@Article{info:doi/10.2196/29188,
author="Yin, Zenong
and Martinez, E. Cristina
and Li, Shiyu
and Martinez, Martha
and Peng, Kezhi
and Land, M. William
and Ullevig, L. Sarah
and Cantu, Adelita
and Falk, Sharon
and Hern{\'a}ndez, E. Arthur
and Ortega, Catherine
and Parra-Medina, Deborah
and Simmonds, J. Maureen",
title="Adapting Chinese Qigong Mind-Body Exercise for Healthy Aging in Older Community-Dwelling Low-income Latino Adults: Pilot Feasibility Study",
journal="JMIR Aging",
year="2021",
month="Nov",
day="1",
volume="4",
number="4",
pages="e29188",
keywords="mHealth",
keywords="community-based participatory research",
keywords="five animal play",
keywords="wuqinxi",
abstract="Background: Research translating the evidence for the benefit of mind-body exercise in older Latinos with limited access to community-based healthy aging programs is sparse. Objective: This study aimed to evaluate the feasibility of Function Improvement Exercises for Older Sedentary Community-Dwelling Latino Residents (FITxOlder), a Community Health Worker (CHW)-led, mobile technology-facilitated Chinese Qigong mind-body exercise program for healthy aging and to explore its impact on physical and cognitive function and quality of life (QoL) in older community-dwelling low-income Latino adults. Methods: This study was designed as a Stage 1 feasibility study to develop and pilot-test FITxOlder. In Phase 1 (Stage 1A), a working group of seniors, CHWs, and senior center staff guided the adaptation of Chinese Qigong into a healthy aging program. In Phase 2 (Stage 1B), 49 older Latino adults participated in a 3-arm controlled study to test the feasibility and preliminary effect of CHW-led FITxOlder on physical and cognitive function and QoL measures over 16 weeks. Results: Although the COVID-19 pandemic disrupted the implementation of the study protocol, we found favorable results regarding participant recruitment, retention, and fidelity of implementation. Notable findings included an 89.3\% participant retention, 79.4\% of the participants completed at least 70\% of the weekly exercise goal, and no report of adverse events. The effects on intervention outcome measures were modest. Conclusions: FITxOlder is feasible for promoting healthy aging in older Latino adults; future research needs to compare its feasibility with other low-impact exercise programs for healthy aging using a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04284137; https://clinicaltrials.gov/ct2/show/NCT04284137 ",
doi="10.2196/29188",
url="https://aging.jmir.org/2021/4/e29188",
url="http://www.ncbi.nlm.nih.gov/pubmed/34723824"
}


@Article{info:doi/10.2196/15220,
author="Elavsky, Steriani
and Klocek, Adam
and Knapova, Lenka
and Smahelova, Martina
and Smahel, David
and Cimler, Richard
and Kuhnova, Jitka",
title="Feasibility of Real-time Behavior Monitoring Via Mobile Technology in Czech Adults Aged 50 Years and Above: 12-Week Study With Ecological Momentary Assessment",
journal="JMIR Aging",
year="2021",
month="Nov",
day="10",
volume="4",
number="4",
pages="e15220",
keywords="mHealth",
keywords="mobile phone",
keywords="older adults",
keywords="health behavior",
keywords="physical activity",
keywords="Fitbit",
abstract="Background: Czech older adults have lower rates of physical activity than the average population and lag behind in the use of digital technologies, compared with their peers from other European countries. Objective: This study aims to assess the feasibility of intensive behavior monitoring through technology in Czech adults aged ?50 years. Methods: Participants (N=30; mean age 61.2 years, SD 6.8 years, range 50-74 years; 16/30, 53\% male; 7/30, 23\% retired) were monitored for 12 weeks while wearing a Fitbit Charge 2 monitor and completed three 8-day bursts of intensive data collection through surveys presented on a custom-made mobile app. Web-based surveys were also completed before and at the end of the 12-week period (along with poststudy focus groups) to evaluate participants' perceptions of their experience in the study. Results: All 30 participants completed the study. Across the three 8-day bursts, participants completed 1454 out of 1744 (83\% compliance rate) surveys administered 3 times per day on a pseudorandom schedule, 451 out of 559 (81\% compliance rate) end-of-day surveys, and 736 episodes of self-reported planned physical activity (with 29/736, 3.9\% of the reports initiated but returned without data). The overall rating of using the mobile app and Fitbit was above average (74.5 out of 100 on the System Usability Scale). The majority reported that the Fitbit (27/30, 90\%) and mobile app (25/30, 83\%) were easy to use and rated their experience positively (25/30, 83\%). Focus groups revealed that some surveys were missed owing to notifications not being noticed or that participants needed a longer time window for survey completion. Some found wearing the monitor in hot weather or at night uncomfortable, but overall, participants were highly motivated to complete the surveys and be compliant with the study procedures. Conclusions: The use of a mobile survey app coupled with a wearable device appears feasible for use among Czech older adults. Participants in this study tolerated the intensive assessment schedule well, but lower compliance may be expected in studies of more diverse groups of older adults. Some difficulties were noted with the pairing and synchronization of devices on some types of smartphones, posing challenges for large-scale studies. ",
doi="10.2196/15220",
url="https://aging.jmir.org/2021/4/e15220",
url="http://www.ncbi.nlm.nih.gov/pubmed/34757317"
}


@Article{info:doi/10.2196/27645,
author="Gell, Nancy
and Hoffman, Elise
and Patel, Kushang",
title="Technology Support Challenges and Recommendations for Adapting an Evidence-Based Exercise Program for Remote Delivery to Older Adults: Exploratory Mixed Methods Study",
journal="JMIR Aging",
year="2021",
month="Dec",
day="9",
volume="4",
number="4",
pages="e27645",
keywords="tele-exercise",
keywords="technology",
keywords="older adults",
keywords="adult learning theory",
keywords="knee osteoarthritis",
keywords="mobile phone",
abstract="Background: Tele-exercise has emerged as a means for older adults to participate in group exercise during the COVID-19 pandemic. However, little is known about the technology support needs of older adults for accessing tele-exercise. Objective: This study aims to examine the needs of older adults for transition to tele-exercise, identify barriers to and facilitators of tele-exercise uptake and continued participation, and describe technology support challenges and successes encountered by older adults starting tele-exercise. Methods: We used an exploratory, sequential mixed methods study design. Participants were older adults with symptomatic knee osteoarthritis (N=44) who started participating in a remotely delivered program called Enhance Fitness. Before the start of the classes, a subsample of the participants (n=10) completed semistructured phone interviews about their technology support needs and the barriers to and facilitators for technology adoption. All of the participants completed the surveys including the Senior Technology Acceptance Model scale and a technology needs assessment. The study team recorded the technology challenges encountered and the attendance rates for 48 sessions delivered over 16 weeks. Results: Four themes emerged from the interviews: participants desire features in a tele-exercise program that foster accountability, direct access to helpful people who can troubleshoot and provide guidance with technology is important, opportunities to participate in high-value activities motivate willingness to persevere through the technology concerns, and belief in the ability to learn new things supersedes technology-related frustration. Among the participants in the tele-exercise classes (mean age 74, SD 6.3 years; 38/44, 86\% female; mean 2.5, SD 0.9 chronic conditions), 71\% (31/44) had a computer with a webcam, but 41\% (18/44) had little or no experience with videoconferencing. The initial technology orientation sessions lasted on average 19.3 (SD 10.3) minutes, and 24\% (11/44) required a follow-up assistance call. During the first 2 weeks of tele-exercise, 47\% of participants (21/44) required technical assistance, which decreased to 12\% (5/44) during weeks 3 to 16. The median attendance was 100\% for the first 6 sessions and 93\% for the subsequent 42 sessions. Conclusions: With appropriate support, older adults can successfully participate in tele-exercise. Recommendations include individualized technology orientation sessions, experiential learning, and availability of standby technical assistance, particularly during the first 2 weeks of classes. Continued development of best practices in this area may allow previously hard-to-reach populations of older adults to participate in health-enhancing, evidence-based exercise programs. ",
doi="10.2196/27645",
url="https://aging.jmir.org/2021/4/e27645",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889743"
}


@Article{info:doi/10.2196/30420,
author="Pan, Jing
and Dong, Hua
and Bryan-Kinns, Nick",
title="Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation",
journal="JMIR Aging",
year="2021",
month="Nov",
day="19",
volume="4",
number="4",
pages="e30420",
keywords="older adults",
keywords="mHealth",
keywords="initial adoption",
keywords="technology acceptance",
keywords="design",
keywords="mobile phone",
abstract="Background: Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective: The aims of this study are to understand older adults' perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods: This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults' perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results: In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults' perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults' adoption of mHealth services. Conclusions: The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults. ",
doi="10.2196/30420",
url="https://aging.jmir.org/2021/4/e30420",
url="http://www.ncbi.nlm.nih.gov/pubmed/34807836"
}


@Article{info:doi/10.2196/29074,
author="Raj, Minakshi
and Iott, Bradley",
title="Evaluation of Family Caregivers' Use of Their Adult Care Recipient's Patient Portal From the 2019 Health Information National Trends Survey: Secondary Analysis",
journal="JMIR Aging",
year="2021",
month="Oct",
day="4",
volume="4",
number="4",
pages="e29074",
keywords="informal caregivers",
keywords="family caregivers",
keywords="patient portal",
keywords="electronic health record",
keywords="telehealth",
keywords="aging in place",
keywords="web-based medical record",
abstract="Background: Patient engagement is critical for realizing the value of telehealth modalities such as the patient portal. Family caregiver engagement may also be critical for facilitating the use of the patient portal among adult patients, including older adults. Objective: This study aims to analyze the 2019 Health Information National Trends Survey to characterize family caregivers' use of their care recipient's patient portal in terms of sociodemographic, health, and caregiving characteristics and caregivers' use of their own portal. Methods: We conducted a secondary analysis of cross-sectional data from the National Cancer Institute's Health Information National Trends Survey 5 Cycle 3. This survey was administered to 5438 US adults between January and May 2019. We analyzed data from 320 respondents who were identified as family caregivers. We created measures to reflect family caregivers' use of their care recipient's and their own portal, caregiver demographic and caregiving characteristics, and care recipient health characteristics. Results: Over half of the caregivers (179/320, 55.9\%) reported using their own portal at least once, whereas only one-third (105/320, 32.8\%) reported using their care recipient's record in the previous 12 months. Caregivers using their own portal were significantly more likely to use their care recipient's portal (odds ratio 11.18; P<.001). Conclusions: Policies should enable patients to designate family caregivers who can access their patient portal. Providers could screen caregivers for challenges in their caregiving responsibilities that may be addressed through the portal so they can better support their adult relatives. Interventions to support family caregivers, especially older caregivers, in using their own portal may facilitate their use of their care recipient's portal. ",
doi="10.2196/29074",
url="https://aging.jmir.org/2021/4/e29074",
url="http://www.ncbi.nlm.nih.gov/pubmed/34605766"
}


@Article{info:doi/10.2196/30841,
author="Bastoni, Sofia
and Wrede, Christian
and da Silva, Cristina Marcia
and Sanderman, Robbert
and Gaggioli, Andrea
and Braakman-Jansen, Annemarie
and van Gemert-Pijnen, Lisette",
title="Factors Influencing Implementation of eHealth Technologies to Support Informal Dementia Care: Umbrella Review",
journal="JMIR Aging",
year="2021",
month="Oct",
day="8",
volume="4",
number="4",
pages="e30841",
keywords="eHealth",
keywords="assistive technologies",
keywords="dementia",
keywords="informal care",
keywords="home care",
keywords="implementation",
abstract="Background: The worldwide increase in community-dwelling people with dementia underscores the need for innovative eHealth technologies that aim to provide support to both patients and their informal caregivers in the home setting. However, sustainable implementation of eHealth technologies within this target group can be difficult. Objective: The goal of this study was to gain a thorough understanding of why it is often difficult to implement eHealth technologies in practice, even though numerous technologies are designed to support people with dementia and their informal caregivers at home. In particular, our study aimed to (1) provide an overview of technologies that have been used and studied in the context of informal dementia care and (2) explore factors influencing the implementation of these technologies. Methods: Following an umbrella review design, five different databases were searched (PubMed, PsycINFO, Medline, Scopus, and Cochrane) for (systematic) reviews. Among 2205 reviews retrieved, 21 were included in our analysis based on our screening and selection procedure. A combination of deductive and inductive thematic analyses was performed, using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework for organizing the findings. Results: We identified technologies designed to be used ``by informal caregivers,'' ``by people with dementia,'' and ``with people with dementia.'' Within those groups, most of the represented technologies included, respectively: (i) devices for in-home monitoring of lifestyle, health, and safety; (ii) technologies for supporting memory, orientation, and day structure; and (iii) technologies to facilitate communication between the informal caregiver and person with dementia. Most of the identified factors influencing implementation related to the condition of dementia, characteristics of the technology, expected/perceived value of users, and characteristics of the informal caregiver. Considerably less information has been reported on factors related to the implementing organization and technology supplier, wider institutional and sociocultural context of policy and regulations, and continued adaptation of technology over time. Conclusions: Our study offers a comprehensive overview of eHealth technologies in the context of informal dementia care and contributes to gaining a better understanding of a broad range of factors influencing their implementation. Our results uncovered a knowledge gap regarding success factors for implementation related to the organizational and broader context and continuous adaptation over the long term. Although future research is needed, the current findings can help researchers and stakeholders in improving the development and implementation of eHealth technologies to support informal dementia care. ",
doi="10.2196/30841",
url="https://aging.jmir.org/2021/4/e30841",
url="http://www.ncbi.nlm.nih.gov/pubmed/34623314"
}


@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/10.2196/30353,
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/10.2196/27630,
author="Xiang, Xiaoling
and Kayser, Jay
and Sun, Yihang
and Himle, Joseph",
title="Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants' Experiences",
journal="JMIR Aging",
year="2021",
month="Nov",
day="22",
volume="4",
number="4",
pages="e27630",
keywords="internet-based cognitive behavioral therapy",
keywords="homebound older adults",
keywords="home care",
keywords="direct care workers",
keywords="depression",
keywords="qualitative study",
abstract="Background: Depression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities. Objective: This study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression. Methods: The participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research. Results: Three themes and various subthemes emerged related to participants' experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants' perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement. Conclusions: iCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence. Trial Registration: ClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289 ",
doi="10.2196/27630",
url="https://aging.jmir.org/2021/4/e27630",
url="http://www.ncbi.nlm.nih.gov/pubmed/34813491"
}


@Article{info:doi/10.2196/16006,
author="Seckin, Gul
and Hughes, Susan",
title="Patient-Reported Outcomes in a Nationally Representative Sample of Older Internet Users: Cross-sectional Survey",
journal="JMIR Aging",
year="2021",
month="Nov",
day="24",
volume="4",
number="4",
pages="e16006",
keywords="internet",
keywords="information",
keywords="health",
keywords="communication",
keywords="strain",
keywords="education",
keywords="eHealth literacy",
abstract="Background: The rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients' ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy. Objective: We explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes. Methods: Our study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age?60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms. Results: Age ($\beta$=--.17; P=.02), gender ($\beta$=--.22; P=.01), and medical satisfaction ($\beta$=--.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender ($\beta$=.13; P=.05) and satisfaction with medical encounters ($\beta$=.34; P<.001) but negatively predicted by education ($\beta$=--.18; P=.03) and eHealth literacy ($\beta$=--.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education ($\beta$=--.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress ($\beta$=--.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress ($\beta$=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem ($\beta$=--.22; P=.01). Conclusions: This study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals. ",
doi="10.2196/16006",
url="https://aging.jmir.org/2021/4/e16006",
url="http://www.ncbi.nlm.nih.gov/pubmed/34822340"
}


@Article{info:doi/10.2196/29788,
author="Kim, Ben
and Ghasemi, Peyman
and Stolee, Paul
and Lee, Joon",
title="Clinicians and Older Adults' Perceptions of the Utility of Patient-Generated Health Data in Caring for Older Adults: Exploratory Mixed Methods Study",
journal="JMIR Aging",
year="2021",
month="Nov",
day="5",
volume="4",
number="4",
pages="e29788",
keywords="mobile health",
keywords="mHealth",
keywords="older adults",
keywords="wearables",
keywords="patient generated health data",
keywords="chronic disease management",
keywords="home care",
keywords="self-care",
keywords="activities of daily living",
keywords="sleep",
abstract="Background: Many people are motivated to self-track their health and optimize their well-being through mobile health apps and wearable devices. The diversity and complexity of these systems have evolved over time, resulting in a large amount of data referred to as patient-generated health data (PGHD), which has recently emerged as a useful set of data elements in health care systems around the world. Despite the increased interest in PGHD, clinicians and older adults' perceptions of PGHD are poorly understood. In particular, although some clinician barriers to using PGHD have been identified, such as concerns about data quality, ease of use, reliability, privacy, and regulatory issues, little is known from the perspectives of older adults. Objective: This study aims to explore the similarities and differences in the perceptions of older adults and clinicians with regard to how various types of PGHD can be used to care for older adults. Methods: A mixed methods study was conducted to explore clinicians and older adults' perceptions of PGHD. Focus groups were conducted with older adults and health care providers from the Greater Toronto area and the Kitchener-Waterloo region. The participants were asked to discuss their perceptions of PGHD, including facilitators and barriers. A questionnaire aimed at exploring the perceived usefulness of a range of different PGHD was also embedded in the study design. Focus group interviews were transcribed for thematic analysis, whereas the questionnaire results were analyzed using descriptive statistics. Results: Of the 9 participants, 4 (44\%) were clinicians (average age 38.3 years, SD 7 years), and 5 (56\%) were older adults (average age 81.0 years, SD 9.1 years). Four main themes were identified from the focus group interviews: influence of PGHD on patient-provider trust, reliability of PGHD, meaningful use of PGHD and PGHD-based decision support systems, and perceived clinical benefits and intrusiveness of PGHD. The questionnaire results were significantly correlated with the frequency of PGHD mentioned in the focus group interviews (r=0.42; P=.03) and demonstrated that older adults and clinicians perceived blood glucose, step count, physical activity, sleep, blood pressure, and stress level as the most useful data for managing health and delivering high-quality care. Conclusions: This embedded mixed methods study generated several important findings about older adults and clinicians' perceptions and perceived usefulness of a range of PGHD. Owing to the exploratory nature of this study, further research is needed to understand the concerns about data privacy, potential negative impact on the trust between older adults and clinicians, data quality and quantity, and usability of PGHD-related technologies for older adults. ",
doi="10.2196/29788",
url="https://aging.jmir.org/2021/4/e29788",
url="http://www.ncbi.nlm.nih.gov/pubmed/34738913"
}


@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/10.2196/28165,
author="Kelleher, Jessica
and Zola, Stuart
and Cui, Xiangqin
and Chen, Shiyu
and Gerber, Caroline
and Parker, Willis Monica
and Davis, Crystal
and Law, Sidney
and Golden, Matthew
and Vaughan, P. Camille",
title="Personalized Visual Mapping Assistive Technology to Improve Functional Ability in Persons With Dementia: Feasibility Cohort Study",
journal="JMIR Aging",
year="2021",
month="Oct",
day="19",
volume="4",
number="4",
pages="e28165",
keywords="aging",
keywords="ageing",
keywords="impaired memory",
keywords="assistive technology",
keywords="assistive technologies",
keywords="function",
keywords="assistive devices",
keywords="cognition",
keywords="cognitive",
keywords="activities of daily living",
keywords="mobile technology",
keywords="mobile technologies",
keywords="dementia",
keywords="Alzheimer",
abstract="Background: Mobile health (mHealth) apps using novel visual mapping assistive technology can allow users to develop personalized maps that aid people living with cognitive impairment in the recall of steps needed to independently complete activities of daily living (ADLs), such as bathing, toileting, and dressing. Objective: This study aims to determine the feasibility and preliminary impact of an mHealth assistive technology app providing guidance to aid individuals living with cognitive impairment in the recall of steps to independently complete ADLs. Methods: A total of 14 Veterans (mean age 65 SD 9.5 years; 14/14, 100\% male; 10/14, 71.4\% Black) and 8 non-Veterans (mean age 78, SD 10.3 years; 5/8, 62.5\% male; 8/8, 100\% Black) were recruited and enrolled from the Department of Veterans Affairs (VA) and non-VA cognitive care clinics. A visual mapping software program, MapHabit, was used to generate a series of personalized visual map templates focused on ADLs created within the MapHabit app. The visual maps were accessed through a tablet device. A 19-item exit questionnaire was administered to the participants to assess perceived improvement in their functional ability after using the MapHabit system for 3 months. Results: A total of 13 (93\%) VA clinic participants and 8 (100\%) non-VA clinic participants completed the 3-month study. Baseline cognitive testing indicated impaired to significantly impaired cognitive function. After 3 months of using the MapHabit system, VA clinic participants reported perceived improvement in social engagement (P=.01) and performance of ADLs (P=.05) compared to the baseline, whereas non-VA clinic participants reported improvements in the performance of ADLs (P=.02), mood (P=.04), social engagement (P=.02), and memory (P=.02). All study participants reported they would recommend the MapHabit system to a colleague, and 85\% (11/14) of VA and 100\% (8/8) of non-VA clinic participants reported a willingness to participate in a future study. Conclusions: Older VA and non-VA clinic participants with cognitive impairment were willing to use an mHealth app to assist with the completion of ADLs, and they reported positive preliminary effects. A larger study is warranted to assess the efficacy in the setting of a randomized controlled trial. ",
doi="10.2196/28165",
url="https://aging.jmir.org/2021/4/e28165",
url="http://www.ncbi.nlm.nih.gov/pubmed/34269690"
}


@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/10.2196/27862,
author="Sharma, Nikita
and Brinke, Klein Jeroen
and Gemert-Pijnen, Van J. E. W. C.
and Braakman-Jansen, A. L. M.",
title="Implementation of Unobtrusive Sensing Systems for Older Adult Care: Scoping Review",
journal="JMIR Aging",
year="2021",
month="Oct",
day="6",
volume="4",
number="4",
pages="e27862",
keywords="elderly care",
keywords="unobtrusive",
keywords="sensing system",
keywords="caregiving",
keywords="implementation",
keywords="mobile phone",
keywords="older adults",
abstract="Background: The continuous growth of the older adult population will have implications for the organization of health and social care. Potentially, in-home monitoring unobtrusive sensing systems (USSs) can be used to support formal or informal caregivers of older adults, as they can monitor deviant physical and physiological behavior changes. Most existing USSs are not specific to older adult care. Hence, to facilitate the implementation of existing USSs in older adult care, it is important to know which USSs would be more suitable for older adults. Objective: This scoping review aims to examine the literature to identify current USSs for monitoring human activities and behaviors and assess their implementation readiness for older adult care. Methods: We conducted a structured search in the Scopus, Web of Science, and ACM Digital Library databases. Predefined inclusion criteria included studies on unobtrusive sensor-based technology; experimental in nature; aimed at monitoring human social, emotional, physical, and physiological behavior; having the potential to be scalable in in-home care; and having at least 5 adults as participants. Using these criteria, we screened studies by title, abstract, and full text. A deductive thematic analysis based on the Proctor implementation framework along with an additional outcome of external validity was applied to the included studies to identify the factors contributing to successful implementation. Finally, the identified factors were used to report the implementation readiness of the included studies for older adult care. Results: In this review, 52 studies were included. Deductive analysis using the implementation framework by Proctor resulted in six factors that can contribute to the successful implementation of USSs in older adult care: study settings, age of participants, activities monitored, sensor setup, sensing technology used, and usefulness of USSs. These factors were associated with the implementation outcomes as follows: study settings and age of participants contributed to external validity, sensor setup contributed to acceptability, usefulness of USSs contributed to adoption, activities monitored contributed to appropriateness, and sensing technology used contributed to implementation cost. Furthermore, the implementation assessment of the included 52 studies showed that none of the studies addressed all the identified factors. This assessment was useful in highlighting studies that have addressed multiple factors; thus, these studies represent a step ahead in the implementation process. Conclusions: This review is the first to scope state-of-the-art USSs suitable for older adult care. Although the included 52 USS studies fulfilled the basic criteria to be suitable for older adult care, systems leveraging radio frequency technology in a no-contact sensor setup for monitoring life risk or health wellness activities are more suitable for older adult care. Finally, this review has extended the discussion about unobtrusiveness as a property of systems that cannot be measured in binary because it varies greatly with user perception and context. ",
doi="10.2196/27862",
url="https://aging.jmir.org/2021/4/e27862",
url="http://www.ncbi.nlm.nih.gov/pubmed/34612822"
}


@Article{info:doi/10.2196/29744,
author="Pech, Marion
and Sauzeon, Helene
and Yebda, Thinhinane
and Benois-Pineau, Jenny
and Amieva, Helene",
title="Falls Detection and Prevention Systems in Home Care for Older Adults: Myth or Reality?",
journal="JMIR Aging",
year="2021",
month="Dec",
day="9",
volume="4",
number="4",
pages="e29744",
keywords="elderly people",
keywords="new technologies",
keywords="fall",
keywords="acceptability",
keywords="digital divide",
keywords="aging",
keywords="falls",
keywords="fall prevention",
keywords="detection",
keywords="geriatrics",
keywords="barriers",
keywords="technology acceptance",
keywords="home care",
keywords="seniors",
doi="10.2196/29744",
url="https://aging.jmir.org/2021/4/e29744",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889755"
}