%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63928 %T Assessment of Gait Parameters Using Wearable Sensors and Their Association With Muscle Mass, Strength, and Physical Performance in Korean Older Adults: Cross-Sectional Study %A Shin,Jinyoung %A Kweon,Hyuk Jung %A Choi,Jaekyung %K gait analysis %K sarcopenia %K wearable electronic devices %K muscle mass %K physical performance %K older adults %K geriatric %K cross-sectional study %K outpatient clinic %K Korea %K mHealth %K mobile health %D 2025 %7 10.4.2025 %9 %J JMIR Form Res %G English %X Background: Gait speed indicates the onset or decline of physical performance in sarcopenia. However, real-time measurements of other gait parameters, such as step length, stride length, step width, and support time, are limited. The advent of wearable technology has facilitated the measurement of these parameters, necessitating further investigation into their potential applications. Objective: This study aimed to investigate the relationship between gait parameters measured using wearable sensors and muscle mass, strength, and physical performance in community-dwelling older adults. Methods: In a cross-sectional study of 91 participants aged ≥65 years, gait parameters, such as step count, step length, cadence, single and double support times, vertical oscillation, and instantaneous vertical loading rate (IVLR), measured using a wireless earbud device, were analyzed on the basis of the appendicular skeletal muscle mass index (SMI), calf circumference, handgrip strength, 5-time chair stand test, short physical performance battery (SPPB), and the SARC-F (strength, assistance with walking, rise from a chair, climb stairs and fall frequency) questionnaire. This study was conducted from July 10 to November 1, 2023, at an outpatient clinic of a university hospital in Seoul, Korea. Multiple regression analysis was performed to investigate independent associations after adjusting for age, sex, BMI, and comorbidities. Results: Among 91 participants (45 men and 46 women; mean age 74.1 years for men and 73.6 years for women), gait speed and vertical oscillation showed negative associations with their performance in the 5-time chair stand test (P<.001) and SARC-F and positive associations with their performance in the SPPB (P<.001). Vertical oscillations were also associated with grip strength (P=.003). Single and double support times were associated with performance in the 5-time chair stand test and SPPB (P<.001). In addition, double support time was associated with SARC-F scores (P<.001). Gait speed, support time, vertical oscillation, and IVLR showed independent associations with performance in the 5-time chair stand test and SPPB (P<.001), both related to muscle strength or physical performance. Gait speed, double support time, and vertical oscillation all had significant associations with SARC-F scores. Conclusions: This study demonstrated a significant association between gait monitoring using wearable sensors and quantitative assessments of muscle strength and physical performance in older people. Furthermore, this study substantiated the extensive applicability of diverse gait parameters in predicting sarcopenia. %R 10.2196/63928 %U https://formative.jmir.org/2025/1/e63928 %U https://doi.org/10.2196/63928 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64324 %T Patient-Related Barriers to Digital Technology Adoption in Alzheimer Disease: Systematic Review %A Panzavolta,Andrea %A Arighi,Andrea %A Guido,Emanuele %A Lavorgna,Luigi %A Di Lorenzo,Francesco %A Dodich,Alessandra %A Cerami,Chiara %K digital technology %K digital e-health %K accessibility %K user-friendliness %K neurocognitive disorders %K Alzheimer disease %K dementia %D 2025 %7 10.4.2025 %9 %J JMIR Aging %G English %X Background: Digital technology in dementia is an area of great development with varying experiences across countries. However, novel digital solutions often lack a patient-oriented perspective, and several relevant barriers prevent their use in clinics. Objective: In this study, we reviewed the existing literature on knowledge, familiarity, and competence in using digital technology and on attitude and experiences with digital tools in Alzheimer disease. The main research question is whether digital competence and attitudes of patients and caregivers may affect the adoption of digital technology. Methods: Following the PRISMA guidelines, a literature search was conducted by two researchers in the group. Inter-rater reliability was calculated with Cohen κ statistics. The risk of bias assessment was also recorded. Results: Of 597 initial records, only 18 papers were considered eligible. Analyses of inter-rater reliability showed good agreement levels. Significant heterogeneity in study design, sample features, and measurement tools emerged across studies. Quality assessment showed a middle-high overall quality of evidence. The main factors affecting the adoption of digital technology in patients and caregivers are severity of cognitive deficits, timing of adoption, and the availability of training and support. Additional factors are age, type of digital device, and ease of use of the digital solution. Conclusions: Adoption of digital technology in dementia is hampered by many patient-related barriers. Improving digital competence in patient-caregiver dyads and implementing systematic, patient-oriented strategies for the development and use of digital tools are needed for a successful incorporation of digital technology in memory clinics. %R 10.2196/64324 %U https://aging.jmir.org/2025/1/e64324 %U https://doi.org/10.2196/64324 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67539 %T Effectiveness of the Safe Step Digital Exercise Program to Prevent Falls in Older Community-Dwelling Adults: Randomized Controlled Trial %A Pettersson,Beatrice %A Lundin-Olsson,Lillemor %A Skelton,Dawn A %A Liv,Per %A Zingmark,Magnus %A Rosendahl,Erik %A Sandlund,Marlene %+ , Department of Community Medicine and Rehabilitation, Umeå University, Universitetstorget 4, Umeå, 90187, Sweden, 46 907865224, beatrice.pettersson@umu.se %K geriatric medicine %K aging %K accidental falls %K independent living %K exercise therapy %K fall prevention %K electronic health %K mobile health %K preventive medicine %K self-management %K effectiveness %K randomized controlled trial %K older adults %K digital technology %D 2025 %7 31.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population. Objective: This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program. Methods: Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively. Results: In total, 1628 people were enrolled in the study, 79% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11%) in the exercise group compared to the control group (53% vs 59.6%; RR 0.89, 95% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1% in the exercise group, 37.1% in the control group; RR 0.92, 95% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9, and 12 months, respectively. Conclusions: Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population. Trial Registration: ClinicalTrials.gov NCT03963570; https://clinicaltrials.gov/study/NCT03963570 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-036194 %M 40163860 %R 10.2196/67539 %U https://www.jmir.org/2025/1/e67539 %U https://doi.org/10.2196/67539 %U http://www.ncbi.nlm.nih.gov/pubmed/40163860 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65269 %T Factors Influencing Health Care Technology Acceptance in Older Adults Based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology: Meta-Analysis %A Yang,Hyo Jun %A Lee,Ji-Hyun %A Lee,Wonjae %+ Graduate School of Culture Technology, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong District, Daejeon, 34141, Republic of Korea, 82 010 7341 4441, wnjlee@kaist.ac.kr %K technology adoption %K older adults %K health care technology %K technology acceptance model %K unified theory of acceptance and use of technology %K meta-analysis %D 2025 %7 28.3.2025 %9 Review %J J Med Internet Res %G English %X Background: The technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT) are widely used to examine health care technology acceptance among older adults. However, existing literature exhibits considerable heterogeneity, making it difficult to determine consistent predictors of acceptance and behavior. Objective: We aimed to (1) determine the influence of perceived usefulness (PU), perceived ease of use (PEOU), and social influence (SI) on the behavioral intention (BI) to use health care technology among older adults and (2) assess the moderating effects of age, gender, geographic region, type of health care technology, and presence of visual demonstrations. Methods: A systematic search was conducted across Google Scholar, Web of Science, Scopus, IEEE Xplore, and ProQuest databases on March 15, 2024, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Of the 1167 initially identified studies, 41 studies (11,574 participants; mean age 67.58, SD 4.76 years; and female:male ratio=2.00) met the inclusion criteria. The studies comprised 12 mobile health, 12 online or telemedicine, 9 wearable, and 8 home or institution hardware investigations, with 23 studies from Asia, 7 from Europe, 7 from African-Islamic regions, and 4 from the United States. Studies were eligible if they used the TAM or UTAUT, examined health care technology adoption among older adults, and reported zero-order correlations. Two independent reviewers screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale, evaluating selection, comparability, and outcome assessment with 34% (14/41) of studies rated as good quality and 66% (27/41) as satisfactory. Results: Random-effects meta-analysis revealed significant positive correlations for PU-BI (r=0.607, 95% CI 0.543-0.665; P<.001), PEOU-BI (r=0.525, 95% CI 0.462-0.583; P<.001), and SI-BI (r=0.551, 95% CI 0.468-0.624; P<.001). High heterogeneity was observed across studies (I²=95.9%, 93.6%, and 95.3% for PU-BI, PEOU-BI, and SI-BI, respectively). Moderator analyses revealed significant differences based on geographic region for PEOU-BI (Q=8.27; P=.04), with strongest effects in Europe (r=0.628) and weakest in African-Islamic regions (r=0.480). Technology type significantly moderated PU-BI (Q=8.08; P=.04) and SI-BI (Q=14.75; P=.002), with home or institutional hardware showing the strongest effects (PU-BI: r=0.736; SI-BI: r=0.690). Visual demonstrations significantly enhanced PU-BI (r=0.706 vs r=0.554; Q=4.24; P=.04) and SI-BI relationships (r=0.670 vs r=0.492; Q=4.38; P=.04). Age and gender showed no significant moderating effects. Conclusions: The findings indicate that PU, PEOU, and SI significantly impact the acceptance of health care technology among older adults, with heterogeneity influenced by geographic region, type of technology, and presence of visual demonstrations. This suggests that tailored strategies for different types of technology and the use of visual demonstrations are important for enhancing adoption rates. Limitations include varying definitions of older adults across studies and the use of correlation coefficients rather than controlled effect sizes. Results should therefore be interpreted within specific contexts and populations. %M 40153796 %R 10.2196/65269 %U https://www.jmir.org/2025/1/e65269 %U https://doi.org/10.2196/65269 %U http://www.ncbi.nlm.nih.gov/pubmed/40153796 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e67322 %T A Smartphone-Based Timed Up and Go Test Self-Assessment for Older Adults: Validity and Reliability Study %A Böttinger,Melissa Johanna %A Mellone,Sabato %A Klenk,Jochen %A Jansen,Carl-Philipp %A Stefanakis,Marios %A Litz,Elena %A Bredenbrock,Anastasia %A Fischer,Jan-Philipp %A Bauer,Jürgen M %A Becker,Clemens %A Gordt-Oesterwind,Katharina %K timed up and go test %K self-assessment %K instrumented assessment %K technology-based assess-ment %K physical capacity %K mobility %K aged %K mobile applications %K smartphone %K diagnostic self evaluation %D 2025 %7 21.3.2025 %9 %J JMIR Aging %G English %X Background: The Timed Up and Go test (TUG) is recommended as an evidence-based tool for measuring physical capacity. Instrumented TUG (iTUG) approaches expand classical supervised clinical applications offering the potential of self-assessment for older adults. Objective: This study aimed to evaluate the concurrent validity and test-retest reliability of a smartphone-based TUG self-assessment “up&go app.” Methods: A total of 52 community-dwelling older adults (>67 years old) were recruited. A validated and medically certified system attached with a belt at the lower back was used as a reference system to validate the “up&go app” algorithm. The participants repeated the TUG 5 times wearing, a smartphone with the “up&go app” in their front trouser pocket and an inertial sensor to test the concurrent validity. A subsample of 37 participants repeated the “up&go app” measurement 2 weeks later to examine the test-retest reliability. Results: The correlation between the “up&go app” and the reference measurement was r=0.99 for the total test duration and r=0.97 for the 5 single repetitions. Agreement between the 5 repetitions was intraclass correlation coefficient (ICC)=0.9 (0.84‐0.94). Leaving out the first repetition, the agreement was ICC=0.95 (0.92‐0.97). Test-retest agreement had an ICC=0.79 (0.53‐0.9). Conclusions: The duration of 5 repetitions of the TUG test, measured with the pocket-worn “up&go app,” was very consistent with the results of a lower-back sensor system, indicating excellent concurrent validity. Participants walked slower in the first round than in the other 4 repetitions within a test run. Test-retest reliability was also excellent. The “up&go app” provides a useful smartphone-based approach to measure 5 repetitions of the TUG. The app could be used by older adults as a self-screening and monitoring tool of physical capacity at home and thereby help to early identify functional limitations and take interventions when necessary. %R 10.2196/67322 %U https://aging.jmir.org/2025/1/e67322 %U https://doi.org/10.2196/67322 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64074 %T Values of Stakeholders Involved in Applying Surveillance Technology for People With Dementia in Nursing Homes: Scoping Review %A van Gaans-Riteco,Daniëlle %A Stoop,Annerieke %A Wouters,Eveline %+ Academic Collaborative Center Care for Older Adults, Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037DB, The Netherlands, 31 134662969, d.p.c.vangaans-riteco@tilburguniversity.edu %K surveillance technology %K nursing home %K stakeholders %K values %K dementia %K safety %D 2025 %7 20.3.2025 %9 Review %J JMIR Aging %G English %X Background: Due to the progressive nature of dementia, concerns about the safety of nursing home residents are frequently raised. Surveillance technology, enabling visual and auditory monitoring, is often seen as a solution for ensuring safe and efficient care. However, tailoring surveillance technology to individual needs is challenging due to the complex and dynamic care environment involving multiple formal and informal stakeholders, each with unique perspectives. Objective: This study aims to explore the scientific literature on the perspectives and values of stakeholders involved in applying surveillance technology for people with dementia in nursing homes. Methods: We conducted a scoping review and systematically searched 5 scientific databases. We identified 31 articles published between 2005 and 2024. Stakeholder characteristics were extracted and synthesized according to the theory of basic human values by Schwartz. Results: In total, 12 stakeholder groups were identified, with nursing staff, residents, and informal caregivers being the most frequently mentioned. Among stakeholder groups close to residents, values related to benevolence, security, conformity, and tradition were most commonly addressed. Furthermore, values such as self-direction, power, and achievement seemed important to most stakeholder groups. Conclusions: Several stakeholder groups emphasized the importance of being and feeling involved in the application of surveillance technologies. In addition, they acknowledged the necessity of paying attention to stakeholders’ perspectives and values. Across these stakeholder groups, values related to benevolence, security, and self-direction were represented, although various stakeholders assigned different meanings to these values. Awareness of stakeholders’ perspectives demands a willingness to acknowledge each other’s values and bridge differences. %M 39899267 %R 10.2196/64074 %U https://aging.jmir.org/2025/1/e64074 %U https://doi.org/10.2196/64074 %U http://www.ncbi.nlm.nih.gov/pubmed/39899267 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e69008 %T Exploring Smart Health Wearable Adoption Among Singaporean Older Adults Based on Self-Determination Theory: Web-Based Survey Study %A Kang,Hyunjin %A Yang,Tingting %A Banu,Nazira %A Ng,Sheryl Wei Ting %A Lee,Jeong Kyu %K smart health wearables %K self-determination theory %K AI anxiety %K perceived privacy risk %K health consciousness %D 2025 %7 19.3.2025 %9 %J JMIR Aging %G English %X Background: Smart health wearables offer significant benefits for older adults, enabling seamless health monitoring and personalized suggestions based on real-time data. Promoting adoption and sustained use among older adults is essential to empower autonomous health management, leading to better health outcomes, improved quality of life, and reduced strain on health care systems. Objective: This study investigates how autonomy-related contextual factors, including artificial intelligence (AI) anxiety, perceived privacy risks, and health consciousness, are related to older adults’ psychological needs of competence, autonomy, and relatedness (RQ1). We then examined whether the fulfillment of these needs positively predicts older adults’ intentions to adopt these devices (H1), and how they mediate the relationship between these factors and older adults’ intentions to use smart health wearables (RQ2). Additionally, it compares experienced and nonexperienced older adult users regarding the influence of these psychological needs on use intentions (RQ3). Methods: A web-based survey was conducted with individuals aged 60 years and above in Singapore, using a Qualtrics survey panel. A total of 306 participants (177 male; mean age of 65.47 years, age range 60‐85 years) completed the survey. A structural equation model was used to analyze associations among AI anxiety, perceived privacy risks, and health consciousness, and the mediating factors of competence, autonomy, and relatedness, as well as their relationship to smart health wearable use intention. Results: Health consciousness positively influenced all intrinsic motivation factors—competence, autonomy, and relatedness—while perceived privacy risks negatively affected all three. AI anxiety was negatively associated with competence only. Both privacy risk perceptions and health consciousness were indirectly linked to older adults’ intentions to use smart health wearables through competence and relatedness. No significant differences were found in motivational structures between older adults with prior experience and those without. Conclusions: This study contributes to the application of self-determination theory in promoting the use of smart technology for health management among older adults. The results highlight the critical role of intrinsic motivation—particularly competence—in older adults’ adoption of smart health wearables. While privacy concerns diminish motivation, health consciousness fosters it. The study results offer valuable implications for designing technologies that align with older adults’ motivations, potentially benefiting aging populations in other technologically advanced societies. Developers should focus on intuitive design, transparent privacy practices, and social features to encourage adoption, empowering older adults to use smart wearables for proactive health management. %R 10.2196/69008 %U https://aging.jmir.org/2025/1/e69008 %U https://doi.org/10.2196/69008 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65776 %T Caregiving Artificial Intelligence Chatbot for Older Adults and Their Preferences, Well-Being, and Social Connectivity: Mixed-Method Study %A Wolfe,Brooke H %A Oh,Yoo Jung %A Choung,Hyesun %A Cui,Xiaoran %A Weinzapfel,Joshua %A Cooper,R Amanda %A Lee,Hae-Na %A Lehto,Rebecca %+ Department of Communication, Michigan State University, 404 Wilson Road, Room 473, East Lansing, MI, 48824, United States, 1 517 355 3470, wolfebro@msu.edu %K older adults %K technology use %K AI chatbots %K artificial intelligence %K well-being %K social connectedness %K mobile phone %D 2025 %7 13.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing number of older adults who are living alone poses challenges for maintaining their well-being, as they often need support with daily tasks, health care services, and social connections. However, advancements in artificial intelligence (AI) technologies have revolutionized health care and caregiving through their capacity to monitor health, provide medication and appointment reminders, and provide companionship to older adults. Nevertheless, the adaptability of these technologies for older adults is stymied by usability issues. This study explores how older adults use and adapt to AI technologies, highlighting both the persistent barriers and opportunities for potential enhancements. Objective: This study aimed to provide deeper insights into older adults’ engagement with technology and AI. The technologies currently used, potential technologies desired for daily life integration, personal technology concerns faced, and overall attitudes toward technology and AI are explored. Methods: Using mixed methods, participants (N=28) completed both a semistructured interview and surveys consisting of health and well-being measures. Participants then participated in a research team–facilitated interaction with an AI chatbot, Amazon Alexa. Interview transcripts were analyzed using thematic analysis, and surveys were evaluated using descriptive statistics. Results: Participants’ average age was 71 years (ranged from 65 years to 84 years). Most participants were familiar with technology use, especially using smartphones (26/28, 93%) and desktops and laptops (21/28, 75%). Participants rated appointment reminders (25/28, 89%), emergency assistance (22/28, 79%), and health monitoring (21/28, 75%). Participants rated appointment reminders (25/28, 89.3%), emergency assistance (22/28, 78.6%), and health monitoring (21/28, 75%) as the most desirable features of AI chatbots for adoption. Digital devices were commonly used for entertainment, health management, professional productivity, and social connectivity. Participants were most interested in integrating technology into their personal lives for scheduling reminders, chore assistance, and providing care to others. Challenges in using new technology included a commitment to learning new technologies, concerns about lack of privacy, and worries about future technology dependence. Overall, older adults’ attitudes coalesced into 3 orientations, which we label as technology adapters, technologically wary, and technology resisters. These results illustrate that not all older adults were resistant to technology and AI. Instead, older adults are aligned with categories on a spectrum between willing, hesitant but willing, and unwilling to use technology and AI. Researchers can use these findings by asking older adults about their orientation toward technology to facilitate the integration of new technologies with each person’s comfortability and preferences. Conclusions: To ensure that AI technologies effectively support older adults, it is essential to foster an ongoing dialogue among developers, older adults, families, and their caregivers, focusing on inclusive designs to meet older adults’ needs. %M 40080043 %R 10.2196/65776 %U https://www.jmir.org/2025/1/e65776 %U https://doi.org/10.2196/65776 %U http://www.ncbi.nlm.nih.gov/pubmed/40080043 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60156 %T Transcultural Adaptation, Validation, Psychometric Analysis, and Interpretation of the 22-Item Thai Senior Technology Acceptance Model for Mobile Health Apps: Cross-Sectional Study %A Buawangpong,Nida %A Siviroj,Penprapa %A Pinyopornpanish,Kanokporn %A Sirikul,Wachiranun %+ Department of Community Medicine, Faculty of Medicine, Chiang Mai University, 110 Intrawarorot road, Sriphum, Mueng, Chiang Mai, 50200, Thailand, 66 53935472, wachiranun.sir@cmu.ac.th %K STAM %K senior technology acceptance model %K validity %K reliability %K mHealth %K older adult %K technology acceptance %K mobile health %K app %K transcultural adaptation %K psychometric analysis %K geriatrics %K cross-sectional study %K Thai %K theory analysis %K Cronbach α %K McDonald ω %K quality of life %K well-being %K social media %K telehealth %K health informatics %K eHealth %K mobile phone %D 2025 %7 11.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The rapid advancement of technology has made mobile health (mHealth) a promising tool to mitigate health problems, particularly among older adults. Despite the numerous benefits of mHealth, assessing individual acceptance is required to address the specific needs of older people and promote their intention to use mHealth. Objective: This study aims to adapt and validate the senior technology acceptance model (STAM) questionnaire for assessing mHealth acceptance in the Thai context. Methods: In this cross-sectional study, we adapted the original, 38-item, English version of the STAM using a 10-point Likert scale for mHealth acceptability among the Thai population. We translated the mHealth STAM into Thai using forward and backward translation. A total of 15 older adults and experts completed the pilot questionnaire and were interviewed to assess its validity. The pilot items of the Thai mHealth STAM were then reworded and revised for better comprehension and cross-cultural compatibility. The construct validity of the Thai mHealth STAM was evaluated by a multidimensional approach, including exploratory and confirmatory factor analysis and nonparametric item response theory analysis. Discriminative indices consisting of sensitivity, specificity, and area under the receiver operating characteristic (AUROC) were used to determine appropriate banding and discriminant validity for the intention to use mHealth. Internal consistency was assessed using Cronbach α and McDonald ω coefficients. Results: Out of the 1100 participants with a mean age of 62.3 (SD 8.8) years, 360 (32.7%) were adults aged 45-59 years, and 740 (67.3%) were older adults aged 60 years and older. Of the 40-item pilot questionnaire, exploratory factor analysis identified 22 items with factor loadings >0.4 across 7 principal components, explaining 91.45% of the variance. Confirmatory factor analysis confirmed that 9-dimensional sets of 22 items had satisfactory fit indices (comparative fit index=0.976, Tucker-Lewis index=0.968, root mean square error of approximation=0.043, standardized root mean squared residual=0.044, and R2 for each item>0.30). The score banding D (low≤151, moderate 152-180, and high≥181) was preferred as the optimal 22-item Thai mHealth STAM cutoff score based on the highest sensitivity of 89% (95% CI 86.1%-91.5%) and AUROC of 72.4% (95% CI 70%-74.8%) for predicting the intention to use mHealth. The final Thai mHealth STAM, consisting of 22 items, exhibited remarkable internal consistency, as evidenced by a Cronbach α of 0.88 (95% CI 0.87-0.89) and a McDonald ω of 0.85 (95% CI 0.83-0.87). For all 22 items, the corrected item-total correlations ranged between 0.26 and 0.71. Conclusions: The 22-item Thai mHealth STAM demonstrated satisfactory psychometric properties in both validity and reliability. The questionnaire has the potential to serve as a practical questionnaire in assessing the acceptance and intention to use mHealth among pre-older and older adults. %M 40068149 %R 10.2196/60156 %U https://aging.jmir.org/2025/1/e60156 %U https://doi.org/10.2196/60156 %U http://www.ncbi.nlm.nih.gov/pubmed/40068149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e51975 %T FRAILSURVEY—an mHealth App for Self-Assessment of Frailty Based on the Portuguese Version of the Groningen Frailty Indicator: Validation and Reliability Study %A Midao,Luis %A Duarte,Mafalda %A Sampaio,Rute %A Almada,Marta %A Dias,Cláudia Camila %A Paúl,Constança %A Costa,Elísio %+ RISE-Health, Biochemistry Lab, Faculty of Pharmacy, University of Porto, R. Jorge de Viterbo Ferreira 228, Porto, 4050-313, Portugal, 351 22 042 8500, luismidao@gmail.com %K frailty %K mHealth %K assessment %K validation %K GFI %K reliability %K self-assessment %K Groningen Frailty Indicator %K FRAILSURVEY %K mobile phone %D 2025 %7 7.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Portugal is facing the challenge of population ageing, with a notable increase in the proportion of older individuals. This has positioned the country among those in Europe with a high prevalence of frailty. Frailty, a geriatric syndrome characterized by diminished physiological reserve and heightened vulnerability to stressors, imposes a substantial burden on public health. Objective: This study seeks to address two primary objectives: (1) translation and psychometric evaluation of the European Portuguese version of the Groningen Frailty Indicator (GFI); and (2) development and evaluation of the FRAILSURVEY app, a novel assessment tool for frailty based on the GFI. By achieving these objectives, the study aims to enhance the accuracy and reliability of frailty assessment in the Portuguese context, ultimately contributing to improved health care outcomes for older individuals in the region. Methods: To accomplish the objectives of the study, a comprehensive research methodology was used. The study comprised 2 major phases: the initial translation and validation of the GFI into European Portuguese and the development of the FRAILSURVEY app. Following this, an extensive examination of the app’s validity and reliability was conducted compared with the conventional paper version of the GFI. A randomized repeated crossover design was used to ensure rigorous evaluation of both assessment methods, using both the paper form of the GFI and the smartphone-based app FRAILSURVEY. Results: The findings of the study revealed promising outcomes in line with the research objectives. The meticulous translation process yielded a final version of the GFI with robust psychometric properties, ensuring clarity and comprehensibility for participants. The study included 522 participants, predominantly women (367/522, 70.3%), with a mean age of 73.7 (SD 6.7) years. Psychometric evaluation of the European Portuguese GFI in paper form demonstrates good reliability (internal consistency: Cronbach a value of 0.759; temporal stability: intraclass correlation coefficient=0.974) and construct validity (revealing a 4D structure explaining 56% of variance). Evaluation of the app-based European Portuguese GFI indicates good reliability (interinstrument reliability: Cohen k=0.790; temporal stability: intraclass correlation coefficient=0.800) and concurrent validity (r=0.694; P<.001). Conclusions: Both the smartphone-based app and the paper version of the GFI were feasible and acceptable for use. The findings supported that FRAILSURVEY exhibited comparable validity and reliability to its paper counterpart. FRAILSURVEY uses a standardized and validated assessment tool, offering objective and consistent measurements while eliminating subjective biases, enhancing accuracy, and ensuring reliability. This app holds promising potential for aiding health care professionals in identifying frailty in older individuals, enabling early intervention, and improving the management of adverse health outcomes associated with this syndrome. Its integration with electronic health records and other data may lead to personalized interventions, improving frailty management and health outcomes for at-risk individuals. %M 40053720 %R 10.2196/51975 %U https://formative.jmir.org/2025/1/e51975 %U https://doi.org/10.2196/51975 %U http://www.ncbi.nlm.nih.gov/pubmed/40053720 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67406 %T Development and Implementation of Strong Foundations, a Digitally Delivered Fall Prevention Program: Usability and Feasibility Pilot Exercise Cohort Study %A Moran,Ryan %A Wing,David %A Davey,Hope %A Barkai,Hava %A Nichols,Jeanne %K digital health %K fall prevention %K fall risk %K older adults %K geriatrics %K system usability scale %K Strong Foundations %K feasibility %K public health %K user acceptance %K exercise %K usability %K digital technology %K mobile phone %D 2025 %7 28.2.2025 %9 %J JMIR Form Res %G English %X Background: Falls remain a major public health problem and a significant cause of preventable injury. Maintaining strength and balance by staying active can prevent falls in older adults, and public health advocates support referral to community exercise programs. Given the growth in use and acceptance of technological interfaces, there remains an interest in understanding the role of a synchronous exercise program designed to improve strength, postural alignment, and balance specifically designed to be delivered in a digital environment with respect to usability and feasibility. Objective: This study aims to design and implement a synchronously delivered digital fall prevention program to adults aged 60 years and older, to understand the usability, feasibility, and attendance. Methods: The “Strong Foundations” program, a 12-week, live, digitally delivered fall-prevention exercise program was informed from different existing in-person exercises and piloted to older adults who were considered a low fall risk by scores of 4 or less from the Centers for Disease Control and Prevention’s (CDC’s) Stopping Elderly Accidents and Deaths Initiative (STEADI) Staying Independent questionnaire. The System Usability Scale (SUS) measured usability and feasibility at the completion of this program, and digital measures of age-related function (timed up and go [TUG] and 30-second chair stand [30 CS]) were collected pre- and postintervention. Data were collected in 2021. Results: A total of 39 older adults were recruited and 38 completed the 12-week program with an average age of 72 years. The average SUS was 80.6, with an 85% attendance rate and an 8.5 (out of 10) self-reported satisfaction score. Digitally collected TUG and 30 CS statistically improved pre- and postintervention by 9% and 24%, respectively; by week 12, 64% (23/36) of participants improved in the timed up and go and 91% (32/35) improved the chair stands. Conclusion: There was excellent usability and acceptability for Strong Foundations, a novel fall-prevention program designed to be delivered digitally and promising improvement of objective measures of fall risk. %R 10.2196/67406 %U https://formative.jmir.org/2025/1/e67406 %U https://doi.org/10.2196/67406 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e56584 %T Acceptance Factors and Barriers to the Implementation of a Digital Intervention With Older Adults With Dementia or Caregivers: Protocol for an Umbrella Review %A Madeira,Ricardo %A Esteves,Dulce %A Pinto,Nuno %A Vercelli,Alessandro %A Vaz Patto,Maria %+ Department of Sport Sciences, University of Beira Interior, R. do Bairro da Nossa Sra. Da Conceição 22, Covilhã, 6201-001, Portugal, 351 275629153, ricardomadeira94@gmail.com %K dementia %K aging %K telemedicine %K implementation %K digital intervention %K older people %K elderly %K geriatrics %K mobile applications %K barriers %K adherence %K caregivers %K self-management %K acceptability %D 2025 %7 24.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increase in average life expectancy, aging, and the rise in the number of people living with dementia contribute to growing interest from the scientific community. As the disease progresses, people with dementia may need help with most daily activities and need to be supervised by their carer to ensure their safety. With the help of technology, health care provides new means of self-managing health that support active aging, allowing older people and people with dementia to live independently in their homes for a longer period of time. Although some systematic reviews have revealed some of the impacts of using digital interventions in this area, a broad systematic review that examines the overall results of the effect of this intervention type is mandatory. Objective: The aim of this review is to further investigate and understand the acceptability and barriers to using technology to monitor and manage health conditions of people living with dementia and their caregivers. Methods: A review of systematic reviews on acceptability factors and barriers for people with dementia and caregivers was carried out. Interventions that assessed acceptability factors and barriers to the use of technology by people with dementia or their carers were included. Each potentially relevant systematic review was assessed in full text by a member of a team of external experts. Results: The analysis of the results will be presented in the form of a detailed table of the characteristics of the reviews included. It will also describe the technologies used and factors of acceptability and barriers to their use. The search and preliminary analysis were carried out between May 5, 2023, and August 1, 2024. Conclusions: This review will play an important role as a comprehensive, evidence-based summary of the barriers and facilitators to the use of digital interventions. This review may help to establish effective policy and clinical guideline recommendations. %M 39993296 %R 10.2196/56584 %U https://www.researchprotocols.org/2025/1/e56584 %U https://doi.org/10.2196/56584 %U http://www.ncbi.nlm.nih.gov/pubmed/39993296 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63898 %T Digital Interventions for Older People Experiencing Homelessness: Systematic Scoping Review %A Adams,Emily %A Donaghy,Eddie %A Sanders,Caroline %A Wolters,Maria Klara %A Ng,Lauren %A St-Jean,Christa %A Galan,Ryan %A Mercer,Stewart William %+ Advanced Care Research Centre, Usher Institute, University of Edinburgh, BioQuarter (Gate, 5-7), 3 Little France Rd, Edinburgh, EH16 4U, United Kingdom, 44 0131 651 7869, stewart.mercer@ed.ac.uk %K homeless %K technology %K digital exclusion %K elderly %K rough sleeping %K digital intervention %K older people %K homelessness %K systematic scoping review %K aging %K premature mortality %K indicators %K scoping review %K databases %K thematic analysis %K telehealth %K mhealth %K ehealth %D 2025 %7 21.2.2025 %9 Review %J J Med Internet Res %G English %X Background: older people experiencing homelessness can have mental and physical indicators of aging several decades earlier than the general population and experience premature mortality due to age-related chronic conditions. Digital interventions could positively impact the health and well-being of homeless people. However, increased reliance on digital delivery may also perpetuate digital inequalities for socially excluded groups. The potential triple disadvantage of being older, homeless, and digitally excluded creates a uniquely problematic situation warranting further research. Few studies have synthesized available literature on digital interventions for older people experiencing homelessness. Objective: This scoping review examined the use, range, and nature of digital interventions available to older people experiencing homelessness and organizations supporting them. Methods: The scoping review followed Arksey and O’Malley’s proposed methodology, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, and recent Joanna Briggs Institute guidelines. We searched 14 databases. Gray literature sources were searched to supplement the electronic database search. A narrative synthesis approach was conducted on the included articles, and common themes were identified inductively through thematic analysis. Results: A total of 19,915 records were identified through database and gray literature searching. We identified 10 articles reporting on digital interventions that had a clearly defined a participant age group of >50 years or a mean participant age of >50 years. A total of 9 of 10 studies were published in the United States. The study design included descriptive studies, uncontrolled pilot studies, and pilot randomized controlled trials. No studies aimed to deliver an intervention exclusively to older people experiencing homelessness or organizations that supported them. Four types of intervention were identified: telecare for people experiencing homelessness, distributing technology to enable digital inclusion, text message reminders, and interventions delivered digitally. Interventions delivered digitally included smoking cessation support, vocational training, physical activity promotion, and cognitive behavioral therapy. Overall, the included studies demonstrated evidence for the acceptability and feasibility of digital interventions for older people experiencing homelessness, and all 10 studies reported some improvements in digital inclusion or enhanced engagement among participants. However, several barriers to digital interventions were identified, particularly aspects related to digital inclusion, such as infrastructure, digital literacy, and age. Proposed facilitators for digital interventions included organizational and peer support. Conclusions: Our findings highlight a paucity of evaluated digital interventions targeted at older people experiencing homelessness. However, the included studies demonstrated evidence of the acceptability and feasibility of digital interventions for older people experiencing homelessness. Further research on digital interventions that provide services and support older people experiencing homelessness is required. Future interventions must address the barriers older people experiencing homelessness face when accessing digital technology with the input of those with lived experience of homelessness. Trial Registration: OSF Registries OSF.IO/7QGTY; https://doi.org/10.17605/OSF.IO/7QGTY %M 39984162 %R 10.2196/63898 %U https://www.jmir.org/2025/1/e63898 %U https://doi.org/10.2196/63898 %U http://www.ncbi.nlm.nih.gov/pubmed/39984162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56418 %T Depression Self-Care Apps’ Characteristics and Applicability to Older Adults: Systematic Assessment %A Yin,Ruoyu %A Rajappan,Dakshayani %A Martinengo,Laura %A Chan,Frederick H F %A Smith,Helen %A Griva,Konstadina %A Subramaniam,Mythily %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Clinical Sciences Building, Singapore, 308232, Singapore, 65 65138572, l.tudor.car@imperial.ac.uk %K older adults %K elder %K elderly %K mental health %K mental illness %K mental disorders %K mHealth %K mobile health %K mobile application %K app %K application %K smartphone %K depression %K self-care %K mobile apps %K systematic assessment %K assessment %K effectiveness %K self-care %K Android app %K mental health apps %K mobile interventions %K behaviour %K therapy %K mood monitoring %K adaptations %K online communities %K impairments %D 2025 %7 21.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression affects 32% of older adults. Loneliness and social isolation are common risk factors for depression in older adults. Mobile apps can connect users and are also effective in depression management in the general population. However, older adults have specific needs in terms of the content of depression self-care interventions and their accessibility. It remains unknown whether existing apps for depression self-care are applicable to older adults. Objective: The initial aim of this assessment was to systematically identify interactive depression self-care apps specifically designed for older adults. As we did not find any, we assessed the applicability of existing depression self-care apps to the needs of older adult users. Methods: Using an established app assessment methodology, we searched for Android and iOS interactive mental health apps providing self-care for depression in English and Chinese in the 42Matters database, Chinese Android app stores, and the first 10 pages of Google and Baidu. We developed an assessment rubric based on extensive revision of the literature. The rubric consisted of the following sections: general characteristics of the apps (eg, developer, platform, and category), app content (eg, epidemiology and risk factors of depression in older adults, techniques to improve mood and well-being), and technical aspects (eg, accessibility, privacy and confidentiality, and engagement). Results: We identified 23 apps (n=19, 82.6%, English and n=4, 17.4%, Chinese apps), with 5 (21.7%) iOS-only apps, 3 (13%) Android-only apps, and 15 (65.2%) apps on both platforms. None specifically targeted older adults with depression. All apps were designed by commercial companies and were free to download. Most of the apps incorporated cognitive behavior therapy, mood monitoring, or journaling. All but 3 (13%) apps had a privacy and confidentiality policy. In addition, 14 (60.9%) apps covered depression risk factors in older adults, and 3 (13%) apps delivered information about depression epidemiology in older adults via a chatbot. Furthermore, 17 (73.9%) apps mentioned other topics relevant to older adults, such as pain management, grief, loneliness, and social isolation. Around 30% (n=7) of the apps were supported by an online forum. Common accessibility issues included a lack of adaptations for users with visual or hearing impairments and incompatibility with larger font sizes in the phone settings. Conclusions: There are no depression apps developed specifically for older adults. Available mobile apps have limited applicability to older adults in terms of their clinical and technical features. Depression self-care apps should aim to incorporate content relevant to older adults, such as grief and loss; include online communities; and improve accessibility to adapt to potential health impairments in older adults. %M 39983112 %R 10.2196/56418 %U https://www.jmir.org/2025/1/e56418 %U https://doi.org/10.2196/56418 %U http://www.ncbi.nlm.nih.gov/pubmed/39983112 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64633 %T Feasibility of a Cinematic–Virtual Reality Program Educating Health Professional Students About the Complexity of Geriatric Care: Pilot Pre-Post Study %A Beverly,Elizabeth A %A Miller,Samuel %A Love,Matthew %A Love,Carrie %K virtual reality %K VR %K aging %K geriatric syndromes %K diabetes %K elder abuse and neglect %K gerontology %K geriatrics %K older %K elderly %K education %K student %K cinematic %K video %K head mounted %K feasibility %K experience %K attitude %K opinion %K perception %K elder abuse %K chronic conditions %K older adult care %K health intervention %K randomized controlled trial %D 2025 %7 12.2.2025 %9 %J JMIR Aging %G English %X Background: The US population is aging. With this demographic shift, more older adults will be living with chronic conditions and geriatric syndromes. To prepare the next generation of health care professionals for this aging population, we need to provide training that captures the complexity of geriatric care. Objective: This pilot study aimed to assess the feasibility of the cinematic–virtual reality (cine-VR) training in the complexity of geriatric care. We measured changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy before and after participating in the training program. Methods: We conducted a single-arm, pretest-posttest pilot study to assess the feasibility of a cine-VR training and measure changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy. Health professional students from a large university in the Midwest were invited to participate in 1 of 4 cine-VR trainings. Participants completed 3 surveys before and after the cine-VR training. We performed paired t tests to examine changes in these constructs before and after the training. Results: A total of 65 health professional students participated in and completed the full cine-VR training for 100% retention. Participants did not report any technological difficulties or adverse effects from wearing the head-mounted displays or viewing the 360-degree video. Out of the 65 participants, 48 completed the pre- and postassessments. We observed an increase in awareness of discrimination towards people with disability (t47=−3.97; P<.001). In addition, we observed significant improvements in self-efficacy to identify and manage elder abuse and neglect (t47=−3.36; P=.002). Finally, we observed an increase in participants’ empathy (t47=−2.33; P=.02). Conclusions: We demonstrated that our cine-VR training program was feasible and acceptable to health professional students at our Midwestern university. Findings suggest that the cine-VR training increased awareness of discrimination towards people with disabilities, improved self-efficacy to identify and manage elder abuse and neglect, and increased empathy. Future research using a randomized controlled trial design with a larger, more diverse sample and a proper control condition is needed to confirm the effectiveness of our cine-VR training. %R 10.2196/64633 %U https://aging.jmir.org/2025/1/e64633 %U https://doi.org/10.2196/64633 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60652 %T Uncovering Specific Navigation Patterns by Assessing User Engagement of People With Dementia and Family Caregivers With an Advance Care Planning Website: Quantitative Analysis of Web Log Data %A Dupont,Charlèss %A Smets,Tinne %A Potts,Courtney %A Monnet,Fanny %A Pivodic,Lara %A De Vleminck,Aline %A Van Audenhove,Chantal %A Mulvenna,Maurice %A Van den Block,Lieve %K dementia %K advance care planning %K user engagement %K web-based tool %K care %K website %K caregiver %K communication %K tool %K online %D 2025 %7 11.2.2025 %9 %J JMIR Aging %G English %X Background: Web-based tools have gained popularity to inform and empower individuals in advance care planning. We have developed an interactive website tailored to the unique needs of people with dementia and their families to support advance care planning. This website aims to break away from the rigid pathways shown in other tools that support advance care planning, in which advance care planning is shown as a linear process from information to reflection, communication, and documentation. Objective: This study aimed to assess the website’s usage by people with dementia and their family caregivers, identify distinct user engagement patterns, and visualize how users navigated the website. Methods: We analyzed the website’s log data obtained from an 8-week evaluation study of the site. Interactions with the website were collected in log data files and included visited web pages or clicked-on hyperlinks. Distinct user engagement patterns were identified using K-means clustering process mining, a technique that extracts insights from log data to model and visualize workflows, was applied to visualize user pathways through the website. Results: A total of 52 participants, 21 individuals with dementia and their family caregivers as dyads and 10 family caregivers were included in the study. Throughout the 8-week study, users spent an average of 35.3 (SD 82.9) minutes over 5.5 (SD 3.4) unique days on the website. Family caregivers mostly used the website (alone or with a person with dementia) throughout the 8-week study. Only 3 people with dementia used it on their own. In total, 3 distinct engagement patterns emerged: low, moderate, and high. Low-engagement participants spent less time on the website during the 8 weeks, following a linear path from information to communication to documentation. Moderate- and high-engagement users showed more dynamic patterns, frequently navigating between information pages and communication tools to facilitate exploration of aspects related to advance care planning. Conclusions: The diverse engagement patterns underscore the need for personalized support in advance care planning and challenge the conventional linear advance care planning representations found in other web-based tools. %R 10.2196/60652 %U https://aging.jmir.org/2025/1/e60652 %U https://doi.org/10.2196/60652 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64847 %T Implications of Public Disclosure of Personal Information in a Mobile Alert App for People Living With Dementia Who Go Missing: Qualitative Descriptive Study %A Adekoya,Adebusola %A Daum,Christine %A Neubauer,Noelannah %A Miguel-Cruz,Antonio %A Liu,Lili %+ , School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567, lili.liu@uwaterloo.ca %K alert systems %K technology %K missing persons %K dementia %K autonomy %K privacy %K stigmatization %K consent %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Aging %G English %X Background: People living with dementia are at risk of getting lost and going missing due to memory loss, confusion, and disorientation. Missing person incidents involving people living with dementia are increasing. Alert systems such as Community ASAP can promote community engagement in locating missing persons with dementia and aid in search and rescue efforts. However, the implications of public disclosure of personal information such as name, age, sex, and physical description within such alert systems have yet to be explored. Objective: This study aimed to identify and discuss the implications of public disclosure of personal information in Community ASAP for people living with dementia at risk of going missing. Methods: This study used a qualitative descriptive research design drawing from naturalistic inquiry. A total of 19 participants including people living with dementia, care partners, first responders, and service providers were recruited from Ontario, Alberta, and British Columbia, Canada. Semistructured interviews were used to explore participants’ perspectives on the perceived implications of the release of personal information when using Community ASAP. NVivo (version 12) was used to manage data, and conventional content analysis was conducted to identify key themes of the implications of public disclosure of personal information in Community ASAP. Results: In total, 10/19 (53%) of the participants were women and 9/19 (47%) were men. Of the 19 participants, 3 (16%) were people living with dementia, 5 (26%) were care partners, 4 (21%) were first responders, and 7 (37%) were service providers. In total, 4 key themes were identified as implications of public disclosure of personal information in Community ASAP: right to autonomy, safety versus privacy, informed and knowledgeable consent, and stigmatization. Participants discussed how the public disclosure of personal information in Community ASAP could undermine a person’s choice not to be found and contribute to stigmatization. Participants emphasized a need to balance safety and privacy concerns. Informed and knowledgeable consent is important when using an alert system to locate missing persons with dementia. Conclusions: Community ASAP can promote community engagement in locating missing persons with dementia. However, the public disclosure of personal information in alert systems has implications. Users’ right to autonomy, a balance between safety and privacy, informed and knowledgeable consent, and risks of stigmatization are perceived impacts of disclosure of personal information in alert systems. %M 39918846 %R 10.2196/64847 %U https://aging.jmir.org/2025/1/e64847 %U https://doi.org/10.2196/64847 %U http://www.ncbi.nlm.nih.gov/pubmed/39918846 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64033 %T Association of Subjective Cognitive Concerns With Performance on Mobile App–Based Cognitive Assessment in Cognitively Normal Older Adults: Observational Study %A Nester,Caroline O %A De Vito,Alyssa N %A Prieto,Sarah %A Kunicki,Zachary J %A Strenger,Jennifer %A Harrington,Karra D %A Roque,Nelson %A Sliwinski,Martin J %A Rabin,Laura A %A Thompson,Louisa I %K subjective cognitive concerns %K subjective cognitive decline %K digital cognitive assessment %K mobile app %K app-based %K preclinical Alzheimer disease %K mild cognitive impairment %K MCI %K preclinical dementia %K mobile monitoring of cognitive change %K Cognitive Function Instrument %K mHealth %K mobile health %K applications %K cognition %K assessment %K remote %K geriatrics %K gerontology %K aging %K memory %K older adult %K elderly %K digital health %K mobile phone %D 2025 %7 4.2.2025 %9 %J JMIR Aging %G English %X Background: Subjective cognitive concerns (SCCs) may be among the earliest clinical symptoms of dementia. There is growing interest in applying a mobile app–based cognitive assessment to remotely screen for cognitive status in preclinical dementia, but the relationship between SCC and relevant mobile assessment metrics is uncertain. Objective: This study aimed to characterize the relationship between SCC and adherence, satisfaction, and performance on mobile app assessments in cognitively unimpaired older adults. Methods: Participants (N=122; Meanage=68.85 [SD 4.93] years; Meaneducation=16.85 [SD 2.39] years; female: n=82, 66.7%; White:n=106, 86.2%) completed 8 assessment days using Mobile Monitoring of Cognitive Change (M2C2), an app-based testing platform, with brief daily sessions within morning, afternoon, and evening time windows (24 total testing sessions). M2C2 includes digital working memory, processing speed, and episodic memory tasks. Participants provided feedback about their satisfaction and motivation related to M2C2 upon study completion. SCC was assessed using the Cognitive Function Instrument. Regression analyses evaluated the association between SCC and adherence, satisfaction, and performance on M2C2, controlling for age, sex, depression, and loneliness. Linear-mixed effects models evaluated whether SCC predicted M2C2 subtest performance over the 8-day testing period, controlling for covariates. Results: SCC was not associated with app satisfaction or protocol motivation, but it was significantly associated with lower rates of protocol adherence (ß=−.20, P=.37, 95% CI −.65 to −.02). Higher SCC endorsement significantly predicted worse overall episodic memory performance (ß=−.20, P=.02, 95% CI −.02 to −.01), but not working memory or processing speed. There was a main effect of SCC on working memory performance at day 1 (estimate=−1.05, SE=0.47, P=.03) and a significant interaction between SCC and working memory over the 8-day period (estimate=0.05, SE=0.02, P=.03), such that SCC was associated with initially worse, then progressively better working memory performance. Conclusions: SCCs are associated with worse overall memory performance on mobile app assessments, patterns of cognitive inefficiency (variable working memory), and mildly diminished adherence across an 8-day assessment period. Findings suggest that mobile app assessments may be sensitive to subtle cognitive changes, with important implications for early detection and treatment for individuals at risk for dementia. %R 10.2196/64033 %U https://aging.jmir.org/2025/1/e64033 %U https://doi.org/10.2196/64033 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e69554 %T Mindfulness Intervention for Health Information Avoidance in Older Adults: Mixed Methods Study %A Gu,Chenyu %A Qian,Liquan %A Zhuo,Xiaojie %+ School of Arts and Media, Wuhan College, No. 333 Huangjiahu Avenue, Jiangxia District, Hubei Province, Wuhan, 430212, China, 86 180 5922 1673, 3074@mju.edu.cn %K health information avoidance %K cyberchondria %K self-determination theory %K mindfulness %K elderly %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The global aging population and rapid development of digital technology have made health management among older adults an urgent public health issue. The complexity of online health information often leads to psychological challenges, such as cyberchondria, exacerbating health information avoidance behaviors. These behaviors hinder effective health management; yet, little research examines their mechanisms or intervention strategies. Objective: This study investigates the mechanisms influencing health information avoidance among older adults, emphasizing the mediating role of cyberchondria. In addition, it evaluates the effectiveness of mindfulness meditation as an intervention strategy to mitigate these behaviors. Methods: A mixed methods approach was used, combining quantitative and qualitative methodologies. Substudy 1 developed a theoretical model based on self-determination theory to explore internal (positive metacognition and health self-efficacy) and external (subjective norms and health information similarity) factors influencing health information avoidance, with cyberchondria as a mediator. A cross-sectional survey (N=236) was conducted to test the proposed model. Substudy 2 involved a 4-week mindfulness meditation intervention (N=94) to assess its impact on reducing health information avoidance behaviors. Results: Study 1 showed that positive metacognition (β=.26, P=.002), health self-efficacy (β=.25, P<.001), and health information similarity (β=.29, P<.001) significantly predicted health information avoidance among older adults. Cyberchondria mediated these effects: positive metacognition (effect=0.106, 95% CI 0.035-0.189), health self-efficacy (effect=0.103, 95% CI 0.043-0.185), and health information similarity (effect=0.120, 95% CI 0.063-0.191). Subjective norms did not significantly predict health information avoidance (β=‒.11, P=.13), and cyberchondria did not mediate this relationship (effect=‒0.045, 95% CI ‒0.102 to 0.016). Study 2 found that after the 4-week mindfulness intervention, the intervention group (group 1: n=46) exhibited significantly higher mindfulness levels than the control group (group 2: n=48; Mgroup1=4.122, Mgroup2=3.606, P<.001) and higher levels compared with preintervention (Mt2=4.122, Mt1=3.502, P<.001, where t1=preintervention and t2=postintervention). However, cyberchondria levels did not change significantly (Mt1=2.848, Mt2=2.685, P=.18). Nevertheless, the results revealed a significant interaction effect between mindfulness and cyberchondria on health information avoidance (effect=‒0.357, P=.002, 95% CI ‒0.580 to ‒0.131), suggesting that mindfulness intervention effectively inhibited the transformation of cyberchondria into health information avoidance behavior. Conclusions: This study reveals the role of cyberchondria in health information avoidance and validates mindfulness meditation as an effective intervention for mitigating such behaviors. Findings offer practical recommendations for improving digital health information delivery and health management strategies for older adults. %M 39874579 %R 10.2196/69554 %U https://publichealth.jmir.org/2025/1/e69554 %U https://doi.org/10.2196/69554 %U http://www.ncbi.nlm.nih.gov/pubmed/39874579 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e63348 %T Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study %A Daniels,Kim %A Vonck,Sharona %A Robijns,Jolien %A Quadflieg,Kirsten %A Bergs,Jochen %A Spooren,Annemie %A Hansen,Dominique %A Bonnechère,Bruno %+ , Centre of Expertise in Care Innovation, Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Guffenslaan 39, Hasselt, 3500, Belgium, 32 485763451, kim.daniels@pxl.be %K mobile health %K mHealth %K feasibility %K physical activity %K older adults %K health promotion %K usability %K mobile phone %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA). Objective: The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot. Methods: Our study used a mixed methods approach to evaluate the MIA app’s acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based. Results: The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app’s workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants. Conclusions: The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults. Trial Registration: ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515 %M 39869906 %R 10.2196/63348 %U https://aging.jmir.org/2025/1/e63348 %U https://doi.org/10.2196/63348 %U http://www.ncbi.nlm.nih.gov/pubmed/39869906 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69080 %T Digital Gaming and Subsequent Health and Well-Being Among Older Adults: Longitudinal Outcome-Wide Analysis %A Nakagomi,Atsushi %A Ide,Kazushige %A Kondo,Katsunori %A Shiba,Koichiro %+ Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage-ku, Chiba, 2638522, Japan, 81 432903177 ext 3177, anakagomi0211@gmail.com %K digital gaming %K older adults %K flourishing %K well-being %K physical activity %K social engagement %K mobile phone %D 2025 %7 27.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital gaming has become increasingly popular among older adults, potentially offering cognitive, social, and physical benefits. However, its broader impact on health and well-being, particularly in real-world settings, remains unclear. Objective: This study aimed to evaluate the multidimensional effects of digital gaming on health and well-being among older adults, using data from the Japan Gerontological Evaluation Study conducted in Matsudo City, Chiba, Japan. Methods: Data were drawn from 3 survey waves (2020 prebaseline, 2021 baseline, and 2022 follow-up) of the Japan Gerontological Evaluation Study, which targets functionally independent older adults. The exposure variable, digital gaming, was defined as regular video game play and was assessed in 2021. In total, 18 outcomes across 6 domains were evaluated in 2022; domain 1—happiness and life satisfaction, domain 2—physical and mental health, domain 3—meaning and purpose, domain 4—character and virtue, domain 5—close social relationships, and domain 6—health behavior. Furthermore, 10 items from the Human Flourishing Index were included in domains 1-5, with 2 items for each domain. Overall flourishing was defined as the average of the means across these 5 domains. In addition, 7 items related to domains 2, 5, and 6 were assessed. The final sample consisted of 2504 participants aged 65 years or older, with questionnaires containing the Human Flourishing Index randomly distributed to approximately half of the respondents (submodule: n=1243). Consequently, we used 2 datasets for analysis. We applied targeted maximum likelihood estimation to estimate the population average treatment effects, with Bonferroni correction used to adjust for multiple testing. Results: Digital gaming was not significantly associated with overall flourishing or with any of the 5 domains from the Human Flourishing Index. Although initial analyses indicated associations between digital gaming and participation in hobby groups (mean difference=0.12, P=.005) as well as meeting with friends (mean difference=0.076, P=.02), these associations did not remain significant after applying the Bonferroni correction for multiple testing. In addition, digital gaming was not associated with increased sedentary behavior or reduced outdoor activities. Conclusions: This study provides valuable insights into the impact of digital gaming on the health and well-being of older adults in a real-world context. Although digital gaming did not show a significant association with improvements in flourishing or in the individual items across the 5 domains, it was also not associated with increased sedentary behavior or reduced outdoor activities. These findings suggest that digital gaming can be part of a balanced lifestyle for older adults, offering opportunities for social engagement, particularly through hobby groups. Considering the solitary nature of gaming, promoting social gaming opportunities may be a promising approach to enhance the positive effects of digital gaming on well-being. %M 39869904 %R 10.2196/69080 %U https://www.jmir.org/2025/1/e69080 %U https://doi.org/10.2196/69080 %U http://www.ncbi.nlm.nih.gov/pubmed/39869904 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65022 %T A User-Centered Design Approach for a Screening App for People With Cognitive Impairment (digiDEM-SCREEN): Development and Usability Study %A Zeiler,Michael %A Dietzel,Nikolas %A Haug,Fabian %A Haug,Julian %A Kammerer,Klaus %A Pryss,Rüdiger %A Heuschmann,Peter %A Graessel,Elmar %A Kolominsky-Rabas,Peter L %A Prokosch,Hans-Ulrich %K dementia %K usability %K development %K digiDEM %K cognitive impairment %K older adults %K aging %K mobile health %K mHealth %K design %K feedback %K screening %K user centred %K cognitive disorder %K user-centered %K mobile app %D 2025 %7 22.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Dementia is a widespread syndrome that currently affects more than 55 million people worldwide. Digital screening instruments are one way to increase diagnosis rates. Developing an app for older adults presents several challenges, both technical and social. In order to make the app user-friendly, feedback from potential future end users is crucial during this development process. Objective: This study aimed to establish a user-centered design process for the development of digiDEM-SCREEN, a user-friendly app to support early identification of persons with slight symptoms of dementia. Methods: This research used qualitative and quantitative methods and involved 3 key stakeholder groups: the digiDEM research team, the software development team, and the target user group (older adults ≥65 years with and without cognitive impairments). The development of the screening app was based on an already existing and scientifically analyzed screening test (Self-Administered Tasks Uncovering Risk of Neurodegeneration; SATURN). An initial prototype was developed based on the recommendations for mobile health apps and the teams’ experiences. The prototype was tested in several iterations by various end users and continuously improved. The app’s usability was evaluated using the System Usability Scale (SUS), and verbal feedback by the end users was obtained using the think-aloud method. Results: The translation process during test development took linguistic and cultural aspects into account. The texts were also adapted to the German-speaking context. Additional instructions were developed and supplemented. The test was administered using different randomization options to minimize learning effects. digiDEM-SCREEN was developed as a tablet and smartphone app. In the first focus group discussion, the developers identified and corrected the most significant criticism in the next version. Based on the iterative improvement process, only minor issues needed to be addressed after the final focus group discussion. The SUS score increased with each version (score of 72.5 for V1 vs 82.4 for V2), while the verbal feedback from end users also improved. Conclusions: The development of digiDEM-SCREEN serves as an excellent example of the importance of involving experts and potential end users in the design and development process of health apps. Close collaboration with end users leads to products that not only meet current standards but also address the actual needs and expectations of users. This is also a crucial step toward promoting broader adoption of such digital tools. This research highlights the significance of a user-centered design approach, allowing content, text, and design to be optimally tailored to the needs of the target audience. From these findings, it can be concluded that future projects in the field of health apps would also benefit from a similar approach. %R 10.2196/65022 %U https://humanfactors.jmir.org/2025/1/e65022 %U https://doi.org/10.2196/65022 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55042 %T The Combined Effect of Multisensory Stimulation and Therapist Support on Physical and Mental Health of Older Adults Living in Nursing Homes: Pilot Randomized Controlled Trial %A Khatib,Sewar %A Palgi,Yuval %A Ashar,Yoni K %A Polyvyannaya,Natalya %A Goldstein,Pavel %+ School of Public Health, University of Haifa, 199 Aba Khoushy Avenue, Mount Carmel, Haifa, 3103301, Israel, 972 48240519, pavelg@stat.haifa.ac.il %K Snoezelen room %K mental health %K sensory stimulation environment %K social support %K nursing homes %K older adults %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing life expectancy has led to a rise in nursing home admissions, a context in which older adults often experience chronic physical and mental health conditions, chronic pain, and reduced well-being. Nonpharmacological approaches are especially important for managing older adults’ chronic pain, mental health conditions (such as anxiety and depression), and overall well-being, including sensory stimulation (SS) and therapist support (TS). However, the combined effects of SS and TS have not been investigated. Objective: This randomized controlled trial examines the specific and combined effects of brief SS and TS interventions on older adults’ physical and mental health and pain intensity levels, among individuals living in nursing homes. Methods: A total of 96 patients aged 65-99 years from a nursing home were randomly assigned to 3 groups: SS, TS, and combined SS+TS interventions, each delivered as four 20-minute sessions. SS was implemented using a multisensory Snoezelen room. Pain intensity levels (per a Visual Analog Scale), blood pressure, heart rate, blood oxygen saturation, and hand grip strength (using a Jamar hand dynamometer) were measured before and after each of the 4 weekly therapeutic sessions. In addition, life satisfaction (per the Satisfaction with Life Scale) and anxiety (per the 7-item General Anxiety Disorder Scale) were evaluated before and after the whole intervention. Mixed model analyses tested the relative efficacy of the 3 interventions, applying simple slope analysis with Tukey correction. Study rationale and analytical plans were preregistered. Results: The combined intervention of SS and TS (SS+TS) resulted in reduced pain levels compared with SS (B=0.209, P=.006) and TS alone (B=0.23, P=.002) over 4 sessions (F6,266=2.62; P=.017; R2=0.23). Further, the combined SS+TS intervention resulted in reduced systolic blood pressure versus SS (B=0.09, P=.01) and TS alone (B=0.016, P<.001) groups (F6,272=5.42; P<.001; R2=0.29). In addition, the combined SS+TS intervention resulted in an increased grip strength versus SS (B=–0.35, P=.003) and TS alone (B=–0.032, P=.008) groups (F6,273=2.25; P=.04; R2=0.19). Moreover, combined SS+TS resulted in an improvement in life satisfaction (B=–4.29, P<.0001) compared with SS (B=–2.38, P=.0042) and TS alone (B=–1.20, P=.13) groups (F2,39=3.47; P=.04). Finally, SS+TS demonstrated greater improvement in symptoms of general anxiety disorder (B=10.64, P<.0001) compared with SS (B=3.30 P=.01) and TS alone (B=1.13, P=.37) (F2,38=13.5; P<.001) groups. No differences between the interventions were shown for blood oxygen saturation (F6,273=2.06; P=.06), diastolic blood pressure (F6,272=1.12; P=.35), and heart rate (F6,273=1.33; P=.23). Conclusions: The combined intervention of SS and TS showed therapeutic benefits for pain management and physical and mental health of older adults living in nursing homes, relative to each therapeutic component in isolation. This brief intervention can be readily implemented to improve well-being and optimize therapeutic resources in nursing home settings. Trial Registration: ClinicalTrials.gov NCT05394389; https://clinicaltrials.gov/ct2/show/NCT05394389 %M 39808474 %R 10.2196/55042 %U https://www.jmir.org/2025/1/e55042 %U https://doi.org/10.2196/55042 %U http://www.ncbi.nlm.nih.gov/pubmed/39808474 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e56718 %T Preliminary Effectiveness of a Telehealth-Delivered Exercise Program in Older Adults Living With and Beyond Cancer: Retrospective Study %A Dunston,Emily R %A Oza,Sonal %A Bai,Yang %A Newton,Maria %A Podlog,Leslie %A Larson,Kish %A Walker,Darren %A Zingg,Rebecca W %A Hansen,Pamela A %A Coletta,Adriana M %K physical activity %K physical function %K telerehabilitation %K remote exercise %K digital health %K cancer survivors %K older adults %K smartphone %D 2025 %7 13.1.2025 %9 %J JMIR Cancer %G English %X Background: Exercise can attenuate the deleterious combined effects of cancer treatment and aging among older adults with cancer, yet exercise participation is low. Telehealth exercise may improve exercise engagement by decreasing time and transportation barriers; however, the utility of telehealth exercise among older adults with cancer is not well established. Objective: We aimed to evaluate the preliminary effectiveness of a one-on-one, supervised telehealth exercise program on physical function, muscular endurance, balance, and flexibility among older adults with cancer. Methods: In this retrospective study, we analyzed electronic health record data collected from the Personal Optimism With Exercise Recovery clinical exercise program delivered via telehealth among older adults with cancer (≥65 y) who completed a virtual initial program telehealth assessment between March 2020 and December 2021. The virtual initial assessment included the following measures: 30-second chair stand test, 30-second maximum push-up test, 2-minute standing march, single leg stance, plank, chair sit and reach, shoulder range of motion, and the clock test. All baseline measures were repeated after 12-weeks of telehealth exercise. Change scores were calculated for all assessments and compared to minimal clinically important difference (MCID) values for assessments with published MCIDs. Paired samples t tests (2-tailed) were conducted to determine change in assessment outcomes. Results: Older adults with cancer who chose to participate in the telehealth exercise program (N=68) were 71.8 (SD 5.3) years of age on average (range 65‐92 y). The 3 most common cancer types in this sample were breast (n=13), prostate (n=13), and multiple myeloma (n=8). All cancer stages were represented in this sample with stage II (n=16, 23.5%) and III (n=18, 26.5%) being the most common. A follow-up telehealth assessment was completed by 29.4% (n=20) of older adults with cancer. Among those who completed a follow-up telehealth assessment, there were significant increases in the 30-second chair stand (n=19; mean change +2.00 repetitions, 95% CI 0.12 to 3.88) and 30-second maximum push-up scores (n=20; mean change +2.85 repetitions, 95% CI 1.60 to 4.11). There were no significant differences for the 2-minute standing march, plank, single leg stance, sit and reach, shoulder mobility, or clock test (P>.05). Nine (47.3%) older adults with cancer had a change in 30-second chair stand scores greater than the MCID of 2 repetitions. Conclusions: Our findings suggest a one-on-one, supervised telehealth exercise program may positively influence measures of physical function, muscular endurance, balance, and flexibility among older adults with cancer, but more adequately powered trials are needed to confirm these findings. %R 10.2196/56718 %U https://cancer.jmir.org/2025/1/e56718 %U https://doi.org/10.2196/56718 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63568 %T Exploring the General Acceptability and User Experience of a Digital Therapeutic for Cognitive Training in a Singaporean Older Adult Population: Qualitative Study %A Kwek,Siong Peng %A Leong,Qiao Ying %A Lee,V Vien %A Lau,Ni Yin %A Vijayakumar,Smrithi %A Ng,Wei Ying %A Rai,Bina %A Raczkowska,Marlena Natalia %A Asplund,Christopher L %A Remus,Alexandria %A Ho,Dean %+ Yong Loo Lin School of Medicine, Heat Resilience & Performance Centre, National University of Singapore, 27 Medical Drive, #03-01, Singapore, 117510, Singapore, 65 66017766, alexandria.remus@nus.edu.sg %K older adults %K cognitive training %K digital therapeutic %K DTx %K remote %K usability %K acceptance %K interviews %K gerontology %K geriatric %K elderly %K experiences %K attitudes %K opinions %K perceptions %K perspectives %K interview %K cognition %K digital health %K qualitative %K thematic %D 2025 %7 13.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Singapore’s large aging population poses significant challenges for the health care system in managing cognitive decline, underscoring the importance of identifying and implementing effective interventions. Cognitive training delivered remotely as a digital therapeutic (DTx) may serve as a scalable and accessible approach to overcoming these challenges. While previous studies indicate the potential of cognitive training as a promising solution for managing cognitive decline, understanding the attitudes and experiences of older adults toward using such DTx platforms remains relatively unexplored. Objective: This study aimed to characterize the general acceptability and user experience of CURATE.DTx, a multitasking-based DTx platform that challenges the cognitive domains of attention, problem-solving, and executive function in the Singaporean older adult population. Methods: A total of 15 older adult participants (mean age 66.1, SD 3.5 years) were recruited for a 90-minute in-person session. This session included a 30-minute playtest of CURATE.DTx, followed by a 60-minute semistructured interview to understand their overall attitudes, experience, motivation, and views of the intervention. Interviews were audio-recorded and transcribed verbatim, then analyzed using an inductive approach. Thematic analysis was used to identify emerging patterns and insights. Results: A total of 3 main themes, and their respective subthemes, emerged from the interviews: comprehension, with subthemes of instruction and task comprehension; acceptability, with subthemes of tablet usability, engagement and enjoyment, and attitude and perceived benefits; and facilitators to adoption, with subthemes of framing and aesthetics, motivation recommendations and the role of medical professionals. Our findings revealed that participants encountered some challenges with understanding certain elements of CURATE.DTx. Nevertheless, they were still highly engaged with it, finding the challenge to be enjoyable. Participants also showed a strong awareness of the importance of cognitive training and expressed a keen interest in using CURATE.DTx for this purpose, especially if recommended by medical professionals. Conclusions: Given the positive engagement and feedback obtained from Singaporean older adults on CURATE.DTx, this study can serve as a basis for future platform iterations and strategies that should be considered during implementation. Future studies should continue implementing an iterative codesign approach to ensure the broader applicability and effectiveness of interventions tailored to this demographic. %M 39805580 %R 10.2196/63568 %U https://formative.jmir.org/2025/1/e63568 %U https://doi.org/10.2196/63568 %U http://www.ncbi.nlm.nih.gov/pubmed/39805580 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e53045 %T Tongue Muscle Training App for Middle-Aged and Older Adults Incorporating Flow-Based Gameplay: Design and Feasibility Pilot Study %A Su,Kuan-Chu %A Wu,Ko-Chiu %A Chou,Kuei-Ru %A Huang,Chia-Hsu %K exergame %K mobile app %K flow %K self-care %K feasibility %K older adults %K dysphagia %K tongue exercises %D 2025 %7 9.1.2025 %9 %J JMIR Serious Games %G English %X Background: Complications due to dysphagia are increasingly prevalent among older adults; however, the tediousness and complexity of conventional tongue rehabilitation treatments affect their willingness to rehabilitate. It is unclear whether integrating gameplay into a tongue training app is a feasible approach to rehabilitation. Objective: Tongue training has been proven helpful for dysphagia treatment. Following the development of a tongue training app, a feasibility trial aimed to identify physiological and psychological factors that affect user and flow experience and explored whether training specialized muscles could produce a flow experience for optimal immersion. We aimed to provide a useful tool for medical rehabilitation so that older adults could retain tongue muscle flexibility. Methods: After consulting professional nurses, we developed a mobile gaming app for middle-aged and older adults to train their tongue muscles. This pilot study used an image recognition system to detect the tongue movements of 32 healthy middle-aged and older adults (7 males, 21.9%; 25 females, 78.1%) during 3 game training tasks, each requiring different reaction speeds. Their physiological and psychological signals, as well as the results of the Flow State Scale 2 (FSS2) questionnaire, were used for correlation analysis regarding relevant flow experiences to establish and evaluate the feasibility of our method. Results: Through exploratory factor analyses, a 2-factor (operation and immersion) structure was confirmed to have an adequate model fit (χ²36=448.478; P<.001; Kaiser-Meyer-Olkin=0.757) and internal consistency reliability (Cronbach α=0.802). The slow, medium, and fast levels all significantly affected the FSS2 score for operation (P=.001), the National Aeronautics and Space Administration Task Load Index (P<.001), and flow distance (P<.001). K-means clustering revealed that participants could be further categorized into 3 groups. Through the analysis of changes in the participants’ physiological and psychological signals for each given task, Pearson correlation indicated that changes were primarily related to flow distance. For the 12 indicators measured in this study, the low, medium, and high operation groups showed significance in 58% (7/12), 50% (6/12), and 25% (3/12) of the indicators, respectively. Similarly, the low, medium, and high immersion groups had changes in 50% (6/12), 33% (4/12), and 17% (2/12) of indicators, respectively. Conclusions: Our research supports the further development of a gaming app to aid older adults with tongue muscle training and measure flow using physiological and psychological signals to enhance training accuracy and feasibility. Next, we aim to conduct a randomized pilot trial, improve app functions, offer alternative rehabilitation options, and encourage long-term participation. Future goals include enhancing long-term efficacy, diversifying training modes, and adding a multiuser interactive option for an added challenge. %R 10.2196/53045 %U https://games.jmir.org/2025/1/e53045 %U https://doi.org/10.2196/53045 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54466 %T Effectiveness of Integrated Digital Solutions to Empower Older Adults in Aspects Related to Their Health: Systematic Review and Meta-Analysis %A Martins,Ana Isabel %A Ribeiro,Óscar %A Santinha,Gonçalo %A Silva,Telmo %A Rocha,Nelson P %A Silva,Anabela G %+ School of Health Sciences, Center for Health Technology and Services Research, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-143, Portugal, 351 234247119, asilva@ua.pt %K empowerment %K older adults %K digital health %K digital solutions %K effectiveness %K empowerment %K health related %K outcomes %K systematic review %K meta-analysis %K synthesize %K evaluate %K apps %K mHealth %K mobile health %D 2025 %7 9.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Digital solutions, such as mobile apps or telemonitoring devices, are frequently considered facilitators in the process of empowering older adults, but they can also act as a source of digital exclusion or disempowerment if they are not adequate for older adults’ needs and characteristics. Objective: This study aimed to synthesize and critically evaluate existing evidence on the effectiveness of integrated digital solutions that enable interaction for empowering older adults in aspects related to their health and to explore potential factors (eg, type of technology, participants’ characteristics) impacting effectiveness. Methods: A systematic search was carried out in PubMed, ScienceDirect, SCOPUS, EBSCO, and SciELO using a combination of terms informed by previous reviews on empowerment. Screening of references was performed against predefined inclusion criteria. Data extraction and the methodological quality of included studies using the PEDro (Physiotherapy Evidence Database) scale were performed by 2 authors. The certainty of evidence was graded for the main comparisons and outcomes of the review using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. When at least 3 studies were available within the same domain of empowerment (knowledge, support by others, capacities, and behaviors) and comparison group, a meta-analysis was performed. Results: A total of 30 manuscripts were included in the review. Regarding knowledge, there was very low certainty of evidence of a medium effect size (ES) favoring the digital intervention group (k=5, ES=0.40, 95% CI 0.07-0.73, I2=79%). Regarding capacities, there was low certainty of evidence of no between-group differences (k=5, d=0.13, 95% CI –0.02 to 0.29, I2=0%) when comparing digital solutions against no intervention, low certainty of evidence of a medium ES favoring the digital intervention group (k=13, d=0.29, 95% CI 0.07-0.52, I2=79%) when comparing digital solutions against usual care, and very low certainty of evidence of no between-group differences (k=4, d=0.97, 95% CI –0.62 to 2.56, I2=97%) when comparing digital interventions to face-to-face interventions. Regarding social support and behaviors, no meta-analysis was possible, and existing evidence is conflicting. Conclusions: There is very-low-to-low certainty of evidence that using integrated digital solutions results in increased knowledge and increased capacities (mainly self-efficacy) when compared to usual care and impacts capacities to an extent similar to face-to-face interventions at postintervention. Interestingly, results also suggest, with low certainty of evidence, that there are no differences between using digital solutions and no intervention for improving capacities. Included studies and technologies were diverse, and meta-analysis showed high heterogeneity, which limits the confidence in the results and suggests that further research might affect the conclusions of this review. Trial Registration: PROSPERO CRD42022346823; https://tinyurl.com/39k29pzc %M 39786841 %R 10.2196/54466 %U https://www.jmir.org/2025/1/e54466 %U https://doi.org/10.2196/54466 %U http://www.ncbi.nlm.nih.gov/pubmed/39786841 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e64636 %T Baseline Smartphone App Survey Return in the Electronic Framingham Heart Study Offspring and Omni 1 Study: eCohort Study %A Rong,Jian %A Pathiravasan,Chathurangi H %A Zhang,Yuankai %A Faro,Jamie M %A Wang,Xuzhi %A Schramm,Eric %A Borrelli,Belinda %A Benjamin,Emelia J %A Liu,Chunyu %A Murabito,Joanne M %K mHealth %K mobile health %K mobile application %K smartphone %K digital health %K digital technology %K digital intervention %K gerontology %K geriatric %K older adult %K aging %K eFHS %K eCohort %K smartphone app %K baseline app surveys %K Framingham Heart Study %K health information %K information collection %K mobile phone %D 2024 %7 31.12.2024 %9 %J JMIR Aging %G English %X Background: Smartphone apps can be used to monitor chronic conditions and offer opportunities for self-assessment conveniently at home. However, few digital studies include older adults. Objective: We aim to describe a new electronic cohort of older adults embedded in the Framingham Heart Study including baseline smartphone survey return rates and survey completion rates by smartphone type (iPhone [Apple Inc] and Android [Google LLC] users). We also aim to report survey results for selected baseline surveys and participant experience with this study’s app. Methods: Framingham Heart Study Offspring and Omni (multiethnic cohort) participants who owned a smartphone were invited to download this study’s app that contained a range of survey types to report on different aspects of health including self-reported measures from the Patient-Reported Outcomes Measurement Information System (PROMIS). iPhone users also completed 4 tasks including 2 cognitive and 2 physical function testing tasks. Baseline survey return and completion rates were calculated for 12 surveys and compared between iPhone and Android users. We calculated standardized scores for the PROMIS surveys. The Mobile App Rating Scale (MARS) was deployed 30 days after enrollment to obtain participant feedback on app functionality and aesthetics. Results: We enrolled 611 smartphone users (average age 73.6, SD 6.3 y; n=346, 56.6% women; n=88, 14.4% Omni participants; 478, 78.2% iPhone users) and 596 (97.5%) returned at least 1 baseline survey. iPhone users had higher app survey return rates than Android users for each survey (range 85.5% to 98.3% vs 73.8% to 95.2%, respectively), but survey completion rates did not differ in the 2 smartphone groups. The return rate for the 4 iPhone tasks ranged from 80.9% (380/470) for the gait task to 88.9% (418/470) for the Trail Making Test task. The Electronic Framingham Heart Study participants had better standardized t scores in 6 of 7 PROMIS surveys compared to the general population mean (t score=50) including higher cognitive function (n=55.6) and lower fatigue (n=45.5). Among 469 participants who returned the MARS survey, app functionality and aesthetics was rated high (total MARS score=8.6 on a 1‐10 scale). Conclusions: We effectively engaged community-dwelling older adults to use a smartphone app designed to collect health information relevant to older adults. High app survey return rates and very high app survey completion rates were observed along with high participant rating of this study’s app. %R 10.2196/64636 %U https://aging.jmir.org/2024/1/e64636 %U https://doi.org/10.2196/64636 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e67992 %T The CareVirtue Digital Journal for Family and Friend Caregivers of People Living With Alzheimer Disease and Related Dementias: Exploratory Topic Modeling and User Engagement Study %A Pickett,Andrew C %A Valdez,Danny %A White,Lillian A %A Loganathar,Priya %A Linden,Anna %A Boutilier,Justin J %A Caldwell,Clover %A Elliott,Christian %A Zuraw,Matthew %A Werner,Nicole E %+ Department of Health & Wellness Design, School of Public Health- Bloomington, Indiana University, 2719 E 10th Street, Bloomington, IN, 47408, United States, 1 812 856 1710, picketac@iu.edu %K caregiving %K dementia %K social support %K technology %K intervention %K Alzheimer disease %K family %K care network %K elder %K CareVirtue %K open text %K online platform %K digital journaling tool %K computational informatics %K thematic analysis %K topic modeling %K neurodegeneration %K gerontology %K sentiment analysis %D 2024 %7 24.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: As Alzheimer disease (AD) and AD-related dementias (ADRD) progress, individuals increasingly require assistance from unpaid, informal caregivers to support them in activities of daily living. These caregivers may experience high levels of financial, mental, and physical strain associated with providing care. CareVirtue is a web-based tool created to connect and support multiple individuals across a care network to coordinate care activities and share important information, thereby reducing care burden. Objective: This study aims to use a computational informatics approach to thematically analyze open text written by AD/ADRD caregivers in the CareVirtue platform. We then explore relationships between identified themes and use patterns. Methods: We analyzed journal posts (n=1555 posts; 170,212 words) generated by 51 unique users of the CareVirtue platform. Latent themes were identified using a neural network approach to topic modeling. We calculated a sentiment score for each post using the Valence Aware Dictionary and Sentiment Reasoner. We then examined relationships between identified topics; semantic sentiment; and use-related data, including post word count and self-reported mood. Results: We identified 5 primary topics in users’ journal posts, including descriptions of specific events, professional and medical care, routine daily activities, nighttime symptoms, and bathroom/toileting issues. This 5-topic model demonstrated adequate fit to the data, having the highest coherence score (0.41) among those tested. We observed group differences across these topics in both word count and semantic sentiment. Further, posts made in the evening were both longer and more semantically positive than other times of the day. Conclusions: Users of the CareVirtue platform journaled about a variety of different topics, including generalized experiences and specific behavioral symptomology of AD/ADRD, suggesting a desire to record and share broadly across the care network. Posts were the most positive in the early evening when the tool was used habitually, rather than when writing about acute events or symptomology. We discuss the value of embedding informatics-based tools into digital interventions to facilitate real-time content delivery. %M 39719081 %R 10.2196/67992 %U https://aging.jmir.org/2024/1/e67992 %U https://doi.org/10.2196/67992 %U http://www.ncbi.nlm.nih.gov/pubmed/39719081 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57308 %T An Evidence-Based IT Program With Chatbot to Support Caregiving and Clinical Care for People With Dementia: The CareHeroes Development and Usability Pilot %A Ruggiano,Nicole %A Brown,Ellen Leslie %A Clarke,Peter J %A Hristidis,Vagelis %A Roberts,Lisa %A Framil Suarez,Carmen Victoria %A Allala,Sai Chaithra %A Hurley,Shannon %A Kopcsik,Chrystine %A Daquin,Jane %A Chevez,Hamilton %A Chang-Lau,Raymond %A Agronin,Marc %A Geldmacher,David S %K Alzheimer disease %K artificial intelligence %K caregivers %K chatbot %K dementia %K mobile applications %K conversational agent %K design %K apps %D 2024 %7 23.12.2024 %9 %J JMIR Aging %G English %X Background: There are numerous communication barriers between family caregivers and providers of people living with dementia, which can pose challenges to caregiving and clinical decision-making. To address these barriers, a new web and mobile-enabled app, called CareHeroes, was developed, which promotes the collection and secured sharing of clinical information between caregivers and providers. It also provides caregiver support and education. Objective: The primary study objective was to examine whether dementia caregivers would use CareHeroes as an adjunct to care and gather psychosocial data from those who used the app. Methods: This paper presents the implementation process used to integrate CareHeroes into clinical care at 2 memory clinics and preliminary outcome evaluation. Family caregivers receiving services at clinics were asked to use the app for a 12-month period to collect, track, and share clinical information with the care recipient’s provider. They also used it to assess their own mental health symptoms. Psychosocial outcomes were assessed through telephone interviews and user data were collected by the app. Results: A total of 21 caregivers enrolled in the pilot study across the 2 memory clinics. Usage data indicated that caregivers used many of the features in the CareHeroes app, though the chatbot was the most frequently used feature. Outcome data indicated that caregivers’ depression was lower at 3-month follow-up (t11=2.03, P=.03). Conclusions: Recruitment and retention of the pilot study were impacted by COVID-19 restrictions, and therefore more testing is needed with a larger sample to determine the potential impact of CareHeroes on caregivers’ mental health. Despite this limitation, the pilot study demonstrated that integrating a new supportive app for caregivers as an adjunct to clinical dementia care is feasible. Implications for future technology intervention development, implementation planning, and testing for caregivers of people living with dementia are discussed. %R 10.2196/57308 %U https://aging.jmir.org/2024/1/e57308 %U https://doi.org/10.2196/57308 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59865 %T Development of a Tablet-Based Outpatient Care Application for People With Dementia: Interview and Workshop Study %A Supplieth,Juliana %A Lech,Sonia %A O’Sullivan,Julie Lorraine %A Spang,Robert %A Voigt-Antons,Jan‐Niklas %A Schuster,Johanna %K dementia %K tablet application development %K multidisciplinary health care %K feasibility study %K general practitioners %K digital health care %D 2024 %7 19.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Dementia management presents a significant challenge for individuals affected by dementia, as well as their families, caregivers, and health care providers. Digital applications may support those living with dementia; however only a few dementia-friendly applications exist. Objective: This paper emphasizes the necessity of considering multiple perspectives to ensure the high-quality development of supportive health care applications. The findings underscore the importance of incorporating input from stakeholders and the needs of affected families into application development. Method: A qualitative approach was chosen, consisting of three interviews and an expert workshop. The interviews and the workshop were recorded and transcribed, and qualitative content analysis was carried out according to the methodology described by Kuckartz with the support of MAXQDA. Results: During the development phases of the application, team meetings and discussions took place. We found that general practitioners and family caregivers play pivotal roles in the treatment and care of people with dementia, often expressing specific preferences and suggestions regarding supportive and assistive technologies. Moreover, the successful development of a useful tablet application requires robust scientific and multidisciplinary discussions and teamwork within the health care community. Conclusion: This paper underscores the necessity of including multiple scientific, clinical, and technical perspectives to ensure the high-quality development of supportive health care applications. Furthermore, adopting a spiral development approach inclusive of feedback loops is imperative for iterative refinement and enhancement of the application. International Registered Report Identifier (IRRID): RR2-10.1024/1662-9647/a000210 %R 10.2196/59865 %U https://humanfactors.jmir.org/2024/1/e59865 %U https://doi.org/10.2196/59865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63041 %T Perspectives on Technology Use in the Context of Caregiving for Persons With Dementia: Qualitative Interview Study %A Grewal,Karl S %A Gowda-Sookochoff,Rory %A Peacock,Shelley %A Cammer,Allison %A McWilliams,Lachlan A %A Spiteri,Raymond J %A Haase,Kristen R %A Harrison,Mary %A Holtslander,Lorraine %A MacRae,Rhoda %A Michael,Joanne %A Green,Shoshana %A O'Connell,Megan E %+ Department of Psychology and Health Studies, College of Arts and Science, University of Saskatchewan, 9 Campus Drive, Sasktoon, SK, S7N 5A5, Canada, 1 3069662496, karl.grewal@usask.ca %K care partner %K caregiving %K dementia %K technology %K content analysis %K mobile phone %K technology adoption %K assistive technology %K support %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Examining ways to support persons with dementia and their caregivers to help minimize the disease’s impact on individuals, families, and society is critical. One emerging avenue for support is technology (eg, smartphones and smart homes). Objective: Given the increasing presence of technology in caregiving, it is pertinent to appreciate whether and how technology can be most useful to a care partner’s everyday life. This study aims to further understand care partner technology use, attitudes, and the potential role of off-the-shelf technologies (eg, smartphones and smart homes) in supporting caregiving from the perspective of care partners for persons with dementia. Methods: We conducted a telephone cross-sectional survey using random digit dialing with 67 self-identified care partners of persons with dementia across one Canadian province. Participants were asked about attitudes toward technology, barriers to and facilitators for technology use, technology use with caregiving, and demographic information. Eight open-ended questions were analyzed using content analysis; 2 closed-ended questions about comfort with and helpfulness of technology (rated on a scale of 1 to 10) were analyzed with frequencies. From these data, an in-depth semistructured interview was created, and 10 (15%) randomly sampled care partners from the initial collection of 67 care partners were interviewed approximately 1 year later, with responses analyzed using content analysis. Results: Frequency analysis rated on a scale of 1 to 10 suggested that care partners were comfortable with technology (wearable technology mean 7.94, SD 2.02; smart home technology mean 6.94, SD 2.09), although they rated the helpfulness of technology less strongly (mean 5.02, SD 2.85). Qualitatively, care partners described using technology for functional tasks and some caregiving. Barriers to technology use included cost, lack of knowledge, security or privacy concerns, and undesirable features of technology. Facilitators included access to support and the presence of desirable features. Some care partners described merging technology with caregiving and reported subsequent benefits. Others stated that technology could not be adopted for caregiving due to the degree of impairment, fear of negative consequences for the person living with dementia, or due to incongruity with the caregiving philosophy. Furthermore, care partners noted that their technology use either increased or was unchanged as they moved through the COVID-19 pandemic. Conclusions: The 2 analyses were conducted separately, but there was notable overlap in the data, suggesting temporal stability of identified content. Both analyses suggested care partners’ relative comfort with technology and its use, but other care partners noted concerns about integrating technology and caregiving. Care partners’ reports of increased technology use throughout the COVID-19 pandemic may also suggest that the pandemic impacted their perceptions of the usefulness of technology, being influenced by the requirements of their reality. Future investigations should examine how to support care partners in adopting relevant technology. %M 39671589 %R 10.2196/63041 %U https://formative.jmir.org/2024/1/e63041 %U https://doi.org/10.2196/63041 %U http://www.ncbi.nlm.nih.gov/pubmed/39671589 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e60155 %T The Effect of the Mediterranean Diet–Integrated Gamified Home-Based Cognitive-Nutritional (GAHOCON) Training Programme for Older People With Cognitive Frailty: Pilot Randomized Controlled Trial %A Kwan,Rick Yiu Cho %A Law,Queenie Pui Sze %A Tsang,Jenny Tsun Yee %A Lam,Siu Hin %A Wang,Kam To %A Sin,Olive Shuk Kan %A Cheung,Daphne Sze Ki %+ School of Nursing, Tung Wah College, Ma Kam Chan Memorial Building, 31 Wylie Road, Homantin, Hong Kong SAR, China (Hong Kong), 852 34686813, rickkwan@twc.edu.hk %K cognitive frailty %K gamification %K health education %K Mediterranean diet %K home based %K cognitive training %K older adults %K geriatric %K elderly %K cognitive training %K cognitive function %K health education %K intervention %K nutritional education %K cognitive impairment %K dementia %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Cognitive frailty is known to be associated with both nutrition and cognitive training. However, effective treatments that engage older adults with cognitive frailty in both the Mediterranean diet and cognitive training are lacking. Objective: This study aims to examine the feasibility and preliminary effects of Gamified Home-Based Cognitive-Nutritional (GAHOCON) on older adults with cognitive frailty, focusing on Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Methods: This study applied a 2-center, assessor-blinded, 2-parallel-group, noninferiority, randomized controlled trial design. Eligible participants were community-dwelling adults aged 60 years or older, living with cognitive frailty, and exhibiting poor adherence to the Mediterranean diet. Participants were randomly assigned to the intervention or control group in a 1:1 ratio. In the intervention group, participants received 4 weeks of center-based training (health education) followed by 8 weeks of home-based training (GAHOCON). In the control group, participants received only the 4 weeks of center-based training and 8 weeks of self-revision of health educational materials at home. During the intervention period, time spent by the participants and the levels of difficulty completed by them weekly on GAHOCON were measured as markers of feasibility. The outcomes included Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Data were collected at baseline (T0) and 1 week postintervention (T1). The Wilcoxon signed rank test was used to examine within-group effects for the outcome variables in each group separately. Results: A total of 25 participants were recruited, with 13 allocated to the intervention group and 12 to the control group. The median cumulative minutes spent on GAHOCON training increased from 117 to 926 minutes. The median level of difficulty completed for game 1 increased from level 14 to level 20, while for game 2, it increased from level 2 to level 24. After the completion of the interventions, Mediterranean diet knowledge was retained in the intervention group but significantly decreased in the control group (r=–0.606, P=.04). Significant improvements were observed in the intervention group in Mediterranean diet adherence (r=–0.728, P=.009), cognitive function (r=–0.752, P=.007), physical frailty (r=–0.668, P=.02), and walking speed (r=–0.587, P=.03), but no such improvements were seen in the control group. Conclusions: GAHOCON is feasible in engaging older adults with cognitive frailty to regularly participate in the intervention. Preliminary evidence suggests that it can retain Mediterranean diet knowledge following nutritional education, improve adherence to the Mediterranean diet, and enhance global cognitive function, physical frailty, and walking speed. However, the difficulty of the later levels of game 1 may be too high. Future studies should adjust the difficulty level of game 1. Additionally, trials with larger sample sizes and longer follow-up periods are needed to confirm its effects. Trial Registration: ClinicalTrials.gov NCT05207930; https://clinicaltrials.gov/ct2/show/NCT05207930 %M 39671585 %R 10.2196/60155 %U https://rehab.jmir.org/2024/1/e60155 %U https://doi.org/10.2196/60155 %U http://www.ncbi.nlm.nih.gov/pubmed/39671585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52834 %T Exploring Older Adults’ Perspectives on Digital Home Care Interventions and Home Modifications: Focus Group Study %A Choukou,Mohamed-Amine %A Banihani,Jasem %A Azizkhani,Sarah %+ Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, R111, 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada, 1 204 333 4778, amine.choukou@umanitoba.ca %K agetech %K attitude %K opinion %K perception %K perspective %K home based %K community based %K research %K strategic planning %K gerontechnology %K geriatric %K older adults %K aging %K co-construction %K workshop %K inductive analysis %K development %K aging-in-place %K independent %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging gerontechnology seeks to enable older adults (OAs) to remain independently and safely in their homes by connecting to health and social support and services. There are increasing attempts to develop gerontechnology, but successful implementations are more likely limited because of the uncertainty of developers about the needs and priorities of OAs. As the global population ages, the challenges faced by older OAs in maintaining independence and well-being within their homes have become increasingly important. With the proportion of OAs expected to triple by 2068, addressing the needs of this demographic has become a pressing social and public health priority. OAs often encounter various challenges related to physical, cognitive, and social well-being, including reduced mobility, memory impairments, and social isolation, which can compromise their ability to age in place and maintain a high quality of life. Objective: The goals of this qualitative research study are to (1) determine the best strategies for promoting aging well in the community with the support of gerontechnology, (2) establish the top priorities for implementing gerontechnology with OAs and their families, and (3) create a road map for the creation and application of gerontechnology for aging well in Manitoba. Methods: A total of 14 OAs participated in a qualitative research study conducted through a coconstruction workshop format, including a presentation of novel research facilities and a demonstration of research and development products. This activity was followed by an interactive discussion focused on revisiting the ongoing research and innovation programs and planning for a new research and innovation agenda. The workshop contents, notes, and recorded conversation underwent a data-driven inductive analysis. Results: Emerging themes included home design, accessibility, and safety for OAs, particularly those with memory impairments. The participants also underlined the need for digital reminders and ambient technologies in current homes as a priority. Participants stressed the importance of including OAs in gerontechnology development programs and the need to consider dignity and independence as the guiding values for future research. Conclusions: This study presents a tentative road map for the development of gerontechnology in Manitoba. The main principles of our road map are the inclusion of OAs as early as possible in gerontechnology development and the prioritization of independence and dignity. Applying these principles would contribute to combatting digital ageism and the marginalization of OAs in technology development because of the perceived lack of technological skills and the stereotypes associated with this presumption. %M 39671577 %R 10.2196/52834 %U https://formative.jmir.org/2024/1/e52834 %U https://doi.org/10.2196/52834 %U http://www.ncbi.nlm.nih.gov/pubmed/39671577 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e62689 %T The Needs and Experiences of People With Early-Stage Dementia Using an Application for Cognitive and Physical Activation in Germany: Qualitative Study %A Klein,Melina %A von Bosse,Alexa %A Kunze,Christophe %K touch-based digital technology %K gerontology %K geriatric %K older %K elderly %K aging %K aged %K tablet-based technology %K tablet %K digital care application %K mHealth %K mobile health %K app %K health app %K home care setting %K caring relatives %K dementia %K MCI %K Alzheimer %K mild cognitive impairment %K cognition %K prototype %K digital health %K telehealth %K dementia %K memory loss %K patient care %K patient health %K patient support %D 2024 %7 10.12.2024 %9 %J JMIR Aging %G English %X Background: The demand for support among people with dementia is increasing, while caregiving capacity is declining. As the trend of aging at home continues, technologies can help maintain the autonomy of people with dementia, enabling them to live independently for as long as possible. Furthermore, digital applications can have numerous positive biopsychosocial effects on the health of people with dementia, enhancing their physical, cognitive, and social functioning. Objective: This study aims to investigate the needs and experiences of people with dementia regarding a prototype tablet-based application designed to promote cognitive and physical activity. Methods: We conducted a methodical triangulation by combining semistructured interviews with people with dementia and external overt participant observation while testing a tablet-based application. A qualitative content analysis, as outlined by Kuckartz, was used to analyze the data. Results: Participants demonstrated varying levels of ability and prior experience with technology. While most were initially hesitant to use the tablet independently, they were more willing to try it after receiving encouragement. Some individuals required more assistance than others, indicating the need for individualized adjustments. Personal relevance to the content appeared to be crucial for cognitive tasks, as it helped to minimize overload for people with dementia. The participants appreciated social interaction with researchers and direct communication. Therefore, it is important to consider the role of personal support when developing and implementing technology. Conclusions: The successful implementation and use of technology requires acceptance and an effective interaction between people with dementia, technology, and caregivers or caring relatives providing personal support. The acceptance of the application was found to be less influenced by the types and presentation of tasks and more by content relevance and social interaction. Ideally, one-on-one support will be provided during use, though this requires additional time and financial resources, which are often limited in caregiving settings. %R 10.2196/62689 %U https://aging.jmir.org/2024/1/e62689 %U https://doi.org/10.2196/62689 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63907 %T Internet-Based Social Activities and Cognitive Functioning 2 Years Later Among Middle-Aged and Older Adults: Prospective Cohort Study %A Jeon,Sangha %A Charles,Susan Turk %K online social interaction %K cognitive health %K age differences %K Health and Retirement Study %K social activity %K internet use %K isolation %D 2024 %7 10.12.2024 %9 %J JMIR Aging %G English %X Background: A number of studies document the benefits of face-to-face social interactions for cognitive functioning among middle-aged and older adults. Social activities in virtual worlds may confer similar if not enhanced cognitive benefits as face-to-face social activities, given that virtual interactions require the additional cognitive tasks of learning and navigating communicative tools and technology platforms. Yet, few studies have examined whether social activities in internet-based settings may have synergistic effects on cognitive functioning beyond those of face-to-face interactions. Objective: This study examined whether internet-based social activity participation is associated with concurrent and later cognitive functioning, after adjusting for face-to-face social activity participation and sociodemographic covariates. Methods: For cross-sectional analyses, we included 3650 adults aged 50 years and older who completed questions in the 2020 Health and Retirement Study about social activity participation, including specific internet-based social activities such as emailing or accessing social networks. Cognitive functioning was measured using the standardized cognitive tasks assessing working memory, episodic memory, and attention and processing speed. The longitudinal analyses included the 2034 participants who also completed follow-up cognitive assessments in 2022. Results: Our results revealed that those with higher levels of internet-based social activity participation had higher levels of concurrent cognitive functioning than those with low levels of internet-based social activity participation, after adjusting for demographic and health-related factors and face-to-face social activity participation (b=0.44, SE 0.07; P<.001). More internet-based social activity participation also predicted better cognitive functioning 2 years later, even when adjusting for baseline cognitive functioning and other covariates (b=0.35, SE 0.09; P<.001). Conclusions: Our findings suggest that greater engagement in internet-based social activities is associated with higher levels of concurrent cognitive functioning and slower cognitive decline in middle-aged and older adults. %R 10.2196/63907 %U https://aging.jmir.org/2024/1/e63907 %U https://doi.org/10.2196/63907 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60650 %T Testing 3 Modalities (Voice Assistant, Chatbot, and Mobile App) to Assist Older African American and Black Adults in Seeking Information on Alzheimer Disease and Related Dementias: Wizard of Oz Usability Study %A Bosco,Cristina %A Shojaei,Fereshtehossadat %A Theisz,Alec Andrew %A Osorio Torres,John %A Cureton,Bianca %A Himes,Anna K %A Jessup,Nenette M %A Barnes,Priscilla A %A Lu,Yvonne %A Hendrie,Hugh C %A Hill,Carl V %A Shih,Patrick C %+ Luddy School of Informatics, Computing, and Engineering, Indiana University, 700 N Woodlawn Ave, Bloomington, IN, 47408, United States, 1 (812) 856 5754, cribosco@iu.edu %K older African American and Black adults %K Alzheimer disease and related dementias %K health literacy %K Wizard of Oz %K voice assistant %K chatbot %K mobile app %K dementia %K geriatric %K aging %K Alzheimer disease %K artificial intelligence %K AI %K mHealth %K digital tools %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older African American and Black adults are twice as likely to develop Alzheimer disease and related dementias (ADRD) and have the lowest level of ADRD health literacy compared to any other ethnic group in the United States. Low health literacy concerning ADRD negatively impacts African American and Black people in accessing adequate health care. Objective: This study explored how 3 technological modalities—voice assistants, chatbots, and mobile apps—can assist older African American and Black adults in accessing ADRD information to improve ADRD health literacy. By testing each modality independently, the focus could be kept on understanding the unique needs and challenges of this population concerning the use of each modality when accessing ADRD-related information. Methods: Using the Wizard of Oz usability testing method, we assessed the 3 modalities with a sample of 15 older African American and Black adults aged >55 years. The 15 participants were asked to interact with the 3 modalities to search for information on local events happening in their geographical area and search for ADRD-related health information. Results: Our findings revealed that, across the 3 modalities, the content should avoid convoluted and complex language and give the possibility to save, store, and share it to be fully accessible by this population. In addition, content should come from credible sources, including information tailored to the participants’ cultural values, as it has to be culturally relevant for African American and Black communities. Finally, the interaction with the tool must be time efficient, and it should be adapted to the user’s needs to foster a sense of control and representation. Conclusions: We conclude that, when designing ADRD-related interventions for African American and Black older adults, it proves to be crucial to tailor the content provided by the technology to the community’s values and construct an interaction with the technology that is built on African American and Black communities’ needs and demands. %R 10.2196/60650 %U https://formative.jmir.org/2024/1/e60650 %U https://doi.org/10.2196/60650 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59588 %T An eHealth Intervention to Improve Quality of Life, Socioemotional, and Health-Related Measures Among Older Adults With Multiple Chronic Conditions: Randomized Controlled Trial %A Gustafson Sr,David H %A Mares,Marie-Louise %A Johnston,Darcie %A Vjorn,Olivia J %A Curtin,John J %A Landucci,Gina %A Pe-Romashko,Klaren %A Gustafson Jr,David H %A Shah,Dhavan V %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, 4111 Mechanical Engineering, 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 1440, gina.landucci@wisc.edu %K eHealth %K telemedicine %K aged %K geriatrics %K multiple chronic conditions %K social support %K quality of life %K primary care %K mobile phone %K smartphone %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: In the United States, over 60% of adults aged 65 years or older have multiple chronic health conditions, with consequences that include reduced quality of life, increasingly complex but less person-centered treatment, and higher health care costs. A previous trial of ElderTree, an eHealth intervention for older adults, found socioemotional benefits for those with high rates of primary care use. Objective: This study tested the effectiveness of an ElderTree intervention designed specifically for older patients with multiple chronic conditions to determine whether combining it with primary care improved socioemotional and physical outcomes. Methods: In a nonblinded randomized controlled trial, 346 participants recruited from primary care clinics were assigned 1:1 to the ElderTree intervention or an attention control and were followed for 12 months. All participants were aged 65 years or older and had electronic health record diagnoses of at least three of 11 chronic conditions. Primary outcomes were mental and physical quality of life, psychological well-being (feelings of competence, connectedness, meaningfulness, and optimism), and loneliness. Tested mediators of the effects of the study arm (ElderTree vs active control) on changes in primary outcomes over time were 6-month changes in health coping, motivation, feelings of relatedness, depression, and anxiety. Tested moderators were sex, scheduled health care use, and number of chronic conditions. Data sources were surveys at baseline and 6 and 12 months comprising validated scales, and continuously collected ElderTree usage. Results: At 12 months, 76.1% (134/176) of ElderTree participants were still using the intervention. There was a significant effect of ElderTree (vs control) on improvements over 12 months in mental quality of life (arm × timepoint interaction: b=0.76, 95% CI 0.14-1.37; P=.02; 12-month ∆d=0.15) but no such effect on the other primary outcomes of physical quality of life, psychological well-being, or loneliness. Sex moderated the effects of the study arm over time on mental quality of life (b=1.33, 95% CI 0.09-2.58; P=.04) and psychological well-being (b=1.13, 95% CI 0.13-2.12; P=.03), with stronger effects for women than men. The effect of the study arm on mental quality of life was mediated by 6-month improvements in relatedness (α=1.25, P=.04; b=0.31, P<.001). Analyses of secondary and exploratory outcomes showed minimal effects of ElderTree. Conclusions: Consistent with the previous iteration of ElderTree, the current iteration designed for older patients with multiple chronic conditions showed signs of improving socioemotional outcomes but no impact on physical outcomes. This may reflect the choice of chronic conditions for inclusion, which need not have impinged on patients’ physical quality of life. Two ongoing trials are testing more specific versions of ElderTree targeting older patients coping with (1) chronic pain and (2) greater debilitation owing to at least 5 chronic conditions. Trial Registration: ClinicalTrials.gov NCT03387735; https://clinicaltrials.gov/study/NCT03387735 International Registered Report Identifier (IRRID): RR2-10.2196/25175 %M 39642938 %R 10.2196/59588 %U https://aging.jmir.org/2024/1/e59588 %U https://doi.org/10.2196/59588 %U http://www.ncbi.nlm.nih.gov/pubmed/39642938 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57320 %T In-Home Positioning for Remote Home Health Monitoring in Older Adults: Systematic Review %A Chan,Andrew %A Cai,Joanne %A Qian,Linna %A Coutts,Brendan %A Phan,Steven %A Gregson,Geoff %A Lipsett,Michael %A Ríos Rincón,Adriana M %+ Glenrose Rehabilitation Hospital, 10105 112 Ave NW, Edmonton, AB, T5G 0H1, Canada, 1 7802037731, aychan1@ualberta.ca %K gerontology %K geriatrics %K older adult %K elderly %K aging %K aging-in-place %K localization %K ambient sensor %K wearable sensor %K acceptability %K home monitor %K health monitor %K technology %K digital health %K e-health %K telehealth %K clinical studies %K cognitive impairment %K neuro %K cognition %D 2024 %7 2.12.2024 %9 Review %J JMIR Aging %G English %X Background: With the growing proportion of Canadians aged >65 years, smart home and health monitoring technologies may help older adults manage chronic disease and support aging in place. Localization technologies have been used to support the management of frailty and dementia by detecting activities in the home. Objective: This systematic review aims to summarize the clinical evidence for in-home localization technologies, review the acceptability of monitoring, and summarize the range of technologies being used for in-home localization. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was followed. MEDLINE, Embase, CINAHL, and Scopus were searched with 2 reviewers performing screening, extractions, and quality assessments. Results: A total of 1935 articles were found, with 36 technology-focused articles and 10 articles that reported on patient outcomes being included. From moderate- to high-quality studies, 2 studies reported mixed results on identifying mild cognitive dementia or frailty, while 4 studies reported mixed results on the acceptability of localization technology. Technologies included ambient sensors; Bluetooth- or Wi-Fi–received signal strength; localizer tags using radio frequency identification, ultra-wideband, Zigbee, or GPS; and inertial measurement units with localizer tags. Conclusions: The clinical utility of localization remains mixed, with in-home sensors not being able to differentiate between older adults with healthy cognition and older adults with mild cognitive impairment. However, frailty was detectable using in-home sensors. Acceptability is moderately positive, particularly with ambient sensors. Localization technologies can achieve room detection accuracies up to 92% and linear accuracies of up to 5-20 cm that may be promising for future clinical applications. Trial Registration: PROSPERO CRD42022339845; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339845 %R 10.2196/57320 %U https://aging.jmir.org/2024/1/e57320 %U https://doi.org/10.2196/57320 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59974 %T Mobility-Based Smartphone Digital Phenotypes for Unobtrusively Capturing Everyday Cognition, Mood, and Community Life-Space in Older Adults: Feasibility, Acceptability, and Preliminary Validity Study %A Hackett,Katherine %A Xu,Shiyun %A McKniff,Moira %A Paglia,Lido %A Barnett,Ian %A Giovannetti,Tania %+ Department of Psychology and Neuroscience, Temple University, 1701 N 13th St, Philadelphia, PA, 19122, United States, 1 484 843 1321, tania.giovannetti@temple.edu %K digital phenotyping %K digital biomarkers %K monitoring %K mHealth %K cognition %K mobility %K life space %K depression %K location data %K Alzheimer disease %K aging %K mobile phone %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Current methods of monitoring cognition in older adults are insufficient to address the growing burden of Alzheimer disease and related dementias (AD/ADRD). New approaches that are sensitive, scalable, objective, and reflective of meaningful functional outcomes are direly needed. Mobility trajectories and geospatial life space patterns reflect many aspects of cognitive and functional integrity and may be useful proxies of age-related cognitive decline. Objective: We investigated the feasibility, acceptability, and preliminary validity of a 1-month smartphone digital phenotyping protocol to infer everyday cognition, function, and mood in older adults from passively obtained GPS data. We also sought to clarify intrinsic and extrinsic factors associated with mobility phenotypes for consideration in future studies. Methods: Overall, 37 adults aged between 63 and 85 years with healthy cognition (n=31, 84%), mild cognitive impairment (n=5, 13%), and mild dementia (n=1, 3%) used an open-source smartphone app (mindLAMP) to unobtrusively capture GPS trajectories for 4 weeks. GPS data were processed into interpretable features across categories of activity, inactivity, routine, and location diversity. Monthly average and day-to-day intraindividual variability (IIV) metrics were calculated for each feature to test a priori hypotheses from a neuropsychological framework. Validation measures collected at baseline were compared against monthly GPS features to examine construct validity. Feasibility and acceptability outcomes included retention, comprehension of study procedures, technical difficulties, and satisfaction ratings at debriefing. Results: All (37/37, 100%) participants completed the 4-week monitoring period without major technical adverse events, 100% (37/37) reported satisfaction with the explanation of study procedures, and 97% (36/37) reported no feelings of discomfort. Participants’ scores on the comprehension of consent quiz were 97% on average and associated with education and race. Technical issues requiring troubleshooting were infrequent, though 41% (15/37) reported battery drain. Moderate to strong correlations (r≥0.3) were identified between GPS features and validators. Specifically, individuals with greater activity and more location diversity demonstrated better cognition, less functional impairment, less depression, more community participation, and more geospatial life space on objective and subjective validation measures. Contrary to predictions, greater IIV and less routine in mobility habits were also associated with positive outcomes. Many demographic and technology-related factors were not associated with GPS features; however, income, being a native English speaker, season of study participation, and occupational status were related to GPS features. Conclusions: Theoretically informed digital phenotypes of mobility are feasibly captured from older adults’ personal smartphones and relate to clinically meaningful measures including cognitive test performance, reported functional decline, mood, and community activity. Future studies should consider the impact of intrinsic and extrinsic factors when interpreting mobility phenotypes. Overall, smartphone digital phenotyping is a promising method to unobtrusively capture relevant risk and resilience factors in the context of aging and AD/ADRD and should continue to be investigated in large, diverse samples. %M 39576984 %R 10.2196/59974 %U https://humanfactors.jmir.org/2024/1/e59974 %U https://doi.org/10.2196/59974 %U http://www.ncbi.nlm.nih.gov/pubmed/39576984 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58517 %T mHealth Apps for Dementia Caregivers: Systematic Examination of Mobile Apps %A Zou,Ning %A Xie,Bo %A He,Daqing %A Hilsabeck,Robin %A Aguirre,Alyssa %K dementia %K informal care %K mobile health applications %K tailoring %K information quality %K mobile phone %D 2024 %7 20.11.2024 %9 %J JMIR Aging %G English %X Background: Informal caregivers of persons living with dementia are increasingly using mobile health (mHealth) apps to obtain care information. mHealth apps are seen as promising tools to better support caregivers’ complex and evolving information needs. Yet, little is known about the types and quality of dementia care information that these apps provide. Is this information for caregivers individually tailored; if so, how? Objective: We aim to address the aforementioned gaps in the literature by systematically examining the types and quality of care-related information provided in publicly available apps for caregivers of persons living with dementia as well as app features used to tailor information to caregivers’ information wants and situations. Methods: In September 2023, we used a multistage process to select mobile apps for caregivers of persons living with dementia. The final sample included 35 apps. We assessed (1) types of dementia care information provided in the apps, using our 3-item Alzheimer disease and related dementias daily care strategy framework, which encompasses educational information, tangible actions, and referral information; (2) quality of apps’ care information, using the 11 indicators recommended by the National Library of Medicine; and (3) types of tailoring to provide personalization, feedback, and content matching, which are common tailoring strategies described in the literature. Results: Educational information was the most prevalent type of information provided (29/35 apps, 83%), followed by information about tangible actions (18/35, 51%) and referrals (14/35, 40%). All apps presented their objectives clearly and avoided unrealistic or emotional claims. However, few provided information to explain whether the app’s content was generated or reviewed by experts (7/35, 20%) or how its content was selected (4/35, 11%). Further, 6 of the 35 (17%) apps implemented 1 type of tailoring; of them, 4 (11%) used content matching and the other 2 (6%) used personalization. No app used 2 types of tailoring; only 2 (6%) used all 3 types (the third is feedback). Conclusions: Existing dementia care apps do not provide sufficient high-quality, tailored information for informal caregivers. Caregivers should exercise caution when they use dementia care apps for informational support. Future research should focus on designing dementia care apps that incorporate quality-assured, transparency-enhanced, evidence-based artificial intelligence–enabled mHealth solutions for caregivers. %R 10.2196/58517 %U https://aging.jmir.org/2024/1/e58517 %U https://doi.org/10.2196/58517 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e57352 %T The Effect of Young People–Assisted, Individualized, Motion-Based Video Games on Physical, Cognitive, and Social Frailty Among Community-Dwelling Older Adults With Frailty: Randomized Controlled Trial %A Wong,Arkers Kwan Ching %A Zhang,Melissa Qian %A Bayuo,Jonathan %A Chow,Karen Kit Sum %A Wong,Siu Man %A Wong,Bonnie Po %A Liu,Bob Chung Man %A Lau,David Chi Ho %A Kowatsch,Tobias %K frailty %K gaming intervention %K motion-based %K video games %K older adults %K gerontology %K geriatrics %K randomized controlled trial %K RCT %K physical fitness %K adolescents %K young people–assisted %K eHealth literacy %K well-being %K therapists %K youth volunteers %K social support %K exergames %K gamification %K active games %K physical activity %D 2024 %7 20.11.2024 %9 %J JMIR Serious Games %G English %X Background: The aging population highlights the need to maintain both physical and psychological well-being. Frailty, a multidimensional syndrome, increases vulnerability to adverse outcomes. Although physical exercise is effective, adherence among older adults with frailty is often low due to barriers. Motion-based video games (MBVGs) may enhance motivation and engagement. Objective: This study aims to evaluate the effect of individualized exercise programs that combine MBVGs, intergenerational support, and therapeutic frameworks on physical, cognitive, and social frailty outcomes in community-dwelling older adults. Methods: This randomized controlled trial was conducted from March 2022 to October 2023 across 6 community centers in Hong Kong. Participants aged 60 years and above with mild neurocognitive disorder were recruited, screened, and randomly assigned to either an intervention (n=101) or control group (n=101). The intervention included an 18-week program with 12 supervised exercise sessions utilizing motion-based technology, led by occupational therapists and assisted by youth volunteers. Data were collected at baseline (T1) and postintervention (T2), focusing on physical, cognitive, and social frailty outcomes, as well as client-related metrics. Statistical analyses were performed using SPSS, with significance set at P<.05. Results: A total of 202 participants were recruited, with a mean age of 78.8 years (SD 7.8). Both groups showed improvements in balance from T1 to T2, with a significant time effect (β=−0.63, P=.03). The intervention group demonstrated enhancements in hand strength and BMI, but no statistically significant between-group differences were observed. The intervention group also exhibited significant improvements in cognitive function (β=2.43, P<.001), while the control group’s scores declined. Short-term memory improved for both groups, with no significant differences noted. Both groups experienced a reduction in depression levels, with a significant within-group effect at T2 (β=−1.16, P=.001). Improvements in social connectedness and eHealth literacy were observed in both groups, with the latter showing a significant within-group effect at T2 (β=3.56, P=.002). No significant effects were found for social isolation, physical activities, or quality of life. Conclusions: The growing aging population necessitates innovative strategies to support aging in place. Results indicated statistically significant improvements only in BMI and cognition, while other outcomes such as loneliness, balance, and eHealth literacy showed positive trends but lacked significance. Despite the limitations observed, particularly regarding the role of volunteer support and the diverse needs of community-dwelling older adults, the findings contribute to the foundation for future research aimed at enhancing biopsychosocial outcomes. Future studies should explore tailored interventions that consider individual preferences and abilities, as well as evaluate specific components of motion-based video games to optimize their effectiveness. Trial Registration: ClinicalTrials.gov NCT05267444; https://clinicaltrials.gov/study/NCT05267444 %R 10.2196/57352 %U https://games.jmir.org/2024/1/e57352 %U https://doi.org/10.2196/57352 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52435 %T Effectiveness of the Support From Community Health Workers and Health Care Professionals on the Sustained Use of Wearable Monitoring Devices Among Community-Dwelling Older Adults: Feasibility Randomized Controlled Trial %A Wong,Arkers Kwan Ching %A Bayuo,Jonathan %A Su,Jing Jing %A Wong,Frances Kam Yuet %A Chow,Karen Kit Sum %A Wong,Bonnie Po %A Wong,Siu Man %A Hui,Vivian %+ School of Nursing, Hong Kong Polytechnic University, GH 502, Hung Hom, Hong Kong, China (Hong Kong), 852 34003805, arkers.wong@polyu.edu.hk %K wearable monitoring device %K lay worker %K smartwatch %K older adult %K nurse %K engagement %K attrition %K engagement %K wearable %K user experience %D 2024 %7 18.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The wearable monitoring device (WMD) is emerging as a promising tool for community-dwelling older adults to monitor personal health, enhance awareness of their activities, and promote healthy behaviors. However, the sustained use of WMDs among this population remains a significant challenge. Objective: This study aims to implement an interventional program that promotes and motivates the continued use of WMDs among older adults through a peer and professional support approach. This program will facilitate the integration of WMDs into their daily lives. Methods: This feasibility trial examined the following: (1) the usability of the WMD from the users’ perspectives; (2) the feasibility of the Live With Wearable Monitoring Device program; and (3) the effectiveness of the Live With Wearable Monitoring Device program among community-dwelling older adults. The intervention, based on Self-Determination Theory, involved using the Live With Wearable Monitoring Device program over a 3-month period, with ongoing professional and peer support provided by community health workers, aided by a nurse and social workers. This support included 1 home visit and biweekly communication via WhatsApp. Data were collected at baseline and at 1, 3, and 6 months. Results: A total of 39 participants were enrolled in the intervention group, while 37 participants were in the control group. The recruitment rate was high (76/89, 85%), and the attrition rate was low (8/76, 11%), indicating that the program is feasible for older adults. Participants in the intervention group exhibited higher self-efficacy, lower anxiety levels, and used the smartwatch more frequently, in terms of both days and hours, compared with the control group. A between-group difference was observed in self-efficacy between the intervention and control groups (β=3.31, 95% CI 0.36-6.25, P=.03), with statistically significant higher mean values recorded at all 4 time points. Conclusions: It is clear that merely providing a WMD to older adults does not guarantee its usage, particularly for those unfamiliar with how to utilize its health-related functions in their daily routines. This study implemented a theory-based program aimed at enhancing the ongoing use of WMDs among older adults, suggesting that continuous professional and peer support may significantly influence WMD usage. Trial Registration: ClinicalTrials.gov NCT05269303; https://clinicaltrials.gov/ct2/show/NCT05269303 %M 39556810 %R 10.2196/52435 %U https://www.jmir.org/2024/1/e52435 %U https://doi.org/10.2196/52435 %U http://www.ncbi.nlm.nih.gov/pubmed/39556810 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e13723 %T Developing Game-Based Design for eHealth in Practice: 4-Phase Game Design Process %A de Vette,Frederiek %A Ruiz-Rodriguez,Aurora %A Tabak,Monique %A Oude Nijeweme-d'Hollosy,Wendy %A Hermens,Hermie %A Vollenbroek-Hutten,Miriam %+ Biomechanical Engineering Group, Faculty of Engineering Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 53 489 5798, a.ruizrodriguez@utwente.nl %K game based %K gamification %K game %K eHealth %K telemedicine %K development %K design %K engagement %K game preferences %K older adults %K self-management %K prototyping %K evaluations %K creative %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Games are increasingly used in eHealth as a strategy for user engagement. There is an enormous diversity of end users and objectives targeted by eHealth. Hence, identifying game content that drives and sustains engagement is challenging. More openness in the game design process and motivational strategies could aid researchers and designers of future game-based apps. Objective: This study aims to provide insights into our approach to develop game-based eHealth in practice with a case study (Personalised ICT Supported Services for Independent Living and Active Ageing [PERSSILAA]). PERSSILAA is a self-management platform that aims to counter frailty by offering training modules to older adults in the domains of healthy nutrition and physical and cognitive training to maintain a healthy lifestyle. We elaborate on the entire game design process and show the motivational strategies applied. Methods: We introduce four game design phases in the process toward game-based eHealth: (1) end-user research, (2) conceptualization, (3) creative design, and (4) refinement (ie, prototyping and evaluations). Results: First, 168 participants participated in end-user research, resulting in an overview of their preferences for game content and a set of game design recommendations. We found that conventional games popular among older adults do not necessarily translate well into engaging concepts for eHealth. Recommendations include focusing game concepts on thinking, problem-solving, variation, discovery, and achievement and using high-quality aesthetics. Second, stakeholder sessions with development partners resulted in strategies for long-term engagement using indicators of user performance on the platform’s training modules. These performance indicators, for example, completed training sessions or exercises, form the basis for game progression. Third, results from prior phases were used in creative design to create the game “Stranded!” The user plays a person who is shipwrecked who must gather parts for a life raft by completing in-game objectives. Finally, iterative prototyping resulted in the final prototype of the game-based app. A total of 35 older adults participated using simulated training modules. End users scored appreciation (74/100), ease of use (73/100), expected effectivity and motivation (62/100), fun and pleasantness of using the app (75/100), and intended future use (66/100), which implies that the app is ready for use by a larger population. Conclusions: The study resulted in a game-based app for which the entire game design process within eHealth was transparently documented and where engagement strategies were based on extensive user research. Our user evaluations indicate that the strategies for long-term engagement led to game content that was perceived as engaging by older adults. As a next step, research is needed on the user experience and actual engagement with the game to support the self-management of older adults, followed by clinical studies on its added value. %M 39514861 %R 10.2196/13723 %U https://formative.jmir.org/2024/1/e13723 %U https://doi.org/10.2196/13723 %U http://www.ncbi.nlm.nih.gov/pubmed/39514861 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53156 %T Assessing the Feasibility and Acceptability of Virtual Reality for Remote Group-Mediated Physical Activity in Older Adults: Pilot Randomized Controlled Trial %A Kershner,Kyle %A Morton,David %A Robison,Justin %A N'dah,Kindia Williams %A Fanning,Jason %+ Department of Health and Exercise Science, Wake Forest University, 1834 Wake Forest Road, Winston-Salem, NC, 27109, United States, 1 3367585042, fanninjt@wfu.edu %K virtual reality %K physical activity %K videoconference %K social connection %K remote meeting %K gerontology %K physical inactivity %K at-home intervention %K descriptive statistics %K eHealth %K comorbidity %K cybersickness %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity represents a major health concern for older adults. Most social, at-home physical activity (PA) interventions use videoconference, email, or telephone communication for program delivery. However, evidence suggests that these platforms may hinder the social connection experienced by users. Recent advancements in virtual reality (VR) suggest that it may be a rich platform for social, at-home interventions because it offers legitimate options for intervention delivery and PA. Objective: This pilot study aims to determine the feasibility and acceptability of VR compared to videoconference as a medium for remote group-mediated behavioral intervention for older adults. The information generated from this investigation will inform the use of VR as a medium for intervention delivery. Methods: Nine low-active older adults (mean age 66.8, SD 4.8 y) were randomized to a 4-week home-based, group-mediated PA intervention delivered via VR or videoconference. Feasibility (ie, the total number of sessions attended and the number of VR accesses outside of scheduled meetings) and acceptability (ie, the number of participants reporting high levels of nausea, program evaluations using Likert-style prompts with responses ranging from –5=very difficult or disconnected to 5=very easy or connected, and participant feedback on immersion and social connection) are illustrated via descriptive statistics and quotes from open-ended responses. Results: None of the participants experienced severe VR-related sickness before randomization, with a low average sickness rating of 1.6 (SD 1.6) out of 27 points. Attendance rates for group meetings were 98% (59/60) and 96% (46/48) for the VR and videoconference groups, respectively. Outside of scheduled meeting times, participants reported a median of 5.5 (IQR 5.3-5.8, range 0-27) VR accesses throughout the entire intervention. Program evaluations suggested that participants felt personally connected to their peers (VR group: median 3.0, IQR 2.5-3.5; videoconference group: median 3.0, IQR 2.7-3.3), found that goals were easy to accomplish (VR group: median 3.0, IQR 2.8-3.3; videoconference group: median 3.0, IQR 2.6-3.4), and had ease in finding PA options (VR group: median 4.0, IQR 3.5-4.3; videoconference group: median 2.0, IQR 1.6-2.4) and engaging in meaningful dialogue with peers (VR group: median 4.0, IQR 4.0-4.0; videoconference group: median 3.5, IQR 3.3-3.8). Open-ended responses regarding VR use indicated increased immersion experiences and intrinsic motivation for PA. Conclusions: These findings suggest that VR may be a useful medium for social PA programming in older adults, given it was found to be feasible and acceptable in this sample. Importantly, all participants indicated low levels of VR-related sickness before randomization, and both groups demonstrated very high attendance at meetings with their groups and behavioral coaches, which is promising for using VR and videoconference in future interventions. Modifications for future iterations of similar interventions are provided. Further work using larger samples and longer follow-up durations is needed. Trial Registration: ClinicalTrials.gov NCT04756245; https://www.clinicaltrials.gov/study/NCT04756245 %M 39514256 %R 10.2196/53156 %U https://formative.jmir.org/2024/1/e53156 %U https://doi.org/10.2196/53156 %U http://www.ncbi.nlm.nih.gov/pubmed/39514256 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e57289 %T Smartphone Apps for Pulmonary Hypertension: Systematic Search and Content Evaluation %A Báez Gutiérrez,Nerea %A Rodríguez Ramallo,Héctor %A Mendoza-Zambrano,Elva María %A Brown Arreola,Berenice %A Santos Ramos,Bernardo %A Abdel-kader Martín,Laila %A Otero Candelera,Remedios %K pulmonary hypertension %K mobile apps %K smartphone %K eHealth %K mHealth %K app %K hypertension %K chronic condition %K mobile health app %K monitoring %K systematic search %K app development %K clinical validation %K evaluation %K pulmonary %D 2024 %7 30.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Pulmonary hypertension (PH) is a chronic and complex condition, requiring consistent management and education. The widespread use of smartphones has opened possibilities for mobile health apps to support both patients and health care professionals in monitoring and managing PH more effectively. Objective: This study aimed to identify and assess the quality of free smartphone apps for PH targeted at either patients or health care professionals. Methods: A systematic search was conducted on freely available apps for patients with PH and health care professionals, accessed from a Spanish IP address, on Android (Google Play) and iOS (App Store) platforms. Searches were performed in October 2022 and 2023. Apps were independently analyzed by two reviewers, focusing on general characteristics. Quality assessment was based on the Mobile Application Rating Scale (MARS) framework, and Mann-Whitney U tests compared mean MARS scores against specific variables. Results: In the overall study, 21 apps were identified. In the 2022 search, 19 apps were listed (9 iOS, 7 Android, 3 available on both platforms). In the subsequent 2023 search, 16 apps were identified (6 Android, 7 iOS, 3 available on both platforms). Of those identified in 2022, 14 remained available in 2023, with only 7 updated since 2022. In addition, 12 apps targeted patients or the general population, while 9 targeted health care professionals; none involved patients in the development or design. Conversely, 13 apps involving health care professionals were identified. There were 10 apps that received pharmaceutical industry funding. The primary goal for 81% (17/21) of the apps was to disseminate general information about PH. The overall mean MARS quality was acceptable in 2022 and 2023, with mean ratings of 3.1 (SD 0.6) and 3.3 (SD 0.5), respectively. The functionality category achieved the highest scores in both years, indicating ease of use and intuitive navigation. In contrast, the subjective quality domain consistently received the lowest ratings in the MARS assessment across both years. None of the apps underwent clinical testing themselves; however, 2 incorporated tools or algorithms derived from trials. The overall quality of iOS apps statistically outperformed that of Android apps in both years (P<.05). Furthermore, the involvement of health care professionals in app development was associated with enhanced quality, a trend observed in both years (P=.003 for both years). Conclusions: This review of mobile health apps for PH reveals their emergent development stage, with generally acceptable quality but lacking refinement. It highlights the critical role of health care professionals in app development, as they contribute significantly to quality and reliability. Despite this, a notable stagnation in app quality and functionality improvement over 2 years points to a need for continuous innovation and clinical validation for effective clinical integration. This research advocates for future app developers to actively engage with health care professionals, integrate patient insights, and mandate rigorous clinical validation for PH management. %R 10.2196/57289 %U https://mhealth.jmir.org/2024/1/e57289 %U https://doi.org/10.2196/57289 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56923 %T Decoding the Influence of eHealth on Autonomy, Competence, and Relatedness in Older Adults: Qualitative Analysis of Self-Determination Through the Motivational Technology Model %A Cotter,Lynne M %A Shah,Dhavan %A Brown,Kaitlyn %A Mares,Marie-Louise %A Landucci,Gina %A Saunders,Sydney %A Johnston,Darcie C %A Pe-Romashko,Klaren %A Gustafson,David %A Maus,Adam %A Thompson,Kasey %A Gustafson,David H %+ School of Journalism and Mass Communication, University of Wisconsin - Madison, 821 University Ave, 5115 Vilas Communication Hall, Madison, WI, 53706, United States, 1 608 262 0388, dshah@wisc.edu %K self-determination theory %K usability %K mobile technology model %K aging %K eHealth %K mobile health %K mHealth %K smart displays %K video calls %K older adult %K chronic conditions %K mobile phone %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults adopt and use eHealth systems to build autonomy, competence, and relatedness and engage in healthy behaviors. The motivational technology model posits that technology features, such as those on websites, smart displays, and mobile phones, must allow for navigability, interactivity, and customizability, which spur feelings of self-determination and intrinsic motivation. We studied ElderTree, an online system for older adults that provides on-demand videos of healthy living content, self-monitoring, and weekly researcher-hosted video meetings. Objective: We aimed to understand the theoretical crossover between the motivational technology model and self-determination theory using features of ElderTree to understand the usability of the technology and how it may support older adults’ autonomy, competence, and relatedness. Methods: Drawing participants from a randomized controlled trial of a mobile health app for older adults with multiple chronic conditions, we conducted qualitative interviews with 22 older adults about their use of the app; the interviews were coded using qualitative thematic analysis. Results: Older adults did find that features within ElderTree such as content available on demand, good navigation, and weekly researcher-led video calls supported feelings of autonomy, competence, and relatedness, respectively. Individual differences such as a background using computers also influenced participants’ experiences with the smart displays. Conclusions: Participants confirmed the features that increased internal motivation, such as interactivity correlating with feelings of relatedness, but they also found other ways to support autonomous health behavior change beyond narrow views of navigability, interactivity, and customization. %M 39476377 %R 10.2196/56923 %U https://aging.jmir.org/2024/1/e56923 %U https://doi.org/10.2196/56923 %U http://www.ncbi.nlm.nih.gov/pubmed/39476377 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e64525 %T Digital Storytelling for People With Cognitive Impairment Using Available Mobile Apps: Systematic Search in App Stores and Content Analysis %A Zhu,Di %A Al Mahmud,Abdullah %A Liu,Wei %A Wang,Dahua %+ Centre for Design Innovation, School of Design and Architecture, Swinburne University of Technology, John St, Hawthorn, Melbourne, 3122, Australia, 61 392143830, aalmahmud@swin.edu.au %K mobile apps %K digital storytelling %K older adults %K mobile phone %K cognitive impairment %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Growing evidence suggests cognitive and social health benefits can be derived from digital storytelling for older adults with cognitive impairment. Digital storytelling apps offer the potential to serve as an on-demand, easy-to-access platform for enhancing cognitive abilities and promoting social well-being. Yet, despite the increasing quantity of such apps being available on the market, there is a gap in research investigating their quality. Objective: This app review aims to assess the digital storytelling apps available in the Chinese market and evaluate them in accordance with the Mobile Application Rating Scale (MARS). The goal was to identify key features and evaluate the overall quality in the context of cognitively impaired users. Methods: A systematic search was conducted in both the Google Play store (Google LLC) and iTunes store (Apple Inc), using English and Chinese keywords. Apps were chosen according to specific criteria that included features, including (but not limited to) memory capture, story saving, cue-based reminiscing, and the ability to share stories or memories with others. The MARS was used by 3 individual researchers to independently assess app quality across several domains, such as engagement, functionality, aesthetics, and information quality, for both Android and iOS apps. Results: From an initial screening of 297 apps, only 9 (3%) met the criteria for detailed evaluation using MARS. The reviewed apps featured capture memory, save, reminisce, and share functions, which are critical in supporting cognitive functions and enhancing user engagement. The analysis revealed patterns in platform diversity and geographical distribution of developers, with apps available on both iOS and Android. Memoirs of Life and Memorize: Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile) had the highest mean MARS scores of 3.35, indicating strong engagement, functionality, and information quality, while the lowest score was 2.33. The overall mean score across all apps was only 3.03 (SD 0.60), highlighting significant variation, particularly in information quality. User feedback also showed considerable variability, ranging from 0 comments for apps such as Grand Storyteller (VarIT Inc) and PWI Storyteller (Project World Impact, LLC) to as many as 5361 comments for FamilySearch, which received extensive positive reviews. This wide range of user feedback underscores the importance of continuous improvement and user-centered design, particularly in enhancing information quality and content accuracy. Conclusions: The systematic search and evaluation highlight the diverse capabilities yet variable quality of digital storytelling apps available within the Chinese market, reflecting user experiences, satisfaction levels, and efficacy in supporting cognitively impaired users. While some apps excel in engagement and functionality, others need significant improvements in information quality and user interface design to better serve those with cognitive impairments. Future research is recommended to investigate regional limitations and features that would result in more inclusive and effective digital storytelling apps. %M 39446478 %R 10.2196/64525 %U https://aging.jmir.org/2024/1/e64525 %U https://doi.org/10.2196/64525 %U http://www.ncbi.nlm.nih.gov/pubmed/39446478 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58312 %T Effects of Monitoring Frailty Through a Mobile/Web-Based Application and a Sensor Kit to Prevent Functional Decline in Frail and Prefrail Older Adults: FACET (Frailty Care and Well Function) Pilot Randomized Controlled Trial %A Valdés-Aragonés,Myriam %A Pérez-Rodríguez,Rodrigo %A Carnicero,José Antonio %A Moreno-Sánchez,Pedro A %A Oviedo-Briones,Myriam %A Villalba-Mora,Elena %A Abizanda-Soler,Pedro %A Rodríguez-Mañas,Leocadio %+ Intelligent Robotics Lab, Universidad Rey Juan Carlos, Camino del Molino 5, 28942, Fuenlabrada, Spain, 34 914888401, rodrigo.perez@urjc.es %K frailty %K functional status %K older adults %K new technologies %K sensor %K monitoring system %K information and communication technologies %K mobile app %K sensor kit %K sensors %K technological ecosystem %K clinical intervention %D 2024 %7 22.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Frailty represents a state of susceptibility to stressors and constitutes a dynamic process. Untreated, this state can progress to disability. Hence, timely detection of alterations in patients’ frailty status is imperative to institute prompt clinical interventions and impede frailty progression. With this aim, the FACET (Frailty Care and Well Function) technological ecosystem was developed to provide clinically gathered data from the home to a medical team for early intervention. Objective: The aim of this study was to assess whether the FACET technological ecosystem prevents frailty progression and improves frailty status, according to the frailty phenotype criteria and Frailty Trait Scale-5 items (FTS-5) at 3 and 6 months of follow-up. Methods: This randomized clinical trial involved 90 older adults aged ≥70 years meeting 2 or more Fried frailty phenotype criteria, having 4 or more comorbidities, and having supervision at home. This study was conducted between August 2018 and June 2019 at the geriatrics outpatient clinics in Getafe University Hospital and Albacete University Hospital. Participants were randomized into a control group receiving standard treatment and the intervention group receiving standard treatment along with the FACET home monitoring system. The system monitored functional tests at home (gait speed, chair stand test, frailty status, and weight). Outcomes were assessed using multivariate linear regression models for continuous response and multivariate logistic models for dichotomous response. P values less than .05 were considered statistically significant. Results: The mean age of the participants was 82.33 years, with 28% (25/90) being males. Participants allocated to the intervention group showed a 74% reduction in the risk of deterioration in the FTS-5 score (P=.04) and 92% lower likelihood of worsening by 1 point according to Fried frailty phenotype criteria compared to the control group (P=.02) at 6 months of follow-up. Frailty status, when assessed through FTS-5, improved in the intervention group at 3 months (P=.004) and 6 months (P=.047), while when the frailty phenotype criteria were used, benefits were shown at 3 months of follow-up (P=.03) but not at 6 months. Conclusions: The FACET technological ecosystem helps in the early identification of changes in the functional status of prefrail and frail older adults, facilitating prompt clinical interventions, thereby improving health outcomes in terms of frailty and functional status and potentially preventing disability and dependency. Trial Registration: ClinicalTrials.gov NCT03707145; https://clinicaltrials.gov/study/NCT03707145 %M 39436684 %R 10.2196/58312 %U https://www.jmir.org/2024/1/e58312 %U https://doi.org/10.2196/58312 %U http://www.ncbi.nlm.nih.gov/pubmed/39436684 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e54736 %T How Time, Living Situation, and Stress Related to Technology Influence User Acceptance and Usability of a Socialization Service for Older Adults and Their Formal and Informal Caregivers: Six-Month Pilot Study %A Pani,Jasmine %A Lorusso,Letizia %A Toccafondi,Lara %A D'Onofrio,Grazia %A Ciccone,Filomena %A Russo,Sergio %A Giuliani,Francesco %A Sancarlo,Daniele %A Calamida,Novella %A Vignani,Gianna %A Pihl,Tarmo %A Rovini,Erika %A Cavallo,Filippo %A Fiorini,Laura %K active aging %K longitudinal study %K technostress %K technology usability and acceptance %K scaling up %D 2024 %7 9.10.2024 %9 %J JMIR Aging %G English %X Background: Considering the growing population of older adults, addressing the influence of loneliness among this demographic group has become imperative, especially due to the link between social isolation and deterioration of mental and physical well-being. Technology has the potential to be used to create innovative solutions to increase socialization and potentially promote healthy aging. Objective: This 6-month study examined the usability and acceptability of a technology-based socialization service and explored how stress and living situation affect older adults’ and their ecosystem’s perceptions of technology, investigating cross-sectional and longitudinal differences among and across user groups. Methods: Participants were recruited in Tuscany and Apulia (Italy) through a network of social cooperatives and a research hospital, respectively. A total of 20 older adults were provided with the same technology installed on a tablet and on a smart television. The technology has three functionalities: video calling, playing games, and sharing news. Additionally, 20 informal caregivers (IC) and 13 formal caregivers (FC) connected to the older adults were included in the study. After both initial training in the use of the system (T0) and 6 months of using the system (T6), questionnaires on usability, acceptability, and technostress were filled in by older adults, IC, and FC. Nonparametric or parametric tests were conducted to investigate group differences at both time points and changes over time. Additional analyses on older adults were done to assess whether differences in usability and acceptability were related to living situation (ie, alone or with someone). Furthermore, correlation analyses were performed between usability, acceptability, and stress toward technology at T0 and T6. Results: At both T0 and T6, older adults had lower usability scores than IC and FC and higher anxiety than IC. Over time, there was a significant decrease in older adults’ attitudes toward technology score, depicting a negative attitude over time (T0 median 4.2, IQR 0.5; T6 median 3.7, IQR 0.8; Cohen d=0.7), while there was no change for IC and FC. At T0, those living alone had lower acceptability than those living with someone but this difference disappeared at T6. People or participants living with someone had a decline in anxiety, attitudes toward technology, enjoyment, and perceived usefulness. Stress toward technology affected usability and acceptability in the older adult group entering the study (ρ=−.85) but this was not observed after 6 months. In the IC group, stress affected trust at T0 (ρ=−.23) but not at T6. Conclusions: At the start of the study, older adults judged the system to be less usable and more stressful than did the caregivers. Indeed, at first, technostress was correlated with usability and acceptability; however, with repeated use, technostress did not influence the perception of technology. Overall, getting accustomed to technology decreased anxiety and stress toward technology. %R 10.2196/54736 %U https://aging.jmir.org/2024/1/e54736 %U https://doi.org/10.2196/54736 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56547 %T Feasibility of Monitoring Heart and Respiratory Rates Using Nonwearable Devices and Consistency of the Measured Parameters: Pilot Feasibility Study %A Ikuta,Kasumi %A Aishima,Miya %A Noguchi-Watanabe,Maiko %A Fukui,Sakiko %K heart rate %K older adults %K respiratory rate %K nonwearable devices %K vital signs %D 2024 %7 8.10.2024 %9 %J JMIR Hum Factors %G English %X Background: As Japan is the world’s fastest-aging society with a declining population, it is challenging to secure human resources for care providers. Therefore, the Japanese government is promoting digital transformation and the use of nursing care equipment, including nonwearable devices that monitor heart and respiratory rates. However, the feasibility of monitoring heart and respiratory rates with nonwearable devices and the consistency of the rates measured have not been reported. Objective: In this study, we focused on a sheet-type nonwearable device (Safety Sheep Sensor) introduced in many nursing homes. We evaluated the feasibility of monitoring heart rate (HR) and respiratory rate (RR) continuously using nonwearable devices and the consistency of the HR and RR measured. Methods: A sheet-type nonwearable device that measured HR and RR every minute through body vibrations was placed under the mattress of each participant. The participants in study 1 were healthy individuals aged 20‐60 years (n=21), while those in study 2 were older adults living in multidwelling houses and required nursing care (n=20). The HR was measured using standard methods by the nurse and using the wearable device (Silmee Bar-type Lite sensor), and RR was measured by the nurse. The primary outcome was the mean difference in HR and RR between nonwearable devices and standard methods. Results: The mean difference in HR was −0.32 (SD 3.12) in study 1 and 0.04 (SD: 3.98) in study 2; both the differences were within the predefined accepted discrepancies (<5 beats/min). The mean difference in RR was −0.98 (SD 3.01) in study 1 and −0.49 (SD 2.40) in study 2; both the differences were within the predefined accepted discrepancies (3 breaths/min). Conclusions: HR and RR measurements obtained using the nonwearable devices and the standard method were similar. Continuous monitoring of vital signs using nonwearable devices can aid in the early detection of abnormal conditions in older people. %R 10.2196/56547 %U https://humanfactors.jmir.org/2024/1/e56547 %U https://doi.org/10.2196/56547 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e64196 %T Effects of a Mobile App to Promote Social Participation on Older Adults: Randomized Controlled Trial %A Kawaguchi,Kenjiro %A Nakagomi,Atsushi %A Ide,Kazushige %A Kondo,Katsunori %+ Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage, Chiba, 263-8522, Japan, 81 90 7596 8742, kawaguchikenjiro@chiba-u.jp %K gerontology %K geriatrics %K older adults %K elderly %K older people %K community dwelling older adult %K aging %K social participation %K walking %K mHealth %K apps %K smartphone %K digital health %K digital technology %K digital interventions %K physical activity %K exercise %D 2024 %7 30.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social participation is crucial for healthy aging, improving physical and mental health, cognitive function, and quality of life among older adults. However, social participation tends to decline with age due to factors like loss of social networks and health issues. Mobile health apps show promise in promoting healthy behaviors among older adults, but their effectiveness in increasing social participation remains understudied. Objective: This randomized controlled trial aimed to evaluate the efficacy of a mobile app called Encouragement of Social Participation (ESP, “Shakai Sanka no Susume;” Hitachi) in promoting social participation and physical activity among community-dwelling older adults. Methods: The study recruited 181 community-dwelling adults aged 60 years or older from 2 municipalities in Japan and through a web-based research panel. Participants were randomly assigned to either the intervention group (n=87), which used the ESP app for 12 weeks, or the control group (n=94), which used only Google Fit. The ESP app incorporated features such as self-monitoring of social participation, personalized feedback, gamification elements, and educational content. Primary outcomes were changes in social participation frequency over the previous 2 months and changes in step counts, measured at baseline and week 12. Secondary outcomes included changes in specific types of social activities and subjective well-being. Data were analyzed using analysis of covariance and linear mixed-effects models. Results: The intervention group showed a significantly greater increase in social participation frequency compared with the control group (adjusted difference 3.03; 95% CI 0.17-5.90; P=.04). Specifically, the intervention group demonstrated higher frequencies of participation in hobbies (adjusted difference: 0.82; 95% CI 0.01-1.63) and cultural clubs (adjusted difference 0.65; 95% CI 0.07-1.23) compared with the control group. However, there were no significant differences in weekly step counts between the groups. Subgroup analyses suggested potentially larger effects among participants who were older than 70 years, female, had lower educational attainment, and were recruited from community settings, although only females and the lower educational attainment subgroups demonstrated 95% CIs that did not encompass zero. Conclusions: The ESP mobile app effectively promoted social participation among community-dwelling older adults, particularly in hobbies and cultural club activities. However, it did not significantly impact physical activity levels as measured by step counts. These findings suggest that mobile apps can be valuable tools for encouraging social engagement in older populations, potentially contributing to healthy aging. Future research should focus on optimizing app features to maintain long-term engagement and exploring strategies to enhance physical activity alongside social participation. Trial Registration: University Medical Information Network Clinical Trial Registry UMIN000049045; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055781 %M 39348180 %R 10.2196/64196 %U https://www.jmir.org/2024/1/e64196 %U https://doi.org/10.2196/64196 %U http://www.ncbi.nlm.nih.gov/pubmed/39348180 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59900 %T The Impact of Digital Technology on the Physical Health of Older Workers: Protocol for a Scoping Review %A Spijker,Jeroen J A %A Barlın,Hande %A Grad,Diana Alecsandra %A Gu,Yang %A Klavina,Aija %A Korkmaz Yaylagul,Nilufer %A Kulla,Gunilla %A Orhun,Eda %A Ševčíková,Anna %A Unim,Brigid %A Tofan,Cristina Maria %+ Centre d'Estudis Demogràfics, Campus de la Universitat Autònoma de Barcelona, Bellaterra, 08193, Spain, 34 935813060, jspijker@ced.uab.es %K digital tools %K digital technology %K digitalization %K physical health %K mobility %K vision loss %K musculoskeletal disorders %K migraine %K older workers %K older population %K aging %K scoping review %K mobile phone %D 2024 %7 26.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital technologies have penetrated most workplaces. However, it is unclear how such digital technologies affect the physical health of older workers. Objective: This scoping review aims to examine and summarize the evidence from scientific literature concerning the impact of digital technology on the physical health of older workers. Methods: This scoping review will be conducted following recommendations outlined by Levac et al and will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines for reporting. Peer-reviewed papers written in English will be searched in the following databases: MEDLINE, Cochrane, ProQuest, Web of Science, Scopus, APA PsycInfo, and ERIH PLUS. The web-based systematic review platform Covidence will be used to create a data extraction template. It will cover the following items: study and participant characteristics, health measures, digital tool characteristics and usage, and research findings. Following the Population, Concept, and Context (PCC) framework, our review will focus on studies involving older workers aged 50 years or older, any form of digital technology (including teleworking and the use of digital tools at work), and how digital technologies affect physical health (such as vision loss, musculoskeletal disorders, and migraines). Studies that focus only on mental health will be excluded. Study selection based on title and abstract screening (first stage), full-text review (second stage), and data extraction (third stage) will be performed by a group of researchers, whereby each paper will be reviewed by at least 2 people. Any conflict regarding the inclusion or exclusion of a study and the data extraction will be resolved by discussion between the researchers who evaluated the papers; a third researcher will be involved if consensus is not reached. Results: A preliminary search of MEDLINE, Epistemonikos, Cochrane, PROSPERO, and JBI Evidence Synthesis was conducted, and no current or ongoing systematic reviews or scoping reviews on the topic were identified. The results of the study are expected in April 2025. Conclusions: Our scoping review will seek to provide an overview of the available evidence and identify research gaps regarding the effect of digital technology and the use of digital tools in the work environment on the physical health of older workers. International Registered Report Identifier (IRRID): PRR1-10.2196/59900 %M 39325529 %R 10.2196/59900 %U https://www.researchprotocols.org/2024/1/e59900 %U https://doi.org/10.2196/59900 %U http://www.ncbi.nlm.nih.gov/pubmed/39325529 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e41093 %T Investigating Older Adults' Use of a Socially Assistive Robot via Time Series Clustering and User Profiling: Descriptive Analysis Study %A Yoo,In-jin %A Park,Do-Hyung %A Lee,Othelia EunKyoung %A Park,Albert %+ Department of Software and Information Systems, University of North Carolina at Charlotte, 9201 University City Boulevard, Woodward 310H, Charlotte, NC, 28223-0001, United States, 1 7046878668, al.park@uncc.edu %K socially assistive robot %K older adults %K robot use pattern %K time series clustering %K profiling analysis %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The aging population and the shortage of geriatric care workers are major global concerns. Socially assistive robots (SARs) have the potential to address these issues, but developing SARs for various types of users is still in its infancy. Objective: This study aims to examine the characteristics and use patterns of SARs. Methods: This study analyzed log data from 64 older adults who used a SAR called Hyodol for 60 days to understand use patterns and their relationship with user characteristics. Data on user interactions, robot-assisted content use, demographics, physical and mental health, and lifestyle were collected. Time series clustering was used to group users based on use patterns, followed by profiling analysis to relate these patterns to user characteristics. Results: Overall, 4 time series clusters were created based on use patterns: helpers, friends, short-term users, and long-term users. Time series and profiling analyses revealed distinct patterns for each group. We found that older adults use SARs differently based on factors beyond demographics and health. This study demonstrates a data-driven approach to understanding user needs, and the findings can help tailor SAR interventions for specific user groups. Conclusions: This study extends our understanding of the factors associated with the long-term use of SARs for geriatric care and makes methodological contributions. %M 39298762 %R 10.2196/41093 %U https://formative.jmir.org/2024/1/e41093 %U https://doi.org/10.2196/41093 %U http://www.ncbi.nlm.nih.gov/pubmed/39298762 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58714 %T Requirement Analysis of Different Variants of a Measurement and Training Station for Older Adults at Risk of Malnutrition and Reduced Mobility: Focus Group Study %A Happe,Lisa %A Sgraja,Marie %A Quinten,Vincent %A Förster,Mareike %A Diekmann,Rebecca %+ Junior Research Group “Nutrition and Physical Function in Older Adults”, Department of Health Services Research, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, Oldenburg, 26127, Germany, 49 441 798 2354, lisa.happe@uol.de %K gerontechnology %K physical activity %K diet %K technical assistance system %K health data %K qualitative research %D 2024 %7 17.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Demographic change is leading to an increasing proportion of older people in the German population and requires new approaches for prevention and rehabilitation to promote the independence and health of older people. Technical assistance systems can offer a promising solution for the early detection of nutritional and physical deficits and the initiation of appropriate interventions. Such a system should combine different components, such as devices for assessing physical and nutritional status, educational elements on these topics, and training and feedback options. The concept is that the whole system can be used independently by older adults (aged ≥70 years) for monitoring and early detection of problems in nutrition or physical function, as well as providing opportunities for intervention. Objective: This study aims to develop technical and digital elements for a measurement and training station (MuTs) with an associated app. Through focus group discussions, target group requirements, barriers, and favorable components for such a system were identified. Methods: Older adults (aged ≥70 years) were recruited from a community-based setting as well as from a geriatric rehabilitation center. Focus group interviews were conducted between August and November 2022. Following a semistructured interview guideline, attitudes, requirements, preferences, and barriers for the MuTs were discussed. Discussions were stimulated by videos, demonstrations of measuring devices, and participants’ ratings of the content presented using rankings. After conducting 1 focus group in the rehabilitation center and 2 in the community, the interview guide was refined, making a more detailed discussion of identified elements and aspects possible. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. Results: A total of 21 older adults (female participants: n=11, 52%; mean age 78.5, SD 4.6 years) participated in 5 focus group discussions. There was a strong interest in the independent measurement of health parameters, such as pulse and hand grip strength, especially among people with health problems who would welcome feedback on their health development. Participants emphasized the importance of personal guidance and interaction before using the device, as well as the need for feedback mechanisms and personalized training for everyday use. Balance and coordination were mentioned as preferred training areas in a MuTs. New training options that motivate and invite people to participate could increase willingness to use the MuTs. Conclusions: The target group is generally open and interested in tracking and optimizing diet and physical activity. A general willingness to use a MuTs independently was identified, as well as a compelling need for guidance and feedback on measurement and training to be part of the station. %M 39288403 %R 10.2196/58714 %U https://aging.jmir.org/2024/1/e58714 %U https://doi.org/10.2196/58714 %U http://www.ncbi.nlm.nih.gov/pubmed/39288403 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e53431 %T Effectiveness of Technological Interventions for Older Adults With Parkinson Disease: Systematic Review %A Bevilacqua,Roberta %A Benadduci,Marco %A Barbarossa,Federico %A Amabili,Giulio %A Di Donna,Valentina %A Martella,Clotilda %A Pelliccioni,Giuseppe %A Riccardi,Giovanni Renato %A Maranesi,Elvira %+ IRCCS INRCA, Via Santa Margherita 5, Ancona, 60124, Italy, 39 0718004767, f.barbarossa@inrca.it %K technological intervention %K Parkinson disease %K randomized controlled trail %K older adults %K efficacy %D 2024 %7 9.9.2024 %9 Review %J JMIR Serious Games %G English %X Background: Among the older population, Parkinson disease (PD) stands out as a leading contributor to disability. Clinically, the foremost objectives in managing PD involve proactively delaying and preventing disability. Understanding the pivotal role of gait and balance in daily functionality holds substantial clinical significance, signaling imminent disability and prompting a reevaluation of management approaches. A key priority lies in identifying novel and effective interventions for symptoms that substantially contribute to disability. Objective: This paper presents a systematic review that critically examines the existing body of literature on the use of technology in the rehabilitation of older patients with PD. By synthesizing current evidence, we aim to provide insights into the state of the field, identify gaps in knowledge, and offer recommendations for future research and clinical practice. Methods: A systematic review of the literature was conducted in September 2023 analyzing manuscripts and papers of the last 5 years from the PubMed, Scopus, Embase, Web of Science, and CINAHL databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 14 papers were included. The inclusion criteria are as follows: (1) randomized controlled trial, (2) PD in people aged 65 years and older, and (3) use of technology in the rehabilitation training in the older population. Results: A large portion of effective interventions relies on the incorporation of technology, particularly through virtual reality exergames. This technology appears to have effects not only on the cognitive aspect but also on the physical domain. The analysis of the results clearly indicates that, in terms of gait and balance performance, the technological intervention outperforms the traditional approach, irrespective of the specific technology employed. Conclusions: This systematic review seeks to shed light on the evolving landscape of technology-assisted rehabilitation for older individuals with PD. As we delve into the available evidence, we will assess the extent to which technology can serve as a valuable adjunct to conventional therapy, offering new avenues for optimized care and improved outcomes in this growing patient demographic. As we sift through the existing evidence, our goal is to evaluate the potential of technology as a valuable supplement to traditional therapy, presenting fresh opportunities for enhanced care and better outcomes in this expanding patient demographic. %M 39250193 %R 10.2196/53431 %U https://games.jmir.org/2024/1/e53431 %U https://doi.org/10.2196/53431 %U http://www.ncbi.nlm.nih.gov/pubmed/39250193 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57601 %T Feasibility of Measuring Smartphone Accelerometry Data During a Weekly Instrumented Timed Up-and-Go Test After Emergency Department Discharge: Prospective Observational Cohort Study %A Suffoletto,Brian %A Kim,David %A Toth,Caitlin %A Mayer,Waverly %A Glaister,Sean %A Cinkowski,Chris %A Ashenburg,Nick %A Lin,Michelle %A Losak,Michael %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K gait %K balance %K fall %K falls %K functional decline %K fall risk %K fall risks %K mobility %K phone %K sensors %K patient monitoring %K monitoring %K emergency department %K emergency departments %K ED %K emergency room %K ER %K discharge %K mobile application %K mobile applications %K app %K apps %K application %K applications %K digital health %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K prediction %K mobile phone %D 2024 %7 4.9.2024 %9 %J JMIR Aging %G English %X Background: Older adults discharged from the emergency department (ED) face elevated risk of falls and functional decline. Smartphones might enable remote monitoring of mobility after ED discharge, yet their application in this context remains underexplored. Objective: This study aimed to assess the feasibility of having older adults provide weekly accelerometer data from an instrumented Timed Up-and-Go (TUG) test over an 11-week period after ED discharge. Methods: This single-center, prospective, observational, cohort study recruited patients aged 60 years and older from an academic ED. Participants downloaded the GaitMate app to their iPhones that recorded accelerometer data during 11 weekly at-home TUG tests. We measured adherence to TUG test completion, quality of transmitted accelerometer data, and participants’ perceptions of the app’s usability and safety. Results: Of the 617 approached patients, 149 (24.1%) consented to participate, and of these 149 participants, 9 (6%) dropped out. Overall, participants completed 55.6% (912/1639) of TUG tests. Data quality was optimal in 31.1% (508/1639) of TUG tests. At 3-month follow-up, 83.2% (99/119) of respondents found the app easy to use, and 95% (114/120) felt safe performing the tasks at home. Barriers to adherence included the need for assistance, technical issues with the app, and forgetfulness. Conclusions: The study demonstrates moderate adherence yet high usability and safety for the use of smartphone TUG tests to monitor mobility among older adults after ED discharge. Incomplete TUG test data were common, reflecting challenges in the collection of high-quality longitudinal mobility data in older adults. Identified barriers highlight the need for improvements in user engagement and technology design. %R 10.2196/57601 %U https://aging.jmir.org/2024/1/e57601 %U https://doi.org/10.2196/57601 %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 %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54186 %T Everyday Uses of Music Listening and Music Technologies by Caregivers and People With Dementia: Survey and Focus Group Study %A Vidas,Dianna %A Carrasco,Romina %A Kelly,Ryan M %A Waycott,Jenny %A Tamplin,Jeanette %A McMahon,Kate %A Flynn,Libby M %A Stretton-Smith,Phoebe A %A Sousa,Tanara Vieira %A Baker,Felicity A %+ School of Computing and Information Systems, The University of Melbourne, Grattan Street, Parkville, 3010, Australia, 61 3 90355511, dianna.vidas@unimelb.edu.au %K dementia %K dementia care %K technology %K music technology %K mobile phone %D 2024 %7 27.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Music has long been identified as a nonpharmacological tool that can provide benefits for people with dementia, and there is considerable interest in designing technologies to support the use of music in dementia care. However, to ensure that music technologies are appropriately designed for supporting caregivers and people living with dementia, there remains a need to better understand how music is currently used in everyday dementia care at home. Objective: This study aims to understand how people living with dementia and their caregivers use music and music technologies in everyday caring, as well as the challenges they experience using music and technology. Methods: This study used a mixed methods design. First, a survey was administered to 13 people living with dementia and 64 caregivers to understand their use of music and technology. Subsequently, 18 survey respondents (family caregivers: n=12, 67%; people living with dementia: n=6, 33%) participated in focus groups regarding their experiences of using music and technology in care. Interview transcripts were analyzed using reflexive thematic analysis. Results: Most of the survey respondents (people living with dementia: 9/13, 69%; family caregivers: 47/63, 75%) reported using music often or very often in their daily lives. Participants reported a range of technologies used for listening to music, such as CDs, radio, and streaming services. Focus groups highlighted the benefits and challenges of using music and music technologies in everyday care. Participants identified using music and music technologies to regulate mood, provide joy, facilitate social interaction and connection, encourage reminiscence, provide continuity of music use before and after the dementia diagnosis, and make caregiving easier. The challenges of using music technology in everyday caring included difficulties with staying up to date with evolving technology and low self-efficacy with technology for people living with dementia. Conclusions: This study shows that people with a dementia diagnosis and their caregivers already use music and music technologies to support their everyday care needs. The results suggest opportunities to design technologies that enable easier access to music and to support people living with dementia with recreational and therapeutic music listening as well as music-based activities. %R 10.2196/54186 %U https://www.jmir.org/2024/1/e54186 %U https://doi.org/10.2196/54186 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53643 %T Reliable Contactless Monitoring of Heart Rate, Breathing Rate, and Breathing Disturbance During Sleep in Aging: Digital Health Technology Evaluation Study %A G Ravindran,Kiran K %A della Monica,Ciro %A Atzori,Giuseppe %A Lambert,Damion %A Hassanin,Hana %A Revell,Victoria %A Dijk,Derk-Jan %+ Surrey Sleep Research Centre, University of Surrey, Guildford, GU2 7XP, United Kingdom, 44 01483 68 3709, k.guruswamyravindran@surrey.ac.uk %K Withings Sleep Analyzer %K Emfit %K Somnofy %K contactless technologies %K vital signs %K evaluation %K apnea-hypopnea index %K wearables %K nearables %D 2024 %7 27.8.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Longitudinal monitoring of vital signs provides a method for identifying changes to general health in an individual, particularly in older adults. The nocturnal sleep period provides a convenient opportunity to assess vital signs. Contactless technologies that can be embedded into the bedroom environment are unintrusive and burdenless and have the potential to enable seamless monitoring of vital signs. To realize this potential, these technologies need to be evaluated against gold standard measures and in relevant populations. Objective: We aimed to evaluate the accuracy of heart rate and breathing rate measurements of 3 contactless technologies (2 undermattress trackers, Withings Sleep Analyzer [WSA] and Emfit QS [Emfit]; and a bedside radar, Somnofy) in a sleep laboratory environment and assess their potential to capture vital signs in a real-world setting. Methods: Data were collected from 35 community-dwelling older adults aged between 65 and 83 (mean 70.8, SD 4.9) years (men: n=21, 60%) during a 1-night clinical polysomnography (PSG) test in a sleep laboratory, preceded by 7 to 14 days of data collection at home. Several of the participants (20/35, 57%) had health conditions, including type 2 diabetes, hypertension, obesity, and arthritis, and 49% (17) had moderate to severe sleep apnea, while 29% (n=10) had periodic leg movement disorder. The undermattress trackers provided estimates of both heart rate and breathing rate, while the bedside radar provided only the breathing rate. The accuracy of the heart rate and breathing rate estimated by the devices was compared with PSG electrocardiogram-derived heart rate (beats per minute) and respiratory inductance plethysmography thorax-derived breathing rate (cycles per minute), respectively. We also evaluated breathing disturbance indexes of snoring and the apnea-hypopnea index, available from the WSA. Results: All 3 contactless technologies provided acceptable accuracy in estimating heart rate (mean absolute error <2.12 beats per minute and mean absolute percentage error <5%) and breathing rate (mean absolute error ≤1.6 cycles per minute and mean absolute percentage error <12%) at 1-minute resolution. All 3 contactless technologies were able to capture changes in heart rate and breathing rate across the sleep period. The WSA snoring and breathing disturbance estimates were also accurate compared with PSG estimates (WSA snore: r2=0.76; P<.001; WSA apnea-hypopnea index: r2=0.59; P<.001). Conclusions: Contactless technologies offer an unintrusive alternative to conventional wearable technologies for reliable monitoring of heart rate, breathing rate, and sleep apnea in community-dwelling older adults at scale. They enable the assessment of night-to-night variation in these vital signs, which may allow the identification of acute changes in health, and longitudinal monitoring, which may provide insight into health trajectories. International Registered Report Identifier (IRRID): RR2-10.3390/clockssleep6010010 %M 39190477 %R 10.2196/53643 %U https://mhealth.jmir.org/2024/1/e53643 %U https://doi.org/10.2196/53643 %U http://www.ncbi.nlm.nih.gov/pubmed/39190477 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56055 %T Optimizing Technology-Based Prompts for Supporting People Living With Dementia in Completing Activities of Daily Living at Home: Experimental Approach to Prompt Modality, Task Breakdown, and Attentional Support %A Cannings,Madeleine %A Brookman,Ruth %A Parker,Simon %A Hoon,Leonard %A Ono,Asuka %A Kawata,Hiroaki %A Matsukawa,Hisashi %A Harris,Celia B %+ The MARCS Institute for Brain, Behaviour, and Development, Western Sydney University, Locked Bag 1797, Penrith, 2571, Australia, 61 297726570, celia.harris@westernsydney.edu.au %K assistive technology %K accessible technology %K accessibility technology %K assistive technologies %K accessible technologies %K assistive device %K assistive devices %K dementia %K people living with dementia %K dementia care %K person-centered technology %K patient-centered technology %K person-centered technologies %K patient-centered technologies %K memory support %K prompting %K user-computer interface %K user interface %K UI %K app %K apps %K digital health %K digital technology %K digital intervention %K digital interventions %K mobile phone %D 2024 %7 23.8.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Assistive technology is becoming increasingly accessible and affordable for supporting people with dementia and their care partners living at home, with strong potential for technology-based prompting to assist with initiation and tracking of complex, multistep activities of daily living. However, there is limited direct comparison of different prompt features to guide optimal technology design. Objective: Across 3 experiments, we investigated the features of tablet-based prompts that best support people with dementia to complete activities of daily living at home, measuring prompt effectiveness and gaining feedback from people with dementia and their care partners about their experiences. Methods: Across experiments, we developed a specialized iPad app to enable data collection with people with dementia at home over an extended experimental period. In experiment 1, we varied the prompts in a 3 (visual type: text instruction, iconic image, and photographic image) × 3 (audio type: no sound, symbolic sound, and verbal instruction) experimental design using repeated measures across multiple testing sessions involving single-step activities. In experiment 2, we tested the most effective prompt breakdown for complex multistep tasks comparing 3 conditions (1-prompt, 3-prompt, and 7-prompt conditions). In experiment 3, we compared initiation and maintenance alerts that involved either an auditory tone or an auditory tone combined with a verbal instruction. Throughout, we asked people with dementia and their care partners to reflect on the usefulness of prompting technology in their everyday lives and what could be developed to better meet their needs. Results: First, our results showed that audible verbal instructions were more useful for task completion than either tone-based or visual prompts. Second, a more granular breakdown of tasks was generally more useful and increased independent use, but this varied across individuals. Third, while a voice or text maintenance alert enabled people with dementia to persist with a multistep task for longer when it was more frequent, task initiation still frequently required support from a care partner. Conclusions: These findings can help inform developers of assistive technology about the design features that promote the usefulness of home prompting systems for people with dementia as well as the preferences and insights of people with dementia and their care partners regarding assistive technology design. %M 39178405 %R 10.2196/56055 %U https://aging.jmir.org/2024/1/e56055 %U https://doi.org/10.2196/56055 %U http://www.ncbi.nlm.nih.gov/pubmed/39178405 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52310 %T Prediction of Hearing Help Seeking to Design a Recommendation Module of an mHealth Hearing App: Intensive Longitudinal Study of Feature Importance Assessment %A Angonese,Giulia %A Buhl,Mareike %A Kuhlmann,Inka %A Kollmeier,Birger %A Hildebrandt,Andrea %+ Psychological Methods and Statistics Lab, Department of Psychology, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, Oldenburg, 26129, Germany, 49 0441 798 4629, giulia.angonese@uni-oldenburg.de %K hearing loss %K mobile health %K mHealth %K older adults %K help seeking %K mobile study %K machine learning %K supervised classification %K feature importance %K profiling %K mobile phone %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual’s profile regarding the outcome of interest. Objective: This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions. Methods: In total, 185 (n=106, 57.3% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, naïve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis. Results: The algorithms correctly predicted action to seek help at study end in 65.9% (122/185) to 70.3% (130/185) of cases, reaching 74.8% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income. Conclusions: This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps. %M 39133539 %R 10.2196/52310 %U https://humanfactors.jmir.org/2024/1/e52310 %U https://doi.org/10.2196/52310 %U http://www.ncbi.nlm.nih.gov/pubmed/39133539 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55693 %T Exploring Older Adults' Perceptions of Using Digital Health Platforms for Self-Managing Musculoskeletal Health Conditions: Focus Group Study %A Clohessy,Sophie %A Kempton,Christian %A Ryan,Kate %A Grinbergs,Peter %A Elliott,Mark T %+ School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 1214142789, m.elliott.3@bham.ac.uk %K musculoskeletal %K digital health platform %K physiotherapy self-management %K digital triaging %K phone app %K qualitative %K focus group %K mobile phone %D 2024 %7 1.8.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technologies can assist and optimize health care processes. This is increasingly the case in the musculoskeletal health domain, where digital platforms can be used to support the self-management of musculoskeletal conditions, as well as access to services. However, given a large proportion of the population with musculoskeletal conditions are older adults (aged ≥60 years), it is important to consider the acceptability of such platforms within this demographic. Objective: This study aims to explore participants’ opinions and perceptions on the use of digital platforms for supporting the self-management of musculoskeletal conditions within older adult (aged ≥60 years) populations and to gather their opinions on real examples. Methods: A total of 2 focus groups (focus group 1: 6/15, 40%; focus group 2: 9/15, 60%) were conducted, in which participants answered questions about their thoughts on using digital health platforms to prevent or manage musculoskeletal conditions. Participants were further presented with 2 example scenarios, which were then discussed. Interviews were audio recorded, transcribed, and analyzed thematically. Participants were aged ≥60 years and with or without current musculoskeletal conditions. Prior experience of using smartphone apps or other digital health platforms for musculoskeletal conditions was not required. Focus groups took place virtually using the Teams (Microsoft Corp) platform. Results: A total of 6 themes were identified across both focus groups: “experiences of digital health platforms,” “preference for human contact,” “barriers to accessing clinical services,” “individual differences and digital literacy,” “trust in technology,” and “features and benefits of digital health technologies.” Each theme is discussed in detail based on the interview responses. The findings revealed that most participants had some existing experience with digital health platforms for preventing or managing musculoskeletal conditions. Overall, there was a lack of trust in and low expectations of quality for digital platforms for musculoskeletal health within this age group. While there was some concern about the use of digital platforms in place of in-person health consultations, several benefits were also identified. Conclusions: Results highlighted the need for better communication on the benefits of using digital platforms to support the self-management of musculoskeletal conditions, without the platforms replacing the role of the health care professionals. The concerns about which apps are of suitable quality and trustworthiness lead us to recommend raising public awareness around the role of organizations that verify and assess the quality of digital health platforms. %M 39088803 %R 10.2196/55693 %U https://aging.jmir.org/2024/1/e55693 %U https://doi.org/10.2196/55693 %U http://www.ncbi.nlm.nih.gov/pubmed/39088803 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50479 %T Effectiveness of Mobile App Interventions to Improve Periodontal Health: Protocol for a Systematic Review and Meta-Analysis %A Musa,Reem %A Elamin,Dalia %A Barrie,Robert %A Kimmie-Dhansay,Faheema %+ Department of Community Dentistry, Faculty of Dentistry, University of Western Cape, Fransie, Francie Van Zijl Dr, Cape Town, 7500, South Africa, 27 0847177976, dr.reemmusa@gmail.com %K mobile app %K periodontal health %K text messages %K application %K effectiveness %K physical well-being %K mental well-being %K social well-being %K oral hygiene %K oral disease %K disease prevention %K periodontal %K health education %K systematic review %D 2024 %7 31.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Periodontal health plays a key role as a shared reference point for evaluating periodontal diseases and identifying significant treatment outcomes. Providing adequate instruction and enhancing the motivation of patients to maintain proper oral hygiene are crucial factors for successful periodontal treatment, with self-performed regular oral hygiene identified as a critical factor in improving the outcomes of treatment for periodontal diseases. Recently, mobile health (mHealth) solutions, especially mobile apps, have emerged as valuable tools for self-management in chronic diseases such as periodontal disease, providing essential health education and monitoring capabilities. However, the use of mHealth apps for periodontal health is complex owing to various interacting components such as patient behavior, socioeconomic status, and adherence to oral hygiene practices. Existing literature has indicated positive effects of mHealth on oral health behaviors, knowledge, attitude, practice, plaque index score, and gingivitis reduction. However, there has been no systematic review of mobile apps specifically targeting patients with periodontal disease. Understanding the design and impact of mHealth apps is crucial for creating high-quality apps. Objective: The aim of this systematic review and meta-analysis is to evaluate the effectiveness of existing mobile apps in promoting periodontal health. Methods: A comprehensive search strategy will be performed in multiple electronic databases (PubMed, EBSCOhost, CINAHL Plus, Dentistry & Oral Sciences, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials) with the following keywords in the title/abstract: “mobile application,” “mobile health,” “mHealth,” “telemedicine,” “periodontal health,” “periodontitis,” and “text message.” Only randomized controlled trials will be included that assessed the following outcomes to measure periodontal health improvement: gingival index, bleeding index, periodontal pocket depth, and clinical attachment loss. Covidence will be used for data collection, and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flowchart will be used to describe the selection process of the included, identified, and excluded studies. The Confidence in Network Meta-Analysis approach will be used for meta-analysis of the extracted data from the included studies. Results: This review will not require ethical approval since no primary data will be included. As of July 2024, a total of 83 articles retrieved from various databases have been imported to Covidence with 13 articles deemed eligible for inclusion in the review. The review is currently ongoing and is expected to be complete by the end of 2024 with the results published in early 2025. Conclusions: This systematic review and meta-analysis will contribute to developing mobile apps with enhanced criteria to improve periodontal clinical outcomes. The review emphasizes the importance of mHealth and preventing periodontal disease, which can set the stage for informed global health care strategies. Trial Registration: PROSPERO CRD42022340827; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=340827 International Registered Report Identifier (IRRID): DERR1-10.2196/50479 %M 39083769 %R 10.2196/50479 %U https://www.researchprotocols.org/2024/1/e50479 %U https://doi.org/10.2196/50479 %U http://www.ncbi.nlm.nih.gov/pubmed/39083769 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58174 %T Assessing the Effectiveness of eHealth Interventions to Manage Multiple Lifestyle Risk Behaviors Among Older Adults: Systematic Review and Meta-Analysis %A Shi,Beibei %A Li,Guangkai %A Wu,Shuang %A Ge,Hongli %A Zhang,Xianliang %A Chen,Si %A Pan,Yang %A He,Qiang %+ School of Physical Education, Shandong University, 17922 Jingshi Road, Lixia District, Shandong Province, Jinan, 250061, China, 86 0531 88395374, hq@sdu.edu.cn %K eHealth %K lifestyle risk behaviors %K older adults %K multiple health behavior change %K mobile phone %D 2024 %7 31.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Developing adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors. Objective: The purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ≥2 major lifestyle risk behaviors in people aged ≥50 years. Methods: The literature search was conducted in 6 electronic databases—PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus—from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ≥2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep. Results: A total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD –0.23, 95% CI –0.33 to –0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. Conclusions: eHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult–oriented research is needed to develop eHealth interventions that can change multiple behaviors. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023444418 %M 39083787 %R 10.2196/58174 %U https://www.jmir.org/2024/1/e58174 %U https://doi.org/10.2196/58174 %U http://www.ncbi.nlm.nih.gov/pubmed/39083787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57586 %T Training Service Users in the Use of Telehealth: Scoping Review %A Galvin,Emer %A Desselle,Shane %A Gavin,Blánaid %A McNicholas,Fiona %A Cullinan,Shane %A Hayden,John %+ School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 111 St Stephen's Green, Dublin, D02 YN77, Ireland, 353 1 402 2100, emergalvin20@rcsi.ie %K telehealth %K video consultations %K training %K education %K older adults %K digital divide %K digital literacy %K review %K scoping review %K modality of care %K training service %K user %K users %K older adult %K gerontology %K geriatric %K geriatrics %K caregiver %K caregivers %K consultation %K consultations %K health care professional %K health care professionals %K PRISMA-ScR %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews %K data extraction %K phone %K phones %K telemonitoring %D 2024 %7 31.7.2024 %9 Review %J J Med Internet Res %G English %X Background: The use of telehealth has rapidly increased, yet some populations may be disproportionally excluded from accessing and using this modality of care. Training service users in telehealth may increase accessibility for certain groups. The extent and nature of these training activities have not been explored. Objective: The objective of this scoping review is to identify and describe activities for training service users in the use of telehealth. Methods: Five databases (MEDLINE [via PubMed], Embase, CINAHL, PsycINFO, and Web of Science) were searched in June 2023. Studies that described activities to train service users in the use of synchronous telehealth consultations were eligible for inclusion. Studies that focused on health care professional education were excluded. Papers were limited to those published in the English language. The review followed the Joanna Briggs Institute guidelines for scoping reviews and was reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Titles and abstracts were screened by 1 reviewer (EG). Full texts were screened by 2 reviewers (EG and JH or SC). Data extraction was guided by the research question. Results: The search identified 8087 unique publications. In total, 13 studies met the inclusion criteria. Telehealth training was commonly described as once-off preparatory phone calls to service users before a telehealth visit, facilitated primarily by student volunteers, and accompanied by written instructions. The training content included guidance on how to download and install software, troubleshoot technical issues, and adjust device settings. Older adults were the most common target population for the training. All but 1 of the studies were conducted during the COVID-19 pandemic. Overall, training was feasible and well-received by service users, and studies mostly reported increased rates of video visits following training. There was limited and mixed evidence that training improved participants’ competency with telehealth. Conclusions: The review mapped the literature on training activities for service users in telehealth. The common features of telehealth training for service users included once-off preparatory phone calls on the technical elements of telehealth, targeted at older adults. Key issues for consideration include the need for co-designed training and improving the broader digital skills of service users. There is a need for further studies to evaluate the outcomes of telehealth training activities in geographically diverse areas. %M 39083789 %R 10.2196/57586 %U https://www.jmir.org/2024/1/e57586 %U https://doi.org/10.2196/57586 %U http://www.ncbi.nlm.nih.gov/pubmed/39083789 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56433 %T The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions %A Herold,Fabian %A Theobald,Paula %A Gronwald,Thomas %A Kaushal,Navin %A Zou,Liye %A de Bruin,Eling D %A Bherer,Louis %A Müller,Notger G %+ Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Am Mühlenberg 9, Potsdam, 14476, Germany, 49 0331977213858, fabian.herold@uni-potsdam.de %K physical activity %K dementia prevention %K cognitive health %K hybrid: aging in place %K active %K exercises %K exercising %K healthy lifestyle %K dementia %K dementia onset %K dementia care %K preventive %K prevention %K cognitive health %K cognition %K cognitive %K hybrid %K hybrid model %D 2024 %7 31.7.2024 %9 Viewpoint %J JMIR Aging %G English %X A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas. %M 39083334 %R 10.2196/56433 %U https://aging.jmir.org/2024/1/e56433 %U https://doi.org/10.2196/56433 %U http://www.ncbi.nlm.nih.gov/pubmed/39083334 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58846 %T The Role of Assistive Technology in Enabling Older Adults to Achieve Independent Living: Past and Future %A Sweeting,Anna %A Warncken,Katie A %A Patel,Martyn %+ Older Peoples Medicine Department, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, United Kingdom, 44 01603286286 ext 4009, martyn.patel@nnuh.nhs.uk %K assistive technology %K older adults %K users %K aging %K aging in place %K UK %K cocreation %K research trial %K independent living %K North Norfolk %K disability %K injury %K tool %K use %K design %K barrier %D 2024 %7 30.7.2024 %9 Viewpoint %J J Med Internet Res %G English %X In this viewpoint, we present evidence of a marked increase in the use of assistive technology (AT) by older adults over the last 25 years. We also explain the way in which this use has expanded not only as an increase in terms of the total number of users but also by going beyond the typical scopes of use from its inception in 1999 to reach new categories of users. We outline our opinions on some of the key driving forces behind this expansion, such as population demographic changes, technological advances, and the promotion of AT as a means to enable older adults to achieve independent living. As well as our review of the evolution of AT over the past 25 years, we also discuss the future of AT research as a field and the need for harmonization of terminology in AT research. Finally, we outline how our experience in North Norfolk (notably the United Kingdom’s most old age–dependent district) suggests that cocreation may be the key to not only successful research trials in the field of AT but also to the successful sustained adoption of AT beyond its original scope of use. %M 39079115 %R 10.2196/58846 %U https://www.jmir.org/2024/1/e58846 %U https://doi.org/10.2196/58846 %U http://www.ncbi.nlm.nih.gov/pubmed/39079115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57694 %T Efficacy of Digital Dance on Brain Imagery, Cognition, and Health: Randomized Controlled Trial %A Tung,Heng-Hsin %A Kuo,Chen-Yuan %A Lee,Pei-Lin %A Chang,Chih-Wen %A Chou,Kun-Hsien %A Lin,Ching-Po %A Chen,Liang-Kung %+ Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd, Beitou District, Taipei, 11217, Taiwan, 886 2 2875 7808, lkchen2@vghtpe.gov.tw %K digital %K somatosensory dance %K somatosensory game %K cognitive performance %K physical function %K resilience %K demoralization %K quality of life %K dance %K dancer %K dancing %K movement %K sport %K sports %K cognitive %K cognition %K brain %K neuroscience %K image %K imagery %K imaging %K RCT %K randomized %K controlled trial %K controlled trials %K somatosensory %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 game %K games %K gaming %D 2024 %7 30.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Multidomain interventions have demonstrable benefits for promoting healthy aging, but self-empowerment strategies to sustain long-term gains remain elusive. Objective: This study evaluated the effects of digital somatosensory dance game participation on brain imagery changes as primary outcomes and other physical and mental health measures as secondary outcomes related to healthy aging. Methods: Between August 31, 2020, and June 27, 2021, this randomized controlled trial recruited 60 eligible participants older than 55 years with no recent engagement in digital dance games. A computer-generated randomization sequence was used to allocate participants 1:1, without stratification, to an intervention group (n=30) who underwent digital somatosensory dance game training or a control group (n=30). An anonymized code masked the intervention allocations from the investigators, and individuals who assigned the interventions were not involved in analyzing the study data. The intervention entailed two 30-minute dance game sessions per week for 6 months, and the control group received healthy aging education. Primary outcomes were brain imagery changes. All variables were measured at baseline and the 6-month follow-up, and intervention effects were estimated using t tests with intention-to-treat analyses. Results: Compared with the control group, intervention participants had significantly different brain imagery in the gray matter volume (GMV) of the left putamen (estimate 0.016, 95% CI 0.008 to 0.024; P<.001), GMV of the left pallidum (estimate 0.02, 95% CI 0.006 to 0.034; P=.004), and fractional amplitude of low frequency fluctuations of the left pallidum (estimate 0.262, 95% CI 0.084 to 0.439; P=.004). Additionally, the intervention group had different imagery in the cerebellum VI GMV (estimate 0.011, 95% CI 0.003 to 0.02; P=.01). The intervention group also had improved total Montreal Cognitive Assessment scores (estimate 1.2, 95% CI 0.27 to −2.13; P<.01), quality of life (estimate 7.08, 95% CI 2.35 to 11.82; P=.004), and time spent sitting on weekdays (estimate −1.96, 95% CI −3.33 to −0.60; P=.005). Furthermore, dance performance was significantly associated with cognitive performance (P=.003), health status (P=.14), resilience (P=.007), and demoralization (P<.001). Conclusions: Digital somatosensory dance game participation for 6 months was associated with brain imagery changes in multiple regions involving somatosensory, motor, visual, and attention functions, which were consistent with phenotypic improvements associated with healthy aging. Trial Registration: ClinicalTrials.gov NCT05411042; https://clinicaltrials.gov/study/NCT05411042 %M 39078687 %R 10.2196/57694 %U https://www.jmir.org/2024/1/e57694 %U https://doi.org/10.2196/57694 %U http://www.ncbi.nlm.nih.gov/pubmed/39078687 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46319 %T Web-Based Warfarin Management (Alfalfa App) Versus Traditional Warfarin Management: Multicenter Prospective Cohort Study %A Chen,Wenfei %A Chen,Jiana %A Jiang,Shaojun %A Wang,Chunhua %A Zhang,Jinhua %+ Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #18 Daoshan Road, Fuzhou, 350001, China, 86 13306912381, pollyzhang2006@126.com %K warfarin %K telemedicine %K smart phone application %K anti-coagulation management %K management %K cohort study %K application %K chronic disease %K support %K effectiveness %K online model %K patient management %D 2024 %7 29.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Poor anticoagulation management of warfarin may lead to patient admission, prolonged hospital stays, and even death due to anticoagulation-related adverse events. Traditional non–web-based outpatient clinics struggle to provide ideal anticoagulation management services for patients, and there is a need to explore a safer, more effective, and more convenient mode of warfarin management. Objective: This study aimed to compare differences in the quality of anticoagulation management and clinical adverse events between a web-based management model (via a smartphone app) and the conventional non–web-based outpatient management model. Methods: This study is a prospective cohort research that includes multiple national centers. Patients meeting the nadir criteria were split into a web-based management group using the Alfalfa app or a non–web-based management group with traditional outpatient management, and they were then monitored for a 6-month follow-up period to collect coagulation test results and clinical events. The effectiveness and safety of the 2 management models were assessed by the following indicators: time in therapeutic range (TTR), bleeding events, thromboembolic events, all-cause mortality events, cumulative event rates, and the distribution of the international normalized ratio (INR). Results: This national multicenter cohort study enrolled 522 patients between June 2019 and May 2021, with 519 (99%) patients reaching the follow-up end point, including 260 (50%) in the non–web-based management group and 259 (50%) in the web-based management group. There were no observable differences in baseline characteristics between the 2 patient groups. The web-based management group had a significantly higher TTR than the non–web-based management group (82.4% vs 71.6%, P<.001), and a higher proportion of patients received effective anticoagulation management (81.2% vs 63.5%, P<.001). The incidence of minor bleeding events in the non–web-based management group was significantly higher than that in the web-based management group (12.1% vs 6.6%, P=.048). Between the 2 groups, there was no statistically significant difference in the incidence of severe bleeding and thromboembolic and all-cause death events. In addition, compared with the non–web-based management group, the web-based management group had a lower proportion of INR in the extreme subtreatment range (17.6% vs 21.3%) and severe supertreatment range (0% vs 0.8%) and a higher proportion in the treatment range (50.4% vs 43.1%), with statistical significance. Conclusions: Compared with traditional non–web-based outpatient management, web-based management via the Alfalfa app may be more beneficial because it can enhance patient anticoagulation management quality, lower the frequency of small bleeding events, and improve INR distribution. %M 39073869 %R 10.2196/46319 %U https://www.jmir.org/2024/1/e46319 %U https://doi.org/10.2196/46319 %U http://www.ncbi.nlm.nih.gov/pubmed/39073869 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53450 %T A Web-Based Resilience-Enhancing Program to Improve Resilience, Physical Activity, and Well-being in Geriatric Population: Randomized Controlled Trial %A Wu,Yi-Chen %A Shen,Shu-Fen %A Chen,Liang-Kung %A Tung,Heng-Hsin %+ Department of Nursing,National Yang Ming Chiao Tung University, No.155, Sec.2, Li-Nong Street, Pei-Tao district 112, Taipei, 11221, Taiwan, 886 0953005831, shannontung719@gmail.com %K geriatric population %K community-dwelling older adult %K web-based resilience-enhancing program %K resilience %K physical activity %K well-being %K pandemic. %D 2024 %7 25.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Resilience is a protective factor in healthy aging, helping to maintain and recover physical and mental functions. The Resilience in Illness Model has proven effective in fostering resilience and well-being. Physical activity is crucial for older adults’ independence and well-being, even as aging causes a progressive decline. Additionally, older adults face challenges such as spousal loss and physical disability, making preventive intervention strategies necessary. Objective: This study aims to develop and evaluate a web-based program to enhance resilience, physical activity, and well-being among community-dwelling older adults. Additionally, we aim to gather feedback on the program’s strengths and limitations. Methods: A 4-week resilience-enhancing program was created, incorporating role-play and talk-in-interaction and focusing on 3 key skills: coping, control belief, and manageability. The program included scenarios such as becoming widowed and suffering a stroke, designed to engage older adults. A pilot test preceded the intervention. As a result of the COVID-19 pandemic, the program shifted from in-person to web-based sessions. A single-blind, parallel-group, randomized controlled trial was conducted. Participants aged over 65 years were recruited offline and randomly assigned to either an intervention or control group. A certified resilience practitioner delivered the program. Outcomes in resilience, physical activity, and well-being were self-assessed at baseline (T0), 4 weeks (T1), and 12 weeks (T2) after the program. A mixed methods approach was used to evaluate feedback. Results: A web-based participatory program enhancing 3 skills—coping, control belief, and manageability for resilience—was well developed. Among 96 participants, 63 were randomized into the intervention group (n=31) and the control group (n=32). The mean age in the intervention group was 69.27 (SD 3.08) years and 74.84 (SD 6.23) years in the control group. Significant between-group differences at baseline were found in age (t45.6=–4.53, P<.001) and physical activity at baseline (t61=2.92, P=.005). No statistically significant between-group differences over time were observed in resilience (SE 7.49, 95% CI –10.74 to 18.61, P=.60), physical activity (SE 15.18, 95% CI –24.74 to 34.74, P=.74), and well-being (SE 3.74, 95% CI –2.68 to 11.98, P=.21) after controlling for baseline differences. The dropout rate was lower in the intervention group (2/31, 6%) compared with the control group (5/32, 16%). Moreover, 77% (24/31) of participants in the intervention group completed the entire program. Program feedback from the participants indicated high satisfaction with the web-based format and mentorship support. Conclusions: This study demonstrated that a web-based resilience-enhancing program is appropriate, acceptable, feasible, and engaging for community-dwelling older adults. The program garnered enthusiasm for its potential to optimize resilience, physical activity, and well-being, with mentorship playing a crucial role in its success. Future studies should aim to refine program content, engagement, and delivery methods to effectively promote healthy aging in this population. Trial Registration: ClinicalTrials.gov NCT05808491; https://clinicaltrials.gov/ct2/show/NCT05808491 %M 39052335 %R 10.2196/53450 %U https://www.jmir.org/2024/1/e53450 %U https://doi.org/10.2196/53450 %U http://www.ncbi.nlm.nih.gov/pubmed/39052335 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47578 %T Consumer Perspectives for a Future Mobile App to Document Real-World Listening Difficulties: Qualitative Study %A Galvin,Karyn %A Tomlin,Dani %A Timmer,Barbra H B %A McNeice,Zoe %A Mount,Nicole %A Gray,Kathleen %A Short,Camille E %+ Department of Audiology and Speech Pathology, University of Melbourne, 550 Swanston St, Carlton, 3053, Australia, 61 61390355323, kgalvin@unimelb.edu.au %K adults %K hearing loss %K listening difficulties %K digital health %K app %K self-management %K mobile health %K smartphone %K mobile phone %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: By enabling individuals with hearing loss to collect their own hearing data in their personal real-world settings, there is scope to improve clinical care, empower consumers, and support shared clinical decision-making and problem-solving. Clinician support for this approach has been established in a separate study. Objective: This study aims to explore, for consumers with hearing loss, their (1) experiences of listening difficulties, to identify the data an app could usefully collect; (2) preferences regarding the features of mobile apps in general; and (3) opinions on the potential value and desirable features of a yet-to-be designed app for documenting listening difficulties in real-world settings. Methods: A total of 3 focus groups involved 27 adults who self-reported hearing loss. Most were fitted with hearing devices. A facilitator used a topic guide to generate discussion, which was video- and audio-recorded. Verbatim transcriptions were analyzed using inductive content analysis. Results: Consumers supported the concept of a mobile app that would facilitate the documenting of listening difficulties in real-world settings important to the individual. Consumers shared valuable insights about their listening difficulties, which will help determine the data that should be collected through an app designed to document these challenges. This information included early indicators of hearing loss (eg, mishearing, difficulty communicating in groups and on the phone, and speaking overly loudly) and prompts to seek hearing devices (eg, spousal pressure and the advice or example provided by others, and needing to rely on lipreading or to constantly request others to repeat themselves). It also included the well-known factors that influence listening difficulties (eg, reverberation, background noise, group conversations) and the impacts and consequences of their difficulties (eg, negative impacts on relationships and employment, social isolation and withdrawal, and negative emotions). Consumers desired a visual-based app that provided options for how data could be collected and how the user could enter data into an app, and which enabled data sharing with a clinician. Conclusions: These findings provide directions for the future co-design and piloting of a prototype mobile app to provide data that are useful for increasing self-awareness of listening difficulties and can be shared with a clinician. %M 39042452 %R 10.2196/47578 %U https://formative.jmir.org/2024/1/e47578 %U https://doi.org/10.2196/47578 %U http://www.ncbi.nlm.nih.gov/pubmed/39042452 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59468 %T Assessing the Clinical Effectiveness of an Exergame-Based Exercise Training Program Using Ring Fit Adventure to Prevent and Postpone Frailty and Sarcopenia Among Older Adults in Rural Long-Term Care Facilities: Randomized Controlled Trial %A Tuan,Sheng-Hui %A Chang,Lin-Hui %A Sun,Shu-Fen %A Li,Chien-Hui %A Chen,Guan-Bo %A Tsai,Yi-Ju %+ Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No 1, University Road, Tainan, 701, Taiwan, 886 6 235 3535 ext 5720, yjtsaincku2024@gmail.com %K exergame %K Ring Fit Adventure %K sarcopenia %K frailty %K long-term care %K multicomponent training %D 2024 %7 18.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Frailty and sarcopenia are geriatric syndromes of increasing concern and are associated with adverse health outcomes. They are more prevalent among long-term care facility (LTCF) users than among community dwellers. Exercise, especially multicomponent and progressive resistance training, is essential for managing these conditions. However, LTCFs, particularly in rural areas, face challenges in implementing structured exercise programs due to health care professional shortages. Moreover, older adults often become bored with repetitive exercise training and may lose interest over time. The Nintendo Switch Ring Fit Adventure (RFA) exergame is a novel exergame that combines resistance, aerobic, and balance exercises and offers a potential solution by boosting motivation in an immersive manner and reducing staff intervention needs. Objective: We aimed to evaluate the clinical effectiveness of an exergame-based exercise training program delivered via RFA (exergame-RFA) in improving muscle mass and functional performance among older adult LTCF users. Methods: This was a randomized controlled trial conducted from August 2022 to September 2023 and involved older adult LTCF users (aged ≥60 y) in rural southern Taiwan. Participants were randomized into an intervention group (exergame-RFA plus standard care) or a control group (standard care alone). The intervention, conducted seated with arm fit skills and trunk control exercises using the RFA, lasted 30 minutes twice weekly over 12 weeks. The primary outcomes measured were the Study of Osteoporotic Fractures index (serving as an indicator of frailty status) and the diagnostic criteria for sarcopenia (appendicular skeletal muscle mass index, handgrip strength, and gait speed). The secondary outcomes included functional performance (box and block test as well as maximum voluntary isometric contraction of the dominant upper extremity), muscle condition (muscle thickness measured using ultrasonography), activities of daily living (Kihon checklist), health-related quality of life (Short Form Health Survey-36), and cognitive function (brain health test). We used an intention-to-treat analysis, incorporating a simple imputation technique in statistical analysis. A mixed ANOVA, with time as a within-participant factor and intervention as a between-participant factor, was used to compare the training effects on outcomes. Results: We recruited 96 individuals, of whom 60 (62%) underwent randomization. Of these 60 participants, 55 (92%) completed the study. Significant group×time interactions were observed in the intervention group in all primary outcomes (all P<.001, except P=.01 for handgrip strength) and most secondary outcomes, including maximum voluntary isometric contraction of the biceps (P=.004) and triceps brachii (P<.001) muscles, biceps muscle thickness measured using ultrasonography (P<.001), box and block test (P<.001), Kihon checklist (physical function: P=.01, mood status: P=.003, and total: P=.003), and brain health test (P<.001). Conclusions: The exergame-RFA intervention significantly improved muscle mass, strength, and functional performance among older adult users of rural LTCFs, offering a novel approach to addressing frailty and sarcopenia. Trial Registration: ClinicalTrials.gov NCT05360667; https://clinicaltrials.gov/study/NCT05360667 International Registered Report Identifier (IRRID): RR2-10.3389/fmed.2022.1071409 %M 39024000 %R 10.2196/59468 %U https://www.jmir.org/2024/1/e59468 %U https://doi.org/10.2196/59468 %U http://www.ncbi.nlm.nih.gov/pubmed/39024000 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e47565 %T Efficacy of COMPAs, an App Designed to Support Communication Between Persons Living With Dementia in Long-Term Care Settings and Their Caregivers: Mixed Methods Implementation Study %A Ansaldo,Ana Inés %A Masson-Trottier,Michèle %A Delacourt,Barbara %A Dubuc,Jade %A Dubé,Catherine %+ Laboratoire de Plasticité cérébrale, Communication et Vieillissement, Centre de recherche de l'Institut Universitaire de gériatrie de Montréal, Université de Montréal, 4565 Queen Mary Road, Montréal, QC, H3W1W5, Canada, 1 5143403540 ext 3933, ana.ines.ansaldo@umontreal.ca %K dementia %K communication %K caregivers %K technology %K burden %K mixed methods design %K quality of life %K mobile phone %K tablet %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills, leading to fewer interactions and isolation for both people living with dementia and their caregivers, negatively impacting the quality of life for both members of the dyad. The resulting stress and burden on caregivers make them particularly susceptible to burnout. Objective: This study aims to examine the efficacy of Communication Proches Aidants (COMPAs), an app designed following the principles of person-centered and emotional communication, which is intended to improve well-being in persons living with dementia and caregivers and reduce caregiver burden. Methods: In this implementation study, volunteer caregivers in 2 long-term care facilities (n=17) were trained in using COMPAs and strategies to improve communication with persons living with dementia. Qualitative and quantitative analyses, semistructured interviews, and questionnaires were completed before and after 8 weeks of intervention with COMPAs. Results: Semistructured interviews revealed that all caregivers perceived a positive impact following COMPAs interventions, namely, improved quality of communication and quality of life among persons living with dementia and caregivers. Improved quality of life was also supported by a statistically significant reduction in the General Health Questionnaire-12 scores (caregivers who improved: 9/17, 53%; z=2.537; P=.01). COMPAs interventions were also associated with a statistically significant increased feeling of personal accomplishment (caregivers improved: 11/17, 65%; t15=2.430; P=.03; d=0.61 [medium effect size]). Conclusions: COMPAs intervention improved well-being in persons living with dementia and their caregivers by developing person-centered communication within the dyad, increasing empathy, and reducing burden in caregivers although most caregivers were unfamiliar with technology. The results hold promise for COMPAs interventions in long-term care settings. Larger group-controlled studies with different populations, in different contexts, and at different stages of dementia will provide a clearer picture of the benefits of COMPAs interventions. %M 38963691 %R 10.2196/47565 %U https://aging.jmir.org/2024/1/e47565 %U https://doi.org/10.2196/47565 %U http://www.ncbi.nlm.nih.gov/pubmed/38963691 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e51987 %T Technology Usability for People Living With Dementia: Concept Analysis %A Chien,Shao-Yun %A Zaslavsky,Oleg %A Berridge,Clara %+ School of Nursing, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 2068493301, ozasl@uw.edu %K usability %K dementia %K older adults %K technology %K concept analysis %K mobile phone %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Usability is a key indicator of the quality of technology products. In tandem with technological advancements, potential use by individuals with dementia is increasing. However, defining the usability of technology for individuals with dementia remains an ongoing challenge. The diverse and progressive nature of dementia adds complexity to the creation of universal usability criteria, highlighting the need for focused deliberations. Technological interventions offer potential benefits for people living with dementia and caregivers. Amid COVID-19, technology’s role in health care access is growing, especially among older adults. Enabling the diverse population of people living with dementia to enjoy the benefits of technologies requires particular attention to their needs, desires, capabilities, and vulnerabilities to potential harm from technologies. Successful technological interventions for dementia require meticulous consideration of technology usability. Objective: This concept analysis aims to examine the usability of technology in the context of individuals living with dementia to establish a clear definition for usability within this specific demographic. Methods: The framework by Walker and Avant was used to guide this concept analysis. We conducted a literature review spanning 1984 to 2024, exploring technology usability for people with dementia through the PubMed, Web of Science, and Google Scholar databases using the keywords “technology usability” and “dementia.” We also incorporated clinical definitions and integrated interview data from 29 dyads comprising individuals with mild Alzheimer dementia and their respective care partners, resulting in a total of 58 older adults. This approach aimed to offer a more comprehensive portrayal of the usability needs of individuals living with dementia, emphasizing practical application. Results: The evidence from the literature review unveiled that usability encompasses attributes such as acceptable learnability, efficiency, and satisfaction. The clinical perspective on dementia stages, subtypes, and symptoms underscores the importance of tailored technology usability assessment. Feedback from 29 dyads also emphasized the value of simplicity, clear navigation, age-sensitive design, personalized features, and audio support. Thus, design should prioritize personalized assistance for individuals living with dementia, moving away from standardized technological approaches. Synthesized from various sources, the defined usability attributes for individuals living with dementia not only encompass the general usability properties of effectiveness, efficiency, and satisfaction but also include other key factors: adaptability, personalization, intuitiveness, and simplicity, to ensure that technology is supportive and yields tangible benefits for this demographic. Conclusions: Usability is crucial for people living with dementia when designing technological interventions. It necessitates an understanding of user characteristics, dementia stages, symptoms, needs, and tasks, as well as consideration of varied physical requirements, potential sensory loss, and age-related changes. Disease progression requires adapting to evolving symptoms. Recommendations include versatile, multifunctional technology designs; accommodating diverse needs; and adjusting software functionalities for personalization. Product feature classification can be flexible based on user conditions. %M 38959053 %R 10.2196/51987 %U https://aging.jmir.org/2024/1/e51987 %U https://doi.org/10.2196/51987 %U http://www.ncbi.nlm.nih.gov/pubmed/38959053 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e52831 %T Examining Associations Between Smartphone Use and Clinical Severity in Frontotemporal Dementia: Proof-of-Concept Study %A Paolillo,Emily W %A Casaletto,Kaitlin B %A Clark,Annie L %A Taylor,Jack C %A Heuer,Hilary W %A Wise,Amy B %A Dhanam,Sreya %A Sanderson-Cimino,Mark %A Saloner,Rowan %A Kramer,Joel H %A Kornak,John %A Kremers,Walter %A Forsberg,Leah %A Appleby,Brian %A Bayram,Ece %A Bozoki,Andrea %A Brushaber,Danielle %A Darby,R Ryan %A Day,Gregory S %A Dickerson,Bradford C %A Domoto-Reilly,Kimiko %A Elahi,Fanny %A Fields,Julie A %A Ghoshal,Nupur %A Graff-Radford,Neill %A G H Hall,Matthew %A Honig,Lawrence S %A Huey,Edward D %A Lapid,Maria I %A Litvan,Irene %A Mackenzie,Ian R %A Masdeu,Joseph C %A Mendez,Mario F %A Mester,Carly %A Miyagawa,Toji %A Naasan,Georges %A Pascual,Belen %A Pressman,Peter %A Ramos,Eliana Marisa %A Rankin,Katherine P %A Rexach,Jessica %A Rojas,Julio C %A VandeVrede,Lawren %A Wong,Bonnie %A Wszolek,Zbigniew K %A Boeve,Bradley F %A Rosen,Howard J %A Boxer,Adam L %A Staffaroni,Adam M %A , %+ Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 19094158, San Francisco, CA, 94158, United States, 1 3476615999, emily.paolillo@ucsf.edu %K digital %K technology %K remote %K monitoring %K cognition %K neuropsychology %K cognitive impairment %K neurodegenerative %K screening %K clinical trials %K mobile phone %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Frontotemporal lobar degeneration (FTLD) is a leading cause of dementia in individuals aged <65 years. Several challenges to conducting in-person evaluations in FTLD illustrate an urgent need to develop remote, accessible, and low-burden assessment techniques. Studies of unobtrusive monitoring of at-home computer use in older adults with mild cognitive impairment show that declining function is reflected in reduced computer use; however, associations with smartphone use are unknown. Objective: This study aims to characterize daily trajectories in smartphone battery use, a proxy for smartphone use, and examine relationships with clinical indicators of severity in FTLD. Methods: Participants were 231 adults (mean age 52.5, SD 14.9 years; n=94, 40.7% men; n=223, 96.5% non-Hispanic White) enrolled in the Advancing Research and Treatment of Frontotemporal Lobar Degeneration (ARTFL study) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS study) Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) Mobile App study, including 49 (21.2%) with mild neurobehavioral changes and no functional impairment (ie, prodromal FTLD), 43 (18.6%) with neurobehavioral changes and functional impairment (ie, symptomatic FTLD), and 139 (60.2%) clinically normal adults, of whom 55 (39.6%) harbored heterozygous pathogenic or likely pathogenic variants in an autosomal dominant FTLD gene. Participants completed the Clinical Dementia Rating plus National Alzheimer’s Coordinating Center Frontotemporal Lobar Degeneration Behavior and Language Domains (CDR+NACC FTLD) scale, a neuropsychological battery; the Neuropsychiatric Inventory; and brain magnetic resonance imaging. The ALLFTD Mobile App was installed on participants’ smartphones for remote, passive, and continuous monitoring of smartphone use. Battery percentage was collected every 15 minutes over an average of 28 (SD 4.2; range 14-30) days. To determine whether temporal patterns of battery percentage varied as a function of disease severity, linear mixed effects models examined linear, quadratic, and cubic effects of the time of day and their interactions with each measure of disease severity on battery percentage. Models covaried for age, sex, smartphone type, and estimated smartphone age. Results: The CDR+NACC FTLD global score interacted with time on battery percentage such that participants with prodromal or symptomatic FTLD demonstrated less change in battery percentage throughout the day (a proxy for less smartphone use) than clinically normal participants (P<.001 in both cases). Additional models showed that worse performance in all cognitive domains assessed (ie, executive functioning, memory, language, and visuospatial skills), more neuropsychiatric symptoms, and smaller brain volumes also associated with less battery use throughout the day (P<.001 in all cases). Conclusions: These findings support a proof of concept that passively collected data about smartphone use behaviors associate with clinical impairment in FTLD. This work underscores the need for future studies to develop and validate passive digital markers sensitive to longitudinal clinical decline across neurodegenerative diseases, with potential to enhance real-world monitoring of neurobehavioral change. %M 38922667 %R 10.2196/52831 %U https://aging.jmir.org/2024/1/e52831 %U https://doi.org/10.2196/52831 %U http://www.ncbi.nlm.nih.gov/pubmed/38922667 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e37625 %T A Novel Web-Based Application for Influenza and COVID-19 Outbreak Detection and Response in Residential Aged Care Facilities %A Hsiao,Kai Hsun %A Quinn,Emma %A Johnstone,Travers %A Gomez,Maria %A Ingleton,Andrew %A Parasuraman,Arun %A Najjar,Zeina %A Gupta,Leena %K web application %K digital health %K communicable disease control %K outbreak %K surveillance %K influenza %K aged care %K aged care homes %D 2024 %7 24.6.2024 %9 %J JMIR Public Health Surveill %G English %X The use of innovative digital health technologies in public health is expanding quickly, including the use of these tools in outbreak response. The translation of a digital health innovation into effective public health practice is a complex process requiring diverse enablers across the people, process, and technology domains. This paper describes a novel web-based application that was designed and implemented by a district-level public health authority to assist residential aged care facilities in influenza and COVID-19 outbreak detection and response. It discusses some of the challenges, enablers, and key lessons learned in designing and implementing such a novel application from the perspectives of the public health practitioners (the authors) that undertook this project. %R 10.2196/37625 %U https://publichealth.jmir.org/2024/1/e37625 %U https://doi.org/10.2196/37625 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52248 %T User Requirements and Perceptions of a Sensor System for Early Stress Detection in People With Dementia and People With Intellectual Disability: Qualitative Study %A Adam,Esmee %A Meiland,Franka %A Frielink,Noud %A Meinders,Erwin %A Smits,Reon %A Embregts,Petri %A Smaling,Hanneke %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, Netherlands, 31 071 526 84 44, e.adam@lumc.nl %K stress detection %K sensor system %K garment integrated %K wearable %K user requirements %K dementia %K intellectual disability %K intellectual disabilities %K long-term care %K perceptions %K wearables %K qualitative study %K residents %K communication impairment %K impairments %K garment sensor %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Timely detection of stress in people with dementia and people with an intellectual disability (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care (LTC) residents with dementia and residents with ID have communication impairments, limiting their ability to express themselves. Wearables can help detect stress but are not always accepted by users and are uncomfortable to wear for longer periods. Integrating sensors into clothing may be a more acceptable approach for users in LTC. To develop a sensor system for early stress detection that is accepted by LTC residents with dementia and residents with ID, understanding their perceptions and requirements is essential. Objective: This study aimed to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users toward the sensor system, and (3) investigate the implementation requirements in LTC settings. Methods: A qualitative design with 18 focus groups and 29 interviews was used. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, people with ID, family caregivers, health care professionals). The focus groups were conducted at 3 time points within a 6-month period, where each new focus group built on the findings of previous rounds. The data from each round were used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data. Results: The study included 44 participants who expressed a positive attitude toward the idea of a garment-integrated sensor system but also identified some potential concerns. In addition to early stress detection, participants recognized other potential purposes or benefits of the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as washability and safety, and user requirements, such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the cost of the sensor system, added value to resident and health care professionals, and education for all users. Conclusions: The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for health care professionals and LTC residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice. %R 10.2196/52248 %U https://formative.jmir.org/2024/1/e52248 %U https://doi.org/10.2196/52248 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55842 %T Digital Phenotyping of Geriatric Depression Using a Community-Based Digital Mental Health Monitoring Platform for Socially Vulnerable Older Adults and Their Community Caregivers: 6-Week Living Lab Single-Arm Pilot Study %A Song,Sunmi %A Seo,YoungBin %A Hwang,SeoYeon %A Kim,Hae-Young %A Kim,Junesun %+ Department of Health and Environmental Science, Undergraduate School, Korea University, 661 B-Hana Science Building, Seongbuk-gu, Seoul, 02841, Republic of Korea, 82 2 3290 5689, junokim@korea.ac.kr %K depression %K monitoring system %K IoT %K AI %K wearable device %K digital mental health phenotyping %K living lab %K senior care %K Internet of Things %K artificial intelligence %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing need for digital services to support geriatric mental health, the development and implementation of digital mental health care systems for older adults have been hindered by a lack of studies involving socially vulnerable older adult users and their caregivers in natural living environments. Objective: This study aims to determine whether digital sensing data on heart rate variability, sleep quality, and physical activity can predict same-day or next-day depressive symptoms among socially vulnerable older adults in their everyday living environments. In addition, this study tested the feasibility of a digital mental health monitoring platform designed to inform older adult users and their community caregivers about day-to-day changes in the health status of older adults. Methods: A single-arm, nonrandomized living lab pilot study was conducted with socially vulnerable older adults (n=25), their community caregivers (n=16), and a managerial social worker over a 6-week period during and after the COVID-19 pandemic. Depressive symptoms were assessed daily using the 9-item Patient Health Questionnaire via scripted verbal conversations with a mobile chatbot. Digital biomarkers for depression, including heart rate variability, sleep, and physical activity, were measured using a wearable sensor (Fitbit Sense) that was worn continuously, except during charging times. Daily individualized feedback, using traffic signal signs, on the health status of older adult users regarding stress, sleep, physical activity, and health emergency status was displayed on a mobile app for the users and on a web application for their community caregivers. Multilevel modeling was used to examine whether the digital biomarkers predicted same-day or next-day depressive symptoms. Study staff conducted pre- and postsurveys in person at the homes of older adult users to monitor changes in depressive symptoms, sleep quality, and system usability. Results: Among the 31 older adult participants, 25 provided data for the living lab and 24 provided data for the pre-post test analysis. The multilevel modeling results showed that increases in daily sleep fragmentation (P=.003) and sleep efficiency (P=.001) compared with one’s average were associated with an increased risk of daily depressive symptoms in older adults. The pre-post test results indicated improvements in depressive symptoms (P=.048) and sleep quality (P=.02), but not in the system usability (P=.18). Conclusions: The findings suggest that wearable sensors assessing sleep quality may be utilized to predict daily fluctuations in depressive symptoms among socially vulnerable older adults. The results also imply that receiving individualized health feedback and sharing it with community caregivers may help improve the mental health of older adults. However, additional in-person training may be necessary to enhance usability. Trial Registration: ClinicalTrials.gov NCT06270121; https://clinicaltrials.gov/study/NCT06270121 %M 38885033 %R 10.2196/55842 %U https://mhealth.jmir.org/2024/1/e55842 %U https://doi.org/10.2196/55842 %U http://www.ncbi.nlm.nih.gov/pubmed/38885033 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58205 %T The Prevalence of Missing Incidents and Their Antecedents Among Older Adult MedicAlert Subscribers: Retrospective Descriptive Study %A Miguel-Cruz,Antonio %A Perez,Hector %A Choi,Yoojin %A Rutledge,Emily %A Daum,Christine %A Liu,Lili %+ Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 2R3, Canada, 1 7802246641, miguelcr@ualberta.ca %K dementia %K Alzheimer disease %K memory loss %K cognitive impairment %K missing incident %K wandering %K critical wandering %K older adults %K retrospective design %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: With the population aging, the number of people living with dementia is expected to rise, which, in turn, is expected to lead to an increase in the prevalence of missing incidents due to critical wandering. However, the estimated prevalence of missing incidents due to dementia is inconclusive in some jurisdictions and overlooked in others. Objective: The aims of the study were to examine (1) the demographic, psychopathological, and environmental antecedents to missing incidents due to critical wandering among older adult MedicAlert Foundation Canada (hereinafter MedicAlert) subscribers; and (2) the characteristics and outcomes of the missing incidents. Methods: This study used a retrospective descriptive design. The sample included 434 older adult MedicAlert subscribers involved in 560 missing incidents between January 2015 and July 2021. Results: The sample was overrepresented by White older adults (329/425, 77.4%). MedicAlert subscribers reported missing were mostly female older adults (230/431, 53.4%), living in urban areas with at least 1 family member (277/433, 63.8%). Most of the MedicAlert subscribers (345/434, 79.5%) self-reported living with dementia. MedicAlert subscribers went missing most frequently from their private homes in the community (96/143, 67.1%), traveling on foot (248/270, 91.9%) and public transport (12/270, 4.4%), during the afternoon (262/560, 46.8%) and evening (174/560, 31.1%). Most were located by first responders (232/486, 47.7%) or Good Samaritans (224/486, 46.1%). Of the 560 missing incidents, 126 (22.5%) were repeated missing incidents. The mean time between missing incidents was 11 (SD 10.8) months. Finally, the majority of MedicAlert subscribers were returned home safely (453/500, 90.6%); and reports of harm, injuries (46/500, 9.2%), and death (1/500, 0.2%) were very low. Conclusions: This study provides the prevalence of missing incidents from 1 database source. The low frequency of missing incidents may not represent populations that are not White. Despite the low number of missing incidents, the 0.2% (1/500) of cases resulting in injuries or death are devastating experiences that may be mitigated through prevention strategies. %M 38857069 %R 10.2196/58205 %U https://aging.jmir.org/2024/1/e58205 %U https://doi.org/10.2196/58205 %U http://www.ncbi.nlm.nih.gov/pubmed/38857069 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e50107 %T Smartwatch-Based Interventions for People With Dementia: User-Centered Design Approach %A Goerss,Doreen %A Köhler,Stefanie %A Rong,Eleonora %A Temp,Anna Gesine %A Kilimann,Ingo %A Bieber,Gerald %A Teipel,Stefan %+ Department of Psychosomatic Medicine, Rostock University Medical Center, Gehlsheimer Str. 20, Rostock, 18147, Germany, 49 3814949471, doreen.goerss@med.uni-rostock.de %K assistive technology %K user-centered design %K usability %K dementia %K smartwatch %K mobile phone %D 2024 %7 7.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Assistive technologies can help people living with dementia maintain their everyday activities. Nevertheless, there is a gap between the potential and use of these materials. Involving future users may help close this gap, but the impact on people with dementia is unclear. Objective: We aimed to determine if user-centered development of smartwatch-based interventions together with people with dementia is feasible. In addition, we evaluated the extent to which user feedback is plausible and therefore helpful for technological improvements. Methods: We examined the interactions between smartwatches and people with dementia or people with mild cognitive impairment. All participants were prompted to complete 2 tasks (drinking water and a specific cognitive task). Prompts were triggered using a smartphone as a remote control and were repeated up to 3 times if participants failed to complete a task. Overall, 50% (20/40) of the participants received regular prompts, and 50% (20/40) received intensive audiovisual prompts to perform everyday tasks. Participants’ reactions were observed remotely via cameras. User feedback was captured via questionnaires, which included topics like usability, design, usefulness, and concerns. The internal consistency of the subscales was calculated. Plausibility was also checked using qualitative approaches. Results: Participants noted their preferences for particular functions and improvements. Patients struggled with rating using the Likert scale; therefore, we assisted them with completing the questionnaire. Usability (mean 78 out of 100, SD 15.22) and usefulness (mean 9 out of 12) were rated high. The smartwatch design was appealing to most participants (31/40, 76%). Only a few participants (6/40, 15%) were concerned about using the watch. Better usability was associated with better cognition. The observed success and self-rated task comprehension were in agreement for most participants (32/40, 80%). In different qualitative analyses, participants’ responses were, in most cases, plausible. Only 8% (3/40) of the participants were completely unaware of their irregular task performance. Conclusions: People with dementia can have positive experiences with smartwatches. Most people with dementia provided valuable information. Developing assistive technologies together with people with dementia can help to prioritize the future development of functional and nonfunctional features. %M 38848116 %R 10.2196/50107 %U https://aging.jmir.org/2024/1/e50107 %U https://doi.org/10.2196/50107 %U http://www.ncbi.nlm.nih.gov/pubmed/38848116 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53261 %T The Effectiveness of Virtual Reality–Based Training on Cognitive, Social, and Physical Functioning in High-Functioning Older Adults (CoSoPhy FX): 2-Arm, Parallel-Group Randomized Controlled Trial %A Szczepocka,Ewa %A Mokros,Łukasz %A Kazmierski,Jakub %A Nowakowska,Karina %A Łucka,Anna %A Antoszczyk,Anna %A Oltra-Cucarella,Javier %A Werzowa,Walter %A Hellevik,Martin Moum %A Skouras,Stavros %A Bagger,Karsten %+ Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, 92-216, Poland, 48 426757372, ewa.szczepocka@umed.lodz.pl %K cognitive functions %K head-mounted-display %K healthy seniors %K virtual reality %K well-being %K mobile phone %D 2024 %7 5.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Virtual reality (VR) has emerged as a promising technology for enhancing the health care of older individuals, particularly in the domains of cognition, physical activity, and social engagement. However, existing VR products and services have limited availability and affordability; hence, there is a need for a scientifically validated and personalized VR service to be used by older adults in their homes, which can improve their overall physical, cognitive, and social well-being. Objective: The main purpose of the CoSoPhy FX (Cognitive, Social, and Physical Effects) study was to analyze the effects of a VR-based digital therapeutics app on the cognitive, social, and physical performance abilities of healthy (high-functioning) older adults. This paper presents the study protocol and the results from the recruitment phase. Methods: A group of 188 healthy older adults aged 65-85 years, recruited at the Medical University of Lodz, Poland, were randomly allocated to the experimental group (VR dual-task training program) or to the control group (using a VR headset app showing nature videos). A total of 3 cognitive exercises were performed in various 360° nature environments delivered via a VR head-mounted display; the participants listened to their preferred music genre. Each patient received 3 sessions of 12 minutes per week for 12 weeks, totaling a minimum of 36 sessions per participant. Attention and working memory (Central Nervous System Vital Signs computerized cognitive battery) were used as primary outcomes, while other cognitive domains in the Central Nervous System Vital Signs battery, quality of life (World Health Organization–5 Well-Being Index), health-related quality of life (EQ-5D-5L), and anxiety (General Anxiety Disorder 7-item questionnaire) were the secondary outcomes. The group-by-time interaction was determined using linear mixed models with participants’ individual slopes. Results: In total, 122 (39%) of the initial 310 participants failed to meet the inclusion criteria, resulting in a recruitment rate of 61% (188/310). Among the participants, 68 successfully completed the intervention and 62 completed the control treatment. The data are currently being analyzed, and we plan to publish the results by the end of September 2024. Conclusions: VR interventions have significant potential among healthy older individuals. VR can address various aspects of well-being by stimulating cognitive functions, promoting physical activity, and facilitating social interaction. However, challenges such as physical discomfort, technology acceptance, safety concerns, and cost must be considered when implementing them for older adults. Further research is needed to determine the long-term effects of VR-based interventions, optimal intervention designs, and the specific populations that would benefit most. Trial Registration: ClinicalTrials.gov NCT05369897; https://clinicaltrials.gov/study/NCT05369897 International Registered Report Identifier (IRRID): DERR1-10.2196/53261 %M 38837194 %R 10.2196/53261 %U https://www.researchprotocols.org/2024/1/e53261 %U https://doi.org/10.2196/53261 %U http://www.ncbi.nlm.nih.gov/pubmed/38837194 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56653 %T Smartphone App Designed to Collect Health Information in Older Adults: Usability Study %A Murabito,Joanne M %A Faro,Jamie M %A Zhang,Yuankai %A DeMalia,Angelo %A Hamel,Alexander %A Agyapong,Nakesha %A Liu,Hongshan %A Schramm,Eric %A McManus,David D %A Borrelli,Belinda %+ Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E Concord St Suite L-516, Boston, MA, 02118, United States, 1 508 935 3500, murabito@bu.edu %K mobile application surveys %K mixed methods %K electronic data collection %K mHealth %K mobile health %K mobile application %K mobile applications %K app %K apps %K application %K applications %K digital health %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K usability %K usable %K usableness %K usefulness %K utility %K health information %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Studies evaluating the usability of mobile-phone assessments in older adults are limited. Objective: This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting. Methods: We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40% women; 15/15, 100% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47% women; 3/15, 20% Hispanic; and 8/15, 53% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent). Results: In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test. Conclusions: Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences. %M 38815261 %R 10.2196/56653 %U https://humanfactors.jmir.org/2024/1/e56653 %U https://doi.org/10.2196/56653 %U http://www.ncbi.nlm.nih.gov/pubmed/38815261 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56184 %T Digital Peer-Supported App Intervention to Promote Physical Activity Among Community-Dwelling Older Adults: Nonrandomized Controlled Trial %A Tabira,Kento %A Oguma,Yuko %A Yoshihara,Shota %A Shibuya,Megumi %A Nakamura,Manabu %A Doihara,Natsue %A Hirata,Akihiro %A Manabe,Tomoki %+ Sports Medicine Research Center, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa, 223-0061, Japan, 81 45 566 1090, yoguma@keio.jp %K physical activity %K physical function %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 digital peer support app %K mHealth %K mobile health %K app %K apps %K application %K applications %K eHealth %K peer support %K exercise %K mobile phone %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support–based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated. Objective: This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users. Methods: We conducted a nonrandomized controlled trial of older adults aged ≥65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test. Results: The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88% (36/41) and 87.7%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, P=.04; duration of MVPA, P=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels. Conclusions: The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials. %M 38814686 %R 10.2196/56184 %U https://aging.jmir.org/2024/1/e56184 %U https://doi.org/10.2196/56184 %U http://www.ncbi.nlm.nih.gov/pubmed/38814686 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46108 %T Mobile Health Apps, Family Caregivers, and Care Planning: Scoping Review %A Kelley,Marjorie M %A Powell,Tia %A Camara,Djibril %A Shah,Neha %A Norton,Jenna M %A Deitelzweig,Chelsea %A Vaidy,Nivedha %A Hsiao,Chun-Ju %A Wang,Jing %A Bierman,Arlene S %+ Agency for Health Care Research and Quality, 5600 Fishers Lane, Rockville, MD, 20857, United States, 1 (301) 427 1104, arlene.bierman@ahrq.hhs.gov %K caregivers %K carers %K informal caregivers %K family caregivers %K mHealth applications %K telemedicine %K mobile health %K mHealth %K eHealth %K digital health %K apps %K chronic condition %K caregiver %K application %K support %K clinicians %K development %K electronic health record %K implementation %K mobile phone %D 2024 %7 23.5.2024 %9 Review %J J Med Internet Res %G English %X Background: People living with multiple chronic conditions (MCCs) face substantial challenges in planning and coordinating increasingly complex care. Family caregivers provide important assistance for people with MCCs but lack sufficient support. Caregiver apps have the potential to help by enhancing care coordination and planning among the health care team, including patients, caregivers, and clinicians. Objective: We aim to conduct a scoping review to assess the evidence on the development and use of caregiver apps that support care planning and coordination, as well as to identify key factors (ie, needs, barriers, and facilitators) related to their use and desired caregiver app functionalities. Methods: Papers intersecting 2 major domains, mobile health (mHealth) apps and caregivers, that were in English and published from 2015 to 2021 were included in the initial search from 6 databases and gray literature and ancestry searches. As per JBI (Joanna Briggs Institute) Scoping Review guidelines and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), 2 authors independently screened full texts with disagreements resolved by a third author. Working in pairs, the authors extracted data using a pilot-tested JBI extraction table and compared results for consensus. Results: We identified 34 papers representing 25 individual studies, including 18 (53%) pilot and feasibility studies, 13 (38%) qualitative studies, and 2 experimental or quasi-experimental studies. None of the identified studies assessed an intervention of a caregiver app for care planning and coordination for people with MCCs. We identified important caregiver needs in terms of information, support, and care coordination related to both caregiving and self-care. We compiled desired functionalities and features enabling apps to meet the care planning and care coordination needs of caregivers, in particular, the integration of caregiver roles into the electronic health record. Conclusions: Caregiver needs identified through this study can inform developers and researchers in the design and implementation of mHealth apps that integrate with the electronic health record to link caregivers, patients, and clinicians to support coordinated care for people with MCCs. In addition, this study highlights the need for more rigorous research on the use of mHealth apps to support caregivers in care planning and coordination. %M 38781588 %R 10.2196/46108 %U https://www.jmir.org/2024/1/e46108 %U https://doi.org/10.2196/46108 %U http://www.ncbi.nlm.nih.gov/pubmed/38781588 %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 %@ 2561-326X %I JMIR Publications %V 8 %N %P e46151 %T Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study %A Lemos,Marta %A Henriques,Ana Rita %A Lopes,David Gil %A Mendonça,Nuno %A Victorino,André %A Costa,Andreia %A Arriaga,Miguel %A Gregório,Maria João %A de Sousa,Rute %A Canhão,Helena %A Rodrigues,Ana M %+ CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisboa, Rua do Instituto Bacteriológico, nº5 Edifício Amarelo, Lisboa, 1150-190, Portugal, 351 214956435 ext 27016, anarita.henriques@nms.unl.pt %K DigiAdherence %K mHealth %K mobile app %K technology %K utility %K usability %K ICT %K application %K patient-centered %K tool %K prevention %K falls %K treatment %K nutrition %K physical activity %K pilot study %K older adults %K adherence %K engagement %K compliance %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity. Objective: This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older. Methods: In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portimão, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed. Results: The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67%) and managing therapies and polypharmacy (16/26, 62%). Conclusions: The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge. International Registered Report Identifier (IRRID): RR2-10.2196/29675 %M 38758585 %R 10.2196/46151 %U https://formative.jmir.org/2024/1/e46151 %U https://doi.org/10.2196/46151 %U http://www.ncbi.nlm.nih.gov/pubmed/38758585 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53587 %T Effectiveness of Gerontechnology Empowerment Program on Awareness and Use of Mobile Apps Among Older Adults for Instrumental Activities of Daily Living: Protocol for a Cluster Randomized Controlled Trial %A Shashidhara,Y N %A Raghavendra,G %A P Kundapur,Poornima %A Binil,V %+ Welcomgroup Graduate School of Hotel Administration, Manipal Academy of Higher Education, Madhava Nagar, Manipal, 576104, India, 91 9880328604, rag.wgsha@manipal.edu %K gerontechnology %K older adults %K awareness %K older people %K instrumental activities of daily living %K iADLs %K mobile apps %K mobile phone %K empowerment %D 2024 %7 13.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Instrumental activities of daily living (iADLs) are crucial for older adults to live independently. Health care and technological advancements will increase the older adult population and life expectancy globally. Difficulties with iADLs impact older adults’ quality of life. Mobile apps can assist older adults, but many require help due to limited awareness. Lack of awareness is a barrier to app use. Existing literature mainly covers health care and app design, needing more focus on iADL apps for older adults. Objective: The study objectives encompass 2 main aspects: first, to evaluate the awareness, use, and factors influencing the use of apps among older adults for iADLs; and second, to create and assess the effectiveness of a gerontechnology empowerment program (GEP) for older adults on the awareness and use of apps for iADLs. Methods: This research uses a quantitative approach divided into 2 distinct phases. In phase 1, we conduct a descriptive survey to assess the level of awareness and use of mobile apps for iADLs and identify the factors that influence the use of such apps among older adults. To ensure clarity and comprehension among participants, we provide them with a subject information sheet in both Kannada and English. The data collected during this phase enable us to gain insights into awareness levels, use patterns, and factors that shape older adults’ use of apps for iADLs. The results serve as the foundation for designing the GEP. In phase 2, a cluster randomization method will be used to select older adults aged 60 to 75 years in Udupi district, Karnataka, India, who are active smartphone users. These participants will be divided into 2 groups: the experimental and the control groups. The experimental group will join the GEP. The sample size for phase 1 is 554, and phase 2 is 50. To assess the effectiveness of this program, we will measure the outcomes before and after its implementation using the same assessment tools used in phase 1. Results: This study is funded by the Indian Council of Medical Research (Adhoc/193/2022/SBHSR on November 18, 2022). Phase 1 data collection is expected to be completed by November 2023, and phase 2 is scheduled to commence in the upcoming months. Phase 1 and 2 findings will be analyzed and discussed in the main paper, which we intend to submit to a high-quality peer-reviewed journal for publication. The research protocol, informed consent forms, and associated documentation received approval from institutional ethics committees (214/2020). Conclusions: Upon the successful testing of the GEP, it can be recommended that welfare departments encourage older adults to use mobile apps for iADLs and establish training programs to provide support to older adults in using these apps. Trial Registration: Clinical Trials Registry - India CTRI/2020/09/027977; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDUxMzM=&Enc=&userName=027977 International Registered Report Identifier (IRRID): DERR1-10.2196/53587 %M 38739442 %R 10.2196/53587 %U https://www.researchprotocols.org/2024/1/e53587 %U https://doi.org/10.2196/53587 %U http://www.ncbi.nlm.nih.gov/pubmed/38739442 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53192 %T Feasibility of Deploying Home-Based Digital Technology, Environmental Sensors, and Web-Based Surveys for Assessing Behavioral Symptoms and Identifying Their Precipitants in Older Adults: Longitudinal, Observational Study %A Au-Yeung,Wan-Tai M %A Liu,Yan %A Hanna,Remonda %A Gothard,Sarah %A Rodrigues,Nathaniel %A Leon Guerrero,Cierra %A Beattie,Zachary %A Kaye,Jeffrey %+ Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode: UHN13, Portland, OR, 97239, United States, 1 503 494 6695, auyeungm@ohsu.edu %K neuropsychiatric symptoms %K mild cognitive impairment %K dementia %K unobtrusive monitoring %K digital biomarkers %K environmental precipitants %K mobile phone %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Apathy, depression, and anxiety are prevalent neuropsychiatric symptoms experienced by older adults. Early detection, prevention, and intervention may improve outcomes. Objective: We aim to demonstrate the feasibility of deploying web-based weekly questionnaires inquiring about the behavioral symptoms of older adults with normal cognition, mild cognitive impairment, or early-stage dementia and to demonstrate the feasibility of deploying an in-home technology platform for measuring participant behaviors and their environment. Methods: The target population of this study is older adults with normal cognition, mild cognitive impairment, or early-stage dementia. This is an observational, longitudinal study with a study period of up to 9 months. The severity of participant behavioral symptoms (apathy, depression, and anxiety) was self-reported weekly through web-based surveys. Participants’ digital biomarkers were continuously collected at their personal residences and through wearables throughout the duration of the study. The indoor physical environment at each residence, such as light level, noise level, temperature, humidity, or air quality, was also measured using indoor environmental sensors. Feasibility was examined, and preliminary correlation analysis between the level of symptoms and the digital biomarkers and between the level of symptoms and the indoor environment was performed. Results: At 13 months after recruitment began, a total of 9 participants had enrolled into this study. The participants showed high adherence rates in completing the weekly questionnaires (response rate: 275/278, 98.9%), and data collection using the digital technology appeared feasible and acceptable to the participants with few exceptions. Participants’ severity of behavioral symptoms fluctuated from week to week. Preliminary results show that the duration of sleep onset and noise level are positively correlated with the anxiety level in a subset of our participants. Conclusions: This study is a step toward more frequent assessment of older adults’ behavioral symptoms and holistic in situ monitoring of older adults’ behaviors and their living environment. The goal of this study is to facilitate the development of objective digital biomarkers of neuropsychiatric symptoms and to identify in-home environmental factors that contribute to these symptoms. %M 38717798 %R 10.2196/53192 %U https://formative.jmir.org/2024/1/e53192 %U https://doi.org/10.2196/53192 %U http://www.ncbi.nlm.nih.gov/pubmed/38717798 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e54128 %T A Personalized and Interactive Web-Based Advance Care Planning Intervention for Older Adults (Koda Health): Pilot Feasibility Study %A Roberts,R Lynae %A Cherry,Katelin D %A Mohan,Desh P %A Statler,Tiffany %A Kirkendall,Eric %A Moses,Adam %A McCraw,Jennifer %A Brown III,Andrew E %A Fofanova,Tatiana Y %A Gabbard,Jennifer %K advance care planning %K ACP %K digital health tools %K system usability %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K adoption %K acceptance %K usability %K digital health %K platform %K website %K websites %D 2024 %7 6.5.2024 %9 %J JMIR Aging %G English %X Background: Advance care planning (ACP) is a process that involves patients expressing their personal goals, values, and future medical care preferences. Digital applications may help facilitate this process, though their use in older adults has not been adequately studied. Objective: This pilot study aimed to evaluate the reach, adoption, and usability of Koda Health, a web-based patient-facing ACP platform, among older adults. Methods: Older adults (aged 50 years and older) who had an active Epic MyChart account at an academic health care system in North Carolina were recruited to participate. A total of 2850 electronic invitations were sent through MyChart accounts with an embedded hyperlink to the Koda platform. Participants who agreed to participate were asked to complete pre- and posttest surveys before and after navigating through the Koda Health platform. Primary outcomes were reach, adoption, and System Usability Scale (SUS) scores. Exploratory outcomes included ACP knowledge and readiness. Results: A total of 161 participants enrolled in the study and created an account on the platform (age: mean 63, SD 9.3 years), with 80% (129/161) of these participants going on to complete all steps of the intervention, thereby generating an advance directive. Participants reported minimal difficulty in using the Koda platform, with an overall SUS score of 76.2. Additionally, knowledge of ACP (eg, mean increase from 3.2 to 4.2 on 5-point scale; P<.001) and readiness (eg, mean increase from 2.6 to 3.2 on readiness to discuss ACP with health care provider; P<.001) significantly increased from before to after the intervention. Conclusions: This study demonstrated that the Koda Health platform is feasible, had above-average usability, and improved ACP documentation of preferences in older adults. Our findings indicate that web-based health tools like Koda may help older individuals learn about and feel more comfortable with ACP while potentially facilitating greater engagement in care planning. %R 10.2196/54128 %U https://aging.jmir.org/2024/1/e54128 %U https://doi.org/10.2196/54128 %0 Journal Article %@ 2561-326X %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 %@ 2561-326X %I JMIR Publications %V 8 %N %P e51076 %T Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study %A Chen,Tzu Han %A Lee,Shin-Da %A Ma,Wei-Fen %+ PhD Program in Healthcare Science, School of Nursing, China Medical University, No 100, Sec 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, 886 4 22053366 ext 7107, lhdaisy@mail.cmu.edu.tw %K app quality %K caregiver %K dementia %K geriatrics %K aging %K technology %K digital health %K mHealth %K mobile health %K seniors %K mobile app %K patient %K adoption %K development %K management %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps. Objective: The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers. Methods: We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads. Results: Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three– and bottom three–rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t15=4.087, P<.001), this may not be a significant determinant of the app’s perceived impact. Conclusions: The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app. %M 38684083 %R 10.2196/51076 %U https://formative.jmir.org/2024/1/e51076 %U https://doi.org/10.2196/51076 %U http://www.ncbi.nlm.nih.gov/pubmed/38684083 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52075 %T Effectiveness of a Smartphone App–Based Intervention With Bluetooth-Connected Monitoring Devices and a Feedback System in Heart Failure (SMART-HF Trial): Randomized Controlled Trial %A Yoon,Minjae %A Lee,Seonhwa %A Choi,Jah Yeon %A Jung,Mi-Hyang %A Youn,Jong-Chan %A Shim,Chi Young %A Choi,Jin-Oh %A Kim,Eung Ju %A Kim,Hyungseop %A Yoo,Byung-Su %A Son,Yeon Joo %A Choi,Dong-Ju %+ Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seognam, 13620, Republic of Korea, 82 317877007, djchoi@snubh.org %K heart failure %K mobile applications %K mobile health %K self-care %K vital sign monitoring %K mobile phone %D 2024 %7 29.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Current heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. Objective: We developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app–based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. Methods: In this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. Results: At 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean –1.3, SD 2.1 vs mean –0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. Conclusions: The mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app–based self-care strategies and feedback for patients with HF. Trial Registration: ClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT05668000 %M 38683665 %R 10.2196/52075 %U https://www.jmir.org/2024/1/e52075 %U https://doi.org/10.2196/52075 %U http://www.ncbi.nlm.nih.gov/pubmed/38683665 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56883 %T Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study %A McMurray,Josephine %A Levy,AnneMarie %A Pang,Wei %A Holyoke,Paul %+ Lazaridis School of Business & Economics, Wilfrid Laurier University, 73 George St, Brantford, ON, N3T3Y3, Canada, 1 548 889 4492, jmcmurray@wlu.ca %K cognitive dysfunction %K dementia neuropsychological tests %K evaluation study %K technology %K aged %K mobile phone %D 2024 %7 19.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rapid aging of the global population, the prevalence of mild cognitive impairment (MCI) and dementia is anticipated to surge worldwide. MCI serves as an intermediary stage between normal aging and dementia, necessitating more sensitive and effective screening tools for early identification and intervention. The BrainFx SCREEN is a novel digital tool designed to assess cognitive impairment. This study evaluated its efficacy as a screening tool for MCI in primary care settings, particularly in the context of an aging population and the growing integration of digital health solutions. Objective: The primary objective was to assess the validity, reliability, and applicability of the BrainFx SCREEN (hereafter, the SCREEN) for MCI screening in a primary care context. We conducted an exploratory study comparing the SCREEN with an established screening tool, the Quick Mild Cognitive Impairment (Qmci) screen. Methods: A concurrent mixed methods, prospective study using a quasi-experimental design was conducted with 147 participants from 5 primary care Family Health Teams (FHTs; characterized by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants included health care practitioners, patients, and FHT administrative executives. Individuals aged ≥55 years with no history of MCI or diagnosis of dementia rostered in a participating FHT were eligible to participate. Participants were screened using both the SCREEN and Qmci. The study also incorporated the Geriatric Anxiety Scale–10 to assess general anxiety levels at each cognitive screening. The SCREEN’s scoring was compared against that of the Qmci and the clinical judgment of health care professionals. Statistical analyses included sensitivity, specificity, internal consistency, and test-retest reliability assessments. Results: The study found that the SCREEN’s longer administration time and complex scoring algorithm, which is proprietary and unavailable for independent analysis, presented challenges. Its internal consistency, indicated by a Cronbach α of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate κ (0.15) values. Sensitivity and specificity were consistent (63.25% and 74.07%, respectively) between cross-tabulation and discrepant analysis. In addition, the study faced limitations due to its demographic skew (96/147, 65.3% female, well-educated participants), the absence of a comprehensive gold standard for MCI diagnosis, and financial constraints limiting the inclusion of confirmatory neuropsychological testing. Conclusions: The SCREEN, in its current form, does not meet the necessary criteria for an optimal MCI screening tool in primary care settings, primarily due to its longer administration time and lower reliability. As the number of digital health technologies increases and evolves, further testing and refinement of tools such as the SCREEN are essential to ensure their efficacy and reliability in real-world clinical settings. This study advocates for continued research in this rapidly advancing field to better serve the aging population. International Registered Report Identifier (IRRID): RR2-10.2196/25520 %M 38640480 %R 10.2196/56883 %U https://www.jmir.org/2024/1/e56883 %U https://doi.org/10.2196/56883 %U http://www.ncbi.nlm.nih.gov/pubmed/38640480 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e50219 %T Acceptance of a Digital Assistant (Anne4Care) for Older Adult Immigrants Living With Dementia: Qualitative Descriptive Study %A Bults,Marloes %A van Leersum,Catharina Margaretha %A Olthuis,Theodorus Johannes Josef %A Siebrand,Egbert %A Malik,Zohrah %A Liu,Lili %A Miguel-Cruz,Antonio %A Jukema,Jan Seerp %A den Ouden,Marjolein Elisabeth Maria %+ Technology, Health & Care Research Group, Saxion University of Applied Sciences, M H Tromplaan 28 Enschede, Enschede, 7513 AB, Netherlands, 31 620946213, m.bults@saxion.nl %K assistive technology %K technology acceptance %K immigrant %K dementia %K marginalized older adults %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: There is a need to develop and coordinate dementia care plans that use assistive technology for vulnerable groups such as immigrant populations. However, immigrant populations are seldom included in various stages of the development and implementation of assistive technology, which does not optimize technology acceptance. Objective: This study aims to gain an in-depth understanding of the acceptance of a digital personal assistant, called Anne4Care, by older adult immigrants living with dementia in their own homes. Methods: This study used a qualitative descriptive research design with naturalistic inquiry. A total of 13 older adults participated in this study. The participants were invited for 2 interviews. After an introduction of Anne4Care, the first interview examined the lives and needs of participants, their expectations, and previous experiences with assistive technology in daily life. Four months later, the second interview sought to understand facilitators and barriers, suggestions for modifications, and the role of health care professionals. Three semistructured interviews were conducted with health care professionals to examine the roles and challenges they experienced in the use and implementation of Anne4Care. Content analysis, using NVivo11, was performed on all transcripts. Results: All 13 participants had an immigration background. There were 10 male and 3 female participants, with ages ranging from 52 to 83 years. Participants were diagnosed with an early-stage form of dementia or acquired brain injury. None of the older adult participants knew or used digital assistive technology at the beginning. They obtained assistance from health care professionals and family caregivers who explained and set up the technology. Four themes were found to be critical aspects of the acceptance of the digital personal assistant Anne4Care: (1) use of Anne4Care, (2) positive aspects of Anne4Care, (3) challenges with Anne4Care, and (4) expectations. Assistance at first increased the burden on health care professionals and families. After the initial effort, most health care professionals and families experienced that Anne4Care reduced their tasks and stress. Contributions of Anne4Care included companionship, help with daily tasks, and opportunities to communicate in multiple languages. On the other hand, some participants expressed anxiety toward the use of Anne4Care. Furthermore, the platform required an internet connection at home and Anne4Care could not be used outside the home. Conclusions: Although older adult immigrants living with dementia had no previous experience with digital assistive technology specifically, the acceptance of the digital personal assistant, called Anne4Care, by older adult immigrants living with dementia was rather high. The digital assistant can be further developed to allow for interactive conversations and for use outside of one’s home. Participation of end users during various stages of the development, refinement, and implementation of health technology innovations is of utmost importance to maximize technology acceptance. %M 38639994 %R 10.2196/50219 %U https://aging.jmir.org/2024/1/e50219 %U https://doi.org/10.2196/50219 %U http://www.ncbi.nlm.nih.gov/pubmed/38639994 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55132 %T The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study %A Fan,Qiping %A Hoang,Minh-Nguyet %A DuBose,Logan %A Ory,Marcia G %A Vennatt,Jeswin %A Salha,Diana %A Lee,Shinduk %A Falohun,Tokunbo %+ Department of Public Health Sciences, Clemson University, 524 Edwards Hall, 201 Epsion Zeta Drive, Clemson, SC, 29634, United States, 1 864 656 3841, qipingfan0403@gmail.com %K evaluation %K usability %K family caregiver %K Alzheimer disease %K dementia %K digital health %K mobile phone %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The increasing prevalence of Alzheimer disease and Alzheimer disease–related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care. Objective: This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers. Methods: For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics. Results: Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ≥50 years (25/30, 83%), women (23/30, 77%), White (25/30, 83%), and financially stable (20/30, 67%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90% (27/30) rated the app overall positively. Most of the participants (21/30, 70%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration. Conclusions: The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population. %M 38630527 %R 10.2196/55132 %U https://aging.jmir.org/2024/1/e55132 %U https://doi.org/10.2196/55132 %U http://www.ncbi.nlm.nih.gov/pubmed/38630527 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54214 %T Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach %A Sobrinho,Andressa Crystine da Silva %A Gomes,Grace Angelica de Oliveira %A Bueno Júnior,Carlos Roberto %+ Faculty of Medicine of the University of São Paulo, Bandeirantes Avenue 9000, Ribeirão Preto, 14055-230, Brazil, 55 16988155152, andressa.sobrinho@usp.br %K information and communications technologies %K ICTs %K health care %K digital inclusion %K focus groups %K health promotion %K user %K usability %K health literacy %K digital competencies %K digital skills %K mobile phone %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeirão Prêto, São Paulo, Brazil, and involved 20 older adults of both genders who were aged ≥60 years and enrolled in the Physical Education Program for the Elderly at the University of São Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90% (18/20) of the participants owned smartphones. However, 20% (4/20) of the participants faced installation challenges and 30% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89% to 70.65%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. %M 38619865 %R 10.2196/54214 %U https://formative.jmir.org/2024/1/e54214 %U https://doi.org/10.2196/54214 %U http://www.ncbi.nlm.nih.gov/pubmed/38619865 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e45978 %T Factors That Influence Successful Adoption of Real-Time Location Systems for Use in a Dementia Care Setting: Mixed Methods Study %A Haslam-Larmer,Lynn %A Grigorovich,Alisa %A Shum,Leia %A Bianchi,Andria %A Newman,Kristine %A Iaboni,Andrea %A McMurray,Josephine %+ Lazaridis School of Business & Economics, Wilfrid Laurier University, 73 George St, Brantford, ON, N3T3Y3, Canada, 1 519 756 8228 ext 5649, jmcmurray@wlu.ca %K remote sensing technologies %K dementia %K real-time location systems %K Fit between Individuals, Tasks, and Technology framework %K FITT framework %K technology implementation %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Technology has been identified as a potential solution to alleviate resource gaps and augment care delivery in dementia care settings such as hospitals, long-term care, and retirement homes. There has been an increasing interest in using real-time location systems (RTLS) across health care settings for older adults with dementia, specifically related to the ability to track a person’s movement and location. Objective: In this study, we aimed to explore the factors that influence the adoption or nonadoption of an RTLS during its implementation in a specialized inpatient dementia unit in a tertiary care rehabilitation hospital. Methods: The study included data from a brief quantitative survey and interviews from a convenience sample of frontline participants. Our deductive analysis of the interview used the 3 categories of the Fit Between Individuals, Task, and Technology framework as follows: individual and task, individual and technology, and task and technology. The purpose of using this framework was to assess the quality of the fit between technology attributes and an individual’s self-reported intentions to adopt RTLS technology. Results: A total of 20 health care providers (HCPs) completed the survey, of which 16 (80%) participated in interviews. Coding and subsequent analysis identified 2 conceptual subthemes in the individual-task fit category, including the identification of the task and the perception that participants were missing at-risk patient events. The task-technology fit category consisted of 3 subthemes, including reorganization of the task, personal control in relation to the task, and efficiency or resource allocation. A total of 4 subthemes were identified in the individual-technology fit category, including privacy and personal agency, trust in the technology, user interfaces, and perceptions of increased safety. Conclusions: By the end of the study, most of the unit’s HCPs were using the tablet app based on their perception of its usefulness, its alignment with their comfort level with technology, and its ability to help them perform job responsibilities. HCPs perceived that they were able to reduce patient search time dramatically, yet any improvements in care were noted to be implied, as this was not measured. There was limited anecdotal evidence of reduced patient risk or adverse events, but greater reported peace of mind for HCPs overseeing patients’ activity levels. %M 38587884 %R 10.2196/45978 %U https://aging.jmir.org/2024/1/e45978 %U https://doi.org/10.2196/45978 %U http://www.ncbi.nlm.nih.gov/pubmed/38587884 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e48265 %T Performance Differences of a Touch-Based Serial Reaction Time Task in Healthy Older Participants and Older Participants With Cognitive Impairment on a Tablet: Experimental Study %A Mychajliw,Christian %A Holz,Heiko %A Minuth,Nathalie %A Dawidowsky,Kristina %A Eschweiler,Gerhard Wilhelm %A Metzger,Florian Gerhard %A Wortha,Franz %+ Geriatric Center, University Hospital for Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, Tübingen, 72076, Germany, 49 07071 ext 2985358, christian.mychajliw@med.uni-tuebingen.de %K serial reaction time task %K SRTT %K implicit learning %K mobile digital assessments %K cognitive impairment %K neurodegeneration %K tablet-based testing %K mild cognitive impairment %K MCI %K dementia %K Alzheimer %K neuropsychology %K aging %K older individuals %D 2024 %7 21.3.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Digital neuropsychological tools for diagnosing neurodegenerative diseases in the older population are becoming more relevant and widely adopted because of their diagnostic capabilities. In this context, explicit memory is mainly examined. The assessment of implicit memory occurs to a lesser extent. A common measure for this assessment is the serial reaction time task (SRTT). Objective: This study aims to develop and empirically test a digital tablet–based SRTT in older participants with cognitive impairment (CoI) and healthy control (HC) participants. On the basis of the parameters of response accuracy, reaction time, and learning curve, we measure implicit learning and compare the HC and CoI groups. Methods: A total of 45 individuals (n=27, 60% HCs and n=18, 40% participants with CoI—diagnosed by an interdisciplinary team) completed a tablet-based SRTT. They were presented with 4 blocks of stimuli in sequence and a fifth block that consisted of stimuli appearing in random order. Statistical and machine learning modeling approaches were used to investigate how healthy individuals and individuals with CoI differed in their task performance and implicit learning. Results: Linear mixed-effects models showed that individuals with CoI had significantly higher error rates (b=−3.64, SE 0.86; z=−4.25; P<.001); higher reaction times (F1,41=22.32; P<.001); and lower implicit learning, measured via the response increase between sequence blocks and the random block (β=−0.34; SE 0.12; t=−2.81; P=.007). Furthermore, machine learning models based on these findings were able to reliably and accurately predict whether an individual was in the HC or CoI group, with an average prediction accuracy of 77.13% (95% CI 74.67%-81.33%). Conclusions: Our results showed that the HC and CoI groups differed substantially in their performance in the SRTT. This highlights the promising potential of implicit learning paradigms in the detection of CoI. The short testing paradigm based on these results is easy to use in clinical practice. %M 38512340 %R 10.2196/48265 %U https://aging.jmir.org/2024/1/e48265 %U https://doi.org/10.2196/48265 %U http://www.ncbi.nlm.nih.gov/pubmed/38512340 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49492 %T Using mHealth to Improve Communication in Adult Day Services Around the Needs of People With Dementia: Mixed Methods Assessment of Acceptability and Feasibility %A Zheng,Amy %A Bergh,Marissa %A Patel Murali,Komal %A Sadarangani,Tina %+ New York University Rory Meyers College of Nursing, 433 First Avenue, 6th Floor, New York, NY, 10010, United States, 1 212 998 5300, msb7677@nyu.edu %K adult day services %K primary health care %K health communication %K dementia %K mobile health %K mHealth %K community-based %K health care %K older adults %K older adult %K chronic condition %K health information %K feasibility %K acceptability %K CareMOBI %K mixed methods design %K caregivers %K caregiver %K care workers %K nurses %K social workers %D 2024 %7 1.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users’ health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers. Objective: This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting. Methods: A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption. Results: A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process. Conclusions: The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting. %M 38427418 %R 10.2196/49492 %U https://formative.jmir.org/2024/1/e49492 %U https://doi.org/10.2196/49492 %U http://www.ncbi.nlm.nih.gov/pubmed/38427418 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e47472 %T Investigating the Integration and the Long-Term Use of Smart Speakers in Older Adults’ Daily Practices: Qualitative Study %A Chang,Fangyuan %A Sheng,Lin %A Gu,Zhenyu %+ Interaction Design Lab, School of Design, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China, 86 13167232872, zygu@sjtu.edu.cn %K smart speaker %K private home %K older adults %K long-term use %K daily practices %K smart speakers %D 2024 %7 12.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As smart speakers become more popular, there have been an increasing number of studies on how they may benefit older adults or how older adults perceive them. Despite the increasing ownership rates of smart speakers among older adults, studies that examine their integration and the long-term use in older adults’ daily practices are scarce. Objective: This study aims to uncover the integration of smart speakers into the daily practices of older adults over the long term, contributing to an in-depth understanding of maintained technology use among this demographic. Methods: To achieve these objectives, the study interviewed 20 older adults who had been using smart speakers for over 6 months. These semistructured interviews enabled participants to share their insights and experiences regarding the maintained use of smart speakers in the long term. Results: We identified 4 dimensions of the long-term use of smart speakers among older adults, including functional integration, spatial integration, cognitive integration, and semantic integration. For the functional integration of smart speakers, the study reported different types of use, including entertainment, information collection, medication reminders, companionship, environment modification, and emergency calls. For the spatial integration of smart speakers, the study showed older adults’ agency in defining, changing, and reshaping daily practices through the spatial organization of smart speakers. For the cognitive integration of smart speakers, the findings showed the cognitive processes involved in adapting to and incorporating smart speakers into daily habits and routines. For the semantic integration of smart speakers, the findings revealed that older adults’ enjoyable user experience and strong bonds with the device contributed to their acceptance of occasional functional errors. Finally, the study proposed several suggestions for designers and developers to better design smart speakers that promote maintainable use behaviors among older adults. Conclusions: On the basis of the findings, this study highlighted the importance of understanding how older adults use smart speakers and the practices through which they integrate them into their daily routines. The findings suggest that smart speakers can provide significant benefits for older adults, including increased convenience and improved quality of life. However, to promote maintainable use behaviors, designers and developers should consider more about the technology use contexts and the specific needs and preferences of older adults when designing these devices. %M 38345844 %R 10.2196/47472 %U https://mhealth.jmir.org/2024/1/e47472 %U https://doi.org/10.2196/47472 %U http://www.ncbi.nlm.nih.gov/pubmed/38345844 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54299 %T Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App %A Young,Stephanie Ruth %A Dworak,Elizabeth McManus %A Byrne,Greg Joseph %A Jones,Callie Madison %A Yao,Lihua %A Yoshino Benavente,Julia Noelani %A Diaz,Maria Varela %A Curtis,Laura %A Gershon,Richard %A Wolf,Michael %A Nowinski,Cindy J %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue 21st Floor, Chicago, IL, 60611-3008, United States, 1 3125033303, stephanieruth.young@northwestern.edu %K cognitive screening %K cognitive %K cognition %K psychometric %K usability %K feasibility %K early detection %K dementia %K Alzheimer’s disease, Alzheimer's %K Alzheimer’s disease and age-related dementia %K mHealth, mobile health apps %K detection %K screening %K mobile health %K mobile phone %K app %K apps %K applications %K applications %K user experience %K smartphone %K smartphones %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 %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians’ ability to conduct screenings. MyCog Mobile is a newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics’ time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile. Research questions included (1) Can older adults complete MyCog Mobile remotely without staff support? (2) Are the internal consistency and test-retest reliability of the measures acceptable? and (3) How do participants rate the user experience of MyCog Mobile? Methods: A sample of adults aged 65 years and older (N=51) self-administered the MyCog Mobile measures remotely on their smartphones twice within a 2- to 3-week interval. The pilot version of MyCog Mobile includes 4 activities: MyFaces measures facial memory, MySorting measures executive functioning, MySequences measures working memory, and MyPictures measures episodic memory. After their first administration, participants also completed a modified version of the Simplified System Usability Scale (S-SUS) and 2 custom survey items. Results: All participants in the sample passed the practice items and completed each measure. Findings indicate that the Mobile Toolbox assessments measure the constructs well (internal consistency 0.73 to 0.91) and are stable over an approximately 2-week delay (test-retest reliability 0.61 to 0.71). Participants’ rating of the user experience (mean S-SUS score 73.17, SD 19.27) indicated that older adults found the usability of MyCog Mobile to be above average. On free-response feedback items, most participants provided positive feedback or no feedback at all, but some indicated a need for clarity in certain task instructions, concerns about participants’ abilities, desire to be able to contact a support person or use in-app technical support, and desire for additional practice items. Conclusions: Pilot evidence suggests that the MyCog Mobile cognitive screener can be reliably self-administered by older adults on their smartphones. Participants in our study generally provided positive feedback about the MyCog Mobile experience and rated the usability of the app highly. Based on participant feedback, we will conduct further usability research to improve support functionality, optimize task instructions and practice opportunities, and ensure that patients feel comfortable using MyCog Mobile. The next steps include a clinical validation study that compares MyCog Mobile to gold-standard assessments and tests the sensitivity and specificity of the measures for identifying dementia. %M 38324368 %R 10.2196/54299 %U https://formative.jmir.org/2024/1/e54299 %U https://doi.org/10.2196/54299 %U http://www.ncbi.nlm.nih.gov/pubmed/38324368 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e52117 %T Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic %A McDermott,Katherine %A Levey,Nadine %A Brewer,Julie %A Ehmann,Madison %A Hooker,Julia E %A Pasinski,Roger %A Yousif,Neda %A Raju,Vidya %A Gholston,Milton %A Greenberg,Jonathan %A Ritchie,Christine S %A Vranceanu,Ana-Maria %+ Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, 02114, United States, 1 617 724 4977, avranceanu@mgh.harvard.edu %K chronic pain %K mind-body %K underserved %K musculoskeletal pain %K pain %K older adults %K pain management %K feasibility %K intervention %D 2023 %7 29.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). Objective: We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. Methods: We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function—self-reported, performance based (6-minute walk test), and objective (step count)—and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). Results: We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. Conclusions: We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. Trial Registration: ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231 International Registered Report Identifier (IRRID): DERR1-10.2196/52117 %M 38157234 %R 10.2196/52117 %U https://www.researchprotocols.org/2023/1/e52117 %U https://doi.org/10.2196/52117 %U http://www.ncbi.nlm.nih.gov/pubmed/38157234 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e52410 %T mHealth Technology Experiences of Middle-Aged and Older Individuals With Visual Impairments: Cross-Sectional Interview Study %A Choi,Soyoung %A Sajib,Md Refat Uz Zaman %A Manzano,Jenna %A Chlebek,Christian Joseph %+ Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 272 Freer Hall, 906 South Goodwin Avenue, Urbana, IL, 61801-3028, United States, 1 2174024128, soyoung@illinois.edu %K aging %K mobile health %K older adults %K technology %K visual impairment %K wearables %K wearable %K vision %K visual %K qualitative analysis %K health behavior %K mHealth %K mHealth technology %K digital technology %K medical application %K application %K app %K applications %K usage %K well-being %K cross-section interview %K interview %K interviews %K tracking %K health data %K symptom monitoring %K monitor %K monitoring %K symptom %K symptoms %K physical activity %K walking %K routine %K mobile phone %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Current mobile health (mHealth) technology is predominantly designed with a visual orientation, often resulting in user interfaces that are inaccessible to visually impaired users. While mHealth technology offers potential for facilitating chronic illness management and enhancing health behaviors among visually impaired older populations, understanding its usage remains limited. Objective: This qualitative research aimed to explore the mHealth technology experiences of middle-aged and older individuals with visual impairments including the accessibility and usability issues they faced. Methods: The qualitative exploration was structured using the mHealth for Older Users framework. Cross-sectional interviews were conducted via Zoom between June 1 and July 31, 2023, using an interview protocol for data collection. A thematic analysis approach was employed to analyze the transcribed interview scripts. Results: Of the 7 participants who took part in the Zoom interviews, 3 were men and 4 were women, with ages ranging from 53 to 70 years. Most participants adopted mHealth apps and wearable devices for promoting health. They exhibited 3 distinct adoption patterns. Seven themes were emerged from the perceived challenges in using mHealth technologies: (1) a scarcity of accessible user manuals, (2) user interfaces that are not visually impaired-friendly, (3) health data visualizations that are not accessible, (4) unintuitive arrangement of app content, (5) health information that is challenging to comprehend, (6) cognitive overload caused by an excess of audible information, and (7) skepticism regarding the accuracy of health records. mHealth technologies seem to positively affect the health and health management of participants. Conclusions: Design considerations for mHealth technologies should consider individuals’ disabilities and chronic conditions and should emphasize the importance of providing accessible manuals and training opportunities when introducing new mHealth solutions. %M 38145472 %R 10.2196/52410 %U https://formative.jmir.org/2023/1/e52410 %U https://doi.org/10.2196/52410 %U http://www.ncbi.nlm.nih.gov/pubmed/38145472 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e50990 %T Key Features of Smart Medication Adherence Products: Updated Scoping Review %A Faisal,Sadaf %A Samoth,Devine %A Aslam,Yusra %A Patel,Hawa %A Park,SooMin %A Baby,Bincy %A Patel,Tejal %+ School of Pharmacy, University of Waterloo, 10 Victoria St. S, Kitchener, ON, N2G 1C5, Canada, 1 519 888 4567 ext 21337, T5patel@uwaterloo.ca %K technology %K medication %K aging %K adherence %K smart medication %K digital technology %K self-management %K older adult %K mobile health %K mHealth %K apps %K digital health %K geriatrics %K older adults %K mHealth app %K application %K management %K scoping review %K medication adherence %K consumer %K use %K mobile phone %D 2023 %7 19.12.2023 %9 Review %J JMIR Aging %G English %X Background: Older adults often face challenges in self-managing their medication owing to physical and cognitive limitations, complex medication regimens, and packaging of medications. Emerging smart medication dispensing and adherence products (SMAPs) offer the options of automated dispensing, tracking medication intake in real time, and reminders and notifications. A 2021 review identified 51 SMAPs owing to the rapid influx of digital technology; an update to this review is required. Objective: This review aims to identify new products and summarize and compare the key features of SMAPs. Methods: Gray and published literature and videos were searched using Google, YouTube, PubMed, Embase, and Scopus. The first 10 pages of Google and the first 100 results of YouTube were screened using 4 and 5 keyword searches, respectively. SMAPs were included if they were able to store and allowed for the dispensation of medications, tracked real-time medication intake data, and could automatically analyze data. Products were excluded if they were stand-alone software applications, not marketed in English, not for in-home use, or only used in clinical trials. In total, 5 researchers independently screened and extracted the data. Results: This review identified 114 SMAPs, including 80 (70.2%) marketed and 34 (29.8%) prototypes, grouped into 15 types. Among the marketed products, 68% (54/80) were available for consumer purchase. Of these products, 26% (14/54) were available worldwide and 78% (42/54) were available in North America. There was variability in the hardware, software, data collection and management features, and cost of the products. Examples of hardware features include battery life, medication storage capacity, availability of types and number of alarms, locking features, and additional technology required for use of the product, whereas software features included reminder and notification capabilities and availability of manufacturer support. Data capture methods included the availability of sensors to record the use of the product and data-syncing capabilities with cloud storage with short-range communications. Data were accessible to users via mobile apps or web-based portals. Some SMAPs provided data security assurance with secure log-ins (use of personal identification numbers or facial recognition), whereas other SMAPs provided data through registered email addresses. Although some SMAPs were available at set prices or free of cost to end users, the cost of other products varied based on availability, shipping fees, and subscription fees. Conclusions: An expanding market for SMAPs with features specific to at-home patient use is emerging. Health care professionals can use these features to select and suggest products that meet their patients’ unique requirements. %M 38113067 %R 10.2196/50990 %U https://aging.jmir.org/2023/1/e50990 %U https://doi.org/10.2196/50990 %U http://www.ncbi.nlm.nih.gov/pubmed/38113067 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46188 %T Researched Apps Used in Dementia Care for People Living With Dementia and Their Informal Caregivers: Systematic Review on App Features, Security, and Usability %A Ye,Bing %A Chu,Charlene H %A Bayat,Sayeh %A Babineau,Jessica %A How,Tuck-Voon %A Mihailidis,Alex %+ Occupational Science and Occupational Therapy, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada, 1 416 597 3422 ext 7910, bing.ye@utoronto.ca %K mobile technologies %K mobile apps %K dementia %K privacy %K security %K usability testing %K informal caregivers %K mobile phone %D 2023 %7 12.10.2023 %9 Review %J J Med Internet Res %G English %X Background: Studies have shown that mobile apps have the potential to serve as nonpharmacological interventions for dementia care, improving the quality of life of people living with dementia and their informal caregivers. However, little is known about the needs for and privacy aspects of these mobile apps in dementia care. Objective: This review seeks to understand the landscape of existing mobile apps in dementia care for people living with dementia and their caregivers with respect to app features, usability testing, privacy, and security. Methods: ACM Digital Library, Cochrane Central Register of Controlled Trials, Compendex, Embase, Inspec, Ovid MEDLINE, PsycINFO, and Scopus were searched. Studies were included if they included people with dementia living in the community, their informal caregivers, or both; focused on apps in dementia care using smartphones or tablet computers; and covered usability evaluation of the app. Records were independently screened, and 2 reviewers extracted the data. The Centre for Evidence-Based Medicine critical appraisal tool and Mixed Methods Appraisal Tool were used to assess the risk of bias in the included studies. Thematic synthesis was used, and the findings were summarized and tabulated based on each research aim. Results: Overall, 44 studies were included in this review, with 39 (89%) published after 2015. In total, 50 apps were included in the study, with more apps developed for people living with dementia as end users compared with caregivers. Most studies (27/44, 61%) used tablet computers. The most common app feature was cognitive stimulation. This review presented 9 app usability themes: user interface, physical considerations, screen size, interaction challenges, meeting user needs, lack of self-awareness of app needs, stigma, technological inexperience, and technical support. In total, 5 methods (questionnaires, interviews, observations, logging, and focus groups) were used to evaluate usability. There was little focus on the privacy and security aspects, including data transfer and protection, of mobile apps for people living with dementia. Conclusions: The limitations of this review include 1 reviewer conducting the full-text screening, its restriction to studies published in English, and the exclusion of apps that lacked empirical usability testing. As a result, there may be an incomplete representation of the available apps in the field of dementia care. However, this review highlights significant concerns related to the usability, privacy, and security of existing mobile apps for people living with dementia and their caregivers. The findings of this review provide a valuable framework to guide app developers and researchers in the areas of privacy policy development, app development strategies, and the importance of conducting thorough usability testing for their apps. By considering these factors, future work in this field can be advanced to enhance the quality and effectiveness of dementia care apps. Trial Registration: PROSPERO CRD42020216141; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216141 International Registered Report Identifier (IRRID): RR2-10.1159/000514838 %M 37824187 %R 10.2196/46188 %U https://www.jmir.org/2023/1/e46188 %U https://doi.org/10.2196/46188 %U http://www.ncbi.nlm.nih.gov/pubmed/37824187 %0 Journal Article %@ 2561-7605 %I %V 6 %N %P e44525 %T Evaluating the Acceptability and Appropriateness of the Augmented Reality Home Assessment Tool (ARHAT): Qualitative Descriptive Study %A Fields,Beth %A Fitzpatrick,McKenzie %A Kinney,Lauryn %A Lee,Jenny %A Sprecher,Bryce %A Tredinnick,Ross %A Ponto,Kevin %A Shin,Jung-hye %K technology %K aging in place %K augmented reality %K home modification %K mobile %K assessment %K mobile application %K qualitative study %K environmental barrier %D 2023 %7 27.9.2023 %9 %J JMIR Aging %G English %X Background: The Augmented Reality Home Assessment Tool (ARHAT) is a mobile app developed to provide rapid, highly accurate assessments of the home environment. It uses 3D-capture technologies to help people identify and address functional limitations and environmental barriers. Objective: This study was conducted to gain stakeholder feedback on the acceptability and appropriateness of the ARHAT for identifying and addressing barriers within home environments. Methods: A qualitative descriptive study was conducted because it allows for variability when obtaining data and seeks to understand stakeholders’ insights on an understudied phenomenon. Each stakeholder group (occupational therapists, housing professionals, and aging adult and caregiver “dyads”) participated in a 60-minute, web-based focus group via a secure Zoom platform. Focus group data were analyzed by 2 trained qualitative research team members using a framework method for analysis. Results: A total of 19 stakeholders, aged from 18 to 85+ years, were included in the study. Of the occupational therapists (n=5, 26%), housing professionals (n=3, 16%), and dyads (n=11, 58%), a total of 32% (n=6) were male and 68% (n=13) were female, with most living in the Midwestern United States (n=10, 53%). The focus group data demonstrate the acceptability and appropriateness of the workflow, style, measurement tools, and impact of the ARHAT. All stakeholders stated that they could see the ARHAT being used at many different levels and by any population. Dyads specifically mentioned that the ARHAT would allow them to do forward planning and made them think of home modifications in a new light. Conclusions: Stakeholders found the ARHAT to be acceptable and appropriate for identifying and addressing functional limitations and barriers in the home environment. This study highlights the importance of considering the workflow, style, measurement tools, and potential impact of home assessment technology early in the developmental process. %R 10.2196/44525 %U https://aging.jmir.org/2023/1/e44525 %U https://doi.org/10.2196/44525 %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 %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43186 %T Design Guidelines of Mobile Apps for Older Adults: Systematic Review and Thematic Analysis %A Gomez-Hernandez,Miguel %A Ferre,Xavier %A Moral,Cristian %A Villalba-Mora,Elena %+ Center for Biomedical Technology, Universidad Politécnica de Madrid, Campus Montegancedo, Pozuelo de Alarcón, 28223, Spain, 34 91067925, xavier.ferre@upm.es %K tablet %K smartphone %K older user %K design recommendations %K usability testing %K user experience design %K UX design %K design %K mobile app %K tool %K quality of life %K software %K training %K visual design %K older adults %K mobile phone %D 2023 %7 21.9.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are fundamental tools in today’s society for practical and social endeavors. However, these technologies are often not usable for older users. Given the increased use of mobile apps by this group of users and the impact that certain services may have on their quality of life, such as mobile health, personal finance, or online administrative procedures, a clear set of guidelines for mobile app designers is needed. Existing recommendations for older adults focus on investigations with certain groups of older adults or have not been extracted from experimental results. Objective: In this research work, we systematically reviewed the scientific literature that provided recommendations for the design of mobile apps based on usability testing with older adults and organized such recommendations into a meaningful set of design guidelines. Methods: We conducted a systematic literature review of journal and conference articles from 2010 to 2021. We included articles that carried out usability tests with populations aged >60 years and presented transferable guidelines on mobile software design, resulting in a final set of 40 articles. We then carried out a thematic analysis with 3 rounds of analysis to provide meaning to an otherwise diverse set of recommendations. At this stage, we discarded recommendations that were made by just 1 article, were based on a specific mobile app and were therefore nontransferrable, were based on other authors’ literature (as opposed to recommendations based on the results of usability tests), or were not sufficiently argued. With the remaining recommendations, we identified commonalities, wrote a faithful statement for each guideline, used a common language for the entire set, and organized the guidelines into categories, thereby giving shape to an otherwise diverse set of recommendations. Results: Among the 27 resulting guidelines, the rules Simplify and Increase the size and distance between interactive controls were transversal and of the greatest significance. The rest of the guidelines were divided into 5 categories (Help & Training, Navigation, Visual Design, Cognitive Load, and Interaction) and consequent subcategories in Visual Design (Layout, Icons, and Appearance) and Interaction (Input and Output). The recommendations were structured, explained in detail, and illustrated with applied examples extracted from the selected studies, where appropriate. We discussed the design implications of applying these guidelines, contextualized with relevant studies. We also discussed the limitations of the approach followed, stressing the need for further experimentation to gain a better understanding of how older adults use mobile apps and how to better design such apps with these users in mind. Conclusions: The compiled guidelines support the design of mobile apps that cater to the needs of older adults because they are based on the results of actual usability tests with users aged >60 years. %M 37733401 %R 10.2196/43186 %U https://mhealth.jmir.org/2023/1/e43186 %U https://doi.org/10.2196/43186 %U http://www.ncbi.nlm.nih.gov/pubmed/37733401 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e46480 %T A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study %A Krafft,Jelena %A Barisch-Fritz,Bettina %A Krell-Roesch,Janina %A Trautwein,Sandra %A Scharpf,Andrea %A Woll,Alexander %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721 608 ext 48513, jelena.krafft@kit.edu %K dementia %K individualized physical exercise %K tailored exercise %K physical activity %K older adults %K app %K mobile health %K mHealth %K usability %K mobile phone %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Aging %G English %X Background: The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia. Objective: This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach. Methods: Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively. Results: A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as “good.” The main usability issues concerned navigation logic and comprehensibility of app content. Conclusions: The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ≥50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study. %M 37606974 %R 10.2196/46480 %U https://aging.jmir.org/2023/1/e46480 %U https://doi.org/10.2196/46480 %U http://www.ncbi.nlm.nih.gov/pubmed/37606974 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42017 %T Assessment of Frailty by the French Version of the Vulnerable Elders Survey-13 on Digital Tablet: Validation Study %A Zolnowski-Kolp,Victoria %A Um Din,Nathavy %A Havreng-Théry,Charlotte %A Pariel,Sylvie %A Veyron,Jacques-Henri %A Lafuente-Lafuente,Carmelo %A Belmin,Joel %+ LivingLab Pratiques en santé dans le grand âge, Hôpital Charles Foix, 7 avenue de la République, Ivry-sur-Seine, 94200, France, 33 0149594565, j.belmin@aphp.fr %K frailty %K Vulnerable Elders Survey-13 (VES-13) %K elderly %K older people %K family caregivers %K French version %K electronic assessment %K digital technology %K digital health %K eHealth %K tablet %K validity %D 2023 %7 2.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Frailty assessment is a major issue in geriatric medicine. The Vulnerable Elders Survey-13 (VES-13) is a simple and practical tool that identifies frailty through a 13-item questionnaire completed by older adults or their family caregivers by self-administration (pencil and paper) or by telephone interview. The VES-13 provides a 10-point score that is also a recognized mortality predictor. Objective: This study aims to design an electronic version of the Echelle de Vulnérabilité des Ainés-13, the French version of the VES-13 (eEVA-13) for use on a digital tablet and validate it. Methods: The scale was implemented as a web App in 3 different screens and used on an Android tablet (14.0× 25.6 cm). Participants were patients attending the outpatient clinic of a French geriatric hospital or hospitalized in a rehabilitation ward and family caregivers of geriatric patients. They completed the scale twice, once by a reference method (self-administered questionnaire or telephone interview) and once by eEVA-13 using the digital tablet. Agreement for diagnosis of frailty was assessed with the κ coefficient, and scores were compared by Bland and Altman plots and interclass correlation coefficients. User experience was assessed by a self-administered questionnaire. Results: In total, 86 participants, including 40 patients and 46 family caregivers, participated in the study. All family caregivers had previously used digital devices, while 13 (32.5%) and 10 (25%) patients had no or infrequent use of them previously. We observed no failure to complete the eEVA-13, and 70% of patients (28/40) and no family caregivers needed support to complete the eEVA-13. The agreement between the eEVA-13 and the reference method for the diagnosis of frailty was excellent (κ=0.92) with agreement in 83 cases and disagreement in 3 cases. The mean difference between the scores provided by the 2 scales was 0.081 (95% CI–1.263 to 1.426). Bland and Altman plots showed a high level of agreement between the eEVA-13 and the reference methods and interclass correlation coefficient value was 0.997 (95% CI 0.994-0.998) for the paper and tablet group and 0.977 (95% CI 0.957-0.988) for the phone and tablet groups. The tablet assessment was found to be easy to use by 77.5% (31/40) of patients and by 96% (44/46) of caregivers. Finally, 85% (39/46) of family caregivers and 50% (20/40) of patients preferred the eEVA-13 to the original version. Conclusions: The eEVA-13 is an appropriate digital tool for diagnosing frailty and can be used by older adults and their family caregivers. The scores obtained with eEVA-13 are highly correlated with those obtained with the original version. The use of health questionnaires on digital tablets is feasible in frail and very old patients, although some patients may need help to use them. %M 37531175 %R 10.2196/42017 %U https://www.jmir.org/2023/1/e42017 %U https://doi.org/10.2196/42017 %U http://www.ncbi.nlm.nih.gov/pubmed/37531175 %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 %@ 2561-7605 %I JMIR Publications %V 6 %N %P e41429 %T Factors Predicting Older People’s Acceptance of a Personalized Health Care Service App and the Effect of Chronic Disease: Cross-Sectional Questionnaire Study %A Koo,Jun Hyuk %A Park,You Hyun %A Kang,Dae Ryong %+ Department of Precision Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426, Republic of Korea, 82 33 741 0391, dr.kang@yonsei.ac.kr %K environmental risk factor %K personalized health care service app %K chronic disease %K unified theory of acceptance and use of technology %K structural equation modeling %K older adult %K acceptance %K adoption %K technology use %K mHealth %K mobile health %K mobile app %K health app %K gerontology %K personalized %K health care service %K intention to use %D 2023 %7 21.6.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Mobile health (mHealth) services enable real-time measurement of information on individuals’ biosignals and environmental risk factors; accordingly, research on health management using mHealth is being actively conducted. Objective: The study aims to identify the predictors of older people’s intention to use mHealth in South Korea and verify whether chronic disease moderates the effect of the identified predictors on behavioral intentions. Methods: A cross-sectional questionnaire study was conducted among 500 participants aged 60 to 75 years. The research hypotheses were tested using structural equation modeling, and indirect effects were verified through bootstrapping. Bootstrapping was performed 10,000 times, and the significance of the indirect effects was confirmed through the bias-corrected percentile method. Results: Of 477 participants, 278 (58.3%) had at least 1 chronic disease. Performance expectancy (β=.453; P=.003) and social influence (β=.693; P<.001) were significant predictors of behavioral intention. Bootstrapping results showed that facilitating conditions (β=.325; P=.006; 95% CI 0.115-0.759) were found to have a significant indirect effect on behavioral intention. Multigroup structural equation modeling testing the presence or absence of chronic disease revealed a significant difference in the path of device trust to performance expectancy (critical ratio=–2.165). Bootstrapping also confirmed that device trust (β=.122; P=.039; 95% CI 0.007-0.346) had a significant indirect effect on behavioral intention in people with chronic disease. Conclusions: This study, which explored the predictors of the intention to use mHealth through a web-based survey of older people, suggests similar results to those of other studies that applied the unified theory of acceptance and use of technology model to the acceptance of mHealth. Performance expectancy, social influence, and facilitating conditions were revealed as predictors of accepting mHealth. In addition, trust in a wearable device for measuring biosignals was investigated as an additional predictor in people with chronic disease. This suggests that different strategies are needed, depending on the characteristics of users. %M 37342076 %R 10.2196/41429 %U https://aging.jmir.org/2023/1/e41429 %U https://doi.org/10.2196/41429 %U http://www.ncbi.nlm.nih.gov/pubmed/37342076 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41919 %T Use and Acceptance of Smart Elderly Care Apps Among Chinese Medical Staff and Older Individuals: Web-Based Hybrid Survey Study %A Zhu,Jieting %A Weng,Huiting %A Ou,Peng %A Li,Lezhi %+ Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, China, 86 0731 85295888, lilezhi@csu.edu.cn %K smart elderly care app %K mobile health %K smartphone %D 2023 %7 13.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: With the advent of China’s aging population and the popularization of smartphones, there is a huge demand for smart elderly care apps. Along with older adults and their dependents, medical staff also need to use a health management platform to manage the health of patients. However, the development of health apps and the large and growing app market pose a problem of declining quality; in fact, important differences can be observed between apps, and patients currently do not have adequate information and formal evidence to discriminate among them. Objective: The aim of this study was to investigate the cognition and usage status of smart elderly care apps among older individuals and medical staff in China. Methods: From March 1, 2022, to March 30, 2022, we used the web survey tool Sojump to conduct snowball sampling through WeChat. The survey links were initially sent to communities in 23 representative major cities in China. We asked the medical staff of community clinics to post the survey link on their WeChat Moments. From April 1 to May 10, 2022, we contacted those who selected “Have used a smart elderly care app” in the questionnaire through WeChat for a request to participate in semistructured interviews. Participants provided informed consent in advance and interviews were scheduled. After the interviews, the audio recordings were transcribed into text and the emerging themes were analyzed and summarized. Results: A total of 810 individuals participated in this study, 54.8% (n=444) of whom were medical staff, 33.1% (n=268) were older people, and the remaining participants were certified nursing assistants (CNAs) and community workers. Overall, 60.5% (490/810) of the participants had used a smart elderly care app on their smartphone. Among the 444 medical staff who participated in the study, the vast majority (n=313, 70.5%) had never used a smart elderly care app, although 34.7% of them recommended elderly care–related apps to patients. Among the 542 medical staff, CNAs, and community workers that completed the questionnaire, only 68 (12.6%) had used a smart elderly care app. We further interviewed 23 people about their feelings and opinions about smart elderly care apps. Three themes emerged with eight subthemes, including functional design, operation interface, and data security. Conclusions: In this survey, there was a huge difference in the usage rate and demand for smart elderly care apps by the participants. Respondents are mainly concerned with app function settings, interface simplicity, and data security. %M 37310777 %R 10.2196/41919 %U https://formative.jmir.org/2023/1/e41919 %U https://doi.org/10.2196/41919 %U http://www.ncbi.nlm.nih.gov/pubmed/37310777 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e46976 %T Older Adults’ Pain Outcomes After mHealth Interventions: Scoping Review %A Shade,Marcia %A Kovaleva,Mariya %A Harp,Kimberly %A Martin-Hammond,Aqueasha %+ College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198, United States, 1 402 559 6641, marcia.shade@unmc.edu %K mHealth %K older adults %K pain %K self-management %K pain management %K mobile health %K musculoskeletal pain %K scoping review %K pain outcomes %K mobile phone %D 2023 %7 31.5.2023 %9 Review %J JMIR Aging %G English %X Background: Pain is prevalent and poorly managed in older adults. Although pain self-management strategies are helpful, adoption and access are limited; thus, technology provides an opportunity for intervention delivery. Mobile health (mHealth) is feasible to use in older adults; however, we have yet to understand the effect of mHealth pain self-management interventions on pain outcomes in older adults. Objective: The purpose of this scoping review is to examine the characteristics of mHealth interventions and their efficacy on pain outcomes in older adults with musculoskeletal pain. Methods: With the assistance of a medical librarian, keywords and subject headings were generated, including but not limited to mobile health application, mHealth, digital, pain, pain management, and older. A search was conducted for papers in journal databases, including PubMed, Embase, CINAHL, Scopus, and IEEE Xplore, between 2000 and 2022. Papers were screened according to predetermined inclusion and exclusion criteria, and reference lists were reviewed for additional paper inclusion. Three authors appraised the methodology of papers independently, then collaboratively to synthesize the evidence. Results: Six publications were included in the scoping review. The design and methodology ranged widely from pilot studies to a comparative effectiveness trial. Older participants in the studies reported a variety of musculoskeletal conditions. Delivery of the mHealth pain self-management interventions incorporated mobile devices, such as a smartphone or tablet. Most mHealth-delivered interventions were multicomponent and incorporated elements of in-person and telephone access to an interventionist. The findings suggested mHealth interventions may reduce pain intensity; however, pain interference and other pain-related conditions did not have a statistically significant reduction. Conclusions: Research that has explored mHealth for pain self-management is beginning to move beyond feasibility. The few experimental studies conducted in older adults are heterogeneous, and the interventions are mostly multicomponent. It is premature to conclude the interventions’ significant effect on pain or pain-related symptoms. As technology continues to integrate into health care, more experimental research is warranted to examine the efficacy of mHealth interventions on a variety of pain outcomes in older adults. %M 37256667 %R 10.2196/46976 %U https://aging.jmir.org/2023/1/e46976 %U https://doi.org/10.2196/46976 %U http://www.ncbi.nlm.nih.gov/pubmed/37256667 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e43197 %T Understanding Older Adults’ Experiences With Technologies for Health Self-management: Interview Study %A Garcia Reyes,Elsy Paola %A Kelly,Ryan %A Buchanan,George %A Waycott,Jenny %+ School of Computing and Information Systems, Faculty of Engineering and Information Technology, The University of Melbourne, Parkville Victoria, Melbourne, 3010, Australia, 61 3 9035 5511, egarciareyes@student.unimelb.edu.au %K older adults %K technology %K health self-management %K motivator %K enabler %K barrier %D 2023 %7 21.3.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments. Objective: This study aimed to understand the types of technologies that older adults use to support their health and the factors that motivate them to use their chosen technologies to support their health. In addition, we aimed to understand the factors that enable the effective use of technologies for health self-management and to identify the barriers that can negatively affect the adoption of technologies. Methods: A total of 22 older adults participated in semistructured interviews regarding their experiences of using technologies for health self-management. Interview transcripts were analyzed through an in-depth thematic analysis. Results: The interviews revealed that a range of technologies, such as videoconferencing software, fitness trackers, and other devices, were being used by older adults to support their health. Interviews showed that participants were motivated to use technologies to monitor health issues, to stay active and connected, and to record and change their behavior in the light of foreseen risks related to their future health status. Enablers that facilitated the effective use of technologies include social and organizational influence, convenient access to health care and safety provided by the technology, and easy setup and low cost of the technology. Barriers include information overload and a sense of futility about future health decline; telehealth being an inadequate substitute for in-person consultation; concerns about trust related to privacy and accuracy; and technologies being stigmatizing, uncomfortable to use, expensive, and unfamiliar. Conclusions: This study suggested that older adults were using a variety of technologies to prevent or prepare for future health decline, evidencing a resilient attitude toward health and aging. In addition, older adults were willing to continue using the technology when there was a perceived need. The enabler mentioned by most participants was the social and organizational influence that included health care staff, family, friends, and organizations. This analysis provides a better understanding of how older adults use technologies to support their health and can guide the provision of appropriate health technologies for them. %M 36943333 %R 10.2196/43197 %U https://aging.jmir.org/2023/1/e43197 %U https://doi.org/10.2196/43197 %U http://www.ncbi.nlm.nih.gov/pubmed/36943333 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e44007 %T Developing a Memory and Communication App for Persons Living With Dementia: An 8-Step Process %A Brown,Ellen L %A Ruggiano,Nicole %A Allala,Sai Chaithra %A Clarke,Peter J %A Davis,Debra %A Roberts,Lisa %A Framil,C Victoria %A Muñoz,Maríateresa Teri Hernandez %A Hough,Monica Strauss %A Bourgeois,Michelle S %+ Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 SW 8th St, Office 226, Miami, FL, 33199, United States, 1 3053481312, ebrown@fiu.edu %K health technology %K interdisiplinary team %K older adults %K dementia %K communication %K communication aids for disabled persons %K communication boards %K app %K Alzheimer disease %K family %K caregiver %K clinical care %K development %K speech %K psychosocial intervention %K software design %D 2023 %7 15.3.2023 %9 Viewpoint %J JMIR Aging %G English %X According to the 2022 Alzheimer’s Association Facts and Figures, more than 6 million Americans have Alzheimer disease and related dementias. They are cared for by millions of family members, friends, or other unpaid caregivers. Communication deficits are common among persons with Alzheimer disease and related dementias and pose challenges to caregiving and clinical care, which is already complex. An interdisciplinary team developed a mobile app prototype to improve communications between people living with dementia and their caregivers and providers and to promote person-centered care. This viewpoint paper provides a road map for how the interdisciplinary team worked together to develop and plan for the implementation and evaluation of a new evidence-based app. In our paper, we provide an 8-step process used by a team of clinicians, researchers, and software engineers to develop a new app to meet the needs of people living with dementia and their caregiver(s). The planned clinical trial has been registered at ClinicalTrials.gov (NCT04571502; https://clinicaltrials.gov/ct2/show/NCT04571502).International Registered Report Identifier (IRRID): RR2-10.3928/19404921-20210825-02 %M 36920462 %R 10.2196/44007 %U https://aging.jmir.org/2023/1/e44007 %U https://doi.org/10.2196/44007 %U http://www.ncbi.nlm.nih.gov/pubmed/36920462 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e41322 %T Proactive and Ongoing Analysis and Management of Ethical Concerns in the Development, Evaluation, and Implementation of Smart Homes for Older Adults With Frailty %A Wang,Rosalie H %A Tannou,Thomas %A Bier,Nathalie %A Couture,Mélanie %A Aubry,Régis %+ Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada, 1 416 946 8566, rosalie.wang@utoronto.ca %K ethics %K older adults %K frailty %K smart home %K assistive technology %K aging in place %K ethical concerns %K implementation %K bioethics %K technology ethics %K autonomy %K privacy %K security %K informed consent %K support ecosystem %D 2023 %7 9.3.2023 %9 Viewpoint %J JMIR Aging %G English %X Successful adoption and sustained use of smart home technology can support the aging in place of older adults with frailty. However, the expansion of this technology has been limited, particularly by a lack of ethical considerations surrounding its application. This can ultimately prevent older adults and members of their support ecosystems from benefiting from the technology. This paper has 2 aims in the effort to facilitate adoption and sustained use: to assert that proactive and ongoing analysis and management of ethical concerns are crucial to the successful development, evaluation, and implementation of smart homes for older adults with frailty and to present recommendations to create a framework, resources, and tools to manage ethical concerns with the collaboration of older adults; members of their support ecosystems; and the research, technical development, clinical, and industry communities. To support our assertion, we reviewed intersecting concepts from bioethics, specifically principlism and ethics of care, and from technology ethics that are salient to smart homes in the management of frailty in older adults. We focused on 6 conceptual domains that can lead to ethical tensions and of which proper analysis is essential: privacy and security, individual and relational autonomy, informed consent and supported decision-making, social inclusion and isolation, stigma and discrimination, and equity of access. To facilitate the proactive and ongoing analysis and management of ethical concerns, we recommended collaboration to develop a framework with 4 proposed elements: a set of conceptual domains as discussed in this paper, along with a tool consisting of reflective questions to guide ethical deliberation throughout the project phases; resources comprising strategies and guidance for the planning and reporting of ethical analysis throughout the project phases; training resources to support leadership, literacy, and competency in project teams for the analysis and management of ethical concerns; and training resources for older adults with frailty, their support ecosystems, and the public to support their awareness and participation in teams and ethical analysis processes. Older adults with frailty require nuanced consideration when incorporating technology into their care because of their complex health and social status and vulnerability. Smart homes may have a greater likelihood of accommodating users and their contexts with committed and comprehensive analysis, anticipation, and management of ethical concerns that reflect the unique circumstances of these users. Smart home technology may then achieve its desired individual, societal, and economic outcomes and serve as a solution to support health; well-being; and responsible, high-quality care. %M 36892912 %R 10.2196/41322 %U https://aging.jmir.org/2023/1/e41322 %U https://doi.org/10.2196/41322 %U http://www.ncbi.nlm.nih.gov/pubmed/36892912 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42172 %T Digital Intervention in Loneliness in Older Adults: Qualitative Analysis of User Studies %A Stuart,Avelie %A Yan,Ronnie Jieru %A Harkin,Lydia Jo %A Katz,Dmitri %A Stevenson,Clifford %A Mehta,Vikram %A Giles,Emilie %A Talbot,Catherine %A Gooch,Daniel %A Bennasar,Mohamed %A Self,Tara %A Nuseibeh,Bashar %A Price,Blaine %+ Computing and Communications, The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 1908653545, blaine.price@open.ac.uk %K loneliness %K older adults %K digital connections %K reflection %K social identity %K user-centered design %K social network %K well-being apps %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Loneliness is a significant well-being issue that affects older adults. Existing, commonly used social connection platforms do not contain facilities to break the cognitive cycle of loneliness, and loneliness interventions implemented without due processes could have detrimental effects on well-being. There is also a lack of digital technology designed with older adults. Objective: We aimed to iteratively design a user-centered smartphone app that can address loneliness in older adults. The aim of this study was to investigate the loneliness-related psychological processes that our conceptual smartphone app promotes. We also identified the emergent needs and concerns that older adults raised regarding the potential benefits and detriments of the app. Methods: We used technology probes to elicit older adults’ reflections on the concept of using the app in 2 studies as follows: concept focus groups (n=33) and concept interviews (n=10). We then conducted a prototype trial with 1 week of use and follow-up interviews (n=12). Results: Thematic analysis explored the experiences and emergent challenges of our app through the design process. This led to the development of 4 themes as follows occurring in all 3 qualitative data sets: reflection on a digital social map is reassuring; app features encourage socializing; the risk of compounding loneliness; and individuals feel more control with mutual, socially beneficial activities. Conclusions: Smartphone apps have the potential to increase older adults’ awareness of the richness of their social connections, which may support loneliness reduction. Our qualitative approach to app design enabled the inclusion of older adults’ experiences in technology design. Thus, we conclude that the older adults in our study most desired functionalities that can support mutual activities and maintain or find new connections rather than enable them to share an emotional state. They were wary of the app replacing their preferred in-person social interaction. Participants also raised concerns about making the user aware of the lack of support in their social network and wanted specific means of addressing their needs. Further user-centered design work could identify how the app can support mutual activities and socializing. %M 36705962 %R 10.2196/42172 %U https://formative.jmir.org/2023/1/e42172 %U https://doi.org/10.2196/42172 %U http://www.ncbi.nlm.nih.gov/pubmed/36705962 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42416 %T Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation %A Young,Stephanie Ruth %A Lattie,Emily Gardiner %A Berry,Andrew B L %A Bui,Lynn %A Byrne,Greg Joseph %A Yoshino Benavente,Julia Noelani %A Bass,Michael %A Gershon,Richard C %A Wolf,Michael S %A Nowinski,Cindy J %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, Chicago, IL, 60611, United States, 1 (312) 503 1725, stephanieruth.young@northwestern.edu %K human-centered design %K mobile health %K mHealth %K usability %K cognitive screening %K older adults %K mobile phone %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Annual cognitive screening in adults aged >65 years can improve early detection of cognitive impairment, yet less than half of all cases are identified in primary care. Time constraints in primary care settings present a major barrier to routine screening. A remote cognitive screener completed on a patient’s own smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: We described the iterative design and proposed the implementation of a remote cognitive screening app, MyCog Mobile, to be completed on a patient’s smartphone before an annual wellness visit. The research questions were as follows: What would motivate primary care clinicians and clinic administrators to implement a remote cognitive screening process? How might we design a remote cognitive screener to fit well with existing primary care workflows? What would motivate an older adult patient to complete a cognitive screener on a smartphone before a primary care visit? How might we optimize the user experience of completing a remote cognitive screener on a smartphone for older adults? Methods: To address research questions 1 and 2, we conducted individual interviews with clinicians (n=5) and clinic administrators (n=3). We also collaborated with clinic administrators to create user journey maps of their existing and proposed MyCog Mobile workflows. To address research questions 3 and 4, we conducted individual semistructured interviews with cognitively healthy older adults (n=5) and solicited feedback from a community stakeholder panel (n=11). We also tested and refined high-fidelity prototypes of the MyCog Mobile app with the older adult interview participants, who rated the usability on the Simplified System Usability Scale and After-Scenario Questionnaire. Results: Clinicians and clinic administrators were motivated to adopt a remote cognitive screening process if it saved time in their workflows. Findings from interviews and user journey mapping informed the proposed implementation and core functionality of MyCog Mobile. Older adult participants were motivated to complete cognitive screeners to ensure that they were cognitively healthy and saw additional benefits to remote screening, such as saving time during their visit and privacy. Older adults also identified potential challenges to remote smartphone screening, which informed the user experience design of the MyCog Mobile app. The average rating across prototype versions was 91 (SD 5.18) on the Simplified System Usability Scale and 6.13 (SD 8.40) on the After-Scenario Questionnaire, indicating above-average usability. Conclusions: Through an iterative, human-centered design process, we developed a viable remote cognitive screening app and proposed an implementation strategy for primary care settings that was optimized for multiple stakeholders. The next steps include validating the cognitive screener in clinical and healthy populations and piloting the finalized app in a community primary care clinic. %M 36626223 %R 10.2196/42416 %U https://formative.jmir.org/2023/1/e42416 %U https://doi.org/10.2196/42416 %U http://www.ncbi.nlm.nih.gov/pubmed/36626223 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e41317 %T Preferences of Older Adult Veterans With Heart Failure for Engaging With Mobile Health Technology to Support Self-care: Qualitative Interview Study Among Patients With Heart Failure and Content Analysis %A Foster,Marva %A Xiong,Wei %A Quintiliani,Lisa %A Hartmann,Christine W %A Gaehde,Stephan %+ VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, 150 S Huntington Avenue, Boston, MA, 02130, United States, 1 857 203 6671, marva.foster@va.gov %K qualitative research %K heart failure %K self-care %K mobile health %K mobile health technology %K older adults %K elderly %K perceptions %K mhealth intervention %K veteran health %K mHealth technology %K elderly health care %K elderly self-care %D 2022 %7 20.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) affects approximately 6.5 million adults in the United States, disproportionately afflicting older adults. Mobile health (mHealth) has emerged as a promising tool to empower older adults in HF self-care. However, little is known about the use of this approach among older adult veterans. Objective: The goal of this study was to explore which features of an app were prioritized for older adult veterans with HF. Methods: Between January and July 2021, we conducted semistructured interviews with patients with heart failure aged 65 years and older at a single facility in an integrated health care system (the Veterans Health Administration). We performed content analysis and derived themes based on the middle-range theory of chronic illness, generating findings both deductively and inductively. The qualitative questions captured data on the 3 key themes of the theory: self-care maintenance, self-care monitoring, and self-care management. Qualitative responses were analyzed using a qualitative data management platform, and descriptive statistics were used to analyze demographic data. Results: Among patients interviewed (n=9), most agreed that a smartphone app for supporting HF self-care was desirable. In addition to 3 a priori themes, we identified 7 subthemes: education on daily HF care, how often to get education on HF, support of medication adherence, dietary restriction support, goal setting for exercises, stress reduction strategies, and prompts of when to call a provider. In addition, we identified 3 inductive themes related to veteran preferences for app components: simplicity, ability to share data with caregivers, and positive framing of HF language. Conclusions: We identified educational and tracking app features that can guide the development of HF self-care for an older adult veteran population. Future research needs to be done to extend these findings and assess the feasibility of and test an app with these features. %M 36538348 %R 10.2196/41317 %U https://formative.jmir.org/2022/12/e41317 %U https://doi.org/10.2196/41317 %U http://www.ncbi.nlm.nih.gov/pubmed/36538348 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e38656 %T Lessons Learned From an Effectiveness Evaluation of Inlife, a Web-Based Social Support Intervention for Caregivers of People With Dementia: Randomized Controlled Trial %A Christie,Hannah Liane %A Dam,Alieske Elisabeth Henrike %A van Boxtel,Martin %A Köhler,Sebastian %A Verhey,Frans %A de Vugt,Marjolein Elisabeth %+ Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Postbus 616, Maastricht, 6200 MD, Netherlands, 31 456213078, hannah.christie@maastrichtuniversity.nl %K dementia %K Alzheimer's %K neurodegenerative %K caregiver %K caregiving %K digital health %K eHealth %K mHealth %K Information communication technology %K RCT %K randomized controlled trial %K social support %K support platform %K online platform %K web-based %K internet-based %K peer-support %K informal support %K social interaction %K support network %D 2022 %7 7.12.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Informal care for people with dementia not only affects the well-being of the primary caregiver but also changes their roles and interactions with the social environment. New online interventions might facilitate access to social support. Recently, an online social support platform, Inlife, was developed in the Netherlands and aims to enhance social support and positive interactions in informal support networks. Objective: This study aimed to evaluate the effectiveness of Inlife for caregivers of people with dementia. Methods: A randomized controlled trial with 96 caregivers of people with dementia was performed. Participants were randomly assigned to the Inlife intervention or the waiting list control group. After 16 weeks of Inlife use, the waiting list control group could start using Inlife. Effects were evaluated at baseline (T0), 8 weeks (T1), and 16 weeks (T2). The 16-week follow-up assessment (T2) served as the primary endpoint to evaluate the results for the primary and secondary outcome variables evaluated with online self-report questionnaires. The primary outcomes included feelings of caregiver competence and perceived social support. The secondary outcomes included received support, feelings of loneliness, psychological complaints (eg, anxiety, stress), and quality of life. Results: No significant improvements were demonstrated for the intervention group (n=48) relative to the control group (n=48) for the primary outcomes (feeling of carer competence: b=–0.057, 95% CI –0.715 to 0.602, P=.87; perceived social support: b=–15.877, 95% CI –78.284 to 46.530, P=.62) or any secondary outcome. This contrasts with our qualitative findings showing the potential of Inlife to facilitate the care process in daily life. Adherence was not optimal for all Inlife users. Additional per-protocol and sensitivity analyses also revealed no beneficial results for high active Inlife users or specific subgroups. Inlife users were more active when part of a larger network. Conclusions: Researchers should be modest regarding the effectiveness of online caregiver interventions in terms of quantitative measures of well-being and quality of life. Nevertheless, online tools have the potential to facilitate the caregiver process in daily life. Lessons learned include the importance of harnessing the power of human interaction in eHealth, making use of the user’s social capital, and the need to develop research methods that can identify benefits in daily life that are ecologically valid for caregivers. Trial Registration: Netherlands Trial Register NTR6131; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6131 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-017-2097-y %M 36476485 %R 10.2196/38656 %U https://aging.jmir.org/2022/4/e38656 %U https://doi.org/10.2196/38656 %U http://www.ncbi.nlm.nih.gov/pubmed/36476485 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e29675 %T A Video-Based Mobile App as a Health Literacy Tool for Older Adults Living at Home: Protocol for a Utility Study %A Nunes-Da-Silva,Catarina %A Victorino,André %A Lemos,Marta %A Porojan,Ludmila %A Costa,Andreia %A Arriaga,Miguel %A Gregório,Maria João %A de Sousa,Rute Dinis %A Rodrigues,Ana Maria %A Canhão,Helena %+ Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, Lisbon, 1169-056, Portugal, 351 218803110 ext 27006, helena.canhao@nms.unl.pt %K mobile app %K technology %K treatment adherence %K health literacy %K seniors %K older adults %D 2022 %7 7.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: People aged ≥65 years are more likely to have health problems related to aging, polypharmacy, and low treatment adherence. Moreover, health literacy levels decrease with increasing age. Objective: The aim of this study is to assess an app’s utility in promoting health-related knowledge in people aged ≥65 years. Methods: We developed a simple, intuitive, and video-based app (DigiAdherence) that presents a recipe, nutritional counseling, and content on physical activity, cognitive exercise, motivation to adhere to treatment, fall prevention, and health literacy. A convenience sample of 25 older adults attending the Personalized Health Care Unit of Portimão or the Family Health Unit of Portas do Arade (ACeS Algarve II – Barlavento, ARS Algarve, Portugal) will be recruited. Subjects must be aged ≥65 years, own a smartphone or tablet, be willing to participate, and consent to participate. Those who do not know how to use or do not have a smartphone/tablet will be excluded. Likewise, people with major cognitive or physical impairment as well as those living in a long-term care center will not be included in this study. Participants will have access to the app for 4 weeks and will be evaluated at 3 different timepoints (V0, before they start using the app; V1, after using it for 30 days; and V2, 60 days after stopping using it). After using the app for 30 days, using a 7-point Likert scale, participants will be asked to score the mobile tool’s utility in encouraging them to take their medications correctly, improving quality of life, increasing their health-related knowledge, and preventing falls. They will also be asked to assess the app’s ease of use and visual esthetics, their motivation to use the app, and their satisfaction with the app. Subjects will be assessed in a clinical interview with a semistructured questionnaire, including questions regarding user experience, satisfaction, the utility of the app, quality of life (EQ-5D-3L instrument), and treatment adherence (Morisky scale). The proportion of participants who considered the app useful for their health at V1 and V2 will be analyzed. Regarding quality of life and treatment adherence perceptions, comparisons will be made between V0 and V1, using the t test for dependent samples. The same comparisons will be made between V0 and V2. Results: This study was funded in December 2019 and authorized by the Executive Board of ACeS Algarve II – Barlavento and by the Ethics Committee of NOVA Medical School (99/2019/CEFCM, June 2020). This protocol was also approved by the Ethics Committee for Health (16/2020, September 2020) and the Executive Board (December 2020) of the Regional Health Administration of the Algarve, IP (Instituto Público). Recruitment was completed in June 2021. Conclusions: Since the next generation of older adults may have higher digital literacy, information and communication technologies could potentially be used to deliver health-related content to improve lifestyles among older adults. International Registered Report Identifier (IRRID): PRR1-10.2196/29675 %M 36476754 %R 10.2196/29675 %U https://www.researchprotocols.org/2022/12/e29675 %U https://doi.org/10.2196/29675 %U http://www.ncbi.nlm.nih.gov/pubmed/36476754 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e40360 %T Designing Mindfulness Conversational Agents for People With Early-Stage Dementia and Their Caregivers: Thematic Analysis of Expert and User Perspectives %A Seah,Cassandra E L %A Zhang,Zheyuan %A Sun,Sijin %A Wiskerke,Esther %A Daniels,Sarah %A Porat,Talya %A Calvo,Rafael A %+ Dyson School of Design Engineering, Imperial College London, Imperial College Rd, South Kensington, London, SW7 9EG, United Kingdom, 44 7742540443, c.seah@imperial.ac.uk %K mindfulness %K dyadic %K dementia %K caregivers %K user needs %K intervention %K mindfulness %K user %K feedback %K design %K accessibility %K relationships %K mindset %K essential %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The number of people with dementia is expected to grow worldwide. Among the ways to support both persons with early-stage dementia and their caregivers (dyads), researchers are studying mindfulness interventions. However, few studies have explored technology-enhanced mindfulness interventions for dyads and the needs of persons with dementia and their caregivers. Objective: The main aim of this study was to elicit essential needs from people with dementia, their caregivers, dementia experts, and mindfulness experts to identify themes that can be used in the design of mindfulness conversational agents for dyads. Methods: Semistructured interviews were conducted with 5 dementia experts, 5 mindfulness experts, 5 people with early-stage dementia, and 5 dementia caregivers. Interviews were transcribed and coded on NVivo (QSR International) before themes were identified through a bottom-up inductive approach. Results: The results revealed that dyadic mindfulness is preferred and that implementation formats such as conversational agents have potential. A total of 5 common themes were also identified from expert and user feedback, which should be used to design mindfulness conversational agents for persons with dementia and their caregivers. The 5 themes included enhancing accessibility, cultivating positivity, providing simplified tangible and thought-based activities, encouraging a mindful mindset shift, and enhancing relationships. Conclusions: In essence, this research concluded with 5 themes that mindfulness conversational agents could be designed based on to meet the needs of persons with dementia and their caregivers. %M 36472897 %R 10.2196/40360 %U https://aging.jmir.org/2022/4/e40360 %U https://doi.org/10.2196/40360 %U http://www.ncbi.nlm.nih.gov/pubmed/36472897 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e39189 %T Lessons and Reflections From an Extended Co-design Process Developing an mHealth App With and for Older Adults: Multiphase, Mixed Methods Study %A Tong,Catherine %A Kernoghan,Alison %A Lemmon,Kassandra %A Fernandes,Paige %A Elliott,Jacobi %A Sacco,Veronica %A Bodemer,Sheila %A Stolee,Paul %+ School of Public Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567, catherine.tong@uwaterloo.ca %K mobile health %K mHealth %K older adults %K health care providers %K co-design %K user experience or UX design %K qualitative %K apps %K elderly %K health care %K care provider %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Aging %G English %X Background: There are many mobile health (mHealth) apps for older adult patients, but research has found that broadly speaking, mHealth still fails to meet the specific needs of older adult users. Others have highlighted the need to embed users in the mHealth design process in a fulsome and meaningful way. Co-design has been widely used in the development of mHealth apps and involves stakeholders in each phase of the design and development process. The involvement of older adults in the co-design processes is variable. To date, co-design approaches have tended toward embedding the stakeholders in early phases (eg, predesign and generative) but not throughout. Objective: The aim of this study was to reflect on the processes and lessons learned from engaging in an extended co-design process to develop an mHealth app for older adults, with older users contributing at each phase. This study aimed to design an mHealth tool to assist older adults in coordinating their care with health care professionals and caregivers. Methods: Our work to conceptualize, develop, and test the mHealth app consisted of 4 phases: phase 1, consulting stakeholders; phase 2, app development and co-designing with older adults; phase 3, field-testing with a smaller sample of older adult volunteer testers; and phase 4, reflecting, internally, on lessons learned from this process. In each phase, we drew on qualitative methods, including in-depth interviews and focus groups, all of which were analyzed in NVivo 11, using team-based thematic analysis. Results: In phase 1, we identified key features that older adults and primary care providers wanted in an app, and each user group identified different priority features (older adults principally sought support to use the mHealth app, whereas primary care providers prioritized recoding illnesses, immunizations, and appointments). Phases 2 and 3 revealed significant mismatches between what the older adult users wanted and what our developers were able and willing to deliver. We were unable to craft the app that our consultations recommended, which the older adult field testers asked for. In phase 4, we reflected on our abilities to embed the voices and perspectives of older adults throughout the project when working with a developer not familiar with or committed to the core principles of co-design. We draw on this challenging experience to highlight several recommendations for those embarking on a co-design process that includes developers and IT vendors, researchers, and older adult users. Conclusions: Although our final mHealth app did not reflect all the needs and wishes of our older adult testers, our consultation process identified key features and contextual information essential for those developing apps to support older adults in managing their health and health care. %M 36306166 %R 10.2196/39189 %U https://aging.jmir.org/2022/4/e39189 %U https://doi.org/10.2196/39189 %U http://www.ncbi.nlm.nih.gov/pubmed/36306166 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e39301 %T Older Wheelchair Users Recommend Age-Friendly Design Improvements to a Wheelchair Maintenance App: Mixed Methods Development Study %A Boccardi,Alyssa %A Wu,Fangzheng %A Pearlman,Jon %A Mhatre,Anand %+ Occupational Therapy Division, Ohio State University Wexner Medical Center, 453 W 10th Ave, Columbus, OH, 43210, United States, 1 (614) 688 2081, anand.mhatre@osumc.edu %K aging %K older adults %K maintenance %K mobile phone %K repair %K smartphone %K wheelchair %D 2022 %7 18.10.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Wheelchair part failures have doubled over the past decade. Preventative wheelchair maintenance reduces wheelchair failures and prevents user consequences. We are developing a smartphone app called WheelTrak, which alerts users when maintenance is required, to encourage maintenance practices and compliance. Objective: This mixed methods study aimed to develop a wheelchair maintenance app using broad stakeholder advice and investigate older adults’ interaction experience with the app and their perceived barriers to and facilitators of maintenance. Methods: Interviews were conducted with stakeholders, including mobility device users, to generate needs statements and app specifications. The app was designed in 2 stages. Stage 1 involved the development of the app according to the specifications and evaluation of the app interface by lead users. Stage 2 included the revision of the app screens and manual functionality testing. Usability testing and semistructured interviews were conducted with older wheelchair and scooter users. The System Usability Scale was used to measure app usability. Results: Interviews with power and manual wheelchair users (37/57, 65%), wheelchair service providers (15/57, 26%), manufacturers (2/57, 4%), seating and mobility researchers (1/57, 2%), and insurance plan providers (2/57, 4%) informed the needs and specifications of the app technology. The 2-stage development process delivered a fully functional app that met the design specifications. In total, 12 older adults (mean age 74.2, SD 9.1 years; n=10, 83% women; and n=2, 17% men) participated in the usability testing study. Of the 12 participants, 9 (75%) agreed to use WheelTrak for preventative maintenance. WheelTrak scored an average System Usability Scale score of 60.25 (SD 16). Four overarching themes were identified: WheelTrak app improvements, barriers to maintenance, consequences related to mobility device failure, and smart technology use and acceptance. Older adults preferred the simplicity, readability, personalization, and availability of educational resources in the app. Barriers to maintenance pertained to health issues and lack of maintenance knowledge among older adults. Facilitators of maintenance included notification for maintenance, app connectivity with the service provider, reporting of device failure, and the presence of a caregiver for maintenance. Conclusions: This study highlighted age-friendly design improvements to the app, making it easy to be used and adopted by older wheelchair users. The WheelTrak app has close to average system usability. Additional usability testing will be conducted following app revision in the future. %M 36256830 %R 10.2196/39301 %U https://aging.jmir.org/2022/4/e39301 %U https://doi.org/10.2196/39301 %U http://www.ncbi.nlm.nih.gov/pubmed/36256830 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e37772 %T Mobile App Prototype in Older Adults for Postfracture Acute Pain Management: User-Centered Design Approach %A Tran-Nguyen,Kevin %A Berger,Caroline %A Bennett,Roxanne %A Wall,Michelle %A Morin,Suzanne N %A Rajabiyazdi,Fateme %+ Department of Systems and Computer Engineering, Carleton University, 1125 Colonel By Dr, Ottawa, ON, Canada, 1 (613) 520 2600 ext 8229, fateme.rajabiyazdi@carleton.ca %K older adults %K mobile app %K skeletal fracture %K usability %K patient-centered %K human-centered design %K digital health %K eHealth %K mobile health %K mHealth %K acute pain self-management %K mobile phone %D 2022 %7 17.10.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Postfracture acute pain is often inadequately managed in older adults. Mobile health (mHealth) technologies can offer opportunities for self-management of pain; however, insufficient apps exist for acute pain management after a fracture, and none are designed for an older adult population. Objective: This study aims to design, develop, and evaluate an mHealth app prototype using a human-centered design approach to support older adults in the self-management of postfracture acute pain. Methods: This study used a multidisciplinary and user-centered design approach. Overall, 7 stakeholders (ie, 1 clinician-researcher specialized in internal medicine, 2 user experience designers, 1 computer science researcher, 1 clinical research assistant researcher, and 2 pharmacists) from the project team, together with 355 external stakeholders, were involved throughout our user-centered development process that included surveys, requirement elicitation, participatory design workshops, mobile app design and development, mobile app content development, and usability testing. We completed this study in 3 phases. We analyzed data from prior surveys administered to 305 members of the Canadian Osteoporosis Patient Network and 34 health care professionals to identify requirements for designing a low-fidelity prototype. Next, we facilitated 4 participatory design workshops with 6 participants for feedback on content, presentation, and interaction with our proposed low-fidelity prototype. After analyzing the collected data using thematic analysis, we designed a medium-fidelity prototype. Finally, to evaluate our medium-fidelity prototype, we conducted usability tests with 10 participants. The results informed the design of our high-fidelity prototype. Throughout all the phases of this development study, we incorporated inputs from health professionals to ensure the accuracy and validity of the medical content in our prototypes. Results: We identified 3 categories of functionalities necessary to include in the design of our initial low-fidelity prototype: the need for support resources, diary entries, and access to educational materials. We then conducted a thematic analysis of the data collected in the design workshops, which revealed 4 themes: feedback on the user interface design and usability, requests for additional functionalities, feedback on medical guides and educational materials, and suggestions for additional medical content. On the basis of these results, we designed a medium-fidelity prototype. All the participants in the usability evaluation tests found the medium-fidelity prototype useful and easy to use. On the basis of the feedback and difficulties experienced by participants, we adjusted our design in preparation for the high-fidelity prototype. Conclusions: We designed, developed, and evaluated an mHealth app to support older adults in the self-management of pain after a fracture. The participants found our proposed prototype useful for managing acute pain and easy to interact with and navigate. Assessment of the clinical outcomes and long-term effects of our proposed mHealth app will be evaluated in the future. %M 36251348 %R 10.2196/37772 %U https://aging.jmir.org/2022/4/e37772 %U https://doi.org/10.2196/37772 %U http://www.ncbi.nlm.nih.gov/pubmed/36251348 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e35592 %T Usability and Acceptability of a Palliative Care Mobile Intervention for Older Adults With Heart Failure and Caregivers: Observational Study %A Villalobos,Jennifer Paola %A Bull,Sheana Salyers %A Portz,Jennifer Dickman %+ Colorado School of Public Health, University of Colorado, 13055 E 17th Ave, Mail Stop #F802, Aurora, CO, 80045, United States, 1 303 551 3823, jennifer.p.villalobos@gmail.com %K mHealth %K older adult %K symptom %K heart failure %K palliative care %K app %K digital health %K cardiology %K heart %K Convoy-Pal %K mobile %K tablet %K smartwatch %K adult %K aging %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Heart failure is a leading cause of death among older adults. Digital health can increase access to and awareness of palliative care for patients with advanced heart failure and their caregivers. However, few palliative care digital interventions target heart failure or patients’ caregivers, family, and friends, termed here as the social convoy. To address this need, the Social Convoy Palliative Care (Convoy-Pal) mobile intervention was developed to deliver self-management tools and palliative care resources to older adults with advanced heart failure and their social convoys. Objective: The goal of the research was to test the acceptability and usability of Convoy-Pal among older adults with advanced heart failure and their social convoys. Methods: Convoy-Pal includes tablet-based and smartwatch tools facilitating self-management and access to palliative care resources. Older adults and social convoy caregivers completed an acceptability and usability interview via Zoom, including open-ended questions and the Mobile Application Rating Scale: User Version (uMARS). Descriptive analysis was conducted to summarize the results of open-ended feedback and self-reported acceptability and usability. Results: A total of 26 participants (16 older adults and 10 social convoy caregivers) participated in the interview. Overall, the feedback from users was good (uMARS mean 3.96/5 [SD 0.81]). Both older adults and social convoy caregivers scored information provided by Convoy-Pal the highest (mean 4.22 [SD 0.75] and mean 4.21 [SD 0.64], respectively). Aesthetics, functionality, and engagement were also perceived as acceptable (mean >3.5). Open-ended feedback resulted in 5 themes including improvements to goal setting, monitoring tools, daily check-in call feature, portal and mobile app, and convoy assessment. Conclusions: Convoy-Pal was perceived as acceptable with good usability among older adults with heart failure and their social convoy caregivers. With good acceptability, Convoy-Pal may ultimately lead to increased access to palliative care resources and facilitate self-management among older adults with heart failure and their social convoy caregivers. %M 36201402 %R 10.2196/35592 %U https://aging.jmir.org/2022/4/e35592 %U https://doi.org/10.2196/35592 %U http://www.ncbi.nlm.nih.gov/pubmed/36201402 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e38067 %T Assessing the Impact of Conversational Artificial Intelligence in the Treatment of Stress and Anxiety in Aging Adults: Randomized Controlled Trial %A Danieli,Morena %A Ciulli,Tommaso %A Mousavi,Seyed Mahed %A Silvestri,Giorgia %A Barbato,Simone %A Di Natale,Lorenzo %A Riccardi,Giuseppe %+ Signal & Interactive Systems Lab, Dipartimento di Ingegneria e Scienze dell'Informazione, Università degli Studi di Trento, via Sommarive 9, Povo di Trento - Trento, 38123, Italy, 39 5381237 ext 686, morena.danieli@unitn.it %K mental health care %K conversational artificial intelligence %K mobile health %K mHealth %K personal health care agent %D 2022 %7 23.9.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: While mental health applications are increasingly becoming available for large populations of users, there is a lack of controlled trials on the impacts of such applications. Artificial intelligence (AI)-empowered agents have been evaluated when assisting adults with cognitive impairments; however, few applications are available for aging adults who are still actively working. These adults often have high stress levels related to changes in their work places, and related symptoms eventually affect their quality of life. Objective: We aimed to evaluate the contribution of TEO (Therapy Empowerment Opportunity), a mobile personal health care agent with conversational AI. TEO promotes mental health and well-being by engaging patients in conversations to recollect the details of events that increased their anxiety and by providing therapeutic exercises and suggestions. Methods: The study was based on a protocolized intervention for stress and anxiety management. Participants with stress symptoms and mild-to-moderate anxiety received an 8-week cognitive behavioral therapy (CBT) intervention delivered remotely. A group of participants also interacted with the agent TEO. The participants were active workers aged over 55 years. The experimental groups were as follows: group 1, traditional therapy; group 2, traditional therapy and mobile health (mHealth) agent; group 3, mHealth agent; and group 4, no treatment (assigned to a waiting list). Symptoms related to stress (anxiety, physical disease, and depression) were assessed prior to treatment (T1), at the end (T2), and 3 months after treatment (T3), using standardized psychological questionnaires. Moreover, the Patient Health Questionnaire-8 and General Anxiety Disorders-7 scales were administered before the intervention (T1), at mid-term (T2), at the end of the intervention (T3), and after 3 months (T4). At the end of the intervention, participants in groups 1, 2, and 3 filled in a satisfaction questionnaire. Results: Despite randomization, statistically significant differences between groups were present at T1. Group 4 showed lower levels of anxiety and depression compared with group 1, and lower levels of stress compared with group 2. Comparisons between groups at T2 and T3 did not show significant differences in outcomes. Analyses conducted within groups showed significant differences between times in group 2, with greater improvements in the levels of stress and scores related to overall well-being. A general worsening trend between T2 and T3 was detected in all groups, with a significant increase in stress levels in group 2. Group 2 reported higher levels of perceived usefulness and satisfaction. Conclusions: No statistically significant differences could be observed between participants who used the mHealth app alone or within the traditional CBT setting. However, the results indicated significant differences within the groups that received treatment and a stable tendency toward improvement, which was limited to individual perceptions of stress-related symptoms. Trial Registration: ClinicalTrials.gov NCT04809090; https://clinicaltrials.gov/ct2/show/NCT04809090 %M 36149730 %R 10.2196/38067 %U https://mental.jmir.org/2022/9/e38067 %U https://doi.org/10.2196/38067 %U http://www.ncbi.nlm.nih.gov/pubmed/36149730 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e32453 %T The Usability of a Smartphone-Based Fall Risk Assessment App for Adult Wheelchair Users: Observational Study %A Frechette,Mikaela %A Fanning,Jason %A Hsieh,Katherine %A Rice,Laura %A Sosnoff,Jacob %+ Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66103, United States, 1 913 588 5235, jsosnoff@kumc.edu %K usability testing %K mobile health %K wheeled device user %K fall risk %K telehealth %K mHealth %K mobile device %K smartphone %K health applications %K older adults %K elderly population %K device usability %D 2022 %7 16.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals who use wheelchairs and scooters rarely undergo fall risk screening. Mobile health technology is a possible avenue to provide fall risk assessment. The promise of this approach is dependent upon its usability. Objective: We aimed to determine the usability of a fall risk mobile health app and identify key technology development insights for aging adults who use wheeled devices. Methods: Two rounds (with 5 participants in each round) of usability testing utilizing an iterative design-evaluation process were performed. Participants completed use of the custom-designed fall risk app, Steady-Wheels. To quantify fall risk, the app led participants through 12 demographic questions and 3 progressively more challenging seated balance tasks. Once completed, participants shared insights on the app’s usability through semistructured interviews and completion of the Systematic Usability Scale. Testing sessions were recorded and transcribed. Codes were identified within the transcriptions to create themes. Average Systematic Usability Scale scores were calculated for each round. Results: The first round of testing yielded 2 main themes: ease of use and flexibility of design. Systematic Usability Scale scores ranged from 72.5 to 97.5 with a mean score of 84.5 (SD 11.4). After modifications were made, the second round of testing yielded 2 new themes: app layout and clarity of instruction. Systematic Usability Scale scores improved in the second iteration and ranged from 87.5 to 97.5 with a mean score of 91.9 (SD 4.3). Conclusions: The mobile health app, Steady-Wheels, has excellent usability and the potential to provide adult wheeled device users with an easy-to-use, remote fall risk assessment tool. Characteristics that promoted usability were guided navigation, large text and radio buttons, clear and brief instructions accompanied by representative illustrations, and simple error recovery. Intuitive fall risk reporting was achieved through the presentation of a single number located on a color-coordinated continuum that delineated low, medium, and high risk. %M 36112405 %R 10.2196/32453 %U https://formative.jmir.org/2022/9/e32453 %U https://doi.org/10.2196/32453 %U http://www.ncbi.nlm.nih.gov/pubmed/36112405 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e39851 %T The Effects of a Digital Well-being Intervention on Older Adults: Retrospective Analysis of Real-world User Data %A Boucher,Eliane %A Honomichl,Ryan %A Ward,Haley %A Powell,Tyler %A Stoeckl,Sarah Elizabeth %A Parks,Acacia %+ Twill, 114 Fifth Avenue, 10th floor, New York, NY, 10011, United States, 1 432 258 5233, eliane@twill.health %K mobile apps %K mental health %K older adults %K technology adoption %K digital health %K mobile phone %D 2022 %7 2.9.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Digital interventions have been shown to be effective for a variety of mental health disorders and problems. However, few studies have examined the effects of digital interventions in older adults; therefore, little is known about how older adults engage with or benefit from these interventions. Given that adoption rates for technology among people aged ≥65 years remain substantially lower than in the general population and that approximately 20% of older adults are affected by mental health disorders, research exploring whether older adults will use and benefit from digital interventions is needed. Objective: This study aimed to examine the extent to which older adults engaged with a digital well-being intervention (Happify) and whether engaging with this program led to improvements in both subjective well-being and anxiety symptoms. Methods: In this retrospective analysis, we analyzed data from 375 real-world Happify users aged ≥65 years who signed up for the platform between January 1, 2019, and December 23, 2021. Changes in well-being and anxiety symptoms across 42 to 182 days were assessed using responses to the in-app assessment, which users were prompted to take every 2 weeks, and were compared among users who engaged with the program at the recommended level (ie, 2 or more activities per week) or below the recommended level. Results: In all, 30% (113/375) of the sample engaged with the platform at the recommended level (ie, completed an average of 2 or more activities per week), and overall, users completed an average of 43.35 (SD 87.80) activities, ranging from 1 to 786, between their first and last assessment. Users were also active on the platform for an average of 19.36 (SD 27.16) days, ranging from 1 to 152 days. Moreover, older adults who engaged at the recommended level experienced significantly greater improvements in subjective well-being (P=.002) and anxiety symptoms (P<.001) relative to those who completed fewer activities. Conclusions: These data provide preliminary evidence that older adults engage with and benefit from digital well-being interventions. We believe that these findings highlight the importance of considering older adult populations in digital health research. More research is needed to understand potential barriers to using digital interventions among older adults and whether digital interventions should be modified to account for this population’s particular needs (eg, ensuring that the intervention is accessible using a variety of devices). However, these results are an important step in demonstrating the feasibility of such interventions in a population that is assumed to be less inclined toward digital approaches. %M 36053569 %R 10.2196/39851 %U https://aging.jmir.org/2022/3/e39851 %U https://doi.org/10.2196/39851 %U http://www.ncbi.nlm.nih.gov/pubmed/36053569 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e33845 %T A Smartwatch Step-Counting App for Older Adults: Development and Evaluation Study %A Boateng,George %A Petersen,Curtis L %A Kotz,David %A Fortuna,Karen L %A Masutani,Rebecca %A Batsis,John A %+ Division of Geriatric Medicine, School of Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC, 27599, United States, 1 919 843 4096, john.batsis@gmail.com %K step tracking %K step counting %K pedometer %K wearable %K smartwatch %K older adults %K physical activity %K machine learning %K walking %K mHealth %K mobile health %K mobile app %K mobile application %K app %K uHealth %D 2022 %7 10.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have been shown to be inaccurate in clinical settings. Step-counting algorithms have been developed for smartwatches, but only using data from younger adults and, often, were only validated in controlled laboratory settings. Objective: We sought to develop and validate a smartwatch step-counting app for older adults and evaluate the algorithm in free-living settings over a long period of time. Methods: We developed and evaluated a step-counting app for older adults on an open-source wrist-worn device (Amulet). The app includes algorithms to infer the level of physical activity and to count steps. We validated the step-counting algorithm in the lab (counting steps from a video recording, n=20) and in free-living conditions—one 2-day field study (n=6) and two 12-week field studies (using the Fitbit as ground truth, n=16). During app system development, we evaluated 4 walking patterns: normal, fast, up and down a staircase, and intermittent speed. For the field studies, we evaluated 5 different cut-off values for the algorithm, using correlation and error rate as the evaluation metrics. Results: The step-counting algorithm performed well. In the lab study, for normal walking (R2=0.5), there was a stronger correlation between the Amulet steps and the video-validated steps; for all activities, the Amulet’s count was on average 3.2 (2.1%) steps lower (SD 25.9) than the video-validated count. For the 2-day field study, the best parameter settings led to an association between Amulet and Fitbit (R2=0.989) and 3.1% (SD 25.1) steps lower than Fitbit, respectively. For the 12-week field study, the best parameter setting led to an R2 value of 0.669. Conclusions: Our findings demonstrate the importance of an iterative process in algorithm development before field-based deployment. This work highlights various challenges and insights involved in developing and validating monitoring systems in real-world settings. Nonetheless, our step-counting app for older adults had good performance relative to the ground truth (a commercial Fitbit step counter). Our app could potentially be used to help improve physical activity among older adults. %M 35947445 %R 10.2196/33845 %U https://aging.jmir.org/2022/3/e33845 %U https://doi.org/10.2196/33845 %U http://www.ncbi.nlm.nih.gov/pubmed/35947445 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e36975 %T A Web-Based Platform (CareVirtue) to Support Caregivers of People Living With Alzheimer Disease and Related Dementias: Mixed Methods Feasibility Study %A Boutilier,Justin J %A Loganathar,Priya %A Linden,Anna %A Scheer,Eleanore %A Noejovich,Sofia %A Elliott,Christian %A Zuraw,Matthew %A Werner,Nicole E %+ Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, 1025 E 7th St, Bloomington, IN, 47405, United States, 1 703 340 7177, newerner@iu.edu %K Alzheimer disease and related dementias %K mHealth %K caregivers %K dementia caregiving %K eHealth %K telehealth %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: People living with Alzheimer disease and related dementias (ADRD) require prolonged and complex care that is primarily managed by informal caregivers who face significant unmet needs regarding support for communicating and coordinating across their informal care network. To address this unmet need, we developed CareVirtue, which provides (1) the ability to invite care network members; (2) a care guide detailing the care plan; (3) a journal where care network members can document, communicate, and coordinate; (4) a shared calendar; and (5) vetted geolocated caregiver resources. Objective: This study aims to evaluate CareVirtue’s feasibility based on: (1) Who used CareVirtue? (2) How did caregivers use CareVirtue? (3) How did caregivers perceive the acceptability of CareVirtue? (4) What factors were associated with CareVirtue use? Methods: We conducted a feasibility study with 51 care networks over a period of 8 weeks and used a mixed methods approach that included both quantitative CareVirtue usage data and semistructured interviews. Results: Care networks ranged from 1 to 8 members. Primary caregivers were predominantly female (38/51, 75%), White (44/51, 86%), married (37/51, 73%), college educated (36/51, 71%), and were, on average, 60.3 (SD 9.8) years of age, with 18% (9/51) living in a rural area. CareVirtue usage varied along 2 axes (total usage and type of usage), with heterogeneity in how the most engaged care networks interacted with CareVirtue. Interviews identified a range of ways CareVirtue was useful, including practically, organizationally, and emotionally. On the Behavioral Intention Scale, 72% (26/36) of primary caregivers reported an average score of at least 3, indicating an above average intention to use. The average was 81.8 (SD 12.8) for the System Usability Scale score, indicating “good” usability, and 3.4 (SD 1.0) for perceived usefulness, suggesting above average usefulness. The average confidence score increased significantly over the study duration from 7.8 in week 2 to 8.9 in week 7 (P=.005; r=0.91, 95% CI 0.84-0.95). The following sociodemographic characteristics were associated with posting in the journal: retired (mean 59.5 posts for retired caregivers and mean 16.9 for nonretired caregivers), income (mean 13 posts for those reporting >US $100K and mean 55.4 for those reporting 90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others. Conclusions: This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits. %M 35896014 %R 10.2196/39335 %U https://aging.jmir.org/2022/3/e39335 %U https://doi.org/10.2196/39335 %U http://www.ncbi.nlm.nih.gov/pubmed/35896014 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33856 %T Assessment of Social Behavior Using a Passive Monitoring App in Cognitively Normal and Cognitively Impaired Older Adults: Observational Study %A Muurling,Marijn %A Reus,Lianne M %A de Boer,Casper %A Wessels,Sterre C %A Jagesar,Raj R %A Vorstman,Jacob A S %A Kas,Martien J H %A Visser,Pieter Jelle %+ Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands, 31 (0)204448527, m.muurling@amsterdamumc.nl %K passive monitoring %K smartphone app %K cognitive impairment %K social behavior %K dementia %K mHealth %K mobile app %K cognitive %K mental health %K social withdrawal %K well-being %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: In people with cognitive impairment, loss of social interactions has a major impact on well-being. Therefore, patients would benefit from early detection of symptoms of social withdrawal. Current measurement techniques such as questionnaires are subjective and rely on recall, in contradiction to smartphone apps, which measure social behavior passively and objectively. Objective: This study uses the remote monitoring smartphone app Behapp to assess social behavior, and aims to investigate (1) the association between social behavior, demographic characteristics, and neuropsychiatric symptoms in cognitively normal (CN) older adults, and (2) if social behavior is altered in cognitively impaired (CI) participants. In addition, we explored in a subset of individuals the association between Behapp outcomes and neuropsychiatric symptoms. Methods: CN, subjective cognitive decline (SCD), and CI older adults installed the Behapp app on their own Android smartphone for 7 to 42 days. CI participants had a clinical diagnosis of mild cognitive impairment (MCI) or Alzheimer-type dementia. The app continuously measured communication events, app use and location. Neuropsychiatric Inventory (NPI) total scores were available for 20 SCD and 22 CI participants. Linear models were used to assess group differences on Behapp outcomes and to assess the association of Behapp outcomes with the NPI. Results: We included CN (n=209), SCD (n=55) and CI (n=22) participants. Older cognitively normal participants called less frequently and made less use of apps (P<.05). No sex effects were found. Compared to the CN and SCD groups, CI individuals called less unique contacts (β=–0.7 [SE 0.29], P=.049) and contacted the same contacts relatively more often (β=0.8 [SE 0.25], P=.004). They also made less use of apps (β=–0.83 [SE 0.25], P=.004). Higher total NPI scores were associated with further traveling (β=0.042 [SE 0.015], P=.03). Conclusions: CI individuals show reduced social activity, especially those activities that are related to repeated and unique behavior, as measured by the smartphone app Behapp. Neuropsychiatric symptoms seemed only marginally associated with social behavior as measured with Behapp. This research shows that the Behapp app is able to objectively and passively measure altered social behavior in a cognitively impaired population. %M 35594063 %R 10.2196/33856 %U https://aging.jmir.org/2022/2/e33856 %U https://doi.org/10.2196/33856 %U http://www.ncbi.nlm.nih.gov/pubmed/35594063 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e37521 %T Technology Acceptance and Usability of a Mobile App to Support the Workflow of Health Care Aides Who Provide Services to Older Adults: Pilot Mixed Methods Study %A Miguel Cruz,Antonio %A Lopez Portillo,Hector Perez %A Daum,Christine %A Rutledge,Emily %A King,Sharla %A Liu,Lili %+ Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 1-45 Corbett Hall, 8205 114 Street, Edmonton, AB, T6G 2G4, Canada, 1 7804926461, miguelcr@ualberta.ca %K usability %K technology acceptance %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K older adults %K caregivers %K health care aides %K mobile phone %D 2022 %7 18.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Health care aides are unlicensed support personnel who provide direct care, personal assistance, and support to people with health conditions. The shortage of health care aides has been attributed to recruitment challenges, high turnover, an aging population, the COVID-19 pandemic, and low retention rates. Mobile apps are among the many information communication technologies that are paving the way for eHealth solutions to help address this workforce shortage by enhancing the workflow of health care aides. In collaboration with Clinisys EMR Inc, we developed a mobile app (Mobile Smart Care System [mSCS]) to support the workflow of health care aides who provide services to older adult residents of a long-term care facility. Objective: The purpose of this study was to investigate the technology acceptance and usability of a mobile app in a real-world environment, while it is used by health care aides who provide services to older adults. Methods: This pilot study used a mixed methods design: sequential mixed methods (QUANTITATIVE, qualitative). Our study included a pre– and post–paper-based questionnaire with no control group (QUAN). Toward the end of the study, 2 focus groups were conducted with a subsample of health care aides (qual, qualitative description design). Technology acceptance and usability questionnaires used a 5-point Likert scale ranging from disagree (1) to agree (5). The items included in the questionnaires were validated in earlier research as having high levels of internal consistency for the Unified Theory of Acceptance and Use of Technology constructs. A total of 60 health care aides who provided services to older adults as part of their routine caseloads used the mobile app for 1 month. Comparisons of the Unified Theory of Acceptance and Use of Technology constructs’ summative scores at pretest and posttest were calculated using a paired t test (2-tailed). We used the partial least squares structural regression model to determine the factors influencing mobile app acceptance and usability for health care aides. The α level of significance for all tests was set at P≤.05 (2-tailed). Results: We found that acceptance of the mSCS was high among health care aides, performance expectancy construct was the strongest predictor of intention to use the mSCS, intention to use the mSCS predicted usage behavior. The qualitative data support the quantitative findings and showed health care aides’ strong belief that the mSCS was useful, portable, and reliable, although there were still opportunities for improvement, especially with regard to the mSCS user interface. Conclusions: Overall, these results support the assertion that mSCS technology acceptance and usability are high among health care aides. In other words, health care aides perceived that the mSCS assisted them in addressing their workflow issues. %M 35583930 %R 10.2196/37521 %U https://aging.jmir.org/2022/2/e37521 %U https://doi.org/10.2196/37521 %U http://www.ncbi.nlm.nih.gov/pubmed/35583930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e31352 %T The Effectiveness of a Computer-Tailored Web-Based Physical Activity Intervention Using Fitbit Activity Trackers in Older Adults (Active for Life): Randomized Controlled Trial %A Alley,Stephanie J %A van Uffelen,Jannique %A Schoeppe,Stephanie %A Parkinson,Lynne %A Hunt,Susan %A Power,Deborah %A Waterman,Natasha %A Waterman,Courtney %A To,Quyen G %A Duncan,Mitch J %A Schneiders,Anthony %A Vandelanotte,Corneel %+ Physical Activity Research Group, Appleton Institute, Central Queensland University, Building 7, Bruce Hwy, Rockhampton, 4701, Australia, 61 749232263, s.alley@cqu.edu.au %K internet %K online %K activity trackers %K activity monitors %K wearables %K physical activity %K mobile phone %D 2022 %7 12.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity is an integral part of healthy aging; yet, most adults aged ≥65 years are not sufficiently active. Preliminary evidence suggests that web-based interventions with computer-tailored advice and Fitbit activity trackers may be well suited for older adults. Objective: The aim of this study was to examine the effectiveness of Active for Life, a 12-week web-based physical activity intervention with 6 web-based modules of computer-tailored advice to increase physical activity in older Australians. Methods: Participants were recruited both through the web and offline and were randomly assigned to 1 of 3 trial arms: tailoring+Fitbit, tailoring only, or a wait-list control. The computer-tailored advice was based on either participants’ Fitbit data (tailoring+Fitbit participants) or self-reported physical activity (tailoring-only participants). The main outcome was change in wrist-worn accelerometer (ActiGraph GT9X)–measured moderate to vigorous physical activity (MVPA) from baseline to after the intervention (week 12). The secondary outcomes were change in self-reported physical activity measured by means of the Active Australia Survey at the midintervention point (6 weeks), after the intervention (week 12), and at follow-up (week 24). Participants had a face-to-face meeting at baseline for a demonstration of the intervention and at baseline and week 12 to return the accelerometers. Generalized linear mixed model analyses were conducted with a γ distribution and log link to compare MVPA and self-reported physical activity changes over time within each trial arm and between each of the trial arms. Results: A total of 243 participants were randomly assigned to tailoring+Fitbit (n=78, 32.1%), tailoring only (n=96, 39.5%), and wait-list control (n=69, 28.4%). Attrition was 28.8% (70/243) at 6 weeks, 31.7% (77/243) at 12 weeks, and 35.4% (86/243) at 24 weeks. No significant overall time by group interaction was observed for MVPA (P=.05). There were no significant within-group changes for MVPA over time in the tailoring+Fitbit group (+3%, 95% CI –24% to 40%) or the tailoring-only group (–4%, 95% CI –24% to 30%); however, a significant decline was seen in the control group (–35%, 95% CI –52% to –11%). The tailoring+Fitbit group participants increased their MVPA 59% (95% CI 6%-138%) more than those in the control group. A significant time by group interaction was observed for self-reported physical activity (P=.02). All groups increased their self-reported physical activity from baseline to week 6, week 12, and week 24, and this increase was greater in the tailoring+Fitbit group than in the control group at 6 weeks (+61%, 95% CI 11%-133%). Conclusions: A computer-tailored physical activity intervention with Fitbit integration resulted in improved MVPA outcomes in comparison with a control group in older adults. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000646246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000646246 %M 35552166 %R 10.2196/31352 %U https://www.jmir.org/2022/5/e31352 %U https://doi.org/10.2196/31352 %U http://www.ncbi.nlm.nih.gov/pubmed/35552166 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e36768 %T Modification in the Motor Skills of Seniors in Care Homes Using Serious Games and the Impact of COVID-19: Field Study %A Kleschnitzki,Jana Marina %A Grossmann,Inga %A Beyer,Reinhard %A Beyer,Luzi %+ Institute of Psychology, Faculty of Human Sciences, Humboldt-University of Berlin, Rudower Chaussee 18, Berlin, 12489, Germany, 49 15231964606, janakleschnitzki@posteo.de %K serious games %K motor skills %K motor %K long-term care %K exercise %K movement %K coronavirus effects %K eHealth %K seniors %K older adult %K elder %K senior population %K aged %K care home %K intervention effects analysis %K COVID-19 %K pandemic %K digital game %K digital health %K physical activity %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. At the beginning of 2020, the COVID-19 pandemic led to many restrictions, which affected seniors in care facilities in the form of severe isolation. The isolation led, among other things, to a lack of exercise, which has led to a multitude of negative effects for this target group. Serious games can potentially help by being used anywhere at any time to strengthen skills with few resources. Objective: The aim of this study is to evaluate the effectiveness of a serious game to strengthen motor skills (study 1) and the influence of pandemic restrictions (study 2) on seniors in care facilities. Methods: The data on motor skills (measured by the Tinetti test) originated from an intervention study with repeated measurements that was interrupted by the pandemic conditions. Data were collected 4 times every 3 months with an intervention group (IG, training 3 times for 1 hour per week) and a control group (CG, no intervention). There were 2 substudies. The first considered the first 6 months until the pandemic restrictions, while the second considered the influence of the restrictions on motor skills. Results: The sample size was 70. The IG comprised 31 (44%) participants, with 22 (71%) female and 9 (29%) male seniors with an average age of 85 years. The CG comprised 39 (56%) participants, with 31 (79%) female and 8 (21%) male seniors with an average age of 87 years. In study 1, mixed-design ANOVA showed no significant interaction between measurement times and group membership for the first measurements (F2.136=1.414, P<.25, partial η2=.044), but there was a significant difference between the CG (mean 16.23, SD 1.1) and the IG (mean 19.81, SD 1.2) at the third time of measurement (P=.02). In study 2 the mixed-design ANOVA (used to investigate motor skills before and after the pandemic conditions between the 2 groups) couldn’t reveal any significant interaction between measurement times and group membership: F1.67=2.997, P<.09, partial η2=.043. However, there was a significant main effect of the time of measurement: F1.67=5.44, P<.02, partial η²=.075. Conclusions: During the first 6 months, the IG showed increased motor skills, whereas the motor skills of the CG slightly deteriorated and showed a statistically significant difference after 6 months. The pandemic restrictions leveled the difference and showed a significant negative effect on motor skills over 3 months. As our results show, digital games have the potential to break down access barriers and promote necessary maintenance for important skills. The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. This potentially great benefit for the challenges of tomorrow shows the relevance of the topic and demonstrates the urgent need for action and research. Trial Registration: Deutsches Register klinischer Studien DRKS00016633; https://tinyurl.com/yckmj4px %M 35536610 %R 10.2196/36768 %U https://games.jmir.org/2022/2/e36768 %U https://doi.org/10.2196/36768 %U http://www.ncbi.nlm.nih.gov/pubmed/35536610 %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 e33498 %T Using Smart Speaker Technology for Health and Well-being in an Older Adult Population: Pre-Post Feasibility Study %A McCloud,Rachel %A Perez,Carly %A Bekalu,Mesfin Awoke %A Viswanath,K %+ Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, United States, 1 706 224 8893, rachel_faulkenberry@dfci.harvard.edu %K technology %K older adults %K communication inequalities %K digital health %K elderly population %K smart technology %K smart speaker %K well-being %K health technology %K mobile phone %D 2022 %7 9.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Although smart speaker technology is poised to help improve the health and well-being of older adults by offering services such as music, medication reminders, and connection to others, more research is needed to determine how older adults from lower socioeconomic position (SEP) accept and use this technology. Objective: This study aimed to investigate the feasibility of using smart speakers to improve the health and well-being of low-SEP older adults. Methods: A total of 39 adults aged between 65 and 85 years who lived in a subsidized housing community were recruited to participate in a 3-month study. The participants had a smart speaker at their home and were given a brief orientation on its use. Over the course of the study, participants were given weekly check-in calls to help assist with any problems and newsletters with tips on how to use the speaker. Participants received a pretest and posttest to gauge comfort with technology, well-being, and perceptions and use of the speaker. The study staff also maintained detailed process notes of interactions with the participants over the course of the study, including a log of all issues reported. Results: At the end of the study period, 38% (15/39) of the participants indicated using the speaker daily, and 38% (15/39) of the participants reported using it several times per week. In addition, 72% (28/39) of the participants indicated that they wanted to continue using the speaker after the end of the study. Most participants (24/39, 62%) indicated that the speaker was useful, and approximately half of the participants felt that the speaker gave them another voice to talk to (19/39, 49%) and connected them with the outside world (18/39, 46%). Although common uses were using the speaker for weather, music, and news, fewer participants reported using it for health-related questions. Despite the initial challenges participants experienced with framing questions to the speaker, additional explanations by the study staff addressed these issues in the early weeks of the study. Conclusions: The results of this study indicate that there is promise for smart speaker technology for low-SEP older adults, particularly to connect them to music, news, and reminders. Future studies will need to provide more upfront training on query formation as well as develop and promote more specific options for older adults, particularly in the area of health and well-being. %M 35532979 %R 10.2196/33498 %U https://aging.jmir.org/2022/2/e33498 %U https://doi.org/10.2196/33498 %U http://www.ncbi.nlm.nih.gov/pubmed/35532979 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37522 %T Using Smart Displays to Implement an eHealth System for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial %A Gustafson,David H %A Mares,Marie-Louise %A Johnston,Darcie C %A Landucci,Gina %A Pe-Romashko,Klaren %A Vjorn,Olivia J %A Hu,Yaxin %A Gustafson,David H %A Maus,Adam %A Mahoney,Jane E %A Mutlu,Bilge %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, Mechanical Engineering Bldg, 4th Fl., 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 2615, dcjohnston@wisc.edu %K eHealth %K aged %K geriatrics %K multiple chronic conditions %K chronic pain %K smart displays %K smart speakers %K quality of life %K primary care %K health expenditures %K mobile phone %D 2022 %7 5.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Voice-controlled smart speakers and displays have a unique but unproven potential for delivering eHealth interventions. Many laptop- and smartphone-based interventions have been shown to improve multiple outcomes, but voice-controlled platforms have not been tested in large-scale rigorous trials. Older adults with multiple chronic health conditions, who need tools to help with their daily management, may be especially good candidates for interventions on voice-controlled devices because these patients often have physical limitations, such as tremors or vision problems, that make the use of laptops and smartphones challenging. Objective: The aim of this study is to assess whether participants using an evidence-based intervention (ElderTree) on a smart display will experience decreased pain interference and improved quality of life and related measures in comparison with participants using ElderTree on a laptop and control participants who are given no device or access to ElderTree. Methods: A total of 291 adults aged ≥60 years with chronic pain and ≥3 additional chronic conditions will be recruited from primary care clinics and community organizations and randomized 1:1:1 to ElderTree access on a smart display along with their usual care, ElderTree access on a touch screen laptop along with usual care, or usual care alone. All patients will be followed for 8 months. The primary outcomes are differences between groups in measures of pain interference and psychosocial quality of life. The secondary outcomes are between-group differences in system use at 8 months, physical quality of life, pain intensity, hospital readmissions, communication with medical providers, health distress, well-being, loneliness, and irritability. We will also examine mediators and moderators of the effects of ElderTree on both platforms. At baseline, 4 months, and 8 months, patients will complete written surveys comprising validated scales selected for good psychometric properties with similar populations. ElderTree use data will be collected continuously in system logs. We will use linear mixed-effects models to evaluate outcomes over time, with treatment condition and time acting as between-participant factors. Separate analyses will be conducted for each outcome. Results: Recruitment began in August 2021 and will run through April 2023. The intervention period will end in December 2023. The findings will be disseminated via peer-reviewed publications. Conclusions: To our knowledge, this is the first study with a large sample and long time frame to examine whether a voice-controlled smart device can perform as well as or better than a laptop in implementing a health intervention for older patients with multiple chronic health conditions. As patients with multiple conditions are such a large cohort, the implications for cost as well as patient well-being are significant. Making the best use of current and developing technologies is a critical part of this effort. Trial Registration: ClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196 International Registered Report Identifier (IRRID): PRR1-10.2196/37522 %M 35511229 %R 10.2196/37522 %U https://www.researchprotocols.org/2022/5/e37522 %U https://doi.org/10.2196/37522 %U http://www.ncbi.nlm.nih.gov/pubmed/35511229 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e35277 %T Development of an Internet of Things Technology Platform (the NEX System) to Support Older Adults to Live Independently: Protocol for a Development and Usability Study %A Timon,Claire M %A Heffernan,Emma %A Kilcullen,Sophia M %A Lee,Hyowon %A Hopper,Louise %A Quinn,Joe %A McDonald,David %A Gallagher,Pamela %A Smeaton,Alan F %A Moran,Kieran %A Hussey,Pamela %A Murphy,Catriona %+ Centre for eIntegrated Care, School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin, D09 NR58, Ireland, 353 17006811, claire.timon@dcu.ie %K independent living %K older adults %K Internet of Things %K wearable electronic devices %K activities of daily living %K mobile phone %D 2022 %7 5.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: In a rapidly aging population, new and efficient ways of providing health and social support to older adults are required that not only preserve independence but also maintain quality of life and safety. Objective: The NEX project aims to develop an integrated Internet of Things system coupled with artificial intelligence to offer unobtrusive health and wellness monitoring to support older adults living independently in their home environment. The primary objective of this study is to develop and evaluate the technical performance and user acceptability of the NEX system. The secondary objective is to apply machine learning algorithms to the data collected via the NEX system to identify and eventually predict changes in the routines of older adults in their own home environment. Methods: The NEX project commenced in December 2019 and is expected to be completed by August 2022. Mixed methods research (web-based surveys and focus groups) was conducted with 426 participants, including older adults (aged ≥60 years), family caregivers, health care professionals, and home care workers, to inform the development of the NEX system (phase 1). The primary outcome will be evaluated in 2 successive trials (the Friendly trial [phase 2] and the Action Research Cycle trial [phase 3]). The secondary objective will be explored in the Action Research Cycle trial (phase 3). For the Friendly trial, 7 older adult participants aged ≥60 years and living alone in their own homes for a 10-week period were enrolled. A total of 30 older adult participants aged ≥60 years and living alone in their own homes will be recruited for a 10-week data collection period (phase 3). Results: Phase 1 of the project (n=426) was completed in December 2020, and phase 2 (n=7 participants for a 10-week pilot study) was completed in September 2021. The expected completion date for the third project phase (30 participants for the 10-week usability study) is June 2022. Conclusions: The NEX project has considered the specific everyday needs of older adults and other stakeholders, which have contributed to the design of the integrated system. The innovation of the NEX system lies in the use of Internet of Things technologies and artificial intelligence to identify and predict changes in the routines of older adults. The findings of this project will contribute to the eHealth research agenda, focusing on the improvement of health care provision and patient support in home and community environments. International Registered Report Identifier (IRRID): DERR1-10.2196/35277 %M 35511224 %R 10.2196/35277 %U https://www.researchprotocols.org/2022/5/e35277 %U https://doi.org/10.2196/35277 %U http://www.ncbi.nlm.nih.gov/pubmed/35511224 %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 e28222 %T Using GPS Tracking to Investigate Outdoor Navigation Patterns in Patients With Alzheimer Disease: Cross-sectional Study %A Puthusseryppady,Vaisakh %A Morrissey,Sol %A Aung,Min Hane %A Coughlan,Gillian %A Patel,Martyn %A Hornberger,Michael %+ Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 59 7139, m.hornberger@uea.ac.uk %K Alzheimer disease %K dementia %K spatial disorientation %K getting lost %K outdoor navigation %K risk factors %K environmental %K GPS tracking %K community %K mobile phone %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Spatial disorientation is one of the earliest and most distressing symptoms seen in patients with Alzheimer disease (AD) and can lead to them getting lost in the community. Although it is a prevalent problem worldwide and is associated with various negative consequences, very little is known about the extent to which outdoor navigation patterns of patients with AD explain why spatial disorientation occurs for them even in familiar surroundings. Objective: This study aims to understand the outdoor navigation patterns of patients with AD in different conditions (alone vs accompanied; disoriented vs not disoriented during the study) and investigate whether patients with AD experienced spatial disorientation when navigating through environments with a high outdoor landmark density and complex road network structure (road intersection density, intersection complexity, and orientation entropy). Methods: We investigated the outdoor navigation patterns of community-dwelling patients with AD (n=15) and age-matched healthy controls (n=18) over a 2-week period using GPS tracking and trajectory mining analytical techniques. Here, for the patients, the occurrence of any spatial disorientation behavior during this tracking period was recorded. We also used a spatial buffer methodology to capture the outdoor landmark density and features of the road network in the environments that the participants visited during the tracking period. Results: The patients with AD had outdoor navigation patterns similar to those of the controls when they were accompanied; however, when they were alone, they had significantly fewer outings per day (total outings: P<.001; day outings: P=.003; night outings: P<.001), lower time spent moving per outing (P=.001), lower total distance covered per outing (P=.009), lower walking distance per outing (P=.02), and lower mean distance from home per outing (P=.004). Our results did not identify any mobility risk factors for spatial disorientation. We also found that the environments visited by patients who experienced disorientation versus those who maintained their orientation during the tracking period did not significantly differ in outdoor landmark density (P=.60) or road network structure (road intersection density: P=.43; intersection complexity: P=.45; orientation entropy: P=.89). Conclusions: Our findings suggest that when alone, patients with AD restrict the spatial and temporal extent of their outdoor navigation in the community to successfully reduce their perceived risk of spatial disorientation. Implications of this work highlight the importance for future research to identify which of these individuals may be at an actual high risk for spatial disorientation as well as to explore the implementation of health care measures to help maintain a balance between patients’ right to safety and autonomy when making outings alone in the community. %M 35451965 %R 10.2196/28222 %U https://aging.jmir.org/2022/2/e28222 %U https://doi.org/10.2196/28222 %U http://www.ncbi.nlm.nih.gov/pubmed/35451965 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e36825 %T A Computerized Cognitive Test Battery for Detection of Dementia and Mild Cognitive Impairment: Instrument Validation Study %A Ye,Siao %A Sun,Kevin %A Huynh,Duong %A Phi,Huy Q %A Ko,Brian %A Huang,Bin %A Hosseini Ghomi,Reza %+ BrainCheck, Inc, 5616 Kirby Dr. # 690, Houston, TX, 77005, United States, 1 888 416 0004, bin@braincheck.com %K cognitive test %K mild cognitive impairment %K dementia %K cognitive decline %K repeatable battery %K discriminant analysis %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Early detection of dementia is critical for intervention and care planning but remains difficult. Computerized cognitive testing provides an accessible and promising solution to address these current challenges. Objective: The aim of this study was to evaluate a computerized cognitive testing battery (BrainCheck) for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment. Methods: A total of 99 participants diagnosed with dementia, mild cognitive impairment (MCI), or normal cognition (NC) completed the BrainCheck battery. Statistical analyses compared participant performances on BrainCheck based on their diagnostic group. Results: BrainCheck battery performance showed significant differences between the NC, MCI, and dementia groups, achieving 88% or higher sensitivity and specificity (ie, true positive and true negative rates) for separating dementia from NC, and 77% or higher sensitivity and specificity in separating the MCI group from the NC and dementia groups. Three-group classification found true positive rates of 80% or higher for the NC and dementia groups and true positive rates of 64% or higher for the MCI group. Conclusions: BrainCheck was able to distinguish between diagnoses of dementia, MCI, and NC, providing a potentially reliable tool for early detection of cognitive impairment. %M 35436212 %R 10.2196/36825 %U https://aging.jmir.org/2022/2/e36825 %U https://doi.org/10.2196/36825 %U http://www.ncbi.nlm.nih.gov/pubmed/35436212 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e31162 %T Technology-Mediated Enrichment in Aged Care: Survey and Interview Study %A Waycott,Jenny %A Zhao,Wei %A Kelly,Ryan M %A Robertson,Elena %+ School of Computing and Information Systems, The University of Melbourne, 700 Swanston Street, Melbourne, 3010, Australia, 61 383448964, jwaycott@unimelb.edu.au %K aged care %K older adults %K technology %K social enrichment %K virtual reality %K robots %K videoconferencing %K care providers %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technologies such as virtual reality (VR), humanoid robots, and digital companion pets have the potential to provide social and emotional enrichment for people living in aged care. However, there is currently limited knowledge about how technologies are being used to provide enrichment, what benefits they provide, and what challenges arise when deploying these technologies in aged care settings. Objective: This study aims to investigate how digital technologies are being used for social and emotional enrichment in the Australian aged care industry and identify the benefits and challenges of using technology for enrichment in aged care. Methods: A web-based survey (N=20) was distributed among people working in the Australian aged care sector. The survey collected information about the types of technologies being deployed and their perceived value. The survey was followed by semistructured interviews (N=12) with aged care workers and technology developers to investigate their experiences of deploying technologies with older adults living in aged care. Survey data were analyzed using summary descriptive statistics and categorizing open-ended text responses. Interview data were analyzed using reflexive thematic analysis. Results: The survey revealed that a range of commercial technologies, such as VR, tablet devices, and mobile phones, are being used in aged care to support social activities and provide entertainment. Respondents had differing views about the value of emerging technologies, such as VR, social robots, and robot pets, but were more united in their views about the value of videoconferencing. Interviews revealed 4 types of technology-mediated enrichment experiences: enhancing social engagement, virtually leaving the care home, reconnecting with personal interests, and providing entertainment and distraction. Our analysis identified 5 barriers: resource constraints, the need to select appropriate devices and apps, client challenges, limited staff and organizational support, and family resistance. Conclusions: This study demonstrates that technologies can be used in aged care to create personally meaningful enrichment experiences for aged care clients. To maximize the effectiveness of technology-mediated enrichment, we argue that a person-centered care approach is crucial. Although enrichment experiences can be created using available technologies, they must be carefully selected and co-deployed with aged care clients. However, significant changes may be required within organizations to allow caregivers to facilitate individual technology-based activities for enrichment. %M 34975014 %R 10.2196/31162 %U https://aging.jmir.org/2022/2/e31162 %U https://doi.org/10.2196/31162 %U http://www.ncbi.nlm.nih.gov/pubmed/34975014 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e35687 %T Continuous Glucose Monitoring Data Sharing in Older Adults With Type 1 Diabetes: Pilot Intervention Study %A Allen,Nancy A %A Litchman,Michelle L %A Chamberlain,James %A Grigorian,Ernest G %A Iacob,Eli %A Berg,Cynthia A %+ College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, United States, 1 801 585 1381, nancy.allen@nurs.utah.edu %K older adults %K type 1 diabetes %K caregiver %K CGM %K data sharing %K mobile phone %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Family members or friends (care partners [CPs]) of older adults with type 1 diabetes (T1DM) regularly become part of the diabetes care team, but they often lack knowledge about how to become involved to prevent hypo- and hyperglycemia. Continuous glucose monitoring (CGM) allows a person with diabetes to see their glucose levels continuously and to receive predictive alerts. A smartphone data-sharing app called the Follow app allows the person with diabetes to share continuous glucose numbers with others and to receive predictive alerts of impending hypo- and hyperglycemia. However, there are barriers to sharing this continuous glucose level data with CPs. Objective: This study aimed to address the barriers to sharing CGM data. Our objective was to examine the feasibility of using CGM with the Follow app and a data-sharing intervention called SHARE plus in older adults with T1DM and their CPs. SHARE plus includes dyadic communication strategies, problem-solving strategies, and action planning to facilitate CGM data sharing. Methods: Older adults with T1DM (n=20) and their CPs (n=20) received the SHARE plus intervention at baseline. People with diabetes wore the CGM for 12 weeks while sharing their glucose data using the Follow app with CPs. Feasibility data were analyzed using descriptive statistics. Results: The SHARE plus intervention was feasible and was associated with high self-reported satisfaction for people with diabetes and their CPs as well as high adherence to CGM (mean 96%, SD 6.8%). Broad improvements were shown in the diabetes-related quality of life through the use of CGM in people with diabetes and their CPs. Although the majority of people with diabetes (11/20, 55%) were willing to share hyperglycemia data, several chose not to. The majority of people with diabetes (14/20, 70%) were willing to talk about glucose numbers with a CP. Conclusions: Older adults with T1DM and their CPs identified having someone else aware of glucose levels and working together with a partner on diabetes self-management as positive aspects of the use of the SHARE plus intervention. Clinicians can use these results to provide data sharing coaching in older adults and their CPs. %M 35293868 %R 10.2196/35687 %U https://diabetes.jmir.org/2022/1/e35687 %U https://doi.org/10.2196/35687 %U http://www.ncbi.nlm.nih.gov/pubmed/35293868 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e32516 %T Refining a Digital Therapeutic Platform for Home Care Agencies in Dementia Care to Elicit Stakeholder Feedback: Focus Group Study With Stakeholders %A Gilson,Aaron %A Gassman,Michele %A Dodds,Debby %A Lombardo,Robin %A Ford II,James H %A Potteiger,Michael %+ Social & Administrative Pharmacy Division, School of Pharmacy, University of Wisconsin–Madison, 777 Highland Avenue, Madison, WI, 53705, United States, 1 608 262 4748, jhfordii@wisc.edu %K dementia %K technology %K mobile app %K home care %K focus groups %K qualitative research %K digital therapeutics %K value-based care %K aging in place %K caregiving %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Persons living with dementia require increasing levels of care, and the care model has evolved. The Centers for Medicare and Medicaid Services is transitioning long-term care services from institutional care to home- or community-based services, including reimbursement for nonclinical services. Although home care companies are positioned to handle this transition, they need innovative solutions to address the special challenges posed by caring for persons living with dementia. To live at home longer, these persons require support from formal caregivers (FCGs; ie, paid professionals), who often lack knowledge of their personal histories and have high turnover, or informal caregivers (eg, family or friends), who may have difficulty coping with behavioral and psychological symptoms of dementia. The Generation Connect platform was developed to support these individuals and their formal and informal caregivers. In preliminary studies, the platform improved mood and influenced caregiver satisfaction. To enhance platform effectiveness, Generation Connect received a grant from the National Institutes of Health Small Business Innovation Research to improve clinical outcomes, reduce health care costs, and lower out-of-pocket costs for persons living with dementia who receive care through home care agencies. Objective: This study aims to evaluate information elicited from a series of stakeholder focus groups to understand existing processes, needs, barriers, and goals for the use of the Generation Connect platform by home care agencies and formal and informal caregivers. Methods: A series of focus groups were conducted with home care agency corporate leadership, home care agency franchise owners, home care agency FCGs, and informal caregivers of persons living with dementia. The qualitative approach allowed for unrestricted idea generation that best informed the platform development to enable home care providers to differentiate their dementia care services, involve informal caregivers, improve FCG well-being, and extend the ability of persons living with dementia to age in place. Using the Technology-Enabled Caregiving in the Home framework, an inductive and iterative content analysis was conducted to identify thematic categories from the transcripts. Results: Overall, 39 participants participated across the 6 stakeholder focus groups. The following five overarching themes were identified: technology related; care services; data, documentation, and outcomes; cost, finance, and resources; and resources for caregivers. Within each theme, the most frequent subthemes were identified. Exemplar stakeholder group statements provided support for each of the identified themes. Conclusions: The focus group results will inform the further development of the Generation Connect platform to reduce the burden of caregiving for persons living with dementia, evaluate changes in cognition, preserve functional independence, and promote caregiver engagement between these individuals. The next step is to evaluate the effectiveness of the revised platform in the National Institutes of Health Small Business Innovation Research phase 2 clinical trial to assess the efficacy of its evidence-based interventions and market viability. %M 35234657 %R 10.2196/32516 %U https://aging.jmir.org/2022/1/e32516 %U https://doi.org/10.2196/32516 %U http://www.ncbi.nlm.nih.gov/pubmed/35234657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e26652 %T Usability, Acceptability, and Satisfaction of a Wearable Activity Tracker in Older Adults: Observational Study in a Real-Life Context in Northern Portugal %A Domingos,Célia %A Costa,Patrício %A Santos,Nadine Correia %A Pêgo,José Miguel %+ Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Largo do Paço, Braga, 4710-057, Portugal, 351 253 604 800, jmpego@med.uminho.pt %K user experience %K Technology Acceptance Model %K health monitoring %K fitness trackers %K aging %K seniors %D 2022 %7 26.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of activity trackers has significantly increased over the last few years. This technology has the potential to improve the levels of physical activity and health-related behaviors in older adults. However, despite the potential benefits, the rate of adoption remains low among older adults. Therefore, understanding how technology is perceived may potentially offer insight to promote its use. Objective: This study aimed to (1) assess acceptability, usability, and user satisfaction with the Xiaomi Mi Band 2 in Portuguese community-dwelling older adults in a real-world context; (2) explore the mediating effect of the usability on the relationship between user characteristics and satisfaction; and (3) examine the moderating effect of user characteristics on the relationship between usability and user satisfaction. Methods: Older adults used the Xiaomi Mi Band 2 over 15 days. The user experience was evaluated through the Technology Acceptance Model 3, System Usability Scale, and User Satisfaction Evaluation Questionnaire. An integrated framework for usability and user satisfaction was used to explore user experience. Statistical data analysis included descriptive data analysis, reliability analysis, confirmatory factor analysis, and mediation and moderation analyses. Results: A sample of 110 older adults with an average age of 68.41 years (SD 3.11) completed the user experience questionnaires. Mean user acceptance was very high—perceived ease of use: 6.45 (SD 0.78); perceptions of external control: 6.74 (SD 0.55); computer anxiety: 6.85 (SD 0.47); and behavioral intention: 6.60 (SD 0.97). The usability was excellent with an average score of 92.70 (SD 10.73), and user satisfaction was classified as a good experience 23.30 (SD 2.40). The mediation analysis confirmed the direct positive effect of usability on satisfaction (β=.530; P<.01) and the direct negative effect of depression on usability (β=–.369; P<.01). Lastly, the indirect effect of usability on user satisfaction was higher in individuals with lower Geriatric Depression Scale levels. Conclusions: Findings demonstrate that the Xiaomi Mi Band 2 is suitable for older adults. Furthermore, the results confirmed usability as a determinant of satisfaction with the technology and extended the existing knowledge about wearable activity trackers in older adults. %M 35080503 %R 10.2196/26652 %U https://www.jmir.org/2022/1/e26652 %U https://doi.org/10.2196/26652 %U http://www.ncbi.nlm.nih.gov/pubmed/35080503 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26767 %T The Use of Smart Speakers in Care Home Residents: Implementation Study %A Edwards,Katie J %A Jones,Ray B %A Shenton,Deborah %A Page,Toni %A Maramba,Inocencio %A Warren,Alison %A Fraser,Fiona %A Križaj,Tanja %A Coombe,Tristan %A Cowls,Hazel %A Chatterjee,Arunangsu %+ Centre for Health Technology, University of Plymouth, Desk 6, Formation Zone, Health and Wellbeing Innovation Centre, The Knowledge Spa, Plymouth, TR1 3HD, United Kingdom, 44 07432155243, katie.edwards@plymouth.ac.uk %K voice-activated technology %K smart speaker %K care home %K technology-enabled care %K older people %K learning disability %K digital technology %K consumer device %K smart device %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of smart speakers to improve well-being had been trialed in social care by others; however, we were not aware of their implementation in most care homes across a region in the Southwest of the United Kingdom. For the widespread adoption of new technology, it must be locally demonstrable and become normalized. Objective: The aim of this study was to install smart speakers in care homes in a rural and coastal region and to explore if and how the devices were being used, the barriers to their implementation, and their potential benefits. Methods: Email, workshops, drop-in sessions, phone, and cold calling was used to contact all 230 care homes, offering a free smart speaker and some advisory support. Care homes accepting the devices were asked to complete a feedback diary. Nonresponse rate for diary completion was high and was thus supplemented with a telephone survey. Results: Over the course of 7 months, we installed 156 devices in 92 care homes for older people, 50 devices for people with physical or mental health needs, and 8 for others. The devices were used mainly for music but also for poetry, recipes, light controls, jokes, and video calls. Care home managers reported the benefits for the residents, including enhanced engagement with home activities, enjoyment, calming effects, and the acquisition of new skills. Implementation problems included internet connectivity, staff capacity, and skills. Conclusions: Affordable consumer devices such as smart speakers should be installed in all care homes to benefit residents. Voice-activated technologies are easy to use and promote interaction. This study indicates that implementation in care homes was possible and that smart speakers had multifaceted benefits for residents and staff. Most care homes in this region now use smart speakers for their residents, thereby normalizing this practice. %M 34932010 %R 10.2196/26767 %U https://www.jmir.org/2021/12/e26767 %U https://doi.org/10.2196/26767 %U http://www.ncbi.nlm.nih.gov/pubmed/34932010 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e30135 %T Automatic Recognition and Analysis of Balance Activity in Community-Dwelling Older Adults: Algorithm Validation %A Hsu,Yu-Cheng %A Wang,Hailiang %A Zhao,Yang %A Chen,Frank %A Tsui,Kwok-Leung %+ School of Public Health (Shenzhen), Sun Yat-sen University, Room 111, Unit 1, Gezhi Garden 3#, No. 132, East Outer Ring Road, Guangzhou Higher Education Mega Center, Guangzhou, 510000, China, 86 020 83226383, zhaoy393@mail.sysu.edu.cn %K fall risk %K balance %K activity recognition %K automatic framework %K community-dwelling elderly %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical mobility and balance assessments identify older adults who have a high risk of falls in clinics. In the past two decades, sensors have been a popular supplement to mobility and balance assessment to provide quantitative information and a cost-effective solution in the community environment. Nonetheless, the current sensor-based balance assessment relies on manual observation or motion-specific features to identify motions of research interest. Objective: The objective of this study was to develop an automatic motion data analytics framework using signal data collected from an inertial sensor for balance activity analysis in community-dwelling older adults. Methods: In total, 59 community-dwelling older adults (19 males and 40 females; mean age = 81.86 years, SD 6.95 years) were recruited in this study. Data were collected using a body-worn inertial measurement unit (including an accelerometer and a gyroscope) at the L4 vertebra of each individual. After data preprocessing and motion detection via a convolutional long short-term memory (LSTM) neural network, a one-class support vector machine (SVM), linear discriminant analysis (LDA), and k-nearest neighborhood (k-NN) were adopted to classify high-risk individuals. Results: The framework developed in this study yielded mean accuracies of 87%, 86%, and 89% in detecting sit-to-stand, turning 360°, and stand-to-sit motions, respectively. The balance assessment classification showed accuracies of 90%, 92%, and 86% in classifying abnormal sit-to-stand, turning 360°, and stand-to-sit motions, respectively, using Tinetti Performance Oriented Mobility Assessment-Balance (POMA-B) criteria by the one-class SVM and k-NN. Conclusions: The sensor-based approach presented in this study provided a time-effective manner with less human efforts to identify and preprocess the inertial signal and thus enabled an efficient balance assessment tool for medical professionals. In the long run, the approach may offer a flexible solution to relieve the community’s burden of continuous health monitoring. %M 34932008 %R 10.2196/30135 %U https://www.jmir.org/2021/12/e30135 %U https://doi.org/10.2196/30135 %U http://www.ncbi.nlm.nih.gov/pubmed/34932008 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e30353 %T Dementia Caregiver Experiences and Recommendations for Using the Behavioral and Environmental Sensing and Intervention System at Home: Usability and Acceptability Study %A Anderson,Martha Smith %A Bankole,Azziza %A Homdee,Nutta %A Mitchell,Brook A %A Byfield,Grace E %A Lach,John %+ Department of Health Care Innovation and Implementation Science, Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA, 24016, United States, 1 540 520 2761, msaconsulting@mail.com %K dementia %K agitation %K sensors %K smart health %K wearable technology %K just-in-time notifications %K caregiver %K dyad %K home-based %K qualitative %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Caregiver burden associated with dementia-related agitation is one of the most common reasons for a community-dwelling person living with dementia to transition to a care facility. The Behavioral and Environmental Sensing and Intervention (BESI) for the Dementia Caregiver Empowerment system uses sensing technology, smartwatches, tablets, and data analytics to detect and predict agitation in persons living with dementia and to provide just-in-time notifications and dyad-specific intervention recommendations to caregivers. The BESI system has shown that there is a valid relationship between dementia-related agitation and environmental factors and that caregivers prefer a home-based monitoring system. Objective: The aim of this study is to obtain input from caregivers of persons living with dementia on the value, usability, and acceptability of the BESI system in the home setting and obtain their insights and recommendations for the next stage of system development. Methods: A descriptive qualitative design with thematic analysis was used to analyze 10 semistructured interviews with caregivers. The interviews comprised 16 questions, with an 80% (128/160) response rate. Results: Postdeployment caregiver feedback about the BESI system and the overall experience were generally positive. Caregivers acknowledged the acceptability of the system by noting the ease of use and saw the system as a fit for them. Functionality issues such as timeliness in agitation notification and simplicity in the selection of agitation descriptors on the tablet interface were identified, and caregivers indicated a desire for more word options to describe agitation behaviors. Agitation intervention suggestions were well received by the caregivers, and the resulting decrease in the number and severity of agitation events helped confirm that the BESI system has good value and acceptability. Thematic analysis suggested several subjective experiences and yielded the themes of usefulness and helpfulness. Conclusions: This study determined preferences for assessing caregiver strain and burden, explored caregiver acceptance of the technology system (in-home sensors, actigraph or smart watch technology, and tablet devices), discerned caregiver insights on the burden and stress of caring for persons living with dementia experiencing agitation in dementia, and solicited caregiver input and recommendations for system changes. The themes of usefulness and helpfulness support the use of caregiver knowledge and experience to inform further development of the technology. %M 34874886 %R 10.2196/30353 %U https://aging.jmir.org/2021/4/e30353 %U https://doi.org/10.2196/30353 %U http://www.ncbi.nlm.nih.gov/pubmed/34874886 %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 %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e30420 %T Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation %A Pan,Jing %A Dong,Hua %A Bryan-Kinns,Nick %+ Brunel Design School, Brunel University London, Kingston Lane, Uxbridge, Middlesex UB8 3PH, London, United Kingdom, 44 01895 257254, Hua.Dong@brunel.ac.uk %K older adults %K mHealth %K initial adoption %K technology acceptance %K design %K mobile phone %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective: The aims of this study are to understand older adults’ perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods: This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults’ perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results: In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults’ perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults’ adoption of mHealth services. Conclusions: The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults. %M 34807836 %R 10.2196/30420 %U https://aging.jmir.org/2021/4/e30420 %U https://doi.org/10.2196/30420 %U http://www.ncbi.nlm.nih.gov/pubmed/34807836 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e16824 %T Developing a Management Guide (the DemPower App) for Couples Where One Partner Has Dementia: Nonrandomized Feasibility Study %A Lasrado,Reena %A Bielsten,Therese %A Hann,Mark %A Schumm,James %A Reilly,Siobhan Theresa %A Davies,Linda %A Swarbrick,Caroline %A Dowlen,Robyn %A Keady,John %A Hellström,Ingrid %+ Social Care & Society, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1613067884, reena.lasrado@manchester.ac.uk %K dementia guide %K self-management for couples with dementia %K dementia self-help %K dementia app %K dementia resource %K feasibility study %K nonrandomized study %K dementia intervention %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Promoting the health and well-being of couples where one partner has dementia is an overlooked area of care practice. Most postdiagnostic services currently lack a couple-centered approach and have a limited focus on the couple relationship. To help address this situation, we developed a tablet-based self-management guide (DemPower) focused on helping couples enhance their well-being and relationship quality. Objective: The aim of this study is to investigate the feasibility and acceptability of the DemPower app. Methods: A nonrandomized feasibility design was used to evaluate the DemPower intervention over 3 months among couples where a partner had a diagnosis of dementia. The study recruited 25 couples in the United Kingdom and 19 couples in Sweden. Outcome measures were obtained at baseline and postintervention. The study process and interventions were evaluated at various stages. Results: The study was completed by 48% (21/44) of couples where one partner had dementia, of whom 86% (18/21) of couples accessed all parts of the DemPower app. Each couple spent an average of 8 hours (SD 3.35 hours) using the app during the study period. In total, 90% (19/21) of couples reported that all sections of DemPower were useful in addressing various aspects of daily life and helped to focus on how they interacted in their relationship. Of the 4 core subjects on which the DemPower app was structured, home and neighborhood received the highest number of visits. Couples used activity sections more often than the core subject pages. The perception of DemPower’s utility varied with each couple’s lived experience of dementia, geographic location, relationship dynamics, and opportunities for social interaction. A 5.2-point increase in the dementia quality of life score for people with dementia and a marginal increase in the Mutuality scale (+1.23 points) for caregiver spouses were found. Design and navigational challenges were reported in the DemPower app. Conclusions: The findings suggest that the DemPower app is a useful resource for couples where one partner has dementia and that the implementation of the app requires the support of memory clinics to reach couples at early diagnosis. Trial Registration: ISRCTN Registry ISRCTN10122979; http://www.isrctn.com/ISRCTN10122979 %M 34783666 %R 10.2196/16824 %U https://aging.jmir.org/2021/4/e16824 %U https://doi.org/10.2196/16824 %U http://www.ncbi.nlm.nih.gov/pubmed/34783666 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e15220 %T Feasibility of Real-time Behavior Monitoring Via Mobile Technology in Czech Adults Aged 50 Years and Above: 12-Week Study With Ecological Momentary Assessment %A Elavsky,Steriani %A Klocek,Adam %A Knapova,Lenka %A Smahelova,Martina %A Smahel,David %A Cimler,Richard %A Kuhnova,Jitka %+ Department of Human Movement Studies, University of Ostrava, Varenska 40a, Ostrava, 70200, Czech Republic, 420 553462588, steriani.elavsky@osu.cz %K mHealth %K mobile phone %K older adults %K health behavior %K physical activity %K Fitbit %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Czech older adults have lower rates of physical activity than the average population and lag behind in the use of digital technologies, compared with their peers from other European countries. Objective: This study aims to assess the feasibility of intensive behavior monitoring through technology in Czech adults aged ≥50 years. Methods: Participants (N=30; mean age 61.2 years, SD 6.8 years, range 50-74 years; 16/30, 53% male; 7/30, 23% retired) were monitored for 12 weeks while wearing a Fitbit Charge 2 monitor and completed three 8-day bursts of intensive data collection through surveys presented on a custom-made mobile app. Web-based surveys were also completed before and at the end of the 12-week period (along with poststudy focus groups) to evaluate participants’ perceptions of their experience in the study. Results: All 30 participants completed the study. Across the three 8-day bursts, participants completed 1454 out of 1744 (83% compliance rate) surveys administered 3 times per day on a pseudorandom schedule, 451 out of 559 (81% compliance rate) end-of-day surveys, and 736 episodes of self-reported planned physical activity (with 29/736, 3.9% of the reports initiated but returned without data). The overall rating of using the mobile app and Fitbit was above average (74.5 out of 100 on the System Usability Scale). The majority reported that the Fitbit (27/30, 90%) and mobile app (25/30, 83%) were easy to use and rated their experience positively (25/30, 83%). Focus groups revealed that some surveys were missed owing to notifications not being noticed or that participants needed a longer time window for survey completion. Some found wearing the monitor in hot weather or at night uncomfortable, but overall, participants were highly motivated to complete the surveys and be compliant with the study procedures. Conclusions: The use of a mobile survey app coupled with a wearable device appears feasible for use among Czech older adults. Participants in this study tolerated the intensive assessment schedule well, but lower compliance may be expected in studies of more diverse groups of older adults. Some difficulties were noted with the pairing and synchronization of devices on some types of smartphones, posing challenges for large-scale studies. %M 34757317 %R 10.2196/15220 %U https://aging.jmir.org/2021/4/e15220 %U https://doi.org/10.2196/15220 %U http://www.ncbi.nlm.nih.gov/pubmed/34757317 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e29788 %T Clinicians and Older Adults’ Perceptions of the Utility of Patient-Generated Health Data in Caring for Older Adults: Exploratory Mixed Methods Study %A Kim,Ben %A Ghasemi,Peyman %A Stolee,Paul %A Lee,Joon %+ Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada, 1 403 220 2968, joonwu.lee@ucalgary.ca %K mobile health %K mHealth %K older adults %K wearables %K patient generated health data %K chronic disease management %K home care %K self-care %K activities of daily living %K sleep %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Many people are motivated to self-track their health and optimize their well-being through mobile health apps and wearable devices. The diversity and complexity of these systems have evolved over time, resulting in a large amount of data referred to as patient-generated health data (PGHD), which has recently emerged as a useful set of data elements in health care systems around the world. Despite the increased interest in PGHD, clinicians and older adults’ perceptions of PGHD are poorly understood. In particular, although some clinician barriers to using PGHD have been identified, such as concerns about data quality, ease of use, reliability, privacy, and regulatory issues, little is known from the perspectives of older adults. Objective: This study aims to explore the similarities and differences in the perceptions of older adults and clinicians with regard to how various types of PGHD can be used to care for older adults. Methods: A mixed methods study was conducted to explore clinicians and older adults’ perceptions of PGHD. Focus groups were conducted with older adults and health care providers from the Greater Toronto area and the Kitchener-Waterloo region. The participants were asked to discuss their perceptions of PGHD, including facilitators and barriers. A questionnaire aimed at exploring the perceived usefulness of a range of different PGHD was also embedded in the study design. Focus group interviews were transcribed for thematic analysis, whereas the questionnaire results were analyzed using descriptive statistics. Results: Of the 9 participants, 4 (44%) were clinicians (average age 38.3 years, SD 7 years), and 5 (56%) were older adults (average age 81.0 years, SD 9.1 years). Four main themes were identified from the focus group interviews: influence of PGHD on patient-provider trust, reliability of PGHD, meaningful use of PGHD and PGHD-based decision support systems, and perceived clinical benefits and intrusiveness of PGHD. The questionnaire results were significantly correlated with the frequency of PGHD mentioned in the focus group interviews (r=0.42; P=.03) and demonstrated that older adults and clinicians perceived blood glucose, step count, physical activity, sleep, blood pressure, and stress level as the most useful data for managing health and delivering high-quality care. Conclusions: This embedded mixed methods study generated several important findings about older adults and clinicians’ perceptions and perceived usefulness of a range of PGHD. Owing to the exploratory nature of this study, further research is needed to understand the concerns about data privacy, potential negative impact on the trust between older adults and clinicians, data quality and quantity, and usability of PGHD-related technologies for older adults. %M 34738913 %R 10.2196/29788 %U https://aging.jmir.org/2021/4/e29788 %U https://doi.org/10.2196/29788 %U http://www.ncbi.nlm.nih.gov/pubmed/34738913 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26305 %T Detecting Parkinson Disease Using a Web-Based Speech Task: Observational Study %A Rahman,Wasifur %A Lee,Sangwu %A Islam,Md Saiful %A Antony,Victor Nikhil %A Ratnu,Harshil %A Ali,Mohammad Rafayet %A Mamun,Abdullah Al %A Wagner,Ellen %A Jensen-Roberts,Stella %A Waddell,Emma %A Myers,Taylor %A Pawlik,Meghan %A Soto,Julia %A Coffey,Madeleine %A Sarkar,Aayush %A Schneider,Ruth %A Tarolli,Christopher %A Lizarraga,Karlo %A Adams,Jamie %A Little,Max A %A Dorsey,E Ray %A Hoque,Ehsan %+ Department of Computer Science, University of Rochester, 250 Hutchinson Rd, Rochester, NY, 14620, United States, 1 5857487677, echowdh2@ur.rochester.edu %K Parkinson’s disease %K speech analysis %K improving access and equity in health care %K mobile phone %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Access to neurological care for Parkinson disease (PD) is a rare privilege for millions of people worldwide, especially in resource-limited countries. In 2013, there were just 1200 neurologists in India for a population of 1.3 billion people; in Africa, the average population per neurologist exceeds 3.3 million people. In contrast, 60,000 people receive a diagnosis of PD every year in the United States alone, and similar patterns of rising PD cases—fueled mostly by environmental pollution and an aging population—can be seen worldwide. The current projection of more than 12 million patients with PD worldwide by 2040 is only part of the picture given that more than 20% of patients with PD remain undiagnosed. Timely diagnosis and frequent assessment are key to ensure timely and appropriate medical intervention, thus improving the quality of life of patients with PD. Objective: In this paper, we propose a web-based framework that can help anyone anywhere around the world record a short speech task and analyze the recorded data to screen for PD. Methods: We collected data from 726 unique participants (PD: 262/726, 36.1% were women; non-PD: 464/726, 63.9% were women; average age 61 years) from all over the United States and beyond. A small portion of the data (approximately 54/726, 7.4%) was collected in a laboratory setting to compare the performance of the models trained with noisy home environment data against high-quality laboratory-environment data. The participants were instructed to utter a popular pangram containing all the letters in the English alphabet, “the quick brown fox jumps over the lazy dog.” We extracted both standard acoustic features (mel-frequency cepstral coefficients and jitter and shimmer variants) and deep learning–based embedding features from the speech data. Using these features, we trained several machine learning algorithms. We also applied model interpretation techniques such as Shapley additive explanations to ascertain the importance of each feature in determining the model’s output. Results: We achieved an area under the curve of 0.753 for determining the presence of self-reported PD by modeling the standard acoustic features through the XGBoost—a gradient-boosted decision tree model. Further analysis revealed that the widely used mel-frequency cepstral coefficient features and a subset of previously validated dysphonia features designed for detecting PD from a verbal phonation task (pronouncing “ahh”) influence the model’s decision the most. Conclusions: Our model performed equally well on data collected in a controlled laboratory environment and in the wild across different gender and age groups. Using this tool, we can collect data from almost anyone anywhere with an audio-enabled device and help the participants screen for PD remotely, contributing to equity and access in neurological care. %M 34665148 %R 10.2196/26305 %U https://www.jmir.org/2021/10/e26305 %U https://doi.org/10.2196/26305 %U http://www.ncbi.nlm.nih.gov/pubmed/34665148 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29884 %T Accuracy and Diversity of Wearable Device–Based Gait Speed Measurement Among Older Men: Observational Study %A Kang,Min-gu %A Kang,Seong-Ji %A Roh,Hye-Kang %A Jung,Hwa-Young %A Kim,Sun‑wook %A Choi,Jung-Yeon %A Kim,Kwang-il %+ Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 Beon-Gil, Seongnamsi Gyeonggi-Do, Seongnam, 13620, Republic of Korea, 82 317877032, kikim907@snu.ac.kr %K gait speed %K sarcopenia %K skeletal muscle mass %K wearable device %D 2021 %7 11.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Gait speed measurements are widely used in clinical practice, as slow gait is a major predictor of frailty and a diagnostic criterion for sarcopenia. With the development of wearable devices, it is possible to estimate the gait speed in daily life by simply wearing the device. Objective: This study aims to accurately determine the characteristics of daily life gait speed and analyze their association with sarcopenia. Methods: We invited community-dwelling men aged >50 years who had visited the outpatient clinic at a tertiary university hospital to participate in the study. Daily life gait speed was assessed using a wearable smart belt (WELT) for a period of 4 weeks. Data from participants who wore the smart belt for at least 10 days during this period were included. After 4 weeks, data from a survey about medical and social history, usual gait speed measurements, handgrip strength measurements, and dual-energy x-ray absorptiometry were analyzed. Results: A total of 217,578 daily life gait speed measurements from 106 participants (mean age 71.1, SD 7.6 years) were analyzed. The mean daily life gait speed was 1.23 (SD 0.26) m/s. The daily life gait speed of the participants varied according to the time of the day and day of the week. Daily life gait speed significantly slowed down with age (P<.001). Participants with sarcopenia had significantly lower mean daily life gait speed (mean 1.12, SD 0.11 m/s) than participants without sarcopenia (mean 1.23, SD 0.08 m/s; P<.001). Analysis of factors related to mean daily life gait speed showed that age and skeletal muscle mass of the lower limbs were significantly associated characteristics. Conclusions: More diverse and accurate information about gait speed can be obtained by measuring daily life gait speed using a wearable device over an appropriate period, compared with one-time measurements performed in a laboratory setting. Importantly, in addition to age, daily life gait speed is significantly associated with skeletal muscle mass of the lower limbs. %M 34633293 %R 10.2196/29884 %U https://www.jmir.org/2021/10/e29884 %U https://doi.org/10.2196/29884 %U http://www.ncbi.nlm.nih.gov/pubmed/34633293 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27267 %T Mobile Safety Alarms Based on GPS Technology in the Care of Older Adults: Systematic Review of Evidence Based on a General Evidence Framework for Digital Health Technologies %A Ehn,Maria %A Richardson,Matt X %A Landerdahl Stridsberg,Sara %A Redekop,Ken %A Wamala-Andersson,Sarah %+ School of Innovation, Design and Engineering, Mälardalen University, Box 883, Västerås, SE-721 23, Sweden, 46 21 107093, maria.ehn@mdh.se %K GPS %K older adults %K dementia %K evidence %K digital health %K NICE %K mobile phone %D 2021 %7 11.10.2021 %9 Review %J J Med Internet Res %G English %X Background: GPS alarms aim to support users in independent activities. Previous systematic reviews have reported a lack of clear evidence of the effectiveness of GPS alarms for the health and welfare of users and their families and for social care provision. As GPS devices are currently being implemented in social care, it is important to investigate whether the evidence of their clinical effectiveness remains insufficient. Standardized evidence frameworks have been developed to ensure that new technologies are clinically effective and offer economic value. The frameworks for analyzing existing evidence of the clinical effectiveness of GPS devices can be used to identify the risks associated with their implementation and demonstrate key aspects of successful piloting or implementation. Objective: The principal aim of this study is to provide an up-to-date systematic review of evidence based on existing studies of the effects of GPS alarms on health, welfare, and social provision in the care of older adults compared with non–GPS-based standard care. In addition, the study findings were assessed by using the evidence standards framework for digital health technologies (DHTs) established by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. Methods: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Primary studies published in peer-reviewed journals and gray literature from January 2005 to August 2020 were identified through searches in 13 databases and several sources of gray literature. Included studies had individuals (aged ≥50 years) who were receiving social care for older adults or for persons with dementia; used GPS devices as an intervention; were performed in Canada, the United States, European Union, Singapore, Australia, New Zealand, Hong Kong, South Korea, or Japan; and addressed quantitative outcomes related to health, welfare, and social care. The study findings were analyzed by using the NICE framework requirements for active monitoring DHTs. Results: Of the screened records, 1.6% (16/986) were included. Following the standards of the NICE framework, practice evidence was identified for the tier 1 categories Relevance to current pathways in health/social care system and Acceptability with users, and minimum evidence was identified for the tier 1 category Credibility with health, social care professionals. However, several evidence categories for tiers 1 and 2 could not be assessed, and no clear evidence demonstrating effectiveness could be identified. Thus, the evidence required for using DHTs to track patient location according to the NICE framework was insufficient. Conclusions: Evidence of the beneficial effects of GPS alarms on the health and welfare of older adults and social care provision remains insufficient. This review illustrated the application of the NICE framework in analyses of evidence, demonstrated successful piloting and acceptability with users of GPS devices, and identified implications for future research. %M 34633291 %R 10.2196/27267 %U https://www.jmir.org/2021/10/e27267 %U https://doi.org/10.2196/27267 %U http://www.ncbi.nlm.nih.gov/pubmed/34633291 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e30841 %T Factors Influencing Implementation of eHealth Technologies to Support Informal Dementia Care: Umbrella Review %A Bastoni,Sofia %A Wrede,Christian %A da Silva,Marcia Cristina %A Sanderman,Robbert %A Gaggioli,Andrea %A Braakman-Jansen,Annemarie %A van Gemert-Pijnen,Lisette %+ Department of Psychology, Health & Technology, Centre for eHealth and Wellbeing Research, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 534895284, s.bastoni@utwente.nl %K eHealth %K assistive technologies %K dementia %K informal care %K home care %K implementation %D 2021 %7 8.10.2021 %9 Review %J JMIR Aging %G English %X Background: The worldwide increase in community-dwelling people with dementia underscores the need for innovative eHealth technologies that aim to provide support to both patients and their informal caregivers in the home setting. However, sustainable implementation of eHealth technologies within this target group can be difficult. Objective: The goal of this study was to gain a thorough understanding of why it is often difficult to implement eHealth technologies in practice, even though numerous technologies are designed to support people with dementia and their informal caregivers at home. In particular, our study aimed to (1) provide an overview of technologies that have been used and studied in the context of informal dementia care and (2) explore factors influencing the implementation of these technologies. Methods: Following an umbrella review design, five different databases were searched (PubMed, PsycINFO, Medline, Scopus, and Cochrane) for (systematic) reviews. Among 2205 reviews retrieved, 21 were included in our analysis based on our screening and selection procedure. A combination of deductive and inductive thematic analyses was performed, using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework for organizing the findings. Results: We identified technologies designed to be used “by informal caregivers,” “by people with dementia,” and “with people with dementia.” Within those groups, most of the represented technologies included, respectively: (i) devices for in-home monitoring of lifestyle, health, and safety; (ii) technologies for supporting memory, orientation, and day structure; and (iii) technologies to facilitate communication between the informal caregiver and person with dementia. Most of the identified factors influencing implementation related to the condition of dementia, characteristics of the technology, expected/perceived value of users, and characteristics of the informal caregiver. Considerably less information has been reported on factors related to the implementing organization and technology supplier, wider institutional and sociocultural context of policy and regulations, and continued adaptation of technology over time. Conclusions: Our study offers a comprehensive overview of eHealth technologies in the context of informal dementia care and contributes to gaining a better understanding of a broad range of factors influencing their implementation. Our results uncovered a knowledge gap regarding success factors for implementation related to the organizational and broader context and continuous adaptation over the long term. Although future research is needed, the current findings can help researchers and stakeholders in improving the development and implementation of eHealth technologies to support informal dementia care. %M 34623314 %R 10.2196/30841 %U https://aging.jmir.org/2021/4/e30841 %U https://doi.org/10.2196/30841 %U http://www.ncbi.nlm.nih.gov/pubmed/34623314 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e27862 %T Implementation of Unobtrusive Sensing Systems for Older Adult Care: Scoping Review %A Sharma,Nikita %A Brinke,Jeroen Klein %A Gemert-Pijnen,J E W C Van %A Braakman-Jansen,L M A %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7522NB, Netherlands, 31 534899238, n.sharma@utwente.nl %K elderly care %K unobtrusive %K sensing system %K caregiving %K implementation %K mobile phone %K older adults %D 2021 %7 6.10.2021 %9 Review %J JMIR Aging %G English %X Background: The continuous growth of the older adult population will have implications for the organization of health and social care. Potentially, in-home monitoring unobtrusive sensing systems (USSs) can be used to support formal or informal caregivers of older adults, as they can monitor deviant physical and physiological behavior changes. Most existing USSs are not specific to older adult care. Hence, to facilitate the implementation of existing USSs in older adult care, it is important to know which USSs would be more suitable for older adults. Objective: This scoping review aims to examine the literature to identify current USSs for monitoring human activities and behaviors and assess their implementation readiness for older adult care. Methods: We conducted a structured search in the Scopus, Web of Science, and ACM Digital Library databases. Predefined inclusion criteria included studies on unobtrusive sensor-based technology; experimental in nature; aimed at monitoring human social, emotional, physical, and physiological behavior; having the potential to be scalable in in-home care; and having at least 5 adults as participants. Using these criteria, we screened studies by title, abstract, and full text. A deductive thematic analysis based on the Proctor implementation framework along with an additional outcome of external validity was applied to the included studies to identify the factors contributing to successful implementation. Finally, the identified factors were used to report the implementation readiness of the included studies for older adult care. Results: In this review, 52 studies were included. Deductive analysis using the implementation framework by Proctor resulted in six factors that can contribute to the successful implementation of USSs in older adult care: study settings, age of participants, activities monitored, sensor setup, sensing technology used, and usefulness of USSs. These factors were associated with the implementation outcomes as follows: study settings and age of participants contributed to external validity, sensor setup contributed to acceptability, usefulness of USSs contributed to adoption, activities monitored contributed to appropriateness, and sensing technology used contributed to implementation cost. Furthermore, the implementation assessment of the included 52 studies showed that none of the studies addressed all the identified factors. This assessment was useful in highlighting studies that have addressed multiple factors; thus, these studies represent a step ahead in the implementation process. Conclusions: This review is the first to scope state-of-the-art USSs suitable for older adult care. Although the included 52 USS studies fulfilled the basic criteria to be suitable for older adult care, systems leveraging radio frequency technology in a no-contact sensor setup for monitoring life risk or health wellness activities are more suitable for older adult care. Finally, this review has extended the discussion about unobtrusiveness as a property of systems that cannot be measured in binary because it varies greatly with user perception and context. %M 34612822 %R 10.2196/27862 %U https://aging.jmir.org/2021/4/e27862 %U https://doi.org/10.2196/27862 %U http://www.ncbi.nlm.nih.gov/pubmed/34612822 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e26361 %T Voice Assistant Reminders and the Latency of Scheduled Medication Use in Older Adults With Pain: Descriptive Feasibility Study %A Shade,Marcia %A Rector,Kyle %A Kupzyk,Kevin %+ College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198, United States, 1 4025596641, marcia.shade@unmc.edu %K adherence %K pain medications %K older adults %K reminders %K mHealth %K voice assistants %D 2021 %7 28.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Pain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports. Objective: We aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain. Methods: A total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample’s self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed. Results: In the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7%) resulted in the opening of MEMS caps within 30 minutes of the reminder. Conclusions: Voice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions. %M 34581677 %R 10.2196/26361 %U https://formative.jmir.org/2021/9/e26361 %U https://doi.org/10.2196/26361 %U http://www.ncbi.nlm.nih.gov/pubmed/34581677 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28320 %T Implementing mHealth-Enabled Integrated Care for Complex Chronic Patients With Osteoarthritis Undergoing Primary Hip or Knee Arthroplasty: Prospective, Two-Arm, Parallel Trial %A Colomina,Jordi %A Drudis,Reis %A Torra,Montserrat %A Pallisó,Francesc %A Massip,Mireia %A Vargiu,Eloisa %A Nadal,Nuria %A Fuentes,Araceli %A Ortega Bravo,Marta %A Miralles,Felip %A Barbé,Ferran %A Torres,Gerard %A de Batlle,Jordi %A , %+ Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida (IRBLleida), Rovira Roure 80, Lleida, 25198, Spain, 34 645624734, jordidebatlle@gmail.com %K mHealth %K osteoarthritis %K arthroplasty %K health plan implementation %K chronic disease %K mobile phone %D 2021 %7 2.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness. Objective: This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)–enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty. Methods: As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio. Results: A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness. Conclusions: Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery. %M 34473068 %R 10.2196/28320 %U https://www.jmir.org/2021/9/e28320 %U https://doi.org/10.2196/28320 %U http://www.ncbi.nlm.nih.gov/pubmed/34473068 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e25781 %T A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study %A Araújo,Fátima %A Nogueira,Maria Nilza %A Silva,Joana %A Rego,Sílvia %+ Escola Superior de Enfermagem do Porto (ESEP), Inovação e Desenvolvimento em Enfermagem, Centro de Investigação em Tecnologias e Serviços de Saúde, Rua Dr. António Bernardino, 830, 844, 856, Porto, 4200-072, Portugal, 351 00351 225 073 5, araujo@esenf.pt %K fall prevention %K technological platform %K elderly %K Otago Exercise Program %D 2021 %7 12.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: According to the United Nations, it is estimated that by 2050, the number of people aged 80 years and older will have increased by 3 times. Increased longevity is often accompanied by structural and functional changes that occur throughout an individual’s lifespan. These changes are often aggravated by chronic comorbidities, adopted behaviors or lifestyles, and environmental exposure, among other factors. Some of the related outcomes are loss of muscle strength, decreased balance control, and mobility impairments, which are strongly associated with the occurrence of falls in the elderly. Despite the continued undervaluation of the importance of knowledge on fall prevention among the elderly population by primary care health professionals, several evidence-based (single or multifaceted) fall prevention programs such as the Otago Exercise Program (OEP) have demonstrated a significant reduction in the risk of falls and fall-related injuries in the elderly within community settings. Recent studies have strived to integrate technology into physical exercise programs, which is effective for adherence and overcoming barriers to exercise, as well as improving physical functioning. Objective: This study aims to assess the impact of the OEP on the functionality of home-dwelling elderly using a common technological platform. Particularly, the impact on muscle strength, balance, mobility, risk of falling, the perception of fear of falling, and the perception of the elderly regarding the ease of use of technology are being examined in this study. Methods: A quasi-experimental study (before and after; single group) will be conducted with male and female participants aged 65 years or older living at home in the district of Porto. Participants will be recruited through the network COLABORAR, with a minimum of 30 participants meeting the study inclusion and exclusion criteria. All participants will sign informed consent forms. The data collection instrument consists of sociodemographic and clinical variables (self-reported), functional evaluation variables, and environmental risk variables. The data collection tool integrates primary and secondary outcome variables. The primary outcome is gait (timed-up and go test; normal step). The secondary outcome variables are lower limb strength and muscle resistance (30-second chair stand test), balance (4-stage balance test), frequency of falls, functional capacity (Lawton and Brody - Portuguese version), fear of falling (Falls Efficacy Scale International - Portuguese version), usability of the technology (System Usability Scale - Portuguese version), and environmental risk variables (home fall prevention checklist for older adults). Technological solutions, such as the FallSensing Home application and Kallisto wearable device, will be used, which will allow the detection and prevention of falls. The intervention is characterized by conducting the OEP through a common technological platform 3 times a week for 8 weeks. Throughout these weeks, the participants will be followed up in person or by telephone contact by the rehabilitation nurse. Considering the COVID-19 outbreak, all guidelines from the National Health Service will be followed. The project was funded by InnoStars, in collaboration with the Local EIT Health Regional Innovation Scheme Hub of the University of Porto. Results: This study was approved on October 9, 2020 by the Ethics Committee of Escola Superior de Enfermagem do Porto (ESEP). The recruitment process was meant to start in October, but due to the COVID-19 pandemic, it was suspended. We expect to restart the study by the beginning of the third quarter of 2021. Conclusions: The findings of this study protocol will contribute to the design and development of future robust studies for technological tests in a clinical context. Trial Registration: ISRCTN 15895163; https://www.isrctn.com/ISRCTN15895163 International Registered Report Identifier (IRRID): PRR1-10.2196/25781 %M 34387557 %R 10.2196/25781 %U https://www.researchprotocols.org/2021/8/e25781 %U https://doi.org/10.2196/25781 %U http://www.ncbi.nlm.nih.gov/pubmed/34387557 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e27047 %T Smart Home Sensing and Monitoring in Households With Dementia: User-Centered Design Approach %A Tiersen,Federico %A Batey,Philippa %A Harrison,Matthew J C %A Naar,Lenny %A Serban,Alina-Irina %A Daniels,Sarah J C %A Calvo,Rafael A %+ Dyson School of Design Engineering, Imperial College London, 25 Exhibition Road, South Kensington, London, SW7 2DB, United Kingdom, 44 (0)20 7594 8888, federico.tiersen16@imperial.ac.uk %K assistive technology %K independent living %K internet of things %K remote monitoring %K dementia %K human centered design %K user-centered design %K patient-centered care %K smart home %K digital health %D 2021 %7 11.8.2021 %9 Original Paper %J JMIR Aging %G English %X Background: As life expectancy grows, so do the challenges of caring for an aging population. Older adults, including people with dementia, want to live independently and feel in control of their lives for as long as possible. Assistive technologies powered by artificial intelligence and internet of things devices are being proposed to provide living environments that support the users’ safety, psychological, and medical needs through remote monitoring and interventions. Objective: This study investigates the functional, psychosocial, and environmental needs of people living with dementia, their caregivers, clinicians, and health and social care service providers toward the design and implementation of smart home systems. Methods: We used an iterative user-centered design approach comprising 9 substudies. First, semistructured interviews (9 people with dementia, 9 caregivers, and 10 academic and clinical staff) and workshops (35 pairs of people with dementia and caregivers, and 12 health and social care clinicians) were conducted to define the needs of people with dementia, home caregivers, and professional stakeholders in both daily activities and technology-specific interactions. Then, the spectrum of needs identified was represented via patient–caregiver personas and discussed with stakeholders in a workshop (14 occupational therapists; 4 National Health Service pathway directors; and 6 researchers in occupational therapy, neuropsychiatry, and engineering) and 2 focus groups with managers of health care services (n=8), eliciting opportunities for innovative care technologies and public health strategies. Finally, these design opportunities were discussed in semistructured interviews with participants of a smart home trial involving environmental sensors, physiological measurement devices, smartwatches, and tablet-based chatbots and cognitive assessment puzzles (10 caregivers and 2 people with dementia). A thematic analysis revealed factors that motivate household members to use these technologies. Results: Outcomes of these activities include a qualitative and quantitative analysis of patient, caregiver, and clinician needs and the identification of challenges and opportunities for the design and implementation of remote monitoring systems in public health pathways. Conclusions: Participatory design methods supported the triangulation of stakeholder perspectives to aid the development of more patient-centered interventions and their translation to clinical practice and public health strategy. We discuss the implications and limitations of our findings, the value and the applicability of our methodology, and directions for future research. %M 34383672 %R 10.2196/27047 %U https://aging.jmir.org/2021/3/e27047 %U https://doi.org/10.2196/27047 %U http://www.ncbi.nlm.nih.gov/pubmed/34383672 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e24724 %T Business Models of eHealth Interventions to Support Informal Caregivers of People With Dementia in the Netherlands: Analysis of Case Studies %A Christie,Hannah Liane %A Boots,Lizzy Mitzy Maria %A Hermans,Ivo %A Govers,Mark %A Tange,Huibert Johannes %A Verhey,Frans Rochus Josef %A de Vugt,Majolein %+ Alzheimer Centrum Limburg, Maastricht University, Postbus 616, Maastricht, 6200 MD, Netherlands, 31 456 21 30 78, hannah.christie@maastrichtuniversity.nl %K eHealth %K dementia %K caregiving %K implementation %K business modeling %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Aging %G English %X Background: In academic research contexts, eHealth interventions for caregivers of people with dementia have shown ample evidence of effectiveness. However, they are rarely implemented in practice, and much can be learned from their counterparts (commercial, governmental, or other origins) that are already being used in practice. Objective: This study aims to examine a sample of case studies of eHealth interventions to support informal caregivers of people with dementia that are currently used in the Netherlands; to investigate what strategies are used to ensure the desirability, feasibility, viability, and sustainability of the interventions; and to apply the lessons learned from this practical, commercial implementation perspective to academically developed eHealth interventions for caregivers of people with dementia. Methods: In step 1, experts (N=483) in the fields of dementia and eHealth were contacted and asked to recommend interventions that met the following criteria: delivered via the internet; suitable for informal caregivers of people with dementia; accessible in the Netherlands, either in Dutch or in English; and used in practice. The contacted experts were academics working on dementia and psychosocial innovations, industry professionals from eHealth software companies, clinicians, patient organizations, and people with dementia and their caregivers. In step 2, contact persons from the suggested eHealth interventions participated in a semistructured telephone interview. The results were analyzed using a multiple case study methodology. Results: In total, the response rate was 7.5% (36/483), and 21 eHealth interventions for caregivers of people with dementia were recommended. Furthermore, 43% (9/21) of the interventions met all 4 criteria and were included in the sample for the case study analysis. Of these 9 interventions, 4 were found to have developed sustainable business models and 5 were implemented in a more exploratory manner and relied on research grants to varying extents, although some had also developed preliminary business models. Conclusions: These findings suggest that the desirability, feasibility, and viability of eHealth interventions for caregivers of people with dementia are linked to their integration into larger structures, their ownership and support of content internally, their development of information and communication technology services externally, and their offer of fixed, low pricing. The origin of the case studies was also important, as eHealth interventions that had originated in an academic research context less reliably found their way to sustainable implementation. In addition, careful selection of digital transformation strategies, more intersectoral cooperation, and more funding for implementation and business modeling research are recommended to help future developers bring eHealth interventions for caregivers of people with dementia into practice. %M 34081009 %R 10.2196/24724 %U https://aging.jmir.org/2021/2/e24724 %U https://doi.org/10.2196/24724 %U http://www.ncbi.nlm.nih.gov/pubmed/34081009 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e20966 %T Usability and Accuracy of a Smartwatch for the Assessment of Physical Activity in the Elderly Population: Observational Study %A Martinato,Matteo %A Lorenzoni,Giulia %A Zanchi,Tommaso %A Bergamin,Alessia %A Buratin,Alessia %A Azzolina,Danila %A Gregori,Dario %+ Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Via Leonardo Loredan, 18, Padova, , Italy, 39 049 827 5384, dario.gregori@unipd.it %K wearable devices %K elderly %K physical activity %K smartwatches %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular physical activity (PA) contributes to the primary and secondary prevention of several chronic diseases and reduces the risk of premature death. Physical inactivity is a modifiable risk factor for cardiovascular disease and a variety of chronic disorders such as diabetes, obesity, hypertension, bone and joint diseases (eg, osteoporosis and osteoarthritis), depression, and colon and breast cancer. Population aging and the related increase in chronic diseases have a major impact on the health care systems of most Western countries and will produce an even more significant effect in the future. Monitoring PA is a valuable method of determining whether people are performing enough PA so as to prevent chronic diseases or are showing early symptoms of those diseases. Objective: The aim of this study was to estimate the accuracy of wearable devices in quantifying the PA of elderly people in a real-life setting. Methods: Participants aged 70 to 90 years with the ability to walk safely without any walking aid for at least 300 meters, who had no walking disabilities or episodes of falling while walking in the last 12 months, were asked to walk 150 meters at their preferred pace wearing a vívoactive HR device (Garmin Ltd) and actual steps were monitored and tallied by a researcher using a hand-tally counter to assess the performance of the device at a natural speed. A Bland-Altman plot was used to analyze the difference between manually counted steps and wearable device–measured steps. The intraclass correlation coefficient (ICC) was computed (with a 95% confidence interval) between step measurements. The generalized linear mixed-model (GLMM) ICCs were estimated, providing a random effect term (random intercept) for the individual measurements (gold standard and device). Both adjusted and conditional ICCs were computed for the GLMM models considering separately the effect of age, sex, BMI, and obesity. Analyses were performed using R software (R Foundation for Statistical Computing) with the rms package. Results: A total of 23 females and 26 males were enrolled in the study. The median age of the participants was 75 years. The Bland-Altman plot revealed that, excluding one observation, all differences across measurements were in the confidence bounds, demonstrating the substantial agreement between the step count measurements. The results were confirmed by an ICC equal to .98 (.96-.99), demonstrating excellent agreement between the two sets of measurements. Conclusions: The level of accuracy of wearable devices in quantifying the PA of elderly people in a real-life setting that was found in this study supports the idea of considering wrist-wearable nonmedical devices (widely available in nonspecialized stores) as reliable tools. Both health care professionals and informal caregivers could monitor the level of PA of their patients. %M 33949953 %R 10.2196/20966 %U https://mhealth.jmir.org/2021/5/e20966 %U https://doi.org/10.2196/20966 %U http://www.ncbi.nlm.nih.gov/pubmed/33949953 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e21808 %T Mobile Apps to Support Family Caregivers of People With Alzheimer Disease and Related Dementias in Managing Disruptive Behaviors: Qualitative Study With Users Embedded in a Scoping Review %A Désormeaux-Moreau,Marjorie %A Michel,Charlie-Maude %A Vallières,Mélanie %A Racine,Maryse %A Poulin-Paquet,Myriame %A Lacasse,Delphine %A Gionet,Pascale %A Genereux,Melissa %A Lachiheb,Wael %A Provencher,Véronique %+ School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12 Avenue N, Sherbrooke, QC, Canada, 1 819 791 7904 ext 70525, veronique.provencher@usherbrooke.ca %K disruptive behaviors management %K dementia %K caregivers %K mobile phone %K app %K scoping review %K focus group %K mHealth %K neurocognitive disorder %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Aging %G English %X Background: People with Alzheimer disease and related dementias often display disruptive behaviors (eg, aggression, wandering, and restlessness), which increase family caregivers’ burden of care. However, there are few tools currently available to help these caregivers manage disruptive behaviors. Mobile apps could meet this need, but to date little is known about them. Objective: The aims of our study were to identify existing mobile apps designed to support family caregivers of people with Alzheimer disease and related dementias in managing disruptive behaviors; explore whether family caregivers view these mobile apps as relevant to meeting their needs and as useful in managing disruptive behaviors; and document the types of mobile apps that are of interest and appeal to most family caregivers (with regard to format, ergonomics, and clarity). Methods: A review of mobile apps initially conducted in February 2018 was updated in March 2019 with 2 platforms (App Store [Apple Inc.] and Google Play [Google]). The selected apps were first analyzed independently by 3 raters (2 students and 1 researcher) for each of the platforms. A focus group discussion was then held with 4 family caregivers to explore their perceptions of the apps according to their needs and interests. The content of the discussion was analyzed. Results: Initially, 7 of 118 apps identified met the inclusion criteria. An eighth app, recommended by one of the knowledge users, was added later. Four family caregivers (women aged between 58 and 78 years) participated in the discussion. Participants expressed a preference for easy-to-understand apps that provide concrete intervention strategies. They reported being most inclined to use two apps, Dementia Advisor and DTA Behaviours. Conclusions: Few mobile apps on the market meet the needs of family caregivers in terms of content and usability. Our results could help to address this gap by identifying what family caregivers deem relevant in a mobile app to help them manage disruptive behaviors. %M 33861207 %R 10.2196/21808 %U https://aging.jmir.org/2021/2/e21808 %U https://doi.org/10.2196/21808 %U http://www.ncbi.nlm.nih.gov/pubmed/33861207 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e20468 %T Mobile Health Intervention Promoting Physical Activity in Adults Post Cardiac Rehabilitation: Pilot Randomized Controlled Trial %A Park,Linda G %A Elnaggar,Abdelaziz %A Lee,Sei J %A Merek,Stephanie %A Hoffmann,Thomas J %A Von Oppenfeld,Julia %A Ignacio,Nerissa %A Whooley,Mary A %+ Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, Room 531A, San Francisco, CA, United States, 1 415 221 4810 ext 22573, abdelaziz.elnaggar@ucsf.edu %K physical activity %K cardiac rehabilitation %K digital health %K mobile app %K wearable device %K mHealth %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiac rehabilitation (CR) is an exercise-based program prescribed after cardiac events associated with improved physical, mental, and social functioning; however, many patients return to a sedentary lifestyle leading to deteriorating functional capacity after discharge from CR. Physical activity (PA) is critical to avoid recurrence of cardiac events and mortality and maintain functional capacity. Leveraging mobile health (mHealth) strategies to increase adherence to PA is a promising approach. Based on the social cognitive theory, we sought to determine whether mHealth strategies (Movn mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve PA and functional capacity over 2 months. Objective: The objectives of this pilot randomized controlled trial were to examine preliminary effects of an mHealth intervention on group differences in PA and functional capacity and group differences in depression and self-efficacy to maintain exercise after CR. Methods: During the final week of outpatient CR, patients were randomized 1:1 to the intervention group or usual care. The intervention group downloaded the Movn mobile app, received supportive push-through messages on motivation and educational messages related to cardiovascular disease (CVD) management 3 times per week, and wore a Charge 2 (Fitbit Inc) activity tracker to track step counts. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6-minute walk test (6MWT) and self-reported questionnaires were collected at baseline and 2 months. Results: We recruited 60 patients from 2 CR sites at a community hospital in Northern California. The mean age was 68.0 (SD 9.3) years, and 23% (14/60) were female; retention rate was 85% (51/60). Our results from 51 patients who completed follow-up showed the intervention group had a statistically significant higher mean daily step count compared with the control (8860 vs 6633; P=.02). There was no difference between groups for the 6MWT, depression, or self-efficacy to maintain exercise. Conclusions: This intervention addresses a major public health initiative to examine the potential for mobile health strategies to promote PA in patients with CVD. Our technology-based pilot mHealth intervention provides promising results on a pragmatic and contemporary approach to promote PA by increasing daily step counts after completing CR. Trial Registration: ClinicalTrials.gov NCT03446313; https://clinicaltrials.gov/ct2/show/NCT03446313 %M 33861204 %R 10.2196/20468 %U https://formative.jmir.org/2021/4/e20468 %U https://doi.org/10.2196/20468 %U http://www.ncbi.nlm.nih.gov/pubmed/33861204 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e26875 %T Requirements for Unobtrusive Monitoring to Support Home-Based Dementia Care: Qualitative Study Among Formal and Informal Caregivers %A Wrede,Christian %A Braakman-Jansen,Annemarie %A van Gemert-Pijnen,Lisette %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 (0)53 489 7537, c.wrede@utwente.nl %K in-home monitoring %K ambient assisted living %K assistive technologies %K dementia %K home care %K informal care %K aging in place %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Due to a growing shortage in residential care, people with dementia will increasingly be encouraged to live at home for longer. Although people with dementia prefer extended independent living, this also puts more pressure on both their informal and formal care networks. To support (in)formal caregivers of people with dementia, there is growing interest in unobtrusive contactless in-home monitoring technologies that allow caregivers to remotely monitor the lifestyle, health, and safety of their care recipients. Despite their potential, these solutions will only be viable if they meet the expectations and needs of formal and informal caregivers of people with dementia. Objective: The objective of this study was to explore the expected benefits, barriers, needs, and requirements toward unobtrusive in-home monitoring from the perspective of formal and informal caregivers of community-dwelling people with dementia. Methods: A combination of semistructured interviews and focus groups was used to collect data among informal (n=19) and formal (n=16) caregivers of people with dementia. Both sets of participants were presented with examples of unobtrusive in-home monitoring followed by questions addressing expected benefits, barriers, and needs. Relevant in-home monitoring goals were identified using a previously developed topic list. Interviews and focus groups were transcribed and inductively analyzed. Requirements for unobtrusive in-home monitoring were elicited based on the procedure of van Velsen and Bergvall-Kåreborn. Results: Formal and informal caregivers saw unobtrusive in-home monitoring as a support tool that should particularly be used to monitor (the risk of) falls, day and night rhythm, personal hygiene, nocturnal restlessness, and eating and drinking behavior. Generally, (in)formal caregivers reported cross-checking self-care information, extended independent living, objective communication, prevention and proactive measures, emotional reassurance, and personalized and optimized care as the key benefits of unobtrusive in-home monitoring. Main concerns centered around privacy, information overload, and ethical concerns related to dehumanizing care. Furthermore, 16 requirements for unobtrusive in-home monitoring were generated that specified desired functions, how the technology should communicate with the user, which services surrounding the technology were seen as needed, and how the technology should be integrated into the existing work context. Conclusions: Despite the presence of barriers, formal and informal caregivers of people with dementia generally saw value in unobtrusive in-home monitoring, and felt that these systems could contribute to a shift from reactive to more proactive and less obtrusive care. However, the full potential of unobtrusive in-home monitoring can only unfold if relevant concerns are considered. Our requirements can inform the development of more acceptable and goal-directed in-home monitoring technologies to support home-based dementia care. %M 33843596 %R 10.2196/26875 %U https://aging.jmir.org/2021/2/e26875 %U https://doi.org/10.2196/26875 %U http://www.ncbi.nlm.nih.gov/pubmed/33843596 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22950 %T Older Adult Peer Support Specialists’ Age-Related Contributions to an Integrated Medical and Psychiatric Self-Management Intervention: Qualitative Study of Text Message Exchanges %A Mbao,Mbita %A Collins-Pisano,Caroline %A Fortuna,Karen %+ Dartmouth College, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States, 1 603 722 5727, karen.L.Fortuna@dartmouth.edu %K older adults %K peer support %K self-management %K mobile technology %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Middle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of adults aged 50 years or above. An emerging workforce of peer support specialists aged 50 years or above or “older adult peer support specialists” is increasingly using technology to deliver peer support services to address both the mental health and physical health needs of middle-aged and older adults with a diagnosis of a serious mental illness. Objective: This exploratory qualitative study examined older adult peer support specialists’ text message exchanges with middle-aged and older adults with a diagnosis of a serious mental illness and their nonmanualized age-related contributions to a standardized integrated medical and psychiatric self-management intervention. Methods: Older adult peer support specialists exchanged text messages with middle-aged and older adults with a diagnosis of a serious mental illness as part of a 12-week standardized integrated medical and psychiatric self-management smartphone intervention. Text message exchanges between older adult peer support specialists (n=3) and people with serious mental illnesses (n=8) were examined (mean age 68.8 years, SD 4.9 years). A total of 356 text messages were sent between older adult peer support specialists and service users with a diagnosis of a serious mental illness. Older adult peer support specialists sent text messages to older participants’ smartphones between 8 AM and 10 PM on weekdays and weekends. Results: Five themes emerged from text message exchanges related to older adult peer support specialists’ age-related contributions to integrated self-management, including (1) using technology to simultaneously manage mental health and physical health issues; (2) realizing new coping skills in late life; (3) sharing roles as parents and grandparents; (4) wisdom; and (5) sharing lived experience of difficulties with normal age-related changes (emerging). Conclusions: Older adult peer support specialists’ lived experience of aging successfully with a mental health challenge may offer an age-related form of peer support that may have implications for promoting successful aging in older adults with a serious mental illness. %M 33650979 %R 10.2196/22950 %U https://formative.jmir.org/2021/3/e22950 %U https://doi.org/10.2196/22950 %U http://www.ncbi.nlm.nih.gov/pubmed/33650979 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e23313 %T Mobile Apps for Older Adults: Systematic Search and Evaluation Within Online Stores %A Portenhauser,Alexandra A %A Terhorst,Yannik %A Schultchen,Dana %A Sander,Lasse B %A Denkinger,Michael D %A Stach,Michael %A Waldherr,Natalie %A Dallmeier,Dhayana %A Baumeister,Harald %A Messner,Eva-Maria %+ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Lise-Meitner-Str. 16, Ulm, Germany, 49 73150 32802, eva-maria.messner@uni-ulm.de %K mHealth %K MARS %K MARS-G %K older adults %K mobile apps %K apps %K aging %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Through the increasingly aging population, the health care system is confronted with various challenges such as expanding health care costs. To manage these challenges, mobile apps may represent a cost-effective and low-threshold approach to support older adults. Objective: This systematic review aimed to evaluate the quality, characteristics, as well as privacy and security measures of mobile apps for older adults in the European commercial app stores. Methods: In the European Google Play and App Store, a web crawler systematically searched for mobile apps for older adults. The identified mobile apps were evaluated by two independent reviewers using the German version of the Mobile Application Rating Scale. A correlation between the user star rating and overall rating was calculated. An exploratory regression analysis was conducted to determine whether the obligation to pay fees predicted overall quality. Results: In total, 83 of 1217 identified mobile apps were included in the analysis. Generally, the mobile apps for older adults were of moderate quality (mean 3.22 [SD 0.68]). Four mobile apps (5%) were evidence-based; 49% (41/83) had no security measures. The user star rating correlated significantly positively with the overall rating (r=.30, P=.01). Obligation to pay fees could not predict overall quality. Conclusions: There is an extensive quality range within mobile apps for older adults, indicating deficits in terms of information quality, data protection, and security precautions, as well as a lack of evidence-based approaches. Central databases are needed to identify high-quality mobile apps. %M 33605884 %R 10.2196/23313 %U https://aging.jmir.org/2021/1/e23313 %U https://doi.org/10.2196/23313 %U http://www.ncbi.nlm.nih.gov/pubmed/33605884 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e18624 %T Developing a Plan for the Sustainable Implementation of an Electronic Health Intervention (Partner in Balance) to Support Caregivers of People With Dementia: Case Study %A Christie,Hannah Liane %A Boots,Lizzy Mitzy Maria %A Peetoom,Kirsten %A Tange,Huibert Johannes %A Verhey,Frans Rochus Josef %A de Vugt,Marjolein Elizabeth %+ Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Universiteit Maastricht, Postbus 616, Maastricht, 6200 MD, Netherlands, 32 0456213078, hannah.christie@maastrichtuniversity.nl %K dementia %K caregiving %K eHealth %K implementation %K business modeling %D 2020 %7 25.6.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Given the increasing use of digital interventions in health care, understanding how best to implement them is crucial. However, evidence on how to implement new academically developed interventions in complex health care environments is lacking. This case study offers an example of how to develop a theory-based implementation plan for Partner in Balance, an electronic health (eHealth) intervention to support the caregivers of people with dementia. Objective: The specific objectives of this study were to (1) formulate evidence-based implementation strategies, (2) develop a sustainable business model, and (3) integrate these elements into an implementation plan. Methods: This case study concerns Partner in Balance, a blended care intervention to support the caregivers of people with dementia, which is effective in improving caregiver self-efficacy, quality of life, and experienced control. The large-scale implementation of Partner in Balance took place in local dementia case-management services, local care homes, dementia support groups, and municipalities. Experiences from real-life pilots (n=22) and qualitative interviews with national stakeholders (n=14) were used to establish an implementation plan consisting of implementation strategies and a business model. Results: The main finding was the need for a business model to facilitate decision-making from potential client organizations, who need reliable pricing information before they can commit to training coaches and implementing the intervention. Additionally, knowledge of the organizational context and a wider health care system are essential to ensure that the intervention meets the needs of its target users. Based on these findings, the research team formulated implementation strategies targeted at the engagement of organizations and staff, dissemination of the intervention, and facilitation of long-term project management in the future. Conclusions: This study offers a theory-based example of implementing an evidence-based eHealth intervention in dementia health care. The findings help fill the knowledge gap on the eHealth implementation context for evidence-based eHealth interventions after the trial phase, and they can be used to inform individuals working to develop and sustainably implement eHealth. %M 32584261 %R 10.2196/18624 %U http://aging.jmir.org/2020/1/e18624/ %U https://doi.org/10.2196/18624 %U http://www.ncbi.nlm.nih.gov/pubmed/32584261 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e17108 %T Behavioral Pain Assessment Implementation in Long-Term Care Using a Tablet App: Case Series and Quasi-Experimental Design %A Zahid,Mahnoor %A Gallant,Natasha L %A Hadjistavropoulos,Thomas %A Stroulia,Eleni %+ Department of Psychology and Centre on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 4457, hadjistt@uregina.ca %K pain measurement %K long-term care %K nursing %K technology Alzheimer disease %K mHealth %D 2020 %7 22.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pain is often underassessed and undertreated among long-term care (LTC) residents living with dementia. When used regularly, the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC) scales have been shown to have beneficial effects on pain assessment and management practices and stress and burnout levels in frontline staff in LTC facilities. Such scales, however, are not utilized as often as recommended, which is likely to be related to additional record-keeping and tracking over time involved with their paper-and-pencil administration. Objective: Using implementation science principles, we assessed the introduction of the PACSLAC-II scale by comparing two methods of administration—a newly developed tablet app version and the original paper-and-pencil version—with respect to the frequency of pain assessment and facility staff feedback. Methods: Using a case series approach, we tracked pain-related quality indicators at baseline, implementation, and follow-up periods. A quasi-experimental design was used to evaluate the effect of the method of administration (ie, paper-and-pencil only [n=18], tablet only [n=12], paper-and-pencil followed by tablet app [n=31], and tablet app followed by paper-and-pencil [n=31]) on pain assessment frequency and frontline staff stress and burnout levels. Finally, semistructured interviews were conducted with frontline staff to obtain perspectives on each method of administration. Results: The implementation effort resulted in a great increase in pain assessment frequency across 7 independent LTC units, although these increases were not maintained during the follow-up period. Frontline staff reported lower levels of workload in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P<.001) and tablet app followed by paper-and-pencil (P<.001) conditions. Frontline staff also reported lower levels of workload in the tablet-only condition than those in the paper-and-pencil only condition (P=.05). Similarly, lower levels of emotional exhaustion were reported by frontline staff in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P=.002) and tablet app followed by paper-and-pencil (P=.002) conditions. Finally, frontline staff reported higher levels of depersonalization in the paper-and-pencil only condition than those in the tablet app only (P=.008), paper-and-pencil followed by tablet app (P<.001), and tablet app followed by paper-and-pencil (P<.001) conditions. Furthermore, narrative data from individual interviews with frontline staff revealed a preference for the tablet app over the paper-and-pencil method of administration. Conclusions: This study provides support for the use of either the tablet app or the paper-and-pencil version of the PACSLAC-II to improve pain-related quality indicators, but a reported preference for and lower levels of stress and burnout with the use of the tablet app method of administration suggests that the use of the tablet app may have more advantages compared with the paper-and-pencil method of administration. %M 32319955 %R 10.2196/17108 %U http://mhealth.jmir.org/2020/4/e17108/ %U https://doi.org/10.2196/17108 %U http://www.ncbi.nlm.nih.gov/pubmed/32319955 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e17136 %T Mobile Apps to Support Caregiver-Resident Communication in Long-Term Care: Systematic Search and Content Analysis %A Wilson,Rozanne %A Cochrane,Diana %A Mihailidis,Alex %A Small,Jeff %+ School of Audiology and Speech Sciences, Faculty of Medicine, The University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada, 1 6048225798, r.wilson@audiospeech.ubc.ca %K mobile apps %K communication barrier %K dementia %K caregivers %K long-term care %K patient-centered care %D 2020 %7 8.4.2020 %9 Original Paper %J JMIR Aging %G English %X Background: In long-term residential care (LTRC), caregivers’ attempts to provide person-centered care can be challenging when assisting residents living with a communication disorder (eg, aphasia) and/or a language-cultural barrier. Mobile communication technology, which includes smartphones and tablets and their software apps, offers an innovative solution for preventing and overcoming communication breakdowns during activities of daily living. There is a need to better understand the availability, relevance, and stability of commercially available communication apps (cApps) that could support person-centered care in the LTRC setting. Objective: This study aimed to (1) systematically identify and evaluate commercially available cApps that could support person-centered communication (PCC) in LTRC and (2) examine the stability of cApps over 2 years. Methods: We conducted systematic searches of the Canadian App Store (iPhone Operating System platform) in 2015 and 2017 using predefined search terms. cApps that met the study’s inclusion criteria underwent content review and quality assessment. Results: Although the 2015 searches identified 519 unique apps, only 27 cApps were eligible for evaluation. The 2015 review identified 2 augmentative and alternative cApps and 2 translation apps as most appropriate for LTRC. Despite a 205% increase (from 199 to 607) in the number of augmentative and alternative communication and translation apps assessed for eligibility in the 2017 review, the top recommended cApps showed suitability for LTRC and marketplace stability. Conclusions: The recommended existing cApps included some PCC features and demonstrated marketplace longevity. However, cApps that focus on the inclusion of more PCC features may be better suited for use in LTRC, which warrants future development. Furthermore, cApp content and quality would improve by including research evidence and experiential knowledge (eg, nurses and health care aides) to inform app development. cApps offer care staff a tool that could promote social participation and person-centered care. International Registered Report Identifier (IRRID): RR2-10.2196/10.2196/17136 %M 32267236 %R 10.2196/17136 %U http://aging.jmir.org/2020/1/e17136/ %U https://doi.org/10.2196/17136 %U http://www.ncbi.nlm.nih.gov/pubmed/32267236 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e13513 %T A Dual-Pronged Approach to Improving Heart Failure Outcomes: A Quality Improvement Project %A Johansson,Marcia %A Athilingam,Ponrathi %+ College of Nursing, University of South Florida, 12901 Bruce B Downs, MDC 22, Tampa, FL, 33612, United States, 1 813 974 5289, mjohansson@usf.edu %K heart failure %K mobile messaging %K structured telephone support %K self-care management %K medication adherence %K quality improvement %D 2020 %7 10.2.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Presently, 6.5 million Americans are living with heart failure (HF). These patients are expected to follow a complex self-management regimen at home. Several demographic and psychosocial factors limit patients with HF in following the prescribed self-management recommendations at home. Poor self-care is associated with increased hospital readmissions. Under the Affordable Care Act, there are financial implications related to hospital readmissions for hospitals and programs such as the Program of All-Inclusive Care for the Elderly (PACE) in Pinellas County, Florida. Previous studies and systematic reviews demonstrated improvement in self-management and quality of life (QoL) in patients with HF with structured telephone support (STS) and SMS text messaging. Objective: This study aimed to evaluate the effects of STS and SMS on self-care, knowledge, medication adherence, and QoL of patients with HF. Methods: A prospective quality improvement project using a pre-post design was implemented. Data were collected at baseline, 30 days, and 3 months from 51 patients with HF who were enrolled in PACE in Pinellas County, Florida. All participants received STS and SMS for 30 days. The feasibility and sustained benefit of using STS and SMS was assessed at a 3-month follow-up. Results: A paired t test was used to compare the mean difference in HF outcomes at the baseline and 30-day follow-up, which demonstrated improved HF self-care maintenance (t49=0.66; P=.01), HF knowledge (t49=0.71; P=.01), medication adherence (t49=0.92; P=.01), and physical and mental health measured using Short-Form-12 (SF-12; t49=0.81; P=.01). The results also demonstrated the sustained benefit with improved HF self-care maintenance, self-care management, self-care confidence, knowledge, medication adherence, and physical and mental health (SF-12) at 3 months with P<.05 for all outcomes. Living status and social support had a strong correlation with HF outcomes. Younger participants (aged less than 65 years) performed extremely well compared with older adults. Conclusions: STS and SMS were feasible to use among PACE participants with sustained benefits at 3 months. Implementing STS and SMS may serve as viable options to improve HF outcomes. Improving outcomes with HF affects hospital systems and the agencies that monitor and provide care for outpatients and those in independent or assisted-living facilities. Investigating viable options and support for implementation will improve outcomes. %R 10.2196/13513 %U https://aging.jmir.org/2020/1/e13513 %U https://doi.org/10.2196/13513 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e15290 %T Existing Mobile Phone Apps for Self-Care Management of People With Alzheimer Disease and Related Dementias: Systematic Analysis %A Guo,Yuqi %A Yang,Fan %A Hu,Fei %A Li,Wei %A Ruggiano,Nicole %A Lee,Hee Yun %+ Social Welfare Program, School of Public Administration, Dongbei University of Finance and Economics, 219 Quanxue Hall, 217 Jianshan Street, Shaohekou District, Dalian, 116025, China, 86 41184710562, fyang10@dufe.edu.cn %K alzheimer disease %K dementia %K self-care %K mobile phone apps %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Alzheimer disease and related dementias (AD/RD) are progressive neurocognitive disorders that currently affect approximately 50 million people worldwide. Mobile phone apps have been well-integrated into daily lives and can be used to deliver and promote health care. There is an increase in the use of technology to provide care and support to AD/RD patients and their families. Objective: This study aimed to review apps designed for AD/RD patients and analyze the benefits of, and challenges to, such technological solutions. Methods: A systematic approach was applied to review the availability, content, features, and quality of mobile phone apps to support self-care among AD/RD patients. Results: The initial search for this review was conducted in January 2019, and the screening and analysis of the included apps were completed in May 2019. A total of 14 apps were included from an initial search of 245 apps. The top 3 features were alert (9/14, 64%), self-care tips (6/14, 42%), and social networking capacity (5/14, 35%). On average, the readability of the apps was a tenth-grade reading level (SD 3.06). The overall quality was 3.71 out of 5 (SD 1.37). Conclusions: Our findings suggest that currently available apps for AD/RD patients may not meet complex needs and may be challenging to use, given the possible impaired communication ability associated with AD/RD. Therefore, high-quality apps need to be developed and rigorously evaluated for feasibility and efficacy. %M 32012045 %R 10.2196/15290 %U http://aging.jmir.org/2020/1/e15290/ %U https://doi.org/10.2196/15290 %U http://www.ncbi.nlm.nih.gov/pubmed/32012045 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13173 %T Evaluation of Heart Failure Apps to Promote Self-Care: Systematic App Search %A Wali,Sahr %A Demers,Catherine %A Shah,Hiba %A Wali,Huda %A Lim,Delphine %A Naik,Nirav %A Ghany,Ahmad %A Vispute,Ayushi %A Wali,Maya %A Keshavjee,Karim %+ Department of Medicine, McMaster University, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada, 1 905 525 9140 ext 73324, demers@hhsc.ca %K mHealth %K heart failure %K self-care %K mobile phone %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heart failure (HF) is a chronic disease that affects over 1% of Canadians and at least 26 million people worldwide. With the continued rise in disease prevalence and an aging population, HF-related costs are expected to create a significant economic burden. Many mobile health (mHealth) apps have been developed to help support patients’ self-care in the home setting, but it is unclear if they are suited to the needs or capabilities of older adults. Objective: This study aimed to identify HF apps and evaluate whether they met the criteria for optimal HF self-care. Methods: We conducted a systematic search of all apps available exclusively for HF self-care across Google Play and the App Store. We then evaluated the apps according to a list of 25 major functions pivotal to promoting HF self-care for older adults. Results: A total of 74 apps for HF self-care were identified, but only 21 apps were listed as being both HF and self-care specific. None of the apps had all 25 of the listed features for an adequate HF self-care app, and only 41% (31/74) apps had the key weight management feature present. HF Storylines received the highest functionality score (18/25, 72%). Conclusions: Our findings suggest that currently available apps are not adequate for use by older adults with HF. This highlights the need for mHealth apps to refine their development process so that user needs and capabilities are identified during the design stage to ensure the usability of the app. %M 31710298 %R 10.2196/13173 %U https://mhealth.jmir.org/2019/11/e13173 %U https://doi.org/10.2196/13173 %U http://www.ncbi.nlm.nih.gov/pubmed/31710298 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e14530 %T Using Computer Tablets to Improve Moods for Older Adults With Dementia and Interactions With Their Caregivers: Pilot Intervention Study %A Gilson,Aaron %A Dodds,Debby %A Kaur,Arveen %A Potteiger,Michael %A Ford II,James H %+ University of Wisconsin-Madison, School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States, 1 608 262 4748, jhfordii@wisc.edu %K mood change %K caregiver interactions %K older adults %K Alzheimer disease %K dementia %K computer tablets %K person-centered care %D 2019 %7 03.09.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Persons living with dementia represent a significant and growing segment of the older adult (aged 65 years and older) population. They are often challenged expressively and may experience difficulties with sharing their feelings or moods. Availability of, and easy access to, tablets facilitates the use of information and communication technologies (ICTs) as a delivery mechanism for nonpharmacological interventions, especially for persons living with dementia. Evidence of the impact of ICTs in different community settings on mood with older adults and the impact of engagement on their caregivers is needed to promote broader adoption and sustainment of these technologies in the United States. Objective: This study aimed to determine the extent of the effects of tablets on positive mood change and examine the effects of study variables on care recipients’ mood changes and caregivers’ daily interactions. Methods: The tablet intervention was developed and evaluated in five programs. The primary outcome was caregivers’ assessment of care recipients’ mood (n=1089) before and after a tablet engagement session using an eight-point mood visual analog scale. Session influence on caregivers’ daily activities was captured for a subsample of participants (n=542). Frequency distributions were computed for each study variables. Chi-square tests of association were calculated to determine the association of the variables on mood changes for all care recipients, as well as those being treated in skilled nursing facilities and in-home, and then for those that affected caregivers’ daily activities. Results: The study sample comprised 1089 care recipient and caregiver engagement sessions. Cumulatively, 50.78% (553/1089) of care recipients showed a transition from negative to positive moods, whereas another 41.78% (455/1089) maintained an already-positive mood after the caregiver engagement session. Chi-square analyses demonstrated that positive mood changes resulted from using music (χ210=72.9; P<.001), using YouTube as the sole app (χ212=64.5; P<.001), using multiple engagement strategies (χ22=42.8; P<.001), and when cared for in a skilled nursing facility (χ24=236.8; P<.001) across the entire care recipient sample. In addition, although many features of the engagement session positively influenced the caregivers’ day, the largest effect was observed when care recipients’ mood was considered to have improved following the session (χ24=234.7; P<.001). Conclusions: The study is one of the first in the United States to explore the impact of ICTs, in particular managed tablets and Web-based video services that can be used on a tablet through an app, on improving mood in persons living with dementia, and enhancing caregivers’ perceptions about their care recipient interactions. Importantly, these pilot data substantiate ICTs as part of a personalized engagement approach, as beneficial alternatives to pharmaceutical interventions for mood enhancement. However, a more comprehensive study that explores the ICT’s impact on additional clinical outcomes is needed to confirm these preliminary findings. %M 31482847 %R 10.2196/14530 %U http://formative.jmir.org/2019/3/e14530/ %U https://doi.org/10.2196/14530 %U http://www.ncbi.nlm.nih.gov/pubmed/31482847 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 2 %P e12496 %T Social Support Patterns of Middle-Aged and Older Adults Within a Physical Activity App: Secondary Mixed Method Analysis %A Lewis,Zakkoyya H %A Swartz,Maria C %A Martinez,Eloisa %A Lyons,Elizabeth J %+ Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, United States, 1 713 745 3763, mchang1@mdanderson.org %K social support %K aged %K middle aged %K physical activity %K technology %K fitness tracker %D 2019 %7 23.08.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity (PA) is critical for maintaining independence and delaying mobility disability in aging adults. However, 27 to 44% of older adults in the United States are meeting the recommended PA level. Activity trackers are proving to be a promising tool to promote PA adherence through activity tracking and enhanced social interaction features. Although social support has been known to be an influential behavior change technique to promote PA, how middle-aged and older adults use the social interaction feature of mobile apps to provide virtual support to promote PA engagement remains mostly underexplored. Objective: This study aimed to describe the social support patterns of middle-aged and older adults using a mobile app as part of a behavioral PA intervention. Methods: Data from 35 participants (mean age 61.66 [SD 6] years) in a 12-week, home-based activity intervention were used for this secondary mixed method analysis. Participants were provided with a Jawbone Up24 activity monitor and an Apple iPad Mini installed with the UP app to facilitate self-monitoring and social interaction. All participants were given an anonymous account and encouraged to interact with other participants using the app. Social support features included comments and likes. Thematic coding was used to identify the type of social support provided within the UP app and characterize the levels of engagement from users. Participants were categorized as superusers or contributors, and passive participants were categorized as lurkers based on the literature. Results: Over the 12-week intervention, participants provided a total of 3153 likes and 1759 comments. Most participants (n=25) were contributors, with 4 categorized as superusers and 6 categorized as lurkers. Comments were coded as emotional support, informational support, instrumental support, self-talk, and other, with emotional support being the most prevalent type. Conclusions: Our cohort of middle-aged and older adults was willing to use the social network feature in an activity app to communicate with anonymous peers. Most of our participants were contributors. In addition, the social support provided through the activity app followed social support constructs. In sum, PA apps are a promising tool for delivering virtual social support to enhance PA engagement and have the potential to make a widespread impact on PA promotion. Trial Registration: ClinicalTrials.gov NCT01869348; https://clinicaltrials.gov/ct2/show/NCT01869348 %M 31518281 %R 10.2196/12496 %U http://aging.jmir.org/2019/2/e12496/ %U https://doi.org/10.2196/12496 %U http://www.ncbi.nlm.nih.gov/pubmed/31518281 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12615 %T A Rapid, Mobile Neurocognitive Screening Test to Aid in Identifying Cognitive Impairment and Dementia (BrainCheck): Cohort Study %A Groppell,Samantha %A Soto-Ruiz,Karina M %A Flores,Benjamin %A Dawkins,William %A Smith,Isabella %A Eagleman,David M %A Katz,Yael %+ BrainCheck Inc, 2450 Holcombe Blvd Ste X+240, Houston, TX, 77021, United States, 1 8326816760, karina.soto.md@gmail.com %K dementia %K neurocognitive tests %K neurocognitive computerized assessment tools (NCAT) %K mild cognitive impairment (MCI) %K BrainCheck %K digital testing %K Alzheimer’s disease %K electronic neurocognitive tools %K computerized cognitive assessment %K digital cognitive assessment %D 2019 %7 21.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: The US population over the age of 65 is expected to double by the year 2050. Concordantly, the incidence of dementia is projected to increase. The subclinical stage of dementia begins years before signs and symptoms appear. Early detection of cognitive impairment and/or cognitive decline may allow for interventions to slow its progression. Furthermore, early detection may allow for implementation of care plans that may affect the quality of life of those affected and their caregivers. Objective: We sought to determine the accuracy and validity of BrainCheck Memory as a diagnostic aid for age-related cognitive impairment, as compared against physician diagnosis and other commonly used neurocognitive screening tests, including the Saint Louis University Mental Status (SLUMS) exam, the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). Methods: We tested 583 volunteers over the age of 49 from various community centers and living facilities in Houston, Texas. The volunteers were divided into five cohorts: a normative population and four comparison groups for the SLUMS exam, the MMSE, the MoCA, and physician diagnosis. Each comparison group completed their respective assessment and BrainCheck Memory. Results: A total of 398 subjects were included in the normative population. A total of 84 participants were in the SLUMS exam cohort, 51 in the MMSE cohort, 35 in the MoCA cohort, and 18 in the physician cohort. BrainCheck Memory assessments were significantly correlated to the SLUMS exam, with coefficients ranging from .5 to .7. Correlation coefficients for the MMSE and BrainCheck and the MoCA and BrainCheck were also significant. Of the 18 subjects evaluated by a physician, 9 (50%) were healthy, 6 (33%) were moderately impaired, and 3 (17%) were severely impaired. A significant difference was found between the severely and moderately impaired subjects and the healthy subjects (P=.02). We derived a BrainCheck Memory composite score that showed stronger correlations with the standard assessments as compared to the individual BrainCheck assessments. Receiver operating characteristic (ROC) curve analysis of this composite score found a sensitivity of 81% and a specificity of 94%. Conclusions: BrainCheck Memory provides a sensitive and specific metric for age-related cognitive impairment in older adults, with the advantages of a mobile, digital, and easy-to-use test. Trial Registration: ClinicalTrials.gov NCT03608722; https://clinicaltrials.gov/ct2/show/NCT03608722 (Archived by WebCite at http://www.webcitation.org/76JLoYUGf) %M 31518280 %R 10.2196/12615 %U http://aging.jmir.org/2019/1/e12615/ %U https://doi.org/10.2196/12615 %U http://www.ncbi.nlm.nih.gov/pubmed/31518280 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e12269 %T Investigating the Adoption of Mobile Health Services by Elderly Users: Trust Transfer Model and Survey Study %A Meng,Fanbo %A Guo,Xitong %A Peng,Zeyu %A Lai,Kee-Hung %A Zhao,Xinli %+ eHealth Research Institute, School of Management, Harbin Institute of Technology, 92 Xidazhi Street, Nangang District, Harbin,, China, 86 451 86414022, xitongguo@hit.edu.cn %K mobile health %K trust %K health services for the elderly %K adoption %K health behavior %D 2019 %7 08.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although elderly users comprise a major user group in the field of mobile health (mHealth) services, their adoption rate of such services is relatively low compared with their use of traditional health services. Increasing the adoption rate of mHealth services among elderly users is beneficial to the aging process. Objective: This study aimed to examine the determinants of mHealth service use intentions using a trust transfer model among elderly users facing declining physiological conditions and lacking support from hospitals. Methods: A survey comprising 395 users aged 60 years and above was conducted in China to validate our research model and hypotheses. Results: The results reveal that (1) trust in mHealth services positively influences use intentions, (2) trust in offline health services positively influences trust in mHealth services, (3) declining physiological conditions strengthen the effects of trust in offline health services regarding trust in mHealth services, (4) support from hospitals weakens the effects of trust in mHealth services on use intentions, and (5) the relationship between trust in offline health services and intention to use mHealth services is partially mediated by trust in mHealth services. The independent variables and moderators collectively explain a 48.3% variance in the use intention of mHealth services. Conclusions: We conclude that the trust transfer theory is useful in explaining the development of initial trust in mHealth services. In addition, declining physiological conditions and support from hospitals are important factors for investigating the adoption of mHealth services among elderly users. %M 30622092 %R 10.2196/12269 %U http://mhealth.jmir.org/2019/1/e12269/ %U https://doi.org/10.2196/12269 %U http://www.ncbi.nlm.nih.gov/pubmed/30622092 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e12274 %T Commercially Available Mobile Apps for Caregivers of People With Alzheimer Disease or Other Related Dementias: Systematic Search %A Wozney,Lori %A Freitas de Souza,Luciane M %A Kervin,Emily %A Queluz,Francine %A McGrath,Patrick J %A Keefe,Janice %+ Nova Scotia Health Authority, 302 Pleasant Street, Dartmouth, NS, B2Y 3Z9, Canada, 1 9024490603, loriwozney@gmail.com %K alzheimer and other related dementias %K apps %K caregivers %K eHealth %K mobile phone %D 2018 %7 07.12.2018 %9 Original Paper %J JMIR Aging %G English %X Background: More than 15 million Americans provide unpaid care for persons with Alzheimer disease or other related dementias (ADRD). While there is good evidence to suggest that caregivers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group format. Alternatively, offering electronic health (eHealth) interventions may assist caregivers in providing quality care while remaining in good health. Research to date has generated little knowledge about what app features support ADRD caregivers’ behavioral changes and how developers might optimize features over the long term. Objective: There is an evident knowledge gap in the current landscape of commercially available apps, their integration of behavioral techniques, content focus, and compliance with usability recommendations. This paper systematically reviews and inventories the apps caregivers might typically be exposed to and determines the support integrated into the apps and their functionality for older adults. Methods: The search strategy was designed to mimic typical Web-based health information-seeking behavior for adults. Apps were included based on their explicit focus on ADRD caregiver knowledge and skill improvement. Two coders with expertise in behavioral interventions and eHealth pilot-tested the data extraction. One coder retained app characteristics and design features. Techniques used to promote change were determined, and 2 questions from the Mobile App Rating Scale were used to assess the app credibility and evidence base. Content topics were evaluated using a thematic framing technique, and each app was assessed using a usability heuristic checklist. Results: The search results generated 18 unique apps that met the inclusion criteria. Some apps were unavailable, and only 8 unique apps were reviewed. Of the 8, 7 (88%) apps did not state which scientific orientation was followed to develop their content. None of the apps made clinical claims of improving caregivers’ and care recipients’ overall health. All apps relied on textual information to disseminate their contents. None of the apps was trialed and evidence based. Apps included on average 7 out of 10 behavioral change techniques, 5 out of 10 C.A.R.E. (Caregivers, Aspirations, Realities, and Expectations) features, and 10 out of 18 features on the usability heuristics checklist. Conclusions: Our findings suggest that caregivers are likely to discover apps that are not actually accessible and have low or no evidence base. Apps were found to be largely static, text-based informational resources, and few supported behaviors needed to maintain caregivers’ health. While apps may be providing a high volume of information, caregivers must still navigate what resources they need with limited guidance. Finally, the commercial marketplace is addressing some of the major usability elements, but many design elements are not addressed. %M 31518255 %R 10.2196/12274 %U http://aging.jmir.org/2018/2/e12274/ %U https://doi.org/10.2196/12274 %U http://www.ncbi.nlm.nih.gov/pubmed/31518255 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e12145 %T Testing a Photo Story Intervention in Paper Versus Electronic Tablet Format Compared to a Traditional Brochure Among Older Adults in Germany: Randomized Controlled Trial %A Tan,Shu Ling %A Whittal,Amanda %A Lippke,Sonia %+ Institute of Sport and Exercise Sciences, Department of Social Sciences of Sports, University of Münster, Horstmarer Landweg 62b, Münster, 48149, Germany, 49 2518332175, shuling.tan@uni-muenster.de %K photo story %K traditional brochure %K health literacy %K communication %K older adults %K tablet intervention %K electronic/information technology %K primary care consultation %D 2018 %7 06.12.2018 %9 Original Paper %J JMIR Aging %G English %X Background: To increase effective communication in primary care consultations among older adults in Germany, the photo story is considered to be a useful tool based on Bandura’s social cognitive theory. With information technology helping to increase effective communication, the use of tablets is gaining attention in health care settings, especially with older adults. However, the effectiveness of tablet technology and photo stories has rarely been tested. Objective: The aim is to compare the effectiveness of a photo story intervention to a traditional brochure. Both were delivered either in paper or tablet format. Methods: A trial was conducted with 126 older adults, aged 50 years and older, who were approached and recruited by researchers and administrative staff from senior day care, doctors in rehabilitation centers, and trainers in sports clubs in Germany. Open and face-to-face assessment methodologies were used. Participants were randomly assigned to one of four intervention conditions: traditional brochure in paper format (condition 1) and tablet format (condition 2), and photo story in paper format (condition 3) and tablet format (condition 4). Each participant received a questionnaire and either the traditional brochure or photo story in a paper or tablet version. To evaluate the effectiveness of each intervention, participants completed evaluation questionnaires before and after each intervention. The second part of the questionnaire measured different indicators of health literacy, communication skills, health measurements, and possible underlying mechanisms. Results: Compared to the traditional brochure, participants considered the photo story easier to understand (t124=2.62, P=.01) and more informative (t124=–2.17, P=.03). Participants preferred the paper format because they found it less monotonous (t124=–3.05, P=.003), less boring (t124=–2.65, P=.009), and not too long (t124=–2.26, P=.03) compared to the tablet format. Among all conditions, the traditional brochure with a tablet (condition 2) was also perceived as more monotonous (mean 3.07, SD 1.08), boring (mean 2.77, SD 1.19), and too long to read (mean 2.50, SD 1.33) in comparison to the traditional brochure in paper format (condition 1). Moreover, the participants scored significantly higher on self-referencing on the traditional brochure in paper format (condition 1) than tablet format for both types of the brochure (conditions 2 and 4). Conclusions: Traditional brochures on a tablet seem to be the least effective communication option in primary care consultations among all conditions for older adults. The findings might be specific for the current generation of older adults in Germany and need to be replicated in other countries with larger sample sizes. Although information technology brings advantages, such as effective interventions in different fields and settings, it may also come with several disadvantages, such as technical requirements of the users and devices. These should be considered when integrating information technology into wider situations and populations. Trial Registration: ClinicalTrials.gov NCT02502292; https://clinicaltrials.gov/ct2/show/NCT02502292 (Archived by Webcite at http://www.webcitation.org/747jdJ8pU) %M 31518254 %R 10.2196/12145 %U http://aging.jmir.org/2018/2/e12145/ %U https://doi.org/10.2196/12145 %U http://www.ncbi.nlm.nih.gov/pubmed/31518254 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e12178 %T Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study %A Lefler,Leanne L %A Rhoads,Sarah J %A Harris,Melodee %A Funderburg,Ashley E %A Lubin,Sandra A %A Martel,Isis D %A Faulkner,Jennifer L %A Rooker,Janet L %A Bell,Deborah K %A Marshall,Heather %A Beverly,Claudia J %+ College of Nursing, University of Arkansas for Medical Sciences, 4301 W Markham, #529, Little Rock, AR, 72205, United States, 1 5012961939, L.Lefler@uams.edu %K heart failure %K remote monitoring %K mHealth %K older adults %K feasibility %K self-management %D 2018 %7 04.12.2018 %9 Original Paper %J JMIR Aging %G English %X Background: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. Objective: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. Methods: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. Results: We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. Conclusions: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF. %M 31518257 %R 10.2196/12178 %U http://aging.jmir.org/2018/2/e12178/ %U https://doi.org/10.2196/12178 %U http://www.ncbi.nlm.nih.gov/pubmed/31518257 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11335 %T Impact of a Wearable Device-Based Walking Programs in Rural Older Adults on Physical Activity and Health Outcomes: Cohort Study %A Jang,Il-Young %A Kim,Hae Reong %A Lee,Eunju %A Jung,Hee-Won %A Park,Hyelim %A Cheon,Seon-Hee %A Lee,Young Soo %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2493, yurangpark@yuhs.ac %K adherence %K frailty %K older adult %K rural area %K wearable device %D 2018 %7 21.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Community-dwelling older adults living in rural areas are in a less favorable environment for health care compared with urban older adults. We believe that intermittent coaching through wearable devices can help optimize health care for older adults in medically limited environments. Objective: We aimed to evaluate whether a wearable device and mobile-based intermittent coaching or self-management could increase physical activity and health outcomes of small groups of older adults in rural areas. Methods: To address the above evaluation goal, we carried out the “Smart Walk” program, a health care model wherein a wearable device is used to promote self-exercise particularly among community-dwelling older adults managed by a community health center. We randomly selected older adults who had enrolled in a population-based, prospective cohort study of aging, the Aging Study of Pyeongchang Rural Area. The “Smart Walk” program was a 13-month program conducted from March 2017 to March 2018 and included 6 months of coaching, 1 month of rest, and 6 months of self-management. We evaluated differences in physical activity and health outcomes according to frailty status and conducted pre- and postanalyses of the Smart Walk program. We also performed intergroup analysis according to adherence of wearable devices. Results: We recruited 22 participants (11 robust and 11 prefrail older adults). The two groups were similar in most of the variables, except for age, frailty index, and Short Physical Performance Battery score associated with frailty criteria. After a 6-month coaching program, the prefrail group showed significant improvement in usual gait speed (mean 0.73 [SD 0.11] vs mean 0.96 [SD 0.27], P=.02), International Physical Activity Questionnaire scores in kcal (mean 2790.36 [SD 2224.62] vs mean 7589.72 [SD 4452.52], P=.01), and European Quality of Life-5 Dimensions score (mean 0.84 [SD 0.07] vs mean 0.90 [SD 0.07], P=.02), although no significant improvement was found in the robust group. The average total step count was significantly different and was approximately four times higher in the coaching period than in the self-management period (5,584,295.83 vs 1,289,084.66, P<.001). We found that participants in the “long-self” group who used the wearable device for the longest time showed increased body weight and body mass index by mean 0.65 (SD 1.317) and mean 0.097 (SD 0.513), respectively, compared with the other groups. Conclusions: Our “Smart Walk” program improved physical fitness, anthropometric measurements, and geriatric assessment categories in a small group of older adults in rural areas with limited resources for monitoring. Further validation through various rural public health centers and in a large number of rural older adults is required. %M 30463838 %R 10.2196/11335 %U http://mhealth.jmir.org/2018/11/e11335/ %U https://doi.org/10.2196/11335 %U http://www.ncbi.nlm.nih.gov/pubmed/30463838 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e11569 %T A Fall Risk mHealth App for Older Adults: Development and Usability Study %A Hsieh,Katherine L %A Fanning,Jason T %A Rogers,Wendy A %A Wood,Tyler A %A Sosnoff,Jacob J %+ Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, 906 South Goodwin Avenue, Urbana, IL, 61801, United States, 1 217 244 7006, jsosnoff@illinois.edu %K usability %K fall risk %K mHealth app %K mobile phone %D 2018 %7 20.11.2018 %9 Original Paper %J JMIR Aging %G English %X Background: Falls are the leading cause of injury-related death in older adults. Due to various constraints, objective fall risk screening is seldom performed in clinical settings. Smartphones offer a high potential to provide fall risk screening for older adults in home settings. However, there is limited understanding of whether smartphone technology for falls screening is usable by older adults who present age-related changes in perceptual, cognitive, and motor capabilities. Objective: The aims of this study were to develop a fall risk mobile health (mHealth) app and to determine the usability of the fall risk app in healthy, older adults. Methods: A fall risk app was developed that consists of a health history questionnaire and 5 progressively challenging mobility tasks to measure individual fall risk. An iterative design-evaluation process of semistructured interviews was performed to determine the usability of the app on a smartphone and tablet. Participants also completed a Systematic Usability Scale (SUS). In the first round of interviews, 6 older adults participated, and in the second round, 5 older adults participated. Interviews were videotaped and transcribed, and the data were coded to create themes. Average SUS scores were calculated for the smartphone and tablet. Results: There were 2 themes identified from the first round of interviews, related to perceived ease of use and perceived usefulness. While instructions for the balance tasks were difficult to understand, participants found it beneficial to learn about their risk for falls, found the app easy to follow, and reported confidence in using the app on their own. Modifications were made to the app, and following the second round of interviews, participants reported high ease of use and usefulness in learning about their risk of falling. Few differences were reported between using a smartphone or tablet. Average SUS scores ranged from 79 to 84. Conclusions: Our fall risk app was found to be highly usable by older adults as reported from interviews and high scores on the SUS. When designing a mHealth app for older adults, developers should include clear and simple instructions and preventative strategies to improve health. Furthermore, if the design accommodates for age-related sensory changes, smartphones can be as effective as tablets. A mobile app to assess fall risk has the potential to be used in home settings by older adults. %M 31518234 %R 10.2196/11569 %U http://aging.jmir.org/2018/2/e11569/ %U https://doi.org/10.2196/11569 %U http://www.ncbi.nlm.nih.gov/pubmed/31518234 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10748 %T Veterans’ Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences %A Connolly,Samantha L %A Miller,Christopher J %A Koenig,Christopher J %A Zamora,Kara A %A Wright,Patricia B %A Stanley,Regina L %A Pyne,Jeffrey M %+ Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S Huntington Avenue, Building 9 Room 208F, Boston, MA, 02130, United States, 1 857 364 5987, Samantha.connolly@va.gov %K smartphone apps %K mobile phone %K mhealth %K mental health %K qualitative analysis %K rurality %K age %K veterans %K depression %K anxiety disorders %K posttraumatic stress disorder %K PTSD %K alcohol abuse %D 2018 %7 22.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans’ attitudes regarding the use of these innovations are largely unknown, particularly among rural and aging populations who may benefit from increased access to care. Objective: The objective of our study was to examine veterans’ attitudes toward smartphone apps and to assess whether openness toward this technology varies by age or rurality. Methods: We conducted semistructured qualitative interviews with 66 veterans from rural and urban areas in Maine, Arkansas, and California. Eligible veterans aged 18 to 70 years had screened positive for postraumatic stress disorder (PTSD), alcohol use disorder, or major depressive disorder, but a history of mental health service utilization was not required. Interviews were digitally recorded, professionally transcribed, and coded by a research team using an established codebook. We then conducted a thematic analysis of segments pertaining to smartphone use, informed by existing theories of technology adoption. Results: Interviews revealed a marked division regarding openness to mental health smartphone apps, such that veterans either expressed strongly positive or negative views about their usage, with few participants sharing ambivalent or neutral opinions. Differences emerged between rural and urban veterans’ attitudes, with rural veterans tending to oppose app usage, describe smartphones as hard to navigate, and cite barriers such as financial limitations and connectivity issues, more so than urban populations. Moreover, rural veterans more often described smartphones as being opposed to their values. Differences did not emerge between younger and older (≥50) veterans regarding beliefs that apps could be effective or compatible with their culture and identity. However, compared with younger veterans, older veterans more often reported not owning a smartphone and described this technology as being difficult to use. Conclusions: Openness toward the use of smartphone apps in mental health treatment may vary based on rurality, and further exploration of the barriers cited by rural veterans is needed to improve access to care. In addition, findings indicate that older patients may be more open to integrating technology into their mental health care than providers might assume, although such patients may have more trouble navigating these devices and may benefit from simplified app designs or smartphone training. Given the strong opinions expressed either for or against smartphone apps, our findings suggest that apps may not be an ideal adjunctive treatment for all patients, but it is important to identify those who are open to and may greatly benefit from this technology. %M 30135050 %R 10.2196/10748 %U http://mhealth.jmir.org/2018/8/e10748/ %U https://doi.org/10.2196/10748 %U http://www.ncbi.nlm.nih.gov/pubmed/30135050 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e172 %T A Mobile App (iBeni) With a Neuropsychological Basis for Cognitive Stimulation for Elderly Adults: Pilot and Validation Study %A Martínez-Alcalá,Claudia I %A Rosales-Lagarde,Alejandra %A Hernández-Alonso,Esmeralda %A Melchor-Agustin,Roberto %A Rodriguez-Torres,Erika E %A Itzá-Ortiz,Benjamín A %+ Consejo Nacional de Ciencia y Tecnología, Av Insurgentes Sur 1582, Col Crédito Constructor, Del Benito Juárez, Ciudad de México, 03940, Mexico, 52 (771) 71 72 000 ext 4332, c_isabel_alcala@hotmail.com %K mobile application %K cognitive stimulation %K cognitive impairment %K older adults %K neuropsychological evaluation. %D 2018 %7 21.08.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cognitive impairment is considered one of the most feared chronic conditions among the older adult population since its incidence is approximately twice more frequent than that of dementia. In Mexico, no studies or reports of older adults using technology for cognitive interventions have been published, given that institutions usually frame cognitive stimulation tasks in paper and pencil (ie, in the traditional manner). Objective: The objective of this study was to create and analyze the effect, viability, and impact of a mobile app for cognitive stimulation implemented among a group of elderly adults (over 60 years of age) from the state of Hidalgo in Mexico. Methods: This study was a nonprobabilistic pilot trial using convenience sampling. An intervention was implemented among a group of 22 older adults between 60 and 80 years of age over 12 weeks. Half of the older adults were stimulated with the mobile app (experimental group) and the other half followed the traditional paper and pencil training (control group). Assessments with the Mini-Mental State Examination (MMSE) and the Neuropsi, a neuropsychological test validated in Mexico, were done before and after both cognitive stimulations. Results: According to the analyzed data, 6/11 (55%) participants from the experimental group obtained better results in their cognitive skills, and 5 (45%) of the adults maintained their score, given that the participants were able to execute the exercises repetitively. Meanwhile, for the control group, only 3/11 (27%) participants obtained better results in the postevaluation. Significant values for results of the MMSE were obtained in the postevaluation for the experimental group compared to the control group, while results did not show significant differences in the Neuropsi. Regarding the validation of the app, all the participants evaluated its pertinence positively. Conclusions: The intervention data show that the experimental group obtained better results in the postevaluation given that the participants were able to execute the exercises repetitively. The control group could not accomplish this since they had to respond on the manual and no further attempts were provided. However, both groups increased their score in the neuropsychological evaluations. This suggests that a longer and more frequent intervention is required. Registered Report Identifier: RR1-10.2196/9603 %M 30131319 %R 10.2196/resprot.9603 %U http://www.researchprotocols.org/2018/8/e172/ %U https://doi.org/10.2196/resprot.9603 %U http://www.ncbi.nlm.nih.gov/pubmed/30131319 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e147 %T Self-Management of Chronic Diseases Among Older Korean Adults: An mHealth Training, Protocol, and Feasibility Study %A Kim,Heejung %A Park,Eunhee %A Lee,Sangeun %A Kim,Mijung %A Park,Eun Jeong %A Hong,Soyun %+ College of Nursing, Yonsei University, Room #407 College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic Of Korea, 82 10 7298 6706, rnsoyun@gmail.com %K mobile health %K feasibility study %K chronic disease %K eHealth Enhanced Chronic Care Model %K elderly %K community health service %D 2018 %7 29.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most training programs for self-management of chronic diseases in Korea currently involve face-to-face interactions primarily in a health care setting. Therefore, older Koreans living in the community continue to seek other training opportunities for the management of chronic diseases. This has led to the development of new training methods, such as mobile health (mHealth) care, which are valuable in community centers and homes. Objective: This feasibility study (1) developed an mHealth training protocol to empower community-dwelling elderly individuals to manage their chronic diseases; (2) examined the feasibility of delivering this mHealth training protocol to elderly individuals through mobile tablets and applications (apps); and (3) discussed the contextual and methodological challenges associated with the development of this protocol. Methods: The mHealth training protocol was developed based on the eHealth Enhanced Chronic Care Model and comprised of four phases. Phase 1 included standardized technology (mobile tablets) training using guidebooks, demonstrations, and guided practice. Phase 2 included provision of standardized information about disease management that was obtained from governmental and professional health care organizations. Phase 3 included provision of training on the use of high-quality mHealth apps that were selected based on individual diagnoses. Phase 4 included encouraging the patients to practice using self-selected mHealth apps based on their individual needs. Quantitative descriptive statistics and qualitative content analyses of user evaluations were used to assess the feasibility and user acceptance of this protocol. Results: Of the 27 older adults included in this study, 25 completed all 4 weeks of the mHealth training. The attrition rate was 7% (2/27), and the reasons included time conflicts, emotional distress, and/or family discouragement. The men required little or no training for Phase 1, and in comparison with men, women seemed to depend more on the mHealth trainers in Phase 3. Gender, level of education, and previous experience of using smartphones were associated with the speed of learning, level of confidence, and overall competence. Conclusions: A tailored and personalized approach is required to develop mHealth training protocols for older adults. Self-management of chronic diseases via mHealth training requires careful consideration of the complex nature of human behavior, emotional responses, and familial influences. Therefore, integration of a theoretical, clinical, and technical approach is necessary for the successful development and implementation of an mHealth training program that targets older adults with chronic diseases in a community setting. %M 29959109 %R 10.2196/mhealth.9988 %U http://mhealth.jmir.org/2018/6/e147/ %U https://doi.org/10.2196/mhealth.9988 %U http://www.ncbi.nlm.nih.gov/pubmed/29959109 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e40 %T Feasibility of Virtual Tablet-Based Group Exercise Among Older Adults in Siberia: Findings From Two Pilot Trials %A Nikitina,Svetlana %A Didino,Daniele %A Baez,Marcos %A Casati,Fabio %+ Department of Information Engineering and Computer Science, University of Trento, Via Sommarive, 9 - Povo, Trento, 38123, Italy, 39 0461 28 5299, svetlana.nikitina@unitn.it %K physical fitness %K exercise training %K tablet computers %K elderly %K social support %D 2018 %7 27.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular physical activity has a positive effect on physical health, well-being, and life satisfaction of older adults. However, engaging in regular physical activity can be challenging for the elderly population because of reduced mobility, low motivation, or lack of the proper infrastructures in their communities. Objective: The objective of this paper was to study the feasibility of home-based online group training—under different group cohesion settings—and its effects on adherence and well-being among Russian older adults. We focused particularly on the technology usability and usage and on the adherence to the training (in light of premeasures of social support, enjoyment of physical activity, and leg muscle strength). As a secondary objective, we also explored the effects of the technology-supported intervention on subjective well-being and loneliness. Methods: Two pilot trials were carried out exploring two different group cohesion settings (weak cohesion and strong cohesion) in the period from 2015 to 2016 in Tomsk, Russian Federation. A total of 44 older adults (59-83 years) participated in the two pilots and followed a strength and balance training program (Otago) for 8 weeks with the help of a tablet-based virtual gym app. Participants in each pilot were assigned to an interaction condition, representing the online group exercising, and an individual condition, representing a home-based individual training. Both conditions featured persuasion strategies but differed in the ability to socialize and train together. Results: Both interaction and individual groups reported a high usability of the technology. Trainees showed a high level of technology acceptance and, particularly, a high score in intention to future use (4.2-5.0 on a 5-point Likert scale). Private texting (short service message [SMS]) was used more than public texting, and the strong cohesion condition resulted in more messages per user. Joint participations to training sessions (copresence) were higher for the social group with higher cohesion. The overall adherence to the training was 74% (SD 27%). Higher levels of social support at baseline were associated with higher adherence in the low cohesion condition (F1,18=5.23, P=.03), whereas in the high cohesion, such association was not found. Overall improvement in the satisfaction with life score was observed between pre and post measures (F1,31=5.85, P=.02), but no decrease in loneliness. Conclusions: Online group exercising was proven feasible among healthy independently living older adults in Russia. The pilots suggest that a physical training performed in a virtual environment positively affect the life satisfaction of the trainees, but it does not provide support for a decrease in loneliness. High cohesion groups are preferable for group exercising, especially to mitigate effects of low social support on adherence. Further research in motivating group interactions in training settings is needed. %M 29487045 %R 10.2196/mhealth.7531 %U http://mhealth.jmir.org/2018/2/e40/ %U https://doi.org/10.2196/mhealth.7531 %U http://www.ncbi.nlm.nih.gov/pubmed/29487045 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e34 %T Activity Monitors as Support for Older Persons’ Physical Activity in Daily Life: Qualitative Study of the Users’ Experiences %A Ehn,Maria %A Eriksson,Lennie Carlén %A Åkerberg,Nina %A Johansson,Ann-Christin %+ School of Innovation, Design and Engineering, Mälardalen University, Box 883, Västerås, S-721 23, Sweden, 46 21 107093 ext 107093, maria.ehn@mdh.se %K exercise %K behavior %K aged %K seniors %K mobile applications %K fitness trackers %D 2018 %7 01.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Falls are a major threat to the health and independence of seniors. Regular physical activity (PA) can prevent 40% of all fall injuries. The challenge is to motivate and support seniors to be physically active. Persuasive systems can constitute valuable support for persons aiming at establishing and maintaining healthy habits. However, these systems need to support effective behavior change techniques (BCTs) for increasing older adults’ PA and meet the senior users’ requirements and preferences. Therefore, involving users as codesigners of new systems can be fruitful. Prestudies of the user’s experience with similar solutions can facilitate future user-centered design of novel persuasive systems. Objective: The aim of this study was to investigate how seniors experience using activity monitors (AMs) as support for PA in daily life. The addressed research questions are as follows: (1) What are the overall experiences of senior persons, of different age and balance function, in using wearable AMs in daily life?; (2) Which aspects did the users perceive relevant to make the measurements as meaningful and useful in the long-term perspective?; and (3) What needs and requirements did the users perceive as more relevant for the activity monitors to be useful in a long-term perspective? Methods: This qualitative interview study included 8 community-dwelling older adults (median age: 83 years). The participants’ experiences in using two commercial AMs together with tablet-based apps for 9 days were investigated. Activity diaries during the usage and interviews after the usage were exploited to gather user experience. Comments in diaries were summarized, and interviews were analyzed by inductive content analysis. Results: The users (n=8) perceived that, by using the AMs, their awareness of own PA had increased. However, the AMs’ impact on the users’ motivation for PA and activity behavior varied between participants. The diaries showed that self-estimated physical effort varied between participants and varied for each individual over time. Additionally, participants reported different types of accomplished activities; talking walks was most frequently reported. To be meaningful, measurements need to provide the user with a reliable receipt of whether his or her current activity behavior is sufficient for reaching an activity goal. Moreover, praise when reaching a goal was described as motivating feedback. To be useful, the devices must be easy to handle. In this study, the users perceived wearables as easy to handle, whereas tablets were perceived difficult to maneuver. Users reported in the diaries that the devices had been functional 78% (58/74) of the total test days. Conclusions: Activity monitors can be valuable for supporting seniors’ PA. However, the potential of the solutions for a broader group of seniors can significantly be increased. Areas of improvement include reliability, usability, and content supporting effective BCTs with respect to increasing older adults’ PA. %M 29391342 %R 10.2196/mhealth.8345 %U http://mhealth.jmir.org/2018/2/e34/ %U https://doi.org/10.2196/mhealth.8345 %U http://www.ncbi.nlm.nih.gov/pubmed/29391342 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e26 %T Prevalence of Health App Use Among Older Adults in Germany: National Survey %A Rasche,Peter %A Wille,Matthias %A Bröhl,Christina %A Theis,Sabine %A Schäfer,Katharina %A Knobe,Matthias %A Mertens,Alexander %+ Department of Mechanical Engineering, Institute of Industrial Engineering and Ergonomics, RWTH Aachen University, Bergdriesch 27, Aachen, 52062, Germany, 49 2418099477, p.rasche@iaw.rwth-aachen.de %K telemedicine %K Germany %K mobile applications %K smartphone %K aged %D 2018 %7 23.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health apps are increasingly becoming an integral part of health care. Especially in older adults, the self-management of chronic diseases by health apps might become an integral part of health care services. Objective: The aim of this explorative study was to investigate the prevalence of health app use and related demographic factors, as well as health status among older adults in Germany. Methods: A nationwide postal survey was conducted. Of the 5000 individuals contacted, a total of 576 participants completed this survey. On the basis of their self-indicated assignment to one of the three predefined user groups (health app users, general app users, and nonusers of apps), participants answered various questions regarding app and health app use, including frequency of use and number of installed apps, demographic factors, and health status. Results: In total, 16.5% (95/576) used health apps, whereas 37.5% (216/576) indicated only using general apps, and 46.0% (265/576) reported using no apps at all. The number of installed health apps was most frequently reported as between 1 and 5 apps per participant, which were usually used on a weekly basis. The most frequently cited type of health apps were exercise-related ones. Individuals using health apps were found to be younger (MeanmHealth 66.6, SD 4.7) and to have a higher level of technical readiness compared with general app users and nonusers of apps (adjusted odds ratio, AOR=4.02 [95% CI 2.23-7.25] for technical readiness, and AOR=0.905 [95% CI 0.85-0.97] for age). The most frequently mentioned sources of information about apps within the group of health and general app users were family and friends. Identified barriers against the use of health apps were a lack of trust, data privacy concerns, and fear of misdiagnosis. Conclusions: Health apps are already used by older adults in Germany. The main type of apps used are exercise-related ones. Barriers to and incentives for the use of health apps and associations with health status and users’ demographics were revealed. %M 29362211 %R 10.2196/mhealth.8619 %U http://mhealth.jmir.org/2018/1/e26/ %U https://doi.org/10.2196/mhealth.8619 %U http://www.ncbi.nlm.nih.gov/pubmed/29362211 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 11 %P e173 %T User Acceptance of Wrist-Worn Activity Trackers Among Community-Dwelling Older Adults: Mixed Method Study %A Puri,Arjun %A Kim,Ben %A Nguyen,Olivier %A Stolee,Paul %A Tung,James %A Lee,Joon %+ Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Lyle Hallman North, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada, 1 5198884567 ext 31567, joon.lee@uwaterloo.ca %K health %K mHealth %K fitness trackers %K older adults %D 2017 %7 15.11.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers are newly emerging technologies with the anticipation for successfully supporting aging-in-place. Consumer-grade wearable activity trackers are increasingly ubiquitous in the market, but the attitudes toward, as well as acceptance and voluntary use of, these trackers in older population are poorly understood. Objective: The aim of this study was to assess acceptance and usage of wearable activity trackers in Canadian community-dwelling older adults, using the potentially influential factors as identified in literature and technology acceptance model. Methods: A mixed methods design was used. A total of 20 older adults aged 55 years and older were recruited from Southwestern Ontario. Participants used 2 different wearable activity trackers (Xiaomi Mi Band and Microsoft Band) separately for each segment in the crossover design study for 21 days (ie, 42 days total). A questionnaire was developed to capture acceptance and experience at the end of each segment, representing 2 different devices. Semistructured interviews were conducted with 4 participants, and a content analysis was performed. Results: Participants ranged in age from 55 years to 84 years (mean age: 64 years). The Mi Band gained higher levels of acceptance (16/20, 80%) compared with the Microsoft Band (10/20, 50%). The equipment characteristics dimension scored significantly higher for the Mi Band (P<.05). The amount a participant was willing to pay for the device was highly associated with technology acceptance (P<.05). Multivariate logistic regression with 3 covariates resulted in an area under the curve of 0.79. Content analysis resulted in the formation of the following main themes: (1) smartphones as facilitators of wearable activity trackers; (2) privacy is less of a concern for wearable activity trackers, (3) value proposition: self-awareness and motivation; (4) subjective norm, social support, and sense of independence; and (5) equipment characteristics matter: display, battery, comfort, and aesthetics. Conclusions: Older adults were mostly accepting of wearable activity trackers, and they had a clear understanding of its value for their lives. Wearable activity trackers were uniquely considered more personal than other types of technologies, thereby the equipment characteristics including comfort, aesthetics, and price had a significant impact on the acceptance. Results indicated that privacy was less of concern for older adults, but it may have stemmed from a lack of understanding of the privacy risks and implications. These findings add to emerging research that investigates acceptance and factors that may influence acceptance of wearable activity trackers among older adults. %M 29141837 %R 10.2196/mhealth.8211 %U http://mhealth.jmir.org/2017/11/e173/ %U https://doi.org/10.2196/mhealth.8211 %U http://www.ncbi.nlm.nih.gov/pubmed/29141837 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e104 %T Mobile Phone-Based Measures of Activity, Step Count, and Gait Speed: Results From a Study of Older Ambulatory Adults in a Naturalistic Setting %A Rye Hanton,Cassia %A Kwon,Yong-Jun %A Aung,Thawda %A Whittington,Jackie %A High,Robin R %A Goulding,Evan H %A Schenk,A Katrin %A Bonasera,Stephen J %+ Department of Internal Medicine, Division of Geriatrics, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, NE, 68198-6155, United States, 1 402 559 8409, sbonasera@unmc.edu %K mobile phone %K functional status %K mobility %K gait speed %K mobility measures %K LLFDI %K SAFFE %K PROMIS short %K PROMIS Global %K step count %K behavioral classification %K frailty phenotype %K normal aging %D 2017 %7 03.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cellular mobile telephone technology shows much promise for delivering and evaluating healthcare interventions in cost-effective manners with minimal barriers to access. There is little data demonstrating that these devices can accurately measure clinically important aspects of individual functional status in naturalistic environments outside of the laboratory. Objective: The objective of this study was to demonstrate that data derived from ubiquitous mobile phone technology, using algorithms developed and previously validated by our lab in a controlled setting, can be employed to continuously and noninvasively measure aspects of participant (subject) health status including step counts, gait speed, and activity level, in a naturalistic community setting. A second objective was to compare our mobile phone-based data against current standard survey-based gait instruments and clinical physical performance measures in order to determine whether they measured similar or independent constructs. Methods: A total of 43 ambulatory, independently dwelling older adults were recruited from Nebraska Medicine, including 25 (58%, 25/43) healthy control individuals from our Engage Wellness Center and 18 (42%, 18/43) functionally impaired, cognitively intact individuals (who met at least 3 of 5 criteria for frailty) from our ambulatory Geriatrics Clinic. The following previously-validated surveys were obtained on study day 1: (1) Late Life Function and Disability Instrument (LLFDI); (2) Survey of Activities and Fear of Falling in the Elderly (SAFFE); (3) Patient Reported Outcomes Measurement Information System (PROMIS), short form version 1.0 Physical Function 10a (PROMIS-PF); and (4) PROMIS Global Health, short form version 1.1 (PROMIS-GH). In addition, clinical physical performance measurements of frailty (10 foot Get up and Go, 4 Meter walk, and Figure-of-8 Walk [F8W]) were also obtained. These metrics were compared to our mobile phone-based metrics collected from the participants in the community over a 24-hour period occurring within 1 week of the initial assessment. Results: We identified statistically significant differences between functionally intact and frail participants in mobile phone-derived measures of percent activity (P=.002, t test), active versus inactive status (P=.02, t test), average step counts (P<.001, repeated measures analysis of variance [ANOVA]) and gait speed (P<.001, t test). In functionally intact individuals, the above mobile phone metrics assessed aspects of functional status independent (Bland-Altman and correlation analysis) of both survey- and/or performance battery-based functional measures. In contrast, in frail individuals, the above mobile phone metrics correlated with submeasures of both SAFFE and PROMIS-GH. Conclusions: Continuous mobile phone-based measures of participant community activity and mobility strongly differentiate between persons with intact functional status and persons with a frailty phenotype. These measures assess dimensions of functional status independent of those measured using current validated questionnaires and physical performance assessments to identify functional compromise. Mobile phone-based gait measures may provide a more readily accessible and less-time consuming measure of gait, while further providing clinicians with longitudinal gait measures that are currently difficult to obtain. %M 28974482 %R 10.2196/mhealth.5090 %U http://mhealth.jmir.org/2017/10/e104/ %U https://doi.org/10.2196/mhealth.5090 %U http://www.ncbi.nlm.nih.gov/pubmed/28974482 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e71 %T Human-Centered Design Study: Enhancing the Usability of a Mobile Phone App in an Integrated Falls Risk Detection System for Use by Older Adult Users %A Harte,Richard %A Quinlan,Leo R %A Glynn,Liam %A Rodríguez-Molinero,Alejandro %A Baker,Paul MA %A Scharf,Thomas %A ÓLaighin,Gearóid %+ NUI Galway, Physiology, School of Medicine, University Road, Galway,, Ireland, 353 91 493710, leo.quinlan@nuigalway.ie %K human-centered design %K user-centered design %K human-computer interface %K human factors engineering %K eHealth %K engineering psychology %K mHealth %D 2017 %7 30.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Design processes such as human-centered design (HCD), which involve the end user throughout the product development and testing process, can be crucial in ensuring that the product meets the needs and capabilities of the user, particularly in terms of safety and user experience. The structured and iterative nature of HCD can often conflict with the necessary rapid product development life-cycles associated with the competitive connected health industry. Objective: The aim of this study was to apply a structured HCD methodology to the development of a smartphone app that was to be used within a connected health fall risk detection system. Our methodology utilizes so called discount usability engineering techniques to minimize the burden on resources during development and maintain a rapid pace of development. This study will provide prospective designers a detailed description of the application of a HCD methodology. Methods: A 3-phase methodology was applied. In the first phase, a descriptive “use case” was developed by the system designers and analyzed by both expert stakeholders and end users. The use case described the use of the app and how various actors would interact with it and in what context. A working app prototype and a user manual were then developed based on this feedback and were subjected to a rigorous usability inspection. Further changes were made both to the interface and support documentation. The now advanced prototype was exposed to user testing by end users where further design recommendations were made. Results: With combined expert and end-user analysis of a comprehensive use case having originally identified 21 problems with the system interface, we have only seen and observed 3 of these problems in user testing, implying that 18 problems were eliminated between phase 1 and 3. Satisfactory ratings were obtained during validation testing by both experts and end users, and final testing by users shows the system requires low mental, physical, and temporal demands according to the NASA Task Load Index (NASA-TLX). Conclusions: From our observation of older adults’ interactions with smartphone interfaces, there were some recurring themes. Clear and relevant feedback as the user attempts to complete a task is critical. Feedback should include pop-ups, sound tones, color or texture changes, or icon changes to indicate that a function has been completed successfully, such as for the connection sequence. For text feedback, clear and unambiguous language should be used so as not to create anxiety, particularly when it comes to saving data. Warning tones or symbols, such as caution symbols or shrill tones, should only be used if absolutely necessary. Our HCD methodology, designed and implemented based on the principles of the International Standard Organizaton (ISO) 9241-210 standard, produced a functional app interface within a short production cycle, which is now suitable for use by older adults in long term clinical trials. %M 28559227 %R 10.2196/mhealth.7046 %U http://mhealth.jmir.org/2017/5/e71/ %U https://doi.org/10.2196/mhealth.7046 %U http://www.ncbi.nlm.nih.gov/pubmed/28559227 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e69 %T Smart Devices for Older Adults Managing Chronic Disease: A Scoping Review %A Kim,Ben YB %A Lee,Joon %+ Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Lyle Hallman North, 3rd Floor, 200 University Avenue W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 31567, joon.lee@uwaterloo.ca %K mobile health %K mHealth %K smartphone %K mobile phone %K tablet %K older adults %K seniors %K chronic disease %K chronic disease management %K scoping review %D 2017 %7 23.05.2017 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The emergence of smartphones and tablets featuring vastly advancing functionalities (eg, sensors, computing power, interactivity) has transformed the way mHealth interventions support chronic disease management for older adults. Baby boomers have begun to widely adopt smart devices and have expressed their desire to incorporate technologies into their chronic care. Although smart devices are actively used in research, little is known about the extent, characteristics, and range of smart device-based interventions. Objective: We conducted a scoping review to (1) understand the nature, extent, and range of smart device-based research activities, (2) identify the limitations of the current research and knowledge gap, and (3) recommend future research directions. Methods: We used the Arksey and O’Malley framework to conduct a scoping review. We identified relevant studies from MEDLINE, Embase, CINAHL, and Web of Science databases using search terms related to mobile health, chronic disease, and older adults. Selected studies used smart devices, sampled older adults, and were published in 2010 or after. The exclusion criteria were sole reliance on text messaging (short message service, SMS) or interactive voice response, validation of an electronic version of a questionnaire, postoperative monitoring, and evaluation of usability. We reviewed references. We charted quantitative data and analyzed qualitative studies using thematic synthesis. To collate and summarize the data, we used the chronic care model. Results: A total of 51 articles met the eligibility criteria. Research activity increased steeply in 2014 (17/51, 33%) and preexperimental design predominated (16/50, 32%). Diabetes (16/46, 35%) and heart failure management (9/46, 20%) were most frequently studied. We identified diversity and heterogeneity in the collection of biometrics and patient-reported outcome measures within and between chronic diseases. Across studies, we found 8 self-management supporting strategies and 4 distinct communication channels for supporting the decision-making process. In particular, self-monitoring (38/40, 95%), automated feedback (15/40, 38%), and patient education (13/40, 38%) were commonly used as self-management support strategies. Of the 23 studies that implemented decision support strategies, clinical decision making was delegated to patients in 10 studies (43%). The impact on patient outcomes was consistent with studies that used cellular phones. Patients with heart failure and asthma reported improved quality of life. Qualitative analysis yielded 2 themes of facilitating technology adoption for older adults and 3 themes of barriers. Conclusions: Limitations of current research included a lack of gerontological focus, dominance of preexperimental design, narrow research scope, inadequate support for participants, and insufficient evidence for clinical outcome. Recommendations for future research include generating evidence for smart device-based programs, using patient-generated data for advanced data mining techniques, validating patient decision support systems, and expanding mHealth practice through innovative technologies. %M 28536089 %R 10.2196/mhealth.7141 %U http://mhealth.jmir.org/2017/5/e69/ %U https://doi.org/10.2196/mhealth.7141 %U http://www.ncbi.nlm.nih.gov/pubmed/28536089 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e39 %T Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study %A Lilje,Stina Charlotta %A Olander,Ewy %A Berglund,Johan %A Skillgate,Eva %A Anderberg,Peter %+ Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-171 77, Sweden, 46 708233332, titti.lilje@gmail.com %K text messages %K older adults %K recurrent low back pain %K manual therapy %D 2017 %7 30.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Clinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients’ experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published. Objectives: The aim of this study was to explore older persons’ common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP. Methods: A total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi’s principles of psychological phenomenological analysis. Results: The participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises. Conclusions: It seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed. %M 28360026 %R 10.2196/mhealth.7184 %U http://mhealth.jmir.org/2017/3/e39/ %U https://doi.org/10.2196/mhealth.7184 %U http://www.ncbi.nlm.nih.gov/pubmed/28360026 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e28 %T Feasibility and Acceptability of a Wearable Technology Physical Activity Intervention With Telephone Counseling for Mid-Aged and Older Adults: A Randomized Controlled Pilot Trial %A Lyons,Elizabeth J %A Swartz,Maria C %A Lewis,Zakkoyya H %A Martinez,Eloisa %A Jennings,Kristofer %+ Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, United States, 1 4097722575, ellyons@utmb.edu %K physical activity %K technology %K mobile health %K health behavior %K self-control %D 2017 %7 06.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As adults age, their physical activity decreases and sedentary behavior increases, leading to increased risk of negative health outcomes. Wearable electronic activity monitors have shown promise for delivering effective behavior change techniques. However, little is known about the feasibility and acceptability of non-Fitbit wearables (Fitbit, Inc, San Francisco, California) combined with telephone counseling among adults aged more than 55 years. Objective: The purpose of our study was to determine the feasibility, acceptability, and effect on physical activity of an intervention combining a wearable physical activity monitor, tablet device, and telephone counseling among adults aged 55-79 years. Methods: Adults (N=40, aged 55-79 years, body mass index=25-35, <60 min of activity per week) were randomized to receive a 12-week intervention or to a wait list control. Intervention participants received a Jawbone Up24 monitor, a tablet with the Jawbone Up app installed, and brief weekly telephone counseling. Participants set daily and weekly step goals and used the monitor’s idle alert to notify them when they were sedentary for more than 1 h. Interventionists provided brief counseling once per week by telephone. Feasibility was measured using observation and study records, and acceptability was measured by self-report using validated items. Physical activity and sedentary time were measured using ActivPAL monitors following standard protocols. Body composition was measured using dual-energy x-ray absorptiometry scans, and fitness was measured using a 6-min walk test. Results: Participants were 61.48 years old (SD 5.60), 85% (34/40) female, 65% (26/40) white. Average activity monitor wear time was 81.85 (SD 3.73) of 90 days. Of the 20 Up24 monitors, 5 were reported broken and 1 lost. No related adverse events were reported. Acceptability items were rated at least 4 on a scale of 1-5. Effect sizes for most outcomes were small, including stepping time per day (d=0.35), steps per day (d=0.26), sitting time per day (d=0.21), body fat (d=0.17), and weight (d=0.33). Conclusions: The intervention was feasible and acceptable in this population. Effect sizes were similar to the sizes found using other wearable electronic activity monitors, indicating that when combined with telephone counseling, wearable activity monitors are a potentially effective tool for increasing physical activity and decreasing sedentary behavior. Trial registration: Clinicaltrials.gov NCT01869348; https://clinicaltrials.gov/ct2/show/NCT01869348 (Archived by WebCite at http://www.webcitation.org/6odlIolqy) %M 28264796 %R 10.2196/mhealth.6967 %U http://mhealth.jmir.org/2017/3/e28/ %U https://doi.org/10.2196/mhealth.6967 %U http://www.ncbi.nlm.nih.gov/pubmed/28264796 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e116 %T Engaging Gatekeeper-Stakeholders in Development of a Mobile Health Intervention to Improve Medication Adherence Among African American and Pacific Islander Elderly Patients With Hypertension %A Yazdanshenas,Hamed %A Bazargan,Mohsen %A Jones,Loretta %A Vawer,May %A Seto,Todd B %A Farooq,Summer %A Taira,Deborah A %+ College of Medicine, Departments of Family Medicine and Orthopedic Surgery, Charles R Drew University of Medicine and Science/University of California, Los Angeles (UCLA), 1748 East, LSRN Bldg, # N150, 118th St, Los Angeles, CA, 90059, United States, 1 3233573452, Yazdanshenas@ucla.edu %K health %K technology %K elderly %K minority %K hypertension %K mHealth %D 2016 %7 26.10.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approximately 70 million people in the United States have hypertension. Although antihypertensive therapy can reduce the morbidity and mortality associated with hypertension, often patients do not take their medication as prescribed. Objective: The goal of this study was to better understand issues affecting the acceptability and usability of mobile health technology (mHealth) to improve medication adherence for elderly African American and Native Hawaiian and Pacific Islander patients with hypertension. Methods: In-depth interviews were conducted with 20 gatekeeper-stakeholders using targeted open-ended questions. Interviews were deidentified, transcribed, organized, and coded manually by two independent coders. Analysis of patient interviews used largely a deductive approach because the targeted open-ended interview questions were designed to explore issues specific to the design and acceptability of a mHealth intervention for seniors. Results: A number of similar themes regarding elements of a successful intervention emerged from our two groups of African American and Native Hawaiian and Pacific Islander gatekeeper-stakeholders. First was the need to teach participants both about the importance of adherence to antihypertensive medications. Second, was the use of mobile phones for messaging and patients need to be able to access ongoing technical support. Third, messaging needs to be short and simple, but personalized, and to come from someone the participant trusts and with whom they have a connection. There were some differences between groups. For instance, there was a strong sentiment among the African American group that the church be involved and that the intervention begin with group workshops, whereas the Native Hawaiian and Pacific Islander group seemed to believe that the teaching could occur on a one-to-one basis with the health care provider. Conclusions: Information from our gatekeeper-stakeholder (key informant) interviews suggests that the design of a mHealth intervention to improve adherence to antihypertensives among the elderly could be very similar for African Americans and Native Hawaiian and Pacific Islanders. The main difference might be in the way in which the program is initiated (possibly through church-based workshops for African Americans and by individual providers for Native Hawaiian and Pacific Islanders). Another difference might be who sends the messages with African Americans wanting someone outside the health care system, but Native Hawaiian and Pacific Islanders preferring a provider. %M 27784651 %R 10.2196/mhealth.5905 %U http://mhealth.jmir.org/2016/4/e116/ %U https://doi.org/10.2196/mhealth.5905 %U http://www.ncbi.nlm.nih.gov/pubmed/27784651 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e29 %T Designing, Implementing, and Evaluating Mobile Health Technologies for Managing Chronic Conditions in Older Adults: A Scoping Review %A Matthew-Maich,Nancy %A Harris,Lauren %A Ploeg,Jenny %A Markle-Reid,Maureen %A Valaitis,Ruta %A Ibrahim,Sarah %A Gafni,Amiram %A Isaacs,Sandra %+ Aging, Community & Health Research Unit, McMaster University, Mohawk College/McMaster University School of Nursing, #354 McMaster-Mohawk Institute for Applied Health Sciences, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada, 1 9055404247 ext 26793, nancy.maich@mohawkcollege.ca %K Telemedicine %K Mobile health %K Health Plan Implementations %K Evaluation Studies as Topic %K Design %K mHealth Innovations %K Frail Elderly %K Older Adults %K Multiple Chronic Conditions %K Home Care Services %K Scoping Review %K Communication %K Information Communication Technologies %D 2016 %7 09.06.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations. Objectives: The purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults. Methods: A 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data. Results: We identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies. Conclusions: There is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations. %M 27282195 %R 10.2196/mhealth.5127 %U http://mhealth.jmir.org/2016/2/e29/ %U https://doi.org/10.2196/mhealth.5127 %U http://www.ncbi.nlm.nih.gov/pubmed/27282195 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e35 %T Older Adults’ Experiences Using a Commercially Available Monitor to Self-Track Their Physical Activity %A McMahon,Siobhan K %A Lewis,Beth %A Oakes,Michael %A Guan,Weihua %A Wyman,Jean F %A Rothman,Alexander J %+ University of Minnesota, School of Nursing, 308 Harvard Street SE, Minneapolis, MN, 55455, United States, 1 2182903422, skmcmaho@umn.edu %K Aged %K Mobile Health %K Self-Appraisal %K Physical Activity %K Motivation %K Monitoring %K Ambulatory %K Wearables %D 2016 %7 13.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Physical activity contributes to older adults’ autonomy, mobility, and quality of life as they age, yet fewer than 1 in 5 engage in activities as recommended. Many older adults track their exercise using pencil and paper, or their memory. Commercially available physical activity monitors (PAM) have the potential to facilitate these tracking practices and, in turn, physical activity. An assessment of older adults’ long-term experiences with PAM is needed to understand this potential. Objective: To assess short and long-term experiences of adults >70 years old using a PAM (Fitbit One) in terms of acceptance, ease-of-use, and usefulness: domains in the technology acceptance model. Methods: This prospective study included 95 community-dwelling older adults, all of whom received a PAM as part of randomized controlled trial piloting a fall-reducing physical activity promotion intervention. Ten-item surveys were administered 10 weeks and 8 months after the study started. Survey ratings are described and analyzed over time, and compared by sex, education, and age. Results: Participants were mostly women (71/95, 75%), 70 to 96 years old, and had some college education (68/95, 72%). Most participants (86/95, 91%) agreed or strongly agreed that the PAM was easy to use, useful, and acceptable both 10 weeks and 8 months after enrolling in the study. Ratings dropped between these time points in all survey domains: ease-of-use (median difference 0.66 points, P=.001); usefulness (median difference 0.16 points, P=.193); and acceptance (median difference 0.17 points, P=.032). Differences in ratings by sex or educational attainment were not statistically significant at either time point. Most participants 80+ years of age (28/37, 76%) agreed or strongly agreed with survey items at long-term follow-up, however their ratings were significantly lower than participants in younger age groups at both time points. Conclusions: Study results indicate it is feasible for older adults (70-90+ years of age) to use PAMs when self-tracking their physical activity, and provide a basis for developing recommendations to integrate PAMs into promotional efforts. Trial Registration: Clinicaltrials.gov NCT02433249; https://clinicaltrials.gov/ct2/show/NCT02433249 (Archived by WebCite at http://www.webcitation.org/6gED6eh0I) %M 27076486 %R 10.2196/mhealth.5120 %U http://mhealth.jmir.org/2016/2/e35/ %U https://doi.org/10.2196/mhealth.5120 %U http://www.ncbi.nlm.nih.gov/pubmed/27076486 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 3 %P e32 %T Attitudes and Preferences on the Use of Mobile Health Technology and Health Games for Self-Management: Interviews With Older Adults on Anticoagulation Therapy %A Lee,Jung-Ah %A Nguyen,Annie Lu %A Berg,Jill %A Amin,Alpesh %A Bachman,Mark %A Guo,Yuqing %A Evangelista,Lorraine %+ University of California, Irvine, Program in Nursing Science, Berk Hall 100A, Irvine, CA, 92697-3959, United States, 1 949 824 2855, jungahl@uci.edu %K anticoagulation therapy %K health apps %K health games %K mobile health technology %K self-management %D 2014 %7 23.07.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Older adults are at substantial risk for cardiovascular disorders that may require anticoagulation therapy. Those on warfarin therapy report dissatisfaction and reduced quality of life (QOL) resulting from the treatment. Advances in the area of mobile health (mHealth) technology have resulted in the design and development of new patient-centric models for the provision of personalized health care services to improve care delivery. However, there is a paucity of research examining the effectiveness of mHealth tools on knowledge, attitudes, and patient satisfaction with treatment, as well as self-management, adherence to therapy, and QOL in older adults with chronic illness conditions requiring long-term warfarin therapy. Objective: The objective of the study was to explore the attitudes and preferences of older adults on warfarin therapy regarding the use of mHealth technology and health games to gain skills for self-management. Methods: We conducted group and individual interviews with patients (60 years or older) on warfarin therapy at two anticoagulation clinics affiliated with an academic medical center. We held 4 group and 2 individual interviews, resulting in 11 patient participants and 2 family caregiver participants. We used structured questions on three topic areas including medication self-management strategies, mHealth technology use, and health games for exercise. We demonstrated some commercial health apps related to medication management, vitamin K content of food, and a videogame for balance exercise. Discussions were audiotaped and transcribed verbatim. Common themes were drawn using content analysis. Results: The participants reported awareness of the importance of staying on schedule with warfarin therapy. They also acknowledged that negative experiences of friends or family members who were taking warfarin influenced their desire to keep on schedule with warfarin therapy. In addition, the participants expressed that the use of mHealth technology may be helpful for medication management. They also expressed the need for family support in the use of health technology devices. Moreover, the participants discussed concerns and challenges to use health technology and health games, and provided suggestions on ways to make mHealth technology and health games elder-friendly. Conclusions: These findings indicate that our older adults on warfarin therapy are interested in mHealth technology specific to warfarin medication management and health games. Further research needs to be done to validate these findings. Elder-friendly designs, technology support, and physical safety using mHealth technology may be useful in this population. These findings can be used to inform a larger study to design and test an elder-centered mHealth technology in this target population. %M 25098413 %R 10.2196/mhealth.3196 %U http://mhealth.jmir.org/2014/3/e32/ %U https://doi.org/10.2196/mhealth.3196 %U http://www.ncbi.nlm.nih.gov/pubmed/25098413 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e11 %T Evaluating User Perceptions of Mobile Medication Management Applications With Older Adults: A Usability Study %A Grindrod,Kelly Anne %A Li,Melissa %A Gates,Allison %+ School of Pharmacy, Faculty of Science, University of Waterloo, 200 University Avenue, Waterloo, ON, N2L3G1, Canada, 1 519 888 4567 ext 21358, kgrindrod@uwaterloo.ca %K medication therapy management %K medication adherence %K mHealth %K mobile health %D 2014 %7 14.03.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Medication nonadherence has a significant impact on the health and wellbeing of individuals with chronic disease. Several mobile medication management applications are available to help users track, remember, and read about their medication therapy. Objective: The objective of this study was to explore the usability and usefulness of existing medication management applications for older adults. Methods: We recruited 35 participants aged 50 and over to participate in a 2-hour usability session. The average age ranged from 52-78 years (mean 67 years) and 71% (25/35) of participants were female. Each participant was provided with an iPad loaded with four medication management applications: MyMedRec, DrugHub, Pillboxie, and PocketPharmacist. These applications were evaluated using the 10 item System Usability Scale (SUS) and visual analog scale. An investigator-moderated 30-minute discussion followed, and was recorded. We used a grounded theory (GT) approach to analyze qualitative data. Results: When assessing mobile medication management applications, participants struggled to think of a need for the applications in their own lives. Many were satisfied with their current management system and proposed future use only if cognition and health declined. Most participants felt capable of using the applications after a period of time and training, but were frustrated by their initial experiences with the applications. The early experiences of participants highlighted the benefits of linear navigation and clear wording (eg, “undo” vs “cancel”) when designing for older users. While there was no order effect, participants attributed their poor performance to the order in which they tried the applications. They also described being a part of a technology generation that did not encounter the computer until adulthood. Of the four applications, PocketPharmacist was found to be the least usable with a score of 42/100 (P<.0001) though it offered a drug interaction feature that was among the favorite features of participants. The usability scores for MyMedRec (56/100), DrugHub (57/100), and Pillboxie (52/100) were not significantly different and participants preferred MyMedRec and DrugHub for their simple, linear interfaces. Conclusions: With training, adults aged 50 and over can be capable and interested in using mHealth applications for their medication management. However, in order to adopt such technology, they must find a need that their current medication management system cannot fill. Interface diversity and multimodal reminder methods should be considered to increase usability for older adults. Lastly, regulation or the involvement of older adults in development may help to alleviate generation bias and mistrust for applications. %M 25099993 %R 10.2196/mhealth.3048 %U http://mhealth.jmir.org/2014/1/e11/ %U https://doi.org/10.2196/mhealth.3048 %U http://www.ncbi.nlm.nih.gov/pubmed/25099993