@Article{info:doi/10.2196/48547,
author="Jiang, Yun
and Wang, Jinjiao",
title="Technological Innovations and Data-Driven Support for Older Adults",
journal="JMIR Aging",
year="2023",
month="May",
day="10",
volume="6",
pages="e48547",
keywords="technological innovation",
keywords="JMIR Aging",
keywords="older adults",
keywords="innovation",
keywords="technology",
keywords="digital ageism",
keywords="digital health",
keywords="older adult care",
doi="10.2196/48547",
url="https://aging.jmir.org/2023/1/e48547",
url="http://www.ncbi.nlm.nih.gov/pubmed/37163345"
}


@Article{info:doi/10.2196/51776,
author="Fear, Kathleen
and Gleber, Conrad",
title="Shaping the Future of Older Adult Care: ChatGPT, Advanced AI, and the Transformation of Clinical Practice",
journal="JMIR Aging",
year="2023",
month="Sep",
day="13",
volume="6",
pages="e51776",
keywords="generative AI",
keywords="artificial intelligence",
keywords="large language models",
keywords="ChatGPT",
keywords="Generative Pre-trained Transformer",
doi="10.2196/51776",
url="https://aging.jmir.org/2023/1/e51776",
url="http://www.ncbi.nlm.nih.gov/pubmed/37703085"
}


@Article{info:doi/10.2196/39898,
author="Hyodo, Kazuki
and Kidokoro, Tetsuhiro
and Yamaguchi, Daisuke
and Iida, Michitaka
and Watanabe, Yuya
and Ueno, Aiko
and Noda, Takayuki
and Kawahara, Kenji
and Nishida, Sumiyo
and Kai, Yuko
and Arao, Takashi",
title="Feasibility, Safety, Enjoyment, and System Usability of Web-Based Aerobic Dance Exercise Program in Older Adults: Single-Arm Pilot Study",
journal="JMIR Aging",
year="2023",
month="Jan",
day="16",
volume="6",
pages="e39898",
keywords="low-intensity exercise",
keywords="home exercise",
keywords="online exercise",
keywords="supervised exercise",
keywords="elderly",
keywords="COVID-19",
keywords="smartphone",
keywords="tablet",
keywords="videoconferencing platform",
abstract="Background: During the COVID-19 epidemic, opportunities for social interaction and physical activity among older people are decreasing, which may have a negative impact on their health. As a solution, a web-based group exercise program provided through a videoconferencing platform would be useful. As a web-based exercise program that older adults can easily, safely, and enjoyably perform at home, we developed a short-duration, light-intensity aerobic dance exercise program. Before studying the effectiveness of this exercise program, its characteristics, such as feasibility, safety, enjoyment, and system usability, should be examined among older adults. Objective: This pilot study aimed to examine the feasibility, safety, and enjoyment of a web-based aerobic dance exercise program and the usability of a web-based exercise delivery system using a videoconferencing platform for older adults. Methods: This study was designed as a prospective single-arm pilot study. A total of 16 older adults participated in an 8-week web-based aerobic dance program held every morning (8:30 AM to 8:50 AM) on weekdays at home. Retention and adherence rates were measured for the program's feasibility. Safety was assessed by the heart rate reserve, an index of exercise intensity calculated from heart rate, and the number of adverse events during exercise sessions. Enjoyment of this exercise program was assessed by an 11-point Likert scale ranging from 0 (not enjoyable at all) to 10 (extremely enjoyable) obtained through telephone interviews after the first-, third-, sixth-, and eighth-week intervention. For usability, the ease of the videoconferencing platform system was assessed through telephone interviews after the intervention. Results: A female participant with hypertension dropped out in the second week because of the continuously reported high blood pressure (?180 mmHg) before attending the exercise session in the first week. Therefore, the retention rate was 93.8\% (15/16). Among the remaining participants, the median (IQR) overall adherence rate was 97.4\% (94.7-100). Regarding safety, the mean (SD) heart rate reserve during the aerobic dance exercise was 29.8\% (6.8\%), showing that the exercise was relatively safe with very light to light intensity. There were no adverse events during the exercise session. The enjoyment score (0-10 points) significantly increased from the first (6.7 [1.7]) to sixth (8.2 [1.3]) and eighth week (8.5 [1.3]). Regarding usability, 11 participants reported difficulties at the beginning, such as basic touch panel operations and the use of unfamiliar applications; however, all got accustomed to it and subsequently reported no difficulty. Conclusions: This study showed high feasibility, enjoyment, and safety of the web-based aerobic dance exercise program in older adults, and the web-based exercise delivery system may have areas for improvement, albeit without serious problems. Our web-based aerobic dance exercise program may contribute to an increase in physical and social activities among older adults. ",
doi="10.2196/39898",
url="https://aging.jmir.org/2023/1/e39898",
url="http://www.ncbi.nlm.nih.gov/pubmed/36645705"
}


@Article{info:doi/10.2196/41810,
author="Stawarz, Katarzyna
and Liang, Ju Ian
and Alexander, Lyndsay
and Carlin, Angela
and Wijekoon, Anjana
and Western, J. Max",
title="Exploring the Potential of Technology to Promote Exercise Snacking for Older Adults Who Are Prefrail in the Home Setting: User-Centered Design Study",
journal="JMIR Aging",
year="2023",
month="May",
day="24",
volume="6",
pages="e41810",
keywords="physical activity",
keywords="older adults",
keywords="Internet of Things",
keywords="user-centered design",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: Older adults are at increased risk of falls, injury, and hospitalization. Maintaining or increasing participation in physical activity during older age can prevent some of the age-related declines in physical functioning that contribute to loss of independence and low reported quality of life. Exercise snacking may overcome some commonly cited barriers to exercise and encourage older adults to engage in muscle strength and balance activity, but the best way to deliver and support this novel format remains unknown. Objective: Our aim was to explore how the novel exercise snacking approach, that is, incorporating short bouts of strength and balance activities into everyday routines, could be supported by technology within a home setting and what types of technologies would be acceptable for older adults who are prefrail. Methods: Following a user-centered design process, 2 design workshops (study 1) were conducted first to understand older adults' (n=11; aged 69-89 years) attitudes toward technology aimed at supporting exercise snacking at home and to inform the design of 2 prototypes. Next, based on the findings of study 1, an exploratory pilot study (study 2) was conducted over 1 day with 2 prototypes (n=5; aged 69-80 years) at the participants' homes. Participants were interviewed over the telephone afterward about their experience. Transcripts were analyzed using framework analysis. Results: The results showed that the participants were positive toward using technology at home to support exercise snacking, but both exercises and technology would need to be simple and match the participants' everyday routines. Workshop discussions (study 1) led to the design of 2 prototypes using a pressure mat to support resistance and balance exercises. The exploratory pilot study (study 2) participants reported the potential in using smart devices to support exercise snacking, but the design of the initial prototypes influenced the participants' attitudes toward them. It also hampered the acceptability of these initial versions and highlighted the challenges in fitting exercise snacking into everyday life. Conclusions: Older adults were positive about using technology in their homes to support strength and balance exercise snacking. However, although promising, the initial prototypes require further refinement and optimization before feasibility, acceptability, and efficacy testing. Technologies to support exercise snacking need to be adaptable and personalized to individuals, to ensure that users are snacking on balance and strengthening exercises that are appropriate for them. ",
doi="10.2196/41810",
url="https://aging.jmir.org/2023/1/e41810",
url="http://www.ncbi.nlm.nih.gov/pubmed/37223992"
}


@Article{info:doi/10.2196/40953,
author="Kelly, M. Ryan
and Xing, Yushan
and Baker, Steven
and Waycott, Jenny",
title="Video Calls as a Replacement for Family Visits During Lockdowns in Aged Care: Interview Study With Family Members",
journal="JMIR Aging",
year="2023",
month="Jun",
day="12",
volume="6",
pages="e40953",
keywords="aged care",
keywords="COVID-19 pandemic",
keywords="lockdowns",
keywords="older adults",
keywords="video calls",
keywords="videoconferencing",
keywords="mobile phone",
keywords="COVID-19",
abstract="Background: Lockdowns have been used to prevent the spread of transmissible illnesses such as influenza, norovirus, and COVID-19 in care homes. However, lockdowns deny care home residents supplemental care and the socioemotional enrichment that comes from seeing family members. Video calling has the potential to enable ongoing contact between residents and family members during lockdowns. However, video calls can be considered by some as a poor substitute for in-person visits. It is important to understand family members' experiences with video calling during lockdowns to ensure the effective use of this technology in the future. Objective: This study aimed to understand how family members use video calls to communicate with relatives living in aged care during lockdowns. We focused on experiences during the COVID-19 pandemic, which involved extensive lockdowns in aged care homes. Methods: We conducted semistructured interviews with 18 adults who had been using video calls with relatives living in aged care during pandemic lockdowns. The interviews focused on how participants had been using video calls, what benefits they gained from video-based interactions, and what challenges they encountered when using the technology. We analyzed the data using the 6-phase reflexive approach to thematic analysis by Braun and Clarke. Results: We developed 4 themes through our analysis. Theme 1 interprets video calling as a medium for the continuation of care during lockdowns. Using video calls, family members were able to provide social enrichment for residents and engaged in health monitoring to uphold residents' welfare. Theme 2 highlights how video calling extended care by supporting frequent contact, transmitting nonverbal cues that were essential for communication, and negating the need for face masks. Theme 3 interprets organizational issues such as the lack of technology and staff time as impediments to the continuation of familial care through video. Finally, theme 4 highlights the need for 2-way communication, interpreting residents' unfamiliarity with video calling and their health conditions as further barriers to the continuation of care. Conclusions: This study suggests that, during restrictions arising from the COVID-19 pandemic, video calls became a medium for enabling family members to continue participating in the care of their relatives. The use of video calls to continue care illustrates their value for families during times of mandatory lockdown and supports the use of video to complement face-to-face visits at other times. However, better support is needed for video calling in aged care homes. This study also revealed a need for video calling systems that are designed for the aged care context. ",
doi="10.2196/40953",
url="https://aging.jmir.org/2023/1/e40953",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191951"
}


@Article{info:doi/10.2196/44425,
author="Maes, Iris
and Mertens, Lieze
and Poppe, Louise
and Vetrovsky, Tomas
and Crombez, Geert
and De Backere, Femke
and Brondeel, Ruben
and Van Dyck, Delfien",
title="Within-Person Associations of Accelerometer-Assessed Physical Activity With Time-Varying Determinants in Older Adults: Time-Based Ecological Momentary Assessment Study",
journal="JMIR Aging",
year="2023",
month="Nov",
day="23",
volume="6",
pages="e44425",
keywords="ecological momentary assessment",
keywords="EMA",
keywords="associations",
keywords="emotions",
keywords="physical concerns",
keywords="intention",
keywords="self-efficacy",
keywords="older adult",
keywords="mobile phone",
abstract="Background: Despite the availability of physical activity (PA) interventions, many older adults are still not active enough. This might be partially explained by the often-limited effects of PA interventions. In general, health behavior change interventions often do not focus on contextual and time-varying determinants, which may limit their effectiveness. However, before the dynamic tailoring of interventions can be developed, one should know which time-dependent determinants are associated with PA and how strong these associations are. Objective: The aim of this study was to examine within-person associations between multiple determinants of the capability, opportunity, motivation, and behavior framework assessed using Ecological Momentary Assessment (EMA) and accelerometer-assessed light PA, moderate to vigorous PA, and total PA performed at 15, 30, 60, and 120 minutes after the EMA trigger. Methods: Observational data were collected from 64 healthy older adults (36/64, 56\% men; mean age 72.1, SD 5.6 y). Participants were asked to answer a time-based EMA questionnaire 6 times per day that assessed emotions (ie, relaxation, satisfaction, irritation, and feeling down), the physical complaint fatigue, intention, intention, and self-efficacy. An Axivity AX3 was wrist worn to capture the participants' PA. Multilevel regression analyses in R were performed to examine these within-person associations. Results: Irritation, feeling down, intention, and self-efficacy were positively associated with subsequent light PA or moderate to vigorous PA at 15, 30, 60, or 120 minutes after the trigger, whereas relaxation, satisfaction, and fatigue were negatively associated. Conclusions: Multiple associations were observed in this study. This knowledge in combination with the time dependency of the determinants is valuable information for future interventions so that suggestions to be active can be provided when the older adult is most receptive. ",
doi="10.2196/44425",
url="https://aging.jmir.org/2023/1/e44425",
url="http://www.ncbi.nlm.nih.gov/pubmed/37995131"
}


@Article{info:doi/10.2196/49154,
author="Holmqvist, Malin
and Johansson, Linda
and Lindenfalk, Bertil
and Thor, Johan
and Ros, Axel",
title="Older Persons' and Health Care Professionals' Design Choices When Co-Designing a Medication Plan Aiming to Promote Patient Safety: Case Study",
journal="JMIR Aging",
year="2023",
month="Oct",
day="5",
volume="6",
pages="e49154",
keywords="co-design",
keywords="engagement",
keywords="medications",
keywords="medication plan",
keywords="older people",
keywords="older adults",
keywords="participatory",
keywords="patient experience",
keywords="patient safety",
keywords="remote",
abstract="Background: Harm from medications is a major patient safety challenge among older persons. Adverse drug events tend to arise when prescribing or evaluating medications; therefore, interventions targeting these may promote patient safety. Guidelines highlight the value of a joint plan for continued treatment. If such a plan includes medications, a medication plan promoting patient safety is advised. There is growing evidence for the benefits of including patients and health care professionals in initiatives for improving health care products and services through co-design. Objective: This study aimed to identify participants' needs and requirements for a medication plan and explore their reasoning for different design choices. Methods: Using a case study design, we collected and analyzed qualitative and quantitative data and compared them side by side. We explored the needs and requirements for a medication plan expressed by 14 participants (older persons, nurses, and physicians) during a co-design initiative in a regional health system in Sweden. We performed a directed content analysis of qualitative data gathered from co-design sessions and interviews. Descriptive statistics were used to analyze the quantitative data from survey answers. Results: A medication plan must provide an added everyday value related to safety, effort, and engagement. The physicians addressed challenges in setting aside time to apply a medication plan, whereas the older persons raised the potential for increased patient involvement. According to the participants, a medication plan needs to support communication, continuity, and interaction. The nurses specifically addressed the need for a plan that was easy to gain an overview of. Important function requirements included providing instant access, automation, and attention. Content requirements included providing detailed information about the medication treatment. Having the plan linked to the medication list and instantly obtainable information was also requested. Conclusions: After discussing the needs and requirements for a medication plan, the participants agreed on an iteratively developed medication plan prototype linked to the medication list within the existing electronic health record. According to the participants, the medication plan prototype may promote patient safety and enable patient engagement, but concerns were raised about its use in daily clinical practice. The last step in the co-design framework is testing the intervention to explore how it works and connects with users. Therefore, testing the medication plan prototype in clinical practice would be a future step. ",
doi="10.2196/49154",
url="https://aging.jmir.org/2023/1/e49154",
url="http://www.ncbi.nlm.nih.gov/pubmed/37796569"
}


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


@Article{info:doi/10.2196/38593,
author="Lemaire, C{\'e}lia
and Humbert, Christophe
and Sueur, C{\'e}dric
and Racin, C{\'e}line",
title="Use of Digital Technologies to Maintain Older Adults' Social Ties During Visitation Restrictions in Long-Term Care Facilities: Scoping Review",
journal="JMIR Aging",
year="2023",
month="Feb",
day="10",
volume="6",
pages="e38593",
keywords="social isolation",
keywords="COVID-19 pandemic",
keywords="remote care",
keywords="nursing homes",
keywords="social ties",
keywords="digital devices",
keywords="older adults",
abstract="Background: Digital technologies were implemented to address the disruption of long-term care facility residents' socialization needs during the COVID-19 pandemic. A literature review regarding this topic is needed to inform public policy, facility managers, family caregivers, and nurses and allied health professionals involved in mediating the use of digital devices for residents' social ties. Objective: Our study outlines key concepts, methodologies, results, issues, and gaps in articles published during pandemic-related visitation restrictions. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) protocol, a scoping review was conducted by searching 3 database aggregator platforms (EBSCO, ProQuest, and PubMed) for studies published in peer-reviewed journals from early 2020 to the end of June 2021, when the most stringent restrictions were in place. We included qualitative and quantitative studies, reviews, commentaries, viewpoints, and letters to the editors in French or English focusing on digital technologies aiming to support the social contact of residents in long-term care facilities during pandemic-related visitation restrictions. Results: Among 763 screened articles, 29 met our selection criteria. For each study, we characterized the (1) authors, title, and date of the publication; (2) country of the first author; (3) research fields; (4) article type; and (5) type of technology mentioned. The analysis distinguished 3 main themes emerging from the literature: (1) impact and expectations of remote social contact on the physical and mental health and well-being of the residents (n=12), (2) with whom or what the social contact took place (n=17), and (3) limitations and barriers to significant social contact related to digital technologies (n=14). The results first underlined the highly positive impact expected by the authors of the digital technologies on health and quality of life of residents of long-term care facilities. Second, they highlighted the plurality of ties to consider, since social contact takes place not only with family caregivers to maintain contact but also for other purposes (end-of-life videoconferences) and with other types of contact (eg, with staff and robots). Third, they exposed the limitations and barriers to significant contact using digital technologies and outlined the required conditions to enable them. Conclusions: The review demonstrated the opportunities and risks outlined by the literature about the implementation of digital technologies to support remote social contact. It showed the plurality of ties to consider and revealed the need to evaluate the positive impact of remote contact from the residents' perspectives. Therefore, to go beyond the risk of digital solutionism, there is a need for studies considering the holistic impact on health regarding the implementation of digital technologies, including the meaning residents give to interpersonal exchanges and the organizational constraints. Trial Registration: OSF Registries osf.io/yhpx3; https://osf.io/yhpx3 ",
doi="10.2196/38593",
url="https://aging.jmir.org/2023/1/e38593",
url="http://www.ncbi.nlm.nih.gov/pubmed/36599164"
}


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


@Article{info:doi/10.2196/46753,
author="Beogo, Idrissa
and Sia, Drissa
and Collin, Stephanie
and Phaelle Gedeon, Andi
and Louism{\'e}, Micha{\"e}l-Christopher
and Ramd{\'e}, Jean
and Gagnon, Marie-Pierre
and Tchouaket Nguemeleu, Eric",
title="Strengthening Social Capital to Address Isolation and Loneliness in Long-Term Care Facilities During the COVID-19 Pandemic: Systematic Review of Research on Information and Communication Technologies",
journal="JMIR Aging",
year="2023",
month="Aug",
day="14",
volume="6",
pages="e46753",
keywords="information and communication technology",
keywords="ICT",
keywords="long-term care facilities",
keywords="COVID-19",
keywords="social isolation",
keywords="loneliness",
keywords="pandemic",
keywords="implementation sciences",
keywords="protocol",
keywords="nursing home",
keywords="mobile phone",
abstract="Background: The COVID-19 pandemic has disproportionately and severely affected older adults, namely those living in long-term care facilities (LTCFs). Aside from experiencing high mortality rates, survivors were critically concerned by social isolation and loneliness (SIL). To address this serious public health concern and stay connected with LTCF residents, information and communication technology (ICT) platforms (eg, video calls) were used as an alternative to maintaining social interactions amid the visiting restriction policy. Objective: This paper aimed to synthesize the effects of ICT-related communication interventions using SMS text messaging or chat, video, voice mail, or photo to address SIL in LTCF residents during the COVID-19 pandemic. Methods: In total, 2793 references published in English and French in 2019 and onward were obtained from 10 relevant databases: PsycINFO-Ovid, Ovid-MEDLINE, CINAHL-EBSCO, Cochrane Library, Web of Science, Scopus, DirectScience, Communication \& Mass Media Complete, IEEE Xplore, and ACM Digital Library. A 2-person screening approach was used, and the studies were screened independently and blindly. A narrative synthesis was performed to interpret the results of the included studies, and their quality was appraised. Results: In total, 4 studies were included in the review. ICT-related applications were used to ensure connectedness to address SIL. ICT interventions consisted mainly of videoconferencing, intergroup video call sessions between residents, and chatting (SMS text messages and phone calls). Roughly 3 classes of mediating ICT tools were used: video calls using software applications (eg, Skype); robot systems embedding video telephones; and ordinary telecommunication such as telephone, internet, social media platforms, and videoconferencing. This review has included the role of humanoid robots in LTCFs as an innovation avenue because of their multipurpose use (eg, communication tools and remotely operable). Conclusions: Remote social capitalization through ICT applications has become an avenue to reduce SIL among LTCF residents. This review examined a social connection approach that will remain relevant and even be fostered after the COVID-19 pandemic. As families remain the main stakeholders of LTCFs, this study's findings could inform policy makers and frontline managers to better shape programs and initiatives to prevent or reduce SIL in LTCFs. International Registered Report Identifier (IRRID): RR2-10.2196/36269 ",
doi="10.2196/46753",
url="https://aging.jmir.org/2023/1/e46753",
url="http://www.ncbi.nlm.nih.gov/pubmed/37578824"
}


@Article{info:doi/10.2196/43130,
author="Yap, L. Tracey
and Horn, D. Susan
and Sharkey, D. Phoebe
and Brooks, R. Katie
and Kennerly, Susan",
title="The Nursing Home Severity Index and Application to Pressure Injury Risk: Measure Development and Validation Study",
journal="JMIR Aging",
year="2023",
month="Feb",
day="9",
volume="6",
pages="e43130",
keywords="geriatrics",
keywords="nursing homes",
keywords="pressure ulcer",
keywords="propensity scores",
keywords="severity of illness index",
keywords="development",
keywords="validation",
keywords="clinical",
keywords="treatment",
keywords="pressure injury",
keywords="injury",
keywords="risk",
keywords="prevention",
abstract="Background: An assessment tool is needed to measure the clinical severity of nursing home residents to improve the prediction of outcomes and provide guidance in treatment planning. Objective: This study aims to describe the development of the Nursing Home Severity Index, a clinical severity measure targeted for nursing home residents with the potential to be individually tailored to different outcomes, such as pressure injury. Methods: A retrospective nonexperimental design was used to develop and validate the Nursing Home Severity Index using secondary data from 9 nursing homes participating in the 12-month preintervention period of the Turn Everyone and Move for Ulcer Prevention (TEAM-UP) pragmatic clinical trial. Expert opinion and clinical literature were used to identify indicators, which were grouped into severity dimensions. Index performance and validation to predict risk of pressure injury were accomplished using secondary data from nursing home electronic health records, Minimum Data Sets, and Risk Management Systems. Logistic regression models including a resident's Worst-Braden score with/without severity dimensions generated propensity scores. Goodness of fit for overall models was assessed using C statistic; the significance of improvement of fit after adding severity components to the model was determined using the likelihood ratio chi-square test. The significance of each component was assessed with odds ratios. Validation based on randomly selected 65\% training and 35\% validation data sets was used to confirm the reliability of the severity measure. Finally, the discriminating ability of models was evaluated using propensity stratification to evaluate which model best discriminated between residents with/without pressure injury. Results: Data from 1015 residents without pressure injuries on admission were used for the Nursing Home Severity Index--Pressure Injury and included laboratory, weights/vitals/pain, underweight, and locomotion severity dimensions. Logistic regression C statistic measuring predictive accuracy increased by 19.3\% (from 0.627 to 0.748; P<.001) when adding four severity dimensions to Worst-Braden scores. Significantly higher odds of developing pressure injuries were associated with increasing dimension scores. The use of the three highest propensity deciles predicting the greatest risk of pressure injury improved predictive accuracy by detecting 21 more residents who developed pressure injury (n=58, 65.2\% vs n=37, 42.0\%) when both severity dimensions and Worst-Braden score were included in prediction modeling. Conclusions: The clinical Nursing Home Severity Index--Pressure Injury was successfully developed and tested using the outcome of pressure injury. Overall predictive capacity was enhanced when using severity dimensions in combination with Worst-Braden scores. This index has the potential to significantly impact the quality of care decisions aimed at improving individual pressure injury prevention plans. Trial Registration: ClinicalTrials.gov NCT02996331; http://clinicaltrials.gov/ct2/show/NCT02996331 ",
doi="10.2196/43130",
url="https://aging.jmir.org/2023/1/e43130",
url="http://www.ncbi.nlm.nih.gov/pubmed/36757779"
}


@Article{info:doi/10.2196/40606,
author="Bin Noon, Gaya
and Hanjahanja-Phiri, Thokozani
and Dave, Harishree
and Fadrique, Laura
and Teague, Jennifer
and Morita, P. Plinio",
title="Exploring the Role of Active Assisted Living in the Continuum of Care for Older Adults: Thematic Analysis",
journal="JMIR Aging",
year="2023",
month="May",
day="22",
volume="6",
pages="e40606",
keywords="ambient assisted living",
keywords="active assisted living",
keywords="AAL",
keywords="internet of things",
keywords="aging well",
keywords="aging in place",
keywords="older adults",
keywords="geriatrics",
keywords="standards",
keywords="policies",
keywords="health care",
abstract="Background: Active assisted living (AAL) refers to systems designed to improve the quality of life, aid in independence, and create healthier lifestyles for those who need assistance at any stage of their lives. As the population of older adults in Canada grows, there is a pressing need for nonintrusive, continuous, adaptable, and reliable health monitoring tools to support aging in place and reduce health care costs. AAL has great potential to support these efforts with the wide variety of solutions currently available; however, additional work is required to address the concerns of care recipients and their care providers with regard to the integration of AAL into care. Objective: This study aims to work closely with stakeholders to ensure that the recommendations for system-service integrations for AAL aligned with the needs and capacity of health care and allied health systems. To this end, an exploratory study was conducted to understand the perceptions of, and concerns with, AAL technology use. Methods: A total of 18 semistructured group interviews were conducted with stakeholders, with each group comprising several participants from the same organization. These participant groups were categorized into care organizations, technology development organizations, technology integration organizations, and potential care recipient or patient advocacy groups. The results of the interviews were coded using a thematic analysis to identify future steps and opportunities regarding AAL. Results: The participants discussed how the use of AAL systems may lead to improved support for care recipients through more comprehensive monitoring and alerting, greater confidence in aging in place, and increased care recipient empowerment and access to care. However, they also raised concerns regarding the management and monetization of data emerging from AAL systems as well as general accountability and liability. Finally, the participants discussed potential barriers to the use and implementation of AAL systems, especially addressing the question of whether AAL systems are even worth it considering the investment required and encroachment on privacy. Other barriers raised included issues with the institutional decision-making process and equity. Conclusions: Better definition of roles is needed in terms of who can access the data and who is responsible for acting on the gathered data. It is important for stakeholders to understand the trade-off between using AAL technologies in care settings and the costs of AAL technologies, including the loss of patient privacy and control. Finally, further work is needed to address the gaps, explore the equity in AAL access, and develop a data governance framework for AAL in the continuum of care. ",
doi="10.2196/40606",
url="https://aging.jmir.org/2023/1/e40606",
url="http://www.ncbi.nlm.nih.gov/pubmed/37213201"
}


@Article{info:doi/10.2196/46480,
author="Krafft, Jelena
and Barisch-Fritz, Bettina
and Krell-Roesch, Janina
and Trautwein, Sandra
and Scharpf, Andrea
and Woll, Alexander",
title="A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study",
journal="JMIR Aging",
year="2023",
month="Aug",
day="22",
volume="6",
pages="e46480",
keywords="dementia",
keywords="individualized physical exercise",
keywords="tailored exercise",
keywords="physical activity",
keywords="older adults",
keywords="app",
keywords="mobile health",
keywords="mHealth",
keywords="usability",
keywords="mobile phone",
abstract="Background: The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia. Objective: This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach. Methods: Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively. Results: A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93\% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as ``good.'' The main usability issues concerned navigation logic and comprehensibility of app content. Conclusions: The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ?50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study. ",
doi="10.2196/46480",
url="https://aging.jmir.org/2023/1/e46480",
url="http://www.ncbi.nlm.nih.gov/pubmed/37606974"
}


@Article{info:doi/10.2196/44777,
author="Zaidi, Maryum
and Gazarian, Priscilla
and Mattie, Heather
and Sheldon, Kennedy Lisa
and Gakumo, Ann C.",
title="Examining the Impact of Selected Sociodemographic Factors and Cancer-Related Fatalistic Beliefs on Patient Engagement via Health Information Technology Among Older Adults: Cross-Sectional Analysis",
journal="JMIR Aging",
year="2023",
month="Oct",
day="20",
volume="6",
pages="e44777",
keywords="health information technology",
keywords="patient portals",
keywords="older adults",
keywords="digital health",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Despite the role of health information technology (HIT) in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults with a high burden of chronic diseases such as cancer. This study examines the role of selected sociodemographic factors and cancer-related fatalistic beliefs on patient engagement expressed through HIT use for patient engagement in adults aged ?65 years. We controlled for cancer diagnosis to account for its potential influence on patient engagement. Objective: This study has 2 aims: to investigate the role of sociodemographic factors such as race, education, poverty index, and psychosocial factors of cancer fatalistic beliefs in accessing and using HIT in older adults and to examine the association between access and use of HIT in the self-management domain of patient activation that serves as a precursor to patient engagement. Methods: This is a secondary data analysis of a subset of the Health Information National Trend Survey (Health Information National Trend Survey 4, cycle 3). The subset included individuals aged ?65 years with and without a cancer diagnosis. The relationships between access to and use of HIT to several sociodemographic variables and psychosocial factors of fatalistic beliefs were analyzed. Logistic and linear regression models were fit to study these associations. Results: This study included 180 individuals aged ?65 years with a cancer diagnosis and 398 without a diagnosis. This analysis indicated that having less than a college education level (P=<.001), being an individual from an ethnic and minority group (P=<.001), and living in poverty (P=.001) were significantly associated with decreased access to HIT. Reduced HIT use was associated with less than a college education (P=.001) and poverty(P=.02). This analysis also indicated that fatalistic beliefs about cancer were significantly associated with lower HIT use (P=.03). Specifically, a 1-point increase in the cancer fatalistic belief score was associated with a 36\% decrease in HIT use. We found that controlling for cancer diagnosis did not affect the outcomes for sociodemographic variables or fatalistic beliefs about cancer. However, patients with access to HIT had a self-management domain of patient activation (SMD) score of 0.21 points higher (P=.003) compared with patients who did not have access. SMD score was higher by 0.28 points (P=.002) for individuals who used HIT and 0.14 points higher (P=.04) who had a prior diagnosis of cancer. Conclusions: Sociodemographic factors (education, race, poverty, and cancer fatalistic beliefs) impact HIT access and use in older adults, regardless of prior cancer diagnosis. Among older adults, HIT users report higher self-management, which is essential for patient activation and engagement. ",
doi="10.2196/44777",
url="https://aging.jmir.org/2023/1/e44777",
url="http://www.ncbi.nlm.nih.gov/pubmed/37655786"
}


@Article{info:doi/10.2196/43777,
author="David, B. Michael C.
and Kolanko, Magdalena
and Del Giovane, Martina
and Lai, Helen
and True, Jessica
and Beal, Emily
and Li, M. Lucia
and Nilforooshan, Ramin
and Barnaghi, Payam
and Malhotra, A. Paresh
and Rostill, Helen
and Wingfield, David
and Wilson, Danielle
and Daniels, Sarah
and Sharp, J. David
and Scott, Gregory",
title="Remote Monitoring of Physiology in People Living With Dementia: An Observational Cohort Study",
journal="JMIR Aging",
year="2023",
month="Mar",
day="9",
volume="6",
pages="e43777",
keywords="dementia",
keywords="remote monitoring",
keywords="physiology",
keywords="Internet of Things",
keywords="alerts",
keywords="monitoring",
keywords="technology",
keywords="detection",
keywords="blood pressure",
keywords="support",
keywords="feasibility",
keywords="system",
keywords="quality of life",
abstract="Background: Internet of Things (IoT) technology enables physiological measurements to be recorded at home from people living with dementia and monitored remotely. However, measurements from people with dementia in this context have not been previously studied. We report on the distribution of physiological measurements from 82 people with dementia over approximately 2 years. Objective: Our objective was to characterize the physiology of people with dementia when measured in the context of their own homes. We also wanted to explore the possible use of an alerts-based system for detecting health deterioration and discuss the potential applications and limitations of this kind of system. Methods: We performed a longitudinal community-based cohort study of people with dementia using ``Minder,'' our IoT remote monitoring platform. All people with dementia received a blood pressure machine for systolic and diastolic blood pressure, a pulse oximeter measuring oxygen saturation and heart rate, body weight scales, and a thermometer, and were asked to use each device once a day at any time. Timings, distributions, and abnormalities in measurements were examined, including the rate of significant abnormalities (``alerts'') defined by various standardized criteria. We used our own study criteria for alerts and compared them with the National Early Warning Score 2 criteria. Results: A total of 82 people with dementia, with a mean age of 80.4 (SD 7.8) years, recorded 147,203 measurements over 958,000 participant-hours. The median percentage of days when any participant took any measurements (ie, any device) was 56.2\% (IQR 33.2\%-83.7\%, range 2.3\%-100\%). Reassuringly, engagement of people with dementia with the system did not wane with time, reflected in there being no change in the weekly number of measurements with respect to time (1-sample t-test on slopes of linear fit, P=.45). A total of 45\% of people with dementia met criteria for hypertension. People with dementia with $\alpha$-synuclein--related dementia had lower systolic blood pressure; 30\% had clinically significant weight loss. Depending on the criteria used, 3.03\%-9.46\% of measurements generated alerts, at 0.066-0.233 per day per person with dementia. We also report 4 case studies, highlighting the potential benefits and challenges of remote physiological monitoring in people with dementia. These include case studies of people with dementia developing acute infections and one of a person with dementia developing symptomatic bradycardia while taking donepezil. Conclusions: We present findings from a study of the physiology of people with dementia recorded remotely on a large scale. People with dementia and their carers showed acceptable compliance throughout, supporting the feasibility of the system. Our findings inform the development of technologies, care pathways, and policies for IoT-based remote monitoring. We show how IoT-based monitoring could improve the management of acute and chronic comorbidities in this clinically vulnerable group. Future randomized trials are required to establish if a system like this has measurable long-term benefits on health and quality of life outcomes. ",
doi="10.2196/43777",
url="https://aging.jmir.org/2023/1/e43777",
url="http://www.ncbi.nlm.nih.gov/pubmed/36892931"
}


@Article{info:doi/10.2196/48646,
author="Chiu, Ching-Ju
and Lo, Yi-Hsuan
and Montayre, Jed
and Abu-Odah, Hammoda
and Chen, Mei-Lan
and Zhao, Yan Ivy",
title="Identifying Preferred Appearance and Functional Requirements of Aged Care Robots Among Older Chinese Immigrants: Cross-Sectional Study",
journal="JMIR Aging",
year="2023",
month="Nov",
day="8",
volume="6",
pages="e48646",
keywords="robotic technology services",
keywords="appearance",
keywords="function",
keywords="aged care",
keywords="immigrant",
keywords="Chinese",
keywords="robot",
keywords="robots",
keywords="robotic",
keywords="robotics",
keywords="older adults",
keywords="elderly",
keywords="preference",
keywords="cross sectional",
keywords="cross-sectional",
keywords="survey",
keywords="healthy aging",
keywords="aging in place",
keywords="social",
keywords="isolation",
keywords="companion",
keywords="companionship",
keywords="Asian",
keywords="Asian population",
keywords="population",
keywords="population studies",
keywords="aging",
abstract="Background: Older Chinese immigrants constitute the largest older Asian ethnic population in New Zealand. Aging in a foreign land can be complex, presenting increasing challenges for gerontology scholars, practitioners, and policy makers. Older Chinese immigrants are more susceptible to experiencing loneliness and social isolation compared to native older people, primarily due to language, transportation, and cultural barriers. These factors subsequently impact their physical and mental health. With advancements in robotic technology, aged care robots are being applied to support older people with their daily living needs. However, studies on using robots with older immigrants living in the community are sparse. Their preferences for the appearance and function of aged care robots are unclear, which impacts the acceptance and usability of robots, highlighting the need for a user-centered design approach. Objective: This study aims to explore older Chinese immigrants' needs and preferences toward the appearance and function of aged care robots and to examine their relationships with the demographic characteristics of participants. Methods: A cross-sectional design was used in this study, which was undertaken between March and May 2020. A total of 103 participants completed a web-based survey. Results: The average age of participants was 68.7 (SD 5.5) years. The results suggest that 41.7\% (n=43) of the 103 participants preferred a humanlike adult appearance, while 32\% (n=33) suggested an animallike appearance. These participants reported higher scores in both rigorousness and friendliness compared to others who preferred different robot appearances. Participants expressed a greater preference for the functions of housework assistance (n=86, 83.5\%), language translation (n=79, 76.7\%), health monitoring (n=78, 75.7\%), facial expressions (n=77, 74.8\%), news reading (n=66, 64.1\%), and security monitoring (n=65, 63.1\%). These preferences were found to be significantly associated with marital status, financial status, and duration of immigration. Conclusions: To support immigrant populations to age well in a foreign country and address the growing shortage of health and social professionals, it is important to develop reliable robotic technology services that are tailored based on the needs and preferences of individuals. We collected and compared the perspectives of immigrant and nonimmigrant participants on using robots to support aging in place. The results on users' needs and preferences inform robotic technology services, indicating a need to prioritize older Chinese immigrants' preference toward aged care robots that perform housework assistance, language translation, and health and safety monitoring, and robots with humanlike features. ",
doi="10.2196/48646",
url="https://aging.jmir.org/2023/1/e48646"
}


@Article{info:doi/10.2196/36807,
author="Mu{\~n}oz Esquivel, Karla
and Gillespie, James
and Kelly, Daniel
and Condell, Joan
and Davies, Richard
and McHugh, Catherine
and Duffy, William
and Nevala, Elina
and Alam{\"a}ki, Antti
and Jalovaara, Juha
and Tedesco, Salvatore
and Barton, John
and Timmons, Suzanne
and Nordstr{\"o}m, Anna",
title="Factors Influencing Continued Wearable Device Use in Older Adult Populations: Quantitative Study",
journal="JMIR Aging",
year="2023",
month="Jan",
day="19",
volume="6",
pages="e36807",
keywords="usability",
keywords="older adults",
keywords="remote sensing",
keywords="sensor systems",
keywords="wearable device",
keywords="mobile phone",
abstract="Background: The increased use of wearable sensor technology has highlighted the potential for remote telehealth services such as rehabilitation. Telehealth services incorporating wearable sensors are most likely to appeal to the older adult population in remote and rural areas, who may struggle with long commutes to clinics. However, the usability of such systems often discourages patients from adopting these services. Objective: This study aimed to understand the usability factors that most influence whether an older adult will decide to continue using a wearable device. Methods: Older adults across 4 different regions (Northern Ireland, Ireland, Sweden, and Finland) wore an activity tracker for 7 days under a free-living environment protocol. In total, 4 surveys were administered, and biometrics were measured by the researchers before the trial began. At the end of the trial period, the researchers administered 2 further surveys to gain insights into the perceived usability of the wearable device. These were the standardized System Usability Scale (SUS) and a custom usability questionnaire designed by the research team. Statistical analyses were performed to identify the key factors that affect participants' intention to continue using the wearable device in the future. Machine learning classifiers were used to provide an early prediction of the intention to continue using the wearable device. Results: The study was conducted with older adult volunteers (N=65; mean age 70.52, SD 5.65 years) wearing a Xiaomi Mi Band 3 activity tracker for 7 days in a free-living environment. The results from the SUS survey showed no notable difference in perceived system usability regardless of region, sex, or age, eliminating the notion that usability perception differs based on geographical location, sex, or deviation in participants' age. There was also no statistically significant difference in SUS score between participants who had previously owned a wearable device and those who wore 1 or 2 devices during the trial. The bespoke usability questionnaire determined that the 2 most important factors that influenced an intention to continue device use in an older adult cohort were device comfort ($\tau$=0.34) and whether the device was fit for purpose ($\tau$=0.34). A computational model providing an early identifier of intention to continue device use was developed using these 2 features. Random forest classifiers were shown to provide the highest predictive performance (80\% accuracy). After including the top 8 ranked questions from the bespoke questionnaire as features of our model, the accuracy increased to 88\%. Conclusions: This study concludes that comfort and accuracy are the 2 main influencing factors in sustaining wearable device use. This study suggests that the reported factors influencing usability are transferable to other wearable sensor systems. Future work will aim to test this hypothesis using the same methodology on a cohort using other wearable technologies. ",
doi="10.2196/36807",
url="https://aging.jmir.org/2023/1/e36807",
url="http://www.ncbi.nlm.nih.gov/pubmed/36656636"
}


@Article{info:doi/10.2196/44439,
author="Ghorayeb, Abir
and Comber, Rob
and Gooberman-Hill, Rachael",
title="Development of a Smart Home Interface With Older Adults: Multi-Method Co-Design Study",
journal="JMIR Aging",
year="2023",
month="Jun",
day="16",
volume="6",
pages="e44439",
keywords="data visualization",
keywords="digital health",
keywords="smart homes",
keywords="older people",
keywords="technology acceptance",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: Smart home technologies have the potential to support aging in place; however, older people's perceptions of the value of smart homes may be influenced by their access to the information gathered by the technology. This information is needed to support their informed decision-making. Limited research has been conducted on how best to design visualizations of smart home data in keeping with the needs and wishes of older people. Objective: We aimed to investigate the design options that impact the usefulness of smart home systems, older people's information needs, their perceptions of data visualization, and the ways they would like information displayed to them. Methods: We used a qualitative approach to empower the participants as co-designers. Data collection comprised a sequence of methods such as interviews, observation, focus groups, scenario design, probes, and design workshops. Each phase informed the next. Overall, 13 older adults (n=8, 62\% female and n=5, 38\% male; aged 65-89 years) consented to participate. A thematic approach was used to analyze the data set, and participants were actively involved in designing the in-home interface, which enabled them to better conceptualize their needs. Results: The information collected was clustered into 5 themes: enabling home, health, and self-monitoring; enabling opportunities for social inclusion and engagement; enhancing cognitive abilities; customizability of the display; and promoting inclusion in recreation and leisure activities. These themes informed 5 design sessions in which participants co-designed visual metaphors for the themes based on their own experiences in an age-inclusive manner. Together, the participants produced a user-friendly prototype, which they chose to call My Buddy. They found it useful to receive social and cognitive triggers, as well as recommendations for special diets or activities based on their mood, health, and social status. Conclusions: Smart home data visualization is much more than a nice-to-have option. Visualization is a must-have feature because it deepens the understanding of the information collected and means that technology provides information of value and relevance to older people. This may improve the acceptability and perceived utility of in-home technology. By understanding what older people want to know from smart home technology and considering how to visualize data in ways that work for them, we can provide an appropriate in-home interface. Such an interface would suggest ways or opportunities to connect and socialize; stimulate contact with close friends or family members; maintain awareness of health and well-being; provide support in decision-making, cognitive tasks, and daily life activities; and monitor health status. Older adults are the best co-designers for the development of visual metaphors that resonate with their own experiences. Our findings promote the development of technologies that foreground and reflect the information needs of older people and engage them as designers of the display. ",
doi="10.2196/44439",
url="https://aging.jmir.org/2023/1/e44439",
url="http://www.ncbi.nlm.nih.gov/pubmed/37327037"
}


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


@Article{info:doi/10.2196/45876,
author="Muurling, Marijn
and Au-Yeung, M. Wan-Tai
and Beattie, Zachary
and Wu, Chao-Yi
and Dodge, Hiroko
and Rodrigues, K. Nathaniel
and Gothard, Sarah
and Silbert, C. Lisa
and Barnes, L. Lisa
and Steele, S. Joel
and Kaye, Jeffrey",
title="Differences in Life Space Activity Patterns Between Older Adults With Mild Cognitive Impairment Living Alone or as a Couple: Cohort Study Using Passive Activity Sensing",
journal="JMIR Aging",
year="2023",
month="Oct",
day="11",
volume="6",
pages="e45876",
keywords="passive monitoring",
keywords="in-home sensor",
keywords="mild cognitive impairment",
keywords="2-person home",
keywords="life space activity",
keywords="sensor",
keywords="older adult",
keywords="aging",
keywords="elder",
keywords="gerontology",
keywords="geriatric",
keywords="cognition",
keywords="cognitive impairment",
keywords="activity pattern",
keywords="at home",
keywords="daily activities",
keywords="activities of daily living",
keywords="digital health",
keywords="old age",
keywords="technology",
abstract="Background: Measuring function with passive in-home sensors has the advantages of real-world, objective, continuous, and unobtrusive measurement. However, previous studies have focused on 1-person homes only, which limits their generalizability. Objective: This study aimed to compare the life space activity patterns of participants living alone with those of participants living as a couple and to compare people with mild cognitive impairment (MCI) with cognitively normal participants in both 1- and 2-person homes. Methods: Passive infrared motion sensors and door contact sensors were installed in 1- and 2-person homes with cognitively normal residents or residents with MCI. A home was classified as an MCI home if at least 1 person in the home had MCI. Time out of home (TOOH), independent life space activity (ILSA), and use of the living room, kitchen, bathroom, and bedroom were calculated. Data were analyzed using the following methods: (1) daily averages over 4 weeks, (2) hourly averages (time of day) over 4 weeks, or (3) longitudinal day-to-day changes. Results: In total, 129 homes with people living alone (n=27, 20.9\%, MCI and n=102, 79.1\%, no-MCI homes) and 52 homes with people living as a couple (n=24, 46.2\%, MCI and n=28, 53.8\%, no-MCI homes) were included with a mean follow-up of 719 (SD 308) days. Using all 3 analysis methods, we found that 2-person homes showed a shorter TOOH, a longer ILSA, and shorter living room and kitchen use. In MCI homes, ILSA was higher in 2-person homes but lower in 1-person homes. The effects of MCI status on other outcomes were only found when using the hourly averages or longitudinal day-to-day changes over time, and they depended on the household type (alone vs residing as a couple). Conclusions: This study shows that in-home behavior is different when a participant is living alone compared to when they are living as a couple, meaning that the household type should be considered when studying in-home behavior. The effects of MCI status can be detected with in-home sensors, even in 2-person homes, but data should be analyzed on an hour-to-hour basis or longitudinally. ",
doi="10.2196/45876",
url="https://aging.jmir.org/2023/1/e45876",
url="http://www.ncbi.nlm.nih.gov/pubmed/37819694"
}


@Article{info:doi/10.2196/50345,
author="Seaton, L. Cherisse
and Rush, L. Kathy
and Li, Hung Eric Ping
and Hasan, Khalad Mohammad
and Fawcus, Linda",
title="Gluu Essentials Digital Skills Training for Middle-Aged and Older Adults That Makes Skills Stick: Results of a Pre-Post Intervention Study",
journal="JMIR Aging",
year="2023",
month="Nov",
day="10",
volume="6",
pages="e50345",
keywords="digital literacy",
keywords="digital skills",
keywords="older adults",
keywords="mobile device proficiency",
keywords="online",
keywords="mobile phone",
abstract="Background: A number of real-world digital literacy training programs exist to support engagement with mobile devices, but these have been understudied. Objective: The purpose of this study was to examine the effectiveness and program acceptability of a digital skills training program among middle-aged and older adults (aged ?50 years) and to gather participants' recommendations for lifelong digital skills promotion. Methods: The Gluu Essentials digital skills training program includes learning resources to support tablet use. Through pre-post surveys, this study assessed mobile device proficiency, confidence in going online and in avoiding frauds and scams, the frequency of engaging in online activities, program engagement, acceptability, and suggestions for continued support. Results: A total of 270 middle-aged and older adults completed baseline surveys. Of these 270 participants, 145 (53.7\%) completed follow-up surveys. Our findings indicate that mobile device proficiency increased (P<.001), whereas confidence was unchanged. Participants also reported going online more frequently to shop (P=.01) and access government services (P=.02) at follow-up. Program engagement varied considerably, but program acceptability was high. Participants' recommendations included the need for providing ongoing programs for support and training because technology constantly changes, reducing costs for technology and internet access, and keeping learning resources simple and easy to access. Conclusions: The Gluu Essentials digital skills training program increased mobile device proficiency and frequency of web-based activities (shopping and accessing government services) among middle-aged and older adults. ",
doi="10.2196/50345",
url="https://aging.jmir.org/2023/1/e50345",
url="http://www.ncbi.nlm.nih.gov/pubmed/37948115"
}


@Article{info:doi/10.2196/41549,
author="Arnaert, Antonia
and Sumbly, Pia
and da Costa, Daniel
and Liu, Yuxin
and Debe, Zoumanan
and Charbonneau, Sylvain",
title="Acceptance of the Apple Watch Series 6 for Telemonitoring of Older Adults With Chronic Obstructive Pulmonary Disease: Qualitative Descriptive Study Part 1",
journal="JMIR Aging",
year="2023",
month="Dec",
day="26",
volume="6",
pages="e41549",
keywords="Apple Watch",
keywords="chronic obstructive pulmonary disease",
keywords="digital health",
keywords="older adults",
keywords="qualitative descriptive",
keywords="technology acceptance",
keywords="telemonitoring",
abstract="Background: The Apple Watch is not a medical device per se; it is a smart wearable device that is increasingly being used for health monitoring. Evidence exists that the Apple Watch Series 6 can reliably measure blood oxygen saturation (SpO2) in patients with chronic obstructive pulmonary disease under controlled circumstances. Objective: This study aimed to better understand older adults' acceptance of the Watch as a part of telemonitoring, even with these advancements. Methods: This study conducted content analysis on data collected from 10 older adults with chronic obstructive pulmonary disease who consented to wear the Watch. Results: Using the Extended Unified Theory of Acceptance and Use of Technology model, results showed that participants experienced potential health benefits; however, the inability of the Watch to reliably measure SpO2 when in respiratory distress was concerning. Participants' level of tech savviness varied, which caused some fear and frustration at the start, yet all felt supported by family and would have explored more features if they owned the Watch. All agreed that the Watch is mainly a medical tool and not a gadget. Conclusions: To conclude, although the Watch may enhance their physical health and well-being, results indicated that participants are more likely to accept the Watch if it ultimately proves to be useful when experiencing respiratory distress. ",
doi="10.2196/41549",
url="https://aging.jmir.org/2023/1/e41549",
url="http://www.ncbi.nlm.nih.gov/pubmed/38147371"
}


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


@Article{info:doi/10.2196/44166,
author="Bratches, R. Reed W.
and Wall, A. Jaclyn
and Puga, Frank
and Pilonieta, Giovanna
and Jablonski, Rita
and Bakitas, Marie
and Geldmacher, S. David
and Odom, Nicholas J.",
title="Patient Portal Use Among Family Caregivers of Individuals With Dementia and Cancer: Regression Analysis From the National Study of Caregiving",
journal="JMIR Aging",
year="2023",
month="Dec",
day="20",
volume="6",
pages="e44166",
keywords="patient portal",
keywords="palliative care",
keywords="family caregiver",
keywords="caregiver",
keywords="dementia",
keywords="cancer",
keywords="clinic",
keywords="age",
keywords="race",
keywords="gender",
keywords="employment",
keywords="education",
keywords="model",
keywords="ethnicity",
keywords="health system",
keywords="intervention",
keywords="regression analysis",
abstract="Background: Family caregivers are often inexperienced and require information from clinic visits to effectively provide care for patients. Despite reported deficiencies, 68\% of health systems facilitate sharing information with family caregivers through the patient portal. The patient portal is especially critical in the context of serious illnesses, like advanced cancer and dementia, where caregiving is intense and informational needs change over the trajectory of disease progression. Objective: The objective of our study was to analyze a large, nationally representative sample of family caregivers from the National Study of Caregiving (NSOC) to determine individual characteristics and demographic factors associated with patient portal use among family caregivers of persons living with dementia and those living with cancer. Methods: We conducted a secondary data analysis using data from the 2020 NSOC sample of family caregivers linked to National Health and Aging Trends Study. Weighted regression analysis by condition (ie, dementia or cancer) was used to examine associations between family caregiver use of the patient portal and demographic variables, including age, race or ethnicity, gender, employment status, caregiver health, education, and religiosity. Results: A total of 462 participants (representing 4,589,844 weighted responses) were included in our analysis. In the fully adjusted regression model for caregivers of persons living with dementia, Hispanic ethnicity was associated with higher odds of patient portal use (OR: 2.81, 95\% CI 1.05-7.57; P=.04), whereas qualification lower than a college degree was associated with lower odds of patient portal use by family caregiver (OR 0.36, 95\% CI 0.18-0.71; P<.001. In the fully adjusted regression model for caregivers of persons living with cancer, no variables were found to be statistically significantly associated with patient portal use at the .05 level. Conclusions: In our analysis of NSOC survey data, we found differences between how dementia and cancer caregivers access the patient portal. As the patient portal is a common method of connecting caregivers with information from clinic visits, future research should focus on understanding how the portal is used by the groups we have identified, and why. ",
doi="10.2196/44166",
url="https://aging.jmir.org/2023/1/e44166"
}


@Article{info:doi/10.2196/50037,
author="Gui, Fang
and Yang, Jiaoyun
and Wu, Qilin
and Liu, Yang
and Zhou, Jia
and An, Ning",
title="Enhancing Caregiver Empowerment Through the Story Mosaic System: Human-Centered Design Approach for Visualizing Older Adult Life Stories",
journal="JMIR Aging",
year="2023",
month="Nov",
day="8",
volume="6",
pages="e50037",
keywords="life story visualization",
keywords="Story Mosaic system",
keywords="human-centered design",
keywords="prototype refinement workshops",
keywords="eldercare",
keywords="caregiver",
keywords="elder",
keywords="older adult",
abstract="Background: Various older adult care settings have embraced the use of the life story approach to enhance the development of comprehensive care plans. However, organizing life stories and extracting useful information is labor-intensive, primarily due to the repetitive, fragmented, and redundant nature of life stories gathered from everyday communication scenarios. Existing life story systems, while available, do not adequately fulfill the requirements of users, especially in the application of care services. Objective: The objective of this study is to design, develop, and evaluate a digital system that provides caregivers with the necessary tools to view and manage the life stories of older adults, enabling expedited access to pertinent information effectively and visually. Methods: This study used a multidisciplinary, user-centered design approach across 4 phases: initial design requirements, prototyping, prototype refinement workshops, and usability testing. During the initial phase, we conducted field research in the Hefei Tianyu Senior Living Service Nursing Home, China, to discover how caregivers currently store and use life stories and their needs, challenges, and obstacles in organizing and retrieving information. Subsequently, we designed a low-fidelity prototype according to the users' requirements. A prototyping workshop involving 6 participants was held to collaboratively design and discuss the prototype's function and interaction. User feedback from the workshops was used to optimize the prototype, leading to the development of the system. We then designed 2 rounds of usability testing with 7 caregivers to evaluate the system's usability and effectiveness. Results: We identified 3 categories of functionalities that are necessary to include in the design of our initial low-fidelity prototype of life story visualizations: life story input, life story organization, and timeline generation. Subsequently, through the workshops, we identified 3 categories for functional optimization: feedback on user interface and usability, optimization suggestions for existing features, and the request for additional functionalities. Next, we designed a medium-fidelity prototype based on human-centered design. The Story Mosaic system underwent usability testing in the Hefei Tianyu Senior Living Service Nursing Home. Overall, 7 users recorded and organized 1123 life stories of 16 older adults. The usability testing results indicated that the system was accessible and easy to use for caregivers. Based on the feedback from the usability testing, we finalized the high-fidelity prototype. Conclusions: We designed, developed, and evaluated the Story Mosaic system to support the visual management of older adults' life stories. This system empowers caregivers through digital technology and innovative design, pioneering personal narrative integration in caregiving. This system can expand to include informal caregivers and family members for continued adaptability and empathy. ",
doi="10.2196/50037",
url="https://aging.jmir.org/2023/1/e50037"
}


@Article{info:doi/10.2196/42972,
author="Hong, Alicia Y.
and Shen, Kang
and Han, Hae-Ra
and Ta Park, Van
and Bagchi, Pramita
and Lu, Kate Huixing
and Chen, Hsiaoyin
and Wang, Huei-yu Judy",
title="A WeChat-based Intervention, Wellness Enhancement for Caregivers (WECARE), for Chinese American Dementia Caregivers: Pilot Assessment of Feasibility, Acceptability, and Preliminary Efficacy",
journal="JMIR Aging",
year="2023",
month="Apr",
day="5",
volume="6",
pages="e42972",
keywords="Alzheimer disease",
keywords="dementia",
keywords="caregiver",
keywords="Chinese American",
keywords="mHealth intervention",
keywords="social media",
keywords="WeChat",
keywords="mHealth",
keywords="mobile health",
keywords="informal care",
keywords="caregiving",
keywords="family care",
keywords="spousal care",
keywords="minority",
keywords="ethnic",
keywords="cultural",
keywords="Chinese",
abstract="Background: Chinese American family caregivers of persons with dementia experience high rates of psychosocial distress and adverse health outcomes. Due to their immigrant and minority status, they face substantial obstacles to care and support, including stigma and misperception of dementia, limited knowledge and use of welfare and services, and poor social support. Few interventions have been developed or tested for this vulnerable population. Objective: This study aims to pilot-test the Wellness Enhancement for Caregivers (WECARE) intervention, a culturally tailored program delivered via WeChat, a social media app highly popular in the Chinese population. The 7-week WECARE was designed specifically for Chinese American dementia caregivers to improve their caregiving skills, reduce stress, and enhance psychosocial well-being. Feasibility, acceptability, and preliminary efficacy of the WECARE were assessed in this pilot. Methods: A total of 24 Chinese American family caregivers of persons with dementia were recruited for a pre-post 1-arm trial of the WECARE. By subscribing to the WECARE official account, participants received interactive multimedia programs on their WeChat account multiple times a week for 7 weeks. A backend database automatically delivered program components and tracked user activities. Three online group meetings were organized to facilitate social networking. Participants completed a baseline and a follow-up survey. Feasibility was assessed by the follow-up rate and curriculum completion rate; acceptability was assessed by user satisfaction and perceived usefulness of the program; and efficacy was assessed with pre-post differences in 2 primary outcomes of depressive symptoms and caregiving burden. Results: The intervention was completed by 23 participants with a retention rate of 96\%. Most of them (n=20, 83\%) were older than 50 years and the majority (n=17, 71\%) were female. The backend database revealed that the mean curriculum completion rate was 67\%. Participants also reported high rates of user satisfaction and perceived usefulness of the intervention and high ratings of weekly programs. The intervention led to significant improvement in participants' psychosocial health outcomes; their depressive symptoms reduced from 5.74 to 3.35 with an effect size of ?0.89 and caregiving burden decreased from 25.78 to 21.96 with an effect size of ?0.48. Conclusions: This pilot study suggests that WeChat-based WECARE intervention was feasible and acceptable; it also demonstrated initial efficacy in improving psychosocial well-being in Chinese American dementia caregivers. Further research with a control group is needed to assess its efficacy and effectiveness. The study highlights the need for more culturally appropriate mobile health interventions for Chinese American family caregivers of persons with dementia. ",
doi="10.2196/42972",
url="https://aging.jmir.org/2023/1/e42972",
url="http://www.ncbi.nlm.nih.gov/pubmed/37018042"
}


@Article{info:doi/10.2196/40762,
author="Thomas, Missy
and Henderson, Dean
and Trudel, Chantal
and Thomas, Neil",
title="Usability of a Community-Based Dementia Resource Website: Mixed Methods Study",
journal="JMIR Aging",
year="2023",
month="Apr",
day="20",
volume="6",
pages="e40762",
keywords="dementia",
keywords="caregivers",
keywords="eHealth",
keywords="community resources",
abstract="Background: Many individuals living with dementia want to live in their own homes for as long as possible. To do so, they frequently require assistance with activities of daily living, which is often provided by friends and relatives acting as informal care partners. In Canada, many informal care partners are currently overworked and overwhelmed. Although community-based dementia-inclusive resources are available to support them, care partners often struggle to find them. Dementia613.ca was created to make the process of finding community dementia-inclusive resources simpler and more straightforward by bringing them together in one eHealth website. Objective: The objective of our study was to determine if dementia613.ca is meeting the goal of connecting care partners and persons living with dementia to dementia-inclusive resources in their community. Methods: A review and assessment of the website was conducted using 3 evaluation methods: web analytics, questionnaires, and task analysis. Google Analytics was used to collect data related to website use over a 9-month period. Data on site content and user characteristics were collected. Furthermore, 2 web-based self-administered questionnaires were developed: one intended for care partners and persons living with dementia, and the other intended for businesses and organizations interested in serving persons living with dementia. Both gathered data on user characteristics and included standard questions used in website evaluations. Responses were collected over a 6-month period. Scenarios, tasks, and questions were developed for the moderated, remote, and task-analysis sessions. These tasks and questions determined how effectively persons living with dementia and their care partners can use dementia613.ca. Overall, 5 sessions were held with persons experiencing moderate cognitive decline and with care partners of persons living with dementia. Results: This evaluation showed that the idea behind dementia613.ca is strong and appeals to persons living with dementia, their care partners, and the businesses and organizations serving this market. Participants indicated that it is a useful community resource that meets a previously unfulfilled need in the area, and highlighted the benefits of bringing community resources together on 1 website. In our questionnaire, >60\% (19/29, 66\%) of people living with dementia and their care partners and 70\% (7/10) of businesses and organizations agreed that the website made it easier to find relevant dementia-inclusive resources. There is room for improvement; participants indicated that the navigation and search features could be further developed. Conclusions: We believe that the dementia613.ca model could be used to inspire and guide the creation of dementia resource websites in other regions in Ontario and beyond. The framework behind it is generalizable and could be replicated to help care partners and persons living with dementia find local resources more easily. ",
doi="10.2196/40762",
url="https://aging.jmir.org/2023/1/e40762",
url="http://www.ncbi.nlm.nih.gov/pubmed/37079355"
}


@Article{info:doi/10.2196/45859,
author="McCrae, S. Christina
and Curtis, F. Ashley
and Stearns, A. Melanie
and Nair, Neetu
and Golzy, Mojgan
and Shenker, I. Joel
and Beversdorf, Q. David
and Cottle, Amelia
and Rowe, A. Meredeth",
title="Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia in Rural Family Caregivers of People With Dementia (NiteCAPP): Mixed Methods Study",
journal="JMIR Aging",
year="2023",
month="Aug",
day="24",
volume="6",
pages="e45859",
keywords="arousal",
keywords="caregivers",
keywords="cognitive behavioral therapy",
keywords="CBT: cognitive behavioral therapy for insomnia",
keywords="CBT-I",
keywords="dementia",
keywords="insomnia",
keywords="internet",
abstract="Background: Informal caregivers of people with dementia frequently experience chronic insomnia, contributing to stress and poor health outcomes. Rural caregivers are particularly vulnerable but have limited access to cognitive behavioral therapy for insomnia (CBT-I), a recommended frontline treatment for chronic insomnia. Web-based delivery promises to improve insomnia, particularly for rural caregivers who have limited access to traditional in-person treatments. Our team translated an efficacious 4-session standard CBT-I content protocol into digital format to create NiteCAPP. Objective: This study aimed to (1) adapt NiteCAPP for dementia caregivers to create NiteCAPP CARES, a tailored digital format with standard CBT-I content plus caregiver-focused modifications; (2) conduct usability testing and evaluate acceptability of NiteCAPP CARES' content and features; and (3) pilot-test the adapted intervention to evaluate feasibility and preliminary effects on sleep and related health outcomes. Methods: We followed Medical Research Council recommendations for evaluating complex medical interventions to explore user needs and adapt and validate content using a stepwise approach: (1) a rural dementia caregiver (n=5) and primary care provider (n=5) advisory panel gave feedback that was used to adapt NiteCAPP; (2) caregiver (n=5) and primary care provider (n=7) focus groups reviewed the newly adapted NiteCAPP CARES and provided feedback that guided further adaptations; and (3) NiteCAPP CARES was pilot-tested in caregivers (n=5) for feasibility and to establish preliminary effects. Self-report usability measures were collected following intervention. Before and after treatment, 14 daily electronic sleep diaries and questionnaires were collected to evaluate arousal, health, mood, burden, subjective cognition, and interpersonal processes. Results: The stepped approach provided user and expert feedback on satisfaction, usefulness, and content, resulting in a new digital CBT-I tailored for rural dementia caregivers: NiteCAPP CARES. The advisory panel recommended streamlining content, eliminating jargon, and including caregiver-focused content. Focus groups gave NiteCAPP CARES high usefulness ratings (mean score 4.4, SD 0.79, scored from 1=least to 5=most favorable; score range 4.2-4.8). Multiple features were evaluated positively, including the intervention's comprehensive and engaging information, caregiver focus, good layout, easy-to-access intervention material, and easy-to-understand sleep graphs. Suggestions for improvement included the provision of day and night viewing options, collapsible text, font size options, tabbed access to videos, and a glossary of terms. Pilot-test users rated usefulness (mean score 4.3, SD 0.83; range 4.1-4.5) and satisfaction (mean score 8.4, SD 1.41, scored from 1=least to 10=most satisfied; range 7.4-9.0) highly. Preliminary effects on caregiver sleep, arousal, health, mood, burden, cognition, and interpersonal processes (all P<.05) were promising. Conclusions: Adaptations made to standard digital CBT-I created a feasible, tailored digital intervention for rural dementia caregivers. Important next steps include further examination of feasibility and efficacy in a randomized controlled trial with an active control condition, a multisite effectiveness trial, and eventual broad dissemination. Trial Registration: ClinicalTrials.gov NCT04632628; https://clinicaltrials.gov/ct2/show/NCT04632628 ",
doi="10.2196/45859",
url="https://aging.jmir.org/2023/1/e45859",
url="http://www.ncbi.nlm.nih.gov/pubmed/37616032"
}


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


@Article{info:doi/10.2196/41185,
author="Dale, Jeremy
and Nanton, Veronica
and Day, Theresa
and Apenteng, Patricia
and Bernstein, Janine Celia
and Grason Smith, Gillian
and Strong, Peter
and Procter, Rob",
title="Uptake and Use of Care Companion, a Web-Based Information Resource for Supporting Informal Carers of Older People: Mixed Methods Study",
journal="JMIR Aging",
year="2023",
month="Sep",
day="21",
volume="6",
pages="e41185",
keywords="informal carers",
keywords="information technology",
keywords="internet",
keywords="information needs",
keywords="mixed methods evaluation",
keywords="Reach, Effectiveness, Adoption, Implementation, and Maintenance",
keywords="RE-AIM",
keywords="mobile phone",
abstract="Background: Informal carers play a major role in supporting relatives and friends who are sick, disabled, or frail. Access to information, guidance, and support that are relevant to the lives and circumstances of carers is critical to carers feeling supported in their role. When unmet, this need is known to adversely affect carer resilience and well-being. To address this problem, Care Companion was co-designed with current and former carers and stakeholders as a free-to-use, web-based resource to provide access to a broad range of tailored information, including links to local and national resources. Objective: This study aimed to investigate the real-world uptake and use of Care Companion in 1 region of England (with known carer population of approximately 100,000), with local health, community, and social care teams being asked to actively promote its use. Methods: The study had a convergent parallel, mixed methods design and drew on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Data included metrics from carers' use of Care Companion, surveys completed by users recruited through general practice, and interviews with carers and health and social care providers regarding their views about Care Companion and their response to it. Quantitative data were analyzed using descriptive statistics. Interview data were analyzed thematically and synthesized to create overarching themes. The qualitative findings were used for in-depth exploration and interpretation of quantitative results. Results: Despite awareness-raising activities by relevant health, social care, and community organizations, there was limited uptake with only 556 carers (0.87\% of the known carer population of 100,000) registering to use Care Companion in total, with median of 2 (mean 7.2; mode 2) visits per registered user. Interviews with carers (n=29) and stakeholders (n=12) identified 7 key themes that influenced registration, use, and perceived value: stakeholders' signposting of carers to Care Companion, expectations about Care Companion, activity levels and conflicting priorities, experience of using Care Companion, relevance to personal circumstances, social isolation and networks, and experience with digital technology. Although many interviewed carers felt that it was potentially useful, few considered it as being of direct relevance to their own circumstances. For some, concerns about social isolation and lack of hands-on support were more pressing issues than the need for information. Conclusions: The gap between the enthusiastic views expressed by carers during Care Companion's co-design and the subsequent low level of uptake and user experience observed in this evaluation suggests that the co-design process may have lacked a sufficiently diverse set of viewpoints. Numerous factors were identified as contributing to Care Companion's level of use, some of which might have been anticipated during its co-design. More emphasis on the development and implementation, including continuing co-design support after deployment, may have supported increased use. ",
doi="10.2196/41185",
url="https://aging.jmir.org/2023/1/e41185",
url="http://www.ncbi.nlm.nih.gov/pubmed/37733406"
}


@Article{info:doi/10.2196/36325,
author="Raffegeau, E. Tiphanie
and Young, R. William
and Fino, C. Peter
and Williams, Mark A.",
title="A Perspective on Using Virtual Reality to Incorporate the Affective Context of Everyday Falls Into Fall Prevention",
journal="JMIR Aging",
year="2023",
month="Jan",
day="11",
volume="6",
pages="e36325",
keywords="aging",
keywords="balance",
keywords="perturbation",
keywords="locomotion",
keywords="cognition",
keywords="exergame",
keywords="anxiety",
doi="10.2196/36325",
url="https://aging.jmir.org/2023/1/e36325",
url="http://www.ncbi.nlm.nih.gov/pubmed/36630173"
}


@Article{info:doi/10.2196/49587,
author="Al Abiad, Nahime
and van Schooten, S. Kimberley
and Renaudin, Valerie
and Delbaere, Kim
and Robert, Thomas",
title="Association of Prospective Falls in Older People With Ubiquitous Step-Based Fall Risk Parameters Calculated From Ambulatory Inertial Signals: Secondary Data Analysis",
journal="JMIR Aging",
year="2023",
month="Nov",
day="24",
volume="6",
pages="e49587",
keywords="fall risk biomarkers",
keywords="prospective falls",
keywords="sensor placement",
keywords="inertial measurement units",
keywords="fall prediction",
keywords="older adults",
keywords="older adult",
keywords="geriatric",
keywords="geriatrics",
keywords="elderly",
keywords="fall",
keywords="sensor",
keywords="sensors",
keywords="inertial measurement",
keywords="model",
keywords="predict",
keywords="prediction",
keywords="predictive",
abstract="Background: In recent years, researchers have been advocating for the integration of ambulatory gait monitoring as a complementary approach to traditional fall risk assessments. However, current research relies on dedicated inertial sensors that are fixed on a specific body part. This limitation impacts the acceptance and adoption of such devices. Objective: Our study objective is twofold: (1) to propose a set of step-based fall risk parameters that can be obtained independently of the sensor placement by using a ubiquitous step detection method and (2) to evaluate their association with prospective falls. Methods: A reanalysis was conducted on the 1-week ambulatory inertial data from the StandingTall study, which was originally described by Delbaere et al. The data were from 301 community-dwelling older people and contained fall occurrences over a 12-month follow-up period. Using the ubiquitous and robust step detection method Smartstep, which is agnostic to sensor placement, a range of step-based fall risk parameters can be calculated based on walking bouts of 200 steps. These parameters are known to describe different dimensions of gait (ie, variability, complexity, intensity, and quantity). First, the correlation between parameters was studied. Then, the number of parameters was reduced through stepwise backward elimination. Finally, the association of parameters with prospective falls was assessed through a negative binomial regression model using the area under the curve metric. Results: The built model had an area under the curve of 0.69, which is comparable to models exclusively built on fixed sensor placement. A higher fall risk was noted with higher gait variability (coefficient of variance of stride time), intensity (cadence), and quantity (number of steps) and lower gait complexity (sample entropy and fractal exponent). Conclusions: These findings highlight the potential of our method for comprehensive and accurate fall risk assessments, independent of sensor placement. This approach has promising implications for ambulatory gait monitoring and fall risk monitoring using consumer-grade devices. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615000138583; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367746 ",
doi="10.2196/49587",
url="https://aging.jmir.org/2023/1/e49587"
}


@Article{info:doi/10.2196/43106,
author="Fakhfakh, Maya
and Blanchette, Virginie
and Plourde, V. Karine
and Gadio, Souleymane
and Elf, Marie
and Jones, Allyson C.
and Meijering, Louise
and Gigu{\`e}re, Anik
and L{\'e}gar{\'e}, France",
title="Canadian Older Adults' Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey",
journal="JMIR Aging",
year="2023",
month="Jan",
day="18",
volume="6",
pages="e43106",
keywords="aged",
keywords="intention",
keywords="decision aid",
keywords="decision support techniques",
keywords="housing",
keywords="unified theory of acceptance and use of technology",
keywords="UTAUT",
keywords="information technology",
keywords="internet",
keywords="shared decision-making",
abstract="Background: Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision. Objective: We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention. Methods: We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ?65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA. Results: Of the 11,972 invited panelists, 1176 (9.82\%) met the eligibility criteria, and 1000 (85.03\%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8\%), White (906/1000, 90.6\%), English speakers (629/1000, 62.9\%), and lived in Ontario or Quebec (628/1000, 62.8\%) and in urban areas (850/1000, 85\%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue ($\beta$=.30; P<.001), objective eHealth literacy ($\beta$=--.06; P=.03), performance expectancy ($\beta$=.55; P<.001), social influence ($\beta$=.37; P<.001), and facilitating conditions ($\beta$=.15; P<.001). Conclusions: Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA. ",
doi="10.2196/43106",
url="https://aging.jmir.org/2023/1/e43106",
url="http://www.ncbi.nlm.nih.gov/pubmed/36566499"
}


@Article{info:doi/10.2196/43197,
author="Garcia Reyes, Paola Elsy
and Kelly, Ryan
and Buchanan, George
and Waycott, Jenny",
title="Understanding Older Adults' Experiences With Technologies for Health Self-management: Interview Study",
journal="JMIR Aging",
year="2023",
month="Mar",
day="21",
volume="6",
pages="e43197",
keywords="older adults",
keywords="technology",
keywords="health self-management",
keywords="motivator",
keywords="enabler",
keywords="barrier",
abstract="Background: Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments. Objective: This study aimed to understand the types of technologies that older adults use to support their health and the factors that motivate them to use their chosen technologies to support their health. In addition, we aimed to understand the factors that enable the effective use of technologies for health self-management and to identify the barriers that can negatively affect the adoption of technologies. Methods: A total of 22 older adults participated in semistructured interviews regarding their experiences of using technologies for health self-management. Interview transcripts were analyzed through an in-depth thematic analysis. Results: The interviews revealed that a range of technologies, such as videoconferencing software, fitness trackers, and other devices, were being used by older adults to support their health. Interviews showed that participants were motivated to use technologies to monitor health issues, to stay active and connected, and to record and change their behavior in the light of foreseen risks related to their future health status. Enablers that facilitated the effective use of technologies include social and organizational influence, convenient access to health care and safety provided by the technology, and easy setup and low cost of the technology. Barriers include information overload and a sense of futility about future health decline; telehealth being an inadequate substitute for in-person consultation; concerns about trust related to privacy and accuracy; and technologies being stigmatizing, uncomfortable to use, expensive, and unfamiliar. Conclusions: This study suggested that older adults were using a variety of technologies to prevent or prepare for future health decline, evidencing a resilient attitude toward health and aging. In addition, older adults were willing to continue using the technology when there was a perceived need. The enabler mentioned by most participants was the social and organizational influence that included health care staff, family, friends, and organizations. This analysis provides a better understanding of how older adults use technologies to support their health and can guide the provision of appropriate health technologies for them. ",
doi="10.2196/43197",
url="https://aging.jmir.org/2023/1/e43197",
url="http://www.ncbi.nlm.nih.gov/pubmed/36943333"
}


@Article{info:doi/10.2196/40004,
author="Brainin, Esther
and Neter, Efrat",
title="Refined Analysis of Older eHealth Users From an Agency Perspective: Quantitative Telephone Interview Study",
journal="JMIR Aging",
year="2023",
month="Apr",
day="26",
volume="6",
pages="e40004",
keywords="eHealth",
keywords="health",
keywords="internet",
keywords="structuration theory",
keywords="agency",
keywords="digital divide",
keywords="age",
keywords="gender",
keywords="education",
keywords="information",
keywords="health condition",
keywords="self-rated health",
keywords="SRH",
keywords="health care services",
keywords="surrogate",
keywords="older adults",
keywords="users",
keywords="patient",
keywords="Giddens",
keywords="Archer",
keywords="Bourdieu",
keywords="capital",
abstract="Background: Most studies on the eHealth divide among older people have compared users to nonusers and found that age, gender, and education were associated with eHealth misuse. They assumed that these characteristics were structural barriers to eHealth adoption. Furthermore, eHealth practices have been examined in a narrow and incomplete way, and the studies disagree about the association between health conditions and eHealth use. Using a more dynamic theoretical lens, we investigated the potential motivations driving older adults' agential adoption of eHealth practices despite their advanced age. Objective: This study aimed to obtain a complete and detailed description of eHealth uses among older adults; examine whether demographic characteristics such as age, gender, and education (previously related to eHealth misuse) are still associated with the various eHealth clusters; and determine whether contextual factors such as changes in the health condition of older eHealth users or their loved ones are associated with older adult eHealth use. Methods: We conducted a 30-minute telephone interview with a representative sample of 442 Israeli adults (aged ?50 years) with a sampling error of 2.04\%. The interviews were conducted in Hebrew, Arabic, and Russian. Using factor analysis with 21 eHealth use questions, we identified 4 eHealth clusters: instrumental and administrative information seeking, information sharing, seeking information from peers, and web-based self-tracking. In addition to age, gender, education, internet experience, frequency of internet use, perceived eHealth literacy, and self-rated health, we asked respondents to indicate how much they had used offline health services because of a health crisis in the past year. Results: We found differences in the number of older eHealth users in the various clusters. They used instrumental and administrative information (420/442, 95\%) and obtained information from peers (348/442, 78.7\%) the most; followed by web-based self-tracking related to health issues (305/442, 69\%), and only a few (52/442, 11.3\%) uploaded and shared health information on the web. When controlling for personal attributes, age, gender, and education were no longer predictors of eHealth use, nor was a chronic ailment. Instead, internet experience, frequency of internet use, and perceived eHealth literacy were associated with 3 eHealth clusters. Looking for health information for family and friends predicted all 4 eHealth clusters. Conclusions: Many older adults can overcome structural barriers such as age, gender, and education. The change in their or their loved ones' circumstances encouraged them to make deliberate efforts to embrace the new practices expected from today's patients. Seeking health information for family and friends and dealing with unexpected health crises motivates them to use eHealth. We suggest that health professionals ignore their tendency to label older people as nonusers and encourage them to benefit from using eHealth and overcome stereotypical ways of perceiving these patients. ",
doi="10.2196/40004",
url="https://aging.jmir.org/2023/1/e40004",
url="http://www.ncbi.nlm.nih.gov/pubmed/37121572"
}


@Article{info:doi/10.2196/43709,
author="Zhang, Yichi
and Lee, J. Edmund W.
and Teo, Wei-Peng",
title="Health-Seeking Behavior and Its Associated Technology Use: Interview Study Among Community-Dwelling Older Adults",
journal="JMIR Aging",
year="2023",
month="May",
day="4",
volume="6",
pages="e43709",
keywords="health",
keywords="health-seeking behavior",
keywords="aging",
keywords="technology",
keywords="telehealth",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="health access",
keywords="qualitative study",
keywords="mobile phone",
abstract="Background: Understanding older people's health-seeking behavior (HSB) is crucial for uncovering their health needs and priorities and developing appropriate policies to address them and avert their disease progression. Technologies play an active role in our daily lives and have been incorporated into health activities to support the older population and facilitate their HSB. However, previous studies of HSB have mainly focused on behaviors during illness, and there are limited studies on how technologies have been used in older people's health-seeking activities. Objective: This study aimed to investigate HSB and the associated technology use among the older population, ultimately proposing implications for practice to address their unmet health needs. Methods: This paper presents partial data from a large qualitative study, which has been approved by the institutional review board and used a phenomenological approach. Semistructured interviews were conducted between April 2022 and July 2022, either via Zoom (Zoom Video Communications Inc) or face-to-face sessions. Inclusion criteria were being aged ?50 years, long-term residence in Singapore, and being able to speak English or Mandarin. The interviews were manually transcribed verbatim, and thematic analysis was performed, with the individual as the unit of analysis to understand the patterns of behaviors. Results: In total, 15 interviews were conducted to reach thematic saturation. We identified 5 main consequences of HSB, which were aligned with the original HSB model. Regarding technology use in health seeking, 4 themes were extracted: the most widely used digital technologies are the mobile health apps and wearable devices with the associated wellness programs launched by the government and local companies, and they have the potential to enhance health communication, promote health maintenance, and increase access to health services; information communication technologies and social media, though not primarily designed for health purposes, play a substantial role in easing the process of seeking health information and managing symptoms. Although the outbreak of the COVID-19 pandemic has resulted in some alterations to older adults' well-being, it has catalyzed the adoption of telehealth as a complement to access health care services, and older adults have different considerations when selecting technologies to facilitate their health seeking and fulfill their health needs. Moreover, 4 archetypes were proposed based on our findings and the insights gained from our participants' observations in their social networks. These findings led to several implications for practice regarding health communication and promotion, health education, technology design and improvement, telemonitoring service implementation, and solutions to address the needs of each proposed archetype. Conclusions: Unlike the commonly held belief that older adults resist technologies and lack technological proficiency, our findings showed that technologies could play a promising role in facilitating older adults' health seeking. Our findings have implications for the design and implementation of health services and policies. ",
doi="10.2196/43709",
url="https://aging.jmir.org/2023/1/e43709",
url="http://www.ncbi.nlm.nih.gov/pubmed/36996003"
}


@Article{info:doi/10.2196/44564,
author="Schroeder, Tanja
and Dodds, Laura
and Georgiou, Andrew
and Gewald, Heiko
and Siette, Joyce",
title="Older Adults and New Technology: Mapping Review of the Factors Associated With Older Adults' Intention to Adopt Digital Technologies",
journal="JMIR Aging",
year="2023",
month="May",
day="16",
volume="6",
pages="e44564",
keywords="technology adoption",
keywords="digital technology",
keywords="older adults",
keywords="seniors",
keywords="intention to use digital technologies",
abstract="Background: Ongoing advancements in digital solutions support older adults' healthy aging and well-being. However, a unified synthesis of sociodemographic, cognitive, attitudinal, emotional, and environmental factors that influence older adults' intention to use these new digital technologies is still lacking. Understanding the salient factors that influence older adults' intention to use digital technologies will help to ensure that technology is developed appropriately and contextually. This understanding is also likely to contribute to developing technology acceptance models specifically for the aging generation, by reorganizing principles and constructing objectivity criteria for future research studies. Objective: This review aims to identify the key factors associated with older adults' intention to use digital technologies and to provide a comprehensive conceptual framework to describe the relationships between these key factors and older adults' intention to use digital technologies. Methods: A mapping review was conducted using 9 databases from inception to November 2022. Articles were selected for review if they had an evaluative component of older adults' intention to use digital technologies. Three researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review and quality appraisal was measured using 3 different tools based on each article's study design. Results: We identified a total of 59 articles investigating older adults' intention to use digital technologies. The majority (40/59, 68\%) of articles did not use an existing framework or model for technology acceptance. Studies mostly adopted a quantitative research design (27/59, 46\%). We found 119 unique factors reported to influence older adults' intention to use digital technologies. These were categorized into 6 distinct themes: Demographics and Health Status, Emotional Awareness and Needs, Knowledge and Perception, Motivation, Social Influencers, and Technology Functional Features. Conclusions: Given the importance of global demographic change toward an aging society, there is surprisingly limited research on the factors that influence older adults' intention to use digital technologies. Our identification of the key factors across different types of digital technology and models supports the future integration of a comprehensive perspective encompassing environmental, psychological, and social determinants for older adults' intention to use digital technologies. ",
doi="10.2196/44564",
url="https://aging.jmir.org/2023/1/e44564",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191976"
}


@Article{info:doi/10.2196/49500,
author="Aclan, Roslyn
and George, Stacey
and Laver, Kate",
title="A Digital Tool for the Self-Assessment of Homes to Increase Age-Friendliness: Validity Study",
journal="JMIR Aging",
year="2023",
month="Oct",
day="26",
volume="6",
pages="e49500",
keywords="age-friendliness",
keywords="aging",
keywords="home environment",
keywords="self-assessment",
keywords="digital",
keywords="tool",
abstract="Background: Age-friendly environments in homes and communities play an important role in optimizing the health and well-being of society. Older people have strong preferences for remaining at home as they age. Home environment assessment tools that enable older people to assess their homes and prepare for aging in place may be beneficial. Objective: This study aims to establish the validity of a digital self-assessment tool by assessing it against the current gold standard, an occupational therapy home assessment. Methods: A cohort of adults aged ?60 years living in metropolitan Adelaide, South Australia, Australia, assessed their homes using a digital self-assessment tool with 89 questions simultaneously with an occupational therapist. Adults who were living within their homes and did not have significant levels of disabilities were recruited. Cohen $\kappa$ and Gwet AC1 were used to assess validity. Results: A total of 61 participants (age: mean 71.2, SD 7.03 years) self-assessed their own homes using the digital self-assessment tool. The overall levels of agreement were high, supporting the validity of the tool in identifying potential hazards. Lower levels of agreement were found in the following domains: steps (77\% agreement, Gwet AC1=0.56), toilets (56\% agreement, $\kappa$=0.10), bathrooms (64\% agreement, $\kappa$=0.46), and backyards (55\% agreement, $\kappa$=0.24). Conclusions: Older people were able to self-assess their homes using a digital self-assessment tool. Digital health tools enable older people to start thinking about their future housing needs. Innovative tools that can identify problems and generate solutions may improve the age-friendliness of the home environment. ",
doi="10.2196/49500",
url="https://aging.jmir.org/2023/1/e49500",
url="http://www.ncbi.nlm.nih.gov/pubmed/37883134"
}


@Article{info:doi/10.2196/41539,
author="Liu, Yuxin
and Arnaert, Antonia
and da Costa, Daniel
and Sumbly, Pia
and Debe, Zoumanan
and Charbonneau, Sylvain",
title="Experiences of Patients With Chronic Obstructive Pulmonary Disease Using the Apple Watch Series 6 Versus the Traditional Finger Pulse Oximeter for Home SpO2 Self-Monitoring: Qualitative Study Part 2",
journal="JMIR Aging",
year="2023",
month="Nov",
day="2",
volume="6",
pages="e41539",
keywords="Apple Watch",
keywords="chronic obstructive pulmonary disease",
keywords="pulse oximeter",
keywords="qualitative descriptive",
keywords="self-monitoring",
keywords="smartwatch",
abstract="Background: Amid the rise in mobile health, the Apple Watch now has the capability to measure peripheral blood oxygen saturation (SpO2). Although the company indicated that the Watch is not a medical device, evidence suggests that SpO2 measurements among patients with chronic obstructive pulmonary disease (COPD) are accurate in controlled settings. Yet, to our knowledge, the SpO2 function has not been validated for patients with COPD in naturalistic settings. Objective: This qualitative study explored the experiences of patients with COPD using the Apple Watch Series 6 versus a traditional finger pulse oximeter for home SpO2 self-monitoring. Methods: We conducted individual semistructured interviews with 8 female and 2 male participants with moderate to severe COPD, and transcripts were qualitatively analyzed. All received a watch to monitor their SpO2 for 5 months. Results: Due to respiratory distress, the watch was unable to collect reliable SpO2 measurements, as it requires the patient to remain in a stable position. However, despite the physical limitations and lack of reliable SpO2 values, participants expressed a preference toward the watch. Moreover, participants' health needs and their unique accessibility experiences influenced which device was more appropriate for self-monitoring purposes. Overall, all shared the perceived importance of prioritizing their physical COPD symptoms over device selection to manage their disease. Conclusions: Differing results between participant preferences and smartwatch limitations warrant further investigation into the reliability and accuracy of the SpO2 function of the watch and the balance among self-management, medical judgment, and dependence on self-monitoring technology. ",
doi="10.2196/41539",
url="https://aging.jmir.org/2023/1/e41539",
url="http://www.ncbi.nlm.nih.gov/pubmed/37917147"
}


@Article{info:doi/10.2196/47729,
author="Balki, Eric
and Hayes, Niall
and Holland, Carol",
title="The Indirect Impact of Educational Attainment as a Distal Resource for Older Adults on Loneliness, Social Isolation, Psychological Resilience, and Technology Use During the COVID-19 Pandemic: Cross-Sectional Quantitative Study",
journal="JMIR Aging",
year="2023",
month="Nov",
day="24",
volume="6",
pages="e47729",
keywords="pandemic",
keywords="educational attainment",
keywords="isolation",
keywords="loneliness",
keywords="socioemotional needs",
keywords="social engagement",
keywords="technology use",
keywords="older adults",
keywords="psychological resilience",
abstract="Background: During the COVID-19 pandemic, government-mandated social distancing prevented the spread of the disease but potentially exacerbated social isolation and loneliness for older people, especially those already vulnerable to isolation. Older adults may have been able to draw from their personal resources such as psychological resilience (PR) and technology use (TU) to combat such effects. Educational attainment (EA) or early-life EA may potentially shape later-life personal resources and their impact on the effects of the pandemic lockdown on outcomes such as loneliness. The developmental adaptation model allows for the supposition that social isolation, TU, and PR may be affected by early EA in older adults. Objective: This study examined the indirect impact of EA on pandemic-linked loneliness in a sample of older adults. The developmental adaptation model was used as the conceptual framework to view EA as a distal influence on loneliness, social isolation, PR, and TU. We hypothesized that EA would predict TU and PR and have a moderating impact on social isolation and loneliness. We also hypothesized that PR and TU would mediate the effect of EA on loneliness. Methods: This was a cross-sectional observational study, in which data were gathered from 92 older adults aged ?65 years in the United Kingdom from March 2020 to June 2021, when the country was under various pandemic-linked social mobility restrictions. The data captured demographic information including age, gender, ethnicity, and the highest degree of education achieved. The University of California Los Angeles Loneliness Scale, Connor--Davidson Resilience Scale, Lubben Social Network Index, and Technology Experience Questionnaire were used as standardized measures. Pearson correlation, moderation, and mediation regression analyses were conducted to investigate the hypotheses. Results: We found a higher prevalence of loneliness in older adults than in prepandemic norms. EA was correlated with greater TU and PR and moderated the impact of social isolation on loneliness. PR mediated and TU partially mediated the relationship between EA and loneliness. Conclusions: Early-life EA was confirmed as a distal resource for older adults and played an indirect role in affecting loneliness levels during the pandemic. It has an impact on present-day personal resources, such as PR and TU, which affect loneliness and also moderate the impact of social isolation on loneliness. Policymakers should be aware that older adults with low levels of EA may be more vulnerable to the harmful impacts of loneliness when isolated by choice. ",
doi="10.2196/47729",
url="https://aging.jmir.org/2023/1/e47729",
url="http://www.ncbi.nlm.nih.gov/pubmed/37999938"
}


@Article{info:doi/10.2196/44037,
author="Bernstein, Sean
and Gilson, Sarah
and Zhu, Mengqi
and Nathan, G. Aviva
and Cui, Michael
and Press, G. Valerie
and Shah, Sachin
and Zarei, Parmida
and Laiteerapong, Neda
and Huang, S. Elbert",
title="Diabetes Life Expectancy Prediction Model Inputs and Results From Patient Surveys Compared With Electronic Health Record Abstraction: Survey Study",
journal="JMIR Aging",
year="2023",
month="Nov",
day="9",
volume="6",
pages="e44037",
keywords="diabetes mellitus",
keywords="patient-reported outcome measure",
keywords="life expectancy",
keywords="diabetes",
keywords="diabetic",
keywords="predict",
keywords="model",
keywords="mortality",
keywords="chart review",
keywords="chart abstraction",
keywords="patient chart",
keywords="prediction model",
keywords="patient-reported outcome",
abstract="Background: Prediction models are being increasingly used in clinical practice, with some requiring patient-reported outcomes (PROs). The optimal approach to collecting the needed inputs is unknown. Objective: Our objective was to compare mortality prediction model inputs and scores based on electronic health record (EHR) abstraction versus patient survey. Methods: Older patients aged ?65 years with type 2 diabetes at an urban primary care practice in Chicago were recruited to participate in a care management trial. All participants completed a survey via an electronic portal that included items on the presence of comorbid conditions and functional status, which are needed to complete a mortality prediction model. We compared the individual data inputs and the overall model performance based on the data gathered from the survey compared to the chart review. Results: For individual data inputs, we found the largest differences in questions regarding functional status such as pushing/pulling, where 41.4\% (31/75) of participants reported difficulties that were not captured in the chart with smaller differences for comorbid conditions. For the overall mortality score, we saw nonsignificant differences (P=.82) when comparing survey and chart-abstracted data. When allocating participants to life expectancy subgroups (<5 years, 5-10 years, >10 years), differences in survey and chart review data resulted in 20\% having different subgroup assignments and, therefore, discordant glucose control recommendations. Conclusions: In this small exploratory study, we found that, despite differences in data inputs regarding functional status, the overall performance of a mortality prediction model was similar when using survey and chart-abstracted data. Larger studies comparing patient survey and chart data are needed to assess whether these findings are reproduceable and clinically important. ",
doi="10.2196/44037",
url="https://aging.jmir.org/2023/1/e44037"
}


@Article{info:doi/10.2196/36663,
author="Campitelli, Anthony
and Paulson, Sally
and Gills, L. Josh
and Jones, D. Megan
and Madero, N. Erica
and Myers, Jennifer
and Glenn, M. Jordan
and Gray, Michelle",
title="A Novel Digital Digit-Symbol Substitution Test Measuring Processing Speed in Adults At Risk for Alzheimer Disease: Validation Study",
journal="JMIR Aging",
year="2023",
month="Jan",
day="27",
volume="6",
pages="e36663",
keywords="Alzheimer disease",
keywords="dementia",
keywords="processing speed",
keywords="digit-symbol substitution",
keywords="aging",
keywords="cognitive",
abstract="Background: Assessing cognitive constructs affected by Alzheimer disease, such as processing speed (PS), is important to screen for potential disease and allow for early detection. Digital PS assessments have been developed to provide widespread, efficient cognitive testing, but all have been validated only based on the correlation between test scores. Best statistical practices dictate that concurrent validity should be assessed for agreement or equivalence rather than using correlation alone. Objective: This study aimed to assess the concurrent validity of a novel digital PS assessment against a gold-standard measure of PS. Methods: Adults aged 45-75 years (n=191) participated in this study. Participants completed the novel digital digit-symbol substitution test (DDSST) and the Repeatable Battery for the Assessment of Neuropsychological Status coding test (RBANS-C). The correlation between the test scores was determined using a Pearson product-moment correlation, and a difference in mean test scores between tests was checked for using a 2-tailed dependent samples t test. Data were analyzed for agreement between the 2 tests using Bland-Altman limits of agreement and equivalency using a two one-sided t tests (TOST) approach. Results: A significant moderate, positive correlation was found between DDSST and RBANS-C scores (r=.577; P<.001), and no difference in mean scores was detected between the tests (P=.93). Bias was nearly zero (0.04). Scores between the tests were found to display adequate agreement with 90\% of score differences falling between --22.66 and 22.75 (90\% limits of agreement=--22.91 to 22.99), and the scores were equivalent (P=.049). Conclusions: Analyses indicate that the DDSST is a valid digital assessment of PS. The DDSST appears to be a suitable option for widespread, immediate, and efficient PS testing. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/ct2/show/NCT04559789 ",
doi="10.2196/36663",
url="https://aging.jmir.org/2023/1/e36663",
url="http://www.ncbi.nlm.nih.gov/pubmed/36705951"
}


@Article{info:doi/10.2196/41448,
author="Schramm, Emily
and Yang, C. Christopher
and Chang, Chia-Hsuan
and Mulhorn, Kristine
and Yoshinaga, Shushi
and Huh-Yoo, Jina",
title="Examining Public Awareness of Ageist Terms on Twitter: Content Analysis",
journal="JMIR Aging",
year="2023",
month="Sep",
day="11",
volume="6",
pages="e41448",
keywords="social media",
keywords="informatics",
keywords="aging",
keywords="ageism",
keywords="public",
keywords="COVID-19",
keywords="disease",
keywords="language",
keywords="older adults",
keywords="Twitter",
keywords="elderly",
keywords="term",
keywords="terminology",
keywords="pandemic",
keywords="tweets",
abstract="Background: The World Health Organization, the Centers for Disease Control and Prevention, and the Gerontological Society of America have made efforts to raise awareness on ageist language and propose appropriate terms to denote the older adult population. The COVID-19 pandemic and older adults' vulnerability to the disease have perpetuated hostile ageist discourse on social media. This is an opportune time to understand the prevalence and use of ageist language and discuss the ways forward. Objective: This study aimed to understand the prevalence and situated use of ageist terms on Twitter. Methods: We collected 60.32 million tweets between March and July 2020 containing terms related to COVID-19. We then conducted a mixed methods study comprising a content analysis and a descriptive quantitative analysis. Results: A total of 58,930 tweets contained the ageist terms ``old people'' or ``elderly.'' The more appropriate term ``older adult'' was found in 11,328 tweets. Twitter users used ageist terms (eg, ``old people'' and ``elderly'') to criticize ageist messages (17/60, 28\%), showing a lack of understanding of appropriate terms to describe older adults. Highly hostile ageist content against older adults came from tweets that contained the derogatory terms ``old people'' (22/30, 73\%) or ``elderly'' (13/30, 43\%). Conclusions: The public discourse observed on Twitter shows a continued lack of understanding of appropriate terms to use when referring to older adults. Effort is needed to eliminate the perpetuation of ageist messages that challenge healthy aging. Our study highlights the need to inform the public about appropriate language use and ageism. ",
doi="10.2196/41448",
url="https://aging.jmir.org/2023/1/e41448"
}


@Article{info:doi/10.2196/41809,
author="Vazquez, Elias Christian
and Xie, Bo
and Shiroma, Kristina
and Charness, Neil",
title="Individualistic Versus Collaborative Learning in an eHealth Literacy Intervention for Older Adults: Quasi-Experimental Study",
journal="JMIR Aging",
year="2023",
month="Feb",
day="9",
volume="6",
pages="e41809",
keywords="eHealth literacy",
keywords="digital literacy",
keywords="older adults",
keywords="eHealth",
keywords="aging",
keywords="web-based information",
keywords="health information",
abstract="Background: Older adults tend to have insufficient health literacy, which includes eHealth literacy---the ability to access, assess, and use digital health information. Interventions using methods such as collaborative learning (CL) and individualistic learning (IL) may be effective in addressing older adults' low eHealth literacy, but little is known about the short- and long-term effects of CL versus IL on older adults' eHealth literacy. Objective: The objective of this study was to use a 3 {\texttimes} 2 {\texttimes} 3 mixed factorial design to examine older adults' learning with CL versus IL for eHealth literacy. Methods: Older adults (N=466; mean age 70.5, SD 7.2; range 60-96 years) from diverse racial and ethnic groups were randomly assigned to either the CL or IL group (233/466, 50\% in each). The intervention consisted of 4 weeks of training in 2-hour sessions held twice a week. Using ANOVA and multiple regression, we focused on the main effects of learning condition and interaction between learning condition and previous computer experience. Learning method (CL or IL) and previous computer experience (experienced, new, or mixed) were between-subject variables, and time of measurement (pretest measurement, posttest measurement, and 6-month follow-up) was the within-subject variable. Primary outcome variables were eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills. Control variables were age, sex, education, health status, race and ethnicity, income, primary language, and previous health literacy. Results: eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills improved significantly (P<.001 in all cases) from before to after the intervention. From postintervention measurement to 6-month follow-up, there was a significant interaction between learning condition and previous computer experience based on 1 outcome measure, computer and web operation skills (F2,55=3.69; P=.03). To maintain computer and web operation skills 6 months after the intervention, it was more effective for people with little to no previous computer experience to learn individually, whereas for people with more previous computer experience, it was more effective to learn collaboratively. From postintervention measurement to 6-month follow-up, statistically significant decreases were found in 3 of the 5 outcome measures: eHealth literacy efficacy, computer and web knowledge, and basic computer and web operation skills (P<.001 for all 3 cases). Conclusions: Older adults' eHealth literacy can be improved through effective intervention, and the IL or CL condition may have little effect on short-term outcomes. However, to maintain long-term benefits, it may be best to learn collaboratively with others who have similar previous computer experience. eHealth literacy is multidimensional, with some components retained better over time. Findings suggest a need for resources to provide continuous training or periodic boosting to maintain intervention gains. ",
doi="10.2196/41809",
url="https://aging.jmir.org/2023/1/e41809",
url="http://www.ncbi.nlm.nih.gov/pubmed/36757773"
}


@Article{info:doi/10.2196/41936,
author="Turbow, Sara
and Vaughan, P. Camille
and Culler, D. Steven
and Hepburn, W. Kenneth
and Rask, J. Kimberly
and Perkins, M. Molly
and Clevenger, K. Carolyn
and Ali, K. Mohammed",
title="The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries",
journal="JMIR Aging",
year="2023",
month="Mar",
day="10",
volume="6",
pages="e41936",
keywords="readmissions",
keywords="care fragmentation",
keywords="health information exchange",
keywords="mortality",
keywords="Alzheimer disease",
keywords="electronic health information",
keywords="information sharing",
keywords="older adults",
keywords="information exchange",
keywords="hospital system",
keywords="health informatics",
abstract="Background: Although electronic health information sharing is expanding nationally, it is unclear whether electronic health information sharing improves patient outcomes, particularly for patients who are at the highest risk of communication challenges, such as older adults with Alzheimer disease. Objective: To determine the association between hospital-level health information exchange (HIE) participation and in-hospital or postdischarge mortality among Medicare beneficiaries with Alzheimer disease or 30-day readmissions to a different hospital following an admission for one of several common conditions. Methods: This was a cohort study of Medicare beneficiaries with Alzheimer disease who had one or more 30-day readmissions in 2018 following an initial admission for select Hospital Readmission Reduction Program conditions (acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, and pneumonia) or common reasons for hospitalization among older adults with Alzheimer disease (dehydration, syncope, urinary tract infection, or behavioral issues). Using unadjusted and adjusted logistic regression, we examined the association between electronic information sharing and in-hospital mortality during the readmission or mortality in the 30 days following the readmission. Results: A total of 28,946 admission-readmission pairs were included. Beneficiaries with same-hospital readmissions were older (aged 81.1, SD 8.6 years) than beneficiaries with readmissions to different hospitals (age range 79.8-80.3 years, P<.001). Compared to admissions and readmissions to the same hospital, beneficiaries who had a readmission to a different hospital that shared an HIE with the admission hospital had 39\% lower odds of dying during the readmission (adjusted odds ratio [AOR] 0.61, 95\% CI 0.39-0.95). There were no differences in in-hospital mortality observed for admission-readmission pairs to different hospitals that participated in different HIEs (AOR 1.02, 95\% CI 0.82-1.28) or to different hospitals where one or both hospitals did not participate in HIE (AOR 1.25, 95\% CI 0.93-1.68), and there was no association between information sharing and postdischarge mortality. Conclusions: These results indicate that information sharing between unrelated hospitals via a shared HIE may be associated with lower in-hospital, but not postdischarge, mortality for older adults with Alzheimer disease. In-hospital mortality during a readmission to a different hospital was higher if the admission and readmission hospitals participated in different HIEs or if one or both hospitals did not participate in an HIE. Limitations of this analysis include that HIE participation was measured at the hospital level, rather than at the provider level. This study provides some evidence that HIEs can improve care for vulnerable populations receiving acute care from different hospitals. ",
doi="10.2196/41936",
url="https://aging.jmir.org/2023/1/e41936",
url="http://www.ncbi.nlm.nih.gov/pubmed/36897638"
}


@Article{info:doi/10.2196/45641,
author="Judson, J. Timothy
and Subash, Meera
and Harrison, D. James
and Yeager, Jan
and Williams, M. Aim{\'e}e
and Grouse, K. Carrie
and Byron, Maria",
title="Patient Perceptions of e-Visits: Qualitative Study of Older Adults to Inform Health System Implementation",
journal="JMIR Aging",
year="2023",
month="May",
day="26",
volume="6",
pages="e45641",
keywords="e-visit",
keywords="patient portal message",
keywords="digital health tool",
keywords="patient portal",
keywords="perception",
keywords="attitude",
keywords="qualitative",
keywords="e-consult",
keywords="remote care",
keywords="remote visit",
keywords="remote consult",
keywords="vulnerable",
keywords="messaging",
keywords="telehealth",
keywords="telemedicine",
keywords="eHealth",
abstract="Background: Electronic visits (e-visits) are billable, asynchronous patient-initiated messages that require at least five minutes of medical decision-making by a provider. Unequal use of patient portal tools like e-visits by certain patient populations may worsen health disparities. To date, no study has attempted to qualitatively assess perceptions of e-visits in older adults. Objective: In this qualitative study, we aimed to understand patient perceptions of e-visits, including their perceived utility, barriers to use, and care implications, with a focus on vulnerable patient groups. Methods: We conducted a qualitative study using in-depth structured individual interviews with patients from diverse backgrounds to assess their knowledge and perceptions surrounding e-visits as compared with unbilled portal messages and other visit types. We used content analysis to analyze interview data. Results: We conducted 20 interviews, all in adults older than 65 years. We identified 4 overarching coding categories or themes. First, participants were generally accepting of the concept of e-visits and willing to try them. Second, nearly two-thirds of the participants voiced a preference for synchronous communication. Third, participants had specific concerns about the name ``e-visit'' and when to choose this type of visit in the patient portal. Fourth, some participants indicated discomfort using or accessing technology for e-visits. Financial barriers to the use of e-visits was not a common theme. Conclusions: Our findings suggest that older adults are generally accepting of the concept of e-visits, but uptake may be limited due to their preference for synchronous communication. We identified several opportunities to improve e-visit implementation. ",
doi="10.2196/45641",
url="https://aging.jmir.org/2023/1/e45641",
url="http://www.ncbi.nlm.nih.gov/pubmed/37234031"
}


@Article{info:doi/10.2196/44525,
author="Fields, Beth
and Fitzpatrick, McKenzie
and Kinney, Lauryn
and Lee, Jenny
and Sprecher, Bryce
and Tredinnick, Ross
and Ponto, Kevin
and Shin, Jung-hye",
title="Evaluating the Acceptability and Appropriateness of the Augmented Reality Home Assessment Tool (ARHAT): Qualitative Descriptive Study",
journal="JMIR Aging",
year="2023",
month="Sep",
day="27",
volume="6",
pages="e44525",
keywords="technology",
keywords="aging in place",
keywords="augmented reality",
keywords="home modification",
keywords="mobile",
keywords="assessment",
keywords="mobile application",
keywords="qualitative study",
keywords="environmental barrier",
abstract="Background: The Augmented Reality Home Assessment Tool (ARHAT) is a mobile app developed to provide rapid, highly accurate assessments of the home environment. It uses 3D-capture technologies to help people identify and address functional limitations and environmental barriers. Objective: This study was conducted to gain stakeholder feedback on the acceptability and appropriateness of the ARHAT for identifying and addressing barriers within home environments. Methods: A qualitative descriptive study was conducted because it allows for variability when obtaining data and seeks to understand stakeholders' insights on an understudied phenomenon. Each stakeholder group (occupational therapists, housing professionals, and aging adult and caregiver ``dyads'') participated in a 60-minute, web-based focus group via a secure Zoom platform. Focus group data were analyzed by 2 trained qualitative research team members using a framework method for analysis. Results: A total of 19 stakeholders, aged from 18 to 85+ years, were included in the study. Of the occupational therapists (n=5, 26\%), housing professionals (n=3, 16\%), and dyads (n=11, 58\%), a total of 32\% (n=6) were male and 68\% (n=13) were female, with most living in the Midwestern United States (n=10, 53\%). The focus group data demonstrate the acceptability and appropriateness of the workflow, style, measurement tools, and impact of the ARHAT. All stakeholders stated that they could see the ARHAT being used at many different levels and by any population. Dyads specifically mentioned that the ARHAT would allow them to do forward planning and made them think of home modifications in a new light. Conclusions: Stakeholders found the ARHAT to be acceptable and appropriate for identifying and addressing functional limitations and barriers in the home environment. This study highlights the importance of considering the workflow, style, measurement tools, and potential impact of home assessment technology early in the developmental process. ",
doi="10.2196/44525",
url="https://aging.jmir.org/2023/1/e44525"
}


@Article{info:doi/10.2196/41429,
author="Koo, Hyuk Jun
and Park, Hyun You
and Kang, Ryong Dae",
title="Factors Predicting Older People's Acceptance of a Personalized Health Care Service App and the Effect of Chronic Disease: Cross-Sectional Questionnaire Study",
journal="JMIR Aging",
year="2023",
month="Jun",
day="21",
volume="6",
pages="e41429",
keywords="environmental risk factor",
keywords="personalized health care service app",
keywords="chronic disease",
keywords="unified theory of acceptance and use of technology",
keywords="structural equation modeling",
keywords="older adult",
keywords="acceptance",
keywords="adoption",
keywords="technology use",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="health app",
keywords="gerontology",
keywords="personalized",
keywords="health care service",
keywords="intention to use",
abstract="Background: Mobile health (mHealth) services enable real-time measurement of information on individuals' biosignals and environmental risk factors; accordingly, research on health management using mHealth is being actively conducted. Objective: The study aims to identify the predictors of older people's intention to use mHealth in South Korea and verify whether chronic disease moderates the effect of the identified predictors on behavioral intentions. Methods: A cross-sectional questionnaire study was conducted among 500 participants aged 60 to 75 years. The research hypotheses were tested using structural equation modeling, and indirect effects were verified through bootstrapping. Bootstrapping was performed 10,000 times, and the significance of the indirect effects was confirmed through the bias-corrected percentile method. Results: Of 477 participants, 278 (58.3\%) had at least 1 chronic disease. Performance expectancy ($\beta$=.453; P=.003) and social influence ($\beta$=.693; P<.001) were significant predictors of behavioral intention. Bootstrapping results showed that facilitating conditions ($\beta$=.325; P=.006; 95\% CI 0.115-0.759) were found to have a significant indirect effect on behavioral intention. Multigroup structural equation modeling testing the presence or absence of chronic disease revealed a significant difference in the path of device trust to performance expectancy (critical ratio=--2.165). Bootstrapping also confirmed that device trust ($\beta$=.122; P=.039; 95\% CI 0.007-0.346) had a significant indirect effect on behavioral intention in people with chronic disease. Conclusions: This study, which explored the predictors of the intention to use mHealth through a web-based survey of older people, suggests similar results to those of other studies that applied the unified theory of acceptance and use of technology model to the acceptance of mHealth. Performance expectancy, social influence, and facilitating conditions were revealed as predictors of accepting mHealth. In addition, trust in a wearable device for measuring biosignals was investigated as an additional predictor in people with chronic disease. This suggests that different strategies are needed, depending on the characteristics of users. ",
doi="10.2196/41429",
url="https://aging.jmir.org/2023/1/e41429",
url="http://www.ncbi.nlm.nih.gov/pubmed/37342076"
}


@Article{info:doi/10.2196/46738,
author="B{\"o}ttinger, J. Melissa
and Litz, Elena
and Gordt-Oesterwind, Katharina
and Jansen, Carl-Philipp
and Memmer, Nicole
and Mychajliw, Christian
and Radeck, Leon
and Bauer, M. J{\"u}rgen
and Becker, Clemens",
title="Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study",
journal="JMIR Aging",
year="2023",
month="Sep",
day="26",
volume="6",
pages="e46738",
keywords="aged",
keywords="self-assessment",
keywords="mobile apps",
keywords="mobile health",
keywords="mHealth",
keywords="community-based participatory research",
keywords="co-creation",
keywords="comprehensive geriatric assessment",
keywords="mobile phone",
abstract="Background: Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a preclinical stage, thereby facilitating preventive efforts and targeted intervention. For this purpose, a Life-integrated Self-Assessment (LiSA) tablet system will be developed through a structured co-creation process. Objective: This study aims to investigate older adults' perceptions of different self-assessment domains, components affecting user experience, risks and benefits associated with LiSA, characteristics of potential LiSA users, and the LiSA concept in general. Methods: A total of 10 community-dwelling older adults aged ?70 years were recruited. In total, 6 co-creation workshops were held and started with expert input followed by semistructured discussion rounds. Participants performed hands-on activities with a tablet, including testing of preinstalled self-assessment apps. All workshops were audio recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze the data following a deductive-inductive approach guided by the Optimized Honeycomb Model for user experience. Results: The group (mean age 77.8, SD 5.1 years) was heterogeneous in terms of previous technology experience and health status. The mean workshop duration was 2 hours (122.5, SD 4.43 min), and an average of 8 (SD 1.15) participants attended each workshop. A total of 11 thematic categories were identified, covering results on all research questions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activity and function and sensory and cognitive functions and requested additional features such as recommendations for actions or reminders. LiSA was perceived as empowering and a motivator to engage in active health care planning as well as enabling shared and informed decision-making. Concerns and barriers included the lack of technical competence, feelings of frustration, and fear of being left alone, with negative assessment results. In essence, participants expressed a positive attitude toward using LiSA repeatedly and identified it as an option to increase the chances of maintaining independence when growing older. Conclusions: The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion, LiSA should include relevant assessments capturing physical activity and function and sensory and cognitive functions as well as recommendations for actions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment. ",
doi="10.2196/46738",
url="https://aging.jmir.org/2023/1/e46738",
url="http://www.ncbi.nlm.nih.gov/pubmed/37751274"
}


@Article{info:doi/10.2196/50990,
author="Faisal, Sadaf
and Samoth, Devine
and Aslam, Yusra
and Patel, Hawa
and Park, SooMin
and Baby, Bincy
and Patel, Tejal",
title="Key Features of Smart Medication Adherence Products: Updated Scoping Review",
journal="JMIR Aging",
year="2023",
month="Dec",
day="19",
volume="6",
pages="e50990",
keywords="technology",
keywords="medication",
keywords="aging",
keywords="adherence",
keywords="smart medication",
keywords="digital technology",
keywords="self-management",
keywords="older adult",
keywords="mobile health",
keywords="mHealth",
keywords="apps",
keywords="digital health",
keywords="geriatrics",
keywords="older adults",
keywords="mHealth app",
keywords="application",
keywords="management",
keywords="scoping review",
keywords="medication adherence",
keywords="consumer",
keywords="use",
keywords="mobile phone",
abstract="Background: Older adults often face challenges in self-managing their medication owing to physical and cognitive limitations, complex medication regimens, and packaging of medications. Emerging smart medication dispensing and adherence products (SMAPs) offer the options of automated dispensing, tracking medication intake in real time, and reminders and notifications. A 2021 review identified 51 SMAPs owing to the rapid influx of digital technology; an update to this review is required. Objective: This review aims to identify new products and summarize and compare the key features of SMAPs. Methods: Gray and published literature and videos were searched using Google, YouTube, PubMed, Embase, and Scopus. The first 10 pages of Google and the first 100 results of YouTube were screened using 4 and 5 keyword searches, respectively. SMAPs were included if they were able to store and allowed for the dispensation of medications, tracked real-time medication intake data, and could automatically analyze data. Products were excluded if they were stand-alone software applications, not marketed in English, not for in-home use, or only used in clinical trials. In total, 5 researchers independently screened and extracted the data. Results: This review identified 114 SMAPs, including 80 (70.2\%) marketed and 34 (29.8\%) prototypes, grouped into 15 types. Among the marketed products, 68\% (54/80) were available for consumer purchase. Of these products, 26\% (14/54) were available worldwide and 78\% (42/54) were available in North America. There was variability in the hardware, software, data collection and management features, and cost of the products. Examples of hardware features include battery life, medication storage capacity, availability of types and number of alarms, locking features, and additional technology required for use of the product, whereas software features included reminder and notification capabilities and availability of manufacturer support. Data capture methods included the availability of sensors to record the use of the product and data-syncing capabilities with cloud storage with short-range communications. Data were accessible to users via mobile apps or web-based portals. Some SMAPs provided data security assurance with secure log-ins (use of personal identification numbers or facial recognition), whereas other SMAPs provided data through registered email addresses. Although some SMAPs were available at set prices or free of cost to end users, the cost of other products varied based on availability, shipping fees, and subscription fees. Conclusions: An expanding market for SMAPs with features specific to at-home patient use is emerging. Health care professionals can use these features to select and suggest products that meet their patients' unique requirements. ",
doi="10.2196/50990",
url="https://aging.jmir.org/2023/1/e50990",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113067"
}


@Article{info:doi/10.2196/46177,
author="Urwyler, Prabitha
and Gupta, Kumar Rajnish
and Falkner, Michael
and Niklaus, Joel
and M{\"u}ri, Martin Ren{\'e}
and Nef, Tobias",
title="Tablet-Based Puzzle Game Intervention for Cognitive Function and Well-Being in Healthy Adults: Pilot Feasibility Randomized Controlled Trial",
journal="JMIR Aging",
year="2023",
month="Nov",
day="1",
volume="6",
pages="e46177",
keywords="puzzle games",
keywords="aging",
keywords="cognitive assessment",
keywords="visual attention",
keywords="adults",
keywords="elderly",
keywords="well-being",
keywords="randomized controlled trial",
keywords="RCT",
keywords="older adult",
abstract="Background: Promoting cognitive health is key to maintaining cognitive and everyday functions and preventing the risk of cognitive impairment or dementia. Existing scientific evidence shows the benefits of various training modalities on cognition. One way to promote cognitive health is through engagement in cognitive activities (eg, board and video games). Objective: This study aims to investigate the benefits of dynamic adaptive casual puzzle games on cognitive function and well-being in healthy adults and older people. Methods: A total of 12 adults and older people (female participants: n=6; mean age 58.92, SD 10.28 years; range 46-75 years) were included in this pilot randomized controlled trial. This study used a crossover design with two phases (8 weeks each) and three measurement waves (pretest, midtest, and posttest). The participants were randomly allocated either to the control or experimental group. In the control group, participants read newspapers between the pre- and midtest, then switched to cognitive training with puzzle games. In the experimental group, the interventions were reversed. Baseline measurements (pretest) were collected before the intervention. The interventions were delivered on tablet computers and took place unsupervised at participants' homes. Results: The outcome measures included global cognitive function, higher cognitive function, and emotional well-being at 3 time points (pretest, midtest, and posttest) using standardized neuropsychological tests. The participants showed improvements in their visual attention and visuospatial measures after the puzzle game intervention. Conclusions: The study showed that digital games are a feasible way to train cognition in healthy adults and older people. The algorithm-based dynamic adaption allows accommodations for persons with different cognitive levels of skill. The results of the study will guide future prevention efforts and trials in high-risk populations. Trial Registration: ClinicalTrials.gov NCT03139799; https://clinicaltrials.gov/study/NCT03139799 ",
doi="10.2196/46177",
url="https://aging.jmir.org/2023/1/e46177"
}


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


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


@Article{info:doi/10.2196/42437,
author="Han, Eunkyung
and Kharrazi, Hadi
and Shi, Leiyu",
title="Identifying Predictors of Nursing Home Admission by Using Electronic Health Records and Administrative Data: Scoping Review",
journal="JMIR Aging",
year="2023",
month="Nov",
day="20",
volume="6",
pages="e42437",
keywords="prediction model",
keywords="nursing home admission",
keywords="electronic health record",
keywords="EHR",
keywords="administrative claims data",
keywords="administrative data",
keywords="claims data",
keywords="health record",
keywords="medical record",
keywords="long-term care",
keywords="nursing home",
keywords="elder care",
keywords="geriatric",
keywords="gerontology",
keywords="machine learning",
keywords="PRISMA",
keywords="scoping review",
keywords="search strategy",
keywords="aging",
keywords="older adult",
abstract="Background: Among older adults, nursing home admissions (NHAs) are considered a significant adverse outcome and have been extensively studied. Although the volume and significance of electronic data sources are expanding, it is unclear what predictors of NHA have been systematically identified in the literature via electronic health records (EHRs) and administrative data. Objective: This study synthesizes findings of recent literature on identifying predictors of NHA that are collected from administrative data or EHRs. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were used for study selection. The PubMed and CINAHL databases were used to retrieve the studies. Articles published between January 1, 2012, and March 31, 2023, were included. Results: A total of 34 papers were selected for final inclusion in this review. In addition to NHA, all-cause mortality, hospitalization, and rehospitalization were frequently used as outcome measures. The most frequently used models for predicting NHAs were Cox proportional hazards models (studies: n=12, 35\%), logistic regression models (studies: n=9, 26\%), and a combination of both (studies: n=6, 18\%). Several predictors were used in the NHA prediction models, which were further categorized into sociodemographic, caregiver support, health status, health use, and social service use factors. Only 5 (15\%) studies used a validated frailty measure in their NHA prediction models. Conclusions: NHA prediction tools based on EHRs or administrative data may assist clinicians, patients, and policy makers in making informed decisions and allocating public health resources. More research is needed to assess the value of various predictors and data sources in predicting NHAs and validating NHA prediction models externally. ",
doi="10.2196/42437",
url="https://aging.jmir.org/2023/1/e42437"
}


@Article{info:doi/10.2196/42652,
author="Trainum, Katie
and Tunis, Rachel
and Xie, Bo
and Hauser, Elliott",
title="Robots in Assisted Living Facilities: Scoping Review",
journal="JMIR Aging",
year="2023",
month="Mar",
day="6",
volume="6",
pages="e42652",
keywords="robotics",
keywords="long-term care",
keywords="nursing home",
keywords="residential care",
keywords="scoping review",
keywords="review method",
keywords="robot",
keywords="aging",
keywords="elder",
keywords="older adult",
keywords="gerontology",
keywords="geriatric",
keywords="senior living",
abstract="Background: Various technological interventions have been proposed and studied to address the growing demand for care of residents in assisted living facilities, in which a preexisting shortage of professional caregivers has been exacerbated by the COVID-19 pandemic. Care robots are one such intervention with the potential to improve both the care of older adults and the work life of their professional caregivers. However, concerns about efficacy, ethics, and best practices in the applications of robotic technologies in care settings remain. Objective: This scoping review aimed to examine the literature on robots used in assisted living facilities and identify gaps in the literature to guide future research. Methods: On February 12, 2022, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, we searched PubMed, CINAHL Plus with Full Text, PsycINFO, IEEE Xplore digital library, and ACM Digital Library using predetermined search terms. Publications were included if they were written in English and focused on the use of robotics in assisted living facilities. Publications were excluded if they did not provide peer-reviewed empirical data, focused on user needs, or developed an instrument to study human-robot interaction. The study findings were then summarized, coded, and analyzed using the Patterns, Advances, Gaps, Evidence for practice, and Research recommendations framework. Results: The final sample included 73 publications from 69 unique studies on the use of robots in assisted living facilities. The findings of studies on older adults were mixed, with some studies suggesting positive impacts of robots, some expressing concerns about robots and barriers to their use, and others being inconclusive. Although many therapeutic benefits of care robots have been identified, methodological limitations have weakened the internal and external validity of the findings of these studies. Few studies (18/69, 26\%) considered the context of care: most studies (48/69, 70\%) collected data only on recipients of care, 15 studies collected data on staff, and 3 studies collected data on relatives or visitors. Theory-driven, longitudinal, and large sample size study designs were rare. Across the authors' disciplines, a lack of consistency in methodological quality and reporting makes it difficult to synthesize and assess research on care robotics. Conclusions: The findings of this study call for more systematic research on the feasibility and efficacy of robots in assisted living facilities. In particular, there is a dearth of research on how robots may change geriatric care and the work environment within assisted living facilities. To maximize the benefits and minimize the consequences for older adults and caregivers, future research will require interdisciplinary collaboration among health sciences, computer science, and engineering as well as agreement on methodological standards. ",
doi="10.2196/42652",
url="https://aging.jmir.org/2023/1/e42652",
url="http://www.ncbi.nlm.nih.gov/pubmed/36877560"
}


@Article{info:doi/10.2196/41187,
author="Korenhof, A. Sophie
and Fang, Yuan
and Luo, Jie
and van der Cammen, M. Tischa J.
and Raat, Hein
and van Grieken, Amy",
title="Monitoring the Well-being of Older People by Energy Usage Patterns: Systematic Review of the Literature and Evidence Synthesis",
journal="JMIR Aging",
year="2023",
month="Mar",
day="31",
volume="6",
pages="e41187",
keywords="smart energy meter",
keywords="healthy aging",
keywords="activities of daily living",
keywords="independent living",
keywords="monitoring",
keywords="older adults",
keywords="devices",
keywords="risk",
keywords="well-being",
keywords="effectiveness",
keywords="design",
keywords="safety",
abstract="Background: Due to the aging population, there is a need for monitoring well-being and safety while living independently. A low-intrusive monitoring system is based on a person's use of energy or water. Objective: The study's objective was to provide a systematic overview of studies that monitor the health and well-being of older people using energy (eg, electricity and gas) and water usage data and study the outcomes on health and well-being. Methods: CENTRAL, Embase, MEDLINE (Ovid), Scopus, Web of Science, and Google Scholar were searched systematically from inception until November 8, 2021. The inclusion criteria were that the study had to be published in English, have full-text availability, target independent-living people aged 60 years and older from the general population, have an observational design, and assess the outcomes of a monitoring system based on energy (ie, electricity, gas, or water) usage on well-being and safety. The quality of the studies was assessed by the QualSyst systematic review tool. Results: The search strategy identified 2920 articles. The majority of studies focused on the technical algorithms underlying energy usage data and related sensors. One study was included in this review. This study reported that the smart energy meter data monitoring system was considered unobtrusive and was well accepted by the older people and professionals involved. Energy usage in a household acted as a unique signature and therefore provided useful insight into well-being and safety. This study lacked statistical power due to the small number of participants and the low number of observed events. In addition, the quality of the study was rated as low. Conclusions: This review identified only 1 study that evaluated the impact of an energy usage monitoring system on the well-being and safety of older people. The absence of reliable evidence impedes any definitive guidance or recommendations for practice. Because this emerging field has not yet been studied thoroughly, many questions remain open for further research. Future studies should focus on the further development of a monitoring system and the evaluation of the implementation and outcomes of these systems. Trial Registration: PROSPERO CRD42022245713; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=245713 ",
doi="10.2196/41187",
url="https://aging.jmir.org/2023/1/e41187",
url="http://www.ncbi.nlm.nih.gov/pubmed/37000477"
}


@Article{info:doi/10.2196/40460,
author="Zhang, Yichi
and Leuk, Siew-Pin Jessie
and Teo, Wei-Peng",
title="Domains, Feasibility, Effectiveness, Cost, and Acceptability of Telehealth in Aging Care: Scoping Review of Systematic Reviews",
journal="JMIR Aging",
year="2023",
month="Apr",
day="18",
volume="6",
pages="e40460",
keywords="telehealth",
keywords="telemedicine",
keywords="telecare",
keywords="telemonitoring",
keywords="aging care",
keywords="health care access",
keywords="scoping review",
keywords="digital health",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
abstract="Background: Aging is becoming a major global challenge. Compared with younger adults, the older population has greater health needs but faces inadequate access to appropriate, affordable, and high-quality health care. Telehealth can remove geographic and time boundaries, as well as enabling socially isolated and physically homebound people to access a wider range of care options. The impacts of different telehealth interventions in terms of their effectiveness, cost, and acceptability in aging care are still unclear. Objective: This scoping review of systematic reviews aimed to provide an overview of the domains of telehealth implemented in aging care; synthesize evidence of telehealth's feasibility, effectiveness, cost benefits, and acceptability in the context of aging care; identify gaps in the literature; and determine the priorities for future research. Methods: Guided by the methodological framework of the Joanna Briggs Institute, we reviewed systematic reviews concerning all types of telehealth interventions involving direct communication between older users and health care providers. In total, 5 major electronic databases, PubMed, Embase (Ovid), Cochrane Library, CINAHL, and PsycINFO (EBSCO), were searched on September 16, 2021, and an updated search was performed on April 28, 2022, across the same databases as well as the first 10 pages of the Google search. Results: A total of 29 systematic reviews, including 1 post hoc subanalysis of a previously published large Cochrane systematic review with meta-analysis, were included. Telehealth has been adopted in various domains in aging care, such as cardiovascular diseases, mental health, cognitive impairment, prefrailty and frailty, chronic diseases, and oral health, and it seems to be a promising, feasible, effective, cost-effective, and acceptable alternative to usual care in selected domains. However, it should be noted that the generalizability of the results might be limited, and further studies with larger sample sizes, more rigorous designs, adequate reporting, and more consistently defined outcomes and methodologies are needed. The factors affecting telehealth use among older adults have been categorized into individual, interpersonal, technological, system, and policy levels, which could help direct collaborative efforts toward improving the security, accessibility, and affordability of telehealth as well as better prepare the older population for digital inclusion. Conclusions: Although telehealth remains in its infancy and there is a lack of high-quality studies to rigorously prove the feasibility, effectiveness, cost benefit, and acceptability of telehealth, mounting evidence has indicated that it could play a promising complementary role in the care of the aging population. ",
doi="10.2196/40460",
url="https://aging.jmir.org/2023/1/e40460",
url="http://www.ncbi.nlm.nih.gov/pubmed/37071459"
}


@Article{info:doi/10.2196/41938,
author="Tahir, Sahar
and Abdulrazak, Bessam
and Baillargeon, Dany
and Girard, Catherine
and Provencher, V{\'e}ronique",
title="Adapting Transportation Planning e-Tools to Older Adults' Needs: Scoping Review",
journal="JMIR Aging",
year="2023",
month="May",
day="16",
volume="6",
pages="e41938",
keywords="active aging, transportation",
keywords="e-tool",
keywords="user-centered",
keywords="review",
keywords="Canadian mobility experience",
abstract="Background: Aging is often accompanied by a decrease in physical and sensory capacities and financial resources, which makes travel and the use of public transport a big challenge for older adults. These mobility limitations may prevent them from going out for groceries, medical appointments, or entertainment, which increases the risk of social isolation. A key element in helping older adults to maintain healthy aging and social engagement is to foster autonomy, freedom, and active mobility. A transportation planning e-tool can provide older adults with information about transport and trip options. There are many transportation planning e-tools, but little is known about whether and how their characteristics and functionalities address older adults' needs and preferences. Objective: This study aims to map existing transportation e-tools and identify gaps to be filled in order to match their functionalities with older adults' needs and preferences. Methods: A scoping review of existing transportation planning e-tools was conducted based on the approach developed by Arksey and O'Malley. A search in the scientific literature (Academic Search Complete, MEDLINE, CINAHL, SocINDEX, and ERIC) as well as gray literature (TRID Database, Google Scholar, Proquest, Google Play, etc) was conducted in June 2020 and updated 3 times; in September 2021, December 2021, and May 2022. After the studies were selected, a comparative analysis was performed by 2 evaluators; an occupational therapy student and a computer science student. These e-tools were analyzed with respect to some characteristics (eg, tool's development status, target customers, and geographic coverage) as well as 10 functionalities (time autonomy, walkability, crowd avoidance, incline avoidance, weather consideration, dark avoidance, winter obstacles avoidance, amenities inclusion, taxi driver's information, and support affordance) that we defined based on older adults' needs and preferences (mainly Canadians). These needs were identified from a literature review and confirmed by workshops (focus groups). Results: The scientific and gray literature search yielded 463 sources, and 42 transportation e-tools were included. None of the e-tools reviewed addresses all 10 functionalities. More specifically, functionalities such as dark avoidance and support affordance were not addressed by any of the included e-tools. Conclusions: Most of the e-tools currently available to plan trips do not address older adults' needs and preferences. The results of this scoping review helped fill this gap by identifying functionalities to include in transportation planning e-tools designed to promote active aging. The findings of this study highlight the need to use a multicriteria optimization algorithm to address older adults' mobility needs and preferences. International Registered Report Identifier (IRRID): RR2-10.2196/33894 ",
doi="10.2196/41938",
url="https://aging.jmir.org/2023/1/e41938",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191985"
}


@Article{info:doi/10.2196/47152,
author="Yu, Ying
and Xiao, Lily
and Ullah, Shahid
and Meyer, Claudia
and Wang, Jing
and Pot, Margriet Anne
and Shifaza, Fathimath",
title="The Experiences of Informal Caregivers of People With Dementia in Web-Based Psychoeducation Programs: Systematic Review and Metasynthesis",
journal="JMIR Aging",
year="2023",
month="May",
day="29",
volume="6",
pages="e47152",
keywords="informal caregivers",
keywords="dementia",
keywords="psychoeducation",
keywords="online",
keywords="web based",
keywords="qualitative research",
keywords="systematic review",
keywords="metasynthesis",
abstract="Background: Informal caregivers of people living with dementia experience a higher level of physical and mental stress compared with other types of caregivers. Psychoeducation programs are viewed as beneficial for building caregivers' knowledge and skills and for decreasing caregiver stress. Objective: This review aimed to synthesize the experiences and perceptions of informal caregivers of people with dementia when participating in web-based psychoeducation programs and the factors that enable and impede informal caregivers' engagement in web-based psychoeducation programs. Methods: This review followed the Joanna Briggs Institute protocol of systematic review and meta-aggregation of qualitative studies. We searched 4 English databases, 4 Chinese databases, and 1 Arabic database in July 2021. Results: A total of 9 studies written in English were included in this review. From these studies, 87 findings were extracted and grouped into 20 categories. These categories were further synthesized into 5 findings: web-based learning as an empowering experience, peer support, satisfactory and unsatisfactory program content, satisfactory and unsatisfactory technical design, and challenges encountered in web-based learning. Conclusions: High-quality and carefully designed web-based psychoeducation programs offered positive experiences for informal caregivers of people living with dementia. To meet broader caregiver education and support needs, program developers should consider information quality and relevancy, the support offered, individual needs, flexibility in delivery, and connectedness between peers and program facilitators. ",
doi="10.2196/47152",
url="https://aging.jmir.org/2023/1/e47152",
url="http://www.ncbi.nlm.nih.gov/pubmed/37247218"
}


@Article{info:doi/10.2196/46976,
author="Shade, Marcia
and Kovaleva, Mariya
and Harp, Kimberly
and Martin-Hammond, Aqueasha",
title="Older Adults' Pain Outcomes After mHealth Interventions: Scoping Review",
journal="JMIR Aging",
year="2023",
month="May",
day="31",
volume="6",
pages="e46976",
keywords="mHealth",
keywords="older adults",
keywords="pain",
keywords="self-management",
keywords="pain management",
keywords="mobile health",
keywords="musculoskeletal pain",
keywords="scoping review",
keywords="pain outcomes",
keywords="mobile phone",
abstract="Background: Pain is prevalent and poorly managed in older adults. Although pain self-management strategies are helpful, adoption and access are limited; thus, technology provides an opportunity for intervention delivery. Mobile health (mHealth) is feasible to use in older adults; however, we have yet to understand the effect of mHealth pain self-management interventions on pain outcomes in older adults. Objective: The purpose of this scoping review is to examine the characteristics of mHealth interventions and their efficacy on pain outcomes in older adults with musculoskeletal pain. Methods: With the assistance of a medical librarian, keywords and subject headings were generated, including but not limited to mobile health application, mHealth, digital, pain, pain management, and older. A search was conducted for papers in journal databases, including PubMed, Embase, CINAHL, Scopus, and IEEE Xplore, between 2000 and 2022. Papers were screened according to predetermined inclusion and exclusion criteria, and reference lists were reviewed for additional paper inclusion. Three authors appraised the methodology of papers independently, then collaboratively to synthesize the evidence. Results: Six publications were included in the scoping review. The design and methodology ranged widely from pilot studies to a comparative effectiveness trial. Older participants in the studies reported a variety of musculoskeletal conditions. Delivery of the mHealth pain self-management interventions incorporated mobile devices, such as a smartphone or tablet. Most mHealth-delivered interventions were multicomponent and incorporated elements of in-person and telephone access to an interventionist. The findings suggested mHealth interventions may reduce pain intensity; however, pain interference and other pain-related conditions did not have a statistically significant reduction. Conclusions: Research that has explored mHealth for pain self-management is beginning to move beyond feasibility. The few experimental studies conducted in older adults are heterogeneous, and the interventions are mostly multicomponent. It is premature to conclude the interventions' significant effect on pain or pain-related symptoms. As technology continues to integrate into health care, more experimental research is warranted to examine the efficacy of mHealth interventions on a variety of pain outcomes in older adults. ",
doi="10.2196/46976",
url="https://aging.jmir.org/2023/1/e46976",
url="http://www.ncbi.nlm.nih.gov/pubmed/37256667"
}


@Article{info:doi/10.2196/42274,
author="Siette, Joyce
and Dodds, Laura
and Sharifi, Fariba
and Nguyen, Amy
and Baysari, Melissa
and Seaman, Karla
and Raban, Magdalena
and Wabe, Nasir
and Westbrook, Johanna",
title="Usability and Acceptability of Clinical Dashboards in Aged Care: Systematic Review",
journal="JMIR Aging",
year="2023",
month="Jun",
day="19",
volume="6",
pages="e42274",
keywords="dashboard",
keywords="visualization",
keywords="usability",
keywords="acceptability",
keywords="user interface design",
keywords="health information technology",
keywords="aged care",
keywords="clinical",
keywords="database",
keywords="development",
abstract="Background: The use of clinical dashboards in aged care systems to support performance review and improve outcomes for older adults receiving care is increasing. Objective: Our aim was to explore evidence from studies of the acceptability and usability of clinical dashboards including their visual features and functionalities in aged care settings. Methods: A systematic review was conducted using 5 databases (MEDLINE, Embase, PsycINFO, Cochrane Library, and CINAHL) from inception to April 2022. Studies were included in the review if they were conducted in aged care environments (home-based community care, retirement villages, and long-term care) and reported a usability or acceptability evaluation of a clinical dashboard for use in aged care environments, including specific dashboard visual features (eg, a qualitative summary of individual user experience or metrics from a usability scale). Two researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review, and the risk of bias was measured using the Mixed Methods Appraisal Tool. Results: In total, 14 articles reporting on 12 dashboards were included. The quality of the articles varied. There was considerable heterogeneity in implementation setting (home care 8/14, 57\%), dashboard user groups (health professionals 9/14, 64\%), and sample size (range 3-292). Dashboard features included a visual representation of information (eg, medical condition prevalence), analytic capability (eg, predictive), and others (eg, stakeholder communication). Dashboard usability was mixed (4 dashboards rated as high), and dashboard acceptability was high for 9 dashboards. Most users considered dashboards to be informative, relevant, and functional, highlighting the use and intention of using this resource in the future. Dashboards that had the presence of one or more of these features (bar charts, radio buttons, checkboxes or other symbols, interactive displays, and reporting capabilities) were found to be highly acceptable. Conclusions: A comprehensive summary of clinical dashboards used in aged care is provided to inform future dashboard development, testing, and implementation. Further research is required to optimize visualization features, usability, and acceptability of dashboards in aged care. ",
doi="10.2196/42274",
url="https://aging.jmir.org/2023/1/e42274",
url="http://www.ncbi.nlm.nih.gov/pubmed/37335599"
}


@Article{info:doi/10.2196/40582,
author="Shu, Sara
and Woo, P. Benjamin K.",
title="Pioneering the Metaverse: The Role of the Metaverse in an Aging Population",
journal="JMIR Aging",
year="2023",
month="Jan",
day="20",
volume="6",
pages="e40582",
keywords="metaverse",
keywords="older adult",
keywords="aging in place",
keywords="dementia",
keywords="gerontology",
keywords="geriatric",
keywords="digital health",
keywords="digital technology",
keywords="computer generated",
keywords="artificial intelligence",
keywords="virtual reality",
keywords="mixed reality",
keywords="augmented reality",
keywords="aging",
keywords="mental health",
doi="10.2196/40582",
url="https://aging.jmir.org/2023/1/e40582",
url="http://www.ncbi.nlm.nih.gov/pubmed/36662547"
}


@Article{info:doi/10.2196/41322,
author="Wang, H. Rosalie
and Tannou, Thomas
and Bier, Nathalie
and Couture, M{\'e}lanie
and Aubry, R{\'e}gis",
title="Proactive and Ongoing Analysis and Management of Ethical Concerns in the Development, Evaluation, and Implementation of Smart Homes for Older Adults With Frailty",
journal="JMIR Aging",
year="2023",
month="Mar",
day="9",
volume="6",
pages="e41322",
keywords="ethics",
keywords="older adults",
keywords="frailty",
keywords="smart home",
keywords="assistive technology",
keywords="aging in place",
keywords="ethical concerns",
keywords="implementation",
keywords="bioethics",
keywords="technology ethics",
keywords="autonomy",
keywords="privacy",
keywords="security",
keywords="informed consent",
keywords="support ecosystem",
doi="10.2196/41322",
url="https://aging.jmir.org/2023/1/e41322",
url="http://www.ncbi.nlm.nih.gov/pubmed/36892912"
}


@Article{info:doi/10.2196/44007,
author="Brown, L. Ellen
and Ruggiano, Nicole
and Allala, Chaithra Sai
and Clarke, J. Peter
and Davis, Debra
and Roberts, Lisa
and Framil, Victoria C.
and Mu{\~n}oz, Hernandez Mar{\'i}ateresa Teri
and Hough, Strauss Monica
and Bourgeois, S. Michelle",
title="Developing a Memory and Communication App for Persons Living With Dementia: An 8-Step Process",
journal="JMIR Aging",
year="2023",
month="Mar",
day="15",
volume="6",
pages="e44007",
keywords="health technology",
keywords="interdisiplinary team",
keywords="older adults",
keywords="dementia",
keywords="communication",
keywords="communication aids for disabled persons",
keywords="communication boards",
keywords="app",
keywords="Alzheimer disease",
keywords="family",
keywords="caregiver",
keywords="clinical care",
keywords="development",
keywords="speech",
keywords="psychosocial intervention",
keywords="software design",
abstract="International Registered Report Identifier (IRRID): RR2-10.3928/19404921-20210825-02 ",
doi="10.2196/44007",
url="https://aging.jmir.org/2023/1/e44007",
url="http://www.ncbi.nlm.nih.gov/pubmed/36920462"
}


@Article{info:doi/10.2196/45442,
author="Randall, Natasha
and Kamino, Waki
and Joshi, Swapna
and Chen, Wei-Chu
and Hsu, Long-Jing
and Tsui, M. Katherine
and {\vS}abanovi{\'c}, Selma",
title="Understanding the Connection Among Ikigai, Well-Being, and Home Robot Acceptance in Japanese Older Adults: Mixed Methods Study",
journal="JMIR Aging",
year="2023",
month="Oct",
day="4",
volume="6",
pages="e45442",
keywords="ikigai",
keywords="meaning in life",
keywords="purpose",
keywords="well-being",
keywords="eudaimonic",
keywords="hedonic",
keywords="happiness",
keywords="home robots",
keywords="social robots",
keywords="human-robot interaction",
keywords="Japan",
abstract="Background: Ikigai (meaning or purpose in life) is a concept understood by most older adults in Japan. The term has also garnered international attention, with recent academic attempts to map it to concepts in the Western well-being literature. In addition, efforts to use social and home robots to increase well-being have grown; however, they have mostly focused on hedonic well-being (eg, increasing happiness and decreasing loneliness) rather than eudaimonic well-being (eg, fostering meaning or purpose in life). Objective: First, we explored how Japanese older adults experience ikigai and relate these to concepts in the Western well-being literature. Second, we investigated how a home robot meant to promote ikigai is perceived by older adults. Methods: We used a mixed methods research design---including 20 interviews with older adults, a survey of 50 older adults, and 10 interviews with family caregivers. For interviews, we asked questions about older adults' sources of ikigai, happiness, and social support, along with their perception of the robot (QT). For surveys, a number of well-being scales were used, including 2 ikigai scales---ikigai-9 and K-1---and 6 Patient-Reported Outcomes Measurement Information System scales, measuring meaning and purpose, positive affect, satisfaction with participation in social roles, satisfaction with participation in discretionary social activities, companionship, and emotional support. Questions related to the perception and desired adoption of the robot and older adults' health status were also included. Results: Our results suggest that health is older adults' most common source of ikigai. Additionally, although self-rated health correlated moderately with ikigai and other well-being measures, reported physical limitation did not. As opposed to social roles (work and family), we found that ikigai is more strongly related to satisfaction with discretionary social activities (leisure, hobbies, and friends) for older adults. Moreover, we found that older adults' sources of ikigai included the eudaimonic aspects of vitality, positive relations with others, contribution, accomplishment, purpose, and personal growth, with the first 3 being most common, and the hedonic aspects of positive affect, life satisfaction, and lack of negative affect, with the first 2 being most common. However, the concept of ikigai was most related to eudaimonic well-being, specifically meaning in life, along the dimension of significance. Finally, we found that Japanese older adults have high expectations of a home robot for well-being, mentioning that it should support them in a multitude of ways before they would likely adopt it. However, we report that those with the highest levels of meaning, and satisfaction with their leisure life and friendships, may be most likely to adopt it. Conclusions: We outline several ways to improve the robot to increase its acceptance, such as improving its voice, adding functional features, and designing it to support multiple aspects of well-being. ",
doi="10.2196/45442",
url="https://aging.jmir.org/2023/1/e45442",
url="http://www.ncbi.nlm.nih.gov/pubmed/37792460"
}


@Article{info:doi/10.2196/31812,
author="Khadjesari, Zarnie
and Houghton, Julie
and Brown, J. Tracey
and Jopling, Helena
and Stevenson, Fiona
and Lynch, Jennifer",
title="Contextual Factors That Impact the Implementation of Patient Portals With a Focus on Older People in Acute Care Hospitals: Scoping Review",
journal="JMIR Aging",
year="2023",
month="Feb",
day="3",
volume="6",
pages="e31812",
keywords="patient portal",
keywords="tethered personal health records",
keywords="acute care hospitals",
keywords="implementation",
keywords="scoping review",
abstract="Background: Older people are the highest users of health services but are less likely to use a patient portal than younger people. Objective: This scoping review aimed to identify and synthesize the literature on contextual factors that impact the implementation of patient portals in acute care hospitals and among older people. Methods: A scoping review was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The following databases were searched from 2010 to June 2020: MEDLINE and Embase via the Ovid platform, CINAHL and PsycINFO via the EBSCO platform, and the Cochrane Library. Eligible reviews were published in English; focused on the implementation of tethered patient portals; included patients, health care professionals, managers, and budget holders; and aimed at identifying the contextual factors (ie, barriers and facilitators) that impact the implementation of patient portals. Review titles and abstracts and full-text publications were screened in duplicate. The study characteristics were charted by one author and checked for accuracy by a second author. The NASSS (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability) framework was used to synthesize the findings. Results: In total, 10 systematic reviews published between 2015 and 2020 were included in the study. Of these, 3 (30\%) reviews addressed patient portals in acute care hospitals, and 2 (20\%) reviews addressed the implementation of patient portals among older people in multiple settings (including acute care hospitals). To maximize the inclusion of the literature on patient portal implementation, we also included 5 reviews of systematic reviews that examined patient portals in multiple care settings (including acute care hospitals). Contextual factors influencing patient portal implementation tended to cluster in specific NASSS domains, namely the condition, technology, and value proposition. Certain aspects within these domains received more coverage than others, such as sociocultural factors and comorbidities, the usability and functionality aspects of the technology, and the demand-side value. There are gaps in the literature pertinent to the consideration of the provision of patient portals for older people in acute care hospitals, including the lack of consideration of the diversity of older adults and their needs, the question of interoperability between systems (likely to be important where care involves multiple services), the involvement of lay caregivers, and looking beyond short-term implementation to ways in which portal use can be sustained. Conclusions: We identified important contextual factors that impact patient portal implementation and key gaps in the literature. Future research should focus on evaluating strategies that address disparities in use and promote engagement with patient portals among older people in acute care settings. ",
doi="10.2196/31812",
url="https://aging.jmir.org/2023/1/e31812",
url="http://www.ncbi.nlm.nih.gov/pubmed/36735321"
}


@Article{info:doi/10.2196/54952,
author="Han, Eunkyung
and Kharrazi, Hadi
and Shi, Leiyu",
title="Correction: Identifying Predictors of Nursing Home Admission by Using Electronic Health Records and Administrative Data: Scoping Review",
journal="JMIR Aging",
year="2023",
month="Dec",
day="19",
volume="6",
pages="e54952",
doi="10.2196/54952",
url="https://aging.jmir.org/2023/1/e54952"
}


@Article{info:doi/10.2196/45799,
author="Matsangidou, Maria
and Solomou, Theodoros
and Frangoudes, Fotos
and Papayianni, Ersi
and Pattichis, S. Constantinos",
title="Offering Outworld Experiences to In-Patients With Dementia Through Virtual Reality: Mixed Methods Study",
journal="JMIR Aging",
year="2023",
month="Aug",
day="31",
volume="6",
pages="e45799",
keywords="virtual reality",
keywords="dementia",
keywords="patient-centered design",
keywords="psychophysiological responses",
keywords="behavioral and psychological symptoms",
keywords="in-patient",
keywords="VR",
keywords="symptom management",
keywords="quality of life",
keywords="intervention",
keywords="mental health",
keywords="mental disorder",
keywords="dementia care",
abstract="Background: Research has suggested that institutionalization can increase the behavioral and psychological symptoms of dementia. To date, recent studies have reported a growing number of successful deployments of virtual reality for people with dementia to alleviate behavioral and psychological symptoms of dementia and improve quality of life. However, virtual reality has yet to be rigorously evaluated, since the findings are still in their infancy, with nonstatistically significant and inconclusive results. Objective: Unlike prior works, to overcome limitations in the current literature, our virtual reality system was co-designed with people with dementia and experts in dementia care and was evaluated with a larger population of patients with mild to severe cases of dementia. Methods: Working with 44 patients with dementia and 51 medical experts, we co-designed a virtual reality system to enhance the symptom management of in-patients with dementia residing in long-term care. We evaluated the system with 16 medical experts and 20 people with dementia. Results: This paper explains the screening process and analysis we used to identify which environments patients would like to receive as an intervention. We also present the system's evaluation results by discussing their impact in depth. According to our findings, virtual reality contributes significantly to the reduction of behavioral and psychological symptoms of dementia, especially for aggressive, agitated, anxious, apathetic, depressive, and fearful behaviors. Conclusions: Ultimately, we hope that the results from this study will offer insight into how virtual reality technology can be designed, deployed, and used in dementia care. ",
doi="10.2196/45799",
url="https://aging.jmir.org/2023/1/e45799"
}


@Article{info:doi/10.2196/51844,
author="Abbott, E. Ethan
and Oh, Wonsuk
and Dai, Yang
and Feuer, Cole
and Chan, Lili
and Carr, G. Brendan
and Nadkarni, N. Girish",
title="Joint Modeling of Social Determinants and Clinical Factors to Define Subphenotypes in Out-of-Hospital Cardiac Arrest Survival: Cluster Analysis",
journal="JMIR Aging",
year="2023",
month="Dec",
day="6",
volume="6",
pages="e51844",
keywords="out-of-hospital-cardiac arrest",
keywords="machine learning",
keywords="social determinants of health",
keywords="SDOH",
keywords="cluster",
keywords="cardiac",
keywords="heart",
keywords="cardiology",
keywords="myocardial",
keywords="phenotype",
keywords="phenotypes",
keywords="subphenotype",
keywords="subphenotypes",
keywords="mortality",
keywords="death",
keywords="survive",
keywords="survival",
keywords="survivor",
keywords="survivors",
keywords="retrospective",
keywords="observational",
keywords="cohort",
keywords="algorithm",
keywords="algorithms",
keywords="k-means",
keywords="clustering",
keywords="association",
keywords="associations",
abstract="Background: Machine learning clustering offers an unbiased approach to better understand the interactions of complex social and clinical variables via integrative subphenotypes, an approach not studied in out-of-hospital cardiac arrest (OHCA). Objective: We conducted a cluster analysis for a cohort of OHCA survivors to examine the association of clinical and social factors for mortality at 1 year. Methods: We used a retrospective observational OHCA cohort identified from Medicare claims data, including area-level social determinants of health (SDOH) features and hospital-level data sets. We applied k-means clustering algorithms to identify subphenotypes of beneficiaries who had survived an OHCA and examined associations of outcomes by subphenotype. Results: We identified 27,028 unique beneficiaries who survived to discharge after OHCA. We derived 4 distinct subphenotypes. Subphenotype 1 included a distribution of more urban, female, and Black beneficiaries with the least robust area-level SDOH measures and the highest 1-year mortality (2375/4417, 53.8\%). Subphenotype 2 was characterized by a greater distribution of male, White beneficiaries and had the strongest zip code--level SDOH measures, with 1-year mortality at 49.9\% (4577/9165). Subphenotype 3 had the highest rates of cardiac catheterization at 34.7\% (1342/3866) and the greatest distribution with a driving distance to the index OHCA hospital from their primary residence >16.1 km at 85.4\% (8179/9580); more were also discharged to a skilled nursing facility after index hospitalization. Subphenotype 4 had moderate median household income at US \$51,659.50 (IQR US \$41,295 to \$67,081) and moderate to high median unemployment at 5.5\% (IQR 4.2\%-7.1\%), with the lowest 1-year mortality (1207/3866, 31.2\%). Joint modeling of these features demonstrated an increased hazard of death for subphenotypes 1 to 3 but not for subphenotype 4 when compared to reference. Conclusions: We identified 4 distinct subphenotypes with differences in outcomes by clinical and area-level SDOH features for OHCA. Further work is needed to determine if individual or other SDOH domains are specifically tied to long-term survival after OHCA. ",
doi="10.2196/51844",
url="https://aging.jmir.org/2023/1/e51844"
}


@Article{info:doi/10.2196/41950,
author="Holmqvist, Malin
and Ros, Axel
and Lindenfalk, Bertil
and Thor, Johan
and Johansson, Linda",
title="How Older Persons and Health Care Professionals Co-designed a Medication Plan Prototype Remotely to Promote Patient Safety: Case Study",
journal="JMIR Aging",
year="2023",
month="Apr",
day="7",
volume="6",
pages="e41950",
keywords="co-design",
keywords="remote",
keywords="older people",
keywords="medications",
keywords="medication plan",
keywords="patient safety",
keywords="patient experience",
keywords="participatory",
keywords="engagement",
abstract="Background: Harm from medications is a major patient safety challenge. Most adverse drug events arise when a medication is prescribed or reevaluated. Therefore, interventions in this area may improve patient safety. A medication plan, that is, a plan for continued treatment with medications, may support patient safety. Participation of patients in the design of health care products or services may improve patient safety. Co-design, as in the Double Diamond framework from the Design Council, England, can emphasize patient involvement. As the COVID-19 pandemic brought restrictions to face-to-face co-design approaches, interest in remote approaches increased. However, it is uncertain how best to perform remote co-design. Therefore, we explored a remote approach, which brought together older persons and health care professionals to co-design a medication plan prototype in the electronic health record, aiming to support patient safety. Objective: This study aimed to describe how remote co-design was applied to create a medication plan prototype and to explore participants' experiences with this approach. Methods: Within a case study design, we explored the experiences of a remote co-design initiative with 14 participants in a regional health care system in southern Sweden. Using descriptive statistics, quantitative data from questionnaires and web-based workshop timestamps were analyzed. A thematic analysis of the qualitative data gathered from workshops, interviews, and free-text responses to the survey questions was performed. Qualitative and quantitative data were compared side by side in the discussion. Results: The analysis of the questionnaires revealed that the participants rated the experiences of the co-design initiative very high. In addition, the balance between how much involved persons expressed their wishes and were listened to was considered very good. Marked timestamps from audio recordings showed that the workshops proceeded according to the plan. The thematic analysis yielded the following main themes: Everyone's perspective matters, Learning by sharing, and Mastering a digital space. The themes encompassed what helped to establish a permissive environment that allowed the participants to be involved and share viewpoints. There was a dynamic process of learning and understanding, realizing that despite different backgrounds, there was consensus about the requirements for a medication plan. The remote co-design process seemed appealing, by balancing opportunities and challenges and building an inviting, creative, and tolerant environment. Conclusions: Participants experienced that the remote co-design initiative was inclusive of their perspectives and facilitated learning by sharing experiences. The Double Diamond framework was applicable in a digital context and supported the co-design process of the medication plan prototype. Remote co-design is still novel, but with attentiveness to power relations between all involved, this approach may increase opportunities for older persons and health care professionals to collaboratively design products or services that can improve patient safety. ",
doi="10.2196/41950",
url="https://aging.jmir.org/2023/1/e41950",
url="http://www.ncbi.nlm.nih.gov/pubmed/37027205"
}


@Article{info:doi/10.2196/42223,
author="Wang, Zixin
and Fang, Yuan
and Chan, Shing-Fong Paul
and Yu, Yuen Fuk
and Sun, Fenghua",
title="The Changes in Levels and Barriers of Physical Activity Among Community-Dwelling Older Adults During and After the Fifth Wave of COVID-19 Outbreak in Hong Kong: Repeated Random Telephone Surveys",
journal="JMIR Aging",
year="2023",
month="Jan",
day="23",
volume="6",
pages="e42223",
keywords="COVID-19",
keywords="physical activity",
keywords="older adults",
keywords="barriers",
keywords="changes",
keywords="repeated random telephone survey",
keywords="China",
keywords="aging",
keywords="elderly population",
keywords="community-dwelling older adults",
keywords="health promotion",
keywords="telehealth",
abstract="Background: COVID-19 has had an impact on physical activity (PA) among older adults; however, it is unclear whether this effect would be long-lasting, and there is a dearth of studies assessing the changes in barriers to performing PA among older adults before and after entering the ``postpandemic era.'' Objective: The aim of this study was to compare the levels and barriers of PA among a random sample of community-dwelling older adults recruited during (February to April 2022) and after the fifth wave of the COVID-19 outbreak (May to July 2022) in Hong Kong. In addition, we investigated factors associated with a low PA level among participants recruited at different time points. Methods: This study involved two rounds of random telephone surveys. Participants were community-dwelling Chinese-speaking individuals aged 65 years or above and having a Hong Kong ID card. Household telephone numbers were randomly selected from the most updated telephone directories. Experienced interviewers carried out telephone interviews between 6 PM and 10 PM on weekdays and between 2 PM and 9 PM on Saturdays to avoid undersampling of working individuals. We called 3900 and 3840 households in the first and second round, respectively; for each round, 640 and 625 households had an eligible older adult and 395 and 370 completed the telephone survey, respectively. Results: As compared to participants in the first round, fewer participants indicated a low level of PA in the second round (28.6\% vs 45.9\%, P<.001). Participants in the second round had higher metabolic equivalent of tasks-minutes/week (median 1707.5 vs 840, P<.001) and minutes of moderate-to-vigorous PA per week (median 240 vs 105, P<.001) than those in the first round. After adjustment for significant background characteristics, participants who perceived a lack of physical capacity to perform PA (first round: adjusted odds ratio [AOR] 3.34, P=.001; second round: 2.92, P=.002) and believed that PA would cause pain and discomfort (first round: AOR 2.04, P=.02; second round: 2.82, P=.001) were more likely to have a low level of PA in both rounds. Lack of time (AOR 4.19, P=.01) and concern about COVID-19 infection during PA (AOR 1.73, P=.02) were associated with a low level of PA among participants in the first round, but not in the second round. A perceived lack of space and facility to perform PA at home (AOR 2.03, P=.02) and unable to find people to do PA with (AOR 1.80, P=.04) were associated with a low PA level in the second round, but not in the first round. Conclusions: The level of PA increased significantly among older adults after Hong Kong entered the ``postpandemic era.'' Different factors influenced older adults' PA level during and after the fifth wave of the COVID-19 outbreak. Regular monitoring of the PA level and its associated factors should be conducted to guide health promotion and policy-making. ",
doi="10.2196/42223",
url="https://aging.jmir.org/2023/1/e42223",
url="http://www.ncbi.nlm.nih.gov/pubmed/36599172"
}


@Article{info:doi/10.2196/41692,
author="Drazich, F. Brittany
and Lee, Won Ji
and Bowles, H. Kathryn
and Taylor, L. Janiece
and Shah, Shivani
and Resnick, Barbara
and Kim, Nayeon
and Szanton, L. Sarah",
title="Pandemic-Related Changes in Technology Use Among a Sample of Previously Hospitalized Older Adult New Yorkers: Observational Study",
journal="JMIR Aging",
year="2023",
month="Mar",
day="29",
volume="6",
pages="e41692",
keywords="older adults",
keywords="technology",
keywords="COVID-19",
keywords="well-being",
keywords="elderly population",
keywords="technology use",
keywords="physical disability",
keywords="virtual health",
keywords="social interaction",
keywords="digital gaming",
keywords="digital learning",
abstract="Background: The COVID-19 pandemic increased the importance of technology for all Americans, including older adults. Although a few studies have indicated that older adults might have increased their technology use during the COVID-19 pandemic, further research is needed to confirm these findings, especially among different populations, and using validated surveys. In particular, research on changes in technology use among previously hospitalized community-dwelling older adults, especially those with physical disability, is needed because older adults with multimorbidity and hospital associated deconditioning were a population greatly impacted by COVID-19 and related distancing measures. Obtaining knowledge regarding previously hospitalized older adults' technology use, before and during the pandemic, could inform the appropriateness of technology-based interventions for vulnerable older adults. Objective: In this paper, we 1) described changes in older adult technology-based communication, technology-based phone use, and technology-based gaming during the COVID-19 pandemic, compared to before the COVID-19 pandemic and 2) tested whether technology use moderated the association between changes in in-person visits and well-being, controlling for covariates. Methods: Between December 2020 and January 2021 we conducted a telephone-based objective survey with 60 previously hospitalized older New Yorkers with physical disability. We measured technology-based communication through three questions pulled from the National Health and Aging Trends Study COVID-19 Questionnaire. We measured technology-based smart phone use and technology-based video gaming through the Media Technology Usage and Attitudes Scale. We used paired t tests and interaction models to analyze survey data. Results: This sample of previously hospitalized older adults with physical disability consisted of 60 participants, 63.3\% of whom identified as female, 50.0\% of whom identified as White, and 63.8\% of whom reported an annual income of \$25,000 or less. This sample had not had physical contact (such as friendly hug or kiss) for a median of 60 days and had not left their home for a median of 2 days. The majority of older adults from this study reported using the internet, owning smart phones, and nearly half learned a new technology during the pandemic. During the pandemic, this sample of older adults significantly increased their technology-based communication (mean difference=.74, P=.003), smart phone use (mean difference=2.9, P=.016), and technology-based gaming (mean difference=.52, P=.030). However, this technology use during the pandemic did not moderate the association between changes in in-person visits and well-being, controlling for covariates. Conclusions: These study findings suggest that previously hospitalized older adults with physical disability are open to using or learning technology, but that technology use might not be able to replace in-person social interactions. Future research might explore the specific components of in-person visits that are missing in virtual interactions, and if they could be replicated in the virtual environment, or through other means. ",
doi="10.2196/41692",
url="https://aging.jmir.org/2023/1/e41692",
url="http://www.ncbi.nlm.nih.gov/pubmed/36881528"
}


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


@Article{info:doi/10.2196/42517,
author="Shiroma, Kristina
and Zimmerman, Tara
and Xie, Bo
and Fleischmann, R. Kenneth
and Rich, Kate
and Lee, Kyung Min
and Verma, Nitin
and Jia, Chenyan",
title="Older Adults' Trust and Distrust in COVID-19 Public Health Information: Qualitative Critical Incident Study",
journal="JMIR Aging",
year="2023",
month="Nov",
day="9",
volume="6",
pages="e42517",
keywords="health information",
keywords="information-seeking behavior",
keywords="COVID-19",
keywords="qualitative research methods",
keywords="communication",
keywords="media and networks",
keywords="aging",
keywords="older adults",
keywords="elderly population",
keywords="mass media",
keywords="public health information",
keywords="trust",
abstract="Background: The COVID-19 infodemic has imposed a disproportionate burden on older adults who face increased challenges in accessing and assessing public health information, but little is known about factors influencing older adults' trust in public health information during COVID-19. Objective: This study aims to identify sources that older adults turn to for trusted COVID-19 public health information and factors that influence their trust. In addition, we explore the relationship between public health information sources and trust factors. Methods: Adults aged 65 years or older (N=30; mean age 71.6, SD 5.57; range 65-84 years) were recruited using Prime Panels. Semistructured phone interviews, guided by critical incident technique, were conducted in October and November 2020. Participants were asked about their sources of COVID-19 public health information, the trustworthiness of that information, and factors influencing their trust. Interview data were examined with thematic analysis. Results: Mass media, known individuals, and the internet were the older adults' main sources for COVID-19 public health information. Although they used social media for entertainment and personal communication, the older adults actively avoided accessing or sharing COVID-19 information on social media. Factors influencing their trust in COVID-19 public health information included confirmation bias, personal research, resigned acceptance, and personal relevance. Conclusions: These findings shed light on older adults' use of information sources and their criteria for evaluating the trustworthiness of public health information during a pandemic. They have implications for the future development of effective public health communication, policies, and interventions for older adults during health crises. ",
doi="10.2196/42517",
url="https://aging.jmir.org/2023/1/e42517",
url="http://www.ncbi.nlm.nih.gov/pubmed/37856774"
}


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


@Article{info:doi/10.2196/46791,
author="Yang, Qingling
and Cheng, Huilin
and Qin, Jing
and Loke, Yuen Alice
and Ngai, Wan Fei
and Chong, Chun Ka
and Zhang, Dexing
and Gao, Yang
and Wang, Haoxiang Harry
and Liu, Zhaomin
and Hao, Chun
and Xie, Jie Yao",
title="A Machine Learning--Based Preclinical Osteoporosis Screening Tool (POST): Model Development and Validation Study",
journal="JMIR Aging",
year="2023",
month="Nov",
day="7",
volume="6",
pages="e46791",
keywords="osteoporosis",
keywords="machine learning",
keywords="screening tool",
keywords="older people",
keywords="health care",
keywords="Hong Kong",
abstract="Background: Identifying persons with a high risk of developing osteoporosis and preventing the occurrence of the first fracture is a health care priority. Most existing osteoporosis screening tools have high sensitivity but relatively low specificity. Objective: We aimed to develop an easily accessible and high-performance preclinical risk screening tool for osteoporosis using a machine learning--based method among the Hong Kong Chinese population. Methods: Participants aged 45 years or older were enrolled from 6 clinics in the 3 major districts of Hong Kong. The potential risk factors for osteoporosis were collected through a validated, self-administered questionnaire and then filtered using a machine learning--based method. Bone mineral density was measured with dual-energy x-ray absorptiometry at the clinics; osteoporosis was defined as a t score of ?2.5 or lower. We constructed machine learning models, including gradient boosting machines, support vector machines, and naive Bayes, as well as the commonly used logistic regression models, for the prediction of osteoporosis. The best-performing model was chosen as the final tool, named the Preclinical Osteoporosis Screening Tool (POST). Model performance was evaluated by the area under the receiver operating characteristic curve (AUC) and other metrics. Results: Among the 800 participants enrolled in this study, the prevalence of osteoporosis was 10.6\% (n=85). The machine learning--based Boruta algorithm identified 15 significantly important predictors from the 113 potential risk factors. Seven variables were further selected based on their accessibility and convenience for daily self-assessment and health care practice, including age, gender, education level, decreased body height, BMI, number of teeth lost, and the intake of vitamin D supplements, to construct the POST. The AUC of the POST was 0.86 and the sensitivity, specificity, and accuracy were all 0.83. The positive predictive value, negative predictive value, and F1-score were 0.41, 0.98, and 0.56, respectively. Conclusions: The machine learning--based POST was conveniently accessible and exhibited accurate discriminative capabilities for the prediction of osteoporosis; it might be useful to guide population-based preclinical screening of osteoporosis and clinical decision-making. ",
doi="10.2196/46791",
url="https://aging.jmir.org/2023/1/e46791"
}