%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e71676 %T A Portal-Based Intervention (PATTERN) Designed to Support Medication Use Among Older Adults: Feasibility and Acceptability Study %A Pack,Allison %A Bailey,Stacy C %A O'Conor,Rachel %A Velazquez,Evelyn %A Wismer,Guisselle %A Yeh,Fangyu %A Curtis,Laura M %A Alcantara,Kenya %A Wolf,Michael S %K older adults %K multiple chronic conditions %K polypharmacy %K primary care %K medication adherence %K patient portal %D 2025 %7 24.4.2025 %9 %J JMIR Form Res %G English %X Background: Poor medication adherence among older adults with multiple chronic conditions and polypharmacy is a public health concern stemming from distinct challenges. Prior interventions have largely used a one-size-fits-all approach or resource-intensive approaches inappropriate for busy primary care clinics. Objective: To address this, Phenotyping Adherence Through Technology-Enabled Reports and Navigation (PATTERN) was adapted from prior work. PATTERN is a portal-based intervention for monitoring self-reported medication adherence challenges among older adults in primary care. This study sought to implement and evaluate PATTERN’s feasibility and acceptability. Methods: We conducted a patient randomized study with a posttest design. Primary care physicians at the participating health center were informed of the study, and approval was obtained to contact their patients. Patient eligibility included being aged 60 years or older, having prescription medications for ≥8 chronic conditions, and an upcoming visit with a physician who had provided approval. Potentially eligible patients were identified using an electronic health record query, and a research coordinator phoned them to confirm eligibility, assess interest, obtain consent, and conduct enrollment. Randomization occurred following enrollment. Those randomized to PATTERN received a medication adherence assessment in their patient portal accounts several days ahead of their visit. The assessment identified whether a patient was experiencing a medication adherence challenge, and if so, the type (cognitive, psychological, medical, regimen-related, social, or economic). Identified challenges were sent to the patient’s primary care physician. Assessment delivery several days ahead of a visit was thought to offer sufficient time for patients to complete it and clinicians to review any challenges. Approximately 2 weeks after visits, the coordinator recontacted participants to conduct posttest interviews. This ensured clinicians had sufficient time to respond to challenges during or after visits. Posttest interviews measured the self-reported use of the portal, demographic and health characteristics, and for those randomized to PATTERN, intervention satisfaction. Self-reported data were captured in REDCap and analyzed descriptively. Electronic health record data were also analyzed descriptively to objectively identify feasibility, that is, whether intervention arm participants completed the PATTERN assessment. Results: We enrolled 64 participants (32 received usual care, and 32 received intervention). Most were female (66%, 42/64), not Hispanic or Latino (94%, 60/64), and identified as White (58%, 37/64). The average (SD) age was 75 (6.8) years. Most participants (80%) self-reported using the patient portal ≥12 times per year. However, electronic health record data revealed that less than half of all participants randomized to PATTERN (47%, 15/32) completed the medication adherence assessment. Of those who remembered completing it, 60% (3/5) were very satisfied with the experience and 20% (1/5) were a little satisfied. Conclusions: PATTERN has the potential for use with older primary care patients experiencing multiple chronic conditions and polypharmacy. Yet, further adaptation is needed to ensure recipients access their patient portal accounts and complete assessments. Trial Registration: ClinicalTrials.Gov NCT05766423; https://clinicaltrials.gov/study/NCT05766423 %R 10.2196/71676 %U https://formative.jmir.org/2025/1/e71676 %U https://doi.org/10.2196/71676 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59507 %T Wearable Activity Tracker–Based Interventions for Physical Activity, Body Composition, and Physical Function Among Community-Dwelling Older Adults: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Li,Ran %A Li,Yangan %A Wang,Lu %A Li,Lijuan %A Fu,Chenying %A Hu,Danrong %A Wei,Quan %+ Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China, 86 18980606730, weiquan@scu.edu.cn %K wearable activity tracker %K physical activity %K older adult %K systematic review %K meta-analysis %D 2025 %7 3.4.2025 %9 Review %J J Med Internet Res %G English %X Background: The global aging population faces great challenges. Wearable activity trackers have emerged as tools to promote physical activity among older adults, potentially improving health outcomes. However, the effectiveness of such interventions on physical activity, body composition, and physical function among community-dwelling older adults remains debated. Objective: This study conducted a systematic review and meta-analysis to evaluate the impact of wearable activity tracker–based interventions on physical activity, body composition, and physical function among community-dwelling older adults. Methods: We searched the PubMed, Embase, Web of Science, and CENTRAL databases from inception until January 2025 to identify related randomized controlled trials. The outcomes were focused on physical activity (physical activity time, daily step count, and daily sedentary time); body composition (BMI and body fat); and physical function (timed up and go test and chair stand test). Subgroup analysis by different controls (usual care or conventional interventions) and different follow-ups (immediate or short term) were performed. Results: In total 23 trials with 4566 participants were eligible for analysis. Compared to usual care, there was lo- to moderate-certainty evidence that the wearable activity tracker–based interventions significantly increased physical activity time (standardized mean difference [SMD]=0.28, 95% CI 0.10-0.47; P=.003) and daily step counts (SMD=0.58, 95% CI 0.33-0.83; P<.001) immediately after intervention, while no significant improvements were observed in daily sedentary time (mean difference [MD]=−1.56, 95% CI −10.88 to 7.76; I2=0%; P=.74). These interventions were at least as effective as conventional interventions but did not show superiority. Compared with usual care, the interventions using wearable activity trackers only demonstrated a notable increase in daily step count over short-term follow-up (SMD=0.23, 95% CI 0.11-0.36; P<.001). As for body composition and physical function, there was low- to moderate-certainty evidence that the wearable activity tracker–based interventions did not have a greater impact on BMI (MD=0.40, 95% CI −0.08 to 0.89; P=.11), body fat (MD=0.67, 95% CI −0.54 to 1.87; P=.28), the timed up and go test (MD=0.14, 95% CI −0.87 to 1.16; P=.78), or the chair stand test (SMD=−0.31, 95% CI −0.62 to 0; P=.05). Conclusions: This systematic review and meta-analysis indicate that wearable activity tracker–based interventions were effective in enhancing physical activity with low to moderate certainty, but did not significantly impact body composition or physical function, with low to moderate certainty, among community-dwelling older adults, particularly immediately after intervention. This intervention showed a more pronounced impact when compared to usual care, rather than to conventional interventions, with low to moderate certainty. It is important to note that this intervention showed moderate-certainty evidence toward improving daily step count, supporting its sustained impact during short-term follow-up. Trial Registration: PROSPERO CRD42024516900; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024516900 %M 40179387 %R 10.2196/59507 %U https://www.jmir.org/2025/1/e59507 %U https://doi.org/10.2196/59507 %U http://www.ncbi.nlm.nih.gov/pubmed/40179387 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e54143 %T A Digitally Capable Aged Care Workforce: Demands and Directions for Workforce Education and Development %A Gray,Kathleen %A Butler-Henderson,Kerryn %A Day,Karen %+ Centre for Digital Transformation of Health, University of Melbourne, Parkville, Melbourne, 3010, Australia, 61 390355511, kgray@unimelb.edu.au %K aged care %K digital health %K digital literacy %K education %K older adults %K professional development %K digital transformation %K digital resources %K users %K community %K learning %K support %K safe %K ethical %K satisfaction %D 2025 %7 2.4.2025 %9 Viewpoint %J JMIR Aging %G English %X As the aged care sector undergoes digital transformation, greater attention is needed to development of digital health capability in its workforce. There are many gaps in our understanding of the current and future impacts of technology on those who perform paid and unpaid aged care work. Research is needed to understand how to make optimal use of both digital resources and human resources for better aged care. In this Viewpoint, we reflect on a workshop held during an international conference that identified shared concepts and concerns to shape further research into workforce capability. Digital technologies and digital data can increase quality of care in a system that operates through partnerships among service providers, service users, and community members. To realize this potential, digital health learning and development are needed in the aged care workforce. As digital dimensions of aged care services expand, the sector needs clearer direction to implement approaches to workforce learning and development. These must be appropriate to support the safe and ethical performance of care work and to increase the satisfaction of those who care and those for whom they care. %M 40173435 %R 10.2196/54143 %U https://aging.jmir.org/2025/1/e54143 %U https://doi.org/10.2196/54143 %U http://www.ncbi.nlm.nih.gov/pubmed/40173435 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e68061 %T Employers’ Perspectives of Caregiver-Friendly Workplace Policies for Caregiver-Employees Caring for Older Adults in Hong Kong: Thematic Analysis %A Lee,Maggie Man-Sin %A Yeoh,Eng-Kiong %A Wong,Eliza Lai-Yi %+ JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, School of Public Health Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China (Hong Kong), 852 2252 8772, lywong@cuhk.edu.hk %K caregiver %K aging %K burnout %K stress %K mental health %K employees %D 2025 %7 31.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Caregiver-friendly workplace policies (CFWPs) are rare in Hong Kong. With Hong Kong facing a “silver tsunami” in the near future, it is important to understand the need for such policies and the views of employers for future facilitation. Objective: This study aimed to identify the support that is currently provided or that could be provided to caregiver-employees (CEs) caring for older adults in Hong Kong and assess the challenge and facilitative support for employers to adopt CFWPs in the specific context of Hong Kong. Methods: A qualitative research design with semistructured individual in-depth interviews with employers from Hong Kong was adopted for this study. A purposive snowball sampling method was used to recruit participants from the 7 primary industries mentioned in the Hong Kong census and from all 3 employer types (private, public, and nongovernmental organizations), which allowed the inclusion of participants sensitized to the idea and potential of CFWPs. Thematic framework analysis was used to evaluate the data collected during the interviews. Results: We interviewed 17 employers and managers from 7 major industries in Hong Kong (2.5 to 120,000 employees). There were 4 (24%) male and 13 (76%) female participants, and the participant age ranged from 30 to 50 years. All participants held managerial positions at the time of the interview. Of the 17 participants, 13 were from private companies, 2 were from public institutions, and 2 were from nongovernmental organizations. Four of the companies had a global presence. Four main themes were identified: (1) current support and potential support for CEs (which was limited to discretionary annual leave and unpaid leave when annual leave was exhausted), (2) challenges in adopting CFWPs, (3) facilitating support for adopting CFWPs, and (4) incentives for adopting CFWPs. The participants rated information and resources for CEs (mean 8.56, SD 0.37), bereavement leave (mean 8.47, SD 0.63), flexible working hours (mean 8.32, SD 0.48), and caregiver-inclusive corporate culture (mean 8.32, SD 0.48) as essential CFWPs for CEs in Hong Kong. Conclusions: While several studies have reported the types of CFWPs and their impacts on CEs, stakeholders’ perspectives on CFWPs have been rarely investigated. This study found that although employers consider CFWPs as necessary and see them as a catalyst for a long-term win-win situation, the current support for CEs is discretionary and industry-specific. Government leadership is critical for formulating, piloting, and implementing CFWPs to create a friendly environment that encourages disclosure with trust and respect across industrial sectors in Hong Kong. This study identified the current unmet needs and demands of CEs from the employer’s perspective, the barriers to large-scale adoption of CFWPs, and the path forward to inform further discourse and policy formulation in Hong Kong. %M 40163861 %R 10.2196/68061 %U https://aging.jmir.org/2025/1/e68061 %U https://doi.org/10.2196/68061 %U http://www.ncbi.nlm.nih.gov/pubmed/40163861 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66058 %T Social Media and eHealth Literacy Among Older Adults: Systematic Literature Review %A Zhang,Chenglin %A Mohamad,Emma %A Azlan,Arina Anis %A Wu,Anqi %A Ma,Yilian %A Qi,Yihan %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Selangor, 43600, Malaysia, 60 389215457, emmamohamad@ukm.edu.my %K eHealth literacy %K digital health literacy %K older adults %K social media %K health information %K systematic review %D 2025 %7 26.3.2025 %9 Review %J J Med Internet Res %G English %X Background: The advent of social media has significantly transformed health communication and the health-related actions of older adults, offering both obstacles and prospects for this generation to embrace eHealth developments. Objective: We aimed to investigate the correlation between social media and eHealth literacy in older individuals and answer four research questions: (1) What are the specific social media behaviors (including general use behaviors and health behaviors) of older adults on social media? (2) How do these behaviors impact their eHealth literacy? (3) How does eHealth literacy influence older adults’ social media behaviors? and (4) What factors influence older adults’ use of social media for health-related purposes? Methods: Using predetermined keywords and inclusion criteria, we searched Scopus, Web of Science, and PubMed databases for English-language journal articles published from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles. The initial search identified 1591 publications, and after removing duplicates, 48.21% (767/1591) of publications remained. Ultimately, 1% (16/1591) of studies met the inclusion criteria. A research question–driven manual qualitative thematic analysis was conducted, guided by the categorization of social media use behaviors, the definition of eHealth literacy, and the social-ecological model to provide direction for coding and thematic analysis. In addition, attention was given to identifying unanticipated behaviors or phenomena during the coding process, and these were subsequently incorporated into the analytical framework. Results: The results indicated that older adults’ general social media use behaviors are primarily characterized by social media preferences, with 2 subthemes identified. Their social media health behaviors revealed 5 main themes and 14 subthemes. Among the primary themes, health information behavior appeared most frequently (12/16, 75%), followed by self-management (8/16, 50%). Other themes included health decision-making (4/16, 25%), telemedicine (3/16, 19%), and health interventions (2/16, 13%). Cross-thematic analysis confirmed that older adults’ social media use behaviors and their eHealth literacy had a reciprocal relationship. Finally, the study revealed that the use of social media to improve eHealth literacy among older adults was influenced by individual, interpersonal, institutional or organizational, and social factors. Conclusions: The reciprocal relationship between older adults’ social media use and eHealth literacy highlights the importance of establishing a long-term positive mechanism that mutually reinforces social media health practices and eHealth literacy. Based on the findings, this review proposes key directions for efforts to achieve this goal: (1) leveraging postpandemic momentum to enhance eHealth literacy among older adults through social media, (2) reconsidering the dimensions of eHealth literacy among older adults in the context of Web 2.0, (3) actively developing age-friendly integrated social media health service platforms, (4) optimizing social media for engaging and reliable health information for older adults, and (5) integrating social support systems to foster lifelong eHealth learning for older adults. %M 40138684 %R 10.2196/66058 %U https://www.jmir.org/2025/1/e66058 %U https://doi.org/10.2196/66058 %U http://www.ncbi.nlm.nih.gov/pubmed/40138684 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e69107 %T Passive Remote Monitoring Technologies’ Influence on Home Care Clients’ Ability to Stay Home: Multiprovincial Randomized Controlled Trial %A Donelle,Lorie %A Hiebert,Bradley %A Warner,Grace %A Reid,Michael %A Reid,Jennifer %A Shariff,Salimah %A Richard,Emily %A Regan,Sandra %A Weeks,Lori %A Ledoux,Kathleen %+ College of Nursing, University of South Carolina, 1601 Greene St, Columbia, SC, 29208, United States, 1 803 777 6528, ldonelle@mailbox.sc.edu %K remote monitoring technology %K home care %K health service use %K aging in place %D 2025 %7 19.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Researchers in Nova Scotia and Ontario, Canada, implemented a passive remote monitoring (PRM) model of home care unique to their health system contexts. Each PRM model integrated tailored PRM devices (eg, motion sensors, cameras, and door alarms) into home care patients’ residences with the aim of linking patients, family and friend caregivers, and health care providers to support older adults’ aging in place. Objective: The purpose of this study was to examine the use of PRM technologies in the home to support older adults’ safe aging in place and avoidance or delay of higher levels of care. Methods: This multiprovincial pragmatic randomized controlled trial examined how PRM technologies support older adults to safely remain in their home and avoid or delay admission to higher levels of care. Pairs of home care patients and their family and friend caregivers were recruited in Ontario and Nova Scotia. Participant pairs were randomly assigned to one of two conditions: (1) standard home care (ie, control) or (2) standard home care plus study-provided PRM (ie, intervention). Participants provided their provincial health insurance numbers to link with provincial health administrative databases and identify if patients were admitted to higher levels of care after 1 year. Cox proportional hazards models were used to evaluate the primary outcome in each province. Results: In total, 313 patient-caregiver pairs were recruited: 174 pairs in Ontario (intervention: n=60; control: n=114) and 139 pairs in Nova Scotia (intervention: n=45; control: n=94). Results indicate PRM was associated with a nonsignificant 30% reduction in risk of patients being admitted to higher levels of care in Ontario (hazard ratio 0.7, 95% CI 0.3-1.4) and no reduction in risk in Nova Scotia (hazard ratio 1.1, 95% CI 0.3-3.7). Adjusting for patient sex had no impact on model estimates for either province. Conclusions: Limitations related, in part, to the impact of the COVID-19 pandemic may have contributed to the effectiveness of the intervention. While our study did not yield statistically significant results (P=.30 and P=.90) regarding the effectiveness of the PRM model in prolonging home stays, the observed trends suggest that technology-assisted aging in place may be a valuable goal for older adults. Further study is required to understand if longer follow-up time allows more effects of PRM on patients’ avoidance of higher levels of care to be detected. Trial Registration: ISRCTN ISRCTN79884651; https://www.isrctn.com/ISRCTN79884651 International Registered Report Identifier (IRRID): RR2-10.2196/15027 %M 40106817 %R 10.2196/69107 %U https://aging.jmir.org/2025/1/e69107 %U https://doi.org/10.2196/69107 %U http://www.ncbi.nlm.nih.gov/pubmed/40106817 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66683 %T Associations Among Online Health Information Seeking Behavior, Online Health Information Perception, and Health Service Utilization: Cross-Sectional Study %A Li,Hongmin %A Li,Dongxu %A Zhai,Min %A Lin,Li %A Cao,ZhiHeng %+ School of Public Health, Jining Medical University, No 133 Hehua Road, Taibaihu District, Shandong, Jining, 272067, China, 86 05373616333, lidongxu0602@126.com %K online health information seeking (OHIS) %K online health information perception (OHIP) %K mediating effect %K health service utilization %K health information %K health perception %K data %K China %K Chinese General Social Survey (CGSS) %K database %K medical information %K survey %D 2025 %7 14.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Seeking online health information can empower individuals to better understand their health concerns, facilitating their ability to manage their health conditions more effectively. It has the potential to change the likelihood and frequency of health service usage. Although existing literature has demonstrated the prevalence of seeking online health information among different populations, the factors affecting online health information perception and discussions on the associations between seeking online health information and health service utilization are limited. Objective: We analyzed the associations between online health information seeking behavior and health service utilization, as well as the online health information perception delivery mechanism. Methods: We analyzed data from the Chinese General Social Survey, the first national representative survey conducted in mainland China. The independent variable was the online health information seeking behavior. The outcome variable was health service utilization by the respondents, and online health information perception was selected as the mediating variable in this analysis. Factor analysis was conducted to obtain online health information perception. Multiple regressions were performed to investigate the effect of online health information seeking behavior on physician visits. Bootstrap methods were conducted to test the mediation effects of online health information perception. Results: This analysis included 1475 cases. Among the participants, 939 (63.66%) sought online health information in the last 12 months. The mean age of the respondents was 46.72 (SD 15.86) years, and 794 (53.83%) were females. After controlling for other variables, individuals with online health information seeking behaviors showed 0.289 times more outpatient visits (P=.003), 0.131 times more traditional Chinese medicine outpatient visits (P=.01), and 0.158 times more Western medicine outpatient visits (P=.007) over the past year compared to those who did not seek health information online. Additionally, multiple regression analyses revealed statistically significant effects of gender, age, and health status on physician visits. The total effect revealed that seeking online health information significantly influenced the total physician visits (β=0.290; P=.003), indicating a certain correlation between online health information seeking behavior and physician visits. Seeking online health information had a significant positive impact on the perception (β=0.265; P<.001). The mediation effects analysis identified that online health information perception led to a significant increase in physician visits with the increase in the online health information seeking behaviors (β=0.232; P=.02). Conclusions: The online health information perception of an individual influences the effect online health information seeking has on the frequency of physician visits. The online health information seeking behavior impacts outpatient service utilization both directly and indirectly through online health information perception and significantly increases the frequency of clinic visits after controlling for other variables. Interventions can be explored to improve the health utilization of residents by increasing their online health information perception. %M 40085841 %R 10.2196/66683 %U https://www.jmir.org/2025/1/e66683 %U https://doi.org/10.2196/66683 %U http://www.ncbi.nlm.nih.gov/pubmed/40085841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64249 %T Experiences and Expectations of Immigrant and Nonimmigrant Older Adults Regarding eHealth Services: Qualitative Interview Study %A Ghorbanian Zolbin,Maedeh %A Kujala,Sari %A Huvila,Isto %+ Department of Computer Science, Aalto University, PO Box 15400, Espoo, 02150, Finland, 358 0449270768, maedeh.ghorbanianzolbin@aalto.fi %K eHealth services %K older adults %K immigrant %K usability %K user experience %K emotion %K self-determination theory %D 2025 %7 14.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of eHealth services could contribute to improving individuals’ quality of life by optimizing effective and efficient care. However, various challenges might limit some older adults’ use of eHealth services. Objective: This study aimed to understand the perspectives of older adults (aged ≥65 years) of different backgrounds regarding eHealth services. We explored the experiences of Iranian immigrant and nonimmigrant older adults with eHealth services to identify their perceived challenges, emotions, and wishes. Immigrants face more challenges, and there is a need to understand their perspectives in addition to those of nonimmigrants. Iranians are one important immigrant group, as their number is limited and their specific needs are less well understood compared to those of the bigger immigrant groups. Methods: This study used a qualitative explorative research design. Semistructured interviews were conducted between February 2023 and May 2023. The participants were 25 older adults: nonimmigrants residing in cities (n=8, 32%), nonimmigrants residing in rural areas (n=9, 36%), and Iranian immigrants residing in cities (n=8, 32%). Data were analyzed through inductive and deductive content analysis and interpreted through self-determination theory. Results: Interacting with eHealth services was challenging for some older adults. They perceived several difficulties, with the most obvious ones being related to values and preferences, as some older adults did not value eHealth services (16/25, 64%), had insufficient digital skills (15/25, 60%), and experienced usability issues (15/25, 60%). The first two challenges were more pronounced among immigrants. In contrast, nonimmigrants from cities, being more familiar with the services, shared more usability issues. These identified challenges prevented older adults from satisfying their basic psychological needs of being competent and autonomous users and having a sense of belonging (aspects of self-determination theory), which were the main source of negative emotions. A common negative feeling was confusion (16/25, 64%) among those with limited experience using smart devices and those with poor self-reported digital skills. Conversely, older adults’ interaction with eHealth services generated positive emotions that were connected to the satisfaction of their basic psychological needs. Being interested in using eHealth services was a common feeling among most participants regardless of their background and was connected to satisfying their need for being competent and autonomous. The positive emotions could be supported by applying older adults’ needs to the design of eHealth services (10/25, 40%) and by supporting their digital skills (19/25, 76%). Conclusions: Some older adults value eHealth services and see their added benefits. However, various challenges limit their use of these services. The analysis of older adults’ needs yielded several practical ideas that could improve the user-friendliness of the services and highlighted the importance of sufficient support services tailored to the cultural needs of specific groups of older adults. %M 40085846 %R 10.2196/64249 %U https://www.jmir.org/2025/1/e64249 %U https://doi.org/10.2196/64249 %U http://www.ncbi.nlm.nih.gov/pubmed/40085846 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e49507 %T Implementation of a Web-Based Program for Advance Care Planning and Evaluation of its Complexity With the Nonadoption, Abandonment, Scale-Up, Spread, And Sustainability (NASSS) Framework: Qualitative Evaluation Study %A van der Smissen,Doris %A Schreijer,Maud A %A van Gemert-Pijnen,Lisette J E W C %A Verdaasdonk,Rudolf M %A van der Heide,Agnes %A Korfage,Ida J %A Rietjens,Judith A C %+ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands, 31 107038460, i.korfage@erasmusmc.nl %K eHealth %K web-based intervention %K implementation %K sustainability %K advance care planning %K NASSS framework %K nonadoption, abandonment, scale-up, spread, and sustainability framework %K health communication %K patient education %K patient-centered care %D 2025 %7 4.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The implementation of eHealth applications often fails. The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework aims to identify complexities in eHealth applications; the more complex, the more risk of implementation failure. Objective: This study aimed to analyze the implementation of the web-based advance care planning (ACP) program “Explore Your Preferences for Treatment and Care” using the NASSS framework. Methods: The NASSS framework enables a systematic approach to improve the implementation of eHealth tools. It is aimed at generating a rich and situated analysis of complexities in multiple domains, based on thematic analysis of existing and newly collected data. It also aims at supporting individuals and organizations to handle these complexities. We used 6 of 7 domains of the NASSS framework (ie, condition, technology, value proposition, adopters, external context, and embedding and adaptation over time) leaving out “organization,” and analyzed the multimodal dataset of a web-based ACP program, its development and evaluation, including peer-reviewed publications, notes of stakeholder group meetings, and interviews with stakeholders. Results: This study showed that the web-based ACP program uses straightforward technology, is embedded in a well-established web-based health platform, and in general appears to generate a positive value for stakeholders. A complexity is the rather broad target population of the program. A potential complexity considers the limited insight into the extent to which health care professionals adopt the program. Awareness of the relevance of the web-based ACP program may still be improved among target populations of ACP and among health care professionals. Furthermore, the program may especially appeal to those who value individual autonomy, self-management, and an explicit and direct communicative approach. Conclusions: Relatively few complexities were identified considering the implementation of the web-based ACP program “Explore Your Preferences for Treatment and Care.” The program is evidence-based, freestanding, and well-maintained, with straightforward, well-understood technology. The program is expected to generate a positive value for different stakeholders. Complexities include the broad target population of the program and sociocultural factors. People with limited digital literacy may need support to use the program. Its uptake might be improved by increasing awareness of ACP and the program among a wider population of potential users and among health care professionals. Addressing these issues may guide future use and sustainability of the program. %M 40053753 %R 10.2196/49507 %U https://aging.jmir.org/2025/1/e49507 %U https://doi.org/10.2196/49507 %U http://www.ncbi.nlm.nih.gov/pubmed/40053753 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55082 %T Online-Based Recruitment Methods for Community-Dwelling Older Adults: Scoping Review and Lessons Learned From the PLAN Trial %A Min,Deborah %A Yun,Ji-Young %A Parslow,Chad %A Jajodia,Anushka %A Han,Hae-Ra %+ School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD, 21205, United States, 1 14106142669, hhan3@jhu.edu %K older adults %K online %K online recruitment %K community-dwelling %K strategies %K America %K Americans %K technology adoption %K digital technologies %K COVID-19 %K pandemic %K digital health %K dementia %K caregivers %K healthcare system %K community health workers %K consultants %K mobile phone %D 2025 %7 25.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Despite rapid technological advancement and a considerably aging US population, there remains a gap in the literature pertaining to online-based recruitment strategies for older adults. Objective: This study aimed to describe the lessons learned from the authors’ experience of recruiting a sample for PLAN (Preparing successful aging through dementia Literacy education And Navigation), an ongoing, community-based randomized controlled trial designed to promote the transition of community-dwelling Korean American older adults with probable dementia and their caregivers into the health care system. The authors also present online-based recruitment strategies focused on older adults reported in relevant published studies to compare with their experiences. Methods: Data sources included PLAN recruitment tracking files, study team meeting minutes, and interviews with community consultants. We also conducted a scoping review of published studies, searching PubMed in July 2021, and updated our search in September 2023. Eligibility criteria included (1) focus on older adults aged more than 65 years, (2) sample recruited from a community setting, and (3) inclusion and description of online-based recruitment strategies. Exclusion criteria (1) did not focus on adults older than 65 years in a community setting, (2) did not include or describe online-based recruitment strategies, or (3) used online-based methods but not for the purpose of recruitment. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Information was extracted using a data charting table and synthesized by conducting a thematic analysis. Results: In total, 8 articles were included in the scoping review and primarily addressed health promotion and recruitment strategy evaluation. When compared with PLAN data sources, five key themes emerged as relevant to the online-based recruitment of community-dwelling older adults: (1) unfamiliarity with technology—limited digital literacy, (2) differences in internet access and use across older age groups, (3) providing technological support to promote recruitment, (4) successful and unsuccessful recruitment using social media, and (5) other diverse online-based methods of recruitment. In particular, direct quotes from multiple sources for the PLAN trial revealed technological challenges that were common among immigrant older adults as the study team used various online-based recruitment activities. Conclusions: The literature was limited in the discussion of online-based recruitment among older participants. Data sources revealed the digital divide and limited digital literacy, particularly among non–English-speaking immigrant older adults and their caregivers. The usefulness of online-based recruitment of older adults is uncertain due, in large part, to limited sociodemographic diversity noted in the samples recruited in the included studies. Future research should explore the role of race and ethnicity and other characteristics, such as socioeconomic status, sex, education, access to technology, and digital literacy, in relation to online-based recruitment for adequate representation of diverse older adults in research. Trial Registration: ClinicalTrials.gov NCT03909347; https://clinicaltrials.gov/study/NCT03909347 %M 39998873 %R 10.2196/55082 %U https://www.jmir.org/2025/1/e55082 %U https://doi.org/10.2196/55082 %U http://www.ncbi.nlm.nih.gov/pubmed/39998873 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60107 %T Best Practices for Implementing Electronic Care Records in Adult Social Care: Rapid Scoping Review %A Snow,Martha %A Silva-Ribeiro,Wagner %A Baginsky,Mary %A Di Giorgio,Sonya %A Farrelly,Nicola %A Larkins,Cath %A Poole,Karen %A Steils,Nicole %A Westwood,Joanne %A Malley,Juliette %+ Care Policy and Evaluation Centre, London School of Economics and Political Science (LSE), PAN 8.01J, Houghton Street, London, WC2A 2AE, United Kingdom, 44 (0)20 7405 7686, m.snow@lse.ac.uk %K digital care records %K adult social care %K digitization %K domiciliary care %K care homes %K electronic care records %K PRISMA %D 2025 %7 14.2.2025 %9 Review %J JMIR Aging %G English %X Background: In the past decade, the use of digital or electronic records in social care has risen worldwide, capturing key information for service delivery. The COVID-19 pandemic accelerated digitization in health and social care. For example, the UK government created a fund specifically for adult social care provider organizations to adopt digital social care records. These developments offer valuable learning opportunities for implementing digital care records in adult social care settings. Objective: This rapid scoping review aimed to understand what is known about the implementation of digital care records in adult social care and how implementation varies across use cases, settings, and broader contexts. Methods: A scoping review methodology was used, with amendments made to enable a rapid review. Comprehensive searches based on the concepts of digital care records, social care, and interoperability were conducted across the MEDLINE, EmCare, Web of Science Core Collection, HMIC Health Management Information Consortium, Social Policy and Practice, and Social Services Abstracts databases. Studies published between 2018 and 2023 in English were included. One reviewer screened titles and abstracts, while 2 reviewers extracted data. Thematic analysis mapped findings against the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. Results: Our search identified 2499 references. After screening titles and abstracts, 71 records were selected for full-text review, resulting in 31 references from 29 studies. Studies originated from 11 countries, including 1 multicountry study, with the United Kingdom being the most represented (10/29, 34%). Studies were most often conducted in nursing homes or facilities (7/29, 24%) with older people as the target population (6/29, 21%). Health records were the most investigated record type (12/29, 41%). We identified 45 facilitators and 102 barriers to digital care record implementation across 28 studies, spanning 6 of the 7 NASSS framework domains and aligning with 5 overarching themes that require greater active management regarding implementation. Intended or actual implementation outcomes were reported in 17 (59%) of the 29 studies. Conclusions: The findings suggest that implementation is complex due to a lack of consensus on what digital care records and expected outcomes and impacts should look like. The literature often lacks clear definitions and robust study designs. To be successful, implementation should consider complexity, while studies should use robust frameworks and mixed methods or quantitative designs where appropriate. Future research should define the target population, gather data on carer or service user experiences, and focus on digital care records specifically used in social care. %M 39951702 %R 10.2196/60107 %U https://aging.jmir.org/2025/1/e60107 %U https://doi.org/10.2196/60107 %U http://www.ncbi.nlm.nih.gov/pubmed/39951702 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e58528 %T Perceptions and Experiences of Caregiver-Employees, Employers, and Health Care Professionals With Caregiver-Friendly Workplace Policy in Hong Kong: Thematic Analysis %A Lee,Maggie Man-Sin %A Yeoh,Eng-kiong %A Wong,Eliza Lai-Yi %A Bai,Xue %A Yeung,Nelson Chun-Yiu %A French,Catherine %A Taddese,Henock %+ School of Public Health, Faculty of Medicine, Imperial College London, St Mary’s Campus, 167 Medical School, London, W2 1NY, United Kingdom, 44 02075949475, h.taddese@imperial.ac.uk %K caregiver employees %K workplace %K discrimination %K dual roles %K caregiver burden %D 2025 %7 10.2.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Caregiver-employees (CEs) for older adults experience a high burden to fulfill their dual roles. Caregiver-friendly workplace policy (CFWP) has been used in many countries to balance employment and caregiving duties, but it is a relatively new concept in Hong Kong. Objective: This study explored the views and experiences of CEs, employers, and health care professionals regarding CFWP (specifically for older adult caregivers) in Hong Kong. Methods: This study explored the CFWP-related views and experiences in Hong Kong using 15 in-depth interviews with purposively sampled CEs for older adults, employers, and health care professionals. Results: Two context-related themes (“lacking leadership” and “unfavorable culture”) were identified with thematic analysis. They explain the absence of CFWP in Hong Kong due to the lack of governmental and organizational leadership, and the additional burden experienced by CEs because of the working culture that underpins work-life separation, overprizing business interest, and unsympathetic corporate attitude. Implicit voice theory was applicable in explaining CEs’ nondisclosure about their status at work due to potential risks. In addition, the two facilitation-related themes (“role struggle” and “inadequate support”) identified in this study exhibit how the dual role had positive and negative spillover effects on each other and the inadequacy of social welfare and health care support systems. Conclusions: We strongly recommend exploring and adopting potential CFWP in Hong Kong, considering the complexity of factors identified in this study. %M 39928924 %R 10.2196/58528 %U https://www.i-jmr.org/2025/1/e58528 %U https://doi.org/10.2196/58528 %U http://www.ncbi.nlm.nih.gov/pubmed/39928924 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68163 %T Mediating Effect of Social Capital on the Association Between Digital Literacy and Life Satisfaction Among Older Adults in South Korea: Cross-Sectional Study %A Jung,Hyein %A Lee,Hocheol %A Nam,Eun Woo %K digital literacy %K digital access %K digital competency %K digital utilization %K life satisfaction %K older adults %K social capital %K mediating effect %K aging %D 2025 %7 6.2.2025 %9 %J JMIR Form Res %G English %X Background: As Korea rapidly transforms into a super-aged society, research indicates that digital literacy among older adults enhances their life satisfaction. Digital literacy refers to the ability to efficiently use digital technologies, encompassing access, competency, and utilization. It reflects the capacity to navigate and benefit from digital environments effectively. Furthermore, social capital positively influences the quality of life, and digital literacy facilitates social capital formation. However, since most studies have only focused on the direct relationship between digital literacy and life satisfaction, research on the mediating role of social capital remains limited. Objective: To analyze the effect of digital literacy on the life satisfaction of older adults in South Korea and to verify whether social capital acts as a mediating factor in this process. Methods: This descriptive cross-sectional study used data from the 2023 Report on the Digital Divide—an annual survey conducted by the Korean Ministry of Science and Information and Communications Technology. The study targeted individuals aged 65 years or older. Descriptive statistics, the Pearson correlation analyses, and the 3-step multiple regression analysis proposed by Baron and Kenny were performed. The bootstrap method was employed, and all analyses were conducted using R, version 4.4.1. Results: The study included 869 participants. Digital literacy had a significant positive effect on their life satisfaction (β=0.103; P=.008). Social capital was also positively associated with life satisfaction (β=0.337; P<.001). Mediation analysis showed that digital literacy influenced life satisfaction both directly (β=0.103; P=.006) and indirectly through social capital (β=0.037; P=.03). Bootstrapping confirmed the significance of the indirect effect (β=0.037, 95% CI 0.005‐0.070; P=.03). The total effect of digital literacy on life satisfaction was also significant (β=0.140, 95% CI 0.058‐0.230; P=.002). Conclusions: This study analyzed the association between digital literacy, social capital, and life satisfaction among older adults in Korea. We identified that social capital mediates the association between digital literacy and life satisfaction among older adults. These findings indicate that tailored digital literacy programs and support policies that promote social capital formation could help bridge the digital divide and foster social inclusion. These measures would enable older adults to access essential services, reduce social isolation, and enhance health and well-being, ultimately improving the overall quality of life. %R 10.2196/68163 %U https://formative.jmir.org/2025/1/e68163 %U https://doi.org/10.2196/68163 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e55929 %T Revisits, Readmission, and Mortality From Emergency Department Admissions for Older Adults With Vague Presentations: Longitudinal Observational Study %A Alvarez Avendano,Sebastian Alejandro %A Cochran,Amy %A Odeh Couvertier,Valerie %A Patterson,Brian %A Shah,Manish %A Zayas-Caban,Gabriel %K gerontology %K geriatric %K older adults %K elderly %K older people %K aging %K emergency department %K emergency room %K ED %K disposition decision %K disposition %K discharge %K admission %K revisit %K readmission %K observational study %K health %K hospital %D 2025 %7 6.2.2025 %9 %J JMIR Aging %G English %X Background: Older adults (65 years and older) often present to the emergency department (ED) with an unclear need for hospitalization, leading to potentially harmful and costly care. This underscores the importance of measuring the trade-off between admission and discharge for these patients in terms of patient outcomes. Objective: This study aimed to measure the relationship between disposition decisions and 3-day, 9-day, and 30-day revisits, readmission, and mortality, using causal inference methods that adjust for potential measured and unmeasured confounding. Methods: A longitudinal observational study (n=3591) was conducted using electronic health records from a large tertiary teaching hospital with an ED between January 1, 2014 and September 27, 2018. The sample consisted of older adult patients with 1 of 6 presentations with significant variability in admission: falls, weakness, syncope, urinary tract infection, pneumonia, and cellulitis. The exposure under consideration was the ED disposition decision (admission to the hospital or discharge). Nine outcome variables were considered: ED revisits, hospital readmission, and mortality within 3, 9, and 30 days of being discharged from either the hospital for admitted patients or the ED for discharged patients. Results: Admission was estimated to significantly decrease the risk of an ED revisit after discharge (30-day window: −6.4%, 95% CI −7.8 to −5.0), while significantly increasing the risk of hospital readmission (30-day window: 5.8%, 95% CI 5.0 to 6.5) and mortality (30-day window: 1.0%, 95% CI 0.4 to 1.6). Admission was found to be especially adverse for patients with weakness and pneumonia, and relatively less adverse for older adult patients with falls and syncope. Conclusions: Admission may not be the safe option for older adults with gray area presentations, and while revisits and readmissions are commonly used to evaluate the quality of care in the ED, their divergence suggests that caution should be used when interpreting either in isolation. %R 10.2196/55929 %U https://aging.jmir.org/2025/1/e55929 %U https://doi.org/10.2196/55929 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e68267 %T Predictive Validity of Hospital-Associated Complications of Older People Identified Using Diagnosis Procedure Combination Data From an Acute Care Hospital in Japan: Observational Study %A Mitsutake,Seigo %A Ishizaki,Tatsuro %A Yano,Shohei %A Hirata,Takumi %A Ito,Kae %A Furuta,Ko %A Shimazaki,Yoshitomo %A Ito,Hideki %A Mudge,Alison %A Toba,Kenji %+ Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173 0015, Japan, 81 3 3964 3241 ext 4229, mitsu@tmig.or.jp %K delirium %K functional decline %K Japan %K older adult %K routinely collected health data %K elder %K hospital complication %K HAC-OP %K incontinence %K pressure injury %K inpatient care %K diagnosis procedure combination %K predictive validity %K hospital length of stay %K administrative data %K acute care %K index hospitalization %K diagnostic code %K linear regression %K logistic regression %K long-term care %K retrospective cohort %K observational study %K patient care %K gerontology %K hospital care %K patient complication %D 2025 %7 6.2.2025 %9 Original Paper %J JMIR Aging %G English %X Background: A composite outcome of hospital-associated complications of older people (HAC-OP; comprising functional decline, delirium, incontinence, falls, and pressure injuries) has been proposed as an outcome measure reflecting quality of acute hospital care. Estimating HAC-OP from routinely collected administrative data could facilitate the rapid and standardized evaluation of interventions in the clinical setting, thereby supporting the development, improvement, and wider implementation of effective interventions. Objective: This study aimed to create a Diagnosis Procedure Combination (DPC) data version of the HAC-OP measure (HAC-OP-DPC) and demonstrate its predictive validity by assessing its associations with hospital length of stay (LOS) and discharge destination. Methods: This retrospective cohort study acquired DPC data (routinely collected administrative data) from a general acute care hospital in Tokyo, Japan. We included data from index hospitalizations for patients aged ≥65 years hospitalized for ≥3 days and discharged between July 2016 and March 2021. HAC-OP-DPC were identified using diagnostic codes for functional decline, incontinence, delirium, pressure injury, and falls occurring during the index hospitalization. Generalized linear regression models were used to examine the associations between HAC-OP-DPC and LOS, and logistic regression models were used to examine the associations between HAC-OP-DPC and discharge to other hospitals and long-term care facilities (LTCFs). Results: Among 15,278 patients, 3610 (23.6%) patients had coding evidence of one or more HAC-OP-DPC (1: 18.8% and ≥2: 4.8%). Using “no HAC-OP-DPC” as the reference category, the analysis showed a significant and graded association with longer LOS (adjusted risk ratio for patients with one HAC-OP-DPC 1.29, 95% CI 1.25-1.33; adjusted risk ratio for ≥2 HAC-OP-DPC 1.97, 95% CI 1.87-2.08), discharge to another hospital (adjusted odds ratio [AOR] for one HAC-OP-DPC 2.36, 95% CI 2.10-2.65; AOR for ≥2 HAC-OP-DPC 6.96, 95% CI 5.81-8.35), and discharge to LTCFs (AOR for one HAC-OP-DPC 1.35, 95% CI 1.09-1.67; AOR for ≥2 HAC-OP-DPC 1.68, 95% CI 1.18-2.39). Each individual HAC-OP was also significantly associated with longer LOS and discharge to another hospital, but only delirium was associated with discharge to LTCF. Conclusions: This study demonstrated the predictive validity of the HAC-OP-DPC measure for longer LOS and discharge to other hospitals and LTCFs. To attain a more robust understanding of these relationships, additional studies are needed to verify our findings in other hospitals and regions. The clinical implementation of HAC-OP-DPC, which is identified using routinely collected administrative data, could support the evaluation of integrated interventions aimed at optimizing inpatient care for older adults. %M 39913911 %R 10.2196/68267 %U https://aging.jmir.org/2025/1/e68267 %U https://doi.org/10.2196/68267 %U http://www.ncbi.nlm.nih.gov/pubmed/39913911 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65492 %T Measuring Digital Health Literacy in Older Adults: Development and Validation Study %A Kim,SungMin %A Park,Choonghee %A Park,Sunghyeon %A Kim,Dai-Jin %A Bae,Ye-Seul %A Kang,Jae-Heon %A Chun,Ji-Won %+ Department of Medical Informatics, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 2 3147 9727, jwchun@catholic.ac.kr %K digital health care %K older adults %K digital health literacy %K exploratory factor analysis %K confirmatory factor analysis %K mobile phone %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: New health care services such as smart health care and digital therapeutics have greatly expanded. To effectively use these services, digital health literacy skills, involving the use of digital devices to explore and understand health information, are important. Older adults, requiring consistent health management highlight the need for enhanced digital health literacy skills. To address this issue, it is imperative to develop methods to assess older adults’ digital health literacy levels. Objective: This study aimed to develop a tool to measure digital health literacy. To this end, it reviewed existing literature to identify the components of digital health literacy, drafted preliminary items, and developed a scale using a representative sample. Methods: We conducted a primary survey targeting 600 adults aged 55-75 years and performed an exploratory factor analysis on 74 preliminary items. Items with low factor loadings were removed, and their contents were modified to enhance their validity. Then, we conducted a secondary survey with 400 participants to perform exploratory and confirmatory factor analyses. Results: A digital health literacy scale consisting of 25 items was developed, comprising 4 subfactors: use of digital devices, understanding health information, use and decision regarding health information, and use intention. The model fit indices indicated excellent structural validity (Tucker-Lewis Index=0.924, comparative fit index=0.916, root-mean-square error of approximation=0.088, standardized root-mean-square residual=0.044). High convergent validity (average variance extracted>0.5) and reliability (composite reliability>0.7) were observed within each factor. Discriminant validity was also confirmed as the square root of the average variance extracted was greater than the correlation coefficients between the factors. This scale demonstrates high reliability and excellent structural validity. Conclusions: This study is a significant first step toward enhancing digital health literacy among older adults by developing an appropriate tool for measuring digital health literacy. We expect this study to contribute to the future provision of tailored education and treatment based on individual literacy levels. %M 39908081 %R 10.2196/65492 %U https://www.jmir.org/2025/1/e65492 %U https://doi.org/10.2196/65492 %U http://www.ncbi.nlm.nih.gov/pubmed/39908081 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e50026 %T Association of Frailty Index at 66 Years of Age with Health Care Costs and Utilization Over 10 Years in Korea: Retrospective Cohort Study %A Jang,Jieun %A Kim,Anna %A Choi,Mingee %A McCarthy,Ellen P %A Olivieri-Mui,Brianne %A Park,Chan Mi %A Kim,Jae-Hyun %A Shin,Jaeyong %A Kim,Dae Hyun %K frailty index %K health care costs %K health care utilization %K elderly %K Korea %K frailty %K aging %K utilization %K older adults %K sociodemographic %K cost %K prevention %D 2025 %7 27.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: The long-term economic impact of frailty measured at the beginning of elderhood is unknown. Objective: The objective of our study was to examine the association between an individual’s frailty index at 66 years of age and their health care costs and utilization over 10 years. Methods: This retrospective cohort study included 215,887 Koreans who participated in the National Screening Program for Transitional Ages at 66 years of age between 2007‐2009. Frailty was categorized using a 39-item deficit accumulation frailty index: robust (<0.15), prefrail (0.15‐0.24), and frail (≥0.25). The primary outcome was total health care cost, while the secondary outcomes were inpatient and outpatient health care costs, inpatient days, and number of outpatient visits. Generalized estimating equations with a gamma distribution and identity link function were used to investigate the association between the frailty index and health care costs and utilization until December 31, 2019. Results: The study population included 53.3% (n=115,113) women, 32.9% (n=71,082) with prefrailty, and 9.7% (n=21,010) with frailty. The frailty level at 66 years of age was associated with higher cumulative total costs (robust to frail: $19,815 to $28.281; P<.001), inpatient costs (US $11,189 to US $16,627; P<.001), and outpatient costs (US $8,625 to US $11,654; P<.001) over the next 10 years. In the robust group, a one-year increase in age was associated with increased total health care costs (mean change per beneficiary per year: US $206.2; SE: $1.2; P<.001), inpatient costs (US $126.8; SE: $1.0; P<.001), and outpatient costs (US $74.4; SE: $0.4; P<.001). In the frail group, the increase in total health care costs was greater compared to the robust group (difference in mean cost per beneficiary per year: US $120.9; SE: $5.3; P<.001), inpatient costs (US $102.8; SE: $5.22; P<.001), and outpatient costs (US $15.6; SE: $1.5; P<.001). Similar results were observed for health care utilization (P<.001). Among the robust group, a one-year increase in age was associated with increased inpatient days (mean change per beneficiary per year: 0.9 d; P<.001) and outpatient visits (2.1 visits; P<.001). In the frail group, inpatient days increased annually compared to the robust group (difference in the mean inpatient days per beneficiary per year: 1.5 d; P<.001), while outpatient visits increased to a lesser extent (difference in the mean outpatient visits per beneficiary per year: −0.2 visits; P<.001). Conclusions: Our study demonstrates the potential utility of assessing frailty at 66 years of age in identifying older adults who are more likely to incur high health care costs and utilize health care services over the subsequent 10 years. The long-term high health care costs and utilization associated with frailty and prefrailty warrants public health strategies to prevent and manage frailty in aging populations. %R 10.2196/50026 %U https://publichealth.jmir.org/2025/1/e50026 %U https://doi.org/10.2196/50026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59921 %T Impact of the Smarter Safer Homes Solution on Quality of Life and Health Outcomes in Older People Living in Their Own Homes: Randomized Controlled Trial %A Lu,Wei %A Silvera-Tawil,David %A Yoon,Hwan-Jin %A Higgins,Liesel %A Zhang,Qing %A Karunanithi,Mohanraj %A Bomke,Julia %A Byrnes,Joshua %A Hewitt,Jennifer %A Smallbon,Vanessa %A Freyne,Jill %A Prabhu,Deepa %A Varnfield,Marlien %+ , Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 7, Surgical Treatment and Rehabilitation Services, 296 Herston Road, Brisbane, QLD, 4029, Australia, 61 732533603, marlien.varnfield@csiro.au %K randomized controlled trial %K digital health %K eHealth %K smart home %K sensor %K health monitoring %K home monitoring %K aged care %K aging in place %K older adult %K quality of life %D 2025 %7 22.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: An increasingly aging population, accompanied by a shortage of residential aged care homes and workforce and consumer feedback, has driven a growing interest in enabling older people to age in place through home-based care. In this context, smart home technologies for remote health monitoring have gained popularity for supporting older people to live in their own homes. Objective: This study aims to investigate the impact of smart home monitoring on multiple outcomes, including quality of life, activities of daily living, and depressive symptoms among older people living in their own homes over a 12-month period. Methods: We conducted an open-label, parallel-group randomized controlled trial. The control group continued to receive their existing care from aged care service providers. Meanwhile, the intervention group, in addition to receiving their usual aged care services, had their activities of daily living monitored using a smart home platform. Surveys including the Adult Social Care Outcomes Toolkit (ASCOT), EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), Katz Index of Independence in Activities of Daily Living (Katz ADL), Lawton Instrumental Activities of Daily Living Scale (IADL), and Geriatric Depression Scale (GDS) were conducted at baseline and 6 and 12 months from baseline. Linear mixed-effects models were used to compare the difference between the intervention and control groups, with the ASCOT as the primary outcome measure. Results: Data from 130 participants were used in the analysis, with no significant differences in baseline characteristics between the control group (n=61) and the intervention group (n=69). In comparison to the control group, the intervention group had a higher ASCOT score at the 6-month assessment (mean difference 0.045, 95% CI 0.001 to 0.089; Cohen d=0.377). However, this difference did not persist at the 12-month assessment (mean difference 0.031, 95% CI –0.014 to 0.076; Cohen d=0.259). There were no significant differences in EQ-5D-5L, Katz ADL, IADL, and GDS observed between the intervention and control groups at the 6-month and 12-month assessments. Conclusions: The study demonstrates that smart home monitoring can improve social care–related quality of life for older people living in their own homes. However, the improvement was not sustained over the long term. The lack of statistically significant findings and diminished long-term improvements may be attributed to the influence of the COVID-19 pandemic during the later stage of the trial. Further research with a larger sample size is needed to evaluate the effect of smart home monitoring on broader quality-of-life measures. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000829213; https://tinyurl.com/2n6a75em International Registered Report Identifier (IRRID): RR2-10.2196/31970 %M 39608020 %R 10.2196/59921 %U https://www.jmir.org/2025/1/e59921 %U https://doi.org/10.2196/59921 %U http://www.ncbi.nlm.nih.gov/pubmed/39608020 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62645 %T The Association Between the Digital Divide and Health Inequalities Among Older Adults in China: Nationally Representative Cross-Sectional Survey %A Wu,Mengqiu %A Xue,Yongxi %A Ma,Chengyu %+ School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China, 86 10 83911576, machengyu@ccmu.edu.cn %K older adults %K digital divide %K internet use %K internet access %K health inequalities %D 2025 %7 15.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Health inequalities among older adults become increasingly pronounced as aging progresses. In the digital era, some researchers argue that access to and use of digital technologies may contribute to or exacerbate these existing health inequalities. Conversely, other researchers believe that digital technologies can help mitigate these disparities. Objective: This study aimed to investigate the relationship between the digital divide and health inequality among older adults and to offer recommendations for promoting health equity. Methods: Data were obtained from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) scale, the Instrumental Activities of Daily Living scale, the Mini-Mental State Examination scale, and a 5-point self-rated health scale, respectively. The chi-square and rank sum tests were used to explore whether internet use and access were associated with health inequality status. After controlling for confounders, multiple linear regression models were used to further determine this association. Sensitivity analysis was conducted using propensity score matching, and heterogeneity was analyzed for different influencing factors. Results: The 2018 analysis highlighted widening health disparities among older adults due to internet access and use, with statistically significant increases in inequalities in self-rated health (3.9%), ADL score (5.8%), and cognition (7.5%). Similarly, internet use widened gaps in self-rated health (7.5%) and cognition (7.6%). Conversely, the 2020 analysis demonstrated that internet access improved health disparities among older adults, reducing gaps in self-rated health (3.8%), ADL score (2.1%), instrumental ADL score (3.5%), and cognition (7.5%), with significant results, except for ADL. Internet use also narrowed disparities, with significant effects on self-rated health (4.8%) and cognition (12.8%). The robustness of the results was confirmed through propensity score–matching paired tests. In addition, the study found heterogeneity in the effects of internet access and use on health inequalities among older adults, depending on sex, age, education, and region. Conclusions: The impact of internet access and use on health inequalities among older adults showed different trends in 2018 and 2020. These findings underscore the importance of addressing the challenges and barriers to internet use among older adults, particularly during the early stages of digital adoption. It is recommended to promote equitable access to the health benefits of the internet through policy interventions, social support, and technological advancements. %M 39813666 %R 10.2196/62645 %U https://www.jmir.org/2025/1/e62645 %U https://doi.org/10.2196/62645 %U http://www.ncbi.nlm.nih.gov/pubmed/39813666 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62824 %T The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study %A Valla,Luca Guido %A Rossi,Michele %A Gaia,Alessandra %A Guaita,Antonio %A Rolandi,Elena %+ Centre for Longitudinal Studies, UCL Social Research Institute, University College London, Room 101, 55-59 Gordon Square, London, WC1H 0AL, United Kingdom, 44 02076792000, a.gaia@ucl.ac.uk %K older adults %K information and communication technology %K ICT %K ICT use %K COVID-19 %K social capital %K health %K mental health %K digital divide %D 2025 %7 9.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. Objective: This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. Methods: We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. Results: COVID-19 had a significant impact on social relationships (β=–4.35, 95% CI 6.38 to –2.32; P<.001), cultural activities (β=–.55, 95% CI –0.75 to –0.35; P<.001), cognitive functioning (β=–1.00, 95% CI –1.28 to –0.72; P<.001), depressive symptoms (β=.42, 95% CI 0.10-0.74; P=.009), physical health (β=.07, 95% CI 0.04-0.10; P<.001), and ICT use (β=–.11, 95% CI –0.18 to –0.03; P=.008). Internet use predicts reduced depressive symptoms (β=–.56, 95% CI –1.07 to –0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities (β=–.73, 95% CI –1.22 to –0.24; P=.003) and cognitive functioning (β=1.36, 95% CI 0.67-2.05; P<.001). Conclusions: The pandemic had adverse effects on older adults’ health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. Trial Registration: ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110 %M 39784108 %R 10.2196/62824 %U https://www.jmir.org/2025/1/e62824 %U https://doi.org/10.2196/62824 %U http://www.ncbi.nlm.nih.gov/pubmed/39784108 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57580 %T Experiences and Views of Older Adults of South Asian, Black African, and Caribbean Backgrounds About the Digitalization of Primary Care Services Since the COVID-19 Pandemic: Qualitative Focus Group Study %A Ahmed,Nisar %A Hall,Alex %A Poku,Brenda %A McDermott,Jane %A Astbury,Jayne %A Todd,Chris %+ National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK, United Kingdom, 44 161306600, nisar.ahmed-2@manchester.ac.uk %K digital health and primary care services %K digital exclusion %K digital divide %K health inequalities %K older adults %K South Asian %K Black African %K Caribbean %K COVID-19 pandemic %K qualitative focus group study %D 2024 %7 18.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity. Objective: This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales—people of South Asian, Black African, and Caribbean backgrounds—in the use of digitalized primary care services since the beginning of the COVID-19 pandemic. Methods: In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis. Results: This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce). Conclusions: Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services. %M 39693146 %R 10.2196/57580 %U https://formative.jmir.org/2024/1/e57580 %U https://doi.org/10.2196/57580 %U http://www.ncbi.nlm.nih.gov/pubmed/39693146 %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 %@ 1929-0748 %I JMIR Publications %V 13 %N %P e65043 %T Characterizing Emergency Department Disposition Conversations for Persons Living With Dementia: Protocol for an Ethnographic Study %A Seidenfeld,Justine %A Tucker,Matthew %A Harris-Gersten,Melissa %A Fix,Gemmae M %A Guzman,Ivonne %A Sperber,Nina R %A Hastings,Susan N %+ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, 411 W Chapel Hill, Durham, NC, 27704, United States, 1 919 286 0411 ext 178386, justine.seidenfeld@va.gov %K ethnography %K direct observations %K emergency medicine %K dementia %K caregivers %D 2024 %7 6.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Almost 40% of persons living with dementia make an emergency department (ED) visit each year. One of the most impactful and costly elements of their ED care is the decision to discharge or admit them to the hospital—the “disposition” decision. When more than one reasonable option exists regarding a health care decision, such as the decision to admit or not, it often requires a complex conversation between patients, care partners, and ED providers, ideally involving shared decision-making. However, little is known about how these conversations are conducted and the real-world context in which they take place. Best practices in ED communication and shared decision-making for persons living with dementia and their care partners are limited. Objective: This study aims to characterize current practices in ED disposition conversations for persons living with dementia and their care partners, informed by perspectives from patient and care partner participants. Methods: This study will use an ethnographic design, including direct observation methods with a semistructured data collection tool to capture the ED encounter for up to 20 patient and care partner dyads, including all discussions about dispositions. Follow-up qualitative, semistructured interviews will be conducted with persons living with dementia and their care partners to explore specific observations made during their ED encounter, and to gain insight into their perspective on their role and elements of decision support used during that conversation. Results: Data collection was initiated in October 2023, with 13 dyads recruited and observed as of July 2024. This study is expected to be completed by December 2024. Conclusions: Novel methods can offer novel insights. By combining direct observation and follow-up interviews about an ED visit, our study design will provide insights into how ED disposition occurs in real-world settings for persons living with dementia. Findings can inform more patient-centered interventions for disposition decision-making. International Registered Report Identifier (IRRID): DERR1-10.2196/65043 %M 39642361 %R 10.2196/65043 %U https://www.researchprotocols.org/2024/1/e65043 %U https://doi.org/10.2196/65043 %U http://www.ncbi.nlm.nih.gov/pubmed/39642361 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e65730 %T Exploring the Perspectives of Older Adults Living With HIV on Virtual Care: Qualitative Study %A Kokorelias,Kristina M %A Valentine,Dean %A Dove,Erica M %A Brown,Paige %A McKinlay,Stuart %A Sheppard,Christine L %A Singh,Hardeep %A Eaton,Andrew D %A Jamieson,Laura %A Wasilewski,Marina B %A Zhabokritsky,Alice %A Flanagan,Ashley %A Abdelhalim,Reham %A Zewude,Rahel %A Parpia,Rabea %A Walmsley,Sharon %A Sirisegaram,Luxey %K HIV %K human immunodeficiency virus %K perspective %K telemedicine %K telehealth %K virtual care %K virtual health %K virtual medicine %K qualitative %K gerontology %K geriatrics %K older adult %K older people %K aging %D 2024 %7 4.12.2024 %9 %J JMIR Aging %G English %X Background: As the population of individuals with HIV ages rapidly due to advancements in antiretroviral therapy, virtual care has become an increasingly vital component in managing their complex health needs. However, little is known about perceptions of virtual care among older adults living with HIV. Objective: This study aimed to understand the perceptions of older adults living with HIV regarding virtual care. Methods: Using an interpretive, qualitative, descriptive methodology, semistructured interviews were conducted with 14 diverse older adults living with HIV. The participants lived in Ontario, Canada, self-identified as HIV-positive, and were aged 50 years or older. Efforts were made to recruit individuals with varying experience with virtual health care. Reflexive thematic analysis was conducted with the interview transcripts to identify prevalent themes. Results: The identified themes included (1) the importance of relationships in virtual care for older adults living with HIV; (2) privacy and confidentiality in virtual care; and (3) challenges and solutions related to access and technological barriers in virtual care. These themes highlight the perceptions of diverse older adults living with HIV concerning virtual care, emphasizing the fundamental role of trust, privacy, and technology access. Conclusions: By embracing the unique perspectives and experiences of this population, we can work toward building more inclusive and responsive health care systems that meet the needs of all individuals, regardless of age, HIV status, or other intersecting identities. %R 10.2196/65730 %U https://aging.jmir.org/2024/1/e65730 %U https://doi.org/10.2196/65730 %0 Journal Article %@ 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 %@ 2561-326X %I JMIR Publications %V 8 %N %P e60453 %T Exploring the Perspectives of Older Adults on a Digital Brain Health Platform Using Natural Language Processing: Cohort Study %A Ding,Huitong %A Gifford,Katherine %A Shih,Ludy C %A Ho,Kristi %A Rahman,Salman %A Igwe,Akwaugo %A Low,Spencer %A Popp,Zachary %A Searls,Edward %A Li,Zexu %A Madan,Sanskruti %A Burk,Alexa %A Hwang,Phillip H %A Anda-Duran,Ileana De %A Kolachalama,Vijaya B %A Au,Rhoda %A Lin,Honghuang %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 7744554881, honghuang.lin@umassmed.edu %K digital brain health %K older adults %K perspectives %K semistructured interviews %K natural language processing %K mobile phone %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although digital technology represents a growing field aiming to revolutionize early Alzheimer disease risk prediction and monitoring, the perspectives of older adults on an integrated digital brain health platform have not been investigated. Objective: This study aims to understand the perspectives of older adults on a digital brain health platform by conducting semistructured interviews and analyzing their transcriptions by natural language processing. Methods: The study included 28 participants from the Boston University Alzheimer’s Disease Research Center, all of whom engaged with a digital brain health platform over an initial assessment period of 14 days. Semistructured interviews were conducted to collect data on participants’ experiences with the digital brain health platform. The transcripts generated from these interviews were analyzed using natural language processing techniques. The frequency of positive and negative terms was evaluated through word count analysis. A sentiment analysis was used to measure the emotional tone and subjective perceptions of the participants toward the digital platform. Results: Word count analysis revealed a generally positive sentiment toward the digital platform, with “like,” “well,” and “good” being the most frequently mentioned positive terms. However, terms such as “problem” and “hard” indicated certain challenges faced by participants. Sentiment analysis showed a slightly positive attitude with a median polarity score of 0.13 (IQR 0.08-0.15), ranging from –1 (completely negative) to 1 (completely positive), and a median subjectivity score of 0.51 (IQR 0.47-0.53), ranging from 0 (completely objective) to 1 (completely subjective). These results suggested an overall positive attitude among the study cohort. Conclusions: The study highlights the importance of understanding older adults’ attitudes toward digital health platforms amid the comprehensive evolution of the digitalization era. Future research should focus on refining digital solutions to meet the specific needs of older adults, fostering a more personalized approach to brain health. %M 39556805 %R 10.2196/60453 %U https://formative.jmir.org/2024/1/e60453 %U https://doi.org/10.2196/60453 %U http://www.ncbi.nlm.nih.gov/pubmed/39556805 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e58641 %T Older Adults’ Perspectives and Experiences With Digital Health in Singapore: Qualitative Study %A Leong,Qiao Ying %A Lee,V Vien %A Ng,Wei Ying %A Vijayakumar,Smrithi %A Lau,Ni Yin %A Mauritzon,Ingela %A Blasiak,Agata %A Ho,Dean %+ The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Centre for Life Sciences, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore, 65 6601 7515, biedh@nus.edu.sg %K digital health %K gerontology %K geriatrics %K elder %K aging %K Singapore %K qualitative %K mHealth %K mobile health %K experience %K technology use %K interview %K perspective %K acceptance %K technology adoption %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Technology use among older adults is increasingly common. Even though there is potential in leveraging technology to help them manage their health, only a small fraction of them use it for health-related purposes. Objective: This study seeks to understand the perspectives of and experiences with digital health (DH) among older adults in Singapore. Methods: A total of 16 participants (age range 60-80 years; n=11, 69% female) were interviewed for approximately an hour (range 27-64 minutes) about their health, DH use, and DH experiences. The interviews were recorded, transcribed verbatim, and thematically analyzed. Results: Five main themes emerged from the interview: support in developing DH literacy, credibility, cost and benefit considerations, intrinsic drive to be healthy, and telehealth. Older adults need support in familiarizing themselves with DH. When considering DH options, older adults often relied on credible sources and preferred DH to be free. Monetary incentives were brought up as motivators. The intrinsic drive to live longer and healthily was expressed to be a huge encouragement to use DH to help obtain health-related knowledge and achieve healthy living goals. The idea of telehealth was also appealing among older adults but was seen to be more suited for individuals who have issues accessing a physical clinic. Conclusions: Our findings offer insights into the various aspects that matter to older adults in the adoption of DH, which in turn can help reshape their health-seeking behavior and lifestyle. As such, policy makers and DH implementors are encouraged to take these into consideration and align their strategies accordingly. %M 39527787 %R 10.2196/58641 %U https://humanfactors.jmir.org/2024/1/e58641 %U https://doi.org/10.2196/58641 %U http://www.ncbi.nlm.nih.gov/pubmed/39527787 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53793 %T Predicting Adherence to Computer-Based Cognitive Training Programs Among Older Adults: Study of Domain Adaptation and Deep Learning %A Singh,Ankita %A Chakraborty,Shayok %A He,Zhe %A Pang,Yuanying %A Zhang,Shenghao %A Subedi,Ronast %A Lustria,Mia Liza %A Charness,Neil %A Boot,Walter %K domain adaptation %K adherence %K cognitive training %K deep neural networks %K early detection of cognitive decline %D 2024 %7 16.9.2024 %9 %J JMIR Aging %G English %X Background: Cognitive impairment and dementia pose a significant challenge to the aging population, impacting the well-being, quality of life, and autonomy of affected individuals. As the population ages, this will place enormous strain on health care and economic systems. While computerized cognitive training programs have demonstrated some promise in addressing cognitive decline, adherence to these interventions can be challenging. Objective: The objective of this study is to improve the accuracy of predicting adherence lapses to ultimately develop tailored adherence support systems to promote engagement with cognitive training among older adults. Methods: Data from 2 previously conducted cognitive training intervention studies were used to forecast adherence levels among older participants. Deep convolutional neural networks were used to leverage their feature learning capabilities and predict adherence patterns based on past behavior. Domain adaptation (DA) was used to address the challenge of limited training data for each participant, by using data from other participants with similar playing patterns. Time series data were converted into image format using Gramian angular fields, to facilitate clustering of participants during DA. To the best of our knowledge, this is the first effort to use DA techniques to predict older adults’ daily adherence to cognitive training programs. Results: Our results demonstrated the promise and potential of deep neural networks and DA for predicting adherence lapses. In all 3 studies, using 2 independent datasets, DA consistently produced the best accuracy values. Conclusions: Our findings highlight that deep learning and DA techniques can aid in the development of adherence support systems for computerized cognitive training, as well as for other interventions aimed at improving health, cognition, and well-being. These techniques can improve engagement and maximize the benefits of such interventions, ultimately enhancing the quality of life of individuals at risk for cognitive impairments. This research informs the development of more effective interventions, benefiting individuals and society by improving conditions associated with aging. %R 10.2196/53793 %U https://aging.jmir.org/2024/1/e53793 %U https://doi.org/10.2196/53793 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59168 %T Understanding Older Adults’ Experiences With a Digital Health Platform in General Practice: Qualitative Interview Study %A Knotnerus,Hanna R %A Ngo,Hà T N %A Maarsingh,Otto R %A van Vugt,Vincent A %K digital health care %K digital health platform %K general practice %K qualitative research %K older adults %K primary care %K mobile phone %D 2024 %7 30.8.2024 %9 %J JMIR Aging %G English %X Background: In our aging population, primary care is under pressure to remain accessible to all. Effective use of digital health care could potentially lower general practitioners’ (GPs) workload. Some general practices are already implementing a digital health platform as a primary method to contact their patients. However, it is unknown how older people experience this novel way to communicate with their GP. Objective: The aim of this study was to study the experiences of patients aged 65 years and older in general practices who use digital health as a primary communication tool. The secondary aims were to identify barriers and facilitators for the use of digital health care and whether a practice focus on digital health influences older patients’ choice to enlist. Methods: We invited all patients aged 65 years and older at 2 general practices in Amsterdam that work with a novel digital health platform. We used purposive sampling to select a heterogeneous group of patients in terms of age, sex, level of education, digital literacy, and experiences with the digital app of their general practice. We conducted 18 semistructured interviews from May through July 2023. All interviews were audio-recorded, transcribed, coded, and thematically analyzed. Results: We generated three themes: (1) experiences of older people with digital health care in general practice, (2) impact of individual factors on digital health experiences, and (3) reasons for choosing a digitally oriented general practice. Participants reported both positive and negative experiences. The main perceived advantages of the digital health platform were increased accessibility, direct GP contact without an intermediary, and saving time through asynchronous communication. The disadvantages mentioned were log-in difficulties and problems with the automated explanatory questionnaire. Individual factors such as age, digital literacy, and expectations of general practice care seemed to impact people’s experiences and could act as barriers or facilitators for using digital health. Reasons for older patients to enlist at a general practice were mainly practical. The digital orientation of the practice hardly played a role in this choice. Conclusions: Older patients in general practice see benefits to using a digital health platform that offers 2-way chat-based communication between the patient and GP. We found that individual factors such as skills, norms and values, attitudes toward digitalization, and expectations of general practice care impacted older patients’ experiences with digital health care. For many older participants, the digital profile of the general practice did not play a role in their choice to enlist. Further improvement of digital health platforms will be necessary to ensure digital health for all in general practice. %R 10.2196/59168 %U https://aging.jmir.org/2024/1/e59168 %U https://doi.org/10.2196/59168 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e43173 %T Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis %A Alsallakh,Mohammad %A Adeloye,Davies %A Vasileiou,Eleftheria %A Sivakumaran,Shanya %A Akbari,Ashley %A Lyons,Ronan A %A Robertson,Chris %A Rudan,Igor %A Davies,Gwyneth A %A Sheikh,Aziz %K influenza %K hospitalization %K mortality %K COVID-19 pandemic %K nonpharmaceutical interventions %K Wales %K COVID-19 %K community health %K hospital admission %K endemic virus %K public health surveillance %D 2024 %7 21.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and the ensuing implementation of control measures caused widespread societal disruption. These disruptions may also have affected community transmission and seasonal circulation patterns of endemic respiratory viruses. Objective: We aimed to investigate the impact of COVID-19–related disruption on influenza-related emergency hospital admissions and deaths in Wales in the first 2 years of the pandemic. Methods: A descriptive analysis of influenza activity was conducted using anonymized pathology, hospitalization, and mortality data from the Secure Anonymised Information Linkage Databank in Wales. The annual incidence of emergency hospitalizations and deaths with influenza-specific diagnosis codes between January 1, 2015, and December 31, 2021, was estimated. Case definitions of emergency hospitalization and death required laboratory confirmation with a polymerase chain reaction test. Trends of admissions and deaths were analyzed monthly and yearly. We conducted 2 sensitivity analyses by extending case definitions to include acute respiratory illnesses with a positive influenza test and by limiting admissions to those with influenza as the primary diagnosis. We also examined yearly influenza testing trends to understand changes in testing behavior during the pandemic. Results: We studied a population of 3,235,883 Welsh residents in 2020 with a median age of 42.5 (IQR 22.9–61.0) years. Influenza testing in Wales increased notably in the last 2 months of 2020, and particularly in 2021 to 39,720 per 100,000 people, compared to the prepandemic levels (1343 in 2019). The percentage of influenza admissions matched to an influenza polymerase chain reaction test increased from 74.8% (1890/2526) in 2019 to 85.2% (98/115) in 2021. However, admissions with a positive test per 100,000 population decreased from 17.0 in 2019 to 2.7 and 0.6 in 2020 and 2021, respectively. Similarly, deaths due to influenza with a positive influenza test per 100,000 population decreased from 0.4 in 2019 to 0.0 in 2020 and 2021. Sensitivity analyses showed similar patterns of decreasing influenza admissions and deaths in the first 2 years of the COVID-19 pandemic. Conclusions: Nonpharmaceutical interventions to control COVID-19 were associated with a substantial reduction in the transmission of the influenza virus, with associated substantial reductions in hospital cases and deaths observed. Beyond the pandemic context, consideration should be given to the role of nonpharmaceutical community-driven interventions to reduce the burden of influenza. %R 10.2196/43173 %U https://publichealth.jmir.org/2024/1/e43173 %U https://doi.org/10.2196/43173 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e59484 %T Demand Forecasting of Nurse Talents in China Based on the Gray GM (1,1) Model: Model Development Study %A Wu,XiuLi %A Kang,Aimei %+ Department of Nursing, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, No. 300, Taizi Lake North Road, Economic and Technological Development Zone, Hanyang District, WuHan, 430010, China, 86 02784788999, 1633582630@qq.com %K nursing human resource %K nursing manpower %K Gray GM (1,1) model %K forecasting %K nursing %D 2024 %7 14.8.2024 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: In a global context, the shortage of nursing personnel has emerged as a significant challenge, particularly in countries such as China experiencing population aging. The inadequacy of nursing human resources has become one of the primary threats affecting the quality of health services available to Chinese residents. Therefore, forecasting the demand for nursing personnel has become an important issue. Objective: This study presents a Gray GM (1,1) forecasting model for predicting the future 10-year demand for nursing workforce and the number of specialized geriatric nurses, aiming to provide a scientific basis for the development of policies in health care institutions in China. Methods: Based on data from the China Statistical Yearbook 2022, the Gray GM (1,1) model was used to predict the demand for nursing jobs and geriatric nurses over the next 10 years (2024-2033). Results: The results indicate that from 2024 to 2033, amidst a continuous growth in the overall population and an increasingly pronounced trend of population aging, the demand for nursing workforce in China, especially for specialized geriatric nurses, is projected to steadily increase. Conclusions: The paper provides a reference basis for the establishment of China’s health care workforce system and the involvement of government departments in health care workforce planning. %M 39141916 %R 10.2196/59484 %U https://apinj.jmir.org/2024/1/e59484 %U https://doi.org/10.2196/59484 %U http://www.ncbi.nlm.nih.gov/pubmed/39141916 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56061 %T Sociodigital Determinants of eHealth Literacy and Related Impact on Health Outcomes and eHealth Use in Korean Older Adults: Community-Based Cross-Sectional Survey %A Kyaw,Myat Yadana %A Aung,Myo Nyein %A Koyanagi,Yuka %A Moolphate,Saiyud %A Aung,Thin Nyein Nyein %A Ma,Hok Ka Carol %A Lee,Hocheol %A Nam,Hae-Kweun %A Nam,Eun Woo %A Yuasa,Motoyuki %K eHealth literacy %K eHEALS %K electronic health information %K eHealth information %K health literacy %K health education %K eHealth education %K health training %K eHealth training %K digital health %K digital technology %K digital intervention %K digital interventions %K gray digital divide %K healthy aging %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K older person %K older people %K aging %K aging %K eHealth Literacy Scale %D 2024 %7 13.8.2024 %9 %J JMIR Aging %G English %X Background: eHealth literacy is an essential skill for pursuing electronic health information, particularly for older people whose health needs increase with age. South Korea is now at the intersection of a rapidly digitalizing society and an increasingly aged population. eHealth literacy enables older people to maximize the effective use of emerging digital technology for their health and quality of life. Understanding the eHealth literacy of Korean older adults is critical to eliminating the gray digital divide and inequity in health information access. Objective: This study aims to investigate factors influencing eHealth literacy in older Korean adults and its impact on health outcomes and eHealth use. Methods: This was a cross-sectional survey. Community-dwelling older adults 65 years and older in 2 urban cities in South Korea were included. eHealth literacy was measured by the eHealth Literacy Scale. Ordinal logistic regression was used to analyze factors associated with eHealth literacy and multivariate ANOVA for the impact of eHealth literacy on health outcomes and eHealth use. Results: In total, 434 participants were analyzed. A total of 22.3% (97/434) of participants had high eHealth literacy skills. Increasing age, higher monthly income, and time spent on the internet were significantly associated with eHealth literacy (P<.001), and social media users were 3.97 times (adjusted odds ratio 3.97, 95% CI 1.02‐15.43; P=.04) more likely to have higher skill. Higher eHealth literacy was associated with better self-perceived health and frequent use of digital technologies for accessing health and care services (P<.001). Conclusions: Disparity in socioeconomic status and engagement on the internet and social media can result in different levels of eHealth literacy skills, which can have consequential impacts on health outcomes and eHealth use. Tailored eHealth interventions, grounded on the social and digital determinants of eHealth literacy, could facilitate eHealth information access among older adults and foster a digitally inclusive healthy aging community. %R 10.2196/56061 %U https://aging.jmir.org/2024/1/e56061 %U https://doi.org/10.2196/56061 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e58635 %T Perception of Medication Safety–Related Behaviors Among Different Age Groups: Web-Based Cross-Sectional Study %A Lang,Yan %A Chen,Kay-Yut %A Zhou,Yuan %A Kosmari,Ludmila %A Daniel,Kathryn %A Gurses,Ayse %A Young,Richard %A Arbaje,Alicia %A Xiao,Yan %+ Department of Business, State University of New York at Oneonta, 108 Ravine Pkwy, Oneonta, NY, 13820, United States, 1 607 436 3251, yan.lang@oneonta.edu %K medication safety %K patient engagement %K aged adults %K survey %K Amazon Mechanical Turk %K medication %K engagement %K older adults %K elderly %K safety %K United States %K USA %K crowdsourcing %K community %K patient portal %K primary care %K medications %K safety behavior %K younger adults %K age %K correlation %K statistical test %D 2024 %7 12.8.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Previous research and safety advocacy groups have proposed various behaviors for older adults to actively engage in medication safety. However, little is known about how older adults perceive the importance and reasonableness of these behaviors in ambulatory settings. Objective: This study aimed to assess older adults’ perceptions of the importance and reasonableness of 8 medication safety behaviors in ambulatory settings and compare their responses with those of younger adults. Methods: We conducted a survey of 1222 adults in the United States using crowdsourcing to evaluate patient behaviors that may enhance medication safety in community settings. A total of 8 safety behaviors were identified based on the literature, such as bringing medications to office visits, confirming medications at home, managing medication refills, using patient portals, organizing medications, checking medications, getting help, and knowing medications. Respondents were asked about their perception of the importance and reasonableness of these behaviors on a 5-point Likert rating scale in the context of collaboration with primary care providers. We assessed the relative ranking of behaviors in terms of importance and reasonableness and examined the association between these dimensions across age groups using statistical tests. Results: Of 1222 adult participants, 125 (10.2%) were aged 65 years or older. Most participants were White, college-educated, and had chronic conditions. Older adults rated all 8 behaviors significantly higher in both importance and reasonableness than did younger adults (P<.001 for combined behaviors). Confirming medications ranked highest in importance (mean score=3.78) for both age groups while knowing medications ranked highest in reasonableness (mean score=3.68). Using patient portals was ranked lowest in importance (mean score=3.53) and reasonableness (mean score=3.49). There was a significant correlation between the perceived importance and reasonableness of the identified behaviors, with coefficients ranging from 0.436 to 0.543 (all P<.001). Conclusions: Older adults perceived the identified safety behaviors as more important and reasonable than younger adults. However, both age groups considered a behavior highly recommended by professionals as the least important and reasonable. Patient engagement strategies, common and specific to age groups, should be considered to improve medication safety in ambulatory settings. %M 39133905 %R 10.2196/58635 %U https://www.i-jmr.org/2024/1/e58635 %U https://doi.org/10.2196/58635 %U http://www.ncbi.nlm.nih.gov/pubmed/39133905 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52536 %T Decomposition Analysis of Depressive Symptom Differences Among Older Adults With Hypertension Between Urban and Rural Areas: Cross-Sectional Study %A Yuan,Lei %A Jiang,Qinqin %A Liu,Yuqing %A Liu,Yijun %A Du,Maolin %A Sun,Jinhai %A Li,Meina %K depression %K older %K hypertension %K Fairlie decomposition %K China %K older adult %K elderly %D 2024 %7 1.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Hypertension is the most prevalent chronic disease among China’s older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China’s older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas. Objective: This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China. Methods: We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension. Results: The sample size for this study was 5210, and 12.8% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1% (n=468) and 10.7% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95% CI 1.10-1.21; ≥7 years: OR 0.47, 95% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95% CI 0.29-0.93), exercise (yes: OR 0.78, 95% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95% CI 0.13-0.43; ≥10.0 hours: OR 0.22, 95% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95% CI 1.11-2.58; severe: OR 3.03, 95% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95% CI 0.16-0.81; ≥100 years: OR 0.19, 95% CI 0.06-0.66), exercise (yes: OR 0.33, 95% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95% CI 0.06-0.44; ≥10.0 hours: OR 0.18, 95% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95% CI 1.39-4.06; severe: OR 3.26, 95% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1%), self-reported income status (contribution 13.2%), exercise (contribution 45.7%), sleep duration (contribution 20.8%), ADL dysfunction (contribution −9.6%), and comorbidities (contribution −22.9%). Conclusions: Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption. %R 10.2196/52536 %U https://publichealth.jmir.org/2024/1/e52536 %U https://doi.org/10.2196/52536 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e54774 %T Hospital Staff Perspectives on the Drivers and Challenges in Implementing a Virtual Rehabilitation Ward: Qualitative Study %A Greene,Leanne %A Rahja,Miia %A Laver,Kate %A Wong,Vun Vun %A Leung,Chris %A Crotty,Maria %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K aged %K telerehabilitation %K rehabilitation %K rehab %K workflow %K hospitalization %K health services accessibility %K accessibility %K clinical decision-making %K equipment failure %K telemedicine %K telehealth %K tele-medicine %K tele-health %K virtual care %K virtual health %K virtual medicine %K remote consultation %K telephone consultation %K video consultation %K remote consultations %K telephone consultations %K video consultations %K personnel %K hospital %D 2024 %7 27.6.2024 %9 %J JMIR Aging %G English %X Background: Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood. Objective: This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff’s perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery. Methods: Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework. Results: The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families. Conclusions: In this qualitative study exploring health care staff’s experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW. %R 10.2196/54774 %U https://aging.jmir.org/2024/1/e54774 %U https://doi.org/10.2196/54774 %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 %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55557 %T Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility, and Lessons for Implementation %A Fisher,Emily %A Venkatesan,Shreenila %A Benevides,Pedro %A Bertrand,Elodie %A Brum,Paula Schimidt %A El Baou,Céline %A Ferri,Cleusa P %A Fossey,Jane %A Jelen,Maria %A Laks,Jerson %A Liu,Lisa %A Mograbi,Daniel C %A Natarajan,Nirupama %A Naylor,Renata %A Pantouli,Despina %A Ramanujam,Vaishnavi %A Rangaswamy,Thara %A Santos de Carvalho,Raquel L %A Stoner,Charlotte %A Vaitheswaran,Sridhar %A Spector,Aimee %+ University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 5770, emily.fisher@ucl.ac.uk %K psychosocial %K intervention %K technology %K COVID-19 %K LMIC %K low and middle income countries %D 2024 %7 11.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Cognitive stimulation therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, and it has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention but has recently been adapted for online delivery. Objective: In this study, we aimed to explore the feasibility and acceptability of online or virtual CST (vCST) delivery in India and Brazil, emphasizing barriers and facilitators to implementation. Methods: A single-group, multisite, mixed methods, feasibility study was conducted, with nested qualitative interviews. Primary feasibility outcomes were recruitment rate, attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and postintervention measures, including cognition and quality of life, were assessed. Qualitative interviews were conducted with people with dementia, family caregivers, and group and organizational leaders following intervention delivery, and the data were analyzed using the Consolidated Framework for Implementation Research. Results: A total of 17 vCST group sessions with 59 participants were conducted for 7 weeks, with 53% (31/59) of participants attending all 14 sessions. Attrition rate was 7% (4/59), and outcome measure completion rate at follow-up was 68% (40/59). Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders and enabled vital access to services during pandemic restrictions. While online services broadened geographic access, challenges emerged concerning inadequate computer literacy, poor technology access, and establishing interpersonal connections online. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities of daily living, but these results were not statistically significant. Conclusions: vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic but raised challenges related to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST while emphasizing ongoing development and solutions to address implementation challenges. %M 38861708 %R 10.2196/55557 %U https://aging.jmir.org/2024/1/e55557 %U https://doi.org/10.2196/55557 %U http://www.ncbi.nlm.nih.gov/pubmed/38861708 %0 Journal Article %@ 2563-6316 %I %V 5 %N %P e43341 %T Health Care System Overstretch and In-Hospital Mortality of Intubated Patients With COVID-19 in Greece From September 2020 to April 2022: Updated Retrospective Cohort Study %A Lytras,Theodore %K COVID-19 %K pandemic %K health care disparities %K intensive care unit %K right to health %K quality of care %K intubation %K mortality %K health disparity %K health inequality %K surveillance data %K inpatient %K mortality %K COVID-19 patient %K hospitalization %K ICU %K disparity %K inequality %K surveillance %K health care system %K Greece %K region %K Delta %K Omicron %K vaccination %K vaccine %K public health %K patient load %K deterioration %K time %D 2024 %7 10.6.2024 %9 %J JMIRx Med %G English %X Background: Our previous analysis showed how in-hospital mortality of intubated patients with COVID-19 in Greece is adversely affected by patient load and regional disparities. Objective: We aimed to update this analysis to include the large Delta and Omicron waves that affected Greece during 2021-2022, while also considering the effect of vaccination on in-hospital mortality. Methods: Anonymized surveillance data were analyzed from all patients with COVID-19 in Greece intubated between September 1, 2020, and April 4, 2022, and followed up until May 17, 2022. Time-split Poisson regression was used to estimate the hazard of dying as a function of fixed and time-varying covariates: the daily total count of intubated patients with COVID-19 in Greece, age, sex, COVID-19 vaccination status, region of the hospital (Attica, Thessaloniki, or rest of Greece), being in an intensive care unit, and an indicator for the period from September 1, 2021. Results: A total of 14,011 intubated patients with COVID-19 were analyzed, of whom 10,466 (74.7%) died. Mortality was significantly higher with a load of 400-499 intubated patients, with an adjusted hazard ratio (HR) of 1.22 (95% CI 1.09-1.38), rising progressively up to 1.48 (95% CI 1.31-1.69) for a load of ≥800 patients. Hospitalization away from the Attica region was also independently associated with increased mortality (Thessaloniki: HR 1.22, 95% CI 1.13-1.32; rest of Greece: HR 1.64, 95% CI 1.54-1.75), as was hospitalization after September 1, 2021 (HR 1.21, 95% CI 1.09-1.36). COVID-19 vaccination did not affect the mortality of these already severely ill patients, the majority of whom (11,944/14,011, 85.2%) were unvaccinated. Conclusions: Our results confirm that in-hospital mortality of severely ill patients with COVID-19 is adversely affected by high patient load and regional disparities, and point to a further significant deterioration after September 1, 2021, especially away from Attica and Thessaloniki. This highlights the need for urgent strengthening of health care services in Greece, ensuring equitable and high-quality care for all. %R 10.2196/43341 %U https://xmed.jmir.org/2024/1/e43341 %U https://doi.org/10.2196/43341 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50446 %T Evaluating a New Digital App–Based Program for Heart Health: Feasibility and Acceptability Pilot Study %A Lockwood,Kimberly G %A Kulkarni,Priya R %A Paruthi,Jason %A Buch,Lauren S %A Chaffard,Mathieu %A Schitter,Eva C %A Branch,OraLee H %A Graham,Sarah A %+ Lark Health, 809 Cuesta Dr, Suite B #1033, Mountain View, CA, 94040, United States, 1 5033801340, kimberly.lockwood@lark.com %K digital health %K cardiovascular disease %K artificial intelligence %K AI %K acceptability and feasibility %K pilot study %K lifestyle coaching %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death in the United States, affecting a significant proportion of adults. Digital health lifestyle change programs have emerged as a promising method of CVD prevention, offering benefits such as on-demand support, lower cost, and increased scalability. Prior research has shown the effectiveness of digital health interventions in reducing negative CVD outcomes. This pilot study focuses on the Lark Heart Health program, a fully digital artificial intelligence (AI)–powered smartphone app, providing synchronous CVD risk counseling, educational content, and personalized coaching. Objective: This pilot study evaluated the feasibility and acceptability of a fully digital AI-powered lifestyle change program called Lark Heart Health. Primary analyses assessed (1) participant satisfaction, (2) engagement with the program, and (3) the submission of health screeners. Secondary analyses were conducted to evaluate weight loss outcomes, given that a major focus of the Heart Health program is weight management. Methods: This study enrolled 509 participants in the 90-day real-world single-arm pilot study of the Heart Health app. Participants engaged with the app by participating in coaching conversations, logging meals, tracking weight, and completing educational lessons. The study outcomes included participant satisfaction, app engagement, the completion of screeners, and weight loss. Results: On average, Heart Health study participants were aged 60.9 (SD 10.3; range 40-75) years, with average BMI indicating class I obesity. Of the 509 participants, 489 (96.1%) stayed enrolled until the end of the study (dropout rate: 3.9%). Study retention, based on providing a weight measurement during month 3, was 80% (407/509; 95% CI 76.2%-83.4%). Participant satisfaction scores indicated high satisfaction with the overall app experience, with an average score of ≥4 out of 5 for all satisfaction indicators. Participants also showed high engagement with the app, with 83.4% (408/489; 95% CI 80.1%-86.7%) of the sample engaging in ≥5 coaching conversations in month 3. The results indicated that participants were successfully able to submit health screeners within the app, with 90% (440/489; 95% CI 87%-92.5%) submitting all 3 screeners measured in the study. Finally, secondary analyses showed that participants lost weight during the program, with analyses showing an average weight nadir of 3.8% (SD 2.9%; 95% CI 3.5%-4.1%). Conclusions: The study results indicate that participants in this study were satisfied with their experience using the Heart Health app, highly engaged with the app features, and willing and able to complete health screening surveys in the app. These acceptability and feasibility results provide a key first step in the process of evidence generation for a new AI-powered digital program for heart health. Future work can expand these results to test outcomes with a commercial version of the Heart Health app in a diverse real-world sample. %M 38787598 %R 10.2196/50446 %U https://formative.jmir.org/2024/1/e50446 %U https://doi.org/10.2196/50446 %U http://www.ncbi.nlm.nih.gov/pubmed/38787598 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54101 %T Insights Into the Use of a Digital Healthy Aging Coach (AGATHA) for Older Adults From Malaysia: App Engagement, Usability, and Impact Study %A Teh,Pei-Lee %A Kwok,Andrei O J %A Cheong,Wing Loong %A Lee,Shaun %+ School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Subang Jaya, Malaysia, 60 355145890, shaun.lee@monash.edu %K digital health %K older adults %K digital divide %K aging %K pilot %K Malaysia %K coach %K digital access %K social barrier %K virtual %K virtual coach %K digital tool %K tool %K engagement %K gamification %K user experience %K app %K technology tool %K digital literacy %K user experience design %K decision support %K support %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital inclusion is considered a pivotal social determinant of health, particularly for older adults who may face significant barriers to digital access due to physical, sensory, and social limitations. Avatar for Global Access to Technology for Healthy Aging (AGATHA) is a virtual healthy aging coach developed by the World Health Organization to address these challenges. Designed as a comprehensive virtual coach, AGATHA comprises a gamified platform that covers multiple health-related topics and modules aimed at fostering user engagement and promoting healthy aging. Objective: The aim of this study was to explore the perception and user experience of Malaysian older adults in their interactions with the AGATHA app and its avatar. The focus of this study was to examine the engagement, usability, and educational impact of the app on health literacy and digital skills. Methods: We performed a qualitative study among adults 60 years and older from suburban and rural communities across six states in Malaysia. Participants were purposefully recruited to ensure representation across various socioeconomic and cultural backgrounds. Each participant attended a 1-hour training session to familiarize themselves with the interface and functionalities of AGATHA. Subsequently, all participants were required to engage with the AGATHA app two to three times per week for up to 2 weeks. Upon completion of this trial phase, an in-depth interview session was conducted to gather detailed feedback on their experiences. Results: Overall, the participants found AGATHA to be highly accessible and engaging. The content was reported to have a comprehensive structure and was delivered in an easily understandable and informative manner. Moreover, the participants found the app to be beneficial in enhancing their understanding pertaining to health-related issues in aging. Some key feedback gathered highlighted the need for increased interactive features that would allow for interaction with peers, better personalization of content tailored to the individual’s health condition, and improvement in the user-experience design to accommodate older users’ specific needs. Furthermore, enhancements in decision-support features within the app were suggested to better assist users in making health decisions. Conclusions: The prototype digital health coaching program AGATHA was well received as a user-friendly tool suitable for beginners, and was also perceived to be useful to enhance older adults’ digital literacy and confidence. The findings of this study offer important insights for designing other digital health tools and interventions targeting older adults, highlighting the importance of a user-centered design and personalization to improve the adoption of digital health solutions among older adults. This study also serves as a useful starting point for further development and refinement of digital health programs aimed at fostering an inclusive, supportive digital environment for older adults. %M 38772022 %R 10.2196/54101 %U https://formative.jmir.org/2024/1/e54101 %U https://doi.org/10.2196/54101 %U http://www.ncbi.nlm.nih.gov/pubmed/38772022 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e46414 %T Digital Adoption by an Organization Supporting Informal Caregivers During COVID-19 Pandemic Showing Impact on Service Use, Organizational Performance, and Carers’ Well-Being: Retrospective Population-Based Database Study With Embedded User Survey %A Szczepura,Ala %A Khan,Amir Jahan %A Wild,Deidre %A Nelson,Sara %A Woodhouse,Sonja %A Collinson,Mark %+ Research Centre for Healthcare & Communities, Coventry University, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, United Kingdom, 44 0 7557 425 463, ab5794@coventry.ac.uk %K digital adoption %K COVID-19 %K informal caregivers %K carer support organization %K organization performance %K integrated care systems %K care systems %K health policy %K aging in place %K digital divide %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic has catalyzed a move from face-to-face to digital delivery of services by hospitals and primary care. However, little is known about the impact of digital transformation on organizations supporting unpaid caregivers. Since the start of the COVID-19 pandemic, the value of care provided by such informal caregivers is estimated to be £111 billion (US$ 152.7 billion) in England. Objective: This study aims to analyze service uptake patterns (including digital service options) over the pandemic period in an English caregivers’ support organization covering a population of 0.98 million; measure changes in organizational performance, service efficiency, and quality; and identify the views of caregivers on service provision and future digital delivery. Methods: This was a retrospective analysis of the use of digital versus nondigital support services (January 2019 to June 2021) by caregivers in city and rural geographic areas. We compared organizational performance and service quality indicators for 2 financial years (2019-2020 and 2020-2021). A survey was conducted to identify barriers and facilitators to digital service uptake, the computer proficiency of caregivers (the Computer Proficiency Questionnaire, 12-item version), and preferences for future digital service provision. Quantitative data were analyzed using Stata 13 (StataCorp LLC). Thematic analysis was used for open-text survey responses. Results: The number of caregivers registered with the organization rose from 14,817 in 2019 to 20,237 in 2021. Monthly contacts rose from 1929 to 6741, with remote contacts increasing from 48.89% (943/1929) to 86.68% (5843/6741); distinctive patterns were observed for city versus rural caregivers. There was an increase in one-to-one contacts (88.8%) and caregiver assessments (20.9%), with no expansion in staffing. Service quality indicators showed an improvement in 5 of 8 variables (all P<.05). The 152 carers completing the survey had similar demographics to all registered caregivers. The Computer Proficiency Questionnaire, 12-item version, mean score of 25.61 (SD 4.40) indicated relatively high computer proficiency. The analysis of open-text responses identified a preference for the organization to continue to offer face-to-face services as well as web-based options. The digital services that were the most highly rated were carers’ well-being assessments, support needs checks, and peer support groups. Conclusions: Our findings show that staff in the caregiver support organization were agile in adapting their services to digital delivery while dealing with increased numbers of registered clients and higher monthly contacts, all without obvious detriment to service quality. Caregivers indicated a preference for blended services, even while recording high computer proficiency. Considering the economic importance of unpaid caregivers, more attention should be given to organizations funded to provide support for them and to the potential for technology to enhance caregivers’ access to, and engagement with, such services. %M 38739915 %R 10.2196/46414 %U https://aging.jmir.org/2024/1/e46414 %U https://doi.org/10.2196/46414 %U http://www.ncbi.nlm.nih.gov/pubmed/38739915 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e54128 %T A Personalized and Interactive Web-Based Advance Care Planning Intervention for Older Adults (Koda Health): Pilot Feasibility Study %A Roberts,R Lynae %A Cherry,Katelin D %A Mohan,Desh P %A Statler,Tiffany %A Kirkendall,Eric %A Moses,Adam %A McCraw,Jennifer %A Brown III,Andrew E %A Fofanova,Tatiana Y %A Gabbard,Jennifer %K advance care planning %K ACP %K digital health tools %K system usability %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K adoption %K acceptance %K usability %K digital health %K platform %K website %K websites %D 2024 %7 6.5.2024 %9 %J JMIR Aging %G English %X Background: Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Digital applications may help facilitate this process, though their use in older adults has not been adequately studied. Objective: This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, a web-based patient-facing ACP platform, among older adults. Methods: Older adults (aged 50 years and older) who had an active Epic MyChart account at an academic health care system in North Carolina were recruited to participate. A total of 2850 electronic invitations were sent through MyChart accounts with an embedded hyperlink to the Koda platform. Participants who agreed to participate were asked to complete pre- and posttest surveys before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and System Usability Scale (SUS) scores. Exploratory outcomes included ACP knowledge and readiness. Results: A total of 161 participants enrolled in the study and created an account on the platform (age: mean 63, SD 9.3 years), with 80% (129/161) of these participants going on to complete all steps of the intervention, thereby generating an advance directive. Participants reported minimal difficulty in using the Koda platform, with an overall SUS score of 76.2. Additionally, knowledge of ACP (eg, mean increase from 3.2 to 4.2 on 5-point scale; P<.001) and readiness (eg, mean increase from 2.6 to 3.2 on readiness to discuss ACP with health care provider; P<.001) significantly increased from before to after the intervention. Conclusions: This study demonstrated that the Koda Health platform is feasible, had above-average usability, and improved ACP documentation of preferences in older adults. Our findings indicate that web-based health tools like Koda may help older individuals learn about and feel more comfortable with ACP while potentially facilitating greater engagement in care planning. %R 10.2196/54128 %U https://aging.jmir.org/2024/1/e54128 %U https://doi.org/10.2196/54128 %0 Journal Article %@ 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 %@ 2561-326X %I JMIR Publications %V 8 %N %P e54120 %T Community-Dwelling Older Adults’ Readiness for Adopting Digital Health Technologies: Cross-Sectional Survey Study %A Ausserhofer,Dietmar %A Piccoliori,Giuliano %A Engl,Adolf %A Mahlknecht,Angelika %A Plagg,Barbara %A Barbieri,Verena %A Colletti,Nicoletta %A Lombardo,Stefano %A Gärtner,Timon %A Tappeiner,Waltraud %A Wieser,Heike %A Wiedermann,Christian Josef %+ Institute of General Medicine and Public Health, Lorenz-Böhler-Str. 13, Bolzano, 39100, Italy, 39 0471 067290, dietmar.ausserhofer@claudiana.bz.it %K frail older adults %K Italy %K Italian %K Europe %K European %K digital health %K health technologies %K health technology %K telemedicine %K telehealth %K eHealth %K e-health %K adoption %K readiness %K usage %K survey %K surveys %K questionnaire %K questionnaires %K robotics %K readiness %K adoption %K cross-sectional study %K population-based survey %K stratified probabilistic sampling %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health technologies offer the potential to improve the daily lives of older adults, maintain their health efficiently, and allow aging in place. Despite increasing evidence of benefits and advantages, readiness for adopting digital interventions among older people remains underexplored. Objective: This study aims to explore the relationships between sociodemographic-, health-, and lifestyle-related factors and technology use in everyday life and community-dwelling older adults’ readiness to adopt telemedicine, smartphones with texting apps, wearables, and robotics. Methods: This was a cross-sectional, population-based survey study with a stratified probabilistic sample of adults aged 75 years or older living in South Tyrol (autonomous province of Bolzano/Bozen, Italy). A random sample of 3600 community-dwelling older adults living at home was invited to complete a questionnaire including single items (older adults’ readiness to use health technology) and scales (PRISMA-7; Program of Research on Integration of Services for the Maintenance of Autonomy). Descriptive and logistic regression analyses were performed to analyze the data. Results: In total, 1695 community-dwelling older adults completed the survey (for a response rate of 47%). In terms of potential digital health technology adoption, wearable devices were favored by 33.7% (n=571), telemedicine by 30.1% (n=510), smartphones and texting apps by 24.5% (n=416), and assistant robots by 13.7% (n=232). Sociodemographic-, health- and lifestyle-related factors, as well as the use of technology in everyday life, played a significant role in explaining readiness to adopt digital health technologies. For telemedicine, age ≥85 years (odds ratio [OR] 0.74, 95% CI 0.56-0.96), financial constraints (OR 0.68, 95% CI 0.49-0.95), and less than 2 hours of physical activity per week (OR 0.75, 95% CI 0.58-0.98) were associated with nonreadiness, while Italian-speaking participants (OR 1.54, 95% CI 1.16-2.05) and those regularly using computers (OR 1.74, 95% CI 1.16-2.60), smartphones (OR 1.69, 95% CI 1.22-2.35), and the internet (OR 2.26, 95% CI 1.47-3.49) reported readiness for adoption. Conclusions: Community-dwelling older adults display varied readiness toward the adoption of digital health technologies, influenced by age, mother tongue, living situation, financial resources, physical activity, and current use of technology. The findings underscore the need for tailored interventions and educational programs to boost digital health technology adoption among community-dwelling older adults. %M 38687989 %R 10.2196/54120 %U https://formative.jmir.org/2024/1/e54120 %U https://doi.org/10.2196/54120 %U http://www.ncbi.nlm.nih.gov/pubmed/38687989 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e52317 %T Adoption and Use of Telemedicine and Digital Health Services Among Older Adults in Light of the COVID-19 Pandemic: Repeated Cross-Sectional Analysis %A Haimi,Motti %A Sergienko,Ruslan %+ Health Administration Department, The Max Stern Yezreel Valley College, D.N Emek Yezreel, Emek Yezreel, 1930600, Israel, 972 0504557767, morx@netvision.net.il %K telemedicine %K digital health %K older adults %K COVID-19 %K use %K digital divide %K usability %K pandemic %K telehealth %K Israel %K working-hours telehealth visits %K after-hours consultation %K teleconsultation %K eHealth %K mobile health %K mHealth %K wearables %K mobile phone %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: As the population ages and the prevalence of long-term diseases rises, the use of telecare is becoming increasingly frequent to aid older people. Objective: This study aims to explore the use and adoption of 3 types of telehealth services among the older population in Israel before, during, and after the COVID-19 pandemic. Methods: We explored the use characteristics of older adults (aged ≥65 years) belonging to Clalit Health Services in several aspects in the use of 3 types of telehealth services: the use of digital services for administrative tasks; the use of synchronous working-hours telehealth visits with the patient’s personal physician during clinic business hours; and the use of after-hours consultations during evenings, nights, and weekends when the clinics are closed. The data were collected and analyzed throughout 3 distinct periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic, and following the COVID-19 peak. Results: Data of 618,850 patients who met the inclusion criteria were extracted. Telehealth services used for administrative purposes were the most popular. The most intriguing finding was that the older population significantly increased their use of all types of telehealth services during the COVID-19 pandemic, and in most types, this use decreased after the COVID-19 peak, but to a level that was higher than the baseline level before the COVID-19 pandemic. Before the COVID-19 pandemic, 23.1% (142,936/618,850) of the study population used working-hours telehealth visits, and 2.2% (13,837/618,850) used after-hours consultations at least once. The percentage of use for these services increased during the COVID-19 pandemic to 59.2% (366,566/618,850) and 5% (30,777/618,850) and then decreased during the third period to 39.5% (244,572/618,850) and 2.4% (14,584/618,850), respectively (P<.001). Multiple patient variables have been found to be associated with the use of the different telehealth services in each period. Conclusions: Despite the limitations and obstacles, the older population uses telehealth services and can increase their use when they are needed. These people can learn how to use digital health services effectively, and they should be given the opportunity to do so by creating suitable and straightforward telehealth solutions tailored to this population and enhancing their usability. %M 38656768 %R 10.2196/52317 %U https://aging.jmir.org/2024/1/e52317 %U https://doi.org/10.2196/52317 %U http://www.ncbi.nlm.nih.gov/pubmed/38656768 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e50938 %T Determinants of Telemedicine Service Use Among Middle-Aged and Older Adults in Germany During the COVID-19 Pandemic: Cross-Sectional Survey Study %A Neumann,Ariana %A König,Hans-Helmut %A Hajek,André %K telemedicine %K telehealth %K digital health %K service use %K COVID-19 %D 2024 %7 23.4.2024 %9 %J JMIR Aging %G English %X Background: The occurrence of the COVID-19 pandemic demanded fast changes in the delivery of health care. As a result, significant growth in the use of telemedicine services occurred. Research, especially from nationally representative German samples, is needed to better understand determinants of telemedicine use. Objective: The purpose of this study was to identify determinants of telemedicine service use among middle-aged and older adults during the COVID-19 pandemic in Germany. Methods: Cross-sectional, nationally representative data were taken from the German sample of the Survey of Health, Ageing and Retirement in Europe (SHARE). The German Corona Survey 2 (n=2039), which was conducted between June and August 2021, was used for this study. Reporting experience with remote medical consultations during the COVID-19 pandemic served as the outcome measure. Associations with socioeconomic, psychological, social, health-related, and COVID-19–related determinants were examined using multiple Firth logistic regressions. Results: Psychological factors including feeling nervous, anxious, or on edge (odds ratio [OR] 1.61, 95% CI 1.04-2.50; P=.03), feeling sad or depressed (OR 1.62, 95% CI 1.05-2.51; P=.03) and feelings of loneliness (OR 1.66, 95% CI 1.07-2.58; P=.02) were positively associated with telemedicine use. Moreover, forgoing medical treatment because of being afraid of being infected by SARS-CoV-2 (OR 1.81, 95% CI 1.10-2.97; P=.02) and describing limitations because of a health problem as severe were positively associated with the outcome (OR 2.11, 95% CI 1.12-4.00; P=.02). Socioeconomic and social factors were not significantly associated with telemedicine use in our sample. Conclusions: Middle-aged and older individuals in Germany seem to use telemedicine services according to psychological needs and health limitations. Especially when psychological symptoms are experienced, telemedicine seems to be a promising service option in this age group. Future research is needed to confirm these initial findings in postpandemic circumstances. %R 10.2196/50938 %U https://aging.jmir.org/2024/1/e50938 %U https://doi.org/10.2196/50938 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56346 %T Effectiveness and Experiences of Quality Improvement Interventions in Older Adult Care: Protocol for a Mixed Methods Systematic Review %A Jabin,Md Shafiqur Rahman %A Samuriwo,Ray %A Chilaka,Marcus %A Yaroson,Emilia Vann %+ Department of Medicine and Optometry, Linnaeus University, Linnéuniversitetet Box 451, Växjö, 351 06, Sweden, 44 07915673612, mjabin@bradford.ac.uk %K patient safety %K acceptability %K accessibility %K appropriateness %K timeliness %K equitability %K social care %D 2024 %7 18.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their own care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older adult care settings and further improve health and social care systems associated with older adults. Objective: This review aims to compile and synthesize the best available evidence regarding the effectiveness of policy and practice QI interventions in older adult care. The secondary aim is to understand the care of older individuals and QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. Methods: The mixed methods review will follow the standard methodology used by Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycINFO, ASSIA, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of patients undergoing older adult care and any health and care professionals involved in the care delivery for older adults; a broad range of QI interventions, including assistive technologies, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older adult care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, that is, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will be followed. Results: A result-based convergent synthesis design will be used in which both quantitative and qualitative studies will be analyzed separately, and the results of both syntheses will be then integrated during a final (convergent) synthesis. The integration will compare the findings of quantitative and qualitative evidence using tables in light of the results of both syntheses. Conclusions: This comprehensive review is expected to reflect on the insights into some QI interventions and their impact, outline some common challenges of quality for older adult care, and benefit both the practical usefulness of care service activities and the society at large. International Registered Report Identifier (IRRID): PRR1-10.2196/56346 %M 38635311 %R 10.2196/56346 %U https://www.researchprotocols.org/2024/1/e56346 %U https://doi.org/10.2196/56346 %U http://www.ncbi.nlm.nih.gov/pubmed/38635311 %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 %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53001 %T Layperson-Supported, Web-Delivered Cognitive Behavioral Therapy for Depression in Older Adults: Randomized Controlled Trial %A Xiang,Xiaoling %A Kayser,Jay %A Turner,Skyla %A Ash,Samson %A Himle,Joseph A %+ School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI, 48109, United States, 1 (734) 763 6581, xiangxi@umich.edu %K internet-based cognitive behavioral therapy %K iCBT %K digital mental health interventions %K older adults %K depression %D 2024 %7 4.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is the most prevalent mental health condition in older adults. However, not all evidence-based treatments are easily accessible. Web-delivered cognitive behavioral therapy (wCBT) facilitated by laypersons is a viable treatment alternative. Objective: This randomized controlled trial aims to evaluate the efficacy of a novel wCBT program, Empower@Home, supported by trained lay coaches, against a waitlist attention control. Empower@Home is among the very few existing wCBT programs specifically designed for older adults. The primary objective was to assess the efficacy of the intervention compared with attention control. The secondary objective was to evaluate the program’s impact on secondary psychosocial outcomes and explore potential change mechanisms. Methods: Older adults (N=70) were recruited via web-based research registries, social media advertisements, and community agency referrals and randomly assigned to either the intervention or control group in a 1:1 allocation ratio. The intervention group received access to Empower@Home, which included 9 web-delivered self-help lessons and weekly telephone coaching sessions by a trained layperson over 10 weeks. The control group received weekly friendly phone calls and depressive symptom monitoring. The primary clinical outcome was the severity of depressive symptoms assessed using the Patient Health Questionnaire-9. The secondary clinical outcomes included anxiety, anger, social isolation, insomnia, pain intensity, and quality of life. Linear mixed modeling was used to determine the treatment effects on depression, and 2-tailed t tests were used to assess within-group changes and between-group differences. Results: Most participants in the intervention group completed all 9 sessions (31/35, 89%). The usability and acceptability ratings were excellent. The intervention group had a large within-group change in depressive symptoms (Cohen d=1.22; P<.001), whereas the attention control group experienced a medium change (Cohen d=0.57; P<.001). The between-group effect size was significant, favoring the intervention group over the control group (Cohen d=0.72; P<.001). In the linear mixed model, the group-by-time interaction was statistically significant (b=–0.68, 95% CI –1.00 to –0.35; P<.001). The treatment effects were mediated by improvements in cognitive behavioral therapy skills acquisition; behavioral activation; and satisfaction with the basic psychological needs of autonomy, competence, and relatedness. Furthermore, the intervention group showed significant within-group improvements in secondary psychosocial outcomes, including anxiety (P=.001), anger (P<.001), social isolation (P=.02), insomnia (P=.007), and pain (P=.03). By contrast, the control group did not experience significant changes in these outcome domains. However, the between-group differences in secondary outcomes were not statistically significant, owing to the small sample size. Conclusions: Empower@Home, a wCBT program supported by lay coaches, was more efficacious in reducing depressive symptoms than friendly telephone calls and depression symptom monitoring. Future studies should examine the effectiveness of the intervention in community and practice settings using nonclinician staff already present in these real-world settings as coaches. Trial Registration: ClinicalTrials.gov NCT05593276; https://clinicaltrials.gov/ct2/show/NCT05593276 International Registered Report Identifier (IRRID): RR2-10.2196/44210 %M 38437013 %R 10.2196/53001 %U https://www.jmir.org/2024/1/e53001 %U https://doi.org/10.2196/53001 %U http://www.ncbi.nlm.nih.gov/pubmed/38437013 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e46522 %T Barriers to and Facilitators of Older People’s Engagement With Web-Based Services: Qualitative Study of Adults Aged >75 Years %A Money,Annemarie %A Hall,Alex %A Harris,Danielle %A Eost-Telling,Charlotte %A McDermott,Jane %A Todd,Chris %+ School of Health Sciences, University of Manchester, 5th Floor, Jean McFarlane Building, Manchester, M13 9PL, United Kingdom, 44 0161 306 7777, annemarie.money@manchester.ac.uk %K digital exclusion %K digital inclusion %K older people %K technology %K aged %K web-based %K internet %D 2024 %7 28.2.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic has accelerated the shift toward the digital provision of many public services, including health and social care, public administration, and financial and leisure services. COVID-19 services including test appointments, results, vaccination appointments and more were primarily delivered through digital channels to the public. Many social, cultural, and economic activities (appointments, ticket bookings, tax and utility payments, shopping, etc) have transitioned to web-based platforms. To use web-based public services, individuals must be digitally included. This is influenced by 3 main factors: access (whether individuals have access to the internet), ability (having the requisite skills and confidence to participate over the web), and affordability (ability to pay for infrastructure [equipment] and data packages). Many older adults, especially those aged >75 years, are still digitally excluded. Objective: This study aims to explore the views of adults aged >75 years on accessing public services digitally. Methods: We conducted semistructured qualitative interviews with a variety of adults aged ≥75 years residing in Greater Manchester, United Kingdom. We also interviewed community support workers. Thematic analysis was used to identify the key themes from the data. Results: Overall, 24 older adults (mean age 81, SD 4.54 y; 14/24, 58% female; 23/24, 96% White British; and 18/24, 75% digitally engaged to some extent) and 2 support workers participated. A total of five themes were identified as key in understanding issues around motivation, engagement, and participation: (1) “initial motivation to participate digitally”—for example, maintaining social connections and gaining skills to be able to connect with family and friends; (2) “narrow use and restricted activity on the web”—undertaking limited tasks on the web and in a modified manner, for example, limited use of web-based public services and selected use of specific services, such as checking but never transferring funds during web-based banking; (3) “impact of digital participation on well-being”—choosing to go to the shops or general practitioner’s surgery to get out of the house and get some exercise; (4) “the last generation?”—respondents feeling that there were generational barriers to adapting to new technology and change; and (5) “making digital accessible”—understanding the support needed to keep those engaged on the web. Conclusions: As we transition toward greater digitalization of public services, it is crucial to incorporate the perspectives of older people. Failing to do so risks excluding them from accessing services they greatly rely on and need. %M 38416543 %R 10.2196/46522 %U https://aging.jmir.org/2024/1/e46522 %U https://doi.org/10.2196/46522 %U http://www.ncbi.nlm.nih.gov/pubmed/38416543 %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 %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50654 %T Testing a Culturally Tailored Advance Care Planning Intervention (MY WAY) for an American Indian Tribe: Protocol for a Quasi-Experimental Waitlist Control Design %A Anderson,Elizabeth %A Goins,R Turner %A Haozous,Emily A %A Schweinhart,April %+ Pacific Institute for Research and Evaluation, 101 Conner Drive, Suite 200, Chapel Hill, NC, 27514, United States, 1 919 265 2635, eanderson@pire.org %K American Indian or Alaskan Native %K advance care planning %K end-of-life care %D 2023 %7 29.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: American Indian and Alaska Native peoples experience poor end-of-life care, including more hospitalizations and lower use of hospice and do-not-resuscitate orders. Although advance care planning (ACP) can improve end-of-life care, ACP rates are disproportionately low in American Indians and Alaska Natives. Objective: We culturally tailored and delivered an existing evidence-based ACP program for an American Indian tribal community. Here, we present the protocol for assessing the intervention’s feasibility and efficacy. Methods: We measured feasibility via participant recruitment, participants’ evaluation (acceptability, appropriateness, comprehension, and satisfaction), and intervention fidelity. Recruitment was measured with participant screening, eligibility, enrollment, and retention. Participant’s evaluation of the intervention was measured with surveys. Fidelity was measured with direct observation and the Make Your Wishes About You (MY WAY) Fidelity Checklist Tool. To assess the intervention’s efficacy, we used a quasi-experimental waitlist control design with 2 cohorts who were surveyed each on three separate occasions. The intervention’s efficacy was assessed by the following: ACP barriers and facilitators as well as ACP self-efficacy, readiness, and completion. Results: A total of 166 participants were screened for eligibility; 11 were deemed ineligible, and 155 participants were enrolled in the study. Of those enrolled, 113 completed the intervention and will be included in subsequent analyses. We finalized data collection in January 2023, and analyses are underway. Study enrollment was successful, and we expect that participants will report high levels of acceptability, appropriateness, comprehension, and satisfaction with the intervention. We expect that the intervention was implemented with fidelity and will demonstrate decreases in ACP barriers and increases in ACP facilitators, self-efficacy, readiness, and completion. Conclusions: Enrolling over twice as many participants as we had hoped suggests that members of this tribal community are willing to engage in end-of-life ACP. We were able to implement a waitlist study design to show that a culturally tailored ACP program for a tribal community is feasible. Trial Registration: ClinicalTrials.gov NCT05304117; https://clinicaltrials.gov/study/NCT05304117 International Registered Report Identifier (IRRID): DERR1-10.2196/50654 %M 38157237 %R 10.2196/50654 %U https://www.researchprotocols.org/2023/1/e50654 %U https://doi.org/10.2196/50654 %U http://www.ncbi.nlm.nih.gov/pubmed/38157237 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e49603 %T Effects of the Implementation of Transport-Driven Poverty Alleviation Policy on Health Care–Seeking Behavior and Medical Expenditure Among Older People in Rural Areas: Quasi-Experimental Study %A Wu,Yuanyang %A Wang,Qianning %A Zheng,Feiyang %A Yu,Tiantian %A Wang,Yanting %A Fan,Si %A Zhang,Xinping %A Yang,Lianping %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China, 86 18071509979, xpzhang602@hust.edu.cn %K transport-driven poverty alleviation %K health care–seeking behavior %K medical expenditures %K difference-in-differences %K quasi-experimental study %D 2023 %7 28.11.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Improving the rural residents’ accessibility to and affordability of health care is recognized as a common target globally. The Health in All Policies approach, from the Declaration of Helsinki to the United Nations’ Decade Of Healthy Ageing, strengthened the far-reaching effect of large-scale public policies on health care–seeking behavior; however, the effects of national transport policy on health care–seeking behavior is unclear. Objective: This quasi-experimental study aimed to examine the effects of the implementation of transport-driven poverty alleviation (TPA) policy on health care–seeking behavior and medical expenditure among older adults in rural areas and the mechanism underlying these effects. Methods: We designed a quasi-experiment to estimate the effects of TPA policy implementation on health care–seeking behavior and medical expenditure among older adults in rural areas through a difference-in-differences (DID) analysis based on data from the China Health and Retirement Longitudinal Study in 2011, 2013, 2015, and 2018. The underlying mechanism was analyzed and effect modification patterns were further investigated by poor households, health status, and age. Results: Our findings validated a positive contribution of TPA policy on health care–seeking behavior among older adults in rural areas. After the implementation of TPA policy, the number of inpatient visits increased by annually 0.35 times per person, outpatient medical expenditure increased by 192% per month, and inpatient medical expenditure increased by 57% annually compared with those of older adults in rural areas without the implementation of TPA policy. Further, there was a significant modification effect, with a positive effect among poor households, healthier older adults, and those aged 60-80 years. Additionally, the policy improved the patients’ capabilities to seek long-distance care (β=23.16, 95% CI –0.99 to 45.31) and high-level hospitals (β=.08, 95% CI –0.02 to 0.13), and increased individual income to acquire more medical services (β=4.57, 95% CI –4.46 to 4.68). Conclusions: These findings validate the positive contribution of TPA policy on health care–seeking behavior among older adults in rural areas; however, the medical expenditure incurred was also high. Concerted efforts are needed to address health care–seeking dilemmas in rural areas, and attention must be paid to curbing medical expenditure growth for older adults in rural areas during TPA policy implementation. %M 38015603 %R 10.2196/49603 %U https://publichealth.jmir.org/2023/1/e49603 %U https://doi.org/10.2196/49603 %U http://www.ncbi.nlm.nih.gov/pubmed/38015603 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47510 %T Sociodemographic Profile, Health Conditions, and Burden of Informal Caregivers of Older Adults in Brazil During the COVID-19 Pandemic: Cross-Sectional, Exploratory, Noninterventional, Descriptive Study %A Ferreira,Pâmela Moraes %A Gomes,Mateus Cunha %A de Araujo,Lucianne Nascimento %A Oliveira,Tainá Sayuri Onuma de %A Ferreira,Glenda %A Aben-Athar,Cintia %A da Silva,Silvio Eder Dias %A Cruz Ramos,Aline M P %A Rodrigues,Diego Pereira %A Sousa,Fabianne %+ Federal University of Para, Rua Augusto Correa 1, Belem, Brazil, 55 91981219404, fabiannesousa@hotmail.com %K informal caregivers %K older adult %K caregiver %K caregivers %K caregiving %K burden %K informal care %K cross-sectional %K gerontology %K older adults %K hospitalized %K overload %K burnout %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Demographic changes in the world population have resulted in an increasingly aging society, with a progressive increase in the number of people in situations of dependence, who require assistance from family members to meet their basic needs. Caring for older adults involves performing diverse activities, resulting in reduced free time and tiredness, and fulfilling the demands and expectations related to personal, family, physical, and social life, consequently compromising the quality of life of the caregiver. In this context, the informal caregiver of hospitalized older adults emerges as the focus of attention. Objective: The aim of this study was to describe the sociodemographic profile, health conditions, and burden of informal caregivers of older adults admitted to a university hospital in Brazil during the COVID-19 pandemic period. Methods: This is a cross-sectional, descriptive, and analytical study that was conducted with 25 informal caregivers of hospitalized older adults in a university hospital in Brazil between August and September 2022. Three instruments were applied: Caregiver Burden Inventory, sociodemographic questionnaire, and health conditions questionnaire. The data were analyzed using SPSS version 28.0. Descriptive (frequency and percentage) and inferential analyses were performed using 2-sided Student t test with 95% CIs. Results: Of the 25 interviewees, 18 (72%) were females, 17 (46%) were married or in a stable union, 14 (56%) completed secondary education, and 11 (44%) lived with the older adults who needed care. The average age of the participants was 44 (SD 12.8) years. Regarding their health conditions, most caregivers self-reported it as good (12/25, 48%). They provided care to their father or mother older than 70 years (14/25, 56%). The Caregiver Burden Inventory analysis showed that the caregivers were the most negatively impacted in the domains of personal life overload (mean 10.8, SD 3.46; P=.047) and physical overload (mean 10.6, SD 2.32; P=.02). Conclusions: In recent years, there has been an increase in the burden on informal caregivers of hospitalized older adults in Brazil, thereby impacting their personal and physical lives. The findings of our study show that health care professionals should be trained to promote health guidelines and actions to improve the personal and physical lives of the caregiver population in Brazil. %M 37995120 %R 10.2196/47510 %U https://formative.jmir.org/2023/1/e47510 %U https://doi.org/10.2196/47510 %U http://www.ncbi.nlm.nih.gov/pubmed/37995120 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e42517 %T Older Adults’ Trust and Distrust in COVID-19 Public Health Information: Qualitative Critical Incident Study %A Shiroma,Kristina %A Zimmerman,Tara %A Xie,Bo %A Fleischmann,Kenneth R %A Rich,Kate %A Lee,Min Kyung %A Verma,Nitin %A Jia,Chenyan %+ School of Information, The University of Texas at Austin, 1616 Guadalupe St, Suite 5.202, Austin, TX, 78701, United States, 1 5124713821, kristinashiroma@utexas.edu %K health information %K information-seeking behavior %K COVID-19 %K qualitative research methods %K communication %K media and networks %K aging %K older adults %K elderly population %K mass media %K public health information %K trust %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 infodemic has imposed a disproportionate burden on older adults who face increased challenges in accessing and assessing public health information, but little is known about factors influencing older adults’ trust in public health information during COVID-19. Objective: This study aims to identify sources that older adults turn to for trusted COVID-19 public health information and factors that influence their trust. In addition, we explore the relationship between public health information sources and trust factors. Methods: Adults aged 65 years or older (N=30; mean age 71.6, SD 5.57; range 65-84 years) were recruited using Prime Panels. Semistructured phone interviews, guided by critical incident technique, were conducted in October and November 2020. Participants were asked about their sources of COVID-19 public health information, the trustworthiness of that information, and factors influencing their trust. Interview data were examined with thematic analysis. Results: Mass media, known individuals, and the internet were the older adults’ main sources for COVID-19 public health information. Although they used social media for entertainment and personal communication, the older adults actively avoided accessing or sharing COVID-19 information on social media. Factors influencing their trust in COVID-19 public health information included confirmation bias, personal research, resigned acceptance, and personal relevance. Conclusions: These findings shed light on older adults’ use of information sources and their criteria for evaluating the trustworthiness of public health information during a pandemic. They have implications for the future development of effective public health communication, policies, and interventions for older adults during health crises. %M 37856774 %R 10.2196/42517 %U https://aging.jmir.org/2023/1/e42517 %U https://doi.org/10.2196/42517 %U http://www.ncbi.nlm.nih.gov/pubmed/37856774 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44028 %T Overcoming the Digital Divide for Older Patients With Respiratory Disease: Focus Group Study %A Metting,Esther %A van Luenen,Sanne %A Baron,Anna-Jetske %A Tran,Anthony %A van Duinhoven,Stijn %A Chavannes,Niels H %A Hevink,Maud %A Lüers,Jos %A Kocks,Janwillem %+ Data Science Center in Health, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713GZ, Netherlands, e.i.metting@rug.nl %K elderly people %K usability %K asthma %K chronic obstructive pulmonary disease %K website %K navigation %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The need for and adoption of eHealth programs are growing worldwide. However, access can be limited among patients with low socioeconomic backgrounds, often resulting in a so-called “digital divide” due to a mismatch between eHealth and target populations that can gain benefit. This digital divide can result in unsuccessful eHealth implementations, which is of critical importance to health care. Objective: This study evaluated the opinions of elderly patients with asthma and chronic obstructive pulmonary disease (COPD) about an existing pharmacy-based personalized patient web portal that provides medication overview and information on associated diagnoses. The aim was to obtain insights on the common barriers of elderly people when using health-related websites, which can help to improve accessibility. Methods: This was a cross-sectional qualitative study of a patient panel of the Groningen Research Institute for Asthma and COPD in primary care. Participants were required to be older than 55 years, be Dutch speaking, have no prior experience with the study website, and be diagnosed with a chronic respiratory illness. Two focus groups were created, and they completed a 45-minute session for testing the website and a 120-minute session for semistructured interviews. The focus group sessions were recorded, transcribed verbatim, and analyzed by content analysis. Results: We enrolled 11 patients (9 women) with a mean age of 66 (SD 9) years. Of these, 5 had asthma, 3 had COPD, 2 had asthma-COPD overlap syndrome, and 1 had bronchiectasis. Participants were generally positive about the website, especially the areas providing disease-related information and the medication overview. They appreciated that the website would enable them to share this information with other health care providers. However, some difficulties were reported with navigation, such as opening a new tab, and others reported that the layout of the website was difficult either because of visual impairments or problems with navigation. It was also felt that monitoring would only be relevant if it is also checked by health care professionals as part of a treatment plan. Participants mentioned few privacy or safety concerns. Conclusions: It is feasible to develop websites for elderly patients; however, developers must take the specific needs and limitations of elderly people into account (eg, navigation problems, poor vision, or poor hand-eye coordination). The provision of information appears to be the most important aspect of the website, and as such, we should endeavor to ensure that the layout and navigation remain basic and accessible. Patients are only motivated to use self-management applications if they are an integrated part of their treatment. The usability of the website can be improved by including older people during development and by implementing design features that can improve accessibility in this group. %M 37788072 %R 10.2196/44028 %U https://formative.jmir.org/2023/1/e44028 %U https://doi.org/10.2196/44028 %U http://www.ncbi.nlm.nih.gov/pubmed/37788072 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 15 %N %P e47550 %T Older Adults’ Experiences With Participation and eHealth in Care Coordination: Qualitative Interview Study in a Primary Care Setting %A Hunsbedt Fjellså,Hilde Marie %A Husebø,Anne Marie Lunde %A Braut,Harald %A Mikkelsen,Aslaug %A Storm,Marianne %+ Department of Public Health, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4036, Norway, 47 51832480, hildemarie.fjellsa@uis.no %K care coordination %K older adults %K participation %K eHealth %K primary health care %D 2023 %7 2.10.2023 %9 Original Paper %J J Particip Med %G English %X Background: Owing to the demographic changes in the elderly population worldwide, delivering coordinated care at home to multimorbid older adults is of great importance. Older adults living with multiple chronic conditions need information to manage and coordinate their care. eHealth can be effective for gaining sufficient information, communicating, and self-managing chronic conditions. However, incorporating older adults’ health preferences and ensuring active involvement remain challenging. More knowledge is needed to ensure successful participation and eHealth use in care coordination. Objective: This study aimed to explore multimorbid older adults’ experiences with participation and eHealth in care coordination with general practitioners (GPs) and district nurses (DNs). Methods: The study had a qualitative explorative approach. Data collection included semistructured interviews with 20 older adults with multimorbidity receiving primary care services from their GPs and DNs. The participants were included by their GPs or nurses at a local intermunicipal acute inpatient care unit. The data analysis was guided by systematic text condensation. Results: We identified 2 categories: (1) older adults in charge of and using eHealth in care coordination, and (2) older adults with a loss of control in care coordination. The first category describes how communication with GPs and DNs can facilitate participation, the importance of managing own medication, and how eHealth can support older adults’ information needs. The second category focuses on older adults who depend on guidance and help from their GPs and DNs to manage their health, describing how a lack of capacity and system support to be involved makes these adults lose control of their care coordination. Conclusions: Being in charge of care coordination is important for older multimorbid adults. The results show that older adults are willing to use eHealth to be informed and to seek information, which ensures high levels of participation in care coordination. Future research should investigate how older adults can be involved in electronic information sharing with health care providers. %M 37782538 %R 10.2196/47550 %U https://jopm.jmir.org/2023/1/e47550 %U https://doi.org/10.2196/47550 %U http://www.ncbi.nlm.nih.gov/pubmed/37782538 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e46738 %T Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study %A Böttinger,Melissa J %A Litz,Elena %A Gordt-Oesterwind,Katharina %A Jansen,Carl-Philipp %A Memmer,Nicole %A Mychajliw,Christian %A Radeck,Leon %A Bauer,Jürgen M %A Becker,Clemens %+ Digital Unit, Center for Geriatric Medicine, Heidelberg University Hospital, Bergheimer Str. 20, Heidelberg, 69115, Germany, 49 6221 54 8146, boettinger@nar.uni-heidelberg.de %K aged %K self-assessment %K mobile apps %K mobile health %K mHealth %K community-based participatory research %K co-creation %K comprehensive geriatric assessment %K mobile phone %D 2023 %7 26.9.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a preclinical stage, thereby facilitating preventive efforts and targeted intervention. For this purpose, a Life-integrated Self-Assessment (LiSA) tablet system will be developed through a structured co-creation process. Objective: This study aims to investigate older adults’ perceptions of different self-assessment domains, components affecting user experience, risks and benefits associated with LiSA, characteristics of potential LiSA users, and the LiSA concept in general. Methods: A total of 10 community-dwelling older adults aged ≥70 years were recruited. In total, 6 co-creation workshops were held and started with expert input followed by semistructured discussion rounds. Participants performed hands-on activities with a tablet, including testing of preinstalled self-assessment apps. All workshops were audio recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze the data following a deductive-inductive approach guided by the Optimized Honeycomb Model for user experience. Results: The group (mean age 77.8, SD 5.1 years) was heterogeneous in terms of previous technology experience and health status. The mean workshop duration was 2 hours (122.5, SD 4.43 min), and an average of 8 (SD 1.15) participants attended each workshop. A total of 11 thematic categories were identified, covering results on all research questions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activity and function and sensory and cognitive functions and requested additional features such as recommendations for actions or reminders. LiSA was perceived as empowering and a motivator to engage in active health care planning as well as enabling shared and informed decision-making. Concerns and barriers included the lack of technical competence, feelings of frustration, and fear of being left alone, with negative assessment results. In essence, participants expressed a positive attitude toward using LiSA repeatedly and identified it as an option to increase the chances of maintaining independence when growing older. Conclusions: The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion, LiSA should include relevant assessments capturing physical activity and function and sensory and cognitive functions as well as recommendations for actions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment. %M 37751274 %R 10.2196/46738 %U https://aging.jmir.org/2023/1/e46738 %U https://doi.org/10.2196/46738 %U http://www.ncbi.nlm.nih.gov/pubmed/37751274 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46002 %T Supporting Vulnerable Older Adults With Telehealth Through Wellness Calls and Tablet Distribution During COVID-19: Quality Improvement Project %A Tewary,Sweta %A Cook,Nicole %A Dezine,Marie %A Shnayder,Oksana %A Pandya,Naushira %+ Nova Southeastern University, 3301 College Ave, Fort Lauderdale, FL, 33314, United States, 1 954 262 4015, st813@nova.edu %K COVID-19 %K telehealth %K older adults %K isolation %K health education %K mental wellness %K telemedicine %K health literacy %K digital health %K mental health %K social isolation %D 2023 %7 11.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Loneliness, social isolation, and lack of technical literacy are associated with poorer health outcomes. To help improve social connection during the COVID-19 pandemic, Nova Southeastern University’s South Florida Geriatric Workforce Enhancement Program partnered with a community-based organization to provide educational resources to promote telehealth services. Objective: This study aimed to provide educational resources to older adults with limited resources and promote the use of telehealth services in this population. Methods: Through this pilot project, we contacted 66 vulnerable older adults who expressed interest in telehealth support through wellness calls, with 44 participants moving on to participate in tablet usage. All tablets were preloaded with educational information on using the device, COVID-19 resources, and accessing telehealth services for patients, caregivers, and families. Results: Feedback from wellness assessments suggested a significant need for telehealth support. Participants used the tablets mainly for telehealth (n=6, 15%), to connect with friends and family (n=10, 26%), and to connect with faith communities (n=3, 8%). Conclusions: The findings from the pilot project suggest that wellness calls and telehealth education are beneficial to support telehealth usage among older adults. %M 37695647 %R 10.2196/46002 %U https://formative.jmir.org/2023/1/e46002 %U https://doi.org/10.2196/46002 %U http://www.ncbi.nlm.nih.gov/pubmed/37695647 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e44983 %T Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review %A Stremmel,Christopher %A Breitschwerdt,Rüdiger %+ Department of Cardiology, LMU University Hospital, Marchioninistr. 15, Munich, 81377, Germany, 49 894400712622, christopher.stremmel@med.uni-muenchen.de %K cardiovascular %K digital medicine %K telehealth %K artificial intelligence %K telemedicine %K mobile phone %K review %D 2023 %7 30.8.2023 %9 Review %J JMIR Cardio %G English %X Background: The digital transformation of our health care system has experienced a clear shift in the last few years due to political, medical, and technical innovations and reorganization. In particular, the cardiovascular field has undergone a significant change, with new broad perspectives in terms of optimized treatment strategies for patients nowadays. Objective: After a short historical introduction, this comprehensive literature review aimed to provide a detailed overview of the scientific evidence regarding digitalization in the diagnostics and therapy of cardiovascular diseases (CVDs). Methods: We performed an extensive literature search of the PubMed database and included all related articles that were published as of March 2022. Of the 3021 studies identified, 1639 (54.25%) studies were selected for a structured analysis and presentation (original articles: n=1273, 77.67%; reviews or comments: n=366, 22.33%). In addition to studies on CVDs in general, 829 studies could be assigned to a specific CVD with a diagnostic and therapeutic approach. For data presentation, all 829 publications were grouped into 6 categories of CVDs. Results: Evidence-based innovations in the cardiovascular field cover a wide medical spectrum, starting from the diagnosis of congenital heart diseases or arrhythmias and overoptimized workflows in the emergency care setting of acute myocardial infarction to telemedical care for patients having chronic diseases such as heart failure, coronary artery disease, or hypertension. The use of smartphones and wearables as well as the integration of artificial intelligence provides important tools for location-independent medical care and the prevention of adverse events. Conclusions: Digital transformation has opened up multiple new perspectives in the cardiovascular field, with rapidly expanding scientific evidence. Beyond important improvements in terms of patient care, these innovations are also capable of reducing costs for our health care system. In the next few years, digital transformation will continue to revolutionize the field of cardiovascular medicine and broaden our medical and scientific horizons. %M 37647103 %R 10.2196/44983 %U https://cardio.jmir.org/2023/1/e44983 %U https://doi.org/10.2196/44983 %U http://www.ncbi.nlm.nih.gov/pubmed/37647103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45750 %T Practices of Care in Participatory Design With Older Adults During the COVID-19 Pandemic: Digitally Mediated Study %A Paluch,Richard %A Cerna,Katerina %A Kirschsieper,Dennis %A Müller,Claudia %+ IT for the Ageing Society, Information Systems, University of Siegen, Kohlbettstraße 15, Siegen, 57072, Germany, 49 2717405330, richard.paluch@uni-siegen.de %K older adults %K care %K Participatory Design %K COVID-19 pandemic %K digital health intervention %K aging %K health technology %K digital media %K gerontology %K mobile phone %D 2023 %7 17.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Participatory Design (PD), albeit an established approach in User-Centered Design, comes with specific challenges when working with older adults as research participants. Addressing these challenges relates to the reflection and negotiation of the positionalities of the researchers and research participants and includes various acts of giving and receiving help. During the COVID-19 pandemic, facets of positionalities and (mutual) care became particularly evident in qualitative and participatory research settings. Objective: The aim of this paper was to systematically analyze care practices of participatory (design) research, which are to different extents practices of the latter. Using a multiyear PD project with older people that had to take place remotely over many months, we specify different practices of care; how they relate to collaborative work in the design project; and represent foundational practices for sustainable, long-term co-design. Our research questions were “How can digitally-mediated PD work during COVID-19 and can we understand such digital PD as ‘care’?” Methods: Our data comes from the Joint Programming Initiative “More Years, Better Lives” (JPI MYBL), a European Union project that aims to promote digital literacy and technology appropriation among older adults in domestic settings. It targeted the cocreation, by older adults and university researchers, of a mobile demo kit website with cocreated resources, aimed at improving the understanding of use options of digital tools. Through a series of workshops, a range of current IT products was explored by a group of 21 older adults, which served as the basis for joint cocreative work on generating design ideas and prototypes. We reflect on the PD process and examine how the actors enact and manifest care. Results: The use of digital technology allowed the participatory project to continue during the COVID-19 pandemic and accentuated the digital skills of older adults and the improvement of digital literacy as part of “care.” We provide empirically based evidence of PD with older adults developing digital literacy and sensitizing concepts, based on the notion of care by Tronto for differentiating aspects and processes of care. The data suggest that it is not enough to focus solely on the technologies and how they are used; it is also necessary to focus on the social structures in which help is available and in which technologies offer opportunities to do care work. Conclusions: We document that the cocreation of different digital media tools can be used to provide a community with mutual care. Our study demonstrates how research participants effectively enact different forms of care and how such “care” is a necessary basis for a genuinely participatory approach, which became especially meaningful as a form of support during COVID-19. We reflect on how notions of “care” and “caring” that were central to the pandemic response are also central to PD. %M 37459177 %R 10.2196/45750 %U https://www.jmir.org/2023/1/e45750 %U https://doi.org/10.2196/45750 %U http://www.ncbi.nlm.nih.gov/pubmed/37459177 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42283 %T Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study %A Darwich,Adam S %A Boström,Anne-Marie %A Guidetti,Susanne %A Raghothama,Jayanth %A Meijer,Sebastiaan %+ Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11C, Huddinge, Stockholm, 141 57, Sweden, 46 8 790 48 05, darwich@kth.se %K aging %K intervention %K health policy %K health services administration and management %K health care intervention %K home care %K home support %K in-home assistance %K personal care %K policy %K reablement %K rehabilitation %K rehabilitation medicine %K social support %K stress %K support %K systems thinking %K user %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use. Objective: The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems. Methods: The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods. Results: The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements “workload” and “distress” were important determinants of home care staff health, provision, and quality of care. Conclusions: The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored. %M 37389904 %R 10.2196/42283 %U https://humanfactors.jmir.org/2023/1/e42283 %U https://doi.org/10.2196/42283 %U http://www.ncbi.nlm.nih.gov/pubmed/37389904 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48166 %T Effectiveness of Digital Health Literacy Interventions in Older Adults: Single-Arm Meta-Analysis %A Dong,Qian %A Liu,Ting %A Liu,Ran %A Yang,Hongxia %A Liu,Cuiping %+ School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, No.619 Changcheng Road, Taian, Shandong Province, 271016, China, 86 13854218960, lcping0926@126.com %K digital health literacy interventions %K older adults %K eHealth literacy efficacy %K knowledge %K self-efficacy %K skills %D 2023 %7 28.6.2023 %9 Review %J J Med Internet Res %G English %X Background: In a world of rapid digital technology development, the lack of digital health literacy (DHL) among older people cannot be ignored. DHL is becoming an essential competency that can facilitate the health status and health management of older adults. DHL interventions that are feasible and appropriate can be implemented on a large scale through the health care system for older people. Objective: The purpose of this meta-analysis was to assess the effectiveness of DHL interventions for older adults. Methods: English publications in PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to November 20, 2022. Two reviewers independently completed the data extraction and quality assessment. Review Manager (version 5.4; Cochrane Informatics & Technology Services) software was used for all meta-analyses. Results: A total of 7 studies, including 2 randomized controlled trials and 5 quasi-experimental studies, involving 710 older adults were considered eligible. The main outcome was scores on the eHealth Literacy Scale, and secondary outcomes were knowledge, self-efficacy, and skills. Quasi-experimental studies compared baseline and postintervention outcomes, while randomized controlled trials compared pre- and postintervention outcomes in the intervention group. Of the 7 studies, 3 used face-to-face instruction, while 4 adopted web-based interventions. Among them, 4 of the interventions were conducted using theoretical guidance, while 3 were not. Intervention duration varied from 2 to 8 weeks. In addition, the studies included were all conducted in developed countries, mainly in the United States. Pooled analysis presented that DHL interventions had positive effects on eHealth literacy efficacy (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001). Subgroup analysis revealed that DHL interventions that chose face-to-face teaching (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), were guided by a conceptual framework (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), and were sustained over 4 weeks (standardized mean difference 1.1, 95% CI 0.46 to 1.84; P=.001) had a more significant effect. Moreover, the outcomes showed considerable gains in knowledge (standardized mean difference 0.93, 95% CI 0.54 to 1.31; P<.001) and self-efficacy (standardized mean difference 0.96, 95% CI 0.16 to 1.77; P=.02). No statistically significant effect was found for skills (standardized mean difference 0.77, 95% CI –0.30 to 1.85; P=.16). The small number of studies, variable study quality, and heterogeneity are some limitations of this review. Conclusions: DHL interventions have positive effects on the health status and health management of older adults. Practical and effective DHL interventions are crucial for the use of modern digital information technology in managing the health of older people. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023410204; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410204 %M 37379077 %R 10.2196/48166 %U https://www.jmir.org/2023/1/e48166 %U https://doi.org/10.2196/48166 %U http://www.ncbi.nlm.nih.gov/pubmed/37379077 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45557 %T The Impact of Counseling on the Dignity of Older People: Protocol for a Mixed Methods Study %A Hung,Ho Yeow %A Azman,Azlinda %A Jamir Singh,Paramjit Singh %+ School of Social Sciences, Universiti Sains Malaysia, Malaysia,, Gelugor St, Penang, 11800, Malaysia, 60 96548150, hoyeowhung123@gmail.com %K counseling %K dignity %K elderly %K emotional management %K psychological %K Singapore %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychological counseling is perceived as a treatment that could significantly improve older individuals’ psychological and behavioral functioning. There is a dearth of information on the impact of psychological counseling on preserving dignity and facilitating good aging among older people in Singapore. Objective: The objectives of this study are as follows: (1) to assess advance care planning among older people and their perception of life and health, end of life, and end-of-life care; (2) to explore older people’s accessibility and receptiveness toward counseling; (3) elucidate older people’s perspectives on counseling and its impact on emotional management and decision-making; (4) to assess older people’s competencies in emotional management; and (5) to propose an intervention model for enhancing older people’s well-being and dignity through psychological counseling in Singapore. Methods: A mixed method study design involving quantitative and qualitative methods will be used. Older individuals receiving some form of preventive, primary, or long-term care in the community through voluntary welfare organizations from the senior activity centers located in eastern Singapore participated in the qualitative phase. Six older individuals from each senior activity center have been enrolled for the interview phase to explore 6 components: the Advanced Care Planning (ACP) booklet, Trait Meta Mood Scale (TMMS), accessibility and receptiveness toward counseling, and emotional management and decision-making. The ACP, an instrument designed to assess advanced care planning among older individuals, and the TMMS, an instrument developed to measure meta-mood experience and emotional management, were used in the quantitative phase among 100 participants. The data will be analyzed thematically using NVivo version 12, whereas descriptive statistics and a 2-tailed, 1-sample t test will be conducted in SPSS (version 25; IBM Corp) for empirical data analyses. Results: The qualitative phase, which involves a semistructured interview, has been completed among 20 older individuals aged 66-86 years. Thematic analysis of the data is still ongoing. Meanwhile, the quantitative phase commenced on March 22, 2022, with 100 participants providing signed informed consent to participate in the study. The study is expected to be completed by March 2023. Conclusions: The mixed methods study will document the current awareness of ACP, accessibility and receptiveness toward counseling, and the potential use of psychological counseling in enhancing well-being and dignity among older people in Singapore. The research findings will benefit policy makers in their decision-making when attempting to mitigate the potential barriers to seeking counseling assistance among older people. International Registered Report Identifier (IRRID): DERR1-10.2196/45557 %M 37272062 %R 10.2196/45557 %U https://www.researchprotocols.org/2023/1/e45557 %U https://doi.org/10.2196/45557 %U http://www.ncbi.nlm.nih.gov/pubmed/37272062 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46156 %T Peer-to–Patient-Aligned Care Team (Peer-to-PACT; P2P), a Peer-Led Home Visit Intervention Program for Targeting and Improving Long-term Care Services and Support for Veterans With High Needs and High Risk: Protocol for a Mixed Methods Feasibility Study %A Garcia-Davis,Sandra %A Palacio,Ana %A Bast,Elizabeth %A Penney,Lauren S %A Finley,Erin %A Kinosian,Bruce %A Intrator,Orna %A Dang,Stuti %+ Geriatric Research, Education, and Clinical Center (GRECC), Bruce W Carter Department of Veterans Affairs Medical Center, 1201 NW 16th Street, 11-GRC, Miami, FL, 33125, United States, 1 305 575 3388, stuti.dang@va.gov %K older veterans with high needs and high risk %K peer support specialists %K unmet needs %K home visit %K patient engagement %K home services %K care coordination %D 2023 %7 12.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Keeping older veterans with high needs and high risk (HNHR) who are at risk of long-term institutional care safely in their homes for as long as possible is a Department of Veterans Affairs priority. Older veterans with HNHR face disproportionate barriers and disparities to engaging in their care, including accessing care and services. Veterans with HNHR often have poor ability to maintain health owing to complicated unmet health and social needs. The use of peer support specialists (peers) is a promising approach to improving patient engagement and addressing unmet needs. The Peer-to–Patient-Aligned Care Team (Peer-to-PACT; P2P) intervention is a multicomponential home visit intervention designed to support older veterans with HNHR to age in place. Participants receive a peer-led home visit to identify unmet needs and home safety risks aligned with the age-friendly health system model; care coordination, health care system navigation, and linking to needed services and resources in collaboration with their PACT; and patient empowerment and coaching using Department of Veterans Affairs whole health principles. Objective: The primary aim of this study is to evaluate the preliminary effect of the P2P intervention on patient health care engagement. The second aim is to identify the number and types of needs and unmet needs as well as needs addressed using the P2P needs identification tool. The third aim is to evaluate the feasibility and acceptability of the P2P intervention delivered over 6 months. Methods: We will use a quantitative-qualitative convergent mixed methods approach to evaluate the P2P intervention outcomes. For our primary outcome, we will conduct an independent, 2-tailed, 2-sample t test to compare the means of the 6-month pre-post differences in the number of outpatient PACT encounters between the intervention and matched comparison groups. Qualitative data analysis will follow a structured rapid approach using deductive coding as well as the Consolidated Framework for Implementation Research. Results: Study enrollment began in July 2020 and was completed in March 2022. Our sample size consists of 114 veterans: 38 (33.3%) P2P intervention participants and 76 (66.7%) matched comparison group participants. Study findings are expected to be published in late 2023. Conclusions: Peers may help bridge the gap between PACT providers and veterans with HNHR by evaluating veterans’ needs outside of the clinic, summarizing identified unmet needs, and developing team-based solutions in partnership with the PACT. The home visit component of the intervention provides eyes in the home and may be a promising and innovative tool to improve patient engagement. International Registered Report Identifier (IRRID): DERR1-10.2196/46156 %M 37307055 %R 10.2196/46156 %U https://www.researchprotocols.org/2023/1/e46156 %U https://doi.org/10.2196/46156 %U http://www.ncbi.nlm.nih.gov/pubmed/37307055 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 7 %N %P e42205 %T The Association of Sociodemographic Variables and Unhealthy Behaviors With Limitations in Activities of Daily Living Among Thai Older Adults: Cross-sectional Study and Projected Trends Over the Next 20 Years %A Nontarak,Jiraluck %A Bundhamcharoen,Kanitta %A Prasitsiriphon,Orawan %A Aekplakorn,Wichai %+ College of Population Studies, Chulalongkorn University, Visid Prajuabmoh Building, Phayathai Road, Pathumwan, Bangkok, 10330, Thailand, 66 0654491942, orawan.pr@chula.ac.th %K ADL limitation %K National Health Examination Survey %K older adults %K activities of daily living %K physical activity %K disability %D 2023 %7 6.6.2023 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: Extended life spans have led to an increase in the number of older people and an increase in the prevalence of disability among people older than 60 years of age. Objective: This study aims to investigate the association of sociodemographic variables and unhealthy behaviors with limitations in activities of daily living (ADL) among Thai older adults. The study also projects the number of older individuals likely to experience ADL limitations in the next 20 years. Methods: We performed sex-specific multinomial logistic regression analysis based on the 5th Thai National Health Examination Survey in 2014 to investigate the association between sociodemographic variables and health behaviors with ADL limitations among Thai older adults. Age- and sex-specific prevalence estimates of ADL limitations were obtained by applying the same models. These estimates were combined with population projections up to 2040 from the Office of the National Economic and Social Development Board, Thailand, to generate projections of older individuals with ADL limitations. Results: Age and physical activity were significant factors for both sexes, with age positively associated with the level of ADL limitations and low physical activity associated with an increased relative probability of mild or moderate to severe ADL limitations compared to individuals with no ADL limitation (1.2-2.2 times). Other variables such as education, marital status, diabetes, hypertension, smoking, alcohol consumption, and having a fruit- and vegetable-based diet showed significant associations, but the results varied regarding sex and levels of ADL limitations. This study also projected the number of older adults with mild and moderate to severe ADL limitations over the next 20 years from 2020 to 2040, revealing an increase of 3.2 and 3.1 times, respectively, along with a significant increase in men compared to that in women. Conclusions: This study identified age and physical activity as significant factors associated with ADL limitations in older adults, while other factors showed varying associations. Over the next 2 decades, projections suggest a significant increase in the number of older adults with ADL limitations, particularly men. Our findings emphasize the importance of interventions to reduce ADL limitations, and health care providers should consider various factors impacting them. %M 37279055 %R 10.2196/42205 %U https://apinj.jmir.org/2023/1/e42205 %U https://doi.org/10.2196/42205 %U http://www.ncbi.nlm.nih.gov/pubmed/37279055 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46721 %T Use of Digital Health Technology Among Older Adults With Cancer in the United States: Findings From a National Longitudinal Cohort Study (2015-2021) %A Zhou,Weijiao %A Cho,Youmin %A Shang,Shaomei %A Jiang,Yun %+ School of Biomedical Informatics, The University of Texas Health Science Center at Houston, UCT600 E635-3, 7000 Fannin St, Houston, TX, 77030, United States, 1 713 500 3591, youmcho@umich.edu %K digital health %K technology %K older adults %K cancer %K survivorship %K cancer survivor %K older cancer survivors %K digital health technology %D 2023 %7 31.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the benefits of digital health technology use, older adults with cancer (ie, aged 65 years) have reported challenges to technology adoption. However, there has been a lack of a good understanding of their digital health technology use patterns and the associated influential factors in the past few years. Objective: This study aimed to examine the trends in and factors associated with digital health technology use among older adults with cancer. Methods: The National Health and Aging Trends Study (NHATS) data set is a national longitudinal cohort study with annual survey waves of Medicare beneficiaries 65 years and older. Participants were community-dwelling older adults who self-reported previous or current cancer diagnoses in each round. The study sample size of each round ranged from 1996 (2015) to 1131 (2021). Digital health technology use was defined as using the internet or online in the last month to order or refill prescriptions, contact medical providers, handle Medicare or other insurance matters, or get information about their health conditions. The association of sociodemographics, clinical factors (self-rated health, chronic conditions, difficulties in activities of daily living, dementia, anxiety, and depression), and physical function (Short Physical Performance Battery and grip strength) with digital health technology use was examined using design-based logistic regression. All statistical analyses accounted for the complex sample design. Results: The prevalence of any digital health technology use increased from 36% in 2015 to 45% in 2019. In 2020-2021, which was amid the COVID-19 pandemic, it ranged from 51% to 52%. In terms of each digital health technology use behavior, in 2015, overall, 28% of older cancer survivors used digital health technology to obtain health information, followed by contacting clinicians (19%), filling prescriptions (14%), and handling insurance (11%). Greater use of digital health technology was associated with younger age, being White, having a college or higher education, having a higher income, having more comorbidities, nondementia, and having a higher gait speed. Conclusions: Digital health technology use in older adults with cancer has gradually increased, particularly during the COVID-19 pandemic. However, socioeconomic and racial disparities have remained in older cancer survivors. Additionally, older adults with cancer may have some unique features associated with digital health technology use; for example, their use of digital health may be increased by their comorbidities (ie, health care needs) and reduced by their frailty. %M 37256672 %R 10.2196/46721 %U https://www.jmir.org/2023/1/e46721 %U https://doi.org/10.2196/46721 %U http://www.ncbi.nlm.nih.gov/pubmed/37256672 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e45641 %T Patient Perceptions of e-Visits: Qualitative Study of Older Adults to Inform Health System Implementation %A Judson,Timothy J %A Subash,Meera %A Harrison,James D %A Yeager,Jan %A Williams,Aimée M %A Grouse,Carrie K %A Byron,Maria %+ Department of Medicine, University of California San Francisco, Box 0131, 521 Parnassus Avenue, San Francisco, CA, 94143, United States, 1 415 514 8755, Timothy.judson@ucsf.edu %K e-visit %K patient portal message %K digital health tool %K patient portal %K perception %K attitude %K qualitative %K e-consult %K remote care %K remote visit %K remote consult %K vulnerable %K messaging %K telehealth %K telemedicine %K eHealth %D 2023 %7 26.5.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Electronic visits (e-visits) are billable, asynchronous patient-initiated messages that require at least five minutes of medical decision-making by a provider. Unequal use of patient portal tools like e-visits by certain patient populations may worsen health disparities. To date, no study has attempted to qualitatively assess perceptions of e-visits in older adults. Objective: In this qualitative study, we aimed to understand patient perceptions of e-visits, including their perceived utility, barriers to use, and care implications, with a focus on vulnerable patient groups. Methods: We conducted a qualitative study using in-depth structured individual interviews with patients from diverse backgrounds to assess their knowledge and perceptions surrounding e-visits as compared with unbilled portal messages and other visit types. We used content analysis to analyze interview data. Results: We conducted 20 interviews, all in adults older than 65 years. We identified 4 overarching coding categories or themes. First, participants were generally accepting of the concept of e-visits and willing to try them. Second, nearly two-thirds of the participants voiced a preference for synchronous communication. Third, participants had specific concerns about the name “e-visit” and when to choose this type of visit in the patient portal. Fourth, some participants indicated discomfort using or accessing technology for e-visits. Financial barriers to the use of e-visits was not a common theme. Conclusions: Our findings suggest that older adults are generally accepting of the concept of e-visits, but uptake may be limited due to their preference for synchronous communication. We identified several opportunities to improve e-visit implementation. %M 37234031 %R 10.2196/45641 %U https://aging.jmir.org/2023/1/e45641 %U https://doi.org/10.2196/45641 %U http://www.ncbi.nlm.nih.gov/pubmed/37234031 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e40606 %T Exploring the Role of Active Assisted Living in the Continuum of Care for Older Adults: Thematic Analysis %A Bin Noon,Gaya %A Hanjahanja-Phiri,Thokozani %A Dave,Harishree %A Fadrique,Laura %A Teague,Jennifer %A Morita,Plinio P %+ School of Public Health Sciences, University of Waterloo, TJB-2266, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 41372, plinio.morita@uwaterloo.ca %K ambient assisted living %K active assisted living %K AAL %K internet of things %K aging well %K aging in place %K older adults %K geriatrics %K standards %K policies %K health care %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Active assisted living (AAL) refers to systems designed to improve the quality of life, aid in independence, and create healthier lifestyles for those who need assistance at any stage of their lives. As the population of older adults in Canada grows, there is a pressing need for nonintrusive, continuous, adaptable, and reliable health monitoring tools to support aging in place and reduce health care costs. AAL has great potential to support these efforts with the wide variety of solutions currently available; however, additional work is required to address the concerns of care recipients and their care providers with regard to the integration of AAL into care. Objective: This study aims to work closely with stakeholders to ensure that the recommendations for system-service integrations for AAL aligned with the needs and capacity of health care and allied health systems. To this end, an exploratory study was conducted to understand the perceptions of, and concerns with, AAL technology use. Methods: A total of 18 semistructured group interviews were conducted with stakeholders, with each group comprising several participants from the same organization. These participant groups were categorized into care organizations, technology development organizations, technology integration organizations, and potential care recipient or patient advocacy groups. The results of the interviews were coded using a thematic analysis to identify future steps and opportunities regarding AAL. Results: The participants discussed how the use of AAL systems may lead to improved support for care recipients through more comprehensive monitoring and alerting, greater confidence in aging in place, and increased care recipient empowerment and access to care. However, they also raised concerns regarding the management and monetization of data emerging from AAL systems as well as general accountability and liability. Finally, the participants discussed potential barriers to the use and implementation of AAL systems, especially addressing the question of whether AAL systems are even worth it considering the investment required and encroachment on privacy. Other barriers raised included issues with the institutional decision-making process and equity. Conclusions: Better definition of roles is needed in terms of who can access the data and who is responsible for acting on the gathered data. It is important for stakeholders to understand the trade-off between using AAL technologies in care settings and the costs of AAL technologies, including the loss of patient privacy and control. Finally, further work is needed to address the gaps, explore the equity in AAL access, and develop a data governance framework for AAL in the continuum of care. %M 37213201 %R 10.2196/40606 %U https://aging.jmir.org/2023/1/e40606 %U https://doi.org/10.2196/40606 %U http://www.ncbi.nlm.nih.gov/pubmed/37213201 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e41936 %T The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries %A Turbow,Sara %A Vaughan,Camille P %A Culler,Steven D %A Hepburn,Kenneth W %A Rask,Kimberly J %A Perkins,Molly M %A Clevenger,Carolyn K %A Ali,Mohammed K %+ Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, United States, 1 404 251 8897, sara.turbow@emory.edu %K readmissions %K care fragmentation %K health information exchange %K mortality %K Alzheimer disease %K electronic health information %K information sharing %K older adults %K information exchange %K hospital system %K health informatics %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Although electronic health information sharing is expanding nationally, it is unclear whether electronic health information sharing improves patient outcomes, particularly for patients who are at the highest risk of communication challenges, such as older adults with Alzheimer disease. Objective: To determine the association between hospital-level health information exchange (HIE) participation and in-hospital or postdischarge mortality among Medicare beneficiaries with Alzheimer disease or 30-day readmissions to a different hospital following an admission for one of several common conditions. Methods: This was a cohort study of Medicare beneficiaries with Alzheimer disease who had one or more 30-day readmissions in 2018 following an initial admission for select Hospital Readmission Reduction Program conditions (acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, and pneumonia) or common reasons for hospitalization among older adults with Alzheimer disease (dehydration, syncope, urinary tract infection, or behavioral issues). Using unadjusted and adjusted logistic regression, we examined the association between electronic information sharing and in-hospital mortality during the readmission or mortality in the 30 days following the readmission. Results: A total of 28,946 admission-readmission pairs were included. Beneficiaries with same-hospital readmissions were older (aged 81.1, SD 8.6 years) than beneficiaries with readmissions to different hospitals (age range 79.8-80.3 years, P<.001). Compared to admissions and readmissions to the same hospital, beneficiaries who had a readmission to a different hospital that shared an HIE with the admission hospital had 39% lower odds of dying during the readmission (adjusted odds ratio [AOR] 0.61, 95% CI 0.39-0.95). There were no differences in in-hospital mortality observed for admission-readmission pairs to different hospitals that participated in different HIEs (AOR 1.02, 95% CI 0.82-1.28) or to different hospitals where one or both hospitals did not participate in HIE (AOR 1.25, 95% CI 0.93-1.68), and there was no association between information sharing and postdischarge mortality. Conclusions: These results indicate that information sharing between unrelated hospitals via a shared HIE may be associated with lower in-hospital, but not postdischarge, mortality for older adults with Alzheimer disease. In-hospital mortality during a readmission to a different hospital was higher if the admission and readmission hospitals participated in different HIEs or if one or both hospitals did not participate in an HIE. Limitations of this analysis include that HIE participation was measured at the hospital level, rather than at the provider level. This study provides some evidence that HIEs can improve care for vulnerable populations receiving acute care from different hospitals. %M 36897638 %R 10.2196/41936 %U https://aging.jmir.org/2023/1/e41936 %U https://doi.org/10.2196/41936 %U http://www.ncbi.nlm.nih.gov/pubmed/36897638 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42340 %T Psychometric Properties of and Measurement Invariance in the Questionnaire of Stereotypes Toward Older Adulthood in Health Care College Students and Health Professionals of Colombia: Psychometric Study %A Martín-Carbonell,Marta %A Espejo,Begoña %A Castro-Melo,Greys Patricia %A Sequeira-Daza,Doris %A Checa,Irene %+ Universitat de València, Av. Blasco Ibáñez, 21, Valencia, 46010, Spain, 34 963864503, bespejo@uv.es %K psychometric properties %K structural equation modeling %K older adulthood %K geriatric %K gerontology %K health care college students %K health care professionals %K questionnaire %K stereotype %K agism %D 2023 %7 9.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In health professionals, negative stereotypes toward older adulthood have been associated with the difficulty in recognizing pathological processes and the refusal to care for older patients because of assuming that communication with them will be uncomfortable and frustrating. For these reasons, research on stereotypes in these groups has acquired growing importance. The usual strategy to identify and evaluate agist stereotypes is to use scales and questionnaires. Although multiple scales are currently used, in Latin America, the Questionnaire for the Evaluation of Negative Stereotypes Toward Older Adulthood (Cuestionario de Estereotipos Negativos sobre la Vejez [CENVE]), developed in Spain, is widely used but without evidence of construct validity in our context. In addition, although in the original version, a factorial structure of 3 factors was found, in later studies, a unifactorial structure was obtained. Objective: The objective is to study the construct validity of the CENVE in a sample of Colombian health personnel to clarify its factorial structure and concurrent validity. Likewise, the measurement invariance according to gender and age was studied. Methods: A nonprobabilistic sample of 877 Colombian health professionals and intern health students was obtained. The data were collected online using the LimeSurvey tool. To study the factor structure of the CENVE, 2 confirmatory factor analysis (CFA) models were carried out, one to test a single factor and the other to test the 3-related-factor structure. The factor measurement reliability was evaluated with the composite reliability index (CRI) and the average variance extracted (AVE). The measurement invariance was studied according to gender (men and women) and age (emerging adults, 18-29 years old, and adults, 30 years old or older). Using a structural equation model, the relationship between age and the latent CENVE total score was studied to obtain evidence of concurrent validity, since studies indicate that the younger the age, the greater the number of stereotypes. Results: The 1-factor structure was confirmed. The reliability results indicated that both indices show adequate values. Likewise, the existence of a strong invariance in measurement by gender and age group was verified. After contrasting the means of the groups, the results showed that men show more negative stereotypes toward old age than women. Likewise, emerging adults also showed more stereotypes than adults. We also verified that age is inversely related to the latent score of the questionnaire, such that the younger the age, the greater the stereotype. These results are in agreement with those obtained by other authors. Conclusions: The CENVE shows good construct and concurrent validity, as well as good reliability, and it can be used to assess stereotypes toward older adulthood in Colombian health professionals and health sciences college students. This will allow us to better understand the effect of stereotypes on agism. %M 36892936 %R 10.2196/42340 %U https://www.jmir.org/2023/1/e42340 %U https://doi.org/10.2196/42340 %U http://www.ncbi.nlm.nih.gov/pubmed/36892936 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e41809 %T Individualistic Versus Collaborative Learning in an eHealth Literacy Intervention for Older Adults: Quasi-Experimental Study %A Vazquez,Christian Elias %A Xie,Bo %A Shiroma,Kristina %A Charness,Neil %+ School of Social Work, The University of Texas at Arlington, 211 S Cooper St, Arlington, TX, 76019, United States, 1 8052596963, christian.vazquez@uta.edu %K eHealth literacy %K digital literacy %K older adults %K eHealth %K aging %K web-based information %K health information %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults tend to have insufficient health literacy, which includes eHealth literacy—the ability to access, assess, and use digital health information. Interventions using methods such as collaborative learning (CL) and individualistic learning (IL) may be effective in addressing older adults’ low eHealth literacy, but little is known about the short- and long-term effects of CL versus IL on older adults’ eHealth literacy. Objective: The objective of this study was to use a 3 × 2 × 3 mixed factorial design to examine older adults’ learning with CL versus IL for eHealth literacy. Methods: Older adults (N=466; mean age 70.5, SD 7.2; range 60-96 years) from diverse racial and ethnic groups were randomly assigned to either the CL or IL group (233/466, 50% in each). The intervention consisted of 4 weeks of training in 2-hour sessions held twice a week. Using ANOVA and multiple regression, we focused on the main effects of learning condition and interaction between learning condition and previous computer experience. Learning method (CL or IL) and previous computer experience (experienced, new, or mixed) were between-subject variables, and time of measurement (pretest measurement, posttest measurement, and 6-month follow-up) was the within-subject variable. Primary outcome variables were eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills. Control variables were age, sex, education, health status, race and ethnicity, income, primary language, and previous health literacy. Results: eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills improved significantly (P<.001 in all cases) from before to after the intervention. From postintervention measurement to 6-month follow-up, there was a significant interaction between learning condition and previous computer experience based on 1 outcome measure, computer and web operation skills (F2,55=3.69; P=.03). To maintain computer and web operation skills 6 months after the intervention, it was more effective for people with little to no previous computer experience to learn individually, whereas for people with more previous computer experience, it was more effective to learn collaboratively. From postintervention measurement to 6-month follow-up, statistically significant decreases were found in 3 of the 5 outcome measures: eHealth literacy efficacy, computer and web knowledge, and basic computer and web operation skills (P<.001 for all 3 cases). Conclusions: Older adults’ eHealth literacy can be improved through effective intervention, and the IL or CL condition may have little effect on short-term outcomes. However, to maintain long-term benefits, it may be best to learn collaboratively with others who have similar previous computer experience. eHealth literacy is multidimensional, with some components retained better over time. Findings suggest a need for resources to provide continuous training or periodic boosting to maintain intervention gains. %M 36757773 %R 10.2196/41809 %U https://aging.jmir.org/2023/1/e41809 %U https://doi.org/10.2196/41809 %U http://www.ncbi.nlm.nih.gov/pubmed/36757773 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e43564 %T Double-Bind of Recruitment of Older Adults Into Studies of Successful Aging via Assistive Information and Communication Technologies: Mapping Review %A Khalili-Mahani,Najmeh %A Sawchuk,Kim %+ Media-Health Lab, Milieux Institute for Arts, Culture and Technology, Concordia University, 1515 Ste. Catherine St. West, Technoculture, Arts and Games Centre (EV 11), Montreal, QC, H3G 1M8, Canada, 1 5148482424 ext 5370, najmeh.khalili-mahani@concordia.ca %K information and communication technologies %K successful aging %K healthy aging %K independent living %K agism %K research methods %K double-bind theory %K mobile phone %D 2022 %7 23.12.2022 %9 Review %J JMIR Aging %G English %X Background: Two fields of research and development targeting the needs of the aging population of the world are flourishing, successful aging and assistive information and communication technologies (A-ICTs). The risks of ageist stereotypes emerging from how we communicate in both discourses are long known. This raises questions about whether using specific age criteria in the context of “aging deficits” can bias participation in, or compliance with, the research process by older adults who try to avoid age-related stigma. Objective: This study aimed to examine subject recruitment, study designs (based on age >65 years criteria), as well as discourses in research objectives and conclusions in health research on affordances of A-ICTs for older adults. Methods: A systematic mapping approach was used to characterize rationales, methods, stated objectives, and expected outcomes of studies indexed in PubMed and retrieved through the search logic ([“Older Adults” OR Seniors OR Elderly] AND [ICT OR gerontechnology OR “Assistive Technology”)] AND (“Healthy Aging” OR “Successful Aging” OR “healthy ageing” OR “successful ageing”). Inclusion criteria were as follows: the study should have recruited older participants (aged >65 years), been qualitative or quantitative research, and involved the introduction of at least one A-ICT for health-related improvements. Exclusion criteria were as follows: reviews, viewpoints, surveys, or studies that used information and communication technology for data collection instead of lifestyle interventions. Content, thematic, and discourse analyses were used to map the study characteristics and synthesize results with respect to the research question. Results: Of 180 studies that passed the search logic, 31 (17.2%) satisfied the inclusion criteria (6 randomized controlled trials, 4 purely quantitative studies, 9 focus groups, 2 observational studies, and 10 mixed methods studies). In all but one case, recruitment was pragmatic and nonrandom. Thematic analysis of rationales revealed a high likelihood of emphasis on the burdens of aging, such as rising costs of care (12/31, 39%) and age-related deficits (14/31, 45%). The objectives of the research fell under 4 categories: promotion of physical activity, acceptance and feasibility of robots and remote health monitoring systems, risk detection, and the future of A-ICTs in health care for older adults. Qualitative studies were more attentive to the nonageist research guidelines. Heterogeneity in the study results (both qualitative and quantitative) was not related to age but to individual agency, acceptance, and adherence. A combination of research strategies (participatory, longitudinal, playful, flexible, and need-based designs) proved successful in characterizing variations in study outcomes. Studies that documented recruitment dynamics revealed that fear of stigma was a factor that biased participants’ engagement. Conclusions: This review indicates that age is not an informative criterion for recruitment and retention of participants. Charting the dynamics of adoption of, and interaction with, A-ICTs is critical for advancing research and technology development. %M 36563033 %R 10.2196/43564 %U https://aging.jmir.org/2022/4/e43564 %U https://doi.org/10.2196/43564 %U http://www.ncbi.nlm.nih.gov/pubmed/36563033 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 14 %N 1 %P e12593 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2022 %7 ..2022 %9 %J Online J Public Health Inform %G English %X The pervasiveness of online mis/disinformation escalated during the COVID-19 pandemic. To address the proliferation of online mis/disinformation, it is critical to build reliability into the tools older adults use to seek health information. On average, older adult populations demonstrate disproportionate susceptibility to false messages spread under the guise of accuracy and were the most engaged with false information about COVID-19 across online platforms when compared to other age-groups. In a design-thinking challenge posed by AARP to graduate students in a Digital Health course at Tufts University School of Medicine, students leveraged existing solutions to design a web browser extension that is responsive to both passive and active health information-seeking methods utilized by older adults in the United States. This paper details the design-thinking process employed, insights gained from primary research, an overview of the prototyped solution, and insights relating to the design of effective health information-seeking platforms for older adults. %M 36457348 %R 10.5210/ojphi.v14i1.12593 %U %U https://doi.org/10.5210/ojphi.v14i1.12593 %U http://www.ncbi.nlm.nih.gov/pubmed/36457348 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e38546 %T The Impact of COVID-19 on Older Adults’ Perceptions of Virtual Care: Qualitative Study %A Abdallah,Lama %A Stolee,Paul %A Lopez,Kimberly J %A Whate,Alexandra %A Boger,Jennifer %A Tong,Catherine %+ School of Public Health Sciences, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L3G1, Canada, 1 5198884567, catherine.tong@uwaterloo.ca %K virtual care %K older adult %K qualitative %K COVID-19 %K elderly population %K aging %K telehealth %K digital care %K technology usability %K patient perspective %K technology access %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Aging %G English %X Background: In response to the COVID-19 pandemic, older adults worldwide have increasingly received health care virtually, and health care organizations and professional bodies have indicated that virtual care is “here to stay.” As older adults are the highest users of the health care system, virtual care implementation can have a significant impact on them and may pose a need for additional support. Objective: This research aims to understand older adults’ perspectives and experiences of virtual care during the pandemic. Methods: As part of a larger study on older adults’ technology use during the pandemic, we conducted semistructured interviews with 20 diverse older Canadians (mean age 76.9 years, SD 6.5) at 2 points: summer of 2020 and winter/early spring of 2021. Participants were asked about their technology skills, experiences with virtual appointments, and perspectives on this type of care delivery. Interviews were digitally recorded and transcribed. A combination of team-based and framework analyses was used to interpret the data. Results: Participants described their experiences with both in-person and virtual care during the pandemic, including issues with accessing care and long gaps between appointments. Overall, participants were generally satisfied with the virtual care they received during the pandemic. Participants described the benefits of virtual care (eg, increased convenience, efficiency, and safety), the limitations of virtual care (eg, need for physical examination and touch, lack of nonverbal communication, difficulties using technology, and systemic barriers in access), and their perspectives on the future of virtual care. Half of our participants preferred a return to in-person care after the COVID-19 pandemic, while the other half preferred a combination of in-person and virtual services. Many participants who preferred to access in-person services were not opposed to virtual care options, as needed; however, they wanted virtual care as an option alongside in-person care. Participants emphasized a need for training and support to be meaningfully implemented to support both older adults and providers in using virtual care. Conclusions: Overall, our research identified both perceived benefits and perceived limitations of virtual care, and older adult participants emphasized their wish for a hybrid model of virtual care, in which virtual care is viewed as an addendum, not a replacement for in-person care. We recognize the limitations of our sample (small, not representative of all older Canadians, and more likely to use technology); this body of literature would greatly benefit from more research with older adults who do not/cannot use technology to receive care. Findings from this study can be mobilized as part of broader efforts to support older patients and providers engaged in virtual and in-person care, particularly post–COVID-19. %M 36054599 %R 10.2196/38546 %U https://aging.jmir.org/2022/4/e38546 %U https://doi.org/10.2196/38546 %U http://www.ncbi.nlm.nih.gov/pubmed/36054599 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e39016 %T Scaling Up Citizen Workshops in Public Libraries to Disseminate and Discuss Primary Care Research Results: Quasi-Experimental Study %A Massougbodji,José %A Zomahoun,Hervé Tchala Vignon %A Adisso,Evehouenou Lionel %A Sawadogo,Jasmine %A Borde,Valérie %A Cameron,Cynthia %A Moisan,Hélène %A Paquette,Jean-Sébastien %A Akbaraly,Zamzam %A Châteauneuf,Lëa-Kim %A David,Geneviève %A , %A Légaré,France %+ VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, 2480, chemin de la Canardière, Québec, QC, G1G 2G1, Canada, 1 418 663 5713, France.Legare@mfa.ulaval.ca %K scaling up %K knowledge translation %K dissemination strategies %K integrated knowledge translation %K public libraries %K citizen workshops %K potentially inappropriate medicines %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Little is known about engaging patients and stakeholders in the process of scaling up effective knowledge translation interventions targeting the public. Objective: Using an integrated knowledge translation approach, we aimed to scale up and evaluate an effective pilot program to disseminate research results in public libraries. Methods: We conducted a scaling-up study targeting the public. On the basis of our successful pilot project, we codeveloped and implemented a large-scale program of free citizen workshops in public libraries, in a close research partnership with stakeholders and patient representatives. Citizen workshops, each facilitated by 1 participating physician and 1 science communicator, consisted of a 45-minute computer-assisted presentation and a 45-minute open exchange. The intervention outcome was knowledge gained. The scale-up outcomes were satisfaction, appropriateness, coverage, and costs. An evaluation questionnaire was used to collect data of interest. Both quantitative and qualitative analyses were performed. Results: The workshop theme chosen by the patient and stakeholder representatives was the high prevalence of medication overuse among people aged ≥65 years. From April to May 2019, 26 workshops were conducted in 25 public libraries reaching 362 people. The mean age of participants was 64.8 (SD 12.5) years. In total, 18 participating physicians and 6 science communicators facilitated the workshops. Participants reported significant knowledge gain (mean difference 2.1, 95% CI 2.0-2.2; P<.001). The median score for overall public satisfaction was 9 out of 10 (IQR 8-10). The public participants globally rated the workshops as having a high level of appropriateness. Coverage was 92% (25/27) of the total number of public libraries targeted. Costs were CAD $6051.84 (US $4519.69) for workshop design and CAD $22,935.41 (US $17,128.85) for scaling them up. Conclusions: This project successfully established a large-scale and successful implementation science or knowledge translation bridge among researchers, clinicians, and citizens via public libraries. This study provides a model for a dissemination practice that benefits the public by both engaging them in the dissemination process and targeting them directly. %M 35690963 %R 10.2196/39016 %U https://aging.jmir.org/2022/3/e39016 %U https://doi.org/10.2196/39016 %U http://www.ncbi.nlm.nih.gov/pubmed/35690963 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e38363 %T Examining the Impact of COVID-19 on People With Dementia From the Perspective of Family and Friends: Thematic Analysis of Tweets %A Bacsu,Juanita-Dawne R %A O'Connell,Megan E %A Cammer,Allison %A Ahmadi,Soheila %A Berger,Corinne %A Azizi,Mehrnoosh %A Gowda-Sookochoff,Rory %A Grewal,Karl S %A Green,Shoshana %A Knight,Sheida %A Spiteri,Raymond J %+ Department of Psychology, University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 3062504399, juanita.bacsu@usask.ca %K coronavirus 2019 %K COVID-19 %K Twitter %K social media %K dementia %K Alzheimer disease %K thematic analysis %K aging %K older adult %K elderly population %K caregiver %K support service %K peer support %K online health community %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic is taking a serious toll on people with dementia. Given the rapidly evolving COVID-19 context, policymakers and practitioners require timely, evidence-informed research to address the changing needs and challenges of people with dementia and their family care partners. Objective: Using Twitter data, the objective of this study was to examine the COVID-19 impact on people with dementia from the perspective of their family members and friends. Methods: Using the Twint application in Python, we collected 6243 relevant tweets over a 15-month time frame. The tweets were divided among 11 coders and analyzed using a 6-step thematic analysis process. Results: Based on our analysis, 3 main themes were identified: (1) frustration and structural inequities (eg, denied dignity and inadequate supports), (2) despair due to loss (eg, isolation, decline, and death), and (3) resiliency, survival, and hope for the future. Conclusions: As the COVID-19 pandemic persists and new variants emerge, people with dementia and their family care partners are facing complex challenges that require timely interventions. More specifically, tackling COVID-19 challenges requires revisiting pandemic policies and protocols to ensure equitable access to health and support services, recognizing the essential role of family care partners, and providing financial assistance and resources to help support people with dementia in the pandemic. Revaluating COVID-19 policies is critical to mitigating the pandemic’s impact on people with dementia and their family care partners. %M 35667087 %R 10.2196/38363 %U https://aging.jmir.org/2022/2/e38363 %U https://doi.org/10.2196/38363 %U http://www.ncbi.nlm.nih.gov/pubmed/35667087 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e32790 %T Associations Between Implementation of the Caregiver Advise Record Enable (CARE) Act and Health Service Utilization for Older Adults with Diabetes: Retrospective Observational Study %A Zheng,Yaguang %A Anton,Bonnie %A Rodakowski,Juleen %A Altieri Dunn,Stefanie C %A Fields,Beth %A Hodges,Jacob C %A Donovan,Heidi %A Feiler,Connie %A Martsolf,Grant %A Bilderback,Andrew %A Martin,Susan C %A Li,Dan %A James,Alton Everette %+ Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY, 10010, United States, 1 212 998 5170, yaguang.zheng@nyu.edu %K electronic health record %K caregiver %K diabetes %K hospital readmission %K emergency department utilization %K CARE Act %K EHRs %K older adults %K utilization %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The Caregiver Advise Record Enable (CARE) Act is a state level law that requires hospitals to identify and educate caregivers (“family members or friends”) upon discharge. Objective: This study examined the association between the implementation of the CARE Act in a Pennsylvania health system and health service utilization (ie, reducing hospital readmission, emergency department [ED] visits, and mortality) for older adults with diabetes. Methods: The key elements of the CARE Act were implemented and applied to the patients discharged to home. The data between May and October 2017 were pulled from inpatient electronic health records. Likelihood-ratio chi-square tests and multivariate logistic regression models were used for statistical analysis. Results: The sample consisted of 2591 older inpatients with diabetes with a mean age of 74.6 (SD 7.1) years. Of the 2591 patients, 46.1% (n=1194) were female, 86.9% (n=2251) were White, 97.4% (n=2523) had type 2 diabetes, and 69.5% (n=1801) identified a caregiver. Of the 1801 caregivers identified, 399 (22.2%) received discharge education and training. We compared the differences in health service utilization between pre- and postimplementation of the CARE Act; however, no significance was found. No significant differences were detected from the bivariate analyses in any outcomes between individuals who identified a caregiver and those who declined to identify a caregiver. After adjusting for risk factors (multivariate analysis), those who identified a caregiver (12.2%, 219/1801) was associated with higher rates of 30-day hospital readmission than those who declined to identify a caregiver (9.9%, 78/790; odds ratio [OR] 1.38, 95% CI 1.04-1.87; P=.02). Significantly lower rates were detected in 7-day readmission (P=.02), as well as 7-day (P=.03) and 30-day (P=.01) ED visits, among patients with diabetes whose identified caregiver received education and training than those whose identified caregiver did not receive education and training in the bivariate analyses. However, after adjusting for risk factors, no significance was found in 7-day readmission (OR 0.53, 95% CI 0.27-1.05; P=.07), 7-day ED visit (OR 0.63, 95% CI 0.38-1.03; P=.07), and 30-day ED visit (OR 0.73, 95% CI 0.52-1.02; P=.07). No significant associations were found for other outcomes (ie, 30-day readmission and 7-day and 30-day mortality) in both the bivariate and multivariate analyses. Conclusions: Our study found that the implementation of the CARE Act was associated with certain health service utilization. The identification of caregivers was associated with higher rates of 30-day hospital readmission in the multivariate analysis, whereas having identified caregivers who received discharge education was associated with lower rates of readmission and ED visit in the bivariate analysis. %M 35727611 %R 10.2196/32790 %U https://aging.jmir.org/2022/2/e32790 %U https://doi.org/10.2196/32790 %U http://www.ncbi.nlm.nih.gov/pubmed/35727611 %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 %@ 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 %@ 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 e34764 %T Bridging Connectivity Issues in Digital Access and Literacy: Reflections on Empowering Vulnerable Older Adults in Singapore %A Lim,Haikel A %A Lee,Joanne Sze Win %A Lim,Meng Han %A Teo,Lynn Pei Zhen %A Sin,Natalene Siew Wen %A Lim,Rou Wei %A Chua,Si Min %A Yeo,Jia Qi %A Ngiam,Nerice Heng Wen %A Tey,Angeline Jie-Yin %A Tham,Celine Yi Xin %A Ng,Kennedy Yao Yi %A Low,Lian Leng %A Tang,Kai Wen Aaron %+ Population Health and Integrated Care Office, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore, 65 62223322, aaron_kw_tang@nhg.com.sg %K COVID-19 %K digital literacy %K digital literacy training %K digital disparities %K digital divide %K social construction of health technologies %K health technology %K COVID-19 pandemic %K pandemic %K COVID %K social isolation %K elder %K older adult %K Asia %K access %K barrier %K empower %K volunteer %K vulnerable %K digital skill %K low income %D 2022 %7 3.5.2022 %9 Viewpoint %J JMIR Aging %G English %X This article describes a ground-up initiative for a volunteer-run digital literacy program in Singapore targeting vulnerable older adults, focusing on the barriers faced in running this program and training these beneficiaries. It further offers possible solutions to overcome these hurdles, providing insight for individuals or organizations seeking to start similar ground-up initiatives. %M 35503520 %R 10.2196/34764 %U https://aging.jmir.org/2022/2/e34764 %U https://doi.org/10.2196/34764 %U http://www.ncbi.nlm.nih.gov/pubmed/35503520 %0 Journal Article %@ 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 1 %P e32075 %T Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study %A Nwosu,Amara Callistus %A McGlinchey,Tamsin %A Sanders,Justin %A Stanley,Sarah %A Palfrey,Jennifer %A Lubbers,Patrick %A Chapman,Laura %A Finucane,Anne %A Mason,Stephen %+ Lancaster Medical School, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4YW, United Kingdom, 44 1524 594547, a.nwosu@lancaster.ac.uk %K palliative care %K terminal care %K supportive care %K quality of life %K symptom management %K digital health %K technology %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Developments in digital health have the potential to transform the delivery of health and social care to help citizens manage their health. Currently, there is a lack of consensus about digital health research priorities in palliative care and a lack of theories about how these technologies might improve care outcomes. Therefore, it is important for health care leaders to identify innovations to ensure that an increasingly frail population has appropriate access to palliative care services. Consequently, it is important to articulate research priorities as the first step in determining how finite resources should be allocated to a field saturated with rapidly developing innovation. Objective: The aim of this study is to identify research priority areas for digital health in palliative care. Methods: We selected digital health trends, most relevant to palliative care, from a list of emerging trends reported by a leading institute of quantitative futurists. We conducted 2 rounds of the Delphi questionnaire, followed by a consensus meeting and public engagement workshop to establish a final consensus on research priorities for digital technology in palliative care. We used the views of public representatives to gain their perspectives on the agreed priorities. Results: A total of 103 experts (representing 11 countries) participated in the first Delphi round. Of the 103 experts, 55 (53.3%) participated in the second round. The final consensus meetings were attended by 10.7% (11/103) of the experts. We identified 16 priority areas, which involved many applications of technologies, including care for patients and caregivers, self-management and reporting of diseases, education and training, communication, care coordination, and research methodology. We summarized the priority areas into eight topics: big data, mobile devices, telehealth and telemedicine, virtual reality, artificial intelligence, smart home, biotechnology, and digital legacy. Conclusions: The priorities identified in this study represent a wide range of important emerging areas in the fields of digital health, personalized medicine, and data science. Human-centered design and robust governance systems should be considered in future research. It is important that the risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely, and safely and do not cause unintentional harm. %M 35311674 %R 10.2196/32075 %U https://aging.jmir.org/2022/1/e32075 %U https://doi.org/10.2196/32075 %U http://www.ncbi.nlm.nih.gov/pubmed/35311674 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e32683 %T One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study %A Dimet-Wiley,Andrea %A Golovko,George %A Watowich,Stanley J %+ Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0645, United States, 1 832 613 5356, watowich@xray.utmb.edu %K hip %K fracture %K mortality %K aging %K older adults %K elderly %K mortality risk %K electronic health record %K EHR %K survival probability %K postfracture mortality rate %K fall %K bone %K injury %K dementia %K diabetes %K type 2 diabetes %K trauma %K treatment %K comorbidity %K mobility %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Hip fracture in older adults is tied to increased mortality risk. Deconvolution of the mortality risk specific to hip fracture from that of various other fracture types has not been performed in recent hip fracture studies but is critical to determining current unmet needs for therapeutic intervention. Objective: This study examined whether hip fracture increases the 1-year postfracture mortality rate relative to several other fracture types and determined whether dementia or type 2 diabetes (T2D) exacerbates postfracture mortality risk. Methods: TriNetX Diamond Network data were used to identify patients with a single event of fracture of the hip, the upper humerus, or several regions near and distal to the hip occurring from 60 to 89 years of age from 2010 to 2019. Propensity score matching, Kaplan-Meier, and hazard ratio analyses were performed for all fracture groupings relative to hip fracture. One-year postfracture mortality rates in elderly populations with dementia or T2D were established. Results: One-year mortality rates following hip fracture consistently exceeded all other lower extremity fracture groupings as well as the upper humerus. Survival probabilities were significantly lower in the hip fracture groups, even after propensity score matching was performed on cohorts for a variety of broad categories of characteristics. Dementia in younger elderly cohorts acted synergistically with hip fracture to exacerbate the 1-year mortality risk. T2D did not exacerbate the 1-year mortality risk beyond mere additive effects. Conclusions: Elderly patients with hip fracture have a significantly decreased survival probability. Greatly increased 1-year mortality rates following hip fracture may arise from differences in bone quality, bone density, trauma, concomitant fractures, postfracture treatments or diagnoses, restoration of prefracture mobility, or a combination thereof. The synergistic effect of dementia may suggest detrimental mechanistic or behavioral combinations for these 2 comorbidities. Renewed efforts should focus on modulating the mechanisms behind this heightened mortality risk, with particular attention to mobility and comorbid dementia. %M 35293865 %R 10.2196/32683 %U https://aging.jmir.org/2022/1/e32683 %U https://doi.org/10.2196/32683 %U http://www.ncbi.nlm.nih.gov/pubmed/35293865 %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 %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31920 %T Design of an Integrated Acceptance Framework for Older Users and eHealth: Influential Factor Analysis %A Yu,Jiyeon %A de Antonio,Angelica %A Villalba-Mora,Elena %+ Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, 28223, Spain, 34 910679250, elena.villalba@upm.es %K eHealth %K older people %K older user %K health technology %K acceptance factors %K adoption %K acceptance framework %K systematic review %K thematic analysis %K influential factor analysis %K mobile phone %D 2022 %7 28.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth and telehealth play a crucial role in assisting older adults who visit hospitals frequently or who live in nursing homes and can benefit from staying at home while being cared for. Adapting to new technologies can be difficult for older people. Thus, to better apply these technologies to older adults’ lives, many studies have analyzed the acceptance factors for this particular population. However, there is not yet a consensual framework that can be used in further development and to search for solutions. Objective: This paper aims to present an integrated acceptance framework (IAF) for older users’ acceptance of eHealth based on 43 studies selected through a systematic review. Methods: We conducted a 4-step study. First, through a systematic review in the field of eHealth from 2010 to 2020, the acceptance factors and basic data for analysis were extracted. Second, we conducted a thematic analysis to group the factors into themes to propose an integrated framework for acceptance. Third, we defined a metric to evaluate the impact of the factors addressed in the studies. Finally, the differences among the important IAF factors were analyzed according to the participants’ health conditions, verification time, and year. Results: Through a systematic review, 731 studies were found in 5 major databases, resulting in 43 (5.9%) selected studies using the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) methodology. First, the research methods and acceptance factors for eHealth were compared and analyzed, extracting a total of 105 acceptance factors, which were grouped later, resulting in an IAF. A total of 5 dimensions (ie, personal, user–technology relational, technological, service-related, and environmental) emerged, with a total of 23 factors. In addition, we assessed the quality of evidence and then conducted a stratification analysis to reveal the more appropriate factors depending on the health condition and assessment time. Finally, we assessed the factors and dimensions that have recently become more important. Conclusions: The result of this investigation is a framework for conducting research on eHealth acceptance. To elaborately analyze the impact of the factors of the proposed framework, the criteria for evaluating the evidence from the studies that have the extracted factors are presented. Through this process, the impact of each factor in the IAF has been presented, in addition to the framework proposal. Moreover, a meta-analysis of the current status of research is presented, highlighting the areas where specific measures are needed to facilitate eHealth acceptance. %M 35089155 %R 10.2196/31920 %U https://www.jmir.org/2022/1/e31920 %U https://doi.org/10.2196/31920 %U http://www.ncbi.nlm.nih.gov/pubmed/35089155 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e31970 %T The Smarter Safer Homes Solution to Support Older People Living in Their Own Homes Through Enhanced Care Models: Protocol for a Stratified Randomized Controlled Trial %A Zhang,Qing %A Varnfield,Marlien %A Higgins,Liesel %A Smallbon,Vanessa %A Bomke,Julia %A O'Dwyer,John %A Byrnes,Joshua M %A Sum,Melissa %A Hewitt,Jennifer %A Lu,Wei %A Karunanithi,Mohanraj %+ Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Surgical, Treatment and Rehabilitation Service-STARS level 7, 296 Herston Road, Herston, 4029, Australia, 61 732533630, Qing.Zhang@csiro.au %K smart home %K aged care %K objective activity of daily living %K randomized trial %K wireless sensor network %K older adults %K care %K methodology %K platform %K benefit %K utilization %K support %K self-management %K digital health %D 2022 %7 24.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: An aging population, accompanied by the prevalence of age-related diseases, presents a significant burden to health systems. This is exacerbated by an increasing shortage of aged care staff due to the existing workforce entering their retirement and fewer young people being attracted to work in aged care. In line with consumer preferences and potential cost-efficiencies, government and aged care providers are increasingly seeking options to move care and support to the community or home as opposed to residential care facilities. However, compared to residential care, home environments may provide limited opportunity for monitoring patients’ progression/decline in functioning and therefore limited opportunity to provide timely intervention. To address this, the Smarter Safer Homes (SSH) platform was designed to enable self-monitoring and/or management, and to provide aged care providers with support to deliver their services. The platform uses open Internet of Things communication protocols to easily incorporate commercially available sensors into the system. Objective: Our research aims to detail the benefits of utilizing the SSH platform as a service in its own right as well as a complementary service to more traditional/historical service offerings in aged care. This work is anticipated to validate the capacity and benefits of the SSH platform to enable older people to self-manage and aged care service providers to support their clients to live functionally and independently in their own homes for as long as possible. Methods: This study was designed as a single-blinded, stratified, 12-month randomized controlled trial with participants recruited from three aged care providers in Queensland, Australia. The study aimed to recruit 200 people, including 145 people from metropolitan areas and 55 from regional areas. Participants were randomized to the intervention group (having the SSH platform installed in their homes to assist age care service providers in monitoring and providing timely support) and the control group (receiving their usual aged care services from providers). Data on community care, health and social-related quality of life, health service utilization, caregiver burden, and user experience of both groups were collected at the start, middle (6 months), and end of the trial (12 months). Results: The trial recruited its first participant in April 2019 and data collection of the last participant was completed in November 2020. The trial eventually recruited 195 participants, with 98 participants allocated to the intervention group and 97 participants allocated to the control group. The study also received participants’ health service data from government data resources in June 2021. Conclusions: A crisis is looming to support the aging population. Digital solutions such as the SSH platform have the potential to address this crisis and support aged care in the home and community. The outcomes of this study could improve and support the delivery of aged care services and provide better quality of life to older Australians in various geographical locations. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000829213; https://tinyurl.com/2n6a75em International Registered Report Identifier (IRRID): DERR1-10.2196/31970 %M 35072640 %R 10.2196/31970 %U https://www.researchprotocols.org/2022/1/e31970 %U https://doi.org/10.2196/31970 %U http://www.ncbi.nlm.nih.gov/pubmed/35072640 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e33512 %T Regional Utilization of Preventive Services in the 55-Plus Age Group: Protocol for a Mixed Methods Study %A Hrudey,Ilona %A Minow,Annemarie %A Walter,Svenja %A March,Stefanie %A Swart,Enno %A Stallmann,Christoph %+ Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany, 49 391 67 24318, ilona.hrudey@med.ovgu.de %K prevention %K utilization %K determinants %K barriers %K Germany %K cancer screening %K medical check-ups %K vaccinations %K preventive dental care %K older people %D 2022 %7 12.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Germany, the proportion of people with chronic diseases and multimorbidity is increasing. To counteract the emergence and worsening of age-related conditions, there is a need for preventive care structures and measures. The preventive services that are financed by statutory health insurance (SHI; eg, vaccinations, cancer screening) are only used by part of the German population. There are no current findings about the utilization of these services by older adults in the eastern German federal state of Saxony-Anhalt, which is particularly strongly affected by demographic change. Objective: The aim of this study is to investigate the actual utilization and determinants of, reasons for, and barriers to utilization of preventive services financed by the SHI in Saxony-Anhalt in the 55-plus age group. Methods: In this study, a convergent mixed methods design is used. The actual use of preventive services will be shown by means of (1) a claims data analysis looking at data on statutory outpatient medical care from both the Central Research Institute of Ambulatory Health Care in Germany (Zi) and the Association of Statutory Health Insurance Dentists in Saxony-Anhalt (KZV LSA). The determinants, attitudes, and behaviors associated with use will be analyzed through (2) a cross-sectional survey as well as (3) qualitative data from semistructured interviews with residents of Saxony-Anhalt and from focus group discussions with physicians. (4) A stock take and systematic evaluation of digitally available informational material on colorectal cancer screening, by way of example, provides an insight into the information available as well as its quality. The conceptual framework of the study is the behavioral model of health services use by Andersen et al (last modified in 2014). Results: (1) The Zi and KZV LSA are currently preparing the requested claims data. (2) The survey was carried out from April 2021 to June 2021 in 2 urban and 2 rural municipalities (encompassing a small town and surrounding area) in Saxony-Anhalt. In total, 3665 people were contacted, with a response rate of 25.84% (n=954). (3) For the semistructured interviews, 18 participants from the 4 different study regions were recruited in the same period. A total of 4 general practitioners and 3 medical specialists participated in 2 focus group discussions. (4) For the systematic evaluation of existing informational material on colorectal cancer screening, 37 different informational materials were identified on the websites of 16 health care actors. Conclusions: This study will provide current and reliable data on the use of preventive services in the 55-plus age group in Saxony-Anhalt. It will yield insights into the determinants, reasons, and barriers associated with their utilization. The results will reveal the potential for preventive measures and enable concrete recommendations for action for the target population of the study. Trial Registration: German Clinical Trials Register DRKS00024059; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024059 International Registered Report Identifier (IRRID): DERR1-10.2196/33512 %M 35019847 %R 10.2196/33512 %U https://www.researchprotocols.org/2022/1/e33512 %U https://doi.org/10.2196/33512 %U http://www.ncbi.nlm.nih.gov/pubmed/35019847 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29876 %T The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic %A Pham,Quynh %A El-Dassouki,Noor %A Lohani,Raima %A Jebanesan,Aravinth %A Young,Karen %+ Centre for Global eHealth Innovation, Techna Institute, University Health Network, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 4765, Q.Pham@uhn.ca %K virtual care %K digital health %K health equity %K cultural equity %K chronic disease %K caregivers %K ethnocultural minority %K older adults %K ethnicity %K ethnic patients %K technology-mediated care %K equity %K diversity %K family %D 2022 %7 7.1.2022 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic has fundamentally changed how Canadians access health care. Although it is undeniable that the rapid adoption of virtual care has played a critical role in reducing viral transmission, the gap in equitable access to virtual care remains pervasive for Canada’s aging and ethnocultural minority communities. Existing virtual care solutions are designed for the English-speaking, health-literate, and tech-savvy patient population, excluding older ethnic adults who often do not see themselves reflected in these identities. In acknowledging the permanency of virtual care brought on by the pandemic, we have a collective responsibility to co-design new models that serve our older ethnic patients who have been historically marginalized by the status quo. Building on existing foundations of caregiving within ethnocultural minority communities, one viable strategy to realize culturally equitable virtual care may be to engage the highly motivated and skilled family caregivers of older ethnic adults as partners in the technology-mediated management of their chronic disease. The time is now to build a model of shared virtual care that embraces Canada’s diverse cultures, while also providing its older ethnic adults with access to health innovations in partnership with equally invested family caregivers who have their health at heart. %M 34994707 %R 10.2196/29876 %U https://www.jmir.org/2022/1/e29876 %U https://doi.org/10.2196/29876 %U http://www.ncbi.nlm.nih.gov/pubmed/34994707 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e26185 %T The Effects of the ManageHF4Life Mobile App on Patients With Chronic Heart Failure: Randomized Controlled Trial %A Dorsch,Michael P %A Farris,Karen B %A Rowell,Brigid E %A Hummel,Scott L %A Koelling,Todd M %+ Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI, 48109, United States, 1 734 647 1452, mdorsch@med.umich.edu %K mHealth %K remote monitoring %K self-management %K self-care %K heart failure %K medical therapy %K mobile app %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The successful management of heart failure (HF) involves guideline-based medical therapy as well as self-management behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. Objective: The aim of this paper was to evaluate the efficacy of enhanced self-management via a mobile app intervention on health-related quality of life, self-management, and HF readmissions. Methods: A single-center randomized controlled trial was performed. Participants older than 45 years and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group (“app group”) used a mobile app, and the intervention prompted daily self-monitoring and promoted self-management. The control group (“no-app group”) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire score and recurrent HF admissions. Results: A total of 83 participants were enrolled and completed all baseline assessments. Baseline characteristics were similar between the groups except for the prevalence of ischemic HF. The app group had a reduced MLHFQ at 6 weeks (mean 37.5, SD 3.5 vs mean 48.2, SD 3.7; P=.04) but not at 12 weeks (mean 44.2, SD 4 vs mean 45.9, SD 4; P=.78), compared to the no-app group. There was no effect of the app on the SCHFI at 6 or 12 weeks. The time to first HF readmission was not statistically different between the app group and the no-app group (app group 11/42, 26% vs no-app group 12/41, 29%; hazard ratio 0.89, 95% CI 0.39-2.02; P=.78) over 12 weeks. Conclusions: The adaptive mobile app intervention, which focused on promoting self-monitoring and self-management, improved the MLHFQ at 6 weeks but did not sustain its effects at 12 weeks. No effect was seen on HF self-management measured by self-report. Further research is needed to enhance engagement in the app for a longer period and to determine if the app can reduce HF readmissions in a larger study. Trial Registration: ClinicalTrials.gov NCT03149510; https://clinicaltrials.gov/ct2/show/NCT03149510 %M 34878990 %R 10.2196/26185 %U https://mhealth.jmir.org/2021/12/e26185 %U https://doi.org/10.2196/26185 %U http://www.ncbi.nlm.nih.gov/pubmed/34878990 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e25887 %T Effects of Digital Technologies on Older People’s Access to Health and Social Care: Umbrella Review %A Kunonga,Tafadzwa Patience %A Spiers,Gemma Frances %A Beyer,Fiona R %A Hanratty,Barbara %A Boulton,Elisabeth %A Hall,Alex %A Bower,Peter %A Todd,Chris %A Craig,Dawn %+ National Institute for Health Research Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, United Kingdom, 44 1912086260, patience.kunonga@newcastle.ac.uk %K digital health %K social care %K access %K older adults %K review of reviews %K umbrella review %D 2021 %7 24.11.2021 %9 Review %J J Med Internet Res %G English %X Background: The 2020 COVID-19 pandemic prompted the rapid implementation of new and existing digital technologies to facilitate access to health and care services during physical distancing. Older people may be disadvantaged in that regard if they are unable to use or have access to smartphones, tablets, computers, or other technologies. Objective: In this study, we synthesized evidence on the impact of digital technologies on older adults’ access to health and social services. Methods: We conducted an umbrella review of systematic reviews published from January 2000 to October 2019 using comprehensive searches of 6 databases. We looked for reviews in a population of adults aged ≥65 years in any setting, reporting outcomes related to the impact of technologies on access to health and social care services. Results: A total of 7 systematic reviews met the inclusion criteria, providing data from 77 randomized controlled trials and 50 observational studies. All of them synthesized findings from low-quality primary studies, 2 of which used robust review methods. Most of the reviews focused on digital technologies to facilitate remote delivery of care, including consultations and therapy. No studies examined technologies used for first contact access to care, such as online appointment scheduling. Overall, we found no reviews of technology to facilitate first contact access to health and social care such as online appointment booking systems for older populations. Conclusions: The impact of digital technologies on equitable access to services for older people is unclear. Research is urgently needed in order to understand the positive and negative consequences of digital technologies on health care access and to identify the groups most vulnerable to exclusion. %M 34821564 %R 10.2196/25887 %U https://www.jmir.org/2021/11/e25887 %U https://doi.org/10.2196/25887 %U http://www.ncbi.nlm.nih.gov/pubmed/34821564 %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 %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26486 %T Prediction of Readmission in Geriatric Patients From Clinical Notes: Retrospective Text Mining Study %A Goh,Kim Huat %A Wang,Le %A Yeow,Adrian Yong Kwang %A Ding,Yew Yoong %A Au,Lydia Shu Yi %A Poh,Hermione Mei Niang %A Li,Ke %A Yeow,Joannas Jie Lin %A Tan,Gamaliel Yu Heng %+ Nanyang Business School, Nanyang Technological University, S3-B2A-34, 50 Nanyang Avenue, Singapore, 639798, Singapore, 65 67904808, akhgoh@ntu.edu.sg %K geriatrics %K readmission risk %K artificial intelligence %K text mining %K psychosocial factors %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Prior literature suggests that psychosocial factors adversely impact health and health care utilization outcomes. However, psychosocial factors are typically not captured by the structured data in electronic medical records (EMRs) but are rather recorded as free text in different types of clinical notes. Objective: We here propose a text-mining approach to analyze EMRs to identify older adults with key psychosocial factors that predict adverse health care utilization outcomes, measured by 30-day readmission. The psychological factors were appended to the LACE (Length of stay, Acuity of the admission, Comorbidity of the patient, and Emergency department use) Index for Readmission to improve the prediction of readmission risk. Methods: We performed a retrospective analysis using EMR notes of 43,216 hospitalization encounters in a hospital from January 1, 2017 to February 28, 2019. The mean age of the cohort was 67.51 years (SD 15.87), the mean length of stay was 5.57 days (SD 10.41), and the mean intensive care unit stay was 5% (SD 22%). We employed text-mining techniques to extract psychosocial topics that are representative of these patients and tested the utility of these topics in predicting 30-day hospital readmission beyond the predictive value of the LACE Index for Readmission. Results: The added text-mined factors improved the area under the receiver operating characteristic curve of the readmission prediction by 8.46% for geriatric patients, 6.99% for the general hospital population, and 6.64% for frequent admitters. Medical social workers and case managers captured more of the psychosocial text topics than physicians. Conclusions: The results of this study demonstrate the feasibility of extracting psychosocial factors from EMR clinical notes and the value of these notes in improving readmission risk prediction. Psychosocial profiles of patients can be curated and quantified from text mining clinical notes and these profiles can be successfully applied to artificial intelligence models to improve readmission risk prediction. %M 34665149 %R 10.2196/26486 %U https://www.jmir.org/2021/10/e26486 %U https://doi.org/10.2196/26486 %U http://www.ncbi.nlm.nih.gov/pubmed/34665149 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27499 %T Identifying Frequent Health Care Users and Care Consumption Patterns: Process Mining of Emergency Medical Services Data %A Maruster,Laura %A van der Zee,Durk-Jouke %A Buskens,Erik %+ Faculty of Economics and Business, University of Groningen, Nettelbosje 2, Groningen, 9747 AE, Netherlands, 31 50 3637316, l.maruster@rug.nl %K process mining %K frequent users %K hospital care %K emergency medical services %K regional care networks %K elderly %K Netherlands %D 2021 %7 6.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Tracing frequent users of health care services is highly relevant to policymakers and clinicians, enabling them to avoid wasting scarce resources. Data collection on frequent users from all possible health care providers may be cumbersome due to patient privacy, competition, incompatible information systems, and the efforts involved. Objective: This study explored the use of a single key source, emergency medical services (EMS) records, to trace and reveal frequent users’ health care consumption patterns. Methods: A retrospective study was performed analyzing EMS calls from the province of Drenthe in the Netherlands between 2012 and 2017. Process mining was applied to identify the structure of patient routings (ie, their consecutive visits to hospitals, nursing homes, and EMS). Routings are used to identify and quantify frequent users, recognizing frail elderly users as a focal group. The structure of these routes was analyzed at the patient and group levels, aiming to gain insight into regional coordination issues and workload distributions among health care providers. Results: Frail elderly users aged 70 years or more represented over 50% of frequent users, making 4 or more calls per year. Over the period of observation, their annual number and the number of calls increased from 395 to 628 and 2607 to 3615, respectively. Structural analysis based on process mining revealed two categories of frail elderly users: low-complexity patients who need dialysis, radiation therapy, or hyperbaric medicine, involving a few health care providers, and high-complexity patients for whom routings appear chaotic. Conclusions: This efficient approach exploits the role of EMS as the unique regional “ferryman,” while the combined use of EMS data and process mining allows for the effective and efficient tracing of frequent users’ utilization of health care services. The approach informs regional policymakers and clinicians by quantifying and detailing frequent user consumption patterns to support subsequent policy adaptations. %M 34612834 %R 10.2196/27499 %U https://www.jmir.org/2021/10/e27499 %U https://doi.org/10.2196/27499 %U http://www.ncbi.nlm.nih.gov/pubmed/34612834 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26744 %T The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review %A Auener,Stefan L %A Remers,Toine E P %A van Dulmen,Simone A %A Westert,Gert P %A Kool,Rudolf B %A Jeurissen,Patrick P T %+ IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, Netherlands, 31 243616359, stefan.auener@radboudumc.nl %K heart failure %K telemonitoring %K remote monitoring %K health care utilization %K eHealth %D 2021 %7 29.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. Objective: This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. Methods: We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used P<.05 and CIs not including 1.00 to determine whether the effect was statistically significant. Results: We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38% (9/24) of studies, whereas emergency department visits were reduced in 13% (1/8) of studies. An increase in nonemergency department visits (6/9, 67% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. Conclusions: Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs. %M 34586072 %R 10.2196/26744 %U https://www.jmir.org/2021/9/e26744 %U https://doi.org/10.2196/26744 %U http://www.ncbi.nlm.nih.gov/pubmed/34586072 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 13 %N 1 %P e11582 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2021 %7 ..2021 %9 %J Online J Public Health Inform %G English %X How might clinicians collect the vitals needed for effective scheduled video visits for older adults? This challenge was presented by AARP to graduate students in a Digital Health course at Tufts University School of Medicine. The design thinking process was used to create a product that would meet this need, keeping the needs and constraints of older adults, especially those with chronic conditions or other barriers to health, central to the solution. The initial steps involved understanding and empathizing with the target audience through interviews and by developing personas and scenarios that identified barriers and opportunities. The later steps were to ideate potential solutions, design a prototype, and define product success. The design thinking process led to the design of Home Health Hub, a remote patient monitoring (RPM) platform designed to meet the unique needs of older adults. Additionally, Home Health Hub can conceivably benefit all users of telehealth, regardless of health status—an important need during the COVID-19 pandemic, and in general due to increased use of virtual visits. Home Health Hub is one example of what can be achieved with the dedicated use of design thinking. The design thinking process can benefit public health practice as a whole by encouraging practitioners to delve into a problem to find the root causes and empathize with the needs and constraints of stakeholders to design innovative, human-centered solutions. %M 34178243 %R 10.5210/ojphi.v13i1.11582 %U %U https://doi.org/10.5210/ojphi.v13i1.11582 %U http://www.ncbi.nlm.nih.gov/pubmed/34178243 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e20196 %T Community-Integrated Intermediary Care (CIIC) Service Model to Enhance Family-Based, Long-Term Care for Older People: Protocol for a Cluster Randomized Controlled Trial in Thailand %A Aung,Myo Nyein %A Moolphate,Saiyud %A Yuasa,Motoyuki %A Aung,Thin Nyein Nyein %A Koyanagi,Yuka %A Supakankunti,Siripen %A Ahmad,Ishtiaq %A Kayano,Ryoma %A Ong,Paul %+ Advanced Research Institute for Health Sciences and Faculty of International Liberal Arts, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, 81 3 3813 3111, dr.myonyeinaung@gmail.com %K aging %K Asia %K care prevention %K health promotion %K long-term care %K implementation research %D 2021 %7 24.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Thailand is one of the most rapidly aging countries in Asia. Traditional family-based care, which has been the basis of most care for older people, is becoming unsustainable as families become smaller. In addition, women tend to be adversely affected as they still form the bulk of caregivers for older people, and many are likely to exit the labor market in order to provide care. Many family caregivers also have no or minimal training, and they may be called upon to provide quite complex care, increasing the proportion of older people receiving suboptimal care if they rely only on informal care that is provided by families and friends. Facing the increasing burden of noncommunicable diseases and age-related morbidity, Thai communities are increasingly in need of community-integrated care models for older persons that can link existing health systems and reduce the burden upon caring families. This need is common to many countries in the Association of Southeast Asian Nations (ASEAN). Objective: In this study, we aimed to assess the effectiveness of a community-integrated intermediary care (CIIC) model to enhance family-based care for older people. Methods: This paper describes a cluster randomized controlled trial comprised of 6 intervention clusters and 6 control clusters that aim to recruit 2000 participants in each arm. This research protocol has been approved by the World Health Organization Ethics Review Committee. The intervention clusters will receive an integrated model of care structured around (1) a community respite service, (2) the strengthening of family care capacity, and (3) an exercise program that aims to prevent entry into long-term care for older people. Control group clusters receive usual care (ie, the current system of long-term care common to all provinces in Thailand), consisting principally of a volunteer-assisted home care service. The trial will be conducted over a period of 2 years. The primary outcome is family caregiver burden measured at a 6-month follow-up, as measured by the Caregiver Burden Inventory. Secondary outcomes consist of biopsychosocial indicators including functional ability, as measured using an activity of daily living scale; depression, as measured by the Geriatric Depression Scale; and quality of life of older people, as measured by the EuroQol 5-dimensions 5-levels scale. Intention-to-treat analysis will be followed. Results: The CIIC facility has been established. Community care prevention programs have been launched at the intervention clusters. Family caregivers are receiving training and assistance. However, the COVID-19 pandemic delayed the intervention. Conclusions: Since ASEAN and many Asian countries share similar traditional family-based, long-term care systems, the proposed CIIC model and the protocol for its implementation and evaluation may benefit other countries wishing to adopt similar community-integrated care models for older people at risk of needing long-term care. Trial Registration: Thai Clinical Trials Registry TCTR20190412004; http://www.thaiclinicaltrials.org/# International Registered Report Identifier (IRRID): DERR1-10.2196/20196 %M 33759787 %R 10.2196/20196 %U https://www.researchprotocols.org/2021/3/e20196 %U https://doi.org/10.2196/20196 %U http://www.ncbi.nlm.nih.gov/pubmed/33759787 %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 %@ 2152-7202 %I JMIR Publications %V 12 %N 3 %P e21214 %T Supporting the Implementation of Connected Care Technologies in the Veterans Health Administration: Cross-Sectional Survey Findings from the Veterans Engagement with Technology Collaborative (VET-C) Cohort %A Etingen,Bella %A Amante,Daniel J %A Martinez,Rachael N %A Smith,Bridget M %A Shimada,Stephanie L %A Richardson,Lorilei %A Patterson,Angela %A Houston,Thomas K %A Frisbee,Kathleen L %A Hogan,Timothy P %+ Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, 5000 5th Ave, Hines, IL, 60141, United States, 1 708 202 4922, bella.etingen@va.gov %K eHealth %K mobile health %K patient engagement %K telehealth %K veterans %D 2020 %7 30.9.2020 %9 Original Paper %J J Participat Med %G English %X Background: Widespread adoption, use, and integration of patient-facing technologies into the workflow of health care systems has been slow, thus limiting the realization of their potential. A growing body of work has focused on how best to promote adoption and use of these technologies and measure their impacts on processes of care and outcomes. This body of work currently suffers from limitations (eg, cross-sectional analyses, limited patient-generated data linked with clinical records) and would benefit from institutional infrastructure to enhance available data and integrate the voice of the patient into implementation and evaluation efforts. Objective: The Veterans Health Administration (VHA) has launched an initiative called the Veterans Engagement with Technology Collaborative cohort to directly address these challenges. This paper reports the process by which the cohort was developed and describes the baseline data being collected from cohort members. The overarching goal of the Veterans Engagement with Technology Collaborative cohort is to directly engage veterans in the evaluation of new VHA patient-facing technologies and in so doing, to create new infrastructure to support related quality improvement and evaluation activities. Methods: Inclusion criteria for veterans to be eligible for membership in the cohort included being an active user of VHA health care services, having a mobile phone, and being an established user of existing VHA patient-facing technologies as represented by use of the secure messaging feature of VHA’s patient portal. Between 2017 and 2018, we recruited veterans who met these criteria and administered a survey to them over the telephone. Results: The majority of participants (N=2727) were male (2268/2727, 83.2%), White (2226/2727, 81.6%), living in their own apartment or house (2519/2696, 93.4%), and had completed some college (1176/2701, 43.5%) or an advanced degree (1178/2701, 43.6%). Cohort members were 59.9 years old, on average. The majority self-reported their health status as being good (1055/2725, 38.7%) or very good (524/2725, 19.2%). Most cohort members owned a personal computer (2609/2725, 95.7%), tablet computer (1616/2716, 59.5%), and/or smartphone (2438/2722, 89.6%). Conclusions: The Veterans Engagement with Technology Collaborative cohort is an example of a VHA learning health care system initiative designed to support the data-driven implementation of patient-facing technologies into practice and measurement of their impacts. With this initiative, VHA is building capacity for future, rapid, rigorous evaluation and quality improvement efforts to enhance understanding of the adoption, use, and impact of patient-facing technologies. %M 33044944 %R 10.2196/21214 %U http://jopm.jmir.org/2020/3/e21214/ %U https://doi.org/10.2196/21214 %U http://www.ncbi.nlm.nih.gov/pubmed/33044944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16213 %T Comparisons Between Hypothesis- and Data-Driven Approaches for Multimorbidity Frailty Index: A Machine Learning Approach %A Peng,Li-Ning %A Hsiao,Fei-Yuan %A Lee,Wei-Ju %A Huang,Shih-Tsung %A Chen,Liang-Kung %+ Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan, 886 2 28757830, lkchen2@vghtpe.gov.tw %K multimorbidity frailty index %K machine learning %K random forest %K unplanned hospitalizations %K intensive care unit admissions %K mortality %D 2020 %7 11.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Using big data and the theory of cumulative deficits to develop the multimorbidity frailty index (mFI) has become a widely accepted approach in public health and health care services. However, constructing the mFI using the most critical determinants and stratifying different risk groups with dose-response relationships remain major challenges in clinical practice. Objective: This study aimed to develop the mFI by using machine learning methods that select variables based on the optimal fitness of the model. In addition, we aimed to further establish 4 entities of risk using a machine learning approach that would achieve the best distinction between groups and demonstrate the dose-response relationship. Methods: In this study, we used Taiwan’s National Health Insurance Research Database to develop a machine learning multimorbidity frailty index (ML-mFI) using the theory of cumulative diseases/deficits of an individual older person. Compared to the conventional mFI, in which the selection of diseases/deficits is based on expert opinion, we adopted the random forest method to select the most influential diseases/deficits that predict adverse outcomes for older people. To ensure that the survival curves showed a dose-response relationship with overlap during the follow-up, we developed the distance index and coverage index, which can be used at any time point to classify the ML-mFI of all subjects into the categories of fit, mild frailty, moderate frailty, and severe frailty. Survival analysis was conducted to evaluate the ability of the ML-mFI to predict adverse outcomes, such as unplanned hospitalizations, intensive care unit (ICU) admissions, and mortality. Results: The final ML-mFI model contained 38 diseases/deficits. Compared with conventional mFI, both indices had similar distribution patterns by age and sex; however, among people aged 65 to 69 years, the mean mFI and ML-mFI were 0.037 (SD 0.048) and 0.0070 (SD 0.0254), respectively. The difference may result from discrepancies in the diseases/deficits selected in the mFI and the ML-mFI. A total of 86,133 subjects aged 65 to 100 years were included in this study and were categorized into 4 groups according to the ML-mFI. Both the Kaplan-Meier survival curves and Cox models showed that the ML-mFI significantly predicted all outcomes of interest, including all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions at 1, 5, and 8 years of follow-up (P<.01). In particular, a dose-response relationship was revealed between the 4 ML-mFI groups and adverse outcomes. Conclusions: The ML-mFI consists of 38 diseases/deficits that can successfully stratify risk groups associated with all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions in older people, which indicates that precise, patient-centered medical care can be a reality in an aging society. %M 32525481 %R 10.2196/16213 %U http://www.jmir.org/2020/6/e16213/ %U https://doi.org/10.2196/16213 %U http://www.ncbi.nlm.nih.gov/pubmed/32525481 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e12517 %T The Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly: Combined Scoping and Systematic Intervention Review %A Berntsen,Gro %A Strisland,Frode %A Malm-Nicolaisen,Kristian %A Smaradottir,Berglind %A Fensli,Rune %A Røhne,Mette %+ Norwegian Center for E-health Research, University Hospital of North Norway, PB 35, 9038 Tromsø, Tromsø, 9038, Norway, 47 90518895, gro.rosvold.berntsen@ehealthresearch.no %K systematic review %K patient-centered care %K delivery of health care, integrated %K secondary prevention %K risk management %D 2019 %7 22.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a call for bold and innovative action to transform the current care systems to meet the needs of an increasing population of frail multimorbid elderly. International health organizations propose complex transformations toward digitally supported (1) Person-centered, (2) Integrated, and (3) Proactive care (Digi-PIP care). However, uncertainty regarding both the design and effects of such care transformations remain. Previous reviews have found favorable but unstable impacts of each key element, but the maturity and synergies of the combination of elements are unexplored. Objective: This study aimed to describe how the literature on whole system complex transformations directed at frail multimorbid elderly reflects (1) operationalization of intervention, (2) maturity, (3) evaluation methodology, and (4) effect on outcomes. Methods: We performed a systematic health service and electronic health literature review of care transformations targeting frail multimorbid elderly. Papers including (1) Person-centered, integrated, and proactive (PIP) care; (2) at least 1 digital support element; and (3) an effect evaluation of patient health and/ or cost outcomes were eligible. We used a previously published ideal for the quality of care to structure descriptions of each intervention. In a secondary deductive-inductive analysis, we collated the descriptions to create an outline of the generic elements of a Digi-PIP care model. The authors then reviewed each intervention regarding the presence of critical elements, study design quality, and intervention effects. Results: Out of 927 potentially eligible papers, 10 papers fulfilled the inclusion criteria. All interventions idealized Person-centered care, but only one intervention made what mattered to the person visible in the care plan. Care coordinators responsible for a whole-person care plan, shared electronically in some instances, was the primary integrated care strategy. Digitally supported risk stratification and management were the main proactive strategies. No intervention included workflow optimization, monitoring of care delivery, or patient-reported outcomes. All interventions had gaps in the chain of care that threatened desired outcomes. After evaluation of study quality, 4 studies remained. They included outcome analyses on patient satisfaction, quality of life, function, disease process quality, health care utilization, mortality, and staff burnout. Only 2 of 24 analyses showed significant effects. Conclusions: Despite a strong common-sense belief that the Digi-PIP ingredients are key to sustainable care in the face of the silver tsunami, research has failed to produce evidence for this. We found that interventions reflect a reductionist paradigm, which forces care workers into standardized narrowly focused interventions for complex problems. There is a paucity of studies that meet complex needs with digitally supported flexible and adaptive teamwork. We predict that consistent results from care transformations for frail multimorbid elderly hinges on an individual care pathway, which reflects a synergetic PIP approach enabled by digital support. %M 31008706 %R 10.2196/12517 %U http://www.jmir.org/2019/4/e12517/ %U https://doi.org/10.2196/12517 %U http://www.ncbi.nlm.nih.gov/pubmed/31008706 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e10254 %T Health Care Cost Analyses for Exploring Cost Savings Opportunities in Older Patients: Longitudinal Retrospective Study %A Agboola,Stephen %A Simons,Mariana %A Golas,Sara %A op den Buijs,Jorn %A Felsted,Jennifer %A Fischer,Nils %A Schertzer,Linda %A Orenstein,Allison %A Jethwani,Kamal %A Kvedar,Joseph %+ Connected Health Innovation, Partners Healthcare, 25 New Chardon Street, Suite 300, Boston, MA, 02114, United States, 1 617 643 0291, sagboola@partners.org %K health care cost analysis %K cost acuity pyramid %K patient segmentation %K multicenter study %K Markov chains %D 2018 %7 01.08.2018 %9 Original Paper %J JMIR Aging %G English %X Background: Half of Medicare reimbursement goes toward caring for the top 5% of the most expensive patients. However, little is known about these patients prior to reaching the top or how their costs change annually. To address these gaps, we analyzed patient flow and associated health care cost trends over 5 years. Objective: To evaluate the cost of health care utilization in older patients by analyzing changes in their long-term expenditures. Methods: This was a retrospective, longitudinal, multicenter study to evaluate health care costs of 2643 older patients from 2011 to 2015. All patients had at least one episode of home health care during the study period and used a personal emergency response service (PERS) at home for any length of time during the observation period. We segmented all patients into top (5%), middle (6%-50%), and bottom (51%-100%) segments by their annual expenditures and built cost pyramids based thereon. The longitudinal health care expenditure trends of the complete study population and each segment were assessed by linear regression models. Patient flows throughout the segments of the cost acuity pyramids from year to year were modeled by Markov chains. Results: Total health care costs of the study population nearly doubled from US $17.7M in 2011 to US $33.0M in 2015 with an expected annual cost increase of US $3.6M (P=.003). This growth was primarily driven by a significantly higher cost increases in the middle segment (US $2.3M, P=.003). The expected annual cost increases in the top and bottom segments were US $1.2M (P=.008) and US $0.1M (P=.004), respectively. Patient and cost flow analyses showed that 18% of patients moved up the cost acuity pyramid yearly, and their costs increased by 672%. This was in contrast to 22% of patients that moved down with a cost decrease of 86%. The remaining 60% of patients stayed in the same segment from year to year, though their costs also increased by 18%. Conclusions: Although many health care organizations target intensive and costly interventions to their most expensive patients, this analysis unveiled potential cost savings opportunities by managing the patients in the lower cost segments that are at risk of moving up the cost acuity pyramid. To achieve this, data analytics integrating longitudinal data from electronic health records and home monitoring devices may help health care organizations optimize resources by enabling clinicians to proactively manage patients in their home or community environments beyond institutional settings and 30- and 60-day telehealth services. %M 31518241 %R 10.2196/10254 %U http://aging.jmir.org/2018/2/e10254/ %U https://doi.org/10.2196/10254 %U http://www.ncbi.nlm.nih.gov/pubmed/31518241 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e200 %T The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points %A Shim,Hyunju %A Ailshire,Jennifer %A Zelinski,Elizabeth %A Crimmins,Eileen %+ USC Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., Los Angeles, CA, 90089-0191, United States, 1 2137405156, hyunjush@usc.edu %K health information technology %K health services %K disease management %K chronic disease %K geriatrics %D 2018 %7 25.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known. Objective: This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions. Methods: The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested. Results: A total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times. Conclusions: The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions. %M 29802088 %R 10.2196/jmir.8203 %U http://www.jmir.org/2018/5/e200/ %U https://doi.org/10.2196/jmir.8203 %U http://www.ncbi.nlm.nih.gov/pubmed/29802088 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e10 %T Health Information–Seeking Behavior of Seniors Who Use the Internet: A Survey %A Medlock,Stephanie %A Eslami,Saeid %A Askari,Marjan %A Arts,Derk L %A Sent,Danielle %A de Rooij,Sophia E %A Abu-Hanna,Ameen %+ Academic Medical Center, Depatment of Medical Informatics, University of Amsterdam, PO Box 22700, Amsterdam, 1100 DE, Netherlands, 31 020 5664543, s.k.medlock@amc.uva.nl %K aged %K aged, 80 and over %K information-seeking behavior %K Internet %K patient education %K empowerment %D 2015 %7 08.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is viewed as an important source for health information and a medium for patient empowerment. However, little is known about how seniors use the Internet in relation to other sources for health information. Objective: The aim was to determine which information resources seniors who use the Internet use and trust for health information, which sources are preferred, and which sources are used by seniors for different information needs. Methods: Questions from published surveys were selected based on their relevance to the study objectives. The Autonomy Preference Index was used to assess information needs and preferences for involvement in health decisions. Invitation to participate in this online survey was sent to the email list of a local senior organization (298 addresses) in the Netherlands. Results: There were 118 respondents with a median age of 72 years (IQR 67-78 years). Health professionals, pharmacists, and the Internet were the most commonly used and trusted sources of health information. Leaflets, television, newspapers, and health magazines were also important sources. Respondents who reported higher use of the Internet also reported higher use of other sources (P<.001). Use of health professionals, pharmacists, leaflets, telephone, television, and radio were not significantly different; use of all other resources was significantly higher in frequent Internet users. When in need of health information, preferred sources were the Internet (46/105, 43.8%), other sources (eg, magazines 38/105, 36.2%), health professionals (18/105, 17.1%), and no information seeking (3/105, 2.8%). Of the 51/107 respondents who indicated that they had sought health information in the last 12 months, 43 sought it after an appointment, 23 were preparing for an appointment, and 20 were deciding if an appointment was needed. The source used varied by the type of information sought. The Internet was used most often for symptoms (27/42, 64%), prognosis (21/31, 68%), and treatment options (23/41, 62%), whereas health professionals were asked for additional information on medications (20/36, 56%), side effects (17/36, 47%), coping (17/31, 55%), practical care (12/14, 86%), and nutrition/exercise (18/30, 60%). Conclusions: For these seniors who use the Internet, the Internet was a preferred source of health information. Seniors who report higher use of the Internet also report higher use of other information resources and were also the primary consumers of paper-based resources. Respondents most frequently searched for health information after an appointment rather than to prepare for an appointment. Resources used varied by health topic. Future research should seek to confirm these findings in a general elderly population, investigate how seniors seek and understand information on the Internet, and investigate how to reach seniors who prefer not to use the Internet for health information. %M 25574815 %R 10.2196/jmir.3749 %U http://www.jmir.org/2015/1/e10/ %U https://doi.org/10.2196/jmir.3749 %U http://www.ncbi.nlm.nih.gov/pubmed/25574815