults. ", doi="10.2196/58142", url="https://mhealth.jmir.org/2025/1/e58142" } @Article{info:doi/10.2196/67314, author="B{\'e}raud-Peign{\'e}, N{\'e}va and Perrot, Alexandra and Maillot, Pauline", title="Active Video Games Training for Older Adults: Comparative Study of User Experience, Workload, Pleasure, and Intensity", journal="JMIR Serious Games", year="2025", month="May", day="26", volume="13", pages="e67314", keywords="combined training", keywords="experience", keywords="video game", keywords="older adult", keywords="elderly", keywords="user experience", keywords="AVG", keywords="UX", keywords="physical stimulation", keywords="exergame", keywords="exergaming", keywords="game", keywords="gamification", keywords="motor", keywords="physical", keywords="physical activity", abstract="Background: Given the appeal of active video games (AVG), many tools are now being used for combined training in older adults. However, there is a lack of comparative data to determine which type of AVG is better suited to older adults. Objective: The purpose of this study was to compare user experience (UX), workload, pleasure, and intensity of three different experiences: (1) an Immersive and Interactive Wall Exergame (I2WE), (2) a consumer device (SWITCH), and (3) a combination of video games and physical stimulation (biking and videogaming, BIKE-VG) for older adults. I2WE and SWITCH are categorized as Moving While Thinking training, meaning that the cognitive task is integrated into the motor or physical task. In contrast, BIKE-VG is categorized as Thinking While Moving training, where the cognitive and motor or physical tasks are not interconnected. The nature of the cognitive, physical, and motor combinations also differentiates them. I2WE is multi-domain training, while BIKE-VG is physical-cognitive training, and SWITCH is motor-cognitive training. Methods: A total of 90 older adults (mean [SD] 69.49 [5.78]) were divided into 3 groups (I2WE, SWITCH, and BIKE-VG). Each participant completed a 45-minute group session and then filled out questionnaires to evaluate UX, workload, pleasure, and intensity. Results: The UX was positive for I2WE and SWITCH, and neutral for BIKE-VG. It was higher for I2WE than for BIKE-VG (t87=2.83; P=.02; d=0.70; 95\% CI 0.15?1.69). The workload was moderate across all 3 groups. The intensity was moderate for all groups, ranging between 50\% and 70\% of the maximum heart rate, and approached high intensity for the I2WE and SWITCH groups. It was significantly higher for I2WE than for BIKE-VG (t66= 2.86; P=.01; d=0.70; 95\% CI 1.04?11.43). The perceived pleasure was significantly higher for I2WE (t87=3.63; P=.001; d=0.9;95\% CI 2.74?13.23) and SWITCH (t87=3.11; P=.01; d=0.87; 95\% CI 1.82?13.69) compared with BIKE-VG. Conclusions: The UX and perceived enjoyment are higher for the Moving While Thinking training compared with the Thinking While Moving training. This indicates that the I2WE and SWITCH training approaches are promising and motivating options for combined training for older adults. ", doi="10.2196/67314", url="https://games.jmir.org/2025/1/e67314" } @Article{info:doi/10.2196/66212, author="Rochon, A. Elizabeth and Thacker, Ayush and Phillips, Mirelle and Ritchie, Christine and Vranceanu, Ana-Maria and Plys, Evan", title="Developing a Dyadic Immersive Virtual Environment Technology Intervention for Persons Living With Dementia and Their Caregivers: Multiphasic User-Centered Design Study", journal="JMIR Aging", year="2025", month="May", day="21", volume="8", pages="e66212", keywords="dementia", keywords="caregivers", keywords="dyads", keywords="technology", keywords="design", keywords="immersive", abstract="Background: Persons living with dementia and their caregivers experience frequent emotional health challenges. Across the illness spectrum, engaging in shared pleasant activities is an important feature of well-being for persons living with dementia--caregiver dyads. Under the umbrella of virtual reality, immersive virtual environment technology (IVET) offers artificial sensory experiences and shows promise in this population. IVET development benefits from a user-centered design approach, and as an emerging field, preliminary testing of safety, usability, and engagement for person living with dementia--caregiver dyads is required. Objective: We aimed to develop a preliminary IVET intervention for psychosocial health among person living with dementia--caregiver dyads. In doing so, we highlight design considerations and user preferences to ensure the safety and usability of technology-based interventions in the context of dementia. Methods: We engaged 10 clinicians, 8 caregivers, and 3 persons living with dementia in 5 rounds of focus groups to evaluate the safety and usability of preliminary intervention features. Following prototype development, we engaged caregivers and persons living with dementia (n=9 dyads) in beta testing workshops to observe real-time user interaction with the intervention and guide refinements. Rapid data analysis was used to extract themes relevant to intervention development. Results: The following themes emerged from focus groups to inform prototype development: (1) designing flexibly to allow users to tailor the intervention experience to their own environmental context and circumstance, (2) designing with the dyad's clinical and relational needs in mind, and (3) accounting for illness and aging-related challenges in design. The following themes emerged from workshops to inform prototype refinements: (1) increasing user support through more feedback and (2) increasing variety of visual and auditory feedback. Conclusions: Using user feedback throughout the development process, we developed a prototype of an IVET intervention, Toolkit for Experiential Well-Being in Dementia (the Isle of TEND), tailored to the needs of persons living with dementia and their caregivers. Our prototype uses specific design features to promote safety, usability, and engagement in the context of dementia. Future feasibility testing of the intervention is warranted. International Registered Report Identifier (IRRID): RR2-10.2196/52799 ", doi="10.2196/66212", url="https://aging.jmir.org/2025/1/e66212" } @Article{info:doi/10.2196/72585, author="Richardson, Julie and Kuspinar, Ayse and Sinclair, Susanne and Beauchamp, Marla and Dufour, Sinead and Tang, Ada and MacDermid, Joy and Durocher, Evelyne and Thabane, Lehana and Xie, Feng and Costa, Andrew", title="Effect of an Online Mobility Self-Management Program on Walking Speed in Older Adults With Preclinical Mobility Limitation: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="May", day="21", volume="14", pages="e72585", keywords="mobility", keywords="self-management", keywords="task-oriented motor learning", keywords="preclinical mobility limitation", keywords="walking speed", abstract="Background: Walking difficulties are a common and costly problem. However, disability associated with the decline in walking ability is not an inevitable consequence. With an aging population, it is increasingly important to establish strategies to help older adults preserve the capacity to live independently and function well in late life. Preclinical mobility limitation (PCML), which is characterized by subtle changes or limitations in mobility that precede disability, manifests as changes in how daily tasks such as walking are performed. Persons with PCML are at increased risk for the onset of disability and chronic disease. For that reason, PCML is a critical stage in the natural history of functional change when there is the opportunity for primary prevention interventions. Objective: To evaluate the effect of a 12-week online mobility self-management program (Stepping Up) on mobility outcomes, including walking speed, aerobic exercise capacity, dual-task cost, physical functioning (balance and strength), balance confidence, extent of community mobility, self-management of mobility, and quality of life in older adults with PCML. Methods: This randomized controlled trial (RCT) will recruit 249 older adults (aged 55-75 years) screened for PCML. Participants will be assigned to the Stepping Up program, a telephone-based coaching walking program or an online chair-based yoga program. Programs will be delivered over 12 weeks and participants will undergo virtual assessments with a blinded physiotherapist at baseline, 12, 24, and 36 weeks. An economic evaluation will be conducted alongside this RCT. Results: A total of 253 participants were enrolled in the trial. Data collection commenced in August 2021 and will be completed in October 2025. Data analysis will begin in November 2025 and results will be published in the Summer of 2026. Conclusions: To our knowledge, PCML has not been addressed by primary prevention interventions that incorporate both task-oriented motor learning exercise and mobility self-management sessions. Results will establish if the Stepping-Up program has the potential to serve as a model for sustainable, accessible, and cost-effective programming for individuals with early mobility limitations. Trial Registration: ClinicalTrials.gov NCT04368949; https://clinicaltrials.gov/study/NCT04368949 International Registered Report Identifier (IRRID): DERR1-10.2196/72585 ", doi="10.2196/72585", url="https://www.researchprotocols.org/2025/1/e72585" } @Article{info:doi/10.2196/67373, author="Ray, J. Samantha and Cherian, Josh and Liberty, Mae Amanda and Hammond, Anne Tracy and Shireman, K. Paula", title="Recognition of Basic Activities of Daily Living Using Wearable Devices for Older Adults: Scoping Review", journal="J Med Internet Res", year="2025", month="May", day="15", volume="27", pages="e67373", keywords="activity recognition", keywords="health monitoring", keywords="wearable sensors", keywords="activities of daily living", keywords="aging in place", abstract="Background: Tracking the performance of activities of daily living (ADLs) using ADL recognition has the potential to facilitate aging-in-place strategies, allowing older adults to live in their homes longer and enabling their families and caregivers to monitor changes in health status. However, the ADL recognition literature historically has evaluated systems in controlled settings with data from younger populations, creating the question of whether these systems will work in real-world conditions for older populations. Objective: This scoping review seeks to establish the state-of-the-art for recognizing basic ADLs using wearable sensors. This primary goal will identify literature gaps and research needed to make ADL tracking viable for aging-in-place solutions. In addition, this paper will quantify how many publications include older adults. This secondary goal assesses how often studies evaluate their system with older adult participants, enhancing the trustworthiness of the approach. Methods: We conducted a scoping review using the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We identify studies focused on basic ADL recognition using wearable sensors within the PubMed, Association of Computing Machinery Digital Library (ACM DL), and Google Scholar databases using papers published in the last 5 calendar years (2019-2024) to identify current trends given the rapid changes in wearable technology devices. Publications must include at least one of the basic ADLs (ie, bathing, dressing, toileting, transferring, continence, and feeding) and include some sort of wearable sensor or device. Studies focusing on instrumental ADLs, general physical activity tracking, fall detection, or only using environmental devices are excluded. Studies that include older adults in the design or evaluation of their ADL recognition system are highlighted. Results: The database search identified 695 papers; 164 papers passed title screening. A total of 58 studies satisfied the inclusion criteria; only 8 studies included older adults despite most studies identifying this population as a focus for their research. Most studies focused on eating (n=27), hygiene (n=24), drinking (n=20), or transitions (n=13). Few works included toileting (n=3), dressing (n=2), or bathing (n=1) activities. Of the 8 studies that included older adults, 5 focused on recognition performance while 3 focused on user experience and system acceptability. Conclusions: Basic ADLs are unevenly covered in the literature; more research is needed for recognizing bathing, dressing, and toileting activities. Despite all studies stating the importance of tracking ADLs in older adults, only 14\% (8/58) of the included works involve older adult participants. A commonality between these outcomes is difficulty collecting or obtaining adequate training data for ADL recognition systems. Many works are predominantly concerned with proving system feasibility and do not assess usability or real-world deployment. For these systems to move from academic experiments to actual systems with clinical utility, ADL recognition systems must consider the design requirements of being part of remote health monitoring systems. ", doi="10.2196/67373", url="https://www.jmir.org/2025/1/e67373" } @Article{info:doi/10.2196/67982, author="Ortiz-Navarro, Beatriz and Losa-Reyna, Jos{\'e} and Mihaiescu-Ion, Veronica and Garcia-Romero, Jer{\'o}nimo and Carrillo de Albornoz-Gil, Margarita and Gal{\'a}n-Mercant, Alejandro", title="Identification of Target Body Composition Parameters by Dual-Energy X-Ray Absorptiometry, Bioelectrical Impedance, and Ultrasonography to Detect Older Adults With Frailty and Prefrailty Status Using a Mobile App in Primary Care Services: Descriptive Cross-Sectional Study", journal="JMIR Aging", year="2025", month="May", day="15", volume="8", pages="e67982", keywords="frailty syndrome", keywords="older adults", keywords="body composition", keywords="bioelectrical impedance analysis", keywords="muscle ultrasound, dual-energy X-Ray absorptiometry", keywords="mobile health apps", keywords="primary care", keywords="PowerFrail App", abstract="Background: Frailty syndrome in older adults represents a significant public health concern, characterized by a reduction in physiological reserves and an increased susceptibility to stressors. This can result in adverse health outcomes, including falls, hospitalization, disability, and mortality. The early identification and management of frailty are essential for improving quality of life and reducing health care costs. Conventional assessment techniques, including dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and muscle ultrasound (US), are efficacious but frequently constrained in primary care settings by financial and accessibility limitations. Objective: The aim of this study is to analyze the differences in anthropometric characteristics, physical function, nutritional status, cognitive status, and body composition among older adults identified as frail, prefrail, or robust in primary care services using the PowerFrail mobile app. Furthermore, the study assesses the predictive capacity of body composition variables (whole-body phase angle [WBPhA] via BIA, US-measured rectus femoris muscle thickness, and DXA-derived lean mass) in identifying frailty and evaluates their feasibility for implementation in primary care. Methods: A descriptive cross-sectional study was conducted with 94 older adult participants aged between 70 and 80 years, recruited through the Andalusian Health Service in Spain. Frailty status was classified using the PowerFrail App, which integrates muscle power assessment and provides personalized physical activity recommendations. Body composition was measured using WBPhA (BIA), muscle US, and DXA. Statistical analyses included 1-way ANOVA for group comparisons, logistic regression to investigate associations, and receiver operating characteristic curve analysis to evaluate the predictive accuracy of the body composition measures. Results: Participants were categorized into frail (n=28), prefrail (n=33), and robust (n=33) groups. All body composition measures exhibited high specificity in detecting frailty, with varying sensitivity. Unadjusted US showed the highest specificity but low sensitivity (10.7\%). WBPhA and right leg lean mass (LeanM RL) demonstrated significant predictive capabilities, especially when adjusted for age and sex, with area under the curve values ranging from 0.678 to 0.762. The adjusted LeanM RL model showed a good balance between sensitivity (35.7\%) and specificity (93.9\%; P=.045), indicating its potential as a reliable frailty predictor. These findings are consistent with previous research emphasizing the importance of muscle mass and cellular health in frailty assessment. Conclusions: Body composition variables, particularly WBPhA, LeanM RL, and US, are effective predictors of frailty in older adults. The PowerFrail mobile app, combined with advanced body composition analysis, offers a practical and noninvasive method for early frailty detection in primary care settings. Integrating such technological tools can enhance the early identification and management of frailty, thereby improving health outcomes in the aging population. ", doi="10.2196/67982", url="https://aging.jmir.org/2025/1/e67982" } @Article{info:doi/10.2196/60889, author="Chen, Siqing and Wang, Chenchen and Ko, Albert and Garber, Ewing Carol and Giovannucci, Edward and Yang, Yuting and Stults-Kolehmainen, Matthew and Yang, Lili", title="Effectiveness of Mobile Health Interventions for Reducing Sitting Time in Older Adults: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2025", month="May", day="8", volume="27", pages="e60889", keywords="older adults", keywords="sedentary behavior", keywords="health behavior", keywords="community", keywords="systematic review", keywords="meta-analysis", abstract="Background: Mobile health (mHealth) provides health information through electronic devices, even at home. The escalating prevalence of sedentary behaviors among older adults, which leads to increased adverse health outcomes, underscores the pressing need for a comprehensive understanding of the effectiveness of mHealth interventions. Objective: This study aims to examine the effectiveness of mHealth interventions in the sitting time of older adults (age 55 years). Methods: A systematic review and meta-analysis of randomized controlled trials was conducted to evaluate the effects of mHealth interventions on total sitting time during waking hours, excluding sleep. A literature search was conducted using multiple databases, including PubMed, Embase, Web of Science, and Cochrane, covering articles published from the inception of each database through October 2023. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were explicitly applied to structure this report. Methodological quality was assessed using the Cochrane Risk of Bias (ROB 2) tool for randomized controlled trials and the Methodological Index for Non-Randomized Studies (MINORS) tool for nonrandomized studies. Two independent reviewers screened the studies, extracted data, and assessed methodological quality using established criteria. Meta-analyses were performed using Review Manager (version 5.4; Cochrane Collaboration). Results: Ten studies were identified, of which 3 were included in the meta-analysis, while the remaining 7 were assessed exclusively in the systematic review. The interventions predominantly took place in community settings (n=3) and home-based settings (n=3). Three studies aimed to decrease sedentary behavior and 7 aimed to increase physical activity. The interventions were primarily conducted once daily (n=7) via mobile devices such as smartphones (n=7) and typically involved a single intervention delivered at different time intervals, such as every 15, 20, or 30 minutes (n=4). The interventions typically lasted 12 weeks (n=4) and used objective assessment tools, such as the ActiGraph GT3X+ (n=8). The included studies applied the habit formation theory (n=1), the self-efficacy theory (n=1), the social cognitive theory (n=1), and the social-ecological theory (n=1) as frameworks. Additionally, behavior change techniques, including ``goal setting,'' ``problem-solving,'' ``action planning,'' and ``review behavior goal(s)'' (n=6), were used. Meta-analysis of the 3 studies included showed a significant decrease in sedentary behavior with mHealth interventions compared with conventional or no interventions (weighted mean difference [WMD]=59.1 min/d, 95\% CI 99.1 to 20.2; P=.003). Conclusions: mHealth interventions effectively reduce sitting time in older adults. Strategies using interventions with specific frequencies and durations, dedicated mobile monitoring devices, and behavior change techniques showed the potential to reduce sedentary behavior among older adults. These results also underscore the potential of mHealth as a key tool for promoting the well-being of older adults through technology-driven public health efforts. Trial Registration: PROSPERO CRD42023443926; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023443926 ", doi="10.2196/60889", url="https://www.jmir.org/2025/1/e60889" } @Article{info:doi/10.2196/68147, author="Lam, Aaron and Simonetti, Simone and D'Rozario, Angela and Ireland, David and Bradford, DanaKai and Fripp, Jurgen and Naismith, L. Sharon", title="Perceptions of the Use of Mobile Apps to Assess Sleep-Dependent Memory in Older Adults With Subjective and Objective Cognitive Impairment: Focus Group Approach", journal="JMIR Aging", year="2025", month="Apr", day="28", volume="8", pages="e68147", keywords="aging", keywords="mild cognitive impairment", keywords="subjective cognitive impairment", keywords="digital health", keywords="cognition", keywords="neuropsychology", keywords="sleep", abstract="Background: Sleep-dependent memory (SDM) is the phenomenon where newly obtained memory traces are consolidated from short-term memory stores to long-term memory, underpinning memory for daily life. Administering SDM tasks presents considerable challenges, particularly for older adults with memory concerns, due to the need for sleep laboratories and research staff being present to administer the task. In response, we have developed a prototype mobile app aimed at automating the data collection process. Objective: This study investigates the perspectives of older adults, with subjective or objective cognitive impairment, regarding barriers and facilitators to using a new mobile app for at-home assessment of SDM. Methods: In total, 11 participants aged 50 years and older were recruited from the Healthy Brain Ageing memory clinic, a specialized research memory clinic that focuses on the assessment and early intervention of cognitive decline. Two focus groups were conducted and thematically analyzed using NVivo (version 13; Lumivero). Results: On average, participants were aged 68.5 (SD 5.1) years, and 4/11 were male. Eight participants had subjective cognitive impairment, and 3 participants had mild cognitive (objective) impairment. Two main themes emerged from the focus groups, shedding light on participants' use of mobile phones and the challenges and facilitators associated with transitioning from traditional laboratory-based assessments to home assessments. These challenges include maintaining accurate data, engaging with humans versus robots, and ensuring accessibility and task compliance. Additionally, potential solutions to these challenges were identified. Conclusions: Our findings underscore the importance of app flexibility in accommodating diverse user needs and preferences as well as in overcoming barriers. While some individuals required high-level assistance, others expressed the ability to navigate the app independently or with minimal support. In conclusion, older adults provided valuable insights into the app modifications, user needs, and accessibility requirements enabling home-based SDM assessment. ", doi="10.2196/68147", url="https://aging.jmir.org/2025/1/e68147" } @Article{info:doi/10.2196/67298, author="Hooyman, Andrew and Huentelman, J. Matt and De Both, Matt and Ryan, Lee and Duff, Kevin and Schaefer, Y. Sydney", title="Relationship Between Within-Session Digital Motor Skill Acquisition and Alzheimer Disease Risk Factors Among the MindCrowd Cohort: Cross-Sectional Descriptive Study", journal="JMIR Aging", year="2025", month="Apr", day="24", volume="8", pages="e67298", keywords="digital health technology", keywords="web-based assessment", keywords="aging", keywords="APOE", keywords="motor skills", keywords="sensitivity", keywords="risk factors", keywords="adults", keywords="older adults", abstract="Background: Previous research has shown that in-lab motor skill acquisition (supervised by an experimenter) is sensitive to biomarkers of Alzheimer disease (AD). However, remote unsupervised screening of AD risk through a skill-based task via the web has the potential to sample a wider and more diverse pool of individuals at scale. Objective: The purpose of this study was to examine a web-based motor skill game (``Super G'') and its sensitivity to risk factors of AD (eg, age, sex, APOE $\epsilon$4 carrier status, and verbal learning deficits). Methods: Emails were sent to 662 previous MindCrowd participants who had agreed to be contacted for future research and have their APOE $\epsilon$4 carrier status recorded and those who were at least 45 years of age or older. Participants who chose to participate were redirected to the Super G site where they completed the Super G task using their personal computer remotely and unsupervised. Once completed, different Super G variables were derived. Linear and logistic multivariable regression was used to examine the relationship between available AD risk factors (age, sex, APOE $\epsilon$4 carrier status, and verbal learning) and distinct Super G performance metrics. Results: Fifty-four participants ({\textasciitilde}8\% response rate) from the MindCrowd web-based cohort (mean age of 62.39 years; 39 females; and 23 APOE $\epsilon$4 carriers) completed 75 trials of Super G. Results show that Super G performance was significantly associated with each of the targeted risk factors. Specifically, slower Super G response time was associated with being an APOE $\epsilon$4 carrier (odds ratio 0.12, 95\% CI 0.02-0.44; P=.006), greater Super G time in target (TinT) was associated with being male (odds ratio 32.03, 95\% CI 3.74-1192,61; P=.01), and lower Super G TinT was associated with greater age ($\beta$ ?3.97, 95\% CI ?6.64 to ?1.30; P=.005). Furthermore, a sex-by-TinT interaction demonstrated a differential relationship between Super G TinT and verbal learning depending on sex ($\beta$male:TinT 6.77, 95\% CI 0.34-13.19; P=.04). Conclusions: This experiment demonstrated that this web-based game, Super G, has the potential to be a skill-based digital biomarker for screening of AD risk on a large scale with relatively limited resources. ", doi="10.2196/67298", url="https://aging.jmir.org/2025/1/e67298" } @Article{info:doi/10.2196/67950, author="Guo, Rongrong and Zhang, Jiwen and Yang, Fangyu and Wu, Ying", title="Efficacy of an Intelligent and Integrated Older Adult Care Model on Quality of Life Among Home-Dwelling Older Adults: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="21", volume="27", pages="e67950", keywords="efficacy", keywords="home care", keywords="integrated care", keywords="intelligent", keywords="elderly people", keywords="quality of life", keywords="mobile phone", abstract="Background: Integrated care models enhanced by the clinical decision support system offer innovative approaches to managing the growing global burden of older adult care. However, their efficacy remains uncertain. Objective: This study aimed to evaluate the efficacy of an intelligent and integrated older adult care model, termed the SMART (Sensors and scales [receptor], a Mobile phone autonomous response system [central nervous system in the spinal cord], a Remote cloud management center [central nervous system in the brain], and a Total care system [effector]) system, in improving the quality of life (QOL) for home-dwelling older adults. Methods: In this stratified randomized controlled trial, we consecutively recruited older adults aged 65 years or older from November 1, 2020, to December 31, 2020. Eligible participants were randomly allocated 1:1 to either the SMART group, receiving routine discharge instructions and personalized integrated care interventions across 11 domains (decreased or lost self-care ability, falls, delirium, dysphagia, incontinence, constipation, urinary retention, cognitive decline, depression, impaired skin integrity, and common diseases) generated by the SMART system, or the usual care group, receiving only routine discharge instructions. The intervention lasted for 3 months. The primary end point was the percent change in QOL from baseline to the 3-month follow-up, assessed using the World Health Organization Quality of Life Instrument - Older Adults Module. Secondary end points included functional status at the 3-month follow-up and percent changes in health self-management ability, social support, and confidence in avoiding falling from baseline to the 3-month follow-up. Data were analyzed following the intention-to-treat principle, using covariance or logistic regression models, as appropriate. Subgroup and sensitivity analyses were conducted to assess result consistency and robustness. Results: In total, 94 participants were recruited, with 48 assigned to the SMART group. The personalized and integrated care by the SMART system significantly improved the QOL among the older adults, with an estimated intervention difference of 11.97\% (95\% CI 7.2\%-16.74\%, P<.001), and social support and health self-management ability as well, with estimated intervention differences of 6.75\% (95\% CI 3.19\%-10.3\%, P<.001) and 4.95\% (95\% CI 0.11\%-10\%, P=.003), respectively, while insignificantly improving in the Modified Falls Efficacy Scale score. Similarly, the SMART system had a 66\% reduction in instrumental activities of daily living disability (odds ratio [OR] 0.34, 95\% CI 0.11-0.83, P=.02). However, the SMART system did not significantly affect activities of daily living disability or the Modified Falls Efficacy Scale score. The subgroup and sensitivity analyses confirmed the robustness of the findings. Conclusions: The personalized and integrated older adult care by the SMART system demonstrated significant efficacy in improving QOL, health self-management ability, and social support, while reducing instrumental activities of daily living disability among home-dwelling older adults. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17010368; https://tinyurl.com/2zax24xr ", doi="10.2196/67950", url="https://www.jmir.org/2025/1/e67950" } @Article{info:doi/10.2196/54629, author="Arader, Lindsay and Miller, Danielle and Perrin, Alexandra and Vicari, Frank and Friel, P. Ciaran and Vrany, A. Elizabeth and Goodwin, M. Ashley and Butler, Mark", title="Digital, Personalized Clinical Trials Among Older Adults, Lessons Learned From the COVID-19 Pandemic, and Directions for the Future: Aggregated Feasibility Data From Three Trials Among Older Adults", journal="J Med Internet Res", year="2025", month="Apr", day="16", volume="27", pages="e54629", keywords="older adults", keywords="personalized", keywords="digital", keywords="clinical trial", keywords="remote", keywords="physical activity", keywords="back pain", keywords="pain", keywords="COVID-19", keywords="clinical trials", keywords="pandemic", keywords="chronic health", keywords="digital intervention", keywords="Fitbits", keywords="Fitbit", keywords="wearable", keywords="wearables", keywords="exercise", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="old", keywords="older", keywords="older people", keywords="aging", keywords="aged", keywords="mobile phone", abstract="Background: The COVID-19 pandemic was extremely disruptive to clinical practice and research. Given older adults' increased likelihood of chronic health concerns, limited resources, and greater risk for adverse outcomes of COVID-19, access to research participation during this time was critical, particularly to interventions that may impact health conditions or behaviors. Fortunately, the implementation of personalized, digital research trials during the pandemic allowed for research and intervention delivery for older adults to continue remotely, resulting in feasibility findings that can benefit researchers, practitioners, and the broader older adult population. Objective: This study discusses 3 digital, remote, and personalized intervention trials implemented during the pandemic to increase physical activity (2 trials) or to reduce back pain (1 trial). Methods: We identified measures used for all 3 trials including Fitbit activity monitor use and self-reported participant satisfaction. Participant levels of Fitbit activity monitor use and satisfaction ratings of the digital trials were compared between younger (younger than 55 years) and older adults (older than 55 years). Differences between these cohorts were analyzed using chi-square tests for categorical outcomes and 2-tailed independent-sample t tests for continuous outcomes. Results: Across the 3 trials, the majority of participants reported high satisfaction with the usability of the trials' digital systems including SMS text message interventions and surveys (?62\% satisfied) and the use of wearable devices such as Fitbits (?81\% satisfied). In addition, the use of the Fitbit device was shown to be feasible, as older adults across all trials wore their Fitbits for the majority of the day (mean 20.3, SD 3.6 hours). Furthermore, consistent Fitbit wear was common; 100\% of participants older than 55 years wore their Fitbit an average of 10 or more hours per day. These trials highlight that digital, remote intervention delivery may be successfully implemented among older adults by way of personalized trials. Across the 3 digital interventions, feasibility and acceptability were high among older adults, and comparable to younger adults. Conclusions: Given the success of the current trials amid pandemic restrictions, we argue that these trials serve as a useful framework to aid in designing personalized, digital, remote interventions in other areas of clinical care among older adults and in planning for future disruptions including new pandemics. ", doi="10.2196/54629", url="https://www.jmir.org/2025/1/e54629" } @Article{info:doi/10.2196/63928, author="Shin, Jinyoung and Kweon, Jung Hyuk and Choi, Jaekyung", title="Assessment of Gait Parameters Using Wearable Sensors and Their Association With Muscle Mass, Strength, and Physical Performance in Korean Older Adults: Cross-Sectional Study", journal="JMIR Form Res", year="2025", month="Apr", day="10", volume="9", pages="e63928", keywords="gait analysis", keywords="sarcopenia", keywords="wearable electronic devices", keywords="muscle mass", keywords="physical performance", keywords="older adults", keywords="geriatric", keywords="cross-sectional study", keywords="outpatient clinic", keywords="Korea", keywords="mHealth", keywords="mobile health", abstract="Background: Gait speed indicates the onset or decline of physical performance in sarcopenia. However, real-time measurements of other gait parameters, such as step length, stride length, step width, and support time, are limited. The advent of wearable technology has facilitated the measurement of these parameters, necessitating further investigation into their potential applications. Objective: This study aimed to investigate the relationship between gait parameters measured using wearable sensors and muscle mass, strength, and physical performance in community-dwelling older adults. Methods: In a cross-sectional study of 91 participants aged ?65 years, gait parameters, such as step count, step length, cadence, single and double support times, vertical oscillation, and instantaneous vertical loading rate (IVLR), measured using a wireless earbud device, were analyzed on the basis of the appendicular skeletal muscle mass index (SMI), calf circumference, handgrip strength, 5-time chair stand test, short physical performance battery (SPPB), and the SARC-F (strength, assistance with walking, rise from a chair, climb stairs and fall frequency) questionnaire. This study was conducted from July 10 to November 1, 2023, at an outpatient clinic of a university hospital in Seoul, Korea. Multiple regression analysis was performed to investigate independent associations after adjusting for age, sex, BMI, and comorbidities. Results: Among 91 participants (45 men and 46 women; mean age 74.1 years for men and 73.6 years for women), gait speed and vertical oscillation showed negative associations with their performance in the 5-time chair stand test (P<.001) and SARC-F and positive associations with their performance in the SPPB (P<.001). Vertical oscillations were also associated with grip strength (P=.003). Single and double support times were associated with performance in the 5-time chair stand test and SPPB (P<.001). In addition, double support time was associated with SARC-F scores (P<.001). Gait speed, support time, vertical oscillation, and IVLR showed independent associations with performance in the 5-time chair stand test and SPPB (P<.001), both related to muscle strength or physical performance. Gait speed, double support time, and vertical oscillation all had significant associations with SARC-F scores. Conclusions: This study demonstrated a significant association between gait monitoring using wearable sensors and quantitative assessments of muscle strength and physical performance in older people. Furthermore, this study substantiated the extensive applicability of diverse gait parameters in predicting sarcopenia. ", doi="10.2196/63928", url="https://formative.jmir.org/2025/1/e63928" } @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/10.2196/67539, author="Pettersson, Beatrice and Lundin-Olsson, Lillemor and Skelton, A. Dawn and Liv, Per and Zingmark, Magnus and Rosendahl, Erik and Sandlund, Marlene", title="Effectiveness of the Safe Step Digital Exercise Program to Prevent Falls in Older Community-Dwelling Adults: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Mar", day="31", volume="27", pages="e67539", keywords="geriatric medicine", keywords="aging", keywords="accidental falls", keywords="independent living", keywords="exercise therapy", keywords="fall prevention", keywords="electronic health", keywords="mobile health", keywords="preventive medicine", keywords="self-management", keywords="effectiveness", keywords="randomized controlled trial", keywords="older adults", keywords="digital technology", abstract="Background: Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population. Objective: This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program. Methods: Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively. Results: In total, 1628 people were enrolled in the study, 79\% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95\% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11\%) in the exercise group compared to the control group (53\% vs 59.6\%; RR 0.89, 95\% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1\% in the exercise group, 37.1\% in the control group; RR 0.92, 95\% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20\%) participants from the exercise group and 63 (8\%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7\%, 13.4\%, 8.6\%, and 9.1\% at 3, 6, 9, and 12 months, respectively. Conclusions: Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population. Trial Registration: ClinicalTrials.gov NCT03963570; https://clinicaltrials.gov/study/NCT03963570 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-036194 ", doi="10.2196/67539", url="https://www.jmir.org/2025/1/e67539" } @Article{info:doi/10.2196/65269, 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/10.2196/67322, author="B{\"o}ttinger, Johanna Melissa and Mellone, Sabato and Klenk, Jochen and Jansen, Carl-Philipp and Stefanakis, Marios and Litz, Elena and Bredenbrock, Anastasia and Fischer, Jan-Philipp and Bauer, M. J{\"u}rgen and Becker, Clemens and Gordt-Oesterwind, Katharina", title="A Smartphone-Based Timed Up and Go Test Self-Assessment for Older Adults: Validity and Reliability Study", journal="JMIR Aging", year="2025", month="Mar", day="21", volume="8", pages="e67322", keywords="timed up and go test", keywords="self-assessment", keywords="instrumented assessment", keywords="technology-based assess-ment", keywords="physical capacity", keywords="mobility", keywords="aged", keywords="mobile applications", keywords="smartphone", keywords="diagnostic self evaluation", abstract="Background: The Timed Up and Go test (TUG) is recommended as an evidence-based tool for measuring physical capacity. Instrumented TUG (iTUG) approaches expand classical supervised clinical applications offering the potential of self-assessment for older adults. Objective: This study aimed to evaluate the concurrent validity and test-retest reliability of a smartphone-based TUG self-assessment ``up\&go app.'' Methods: A total of 52 community-dwelling older adults (>67 years old) were recruited. A validated and medically certified system attached with a belt at the lower back was used as a reference system to validate the ``up\&go app'' algorithm. The participants repeated the TUG 5 times wearing, a smartphone with the ``up\&go app'' in their front trouser pocket and an inertial sensor to test the concurrent validity. A subsample of 37 participants repeated the ``up\&go app'' measurement 2 weeks later to examine the test-retest reliability. Results: The correlation between the ``up\&go app'' and the reference measurement was r=0.99 for the total test duration and r=0.97 for the 5 single repetitions. Agreement between the 5 repetitions was intraclass correlation coefficient (ICC)=0.9 (0.84?0.94). Leaving out the first repetition, the agreement was ICC=0.95 (0.92?0.97). Test-retest agreement had an ICC=0.79 (0.53?0.9). Conclusions: The duration of 5 repetitions of the TUG test, measured with the pocket-worn ``up\&go app,'' was very consistent with the results of a lower-back sensor system, indicating excellent concurrent validity. Participants walked slower in the first round than in the other 4 repetitions within a test run. Test-retest reliability was also excellent. The ``up\&go app'' provides a useful smartphone-based approach to measure 5 repetitions of the TUG. The app could be used by older adults as a self-screening and monitoring tool of physical capacity at home and thereby help to early identify functional limitations and take interventions when necessary. ", doi="10.2196/67322", url="https://aging.jmir.org/2025/1/e67322" } @Article{info:doi/10.2196/64074, author="van Gaans-Riteco, Dani{\"e}lle and Stoop, Annerieke and Wouters, Eveline", title="Values of Stakeholders Involved in Applying Surveillance Technology for People With Dementia in Nursing Homes: Scoping Review", journal="JMIR Aging", year="2025", month="Mar", day="20", volume="8", pages="e64074", keywords="surveillance technology", keywords="nursing home", keywords="stakeholders", keywords="values", keywords="dementia", keywords="safety", abstract="Background: Due to the progressive nature of dementia, concerns about the safety of nursing home residents are frequently raised. Surveillance technology, enabling visual and auditory monitoring, is often seen as a solution for ensuring safe and efficient care. However, tailoring surveillance technology to individual needs is challenging due to the complex and dynamic care environment involving multiple formal and informal stakeholders, each with unique perspectives. Objective: This study aims to explore the scientific literature on the perspectives and values of stakeholders involved in applying surveillance technology for people with dementia in nursing homes. Methods: We conducted a scoping review and systematically searched 5 scientific databases. We identified 31 articles published between 2005 and 2024. Stakeholder characteristics were extracted and synthesized according to the theory of basic human values by Schwartz. Results: In total, 12 stakeholder groups were identified, with nursing staff, residents, and informal caregivers being the most frequently mentioned. Among stakeholder groups close to residents, values related to benevolence, security, conformity, and tradition were most commonly addressed. Furthermore, values such as self-direction, power, and achievement seemed important to most stakeholder groups. Conclusions: Several stakeholder groups emphasized the importance of being and feeling involved in the application of surveillance technologies. In addition, they acknowledged the necessity of paying attention to stakeholders' perspectives and values. Across these stakeholder groups, values related to benevolence, security, and self-direction were represented, although various stakeholders assigned different meanings to these values. Awareness of stakeholders' perspectives demands a willingness to acknowledge each other's values and bridge differences. ", doi="10.2196/64074", url="https://aging.jmir.org/2025/1/e64074", url="http://www.ncbi.nlm.nih.gov/pubmed/39899267" } @Article{info:doi/10.2196/69008, author="Kang, Hyunjin and Yang, Tingting and Banu, Nazira and Ng, Ting Sheryl Wei and Lee, Kyu Jeong", title="Exploring Smart Health Wearable Adoption Among Singaporean Older Adults Based on Self-Determination Theory: Web-Based Survey Study", journal="JMIR Aging", year="2025", month="Mar", day="19", volume="8", pages="e69008", keywords="smart health wearables", keywords="self-determination theory", keywords="AI anxiety", keywords="perceived privacy risk", keywords="health consciousness", abstract="Background: Smart health wearables offer significant benefits for older adults, enabling seamless health monitoring and personalized suggestions based on real-time data. Promoting adoption and sustained use among older adults is essential to empower autonomous health management, leading to better health outcomes, improved quality of life, and reduced strain on health care systems. Objective: This study investigates how autonomy-related contextual factors, including artificial intelligence (AI) anxiety, perceived privacy risks, and health consciousness, are related to older adults' psychological needs of competence, autonomy, and relatedness (RQ1). We then examined whether the fulfillment of these needs positively predicts older adults' intentions to adopt these devices (H1), and how they mediate the relationship between these factors and older adults' intentions to use smart health wearables (RQ2). Additionally, it compares experienced and nonexperienced older adult users regarding the influence of these psychological needs on use intentions (RQ3). Methods: A web-based survey was conducted with individuals aged 60 years and above in Singapore, using a Qualtrics survey panel. A total of 306 participants (177 male; mean age of 65.47 years, age range 60?85 years) completed the survey. A structural equation model was used to analyze associations among AI anxiety, perceived privacy risks, and health consciousness, and the mediating factors of competence, autonomy, and relatedness, as well as their relationship to smart health wearable use intention. Results: Health consciousness positively influenced all intrinsic motivation factors---competence, autonomy, and relatedness---while perceived privacy risks negatively affected all three. AI anxiety was negatively associated with competence only. Both privacy risk perceptions and health consciousness were indirectly linked to older adults' intentions to use smart health wearables through competence and relatedness. No significant differences were found in motivational structures between older adults with prior experience and those without. Conclusions: This study contributes to the application of self-determination theory in promoting the use of smart technology for health management among older adults. The results highlight the critical role of intrinsic motivation---particularly competence---in older adults' adoption of smart health wearables. While privacy concerns diminish motivation, health consciousness fosters it. The study results offer valuable implications for designing technologies that align with older adults' motivations, potentially benefiting aging populations in other technologically advanced societies. Developers should focus on intuitive design, transparent privacy practices, and social features to encourage adoption, empowering older adults to use smart wearables for proactive health management. ", doi="10.2196/69008", url="https://aging.jmir.org/2025/1/e69008" } @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/10.2196/60156, author="Buawangpong, Nida and Siviroj, Penprapa and Pinyopornpanish, Kanokporn and Sirikul, Wachiranun", title="Transcultural Adaptation, Validation, Psychometric Analysis, and Interpretation of the 22-Item Thai Senior Technology Acceptance Model for Mobile Health Apps: Cross-Sectional Study", journal="JMIR Aging", year="2025", month="Mar", day="11", volume="8", pages="e60156", keywords="STAM", keywords="senior technology acceptance model", keywords="validity", keywords="reliability", keywords="mHealth", keywords="older adult", keywords="technology acceptance", keywords="mobile health", keywords="app", keywords="transcultural adaptation", keywords="psychometric analysis", keywords="geriatrics", keywords="cross-sectional study", keywords="Thai", keywords="theory analysis", keywords="Cronbach $\alpha$", keywords="McDonald $\omega$", keywords="quality of life", keywords="well-being", keywords="social media", keywords="telehealth", keywords="health informatics", keywords="eHealth", keywords="mobile phone", abstract="Background: The rapid advancement of technology has made mobile health (mHealth) a promising tool to mitigate health problems, particularly among older adults. Despite the numerous benefits of mHealth, assessing individual acceptance is required to address the specific needs of older people and promote their intention to use mHealth. Objective: This study aims to adapt and validate the senior technology acceptance model (STAM) questionnaire for assessing mHealth acceptance in the Thai context. Methods: In this cross-sectional study, we adapted the original, 38-item, English version of the STAM using a 10-point Likert scale for mHealth acceptability among the Thai population. We translated the mHealth STAM into Thai using forward and backward translation. A total of 15 older adults and experts completed the pilot questionnaire and were interviewed to assess its validity. The pilot items of the Thai mHealth STAM were then reworded and revised for better comprehension and cross-cultural compatibility. The construct validity of the Thai mHealth STAM was evaluated by a multidimensional approach, including exploratory and confirmatory factor analysis and nonparametric item response theory analysis. Discriminative indices consisting of sensitivity, specificity, and area under the receiver operating characteristic (AUROC) were used to determine appropriate banding and discriminant validity for the intention to use mHealth. Internal consistency was assessed using Cronbach $\alpha$ and McDonald $\omega$ coefficients. Results: Out of the 1100 participants with a mean age of 62.3 (SD 8.8) years, 360 (32.7\%) were adults aged 45-59 years, and 740 (67.3\%) were older adults aged 60 years and older. Of the 40-item pilot questionnaire, exploratory factor analysis identified 22 items with factor loadings >0.4 across 7 principal components, explaining 91.45\% of the variance. Confirmatory factor analysis confirmed that 9-dimensional sets of 22 items had satisfactory fit indices (comparative fit index=0.976, Tucker-Lewis index=0.968, root mean square error of approximation=0.043, standardized root mean squared residual=0.044, and R2 for each item>0.30). The score banding D (low?151, moderate 152-180, and high?181) was preferred as the optimal 22-item Thai mHealth STAM cutoff score based on the highest sensitivity of 89\% (95\% CI 86.1\%-91.5\%) and AUROC of 72.4\% (95\% CI 70\%-74.8\%) for predicting the intention to use mHealth. The final Thai mHealth STAM, consisting of 22 items, exhibited remarkable internal consistency, as evidenced by a Cronbach $\alpha$ of 0.88 (95\% CI 0.87-0.89) and a McDonald $\omega$ of 0.85 (95\% CI 0.83-0.87). For all 22 items, the corrected item-total correlations ranged between 0.26 and 0.71. Conclusions: The 22-item Thai mHealth STAM demonstrated satisfactory psychometric properties in both validity and reliability. The questionnaire has the potential to serve as a practical questionnaire in assessing the acceptance and intention to use mHealth among pre-older and older adults. ", doi="10.2196/60156", url="https://aging.jmir.org/2025/1/e60156" } @Article{info:doi/10.2196/51975, author="Midao, Luis and Duarte, Mafalda and Sampaio, Rute and Almada, Marta and Dias, Camila Cl{\'a}udia and Pa{\'u}l, Constan{\c{c}}a and Costa, El{\'i}sio", title="FRAILSURVEY---an mHealth App for Self-Assessment of Frailty Based on the Portuguese Version of the Groningen Frailty Indicator: Validation and Reliability Study", journal="JMIR Form Res", year="2025", month="Mar", day="7", volume="9", pages="e51975", keywords="frailty", keywords="mHealth", keywords="assessment", keywords="validation", keywords="GFI", keywords="reliability", keywords="self-assessment", keywords="Groningen Frailty Indicator", keywords="FRAILSURVEY", keywords="mobile phone", abstract="Background: Portugal is facing the challenge of population ageing, with a notable increase in the proportion of older individuals. This has positioned the country among those in Europe with a high prevalence of frailty. Frailty, a geriatric syndrome characterized by diminished physiological reserve and heightened vulnerability to stressors, imposes a substantial burden on public health. Objective: This study seeks to address two primary objectives: (1) translation and psychometric evaluation of the European Portuguese version of the Groningen Frailty Indicator (GFI); and (2) development and evaluation of the FRAILSURVEY app, a novel assessment tool for frailty based on the GFI. By achieving these objectives, the study aims to enhance the accuracy and reliability of frailty assessment in the Portuguese context, ultimately contributing to improved health care outcomes for older individuals in the region. Methods: To accomplish the objectives of the study, a comprehensive research methodology was used. The study comprised 2 major phases: the initial translation and validation of the GFI into European Portuguese and the development of the FRAILSURVEY app. Following this, an extensive examination of the app's validity and reliability was conducted compared with the conventional paper version of the GFI. A randomized repeated crossover design was used to ensure rigorous evaluation of both assessment methods, using both the paper form of the GFI and the smartphone-based app FRAILSURVEY. Results: The findings of the study revealed promising outcomes in line with the research objectives. The meticulous translation process yielded a final version of the GFI with robust psychometric properties, ensuring clarity and comprehensibility for participants. The study included 522 participants, predominantly women (367/522, 70.3\%), with a mean age of 73.7 (SD 6.7) years. Psychometric evaluation of the European Portuguese GFI in paper form demonstrates good reliability (internal consistency: Cronbach a value of 0.759; temporal stability: intraclass correlation coefficient=0.974) and construct validity (revealing a 4D structure explaining 56\% of variance). Evaluation of the app-based European Portuguese GFI indicates good reliability (interinstrument reliability: Cohen k=0.790; temporal stability: intraclass correlation coefficient=0.800) and concurrent validity (r=0.694; P<.001). Conclusions: Both the smartphone-based app and the paper version of the GFI were feasible and acceptable for use. The findings supported that FRAILSURVEY exhibited comparable validity and reliability to its paper counterpart. FRAILSURVEY uses a standardized and validated assessment tool, offering objective and consistent measurements while eliminating subjective biases, enhancing accuracy, and ensuring reliability. This app holds promising potential for aiding health care professionals in identifying frailty in older individuals, enabling early intervention, and improving the management of adverse health outcomes associated with this syndrome. Its integration with electronic health records and other data may lead to personalized interventions, improving frailty management and health outcomes for at-risk individuals. ", doi="10.2196/51975", url="https://formative.jmir.org/2025/1/e51975", url="http://www.ncbi.nlm.nih.gov/pubmed/40053720" } @Article{info:doi/10.2196/67406, author="Moran, Ryan and Wing, David and Davey, Hope and Barkai, Hava and Nichols, Jeanne", title="Development and Implementation of Strong Foundations, a Digitally Delivered Fall Prevention Program: Usability and Feasibility Pilot Exercise Cohort Study", journal="JMIR Form Res", year="2025", month="Feb", day="28", volume="9", pages="e67406", keywords="digital health", keywords="fall prevention", keywords="fall risk", keywords="older adults", keywords="geriatrics", keywords="system usability scale", keywords="Strong Foundations", keywords="feasibility", keywords="public health", keywords="user acceptance", keywords="exercise", keywords="usability", keywords="digital technology", keywords="mobile phone", abstract="Background: Falls remain a major public health problem and a significant cause of preventable injury. Maintaining strength and balance by staying active can prevent falls in older adults, and public health advocates support referral to community exercise programs. Given the growth in use and acceptance of technological interfaces, there remains an interest in understanding the role of a synchronous exercise program designed to improve strength, postural alignment, and balance specifically designed to be delivered in a digital environment with respect to usability and feasibility. Objective: This study aims to design and implement a synchronously delivered digital fall prevention program to adults aged 60 years and older, to understand the usability, feasibility, and attendance. Methods: The ``Strong Foundations'' program, a 12-week, live, digitally delivered fall-prevention exercise program was informed from different existing in-person exercises and piloted to older adults who were considered a low fall risk by scores of 4 or less from the Centers for Disease Control and Prevention's (CDC's) Stopping Elderly Accidents and Deaths Initiative (STEADI) Staying Independent questionnaire. The System Usability Scale (SUS) measured usability and feasibility at the completion of this program, and digital measures of age-related function (timed up and go [TUG] and 30-second chair stand [30 CS]) were collected pre- and postintervention. Data were collected in 2021. Results: A total of 39 older adults were recruited and 38 completed the 12-week program with an average age of 72 years. The average SUS was 80.6, with an 85\% attendance rate and an 8.5 (out of 10) self-reported satisfaction score. Digitally collected TUG and 30 CS statistically improved pre- and postintervention by 9\% and 24\%, respectively; by week 12, 64\% (23/36) of participants improved in the timed up and go and 91\% (32/35) improved the chair stands. Conclusion: There was excellent usability and acceptability for Strong Foundations, a novel fall-prevention program designed to be delivered digitally and promising improvement of objective measures of fall risk. ", doi="10.2196/67406", url="https://formative.jmir.org/2025/1/e67406" } @Article{info:doi/10.2196/56584, author="Madeira, Ricardo and Esteves, Dulce and Pinto, Nuno and Vercelli, Alessandro and Vaz Patto, Maria", title="Acceptance Factors and Barriers to the Implementation of a Digital Intervention With Older Adults With Dementia or Caregivers: Protocol for an Umbrella Review", journal="JMIR Res Protoc", year="2025", month="Feb", day="24", volume="14", pages="e56584", keywords="dementia", keywords="aging", keywords="telemedicine", keywords="implementation", keywords="digital intervention", keywords="older people", keywords="elderly", keywords="geriatrics", keywords="mobile applications", keywords="barriers", keywords="adherence", keywords="caregivers", keywords="self-management", keywords="acceptability", abstract="Background: The increase in average life expectancy, aging, and the rise in the number of people living with dementia contribute to growing interest from the scientific community. As the disease progresses, people with dementia may need help with most daily activities and need to be supervised by their carer to ensure their safety. With the help of technology, health care provides new means of self-managing health that support active aging, allowing older people and people with dementia to live independently in their homes for a longer period of time. Although some systematic reviews have revealed some of the impacts of using digital interventions in this area, a broad systematic review that examines the overall results of the effect of this intervention type is mandatory. Objective: The aim of this review is to further investigate and understand the acceptability and barriers to using technology to monitor and manage health conditions of people living with dementia and their caregivers. Methods: A review of systematic reviews on acceptability factors and barriers for people with dementia and caregivers was carried out. Interventions that assessed acceptability factors and barriers to the use of technology by people with dementia or their carers were included. Each potentially relevant systematic review was assessed in full text by a member of a team of external experts. Results: The analysis of the results will be presented in the form of a detailed table of the characteristics of the reviews included. It will also describe the technologies used and factors of acceptability and barriers to their use. The search and preliminary analysis were carried out between May 5, 2023, and August 1, 2024. Conclusions: This review will play an important role as a comprehensive, evidence-based summary of the barriers and facilitators to the use of digital interventions. This review may help to establish effective policy and clinical guideline recommendations. ", doi="10.2196/56584", url="https://www.researchprotocols.org/2025/1/e56584" } @Article{info:doi/10.2196/63898, author="Adams, Emily and Donaghy, Eddie and Sanders, Caroline and Wolters, Klara Maria and Ng, Lauren and St-Jean, Christa and Galan, Ryan and Mercer, William Stewart", title="Digital Interventions for Older People Experiencing Homelessness: Systematic Scoping Review", journal="J Med Internet Res", year="2025", month="Feb", day="21", volume="27", pages="e63898", keywords="homeless", keywords="technology", keywords="digital exclusion", keywords="elderly", keywords="rough sleeping", keywords="digital intervention", keywords="older people", keywords="homelessness", keywords="systematic scoping review", keywords="aging", keywords="premature mortality", keywords="indicators", keywords="scoping review", keywords="databases", keywords="thematic analysis", keywords="telehealth", keywords="mhealth", keywords="ehealth", abstract="Background: older people experiencing homelessness can have mental and physical indicators of aging several decades earlier than the general population and experience premature mortality due to age-related chronic conditions. Digital interventions could positively impact the health and well-being of homeless people. However, increased reliance on digital delivery may also perpetuate digital inequalities for socially excluded groups. The potential triple disadvantage of being older, homeless, and digitally excluded creates a uniquely problematic situation warranting further research. Few studies have synthesized available literature on digital interventions for older people experiencing homelessness. Objective: This scoping review examined the use, range, and nature of digital interventions available to older people experiencing homelessness and organizations supporting them. Methods: The scoping review followed Arksey and O'Malley's proposed methodology, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, and recent Joanna Briggs Institute guidelines. We searched 14 databases. Gray literature sources were searched to supplement the electronic database search. A narrative synthesis approach was conducted on the included articles, and common themes were identified inductively through thematic analysis. Results: A total of 19,915 records were identified through database and gray literature searching. We identified 10 articles reporting on digital interventions that had a clearly defined a participant age group of >50 years or a mean participant age of >50 years. A total of 9 of 10 studies were published in the United States. The study design included descriptive studies, uncontrolled pilot studies, and pilot randomized controlled trials. No studies aimed to deliver an intervention exclusively to older people experiencing homelessness or organizations that supported them. Four types of intervention were identified: telecare for people experiencing homelessness, distributing technology to enable digital inclusion, text message reminders, and interventions delivered digitally. Interventions delivered digitally included smoking cessation support, vocational training, physical activity promotion, and cognitive behavioral therapy. Overall, the included studies demonstrated evidence for the acceptability and feasibility of digital interventions for older people experiencing homelessness, and all 10 studies reported some improvements in digital inclusion or enhanced engagement among participants. However, several barriers to digital interventions were identified, particularly aspects related to digital inclusion, such as infrastructure, digital literacy, and age. Proposed facilitators for digital interventions included organizational and peer support. Conclusions: Our findings highlight a paucity of evaluated digital interventions targeted at older people experiencing homelessness. However, the included studies demonstrated evidence of the acceptability and feasibility of digital interventions for older people experiencing homelessness. Further research on digital interventions that provide services and support older people experiencing homelessness is required. Future interventions must address the barriers older people experiencing homelessness face when accessing digital technology with the input of those with lived experience of homelessness. Trial Registration: OSF Registries OSF.IO/7QGTY; https://doi.org/10.17605/OSF.IO/7QGTY ", doi="10.2196/63898", url="https://www.jmir.org/2025/1/e63898" } @Article{info:doi/10.2196/56418, author="Yin, Ruoyu and Rajappan, Dakshayani and Martinengo, Laura and Chan, F. Frederick H. and Smith, Helen and Griva, Konstadina and Subramaniam, Mythily and Tudor Car, Lorainne", title="Depression Self-Care Apps' Characteristics and Applicability to Older Adults: Systematic Assessment", journal="J Med Internet Res", year="2025", month="Feb", day="21", volume="27", pages="e56418", keywords="older adults", keywords="elder", keywords="elderly", keywords="mental health", keywords="mental illness", keywords="mental disorders", keywords="mHealth", keywords="mobile health", keywords="mobile application", keywords="app", keywords="application", keywords="smartphone", keywords="depression", keywords="self-care", keywords="mobile apps", keywords="systematic assessment", keywords="assessment", keywords="effectiveness", keywords="Android app", keywords="mental health apps", keywords="mobile interventions", keywords="behaviour", keywords="therapy", keywords="mood monitoring", keywords="adaptations", keywords="online communities", keywords="impairments", abstract="Background: Depression affects 32\% of older adults. Loneliness and social isolation are common risk factors for depression in older adults. Mobile apps can connect users and are also effective in depression management in the general population. However, older adults have specific needs in terms of the content of depression self-care interventions and their accessibility. It remains unknown whether existing apps for depression self-care are applicable to older adults. Objective: The initial aim of this assessment was to systematically identify interactive depression self-care apps specifically designed for older adults. As we did not find any, we assessed the applicability of existing depression self-care apps to the needs of older adult users. Methods: Using an established app assessment methodology, we searched for Android and iOS interactive mental health apps providing self-care for depression in English and Chinese in the 42Matters database, Chinese Android app stores, and the first 10 pages of Google and Baidu. We developed an assessment rubric based on extensive revision of the literature. The rubric consisted of the following sections: general characteristics of the apps (eg, developer, platform, and category), app content (eg, epidemiology and risk factors of depression in older adults, techniques to improve mood and well-being), and technical aspects (eg, accessibility, privacy and confidentiality, and engagement). Results: We identified 23 apps (n=19, 82.6\%, English and n=4, 17.4\%, Chinese apps), with 5 (21.7\%) iOS-only apps, 3 (13\%) Android-only apps, and 15 (65.2\%) apps on both platforms. None specifically targeted older adults with depression. All apps were designed by commercial companies and were free to download. Most of the apps incorporated cognitive behavior therapy, mood monitoring, or journaling. All but 3 (13\%) apps had a privacy and confidentiality policy. In addition, 14 (60.9\%) apps covered depression risk factors in older adults, and 3 (13\%) apps delivered information about depression epidemiology in older adults via a chatbot. Furthermore, 17 (73.9\%) apps mentioned other topics relevant to older adults, such as pain management, grief, loneliness, and social isolation. Around 30\% (n=7) of the apps were supported by an online forum. Common accessibility issues included a lack of adaptations for users with visual or hearing impairments and incompatibility with larger font sizes in the phone settings. Conclusions: There are no depression apps developed specifically for older adults. Available mobile apps have limited applicability to older adults in terms of their clinical and technical features. Depression self-care apps should aim to incorporate content relevant to older adults, such as grief and loss; include online communities; and improve accessibility to adapt to potential health impairments in older adults. ", doi="10.2196/56418", url="https://www.jmir.org/2025/1/e56418" } @Article{info:doi/10.2196/64633, author="Beverly, A. Elizabeth and Miller, Samuel and Love, Matthew and Love, Carrie", title="Feasibility of a Cinematic--Virtual Reality Program Educating Health Professional Students About the Complexity of Geriatric Care: Pilot Pre-Post Study", journal="JMIR Aging", year="2025", month="Feb", day="12", volume="8", pages="e64633", keywords="virtual reality", keywords="VR", keywords="aging", keywords="geriatric syndromes", keywords="diabetes", keywords="elder abuse and neglect", keywords="gerontology", keywords="geriatrics", keywords="older", keywords="elderly", keywords="education", keywords="student", keywords="cinematic", keywords="video", keywords="head mounted", keywords="feasibility", keywords="experience", keywords="attitude", keywords="opinion", keywords="perception", keywords="elder abuse", keywords="chronic conditions", keywords="older adult care", keywords="health intervention", keywords="randomized controlled trial", abstract="Background: The US population is aging. With this demographic shift, more older adults will be living with chronic conditions and geriatric syndromes. To prepare the next generation of health care professionals for this aging population, we need to provide training that captures the complexity of geriatric care. Objective: This pilot study aimed to assess the feasibility of the cinematic--virtual reality (cine-VR) training in the complexity of geriatric care. We measured changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy before and after participating in the training program. Methods: We conducted a single-arm, pretest-posttest pilot study to assess the feasibility of a cine-VR training and measure changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy. Health professional students from a large university in the Midwest were invited to participate in 1 of 4 cine-VR trainings. Participants completed 3 surveys before and after the cine-VR training. We performed paired t tests to examine changes in these constructs before and after the training. Results: A total of 65 health professional students participated in and completed the full cine-VR training for 100\% retention. Participants did not report any technological difficulties or adverse effects from wearing the head-mounted displays or viewing the 360-degree video. Out of the 65 participants, 48 completed the pre- and postassessments. We observed an increase in awareness of discrimination towards people with disability (t47=?3.97; P<.001). In addition, we observed significant improvements in self-efficacy to identify and manage elder abuse and neglect (t47=?3.36; P=.002). Finally, we observed an increase in participants' empathy (t47=?2.33; P=.02). Conclusions: We demonstrated that our cine-VR training program was feasible and acceptable to health professional students at our Midwestern university. Findings suggest that the cine-VR training increased awareness of discrimination towards people with disabilities, improved self-efficacy to identify and manage elder abuse and neglect, and increased empathy. Future research using a randomized controlled trial design with a larger, more diverse sample and a proper control condition is needed to confirm the effectiveness of our cine-VR training. ", doi="10.2196/64633", url="https://aging.jmir.org/2025/1/e64633" } @Article{info:doi/10.2196/60652, author="Dupont, Charl{\`e}ss and Smets, Tinne and Potts, Courtney and Monnet, Fanny and Pivodic, Lara and De Vleminck, Aline and Van Audenhove, Chantal and Mulvenna, Maurice and Van den Block, Lieve", title="Uncovering Specific Navigation Patterns by Assessing User Engagement of People With Dementia and Family Caregivers With an Advance Care Planning Website: Quantitative Analysis of Web Log Data", journal="JMIR Aging", year="2025", month="Feb", day="11", volume="8", pages="e60652", keywords="dementia", keywords="advance care planning", keywords="user engagement", keywords="web-based tool", keywords="care", keywords="website", keywords="caregiver", keywords="communication", keywords="tool", keywords="online", abstract="Background: Web-based tools have gained popularity to inform and empower individuals in advance care planning. We have developed an interactive website tailored to the unique needs of people with dementia and their families to support advance care planning. This website aims to break away from the rigid pathways shown in other tools that support advance care planning, in which advance care planning is shown as a linear process from information to reflection, communication, and documentation. Objective: This study aimed to assess the website's usage by people with dementia and their family caregivers, identify distinct user engagement patterns, and visualize how users navigated the website. Methods: We analyzed the website's log data obtained from an 8-week evaluation study of the site. Interactions with the website were collected in log data files and included visited web pages or clicked-on hyperlinks. Distinct user engagement patterns were identified using K-means clustering process mining, a technique that extracts insights from log data to model and visualize workflows, was applied to visualize user pathways through the website. Results: A total of 52 participants, 21 individuals with dementia and their family caregivers as dyads and 10 family caregivers were included in the study. Throughout the 8-week study, users spent an average of 35.3 (SD 82.9) minutes over 5.5 (SD 3.4) unique days on the website. Family caregivers mostly used the website (alone or with a person with dementia) throughout the 8-week study. Only 3 people with dementia used it on their own. In total, 3 distinct engagement patterns emerged: low, moderate, and high. Low-engagement participants spent less time on the website during the 8 weeks, following a linear path from information to communication to documentation. Moderate- and high-engagement users showed more dynamic patterns, frequently navigating between information pages and communication tools to facilitate exploration of aspects related to advance care planning. Conclusions: The diverse engagement patterns underscore the need for personalized support in advance care planning and challenge the conventional linear advance care planning representations found in other web-based tools. ", doi="10.2196/60652", url="https://aging.jmir.org/2025/1/e60652" } @Article{info:doi/10.2196/64847, author="Adekoya, Adebusola and Daum, Christine and Neubauer, Noelannah and Miguel-Cruz, Antonio and Liu, Lili", title="Implications of Public Disclosure of Personal Information in a Mobile Alert App for People Living With Dementia Who Go Missing: Qualitative Descriptive Study", journal="JMIR Aging", year="2025", month="Feb", day="7", volume="8", pages="e64847", keywords="alert systems", keywords="technology", keywords="missing persons", keywords="dementia", keywords="autonomy", keywords="privacy", keywords="stigmatization", keywords="consent", abstract="Background: People living with dementia are at risk of getting lost and going missing due to memory loss, confusion, and disorientation. Missing person incidents involving people living with dementia are increasing. Alert systems such as Community ASAP can promote community engagement in locating missing persons with dementia and aid in search and rescue efforts. However, the implications of public disclosure of personal information such as name, age, sex, and physical description within such alert systems have yet to be explored. Objective: This study aimed to identify and discuss the implications of public disclosure of personal information in Community ASAP for people living with dementia at risk of going missing. Methods: This study used a qualitative descriptive research design drawing from naturalistic inquiry. A total of 19 participants including people living with dementia, care partners, first responders, and service providers were recruited from Ontario, Alberta, and British Columbia, Canada. Semistructured interviews were used to explore participants' perspectives on the perceived implications of the release of personal information when using Community ASAP. NVivo (version 12) was used to manage data, and conventional content analysis was conducted to identify key themes of the implications of public disclosure of personal information in Community ASAP. Results: In total, 10/19 (53\%) of the participants were women and 9/19 (47\%) were men. Of the 19 participants, 3 (16\%) were people living with dementia, 5 (26\%) were care partners, 4 (21\%) were first responders, and 7 (37\%) were service providers. In total, 4 key themes were identified as implications of public disclosure of personal information in Community ASAP: right to autonomy, safety versus privacy, informed and knowledgeable consent, and stigmatization. Participants discussed how the public disclosure of personal information in Community ASAP could undermine a person's choice not to be found and contribute to stigmatization. Participants emphasized a need to balance safety and privacy concerns. Informed and knowledgeable consent is important when using an alert system to locate missing persons with dementia. Conclusions: Community ASAP can promote community engagement in locating missing persons with dementia. However, the public disclosure of personal information in alert systems has implications. Users' right to autonomy, a balance between safety and privacy, informed and knowledgeable consent, and risks of stigmatization are perceived impacts of disclosure of personal information in alert systems. ", doi="10.2196/64847", url="https://aging.jmir.org/2025/1/e64847", url="http://www.ncbi.nlm.nih.gov/pubmed/39918846" } @Article{info:doi/10.2196/64033, author="Nester, O. Caroline and De Vito, N. Alyssa and Prieto, Sarah and Kunicki, J. Zachary and Strenger, Jennifer and Harrington, D. Karra and Roque, Nelson and Sliwinski, J. Martin and Rabin, A. Laura and Thompson, I. Louisa", title="Association of Subjective Cognitive Concerns With Performance on Mobile App--Based Cognitive Assessment in Cognitively Normal Older Adults: Observational Study", journal="JMIR Aging", year="2025", month="Feb", day="4", volume="8", pages="e64033", keywords="subjective cognitive concerns", keywords="subjective cognitive decline", keywords="digital cognitive assessment", keywords="mobile app", keywords="app-based", keywords="preclinical Alzheimer disease", keywords="mild cognitive impairment", keywords="MCI", keywords="preclinical dementia", keywords="mobile monitoring of cognitive change", keywords="Cognitive Function Instrument", keywords="mHealth", keywords="mobile health", keywords="applications", keywords="cognition", keywords="assessment", keywords="remote", keywords="geriatrics", keywords="gerontology", keywords="aging", keywords="memory", keywords="older adult", keywords="elderly", keywords="digital health", keywords="mobile phone", abstract="Background: Subjective cognitive concerns (SCCs) may be among the earliest clinical symptoms of dementia. There is growing interest in applying a mobile app--based cognitive assessment to remotely screen for cognitive status in preclinical dementia, but the relationship between SCC and relevant mobile assessment metrics is uncertain. Objective: This study aimed to characterize the relationship between SCC and adherence, satisfaction, and performance on mobile app assessments in cognitively unimpaired older adults. Methods: Participants (N=122; Meanage=68.85 [SD 4.93] years; Meaneducation=16.85 [SD 2.39] years; female: n=82, 66.7\%; White:n=106, 86.2\%) completed 8 assessment days using Mobile Monitoring of Cognitive Change (M2C2), an app-based testing platform, with brief daily sessions within morning, afternoon, and evening time windows (24 total testing sessions). M2C2 includes digital working memory, processing speed, and episodic memory tasks. Participants provided feedback about their satisfaction and motivation related to M2C2 upon study completion. SCC was assessed using the Cognitive Function Instrument. Regression analyses evaluated the association between SCC and adherence, satisfaction, and performance on M2C2, controlling for age, sex, depression, and loneliness. Linear-mixed effects models evaluated whether SCC predicted M2C2 subtest performance over the 8-day testing period, controlling for covariates. Results: SCC was not associated with app satisfaction or protocol motivation, but it was significantly associated with lower rates of protocol adherence ({\ss}=?.20, P=.37, 95\% CI ?.65 to ?.02). Higher SCC endorsement significantly predicted worse overall episodic memory performance ({\ss}=?.20, P=.02, 95\% CI ?.02 to ?.01), but not working memory or processing speed. There was a main effect of SCC on working memory performance at day 1 (estimate=?1.05, SE=0.47, P=.03) and a significant interaction between SCC and working memory over the 8-day period (estimate=0.05, SE=0.02, P=.03), such that SCC was associated with initially worse, then progressively better working memory performance. Conclusions: SCCs are associated with worse overall memory performance on mobile app assessments, patterns of cognitive inefficiency (variable working memory), and mildly diminished adherence across an 8-day assessment period. Findings suggest that mobile app assessments may be sensitive to subtle cognitive changes, with important implications for early detection and treatment for individuals at risk for dementia. ", doi="10.2196/64033", url="https://aging.jmir.org/2025/1/e64033" } @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/10.2196/63348, author="Daniels, Kim and Vonck, Sharona and Robijns, Jolien and Quadflieg, Kirsten and Bergs, Jochen and Spooren, Annemie and Hansen, Dominique and Bonnech{\`e}re, Bruno", title="Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study", journal="JMIR Aging", year="2025", month="Jan", day="27", volume="8", pages="e63348", keywords="mobile health", keywords="mHealth", keywords="feasibility", keywords="physical activity", keywords="older adults", keywords="health promotion", keywords="usability", keywords="mobile phone", abstract="Background: Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA). Objective: The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot. Methods: Our study used a mixed methods approach to evaluate the MIA app's acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based. Results: The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57\% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6\%. Analysis showed general satisfaction with the app's workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants. Conclusions: The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults. Trial Registration: ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515 ", doi="10.2196/63348", url="https://aging.jmir.org/2025/1/e63348" } @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/10.2196/65022, author="Zeiler, Michael and Dietzel, Nikolas and Haug, Fabian and Haug, Julian and Kammerer, Klaus and Pryss, R{\"u}diger and Heuschmann, Peter and Graessel, Elmar and Kolominsky-Rabas, L. Peter and Prokosch, Hans-Ulrich", title="A User-Centered Design Approach for a Screening App for People With Cognitive Impairment (digiDEM-SCREEN): Development and Usability Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="22", volume="12", pages="e65022", keywords="dementia", keywords="usability", keywords="development", keywords="digiDEM", keywords="cognitive impairment", keywords="older adults", keywords="aging", keywords="mobile health", keywords="mHealth", keywords="design", keywords="feedback", keywords="screening", keywords="user centred", keywords="cognitive disorder", keywords="user-centered", keywords="mobile app", abstract="Background: Dementia is a widespread syndrome that currently affects more than 55 million people worldwide. Digital screening instruments are one way to increase diagnosis rates. Developing an app for older adults presents several challenges, both technical and social. In order to make the app user-friendly, feedback from potential future end users is crucial during this development process. Objective: This study aimed to establish a user-centered design process for the development of digiDEM-SCREEN, a user-friendly app to support early identification of persons with slight symptoms of dementia. Methods: This research used qualitative and quantitative methods and involved 3 key stakeholder groups: the digiDEM research team, the software development team, and the target user group (older adults ?65 years with and without cognitive impairments). The development of the screening app was based on an already existing and scientifically analyzed screening test (Self-Administered Tasks Uncovering Risk of Neurodegeneration; SATURN). An initial prototype was developed based on the recommendations for mobile health apps and the teams' experiences. The prototype was tested in several iterations by various end users and continuously improved. The app's usability was evaluated using the System Usability Scale (SUS), and verbal feedback by the end users was obtained using the think-aloud method. Results: The translation process during test development took linguistic and cultural aspects into account. The texts were also adapted to the German-speaking context. Additional instructions were developed and supplemented. The test was administered using different randomization options to minimize learning effects. digiDEM-SCREEN was developed as a tablet and smartphone app. In the first focus group discussion, the developers identified and corrected the most significant criticism in the next version. Based on the iterative improvement process, only minor issues needed to be addressed after the final focus group discussion. The SUS score increased with each version (score of 72.5 for V1 vs 82.4 for V2), while the verbal feedback from end users also improved. Conclusions: The development of digiDEM-SCREEN serves as an excellent example of the importance of involving experts and potential end users in the design and development process of health apps. Close collaboration with end users leads to products that not only meet current standards but also address the actual needs and expectations of users. This is also a crucial step toward promoting broader adoption of such digital tools. This research highlights the significance of a user-centered design approach, allowing content, text, and design to be optimally tailored to the needs of the target audience. From these findings, it can be concluded that future projects in the field of health apps would also benefit from a similar approach. ", doi="10.2196/65022", url="https://humanfactors.jmir.org/2025/1/e65022" } @Article{info:doi/10.2196/55042, author="Khatib, Sewar and Palgi, Yuval and Ashar, K. Yoni and Polyvyannaya, Natalya and Goldstein, Pavel", title="The Combined Effect of Multisensory Stimulation and Therapist Support on Physical and Mental Health of Older Adults Living in Nursing Homes: Pilot Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Jan", day="14", volume="27", pages="e55042", keywords="Snoezelen room", keywords="mental health", keywords="sensory stimulation environment", keywords="social support", keywords="nursing homes", keywords="older adults", abstract="Background: Increasing life expectancy has led to a rise in nursing home admissions, a context in which older adults often experience chronic physical and mental health conditions, chronic pain, and reduced well-being. Nonpharmacological approaches are especially important for managing older adults' chronic pain, mental health conditions (such as anxiety and depression), and overall well-being, including sensory stimulation (SS) and therapist support (TS). However, the combined effects of SS and TS have not been investigated. Objective: This randomized controlled trial examines the specific and combined effects of brief SS and TS interventions on older adults' physical and mental health and pain intensity levels, among individuals living in nursing homes. Methods: A total of 96 patients aged 65-99 years from a nursing home were randomly assigned to 3 groups: SS, TS, and combined SS+TS interventions, each delivered as four 20-minute sessions. SS was implemented using a multisensory Snoezelen room. Pain intensity levels (per a Visual Analog Scale), blood pressure, heart rate, blood oxygen saturation, and hand grip strength (using a Jamar hand dynamometer) were measured before and after each of the 4 weekly therapeutic sessions. In addition, life satisfaction (per the Satisfaction with Life Scale) and anxiety (per the 7-item General Anxiety Disorder Scale) were evaluated before and after the whole intervention. Mixed model analyses tested the relative efficacy of the 3 interventions, applying simple slope analysis with Tukey correction. Study rationale and analytical plans were preregistered. Results: The combined intervention of SS and TS (SS+TS) resulted in reduced pain levels compared with SS (B=0.209, P=.006) and TS alone (B=0.23, P=.002) over 4 sessions (F6,266=2.62; P=.017; R2=0.23). Further, the combined SS+TS intervention resulted in reduced systolic blood pressure versus SS (B=0.09, P=.01) and TS alone (B=0.016, P<.001) groups (F6,272=5.42; P<.001; R2=0.29). In addition, the combined SS+TS intervention resulted in an increased grip strength versus SS (B=--0.35, P=.003) and TS alone (B=--0.032, P=.008) groups (F6,273=2.25; P=.04; R2=0.19). Moreover, combined SS+TS resulted in an improvement in life satisfaction (B=--4.29, P<.0001) compared with SS (B=--2.38, P=.0042) and TS alone (B=--1.20, P=.13) groups (F2,39=3.47; P=.04). Finally, SS+TS demonstrated greater improvement in symptoms of general anxiety disorder (B=10.64, P<.0001) compared with SS (B=3.30 P=.01) and TS alone (B=1.13, P=.37) (F2,38=13.5; P<.001) groups. No differences between the interventions were shown for blood oxygen saturation (F6,273=2.06; P=.06), diastolic blood pressure (F6,272=1.12; P=.35), and heart rate (F6,273=1.33; P=.23). Conclusions: The combined intervention of SS and TS showed therapeutic benefits for pain management and physical and mental health of older adults living in nursing homes, relative to each therapeutic component in isolation. This brief intervention can be readily implemented to improve well-being and optimize therapeutic resources in nursing home settings. Trial Registration: ClinicalTrials.gov NCT05394389; https://clinicaltrials.gov/ct2/show/NCT05394389 ", doi="10.2196/55042", url="https://www.jmir.org/2025/1/e55042", url="http://www.ncbi.nlm.nih.gov/pubmed/39808474" } @Article{info:doi/10.2196/56718, author="Dunston, R. Emily and Oza, Sonal and Bai, Yang and Newton, Maria and Podlog, Leslie and Larson, Kish and Walker, Darren and Zingg, W. Rebecca and Hansen, A. Pamela and Coletta, M. Adriana", title="Preliminary Effectiveness of a Telehealth-Delivered Exercise Program in Older Adults Living With and Beyond Cancer: Retrospective Study", journal="JMIR Cancer", year="2025", month="Jan", day="13", volume="11", pages="e56718", keywords="physical activity", keywords="physical function", keywords="telerehabilitation", keywords="remote exercise", keywords="digital health", keywords="cancer survivors", keywords="older adults", keywords="smartphone", abstract="Background: Exercise can attenuate the deleterious combined effects of cancer treatment and aging among older adults with cancer, yet exercise participation is low. Telehealth exercise may improve exercise engagement by decreasing time and transportation barriers; however, the utility of telehealth exercise among older adults with cancer is not well established. Objective: We aimed to evaluate the preliminary effectiveness of a one-on-one, supervised telehealth exercise program on physical function, muscular endurance, balance, and flexibility among older adults with cancer. Methods: In this retrospective study, we analyzed electronic health record data collected from the Personal Optimism With Exercise Recovery clinical exercise program delivered via telehealth among older adults with cancer (?65 y) who completed a virtual initial program telehealth assessment between March 2020 and December 2021. The virtual initial assessment included the following measures: 30-second chair stand test, 30-second maximum push-up test, 2-minute standing march, single leg stance, plank, chair sit and reach, shoulder range of motion, and the clock test. All baseline measures were repeated after 12-weeks of telehealth exercise. Change scores were calculated for all assessments and compared to minimal clinically important difference (MCID) values for assessments with published MCIDs. Paired samples t tests (2-tailed) were conducted to determine change in assessment outcomes. Results: Older adults with cancer who chose to participate in the telehealth exercise program (N=68) were 71.8 (SD 5.3) years of age on average (range 65?92 y). The 3 most common cancer types in this sample were breast (n=13), prostate (n=13), and multiple myeloma (n=8). All cancer stages were represented in this sample with stage II (n=16, 23.5\%) and III (n=18, 26.5\%) being the most common. A follow-up telehealth assessment was completed by 29.4\% (n=20) of older adults with cancer. Among those who completed a follow-up telehealth assessment, there were significant increases in the 30-second chair stand (n=19; mean change +2.00 repetitions, 95\% CI 0.12 to 3.88) and 30-second maximum push-up scores (n=20; mean change +2.85 repetitions, 95\% CI 1.60 to 4.11). There were no significant differences for the 2-minute standing march, plank, single leg stance, sit and reach, shoulder mobility, or clock test (P>.05). Nine (47.3\%) older adults with cancer had a change in 30-second chair stand scores greater than the MCID of 2 repetitions. Conclusions: Our findings suggest a one-on-one, supervised telehealth exercise program may positively influence measures of physical function, muscular endurance, balance, and flexibility among older adults with cancer, but more adequately powered trials are needed to confirm these findings. ", doi="10.2196/56718", url="https://cancer.jmir.org/2025/1/e56718" } @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/10.2196/53045, author="Su, Kuan-Chu and Wu, Ko-Chiu and Chou, Kuei-Ru and Huang, Chia-Hsu", title="Tongue Muscle Training App for Middle-Aged and Older Adults Incorporating Flow-Based Gameplay: Design and Feasibility Pilot Study", journal="JMIR Serious Games", year="2025", month="Jan", day="9", volume="13", pages="e53045", keywords="exergame", keywords="mobile app", keywords="flow", keywords="self-care", keywords="feasibility", keywords="older adults", keywords="dysphagia", keywords="tongue exercises", abstract="Background: Complications due to dysphagia are increasingly prevalent among older adults; however, the tediousness and complexity of conventional tongue rehabilitation treatments affect their willingness to rehabilitate. It is unclear whether integrating gameplay into a tongue training app is a feasible approach to rehabilitation. Objective: Tongue training has been proven helpful for dysphagia treatment. Following the development of a tongue training app, a feasibility trial aimed to identify physiological and psychological factors that affect user and flow experience and explored whether training specialized muscles could produce a flow experience for optimal immersion. We aimed to provide a useful tool for medical rehabilitation so that older adults could retain tongue muscle flexibility. Methods: After consulting professional nurses, we developed a mobile gaming app for middle-aged and older adults to train their tongue muscles. This pilot study used an image recognition system to detect the tongue movements of 32 healthy middle-aged and older adults (7 males, 21.9\%; 25 females, 78.1\%) during 3 game training tasks, each requiring different reaction speeds. Their physiological and psychological signals, as well as the results of the Flow State Scale 2 (FSS2) questionnaire, were used for correlation analysis regarding relevant flow experiences to establish and evaluate the feasibility of our method. Results: Through exploratory factor analyses, a 2-factor (operation and immersion) structure was confirmed to have an adequate model fit ($\chi${\texttwosuperior}36=448.478; P<.001; Kaiser-Meyer-Olkin=0.757) and internal consistency reliability (Cronbach $\alpha$=0.802). The slow, medium, and fast levels all significantly affected the FSS2 score for operation (P=.001), the National Aeronautics and Space Administration Task Load Index (P<.001), and flow distance (P<.001). K-means clustering revealed that participants could be further categorized into 3 groups. Through the analysis of changes in the participants' physiological and psychological signals for each given task, Pearson correlation indicated that changes were primarily related to flow distance. For the 12 indicators measured in this study, the low, medium, and high operation groups showed significance in 58\% (7/12), 50\% (6/12), and 25\% (3/12) of the indicators, respectively. Similarly, the low, medium, and high immersion groups had changes in 50\% (6/12), 33\% (4/12), and 17\% (2/12) of indicators, respectively. Conclusions: Our research supports the further development of a gaming app to aid older adults with tongue muscle training and measure flow using physiological and psychological signals to enhance training accuracy and feasibility. Next, we aim to conduct a randomized pilot trial, improve app functions, offer alternative rehabilitation options, and encourage long-term participation. Future goals include enhancing long-term efficacy, diversifying training modes, and adding a multiuser interactive option for an added challenge. ", doi="10.2196/53045", url="https://games.jmir.org/2025/1/e53045" } @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/10.2196/64636, author="Rong, Jian and Pathiravasan, H. Chathurangi and Zhang, Yuankai and Faro, M. Jamie and Wang, Xuzhi and Schramm, Eric and Borrelli, Belinda and Benjamin, J. Emelia and Liu, Chunyu and Murabito, M. Joanne", title="Baseline Smartphone App Survey Return in the Electronic Framingham Heart Study Offspring and Omni 1 Study: eCohort Study", journal="JMIR Aging", year="2024", month="Dec", day="31", volume="7", pages="e64636", keywords="mHealth", keywords="mobile health", keywords="mobile application", keywords="smartphone", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="gerontology", keywords="geriatric", keywords="older adult", keywords="aging", keywords="eFHS", keywords="eCohort", keywords="smartphone app", keywords="baseline app surveys", keywords="Framingham Heart Study", keywords="health information", keywords="information collection", keywords="mobile phone", abstract="Background: Smartphone apps can be used to monitor chronic conditions and offer opportunities for self-assessment conveniently at home. However, few digital studies include older adults. Objective: We aim to describe a new electronic cohort of older adults embedded in the Framingham Heart Study including baseline smartphone survey return rates and survey completion rates by smartphone type (iPhone [Apple Inc] and Android [Google LLC] users). We also aim to report survey results for selected baseline surveys and participant experience with this study's app. Methods: Framingham Heart Study Offspring and Omni (multiethnic cohort) participants who owned a smartphone were invited to download this study's app that contained a range of survey types to report on different aspects of health including self-reported measures from the Patient-Reported Outcomes Measurement Information System (PROMIS). iPhone users also completed 4 tasks including 2 cognitive and 2 physical function testing tasks. Baseline survey return and completion rates were calculated for 12 surveys and compared between iPhone and Android users. We calculated standardized scores for the PROMIS surveys. The Mobile App Rating Scale (MARS) was deployed 30 days after enrollment to obtain participant feedback on app functionality and aesthetics. Results: We enrolled 611 smartphone users (average age 73.6, SD 6.3 y; n=346, 56.6\% women; n=88, 14.4\% Omni participants; 478, 78.2\% iPhone users) and 596 (97.5\%) returned at least 1 baseline survey. iPhone users had higher app survey return rates than Android users for each survey (range 85.5\% to 98.3\% vs 73.8\% to 95.2\%, respectively), but survey completion rates did not differ in the 2 smartphone groups. The return rate for the 4 iPhone tasks ranged from 80.9\% (380/470) for the gait task to 88.9\% (418/470) for the Trail Making Test task. The Electronic Framingham Heart Study participants had better standardized t scores in 6 of 7 PROMIS surveys compared to the general population mean (t score=50) including higher cognitive function (n=55.6) and lower fatigue (n=45.5). Among 469 participants who returned the MARS survey, app functionality and aesthetics was rated high (total MARS score=8.6 on a 1?10 scale). Conclusions: We effectively engaged community-dwelling older adults to use a smartphone app designed to collect health information relevant to older adults. High app survey return rates and very high app survey completion rates were observed along with high participant rating of this study's app. ", doi="10.2196/64636", url="https://aging.jmir.org/2024/1/e64636" } @Article{info:doi/10.2196/67992, author="Pickett, C. Andrew and Valdez, Danny and White, A. Lillian and Loganathar, Priya and Linden, Anna and Boutilier, J. Justin and Caldwell, Clover and Elliott, Christian and Zuraw, Matthew and Werner, E. Nicole", title="The CareVirtue Digital Journal for Family and Friend Caregivers of People Living With Alzheimer Disease and Related Dementias: Exploratory Topic Modeling and User Engagement Study", journal="JMIR Aging", year="2024", month="Dec", day="24", volume="7", pages="e67992", keywords="caregiving", keywords="dementia", keywords="social support", keywords="technology", keywords="intervention", keywords="Alzheimer disease", keywords="family", keywords="care network", keywords="elder", keywords="CareVirtue", keywords="open text", keywords="online platform", keywords="digital journaling tool", keywords="computational informatics", keywords="thematic analysis", keywords="topic modeling", keywords="neurodegeneration", keywords="gerontology", keywords="sentiment analysis", abstract="Background: As Alzheimer disease (AD) and AD-related dementias (ADRD) progress, individuals increasingly require assistance from unpaid, informal caregivers to support them in activities of daily living. These caregivers may experience high levels of financial, mental, and physical strain associated with providing care. CareVirtue is a web-based tool created to connect and support multiple individuals across a care network to coordinate care activities and share important information, thereby reducing care burden. Objective: This study aims to use a computational informatics approach to thematically analyze open text written by AD/ADRD caregivers in the CareVirtue platform. We then explore relationships between identified themes and use patterns. Methods: We analyzed journal posts (n=1555 posts; 170,212 words) generated by 51 unique users of the CareVirtue platform. Latent themes were identified using a neural network approach to topic modeling. We calculated a sentiment score for each post using the Valence Aware Dictionary and Sentiment Reasoner. We then examined relationships between identified topics; semantic sentiment; and use-related data, including post word count and self-reported mood. Results: We identified 5 primary topics in users' journal posts, including descriptions of specific events, professional and medical care, routine daily activities, nighttime symptoms, and bathroom/toileting issues. This 5-topic model demonstrated adequate fit to the data, having the highest coherence score (0.41) among those tested. We observed group differences across these topics in both word count and semantic sentiment. Further, posts made in the evening were both longer and more semantically positive than other times of the day. Conclusions: Users of the CareVirtue platform journaled about a variety of different topics, including generalized experiences and specific behavioral symptomology of AD/ADRD, suggesting a desire to record and share broadly across the care network. Posts were the most positive in the early evening when the tool was used habitually, rather than when writing about acute events or symptomology. We discuss the value of embedding informatics-based tools into digital interventions to facilitate real-time content delivery. ", doi="10.2196/67992", url="https://aging.jmir.org/2024/1/e67992" } @Article{info:doi/10.2196/57308, author="Ruggiano, Nicole and Brown, Leslie Ellen and Clarke, J. Peter and Hristidis, Vagelis and Roberts, Lisa and Framil Suarez, Victoria Carmen and Allala, Chaithra Sai and Hurley, Shannon and Kopcsik, Chrystine and Daquin, Jane and Chevez, Hamilton and Chang-Lau, Raymond and Agronin, Marc and Geldmacher, S. David", title="An Evidence-Based IT Program With Chatbot to Support Caregiving and Clinical Care for People With Dementia: The CareHeroes Development and Usability Pilot", journal="JMIR Aging", year="2024", month="Dec", day="23", volume="7", pages="e57308", keywords="Alzheimer disease", keywords="artificial intelligence", keywords="caregivers", keywords="chatbot", keywords="dementia", keywords="mobile applications", keywords="conversational agent", keywords="design", keywords="apps", abstract="Background: There are numerous communication barriers between family caregivers and providers of people living with dementia, which can pose challenges to caregiving and clinical decision-making. To address these barriers, a new web and mobile-enabled app, called CareHeroes, was developed, which promotes the collection and secured sharing of clinical information between caregivers and providers. It also provides caregiver support and education. Objective: The primary study objective was to examine whether dementia caregivers would use CareHeroes as an adjunct to care and gather psychosocial data from those who used the app. Methods: This paper presents the implementation process used to integrate CareHeroes into clinical care at 2 memory clinics and preliminary outcome evaluation. Family caregivers receiving services at clinics were asked to use the app for a 12-month period to collect, track, and share clinical information with the care recipient's provider. They also used it to assess their own mental health symptoms. Psychosocial outcomes were assessed through telephone interviews and user data were collected by the app. Results: A total of 21 caregivers enrolled in the pilot study across the 2 memory clinics. Usage data indicated that caregivers used many of the features in the CareHeroes app, though the chatbot was the most frequently used feature. Outcome data indicated that caregivers' depression was lower at 3-month follow-up (t11=2.03, P=.03). Conclusions: Recruitment and retention of the pilot study were impacted by COVID-19 restrictions, and therefore more testing is needed with a larger sample to determine the potential impact of CareHeroes on caregivers' mental health. Despite this limitation, the pilot study demonstrated that integrating a new supportive app for caregivers as an adjunct to clinical dementia care is feasible. Implications for future technology intervention development, implementation planning, and testing for caregivers of people living with dementia are discussed. ", doi="10.2196/57308", url="https://aging.jmir.org/2024/1/e57308" } @Article{info:doi/10.2196/59865, author="Supplieth, Juliana and Lech, Sonia and O'Sullivan, Lorraine Julie and Spang, Robert and Voigt-Antons, Jan?Niklas and Schuster, Johanna", title="Development of a Tablet-Based Outpatient Care Application for People With Dementia: Interview and Workshop Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="19", volume="11", pages="e59865", keywords="dementia", keywords="tablet application development", keywords="multidisciplinary health care", keywords="feasibility study", keywords="general practitioners", keywords="digital health care", abstract="Background: Dementia management presents a significant challenge for individuals affected by dementia, as well as their families, caregivers, and health care providers. Digital applications may support those living with dementia; however only a few dementia-friendly applications exist. Objective: This paper emphasizes the necessity of considering multiple perspectives to ensure the high-quality development of supportive health care applications. The findings underscore the importance of incorporating input from stakeholders and the needs of affected families into application development. Method: A qualitative approach was chosen, consisting of three interviews and an expert workshop. The interviews and the workshop were recorded and transcribed, and qualitative content analysis was carried out according to the methodology described by Kuckartz with the support of MAXQDA. Results: During the development phases of the application, team meetings and discussions took place. We found that general practitioners and family caregivers play pivotal roles in the treatment and care of people with dementia, often expressing specific preferences and suggestions regarding supportive and assistive technologies. Moreover, the successful development of a useful tablet application requires robust scientific and multidisciplinary discussions and teamwork within the health care community. Conclusion: This paper underscores the necessity of including multiple scientific, clinical, and technical perspectives to ensure the high-quality development of supportive health care applications. Furthermore, adopting a spiral development approach inclusive of feedback loops is imperative for iterative refinement and enhancement of the application. International Registered Report Identifier (IRRID): RR2-10.1024/1662-9647/a000210 ", doi="10.2196/59865", url="https://humanfactors.jmir.org/2024/1/e59865" } @Article{info:doi/10.2196/63041, author="Grewal, S. Karl and Gowda-Sookochoff, Rory and Peacock, Shelley and Cammer, Allison and McWilliams, A. Lachlan and Spiteri, J. Raymond and Haase, R. Kristen and Harrison, Mary and Holtslander, Lorraine and MacRae, Rhoda and Michael, Joanne and Green, Shoshana and O'Connell, E. Megan", title="Perspectives on Technology Use in the Context of Caregiving for Persons With Dementia: Qualitative Interview Study", journal="JMIR Form Res", year="2024", month="Dec", day="13", volume="8", pages="e63041", keywords="care partner", keywords="caregiving", keywords="dementia", keywords="technology", keywords="content analysis", keywords="mobile phone", keywords="technology adoption", keywords="assistive technology", keywords="support", abstract="Background: Examining ways to support persons with dementia and their caregivers to help minimize the disease's impact on individuals, families, and society is critical. One emerging avenue for support is technology (eg, smartphones and smart homes). Objective: Given the increasing presence of technology in caregiving, it is pertinent to appreciate whether and how technology can be most useful to a care partner's everyday life. This study aims to further understand care partner technology use, attitudes, and the potential role of off-the-shelf technologies (eg, smartphones and smart homes) in supporting caregiving from the perspective of care partners for persons with dementia. Methods: We conducted a telephone cross-sectional survey using random digit dialing with 67 self-identified care partners of persons with dementia across one Canadian province. Participants were asked about attitudes toward technology, barriers to and facilitators for technology use, technology use with caregiving, and demographic information. Eight open-ended questions were analyzed using content analysis; 2 closed-ended questions about comfort with and helpfulness of technology (rated on a scale of 1 to 10) were analyzed with frequencies. From these data, an in-depth semistructured interview was created, and 10 (15\%) randomly sampled care partners from the initial collection of 67 care partners were interviewed approximately 1 year later, with responses analyzed using content analysis. Results: Frequency analysis rated on a scale of 1 to 10 suggested that care partners were comfortable with technology (wearable technology mean 7.94, SD 2.02; smart home technology mean 6.94, SD 2.09), although they rated the helpfulness of technology less strongly (mean 5.02, SD 2.85). Qualitatively, care partners described using technology for functional tasks and some caregiving. Barriers to technology use included cost, lack of knowledge, security or privacy concerns, and undesirable features of technology. Facilitators included access to support and the presence of desirable features. Some care partners described merging technology with caregiving and reported subsequent benefits. Others stated that technology could not be adopted for caregiving due to the degree of impairment, fear of negative consequences for the person living with dementia, or due to incongruity with the caregiving philosophy. Furthermore, care partners noted that their technology use either increased or was unchanged as they moved through the COVID-19 pandemic. Conclusions: The 2 analyses were conducted separately, but there was notable overlap in the data, suggesting temporal stability of identified content. Both analyses suggested care partners' relative comfort with technology and its use, but other care partners noted concerns about integrating technology and caregiving. Care partners' reports of increased technology use throughout the COVID-19 pandemic may also suggest that the pandemic impacted their perceptions of the usefulness of technology, being influenced by the requirements of their reality. Future investigations should examine how to support care partners in adopting relevant technology. ", doi="10.2196/63041", url="https://formative.jmir.org/2024/1/e63041" } @Article{info:doi/10.2196/60155, author="Kwan, Cho Rick Yiu and Law, Sze Queenie Pui and Tsang, Yee Jenny Tsun and Lam, Hin Siu and Wang, To Kam and Sin, Kan Olive Shuk and Cheung, Ki Daphne Sze", title="The Effect of the Mediterranean Diet--Integrated Gamified Home-Based Cognitive-Nutritional (GAHOCON) Training Programme for Older People With Cognitive Frailty: Pilot Randomized Controlled Trial", journal="JMIR Rehabil Assist Technol", year="2024", month="Dec", day="13", volume="11", pages="e60155", keywords="cognitive frailty", keywords="gamification", keywords="health education", keywords="Mediterranean diet", keywords="home based", keywords="cognitive training", keywords="older adults", keywords="geriatric", keywords="elderly", keywords="cognitive function", keywords="intervention", keywords="nutritional education", keywords="cognitive impairment", keywords="dementia", abstract="Background: Cognitive frailty is known to be associated with both nutrition and cognitive training. However, effective treatments that engage older adults with cognitive frailty in both the Mediterranean diet and cognitive training are lacking. Objective: This study aims to examine the feasibility and preliminary effects of Gamified Home-Based Cognitive-Nutritional (GAHOCON) on older adults with cognitive frailty, focusing on Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Methods: This study applied a 2-center, assessor-blinded, 2-parallel-group, noninferiority, randomized controlled trial design. Eligible participants were community-dwelling adults aged 60 years or older, living with cognitive frailty, and exhibiting poor adherence to the Mediterranean diet. Participants were randomly assigned to the intervention or control group in a 1:1 ratio. In the intervention group, participants received 4 weeks of center-based training (health education) followed by 8 weeks of home-based training (GAHOCON). In the control group, participants received only the 4 weeks of center-based training and 8 weeks of self-revision of health educational materials at home. During the intervention period, time spent by the participants and the levels of difficulty completed by them weekly on GAHOCON were measured as markers of feasibility. The outcomes included Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Data were collected at baseline (T0) and 1 week postintervention (T1). The Wilcoxon signed rank test was used to examine within-group effects for the outcome variables in each group separately. Results: A total of 25 participants were recruited, with 13 allocated to the intervention group and 12 to the control group. The median cumulative minutes spent on GAHOCON training increased from 117 to 926 minutes. The median level of difficulty completed for game 1 increased from level 14 to level 20, while for game 2, it increased from level 2 to level 24. After the completion of the interventions, Mediterranean diet knowledge was retained in the intervention group but significantly decreased in the control group (r=--0.606, P=.04). Significant improvements were observed in the intervention group in Mediterranean diet adherence (r=--0.728, P=.009), cognitive function (r=--0.752, P=.007), physical frailty (r=--0.668, P=.02), and walking speed (r=--0.587, P=.03), but no such improvements were seen in the control group. Conclusions: GAHOCON is feasible in engaging older adults with cognitive frailty to regularly participate in the intervention. Preliminary evidence suggests that it can retain Mediterranean diet knowledge following nutritional education, improve adherence to the Mediterranean diet, and enhance global cognitive function, physical frailty, and walking speed. However, the difficulty of the later levels of game 1 may be too high. Future studies should adjust the difficulty level of game 1. Additionally, trials with larger sample sizes and longer follow-up periods are needed to confirm its effects. Trial Registration: ClinicalTrials.gov NCT05207930; https://clinicaltrials.gov/ct2/show/NCT05207930 ", doi="10.2196/60155", url="https://rehab.jmir.org/2024/1/e60155" } @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/10.2196/60650, author="Bosco, Cristina and Shojaei, Fereshtehossadat and Theisz, Andrew Alec and Osorio Torres, John and Cureton, Bianca and Himes, K. Anna and Jessup, M. Nenette and Barnes, A. Priscilla and Lu, Yvonne and Hendrie, C. Hugh and Hill, V. Carl and Shih, C. Patrick", title="Testing 3 Modalities (Voice Assistant, Chatbot, and Mobile App) to Assist Older African American and Black Adults in Seeking Information on Alzheimer Disease and Related Dementias: Wizard of Oz Usability Study", journal="JMIR Form Res", year="2024", month="Dec", day="9", volume="8", pages="e60650", keywords="older African American and Black adults", keywords="Alzheimer disease and related dementias", keywords="health literacy", keywords="Wizard of Oz", keywords="voice assistant", keywords="chatbot", keywords="mobile app", keywords="dementia", keywords="geriatric", keywords="aging", keywords="Alzheimer disease", keywords="artificial intelligence", keywords="AI", keywords="mHealth", keywords="digital tools", abstract="Background: Older African American and Black adults are twice as likely to develop Alzheimer disease and related dementias (ADRD) and have the lowest level of ADRD health literacy compared to any other ethnic group in the United States. Low health literacy concerning ADRD negatively impacts African American and Black people in accessing adequate health care. Objective: This study explored how 3 technological modalities---voice assistants, chatbots, and mobile apps---can assist older African American and Black adults in accessing ADRD information to improve ADRD health literacy. By testing each modality independently, the focus could be kept on understanding the unique needs and challenges of this population concerning the use of each modality when accessing ADRD-related information. Methods: Using the Wizard of Oz usability testing method, we assessed the 3 modalities with a sample of 15 older African American and Black adults aged >55 years. The 15 participants were asked to interact with the 3 modalities to search for information on local events happening in their geographical area and search for ADRD-related health information. Results: Our findings revealed that, across the 3 modalities, the content should avoid convoluted and complex language and give the possibility to save, store, and share it to be fully accessible by this population. In addition, content should come from credible sources, including information tailored to the participants' cultural values, as it has to be culturally relevant for African American and Black communities. Finally, the interaction with the tool must be time efficient, and it should be adapted to the user's needs to foster a sense of control and representation. Conclusions: We conclude that, when designing ADRD-related interventions for African American and Black older adults, it proves to be crucial to tailor the content provided by the technology to the community's values and construct an interaction with the technology that is built on African American and Black communities' needs and demands. ", doi="10.2196/60650", url="https://formative.jmir.org/2024/1/e60650" } @Article{info:doi/10.2196/59588, author="Gustafson Sr, H. David and Mares, Marie-Louise and Johnston, Darcie and Vjorn, J. Olivia and Curtin, J. John and Landucci, Gina and Pe-Romashko, Klaren and Gustafson Jr, H. David and Shah, V. Dhavan", title="An eHealth Intervention to Improve Quality of Life, Socioemotional, and Health-Related Measures Among Older Adults With Multiple Chronic Conditions: Randomized Controlled Trial", journal="JMIR Aging", year="2024", month="Dec", day="6", volume="7", pages="e59588", keywords="eHealth", keywords="telemedicine", keywords="aged", keywords="geriatrics", keywords="multiple chronic conditions", keywords="social support", keywords="quality of life", keywords="primary care", keywords="mobile phone", keywords="smartphone", abstract="Background: In the United States, over 60\% of adults aged 65 years or older have multiple chronic health conditions, with consequences that include reduced quality of life, increasingly complex but less person-centered treatment, and higher health care costs. A previous trial of ElderTree, an eHealth intervention for older adults, found socioemotional benefits for those with high rates of primary care use. Objective: This study tested the effectiveness of an ElderTree intervention designed specifically for older patients with multiple chronic conditions to determine whether combining it with primary care improved socioemotional and physical outcomes. Methods: In a nonblinded randomized controlled trial, 346 participants recruited from primary care clinics were assigned 1:1 to the ElderTree intervention or an attention control and were followed for 12 months. All participants were aged 65 years or older and had electronic health record diagnoses of at least three of 11 chronic conditions. Primary outcomes were mental and physical quality of life, psychological well-being (feelings of competence, connectedness, meaningfulness, and optimism), and loneliness. Tested mediators of the effects of the study arm (ElderTree vs active control) on changes in primary outcomes over time were 6-month changes in health coping, motivation, feelings of relatedness, depression, and anxiety. Tested moderators were sex, scheduled health care use, and number of chronic conditions. Data sources were surveys at baseline and 6 and 12 months comprising validated scales, and continuously collected ElderTree usage. Results: At 12 months, 76.1\% (134/176) of ElderTree participants were still using the intervention. There was a significant effect of ElderTree (vs control) on improvements over 12 months in mental quality of life (arm {\texttimes} timepoint interaction: b=0.76, 95\% CI 0.14-1.37; P=.02; 12-month ?d=0.15) but no such effect on the other primary outcomes of physical quality of life, psychological well-being, or loneliness. Sex moderated the effects of the study arm over time on mental quality of life (b=1.33, 95\% CI 0.09-2.58; P=.04) and psychological well-being (b=1.13, 95\% CI 0.13-2.12; P=.03), with stronger effects for women than men. The effect of the study arm on mental quality of life was mediated by 6-month improvements in relatedness ($\alpha$=1.25, P=.04; b=0.31, P<.001). Analyses of secondary and exploratory outcomes showed minimal effects of ElderTree. Conclusions: Consistent with the previous iteration of ElderTree, the current iteration designed for older patients with multiple chronic conditions showed signs of improving socioemotional outcomes but no impact on physical outcomes. This may reflect the choice of chronic conditions for inclusion, which need not have impinged on patients' physical quality of life. Two ongoing trials are testing more specific versions of ElderTree targeting older patients coping with (1) chronic pain and (2) greater debilitation owing to at least 5 chronic conditions. Trial Registration: ClinicalTrials.gov NCT03387735; https://clinicaltrials.gov/study/NCT03387735 International Registered Report Identifier (IRRID): RR2-10.2196/25175 ", doi="10.2196/59588", url="https://aging.jmir.org/2024/1/e59588" } @Article{info:doi/10.2196/57320, 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/10.2196/59974, author="Hackett, Katherine and Xu, Shiyun and McKniff, Moira and Paglia, Lido and Barnett, Ian and Giovannetti, Tania", title="Mobility-Based Smartphone Digital Phenotypes for Unobtrusively Capturing Everyday Cognition, Mood, and Community Life-Space in Older Adults: Feasibility, Acceptability, and Preliminary Validity Study", journal="JMIR Hum Factors", year="2024", month="Nov", day="22", volume="11", pages="e59974", keywords="digital phenotyping", keywords="digital biomarkers", keywords="monitoring", keywords="mHealth", keywords="cognition", keywords="mobility", keywords="life space", keywords="depression", keywords="location data", keywords="Alzheimer disease", keywords="aging", keywords="mobile phone", abstract="Background: Current methods of monitoring cognition in older adults are insufficient to address the growing burden of Alzheimer disease and related dementias (AD/ADRD). New approaches that are sensitive, scalable, objective, and reflective of meaningful functional outcomes are direly needed. Mobility trajectories and geospatial life space patterns reflect many aspects of cognitive and functional integrity and may be useful proxies of age-related cognitive decline. Objective: We investigated the feasibility, acceptability, and preliminary validity of a 1-month smartphone digital phenotyping protocol to infer everyday cognition, function, and mood in older adults from passively obtained GPS data. We also sought to clarify intrinsic and extrinsic factors associated with mobility phenotypes for consideration in future studies. Methods: Overall, 37 adults aged between 63 and 85 years with healthy cognition (n=31, 84\%), mild cognitive impairment (n=5, 13\%), and mild dementia (n=1, 3\%) used an open-source smartphone app (mindLAMP) to unobtrusively capture GPS trajectories for 4 weeks. GPS data were processed into interpretable features across categories of activity, inactivity, routine, and location diversity. Monthly average and day-to-day intraindividual variability (IIV) metrics were calculated for each feature to test a priori hypotheses from a neuropsychological framework. Validation measures collected at baseline were compared against monthly GPS features to examine construct validity. Feasibility and acceptability outcomes included retention, comprehension of study procedures, technical difficulties, and satisfaction ratings at debriefing. Results: All (37/37, 100\%) participants completed the 4-week monitoring period without major technical adverse events, 100\% (37/37) reported satisfaction with the explanation of study procedures, and 97\% (36/37) reported no feelings of discomfort. Participants' scores on the comprehension of consent quiz were 97\% on average and associated with education and race. Technical issues requiring troubleshooting were infrequent, though 41\% (15/37) reported battery drain. Moderate to strong correlations (r?0.3) were identified between GPS features and validators. Specifically, individuals with greater activity and more location diversity demonstrated better cognition, less functional impairment, less depression, more community participation, and more geospatial life space on objective and subjective validation measures. Contrary to predictions, greater IIV and less routine in mobility habits were also associated with positive outcomes. Many demographic and technology-related factors were not associated with GPS features; however, income, being a native English speaker, season of study participation, and occupational status were related to GPS features. Conclusions: Theoretically informed digital phenotypes of mobility are feasibly captured from older adults' personal smartphones and relate to clinically meaningful measures including cognitive test performance, reported functional decline, mood, and community activity. Future studies should consider the impact of intrinsic and extrinsic factors when interpreting mobility phenotypes. Overall, smartphone digital phenotyping is a promising method to unobtrusively capture relevant risk and resilience factors in the context of aging and AD/ADRD and should continue to be investigated in large, diverse samples. ", doi="10.2196/59974", url="https://humanfactors.jmir.org/2024/1/e59974" } @Article{info:doi/10.2196/58517, author="Zou, Ning and Xie, Bo and He, Daqing and Hilsabeck, Robin and Aguirre, Alyssa", title="mHealth Apps for Dementia Caregivers: Systematic Examination of Mobile Apps", journal="JMIR Aging", year="2024", month="Nov", day="20", volume="7", pages="e58517", keywords="dementia", keywords="informal care", keywords="mobile health applications", keywords="tailoring", keywords="information quality", keywords="mobile phone", abstract="Background: Informal caregivers of persons living with dementia are increasingly using mobile health (mHealth) apps to obtain care information. mHealth apps are seen as promising tools to better support caregivers' complex and evolving information needs. Yet, little is known about the types and quality of dementia care information that these apps provide. Is this information for caregivers individually tailored; if so, how? Objective: We aim to address the aforementioned gaps in the literature by systematically examining the types and quality of care-related information provided in publicly available apps for caregivers of persons living with dementia as well as app features used to tailor information to caregivers' information wants and situations. Methods: In September 2023, we used a multistage process to select mobile apps for caregivers of persons living with dementia. The final sample included 35 apps. We assessed (1) types of dementia care information provided in the apps, using our 3-item Alzheimer disease and related dementias daily care strategy framework, which encompasses educational information, tangible actions, and referral information; (2) quality of apps' care information, using the 11 indicators recommended by the National Library of Medicine; and (3) types of tailoring to provide personalization, feedback, and content matching, which are common tailoring strategies described in the literature. Results: Educational information was the most prevalent type of information provided (29/35 apps, 83\%), followed by information about tangible actions (18/35, 51\%) and referrals (14/35, 40\%). All apps presented their objectives clearly and avoided unrealistic or emotional claims. However, few provided information to explain whether the app's content was generated or reviewed by experts (7/35, 20\%) or how its content was selected (4/35, 11\%). Further, 6 of the 35 (17\%) apps implemented 1 type of tailoring; of them, 4 (11\%) used content matching and the other 2 (6\%) used personalization. No app used 2 types of tailoring; only 2 (6\%) used all 3 types (the third is feedback). Conclusions: Existing dementia care apps do not provide sufficient high-quality, tailored information for informal caregivers. Caregivers should exercise caution when they use dementia care apps for informational support. Future research should focus on designing dementia care apps that incorporate quality-assured, transparency-enhanced, evidence-based artificial intelligence--enabled mHealth solutions for caregivers. ", doi="10.2196/58517", url="https://aging.jmir.org/2024/1/e58517" } @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/10.2196/52435, 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/10.2196/13723, author="de Vette, Frederiek and Ruiz-Rodriguez, Aurora and Tabak, Monique and Oude Nijeweme-d'Hollosy, Wendy and Hermens, Hermie and Vollenbroek-Hutten, Miriam", title="Developing Game-Based Design for eHealth in Practice: 4-Phase Game Design Process", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e13723", keywords="game based", keywords="gamification", keywords="game", keywords="eHealth", keywords="telemedicine", keywords="development", keywords="design", keywords="engagement", keywords="game preferences", keywords="older adults", keywords="self-management", keywords="prototyping", keywords="evaluations", keywords="creative", abstract="Background: Games are increasingly used in eHealth as a strategy for user engagement. There is an enormous diversity of end users and objectives targeted by eHealth. Hence, identifying game content that drives and sustains engagement is challenging. More openness in the game design process and motivational strategies could aid researchers and designers of future game-based apps. Objective: This study aims to provide insights into our approach to develop game-based eHealth in practice with a case study (Personalised ICT Supported Services for Independent Living and Active Ageing [PERSSILAA]). PERSSILAA is a self-management platform that aims to counter frailty by offering training modules to older adults in the domains of healthy nutrition and physical and cognitive training to maintain a healthy lifestyle. We elaborate on the entire game design process and show the motivational strategies applied. Methods: We introduce four game design phases in the process toward game-based eHealth: (1) end-user research, (2) conceptualization, (3) creative design, and (4) refinement (ie, prototyping and evaluations). Results: First, 168 participants participated in end-user research, resulting in an overview of their preferences for game content and a set of game design recommendations. We found that conventional games popular among older adults do not necessarily translate well into engaging concepts for eHealth. Recommendations include focusing game concepts on thinking, problem-solving, variation, discovery, and achievement and using high-quality aesthetics. Second, stakeholder sessions with development partners resulted in strategies for long-term engagement using indicators of user performance on the platform's training modules. These performance indicators, for example, completed training sessions or exercises, form the basis for game progression. Third, results from prior phases were used in creative design to create the game ``Stranded!'' The user plays a person who is shipwrecked who must gather parts for a life raft by completing in-game objectives. Finally, iterative prototyping resulted in the final prototype of the game-based app. A total of 35 older adults participated using simulated training modules. End users scored appreciation (74/100), ease of use (73/100), expected effectivity and motivation (62/100), fun and pleasantness of using the app (75/100), and intended future use (66/100), which implies that the app is ready for use by a larger population. Conclusions: The study resulted in a game-based app for which the entire game design process within eHealth was transparently documented and where engagement strategies were based on extensive user research. Our user evaluations indicate that the strategies for long-term engagement led to game content that was perceived as engaging by older adults. As a next step, research is needed on the user experience and actual engagement with the game to support the self-management of older adults, followed by clinical studies on its added value. ", doi="10.2196/13723", url="https://formative.jmir.org/2024/1/e13723" } @Article{info:doi/10.2196/53156, author="Kershner, Kyle and Morton, David and Robison, Justin and N'dah, Williams Kindia and Fanning, Jason", title="Assessing the Feasibility and Acceptability of Virtual Reality for Remote Group-Mediated Physical Activity in Older Adults: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e53156", keywords="virtual reality", keywords="physical activity", keywords="videoconference", keywords="social connection", keywords="remote meeting", keywords="gerontology", keywords="physical inactivity", keywords="at-home intervention", keywords="descriptive statistics", keywords="eHealth", keywords="comorbidity", keywords="cybersickness", abstract="Background: Physical inactivity represents a major health concern for older adults. Most social, at-home physical activity (PA) interventions use videoconference, email, or telephone communication for program delivery. However, evidence suggests that these platforms may hinder the social connection experienced by users. Recent advancements in virtual reality (VR) suggest that it may be a rich platform for social, at-home interventions because it offers legitimate options for intervention delivery and PA. Objective: This pilot study aims to determine the feasibility and acceptability of VR compared to videoconference as a medium for remote group-mediated behavioral intervention for older adults. The information generated from this investigation will inform the use of VR as a medium for intervention delivery. Methods: Nine low-active older adults (mean age 66.8, SD 4.8 y) were randomized to a 4-week home-based, group-mediated PA intervention delivered via VR or videoconference. Feasibility (ie, the total number of sessions attended and the number of VR accesses outside of scheduled meetings) and acceptability (ie, the number of participants reporting high levels of nausea, program evaluations using Likert-style prompts with responses ranging from --5=very difficult or disconnected to 5=very easy or connected, and participant feedback on immersion and social connection) are illustrated via descriptive statistics and quotes from open-ended responses. Results: None of the participants experienced severe VR-related sickness before randomization, with a low average sickness rating of 1.6 (SD 1.6) out of 27 points. Attendance rates for group meetings were 98\% (59/60) and 96\% (46/48) for the VR and videoconference groups, respectively. Outside of scheduled meeting times, participants reported a median of 5.5 (IQR 5.3-5.8, range 0-27) VR accesses throughout the entire intervention. Program evaluations suggested that participants felt personally connected to their peers (VR group: median 3.0, IQR 2.5-3.5; videoconference group: median 3.0, IQR 2.7-3.3), found that goals were easy to accomplish (VR group: median 3.0, IQR 2.8-3.3; videoconference group: median 3.0, IQR 2.6-3.4), and had ease in finding PA options (VR group: median 4.0, IQR 3.5-4.3; videoconference group: median 2.0, IQR 1.6-2.4) and engaging in meaningful dialogue with peers (VR group: median 4.0, IQR 4.0-4.0; videoconference group: median 3.5, IQR 3.3-3.8). Open-ended responses regarding VR use indicated increased immersion experiences and intrinsic motivation for PA. Conclusions: These findings suggest that VR may be a useful medium for social PA programming in older adults, given it was found to be feasible and acceptable in this sample. Importantly, all participants indicated low levels of VR-related sickness before randomization, and both groups demonstrated very high attendance at meetings with their groups and behavioral coaches, which is promising for using VR and videoconference in future interventions. Modifications for future iterations of similar interventions are provided. Further work using larger samples and longer follow-up durations is needed. Trial Registration: ClinicalTrials.gov NCT04756245; https://www.clinicaltrials.gov/study/NCT04756245 ", doi="10.2196/53156", url="https://formative.jmir.org/2024/1/e53156" } @Article{info:doi/10.2196/57289, author="B{\'a}ez Guti{\'e}rrez, Nerea and Rodr{\'i}guez Ramallo, H{\'e}ctor and Mendoza-Zambrano, Mar{\'i}a Elva and Brown Arreola, Berenice and Santos Ramos, Bernardo and Abdel-kader Mart{\'i}n, Laila and Otero Candelera, Remedios", title="Smartphone Apps for Pulmonary Hypertension: Systematic Search and Content Evaluation", journal="JMIR Mhealth Uhealth", year="2024", month="Oct", day="30", volume="12", pages="e57289", keywords="pulmonary hypertension", keywords="mobile apps", keywords="smartphone", keywords="eHealth", keywords="mHealth", keywords="app", keywords="hypertension", keywords="chronic condition", keywords="mobile health app", keywords="monitoring", keywords="systematic search", keywords="app development", keywords="clinical validation", keywords="evaluation", keywords="pulmonary", abstract="Background: Pulmonary hypertension (PH) is a chronic and complex condition, requiring consistent management and education. The widespread use of smartphones has opened possibilities for mobile health apps to support both patients and health care professionals in monitoring and managing PH more effectively. Objective: This study aimed to identify and assess the quality of free smartphone apps for PH targeted at either patients or health care professionals. Methods: A systematic search was conducted on freely available apps for patients with PH and health care professionals, accessed from a Spanish IP address, on Android (Google Play) and iOS (App Store) platforms. Searches were performed in October 2022 and 2023. Apps were independently analyzed by two reviewers, focusing on general characteristics. Quality assessment was based on the Mobile Application Rating Scale (MARS) framework, and Mann-Whitney U tests compared mean MARS scores against specific variables. Results: In the overall study, 21 apps were identified. In the 2022 search, 19 apps were listed (9 iOS, 7 Android, 3 available on both platforms). In the subsequent 2023 search, 16 apps were identified (6 Android, 7 iOS, 3 available on both platforms). Of those identified in 2022, 14 remained available in 2023, with only 7 updated since 2022. In addition, 12 apps targeted patients or the general population, while 9 targeted health care professionals; none involved patients in the development or design. Conversely, 13 apps involving health care professionals were identified. There were 10 apps that received pharmaceutical industry funding. The primary goal for 81\% (17/21) of the apps was to disseminate general information about PH. The overall mean MARS quality was acceptable in 2022 and 2023, with mean ratings of 3.1 (SD 0.6) and 3.3 (SD 0.5), respectively. The functionality category achieved the highest scores in both years, indicating ease of use and intuitive navigation. In contrast, the subjective quality domain consistently received the lowest ratings in the MARS assessment across both years. None of the apps underwent clinical testing themselves; however, 2 incorporated tools or algorithms derived from trials. The overall quality of iOS apps statistically outperformed that of Android apps in both years (P<.05). Furthermore, the involvement of health care professionals in app development was associated with enhanced quality, a trend observed in both years (P=.003 for both years). Conclusions: This review of mobile health apps for PH reveals their emergent development stage, with generally acceptable quality but lacking refinement. It highlights the critical role of health care professionals in app development, as they contribute significantly to quality and reliability. Despite this, a notable stagnation in app quality and functionality improvement over 2 years points to a need for continuous innovation and clinical validation for effective clinical integration. This research advocates for future app developers to actively engage with health care professionals, integrate patient insights, and mandate rigorous clinical validation for PH management. ", doi="10.2196/57289", url="https://mhealth.jmir.org/2024/1/e57289" } @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/10.2196/64525, author="Zhu, Di and Al Mahmud, Abdullah and Liu, Wei and Wang, Dahua", title="Digital Storytelling for People With Cognitive Impairment Using Available Mobile Apps: Systematic Search in App Stores and Content Analysis", journal="JMIR Aging", year="2024", month="Oct", day="24", volume="7", pages="e64525", keywords="mobile apps", keywords="digital storytelling", keywords="older adults", keywords="mobile phone", keywords="cognitive impairment", abstract="Background: Growing evidence suggests cognitive and social health benefits can be derived from digital storytelling for older adults with cognitive impairment. Digital storytelling apps offer the potential to serve as an on-demand, easy-to-access platform for enhancing cognitive abilities and promoting social well-being. Yet, despite the increasing quantity of such apps being available on the market, there is a gap in research investigating their quality. Objective: This app review aims to assess the digital storytelling apps available in the Chinese market and evaluate them in accordance with the Mobile Application Rating Scale (MARS). The goal was to identify key features and evaluate the overall quality in the context of cognitively impaired users. Methods: A systematic search was conducted in both the Google Play store (Google LLC) and iTunes store (Apple Inc), using English and Chinese keywords. Apps were chosen according to specific criteria that included features, including (but not limited to) memory capture, story saving, cue-based reminiscing, and the ability to share stories or memories with others. The MARS was used by 3 individual researchers to independently assess app quality across several domains, such as engagement, functionality, aesthetics, and information quality, for both Android and iOS apps. Results: From an initial screening of 297 apps, only 9 (3\%) met the criteria for detailed evaluation using MARS. The reviewed apps featured capture memory, save, reminisce, and share functions, which are critical in supporting cognitive functions and enhancing user engagement. The analysis revealed patterns in platform diversity and geographical distribution of developers, with apps available on both iOS and Android. Memoirs of Life and Memorize: Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile) had the highest mean MARS scores of 3.35, indicating strong engagement, functionality, and information quality, while the lowest score was 2.33. The overall mean score across all apps was only 3.03 (SD 0.60), highlighting significant variation, particularly in information quality. User feedback also showed considerable variability, ranging from 0 comments for apps such as Grand Storyteller (VarIT Inc) and PWI Storyteller (Project World Impact, LLC) to as many as 5361 comments for FamilySearch, which received extensive positive reviews. This wide range of user feedback underscores the importance of continuous improvement and user-centered design, particularly in enhancing information quality and content accuracy. Conclusions: The systematic search and evaluation highlight the diverse capabilities yet variable quality of digital storytelling apps available within the Chinese market, reflecting user experiences, satisfaction levels, and efficacy in supporting cognitively impaired users. While some apps excel in engagement and functionality, others need significant improvements in information quality and user interface design to better serve those with cognitive impairments. Future research is recommended to investigate regional limitations and features that would result in more inclusive and effective digital storytelling apps. ", doi="10.2196/64525", url="https://aging.jmir.org/2024/1/e64525", url="http://www.ncbi.nlm.nih.gov/pubmed/39446478" } @Article{info:doi/10.2196/58312, author="Vald{\'e}s-Aragon{\'e}s, Myriam and P{\'e}rez-Rodr{\'i}guez, Rodrigo and Carnicero, Antonio Jos{\'e} and Moreno-S{\'a}nchez, A. Pedro and Oviedo-Briones, Myriam and Villalba-Mora, Elena and Abizanda-Soler, Pedro and Rodr{\'i}guez-Ma{\~n}as, Leocadio", title="Effects of Monitoring Frailty Through a Mobile/Web-Based Application and a Sensor Kit to Prevent Functional Decline in Frail and Prefrail Older Adults: FACET (Frailty Care and Well Function) Pilot Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Oct", day="22", volume="26", pages="e58312", keywords="frailty", keywords="functional status", keywords="older adults", keywords="new technologies", keywords="sensor", keywords="monitoring system", keywords="information and communication technologies", keywords="mobile app", keywords="sensor kit", keywords="sensors", keywords="technological ecosystem", keywords="clinical intervention", abstract="Background: Frailty represents a state of susceptibility to stressors and constitutes a dynamic process. Untreated, this state can progress to disability. Hence, timely detection of alterations in patients' frailty status is imperative to institute prompt clinical interventions and impede frailty progression. With this aim, the FACET (Frailty Care and Well Function) technological ecosystem was developed to provide clinically gathered data from the home to a medical team for early intervention. Objective: The aim of this study was to assess whether the FACET technological ecosystem prevents frailty progression and improves frailty status, according to the frailty phenotype criteria and Frailty Trait Scale-5 items (FTS-5) at 3 and 6 months of follow-up. Methods: This randomized clinical trial involved 90 older adults aged ?70 years meeting 2 or more Fried frailty phenotype criteria, having 4 or more comorbidities, and having supervision at home. This study was conducted between August 2018 and June 2019 at the geriatrics outpatient clinics in Getafe University Hospital and Albacete University Hospital. Participants were randomized into a control group receiving standard treatment and the intervention group receiving standard treatment along with the FACET home monitoring system. The system monitored functional tests at home (gait speed, chair stand test, frailty status, and weight). Outcomes were assessed using multivariate linear regression models for continuous response and multivariate logistic models for dichotomous response. P values less than .05 were considered statistically significant. Results: The mean age of the participants was 82.33 years, with 28\% (25/90) being males. Participants allocated to the intervention group showed a 74\% reduction in the risk of deterioration in the FTS-5 score (P=.04) and 92\% lower likelihood of worsening by 1 point according to Fried frailty phenotype criteria compared to the control group (P=.02) at 6 months of follow-up. Frailty status, when assessed through FTS-5, improved in the intervention group at 3 months (P=.004) and 6 months (P=.047), while when the frailty phenotype criteria were used, benefits were shown at 3 months of follow-up (P=.03) but not at 6 months. Conclusions: The FACET technological ecosystem helps in the early identification of changes in the functional status of prefrail and frail older adults, facilitating prompt clinical interventions, thereby improving health outcomes in terms of frailty and functional status and potentially preventing disability and dependency. Trial Registration: ClinicalTrials.gov NCT03707145; https://clinicaltrials.gov/study/NCT03707145 ", doi="10.2196/58312", url="https://www.jmir.org/2024/1/e58312", url="http://www.ncbi.nlm.nih.gov/pubmed/39436684" } @Article{info:doi/10.2196/54736, author="Pani, Jasmine and Lorusso, Letizia and Toccafondi, Lara and D'Onofrio, Grazia and Ciccone, Filomena and Russo, Sergio and Giuliani, Francesco and Sancarlo, Daniele and Calamida, Novella and Vignani, Gianna and Pihl, Tarmo and Rovini, Erika and Cavallo, Filippo and Fiorini, Laura", title="How Time, Living Situation, and Stress Related to Technology Influence User Acceptance and Usability of a Socialization Service for Older Adults and Their Formal and Informal Caregivers: Six-Month Pilot Study", journal="JMIR Aging", year="2024", month="Oct", day="9", volume="7", pages="e54736", keywords="active aging", keywords="longitudinal study", keywords="technostress", keywords="technology usability and acceptance", keywords="scaling up", abstract="Background: Considering the growing population of older adults, addressing the influence of loneliness among this demographic group has become imperative, especially due to the link between social isolation and deterioration of mental and physical well-being. Technology has the potential to be used to create innovative solutions to increase socialization and potentially promote healthy aging. Objective: This 6-month study examined the usability and acceptability of a technology-based socialization service and explored how stress and living situation affect older adults' and their ecosystem's perceptions of technology, investigating cross-sectional and longitudinal differences among and across user groups. Methods: Participants were recruited in Tuscany and Apulia (Italy) through a network of social cooperatives and a research hospital, respectively. A total of 20 older adults were provided with the same technology installed on a tablet and on a smart television. The technology has three functionalities: video calling, playing games, and sharing news. Additionally, 20 informal caregivers (IC) and 13 formal caregivers (FC) connected to the older adults were included in the study. After both initial training in the use of the system (T0) and 6 months of using the system (T6), questionnaires on usability, acceptability, and technostress were filled in by older adults, IC, and FC. Nonparametric or parametric tests were conducted to investigate group differences at both time points and changes over time. Additional analyses on older adults were done to assess whether differences in usability and acceptability were related to living situation (ie, alone or with someone). Furthermore, correlation analyses were performed between usability, acceptability, and stress toward technology at T0 and T6. Results: At both T0 and T6, older adults had lower usability scores than IC and FC and higher anxiety than IC. Over time, there was a significant decrease in older adults' attitudes toward technology score, depicting a negative attitude over time (T0 median 4.2, IQR 0.5; T6 median 3.7, IQR 0.8; Cohen d=0.7), while there was no change for IC and FC. At T0, those living alone had lower acceptability than those living with someone but this difference disappeared at T6. People or participants living with someone had a decline in anxiety, attitudes toward technology, enjoyment, and perceived usefulness. Stress toward technology affected usability and acceptability in the older adult group entering the study ($\rho$=?.85) but this was not observed after 6 months. In the IC group, stress affected trust at T0 ($\rho$=?.23) but not at T6. Conclusions: At the start of the study, older adults judged the system to be less usable and more stressful than did the caregivers. Indeed, at first, technostress was correlated with usability and acceptability; however, with repeated use, technostress did not influence the perception of technology. Overall, getting accustomed to technology decreased anxiety and stress toward technology. ", doi="10.2196/54736", url="https://aging.jmir.org/2024/1/e54736" } @Article{info:doi/10.2196/56547, author="Ikuta, Kasumi and Aishima, Miya and Noguchi-Watanabe, Maiko and Fukui, Sakiko", title="Feasibility of Monitoring Heart and Respiratory Rates Using Nonwearable Devices and Consistency of the Measured Parameters: Pilot Feasibility Study", journal="JMIR Hum Factors", year="2024", month="Oct", day="8", volume="11", pages="e56547", keywords="heart rate", keywords="older adults", keywords="respiratory rate", keywords="nonwearable devices", keywords="vital signs", abstract="Background: As Japan is the world's fastest-aging society with a declining population, it is challenging to secure human resources for care providers. Therefore, the Japanese government is promoting digital transformation and the use of nursing care equipment, including nonwearable devices that monitor heart and respiratory rates. However, the feasibility of monitoring heart and respiratory rates with nonwearable devices and the consistency of the rates measured have not been reported. Objective: In this study, we focused on a sheet-type nonwearable device (Safety Sheep Sensor) introduced in many nursing homes. We evaluated the feasibility of monitoring heart rate (HR) and respiratory rate (RR) continuously using nonwearable devices and the consistency of the HR and RR measured. Methods: A sheet-type nonwearable device that measured HR and RR every minute through body vibrations was placed under the mattress of each participant. The participants in study 1 were healthy individuals aged 20?60 years (n=21), while those in study 2 were older adults living in multidwelling houses and required nursing care (n=20). The HR was measured using standard methods by the nurse and using the wearable device (Silmee Bar-type Lite sensor), and RR was measured by the nurse. The primary outcome was the mean difference in HR and RR between nonwearable devices and standard methods. Results: The mean difference in HR was ?0.32 (SD 3.12) in study 1 and 0.04 (SD: 3.98) in study 2; both the differences were within the predefined accepted discrepancies (<5 beats/min). The mean difference in RR was ?0.98 (SD 3.01) in study 1 and ?0.49 (SD 2.40) in study 2; both the differences were within the predefined accepted discrepancies (3 breaths/min). Conclusions: HR and RR measurements obtained using the nonwearable devices and the standard method were similar. Continuous monitoring of vital signs using nonwearable devices can aid in the early detection of abnormal conditions in older people. ", doi="10.2196/56547", url="https://humanfactors.jmir.org/2024/1/e56547" } @Article{info:doi/10.2196/64196, author="Kawaguchi, Kenjiro and Nakagomi, Atsushi and Ide, Kazushige and Kondo, Katsunori", title="Effects of a Mobile App to Promote Social Participation on Older Adults: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Sep", day="30", volume="26", pages="e64196", keywords="gerontology", keywords="geriatrics", keywords="older adults", keywords="elderly", keywords="older people", keywords="community dwelling older adult", keywords="aging", keywords="social participation", keywords="walking", keywords="mHealth", keywords="apps", keywords="smartphone", keywords="digital health", keywords="digital technology", keywords="digital interventions", keywords="physical activity", keywords="exercise", abstract="Background: Social participation is crucial for healthy aging, improving physical and mental health, cognitive function, and quality of life among older adults. However, social participation tends to decline with age due to factors like loss of social networks and health issues. Mobile health apps show promise in promoting healthy behaviors among older adults, but their effectiveness in increasing social participation remains understudied. Objective: This randomized controlled trial aimed to evaluate the efficacy of a mobile app called Encouragement of Social Participation (ESP, ``Shakai Sanka no Susume;'' Hitachi) in promoting social participation and physical activity among community-dwelling older adults. Methods: The study recruited 181 community-dwelling adults aged 60 years or older from 2 municipalities in Japan and through a web-based research panel. Participants were randomly assigned to either the intervention group (n=87), which used the ESP app for 12 weeks, or the control group (n=94), which used only Google Fit. The ESP app incorporated features such as self-monitoring of social participation, personalized feedback, gamification elements, and educational content. Primary outcomes were changes in social participation frequency over the previous 2 months and changes in step counts, measured at baseline and week 12. Secondary outcomes included changes in specific types of social activities and subjective well-being. Data were analyzed using analysis of covariance and linear mixed-effects models. Results: The intervention group showed a significantly greater increase in social participation frequency compared with the control group (adjusted difference 3.03; 95\% CI 0.17-5.90; P=.04). Specifically, the intervention group demonstrated higher frequencies of participation in hobbies (adjusted difference: 0.82; 95\% CI 0.01-1.63) and cultural clubs (adjusted difference 0.65; 95\% CI 0.07-1.23) compared with the control group. However, there were no significant differences in weekly step counts between the groups. Subgroup analyses suggested potentially larger effects among participants who were older than 70 years, female, had lower educational attainment, and were recruited from community settings, although only females and the lower educational attainment subgroups demonstrated 95\% CIs that did not encompass zero. Conclusions: The ESP mobile app effectively promoted social participation among community-dwelling older adults, particularly in hobbies and cultural club activities. However, it did not significantly impact physical activity levels as measured by step counts. These findings suggest that mobile apps can be valuable tools for encouraging social engagement in older populations, potentially contributing to healthy aging. Future research should focus on optimizing app features to maintain long-term engagement and exploring strategies to enhance physical activity alongside social participation. Trial Registration: University Medical Information Network Clinical Trial Registry UMIN000049045; https://center6.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000055781 ", doi="10.2196/64196", url="https://www.jmir.org/2024/1/e64196", url="http://www.ncbi.nlm.nih.gov/pubmed/39348180" } @Article{info:doi/10.2196/59900, author="Spijker, A. Jeroen J. and Barl?n, Hande and Grad, Alecsandra Diana and Gu, Yang and Klavina, Aija and Korkmaz Yaylagul, Nilufer and Kulla, Gunilla and Orhun, Eda and {\vS}ev{\v c}{\'i}kov{\'a}, Anna and Unim, Brigid and Tofan, Maria Cristina", title="The Impact of Digital Technology on the Physical Health of Older Workers: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Sep", day="26", volume="13", pages="e59900", keywords="digital tools", keywords="digital technology", keywords="digitalization", keywords="physical health", keywords="mobility", keywords="vision loss", keywords="musculoskeletal disorders", keywords="migraine", keywords="older workers", keywords="older population", keywords="aging", keywords="scoping review", keywords="mobile phone", abstract="Background: Digital technologies have penetrated most workplaces. However, it is unclear how such digital technologies affect the physical health of older workers. Objective: This scoping review aims to examine and summarize the evidence from scientific literature concerning the impact of digital technology on the physical health of older workers. Methods: This scoping review will be conducted following recommendations outlined by Levac et al and will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines for reporting. Peer-reviewed papers written in English will be searched in the following databases: MEDLINE, Cochrane, ProQuest, Web of Science, Scopus, APA PsycInfo, and ERIH PLUS. The web-based systematic review platform Covidence will be used to create a data extraction template. It will cover the following items: study and participant characteristics, health measures, digital tool characteristics and usage, and research findings. Following the Population, Concept, and Context (PCC) framework, our review will focus on studies involving older workers aged 50 years or older, any form of digital technology (including teleworking and the use of digital tools at work), and how digital technologies affect physical health (such as vision loss, musculoskeletal disorders, and migraines). Studies that focus only on mental health will be excluded. Study selection based on title and abstract screening (first stage), full-text review (second stage), and data extraction (third stage) will be performed by a group of researchers, whereby each paper will be reviewed by at least 2 people. Any conflict regarding the inclusion or exclusion of a study and the data extraction will be resolved by discussion between the researchers who evaluated the papers; a third researcher will be involved if consensus is not reached. Results: A preliminary search of MEDLINE, Epistemonikos, Cochrane, PROSPERO, and JBI Evidence Synthesis was conducted, and no current or ongoing systematic reviews or scoping reviews on the topic were identified. The results of the study are expected in April 2025. Conclusions: Our scoping review will seek to provide an overview of the available evidence and identify research gaps regarding the effect of digital technology and the use of digital tools in the work environment on the physical health of older workers. International Registered Report Identifier (IRRID): PRR1-10.2196/59900 ", doi="10.2196/59900", url="https://www.researchprotocols.org/2024/1/e59900", url="http://www.ncbi.nlm.nih.gov/pubmed/39325529" } @Article{info:doi/10.2196/41093, author="Yoo, In-jin and Park, Do-Hyung and Lee, EunKyoung Othelia and Park, Albert", title="Investigating Older Adults' Use of a Socially Assistive Robot via Time Series Clustering and User Profiling: Descriptive Analysis Study", journal="JMIR Form Res", year="2024", month="Sep", day="19", volume="8", pages="e41093", keywords="socially assistive robot", keywords="older adults", keywords="robot use pattern", keywords="time series clustering", keywords="profiling analysis", abstract="Background: The aging population and the shortage of geriatric care workers are major global concerns. Socially assistive robots (SARs) have the potential to address these issues, but developing SARs for various types of users is still in its infancy. Objective: This study aims to examine the characteristics and use patterns of SARs. Methods: This study analyzed log data from 64 older adults who used a SAR called Hyodol for 60 days to understand use patterns and their relationship with user characteristics. Data on user interactions, robot-assisted content use, demographics, physical and mental health, and lifestyle were collected. Time series clustering was used to group users based on use patterns, followed by profiling analysis to relate these patterns to user characteristics. Results: Overall, 4 time series clusters were created based on use patterns: helpers, friends, short-term users, and long-term users. Time series and profiling analyses revealed distinct patterns for each group. We found that older adults use SARs differently based on factors beyond demographics and health. This study demonstrates a data-driven approach to understanding user needs, and the findings can help tailor SAR interventions for specific user groups. Conclusions: This study extends our understanding of the factors associated with the long-term use of SARs for geriatric care and makes methodological contributions. ", doi="10.2196/41093", url="https://formative.jmir.org/2024/1/e41093" } @Article{info:doi/10.2196/58714, author="Happe, Lisa and Sgraja, Marie and Quinten, Vincent and F{\"o}rster, Mareike and Diekmann, Rebecca", title="Requirement Analysis of Different Variants of a Measurement and Training Station for Older Adults at Risk of Malnutrition and Reduced Mobility: Focus Group Study", journal="JMIR Aging", year="2024", month="Sep", day="17", volume="7", pages="e58714", keywords="gerontechnology", keywords="physical activity", keywords="diet", keywords="technical assistance system", keywords="health data", keywords="qualitative research", abstract="Background: Demographic change is leading to an increasing proportion of older people in the German population and requires new approaches for prevention and rehabilitation to promote the independence and health of older people. Technical assistance systems can offer a promising solution for the early detection of nutritional and physical deficits and the initiation of appropriate interventions. Such a system should combine different components, such as devices for assessing physical and nutritional status, educational elements on these topics, and training and feedback options. The concept is that the whole system can be used independently by older adults (aged ?70 years) for monitoring and early detection of problems in nutrition or physical function, as well as providing opportunities for intervention. Objective: This study aims to develop technical and digital elements for a measurement and training station (MuTs) with an associated app. Through focus group discussions, target group requirements, barriers, and favorable components for such a system were identified. Methods: Older adults (aged ?70 years) were recruited from a community-based setting as well as from a geriatric rehabilitation center. Focus group interviews were conducted between August and November 2022. Following a semistructured interview guideline, attitudes, requirements, preferences, and barriers for the MuTs were discussed. Discussions were stimulated by videos, demonstrations of measuring devices, and participants' ratings of the content presented using rankings. After conducting 1 focus group in the rehabilitation center and 2 in the community, the interview guide was refined, making a more detailed discussion of identified elements and aspects possible. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. Results: A total of 21 older adults (female participants: n=11, 52\%; mean age 78.5, SD 4.6 years) participated in 5 focus group discussions. There was a strong interest in the independent measurement of health parameters, such as pulse and hand grip strength, especially among people with health problems who would welcome feedback on their health development. Participants emphasized the importance of personal guidance and interaction before using the device, as well as the need for feedback mechanisms and personalized training for everyday use. Balance and coordination were mentioned as preferred training areas in a MuTs. New training options that motivate and invite people to participate could increase willingness to use the MuTs. Conclusions: The target group is generally open and interested in tracking and optimizing diet and physical activity. A general willingness to use a MuTs independently was identified, as well as a compelling need for guidance and feedback on measurement and training to be part of the station. ", doi="10.2196/58714", url="https://aging.jmir.org/2024/1/e58714" } @Article{info:doi/10.2196/53431, author="Bevilacqua, Roberta and Benadduci, Marco and Barbarossa, Federico and Amabili, Giulio and Di Donna, Valentina and Martella, Clotilda and Pelliccioni, Giuseppe and Riccardi, Renato Giovanni and Maranesi, Elvira", title="Effectiveness of Technological Interventions for Older Adults With Parkinson Disease: Systematic Review", journal="JMIR Serious Games", year="2024", month="Sep", day="9", volume="12", pages="e53431", keywords="technological intervention", keywords="Parkinson disease", keywords="randomized controlled trail", keywords="older adults", keywords="efficacy", abstract="Background: Among the older population, Parkinson disease (PD) stands out as a leading contributor to disability. Clinically, the foremost objectives in managing PD involve proactively delaying and preventing disability. Understanding the pivotal role of gait and balance in daily functionality holds substantial clinical significance, signaling imminent disability and prompting a reevaluation of management approaches. A key priority lies in identifying novel and effective interventions for symptoms that substantially contribute to disability. Objective: This paper presents a systematic review that critically examines the existing body of literature on the use of technology in the rehabilitation of older patients with PD. By synthesizing current evidence, we aim to provide insights into the state of the field, identify gaps in knowledge, and offer recommendations for future research and clinical practice. Methods: A systematic review of the literature was conducted in September 2023 analyzing manuscripts and papers of the last 5 years from the PubMed, Scopus, Embase, Web of Science, and CINAHL databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 14 papers were included. The inclusion criteria are as follows: (1) randomized controlled trial, (2) PD in people aged 65 years and older, and (3) use of technology in the rehabilitation training in the older population. Results: A large portion of effective interventions relies on the incorporation of technology, particularly through virtual reality exergames. This technology appears to have effects not only on the cognitive aspect but also on the physical domain. The analysis of the results clearly indicates that, in terms of gait and balance performance, the technological intervention outperforms the traditional approach, irrespective of the specific technology employed. Conclusions: This systematic review seeks to shed light on the evolving landscape of technology-assisted rehabilitation for older individuals with PD. As we delve into the available evidence, we will assess the extent to which technology can serve as a valuable adjunct to conventional therapy, offering new avenues for optimized care and improved outcomes in this growing patient demographic. As we sift through the existing evidence, our goal is to evaluate the potential of technology as a valuable supplement to traditional therapy, presenting fresh opportunities for enhanced care and better outcomes in this expanding patient demographic. ", doi="10.2196/53431", url="https://games.jmir.org/2024/1/e53431", url="http://www.ncbi.nlm.nih.gov/pubmed/39250193" } @Article{info:doi/10.2196/57601, author="Suffoletto, Brian and Kim, David and Toth, Caitlin and Mayer, Waverly and Glaister, Sean and Cinkowski, Chris and Ashenburg, Nick and Lin, Michelle and Losak, Michael", title="Feasibility of Measuring Smartphone Accelerometry Data During a Weekly Instrumented Timed Up-and-Go Test After Emergency Department Discharge: Prospective Observational Cohort Study", journal="JMIR Aging", year="2024", month="Sep", day="4", volume="7", pages="e57601", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="ageing", keywords="aging", keywords="gait", keywords="balance", keywords="fall", keywords="falls", keywords="functional decline", keywords="fall risk", keywords="fall risks", keywords="mobility", keywords="phone", keywords="sensors", keywords="patient monitoring", keywords="monitoring", keywords="emergency department", keywords="emergency departments", keywords="ED", keywords="emergency room", keywords="ER", keywords="discharge", keywords="mobile application", keywords="mobile applications", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="digital interventions", keywords="smartphone", keywords="smartphones", keywords="prediction", keywords="mobile phone", abstract="Background: Older adults discharged from the emergency department (ED) face elevated risk of falls and functional decline. Smartphones might enable remote monitoring of mobility after ED discharge, yet their application in this context remains underexplored. Objective: This study aimed to assess the feasibility of having older adults provide weekly accelerometer data from an instrumented Timed Up-and-Go (TUG) test over an 11-week period after ED discharge. Methods: This single-center, prospective, observational, cohort study recruited patients aged 60 years and older from an academic ED. Participants downloaded the GaitMate app to their iPhones that recorded accelerometer data during 11 weekly at-home TUG tests. We measured adherence to TUG test completion, quality of transmitted accelerometer data, and participants' perceptions of the app's usability and safety. Results: Of the 617 approached patients, 149 (24.1\%) consented to participate, and of these 149 participants, 9 (6\%) dropped out. Overall, participants completed 55.6\% (912/1639) of TUG tests. Data quality was optimal in 31.1\% (508/1639) of TUG tests. At 3-month follow-up, 83.2\% (99/119) of respondents found the app easy to use, and 95\% (114/120) felt safe performing the tasks at home. Barriers to adherence included the need for assistance, technical issues with the app, and forgetfulness. Conclusions: The study demonstrates moderate adherence yet high usability and safety for the use of smartphone TUG tests to monitor mobility among older adults after ED discharge. Incomplete TUG test data were common, reflecting challenges in the collection of high-quality longitudinal mobility data in older adults. Identified barriers highlight the need for improvements in user engagement and technology design. ", doi="10.2196/57601", url="https://aging.jmir.org/2024/1/e57601" } @Article{info:doi/10.2196/59168, author="Knotnerus, R. Hanna and Ngo, N. H{\`a} T. and Maarsingh, R. Otto and van Vugt, A. Vincent", title="Understanding Older Adults' Experiences With a Digital Health Platform in General Practice: Qualitative Interview Study", journal="JMIR Aging", year="2024", month="Aug", day="30", volume="7", pages="e59168", keywords="digital health care", keywords="digital health platform", keywords="general practice", keywords="qualitative research", keywords="older adults", keywords="primary care", keywords="mobile phone", abstract="Background: In our aging population, primary care is under pressure to remain accessible to all. Effective use of digital health care could potentially lower general practitioners' (GPs) workload. Some general practices are already implementing a digital health platform as a primary method to contact their patients. However, it is unknown how older people experience this novel way to communicate with their GP. Objective: The aim of this study was to study the experiences of patients aged 65 years and older in general practices who use digital health as a primary communication tool. The secondary aims were to identify barriers and facilitators for the use of digital health care and whether a practice focus on digital health influences older patients' choice to enlist. Methods: We invited all patients aged 65 years and older at 2 general practices in Amsterdam that work with a novel digital health platform. We used purposive sampling to select a heterogeneous group of patients in terms of age, sex, level of education, digital literacy, and experiences with the digital app of their general practice. We conducted 18 semistructured interviews from May through July 2023. All interviews were audio-recorded, transcribed, coded, and thematically analyzed. Results: We generated three themes: (1) experiences of older people with digital health care in general practice, (2) impact of individual factors on digital health experiences, and (3) reasons for choosing a digitally oriented general practice. Participants reported both positive and negative experiences. The main perceived advantages of the digital health platform were increased accessibility, direct GP contact without an intermediary, and saving time through asynchronous communication. The disadvantages mentioned were log-in difficulties and problems with the automated explanatory questionnaire. Individual factors such as age, digital literacy, and expectations of general practice care seemed to impact people's experiences and could act as barriers or facilitators for using digital health. Reasons for older patients to enlist at a general practice were mainly practical. The digital orientation of the practice hardly played a role in this choice. Conclusions: Older patients in general practice see benefits to using a digital health platform that offers 2-way chat-based communication between the patient and GP. We found that individual factors such as skills, norms and values, attitudes toward digitalization, and expectations of general practice care impacted older patients' experiences with digital health care. For many older participants, the digital profile of the general practice did not play a role in their choice to enlist. Further improvement of digital health platforms will be necessary to ensure digital health for all in general practice. ", doi="10.2196/59168", url="https://aging.jmir.org/2024/1/e59168" } @Article{info:doi/10.2196/54186, author="Vidas, Dianna and Carrasco, Romina and Kelly, M. Ryan and Waycott, Jenny and Tamplin, Jeanette and McMahon, Kate and Flynn, M. Libby and Stretton-Smith, A. Phoebe and Sousa, Vieira Tanara and Baker, A. Felicity", title="Everyday Uses of Music Listening and Music Technologies by Caregivers and People With Dementia: Survey and Focus Group Study", journal="J Med Internet Res", year="2024", month="Aug", day="27", volume="26", pages="e54186", keywords="dementia", keywords="dementia care", keywords="technology", keywords="music technology", keywords="mobile phone", abstract="Background: Music has long been identified as a nonpharmacological tool that can provide benefits for people with dementia, and there is considerable interest in designing technologies to support the use of music in dementia care. However, to ensure that music technologies are appropriately designed for supporting caregivers and people living with dementia, there remains a need to better understand how music is currently used in everyday dementia care at home. Objective: This study aims to understand how people living with dementia and their caregivers use music and music technologies in everyday caring, as well as the challenges they experience using music and technology. Methods: This study used a mixed methods design. First, a survey was administered to 13 people living with dementia and 64 caregivers to understand their use of music and technology. Subsequently, 18 survey respondents (family caregivers: n=12, 67\%; people living with dementia: n=6, 33\%) participated in focus groups regarding their experiences of using music and technology in care. Interview transcripts were analyzed using reflexive thematic analysis. Results: Most of the survey respondents (people living with dementia: 9/13, 69\%; family caregivers: 47/63, 75\%) reported using music often or very often in their daily lives. Participants reported a range of technologies used for listening to music, such as CDs, radio, and streaming services. Focus groups highlighted the benefits and challenges of using music and music technologies in everyday care. Participants identified using music and music technologies to regulate mood, provide joy, facilitate social interaction and connection, encourage reminiscence, provide continuity of music use before and after the dementia diagnosis, and make caregiving easier. The challenges of using music technology in everyday caring included difficulties with staying up to date with evolving technology and low self-efficacy with technology for people living with dementia. Conclusions: This study shows that people with a dementia diagnosis and their caregivers already use music and music technologies to support their everyday care needs. The results suggest opportunities to design technologies that enable easier access to music and to support people living with dementia with recreational and therapeutic music listening as well as music-based activities. ", doi="10.2196/54186", url="https://www.jmir.org/2024/1/e54186" } @Article{info:doi/10.2196/53643, author="G Ravindran, K. Kiran and della Monica, Ciro and Atzori, Giuseppe and Lambert, Damion and Hassanin, Hana and Revell, Victoria and Dijk, Derk-Jan", title="Reliable Contactless Monitoring of Heart Rate, Breathing Rate, and Breathing Disturbance During Sleep in Aging: Digital Health Technology Evaluation Study", journal="JMIR Mhealth Uhealth", year="2024", month="Aug", day="27", volume="12", pages="e53643", keywords="Withings Sleep Analyzer", keywords="Emfit", keywords="Somnofy", keywords="contactless technologies", keywords="vital signs", keywords="evaluation", keywords="apnea-hypopnea index", keywords="wearables", keywords="nearables", abstract="Background: Longitudinal monitoring of vital signs provides a method for identifying changes to general health in an individual, particularly in older adults. The nocturnal sleep period provides a convenient opportunity to assess vital signs. Contactless technologies that can be embedded into the bedroom environment are unintrusive and burdenless and have the potential to enable seamless monitoring of vital signs. To realize this potential, these technologies need to be evaluated against gold standard measures and in relevant populations. Objective: We aimed to evaluate the accuracy of heart rate and breathing rate measurements of 3 contactless technologies (2 undermattress trackers, Withings Sleep Analyzer [WSA] and Emfit QS [Emfit]; and a bedside radar, Somnofy) in a sleep laboratory environment and assess their potential to capture vital signs in a real-world setting. Methods: Data were collected from 35 community-dwelling older adults aged between 65 and 83 (mean 70.8, SD 4.9) years (men: n=21, 60\%) during a 1-night clinical polysomnography (PSG) test in a sleep laboratory, preceded by 7 to 14 days of data collection at home. Several of the participants (20/35, 57\%) had health conditions, including type 2 diabetes, hypertension, obesity, and arthritis, and 49\% (17) had moderate to severe sleep apnea, while 29\% (n=10) had periodic leg movement disorder. The undermattress trackers provided estimates of both heart rate and breathing rate, while the bedside radar provided only the breathing rate. The accuracy of the heart rate and breathing rate estimated by the devices was compared with PSG electrocardiogram-derived heart rate (beats per minute) and respiratory inductance plethysmography thorax-derived breathing rate (cycles per minute), respectively. We also evaluated breathing disturbance indexes of snoring and the apnea-hypopnea index, available from the WSA. Results: All 3 contactless technologies provided acceptable accuracy in estimating heart rate (mean absolute error <2.12 beats per minute and mean absolute percentage error <5\%) and breathing rate (mean absolute error ?1.6 cycles per minute and mean absolute percentage error <12\%) at 1-minute resolution. All 3 contactless technologies were able to capture changes in heart rate and breathing rate across the sleep period. The WSA snoring and breathing disturbance estimates were also accurate compared with PSG estimates (WSA snore: r2=0.76; P<.001; WSA apnea-hypopnea index: r2=0.59; P<.001). Conclusions: Contactless technologies offer an unintrusive alternative to conventional wearable technologies for reliable monitoring of heart rate, breathing rate, and sleep apnea in community-dwelling older adults at scale. They enable the assessment of night-to-night variation in these vital signs, which may allow the identification of acute changes in health, and longitudinal monitoring, which may provide insight into health trajectories. International Registered Report Identifier (IRRID): RR2-10.3390/clockssleep6010010 ", doi="10.2196/53643", url="https://mhealth.jmir.org/2024/1/e53643", url="http://www.ncbi.nlm.nih.gov/pubmed/39190477" } @Article{info:doi/10.2196/56055, author="Cannings, Madeleine and Brookman, Ruth and Parker, Simon and Hoon, Leonard and Ono, Asuka and Kawata, Hiroaki and Matsukawa, Hisashi and Harris, B. Celia", title="Optimizing Technology-Based Prompts for Supporting People Living With Dementia in Completing Activities of Daily Living at Home: Experimental Approach to Prompt Modality, Task Breakdown, and Attentional Support", journal="JMIR Aging", year="2024", month="Aug", day="23", volume="7", pages="e56055", keywords="assistive technology", keywords="accessible technology", keywords="accessibility technology", keywords="assistive technologies", keywords="accessible technologies", keywords="assistive device", keywords="assistive devices", keywords="dementia", keywords="people living with dementia", keywords="dementia care", keywords="person-centered technology", keywords="patient-centered technology", keywords="person-centered technologies", keywords="patient-centered technologies", keywords="memory support", keywords="prompting", keywords="user-computer interface", keywords="user interface", keywords="UI", keywords="app", keywords="apps", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="digital interventions", keywords="mobile phone", abstract="Background: Assistive technology is becoming increasingly accessible and affordable for supporting people with dementia and their care partners living at home, with strong potential for technology-based prompting to assist with initiation and tracking of complex, multistep activities of daily living. However, there is limited direct comparison of different prompt features to guide optimal technology design. Objective: Across 3 experiments, we investigated the features of tablet-based prompts that best support people with dementia to complete activities of daily living at home, measuring prompt effectiveness and gaining feedback from people with dementia and their care partners about their experiences. Methods: Across experiments, we developed a specialized iPad app to enable data collection with people with dementia at home over an extended experimental period. In experiment 1, we varied the prompts in a 3 (visual type: text instruction, iconic image, and photographic image) {\texttimes} 3 (audio type: no sound, symbolic sound, and verbal instruction) experimental design using repeated measures across multiple testing sessions involving single-step activities. In experiment 2, we tested the most effective prompt breakdown for complex multistep tasks comparing 3 conditions (1-prompt, 3-prompt, and 7-prompt conditions). In experiment 3, we compared initiation and maintenance alerts that involved either an auditory tone or an auditory tone combined with a verbal instruction. Throughout, we asked people with dementia and their care partners to reflect on the usefulness of prompting technology in their everyday lives and what could be developed to better meet their needs. Results: First, our results showed that audible verbal instructions were more useful for task completion than either tone-based or visual prompts. Second, a more granular breakdown of tasks was generally more useful and increased independent use, but this varied across individuals. Third, while a voice or text maintenance alert enabled people with dementia to persist with a multistep task for longer when it was more frequent, task initiation still frequently required support from a care partner. Conclusions: These findings can help inform developers of assistive technology about the design features that promote the usefulness of home prompting systems for people with dementia as well as the preferences and insights of people with dementia and their care partners regarding assistive technology design. ", doi="10.2196/56055", url="https://aging.jmir.org/2024/1/e56055" } @Article{info:doi/10.2196/52310, author="Angonese, Giulia and Buhl, Mareike and Kuhlmann, Inka and Kollmeier, Birger and Hildebrandt, Andrea", title="Prediction of Hearing Help Seeking to Design a Recommendation Module of an mHealth Hearing App: Intensive Longitudinal Study of Feature Importance Assessment", journal="JMIR Hum Factors", year="2024", month="Aug", day="12", volume="11", pages="e52310", keywords="hearing loss", keywords="mobile health", keywords="mHealth", keywords="older adults", keywords="help seeking", keywords="mobile study", keywords="machine learning", keywords="supervised classification", keywords="feature importance", keywords="profiling", keywords="mobile phone", abstract="Background: Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual's profile regarding the outcome of interest. Objective: This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions. Methods: In total, 185 (n=106, 57.3\% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, na{\"i}ve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis. Results: The algorithms correctly predicted action to seek help at study end in 65.9\% (122/185) to 70.3\% (130/185) of cases, reaching 74.8\% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income. Conclusions: This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps. ", doi="10.2196/52310", url="https://humanfactors.jmir.org/2024/1/e52310", url="http://www.ncbi.nlm.nih.gov/pubmed/39133539" } @Article{info:doi/10.2196/55693, 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/10.2196/50479, author="Musa, Reem and Elamin, Dalia and Barrie, Robert and Kimmie-Dhansay, Faheema", title="Effectiveness of Mobile App Interventions to Improve Periodontal Health: Protocol for a Systematic Review and Meta-Analysis", journal="JMIR Res Protoc", year="2024", month="Jul", day="31", volume="13", pages="e50479", keywords="mobile app", keywords="periodontal health", keywords="text messages", keywords="application", keywords="effectiveness", keywords="physical well-being", keywords="mental well-being", keywords="social well-being", keywords="oral hygiene", keywords="oral disease", keywords="disease prevention", keywords="periodontal", keywords="health education", keywords="systematic review", abstract="Background: Periodontal health plays a key role as a shared reference point for evaluating periodontal diseases and identifying significant treatment outcomes. Providing adequate instruction and enhancing the motivation of patients to maintain proper oral hygiene are crucial factors for successful periodontal treatment, with self-performed regular oral hygiene identified as a critical factor in improving the outcomes of treatment for periodontal diseases. Recently, mobile health (mHealth) solutions, especially mobile apps, have emerged as valuable tools for self-management in chronic diseases such as periodontal disease, providing essential health education and monitoring capabilities. However, the use of mHealth apps for periodontal health is complex owing to various interacting components such as patient behavior, socioeconomic status, and adherence to oral hygiene practices. Existing literature has indicated positive effects of mHealth on oral health behaviors, knowledge, attitude, practice, plaque index score, and gingivitis reduction. However, there has been no systematic review of mobile apps specifically targeting patients with periodontal disease. Understanding the design and impact of mHealth apps is crucial for creating high-quality apps. Objective: The aim of this systematic review and meta-analysis is to evaluate the effectiveness of existing mobile apps in promoting periodontal health. Methods: A comprehensive search strategy will be performed in multiple electronic databases (PubMed, EBSCOhost, CINAHL Plus, Dentistry \& Oral Sciences, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials) with the following keywords in the title/abstract: ``mobile application,'' ``mobile health,'' ``mHealth,'' ``telemedicine,'' ``periodontal health,'' ``periodontitis,'' and ``text message.'' Only randomized controlled trials will be included that assessed the following outcomes to measure periodontal health improvement: gingival index, bleeding index, periodontal pocket depth, and clinical attachment loss. Covidence will be used for data collection, and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flowchart will be used to describe the selection process of the included, identified, and excluded studies. The Confidence in Network Meta-Analysis approach will be used for meta-analysis of the extracted data from the included studies. Results: This review will not require ethical approval since no primary data will be included. As of July 2024, a total of 83 articles retrieved from various databases have been imported to Covidence with 13 articles deemed eligible for inclusion in the review. The review is currently ongoing and is expected to be complete by the end of 2024 with the results published in early 2025. Conclusions: This systematic review and meta-analysis will contribute to developing mobile apps with enhanced criteria to improve periodontal clinical outcomes. The review emphasizes the importance of mHealth and preventing periodontal disease, which can set the stage for informed global health care strategies. Trial Registration: PROSPERO CRD42022340827; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=340827 International Registered Report Identifier (IRRID): DERR1-10.2196/50479 ", doi="10.2196/50479", url="https://www.researchprotocols.org/2024/1/e50479" } @Article{info:doi/10.2196/58174, author="Shi, Beibei and Li, Guangkai and Wu, Shuang and Ge, Hongli and Zhang, Xianliang and Chen, Si and Pan, Yang and He, Qiang", title="Assessing the Effectiveness of eHealth Interventions to Manage Multiple Lifestyle Risk Behaviors Among Older Adults: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2024", month="Jul", day="31", volume="26", pages="e58174", keywords="eHealth", keywords="lifestyle risk behaviors", keywords="older adults", keywords="multiple health behavior change", keywords="mobile phone", abstract="Background: Developing adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors. Objective: The purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ?2 major lifestyle risk behaviors in people aged ?50 years. Methods: The literature search was conducted in 6 electronic databases---PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus---from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ?2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep. Results: A total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95\% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95\% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95\% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95\% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95\% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD --0.23, 95\% CI --0.33 to --0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. Conclusions: eHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult--oriented research is needed to develop eHealth interventions that can change multiple behaviors. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42023444418 ", doi="10.2196/58174", url="https://www.jmir.org/2024/1/e58174" } @Article{info:doi/10.2196/57586, author="Galvin, Emer and Desselle, Shane and Gavin, Bl{\'a}naid and McNicholas, Fiona and Cullinan, Shane and Hayden, John", title="Training Service Users in the Use of Telehealth: Scoping Review", journal="J Med Internet Res", year="2024", month="Jul", day="31", volume="26", pages="e57586", keywords="telehealth", keywords="video consultations", keywords="training", keywords="education", keywords="older adults", keywords="digital divide", keywords="digital literacy", keywords="review", keywords="scoping review", keywords="modality of care", keywords="training service", keywords="user", keywords="users", keywords="older adult", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="caregiver", keywords="caregivers", keywords="consultation", keywords="consultations", keywords="health care professional", keywords="health care professionals", keywords="PRISMA-ScR", keywords="Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews", keywords="data extraction", keywords="phone", keywords="phones", keywords="telemonitoring", abstract="Background: The use of telehealth has rapidly increased, yet some populations may be disproportionally excluded from accessing and using this modality of care. Training service users in telehealth may increase accessibility for certain groups. The extent and nature of these training activities have not been explored. Objective: The objective of this scoping review is to identify and describe activities for training service users in the use of telehealth. Methods: Five databases (MEDLINE [via PubMed], Embase, CINAHL, PsycINFO, and Web of Science) were searched in June 2023. Studies that described activities to train service users in the use of synchronous telehealth consultations were eligible for inclusion. Studies that focused on health care professional education were excluded. Papers were limited to those published in the English language. The review followed the Joanna Briggs Institute guidelines for scoping reviews and was reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Titles and abstracts were screened by 1 reviewer (EG). Full texts were screened by 2 reviewers (EG and JH or SC). Data extraction was guided by the research question. Results: The search identified 8087 unique publications. In total, 13 studies met the inclusion criteria. Telehealth training was commonly described as once-off preparatory phone calls to service users before a telehealth visit, facilitated primarily by student volunteers, and accompanied by written instructions. The training content included guidance on how to download and install software, troubleshoot technical issues, and adjust device settings. Older adults were the most common target population for the training. All but 1 of the studies were conducted during the COVID-19 pandemic. Overall, training was feasible and well-received by service users, and studies mostly reported increased rates of video visits following training. There was limited and mixed evidence that training improved participants' competency with telehealth. Conclusions: The review mapped the literature on training activities for service users in telehealth. The common features of telehealth training for service users included once-off preparatory phone calls on the technical elements of telehealth, targeted at older adults. Key issues for consideration include the need for co-designed training and improving the broader digital skills of service users. There is a need for further studies to evaluate the outcomes of telehealth training activities in geographically diverse areas. ", doi="10.2196/57586", url="https://www.jmir.org/2024/1/e57586" } @Article{info:doi/10.2196/56433, author="Herold, Fabian and Theobald, Paula and Gronwald, Thomas and Kaushal, Navin and Zou, Liye and de Bruin, D. Eling and Bherer, Louis and M{\"u}ller, G. Notger", title="The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions", journal="JMIR Aging", year="2024", month="Jul", day="31", volume="7", pages="e56433", keywords="physical activity", keywords="dementia prevention", keywords="cognitive health", keywords="hybrid: aging in place", keywords="active", keywords="exercises", keywords="exercising", keywords="healthy lifestyle", keywords="dementia", keywords="dementia onset", keywords="dementia care", keywords="preventive", keywords="prevention", keywords="cognition", keywords="cognitive", keywords="hybrid", keywords="hybrid model", doi="10.2196/56433", url="https://aging.jmir.org/2024/1/e56433", url="http://www.ncbi.nlm.nih.gov/pubmed/39083334" } @Article{info:doi/10.2196/58846, author="Sweeting, Anna and Warncken, A. Katie and Patel, Martyn", title="The Role of Assistive Technology in Enabling Older Adults to Achieve Independent Living: Past and Future", journal="J Med Internet Res", year="2024", month="Jul", day="30", volume="26", pages="e58846", keywords="assistive technology", keywords="older adults", keywords="users", keywords="aging", keywords="aging in place", keywords="UK", keywords="cocreation", keywords="research trial", keywords="independent living", keywords="North Norfolk", keywords="disability", keywords="injury", keywords="tool", keywords="use", keywords="design", keywords="barrier", doi="10.2196/58846", url="https://www.jmir.org/2024/1/e58846" } @Article{info:doi/10.2196/57694, author="Tung, Heng-Hsin and Kuo, Chen-Yuan and Lee, Pei-Lin and Chang, Chih-Wen and Chou, Kun-Hsien and Lin, Ching-Po and Chen, Liang-Kung", title="Efficacy of Digital Dance on Brain Imagery, Cognition, and Health: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Jul", day="30", volume="26", pages="e57694", keywords="digital", keywords="somatosensory dance", keywords="somatosensory game", keywords="cognitive performance", keywords="physical function", keywords="resilience", keywords="demoralization", keywords="quality of life", keywords="dance", keywords="dancer", keywords="dancing", keywords="movement", keywords="sport", keywords="sports", keywords="cognitive", keywords="cognition", keywords="brain", keywords="neuroscience", keywords="image", keywords="imagery", keywords="imaging", keywords="RCT", keywords="randomized", keywords="controlled trial", keywords="controlled trials", keywords="somatosensory", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="ageing", keywords="aging", keywords="aged", keywords="game", keywords="games", keywords="gaming", abstract="Background: Multidomain interventions have demonstrable benefits for promoting healthy aging, but self-empowerment strategies to sustain long-term gains remain elusive. Objective: This study evaluated the effects of digital somatosensory dance game participation on brain imagery changes as primary outcomes and other physical and mental health measures as secondary outcomes related to healthy aging. Methods: Between August 31, 2020, and June 27, 2021, this randomized controlled trial recruited 60 eligible participants older than 55 years with no recent engagement in digital dance games. A computer-generated randomization sequence was used to allocate participants 1:1, without stratification, to an intervention group (n=30) who underwent digital somatosensory dance game training or a control group (n=30). An anonymized code masked the intervention allocations from the investigators, and individuals who assigned the interventions were not involved in analyzing the study data. The intervention entailed two 30-minute dance game sessions per week for 6 months, and the control group received healthy aging education. Primary outcomes were brain imagery changes. All variables were measured at baseline and the 6-month follow-up, and intervention effects were estimated using t tests with intention-to-treat analyses. Results: Compared with the control group, intervention participants had significantly different brain imagery in the gray matter volume (GMV) of the left putamen (estimate 0.016, 95\% CI 0.008 to 0.024; P<.001), GMV of the left pallidum (estimate 0.02, 95\% CI 0.006 to 0.034; P=.004), and fractional amplitude of low frequency fluctuations of the left pallidum (estimate 0.262, 95\% CI 0.084 to 0.439; P=.004). Additionally, the intervention group had different imagery in the cerebellum VI GMV (estimate 0.011, 95\% CI 0.003 to 0.02; P=.01). The intervention group also had improved total Montreal Cognitive Assessment scores (estimate 1.2, 95\% CI 0.27 to ?2.13; P<.01), quality of life (estimate 7.08, 95\% CI 2.35 to 11.82; P=.004), and time spent sitting on weekdays (estimate ?1.96, 95\% CI ?3.33 to ?0.60; P=.005). Furthermore, dance performance was significantly associated with cognitive performance (P=.003), health status (P=.14), resilience (P=.007), and demoralization (P<.001). Conclusions: Digital somatosensory dance game participation for 6 months was associated with brain imagery changes in multiple regions involving somatosensory, motor, visual, and attention functions, which were consistent with phenotypic improvements associated with healthy aging. Trial Registration: ClinicalTrials.gov NCT05411042; https://clinicaltrials.gov/study/NCT05411042 ", doi="10.2196/57694", url="https://www.jmir.org/2024/1/e57694", url="http://www.ncbi.nlm.nih.gov/pubmed/39078687" } @Article{info:doi/10.2196/46319, author="Chen, Wenfei and Chen, Jiana and Jiang, Shaojun and Wang, Chunhua and Zhang, Jinhua", title="Web-Based Warfarin Management (Alfalfa App) Versus Traditional Warfarin Management: Multicenter Prospective Cohort Study", journal="J Med Internet Res", year="2024", month="Jul", day="29", volume="26", pages="e46319", keywords="warfarin", keywords="telemedicine", keywords="smart phone application", keywords="anti-coagulation management", keywords="management", keywords="cohort study", keywords="application", keywords="chronic disease", keywords="support", keywords="effectiveness", keywords="online model", keywords="patient management", abstract="Background: Poor anticoagulation management of warfarin may lead to patient admission, prolonged hospital stays, and even death due to anticoagulation-related adverse events. Traditional non--web-based outpatient clinics struggle to provide ideal anticoagulation management services for patients, and there is a need to explore a safer, more effective, and more convenient mode of warfarin management. Objective: This study aimed to compare differences in the quality of anticoagulation management and clinical adverse events between a web-based management model (via a smartphone app) and the conventional non--web-based outpatient management model. Methods: This study is a prospective cohort research that includes multiple national centers. Patients meeting the nadir criteria were split into a web-based management group using the Alfalfa app or a non--web-based management group with traditional outpatient management, and they were then monitored for a 6-month follow-up period to collect coagulation test results and clinical events. The effectiveness and safety of the 2 management models were assessed by the following indicators: time in therapeutic range (TTR), bleeding events, thromboembolic events, all-cause mortality events, cumulative event rates, and the distribution of the international normalized ratio (INR). Results: This national multicenter cohort study enrolled 522 patients between June 2019 and May 2021, with 519 (99\%) patients reaching the follow-up end point, including 260 (50\%) in the non--web-based management group and 259 (50\%) in the web-based management group. There were no observable differences in baseline characteristics between the 2 patient groups. The web-based management group had a significantly higher TTR than the non--web-based management group (82.4\% vs 71.6\%, P<.001), and a higher proportion of patients received effective anticoagulation management (81.2\% vs 63.5\%, P<.001). The incidence of minor bleeding events in the non--web-based management group was significantly higher than that in the web-based management group (12.1\% vs 6.6\%, P=.048). Between the 2 groups, there was no statistically significant difference in the incidence of severe bleeding and thromboembolic and all-cause death events. In addition, compared with the non--web-based management group, the web-based management group had a lower proportion of INR in the extreme subtreatment range (17.6\% vs 21.3\%) and severe supertreatment range (0\% vs 0.8\%) and a higher proportion in the treatment range (50.4\% vs 43.1\%), with statistical significance. Conclusions: Compared with traditional non--web-based outpatient management, web-based management via the Alfalfa app may be more beneficial because it can enhance patient anticoagulation management quality, lower the frequency of small bleeding events, and improve INR distribution. ", doi="10.2196/46319", url="https://www.jmir.org/2024/1/e46319", url="http://www.ncbi.nlm.nih.gov/pubmed/39073869" } @Article{info:doi/10.2196/53450, author="Wu, Yi-Chen and Shen, Shu-Fen and Chen, Liang-Kung and Tung, Heng-Hsin", title="A Web-Based Resilience-Enhancing Program to Improve Resilience, Physical Activity, and Well-being in Geriatric Population: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Jul", day="25", volume="26", pages="e53450", keywords="geriatric population", keywords="community-dwelling older adult", keywords="web-based resilience-enhancing program", keywords="resilience", keywords="physical activity", keywords="well-being", keywords="pandemic.", abstract="Background: Resilience is a protective factor in healthy aging, helping to maintain and recover physical and mental functions. The Resilience in Illness Model has proven effective in fostering resilience and well-being. Physical activity is crucial for older adults' independence and well-being, even as aging causes a progressive decline. Additionally, older adults face challenges such as spousal loss and physical disability, making preventive intervention strategies necessary. Objective: This study aims to develop and evaluate a web-based program to enhance resilience, physical activity, and well-being among community-dwelling older adults. Additionally, we aim to gather feedback on the program's strengths and limitations. Methods: A 4-week resilience-enhancing program was created, incorporating role-play and talk-in-interaction and focusing on 3 key skills: coping, control belief, and manageability. The program included scenarios such as becoming widowed and suffering a stroke, designed to engage older adults. A pilot test preceded the intervention. As a result of the COVID-19 pandemic, the program shifted from in-person to web-based sessions. A single-blind, parallel-group, randomized controlled trial was conducted. Participants aged over 65 years were recruited offline and randomly assigned to either an intervention or control group. A certified resilience practitioner delivered the program. Outcomes in resilience, physical activity, and well-being were self-assessed at baseline (T0), 4 weeks (T1), and 12 weeks (T2) after the program. A mixed methods approach was used to evaluate feedback. Results: A web-based participatory program enhancing 3 skills---coping, control belief, and manageability for resilience---was well developed. Among 96 participants, 63 were randomized into the intervention group (n=31) and the control group (n=32). The mean age in the intervention group was 69.27 (SD 3.08) years and 74.84 (SD 6.23) years in the control group. Significant between-group differences at baseline were found in age (t45.6=--4.53, P<.001) and physical activity at baseline (t61=2.92, P=.005). No statistically significant between-group differences over time were observed in resilience (SE 7.49, 95\% CI --10.74 to 18.61, P=.60), physical activity (SE 15.18, 95\% CI --24.74 to 34.74, P=.74), and well-being (SE 3.74, 95\% CI --2.68 to 11.98, P=.21) after controlling for baseline differences. The dropout rate was lower in the intervention group (2/31, 6\%) compared with the control group (5/32, 16\%). Moreover, 77\% (24/31) of participants in the intervention group completed the entire program. Program feedback from the participants indicated high satisfaction with the web-based format and mentorship support. Conclusions: This study demonstrated that a web-based resilience-enhancing program is appropriate, acceptable, feasible, and engaging for community-dwelling older adults. The program garnered enthusiasm for its potential to optimize resilience, physical activity, and well-being, with mentorship playing a crucial role in its success. Future studies should aim to refine program content, engagement, and delivery methods to effectively promote healthy aging in this population. Trial Registration: ClinicalTrials.gov NCT05808491; https://clinicaltrials.gov/ct2/show/NCT05808491 ", doi="10.2196/53450", url="https://www.jmir.org/2024/1/e53450" } @Article{info:doi/10.2196/47578, author="Galvin, Karyn and Tomlin, Dani and Timmer, B. Barbra H. and McNeice, Zoe and Mount, Nicole and Gray, Kathleen and Short, E. Camille", title="Consumer Perspectives for a Future Mobile App to Document Real-World Listening Difficulties: Qualitative Study", journal="JMIR Form Res", year="2024", month="Jul", day="23", volume="8", pages="e47578", keywords="adults", keywords="hearing loss", keywords="listening difficulties", keywords="digital health", keywords="app", keywords="self-management", keywords="mobile health", keywords="smartphone", keywords="mobile phone", abstract="Background: By enabling individuals with hearing loss to collect their own hearing data in their personal real-world settings, there is scope to improve clinical care, empower consumers, and support shared clinical decision-making and problem-solving. Clinician support for this approach has been established in a separate study. Objective: This study aims to explore, for consumers with hearing loss, their (1) experiences of listening difficulties, to identify the data an app could usefully collect; (2) preferences regarding the features of mobile apps in general; and (3) opinions on the potential value and desirable features of a yet-to-be designed app for documenting listening difficulties in real-world settings. Methods: A total of 3 focus groups involved 27 adults who self-reported hearing loss. Most were fitted with hearing devices. A facilitator used a topic guide to generate discussion, which was video- and audio-recorded. Verbatim transcriptions were analyzed using inductive content analysis. Results: Consumers supported the concept of a mobile app that would facilitate the documenting of listening difficulties in real-world settings important to the individual. Consumers shared valuable insights about their listening difficulties, which will help determine the data that should be collected through an app designed to document these challenges. This information included early indicators of hearing loss (eg, mishearing, difficulty communicating in groups and on the phone, and speaking overly loudly) and prompts to seek hearing devices (eg, spousal pressure and the advice or example provided by others, and needing to rely on lipreading or to constantly request others to repeat themselves). It also included the well-known factors that influence listening difficulties (eg, reverberation, background noise, group conversations) and the impacts and consequences of their difficulties (eg, negative impacts on relationships and employment, social isolation and withdrawal, and negative emotions). Consumers desired a visual-based app that provided options for how data could be collected and how the user could enter data into an app, and which enabled data sharing with a clinician. Conclusions: These findings provide directions for the future co-design and piloting of a prototype mobile app to provide data that are useful for increasing self-awareness of listening difficulties and can be shared with a clinician. ", doi="10.2196/47578", url="https://formative.jmir.org/2024/1/e47578" } @Article{info:doi/10.2196/59468, author="Tuan, Sheng-Hui and Chang, Lin-Hui and Sun, Shu-Fen and Li, Chien-Hui and Chen, Guan-Bo and Tsai, Yi-Ju", title="Assessing the Clinical Effectiveness of an Exergame-Based Exercise Training Program Using Ring Fit Adventure to Prevent and Postpone Frailty and Sarcopenia Among Older Adults in Rural Long-Term Care Facilities: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Jul", day="18", volume="26", pages="e59468", keywords="exergame", keywords="Ring Fit Adventure", keywords="sarcopenia", keywords="frailty", keywords="long-term care", keywords="multicomponent training", abstract="Background: Frailty and sarcopenia are geriatric syndromes of increasing concern and are associated with adverse health outcomes. They are more prevalent among long-term care facility (LTCF) users than among community dwellers. Exercise, especially multicomponent and progressive resistance training, is essential for managing these conditions. However, LTCFs, particularly in rural areas, face challenges in implementing structured exercise programs due to health care professional shortages. Moreover, older adults often become bored with repetitive exercise training and may lose interest over time. The Nintendo Switch Ring Fit Adventure (RFA) exergame is a novel exergame that combines resistance, aerobic, and balance exercises and offers a potential solution by boosting motivation in an immersive manner and reducing staff intervention needs. Objective: We aimed to evaluate the clinical effectiveness of an exergame-based exercise training program delivered via RFA (exergame-RFA) in improving muscle mass and functional performance among older adult LTCF users. Methods: This was a randomized controlled trial conducted from August 2022 to September 2023 and involved older adult LTCF users (aged ?60 y) in rural southern Taiwan. Participants were randomized into an intervention group (exergame-RFA plus standard care) or a control group (standard care alone). The intervention, conducted seated with arm fit skills and trunk control exercises using the RFA, lasted 30 minutes twice weekly over 12 weeks. The primary outcomes measured were the Study of Osteoporotic Fractures index (serving as an indicator of frailty status) and the diagnostic criteria for sarcopenia (appendicular skeletal muscle mass index, handgrip strength, and gait speed). The secondary outcomes included functional performance (box and block test as well as maximum voluntary isometric contraction of the dominant upper extremity), muscle condition (muscle thickness measured using ultrasonography), activities of daily living (Kihon checklist), health-related quality of life (Short Form Health Survey-36), and cognitive function (brain health test). We used an intention-to-treat analysis, incorporating a simple imputation technique in statistical analysis. A mixed ANOVA, with time as a within-participant factor and intervention as a between-participant factor, was used to compare the training effects on outcomes. Results: We recruited 96 individuals, of whom 60 (62\%) underwent randomization. Of these 60 participants, 55 (92\%) completed the study. Significant group{\texttimes}time interactions were observed in the intervention group in all primary outcomes (all P<.001, except P=.01 for handgrip strength) and most secondary outcomes, including maximum voluntary isometric contraction of the biceps (P=.004) and triceps brachii (P<.001) muscles, biceps muscle thickness measured using ultrasonography (P<.001), box and block test (P<.001), Kihon checklist (physical function: P=.01, mood status: P=.003, and total: P=.003), and brain health test (P<.001). Conclusions: The exergame-RFA intervention significantly improved muscle mass, strength, and functional performance among older adult users of rural LTCFs, offering a novel approach to addressing frailty and sarcopenia. Trial Registration: ClinicalTrials.gov NCT05360667; https://clinicaltrials.gov/study/NCT05360667 International Registered Report Identifier (IRRID): RR2-10.3389/fmed.2022.1071409 ", doi="10.2196/59468", url="https://www.jmir.org/2024/1/e59468", url="http://www.ncbi.nlm.nih.gov/pubmed/39024000" } @Article{info:doi/10.2196/47565, author="Ansaldo, In{\'e}s Ana and Masson-Trottier, Mich{\`e}le and Delacourt, Barbara and Dubuc, Jade and Dub{\'e}, Catherine", title="Efficacy of COMPAs, an App Designed to Support Communication Between Persons Living With Dementia in Long-Term Care Settings and Their Caregivers: Mixed Methods Implementation Study", journal="JMIR Aging", year="2024", month="Jul", day="4", volume="7", pages="e47565", keywords="dementia", keywords="communication", keywords="caregivers", keywords="technology", keywords="burden", keywords="mixed methods design", keywords="quality of life", keywords="mobile phone", keywords="tablet", abstract="Background: Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills, leading to fewer interactions and isolation for both people living with dementia and their caregivers, negatively impacting the quality of life for both members of the dyad. The resulting stress and burden on caregivers make them particularly susceptible to burnout. Objective: This study aims to examine the efficacy of Communication Proches Aidants (COMPAs), an app designed following the principles of person-centered and emotional communication, which is intended to improve well-being in persons living with dementia and caregivers and reduce caregiver burden. Methods: In this implementation study, volunteer caregivers in 2 long-term care facilities (n=17) were trained in using COMPAs and strategies to improve communication with persons living with dementia. Qualitative and quantitative analyses, semistructured interviews, and questionnaires were completed before and after 8 weeks of intervention with COMPAs. Results: Semistructured interviews revealed that all caregivers perceived a positive impact following COMPAs interventions, namely, improved quality of communication and quality of life among persons living with dementia and caregivers. Improved quality of life was also supported by a statistically significant reduction in the General Health Questionnaire-12 scores (caregivers who improved: 9/17, 53\%; z=2.537; P=.01). COMPAs interventions were also associated with a statistically significant increased feeling of personal accomplishment (caregivers improved: 11/17, 65\%; t15=2.430; P=.03; d=0.61 [medium effect size]). Conclusions: COMPAs intervention improved well-being in persons living with dementia and their caregivers by developing person-centered communication within the dyad, increasing empathy, and reducing burden in caregivers although most caregivers were unfamiliar with technology. The results hold promise for COMPAs interventions in long-term care settings. Larger group-controlled studies with different populations, in different contexts, and at different stages of dementia will provide a clearer picture of the benefits of COMPAs interventions. ", doi="10.2196/47565", url="https://aging.jmir.org/2024/1/e47565", url="http://www.ncbi.nlm.nih.gov/pubmed/38963691" } @Article{info:doi/10.2196/51987, author="Chien, Shao-Yun and Zaslavsky, Oleg and Berridge, Clara", title="Technology Usability for People Living With Dementia: Concept Analysis", journal="JMIR Aging", year="2024", month="Jul", day="3", volume="7", pages="e51987", keywords="usability", keywords="dementia", keywords="older adults", keywords="technology", keywords="concept analysis", keywords="mobile phone", abstract="Background: Usability is a key indicator of the quality of technology products. In tandem with technological advancements, potential use by individuals with dementia is increasing. However, defining the usability of technology for individuals with dementia remains an ongoing challenge. The diverse and progressive nature of dementia adds complexity to the creation of universal usability criteria, highlighting the need for focused deliberations. Technological interventions offer potential benefits for people living with dementia and caregivers. Amid COVID-19, technology's role in health care access is growing, especially among older adults. Enabling the diverse population of people living with dementia to enjoy the benefits of technologies requires particular attention to their needs, desires, capabilities, and vulnerabilities to potential harm from technologies. Successful technological interventions for dementia require meticulous consideration of technology usability. Objective: This concept analysis aims to examine the usability of technology in the context of individuals living with dementia to establish a clear definition for usability within this specific demographic. Methods: The framework by Walker and Avant was used to guide this concept analysis. We conducted a literature review spanning 1984 to 2024, exploring technology usability for people with dementia through the PubMed, Web of Science, and Google Scholar databases using the keywords ``technology usability'' and ``dementia.'' We also incorporated clinical definitions and integrated interview data from 29 dyads comprising individuals with mild Alzheimer dementia and their respective care partners, resulting in a total of 58 older adults. This approach aimed to offer a more comprehensive portrayal of the usability needs of individuals living with dementia, emphasizing practical application. Results: The evidence from the literature review unveiled that usability encompasses attributes such as acceptable learnability, efficiency, and satisfaction. The clinical perspective on dementia stages, subtypes, and symptoms underscores the importance of tailored technology usability assessment. Feedback from 29 dyads also emphasized the value of simplicity, clear navigation, age-sensitive design, personalized features, and audio support. Thus, design should prioritize personalized assistance for individuals living with dementia, moving away from standardized technological approaches. Synthesized from various sources, the defined usability attributes for individuals living with dementia not only encompass the general usability properties of effectiveness, efficiency, and satisfaction but also include other key factors: adaptability, personalization, intuitiveness, and simplicity, to ensure that technology is supportive and yields tangible benefits for this demographic. Conclusions: Usability is crucial for people living with dementia when designing technological interventions. It necessitates an understanding of user characteristics, dementia stages, symptoms, needs, and tasks, as well as consideration of varied physical requirements, potential sensory loss, and age-related changes. Disease progression requires adapting to evolving symptoms. Recommendations include versatile, multifunctional technology designs; accommodating diverse needs; and adjusting software functionalities for personalization. Product feature classification can be flexible based on user conditions. ", doi="10.2196/51987", url="https://aging.jmir.org/2024/1/e51987" } @Article{info:doi/10.2196/52831, author="Paolillo, W. Emily and Casaletto, B. Kaitlin and Clark, L. Annie and Taylor, C. Jack and Heuer, W. Hilary and Wise, B. Amy and Dhanam, Sreya and Sanderson-Cimino, Mark and Saloner, Rowan and Kramer, H. Joel and Kornak, John and Kremers, Walter and Forsberg, Leah and Appleby, Brian and Bayram, Ece and Bozoki, Andrea and Brushaber, Danielle and Darby, Ryan R. and Day, S. Gregory and Dickerson, C. Bradford and Domoto-Reilly, Kimiko and Elahi, Fanny and Fields, A. Julie and Ghoshal, Nupur and Graff-Radford, Neill and G H Hall, Matthew and Honig, S. Lawrence and Huey, D. Edward and Lapid, I. Maria and Litvan, Irene and Mackenzie, R. Ian and Masdeu, C. Joseph and Mendez, F. Mario and Mester, Carly and Miyagawa, Toji and Naasan, Georges and Pascual, Belen and Pressman, Peter and Ramos, Marisa Eliana and Rankin, P. Katherine and Rexach, Jessica and Rojas, C. Julio and VandeVrede, Lawren and Wong, Bonnie and Wszolek, K. Zbigniew and Boeve, F. Bradley and Rosen, J. Howard and Boxer, L. Adam and Staffaroni, M. Adam and ", title="Examining Associations Between Smartphone Use and Clinical Severity in Frontotemporal Dementia: Proof-of-Concept Study", journal="JMIR Aging", year="2024", month="Jun", day="26", volume="7", pages="e52831", keywords="digital", keywords="technology", keywords="remote", keywords="monitoring", keywords="cognition", keywords="neuropsychology", keywords="cognitive impairment", keywords="neurodegenerative", keywords="screening", keywords="clinical trials", keywords="mobile phone", abstract="Background: Frontotemporal lobar degeneration (FTLD) is a leading cause of dementia in individuals aged <65 years. Several challenges to conducting in-person evaluations in FTLD illustrate an urgent need to develop remote, accessible, and low-burden assessment techniques. Studies of unobtrusive monitoring of at-home computer use in older adults with mild cognitive impairment show that declining function is reflected in reduced computer use; however, associations with smartphone use are unknown. Objective: This study aims to characterize daily trajectories in smartphone battery use, a proxy for smartphone use, and examine relationships with clinical indicators of severity in FTLD. Methods: Participants were 231 adults (mean age 52.5, SD 14.9 years; n=94, 40.7\% men; n=223, 96.5\% non-Hispanic White) enrolled in the Advancing Research and Treatment of Frontotemporal Lobar Degeneration (ARTFL study) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS study) Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) Mobile App study, including 49 (21.2\%) with mild neurobehavioral changes and no functional impairment (ie, prodromal FTLD), 43 (18.6\%) with neurobehavioral changes and functional impairment (ie, symptomatic FTLD), and 139 (60.2\%) clinically normal adults, of whom 55 (39.6\%) harbored heterozygous pathogenic or likely pathogenic variants in an autosomal dominant FTLD gene. Participants completed the Clinical Dementia Rating plus National Alzheimer's Coordinating Center Frontotemporal Lobar Degeneration Behavior and Language Domains (CDR+NACC FTLD) scale, a neuropsychological battery; the Neuropsychiatric Inventory; and brain magnetic resonance imaging. The ALLFTD Mobile App was installed on participants' smartphones for remote, passive, and continuous monitoring of smartphone use. Battery percentage was collected every 15 minutes over an average of 28 (SD 4.2; range 14-30) days. To determine whether temporal patterns of battery percentage varied as a function of disease severity, linear mixed effects models examined linear, quadratic, and cubic effects of the time of day and their interactions with each measure of disease severity on battery percentage. Models covaried for age, sex, smartphone type, and estimated smartphone age. Results: The CDR+NACC FTLD global score interacted with time on battery percentage such that participants with prodromal or symptomatic FTLD demonstrated less change in battery percentage throughout the day (a proxy for less smartphone use) than clinically normal participants (P<.001 in both cases). Additional models showed that worse performance in all cognitive domains assessed (ie, executive functioning, memory, language, and visuospatial skills), more neuropsychiatric symptoms, and smaller brain volumes also associated with less battery use throughout the day (P<.001 in all cases). Conclusions: These findings support a proof of concept that passively collected data about smartphone use behaviors associate with clinical impairment in FTLD. This work underscores the need for future studies to develop and validate passive digital markers sensitive to longitudinal clinical decline across neurodegenerative diseases, with potential to enhance real-world monitoring of neurobehavioral change. ", doi="10.2196/52831", url="https://aging.jmir.org/2024/1/e52831", url="http://www.ncbi.nlm.nih.gov/pubmed/38922667" } @Article{info:doi/10.2196/37625, author="Hsiao, Hsun Kai and Quinn, Emma and Johnstone, Travers and Gomez, Maria and Ingleton, Andrew and Parasuraman, Arun and Najjar, Zeina and Gupta, Leena", title="A Novel Web-Based Application for Influenza and COVID-19 Outbreak Detection and Response in Residential Aged Care Facilities", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="24", volume="10", pages="e37625", keywords="web application", keywords="digital health", keywords="communicable disease control", keywords="outbreak", keywords="surveillance", keywords="influenza", keywords="aged care", keywords="aged care homes", doi="10.2196/37625", url="https://publichealth.jmir.org/2024/1/e37625" } @Article{info:doi/10.2196/52248, author="Adam, Esmee and Meiland, Franka and Frielink, Noud and Meinders, Erwin and Smits, Reon and Embregts, Petri and Smaling, Hanneke", title="User Requirements and Perceptions of a Sensor System for Early Stress Detection in People With Dementia and People With Intellectual Disability: Qualitative Study", journal="JMIR Form Res", year="2024", month="Jun", day="21", volume="8", pages="e52248", keywords="stress detection", keywords="sensor system", keywords="garment integrated", keywords="wearable", keywords="user requirements", keywords="dementia", keywords="intellectual disability", keywords="intellectual disabilities", keywords="long-term care", keywords="perceptions", keywords="wearables", keywords="qualitative study", keywords="residents", keywords="communication impairment", keywords="impairments", keywords="garment sensor", abstract="Background: Timely detection of stress in people with dementia and people with an intellectual disability (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care (LTC) residents with dementia and residents with ID have communication impairments, limiting their ability to express themselves. Wearables can help detect stress but are not always accepted by users and are uncomfortable to wear for longer periods. Integrating sensors into clothing may be a more acceptable approach for users in LTC. To develop a sensor system for early stress detection that is accepted by LTC residents with dementia and residents with ID, understanding their perceptions and requirements is essential. Objective: This study aimed to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users toward the sensor system, and (3) investigate the implementation requirements in LTC settings. Methods: A qualitative design with 18 focus groups and 29 interviews was used. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, people with ID, family caregivers, health care professionals). The focus groups were conducted at 3 time points within a 6-month period, where each new focus group built on the findings of previous rounds. The data from each round were used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data. Results: The study included 44 participants who expressed a positive attitude toward the idea of a garment-integrated sensor system but also identified some potential concerns. In addition to early stress detection, participants recognized other potential purposes or benefits of the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as washability and safety, and user requirements, such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the cost of the sensor system, added value to resident and health care professionals, and education for all users. Conclusions: The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for health care professionals and LTC residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice. ", doi="10.2196/52248", url="https://formative.jmir.org/2024/1/e52248" } @Article{info:doi/10.2196/55842, author="Song, Sunmi and Seo, YoungBin and Hwang, SeoYeon and Kim, Hae-Young and Kim, Junesun", title="Digital Phenotyping of Geriatric Depression Using a Community-Based Digital Mental Health Monitoring Platform for Socially Vulnerable Older Adults and Their Community Caregivers: 6-Week Living Lab Single-Arm Pilot Study", journal="JMIR Mhealth Uhealth", year="2024", month="Jun", day="17", volume="12", pages="e55842", keywords="depression", keywords="monitoring system", keywords="IoT", keywords="AI", keywords="wearable device", keywords="digital mental health phenotyping", keywords="living lab", keywords="senior care", keywords="Internet of Things", keywords="artificial intelligence", abstract="Background: Despite the increasing need for digital services to support geriatric mental health, the development and implementation of digital mental health care systems for older adults have been hindered by a lack of studies involving socially vulnerable older adult users and their caregivers in natural living environments. Objective: This study aims to determine whether digital sensing data on heart rate variability, sleep quality, and physical activity can predict same-day or next-day depressive symptoms among socially vulnerable older adults in their everyday living environments. In addition, this study tested the feasibility of a digital mental health monitoring platform designed to inform older adult users and their community caregivers about day-to-day changes in the health status of older adults. Methods: A single-arm, nonrandomized living lab pilot study was conducted with socially vulnerable older adults (n=25), their community caregivers (n=16), and a managerial social worker over a 6-week period during and after the COVID-19 pandemic. Depressive symptoms were assessed daily using the 9-item Patient Health Questionnaire via scripted verbal conversations with a mobile chatbot. Digital biomarkers for depression, including heart rate variability, sleep, and physical activity, were measured using a wearable sensor (Fitbit Sense) that was worn continuously, except during charging times. Daily individualized feedback, using traffic signal signs, on the health status of older adult users regarding stress, sleep, physical activity, and health emergency status was displayed on a mobile app for the users and on a web application for their community caregivers. Multilevel modeling was used to examine whether the digital biomarkers predicted same-day or next-day depressive symptoms. Study staff conducted pre- and postsurveys in person at the homes of older adult users to monitor changes in depressive symptoms, sleep quality, and system usability. Results: Among the 31 older adult participants, 25 provided data for the living lab and 24 provided data for the pre-post test analysis. The multilevel modeling results showed that increases in daily sleep fragmentation (P=.003) and sleep efficiency (P=.001) compared with one's average were associated with an increased risk of daily depressive symptoms in older adults. The pre-post test results indicated improvements in depressive symptoms (P=.048) and sleep quality (P=.02), but not in the system usability (P=.18). Conclusions: The findings suggest that wearable sensors assessing sleep quality may be utilized to predict daily fluctuations in depressive symptoms among socially vulnerable older adults. The results also imply that receiving individualized health feedback and sharing it with community caregivers may help improve the mental health of older adults. However, additional in-person training may be necessary to enhance usability. Trial Registration: ClinicalTrials.gov NCT06270121; https://clinicaltrials.gov/study/NCT06270121 ", doi="10.2196/55842", url="https://mhealth.jmir.org/2024/1/e55842", url="http://www.ncbi.nlm.nih.gov/pubmed/38885033" } @Article{info:doi/10.2196/58205, author="Miguel-Cruz, Antonio and Perez, Hector and Choi, Yoojin and Rutledge, Emily and Daum, Christine and Liu, Lili", title="The Prevalence of Missing Incidents and Their Antecedents Among Older Adult MedicAlert Subscribers: Retrospective Descriptive Study", journal="JMIR Aging", year="2024", month="Jun", day="10", volume="7", pages="e58205", keywords="dementia", keywords="Alzheimer disease", keywords="memory loss", keywords="cognitive impairment", keywords="missing incident", keywords="wandering", keywords="critical wandering", keywords="older adults", keywords="retrospective design", abstract="Background: With the population aging, the number of people living with dementia is expected to rise, which, in turn, is expected to lead to an increase in the prevalence of missing incidents due to critical wandering. However, the estimated prevalence of missing incidents due to dementia is inconclusive in some jurisdictions and overlooked in others. Objective: The aims of the study were to examine (1) the demographic, psychopathological, and environmental antecedents to missing incidents due to critical wandering among older adult MedicAlert Foundation Canada (hereinafter MedicAlert) subscribers; and (2) the characteristics and outcomes of the missing incidents. Methods: This study used a retrospective descriptive design. The sample included 434 older adult MedicAlert subscribers involved in 560 missing incidents between January 2015 and July 2021. Results: The sample was overrepresented by White older adults (329/425, 77.4\%). MedicAlert subscribers reported missing were mostly female older adults (230/431, 53.4\%), living in urban areas with at least 1 family member (277/433, 63.8\%). Most of the MedicAlert subscribers (345/434, 79.5\%) self-reported living with dementia. MedicAlert subscribers went missing most frequently from their private homes in the community (96/143, 67.1\%), traveling on foot (248/270, 91.9\%) and public transport (12/270, 4.4\%), during the afternoon (262/560, 46.8\%) and evening (174/560, 31.1\%). Most were located by first responders (232/486, 47.7\%) or Good Samaritans (224/486, 46.1\%). Of the 560 missing incidents, 126 (22.5\%) were repeated missing incidents. The mean time between missing incidents was 11 (SD 10.8) months. Finally, the majority of MedicAlert subscribers were returned home safely (453/500, 90.6\%); and reports of harm, injuries (46/500, 9.2\%), and death (1/500, 0.2\%) were very low. Conclusions: This study provides the prevalence of missing incidents from 1 database source. The low frequency of missing incidents may not represent populations that are not White. Despite the low number of missing incidents, the 0.2\% (1/500) of cases resulting in injuries or death are devastating experiences that may be mitigated through prevention strategies. ", doi="10.2196/58205", url="https://aging.jmir.org/2024/1/e58205", url="http://www.ncbi.nlm.nih.gov/pubmed/38857069" } @Article{info:doi/10.2196/50107, author="Goerss, Doreen and K{\"o}hler, Stefanie and Rong, Eleonora and Temp, Gesine Anna and Kilimann, Ingo and Bieber, Gerald and Teipel, Stefan", title="Smartwatch-Based Interventions for People With Dementia: User-Centered Design Approach", journal="JMIR Aging", year="2024", month="Jun", day="7", volume="7", pages="e50107", keywords="assistive technology", keywords="user-centered design", keywords="usability", keywords="dementia", keywords="smartwatch", keywords="mobile phone", abstract="Background: Assistive technologies can help people living with dementia maintain their everyday activities. Nevertheless, there is a gap between the potential and use of these materials. Involving future users may help close this gap, but the impact on people with dementia is unclear. Objective: We aimed to determine if user-centered development of smartwatch-based interventions together with people with dementia is feasible. In addition, we evaluated the extent to which user feedback is plausible and therefore helpful for technological improvements. Methods: We examined the interactions between smartwatches and people with dementia or people with mild cognitive impairment. All participants were prompted to complete 2 tasks (drinking water and a specific cognitive task). Prompts were triggered using a smartphone as a remote control and were repeated up to 3 times if participants failed to complete a task. Overall, 50\% (20/40) of the participants received regular prompts, and 50\% (20/40) received intensive audiovisual prompts to perform everyday tasks. Participants' reactions were observed remotely via cameras. User feedback was captured via questionnaires, which included topics like usability, design, usefulness, and concerns. The internal consistency of the subscales was calculated. Plausibility was also checked using qualitative approaches. Results: Participants noted their preferences for particular functions and improvements. Patients struggled with rating using the Likert scale; therefore, we assisted them with completing the questionnaire. Usability (mean 78 out of 100, SD 15.22) and usefulness (mean 9 out of 12) were rated high. The smartwatch design was appealing to most participants (31/40, 76\%). Only a few participants (6/40, 15\%) were concerned about using the watch. Better usability was associated with better cognition. The observed success and self-rated task comprehension were in agreement for most participants (32/40, 80\%). In different qualitative analyses, participants' responses were, in most cases, plausible. Only 8\% (3/40) of the participants were completely unaware of their irregular task performance. Conclusions: People with dementia can have positive experiences with smartwatches. Most people with dementia provided valuable information. Developing assistive technologies together with people with dementia can help to prioritize the future development of functional and nonfunctional features. ", doi="10.2196/50107", url="https://aging.jmir.org/2024/1/e50107", url="http://www.ncbi.nlm.nih.gov/pubmed/38848116" } @Article{info:doi/10.2196/53261, author="Szczepocka, Ewa and Mokros, ?ukasz and Kazmierski, Jakub and Nowakowska, Karina and ?ucka, Anna and Antoszczyk, Anna and Oltra-Cucarella, Javier and Werzowa, Walter and Hellevik, Moum Martin and Skouras, Stavros and Bagger, Karsten", title="The Effectiveness of Virtual Reality--Based Training on Cognitive, Social, and Physical Functioning in High-Functioning Older Adults (CoSoPhy FX): 2-Arm, Parallel-Group Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Jun", day="5", volume="13", pages="e53261", keywords="cognitive functions", keywords="head-mounted-display", keywords="healthy seniors", keywords="virtual reality", keywords="well-being", keywords="mobile phone", abstract="Background: Virtual reality (VR) has emerged as a promising technology for enhancing the health care of older individuals, particularly in the domains of cognition, physical activity, and social engagement. However, existing VR products and services have limited availability and affordability; hence, there is a need for a scientifically validated and personalized VR service to be used by older adults in their homes, which can improve their overall physical, cognitive, and social well-being. Objective: The main purpose of the CoSoPhy FX (Cognitive, Social, and Physical Effects) study was to analyze the effects of a VR-based digital therapeutics app on the cognitive, social, and physical performance abilities of healthy (high-functioning) older adults. This paper presents the study protocol and the results from the recruitment phase. Methods: A group of 188 healthy older adults aged 65-85 years, recruited at the Medical University of Lodz, Poland, were randomly allocated to the experimental group (VR dual-task training program) or to the control group (using a VR headset app showing nature videos). A total of 3 cognitive exercises were performed in various 360{\textdegree} nature environments delivered via a VR head-mounted display; the participants listened to their preferred music genre. Each patient received 3 sessions of 12 minutes per week for 12 weeks, totaling a minimum of 36 sessions per participant. Attention and working memory (Central Nervous System Vital Signs computerized cognitive battery) were used as primary outcomes, while other cognitive domains in the Central Nervous System Vital Signs battery, quality of life (World Health Organization--5 Well-Being Index), health-related quality of life (EQ-5D-5L), and anxiety (General Anxiety Disorder 7-item questionnaire) were the secondary outcomes. The group-by-time interaction was determined using linear mixed models with participants' individual slopes. Results: In total, 122 (39\%) of the initial 310 participants failed to meet the inclusion criteria, resulting in a recruitment rate of 61\% (188/310). Among the participants, 68 successfully completed the intervention and 62 completed the control treatment. The data are currently being analyzed, and we plan to publish the results by the end of September 2024. Conclusions: VR interventions have significant potential among healthy older individuals. VR can address various aspects of well-being by stimulating cognitive functions, promoting physical activity, and facilitating social interaction. However, challenges such as physical discomfort, technology acceptance, safety concerns, and cost must be considered when implementing them for older adults. Further research is needed to determine the long-term effects of VR-based interventions, optimal intervention designs, and the specific populations that would benefit most. Trial Registration: ClinicalTrials.gov NCT05369897; https://clinicaltrials.gov/study/NCT05369897 International Registered Report Identifier (IRRID): DERR1-10.2196/53261 ", doi="10.2196/53261", url="https://www.researchprotocols.org/2024/1/e53261", url="http://www.ncbi.nlm.nih.gov/pubmed/38837194" } @Article{info:doi/10.2196/56653, 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/10.2196/56184, author="Tabira, Kento and Oguma, Yuko and Yoshihara, Shota and Shibuya, Megumi and Nakamura, Manabu and Doihara, Natsue and Hirata, Akihiro and Manabe, Tomoki", title="Digital Peer-Supported App Intervention to Promote Physical Activity Among Community-Dwelling Older Adults: Nonrandomized Controlled Trial", journal="JMIR Aging", year="2024", month="May", day="30", volume="7", pages="e56184", keywords="physical activity", keywords="physical function", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="ageing", keywords="aging", keywords="aged", keywords="digital peer support app", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="eHealth", keywords="peer support", keywords="exercise", keywords="mobile phone", abstract="Background: The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support--based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated. Objective: This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users. Methods: We conducted a nonrandomized controlled trial of older adults aged ?65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test. Results: The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88\% (36/41) and 87.7\%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, P=.04; duration of MVPA, P=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels. Conclusions: The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials. ", doi="10.2196/56184", url="https://aging.jmir.org/2024/1/e56184", url="http://www.ncbi.nlm.nih.gov/pubmed/38814686" } @Article{info:doi/10.2196/46108, author="Kelley, M. Marjorie and Powell, Tia and Camara, Djibril and Shah, Neha and Norton, M. Jenna and Deitelzweig, Chelsea and Vaidy, Nivedha and Hsiao, Chun-Ju and Wang, Jing and Bierman, S. Arlene", title="Mobile Health Apps, Family Caregivers, and Care Planning: Scoping Review", journal="J Med Internet Res", year="2024", month="May", day="23", volume="26", pages="e46108", keywords="caregivers", keywords="carers", keywords="informal caregivers", keywords="family caregivers", keywords="mHealth applications", keywords="telemedicine", keywords="mobile health", keywords="mHealth", keywords="eHealth", keywords="digital health", keywords="apps", keywords="chronic condition", keywords="caregiver", keywords="application", keywords="support", keywords="clinicians", keywords="development", keywords="electronic health record", keywords="implementation", keywords="mobile phone", abstract="Background: People living with multiple chronic conditions (MCCs) face substantial challenges in planning and coordinating increasingly complex care. Family caregivers provide important assistance for people with MCCs but lack sufficient support. Caregiver apps have the potential to help by enhancing care coordination and planning among the health care team, including patients, caregivers, and clinicians. Objective: We aim to conduct a scoping review to assess the evidence on the development and use of caregiver apps that support care planning and coordination, as well as to identify key factors (ie, needs, barriers, and facilitators) related to their use and desired caregiver app functionalities. Methods: Papers intersecting 2 major domains, mobile health (mHealth) apps and caregivers, that were in English and published from 2015 to 2021 were included in the initial search from 6 databases and gray literature and ancestry searches. As per JBI (Joanna Briggs Institute) Scoping Review guidelines and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), 2 authors independently screened full texts with disagreements resolved by a third author. Working in pairs, the authors extracted data using a pilot-tested JBI extraction table and compared results for consensus. Results: We identified 34 papers representing 25 individual studies, including 18 (53\%) pilot and feasibility studies, 13 (38\%) qualitative studies, and 2 experimental or quasi-experimental studies. None of the identified studies assessed an intervention of a caregiver app for care planning and coordination for people with MCCs. We identified important caregiver needs in terms of information, support, and care coordination related to both caregiving and self-care. We compiled desired functionalities and features enabling apps to meet the care planning and care coordination needs of caregivers, in particular, the integration of caregiver roles into the electronic health record. Conclusions: Caregiver needs identified through this study can inform developers and researchers in the design and implementation of mHealth apps that integrate with the electronic health record to link caregivers, patients, and clinicians to support coordinated care for people with MCCs. In addition, this study highlights the need for more rigorous research on the use of mHealth apps to support caregivers in care planning and coordination. ", doi="10.2196/46108", url="https://www.jmir.org/2024/1/e46108", url="http://www.ncbi.nlm.nih.gov/pubmed/38781588" } @Article{info:doi/10.2196/54101, author="Teh, Pei-Lee and Kwok, J. Andrei O. and Cheong, Loong Wing and Lee, Shaun", title="Insights Into the Use of a Digital Healthy Aging Coach (AGATHA) for Older Adults From Malaysia: App Engagement, Usability, and Impact Study", journal="JMIR Form Res", year="2024", month="May", day="21", volume="8", pages="e54101", keywords="digital health", keywords="older adults", keywords="digital divide", keywords="aging", keywords="pilot", keywords="Malaysia", keywords="coach", keywords="digital access", keywords="social barrier", keywords="virtual", keywords="virtual coach", keywords="digital tool", keywords="tool", keywords="engagement", keywords="gamification", keywords="user experience", keywords="app", keywords="technology tool", keywords="digital literacy", keywords="user experience design", keywords="decision support", keywords="support", abstract="Background: Digital inclusion is considered a pivotal social determinant of health, particularly for older adults who may face significant barriers to digital access due to physical, sensory, and social limitations. Avatar for Global Access to Technology for Healthy Aging (AGATHA) is a virtual healthy aging coach developed by the World Health Organization to address these challenges. Designed as a comprehensive virtual coach, AGATHA comprises a gamified platform that covers multiple health-related topics and modules aimed at fostering user engagement and promoting healthy aging. Objective: The aim of this study was to explore the perception and user experience of Malaysian older adults in their interactions with the AGATHA app and its avatar. The focus of this study was to examine the engagement, usability, and educational impact of the app on health literacy and digital skills. Methods: We performed a qualitative study among adults 60 years and older from suburban and rural communities across six states in Malaysia. Participants were purposefully recruited to ensure representation across various socioeconomic and cultural backgrounds. Each participant attended a 1-hour training session to familiarize themselves with the interface and functionalities of AGATHA. Subsequently, all participants were required to engage with the AGATHA app two to three times per week for up to 2 weeks. Upon completion of this trial phase, an in-depth interview session was conducted to gather detailed feedback on their experiences. Results: Overall, the participants found AGATHA to be highly accessible and engaging. The content was reported to have a comprehensive structure and was delivered in an easily understandable and informative manner. Moreover, the participants found the app to be beneficial in enhancing their understanding pertaining to health-related issues in aging. Some key feedback gathered highlighted the need for increased interactive features that would allow for interaction with peers, better personalization of content tailored to the individual's health condition, and improvement in the user-experience design to accommodate older users' specific needs. Furthermore, enhancements in decision-support features within the app were suggested to better assist users in making health decisions. Conclusions: The prototype digital health coaching program AGATHA was well received as a user-friendly tool suitable for beginners, and was also perceived to be useful to enhance older adults' digital literacy and confidence. The findings of this study offer important insights for designing other digital health tools and interventions targeting older adults, highlighting the importance of a user-centered design and personalization to improve the adoption of digital health solutions among older adults. This study also serves as a useful starting point for further development and refinement of digital health programs aimed at fostering an inclusive, supportive digital environment for older adults. ", doi="10.2196/54101", url="https://formative.jmir.org/2024/1/e54101", url="http://www.ncbi.nlm.nih.gov/pubmed/38772022" } @Article{info:doi/10.2196/46151, author="Lemos, Marta and Henriques, Rita Ana and Lopes, Gil David and Mendon{\c{c}}a, Nuno and Victorino, Andr{\'e} and Costa, Andreia and Arriaga, Miguel and Greg{\'o}rio, Jo{\~a}o Maria and de Sousa, Rute and Canh{\~a}o, Helena and Rodrigues, M. Ana", title="Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study", journal="JMIR Form Res", year="2024", month="May", day="17", volume="8", pages="e46151", keywords="DigiAdherence", keywords="mHealth", keywords="mobile app", keywords="technology", keywords="utility", keywords="usability", keywords="ICT", keywords="application", keywords="patient-centered", keywords="tool", keywords="prevention", keywords="falls", keywords="treatment", keywords="nutrition", keywords="physical activity", keywords="pilot study", keywords="older adults", keywords="adherence", keywords="engagement", keywords="compliance", abstract="Background: Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity. Objective: This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older. Methods: In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portim{\~a}o, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed. Results: The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67\%) and managing therapies and polypharmacy (16/26, 62\%). Conclusions: The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge. International Registered Report Identifier (IRRID): RR2-10.2196/29675 ", doi="10.2196/46151", url="https://formative.jmir.org/2024/1/e46151", url="http://www.ncbi.nlm.nih.gov/pubmed/38758585" } @Article{info:doi/10.2196/53587, author="Shashidhara, N. Y. and Raghavendra, G. and P Kundapur, Poornima and Binil, V.", title="Effectiveness of Gerontechnology Empowerment Program on Awareness and Use of Mobile Apps Among Older Adults for Instrumental Activities of Daily Living: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="May", day="13", volume="13", pages="e53587", keywords="gerontechnology", keywords="older adults", keywords="awareness", keywords="older people", keywords="instrumental activities of daily living", keywords="iADLs", keywords="mobile apps", keywords="mobile phone", keywords="empowerment", abstract="Background: Instrumental activities of daily living (iADLs) are crucial for older adults to live independently. Health care and technological advancements will increase the older adult population and life expectancy globally. Difficulties with iADLs impact older adults' quality of life. Mobile apps can assist older adults, but many require help due to limited awareness. Lack of awareness is a barrier to app use. Existing literature mainly covers health care and app design, needing more focus on iADL apps for older adults. Objective: The study objectives encompass 2 main aspects: first, to evaluate the awareness, use, and factors influencing the use of apps among older adults for iADLs; and second, to create and assess the effectiveness of a gerontechnology empowerment program (GEP) for older adults on the awareness and use of apps for iADLs. Methods: This research uses a quantitative approach divided into 2 distinct phases. In phase 1, we conduct a descriptive survey to assess the level of awareness and use of mobile apps for iADLs and identify the factors that influence the use of such apps among older adults. To ensure clarity and comprehension among participants, we provide them with a subject information sheet in both Kannada and English. The data collected during this phase enable us to gain insights into awareness levels, use patterns, and factors that shape older adults' use of apps for iADLs. The results serve as the foundation for designing the GEP. In phase 2, a cluster randomization method will be used to select older adults aged 60 to 75 years in Udupi district, Karnataka, India, who are active smartphone users. These participants will be divided into 2 groups: the experimental and the control groups. The experimental group will join the GEP. The sample size for phase 1 is 554, and phase 2 is 50. To assess the effectiveness of this program, we will measure the outcomes before and after its implementation using the same assessment tools used in phase 1. Results: This study is funded by the Indian Council of Medical Research (Adhoc/193/2022/SBHSR on November 18, 2022). Phase 1 data collection is expected to be completed by November 2023, and phase 2 is scheduled to commence in the upcoming months. Phase 1 and 2 findings will be analyzed and discussed in the main paper, which we intend to submit to a high-quality peer-reviewed journal for publication. The research protocol, informed consent forms, and associated documentation received approval from institutional ethics committees (214/2020). Conclusions: Upon the successful testing of the GEP, it can be recommended that welfare departments encourage older adults to use mobile apps for iADLs and establish training programs to provide support to older adults in using these apps. Trial Registration: Clinical Trials Registry - India CTRI/2020/09/027977; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDUxMzM=\&Enc=\&userName=027977 International Registered Report Identifier (IRRID): DERR1-10.2196/53587 ", doi="10.2196/53587", url="https://www.researchprotocols.org/2024/1/e53587", url="http://www.ncbi.nlm.nih.gov/pubmed/38739442" } @Article{info:doi/10.2196/53192, author="Au-Yeung, M. Wan-Tai and Liu, Yan and Hanna, Remonda and Gothard, Sarah and Rodrigues, Nathaniel and Leon Guerrero, Cierra and Beattie, Zachary and Kaye, Jeffrey", title="Feasibility of Deploying Home-Based Digital Technology, Environmental Sensors, and Web-Based Surveys for Assessing Behavioral Symptoms and Identifying Their Precipitants in Older Adults: Longitudinal, Observational Study", journal="JMIR Form Res", year="2024", month="May", day="8", volume="8", pages="e53192", keywords="neuropsychiatric symptoms", keywords="mild cognitive impairment", keywords="dementia", keywords="unobtrusive monitoring", keywords="digital biomarkers", keywords="environmental precipitants", keywords="mobile phone", abstract="Background: Apathy, depression, and anxiety are prevalent neuropsychiatric symptoms experienced by older adults. Early detection, prevention, and intervention may improve outcomes. Objective: We aim to demonstrate the feasibility of deploying web-based weekly questionnaires inquiring about the behavioral symptoms of older adults with normal cognition, mild cognitive impairment, or early-stage dementia and to demonstrate the feasibility of deploying an in-home technology platform for measuring participant behaviors and their environment. Methods: The target population of this study is older adults with normal cognition, mild cognitive impairment, or early-stage dementia. This is an observational, longitudinal study with a study period of up to 9 months. The severity of participant behavioral symptoms (apathy, depression, and anxiety) was self-reported weekly through web-based surveys. Participants' digital biomarkers were continuously collected at their personal residences and through wearables throughout the duration of the study. The indoor physical environment at each residence, such as light level, noise level, temperature, humidity, or air quality, was also measured using indoor environmental sensors. Feasibility was examined, and preliminary correlation analysis between the level of symptoms and the digital biomarkers and between the level of symptoms and the indoor environment was performed. Results: At 13 months after recruitment began, a total of 9 participants had enrolled into this study. The participants showed high adherence rates in completing the weekly questionnaires (response rate: 275/278, 98.9\%), and data collection using the digital technology appeared feasible and acceptable to the participants with few exceptions. Participants' severity of behavioral symptoms fluctuated from week to week. Preliminary results show that the duration of sleep onset and noise level are positively correlated with the anxiety level in a subset of our participants. Conclusions: This study is a step toward more frequent assessment of older adults' behavioral symptoms and holistic in situ monitoring of older adults' behaviors and their living environment. The goal of this study is to facilitate the development of objective digital biomarkers of neuropsychiatric symptoms and to identify in-home environmental factors that contribute to these symptoms. ", doi="10.2196/53192", url="https://formative.jmir.org/2024/1/e53192", url="http://www.ncbi.nlm.nih.gov/pubmed/38717798" } @Article{info:doi/10.2196/54128, author="Roberts, Lynae R. and Cherry, D. Katelin and Mohan, P. Desh and Statler, Tiffany and Kirkendall, Eric and Moses, Adam and McCraw, Jennifer and Brown III, E. Andrew and Fofanova, Y. Tatiana and Gabbard, Jennifer", title="A Personalized and Interactive Web-Based Advance Care Planning Intervention for Older Adults (Koda Health): Pilot Feasibility Study", journal="JMIR Aging", year="2024", month="May", day="6", volume="7", pages="e54128", keywords="advance care planning", keywords="ACP", keywords="digital health tools", keywords="system usability", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="ageing", keywords="aging", keywords="adoption", keywords="acceptance", keywords="usability", keywords="digital health", keywords="platform", keywords="website", keywords="websites", abstract="Background: Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Digital applications may help facilitate this process, though their use in older adults has not been adequately studied. Objective: This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, a web-based patient-facing ACP platform, among older adults. Methods: Older adults (aged 50 years and older) who had an active Epic MyChart account at an academic health care system in North Carolina were recruited to participate. A total of 2850 electronic invitations were sent through MyChart accounts with an embedded hyperlink to the Koda platform. Participants who agreed to participate were asked to complete pre- and posttest surveys before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and System Usability Scale (SUS) scores. Exploratory outcomes included ACP knowledge and readiness. Results: A total of 161 participants enrolled in the study and created an account on the platform (age: mean 63, SD 9.3 years), with 80\% (129/161) of these participants going on to complete all steps of the intervention, thereby generating an advance directive. Participants reported minimal difficulty in using the Koda platform, with an overall SUS score of 76.2. Additionally, knowledge of ACP (eg, mean increase from 3.2 to 4.2 on 5-point scale; P<.001) and readiness (eg, mean increase from 2.6 to 3.2 on readiness to discuss ACP with health care provider; P<.001) significantly increased from before to after the intervention. Conclusions: This study demonstrated that the Koda Health platform is feasible, had above-average usability, and improved ACP documentation of preferences in older adults. Our findings indicate that web-based health tools like Koda may help older individuals learn about and feel more comfortable with ACP while potentially facilitating greater engagement in care planning. ", doi="10.2196/54128", url="https://aging.jmir.org/2024/1/e54128" } @Article{info:doi/10.2196/54120, 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/10.2196/51076, author="Chen, Han Tzu and Lee, Shin-Da and Ma, Wei-Fen", title="Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study", journal="JMIR Form Res", year="2024", month="Apr", day="29", volume="8", pages="e51076", keywords="app quality", keywords="caregiver", keywords="dementia", keywords="geriatrics", keywords="aging", keywords="technology", keywords="digital health", keywords="mHealth", keywords="mobile health", keywords="seniors", keywords="mobile app", keywords="patient", keywords="adoption", keywords="development", keywords="management", abstract="Background: The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps. Objective: The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers. Methods: We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads. Results: Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three-- and bottom three--rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t15=4.087, P<.001), this may not be a significant determinant of the app's perceived impact. Conclusions: The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app. ", doi="10.2196/51076", url="https://formative.jmir.org/2024/1/e51076", url="http://www.ncbi.nlm.nih.gov/pubmed/38684083" } @Article{info:doi/10.2196/52075, author="Yoon, Minjae and Lee, Seonhwa and Choi, Yeon Jah and Jung, Mi-Hyang and Youn, Jong-Chan and Shim, Young Chi and Choi, Jin-Oh and Kim, Ju Eung and Kim, Hyungseop and Yoo, Byung-Su and Son, Joo Yeon and Choi, Dong-Ju", title="Effectiveness of a Smartphone App--Based Intervention With Bluetooth-Connected Monitoring Devices and a Feedback System in Heart Failure (SMART-HF Trial): Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Apr", day="29", volume="26", pages="e52075", keywords="heart failure", keywords="mobile applications", keywords="mobile health", keywords="self-care", keywords="vital sign monitoring", keywords="mobile phone", abstract="Background: Current heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. Objective: We developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app--based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. Methods: In this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. Results: At 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean --1.3, SD 2.1 vs mean --0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. Conclusions: The mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app--based self-care strategies and feedback for patients with HF. Trial Registration: ClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT05668000 ", doi="10.2196/52075", url="https://www.jmir.org/2024/1/e52075", url="http://www.ncbi.nlm.nih.gov/pubmed/38683665" } @Article{info:doi/10.2196/56883, author="McMurray, Josephine and Levy, AnneMarie and Pang, Wei and Holyoke, Paul", title="Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Apr", day="19", volume="26", pages="e56883", keywords="cognitive dysfunction", keywords="dementia neuropsychological tests", keywords="evaluation study", keywords="technology", keywords="aged", keywords="mobile phone", abstract="Background: With the rapid aging of the global population, the prevalence of mild cognitive impairment (MCI) and dementia is anticipated to surge worldwide. MCI serves as an intermediary stage between normal aging and dementia, necessitating more sensitive and effective screening tools for early identification and intervention. The BrainFx SCREEN is a novel digital tool designed to assess cognitive impairment. This study evaluated its efficacy as a screening tool for MCI in primary care settings, particularly in the context of an aging population and the growing integration of digital health solutions. Objective: The primary objective was to assess the validity, reliability, and applicability of the BrainFx SCREEN (hereafter, the SCREEN) for MCI screening in a primary care context. We conducted an exploratory study comparing the SCREEN with an established screening tool, the Quick Mild Cognitive Impairment (Qmci) screen. Methods: A concurrent mixed methods, prospective study using a quasi-experimental design was conducted with 147 participants from 5 primary care Family Health Teams (FHTs; characterized by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants included health care practitioners, patients, and FHT administrative executives. Individuals aged ?55 years with no history of MCI or diagnosis of dementia rostered in a participating FHT were eligible to participate. Participants were screened using both the SCREEN and Qmci. The study also incorporated the Geriatric Anxiety Scale--10 to assess general anxiety levels at each cognitive screening. The SCREEN's scoring was compared against that of the Qmci and the clinical judgment of health care professionals. Statistical analyses included sensitivity, specificity, internal consistency, and test-retest reliability assessments. Results: The study found that the SCREEN's longer administration time and complex scoring algorithm, which is proprietary and unavailable for independent analysis, presented challenges. Its internal consistency, indicated by a Cronbach $\alpha$ of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate $\kappa$ (0.15) values. Sensitivity and specificity were consistent (63.25\% and 74.07\%, respectively) between cross-tabulation and discrepant analysis. In addition, the study faced limitations due to its demographic skew (96/147, 65.3\% female, well-educated participants), the absence of a comprehensive gold standard for MCI diagnosis, and financial constraints limiting the inclusion of confirmatory neuropsychological testing. Conclusions: The SCREEN, in its current form, does not meet the necessary criteria for an optimal MCI screening tool in primary care settings, primarily due to its longer administration time and lower reliability. As the number of digital health technologies increases and evolves, further testing and refinement of tools such as the SCREEN are essential to ensure their efficacy and reliability in real-world clinical settings. This study advocates for continued research in this rapidly advancing field to better serve the aging population. International Registered Report Identifier (IRRID): RR2-10.2196/25520 ", doi="10.2196/56883", url="https://www.jmir.org/2024/1/e56883", url="http://www.ncbi.nlm.nih.gov/pubmed/38640480" } @Article{info:doi/10.2196/50219, author="Bults, Marloes and van Leersum, Margaretha Catharina and Olthuis, Josef Theodorus Johannes and Siebrand, Egbert and Malik, Zohrah and Liu, Lili and Miguel-Cruz, Antonio and Jukema, Seerp Jan and den Ouden, Maria Marjolein Elisabeth", title="Acceptance of a Digital Assistant (Anne4Care) for Older Adult Immigrants Living With Dementia: Qualitative Descriptive Study", journal="JMIR Aging", year="2024", month="Apr", day="19", volume="7", pages="e50219", keywords="assistive technology", keywords="technology acceptance", keywords="immigrant", keywords="dementia", keywords="marginalized older adults", abstract="Background: There is a need to develop and coordinate dementia care plans that use assistive technology for vulnerable groups such as immigrant populations. However, immigrant populations are seldom included in various stages of the development and implementation of assistive technology, which does not optimize technology acceptance. Objective: This study aims to gain an in-depth understanding of the acceptance of a digital personal assistant, called Anne4Care, by older adult immigrants living with dementia in their own homes. Methods: This study used a qualitative descriptive research design with naturalistic inquiry. A total of 13 older adults participated in this study. The participants were invited for 2 interviews. After an introduction of Anne4Care, the first interview examined the lives and needs of participants, their expectations, and previous experiences with assistive technology in daily life. Four months later, the second interview sought to understand facilitators and barriers, suggestions for modifications, and the role of health care professionals. Three semistructured interviews were conducted with health care professionals to examine the roles and challenges they experienced in the use and implementation of Anne4Care. Content analysis, using NVivo11, was performed on all transcripts. Results: All 13 participants had an immigration background. There were 10 male and 3 female participants, with ages ranging from 52 to 83 years. Participants were diagnosed with an early-stage form of dementia or acquired brain injury. None of the older adult participants knew or used digital assistive technology at the beginning. They obtained assistance from health care professionals and family caregivers who explained and set up the technology. Four themes were found to be critical aspects of the acceptance of the digital personal assistant Anne4Care: (1) use of Anne4Care, (2) positive aspects of Anne4Care, (3) challenges with Anne4Care, and (4) expectations. Assistance at first increased the burden on health care professionals and families. After the initial effort, most health care professionals and families experienced that Anne4Care reduced their tasks and stress. Contributions of Anne4Care included companionship, help with daily tasks, and opportunities to communicate in multiple languages. On the other hand, some participants expressed anxiety toward the use of Anne4Care. Furthermore, the platform required an internet connection at home and Anne4Care could not be used outside the home. Conclusions: Although older adult immigrants living with dementia had no previous experience with digital assistive technology specifically, the acceptance of the digital personal assistant, called Anne4Care, by older adult immigrants living with dementia was rather high. The digital assistant can be further developed to allow for interactive conversations and for use outside of one's home. Participation of end users during various stages of the development, refinement, and implementation of health technology innovations is of utmost importance to maximize technology acceptance. ", doi="10.2196/50219", url="https://aging.jmir.org/2024/1/e50219", url="http://www.ncbi.nlm.nih.gov/pubmed/38639994" } @Article{info:doi/10.2196/55132, author="Fan, Qiping and Hoang, Minh-Nguyet and DuBose, Logan and Ory, G. Marcia and Vennatt, Jeswin and Salha, Diana and Lee, Shinduk and Falohun, Tokunbo", title="The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study", journal="JMIR Aging", year="2024", month="Apr", day="17", volume="7", pages="e55132", keywords="evaluation", keywords="usability", keywords="family caregiver", keywords="Alzheimer disease", keywords="dementia", keywords="digital health", keywords="mobile phone", abstract="Background: The increasing prevalence of Alzheimer disease and Alzheimer disease--related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care. Objective: This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers. Methods: For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics. Results: Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ?50 years (25/30, 83\%), women (23/30, 77\%), White (25/30, 83\%), and financially stable (20/30, 67\%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90\% (27/30) rated the app overall positively. Most of the participants (21/30, 70\%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration. Conclusions: The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population. ", doi="10.2196/55132", url="https://aging.jmir.org/2024/1/e55132", url="http://www.ncbi.nlm.nih.gov/pubmed/38630527" } @Article{info:doi/10.2196/54214, author="Sobrinho, Silva Andressa Crystine da and Gomes, Oliveira Grace Angelica de and Bueno J{\'u}nior, Roberto Carlos", title="Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach", journal="JMIR Form Res", year="2024", month="Apr", day="15", volume="8", pages="e54214", keywords="information and communications technologies", keywords="ICTs", keywords="health care", keywords="digital inclusion", keywords="focus groups", keywords="health promotion", keywords="user", keywords="usability", keywords="health literacy", keywords="digital competencies", keywords="digital skills", keywords="mobile phone", abstract="Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeir{\~a}o Pr{\^e}to, S{\~a}o Paulo, Brazil, and involved 20 older adults of both genders who were aged ?60 years and enrolled in the Physical Education Program for the Elderly at the University of S{\~a}o Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90\% (18/20) of the participants owned smartphones. However, 20\% (4/20) of the participants faced installation challenges and 30\% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89\% to 70.65\%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. ", doi="10.2196/54214", url="https://formative.jmir.org/2024/1/e54214", url="http://www.ncbi.nlm.nih.gov/pubmed/38619865" } @Article{info:doi/10.2196/45978, author="Haslam-Larmer, Lynn and Grigorovich, Alisa and Shum, Leia and Bianchi, Andria and Newman, Kristine and Iaboni, Andrea and McMurray, Josephine", title="Factors That Influence Successful Adoption of Real-Time Location Systems for Use in a Dementia Care Setting: Mixed Methods Study", journal="JMIR Aging", year="2024", month="Apr", day="8", volume="7", pages="e45978", keywords="remote sensing technologies", keywords="dementia", keywords="real-time location systems", keywords="Fit between Individuals, Tasks, and Technology framework", keywords="FITT framework", keywords="technology implementation", abstract="Background: Technology has been identified as a potential solution to alleviate resource gaps and augment care delivery in dementia care settings such as hospitals, long-term care, and retirement homes. There has been an increasing interest in using real-time location systems (RTLS) across health care settings for older adults with dementia, specifically related to the ability to track a person's movement and location. Objective: In this study, we aimed to explore the factors that influence the adoption or nonadoption of an RTLS during its implementation in a specialized inpatient dementia unit in a tertiary care rehabilitation hospital. Methods: The study included data from a brief quantitative survey and interviews from a convenience sample of frontline participants. Our deductive analysis of the interview used the 3 categories of the Fit Between Individuals, Task, and Technology framework as follows: individual and task, individual and technology, and task and technology. The purpose of using this framework was to assess the quality of the fit between technology attributes and an individual's self-reported intentions to adopt RTLS technology. Results: A total of 20 health care providers (HCPs) completed the survey, of which 16 (80\%) participated in interviews. Coding and subsequent analysis identified 2 conceptual subthemes in the individual-task fit category, including the identification of the task and the perception that participants were missing at-risk patient events. The task-technology fit category consisted of 3 subthemes, including reorganization of the task, personal control in relation to the task, and efficiency or resource allocation. A total of 4 subthemes were identified in the individual-technology fit category, including privacy and personal agency, trust in the technology, user interfaces, and perceptions of increased safety. Conclusions: By the end of the study, most of the unit's HCPs were using the tablet app based on their perception of its usefulness, its alignment with their comfort level with technology, and its ability to help them perform job responsibilities. HCPs perceived that they were able to reduce patient search time dramatically, yet any improvements in care were noted to be implied, as this was not measured. There was limited anecdotal evidence of reduced patient risk or adverse events, but greater reported peace of mind for HCPs overseeing patients' activity levels. ", doi="10.2196/45978", url="https://aging.jmir.org/2024/1/e45978", url="http://www.ncbi.nlm.nih.gov/pubmed/38587884" } @Article{info:doi/10.2196/48265, author="Mychajliw, Christian and Holz, Heiko and Minuth, Nathalie and Dawidowsky, Kristina and Eschweiler, Wilhelm Gerhard and Metzger, Gerhard Florian and Wortha, Franz", title="Performance Differences of a Touch-Based Serial Reaction Time Task in Healthy Older Participants and Older Participants With Cognitive Impairment on a Tablet: Experimental Study", journal="JMIR Aging", year="2024", month="Mar", day="21", volume="7", pages="e48265", keywords="serial reaction time task", keywords="SRTT", keywords="implicit learning", keywords="mobile digital assessments", keywords="cognitive impairment", keywords="neurodegeneration", keywords="tablet-based testing", keywords="mild cognitive impairment", keywords="MCI", keywords="dementia", keywords="Alzheimer", keywords="neuropsychology", keywords="aging", keywords="older individuals", abstract="Background: Digital neuropsychological tools for diagnosing neurodegenerative diseases in the older population are becoming more relevant and widely adopted because of their diagnostic capabilities. In this context, explicit memory is mainly examined. The assessment of implicit memory occurs to a lesser extent. A common measure for this assessment is the serial reaction time task (SRTT). Objective: This study aims to develop and empirically test a digital tablet--based SRTT in older participants with cognitive impairment (CoI) and healthy control (HC) participants. On the basis of the parameters of response accuracy, reaction time, and learning curve, we measure implicit learning and compare the HC and CoI groups. Methods: A total of 45 individuals (n=27, 60\% HCs and n=18, 40\% participants with CoI---diagnosed by an interdisciplinary team) completed a tablet-based SRTT. They were presented with 4 blocks of stimuli in sequence and a fifth block that consisted of stimuli appearing in random order. Statistical and machine learning modeling approaches were used to investigate how healthy individuals and individuals with CoI differed in their task performance and implicit learning. Results: Linear mixed-effects models showed that individuals with CoI had significantly higher error rates (b=?3.64, SE 0.86; z=?4.25; P<.001); higher reaction times (F1,41=22.32; P<.001); and lower implicit learning, measured via the response increase between sequence blocks and the random block ($\beta$=?0.34; SE 0.12; t=?2.81; P=.007). Furthermore, machine learning models based on these findings were able to reliably and accurately predict whether an individual was in the HC or CoI group, with an average prediction accuracy of 77.13\% (95\% CI 74.67\%-81.33\%). Conclusions: Our results showed that the HC and CoI groups differed substantially in their performance in the SRTT. This highlights the promising potential of implicit learning paradigms in the detection of CoI. The short testing paradigm based on these results is easy to use in clinical practice. ", doi="10.2196/48265", url="https://aging.jmir.org/2024/1/e48265", url="http://www.ncbi.nlm.nih.gov/pubmed/38512340" } @Article{info:doi/10.2196/49492, author="Zheng, Amy and Bergh, Marissa and Patel Murali, Komal and Sadarangani, Tina", title="Using mHealth to Improve Communication in Adult Day Services Around the Needs of People With Dementia: Mixed Methods Assessment of Acceptability and Feasibility", journal="JMIR Form Res", year="2024", month="Mar", day="1", volume="8", pages="e49492", keywords="adult day services", keywords="primary health care", keywords="health communication", keywords="dementia", keywords="mobile health", keywords="mHealth", keywords="community-based", keywords="health care", keywords="older adults", keywords="older adult", keywords="chronic condition", keywords="health information", keywords="feasibility", keywords="acceptability", keywords="CareMOBI", keywords="mixed methods design", keywords="caregivers", keywords="caregiver", keywords="care workers", keywords="nurses", keywords="social workers", abstract="Background: Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users' health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers. Objective: This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting. Methods: A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption. Results: A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process. Conclusions: The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting. ", doi="10.2196/49492", url="https://formative.jmir.org/2024/1/e49492", url="http://www.ncbi.nlm.nih.gov/pubmed/38427418" } @Article{info:doi/10.2196/47472, author="Chang, Fangyuan and Sheng, Lin and Gu, Zhenyu", title="Investigating the Integration and the Long-Term Use of Smart Speakers in Older Adults' Daily Practices: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2024", month="Feb", day="12", volume="12", pages="e47472", keywords="smart speaker", keywords="private home", keywords="older adults", keywords="long-term use", keywords="daily practices", keywords="smart speakers", abstract="Background: As smart speakers become more popular, there have been an increasing number of studies on how they may benefit older adults or how older adults perceive them. Despite the increasing ownership rates of smart speakers among older adults, studies that examine their integration and the long-term use in older adults' daily practices are scarce. Objective: This study aims to uncover the integration of smart speakers into the daily practices of older adults over the long term, contributing to an in-depth understanding of maintained technology use among this demographic. Methods: To achieve these objectives, the study interviewed 20 older adults who had been using smart speakers for over 6 months. These semistructured interviews enabled participants to share their insights and experiences regarding the maintained use of smart speakers in the long term. Results: We identified 4 dimensions of the long-term use of smart speakers among older adults, including functional integration, spatial integration, cognitive integration, and semantic integration. For the functional integration of smart speakers, the study reported different types of use, including entertainment, information collection, medication reminders, companionship, environment modification, and emergency calls. For the spatial integration of smart speakers, the study showed older adults' agency in defining, changing, and reshaping daily practices through the spatial organization of smart speakers. For the cognitive integration of smart speakers, the findings showed the cognitive processes involved in adapting to and incorporating smart speakers into daily habits and routines. For the semantic integration of smart speakers, the findings revealed that older adults' enjoyable user experience and strong bonds with the device contributed to their acceptance of occasional functional errors. Finally, the study proposed several suggestions for designers and developers to better design smart speakers that promote maintainable use behaviors among older adults. Conclusions: On the basis of the findings, this study highlighted the importance of understanding how older adults use smart speakers and the practices through which they integrate them into their daily routines. The findings suggest that smart speakers can provide significant benefits for older adults, including increased convenience and improved quality of life. However, to promote maintainable use behaviors, designers and developers should consider more about the technology use contexts and the specific needs and preferences of older adults when designing these devices. ", doi="10.2196/47472", url="https://mhealth.jmir.org/2024/1/e47472", url="http://www.ncbi.nlm.nih.gov/pubmed/38345844" } @Article{info:doi/10.2196/54299, author="Young, Ruth Stephanie and Dworak, McManus Elizabeth and Byrne, Joseph Greg and Jones, Madison Callie and Yao, Lihua and Yoshino Benavente, Noelani Julia and Diaz, Varela Maria and Curtis, Laura and Gershon, Richard and Wolf, Michael and Nowinski, J. Cindy", title="Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App", journal="JMIR Form Res", year="2024", month="Feb", day="7", volume="8", pages="e54299", keywords="cognitive screening", keywords="cognitive", keywords="cognition", keywords="psychometric", keywords="usability", keywords="feasibility", keywords="early detection", keywords="dementia", keywords="Alzheimer's disease, Alzheimer's", keywords="Alzheimer's disease and age-related dementia", keywords="mHealth, mobile health apps", keywords="detection", keywords="screening", keywords="mobile health", keywords="mobile phone", keywords="app", keywords="apps", keywords="applications", keywords="user experience", keywords="smartphone", keywords="smartphones", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="ageing", keywords="aging", keywords="aged", abstract="Background: Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians' ability to conduct screenings. MyCog Mobile is a newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics' time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile. Research questions included (1) Can older adults complete MyCog Mobile remotely without staff support? (2) Are the internal consistency and test-retest reliability of the measures acceptable? and (3) How do participants rate the user experience of MyCog Mobile? Methods: A sample of adults aged 65 years and older (N=51) self-administered the MyCog Mobile measures remotely on their smartphones twice within a 2- to 3-week interval. The pilot version of MyCog Mobile includes 4 activities: MyFaces measures facial memory, MySorting measures executive functioning, MySequences measures working memory, and MyPictures measures episodic memory. After their first administration, participants also completed a modified version of the Simplified System Usability Scale (S-SUS) and 2 custom survey items. Results: All participants in the sample passed the practice items and completed each measure. Findings indicate that the Mobile Toolbox assessments measure the constructs well (internal consistency 0.73 to 0.91) and are stable over an approximately 2-week delay (test-retest reliability 0.61 to 0.71). Participants' rating of the user experience (mean S-SUS score 73.17, SD 19.27) indicated that older adults found the usability of MyCog Mobile to be above average. On free-response feedback items, most participants provided positive feedback or no feedback at all, but some indicated a need for clarity in certain task instructions, concerns about participants' abilities, desire to be able to contact a support person or use in-app technical support, and desire for additional practice items. Conclusions: Pilot evidence suggests that the MyCog Mobile cognitive screener can be reliably self-administered by older adults on their smartphones. Participants in our study generally provided positive feedback about the MyCog Mobile experience and rated the usability of the app highly. Based on participant feedback, we will conduct further usability research to improve support functionality, optimize task instructions and practice opportunities, and ensure that patients feel comfortable using MyCog Mobile. The next steps include a clinical validation study that compares MyCog Mobile to gold-standard assessments and tests the sensitivity and specificity of the measures for identifying dementia. ", doi="10.2196/54299", url="https://formative.jmir.org/2024/1/e54299", url="http://www.ncbi.nlm.nih.gov/pubmed/38324368" } @Article{info:doi/10.2196/52117, author="McDermott, Katherine and Levey, Nadine and Brewer, Julie and Ehmann, Madison and Hooker, E. Julia and Pasinski, Roger and Yousif, Neda and Raju, Vidya and Gholston, Milton and Greenberg, Jonathan and Ritchie, S. Christine and Vranceanu, Ana-Maria", title="Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic", journal="JMIR Res Protoc", year="2023", month="Dec", day="29", volume="12", pages="e52117", keywords="chronic pain", keywords="mind-body", keywords="underserved", keywords="musculoskeletal pain", keywords="pain", keywords="older adults", keywords="pain management", keywords="feasibility", keywords="intervention", abstract="Background: Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). Objective: We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. Methods: We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ?55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (?75\% of patients who are approached agree to participate), acceptability (?75\% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (?75\% of session components are delivered as intended). Secondary outcomes include physical function---self-reported, performance based (6-minute walk test), and objective (step count)---and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). Results: We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. Conclusions: We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. Trial Registration: ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231 International Registered Report Identifier (IRRID): DERR1-10.2196/52117 ", doi="10.2196/52117", url="https://www.researchprotocols.org/2023/1/e52117", url="http://www.ncbi.nlm.nih.gov/pubmed/38157234" } @Article{info:doi/10.2196/52410, author="Choi, Soyoung and Sajib, Zaman Md Refat Uz and Manzano, Jenna and Chlebek, Joseph Christian", title="mHealth Technology Experiences of Middle-Aged and Older Individuals With Visual Impairments: Cross-Sectional Interview Study", journal="JMIR Form Res", year="2023", month="Dec", day="25", volume="7", pages="e52410", keywords="aging", keywords="mobile health", keywords="older adults", keywords="technology", keywords="visual impairment", keywords="wearables", keywords="wearable", keywords="vision", keywords="visual", keywords="qualitative analysis", keywords="health behavior", keywords="mHealth", keywords="mHealth technology", keywords="digital technology", keywords="medical application", keywords="application", keywords="app", keywords="applications", keywords="usage", keywords="well-being", keywords="cross-section interview", keywords="interview", keywords="interviews", keywords="tracking", keywords="health data", keywords="symptom monitoring", keywords="monitor", keywords="monitoring", keywords="symptom", keywords="symptoms", keywords="physical activity", keywords="walking", keywords="routine", keywords="mobile phone", abstract="Background: Current mobile health (mHealth) technology is predominantly designed with a visual orientation, often resulting in user interfaces that are inaccessible to visually impaired users. While mHealth technology offers potential for facilitating chronic illness management and enhancing health behaviors among visually impaired older populations, understanding its usage remains limited. Objective: This qualitative research aimed to explore the mHealth technology experiences of middle-aged and older individuals with visual impairments including the accessibility and usability issues they faced. Methods: The qualitative exploration was structured using the mHealth for Older Users framework. Cross-sectional interviews were conducted via Zoom between June 1 and July 31, 2023, using an interview protocol for data collection. A thematic analysis approach was employed to analyze the transcribed interview scripts. Results: Of the 7 participants who took part in the Zoom interviews, 3 were men and 4 were women, with ages ranging from 53 to 70 years. Most participants adopted mHealth apps and wearable devices for promoting health. They exhibited 3 distinct adoption patterns. Seven themes were emerged from the perceived challenges in using mHealth technologies: (1) a scarcity of accessible user manuals, (2) user interfaces that are not visually impaired-friendly, (3) health data visualizations that are not accessible, (4) unintuitive arrangement of app content, (5) health information that is challenging to comprehend, (6) cognitive overload caused by an excess of audible information, and (7) skepticism regarding the accuracy of health records. mHealth technologies seem to positively affect the health and health management of participants. Conclusions: Design considerations for mHealth technologies should consider individuals' disabilities and chronic conditions and should emphasize the importance of providing accessible manuals and training opportunities when introducing new mHealth solutions. ", doi="10.2196/52410", url="https://formative.jmir.org/2023/1/e52410", url="http://www.ncbi.nlm.nih.gov/pubmed/38145472" } @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/10.2196/46188, author="Ye, Bing and Chu, H. Charlene and Bayat, Sayeh and Babineau, Jessica and How, Tuck-Voon and Mihailidis, Alex", title="Researched Apps Used in Dementia Care for People Living With Dementia and Their Informal Caregivers: Systematic Review on App Features, Security, and Usability", journal="J Med Internet Res", year="2023", month="Oct", day="12", volume="25", pages="e46188", keywords="mobile technologies", keywords="mobile apps", keywords="dementia", keywords="privacy", keywords="security", keywords="usability testing", keywords="informal caregivers", keywords="mobile phone", abstract="Background: Studies have shown that mobile apps have the potential to serve as nonpharmacological interventions for dementia care, improving the quality of life of people living with dementia and their informal caregivers. However, little is known about the needs for and privacy aspects of these mobile apps in dementia care. Objective: This review seeks to understand the landscape of existing mobile apps in dementia care for people living with dementia and their caregivers with respect to app features, usability testing, privacy, and security. Methods: ACM Digital Library, Cochrane Central Register of Controlled Trials, Compendex, Embase, Inspec, Ovid MEDLINE, PsycINFO, and Scopus were searched. Studies were included if they included people with dementia living in the community, their informal caregivers, or both; focused on apps in dementia care using smartphones or tablet computers; and covered usability evaluation of the app. Records were independently screened, and 2 reviewers extracted the data. The Centre for Evidence-Based Medicine critical appraisal tool and Mixed Methods Appraisal Tool were used to assess the risk of bias in the included studies. Thematic synthesis was used, and the findings were summarized and tabulated based on each research aim. Results: Overall, 44 studies were included in this review, with 39 (89\%) published after 2015. In total, 50 apps were included in the study, with more apps developed for people living with dementia as end users compared with caregivers. Most studies (27/44, 61\%) used tablet computers. The most common app feature was cognitive stimulation. This review presented 9 app usability themes: user interface, physical considerations, screen size, interaction challenges, meeting user needs, lack of self-awareness of app needs, stigma, technological inexperience, and technical support. In total, 5 methods (questionnaires, interviews, observations, logging, and focus groups) were used to evaluate usability. There was little focus on the privacy and security aspects, including data transfer and protection, of mobile apps for people living with dementia. Conclusions: The limitations of this review include 1 reviewer conducting the full-text screening, its restriction to studies published in English, and the exclusion of apps that lacked empirical usability testing. As a result, there may be an incomplete representation of the available apps in the field of dementia care. However, this review highlights significant concerns related to the usability, privacy, and security of existing mobile apps for people living with dementia and their caregivers. The findings of this review provide a valuable framework to guide app developers and researchers in the areas of privacy policy development, app development strategies, and the importance of conducting thorough usability testing for their apps. By considering these factors, future work in this field can be advanced to enhance the quality and effectiveness of dementia care apps. Trial Registration: PROSPERO CRD42020216141; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=216141 International Registered Report Identifier (IRRID): RR2-10.1159/000514838 ", doi="10.2196/46188", url="https://www.jmir.org/2023/1/e46188", url="http://www.ncbi.nlm.nih.gov/pubmed/37824187" } @Article{info:doi/10.2196/44525, author="Fields, Beth and Fitzpatrick, McKenzie and Kinney, Lauryn and Lee, Jenny and Sprecher, Bryce and Tredinnick, Ross and Ponto, Kevin and Shin, Jung-hye", title="Evaluating the Acceptability and Appropriateness of the Augmented Reality Home Assessment Tool (ARHAT): Qualitative Descriptive Study", journal="JMIR Aging", year="2023", month="Sep", day="27", volume="6", pages="e44525", keywords="technology", keywords="aging in place", keywords="augmented reality", keywords="home modification", keywords="mobile", keywords="assessment", keywords="mobile application", keywords="qualitative study", keywords="environmental barrier", abstract="Background: The Augmented Reality Home Assessment Tool (ARHAT) is a mobile app developed to provide rapid, highly accurate assessments of the home environment. It uses 3D-capture technologies to help people identify and address functional limitations and environmental barriers. Objective: This study was conducted to gain stakeholder feedback on the acceptability and appropriateness of the ARHAT for identifying and addressing barriers within home environments. Methods: A qualitative descriptive study was conducted because it allows for variability when obtaining data and seeks to understand stakeholders' insights on an understudied phenomenon. Each stakeholder group (occupational therapists, housing professionals, and aging adult and caregiver ``dyads'') participated in a 60-minute, web-based focus group via a secure Zoom platform. Focus group data were analyzed by 2 trained qualitative research team members using a framework method for analysis. Results: A total of 19 stakeholders, aged from 18 to 85+ years, were included in the study. Of the occupational therapists (n=5, 26\%), housing professionals (n=3, 16\%), and dyads (n=11, 58\%), a total of 32\% (n=6) were male and 68\% (n=13) were female, with most living in the Midwestern United States (n=10, 53\%). The focus group data demonstrate the acceptability and appropriateness of the workflow, style, measurement tools, and impact of the ARHAT. All stakeholders stated that they could see the ARHAT being used at many different levels and by any population. Dyads specifically mentioned that the ARHAT would allow them to do forward planning and made them think of home modifications in a new light. Conclusions: Stakeholders found the ARHAT to be acceptable and appropriate for identifying and addressing functional limitations and barriers in the home environment. This study highlights the importance of considering the workflow, style, measurement tools, and potential impact of home assessment technology early in the developmental process. ", doi="10.2196/44525", url="https://aging.jmir.org/2023/1/e44525" } @Article{info:doi/10.2196/46738, author="B{\"o}ttinger, J. Melissa and Litz, Elena and Gordt-Oesterwind, Katharina and Jansen, Carl-Philipp and Memmer, Nicole and Mychajliw, Christian and Radeck, Leon and Bauer, M. J{\"u}rgen and Becker, Clemens", title="Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study", journal="JMIR Aging", year="2023", month="Sep", day="26", volume="6", pages="e46738", keywords="aged", keywords="self-assessment", keywords="mobile apps", keywords="mobile health", keywords="mHealth", keywords="community-based participatory research", keywords="co-creation", keywords="comprehensive geriatric assessment", keywords="mobile phone", abstract="Background: Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a preclinical stage, thereby facilitating preventive efforts and targeted intervention. For this purpose, a Life-integrated Self-Assessment (LiSA) tablet system will be developed through a structured co-creation process. Objective: This study aims to investigate older adults' perceptions of different self-assessment domains, components affecting user experience, risks and benefits associated with LiSA, characteristics of potential LiSA users, and the LiSA concept in general. Methods: A total of 10 community-dwelling older adults aged ?70 years were recruited. In total, 6 co-creation workshops were held and started with expert input followed by semistructured discussion rounds. Participants performed hands-on activities with a tablet, including testing of preinstalled self-assessment apps. All workshops were audio recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze the data following a deductive-inductive approach guided by the Optimized Honeycomb Model for user experience. Results: The group (mean age 77.8, SD 5.1 years) was heterogeneous in terms of previous technology experience and health status. The mean workshop duration was 2 hours (122.5, SD 4.43 min), and an average of 8 (SD 1.15) participants attended each workshop. A total of 11 thematic categories were identified, covering results on all research questions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activity and function and sensory and cognitive functions and requested additional features such as recommendations for actions or reminders. LiSA was perceived as empowering and a motivator to engage in active health care planning as well as enabling shared and informed decision-making. Concerns and barriers included the lack of technical competence, feelings of frustration, and fear of being left alone, with negative assessment results. In essence, participants expressed a positive attitude toward using LiSA repeatedly and identified it as an option to increase the chances of maintaining independence when growing older. Conclusions: The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion, LiSA should include relevant assessments capturing physical activity and function and sensory and cognitive functions as well as recommendations for actions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment. ", doi="10.2196/46738", url="https://aging.jmir.org/2023/1/e46738", url="http://www.ncbi.nlm.nih.gov/pubmed/37751274" } @Article{info:doi/10.2196/43186, author="Gomez-Hernandez, Miguel and Ferre, Xavier and Moral, Cristian and Villalba-Mora, Elena", title="Design Guidelines of Mobile Apps for Older Adults: Systematic Review and Thematic Analysis", journal="JMIR Mhealth Uhealth", year="2023", month="Sep", day="21", volume="11", pages="e43186", keywords="tablet", keywords="smartphone", keywords="older user", keywords="design recommendations", keywords="usability testing", keywords="user experience design", keywords="UX design", keywords="design", keywords="mobile app", keywords="tool", keywords="quality of life", keywords="software", keywords="training", keywords="visual design", keywords="older adults", keywords="mobile phone", abstract="Background: Mobile apps are fundamental tools in today's society for practical and social endeavors. However, these technologies are often not usable for older users. Given the increased use of mobile apps by this group of users and the impact that certain services may have on their quality of life, such as mobile health, personal finance, or online administrative procedures, a clear set of guidelines for mobile app designers is needed. Existing recommendations for older adults focus on investigations with certain groups of older adults or have not been extracted from experimental results. Objective: In this research work, we systematically reviewed the scientific literature that provided recommendations for the design of mobile apps based on usability testing with older adults and organized such recommendations into a meaningful set of design guidelines. Methods: We conducted a systematic literature review of journal and conference articles from 2010 to 2021. We included articles that carried out usability tests with populations aged >60 years and presented transferable guidelines on mobile software design, resulting in a final set of 40 articles. We then carried out a thematic analysis with 3 rounds of analysis to provide meaning to an otherwise diverse set of recommendations. At this stage, we discarded recommendations that were made by just 1 article, were based on a specific mobile app and were therefore nontransferrable, were based on other authors' literature (as opposed to recommendations based on the results of usability tests), or were not sufficiently argued. With the remaining recommendations, we identified commonalities, wrote a faithful statement for each guideline, used a common language for the entire set, and organized the guidelines into categories, thereby giving shape to an otherwise diverse set of recommendations. Results: Among the 27 resulting guidelines, the rules Simplify and Increase the size and distance between interactive controls were transversal and of the greatest significance. The rest of the guidelines were divided into 5 categories (Help \& Training, Navigation, Visual Design, Cognitive Load, and Interaction) and consequent subcategories in Visual Design (Layout, Icons, and Appearance) and Interaction (Input and Output). The recommendations were structured, explained in detail, and illustrated with applied examples extracted from the selected studies, where appropriate. We discussed the design implications of applying these guidelines, contextualized with relevant studies. We also discussed the limitations of the approach followed, stressing the need for further experimentation to gain a better understanding of how older adults use mobile apps and how to better design such apps with these users in mind. Conclusions: The compiled guidelines support the design of mobile apps that cater to the needs of older adults because they are based on the results of actual usability tests with users aged >60 years. ", doi="10.2196/43186", url="https://mhealth.jmir.org/2023/1/e43186", url="http://www.ncbi.nlm.nih.gov/pubmed/37733401" } @Article{info:doi/10.2196/46480, author="Krafft, Jelena and Barisch-Fritz, Bettina and Krell-Roesch, Janina and Trautwein, Sandra and Scharpf, Andrea and Woll, Alexander", title="A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study", journal="JMIR Aging", year="2023", month="Aug", day="22", volume="6", pages="e46480", keywords="dementia", keywords="individualized physical exercise", keywords="tailored exercise", keywords="physical activity", keywords="older adults", keywords="app", keywords="mobile health", keywords="mHealth", keywords="usability", keywords="mobile phone", abstract="Background: The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia. Objective: This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach. Methods: Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively. Results: A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93\% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as ``good.'' The main usability issues concerned navigation logic and comprehensibility of app content. Conclusions: The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ?50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study. ", doi="10.2196/46480", url="https://aging.jmir.org/2023/1/e46480", url="http://www.ncbi.nlm.nih.gov/pubmed/37606974" } @Article{info:doi/10.2196/42017, author="Zolnowski-Kolp, Victoria and Um Din, Nathavy and Havreng-Th{\'e}ry, Charlotte and Pariel, Sylvie and Veyron, Jacques-Henri and Lafuente-Lafuente, Carmelo and Belmin, Joel", title="Assessment of Frailty by the French Version of the Vulnerable Elders Survey-13 on Digital Tablet: Validation Study", journal="J Med Internet Res", year="2023", month="Aug", day="2", volume="25", pages="e42017", keywords="frailty", keywords="Vulnerable Elders Survey-13 (VES-13)", keywords="elderly", keywords="older people", keywords="family caregivers", keywords="French version", keywords="electronic assessment", keywords="digital technology", keywords="digital health", keywords="eHealth", keywords="tablet", keywords="validity", abstract="Background: Frailty assessment is a major issue in geriatric medicine. The Vulnerable Elders Survey-13 (VES-13) is a simple and practical tool that identifies frailty through a 13-item questionnaire completed by older adults or their family caregivers by self-administration (pencil and paper) or by telephone interview. The VES-13 provides a 10-point score that is also a recognized mortality predictor. Objective: This study aims to design an electronic version of the Echelle de Vuln{\'e}rabilit{\'e} des Ain{\'e}s-13, the French version of the VES-13 (eEVA-13) for use on a digital tablet and validate it. Methods: The scale was implemented as a web App in 3 different screens and used on an Android tablet (14.0{\texttimes} 25.6 cm). Participants were patients attending the outpatient clinic of a French geriatric hospital or hospitalized in a rehabilitation ward and family caregivers of geriatric patients. They completed the scale twice, once by a reference method (self-administered questionnaire or telephone interview) and once by eEVA-13 using the digital tablet. Agreement for diagnosis of frailty was assessed with the $\kappa$ coefficient, and scores were compared by Bland and Altman plots and interclass correlation coefficients. User experience was assessed by a self-administered questionnaire. Results: In total, 86 participants, including 40 patients and 46 family caregivers, participated in the study. All family caregivers had previously used digital devices, while 13 (32.5\%) and 10 (25\%) patients had no or infrequent use of them previously. We observed no failure to complete the eEVA-13, and 70\% of patients (28/40) and no family caregivers needed support to complete the eEVA-13. The agreement between the eEVA-13 and the reference method for the diagnosis of frailty was excellent ($\kappa$=0.92) with agreement in 83 cases and disagreement in 3 cases. The mean difference between the scores provided by the 2 scales was 0.081 (95\% CI--1.263 to 1.426). Bland and Altman plots showed a high level of agreement between the eEVA-13 and the reference methods and interclass correlation coefficient value was 0.997 (95\% CI 0.994-0.998) for the paper and tablet group and 0.977 (95\% CI 0.957-0.988) for the phone and tablet groups. The tablet assessment was found to be easy to use by 77.5\% (31/40) of patients and by 96\% (44/46) of caregivers. Finally, 85\% (39/46) of family caregivers and 50\% (20/40) of patients preferred the eEVA-13 to the original version. Conclusions: The eEVA-13 is an appropriate digital tool for diagnosing frailty and can be used by older adults and their family caregivers. The scores obtained with eEVA-13 are highly correlated with those obtained with the original version. The use of health questionnaires on digital tablets is feasible in frail and very old patients, although some patients may need help to use them. ", doi="10.2196/42017", url="https://www.jmir.org/2023/1/e42017", url="http://www.ncbi.nlm.nih.gov/pubmed/37531175" } @Article{info:doi/10.2196/45750, author="Paluch, Richard and Cerna, Katerina and Kirschsieper, Dennis and M{\"u}ller, Claudia", title="Practices of Care in Participatory Design With Older Adults During the COVID-19 Pandemic: Digitally Mediated Study", journal="J Med Internet Res", year="2023", month="Jul", day="17", volume="25", pages="e45750", keywords="older adults", keywords="care", keywords="Participatory Design", keywords="COVID-19 pandemic", keywords="digital health intervention", keywords="aging", keywords="health technology", keywords="digital media", keywords="gerontology", keywords="mobile phone", abstract="Background: Participatory Design (PD), albeit an established approach in User-Centered Design, comes with specific challenges when working with older adults as research participants. Addressing these challenges relates to the reflection and negotiation of the positionalities of the researchers and research participants and includes various acts of giving and receiving help. During the COVID-19 pandemic, facets of positionalities and (mutual) care became particularly evident in qualitative and participatory research settings. Objective: The aim of this paper was to systematically analyze care practices of participatory (design) research, which are to different extents practices of the latter. Using a multiyear PD project with older people that had to take place remotely over many months, we specify different practices of care; how they relate to collaborative work in the design project; and represent foundational practices for sustainable, long-term co-design. Our research questions were ``How can digitally-mediated PD work during COVID-19 and can we understand such digital PD as `care'?'' Methods: Our data comes from the Joint Programming Initiative ``More Years, Better Lives'' (JPI MYBL), a European Union project that aims to promote digital literacy and technology appropriation among older adults in domestic settings. It targeted the cocreation, by older adults and university researchers, of a mobile demo kit website with cocreated resources, aimed at improving the understanding of use options of digital tools. Through a series of workshops, a range of current IT products was explored by a group of 21 older adults, which served as the basis for joint cocreative work on generating design ideas and prototypes. We reflect on the PD process and examine how the actors enact and manifest care. Results: The use of digital technology allowed the participatory project to continue during the COVID-19 pandemic and accentuated the digital skills of older adults and the improvement of digital literacy as part of ``care.'' We provide empirically based evidence of PD with older adults developing digital literacy and sensitizing concepts, based on the notion of care by Tronto for differentiating aspects and processes of care. The data suggest that it is not enough to focus solely on the technologies and how they are used; it is also necessary to focus on the social structures in which help is available and in which technologies offer opportunities to do care work. Conclusions: We document that the cocreation of different digital media tools can be used to provide a community with mutual care. Our study demonstrates how research participants effectively enact different forms of care and how such ``care'' is a necessary basis for a genuinely participatory approach, which became especially meaningful as a form of support during COVID-19. We reflect on how notions of ``care'' and ``caring'' that were central to the pandemic response are also central to PD. ", doi="10.2196/45750", url="https://www.jmir.org/2023/1/e45750", url="http://www.ncbi.nlm.nih.gov/pubmed/37459177" } @Article{info:doi/10.2196/41429, author="Koo, Hyuk Jun and Park, Hyun You and Kang, Ryong Dae", title="Factors Predicting Older People's Acceptance of a Personalized Health Care Service App and the Effect of Chronic Disease: Cross-Sectional Questionnaire Study", journal="JMIR Aging", year="2023", month="Jun", day="21", volume="6", pages="e41429", keywords="environmental risk factor", keywords="personalized health care service app", keywords="chronic disease", keywords="unified theory of acceptance and use of technology", keywords="structural equation modeling", keywords="older adult", keywords="acceptance", keywords="adoption", keywords="technology use", keywords="mHealth", keywords="mobile health", keywords="mobile app", keywords="health app", keywords="gerontology", keywords="personalized", keywords="health care service", keywords="intention to use", abstract="Background: Mobile health (mHealth) services enable real-time measurement of information on individuals' biosignals and environmental risk factors; accordingly, research on health management using mHealth is being actively conducted. Objective: The study aims to identify the predictors of older people's intention to use mHealth in South Korea and verify whether chronic disease moderates the effect of the identified predictors on behavioral intentions. Methods: A cross-sectional questionnaire study was conducted among 500 participants aged 60 to 75 years. The research hypotheses were tested using structural equation modeling, and indirect effects were verified through bootstrapping. Bootstrapping was performed 10,000 times, and the significance of the indirect effects was confirmed through the bias-corrected percentile method. Results: Of 477 participants, 278 (58.3\%) had at least 1 chronic disease. Performance expectancy ($\beta$=.453; P=.003) and social influence ($\beta$=.693; P<.001) were significant predictors of behavioral intention. Bootstrapping results showed that facilitating conditions ($\beta$=.325; P=.006; 95\% CI 0.115-0.759) were found to have a significant indirect effect on behavioral intention. Multigroup structural equation modeling testing the presence or absence of chronic disease revealed a significant difference in the path of device trust to performance expectancy (critical ratio=--2.165). Bootstrapping also confirmed that device trust ($\beta$=.122; P=.039; 95\% CI 0.007-0.346) had a significant indirect effect on behavioral intention in people with chronic disease. Conclusions: This study, which explored the predictors of the intention to use mHealth through a web-based survey of older people, suggests similar results to those of other studies that applied the unified theory of acceptance and use of technology model to the acceptance of mHealth. Performance expectancy, social influence, and facilitating conditions were revealed as predictors of accepting mHealth. In addition, trust in a wearable device for measuring biosignals was investigated as an additional predictor in people with chronic disease. This suggests that different strategies are needed, depending on the characteristics of users. ", doi="10.2196/41429", url="https://aging.jmir.org/2023/1/e41429", url="http://www.ncbi.nlm.nih.gov/pubmed/37342076" } @Article{info:doi/10.2196/41919, author="Zhu, Jieting and Weng, Huiting and Ou, Peng and Li, Lezhi", title="Use and Acceptance of Smart Elderly Care Apps Among Chinese Medical Staff and Older Individuals: Web-Based Hybrid Survey Study", journal="JMIR Form Res", year="2023", month="Jun", day="13", volume="7", pages="e41919", keywords="smart elderly care app", keywords="mobile health", keywords="smartphone", abstract="Background: With the advent of China's aging population and the popularization of smartphones, there is a huge demand for smart elderly care apps. Along with older adults and their dependents, medical staff also need to use a health management platform to manage the health of patients. However, the development of health apps and the large and growing app market pose a problem of declining quality; in fact, important differences can be observed between apps, and patients currently do not have adequate information and formal evidence to discriminate among them. Objective: The aim of this study was to investigate the cognition and usage status of smart elderly care apps among older individuals and medical staff in China. Methods: From March 1, 2022, to March 30, 2022, we used the web survey tool Sojump to conduct snowball sampling through WeChat. The survey links were initially sent to communities in 23 representative major cities in China. We asked the medical staff of community clinics to post the survey link on their WeChat Moments. From April 1 to May 10, 2022, we contacted those who selected ``Have used a smart elderly care app'' in the questionnaire through WeChat for a request to participate in semistructured interviews. Participants provided informed consent in advance and interviews were scheduled. After the interviews, the audio recordings were transcribed into text and the emerging themes were analyzed and summarized. Results: A total of 810 individuals participated in this study, 54.8\% (n=444) of whom were medical staff, 33.1\% (n=268) were older people, and the remaining participants were certified nursing assistants (CNAs) and community workers. Overall, 60.5\% (490/810) of the participants had used a smart elderly care app on their smartphone. Among the 444 medical staff who participated in the study, the vast majority (n=313, 70.5\%) had never used a smart elderly care app, although 34.7\% of them recommended elderly care--related apps to patients. Among the 542 medical staff, CNAs, and community workers that completed the questionnaire, only 68 (12.6\%) had used a smart elderly care app. We further interviewed 23 people about their feelings and opinions about smart elderly care apps. Three themes emerged with eight subthemes, including functional design, operation interface, and data security. Conclusions: In this survey, there was a huge difference in the usage rate and demand for smart elderly care apps by the participants. Respondents are mainly concerned with app function settings, interface simplicity, and data security. ", doi="10.2196/41919", url="https://formative.jmir.org/2023/1/e41919", url="http://www.ncbi.nlm.nih.gov/pubmed/37310777" } @Article{info:doi/10.2196/46976, author="Shade, Marcia and Kovaleva, Mariya and Harp, Kimberly and Martin-Hammond, Aqueasha", title="Older Adults' Pain Outcomes After mHealth Interventions: Scoping Review", journal="JMIR Aging", year="2023", month="May", day="31", volume="6", pages="e46976", keywords="mHealth", keywords="older adults", keywords="pain", keywords="self-management", keywords="pain management", keywords="mobile health", keywords="musculoskeletal pain", keywords="scoping review", keywords="pain outcomes", keywords="mobile phone", abstract="Background: Pain is prevalent and poorly managed in older adults. Although pain self-management strategies are helpful, adoption and access are limited; thus, technology provides an opportunity for intervention delivery. Mobile health (mHealth) is feasible to use in older adults; however, we have yet to understand the effect of mHealth pain self-management interventions on pain outcomes in older adults. Objective: The purpose of this scoping review is to examine the characteristics of mHealth interventions and their efficacy on pain outcomes in older adults with musculoskeletal pain. Methods: With the assistance of a medical librarian, keywords and subject headings were generated, including but not limited to mobile health application, mHealth, digital, pain, pain management, and older. A search was conducted for papers in journal databases, including PubMed, Embase, CINAHL, Scopus, and IEEE Xplore, between 2000 and 2022. Papers were screened according to predetermined inclusion and exclusion criteria, and reference lists were reviewed for additional paper inclusion. Three authors appraised the methodology of papers independently, then collaboratively to synthesize the evidence. Results: Six publications were included in the scoping review. The design and methodology ranged widely from pilot studies to a comparative effectiveness trial. Older participants in the studies reported a variety of musculoskeletal conditions. Delivery of the mHealth pain self-management interventions incorporated mobile devices, such as a smartphone or tablet. Most mHealth-delivered interventions were multicomponent and incorporated elements of in-person and telephone access to an interventionist. The findings suggested mHealth interventions may reduce pain intensity; however, pain interference and other pain-related conditions did not have a statistically significant reduction. Conclusions: Research that has explored mHealth for pain self-management is beginning to move beyond feasibility. The few experimental studies conducted in older adults are heterogeneous, and the interventions are mostly multicomponent. It is premature to conclude the interventions' significant effect on pain or pain-related symptoms. As technology continues to integrate into health care, more experimental research is warranted to examine the efficacy of mHealth interventions on a variety of pain outcomes in older adults. ", doi="10.2196/46976", url="https://aging.jmir.org/2023/1/e46976", url="http://www.ncbi.nlm.nih.gov/pubmed/37256667" } @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/10.2196/44007, author="Brown, L. Ellen and Ruggiano, Nicole and Allala, Chaithra Sai and Clarke, J. Peter and Davis, Debra and Roberts, Lisa and Framil, Victoria C. and Mu{\~n}oz, Hernandez Mar{\'i}ateresa Teri and Hough, Strauss Monica and Bourgeois, S. Michelle", title="Developing a Memory and Communication App for Persons Living With Dementia: An 8-Step Process", journal="JMIR Aging", year="2023", month="Mar", day="15", volume="6", pages="e44007", keywords="health technology", keywords="interdisiplinary team", keywords="older adults", keywords="dementia", keywords="communication", keywords="communication aids for disabled persons", keywords="communication boards", keywords="app", keywords="Alzheimer disease", keywords="family", keywords="caregiver", keywords="clinical care", keywords="development", keywords="speech", keywords="psychosocial intervention", keywords="software design", abstract="International Registered Report Identifier (IRRID): RR2-10.3928/19404921-20210825-02 ", doi="10.2196/44007", url="https://aging.jmir.org/2023/1/e44007", url="http://www.ncbi.nlm.nih.gov/pubmed/36920462" } @Article{info:doi/10.2196/41322, 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/10.2196/42172, author="Stuart, Avelie and Yan, Jieru Ronnie and Harkin, Jo Lydia and Katz, Dmitri and Stevenson, Clifford and Mehta, Vikram and Giles, Emilie and Talbot, Catherine and Gooch, Daniel and Bennasar, Mohamed and Self, Tara and Nuseibeh, Bashar and Price, Blaine", title="Digital Intervention in Loneliness in Older Adults: Qualitative Analysis of User Studies", journal="JMIR Form Res", year="2023", month="Jan", day="27", volume="7", pages="e42172", keywords="loneliness", keywords="older adults", keywords="digital connections", keywords="reflection", keywords="social identity", keywords="user-centered design", keywords="social network", keywords="well-being apps", abstract="Background: Loneliness is a significant well-being issue that affects older adults. Existing, commonly used social connection platforms do not contain facilities to break the cognitive cycle of loneliness, and loneliness interventions implemented without due processes could have detrimental effects on well-being. There is also a lack of digital technology designed with older adults. Objective: We aimed to iteratively design a user-centered smartphone app that can address loneliness in older adults. The aim of this study was to investigate the loneliness-related psychological processes that our conceptual smartphone app promotes. We also identified the emergent needs and concerns that older adults raised regarding the potential benefits and detriments of the app. Methods: We used technology probes to elicit older adults' reflections on the concept of using the app in 2 studies as follows: concept focus groups (n=33) and concept interviews (n=10). We then conducted a prototype trial with 1 week of use and follow-up interviews (n=12). Results: Thematic analysis explored the experiences and emergent challenges of our app through the design process. This led to the development of 4 themes as follows occurring in all 3 qualitative data sets: reflection on a digital social map is reassuring; app features encourage socializing; the risk of compounding loneliness; and individuals feel more control with mutual, socially beneficial activities. Conclusions: Smartphone apps have the potential to increase older adults' awareness of the richness of their social connections, which may support loneliness reduction. Our qualitative approach to app design enabled the inclusion of older adults' experiences in technology design. Thus, we conclude that the older adults in our study most desired functionalities that can support mutual activities and maintain or find new connections rather than enable them to share an emotional state. They were wary of the app replacing their preferred in-person social interaction. Participants also raised concerns about making the user aware of the lack of support in their social network and wanted specific means of addressing their needs. Further user-centered design work could identify how the app can support mutual activities and socializing. ", doi="10.2196/42172", url="https://formative.jmir.org/2023/1/e42172", url="http://www.ncbi.nlm.nih.gov/pubmed/36705962" } @Article{info:doi/10.2196/42416, author="Young, Ruth Stephanie and Lattie, Gardiner Emily and Berry, L. Andrew B. and Bui, Lynn and Byrne, Joseph Greg and Yoshino Benavente, Noelani Julia and Bass, Michael and Gershon, C. Richard and Wolf, S. Michael and Nowinski, J. Cindy", title="Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation", journal="JMIR Form Res", year="2023", month="Jan", day="10", volume="7", pages="e42416", keywords="human-centered design", keywords="mobile health", keywords="mHealth", keywords="usability", keywords="cognitive screening", keywords="older adults", keywords="mobile phone", abstract="Background: Annual cognitive screening in adults aged >65 years can improve early detection of cognitive impairment, yet less than half of all cases are identified in primary care. Time constraints in primary care settings present a major barrier to routine screening. A remote cognitive screener completed on a patient's own smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: We described the iterative design and proposed the implementation of a remote cognitive screening app, MyCog Mobile, to be completed on a patient's smartphone before an annual wellness visit. The research questions were as follows: What would motivate primary care clinicians and clinic administrators to implement a remote cognitive screening process? How might we design a remote cognitive screener to fit well with existing primary care workflows? What would motivate an older adult patient to complete a cognitive screener on a smartphone before a primary care visit? How might we optimize the user experience of completing a remote cognitive screener on a smartphone for older adults? Methods: To address research questions 1 and 2, we conducted individual interviews with clinicians (n=5) and clinic administrators (n=3). We also collaborated with clinic administrators to create user journey maps of their existing and proposed MyCog Mobile workflows. To address research questions 3 and 4, we conducted individual semistructured interviews with cognitively healthy older adults (n=5) and solicited feedback from a community stakeholder panel (n=11). We also tested and refined high-fidelity prototypes of the MyCog Mobile app with the older adult interview participants, who rated the usability on the Simplified System Usability Scale and After-Scenario Questionnaire. Results: Clinicians and clinic administrators were motivated to adopt a remote cognitive screening process if it saved time in their workflows. Findings from interviews and user journey mapping informed the proposed implementation and core functionality of MyCog Mobile. Older adult participants were motivated to complete cognitive screeners to ensure that they were cognitively healthy and saw additional benefits to remote screening, such as saving time during their visit and privacy. Older adults also identified potential challenges to remote smartphone screening, which informed the user experience design of the MyCog Mobile app. The average rating across prototype versions was 91 (SD 5.18) on the Simplified System Usability Scale and 6.13 (SD 8.40) on the After-Scenario Questionnaire, indicating above-average usability. Conclusions: Through an iterative, human-centered design process, we developed a viable remote cognitive screening app and proposed an implementation strategy for primary care settings that was optimized for multiple stakeholders. The next steps include validating the cognitive screener in clinical and healthy populations and piloting the finalized app in a community primary care clinic. ", doi="10.2196/42416", url="https://formative.jmir.org/2023/1/e42416", url="http://www.ncbi.nlm.nih.gov/pubmed/36626223" } @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/10.2196/38656, author="Christie, Liane Hannah and Dam, Henrike Alieske Elisabeth and van Boxtel, Martin and K{\"o}hler, Sebastian and Verhey, Frans and de Vugt, Elisabeth Marjolein", title="Lessons Learned From an Effectiveness Evaluation of Inlife, a Web-Based Social Support Intervention for Caregivers of People With Dementia: Randomized Controlled Trial", journal="JMIR Aging", year="2022", month="Dec", day="7", volume="5", number="4", pages="e38656", keywords="dementia", keywords="Alzheimer's", keywords="neurodegenerative", keywords="caregiver", keywords="caregiving", keywords="digital health", keywords="eHealth", keywords="mHealth", keywords="Information communication technology", keywords="RCT", keywords="randomized controlled trial", keywords="social support", keywords="support platform", keywords="online platform", keywords="web-based", keywords="internet-based", keywords="peer-support", keywords="informal support", keywords="social interaction", keywords="support network", abstract="Background: Informal care for people with dementia not only affects the well-being of the primary caregiver but also changes their roles and interactions with the social environment. New online interventions might facilitate access to social support. Recently, an online social support platform, Inlife, was developed in the Netherlands and aims to enhance social support and positive interactions in informal support networks. Objective: This study aimed to evaluate the effectiveness of Inlife for caregivers of people with dementia. Methods: A randomized controlled trial with 96 caregivers of people with dementia was performed. Participants were randomly assigned to the Inlife intervention or the waiting list control group. After 16 weeks of Inlife use, the waiting list control group could start using Inlife. Effects were evaluated at baseline (T0), 8 weeks (T1), and 16 weeks (T2). The 16-week follow-up assessment (T2) served as the primary endpoint to evaluate the results for the primary and secondary outcome variables evaluated with online self-report questionnaires. The primary outcomes included feelings of caregiver competence and perceived social support. The secondary outcomes included received support, feelings of loneliness, psychological complaints (eg, anxiety, stress), and quality of life. Results: No significant improvements were demonstrated for the intervention group (n=48) relative to the control group (n=48) for the primary outcomes (feeling of carer competence: b=--0.057, 95\% CI --0.715 to 0.602, P=.87; perceived social support: b=--15.877, 95\% CI --78.284 to 46.530, P=.62) or any secondary outcome. This contrasts with our qualitative findings showing the potential of Inlife to facilitate the care process in daily life. Adherence was not optimal for all Inlife users. Additional per-protocol and sensitivity analyses also revealed no beneficial results for high active Inlife users or specific subgroups. Inlife users were more active when part of a larger network. Conclusions: Researchers should be modest regarding the effectiveness of online caregiver interventions in terms of quantitative measures of well-being and quality of life. Nevertheless, online tools have the potential to facilitate the caregiver process in daily life. Lessons learned include the importance of harnessing the power of human interaction in eHealth, making use of the user's social capital, and the need to develop research methods that can identify benefits in daily life that are ecologically valid for caregivers. Trial Registration: Netherlands Trial Register NTR6131; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6131 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-017-2097-y ", doi="10.2196/38656", url="https://aging.jmir.org/2022/4/e38656", url="http://www.ncbi.nlm.nih.gov/pubmed/36476485" } @Article{info:doi/10.2196/29675, author="Nunes-Da-Silva, Catarina and Victorino, Andr{\'e} and Lemos, Marta and Porojan, Ludmila and Costa, Andreia and Arriaga, Miguel and Greg{\'o}rio, Jo{\~a}o Maria and de Sousa, Dinis Rute and Rodrigues, Maria Ana and Canh{\~a}o, Helena", title="A Video-Based Mobile App as a Health Literacy Tool for Older Adults Living at Home: Protocol for a Utility Study", journal="JMIR Res Protoc", year="2022", month="Dec", day="7", volume="11", number="12", pages="e29675", keywords="mobile app", keywords="technology", keywords="treatment adherence", keywords="health literacy", keywords="seniors", keywords="older adults", abstract="Background: People aged ?65 years are more likely to have health problems related to aging, polypharmacy, and low treatment adherence. Moreover, health literacy levels decrease with increasing age. Objective: The aim of this study is to assess an app's utility in promoting health-related knowledge in people aged ?65 years. Methods: We developed a simple, intuitive, and video-based app (DigiAdherence) that presents a recipe, nutritional counseling, and content on physical activity, cognitive exercise, motivation to adhere to treatment, fall prevention, and health literacy. A convenience sample of 25 older adults attending the Personalized Health Care Unit of Portim{\~a}o or the Family Health Unit of Portas do Arade (ACeS Algarve II -- Barlavento, ARS Algarve, Portugal) will be recruited. Subjects must be aged ?65 years, own a smartphone or tablet, be willing to participate, and consent to participate. Those who do not know how to use or do not have a smartphone/tablet will be excluded. Likewise, people with major cognitive or physical impairment as well as those living in a long-term care center will not be included in this study. Participants will have access to the app for 4 weeks and will be evaluated at 3 different timepoints (V0, before they start using the app; V1, after using it for 30 days; and V2, 60 days after stopping using it). After using the app for 30 days, using a 7-point Likert scale, participants will be asked to score the mobile tool's utility in encouraging them to take their medications correctly, improving quality of life, increasing their health-related knowledge, and preventing falls. They will also be asked to assess the app's ease of use and visual esthetics, their motivation to use the app, and their satisfaction with the app. Subjects will be assessed in a clinical interview with a semistructured questionnaire, including questions regarding user experience, satisfaction, the utility of the app, quality of life (EQ-5D-3L instrument), and treatment adherence (Morisky scale). The proportion of participants who considered the app useful for their health at V1 and V2 will be analyzed. Regarding quality of life and treatment adherence perceptions, comparisons will be made between V0 and V1, using the t test for dependent samples. The same comparisons will be made between V0 and V2. Results: This study was funded in December 2019 and authorized by the Executive Board of ACeS Algarve II -- Barlavento and by the Ethics Committee of NOVA Medical School (99/2019/CEFCM, June 2020). This protocol was also approved by the Ethics Committee for Health (16/2020, September 2020) and the Executive Board (December 2020) of the Regional Health Administration of the Algarve, IP (Instituto P{\'u}blico). Recruitment was completed in June 2021. Conclusions: Since the next generation of older adults may have higher digital literacy, information and communication technologies could potentially be used to deliver health-related content to improve lifestyles among older adults. International Registered Report Identifier (IRRID): PRR1-10.2196/29675 ", doi="10.2196/29675", url="https://www.researchprotocols.org/2022/12/e29675", url="http://www.ncbi.nlm.nih.gov/pubmed/36476754" } @Article{info:doi/10.2196/40360, author="Seah, L. Cassandra E. and Zhang, Zheyuan and Sun, Sijin and Wiskerke, Esther and Daniels, Sarah and Porat, Talya and Calvo, A. Rafael", title="Designing Mindfulness Conversational Agents for People With Early-Stage Dementia and Their Caregivers: Thematic Analysis of Expert and User Perspectives", journal="JMIR Aging", year="2022", month="Dec", day="6", volume="5", number="4", pages="e40360", keywords="mindfulness", keywords="dyadic", keywords="dementia", keywords="caregivers", keywords="user needs", keywords="intervention", keywords="user", keywords="feedback", keywords="design", keywords="accessibility", keywords="relationships", keywords="mindset", keywords="essential", abstract="Background: The number of people with dementia is expected to grow worldwide. Among the ways to support both persons with early-stage dementia and their caregivers (dyads), researchers are studying mindfulness interventions. However, few studies have explored technology-enhanced mindfulness interventions for dyads and the needs of persons with dementia and their caregivers. Objective: The main aim of this study was to elicit essential needs from people with dementia, their caregivers, dementia experts, and mindfulness experts to identify themes that can be used in the design of mindfulness conversational agents for dyads. Methods: Semistructured interviews were conducted with 5 dementia experts, 5 mindfulness experts, 5 people with early-stage dementia, and 5 dementia caregivers. Interviews were transcribed and coded on NVivo (QSR International) before themes were identified through a bottom-up inductive approach. Results: The results revealed that dyadic mindfulness is preferred and that implementation formats such as conversational agents have potential. A total of 5 common themes were also identified from expert and user feedback, which should be used to design mindfulness conversational agents for persons with dementia and their caregivers. The 5 themes included enhancing accessibility, cultivating positivity, providing simplified tangible and thought-based activities, encouraging a mindful mindset shift, and enhancing relationships. Conclusions: In essence, this research concluded with 5 themes that mindfulness conversational agents could be designed based on to meet the needs of persons with dementia and their caregivers. ", doi="10.2196/40360", url="https://aging.jmir.org/2022/4/e40360", url="http://www.ncbi.nlm.nih.gov/pubmed/36472897" } @Article{info:doi/10.2196/39189, author="Tong, Catherine and Kernoghan, Alison and Lemmon, Kassandra and Fernandes, Paige and Elliott, Jacobi and Sacco, Veronica and Bodemer, Sheila and Stolee, Paul", title="Lessons and Reflections From an Extended Co-design Process Developing an mHealth App With and for Older Adults: Multiphase, Mixed Methods Study", journal="JMIR Aging", year="2022", month="Oct", day="28", volume="5", number="4", pages="e39189", keywords="mobile health", keywords="mHealth", keywords="older adults", keywords="health care providers", keywords="co-design", keywords="user experience or UX design", keywords="qualitative", keywords="apps", keywords="elderly", keywords="health care", keywords="care provider", abstract="Background: There are many mobile health (mHealth) apps for older adult patients, but research has found that broadly speaking, mHealth still fails to meet the specific needs of older adult users. Others have highlighted the need to embed users in the mHealth design process in a fulsome and meaningful way. Co-design has been widely used in the development of mHealth apps and involves stakeholders in each phase of the design and development process. The involvement of older adults in the co-design processes is variable. To date, co-design approaches have tended toward embedding the stakeholders in early phases (eg, predesign and generative) but not throughout. Objective: The aim of this study was to reflect on the processes and lessons learned from engaging in an extended co-design process to develop an mHealth app for older adults, with older users contributing at each phase. This study aimed to design an mHealth tool to assist older adults in coordinating their care with health care professionals and caregivers. Methods: Our work to conceptualize, develop, and test the mHealth app consisted of 4 phases: phase 1, consulting stakeholders; phase 2, app development and co-designing with older adults; phase 3, field-testing with a smaller sample of older adult volunteer testers; and phase 4, reflecting, internally, on lessons learned from this process. In each phase, we drew on qualitative methods, including in-depth interviews and focus groups, all of which were analyzed in NVivo 11, using team-based thematic analysis. Results: In phase 1, we identified key features that older adults and primary care providers wanted in an app, and each user group identified different priority features (older adults principally sought support to use the mHealth app, whereas primary care providers prioritized recoding illnesses, immunizations, and appointments). Phases 2 and 3 revealed significant mismatches between what the older adult users wanted and what our developers were able and willing to deliver. We were unable to craft the app that our consultations recommended, which the older adult field testers asked for. In phase 4, we reflected on our abilities to embed the voices and perspectives of older adults throughout the project when working with a developer not familiar with or committed to the core principles of co-design. We draw on this challenging experience to highlight several recommendations for those embarking on a co-design process that includes developers and IT vendors, researchers, and older adult users. Conclusions: Although our final mHealth app did not reflect all the needs and wishes of our older adult testers, our consultation process identified key features and contextual information essential for those developing apps to support older adults in managing their health and health care. ", doi="10.2196/39189", url="https://aging.jmir.org/2022/4/e39189", url="http://www.ncbi.nlm.nih.gov/pubmed/36306166" } @Article{info:doi/10.2196/39301, author="Boccardi, Alyssa and Wu, Fangzheng and Pearlman, Jon and Mhatre, Anand", title="Older Wheelchair Users Recommend Age-Friendly Design Improvements to a Wheelchair Maintenance App: Mixed Methods Development Study", journal="JMIR Aging", year="2022", month="Oct", day="18", volume="5", number="4", pages="e39301", keywords="aging", keywords="older adults", keywords="maintenance", keywords="mobile phone", keywords="repair", keywords="smartphone", keywords="wheelchair", abstract="Background: Wheelchair part failures have doubled over the past decade. Preventative wheelchair maintenance reduces wheelchair failures and prevents user consequences. We are developing a smartphone app called WheelTrak, which alerts users when maintenance is required, to encourage maintenance practices and compliance. Objective: This mixed methods study aimed to develop a wheelchair maintenance app using broad stakeholder advice and investigate older adults' interaction experience with the app and their perceived barriers to and facilitators of maintenance. Methods: Interviews were conducted with stakeholders, including mobility device users, to generate needs statements and app specifications. The app was designed in 2 stages. Stage 1 involved the development of the app according to the specifications and evaluation of the app interface by lead users. Stage 2 included the revision of the app screens and manual functionality testing. Usability testing and semistructured interviews were conducted with older wheelchair and scooter users. The System Usability Scale was used to measure app usability. Results: Interviews with power and manual wheelchair users (37/57, 65\%), wheelchair service providers (15/57, 26\%), manufacturers (2/57, 4\%), seating and mobility researchers (1/57, 2\%), and insurance plan providers (2/57, 4\%) informed the needs and specifications of the app technology. The 2-stage development process delivered a fully functional app that met the design specifications. In total, 12 older adults (mean age 74.2, SD 9.1 years; n=10, 83\% women; and n=2, 17\% men) participated in the usability testing study. Of the 12 participants, 9 (75\%) agreed to use WheelTrak for preventative maintenance. WheelTrak scored an average System Usability Scale score of 60.25 (SD 16). Four overarching themes were identified: WheelTrak app improvements, barriers to maintenance, consequences related to mobility device failure, and smart technology use and acceptance. Older adults preferred the simplicity, readability, personalization, and availability of educational resources in the app. Barriers to maintenance pertained to health issues and lack of maintenance knowledge among older adults. Facilitators of maintenance included notification for maintenance, app connectivity with the service provider, reporting of device failure, and the presence of a caregiver for maintenance. Conclusions: This study highlighted age-friendly design improvements to the app, making it easy to be used and adopted by older wheelchair users. The WheelTrak app has close to average system usability. Additional usability testing will be conducted following app revision in the future. ", doi="10.2196/39301", url="https://aging.jmir.org/2022/4/e39301", url="http://www.ncbi.nlm.nih.gov/pubmed/36256830" } @Article{info:doi/10.2196/37772, author="Tran-Nguyen, Kevin and Berger, Caroline and Bennett, Roxanne and Wall, Michelle and Morin, N. Suzanne and Rajabiyazdi, Fateme", title="Mobile App Prototype in Older Adults for Postfracture Acute Pain Management: User-Centered Design Approach", journal="JMIR Aging", year="2022", month="Oct", day="17", volume="5", number="4", pages="e37772", keywords="older adults", keywords="mobile app", keywords="skeletal fracture", keywords="usability", keywords="patient-centered", keywords="human-centered design", keywords="digital health", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="acute pain self-management", keywords="mobile phone", abstract="Background: Postfracture acute pain is often inadequately managed in older adults. Mobile health (mHealth) technologies can offer opportunities for self-management of pain; however, insufficient apps exist for acute pain management after a fracture, and none are designed for an older adult population. Objective: This study aims to design, develop, and evaluate an mHealth app prototype using a human-centered design approach to support older adults in the self-management of postfracture acute pain. Methods: This study used a multidisciplinary and user-centered design approach. Overall, 7 stakeholders (ie, 1 clinician-researcher specialized in internal medicine, 2 user experience designers, 1 computer science researcher, 1 clinical research assistant researcher, and 2 pharmacists) from the project team, together with 355 external stakeholders, were involved throughout our user-centered development process that included surveys, requirement elicitation, participatory design workshops, mobile app design and development, mobile app content development, and usability testing. We completed this study in 3 phases. We analyzed data from prior surveys administered to 305 members of the Canadian Osteoporosis Patient Network and 34 health care professionals to identify requirements for designing a low-fidelity prototype. Next, we facilitated 4 participatory design workshops with 6 participants for feedback on content, presentation, and interaction with our proposed low-fidelity prototype. After analyzing the collected data using thematic analysis, we designed a medium-fidelity prototype. Finally, to evaluate our medium-fidelity prototype, we conducted usability tests with 10 participants. The results informed the design of our high-fidelity prototype. Throughout all the phases of this development study, we incorporated inputs from health professionals to ensure the accuracy and validity of the medical content in our prototypes. Results: We identified 3 categories of functionalities necessary to include in the design of our initial low-fidelity prototype: the need for support resources, diary entries, and access to educational materials. We then conducted a thematic analysis of the data collected in the design workshops, which revealed 4 themes: feedback on the user interface design and usability, requests for additional functionalities, feedback on medical guides and educational materials, and suggestions for additional medical content. On the basis of these results, we designed a medium-fidelity prototype. All the participants in the usability evaluation tests found the medium-fidelity prototype useful and easy to use. On the basis of the feedback and difficulties experienced by participants, we adjusted our design in preparation for the high-fidelity prototype. Conclusions: We designed, developed, and evaluated an mHealth app to support older adults in the self-management of pain after a fracture. The participants found our proposed prototype useful for managing acute pain and easy to interact with and navigate. Assessment of the clinical outcomes and long-term effects of our proposed mHealth app will be evaluated in the future. ", doi="10.2196/37772", url="https://aging.jmir.org/2022/4/e37772", url="http://www.ncbi.nlm.nih.gov/pubmed/36251348" } @Article{info:doi/10.2196/35592, author="Villalobos, Paola Jennifer and Bull, Salyers Sheana and Portz, Dickman Jennifer", title="Usability and Acceptability of a Palliative Care Mobile Intervention for Older Adults With Heart Failure and Caregivers: Observational Study", journal="JMIR Aging", year="2022", month="Oct", day="6", volume="5", number="4", pages="e35592", keywords="mHealth", keywords="older adult", keywords="symptom", keywords="heart failure", keywords="palliative care", keywords="app", keywords="digital health", keywords="cardiology", keywords="heart", keywords="Convoy-Pal", keywords="mobile", keywords="tablet", keywords="smartwatch", keywords="adult", keywords="aging", abstract="Background: Heart failure is a leading cause of death among older adults. Digital health can increase access to and awareness of palliative care for patients with advanced heart failure and their caregivers. However, few palliative care digital interventions target heart failure or patients' caregivers, family, and friends, termed here as the social convoy. To address this need, the Social Convoy Palliative Care (Convoy-Pal) mobile intervention was developed to deliver self-management tools and palliative care resources to older adults with advanced heart failure and their social convoys. Objective: The goal of the research was to test the acceptability and usability of Convoy-Pal among older adults with advanced heart failure and their social convoys. Methods: Convoy-Pal includes tablet-based and smartwatch tools facilitating self-management and access to palliative care resources. Older adults and social convoy caregivers completed an acceptability and usability interview via Zoom, including open-ended questions and the Mobile Application Rating Scale: User Version (uMARS). Descriptive analysis was conducted to summarize the results of open-ended feedback and self-reported acceptability and usability. Results: A total of 26 participants (16 older adults and 10 social convoy caregivers) participated in the interview. Overall, the feedback from users was good (uMARS mean 3.96/5 [SD 0.81]). Both older adults and social convoy caregivers scored information provided by Convoy-Pal the highest (mean 4.22 [SD 0.75] and mean 4.21 [SD 0.64], respectively). Aesthetics, functionality, and engagement were also perceived as acceptable (mean >3.5). Open-ended feedback resulted in 5 themes including improvements to goal setting, monitoring tools, daily check-in call feature, portal and mobile app, and convoy assessment. Conclusions: Convoy-Pal was perceived as acceptable with good usability among older adults with heart failure and their social convoy caregivers. With good acceptability, Convoy-Pal may ultimately lead to increased access to palliative care resources and facilitate self-management among older adults with heart failure and their social convoy caregivers. ", doi="10.2196/35592", url="https://aging.jmir.org/2022/4/e35592", url="http://www.ncbi.nlm.nih.gov/pubmed/36201402" } @Article{info:doi/10.2196/38067, author="Danieli, Morena and Ciulli, Tommaso and Mousavi, Mahed Seyed and Silvestri, Giorgia and Barbato, Simone and Di Natale, Lorenzo and Riccardi, Giuseppe", title="Assessing the Impact of Conversational Artificial Intelligence in the Treatment of Stress and Anxiety in Aging Adults: Randomized Controlled Trial", journal="JMIR Ment Health", year="2022", month="Sep", day="23", volume="9", number="9", pages="e38067", keywords="mental health care", keywords="conversational artificial intelligence", keywords="mobile health", keywords="mHealth", keywords="personal health care agent", abstract="Background: While mental health applications are increasingly becoming available for large populations of users, there is a lack of controlled trials on the impacts of such applications. Artificial intelligence (AI)-empowered agents have been evaluated when assisting adults with cognitive impairments; however, few applications are available for aging adults who are still actively working. These adults often have high stress levels related to changes in their work places, and related symptoms eventually affect their quality of life. Objective: We aimed to evaluate the contribution of TEO (Therapy Empowerment Opportunity), a mobile personal health care agent with conversational AI. TEO promotes mental health and well-being by engaging patients in conversations to recollect the details of events that increased their anxiety and by providing therapeutic exercises and suggestions. Methods: The study was based on a protocolized intervention for stress and anxiety management. Participants with stress symptoms and mild-to-moderate anxiety received an 8-week cognitive behavioral therapy (CBT) intervention delivered remotely. A group of participants also interacted with the agent TEO. The participants were active workers aged over 55 years. The experimental groups were as follows: group 1, traditional therapy; group 2, traditional therapy and mobile health (mHealth) agent; group 3, mHealth agent; and group 4, no treatment (assigned to a waiting list). Symptoms related to stress (anxiety, physical disease, and depression) were assessed prior to treatment (T1), at the end (T2), and 3 months after treatment (T3), using standardized psychological questionnaires. Moreover, the Patient Health Questionnaire-8 and General Anxiety Disorders-7 scales were administered before the intervention (T1), at mid-term (T2), at the end of the intervention (T3), and after 3 months (T4). At the end of the intervention, participants in groups 1, 2, and 3 filled in a satisfaction questionnaire. Results: Despite randomization, statistically significant differences between groups were present at T1. Group 4 showed lower levels of anxiety and depression compared with group 1, and lower levels of stress compared with group 2. Comparisons between groups at T2 and T3 did not show significant differences in outcomes. Analyses conducted within groups showed significant differences between times in group 2, with greater improvements in the levels of stress and scores related to overall well-being. A general worsening trend between T2 and T3 was detected in all groups, with a significant increase in stress levels in group 2. Group 2 reported higher levels of perceived usefulness and satisfaction. Conclusions: No statistically significant differences could be observed between participants who used the mHealth app alone or within the traditional CBT setting. However, the results indicated significant differences within the groups that received treatment and a stable tendency toward improvement, which was limited to individual perceptions of stress-related symptoms. Trial Registration: ClinicalTrials.gov NCT04809090; https://clinicaltrials.gov/ct2/show/NCT04809090 ", doi="10.2196/38067", url="https://mental.jmir.org/2022/9/e38067", url="http://www.ncbi.nlm.nih.gov/pubmed/36149730" } @Article{info:doi/10.2196/32453, author="Frechette, Mikaela and Fanning, Jason and Hsieh, Katherine and Rice, Laura and Sosnoff, Jacob", title="The Usability of a Smartphone-Based Fall Risk Assessment App for Adult Wheelchair Users: Observational Study", journal="JMIR Form Res", year="2022", month="Sep", day="16", volume="6", number="9", pages="e32453", keywords="usability testing", keywords="mobile health", keywords="wheeled device user", keywords="fall risk", keywords="telehealth", keywords="mHealth", keywords="mobile device", keywords="smartphone", keywords="health applications", keywords="older adults", keywords="elderly population", keywords="device usability", abstract="Background: Individuals who use wheelchairs and scooters rarely undergo fall risk screening. Mobile health technology is a possible avenue to provide fall risk assessment. The promise of this approach is dependent upon its usability. Objective: We aimed to determine the usability of a fall risk mobile health app and identify key technology development insights for aging adults who use wheeled devices. Methods: Two rounds (with 5 participants in each round) of usability testing utilizing an iterative design-evaluation process were performed. Participants completed use of the custom-designed fall risk app, Steady-Wheels. To quantify fall risk, the app led participants through 12 demographic questions and 3 progressively more challenging seated balance tasks. Once completed, participants shared insights on the app's usability through semistructured interviews and completion of the Systematic Usability Scale. Testing sessions were recorded and transcribed. Codes were identified within the transcriptions to create themes. Average Systematic Usability Scale scores were calculated for each round. Results: The first round of testing yielded 2 main themes: ease of use and flexibility of design. Systematic Usability Scale scores ranged from 72.5 to 97.5 with a mean score of 84.5 (SD 11.4). After modifications were made, the second round of testing yielded 2 new themes: app layout and clarity of instruction. Systematic Usability Scale scores improved in the second iteration and ranged from 87.5 to 97.5 with a mean score of 91.9 (SD 4.3). Conclusions: The mobile health app, Steady-Wheels, has excellent usability and the potential to provide adult wheeled device users with an easy-to-use, remote fall risk assessment tool. Characteristics that promoted usability were guided navigation, large text and radio buttons, clear and brief instructions accompanied by representative illustrations, and simple error recovery. Intuitive fall risk reporting was achieved through the presentation of a single number located on a color-coordinated continuum that delineated low, medium, and high risk. ", doi="10.2196/32453", url="https://formative.jmir.org/2022/9/e32453", url="http://www.ncbi.nlm.nih.gov/pubmed/36112405" } @Article{info:doi/10.2196/39851, 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/10.2196/33845, author="Boateng, George and Petersen, L. Curtis and Kotz, David and Fortuna, L. Karen and Masutani, Rebecca and Batsis, A. John", title="A Smartwatch Step-Counting App for Older Adults: Development and Evaluation Study", journal="JMIR Aging", year="2022", month="Aug", day="10", volume="5", number="3", pages="e33845", keywords="step tracking", keywords="step counting", keywords="pedometer", keywords="wearable", keywords="smartwatch", keywords="older adults", keywords="physical activity", keywords="machine learning", keywords="walking", keywords="mHealth", keywords="mobile health", keywords="mobile app", keywords="mobile application", keywords="app", keywords="uHealth", abstract="Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have been shown to be inaccurate in clinical settings. Step-counting algorithms have been developed for smartwatches, but only using data from younger adults and, often, were only validated in controlled laboratory settings. Objective: We sought to develop and validate a smartwatch step-counting app for older adults and evaluate the algorithm in free-living settings over a long period of time. Methods: We developed and evaluated a step-counting app for older adults on an open-source wrist-worn device (Amulet). The app includes algorithms to infer the level of physical activity and to count steps. We validated the step-counting algorithm in the lab (counting steps from a video recording, n=20) and in free-living conditions---one 2-day field study (n=6) and two 12-week field studies (using the Fitbit as ground truth, n=16). During app system development, we evaluated 4 walking patterns: normal, fast, up and down a staircase, and intermittent speed. For the field studies, we evaluated 5 different cut-off values for the algorithm, using correlation and error rate as the evaluation metrics. Results: The step-counting algorithm performed well. In the lab study, for normal walking (R2=0.5), there was a stronger correlation between the Amulet steps and the video-validated steps; for all activities, the Amulet's count was on average 3.2 (2.1\%) steps lower (SD 25.9) than the video-validated count. For the 2-day field study, the best parameter settings led to an association between Amulet and Fitbit (R2=0.989) and 3.1\% (SD 25.1) steps lower than Fitbit, respectively. For the 12-week field study, the best parameter setting led to an R2 value of 0.669. Conclusions: Our findings demonstrate the importance of an iterative process in algorithm development before field-based deployment. This work highlights various challenges and insights involved in developing and validating monitoring systems in real-world settings. Nonetheless, our step-counting app for older adults had good performance relative to the ground truth (a commercial Fitbit step counter). Our app could potentially be used to help improve physical activity among older adults. ", doi="10.2196/33845", url="https://aging.jmir.org/2022/3/e33845", url="http://www.ncbi.nlm.nih.gov/pubmed/35947445" } @Article{info:doi/10.2196/36975, author="Boutilier, J. Justin and Loganathar, Priya and Linden, Anna and Scheer, Eleanore and Noejovich, Sofia and Elliott, Christian and Zuraw, Matthew and Werner, E. Nicole", title="A Web-Based Platform (CareVirtue) to Support Caregivers of People Living With Alzheimer Disease and Related Dementias: Mixed Methods Feasibility Study", journal="JMIR Aging", year="2022", month="Aug", day="4", volume="5", number="3", pages="e36975", keywords="Alzheimer disease and related dementias", keywords="mHealth", keywords="caregivers", keywords="dementia caregiving", keywords="eHealth", keywords="telehealth", abstract="Background: People living with Alzheimer disease and related dementias (ADRD) require prolonged and complex care that is primarily managed by informal caregivers who face significant unmet needs regarding support for communicating and coordinating across their informal care network. To address this unmet need, we developed CareVirtue, which provides (1) the ability to invite care network members; (2) a care guide detailing the care plan; (3) a journal where care network members can document, communicate, and coordinate; (4) a shared calendar; and (5) vetted geolocated caregiver resources. Objective: This study aims to evaluate CareVirtue's feasibility based on: (1) Who used CareVirtue? (2) How did caregivers use CareVirtue? (3) How did caregivers perceive the acceptability of CareVirtue? (4) What factors were associated with CareVirtue use? Methods: We conducted a feasibility study with 51 care networks over a period of 8 weeks and used a mixed methods approach that included both quantitative CareVirtue usage data and semistructured interviews. Results: Care networks ranged from 1 to 8 members. Primary caregivers were predominantly female (38/51, 75\%), White (44/51, 86\%), married (37/51, 73\%), college educated (36/51, 71\%), and were, on average, 60.3 (SD 9.8) years of age, with 18\% (9/51) living in a rural area. CareVirtue usage varied along 2 axes (total usage and type of usage), with heterogeneity in how the most engaged care networks interacted with CareVirtue. Interviews identified a range of ways CareVirtue was useful, including practically, organizationally, and emotionally. On the Behavioral Intention Scale, 72\% (26/36) of primary caregivers reported an average score of at least 3, indicating an above average intention to use. The average was 81.8 (SD 12.8) for the System Usability Scale score, indicating ``good'' usability, and 3.4 (SD 1.0) for perceived usefulness, suggesting above average usefulness. The average confidence score increased significantly over the study duration from 7.8 in week 2 to 8.9 in week 7 (P=.005; r=0.91, 95\% CI 0.84-0.95). The following sociodemographic characteristics were associated with posting in the journal: retired (mean 59.5 posts for retired caregivers and mean 16.9 for nonretired caregivers), income (mean 13 posts for those reporting >US \$100K and mean 55.4 for those reporting