@Article{info:doi/10.2196/21608,
author="Dula, Nicole Adrienne
and Gealogo Brown, Gretchel
and Aggarwal, Aarushi
and Clark, L. Kal",
title="Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go?",
journal="JMIR Aging",
year="2020",
month="Oct",
day="21",
volume="3",
number="2",
pages="e21608",
keywords="stroke",
keywords="ischemic stroke",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="emergency medicine",
keywords="cerebrovascular",
doi="10.2196/21608",
url="http://aging.jmir.org/2020/2/e21608/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006936"
}


@Article{info:doi/10.2196/23176,
author="Schifeling, H. Christopher
and Shanbhag, Prajakta
and Johnson, Angene
and Atwater, C. Riannon
and Koljack, Claire
and Parnes, L. Bennett
and Vejar, M. Maria
and Farro, A. Samantha
and Phimphasone-Brady, Phoutdavone
and Lum, D. Hillary",
title="Disparities in Video and Telephone Visits Among Older Adults During the COVID-19 Pandemic: Cross-Sectional Analysis",
journal="JMIR Aging",
year="2020",
month="Nov",
day="10",
volume="3",
number="2",
pages="e23176",
keywords="telemedicine",
keywords="telehealth",
keywords="telephone",
keywords="videoconferencing",
keywords="health care disparities",
keywords="older adults",
keywords="geriatrics",
keywords="advance care planning",
keywords="advanced directives",
keywords="COVID-19",
keywords="coronavirus pandemic",
keywords="SARS-CoV-2",
keywords="primary care",
abstract="Background: Telephone and video telemedicine appointments have been a crucial service delivery method during the COVID-19 pandemic for maintaining access to health care without increasing the risk of exposure. Although studies conducted prior to the pandemic have suggested that telemedicine is an acceptable format for older adults, there is a paucity of data on the practical implementation of telemedicine visits. Due to prior lack of reimbursement for telemedicine visits involving nonrural patients, no studies have compared telephone visits to video visits in geriatric primary care. Objective: This study aimed to determine (1) whether video visits had longer durations, more visit diagnoses, and more advance care planning discussions than telephone visits during the rapid implementation of telemedicine in the COVID-19 pandemic, and (2) whether disparities in visit type existed based on patient characteristics. Methods: We conducted a retrospective, cross-sectional analysis of patients seen at two geriatric clinics from April 23 to May 22, 2020. Approximately 25\% of patients who had telephone and video appointments during this time underwent chart review. We analyzed patient characteristics, visit characteristics, duration of visits, number of visit diagnoses, and the presence of advance care planning discussion in clinical documentation. Results: Of the 190 appointments reviewed, 47.4\% (n=90) were video visits. Compared to telephone appointments, videoconferencing was, on average, 7 minutes longer (mean 37.3 minutes, SD 10 minutes; P<.001) and had, on average, 1.2 more visit diagnoses (mean 5.7, SD 3; P=.001). Video and telephone visits had similar rates of advance care planning. Furthermore, hearing, vision, and cognitive impairment did not result in different rates of video or telephone appointments. Non-White patients, patients who needed interpreter services, and patients who received Medicaid were less likely to have video visits than White patients, patients who did not need an interpreter, and patients who did not receive Medicaid, respectively (P=.003, P=.01, P<.001, respectively). Conclusions: Although clinicians spent more time on video visits than telephone visits, more than half of this study's older patients did not use video visits, especially if they were from racial or ethnic minority backgrounds or Medicaid beneficiaries. This potential health care disparity merits greater attention. ",
doi="10.2196/23176",
url="http://aging.jmir.org/2020/2/e23176/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33048821"
}


@Article{info:doi/10.2196/17286,
author="Abdi, Sarah
and de Witte, Luc
and Hawley, Mark",
title="Emerging Technologies With Potential Care and Support Applications for Older People: Review of Gray Literature",
journal="JMIR Aging",
year="2020",
month="Aug",
day="11",
volume="3",
number="2",
pages="e17286",
keywords="artificial intelligence",
keywords="internet of things",
keywords="mobile phone",
keywords="robotics",
keywords="emerging technologies",
keywords="older people",
keywords="care and support",
abstract="Background: The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care systems. Emerging technological developments have the potential to address some of the care and support challenges of older people. However, limited work has been done to identify emerging technological developments with the potential to meet the care and support needs of the aging population. Objective: This review aimed to gain an overview of emerging technologies with potential care and support applications for older people, particularly for those living at home. Methods: A scoping gray literature review was carried out by using the databases of 13 key organizations, hand searching reference lists of included documents, using funding data, and consulting technology experts. A narrative synthesis approach was used to analyze and summarize the findings of the literature review. Results: A total of 39 documents were included in the final analysis. From the analysis, 8 emerging technologies were identified that could potentially be used to meet older people's needs in various care and support domains. These emerging technologies were (1) assistive autonomous robots; (2) self-driving vehicles; (3) artificial intelligence--enabled health smart apps and wearables; (4) new drug release mechanisms; (5) portable diagnostics; (6) voice-activated devices; (7) virtual, augmented, and mixed reality; and (8) intelligent homes. These emerging technologies were at different levels of development, with some being trialed for care applications, whereas others being in the early phases of development. However, only a few documents mentioned including older people during the process of designing and developing these technologies. Conclusions: This review has identified key emerging technologies with the potential to contribute to the support and care needs of older people. However, to increase the adoption of these technologies by older people, there is a need to involve them and other stakeholders, such as formal and informal carers, in the process of designing and developing these technologies. ",
doi="10.2196/17286",
url="http://aging.jmir.org/2020/2/e17286/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32780020"
}


@Article{info:doi/10.2196/18008,
author="Bayat, Sayeh
and Naglie, Gary
and Rapoport, J. Mark
and Stasiulis, Elaine
and Chikhaoui, Belkacem
and Mihailidis, Alex",
title="Inferring Destinations and Activity Types of Older Adults From GPS Data: Algorithm Development and Validation",
journal="JMIR Aging",
year="2020",
month="Jul",
day="28",
volume="3",
number="2",
pages="e18008",
keywords="outdoor mobility",
keywords="older adults",
keywords="GPS",
keywords="life space",
keywords="activity types",
keywords="machine learning",
abstract="Background: Outdoor mobility is an important aspect of older adults' functional status. GPS has been used to create indicators reflecting the spatiotemporal dimensions of outdoor mobility for applications in health and aging. However, outdoor mobility is a multidimensional construct. There is, as of yet, no classification algorithm that groups and characterizes older adults' outdoor mobility based on its semantic aspects (ie, mobility intentions and motivations) by integrating geographic and domain knowledge. Objective: This study assesses the feasibility of using GPS to determine semantic dimensions of older adults' outdoor mobility, including destinations and activity types. Methods: A total of 5 healthy individuals, aged 65 years or older, carried a GPS device when traveling outside their homes for 4 weeks. The participants were also given a travel diary to record details of all excursions from their homes, including date, time, and destination information. We first designed and implemented an algorithm to extract destinations and infer activity types (eg, food, shopping, and sport) from the GPS data. We then evaluated the performance of the GPS-derived destination and activity information against the traditional diary method. Results: Our results detected the stop locations of older adults from their GPS data with an F1 score of 87\%. On average, the extracted home locations were within a 40.18-meter (SD 1.18) distance of the actual home locations. For the activity-inference algorithm, our results reached an F1 score of 86\% for all participants, suggesting a reasonable accuracy against the travel diary recordings. Our results also suggest that the activity inference's accuracy measure differed by neighborhood characteristics (ie, Walk Score). Conclusions: We conclude that GPS technology is accurate for determining semantic dimensions of outdoor mobility. However, further improvements may be needed to develop a robust application of this system that can be adopted in clinical practice. ",
doi="10.2196/18008",
url="http://aging.jmir.org/2020/2/e18008/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32720647"
}


@Article{info:doi/10.2196/19554,
author="Wilmink, Gerald
and Dupey, Katherine
and Alkire, Schon
and Grote, Jeffrey
and Zobel, Gregory
and Fillit, M. Howard
and Movva, Satish",
title="Artificial Intelligence--Powered Digital Health Platform and Wearable Devices Improve Outcomes for Older Adults in Assisted Living Communities: Pilot Intervention Study",
journal="JMIR Aging",
year="2020",
month="Sep",
day="10",
volume="3",
number="2",
pages="e19554",
keywords="health technology",
keywords="artificial intelligence",
keywords="AI",
keywords="preventive",
keywords="senior technology",
keywords="assisted living",
keywords="long-term services",
keywords="long-term care providers",
abstract="Background: Wearables and artificial intelligence (AI)--powered digital health platforms that utilize machine learning algorithms can autonomously measure a senior's change in activity and behavior and may be useful tools for proactive interventions that target modifiable risk factors. Objective: The goal of this study was to analyze how a wearable device and AI-powered digital health platform could provide improved health outcomes for older adults in assisted living communities. Methods: Data from 490 residents from six assisted living communities were analyzed retrospectively over 24 months. The intervention group (+CP) consisted of 3 communities that utilized CarePredict (n=256), and the control group (--CP) consisted of 3 communities (n=234) that did not utilize CarePredict. The following outcomes were measured and compared to baseline: hospitalization rate, fall rate, length of stay (LOS), and staff response time. Results: The residents of the +CP and --CP communities exhibit no statistical difference in age (P=.64), sex (P=.63), and staff service hours per resident (P=.94). The data show that the +CP communities exhibited a 39\% lower hospitalization rate (P=.02), a 69\% lower fall rate (P=.01), and a 67\% greater length of stay (P=.03) than the --CP communities. The staff alert acknowledgment and reach resident times also improved in the +CP communities by 37\% (P=.02) and 40\% (P=.02), respectively. Conclusions: The AI-powered digital health platform provides the community staff with actionable information regarding each resident's activities and behavior, which can be used to identify older adults that are at an increased risk for a health decline. Staff can use this data to intervene much earlier, protecting seniors from conditions that left untreated could result in hospitalization. In summary, the use of wearables and AI-powered digital health platform can contribute to improved health outcomes for seniors in assisted living communities. The accuracy of the system will be further validated in a larger trial. ",
doi="10.2196/19554",
url="http://aging.jmir.org/2020/2/e19554/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32723711"
}


@Article{info:doi/10.2196/19527,
author="Robinson, A. Stephanie
and Wan, S. Emily
and Shimada, L. Stephanie
and Richardson, R. Caroline
and Moy, L. Marilyn",
title="Age and Attitudes Towards an Internet-Mediated, Pedometer-Based Physical Activity Intervention for Chronic Obstructive Pulmonary Disease: Secondary Analysis",
journal="JMIR Aging",
year="2020",
month="Sep",
day="9",
volume="3",
number="2",
pages="e19527",
keywords="aging",
keywords="COPD",
keywords="chronic conditions",
keywords="physical activity",
keywords="eHealth",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is prevalent among older adults. Promoting physical activity and increasing exercise capacity are recommended for all individuals with COPD. Pulmonary rehabilitation is the standard of care to improve exercise capacity, although there are barriers that hinder accessibility. Technology has the potential to overcome some of these barriers, but it is unclear how aging adults with a chronic disease like COPD perceive technology-based platforms to support their disease self-management. Objective: Guided by the unified theory of acceptance and use of technology, the current retrospective secondary analysis explores if age moderates multiple factors that influence an individual with COPD's openness toward an internet-mediated, pedometer-based physical activity intervention. Methods: As part of an efficacy study, participants with COPD (N=59) were randomly assigned to use an internet-mediated, pedometer-based physical activity intervention for 12 weeks. At completion, they were asked about their experience with the intervention using a survey, including their performance expectancy and effort expectancy, facilitating conditions (ie, internet use frequency and ability), and use of the intervention technology. Logistic regression and general linear modeling examined the associations between age and these factors. Results: Participants ranged in age from 49 to 89 years (mean 68.66, SD 8.93). Disease severity was measured by forced expiratory volume in the first second percent predicted (mean 60.01, SD 20.86). Nearly all participants (54/59) believed the intervention was useful. Regarding effort expectancy, increasing age was associated with reporting that it was easy to find the time to engage in the intervention. Regarding facilitating conditions, approximately half of the participants believed the automated step count goals were too high (23/59) and many did not feel comfortable reaching their goals (22/59). The probability of these perceptions increased with age, even after accounting for disease severity. Age was not associated with other facilitating conditions or use of the technology. Conclusions: Age does not influence performance expectancy or use of technology with an internet-mediated, pedometer-based physical activity intervention. Age is associated with certain expectations of effort and facilitating conditions. Consideration of age of the user is needed when personalizing step count goals and time needed to log in to the website. Trial Registration: ClinicalTrials.gov NCT01772082; https://clinicaltrials.gov/ct2/show/NCT01772082 ",
doi="10.2196/19527",
url="http://aging.jmir.org/2020/2/e19527/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32902390"
}


@Article{info:doi/10.2196/19852,
author="Bartels, Laureen Sara
and van Knippenberg, M. Rosalia J.
and Malinowsky, Camilla
and Verhey, J. Frans R.
and de Vugt, E. Marjolein",
title="Smartphone-Based Experience Sampling in People With Mild Cognitive Impairment: Feasibility and Usability Study",
journal="JMIR Aging",
year="2020",
month="Oct",
day="16",
volume="3",
number="2",
pages="e19852",
keywords="experience sampling method",
keywords="mild cognitive impairment",
keywords="cognition",
keywords="feasibility",
keywords="smartphones",
abstract="Background: Daily functioning of people with cognitive disorders such as mild cognitive impairment (MCI) is usually depicted by retrospective questionnaires, which can be memory-biased and neglect fluctuations over time or contexts. Objective: This study examines the feasibility and usability of applying the experience sampling method (ESM) in people with MCI to provide a detailed and dynamic picture of behavioral, emotional, and cognitive patterns in everyday life. Methods: For 6 consecutive days, 21 people with MCI used an ESM app on their smartphones. At 8 semi-random timepoints per day, participants filled in momentary questionnaires on mood, activities, social context, and subjective cognitive complaints. Feasibility was determined through self-reports and observable human-technology interactions. Usability was demonstrated on an individual and group level. Results: Of the 21 participants, 3 dropped out due to forgetting to carry their smartphones or forgetting the study instructions. In the remaining 18 individuals, the compliance rate was high, at 78.7\%. Participants reported that momentary questions reflected their daily experiences well. Of the 18 participants, 13 (72\%) experienced the increase in awareness of their own memory functions as pleasant or neutral. Conclusions: Support was found for the general feasibility of smartphone-based experience sampling in people with MCI. However, many older adults with MCI are currently not in possession of smartphones, and study adherence seems challenging for a minority of individuals. Momentary data can increase the insights into daily patterns and may guide the person-tailored development of self-management strategies in clinical settings. ",
doi="10.2196/19852",
url="http://aging.jmir.org/2020/2/e19852/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33064084"
}


@Article{info:doi/10.2196/21964,
author="Choi, K. Yong
and Thompson, J. Hilaire
and Demiris, George",
title="Use of an Internet-of-Things Smart Home System for Healthy Aging in Older Adults in Residential Settings: Pilot Feasibility Study",
journal="JMIR Aging",
year="2020",
month="Nov",
day="10",
volume="3",
number="2",
pages="e21964",
keywords="Internet of Things",
keywords="smart home",
keywords="independent living",
keywords="aging",
keywords="healthy aging",
abstract="Background: The Internet-of-Things (IoT) technologies can create smart residences that integrate technology within the home to enhance residents' safety as well as monitor their health and wellness. However, there has been little research on real-world testing of IoT smart home devices with older adults, and the feasibility and acceptance of such tools have not been systematically examined. Objective: This study aims to conduct a pilot study to investigate the feasibility of using IoT smart home devices in the actual residences of older adults to facilitate healthy aging. Methods: We conducted a 2-month feasibility study on community-dwelling older adults. Participants chose among different IoT devices to be installed and deployed within their homes. The IoT devices tested varied depending on the participant's preference: a door and window sensor, a multipurpose sensor (motion, temperature, luminosity, and humidity), a voice-operated smart speaker, and an internet protocol (IP) video camera. Results: We recruited a total of 37 older adults for this study, with 35 (95\%) successfully completing all procedures in the 2-month study. The average age of the sample was 78 (SD 9) years and primarily comprised women (29/37, 78\%), those who were educated (31/37, 86\%; bachelor's degree or higher), and those affected by chronic conditions (33/37, 89\%). The most widely chosen devices among the participants were multipurpose sensors and smart speakers. An IP camera was a significantly unpopular choice among participants in both phases. The participant feedback suggests that perceived privacy concerns, perceived usefulness, and curiosity to technology were strong factors when considering which device to have installed in their home. Conclusions: Overall, our deployment results revealed that the use of IoT smart home devices is feasible in actual residences of older adults. These findings may inform the follow-up assessment of IoT technologies and their impact on health-related outcomes and advance our understanding of the role of IoT home-based monitoring technologies to promote successful aging-in-place for older adults. Future trials should consider older adults' preferences for the different types of smart home devices to be installed in real-world residential settings. ",
doi="10.2196/21964",
url="http://aging.jmir.org/2020/2/e21964/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33170128"
}


@Article{info:doi/10.2196/17105,
author="Rai, Kaur Harleen
and Schneider, Justine
and Orrell, Martin",
title="An Individual Cognitive Stimulation Therapy App for People With Dementia: Development and Usability Study of Thinkability",
journal="JMIR Aging",
year="2020",
month="Nov",
day="16",
volume="3",
number="2",
pages="e17105",
keywords="dementia",
keywords="cognitive stimulation therapy",
keywords="eHealth",
keywords="development",
abstract="Background: There is a lack of technological resources for the mental stimulation and communication of people with dementia, which can be helpful in improving cognition and quality of life. Paper-based individual cognitive stimulation therapy (iCST) for people with dementia has the potential to be adapted to a touchscreen format. This can improve accessibility and provide mental stimulation using interactive features. There is a need for a rigorous and systematic approach toward development, leading to improved suitability and implementation of the intervention, so that more people can benefit from its use. Objective: This study aims to develop and investigate the usability of Thinkability, an iCST app that can be used by people with dementia and carers on touchscreen tablets. Methods: The Medical Research Council framework for evaluating complex interventions and the Centre for eHealth Research roadmap served as frameworks for the stages of intervention and technology development. The development of the iCST app itself adopted an agile approach with elements from action research. Hence, it was developed in 3 successive sprints and was evaluated by relevant stakeholders at each sprint. Sprint 1 included 2 patient and public involvement (PPI) consultation meetings, sprint 2 included 1 PPI consultation meeting, and 4 focus groups and 10 individual interviews were organized in sprint 3. A feasibility trial is currently underway. Results: The findings from each sprint were used to inform the development. Sprint 1 helped to identify the relevant evidence base and explored the attitudes of people with dementia and carers toward a potential iCST app. In sprint 2, an initial prototype was evaluated in a small PPI consultation meeting. In sprint 3, feedback was gathered through a qualitative study on the quality and perceived effectiveness of the iCST app. It was well received by people with dementia and carers. A need for more updated and personalized content was highlighted. Conclusions: This study proves that an agile approach toward technology development involving all relevant stakeholders is effective in creating suitable technology. Adding to our previous knowledge of noncomputerized cognitive stimulation therapy, the release of the iCST app will make this psychosocial intervention accessible to more users worldwide. ",
doi="10.2196/17105",
url="http://aging.jmir.org/2020/2/e17105/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33196451"
}


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


@Article{info:doi/10.2196/20310,
author="Hassan, Ibrahim Alhassan Yosri",
title="Challenges and Recommendations for the Deployment of Information and Communication Technology Solutions for Informal Caregivers: Scoping Review",
journal="JMIR Aging",
year="2020",
month="Jul",
day="29",
volume="3",
number="2",
pages="e20310",
keywords="informal caregivers",
keywords="ICT",
keywords="digital health",
keywords="eHealth",
keywords="health economics",
keywords="internet",
keywords="health technology",
keywords="ageing",
keywords="home care",
keywords="digital solutions",
abstract="Background: Information and communication technology (ICT)--based solutions have the potential to support informal caregivers in home care delivery. However, there are many challenges to the deployment of these solutions. Objective: The aim of this study was to review literature to explore the challenges of the deployment of ICT-based support solutions for informal caregivers and provide relevant recommendations on how to overcome these challenges. Methods: A scoping review methodology was used following the Arksey and O'Malley methodological framework to map the relevant literature. A search was conducted using PubMed, IEEE library, and Scopus. Publication screening and scrutiny were conducted following inclusion criteria based on inductive thematic analysis to gain insight into patterns of challenges rising from deploying ICT-based support solutions for informal caregivers. The analysis took place through an iterative process of combining, categorizing, summarizing, and comparing information across studies. Through this iterative process, relevant information was identified and coded under emergent broader themes as they pertain to each of the research questions. Results: The analysis identified 18 common challenges using a coding scheme grouping them under four thematic categories: technology-related, organizational, socioeconomic, and ethical challenges. These range from specific challenges related to the technological component of the ICT-based service such as design and usability of technology, to organizational challenges such as fragmentation of support solutions to socioeconomic challenges such as funding of technology and sustainability of solutions to ethical challenges around autonomy and privacy of data. For each identified challenge, recommendations were created on how to overcome it. The recommendations from this study can provide guidance for the deployment of ICT-based support solutions for informal caregivers. Conclusions: Despite a growing interest in the potential offered by ICT solutions for informal caregiving, diverse and overlapping challenges to their deployment still remain. Designers for ICTs for informal caregivers should follow participatory design and involve older informal caregivers in the design process as much as possible. A collaboration between designers and academic researchers is also needed to ensure ICT solutions are designed with the current empirical evidence in mind. Taking actions to build the digital skills of informal caregivers early in the caregiving process is crucial for optimal use of available ICT solutions. Moreover, the lack of awareness of the potential added-value and trust toward ICT-based support solutions requires strategies to raise awareness among all stakeholders---including policy makers, health care professionals, informal caregivers, and care recipients---about support opportunities offered by ICT. On the macro-level, policies to fund ICT solutions that have been shown to be effective at supporting and improving informal caregiver health outcomes via subsidies or other incentives should be considered. ",
doi="10.2196/20310",
url="http://aging.jmir.org/2020/2/e20310/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32723720"
}


@Article{info:doi/10.2196/21264,
author="Levinson, J. Anthony
and Ayers, Stephanie
and Butler, Lianna
and Papaioannou, Alexandra
and Marr, Sharon
and Sztramko, Richard",
title="Barriers and Facilitators to Implementing Web-Based Dementia Caregiver Education From the Clinician's Perspective: Qualitative Study",
journal="JMIR Aging",
year="2020",
month="Oct",
day="2",
volume="3",
number="2",
pages="e21264",
keywords="dementia",
keywords="caregiver",
keywords="online education",
keywords="implementation science",
keywords="internet",
keywords="eHealth",
abstract="Background: Internet-based dementia caregiver interventions have been shown to be effective for a range of caregiver outcomes; however, little is known about how to best implement them. We developed iGeriCare, an evidence-based, multimedia, web-based educational resource for family caregivers of people living with dementia. Objective: This study aims to obtain feedback and opinions from experts and clinicians involved in dementia care and caregiver education about 1 iGeriCare and 2 barriers and facilitators to implementing a web-based caregiver program. Methods: We carried out semistructured interviews with individuals who had a role in dementia care and/or caregiver education in several key stakeholder settings in Southern Ontario, Canada. We queried participants' perceptions of iGeriCare, caregiver education, the implementation process, and their experience with facilitators and barriers. Transcripts were coded and analyzed using a grounded theory approach. The themes that emerged were organized using the Consolidated Framework for Implementation Research. Results: A total of 12 participants from a range of disciplines described their perceptions of iGeriCare and identified barriers and facilitators to the implementation of the intervention. The intervention was generally perceived as a high-quality resource for caregiver education and support, with many stakeholders highlighting the relative advantage of a web-based format. The intervention was seen to meet dementia caregiver needs, partially because of its flexibility, accessibility, and compatibility within existing clinical workflows. In addition, the intervention helps to overcome time constraints for both caregivers and clinicians. Conclusions: Study findings indicate a generally positive response to the use of internet-based interventions for dementia caregiver education. Results suggest that iGeriCare may be a useful clinical resource to complement traditional face-to-face and print material--based caregiver education. More comprehensive studies are required to identify the effectiveness and longevity of web-based caregiver education interventions and to better understand barriers and facilitators with regard to the implementation of technology-enhanced caregiver educational interventions in various health care settings. ",
doi="10.2196/21264",
url="http://aging.jmir.org/2020/2/e21264/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006563"
}


@Article{info:doi/10.2196/17182,
author="Appalasamy, Rani Jamuna
and Joseph, Pauline Joyce
and Seeta Ramaiah, Siva
and Md Zain, Zaini Anuar
and Quek, Fatt Kia
and Tha, Kyi Kyi",
title="Video Narratives Intervention Among Stroke Survivors: Feasibility and Acceptability Study of a Randomized Controlled Trial",
journal="JMIR Aging",
year="2020",
month="Jul",
day="10",
volume="3",
number="2",
pages="e17182",
keywords="feasibility and acceptability",
keywords="medication understanding",
keywords="use self-efficacy",
keywords="stroke",
keywords="video narratives",
abstract="Background: A large number of stroke survivors worldwide suffer from moderate to severe disability. In Malaysia, long-term uncontrolled stroke risk factors lead to unforeseen rates of recurrent stroke and a growing incidence of stroke occurrence across ages, predominantly among the elderly population. This situation has motivated research efforts focused on tapping into patient education, especially related to patient self-efficacy of understanding and taking medication appropriately. Video narratives integrated with health belief model constructs have demonstrated potential impacts as an aide to patient education efforts. Objective: The aim of this study was to investigate the feasibility and acceptability of study procedures based on a randomized controlled trial protocol of a video narratives intervention among poststroke patients. We also aimed to obtain preliminary findings of video narratives related to medication understanding and use self-efficacy (MUSE) and blood pressure control. Methods: A parallel group randomized controlled trial including a control group (without video viewing) and an intervention group (with video viewing) was conducted by researchers at a neurology outpatient clinic on poststroke patients (N=54). Baseline data included patients' sociodemographic characteristics, medical information, and all outcome measures. Measurements of MUSE and blood pressure following the trial were taken during a 3-month follow-up period. Feasibility of the trial was assessed based on recruitment and study completion rates along with patients' feedback on the burden of the study procedures and outcome measures. Acceptability of the trial was analyzed qualitatively. Statistical analysis was applied to ascertain the preliminary results of video narratives. Results: The recruitment rate was 60 out of 117 patients (51.3\%). Nevertheless, the dropout rate of 10\% was within the acceptable range. Patients were aged between 21 and 74 years. Nearly 50 of the patients (>85\%) had adequate health literacy and exposure to stroke education. Most of the patients (>80\%) were diagnosed with ischemic stroke, whereby the majority had primary hypertension. The technicalities of randomization and patient approach were carried out with minimal challenge and adequate patient satisfaction. The video contents received good responses with respect to comprehension and simplicity. Moreover, an in-depth phone interview with 8 patients indicated that the video narratives were considered to be useful and inspiring. These findings paralleled the preliminary findings of significant improvement within groups in MUSE (P=.001) and systolic blood pressure control (P=.04). Conclusions: The queries and feedback from each phase in this study have been acknowledged and will be taken forward in the full trial. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN 12618000174280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373554 ",
doi="10.2196/17182",
url="https://aging.jmir.org/2020/2/e17182",
url="http://www.ncbi.nlm.nih.gov/pubmed/32469839"
}


@Article{info:doi/10.2196/25607,
author="Stephens, Alastair
and Rudd, Hannah
and Stephens, Emilia
and Ward, Jayne",
title="Secondary Prevention of Hip Fragility Fractures During the COVID-19 Pandemic: Service Evaluation of ``MRS BAD BONES''",
journal="JMIR Aging",
year="2020",
month="Dec",
day="22",
volume="3",
number="2",
pages="e25607",
keywords="osteoporosis",
keywords="fragility fracture",
keywords="guideline",
keywords="mnemonic",
keywords="acronym",
keywords="COVID-19",
keywords="bone",
keywords="morbidity",
keywords="mortality",
keywords="fracture",
keywords="elderly",
keywords="older adults",
keywords="geriatrics",
keywords="audit",
keywords="prevention",
abstract="Background: Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians. Objective: This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population. Methods: A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, ``MRS BAD BONES,'' which addressed key factors in the assessment and management of osteoporosis: medication review, rheumatology/renal advice, smoking cessation; blood tests, alcohol limits, DEXA (dual energy X-ray absorptiometry) scan; bone-sparing medications, orthogeriatric review, nutrition, exercise, supplements. The Fisher exact test was used for comparison analyses between each phase. Results: Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88\% (n=44) of patients prelockdown, which fell to 0\% due to redeployment, before recovering to 38\% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6\% (n=40) to 58.0\% (n=29) (P=.02); of bone-sparing medications from 60.7\% (n=17) to 18.2\% (n=4) (P=.004), and DEXA scan requests from 40.1\% (n=9) to 3.6\% (n=1) (P=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7\% (n=42) (P=.003), bone-sparing medications to 72.4\% (n=21) (P<.001), and DEXA scan requests to 60\% (n=12) (P<.001). Conclusions: The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The ``MRS BAD BONES'' mnemonic significantly improved management and could be used in a wider setting. ",
doi="10.2196/25607",
url="https://aging.jmir.org/2020/2/e25607",
url="http://www.ncbi.nlm.nih.gov/pubmed/33326412"
}