%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54452 %T Using Virtual Reality to Improve Outcomes Related to Quality of Life Among Older Adults With Serious Illnesses: Systematic Review of Randomized Controlled Trials %A Maheta,Bhagvat %A Kraft,Alexandra %A Interrante,Nickolas %A Fereydooni,Soraya %A Bailenson,Jeremy %A Beams,Brian %A Keny,​​Christina %A Osborne,Thomas %A Giannitrapani,Karleen %A Lorenz,Karl %+ Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd, Palo Alto, CA, 94025, United States, 1 (650) 614 9997, kalorenz@stanford.edu %K virtual reality %K serious illness %K pain %K anxiety %K older adults %K patient outcomes %K systematic review %K palliative care %K hospice %D 2025 %7 26.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Virtual reality (VR) has promise as an innovative nonpharmacologic treatment for improving a patient’s quality of life. VR can be used as an adjunct or treatment for many acute and chronic conditions, including serious illnesses. Objective: This systematic review aims to assess the current state of the literature of randomized controlled trials that use VR in patients with serious illnesses. Two secondary aims include assessing intervention components associated with improved quality of life and functional outcomes among older adults, as well as evaluating how well the randomized controlled trials adhere to consensus standards for VR research. Methods: We searched PubMed, Embase, and CINAHL for randomized controlled studies published at any time. We screened and accepted studies that reported outcomes related to patients’ quality of life, provided an immersive VR intervention, and included patients with serious illness. We narratively summarized key attributes of publications that shed light on study efficacy, generalizability, replicability, and clinical utility. All studies were assessed for study quality with the Cochrane Risk of Bias tool and for concordance with 8 recent consensus standards for VR research. Results: From the 12,621 articles searched in May 2024, a total of 24 (0.19%) studies met the inclusion criteria, and of these, 88% (21/24) reported an improvement in at least 1 patient quality of life outcome and 67% (16/24) had a high risk of bias. In 7 (n=24, 29%) studies, VR was used to provide distraction therapy to reduce pain. In total, 5 (n=24, 21%) studies included training, supervision, and assistance in VR use, which demonstrated improvements in patient quality of life–related outcomes. Of 24 studies, 9 (38%) included patients with stroke, 9 (38%) included patients with cancer, 4 (17%) included patients with cardiovascular disease, 1 (4%) included patients with chronic obstructive pulmonary disease, and 1 (4%) included patients who reported pain in hospital. In all 9 studies that included patients with stroke, the main purpose of VR was to improve mobility and strength; these studies had higher frequency and longer durations of VR use, ranging from 2 to 9 weeks, as compared to a VR use duration of <2 weeks for studies aiming to reduce pain or anxiety. Regarding consensus standards for VR research, 29% (7/24) of the studies adhered to all 8 criteria, and all studies (24/24, 100%) adhered to ≥5 criteria. Conclusions: Nascent evidence suggests VR’s potential in mitigating pain, anxiety, and depression and improving mobility among persons with serious illnesses. Most studies did not provide detailed information about unassisted or assisted use, suggesting that VR for older adults is currently most appropriate for observed settings with assistance available. Trial Registration: PROSPERO CRD42022346178; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346178 %M 40009834 %R 10.2196/54452 %U https://www.jmir.org/2025/1/e54452 %U https://doi.org/10.2196/54452 %U http://www.ncbi.nlm.nih.gov/pubmed/40009834 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64716 %T Digital Migration of the Loewenstein Acevedo Scales for Semantic Interference and Learning (LASSI-L): Development and Validation Study in Older Participants %A Harvey,Philip %A Curiel-Cid,Rosie %A Kallestrup,Peter %A Mueller,Annalee %A Rivera-Molina,Andrea %A Czaja,Sara %A Crocco,Elizabeth %A Loewenstein,David %K mild cognitive impairment %K cognitive challenge tests %K elder %K aging %K amyloid biomarkers %K cognition %K cognitive decline %K deterioration %K semantic interference %K Alzheimer disease %K self-administered %K voice recognition %K technology %K assessment study %K accuracy %K artificial intelligence %K treatment %K medication %K mental health %K biomarkers %K amnesia %K neurodegeneration %K patient health %K health monitoring %K digital mental health %K neuroscience %K neurotechnology %K Loewenstein Acevedo Scales for Semantic Interference and Learning %K LASSI-L %K digital Loewenstein-Acevedo Scales for Semantic Interference %K LASSI-D %D 2025 %7 19.2.2025 %9 %J JMIR Ment Health %G English %X Background: The early detection of mild cognitive impairment is crucial for providing treatment before further decline. Cognitive challenge tests such as the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) can identify individuals at highest risk for cognitive deterioration. Performance on elements of the LASSI-L, particularly proactive interference, correlate with the presence of critical Alzheimer disease biomarkers. However, in-person paper tests require skilled testers and are not practical in many community settings or for large-scale screening in prevention. Objective: This study reports on the development and initial validation of a self-administered computerized version of the Loewenstein-Acevedo Scales for Semantic Interference (LASSI), the digital LASSI (LASSI-D). A self-administered digital version, with an artificial intelligence–generated avatar assistant, was the migrated assessment. Methods: Cloud-based software was developed, using voice recognition technology, for English and Spanish versions of the LASSI-D. Participants were assessed with either the LASSI-L or LASSI-D first, in a sequential assessment study. Participants with amnestic mild cognitive impairment (aMCI; n=54) or normal cognition (NC; n=58) were also tested with traditional measures such as the Alzheimer Disease Assessment Scale-Cognition. We examined group differences in performance across the legacy and digital versions of the LASSI, as well as correlations between LASSI performance and other measures across the versions. Results: Differences on recall and intrusion variables between aMCI and NC samples on both versions were all statistically significant (all P<.001), with at least medium effect sizes (d>0.68). There were no statistically significant performance differences in these variables between legacy and digital administration in either sample (all P<.13). There were no language differences in any variables (P>.10), and correlations between LASSI variables and other cognitive variables were statistically significant (all P<.01). The most predictive legacy variables, proactive interference and failure to recover from proactive interference, were identical across legacy and migrated versions within groups and were identical to results of previous studies with the legacy LASSI-L. Classification accuracy was 88% for NC and 78% for aMCI participants. Conclusions: The results for the digital migration of the LASSI-D were highly convergent with the legacy LASSI-L. Across all indices of similarity, including sensitivity, criterion validity, classification accuracy, and performance, the versions converged across languages. Future studies will present additional validation data, including correlations with blood-based Alzheimer disease biomarkers and alternative forms. The current data provide convincing evidence of the use of a fully self-administered digitally migrated cognitive challenge test. %R 10.2196/64716 %U https://mental.jmir.org/2025/1/e64716 %U https://doi.org/10.2196/64716 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e72007 %T Authors’ Reply: Enhancing the Clinical Relevance of Al Research for Medication Decision-Making %A Vordenberg,Sarah E %A Nichols,Julianna %A Marshall,Vincent D %A Weir,Kristie Rebecca %A Dorsch,Michael P %+ , College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI, 48109, United States, 1 734 763 6691, skelling@med.umich.edu %K older adults %K artificial intelligence %K vignette %K pharmacology %K medication %K decision-making %K aging %K attitude %K perception %K perspective %K electronic heath record %D 2025 %7 18.2.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39964740 %R 10.2196/72007 %U https://www.jmir.org/2025/1/e72007 %U https://doi.org/10.2196/72007 %U http://www.ncbi.nlm.nih.gov/pubmed/39964740 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70657 %T Enhancing the Clinical Relevance of Al Research for Medication Decision-Making %A Wang,Qi %A Chen,Mingxian %+ Department of Gastroenterology, Tongde Hospital of Zhejiang Province, 234 Gucui Street, Xihu Region, Hangzhou, 310012, China, 86 151 576 82797, chenmingxian2005@126.com %K older adults %K artificial intelligence %K medication %K decision-making %K data security %K patient trust %D 2025 %7 18.2.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39964744 %R 10.2196/70657 %U https://www.jmir.org/2025/1/e70657 %U https://doi.org/10.2196/70657 %U http://www.ncbi.nlm.nih.gov/pubmed/39964744 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65492 %T Measuring Digital Health Literacy in Older Adults: Development and Validation Study %A Kim,SungMin %A Park,Choonghee %A Park,Sunghyeon %A Kim,Dai-Jin %A Bae,Ye-Seul %A Kang,Jae-Heon %A Chun,Ji-Won %+ Department of Medical Informatics, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 2 3147 9727, jwchun@catholic.ac.kr %K digital health care %K older adults %K digital health literacy %K exploratory factor analysis %K confirmatory factor analysis %K mobile phone %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: New health care services such as smart health care and digital therapeutics have greatly expanded. To effectively use these services, digital health literacy skills, involving the use of digital devices to explore and understand health information, are important. Older adults, requiring consistent health management highlight the need for enhanced digital health literacy skills. To address this issue, it is imperative to develop methods to assess older adults’ digital health literacy levels. Objective: This study aimed to develop a tool to measure digital health literacy. To this end, it reviewed existing literature to identify the components of digital health literacy, drafted preliminary items, and developed a scale using a representative sample. Methods: We conducted a primary survey targeting 600 adults aged 55-75 years and performed an exploratory factor analysis on 74 preliminary items. Items with low factor loadings were removed, and their contents were modified to enhance their validity. Then, we conducted a secondary survey with 400 participants to perform exploratory and confirmatory factor analyses. Results: A digital health literacy scale consisting of 25 items was developed, comprising 4 subfactors: use of digital devices, understanding health information, use and decision regarding health information, and use intention. The model fit indices indicated excellent structural validity (Tucker-Lewis Index=0.924, comparative fit index=0.916, root-mean-square error of approximation=0.088, standardized root-mean-square residual=0.044). High convergent validity (average variance extracted>0.5) and reliability (composite reliability>0.7) were observed within each factor. Discriminant validity was also confirmed as the square root of the average variance extracted was greater than the correlation coefficients between the factors. This scale demonstrates high reliability and excellent structural validity. Conclusions: This study is a significant first step toward enhancing digital health literacy among older adults by developing an appropriate tool for measuring digital health literacy. We expect this study to contribute to the future provision of tailored education and treatment based on individual literacy levels. %M 39908081 %R 10.2196/65492 %U https://www.jmir.org/2025/1/e65492 %U https://doi.org/10.2196/65492 %U http://www.ncbi.nlm.nih.gov/pubmed/39908081 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60794 %T Investigating Older Adults’ Perceptions of AI Tools for Medication Decisions: Vignette-Based Experimental Survey %A Vordenberg,Sarah E %A Nichols,Julianna %A Marshall,Vincent D %A Weir,Kristie Rebecca %A Dorsch,Michael P %+ College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI, 48109, United States, 1 734 763 6691, skelling@med.umich.edu %K older adults %K survey %K decisions %K artificial intelligence %K vignette %K drug %K pharmacology %K pharmaceutic %K medication %K decision-making %K geriatric %K aging %K surveys %K attitude %K perception %K perspective %K recommendation %K electronic heath record %D 2024 %7 16.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the public release of large language models, research is needed to explore whether older adults would be receptive to personalized medication advice given by artificial intelligence (AI) tools. Objective: This study aims to identify predictors of the likelihood of older adults stopping a medication and the influence of the source of the information. Methods: We conducted a web-based experimental survey in which US participants aged ≥65 years were asked to report their likelihood of stopping a medication based on the source of information using a 6-point Likert scale (scale anchors: 1=not at all likely; 6=extremely likely). In total, 3 medications were presented in a randomized order: aspirin (risk of bleeding), ranitidine (cancer-causing chemical), or simvastatin (lack of benefit with age). In total, 5 sources of information were presented: primary care provider (PCP), pharmacist, AI that connects with the electronic health record (EHR) and provides advice to the PCP (“EHR-PCP”), AI with EHR access that directly provides advice (“EHR-Direct”), and AI that asks questions to provide advice (“Questions-Direct”) directly. We calculated descriptive statistics to identify participants who were extremely likely (score 6) to stop the medication and used logistic regression to identify demographic predictors of being likely (scores 4-6) as opposed to unlikely (scores 1-3) to stop a medication. Results: Older adults (n=1245) reported being extremely likely to stop a medication based on a PCP’s recommendation (n=748, 60.1% [aspirin] to n=858, 68.9% [ranitidine]) compared to a pharmacist (n=227, 18.2% [simvastatin] to n=361, 29% [ranitidine]). They were infrequently extremely likely to stop a medication when recommended by AI (EHR-PCP: n=182, 14.6% [aspirin] to n=289, 23.2% [ranitidine]; EHR-Direct: n=118, 9.5% [simvastatin] to n=212, 17% [ranitidine]; Questions-Direct: n=121, 9.7% [aspirin] to n=204, 16.4% [ranitidine]). In adjusted analyses, characteristics that increased the likelihood of following an AI recommendation included being Black or African American as compared to White (Questions-Direct: odds ratio [OR] 1.28, 95% CI 1.06-1.54 to EHR-PCP: OR 1.42, 95% CI 1.17-1.73), having higher self-reported health (EHR-PCP: OR 1.09, 95% CI 1.01-1.18 to EHR-Direct: OR 1.13 95%, CI 1.05-1.23), having higher confidence in using an EHR (Questions-Direct: OR 1.36, 95% CI 1.16-1.58 to EHR-PCP: OR 1.55, 95% CI 1.33-1.80), and having higher confidence using apps (EHR-Direct: OR 1.38, 95% CI 1.18-1.62 to EHR-PCP: OR 1.49, 95% CI 1.27-1.74). Older adults with higher health literacy were less likely to stop a medication when recommended by AI (EHR-PCP: OR 0.81, 95% CI 0.75-0.88 to EHR-Direct: OR 0.85, 95% CI 0.78-0.92). Conclusions: Older adults have reservations about following an AI recommendation to stop a medication. However, individuals who are Black or African American, have higher self-reported health, or have higher confidence in using an EHR or apps may be receptive to AI-based medication recommendations. %R 10.2196/60794 %U https://www.jmir.org/2024/1/e60794 %U https://doi.org/10.2196/60794 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52834 %T Exploring Older Adults’ Perspectives on Digital Home Care Interventions and Home Modifications: Focus Group Study %A Choukou,Mohamed-Amine %A Banihani,Jasem %A Azizkhani,Sarah %+ Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, R111, 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada, 1 204 333 4778, amine.choukou@umanitoba.ca %K agetech %K attitude %K opinion %K perception %K perspective %K home based %K community based %K research %K strategic planning %K gerontechnology %K geriatric %K older adults %K aging %K co-construction %K workshop %K inductive analysis %K development %K aging-in-place %K independent %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging gerontechnology seeks to enable older adults (OAs) to remain independently and safely in their homes by connecting to health and social support and services. There are increasing attempts to develop gerontechnology, but successful implementations are more likely limited because of the uncertainty of developers about the needs and priorities of OAs. As the global population ages, the challenges faced by older OAs in maintaining independence and well-being within their homes have become increasingly important. With the proportion of OAs expected to triple by 2068, addressing the needs of this demographic has become a pressing social and public health priority. OAs often encounter various challenges related to physical, cognitive, and social well-being, including reduced mobility, memory impairments, and social isolation, which can compromise their ability to age in place and maintain a high quality of life. Objective: The goals of this qualitative research study are to (1) determine the best strategies for promoting aging well in the community with the support of gerontechnology, (2) establish the top priorities for implementing gerontechnology with OAs and their families, and (3) create a road map for the creation and application of gerontechnology for aging well in Manitoba. Methods: A total of 14 OAs participated in a qualitative research study conducted through a coconstruction workshop format, including a presentation of novel research facilities and a demonstration of research and development products. This activity was followed by an interactive discussion focused on revisiting the ongoing research and innovation programs and planning for a new research and innovation agenda. The workshop contents, notes, and recorded conversation underwent a data-driven inductive analysis. Results: Emerging themes included home design, accessibility, and safety for OAs, particularly those with memory impairments. The participants also underlined the need for digital reminders and ambient technologies in current homes as a priority. Participants stressed the importance of including OAs in gerontechnology development programs and the need to consider dignity and independence as the guiding values for future research. Conclusions: This study presents a tentative road map for the development of gerontechnology in Manitoba. The main principles of our road map are the inclusion of OAs as early as possible in gerontechnology development and the prioritization of independence and dignity. Applying these principles would contribute to combatting digital ageism and the marginalization of OAs in technology development because of the perceived lack of technological skills and the stereotypes associated with this presumption. %M 39671577 %R 10.2196/52834 %U https://formative.jmir.org/2024/1/e52834 %U https://doi.org/10.2196/52834 %U http://www.ncbi.nlm.nih.gov/pubmed/39671577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58444 %T Reliable Web-Based Auditory Cognitive Testing: Observational Study %A Lad,Meher %A Taylor,John-Paul %A Griffiths,Timothy David %+ Translational and Clinical Research Institute, Newcastle University, Auditory Laboratory, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom, 44 0191 208 6000, meher.lad@newcastle.ac.uk %K auditory testing %K hearing loss %K cognitive testing %K auditory %K observational study %K older adult %K hearing %K questionnaire %K auditory cognitive testing %K in person %K web-based setting %K auditory memory %K Pearson %K female %K women %K audiology %D 2024 %7 9.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based experimentation, accelerated by the COVID-19 pandemic, has enabled large-scale participant recruitment and data collection. Auditory testing on the web has shown promise but faces challenges such as uncontrolled environments and verifying headphone use. Prior studies have successfully replicated auditory experiments but often involved younger participants, limiting the generalizability to older adults with varying hearing abilities. This study explores the feasibility of conducting reliable auditory cognitive testing using a web-based platform, especially among older adults. Objective: This study aims to determine whether demographic factors such as age and hearing status influence participation in web-based auditory cognitive experiments and to assess the reproducibility of auditory cognitive measures—specifically speech-in-noise perception and auditory memory (AuM)—between in-person and web-based settings. Additionally, this study aims to examine the relationship between musical sophistication, measured by the Goldsmiths Musical Sophistication Index (GMSI), and auditory cognitive measures across different testing environments. Methods: A total of 153 participants aged 50 to 86 years were recruited from local registries and memory clinics; 58 of these returned for web-based, follow-up assessments. An additional 89 participants from the PREVENT cohort were included in the web-based study, forming a combined sample. Participants completed speech-in-noise perception tasks (Digits-in-Noise and Speech-in-Babble), AuM tests for frequency and amplitude modulation rate, and the GMSI questionnaire. In-person testing was conducted in a soundproof room with standardized equipment, while web-based tests required participants to use headphones in a quiet room via a web-based app. The reproducibility of auditory measures was evaluated using Pearson and intraclass correlation coefficients, and statistical analyses assessed relationships between variables across settings. Results: Older participants and those with severe hearing loss were underrepresented in the web-based follow-up. The GMSI questionnaire demonstrated the highest reproducibility (r=0.82), while auditory cognitive tasks showed moderate reproducibility (Digits-in-Noise and Speech-in-Babble r=0.55 AuM tests for frequency r=0.75 and amplitude modulation rate r=0.44). There were no significant differences in the correlation between age and auditory measures across in-person and web-based settings (all P>.05). The study replicated previously reported associations between AuM and GMSI scores, as well as sentence-in-noise perception, indicating consistency across testing environments. Conclusions: Web-based auditory cognitive testing is feasible and yields results comparable to in-person testing, especially for questionnaire-based measures like the GMSI. While auditory tasks demonstrated moderate reproducibility, the consistent replication of key associations suggests that web-based testing is a viable alternative for auditory cognition research. However, the underrepresentation of older adults and those with severe hearing loss highlights a need to address barriers to web-based participation. Future work should explore methods to enhance inclusivity, such as remote guided testing, and address factors like digital literacy and equipment standards to improve the representativeness and quality of web-based auditory research. %M 39652871 %R 10.2196/58444 %U https://www.jmir.org/2024/1/e58444 %U https://doi.org/10.2196/58444 %U http://www.ncbi.nlm.nih.gov/pubmed/39652871 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e65043 %T Characterizing Emergency Department Disposition Conversations for Persons Living With Dementia: Protocol for an Ethnographic Study %A Seidenfeld,Justine %A Tucker,Matthew %A Harris-Gersten,Melissa %A Fix,Gemmae M %A Guzman,Ivonne %A Sperber,Nina R %A Hastings,Susan N %+ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, 411 W Chapel Hill, Durham, NC, 27704, United States, 1 919 286 0411 ext 178386, justine.seidenfeld@va.gov %K ethnography %K direct observations %K emergency medicine %K dementia %K caregivers %D 2024 %7 6.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Almost 40% of persons living with dementia make an emergency department (ED) visit each year. One of the most impactful and costly elements of their ED care is the decision to discharge or admit them to the hospital—the “disposition” decision. When more than one reasonable option exists regarding a health care decision, such as the decision to admit or not, it often requires a complex conversation between patients, care partners, and ED providers, ideally involving shared decision-making. However, little is known about how these conversations are conducted and the real-world context in which they take place. Best practices in ED communication and shared decision-making for persons living with dementia and their care partners are limited. Objective: This study aims to characterize current practices in ED disposition conversations for persons living with dementia and their care partners, informed by perspectives from patient and care partner participants. Methods: This study will use an ethnographic design, including direct observation methods with a semistructured data collection tool to capture the ED encounter for up to 20 patient and care partner dyads, including all discussions about dispositions. Follow-up qualitative, semistructured interviews will be conducted with persons living with dementia and their care partners to explore specific observations made during their ED encounter, and to gain insight into their perspective on their role and elements of decision support used during that conversation. Results: Data collection was initiated in October 2023, with 13 dyads recruited and observed as of July 2024. This study is expected to be completed by December 2024. Conclusions: Novel methods can offer novel insights. By combining direct observation and follow-up interviews about an ED visit, our study design will provide insights into how ED disposition occurs in real-world settings for persons living with dementia. Findings can inform more patient-centered interventions for disposition decision-making. International Registered Report Identifier (IRRID): DERR1-10.2196/65043 %M 39642361 %R 10.2196/65043 %U https://www.researchprotocols.org/2024/1/e65043 %U https://doi.org/10.2196/65043 %U http://www.ncbi.nlm.nih.gov/pubmed/39642361 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e64367 %T Factors Affecting Clinician Readiness to Adopt Smart Home Technology for Remote Health Monitoring: Systematic Review %A Dermody,Gordana %A Wadsworth,Daniel %A Dunham,Melissa %A Glass,Courtney %A Fritz,Roschelle %+ School of Health, Nursing, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, 4556, Australia, 61 0451980220, gdermody@usc.edu.au %K clinician %K provider %K health professional %K smart home %K remote monitoring %K technology %K readiness %K adoption %K preparedness %D 2024 %7 5.12.2024 %9 Review %J JMIR Aging %G English %X Background: The population of older adults worldwide continues to increase, placing higher demands on primary health care and long-term care. The costs of housing older people in care facilities have economic and societal impacts that are unsustainable without innovative solutions. Many older people wish to remain independent in their homes and age in place. Assistive technology such as health-assistive smart homes with clinician monitoring could be a widely adopted alternative to aged-care facilities in the future. While studies have found that older persons have demonstrated a readiness to adopt health-assistive smart homes, little is known about clinician readiness to adopt this technology to support older adults to age as independently as possible. Objective: The purpose of this systematic review was to identify the factors that affect clinician readiness to adopt smart home technology for remote health monitoring. Methods: This review was conducted in accordance with the Joanna Briggs Institute methodology for systematic Reviews and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting. Results: Several factors affected clinicians’ perspectives on their readiness to adopt smart home technology for remote health monitoring, including challenges such as patient privacy and dignity, data security, and ethical use of “invasive” technologies. Perceived benefits included enhancing the quality of care and outcomes. Conclusions: Clinicians, including nurses, reported both challenges and benefits of adopting smart home technology for remote health monitoring. Clear strategies and frameworks to allay fears and overcome professional concerns and misconceptions form key parts of the Readiness for Adoption Pathway proposed. The use of more rigorous scientific methods and reporting is needed to advance the state of the science. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020195989; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195989 %M 39012852 %R 10.2196/64367 %U https://aging.jmir.org/2024/1/e64367 %U https://doi.org/10.2196/64367 %U http://www.ncbi.nlm.nih.gov/pubmed/39012852 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58895 %T Disaster Preparedness Intervention for Older Adults (Seniors’ Positive Involvement in Community Emergencies): Protocol for a Quasi-Experimental Study %A White-Lewis,Sharon %A Lightner,Joseph %A Crowley,Julia %A Grimes,Amanda %A Spears,Kathleen %A Chesnut,Steven %+ School of Nursing and Health Sciences, University of Missouri Kansas City, Kansas City, MO, United States, 1 913 592 4477, whitelewiss@umkc.edu %K older adults %K disaster preparedness %K emergency preparedness %K disaster protocol %K disaster engagement %K disaster recovery %K personal preparedness %K community dwelling older adults %K elderly %K aging in place %K activities in daily life %K resiliency %K community health %D 2024 %7 4.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults comprise a substantial proportion of the US population requiring support during disaster events. Previous research demonstrates that older adults are resilient but deficient in disaster preparedness and lacking in community engagement. There is a gap in high-quality research in this area. Objective: This study aims to fill this gap by developing a 4-phase intervention to improve mobility and balance, decrease fall risks (mitigation), increase knowledge of disaster preparedness (preparedness), improve community emergency operation plans (response), and improve self-efficacy in disaster recovery (recovery) for older adults. Methods: This is a community-based, 10-month study in a large Midwestern urban and suburban location targeting community-dwelling older adults. The 4 phases of interventions address mitigation, preparedness, response, and recovery—aspects improving outcomes from disaster events. In total, 4 to 6 one-hour seminars each month are provided to community-dwelling older adults to improve disaster preparedness and recovery planning. A critical incident packet with resources on essential information such as medications, a communication plan, evacuation resources, and supplies was started and is being reviewed. Preintervention surveys are orally given, with research assistants aiding in any difficulties the participants have. After the surveys, 2 individual 20-minute presentations separated by a short break for snacks and initial completion of their disaster plan preserve the older adult’s attention. Mitigation efforts to improve mobility and safety are offered with 10 visits to the older adults’ residences, adapting physical activity and balance exercises to the individual’s needs. To address response needs, the emergency operations plans for 2 of the major cities are being amended for specific functional needs and access guidelines. Measurements include accelerometers to assess improvement in mobility, fall risk assessments, an abbreviated Federal Emergency Management Association Household Survey, an assessment for disaster engagement with partners tool, a brief pain inventory assessment, and the General Self-Efficacy Scale. We analyze data descriptively and compare pre- and postintervention data for each phase with paired-samples t test and other nonparametric techniques (proportion tests and Wilcoxon signed-rank tests). Overarching objectives prioritized during this intervention include underscoring respect for the experience and resilience found in older adults and engaging them in specialized roles to support their communities during disaster events. Results: The intervention was funded in July 2023; enrollment began in November 2023 and is continuing. We will conclude data collection by July 2025. Published study results can be expected in early 2025. Conclusions: With improved disaster preparedness, mobility, recovery planning, and inclusion as a resource in community disasters, older adults are expected to be safer and be able to age in place. If successful, future studies will focus on outreach and sustainability. This study will serve as a model for older adult disaster preparedness and community involvement. International Registered Report Identifier (IRRID): DERR1-10.2196/58895 %R 10.2196/58895 %U https://www.researchprotocols.org/2024/1/e58895 %U https://doi.org/10.2196/58895 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e65730 %T Exploring the Perspectives of Older Adults Living With HIV on Virtual Care: Qualitative Study %A Kokorelias,Kristina M %A Valentine,Dean %A Dove,Erica M %A Brown,Paige %A McKinlay,Stuart %A Sheppard,Christine L %A Singh,Hardeep %A Eaton,Andrew D %A Jamieson,Laura %A Wasilewski,Marina B %A Zhabokritsky,Alice %A Flanagan,Ashley %A Abdelhalim,Reham %A Zewude,Rahel %A Parpia,Rabea %A Walmsley,Sharon %A Sirisegaram,Luxey %K HIV %K human immunodeficiency virus %K perspective %K telemedicine %K telehealth %K virtual care %K virtual health %K virtual medicine %K qualitative %K gerontology %K geriatrics %K older adult %K older people %K aging %D 2024 %7 4.12.2024 %9 %J JMIR Aging %G English %X Background: As the population of individuals with HIV ages rapidly due to advancements in antiretroviral therapy, virtual care has become an increasingly vital component in managing their complex health needs. However, little is known about perceptions of virtual care among older adults living with HIV. Objective: This study aimed to understand the perceptions of older adults living with HIV regarding virtual care. Methods: Using an interpretive, qualitative, descriptive methodology, semistructured interviews were conducted with 14 diverse older adults living with HIV. The participants lived in Ontario, Canada, self-identified as HIV-positive, and were aged 50 years or older. Efforts were made to recruit individuals with varying experience with virtual health care. Reflexive thematic analysis was conducted with the interview transcripts to identify prevalent themes. Results: The identified themes included (1) the importance of relationships in virtual care for older adults living with HIV; (2) privacy and confidentiality in virtual care; and (3) challenges and solutions related to access and technological barriers in virtual care. These themes highlight the perceptions of diverse older adults living with HIV concerning virtual care, emphasizing the fundamental role of trust, privacy, and technology access. Conclusions: By embracing the unique perspectives and experiences of this population, we can work toward building more inclusive and responsive health care systems that meet the needs of all individuals, regardless of age, HIV status, or other intersecting identities. %R 10.2196/65730 %U https://aging.jmir.org/2024/1/e65730 %U https://doi.org/10.2196/65730 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e58641 %T Older Adults’ Perspectives and Experiences With Digital Health in Singapore: Qualitative Study %A Leong,Qiao Ying %A Lee,V Vien %A Ng,Wei Ying %A Vijayakumar,Smrithi %A Lau,Ni Yin %A Mauritzon,Ingela %A Blasiak,Agata %A Ho,Dean %+ The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Centre for Life Sciences, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore, 65 6601 7515, biedh@nus.edu.sg %K digital health %K gerontology %K geriatrics %K elder %K aging %K Singapore %K qualitative %K mHealth %K mobile health %K experience %K technology use %K interview %K perspective %K acceptance %K technology adoption %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Technology use among older adults is increasingly common. Even though there is potential in leveraging technology to help them manage their health, only a small fraction of them use it for health-related purposes. Objective: This study seeks to understand the perspectives of and experiences with digital health (DH) among older adults in Singapore. Methods: A total of 16 participants (age range 60-80 years; n=11, 69% female) were interviewed for approximately an hour (range 27-64 minutes) about their health, DH use, and DH experiences. The interviews were recorded, transcribed verbatim, and thematically analyzed. Results: Five main themes emerged from the interview: support in developing DH literacy, credibility, cost and benefit considerations, intrinsic drive to be healthy, and telehealth. Older adults need support in familiarizing themselves with DH. When considering DH options, older adults often relied on credible sources and preferred DH to be free. Monetary incentives were brought up as motivators. The intrinsic drive to live longer and healthily was expressed to be a huge encouragement to use DH to help obtain health-related knowledge and achieve healthy living goals. The idea of telehealth was also appealing among older adults but was seen to be more suited for individuals who have issues accessing a physical clinic. Conclusions: Our findings offer insights into the various aspects that matter to older adults in the adoption of DH, which in turn can help reshape their health-seeking behavior and lifestyle. As such, policy makers and DH implementors are encouraged to take these into consideration and align their strategies accordingly. %M 39527787 %R 10.2196/58641 %U https://humanfactors.jmir.org/2024/1/e58641 %U https://doi.org/10.2196/58641 %U http://www.ncbi.nlm.nih.gov/pubmed/39527787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58466 %T Identifying and Estimating Frailty Phenotypes by Vocal Biomarkers: Cross-Sectional Study %A Lin,Yu-Chun %A Yan,Huang-Ting %A Lin,Chih-Hsueh %A Chang,Hen-Hong %+ Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, No 91, Hsueh-Shih Road, North District, Taichung, 40402, Taiwan, 886 22053366 ext 3609, tcmchh55@gmail.com %K frailty phenotypes %K older adults %K successful aging %K vocal biomarkers %K frailty %K phenotype %K vocal biomarker %K cross-sectional %K gerontology %K geriatrics %K older adult %K Taiwan %K energy-based %K hybrid-based %K sarcopenia %D 2024 %7 8.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Researchers have developed a variety of indices to assess frailty. Recent research indicates that the human voice reflects frailty status. Frailty phenotypes are seldom discussed in the literature on the aging voice. Objective: This study aims to examine potential phenotypes of frail older adults and determine their correlation with vocal biomarkers. Methods: Participants aged ≥60 years who visited the geriatric outpatient clinic of a teaching hospital in central Taiwan between 2020 and 2021 were recruited. We identified 4 frailty phenotypes: energy-based frailty, sarcopenia-based frailty, hybrid-based frailty–energy, and hybrid-based frailty–sarcopenia. Participants were asked to pronounce a sustained vowel “/a/” for approximately 1 second. The speech signals were digitized and analyzed. Four voice parameters—the average number of zero crossings (A1), variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4)—were used for analyzing changes in voice. Logistic regression was used to elucidate the prediction model. Results: Among 277 older adults, an increase in A1 values was associated with a lower likelihood of energy-based frailty (odds ratio [OR] 0.81, 95% CI 0.68-0.96), whereas an increase in A2 values resulted in a higher likelihood of sarcopenia-based frailty (OR 1.34, 95% CI 1.18-1.52). Respondents with larger A3 and A4 values had a higher likelihood of hybrid-based frailty–sarcopenia (OR 1.03, 95% CI 1.002-1.06) and hybrid-based frailty–energy (OR 1.43, 95% CI 1.02-2.01), respectively. Conclusions: Vocal biomarkers might be potentially useful in estimating frailty phenotypes. Clinicians can use 2 crucial acoustic parameters, namely A1 and A2, to diagnose a frailty phenotype that is associated with insufficient energy or reduced muscle function. The assessment of A3 and A4 involves a complex frailty phenotype. %M 39515817 %R 10.2196/58466 %U https://www.jmir.org/2024/1/e58466 %U https://doi.org/10.2196/58466 %U http://www.ncbi.nlm.nih.gov/pubmed/39515817 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e59141 %T Home-Based, Low-Intensity, Gamification-Based, Interactive Physical-Cognitive Training for Older Adults Using the ADDIE Model: Design, Development, and Evaluation of User Experience %A Kamnardsiri,Teerawat %A Kumfu,Sirintip %A Munkhetvit,Peeraya %A Boripuntakul,Sirinun %A Sungkarat,Somporn %K exergame %K physical-cognitive training %K computer-based interventions %K gamification %K older adults %K instructional design model %K low-intensity %D 2024 %7 29.10.2024 %9 %J JMIR Serious Games %G English %X Background: Declines in physical and cognitive function are natural biological processes, leading to an increased risk of falls. Promising evidence suggests that combined physical-cognitive exercise has beneficial effects in improving both physical and cognitive health. Although moderate-to-high exercise intensity is commonly recommended, it might be impractical for older adults facing physical limitations or contraindications. Thus, low-intensity exercise is a viable option. The main barriers to engaging in exercise in older adults include transportation, time, motivation, and enjoyment. To overcome these challenges, a home-based, gamification-based training system may provide an effective approach to enhance exercise adherence. Objective: This study aimed to develop and evaluate the usability of a low-intensity, gamification-based, interactive physical-cognitive exercise for older adults in a home-based setting. Methods: The prototype of a game-based physical-cognitive exercise was created following the ADDIE model (analysis, design, development, implementation, and evaluation) and assessed for user experience in older adults. A total of 15 older adults engaged in the game-based physical-cognitive exercise at home for 60 minutes per day, 3 days per week, for 4 weeks. The usability of the game-based training system was evaluated using the system usability scale (SUS) after completion of a 4-week training program. As for satisfaction, the 8-item Physical Activity Enjoyment Scale (PACES) questionnaire was used to assess participants’ enjoyment level after 1 week and 4 weeks of training. Descriptive statistics were used to illustrate the SUS score. A Wilcoxon signed-rank test was used to compare the PACES scores between the first week and the end of the 4-week period, with significance set at P<.05. Results: As for experts’ consensus, the game-based training consisted of 3 games: Ocean Diver, Road Runner, and Moving and Memorizing. The games had 3 levels of difficulty: beginner, intermediate, and advanced. A computer vision–based system was selected as the delivery platform for a home setting. The total SUS score for all participants was mean 87.22 (SD 5.76), indicating the user’s perception of the usability of a system ranging from good to excellent. At the end of the 4-week training, the total PACES score was significantly greater than the first week, suggesting an improvement in enjoyment (first week: mean 44.93, SD 3.99 vs fourth week: mean 50.53, SD 4.70; P=.001). Conclusions: The prototype of low-intensity, gamification-based, interactive physical-cognitive training was designed and developed using the ADDIE model, which included both experts and end users in the process. The findings showed that the exergame prototype was a usable and practical approach for a home-based setting, enhancing older adults’ enjoyment and motivation. Further research is warranted to determine the effectiveness of such gamification-based training in promoting physical and cognitive functions. %R 10.2196/59141 %U https://games.jmir.org/2024/1/e59141 %U https://doi.org/10.2196/59141 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54916 %T Phenotyping Adherence Through Technology-Enabled Reports and Navigation (the PATTERN Study): Qualitative Study for Intervention Adaptation Using the Exploration, Preparation, Implementation, and Sustainment Framework %A Pack,Allison P %A Bailey,Stacy C %A O'Conor,Rachel %A Velazquez,Evelyn %A Wismer,Guisselle %A Yeh,Fangyu %A Curtis,Laura M %A Alcantara,Kenya %A Wolf,Michael S %+ Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 0274, allison.pack@northwestern.edu %K older adults %K polypharmacy %K medication adherence %K intervention development %K qualitative research %D 2024 %7 17.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults with multiple chronic conditions (MCC) and polypharmacy often face challenges with medication adherence. Nonadherence can lead to suboptimal treatment outcomes, adverse drug events, and poor quality of life. Objective: To facilitate medication adherence among older adults with MCC and polypharmacy in primary care, we are adapting a technology-enabled intervention previously implemented in a specialty clinic. The objective of this study was to obtain multilevel feedback to inform the adaptation of the proposed intervention (Phenotyping Adherence Through Technology-Enabled Reports and Navigation [PATTERN]). Methods: We conducted a formative qualitative study among patients, clinicians, and clinic administrators affiliated with a large academic health center in Chicago, Illinois. Patient eligibility included being aged 65 years or older, living with MCC, and contending with polypharmacy. Eligibility criteria for clinicians and administrators included being employed by any primary care clinic affiliated with the participating health center. Individual semistructured interviews were conducted remotely by a trained member of the study team using interview guides informed by the Exploration, Preparation, Implementation, and Sustainment Framework. Thematic analysis of interview audio recordings drew from the Rapid Identification of Themes from Audio Recordings procedures. Results: In total, we conducted 25 interviews, including 12 with clinicians and administrators, and 13 with patients. Thematic analysis revealed participants largely found the idea of technology-based medication adherence monitoring to be acceptable and appropriate for the target population in primary care, although several concerns were raised; we discuss these in detail. Conclusions: Our medication adherence monitoring intervention, adapted from specialty care, will be implemented in primary care. Formative interviews, informed by the Exploration, Preparation, Implementation, and Sustainment Framework and conducted among patients, clinicians, and administrators, have identified intervention adaptation needs. Results from this study could inform other interventions using the patient portal with older adults. %M 39418094 %R 10.2196/54916 %U https://formative.jmir.org/2024/1/e54916 %U https://doi.org/10.2196/54916 %U http://www.ncbi.nlm.nih.gov/pubmed/39418094 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60270 %T Home-Based Digital Exercise Training Program to Improve Physical Function of Older Sepsis Survivors: Protocol of the HEAL Sepsis Randomized Clinical Trial %A Zeidan,Rola S %A Ohama,Margaret K %A Evripidou,Natalia %A Anton,Stephen D %A Hamed,Laith L %A Lin,Yi %A Leeuwenburgh,Christiaan %A Guirguis,Faheem W %A Efron,Philip A %A Flynn,Sheryl %A Smith,Barbara %A Bacher,Rhonda %A Bakarasan,Naveen %A Sarmiento Delgado,Juan %A Mankowski,Robert T %+ Department of Physiology and Aging, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32603, United States, 1 3523923791, rmankowski@uabmc.edu %K sepsis %K physical function %K exercise %K rehabilitation %K remotely delivered %K aging %D 2024 %7 17.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: While sepsis, an exaggerated response to infection, can affect people of all age groups, it is more prevalent in middle-aged and older adults. Older adults suffer worse short-term and long-term outcomes than younger patients. Older sepsis survivors are commonly discharged to long-term acute care facilities, where they often die within 1 year. Those who return home from the hospital lose the momentum of physical function improvement after early inpatient rehabilitation, and often face exacerbation of comorbidities and decline in physical function. Additionally, patients who are discharged home often live at distant locations and are not able to commute to rehabilitation centers due to their poor health status. Therefore, remotely delivered exercise interventions tailored to this population hold promise to improve physical function safely and effectively after sepsis. However, this type of intervention has yet to be tested in this population. Objective: This study aims to assess the safety, feasibility, and ease of recruitment and retention of participants for a remotely delivered physical activity intervention for improving physical function in middle-aged and older sepsis survivors. Methods: The proposed intervention will be delivered through a digital health platform that comprises a patient-facing mobile app and a 12-week physical activity program specifically designed for middle-aged and older sepsis survivors with poor health status who may face challenges participating in traditional out-patient or community-based exercise interventions. This study is ongoing and plans to enroll 40 sepsis survivors aged 55 years and older who will be randomized to either a remotely delivered exercise intervention group or a control group (electronic health diary). Both groups will use a tablet containing the Health in Motion app (Blue Marble Health). The intervention group will receive a clinician-designed personalized avatar-guided home exercise program and reminders while the control group will self-report daily activities using the in-app health diary feature. Results: This study is the first to use a home-based, remotely monitored 12-week exercise program to improve physical function in sepsis survivors. This study will evaluate the safety, feasibility, and efficacy, providing the necessary knowledge to design and calculate power for future larger trials. Conclusions: This study will provide important information for planning a future randomized clinical trial to test the efficacy of a remotely delivered exercise intervention in this high-risk population. Trial Registration: ClinicalTrials.gov NCT05568511; https://clinicaltrials.gov/study/NCT05568511 International Registered Report Identifier (IRRID): DERR1-10.2196/60270 %M 39418096 %R 10.2196/60270 %U https://www.researchprotocols.org/2024/1/e60270 %U https://doi.org/10.2196/60270 %U http://www.ncbi.nlm.nih.gov/pubmed/39418096 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e50847 %T Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Randomized Controlled Trial %A Xie,Yanhong %A Shen,Shanshan %A Liu,Caixia %A Hong,Hong %A Guan,Huilan %A Zhang,Jingmei %A Yu,Wanqi %K dementia %K family caregiver %K web-based training %K care burden %K care ability %K caregivers %K carer %K caregiving %K informal care %K RCT %K controlled trial %K randomized %K gerontology %K geriatric %K older adult %K elder %K elderly %K older person %K older people %K ageing %K aging %K dementia care %K randomized controlled trial %K internet-based training %D 2024 %7 4.10.2024 %9 %J JMIR Aging %G English %X Background: As dementia progresses, patients exhibit various psychological and behavioral symptoms, imposing a significant burden on families and society, including behavioral and psychological symptoms of dementia. However, caregivers lack professional care knowledge and skills, making it difficult for them to effectively cope with the diverse challenges of caregiving. Therefore, it is necessary to provide caregivers with professional knowledge and skills guidance. Objective: This study aimed to analyze the impact of internet-based training on behavioral and psychological symptoms of dementia in patients, and explore how this training model affects the caregiving abilities and caregiving burden of the family caregivers of patients with dementia. Methods: Using a consecutive enrollment method, the Department of Geriatrics at Zhejiang Hospital (Zhejiang, China) recruited 72 informal caregivers of patients with dementia. These caregivers were randomly divided into an intervention group and a control group, with 36 participants in each group. The intervention group underwent caregiver skill training via a web-based platform, whereas the control group initially received face-to-face follow-up guidance and was subsequently offered web-based training after 6 months. To assess the effectiveness of the intervention program, we used the Neuropsychiatric Inventory Questionnaire (NPI-Q), the Chinese version of the Zarit Burden Interview (CZBI), and the Sense of Competence in Dementia Care Staff Scale (SCIDS) for evaluations conducted before the intervention, 3 months after the intervention, and 6 months after the intervention. Results: Between July 2019 and December 2020, a total of 66 patients successfully completed the intervention and follow-up. After 6 months of intervention, the NPI-Q score of the intervention group was 3.18 (SD 3.81), the CZBI score was 10.97 (SD 5.43), and the SCIDS score was 71.88 (SD 4.78). The NPI-Q score of the control group was 8.09 (SD 8.52), the CZBI score was 30.30 (SD 13.05), and the SCIDS score was 50.12 (SD 9.10). There were statistically significant differences in NPI-Q (P=.004), CZBI (P<.001), and SCIDS scores (P<.001) between the intervention group and the control group. Repeated measures analysis of variance showed that compared with before the intervention, there were statistically significant differences in CZBI (P<.001) and SCIDS (P<.001) scores 3 months after the intervention, while the difference in NPI-Q (P=.11) scores was not significant. The total scores of NPI-Q (P<.001), CZBI (P<.001), and SCIDS (P<.001) were significantly improved 6 months after the intervention. In addition, the results of the covariance analysis showed that after excluding the time effect, the web-based training intervention significantly reduced the NPI-Q score (−2.79, 95% CI −4.38 to −1.19; P<.001) of patients with dementia and the CZBI score (−13.52, 95% CI −15.87 to −11.16; P<.001) of caregivers, while increasing the SCIDS score (12.24, 95% CI 9.02-15.47; P<.001). Conclusions: Internet-based training could significantly reduce the level of behavioral symptoms in older patients with dementia and alleviate the burden on caregivers, enhancing their caregiving abilities. Our results confirmed the effectiveness and feasibility of web-based training, which was of great significance in providing caregiving knowledge training for informal caregivers of persons with dementia. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200057858; https://www.chictr.org.cn/showproj.html?proj=136442 %R 10.2196/50847 %U https://aging.jmir.org/2024/1/e50847 %U https://doi.org/10.2196/50847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58110 %T Ability of Heart Rate Recovery and Gait Kinetics in a Single Wearable to Predict Frailty: Quasiexperimental Pilot Study %A Merchant,Reshma Aziz %A Loke,Bernard %A Chan,Yiong Huak %+ Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 +6567795555, mdcram@nus.edu.sg %K falls %K fall prevention %K wearables %K older adult %K community dwelling older adults %K gait %K gait kinetics %K gait analysis %K biomechanics %K sensors %K gerontology %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Aging is a risk factor for falls, frailty, and disability. The utility of wearables to screen for physical performance and frailty at the population level is an emerging research area. To date, there is a limited number of devices that can measure frailty and physical performance simultaneously. Objective: The aim of this study is to evaluate the accuracy and validity of a continuous digital monitoring wearable device incorporating gait mechanics and heart rate recovery measurements for detecting frailty, poor physical performance, and falls risk in older adults at risk of falls. Methods: This is a substudy of 156 community-dwelling older adults ≥60 years old with falls or near falls in the past 12 months who were recruited for a fall prevention intervention study. Of the original participants, 22 participants agreed to wear wearables on their ankles. An interview questionnaire involving demographics, cognition, frailty (FRAIL), and physical function questions as well as the Falls Risk for Older People in the Community (FROP-Com) was administered. Physical performance comprised gait speed, timed up and go (TUG), and the Short Physical Performance Battery (SPPB) test. A gait analyzer was used to measure gait mechanics and steps (FRAIL-functional: fatigue, resistance, and aerobic), and a heart rate analyzer was used to measure heart rate recovery (FRAIL-nonfunctional: weight loss and chronic illness). Results: The participants’ mean age was 74.6 years. Of the 22 participants, 9 (41%) were robust, 10 (46%) were prefrail, and 3 (14%) were frail. In addition, 8 of 22 (36%) had at least one fall in the past year. Participants had a mean gait speed of 0.8 m/s, a mean SPPB score of 8.9, and mean TUG time of 13.8 seconds. The sensitivity, specificity, and area under the curve (AUC) for the gait analyzer against the functional domains were 1.00, 0.84, and 0.92, respectively, for SPPB (balance and gait); 0.38, 0.89, and 0.64, respectively, for FRAIL-functional; 0.45, 0.91, and 0.68, respectively, for FROP-Com; 0.60, 1.00, and 0.80, respectively, for gait speed; and 1.00, 0.94, and 0.97, respectively, for TUG. The heart rate analyzer demonstrated superior validity for the nonfunctional components of frailty, with a sensitivity of 1.00, specificity of 0.73, and AUC of 0.83. Conclusions: Agreement between the gait and heart rate analyzers and the functional components of the FRAIL scale, gait speed, and FROP-Com was significant. In addition, there was significant agreement between the heart rate analyzer and the nonfunctional components of the FRAIL scale. The gait and heart rate analyzers could be used in a screening test for frailty and falls in community-dwelling older adults but require further improvement and validation at the population level. %M 39361400 %R 10.2196/58110 %U https://formative.jmir.org/2024/1/e58110 %U https://doi.org/10.2196/58110 %U http://www.ncbi.nlm.nih.gov/pubmed/39361400 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e54724 %T Use of Immersive Virtual Reality in Nursing Homes for People With Dementia: Feasibility Study to Assess Cognitive, Motor, and Emotional Responses %A Prinz,Alexander %A Buerger,Dan %A Krafft,Jelena %A Bergmann,Matteo %A Woll,Alexander %A Barisch-Fritz,Bettina %A Witte,Kerstin %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721 49049244, bettina.barisch-fritz@kit.edu %K persons with dementia %K virtual reality %K VR %K immersive virtual reality %K iVR %K head-mounted display %K HMD %K physical performance %K physical activity %K physical function %K motor performance %K Alzheimer’s disease %K Alzheimer’s %K Alzheimer’s treatment %K Alzheimer’s care %K Alzheimer’s symptom control %K dementia %K dementia therapy %K dementia care %K cognitive decline %K cognitive impairment %K cognitive impairments %K neurocognition %K neurology %K neurologist %K neurologists %K nursing home %K nursing homes %K nursing facility %K senior home %K long-term care center %K long-term care facility %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: Physical activity interventions for people with dementia have shown promising effects in improving cognition and physical function or slowing disease-related decline. Immersive virtual reality (iVR), using head-mounted displays, facilitates realistic experiences by blurring the boundaries between VR and the real world. The use of iVR for people with dementia offers the potential to increase active time and improve dementia therapy and care through exercise interventions. However, the feasibility of using VR use in people with dementia, considering changes in motor, cognitive, psychological, and physiological parameters, remains insufficiently investigated. Objective: This study aims to investigate the feasibility of using iVR in people with dementia or mild cognitive impairment in nursing homes. Specifically, we examined changes in motor performance (balance and mobility), cognitive performance (global cognition and executive functions), emotional responses, and fear of falling using iVR. Methods: Utilizing a pre-post design, this study recruited 35 participants with mild-to-moderate dementia, assessed by the Mini-Mental State Examination (MMSE). Participants underwent a single session involving iVR exposure, with pre- and postexposure assessments and a feedback form, to exclude negative effects on cognitive and motor functions, mood, anxiety levels, and balance performance. The use of iVR involved 4 scenes, with a total length of 8 minutes. These scenes depicted a park with short and rather passive impressions presented as a 360° video in a head-mounted display. Before and after using the iVR, cognitive parameters were assessed using the Trail-Making Test A (TMT-A), motor parameters were assessed using the FICSIT-4 (Frailty and Injuries: Cooperative Studies of Intervention Techniques-4) and Timed-Up-and-Go (TUG) tests, and psychological parameters were assessed using the Dementia Mood Picture Test, State-Trait Anxiety Inventory, and Short Falls Efficacy Scale-International (Short FES-I). The Emotion Rating Scale and the duration of use were recorded during use, and a feedback questionnaire was completed afterward in addition to the posttests. Paired t tests and Wilcoxon tests were used to examine pre-post differences. Results: Of the 35 initial participants, 33 completed the study, which corresponds to a dropout rate of 6%. All 33 participants, who had a mean of 83.71 (SD 5.01) years, had dementia. They showed no statistically significant difference in cognitive and motor performance before and after iVR use. Thus, no negative effects on cognitive and motor functions, mood, anxiety levels, and balance performance were observed. The emotion rating scale also showed that 72% (n=24) felt joy and fun during iVR use, 100% (n=33) showed no emotions such as fear, sadness, or anger, and 93% (n=31) were attentive during iVR use. Conclusions: The feasibility of using iVR for people with dementia can be rated positively. There were no changes in motor, cognitive, or emotional parameters that would increase the risk of falls or other negative emotional reactions during or after iVR use. Further studies are needed to investigate prolonged use in a more stimulating computer-generated environment and possible physical and cognitive tasks for people with dementia in nursing homes. Trial Registration: German Clinical Trials Register DRKS00030616; https://drks.de/search/de/trial/DRKS00030616 %R 10.2196/54724 %U https://xr.jmir.org/2024/1/e54724 %U https://doi.org/10.2196/54724 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e54128 %T A Personalized and Interactive Web-Based Advance Care Planning Intervention for Older Adults (Koda Health): Pilot Feasibility Study %A Roberts,R Lynae %A Cherry,Katelin D %A Mohan,Desh P %A Statler,Tiffany %A Kirkendall,Eric %A Moses,Adam %A McCraw,Jennifer %A Brown III,Andrew E %A Fofanova,Tatiana Y %A Gabbard,Jennifer %K advance care planning %K ACP %K digital health tools %K system usability %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K adoption %K acceptance %K usability %K digital health %K platform %K website %K websites %D 2024 %7 6.5.2024 %9 %J JMIR Aging %G English %X Background: Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Digital applications may help facilitate this process, though their use in older adults has not been adequately studied. Objective: This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, a web-based patient-facing ACP platform, among older adults. Methods: Older adults (aged 50 years and older) who had an active Epic MyChart account at an academic health care system in North Carolina were recruited to participate. A total of 2850 electronic invitations were sent through MyChart accounts with an embedded hyperlink to the Koda platform. Participants who agreed to participate were asked to complete pre- and posttest surveys before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and System Usability Scale (SUS) scores. Exploratory outcomes included ACP knowledge and readiness. Results: A total of 161 participants enrolled in the study and created an account on the platform (age: mean 63, SD 9.3 years), with 80% (129/161) of these participants going on to complete all steps of the intervention, thereby generating an advance directive. Participants reported minimal difficulty in using the Koda platform, with an overall SUS score of 76.2. Additionally, knowledge of ACP (eg, mean increase from 3.2 to 4.2 on 5-point scale; P<.001) and readiness (eg, mean increase from 2.6 to 3.2 on readiness to discuss ACP with health care provider; P<.001) significantly increased from before to after the intervention. Conclusions: This study demonstrated that the Koda Health platform is feasible, had above-average usability, and improved ACP documentation of preferences in older adults. Our findings indicate that web-based health tools like Koda may help older individuals learn about and feel more comfortable with ACP while potentially facilitating greater engagement in care planning. %R 10.2196/54128 %U https://aging.jmir.org/2024/1/e54128 %U https://doi.org/10.2196/54128 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e49608 %T Advocating for Older Adults in the Age of Social Media: Strategies to Achieve Peak Engagement on Twitter %A Ng,Reuben %A Indran,Nicole %A Liu,Luyao %K age advocacy %K social media engagement %K older adults %K ageism %K data science %D 2024 %7 1.5.2024 %9 %J JMIR Aging %G English %X Background: Over the last decade, many organizations dedicated to serving the needs and interests of older adults have turned to social media platforms, such as Twitter, subsequently rebranded X, to improve the visibility of age-related issues. However, notwithstanding their growing digital presence and participation, minimal attention has been paid to the use of social media among these advocacy groups. To achieve policy change, advocacy organizations must first be able to engage and mobilize audiences. Objective: Our study aims to elucidate how different tweet features affect the time it takes for posts uploaded by age advocacy organizations to reach peak engagement. Methods: We collated 204,905 tweets from 53 age advocacy organizations posted over a 12-year period. The engagement score of each tweet was calculated by combining well-established metrics, namely likes, retweets, quote tweets, and replies. We ran Cox models with tweet features as predictors and time-to-peak engagement as the outcome. “Peak engagement” (event) refers to engagement scores above the 75th percentile, and “time” refers to months taken to reach peak engagement per tweet. Results: Approximately 1 in 2 tweets (n=103,068, 50.3%) had either no hashtags or just 1 hashtag. Around two-thirds (n=131,220, 64%) of the tweets included a URL. Visual information was highly underused, with most tweets not including GIFs (n=204,202, 99.7%), videos (n=199,800, 97.5%), or photos (n=143,844, 70.2%). Roughly half (n=101,470, 49.5%) of the tweets contained mentions and 9.3% (n=19,009) of tweets were replies. Only 4.5% (n=9285) of tweets were quote tweets. Most tweets were uploaded in the afternoon (n=86,004, 42%) and on a weekday (n=180,499, 88.1%). As hypothesized, features associated with peak engagement were the inclusion of visual elements like photos, which increased peak engagement by 3 times (P<.001), and the use of 3 or more hashtags (P<.001). Quote tweets increased engagement by 3 times (P<.001), as compared to regular tweets, controlling for account-level covariates. Tweets from organizations with a higher tweet volume were 40% less likely to reach peak engagement (P<.001). Conclusions: Social media as a networked platform has the potential to reach users on a global scale and at an exponential speed. Having uncovered the features that are more likely to reach peak engagement on Twitter, our study serves as an invaluable resource for age advocacy organizations in their movement to create a more age-inclusive world. %R 10.2196/49608 %U https://aging.jmir.org/2024/1/e49608 %U https://doi.org/10.2196/49608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54120 %T Community-Dwelling Older Adults’ Readiness for Adopting Digital Health Technologies: Cross-Sectional Survey Study %A Ausserhofer,Dietmar %A Piccoliori,Giuliano %A Engl,Adolf %A Mahlknecht,Angelika %A Plagg,Barbara %A Barbieri,Verena %A Colletti,Nicoletta %A Lombardo,Stefano %A Gärtner,Timon %A Tappeiner,Waltraud %A Wieser,Heike %A Wiedermann,Christian Josef %+ Institute of General Medicine and Public Health, Lorenz-Böhler-Str. 13, Bolzano, 39100, Italy, 39 0471 067290, dietmar.ausserhofer@claudiana.bz.it %K frail older adults %K Italy %K Italian %K Europe %K European %K digital health %K health technologies %K health technology %K telemedicine %K telehealth %K eHealth %K e-health %K adoption %K readiness %K usage %K survey %K surveys %K questionnaire %K questionnaires %K robotics %K readiness %K adoption %K cross-sectional study %K population-based survey %K stratified probabilistic sampling %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health technologies offer the potential to improve the daily lives of older adults, maintain their health efficiently, and allow aging in place. Despite increasing evidence of benefits and advantages, readiness for adopting digital interventions among older people remains underexplored. Objective: This study aims to explore the relationships between sociodemographic-, health-, and lifestyle-related factors and technology use in everyday life and community-dwelling older adults’ readiness to adopt telemedicine, smartphones with texting apps, wearables, and robotics. Methods: This was a cross-sectional, population-based survey study with a stratified probabilistic sample of adults aged 75 years or older living in South Tyrol (autonomous province of Bolzano/Bozen, Italy). A random sample of 3600 community-dwelling older adults living at home was invited to complete a questionnaire including single items (older adults’ readiness to use health technology) and scales (PRISMA-7; Program of Research on Integration of Services for the Maintenance of Autonomy). Descriptive and logistic regression analyses were performed to analyze the data. Results: In total, 1695 community-dwelling older adults completed the survey (for a response rate of 47%). In terms of potential digital health technology adoption, wearable devices were favored by 33.7% (n=571), telemedicine by 30.1% (n=510), smartphones and texting apps by 24.5% (n=416), and assistant robots by 13.7% (n=232). Sociodemographic-, health- and lifestyle-related factors, as well as the use of technology in everyday life, played a significant role in explaining readiness to adopt digital health technologies. For telemedicine, age ≥85 years (odds ratio [OR] 0.74, 95% CI 0.56-0.96), financial constraints (OR 0.68, 95% CI 0.49-0.95), and less than 2 hours of physical activity per week (OR 0.75, 95% CI 0.58-0.98) were associated with nonreadiness, while Italian-speaking participants (OR 1.54, 95% CI 1.16-2.05) and those regularly using computers (OR 1.74, 95% CI 1.16-2.60), smartphones (OR 1.69, 95% CI 1.22-2.35), and the internet (OR 2.26, 95% CI 1.47-3.49) reported readiness for adoption. Conclusions: Community-dwelling older adults display varied readiness toward the adoption of digital health technologies, influenced by age, mother tongue, living situation, financial resources, physical activity, and current use of technology. The findings underscore the need for tailored interventions and educational programs to boost digital health technology adoption among community-dwelling older adults. %M 38687989 %R 10.2196/54120 %U https://formative.jmir.org/2024/1/e54120 %U https://doi.org/10.2196/54120 %U http://www.ncbi.nlm.nih.gov/pubmed/38687989 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e52031 %T Designing Telemedicine for Older Adults With Multimorbidity: Content Analysis Study %A Buawangpong,Nida %A Pinyopornpanish,Kanokporn %A Pliannuom,Suphawita %A Nantsupawat,Nopakoon %A Wiwatkunupakarn,Nutchar %A Angkurawaranon,Chaisiri %A Jiraporncharoen,Wichuda %+ Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Bunrueang Rit Rd, Suthep, Mueang Chiang Mai District, Chiang Mai, 50200, Thailand, 66 53935462, wichuda.j@cmu.ac.th %K telemedicine %K telehealth %K chronic disease %K multimorbidity %K older adults %K mobile phone %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Telemedicine is a potential option for caring for older adults with multimorbidity. There is a need to explore the perceptions about telemedicine among older adults with multimorbidity to tailor it to the needs of older adults with multiple chronic conditions. Objective: This study aims to explore the perceptions about telemedicine among older patients with multimorbidity. Methods: A qualitative study was conducted using semistructured interviews. The interview questions examined older adults’ perspectives about telemedicine, including their expectations regarding telemedicine services and the factors that affect its use. Thematic analysis was performed using NVivo (version 12; Lumivero). The study was reported using the Standards for Reporting Qualitative Research guidelines. Results: In total, 29 patients with multimorbidity—21 (72%) female patients and 8 (28%) male patients with a mean age of 69 (SD 10.39) years—were included. Overall, 4 themes and 7 subthemes emerged: theme 1—perceived benefit of telemedicine among older adults with multimorbidities, theme 2—appropriate use of telemedicine for multimorbid care, theme 3—telemedicine system catering to the needs of older patients, and theme 4—respect patients’ decision to decline to use telemedicine. Conclusions: Telemedicine for older adults with multimorbidity should focus on those with stable conditions. This can help increase access to care for those requiring continuous condition monitoring. A structured telemedicine program and patient-centered services can help increase patient acceptance of telemedicine. However, health care providers must accept the limitations of older patients that may prevent them from receiving telemedicine services. %M 38198201 %R 10.2196/52031 %U https://aging.jmir.org/2024/1/e52031 %U https://doi.org/10.2196/52031 %U http://www.ncbi.nlm.nih.gov/pubmed/38198201 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e48063 %T Effects of a Gamified Agent-Based System for Personalized Elderly Care: Pilot Usability Study %A Martinho,Diogo %A Crista,Vítor %A Carneiro,João %A Matsui,Kenji %A Corchado,Juan Manuel %A Marreiros,Goreti %+ Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development, Polytechnic of Porto - School of Engineering (ISEP), R. Dr. António Bernardino de Almeida 431, Porto, 4249-015, Portugal, 351 911007406, diepm@isep.ipp.pt %K gamification %K cognitive assistants %K elderly care %K coaching system %K older people %K technology %K virtual assistant %K cognitive %K usability %K intervention %K physical activity %K agent-based system %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: The global percentage of older people has increased significantly over the last decades. Information and communication technologies have become essential to develop and motivate them to pursue healthier ways of living. This paper examines a personalized coaching health care service designed to maintain living conditions and active aging among older people. Among the technologies the service includes, we highlight the use of both gamification and cognitive assistant technologies designed to support older people and an application combining a cognitive virtual assistant to directly interact with the older person and provide feedback on their current health condition and several gamification techniques to motivate the older person to stay engaged with the application and pursuit of healthier daily habits. Objective: This pilot study aimed to investigate the feasibility and usability of a gamified agent-based system for older people and obtain preliminary results on the effectiveness of the intervention regarding physical activity health outcomes. Methods: The study was designed as an intervention study comparing pre- and posttest results. The proposed gamified agent-based system was used by 12 participants over 7 days (1 week), and step count data were collected with access to the Google Fit application programming interface. Step count data after the intervention were compared with average step count data before the intervention (average daily values over a period of 4 weeks before the intervention). A　1-tailed Student t test was used to determine the relationship between the dependent and independent variables. Usability was measured using the System Usability Scale questionnaire, which was answered by 8 of the 12 participants in the study. Results: The posttest results showed significant pre- to posttest changes (P=.30; 1-tailed Student t test) with a moderate effect size (Cohen d=0.65). The application obtained an average usability score of 78. Conclusions: The presented pilot was validated, showing the positive health effects of using gamification techniques and a virtual cognitive assistant. Additionally, usability metrics considered for this study confirmed high adherence and interest from most participants in the pilot. %M 37995116 %R 10.2196/48063 %U https://games.jmir.org/2023/1/e48063 %U https://doi.org/10.2196/48063 %U http://www.ncbi.nlm.nih.gov/pubmed/37995116 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e49154 %T Older Persons’ and Health Care Professionals’ Design Choices When Co-Designing a Medication Plan Aiming to Promote Patient Safety: Case Study %A Holmqvist,Malin %A Johansson,Linda %A Lindenfalk,Bertil %A Thor,Johan %A Ros,Axel %+ Department of Public Health and Healthcare, Region Jönköping County, Box 1024, Jönköping, 551 11, Sweden, 46 706702569, malin.m.holmqvist@rjl.se %K co-design %K engagement %K medications %K medication plan %K older people %K older adults %K participatory %K patient experience %K patient safety %K remote %D 2023 %7 5.10.2023 %9 Original Paper %J JMIR Aging %G English %X 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. %M 37796569 %R 10.2196/49154 %U https://aging.jmir.org/2023/1/e49154 %U https://doi.org/10.2196/49154 %U http://www.ncbi.nlm.nih.gov/pubmed/37796569 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48618 %T Technology Acceptance of a Social Robot (LOVOT) Among Single Older Adults in Hong Kong and Singapore: Protocol for a Multimethod Study %A Tan,Cheng Kian Kelvin %A Lou,Vivian W Q %A Cheng,Clio Yuen Man %A He,Phoebe Chu %A Mor,Yan Ying %+ Sau Po Centre on Ageing, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong, 852 2831 5334, wlou@hku.hk %K gerontechnology %K older people %K senior technology acceptance %K single people %K social robot %D 2023 %7 17.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Given the rapidly aging nature of our global population, policy makers around the world are now emphatically promoting active aging. To address the psychosocial needs of older persons and support active aging, researchers are exploring the use of assistive technologies, specifically social robots as companions. However, there is limited evidence on the efficacy of social robots in promoting active aging for older people in the Hong Kong and Singapore contexts. Objective: This study presents the protocol of a study that investigates the acceptance and quality of interaction between a Japanese social robot, LOVOT, and single older adults in Hong Kong and Singapore. Methods: We used a baseline assessment to measure the primary outcome, participants’ acceptance of technology, and a sense of loneliness, namely, the participants’ differences in responses to LOVOT before and following their interaction with the social robot in this multimethod study design. The baseline assessment consisted of the Qualtrics survey, which measures senior technology acceptance, loneliness, older people’s quality of life, subjective happiness, cultural values, willingness to pay, and demographic characteristics, along with the LOVOT’s sociability and system usability. In the study, participants interacted with LOVOT in 3 sessions before being surveyed to measure the older people’s acceptance and attitudes toward LOVOT. A pre–social robot intervention also occurred in the first session. The study was conducted in both Hong Kong and Singapore. A total of 15 single older adults (ie, individuals who live alone) from Hong Kong and another 15 from Singapore were recruited. Participants were 60-75 years of age, lived by themselves, and had no known cognitive or mental issues. Results: The study began recruiting in March 2022, and recruitment was completed at the end of October 2022. Data collection and data set construction were completed at the end of January 2023. Analysis of the data is currently being conducted, and we plan to publish the results by mid-2023. Conclusions: At an individual level, the study will clarify if LOVOT influences single older adults’ psychosocial well-being by reducing their loneliness. At a community level, the study’s findings will illustrate whether LOVOT can provide increased social connectedness while decreasing individual loneliness. Last, this study’s conclusions can inform policy makers to provide social robots to older people to improve their quality of life. Findings can also inform gerontechnology developers on which aspects and cultural considerations to take into account for future inventions. International Registered Report Identifier (IRRID): DERR1-10.2196/48618 %M 37590084 %R 10.2196/48618 %U https://www.researchprotocols.org/2023/1/e48618 %U https://doi.org/10.2196/48618 %U http://www.ncbi.nlm.nih.gov/pubmed/37590084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46617 %T The Effects of Stakeholder Perceptions on the Use of Humanoid Robots in Care for Older Adults: Postinteraction Cross-Sectional Study %A Tobis,Slawomir %A Piasek-Skupna,Joanna %A Neumann-Podczaska,Agnieszka %A Suwalska,Aleksandra %A Wieczorowska-Tobis,Katarzyna %+ Department of Occupational Therapy, Poznan University of Medical Sciences, Swiecickiego 6, Poznan, 60-781, Poland, 48 618546573, stobis@ump.edu.pl %K older adult %K care robot %K stakeholder %K perception %K needs and requirements %K user need %K patient need %K elder %K gerontology %K geriatric %K caregiver %K attitude %K opinion %K home care %K caregiving %K robot %D 2023 %7 4.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Efficient use of humanoid social robots in the care for older adults requires precise knowledge of expectations in this area. There is little research in this field that includes the interaction of stakeholders with the robot. Even fewer studies have compared the perceptions of older people (as care recipients) and professional caregivers (representing those taking care of older adults in teams with robots). Objective: The aim of this study was to analyze whether specific aspects of the perceptions about humanoid robots influence attitudes after interacting with the robot and to compare the opinions of different stakeholders (older people and their professional caregivers) on this topic. We analyzed the potential impact of the differences in perception of the robot between stakeholder groups with respect to how the robot should be designed and tailored to fit the specific needs of future users. We also attempted to define areas where targeted educational activities could bring the attitudes of the two groups of stakeholders closer to each other. Methods: The studied group was a conveniently available sample of individuals who took part in the presentation of and interaction with a humanoid social robot. Among them, there were 48 community-dwelling older adults (aged ≥60 years), who were participants of day care units (which may signal the presence of self-care needs), and 53 professional caregivers. The participants were asked to express their views after an interaction with a humanoid social robot (TIAGo) using the Users’ Needs, Requirements and Abilities Questionnaire (UNRAQ) and the Godspeed Questionnaire Series (GQS). Results: Compared to the caregivers, older adults not only assessed the robot more positively with respect to its roles as a companion and assistant (P=.009 and P=.003, respectively) but also had higher scores on their need to increase their knowledge about the robot (P=.049). Regarding the robot’s functions, the greatest differences between groups were observed for the social aspects on the UNRAQ, including decreasing the sense of loneliness (P=.003) and accompanying the user in everyday activities (P=.005). As for the GQS, the mean scores of the Animacy, Likeability, and Perceived Intelligence scales were significantly higher for older participants than for caregivers (P=.04, P<.001, and P<.001, respectively). The only parameter for which the caregivers’ scores were higher than those of the older adults was the Artificial-Lifelike item from the Anthropomorphism scale of the GQS (P=.03). Conclusions: The acceptance of the social functions of a humanoid robot is related to its perception in all analyzed aspects, whereas the expected usefulness of a care robot is not linked to aspects of anthropomorphism. Successful implementation of robots in the care for older people thus depends on considering not only the fears, needs, and requirements of various stakeholders but also on the perceptions of the robot. Given the differences between the stakeholders, targeted and properly structured educational and training activities for caregivers and prospective users may enable a seamless integration of robotic technologies in care provision. %M 37540548 %R 10.2196/46617 %U https://www.jmir.org/2023/1/e46617 %U https://doi.org/10.2196/46617 %U http://www.ncbi.nlm.nih.gov/pubmed/37540548 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e41810 %T Exploring the Potential of Technology to Promote Exercise Snacking for Older Adults Who Are Prefrail in the Home Setting: User-Centered Design Study %A Stawarz,Katarzyna %A Liang,Ian Ju %A Alexander,Lyndsay %A Carlin,Angela %A Wijekoon,Anjana %A Western,Max J %+ School of Computer Science and Informatics, Cardiff University, Abacws, Senghennydd Road, Cardiff, CF24 4AG, United Kingdom, 44 029 2251 0037, stawarzk@cardiff.ac.uk %K physical activity %K older adults %K Internet of Things %K user-centered design %K qualitative research %K mobile phone %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Aging %G English %X 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. %M 37223992 %R 10.2196/41810 %U https://aging.jmir.org/2023/1/e41810 %U https://doi.org/10.2196/41810 %U http://www.ncbi.nlm.nih.gov/pubmed/37223992 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e40606 %T Exploring the Role of Active Assisted Living in the Continuum of Care for Older Adults: Thematic Analysis %A Bin Noon,Gaya %A Hanjahanja-Phiri,Thokozani %A Dave,Harishree %A Fadrique,Laura %A Teague,Jennifer %A Morita,Plinio P %+ School of Public Health Sciences, University of Waterloo, TJB-2266, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 41372, plinio.morita@uwaterloo.ca %K ambient assisted living %K active assisted living %K AAL %K internet of things %K aging well %K aging in place %K older adults %K geriatrics %K standards %K policies %K health care %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Aging %G English %X 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. %M 37213201 %R 10.2196/40606 %U https://aging.jmir.org/2023/1/e40606 %U https://doi.org/10.2196/40606 %U http://www.ncbi.nlm.nih.gov/pubmed/37213201 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33498 %T Using Smart Speaker Technology for Health and Well-being in an Older Adult Population: Pre-Post Feasibility Study %A McCloud,Rachel %A Perez,Carly %A Bekalu,Mesfin Awoke %A Viswanath,K %+ Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, United States, 1 706 224 8893, rachel_faulkenberry@dfci.harvard.edu %K technology %K older adults %K communication inequalities %K digital health %K elderly population %K smart technology %K smart speaker %K well-being %K health technology %K mobile phone %D 2022 %7 9.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Although smart speaker technology is poised to help improve the health and well-being of older adults by offering services such as music, medication reminders, and connection to others, more research is needed to determine how older adults from lower socioeconomic position (SEP) accept and use this technology. Objective: This study aimed to investigate the feasibility of using smart speakers to improve the health and well-being of low-SEP older adults. Methods: A total of 39 adults aged between 65 and 85 years who lived in a subsidized housing community were recruited to participate in a 3-month study. The participants had a smart speaker at their home and were given a brief orientation on its use. Over the course of the study, participants were given weekly check-in calls to help assist with any problems and newsletters with tips on how to use the speaker. Participants received a pretest and posttest to gauge comfort with technology, well-being, and perceptions and use of the speaker. The study staff also maintained detailed process notes of interactions with the participants over the course of the study, including a log of all issues reported. Results: At the end of the study period, 38% (15/39) of the participants indicated using the speaker daily, and 38% (15/39) of the participants reported using it several times per week. In addition, 72% (28/39) of the participants indicated that they wanted to continue using the speaker after the end of the study. Most participants (24/39, 62%) indicated that the speaker was useful, and approximately half of the participants felt that the speaker gave them another voice to talk to (19/39, 49%) and connected them with the outside world (18/39, 46%). Although common uses were using the speaker for weather, music, and news, fewer participants reported using it for health-related questions. Despite the initial challenges participants experienced with framing questions to the speaker, additional explanations by the study staff addressed these issues in the early weeks of the study. Conclusions: The results of this study indicate that there is promise for smart speaker technology for low-SEP older adults, particularly to connect them to music, news, and reminders. Future studies will need to provide more upfront training on query formation as well as develop and promote more specific options for older adults, particularly in the area of health and well-being. %M 35532979 %R 10.2196/33498 %U https://aging.jmir.org/2022/2/e33498 %U https://doi.org/10.2196/33498 %U http://www.ncbi.nlm.nih.gov/pubmed/35532979 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33714 %T Perceptions of In-home Monitoring Technology for Activities of Daily Living: Semistructured Interview Study With Community-Dwelling Older Adults %A Camp,Nicola %A Johnston,Julie %A Lewis,Martin G C %A Zecca,Massimiliano %A Di Nuovo,Alessandro %A Hunter,Kirsty %A Magistro,Daniele %+ School of Science and Technology, Nottingham Trent University, College Drive, Clifton, Nottingham, NG3 5FP, United Kingdom, 44 01159418418, nicola.camp@ntu.ac.uk %K aging %K wearable sensors %K environmental sensors %K social robots %K activities of daily living %K aging %K older adults %K elderly %K robots %K wearables %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Many older adults prefer to remain in their own homes for as long as possible. However, there are still questions surrounding how best to ensure that an individual can cope with autonomous living. Technological monitoring systems are an attractive solution; however, there is disagreement regarding activities of daily living (ADL) and the optimal technologies that should be used to monitor them. Objective: This study aimed to understand older adults’ perceptions of important ADL and the types of technologies they would be willing to use within their own homes. Methods: Semistructured interviews were conducted on the web with 32 UK adults, divided equally into a younger group (aged 55-69 years) and an older group (≥70 years). Results: Both groups agreed that ADL related to personal hygiene and feeding were the most important and highlighted the value of socializing. The older group considered several activities to be more important than their younger counterparts, including stair use and foot care. The older group had less existing knowledge of monitoring technology but was more willing to accept wearable sensors than the younger group. The younger group preferred sensors placed within the home but highlighted that they would not have them until they felt that daily life was becoming a struggle. Conclusions: Overall, technological monitoring systems were perceived as an acceptable method for monitoring ADL. However, developers and carers must be aware that individuals may express differences in their willingness to engage with certain types of technology depending on their age and circumstances. %M 35511248 %R 10.2196/33714 %U https://aging.jmir.org/2022/2/e33714 %U https://doi.org/10.2196/33714 %U http://www.ncbi.nlm.nih.gov/pubmed/35511248 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34764 %T Bridging Connectivity Issues in Digital Access and Literacy: Reflections on Empowering Vulnerable Older Adults in Singapore %A Lim,Haikel A %A Lee,Joanne Sze Win %A Lim,Meng Han %A Teo,Lynn Pei Zhen %A Sin,Natalene Siew Wen %A Lim,Rou Wei %A Chua,Si Min %A Yeo,Jia Qi %A Ngiam,Nerice Heng Wen %A Tey,Angeline Jie-Yin %A Tham,Celine Yi Xin %A Ng,Kennedy Yao Yi %A Low,Lian Leng %A Tang,Kai Wen Aaron %+ Population Health and Integrated Care Office, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore, 65 62223322, aaron_kw_tang@nhg.com.sg %K COVID-19 %K digital literacy %K digital literacy training %K digital disparities %K digital divide %K social construction of health technologies %K health technology %K COVID-19 pandemic %K pandemic %K COVID %K social isolation %K elder %K older adult %K Asia %K access %K barrier %K empower %K volunteer %K vulnerable %K digital skill %K low income %D 2022 %7 3.5.2022 %9 Viewpoint %J JMIR Aging %G English %X This article describes a ground-up initiative for a volunteer-run digital literacy program in Singapore targeting vulnerable older adults, focusing on the barriers faced in running this program and training these beneficiaries. It further offers possible solutions to overcome these hurdles, providing insight for individuals or organizations seeking to start similar ground-up initiatives. %M 35503520 %R 10.2196/34764 %U https://aging.jmir.org/2022/2/e34764 %U https://doi.org/10.2196/34764 %U http://www.ncbi.nlm.nih.gov/pubmed/35503520 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e34606 %T Designing Tangibles to Support Emotion Logging for Older Adults: Development and Usability Study %A Gooch,Daniel %A Mehta,Vikram %A Stuart,Avelie %A Katz,Dmitri %A Bennasar,Mohamed %A Levine,Mark %A Bandara,Arosha %A Nuseibeh,Bashar %A Bennaceur,Amel %A Price,Blaine %+ School of Computing and Communications, The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 1908858234, Daniel.Gooch@open.ac.uk %K older adults %K health %K emotion %K affect %K well-being %K tangible interaction %K TUI %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The global population is aging, leading to shifts in health care needs. In addition to developing technology to support physical health, there is an increasing recognition of the need to consider how technology can support emotional health. This raises the question of how to design devices that older adults can interact with to log their emotions. Objective: We designed and developed 2 novel tangible devices, inspired by existing paper-based scales of emotions. The findings from a field trial of these devices with older adults are reported. Methods: Using interviews, field deployment, and fixed logging tasks, we assessed the developed devices. Results: Our results demonstrate that the tangible devices provided data comparable with standardized psychological scales of emotion. The participants developed their own patterns of use around the devices, and their experience of using the devices uncovered a variety of design considerations. We discuss the difficulty of customizing devices for specific user needs while logging data comparable to psychological scales of emotion. We also highlight the value of reflecting on sparse emotional data. Conclusions: Our work demonstrates the potential for tangible emotional logging devices. It also supports further research on whether such devices can support the emotional health of older adults by encouraging reflection of their emotional state. %M 35475781 %R 10.2196/34606 %U https://humanfactors.jmir.org/2022/2/e34606 %U https://doi.org/10.2196/34606 %U http://www.ncbi.nlm.nih.gov/pubmed/35475781 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37282 %T The Effect of Transcranial Alternating Current Stimulation With Cognitive Training on Executive Brain Function in Individuals With Dementia: Protocol for a Crossover Randomized Controlled Trial %A Jacobson,Natasha %A Lithgow,Brian %A Jafari Jozani,Mohammad %A Moussavi,Zahra %+ Department of Electrical and Computer Engineering, University of Manitoba, SP-423 Engineering Building, Fort Gary Campus, 97 Dafoe Rd, Winnipeg, MB, R3T 5V6, Canada, 1 204 474 7023, Zahra.Moussavi@Umanitoba.ca %K transcranial alternating current stimulation %K Alzheimer disease %K cognitive impairment %K double blind %K treatment %K placebo-controlled %K randomized %K crossover %K dementia %K cognitive %D 2022 %7 27.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although memory and cognitive declines are associated with normal brain aging, they may also be precursors to dementia. Objective: We aim to offer a novel approach to prevent or slow the progress of neurodegenerative dementia, or plausibly, improve the cognitive functions of individuals with dementia. Methods: We will recruit and enroll 75 participants (older than 50 years old with either mild cognitive impairment or probable early or moderate dementia) for this double-blind randomized controlled study to estimate the efficacy of active transcranial alternating current stimulation with cognitive treatment (in comparison with sham transcranial alternating current stimulation). This will be a crossover study; a cycle consists of sham or active treatment for a period of 4 weeks (5 days per week, in two 30-minute sessions with a half-hour break in between), and participants are randomized into 2 groups, with stratification by age, sex, and cognitive level (measured with the Montreal Cognitive Assessment). Outcomes will be assessed before and after each treatment cycle. The primary outcomes are changes in Wechsler Memory Scale Older Adult Battery and Alzheimer Disease Assessment Scale scores. Secondary outcomes are changes in performance on tests of frontal lobe functioning (verbal fluency), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire), mood changes (Montgomery-Åsberg Depression Rating Scale), and short-term recall (visual 1-back task). Exploratory outcome measures will also be assessed: static and dynamic vestibular response using electrovestibulography, neuronal changes using functional near-infrared spectroscopy, and change in spatial orientation using virtual reality navigation. Results: As of February 10, 2022, the study is ongoing: 7 patients have been screened, and all were deemed eligible for and enrolled in the study; 4 participants have completed baseline assessments. Conclusions: We anticipate that transcranial alternating current stimulation will be a well-tolerated treatment, with no serious side effects and with considerable short- and long-term cognitive improvements. Trial Registration: Clinicaltrials.gov NCT05203523; https://clinicaltrials.gov/show/NCT05203523 International Registered Report Identifier (IRRID): DERR1-10.2196/37282 %M 35475789 %R 10.2196/37282 %U https://www.researchprotocols.org/2022/4/e37282 %U https://doi.org/10.2196/37282 %U http://www.ncbi.nlm.nih.gov/pubmed/35475789 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e32473 %T Voice-Enabled Intelligent Virtual Agents for People With Amnesia: Systematic Review %A Boumans,Roel %A van de Sande,Yana %A Thill,Serge %A Bosse,Tibor %+ Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, 6525 GD, Netherlands, 31 0622372708, roel.boumans@ru.nl %K intelligent virtual agent %K amnesia %K dementia %K Alzheimer %K systematic review %K mobile phone %D 2022 %7 25.4.2022 %9 Review %J JMIR Aging %G English %X Background: Older adults often have increasing memory problems (amnesia), and approximately 50 million people worldwide have dementia. This syndrome gradually affects a patient over a period of 10-20 years. Intelligent virtual agents may support people with amnesia. Objective: This study aims to identify state-of-the-art experimental studies with virtual agents on a screen capable of verbal dialogues with a target group of older adults with amnesia. Methods: We conducted a systematic search of PubMed, SCOPUS, Microsoft Academic, Google Scholar, Web of Science, and CrossRef on virtual agent and amnesia on papers that describe such experiments. Search criteria were (Virtual Agent OR Virtual Assistant OR Virtual Human OR Conversational Agent OR Virtual Coach OR Chatbot) AND (Amnesia OR Dementia OR Alzheimer OR Mild Cognitive Impairment). Risk of bias was evaluated using the QualSyst tool (University of Alberta), which scores 14 study quality items. Eligible studies are reported in a table including country, study design type, target sample size, controls, study aims, experiment population, intervention details, results, and an image of the agent. Results: A total of 8 studies was included in this meta-analysis. The average number of participants in the studies was 20 (SD 12). The verbal interactions were generally short. The usability was generally reported to be positive. The human utterance was seen in 7 (88%) out of 8 studies based on short words or phrases that were predefined in the agent’s speech recognition algorithm. The average study quality score was 0.69 (SD 0.08) on a scale of 0 to 1. Conclusions: The number of experimental studies on talking about virtual agents that support people with memory problems is still small. The details on the verbal interaction are limited, which makes it difficult to assess the quality of the interaction and the possible effects of confounding parameters. In addition, the derivation of the aggregated data was difficult. Further research with extended and prolonged dialogues is required. %M 35468084 %R 10.2196/32473 %U https://aging.jmir.org/2022/2/e32473 %U https://doi.org/10.2196/32473 %U http://www.ncbi.nlm.nih.gov/pubmed/35468084 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34326 %T Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment %A Mao,Alice %A Tam,Lydia %A Xu,Audrey %A Osborn,Kim %A Sheffrin,Meera %A Gould,Christine %A Schillinger,Erika %A Martin,Marina %A Mesias,Matthew %+ Division of Primary Care and Population Health, Department of Medicine, Stanford University, 1265 Welch Road, Stanford, CA, 94305, United States, 1 1 847 769 2725, amao@onlok.org %K telemedicine %K barriers to access to care %K older adults %K eHealth %K e-visit %K access %K accessibility %K barrier %K elder %K gerontology %K geriatric %K need assessment %K mixed method %K cross-sectional %K telehealth %K community care %K independent living %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Despite the increasing availability of telemedicine video visits during the COVID-19 pandemic, older adults have greater challenges in getting care through telemedicine. Objective: We aim to better understand the barriers to telemedicine in community-dwelling older adults to improve the access to and experience of virtual visits. Methods: We conducted a mixed methods needs assessment of older adults at two independent living facilities (sites A and B) in Northern California between September 2020 and March 2021. Voluntary surveys were distributed. Semistructured interviews were then conducted with participants who provided contact information. Surveys ascertained participants’ preferred devices as well as comfort level, support, and top barriers regarding telephonic and video visits. Qualitative analysis of transcribed interviews identified key themes. Results: Survey respondents’ (N=249) average age was 84.6 (SD 6.6) years, and 76.7% (n=191) of the participants were female. At site A, 88.9% (111/125) had a bachelor’s degree or beyond, and 99.2% (124/125) listed English as their preferred language. At site B, 42.9% (51/119) had a bachelor’s degree or beyond, and 13.4% (16/119) preferred English, while 73.1% (87/119) preferred Mandarin. Regarding video visits, 36.5% (91/249) of all participants felt comfortable connecting with their health care team through video visits. Regarding top barriers, participants at site A reported not knowing how to connect to the platform (30/125, 24%), not being familiar with the technology (28/125, 22.4%), and having difficulty hearing (19/125, 15.2%), whereas for site B, the top barriers were not being able to speak English well (65/119, 54.6%), lack of familiarity with technology and the internet (44/119, 36.9%), and lack of interest in seeing providers outside of the clinic (42/119, 35.3%). Three key themes emerged from the follow-up interviews (n=15): (1) the perceived limitations of video visits, (2) the overwhelming process of learning the technology for telemedicine, and (3) the desire for in-person or on-demand help with telemedicine. Conclusions: Substantial barriers exist for older adults in connecting with their health care team through telemedicine, particularly through video visits. The largest barriers include difficulty with technology or using the video visit platform, hearing difficulty, language barriers, and lack of desire to see providers virtually. Efforts to improve telemedicine access for older adults should take into account patient perspectives. %M 35438648 %R 10.2196/34326 %U https://aging.jmir.org/2022/2/e34326 %U https://doi.org/10.2196/34326 %U http://www.ncbi.nlm.nih.gov/pubmed/35438648 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34577 %T Naturally Occurring Retirement Communities: Scoping Review %A Parniak,Simone %A DePaul,Vincent G %A Frymire,Clare %A DePaul,Samuel %A Donnelly,Catherine %+ Health Services and Policy Research Institute, Faculty of Health Sciences, Queen's University, Abramsky Hall, Room 309, 21 Arch Street, Kingston, ON, K7L3N6, Canada, 1 343 364 6015, simone.parniak@queensu.ca %K naturally occurring retirement communities %K NORC %K NORC supportive service programs %K aging in place %K older adults %K scoping review %D 2022 %7 14.4.2022 %9 Review %J JMIR Aging %G English %X Background: As Canada’s population ages, there is a need to explore community-based solutions to support older adults. Naturally occurring retirement communities (NORCs), defined in 1986 as buildings or areas not specifically designed for, but which attract, older adults and associated NORC supportive service programs (NORC-SSPs) have been described as potential resources to support aging in place. Though the body of literature on NORCs has been growing since the 1980s, no synthesis of this work has been conducted to date. Objective: The goal of this scoping review is to highlight the current state of NORC literature to inform future research and offer a summarized description of NORCs and how they have supported, and can support, older adults to age in place. Methods: Using a published framework, a scoping review was conducted by searching 13 databases from earliest date of coverage to January 2022. We included English peer- and non–peer-reviewed scholarly journal publications that described, critiqued, reflected on, or researched NORCs. Aging-in-place literature with little to no mention of NORCs was excluded, as were studies that recruited participants from NORCs but did not connect findings to the setting. A qualitative content analysis of the literature was conducted, guided by a conceptual framework, to examine the promise of NORC programs to promote aging in place. Results: From 787 publications, we included 64 (8.1%) articles. All publications were North American, and nearly half used a descriptive research approach (31/64, 48%). A little more than half provided a specific definition of a NORC (33/64, 52%); of these, 13 (39%) used the 1986 definition; yet, there were discrepancies in the defined proportions of older adults that constitute a NORC (eg, 40% or 50%). Of the 64 articles, 6 (9%) described processes for identifying NORCs and 39 (61%) specifically described NORC-SSPs and included both external partnerships with organizations for service delivery (33/39, 85%) and internal resources such as staff, volunteers, or neighbors. Identified key components of a NORC-SSP included activities fostering social relationships (25/64, 39%) and access to resources and services (26/64, 41%). Sustainability and funding of NORC-SSPs were described (27/64, 42%), particularly as challenges to success. Initial outcomes, including self-efficacy (6/64, 9%) and increased access to social and health supports (14/64, 22%) were cited; however, long-term outcomes were lacking. Conclusions: This review synthesizes the NORC literature to date and demonstrates that NORC-SSPs have potential as an alternative model of supporting aging in place. Longitudinal research exploring the impacts of both NORCs and NORC-SSPs on older adult health and well-being is recommended. Future research should also explore ways to improve the sustainability of NORC-SSPs. %M 35436204 %R 10.2196/34577 %U https://aging.jmir.org/2022/2/e34577 %U https://doi.org/10.2196/34577 %U http://www.ncbi.nlm.nih.gov/pubmed/35436204 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e31162 %T Technology-Mediated Enrichment in Aged Care: Survey and Interview Study %A Waycott,Jenny %A Zhao,Wei %A Kelly,Ryan M %A Robertson,Elena %+ School of Computing and Information Systems, The University of Melbourne, 700 Swanston Street, Melbourne, 3010, Australia, 61 383448964, jwaycott@unimelb.edu.au %K aged care %K older adults %K technology %K social enrichment %K virtual reality %K robots %K videoconferencing %K care providers %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technologies such as virtual reality (VR), humanoid robots, and digital companion pets have the potential to provide social and emotional enrichment for people living in aged care. However, there is currently limited knowledge about how technologies are being used to provide enrichment, what benefits they provide, and what challenges arise when deploying these technologies in aged care settings. Objective: This study aims to investigate how digital technologies are being used for social and emotional enrichment in the Australian aged care industry and identify the benefits and challenges of using technology for enrichment in aged care. Methods: A web-based survey (N=20) was distributed among people working in the Australian aged care sector. The survey collected information about the types of technologies being deployed and their perceived value. The survey was followed by semistructured interviews (N=12) with aged care workers and technology developers to investigate their experiences of deploying technologies with older adults living in aged care. Survey data were analyzed using summary descriptive statistics and categorizing open-ended text responses. Interview data were analyzed using reflexive thematic analysis. Results: The survey revealed that a range of commercial technologies, such as VR, tablet devices, and mobile phones, are being used in aged care to support social activities and provide entertainment. Respondents had differing views about the value of emerging technologies, such as VR, social robots, and robot pets, but were more united in their views about the value of videoconferencing. Interviews revealed 4 types of technology-mediated enrichment experiences: enhancing social engagement, virtually leaving the care home, reconnecting with personal interests, and providing entertainment and distraction. Our analysis identified 5 barriers: resource constraints, the need to select appropriate devices and apps, client challenges, limited staff and organizational support, and family resistance. Conclusions: This study demonstrates that technologies can be used in aged care to create personally meaningful enrichment experiences for aged care clients. To maximize the effectiveness of technology-mediated enrichment, we argue that a person-centered care approach is crucial. Although enrichment experiences can be created using available technologies, they must be carefully selected and co-deployed with aged care clients. However, significant changes may be required within organizations to allow caregivers to facilitate individual technology-based activities for enrichment. %M 34975014 %R 10.2196/31162 %U https://aging.jmir.org/2022/2/e31162 %U https://doi.org/10.2196/31162 %U http://www.ncbi.nlm.nih.gov/pubmed/34975014 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e28724 %T Telemedicine Acceptance Among Older Adult Patients With Cancer: Scoping Review %A Pang,Ning-Qi %A Lau,Jerrald %A Fong,Si-Ying %A Wong,Celine Yu-Hui %A Tan,Ker-Kan %+ Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 8, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 67724220, surtkk@nus.edu.sg %K older adult patients %K cancer %K telemedicine %K acceptability %K satisfaction %D 2022 %7 29.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Cancer is likely to remain the most prevalent noncommunicable disease in high-income countries with an older population. Interestingly, no review of attitudes toward telemedicine among older adults has been performed. This is likely to be the group most affected by both cancer and the increasing use of technology in health care. Objective: We aimed to map research on the acceptance of telemedicine among older adults who are cancer patients. Methods: We conducted a scoping review. PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to September 2020. Articles were included if the study population had a mean or median age ≥65 years, with cancer diagnoses and if the study assessed patients’ acceptance of a telemedicine intervention. Quantitative, qualitative, and mixed method studies were included. Results: Out of a total of 887 articles that were identified, 19 were included in the review. Interventions were delivered via telephone, videoconference, web portal, mobile app, wearable technology, and text messaging and included teleconsultation, monitoring and follow-up, psychosocial support and nursing care, and prompts. The most often cited facilitating factor was convenience. Other facilitators included an increase in telemedicine care accessibility, previous positive experiences of telemedicine, appropriate technical knowledge and support, decreased cost, physician recommendations, and privacy conferred by the telemedicine intervention. Barriers include a preference for conventional care along with negative perceptions of telemedicine, concerns about technical difficulties, and confidentiality concerns in the adoption of telemedicine. Conclusions: None of the studies explored the ability of tailored interventions to address facilitators and barriers of the acceptance of telemedicine in order to increase its adoption by older adults. Facilitators and barriers will likely differ across different cultural contexts and by type of telemedicine; however, this is a gap in current knowledge. In-depth studies are necessary to determine if interventions could potentially address the barriers identified in this review, to increase acceptability. %M 35348462 %R 10.2196/28724 %U https://www.jmir.org/2022/3/e28724 %U https://doi.org/10.2196/28724 %U http://www.ncbi.nlm.nih.gov/pubmed/35348462 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29541 %T Health Information Systems for Older Persons in Select Government Tertiary Hospitals and Health Centers in the Philippines: Cross-sectional Study %A Garcia,Angely P %A De La Vega,Shelley F %A Mercado,Susan P %+ Institute on Aging, National Institutes of Health, University of the Philippines Manila, Rm 211 NIH Bldg, 623 Pedro Gil St. Ermita, Manila, 1000, Philippines, 63 9064029690, apgarcia@up.edu.ph %K health information systems %K the Philippines %K aged %K hospitals %K community health centers %K database %K geriatric assessment %K elderly %K digital health %K medical records %K health policy %D 2022 %7 14.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid aging of the world’s population requires systems that support health facilities’ provision of integrated care at multiple levels of the health care system. The use of health information systems (HISs) at the point of care has shown positive effects on clinical processes and patient health in several settings of care. Objective: We sought to describe HISs for older persons (OPs) in select government tertiary hospitals and health centers in the Philippines. Specifically, we aimed to review the existing policies and guidelines related to HISs for OPs in the country, determine the proportion of select government hospitals and health centers with existing health information specific for OPs, and describe the challenges related to HISs in select health facilities. Methods: We utilized the data derived from the findings of the Focused Interventions for Frail Older Adults Research and Development Project (FITforFrail), a cross-sectional and ethics committee–approved study. A facility-based listing of services and human resources specific to geriatric patients was conducted in purposively sampled 27 tertiary government hospitals identified as geriatric centers and 16 health centers across all regions in the Philippines. We also reviewed the existing policies and guidelines related to HISs for OPs in the country. Results: Based on the existing guidelines, multiple agencies were involved in the provision of services for OPs, with several records containing health information of OPs. However, there is no existing HIS specific for OPs in the country. Only 14 (52%) of the 27 hospitals and 4 (25%) of the 16 health centers conduct comprehensive geriatric assessment (CGA). All tertiary hospitals and health centers are able to maintain medical records of their patients, and almost all (26/27, 96%) hospitals and all (16/16, 100%) health centers have data on top causes of morbidity and mortality. Meanwhile, the presence of specific disease registries varied per hospitals and health centers. Challenges to HISs include the inability to update databases due to inadequately trained personnel, use of an offline facility–based HIS, an unstable internet connection, and technical issues and nonuniform reporting of categories for age group classification. Conclusions: Current HISs for OPs are characterized by fragmentation, multiple sources, and inaccessibility. Barriers to achieving appropriate HISs for OPs include the inability to update HISs in hospitals and health centers and a lack of standardization by age group and disease classification. Thus, we recommend a 1-person, 1-record electronic medical record system for OPs and the disaggregation and analysis across demographic and socioeconomic parameters to inform policies and programs that address the complex needs of OPs. CGA as a required routine procedure for all OPs and its integration with the existing HISs in the country are also recommended. %M 35156927 %R 10.2196/29541 %U https://www.jmir.org/2022/2/e29541 %U https://doi.org/10.2196/29541 %U http://www.ncbi.nlm.nih.gov/pubmed/35156927 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31920 %T Design of an Integrated Acceptance Framework for Older Users and eHealth: Influential Factor Analysis %A Yu,Jiyeon %A de Antonio,Angelica %A Villalba-Mora,Elena %+ Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, 28223, Spain, 34 910679250, elena.villalba@upm.es %K eHealth %K older people %K older user %K health technology %K acceptance factors %K adoption %K acceptance framework %K systematic review %K thematic analysis %K influential factor analysis %K mobile phone %D 2022 %7 28.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth and telehealth play a crucial role in assisting older adults who visit hospitals frequently or who live in nursing homes and can benefit from staying at home while being cared for. Adapting to new technologies can be difficult for older people. Thus, to better apply these technologies to older adults’ lives, many studies have analyzed the acceptance factors for this particular population. However, there is not yet a consensual framework that can be used in further development and to search for solutions. Objective: This paper aims to present an integrated acceptance framework (IAF) for older users’ acceptance of eHealth based on 43 studies selected through a systematic review. Methods: We conducted a 4-step study. First, through a systematic review in the field of eHealth from 2010 to 2020, the acceptance factors and basic data for analysis were extracted. Second, we conducted a thematic analysis to group the factors into themes to propose an integrated framework for acceptance. Third, we defined a metric to evaluate the impact of the factors addressed in the studies. Finally, the differences among the important IAF factors were analyzed according to the participants’ health conditions, verification time, and year. Results: Through a systematic review, 731 studies were found in 5 major databases, resulting in 43 (5.9%) selected studies using the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) methodology. First, the research methods and acceptance factors for eHealth were compared and analyzed, extracting a total of 105 acceptance factors, which were grouped later, resulting in an IAF. A total of 5 dimensions (ie, personal, user–technology relational, technological, service-related, and environmental) emerged, with a total of 23 factors. In addition, we assessed the quality of evidence and then conducted a stratification analysis to reveal the more appropriate factors depending on the health condition and assessment time. Finally, we assessed the factors and dimensions that have recently become more important. Conclusions: The result of this investigation is a framework for conducting research on eHealth acceptance. To elaborately analyze the impact of the factors of the proposed framework, the criteria for evaluating the evidence from the studies that have the extracted factors are presented. Through this process, the impact of each factor in the IAF has been presented, in addition to the framework proposal. Moreover, a meta-analysis of the current status of research is presented, highlighting the areas where specific measures are needed to facilitate eHealth acceptance. %M 35089155 %R 10.2196/31920 %U https://www.jmir.org/2022/1/e31920 %U https://doi.org/10.2196/31920 %U http://www.ncbi.nlm.nih.gov/pubmed/35089155 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e33118 %T Development of a Community-Based e-Health Program for Older Adults With Chronic Diseases: Pilot Pre-Post Study %A Wu,Vivien Xi %A Dong,Yanhong %A Tan,Poh Choo %A Gan,Peiying %A Zhang,Di %A Chi,Yuchen %A Chao,Felicia Fang Ting %A Lu,Jinhua %A Teo,Boon Heng Dennis %A Tan,Yue Qian %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66012756, nurwux@nus.edu.sg %K eHealth %K self-management %K older adults %K chronic disease %K community care %K elderly %K community %K innovation %K development %K pilot %K evaluation %K health literacy %K empowerment %K feasibility %K engagement %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Chronic diseases may impact older adults’ health outcomes, health care costs, and quality of life. Self-management is expected to encourage individuals to make autonomous decisions, adhere to treatment plans, deal with emotional and social consequences, and provide choices for healthy lifestyle. New eHealth solutions significantly increase the health literacy and empower patients in self-management of chronic conditions. Objective: This study aims to develop a Community-Based e-Health Program (CeHP) for older adults with chronic diseases and conduct a pilot evaluation. Methods: A pilot study with a 2-group pre- and posttest repeated measures design was adopted. Community-dwelling older adults with chronic diseases were recruited from senior activity centers in Singapore. A systematic 3-step process of developing CeHP was coupled with a smart-device application. The development of the CeHP intervention consists of theoretical framework, client-centric participatory action research process, content validity assessment, and pilot testing. Self-reported survey questionnaires and health outcomes were measured before and after the CeHP. The instruments used were the Self-care of Chronic Illness Inventory (SCCII), Healthy Aging Instrument (HAI), Short-Form Health Literacy Scale, 12 Items (HLS-SF 12), Patient Empowerment Scale (PES), and Social Support Questionnaire, 6 items. The following health outcomes were measured: Montreal Cognitive Assessment, Symbol Digit Modalities Test, total cholesterol (TC), high-density lipoproteins, low-density lipoproteins/very-low-density lipoproteins (LDL/VLDL), fasting glucose, glycated hemoglobin (HbA1c), and BMI. Results: The CeHP consists of health education, monitoring, and an advisory system for older adults to manage their chronic conditions. It is an 8-week intensive program, including face-to-face and eHealth (Care4Senior App) sessions. Care4Senior App covers health education topics focusing on the management of hypertension, hyperlipidemia, and diabetes, brain health, healthy diet, lifestyle modification, medication adherence, exercise, and mindfulness practice. Content validity assessment indicated that the content of the CeHP is valid, with a content validity index (CVI) ranging 0.86-1 and a scale-CVI of 1. Eight participants in the CeHP group and 4 in the control group completed both baseline and post intervention assessments. Participants in the CeHP group showed improvements in fasting glucose, HbA1c, TC, LDL/VLDL, BMI, SCCII indices (Maintenance, Monitoring, and Management), HAI, and PES scores post intervention, although these changes were not significant. For the participants in the control group, the scores for SCCII (management and confidence) and HLS-SF 12 decreased post intervention. Conclusions: The CeHP is feasible, and it engages and empowers community-dwelling older adults to manage their chronic conditions. The rigorous process of program development and pilot evaluation provided valid evidence to expand the CeHP to a larger-scale implementation to encourage self-management, reduce debilitating complications of poorly controlled chronic diseases, promote healthy longevity and social support, and reduce health care costs. %M 35037882 %R 10.2196/33118 %U https://aging.jmir.org/2022/1/e33118 %U https://doi.org/10.2196/33118 %U http://www.ncbi.nlm.nih.gov/pubmed/35037882 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26767 %T The Use of Smart Speakers in Care Home Residents: Implementation Study %A Edwards,Katie J %A Jones,Ray B %A Shenton,Deborah %A Page,Toni %A Maramba,Inocencio %A Warren,Alison %A Fraser,Fiona %A Križaj,Tanja %A Coombe,Tristan %A Cowls,Hazel %A Chatterjee,Arunangsu %+ Centre for Health Technology, University of Plymouth, Desk 6, Formation Zone, Health and Wellbeing Innovation Centre, The Knowledge Spa, Plymouth, TR1 3HD, United Kingdom, 44 07432155243, katie.edwards@plymouth.ac.uk %K voice-activated technology %K smart speaker %K care home %K technology-enabled care %K older people %K learning disability %K digital technology %K consumer device %K smart device %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of smart speakers to improve well-being had been trialed in social care by others; however, we were not aware of their implementation in most care homes across a region in the Southwest of the United Kingdom. For the widespread adoption of new technology, it must be locally demonstrable and become normalized. Objective: The aim of this study was to install smart speakers in care homes in a rural and coastal region and to explore if and how the devices were being used, the barriers to their implementation, and their potential benefits. Methods: Email, workshops, drop-in sessions, phone, and cold calling was used to contact all 230 care homes, offering a free smart speaker and some advisory support. Care homes accepting the devices were asked to complete a feedback diary. Nonresponse rate for diary completion was high and was thus supplemented with a telephone survey. Results: Over the course of 7 months, we installed 156 devices in 92 care homes for older people, 50 devices for people with physical or mental health needs, and 8 for others. The devices were used mainly for music but also for poetry, recipes, light controls, jokes, and video calls. Care home managers reported the benefits for the residents, including enhanced engagement with home activities, enjoyment, calming effects, and the acquisition of new skills. Implementation problems included internet connectivity, staff capacity, and skills. Conclusions: Affordable consumer devices such as smart speakers should be installed in all care homes to benefit residents. Voice-activated technologies are easy to use and promote interaction. This study indicates that implementation in care homes was possible and that smart speakers had multifaceted benefits for residents and staff. Most care homes in this region now use smart speakers for their residents, thereby normalizing this practice. %M 34932010 %R 10.2196/26767 %U https://www.jmir.org/2021/12/e26767 %U https://doi.org/10.2196/26767 %U http://www.ncbi.nlm.nih.gov/pubmed/34932010 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e24665 %T Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study %A Lapierre,Nolwenn %A Um Din,Nathavy %A Igout,Manuella %A Chevrier,Joël %A Belmin,Joël %+ Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, AP-HP.Sorbonne Université, 7 Av de la République, Ivry-Sur-Seine, 94200, France, 33 0149594571, nolwennlapierre@gmail.com %K older adult %K fall %K fear of falling %K exergame %K randomized controlled trial %K psychomotor therapy %K rehabilitation %K fear %K risk %K elderly %K protocol %K therapy %D 2021 %7 26.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. Objective: This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. Methods: This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. Results: The protocol (2019-11-22) has been approved by the Comité de Protection des Personnes Nord-Ouest I–Université de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. Conclusions: The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. Trial Registration: ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988 International Registered Report Identifier (IRRID): DERR1-10.2196/24665 %M 34435968 %R 10.2196/24665 %U https://www.researchprotocols.org/2021/8/e24665 %U https://doi.org/10.2196/24665 %U http://www.ncbi.nlm.nih.gov/pubmed/34435968 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e22406 %T Administering Virtual Reality Therapy to Manage Behavioral and Psychological Symptoms in Patients With Dementia Admitted to an Acute Care Hospital: Results of a Pilot Study %A Appel,Lora %A Kisonas,Erika %A Appel,Eva %A Klein,Jennifer %A Bartlett,Deanna %A Rosenberg,Jarred %A Smith,Christopher NC %+ Faculty of Health, School of Health Policy and Management, York University, 426 Health, Nursing and Environmental Studies Building, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 6475046537, lora.appel@uhn.ca %K virtual reality %K wearable electronic devices %K sensory art therapies %K hospitalization %K hospitals, community %K hospitals, general %K aged %K humans %K dementia %K behavioral symptoms %K nature %K mobile phone %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As virtual reality (VR) technologies become increasingly accessible and affordable, clinicians are eager to try VR therapy as a novel means to manage behavioral and psychological symptoms of dementia, which are exacerbated during acute care hospitalization, with the goal of reducing the use of antipsychotics, sedatives, and physical restraints associated with negative adverse effects, increased length of stay, and caregiver burden. To date, no evaluations of immersive VR therapy have been reported for patients with dementia in acute care hospitals. Objective: This study aimed to determine the feasibility (acceptance, comfort, and safety) of using immersive VR therapy for people living with dementia (mild, moderate, and advanced) during acute care hospitalization and explore its potential to manage behavioral and psychological symptoms of dementia. Methods: A prospective, longitudinal pilot study was conducted at a community teaching hospital in Toronto. The study was nonrandomized and unblinded. A total of 10 patients aged >65 years (mean 86.5, SD 5.7) diagnosed with dementia participated in one or more research coordinator–facilitated sessions of viewing immersive 360° VR footage of nature scenes displayed on a Samsung Gear VR head-mounted display. This mixed-methods study included review of patient charts, standardized observations during the intervention, and pre- and postintervention semistructured interviews about the VR experience. Results: All recruited participants (N=10) completed the study. Of the 10 participants, 7 (70%) displayed enjoyment or relaxation during the VR session, which averaged 6 minutes per view, and 1 (10%) experienced dizziness. No interference between the VR equipment and hearing aids or medical devices was reported. Conclusions: It is feasible to expose older people with dementia of various degrees admitted to an acute care hospital to immersive VR therapy. VR therapy was found to be acceptable to and comfortable by most participants. This pilot study provides the basis for conducting the first randomized controlled trial to evaluate the impact of VR therapy on managing behavioral and psychological symptoms of dementia in acute care hospitals. %M 33533720 %R 10.2196/22406 %U https://formative.jmir.org/2021/2/e22406 %U https://doi.org/10.2196/22406 %U http://www.ncbi.nlm.nih.gov/pubmed/33533720 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e18074 %T Stakeholder Feedback of Electronic Medication Adherence Products: Qualitative Analysis %A Faisal,Sadaf %A Ivo,Jessica %A McDougall,Aidan %A Patel,Tejal %+ School of Pharmacy, University of Waterloo, 10 Victoria St S, Kitchener, ON, N2G 1C5, Canada, 1 519 888 4567 ext 21337, t5patel@uwaterloo.ca %K medication nonadherence %K technology %K aged %K patient preferences %K eHealth %K qualitative research %K adherence %D 2020 %7 1.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Medication management among older adults continues to be a challenge, and innovative electronic medication adherence products have been developed to address this need. Objective: The aim of this study is to examine user experience with electronic medication adherence products, with particular emphasis on features, usefulness, and preferences. Methods: Older adults, caregivers, and health care providers tested the usability of 22 electronic medication adherence products. After testing 5 products, participants were invited to participate in a one-on-one interview to investigate their perceptions and experiences with the features, usefulness, and preference for electronic medication adherence products tested. The interviews were audio recorded, transcribed, and analyzed using exploratory inductive coding to generate themes. The first 13 interviews were independently coded by 2 researchers. The percentage agreement and Cohen kappa after analyzing those interviews were 79% and 0.79, respectively. A single researcher analyzed the remaining interviews. Results: Of the 37 participants, 21 (57%) were older adults, 5 (14%) were caregivers, and 11 (30%) were health care providers. The themes and subthemes generated from the qualitative analysis included product factors (subthemes: simplicity and product features, including availability and usability of alarms, portability, restricted access to medications, and storage capacity) and user factors (subthemes: sentiment, affordability, physical and cognitive capability, and technology literacy and learnability). Conclusions: Electronic medication adherence products have the potential to enable independent medication management in older adults. The choice of a particular product should be made after considering individual preferences for product features, affordability, and the sentiment of the users. Older adults, caregivers, and health care providers prefer electronic medication adherence products that are simple to set up and use, are portable, have easy-to-access medication compartments, are secure, and have adequate storage capacity. %M 33258778 %R 10.2196/18074 %U https://www.jmir.org/2020/12/e18074 %U https://doi.org/10.2196/18074 %U http://www.ncbi.nlm.nih.gov/pubmed/33258778 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e23176 %T Disparities in Video and Telephone Visits Among Older Adults During the COVID-19 Pandemic: Cross-Sectional Analysis %A Schifeling,Christopher H %A Shanbhag,Prajakta %A Johnson,Angene %A Atwater,Riannon C %A Koljack,Claire %A Parnes,Bennett L %A Vejar,Maria M %A Farro,Samantha A %A Phimphasone-Brady,Phoutdavone %A Lum,Hillary D %+ Division of Geriatric Medicine, University of Colorado School of Medicine, Mail Stop B179, 12631 E 17th Avenue, Room 8119, Aurora, CO, 80045, United States, 1 303 724 1911, hillary.lum@cuanschutz.edu %K telemedicine %K telehealth %K telephone %K videoconferencing %K health care disparities %K older adults %K geriatrics %K advance care planning %K advanced directives %K COVID-19 %K coronavirus pandemic %K SARS-CoV-2 %K primary care %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Telephone and video telemedicine appointments have been a crucial service delivery method during the COVID-19 pandemic for maintaining access to health care without increasing the risk of exposure. Although studies conducted prior to the pandemic have suggested that telemedicine is an acceptable format for older adults, there is a paucity of data on the practical implementation of telemedicine visits. Due to prior lack of reimbursement for telemedicine visits involving nonrural patients, no studies have compared telephone visits to video visits in geriatric primary care. Objective: This study aimed to determine (1) whether video visits had longer durations, more visit diagnoses, and more advance care planning discussions than telephone visits during the rapid implementation of telemedicine in the COVID-19 pandemic, and (2) whether disparities in visit type existed based on patient characteristics. Methods: We conducted a retrospective, cross-sectional analysis of patients seen at two geriatric clinics from April 23 to May 22, 2020. Approximately 25% of patients who had telephone and video appointments during this time underwent chart review. We analyzed patient characteristics, visit characteristics, duration of visits, number of visit diagnoses, and the presence of advance care planning discussion in clinical documentation. Results: Of the 190 appointments reviewed, 47.4% (n=90) were video visits. Compared to telephone appointments, videoconferencing was, on average, 7 minutes longer (mean 37.3 minutes, SD 10 minutes; P<.001) and had, on average, 1.2 more visit diagnoses (mean 5.7, SD 3; P=.001). Video and telephone visits had similar rates of advance care planning. Furthermore, hearing, vision, and cognitive impairment did not result in different rates of video or telephone appointments. Non-White patients, patients who needed interpreter services, and patients who received Medicaid were less likely to have video visits than White patients, patients who did not need an interpreter, and patients who did not receive Medicaid, respectively (P=.003, P=.01, P<.001, respectively). Conclusions: Although clinicians spent more time on video visits than telephone visits, more than half of this study’s older patients did not use video visits, especially if they were from racial or ethnic minority backgrounds or Medicaid beneficiaries. This potential health care disparity merits greater attention. %M 33048821 %R 10.2196/23176 %U http://aging.jmir.org/2020/2/e23176/ %U https://doi.org/10.2196/23176 %U http://www.ncbi.nlm.nih.gov/pubmed/33048821 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e19987 %T Embodied Conversational Agent Appearance for Health Assessment of Older Adults: Explorative Study %A ter Stal,Silke %A Broekhuis,Marijke %A van Velsen,Lex %A Hermens,Hermie %A Tabak,Monique %+ eHealth Group, Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede, Netherlands, 31 088 0875 777, s.terstal@utwente.nl %K embodied conversational agent %K appearance design %K health status assessment %K older adults %K eHealth %D 2020 %7 4.9.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Embodied conversational agents (ECAs) have great potential for health apps but are rarely investigated as part of such apps. To promote the uptake of health apps, we need to understand how the design of ECAs can influence the preferences, motivation, and behavior of users. Objective: This is one of the first studies that investigates how the appearance of an ECA implemented within a health app affects users’ likeliness of following agent advice, their perception of agent characteristics, and their feeling of rapport. In addition, we assessed usability and intention to use. Methods: The ECA was implemented within a frailty assessment app in which three health questionnaires were translated into agent dialogues. In a within-subject experiment, questionnaire dialogues were randomly offered by a young female agent or an older male agent. Participants were asked to think aloud during interaction. Afterward, they rated the likeliness of following the agent’s advice, agent characteristics, rapport, usability, and intention to use and participated in a semistructured interview. Results: A total of 20 older adults (72.2 [SD 3.5] years) participated. The older male agent was perceived as more authoritative than the young female agent (P=.03), but no other differences were found. The app scored high on usability (median 6.1) and intention to use (median 6.0). Participants indicated they did not see an added value of the agent to the health app. Conclusions: Agent age and gender little influence users’ impressions after short interaction but remain important at first glance to lower the threshold to interact with the agent. Thus, it is important to take the design of ECAs into account when implementing them into health apps. %M 32886068 %R 10.2196/19987 %U https://humanfactors.jmir.org/2020/3/e19987 %U https://doi.org/10.2196/19987 %U http://www.ncbi.nlm.nih.gov/pubmed/32886068 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 8 %P e20359 %T Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review %A Kruse,Clemens %A Fohn,Joanna %A Wilson,Nakia %A Nunez Patlan,Evangelina %A Zipp,Stephanie %A Mileski,Michael %+ School of Health Administration, Texas State University, 601 University Dr, Encino Hall 250, San Marcos, TX, 78666, United States, 1 210 355 4742, scottkruse@txstate.edu %K telehealth %K telemedicine %K older adults %K barriers %K health outcomes %D 2020 %7 12.8.2020 %9 Review %J JMIR Med Inform %G English %X Background: Rising telehealth capabilities and improving access to older adults can aid in improving health outcomes and quality of life indicators. Telehealth is not being used ubiquitously at present. Objective: This review aimed to identify the barriers that prevent ubiquitous use of telehealth and the ways in which telehealth improves health outcomes and quality of life indicators for older adults. Methods: This systematic review was conducted and reported in accordance with the Kruse protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviewers queried the following four research databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE), Web of Science, and Embase (Science Direct). Reviewers analyzed 57 articles, performed a narrative analysis to identify themes, and identified barriers and reports of health outcomes and quality of life indicators found in the literature. Results: Reviewers analyzed 57 studies across the following five interventions of telehealth: eHealth, mobile health (mHealth), telemonitoring, telecare (phone), and telehealth video calls, with a Cohen κ of 0.75. Reviewers identified 14 themes for barriers. The most common of which were technical literacy (25/144 occurrences, 17%), lack of desire (19/144 occurrences, 13%), and cost (11/144 occurrences, 8%). Reviewers identified 13 medical outcomes associated with telehealth interventions. The most common of which were decrease in psychological stress (21/118 occurrences, 18%), increase in autonomy (18/118 occurrences, 15%), and increase in cognitive ability (11/118 occurrences, 9%). Some articles did not report medical outcomes (18/57, 32%) and some did not report barriers (19/57, 33%). Conclusions: The literature suggests that the elimination of barriers could increase the prevalence of telehealth use by older adults. By increasing use of telehealth, proximity to care is no longer an issue for access, and thereby care can reach populations with chronic conditions and mobility restrictions. Future research should be conducted on methods for personalizing telehealth in older adults before implementation. Trial Registration: PROSPERO CRD42020182162; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020182162. International Registered Report Identifier (IRRID): RR2-10.2196/15490 %M 32784177 %R 10.2196/20359 %U http://medinform.jmir.org/2020/8/e20359/ %U https://doi.org/10.2196/20359 %U http://www.ncbi.nlm.nih.gov/pubmed/32784177 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e17299 %T Clinician Perspectives on the Design and Application of Wearable Cardiac Technologies for Older Adults: Qualitative Study %A Ferguson,Caleb %A Inglis,Sally C %A Breen,Paul P %A Gargiulo,Gaetano D %A Byiers,Victoria %A Macdonald,Peter S %A Hickman,Louise D %+ Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District and Western Sydney University, Blacktown Hospital, Marcel Crescent, Blacktown, 2148, Australia, 61 410207543, c.ferguson@westernsydney.edu.au %K technology %K arrhythmia %K monitoring %K older people %K cardiology %K qualitative %K wearable %D 2020 %7 18.6.2020 %9 Original Paper %J JMIR Aging %G English %X Background: New wearable devices (for example, AliveCor or Zio patch) offer promise in detecting arrhythmia and monitoring cardiac health status, among other clinically useful parameters in older adults. However, the clinical utility and usability from the perspectives of clinicians is largely unexplored. Objective: This study aimed to explore clinician perspectives on the use of wearable cardiac monitoring technology for older adults. Methods: A descriptive qualitative study was conducted using semistructured focus group interviews. Clinicians were recruited through purposive sampling of physicians, nurses, and allied health staff working in 3 tertiary-level hospitals. Verbatim transcripts were analyzed using thematic content analysis to identify themes. Results: Clinicians representing physicians, nurses, and allied health staff working in 3 tertiary-level hospitals completed 4 focus group interviews between May 2019 and July 2019. There were 50 participants (28 men and 22 women), including cardiologists, geriatricians, nurses, and allied health staff. The focus groups generated the following 3 overarching, interrelated themes: (1) the current state of play, understanding the perceived challenges of patient cardiac monitoring in hospitals, (2) priorities in cardiac monitoring, what parameters new technologies should measure, and (3) cardiac monitoring of the future, “the ideal device.” Conclusions: There remain pitfalls related to the design of wearable cardiac technology for older adults that present clinical challenges. These pitfalls and challenges likely negatively impact the uptake of wearable cardiac monitoring in routine clinical care. Partnering with clinicians and patients in the co-design of new wearable cardiac monitoring technologies is critical to optimize the use of these devices and their uptake in clinical care. %M 32554377 %R 10.2196/17299 %U http://aging.jmir.org/2020/1/e17299/ %U https://doi.org/10.2196/17299 %U http://www.ncbi.nlm.nih.gov/pubmed/32554377 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15450 %T Views of Swedish Elder Care Personnel on Ongoing Digital Transformation: Cross-Sectional Study %A Baudin,Katarina %A Gustafsson,Christine %A Frennert,Susanne %+ School of Health, Care and Social Welfare, Mälardalen University, Box 325, Eskilstuna, SE-631 05, Sweden, 46 735029494, katarina.baudin@mdh.se %K elder care %K welfare technology %K gender %K municipality %K participation %K digitalization %K age %D 2020 %7 16.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Swedish municipalities are facing demographic challenges due to the growing number of older people and the resulting increased need for health care services. Welfare technologies are being launched as possible solutions for meeting some of these challenges. Objective: The aim of this study was to explore the perception, experimentation, evaluation, and procurement of welfare technology practices among professionals working in municipal elder care in relation to their gender, age, and profession. Methods: Data for this explorative cross-sectional study were collected from 393 responses to a web-based survey on municipal elder care in Sweden. Chi square tests were performed to determine the associations. Results: The results revealed gender, age, and professional differences in perspectives of municipal elder care workers. Differences were particularly evident in attitudes toward technology, both the use of technology in general and in the workplace, and involvement and participation in decision making regarding the procurement of new welfare technologies. Men (37/53, 70%) expressed a more positive attitude toward and curiosity regarding new technologies than women (157/336, 46.7%) (P=.03). Regarding age, the younger respondents (18-24 years old) perceived the digital transformation in the workplace as “too slow” (4/4, 100%), whereas the majority of older respondents (65-74 years old) perceived it as happening at the “right pace” (4/7, 57%). The elder care personnel felt encouraged by management to explore and experiment with new welfare technologies, but never did so either for management or with patients. Even though the majority of the respondents were women, more men (4/7, 57%) were involved in the procurement process for welfare technology devices and solutions than women (98/336, 29.2%) (P<.001). Conclusions: Personnel working within municipal elder care were generally very positive toward new technologies. However, both gender and age differences may influence these perspectives such as the personnel’s resistance to welfare technology and patients’ participation in welfare technology usage and deployment. Different levels of participation in the decision-making process regarding new technology deployment may negatively affect the overall digital transformation within municipal elder care. %M 32543444 %R 10.2196/15450 %U http://www.jmir.org/2020/6/e15450/ %U https://doi.org/10.2196/15450 %U http://www.ncbi.nlm.nih.gov/pubmed/32543444 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17331 %T The Role of Virtual Reality in Improving Health Outcomes for Community-Dwelling Older Adults: Systematic Review %A Dermody,Gordana %A Whitehead,Lisa %A Wilson,Graham %A Glass,Courtney %+ School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, Australia, 61 8 6304 3470, g.dermody@ecu.edu.au %K virtual reality %K aged %K aged, 80 and over %K outcome assessment, health care %K independent living %K systematic review %D 2020 %7 1.6.2020 %9 Review %J J Med Internet Res %G English %X Background: Virtual reality (VR) delivered through immersive headsets creates an opportunity to deliver interventions to improve physical, mental, and psychosocial health outcomes. VR app studies with older adults have primarily focused on rehabilitation and physical function including gait, balance, fall prevention, pain management, and cognition. Several systematic reviews have previously been conducted, but much of the extant literature is focused on rehabilitation or other institutional settings, and little is known about the effectiveness of VR apps using immersive headsets to target health outcomes among community-dwelling older adults. Objective: The objective of this review was to evaluate the effectiveness of VR apps delivered using commercially available immersive headsets to improve physical, mental, or psychosocial health outcomes in community-dwelling older adults. Methods: Peer-reviewed publications that included community-dwelling older adults aged ≥60 years residing in residential aged care settings and nursing homes were included. This systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness evidence. The title of this review was registered with JBI, and the systematic review protocol was registered with the International Prospective Register of Systematic Reviews. Results: In total, 7 studies that specifically included community-dwelling older adults were included in this review. VR apps using a head-mounted display led to improvements in a number of health outcomes, including pain management, posture, cognitive functioning specifically related to Alzheimer disease, and a decreased risk of falls. A total of 6 studies reported a statistically significant difference post VR intervention, and 1 study reported an improvement in cognitive function to reduce navigational errors. Only one study reported on the usability and acceptability of the interventions delivered through VR. While one study used a distraction mechanism for pain management, none of the studies used gaming technology to promote enjoyment. Conclusions: Interventions to improve health outcomes through VR have demonstrated potential; however, the ability to synthesize findings by primary outcome for the older adult population is not possible. A number of factors, especially related to frailty, usability, and acceptability, also need to be explored before more substantial recommendations on the effectiveness of VR interventions for older adults can be made. Trial Registration: PROSPERO CRD42019143504; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143504 %M 32478662 %R 10.2196/17331 %U https://www.jmir.org/2020/6/e17331 %U https://doi.org/10.2196/17331 %U http://www.ncbi.nlm.nih.gov/pubmed/32478662 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 5 %P e16039 %T Evaluation and Dissemination of a Checklist to Improve Implementation of Work Environment Initiatives in the Eldercare Sector: Protocol for a Prospective Observational Study %A Rasmussen,Charlotte Diana Nørregaard %A Højberg,Helene %A Larsen,Anne Konring %A Munch,Pernille Kold %A Osborne,Richard %A Kwak,Lydia %A Jensen,Irene %A Linnan,Laura %A Jørgensen,Marie Birk %+ The National Research Centre for the Working Environment, Lersø Parkalle 105, København Ø, Denmark, 45 39 16 54 66, cnr@nfa.dk %K RE-AIM %K implementation %K workplace %K digital %D 2020 %7 13.5.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: To measure sustainable improvements in the work environment, a flexible and highly responsive tool is needed that will give important focus to the implementation process. A digital checklist was developed in collaboration with key stakeholders to document the implementation of changes in eldercare sector workplaces. Objective: This paper describes the study protocol of a dissemination study that aims to examine when, why, and how the digital checklist is spread to the Danish eldercare sector following a national campaign particularly targeting nursing homes and home care. Methods: This prospective observational study will use quantitative data from Google Analytics describing use of the checklist as documented website engagement, a survey among members in the largest union in the sector, information from a central business register, and monitoring of campaign activities. The evaluation will be guided by the five elements of the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance. Results: The study was approved in June 2016 and began in October 2018. The campaign that is the foundation for the evaluation began in 2017 and ended in 2018. However, the webpage where we collect data is still running. Results are expected in 2020. Conclusions: This protocol provides a working example of how to evaluate dissemination of a checklist to improve implementation of work environment initiatives in the eldercare sector in Denmark. To our knowledge, implementation in a nationwide Danish work environment has not been previously undertaken. Given that the checklist is sector-specific for work environment initiatives and developed through systematic collaboration between research and practice, it is likely to have high utility and impact; however, the proposed evaluation will determine this. This study will advance dissemination research and, in particular, the evaluation of the impact of these types of studies. Finally, this study advances the field through digital tools that can be used for evaluation of dissemination efforts (eg, Google Analytics associated with website) in the context of a rigorous research design activity. International Registered Report Identifier (IRRID): DERR1-10.2196/16039 %M 32401212 %R 10.2196/16039 %U https://www.researchprotocols.org/2020/5/e16039 %U https://doi.org/10.2196/16039 %U http://www.ncbi.nlm.nih.gov/pubmed/32401212 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 2 %P e15381 %T Exploring Older Adults’ Beliefs About the Use of Intelligent Assistants for Consumer Health Information Management: A Participatory Design Study %A Martin-Hammond,Aqueasha %A Vemireddy,Sravani %A Rao,Kartik %+ Department of Human-Centered Computing, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, 535 West Michigan St, Indianapolis, IN, 46202, United States, 1 3172787686, aqumarti@iupui.edu %K intelligent assistants %K artificial intelligence %K chatbots %K conversational agents %K digital health %K elderly %K aging in place %K participatory design %K co-design %K health information seeking %D 2019 %7 11.12.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Intelligent assistants (IAs), also known as intelligent agents, use artificial intelligence to help users achieve a goal or complete a task. IAs represent a potential solution for providing older adults with individualized assistance at home, for example, to reduce social isolation, serve as memory aids, or help with disease management. However, to design IAs for health that are beneficial and accepted by older adults, it is important to understand their beliefs about IAs, how they would like to interact with IAs for consumer health, and how they desire to integrate IAs into their homes. Objective: We explore older adults’ mental models and beliefs about IAs, the tasks they want IAs to support, and how they would like to interact with IAs for consumer health. For the purpose of this study, we focus on IAs in the context of consumer health information management and search. Methods: We present findings from an exploratory, qualitative study that investigated older adults’ perspectives of IAs that aid with consumer health information search and management tasks. Eighteen older adults participated in a multiphase, participatory design workshop in which we engaged them in discussion, brainstorming, and design activities that helped us identify their current challenges managing and finding health information at home. We also explored their beliefs and ideas for an IA to assist them with consumer health tasks. We used participatory design activities to identify areas in which they felt IAs might be useful, but also to uncover the reasoning behind the ideas they presented. Discussions were audio-recorded and later transcribed. We compiled design artifacts collected during the study to supplement researcher transcripts and notes. Thematic analysis was used to analyze data. Results: We found that participants saw IAs as potentially useful for providing recommendations, facilitating collaboration between themselves and other caregivers, and for alerts of serious illness. However, they also desired familiar and natural interactions with IAs (eg, using voice) that could, if need be, provide fluid and unconstrained interactions, reason about their symptoms, and provide information or advice. Other participants discussed the need for flexible IAs that could be used by those with low technical resources or skills. Conclusions: From our findings, we present a discussion of three key components of participants’ mental models, including the people, behaviors, and interactions they described that were important for IAs for consumer health information management and seeking. We then discuss the role of access, transparency, caregivers, and autonomy in design for addressing participants’ concerns about privacy and trust as well as its role in assisting others that may interact with an IA on the older adults’ behalf. International Registered Report Identifier (IRRID): RR2-10.1145/3240925.3240972 %M 31825322 %R 10.2196/15381 %U http://aging.jmir.org/2019/2/e15381/ %U https://doi.org/10.2196/15381 %U http://www.ncbi.nlm.nih.gov/pubmed/31825322 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e10019 %T Mobilizing mHealth Data Collection in Older Adults: Challenges and Opportunities %A Cosco,Theodore D %A Firth,Joseph %A Vahia,Ipsit %A Sixsmith,Andrew %A Torous,John %+ Gerontology Research Center, Simon Fraser University, #2800-515 West Hasting Street, Vancouver, BC, V6B 5K3, Canada, 1 7787825915, tcosco@sfu.ca %K mHealth %K older adults %K data collection %K digital divide %D 2019 %7 19.03.2019 %9 Viewpoint %J JMIR Aging %G English %X Worldwide, there is an unprecedented and ongoing expansion of both the proportion of older adults in society and innovations in digital technology. This rapidly increasing number of older adults is placing unprecedented demands on health care systems, warranting the development of new solutions. Although advancements in smart devices and wearables present novel methods for monitoring and improving the health of aging populations, older adults are currently the least likely age group to engage with such technologies. In this commentary, we critically examine the potential for technology-driven data collection and analysis mechanisms to improve our capacity to research, understand, and address the implications of an aging population. Alongside unprecedented opportunities to harness these technologies, there are equally unprecedented challenges. Notably, older adults may experience the first-level digital divide, that is, lack of access to technologies, and/or the second-level digital divide, that is, lack of use/skill, alongside issues with data input and analysis. To harness the benefits of these innovative approaches, we must first engage older adults in a meaningful manner and adjust the framework of smart devices to accommodate the unique physiological and psychological characteristics of the aging populace. Through an informed approach to the development of technologies with older adults, the field can leverage innovation to increase the quality and quantity of life for the expanding population of older adults. %M 31518253 %R 10.2196/10019 %U http://aging.jmir.org/2019/1/e10019/ %U https://doi.org/10.2196/10019 %U http://www.ncbi.nlm.nih.gov/pubmed/31518253 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11694 %T Older Adults’ Perspectives on Using Digital Technology to Maintain Good Mental Health: Interactive Group Study %A Andrews,Jacob A %A Brown,Laura JE %A Hawley,Mark S %A Astell,Arlene J %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, United Kingdom, 44 1142220682, mark.hawley@sheffield.ac.uk %K mental health %K older adults %K technology %K digital technology %K Internet %K apps %D 2019 %7 13.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A growing number of apps to support good mental health and well-being are available on digital platforms. However, very few studies have examined older adults’ attitudes toward the use of these apps, despite increasing uptake of digital technologies by this demographic. Objective: This study sought to explore older adults’ perspectives on technology to support good mental health. Methods: A total of 15 older adults aged 50 years or older, in two groups, participated in sessions to explore the use of digital technologies to support mental health. Interactive activities were designed to capture participants’ immediate reactions to apps and websites designed to support mental health and to explore their experiences of using technology for these purposes in their own lives. Template analysis was used to analyze transcripts of the group discussions. Results: Older adults were motivated to turn to technology to improve mood through mechanisms of distraction, normalization, and facilitated expression of mental states, while aiming to reduce burden on others. Perceived barriers to use included fear of consequences and the impact of low mood on readiness to engage with technology, as well as a lack of prior knowledge applicable to digital technologies. Participants were aware of websites available to support mental health, but awareness alone did not motivate use. Conclusions: Older adults are motivated to use digital technologies to improve their mental health, but barriers remain that developers need to address for this population to access them. %M 30758292 %R 10.2196/11694 %U http://www.jmir.org/2019/2/e11694/ %U https://doi.org/10.2196/11694 %U http://www.ncbi.nlm.nih.gov/pubmed/30758292 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 1 %P e11556 %T Evaluation and Implementation of ListeningTime: A Web-Based Preparatory Communication Tool for Elderly Patients With Cancer and Their Health Care Providers %A Noordman,Janneke %A Driesenaar,Jeanine A %A van Bruinessen,Inge R %A Portielje,Johanneke EA %A van Dulmen,Sandra %+ Nivel: Netherlands Institute for Health Services Research, PO Box 1568, Utrecht, 3500 BN, Netherlands, 31 302729770, j.noordman@nivel.nl %K audio-facility %K cancer patients %K communication %K internet %K health care providers %K videos %K Web-based tool %D 2019 %7 30.01.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Effective patient-provider communication is an important condition to deliver optimal care and it supports patients in coping with their disease. The complex and emotionally loaded setting of oncology care challenges both health care providers (HCPs) and patients in reaching effective communication. ListeningTime is developed for elderly patients with cancer and their oncological HCPs to help them (better) prepare the clinical encounter and overcome communication barriers. ListeningTime is a Web-based preparatory communication tool including modeling videos and has an audio-facility to listen back to recorded encounters. Objective: This study aims to evaluate the usability, perceived usefulness, and actual use of ListeningTime, through the eyes of elderly patients with cancer and their oncological HCPs. If highly rated, the ultimate goal is to make ListeningTime publicly available. Methods: First, members of a panel of elderly cancer survivors and patients (age ≥65 years) were approached to evaluate ListeningTime through a Web-based questionnaire. The usability and perceived usefulness were assessed. Second, ListeningTime was evaluated in real-life practice through a pilot study in 3 Dutch hospitals. In these hospitals, elderly patients with cancer and their oncological HCPs were approached to evaluate ListeningTime through a similar Web-based questionnaire, measuring the perceived usefulness. In addition, we examined log files and user statistics to get insight into how the program was used. Results: A total of 30 cancer survivors or patients from the patient panel, and 17 patients and 8 HCPs from the hospitals, evaluated ListeningTime. Overall, both panel members and hospital patients were positive about the ListeningTime website, audio-facility, and video fragments. Some patients suggested improvements with respect to the actors’ performances in the video fragments and believed that ListeningTime is mainly suitable for non experienced patients. HCPs were also positive about ListeningTime; they valued the video fragments for patients and the audio-facility for patients and themselves. However, providers did not relisten their own recorded encounters. Patients did use the audio-facility to relisten their encounters. Conclusions: ListeningTime was highly rated, both by patients and their oncological HCPs. As a result, the video fragments of ListeningTime are now made publicly available for elderly patients with cancer through the Dutch website “kanker.nl.” %M 30698525 %R 10.2196/11556 %U http://cancer.jmir.org/2019/1/e11556/ %U https://doi.org/10.2196/11556 %U http://www.ncbi.nlm.nih.gov/pubmed/30698525 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e11054 %T Understanding Care Navigation by Older Adults With Multimorbidity: Mixed-Methods Study Using Social Network and Framework Analyses %A Vos,Jolien %A Gerling,Kathrin %A Linehan,Conor %A Siriwardena,Aloysius N %A Windle,Karen %+ UCL Interaction Centre, University College London, 66-72 Gower Street, London,, United Kingdom, 44 20 3108 7050, j.vos@ucl.ac.uk %K care navigation %K long-term conditions %K multimorbidity %K older adults %K social network analysis %D 2018 %7 14.11.2018 %9 Original Paper %J JMIR Aging %G English %X Background: Health and social care systems were designed to be used primarily by people with single and acute diseases. However, a growing number of older adults are diagnosed with multiple long-term conditions (LTCs). The process of navigating the intricacies of health and social care systems to receive appropriate care presents significant challenges for older people living with multiple LTCs, which in turn can negatively influence their well-being and quality of life. Objective: The long-term goal of this work is to design technology to assist people with LTCs in navigating health and social care systems. To do so, we must first understand how older people living with LTCs currently engage with and navigate their care networks. No published research describes and analyses the structure of formal and informal care networks of older adults with multiple LTCs, the frequency of interactions with each type of care service, and the problems that typically arise in these interactions. Methods: We conducted a mixed-methods study and recruited 62 participants aged ≥55 years who were living in England, had ≥2 LTCs, and had completed a social network analysis questionnaire. Semistructured interviews were conducted with roughly a 10% subsample of the questionnaire sample: 4 women and 3 men. On average, interviewees aged 70 years and had 4 LTCs. Results: Personal care networks were complex and adapted to each individual. The task of building and subsequently navigating one’s personal care network rested mainly on patients’ shoulders. It was frequently the patients’ task to bridge and connect the different parts of the system. The major factor leading to a satisfying navigation experience was found to be patients’ assertive, determined, and proactive approaches. Furthermore, smooth communication and interaction between different parts of the care system led to more satisfying navigation experiences. Conclusions: Technology to support care navigation for older adults with multiple LTCs needs to support patients in managing complex health and social care systems by effectively integrating the management of multiple conditions and facilitating communication among multiple stakeholders, while also offering flexibility to adapt to individual situations. Quality of care seems to be dependent on the determination and ability of patients. Those with less determination and fewer organization skills experience worse care. Thus, technology must aim to fulfill these coordination functions to ensure care is equitable across those who need it. %M 31518236 %R 10.2196/11054 %U http://aging.jmir.org/2018/2/e11054/ %U https://doi.org/10.2196/11054 %U http://www.ncbi.nlm.nih.gov/pubmed/31518236 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 7 %P e164 %T Characteristics of Cognitive Behavioral Therapy for Older Adults Living in Residential Care: Protocol for a Systematic Review %A Chan,Phoebe %A Bhar,Sunil %A Davison,Tanya E %A Doyle,Colleen %A Knight,Bob G %A Koder,Deborah %A Laidlaw,Kenneth %A Pachana,Nancy A %A Wells,Yvonne %A Wuthrich,Viviana M %+ Department of Psychological Sciences, Swinburne University of Technology, PO Box 218, Hawthorn, Melbourne, Vic 3122, Australia, 61 3 9214 8371, phoebechan@swin.edu.au %K cognitive behavioural therapy %K older adults %K residential care %K delivery %K characteristics %K systematic review %D 2018 %7 04.07.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence rates of depressive and anxiety disorders are high in residential aged care settings. Older adults in such settings might be prone to these disorders because of losses associated with transitioning to residential care, uncertainty about the future, as well as a decline in personal autonomy, health, and cognition. Cognitive behavioral therapy (CBT) is efficacious in treating late-life depression and anxiety. However, there remains a dearth of studies examining CBT in residential settings compared with community settings. Typically, older adults living in residential settings have higher care needs than those living in the community. To date, no systematic reviews have been conducted on the content and the delivery characteristics of CBT for older adults living in residential aged care settings. Objective: The objective of this paper is to describe the systematic review protocol on the characteristics of CBT for depression and/or anxiety for older adults living in residential aged care settings. Methods: This protocol was developed in compliance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Studies that fulfill the inclusion criteria will be identified by systematically searching relevant electronic databases, reference lists, and citation indexes. In addition, the PRISMA flowchart will be used to record the selection process. A pilot-tested data collection form will be used to extract and record data from the included studies. Two reviewers will be involved in screening the titles and abstracts of retrieved records, screening the full text of potentially relevant reports, and extracting data. Then, the delivery and content characteristics of different CBT programs of the included studies, where available, will be summarized in a table. Furthermore, the Downs and Black checklist will be used to assess the methodological quality of the included studies. Results: Systematic searches will commence in May 2018, and data extraction is expected to commence in July 2018. Data analyses and writing will happen in October 2018. Conclusions: In this section, the limitations of the systematic review will be outlined. Clinical implications for treating late-life depression and/or anxiety, and implications for residential care facilities will be discussed. Trial Registration: PROSPERO 42017080113; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=80113 (Archived by WebCite at http://www.webcitation.org/70dV4Qf54) Registered Report Identifier: RR1-10.2196/9902 %M 29973335 %R 10.2196/resprot.9902 %U http://www.researchprotocols.org/2018/7/e164/ %U https://doi.org/10.2196/resprot.9902 %U http://www.ncbi.nlm.nih.gov/pubmed/29973335 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e128 %T A Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) in Older Adults With Obesity: Protocol for the MORPH Trial %A Fanning,Jason %A Brooks,Amber K %A Ip,Edward %A Nicklas,Barbara J %A Rejeski,W Jack %+ Department of Health and Exercise Science, Wake Forest University, PO Box 7868, Winston-Salem, NC, 27106, United States, 1 3367585042, fanninjt@wfu.edu %K technology %K weight loss %K sedentary lifestyle %K chronic pain %K mindfulness %D 2018 %7 14.05.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is a complex, age-related health issue that affects both physical functioning and quality of life. Because the impact of chronic pain is worsened by obesity and inactivity, nonpharmacological interventions that promote movement, reduce sitting, and aid in weight loss are needed to help manage pain symptoms among older adults with chronic pain. Objective: The Mobile Intervention to Reduce Pain and Improve Health (MORPH) pilot trial aims to develop and test the feasibility and acceptability of a novel, patient-centered intervention to reduce chronic pain and improve physical functioning in older adults, leveraging the combination of telecoaching and individually adaptive mHealth tools to decrease both body mass and sedentary behavior. Methods: MORPH comprises 2 phases, including a 1-year iterative development phase, and a 1-year pilot randomized controlled trial (RCT). During the development phase, representative participants will engage in one-on-one structured interviews and a 1-week field test. The resulting feedback will be used to guide the development of the finalized MORPH intervention package. During the second phase, the finalized intervention will be tested in a pilot RCT (N=30) in which older adult participants with chronic pain and obesity will be assigned to receive the 12-week MORPH intervention or to a waitlist control. Primary outcomes include self-reported pain symptoms and physical function. Results: Phase 1 recruitment is ongoing as of December 2017. Conclusions: The MORPH intervention brings together a strong body of evidence using group-based behavioral intervention designs with contemporary mHealth principles, allowing for intervention when and where it matters the most. Given the ubiquity of smartphone devices and the popularity of consumer activity and weight monitors, the results of this study may serve to inform the development of scalable, socially driven behavioral pain management interventions. Trial Registration: ClinicalTrials.gov NCT03377634; https://clinicaltrials.gov/ct2/show/NCT03377634 (Archived by WebCite at http://www.webcitation.org/6yj0J5Pan) Registered Report Identifier: RR1-10.2196/9712 %M 29759957 %R 10.2196/resprot.9712 %U http://www.researchprotocols.org/2018/5/e128/ %U https://doi.org/10.2196/resprot.9712 %U http://www.ncbi.nlm.nih.gov/pubmed/29759957 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 2 %P e21 %T An Assistive Technology System that Provides Personalized Dressing Support for People Living with Dementia: Capability Study %A Burleson,Winslow %A Lozano,Cecil %A Ravishankar,Vijay %A Lee,Jisoo %A Mahoney,Diane %+ NYU-X, College of Nursing, New York University, 433 1st Ave, New York, NY, 10010, United States, 1 4802523929, wb50@nyu.edu %K Alzheimer disease %K disorders, neurocognitive %K image processing, computer-assisted %D 2018 %7 01.05.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Individuals living with advancing stages of dementia (persons with dementia, PWDs) or other cognitive disorders do not have the luxury of remembering how to perform basic day-to-day activities, which in turn makes them increasingly dependent on the assistance of caregivers. Dressing is one of the most common and stressful activities provided by caregivers because of its complexity and privacy challenges posed during the process. Objective: In preparation for in-home trials with PWDs, the aim of this study was to develop and evaluate a prototype intelligent system, the DRESS prototype, to assess its ability to provide automated assistance with dressing that can afford independence and privacy to individual PWDs and potentially provide additional freedom to their caregivers (family members and professionals). Methods: This laboratory study evaluated the DRESS prototype’s capacity to detect dressing events. These events were engaged in by 11 healthy participants simulating common correct and incorrect dressing scenarios. The events ranged from donning a shirt and pants inside out or backwards to partial dressing—typical issues that challenge a PWD and their caregivers. Results: A set of expected detections for correct dressing was prepared via video analysis of all participants’ dressing behaviors. In the initial phases of donning either shirts or pants, the DRESS prototype missed only 4 out of 388 expected detections. The prototype’s ability to recognize other missing detections varied across conditions. There were also some unexpected detections such as detection of the inside of a shirt as it was being put on. Throughout the study, detection of dressing events was adversely affected by the relatively smaller effective size of the markers at greater distances. Although the DRESS prototype incorrectly identified 10 of 22 cases for shirts, the prototype preformed significantly better for pants, incorrectly identifying only 5 of 22 cases. Further analyses identified opportunities to improve the DRESS prototype’s reliability, including increasing the size of markers, minimizing garment folding or occlusions, and optimal positioning of participants with respect to the DRESS prototype. Conclusions: This study demonstrates the ability to detect clothing orientation and position and infer current state of dressing using a combination of sensors, intelligent software, and barcode tracking. With improvements identified by this study, the DRESS prototype has the potential to provide a viable option to provide automated dressing support to assist PWDs in maintaining their independence and privacy, while potentially providing their caregivers with the much-needed respite. %M 29716885 %R 10.2196/medinform.5587 %U http://medinform.jmir.org/2018/2/e21/ %U https://doi.org/10.2196/medinform.5587 %U http://www.ncbi.nlm.nih.gov/pubmed/29716885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e123 %T Understanding Older People’s Readiness for Receiving Telehealth: Mixed-Method Study %A van Houwelingen,Cornelis TM %A Ettema,Roelof GA %A Antonietti,Michelangelo GEF %A Kort,Helianthe SM %+ Technology for Healthcare Innovations Research Group, Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht,, Netherlands, 31 641097762, thijs.vanhouwelingen@hu.nl %K older adults %K videoconferencing %K technology %K path analysis %K observations %K community-dwelling people %K UTAUT %K TAM %K self-efficacy %K digital literacy %D 2018 %7 06.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face. Since most care is delivered to older people, the prospect of telehealth raises the question of whether this population is ready for this new way of receiving care. To study this, we created a theoretical framework consisting of 6 factors associated with older people’s intention to use technology. Objective: The objective of this study was to understand community-dwelling older people’s readiness for receiving telehealth by studying their intention to use videoconferencing and capacities for using digital technology in daily life as indicators. Methods: A mixed-method triangulation design was used. First, a cross-sectional survey study was performed to investigate older people’s intention to use videoconferencing, by testing our theoretical framework with a multilevel path analysis (phase 1). Second, for deeper understanding of older people’s actual use of digital technology, qualitative observations of older people executing technological tasks (eg, on a computer, cell phone) were conducted at their homes (phase 2). Results: In phase 1, a total of 256 people aged 65 years or older participated in the survey study (50.0% male; median age, 70 years; Q1-Q3: 67-76). Using a significance level of .05, we found seven significant associations regarding older people’s perception of videoconferencing. Older people’s (1) intention to use videoconferencing was predicted by their performance expectancy (odds ratio [OR] 1.26, 95% CI 1.13-1.39), effort expectancy (OR 1.23, 95% CI 1.07-1.39), and perceived privacy and security (OR 1.30, 95% CI 1.17-1.43); (2) their performance expectancy was predicted by their effort expectancy (OR 1.38, 95% CI 1.24-1.52); and (3) their effort expectancy was predicted by their self-efficacy (OR 1.55, 95% CI 1.42-1.68). In phase 2, a total of 6 men and 9 women aged between 65 and 87 years participated in the qualitative observation study. Of the primary themes, 5 themes were identified that could provide greater understanding of older people’s capacities and incapacities in using digital technology: (1) “self-efficacy and digital literacy,” (2) “obstacles to using technology,” (3) “prior experience and frequency of use,” (4) “sources of support and facilitating conditions,” and (5) “performance expectancy.” These 5 themes recurred in all 15 observations. Conclusions: Performance expectancy, effort expectancy, and perceived privacy and security are direct predictors of older people’s intention to use videoconferencing. Self-efficacy appeared to play a role in both older people’s intention to use, as well as their actual use of technology. The path analysis revealed that self-efficacy was significantly associated with older people’s effort expectancy. Furthermore, self-efficacy and digital literacy appeared to play a major role in older people’s capacities to make use of digital technology. %M 29625950 %R 10.2196/jmir.8407 %U http://www.jmir.org/2018/4/e123/ %U https://doi.org/10.2196/jmir.8407 %U http://www.ncbi.nlm.nih.gov/pubmed/29625950 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e56 %T Telegerontology as a Novel Approach to Address Health and Safety by Supporting Community-Based Rural Dementia Care Triads: Randomized Controlled Trial Protocol %A Wallack,Elizabeth M %A Harris,Chelsea %A Ploughman,Michelle %A Butler,Roger %+ Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, 100 Forest Rd, Room 400, 4th Floor, L.A. Miller Centre, St John's, NL, A1A 1E5, Canada, 1 7097772082, ewallack@mun.ca %K Aging %K Remote Assessment %K Monitoring %D 2018 %7 22.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Telegerontology is an approach using videoconferencing to connect an interdisciplinary team in a regional specialty center to patients in rural communities, which is becoming increasingly practical for addressing current limitations in rural community-based dementia care. Objective: Using the remotely-delivered expertise of the Telegerontology dementia care team, we aim to enhance the caregiver/patient/physician triad and thereby provide the necessary support for the person with dementia to “age in place.” Methods: This is a cluster randomized feasibility trial with four rural regions in the province of Newfoundland and Labrador, Canada (2 regions randomly assigned to “intervention” and 2 to “control”). The study population includes 22 “dementia triads” that consist of a community-dwelling older Canadian with moderate to late dementia, their family caregivers, and their Primary Care Physician (PCP). Over the 6-month active study period, all participants will be provided an iPad. The intervention is intended as an adjunct to existing PCP care, consisting of weekly Skype-based videoconferencing calls with the Telegerontology physician, and other team members as needed (occupational therapist, physical therapist etc). Control participants receive usual community-based dementia care with their PCP. A baseline (pre-) assessment will be performed during a home visit with the study team. Post intervention, 6- and 12-month follow-up assessments will be collected remotely using specialized dementia monitoring applications and Skype calls. Primary outcomes include admission to long-term care, falls, emergency room visits, hospital stays, and caregiver burden. Results: Results will be available in March of 2018. Conclusions: Results from this study will demonstrate a novel approach to dementia care that has the potential to impact both rural PCPs, family caregivers, and people with dementia, as well as provide evidence for the utility of Telegerontology in models of eHealth-based care. %M 29472178 %R 10.2196/resprot.8744 %U http://www.researchprotocols.org/2018/2/e56/ %U https://doi.org/10.2196/resprot.8744 %U http://www.ncbi.nlm.nih.gov/pubmed/29472178 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 1 %P e5 %T How Can Social Media Lead to Co-Production (Co-Delivery) of New Services for the Elderly Population? A Qualitative Study %A Daneshvar,Hadi %A Anderson,Stuart %A Williams,Robin %A Mozaffar,Hajar %+ School of Informatics, University of Edinburgh, IF-3.25, Informatics Forum,, 10 Crichton St,, Edinburgh, EH8 9AB, United Kingdom, 44 7578561742, h.daneshvar@gmail.com %K social media %K eHealth %K mHealth %K social networking %K Web 2.0 %K health informatics %D 2018 %7 12.02.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The future of health care services in the European Union faces the triple challenges of aging, fiscal restriction, and inclusion. Co-production offers ways to manage informal care resources to help them cater for the growing needs of elderly people. Social media (SM) is seen as a critical enabler for co-production. Objective: The objective of this study was to investigate how SM—private Facebook groups, forums, Twitter, and blogging—acts as an enabler of co-production in health and care by facilitating its four underlying principles: equality, diversity, accessibility, and reciprocity. Methods: We used normalization process theory as our theoretical framework to design this study. We conducted a qualitative study and collected data through 20 semistructured interviews and observation of the activities of 10 online groups and individuals. We then used thematic analysis and drew on principles of co-production (equality, diversity, accessibility, and reciprocity) as a deductive coding framework to analyze our findings. Results: Our findings point to distinct patterns of feature use by different people involved in care of elderly people. This diversity makes possible the principles of co-production by offering equality among users, enabling diversity of use, making experiences accessible, and encouraging reciprocity in the sharing of knowledge and mutual support. We also identified that explication of common resources may lead to new forms of competition and conflicts. These conflicts require better management to enhance the coordination of the common pool of resources. Conclusions: SM uses afford new forms of organizing and collective engagement between patients, carers, and professionals, which leads to change in health and care communication and coordination. %M 29434014 %R 10.2196/humanfactors.7856 %U http://humanfactors.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/humanfactors.7856 %U http://www.ncbi.nlm.nih.gov/pubmed/29434014