@Article{info:doi/10.2196/65183,
author="Cai, Ruixue
and Chao, Jianqian
and Gao, Chenlu
and Gao, Lei
and Hu, Kun
and Li, Peng",
title="Association Between Sleep Duration and Cognitive Frailty in Older Chinese Adults: Prospective Cohort Study",
journal="JMIR Aging",
year="2025",
month="Apr",
day="23",
volume="8",
pages="e65183",
keywords="aging",
keywords="frailty",
keywords="cognition",
keywords="cohort study",
keywords="sleep duration",
keywords="sleep quality",
keywords="longitudinal study",
abstract="Background: Disturbed sleep patterns are common among older adults and may contribute to cognitive and physical declines. However, evidence for the relationship between sleep duration and cognitive frailty, a concept combining physical frailty and cognitive impairment in older adults, is lacking. Objective: This study aimed to examine the associations of sleep duration and its changes with cognitive frailty. Methods: We analyzed data from the 2008?2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Cognitive frailty was rendered based on the modified Fried frailty phenotype and Mini-Mental State Examination. Sleep duration was categorized as short (<6 h), moderate (6?9 h), and long (>9 h). We examined the association of sleep duration with cognitive frailty status at baseline using logistic regressions and with the future incidence of cognitive frailty using Cox proportional hazards models. Restricted cubic splines were used to explore potential nonlinear associations. Results: Among 11,303 participants, 1298 (11.5\%) had cognitive frailty at baseline. Compared to participants who had moderate sleep duration, the odds of having cognitive frailty were higher in those with long sleep duration (odds ratio 1.71, 95\% CI 1.48?1.97; P<.001). A J-shaped association between sleep duration and cognitive frailty was also observed (P<.001). Additionally, during a mean follow-up of 6.7 (SD 2.6) years among 5201 participants who were not cognitively frail at baseline, 521 (10\%) participants developed cognitive frailty. A higher risk of cognitive frailty was observed in participants with long sleep duration (hazard ratio 1.32, 95\% CI 1.07?1.62; P=.008). Conclusions: Long sleep duration was associated with cognitive frailly in older Chinese adults. These findings provide insights into the relationship between sleep duration and cognitive frailty, with potential implications for public health policies and clinical practice. ",
doi="10.2196/65183",
url="https://aging.jmir.org/2025/1/e65183"
}


@Article{info:doi/10.2196/64853,
author="Kang, Bada
and Hong, Dahye
and Yoon, Seolah
and Kang, Chaeeun
and Kim, Ivy Jennifer",
title="Assessing Social Interaction and Loneliness and Their Association With Frailty Among Older Adults With Subjective Cognitive Decline or Mild Cognitive Impairment: Ecological Momentary Assessment Approach",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="22",
volume="13",
pages="e64853",
keywords="geriatric",
keywords="older",
keywords="elderly",
keywords="ageing",
keywords="association",
keywords="correlation",
keywords="cognitive impairment",
keywords="ecological momentary assessment",
keywords="frailty",
keywords="mild behavioral impairment",
keywords="dementia",
keywords="Alzheimer",
keywords="isolation",
keywords="lonely",
keywords="social",
keywords="interaction",
keywords="self-reported",
keywords="psychogeriatrics",
abstract="Background: Frail older adults are at greater risk of adverse health-related outcomes such as falls, disability, and mortality. Mild behavioral impairment (MBI), which is characterized by neurobehavioral symptoms in individuals without dementia, is a crucial factor in identifying at-risk groups and implementing early interventions for frail older adults. However, the specific role of social functioning, which encompasses social interaction and loneliness levels, in relation to frailty within this group remains unclear. Objective: This study investigated the association between frailty status, social interaction frequency, and loneliness levels among older adults with subjective cognitive decline (SCD) or mild cognitive impairment (MCI) while adjusting for MBI symptoms in 2 contexts: the presence and severity of MBI symptoms. Methods: Older adults with SCD or MCI were recruited from an outpatient clinic specializing in the early diagnosis and care management of dementia at a community health center, as well as from a community service center in Seoul, South Korea. Using an ecological momentary assessment approach, participants reported their daily social interaction frequency and loneliness level via a mobile app, 4 times daily for 2 weeks. Frailty status, the outcome variable, was assessed using the Korean version of the frailty phenotype questionnaire. Additionally, MBI symptoms were assessed using the 34-item MBI-Checklist covering 5 domains. Multinomial logistic regression analyses were performed to investigate the association between frailty status (robust, prefrail, and frail), and the independent variables, adjusting for the presence or severity of MBI symptoms. Results: Among the 101 participants analyzed, 29.7\% (n=30) of participants were classified as prefrail, and 12.8\% (n=13) of participants were classified as frail. Higher average daily social interaction scores were consistently associated with lower odds of a frail status compared to a robust status. This was evident in the models adjusted for both the global presence (relative risk ratio [RRR] 0.18, P=.02) and global severity (RRR 0.20, P=.02) of MBI symptoms. Conclusions: Frequent social interaction was inversely associated with frail status in older adults with SCD or MCI, even after adjusting for the presence and severity of MBI symptoms. These findings highlight the potential of social functioning as a modifiable factor for addressing frailty among older adults at risk of cognitive and functional decline. Future prospective studies using real-time measurements are needed to refine these findings and further investigate additional risk factors and functional outcomes in this group. ",
doi="10.2196/64853",
url="https://mhealth.jmir.org/2025/1/e64853",
url="http://www.ncbi.nlm.nih.gov/pubmed/40210431"
}


@Article{info:doi/10.2196/71030,
author="Li, Xueqin
and Liu, Jin
and Huang, Ning
and Zhao, Wanyu
and He, Hongbo",
title="Association Between Internet Use and Sleep Health Among Middle-Aged and Older Chinese Individuals: Nationwide Longitudinal Study",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="16",
volume="27",
pages="e71030",
keywords="internet use",
keywords="sleep",
keywords="Chinese middle-aged and older adults",
keywords="internet frequency",
keywords="cohort study",
abstract="Background: Sleep disorders are common among older adults and have a bidirectional impact on their emotional well-being. While some studies suggest that internet use may offer mental health benefits to this population, the relationship between internet use and sleep outcomes remains underexplored. Objective: This study investigates the association between internet use (including use frequency) and sleep quality and duration in middle-aged and older Chinese adults. Methods: A longitudinal analysis was conducted using the China Health and Retirement Longitudinal Study data from 2015 to 2018. Sleep quality was assessed using the sleep item from the Centre for Epidemiologic Studies Depression Scale, categorized as ``good'' (<1 day; reference), ``fair'' (1-4 days), or ``poor'' (5-7 days). Sleep duration was classified as short (<6 hours), medium (6-9 hours; reference), or long (>9 hours). Adjusted multinomial logistic regressions were used to examine the associations between internet use or frequency in 2015 and sleep quality or duration in 2018, controlling for age, sex, residence, diseases, smoking, drinking, and napping time and further exploring sex and age group variations. Results: The baseline analysis included 18,460 participants aged 45 years and older, with 1272 (6.9\%) internet users, 8825 (48.1\%) participants had fair or poor sleep, and 6750 (37.2\%) participants had abnormal sleep duration. Internet users, particularly those who used it almost daily, were less likely to report poor sleep quality (relative risk [RR] 0.71, 95\% CI 0.54-0.94) and longer sleep duration (RR 0.22, 95\% CI 0.11-0.44) than nonusers. In the longitudinal analysis, baseline internet users had a significantly reduced risk of fair (RR 0.66, 95\% CI 0.51-0.86) and poor sleep quality (RR 0.60, 95\% CI 0.44-0.81), as well as short (RR 0.73, 95\% CI 0.53-1.00) and long sleep duration (RR 0.39, 95\% CI 0.21-0.72) during the follow-up period than nonusers. These associations remained significant for almost daily internet use (RR 0.32, 95\% CI 0.15-0.69). Subgroup analyses by sex revealed a positive relationship between internet use and sleep quality, with a stronger effect in female (poor sleep: RR 0.57, 95\% CI 0.36-0.89) than male (poor sleep: RR 0.61, 95\% CI 0.40-0.92) participants. The effect on sleep duration was significant only in daily male users, showing a reduced risk of long sleep duration (RR 0.30, 95\% CI 0.11-0.78). In the age subgroup analysis, most internet users were in the 45- to 59-year age group, with results consistent with the overall findings. Conclusions: This study suggests that internet use is associated with a reduced risk of sleep problems in middle-aged and older adults. The findings indicate that moderate, regular internet engagement---such as daily use---may promote better sleep health in this population. ",
doi="10.2196/71030",
url="https://www.jmir.org/2025/1/e71030"
}


@Article{info:doi/10.2196/66167,
author="Sanchez-Escudero, Pablo Juan
and Aguillon, David
and Valencia, Stella
and Garcia-Barrera, A. Mauricio
and Aguirre-Acevedo, Camilo Daniel
and Trujillo, Natalia",
title="Digital Ergonomics of NavegApp, a Novel Serious Game for Spatial Cognition Assessment: Content Validity and Usability Study",
journal="JMIR Serious Games",
year="2025",
month="Apr",
day="2",
volume="13",
pages="e66167",
keywords="serious games",
keywords="spatial cognition",
keywords="digital neuropsychology",
keywords="Alzheimer disease",
keywords="content validity",
keywords="usability",
abstract="Background: Alzheimer disease (AD) is the leading cause of dementia worldwide. With aging populations and limited access to effective treatments, there is an urgent need for innovative markers to support timely preventive interventions. Emerging evidence highlights spatial cognition (SC) as a valuable source of cognitive markers for AD. This study presents NavegApp, a serious game (SG) designed to assess 3 key components of SC, which show potential as cognitive markers for the early detection of AD. Objective: This study aimed to determine the content validity and usability perception of NavegApp across multiple groups of interest. Methods: A multistep process integrating methodologies from software engineering, psychometrics, and health measurement was implemented to validate the software. Our approach was structured into 3 stages, guided by the software life cycle for health and the Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) recommendations for evaluating the psychometric quality of health instruments. To assess content validity, a panel of 8 experts evaluated the relevance and representativeness of tasks included in the app. In addition, 212 participants, categorized into 5 groups based on their clinical status and risk level for AD, were recruited to evaluate the app's digital ergonomics and usability at various stages of development. Complementary analyses were performed to identify group differences and to explore the association between task difficulty and user agreeableness. Results: NavegApp was validated as a highly usable tool by both experts and users. The expert panel confirmed that the tasks included in the game were representative (Aiken V=0.96-1.00) and relevant (Aiken V=0.96-1.00) for measuring SC components. Both experts and nonexperts rated NavegApp's digital ergonomics positively, with minimal differences between groups (rrb 0.08-0.29). Differences in usability perceptions were observed among participants with sporadic mild cognitive impairment compared to cognitively healthy individuals (rrb 0.26-0.29). A moderate association was also identified between task difficulty and user agreeableness (Cram{\'e}r V=0.37, 95\% CI 0.28-0.54). Conclusions: NavegApp is a valid and user-friendly SG designed for SC assessment, developed by integrating software engineering and psychometric evaluation methodologies. While the results are promising, further studies are warranted to evaluate its diagnostic accuracy and construct validity. This work outlines a comprehensive framework for SG development in cognitive assessment, emphasizing the importance of incorporating psychometric validity measures from the outset of the design process. ",
doi="10.2196/66167",
url="https://games.jmir.org/2025/1/e66167"
}


@Article{info:doi/10.2196/64352,
author="Gomes da Rocha, Carla
and von Gunten, Armin
and Vandel, Pierre
and Jopp, S. Daniela
and Ribeiro, Olga
and Verloo, Henk",
title="Building Consensus on the Relevant Criteria to Screen for Depressive Symptoms Among Near-Centenarians and Centenarians: Modified e-Delphi Study",
journal="JMIR Aging",
year="2025",
month="Mar",
day="5",
volume="8",
pages="e64352",
keywords="centenarians",
keywords="near-centenarians",
keywords="depressive symptoms",
keywords="depression diagnosis",
keywords="screening",
keywords="assessment",
keywords="e-Delphi technique",
keywords="web-based survey",
abstract="Background: The number of centenarians worldwide is expected to increase dramatically, reaching 3.4 million by 2050 and >25 million by 2100. Despite these projections, depression remains a prevalent yet underdiagnosed and undertreated condition among this population that carries significant health risks. Objective: This study aimed to identify and achieve consensus on the most representative signs and symptoms of depression in near-centenarians and centenarians (aged ?95 years) through an e-Delphi study with an international and interdisciplinary panel of experts. Ultimately, the outcomes of this study might help create a screening instrument that is specifically designed for this unique population. Methods: A modified e-Delphi study was carried out to achieve expert consensus on depressive symptoms in near-centenarians and centenarians. A panel of 28 international experts was recruited. Consensus was defined as 70\% agreement on the relevance of each item. Data were collected through a web-based questionnaire over 3 rounds. Experts rated 104 items that were divided into 24 dimensions and 80 criteria to identify the most representative signs and symptoms of depression in this age group. Results: The panel consisted of experts from various countries, including physicians with experience in old age psychiatry or geriatrics as well as nurses and psychologists. The response rate remained consistent over the rounds (20/28, 71\% to 21/28, 75\%). In total, 4 new dimensions and 8 new criteria were proposed by the experts, and consensus was reached on 86\% (24/28) of the dimensions and 80\% (70/88) of the criteria. The most consensual potentially relevant dimensions were lack of hope (21/21, 100\%), loss of interest (27/28, 96\%), lack of reactivity to pleasant events (27/28, 96\%), depressed mood (26/28, 93\%), and previous episodes of depression or diagnosed depression (19/21, 90\%). In addition, the most consensual potentially relevant criteria were despondency, gloom, and despair (25/25, 100\%); depressed (27/27, 100\%); lack of reactivity to pleasant events or circumstances (28/28, 100\%); suicidal ideation (28/28, 100\%); suicide attempt(s) (28/28, 100\%); ruminations (27/28, 96\%); recurrent thoughts of death or suicide (27/28, 96\%); feelings of worthlessness (25/26, 96\%); critical life events (20/21, 95\%); anhedonia (20/21, 95\%); loss of interest in activities (26/28, 93\%); loss of pleasure in activities (26/28, 93\%); and sadness (24/26, 92\%). Moreover, when assessing depression in very old age, the duration, number, frequency, and severity of signs and symptoms should also be considered, as evidenced by the high expert agreement. Conclusions: The classification of most elements as relevant highlights the importance of a multidimensional approach for optimal depression screening among individuals of very old age. This study offers a first step toward improving depression assessment in near-centenarians and centenarians. The development of a more adapted screening tool could improve early detection and intervention, enhancing the quality of mental health care for this population. ",
doi="10.2196/64352",
url="https://aging.jmir.org/2025/1/e64352",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053803"
}


@Article{info:doi/10.2196/65292,
author="Huynh, Duong
and Sun, Kevin
and Patterson, Mary
and Hosseini Ghomi, Reza
and Huang, Bin",
title="Performance of a Digital Cognitive Assessment in Predicting Dementia Stages Delineated by the Dementia Severity Rating Scale: Retrospective Study",
journal="JMIR Aging",
year="2025",
month="Feb",
day="26",
volume="8",
pages="e65292",
keywords="stage",
keywords="severity",
keywords="progression",
keywords="correlation",
keywords="association",
keywords="cognitive impairment",
keywords="functional activities",
keywords="cognitive assessment",
keywords="BrainCheck",
keywords="dementia",
keywords="Alzheimer disease",
keywords="gerontology",
keywords="geriatric",
keywords="old",
keywords="elderly",
keywords="aging",
keywords="retrospective analysis",
keywords="digital assessment",
keywords="patient assessment",
keywords="digital cognitive assessment",
keywords="digital health",
keywords="neurodegeneration",
keywords="memory loss",
keywords="memory function",
keywords="risk factors",
abstract="Background: Dementia is characterized by impairments in an individual's cognitive and functional abilities. Digital cognitive assessments have been shown to be effective in detecting mild cognitive impairment and dementia, but whether they can stage the disease remains to be studied. Objective: In this study, we examined (1) the correlation between scores obtained from BrainCheck standard battery of cognitive assessments (BC-Assess), a digital cognitive assessment, and scores obtained from the Dementia Severity Rating Scale (DSRS), and (2) the accuracy of using the BC-Assess score to predict dementia stage delineated by the DSRS score. We also explored whether BC-Assess can be combined with information from the Katz Index of Independence in activities of daily living (ADL) to obtain enhanced accuracy. Methods: Retrospective analysis was performed on a BrainCheck dataset containing 1751 patients with dementia with different cognitive and functional assessments completed for cognitive care planning, including the DSRS, the ADL, and the BC-Assess. The patients were staged according to their DSRS total score (DSRS-TS): 982 mild (DSRS-TS 10?18), 656 moderate (DSRS-TS 19-26), and 113 severe (DSRS-TS 37-54) patients. Pearson correlation was used to assess the associations between BC-Assess overall score (BC-OS), ADL total score (ADL-TS), and DSRS-TS. Logistic regression was used to evaluate the possibility of using patients' BC-OS and ADL-TS to predict their stage. Results: We found moderate Pearson correlations between DSRS-TS and BC-OS (r=?0.53), between DSRS-TS and ADL-TS (r=?0.55), and a weak correlation between BC-OS and ADL-TS (r=0.37). Both BC-OS and ADL-TS significantly decreased with increasing severity. BC-OS demonstrated to be a good predictor of dementia stages, with an area under the receiver operating characteristic curve (ROC-AUC) of classification using logistic regression ranging from .733 to .917. When BC-Assess was combined with ADL, higher prediction accuracies were achieved, with an ROC-AUC ranging from 0.786 to 0.961. Conclusions: Our results suggest that BC-Assess could serve as an effective alternative tool to DSRS for grading dementia severity, particularly in cases where DSRS, or other global assessments, may be challenging to obtain due to logistical and time constraints. ",
doi="10.2196/65292",
url="https://aging.jmir.org/2025/1/e65292"
}


@Article{info:doi/10.2196/57264,
author="Schenzel, A. Holly
and Palmer, K. Allyson
and Shah, B. Neel
and Lawson, K. Donna
and Fischer, M. Karen
and Lapid, I. Maria
and DeFoster, E. Ruth",
title="Weighted Blankets for Agitation in Hospitalized Patients with Dementia: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="26",
volume="14",
pages="e57264",
keywords="dementia",
keywords="hospitalized dementia patients",
keywords="agitation",
keywords="aggression",
keywords="behaviors",
keywords="sleep",
keywords="weighted blankets",
keywords="nonpharmacologic strategy",
keywords="pilot study",
keywords="inpatients",
keywords="occupational therapy",
abstract="Background: There are limited therapies approved for the treatment of aggression and agitation in patients with dementia. While antipsychotics and benzodiazepines are commonly used, these medications have been associated with significant side effects and US Food and Drug Administration (FDA) boxed warnings. Weighted blankets have been associated with decreased anxiety and improved sleep. Weighted blankets are potentially a nonpharmacologic option to reduce agitation in hospitalized patients with dementia. Objective: The aim of this study is to investigate the effect of weighted blankets on aggression and agitation in hospitalized patients with dementia. Methods: A pilot study will be conducted on a total of 30 hospitalized patients with a documented clinical diagnosis of dementia and ongoing agitated behaviors admitted to a medicine or psychiatry service. Patients will be randomly allocated to receive either a weighted blanket for 3 nights or continued usual care. The primary outcome is the change in the observational version of the Cohen-Mansfield Agitation Inventory (CMAI-O) over the course of the 3-night study period. The secondary outcomes are changes in Edmonton Symptom Assessment System Revised (ESAS-r) and Clinical Global Impression (CGI) scores, hours of sleep, use of antipsychotics and benzodiazepines, and incidence of delirium. Identical study assessments will be completed for both the usual care and the weighted blanket study groups. At 5 study time points (baseline, postnight 1, postnight 2, postnight 3, and a final assessment 48-72 h after the last use of the weighted blanket), patients will be assessed with the CMAI-O, ESAS-r, and CGI tools. All assessments will be completed by the bedside nurse or patient care assistant caring for the patient each day. Within 2 to 4 weeks post discharge from the hospital, study coordinators will contact the patient's legally authorized representative (LAR) to assess for continued use of the weighted blanket. Results: Enrollment of participants began on April 23, 2023. As of November 2024, a total of 24 participants have been enrolled in the study. Baseline characteristics of enrolled participants will be analyzed and reported upon completion of enrollment. We anticipate completing data collection by March 2026. Conclusions: The study will determine the effect of weighted blankets on agitation in hospitalized patients with dementia. Insights into the effect of weighted blankets on sleep will also be gained. The results of this study will be relevant in the setting of increasing numbers of older adults with dementia exhibiting agitation, leading to increased hospitalizations, caregiver burden, and health care costs. Trial Registration: ClinicalTrials.gov NCT03643991; http://clinicaltrials.gov/ct2/show/NCT03643991 International Registered Report Identifier (IRRID): DERR1-10.2196/57264 ",
doi="10.2196/57264",
url="https://www.researchprotocols.org/2025/1/e57264"
}


@Article{info:doi/10.2196/66690,
author="Meier-Diedrich, Eva
and Esch, Tobias
and H{\"a}gglund, Maria
and Heinze, Martin
and Hochwarter, Stefan
and Speck, Justin
and Wagener, Marie
and Dahling, Volker
and Schwarz, Julian",
title="Experiences of Older Mental Health Patients and Their Care Partners Using a Proxy Account to Access Open Notes: Qualitative Interview Study",
journal="JMIR Aging",
year="2025",
month="Feb",
day="24",
volume="8",
pages="e66690",
keywords="psychiatry",
keywords="eHealth",
keywords="mental health",
keywords="digital literacy",
keywords="older patients",
keywords="older adult",
keywords="care partner",
keywords="proxy access",
keywords="open record access",
keywords="Open Notes",
keywords="patient portal",
keywords="artificial intelligence",
keywords="AI",
abstract="Background: Older patients with serious mental illnesses such as cognitive disorders often rely on family members or spouses (care partners [CPs]) to meet their health care needs. CPs frequently lack essential information to fully understand the patients' illnesses and effectively support their treatment. Open Notes provide patients with digital access to their health care professionals' clinical notes and are associated with many positive outcomes, such as increased adherence and empowerment. However, older patients who use Open Notes may encounter use barriers such as limited digital literacy. Recent developments allow CPs to access Open Notes (proxy access) and receive valuable information, which holds significant potential for improving the care of older patients. Objective: This study explored the experiences, barriers, and opportunities of older mental health patients and their CPs related to using Open Notes. Furthermore, influencing factors and interdependencies were identified. Methods: Older patients (n=10) and their CPs (n=10) were provided with web-based proxy access to clinical documentation through a web-based patient portal. In-depth qualitative interviews (N=20) were conducted to explore experiences with this access. Data analysis was conducted in accordance with the constructivist grounded theory approach. Results: The prerequisites for using Open Notes with proxy access were sufficient digital literacy on the part of the patient or CP, as well as the establishment of a trusting relationship between patients and CPs. Access to Open Notes enabled patients and CPs to gain a deeper understanding of the illness and its treatment while also facilitating enhanced contact with health care professionals. This resulted in greater involvement in the treatment process but may also prompt changes in relationship dynamics---CPs are better equipped to support patients in their health care but may also tend to monitor or control them through Open Notes. As a result, the introduction of Open Notes was accompanied by mixed feelings. Conclusions: It is of utmost importance to provide older patients with comprehensive access to Open Notes to preserve their health autonomy. However, the involvement of CPs through proxy access is of great value in improving the care of older patients, especially those with cognitive impairments. ",
doi="10.2196/66690",
url="https://aging.jmir.org/2025/1/e66690"
}


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


@Article{info:doi/10.2196/66838,
author="Shin, Hyeonsang
and Seong, Woohyun
and Woo, Yeonju
and Kim, Joo-Hee
and Park, Kwang-Rak
and Lee, Hyuk Dong",
title="Neural Mechanism of Cognitive Reserve in Acupuncture Stimulation: Protocol for a Randomized, Placebo-Controlled Functional Near-Infrared Spectroscopy Trial",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="19",
volume="14",
pages="e66838",
keywords="cognitive reserve",
keywords="acupuncture",
keywords="dementia",
keywords="mild cognitive impairment",
keywords="neuroimaging",
keywords="fNIRS",
keywords="brain connectivity",
keywords="neural mechanism",
keywords="RCT",
keywords="randomized controlled trial",
abstract="Background: Dementia is a clinical syndrome characterized by a progressive decline in various cognitive domains. Since there is still no treatment for dementia, early diagnosis and prevention are the best approaches. In this context, the cognitive reserve (CR) concept has received considerable attention in dementia research with regard to prognosis. It originates from discrepancies between the degree of brain pathology and clinical manifestations. Acupuncture, as a complementary intervention, has long been widely applied in neurological diseases in East Asia. At the macroscale level, how acupuncture stimulation affects neural activity concerning CR in normal aging and dementia is largely unknown. Objective: The aim of this study is to investigate the acute neural mechanisms of acupuncture stimulation concerning CR in the normal aging group and the group with cognitive impairment using neuroimaging methods. Methods: This study is a randomized, placebo-controlled trial. Participants without (n=30) and with cognitive impairment (n=30) will be randomly assigned to the verum or sham acupuncture groups. The verum acupuncture group will receive acupuncture stimulation at acupoints related to cognitive function and gain deqi sensation. The sham acupuncture group will receive superficial needling at nonacupoints not related to cognitive function. Each group will undergo cognitive function tests, functional near-infrared spectroscopy imaging before and after acupuncture stimulation, and an assessment of CR. The primary outcomes will be differences in resting brain activities according to disease status, differences in resting brain connectivity before and after acupuncture stimulation between the 2 groups, and changes in brain activity in relation to the CR index. The secondary outcomes will be brain connectivity or network metrics associated with CR and differences in neural activity between the cognitive task and resting states. Results: The recruitment began in August 2023; to date, there have been 50 participants, divided into 20 in the group with cognitive impairment and 30 in the unimpaired group. The recruitment process will continue until February 2025. Conclusions: CR refers to the individual susceptibility to age-related brain changes and pathologies in cognitive impairment, and it is a factor affecting the trajectories of the disease. Although acupuncture is a widely used intervention for various neurological diseases, including dementia, its mechanism associated with CR at the macroscale has not been clearly identified. This study could contribute to identifying the neural mechanisms of acupuncture stimulation associated with CR using neuroimaging methods and provide a basis for future longitudinal research. Trial Registration: Clinical Research Information Service of the Republic of Korea KCT0008719; https://tinyurl.com/ydv5537n International Registered Report Identifier (IRRID): DERR1-10.2196/66838 ",
doi="10.2196/66838",
url="https://www.researchprotocols.org/2025/1/e66838"
}


@Article{info:doi/10.2196/65379,
author="Deng, Cheng
and Shen, Na
and Li, Guangzhou
and Zhang, Ke
and Yang, Shijun",
title="Digital Isolation and Dementia Risk in Older Adults: Longitudinal Cohort Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="19",
volume="27",
pages="e65379",
keywords="dementia",
keywords="digital isolation",
keywords="cognitive decline",
keywords="older adults",
keywords="elderly",
keywords="geriatric",
keywords="longitudinal cohort study",
keywords="cognitive impairment",
keywords="aging",
keywords="social isolation",
keywords="risk",
keywords="digital engagement",
abstract="Background: Dementia poses a significant global health challenge, characterized by progressive cognitive decline and functional impairment. With the aging global population, dementia prevalence is projected to surge, reaching an estimated 153 million cases by 2050. While the impact of traditional social isolation on dementia risk has been extensively studied, the influence of digital isolation, a phenomenon unique to the digital age, remains underexplored. Objective: This study aimed to investigate the association between digital isolation and dementia risk among older adults, hypothesizing that higher levels of digital isolation significantly increase the risk of developing dementia. Methods: We conducted a longitudinal cohort study using data from the National Health and Aging Trends Study (NHATS), analyzing 8189 participants aged 65 years and older from the 3rd (2013) to the 12th wave (2022). Digital isolation was quantified using a composite digital isolation index, derived from participants' usage of digital devices, electronic communication, internet access, and engagement in online activities. Participants were stratified into low isolation and moderate to high isolation groups. Dementia incidence was assessed using cognitive tests and proxy reports. Cox proportional hazards models were used to estimate the association between digital isolation and dementia risk, adjusting for potential confounders including sociodemographic factors, baseline health conditions, and lifestyle variables. Results: The moderate to high isolation group demonstrated a significantly elevated risk of dementia compared with the low isolation group. In the discovery cohort, the adjusted hazard ratio (HR) was 1.22 (95\% CI 1.01-1.47, P=.04), while the validation cohort showed an HR of 1.62 (95\% CI 1.27-2.08, P<.001). The pooled analysis across both cohorts revealed an adjusted HR of 1.36 (95\% CI 1.16-1.59, P<.001). Kaplan-Meier curves corroborated a higher incidence of dementia in the moderate to high isolation group. Conclusions: Our findings indicate that digital isolation is a significant risk factor for dementia among older adults. This study underscores the importance of digital engagement in mitigating dementia risk and suggests that promoting digital literacy and access to digital resources should be integral components of public health strategies aimed at dementia prevention. ",
doi="10.2196/65379",
url="https://www.jmir.org/2025/1/e65379",
url="http://www.ncbi.nlm.nih.gov/pubmed/39969956"
}


@Article{info:doi/10.2196/64445,
author="Abdulazeem, Hebatullah
and Borges do Nascimento, J{\'u}nior Israel
and Weerasekara, Ishanka
and Sharifan, Amin
and Grandi Bianco, Victor
and Cunningham, Ciara
and Kularathne, Indunil
and Deeken, Genevieve
and de Barros, Jerome
and Sathian, Brijesh
and {\O}stengaard, Lasse
and Lamontagne-Godwin, Frederique
and van Hoof, Joost
and Lazeri, Ledia
and Redlich, Cassie
and Marston, R. Hannah
and Dos Santos, Alistair Ryan
and Azzopardi-Muscat, Natasha
and Yon, Yongjie
and Novillo-Ortiz, David",
title="Use of Digital Health Technologies for Dementia Care: Bibliometric Analysis and Report",
journal="JMIR Ment Health",
year="2025",
month="Feb",
day="10",
volume="12",
pages="e64445",
keywords="people living with dementia",
keywords="digital health technologies",
keywords="bibliometric analysis",
keywords="evidence-based medicine",
abstract="Background: Dementia is a syndrome that compromises neurocognitive functions of the individual and that is affecting 55 million individuals globally, as well as global health care systems, national economic systems, and family members. Objective: This study aimed to determine the status quo of scientific production on use of digital health technologies (DHTs) to support (older) people living with dementia, their families, and care partners. In addition, our study aimed to map the current landscape of global research initiatives on DHTs on the prevention, diagnosis, treatment, and support of people living with dementia and their caregivers. Methods: A bibliometric analysis was performed as part of a systematic review protocol using MEDLINE, Embase, Scopus, Epistemonikos, the Cochrane Database of Systematic Reviews, and Google Scholar for systematic and scoping reviews on DHTs and dementia up to February 21, 2024. Search terms included various forms of dementia and DHTs. Two independent reviewers conducted a 2-stage screening process with disagreements resolved by a third reviewer. Eligible reviews were then subjected to a bibliometric analysis using VOSviewer to evaluate document types, authorship, countries, institutions, journal sources, references, and keywords, creating social network maps to visualize emergent research trends. Results: A total of 704 records met the inclusion criteria for bibliometric analysis. Most reviews were systematic, with a substantial number covering mobile health, telehealth, and computer-based cognitive interventions. Bibliometric analysis revealed that the Journal of Medical Internet Research had the highest number of reviews and citations. Researchers from 66 countries contributed, with the United Kingdom and the United States as the most prolific. Overall, the number of publications covering the intersection of DHTs and dementia has increased steadily over time. However, the diversity of reviews conducted on a single topic has resulted in duplicated scientific efforts. Our assessment of contributions from countries, institutions, and key stakeholders reveals significant trends and knowledge gaps, particularly highlighting the dominance of high-income countries in this research domain. Furthermore, our findings emphasize the critical importance of interdisciplinary, collaborative teams and offer clear directions for future research, especially in underrepresented regions. Conclusions: Our study shows a steady increase in dementia- and DHT-related publications, particularly in areas such as mobile health, virtual reality, artificial intelligence, and sensor-based technologies interventions. This increase underscores the importance of systematic approaches and interdisciplinary collaborations, while identifying knowledge gaps, especially in lower-income regions. It is crucial that researchers worldwide adhere to evidence-based medicine principles to avoid duplication of efforts. This analysis offers a valuable foundation for policy makers and academics, emphasizing the need for an international collaborative task force to address knowledge gaps and advance dementia care globally. Trial Registration: PROSPERO CRD42024511241; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=511241 ",
doi="10.2196/64445",
url="https://mental.jmir.org/2025/1/e64445"
}


@Article{info:doi/10.2196/65399,
author="Guo, Lin
and Li, Yunwei
and Cheng, Kai
and Zhao, Ying
and Yin, Wenqiang
and Liu, Ying",
title="Impact of Internet Usage on Depression Among Older Adults: Comprehensive Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="31",
volume="27",
pages="e65399",
keywords="internet usage",
keywords="depression",
keywords="older people",
keywords="mechanism",
keywords="heterogeneity",
keywords="mobile phone",
abstract="Background: Depression is a widespread mental health issue affecting older adults globally, with substantial implications for their well-being. Although digital interventions have proven effective in high-income countries, research on the potential of internet usage to alleviate depression among older adults in high-income countries remains limited. Objective: This study aimed to examine the impact of internet usage on depression among older adults in high-income countries by developing a comprehensive theoretical framework and testing key hypotheses. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), a 2-stage instrumental variable approach was applied to address endogeneity and estimate causal relationships between internet usage and depression. Results: The findings indicate that internet usage results in a 1.41\% reduction in depression levels among older adults. This effect is mediated by four primary mechanisms: (1) enhanced social interaction, (2) increased physical activity, (3) improved intergenerational contact, and (4) expanded access to educational opportunities. A heterogeneity analysis revealed that these effects are more pronounced in urban areas, eastern regions, and regions with superior internet infrastructure. Conclusions: Internet usage plays a crucial role in alleviating depression among older adults in high-income countries, with regional variations. The findings highlight the need for targeted policy interventions to improve internet access and digital literacy, which can mitigate depression and enhance the mental health of older adults. ",
doi="10.2196/65399",
url="https://www.jmir.org/2025/1/e65399"
}


@Article{info:doi/10.2196/66104,
author="Bai, Anying
and He, Shan
and Jiang, Yu
and Xu, Weihao
and Lin, Zhanyi",
title="Comparison of 3 Aging Metrics in Dual Declines to Capture All-Cause Dementia and Mortality Risk: Cohort Study",
journal="JMIR Aging",
year="2025",
month="Jan",
day="30",
volume="8",
pages="e66104",
keywords="gerontology",
keywords="geriatrics",
keywords="older adults",
keywords="older people",
keywords="aging",
keywords="motoric cognitive risk syndrome",
keywords="MCR",
keywords="physio-cognitive decline syndrome",
keywords="PCDS",
keywords="cognitive frailty",
keywords="CF",
keywords="frailty",
keywords="discrimination",
keywords="risk factors",
keywords="prediction",
keywords="dementia risk",
keywords="mortality risk",
abstract="Background: The utility of aging metrics that incorporate cognitive and physical function is not fully understood. Objective: We aim to compare the predictive capacities of 3 distinct aging metrics---motoric cognitive risk syndrome (MCR), physio-cognitive decline syndrome (PCDS), and cognitive frailty (CF)---for incident dementia and all-cause mortality among community-dwelling older adults. Methods: We used longitudinal data from waves 10-15 of the Health and Retirement Study. Cox proportional hazards regression analysis was employed to evaluate the effects of MCR, PCDS, and CF on incident all-cause dementia and mortality, controlling for socioeconomic and lifestyle factors, as well as medical comorbidities. Discrimination analysis was conducted to assess and compare the predictive accuracy of the 3 aging metrics. Results: A total of 2367 older individuals aged 65 years and older, with no baseline prevalence of dementia or disability, were ultimately included. The prevalence rates of MCR, PCDS, and CF were 5.4\%, 6.3\%, and 1.3\%, respectively. Over a decade-long follow-up period, 341 cases of dementia and 573 deaths were recorded. All 3 metrics were predictive of incident all-cause dementia and mortality when adjusting for multiple confounders, with variations in the strength of their associations (incident dementia: MCR odds ratio [OR] 1.90, 95\% CI 1.30?2.78; CF 5.06, 95\% CI 2.87?8.92; PCDS 3.35, 95\% CI 2.44?4.58; mortality: MCR 1.60, 95\% CI 1.17?2.19; CF 3.26, 95\% CI 1.99?5.33; and PCDS 1.58, 95\% CI 1.17?2.13). The C-index indicated that PCDS and MCR had the highest discriminatory accuracy for all-cause dementia and mortality, respectively. Conclusions: Despite the inherent differences among the aging metrics that integrate cognitive and physical functions, they consistently identified risks of dementia and mortality. This underscores the importance of implementing targeted preventive strategies and intervention programs based on these metrics to enhance the overall quality of life and reduce premature deaths in aging populations. ",
doi="10.2196/66104",
url="https://aging.jmir.org/2025/1/e66104"
}


@Article{info:doi/10.2196/59203,
author="M{\"o}llmann, Louise Henriette
and Alhammadi, Eman
and Boulghoudan, Soufian
and Kuhlmann, Julian
and Mevissen, Anica
and Olbrich, Philipp
and Rahm, Louisa
and Frohnhofen, Helmut",
title="Assessment of Geriatric Problems and Risk Factors for Delirium in Surgical Medicine: Protocol for Multidisciplinary Prospective Clinical Study",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="22",
volume="14",
pages="e59203",
keywords="delirium",
keywords="older patients",
keywords="perioperative assessment",
keywords="age-related surgical risk factors",
keywords="geriatric assessment",
keywords="gerontology",
keywords="aging",
keywords="surgical medicine",
keywords="surgical care",
keywords="surgery",
keywords="multidisciplinary",
keywords="prospective study",
keywords="perioperative",
keywords="screening",
keywords="palliative care",
keywords="health informatics",
abstract="Background: An aging population in combination with more gentle and less stressful surgical procedures leads to an increased number of operations on older patients. This collectively raises novel challenges due to higher age heavily impacting treatment. A major problem, emerging in up to 50\% of cases, is perioperative delirium. It is thus vital to understand whether and which existing geriatric assessments are capable of reliably identifying risk factors, how high the incidence of delirium is, and whether the resulting management of these risk factors might lead to a reduced incidence of delirium. Objective: This study aimed to determine the frequency and severity of geriatric medical problems in elective patients of the Clinics of Oral and Maxillofacial Surgery, Vascular Surgery, and Orthopedics, General Surgery, and Trauma Surgery, revealing associations with the incidence of perioperative delirium regarding potential risk factors, and recording the long-term effects of geriatric problems and any perioperative delirium that might have developed later the patient's life. Methods: We performed both pre- and postoperative assessments in patients of 4 different surgical departments who are older than 70 years. Patient-validated screening instruments will be used to identify risk factors. A geriatric assessment with the content of basal and instrumental activities of daily living (basal activities of daily living [Katz index], instrumental activities of daily living [Lawton and Brody score], cognition [6-item screener and clock drawing test], mobility [de Morton Mobility Index and Sit-to-Stand test], sleep [Pittsburgh Sleep Quality Index and Insomnia Severity Index/STOP-BANG], drug therapy [polypharmacy and quality of medication, Fit For The Aged classification, and anticholinergic burden score], and pain assessment and delirium risk (Delirium Risk Assessment Tool) will be performed. Any medical problems detected will be treated according to current standards, and no intervention is planned as part of the study. In addition, a telephone follow-up will be performed 3, 6, and 12 months after discharge. Results: Recruitment started in August 2022, with 421 patients already recruited at the time of submission. Initial analyses of the data are to be published at the end of 2024 or the beginning of 2025. Conclusions: In the current study, we investigate whether the risk factors addressed in the assessment are associated with an increase in the delirium rate. The aim is then to reduce this comprehensive assessment to the central aspects to be able to conduct targeted and efficient risk screening. Trial Registration: German Clinical Trials Registry DRKS00028614; https://www.drks.de/search/de/trial/DRKS00028614 International Registered Report Identifier (IRRID): DERR1-10.2196/59203 ",
doi="10.2196/59203",
url="https://www.researchprotocols.org/2025/1/e59203",
url="http://www.ncbi.nlm.nih.gov/pubmed/39841510"
}


@Article{info:doi/10.2196/60382,
author="McCage, Sydney
and Walker, Kristin
and Cornelius, Talea
and Parker, A. Robert
and Dams-O'Connor, Kristen
and Dickerson, Brad
and Ritchie, Christine
and Vranceanu, Ana-Maria
and Bannon, Sarah",
title="A Live Video Resiliency Dyadic Intervention for Persons With Dementia and Their Care-Partners Early After Diagnosis: Protocol for Open Pilot of Resilient Together for Dementia",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="15",
volume="14",
pages="e60382",
keywords="dementia",
keywords="dyad",
keywords="emotional distress",
keywords="intervention",
keywords="diagnosis",
keywords="telehealth",
keywords="resilient",
keywords="dyadic intervention",
keywords="care-partner",
keywords="Alzheimer's disease",
keywords="ADRD",
keywords="psychosocial",
keywords="depression",
abstract="Background: Alzheimer disease and related dementias (ADRDs) are increasingly common progressive conditions that have a substantial impact on individuals and their primary care partners---together described as a dyad. The stressors experienced by dyad members at around the time of ADRD diagnosis commonly produce clinically elevated emotional distress (ie, depression and anxiety symptoms), which can become chronic and negatively impact health, relationships, and the overall quality of life. Dyads commonly report unmet needs for early support to address these challenges early after diagnosis. Objective: This study is part of a larger study that has the primary objective to develop, adapt, and establish the feasibility of Resilient Together for Dementia (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress early after diagnosis. The present study protocol describes an open pilot of the RT-ADRD intervention. This study will allow the study team to gather feedback on intervention components, administration of study measures, issues within general protocol, and perceptions about live video interventions prior to a larger feasibility trial. Methods: All study procedures will be conducted on the web (via phone and health care system--supported videoconferencing) to optimize accessibility, inclusion, and representativeness. Eligible dyads will include couples (up to N=10) referred from Mount Sinai Hospital (MSH) clinics within 3 months of an ADRD diagnosis. Dyads will be referred by their diagnosing clinicians (eg, neurologists, geriatricians, and neuropsychologists) and screened for eligibility. Eligible dyads will have at least one member who exhibits clinically elevated emotional distress and will demonstrate capacity to consent to research participation on a standardized assessment. Consenting dyads will complete baseline assessments of emotional distress, quality of life, relationship functioning, and resiliency skills. Dyads will then participate in 6 weekly RT-ADRD sessions together (30-60 minutes each). After the conclusion of the intervention, dyad members will complete posttest assessments with similar measures as the pretest. Finally, dyads will participate together in a single 60-minute exit interview to gather information on intervention content and procedures to refine the intervention before a pilot feasibility trial. Results: This study has been approved by the MSH institutional review board and is registered on ClinicalTrials.gov (NCT06421545). We anticipate that the study will be completed by late 2024. Conclusions: We will use these results to administer changes and develop procedures for a pilot feasibility trial of RT-ADRD relative to a minimally enhanced control condition. Our study will allow us to gather comprehensive information on proposed RT-ADRD procedures and content and the best ways of delivering prevention-focused interventions to reduce the potential for chronic emotional distress stemming from ADRDs. International Registered Report Identifier (IRRID): DERR1-10.2196/60382 ",
doi="10.2196/60382",
url="https://www.researchprotocols.org/2025/1/e60382"
}


@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/10.2196/64564,
author="Zhang, Kaili
and Huang, Bowen
and Divigalpitiya, Prasanna",
title="Identifying Community-Built Environment's Effect on Physical Activity and Depressive Symptoms Trajectories Among Middle-aged and Older Adults: Chinese National Longitudinal Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Jan",
day="13",
volume="11",
pages="e64564",
keywords="community-built environment",
keywords="physical activity",
keywords="depressive symptom trajectories",
keywords="middle-aged and older adults",
keywords="latent growth curve modeling",
keywords="longitudinal study",
abstract="Background: The effects of physical activity (PA) across different domains and intensities on depressive symptoms remain inconclusive. Incorporating the community-built environment (CBE) into longitudinal analyses of PA's impact on depressive symptoms is crucial. Objective: This study aims to examine the effects of PA at different intensities---low-intensity PA (eg, walking activities) and moderate-to-vigorous-intensity PA (eg, activities requiring substantial effort and causing faster breathing or shortness of breath)---across leisure-time and occupational domains on depressive symptom trajectories among middle-aged and older adults. Additionally, it investigated how CBEs influence depressive symptoms and PA trajectories. Methods: This longitudinal study included 6865 middle-aged and older adults from the China Health and Retirement Longitudinal Survey. A CBE variable system was developed using a community questionnaire to assess attributes of the physical built environment. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Latent growth curve modeling was applied to analyze 3 waves of the cohort data (2015, 2018, and 2020) to explore the differential effects of PA on depressive symptoms and the role of the CBE. Results: In the 2015 and 2018 waves, higher low-intensity leisure-time physical activity (LTPA) was associated with lower depressive symptoms ($\beta$=--.025, P=.01 and $\beta$=--.027, P=.005, respectively). Across all waves, moderate-to-vigorous-intensity LTPA showed no significant predictive effects (P=.21 in 2015, P=.57 in 2018, and P=.85 in 2020, respectively). However, higher occupational physical activity (OPA), particularly at moderate-to-vigorous intensities, was consistently associated with higher depressive symptoms. Parallel process latent growth curve modeling revealed that the initial level of total LTPA negatively predicted the initial level of depressive symptoms ($\beta$=--.076, P=.01). OPA exhibited dual effects, positively predicting the initial level of depressive symptoms ($\beta$=.108, P<.001) but negatively predicting their upward trajectory ($\beta$=--.136, P=.009). Among CBE variables, better infrastructure conditions ($\beta$=--.082, P<.001) and greater accessibility to public facilities ($\beta$=--.036, P=.045) negatively predicted the initial level of depressive symptoms. However, greater accessibility to public facilities positively predicted the upward trajectory of depressive symptoms ($\beta$=.083, P=.04). Better infrastructure conditions ($\beta$=.100, P=.002) and greater accessibility to public transport ($\beta$=.060, P=.01) positively predicted the initial level of total LTPA. Meanwhile, better infrastructure conditions ($\beta$=--.281, P<.001) and greater accessibility to public facilities ($\beta$=--.073, P<.001) negatively predicted the initial level of total OPA. Better infrastructure conditions positively predicted the declining trajectory of total OPA ($\beta$=.100, P=.004). Conclusions: This study underscores the importance of considering the differential effects of PA across domains and intensities on depressive symptoms in public policies and guidelines. Given the influence of the environment on PA and depressive symptoms, targeted community measures should be implemented. ",
doi="10.2196/64564",
url="https://publichealth.jmir.org/2025/1/e64564",
url="http://www.ncbi.nlm.nih.gov/pubmed/39804686"
}


@Article{info:doi/10.2196/62824,
author="Valla, Guido Luca
and Rossi, Michele
and Gaia, Alessandra
and Guaita, Antonio
and Rolandi, Elena",
title="The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="9",
volume="27",
pages="e62824",
keywords="older adults",
keywords="information and communication technology",
keywords="ICT",
keywords="ICT use",
keywords="COVID-19",
keywords="social capital",
keywords="health",
keywords="mental health",
keywords="digital divide",
abstract="Background: During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. Objective: This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. Methods: We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. Results: COVID-19 had a significant impact on social relationships ($\beta$=--4.35, 95\% CI 6.38 to --2.32; P<.001), cultural activities ($\beta$=--.55, 95\% CI --0.75 to --0.35; P<.001), cognitive functioning ($\beta$=--1.00, 95\% CI --1.28 to --0.72; P<.001), depressive symptoms ($\beta$=.42, 95\% CI 0.10-0.74; P=.009), physical health ($\beta$=.07, 95\% CI 0.04-0.10; P<.001), and ICT use ($\beta$=--.11, 95\% CI --0.18 to --0.03; P=.008). Internet use predicts reduced depressive symptoms ($\beta$=--.56, 95\% CI --1.07 to --0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities ($\beta$=--.73, 95\% CI --1.22 to --0.24; P=.003) and cognitive functioning ($\beta$=1.36, 95\% CI 0.67-2.05; P<.001). Conclusions: The pandemic had adverse effects on older adults' health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. Trial Registration: ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110 ",
doi="10.2196/62824",
url="https://www.jmir.org/2025/1/e62824"
}


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


@Article{info:doi/10.2196/55856,
author="Georgescu, Livia Alexandra
and Cummins, Nicholas
and Molimpakis, Emilia
and Giacomazzi, Eduardo
and Rodrigues Marczyk, Joana
and Goria, Stefano",
title="Screening for Depression and Anxiety Using a Nonverbal Working Memory Task in a Sample of Older Brazilians: Observational Study of Preliminary Artificial Intelligence Model Transferability",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="12",
volume="8",
pages="e55856",
keywords="depression",
keywords="anxiety",
keywords="Brazil",
keywords="machine learning",
keywords="n-back",
keywords="working memory",
keywords="artificial intelligence",
keywords="gerontology",
keywords="older adults",
keywords="mental health",
keywords="AI",
keywords="transferability",
keywords="detection",
keywords="screening",
keywords="questionnaire",
keywords="longitudinal study",
abstract="Background: Anxiety and depression represent prevalent yet frequently undetected mental health concerns within the older population. The challenge of identifying these conditions presents an opportunity for artificial intelligence (AI)--driven, remotely available, tools capable of screening and monitoring mental health. A critical criterion for such tools is their cultural adaptability to ensure effectiveness across diverse populations. Objective: This study aims to illustrate the preliminary transferability of two established AI models designed to detect high depression and anxiety symptom scores. The models were initially trained on data from a nonverbal working memory game (1- and 2-back tasks) in a dataset by thymia, a company that develops AI solutions for mental health and well-being assessments, encompassing over 6000 participants from the United Kingdom, United States, Mexico, Spain, and Indonesia. We seek to validate the models' performance by applying it to a new dataset comprising older Brazilian adults, thereby exploring its transferability and generalizability across different demographics and cultures. Methods: A total of 69 Brazilian participants aged 51-92 years old were recruited with the help of La{\c{c}}os Sa{\'u}de, a company specializing in nurse-led, holistic home care. Participants received a link to the thymia dashboard every Monday and Thursday for 6 months. The dashboard had a set of activities assigned to them that would take 10-15 minutes to complete, which included a 5-minute game with two levels of the n-back tasks. Two Random Forest models trained on thymia data to classify depression and anxiety based on thresholds defined by scores of the Patient Health Questionnaire (8 items) (PHQ-8) ?10 and those of the Generalized Anxiety Disorder Assessment (7 items) (GAD-7) ?10, respectively, were subsequently tested on the La{\c{c}}os Sa{\'u}de patient cohort. Results: The depression classification model exhibited robust performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.78, a specificity of 0.69, and a sensitivity of 0.72. The anxiety classification model showed an initial AUC of 0.63, with a specificity of 0.58 and a sensitivity of 0.64. This performance surpassed a benchmark model using only age and gender, which had AUCs of 0.47 for PHQ-8 and 0.53 for GAD-7. After recomputing the AUC scores on a cross-sectional subset of the data (the first n-back game session), we found AUCs of 0.79 for PHQ-8 and 0.76 for GAD-7. Conclusions: This study successfully demonstrates the preliminary transferability of two AI models trained on a nonverbal working memory task, one for depression and the other for anxiety classification, to a novel sample of older Brazilian adults. Future research could seek to replicate these findings in larger samples and other cultural contexts. Trial Registration: ISRCTN Registry ISRCTN90727704; https://www.isrctn.com/ISRCTN90727704 ",
doi="10.2196/55856",
url="https://formative.jmir.org/2024/1/e55856"
}


@Article{info:doi/10.2196/56959,
author="Gould, E. Christine
and Carlson, Chalise
and Wetherell, L. Julie
and Goldstein, K. Mary
and Anker, Lauren
and Beaudreau, A. Sherry",
title="Brief Video-Delivered Intervention to Reduce Anxiety and Improve Functioning in Older Veterans: Pilot Randomized Controlled Trial",
journal="JMIR Aging",
year="2024",
month="Dec",
day="9",
volume="7",
pages="e56959",
keywords="guided self-management",
keywords="internet",
keywords="progressive relaxation",
keywords="technology",
keywords="anxiety",
keywords="telehealth",
keywords="veterans",
keywords="older adults",
abstract="Background: Older veterans with anxiety disorders encounter multiple barriers to receiving mental health services, including transportation difficulties, physical limitations, and limited access to providers trained to work with older persons. To address both accessibility and the shortage of available providers, evidence-based treatments that can be delivered via guided self-management modalities are a potential solution. Objective: This study aims to determine the feasibility and acceptability of a randomized controlled trial of 2 guided self-management interventions. This study compared the treatment effects of these 2 interventions (relaxation and health psychoeducation) on anxiety symptom severity and functioning in older veterans with anxiety disorders. Our exploratory aims examined factors related to home practices and treatment engagement and perceptions of the practices. Methods: Participants were randomized to one of two video-delivered interventions: (1) Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment (BREATHE)---breathing and progressive relaxation or (2) Healthy Living for Reduced Anxiety---psychoeducation about lifestyle changes. Telephone coaching calls were conducted weekly. Measures of anxiety, depression, and functioning were obtained at baseline, week 4 (end of treatment), week 8, and week 12. Participants completed a semistructured interview at week 12. Analyses included descriptive statistics to summarize measures of intervention engagement; mixed-effects models to characterize symptom change, and qualitative analyses. Results: Overall, 56 participants (n=48, 86\% men; n=23, 41\% from ethnic or racial minority groups; mean age 71.36, SD 6.19 y) were randomized. No difference in retention between study arms was found. The Healthy Living group (29/56, 52\%) completed significantly more lessons (mean 3.68, SD 0.86) than the BREATHE group (27/56, 48\%; mean 2.85, SD 1.43; t53=2.60; P=.01) but did not differ in completion of coaching calls. In the BREATHE group, greater baseline anxiety scores (r=--0.41; P=.03) and greater severity of medical comorbidity (r=--0.50; P=.009) were associated with fewer completed practices. There was no effect of intervention on change in total anxiety scores or functioning. For specific anxiety subtypes, Healthy Living produced a greater decline in somatic anxiety compared with BREATHE. Qualitative analyses found barriers to practicing, including difficulty setting time aside to practice, forgetting, or having other activities that interfered with BREATHE practices. Some participants described adapting their practice routine to fit their daily lives; some also used relaxation skills in everyday situations. Conclusions: These findings suggest that a larger randomized controlled trial of guided self-management approaches to treating late-life anxiety is feasible; however, BREATHE was not effective in reducing anxiety compared with Healthy Living. Possible contributing factors may have been the reliance on a single technique. Progressive relaxation was reported to be enjoyable for most participants, but maintaining home practices was challenging. Those with milder anxiety severity and fewer health problems were better able to adhere to practices. Trial Registration: ClinicalTrials.gov NCT02400723; https://clinicaltrials.gov/study/NCT02400723 ",
doi="10.2196/56959",
url="https://aging.jmir.org/2024/1/e56959"
}


@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/10.2196/63262,
author="Brandl, Lena
and Jansen-Kosterink, Stephanie
and Brodbeck, Jeannette
and Jacinto, Sofia
and Mooser, Bettina
and Heylen, Dirk",
title="Moving Toward Meaningful Evaluations of Monitoring in e-Mental Health Based on the Case of a Web-Based Grief Service for Older Mourners: Mixed Methods Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="28",
volume="8",
pages="e63262",
keywords="e-mental health",
keywords="digital mental health service",
keywords="mental health",
keywords="digital health",
keywords="internet intervention",
keywords="monitoring mental health",
keywords="monitor",
keywords="e-coach",
keywords="coaching",
keywords="grieve",
keywords="mourn",
keywords="old",
keywords="affective states",
keywords="artificial intelligence",
keywords="predictive",
keywords="repeatedly measured predictors in regression",
keywords="fuzzy cognitive map",
keywords="algorithm",
keywords="AI",
abstract="Background: Artificial intelligence (AI) tools hold much promise for mental health care by increasing the scalability and accessibility of care. However, current development and evaluation practices of AI tools limit their meaningfulness for health care contexts and therefore also the practical usefulness of such tools for professionals and clients alike. Objective: The aim of this study is to demonstrate the evaluation of an AI monitoring tool that detects the need for more intensive care in a web-based grief intervention for older mourners who have lost their spouse, with the goal of moving toward meaningful evaluation of AI tools in e-mental health. Method: We leveraged the insights from three evaluation approaches: (1) the F1-score evaluated the tool's capacity to classify user monitoring parameters as either in need of more intensive support or recommendable to continue using the web-based grief intervention as is; (2) we used linear regression to assess the predictive value of users' monitoring parameters for clinical changes in grief, depression, and loneliness over the course of a 10-week intervention; and (3) we collected qualitative experience data from e-coaches (N=4) who incorporated the monitoring in their weekly email guidance during the 10-week intervention. Results: Based on n=174 binary recommendation decisions, the F1-score of the monitoring tool was 0.91. Due to minimal change in depression and loneliness scores after the 10-week intervention, only 1 linear regression was conducted. The difference score in grief before and after the intervention was included as a dependent variable. Participants' (N=21) mean score on the self-report monitoring and the estimated slope of individually fitted growth curves and its standard error (ie, participants' response pattern to the monitoring questions) were used as predictors. Only the mean monitoring score exhibited predictive value for the observed change in grief (R2=1.19, SE 0.33; t16=3.58, P=.002). The e-coaches appreciated the monitoring tool as an opportunity to confirm their initial impression about intervention participants, personalize their email guidance, and detect when participants' mental health deteriorated during the intervention. Conclusions: The monitoring tool evaluated in this paper identified a need for more intensive support reasonably well in a nonclinical sample of older mourners, had some predictive value for the change in grief symptoms during a 10-week intervention, and was appreciated as an additional source of mental health information by e-coaches who supported mourners during the intervention. Each evaluation approach in this paper came with its own set of limitations, including (1) skewed class distributions in prediction tasks based on real-life health data and (2) choosing meaningful statistical analyses based on clinical trial designs that are not targeted at evaluating AI tools. However, combining multiple evaluation methods facilitates drawing meaningful conclusions about the clinical value of AI monitoring tools for their intended mental health context. ",
doi="10.2196/63262",
url="https://formative.jmir.org/2024/1/e63262"
}


@Article{info:doi/10.2196/57050,
author="Matos Queir{\'o}s, Alcina
and von Gunten, Armin
and Rosselet Amoussou, Jo{\"e}lle
and Lima, Maria Andreia
and Martins, Manuela Maria
and Verloo, Henk",
title="Relationship Between Depression and Falls Among Nursing Home Residents: Integrative Review",
journal="Interact J Med Res",
year="2024",
month="Nov",
day="28",
volume="13",
pages="e57050",
keywords="depression",
keywords="falls",
keywords="nursing home",
keywords="nursing home resident",
keywords="cross-sectional study",
keywords="cohort study",
keywords="integrative review",
keywords="fall risk",
keywords="older adults",
abstract="Background: Depression is a highly prevalent psychopathological condition among older adults, particularly those institutionalized in nursing homes (NHs). Unfortunately, it is poorly identified and diagnosed. NH residents are twice as likely to fall as community-dwelling older adults. There is a need for more knowledge about the mechanisms and relationships between depression and falls. Objective: This study aims to identify, analyze, and synthesize research on the relationships between depression and falls among NH residents. Methods: A literature search was conducted in October 2023 in the following bibliographic databases: MEDLINE ALL Ovid, Embase, CINAHL with Full Text EBSCO, APA PsycInfo Ovid, Web of Science Core Collection, the Cochrane Database of Systematic Reviews Wiley, and ProQuest Dissertations \& Theses A\&I. Clinical trials were searched for in the Cochrane Central Register of Controlled Trials Wiley, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. Additional searches were performed using Google Scholar, the DART-Europe E-theses Portal, and backward citation tracking. The Newcastle-Ottawa Scale and the Appraisal tool for Cross-Sectional Studies were used to evaluate study quality. Results: The review included 7 quantitative studies published in 7 different countries from 3 continents; of these, 6 (86\%) were cross-sectional studies, and 1 (14\%) was a prospective cohort study. Results suggested high frequencies of depressive symptoms and falls among older adults living in NHs, and depressive symptoms were considered a risk factor for falls. The 15-item and 10-item versions of the Geriatric Depression Scale were the most commonly used measurement tools, followed by the Cornell Scale for Depression in Dementia and the Resident Assessment Instrument-Minimum Data Set 2.0. The prevalence of depression was heterogeneous, varying from 21.5\% to 47.7\% of NH residents. The studies used heterogeneous descriptions of a fall, and some considered the risk of falls, recurrent fallers, and near falls in their data. The prevalence of fallers was disparate, varying from 17.2\% to 63.1\%. Of the 7 retained studies, 6 (86\%) reported a relationship between depression and falls or the risk of falls. Among the 19 other risk factors identified in the review as being associated with falls among NH residents were a history of falls in the last 180 days, >1 fall in the past 12 months, and respiratory illnesses. Conclusions: There is a paucity of research examining falls among older adults with depressive symptoms in NHs. These findings should alert nurses to the need to consider depression as a risk factor in their work to prevent falls. More research is needed to gain a comprehensive understanding of fall risk among NH residents with depressive symptoms. International Registered Report Identifier (IRRID): RR2-10.2196/46995 ",
doi="10.2196/57050",
url="https://www.i-jmr.org/2024/1/e57050",
url="http://www.ncbi.nlm.nih.gov/pubmed/39608784"
}


@Article{info:doi/10.2196/59974,
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/10.2196/59818,
author="Wu, Yuting
and Gong, Cong
and Pi, Lifang
and Zheng, Meixin
and Liu, Weifang
and Wang, Yamei",
title="Interrelationships Among Individual Factors, Family Factors, and Quality of Life in Older Chinese Adults: Cross-Sectional Study Using Structural Equation Modeling",
journal="JMIR Aging",
year="2024",
month="Oct",
day="28",
volume="7",
pages="e59818",
keywords="quality of life",
keywords="older adults",
keywords="individual factor",
keywords="family factor",
keywords="structural equation modeling (SEM)",
abstract="Background: China's rapidly aging population necessitates effective strategies for ensuring older adults' quality of life (QOL). While individual factors (IF) and family factors (FF) are known to influence QOL, existing research often examines these factors in isolation or focuses on specific subpopulations, overlooking potential interactions and mediating pathways. Objective: This study aims to examine both direct and indirect pathways connecting IF and FF to older adults' QOL, focusing on the mediating roles of health risks (HR) and health care service demand (HSD). Methods: This study uses structural equation modeling (SEM) to analyze cross-sectional data from 8600 older participants in the 2015 China Health and Retirement Longitudinal Study (CHARLS), a nationally representative study using a multistage probability proportional to size sampling method. Results: Among the 8600 participants, the majority (5586/8502, 65.7\%) were aged 60-70 years, with a near-equal distribution of males and females at around 50\%. The average PCS score was 76.77, while the MCS score averaged 59.70. Both IF ($\beta$=0.165, P<.001) and FF ($\beta$=0.189, P<.001) had a direct positive effect on QOL. Furthermore, the indirect effects of IF ($\beta$=0.186, P<.001) and FF ($\beta$=0.211, P<.001) through HR and HSD were also significant. In the direct model, IF and FF had a greater impact on MCS ($\beta$=0.841) than on PCS ($\beta$=0.639). However, after including the 2 mediating factors, HR and HSD, the influence of IF and FF on MCS ($\beta$=0.739) became consistent with that on PCS ($\beta$=0.728). Subgroup analyses revealed that the direct effect of IF on QOL was significant in the 60-70 age group ($\beta$=0.151, P<.001) but not in those over 70 years old ($\beta$=0.122, P=.074). Comorbidity status significantly influenced the pathway from HR to HSD, with older adults having 2 or more chronic diseases ($\beta$=0.363) showing a greater impact compared to those with fewer than 2 chronic diseases ($\beta$=0.358). Conclusions: Both IF (education, per capita disposable income, and endowment insurance) and FF (satisfaction with a spouse and children) directly impact the QOL in older people. Meanwhile, IF and FF have equal influence on QOL through the mediating role of HR and HSD. Recognizing the interplay among these factors is crucial for targeted interventions to enhance the well-being of older adults in China. ",
doi="10.2196/59818",
url="https://aging.jmir.org/2024/1/e59818"
}


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


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


@Article{info:doi/10.2196/56452,
author="Au-Yeung, M. Wan-Tai
and Miller, Lyndsey
and Wu, Chao-Yi
and Beattie, Zachary
and Nunnerley, Michael
and Hanna, Remonda
and Gothard, Sarah
and Wild, Katherine
and Kaye, Jeffrey",
title="Examining the Relationships Between Indoor Environmental Quality Parameters Pertaining to Light, Noise, Temperature, and Humidity and the Behavioral and Psychological Symptoms of People Living With Dementia: Scoping Review",
journal="Interact J Med Res",
year="2024",
month="Aug",
day="9",
volume="13",
pages="e56452",
keywords="dementia",
keywords="behavioral and psychological symptoms of dementia",
keywords="neuropsychiatric symptoms",
keywords="physical environment",
keywords="light",
keywords="noise",
keywords="temperature",
keywords="humidity",
abstract="Background: A common challenge for individuals caring for people with Alzheimer disease and related dementias is managing the behavioral and psychological symptoms of dementia (BPSD). Effective management of BPSD will increase the quality of life of people living with dementia, lessen caregivers' burden, and lower health care cost. Objective: In this review, we seek to (1) examine how indoor environmental quality parameters pertaining to light, noise, temperature, and humidity are associated with BPSD and how controlling these parameters can help manage these symptoms and (2) identify the current state of knowledge in this area, current gaps in the research, and potential future directions. Methods: Searches were conducted in the CINAHL, Embase, MEDLINE, and PsycINFO databases for papers published from January 2007 to February 2024. We searched for studies examining the relationship between indoor environmental quality parameters pertaining to light, noise, temperature, and humidity and BPSD. Results: A total of 3123 papers were identified in the original search in October 2020. After an additional 2 searches and screening, 38 (0.69\%) of the 5476 papers were included. Among the included papers, light was the most studied environmental factor (34/38, 89\%), while there were fewer studies (from 5/38, 13\% to 11/38, 29\%) examining the relationships between other environmental factors and BPSD. Of the 38 studies, 8 (21\%) examined multiple indoor environmental quality parameters. Subjective data were the only source of environmental assessments in 6 (16\%) of the 38 studies. The findings regarding the relationship between agitation and light therapy are conflicted, while the studies that examined the relationship between BPSD and temperature or humidity are all observational. The results suggest that when the environmental factors are deemed overstimulating or understimulating for an individual with dementia, the behavioral symptoms tend to be exacerbated. Conclusions: The findings of this scoping review may inform the design of long-term care units and older adult housing to support aging in place. More research is still needed to better understand the relationship between indoor environmental quality parameters and BPSD, and there is a need for more objective measurements of both the indoor environmental quality parameters and behavioral symptoms. One future direction is to incorporate objective sensing and advanced computational methods in real-time assessments to initiate just-in-time environmental interventions. Better management of BPSD will benefit patients, caregivers, and the health care system. ",
doi="10.2196/56452",
url="https://www.i-jmr.org/2024/1/e56452"
}


@Article{info:doi/10.2196/57101,
author="Imai, Ayu
and Matsuoka, Teruyuki
and Nakayama, Chikara
and Hashimoto, Nana
and Sano, Mutsuo
and Narumoto, Jin",
title="Effectiveness of a Virtual Reality Open-Air Bath Program in Reducing Loneliness and Improving Brain Function for Dementia Prevention in Older Adults: Protocol for a Prospective Randomized Crossover Study",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="1",
volume="13",
pages="e57101",
keywords="loneliness",
keywords="virtual reality",
keywords="VR",
keywords="Alzheimer disease",
keywords="predementia",
keywords="intervention",
keywords="subjective cognitive decline",
keywords="mild cognitive impairment",
keywords="dementia",
keywords="older adult",
keywords="geriatric",
keywords="depression",
keywords="cognitive impairments",
abstract="Background: Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by the COVID-19 pandemic. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action. Objective: This study aims to assess the impact of a virtual reality (VR)--based open-air bath program on depression and loneliness in older individuals with subjective cognitive decline/mild cognitive impairment attending the Dementia Medical Center in Kyoto, Japan. We further aim to evaluate the feasibility of the program (participant recruitment and adherence) and to measure program enjoyment and satisfaction. Methods: The study design is a crossover trial with a 1:1 ratio, wherein 12 participants will be randomly assigned to groups 1 and 2, with group 2 serving as a waitlist control and group 1 receiving the VR program from the onset for 6 months; the VR program will be conducted 6 times (monthly). Program completion for group 1 will be followed by an observation period from months 7 to 12. Group 2 will participate in the VR program from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the University of California, Los Angeles Loneliness Scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated-measures ANOVA. Head magnetic resonance imaging and single-photon emission computed tomography scans will be performed before and after the VR program to evaluate changes and effects on brain regions. Results: Recruitment began in September 2023 and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025. Conclusions: This study examines the preliminary effects of VR on loneliness in older adults with predementia through open-air bath simulations. VR experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR's impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials. Trial Registration: University hospital Medical Information Network UMIN000052667; https://tinyurl.com/3yaccay5 International Registered Report Identifier (IRRID): DERR1-10.2196/57101 ",
doi="10.2196/57101",
url="https://www.researchprotocols.org/2024/1/e57101",
url="http://www.ncbi.nlm.nih.gov/pubmed/39088243"
}


@Article{info:doi/10.2196/60009,
author="Yoon, Seolah
and Jeong, Innhee
and Kim, Ivy Jennifer
and Hong, Dahye
and Kang, Bada",
title="Correlates of Mild Behavioral Impairment in Older Adults: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="29",
volume="13",
pages="e60009",
keywords="mild behavioral impairment",
keywords="older adults",
keywords="mild cognitive impairment",
keywords="subjective cognitive decline",
keywords="behavioral symptoms",
keywords="scoping review",
keywords="protocol",
keywords="elderly",
keywords="behavioral impairment",
keywords="cognitive",
keywords="cognitive decline",
keywords="scoping review protocol",
keywords="older adult",
keywords="neuropsychological",
keywords="impairment",
keywords="behavioral",
keywords="behavior",
abstract="Background: Understanding mild behavioral impairment, a relatively recent notion in neuropsychological studies, provides significant insights into early behavioral indicators of cognitive decline and predicts the onset of dementia in older adults. Although the importance of understanding mild behavioral impairment is acknowledged, comprehensive reviews of its correlates with older adults are limited. Objective: This scoping review aims to identify the impact of mild behavioral impairment on health outcomes in older adults and the factors associated with mild behavioral impairment. Methods: The review will adhere to the Joanna Briggs Institute's methodological principles for scoping reviews. We will include studies focusing mainly on mild behavioral impairment in older adults, with the literature on this topic being limited to the period from 2003 to the present. Other clinical diagnoses, such as cognitive impairment, Parkinson disease, and multiple sclerosis, will not be included. We will use databases including PubMed (MEDLINE), CINAHL, Web of Science, Embase, PsycINFO, Cochrane, and Scopus for relevant articles published in English. Both gray literature and peer-reviewed articles will be considered during screening. Three independent reviewers will extract data using a predefined data extraction tool. Extracted data will be presented using tables, figures, and a narrative summary aligned with review questions, accompanied by an analysis of study characteristics and categorization of mild behavioral impairment correlates. Results: The results will be presented as a descriptive summary, structured according to the associated factors related to mild behavioral impairment, and the health outcomes. Additionally, the data on study characteristics will be presented in tabular format. An exploratory search was conducted in July 2023 to establish a comprehensive search strategy, and iterative refinements to the scoping review protocol and formalization of methods were completed. A follow-up search is planned for May 2024, with the aim of submitting the findings for publication in peer-reviewed journals. Conclusions: To our knowledge, this would be the first study to map the literature on the health-related factors and outcomes of mild behavioral impairment. The findings will support the development of interventions to prevent the occurrence of mild behavioral impairment and mitigate the negative outcomes of mild behavioral impairment. International Registered Report Identifier (IRRID): DERR1-10.2196/60009 ",
doi="10.2196/60009",
url="https://www.researchprotocols.org/2024/1/e60009"
}


@Article{info:doi/10.2196/51520,
author="Teano, L. Anthony
and Scott, Ashley
and Gipson, Cassandra
and Albert, Marilyn
and Pettigrew, Corinne",
title="Social Media Programs for Outreach and Recruitment Supporting Aging and Alzheimer Disease and Related Dementias Research: Longitudinal Descriptive Study",
journal="JMIR Aging",
year="2024",
month="Jul",
day="9",
volume="7",
pages="e51520",
keywords="education",
keywords="social media",
keywords="outreach",
keywords="recruitment",
keywords="Alzheimer's disease",
keywords="Alzheimer disease",
abstract="Background: Social media may be a useful method for research centers to deliver health messages, increase their visibility in the local community, and recruit study participants. Sharing examples of social media--based community outreach and educational programs, and evaluating their outcomes in this setting, is important for understanding whether these efforts have a measurable impact. Objective: The aim of this study is to describe one center's social media activities for community education on topics related to aging, memory loss, and Alzheimer disease and related dementias, and provide metrics related to recruitment into clinical research studies. Methods: Several social media platforms were used, including Facebook, X (formerly Twitter), and YouTube. Objective assessments quantified monthly, based on each platform's native dashboard, included the number of followers, number of posts, post reach and engagement, post impressions, and video views. The number of participants volunteering for research during this period was additionally tracked using a secure database. Educational material posted to social media most frequently included content developed by center staff, content from partner organizations, and news articles or resources featuring center researchers. Multiple educational programs were developed, including social media series, web-based talks, Twitter chats, and webinars. In more recent years, Facebook content was occasionally boosted to increase visibility in the local geographical region. Results: Up to 4 years of page metrics demonstrated continuing growth in reaching social media audiences, as indicated by increases over time in the numbers of likes or followers on Facebook and X/Twitter and views of YouTube videos (growth trajectories). While Facebook reach and X/Twitter impression rates were reasonable, Facebook engagement rates were more modest. Months that included boosted Facebook posts resulted in a greater change in page followers and page likes, and higher reach and engagement rates (all P?.002). Recruitment of participants into center-affiliated research studies increased during this time frame, particularly in response to boosted Facebook posts. Conclusions: These data demonstrate that social media activities can provide meaningful community educational opportunities focused on Alzheimer disease and related dementias and have a measurable impact on the recruitment of participants into research studies. Additionally, this study highlights the importance of tracking outreach program outcomes for evaluating return on investment. ",
doi="10.2196/51520",
url="https://aging.jmir.org/2024/1/e51520"
}


@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/10.2196/52831,
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/10.2196/55842,
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/10.2196/46072,
author="Liang, Wei
and Wang, Yanping
and Huang, Qian
and Shang, Borui
and Su, Ning
and Zhou, Lin
and Rhodes, E. Ryan
and Baker, Steven Julien
and Duan, Yanping",
title="Adherence to 24-Hour Movement Guidelines Among Chinese Older Adults: Prevalence, Correlates, and Associations With Physical and Mental Health Outcomes",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="13",
volume="10",
pages="e46072",
keywords="physical activity",
keywords="sedentary behavior",
keywords="sleep",
keywords="cardiometabolic indicators",
keywords="physical fitness",
keywords="mental health",
keywords="post--COVID-19 era",
keywords="older adults",
keywords="COVID-19",
keywords="systolic blood pressure",
keywords="diastolic blood pressure",
keywords="depression",
keywords="loneliness",
abstract="Background: It is known that 24-hour movement behaviors, including physical activity (PA), sedentary behavior (SB), and sleep, are crucial components affecting older adults' health. Canadian 24-hour movement guidelines for older adults were launched in 2020, emphasizing the combined role of these 3 movement behaviors in promoting older adults' health. However, research on the prevalence and correlates of guideline adherence and its associations with health-related outcomes is limited, especially among Chinese older adults. Objective: This study aimed to investigate the prevalence and correlates of meeting 24-hour movement guidelines among Chinese older adults. Furthermore, this study aimed to examine the associations of guideline adherence with older adults' physical and mental health outcomes. Methods: Using a stratified cluster random sampling approach, a total of 4562 older adults (mean age 67.68 years, SD 5.03 years; female proportion: 2544/4562, 55.8\%) were recruited from the latest provincial health surveillance of Hubei China from July 25 to November 19, 2020. Measures included demographics, movement behaviors (PA, SB, and sleep), BMI, waist circumference, waist-hip ratio (WHR), percentage body fat (PBF), systolic and diastolic blood pressure, physical fitness, depressive symptoms, and loneliness. Generalized linear mixed models were employed to examine the associations between variables using SPSS 28.0 (IBM Corp). Results: Only 1.8\% (83/4562) of participants met all 3 movement guidelines, while 32.1\% (1466/4562), 3.4\% (155/4562), and 66.4\% (3031/4562) met the individual behavioral guidelines for PA, SB, and sleep, respectively. Participants who were older, were female, and lived in municipalities with lower economic levels were less likely to meet all 3 movement guidelines. Adhering to individual or combined movement guidelines was associated with greater physical fitness and lower values of BMI, waist circumference, WHR, PBF, depressive symptoms, and loneliness, with the exception of the relationship of SB+sleep guidelines with loneliness. Furthermore, only meeting SB guidelines or meeting both PA and SB guidelines was associated with lower systolic blood pressure. Conclusions: This is the first study to investigate adherence to 24-hour movement guidelines among Chinese older adults with regard to prevalence, correlates, and associations with physical and mental health outcomes. The findings emphasize the urgent need for promoting healthy movement behaviors among Chinese older adults. Future interventions to improve older adults' physical and mental health should involve enhancing their overall movement behaviors and should consider demographic differences. ",
doi="10.2196/46072",
url="https://publichealth.jmir.org/2024/1/e46072",
url="http://www.ncbi.nlm.nih.gov/pubmed/38869941"
}


@Article{info:doi/10.2196/49618,
author="Pilunthanakul, Thanita
and Tan, Yee Giles Ming",
title="Ad Hoc Modifications to a High Dependency Psychiatric Unit for People With Dementia During the COVID-19 Period",
journal="Interact J Med Res",
year="2024",
month="Jun",
day="11",
volume="13",
pages="e49618",
keywords="dementia",
keywords="COVID-19",
keywords="high dependency psychiatric unit",
keywords="psychiatric intensive care unit",
keywords="caregiver stress",
keywords="SARS-CoV-2",
keywords="psychiatric",
keywords="psychiatry",
keywords="mental health",
keywords="health care system",
keywords="Alzheimer",
keywords="ward",
keywords="care facility",
doi="10.2196/49618",
url="https://www.i-jmr.org/2024/1/e49618",
url="http://www.ncbi.nlm.nih.gov/pubmed/38861715"
}


@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/10.2196/53192,
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/10.2196/55211,
author="Haghayegh, Shahab
and Gao, Chenlu
and Sugg, Elizabeth
and Zheng, Xi
and Yang, Hui-Wen
and Saxena, Richa
and Rutter, K. Martin
and Weedon, Michael
and Ibanez, Agustin
and Bennett, A. David
and Li, Peng
and Gao, Lei
and Hu, Kun",
title="Association of Rest-Activity Rhythm and Risk of Developing Dementia or Mild Cognitive Impairment in the Middle-Aged and Older Population: Prospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="7",
volume="10",
pages="e55211",
keywords="circadian rhythm",
keywords="dementia",
keywords="actigraphy",
keywords="cognitive decline",
keywords="RAR",
keywords="rest-activity rhythms",
keywords="cognitive impairment",
abstract="Background: The relationship between 24-hour rest-activity rhythms (RARs) and risk for dementia or mild cognitive impairment (MCI) remains an area of growing interest. Previous studies were often limited by small sample sizes, short follow-ups, and older participants. More studies are required to fully explore the link between disrupted RARs and dementia or MCI in middle-aged and older adults. Objective: We leveraged the UK Biobank data to examine how RAR disturbances correlate with the risk of developing dementia and MCI in middle-aged and older adults. Methods: We analyzed the data of 91,517 UK Biobank participants aged between 43 and 79 years. Wrist actigraphy recordings were used to derive nonparametric RAR metrics, including the activity level of the most active 10-hour period (M10) and its midpoint, the activity level of the least active 5-hour period (L5) and its midpoint, relative amplitude (RA) of the 24-hour cycle [RA=(M10-L5)/(M10+L5)], interdaily stability, and intradaily variability, as well as the amplitude and acrophase of 24-hour rhythms (cosinor analysis). We used Cox proportional hazards models to examine the associations between baseline RAR and subsequent incidence of dementia or MCI, adjusting for demographic characteristics, comorbidities, lifestyle factors, shiftwork status, and genetic risk for Alzheimer's disease. Results: During the follow-up of up to 7.5 years, 555 participants developed MCI or dementia. The dementia or MCI risk increased for those with lower M10 activity (hazard ratio [HR] 1.28, 95\% CI 1.14-1.44, per 1-SD decrease), higher L5 activity (HR 1.15, 95\% CI 1.10-1.21, per 1-SD increase), lower RA (HR 1.23, 95\% CI 1.16-1.29, per 1-SD decrease), lower amplitude (HR 1.32, 95\% CI 1.17-1.49, per 1-SD decrease), and higher intradaily variability (HR 1.14, 95\% CI 1.05-1.24, per 1-SD increase) as well as advanced L5 midpoint (HR 0.92, 95\% CI 0.85-0.99, per 1-SD advance). These associations were similar in people aged <70 and >70 years, and in non--shift workers, and they were independent of genetic and cardiovascular risk factors. No significant associations were observed for M10 midpoint, interdaily stability, or acrophase. Conclusions: Based on findings from a large sample of middle-to-older adults with objective RAR assessment and almost 8-years of follow-up, we suggest that suppressed and fragmented daily activity rhythms precede the onset of dementia or MCI and may serve as risk biomarkers for preclinical dementia in middle-aged and older adults. ",
doi="10.2196/55211",
url="https://publichealth.jmir.org/2024/1/e55211",
url="http://www.ncbi.nlm.nih.gov/pubmed/38713911"
}


@Article{info:doi/10.2196/49129,
author="Kim, Hoon Seung
and Kim, Hyunkyu
and Jeong, Hoon Sung
and Park, Eun-Cheol",
title="Association of the Type of Public Pension With Mental Health Among South Korean Older Adults: Longitudinal Observational Study",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="2",
volume="10",
pages="e49129",
keywords="depression",
keywords="retirement",
keywords="contributory public pension",
keywords="low-income household",
keywords="public health",
keywords="mental health",
keywords="data",
keywords="big data",
keywords="longitudinal data",
keywords="low income",
abstract="Background: As income and health are closely related, retirement is considered undesirable for health. Many studies have shown the association between pension and health, but no research has considered the association between contribution-based public pensions or their types and health. Objective: This study investigates the association between the type of contributory public pension and depressive symptoms among older adults. Methods: We analyzed the data of 4541 older adults who participated in the South Korea Welfare Panel Study (2014-2020). Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression scale. Public pensions in South Korea are classified into specific corporate pensions and national pensions. For subgroup analyses, pensioners were categorized according to the amount of pension received and the proportion of public pension over gross income. Analyses using generalized estimating equations were conducted for longitudinal data. Results: Individuals receiving public pension, regardless of the pension type, demonstrated significantly decreased depressive symptoms (national pension: $\beta$=--.734; P<.001; specific corporate pension: $\beta$=--.775; P=.02). For both pension types, the higher the amount of benefits, the lower were the depression scores. However, this association was absent for those who received the smaller amount among the specific corporate pensioners. In low-income households, the decrease in the depressive symptoms based on the amount of public pension benefits was greater (fourth quartile of national pension: $\beta$=--1.472; P<.001; second and third quartiles of specific corporate pension: $\beta$=--3.646; P<.001). Conclusions: Our study shows that contributory public pension is significantly associated with lower depressive symptoms, and this association is prominent in low-income households. Thus, contributory public pensions may be good income sources for improving the mental health of older adults after retirement. ",
doi="10.2196/49129",
url="https://publichealth.jmir.org/2024/1/e49129",
url="http://www.ncbi.nlm.nih.gov/pubmed/38696246"
}


@Article{info:doi/10.2196/50537,
author="Ambrosini, Emilia
and Giangregorio, Chiara
and Lomurno, Eugenio
and Moccia, Sara
and Milis, Marios
and Loizou, Christos
and Azzolino, Domenico
and Cesari, Matteo
and Cid Gala, Manuel
and Gal{\'a}n de Isla, Carmen
and Gomez-Raja, Jonathan
and Borghese, Alberto Nunzio
and Matteucci, Matteo
and Ferrante, Simona",
title="Automatic Spontaneous Speech Analysis for the Detection of Cognitive Functional Decline in Older Adults: Multilanguage Cross-Sectional Study",
journal="JMIR Aging",
year="2024",
month="Apr",
day="29",
volume="7",
pages="e50537",
keywords="cognitive decline",
keywords="speech processing",
keywords="machine learning",
keywords="multilanguage",
keywords="Mini-Mental Status Examination",
abstract="Background: The rise in life expectancy is associated with an increase in long-term and gradual cognitive decline. Treatment effectiveness is enhanced at the early stage of the disease. Therefore, there is a need to find low-cost and ecological solutions for mass screening of community-dwelling older adults. Objective: This work aims to exploit automatic analysis of free speech to identify signs of cognitive function decline. Methods: A sample of 266 participants older than 65 years were recruited in Italy and Spain and were divided into 3 groups according to their Mini-Mental Status Examination (MMSE) scores. People were asked to tell a story and describe a picture, and voice recordings were used to extract high-level features on different time scales automatically. Based on these features, machine learning algorithms were trained to solve binary and multiclass classification problems by using both mono- and cross-lingual approaches. The algorithms were enriched using Shapley Additive Explanations for model explainability. Results: In the Italian data set, healthy participants (MMSE score?27) were automatically discriminated from participants with mildly impaired cognitive function (20?MMSE score?26) and from those with moderate to severe impairment of cognitive function (11?MMSE score?19) with accuracy of 80\% and 86\%, respectively. Slightly lower performance was achieved in the Spanish and multilanguage data sets. Conclusions: This work proposes a transparent and unobtrusive assessment method, which might be included in a mobile app for large-scale monitoring of cognitive functionality in older adults. Voice is confirmed to be an important biomarker of cognitive decline due to its noninvasive and easily accessible nature. ",
doi="10.2196/50537",
url="https://aging.jmir.org/2024/1/e50537",
url="http://www.ncbi.nlm.nih.gov/pubmed/38386279"
}


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


@Article{info:doi/10.2196/56883,
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/10.2196/52443,
author="Otaka, Eri
and Osawa, Aiko
and Kato, Kenji
and Obayashi, Yota
and Uehara, Shintaro
and Kamiya, Masaki
and Mizuno, Katsuhiro
and Hashide, Shusei
and Kondo, Izumi",
title="Positive Emotional Responses to Socially Assistive Robots in People With Dementia: Pilot Study",
journal="JMIR Aging",
year="2024",
month="Apr",
day="11",
volume="7",
pages="e52443",
keywords="dementia care",
keywords="robotics",
keywords="emotion",
keywords="facial expression",
keywords="expression intensity",
keywords="long-term care",
keywords="sensory modality",
keywords="gerontology",
keywords="gerontechnology",
abstract="Background: Interventions and care that can evoke positive emotions and reduce apathy or agitation are important for people with dementia. In recent years, socially assistive robots used for better dementia care have been found to be feasible. However, the immediate responses of people with dementia when they are given multiple sensory modalities from socially assistive robots have not yet been sufficiently elucidated. Objective: This study aimed to quantitatively examine the immediate emotional responses of people with dementia to stimuli presented by socially assistive robots using facial expression analysis in order to determine whether they elicited positive emotions. Methods: This pilot study adopted a single-arm interventional design. Socially assistive robots were presented to nursing home residents in a three-step procedure: (1) the robot was placed in front of participants (visual stimulus), (2) the robot was manipulated to produce sound (visual and auditory stimuli), and (3) participants held the robot in their hands (visual, auditory, and tactile stimuli). Expression intensity values for ``happy,'' ``sad,'' ``angry,'' ``surprised,'' ``scared,'' and ``disgusted'' were calculated continuously using facial expression analysis with FaceReader. Additionally, self-reported feelings were assessed using a 5-point Likert scale. In addition to the comparison between the subjective and objective emotional assessments, expression intensity values were compared across the aforementioned 3 stimuli patterns within each session. Finally, the expression intensity value for ``happy'' was compared between the different types of robots. Results: A total of 29 participants (mean age 88.7, SD 6.2 years; n=27 female; Japanese version of Mini-Mental State Examination mean score 18.2, SD 5.1) were recruited. The expression intensity value for ``happy'' was the largest in both the subjective and objective assessments and increased significantly when all sensory modalities (visual, auditory, and tactile) were presented (median expression intensity 0.21, IQR 0.09-0.35) compared to the other 2 patterns (visual alone: median expression intensity 0.10, IQR 0.03-0.22; P<.001; visual and auditory: median expression intensity 0.10, IQR 0.04-0.23; P<.001). The comparison of different types of robots revealed a significant increase when all stimuli were presented by doll-type and animal-type robots, but not humanoid-type robots. Conclusions: By quantifying the emotional responses of people with dementia, this study highlighted that socially assistive robots may be more effective in eliciting positive emotions when multiple sensory stimuli, including tactile stimuli, are involved. More studies, including randomized controlled trials, are required to further explore the effectiveness of using socially assistive robots in dementia care. Trial Registration: UMIN Clinical Trials Registry UMIN000046256; https://tinyurl.com/yw37auan ",
doi="10.2196/52443",
url="https://aging.jmir.org/2024/1/e52443"
}


@Article{info:doi/10.2196/54353,
author="Sakal, Collin
and Li, Tingyou
and Li, Juan
and Yang, Can
and Li, Xinyue",
title="Association Between Sleep Efficiency Variability and Cognition Among Older Adults: Cross-Sectional Accelerometer Study",
journal="JMIR Aging",
year="2024",
month="Apr",
day="4",
volume="7",
pages="e54353",
keywords="aging",
keywords="cognition",
keywords="accelerometer",
keywords="sleep",
keywords="sleep efficiency",
keywords="geriatrics",
keywords="gerontology",
keywords="actigraphy",
keywords="digital health",
keywords="mhealth",
keywords="cognitive impairments",
keywords="mobile health",
keywords="efficiency",
keywords="variability",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="sleep quality",
keywords="machine learning",
keywords="quality of sleep",
abstract="Background: Sleep efficiency is often used as a measure of sleep quality. Getting sufficiently high-quality sleep has been associated with better cognitive function among older adults; however, the relationship between day-to-day sleep quality variability and cognition has not been well-established. Objective: We aimed to determine the relationship between day-to-day sleep efficiency variability and cognitive function among older adults, using accelerometer data and 3 cognitive tests. Methods: We included older adults aged >65 years with at least 5 days of accelerometer wear time from the National Health and Nutrition Examination Survey (NHANES) who completed the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's Disease Word-Learning subtest (CERAD-WL), and the Animal Fluency Test (AFT). Sleep efficiency was derived using a data-driven machine learning algorithm. We examined associations between sleep efficiency variability and scores on each cognitive test adjusted for age, sex, education, household income, marital status, depressive symptoms, diabetes, smoking habits, alcohol consumption, arthritis, heart disease, prior heart attack, prior stroke, activities of daily living, and instrumental activities of daily living. Associations between average sleep efficiency and each cognitive test score were further examined for comparison purposes. Results: A total of 1074 older adults from the NHANES were included in this study. Older adults with low average sleep efficiency exhibited higher levels of sleep efficiency variability (Pearson r=?0.63). After adjusting for confounding factors, greater average sleep efficiency was associated with higher scores on the DSST (per 10\% increase, $\beta$=2.25, 95\% CI 0.61 to 3.90) and AFT (per 10\% increase, $\beta$=.91, 95\% CI 0.27 to 1.56). Greater sleep efficiency variability was univariably associated with worse cognitive function based on the DSST (per 10\% increase, $\beta$=?3.34, 95\% CI ?5.33 to ?1.34), CERAD-WL (per 10\% increase, $\beta$=?1.00, 95\% CI ?1.79 to ?0.21), and AFT (per 10\% increase, $\beta$=?1.02, 95\% CI ?1.68 to ?0.36). In fully adjusted models, greater sleep efficiency variability remained associated with lower DSST (per 10\% increase, $\beta$=?2.01, 95\% CI ?3.62 to ?0.40) and AFT (per 10\% increase, $\beta$=?.84, 95\% CI ?1.47 to ?0.21) scores but not CERAD-WL (per 10\% increase, $\beta$=?.65, 95\% CI ?1.39 to 0.08) scores. Conclusions: Targeting consistency in sleep quality may be useful for interventions seeking to preserve cognitive function among older adults. ",
doi="10.2196/54353",
url="https://aging.jmir.org/2024/1/e54353"
}


@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/10.2196/53001,
author="Xiang, Xiaoling
and Kayser, Jay
and Turner, Skyla
and Ash, Samson
and Himle, A. Joseph",
title="Layperson-Supported, Web-Delivered Cognitive Behavioral Therapy for Depression in Older Adults: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="4",
volume="26",
pages="e53001",
keywords="internet-based cognitive behavioral therapy",
keywords="iCBT",
keywords="digital mental health interventions",
keywords="older adults",
keywords="depression",
abstract="Background: Depression is the most prevalent mental health condition in older adults. However, not all evidence-based treatments are easily accessible. Web-delivered cognitive behavioral therapy (wCBT) facilitated by laypersons is a viable treatment alternative. Objective: This randomized controlled trial aims to evaluate the efficacy of a novel wCBT program, Empower@Home, supported by trained lay coaches, against a waitlist attention control. Empower@Home is among the very few existing wCBT programs specifically designed for older adults. The primary objective was to assess the efficacy of the intervention compared with attention control. The secondary objective was to evaluate the program's impact on secondary psychosocial outcomes and explore potential change mechanisms. Methods: Older adults (N=70) were recruited via web-based research registries, social media advertisements, and community agency referrals and randomly assigned to either the intervention or control group in a 1:1 allocation ratio. The intervention group received access to Empower@Home, which included 9 web-delivered self-help lessons and weekly telephone coaching sessions by a trained layperson over 10 weeks. The control group received weekly friendly phone calls and depressive symptom monitoring. The primary clinical outcome was the severity of depressive symptoms assessed using the Patient Health Questionnaire-9. The secondary clinical outcomes included anxiety, anger, social isolation, insomnia, pain intensity, and quality of life. Linear mixed modeling was used to determine the treatment effects on depression, and 2-tailed t tests were used to assess within-group changes and between-group differences. Results: Most participants in the intervention group completed all 9 sessions (31/35, 89\%). The usability and acceptability ratings were excellent. The intervention group had a large within-group change in depressive symptoms (Cohen d=1.22; P<.001), whereas the attention control group experienced a medium change (Cohen d=0.57; P<.001). The between-group effect size was significant, favoring the intervention group over the control group (Cohen d=0.72; P<.001). In the linear mixed model, the group-by-time interaction was statistically significant (b=--0.68, 95\% CI --1.00 to --0.35; P<.001). The treatment effects were mediated by improvements in cognitive behavioral therapy skills acquisition; behavioral activation; and satisfaction with the basic psychological needs of autonomy, competence, and relatedness. Furthermore, the intervention group showed significant within-group improvements in secondary psychosocial outcomes, including anxiety (P=.001), anger (P<.001), social isolation (P=.02), insomnia (P=.007), and pain (P=.03). By contrast, the control group did not experience significant changes in these outcome domains. However, the between-group differences in secondary outcomes were not statistically significant, owing to the small sample size. Conclusions: Empower@Home, a wCBT program supported by lay coaches, was more efficacious in reducing depressive symptoms than friendly telephone calls and depression symptom monitoring. Future studies should examine the effectiveness of the intervention in community and practice settings using nonclinician staff already present in these real-world settings as coaches. Trial Registration: ClinicalTrials.gov NCT05593276; https://clinicaltrials.gov/ct2/show/NCT05593276 International Registered Report Identifier (IRRID): RR2-10.2196/44210 ",
doi="10.2196/53001",
url="https://www.jmir.org/2024/1/e53001",
url="http://www.ncbi.nlm.nih.gov/pubmed/38437013"
}


@Article{info:doi/10.2196/40187,
author="Kong, Fanqian
and Yu, Libo
and Hou, Yanbin
and Zhu, Lijie
and Zhou, Jing
and Huang, Lingjie
and Lv, Yueer
and Wang, Li
and Zhang, Li
and Yang, Yiling
and Ying, Yuchen",
title="Efficacy of Internet-Based Cognitive Behavioral Therapy for Subthreshold Depression Among Older Adults in Institutional Long-Term Care Settings: Pragmatic Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="1",
volume="26",
pages="e40187",
keywords="internet-based cognitive behavioral therapy",
keywords="subthreshold depression",
keywords="randomized controlled trial",
keywords="older adults",
keywords="LTC setting",
abstract="Background: Subthreshold depression (sD) is prevalent in older populations in long-term care (LTC) settings, but psychological therapy in LTC settings in China is not readily available. Thus, internet-based cognitive behavioral therapy (ICBT) may be suitable for this population, but research on the efficacy of ICBT for older adults with sD, especially those living in LTC settings, is limited. Objective: This study aimed to evaluate the efficacy and acceptability of ICBT treatment for sD among LTC residents in China. We also examined whether ICBT is as effective as group-based cognitive behavioral therapy (CBT) for treating sD in this population. Methods: We conducted a pragmatic randomized controlled trial, which included 18 LTC institutions. A total of 354 participants were randomized to ICBT, group-based CBT, or a waiting list and were followed up for 12 months. The primary outcome was self-reported depressive symptoms on the Center for Epidemiological Studies Depression Scale (CES-D). Secondary outcomes were the scores of the Patient Health Questionnaire--9 (PHQ-9), Generalized Anxiety Disorder 7-Item (GAD-7), and Geriatric Depression Scale (GDS). A mixed-effects model was used to assess the efficacy of ICBT. Results: The ICBT group showed a significant improvement in self-reported depressive symptoms, which was maintained at the 12-month follow-up (all P<.001). The ICBT group exhibited a significantly larger reduction in the scores of the CES-D (Cohen d=0.07, 95\% CI 0.04-0.09; P=.01), PHQ-9 (d=0.30, 95\% CI 0.28-0.33; P<.001), GDS (d=0.10, 95\% CI 0.08-0.13; P<.001), and GAD-7 (d=0.19, 95\% CI 0.17-0.22; P<.001) compared with a waiting list at postintervention. ICBT had significantly stronger effects than CBT on the PHQ-9 and GAD-7 at postintervention (d=0.15, 95\% CI 0.13-0.17; P<.001 and d=0.21, 95\% CI 0.19-0.23; P<.001, respectively), 6-month follow-up (d=0.18, 95\% CI 0.16-0.21; P<.001 and d=0.18, 95\% CI 0.15-0.21; P<.001, respectively), and 12-month follow-up (d=0.15, 95\% CI 0.11-0.19; P<.001 and d=0.18, 95\% CI 0.14-0.21; P<.001, respectively). Conclusions: ICBT is a relatively effective and acceptable intervention for reducing depressive symptoms among Chinese LTC residents with sD. These findings indicate the usefulness of ICBT application for sD in LTC settings. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000030697; https://www.chictr.org.cn/showproj.aspx?proj=50781 ",
doi="10.2196/40187",
url="https://www.jmir.org/2024/1/e40187",
url="http://www.ncbi.nlm.nih.gov/pubmed/38427424"
}


@Article{info:doi/10.2196/51862,
author="Bjelkar{\o}y, Torheim Maria
and Simonsen, Breines Tone
and Siddiqui, Ghazal Tahreem
and Halset, Sigrid
and Cheng, Socheat
and Grambaite, Ramune
and Benth, {\vS}altyt? J?rat?
and Gerwing, Jennifer
and Kristoffersen, Saxhaug Espen
and Lundqvist, Christofer",
title="Brief Intervention as a Method to Reduce Z-Hypnotic Use by Older Adults: Feasibility Case Series",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="8",
volume="8",
pages="e51862",
keywords="prescription medication misuse",
keywords="older adults",
keywords="brief intervention",
keywords="z-drugs",
keywords="benzodiazepine-related drugs",
keywords="BZD-related drugs",
keywords="z-hypnotic",
keywords="intervention",
keywords="feasibility",
keywords="case series",
keywords="insomnia",
keywords="sleep",
keywords="substance overuse",
keywords="older adult",
keywords="treatment",
keywords="reduction",
keywords="benzodiazepine",
keywords="hypnotics",
abstract="Background: Z-hypnotics or z-drugs are commonly prescribed for insomnia and sleep difficulties in older adults. These drugs are associated with adverse events and dependence and are not recommended for long-term use. Despite evidence of older adults being more sensitive to a wide array of adverse events and clinical guidelines advocating limiting use, inappropriate use in this population is still prevalent. Previous intervention studies have focused mainly on prescriber information. Simple, individually focused intervention designs are less studied. Brief intervention (BI) is a simple, easily transferable method mainly used to treat patients at risk of alcohol overuse. Objective: Our objective was to design and test the feasibility and acceptability of a BI intervention adapted to address individual, inappropriate use of z-hypnotics among older adults. This preparatory study aimed to optimize the intervention in advance of a quantitative randomized controlled trial investigating the treatment effect in a larger population. Methods: This feasibility case series was conducted at Akershus University Hospital, Norway, in autumn 2021. We included 5 adults aged ?65 years with long-term (?4 weeks) use of z-hypnotics and 2 intervening physicians. Additionally, 2 study investigators contributed with process evaluation notes. The BI consists of information on the risk of inappropriate use and individualized advice on how to reduce use. The focus of the intervention is behavioral and aims, in cooperation with the patient and based on shared decision-making, to change patient behavior regarding sleep medication rather than physician-based detoxification and termination of z-hypnotic prescriptions. Qualitative and descriptive quantitative data were collected from intervening physicians, study investigators, and participants at baseline, immediately after the intervention, and at the 6-week follow-up. Results: Data were obtained from 2 physicians, 2 study investigators, and 5 participants (4 women) with a median age of 84 years. The average time spent on the BI consultation was 15 minutes. All 5 participants completed the intervention without problems. The participants and 2 intervening physicians reported the intervention as acceptable and were satisfied with the delivery of the intervention. After the intervention, 2 participants stopped their use of z-hypnotics completely and participated in the follow-up interview. Study investigators identified logistical challenges regarding location and time requirements. Identified aspects that may improve the intervention and reduce dropouts included revising the intervention content, focusing on rebound insomnia, adding an information leaflet, and supporting the patient in the period between the intervention and follow-up. The notion that the intervention should best be located and conducted by the patient's own general practitioner was supported by the participants. Conclusions: We identified important aspects to improve the designed intervention and found that the BI is feasible and acceptable for incorporation into a larger randomized trial investigating the treatment effect of BI for reducing z-hypnotic use by older adults. Trial Registration: ClinicalTrials.gov NCT03162081; http://tinyurl.com/rmzx6brn ",
doi="10.2196/51862",
url="https://formative.jmir.org/2024/1/e51862",
url="http://www.ncbi.nlm.nih.gov/pubmed/38329779"
}


@Article{info:doi/10.2196/48175,
author="Thangavel, Gomathi
and Memedi, Mevludin
and Hedstr{\"o}m, Karin",
title="Information and Communication Technology for Managing Social Isolation and Loneliness Among People Living With Parkinson Disease: Qualitative Study of Barriers and Facilitators",
journal="J Med Internet Res",
year="2024",
month="Jan",
day="17",
volume="26",
pages="e48175",
keywords="social isolation",
keywords="loneliness",
keywords="Parkinson disease",
keywords="ICT",
keywords="information and communication technology",
abstract="Background: Parkinson disease (PD) is a complex, noncurable, and progressive neurological disease affecting different areas of the human nervous system. PD is associated with both motor and nonmotor symptoms, which negatively affect patients' quality of life and may cause changes in socialization such as intentional social withdrawal. This may further lead to social isolation and loneliness. The use of information and communication technology (ICT) plays an important role in managing social isolation and loneliness. Currently, there is a lack of research focusing on designing and developing ICT solutions that specifically address social isolation and loneliness among people living with PD. Objective: This study addresses this gap by investigating barriers and social needs in the context of social isolation, loneliness, and technology use among people living with PD. The insights gained can inform the development of effective ICT solutions, which can address social isolation and loneliness and improve the quality of life for people living with PD. Methods: A qualitative study with 2 phases of data collection were conducted. During the first phase, 9 health care professionals and 16 people living with PD were interviewed to understand how PD affects social life and technology use. During the second phase, 2 focus groups were conducted with 4 people living with PD in each group to gather insights into their needs and identify ways to manage social isolation and loneliness. Thematic analysis was used to analyze both data sets and identify key themes. Results: The results showed that the barriers experienced by people living with PD due to PD such as ``fatigue,'' ``psychological conditions,'' ``social stigma,'' and ``medication side effects'' affect their social life. People living with PD also experience difficulties using a keyboard and mouse, remembering passwords, and navigating complex applications due to their PD-related physical and cognitive limitations. To manage their social isolation and loneliness, people living with PD suggested having a simple and easy-to-use solution, allowing them to participate in a digital community based on their interests, communicate with others, and receive recommendations for social events. Conclusions: The new ICT solutions focusing on social isolation and loneliness among people living with PD should consider the barriers restricting user's social activities and technology use. Given the wide range of needs and barriers experienced by people living with PD, it is more suitable to adopt user-centered design approaches that emphasize the active participation of end users in the design process. Importantly, any ICT solution designed for people living with PD should not encourage internet addiction, which will further contribute to the person's withdrawal from society. ",
doi="10.2196/48175",
url="https://www.jmir.org/2024/1/e48175",
url="http://www.ncbi.nlm.nih.gov/pubmed/38231548"
}


@Article{info:doi/10.2196/50787,
author="Wu, Man
and Li, Chaoyang
and Hu, Ting
and Zhao, Xueyang
and Qiao, Guiyuan
and Gao, Xiaolian
and Zhu, Xinhong
and Yang, Fen",
title="Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="17",
volume="12",
pages="e50787",
keywords="telecare",
keywords="depression",
keywords="anxiety",
keywords="quality of life",
keywords="older adults",
keywords="meta-analysis",
abstract="Background: Depression is the most common psychiatric disorder among older adults. Despite the effectiveness of pharmacological and psychological therapies, many patients with late-life depression (LLD) are unable to access timely treatment. Telecare has been shown to be effective in addressing patients' psychosocial issues, while its effectiveness in serving patients with LLD remains unclear. Objective: This study aimed to evaluate the effectiveness of telecare in reducing depression and anxiety symptoms and improving quality of life (QoL) in patients with LLD. Methods: Databases including the Cochrane Library, Web of Science, PubMed, Embase, and EBSCO were searched for randomized controlled trials (RCTs) evaluating the effectiveness of telecare for LLD from database establishment to December 28, 2022. Results: A total of 12 RCTs involving 1663 participants were identified in this study. The meta-analysis showed that (1) telecare significantly reduced depressive symptoms in patients with LLD compared to those in usual care (UC; standardized mean difference [SMD]=--0.46, 95\% CI --0.53 to --0.38; P<.001), with the best improvement observed within 3 months of intervention (SMD=--0.72, 95\% CI --1.16 to --0.28; P<.001); (2) other scales appeared more effective than the Patient Health Questionnaire-9 for LLD in telecare interventions (SMD=--0.65, 95\% CI --0.96 to --0.35; P<.001); (3) telecare was more effective than telephone-based interventions for remote monitoring of LLD (SMD=--1.13, 95\% CI --1.51 to --0.76; P<.001); (4) the reduction of depressive symptoms was more pronounced in patients with LLD with chronic conditions (SMD=--0.67, 95\% CI --0.89 to --0.44; P<.001); (5) telecare was more effective for LLD in Europe and the Americas than in other regions (SMD=--0.73, 95\% CI --0.99 to --0.47; P<.001); (6) telecare significantly reduced anxiety symptoms in patients with LLD (SMD=--0.53, 95\% CI --0.73 to --0.33; P=.02); and (7) there was no significant improvement in the psychological components of QoL in patients with LLD compared to those receiving UC (SMD=0.30, 95\% CI 0.18-0.43; P=.80). Conclusions: Telecare is a promising modality of care for treatment, which can alleviate depression and anxiety symptoms in patients with LLD. Continued in-depth research into the effectiveness of telecare in treating depression could better identify where older patients would benefit from this intervention. ",
doi="10.2196/50787",
url="https://mhealth.jmir.org/2024/1/e50787",
url="http://www.ncbi.nlm.nih.gov/pubmed/38231546"
}


@Article{info:doi/10.2196/43185,
author="Solberg, M. Laurence
and Duckworth, J. Laurie
and Dunn, M. Elizabeth
and Dickinson, Theresa
and Magoc, Tanja
and Snigurska, A. Urszula
and Ser, E. Sarah
and Celso, Brian
and Bailey, Meghan
and Bowen, Courtney
and Radhakrishnan, Nila
and Patel, R. Chirag
and Lucero, Robert
and Bjarnadottir, I. Ragnhildur",
title="Use of a Data Repository to Identify Delirium as a Presenting Symptom of COVID-19 Infection in Hospitalized Adults: Cross-Sectional Cohort Pilot Study",
journal="JMIR Aging",
year="2023",
month="Nov",
day="30",
volume="6",
pages="e43185",
keywords="COVID-19",
keywords="delirium",
keywords="neurocognitive disorder",
keywords="data repository",
keywords="adults",
keywords="pilot study",
keywords="symptom",
keywords="electronic health record",
keywords="viral infection",
keywords="clinical",
keywords="patient",
keywords="research",
keywords="diagnosis",
keywords="disorder",
keywords="memory",
keywords="covid",
keywords="memory loss",
keywords="old",
keywords="old age",
abstract="Background: Delirium, an acute confusional state highlighted by inattention, has been reported to occur in 10\% to 50\% of patients with COVID-19. People hospitalized with COVID-19 have been noted to present with or develop delirium and neurocognitive disorders. Caring for patients with delirium is associated with more burden for nurses, clinicians, and caregivers. Using information in electronic health record data to recognize delirium and possibly COVID-19 could lead to earlier treatment of the underlying viral infection and improve outcomes in clinical and health care systems cost per patient. Clinical data repositories can further support rapid discovery through cohort identification tools, such as the Informatics for Integrating Biology and the Bedside tool. Objective: The specific aim of this research was to investigate delirium in hospitalized older adults as a possible presenting symptom in COVID-19 using a data repository to identify neurocognitive disorders with a novel group of International Classification of Diseases, Tenth Revision (ICD-10) codes. Methods: We analyzed data from 2 catchment areas with different demographics. The first catchment area (7 counties in the North-Central Florida) is predominantly rural while the second (1 county in North Florida) is predominantly urban. The Integrating Biology and the Bedside data repository was queried for patients with COVID-19 admitted to inpatient units via the emergency department (ED) within the health center from April 1, 2020, and April 1, 2022. Patients with COVID-19 were identified by having a positive COVID-19 laboratory test or a diagnosis code of U07.1. We identified neurocognitive disorders as delirium or encephalopathy, using ICD-10 codes. Results: Less than one-third (1437/4828, 29.8\%) of patients with COVID-19 were diagnosed with a co-occurring neurocognitive disorder. A neurocognitive disorder was present on admission for 15.8\% (762/4828) of all patients with COVID-19 admitted through the ED. Among patients with both COVID-19 and a neurocognitive disorder, 56.9\% (817/1437) were aged ?65 years, a significantly higher proportion than those with no neurocognitive disorder (P<.001). The proportion of patients aged <65 years was significantly higher among patients diagnosed with encephalopathy only than patients diagnosed with delirium only and both delirium and encephalopathy (P<.001). Most (1272/4828, 26.3\%) patients with COVID-19 admitted through the ED during our study period were admitted during the Delta variant peak. Conclusions: The data collected demonstrated that an increased number of older patients with neurocognitive disorder present on admission were infected with COVID-19. Knowing that delirium increases the staffing, nursing care needs, hospital resources used, and the length of stay as previously noted, identifying delirium early may benefit hospital administration when planning for newly anticipated COVID-19 surges. A robust and accessible data repository, such as the one used in this study, can provide invaluable support to clinicians and clinical administrators in such resource reallocation and clinical decision-making. ",
doi="10.2196/43185",
url="https://aging.jmir.org/2023/1/e43185",
url="http://www.ncbi.nlm.nih.gov/pubmed/37910448"
}


@Article{info:doi/10.2196/49319,
author="Sharma, Nikita
and Braakman-Jansen, A. Louise M.
and Oinas-Kukkonen, Harri
and Croockewit, Hendrik Jan
and Gemert-Pijnen, van JEWC",
title="Exploring the Needs and Requirements of Informal Caregivers of Older Adults With Cognitive Impairment From Sensor-Based Care Solutions: Multimethod Study",
journal="JMIR Aging",
year="2023",
month="Oct",
day="25",
volume="6",
pages="e49319",
keywords="informal caregiving",
keywords="cognitive impairment",
keywords="unobtrusive sensing solutions",
keywords="in-home care",
keywords="aging in place",
keywords="assistive technologies",
abstract="Background: With the increase in the older adult population, sensor-based care solutions that can monitor the deviations in physical, emotional, and physiological activities in real-time from a distance are demanded for prolonging the stay of community-dwelling older adults with cognitive impairment. To effectively develop and implement these care solutions, it is important to understand the current experiences, future expectations, perceived usefulness (PU), and communication needs of the informal caregivers of older adults with cognitive impairment regarding such solutions. Objective: This comprehensive study with informal caregivers of older adults with cognitive impairment aims to (1) highlight current experiences with (if any) and future expectations from general sensor-based care solutions, (2) explore PU specifically toward unobtrusive sensing solutions (USSs), (3) determine the information communication (IC) needs and requirements for communicating the information obtained through USSs in different care scenarios (fall, nocturnal unrest, agitation, and normal daily life), and (4) elicit the design features for designing the interaction platform in accordance with the persuasive system design (PSD) model. Methods: A multimethod research approach encompassing a survey (N=464) and in-depth interviews (10/464, 2.2\%) with informal caregivers of older adults with cognitive impairment was used. The insights into past experiences with and future expectations from the sensor-based care solutions were obtained through inductive thematic analysis of the interviews. A convergent mixed methods approach was used to explore PU and gather the IC needs from USSs by using scenario-specific questions in both survey and interviews. Finally, the design features were elicited by using the PSD model on the obtained IC needs and requirements. Results: Informal caregivers expect care infrastructure to consider centralized and empathetic care approaches. Specifically, sensor-based care solutions should be adaptable to care needs, demonstrate trust and reliability, and ensure privacy and safety. Most informal caregivers found USSs to be useful for emergencies (mean 4.09, SD 0.04) rather than for monitoring normal daily life activities (mean 3.50, SD 0.04). Moreover, they display variations in information needs including mode, content, time, and stakeholders involved based on the care scenario at hand. Finally, PSD features, namely, reduction, tailoring, personalization, reminders, suggestions, trustworthiness, and social learning, were identified for various care scenarios. Conclusions: From the obtained results, it can be concluded that the care scenario at hand drives PU and IC design needs and requirements toward USSs. Therefore, future technology developers are recommended to develop technology that can be easily adapted to diverse care scenarios, whereas designers of such sensor-driven platforms are encouraged to go beyond tailoring and strive for strong personalization while maintaining the privacy of the users. ",
doi="10.2196/49319",
url="https://aging.jmir.org/2023/1/e49319",
url="http://www.ncbi.nlm.nih.gov/pubmed/37878353"
}


@Article{info:doi/10.2196/48143,
author="Engineer, Margi
and Kot, Sushant
and Dixon, Emma",
title="Investigating the Readability and Linguistic, Psychological, and Emotional Characteristics of Digital Dementia Information Written in the English Language: Multitrait-Multimethod Text Analysis",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="25",
volume="7",
pages="e48143",
keywords="natural language processing",
keywords="consumer health information",
keywords="readability",
keywords="Alzheimer disease and related dementias",
keywords="caregivers",
abstract="Background: Past research in the Western context found that people with dementia search for digital dementia information in peer-reviewed medical research articles, dementia advocacy and medical organizations, and blogs written by other people with dementia. This past work also demonstrated that people with dementia do not perceive English digital dementia information as emotionally or cognitively accessible. Objective: In this study, we sought to investigate the readability; linguistic, psychological, and emotional characteristics; and target audiences of digital dementia information. We conducted a textual analysis of 3 different types of text-based digital dementia information written in English: 300 medical articles, 35 websites, and 50 blogs. Methods: We assessed the text's readability using the Flesch Reading Ease and Flesch-Kincaid Grade Level measurements, as well as tone, analytical thinking, clout, authenticity, and word frequencies using a natural language processing tool, Linguistic Inquiry and Word Count Generator. We also conducted a thematic analysis to categorize the target audiences for each information source and used these categorizations for further statistical analysis. Results: The median Flesch-Kincaid Grade Level readability score and Flesch Reading Ease score for all types of information (N=1139) were 12.1 and 38.6, respectively, revealing that the readability scores of all 3 information types were higher than the minimum requirement. We found that medical articles had significantly (P=.05) higher word count and analytical thinking scores as well as significantly lower clout, authenticity, and emotional tone scores than websites and blogs. Further, blogs had significantly (P=.48) higher word count and authenticity scores but lower analytical scores than websites. Using thematic analysis, we found that most of the blogs (156/227, 68.7\%) and web pages (399/612, 65.2\%) were targeted at people with dementia. Website information targeted at a general audience had significantly lower readability scores. In addition, website information targeted at people with dementia had higher word count and lower emotional tone ratings. The information on websites targeted at caregivers had significantly higher clout and lower authenticity scores. Conclusions: Our findings indicate that there is an abundance of digital dementia information written in English that is targeted at people with dementia, but this information is not readable by a general audience. This is problematic considering that people with <12 years of education are at a higher risk of developing dementia. Further, our findings demonstrate that digital dementia information written in English has a negative tone, which may be a contributing factor to the mental health crisis many people with dementia face after receiving a diagnosis. Therefore, we call for content creators to lower readability scores to make the information more accessible to a general audience and to focus their efforts on providing information in a way that does not perpetuate overly negative narratives of dementia. ",
doi="10.2196/48143",
url="https://formative.jmir.org/2023/1/e48143",
url="http://www.ncbi.nlm.nih.gov/pubmed/37878351"
}


@Article{info:doi/10.2196/46483,
author="Hamrick, Phillip
and Sanborn, Victoria
and Ostrand, Rachel
and Gunstad, John",
title="Lexical Speech Features of Spontaneous Speech in Older Persons With and Without Cognitive Impairment: Reliability Analysis",
journal="JMIR Aging",
year="2023",
month="Oct",
day="10",
volume="6",
pages="e46483",
keywords="Alzheimer's disease",
keywords="cognitive dysfunction",
keywords="early diagnosis",
keywords="psychometrics",
keywords="speech",
keywords="technology assessment",
abstract="Background: Speech analysis data are promising digital biomarkers for the early detection of Alzheimer disease. However, despite its importance, very few studies in this area have examined whether older adults produce spontaneous speech with characteristics that are sufficiently consistent to be used as proxy markers of cognitive status. Objective: This preliminary study seeks to investigate consistency across lexical characteristics of speech in older adults with and without cognitive impairment. Methods: A total of 39 older adults from a larger, ongoing study (age: mean 81.1, SD 5.9 years) were included. Participants completed neuropsychological testing and both picture description tasks and expository tasks to elicit speech. Participants with T-scores of ?40 on ?2 cognitive tests were categorized as having mild cognitive impairment (MCI). Speech features were computed automatically by using Python and the Natural Language Toolkit. Results: Reliability indices based on mean correlations for picture description tasks and expository tasks were similar in persons with and without MCI (with r ranging from 0.49 to 0.65 within tasks). Intraindividual variability was generally preserved across lexical speech features. Speech rate and filler rate were the most consistent indices for the cognitively intact group, and speech rate was the most consistent for the MCI group. Conclusions: Our findings suggest that automatically calculated lexical properties of speech are consistent in older adults with varying levels of cognitive impairment. These findings encourage further investigation of the utility of speech analysis and other digital biomarkers for monitoring cognitive status over time. ",
doi="10.2196/46483",
url="https://aging.jmir.org/2023/1/e46483"
}


@Article{info:doi/10.2196/45539,
author="Lu, Zhipeng
and Wang, Wenjin
and Yan, Wei
and Kew, Lin Chung
and Seo, Hwaryoung Jinsil
and Ory, Marcia",
title="The Application of Fully Immersive Virtual Reality on Reminiscence Interventions for Older Adults: Scoping Review",
journal="JMIR Serious Games",
year="2023",
month="Oct",
day="6",
volume="11",
pages="e45539",
keywords="older adults",
keywords="fully immersive virtual reality",
keywords="reminiscence",
keywords="Alzheimer",
keywords="cognitive function",
keywords="mental health",
keywords="psychological well-being",
keywords="memory care",
keywords="dementia",
keywords="scoping review",
abstract="Background: The increasing number of older adults with mental, behavioral, and memory challenges presents significant public health concerns. Reminiscence is one type of nonpharmacological intervention that can effectively evoke memories, stimulate mental activities, and improve psychological well-being in older adults through a series of discussions on previous experiences. Fully immersive virtual reality (FIVR) may be a useful tool for reminiscence interventions because it uses realistic virtual environments connected to a person's significant past stories. Objective: This review aims to examine empirical evidence regarding the application of FIVR in reminiscence interventions, its usability and acceptability, and its effectiveness in assisting the intervention to achieve optimal outcomes. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach for scoping reviews. The PubMed, PsycINFO, Embase, CINAHL, Web of Science, ACM, and IEEE Xplore electronic databases were used for the search. We included peer-reviewed studies that used FIVR as an assistive tool for reminiscence interventions; were published between January 1, 2000, and August 1, 2022; reported empirical research; involved older adults as participants; and addressed health- and behavior-related outcomes or the feasibility and usability of FIVR. We used Endnote X9 to organize the search results and Microsoft Excel for data extraction and synthesis. Results: Of the 806 articles collected from the databases and other resources, 11 were identified. Most of the studies involved participants aged between 70 and 90 years. Only 1 study did not involve those with cognitive impairments, whereas 3 specifically targeted people living with dementia. The results indicated that FIVR reminiscence interventions enhanced engagement and reduced fatigue. Although some studies have observed positive effects on anxiety, apathy, depression, cognitive functions, and caregiver burden reduction, these findings were inconsistent across other research. In addition, FIVR showed overall usability and acceptability with manageable side effects among older adults across various health conditions during reminiscence sessions. However, 1 study reported adverse feelings among participants, triggered by unpleasant memories evoked by the virtual reality content. Conclusions: The role of FIVR in reminiscence interventions remains nascent, with limited studies evaluating its impacts on older adults. Many of the reviewed studies had notable limitations: small sample sizes, absence of rigorous research design, limited assessment of long-term effects, lack of measures for health and behavior outcomes, and quality of life. Beyond these limitations, this review identified a list of future research directions in 6 categories. On the basis of the review findings, we provide practical recommendations to enhance FIVR reminiscence interventions, covering topics such as virtual reality content, device choice, intervention types, and the role and responsibility of facilitators. ",
doi="10.2196/45539",
url="https://games.jmir.org/2023/1/e45539",
url="http://www.ncbi.nlm.nih.gov/pubmed/37801360"
}


@Article{info:doi/10.2196/45532,
author="Bannon, Sarah
and Brewer, Julie
and Ahmad, Nina
and Cornelius, Talea
and Jackson, Jonathan
and Parker, A. Robert
and Dams-O'Connor, Kristen
and Dickerson, C. Bradford
and Ritchie, Christine
and Vranceanu, Ana-Maria",
title="A Live Video Dyadic Resiliency Intervention to Prevent Chronic Emotional Distress Early After Dementia Diagnoses: Protocol for a Dyadic Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="20",
volume="12",
pages="e45532",
keywords="dyad",
keywords="dementia",
keywords="emotional distress",
keywords="intervention",
keywords="diagnosis",
keywords="telehealth",
abstract="Background: By 2030, approximately 75 million adults will be living with Alzheimer disease and related dementias (ADRDs). ADRDs produce cognitive, emotional, and behavioral changes for persons living with dementia that undermine independence and produce considerable stressors for persons living with dementia and their spousal care-partners---together called a ``dyad.'' Clinically elevated emotional distress (ie, depression and anxiety symptoms) is common for both dyad members after ADRD diagnosis, which can become chronic and negatively impact relationship functioning, health, quality of life, and collaborative management of progressive symptoms. Objective: This study is part of a larger study that aims to develop, adapt, and establish the feasibility of Resilient Together for Alzheimer Disease and Related Dementias (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress. This study aims to gather comprehensive information to develop the first iteration of RT-ADRD and inform a subsequent open pilot. Here, we describe the proposed study design and procedures. Methods: All procedures will be conducted virtually (via phone and Zoom) to minimize participant burden and gather information regarding feasibility and best practices surrounding virtual procedures for older adults. We will recruit dyads (up to n=20) from Mount Sinai Hospital (MSH) clinics within 1 month of ADRD diagnosis. Dyads will be self-referred or referred by their treating neurologists and complete screening to assess emotional distress and capacity to consent to participate in the study. Consenting dyads will then participate in a 60-minute qualitative interview using an interview guide designed to assess common challenges, unmet needs, and support preferences and to gather feedback on the proposed RT-ADRD intervention content and design. Each dyad member will then have the opportunity to participate in an optional individual interview to gather additional feedback. Finally, each dyad member will complete a brief quantitative survey remotely (by phone, tablet, or computer) via a secure platform to assess feasibility of assessment and gather preliminary data to explore associations between proposed mechanisms of change and secondary outcomes. We will conduct preliminary explorations of feasibility markers, including recruitment, screening, live video interviews, quantitative data collection, and mixed methods analyses. Results: This study has been approved by the MSH Institutional Review Board. We anticipate that the study will be completed by late 2023. Conclusions: We will use results from this study to develop the first live video telehealth dyadic resiliency intervention focused on the prevention of chronic emotional distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from dyads on important factors to address in an early prevention-focused intervention and to explore feasibility of study procedures to inform future open pilot and pilot feasibility randomized control trial investigations of RT-ADRD. International Registered Report Identifier (IRRID): PRR1-10.2196/45532 ",
doi="10.2196/45532",
url="https://www.researchprotocols.org/2023/1/e45532",
url="http://www.ncbi.nlm.nih.gov/pubmed/37728979"
}


@Article{info:doi/10.2196/47691,
author="Xiang, Xiaoling
and Kayser, Jay
and Ash, Samson
and Zheng, Chuxuan
and Sun, Yihang
and Weaver, Addie
and Dunkle, Ruth
and Blackburn, A. James
and Halavanau, Alex
and Xue, Jia
and Himle, A. Joseph",
title="Web-Based Cognitive Behavioral Therapy for Depression Among Homebound Older Adults: Development and Usability Study",
journal="JMIR Aging",
year="2023",
month="Sep",
day="19",
volume="6",
pages="e47691",
keywords="internet-based cognitive behavioral therapy",
keywords="usability",
keywords="geriatric depression",
keywords="community-engaged research",
keywords="web-based",
keywords="geriatrics",
keywords="geriatric",
keywords="depression",
keywords="psychotherapy",
keywords="mental health",
keywords="older adults",
keywords="older adult",
keywords="cognitive behavioral therapy",
keywords="CBT",
keywords="design",
keywords="development",
keywords="community",
keywords="user centered design",
keywords="digital health",
keywords="aging",
keywords="old age",
keywords="digital mental health",
keywords="web-based health",
keywords="internet",
abstract="Background: Homebound older adults are a high-risk group for depression. However, many of them face barriers to accessing evidence-supported mental health treatments. Digital mental health interventions can potentially improve treatment access, but few web-based interventions are explicitly tailored for depression in older adults. Objective: This paper describes the development process of Empower@Home, a web-delivered intervention for depression in homebound older adults that is based on cognitive behavioral therapy, and reports on the outcomes of usability studies. Methods: Empower@Home was developed in collaboration with community agencies, stakeholders, and older adults, guided by user-centered design principles. User needs were assessed through secondary data analysis, demographic and health profiles from administrative data, and interviews and surveys of community partners. A comparative usability evaluation was conducted with 10 older adults to assess the usability of Empower@Home compared to 2 similar programs. Field testing was conducted with 4 end users to detect additional usability issues. Results: Feedback and recommendations from community partners heavily influenced the content and design of Empower@Home. The intervention consists of 9 sessions, including psychoeducation and an introduction to cognitive behavioral therapy skills and tools through short video clips, in-session exercises, an animated storyline, and weekly out-of-session home practice. A printed workbook accompanies the web-based lessons. In comparative usability testing (N=10), Empower@Home received a System Usability Scale score of 78 (SD 7.4), which was significantly higher than the 2 comparator programs (t9=3.28; P=.005 and t9=2.78; P=.011). Most participants, 80\% (n=8), preferred Empower@Home over the comparators. In the longitudinal field test (n=4), all participants reported liking the program procedures and feeling confident in performing program-related tasks. The single-subject line graph showed an overall downward trend in their depression scores over time, offering an encouraging indication of the intervention's potential effects. Conclusions: Collaboration with community stakeholders and careful consideration of potential implementation issues during the design process can result in more usable, engaging, and effective digital mental health interventions. ",
doi="10.2196/47691",
url="https://aging.jmir.org/2023/1/e47691",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725423"
}


@Article{info:doi/10.2196/49752,
author="Xu, Ling
and Fields, L. Noelle
and Daniel, M. Kathryn
and Cipher, J. Daisha
and Troutman, A. Brooke",
title="Reminiscence and Digital Storytelling to Improve the Social and Emotional Well-Being of Older Adults With Alzheimer's Disease and Related Dementias: Protocol for a Mixed Methods Study Design and a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="7",
volume="12",
pages="e49752",
keywords="Alzheimer's disease and related dementias",
keywords="ADRD",
keywords="digital storytelling",
keywords="DST",
keywords="intergenerational reminiscence",
keywords="older adult",
keywords="young adult",
keywords="randomized controlled trial",
abstract="Background: Increasing attention is being given to the growing concerns about social isolation, loneliness, and compromised emotional well-being experienced by young adults and older individuals affected by Alzheimer disease and related dementias (ADRD). Studies suggest that reminiscence strategies combined with an intergenerational approach may yield significant social and mental health benefits for participants. Experts also recommended the production of a digital life story book as part of reminiscence. Reminiscence is typically implemented by trained professionals (eg, social workers and nurses); however, there has been growing interest in using trained volunteers owing to staffing shortages and the costs associated with reminiscence programs. Objective: The proposed study will develop and test how reminiscence offered by trained young adult volunteers using a digital storytelling platform may help older adults with ADRD to improve their social and emotional well-being. Methods: The proposed project will conduct a randomized controlled trial to assess the effects of the intervention. The older and young adult participants will be randomly assigned to the intervention (reminiscence based) or control groups and then be randomly matched within each group. Data will be collected at baseline before the intervention, in the middle of the intervention, at end of the intervention, and at 3 months after the intervention. An explanatory sequential mixed methods design will be used to take advantage of the strengths of both quantitative and qualitative methods. The quantitative data from surveys will be entered into SPSS and analyzed using covariate-adjusted linear mixed models for repeated measures to compare the intervention and control groups over time on the major outcomes of participants. Conventional content analysis of qualitative interviews will be conducted using data analysis software. Results: The project was modified to a telephone-based intervention owing to the COVID-19 pandemic. Data collection started in 2020 and ended in 2022. In total, 103 dyads were matched at the beginning of the intervention. Of the 103 dyads, 90 (87.4\%) dyads completed the midtest survey and 64 (62.1\%) dyads completed the whole intervention and the posttest survey. Although we are still cleaning and finalizing data analyses, the preliminary results from both quantitative and qualitative data showed promising results of this intergenerational reminiscence approach that benefits both the older adults who have cognitive impairments and the young adult participants. Conclusions: Intergenerational reminiscence provided by young adult college student offers promising benefits for both the younger and older generations. Future studies may consider scaling up this pilot into a trackable, replicable model that includes more participants with diverse background (eg, public vs private college students and older adults from other agencies) to test the effectiveness of this intervention for older adults with ADRD. Trial Registration: ClinicalTrials.gov NCT05984732; https://classic.clinicaltrials.gov/ct2/show/NCT05984732 International Registered Report Identifier (IRRID): DERR1-10.2196/49752 ",
doi="10.2196/49752",
url="https://www.researchprotocols.org/2023/1/e49752",
url="http://www.ncbi.nlm.nih.gov/pubmed/37676706"
}


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


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


@Article{info:doi/10.2196/42561,
author="Meyer, Kylie
and Gonzalez, Alexander
and Benton, Donna",
title="Qualitative Evaluation of Family Caregivers' Experiences Participating in Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER): Web-Based Intervention to Improve Relationship Quality",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="22",
volume="7",
pages="e42561",
keywords="aging",
keywords="Alzheimer's",
keywords="Alzheimer",
keywords="caregiver",
keywords="caregiving",
keywords="dementia: digital health",
keywords="digital intervention",
keywords="family care",
keywords="informal care",
keywords="intervention",
keywords="older adult",
keywords="quality of care",
abstract="Background: The onset of Alzheimer disease and related dementias (AD/ADRD) can alter relationships between family caregivers and persons living with AD/ADRD, such as through the occurrence of distressful behavioral and psychological symptoms of dementia. Poorly perceived relationship quality by caregivers contributes to negative outcomes for both care partners, such as low-quality caregiving and potential mistreatment of older adults. Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER) is a new, web-based, asynchronous psychoeducational intervention with content informed by focus groups with family caregivers. The program was developed to prevent low-quality caregiving and potential mistreatment of older adults by focusing on building healthy caregiving relationships. Objective: The purpose of this study is to describe caregivers' experiences participating in KINDER to understand intervention acceptability. Of particular interest was learning how comfortable caregivers were viewing content addressing potential mistreatment, as well as whether asynchronous delivery created any barriers to participating in the intervention. Findings will inform future program refinements before efficacy testing. Methods: Although 23 caregivers enrolled in the KINDER parent study, only 7 of them completed the 8-week intervention. In-depth, semistructured qualitative interviews were conducted with all participants who completed the program to understand their experiences while attending KINDER and to decipher barriers to participation. We also asked participants about which program elements were most valuable and which were least valuable to them, as well as how the program could be improved. Interview transcripts were analyzed by 2 coders using thematic analysis. Results: Our findings indicate that caregivers were overall satisfied with KINDER's focus and content. Participants particularly liked how KINDER materials felt authentic and relevant to supporting healthy care relationships (Theme 1). The program's multiple components were found to be valuable, especially story-based video vignettes and readings (Theme 2). Most caregivers were comfortable viewing depictions of mistreatment and understood the importance of this content (Theme 3). Notably, while caregivers appreciated the convenience of participating in an asynchronous web-based intervention, several expressed a desire for more opportunities to speak with other caregivers (Theme 4). Technology challenges, such as a lack of clarity about automated intervention activities, deterred completion. Conclusions: Findings from this study suggest an asynchronous web-based intervention covering sensitive topics such as mistreatment is acceptable for at least some AD/ADRD caregivers. Caregivers' comments that materials felt authentic may suggest that the integration of caregiver voices before intervention development enhanced the relevance of content. To make KINDER easier to deliver and participate in, the investigators plan to reduce the use of automation and integrate more group-based programming, as recommended by participants. Further, given the higher-than-expected dropout rate, in future studies, the investigators will collect data to determine the reasons for participants not completing study activities. ",
doi="10.2196/42561",
url="https://formative.jmir.org/2023/1/e42561",
url="http://www.ncbi.nlm.nih.gov/pubmed/37606980"
}


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


@Article{info:doi/10.2196/42469,
author="Wang, Yaping
and Liang, Wannian
and Liu, Min
and Liu, Jue",
title="Association of Catastrophic Health Expenditure With the Risk of Depression in Chinese Adults: Population-Based Cohort Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Aug",
day="15",
volume="9",
pages="e42469",
keywords="catastrophic health expenditure",
keywords="depression",
keywords="universal health coverage",
keywords="economic burden",
keywords="socioeconomic status",
abstract="Background: Depression is one of the most common mental illnesses, and it may have a lasting effect on one's whole life. As a form of financial hardship, catastrophic health expenditure (CHE) may be associated with depression. However, current evidence about the relationship between CHE and the risk of depression is insufficient. Objective: This study aimed to explore the relationship between CHE and the risk of depression among Chinese adults. Methods: In this study, we used 3 waves of the China Family Panel Studies (CFPS) from 2012, 2016, and 2018. The CFPS are a nationally representative study covering 25 of 31 provinces in Chinese mainland and representing nearly 94.5\% of the total population. We selected eligible household heads as participants, divided them into 2 groups by CHE events at baseline (exposed group: with CHE; unexposed group: without CHE), and followed them up. Households with CHE were defined as having out-of-pocket medical expenditures exceeding 40\% of the total household nonfood expenditure, and people with depression were identified by the 8-item Centre for Epidemiological Studies Depression Scale (CES-D). We first described the baseline characteristics and used logistical regression to estimate their effects on CHE events. Then, we used Cox proportional hazard models to estimate adjusted hazard ratios and 95\% CIs of depression among participants with CHE compared with those without CHE. Finally, we analyzed the subgroup difference in the association between CHE and depression. Results: Of a total of 13,315 households, 9629 were eligible for analysis. Among them, 6824 (70.9\%) were men. The mean age was 50.15 (SD 12.84) years. Only 987 (10.3\%) participants had no medical insurance. The prevalence of CHE at baseline was 12.9\% (1393/9629). Participants with a higher family economic level (adjusted odds ratio [aOR] 1.15, 95\% CI 1.02-1.31) and with the highest socioeconomic development level (aOR 1.18, 95\% CI 1.04-1.34) had a higher prevalence of CHE than reference groups. During a median of 71 (IQR 69-72) person-months of follow-up, the depression incidence of participants with CHE (1.41 per 1000 person-months) was higher than those without CHE (0.73 per 1000 person-months). Multivariable models revealed that the adjusted hazard ratio for the incidence of depression in participants with CHE was 1.33 (95\% CI 1.08-1.64), and this association appeared to be greater in participants without outpatient services (for interaction, P=.048). Conclusions: CHE was significantly associated with increased risk of depression among Chinese adults. Concentrated work should be done to monitor CHE, and more efforts to ensure financial protection need to be made to prevent depression, especially for people with high health care needs. ",
doi="10.2196/42469",
url="https://publichealth.jmir.org/2023/1/e42469",
url="http://www.ncbi.nlm.nih.gov/pubmed/37581926"
}


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


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


@Article{info:doi/10.2196/42707,
author="Braz, Rodrigues Patricia
and Moreira, Ricardo Tiago
and Ribeiro, Queiroz Andr{\'e}ia
and de Faria, Ribeiro Luciane
and Carbogim, Costa Fabio da
and P{\"u}schel, Ara{\'u}jo Vilanice Alves de
and Fhon, Silva Jack Roberto
and Freitas, Rezende Eduarda
and Pinto, Carvalho Ione
and Zacharias, Machado Fabiana Costa
and Cruz, Panitz Gylce Eloisa Cabreira
and Machado, Miranda Richardson
and Santana, Ferreira Rosimere
and de Souza, Alfradique Priscilla
and Bitencourt, Ribeiro Graziele
and Bulgarelli, Favero Alexandre
and Cavalcante, Bezerra Ricardo",
title="COVID-19 Infodemic and Impacts on the Mental Health of Older People: Cross-sectional Multicenter Survey Study",
journal="JMIR Aging",
year="2023",
month="May",
day="17",
volume="6",
pages="e42707",
keywords="information dissemination",
keywords="health communication",
keywords="COVID-19",
keywords="COVID-19 pandemic",
keywords="public health",
keywords="health of older people",
keywords="mental health",
abstract="Background: The COVID-19 pandemic received widespread media coverage due to its novelty, an early lack of data, and the rapid rise in deaths and cases. This excessive coverage created a secondary ``infodemic'' that was considered to be a serious public and mental health problem by the World Health Organization and the international scientific community. The infodemic particularly affected older individuals, specifically those who are vulnerable to misinformation due to political positions, low interpretive and critical analysis capacity, and limited technical-scientific knowledge. Thus, it is important to understand older people's reaction to COVID-19 information disseminated by the media and the effect on their lives and mental health. Objective: We aimed to describe the profile of exposure to COVID-19 information among older Brazilian individuals and the impact on their mental health, perceived stress, and the presence of generalized anxiety disorder (GAD). Methods: This cross-sectional, exploratory study surveyed 3307 older Brazilians via the web, social networks, and email between July 2020 and March 2021. Descriptive analysis and bivariate analysis were performed to estimate associations of interest. Results: Major proportions of the 3307 participants were aged 60 to 64 years (n=1285, 38.9\%), female (n=2250, 68.4\%), and married (n=1835, 55.5\%) and self-identified as White (n=2364, 71.5\%). Only 295 (8.9\%) had never started or completed a basic education. COVID-19 information was mainly accessed on television (n=2680, 81.1\%) and social networks (n=1943, 58.8\%). Television exposure was ?3 hours in 1301 (39.3\%) participants, social network use was 2 to 5 hours in 1084 (32.8\%) participants, and radio exposure was ?1 hour in 1223 (37\%) participants. Frequency of exposure to social networks was significantly associated with perceived stress (P=.04) and GAD (P=.01). A Bonferroni post hoc test revealed significantly different perceived stress in participants who were exposed to social networks for 1 hour (P=.04) and those who had no exposure (P=.04). A crude linear regression showed that ``some'' social media use (P=.02) and 1 hour of exposure to social media (P<.001) were associated with perceived stress. Adjusting for sociodemographic variables revealed no associations with this outcome variable. In a crude logistic regression, some social media use (P<.001) and 2 to 5 hours of exposure to social media (P=.03) were associated with GAD. Adjusting for the indicated variables showed that some social network use (P<.001) and 1 hour (P=.04) and 2 to 5 hours (P=.03) of exposure to social media were associated with GAD. Conclusions: Older people, especially women, were often exposed to COVID-19--related information through television and social networks; this affected their mental health, specifically GAD and stress. Thus, the impact of the infodemic should be considered during anamnesis for older people, so that they can share their feelings about it and receive appropriate psychosocial care. ",
doi="10.2196/42707",
url="https://aging.jmir.org/2023/1/e42707",
url="http://www.ncbi.nlm.nih.gov/pubmed/37195762"
}


@Article{info:doi/10.2196/39848,
author="Phang, Kie Jie
and Kwan, Heng Yu
and Yoon, Sungwon
and Goh, Hendra
and Yee, Qi Wan
and Tan, Seng Chuen
and Low, Leng Lian",
title="Digital Intergenerational Program to Reduce Loneliness and Social Isolation Among Older Adults: Realist Review",
journal="JMIR Aging",
year="2023",
month="Jan",
day="4",
volume="6",
pages="e39848",
keywords="aged",
keywords="loneliness",
keywords="older people",
keywords="review",
keywords="social isolation",
abstract="Background: There is a compelling need for an innovative and creative approach to promote social connectedness among older adults to optimize their well-being and quality of life. One possible solution may be through a digital intergenerational program. Objective: This realist review aimed to identify existing digital intergenerational programs that were used to reduce loneliness or social isolation among older adults and analyze them in terms of strategy, context, mechanisms, and outcomes. Methods: We performed a realist review with an extensive search of published and gray literature. For scholarly literature, we searched PubMed, Embase, CINAHL, PsycINFO (Ovid), and Social Sciences Citation Index databases for articles published between January 2000 to August 2020. A grey literature search was performed using the Google search engine, and the search was completed in May 2021. We included programs that evaluated digital intergenerational programs for older adults, which described outcomes of loneliness or social isolation. We included quantitative, mixed methods, and qualitative studies, as well as relevant theoretical papers, policy documents, and implementation documents. The studies were appraised based on their relevance and rigor. We synthesized the available evidence from the literature into Strategy-Context-Mechanism-Outcome (S-C-M-O) configurations to better understand what, when, and how programs work. Results: A total of 31 documents reporting 27 digital intergenerational programs were reviewed. Our final results identified 4 S-C-M-O configurations. For S-C-M-O configuration 1, we found that for community-dwelling older adults, provision of access to and training in digital technology may increase older adults' self-efficacy in digital devices and therefore increase the use of digital communication with family. In S-C-M-O configuration 2, digital psychosocial support and educational interventions from nurses were found to be useful in reducing loneliness among community-dwelling older adults. In S-C-M-O configuration 3, a video call with a student or family was found to reduce loneliness among older adults residing in long-term residential care facilities. Finally, for S-C-M-O configuration 4, we found that behavioral activation provided through videoconferencing by a lay coach may be useful in reducing loneliness among older adults who are lonely. However, as almost half (11/27, 41\%) of the included programs only reported quantitative results, this review focused on screening the discussion section of publications to identify author opinions or any qualitative information to elucidate the mechanisms of how programs work. Conclusions: This review identified the key strategy, context, and mechanism influencing the success of programs that promote intergenerational interaction through digital means. This review revealed that different strategies should be adopted for different groups of older adults (eg, older adults who are lonely, older adults who reside in long-term residential care facilities, and community-dwelling older adults). The S-C-M-O configurations should be considered when designing and implementing digital intergenerational programs for older adults. ",
doi="10.2196/39848",
url="https://aging.jmir.org/2023/1/e39848",
url="http://www.ncbi.nlm.nih.gov/pubmed/36598801"
}


@Article{info:doi/10.2196/39314,
author="Wang, Qiong
and Zhang, Shimin
and Wang, Yi
and Zhao, Dan
and Zhou, Chengchao",
title="Dual Sensory Impairment as a Predictor of Loneliness and Isolation in Older Adults: National Cohort Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Nov",
day="14",
volume="8",
number="11",
pages="e39314",
keywords="loneliness",
keywords="social isolation",
keywords="dual sensory impairment",
keywords="vision impairment",
keywords="hearing impairment",
keywords="mental health",
abstract="Background: Loneliness and social isolation are global public health challenges. Sensory impairments (SIs) are highly prevalent among older adults but are often ignored as a part of normal aging. Identifying the role of SIs in loneliness and social isolation could provide insight into strategies for improving public health among older adults. Objective: This study aims to analyze the effects of SIs on loneliness and social isolation among older adults in rural and urban China. Methods: This cohort study of 3069 older adults (aged 60+) used data from 4 waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of adults aged 45 years or older. SIs include hearing impairment (HI), vision impairment (VI), and dual sensory impairment (DSI). DSI is defined as the co-occurrence of VI and HI. Participants with complete data on hearing, vision, social isolation, and loneliness were included in the analysis. Generalized estimating equation models adjusted for covariates were used to examine the relationships of DSI with loneliness and social isolation among older adults. Results: Older adults in rural areas have higher prevalence of DSI, loneliness, and social isolation than their urban counterparts. In rural areas, participants with VI only (odds ratio [OR] 1.34, 95\% CI 1.12-1.62; P=.002), HI only (OR 1.32, 95\% CI 1.02-1.71; P=.03), and DSI (OR 1.84, 95\% CI 1.56-2.18; P<.001) were more likely to experience loneliness compared with participants without SIs. DSI showed a statistically significant association with loneliness compared with VI only (OR 1.37, 95\% CI 1.22-1.54; P<.001) and HI only (OR 1.39, 95\% CI 1.13-1.72; P=.002). In urban areas, participants with VI only (OR 2.44, 95\% CI 1.57-3.80; P<.001), HI only (OR 2.47, 95\% CI 1.41-4.32; P=.002), and DSI (OR 1.88, 95\% CI 1.24-2.85; P=.003) were more likely to experience loneliness compared with participants without SIs. DSI was not associated with the increased likelihood of loneliness compared with HI only or VI only. SIs were not associated with social isolation among older adults in urban and rural areas. Until 2018, 86.97\% (2669/3069) reported VI, but only 27.11\% (832/3069) and 9.45\% (290/3069) were treated with glasses and cataract surgery, respectively; besides, 75 individuals received both glasses and cataract surgery treatment. The prevalence of HI was 74.39\% (2283/3069) in 2018, but only 0.72\% (22/3069) were treated with a hearing aid. Conclusions: SIs are associated with an increased risk of loneliness rather than social isolation. A compounded risk of DSI on loneliness exists in rural areas rather than in urban areas. These findings expand our knowledge about the effects of SIs on loneliness and social isolation in non-Western populations. Interventions targeting HI only and DSI might be particularly effective for mitigating loneliness of older adults in urban and rural areas, respectively. Considering the high prevalence and low treatment rate of SIs, measures should be taken to make treatment more accessible. ",
doi="10.2196/39314",
url="https://publichealth.jmir.org/2022/11/e39314",
url="http://www.ncbi.nlm.nih.gov/pubmed/36374533"
}


@Article{info:doi/10.2196/40125,
author="Balki, Eric
and Hayes, Niall
and Holland, Carol",
title="Effectiveness of Technology Interventions in Addressing Social Isolation, Connectedness, and Loneliness in Older Adults: Systematic Umbrella Review",
journal="JMIR Aging",
year="2022",
month="Oct",
day="24",
volume="5",
number="4",
pages="e40125",
keywords="information and communications technology",
keywords="interventions",
keywords="loneliness",
keywords="older adults",
keywords="social connectedness",
keywords="social isolation",
keywords="technology interventions",
abstract="Background: The global population of older adults (aged >60 years) is expected to triple to 2 billion by 2050. Proportionate rises in older adults affected by loneliness and social isolation (or social connectedness) are expected. Rapid deployability and social changes have increased the availability of technological devices, creating new opportunities for older adults. Objective: This study aimed to identify, synthesize, and critically appraise the effectiveness of technology interventions improving social connectedness in older adults by assessing the quality of reviews, common observations, and derivable themes. Methods: Following the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), 4 databases (PsycINFO, PubMed, Embase, and MEDLINE) were searched between February 2020 and March 2022. We identified reviews with adults aged ?50 years in community and residential settings, reporting outcomes related to the impact of technologies on social disconnectedness with inclusion criteria based on the population, intervention, context, outcomes, and study schema---review-type articles (systematic, meta-analyses, integrative, and scoping)---and with digital interventions included. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to measure the strength of outcome recommendations including the risk of bias. The reviews covered 326 primary studies with 79,538 participants. Findings were extracted, synthesized, and organized according to emerging themes. Results: Overall, 972 publications met the initial search criteria, and 24 met our inclusion criteria. Revised Assessment of Multiple Systematic Reviews was used to assess the quality of the analysis. Eligible reviews (3/24, 12\%) were excluded because of their low Revised Assessment of Multiple Systematic Reviews scores (<22). The included reviews were dedicated to information and communications technology (ICT; 11/24, 46\%), videoconferencing (4/24, 17\%), computer or internet training (3/24, 12\%), telecare (2/24, 8\%), social networking sites (2/24, 8\%), and robotics (2/27, 8\%). Although technology was found to improve social connectedness, its effectiveness depended on study design and is improved by shorter durations, longer training times, and the facilitation of existing relationships. ICT and videoconferencing showed the best results, followed by computer training. Social networking sites achieved mixed results. Robotics and augmented reality showed promising results but lacked sufficient data for informed conclusions. The overall quality of the studies based on GRADE was medium low to very low. Conclusions: Technology interventions can improve social connectedness in older adults. The specific effectiveness rates favor ICT and videoconferencing, but with limited evidence, as indicated by low GRADE ratings. Future intervention and study design guidelines should carefully assess the methodological quality of studies and the overall certainty of specific outcome measures. The lack of randomized controlled trials in underlying primary studies (<28\%) and suboptimal methodologies limited our findings. Robotics and augmented or virtual reality warrant further research. Low GRADE scores highlight the need for high-quality research in these areas. Trial Registration: PROSPERO CRD42022363475; https://tinyurl.com/mdd6zds ",
doi="10.2196/40125",
url="https://aging.jmir.org/2022/4/e40125",
url="http://www.ncbi.nlm.nih.gov/pubmed/36279155"
}


@Article{info:doi/10.2196/41255,
author="Granbom, Marianne
and J{\"o}nson, H{\aa}kan
and Kottorp, Anders",
title="Older Adults Living in Disadvantaged Areas: Protocol for a Mixed Methods Baseline Study on Homes, Quality of Life, and Participation in Transitioning Neighborhoods",
journal="JMIR Res Protoc",
year="2022",
month="Oct",
day="12",
volume="11",
number="10",
pages="e41255",
keywords="aging",
keywords="housing",
keywords="neighborhood",
keywords="quality of life",
keywords="participation",
keywords="rural areas",
keywords="disadvantaged areas",
keywords="aging-in-place",
keywords="relocation",
keywords="socioeconomic status",
keywords="older adults",
keywords="elderly",
keywords="mental health",
keywords="physical health",
keywords="social participation",
keywords="health dynamics",
abstract="Background: Swedish policy states that older adults should be able to age safely with continued independence and lead active lives. However, this plays out differently in different Swedish municipalities depending upon degree of demographic change, globalization, and urbanization. Internationally, older adults living in disadvantaged areas have worse physical and mental health, activity restrictions, and reduced life expectancy. In Sweden, research on how disadvantaged areas impact older adults' quality of life is virtually nonexistent. We argue that disadvantaged areas exist in both urban and rural contexts. Objective: We aimed to investigate how older adults' homes and neighborhoods influence their community participation, quality of life, identity, and belonging in urban and rural disadvantaged areas in Sweden, and how these person--context dynamics are experienced by older adults in transitioning neighborhoods. Methods: The study has a mixed methods design and includes 3 phases. Adults 65 years and older living in certain urban and rural disadvantaged areas in the south of Sweden will be included. Phase 1 is an interview study in which qualitative data are collected on neighborhood attachment, identity, and belonging through semistructured interviews and photo-elicitation interviews with 40 subjects. A variety of qualitative data analysis procedures are used. In phase 2, a survey study will be conducted to explore associations between observable and self-rated aspects of housing and neighborhood (physical, social, and emotional), participation, and quality of life; 400 subjects will be recruited and added to the 40 phase-1 subjects for a total of 440. The survey will include standardized measures and study-specific questions. Survey data will be analyzed with mainstream statistical analyses and structural equation modeling to understand the interactions between quality of life, home and neighborhood factors, and sociodemographic factors. In phase 3, the integration study, survey data from the 40 participants who participated in both data collections will be analyzed together with qualitative data with a mixed methods analysis approach. Results: As of the submission of this protocol (August 2022), recruitment for the interview study is complete (N=39), and 267 participants have been recruited and have completed data collection in the survey study. We expect recruitment and data collection to be finalized by December 2022. Conclusions: With an increasing proportion of older adults, an increasing number of disadvantaged areas, and an increasing dependency ratio in more than 50\% of Swedish municipalities, these municipalities are transforming and becoming increasingly segregated. This study will add unique knowledge on what it is like to be older in a disadvantaged area and deepen knowledge on housing and health dynamics in later life. Further, the design of the current study will allow future follow-up studies to facilitate longitudinal analysis (if funding is granted) on aging in a transforming societal context. International Registered Report Identifier (IRRID): DERR1-10.2196/41255 ",
doi="10.2196/41255",
url="https://www.researchprotocols.org/2022/10/e41255",
url="http://www.ncbi.nlm.nih.gov/pubmed/36222809"
}


@Article{info:doi/10.2196/38067,
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/10.2196/33460,
author="Soroski, Thomas
and da Cunha Vasco, Thiago
and Newton-Mason, Sally
and Granby, Saffrin
and Lewis, Caitlin
and Harisinghani, Anuj
and Rizzo, Matteo
and Conati, Cristina
and Murray, Gabriel
and Carenini, Giuseppe
and Field, S. Thalia
and Jang, Hyeju",
title="Evaluating Web-Based Automatic Transcription for Alzheimer Speech Data: Transcript Comparison and Machine Learning Analysis",
journal="JMIR Aging",
year="2022",
month="Sep",
day="21",
volume="5",
number="3",
pages="e33460",
keywords="Alzheimer disease",
keywords="mild cognitive impairment",
keywords="speech",
keywords="natural language processing",
keywords="speech recognition software",
keywords="machine learning",
keywords="neurodegenerative disease",
keywords="transcription software",
keywords="memory",
abstract="Background: Speech data for medical research can be collected noninvasively and in large volumes. Speech analysis has shown promise in diagnosing neurodegenerative disease. To effectively leverage speech data, transcription is important, as there is valuable information contained in lexical content. Manual transcription, while highly accurate, limits the potential scalability and cost savings associated with language-based screening. Objective: To better understand the use of automatic transcription for classification of neurodegenerative disease, namely, Alzheimer disease (AD), mild cognitive impairment (MCI), or subjective memory complaints (SMC) versus healthy controls, we compared automatically generated transcripts against transcripts that went through manual correction. Methods: We recruited individuals from a memory clinic (``patients'') with a diagnosis of mild-to-moderate AD, (n=44, 30\%), MCI (n=20, 13\%), SMC (n=8, 5\%), as well as healthy controls (n=77, 52\%) living in the community. Participants were asked to describe a standardized picture, read a paragraph, and recall a pleasant life experience. We compared transcripts generated using Google speech-to-text software to manually verified transcripts by examining transcription confidence scores, transcription error rates, and machine learning classification accuracy. For the classification tasks, logistic regression, Gaussian naive Bayes, and random forests were used. Results: The transcription software showed higher confidence scores (P<.001) and lower error rates (P>.05) for speech from healthy controls compared with patients. Classification models using human-verified transcripts significantly (P<.001) outperformed automatically generated transcript models for both spontaneous speech tasks. This comparison showed no difference in the reading task. Manually adding pauses to transcripts had no impact on classification performance. However, manually correcting both spontaneous speech tasks led to significantly higher performances in the machine learning models. Conclusions: We found that automatically transcribed speech data could be used to distinguish patients with a diagnosis of AD, MCI, or SMC from controls. We recommend a human verification step to improve the performance of automatic transcripts, especially for spontaneous tasks. Moreover, human verification can focus on correcting errors and adding punctuation to transcripts. However, manual addition of pauses is not needed, which can simplify the human verification step to more efficiently process large volumes of speech data. ",
doi="10.2196/33460",
url="https://aging.jmir.org/2022/3/e33460",
url="http://www.ncbi.nlm.nih.gov/pubmed/36129754"
}


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


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


@Article{info:doi/10.2196/36269,
author="Beogo, Idrissa
and Sia, Drissa
and Tchouaket Nguemeleu, Eric
and Zhao, Junqiang
and Gagnon, Marie-Pierre
and Etowa, Josephine",
title="Strengthening Social Capital to Address Isolation and Loneliness in Long-term Care Facilities During the COVID-19 Pandemic: Protocol for a Systematic Review of Research on Information and Communication Technologies",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="24",
volume="11",
number="3",
pages="e36269",
keywords="ICT, long-term care facilities, COVID-19, social isolation, loneliness, pandemic, implementation sciences, protocol",
keywords="nursing home",
keywords="long-term care",
keywords="mental health",
keywords="aging",
keywords="older adults",
keywords="virtual communication",
keywords="virtual care",
keywords="information technology",
keywords="healthcare",
keywords="healthcare sector",
keywords="health care",
abstract="Background: The COVID-19 pandemic has had the greatest impact in long-term care facilities (LTCFs) by disproportionately harming older adults and heightening social isolation and loneliness (SIL). Living in close quarters with others and in need of around-the-clock assistance, interactions with older adults, which were previously in person, have been replaced by virtual chatting using information and communication technologies (ICTs). ICT applications such as FaceTime, Zoom, and Microsoft Teams video chatting have been overwhelmingly used by families to maintain residents' social capital and subsequently reduce their SIL. Objective: Because of the lack of substantive knowledge on this ever-increasing form of social communication, this systematic review intends to synthesize the effects of ICT interventions to address SIL among residents in LTCFs during the COVID-19 period. Methods: We will include studies published in Chinese, English, and French from December 2019 onwards. Beyond the traditional search strategy approach, 4 of the 12 electronic databases to be queried will be in Chinese. We will include quantitative and intervention studies as well as qualitative and mixed methods designs. Using a 2-person approach, the principal investigator and one author will blindly screen eligible articles, extract data, and assess risk of bias. In order to improve the first round of screening, a pilot-tested algorithm will be used. Disagreements will be resolved through discussion with a third author. Results will be presented as structured summaries of the included studies. We plan to conduct a meta-analysis if sufficient data are available. Results: A total of 1803 articles have been retrieved to date. Queries of the Chinese databases are ongoing. The systematic review and subsequent manuscript will be completed by the fall of 2022. Conclusions: ICT applications have become a promising avenue to reduce SIL by providing a way to maintain communication between LTCF residents and their families and will certainly remain in the post--COVID-19 period. This review will investigate and describe context-pertinent and high-quality programs and initiatives to inform, at the macro level, policy makers and researchers, frontline managers, and families. These methods will remain relevant in the post--COVID-19 era. International Registered Report Identifier (IRRID): DERR1-10.2196/36269 ",
doi="10.2196/36269",
url="https://www.researchprotocols.org/2022/3/e36269",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275841"
}


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


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


@Article{info:doi/10.2196/20466,
author="Silva, Patr{\'i}cia
and Delerue Matos, Alice
and Martinez-Pecino, Roberto",
title="The Contribution of the Internet to Reducing Social Isolation in Individuals Aged 50 Years and Older: Quantitative Study of Data From the Survey of Health, Ageing and Retirement in Europe",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="3",
volume="24",
number="1",
pages="e20466",
keywords="social isolation",
keywords="internet",
keywords="50+ individuals",
keywords="e-inclusion",
keywords="SHARE",
abstract="Background: Social isolation has a negative impact on the quality of life of older people; therefore, studies have focused on identifying its sociodemographic, economic, and health determinants. In view of the growing importance of the internet as a means of communication, it is essential to assess whether internet use interferes with social isolation. Objective: This study specifically aims to clarify the relationship between internet use and social isolation of individuals aged ?50 years, for which other surveys present contradictory results. Methods: We performed logistic regression analysis with social isolation as the dependent variable, internet use as the interest variable, and several other sociodemographic, economic, and health characteristics of the individuals as control variables. The sample size was 67,173 individuals aged 50 years and older from 17 European countries (Portugal, Greece, Italy, Spain, Denmark, Sweden, Austria, Belgium, France, Germany, Switzerland, Luxemburg, Poland, Czech Republic, Slovenia, Estonia, and Croatia) plus Israel, who were interviewed in the Survey of Health, Ageing and Retirement in Europe (SHARE), wave 6. Results: The results show that countries differ in the level of social isolation and rate of internet use by individuals aged 50 years and older. They also evidence that in most of the countries analyzed, social isolation of internet users was lower compared to that of nonusers after controlling for a set of sociodemographic, economic, and health characteristics of the individuals that have been previously described in the literature as determinants of social isolation. Indeed, on average, although 31.4\% of individuals in the nonuser group experienced high social isolation, only 12.9\% of individuals who used the internet experienced this condition. Conclusions: Internet users show lower social isolation. This result underlines the importance of promoting e-inclusion in Europe as a way to counter social isolation of individuals aged 50 years and older. ",
doi="10.2196/20466",
url="https://www.jmir.org/2022/1/e20466",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982040"
}


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


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


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


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


@Article{info:doi/10.2196/31586,
author="Loveys, Kate
and Sagar, Mark
and Pickering, Isabella
and Broadbent, Elizabeth",
title="A Digital Human for Delivering a Remote Loneliness and Stress Intervention to At-Risk Younger and Older Adults During the COVID-19 Pandemic: Randomized Pilot Trial",
journal="JMIR Ment Health",
year="2021",
month="Nov",
day="8",
volume="8",
number="11",
pages="e31586",
keywords="COVID-19",
keywords="loneliness",
keywords="stress",
keywords="well-being",
keywords="eHealth",
keywords="digital human",
keywords="conversational agent",
keywords="older adults",
keywords="chronic illness",
abstract="Background: Loneliness is a growing public health issue that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Computer agents are capable of delivering psychological therapies through the internet; however, there is limited research on their acceptability to date. Objective: The objectives of this study were to evaluate (1) the feasibility and acceptability of a remote loneliness and stress intervention with digital human delivery to at-risk adults and (2) the feasibility of the study methods in preparation for a randomized controlled trial. Methods: A parallel randomized pilot trial with a mixed design was conducted. Participants were adults aged 18 to 69 years with an underlying medical condition or aged 70 years or older with a Mini-Mental State Examination score of >24 (ie, at greater risk of developing severe COVID-19). Participants took part from their place of residence (independent living retirement village, 20; community dwelling, 7; nursing home, 3). Participants were randomly allocated to the intervention or waitlist control group that received the intervention 1 week later. The intervention involved completing cognitive behavioral and positive psychology exercises with a digital human facilitator on a website for at least 15 minutes per day over 1 week. The exercises targeted loneliness, stress, and psychological well-being. Feasibility was evaluated using dropout rates and behavioral observation data. Acceptability was evaluated from behavioral engagement data, the Friendship Questionnaire (adapted), self-report items, and qualitative questions. Psychological measures were administered to evaluate the feasibility of the trial methods and included the UCLA Loneliness Scale, the 4-item Perceived Stress Scale, a 1-item COVID-19 distress measure, the Flourishing Scale, and the Scale of Positive and Negative Experiences. Results: The study recruited 30 participants (15 per group). Participants were 22 older adults and 8 younger adults with a health condition. Six participants dropped out of the study. Thus, the data of 24 participants were analyzed (intervention group, 12; waitlist group, 12). The digital human intervention and trial methods were generally found to be feasible and acceptable in younger and older adults living independently, based on intervention completion, and behavioral, qualitative, and some self-report data. The intervention and trial methods were less feasible to nursing home residents who required caregiver assistance. Acceptability could be improved with additional content, tailoring to the population, and changes to the digital human's design. Conclusions: Digital humans are a promising and novel technological solution for providing at-risk adults with access to remote psychological support during the COVID-19 pandemic. Research should further examine design techniques to improve their acceptability in this application and investigate intervention effectiveness in a randomized controlled trial. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12620000786998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380113 ",
doi="10.2196/31586",
url="https://mental.jmir.org/2021/11/e31586",
url="http://www.ncbi.nlm.nih.gov/pubmed/34596572"
}


@Article{info:doi/10.2196/29953,
author="Luo, Yan",
title="The Association of Delayed Care With Depression Among US Middle-Aged and Older Adults During the COVID-19 Pandemic: Cross-sectional Analysis",
journal="JMIR Aging",
year="2021",
month="Oct",
day="5",
volume="4",
number="4",
pages="e29953",
keywords="depression",
keywords="COVID-19",
keywords="delayed care",
keywords="middle-aged adults",
keywords="older adults",
abstract="Background: During the COVID-19 pandemic, the depression level among US adults has significantly increased. Age disparity in depression during the pandemic has been reported in recent studies. Delay or avoidance of medical care is one of the collateral damages associated with the COVID-19 pandemic, and it can lead to increased morbidity and mortality. Objective: This study aimed to assess the prevalence of depression and delayed care among US middle-aged adults and older adults during the pandemic, as well as investigate the association of delayed care with depression among those 2 age groups. Methods: This cross-sectional study used data from the 2020 Health and Retirement Study (HRS) COVID-19 Project (Early, Version 1.0). Univariate analyses, bivariate analyses, and binary logistic regression were applied. US adults older than 46 years were included. Depression was measured by the Composite International Diagnostic Interview-Short Form (CIDI-SF). Delayed care was measured by the following 4 items: delayed surgery, delayed seeing a doctor, delayed dental care, and other delayed care. Results: A total of 3246 participants were identified. More than half of the participants were older than 65 years (n=1890, 58.2\%), and 274 (8.8\%) participants had depression during the pandemic. Delayed dental care was positively associated with depression among both middle-aged adults (OR 2.05, 95\% CI 1.04-4.03; P=.04) and older adults (OR 3.08, 95\% CI 1.07-8.87; P=.04). Delayed surgery was positively associated with depression among older adults (OR 3.69, 95\% CI 1.06-12.90; P=.04). Self-reported pain was positively related to depression among both age groups. Middle-aged adults who reported higher education levels (some college or above) or worse self-reported health had a higher likelihood of having depression. While perceived more loneliness was positively associated with depression among older adults, financial difficulty was positively associated with depression among middle-aged adults. Conclusions: This study found that depression was prevalent among middle-aged and older adults during the pandemic. The study highlighted the collateral damage of the COVID-19 pandemic by identifying the association of delayed surgery and dental care with depression during the pandemic. Although surgery and dental care cannot be delivered by telehealth, telehealth services can still be provided to address patients' concerns on delayed surgery and dental care. Moreover, the implementation of telemental health services is needed to address mental health symptoms among US middle-aged and older adults during the pandemic. Future research that uses more comprehensive measurements for delayed care is needed to decipher the path through which delayed care is associated with depression. ",
doi="10.2196/29953",
url="https://aging.jmir.org/2021/4/e29953",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524964"
}


@Article{info:doi/10.2196/24665,
author="Lapierre, Nolwenn
and Um Din, Nathavy
and Igout, Manuella
and Chevrier, Jo{\"e}l
and Belmin, Jo{\"e}l",
title="Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="26",
volume="10",
number="8",
pages="e24665",
keywords="older adult",
keywords="fall",
keywords="fear of falling",
keywords="exergame",
keywords="randomized controlled trial",
keywords="psychomotor therapy",
keywords="rehabilitation",
keywords="fear",
keywords="risk",
keywords="elderly",
keywords="protocol",
keywords="therapy",
abstract="Background: Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. Objective: This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. Methods: This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. Results: The protocol (2019-11-22) has been approved by the Comit{\'e} de Protection des Personnes Nord-Ouest I--Universit{\'e} de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. Conclusions: The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. Trial Registration: ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988 International Registered Report Identifier (IRRID): DERR1-10.2196/24665 ",
doi="10.2196/24665",
url="https://www.researchprotocols.org/2021/8/e24665",
url="http://www.ncbi.nlm.nih.gov/pubmed/34435968"
}


@Article{info:doi/10.2196/29031,
author="Verloo, Henk
and Lorette, Adrien
and Rosselet Amoussou, Jo{\"e}lle
and Gill{\`e}s de P{\'e}lichy, Estelle
and Matos Queir{\'o}s, Alcina
and von Gunten, Armin
and Perruchoud, Elodie",
title="Using Living Labs to Explore Needs and Solutions for Older Adults With Dementia: Scoping Review",
journal="JMIR Aging",
year="2021",
month="Aug",
day="19",
volume="4",
number="3",
pages="e29031",
keywords="living lab",
keywords="aged",
keywords="dementia",
keywords="cognitive dysfunction",
keywords="long-term care",
keywords="primary health care",
keywords="technology",
keywords="mobile phone",
abstract="Background: Numerous living labs have established a new approach for studying the health, independent living, and well-being of older adults with dementia. Living labs interact with a broad set of stakeholders, including students, academic institutions, private companies, health care organizations, and patient representative bodies and even with other living labs. Hence, it is crucial to identify the types of cocreations that should be attempted and how they can be facilitated through living labs. Objective: This study aims to scope publications that examine all types of living lab activities, exploring the needs and expectations of older adults with dementia and seeking solutions, whether they live in the community or long-term health care facilities (LTHFs). Methods: This scoping review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations for the extension of scoping reviews. We searched six bibliographic databases for publications up to March 2020, and a forward-backward citation chasing was performed. Additional searches were conducted using Google Scholar. The quality of the selected papers was assessed. Results: Of the 5609 articles identified, we read 58 (1.03\%) articles and retained 12 (0.21\%) articles for inclusion and final analysis. All 12 articles presented an innovative product, developed in 4 main living labs, to assist older adults with cognitive disorders or dementia living in the community or LTHFs. The objectives of these studies were to optimize health, quality of life, independent living, home care, and safety of older adults with cognitive disorders or dementia, as well as to support professional and family caregivers or reduce their burdens. The overall methodological quality of the studies ranged from poor to moderate. Conclusions: This scoping review identified several living labs playing a pivotal role in research aimed at older adults with dementia living in the community or LTHFs. However, it also revealed that living labs should conduct more better-quality interventional research to prove the effectiveness of their technological products or service solutions. International Registered Report Identifier (IRRID): RR2-10.2147/SHTT.S233130 ",
doi="10.2196/29031",
url="https://aging.jmir.org/2021/3/e29031",
url="http://www.ncbi.nlm.nih.gov/pubmed/34420916"
}


@Article{info:doi/10.2196/27047,
author="Tiersen, Federico
and Batey, Philippa
and Harrison, C. Matthew J.
and Naar, Lenny
and Serban, Alina-Irina
and Daniels, C. Sarah J.
and Calvo, A. Rafael",
title="Smart Home Sensing and Monitoring in Households With Dementia: User-Centered Design Approach",
journal="JMIR Aging",
year="2021",
month="Aug",
day="11",
volume="4",
number="3",
pages="e27047",
keywords="assistive technology",
keywords="independent living",
keywords="internet of things",
keywords="remote monitoring",
keywords="dementia",
keywords="human centered design",
keywords="user-centered design",
keywords="patient-centered care",
keywords="smart home",
keywords="digital health",
abstract="Background: As life expectancy grows, so do the challenges of caring for an aging population. Older adults, including people with dementia, want to live independently and feel in control of their lives for as long as possible. Assistive technologies powered by artificial intelligence and internet of things devices are being proposed to provide living environments that support the users' safety, psychological, and medical needs through remote monitoring and interventions. Objective: This study investigates the functional, psychosocial, and environmental needs of people living with dementia, their caregivers, clinicians, and health and social care service providers toward the design and implementation of smart home systems. Methods: We used an iterative user-centered design approach comprising 9 substudies. First, semistructured interviews (9 people with dementia, 9 caregivers, and 10 academic and clinical staff) and workshops (35 pairs of people with dementia and caregivers, and 12 health and social care clinicians) were conducted to define the needs of people with dementia, home caregivers, and professional stakeholders in both daily activities and technology-specific interactions. Then, the spectrum of needs identified was represented via patient--caregiver personas and discussed with stakeholders in a workshop (14 occupational therapists; 4 National Health Service pathway directors; and 6 researchers in occupational therapy, neuropsychiatry, and engineering) and 2 focus groups with managers of health care services (n=8), eliciting opportunities for innovative care technologies and public health strategies. Finally, these design opportunities were discussed in semistructured interviews with participants of a smart home trial involving environmental sensors, physiological measurement devices, smartwatches, and tablet-based chatbots and cognitive assessment puzzles (10 caregivers and 2 people with dementia). A thematic analysis revealed factors that motivate household members to use these technologies. Results: Outcomes of these activities include a qualitative and quantitative analysis of patient, caregiver, and clinician needs and the identification of challenges and opportunities for the design and implementation of remote monitoring systems in public health pathways. Conclusions: Participatory design methods supported the triangulation of stakeholder perspectives to aid the development of more patient-centered interventions and their translation to clinical practice and public health strategy. We discuss the implications and limitations of our findings, the value and the applicability of our methodology, and directions for future research. ",
doi="10.2196/27047",
url="https://aging.jmir.org/2021/3/e27047",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383672"
}


@Article{info:doi/10.2196/29021,
author="Niculescu, Iulia
and Quirt, Hannah
and Arora, Twinkle
and Borsook, Terry
and Green, Robin
and Ford, Brett
and Iaboni, Andrea",
title="Ecological Momentary Assessment of Depression in People With Advanced Dementia: Longitudinal Pilot Study",
journal="JMIR Aging",
year="2021",
month="Aug",
day="4",
volume="4",
number="3",
pages="e29021",
keywords="dementia",
keywords="depression",
keywords="ecological momentary assessment",
keywords="tool performance",
abstract="Background: Barriers to assessing depression in advanced dementia include the presence of informant and patient recall biases. Ecological momentary assessment provides an improved approach for mood assessment by collecting observations in intervals throughout the day, decreasing recall bias, and increasing ecological validity. Objective: This study aims to evaluate the feasibility, reliability, and validity of the modified 4-item Cornell Scale for Depression in Dementia for Momentary Assessment (mCSDD4-MA) tool to assess depression in patients with advanced dementia. Methods: A intensive longitudinal pilot study design was used. A total of 12 participants with advanced dementia were enrolled from an inpatient psychogeriatric unit. Participants were assessed using clinical depression assessments at admission and discharge. Research staff recorded observations four times a day for 6 weeks on phones with access to the mCSDD4-MA tool. Descriptive data related to feasibility were reported (ie, completion rates). Statistical models were used to examine the interrater reliability and construct and predictive validity of the data. Results: Overall, 1923 observations were completed, representing 55.06\% (1923/3496) of all rating opportunities with 2 raters and 66.01\% (1923/2913) with at least one rater. Moderate interrater reliability was demonstrated for all items, except for lack of interest. Moderate correlations were observed between observers and patient-reported outcomes, where observers reported fewer symptoms relative to participants' self-reports. Several items were associated with and able to predict depression. Conclusions: The mCSDD4-MA tool was feasible to use, and most items in the tool showed moderate reliability and validity for assessing depression in dementia. Repeated and real-time depression assessment in advanced dementia holds promise for the identification of clinical depression and depressive symptoms. ",
doi="10.2196/29021",
url="https://aging.jmir.org/2021/3/e29021",
url="http://www.ncbi.nlm.nih.gov/pubmed/34346884"
}


@Article{info:doi/10.2196/25876,
author="Rosenblum, Sara
and Cohen Elimelech, Ortal",
title="Gender Differences in State Anxiety Related to Daily Function Among Older Adults During the COVID-19 Pandemic: Questionnaire Study",
journal="JMIR Aging",
year="2021",
month="Jun",
day="3",
volume="4",
number="2",
pages="e25876",
keywords="COVID-19",
keywords="coronavirus",
keywords="anxiety",
keywords="cognition",
keywords="aging",
keywords="eHealth",
keywords="online data",
abstract="Background: The COVID-19 pandemic poses a challenge to people's day-to-day functioning and emotional and physical health, especially among older adults. Objective: The aim of this study is to analyze gender differences in state anxiety, daily functional self-actualization, and functional cognition as well as the relationships among those factors in older adults during the COVID-19 pandemic lockdown. Methods: We collected data on the web from a sample of 204 people (102 men and 102 women) aged 60 years and older. In addition to a demographic questionnaire, we used the State-Trait Personality Inventory to assess state anxiety, the Daily Functional Actualization questionnaire to evaluate daily functional self-actualization, and the Daily Living Questionnaire to measure functional cognition. Results: Significant gender differences were found for state anxiety (t202=?2.36, P=.02); daily functional self-actualization (t202=2.15, P=.03); and the functional cognition components: complex tasks (Z=?3.07, P=.002); cognitive symptoms that might be interfering (Z=?2.15, P=.028); executive functions (Z=?2.21, P=.024); and executive function monitoring (Z=?2.21, P=.027). Significant medium correlations were found between both state anxiety level and daily functional self-actualization (r=?0.62, P<.001) and functional cognition (r=0.37-0.40, P<.001). Gender predicted 3\% of the variance in state anxiety level, while daily functional self-actualization predicted 41\% and complex activities (Daily Living Questionnaire) predicted an additional 3\% (F3,200=58.01, P<.001). Conclusions: In older adults, anxiety is associated with cognitive decline, which may harm daily functional abilities and lead to social isolation, loneliness, and decreased well-being. Self-awareness and knowledge of gender differences and relationships between common available resources of daily functional self-actualization and functional cognition with anxiety may be strengthening factors in crisis periods such as the COVID-19 pandemic. ",
doi="10.2196/25876",
url="https://aging.jmir.org/2021/2/e25876",
url="http://www.ncbi.nlm.nih.gov/pubmed/33939623"
}


@Article{info:doi/10.2196/26462,
author="Wei, Jing
and Boger, Jennifer",
title="Sleep Detection for Younger Adults, Healthy Older Adults, and Older Adults Living With Dementia Using Wrist Temperature and Actigraphy: Prototype Testing and Case Study Analysis",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="1",
volume="9",
number="6",
pages="e26462",
keywords="sleep monitoring",
keywords="wearables",
keywords="accelerometer",
keywords="wrist temperature",
keywords="circadian rhythm",
keywords="younger adults",
keywords="older adults",
keywords="dementia",
keywords="mobile phone",
abstract="Background: Sleep is essential for one's health and quality of life. Wearable technologies that use motion and temperature sensors have made it possible to self-monitor sleep. Although there is a growing body of research on sleep monitoring using wearable devices for healthy young-to-middle-aged adults, few studies have focused on older adults, including those living with dementia. Objective: This study aims to investigate the impact of age and dementia on sleep detection through movement and wrist temperature. Methods: A total of 10 younger adults, 10 healthy older adults, and 8 older adults living with dementia (OAWD) were recruited. Each participant wore a Mi Band 2 (accemetry-based sleep detection) and our custom-built wristband (actigraphy and wrist temperature) 24 hours a day for 2 weeks and was asked to keep a daily sleep journal. Sleep parameters detected by the Mi Band 2 were compared with sleep journals, and visual analysis of actigraphy and temperature data was performed. Results: The absolute differences in sleep onset and offset between the sleep journals and Mi Band 2 were 39 (SD 51) minutes and 31 (SD 52) minutes for younger adults, 49 (SD 58) minutes and 33 (SD 58) minutes for older adults, and 253 (SD 104) minutes and 161 (SD 94) minutes for OAWD. The Mi Band 2 was unable to accurately detect sleep in 3 healthy older adults and all OAWDs. The average sleep and wake temperature difference of OAWD (1.26 {\textdegree}C, SD 0.82 {\textdegree}C) was significantly lower than that of healthy older adults (2.04 {\textdegree}C, SD 0.70 {\textdegree}C) and healthy younger adults (2.48 {\textdegree}C, SD 0.88 {\textdegree}C). Actigraphy data showed that older adults had more movement during sleep compared with younger adults and that this trend appears to increase for those with dementia. Conclusions: The Mi Band 2 did not accurately detect sleep in older adults who had greater levels of nighttime movement. As more nighttime movement appears to be a phenomenon that increases in prevalence with age and even more so with dementia, further research needs to be conducted with a larger sample size and greater diversity of commercially available wearable devices to explore these trends more conclusively. All participants, including older adults and OAWD, had a distinct sleep and wake wrist temperature contrast, which suggests that wrist temperature could be leveraged to create more robust and broadly applicable sleep detection algorithms. ",
doi="10.2196/26462",
url="https://mhealth.jmir.org/2021/6/e26462",
url="http://www.ncbi.nlm.nih.gov/pubmed/34061038"
}


@Article{info:doi/10.2196/26474,
author="Lebrasseur, Audrey
and Fortin-B{\'e}dard, No{\'e}mie
and Lettre, Josiane
and Raymond, Emilie
and Bussi{\`e}res, Eve-Line
and Lapierre, Nolwenn
and Faieta, Julie
and Vincent, Claude
and Duchesne, Louise
and Ouellet, Marie-Christine
and Gagnon, Eric
and Tourigny, Andr{\'e}
and Lamontagne, Marie-{\`E}ve
and Routhier, Fran{\c{c}}ois",
title="Impact of the COVID-19 Pandemic on Older Adults: Rapid Review",
journal="JMIR Aging",
year="2021",
month="Apr",
day="12",
volume="4",
number="2",
pages="e26474",
keywords="COVID-19",
keywords="impact",
keywords="rapid review",
keywords="older adults",
keywords="aged individuals",
keywords="review",
abstract="Background: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. Objective: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. Methods: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework--Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Results: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7\%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. Conclusions: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers. ",
doi="10.2196/26474",
url="https://aging.jmir.org/2021/2/e26474",
url="http://www.ncbi.nlm.nih.gov/pubmed/33720839"
}


@Article{info:doi/10.2196/26875,
author="Wrede, Christian
and Braakman-Jansen, Annemarie
and van Gemert-Pijnen, Lisette",
title="Requirements for Unobtrusive Monitoring to Support Home-Based Dementia Care: Qualitative Study Among Formal and Informal Caregivers",
journal="JMIR Aging",
year="2021",
month="Apr",
day="12",
volume="4",
number="2",
pages="e26875",
keywords="in-home monitoring",
keywords="ambient assisted living",
keywords="assistive technologies",
keywords="dementia",
keywords="home care",
keywords="informal care",
keywords="aging in place",
abstract="Background: Due to a growing shortage in residential care, people with dementia will increasingly be encouraged to live at home for longer. Although people with dementia prefer extended independent living, this also puts more pressure on both their informal and formal care networks. To support (in)formal caregivers of people with dementia, there is growing interest in unobtrusive contactless in-home monitoring technologies that allow caregivers to remotely monitor the lifestyle, health, and safety of their care recipients. Despite their potential, these solutions will only be viable if they meet the expectations and needs of formal and informal caregivers of people with dementia. Objective: The objective of this study was to explore the expected benefits, barriers, needs, and requirements toward unobtrusive in-home monitoring from the perspective of formal and informal caregivers of community-dwelling people with dementia. Methods: A combination of semistructured interviews and focus groups was used to collect data among informal (n=19) and formal (n=16) caregivers of people with dementia. Both sets of participants were presented with examples of unobtrusive in-home monitoring followed by questions addressing expected benefits, barriers, and needs. Relevant in-home monitoring goals were identified using a previously developed topic list. Interviews and focus groups were transcribed and inductively analyzed. Requirements for unobtrusive in-home monitoring were elicited based on the procedure of van Velsen and Bergvall-K{\aa}reborn. Results: Formal and informal caregivers saw unobtrusive in-home monitoring as a support tool that should particularly be used to monitor (the risk of) falls, day and night rhythm, personal hygiene, nocturnal restlessness, and eating and drinking behavior. Generally, (in)formal caregivers reported cross-checking self-care information, extended independent living, objective communication, prevention and proactive measures, emotional reassurance, and personalized and optimized care as the key benefits of unobtrusive in-home monitoring. Main concerns centered around privacy, information overload, and ethical concerns related to dehumanizing care. Furthermore, 16 requirements for unobtrusive in-home monitoring were generated that specified desired functions, how the technology should communicate with the user, which services surrounding the technology were seen as needed, and how the technology should be integrated into the existing work context. Conclusions: Despite the presence of barriers, formal and informal caregivers of people with dementia generally saw value in unobtrusive in-home monitoring, and felt that these systems could contribute to a shift from reactive to more proactive and less obtrusive care. However, the full potential of unobtrusive in-home monitoring can only unfold if relevant concerns are considered. Our requirements can inform the development of more acceptable and goal-directed in-home monitoring technologies to support home-based dementia care. ",
doi="10.2196/26875",
url="https://aging.jmir.org/2021/2/e26875",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843596"
}


@Article{info:doi/10.2196/24727,
author="Zeghari, Radia
and K{\"o}nig, Alexandra
and Guerchouche, Rachid
and Sharma, Garima
and Joshi, Jyoti
and Fabre, Roxane
and Robert, Philippe
and Manera, Valeria",
title="Correlations Between Facial Expressivity and Apathy in Elderly People With Neurocognitive Disorders: Exploratory Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="31",
volume="5",
number="3",
pages="e24727",
keywords="apathy",
keywords="action units",
keywords="assessment",
keywords="ICT",
keywords="facial video analysis",
keywords="neurocognitive disorders",
keywords="neurocognitive",
keywords="facial analysis",
abstract="Background: Neurocognitive disorders are often accompanied by behavioral symptoms such as anxiety, depression, and/or apathy. These symptoms can occur very early in the disease progression and are often difficult to detect and quantify in nonspecialized clinical settings. Objective: We focus in this study on apathy, one of the most common and debilitating neuropsychiatric symptoms in neurocognitive disorders. Specifically, we investigated whether facial expressivity extracted through computer vision software correlates with the severity of apathy symptoms in elderly subjects with neurocognitive disorders. Methods: A total of 63 subjects (38 females and 25 males) with neurocognitive disorder participated in the study. Apathy was assessed using the Apathy Inventory (AI), a scale comprising 3 domains of apathy: loss of interest, loss of initiation, and emotional blunting. The higher the scale score, the more severe the apathy symptoms. Participants were asked to recall a positive and a negative event of their life, while their voice and face were recorded using a tablet device. Action units (AUs), which are basic facial movements, were extracted using OpenFace 2.0. A total of 17 AUs (intensity and presence) for each frame of the video were extracted in both positive and negative storytelling. Average intensity and frequency of AU activation were calculated for each participant in each video. Partial correlations (controlling for the level of depression and cognitive impairment) were performed between these indexes and AI subscales. Results: Results showed that AU intensity and frequency were negatively correlated with apathy scale scores, in particular with the emotional blunting component. The more severe the apathy symptoms, the less expressivity in specific emotional and nonemotional AUs was displayed from participants while recalling an emotional event. Different AUs showed significant correlations depending on the sex of the participant and the task's valence (positive vs negative story), suggesting the importance of assessing male and female participants independently. Conclusions: Our study suggests the interest of employing computer vision-based facial analysis to quantify facial expressivity and assess the severity of apathy symptoms in subjects with neurocognitive disorders. This may represent a useful tool for a preliminary apathy assessment in nonspecialized settings and could be used to complement classical clinical scales. Future studies including larger samples should confirm the clinical relevance of this kind of instrument. ",
doi="10.2196/24727",
url="https://formative.jmir.org/2021/3/e24727",
url="http://www.ncbi.nlm.nih.gov/pubmed/33787499"
}


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


@Article{info:doi/10.2196/25779,
author="Daly, R. Jessica
and Depp, Colin
and Graham, A. Sarah
and Jeste, V. Dilip
and Kim, Ho-Cheol
and Lee, E. Ellen
and Nebeker, Camille",
title="Health Impacts of the Stay-at-Home Order on Community-Dwelling Older Adults and How Technologies May Help: Focus Group Study",
journal="JMIR Aging",
year="2021",
month="Mar",
day="22",
volume="4",
number="1",
pages="e25779",
keywords="aging",
keywords="quarantine",
keywords="mental health",
keywords="physical health",
keywords="social isolation",
keywords="COVID-19 pandemic",
keywords="continued care senior housing community",
keywords="CCSHC",
keywords="qualitative research",
keywords="videoconferencing",
keywords="older adults",
keywords="gerontechnology",
keywords="loneliness",
keywords="housing for the elderly",
keywords="independent living",
abstract="Background: As of March 2021, in the USA, the COVID-19 pandemic has resulted in over 500,000 deaths, with a majority being people over 65 years of age. Since the start of the pandemic in March 2020, preventive measures, including lockdowns, social isolation, quarantine, and social distancing, have been implemented to reduce viral spread. These measures, while effective for risk prevention, may contribute to increased social isolation and loneliness among older adults and negatively impact their mental and physical health. Objective: This study aimed to assess the impact of the COVID-19 pandemic and the resulting ``Stay-at-Home'' order on the mental and physical health of older adults and to explore ways to safely increase social connectedness among them. Methods: This qualitative study involved older adults living in a Continued Care Senior Housing Community (CCSHC) in southern California, USA. Four 90-minute focus groups were convened using the Zoom Video Communications platform during May 2020, involving 21 CCSHC residents. Participants were asked to describe how they were managing during the ``stay-at-home'' mandate that was implemented in March 2020, including its impact on their physical and mental health. Transcripts of each focus group were analyzed using qualitative methods. Results: Four themes emerged from the qualitative data: (1) impact of the quarantine on health and well-being, (2) communication innovation and technology use, (3) effective ways of coping with the quarantine, and (4) improving access to technology and training. Participants reported a threat to their mental and physical health directly tied to the quarantine and exacerbated by social isolation and decreased physical activity. Technology was identified as a lifeline for many who are socially isolated from their friends and family. Conclusions: Our study findings suggest that technology access, connectivity, and literacy are potential game-changers to supporting the mental and physical health of older adults and must be prioritized for future research. ",
doi="10.2196/25779",
url="https://aging.jmir.org/2021/1/e25779",
url="http://www.ncbi.nlm.nih.gov/pubmed/33690146"
}


@Article{info:doi/10.2196/19931,
author="Wittich, Walter
and Pichora-Fuller, Kathleen M.
and Johnson, Aaron
and Joubert, Sven
and Kehayia, Eva
and Bachir, Vanessa
and Aubin, Gabrielle
and Jaiswal, Atul
and Phillips, Natalie",
title="Effect of Reading Rehabilitation for Age-Related Macular Degeneration on Cognitive Functioning: Protocol for a Nonrandomized Pre-Post Intervention Study",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="11",
volume="10",
number="3",
pages="e19931",
keywords="low vision",
keywords="rehabilitation",
keywords="cognition",
keywords="aging",
keywords="dementia",
keywords="reading",
abstract="Background: Age-related vision impairments and dementia both become more prevalent with increasing age. Research into the mechanisms of these conditions has proposed that some of their causes (eg, macular degeneration/glaucoma and Alzheimer's disease) could be symptoms of an underlying common cause. Research into sensory-cognitive aging has provided data that sensory decline may be linked to the progression of dementia through reduced sensory stimulation. While hearing loss rehabilitation may have a beneficial effect on cognitive functioning, there are no data available on whether low vision rehabilitation, specifically for reading, could have a beneficial effect on cognitive health. Objective: The research questions are: (1) Does low vision rehabilitation reduce reading effort? (2) If so, does reduced reading effort increase reading activity, and (3) If so, does increased reading activity improve cognitive functioning? The primary objective is to evaluate cognition before, as well as at 6 months and 12 months after, 3 weeks of low vision reading rehabilitation using magnification in individuals with age-related macular degeneration, with or without coexisting hearing impairments. We hypothesize that improvements postrehab will be observed at 6 months and maintained at 12 months for participants with vision loss and less so for those with dual sensory loss. The secondary objective is to correlate participant characteristics with all cognitive outcomes to identify which may play an important role in reading rehabilitation. Methods: We employ a quasiexperimental approach (nonrandomized, pre-post intervention study). A 3x3 design (3 groups x 3 time points) allows us to examine whether cognitive performance will change before and after 6 months and 12 months of a low vision reading intervention, when comparing 75 low vision and 75 dual sensory impaired (vision \& hearing) participants to 75 age-matched healthy controls. The study includes outcome measures of vision (eg, reading acuity and speed), cognition (eg, short-term and long-term memory, processing speed), participant descriptors, demographics, and clinical data (eg, speech perception in noise, mental health). Results: The study has received approval, and recruitment began on April 24, 2019. As of March 4, 2021, 38 low vision and 7 control participants have been enrolled. Lockdown forced a pause in recruitment, which will recommence once the COVID-19 crisis has reached a point where face-to-face data collection with older adults becomes feasible again. Conclusions: Evidence of protective effects caused by reading rehabilitation will have a considerable impact on the vision rehabilitation community and their clients as well as all professionals involved in the care of older adults with or without dementia. If we demonstrate that reading rehabilitation has a beneficial effect on cognition, the demand for rehabilitation services will increase, potentially preventing cognitive decline across groups of older adults at risk of developing macular degeneration. Trial Registration: ClinicalTrials.gov NCT04276610; Unique Protocol ID: CRIR-1284-1217; https://clinicaltrials.gov/ct2/show/NCT04276610 International Registered Report Identifier (IRRID): DERR1-10.2196/19931 ",
doi="10.2196/19931",
url="https://www.researchprotocols.org/2021/3/e19931",
url="http://www.ncbi.nlm.nih.gov/pubmed/33704074"
}


@Article{info:doi/10.2196/26340,
author="Mansbach, E. William
and Mace, A. Ryan
and Tanner, A. Melissa",
title="A New Tool for Detecting COVID-19 Psychological Burden Among Postacute and Long-term Care Residents (Mood-5 Scale): Observational Study",
journal="JMIR Aging",
year="2021",
month="Mar",
day="10",
volume="4",
number="1",
pages="e26340",
keywords="nursing homes",
keywords="long-term care",
keywords="COVID-19",
keywords="depression",
keywords="stress",
keywords="coping",
keywords="burden",
keywords="mental health",
keywords="elderly",
keywords="older adults",
keywords="risk",
keywords="telehealth",
keywords="self-assessment",
keywords="scale",
keywords="mood",
abstract="Background: Older adults are at high risk for developing serious somatic and psychological symptoms associated with COVID-19. Currently available instruments may not be sensitive to the concerns about COVID-19 in postacute and long-term care and their applications in telehealth remain to be clarified. Objective: We investigated the psychometric properties of the Mood-5 Scale (M5) as a rapid self-assessment of the COVID-19 psychological burden among postacute and long-term care residents. Methods: Residents (N=131), aged 50 years and above, from 20 postacute and long-term care facilities in Maryland, USA, were evaluated in-person or via telehealth (43/131, 32.8\%) across a 4-week period (May 11 to June 5, 2020) during the COVID-19 pandemic. The COVID-19 psychological burden experienced by the residents was rated by geriatric psychologists who independently reviewed their clinical documentation. Psychometric analyses were performed on the M5 in relation to psychological tests, COVID-19 psychological burden, and diagnostic data collected during the evaluation. Results: The M5 demonstrated acceptable internal consistency (Cronbach $\alpha$=.77). M5 scores were not confounded by demographic variables or telehealth administration (P>.08). Convergent validity for the M5 was established via positive associations with anxiety (r=0.56, P<.001) and depressive (r=0.49, P<.001) symptoms. An M5 cutoff score of 3 demonstrated strong sensitivity (0.92) and adequate specificity (0.75) for identifying COVID-19 psychological distress among postacute and long-term care residents (area under the curve of 0.89, positive predictive value=0.79, negative predictive value=0.91). Conclusions: The M5 is a reliable and valid tool for self-assessment of mood that can help identify postacute and long-term care residents with significant psychological burden associated with COVID-19. It can be completed in less than 1 minute and is appropriate for use in both in-person and virtual visits. ",
doi="10.2196/26340",
url="https://aging.jmir.org/2021/1/e26340",
url="http://www.ncbi.nlm.nih.gov/pubmed/33640866"
}


@Article{info:doi/10.2196/22950,
author="Mbao, Mbita
and Collins-Pisano, Caroline
and Fortuna, Karen",
title="Older Adult Peer Support Specialists' Age-Related Contributions to an Integrated Medical and Psychiatric Self-Management Intervention: Qualitative Study of Text Message Exchanges",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="2",
volume="5",
number="3",
pages="e22950",
keywords="older adults",
keywords="peer support",
keywords="self-management",
keywords="mobile technology",
abstract="Background: Middle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of adults aged 50 years or above. An emerging workforce of peer support specialists aged 50 years or above or ``older adult peer support specialists'' is increasingly using technology to deliver peer support services to address both the mental health and physical health needs of middle-aged and older adults with a diagnosis of a serious mental illness. Objective: This exploratory qualitative study examined older adult peer support specialists' text message exchanges with middle-aged and older adults with a diagnosis of a serious mental illness and their nonmanualized age-related contributions to a standardized integrated medical and psychiatric self-management intervention. Methods: Older adult peer support specialists exchanged text messages with middle-aged and older adults with a diagnosis of a serious mental illness as part of a 12-week standardized integrated medical and psychiatric self-management smartphone intervention. Text message exchanges between older adult peer support specialists (n=3) and people with serious mental illnesses (n=8) were examined (mean age 68.8 years, SD 4.9 years). A total of 356 text messages were sent between older adult peer support specialists and service users with a diagnosis of a serious mental illness. Older adult peer support specialists sent text messages to older participants' smartphones between 8 AM and 10 PM on weekdays and weekends. Results: Five themes emerged from text message exchanges related to older adult peer support specialists' age-related contributions to integrated self-management, including (1) using technology to simultaneously manage mental health and physical health issues; (2) realizing new coping skills in late life; (3) sharing roles as parents and grandparents; (4) wisdom; and (5) sharing lived experience of difficulties with normal age-related changes (emerging). Conclusions: Older adult peer support specialists' lived experience of aging successfully with a mental health challenge may offer an age-related form of peer support that may have implications for promoting successful aging in older adults with a serious mental illness. ",
doi="10.2196/22950",
url="https://formative.jmir.org/2021/3/e22950",
url="http://www.ncbi.nlm.nih.gov/pubmed/33650979"
}


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


@Article{info:doi/10.2196/22406,
author="Appel, Lora
and Kisonas, Erika
and Appel, Eva
and Klein, Jennifer
and Bartlett, Deanna
and Rosenberg, Jarred
and Smith, NC Christopher",
title="Administering Virtual Reality Therapy to Manage Behavioral and Psychological Symptoms in Patients With Dementia Admitted to an Acute Care Hospital: Results of a Pilot Study",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="3",
volume="5",
number="2",
pages="e22406",
keywords="virtual reality",
keywords="wearable electronic devices",
keywords="sensory art therapies",
keywords="hospitalization",
keywords="hospitals, community",
keywords="hospitals, general",
keywords="aged",
keywords="humans",
keywords="dementia",
keywords="behavioral symptoms",
keywords="nature",
keywords="mobile phone",
abstract="Background: As virtual reality (VR) technologies become increasingly accessible and affordable, clinicians are eager to try VR therapy as a novel means to manage behavioral and psychological symptoms of dementia, which are exacerbated during acute care hospitalization, with the goal of reducing the use of antipsychotics, sedatives, and physical restraints associated with negative adverse effects, increased length of stay, and caregiver burden. To date, no evaluations of immersive VR therapy have been reported for patients with dementia in acute care hospitals. Objective: This study aimed to determine the feasibility (acceptance, comfort, and safety) of using immersive VR therapy for people living with dementia (mild, moderate, and advanced) during acute care hospitalization and explore its potential to manage behavioral and psychological symptoms of dementia. Methods: A prospective, longitudinal pilot study was conducted at a community teaching hospital in Toronto. The study was nonrandomized and unblinded. A total of 10 patients aged >65 years (mean 86.5, SD 5.7) diagnosed with dementia participated in one or more research coordinator--facilitated sessions of viewing immersive 360{\textdegree} VR footage of nature scenes displayed on a Samsung Gear VR head-mounted display. This mixed-methods study included review of patient charts, standardized observations during the intervention, and pre- and postintervention semistructured interviews about the VR experience. Results: All recruited participants (N=10) completed the study. Of the 10 participants, 7 (70\%) displayed enjoyment or relaxation during the VR session, which averaged 6 minutes per view, and 1 (10\%) experienced dizziness. No interference between the VR equipment and hearing aids or medical devices was reported. Conclusions: It is feasible to expose older people with dementia of various degrees admitted to an acute care hospital to immersive VR therapy. VR therapy was found to be acceptable to and comfortable by most participants. This pilot study provides the basis for conducting the first randomized controlled trial to evaluate the impact of VR therapy on managing behavioral and psychological symptoms of dementia in acute care hospitals. ",
doi="10.2196/22406",
url="https://formative.jmir.org/2021/2/e22406",
url="http://www.ncbi.nlm.nih.gov/pubmed/33533720"
}


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


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


@Article{info:doi/10.2196/16596,
author="Kwan, YC Rick
and Lee, Deborah
and Lee, H. Paul
and Tse, Mimi
and Cheung, SK Daphne
and Thiamwong, Ladda
and Choi, Kup-Sze",
title="Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="31",
volume="8",
number="7",
pages="e16596",
keywords="cognitive frailty",
keywords="brisk walking",
keywords="smartphone",
keywords="moderate-to-vigorous physical activity",
keywords="older people",
abstract="Background: Cognitive frailty is the coexistence of physical frailty and cognitive impairment and is an at-risk state for many adverse health outcomes. Moderate-to-vigorous physical activity (MVPA) is protective against the progression of cognitive frailty. Physical inactivity is common in older people, and brisk walking is a feasible form of physical activity that can enhance their MVPA. Mobile health (mHealth) employing persuasive technology has been successful in increasing the levels of physical activity in older people. However, its feasibility and effects on older people with cognitive frailty are unclear. Objective: We aimed to identify the issues related to the feasibility of an mHealth intervention and the trial (ie, recruitment, retention, participation, and compliance) and to examine the effects of the intervention on cognitive function, physical frailty, walking time, and MVPA. Methods: An open-label, parallel design, randomized controlled trial (RCT) was employed. The eligibility criteria for the participants were age ?60 years, having cognitive frailty, and having physical inactivity. In the intervention group, participants received both conventional behavior change intervention and mHealth (ie, smartphone-assisted program using Samsung Health and WhatsApp) interventions. In the control group, participants received conventional behavior change intervention only. The outcomes included cognitive function, frailty, walking time, and MVPA. Permuted block randomization in 1:1 ratio was used. The feasibility issue was described in terms of participant recruitment, retention, participation, and compliance. Wilcoxon signed-rank test was used to test the within-group effects in both groups separately. Results: We recruited 99 participants; 33 eligible participants were randomized into either the intervention group (n=16) or the control (n=17) group. The median age was 71.0 years (IQR 9.0) and the majority of them were females (28/33, 85\%). The recruitment rate was 33\% (33/99), the participant retention rate was 91\% (30/33), and the attendance rate of all the face-to-face sessions was 100\% (33/33). The majority of the smartphone messages were read by the participants within 30 minutes (91/216, 42.1\%). ActiGraph (58/66 days, 88\%) and smartphone (54/56 days, 97\%) wearing compliances were good. After the interventions, cognitive function improvement was significant in both the intervention (P=.003) and the control (P=.009) groups. The increase in frailty reduction (P=.005), walking time (P=.03), step count (P=.02), brisk walking time (P=.009), peak cadence (P=.003), and MVPA time (P=.02) were significant only in the intervention group. Conclusions: Our mHealth intervention is feasible for implementation in older people with cognitive impairment and is effective at enhancing compliance with the brisk walking training program delivered by the conventional behavior change interventions. We provide preliminary evidence that this mHealth intervention can increase MVPA time to an extent sufficient to yield clinical benefits (ie, reduction in cognitive frailty). A full-powered and assessor-blinded RCT should be employed in the future to warrant these effects. Trial Registration: HKU Clinical Trials Registry HKUCTR-2283; http://www.hkuctr.com/Study/Show/31df4708944944bd99e730d839db4756 ",
doi="10.2196/16596",
url="https://mhealth.jmir.org/2020/7/e16596",
url="http://www.ncbi.nlm.nih.gov/pubmed/32735218"
}


@Article{info:doi/10.2196/13247,
author="Kim, Heejung
and Kim, Sunah
and Kong, Sook Seong
and Jeong, Yi-Rang
and Kim, Hyein
and Kim, Namhee",
title="Possible Application of Ecological Momentary Assessment to Older Adults' Daily Depressive Mood: Integrative Literature Review",
journal="JMIR Ment Health",
year="2020",
month="Jun",
day="2",
volume="7",
number="6",
pages="e13247",
keywords="ecological momentary assessment",
keywords="depression",
keywords="aged",
keywords="review",
abstract="Background: Ecological momentary assessment is a method of investigating individuals' real-time experiences, behaviors, and moods in their natural environment over time. Despite its general usability and clinical value for evaluating daily depressive mood, there are several methodological challenges when applying ecological momentary assessment to older adults. Objective: The aims of this integrative literature review were to examine possible uses of the ecological momentary assessment methodology with older adults and to suggest strategies to increase the feasibility of its application in geriatric depression research and practice. Methods: We searched 4 electronic databases (MEDLINE, CINAHL, PsycINFO, and EMBASE) and gray literature; we also hand searched the retrieved articles' references. We limited all database searches to articles published in peer-reviewed journals from 2009 to 2019. Search terms were ``ecological momentary assessment,'' ``smartphone assessment,'' ``real time assessment,'' ``electronic daily diary,'' ``mHealth momentary assessment,'' ``mobile-based app,'' and ``experience sampling method,'' combined with the relevant terms of depression. We included any studies that enrolled older adults even as a subgroup and that reported depressive mood at least once a day for more than 2 days. Results: Of the 38 studies that met the inclusion criteria, only 1 study enrolled adults aged 65 years or older as the entire sample; the remainder of the reviewed studies used mixed samples of both younger and older adults. Most of the analyzed studies (18/38, 47\%) were quantitative, exploratory (descriptive, correlational, and predictive), and cohort in design. Ecological momentary assessment was used to describe the fluctuating pattern of participants' depressive moods primarily and to examine the correlation between mood patterns and other health outcomes as a concurrent symptom. We found 3 key methodological issues: (1) heterogeneity in study design and protocol, (2) issues with definitions of dropout and adherence, and (3) variation in how depressive symptoms were measured with ecological momentary assessment. Some studies (8/38, 21\%) examined the age difference of participants with respect to dropout or poor compliance rate. Detailed participant burden was reported, such as technical problems, aging-related health problems, or discomfort while using the device. Conclusions: Ecological momentary assessment has been used for comprehensive assessment of multiple mental health indicators in relation to depressive mood. Our findings provide methodological considerations for further studies that may be implemented using ecological momentary assessment to assess daily depressive mood in older adults. Conducting more feasibility studies focusing on older adults with standardized data collection protocols and mixed-methods research is required to reflect users' experiences. Further telepsychiatric evaluation and diagnosis based on ecological momentary assessment data should involve standardized and sophisticated strategies to maximize the potential of ecological momentary assessment for older adults with depression in the community setting. ",
doi="10.2196/13247",
url="https://mental.jmir.org/2020/6/e13247",
url="http://www.ncbi.nlm.nih.gov/pubmed/32484442"
}


@Article{info:doi/10.2196/13302,
author="Madden, Michael Kenneth
and Feldman, Boris",
title="Weekly, Seasonal, and Geographic Patterns in Health Contemplations About Sundown Syndrome: An Ecological Correlational Study",
journal="JMIR Aging",
year="2019",
month="May",
day="28",
volume="2",
number="1",
pages="e13302",
keywords="sundown syndrome",
keywords="geriatric medicine",
keywords="dementia",
keywords="circadian rhythms",
keywords="infodemiology",
keywords="infoveillance",
keywords="internet",
abstract="Background: Sundown syndrome (ie, agitation later in the day) is common in older adults with dementia. The underlying etiology for these behaviors is unclear. Possibilities include increased caregiver fatigue at the end of the day and disruption of circadian rhythms by both age and neurodegenerative illness. Objective: This study sought to examine circumseptan (weekly) patterns in search volumes related to sundown syndrome, in order to determine if such searches peaked at the end of the weekend, a time when caregiver supports are least available. We also sought to examine both seasonal differences and associations of state-by-state search activity with both state latitude and yearly sun exposure. Methods: Daily Internet search query data was obtained from Google Trends (2005-2017 inclusive). Circumseptan patterns were determined by wavelet analysis, and seasonality was determined by the difference in search volumes between winter (December, January, and February) and summer (June, July, and August) months. Geographic associations between percent sunny days and latitude were done on a state-by-state basis. Results: ``Sundowning'' searches showed a significant increase at the end of the weekend with activity being 10.9\% (SD 4.0) higher on Sunday as compared to the rest of the week. Search activity showed a seasonal pattern with search activity significantly highest in the winter months (36.6 [SD 0.6] vs 13.7 [SD 0.2], P<.001). State-by-state variations in ``sundowning'' searches showed a significant negative association with increasing mean daily sunlight (R2=.16, $\beta$=-.429 [SD .149], P=.006) and showed a positive association with increasing latitude (R2=.38, $\beta$=.648 [SD .122], P<.001). Conclusions: Interest in ``sundowning'' is highest after a weekend, which is a time when external caregiver support is reduced. Searches related to sundown syndrome also were highest in winter, in states with less sun, and in states at more northerly latitudes, supporting disrupted circadian rhythms as another contributing factor to these behaviors. ",
doi="10.2196/13302",
url="http://aging.jmir.org/2019/1/e13302/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518264"
}


@Article{info:doi/10.2196/11694,
author="Andrews, A. Jacob
and Brown, JE Laura
and Hawley, S. Mark
and Astell, J. Arlene",
title="Older Adults' Perspectives on Using Digital Technology to Maintain Good Mental Health: Interactive Group Study",
journal="J Med Internet Res",
year="2019",
month="Feb",
day="13",
volume="21",
number="2",
pages="e11694",
keywords="mental health",
keywords="older adults",
keywords="technology",
keywords="digital technology",
keywords="Internet",
keywords="apps",
abstract="Background: A growing number of apps to support good mental health and well-being are available on digital platforms. However, very few studies have examined older adults' attitudes toward the use of these apps, despite increasing uptake of digital technologies by this demographic. Objective: This study sought to explore older adults' perspectives on technology to support good mental health. Methods: A total of 15 older adults aged 50 years or older, in two groups, participated in sessions to explore the use of digital technologies to support mental health. Interactive activities were designed to capture participants' immediate reactions to apps and websites designed to support mental health and to explore their experiences of using technology for these purposes in their own lives. Template analysis was used to analyze transcripts of the group discussions. Results: Older adults were motivated to turn to technology to improve mood through mechanisms of distraction, normalization, and facilitated expression of mental states, while aiming to reduce burden on others. Perceived barriers to use included fear of consequences and the impact of low mood on readiness to engage with technology, as well as a lack of prior knowledge applicable to digital technologies. Participants were aware of websites available to support mental health, but awareness alone did not motivate use. Conclusions: Older adults are motivated to use digital technologies to improve their mental health, but barriers remain that developers need to address for this population to access them. ",
doi="10.2196/11694",
url="http://www.jmir.org/2019/2/e11694/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30758292"
}


@Article{info:doi/10.2196/11331,
author="Parsey, M. Carolyn
and Schmitter-Edgecombe, Maureen",
title="Using Actigraphy to Predict the Ecological Momentary Assessment of Mood, Fatigue, and Cognition in Older Adulthood: Mixed-Methods Study",
journal="JMIR Aging",
year="2019",
month="Jan",
day="18",
volume="2",
number="1",
pages="e11331",
keywords="actigraphy",
keywords="aging",
keywords="ecological momentary assessment",
keywords="mood",
keywords="sleep",
abstract="Background: Sleep quality has been associated with cognitive and mood outcomes in otherwise healthy older adults. However, most studies have evaluated sleep quality as aggregate and mean measures, rather than addressing the impact of previous night's sleep on next-day functioning. Objective: This study aims to evaluate the ability of previous night's sleep parameters on self-reported mood, cognition, and fatigue to understand short-term impacts of sleep quality on next-day functioning. Methods: In total, 73 cognitively healthy older adults (19 males, 54 females) completed 7 days of phone-based self-report questions, along with 24-hour actigraph data collection. We evaluated a model of previous night's sleep parameters as predictors of mood, fatigue, and perceived thinking abilities the following day. Results: Previous night's sleep predicted fatigue in the morning and midday, as well as sleepiness or drowsiness in the morning; however, sleep measures did not predict subjective report of mood or perceived thinking abilities the following day. Conclusions: This study suggests that objectively measured sleep quality from the previous night may not have a direct or substantial relationship with subjective reporting of cognition or mood the following day, despite frequent patient reports. Continued efforts to examine the relationship among cognition, sleep, and everyday functioning are encouraged. ",
doi="10.2196/11331",
url="http://aging.jmir.org/2019/1/e11331/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518282"
}


@Article{info:doi/10.2196/aging.9130,
author="Cruickshank, Callum
and MacIntyre, J. Donald",
title="Digital Access in Working-Age and Older Adults and Their Caregivers Attending Psychiatry Outpatient Clinics: Quantitative Survey",
journal="JMIR Aging",
year="2018",
month="Nov",
day="22",
volume="1",
number="2",
pages="e4",
keywords="general psychiatry",
keywords="internet access",
keywords="memory assessment and treatment service",
keywords="mobile phone",
keywords="old age psychiatry",
abstract="Background: It has been suggested that improving access to mental health services, supporting self-management, and increasing clinical productivity can be achieved through the delivery of technology-enabled care by personal mobile-based and internet-based services. There is little evidence available about whether working-age and older adults with mental health problems or their caregivers have access to these technologies or their confidence with these technologies. Objective: This study aimed to ascertain the prevalence and range of devices used to access the internet in patients and caregivers attending general and older adult psychiatry outpatient services and their confidence in using these technologies. Methods: We conducted an anonymous survey of 77 patients and caregivers from a general psychiatry and old age psychiatry clinic to determine rates of internet access and device ownership, and attitudes to technology-enabled care. Results: We found high levels of internet access and confidence in using the internet in working-age adults, their caregivers, and older adult caregivers but not in older adult patients. The smartphone usage predominated in working-age adults and their caregivers. Older adult caregivers were more likely to use desktop or laptop computers. In our sample, tablets were the least popular form factor. Conclusions: Access rates and uptake of internet-based services have the potential to be high in working-age adults and their caregivers but are likely to be markedly lower among older adult patients attending psychiatry clinics. Applications designed for tablets are likely to have low uptake. All groups identified appointment reminders as likely to be beneficial. ",
doi="10.2196/aging.9130",
url="http://aging.jmir.org/2018/2/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518247"
}


@Article{info:doi/10.2196/10973,
author="Eichenberg, Christiane
and Schott, Markus
and Sawyer, Adam
and Aumayr, Georg
and Pl{\"o}{\ss}nig, Manuela",
title="Feasibility and Conceptualization of an e-Mental Health Treatment for Depression in Older Adults: Mixed-Methods Study",
journal="JMIR Aging",
year="2018",
month="Oct",
day="23",
volume="1",
number="2",
pages="e10973",
keywords="depression",
keywords="online therapy",
keywords="e-mental health",
abstract="Background: Depression is one of the most common mental disorders in older adults. Unfortunately, it often goes unrecognized in the older population. Objective: The aim of this study was to identify how Web-based apps can recognize and help treat depression in older adults. Methods: Focus groups were conducted with mental health care experts. A Web-based survey of 56 older adults suffering from depression was conducted. Qualitative interviews were conducted with 2 individuals. Results: Results of the focus groups highlighted that there is a need for a collaborative care platform for depression in old age. Findings from the Web-based study showed that younger participants (aged 50 to 64 years) used electronic media more often than older participants (aged 65 years and older). The interviews pointed in a comparable direction. Conclusions: Overall, an e-mental (electronic mental) health treatment for depression in older adults would be well accepted. Web-based care platforms should be developed, evaluated, and in case of evidence for their effectiveness, integrated into the everyday clinic. ",
doi="10.2196/10973",
url="http://aging.jmir.org/2018/2/e10973/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518235"
}