%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64449 %T Comparison of Smart Display Versus Laptop Platforms for an eHealth Intervention to Improve Functional Health for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Clinical Trial %A Gustafson Sr,David H %A Mares,Marie-Louise %A Johnston,Darcie C %A Curtin,John J %A Pe-Romashko,Klaren %A Landucci,Gina %+ , Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 1440, gina.landucci@wisc.edu %K eHealth %K aged %K geriatrics %K functional health %K multiple chronic conditions %K smart display %K smart speaker %K primary care %K quality of life %D 2025 %7 3.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Maintaining functional health, or the ability to live independently, is a primary goal of individuals as they age, but most older adults develop chronic conditions that threaten this goal. Physical activity is a key aspect of self-care that can improve functional health, and digital interventions offering guidance on appropriate exercise can help. However, older adults with multiple morbidities may be unable to use a laptop or smartphone-based eHealth because poor vision, dexterity, mobility, or other physical challenges make typing or touch navigation difficult. A smart display platform—comprising a smart speaker plus a small visual screen—has the potential to remove these barriers because it is voice-activated. Objective: The study aims to compare usage patterns of an eHealth intervention for older adults when delivered via a voice-based smart display versus a typing-based laptop, and assess whether the smart display outperforms the laptop in improving functional health and its specific physical and mental aspects. Methods: A minimum of 356 adults aged 60 years and older with at least 5 chronic health conditions are to be recruited from primary care clinics and community organizations. Participants will be randomized 1:1 to 12 months of access to an evidence-based intervention, ElderTree, delivered on either a smart display or a touchscreen laptop, with a postintervention follow-up at 18 months. The primary outcome is differences between groups on a comprehensive measure of physical and mental functional health. Secondary outcomes are between-group differences in the subscales of functional health (eg, physical function and depression), as well as measures of health distress, loneliness, unscheduled health care, and falls. We will also examine mediators and moderators of the effects of ElderTree on both platforms. Participants will complete surveys at baseline, 6, 12, and 18 months, and ElderTree use data will be collected continuously during the intervention period in system logs. We will use linear mixed-effect models to evaluate outcomes over time, with treatment condition and time point as between-subjects factors. Separate analyses will be conducted for each outcome. Results: Recruitment began in July 2023 and was completed in May 2024, with 387 participants enrolled. The 12-month intervention period will end in May 2025; data collection will end in November 2025. Findings will be disseminated via peer-reviewed publications. Conclusions: Voice-activated digital health interventions have theoretical but untested advantages over typing-based technologies for older adults with physical limitations. As the population ages, and as multiple morbidities threaten the functional health of the majority of older adults, innovations in self-management are a matter of public health as well as individual quality of life. Trial Registration: ClinicalTrials.gov NCT05240534; https://clinicaltrials.gov/study/NCT05240534 International Registered Report Identifier (IRRID): DERR1-10.2196/64449 %M 40080672 %R 10.2196/64449 %U https://www.researchprotocols.org/2025/1/e64449 %U https://doi.org/10.2196/64449 %U http://www.ncbi.nlm.nih.gov/pubmed/40080672 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63168 %T Digital Health Intervention Effect on Older Adults With Chronic Diseases Living Alone: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Park,Yoonseo %A Kim,Eun-Ji %A Park,Sewon %A Lee,Munjae %+ Department of Medical Science, School of Medicine, Ajou University, 206, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea, 82 031 219 5289, emunjae@ajou.ac.kr %K digital health %K chronic diseases %K older adults %K independent living %K aging %K chronic disease %K living alone %K self-management %K medical cost %K cost management %K health promotion %K effectiveness %K quality of life %K physical activity %K health care %K health informatics %K systematic review %K meta-analysis %K PRISMA %D 2025 %7 31.3.2025 %9 Review %J J Med Internet Res %G English %X Background: The incidence of chronic diseases is increasing owing to the aging population; in particular, older adults living alone struggle with self-management and medical expenses. Digital health can contribute to medical cost management and health promotion, but its effectiveness for older adults living alone remains unclear. In a rapidly aging society, it is important to demonstrate the effect of digital health on improving the lives of older adults living alone and reducing the burden of chronic diseases. Objective: This study aims to examine the intervention effects of digital health on self-management, quality of life, and medical factors for older adults living alone with common chronic diseases such as cardiovascular disease, respiratory disease, and musculoskeletal disorders through a systematic literature review and meta-analysis. Methods: We searched the literature using 3 databases, including PubMed, CINAHL, and Cochrane CENTRAL, for literature published in overseas academic journals up to October 2024. The final 11 papers were used for analysis based on selection and exclusion criteria. Meta-analysis was used to calculate the mean difference and standardized mean difference (SMD) for the selected literature using RevMan (version 5.4; Cochrane). The effect size and heterogeneity were calculated through 95% CI. Results: As a result of conducting a meta-analysis of 8 of 11 documents, there was a significant effect of self-management factors on moderate-to-vigorous physical activity (SMD=0.08; z=2.07; P=.04). However, among self-management factors, low-density lipoprotein cholesterol (SMD=–0.04; z=0.91; P=.36) did not show statistically significant results. Among the medical factors, general quality of life (SMD=0.11; z=0.93; P=.35), depression (SMD=–3.95; z=1.59; P=.11), and hospital days (SMD=–1.57; z=0.91; P=.36) also did not show statistically significant results. However, it was confirmed that they improved after a digital health intervention. Conclusions: This study demonstrated that digital health interventions are effective in improving physical activity in older adults with chronic diseases living alone. However, owing to the characteristics of older adults living alone, there is a need to further expand digital health to combine care services that can manage diseases at home. %M 40163849 %R 10.2196/63168 %U https://www.jmir.org/2025/1/e63168 %U https://doi.org/10.2196/63168 %U http://www.ncbi.nlm.nih.gov/pubmed/40163849 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59649 %T The Role of Machine Learning in Cognitive Impairment in Parkinson Disease: Systematic Review and Meta-Analysis %A Wu,Yanyun %A Cheng,Yangfan %A Xiao,Yi %A Shang,Huifang %A Ou,Ruwei %+ Department of Neurology, West China Hospital of Sichuan University, No.37, Guoxue Lane, Chengdu, 610041, China, 86 18980607525, ouruwei@aliyun.com %K Parkinson disease %K cognitive impairment %K machine learning %K systematic review %K meta-analysis %D 2025 %7 14.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Parkinson disease (PD) is a common neurodegenerative disease characterized by both motor and nonmotor symptoms. Cognitive impairment often occurs early in the disease and can persist throughout its progression, severely impacting patients’ quality of life. The utilization of machine learning (ML) has recently shown promise in identifying cognitive impairment in patients with PD. Objective: This study aims to summarize different ML models applied to cognitive impairment in patients with PD and to identify determinants for improving diagnosis and predictive power for early detection of cognitive impairment. Methods: PubMed, Cochrane, Embase, and Web of Science were searched for relevant articles on March 2, 2024. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Bivariate meta-analysis was used to estimate pooled sensitivity and specificity results, presented as odds ratio (OR) and 95% CI. A summary receiver operator characteristic (SROC) curve was used. Results: A total of 38 articles met the criteria, involving 8564 patients with PD and 1134 healthy controls. Overall, 120 models reported sensitivity and specificity, with mean values of 71.07% (SD 13.72%) and 77.01% (SD 14.31%), respectively. Predictors commonly used in ML models included clinical features, neuroimaging features, and other variables. No significant heterogeneity was observed in the bivariate meta-analysis, which included 12 studies. Using sensitivity as the metric, the combined sensitivity and specificity were 0.76 (95% CI 0.67-0.83) and 0.83 (95% CI 0.76-0.88), respectively. When specificity was used, the combined values were 0.77 (95% CI 0.65-0.86) and 0.76 (95% CI 0.63-0.85), respectively. The area under the curves of the SROC were 0.87 (95% CI 0.83-0.89) and 0.83 (95% CI 0.80-0.86) respectively. Conclusions: Our findings provide a comprehensive summary of various ML models and demonstrate the effectiveness of ML as a tool for diagnosing and predicting cognitive impairment in patients with PD. Trial Registration: PROSPERO CRD42023480196; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023480196 %M 40153789 %R 10.2196/59649 %U https://www.jmir.org/2025/1/e59649/ %U https://doi.org/10.2196/59649 %U http://www.ncbi.nlm.nih.gov/pubmed/40153789 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60936 %T Determinants of Telehealth Adoption Among Older Adults: Cross-Sectional Survey Study %A Tan,Siow-Hooi %A Yap,Yee-Yann %A Tan,Siow-Kian %A Wong,Chee-Kuan %+ , Faculty of Management, Multimedia University, Persiaran Multimedia, Cyberjaya, 63100, Malaysia, 60 38312 ext 5658, shtan@mmu.edu.my %K telehealth services adoption %K survey %K questionnaire %K telehealth %K older adult population %K subjective well-being %K transition cost %K technology acceptance model %K importance-performance map analysis %K IPMA %D 2025 %7 24.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The aging population and the accompanying rise in chronic diseases have intensified the need to study the adoption of telehealth services. However, the success of telehealth services depends not only on their ease and usefulness but also on addressing broader concerns. Despite being a substantial user group in traditional health services, older adults may encounter barriers to adopting telehealth services. Increasing the adoption of telehealth among the older adult population is crucial for enhancing their access to care and managing the challenges of aging effectively. Objective: We aimed to explore factors influencing the adoption of telehealth services among older adults in Malaysia, going beyond the conventional framework by incorporating transition cost and subjective well-being as additional constructs. Methods: A cross-sectional survey was conducted among 119 adults aged ≥60 years in Malaysia, using 39 survey items adapted from existing studies. Data analysis was performed using partial least squares structural equation modeling, with both the measurement model and structural model being evaluated. To determine the predictive relevance of the model, PLSpredict was applied. In addition, importance-performance map analysis was conducted to further expand on the structural model results by assessing the performance of each variable. Results: Of the 119 participants, 52 (43.7%) were women and 67 (56.3%) were men. The study found that subjective well-being (β=0.448; P<.001) was the most significant factor, followed by attitude (β=0.242; P<.001), transition cost (β=−0.163; P<.001), and perceived usefulness (β=0.100, P=.02) in influencing telehealth service intention. Furthermore, perceived ease of use (β=0.271; P<.001), availability (β=0.323; P<.001), subjective well-being (β=0.261; P<.001), and trust (β=0.156, P=.004) positively influenced perceived usefulness, while inertia (β=0.024, P=.22) did not. In addition, availability (β=0.420; P<.001) and subjective well-being (β=0.260; P<.001) were positively related to perceived ease of use, with inertia (β=−0.246; P<.001) having a negative impact. The importance-performance map analysis results showed that subjective well-being (importance=0.532) was the most crucial factor for older adult users, while availability (importance=70.735) had the highest performance in telehealth services. Conclusions: This research underscores the importance of catering to the subjective well-being of older adults and optimizing the availability of telehealth services to encourage adoption, ultimately advancing health care accessibility and quality for this vulnerable demographic. %M 40126531 %R 10.2196/60936 %U https://aging.jmir.org/2025/1/e60936 %U https://doi.org/10.2196/60936 %U http://www.ncbi.nlm.nih.gov/pubmed/40126531 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64635 %T Differences in Telemedicine Use for Patients With Diabetes in an Academic Versus Safety Net Health System: Retrospective Cohort Study %A Shih,Jonathan J %A Kuznia,Magdalene %A Nouri,Sarah %A Sherwin,Elizabeth B %A Kemper,Kathryn E %A Rubinsky,Anna D %A Lyles,Courtney R %A Khoong,Elaine C %+ Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, 2540 23rd Street, Room 4708, San Francisco, CA, 94110, United States, 1 415 502 6300, Elaine.Khoong@ucsf.edu %K telehealth %K telemedicine %K diabetes %K delivery of health care %K primary health care %K health care utilization %K health care disparities %K chronic disease %K COVID-19 %K safety net providers %K public health emergency %K older adults %D 2025 %7 24.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 public health emergency catalyzed widespread adoption of both video- and audio-only telemedicine visits. This proliferation highlighted inequities in use by age, race and ethnicity, and preferred language. Few studies have investigated how differences in health system telemedicine implementation affected these inequities. Objective: This study aims to describe patients who used telemedicine during the public health emergency and identify predictors of telemedicine use across 2 health systems with different telemedicine implementations. Methods: This retrospective cohort study included adults with diabetes receiving primary care between July 2020 and March 2021 at 2 independent health systems in San Francisco, California. Participant sociodemographic characteristics, health information, and telemedicine utilization were acquired from electronic health records. The primary outcome was visit type (any audio or video telemedicine vs in-person only) during the study period. We used multivariable logistic regression to assess the association between visit type and key predictors associated with digital exclusion (age, race and ethnicity, preferred language, and neighborhood socioeconomic status), adjusting for baseline health. We included an interaction term to evaluate health system impact on each predictor and then stratified by health system (academic, which prioritized video-enabled visits, vs safety net, which prioritized audio-only visits). Results: Among 10,201 patients, we found higher odds of telemedicine use in the safety net system compared with the academic system (adjusted odds ratio [aOR] 2.94, 95% CI 2.48-3.48). Patients with younger age (18-34 years: aOR 2.55, 95% CI 1.63-3.97; 35-49 years: aOR 1.39, 95% CI 1.12-1.73 vs 75+ years) and Chinese-language preference (aOR 2.04, 95% CI 1.66-2.5 vs English) had higher odds of having a telemedicine visit. Non-Hispanic Asian (aOR 0.67, 95% CI 0.56-0.79), non-Hispanic Black (aOR 0.83, 95% CI 0.68-1), and Hispanic or Latine (aOR 0.76, 95% CI 0.61-0.95) patients had lower odds of having a telemedicine visit than non-Hispanic White patients. We found significant interactions between health system and age, race and ethnicity, and preferred language (P<.05). After stratifying by health system, several differences persisted in the academic system: non-Hispanic Asian (aOR 0.57, 95% CI 0.46-0.70) and Latine (aOR 0.67, 95% CI 0.50-0.91) patients had lower odds of a telemedicine visit, and younger age groups had higher odds (18-34 years: aOR 3.97, 95% CI 1.99-7.93; 35-49 years: aOR 1.86, 95% CI 1.36-2.56). In the safety net system, Chinese-speaking patients had higher odds of having a telemedicine visit (aOR 2.52, 95% CI 1.85-3.42). Conclusions: We found disparities in telemedicine utilization by age, race and ethnicity, and preferred language, primarily in the health system that used more video visits. While telemedicine expanded rapidly recently, certain populations remain at risk for digital exclusion. These findings suggest that system-level factors influence telemedicine adoption and implementation decisions impact accessibility for populations at risk for digital exclusion. %M 40126552 %R 10.2196/64635 %U https://www.jmir.org/2025/1/e64635 %U https://doi.org/10.2196/64635 %U http://www.ncbi.nlm.nih.gov/pubmed/40126552 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56227 %T Behavioral Therapy–Based Digital Interventions for Treating Osteoarthritis: Systematic Review and Meta-Analysis %A Zhu,Beiyao %A Zhu,Dian %A Xue,Xiao'ao %A Yang,Hongyi %A Zhang,Shurong %+ Department of Sports Medicine, Huashan Hospital, Fudan University, No 12 Urumqi Middle Road, Jing'an District, Shanghai, 200040, China, 86 18901626266, zhangshurong@huashan.org.cn %K osteoarthritis %K digital intervention %K behavioral therapy %K treatment %K systematic review %K meta-analysis %K pain %K impairment %K quality of life %K socioeconomic burden %K psychotherapy-based digital intervention %K patient %K pain reduction %D 2025 %7 19.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Osteoarthritis (OA) is characterized by pain, functional impairments, muscle weakness, and joint stiffness. Since OA heightens reliance on heath care resources and exacerbates socioeconomic burden, remote OA rehabilitation using digital technologies is rapidly evolving. Objective: The aim of this study was to analyze the efficacy of behavioral therapy–based digital interventions for patients with OA. Methods: This study is a systematic review of randomized controlled trials (RCTs) that assessed the effects of behavioral therapy–based digital intervention tools for OA. These RCTs were searched from inception to June 2023 in the Web of Science, Embase, Cochrane Library, Ovid, and PubMed databases. Results: Ten eligible RCTs comprising 1895 patients with OA were included. Digital tools based on either cognitive behavioral therapy (CBT) or behavior change technique (BCT) were investigated. All studies demonstrated low-to-moderate effects on pain reduction in the short term (standardized mean difference [SMD] –0.20, 95% CI –0.35 to –0.05). Six studies reported improvement in physical function (SMD –0.20, 95% CI –0.41 to 0.00), and 5 confirmed increased pain self-efficacy (SMD 0.22, 95% CI 0.02-0.42). In subgroup analysis, compared with CBT, BCT-based digital interventions demonstrated their effects on pain reduction (SMD –0.25, 95% CI –0.49 to 0.00) and physical function (SMD –0.26, 95% CI –0.54 to –0.01) in the short term. In addition, physiotherapist involvement in treatment had a positive effect on pain control (SMD –0.14, 95% CI –0.27 to –0.02). Furthermore, web-based digital tools improved physical function in the short term (SMD –0.28, 95% CI –0.54 to –0.01). Conclusions: Moderate- and low-quality evidence supported that behavioral therapy–based digital tools improved pain intensity, physical function, and self-efficacy in the short term. However, affective interactions between patients and professionals may affect the clinical outcomes. Trial Registration: PROSPERO CRD42023430716; https://tinyurl.com/yc49vzyy %M 40106814 %R 10.2196/56227 %U https://www.jmir.org/2025/1/e56227 %U https://doi.org/10.2196/56227 %U http://www.ncbi.nlm.nih.gov/pubmed/40106814 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e65075 %T Associations Between Sleep Duration and Activity of Daily Living Disability Among Older Adults in China: Cross-Sectional Study %A Fan,Huimin %A Yu,Weijie %A Rong,Hongguo %A Geng,Xiaokun %K sleep %K sleep duration %K activities of daily living %K CHARLS %K survey %K questionnaire %K self-reported %K gerontology %K geriatric %K older adult %K elder %K elderly %K aging %K ADL %K physical function %K physical functioning %K well-being %K association %K correlation %K China Health and Retirement Longitudinal Study %D 2025 %7 5.3.2025 %9 %J Interact J Med Res %G English %X Background: China has the largest elderly population globally; the growth rate of the aged tendency of the population was higher than that of Western countries. Given the distinctions in historical, ethnic, and economic status as well as socio-cultural background, Chinese adults had different sleep patterns compared with adults in other countries. Considering the heavy disease burden caused by activities of daily living (ADL) disability, we conducted a cross-sectional analysis using data from the China Health and Retirement Longitudinal Study (CHARLS) to test the hypothesis that individuals with short and longer sleep duration are more likely to have ADL disability. Objective: ADL disability is a common condition affecting the quality of life among older people. This study aimed to explore the associations between sleep duration and ADL disability among middle-aged and older adults in China. Methods: This cross-sectional study used data from 17,607 participants from the 2018 CHARLS (from 2018 to 2020), an ongoing representative survey of adults aged 45 years or older and their spouses. Self-reported sleep duration per night was obtained from face-to-face interviews. The ADL was measured using a 6-item summary assessed with an ADL scale that included eating, dressing, getting into or out of bed, bathing, using the toilet, and continence. Multiple generalized linear regression models—adjusted for age, sex, education, marital status, tobacco and alcohol use, depression, place of residence, sensory impairment, self-reported health status, life satisfaction, daytime napping, chronic disease condition, and sample weights—were used. Results: Data were analyzed from 17,607 participants, of whom 8375 (47.6%) were men. The mean (SD) age was 62.7 (10.0) years. Individuals with 4 hours or less (odds ratio [OR] 1.91, 95% CI 1.60‐2.27; P<.001), 5 hours (OR 1.33, 95% CI 1.09‐1.62; P=.006), 9 hours (OR 1.48, 95% CI 1.13‐1.93; P<.001), and 10 hours or more (OR 1.88, 95% CI 1.47‐2.14; P<.001) of sleep per night had a higher risk of ADL disability than those in the reference group (7 hours per night) after adjusting for several covariates. Restricted cubic splines analysis suggested a U-shaped association between sleep duration and ADL disability. When sleep duration fell below 7 hours, an increased sleep duration was associated with a significantly low risk of ADL disability, which was negatively correlated with sleep duration until it fell below 7 hours (OR 0.83, 95% CI 0.79‐0.87; P<.001). When sleep duration exceeded 7 hours, the risk of ADL disability would increase facing prolonged sleep duration (OR 1.19, 95% CI 1.12‐1.27; P<.001). ADL disability should be monitored in individuals with insufficient (≤4 or 5 hours per night) or excessive (9 or ≥10 hours per night) sleep duration. Conclusions:: In this study, a U-shaped association between sleep duration and ADL disability was found. Future longitudinal studies are needed to establish temporality and examine the mechanisms of the associations between sleep duration and ADL disability. %R 10.2196/65075 %U https://www.i-jmr.org/2025/1/e65075 %U https://doi.org/10.2196/65075 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e59391 %T Exploring Older Adult Cancer Survivors’ Digital Information Needs: Qualitative Pilot Study %A Newton,Lorelei %A Monkman,Helen %A Fullerton,Claire %K older adults %K cancer survivors %K digital health literacy %K digital health technologies %K aging %K qualitative %K pilot study %K semistructured interview %D 2025 %7 27.2.2025 %9 %J JMIR Cancer %G English %X Background: Older adults (aged >65 years) are disproportionately affected by cancer at a time when Canadians are surviving cancer in an unprecedented fashion. Contrary to persistent ageist assumptions, not only do the majority of older adult cancer survivors use digital health technologies (DHTs) regularly, such technologies also serve as important sources of their health information. Although older adults’ transition to cancer survivorship is connected to the availability and provision of relevant and reliable information, little evidence exists as to how they use DHTs to supplement their understanding of their unique situation to manage, and make decisions about, their ongoing cancer-related concerns. Objective: This pilot study, which examined older adult cancer survivors’ use of DHTs, was conducted to support a larger study designed to explore how digital health literacy dimensions might affect the management of cancer survivorship sequelae. Understanding DHT use is also an important consideration for digital health literacy. Thus, we sought to investigate older adult cancer survivors’ perceptions of DHTs in the context of accessing information about their health, health care systems, and health care providers. Methods: A qualitative pilot study, which involved semistructured interviews with older adult cancer survivors (N=5), was conducted to explore how participants interacted with, accessed, and searched for information, as well as how DHT use related to their cancer survivorship. Institutional ethics approval (#21‐0421) was obtained. Interpretive description inquiry—a practice-based approach suitable for generating applied knowledge—supported exploration of the research question. Thematic analysis was used to examine the transcripts for patterns of meaning (themes). Results: Assessing the credibility of digital information remains challenging for older adult cancer survivors. Identified benefits of DHTs included improved access to meet health information needs, older adult cancer survivors feeling empowered to make informed decisions regarding their health trajectory, and the ability to connect with interdisciplinary teams for care continuity. Additionally, participants described feeling disconnected when DHTs seemed to be used as substitutes for human interaction. The results of this pilot study were used to create 12 additional questions to supplement a digital health literacy survey, through which we will seek a more fulsome account of the relationship between digital health literacy and DHTs for older adult cancer survivors. Conclusions: Overall, this pilot study confirmed the utility of DHTs in enhancing the connection of older adult cancer survivors to their health care needs. Importantly, this connection exists on a continuum, and providing greater access to technologies, in combination with human support, leads to feelings of empowerment. DHTs are an important aspect of contemporary health care; yet, these technologies must be seen as complementary and not as replacements for human interaction. Otherwise, we risk dehumanizing patients and disconnecting them from the care that they need and deserve. %R 10.2196/59391 %U https://cancer.jmir.org/2025/1/e59391 %U https://doi.org/10.2196/59391 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64148 %T Estimation of Machine Learning–Based Models to Predict Dementia Risk in Patients With Atherosclerotic Cardiovascular Diseases: UK Biobank Study %A Gu,Zhengsheng %A Liu,Shuang %A Ma,Huijuan %A Long,Yifan %A Jiao,Xuehao %A Gao,Xin %A Du,Bingying %A Bi,Xiaoying %A Shi,Xingjie %+ KLATASDS-MOE, Academy of Statistics and Interdisciplinary Sciences, School of Statistics, East China Normal University, No 3663 North Zhongshan Road, Putuo District, Shanghai, 200062, China, 86 21 622 332 23, xjshi@fem.ecnu.edu.cn %K atherosclerotic cardiovascular disease %K dementia %K Alzheimer disease %K vascular dementia %K machine learning %K UK Biobank %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The atherosclerotic cardiovascular disease (ASCVD) is associated with dementia. However, the risk factors of dementia in patients with ASCVD remain unclear, necessitating the development of accurate prediction models. Objective: The aim of the study is to develop a machine learning model for use in patients with ASCVD to predict dementia risk using available clinical and sociodemographic data. Methods: This prognostic study included patients with ASCVD between 2006 and 2010, with registration of follow-up data ending on April 2023 based on the UK Biobank. We implemented a data-driven strategy, identifying predictors from 316 variables and developing a machine learning model to predict the risk of incident dementia, Alzheimer disease, and vascular dementia within 5, 10, and longer-term follow-up in patients with ASCVD. Results: A total of 29,561 patients with ASCVD were included, and 1334 (4.51%) developed dementia during a median follow-up time of 10.3 (IQR 7.6-12.4) years. The best prediction model (UK Biobank ASCVD risk prediction model) was light gradient boosting machine, comprising 10 predictors including age, time to complete pairs matching tasks, mean time to correctly identify matches, mean sphered cell volume, glucose levels, forced expiratory volume in 1 second z score, C-reactive protein, forced vital capacity, time engaging in activities, and age first had sexual intercourse. This model achieved the following performance metrics for all incident dementia: area under the receiver operating characteristic curve: mean 0.866 (SD 0.027), accuracy: mean 0.883 (SD 0.010), sensitivity: mean 0.637 (SD 0.084), specificity: mean 0.914 (SD 0.012), precision: mean 0.479 (SD 0.031), and F1-score: mean 0.546 (SD 0.043). Meanwhile, this model was well-calibrated (Kolmogorov-Smirnov test showed goodness-of-fit P value>.99) and maintained robust performance across different temporal cohorts. Besides, the model had a beneficial potential in clinical practice with a decision curve analysis. Conclusions: The findings of this study suggest that predictive modeling could inform patients and clinicians about ASCVD at risk for dementia. %M 40009844 %R 10.2196/64148 %U https://aging.jmir.org/2025/1/e64148 %U https://doi.org/10.2196/64148 %U http://www.ncbi.nlm.nih.gov/pubmed/40009844 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64633 %T Feasibility of a Cinematic–Virtual Reality Program Educating Health Professional Students About the Complexity of Geriatric Care: Pilot Pre-Post Study %A Beverly,Elizabeth A %A Miller,Samuel %A Love,Matthew %A Love,Carrie %K virtual reality %K VR %K aging %K geriatric syndromes %K diabetes %K elder abuse and neglect %K gerontology %K geriatrics %K older %K elderly %K education %K student %K cinematic %K video %K head mounted %K feasibility %K experience %K attitude %K opinion %K perception %K elder abuse %K chronic conditions %K older adult care %K health intervention %K randomized controlled trial %D 2025 %7 12.2.2025 %9 %J JMIR Aging %G English %X Background: The US population is aging. With this demographic shift, more older adults will be living with chronic conditions and geriatric syndromes. To prepare the next generation of health care professionals for this aging population, we need to provide training that captures the complexity of geriatric care. Objective: This pilot study aimed to assess the feasibility of the cinematic–virtual reality (cine-VR) training in the complexity of geriatric care. We measured changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy before and after participating in the training program. Methods: We conducted a single-arm, pretest-posttest pilot study to assess the feasibility of a cine-VR training and measure changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy. Health professional students from a large university in the Midwest were invited to participate in 1 of 4 cine-VR trainings. Participants completed 3 surveys before and after the cine-VR training. We performed paired t tests to examine changes in these constructs before and after the training. Results: A total of 65 health professional students participated in and completed the full cine-VR training for 100% retention. Participants did not report any technological difficulties or adverse effects from wearing the head-mounted displays or viewing the 360-degree video. Out of the 65 participants, 48 completed the pre- and postassessments. We observed an increase in awareness of discrimination towards people with disability (t47=−3.97; P<.001). In addition, we observed significant improvements in self-efficacy to identify and manage elder abuse and neglect (t47=−3.36; P=.002). Finally, we observed an increase in participants’ empathy (t47=−2.33; P=.02). Conclusions: We demonstrated that our cine-VR training program was feasible and acceptable to health professional students at our Midwestern university. Findings suggest that the cine-VR training increased awareness of discrimination towards people with disabilities, improved self-efficacy to identify and manage elder abuse and neglect, and increased empathy. Future research using a randomized controlled trial design with a larger, more diverse sample and a proper control condition is needed to confirm the effectiveness of our cine-VR training. %R 10.2196/64633 %U https://aging.jmir.org/2025/1/e64633 %U https://doi.org/10.2196/64633 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57379 %T Application of Patient-Generated Health Data Among Older Adults With Cancer: Scoping Review %A Kim,Yesol %A Kim,Geonah %A Cho,Hyeonmi %A Kim,Yeonju %A Choi,Mona %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3341, monachoi@yuhs.ac %K patient-generated health data %K wearable devices %K patient-reported outcomes %K patient-centered care %K older adults %K cancer %K scoping review %D 2025 %7 4.2.2025 %9 Review %J J Med Internet Res %G English %X Background: The advancement of information and communication technologies has spurred a growing interest in and increased applications of patient-generated health data (PGHD). In particular, PGHD may be promising for older adults with cancer who have increased survival rates and experience a variety of symptoms. Objective: This scoping review aimed to identify the characteristics of research on PGHD as applied to older adults with cancer and to assess the current use of PGHD. Methods: Guided by Arksey and O’Malley as well as the JBI (Joanna Briggs Institute) methodology for scoping reviews, 6 electronic databases were searched: PubMed, Embase, CINAHL, Cochrane Library, Scopus, and Web of Science. In addition, the reference lists of the selected studies were screened to identify gray literature. The researchers independently screened the literature according to the predefined eligibility criteria. Data from the selected studies were extracted, capturing study, participant, and PGHD characteristics. Results: Of the 1090 identified studies, 88 were selected. The publication trend gradually increased, with a majority of studies published since 2017 (69/88, 78%). Almost half of the studies were conducted in North America (38/88, 43%), followed by Europe (30/88, 34%). The most common setting in which the studies were conducted was the participant’s home (69/88, 78%). The treatment status varied; the median sample size was 50 (IQR 33.8-84.0). The devices that were used to measure the PGHD were classified as research-grade wearable devices (57/113, 50.4%), consumer-grade wearable devices (28/113, 24.8%), or smartphones or tablet PCs for mobile apps (23/113, 20.4%). More than half of the studies measured physical activity (69/123, 56.1%), followed by patient-reported outcomes (23/123, 18.7%), vital signs (13/123, 10.6%), and sleep (12/123, 9.8%). The PGHD were mainly collected passively (63/88, 72%), and active collection methods were used from 2015 onward (20/88, 23%). In this review, the stages of PGHD use were classified as follows: (1) identification, monitoring, review, and analysis (88/88, 100%); (2) feedback and reporting (32/88, 39%); (3) motivation (30/88, 34%); and (4) education and coaching (19/88, 22%). Conclusions: This scoping review provides a comprehensive summary of the overall characteristics and use stages of PGHD in older adults with various types and stages of cancer. Future research should emphasize the use of PGHD, which interacts with patients to provide patient-centered care through patient engagement. By enhancing symptom monitoring, enabling timely interventions, and promoting patient involvement, PGHD have the potential to improve the well-being of older adults with cancer, contributing to better health management and quality of life. Therefore, our findings may provide valuable insights into PGHD that health care providers and researchers can use for geriatric cancer care. Trial Registration: Open Science Framework Registry OSF.IO/FZRD5; https://doi.org/10.17605/OSF.IO/FZRD5 %M 39903506 %R 10.2196/57379 %U https://www.jmir.org/2025/1/e57379 %U https://doi.org/10.2196/57379 %U http://www.ncbi.nlm.nih.gov/pubmed/39903506 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e55455 %T Wearable Smartphone-Based Multisensory Feedback System for Torso Posture Correction: Iterative Design and Within-Subjects Study %A Pereira,Amanda Polin %A Machado Neto,Olibario Jose %A Elui,Valeria Meirelles Carril %A Pimentel,Maria da Graca Campos %+ Institute of Mathematics and Computer Sciences, University of São Paulo, Avenida Trabalhador São-carlense, 400, 1203, São Carlos SP, 13566-590, Brazil, 55 1633739671, mgp@icmc.usp.br %K stroke rehabilitation %K posture %K postural balance %K wearable technology %K multisensory feedback %K smartphone %K stroke %K mHealth %K mobile health %K digital health %K digital technology %K digital intervention %K wearable technology %K gerontology %D 2025 %7 22.1.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The prevalence of stroke is high in both males and females, and it rises with age. Stroke often leads to sensor and motor issues, such as hemiparesis affecting one side of the body. Poststroke patients require torso stabilization exercises, but maintaining proper posture can be challenging due to their condition. Objective: Our goal was to develop the Postural SmartVest, an affordable wearable technology that leverages a smartphone's built-in accelerometer to monitor sagittal and frontal plane changes while providing visual, tactile, and auditory feedback to guide patients in achieving their best-at-the-time posture during rehabilitation. Methods: To design the Postural SmartVest, we conducted brainstorming sessions, therapist interviews, gathered requirements, and developed the first prototype. We used this initial prototype in a feasibility study with individuals without hemiparesis (n=40, average age 28.4). They used the prototype during 1-hour seated sessions. Their feedback led to a second prototype, which we used in a pilot study with a poststroke patient. After adjustments and a kinematic assessment using the Vicon Gait Plug-in system, the third version became the Postural SmartVest. We assessed the Postural SmartVest in a within-subject experiment with poststroke patients (n=40, average age 57.1) and therapists (n=20, average age 31.3) during rehabilitation sessions. Participants engaged in daily activities, including walking and upper limb exercises, without and with app feedback. Results: The Postural SmartVest comprises a modified off-the-shelf athletic lightweight compression tank top with a transparent pocket designed to hold a smartphone running a customizable Android app securely. This app continuously monitors sagittal and frontal plane changes using the built-in accelerometer sensor, providing multisensory feedback through audio, vibration, and color changes. Patients reported high ratings for weight, comfort, dimensions, effectiveness, ease of use, stability, durability, and ease of adjustment. Therapists noted a positive impact on rehabilitation sessions and expressed their willingness to recommend it. A 2-tailed t-test showed a significant difference (P<.001) between the number of the best-at-the-time posture positions patients could maintain in 2 stages, without feedback (mean 13.1, SD 7.12) and with feedback (mean 4.2, SD 3.97), demonstrating the effectiveness of the solution in improving posture awareness. Conclusions: The Postural SmartVest aids therapists during poststroke rehabilitation sessions and assists patients in improving their posture during these sessions. %R 10.2196/55455 %U https://aging.jmir.org/2025/1/e55455 %U https://doi.org/10.2196/55455 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64374 %T Development and Validation of a Predictive Model Based on Serum Silent Information Regulator 6 Levels in Chinese Older Adult Patients: Cross-Sectional Descriptive Study %A You,Yuzi %A Liang,Wei %A Zhao,Yajie %K aging %K coronary artery disease %K nomogram %K SIRT6 %K TyG index %K silent information regulator 6 %K triglyceride glucose index %D 2025 %7 15.1.2025 %9 %J JMIR Aging %G English %X Background: Serum levels of silent information regulator 6 (SIRT6), a key biomarker of aging, were identified as a predictor of coronary artery disease (CAD), but whether SIRT6 can distinguish severity of coronary artery lesions in older adult patients is unknown. Objectives: This study developed a nomogram to demonstrate the functionality of SIRT6 in assessing severity of coronary artery atherosclerosis. Methods: Patients aged 60 years and older with angina pectoris were screened for this single-center clinical study between October 1, 2022, and March 31, 2023. Serum specimens of eligible patients were collected for SIRT6 detection by enzyme-linked immunosorbent assay. Clinical data and putative predictors, including 29 physiological characteristics, biochemical parameters, carotid artery ultrasonographic results, and complete coronary angiography findings, were evaluated, with CAD diagnosis as the primary outcome. The nomogram was derived from the Extreme Gradient Boosting (XGBoost) model, with logistic regression for variable selection. Model performance was assessed by examining discrimination, calibration, and clinical use separately. A 10-fold cross-validation technique was used to compare all models. The models’ performance was further evaluated on the internal validation set to ensure that the obtained results were not due to overoptimization. Results: Eligible patients (n=222) were divided into 2 cohorts: the development cohort (n=178) and the validation cohort (n=44). Serum SIRT6 levels were identified as both an independent risk factor and a predictor for CAD in older adults. The area under the receiver operating characteristic curve (AUROC) was 0.725 (95% CI 0.653‐0.797). The optimal cutoff value of SIRT6 for predicting CAD was 546.384 pg/mL. Predictors included in this nomogram were serum SIRT6 levels, triglyceride glucose (TyG) index, and apolipoprotein B. The model achieved an AUROC of 0.956 (95% CI 0.928‐0.983) in the development cohort. Similarly, in the internal validation cohort, the AUROC was 0.913 (95% CI 0.828‐0.999). All models demonstrated satisfactory calibration, with predicted outcomes closely aligning with actual results. Conclusions: SIRT6 shows promise in predicting CAD, with enhanced predictive abilities when combined with the TyG index. In clinical settings, monitoring fluctuations in SIRT6 and TyG may offer valuable insights for early CAD detection. The nomogram for CAD outcome prediction in older adult patients with angina pectoris may aid in clinical trial design and personalized clinical decision-making, particularly in institutions where SIRT6 is being explored as a biomarker for aging or cardiovascular health. %R 10.2196/64374 %U https://aging.jmir.org/2025/1/e64374 %U https://doi.org/10.2196/64374 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e62930 %T Exploring Dance as a Therapeutic Approach for Parkinson Disease Through the Social Robotics for Active and Healthy Ageing (SI-Robotics): Results From a Technical Feasibility Study %A Bevilacqua,Roberta %A Maranesi,Elvira %A Benadduci,Marco %A Cortellessa,Gabriella %A Umbrico,Alessandro %A Fracasso,Francesca %A Melone,Giovanni %A Margaritini,Arianna %A La Forgia,Angela %A Di Bitonto,Pierpaolo %A Potenza,Ada %A Fiorini,Laura %A La Viola,Carlo %A Cavallo,Filippo %A Leone,Alessandro %A Caroppo,Andrea %A Rescio,Gabriele %A Marzorati,Mauro %A Cesta,Amedeo %A Pelliccioni,Giuseppe %A Riccardi,Giovanni Renato %A Rossi,Lorena %K Parkinson disease %K rehabilitation %K Irish dancing %K balance %K gait %K socially interacting robot %D 2025 %7 14.1.2025 %9 %J JMIR Aging %G English %X Background: Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms. Recently, dance has started to be considered an effective intervention for people with PD. Several findings in the literature emphasize the necessity for deeper exploration into the synergistic impacts of dance therapy and exergaming for PD management. Moreover, socially engaging robotic platforms equipped with advanced interaction and perception features offer potential for monitoring patients’ posture and enhancing workout routines with tailored cues. Objective: This paper presents the results of the Social Robotics for Active and Healthy Ageing (SI-Robotics) project, aimed at designing an innovative rehabilitation program targeted at seniors affected by (early-stage) PD. This study therefore aims to assess the usefulness of a dance-based rehabilitation program enriched by artificial intelligence–based exergames and contextual robotic assistance in improving motor function, balance, gait, and quality of life in patients with PD. The acceptability of the system is also investigated. Methods: The study is designed as a technical feasibility pilot to test the SI-Robotics system. For this study, 20 patients with PD were recruited. A total of 16 Irish dance–based rehabilitation sessions of 50 minutes were conducted (2 sessions per week, for 8 wks), involving 2 patients at a time. The designed rehabilitation session involves three main actors: (1) a therapist, (2) a patient, and (3) a socially interacting robot. To stimulate engagement, sessions were organized in the shape of exergames where an avatar shows patients the movements they should perform to correctly carry out a dance-based rehabilitation exercise. Results: Statistical analysis reveals a significant difference on the Performance-Oriented Mobility Assessment scale, both on balance and gait aspects, together with improvements in Short Physical Performance Battery, Unified Parkinson Disease Rating Scale–III, and Timed Up and Go test, underlying the usefulness of the rehabilitation intervention on the motor symptoms of PD. The analysis of the Unified Theory of Acceptance and Use of Technology subscales provided valuable insights into users’ perceptions and interactions with the system. Conclusions: This research underscores the promise of merging dance therapy with interactive exergaming on a robotic platform as an innovative strategy to enhance motor function, balance, gait, and overall quality of life for patients grappling with PD. Trial Registration: ClinicalTrials.gov NCT05005208; https://clinicaltrials.gov/study/NCT05005208 %R 10.2196/62930 %U https://aging.jmir.org/2025/1/e62930 %U https://doi.org/10.2196/62930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54676 %T Machine Learning and Deep Learning for Diagnosis of Lumbar Spinal Stenosis: Systematic Review and Meta-Analysis %A Wang,Tianyi %A Chen,Ruiyuan %A Fan,Ning %A Zang,Lei %A Yuan,Shuo %A Du,Peng %A Wu,Qichao %A Wang,Aobo %A Li,Jian %A Kong,Xiaochuan %A Zhu,Wenyi %+ Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China, 86 51718268, zanglei@ccmu.edu.cn %K lumbar spinal stenosis %K LSS %K machine learning %K ML %K deep learning %K artificial intelligence %K AI %K diagnosis %K spine stenosis %K lumbar %K predictive model %K early detection %K diagnostic %K older adult %K %D 2024 %7 23.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Lumbar spinal stenosis (LSS) is a major cause of pain and disability in older individuals worldwide. Although increasing studies of traditional machine learning (TML) and deep learning (DL) were conducted in the field of diagnosing LSS and gained prominent results, the performance of these models has not been analyzed systematically. Objective: This systematic review and meta-analysis aimed to pool the results and evaluate the heterogeneity of the current studies in using TML or DL models to diagnose LSS, thereby providing more comprehensive information for further clinical application. Methods: This review was performed under the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using articles extracted from PubMed, Embase databases, and Cochrane Library databases. Studies that evaluated DL or TML algorithms assessment value on diagnosing LSS were included, while those with duplicated or unavailable data were excluded. Quality Assessment of Diagnostic Accuracy Studies 2 was used to estimate the risk of bias in each study. The MIDAS module and the METAPROP module of Stata (StataCorp) were used for data synthesis and statistical analyses. Results: A total of 12 studies with 15,044 patients reported the assessment value of TML or DL models for diagnosing LSS. The risk of bias assessment yielded 4 studies with high risk of bias, 3 with unclear risk of bias, and 5 with completely low risk of bias. The pooled sensitivity and specificity were 0.84 (95% CI: 0.82-0.86; I2=99.06%) and 0.87 (95% CI 0.84-0.90; I2=98.7%), respectively. The diagnostic odds ratio was 36 (95% CI 26-49), the positive likelihood ratio (LR+) was 6.6 (95% CI 5.1-8.4), and the negative likelihood ratio (LR–) was 0.18 (95% CI 0.16-0.21). The summary receiver operating characteristic curves, the area under the curve of TML or DL models for diagnosing LSS of 0.92 (95% CI 0.89-0.94), indicating a high diagnostic value. Conclusions: This systematic review and meta-analysis emphasize that despite the generally satisfactory diagnostic performance of artificial intelligence systems in the experimental stage for the diagnosis of LSS, none of them is reliable and practical enough to apply in real clinical practice. Further efforts, including optimization of model balance, widely accepted objective reference standards, multimodal strategy, large dataset for training and testing, external validation, and sufficient and scientific report, should be made to bridge the distance between current TML or DL models and real-life clinical applications in future studies. Trial Registration: PROSPERO CRD42024566535; https://tinyurl.com/msx59x8k %M 39715552 %R 10.2196/54676 %U https://www.jmir.org/2024/1/e54676 %U https://doi.org/10.2196/54676 %U http://www.ncbi.nlm.nih.gov/pubmed/39715552 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54678 %T Targeting Daily Positive Events to Improve Emotional and Functional Well-Being in Adults With Fibromyalgia: Insights From the LARKSPUR Randomized Controlled Trial %A Ong,Anthony %A Wilcox,Kenneth %A Reid,M Carrington %A Wethington,Elaine %A Cintron,Dakota %A Addington,Elizabeth %A Goktas,Selin %A Moskowitz,Judith %+ Department of Psychology, Cornell University, G421 Martha Van Rensselaer Hall, Cornell University, Ithaca, NY, 14850, United States, 1 6072294119, anthony.ong@cornell.edu %K positive affect %K chronic pain %K chronic condition %K long-term pain %K positive psychology %K positive events %K fibromyalgia %K mHealth %K app %K digital technology %K digital interventions %K gerontology %K geriatrics %K older adult %K aging %K well-being %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and cognitive difficulties, affecting individuals across all age groups. Positive affect (PA) interventions have shown promise in enhancing emotional well-being and pain management in patients with diverse chronic pain conditions. However, the efficacy of internet-delivered PA interventions for individuals with fibromyalgia remains understudied. Objective: This randomized controlled trial investigated the efficacy of a web-based PA regulation intervention—Lessons in Affect Regulation to Keep Stress and Pain Under Control (LARKSPUR)—in enhancing emotional and functional well-being among adults with fibromyalgia syndrome. Methods: A total of 95 participants with fibromyalgia syndrome aged 50 years and older (89/95, 94% female) were randomized to one of two fully automated conditions: (1) LARKSPUR (n=49) or (2) emotion reporting/attention control (n=46). At the postintervention and 1-month follow-up time points, participants completed 7 consecutive, end-of-day, web-based reports capturing positive events (PE), pain, fatigue, PA, and negative affect. Results: Compared to control, LARKSPUR resulted in greater improvements in daily affective responsivity to PE at the postintervention time point, including greater reductions in negative affect (bL–bC=–0.06, 95% highest posterior density interval [HPD] –0.10 to –0.02) and increases in PA (bL–bC=0.10, 95% HPD 0.02-0.19). Furthermore, across the postintervention and 1-month follow-up time points, LARKSPUR led to greater reductions in pain (bL–bC=–0.20, 95% HPD –0.36 to –0.04) and fatigue (bL–bC=–0.24, 95% HPD –0.41 to –0.06) following PE. Conclusions: This randomized controlled trial provides initial evidence that a web-based PA skills intervention can enhance emotional well-being and reduce pain and fatigue in aging adults with fibromyalgia. Trial Registration: ClinicalTrials.gov NCT04869345; https://clinicaltrials.gov/study/NCT04869345 %M 39657168 %R 10.2196/54678 %U https://www.jmir.org/2024/1/e54678 %U https://doi.org/10.2196/54678 %U http://www.ncbi.nlm.nih.gov/pubmed/39657168 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59588 %T An eHealth Intervention to Improve Quality of Life, Socioemotional, and Health-Related Measures Among Older Adults With Multiple Chronic Conditions: Randomized Controlled Trial %A Gustafson Sr,David H %A Mares,Marie-Louise %A Johnston,Darcie %A Vjorn,Olivia J %A Curtin,John J %A Landucci,Gina %A Pe-Romashko,Klaren %A Gustafson Jr,David H %A Shah,Dhavan V %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, 4111 Mechanical Engineering, 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 1440, gina.landucci@wisc.edu %K eHealth %K telemedicine %K aged %K geriatrics %K multiple chronic conditions %K social support %K quality of life %K primary care %K mobile phone %K smartphone %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: In the United States, over 60% of adults aged 65 years or older have multiple chronic health conditions, with consequences that include reduced quality of life, increasingly complex but less person-centered treatment, and higher health care costs. A previous trial of ElderTree, an eHealth intervention for older adults, found socioemotional benefits for those with high rates of primary care use. Objective: This study tested the effectiveness of an ElderTree intervention designed specifically for older patients with multiple chronic conditions to determine whether combining it with primary care improved socioemotional and physical outcomes. Methods: In a nonblinded randomized controlled trial, 346 participants recruited from primary care clinics were assigned 1:1 to the ElderTree intervention or an attention control and were followed for 12 months. All participants were aged 65 years or older and had electronic health record diagnoses of at least three of 11 chronic conditions. Primary outcomes were mental and physical quality of life, psychological well-being (feelings of competence, connectedness, meaningfulness, and optimism), and loneliness. Tested mediators of the effects of the study arm (ElderTree vs active control) on changes in primary outcomes over time were 6-month changes in health coping, motivation, feelings of relatedness, depression, and anxiety. Tested moderators were sex, scheduled health care use, and number of chronic conditions. Data sources were surveys at baseline and 6 and 12 months comprising validated scales, and continuously collected ElderTree usage. Results: At 12 months, 76.1% (134/176) of ElderTree participants were still using the intervention. There was a significant effect of ElderTree (vs control) on improvements over 12 months in mental quality of life (arm × timepoint interaction: b=0.76, 95% CI 0.14-1.37; P=.02; 12-month ∆d=0.15) but no such effect on the other primary outcomes of physical quality of life, psychological well-being, or loneliness. Sex moderated the effects of the study arm over time on mental quality of life (b=1.33, 95% CI 0.09-2.58; P=.04) and psychological well-being (b=1.13, 95% CI 0.13-2.12; P=.03), with stronger effects for women than men. The effect of the study arm on mental quality of life was mediated by 6-month improvements in relatedness (α=1.25, P=.04; b=0.31, P<.001). Analyses of secondary and exploratory outcomes showed minimal effects of ElderTree. Conclusions: Consistent with the previous iteration of ElderTree, the current iteration designed for older patients with multiple chronic conditions showed signs of improving socioemotional outcomes but no impact on physical outcomes. This may reflect the choice of chronic conditions for inclusion, which need not have impinged on patients’ physical quality of life. Two ongoing trials are testing more specific versions of ElderTree targeting older patients coping with (1) chronic pain and (2) greater debilitation owing to at least 5 chronic conditions. Trial Registration: ClinicalTrials.gov NCT03387735; https://clinicaltrials.gov/study/NCT03387735 International Registered Report Identifier (IRRID): RR2-10.2196/25175 %M 39642938 %R 10.2196/59588 %U https://aging.jmir.org/2024/1/e59588 %U https://doi.org/10.2196/59588 %U http://www.ncbi.nlm.nih.gov/pubmed/39642938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57009 %T The Role of Health in the Technology Acceptance Model Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis %A DeLange Martinez,Pauline %A Tancredi,Daniel %A Pavel,Misha %A Garcia,Lorena %A Young,Heather M %+ Betty Irene Moore School of Nursing, University of California, Davis, 2750 48th St, Sacramento, CA, 95817, United States, 1 916 426 2862, pdmartinez@ucdavis.edu %K aged %K older adults %K Asian American %K immigrant %K vulnerable populations %K internet %K information and communications technology %K ICT %K digital divide %K technology acceptance model %K mobile phone %D 2024 %7 3.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-rated health is associated with information and communications technology (ICT) use among older adults. Non–US born, older Asian American individuals are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the technology acceptance model for low-income, Asian American older adults, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of ICT use. However, the association between health and technology acceptance has not been explored among Asian American older adults. Objective: This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of ICTs among low-income, Asian American older adults. Methods: This cross-sectional survey included Asian American individuals aged ≥62 years living in affordable housing for older adults (N=392). Using hierarchical multiple regression, we explored the association between self-rated health and ICT use and technology acceptance model mediators (PU and PEOU) while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association between age and subjective cognitive decline and the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines, revealing that the relationship between subjective cognitive decline and ICT use varied in 3 age segments, which led to updating our analysis to estimate differences in ICT use among age categories with and without subjective cognitive decline. Results: Self-rated health was not significantly associated with ICT use (β=.087; P=.13), PU (β=.106; P=.10), or PEOU (β=.062; P=.31). However, the interaction terms of subjective cognitive decline and age significantly improved the model fit for ICT use (ΔR2=0.011; P=.04). In reviewing scatterplots, we determined that, in the youngest age group (62-74 years), ICT use increased with subjective cognitive decline, whereas in the older age groups (75-84 and ≥85 years), ICT use decreased with subjective cognitive decline, more so in the oldest age category. Through regression analysis, among participants with subjective cognitive decline, ICT use significantly decreased in the middle and older age groups as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant. Conclusions: This study contributes to the understanding of the complex relationship between health and ICT acceptance among low-income, Asian American older adults and suggests the need for tailored interventions to promote digital engagement and quality of life for this population. %M 39625744 %R 10.2196/57009 %U https://formative.jmir.org/2024/1/e57009 %U https://doi.org/10.2196/57009 %U http://www.ncbi.nlm.nih.gov/pubmed/39625744 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57320 %T In-Home Positioning for Remote Home Health Monitoring in Older Adults: Systematic Review %A Chan,Andrew %A Cai,Joanne %A Qian,Linna %A Coutts,Brendan %A Phan,Steven %A Gregson,Geoff %A Lipsett,Michael %A Ríos Rincón,Adriana M %+ Glenrose Rehabilitation Hospital, 10105 112 Ave NW, Edmonton, AB, T5G 0H1, Canada, 1 7802037731, aychan1@ualberta.ca %K gerontology %K geriatrics %K older adult %K elderly %K aging %K aging-in-place %K localization %K ambient sensor %K wearable sensor %K acceptability %K home monitor %K health monitor %K technology %K digital health %K e-health %K telehealth %K clinical studies %K cognitive impairment %K neuro %K cognition %D 2024 %7 2.12.2024 %9 Review %J JMIR Aging %G English %X Background: With the growing proportion of Canadians aged >65 years, smart home and health monitoring technologies may help older adults manage chronic disease and support aging in place. Localization technologies have been used to support the management of frailty and dementia by detecting activities in the home. Objective: This systematic review aims to summarize the clinical evidence for in-home localization technologies, review the acceptability of monitoring, and summarize the range of technologies being used for in-home localization. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was followed. MEDLINE, Embase, CINAHL, and Scopus were searched with 2 reviewers performing screening, extractions, and quality assessments. Results: A total of 1935 articles were found, with 36 technology-focused articles and 10 articles that reported on patient outcomes being included. From moderate- to high-quality studies, 2 studies reported mixed results on identifying mild cognitive dementia or frailty, while 4 studies reported mixed results on the acceptability of localization technology. Technologies included ambient sensors; Bluetooth- or Wi-Fi–received signal strength; localizer tags using radio frequency identification, ultra-wideband, Zigbee, or GPS; and inertial measurement units with localizer tags. Conclusions: The clinical utility of localization remains mixed, with in-home sensors not being able to differentiate between older adults with healthy cognition and older adults with mild cognitive impairment. However, frailty was detectable using in-home sensors. Acceptability is moderately positive, particularly with ambient sensors. Localization technologies can achieve room detection accuracies up to 92% and linear accuracies of up to 5-20 cm that may be promising for future clinical applications. Trial Registration: PROSPERO CRD42022339845; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339845 %R 10.2196/57320 %U https://aging.jmir.org/2024/1/e57320 %U https://doi.org/10.2196/57320 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54127 %T Challenges and Opportunities in Digital Screening for Hypertension and Diabetes Among Community Groups of Older Adults in Vietnam: Mixed Methods Study %A Nong,Trang Thi Thu %A Nguyen,Giang Hoang %A Lepe,Alexander %A Tran,Thuy Bich %A Nguyen,Lan Thi Phuong %A Koot,Jaap A R %+ HelpAge International in Vietnam, A201, No 2, Alley 59, Lang Ha street, Thanh Cong ward, Ba Dinh district, Hanoi, 100000, Vietnam, 84 0947375689, trangnt@helpagevn.org %K NCD screening %K DHIS2 tracker %K District Health Information Software, version 2 tracker %K digital application %K ISHC health volunteers %K non-communicable diseases %K prevention %K Vietnam %K mobile phone %D 2024 %7 2.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The project of scaling up noncommunicable disease (NCD) interventions in Southeast Asia aimed to strengthen the prevention and control of hypertension and diabetes, focusing on primary health care and community levels. In Vietnam, health volunteers who were members of the Intergenerational Self-Help Clubs (ISHCs) implemented community-based NCD screening and health promotion activities in communities. The ISHC health volunteers used an app based on District Health Information Software, version 2 (DHIS2) tracker (Society for Health Information Systems Programmes, India) to record details of participants during screening and other health activities. Objective: This study aimed to assess the strengths, barriers, and limitations of the NCD screening app used by the ISHC health volunteers on tablets and to provide recommendations for further scaling up. Methods: A mixed methods observational study with a convergent parallel design was performed. For the quantitative data analysis, 2 rounds of screening data collected from all 59 ISHCs were analyzed on completeness and quality. For the qualitative analysis, 2 rounds of evaluation of the screening app were completed. Focus group discussions with ISHC health volunteers and club management boards and in-depth interviews with members of the Association of the Elderly and Commune Health Station staff were performed. Results: In the quantitative analysis, data completeness of all 6704 screenings (n=3485 individuals) was very high. For anthropomorphic measurements, such as blood pressure, body weight, and abdominal circumference, less than 1% errors were found. The data on NCD risk factors were not adequately recorded in 1908 (29.5%) of the screenings. From the qualitative analysis, the NCD screening app was appreciated by ISHC health volunteers and supervisors, as an easier and more efficient way to report to higher levels, secure data, and strengthen relationships with relevant stakeholders, using tablets to connect to the internet and internet-based platforms to access information for self-learning and sharing to promote a healthy lifestyle as the strengths. The barriers and limitations reported by the respondents were a non–age-friendly app, incomplete translation of parts of the app into Vietnamese, some issues with the tablet’s display, lack of sharing of responsibilities among the health volunteers, and suboptimal involvement of the health sector; limited digital literacy among ISHC health volunteers. Recommendations are continuous capacity building, improving app issues, improving tablet issues, and involving relevant stakeholders or younger members in technology adoption to support older people. Conclusions: The implementation of the NCD screening app by ISHC volunteers can be an effective way to improve community-led NCD screening and increase the uptake of NCD prevention and management services at the primary health care level. However, our study has shown that some barriers need to be addressed to maximize the efficient use of the app by ISHC health volunteers to record, report, and manage the screening data. %M 39622043 %R 10.2196/54127 %U https://www.jmir.org/2024/1/e54127 %U https://doi.org/10.2196/54127 %U http://www.ncbi.nlm.nih.gov/pubmed/39622043 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58261 %T Functional Monitoring of Patients With Knee Osteoarthritis Based on Multidimensional Wearable Plantar Pressure Features: Cross-Sectional Study %A Xie,Junan %A Li,Shilin %A Song,Zhen %A Shu,Lin %A Zeng,Qing %A Huang,Guozhi %A Lin,Yihuan %+ School of Future Technology, South China University of Technology, No. 777 East Xingye Avenue, Panyu District, Guangzhou, China, 86 13719139981, shul@scut.edu.cn %K knee osteoarthritis %K KOA %K 40-m fast-paced walk test %K 40mFPWT %K timed up-and-go test %K TUGT %K timed up and go %K TUG %K functional assessment %K monitoring %K wearable %K gait %K walk test %K plantar %K knee %K joint %K arthritis %K gait analysis %K regression model %K machine learning %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Patients with knee osteoarthritis (KOA) often present lower extremity motor dysfunction. However, traditional radiography is a static assessment and cannot achieve long-term dynamic functional monitoring. Plantar pressure signals have demonstrated potential applications in the diagnosis and rehabilitation monitoring of KOA. Objective: Through wearable gait analysis technology, we aim to obtain abundant gait information based on machine learning techniques to develop a simple, rapid, effective, and patient-friendly functional assessment model for the KOA rehabilitation process to provide long-term remote monitoring, which is conducive to reducing the burden of social health care system. Methods: This cross-sectional study enrolled patients diagnosed with KOA who were able to walk independently for 2 minutes. Participants were given clinically recommended functional tests, including the 40-m fast-paced walk test (40mFPWT) and timed up-and-go test (TUGT). We used a smart shoe system to gather gait pressure data from patients with KOA. The multidimensional gait features extracted from the data and physical characteristics were used to establish the KOA functional feature database for the plantar pressure measurement system. 40mFPWT and TUGT regression prediction models were trained using a series of mature machine learning algorithms. Furthermore, model stacking and average ensemble learning methods were adopted to further improve the generalization performance of the model. Mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean squared error (RMSE) were used as regression performance metrics to evaluate the results of different models. Results: A total of 92 patients with KOA were included, exhibiting varying degrees of severity as evaluated by the Kellgren and Lawrence classification. A total of 380 gait features and 4 physical characteristics were extracted to form the feature database. Effective stepwise feature selection determined optimal feature subsets of 11 variables for the 40mFPWT and 10 variables for the TUGT. Among all models, the weighted average ensemble model using 4 tree-based models had the best generalization performance in the test set, with an MAE of 2.686 seconds, MAPE of 9.602%, and RMSE of 3.316 seconds for the prediction of the 40mFPWT and an MAE of 1.280 seconds, MAPE of 12.389%, and RMSE of 1.905 seconds for the prediction of the TUGT. Conclusions: This wearable plantar pressure feature technique can objectively quantify indicators that reflect functional status and is promising as a new tool for long-term remote functional monitoring of patients with KOA. Future work is needed to further explore and investigate the relationship between gait characteristics and functional status with more functional tests and in larger sample cohorts. %M 39586093 %R 10.2196/58261 %U https://aging.jmir.org/2024/1/e58261 %U https://doi.org/10.2196/58261 %U http://www.ncbi.nlm.nih.gov/pubmed/39586093 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51989 %T Decomposition of Heart Failure Prevalence and Mortality Among Older Adults in the United States: Medicare-Based Partitioning Analysis %A Yu,Bin %A Kravchenko,Julia %A Yashkin,Arseniy %A Akushevich,Igor %K heart failure %K prevalence %K mortality %K partitioning %K time trends %K epidemiologic determinants %D 2024 %7 20.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Heart failure (HF) is a challenging clinical and public health problem characterized by high prevalence and mortality among US older adults, along with a recent decline in HF prevalence and increase in mortality. The changes of prevalence can be decomposed into pre-existing disease prevalence, disease incidence, and respective survival, while the changes of mortality can be decomposed into mortality in the general population independent from HF, pre-existing HF prevalence, incidence, and respective survival. These epidemiological components may contribute differently to the changes in prevalence and mortality. Objective: We aimed to investigate and compare the relative contributions of epidemiologic determinants in HF prevalence and mortality trends. Methods: This study was a secondary data analysis of 5% of Medicare claims data for 1992‐2017 in the United States. Medicare is a federal health insurance program for older adults aged 65+ years as well as people with specific disabilities and end-stage renal disease. Age-adjusted prevalence and incidence-based mortality (IBM; all-cause mortality that occurred in patients with HF) were partitioned into their respective epidemiologic determinants using the partitioning analysis approach. Results: The age-adjusted HF prevalence (1/100 person-years) increased from 11 in 1994 to 14.6 in 2005, followed by a decline to 12.6 in 2017, and the age-adjusted HF IBM (1/100,000) increased from 2220.8 in 1994 to 2563.7 in 2000, then declined to 2075.9 in 2016, followed by an increase to 2094.7 in 2017. The HF incidence (1/1000 person-years) declined from 29.4 in 1992 to 19.9 in 2017. The 1-, 3-, and 5-year survival trend showed declines in recent years. Partitioning of HF prevalence showed three phases: (1) decelerated increasing prevalence (1994‐2006), (2) accelerated declining prevalence (2007‐2014), and (3) decelerated declining prevalence (2015‐2017). During the whole period, the decreasing HF incidence contributed to the declines in prevalence, overpowering prevalence increases contributed from survival. Likewise, partitioning of HF IBM showed three phases: (1) decelerated increasing mortality (1994‐2001), (2) accelerated declining mortality (2002‐2012), and (3) decelerated declining mortality (2013‐2017). The decreasing HF incidence in 1994‐2017 and increasing survival in 2002‐2006 contributed to the declines in mortality, while the decreasing survival in 2007‐2017 contributed to the mortality increase. Conclusions: Decade-long declines in HF prevalence and mortality mainly reflected decreasing incidence, while the most recent increase of mortality was predominantly due to the declining survival. If current trends persist, HF prevalence and mortality are forecasted to grow substantially in the next decade. Prevention strategies should continue the prevention of HF risk factors as well as improvement of treatment and management of HF after diagnosis. %R 10.2196/51989 %U https://publichealth.jmir.org/2024/1/e51989 %U https://doi.org/10.2196/51989 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e64248 %T Patient Profile and Cost Savings of Long-Term Care in a Spanish Hospital: Retrospective Observational Study %A Mira,José Joaquín %A García-Torres,Daniel %A Bonell-Guerrero,María del Mar %A Cáceres-Sevilla,Ana Isabel %A Ramirez-Sanz,Martina %A Martínez-Lleo,Rosa %A Carratalá,Concepción %+ Health Psychology Department, Universidad Miguel Hernández, Universidad Avenue, Elche, 03202, Spain, 34 966658984, jose.mira@umh.es %K chronicity %K length of stay %K hospital %K chronic %K long-term care %K demographics %K gerontology %K Hospitals for Acute and Chronic Long-Term Extended Stay %K HACLES %K healthcare economics %K cost savings %D 2024 %7 19.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Long-term care hospitals have been considered an efficient response to the health care needs of an increasingly aging population. These centers are expected to contribute to better hospital bed management and more personalized care for patients needing continuous care. The evaluation of their outcomes is necessary after a sufficient period to assess their impact. Hospitals for Acute and Chronic Long-Term Extended Stay (HACLES) emerged in Spain in the late 20th century as a response to the aging population and the increase in chronic diseases. Objective: This study aimed to analyze the profile of patients treated in a HACLES, particularly analyzing gender differences, and evaluate the cost savings associated with using these centers. Methods: A retrospective study was conducted based on data from patients 65 years old or older admitted to a HACLES between 2022 and 2023. Gender, age, household cohabitation data, diagnosis and comorbidity, daily medication intake, and degree of dependency were obtained to describe the profile of patients who attended the HACLES. Data coded in SIA-Abucasis (version 37.00.03; Consellería Sanitat, Generalitat Valenciana; a digital medical record system used in the Valencian region) were reviewed, and descriptive statistics and comparison tests were used. The direct cost savings of HACLES admissions were calculated by comparing the daily cost of a general hospital bed with that of a HACLES bed. Results: Data from 123 patients with a mean age of 77 years were analyzed. Most (n=81, 65.9%) had a cohabiting family member as their primary caregiver. Palliative care was the most frequent reason for admission (n=75, 61%). The mortality rate (odds ratio [OR] 61.8, 95% CI 53.2-70.5) was similar between men and women (OR 54.1, 95% CI 47.8-71.5 vs OR 59.7, 95% CI 42.2-66.0; P=.23). The cognitive assessment, using the Pfeiffer scale, improved at discharge (mean 3.2, SD 3.2 vs mean 2.5, SD 3.1; P=.003). The length of stay was significantly larger for patients who returned home compared with patients discharged to other facilities (mean 89.8, SD 58.2 versus mean 33.1, SD 43.1 days; P<.001). The direct cost savings were estimated at US $42,614,846 per 1000 admissions. Conclusions: Patients typically treated in HACLES are older, with a high level of cognitive impairment and physical dependency, and a significant proportion are in palliative care, highlighting the importance of adapting care to the individual needs of the admitted patients. The HACLES model contributes to the sustainability of the public health system. %M 39561362 %R 10.2196/64248 %U https://www.i-jmr.org/2024/1/e64248 %U https://doi.org/10.2196/64248 %U http://www.ncbi.nlm.nih.gov/pubmed/39561362 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56636 %T Digital Exclusion and Cognitive Function in Elderly Populations in Developing Countries: Insights Derived From 2 Longitudinal Cohort Studies %A Duan,Sainan %A Chen,Dongxu %A Wang,Jinping %A Paramboor,Mohammed Sharooq %A Xia,Zhen %A Xu,Wanting %A Han,Kun %A Zhu,Tao %A Jiang,Xiaoqin %+ Department of Anesthesiology, West China Second University Hospital, Sichuan University, No 20, Section 3, South Renmin Road, Chengdu, 610041, China, 86 18180609218, 1598862657jxq@scu.edu.cn %K digital exclusion %K cognition %K cohort study %K developing country %K China Health and Retirement Longitudinal Study %K CHARLS %K %K MHAS %K cognitive decline %D 2024 %7 15.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognition disorders not only lead to adverse health consequences but also contribute to a range of socioeconomic challenges and diminished capacity for performing routine daily activities. In the digital era, understanding the impact of digital exclusion on cognitive function is crucial, especially in developing countries. Objective: This study aimed to evaluate the association between digital exclusion and cognitive function among elderly populations in developing countries. Methods: Using data from CHARLS (China Health and Retirement Longitudinal Study) from 2011 to 2020 and MHAS (Mexican Health & Aging Study) from 2012 to 2021, we defined digital exclusion as self-reported absence from the internet. Cognitive function was assessed through 5 tests: orientation, immediate verbal recall, delayed verbal recall, serial 7s, and figure recall. Cognitive function was assessed in 2 categories: worse cognition (a categorical variable that classifies cognition as either better or worse compared to the entire cohort population) and cognitive scores (a continuous variable representing raw cognitive scores across multiple follow-up waves). Logistic regression analyses and generalized estimating equation (GEE) analyses were used to examine the relationship between cognitive function and digital exclusion, adjusting for potential confounders, including demographics, lifestyle factors, history of chronic diseases, basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and basic cognitive abilities. Results: After excluding participants with probable cognitive impairment at baseline and those who did not have a complete cognitive assessment in any given year (ie, all tests in the cognitive assessment must be completed in any follow-up wave), a total of 24,065 participants in CHARLS (n=11,505, 47.81%) and MHAS (n=12,560, 52.19%) were included. Of these, 96.78% (n=11,135) participants in CHARLS and 70.02% (n=8795) in MHAS experienced digital exclusion. Adjusted logistic regression analyses revealed that individuals with digital exclusion were more likely to exhibit worse cognitive performance in both CHARLS (odds ratio [OR] 2.04, 95% CI 1.42-2.99; P<.001) and MHAS (OR 1.40, 95% CI 1.26-1.55; P<.001). Gender and age did not significantly modify the relationship between digital exclusion and worse cognition (intervention P>.05). The fully adjusted mean differences in global cognitive scores between the 2 groups were 0.98 (95% CI 0.70-1.28; P<.001) in CHARLS and 0.50 (95% CI 0.40-0.59; P<.001) in MHAS. Conclusions: A substantial proportion of older adults, particularly in China, remain excluded from internet access. Our study examined longitudinal changes in cognitive scores and performed cross-sectional comparisons using Z-score standardization. The findings suggest that digital exclusion is linked to an increased risk of cognitive decline among older adults in developing countries. Promoting internet access may help mitigate this risk and support better cognitive health in these populations. %M 39546790 %R 10.2196/56636 %U https://www.jmir.org/2024/1/e56636 %U https://doi.org/10.2196/56636 %U http://www.ncbi.nlm.nih.gov/pubmed/39546790 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58175 %T Quantifying the Enhancement of Sarcopenic Skeletal Muscle Preservation Through a Hybrid Exercise Program: Randomized Controlled Trial %A Guo,Hongzhi %A Cao,Jianwei %A He,Shichun %A Wei,Meiqi %A Meng,Deyu %A Yu,Ichen %A Wang,Ziyi %A Chang,Xinyi %A Yang,Guang %A Wang,Ziheng %K sarcopenia %K older adults %K physical exercise program %K explainable artificial intelligence %K tai chi %D 2024 %7 15.11.2024 %9 %J JMIR Aging %G English %X Background: Sarcopenia is characterized by the loss of skeletal muscle mass and muscle function with increasing age. The skeletal muscle mass of older people who endure sarcopenia may be improved via the practice of strength training and tai chi. However, it remains unclear if the hybridization of strength exercise training and traditional Chinese exercise will have a better effect. Objective: We designed a strength training and tai chi exercise hybrid program to improve sarcopenia in older people. Moreover, explainable artificial intelligence was used to predict postintervention sarcopenic status and quantify the feature contribution. Methods: To assess the influence of sarcopenia in the older people group, 93 participated as experimental participants in a 24-week randomized controlled trial and were randomized into 3 intervention groups, namely the tai chi exercise and strength training hybrid group (TCSG; n=33), the strength training group (STG; n=30), and the control group (n=30). Abdominal computed tomography was used to evaluate the skeletal muscle mass at the third lumbar (L3) vertebra. Analysis of demographic characteristics of participants at baseline used 1-way ANOVA and χ2 tests, and repeated-measures ANOVA was used to analyze experimental data. In addition, 10 machine-learning classification models were used to calculate if these participants could reverse the degree of sarcopenia after the intervention. Results: A significant interaction effect was found in skeletal muscle density at the L3 vertebra, skeletal muscle area at the L3 vertebra (L3 SMA), grip strength, muscle fat infiltration, and relative skeletal muscle mass index (all P values were <.05). Grip strength, relative skeletal muscle mass index, and L3 SMA were significantly improved after the intervention for participants in the TCSG and STG (all P values were <.05). After post hoc tests, we found that participants in the TCSG experienced a better effect on L3 SMA than those in the STG and participants in the control group. The LightGBM classification model had the greatest performance in accuracy (88.4%), recall score (74%), and F1-score (76.1%). Conclusions: The skeletal muscle area of older adults with sarcopenia may be improved by a hybrid exercise program composed of strength training and tai chi. In addition, we identified that the LightGBM classification model had the best performance to predict the reversion of sarcopenia. Trial Registration: ClinicalTrials.gov NCT05694117; https://clinicaltrials.gov/study/NCT05694117 %R 10.2196/58175 %U https://aging.jmir.org/2024/1/e58175 %U https://doi.org/10.2196/58175 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57168 %T Association Between Fatty Liver Index and Incidence of Cataract Surgery in Individuals Aged 50 Years and Older Based on the Korean National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) Data: Longitudinal Retrospective Cohort Study %A Kim,Yonghwan %A Kim,Jeongsook %A Seo,Eoi Jong %A Kim,Kyung Tae %A Lee,Jae-woo %A Kim,Joungyoun %A Kang,Hee-Taik %K fatty liver index %K nonalcoholic fatty liver disease %K all-cataract %K senile-cataract %K surgery %K NAFLD %K Korean National Health Insurance Service %K Health Screening Cohort %K NHIS-HEALS %D 2024 %7 14.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Cataract is a leading cause of vision impairment. Obesity-related risk factors, including insulin resistance, increase the risk of cataract. The fatty liver index (FLI) is a biomarker for noninvasive fat layer prediction of nonalcoholic fatty liver disease. The FLI has been used to evaluate the metabolic contribution in other organs besides the eye. However, no study exists on the FLI and eye disease. Objective: This retrospective cohort study for the association between the FLI and incidence of cataract surgery in individuals older than 50 years was designed to show that a higher FLI is associated with an increased incidence of cataract surgery in individuals aged 50 years and older. Methods: This study was retrospectively designed based on the Korean National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) cohort (median follow-up of 9.8 years). Participants were assigned to 1 of 3 groups based on the FLI: low (FLI<30), intermediate (FLI 30-59), or high (FLI≥60). Kaplan-Meier survival analysis was performed on the cumulative incidence of all-cataract and senile-cataract surgery. Multivariable Cox proportional hazards regression models were used to study the association between the FLI group and cataract surgery after adjusting for potential confounders. Results: Of the 138,347 included participants, the incidence of cataract surgery was 12.49% (4779/38,274), 13.95% (6680/47,875), and 14.16% (7496/52,930) in the low, intermediate, and high FLI groups, respectively. After adjusting for all confounding factors, hazard ratios (HRs; 95% CIs) in the high FLI group for all-cataract surgery were 1.111 (1.028‐1.199) and 1.184 (1.101‐1.274) in men and women, respectively, when compared with the low FLI group. HRs (95% CIs) in the high FLI group for senile-cataract surgery were 1.106 (1.022‐1.197) and 1.147 (1.065‐1.237) in men and women, respectively, when compared with the low FLI group. The project was conducted between August 2023 and February 2024 without donations from external bodies. Conclusions: Individuals with a higher FLI had a higher risk of all-cataract surgery. This association was maintained even after limiting the analyses to senile-cataract surgery. %R 10.2196/57168 %U https://publichealth.jmir.org/2024/1/e57168 %U https://doi.org/10.2196/57168 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63814 %T Examining Whether Patient Portal and Video Visit Use Differs by Race and Ethnicity Among Older Adults in a US Integrated Health Care Delivery System: Cross-Sectional Electronic Health Record and Survey-Based Study %A Gordon,Nancy P %A Yin,Chelsea %A Lo,Joan C %+ Kaiser Permanente Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Pleasanton, CA, 94588, United States, 1 5109107992, nancypgordon@yahoo.com %K patient portal use %K video visit use %K older adults %K racial and ethnic differences %K telehealth %K mobile phone %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Health care systems are increasingly encouraging patients to use patient portals and participate in video visits. However, there is limited information about how portal use differs among older adults. Objective: This study aimed to understand how patient portal and video visit use differed by age, race, and ethnicity among older adult patients with access to the same digital health resources. Methods: This cross-sectional study used electronic health record and survey data for adults aged 65 to 85 years who were members of a large Northern California health care delivery system throughout 2019 and 2020. The electronic health record cohort (N=471,152) included 320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8473 South Asian, 6716 Japanese, 2930 Vietnamese, and 2015 Korean adults. Racial and ethnic group and age group (65 to 75 years vs 76 to 85 years) differences in having a patient portal account by December 2020, the performance of 2 portal activities (sending ≥1 message to a clinician in 2019 or 2020 and viewing ≥1 laboratory test result in 2020), and having ≥1 video visit during 2020 were examined. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit use, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Data from a 2020 member survey were used to compare internet use factors among 2867 White, 306 Black, 343 Latino, 225 Chinese, and 242 Filipino adults. Results: Black, Latino, and Filipino adults were less likely to have a patient portal account than White adults, and Filipino adults were less likely to have a patient portal account than Chinese adults. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have sent messages and viewed test results than White adults, while Chinese and Japanese adults’ use of these features was similar to that of White adults. Filipino, Vietnamese, and Korean adults were less likely to have performed the aforementioned activities than Chinese adults. Video visit use was lower among Black and Latino adults and higher among Chinese and South Asian adults compared with White adults (aged 76 to 85 years) and lower among Filipino, Korean, and Vietnamese adults compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain the lower use of messaging by Black, Latino, and Filipino adults compared with White and Chinese adults. Conclusions: Patient portal and video visit use differed by race, ethnicity, and age group among older adult patients with access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscore the importance of disaggregating use data by Asian ethnicity. %M 39509698 %R 10.2196/63814 %U https://aging.jmir.org/2024/1/e63814 %U https://doi.org/10.2196/63814 %U http://www.ncbi.nlm.nih.gov/pubmed/39509698 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e53083 %T Remote Foot Temperature Monitoring Among Veterans: Large Observational Study of Noncompliance and Its Correlates %A Littman,Alyson J %A Timmons,Andrew K %A Korpak,Anna %A Chan,Kwun C G %A Jones,Kenneth T %A Shirley,Suzanne %A Nordrum,Kyle %A Robbins,Jeffrey %A Masadeh,Suhail %A Moy,Ernest %K diabetes %K self-monitoring %K ulceration %K compliance %K foot temperature monitoring %K SmartMat %K adherence %K remote %K monitoring %K non-compliance %K foot %K ulcer %K diabetic %K veteran %K observational %K health record %K EHR %K noncompliance %K electronic health record %D 2024 %7 5.11.2024 %9 %J JMIR Diabetes %G English %X Background: In-home remote foot temperature monitoring (RTM) holds promise as a method to reduce foot ulceration in high-risk patients with diabetes. Few studies have evaluated adherence to this method or evaluated the factors associated with noncompliance. Objective: The aims of this study were to estimate noncompliance in patients who were enrolled in RTM nationwide across Department of Veterans Affairs (VA) and to evaluate characteristics associated with noncompliance. Methods: We conducted an observational study including 1137 patients in the VA who were enrolled in RTM between January 2019 and June 2021, with follow-up through October 2021. Patient information was obtained from the VA’s electronic health record and RTM use was obtained from the company. Noncompliance was defined as using the mat <2 days per week for ≥4 of the 12 months of follow-up. Using a multivariable model, we calculated odds ratios (ORs) and 95% CIs for associations between various factors and noncompliance and compared using Akaike information criterion statistics, a measure of model fit. Results: The sample was predominantly male (n=1125, 98.94%) ; 21.1% (n=230) were Black and 75.7% (n=825) were White. Overall, 37.6% (428/1137) of patients were classified as noncompliant. In the multivariable model, an intermediate area deprivation index was statistically significantly and inversely associated with noncompliance (area deprivation index 50‐74 vs 1‐24; OR 0.56, 95% CI 0.35-0.89); factors significantly and positively associated with noncompliance included recent history of osteomyelitis (OR 1.44, 95% CI 1.06-1.97), Gagne comorbidity index score ≥4 (vs ≤0; OR 1.81, 95% CI 1.15-2.83), telehealth encounters (28+ vs <6; OR 1.70, 95% CI 1.02-2.84), hemoglobin A1c≥10 (vs <5.7; OR 2.67, 95% CI 1.27-5.58), and current smoking (OR 2.06, 95% CI 1.32-3.20). Based on Akaike information criterion differences, the strongest factors associated with noncompliance were behavioral factors (poor glucose control [as measured by hemoglobin A1c] and smoking), and to a lesser extent, factors such as a recent history of osteomyelitis and an elevated Gagne comorbidity index, indicating a high comorbidity burden. Conclusions: To reduce the risk of ulcer recurrence and amputation, proactively providing additional support for self-monitoring to patients with characteristics identified in this study (poor glucose control, current smoking, high comorbidity burden) may be helpful. Furthermore, research is needed to better understand barriers to use, and whether the addition of design features, reminders, or incentives may reduce noncompliance and the risk of foot ulcers. %R 10.2196/53083 %U https://diabetes.jmir.org/2024/1/e53083 %U https://doi.org/10.2196/53083 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59018 %T Impact of Dance or Music and Meditation on the Progression of Parkinson Disease With Mild or Moderate Severity: Protocol for a Pilot Randomized Controlled Trial %A Mehrotra,Bhagyashree %A Rai,Neha %A MR,Rajani %A Budhakar,Aparna %A Aggarwal,Ritika %A Agarbattiwala,Raj Vinodkumar %A Thomas,Mona %A Patole,Sampada %A Doshi,Paresh %+ Stereotactic and Functional Neurosurgery Department, Jaslok Hospital and Research Centre, 15, G Deshmukh Marg, Pedder Road, IT Colony, Tardeo, Mumbai, 400026, India, 91 9820063854, pdoshi@neurologicalsurgery.in %K music therapy %K dance therapy %K neurodegenerative disorders %K meditation %K quality of life %K music %K pilot study %K Parkinson disease %K well-being %D 2024 %7 29.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor dysfunctions and nonmotor symptoms. Current treatments do not alter disease progression, highlighting the need for alternative therapies. Music, dance, and mindfulness meditation have shown the potential to improve symptoms and quality of life in patients with PD. Objective: This study aims to evaluate the effectiveness of dance or music and meditation on PD progression, cognitive functions, mood, behavior, and caregiver burden. Methods: This study is a single-blinded, longitudinal, parallel, randomized controlled trial. The participants consist of 30 patients with mild to moderate PD residing in Mumbai, India, who can physically participate in the activities. The exclusion criteria include advanced PD, severe balance issues, age >80 years, and other movement disorders. Participants in the intervention group will engage in dance or music sessions and guided meditation thrice weekly for 6 months. The control group will continue their usual activities and medication. The primary outcome is the progression of PD symptoms, measured using the Unified Parkinson’s Disease Rating Scale I-III, and quality of life, measured using the Parkinson’s Disease Questionnaire-39. The secondary outcomes include cognitive functions (Mini-Mental State Examination), mood (Beck Depression Inventory and Parkinson Anxiety Scale), mobility (timed up and go and Berg Balance Test), behavioral disorders (Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease Rating Scale), and caregiver burden (Zarit Burden Interview and Parkinson’s Disease Questionnaire-Carer). Results: Data collection was completed in February 2024, with 28 participants finishing the study (intervention group: n=15, 54% and control group: n=13, 46%). Data analysis is underway, with results expected to be published in December 2024. Conclusions: This study aims to provide significant insights into the effectiveness of dance or music and meditation in improving the quality of life and slowing the progression of PD. The findings are anticipated to support using these nonpharmaceutical therapies as complementary approaches to managing PD. Trial Registration: CTRI/2023/03/051064; https://tinyurl.com/2xdus53j International Registered Report Identifier (IRRID): DERR1-10.2196/59018 %M 39471378 %R 10.2196/59018 %U https://www.researchprotocols.org/2024/1/e59018 %U https://doi.org/10.2196/59018 %U http://www.ncbi.nlm.nih.gov/pubmed/39471378 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e60209 %T Assessment of Wearable Device Adherence for Monitoring Physical Activity in Older Adults: Pilot Cohort Study %A Ding,Huitong %A Ho,Kristi %A Searls,Edward %A Low,Spencer %A Li,Zexu %A Rahman,Salman %A Madan,Sanskruti %A Igwe,Akwaugo %A Popp,Zachary %A Burk,Alexa %A Wu,Huanmei %A Ding,Ying %A Hwang,Phillip H %A Anda-Duran,Ileana De %A Kolachalama,Vijaya B %A Gifford,Katherine A %A Shih,Ludy C %A Au,Rhoda %A Lin,Honghuang %K physical activity %K remote monitoring %K wearable device %K adherence %K older adults %D 2024 %7 25.10.2024 %9 %J JMIR Aging %G English %X Background: Physical activity has emerged as a modifiable behavioral factor to improve cognitive function. However, research on adherence to remote monitoring of physical activity in older adults is limited. Objective: This study aimed to assess adherence to remote monitoring of physical activity in older adults within a pilot cohort from objective user data, providing insights for the scalability of such monitoring approaches in larger, more comprehensive future studies. Methods: This study included 22 participants from the Boston University Alzheimer’s Disease Research Center Clinical Core. These participants opted into wearing the Verisense watch as part of their everyday routine during 14-day intervals every 3 months. Eighteen continuous physical activity measures were assessed. Adherence was quantified daily and cumulatively across the follow-up period. The coefficient of variation was used as a key metric to assess data consistency across participants over multiple days. Day-to-day variability was estimated by calculating intraclass correlation coefficients using a 2-way random-effects model for the baseline, second, and third days. Results: Adherence to the study on a daily basis outperformed cumulative adherence levels. The median proportion of adherence days (wearing time surpassed 90% of the day) stood at 92.1%, with an IQR spanning from 86.9% to 98.4%. However, at the cumulative level, 32% (7/22) of participants in this study exhibited lower adherence, with the device worn on fewer than 4 days within the requested initial 14-day period. Five physical activity measures have high variability for some participants. Consistent activity data for 4 physical activity measures might be attainable with just a 3-day period of device use. Conclusions: This study revealed that while older adults generally showed high daily adherence to the wearable device, consistent usage across consecutive days proved difficult. These findings underline the effectiveness of wearables in monitoring physical activity in older populations and emphasize the ongoing necessity to simplify usage protocols and enhance user engagement to guarantee the collection of precise and comprehensive data. %R 10.2196/60209 %U https://aging.jmir.org/2024/1/e60209 %U https://doi.org/10.2196/60209 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59762 %T Assessing the Impact of Frailty on Infection Risk in Older Adults: Prospective Observational Cohort Study %A Yang,Ya %A Che,Kechun %A Deng,Jiayan %A Tang,Xinming %A Jing,Wenyuan %A He,Xiuping %A Yang,Jiacheng %A Zhang,Wenya %A Yin,Mingjuan %A Pan,Congcong %A Huang,Xiaoling %A Zhang,Zewu %A Ni,Jindong %K community elderly %K frailty %K infectious diseases %K infectious disease %K older %K China %K questionnaire %K survey %K cohort %K COVID-19 %K infection %K chi-square %K longitudinal analysis %K age-related chronic disease %K chronic disease %K chronic diseases %D 2024 %7 16.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Infectious diseases are among the leading causes of death and disability and are recognized as a major cause of health loss globally. At the same time, frailty as a geriatric syndrome is a rapidly growing major public health problem. However, few studies have investigated the incidence and risk of infectious diseases in frail older people. Thus, research on frailty and infectious diseases is urgently needed. Objective: The purpose of this study was to evaluate the association between frailty and infectious diseases among older adults aged 65 years and older. Methods: In this prospective observational cohort study, we have analyzed the infectious disease prevalence outcomes of older adults aged 65 years and older who participated in frailty epidemiological surveys from March 1, 2018, to March 2023 in Dalang Town, Dongguan City, and from March 1, 2020, to March 2023 in Guancheng Street, Dongguan City. This study has an annual on-site follow-up. Incidence data for infectious diseases were collected through the Chinese Disease Control and Prevention Information System—Infectious Disease Monitoring and Public Health Emergency Monitoring System. A project-developed frailty assessment scale was used to assess the frailty status of study participants. We compared the incidence rate ratios (IRR) of each disease across frailty status, age, and gender to determine the associations among frailty, gender, age, and infectious diseases. Cox proportional hazards regression was conducted to identify the effect of frailty on the risk of demographic factors and frailty on the risk of infectious diseases, with estimations of the hazard ratio and 95% CI. Results: A total of 235 cases of 12 infectious diseases were reported during the study period, with an incidence of 906.21/100,000 person-years in the frailty group. In the same age group, the risk of infection was higher in men than women. Frail older adults had a hazard ratio for infectious diseases of 1.50 (95% CI 1.14‐1.97) compared with healthy older adults. We obtained the same result after sensitivity analyses. For respiratory tract–transmitted diseases (IRR 1.97, 95% CI 1.44‐2.71) and gastrointestinal tract–transmitted diseases (IRR 3.67, 95% CI 1.39‐10.74), frail older adults are at risk. Whereas no significant association was found for blood-borne, sexually transmitted, and contact-transmitted diseases (IRR 0.76, 95% CI 0.37‐1.45). Conclusions: Our study provides additional evidence that frailty components are significantly associated with infectious diseases. Health care professionals must pay more attention to frailty in infectious disease prevention and control. %R 10.2196/59762 %U https://publichealth.jmir.org/2024/1/e59762 %U https://doi.org/10.2196/59762 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63024 %T Exploring the Linkages Among Chronic Illness, Substance Use, and COVID-19 Infection in Adults Aged 50 Years and Older: Retrospective Cross-Sectional Analysis of National Representative Data %A Ruksakulpiwat,Suebsarn %A Niyomyart,Atsadaporn %A Riangkam,Chontira %A Phianhasin,Lalipat %A Benjasirisan,Chitchanok %A Adams,Jon %+ Department of Medical Nursing, Faculty of Nursing, Mahidol University, 2 Wanglang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand, 66 984782692, suebsarn25@gmail.com %K multiple chronic conditions %K medical complexity %K co-occurring conditions %K substance use %K COVID-19 %K SARS-CoV-2 %K older adults %K gerontology %K geriatrics %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The co-occurrence of chronic illnesses and substance use presents complex challenges for health care systems. Understanding the interplay between these factors, compounded by the context of the COVID-19 pandemic, is essential for effective intervention strategies. Objective: This study aims to investigate the relationships among chronic illness, substance use, and COVID-19 infection in adults aged 50 years and older. Methods: Participants were 1196 adults aged 50 years and older. Descriptive statistics were used to describe demographic information. Logistic regressions and multiple regression analyses were used to determine associations between chronic illnesses, substance use, and COVID-19 infection. Mediation analysis was used to determine the effect of chronic illness mediators in the association between COVID-19 concerns and substance use. Results: The mean age was 68 (SD 10.3) years, with 58.6% (701/1196) being women. Adjusted analysis revealed that age and sex (women) significantly predicted a lower level of substance use (P<.05). However, marital status (separated or widowed) and chronic illness significantly predicted a higher level of substance use (P<.05). Furthermore, having dementia, arthritis, and high cholesterol significantly predicted a higher level of concern about the COVID-19 pandemic (P<.05). Logistic regression analysis indicated that individuals with hypertension (odds ratio [OR] 1.91, 95% CI 1.37-2.66; P<.001), lung disease (OR 2.42, 95% CI 1.23-4.75; P=.01), heart condition (OR 1.99, 95% CI 1.28-3.10; P=.002), stroke (OR 2.35, 95% CI 1.07-5.16; P=.03), and arthritis (OR 1.72, 95% CI 1.25-2.37; P=.001) were more likely to have their work affected by the COVID-19 pandemic. The mediation analysis showed a significant effect of COVID-19 concern on substance use through the mediation of chronic illness, with a 95% CI of –0.02 to –0.01 and an indirect effect of –0.01. Conclusions: Our study reveals complex associations among chronic illnesses, substance use, and COVID-19 infection among adults aged 50 years and older. It underscores the impact of demographics and specific chronic conditions on substance use behaviors and COVID-19 concerns. In addition, certain chronic illnesses were linked to heightened vulnerability in employment status during the pandemic. These findings emphasize the need for targeted interventions addressing physical health and substance use in this population during the COVID-19 pandemic. %M 39405517 %R 10.2196/63024 %U https://aging.jmir.org/2024/1/e63024 %U https://doi.org/10.2196/63024 %U http://www.ncbi.nlm.nih.gov/pubmed/39405517 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50617 %T Investigating Frailty, Polypharmacy, Malnutrition, Chronic Conditions, and Quality of Life in Older Adults: Large Population-Based Study %A Liu,Yunmei %A Huang,Lei %A Hu,Fei %A Zhang,Xiuwen %+ Department of General Surgery, Feidong People’s Hospital, East District of the First Affiliated Hospital of Anhui Medical University, Cuozhen Road 20, Dianpu Town, Anhui Province, Hefei, 231600, China, 86 13856015472, zhangyisheng08@126.com %K statistical analyses %K data mining %K older adults %K geriatric syndromes %K frailty %K polypharmacy %K malnutrition %K chronic conditions %K quality of life %K large population-based study %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Aging, a significant public health issue, is associated with multiple concurrent chronic diseases and aging-related conditions (geriatric syndromes). Objective: This study aims to investigate the impact of age and chronic conditions on geriatric syndromes and the intercorrelations between multiple geriatric syndromes and quality of life (QoL) in older adults (aged ≥65 years) at the population level. Methods: A large representative sample was randomly selected from a county in China, Feidong, with 17 towns and 811,867 residents. Multiple chronic conditions, geriatric syndromes (frailty, polypharmacy, and malnutrition), and QoL were assessed and compared. Associations of demographic information and chronic conditions with geriatric conditions and QoL in older adults were assessed using multivariable-adjusted logistic regression. Intercorrelations between age, multiple geriatric syndromes, and QoL were investigated using both correlation analysis and restricted cubic splines–based multivariable-adjusted dose-response analysis. Results: Older adults comprised 43.42% (3668/8447) of the entire study population. The prevalence of frailty, premalnutrition or malnutrition, polypharmacy, and impaired QoL (median age 73, IQR 69-78 years; 1871/3668, 51% men) was 8.26% (303/3668), 15.59% (572/3668), 3.22% (118/3668), and 10.8% (396/3668), respectively. Different age and sex subgroups mostly had similar prevalence of geriatric syndromes (except that frailty occurred more often with older age). Premalnutrition or malnutrition were associated with a lower frequency of obesity and a higher frequency of constipation, polypharmacy with a higher frequency of diabetes and constipation, frailty with a higher frequency of constipation and hernia, and impaired QoL with a higher frequency of hypertension, diabetes, physical disability, and constipation. Mini Nutritional Assessment–Short Form, Groningen Frailty Indicator, and EQ-5D-5L scores, as well as the number of medications used, mostly predicted each other and QoL. Impaired QoL was associated with a higher frequency of frailty, premalnutrition or malnutrition, and polypharmacy, and frailty with a higher frequency of premalnutrition or malnutrition and polypharmacy. At a 1.5-year follow-up, impaired QoL was linked to polypharmacy and frailty at baseline, premalnutrition or malnutrition and polypharmacy were associated with frailty at baseline, and frailty was linked to both premalnutrition or malnutrition and polypharmacy at baseline. Causal mediation analyses showed that frailty mediated the link between polypharmacy and worse QoL and that polypharmacy mediated the link between frailty and worse QoL. Conclusions: In this large population-based study of older adults, multiple chronic conditions were associated with ≥1 of the investigated geriatric syndromes. Geriatric syndromes were mostly intercorrelated with, and well predictive of, each other and QoL; and causal relationships existed between geriatric syndromes and QoL, with other geriatric syndromes being mediators. The findings might be biased by residual confounding factors. It is important to perform personalized geriatric syndrome assessments stratified by chronic condition; active prevention of, or intervention for, any syndrome might help to reduce the others and improve QoL. %M 39145920 %R 10.2196/50617 %U https://publichealth.jmir.org/2024/1/e50617 %U https://doi.org/10.2196/50617 %U http://www.ncbi.nlm.nih.gov/pubmed/39145920 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59810 %T Determinants of Visual Impairment Among Chinese Middle-Aged and Older Adults: Risk Prediction Model Using Machine Learning Algorithms %A Mao,Lijun %A Yu,Zhen %A Lin,Luotao %A Sharma,Manoj %A Song,Hualing %A Zhao,Hailei %A Xu,Xianglong %K visual impairment %K China %K middle-aged and elderly adults %K machine learning %K prediction model %D 2024 %7 9.10.2024 %9 %J JMIR Aging %G English %X Background: Visual impairment (VI) is a prevalent global health issue, affecting over 2.2 billion people worldwide, with nearly half of the Chinese population aged 60 years and older being affected. Early detection of high-risk VI is essential for preventing irreversible vision loss among Chinese middle-aged and older adults. While machine learning (ML) algorithms exhibit significant predictive advantages, their application in predicting VI risk among the general middle-aged and older adult population in China remains limited. Objective: This study aimed to predict VI and identify its determinants using ML algorithms. Methods: We used 19,047 participants from 4 waves of the China Health and Retirement Longitudinal Study (CHARLS) that were conducted between 2011 and 2018. To envisage the prevalence of VI, we generated a geographical distribution map. Additionally, we constructed a model using indicators of a self-reported questionnaire, a physical examination, and blood biomarkers as predictors. Multiple ML algorithms, including gradient boosting machine, distributed random forest, the generalized linear model, deep learning, and stacked ensemble, were used for prediction. We plotted receiver operating characteristic and calibration curves to assess the predictive performance. Variable importance analysis was used to identify key predictors. Results: Among all participants, 33.9% (6449/19,047) had VI. Qinghai, Chongqing, Anhui, and Sichuan showed the highest VI rates, while Beijing and Xinjiang had the lowest. The generalized linear model, gradient boosting machine, and stacked ensemble achieved acceptable area under curve values of 0.706, 0.710, and 0.715, respectively, with the stacked ensemble performing best. Key predictors included hearing impairment, self-expectation of health status, pain, age, hand grip strength, depression, night sleep duration, high-density lipoprotein cholesterol, and arthritis or rheumatism. Conclusions: Nearly one-third of middle-aged and older adults in China had VI. The prevalence of VI shows regional variations, but there are no distinct east-west or north-south distribution differences. ML algorithms demonstrate accurate predictive capabilities for VI. The combination of prediction models and variable importance analysis provides valuable insights for the early identification and intervention of VI among Chinese middle-aged and older adults. %R 10.2196/59810 %U https://aging.jmir.org/2024/1/e59810 %U https://doi.org/10.2196/59810 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58089 %T Implementation of a Virtual Reality Intervention in Outpatient Physiotherapy for Chronic Pain: Protocol for a Pilot Implementation Study %A Elser,Alexander %A Kopkow,Christian %A Schäfer,Axel Georg %+ Faculty of Social Work and Health, HAWK University of Applied Sciences and Arts Hildesheim/Holzminden/Göttingen, Hohnsen 4, Hildesheim, 31134, Germany, 49 5121881 12, alexander.elser@hawk.de %K chronic pain %K implementation %K virtual reality %K VR %K physiotherapy %K virtual reality intervention %K pain %K outpatient %K chronic pain conditions %K evidence-based %D 2024 %7 23.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is a global health issue that causes physical, psychological, and social disabilities for patients, as well as high costs for societies. Virtual reality (VR) is a new treatment that provides an opportunity to narrow the gap between clinical practice and recommended care in the use of patient education and behavioral interventions in the outpatient physiotherapy setting. However, there is currently no implementation strategy to integrate VR treatments into this setting. Objective: This protocol outlines a pilot implementation study that aims to (1) identify barriers and facilitators for implementing a VR intervention in outpatient physiotherapy care for people with chronic pain and (2) develop and pilot test an implementation strategy in 5 practices in Germany. Methods: The study consists of 4 phases. The first phase involves adapting the treatment protocol of the VR intervention to the local context of outpatient physiotherapy practices in Germany. The second phase includes the collection of barriers and facilitators through semistructured interviews from physiotherapists and the development of a theory-driven implementation strategy based on the Theoretical Domains framework and the Behavior Change Wheel. This strategy will be applied in the third phase, which will also include a 6-month span of using VR interventions in practices, along with a process evaluation. The fourth phase consists of semistructured interviews to evaluate the developed implementation strategy. Results: The recruitment process and phase 1, including the adaptation of the treatment protocol, have already been completed. We recruited 5 physiotherapy practices in Lower Saxony, Germany, where the VR intervention will be implemented. The collection of barriers and facilitators through semistructured interviews is scheduled to begin in February 2024. Conclusions: This pilot implementation study aims to develop a theory-driven implementation strategy for integrating a VR intervention into outpatient physiotherapy care for people with chronic pain. The identified barriers and facilitators, along with the implementation strategy, will serve as a starting point for future randomized controlled implementation studies in different settings to refine the implementation process and integrate VR interventions into the outpatient care of people with chronic pain. Trial Registration: German Clinical Trials Register DRKS00030862; https://tinyurl.com/3zf7uujx International Registered Report Identifier (IRRID): DERR1-10.2196/58089 %M 39312768 %R 10.2196/58089 %U https://www.researchprotocols.org/2024/1/e58089 %U https://doi.org/10.2196/58089 %U http://www.ncbi.nlm.nih.gov/pubmed/39312768 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52964 %T Investigating the Use of Telemedicine by Health Care Providers to Diagnose and Manage Patients With Musculoskeletal Disorders: Systematic Review and Meta-Analysis %A Vincent,Raphaël %A Charron,Maxime %A Lafrance,Simon %A Cormier,Audrey-Anne %A Kairy,Dahlia %A Desmeules,François %+ School of Rehabilitation, Faculty of Medicine, Université de Montréal, 7077 Avenue du Parc, Montréal, QC, H3N 1X7, Canada, 1 514 343 6791, f.desmeules@umontreal.ca %K telemedicine %K musculoskeletal diseases %K physical examination %K diagnosis %K treatment %K health care %K telecare %K meta-analysis %K systematic review %K telehealth %K orthopedic %K test %K musculoskeletal disorder %K MSKD %K older adult %K older adults %K older person %K older people %K aging %K musculoskeletal %K mobile phone %D 2024 %7 23.9.2024 %9 Review %J J Med Internet Res %G English %X Background: Access to care is a major challenge for patients with musculoskeletal disorders (MSKDs). Telemedicine is one of the solutions to improve access to care. However, initial remote diagnosis of MSKDs involves some challenges, such as the impossibility of touching the patient during the physical examination, which makes it more complex to obtain a valid diagnosis. No meta-analysis has been performed to date to synthesize evidence regarding the initial assessment including a physical evaluation using telemedicine to diagnose patients with MSKDs. Objective: This study aims to appraise the evidence on diagnostic and treatment plan concordance between remote assessment using synchronous or asynchronous forms of telemedicine and usual in-person assessment for the initial evaluation of various MSKDs. Methods: An electronic search was conducted up to August 2023 using terms related to telemedicine and assessment of MSKDs. Methodological quality of studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Random-effect model meta-analyses were performed. The Grading of Recommendations, Assessment, Development, and Evaluations framework was used to synthesize the quality and certainty of the evidence. Results: A total of 23 concordance studies were eligible and included adult participants (N=1493) with various MSKDs. On the basis of high certainty, pooled κ and prevalence-adjusted and bias-adjusted κ for the diagnostic concordance between remote and in-person assessments of MSKDs were 0.80 (95% CI 0.72-0.89; 7 studies, 353 patients) and 0.83 (95% CI 0.76-0.89; 6 studies, 306 patients). On the basis of moderate certainty, pooled Gwet AC1 for treatment plan concordance between remote and in-person assessments of MSKDs was 0.90 (95% CI 0.80-0.99; 2 studies, 142 patients). Conclusions: The diagnostic concordance for MSKDs is good to very good. Treatment plan concordance is probably good to excellent. Studies evaluating the accuracy to detect red and yellow flags as well as the potential increase in associated health care resources use, such as imaging tests, are needed. %M 39312765 %R 10.2196/52964 %U https://www.jmir.org/2024/1/e52964 %U https://doi.org/10.2196/52964 %U http://www.ncbi.nlm.nih.gov/pubmed/39312765 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e60858 %T Effectiveness of 675-nm Wavelength Laser Therapy in the Treatment of Androgenetic Alopecia Among Indian Patients: Clinical Experimental Study %A Chandrashekar,BS %A Lobo,Oliver Clement %A Fusco,Irene %A Madeddu,Francesca %A Zingoni,Tiziano %+ El.En. Group, Via Baldanzese 17, Calenzano, 50041, Italy, 39 3286853105, i.fusco@deka.it %K androgenetic alopecia %K AGA %K 675-nm laser %K Indian patients %K hair restoration %K effectiveness %K laser therapy %K therapy %K treatment %K Indian %K patients %K patient %K India %K hair loss %K hair %K laser stimulation %K hair density %D 2024 %7 23.9.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Androgenetic alopecia (AGA) is the most prevalent cause of hair loss around the world. Objective: The purpose of this study was to evaluate the efficacy of laser stimulation with a 675-nm wavelength for the treatment of AGA in male and female Indian patients. Methods: A total of 20 Indian healthy patients aged 23-57 years who presented a grade of alopecia stage I to stage V underwent one single pass with a 675-nm laser to the scalp area twice a week for a total of 8 sessions, followed by once a week for 4 sessions and once in 2 weeks for 2 sessions. There are 14 laser treatments in total. Macro- and dermatoscopic images have been acquired at T0 (baseline) and T1 (4 months). The vertex, frontal, and parietal areas of the scalp were evaluated. Many parameters were analyzed including hair count and hair density of terminal; mean thickness; vellus follicles; total follicular units; units with 1 hair, 2 hairs, 3 hairs, 4 hairs, and >4 hairs; unit density; and average hair/unit. Results: The macroimages and dermatoscopic evaluations showed good improvement over the entire treated area, with a clear increase in the number of hairs and hair thickness. General parameters such as hair count and hair density showed a percentage increase of around 17%. The hair mean thickness parameters showed a significant (P<.001) percentage increase of 13.91%. Similar results were obtained for terminal and vellus hair: terminal hair count and hair density significantly (P=.04 and P=.01, respectively) increased by 17.45%, vellus hair count increased by 16.67% (P=.06), and the density of vellus hair increased by 16.61% (P=.06). Conclusions: The study findings demonstrate that the 675-nm laser system improved AGA in Indian patients, facilitating the anagen phase and improving hair density and other positive hair parameters. %M 39312769 %R 10.2196/60858 %U https://derma.jmir.org/2024/1/e60858 %U https://doi.org/10.2196/60858 %U http://www.ncbi.nlm.nih.gov/pubmed/39312769 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55089 %T Ayurvedic Management of Presbycusis (Project TOPMAC): Protocol for an Exploratory Randomized Controlled Trial %A V,Krishna Kumar %A Thomas,Sanjeev V %A C Nair,Murugan %A Nair,Parvathy G %A L,Nisha M %A S,Anuradha %A Tripathi,Arunabh %A Mundada,Pallavi %A Yadav,Babita %A Rao,B C S %A D,Sudhakar %A N,Srikanth %+ Central Council for Research in Ayurvedic Sciences, D Block, Janakpuri Institutional Area, New Delhi, 110058, India, 91 7306892140, drkkempran@gmail.com %K presbycusis %K Karnapurana %K Kshirabala Taila %K Rasayana %K Withania somnifera (L.) Dunal %K age-related hearing loss %K hearing loss %K sensorineural %K auditory information %K older adults %K older adult %K geriatrics %K tinnitus %K population-based %K cognitive deterioration %K topical oil pooling %K efficacy %K TOPMAC %K intervention %K hearing status %K effectiveness %K Ayurveda %D 2024 %7 23.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Presbycusis is characterized by sensorineural hearing loss in both ears at high frequencies, which affects more than half of the older adults by the age of 75 years and is often accompanied by tinnitus and cognitive deterioration. Unfortunately, there are no treatments available to restore hearing loss. Treatment mainly focuses on improving the quality of life and communication with hearing aids. Traditional medicine like Ayurveda also explains ailments of a similar nature as Badhirya and advises using drugs with antiaging and neuroprotective activity for treatment. In Ayurveda, Badhirya and Karnanada (senile deafness with tinnitus) are due to vitiation of Vata Dosha. Treatments such as topical oil pooling (Karnapurana) are usually advised to counter Vata, improve hearing capacity, and reduce tinnitus. Kshirabala Taila, a medicated oil formulation prepared with Sida cordifolia Linnaeus, is one of the most preferred oils for topical oil pooling in such conditions, as it has a definitive indication for sensory dysfunctions. Drugs like Withania somnifera (L.) Dunal (Ashwagandha) are also used, as they ameliorate neurodegeneration and help to improve cognitive dysfunction. Objective: We propose an exploratory randomized controlled trial study for evaluating the efficacy of TOPMAC (Topical Oil Pooling with Kshirabala Taila and Supplementation of Ashwagandha Churna) in tinnitus suppression and hearing and cognitive function protection in patients aged 60-75 years with mild to moderate presbycusis. Methods: A parallel, 2-group, exploratory randomized controlled trial will be conducted in an Indian Ayurvedic research center at its outpatient service. Participants (N=60) with mild to moderate presbycusis will be recruited by screening. Participants will be randomized (computer-generated 1:1) to receive either basic treatment and health education (BTHE) or BTHE+TOPMAC for 24 weeks. The primary objective is to compare the efficacy of TOPMAC with that of BTHE in the protection of hearing function. The secondary objective is to compare the efficacy of TOPMAC with that of BTHE in tinnitus suppression and cognitive function protection. Results: This project was funded in January 2023. The institutional ethics committees at National Ayurveda Research Institute for Panchakarma (3/1/2020/NARIP/Tech/2036) and Institute for Communicative and Cognitive Neuro Sciences (IEC006) approved this study. The first patient was enrolled in September 2023; 22 participants were enrolled as of August 2024. The data analysis is yet to start, and the results are expected to be published by January 2025. Conclusions: If this exploratory trial is proven effective, it will steer the setting of a definitive randomized controlled trial to test whether the TOPMAC intervention can be incorporated as a cost-effective integrative approach for managing presbycusis. The Indian government has already launched a National Program for Prevention and Control of Deafness to benefit the deaf population. TOPMAC may later be considered for integration with the national program. Trial Registration: Clinical Trials Registry India CTRI/2023/04/051485; https://tinyurl.com/2h2hry3n International Registered Report Identifier (IRRID): DERR1-10.2196/55089 %M 39312772 %R 10.2196/55089 %U https://www.researchprotocols.org/2024/1/e55089 %U https://doi.org/10.2196/55089 %U http://www.ncbi.nlm.nih.gov/pubmed/39312772 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54402 %T Examining the Relationship Between Social Support, Self-Efficacy, Diabetes Self-Management, and Quality of Life Among Rural Individuals With Type 2 Diabetes in Eastern China: Path Analytical Approach %A Wang,Lizhu %A Li,Li %A Qiu,Yang %A Li,Sihan %A Wang,Zhonghua %+ School of Health Policy and Management, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 13851584945, wzh04@njmu.edu.cn %K Type 2 diabetes %K social support %K self-efficacy %K self-management %K quality of life %K structural equation modeling %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Patients with type 2 diabetes (T2D) in rural China frequently exhibit inadequate diabetes self-management (DSM) and a reduced quality of life (QoL). Social support and self-efficacy are known to influence DSM and QoL. However, the pathways through which social support and self-efficacy impact DSM and QoL among patients with T2D in rural China has yet to be fully elucidated. Objective: This study offers a foundation for developing policies in rural chronic disease management, thereby, contributing to the improvement of T2D prevention and control in China and other transitional countries. Methods: This study used a cross-sectional design, collecting data from a survey conducted between May and July 2021 on DSM and QoL among rural patients diagnosed with T2D in 2 townships in East China. All patients with T2D were enrolled through cluster sampling from the township health center database, and a questionnaire survey was administered by investigators. Structural equation modeling and multiple regression analyses were used to explore the pathways through which social support influences DSM and QoL, as well as the mediating role of self-efficacy. Results: It was found that the DSM score (mean 37.42, SD 7.70) was less than half of the maximum theoretical score. The QoL score (mean 48.92, SD 8.88) accounted for 36% of the maximum theoretical score. Social support directly and positively affected the DSM and QoL of Chinese rural patients with T2D (P<.01); an increase of 1 unit in social support was associated with a direct increment of 0.339 units in DSM and 0.397 units in QoL. Self-efficacy played a positive mediating role (P<.01), further increasing DSM and QoL by 0.147 and 0.159 units, respectively. The mediating effect of self-efficacy accounted for 30.2% and 28.6% of the total effect of social support on DSM and QoL. Furthermore, the family and friend dimension of social support, along with the symptom and disease management dimensions of self-efficacy, were significantly associated with DSM or QoL (P<.01). Conclusions: The study confirmed the direct and indirect influences of social support on DSM and QoL and elucidated the mediating effect of self-efficacy among rural patients with T2D in eastern China. Interventions should be developed to enhance both social support and self-efficacy, creating a positive cycle of mutual reinforcement to improve DSM and QoL among this group. %M 39298755 %R 10.2196/54402 %U https://publichealth.jmir.org/2024/1/e54402 %U https://doi.org/10.2196/54402 %U http://www.ncbi.nlm.nih.gov/pubmed/39298755 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55572 %T Factors Influencing Malnutrition Among Older Adult Residents in the Western Region of Saudi Arabia: Sex Differential Study %A Ghabashi,Mai Adil %A Azzeh,Firas Sultan %+ Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 715, Makkah, 21955, Saudi Arabia, 966 540833661, fsazzeh@uqu.edu.sa %K Elderly %K Makkah %K Malnutrition %K Mini Nutritional Assessment Short Form %K Risk factors %D 2024 %7 16.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The global population of older adults is on the rise. As people age, their physical functions gradually decline, leading to a decrease in the overall functioning of different organ systems. Due to these changes, older individuals are at a higher risk of encountering various adverse health outcomes and complications, such as malnutrition. Objective: This study aims to investigate the prevalence of malnutrition and its associated factors among older adults dwelling in the western region of Saudi Arabia. We have analyzed these factors separately for both men and women to understand any potential sex differences. Methods: A nonrandomized cross-sectional study was conducted for older adults aged ≥60 years in the western region of Saudi Arabia. Personal information was obtained through a closed questionnaire. The Mini Nutritional Assessment Short Form was used to determine the malnutrition status of older adults. Consequently, the individuals were divided into 2 groups: normal and malnourished. To assess the risk factors related to malnutrition, the odds ratio (OR) and 95% CI were determined using a binary logistic regression. Results: The prevalence of malnutrition in men and women was around 7% and 5%, respectively. Potential risk factors related to malnutrition in men were higher age (OR 1.263, 95% CI 1.086-1.468; P=.002), being widowed (OR 8.392, 95% CI 1.002-70.258; P=.049), and having dental problems (OR 9.408, 95% CI 1.863-47.514; P=.007). On the other hand, risk factors associated with malnutrition in women were lower BMI (OR 0.843, 95% CI 0.747-0.952; P=.006) and being disabled (OR 18.089, 95% CI 0.747-0.952; P=.006). Conclusions: The findings of this study provide important insights into the risk factors for malnutrition among older adults in the western region of Saudi Arabia. While the overall prevalence of malnutrition was relatively low, the analysis revealed distinct risk factors for older men and women. Interventions developed based on the identified risk factors may prove effective in addressing the issue of malnutrition within this population. %M 39284178 %R 10.2196/55572 %U https://aging.jmir.org/2024/1/e55572 %U https://doi.org/10.2196/55572 %U http://www.ncbi.nlm.nih.gov/pubmed/39284178 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51564 %T Smartphone-Based Hand Function Assessment: Systematic Review %A Fu,Yan %A Zhang,Yuxin %A Ye,Bing %A Babineau,Jessica %A Zhao,Yan %A Gao,Zhengke %A Mihailidis,Alex %+ School of Mechanical Science and Engineering, Huazhong University of Science and Technology, 1037 Luoyu Road, Hongshan District, Wuhan, 430074, China, 86 17381571416, 953385493@qq.com %K hand function assessment %K smartphone-based sensing %K rehabilitation %K digital health %K mobile health %K mHealth %K mobile phone %D 2024 %7 16.9.2024 %9 Review %J J Med Internet Res %G English %X Background: Hand function assessment heavily relies on specific task scenarios, making it challenging to ensure validity and reliability. In addition, the wide range of assessment tools, limited and expensive data recording, and analysis systems further aggravate the issue. However, smartphones provide a promising opportunity to address these challenges. Thus, the built-in, high-efficiency sensors in smartphones can be used as effective tools for hand function assessment. Objective: This review aims to evaluate existing studies on hand function evaluation using smartphones. Methods: An information specialist searched 8 databases on June 8, 2023. The search criteria included two major concepts: (1) smartphone or mobile phone or mHealth and (2) hand function or function assessment. Searches were limited to human studies in the English language and excluded conference proceedings and trial register records. Two reviewers independently screened all studies, with a third reviewer involved in resolving discrepancies. The included studies were rated according to the Mixed Methods Appraisal Tool. One reviewer extracted data on publication, demographics, hand function types, sensors used for hand function assessment, and statistical or machine learning (ML) methods. Accuracy was checked by another reviewer. The data were synthesized and tabulated based on each of the research questions. Results: In total, 46 studies were included. Overall, 11 types of hand dysfunction–related problems were identified, such as Parkinson disease, wrist injury, stroke, and hand injury, and 6 types of hand dysfunctions were found, namely an abnormal range of motion, tremors, bradykinesia, the decline of fine motor skills, hypokinesia, and nonspecific dysfunction related to hand arthritis. Among all built-in smartphone sensors, the accelerometer was the most used, followed by the smartphone camera. Most studies used statistical methods for data processing, whereas ML algorithms were applied for disease detection, disease severity evaluation, disease prediction, and feature aggregation. Conclusions: This systematic review highlights the potential of smartphone-based hand function assessment. The review suggests that a smartphone is a promising tool for hand function evaluation. ML is a conducive method to classify levels of hand dysfunction. Future research could (1) explore a gold standard for smartphone-based hand function assessment and (2) take advantage of smartphones’ multiple built-in sensors to assess hand function comprehensively, focus on developing ML methods for processing collected smartphone data, and focus on real-time assessment during rehabilitation training. The limitations of the research are 2-fold. First, the nascent nature of smartphone-based hand function assessment led to limited relevant literature, affecting the evidence’s completeness and comprehensiveness. This can hinder supporting viewpoints and drawing conclusions. Second, literature quality varies due to the exploratory nature of the topic, with potential inconsistencies and a lack of high-quality reference studies and meta-analyses. %M 39283676 %R 10.2196/51564 %U https://www.jmir.org/2024/1/e51564 %U https://doi.org/10.2196/51564 %U http://www.ncbi.nlm.nih.gov/pubmed/39283676 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53064 %T Exploring the Feasibility of Digital Voice Assistants for Delivery of a Home-Based Exercise Intervention in Older Adults With Obesity and Type 2 Diabetes Mellitus: Randomized Controlled Trial %A Glavas,Costas %A Scott,David %A Sood,Surbhi %A George,Elena S %A Daly,Robin M %A Gvozdenko,Eugene %A de Courten,Barbora %A Jansons,Paul %+ Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 448776661, cglavas@deakin.edu.au %K older adults %K type 2 diabetes mellitus %K voice activation %K digital health %K exercise %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Current clinical guidelines for the management of type 2 diabetes mellitus (T2DM) in older adults recommend the use of antihyperglycemic medications, monitoring of blood glucose levels, regular exercise, and a healthy diet to improve glycemic control and reduce associated comorbidities. However, adherence to traditional exercise programs is poor (<35%). Common barriers to adherence include fear of hypoglycemia and the need for blood glucose level monitoring before exercise. Digital health strategies offer great promise for managing T2DM as they facilitate patient-practitioner communication, support self-management, and improve access to health care services for underserved populations. We have developed a novel web-based software program allowing practitioners to create tailored interventions and deliver them to patients via digital voice assistants (DVAs) in their own homes. Objective: We aim to evaluate the feasibility of a 12-week, home-based, personalized lifestyle intervention delivered and monitored by DVAs for older adults with obesity and T2DM. Methods: In total, 50 older adults with obesity aged 50-75 years with oral hypoglycemic agent–treated T2DM were randomized to the intervention (DVA, n=25) or a control group (n=25). Participants allocated to the DVA group were prescribed a home-based muscle strengthening exercise program (~20- to 30-min sessions) and healthy eating intervention, delivered via DVAs (Alexa Echo Show 8; Amazon) using newly developed software (“Buddy Link”; Great Australian Pty Ltd). Control group participants received generalized physical activity information via email. Outcomes were feasibility, DVA usability (System Usability Scale), and objectively assessed physical activity and sedentary time (wrist-worn accelerometers). Results: In total, 45 (90%) out of 50 participants completed this study. Mean adherence to prescribed exercise was 85% (SD 43%) with no intervention-related adverse events. System usability was rated above average (70.4, SD 16.9 out of 100). Compared with controls, the DVA group significantly decreased sedentary time (mean difference –67, SD 23; 95% CI –113 to –21 min/d), which was represented by a medium to large effect size (d=–0.6). Conclusions: A home-based lifestyle intervention delivered and monitored by health professionals using DVAs was feasible for reducing sedentary behavior and increasing moderate-intensity activity in older adults with obesity and T2DM. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000307808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381364&isReview=true %M 39270212 %R 10.2196/53064 %U https://aging.jmir.org/2024/1/e53064 %U https://doi.org/10.2196/53064 %U http://www.ncbi.nlm.nih.gov/pubmed/39270212 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e62667 %T Effect of Semaglutide on Physical Function, Body Composition, and Biomarkers of Aging in Older Adults With Overweight and Insulin Resistance: Protocol for an Open-Labeled Randomized Controlled Trial %A Cortes,Tiffany M %A Vasquez,Libia %A Serra,Monica C %A Robbins,Ronna %A Stepanenko,Allison %A Brown,Kevin %A Barrus,Hannah %A Campos,Annalisa %A Espinoza,Sara E %A Musi,Nicolas %+ Division of Endocrinology, Department of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States, 1 210 949 9759, cortest@uthscsa.edu %K glucagon-like peptide %K lean body mass %K physical function %K biomarkers of aging %K semaglutide %D 2024 %7 13.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults with type 2 diabetes mellitus (T2DM) or prediabetes are at increased risk of adverse changes in body composition, physical function, and aging-related biomarkers compared to those with normal glucose tolerance. Semaglutide is a glucagon-like peptide 1 receptor agonist that has been approved for T2DM and chronic weight management. Although semaglutide is effective for weight loss and T2DM management, its effects on lean body mass, physical function, and biomarkers of aging are understudied in older adults. Objective: This study aims to compare the effects of lifestyle counseling with and that without semaglutide on body composition, physical function, and biomarkers of aging in older adults. Methods: This is an open-label randomized controlled trial. A total of 20 adults (aged 65 years and older) with elevated BMI (27-40 kg/m2) and prediabetes or well-controlled T2DM (hemoglobin A1c 5.7%-7.5%) are recruited, stratified by sex, and randomized 1:1 to one of 2 groups (semaglutide plus lifestyle counseling vs lifestyle counseling alone) and followed up for 5 months. Those in the semaglutide group are titrated to 1 mg weekly, as tolerated, for 12 weeks. Lifestyle counseling is given by registered dietitians and based on the Diabetes Prevention Program Lifestyle Change Program. Our primary outcomes include changes in lean mass, physical function, and biomarkers of aging. Body composition is measured by dual-energy x-ray absorptiometry and includes total fat mass and lean mass. Physical function is measured by 6-minute walk distance, grip strength, and short physical performance battery. Biomarkers of aging are measured in blood, skeletal muscle, and abdominal adipose tissue to include C-reactive protein, interleukin-6, tumor necrosis factors α, and β galactosidase staining. Results: The study was funded in December 2021 with a projected data collection period from spring 2023 through summer 2024. Conclusions: Despite the elevated risk of adverse changes in body composition, physical function, and biomarkers of aging among older adults with glucose intolerance and elevated adiposity, the benefits and risks of commonly prescribed antihyperglycemic or weight loss medications such as semaglutide are understudied. This study aims to fill this knowledge gap to inform clinicians about the potential for additional clinically meaningful, nonglycemic effects of semaglutide. Trial Registration: ClinicalTrials.gov NCT05786521; https://clinicaltrials.gov/study/NCT05786521 International Registered Report Identifier (IRRID): DERR1-10.2196/62667 %M 39269759 %R 10.2196/62667 %U https://www.researchprotocols.org/2024/1/e62667 %U https://doi.org/10.2196/62667 %U http://www.ncbi.nlm.nih.gov/pubmed/39269759 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e53431 %T Effectiveness of Technological Interventions for Older Adults With Parkinson Disease: Systematic Review %A Bevilacqua,Roberta %A Benadduci,Marco %A Barbarossa,Federico %A Amabili,Giulio %A Di Donna,Valentina %A Martella,Clotilda %A Pelliccioni,Giuseppe %A Riccardi,Giovanni Renato %A Maranesi,Elvira %+ IRCCS INRCA, Via Santa Margherita 5, Ancona, 60124, Italy, 39 0718004767, f.barbarossa@inrca.it %K technological intervention %K Parkinson disease %K randomized controlled trail %K older adults %K efficacy %D 2024 %7 9.9.2024 %9 Review %J JMIR Serious Games %G English %X Background: Among the older population, Parkinson disease (PD) stands out as a leading contributor to disability. Clinically, the foremost objectives in managing PD involve proactively delaying and preventing disability. Understanding the pivotal role of gait and balance in daily functionality holds substantial clinical significance, signaling imminent disability and prompting a reevaluation of management approaches. A key priority lies in identifying novel and effective interventions for symptoms that substantially contribute to disability. Objective: This paper presents a systematic review that critically examines the existing body of literature on the use of technology in the rehabilitation of older patients with PD. By synthesizing current evidence, we aim to provide insights into the state of the field, identify gaps in knowledge, and offer recommendations for future research and clinical practice. Methods: A systematic review of the literature was conducted in September 2023 analyzing manuscripts and papers of the last 5 years from the PubMed, Scopus, Embase, Web of Science, and CINAHL databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 14 papers were included. The inclusion criteria are as follows: (1) randomized controlled trial, (2) PD in people aged 65 years and older, and (3) use of technology in the rehabilitation training in the older population. Results: A large portion of effective interventions relies on the incorporation of technology, particularly through virtual reality exergames. This technology appears to have effects not only on the cognitive aspect but also on the physical domain. The analysis of the results clearly indicates that, in terms of gait and balance performance, the technological intervention outperforms the traditional approach, irrespective of the specific technology employed. Conclusions: This systematic review seeks to shed light on the evolving landscape of technology-assisted rehabilitation for older individuals with PD. As we delve into the available evidence, we will assess the extent to which technology can serve as a valuable adjunct to conventional therapy, offering new avenues for optimized care and improved outcomes in this growing patient demographic. As we sift through the existing evidence, our goal is to evaluate the potential of technology as a valuable supplement to traditional therapy, presenting fresh opportunities for enhanced care and better outcomes in this expanding patient demographic. %M 39250193 %R 10.2196/53431 %U https://games.jmir.org/2024/1/e53431 %U https://doi.org/10.2196/53431 %U http://www.ncbi.nlm.nih.gov/pubmed/39250193 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45858 %T Peer Support for Chronic Pain in Online Health Communities: Quantitative Study on the Dynamics of Social Interactions in a Chronic Pain Forum %A Necaise,Aaron %A Amon,Mary Jean %+ School of Modeling, Simulation, and Training, University of Central Florida, Partnership II, 3100 Technology Parkway, Orlando, FL, 32816, United States, 1 321 300 4582, aaron.necaise@ucf.edu %K social media %K chronic pain %K peer support %K sentiment analysis %K wavelet analysis %K nonlinear dynamics %K growth curve modeling %K online health communities %K affective synchrony %D 2024 %7 5.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Peer support for chronic pain is increasingly taking place on social media via social networking communities. Several theories on the development and maintenance of chronic pain highlight how rumination, catastrophizing, and negative social interactions can contribute to poor health outcomes. However, little is known regarding the role web-based health discussions play in the development of negative versus positive health attitudes relevant to chronic pain. Objective: This study aims to investigate how participation in online peer-to-peer support communities influenced pain expressions by examining how the sentiment of user language evolved in response to peer interactions. Methods: We collected the comment histories of 199 randomly sampled Reddit (Reddit, Inc) users who were active in a popular peer-to-peer chronic pain support community over 10 years. A total of 2 separate natural language processing methods were compared to calculate the sentiment of user comments on the forum (N=73,876). We then modeled the trajectories of users’ language sentiment using mixed-effects growth curve modeling and measured the degree to which users affectively synchronized with their peers using bivariate wavelet analysis. Results: In comparison to a shuffled baseline, we found evidence that users entrained their language sentiment to match the language of community members they interacted with (t198=4.02; P<.001; Cohen d=0.40). This synchrony was most apparent in low-frequency sentiment changes unfolding over hundreds of interactions as opposed to reactionary changes occurring from comment to comment (F2,198=17.70; P<.001). We also observed a significant trend in sentiment across all users (β=–.02; P=.003), with users increasingly using more negative language as they continued to interact with the community. Notably, there was a significant interaction between affective synchrony and community tenure (β=.02; P=.02), such that greater affective synchrony was associated with negative sentiment trajectories among short-term users and positive sentiment trajectories among long-term users. Conclusions: Our results are consistent with the social communication model of pain, which describes how social interactions can influence the expression of pain symptoms. The difference in long-term versus short-term affective synchrony observed between community members suggests a process of emotional coregulation and social learning. Participating in health discussions on Reddit appears to be associated with both negative and positive changes in sentiment depending on how individual users interacted with their peers. Thus, in addition to characterizing the sentiment dynamics existing within online chronic pain communities, our work provides insight into the potential benefits and drawbacks of relying on support communities organized on social media platforms. %M 39235845 %R 10.2196/45858 %U https://www.jmir.org/2024/1/e45858 %U https://doi.org/10.2196/45858 %U http://www.ncbi.nlm.nih.gov/pubmed/39235845 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57196 %T Perspectives and Experiences on eHealth Solutions for Coping With Chronic Pain: Qualitative Study Among Older People Living With Chronic Pain %A De Lucia,Annalisa %A Donisi,Valeria %A Pasini,Ilenia %A Polati,Enrico %A Del Piccolo,Lidia %A Schweiger,Vittorio %A Perlini,Cinzia %+ Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale Ludovico Antonio Scuro, 10, Verona, 37134, Italy, 39 045 812 6414, valeria.donisi@univr.it %K older adults %K qualitative method %K pain %K coping strategies %K eHealth %K pain management %K mobile phone %D 2024 %7 5.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Chronic noncancer pain (CNCP) is a major health issue among the older population, affecting multiple aspects of individual functioning. Recently, the use of eHealth solutions has been proposed in supporting chronic pain self-management even among older adults, although some barriers have emerged. Few qualitative studies, with none conducted in Mediterranean countries, have explored older people’s experiences and perceptions regarding the types of strategies used to cope with chronic pain and eHealth tools for chronic pain management. Objective: This study’s objectives were to explore the perspectives and experiences of older adults regarding the coping strategies used to manage chronic pain, the use of digital technologies in everyday life, and the potentiality and barriers in using those technologies for health and pain management. Methods: A multimethod approach (ie, self-report questionnaires and a semistructured interview) has been adopted targeting older adults (ie, those who are aged 65 to 80 years and presenting different types of CNCP) who are attending a pain therapy center in Italy. Qualitative answers were analyzed using thematic analysis. Results: Overall, participants reported using a variety of pain coping strategies; however, they showed an attitude of resignation to their CNCP condition. Nearly 70% (12/18) of the interviewees referred to using digital technologies for purposes related to health and pain management, mostly involving very basic management activities. The participants’ opinions on the useful functions that need to be incorporated in eHealth tools for chronic pain management have been categorized into four themes: (1) specific pain self-management skills, (2) support in organizing various health-related aspects, (3) sharing experiences with others, and (4) increasing pain-related personal knowledge. Conversely, the following potential barriers to adopting eHealth tools emerged: (1) computer illiteracy, (2) negative effects or risks, (3) impersonal interaction, and (4) physical limitations. Conclusions: The use of eHealth solutions still seems low, often being accompanied by a perceived lack of digital skills or attitude among a sample of older adults from Italy with CNCP. Before introducing innovative eHealth solutions, it would be of primary importance to take action to enhance, on the one hand, self-efficacy in pain management and, on the other, the digital literacy level among older people. %M 39235831 %R 10.2196/57196 %U https://aging.jmir.org/2024/1/e57196 %U https://doi.org/10.2196/57196 %U http://www.ncbi.nlm.nih.gov/pubmed/39235831 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e59867 %T Implementation of Artificial Intelligence–Based Diabetic Retinopathy Screening in a Tertiary Care Hospital in Quebec: Prospective Validation Study %A Antaki,Fares %A Hammana,Imane %A Tessier,Marie-Catherine %A Boucher,Andrée %A David Jetté,Maud Laurence %A Beauchemin,Catherine %A Hammamji,Karim %A Ong,Ariel Yuhan %A Rhéaume,Marc-André %A Gauthier,Danny %A Harissi-Dagher,Mona %A Keane,Pearse A %A Pomp,Alfons %+ Institute of Ophthalmology, University College London, 11-43 Bath St, London, EC1V 9EL, United Kingdom, 44 20 7608 6800, f.antaki@ucl.ac.uk %K artificial intelligence %K diabetic retinopathy %K screening %K clinical validation %K diabetic %K diabetes %K screening %K tertiary care hospital %K validation study %K Quebec %K Canada %K vision %K vision loss %K ophthalmological %K AI %K detection %K eye %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Diabetic retinopathy (DR) affects about 25% of people with diabetes in Canada. Early detection of DR is essential for preventing vision loss. Objective: We evaluated the real-world performance of an artificial intelligence (AI) system that analyzes fundus images for DR screening in a Quebec tertiary care center. Methods: We prospectively recruited adult patients with diabetes at the Centre hospitalier de l’Université de Montréal (CHUM) in Montreal, Quebec, Canada. Patients underwent dual-pathway screening: first by the Computer Assisted Retinal Analysis (CARA) AI system (index test), then by standard ophthalmological examination (reference standard). We measured the AI system's sensitivity and specificity for detecting referable disease at the patient level, along with its performance for detecting any retinopathy and diabetic macular edema (DME) at the eye level, and potential cost savings. Results: This study included 115 patients. CARA demonstrated a sensitivity of 87.5% (95% CI 71.9-95.0) and specificity of 66.2% (95% CI 54.3-76.3) for detecting referable disease at the patient level. For any retinopathy detection at the eye level, CARA showed 88.2% sensitivity (95% CI 76.6-94.5) and 71.4% specificity (95% CI 63.7-78.1). For DME detection, CARA had 100% sensitivity (95% CI 64.6-100) and 81.9% specificity (95% CI 75.6-86.8). Potential yearly savings from implementing CARA at the CHUM were estimated at CAD $245,635 (US $177,643.23, as of July 26, 2024) considering 5000 patients with diabetes. Conclusions: Our study indicates that integrating a semiautomated AI system for DR screening demonstrates high sensitivity for detecting referable disease in a real-world setting. This system has the potential to improve screening efficiency and reduce costs at the CHUM, but more work is needed to validate it. %M 39226095 %R 10.2196/59867 %U https://diabetes.jmir.org/2024/1/e59867 %U https://doi.org/10.2196/59867 %U http://www.ncbi.nlm.nih.gov/pubmed/39226095 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53513 %T Medication Management Strategies to Support Medication Adherence: Interview Study With Older Adults %A Gualtieri,Lisa %A Rigby,Mathilda %A Wang,Deelia %A Mann,Elaine %+ Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, United States, 1 7813309456, lisa.gualtieri@tufts.edu %K home medication management %K medication adherence %K prescription drugs %K adherence devices %K adherence apps %K pill cases %K aging in place %K independent living %K aging %K medication %K older adults %K prescription %K interview %K interview design %K design %K app %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Home medication management has been insufficiently studied, including the factors that impact the development and effectiveness of adherence strategies under both routine and anomalous circumstances. Older adults are a particularly important population to study due to the greater likelihood of taking medication in combination with the desire to “age in place.” Objective: This interview study aims to understand how older adults develop medication management strategies, identify when and why such strategies succeed or fail, learn more about how older adults think about their medication, and explore interventions that increase medication adherence. Methods: This study used a qualitative, semistructured interview design to elicit older adults’ experiences with home medication management. Overall, 22 participants aged ≥50 years taking 1 to 3 prescription medications were recruited and interviewed. Interview responses were recorded, and thematic, qualitative analysis was performed by reviewing recordings and identifying recurring patterns and themes. Responses were systematically coded, which not only facilitated the identification of these themes but also allowed us to quantify the prevalence of behaviors and perceptions, providing a robust understanding of medication management and medication adherence. Results: Participants reported developing home medication management strategies on their own, with none of the participants receiving guidance from health care providers and 59% (13/22) of the participants using trial and error. The strategies developed by study participants were all unique and generally encompassed prescription medication and vitamins or supplements, with no demarcation between what was prescribed or recommended by a physician and what they selected independently. Participants thought about their medications by their chemical name (10/22, 45%), by the appearance of the pill (8/22, 36%), by the medication’s purpose (2/22, 9%), or by the medication’s generic name (2/22, 9%). Pill cases (17/22, 77%) were more popular than prescription bottles (5/22, 23%) for storage of daily medication. Most participants (19/22, 86%) stored their pill cases or prescription bottles in visible locations in the home, and those using pill cases varied in their refill routines. Participants used ≥2 routines or objects as triggers to take their medication. Nonadherence was associated with a disruption to their routine. Finally, only 14% (3/22) of the participants used a time-based reminder or alarm, and none of the participants used a medication adherence device or app. Conclusions: Participants in our study varied considerably in their home medication management strategies and developed unique routines to remember to take their medication as well as to refill their pill cases. To reduce trial and error in establishing a strategy, there are opportunities for physicians and pharmacists to provide adherence guidance to older adults. To minimize the impact of disruptions on adherence, there are opportunities to develop more durable strategies and to design aids to medication adherence that leverage established daily routines. %M 39137021 %R 10.2196/53513 %U https://www.i-jmr.org/2024/1/e53513 %U https://doi.org/10.2196/53513 %U http://www.ncbi.nlm.nih.gov/pubmed/39137021 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e52648 %T Evaluation of a New Telemedicine System for Early Detection of Cardiac Instability in Patients With Chronic Heart Failure: Real-Life Out-of-Hospital Study %A Urien,Jean Marie %A Berthelot,Emmanuelle %A Raphael,Pierre %A Moine,Thomas %A Lopes,Marie Emilie %A Assayag,Patrick %A Jourdain,Patrick %+ CHU Bicêtre, 78 rue du general Leclerc, Le Kremlin Bicêtre, 94270, France, 33 145213735, emmanuelle.berthelot@aphp.fr %K telemedicine system %K follow-up %K detection %K heart failure %K chronic heart failure %K CHF %K heart disease %K ambulatory patient %K ambulatory patients %K home-based %K TwoCan Pulse %K telecardiology %K cardiology %K e-device %K mHealth %K mobile health %K app %K apps %K application %K applications %K effectiveness %K real-life setting %K remote monitoring %K virtual monitoring %K France %K men %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older man %K ageing %K aging %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: For a decade, despite results from many studies, telemedicine systems have suffered from a lack of recommendations for chronic heart failure (CHF) care because of variable study results. Another limitation is the hospital-based architecture of most telemedicine systems. Some systems use an algorithm based on daily weight, transcutaneous oxygen measurement, and heart rate to detect and treat acute heart failure (AHF) in patients with CHF as early on as possible. Objective: The aim of this study is to determine the efficacy of a telemonitoring system in detecting clinical destabilization in real-life settings (out-of-hospital management) without generating too many false positive alerts. Methods: All patients self-monitoring at home using the system after a congestive AHF event treated at a cardiology clinic in France between March 2020 and March 2021 with at least 75% compliance on daily measurements were included retrospectively. New-onset AHF was defined by the presence of at least 1 of the following criteria: transcutaneous oxygen saturation loss, defined as a transcutaneous oxygen measurement under 90%; rise of cardiac frequency above 110 beats per minute; weight gain of at least 2 kg; and symptoms of congestive AHF, described over the phone. An AHF alert was generated when the criteria reached our definition of new-onset acute congestive heart failure (HF). Results: A total of 111 consecutive patients (n=70 men) with a median age of 76.60 (IQR 69.5-83.4) years receiving the telemonitoring system were included. Thirty-nine patients (35.1%) reached the HF warning level, and 28 patients (25%) had confirmed HF destabilization during follow-up. No patient had AHF without being detected by the telemonitoring system. Among incorrect AHF alerts (n=11), 5 patients (45%) had taken inaccurate measurements, 3 patients (27%) had supraventricular arrhythmia, 1 patient (9%) had a pulmonary bacterial infection, and 1 patient (9%) contracted COVID-19. A weight gain of at least 2 kg within 4 days was significantly associated with a correct AHF alert (P=.004), and a heart rate of more than 110 beats per minute was more significantly associated with an incorrect AHF alert (P=.007). Conclusions: This single-center study highlighted the efficacy of the telemedicine system in detecting and quickly treating cardiac instability complicating the course of CHF by detecting new-onset AHF as well as supraventricular arrhythmia, thus helping cardiologists provide better follow-up to ambulatory patients. %M 39137030 %R 10.2196/52648 %U https://cardio.jmir.org/2024/1/e52648 %U https://doi.org/10.2196/52648 %U http://www.ncbi.nlm.nih.gov/pubmed/39137030 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57402 %T Toward Safe and Confident Silver Drivers: Interview Study Investigating Older Adults’ Driving Practices %A Kim,Sunyoung %A Sivangula,Phaneendra %+ Department of Library and Information Science, Rutgers University, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 8489327585, sk1897@comminfo.rutgers.edu %K older adults %K driving %K transportation %K healthy aging %K aging in place %K quality of life %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Aging %G English %X Background: As the aging population in the United States continues to increase rapidly, preserving the mobility and independence of older adults becomes increasingly critical for enabling aging in place successfully. While personal vehicular transport remains a popular choice among this demographic due to its provision of independence and control over their lives, age-related changes may heighten the risk of common driving errors and diminish driving abilities. Objective: This study aims to investigate the driving practices of older adults and their efforts to maintain safe and confident driving habits. Specifically, we sought to identify the factors that positively and negatively influence older adults’ driving performance and confidence, as well as the existing efforts put into sustaining their driving abilities. Methods: We recruited 20 adults aged ≥65 years who remained active drivers during the recruitment from the greater New York area. Then, we conducted semistructured interviews with them to examine their perceptions, needs, and challenges regarding safe and confident driving. Results: Our findings uncovered a notable disparity between older adults’ self-perceived driving skills and the challenges they face, particularly caused by age-related limitations and health conditions such as vision and memory declines and medication routines. Drawing on these findings, we proposed strategies to bridge this gap and empower older adults to drive safely and confidently, including fostering a realistic understanding of their capabilities, encouraging open dialogue regarding their driving, encouraging regular assessments, and increasing awareness of available resources. Conclusions: This study uncovered a noticeable disparity between the perceived driving competence of older adults and the actual challenges they confront while driving. This divergence underscores a significant need for better support beyond the existing aid available to preserve older adults’ driving skills. We hope that our recommendations will offer valuable insights for practitioners and scholars committed to enhancing the overall well-being and quality of life for older adults as they age in their homes. %M 39133531 %R 10.2196/57402 %U https://aging.jmir.org/2024/1/e57402 %U https://doi.org/10.2196/57402 %U http://www.ncbi.nlm.nih.gov/pubmed/39133531 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55507 %T Preventing Cognitive Decline in Older Latino Adults With HIV Through a Culturally Tailored Health Promotion Intervention: Protocol for a Single-Arm Pilot Trial %A Jimenez,Daniel E %A Ross,Emily J %A Weinstein,Elliott %A Gouse,Hetta %A Pan,Yue %A Martinez Garza,David %A Burke,Shanna L %A Joo,Jin Hui %A Behar-Zusman,Victoria %+ Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1436, Miami, FL, 33136, United States, 1 3052432776, dej18@miami.edu %K Latinos %K HIV %K AIDS %K cognitive decline %K health promotion %K intervention %K protocol %K single-arm %K pilot trial %K prevention %K older %K cognitive impairment %K impairment %K treatment %K dementia %K psychosocial %K men %K women %K cohort %D 2024 %7 12.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older Latino adults with HIV are at increased risk for mild cognitive impairment and earlier onset of aging-related cognitive decline. Improvements in cognitive functioning and cognitive outcomes are possible among people with HIV who adopt health promotion behaviors. However, health promotion interventions for older Latino adults with HIV have not been extensively used or widely recognized as viable treatment options. Happy Older Latinos are Active (HOLA) is a multicomponent, health promotion intervention that is uniquely tailored for older Latino adults with HIV. Objective: This study aims to (1) determine the feasibility and acceptability of an adapted version of HOLA aimed at improving cognitive functioning among older Latino adults with HIV; (2) explore whether HOLA will produce changes in cognitive functioning; (3) explore whether HOLA will produce changes in activity, psychosocial functioning, or biomarkers of cognition; and (4) explore whether changes in activity, psychosocial functioning or cognitive biomarkers correlate with changes in cognition, while accounting for genetic risk for dementia. Methods: A single-arm pilot trial with 30 Latino (aged 50 years and older) men and women with HIV was conducted to assess feasibility, acceptability, and preliminary effects on cognition. Participants were assessed at 2 time points (baseline and postintervention) on measures of neurocognitive and psychosocial functioning. In addition, blood samples were collected to determine biomarkers of cognition at baseline and postintervention. Successful recruitment was defined as meeting 100% of the targeted sample (N=30), with 20% (n=6) or less of eligible participants refusing to participate. Adequate retention was defined as 85% (n=25) or more of participants completing the postintervention assessment and acceptability was defined as 80% (n=38) or more of sessions attended by participants. Results: Participant recruitment began on February 22, 2022, and was completed on August 15, 2022. The last study visit took place on February 20, 2023. Data analysis is currently ongoing. Conclusions: Encouraging findings from this exploratory study may provide a blueprint for scaling up the HOLA intervention to a larger cohort of older Latino adults with HIV who may be currently experiencing or are at risk for HIV-related cognitive challenges. Trial Registration: ClinicalTrials.gov NCT04791709; https://clinicaltrials.gov/study/NCT04791709 International Registered Report Identifier (IRRID): DERR1-10.2196/55507 %M 39133532 %R 10.2196/55507 %U https://www.researchprotocols.org/2024/1/e55507 %U https://doi.org/10.2196/55507 %U http://www.ncbi.nlm.nih.gov/pubmed/39133532 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58296 %T The Effectiveness of Collaborative Care Interventions for the Management of Patients With Multimorbidity: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression Analysis %A Knudsen,Anne-Maj %A Dalgård Dunvald,Ann-Cathrine %A Hangaard,Stine %A Hejlesen,Ole %A Kronborg,Thomas %+ Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark, 45 99409940, annemk@hst.aau.dk %K multimorbidity %K comorbidity %K multiple chronic conditions %K patient care team %K multidisciplinary teams %K collaborative care %K quality of life %K systematic review %K meta-analysis %D 2024 %7 8.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Collaborative care interventions have been proposed as a promising strategy to support patients with multimorbidity. Despite this, the effectiveness of collaborative care interventions requires further evaluation. Existing systematic reviews describing the effectiveness of collaborative care interventions in multimorbidity management tend to focus on specific interventions, patient subgroups, and settings. This necessitates a comprehensive review that will provide an overview of the effectiveness of collaborative care interventions for adult patients with multimorbidity. Objective: This systematic review aims to systematically assess the effectiveness of collaborative care interventions in comparison to usual care concerning health-related quality of life (HRQoL), mental health, and mortality among adult patients with multimorbidity. Methods: Randomized controlled trials evaluating collaborative care interventions designed for adult patients (18 years and older) with multimorbidity compared with usual care will be considered for inclusion in this review. HRQoL will be the primary outcome. Mortality and mental health outcomes such as rating scales for anxiety and depression will serve as secondary outcomes. The systematic search will be conducted in the CENTRAL, PubMed, CINAHL, and Embase databases. Additional reference and citation searches will be performed in Google Scholar, Web of Science, and Scopus. Data extraction will be comprehensive and include information about participant characteristics, study design, intervention details, and main outcomes. Included studies will be assessed for limitations according to the Cochrane Risk of Bias tool. Meta-analysis will be conducted to estimate the pooled effect size. Meta-regression or subgroup analysis will be undertaken to explore if certain factors can explain the variation in effect between studies, if feasible. The certainty of evidence will be evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Results: The preliminary literature search was performed on February 16, 2024, and yielded 5255 unique records. A follow-up search will be performed across all databases before submission. The findings will be presented in forest plots, a summary of findings table, and in narrative format. This systematic review is expected to be completed by late 2024. Conclusions: This review will provide an overview of pooled estimates of treatment effects across HRQoL, mental health, and mortality from randomized controlled trials evaluating collaborative care interventions for adults with multimorbidity. Furthermore, the intention is to clarify the participant, intervention, or study characteristics that may influence the effect of the interventions. This review is expected to provide valuable insights for researchers, clinicians, and other decision-makers about the effectiveness of collaborative care interventions targeting adult patients with multimorbidity. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42024512554; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=512554 International Registered Report Identifier (IRRID): DERR1-10.2196/58296 %M 39115256 %R 10.2196/58296 %U https://www.researchprotocols.org/2024/1/e58296 %U https://doi.org/10.2196/58296 %U http://www.ncbi.nlm.nih.gov/pubmed/39115256 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52973 %T Engagement With Conversational Agent–Enabled Interventions in Cardiometabolic Disease Management: Protocol for a Systematic Review %A Kashyap,Nick %A Sebastian,Ann Tresa %A Lynch,Chris %A Jansons,Paul %A Maddison,Ralph %A Dingler,Tilman %A Oldenburg,Brian %+ Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Plenty Road and Kingsbury Dr, Bundoora, Melbourne, 3086, Australia, 61 422023197, Nick.Kashyap@baker.edu.au %K cardiometabolic disease %K cardiovascular disease %K diabetes %K chronic disease %K chatbot %K acceptability %K technology acceptance model %K design %K natural language processing %K adult %K heart failure %K digital health intervention %K Australia %K systematic review %K meta-analysis %K digital health %K conversational agent–enabled %K health informatics %K management %D 2024 %7 7.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cardiometabolic diseases (CMDs) are a group of interrelated conditions, including heart failure and diabetes, that increase the risk of cardiovascular and metabolic complications. The rising number of Australians with CMDs has necessitated new strategies for those managing these conditions, such as digital health interventions. The effectiveness of digital health interventions in supporting people with CMDs is dependent on the extent to which users engage with the tools. Augmenting digital health interventions with conversational agents, technologies that interact with people using natural language, may enhance engagement because of their human-like attributes. To date, no systematic review has compiled evidence on how design features influence the engagement of conversational agent–enabled interventions supporting people with CMDs. This review seeks to address this gap, thereby guiding developers in creating more engaging and effective tools for CMD management. Objective: The aim of this systematic review is to synthesize evidence pertaining to conversational agent–enabled intervention design features and their impacts on the engagement of people managing CMD. Methods: The review is conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches will be conducted in the Ovid (Medline), Web of Science, and Scopus databases, which will be run again prior to manuscript submission. Inclusion criteria will consist of primary research studies reporting on conversational agent–enabled interventions, including measures of engagement, in adults with CMD. Data extraction will seek to capture the perspectives of people with CMD on the use of conversational agent–enabled interventions. Joanna Briggs Institute critical appraisal tools will be used to evaluate the overall quality of evidence collected. Results: This review was initiated in May 2023 and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in June 2023, prior to title and abstract screening. Full-text screening of articles was completed in July 2023 and data extraction began August 2023. Final searches were conducted in April 2024 prior to finalizing the review and the manuscript was submitted for peer review in July 2024. Conclusions: This review will synthesize diverse observations pertaining to conversational agent–enabled intervention design features and their impacts on engagement among people with CMDs. These observations can be used to guide the development of more engaging conversational agent–enabled interventions, thereby increasing the likelihood of regular intervention use and improved CMD health outcomes. Additionally, this review will identify gaps in the literature in terms of how engagement is reported, thereby highlighting areas for future exploration and supporting researchers in advancing the understanding of conversational agent–enabled interventions. Trial Registration: PROSPERO CRD42023431579; https://tinyurl.com/55cxkm26 International Registered Report Identifier (IRRID): DERR1-10.2196/52973 %M 39110504 %R 10.2196/52973 %U https://www.researchprotocols.org/2024/1/e52973 %U https://doi.org/10.2196/52973 %U http://www.ncbi.nlm.nih.gov/pubmed/39110504 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55693 %T Exploring Older Adults' Perceptions of Using Digital Health Platforms for Self-Managing Musculoskeletal Health Conditions: Focus Group Study %A Clohessy,Sophie %A Kempton,Christian %A Ryan,Kate %A Grinbergs,Peter %A Elliott,Mark T %+ School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 1214142789, m.elliott.3@bham.ac.uk %K musculoskeletal %K digital health platform %K physiotherapy self-management %K digital triaging %K phone app %K qualitative %K focus group %K mobile phone %D 2024 %7 1.8.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technologies can assist and optimize health care processes. This is increasingly the case in the musculoskeletal health domain, where digital platforms can be used to support the self-management of musculoskeletal conditions, as well as access to services. However, given a large proportion of the population with musculoskeletal conditions are older adults (aged ≥60 years), it is important to consider the acceptability of such platforms within this demographic. Objective: This study aims to explore participants’ opinions and perceptions on the use of digital platforms for supporting the self-management of musculoskeletal conditions within older adult (aged ≥60 years) populations and to gather their opinions on real examples. Methods: A total of 2 focus groups (focus group 1: 6/15, 40%; focus group 2: 9/15, 60%) were conducted, in which participants answered questions about their thoughts on using digital health platforms to prevent or manage musculoskeletal conditions. Participants were further presented with 2 example scenarios, which were then discussed. Interviews were audio recorded, transcribed, and analyzed thematically. Participants were aged ≥60 years and with or without current musculoskeletal conditions. Prior experience of using smartphone apps or other digital health platforms for musculoskeletal conditions was not required. Focus groups took place virtually using the Teams (Microsoft Corp) platform. Results: A total of 6 themes were identified across both focus groups: “experiences of digital health platforms,” “preference for human contact,” “barriers to accessing clinical services,” “individual differences and digital literacy,” “trust in technology,” and “features and benefits of digital health technologies.” Each theme is discussed in detail based on the interview responses. The findings revealed that most participants had some existing experience with digital health platforms for preventing or managing musculoskeletal conditions. Overall, there was a lack of trust in and low expectations of quality for digital platforms for musculoskeletal health within this age group. While there was some concern about the use of digital platforms in place of in-person health consultations, several benefits were also identified. Conclusions: Results highlighted the need for better communication on the benefits of using digital platforms to support the self-management of musculoskeletal conditions, without the platforms replacing the role of the health care professionals. The concerns about which apps are of suitable quality and trustworthiness lead us to recommend raising public awareness around the role of organizations that verify and assess the quality of digital health platforms. %M 39088803 %R 10.2196/55693 %U https://aging.jmir.org/2024/1/e55693 %U https://doi.org/10.2196/55693 %U http://www.ncbi.nlm.nih.gov/pubmed/39088803 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e55785 %T Effects of Electronic Serious Games on Older Adults With Alzheimer’s Disease and Mild Cognitive Impairment: Systematic Review With Meta-Analysis of Randomized Controlled Trials %A Zuo,Xinyi %A Tang,Yong %A Chen,Yifang %A Zhou,Zhimiao %+ Sociology Department, School of Government, Shenzhen University, 1066 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, 518055, China, 86 13670191924, tangyong@szu.edu.cn %K digital serious games %K cognitive ability %K daily behavioral capacity %K mental health %K depression %K older adults with AD and MCI %K AD %K Alzheimer’s disease %K MD %K mild cognitive impairment %K systematic review %K meta-analysis %D 2024 %7 31.7.2024 %9 Review %J JMIR Serious Games %G English %X Background: Serious games (SGs) are nonpharmacological interventions that are widely applied among older adults. To date, no evidence has been published regarding the effect of digital SGs on cognitive ability, daily behavioral capacity, or depression in older adults with Alzheimer’s disease (AD) and mild cognitive impairment (MCI). Objective: This study aimed to assess the effect of SGs on older adults with AD and MCI by summarizing and pooling the results of previous studies. Methods: This meta-analysis examined the effectiveness of digital SGs in improving cognitive ability, enhancing daily behavioral capacity, and alleviating depression in older adults with AD and MCI. We searched the following databases up to December 31, 2023, to identify relevant high-quality randomized controlled trials (RCTs): PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Stata 15.1 and Review Manager 5.3 were used to screen the 14 studies, extract data, code the data, and perform meta-analysis. Mean differences and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. Eligibility criteria were developed in accordance with the Population, Intervention, Comparison, Outcomes, and Study Design framework: (1) population (older adults with AD and MCI), (2) intervention (digital SG intervention), (3) comparison (digital SG intervention vs routine health care), (4) outcomes (cognitive ability, daily behavioral capacity, and depression), and (5) study or research design (RCT). Sensitivity analysis was performed, and a funnel plot was constructed. Results: From January 2017 to December 2023, we enrolled 714 individuals across 14 RCTs, with 374 (52.4%) in the severe game group using digital SGs and 340 (47.6%) in the control group using traditional methods. The results of our meta-analysis indicated that using digital SGs in older adults with AD and MCI is more effective than traditional training methods in several key areas. Specifically, digital SG therapy significantly increased cognitive ability, as found in the Mini-Mental State Examination (SMD 2.11, 95% CI 1.42-2.80; P<.001) and the Montreal Cognitive Assessment (SMD 2.75, 95% CI 1.98-3.51; P<.001), significantly increased daily behavioral capacity (SMD 0.53, 95% CI 0.06-0.99; P=.03), and significantly reduced depression (SMD –2.08, 95% CI –2.94 to –1.22; P<.001) in older adults with AD and MCI. No publication bias was detected based on the results of Begg and Egger tests. Conclusions: Digital SGs offer a viable and effective nonpharmacological approach for older adults with AD and MCI, yielding better results compared to traditional formats. However, caution is warranted in interpreting these findings due to limited RCTs, small sample sizes, and low-quality meta-analyzed evidence. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRDCRD42023486090; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=486090 %R 10.2196/55785 %U https://games.jmir.org/2024/1/e55785 %U https://doi.org/10.2196/55785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58846 %T The Role of Assistive Technology in Enabling Older Adults to Achieve Independent Living: Past and Future %A Sweeting,Anna %A Warncken,Katie A %A Patel,Martyn %+ Older Peoples Medicine Department, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, United Kingdom, 44 01603286286 ext 4009, martyn.patel@nnuh.nhs.uk %K assistive technology %K older adults %K users %K aging %K aging in place %K UK %K cocreation %K research trial %K independent living %K North Norfolk %K disability %K injury %K tool %K use %K design %K barrier %D 2024 %7 30.7.2024 %9 Viewpoint %J J Med Internet Res %G English %X In this viewpoint, we present evidence of a marked increase in the use of assistive technology (AT) by older adults over the last 25 years. We also explain the way in which this use has expanded not only as an increase in terms of the total number of users but also by going beyond the typical scopes of use from its inception in 1999 to reach new categories of users. We outline our opinions on some of the key driving forces behind this expansion, such as population demographic changes, technological advances, and the promotion of AT as a means to enable older adults to achieve independent living. As well as our review of the evolution of AT over the past 25 years, we also discuss the future of AT research as a field and the need for harmonization of terminology in AT research. Finally, we outline how our experience in North Norfolk (notably the United Kingdom’s most old age–dependent district) suggests that cocreation may be the key to not only successful research trials in the field of AT but also to the successful sustained adoption of AT beyond its original scope of use. %M 39079115 %R 10.2196/58846 %U https://www.jmir.org/2024/1/e58846 %U https://doi.org/10.2196/58846 %U http://www.ncbi.nlm.nih.gov/pubmed/39079115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55366 %T eHealth-Integrated Psychosocial and Physical Interventions for Chronic Pain in Older Adults: Scoping Review %A De Lucia,Annalisa %A Perlini,Cinzia %A Chiarotto,Alessandro %A Pachera,Sara %A Pasini,Ilenia %A Del Piccolo,Lidia %A Donisi,Valeria %+ Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale Ludovico Antonio Scuro 10, Verona, 37134, Italy, 39 0458124038, cinzia.perlini@univr.it %K chronic pain %K older adults %K eHealth %K scoping review %K psychological intervention %K physical intervention %K multimodal intervention %K biopsychosocial model for chronic pain %K self-management %K mobile phone %D 2024 %7 29.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Chronic noncancer pain (CNCP) is highly present among older adults, affecting their physical, psychological, and social functioning. A biopsychosocial multimodal approach to CNCP management is currently extensively suggested by international clinical practice guidelines. Recently, the growing development and application of eHealth within pain management has yielded encouraging results in terms of effectiveness and feasibility; however, its use among the older population remains underexamined. Objective: The overall aim of this scoping review was to systematically map existing literature about eHealth multimodal interventions (including both physical and psychosocial components) targeting older adults with CNCP. Methods: This review adhered to the JBI methodology, a protocol was a priori registered as a preprint on the medRxiv platform, and the results were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO) were systematically searched for relevant articles. Studies were included if they reported on multimodal interventions (including both physical and psychosocial components) delivered through any eHealth modality to an older population with any type of CNCP. Two reviewers selected the studies: first by screening titles and abstracts and second by screening full-text articles. The quality of the included studies was evaluated using the Quality Assessment Tool for Studies with Diverse Designs. The results of the studies were summarized narratively. Results: A total of 9 studies (n=6, 67% published between 2021 and 2023) with quality rated as medium to high were included, of which 7 (78%) were randomized controlled trials (n=5, 71% were pilot and feasibility studies). All the included studies evaluated self-management interventions, most of them (n=7, 78%) specifically designed for older adults. The participants were aged between 65 and 75 years on average (mean 68.5, SD 3.5 y) and had been diagnosed with different types of CNCP (eg, osteoarthritis and chronic low back pain). Most of the included studies (5/9, 56%) involved the use of multiple eHealth modalities, with a higher use of web-based programs and video consulting. Only 1 (11%) of the 9 studies involved a virtual reality–based intervention. The evaluated interventions showed signs of effectiveness in the targeted biopsychosocial outcomes, and the participants’ engagement and ratings of satisfaction were generally positive. However, several research gaps were identified and discussed. Conclusions: Overall, of late, there has been a growing interest in the potential that eHealth multimodal interventions offer in terms of improving pain, physical, and psychosocial outcomes in older adults with CNCP. However, existing literature on this topic still seems scarce and highly heterogeneous, with few proper randomized controlled trials, precluding robust conclusions. Several gaps emerged in terms of the older population considered and the lack of evaluation of comorbidities. International Registered Report Identifier (IRRID): RR2-10.1101/2023.07.27.23293235 %M 39073865 %R 10.2196/55366 %U https://www.jmir.org/2024/1/e55366 %U https://doi.org/10.2196/55366 %U http://www.ncbi.nlm.nih.gov/pubmed/39073865 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56277 %T Deprescribing as a Way to Reduce Inappropriate Use of Drugs for Overactive Bladder in Primary Care (DROP): Protocol for a Cluster Randomized Controlled Trial With an Embedded Explanatory Sequential Mixed Methods Study %A Soerensen,Ann Lykkegaard %A Haase Juhl,Marie %A Krogh,Marlene Lunddal %A Grønkjær,Mette %A Kristensen,Jette Kolding %A Olesen,Anne Estrup %+ Department of Pharmacology, Aalborg University Hospital, Gartnerboligen, ground floor, Mølleparkvej 8a, Aalborg, 9000, Denmark, 45 72691086, ann.lykkegaard@rn.dk %K deprescribing %K overactive bladder %K general practice %K patient safety %K potentially inappropriate medication %K geriatric %K elderly %K medication safety %K geriatrics %K anticholinergic drugs %K safety %K prescription %K Denmark %K general practitioner %K evidence-based intervention %K evidence-based %K intervention %K health care %K medication %K efficacy %K DROP study %K DROP %D 2024 %7 23.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Potentially inappropriate medication remains a significant concern in general practices, particularly in the context of overactive bladder (OAB) treatment for individuals aged 65 years and older. This study focuses on the exploration of alternative options for treating OAB and the deprescribing of anticholinergic drugs commonly used in OAB. The research aims to comprehensively evaluate the efficiency of deprescribing through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and health care personnel. Objective: This study aims to evaluate the efficiency and safety of the intervention in which health care staff in primary care encourage patients to participate in deprescribing their drugs for OAB. In addition, we aim to identify factors contributing to or obstructing the deprescribing process that will drive more informed decisions in the field of deprescribing and support effective and safe treatment of patients. Methods: The drugs for overactive bladder in primary care (DROP) study uses a rigorous research design, using a randomized controlled trial (RCT) with an embedded sequential explanatory mixed methods approach. All general practices within the North Denmark Region will be paired based on the number of general practitioners (GPs) and urban or rural locations. The matched pairs will be randomized into intervention and control groups. The intervention group will receive an algorithm designed to guide the deprescribing of drugs for OAB, promoting appropriate medication use. Quantitative data will be collected from the RCT including data from Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients. Finally, the quantitative and qualitative findings are merged to understand deprescribing for OAB comprehensively. This integrated approach enhances insights and supports future intervention improvement. Results: The DROP study is currently in progress, with randomization of general practices underway. While they have not been invited to participate yet, they will be. The inclusion of GP practices is scheduled from December 2023 to April 2024. The follow-up period for each patient is 6 months. Results will be analyzed through an intention-to-treat analysis for the RCT and a thematic analysis for the qualitative component. Quantitative outcomes will focus on changes in prescriptions and symptoms, while the qualitative analysis will explore experiences and perceptions. Conclusions: The DROP study aims to provide an evidence-based intervention in primary care that ensures the deprescription of drugs for OAB when there is an unfavorable risk-benefit profile. The DROP study’s contribution lies in generating evidence for deprescribing practices and influencing best practices in health care. Trial Registration: ClinicalTrials.gov NCT06110975; https://clinicaltrials.gov/study/NCT06110975 International Registered Report Identifier (IRRID): DERR1-10.2196/56277 %M 39042875 %R 10.2196/56277 %U https://www.researchprotocols.org/2024/1/e56277 %U https://doi.org/10.2196/56277 %U http://www.ncbi.nlm.nih.gov/pubmed/39042875 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47578 %T Consumer Perspectives for a Future Mobile App to Document Real-World Listening Difficulties: Qualitative Study %A Galvin,Karyn %A Tomlin,Dani %A Timmer,Barbra H B %A McNeice,Zoe %A Mount,Nicole %A Gray,Kathleen %A Short,Camille E %+ Department of Audiology and Speech Pathology, University of Melbourne, 550 Swanston St, Carlton, 3053, Australia, 61 61390355323, kgalvin@unimelb.edu.au %K adults %K hearing loss %K listening difficulties %K digital health %K app %K self-management %K mobile health %K smartphone %K mobile phone %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: By enabling individuals with hearing loss to collect their own hearing data in their personal real-world settings, there is scope to improve clinical care, empower consumers, and support shared clinical decision-making and problem-solving. Clinician support for this approach has been established in a separate study. Objective: This study aims to explore, for consumers with hearing loss, their (1) experiences of listening difficulties, to identify the data an app could usefully collect; (2) preferences regarding the features of mobile apps in general; and (3) opinions on the potential value and desirable features of a yet-to-be designed app for documenting listening difficulties in real-world settings. Methods: A total of 3 focus groups involved 27 adults who self-reported hearing loss. Most were fitted with hearing devices. A facilitator used a topic guide to generate discussion, which was video- and audio-recorded. Verbatim transcriptions were analyzed using inductive content analysis. Results: Consumers supported the concept of a mobile app that would facilitate the documenting of listening difficulties in real-world settings important to the individual. Consumers shared valuable insights about their listening difficulties, which will help determine the data that should be collected through an app designed to document these challenges. This information included early indicators of hearing loss (eg, mishearing, difficulty communicating in groups and on the phone, and speaking overly loudly) and prompts to seek hearing devices (eg, spousal pressure and the advice or example provided by others, and needing to rely on lipreading or to constantly request others to repeat themselves). It also included the well-known factors that influence listening difficulties (eg, reverberation, background noise, group conversations) and the impacts and consequences of their difficulties (eg, negative impacts on relationships and employment, social isolation and withdrawal, and negative emotions). Consumers desired a visual-based app that provided options for how data could be collected and how the user could enter data into an app, and which enabled data sharing with a clinician. Conclusions: These findings provide directions for the future co-design and piloting of a prototype mobile app to provide data that are useful for increasing self-awareness of listening difficulties and can be shared with a clinician. %M 39042452 %R 10.2196/47578 %U https://formative.jmir.org/2024/1/e47578 %U https://doi.org/10.2196/47578 %U http://www.ncbi.nlm.nih.gov/pubmed/39042452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51400 %T Initial Perspectives From Rural-Residing Adults on a Digital Cognitive Health Coaching Intervention: Exploratory Qualitative Analysis %A Myers,Jennifer Rae %A Bryk,Kelsey N %A Madero,Erica N %A McFarlane,Jacob %A Campitelli,Anthony %A Gills,Joshua %A Jones,Megan %A Paulson,Sally %A Gray,Michelle %A Glenn,Jordan M %+ Neurotrack Technologies, 399 Bradford St #101, Redwood City, CA, 94063, United States, 1 6505498566, jennifer.r.myers@outlook.com %K Alzheimer disease %K cognition %K intervention %K rural issues %K digital health %K geriatric %K geriatrics %K elder %K elderly %K diabetes %K diabetes mellitus %K dementia %K digital cognitive health coaching %K rural %K countryside %K qualitative study %K thematic analysis %K mHealth %K telehealth %K health informatics %K mental health %K behavioral change %K healthy lifestyle %K coach support %K self-awareness %K prevention %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing body of research has examined lifestyle-based interventions for dementia prevention. Specifically, health coaching interventions have been linked to decreased risk of Alzheimer disease (AD) comorbidities, such as diabetes. Despite the association, there is a lack of research examining the efficacy and perception of digital health coaching on reducing AD risk. Understanding the perceived benefits of participating in a digital health coach program is critical to ensure long-term use, including participant adherence and engagement. Objective: The purpose of this study is to examine the initial attitudes toward a digital health coaching intervention aimed at preventing cognitive decline among at-risk, rural participants. Methods: This exploratory qualitative study is part of the ongoing Digital Cognitive Multidomain Alzheimer Risk Velocity Study (DC-MARVel; ClinicalTrials.gov NCT04559789), a 2-year randomized control trial examining the effects of a digital health coaching intervention on dementia risk, cognitive decline, and general health outcomes. Participants were recruited from the northwest region of Arkansas via word of mouth, email, local radio, and social media. At the time of the analysis, 103 participants randomly assigned to the health coaching group completed an average of 4 coaching sessions over a 4-month period. The intervention included asynchronous messages 1-2 times per week from their health coach that contained health education articles based on the participant’s goals (eg, increase physical activity), unlimited access to their coach for questions and recommendations, and monthly meetings with their coach via videoconference or phone to discuss their goals. Participants were asked 2 open-ended questions, “What were your top 1 or 2 takeaways from your recent Health Coaching session?” and “Is there anything you would change about our Health Coaching sessions?” A thematic analysis was conducted using feedback responses from 80 participants (mean age, SD 7.6 years). Results: The following four themes emerged from participants’ feedback: (1) healthy lifestyle and behavioral changes, (2) a sense of self-awareness through introspection, (3) value in coach support, and (4) a desire for a change in program format (eg, frequency). In total, 93% (n=74) of participants expressed that the intervention needed no changes. Conclusions: Initial participation in the digital cognitive health coaching intervention was well received, as evidenced by participants reporting value in goal setting and strategies for healthy lifestyle and behavioral changes as well as self-reflection on their personal lifestyle choices. Feedback about their assigned coach also offers insight into the importance of the coach-participant relationship and may serve as a significant factor in overall participant success. Given the exploratory nature of this study, more robust research is needed to elicit more information from participants about their experiences to fully understand the acceptability of the digital health coaching intervention. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789 International Registered Report Identifier (IRRID): RR2-10.2196/31841 %M 39038282 %R 10.2196/51400 %U https://formative.jmir.org/2024/1/e51400 %U https://doi.org/10.2196/51400 %U http://www.ncbi.nlm.nih.gov/pubmed/39038282 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58158 %T Evaluating and Enhancing Large Language Models’ Performance in Domain-Specific Medicine: Development and Usability Study With DocOA %A Chen,Xi %A Wang,Li %A You,MingKe %A Liu,WeiZhi %A Fu,Yu %A Xu,Jie %A Zhang,Shaoting %A Chen,Gang %A Li,Kang %A Li,Jian %+ Sports Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, China, 86 18980601388, lijian_sportsmed@163.com %K large language model %K retrieval-augmented generation %K domain-specific benchmark framework %K osteoarthritis management %D 2024 %7 22.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The efficacy of large language models (LLMs) in domain-specific medicine, particularly for managing complex diseases such as osteoarthritis (OA), remains largely unexplored. Objective: This study focused on evaluating and enhancing the clinical capabilities and explainability of LLMs in specific domains, using OA management as a case study. Methods: A domain-specific benchmark framework was developed to evaluate LLMs across a spectrum from domain-specific knowledge to clinical applications in real-world clinical scenarios. DocOA, a specialized LLM designed for OA management integrating retrieval-augmented generation and instructional prompts, was developed. It can identify the clinical evidence upon which its answers are based through retrieval-augmented generation, thereby demonstrating the explainability of those answers. The study compared the performance of GPT-3.5, GPT-4, and a specialized assistant, DocOA, using objective and human evaluations. Results: Results showed that general LLMs such as GPT-3.5 and GPT-4 were less effective in the specialized domain of OA management, particularly in providing personalized treatment recommendations. However, DocOA showed significant improvements. Conclusions: This study introduces a novel benchmark framework that assesses the domain-specific abilities of LLMs in multiple aspects, highlights the limitations of generalized LLMs in clinical contexts, and demonstrates the potential of tailored approaches for developing domain-specific medical LLMs. %M 38833165 %R 10.2196/58158 %U https://www.jmir.org/2024/1/e58158 %U https://doi.org/10.2196/58158 %U http://www.ncbi.nlm.nih.gov/pubmed/38833165 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e54748 %T Self-Explainable Graph Neural Network for Alzheimer Disease and Related Dementias Risk Prediction: Algorithm Development and Validation Study %A Hu,Xinyue %A Sun,Zenan %A Nian,Yi %A Wang,Yichen %A Dang,Yifang %A Li,Fang %A Feng,Jingna %A Yu,Evan %A Tao,Cui %+ Department of Artificial Intelligence and Informatics, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, United States, 1 904 956 3256, tao.cui@mayo.edu %K Alzheimer disease and related dementias %K risk prediction %K graph neural network %K relation importance %K machine learning %D 2024 %7 8.7.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Alzheimer disease and related dementias (ADRD) rank as the sixth leading cause of death in the United States, underlining the importance of accurate ADRD risk prediction. While recent advancements in ADRD risk prediction have primarily relied on imaging analysis, not all patients undergo medical imaging before an ADRD diagnosis. Merging machine learning with claims data can reveal additional risk factors and uncover interconnections among diverse medical codes. Objective: The study aims to use graph neural networks (GNNs) with claim data for ADRD risk prediction. Addressing the lack of human-interpretable reasons behind these predictions, we introduce an innovative, self-explainable method to evaluate relationship importance and its influence on ADRD risk prediction. Methods: We used a variationally regularized encoder-decoder GNN (variational GNN [VGNN]) integrated with our proposed relation importance method for estimating ADRD likelihood. This self-explainable method can provide a feature-important explanation in the context of ADRD risk prediction, leveraging relational information within a graph. Three scenarios with 1-year, 2-year, and 3-year prediction windows were created to assess the model’s efficiency, respectively. Random forest (RF) and light gradient boost machine (LGBM) were used as baselines. By using this method, we further clarify the key relationships for ADRD risk prediction. Results: In scenario 1, the VGNN model showed area under the receiver operating characteristic (AUROC) scores of 0.7272 and 0.7480 for the small subset and the matched cohort data set. It outperforms RF and LGBM by 10.6% and 9.1%, respectively, on average. In scenario 2, it achieved AUROC scores of 0.7125 and 0.7281, surpassing the other models by 10.5% and 8.9%, respectively. Similarly, in scenario 3, AUROC scores of 0.7001 and 0.7187 were obtained, exceeding 10.1% and 8.5% than the baseline models, respectively. These results clearly demonstrate the significant superiority of the graph-based approach over the tree-based models (RF and LGBM) in predicting ADRD. Furthermore, the integration of the VGNN model and our relation importance interpretation could provide valuable insight into paired factors that may contribute to or delay ADRD progression. Conclusions: Using our innovative self-explainable method with claims data enhances ADRD risk prediction and provides insights into the impact of interconnected medical code relationships. This methodology not only enables ADRD risk modeling but also shows potential for other image analysis predictions using claims data. %M 38976869 %R 10.2196/54748 %U https://aging.jmir.org/2024/1/e54748 %U https://doi.org/10.2196/54748 %U http://www.ncbi.nlm.nih.gov/pubmed/38976869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58503 %T Clinicians’ Perspectives on the Telehealth Serious Illness Care Program for Older Adults With Myeloid Malignancies: Single-Arm Pilot Study %A LoCastro,Marissa %A Wang,Ying %A Yu,Tristan %A Mortaz-Hedjri,Soroush %A Mendler,Jason %A Norton,Sally %A Bernacki,Rachelle %A Carroll,Thomas %A Klepin,Heidi %A Wedow,Lucy %A Goonan,Sean %A Erdos,Hannah %A Bagnato,Brenda %A Liesveld,Jane %A Huselton,Eric %A Kluger,Benzi %A Loh,Kah Poh %+ Division of Hematology Oncology, Department of Medicine, James P. Wilmot Cancer Institute, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, United States, 1 585 276 4353, Kahpoh_Loh@urmc.rochester.edu %K serious illness conversations %K serious illness conversation %K SIC %K Serious Illness Care Program %K SICP %K hematologic malignancy %K geriatric oncology %K acute myeloid leukemia %K AML %K myelodysplastic syndrome %K MDS %K cancer %K oncology %K oncologist %K oncologists %K metastases %K telemedicine %K telehealth %K tele-medicine %K tele-health %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Serious illness conversations may help patients avoid unwanted treatments. We previously piloted the telehealth Serious Illness Care Program (SICP) for older adults with acute myeloid leukemia and myelodysplastic syndrome. Objective: In this study, we aimed to understand the experience of the telehealth SICP from the clinician’s perspective. Methods: We studied 10 clinicians who delivered the telehealth SICP to 20 older adults with acute myeloid leukemia or myelodysplastic syndrome. Quantitative outcomes included confidence and acceptability. Confidence was measured using a 22-item survey (range 1-7; a higher score is better). Acceptability was measured using an 11-item survey (5-point Likert scale). Hypothesis testing was performed at α=.10 (2-tailed) due to the pilot nature and small sample size. Clinicians participated in audio-recorded qualitative interviews at the end of the study to discuss their experience. Results: A total of 8 clinicians completed the confidence measure and 7 clinicians completed the acceptability measure. We found a statistically significant increase in overall confidence (mean increase of 0.5, SD 0.6; P=.03). The largest increase in confidence was in helping families with reconciliation and goodbye (mean 1.4, SD 1.5; P=.04). The majority of clinicians agreed that the format was simple (6/7, 86%) and easy to use (6/7, 86%). Clinicians felt that the telehealth SICP was effective in understanding their patients’ values about end-of-life care (7/7, 100%). A total of three qualitative themes emerged: (1) the telehealth SICP deepened relationships and renewed trust; (2) each telehealth SICP visit felt unique and personal in a positive way; and (3) uninterrupted, unrushed time optimized the visit experience. Conclusions: The telehealth SICP increased confidence in having serious illness conversations while deepening patient-clinician relationships. Trial Registration: ClinicalTrials.gov NCT04745676; https://www.clinicaltrials.gov/study/NCT04745676 %M 38935428 %R 10.2196/58503 %U https://formative.jmir.org/2024/1/e58503 %U https://doi.org/10.2196/58503 %U http://www.ncbi.nlm.nih.gov/pubmed/38935428 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52402 %T The Incidence and Outcomes of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic in South Korea: Multicenter Registry Study %A Lee,Heekyung %A Oh,Jaehoon %A Choi,Hyuk Joong %A Shin,Hyungoo %A Cho,Yongil %A Lee,Juncheol %+ Department of Emergency Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea, 82 2 2290 9829, ojjai@hanyang.ac.kr %K heart arrest %K cardiopulmonary resuscitation %K SARS-CoV-2 %K mortality %K outpatient %K cardiac arrest %K multicenter registry study %K out-of-hospital cardiac arrest %K heart attack %K observational study %K adult %K older adults %K analysis %K pandemic %K prepandemic %K endemic %K defibrillator %K COVID-19 %D 2024 %7 24.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has profoundly affected out-of-hospital cardiac arrest (OHCA) and disrupted the chain of survival. Even after the end of the pandemic, the risk of new variants and surges persists. Analyzing the characteristics of OHCA during the pandemic is important to prepare for the next pandemic and to avoid repeated negative outcomes. However, previous studies have yielded somewhat varied results, depending on the health care system or the specific characteristics of social structures. Objective: We aimed to investigate and compare the incidence, outcomes, and characteristics of OHCA during the prepandemic and pandemic periods using data from a nationwide multicenter OHCA registry. Methods: We conducted a multicenter, retrospective, observational study using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry. This study included adult patients with OHCA in South Korea across 3 distinct 1-year periods: the prepandemic period (from January to December 2019), early phase pandemic period (from July 2020 to June 2021), and late phase pandemic period (from July 2021 to June 2022). We extracted and contrasted the characteristics of patients with OHCA, prehospital time factors, and outcomes for the patients across these 3 periods. The primary outcomes were survival to hospital admission and survival to hospital discharge. The secondary outcome was good neurological outcome. Results: From the 3 designated periods, a total of 9031 adult patients with OHCA were eligible for analysis (prepandemic: n=2728; early pandemic: n=2954; and late pandemic: n=3349). Witnessed arrest (P<.001) and arrest at home or residence (P=.001) were significantly more frequent during the pandemic period than during the prepandemic period, and automated external defibrillator use by bystanders was lower in the early phase of the pandemic than during other periods. As the pandemic advanced, the rates of the first monitored shockable rhythm (P=.10) and prehospital endotracheal intubation (P<.001) decreased significantly. Time from cardiac arrest cognition to emergency department arrival increased sequentially (prepandemic: 33 min; early pandemic: 35 min; and late pandemic: 36 min; P<.001). Both survival and neurological outcomes worsened as the pandemic progressed, with survival to discharge showing the largest statistical difference (prepandemic: 385/2728, 14.1%; early pandemic: 355/2954, 12%; and late pandemic: 392/3349, 11.7%; P=.01). Additionally, none of the outcomes differed significantly between the early and late phase pandemic periods (all P>.05). Conclusions: During the pandemic, especially amid community COVID-19 surges, the incidence of OHCA increased while survival rates and good neurological outcome at discharge decreased. Prehospital OHCA factors, which are directly related to OHCA prognosis, were adversely affected by the pandemic. Ongoing discussions are needed to maintain the chain of survival in the event of a new pandemic. Trial Registration: ClinicalTrials.gov NCT03222999; https://classic.clinicaltrials.gov/ct2/show/NCT03222999 %M 38913998 %R 10.2196/52402 %U https://publichealth.jmir.org/2024/1/e52402 %U https://doi.org/10.2196/52402 %U http://www.ncbi.nlm.nih.gov/pubmed/38913998 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e52069 %T Remote Evidence-Based Programs for Health Promotion to Support Older Adults During the COVID-19 Pandemic and Beyond: Mixed Methods Outcome Evaluation %A Steinman,Lesley %A Chadwick,Kelly %A Chavez Santos,Erica %A Sravanam,Sruthi %A Johnson,Selisha Snowy %A Rensema,Elspeth %A Mayotte,Caitlin %A Denison,Paige %A Lorig,Kate %+ Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, UW Box 351621, Seattle, WA, 98195, United States, 1 2065439837, lesles@uw.edu %K older adults %K health equity %K rural %K chronic disease %K outcome evaluation %K behavior change %K technology %K community based %K evidence based %K health promotion %K mobile phone %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Evidence-based programs (EBPs) for health promotion were developed to reach older adults where they live, work, pray, and play. When the COVID-19 pandemic placed a disproportionate burden on older adults living with chronic conditions and the community-based organizations that support them, these in-person programs shifted to remote delivery. While EBPs have demonstrated effectiveness when delivered in person, less is known about outcomes when delivered remotely. Objective: This study evaluated changes in remote EBP participants’ health and well-being in a national mixed methods outcome evaluation in January 1, 2021, to March 31, 2022. Methods: We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for equity framework to guide the evaluation. We purposively sampled for diverse remote EBP delivery modes and delivery organizations, staff, and traditionally underserved older adults, including people of color and rural dwellers. We included 5 EBPs for self-management, falls prevention, and physical activity: videoconferencing (Chronic Disease Self-Management Program, Diabetes Self-Management Program, and EnhanceFitness), telephone plus mailed materials (Chronic Pain Self-Management Program), and enhanced self-directed mailed materials (Walk With Ease). Participant and provider data included validated surveys, in-depth interviews, and open-ended survey questions. We used descriptive statistics to characterize the sample and the magnitude of change and paired t tests (2-tailed) and the Fisher exact test to test for change in outcomes between enrollment and 6-month follow-up. Thematic analysis was used to identify similarities and differences in outcomes within and across programs. Joint display tables facilitated the integration of quantitative and qualitative findings. Results: A total of 586 older adults, 198 providers, and 37 organizations providing EBPs participated in the evaluation. Of the 586 older adults, 289 (49.3%) provided follow-up outcome data. The mean age of the EBP participants was 65.4 (SD 12.0) years. Of the 289 EBP participants, 241 (83.4%) were female, 108 (37.3%) were people of color, 113 (39.1%) lived alone, and 99 (34.3%) were experiencing financial hardship. In addition, the participants reported a mean of 2.5 (SD 1.7) chronic conditions. Overall, the remote EBP participants showed statistically significant improvements in health, energy, sleep quality, loneliness, depressive symptoms, and technology anxiety. Qualitatively, participants shared improvements in knowledge, attitudes, and skills for healthier living; reduced their social isolation and loneliness; and gained better access to programs. Three-fourths of the providers (149/198, 75.2%) felt that effectiveness was maintained when switching from in-person to remote delivery. Conclusions: The findings suggest that participating in remote EBPs can improve health, social, and technological outcomes of interest for older adults and providers, with benefits extending to policy makers. Future policy and practice can better support remote EBP delivery as one model for health promotion, improving access for all older adults. %M 38869932 %R 10.2196/52069 %U https://aging.jmir.org/2024/1/e52069 %U https://doi.org/10.2196/52069 %U http://www.ncbi.nlm.nih.gov/pubmed/38869932 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55638 %T Assessing the Efficacy of the ARMOR Tool–Based Deprescribing Intervention for Fall Risk Reduction in Older Patients Taking Fall Risk–Increasing Drugs (DeFRID Trial): Protocol for a Randomized Controlled Trial %A Priyadarshini,Rekha %A Eerike,Madhavi %A Varatharajan,Sakthivadivel %A Ramaswamy,Gomathi %A Raj,Gerard Marshall %A Cherian,Jerin Jose %A Rajendran,Priyadharsini %A Gunasekaran,Venugopalan %A Rao,Shailaja V %A Konda,Venu Gopala Rao %+ Department of Pharmacology, All India Institute of Medical Sciences Bibinagar, Bibinagar, Hyderabad, 508126, India, 91 9941476332, dr.madhavieerike@gmail.com %K deprescribing %K geriatric %K fall risk–increasing drugs %K FRIDs %K ARMOR tool %K Assess, Review, Minimize, Optimize, and Reassess %K falls %K older patients %K fall risk %D 2024 %7 11.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Falls in older patients can lead to serious health complications and increased health care costs. Fall risk–increasing drugs (FRIDs) are a group of drugs that may induce falls or increase the tendency to fall (ie, fall risk). Deprescribing is the process of withdrawal from an inappropriate medication, supervised by a health care professional, with the goal of managing polypharmacy and improving outcomes. Objective: This study aims to assess the effectiveness of a deprescribing intervention based on the Assess, Review, Minimize, Optimize, and Reassess (ARMOR) tool in reducing the risk of falls in older patients and evaluate the cost-effectiveness of deprescribing FRIDs. Methods: This is an open-label, parallel-group randomized controlled academic trial. Individuals aged 60-80 years who are currently taking 5 or more prescribed drugs, including at least 1 FRID, will be recruited. Demographic data, medical conditions, medication lists, orthostatic hypotension, and fall history details will be collected. Fall concern will be assessed using the Fall Efficacy Scale, and fall risk will be assessed by the Timed Up and Go test and Tinetti Performance-Oriented Mobility Assessment tool. In this study, all treating physicians will be randomized using a stratified randomization method based on seniority. Randomized physicians will do deprescribing with the ARMOR tool for patients on FRIDs. Participants will maintain diaries, and monthly phone follow-ups will be undertaken to monitor falls and adverse events. Physical assessments will be performed to evaluate fall risk every 3 months for a year. The rationality of prescription drugs will be evaluated using the World Health Organization’s core indicators. Results: The study received a grant from the Indian Council of Medical Research–Safe and Rational Use of Medicine in October 2023. The study is scheduled to commence in April 2024 and conclude by 2026. Efficacy will be measured by fall frequency and changes in fall risk scores. Cost-effectiveness analysis will also include the incremental cost-effectiveness ratio calculation. Adverse events related to deprescription will be recorded. Conclusions: This trial will provide essential insights into the efficacy of the ARMOR tool in reducing falls among the geriatric population who are taking FRIDs. Additionally, it will provide valuable information on the cost-effectiveness of deprescribing practices, offering significant implications for improving the well-being of older patients and optimizing health care resource allocation. The findings from this study will be pertinent for health care professionals, policy makers, and researchers focused on geriatric care and fall prevention strategies. Trial Registration: Clinical Trials Registry – India CTRI/2023/12/060516; https://ctri.nic.in/Clinicaltrials/pubview2.php International Registered Report Identifier (IRRID): PRR1-10.2196/55638 %M 38861709 %R 10.2196/55638 %U https://www.researchprotocols.org/2024/1/e55638 %U https://doi.org/10.2196/55638 %U http://www.ncbi.nlm.nih.gov/pubmed/38861709 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58205 %T The Prevalence of Missing Incidents and Their Antecedents Among Older Adult MedicAlert Subscribers: Retrospective Descriptive Study %A Miguel-Cruz,Antonio %A Perez,Hector %A Choi,Yoojin %A Rutledge,Emily %A Daum,Christine %A Liu,Lili %+ Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 2R3, Canada, 1 7802246641, miguelcr@ualberta.ca %K dementia %K Alzheimer disease %K memory loss %K cognitive impairment %K missing incident %K wandering %K critical wandering %K older adults %K retrospective design %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: With the population aging, the number of people living with dementia is expected to rise, which, in turn, is expected to lead to an increase in the prevalence of missing incidents due to critical wandering. However, the estimated prevalence of missing incidents due to dementia is inconclusive in some jurisdictions and overlooked in others. Objective: The aims of the study were to examine (1) the demographic, psychopathological, and environmental antecedents to missing incidents due to critical wandering among older adult MedicAlert Foundation Canada (hereinafter MedicAlert) subscribers; and (2) the characteristics and outcomes of the missing incidents. Methods: This study used a retrospective descriptive design. The sample included 434 older adult MedicAlert subscribers involved in 560 missing incidents between January 2015 and July 2021. Results: The sample was overrepresented by White older adults (329/425, 77.4%). MedicAlert subscribers reported missing were mostly female older adults (230/431, 53.4%), living in urban areas with at least 1 family member (277/433, 63.8%). Most of the MedicAlert subscribers (345/434, 79.5%) self-reported living with dementia. MedicAlert subscribers went missing most frequently from their private homes in the community (96/143, 67.1%), traveling on foot (248/270, 91.9%) and public transport (12/270, 4.4%), during the afternoon (262/560, 46.8%) and evening (174/560, 31.1%). Most were located by first responders (232/486, 47.7%) or Good Samaritans (224/486, 46.1%). Of the 560 missing incidents, 126 (22.5%) were repeated missing incidents. The mean time between missing incidents was 11 (SD 10.8) months. Finally, the majority of MedicAlert subscribers were returned home safely (453/500, 90.6%); and reports of harm, injuries (46/500, 9.2%), and death (1/500, 0.2%) were very low. Conclusions: This study provides the prevalence of missing incidents from 1 database source. The low frequency of missing incidents may not represent populations that are not White. Despite the low number of missing incidents, the 0.2% (1/500) of cases resulting in injuries or death are devastating experiences that may be mitigated through prevention strategies. %M 38857069 %R 10.2196/58205 %U https://aging.jmir.org/2024/1/e58205 %U https://doi.org/10.2196/58205 %U http://www.ncbi.nlm.nih.gov/pubmed/38857069 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49617 %T Metabolic Score for Insulin Resistance and New-Onset Type 2 Diabetes in a Middle-Aged and Older Adult Population: Nationwide Prospective Cohort Study and Implications for Primary Care %A Cheng,Hui %A Jia,Zhihui %A Li,Yu Ting %A Yu,Xiao %A Wang,Jia Ji %A Xie,Yao Jie %A Hernandez,Jose %A Wang,Harry H X %+ School of Public Health, Sun Yat-Sen University, No 74 Zhongshan Road 2, Guangzhou, 510080, China, 86 20 87330672, wanghx27@mail.sysu.edu.cn %K metabolic score for insulin resistance %K type 2 diabetes mellitus %K blood pressure %K longitudinal study %K primary care %D 2024 %7 3.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The metabolic score for insulin resistance (METS-IR) has emerged as a noninsulin-based index for the approximation of insulin resistance (IR), yet longitudinal evidence supporting the utility of METS-IR in the primary prevention of type 2 diabetes mellitus (T2DM) remains limited. Objective: We aimed to investigate the longitudinal association between METS-IR, which combines fasting plasma glucose (FPG), lipid profiles, and anthropometrics that can be routinely obtained in resource-limited primary care settings, and the incidence of new-onset T2DM. Methods: We conducted a closed-cohort analysis of a nationwide, prospective cohort of 7583 Chinese middle-aged and older adults who were free of T2DM at baseline, sampled from 28 out of 31 provinces in China. We examined the characteristics of participants stratified by elevated blood pressure (BP) at baseline and new-onset T2DM at follow-up. We performed Cox proportional hazard regression analysis to explore associations of baseline METS-IR with incident T2DM in participants overall and in participants stratified by baseline BP. We also applied net reclassification improvement and integrated discrimination improvement to examine the incremental value of METS-IR. Results: During a mean follow-up period of 6.3 years, T2DM occurred in 527 participants, among which two-thirds (332/527, 62.9%; 95% CI 58.7%-67.1%) had baseline FPG<110 mg/dL. A SD unit increase in baseline METS-IR was associated with the first incidence of T2DM (adjusted hazard ratio [aHR] 1.33, 95% CI 1.22-1.45; P<.001) in all participants. We obtained similar results in participants with normal baseline BP (aHR 1.41, 95% CI 1.22-1.62; P<.001) and elevated baseline BP (aHR 1.29, 95% CI 1.16-1.44; P<.001). The predictive capability for incident T2DM was improved by adding METS-IR to FPG. In study participants with new-onset T2DM whose baseline FPG was <126 mg/dL and <110 mg/dL, 62.9% (332/527; 95% CI 60%-65.9%) and 58.1% (193/332; 95% CI 54.3%-61.9%) of participants had baseline METS-IR above the cutoff values, respectively. Conclusions: METS-IR was significantly associated with new-onset T2DM, regardless of baseline BP level. Regular monitoring of METS-IR on top of routine blood glucose in clinical practice may add to the ability to enhance the early identification of primary care populations at risk for T2DM. %M 38569189 %R 10.2196/49617 %U https://publichealth.jmir.org/2024/1/e49617 %U https://doi.org/10.2196/49617 %U http://www.ncbi.nlm.nih.gov/pubmed/38569189 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52457 %T Electronic Health Literacy Scale-Web3.0 for Older Adults with Noncommunicable Diseases: Validation Study %A Cai,Wenfei %A Liang,Wei %A Liu,Huaxuan %A Zhou,Rundong %A Zhang,Jie %A Zhou,Lin %A Su,Ning %A Zhu,Hanxiao %A Yang,Yide %+ School of Physical Education, Shenzhen University, 3688 Nanhai Road, Nanshan District, Shenzhen, 518060, China, 86 15217940540, wliang1020@szu.edu.cn %K eHealth literacy %K measurement %K Web 3.0 %K psychometric properties %K NCD %K older adults %K noncommunicable diseases %K Electronic Health Literacy %K health literacy %K eHealth %K reliability %K validity %D 2024 %7 3.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In the current digital era, eHealth literacy plays an indispensable role in health care and self-management among older adults with noncommunicable diseases (NCDs). Measuring eHealth literacy appropriately and accurately ensures the successful implementation and evaluation of pertinent research and interventions. However, existing eHealth literacy measures focus mainly on individuals’ abilities of accessing and comprehending eHealth information (Web1.0), whereas the capabilities for web-based interaction (Web2.0) and using eHealth information (Web3.0) have not been adequately evaluated. Objective: This study aimed to examine the reliability, validity, and measurement invariance of the eHealth Literacy Scale-Web3.0 (eHLS-Web3.0) among older adults with NCDs. Methods: A total of 642 Chinese older adults with NCDs (mean age 65.78, SD 3.91 years; 55.8% female) were recruited in the baseline assessment, of whom 134 (mean age 65.63, SD 3.99 years; 58.2% female) completed the 1-month follow-up assessment. Baseline measures included the Chinese version of the 24-item 3D eHLS-Web3.0, the Chinese version of the 8-item unidimensional eHealth Literacy Scale (eHEALS), and demographic information. Follow-up measures included the 24-item eHLS-Web3.0 and accelerometer-measured physical activity and sedentary behavior. A series of statistical analyses, for example, Cronbach α, composite reliability coefficient (CR), confirmatory factor analysis (CFA), and multigroup CFA, were performed to examine the internal consistency and test-retest reliabilities, as well as the construct, concurrent, convergent, discriminant, and predictive validities, and the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence. Results: Cronbach α and CR were within acceptable ranges of 0.89-0.94 and 0.90-0.97, respectively, indicating adequate internal consistency of the eHLS-Web3.0 and its subscales. The eHLS-Web3.0 also demonstrated cross-time stability, with baseline and follow-up measures showing a significant intraclass correlation of 0.81-0.91. The construct validity of the 3D structure model of the eHLS-Web3.0 was supported by confirmatory factor analyses. The eHLS-Web3.0 exhibited convergent validity with an average variance extracted value of 0.58 and a CR value of 0.97. Discriminant validity was supported by CFA results for a proposed 4-factor model integrating the 3 eHLS-Web3.0 subscales and eHEALS. The predictive validity of the eHLS-Web3.0 for health behaviors was supported by significant associations of the eHLS-Web3.0 with light physical activity (β=.36, P=.004), moderate to vigorous physical activity (β=.49, P<.001), and sedentary behavior (β=–.26, P=.002). Finally, the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence was supported by the establishment of configural, metric, strong, and strict invariances. Conclusions: The present study provides timely empirical evidence on the reliability, validity, and measurement invariance of the eHLS-Web3.0, suggesting that the 24-item 3D eHLS-Web3.0 is an appropriate and valid tool for measuring eHealth literacy among older adults with NCDs within the Web3.0 sphere. %M 38830207 %R 10.2196/52457 %U https://www.jmir.org/2024/1/e52457 %U https://doi.org/10.2196/52457 %U http://www.ncbi.nlm.nih.gov/pubmed/38830207 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e53098 %T Combating Barriers to the Development of a Patient-Oriented Frailty Website %A Greeley,Brian %A Chung,Sally Seohyeon %A Graves,Lorraine %A Song,Xiaowei %K frailty %K frailty website %K patient-oriented assessment %K community-dwelling older adults %K internet security %K privacy %K barrier %K barriers %K development %K implementation %K patient-oriented %K internet %K virtual health resource %K community dwelling %K older adult %K older adults %K health care professional %K caregiver %K caregivers %K technology %K real-time %K monitoring %K aging %K ageing %D 2024 %7 28.5.2024 %9 %J JMIR Aging %G English %X This viewpoint article, which represents the opinions of the authors, discusses the barriers to developing a patient-oriented frailty website and potential solutions. A patient-oriented frailty website is a health resource where community-dwelling older adults can navigate to and answer a series of health-related questions to receive a frailty score and health summary. This information could then be shared with health care professionals to help with the understanding of health status prior to acute illness, as well as to screen and identify older adult individuals for frailty. Our viewpoints were drawn from 2 discussion sessions that included caregivers and care providers, as well as community-dwelling older adults. We found that barriers to a patient-oriented frailty website include, but are not limited to, its inherent restrictiveness to frail persons, concerns over data privacy, time commitment worries, and the need for health and lifestyle resources in addition to an assessment summary. For each barrier, we discuss potential solutions and caveats to those solutions, including assistance from caregivers, hosting the website on a trusted source, reducing the number of health questions that need to be answered, and providing resources tailored to each users’ responses, respectively. In addition to screening and identifying frail older adults, a patient-oriented frailty website will help promote healthy aging in nonfrail adults, encourage aging in place, support real-time monitoring, and enable personalized and preventative care. %R 10.2196/53098 %U https://aging.jmir.org/2024/1/e53098 %U https://doi.org/10.2196/53098 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53163 %T Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing %A Sien,Sang-Wha %A Kobekyaa,Francis Kyerepagr %A Puts,Martine %A Currie,Leanne %A Tompson,Margaret %A Hedges,Penelope %A McGrenere,Joanna %A Mariano,Caroline %A Haase,Kristen R %+ School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 604 822 0979, kristenrhaase@gmail.com %K cancer %K aging %K self-management %K usability testing %K design thinking %K design %K oncology %K develop %K development %K 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 mHealth %K mobile health %K app %K apps %K application %K applications %K symptom %K symptoms %K comorbidity %K comorbidities %K comorbid %K multimorbidity %K multimorbidities %K co-design %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Globally, cancer predominates in adults aged older than 60 years, and 70% of older adults have ≥1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake. Objective: We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity. Methods: This study used Grey’s self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses. Results: In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy. Conclusions: This app has the potential to support the complex health care needs of older adults with cancer, creating a “home base” for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation. %M 38717806 %R 10.2196/53163 %U https://aging.jmir.org/2024/1/e53163 %U https://doi.org/10.2196/53163 %U http://www.ncbi.nlm.nih.gov/pubmed/38717806 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49129 %T Association of the Type of Public Pension With Mental Health Among South Korean Older Adults: Longitudinal Observational Study %A Kim,Seung Hoon %A Kim,Hyunkyu %A Jeong,Sung Hoon %A Park,Eun-Cheol %+ Department of Ophthalmology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, 31 Sooncheonhyang 6-gil, Dongnam-gu, Chenonan, 31151, Republic of Korea, 82 425702114, immergru@gmail.com %K depression %K retirement %K contributory public pension %K low-income household %K public health %K mental health %K data %K big data %K retirement %K longitudinal data %K low income %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As income and health are closely related, retirement is considered undesirable for health. Many studies have shown the association between pension and health, but no research has considered the association between contribution-based public pensions or their types and health. Objective: This study investigates the association between the type of contributory public pension and depressive symptoms among older adults. Methods: We analyzed the data of 4541 older adults who participated in the South Korea Welfare Panel Study (2014-2020). Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression scale. Public pensions in South Korea are classified into specific corporate pensions and national pensions. For subgroup analyses, pensioners were categorized according to the amount of pension received and the proportion of public pension over gross income. Analyses using generalized estimating equations were conducted for longitudinal data. Results: Individuals receiving public pension, regardless of the pension type, demonstrated significantly decreased depressive symptoms (national pension: β=–.734; P<.001; specific corporate pension: β=–.775; P=.02). For both pension types, the higher the amount of benefits, the lower were the depression scores. However, this association was absent for those who received the smaller amount among the specific corporate pensioners. In low-income households, the decrease in the depressive symptoms based on the amount of public pension benefits was greater (fourth quartile of national pension: β=–1.472; P<.001; second and third quartiles of specific corporate pension: β=–3.646; P<.001). Conclusions: Our study shows that contributory public pension is significantly associated with lower depressive symptoms, and this association is prominent in low-income households. Thus, contributory public pensions may be good income sources for improving the mental health of older adults after retirement. %M 38696246 %R 10.2196/49129 %U https://publichealth.jmir.org/2024/1/e49129 %U https://doi.org/10.2196/49129 %U http://www.ncbi.nlm.nih.gov/pubmed/38696246 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54852 %T Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study %A Andrikopoulou,Elisavet %A Chatzistergos,Panagiotis %A Chockalingam,Nachiappan %+ Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Leek Road, Science Centre, Stoke on Trent, ST4 2DF, United Kingdom, 44 178229 ext 5920, pchatzistergos@gmail.com %K diabetic foot %K first-ever diabetic foot ulcer %K qualitative research %K quantitative evaluation %K surveys and questionnaires %K telephone interviews %K primary care %K community care %K acute care %K education of patients %K foot ulcer %K exploration %K diabetes %K foot ulceration %K United Kingdom %K diabetic foot ulceration %K DFU %K amputation %K complication %K complication %K perspectives %K experiences %K health care professionals %K barrier %K barriers %K effective care %K foot care %K primary ulcers %K quality of life %D 2024 %7 24.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Diabetes affects more than 4.3 million individuals in the United Kingdom, with 19% to 34% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes. Preventing first-ever ulcers is the most effective strategy to reduce the occurrence of diabetes-related amputations, but research in this space is lacking. Objective: This protocol seeks to document the experiences and perspectives of frontline health care professionals who work with people who have diabetes and diabetes-related foot problems. Special attention is given to their perceptions of barriers to effective care, their views about barriers to effective and inclusive engagement with people with diabetes, and their experience with the first-ever DFU. Another aspect of the study is the focus on whether clinical management is affected by data sharing, data availability, and interoperability issues. Methods: This is a mixed methods explanatory protocol, which is sequential, and its purpose is to use the qualitative data to explain the initial quantitative data collected through a survey of frontline health care professionals. Data analysis of quantitative data will be completed first and then synthesized with the qualitative data analysis. Qualitative data will be analyzed using the framework method. This study will use joint displays to integrate the data. Ethical approval has been granted by the ethics committee of Staffordshire University. Results: The quantitative data collection started in March 2023 and will close in May 2024. The qualitative interviews commenced in November 2023 with volunteer participants who initially completed the survey. Conclusions: This study’s survey focuses on data interoperability and the interviews focus more on the perspectives and experiences of clinicians and their perceived barriers for the effective management of diabetes foot ulcers. Including a geographically relevant and diverse cohort of health care professionals that spans a wide range of roles and care settings involved in diabetes-related foot care is very important for the successful application of this protocol. Special care is given to advertise and promote participation as widely as possible. The qualitative part of this protocol is also limited to 30-40 interview participants, as it is not realistic to interview higher numbers, due to time and resource constraints. International Registered Report Identifier (IRRID): DERR1-10.2196/54852 %M 38656782 %R 10.2196/54852 %U https://www.researchprotocols.org/2024/1/e54852 %U https://doi.org/10.2196/54852 %U http://www.ncbi.nlm.nih.gov/pubmed/38656782 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55192 %T Health Needs Assessment in Home-Living Older Adults: Protocol for a Pre-Post Study %A Kvalsvik,Fifi %A Larsen,Bente Hamre %A Eilertsen,Grethe %A Falkenberg,Helle K %A Dalen,Ingvild %A Haaland,Stine %A Storm,Marianne %+ Department of Public Health, Faculty of Health Sciences, University of Stavanger, P.O. Box 8600 Forus, Stavanger, 4036, Norway, 47 46649888, fifi.kvalsvik@uis.no %K assessment %K frailty %K healthy aging %K health care %K home-living older adults %K pre-post study %K protocol %D 2024 %7 18.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Conducting a health needs assessment for older adults is important, particularly for early detection and management of frailty. Such assessments can help to improve health outcomes, maintain overall well-being, and support older adults in retaining their independence as they age at home. Objective: In this study, a systematic approach to health needs assessment is adopted in order to reflect real-world practices in municipal health care and capture the nuances of frailty. The aim is to assess changes in frailty levels in home-living older adults over 5 months and to examine the observable functional changes from a prestudy baseline (t1) to a poststudy period (t2). Additionally, the study explores the feasibility of conducting the health needs assessment from the perspective of home-living older adults and their informal caregivers. Methods: Interprofessional teams of registered nurses, physiotherapists, and occupational therapists will conduct 2 health needs assessments covering physical, cognitive, psychological, social, and behavioral domains. The study includes 40 home-living older adults of 75 years of age or older, who have applied for municipal health and care services in Norway. A quantitative approach will be applied to assess changes in frailty levels in home-living older adults over 5 months. In addition, we will examine the observable functional changes from t1 to t2 and how these changes correlate to frailty levels. Following this, a qualitative approach will be used to examine the perspectives of participants and their informal caregivers regarding the health needs assessment and its feasibility. The final sample size for the qualitative phase will be determined based on the participant’s willingness to be interviewed. The quantitative data consist of descriptive statistics, simple tests, and present plots and correlation coefficients. For the qualitative analysis, we will apply thematic analysis. Results: The initial baseline assessments were completed in July 2023, and the second health needs assessments are ongoing. We expect the results to be available for analysis in the spring of 2024. Conclusions: This study has potential benefits for not only older adults and their informal caregivers but also health care professionals. Moreover, it can be used to inform future studies focused on health needs assessments of this specific demographic group. The study also provides meaningful insights for local policy makers, with potential future implications at the national level. Trial Registration: ClinicalTrials.gov NCT05837728; https://clinicaltrials.gov/study/NCT05837728 International Registered Report Identifier (IRRID): DERR1-10.2196/55192 %M 38635319 %R 10.2196/55192 %U https://www.researchprotocols.org/2024/1/e55192 %U https://doi.org/10.2196/55192 %U http://www.ncbi.nlm.nih.gov/pubmed/38635319 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55132 %T The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study %A Fan,Qiping %A Hoang,Minh-Nguyet %A DuBose,Logan %A Ory,Marcia G %A Vennatt,Jeswin %A Salha,Diana %A Lee,Shinduk %A Falohun,Tokunbo %+ Department of Public Health Sciences, Clemson University, 524 Edwards Hall, 201 Epsion Zeta Drive, Clemson, SC, 29634, United States, 1 864 656 3841, qipingfan0403@gmail.com %K evaluation %K usability %K family caregiver %K Alzheimer disease %K dementia %K digital health %K mobile phone %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The increasing prevalence of Alzheimer disease and Alzheimer disease–related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care. Objective: This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers. Methods: For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics. Results: Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ≥50 years (25/30, 83%), women (23/30, 77%), White (25/30, 83%), and financially stable (20/30, 67%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90% (27/30) rated the app overall positively. Most of the participants (21/30, 70%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration. Conclusions: The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population. %M 38630527 %R 10.2196/55132 %U https://aging.jmir.org/2024/1/e55132 %U https://doi.org/10.2196/55132 %U http://www.ncbi.nlm.nih.gov/pubmed/38630527 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49433 %T Chronic Disease Patterns and Their Relationship With Health-Related Quality of Life in South Korean Older Adults With the 2021 Korean National Health and Nutrition Examination Survey: Latent Class Analysis %A Lee,Mi-Sun %A Lee,Hooyeon %+ Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 2 3147 8381, hylee@catholic.ac.kr %K chronic disease %K latent class analysis %K multimorbidity %K older adults %K quality of life %D 2024 %7 10.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Improved life expectancy has increased the prevalence of older adults living with multimorbidities, which likely deteriorates their health-related quality of life (HRQoL). Understanding which chronic conditions frequently co-occur can facilitate person-centered care tailored to the needs of individuals with specific multimorbidity profiles. Objective: The study objectives were to (1) examine the prevalence of multimorbidity among Korean older adults (ie, those aged 65 years and older), (2) investigate chronic disease patterns using latent class analysis, and (3) assess which chronic disease patterns are more strongly associated with HRQoL. Methods: A sample of 1806 individuals aged 65 years and older from the 2021 Korean National Health and Nutrition Examination Survey was analyzed. Latent class analysis was conducted to identify the clustering pattern of chronic diseases. HRQoL was assessed by an 8-item health-related quality of life scale (HINT-8). Multiple linear regression was used to analyze the association with the total score of the HINT-8. Logistic regression analysis was performed to evaluate the odds ratio of having problems according to the HINT-8 items. Results: The prevalence of multimorbidity in the sample was 54.8%. Three chronic disease patterns were identified: relatively healthy, cardiometabolic condition, arthritis, allergy, or asthma. The total scores of the HINT-8 were the highest in participants characterized as arthritis, allergy, or asthma group, indicating the lowest quality of life. Conclusions: Current health care models are disease-oriented, meaning that the management of chronic conditions applies to a single condition and may not be relevant to those with multimorbidities. Identifying chronic disease patterns and their impact on overall health and well-being is critical for guiding integrated care. %M 38598275 %R 10.2196/49433 %U https://publichealth.jmir.org/2024/1/e49433 %U https://doi.org/10.2196/49433 %U http://www.ncbi.nlm.nih.gov/pubmed/38598275 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48947 %T Sex- and Age-Specific Prevalence of Osteopenia and Osteoporosis: Sampling Survey %A Fan,Yao %A Li,Qun %A Liu,Yu %A Miao,Jing %A Zhao,Ting %A Cai,Jinxin %A Liu,Min %A Cao,Jun %A Xu,Haifeng %A Wei,Lai %A Li,Mengxia %A Shen,Chong %+ Department of Epidemiology, School of Public Health, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 25 86868443, sc@njmu.edu.cn %K cross-sectional study %K osteopenia %K osteoporosis %K prevalence %K quantitative ultrasound %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Osteopenia and osteoporosis are posing a long-term influence on the aging population’s health contributing to a higher risk of mortality, loss of autonomy, hospitalization, and huge health system costs and social burden. Therefore, more pertinent data are needed to demonstrate the current state of osteoporosis. Objective: This sampling survey seeks to assess the trends in the prevalence of osteopenia and osteoporosis in a Chinese Han population. Methods: A community-based cross-sectional study involving 16,377 participants used a multistage sampling method. Bone mineral density was measured using the quantitative ultrasonic densitometry. Student t test and Mann-Whitney U test were used to test the difference between normally and nonnormally distributed quantitative variables between male and female participants. A chi-square (χ2) test was used to compare categorized variables. Stratified analysis was conducted to describe the prevalence rates of osteoporosis (T score ≤–2.5) and osteopenia (T score –2.5 to –1.0) across age, sex, calcium intake, and menopause. A direct standardization method was used to calculate the age-standardized prevalence rates of osteoporosis and osteopenia. T-score was further categorized into quartiles (T1-T4) by age- and sex-specified groups. Results: The prevalence rates of osteopenia and osteoporosis were 40.5% (6633/16,377) and 7.93% (1299/16,377), respectively, and the age-standardized prevalence rates were 27.32% (287,877,129.4/1,053,861,940) and 3.51% (36,974,582.3/1,053,861,940), respectively. There was an increase in osteopenia and osteoporosis prevalence from 21.47% (120/559) to 56.23% (754/1341) and 0.89% (5/559) to 17.23% (231/1341), respectively, as age increased from 18 years to 75 years old. The prevalence rates of osteopenia and osteoporosis were significantly higher in female participants (4238/9645, 43.94% and 1130/9645, 11.72%) than in male participants (2395/6732, 35.58% and 169/6732, 2.51%; P<.001), and in postmenopausal female participants (3638/7493, 48.55% and 1053/7493, 14.05%) than in premenopausal female participants (538/2026, 26.55% and 53/2026, 2.62%; P<.001). In addition, female participants with a history of calcium intake had a lower osteoporosis prevalence rate than female participants without any history of calcium intake in all age groups (P=.004). From low quartile to high quartile of T-score, the prevalence of diabetes mellitus (752/4037, 18.63%; 779/4029, 19.33%; 769/3894, 19.75%; and 869/3879, 22.4%) and dyslipidemia (2228/4036, 55.2%; 2304/4027, 57.21%; 2306/3891, 59.26%; and 2379/3878, 61.35%) were linearly increased (P<.001), while the prevalence of cancer (112/4037, 2.77%; 110/4029, 2.73%; 103/3894, 2.65%; and 77/3879, 1.99%) was decreased (P=.03). Conclusions: Our data imply that as people age, osteopenia and osteoporosis are more common in females than in males, particularly in postmenopausal females than in premenopausal females, and bone mineral density significantly affects the prevalence of chronic diseases. These findings offer information that can be applied to intervention programs meant to prevent or lessen the burden of osteoporosis in China. %M 38578689 %R 10.2196/48947 %U https://publichealth.jmir.org/2024/1/e48947 %U https://doi.org/10.2196/48947 %U http://www.ncbi.nlm.nih.gov/pubmed/38578689 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53006 %T Development of a Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized Controlled Trial %A Sun,Ting %A Xu,Xuejie %A Ding,Zenghui %A Xie,Hui %A Ma,Linlin %A Zhang,Jing %A Xia,Yuxin %A Zhang,Guoli %A Ma,Zuchang %+ Hefei Institutes of Physical Science, Chinese Academy of Sciences, #350 Shushan Lake Road, Shushan District, Hefei, 230031, China, 86 13956984669, ZCMa121@126.com %K adherence %K hypertension %K health behavior %K mHealth %K digital health %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with “adherence” playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension. Objective: The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence. Methods: A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant. Results: The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (–7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes. Conclusions: The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782 International Registered Report Identifier (IRRID): RR2-10.2196/46883 %M 38578692 %R 10.2196/53006 %U https://mhealth.jmir.org/2024/1/e53006 %U https://doi.org/10.2196/53006 %U http://www.ncbi.nlm.nih.gov/pubmed/38578692 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e52923 %T A Self-Guided Web-Based App (MyDiaMate) for Enhancing Mental Health in Adults With Type 1 Diabetes: Insights From a Real-World Study in the Netherlands %A Embaye,Jiska %A de Wit,Maartje %A Snoek,Frank %+ Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands, 31 2004440190, j.embaye@amsterdamumc.nl %K type 1 diabetes %K e-mental health %K web based %K self-help %K real world %K naturalistic %K uptake %K adoption %K usage %K mental health %K distress %K emotional well-being %K cognitive behavioral therapy %K internet-based cognitive behavioral therapy %K Europe %K Netherlands %K Dutch %D 2024 %7 3.4.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: MyDiaMate is a web-based intervention specifically designed for adults with type 1 diabetes (T1D) that aims to help them improve and maintain their mental health. Prior pilot-testing of MyDiaMate verified its acceptability, feasibility, and usability. Objective: This study aimed to investigate the real-world uptake and usage of MyDiaMate in the Netherlands. Methods: Between March 2021 and December 2022, MyDiaMate was made freely available to Dutch adults with T1D. Usage (participation and completion rates of the modules) was tracked using log data. Users could volunteer to participate in the user profile study, which required filling out a set of baseline questionnaires. The usage of study participants was examined separately for participants scoring above and below the cutoffs of the “Problem Areas in Diabetes” (PAID-11) questionnaire (diabetes distress), the “World Health Organization Well-being Index” (WHO-5) questionnaire (emotional well-being), and the fatigue severity subscale of the “Checklist Individual Strength” (CIS) questionnaire (fatigue). Two months after creating an account, study participants received an evaluation questionnaire to provide us with feedback. Results: In total, 1008 adults created a MyDiaMate account, of whom 343 (34%) participated in the user profile study. The mean age was 43 (SD 14.9; 18-76) years. Most participants were female (n=217, 63.3%) and higher educated (n=198, 57.6%). The majority had been living with T1D for over 5 years (n=241, 73.5%). Of the study participants, 59.1% (n=199) of them reported low emotional well-being (WHO-5 score≤50), 70.9% (n=239) of them reported elevated diabetes distress (PAID-11 score≥18), and 52.4% (n=178) of them reported severe fatigue (CIS score≥35). Participation rates varied between 9.5% (n=19) for social environment to 100% (n=726) for diabetes in balance, which opened by default. Completion rates ranged from 4.3% (n=1) for energy, an extensive cognitive behavioral therapy module, to 68.6% (n=24) for the shorter module on hypos. There were no differences in terms of participation and completion rates of the modules between study participants with a more severe profile, that is, lower emotional well-being, greater diabetes distress, or more fatigue symptoms, and those with a less severe profile. Further, no technical problems were reported, and various suggestions were made by study participants to improve the application, suggesting a need for more personalization. Conclusions: Data from this naturalistic study demonstrated the potential of MyDiaMate as a self-help tool for adults with T1D, supplementary to ongoing diabetes care, to improve healthy coping with diabetes and mental health. Future research is needed to explore engagement strategies and test the efficacy of MyDiaMate in a randomized controlled trial. %M 38568733 %R 10.2196/52923 %U https://diabetes.jmir.org/2024/1/e52923 %U https://doi.org/10.2196/52923 %U http://www.ncbi.nlm.nih.gov/pubmed/38568733 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46287 %T Augmenting K-Means Clustering With Qualitative Data to Discover the Engagement Patterns of Older Adults With Multimorbidity When Using Digital Health Technologies: Proof-of-Concept Trial %A Sheng,Yiyang %A Bond,Raymond %A Jaiswal,Rajesh %A Dinsmore,John %A Doyle,Julie %+ NetwellCASALA, Dundalk Institution of Technology, Dublin Road, PJ Carrolls Building, Dundalk Institute of Technology, Co.Louth, Ireland, Dundalk, A91 K584, Ireland, 353 894308214, shengexz@gmail.com %K aging %K digital health %K multimorbidity %K chronic disease %K engagement %K k-means clustering %D 2024 %7 28.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Multiple chronic conditions (multimorbidity) are becoming more prevalent among aging populations. Digital health technologies have the potential to assist in the self-management of multimorbidity, improving the awareness and monitoring of health and well-being, supporting a better understanding of the disease, and encouraging behavior change. Objective: The aim of this study was to analyze how 60 older adults (mean age 74, SD 6.4; range 65-92 years) with multimorbidity engaged with digital symptom and well-being monitoring when using a digital health platform over a period of approximately 12 months. Methods: Principal component analysis and clustering analysis were used to group participants based on their levels of engagement, and the data analysis focused on characteristics (eg, age, sex, and chronic health conditions), engagement outcomes, and symptom outcomes of the different clusters that were discovered. Results: Three clusters were identified: the typical user group, the least engaged user group, and the highly engaged user group. Our findings show that age, sex, and the types of chronic health conditions do not influence engagement. The 3 primary factors influencing engagement were whether the same device was used to submit different health and well-being parameters, the number of manual operations required to take a reading, and the daily routine of the participants. The findings also indicate that higher levels of engagement may improve the participants’ outcomes (eg, reduce symptom exacerbation and increase physical activity). Conclusions: The findings indicate potential factors that influence older adult engagement with digital health technologies for home-based multimorbidity self-management. The least engaged user groups showed decreased health and well-being outcomes related to multimorbidity self-management. Addressing the factors highlighted in this study in the design and implementation of home-based digital health technologies may improve symptom management and physical activity outcomes for older adults self-managing multimorbidity. %M 38546724 %R 10.2196/46287 %U https://www.jmir.org/2024/1/e46287 %U https://doi.org/10.2196/46287 %U http://www.ncbi.nlm.nih.gov/pubmed/38546724 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e49130 %T Digital Health Interventions in Older Adult Populations Living With Chronic Disease in High-Income Countries: Protocol for a Scoping Review %A Ashraf,Mir Nabila %A Gallant,Natasha L %A Bradley,Cara %+ Department of Psychology and Centre on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 4219, Natasha.Gallant@uregina.ca %K chronic disease %K high-income countries %K digital health %K interventions %K older adults %K quality of life %D 2024 %7 28.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, around 80% percent of adults aged 65 years or older are living with at least 1 chronic disease, and 68% percent have 2 or more chronic diseases. Older adults living with chronic diseases require greater health care services, but these health care services are not always easily accessible. Furthermore, the COVID-19 pandemic has resulted in unprecedented changes in the provision of health care services for older adults. During the COVID-19 pandemic, digital health interventions for chronic disease management were developed out of necessity, but the evidence regarding these and developed interventions is lacking. Objective: In this scoping review, we aim to identify available digital health interventions such as emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms for chronic disease management for older adults in high-income countries. Methods: We will follow the Arksey and O’Malley framework to conduct the scoping review. Our full search strategy was developed following a preliminary search on MEDLINE. We will include studies where older adults are at least 65 years of age, living with at least 1 chronic disease (eg, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes), and residing in high-income countries. Digital health interventions will be broadly defined to include emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms. Results: This scoping review is currently ongoing. As of March 2023, our full search strategy has resulted in a total of 9901 records. We completed the screening of titles and abstracts and obtained 442 abstracts for full-text review. We are aiming to complete our full-text review in October 2024, data extraction in November 2024, and data synthesis in December 2024. Conclusions: This scoping review will generate evidence that will contribute to the further development of digital health interventions for future chronic disease management among older adults in high-income countries. More evidence-based research is needed to better understand the feasibility and limitations associated with the use of digital health interventions for this population. These evidence-based findings can then be disseminated to decision-makers and policy makers in other high-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/49130 %M 38546710 %R 10.2196/49130 %U https://www.researchprotocols.org/2024/1/e49130 %U https://doi.org/10.2196/49130 %U http://www.ncbi.nlm.nih.gov/pubmed/38546710 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e48132 %T Expectation, Attitude, and Barriers to Receiving Telehomecare Among Caregivers of Homebound or Bedridden Older Adults: Qualitative Study %A Onseng,Pansiree %A Jiraporncharoen,Wichuda %A Moonkayaow,Sasiwimon %A Veerasirikul,Pimchai %A Wiwatkunupakarn,Nutchar %A Angkurawaranon,Chaisiri %A Pinyopornpanish,Kanokporn %+ Department of Family Medicine, Chiang Mai University, 110 Intawarorot Rd., Sriphum, Muang, Chiang Mai, 50200, Thailand, 66 53935462, kanokporn.pinyopo@cmu.ac.th %K telehomecare %K telemedicine %K telehealth %K caregivers %K older adults %K attitudes %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Aging %G English %X Background: In recent years, telehomecare has become an increasingly important option for health care providers to deliver continuous care to their patients. Objective: This study aims to explore the expectations, attitudes, and barriers to telehomecare among caregivers of homebound or bedridden older adults. Methods: This qualitative study used semistructured interviews to explore caregivers’ perspectives on telehomecare for homebound or bedridden older adults. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines. Participants were selected using convenience sampling from caregivers of homebound or bedridden older adults with experience in both in-person home visits and telehomecare services provided by the Department of Family Medicine at Chiang Mai University, in an urban area of Chiang Mai Province in Northern Thailand. Semistructured interviews were conducted. The interviews were audio recorded with participant consent and transcribed verbatim. The framework method was used, involving multiple readings of transcripts to facilitate familiarization and accuracy checking. The study used the technology acceptance model and comprehensive geriatric assessment as the analytical framework. Results: The study included 20 caregivers of older adult patients. The patients were predominantly female (15/20, 75%), with an average age of 86.2 years. Of these patients, 40% (n=8) of patients were bedridden, and 60% (n=12) of patients were homebound. Caregivers expressed generally positive attitudes toward telehomecare. They considered it valuable for overall health assessment, despite recognizing certain limitations, particularly in physical assessments. Psychological assessments were perceived as equally effective. While in-person visits offered more extensive environmental assessments, caregivers found ways to make telehomecare effective. Telehomecare facilitated multidisciplinary care, enabling communication with specialists. Caregivers play a key role in care planning and adherence. Challenges included communication issues due to low volume, patient inattention, and faulty devices and internet signals. Some caregivers helped overcome these barriers. The loss of information was mitigated by modifying signaling equipment. Technology use was a challenge for some older adult caregivers. Despite these challenges, telehomecare offered advantages in remote communication and resolving scheduling conflicts. Caregivers varied in their preferences. Some preferred in-person visits for a broader view, while others favored telehomecare for its convenience. Some had no strong preference, appreciating both methods, while others considered the situation and patient conditions when choosing between them. Increased experience with telehomecare led to more confidence in its use. Conclusions: Caregivers have positive attitudes and high expectations for telehomecare services. Although there may be barriers to receiving care through this mode, caregivers have demonstrated the ability to overcome these challenges, which has strengthened their confidence in telehomecare. However, it is important to enhance the skills of caregivers and health care teams to overcome barriers and optimize the use of telehomecare. %M 38324373 %R 10.2196/48132 %U https://aging.jmir.org/2024/1/e48132 %U https://doi.org/10.2196/48132 %U http://www.ncbi.nlm.nih.gov/pubmed/38324373 %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 %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45818 %T CD4/CD8 Ratio Recovered as a Predictor of Decreased Liver Damage in Adults Infected With HIV: 16-Year Observational Cohort Study %A Liang,Bingyu %A Sun,Rujing %A Liao,Yanyan %A Nong,Aidan %A He,Jinfeng %A Qin,Fengxiang %A Ou,Yanyun %A Che,Jianhua %A Wu,Zhenxian %A Yang,Yuan %A Qin,Jiao %A Cai,Jie %A Bao,Lijuan %A Ye,Li %A Liang,Hao %+ Biosafety III Laboratory, Life Science Institute, Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, China, 86 13737089380, lianghao@gxmu.edu.cn %K AIDS %K antiretroviral therapy %K CD4/CD8 %K efavirenz %K HIV %K liver damage %K lopinavir %K nevirapine %D 2024 %7 9.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the life expectancy of individuals infected with HIV continues to increase, vigilant monitoring of non–AIDS-related events becomes imperative, particularly those pertaining to liver diseases. In comparison to the general population, patients infected with HIV experience a higher frequency of liver-related deaths. The CD4/CD8 ratio is emerging as a potential biomarker for non–AIDS-related events. However, few existing studies have been specially designed to explore the relationship between the CD4/CD8 ratio and specific types of non–AIDS-related events, notably liver damage. Objective: This study aimed to investigate the potential association between the CD4/CD8 ratio and the development of liver damage in a sizable cohort of patients infected with HIV receiving antiretroviral treatment (ART). Additionally, the study sought to assess the effectiveness of 3 antiretroviral drugs in recovering the CD4/CD8 ratio and reducing the occurrence of liver damage in this population. Methods: We conducted an observational cohort study among adults infected with HIV receiving ART from 2004 to 2020 in Guangxi, China. Propensity score matching, multivariable Cox proportional hazard, and Fine-Gray competing risk regression models were used to determine the relationship between the CD4/CD8 ratio recovered and liver damage. Results: The incidence of liver damage was 20.12% among 2440 eligible individuals during a median follow-up period of 4 person-years. Patients whose CD4/CD8 ratio did not recover to 1.0 exhibited a higher incidence of liver damage compared to patients with a CD4/CD8 ratio recovered (adjusted hazard ratio 7.90, 95% CI 4.39-14.21; P<.001; subdistribution hazard ratio 6.80, 95% CI 3.83-12.11; P<.001), findings consistent with the propensity score matching analysis (adjusted hazard ratio 6.94, 95% CI 3.41-14.12; P<.001; subdistribution hazard ratio 5.67, 95% CI 2.74-11.73; P<.001). The Efavirenz-based regimen exhibited the shortest time for CD4/CD8 ratio recovery (median 71, IQR 49-88 months) and demonstrated a lower prevalence of liver damage (4.18/100 person-years). Conclusions: Recovery of the CD4/CD8 ratio was associated with a decreased risk of liver damage in patients infected with HIV receiving ART, adding evidence for considering the CD4/CD8 ratio as a potential marker for identifying individuals at risk of non–AIDS-related diseases. An efavirenz-based regimen emerged as a recommended choice for recovering the CD4/CD8 ratio and mitigating the risk of liver damage. %M 37846087 %R 10.2196/45818 %U https://publichealth.jmir.org/2024/1/e45818 %U https://doi.org/10.2196/45818 %U http://www.ncbi.nlm.nih.gov/pubmed/37846087 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49817 %T Demographic, Clinical, and Quality of Life Profiles of Older People With Diabetes During the COVID-19 Pandemic: Cross-Sectional Study %A Sousa,Fabianne %A de Araujo,Lucianne Nascimento %A de Oliveira,Tainá Sayuri Onuma %A Gomes,Mateus Cunha %A Ferreira,Glenda %A Aben-Athar,Cintia %A da Silva,Silvio Eder Dias %A Cruz Ramos,Aline MP %A Rodrigues,Diego Pereira %+ Nursing School, Federal University of Para, Rua Agusto Correa 1 S/N, Belém, 66075-110, Brazil, 55 91 981219404, fabiannesousa@hotmail.com %K aged %K diabetes mellitus %K COVID-19 %K cross-sectional study %K quality of life %K long COVID-19 %K diabetic %K older people %D 2023 %7 16.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes mellitus, one of the main diseases that affects the Brazilian population older than 60 years, is defined as a divergent group of metabolic disorders that present a high level of glycemia (hyperglycemia), causing damage to various organs and systems of the body, including the heart, kidneys, eyes, and nervous system. It is believed that in 2025, in Brazil alone, there will be more than 18.5 million individuals diagnosed with diabetes mellitus. Therefore, it is important to know the individuals’ quality of life in the context of life and culture. Objective: This study aimed to assess the demographic, clinical, and quality of life profiles of older adults with diabetes during the COVID-19 pandemic in a university hospital complex in the northern Amazon region. Methods: We conducted a cross-sectional, exploratory, noninterventional, descriptive, and analytical study using a nonrandom sample of 54 older people diagnosed with diabetes mellitus at the geriatrics outpatient clinic of the medium and high complexity university hospital in the western Brazilian Amazon between 2020 and 2022. We used 3 instruments, namely, a sociodemographic questionnaire, a clinical conditions questionnaire, and Diabetes-39. Qualitative data were described using absolute and relative frequencies. The Kolmogorov-Smirnov normality test was applied, and the z test was used for inferential analysis. SPSS software (version 27) was used for data analysis, and the significance level was 5%. Results: Of the 54 interviewees, the majority were women, married, retired, and had a good quality of life. Of these, 48.1% (n=26) were infected by COVID-19, 61.5% (n=16) of whom progressed to long COVID, presenting with fatigue or muscle weakness. As for the quality of life, the “social overload” (P<.001) and “sexual functioning” (P<.001) dimensions had with low scores compared to the “energy and mobility” (P=.005), “diabetes control” (P<.001), and “anxiety and worry” (P<.001) dimensions. Quality of life was negatively impacted in the “anxiety and worry” dimension. Among those affected by COVID-19, most progressed to long COVID; however, there was a lack of data on this theme in the population of older people with diabetes. Conclusions: The majority of interviewees progressed to long COVID, with their quality of life negatively impacted in the “anxiety and worry” dimension, reflecting that health actions prioritizing mental health should be implemented by health professionals. %M 37971795 %R 10.2196/49817 %U https://formative.jmir.org/2023/1/e49817 %U https://doi.org/10.2196/49817 %U http://www.ncbi.nlm.nih.gov/pubmed/37971795 %0 Journal Article %@ 2561-7605 %I %V 6 %N %P e44037 %T Diabetes Life Expectancy Prediction Model Inputs and Results From Patient Surveys Compared With Electronic Health Record Abstraction: Survey Study %A Bernstein,Sean %A Gilson,Sarah %A Zhu,Mengqi %A Nathan,Aviva G %A Cui,Michael %A Press,Valerie G %A Shah,Sachin %A Zarei,Parmida %A Laiteerapong,Neda %A Huang,Elbert S %K diabetes mellitus %K patient-reported outcome measure %K life expectancy %K diabetes %K diabetic %K predict %K model %K mortality %K chart review %K chart abstraction %K patient chart %K prediction model %K patient-reported outcome %D 2023 %7 9.11.2023 %9 %J JMIR Aging %G English %X Background: Prediction models are being increasingly used in clinical practice, with some requiring patient-reported outcomes (PROs). The optimal approach to collecting the needed inputs is unknown. Objective: Our objective was to compare mortality prediction model inputs and scores based on electronic health record (EHR) abstraction versus patient survey. Methods: Older patients aged ≥65 years with type 2 diabetes at an urban primary care practice in Chicago were recruited to participate in a care management trial. All participants completed a survey via an electronic portal that included items on the presence of comorbid conditions and functional status, which are needed to complete a mortality prediction model. We compared the individual data inputs and the overall model performance based on the data gathered from the survey compared to the chart review. Results: For individual data inputs, we found the largest differences in questions regarding functional status such as pushing/pulling, where 41.4% (31/75) of participants reported difficulties that were not captured in the chart with smaller differences for comorbid conditions. For the overall mortality score, we saw nonsignificant differences (P=.82) when comparing survey and chart-abstracted data. When allocating participants to life expectancy subgroups (<5 years, 5-10 years, >10 years), differences in survey and chart review data resulted in 20% having different subgroup assignments and, therefore, discordant glucose control recommendations. Conclusions: In this small exploratory study, we found that, despite differences in data inputs regarding functional status, the overall performance of a mortality prediction model was similar when using survey and chart-abstracted data. Larger studies comparing patient survey and chart data are needed to assess whether these findings are reproduceable and clinically important. %R 10.2196/44037 %U https://aging.jmir.org/2023/1/e44037 %U https://doi.org/10.2196/44037 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e44777 %T Examining the Impact of Selected Sociodemographic Factors and Cancer-Related Fatalistic Beliefs on Patient Engagement via Health Information Technology Among Older Adults: Cross-Sectional Analysis %A Zaidi,Maryum %A Gazarian,Priscilla %A Mattie,Heather %A Sheldon,Lisa Kennedy %A Gakumo,C Ann %+ Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, 113 Wilder Street, Suite 291, Lowell, MA, 01854-3058, United States, 1 978 934 4776, maryum_zaidi@uml.edu %K health information technology %K patient portals %K older adults %K digital health %K self-management %K mobile phone %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Despite the role of health information technology (HIT) in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults with a high burden of chronic diseases such as cancer. This study examines the role of selected sociodemographic factors and cancer-related fatalistic beliefs on patient engagement expressed through HIT use for patient engagement in adults aged ≥65 years. We controlled for cancer diagnosis to account for its potential influence on patient engagement. Objective: This study has 2 aims: to investigate the role of sociodemographic factors such as race, education, poverty index, and psychosocial factors of cancer fatalistic beliefs in accessing and using HIT in older adults and to examine the association between access and use of HIT in the self-management domain of patient activation that serves as a precursor to patient engagement. Methods: This is a secondary data analysis of a subset of the Health Information National Trend Survey (Health Information National Trend Survey 4, cycle 3). The subset included individuals aged ≥65 years with and without a cancer diagnosis. The relationships between access to and use of HIT to several sociodemographic variables and psychosocial factors of fatalistic beliefs were analyzed. Logistic and linear regression models were fit to study these associations. Results: This study included 180 individuals aged ≥65 years with a cancer diagnosis and 398 without a diagnosis. This analysis indicated that having less than a college education level (P=<.001), being an individual from an ethnic and minority group (P=<.001), and living in poverty (P=.001) were significantly associated with decreased access to HIT. Reduced HIT use was associated with less than a college education (P=.001) and poverty(P=.02). This analysis also indicated that fatalistic beliefs about cancer were significantly associated with lower HIT use (P=.03). Specifically, a 1-point increase in the cancer fatalistic belief score was associated with a 36% decrease in HIT use. We found that controlling for cancer diagnosis did not affect the outcomes for sociodemographic variables or fatalistic beliefs about cancer. However, patients with access to HIT had a self-management domain of patient activation (SMD) score of 0.21 points higher (P=.003) compared with patients who did not have access. SMD score was higher by 0.28 points (P=.002) for individuals who used HIT and 0.14 points higher (P=.04) who had a prior diagnosis of cancer. Conclusions: Sociodemographic factors (education, race, poverty, and cancer fatalistic beliefs) impact HIT access and use in older adults, regardless of prior cancer diagnosis. Among older adults, HIT users report higher self-management, which is essential for patient activation and engagement. %M 37655786 %R 10.2196/44777 %U https://aging.jmir.org/2023/1/e44777 %U https://doi.org/10.2196/44777 %U http://www.ncbi.nlm.nih.gov/pubmed/37655786 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43687 %T Patterns and Trends in Mortality Associated With and Due to Diabetes Mellitus in a Transitioning Region With 3.17 Million People: Observational Study %A Li,Xiaopan %A Liu,Ru %A Chen,Yichen %A Han,Yan %A Wang,Qizhe %A Xu,Yaxin %A Zhou,Jing %A Jiang,Sunfang %+ Department of General Practice, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200233, China, 86 13817597264, jiang.sunfang@zs-hospital.sh.cn %K diabetes mellitus %K mortality %K years of life lost %K multimorbidity %K trend analysis %K diabetes %K disease %K urbanization %K aging %K epidemiology %D 2023 %7 4.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Diabetes mellitus (DM) imposes a significant disease burden in economically transitioning regions. Most transitioning regions share similar experience in urbanization processes. Shanghai’s Pudong district serves as a representative area of such regions. Objective: We aimed to assess the burden of and trends in DM mortality in Shanghai’s Pudong district and analyze the impact of aging and multimorbidity. Methods: A longitudinal, population-based study was conducted to analyze DM mortality in Pudong from 2005 to 2020. We used joinpoint regression to analyze epidemiological features and long-term trends in crude mortality rate (CMR), age-standardized mortality rate worldwide (ASMRW), and years of life lost (YLL). Furthermore, the decomposition method was used to evaluate the contribution of demographic and nondemographic factors associated with mortality. Results: There were 49,414 deaths among individuals with DM, including 15,512 deaths due to DM. The CMR and ASMRW were 109.55/105 and 38.01/105 person-years, respectively. Among the mortality associated with and due to DM, the total annual ASMRW increased by 3.65% (95% CI 3.25%-4.06%) and 1.38% (95% CI 0.74%-2.02%), respectively. Additionally, the total annual YLL rate increased by 4.98% (95% CI 3.92%-6.05%) and 2.68% (95% CI 1.34%-4.04%). The rates of YLL increase in persons aged 30 to 44 years (3.98%, 95% CI 0.32%-7.78%) and 45 to 59 years (4.31%, 95% CI 2.95%-5.69%) were followed by the increase in persons aged 80 years and older (10.53%, 95% CI 9.45%-11.62%) for deaths associated with DM. The annual CMR attributable to demographic factors increased by 41.9% (95% CI 17.73%-71.04%) and 36.72% (95% CI 16.69%-60.2%) for deaths associated with and due to DM, respectively. Hypertension, cerebrovascular disease, and ischemic heart disease were the top 3 comorbidities. Conclusions: Aging and multimorbidity played essential roles in changing the burden of DM in an urbanizing and transitioning region. There is an increasing disease burden among young and middle-aged people, emphasizing the need for greater attention to these groups. Health management is an emerging method that holds important implications for alleviating the future burden of DM. %M 37665630 %R 10.2196/43687 %U https://publichealth.jmir.org/2023/1/e43687 %U https://doi.org/10.2196/43687 %U http://www.ncbi.nlm.nih.gov/pubmed/37665630 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45004 %T Adapting the Diabetes Prevention Program for Older Adults: Descriptive Study %A Beasley,Jeannette M %A Johnston,Emily A %A Costea,Denisa %A Sevick,Mary Ann %A Rogers,Erin S %A Jay,Melanie %A Zhong,Judy %A Chodosh,Joshua %+ Department of Nutrition and Food Studies, New York University Steinhardt School of School of Culture, Education, and Human Development, 411 Lafayette Street, 526, New York, NY, 10003, United States, 1 2129985782, jbeasley@nyu.edu %K aging %K diabetes prevention program %K nutrition %K diet %K physical activity %K weight loss %K weight %K exercise %K diabetes %K prevention %K diabetic %K ageing %K older adult %K online intervention %K digital intervention %K virtual delivery %K lifestyle coach %K group-based intervention %D 2023 %7 29.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Prediabetes affects 26.4 million people aged 65 years or older (48.8%) in the United States. Although older adults respond well to the evidence-based Diabetes Prevention Program, they are a heterogeneous group with differing physiological, biomedical, and psychosocial needs who can benefit from additional support to accommodate age-related changes in sensory and motor function. Objective: The purpose of this paper is to describe adaptations of the Centers for Disease Control and Prevention’s Diabetes Prevention Program aimed at preventing diabetes among older adults (ages ≥65 years) and findings from a pilot of 2 virtual sessions of the adapted program that evaluated the acceptability of the content. Methods: The research team adapted the program by incorporating additional resources necessary for older adults. A certified lifestyle coach delivered 2 sessions of the adapted content via videoconference to 189 older adults. Results: The first session had a 34.9% (38/109) response rate to the survey, and the second had a 34% (30/88) response rate. Over three-quarters (50/59, 85%) of respondents agreed that they liked the virtual program, with 82% (45/55) agreeing that they would recommend it to a family member or a friend. Conclusions: This data will be used to inform intervention delivery in a randomized controlled trial comparing in-person versus virtual delivery of the adapted program. %M 37642989 %R 10.2196/45004 %U https://formative.jmir.org/2023/1/e45004 %U https://doi.org/10.2196/45004 %U http://www.ncbi.nlm.nih.gov/pubmed/37642989 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46711 %T Key Considerations When Developing and Implementing Digital Technology for Early Detection of Dementia-Causing Diseases Among Health Care Professionals: Qualitative Study %A Wilson,Sarah %A Tolley,Clare %A Mc Ardle,Riona %A Beswick,Emily %A Slight,Sarah P %+ School of Pharmacy, Newcastle University, King George VI building, Newcastle upon Tyne, NE1 7RU, United Kingdom, 44 1912082358, sarah.wilson@newcastle.ac.uk %K qualitative %K health care professional %K early detection of disease %K dementia %K digital technology %K early detection of dementia %K digital health %K health care worker %K digital tool %D 2023 %7 22.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Health Organization (WHO) promotes using digital technologies to accelerate global attainment of health and well-being. This has led to a growth in research exploring the use of digital technology to aid early detection and preventative interventions for dementia-causing diseases such as Alzheimer disease. The opinions and perspectives of health care professionals must be incorporated into the development and implementation of technology to promote its successful adoption in clinical practice. Objective: This study aimed to explore health care professionals’ perspectives on the key considerations of developing and implementing digital technologies for the early detection of dementia-causing diseases in the National Health Service (NHS). Methods: Health care professionals with patient-facing roles in primary or secondary care settings in the NHS were recruited through various web-based NHS clinical networks. Participants were interviewed to explore their experiences of the current dementia diagnostic practices, views on early detection and use of digital technology to aid these practices, and the challenges of implementing such interventions in health care. An inductive thematic analysis approach was applied to identify central concepts and themes in the interviews, allowing the data to determine our themes. A list of central concepts and themes was applied systematically to the whole data set using NVivo (version 1.6.1; QSR International). Using the constant comparison technique, the researchers moved backward and forward between these data and evolving explanations until a fit was made. Results: Eighteen semistructured interviews were conducted, with 11 primary and 7 secondary care health care professionals. We identified 3 main categories of considerations relevant to health care service users, health care professionals, and the digital health technology itself. Health care professionals recognized the potential of using digital technology to collect real-time data and the possible benefits of detecting dementia-causing diseases earlier if an effective intervention were available. However, some were concerned about postdetection management, questioning the point of an early detection of dementia-causing diseases if an effective intervention cannot be provided and feared this would only lead to increased anxiety in patients. Health care professionals also expressed mixed opinions on who should be screened for early detection. Some suggested it should be available to everyone to mitigate the chance of excluding those who are not in touch with their health care or are digitally excluded. Others were concerned about the resources that would be required to make the technology available to everyone. Conclusions: This study highlights the need to design digital health technology in a way that is accessible to all and does not add burden to health care professionals. Further work is needed to ensure inclusive strategies are used in digital research to promote health equity. %M 37606986 %R 10.2196/46711 %U https://www.jmir.org/2023/1/e46711 %U https://doi.org/10.2196/46711 %U http://www.ncbi.nlm.nih.gov/pubmed/37606986 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45955 %T Exploring the Perspectives and Experiences of Older Adults With Asthma and Chronic Obstructive Pulmonary Disease Toward Mobile Health: Qualitative Study %A Kouri,Andrew %A Gupta,Samir %A Straus,Sharon E %A Sale,Joanna E M %+ Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 (416) 323 6400, andrew.kouri@mail.utoronto.ca %K older adults %K mHealth %K asthma %K chronic obstructive pulmonary disease %K qualitative research %K digital health %K qualitative study %K airway disease %K barrier %K health technology %K interview %K smartphone %K airway %K implementation %K mobile phone %D 2023 %7 22.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of mobile health (mHealth) in asthma and chronic obstructive pulmonary disease (COPD) is growing, and as the population ages, a greater number of older adults stand to benefit from mHealth-enhanced airway disease care. Though older adults are a heterogeneous population of health technology users, older age represents a potential barrier to health technology adoption, and there is currently a lack of knowledge on how older age influences mHealth use in asthma and COPD. Objective: In this qualitative study, we sought to explore the experiences and perspectives of adults who were aged 65 years and older with asthma and COPD toward mHealth use. Methods: Semistructured individual interviews were conducted with adults who were aged 65 years and older with asthma or COPD and owned a smartphone. Applying phenomenological methodology, we analyzed interview transcripts in order to develop themes and propose an essential experience of mHealth use among older adults with airway disease. We then summarized our qualitative findings and proposed strategies to leverage our results in order to guide future research and implementation efforts targeting older adults’ use of airway mHealth. Results: Twenty participants (mean age 79.8, SD 4.4 years) were interviewed. Participants described a central tension between (1) the perception that mHealth could help maintain independence throughout aging and (2) an apprehension toward the ways in which mHealth could negatively affect established health care experiences. Several elements of these 2 themes are absent from previous research focusing on younger adults with asthma and COPD. The individual elements of these 2 themes informed potential strategies to optimize future older adults’ use of asthma and COPD mHealth tools. Conclusions: Focusing on the perspectives and experiences of older adults with asthma and COPD in their use of mHealth identified novel understandings of health technology use in this important demographic in need of greater care. These lessons were translated into potential strategies that will need to be objectively evaluated in future airway mHealth research, development, and implementation efforts. %M 37606961 %R 10.2196/45955 %U https://www.jmir.org/2023/1/e45955 %U https://doi.org/10.2196/45955 %U http://www.ncbi.nlm.nih.gov/pubmed/37606961 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46298 %T Association Between Daily Internet Use and Incidence of Chronic Diseases Among Older Adults: Prospective Cohort Study %A Li,Peiyi %A Zhang,Chenyang %A Gao,Shuanliang %A Zhang,Yanbo %A Liang,Xiaolong %A Wang,Chengdi %A Zhu,Tao %A Li,Weimin %+ Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Guo Xue Xiang 37, Sichuan, Chengdu, 610041, China, 86 028 85423998, weimi003@scu.edu.cn %K daily internet use %K chronic disease %K disease prevention %K middle-aged and older adult %K usage %K internet use %K technology use %K chronic illness %K association %K incidence %K middle age %K older adult %K gerontology %K geriatric %K aging %K elder %K national survey %D 2023 %7 17.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic disease incidence among the elderly is increasing, which is correlated with the acceleration of population aging. Evolving internet technologies may help prevent and provide interventions for chronic diseases in an accelerating aging process. However, the impact of daily internet use on the incidence of chronic diseases is not well understood. Objective: This study aims to investigate whether daily internet use by middle-aged and older adults may inhibit or promote the occurrence of chronic diseases. Methods: We included participants from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal survey of Chinese residents aged ≥45 years. We assessed 8-year data from wave 1 (June 2011-March 2012) to wave 4 (July-September 2018) in CHARLS. Data from wave 4 were used for a cross-sectional study, and data from all 4 waves were used for a longitudinal study. Self-reported data were used to track variables, including internet use, use frequency, and the incidence of different chronic diseases. Cox proportional hazards modeling was applied in the longitudinal study to examine the relationship between daily internet use and chronic diseases among middle-aged and older adults, while adjusting for sociodemographic characteristics and health behaviors. In addition, longitudinal data were used to analyze internet usage trends, and cross-sectional data were used to analyze the factors influencing internet use. Results: Among the 20,113 participants included in the longitudinal analyses, internet use increased significantly, from 2% to 12.3%, between 2011 and 2018. The adjusted model found statistically significant relationships between daily internet use and a lower incidence of the following chronic diseases: hypertension (hazard ratio [HR] 0.78, 95% CI 0.65-0.95, P=.01), chronic lung disease (HR 0.74, 95% CI 0.57-0.97, P=.03), stroke (HR 0.69, 95% CI 0.50-0.94, P=.02), digestive disease (HR 0.73, 95% CI 0.58-0.91, P=.005), memory-related disorders (HR 0.58, 95% CI 0.37-0.91, P=.02), arthritis or rheumatism (HR 0.60, 95% CI 0.48-0.76, P<.001), asthma (HR 0.52, 95% CI 0.33-0.84, P=.007), depression (HR 0.80, 95% CI 0.71-0.89, P<.001), and vision impairment (HR 0.83, 95% CI 0.74-0.93, P=.004). Moreover, our study also showed that with increasing frequency of internet use, the risk of some chronic diseases decreases. Conclusions: This study found that middle-aged and older adults who use the internet have a reduced risk of developing chronic diseases versus those who do not use the internet. The increasing prevalence of daily internet use among middle-aged and older adults may stimulate contemplation of the potential role of internet platforms in future research on chronic disease prevention. %M 37459155 %R 10.2196/46298 %U https://www.jmir.org/2023/1/e46298 %U https://doi.org/10.2196/46298 %U http://www.ncbi.nlm.nih.gov/pubmed/37459155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46014 %T Application of Artificial Intelligence in Geriatric Care: Bibliometric Analysis %A Wang,Jingjing %A Liang,Yiqing %A Cao,Songmei %A Cai,Peixuan %A Fan,Yimeng %+ Department of Nursing, The Affiliated Hospital of Jiangsu University, No 438 North Jiefang Road, Jingkou District, Jiangsu Province, Zhenjiang, 212000, China, 86 13815159881, caosongmei75@126.com %K artificial intelligence %K older adults %K geriatric care %K bibliometric analysis %D 2023 %7 23.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) can improve the health and well-being of older adults and has the potential to assist and improve nursing care. In recent years, research in this area has been increasing. Therefore, it is necessary to understand the status of development and main research hotspots and identify the main contributors and their relationships in the application of AI in geriatric care via bibliometric analysis. Objective: Using bibliometric analysis, this study aims to examine the current research hotspots and collaborative networks in the application of AI in geriatric care over the past 23 years. Methods: The Web of Science Core Collection database was used as a source. All publications from inception to August 2022 were downloaded. The external characteristics of the publications were summarized through HistCite and the Web of Science. Keywords and collaborative networks were analyzed using VOSviewers and Citespace. Results: We obtained a total of 230 publications. The works originated in 499 institutions in 39 countries, were published in 124 journals, and were written by 1216 authors. Publications increased sharply from 2014 to 2022, accounting for 90.87% (209/230) of all publications. The United States and the International Journal of Social Robotics had the highest number of publications on this topic. The 1216 authors were divided into 5 main clusters. Among the 230 publications, 4 clusters were modeled, including Alzheimer disease, aged care, acceptance, and the surveillance and treatment of diseases. Machine learning, deep learning, and rehabilitation had also become recent research hotspots. Conclusions: Research on the application of AI in geriatric care has developed rapidly. The development of research and cooperation among countries/regions and institutions are limited. In the future, strengthening the cooperation and communication between different countries/regions and institutions may further drive this field’s development. This study provides researchers with the information necessary to understand the current state, collaborative networks, and main research hotspots of the field. In addition, our results suggest a series of recommendations for future research. %M 37351923 %R 10.2196/46014 %U https://www.jmir.org/2023/1/e46014 %U https://doi.org/10.2196/46014 %U http://www.ncbi.nlm.nih.gov/pubmed/37351923 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44627 %T Developing Early Markers of Cognitive Decline and Dementia Derived From Survey Response Behaviors: Protocol for Analyses of Preexisting Large-scale Longitudinal Data %A Jin,Haomiao %A Junghaenel,Doerte U %A Orriens,Bart %A Lee,Pey-Jiuan %A Schneider,Stefan %+ School of Health Sciences, University of Surrey, Kate Granger Building, Priestley Road, Guildford, GU2 7YH, United Kingdom, 44 07438534086, h.jin@surrey.ac.uk %K dementia %K mild cognitive impairment %K early markers %K survey response behaviors %K epidemiology %D 2023 %7 21.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Accumulating evidence shows that subtle alterations in daily functioning are among the earliest and strongest signals that predict cognitive decline and dementia. A survey is a small slice of everyday functioning; nevertheless, completing a survey is a complex and cognitively demanding task that requires attention, working memory, executive functioning, and short- and long-term memory. Examining older people’s survey response behaviors, which focus on how respondents complete surveys irrespective of the content being sought by the questions, may represent a valuable but often neglected resource that can be leveraged to develop behavior-based early markers of cognitive decline and dementia that are cost-effective, unobtrusive, and scalable for use in large population samples. Objective: This paper describes the protocol of a multiyear research project funded by the US National Institute on Aging to develop early markers of cognitive decline and dementia derived from survey response behaviors at older ages. Methods: Two types of indices summarizing different aspects of older adults’ survey response behaviors are created. Indices of subtle reporting mistakes are derived from questionnaire answer patterns in a number of population-based longitudinal aging studies. In parallel, para-data indices are generated from computer use behaviors recorded on the backend server of a large web-based panel study known as the Understanding America Study (UAS). In-depth examinations of the properties of the created questionnaire answer pattern and para-data indices will be conducted for the purpose of evaluating their concurrent validity, sensitivity to change, and predictive validity. We will synthesize the indices using individual participant data meta-analysis and conduct feature selection to identify the optimal combination of indices for predicting cognitive decline and dementia. Results: As of October 2022, we have identified 15 longitudinal ageing studies as eligible data sources for creating questionnaire answer pattern indices and obtained para-data from 15 UAS surveys that were fielded from mid-2014 to 2015. A total of 20 questionnaire answer pattern indices and 20 para-data indices have also been identified. We have conducted a preliminary investigation to test the utility of the questionnaire answer patterns and para-data indices for the prediction of cognitive decline and dementia. These early results are based on only a subset of indices but are suggestive of the findings that we anticipate will emerge from the planned analyses of multiple behavioral indices derived from many diverse studies. Conclusions: Survey response behaviors are a relatively inexpensive data source, but they are seldom used directly for epidemiological research on cognitive impairment at older ages. This study is anticipated to develop an innovative yet unconventional approach that may complement existing approaches aimed at the early detection of cognitive decline and dementia. International Registered Report Identifier (IRRID): DERR1-10.2196/44627 %M 36809337 %R 10.2196/44627 %U https://www.researchprotocols.org/2023/1/e44627 %U https://doi.org/10.2196/44627 %U http://www.ncbi.nlm.nih.gov/pubmed/36809337 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e36663 %T A Novel Digital Digit-Symbol Substitution Test Measuring Processing Speed in Adults At Risk for Alzheimer Disease: Validation Study %A Campitelli,Anthony %A Paulson,Sally %A Gills,Josh L %A Jones,Megan D %A Madero,Erica N %A Myers,Jennifer %A Glenn,Jordan M %A Gray,Michelle %+ Exercise Science Research Center, University of Arkansas, 308 HPER Building, 115 Stadium Drive, Fayetteville, AR, 72701, United States, 1 479 575 6762, rgray@uark.edu %K Alzheimer disease %K dementia %K processing speed %K digit-symbol substitution %K aging %K cognitive %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Assessing cognitive constructs affected by Alzheimer disease, such as processing speed (PS), is important to screen for potential disease and allow for early detection. Digital PS assessments have been developed to provide widespread, efficient cognitive testing, but all have been validated only based on the correlation between test scores. Best statistical practices dictate that concurrent validity should be assessed for agreement or equivalence rather than using correlation alone. Objective: This study aimed to assess the concurrent validity of a novel digital PS assessment against a gold-standard measure of PS. Methods: Adults aged 45-75 years (n=191) participated in this study. Participants completed the novel digital digit-symbol substitution test (DDSST) and the Repeatable Battery for the Assessment of Neuropsychological Status coding test (RBANS-C). The correlation between the test scores was determined using a Pearson product-moment correlation, and a difference in mean test scores between tests was checked for using a 2-tailed dependent samples t test. Data were analyzed for agreement between the 2 tests using Bland-Altman limits of agreement and equivalency using a two one-sided t tests (TOST) approach. Results: A significant moderate, positive correlation was found between DDSST and RBANS-C scores (r=.577; P<.001), and no difference in mean scores was detected between the tests (P=.93). Bias was nearly zero (0.04). Scores between the tests were found to display adequate agreement with 90% of score differences falling between –22.66 and 22.75 (90% limits of agreement=–22.91 to 22.99), and the scores were equivalent (P=.049). Conclusions: Analyses indicate that the DDSST is a valid digital assessment of PS. The DDSST appears to be a suitable option for widespread, immediate, and efficient PS testing. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/ct2/show/NCT04559789 %M 36705951 %R 10.2196/36663 %U https://aging.jmir.org/2023/1/e36663 %U https://doi.org/10.2196/36663 %U http://www.ncbi.nlm.nih.gov/pubmed/36705951 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e38182 %T Associations Among Multimorbid Conditions in Hospitalized Middle-aged and Older Adults in China: Statistical Analysis of Medical Records %A Zhang,Yan %A Chen,Chao %A Huang,Lingfeng %A Liu,Gang %A Lian,Tingyu %A Yin,Mingjuan %A Zhao,Zhiguang %A Xu,Jian %A Chen,Ruoling %A Fu,Yingbin %A Liang,Dongmei %A Zeng,Jinmei %A Ni,Jindong %+ Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Songshan Lake, Dongguan, 523808, China, 86 15817668208, nijd-gw@gdmu.edu.cn %K multimorbidity %K chronic conditions %K aging %K association rule mining %K decision tree analysis %D 2022 %7 24.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Multimorbidity has become a new challenge for medical systems and public health policy. Understanding the patterns of and associations among multimorbid conditions should be given priority. It may assist with the early detection of multimorbidity and thus improve quality of life in older adults. Objective: This study aims to comprehensively analyze and compare associations among multimorbid conditions by age and sex in a large number of middle-aged and older Chinese adults. Methods: Data from the home pages of inpatient medical records in the Shenzhen National Health Information Platform were evaluated. From January 1, 2017, to December 31, 2018, inpatients aged 50 years and older who had been diagnosed with at least one of 40 conditions were included in this study. Their demographic characteristics (age and sex) and inpatient diagnoses were extracted. Association rule mining, Chi-square tests, and decision tree analyses were combined to identify associations between multiple chronic conditions. Results: In total, 306,264 hospitalized cases with available information on related chronic conditions were included in this study. The prevalence of multimorbidity in the overall population was 76.46%. The combined results of the 3 analyses showed that, in patients aged 50 years to 64 years, lipoprotein metabolism disorder tended to be comorbid with multiple chronic conditions. Gout and lipoprotein metabolism disorder had the strongest association. Among patients aged 65 years or older, there were strong associations between cerebrovascular disease, heart disease, lipoprotein metabolism disorder, and peripheral vascular disease. The strongest associations were observed between senile cataract and glaucoma in men and women. In particular, the association between osteoporosis and malignant tumor was only observed in middle-aged and older men, while the association between anemia and chronic kidney disease was only observed in older women. Conclusions: Multimorbidity was prevalent among middle-aged and older Chinese individuals. The results of this comprehensive analysis of 4 age-sex subgroups suggested that associations between particular conditions within the sex and age groups occurred more frequently than expected by random chance. This provides evidence for further research on disease clusters and for health care providers to develop different strategies based on age and sex to improve the early identification and treatment of multimorbidity. %M 36422885 %R 10.2196/38182 %U https://publichealth.jmir.org/2022/11/e38182 %U https://doi.org/10.2196/38182 %U http://www.ncbi.nlm.nih.gov/pubmed/36422885 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e35785 %T Patterns of HIV or AIDS Mortality Among Older People From 1990 to 2019 in China: Age-Period-Cohort Analysis %A Ren,Ningjun %A Li,Yuansheng %A Wan,Zhengwei %A Wang,Ruolan %A Zhang,Wenxin %A Dzakah,Emmanuel Enoch %A Zhang,Junhui %A Li,Ailing %A Fan,Song %+ School of Public Health, Southwest Medical University, No.1, Section 1, Xianglin Road, Longmatan District, Luzhou, 64600, China, 86 8303175813, fansong@swmu.edu.cn %K HIV %K AIDS %K aging %K mortality %K trends %K age-period-cohort model %K APC %D 2022 %7 17.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With the increasing effectiveness of antiretroviral therapy and shifting demographics, the problem of older people with HIV or AIDS is increasingly grim in China, and neglecting infection among them may cause more serious social problems, exacerbate the difficulty of controlling HIV or AIDS transmission, and increase the risk of death. Objective: We investigated the variations in the trends of Chinese mortality by age, period, and cohort, from 1990 to 2019, to reveal the relationship between age, period, cohort, and HIV burden, as well as providing guidance for resource allocation to prevent HIV-related deaths in vulnerable target populations. Methods: We extracted the HIV or AIDS mortality data from the Global Burden of Disease. The joinpoint regression model was applied to detect changes in HIV or AIDS trends. The age-period-cohort model was used to explore the age, period, and cohort effects. Results: The trends in age-standardized mortality rates in HIV or AIDS were increased in both genders, from 0.50 to 4.54/105 individuals for males, and from 0.19 to 1.43/105 individuals for females. Joinpoint regression model showed the average annual percentage change of age-standardized mortality rates was 7.0 for male and 6.4 for female individuals, showing an increasing trend. The age effect of male HIV or AIDS mortality showed a net increase of 0.59 (–0.21 to 0.38) from the ages 50-79 years. There is a gradual upward trend in the change in risk of death from HIV or AIDS for the period effect among the older population, lowest at ages 50-54 years (–0.80 for male and –0.78 for female individuals) and highest at ages 75-79 years (0.86 for male and 0.69 for female individuals). The variation of cohort effects was complex, but both genders had a nearly consistent tendency; people born in 1920-1929 had the lowest cohort effect, and those born in 1950-1954 had the highest values. Conclusions: Our study showed a marked rise in HIV mortality for both genders in China from 1990 to 2019. Aging is an important issue in current HIV prevention and control. There is an urgent need to promote HIV testing and health education. Our findings will help predict future HIV or AIDS mortality changes and identify age-specific priority populations for intervention. %M 36394944 %R 10.2196/35785 %U https://publichealth.jmir.org/2022/11/e35785 %U https://doi.org/10.2196/35785 %U http://www.ncbi.nlm.nih.gov/pubmed/36394944 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e27990 %T A Personalized Ontology-Based Decision Support System for Complex Chronic Patients: Retrospective Observational Study %A Román-Villarán,Esther %A Alvarez-Romero,Celia %A Martínez-García,Alicia %A Escobar-Rodríguez,German Antonio %A García-Lozano,María José %A Barón-Franco,Bosco %A Moreno-Gaviño,Lourdes %A Moreno-Conde,Jesús %A Rivas-González,José Antonio %A Parra-Calderón,Carlos Luis %+ Computational Health Informatics Group, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital, Consejo Superior de Investigaciones Científicas, University of Seville, Avenida Manuel Siurot s/n, Seville, 41013, Spain, 34 955 013 662, celia.alvarez@juntadeandalucia.es %K adherence %K ontology %K clinical decision support system %K CDSS %K complex chronic patients %K functional validation %K multimorbidity %K polypharmacy %K atrial fibrillation %K anticoagulants %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Due to an increase in life expectancy, the prevalence of chronic diseases is also on the rise. Clinical practice guidelines (CPGs) provide recommendations for suitable interventions regarding different chronic diseases, but a deficiency in the implementation of these CPGs has been identified. The PITeS-TiiSS (Telemedicine and eHealth Innovation Platform: Information Communications Technology for Research and Information Challenges in Health Services) tool, a personalized ontology-based clinical decision support system (CDSS), aims to reduce variability, prevent errors, and consider interactions between different CPG recommendations, among other benefits. Objective: The aim of this study is to design, develop, and validate an ontology-based CDSS that provides personalized recommendations related to drug prescription. The target population is older adult patients with chronic diseases and polypharmacy, and the goal is to reduce complications related to these types of conditions while offering integrated care. Methods: A study scenario about atrial fibrillation and treatment with anticoagulants was selected to validate the tool. After this, a series of knowledge sources were identified, including CPGs, PROFUND index, LESS/CHRON criteria, and STOPP/START criteria, to extract the information. Modeling was carried out using an ontology, and mapping was done with Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT; International Health Terminology Standards Development Organisation). Once the CDSS was developed, validation was carried out by using a retrospective case study. Results: This project was funded in January 2015 and approved by the Virgen del Rocio University Hospital ethics committee on November 24, 2015. Two different tasks were carried out to test the functioning of the tool. First, retrospective data from a real patient who met the inclusion criteria were used. Second, the analysis of an adoption model was performed through the study of the requirements and characteristics that a CDSS must meet in order to be well accepted and used by health professionals. The results are favorable and allow the proposed research to continue to the next phase. Conclusions: An ontology-based CDSS was successfully designed, developed, and validated. However, in future work, validation in a real environment should be performed to ensure the tool is usable and reliable. %M 35916719 %R 10.2196/27990 %U https://formative.jmir.org/2022/8/e27990 %U https://doi.org/10.2196/27990 %U http://www.ncbi.nlm.nih.gov/pubmed/35916719 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35929 %T Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review %A Singh,Hardeep %A Tang,Terence %A Steele Gray,Carolyn %A Kokorelias,Kristina %A Thombs,Rachel %A Plett,Donna %A Heffernan,Matthew %A Jarach,Carlotta M %A Armas,Alana %A Law,Susan %A Cunningham,Heather V %A Nie,Jason Xin %A Ellen,Moriah E %A Thavorn,Kednapa %A Nelson,Michelle LA %+ Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada, 1 416 946 3724, hardeepk.singh@mail.utoronto.ca %K transitions %K health %K medical informatics %K aged %K mobile phone %D 2022 %7 19.5.2022 %9 Review %J JMIR Aging %G English %X Background: Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective: To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods: This 2-phase rapid review involved a selective review of providers’ roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults’ hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results: In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients’ status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions: This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045596 %M 35587874 %R 10.2196/35929 %U https://aging.jmir.org/2022/2/e35929 %U https://doi.org/10.2196/35929 %U http://www.ncbi.nlm.nih.gov/pubmed/35587874 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35696 %T A Model for Estimating Biological Age From Physiological Biomarkers of Healthy Aging: Cross-sectional Study %A Husted,Karina Louise Skov %A Brink-Kjær,Andreas %A Fogelstrøm,Mathilde %A Hulst,Pernille %A Bleibach,Akita %A Henneberg,Kaj-Åge %A Sørensen,Helge Bjarup Dissing %A Dela,Flemming %A Jacobsen,Jens Christian Brings %A Helge,Jørn Wulff %+ Xlab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen, 2200, Denmark, 45 28127945, karinalu@sund.ku.dk %K biological age %K model development %K principal component analysis %K healthy aging %K biomarkers %K aging %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Individual differences in the rate of aging and susceptibility to disease are not accounted for by chronological age alone. These individual differences are better explained by biological age, which may be estimated by biomarker prediction models. In the light of the aging demographics of the global population and the increase in lifestyle-related morbidities, it is interesting to invent a new biological age model to be used for health promotion. Objective: This study aims to develop a model that estimates biological age based on physiological biomarkers of healthy aging. Methods: Carefully selected physiological variables from a healthy study population of 100 women and men were used as biomarkers to establish an estimate of biological age. Principal component analysis was applied to the biomarkers and the first principal component was used to define the algorithm estimating biological age. Results: The first principal component accounted for 31% in women and 25% in men of the total variance in the biological age model combining mean arterial pressure, glycated hemoglobin, waist circumference, forced expiratory volume in 1 second, maximal oxygen consumption, adiponectin, high-density lipoprotein, total cholesterol, and soluble urokinase-type plasminogen activator receptor. The correlation between the corrected biological age and chronological age was r=0.86 (P<.001) and r=0.81 (P<.001) for women and men, respectively, and the agreement was high and unbiased. No difference was found between mean chronological age and mean biological age, and the slope of the regression line was near 1 for both sexes. Conclusions: Estimating biological age from these 9 biomarkers of aging can be used to assess general health compared with the healthy aging trajectory. This may be useful to evaluate health interventions and as an aid to enhance awareness of individual health risks and behavior when deviating from this trajectory. Trial Registration: ClinicalTrials.gov NCT03680768; https://clinicaltrials.gov/ct2/show/NCT03680768 International Registered Report Identifier (IRRID): RR2-10.2196/19209 %M 35536617 %R 10.2196/35696 %U https://aging.jmir.org/2022/2/e35696 %U https://doi.org/10.2196/35696 %U http://www.ncbi.nlm.nih.gov/pubmed/35536617 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e32006 %T Factors Predicting Engagement of Older Adults With a Coach-Supported eHealth Intervention Promoting Lifestyle Change and Associations Between Engagement and Changes in Cardiovascular and Dementia Risk: Secondary Analysis of an 18-Month Multinational Randomized Controlled Trial %A Coley,Nicola %A Andre,Laurine %A Hoevenaar-Blom,Marieke P %A Ngandu,Tiia %A Beishuizen,Cathrien %A Barbera,Mariagnese %A van Wanrooij,Lennard %A Kivipelto,Miia %A Soininen,Hilkka %A van Gool,Willem %A Brayne,Carol %A Moll van Charante,Eric %A Richard,Edo %A Andrieu,Sandrine %A , %A , %+ Center for Epidemiology and Research in Population health (CERPOP), University of Toulouse III Paul Sabatier (UPS), National Institute of Health and Medical Research (INSERM) mixed research unit (UMR) 1295, 37 allées Jules Guesde, Toulouse, 31000, France, 33 561145680, nicola.coley@inserm.fr %K aging %K eHealth %K disparities %K engagement %K prevention %K cardiovascular %K lifestyle %K risk factors %D 2022 %7 9.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions could help to prevent age-related diseases, but little is known about how older adults engage with such interventions, especially in the long term, or whether engagement is associated with changes in clinical, behavioral, or biological outcomes in this population. Disparities in engagement levels with digital health interventions may exist among older people and be associated with health inequalities. Objective: This study aimed to describe older adults’ engagement with an eHealth intervention, identify factors associated with engagement, and examine associations between engagement and changes in cardiovascular and dementia risk factors (blood pressure, cholesterol, BMI, physical activity, diet, and cardiovascular and dementia risk scores). Methods: This was a secondary analysis of the 18-month randomized controlled Healthy Ageing Through Internet Counselling in the Elderly trial of a tailored internet-based intervention encouraging behavior changes, with remote support from a lifestyle coach, to reduce cardiovascular and cognitive decline risk in 2724 individuals aged ≥65 years, recruited offline in the Netherlands, Finland, and France. Engagement was assessed via log-in frequency, number of lifestyle goals set, measurements entered and messages sent to coaches, and percentage of education materials read. Clinical and biological data were collected during in-person visits at baseline and 18 months. Lifestyle data were self-reported on a web-based platform. Results: Of the 1389 intervention group participants, 1194 (85.96%) sent at least one message. They logged in a median of 29 times, and set a median of 1 goal. Higher engagement was associated with significantly greater improvement in biological and behavioral risk factors, with evidence of a dose-response effect. Compared with the control group, the adjusted mean difference (95% CI) in 18-month change in the primary outcome, a composite z-score comprising blood pressure, BMI, and cholesterol, was −0.08 (−0.12 to −0.03), −0.04 (−0.08 to 0.00), and 0.00 (−0.08 to 0.08) in the high, moderate, and low engagement groups, respectively. Low engagers showed no improvement in any outcome measures compared with the control group. Participants not using a computer regularly before the study engaged much less with the intervention than those using a computer up to 7 (adjusted odds ratio 5.39, 95% CI 2.66-10.95) or ≥7 hours per week (adjusted odds ratio 6.58, 95% CI 3.21-13.49). Those already working on or with short-term plans for lifestyle improvement at baseline, and with better cognition, engaged more. Conclusions: Greater engagement with an eHealth lifestyle intervention was associated with greater improvement in risk factors in older adults. However, those with limited computer experience, who tended to have a lower level of education, or who had poorer cognition engaged less. Additional support or forms of intervention delivery for such individuals could help minimize potential health inequalities associated with the use of digital health interventions in older people. %M 35385395 %R 10.2196/32006 %U https://www.jmir.org/2022/5/e32006 %U https://doi.org/10.2196/32006 %U http://www.ncbi.nlm.nih.gov/pubmed/35385395 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37522 %T Using Smart Displays to Implement an eHealth System for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial %A Gustafson,David H %A Mares,Marie-Louise %A Johnston,Darcie C %A Landucci,Gina %A Pe-Romashko,Klaren %A Vjorn,Olivia J %A Hu,Yaxin %A Gustafson,David H %A Maus,Adam %A Mahoney,Jane E %A Mutlu,Bilge %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, Mechanical Engineering Bldg, 4th Fl., 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 2615, dcjohnston@wisc.edu %K eHealth %K aged %K geriatrics %K multiple chronic conditions %K chronic pain %K smart displays %K smart speakers %K quality of life %K primary care %K health expenditures %K mobile phone %D 2022 %7 5.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Voice-controlled smart speakers and displays have a unique but unproven potential for delivering eHealth interventions. Many laptop- and smartphone-based interventions have been shown to improve multiple outcomes, but voice-controlled platforms have not been tested in large-scale rigorous trials. Older adults with multiple chronic health conditions, who need tools to help with their daily management, may be especially good candidates for interventions on voice-controlled devices because these patients often have physical limitations, such as tremors or vision problems, that make the use of laptops and smartphones challenging. Objective: The aim of this study is to assess whether participants using an evidence-based intervention (ElderTree) on a smart display will experience decreased pain interference and improved quality of life and related measures in comparison with participants using ElderTree on a laptop and control participants who are given no device or access to ElderTree. Methods: A total of 291 adults aged ≥60 years with chronic pain and ≥3 additional chronic conditions will be recruited from primary care clinics and community organizations and randomized 1:1:1 to ElderTree access on a smart display along with their usual care, ElderTree access on a touch screen laptop along with usual care, or usual care alone. All patients will be followed for 8 months. The primary outcomes are differences between groups in measures of pain interference and psychosocial quality of life. The secondary outcomes are between-group differences in system use at 8 months, physical quality of life, pain intensity, hospital readmissions, communication with medical providers, health distress, well-being, loneliness, and irritability. We will also examine mediators and moderators of the effects of ElderTree on both platforms. At baseline, 4 months, and 8 months, patients will complete written surveys comprising validated scales selected for good psychometric properties with similar populations. ElderTree use data will be collected continuously in system logs. We will use linear mixed-effects models to evaluate outcomes over time, with treatment condition and time acting as between-participant factors. Separate analyses will be conducted for each outcome. Results: Recruitment began in August 2021 and will run through April 2023. The intervention period will end in December 2023. The findings will be disseminated via peer-reviewed publications. Conclusions: To our knowledge, this is the first study with a large sample and long time frame to examine whether a voice-controlled smart device can perform as well as or better than a laptop in implementing a health intervention for older patients with multiple chronic health conditions. As patients with multiple conditions are such a large cohort, the implications for cost as well as patient well-being are significant. Making the best use of current and developing technologies is a critical part of this effort. Trial Registration: ClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196 International Registered Report Identifier (IRRID): PRR1-10.2196/37522 %M 35511229 %R 10.2196/37522 %U https://www.researchprotocols.org/2022/5/e37522 %U https://doi.org/10.2196/37522 %U http://www.ncbi.nlm.nih.gov/pubmed/35511229 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35847 %T Delivering Personalized Recommendations to Support Caregivers of People Living With Dementia: Mixed Methods Study %A Cha,Jinhee %A Peterson,Colleen M %A Millenbah,Ashley N %A Louwagie,Katie %A Baker,Zachary G %A Shah,Ayush %A Jensen,Christine J %A Gaugler,Joseph E %+ Medical School and School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, United States, 1 6513523161, cha00003@umn.edu %K caregivers %K caregiving %K Alzheimer %K dementia %K intervention %K COVID-19 %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Estimates suggest that 6.2 million Americans aged ≥65 years are living with Alzheimer dementia in 2021, and by 2060, this number could more than double to 13.8 million. As a result, public health officials anticipate a greater need for caregivers of persons with Alzheimer disease or related dementia and support resources for both people living with dementia and their caregivers. Despite the growing need for dementia caregiver support services, there is a lack of consensus regarding how to tailor these services to best meet the heterogeneous needs of individual caregivers. To fill this gap, Care to Plan (CtP), a web-based tool for caregivers of people living with dementia, was developed to provide tailored support recommendations to dementia caregivers. Objective: The aim of this study is to formally explore the feasibility, acceptability, and utility of CtP for 20 family members of people living with dementia within a health system over a 1-month time period using a mixed methods parallel convergent design. Methods: A moderately sized health system in the mid-Atlantic region was selected as the site for CtP implementation, where 20 caregivers who were family members of people living with dementia were enrolled. The web-based CtP tool was used by caregivers and facilitated by a health care professional (ie, a senior care navigator [SCN]). Caregivers were given a 21-item review checklist to assess barriers and facilitators associated with reviewing CtP with an SCN. Following the 21-item review checklist, semistructured telephone interviews, which included 18 open-ended questions, focused on the facilitators of and barriers to CtP implementation and recommendations for future implementation. Results: Quantitative results suggested that 85% (17/20) of caregivers indicated that CtP was helpful and 90% (18/20) would recommend CtP to someone in a similar situation. The qualitative analysis identified 4 themes regarding facilitators of and barriers to implementation: caregiver factors, SCN factors, CtP tool system factors, and recommendations and resources factors. Conclusions: CtP was found to be not only feasible but also a valuable tool for caregivers seeking resources for themselves and their people living with dementia. Long-term evaluation findings aim to generate results on how CtP can be integrated into care plans for caregivers and how SCNs can provide additional support for caregivers of people living with dementia over an extended period. %M 35503650 %R 10.2196/35847 %U https://aging.jmir.org/2022/2/e35847 %U https://doi.org/10.2196/35847 %U http://www.ncbi.nlm.nih.gov/pubmed/35503650 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35925 %T Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations %A Kokorelias,Kristina Marie %A Nelson,Michelle LA %A Tang,Terence %A Steele Gray,Carolyn %A Ellen,Moriah %A Plett,Donna %A Jarach,Carlotta Micaela %A Xin Nie,Jason %A Thavorn,Kednapa %A Singh,Hardeep %+ Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University, Rehabilitation Sciences Institute, Toronto, ON, M5G 1V7, Canada, 1 416 946 3724, hardeepk.singh@utoronto.ca %K older adults %K digital technology %K transitions %K older adult population %K digital health %K Digital Hospital %K health intervention %K aging %K gender diversity %K home transition %K epidemiology %D 2022 %7 27.4.2022 %9 Review %J JMIR Aging %G English %X Background: Digital health technologies have been proposed to support hospital-to-home transition for older adults. The COVID-19 pandemic and the associated physical distancing guidelines have propelled a shift toward digital health technologies. However, the characteristics of older adults who participated in digital health research interventions to support hospital-to-home transitions remain unclear. This information is needed to assess whether current digital health interventions are generalizable to the needs of the broader older adult population. Objective: This rapid review of the existing literature aimed to identify the characteristics of the populations targeted by studies testing the implementation of digital health interventions designed to support hospital-to-home transitions, identify the characteristics of the samples included in studies testing digital health interventions used to support hospital-to-home transitions, and create recommendations for enhancing the diversity of samples within future hospital-to-home digital health interventions. Methods: A rapid review methodology based on scoping review guidelines by Arksey and O’Malley was developed. A search for peer-reviewed literature published between 2010 and 2021 on digital health solutions that support hospital-to-home transitions for older adults was conducted using MEDLINE, Embase, and CINAHL databases. The data were analyzed using descriptive statistics and qualitative content analysis. The Sex- and Gender-Based Analysis Plus lens theoretically guided the study design, analysis, and interpretation. Results: A total of 34 studies met the inclusion criteria. Our findings indicate that many groups of older adults were excluded from these interventions and remain understudied. Specifically, the oldest old and those living with cognitive impairments were excluded from the studies included in this review. In addition, very few studies have described the characteristics related to gender diversity, education, race, ethnicity, and culture. None of the studies commented on the sexual orientation of the participants. Conclusions: This is the first review, to our knowledge, that has mapped the literature focusing on the inclusion of older adults in digital hospital-to-home interventions. The findings suggest that the literature on digital health interventions tends to operationalize older adults as a homogenous group, ignoring the heterogeneity in older age definitions. Inconsistency in the literature surrounding the characteristics of the included participants suggests a need for further study to better understand how digital technologies to support hospital-to-home transitions can be inclusive. %M 35475971 %R 10.2196/35925 %U https://aging.jmir.org/2022/2/e35925 %U https://doi.org/10.2196/35925 %U http://www.ncbi.nlm.nih.gov/pubmed/35475971 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35075 %T An Electronic Patient-Reported Outcomes Tool for Older Adults With Complex Chronic Conditions: Cost-Utility Analysis %A Miranda,Rafael N %A Bhuiya,Aunima R %A Thraya,Zak %A Hancock-Howard,Rebecca %A Chan,Brian CF %A Steele Gray,Carolyn %A Wodchis,Walter P %A Thavorn,Kednapa %+ Clinical Epidemiology Program, Ottawa Hospital Research Institute, The General Campus, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada, 1 613 737 8899 ext 72330, kthavorn@ohri.ca %K eHealth %K multimorbidity %K primary care %K cost-effectiveness %K older adult %K elder %K cost %K patient reported outcome %K community %K complex care %K aging %K Canada %K North America %K chronic disease %K chronic condition %K decision tree %K model %K sensitivity analysis %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: eHealth technologies for self-management can improve quality of life, but little is known about whether the benefits gained outweigh their costs. The electronic patient-reported outcome (ePRO) mobile app and portal system supports patients with multiple chronic conditions to collaborate with primary health care providers to set and monitor health-related goals. Objective: This study aims to estimate the cost of ePRO and the cost utility of the ePRO intervention compared with usual care provided to patients with multiple chronic conditions and complex needs living in the community, from the perspective of the publicly funded health care payer in Ontario, Canada. Methods: We developed a decision tree model to estimate the incremental cost per quality-adjusted life year (QALY) gained for the ePRO tool versus usual care over a time horizon of 15 months. Resource utilization and effectiveness of the ePRO tool were drawn from a randomized clinical trial with 6 family health teams involving 45 participants. Unit costs associated with health care utilization (adjusted to 2020 Canadian dollars) were drawn from literature and publicly available sources. A series of sensitivity analyses were conducted to assess the robustness of the findings. Results: The total cost of the ePRO tool was CAD $79,467 (~US $ 63,581; CAD $1733 [~US $1386] per person). Compared with standard care, the ePRO intervention was associated with higher costs (CAD $1710 [~US $1368]) and fewer QALYs (–0.03). The findings were consistent with the clinical evidence, suggesting no statistical difference in health-related quality of life between ePRO and usual care groups. However, the tool would be considered a cost-effective option if it could improve by at least 0.03 QALYs. The probability that the ePRO is cost-effective was 17.3% at a willingness-to-pay (WTP) threshold of CAD $50,000 (~US $40,000)/QALY. Conclusions: The ePRO tool is not a cost-effective technology at the commonly used WTP value of CAD $50,000 (~US $40,000)/QALY, but long-term and the societal impacts of ePRO were not included in this analysis. Further research is needed to better understand its impact on long-term outcomes and in real-world settings. The present findings add to the growing evidence about eHealth interventions’ capacity to respond to complex aging populations within finite-resourced health systems. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 %M 35442194 %R 10.2196/35075 %U https://aging.jmir.org/2022/2/e35075 %U https://doi.org/10.2196/35075 %U http://www.ncbi.nlm.nih.gov/pubmed/35442194 %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 %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33372 %T The Willingness to Pay for Telemedicine Among Patients With Chronic Diseases: Systematic Review %A Chua,Valerie %A Koh,Jin Hean %A Koh,Choon Huat Gerald %A Tyagi,Shilpa %+ Office of Healthcare Transformation, Ministry of Health, 1 Maritime Square, #12-10 Harborfront Centre, Singapore, 099253, Singapore, 65 6679 3147, valerie.chua.ruisi@u.nus.edu %K willingness to pay %K telemedicine %K chronic disease %K patients %K systematic review %K mobile phone %D 2022 %7 13.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Telemedicine is increasingly being leveraged, as the need for remote access to health care has been driven by the rising chronic disease incidence and the COVID-19 pandemic. It is also important to understand patients’ willingness to pay (WTP) for telemedicine and the factors contributing toward it, as this knowledge may inform health policy planning processes, such as resource allocation or the development of a pricing strategy for telemedicine services. Currently, most of the published literature is focused on cost-effectiveness analysis findings, which guide health care financing from the health system’s perspective. However, there is limited exploration of the WTP from a patient’s perspective, despite it being pertinent to the sustainability of telemedicine interventions. Objective: To address this gap in research, this study aims to conduct a systematic review to describe the WTP for telemedicine interventions and to identify the factors influencing WTP among patients with chronic diseases in high-income settings. Methods: We systematically searched 4 databases (PubMed, PsycINFO, Embase, and EconLit). A total of 2 authors were involved in the appraisal. Studies were included if they reported the WTP amounts or identified the factors associated with patients’ WTP, involved patients aged ≥18 years who were diagnosed with chronic diseases, and were from high-income settings. Results: A total of 11 studies from 7 countries met this study’s inclusion criteria. The proportion of people willing to pay for telemedicine ranged from 19% to 70% across the studies, whereas the values for WTP amounts ranged from US $0.89 to US $821.25. We found a statistically significant correlation of age and distance to a preferred health facility with the WTP for telemedicine. Higher age was associated with a lower WTP, whereas longer travel distance was associated with a higher WTP. Conclusions: On the basis of our findings, the following are recommendations that may enhance the WTP: exposure to the telemedicine intervention before assessing the WTP, the lowering of telemedicine costs, and the provision of patient education to raise awareness on telemedicine’s benefits and address patients’ concerns. In addition, we recommend that future research be directed at standardizing the reporting of WTP studies with the adoption of a common metric for WTP amounts, which may facilitate the generalization of findings and effect estimates. %M 35416779 %R 10.2196/33372 %U https://www.jmir.org/2022/4/e33372 %U https://doi.org/10.2196/33372 %U http://www.ncbi.nlm.nih.gov/pubmed/35416779 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31912 %T Effects of a Nurse-Led Telehealth Self-care Promotion Program on the Quality of Life of Community-Dwelling Older Adults: Systematic Review and Meta-analysis %A Wong,Arkers Kwan Ching %A Bayuo,Jonathan %A Wong,Frances Kam Yuet %A Yuen,Wing Shan %A Lee,Athena Yin Lam %A Chang,Pui King %A Lai,Jojo Tsz Chui %+ School of Nursing, The Hong Kong Polytechnic University, Hung Hom Campus, FG 512, Kowloon, Hong Kong, 852 34003805, arkers.wong@polyu.edu.hk %K telehealth %K meta-analysis %K self-care %K community-dwelling older adult %K nurse %D 2022 %7 21.3.2022 %9 Review %J J Med Internet Res %G English %X Background: In recent years, telehealth has become a common channel for health care professionals to use to promote health and provide distance care. COVID-19 has further fostered the widespread use of this new technology, which can improve access to care while protecting the community from exposure to infection by direct personal contact, and reduce the time and cost of traveling for both health care users and providers. This is especially true for community-dwelling older adults who have multiple chronic diseases and require frequent hospital visits. Nurses are globally recognized as health care professionals who provide effective community-based care to older adults, facilitating their desire to age in place. However, to date, it is unclear whether the use of telehealth can facilitate their work of promoting self-care to community-dwelling older adults. Objective: This review aims to summarize findings from randomized controlled trials on the effect of nurse-led telehealth self-care promotion programs compared with the usual on-site or face-to-face services on the quality of life (QoL), self-efficacy, depression, and hospital admissions among community-dwelling older adults. Methods: A search of 6 major databases was undertaken of relevant studies published from May 2011 to April 2021. Standardized mean differences (SMDs) and their 95% CIs were calculated from postintervention outcomes for continuous data, while the odds ratio was obtained for dichotomous data using the Mantel–Haenszel test. Results: From 1173 possible publications, 13 trials involving a total of 4097 participants were included in this meta-analysis. Compared with the control groups, the intervention groups of community-dwelling older adults significantly improved in overall QoL (SMD 0.12; 95% CI 0.03 to 0.20; P=.006; I2=21%), self-efficacy (SMD 0.19; 95% CI 0.08 to 0.30; P<.001; I2=0%), and depression level (SMD –0.22; 95% CI –0.36 to –0.08; P=.003; I2=89%). Conclusions: This meta-analysis suggests that employing telehealth in nurse-led self-care promotion programs may have a positive impact on older adults, although more studies are needed to strengthen the evidence base, particularly regarding organization and delivery. Trial Registration: PROSPERO (Prospective International Register of Systematic Reviews) CRD42021257299; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257299 %M 35311680 %R 10.2196/31912 %U https://www.jmir.org/2022/3/e31912 %U https://doi.org/10.2196/31912 %U http://www.ncbi.nlm.nih.gov/pubmed/35311680 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e29623 %T Older Adults’ and Clinicians’ Perspectives on a Smart Health Platform for the Aging Population: Design and Evaluation Study %A Cristiano,Alessia %A Musteata,Stela %A De Silvestri,Sara %A Bellandi,Valerio %A Ceravolo,Paolo %A Cesari,Matteo %A Azzolino,Domenico %A Sanna,Alberto %A Trojaniello,Diana %+ Center for Advanced Technology in Health and Wellbeing, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy, 39 0226432919, trojaniello.diana@hsr.it %K smart health %K remote monitoring %K requirement elicitation %K older population %K age-related chronic conditions %K healthy aging %K Internet of Things %K mobile phone %D 2022 %7 28.2.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Over recent years, interest in the development of smart health technologies aimed at supporting independent living for older populations has increased. The integration of innovative technologies, such as the Internet of Things, wearable technologies, artificial intelligence, and ambient-assisted living applications, represents a valuable solution for this scope. Designing such an integrated system requires addressing several aspects (eg, equipment selection, data management, analytics, costs, and users’ needs) and involving different areas of expertise (eg, medical science, service design, biomedical and computer engineering). Objective: The objective of this study is 2-fold; we aimed to design the functionalities of a smart health platform addressing 5 chronic conditions prevalent in the older population (ie, hearing loss, cardiovascular diseases, cognitive impairments, mental health problems, and balance disorders) by considering both older adults’ and clinicians’ perspectives and to evaluate the identified smart health platform functionalities with a small group of older adults. Methods: Overall, 24 older adults (aged >65 years) and 118 clinicians were interviewed through focus group activities and web-based questionnaires to elicit the smart health platform requirements. Considering the elicited requirements, the main functionalities of smart health platform were designed. Then, a focus group involving 6 older adults was conducted to evaluate the proposed solution in terms of usefulness, credibility, desirability, and learnability. Results: Eight main functionalities were identified and assessed—cognitive training and hearing training (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 6/6, 100%; learnability: 6/6, 100%), monitoring of physiological parameters (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 6/6, 100%; learnability: 5/6, 83%), physical training (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 5/6, 83%; learnability: 2/6, 33%), psychoeducational intervention (usefulness: 6/6, 100%; credibility: 6/6, 100%; desirability: 4/6, 67%; learnability: 2/6, 33%), mood monitoring (usefulness: 4/6, 67%; credibility: 4/6, 67%; desirability: 3/6, 50%; learnability: 5/6, 50%), diet plan (usefulness: 5/6, 83%; credibility: 4/6, 67%; desirability: 1/6, 17%; learnability: 2/6, 33%), and environment monitoring and adjustment (usefulness: 1/6, 17%; credibility: 1/6, 17%; desirability: 0/6, 0%; learnability: 0/6, 0%). Most of them were highly appreciated by older participants, with the only exception being environment monitoring and adjustment. The results showed that the proposed functionalities met the needs and expectations of users (eg, improved self-management of patients’ disease and enhanced patient safety). However, some aspects need to be addressed (eg, technical and privacy issues). Conclusions: The presented smart health platform functionalities seem to be able to meet older adults’ needs and desires to enhance their self-awareness and self-management of their medical condition, encourage healthy and independent living, and provide evidence-based support for clinicians’ decision-making. Further research with a larger and more heterogeneous pool of stakeholders in terms of demographics and clinical conditions is needed to assess system acceptability and overall user experience in free-living conditions. %M 35225818 %R 10.2196/29623 %U https://aging.jmir.org/2022/1/e29623 %U https://doi.org/10.2196/29623 %U http://www.ncbi.nlm.nih.gov/pubmed/35225818 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e34790 %T Online Health Information Seeking Behaviors Among Older Adults: Systematic Scoping Review %A Zhao,Yuxiang Chris %A Zhao,Mengyuan %A Song,Shijie %+ Business School, Hohai University, Fo-Cheng West Rd 8, Nanjing, 211000, China, 86 15951973800, ssong@hhu.edu.cn %K older adults %K online health information seeking %K health information behavior %K aging technology %K systematic scoping review %D 2022 %7 16.2.2022 %9 Review %J J Med Internet Res %G English %X Background: With the world’s population aging, more health-conscious older adults are seeking health information to make better-informed health decisions. The rapid growth of the internet has empowered older adults to access web-based health information sources. However, research explicitly exploring older adults’ online health information seeking (OHIS) behavior is still underway. Objective: This systematic scoping review aims to understand older adults’ OHIS and answer four research questions: (1) What types of health information do older adults seek and where do they seek health information on the internet? (2) What are the factors that influence older adults’ OHIS? (3) What are the barriers to older adults’ OHIS? (4) How can we intervene and support older adults’ OHIS? Methods: A comprehensive literature search was performed in November 2020, involving the following academic databases: Web of Science; Cochrane Library database; PubMed; MEDLINE; CINAHL Plus; APA PsycINFO; Library and Information Science Source; Library, Information Science and Technology Abstracts; Psychology and Behavioral Sciences Collection; Communication & Mass Media Complete; ABI/INFORM; and ACM Digital Library. The initial search identified 8047 publications through database search strategies. After the removal of duplicates, a data set consisting of 5949 publications was obtained for screening. Among these, 75 articles met the inclusion criteria. Qualitative content analysis was performed to identify themes related to the research questions. Results: The results suggest that older adults seek 10 types of health information from 6 types of internet-based information sources and that 2 main categories of influencing factors, individual-related and source-related, impact older adults’ OHIS. Moreover, the results reveal that in their OHIS, older adults confront 3 types of barriers, namely individual, social, and those related to information and communication technologies. Some intervention programs based on educational training workshops have been created to intervene and support older adults’ OHIS. Conclusions: Although OHIS has become increasingly common among older adults, the review reveals that older adults’ OHIS behavior is not adequately investigated. The findings suggest that more studies are needed to understand older adults’ OHIS behaviors and better support their medical and health decisions in OHIS. Based on the results, the review proposes multiple objectives for future studies, including (1) more investigations on the OHIS behavior of older adults above 85 years; (2) conducting more longitudinal, action research, and mixed methods studies; (3) elaboration of the mobile context and cross-platform scenario of older adults’ OHIS; (4) facilitating older adults’ OHIS by explicating technology affordance; and (5) promoting and measuring the performance of OHIS interventions for older adults. %M 35171099 %R 10.2196/34790 %U https://www.jmir.org/2022/2/e34790 %U https://doi.org/10.2196/34790 %U http://www.ncbi.nlm.nih.gov/pubmed/35171099 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29837 %T Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review %A Gillam,Juliet %A Davies,Nathan %A Aworinde,Jesutofunmi %A Yorganci,Emel %A Anderson,Janet E %A Evans,Catherine %+ Cicely Saunders Institute, King's College London, Bessemer Road, London, SE5 9PJ, United Kingdom, 44 7500 708 293, juliet.h.gillam@kcl.ac.uk %K telemedicine %K implementation science %K dementia %K long-term care %K systematic review %D 2022 %7 3.2.2022 %9 Review %J J Med Internet Res %G English %X Background: As dementia progresses, symptoms and concerns increase, causing considerable distress for the person and their caregiver. The integration of care between care homes and health care services is vital to meet increasing care needs and maintain quality of life. However, care home access to high-quality health care is inequitable. eHealth can facilitate this by supporting remote specialist input on care processes, such as clinical assessment and decision-making, and streamlining care on site. How to best implement eHealth in the care home setting is unclear. Objective: The aim of this review was to identify the key factors that influence the implementation of eHealth for people living with dementia in long-term care. Methods: A systematic search of Embase, PsycINFO, MEDLINE, and CINAHL was conducted to identify studies published between 2000 and 2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analyzed and deductively mapped onto the 6 constructs of the adapted Consolidated Framework for Implementation Research (CFIR). The results are presented as a narrative synthesis. Results: A total of 29 studies were included, focusing on a variety of eHealth interventions, including remote video consultations and clinical decision support tools. Key factors that influenced eHealth implementation were identified across all 6 constructs of the CFIR. Most concerned the inner setting construct on requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership, and sufficient training and resources. A total of 4 novel subconstructs were identified to inform the implementation requirements to meet resident needs and engage end users. Conclusions: Implementing eHealth in care homes for people with dementia is multifactorial and complex, involving interaction between residents, staff, and organizations. It requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed and translated into 18 practical recommendations on the implementation of eHealth in long-term care to guide implementers or innovators in care homes. Successful implementation of eHealth is required to maximize uptake and drive improvements in integrated health and social care. %M 35113029 %R 10.2196/29837 %U https://www.jmir.org/2022/2/e29837 %U https://doi.org/10.2196/29837 %U http://www.ncbi.nlm.nih.gov/pubmed/35113029 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e27355 %T Mobile Device Ownership, Current Use, and Interest in Mobile Health Interventions Among Low-Income Older Chinese Immigrants With Type 2 Diabetes: Cross-sectional Survey Study %A Hu,Lu %A Trinh-Shevrin,Chau %A Islam,Nadia %A Wu,Bei %A Cao,Shimin %A Freeman,Jincong %A Sevick,Mary Ann %+ Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, 180 Madison Ave, New York, NY, 10016, United States, 1 6465013438, lu.hu@nyumc.org %K technology use %K Chinese immigrants %K type 2 diabetes %K mHealth %K health disparities %K immigrant health %K diabetes %K mobile health %K intervention %K smartphone %K immigrant %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D. Objective: This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D. Methods: In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant’s preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use. Results: The sample (N=91) was predominantly female (n=57, 63%), married (n=68, 75%), and had a high school education or less (n=58, 64%); most participants had an annual household income of less than US $25,000 (n=63, 69%) and had limited English proficiency (n=78, 86%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69%) reported health care providers, followed by 13 who reported the internet (14%), and 10 who reported family, friends, and coworkers (11%). Less than one-quarter (21/91, 23%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management. Conclusions: Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group. %M 35107426 %R 10.2196/27355 %U https://aging.jmir.org/2022/1/e27355 %U https://doi.org/10.2196/27355 %U http://www.ncbi.nlm.nih.gov/pubmed/35107426 %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 %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e25251 %T Exploring Barriers to and Enablers of the Adoption of Information and Communication Technology for the Care of Older Adults With Chronic Diseases: Scoping Review %A Zaman,Sojib Bin %A Khan,Raihan Kabir %A Evans,Roger G %A Thrift,Amanda G %A Maddison,Ralph %A Islam,Sheikh Mohammed Shariful %+ Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, 27-31 Wright Street, Clayton, VIC, Melbourne, 3168, Australia, 61 414026891, sojib.zaman@monash.edu %K older adults %K gerontechnology %K usability challenges %K chronic disease %K information technology %K mobile phone %D 2022 %7 7.1.2022 %9 Review %J JMIR Aging %G English %X Background: Information and communication technology (ICT) offers considerable potential for supporting older adults in managing their health, including chronic diseases. However, there are mixed opinions about the benefits and effectiveness of ICT interventions for older adults with chronic diseases. Objective: We aim to map the use of ICT interventions in health care and identified barriers to and enablers of its use among older adults with chronic disease. Methods: A scoping review was conducted using 5 databases (Ovid MEDLINE, Embase, Scopus, PsycINFO, and ProQuest) to identify eligible articles from January 2000 to July 2020. Publications incorporating the use of ICT interventions, otherwise known as eHealth, such as mobile health, telehealth and telemedicine, decision support systems, electronic health records, and remote monitoring in people aged ≥55 years with chronic diseases were included. We conducted a strengths, weaknesses, opportunities, and threats framework analysis to explore the implied enablers of and barriers to the use of ICT interventions. Results: Of the 1149 identified articles, 31 (2.7%; n=4185 participants) met the inclusion criteria. Of the 31 articles, 5 (16%) mentioned the use of various eHealth interventions. A range of technologies was reported, including mobile health (8/31, 26%), telehealth (7/31, 23%), electronic health record (2/31, 6%), and mixed ICT interventions (14/31, 45%). Various chronic diseases affecting older adults were identified, including congestive heart failure (9/31, 29%), diabetes (7/31, 23%), chronic respiratory disease (6/31, 19%), and mental health disorders (8/31, 26%). ICT interventions were all designed to help people self-manage chronic diseases and demonstrated positive effects. However, patient-related and health care provider–related challenges, in integrating ICT interventions in routine practice, were identified. Barriers to using ICT interventions in older adults included knowledge gaps, a lack of willingness to adopt new skills, and reluctance to use technologies. Implementation challenges related to ICT interventions such as slow internet connectivity and lack of an appropriate reimbursement policy were reported. Advantages of using ICT interventions include their nonpharmacological nature, provision of health education, encouragement for continued physical activity, and maintenance of a healthy diet. Participants reported that the use of ICT was a fun and effective way of increasing their motivation and supporting self-management tasks. It gave them reassurance and peace of mind by promoting a sense of security and reducing anxiety. Conclusions: ICT interventions have the potential to support the care of older adults with chronic diseases. However, they have not been effectively integrated with routine health care. There is a need to improve awareness and education about ICT interventions among those who could benefit from them, including older adults, caregivers, and health care providers. More sustainable funding is required to promote the adoption of ICT interventions. We recommend involving clinicians and caregivers at the time of designing ICT interventions. %M 34994695 %R 10.2196/25251 %U https://aging.jmir.org/2022/1/e25251 %U https://doi.org/10.2196/25251 %U http://www.ncbi.nlm.nih.gov/pubmed/34994695 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e27645 %T Technology Support Challenges and Recommendations for Adapting an Evidence-Based Exercise Program for Remote Delivery to Older Adults: Exploratory Mixed Methods Study %A Gell,Nancy %A Hoffman,Elise %A Patel,Kushang %+ Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA, 98195-6540, United States, 1 2066168052, kvpatel@uw.edu %K tele-exercise %K technology %K older adults %K adult learning theory %K knee osteoarthritis %K mobile phone %D 2021 %7 9.12.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Tele-exercise has emerged as a means for older adults to participate in group exercise during the COVID-19 pandemic. However, little is known about the technology support needs of older adults for accessing tele-exercise. Objective: This study aims to examine the needs of older adults for transition to tele-exercise, identify barriers to and facilitators of tele-exercise uptake and continued participation, and describe technology support challenges and successes encountered by older adults starting tele-exercise. Methods: We used an exploratory, sequential mixed methods study design. Participants were older adults with symptomatic knee osteoarthritis (N=44) who started participating in a remotely delivered program called Enhance Fitness. Before the start of the classes, a subsample of the participants (n=10) completed semistructured phone interviews about their technology support needs and the barriers to and facilitators for technology adoption. All of the participants completed the surveys including the Senior Technology Acceptance Model scale and a technology needs assessment. The study team recorded the technology challenges encountered and the attendance rates for 48 sessions delivered over 16 weeks. Results: Four themes emerged from the interviews: participants desire features in a tele-exercise program that foster accountability, direct access to helpful people who can troubleshoot and provide guidance with technology is important, opportunities to participate in high-value activities motivate willingness to persevere through the technology concerns, and belief in the ability to learn new things supersedes technology-related frustration. Among the participants in the tele-exercise classes (mean age 74, SD 6.3 years; 38/44, 86% female; mean 2.5, SD 0.9 chronic conditions), 71% (31/44) had a computer with a webcam, but 41% (18/44) had little or no experience with videoconferencing. The initial technology orientation sessions lasted on average 19.3 (SD 10.3) minutes, and 24% (11/44) required a follow-up assistance call. During the first 2 weeks of tele-exercise, 47% of participants (21/44) required technical assistance, which decreased to 12% (5/44) during weeks 3 to 16. The median attendance was 100% for the first 6 sessions and 93% for the subsequent 42 sessions. Conclusions: With appropriate support, older adults can successfully participate in tele-exercise. Recommendations include individualized technology orientation sessions, experiential learning, and availability of standby technical assistance, particularly during the first 2 weeks of classes. Continued development of best practices in this area may allow previously hard-to-reach populations of older adults to participate in health-enhancing, evidence-based exercise programs. %M 34889743 %R 10.2196/27645 %U https://aging.jmir.org/2021/4/e27645 %U https://doi.org/10.2196/27645 %U http://www.ncbi.nlm.nih.gov/pubmed/34889743 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31586 %T A Digital Human for Delivering a Remote Loneliness and Stress Intervention to At-Risk Younger and Older Adults During the COVID-19 Pandemic: Randomized Pilot Trial %A Loveys,Kate %A Sagar,Mark %A Pickering,Isabella %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Building 507, Level 3, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 0003, e.broadbent@auckland.ac.nz %K COVID-19 %K loneliness %K stress %K well-being %K eHealth %K digital human %K conversational agent %K older adults %K chronic illness %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is a growing public health issue that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Computer agents are capable of delivering psychological therapies through the internet; however, there is limited research on their acceptability to date. Objective: The objectives of this study were to evaluate (1) the feasibility and acceptability of a remote loneliness and stress intervention with digital human delivery to at-risk adults and (2) the feasibility of the study methods in preparation for a randomized controlled trial. Methods: A parallel randomized pilot trial with a mixed design was conducted. Participants were adults aged 18 to 69 years with an underlying medical condition or aged 70 years or older with a Mini-Mental State Examination score of >24 (ie, at greater risk of developing severe COVID-19). Participants took part from their place of residence (independent living retirement village, 20; community dwelling, 7; nursing home, 3). Participants were randomly allocated to the intervention or waitlist control group that received the intervention 1 week later. The intervention involved completing cognitive behavioral and positive psychology exercises with a digital human facilitator on a website for at least 15 minutes per day over 1 week. The exercises targeted loneliness, stress, and psychological well-being. Feasibility was evaluated using dropout rates and behavioral observation data. Acceptability was evaluated from behavioral engagement data, the Friendship Questionnaire (adapted), self-report items, and qualitative questions. Psychological measures were administered to evaluate the feasibility of the trial methods and included the UCLA Loneliness Scale, the 4-item Perceived Stress Scale, a 1-item COVID-19 distress measure, the Flourishing Scale, and the Scale of Positive and Negative Experiences. Results: The study recruited 30 participants (15 per group). Participants were 22 older adults and 8 younger adults with a health condition. Six participants dropped out of the study. Thus, the data of 24 participants were analyzed (intervention group, 12; waitlist group, 12). The digital human intervention and trial methods were generally found to be feasible and acceptable in younger and older adults living independently, based on intervention completion, and behavioral, qualitative, and some self-report data. The intervention and trial methods were less feasible to nursing home residents who required caregiver assistance. Acceptability could be improved with additional content, tailoring to the population, and changes to the digital human’s design. Conclusions: Digital humans are a promising and novel technological solution for providing at-risk adults with access to remote psychological support during the COVID-19 pandemic. Research should further examine design techniques to improve their acceptability in this application and investigate intervention effectiveness in a randomized controlled trial. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12620000786998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380113 %M 34596572 %R 10.2196/31586 %U https://mental.jmir.org/2021/11/e31586 %U https://doi.org/10.2196/31586 %U http://www.ncbi.nlm.nih.gov/pubmed/34596572 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32216 %T Evaluation of Novel Concentrated Interdisciplinary Group Rehabilitation for Patients With Chronic Illnesses: Protocol for a Nonrandomized Clinical Intervention Study %A Kvale,Gerd %A Frisk,Bente %A Jürgensen,Marte %A Børtveit,Tore %A Ødegaard-Olsen,Øystein Theodor %A Wilhelmsen-Langeland,Ane %A Aarli,Bernt Bøgvald %A Sandnes,Kristina %A Rykken,Sidsel %A Haugstvedt,Anne %A Hystad,Sigurd William %A Søfteland,Eirik %+ Division of Psychiatry, Haukeland University Hospital, PO Box 1400, Bergen, 5021, Norway, 47 55975000, gerd.kvale@helse-bergen.no %K COVID-19 %K chronic illnesses %K concentrated rehabilitation %K low back pain %K post–COVID-19 symptoms %K post–COVID-19 syndrome %K long COVID %K fatigue %K type 2 diabetes %K anxiety %K depression %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: An aging population with a growing burden of chronic complex illnesses will seriously challenge the public health care system. Consequently, novel and efficacious treatment approaches are highly warranted. Based on our experiences with concentrated treatment formats for other health challenges, we developed a highly concentrated interdisciplinary group rehabilitation approach for chronic illnesses. Objective: We aim to explore the acceptability of the intervention and describe potential changes in functional impairment at follow-up. Methods: The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up. The intervention will be delivered to patients with highly diverse primary symptoms, namely patients with low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes. Results: Recruitment started between August 2020 and January 2021 (according to the illness category). For initial 3-month results, recruitment is expected to be completed by the end of 2021. Conclusions: If successful, this study may have a substantial impact on the treatment of low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes, which together constitute a major socioeconomic cost. Further, the study may widen the evidence base for the use of the concentrated treatment format in a diverse group of medical conditions. International Registered Report Identifier (IRRID): DERR1-10.2196/32216 %M 34505838 %R 10.2196/32216 %U https://www.researchprotocols.org/2021/10/e32216 %U https://doi.org/10.2196/32216 %U http://www.ncbi.nlm.nih.gov/pubmed/34505838 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e25750 %T Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men: Protocol for an Observational Cohort Study %A Egan,James E %A Haberlen,Sabina A %A Meanley,Steven %A Ware,Deanna %A Brown,Andre L %A Siconolfi,Daniel %A Brennan-Ing,Mark %A Stall,Ron %A Plankey,Michael W %A Friedman,M Reuel %+ Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, PUBHL 6119, 130 Desoto St, Pittsburgh, PA, 15261, United States, 1 412 624 2255, jee48@pitt.edu %K HIV %K aging %K MSM %K gay and bisexual men %D 2021 %7 23.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the graying of sexual and gender minority communities and the growing number of people aged ≥50 years living with HIV, it is increasingly important to understand resilience in the context of the psychosocial aspects of aging and aging well. Objective: This paper aims to describe the methods and sample for the Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men study. Methods: This observational cohort study was conducted within the Multisite AIDS Cohort Study (MACS) and was designed to explore resiliencies to explain patterns of health and illness among middle-aged and older sexual minority men. To be eligible, a participant had to be an active participant in the MACS, be at least 40 years of age as of April 1, 2016, and report any sex with another man since enrollment in the MACS. Results: Eligible participants (N=1318) completed six biannual surveys between April 2016 and April 2019. The mean age of the sample was 59.6 years (range 40-91 years). The sample was mostly White, educated, gay-identified, and included both HIV-positive (656/1318, 49.77%) and HIV-negative (662/1318, 50.23%) men. Conclusions: Understanding resiliencies in aging is a critical springboard for the development of more holistic public health theories and interventions that support healthy aging among older sexual minority men. International Registered Report Identifier (IRRID): RR1-10.2196/25750 %M 34554100 %R 10.2196/25750 %U https://www.researchprotocols.org/2021/9/e25750 %U https://doi.org/10.2196/25750 %U http://www.ncbi.nlm.nih.gov/pubmed/34554100 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e26930 %T An Ecological Monitoring and Management App (EMMA) for Older Adults With Chronic Pain: Protocol for a Design and Feasibility Study %A Ledermann,Katharina %A Abou Khaled,Omar %A Caon,Maurizio %A Berger,Thomas %A Chabwine,Joelle N %A Wicht,Joachim %A Martin-Soelch,Chantal %+ Department of Consiliar and Liaison Psychiary, University Hospital Zurich, Culmannstrasse 8, Zurich, 8091, Switzerland, 41 0765330316, katharina.ledermann@hotmail.com %K chronic pain %K older adults %K mHealth %K online intervention %K self-management %D 2021 %7 26.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is a complex problem for many older adults that affects both physical functioning and psychological well-being. Mobile health (mHealth) technologies have shown promise in supporting older persons in managing chronic conditions. Cognitive behavior therapy is recommended for older people with chronic pain. However, web-based treatment programs for chronic pain are not aimed at the needs of older people and offer standard therapies without providing tailored treatment for this population. Objective: To address this problem, we aim to develop a psychological web-based intervention for ecological monitoring of daily life experiences with chronic pain called EMMA to support self-management of chronic pain in older adults. Methods: The key clinical and engagement features of the intervention were established through the integration of evidence-based material from cognitive behavioral therapy for the treatment of chronic pain in older adults. The development process uses a co-design approach and actively involves end-users in the design process by incorporating feedback from focus groups with older adults in order to inform a user-centered intervention design. For the co-design process, we will include 10 older adults with chronic pain, who will discuss the requirements for the app in workshops in order to ensure suitability of the app for older adults with chronic pain. In order to test the feasibility and acceptability of the intervention, we will include a sample of 30 older adults with chronic pain who will test all features of the intervention for a period of 8 consecutive weeks. After the trial period, validated instruments will be used to assess usability and acceptability, as well as influence on pain levels and associated physical and psychological symptoms. Participants will be invited to take part in a semistructured telephone interviews after the trial period to explore their experiences using the app. Results: Digitalization of the pain diary and psychotherapeutic content has started. Recruitment of participants for the co-design workshops will start as soon as we have a functioning prototype of the electronic pain diary and EMMA intervention, which is expected to be in September 2021. The feasibility study will start as soon as the co-design process is finished and required changes have been implemented into the pain diary and the EMMA intervention. We expect to start the feasibility study early in 2022. Conclusions: Required changes to assure usability and acceptability will be directly implemented in the app. EMMA brings together a strong body of evidence using cognitive behavioral and self-management theory with contemporary mHealth principles, allowing for a cost-effective intervention that can be used to target chronic pain anywhere and anytime by older adults. Given the ubiquity of mHealth interventions for chronic conditions, the results of this study may serve to inform the development of tailored self-management interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/26930 %M 34435969 %R 10.2196/26930 %U https://www.researchprotocols.org/2021/8/e26930 %U https://doi.org/10.2196/26930 %U http://www.ncbi.nlm.nih.gov/pubmed/34435969 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e16846 %T Association of Postoperative Clinical Outcomes With Sarcopenia, Frailty, and Nutritional Status in Older Patients With Colorectal Cancer: Protocol for a Prospective Cohort Study %A Humphry,Nia Angharad %A Wilson,Thomas %A Cox,Michael Christian %A Carter,Ben %A Arkesteijn,Marco %A Reeves,Nicola Laura %A Brakenridge,Scott %A McCarthy,Kathryn %A Bunni,John %A Draper,John %A Hewitt,Jonathan %+ School of Medicine, Cardiff University, 9th Floor Neuadd Meirionydd, University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom, 44 7815913222, HumphryNA1@cardiff.ac.uk %K sarcopenia %K frailty %K nutritional status %K urine metabolomics %K surgery %K geriatric medicine %D 2021 %7 17.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older patients account for a significant proportion of patients undergoing colorectal cancer surgery and are vulnerable to a number of preoperative risk factors that are not often present in younger patients. Further, three preoperative risk factors that are more prevalent in older adults include frailty, sarcopenia, and malnutrition. Although each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. A particular area of increasing interest is the use of urine metabolomics for the objective evaluation of dietary profiles and malnutrition. Objective: Herein, we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. The objectives are to determine the association between clinical outcomes and frailty, nutritional status, and sarcopenia. Methods: The procedures will include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (hand grip strength and 4-meter walk test), muscle mass evaluations via computerized tomography morphometric analysis, and the evaluation of nutritional status via the analysis of urinary dietary biomarkers. The primary feasibility outcome is the estimation of the incidence rate of postoperative complications, and the primary clinical outcome is the association between the presence of postoperative complications and frailty, sarcopenia, and nutritional status. The secondary outcome measures are the length of hospital stay, 30-day hospital readmission rate, and mortality rate at days 30 and 90. Results: Our study was approved by the National Health Service Research Ethics Committee (reference number: 19/WA/0190) via the Integrated Research Application System (project ID: 231694) prior to subject recruitment. Cardiff University is acting as the study sponsor. Our study is financially supported through an external, peer-reviewed grant from the British Geriatrics Society and internal funding resources from Cardiff University. The results will be disseminated through peer-review publications, social media, and conference proceedings. Conclusions: As frailty, sarcopenia, and malnutrition are all areas of common derangement in the older surgical population, prospectively studying these risk factors in concert will allow for the analysis of their interplay as well as the development of predictive models for those at risk of commonly tracked surgical complications and outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/16846 %M 34402798 %R 10.2196/16846 %U https://www.researchprotocols.org/2021/8/e16846 %U https://doi.org/10.2196/16846 %U http://www.ncbi.nlm.nih.gov/pubmed/34402798 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25175 %T A Web-Based eHealth Intervention to Improve the Quality of Life of Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial %A Gustafson Sr,David H %A Mares,Marie-Louise %A Johnston,Darcie C %A Mahoney,Jane E %A Brown,Randall T %A Landucci,Gina %A Pe-Romashko,Klaren %A Cody,Olivia J %A Gustafson Jr,David H %A Shah,Dhavan V %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, Mechanical Engineering, 4th Fl, 1513 University Avenue, Madison, WI, 53706, United States, 1 608 890 2615, dcjohnston@wisc.edu %K eHealth %K telemedicine %K aged %K geriatrics %K multiple chronic conditions %K depression %K social support %K quality of life %K primary care %K health expenditures %K mobile phone %D 2021 %7 19.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Multiple chronic conditions (MCCs) are common among older adults and expensive to manage. Two-thirds of Medicare beneficiaries have multiple conditions (eg, diabetes and osteoarthritis) and account for more than 90% of Medicare spending. Patients with MCCs also experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on laboratory results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving these patients’ lives. Objective: This study aims to assess the effects of ElderTree (ET), an eHealth intervention for older adults with MCCs, on quality of life and related measures. Methods: In this unblinded study, 346 adults aged 65 years and older with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, and BMI ≥30 kg/m2) were recruited from primary care clinics and randomized in a ratio of 1:1 to one of 2 conditions: usual care (UC) plus laptop computer, internet service, and ET or a control consisting of UC plus laptop and internet but no ET. Patients with ET have access for 12 months and will be followed up for an additional 6 months, for a total of 18 months. The primary outcomes of this study are the differences between the 2 groups with regard to measures of quality of life, psychological well-being, and loneliness. The secondary outcomes are between-group differences in laboratory scores, falls, symptom distress, medication adherence, and crisis and long-term health care use. We will also examine the mediators and moderators of the effects of ET. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; laboratory data are collected from eHealth records; health care use and chronic conditions are collected from health records and patient surveys; and ET use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. Results: Recruitment was conducted from January 2018 to December 2019, and 346 participants were recruited. The intervention period will end in June 2021. Conclusions: With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ET may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. Trial Registration: ClinicalTrials.gov NCT03387735; https://www.clinicaltrials.gov/ct2/show/NCT03387735. International Registered Report Identifier (IRRID): DERR1-10.2196/25175 %M 33605887 %R 10.2196/25175 %U http://www.researchprotocols.org/2021/2/e25175/ %U https://doi.org/10.2196/25175 %U http://www.ncbi.nlm.nih.gov/pubmed/33605887 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e25307 %T Technology-Assisted Home Care for People With Dementia and Their Relatives: Scoping Review %A Palmdorf,Sarah %A Stark,Anna Lea %A Nadolny,Stephan %A Eliaß,Gerrit %A Karlheim,Christoph %A Kreisel,Stefan H %A Gruschka,Tristan %A Trompetter,Eva %A Dockweiler,Christoph %+ Centre for ePublic Health Research, School of Public Health, Bielefeld University, Universitätsstraße 25, Bielefeld, 33615, Germany, 49 521106437, christoph.dockweiler@uni-bielefeld.de %K dementia %K home care %K assistive technologies %K scoping review %D 2021 %7 20.1.2021 %9 Review %J JMIR Aging %G English %X Background: Assistive technologies for people with dementia and their relatives have the potential to ensure, improve, and facilitate home care and thereby enhance the health of the people caring or being cared for. The number and diversity of technologies and research have continuously increased over the past few decades. As a result, the research field has become complex. Objective: The goal of this scoping review was to provide an overview of the research on technology-assisted home care for people with dementia and their relatives in order to guide further research and technology development. Methods: A scoping review was conducted following a published framework and by searching 4 databases (MEDLINE, CINAHL, PsycInfo, and CENTRAL) for studies published between 2013 and 2018. We included qualitative and quantitative studies in English or German focusing on technologies that support people with dementia or their informal carers in the home care setting. Studies that targeted exclusively people with mild cognitive impairment, delirium, or health professionals were excluded as well as studies that solely consisted of assessments without implication for the people with dementia or their relatives and prototype developments. We mapped the research field regarding study design, study aim, setting, sample size, technology type, and technology aim, and we report relative and absolute frequencies. Results: From an initial 5328 records, we included 175 studies. We identified a variety of technology types including computers, telephones, smartphones, televisions, gaming consoles, monitoring devices, ambient assisted living, and robots. Assistive technologies were most commonly used by people with dementia (77/175, 44.0%), followed by relatives (68/175, 38.9%), and both target groups (30/175, 17.1%). Their most frequent goals were to enable or improve care, provide therapy, or positively influence symptoms of people with dementia (eg, disorientation). The greatest proportions of studies were case studies and case series (72/175, 41.1%) and randomized controlled trials (44/175, 25.1%). The majority of studies reported small sample sizes of between 1 and 50 participants (122/175, 69.7%). Furthermore, most of the studies analyzed the effectiveness (85/233, 36.5%) of the technology, while others targeted feasibility or usability or were explorative. Conclusions: This review demonstrated the variety of technologies that support people with dementia and their relatives in the home care setting. Whereas this diversity provides the opportunity for needs-oriented technical solutions that fit individual care arrangements, it complicates the choice of the right technology. Therefore, research on the users’ informational needs is required. Moreover, there is a need for larger studies on the technologies’ effectiveness that could contribute to a higher acceptance and thus to a transition of technologies from research into the daily lives of people with dementia and their relatives. %M 33470935 %R 10.2196/25307 %U http://aging.jmir.org/2021/1/e25307/ %U https://doi.org/10.2196/25307 %U http://www.ncbi.nlm.nih.gov/pubmed/33470935 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e20220 %T Building a Digital Bridge to Support Patient-Centered Care Transitions From Hospital to Home for Older Adults With Complex Care Needs: Protocol for a Co-Design, Implementation, and Evaluation Study %A Steele Gray,Carolyn %A Tang,Terence %A Armas,Alana %A Backo-Shannon,Mira %A Harvey,Sarah %A Kuluski,Kerry %A Loganathan,Mayura %A Nie,Jason X %A Petrie,John %A Ramsay,Tim %A Reid,Robert %A Thavorn,Kednapa %A Upshur,Ross %A Wodchis,Walter P %A Nelson,Michelle %+ Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, , Canada, 1 416 461 8252 ext 2908, Carolyn.SteeleGray@sinaihealth.ca %K digital health technology %K care transitions %K multimorbidity %K pragmatic trial %K co-design %K hospital %K primary care %D 2020 %7 25.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults with multimorbidity and complex care needs (CCN) are among those most likely to experience frequent care transitions between settings, particularly from hospital to home. Transition periods mark vulnerable moments in care for individuals with CCN. Poor communication and incomplete information transfer between clinicians and organizations involved in the transition from hospital to home can impede access to needed support and resources. Establishing digitally supported communication that enables person-centered care and supported self-management may offer significant advantages as we support older adults with CCN transitioning from hospital to home. Objective: This protocol outlines the plan for the development, implementation, and evaluation of a Digital Bridge co-designed to support person-centered health care transitions for older adults with CCN. The Digital Bridge builds on the foundation of two validated technologies: Care Connector, designed to improve interprofessional communication in hospital, and the electronic Patient-Reported Outcomes (ePRO) tool, designed to support goal-oriented care planning and self-management in primary care settings. This project poses three overarching research questions that focus on adapting the technology to local contexts, evaluating the impact of the Digital Bridge in relation to the quadruple aim, and exploring the potential to scale and spread the technology. Methods: The study includes two phases: workflow co-design (phase 1), followed by implementation and evaluation (phase 2). Phase 1 will include iterative co-design working groups with patients, caregivers, hospital providers, and primary care providers to develop a transition workflow that will leverage the use of Care Connector and ePRO to support communication through the transition process. Phase 2 will include implementation and evaluation of the Digital Bridge within two hospital systems in Ontario in acute and rehab settings (600 patients: 300 baseline and 300 implementation). The primary outcome measure for this study is the Care Transitions Measure–3 to assess transition quality. An embedded ethnography will be included to capture context and process data to inform the implementation assessment and development of a scale and spread strategy. An Integrated Knowledge Translation approach is taken to inform the study. An advisory group will be established to provide insight and feedback regarding the project design and implementation, leading the development of the project knowledge translation strategy and associated outputs. Results: This project is underway and expected to be complete by Spring 2024. Conclusions: Given the real-world implementation of Digital Bridge, practice changes in the research sites and variable adherence to the implementation protocols are likely. Capturing and understanding these considerations through a mixed-methods approach will help identify the range of factors that may influence study results. Should a favorable evaluation suggest wide adoption of the proposed intervention, this project could lead to positive impact at patient, clinician, organizational, and health system levels. Trial Registration: ClinicalTrials.gov NCT04287192; https://clinicaltrials.gov/ct2/show/NCT04287192 International Registered Report Identifier (IRRID): PRR1-10.2196/20220 %M 33237037 %R 10.2196/20220 %U https://www.researchprotocols.org/2020/11/e20220 %U https://doi.org/10.2196/20220 %U http://www.ncbi.nlm.nih.gov/pubmed/33237037 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e17142 %T A Smartphone App for Self-Management of Heart Failure in Older African Americans: Feasibility and Usability Study %A Heiney,Sue P %A Donevant,Sara B %A Arp Adams,Swann %A Parker,Pearman D %A Chen,Hongtu %A Levkoff,Sue %+ College of Nursing, University of South Carolina, 1601 Greene St, Columbia, SC, 29208, United States, 1 803 777 8214, heineys@mailbox.sc.edu %K heart failure %K mobile health app %K self-management %D 2020 %7 3.4.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Mobile health (mHealth) apps are dramatically changing how patients and providers manage and monitor chronic health conditions, especially in the area of self-monitoring. African Americans have higher mortality rates from heart failure than other racial groups in the United States. Therefore, self-management of heart failure may improve health outcomes for African American patients. Objective: The aim of the present study was to determine the feasibility of using an mHealth app, and explore the outcomes of quality of life, including self-care maintenance, management, and confidence, among African American patients managing their condition after discharge with a diagnosis of heart failure. Methods: Prior to development of the app, we conducted qualitative interviews with 7 African American patients diagnosed with heart failure, 3 African American patients diagnosed with cardiovascular disease, and 6 health care providers (cardiologists, nurse practitioners, and a geriatrician) who worked with heart failure patients. In addition, we asked 6 hospital chaplains to provide positive spiritual messages for the patients, since spirituality is an important coping method for many African Americans. These formative data were then used for creating a prototype of the app, named Healthy Heart. Specifically, the Healthy Heart app incorporated the following evidence-based features to promote self-management: one-way messages, journaling (ie, weight and symptoms), graphical display of data, and customized feedback (ie, clinical decision support) based on daily or weekly weight. The educational messages about heart failure self-management were derived from the teaching materials provided to the patients diagnosed with heart failure, and included information on diet, sleep, stress, and medication adherence. The information was condensed and simplified to be appropriate for text messages and to meet health literacy standards. Other messages were derived from interviews conducted during the formative stage of app development, including interviews with African American chaplains. Usability testing was conducted over a series of meetings between nurses, social workers, and computer engineers. A pilot one-group pretest-posttest design was employed with participants using the mHealth app for 4 weeks. Descriptive statistics were computed for each of the demographic variables, overall and subscales for Health Related Quality of Life Scale 14 (HQOL14) and subscales for the Self-Care of Heart Failure Index (SCHFI) Version 6 using frequencies for categorical measures and means with standard deviations for continuous measures. Baseline and postintervention comparisons were computed using the Fisher exact test for overall health and paired t tests for HQOL14 and SCHFI questionnaire subscales. Results: A total of 12 African American participants (7 men, 5 women; aged 51-69 years) diagnosed with heart failure were recruited for the study. There was no significant increase in quality of life (P=.15), but clinically relevant changes in self-care maintenance, management, and confidence were observed. Conclusions: An mHealth app to assist with the self-management of heart failure is feasible in patients with low literacy, low health literacy, and limited smartphone experience. Based on the clinically relevant changes observed in this feasibility study of the Healthy Heart app, further research should explore effectiveness in this vulnerable population. %M 32242822 %R 10.2196/17142 %U http://aging.jmir.org/2020/1/e17142/ %U https://doi.org/10.2196/17142 %U http://www.ncbi.nlm.nih.gov/pubmed/32242822 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 2 %P e13865 %T Understanding Comorbidities and Their Contribution to Predictors of Medical Resource Utilization for an Age- and Sex-Matched Patient Population Living With HIV: Cross-Sectional Study %A Odlum,Michelle %A Yoon,Sunmoo %+ Columbia University School of Nursing, 560 W 168th St, New York, NY, 10026, United States, 1 347 806 2090, mlo12@columbia.edu %K HIV %K sex differences %K Charlson scores %K comorbidity %K electronic health records %K health resource %D 2019 %7 11.09.2019 %9 Original Paper %J JMIR Aging %G English %X Background: More than 60% of people aging with HIV are observed to have multiple comorbidities, which are attributed to a variety of factors (eg, biological and environmental), with sex differences observed. However, understanding these differences and their contribution to medical resource utilization remains challenging as studies conducted exclusively and predominantly among males do not translate well to females, resulting in inconsistent findings across study cohorts and limiting our knowledge of sex-specific comorbidities. Objective: The objective of the study was to provide further insight into aging-related comorbidities, their associated sex-based differences, and their contribution to medical resource utilization, through the analysis of HIV patient data matched by sex. Methods: International Classification of Disease 9/10 diagnostic codes that comprise the electronic health records of males (N=229) and females (N=229) were categorized by individual characteristics, chronic and mental health conditions, treatment, high-risk behaviors, and infections and the codes were used as predictors of medical resource utilization represented by Charlson comorbidity scores. Results: Significant contributors to high Charlson scores in males were age (beta=2.37; 95% CI 1.45-3.29), longer hospital stay (beta=.046; 95% CI 0.009-0.083), malnutrition (beta=2.96; 95% CI 1.72-4.20), kidney failure (beta=2.23; 95% CI 0.934-3.52), chemotherapy (beta=3.58; 95% CI 2.16-5.002), history of tobacco use (beta=1.40; 95% CI 0.200-2.61), and hepatitis C (beta=1.49; 95% CI 0.181-2.79). Significant contributors to high Charlson scores in females were age (beta=1.37; 95% CI 0.361-2.38), longer hospital stay (beta=.042; 95% CI 0.005-0.078), heart failure (beta=2.41; 95% CI 0.833-3.98), chemotherapy (beta=3.48; 95% CI 1.626-5.33), and substance abuse beta=1.94; 95% CI 0.180, 3.702). Conclusions: Our findings identified sex-based differences in medical resource utilization. These include kidney failure for men and heart failure for women. Increased prevalence of comorbidities in people living long with HIV has the potential to overburden global health systems. The development of narrower HIV phenotypes and aging-related comorbidity phenotypes with greater clinical validity will support intervention efficacy. %M 31516123 %R 10.2196/13865 %U http://aging.jmir.org/2019/2/e13865/ %U https://doi.org/10.2196/13865 %U http://www.ncbi.nlm.nih.gov/pubmed/31516123 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e11723 %T Mobile Technology for Healthy Aging Among Older HIV-Positive Black Men Who Have Sex with Men: Qualitative Study %A Tan,Judy You Rong %A Nguyen,Tung T %A Tabrisky,Alyssa %A Siedle-Khan,Robert %A Napoles,Anna Maria %+ Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, UCSF Box 0886, 550 16th Street, 3rd Floor, San Francisco, CA,, United States, 1 415 502 1000 ext 17163, judy.tan@ucsf.edu %K aging %K HIV %K black men who have sex with men %K mHealth %K HIV care and treatment %D 2018 %7 10.12.2018 %9 Original Paper %J JMIR Aging %G English %X Background: People living with HIV are living longer in the United States as a result of antiretroviral therapy. Black men who have sex with men (MSM) are disproportionally affected by HIV and have low rates of engagement in HIV care and treatment. Mobile technology holds promise as an intervention platform; however, little is known regarding its use among older black MSM living with HIV. Objective: The goal of this study was to explore mobile technology use and narratives of aging with HIV among older black MSM to inform mobile health intervention development. Methods: A total of 12 black MSM living with HIV, aged 50 years or older, completed in-person, semistructured interviews exploring the issues of aging, HIV care engagement, and mobile technology use. The interviews were audiotaped, transcribed, and analyzed using qualitative research methods. Results: Men appreciated having survived the AIDS epidemic, but some expressed discomfort and ambivalence toward aging. Men described various levels of engagement in HIV care and treatment; challenges included social isolation and need for support that was not focused on HIV. Almost all described using mobile technology to engage in health care, whereas some referenced important barriers and challenges to technology use. Conclusions: Findings highlighted a high level of interest toward a mobile technology–based intervention targeting older black men but also identified barriers and challenges to using mobile technology for health care engagement. Mobile technology is well incorporated into older black MSM’s lives and shows potential as an intervention platform for addressing aging issues to enhance engagement in HIV care and treatment. %M 31518233 %R 10.2196/11723 %U http://aging.jmir.org/2018/2/e11723/ %U https://doi.org/10.2196/11723 %U http://www.ncbi.nlm.nih.gov/pubmed/31518233 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e12178 %T Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study %A Lefler,Leanne L %A Rhoads,Sarah J %A Harris,Melodee %A Funderburg,Ashley E %A Lubin,Sandra A %A Martel,Isis D %A Faulkner,Jennifer L %A Rooker,Janet L %A Bell,Deborah K %A Marshall,Heather %A Beverly,Claudia J %+ College of Nursing, University of Arkansas for Medical Sciences, 4301 W Markham, #529, Little Rock, AR, 72205, United States, 1 5012961939, L.Lefler@uams.edu %K heart failure %K remote monitoring %K mHealth %K older adults %K feasibility %K self-management %D 2018 %7 04.12.2018 %9 Original Paper %J JMIR Aging %G English %X Background: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. Objective: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. Methods: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. Results: We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. Conclusions: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF. %M 31518257 %R 10.2196/12178 %U http://aging.jmir.org/2018/2/e12178/ %U https://doi.org/10.2196/12178 %U http://www.ncbi.nlm.nih.gov/pubmed/31518257 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 1 %P e10649 %T Understanding Why Older Adults With Type 2 Diabetes Join Diabetes Online Communities: Semantic Network Analyses %A Lewis,Jakeem Amir %A Gee,Perry M %A Ho,Chia-Ling Lynn %A Miller,Lisa M Soederberg %+ Department of Human Ecology, University of California, Davis, 1309 Hart Hall, One Shields Ave., Davis, CA, 95616, United States, 1 530 752 1011, jallewis@ucdavis.edu %K online community %K diabetes %K health information %K health support %K chronic health difficulty %K self-management %K social support %D 2018 %7 28.06.2018 %9 Original Paper %J JMIR Aging %G English %X Background: As individuals age, chronic health difficulties may disrupt physical and social well-being. Individuals can turn to online communities to interact with similar peers, which may help buffer negative effects resulting from health difficulties. Objective: This study investigated the reasons that older adults join a diabetes online community to better understand the specific resources that are being sought. Methods: We used semantic network analyses to categorize the reasons participants provided for joining a community during the sign-up process. Results: The most frequent reasons for joining were to seek information about their health condition, to help with self-management of health difficulties, for feelings of informational and social support, and for having a community with whom to share. Women were more likely to go online for sharing and companionship as well as for information and social support reasons, whereas men were more likely to go online for general information and self-management reasons. Conclusions: This study shows the reasons older adults seek to join a diabetes online community: for increased information and support regarding chronic health difficulties. Practitioners may want to consider ways to promote access to online communities among their older patients as a source of health information and a resource to provide a sense of community. %M 31518243 %R 10.2196/10649 %U http://aging.jmir.org/2018/1/e10649/ %U https://doi.org/10.2196/10649 %U http://www.ncbi.nlm.nih.gov/pubmed/31518243 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 1 %P e10176 %T Diabetes Online Community User Perceptions of Successful Aging With Diabetes: Analysis of a #DSMA Tweet Chat %A Litchman,Michelle L %A Snider,Christopher %A Edelman,Linda S %A Wawrzynski,Sarah E %A Gee,Perry M %+ College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT,, United States, 1 801 585 9612, michelle.litchman@nurs.utah.edu %K diabetes %K aging %K social media %K Twitter %D 2018 %7 22.06.2018 %9 Original Paper %J JMIR Aging %G English %X Background: According to the American Diabetes Association, there are approximately 30.3 million Americans with diabetes, and the incidence is growing by nearly 1.5 million cases per year. These individuals are at particularly high risk of developing secondary comorbid conditions related to diabetes and aging. Nearly 45% of individuals aged 65 to 75 years use social media, and this number is steadily growing. The use of social media provides the opportunity to assess the perceptions and needs of this population. Objective: The purpose of this study was to examine stakeholder perceptions of successful aging with diabetes. Methods: This study presents a retrospective analysis of a tweet chat focused on aging with diabetes. Tweets were collected using Symplur Signals data analytics software (Symplur LLC) and analyzed for content analysis, sentiment, and participant demographics. Two authors reviewed discussion posts for accuracy of analysis. Results: A total of 59 individuals participated in this tweet chat generating 494 tweets and nearly 2 million impressions. Most (36/59, 63%) tweet chat participants were people living with diabetes; 25% (14/59) were caregivers and advocates. Seven countries were represented in the conversation. A majority (352/494, 71.3%) of the tweets indicated positive sentiment related to aging with diabetes. Five major themes emerged from the qualitative analysis: (1) personal decline now and in the future, (2) limited access to treatment, (3) inability to provide self-care, (4) health care provider capacity to support aging with diabetes, and (5) life-long online peer health support to facilitate diabetes management. Conclusions: Individuals with diabetes are living longer and want to be supported with specialized care and access to technology that will allow them to successfully age. Aging- and diabetes-related changes may complicate diabetes management into old age. People with diabetes desire options including aging in place; therefore, special training for care partners and health care providers who care for older adults is needed. %M 31518231 %R 10.2196/10176 %U http://aging.jmir.org/2018/1/e10176/ %U https://doi.org/10.2196/10176 %U http://www.ncbi.nlm.nih.gov/pubmed/31518231 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e29 %T Designing, Implementing, and Evaluating Mobile Health Technologies for Managing Chronic Conditions in Older Adults: A Scoping Review %A Matthew-Maich,Nancy %A Harris,Lauren %A Ploeg,Jenny %A Markle-Reid,Maureen %A Valaitis,Ruta %A Ibrahim,Sarah %A Gafni,Amiram %A Isaacs,Sandra %+ Aging, Community & Health Research Unit, McMaster University, Mohawk College/McMaster University School of Nursing, #354 McMaster-Mohawk Institute for Applied Health Sciences, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada, 1 9055404247 ext 26793, nancy.maich@mohawkcollege.ca %K Telemedicine %K Mobile health %K Health Plan Implementations %K Evaluation Studies as Topic %K Design %K mHealth Innovations %K Frail Elderly %K Older Adults %K Multiple Chronic Conditions %K Home Care Services %K Scoping Review %K Communication %K Information Communication Technologies %D 2016 %7 09.06.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations. Objectives: The purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults. Methods: A 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data. Results: We identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies. Conclusions: There is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations. %M 27282195 %R 10.2196/mhealth.5127 %U http://mhealth.jmir.org/2016/2/e29/ %U https://doi.org/10.2196/mhealth.5127 %U http://www.ncbi.nlm.nih.gov/pubmed/27282195