@Article{info:doi/10.2196/20110,
author="Edelman, S. Linda
and McConnell, S. Eleanor
and Kennerly, M. Susan
and Alderden, Jenny
and Horn, D. Susan
and Yap, L. Tracey",
title="Mitigating the Effects of a Pandemic: Facilitating Improved Nursing Home Care Delivery Through Technology",
journal="JMIR Aging",
year="2020",
month="May",
day="26",
volume="3",
number="1",
pages="e20110",
keywords="nursing home",
keywords="technology",
keywords="social isolation",
keywords="covid-19",
doi="10.2196/20110",
url="http://aging.jmir.org/2020/1/e20110/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32412909"
}


@Article{info:doi/10.2196/19007,
author="Goethals, Luc
and Barth, Nathalie
and Guyot, Jessica
and Hupin, David
and Celarier, Thomas
and Bongue, Bienvenu",
title="Impact of Home Quarantine on Physical Activity Among Older Adults Living at Home During the COVID-19 Pandemic: Qualitative Interview Study",
journal="JMIR Aging",
year="2020",
month="May",
day="7",
volume="3",
number="1",
pages="e19007",
keywords="older adults",
keywords="physical activity",
keywords="COVID-19",
keywords="social marketing",
abstract="Background: Older adults and those with pre-existing medical conditions are at risk of death from severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). In this period of quarantine, one of the reasons for going out is physical activity. This issue is important, as the impact of a sedentary lifestyle might be lower for children and young adults, but is far more severe for older adults. Although older adults need to stay at home because they have a higher risk of coronavirus disease (COVID-19), they need to avoid a sedentary lifestyle. Physical activity is important for older adults, especially to maintain their level of independence, mental health, and well-being. Maintaining mobility in old age is necessary, as it may predict loss of independence in older adults. Objective: Our first objective was to evaluate the impact of this quarantine period on physical activity programs and on the physical and mental health of older adults. Our second objective was to discuss alternatives to physical activity programs that could be suggested for this population to avoid a sedentary lifestyle. Methods: We conducted a qualitative survey using semistructured interviews with professionals (managers in charge of physical activity programs for older adults and sports trainers who run these physical activity programs) from the French Federation of Physical Education and Voluntary Gymnastics (FFPEVG) and older adults participating in a physical activity program of the FFPEVG. We followed a common interview guide. For analysis, we carried out a thematic analysis of the interviews. Results: This study suggests that the COVID-19 epidemic has affected, before quarantine measures, the number of seniors attending group physical activity programs in the two study territories. In addition, despite the decline in their participation in group physical activities before the quarantine, older adults expressed the need to perform physical activity at home. There is a need to help older adults integrate simple and safe ways to stay physically active in a limited space. A national policy to support older adults for physical activity at home appears essential in this context. Conclusions: Given the results of our study, it seems necessary to globally communicate how important it is for older adults to maintain physical activity at home. We are concerned about the level of independence and mental health state of older adults after the end of quarantine if there is no appropriate campaign to promote physical activity among them at home. ",
doi="10.2196/19007",
url="http://aging.jmir.org/2020/1/e19007/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32356777"
}


@Article{info:doi/10.2196/18398,
author="Neil-Sztramko, E. Sarah
and Coletta, Giulia
and Dobbins, Maureen
and Marr, Sharon",
title="Impact of the AGE-ON Tablet Training Program on Social Isolation, Loneliness, and Attitudes Toward Technology in Older Adults: Single-Group Pre-Post Study",
journal="JMIR Aging",
year="2020",
month="Apr",
day="20",
volume="3",
number="1",
pages="e18398",
keywords="technology",
keywords="older adults",
keywords="tablet training",
keywords="education",
abstract="Background: The internet and technology can help older adults connect with family and friends. However, many older adults face obstacles to internet and technology use, such as lack of knowledge or self-efficacy. Objective: The purpose of this study was to explore the impact of the AGE-ON tablet training program on social isolation, loneliness, and quality of life. Methods: Adults aged >60 years took part in a series of 6 weekly workshops covering the basic features of a tablet. Before and after the program, social isolation, loneliness, social support, and quality of life were assessed. In addition, data on current tablet use and attitudes toward technology use were collected. Satisfaction with the program was also assessed at the end of the study using 6 Likert scale questions. Results: The participants (N=32; mean age 76.3, SD 8.6 years) were predominantly female (n=20, 63\%) and retired (n=30, 94\%). The participants reported that they were highly satisfied with the program. After completing the program, no differences in social isolation, loneliness, social support, or quality of life were found. Frequency of tablet use increased and the attitudes of the participants toward technology improved. Conclusions: The AGE-ON program resulted in increased tablet use frequency and may improve comfort and attitudes toward tablet use among older adults. This program may assist older adults in overcoming obstacles to internet and technology use to better connect with family and friends; however, further work targeting older adults who are socially isolated or at risk of social isolation is needed to more fully understand whether tablet training programs are beneficial in this population. Trial Registration: ClinicalTrials.gov NCT03472729; https://clinicaltrials.gov/ct2/show/NCT03472729 ",
doi="10.2196/18398",
url="http://aging.jmir.org/2020/1/e18398/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32310146"
}


@Article{info:doi/10.2196/17299,
author="Ferguson, Caleb
and Inglis, C. Sally
and Breen, P. Paul
and Gargiulo, D. Gaetano
and Byiers, Victoria
and Macdonald, S. Peter
and Hickman, D. Louise",
title="Clinician Perspectives on the Design and Application of Wearable Cardiac Technologies for Older Adults: Qualitative Study",
journal="JMIR Aging",
year="2020",
month="Jun",
day="18",
volume="3",
number="1",
pages="e17299",
keywords="technology",
keywords="arrhythmia",
keywords="monitoring",
keywords="older people",
keywords="cardiology",
keywords="qualitative",
keywords="wearable",
abstract="Background: New wearable devices (for example, AliveCor or Zio patch) offer promise in detecting arrhythmia and monitoring cardiac health status, among other clinically useful parameters in older adults. However, the clinical utility and usability from the perspectives of clinicians is largely unexplored. Objective: This study aimed to explore clinician perspectives on the use of wearable cardiac monitoring technology for older adults. Methods: A descriptive qualitative study was conducted using semistructured focus group interviews. Clinicians were recruited through purposive sampling of physicians, nurses, and allied health staff working in 3 tertiary-level hospitals. Verbatim transcripts were analyzed using thematic content analysis to identify themes. Results: Clinicians representing physicians, nurses, and allied health staff working in 3 tertiary-level hospitals completed 4 focus group interviews between May 2019 and July 2019. There were 50 participants (28 men and 22 women), including cardiologists, geriatricians, nurses, and allied health staff. The focus groups generated the following 3 overarching, interrelated themes: (1) the current state of play, understanding the perceived challenges of patient cardiac monitoring in hospitals, (2) priorities in cardiac monitoring, what parameters new technologies should measure, and (3) cardiac monitoring of the future, ``the ideal device.'' Conclusions: There remain pitfalls related to the design of wearable cardiac technology for older adults that present clinical challenges. These pitfalls and challenges likely negatively impact the uptake of wearable cardiac monitoring in routine clinical care. Partnering with clinicians and patients in the co-design of new wearable cardiac monitoring technologies is critical to optimize the use of these devices and their uptake in clinical care. ",
doi="10.2196/17299",
url="http://aging.jmir.org/2020/1/e17299/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32554377"
}


@Article{info:doi/10.2196/15995,
author="Zheng, Yaguang
and Weinger, Katie
and Greenberg, Jordan
and Burke, E. Lora
and Sereika, M. Susan
and Patience, Nicole
and Gregas, C. Matt
and Li, Zhuoxin
and Qi, Chenfang
and Yamasaki, Joy
and Munshi, N. Medha",
title="Actual Use of Multiple Health Monitors Among Older Adults With Diabetes: Pilot Study",
journal="JMIR Aging",
year="2020",
month="Mar",
day="23",
volume="3",
number="1",
pages="e15995",
keywords="mobile health",
keywords="aged",
keywords="lifestyle",
keywords="self-management",
keywords="diabetes mellitus, type 2",
abstract="Background: Previous studies have reported older adults' perceptions of using health monitors; however, no studies have examined the actual use of multiple health monitors for lifestyle changes over time among older adults with type 2 diabetes (T2D). Objective: The primary aim of this study was to examine the actual use of multiple health monitors for lifestyle changes over 3 months among older adults with T2D. The secondary aim was to explore changes in caloric intake and physical activity (PA) over 3 months. Methods: This was a single-group study lasting 3 months. The study sample included participants who were aged ?65 years with a diagnosis of T2D. Participants were recruited through fliers posted at the Joslin Diabetes Center in Boston. Participants attended five 60-min, biweekly group sessions, which focused on self-monitoring, goal setting, self-regulation to achieve healthy eating and PA habits, and the development of problem-solving skills. Participants were provided with the Lose It! app to record daily food intake and devices such as a Fitbit Alta for monitoring PA, a Bluetooth-enabled blood glucose meter, and a Bluetooth-enabled digital scale. Descriptive statistics were used for analysis. Results: Of the enrolled participants (N=9), the sample was white (8/9, 89\%) and female (4/9, 44\%), with a mean age of 76.4 years (SD 6.0; range 69-89 years), 15.7 years (SD 2.0) of education, 33.3 kg/m2 (SD 3.1) BMI, and 7.4\% (SD 0.8) hemoglobin A1c. Over the 84 days of self-monitoring, the mean percentage of days using the Lose It!, Fitbit Alta, blood glucose meter, and scale were 82.7 (SD 17.6), 85.2 (SD 19.7), 65.3 (SD 30.1), and 53.0 (SD 34.5), respectively. From baseline to completion of the study, the mean daily calorie intake was 1459 (SD 661) at week 1, 1245 (SD 554) at week 11, and 1333 (SD 546) at week 12, whereas the mean daily step counts were 5618 (SD 3654) at week 1, 5792 (SD 3814) at week 11, and 4552 (SD 3616) at week 12. The mean percentage of weight loss from baseline was 4.92\% (SD 0.25). The dose of oral hypoglycemic agents or insulin was reduced in 55.6\% (5/9) of the participants. Conclusions: The results from the pilot study are encouraging and suggest the need for a larger study to confirm the outcomes. In addition, a study design that includes a control group with educational sessions but without the integration of technology would offer additional insight to understand the value of mobile health in behavior changes and the health outcomes observed during this pilot study. ",
doi="10.2196/15995",
url="http://aging.jmir.org/2020/1/e15995/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32202506"
}


@Article{info:doi/10.2196/17769,
author="Peterson, M. Colleen
and Mikal, P. Jude
and McCarron, R. Hayley
and Finlay, M. Jessica
and Mitchell, L. Lauren
and Gaugler, E. Joseph",
title="The Feasibility and Utility of a Personal Health Record for Persons With Dementia and Their Family Caregivers for Web-Based Care Coordination: Mixed Methods Study",
journal="JMIR Aging",
year="2020",
month="Jun",
day="26",
volume="3",
number="1",
pages="e17769",
keywords="Alzheimer disease",
keywords="technology",
keywords="disease management",
keywords="personal health record",
keywords="family caregiving",
keywords="informal caregiving",
keywords="caregiver burnout",
keywords="web-based intervention",
keywords="assistive technology",
abstract="Background: Managing the complex and long-term care needs of persons living with Alzheimer disease and related dementias (ADRD) can adversely impact the health of informal caregivers and their care recipients. Web-based personal health records (PHRs) are one way to potentially alleviate a caregiver's burden by simplifying ADRD health care management Objective: This study aimed to evaluate Personal Health Record for Persons with Dementia and Their Family Caregivers (PHR-ADRD), a free web-based information exchange tool, using a multiphase mixed methods approach. Methods: Dementia caregivers (N=34) were surveyed for their well-being and perceptions of PHR-ADRD feasibility and utility at 6 and 12 months using close- and open-ended questions as well as a semistructured interview (n=8). Exploratory analyses compared participants' characteristics as well as PHR-ADRD use and experiences based on overall favorability status. Results: Feasibility and utility scores decreased over time, but a subset of participants indicated that the system was helpful. Quantitative comparisons could not explain why some participants indicated favorable, neutral, or unfavorable views of the system overall or had not engaged with PHR-ADRD. Qualitative findings suggested that technology literacy and primary care provider buy-in were barriers. Both qualitative and qualitative findings indicated that time constraints to learn and use the system affected most participants. Conclusions: Development and dissemination of PHRs for family caregivers of persons with ADRD should aim to make systems user-friendly for persons with limited time and technological literacy. Establishing health care provider buy-in may be essential to the future success of any PHR system. ",
doi="10.2196/17769",
url="http://aging.jmir.org/2020/1/e17769/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32589158"
}


@Article{info:doi/10.2196/17255,
author="Christie, Liane Hannah
and Schichel, Philomela Mignon Chlo{\"e}
and Tange, Johannes Huibert
and Veenstra, Yvonne Marja
and Verhey, Josef Frans Rochus
and de Vugt, Elizabeth Marjolein",
title="Perspectives From Municipality Officials on the Adoption, Dissemination, and Implementation of Electronic Health Interventions to Support Caregivers of People With Dementia: Inductive Thematic Analysis",
journal="JMIR Aging",
year="2020",
month="May",
day="13",
volume="3",
number="1",
pages="e17255",
keywords="dementia",
keywords="caregiver",
keywords="internet",
keywords="eHealth",
keywords="implementation, senior friendly communities",
abstract="Background: Very few evidence-based electronic health (eHealth) interventions for caregivers of people with dementia are implemented into practice. As part of a cross-border collaboration focusing on dementia and depression in older people, two eHealth interventions for caregivers of people with dementia (``Myinlife'' and ``Partner in Balance'') were adopted by nine municipalities in the Euregion Meuse-Rhine. Objective: This study aimed to (1) identify determinants for the implementation of eHealth interventions for caregivers of people with dementia in a municipality context and (2) formulate implementation strategies for these interventions. Methods: Eight municipality officials were interviewed using open-ended, semistructured interviews about their background, thoughts on the implementation of the intervention, recommended strategies, and thoughts on eHealth in general. One additional municipality discontinued the implementation project and submitted answers to the interview questions via email. The interviews were transcribed and independently analyzed using inductive thematic analysis. Results: The interviews provided information on the perspectives of municipality officials on implementing eHealth for caregivers of people with dementia in their local communities. Key findings from the inductive thematic analysis included the importance of face-to-face interviews in developing tailor-made implementation plans, the need for regular meetings, the enthusiasm of municipality officials to implement these interventions, the need for long-term sustainability planning through collecting data on the required resources and benefits, and the effect of name brand recognition in adoption. Conclusions: The findings contribute toward filling the previously identified gap in the literature on the implementation context of eHealth interventions for caregivers of people with dementia. Municipality officials' views indicated which implementation determinants they expected would influence the adoption, dissemination, and future implementation of eHealth interventions for caregivers of people with dementia in a municipal context. These insights were applied to tailored implementation strategies to facilitate the future implementation of interventions such as Myinlife and Partner in Balance. ",
doi="10.2196/17255",
url="http://aging.jmir.org/2020/1/e17255/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32401217"
}


@Article{info:doi/10.2196/15480,
author="Efthymiou, Areti
and Papastavrou, Evridiki
and Middleton, Nicos
and Markatou, Artemis
and Sakka, Paraskevi",
title="How Caregivers of People With Dementia Search for Dementia-Specific Information on the Internet: Survey Study",
journal="JMIR Aging",
year="2020",
month="May",
day="19",
volume="3",
number="1",
pages="e15480",
keywords="caregivers",
keywords="internet",
keywords="dementia",
keywords="eHealth",
abstract="Background: During the last decade, more research has focused on web-based interventions delivered to support caregivers of people with dementia. However, little information is available in relation to internet use among caregivers in general, especially those caring for people with dementia. Objective: The aim of this study was to evaluate the dementia-related internet use and factors that may be associated with its use among caregivers of people with dementia in Greece. Methods: Secondary data from the Greek Dementia Survey of the Athens Association of Alzheimer's Disease and Related Disorders were collected from April to June 2017. A total of 580 caregivers of people with dementia participated in the study. Results: The majority of the caregivers reported that they had used the internet in the previous 3 months (84.1\%, 488/580). Nearly half of the caregivers (47.5\%, 276/580) reported that they had received dementia services online. Bivariate analysis showed that a dementia-specific search of information was associated with age, education, kinship, and years of care. Age (odds ratio [OR] 2.362, 95\% CI 1.05-5.33) and education (OR 2.228, 95\% CI 1.01-4.94) were confirmed as predictors, with younger caregivers and those with higher educational attainment being more likely to search for dementia-specific information. Use of the internet to search for dementia information was only related to hours of care. The internet use by caregivers within the previous 3 months was associated with variables such as age, education, occupation, kinship, years of care, and self-reported impact on physical and social health. Conclusions: Caregivers of people with dementia in Greece, as in the other southern European countries, are essential agents of the national health system. The existing short- and long-term respite care services are limited or nonexistent. Currently, caregivers receive mostly support and education from memory clinics and municipality consultation centers, which are mainly based in central cities in Greece. Despite the dementia awareness movement in Greece, there is still space to integrate the role of technology in the support and education of caregivers. Development of training programs for enhancing electronic health literacy skills as well as web-based services provision could support Greek caregivers in their everyday caring tasks. ",
doi="10.2196/15480",
url="http://aging.jmir.org/2020/1/e15480/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32427105"
}


@Article{info:doi/10.2196/18624,
author="Christie, Liane Hannah
and Boots, Maria Lizzy Mitzy
and Peetoom, Kirsten
and Tange, Johannes Huibert
and Verhey, Josef Frans Rochus
and de Vugt, Elizabeth Marjolein",
title="Developing a Plan for the Sustainable Implementation of an Electronic Health Intervention (Partner in Balance) to Support Caregivers of People With Dementia: Case Study",
journal="JMIR Aging",
year="2020",
month="Jun",
day="25",
volume="3",
number="1",
pages="e18624",
keywords="dementia",
keywords="caregiving",
keywords="eHealth",
keywords="implementation",
keywords="business modeling",
abstract="Background: Given the increasing use of digital interventions in health care, understanding how best to implement them is crucial. However, evidence on how to implement new academically developed interventions in complex health care environments is lacking. This case study offers an example of how to develop a theory-based implementation plan for Partner in Balance, an electronic health (eHealth) intervention to support the caregivers of people with dementia. Objective: The specific objectives of this study were to (1) formulate evidence-based implementation strategies, (2) develop a sustainable business model, and (3) integrate these elements into an implementation plan. Methods: This case study concerns Partner in Balance, a blended care intervention to support the caregivers of people with dementia, which is effective in improving caregiver self-efficacy, quality of life, and experienced control. The large-scale implementation of Partner in Balance took place in local dementia case-management services, local care homes, dementia support groups, and municipalities. Experiences from real-life pilots (n=22) and qualitative interviews with national stakeholders (n=14) were used to establish an implementation plan consisting of implementation strategies and a business model. Results: The main finding was the need for a business model to facilitate decision-making from potential client organizations, who need reliable pricing information before they can commit to training coaches and implementing the intervention. Additionally, knowledge of the organizational context and a wider health care system are essential to ensure that the intervention meets the needs of its target users. Based on these findings, the research team formulated implementation strategies targeted at the engagement of organizations and staff, dissemination of the intervention, and facilitation of long-term project management in the future. Conclusions: This study offers a theory-based example of implementing an evidence-based eHealth intervention in dementia health care. The findings help fill the knowledge gap on the eHealth implementation context for evidence-based eHealth interventions after the trial phase, and they can be used to inform individuals working to develop and sustainably implement eHealth. ",
doi="10.2196/18624",
url="http://aging.jmir.org/2020/1/e18624/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32584261"
}


@Article{info:doi/10.2196/16131,
author="Rabe, Sophie
and Azhand, Arash
and Pommer, Wolfgang
and M{\"u}ller, Swantje
and Steinert, Anika",
title="Descriptive Evaluation and Accuracy of a Mobile App to Assess Fall Risk in Seniors: Retrospective Case-Control Study",
journal="JMIR Aging",
year="2020",
month="Feb",
day="14",
volume="3",
number="1",
pages="e16131",
keywords="falls",
keywords="seniors",
keywords="fall risk assessment",
keywords="app",
keywords="mHealth",
keywords="retrospective cohort study",
keywords="discriminative ability",
abstract="Background: Fall-risk assessment is complex. Based on current scientific evidence, a multifactorial approach, including the analysis of physical performance, gait parameters, and both extrinsic and intrinsic risk factors, is highly recommended. A smartphone-based app was designed to assess the individual risk of falling with a score that combines multiple fall-risk factors into one comprehensive metric using the previously listed determinants. Objective: This study provides a descriptive evaluation of the designed fall-risk score as well as an analysis of the app's discriminative ability based on real-world data. Methods: Anonymous data from 242 seniors was analyzed retrospectively. Data was collected between June 2018 and May 2019 using the fall-risk assessment app. First, we provided a descriptive statistical analysis of the underlying dataset. Subsequently, multiple learning models (Logistic Regression, Gaussian Naive Bayes, Gradient Boosting, Support Vector Classification, and Random Forest Regression) were trained on the dataset to obtain optimal decision boundaries. The receiver operating curve with its corresponding area under the curve (AUC) and sensitivity were the primary performance metrics utilized to assess the fall-risk score's ability to discriminate fallers from nonfallers. For the sake of completeness, specificity, precision, and overall accuracy were also provided for each model. Results: Out of 242 participants with a mean age of 84.6 years old (SD 6.7), 139 (57.4\%) reported no previous falls (nonfaller), while 103 (42.5\%) reported a previous fall (faller). The average fall risk was 29.5 points (SD 12.4). The performance metrics for the Logistic Regression Model were AUC=0.9, sensitivity=100\%, specificity=52\%, and accuracy=73\%. The performance metrics for the Gaussian Naive Bayes Model were AUC=0.9, sensitivity=100\%, specificity=52\%, and accuracy=73\%. The performance metrics for the Gradient Boosting Model were AUC=0.85, sensitivity=88\%, specificity=62\%, and accuracy=73\%. The performance metrics for the Support Vector Classification Model were AUC=0.84, sensitivity=88\%, specificity=67\%, and accuracy=76\%. The performance metrics for the Random Forest Model were AUC=0.84, sensitivity=88\%, specificity=57\%, and accuracy=70\%. Conclusions: Descriptive statistics for the dataset were provided as comparison and reference values. The fall-risk score exhibited a high discriminative ability to distinguish fallers from nonfallers, irrespective of the learning model evaluated. The models had an average AUC of 0.86, an average sensitivity of 93\%, and an average specificity of 58\%. Average overall accuracy was 73\%. Thus, the fall-risk app has the potential to support caretakers in easily conducting a valid fall-risk assessment. The fall-risk score's prospective accuracy will be further validated in a prospective trial. ",
doi="10.2196/16131",
url="http://aging.jmir.org/2020/1/e16131/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130111"
}


@Article{info:doi/10.2196/18179,
author="Shu, Sara
and Woo, P. Benjamin K.",
title="The Roles of YouTube and WhatsApp in Dementia Education for the Older Chinese American Population: Longitudinal Analysis",
journal="JMIR Aging",
year="2020",
month="Apr",
day="13",
volume="3",
number="1",
pages="e18179",
keywords="dementia",
keywords="mental health",
keywords="social media",
keywords="geriatrics",
keywords="health promotion",
keywords="health education",
abstract="Background: Dementia remains a stigmatized topic in the Chinese community. Objective: This study aims to analyze and compare the usage of dementia educational YouTube videos and the modalities of video sharing over a 6-year period. Methods: Dementia educational videos were uploaded to YouTube. Data was collected over a 6-year period. Results from the first 3 years were compared to those from the second 3 years using descriptive statistics and chi-square analysis. Results: Over 6 years, the dementia educational videos generated a total watch time of 269,388 minutes, 37,690 views, and an average view duration of 7.1 minutes. Comparing the first and second 3-year periods of video performance data, there was a longer watch time (59,262 vs 210,126 minutes), more total views (9387 vs 28,303 views), and a longer average view duration (6.3 vs 7.4 minutes). Furthermore, WhatsApp has become a leading external traffic source and top sharing service, accounting for 43.5\% (929/2137) and 67.0\% (677/1011), respectively. Conclusions: Over 6 years, YouTube has become an increasingly popular tool to deliver culturally sensitive dementia education to Chinese Americans. WhatsApp continues to be the preferred method of sharing dementia education and has become a top external traffic source to dementia educational videos. Taken together, these social media platforms are promising means of reducing the disparity in dementia knowledge in linguistically and culturally isolated populations. ",
doi="10.2196/18179",
url="http://aging.jmir.org/2020/1/e18179/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32281940"
}


@Article{info:doi/10.2196/15491,
author="Merkel, Sebastian
and Hess, Moritz",
title="The Use of Internet-Based Health and Care Services by Elderly People in Europe and the Importance of the Country Context: Multilevel Study",
journal="JMIR Aging",
year="2020",
month="Jun",
day="3",
volume="3",
number="1",
pages="e15491",
keywords="eHealth",
keywords="Europe",
keywords="elderly people",
abstract="Background: Digital health care is becoming increasingly important, but it has the risk of further increasing the digital divide, as not all individuals have the opportunity, skills, and knowledge to fully benefit from potential advantages. In particular, elderly people have less experience with the internet, and hence, they are in danger of being excluded. Knowledge on the influences of the adoption of internet-based health and care services by elderly people will help to develop and promote strategies for decreasing the digital divide. Objective: This study examined if and how elderly people are using digital services to access health and social care. Moreover, it examined what personal characteristics are associated with using these services and if there are country differences. Methods: Data for this study were obtained from the Special Eurobarometer 460 (SB 460), which collected data on Europeans' handling of and attitudes toward digital technologies, robots, and artificial intelligence, including data on the use of internet-based health and social care services, among 27,901 EU citizens aged 15 years or older. Multilevel logistic regression models were adopted to analyze the association of using the internet for health and social care services with several individual and country-level variables. Results: At the individual level, young age, high education, high social class, and living in an urban area were positively associated with a high probability of using internet-based health and social services. At the country level, the proportion of elderly people who participated in any training activity within the last month was positively associated with the proportion of elderly people using these services. Conclusions: The probability of using internet-based health and social services and their accompanying advantages strongly depend on the socioeconomic background. Training and educational programs might be helpful to mitigate these differences. ",
doi="10.2196/15491",
url="http://aging.jmir.org/2020/1/e15491/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32490837"
}


@Article{info:doi/10.2196/17142,
author="Heiney, P. Sue
and Donevant, B. Sara
and Arp Adams, Swann
and Parker, D. Pearman
and Chen, Hongtu
and Levkoff, Sue",
title="A Smartphone App for Self-Management of Heart Failure in Older African Americans:  Feasibility and Usability Study",
journal="JMIR Aging",
year="2020",
month="Apr",
day="3",
volume="3",
number="1",
pages="e17142",
keywords="heart failure",
keywords="mobile health app",
keywords="self-management",
abstract="Background: Mobile health (mHealth) apps are dramatically changing how patients and providers manage and monitor chronic health conditions, especially in the area of self-monitoring.  African Americans have higher mortality rates from heart failure than other racial groups in the United States. Therefore, self-management of heart failure may improve health outcomes for African American patients. Objective: The aim of the present study was to determine the feasibility of using an mHealth app, and explore the outcomes of quality of life, including self-care maintenance, management, and confidence, among African American patients managing their condition after discharge with a diagnosis of heart failure. Methods: Prior to development of the app, we conducted qualitative interviews with 7 African American patients diagnosed with heart failure, 3 African American patients diagnosed with cardiovascular disease, and 6 health care providers (cardiologists, nurse practitioners, and a geriatrician) who worked with heart failure patients.  In addition, we asked 6 hospital chaplains to provide positive spiritual messages for the patients, since spirituality is an important coping method for many African Americans.  These formative data were then used for creating a prototype of the app, named Healthy Heart.  Specifically, the Healthy Heart app incorporated the following evidence-based features to promote self-management: one-way messages, journaling (ie, weight and symptoms), graphical display of data, and customized feedback (ie, clinical decision support) based on daily or weekly weight.  The educational messages about heart failure self-management were derived from the teaching materials provided to the patients diagnosed with heart failure, and included information on diet, sleep, stress, and medication adherence. The information was condensed and simplified to be appropriate for text messages and to meet health literacy standards.  Other messages were derived from interviews conducted during the formative stage of app development, including interviews with African American chaplains. Usability testing was conducted over a series of meetings between nurses, social workers, and computer engineers. A pilot one-group pretest-posttest design was employed with participants using the mHealth app for 4 weeks. Descriptive statistics were computed for each of the demographic variables, overall and subscales for Health Related Quality of Life Scale 14 (HQOL14) and subscales for the Self-Care of Heart Failure Index (SCHFI) Version 6 using frequencies for categorical measures and means with standard deviations for continuous measures.  Baseline and postintervention comparisons were computed using the Fisher exact test for overall health and paired t tests for HQOL14 and SCHFI questionnaire subscales. Results: A total of 12 African American participants (7 men, 5 women; aged 51-69 years) diagnosed with heart failure were recruited for the study. There was no significant increase in quality of life (P=.15), but clinically relevant changes in self-care maintenance, management, and confidence were observed. Conclusions: An mHealth app to assist with the self-management of heart failure is feasible in patients with low literacy, low health literacy, and limited smartphone experience. Based on the clinically relevant changes observed in this feasibility study of the Healthy Heart app, further research should explore effectiveness in this vulnerable population. ",
doi="10.2196/17142",
url="http://aging.jmir.org/2020/1/e17142/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32242822"
}


@Article{info:doi/10.2196/20321,
author="Shu, Sara
and Woo, P. Benjamin K.",
title="Digital Media as a Proponent for Healthy Aging in the Older Chinese American Population: Longitudinal Analysis",
journal="JMIR Aging",
year="2020",
month="Jun",
day="16",
volume="3",
number="1",
pages="e20321",
keywords="geriatrics",
keywords="health promotion",
keywords="health education",
keywords="social media",
keywords="Parkinson disease",
keywords="fall prevention",
keywords="oral health",
keywords="pulmonary disease",
keywords="gastrointestinal health",
abstract="Background: Ensuring health literacy among underserved populations is essential amid an aging population. Accessible and appropriate (both culturally and linguistically) information is important when considering digital media education for older Chinese Americans. Objective: This study aims to investigate how social media fare over time in disseminating health information and how we may most effectively educate this population. Methods: For this study, 5 geriatric-themed educational videos about Parkinson disease, fall prevention, gastrointestinal health, oral health, and pulmonary disease were uploaded to YouTube. Data were collected over a 40-month period. Descriptive statistics and chi-square analysis were used to compare results from the first and second 20-month periods. Results: In 40 months, the 5 videos in aggregate accrued 1171.1 hours of watch time, 7299 views, and an average view duration of 9.6 minutes. Comparing the first and second 20-month periods, there was a significant increase in mobile device usage, from 79.4\% (3541/4458) to 83.3\% (2367/2841). There was no significant difference in the usage of various external traffic sources and methods of sharing, with WhatsApp accounting for the majority of sharing in both 20-month periods. Conclusions: Our study provides insight into where to focus future strategies to optimize digital media content, and how to best recruit, direct, and disseminate health education to an older adult Chinese American population. Combining the success of YouTube, social media, and messaging platforms such as WhatsApp can help to transcend cultural and linguistic barriers to promote healthy aging. ",
doi="10.2196/20321",
url="http://aging.jmir.org/2020/1/e20321/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32543447"
}


@Article{info:doi/10.2196/15290,
author="Guo, Yuqi
and Yang, Fan
and Hu, Fei
and Li, Wei
and Ruggiano, Nicole
and Lee, Yun Hee",
title="Existing Mobile Phone Apps for Self-Care Management of People With Alzheimer Disease and Related Dementias: Systematic Analysis",
journal="JMIR Aging",
year="2020",
month="Jan",
day="24",
volume="3",
number="1",
pages="e15290",
keywords="alzheimer disease",
keywords="dementia",
keywords="self-care",
keywords="mobile phone apps",
abstract="Background: Alzheimer disease and related dementias (AD/RD) are progressive neurocognitive disorders that currently affect approximately 50 million people worldwide. Mobile phone apps have been well-integrated into daily lives and can be used to deliver and promote health care. There is an increase in the use of technology to provide care and support to AD/RD patients and their families. Objective: This study aimed to review apps designed for AD/RD patients and analyze the benefits of, and challenges to, such technological solutions. Methods: A systematic approach was applied to review the availability, content, features, and quality of mobile phone apps to support self-care among AD/RD patients. Results: The initial search for this review was conducted in January 2019, and the screening and analysis of the included apps were completed in May 2019. A total of 14 apps were included from an initial search of 245 apps. The top 3 features were alert (9/14, 64\%), self-care tips (6/14, 42\%), and social networking capacity (5/14, 35\%). On average, the readability of the apps was a tenth-grade reading level (SD 3.06). The overall quality was 3.71 out of 5 (SD 1.37). Conclusions: Our findings suggest that currently available apps for AD/RD patients may not meet complex needs and may be challenging to use, given the possible impaired communication ability associated with AD/RD. Therefore, high-quality apps need to be developed and rigorously evaluated for feasibility and efficacy. ",
doi="10.2196/15290",
url="http://aging.jmir.org/2020/1/e15290/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012045"
}


@Article{info:doi/10.2196/13513,
author="Johansson, Marcia
and Athilingam, Ponrathi",
title="A Dual-Pronged Approach to Improving Heart Failure Outcomes: A Quality Improvement Project",
journal="JMIR Aging",
year="2020",
month="Feb",
day="10",
volume="3",
number="1",
pages="e13513",
keywords="heart failure",
keywords="mobile messaging",
keywords="structured telephone support",
keywords="self-care management",
keywords="medication adherence",
keywords="quality improvement",
abstract="Background: Presently, 6.5 million Americans are living with heart failure (HF). These patients are expected to follow a complex self-management regimen at home. Several demographic and psychosocial factors limit patients with HF in following the prescribed self-management recommendations at home. Poor self-care is associated with increased hospital readmissions. Under the Affordable Care Act, there are financial implications related to hospital readmissions for hospitals and programs such as the Program of All-Inclusive Care for the Elderly (PACE) in Pinellas County, Florida. Previous studies and systematic reviews demonstrated improvement in self-management and quality of life (QoL) in patients with HF with structured telephone support (STS) and SMS text messaging. Objective: This study aimed to evaluate the effects of STS and SMS on self-care, knowledge, medication adherence, and QoL of patients with HF. Methods: A prospective quality improvement project using a pre-post design was implemented. Data were collected at baseline, 30 days, and 3 months from 51 patients with HF who were enrolled in PACE in Pinellas County, Florida. All participants received STS and SMS for 30 days. The feasibility and sustained benefit of using STS and SMS was assessed at a 3-month follow-up. Results: A paired t test was used to compare the mean difference in HF outcomes at the baseline and 30-day follow-up, which demonstrated improved HF self-care maintenance (t49=0.66; P=.01), HF knowledge (t49=0.71; P=.01), medication adherence (t49=0.92; P=.01), and physical and mental health measured using Short-Form-12 (SF-12; t49=0.81; P=.01). The results also demonstrated the sustained benefit with improved HF self-care maintenance, self-care management, self-care confidence, knowledge, medication adherence, and physical and mental health (SF-12) at 3 months with P<.05 for all outcomes. Living status and social support had a strong correlation with HF outcomes. Younger participants (aged less than 65 years) performed extremely well compared with older adults. Conclusions: STS and SMS were feasible to use among PACE participants with sustained benefits at 3 months. Implementing STS and SMS may serve as viable options to improve HF outcomes. Improving outcomes with HF affects hospital systems and the agencies that monitor and provide care for outpatients and those in independent or assisted-living facilities. Investigating viable options and support for implementation will improve outcomes. ",
doi="10.2196/13513",
url="https://aging.jmir.org/2020/1/e13513"
}


@Article{info:doi/10.2196/17136,
author="Wilson, Rozanne
and Cochrane, Diana
and Mihailidis, Alex
and Small, Jeff",
title="Mobile Apps to Support Caregiver-Resident Communication in Long-Term Care: Systematic Search and Content Analysis",
journal="JMIR Aging",
year="2020",
month="Apr",
day="8",
volume="3",
number="1",
pages="e17136",
keywords="mobile apps",
keywords="communication barrier",
keywords="dementia",
keywords="caregivers",
keywords="long-term care",
keywords="patient-centered care",
abstract="Background: In long-term residential care (LTRC), caregivers' attempts to provide person-centered care can be challenging when assisting residents living with a communication disorder (eg, aphasia) and/or a language-cultural barrier. Mobile communication technology, which includes smartphones and tablets and their software apps, offers an innovative solution for preventing and overcoming communication breakdowns during activities of daily living. There is a need to better understand the availability, relevance, and stability of commercially available communication apps (cApps) that could support person-centered care in the LTRC setting. Objective: This study aimed to (1) systematically identify and evaluate commercially available cApps that could support person-centered communication (PCC) in LTRC and (2) examine the stability of cApps over 2 years. Methods: We conducted systematic searches of the Canadian App Store (iPhone Operating System platform) in 2015 and 2017 using predefined search terms. cApps that met the study's inclusion criteria underwent content review and quality assessment. Results: Although the 2015 searches identified 519 unique apps, only 27 cApps were eligible for evaluation. The 2015 review identified 2 augmentative and alternative cApps and 2 translation apps as most appropriate for LTRC. Despite a 205\% increase (from 199 to 607) in the number of augmentative and alternative communication and translation apps assessed for eligibility in the 2017 review, the top recommended cApps showed suitability for LTRC and marketplace stability. Conclusions: The recommended existing cApps included some PCC features and demonstrated marketplace longevity. However, cApps that focus on the inclusion of more PCC features may be better suited for use in LTRC, which warrants future development. Furthermore, cApp content and quality would improve by including research evidence and experiential knowledge (eg, nurses and health care aides) to inform app development. cApps offer care staff a tool that could promote social participation and person-centered care. International Registered Report Identifier (IRRID): RR2-10.2196/10.2196/17136 ",
doi="10.2196/17136",
url="http://aging.jmir.org/2020/1/e17136/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32267236"
}


@Article{info:doi/10.2196/18754,
author="Guo, Yuqi
and Yang, Fan
and Hu, Fei
and Li, Wei
and Ruggiano, Nicole
and Lee, Yun Hee",
title="Correction: Existing Mobile Phone Apps for Self-Care Management of People With Alzheimer Disease and Related Dementias: Systematic Analysis",
journal="JMIR Aging",
year="2020",
month="May",
day="19",
volume="3",
number="1",
pages="e18754",
doi="10.2196/18754",
url="http://aging.jmir.org/2020/1/e18754/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32427566"
}