%0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12199 %T Feasibility and Acceptability of Technology-Based Exercise and Posture Training in Older Adults With Age-Related Hyperkyphosis: Pre-Post Study %A Katzman,Wendy B %A Gladin,Amy %A Lane,Nancy E %A Wong,Shirley %A Liu,Felix %A Jin,Chengshi %A Fukuoka,Yoshimi %+ Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, Suite 400, San Francisco, CA, 94158, United States, 1 415 514 6776, wendy.katzman@ucsf.edu %K acceptability %K exercise %K feasibility %K hyperkyphosis %K kyphosis %K posture %K spine %K technology-based %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Hyperkyphosis is common among older adults and is associated with multiple adverse health outcomes. Kyphosis-specific exercise and posture training programs improve hyperkyphosis, but in-person programs are expensive to implement and maintain over long periods. It is unclear if a technology-based posture training program disseminated through a mobile phone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis. Objective: The primary purpose was to assess the feasibility of subject recruitment, short-term retention and adherence, and acceptability of a technology-based exercise and posture training program disseminated as video clip links and text messaging prompts via a mobile phone. The secondary purpose was to explore the potential efficacy of this program for kyphosis, physical function, and health-related quality of life in older adults with hyperkyphosis. Methods: In this 6-week pre-post design pilot trial, we recruited community-dwelling adults aged ≥65 years with hyperkyphosis ≥40° (±5°) and access to a mobile phone. The intervention had two parts: (1) exercise and posture training via video clips sent to participants daily via text messaging, including 6 weekly video clip links to be viewed on the participant’s mobile phone, and (2) text messaging prompts to practice good posture. We analyzed the subject recruitment, adherence, retention, and acceptability of the intervention. Outcomes included change in kyphometer-measured kyphosis, occiput-to-wall (OTW) distance, Short Physical Performance Battery score, Scoliosis Research Society (SRS-30) score, Center for Epidemiological Studies Depression score, and Physical Activity Scale for the Elderly (PASE) score. Results: A total of 64 potential participants were recruited, 17 were enrolled, and 12 completed postintervention testing at 6 weeks. The average age was 71.6 (SD 4.9) years, and 50% were women. The median adherence to daily video viewing was 100% (range, 14%-100%) and to practicing good posture at least three times per day was 71% (range, 0%-100%). Qualitative evaluation of intervention acceptability revealed that the mobile phone screen was too small for participants to view the videos well and daily prompts to practice posture were too frequent. Kyphosis, OTW distance, and physical activity significantly improved after the 6-week intervention. Kyphosis decreased by 8° (95% CI –12 to –5; P<.001), OTW decreased by 1.9 cm (95% CI –3.3 to –0.7; P=.007), and physical activity measured by PASE increased by 29 points (95% CI 3 to 54; P=.03). The health-related quality of life SRS-30 score increased by 0.11 point (SD 0.19), but this increase was not statistically significant (P=.09). Conclusions: Technology-based exercise and posture training using video clip viewing and text messaging reminders is feasible and acceptable for a small cohort of older adults with hyperkyphosis. Technology-based exercise and posture training warrants further study as a potential self-management program for age-related hyperkyphosis, which may be more easily disseminated than in-person training. %M 31363712 %R 10.2196/12199 %U http://aging.jmir.org/2019/1/e12199/ %U https://doi.org/10.2196/12199 %U http://www.ncbi.nlm.nih.gov/pubmed/31363712 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12303 %T Relevance of Activity Tracking With Mobile Devices in the Relationship Between Physical Activity Levels and Satisfaction With Physical Fitness in Older Adults: Representative Survey %A Schlomann,Anna %A Seifert,Alexander %A Rietz,Christian %+ Department of Special Education and Rehabilitation Science, University of Cologne, Herbert-Lewin-Straße 2, Cologne, 50931, Germany, 49 221470 ext 3343, anna.schlomann@uni-koeln.de %K physical fitness %K wearable electronic devices %K smartphone %K mobile phone %K aged %K satisfaction %K fitness trackers %D 2019 %7 06.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity has been shown to positively affect many aspects of life, and the positive relationship between physical activity levels and health is well established. Recently, research on the interrelationship between physical activity levels and subjective experiences has gained attention. However, the underlying mechanisms that link physical activity levels with subjective experiences of physical fitness have not been sufficiently explained. Objective: This study aimed to explore the role of physical activity tracking (PAT) in the relationship between physical activity levels and satisfaction with physical fitness in older adults. It is hypothesized that higher levels of physical activity are associated with a higher satisfaction with physical fitness in older adults and that this positive association is stronger for older people who use mobile devices for PAT. Methods: As part of this study, 1013 participants aged 50 years or older and living in Switzerland were interviewed via computer-assisted telephone interviews. Bivariate and multivariate analyses were applied. The interaction effects between physical activity levels and PAT were evaluated using multiple linear regression analysis. Results: Descriptive analyses showed that 719 participants used at least 1 mobile device and that 136 out of 719 mobile device users (18.9%) used mobile devices for PAT. In the multivariate regression analysis, frequent physical activity was found to have a positive effect on satisfaction with physical fitness (beta=.24, P<.001). A significant interaction effect between physical activity levels and PAT (beta=.30, P=.03) provides some first evidence that the positive effects of physical activity on satisfaction with physical fitness can be enhanced by PAT. Conclusions: The results indicate the potential of PAT to enhance the physical fitness of older adults. However, the results also raise new issues in this context. Recommendations for further research and practice include the acquisition of longitudinal data, a more detailed observation of durations of use, and the development of devices for PAT considering health psychology and gerontology theories. %M 31518263 %R 10.2196/12303 %U http://aging.jmir.org/2019/1/e12303/ %U https://doi.org/10.2196/12303 %U http://www.ncbi.nlm.nih.gov/pubmed/31518263 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e10019 %T Mobilizing mHealth Data Collection in Older Adults: Challenges and Opportunities %A Cosco,Theodore D %A Firth,Joseph %A Vahia,Ipsit %A Sixsmith,Andrew %A Torous,John %+ Gerontology Research Center, Simon Fraser University, #2800-515 West Hasting Street, Vancouver, BC, V6B 5K3, Canada, 1 7787825915, tcosco@sfu.ca %K mHealth %K older adults %K data collection %K digital divide %D 2019 %7 19.03.2019 %9 Viewpoint %J JMIR Aging %G English %X Worldwide, there is an unprecedented and ongoing expansion of both the proportion of older adults in society and innovations in digital technology. This rapidly increasing number of older adults is placing unprecedented demands on health care systems, warranting the development of new solutions. Although advancements in smart devices and wearables present novel methods for monitoring and improving the health of aging populations, older adults are currently the least likely age group to engage with such technologies. In this commentary, we critically examine the potential for technology-driven data collection and analysis mechanisms to improve our capacity to research, understand, and address the implications of an aging population. Alongside unprecedented opportunities to harness these technologies, there are equally unprecedented challenges. Notably, older adults may experience the first-level digital divide, that is, lack of access to technologies, and/or the second-level digital divide, that is, lack of use/skill, alongside issues with data input and analysis. To harness the benefits of these innovative approaches, we must first engage older adults in a meaningful manner and adjust the framework of smart devices to accommodate the unique physiological and psychological characteristics of the aging populace. Through an informed approach to the development of technologies with older adults, the field can leverage innovation to increase the quality and quantity of life for the expanding population of older adults. %M 31518253 %R 10.2196/10019 %U http://aging.jmir.org/2019/1/e10019/ %U https://doi.org/10.2196/10019 %U http://www.ncbi.nlm.nih.gov/pubmed/31518253 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12616 %T Understanding Social Network and Support for Older Immigrants in Ontario, Canada: Protocol for a Mixed-Methods Study %A Guruge,Sepali %A Sidani,Souraya %A Wang,Lu %A Sethi,Bharati %A Spitzer,Denise %A Walton-Roberts,Margaret %A Hyman,Ilene %+ Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 416 979 5000 ext 4964, sguruge@ryerson.ca %K geographic information system %K immigrants %K social network %K social support %D 2019 %7 04.03.2019 %9 Protocol %J JMIR Aging %G English %X Background: Older adults are the fastest growing age group worldwide and in Canada. Immigrants represent a significant proportion of older Canadians. Social isolation is common among older adults and has many negative consequences, including limited community and civic participation, increased income insecurity, and increased risk of elder abuse. Additional factors such as the social, cultural, and economic changes that accompany migration, language differences, racism, and ageism heighten older immigrants’ vulnerability to social isolation. Objective: This mixed-methods sequential (qualitative-quantitative) study seeks to clarify older immigrants’ social needs, networks, and support and how these shape their capacity, resilience, and independence in aging well in Ontario. Methods: Theoretically, our research is informed by an intersectionality perspective and an ecological model, allowing us to critically examine the complexity surrounding multiple dimensions of social identity (eg, gender and immigration) and how these interrelate at the micro (individual and family), meso (community), and macro (societal) levels in diverse geographical settings. Methodologically, the project is guided by a collaborative, community-based, mixed-methods approach to engaging a range of stakeholders in Toronto, Ottawa, Waterloo, and London in generating knowledge. The 4 settings were strategically chosen for their diversity in the level of urbanization, size of community, and the number of immigrants and immigrant-serving organizations. Interviews will be conducted in Arabic, Mandarin, and Spanish with older women, older men, family members, community leaders, and service providers. The study protocol has received ethics approval from the 4 participating universities. Results: Quantitative and qualitative data collection is ongoing. The project is funded by the Social Sciences and Humanities Council of Canada. Conclusions: Comparative analyses of qualitative and quantitative data within and across sites will provide insights about common and unique factors that contribute to the well-being of older immigrants in different regions of Ontario. Given the comprehensive approach to incorporating local knowledge and expert contributions from multilevel stakeholders, the empirical and theoretical findings will be highly relevant to our community partners, help facilitate practice change, and improve the well-being of older men and women in immigrant communities. International Registered Report Identifier (IRRID): DERR1-10.2196/12616 %M 31518267 %R 10.2196/12616 %U http://aging.jmir.org/2019/1/e12616/ %U https://doi.org/10.2196/12616 %U http://www.ncbi.nlm.nih.gov/pubmed/31518267 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e13378 %T A Web-Based Mobile App With a Smartwatch to Support Social Engagement in Persons With Memory Loss: Pilot Randomized Controlled Trial %A McCarron,Hayley R %A Zmora,Rachel %A Gaugler,Joseph E %+ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, D351 Mayo, 425 Delaware Street SE, Minneapolis, MN,, United States, 1 612 626 9552, mccar988@umn.edu %K Alzheimer disease %K dementia %K social support %K quality of life %K well-being %K technology %K social engagement %K facial recognition %K smartwatch %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Aging %G English %X Background: It is estimated that the number of individuals living with dementia worldwide will increase from 50 million in 2017 to 152 million by 2050. Assistive technology has been recognized as a promising tool to improve the lives of persons living with memory loss and their caregivers. The use of assistive technology in dementia care is expanding, although it is most often intended to manage care and promote safety. There is a lack of assistive technology designed to aid persons with memory loss in participating in meaningful activities. The Social Support Aid (SSA) is a mobile phone-based app that employs facial recognition software. It was designed to assist persons with memory loss remember the names and relationships of the people they interact with to promote social engagement. Objective: This study uses a pilot randomized controlled trial (RCT) design to evaluate the SSA. The objectives were to ascertain (1) the feasibility and utility of the SSA, (2) whether the outcomes of SSA use suggest potential benefits for persons living with memory loss and their care partners, and (3) how study design components could inform subsequent RCTs. Methods: Persons with memory loss were randomized to the SSA (n=20) or the usual care control group (n=28). Quantitative data were collected at three timepoints (baseline, 3 months, and 6 months). Participants in the intervention group participated in qualitative interviews following completion of their 6-month survey. Results: Participant eligibility, willingness to be randomized, and retention were not barriers to conducting a full-scale RCT; however, recruitment strategies should be addressed before doing so. Feasibility and utility scores indicated that participants felt neutral about the technology. Use of the SSA was not significantly associated with changes in quality of social interactions or quality of life measures over the 6 months of follow-up (P>.05). The qualitative analysis revealed three themes that described how and why the SSA worked or not: (1) outcomes, (2) reasons why it was or was not useful, and (3) recommendations. Conclusions: There is a need to develop effective assistive technology that improves the quality of life of persons with memory loss. Assistive technology that allows persons living with memory loss to maintain some level of autonomy should be a priority for future research. This study suggests reasons why the SSA facial recognition software did not appear to improve the quality of social interaction and quality of life of people with memory loss. Results also provide recommendations for future assistive technology development and evaluation. Trial Registration: ClinicalTrials.gov NCT03645694; https://clinicaltrials.gov/ct2/show/NCT03645694 (Archived by WebCite at http://www.webcitation.org/78dcVZIqq) %M 31518270 %R 10.2196/13378 %U http://aging.jmir.org/2019/1/e13378/ %U https://doi.org/10.2196/13378 %U http://www.ncbi.nlm.nih.gov/pubmed/31518270 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e11599 %T Evaluating the Impact of Music & Memory’s Personalized Music and Tablet Engagement Program in Wisconsin Assisted Living Communities: Pilot Study %A Ford II,James H %A Dodds,Debby %A Hyland,Julie %A Potteiger,Michael %+ School of Pharmacy, University of Wisconsin–Madison, 777 Highland Avenue, Madison, WI, 53705, United States, 1 6082624748, jhfordii@wisc.edu %K Music & Memory %K assisted living facilities %K quality of life %K agitation %K medication adherance %K iPod %K iPad %K implementation science %K patient participation %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Individuals with Alzheimer disease or related dementia represent a significant and growing segment of the older adult (aged 65 years and above) population. In addition to physical health concerns, including comorbid medical conditions, these individuals often exhibit behavioral and psychological symptoms of dementia (BPSD). The presence of BPSD in long-term care residential facilities can disrupt resident’s care and impact staff. Nonpharmacological interventions such as personalized music and tablet engagement maintain cognitive function, improve quality of life (QOL), and mitigate BPSD for older adults with dementia. Evidence of the impact of such interventions in assisted living communities (ALCs) is needed for widespread adoption and sustainment of these technologies. Objective: The aim of this study was to assess the impact of Music & Memory’s personalized music and tablet engagement (PMATE) program on QOL, agitation, and medication use for residents living in 6 Wisconsin ALCs. Methods: The data collected were on the utilization of iPods and iPads by the residents. Residents’ outcomes were assessed using the Pittsburgh Agitation Scale, the Quality of Life in Late Stage Dementia scale, and self-reported medication use. A mixed-methods approach was utilized to examine the impact of the PMATE program on these outcomes. Descriptive statistics were calculated. A paired t test explored changes in residents’ QOL. A 1-way analysis of variance was utilized to examine changes in resident’s agitation and QOL based on the resident’s utilization of the PMATE program. Qualitative interviews were conducted with the individuals responsible for PMATE implementation in the ALC. Residents excluded from the analysis were those who passed away, were discharged, or refused to participate. Results: A total of 5 apps, based on average times used by residents, were identified. In all, 4 of the 5 apps were rated as being useful to promote residents’ engagement. PMATE utilization was not associated with changes in the residents’ agitation levels or antipsychotic medication use over time. Over a 3-month period, the change in residents’ QOL was significant (P=.047), and the differences across ALCs were also significant (F25=3.76, P=.02). High utilizers of the PMATE program (>2500 min over 3 months) showed greater improvements in QOL as compared with low utilizers (a change of −5.90 points vs an increase of 0.43 points). The difference was significant (P=.03). Similar significant findings were found between the high- and midutilizers. Conclusions: The study is one of the first to explore the impact of Music & Memory’s PMATE program on residents living in ALCs. Findings suggest that higher utilization over time improves residents’ QOL. However, a more comprehensive study with improved data collection efforts across multiple ALCs is needed to confirm these preliminary findings. %M 31518259 %R 10.2196/11599 %U http://aging.jmir.org/2019/1/e11599/ %U https://doi.org/10.2196/11599 %U http://www.ncbi.nlm.nih.gov/pubmed/31518259 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12633 %T Information and Communications Technology as a Health Promotion Method for Older Adults in Assisted-Living Facilities: Three-Arm Group-Randomized Trial %A Chiu,Ching-Ju %A Wu,Chi Hui %+ Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan,, Taiwan, 886 6 2353535 ext 5739, cjchiu@mail.ncku.edu.tw %K information and computer technology %K quality of life %K social support %K psychological well-being %K long-term care facilities %K disabled %K elderly %K disability %K assisted living %K seniors %K geriatrics %D 2019 %7 06.05.2019 %9 Original Paper %J JMIR Aging %G English %X Background: The application of technology is an important and growing aspect in the field of long-term care. Growing evidence shows the positive impact of technology aids in helping the lives of the elderly. However, it is not known which aspects of information and communications technology (ICT) are preferred by older adults living in long-term care facilities. Objective: The goal of the research was to compare the impact of ICT-communication, ICT-entertainment, and conventional care on older adults’ health and psychological change after interventions among older adults in assisted-living facilities. Methods: A three-arm group-randomized trial design was used to evaluate participants who resided in three different but comparable assisted-living facilities and received different aspects of the ICT interventions. A total of 54 older adults with disabilities received one of the three interventions over 12 weeks and completed pre- and postevaluations on quality of life, social support, and psychological well-being. Results: Participants completing this study had a mean age of 73 (SD 11.4) years, and 50% (27/54) were male. Both the ICT-communication and ICT-entertainment groups showed significant improvement in the mental component of quality of life (4.11, P=.012 and 37.32, P<.001, respectively), family/friend–related social support (0.05, P=.001 and 0.04, P<.001, respectively), happiness (0.79, P=.038 and 3.72, P=.001, respectively), and depressive symptoms (–2.74, P=.001 and –7.33, P<.001, respectively). Importantly, participants in the ICT-entertainment group improved significantly more than the other two groups. The ICT-entertainment group also showed improvement in the physical component of quality of life (20.49, P<.001) and health care worker–related social support (0.1, P=.008). Conclusions: Results suggest that the entertainment but not the communication part of ICT is the most effective health promotion method for improving the health and psychological well-being of older adults in assisted-living facilities. %M 31518261 %R 10.2196/12633 %U http://aging.jmir.org/2019/1/e12633/ %U https://doi.org/10.2196/12633 %U http://www.ncbi.nlm.nih.gov/pubmed/31518261 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12276 %T Mobile Support for Older Adults and Their Caregivers: Dyad Usability Study %A Quinn,Charlene C %A Staub,Sheila %A Barr,Erik %A Gruber-Baldini,Ann %+ Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 W Redwood St, HH 215, Baltimore, MD, 21201, United States, 1 4107062406, cquinn@som.umaryland.edu %K older adult %K caregiver %K mobile health %K patient engagement %D 2019 %7 23.05.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Evaluation of digital health applications to support older adults’ independence and family caregiving is needed. Digital health is increasingly providing opportunities for older adults and their family caregivers to educate, engage, and share health information across digital platforms. Few apps have documented evidence of usability by older adults and their caregivers. Objective: The objective of this study was to determine the usability of a mobile app in a community-based older adult population aged ≥65 years. The app was designed to improve engagement of the patient-informal caregiver team. Methods: This observational usability study was conducted in participants’ homes and independent living facilities in Baltimore, Maryland. Community-dwelling older adults aged ≥65 years and their caregivers enrolled as a dyad (n=24, 12 dyads). The usability evaluation was a mobile and Web-based app that allowed older adult users to record social and health information and share this information with their caregivers. The older adult-caregiver dyad downloaded the app to a smart phone or accessed the Web version, participated in training and onboarding, and used the app for a 1-month period. Participants responded to weekly surveys sent by app push notifications and to the usability and satisfaction surveys at the end of the study. Participant satisfaction and usability were assessed using the Modified Mobile Application Rating Scale (M-MARS) and the System Usability Scale (SUS). Results: The final sample comprised 16 people (8 dyads). Responses to the M-MARS were comparable between older adults and caregiver respondents in terms of engagement and functionality. Caregivers rated aesthetics slightly higher (mean 3.7) than older adult participants did (mean 3.3). Although most responses to the SUS were around the mean (2.3-3.4), older adults and their caregivers differed with regard to integration of app features (mean 3.7 vs 2.8) and the need to learn more before using the app (mean 2.3 vs 3.1). Conclusions: Technology ownership and use among older adults and caregivers was high. Usability and engagement of the mobile app was average. Additional training is recommended for older adults and their caregivers, including that on targeted behaviors for digital health record keeping. %M 31518271 %R 10.2196/12276 %U http://aging.jmir.org/2019/1/e12276/ %U https://doi.org/10.2196/12276 %U http://www.ncbi.nlm.nih.gov/pubmed/31518271 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e10476 %T Older Adults’ Attitudes Toward Ambulatory Technology to Support Monitoring and Coaching of Healthy Behaviors: Qualitative Study %A Cabrita,Miriam %A Tabak,Monique %A Vollenbroek-Hutten,Miriam MR %+ eHealth Group, Roessingh Research and Development, Postbus 310, Enschede,, Netherlands, 31 88 087 5737, m.cabrita@rrd.nl %K wearable technology %K telemedicine %K independent living %K healthy aging %K nutritional status %K cognitive function %K physical activity %D 2019 %7 12.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Prevention of functional decline demands a holistic perspective of health management. Older adults are becoming avid users of technology; however, technology is not yet largely used in supporting self-management of health in daily life. Previous research suggests that the low adherence to these technologies is likely to be associated with the fact that opinions and wishes of the older population are not always taken into consideration when designing new technology. Objective: The aim of this study was to investigate the attitudes of older adults living independently regarding technology to support healthy behaviors, addressing nutrition, physical and cognitive function, and well-being. Methods: In-depth semistructured interviews were performed with 12 older adults addressing 4 themes: (1) current practices in health management, (2) attitudes toward using technology to support health management, (3) wishes from technology, and (4) change in attitudes after actual use of technology. The fourth theme was investigated with a follow-up interview after participants had used a step counter, a smart scale, and a mobile app for 1 month. Data collected were analyzed using inductive thematic analysis. Results: Participants were active in self-managing their health and foresaw an added value on using technology to support them in adopting healthier behaviors in everyday life. Attitudes and wishes differed considerably per health domain, with cognitive function being the most sensitive topic. Fears from technology mentioned were attention theft, replacement of human touch, and disuse of existing abilities. Poststudy interviews suggest that attitudes toward technology improve after a short period of use. Conclusions: Technology to support aging in place must target health literacy, allow personalization in the design but also in the use of the technology, and tackle existing fears concerning technology. Further research should investigate the effect of these strategies on the adherence to technology to be used in daily life. We outline a set of recommendations of interest to those involved in developing and implementing technology to support aging in place, focusing on acceptance, barriers, and ethical concerns. %M 31518252 %R 10.2196/10476 %U http://aging.jmir.org/2019/1/e10476/ %U https://doi.org/10.2196/10476 %U http://www.ncbi.nlm.nih.gov/pubmed/31518252 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12393 %T Engaging Aging Individuals in the Design of Technologies and Services to Support Health and Well-Being: Constructivist Grounded Theory Study %A Du Preez,Vikki %A De La Harpe,Retha %+ Department of Design, Faculty of Informatics and Design, Cape Peninsula University of Technology, District Six Campus, Keizergracht Street, Cape Town, 8001, South Africa, 27 21 460 3280, dupreezv@cput.ac.za %K technology %K healthy aging %K grounded theory %K qualitative research %D 2019 %7 20.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Changes noted within the aging population are physical, cognitive, as well as emotional. Social isolation and loneliness are also serious problems that the aging population may encounter. As technology and apps become more accessible, many basic services, such as those offered by social services, well-being organizations, and health care institutions, have invested in the development of supportive devices, services, and Web-based interactions. Despite the perceived benefits that these devices and services offer, many aging individuals choose not to engage, or engage in a limited manner. To explore this phenomenon, we developed a theory to describe the condition for engagement. Objective: The main objective of this study was to understand the perceptions of an aging South African population regarding Web-based services and technologies that could support aging in place (AiP). Although the concept of AiP speaks to a great number of everyday activities, this paper explores aspects of health and well-being as being central to AiP. Methods: The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, category development, and data comparisons. Data were collected through qualitative methods, including interviews (13 participants aged between 64 and 85 years), 2 participatory workshops (15 participants), and observations. The study focused on Charmaz’s approach to constructivist GT, which puts forward the premise that theory or knowledge cannot take shape in a purely objective manner. Instead, theory is constructed through the interaction of the researcher and research participant. Coding and data analysis were supported with ATLAS.ti (ATLAS.ti Scientific Software Development GmbH). Results: The study resulted in a substantive theory exploring the process of interaction and engaging factors through user insights and experiences. The emerging design theory, Ageing User Decision-Driven Engagement (AUDDE), explored the elements that support engagement with technology and supportive apps, which could offer access to required health and wellness services. Conclusions: In AUDDE, the perceived value of the interaction is a crucial catalyst for engagement. Aging users continuously make meaning of their experiences, which affects their current and future actions. %M 31518258 %R 10.2196/12393 %U http://aging.jmir.org/2019/1/e12393/ %U https://doi.org/10.2196/12393 %U http://www.ncbi.nlm.nih.gov/pubmed/31518258 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e13864 %T Mobile and Connected Health Technology Needs for Older Adults Aging in Place: Cross-Sectional Survey Study %A Wang,Jing %A Du,Yan %A Coleman,Deidra %A Peck,Michelle %A Myneni,Sahiti %A Kang,Hong %A Gong,Yang %+ School of Nursing, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States, 1 210 450 8561, wangj1@uthscsa.edu %K mobile health %K connected health %K wearable technology %K remote monitoring %K independent living %K aging in place %D 2019 %7 15.05.2019 %9 Original Paper %J JMIR Aging %G English %X Background: An increasing number of mobile and wearable devices are available in the market. However, the extent to which these devices can be used to assist older adults to age in place remains unclear. Objective: This study aimed to assess older adults’ perceptions of using mobile and connected health technologies. Methods: Using a cross-sectional design, a total of 51 participants were recruited from a senior community center. Demographics and usage of mobile or wearable devices and online health communities were collected using a survey questionnaire. Descriptive statistics assessed usage of devices and online health communities. The Fisher exact test was used to examine the relationship between technology usage and having access to a smartphone. Results: The sample was primarily comprised non-Hispanic white (35/51, 69%), educated (39/51, 76% any college), and female (36/51, 71%) participants, with an average age of 70 (SD 8) years. All participants were insured and nearly all lived at home (49/51, 94%). A total of 86% (44/51) of the participants had heard of wearable health devices, but only 18 out of 51 (35%) had ever used them. Over 80% (42/51) expressed interest in using such devices and were interested in tracking exercise and physical activity (46/51, 90%), sleep (38/51, 75%), blood pressure (34/51, 67%), diet (31/51, 61%), blood sugar (28/51, 55%), weight (26/51, 51%), and fall risk (23/51, 45%). The greatest concerns about using wearable devices were cost (31/51, 61%), safety (14/51, 28%), and privacy (13/51, 26%); one-fourth (12/51) reported having no concerns. They were mostly interested in sharing data from mobile and connected devices with their health care providers followed by family, online communities, friends, and no one. About 41% (21/51) of the older adults surveyed reported having ever heard of an online health community, and roughly 40% (20/51) of the participants reported being interested in joining such a community. Most participants reported having access to a smartphone (38/51, 74%), and those with such access were significantly more likely to show interest in using a wearable health device (P<.001) and joining an online health community (P=.05). Conclusions: Our findings suggest that, although few older adults are currently using mobile and wearable devices and connected health technologies for managing health, they are open to this idea and are mostly interested in sharing such data with their health care providers. Further studies are warranted to explore strategies to balance the data sharing preference of older adults and how to best integrate mobile and wearable device data with clinical workflow for health care providers to promote healthy aging in place. %M 31518283 %R 10.2196/13864 %U http://aging.jmir.org/2019/1/e13864/ %U https://doi.org/10.2196/13864 %U http://www.ncbi.nlm.nih.gov/pubmed/31518283 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12415 %T Care Team Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: Qualitative Study %A Kozikowski,Andrzej %A Shotwell,Jillian %A Wool,Eve %A Slaboda,Jill C %A Abrashkin,Karen A %A Rhodes,Karin %A Smith,Kristofer L %A Pekmezaris,Renee %A Norman,Gregory J %+ West Health Institute, 10350 North Torrey Pines RD, La Jolla, CA, 92014, United States, 1 858 412 8642, gjnorman@westhealth.org %K home-based primary care %K homebound patients %K telehealth technology %D 2019 %7 2.6.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Novel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs. Objective: The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to increase the reach of HBPC to more homebound patients. Methods: We collected qualitative data from HBPC staff (ie, physicians, registered nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York metropolitan area through 16 semistructured interviews and three focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (ie, relatedness, competence, and autonomy) as an analytical lens. Results: Four broad themes—pros and cons of scaling, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship—and multiple second-level themes emerged from the analysis. Staff acknowledged the need to scale the program without diminishing effective patient-centered care. Participants perceived alerts generated from patients and caregivers using telehealth as potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. However, they also noted that telehealth could increase efficiency and enable more informed care provision. Telehealth could enhance the patient-provider relationship by enabling caregivers to be an integral part of the patient’s care team. Staff members raised the concern that patients or caregivers might unnecessarily overutilize the technology, and that some home visits are more appropriate in person rather than via telehealth. Conclusions: These findings suggest the importance of considering the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program will hopefully facilitate the optimal integration of telehealth innovations. %M 31518266 %R 10.2196/12415 %U http://aging.jmir.org/2019/1/e12415/ %U https://doi.org/10.2196/12415 %U http://www.ncbi.nlm.nih.gov/pubmed/31518266 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e11237 %T Health Information–Seeking Behaviors of Family Caregivers: Analysis of the Health Information National Trends Survey %A Bangerter,Lauren R %A Griffin,Joan %A Harden,Kristin %A Rutten,Lila J %+ Robert D and Patricia E Kern Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, United States, 1 5072932509, bangerter.lauren@mayo.edu %K disparities %K family caregivers %K Health Information National Trends Survey %K internet use %K mobile phone %D 2019 %7 14.01.2019 %9 Original Paper %J JMIR Aging %G English %X Background: The growing population of aging adults relies on informal caregivers to help meet their health care needs, get help with decision making, and gather health information. Objective: The objective of this study was to examine health information–seeking behaviors among caregivers and to identify caregiver characteristics that contribute to difficulty in seeking health information. Methods: Data from the Health Information National Trends Survey 5, Cycle 1 (N=3181) were used to compare health information seeking of caregivers (n=391) with noncaregivers (n=2790). Results: Caregivers sought health information for themselves and others using computers, smartphones, or other electronic means more frequently than noncaregivers. Caregivers born outside of the United States reported greater difficulty seeking health information (beta=.42; P=.02). Nonwhite caregivers (beta =−.33; P=.03), those with less education (beta =−.35; P=.02), those with private insurance (beta =−.37; P=.01), and those without a regular health care provider (beta =−.35; P=.01) had less confidence seeking health information. Caregivers with higher income had more confidence (beta =.12; P≤.001) seeking health information. Conclusions: This study highlights the prevalence of electronic means to find health information among caregivers. Notable differences in difficulty and confidence in health information seeking exist between caregivers, indicating the need for more attention to the socioeconomic status and caregivers born outside of the United States. Findings can guide efforts to optimize caregivers’ health information–seeking experiences. %M 31518309 %R 10.2196/11237 %U https://aging.jmir.org/2019/1/e11237/ %U https://doi.org/10.2196/11237 %U http://www.ncbi.nlm.nih.gov/pubmed/31518309 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12850 %T Mentalizing Imagery Therapy Mobile App to Enhance the Mood of Family Dementia Caregivers: Feasibility and Limited Efficacy Testing %A Sikder,Abu Taher %A Yang,Francis Cheng %A Schafer,Rhiana %A Dowling,Glenna A %A Traeger,Lara %A Jain,Felipe Ananda %+ Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA, 02114, United States, 1 617 643 4682, felipe.jain@post.harvard.edu %K family caregivers %K mindfulness %K depression %K mobile apps %K psychotherapy %D 2019 %7 21.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Family caregivers of patients with Alzheimer disease and related dementias (AD and ADRD) often experience high stress and are at high risk for depression. Technologically delivered therapy is attractive for AD and ADRD caregivers because of the time demands associated with in-person participation. Objective: We aimed to study the feasibility and conduct limited efficacy testing of a mobile app intervention delivering mentalizing imagery therapy (MIT) for family caregivers. Methods: A 4-week trial of the MIT app for family AD and ADRD caregivers was conducted to assess the feasibility of use and investigate changes in depression symptoms, mood, and caregiving experience. Semistructured interviews were conducted to characterize participants’ perceived feasibility and benefits. Results: A total of 17 of the 21 (80%) consented participants (mean age 67 years, range 54-79) utilized the app at least once and were further analyzed. Average usage of audio recordings was on 14 (SD 10) days out of 28 possible and comprised 29 (SD 28) individual sessions. There were improvements in depression with a large effect size for those who used the app at least moderately (P=.008), increases in positive mood postintervention (P<.05), and acute increases in mood following daily guided imagery practice (Stretching and Breathing, P<.001; Eye in the Center, P<.001; Nesting Doll, P=.002; Situation Solver, P=.003; and Life Globe, P=.006). Semistructured interviews revealed perceived benefits such as greater ability to remain “centered” despite caregiving challenges and positive reframing of the caregiver experience. Conclusions: App delivery of MIT is feasible for family AD and ADRD caregivers, including aging seniors. Results showed moderate to high usage of the app for a majority of users. Limited efficacy testing provides justification for studying the MIT app for AD and ADRD caregivers to improve mood and reduce depression in larger, controlled trials. %M 31518275 %R 10.2196/12850 %U http://aging.jmir.org/2019/1/e12850/ %U https://doi.org/10.2196/12850 %U http://www.ncbi.nlm.nih.gov/pubmed/31518275 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12192 %T Factors Influencing the Adoption of Smart Health Technologies for People With Dementia and Their Informal Caregivers: Scoping Review and Design Framework %A Guisado-Fernández,Estefanía %A Giunti,Guido %A Mackey,Laura M %A Blake,Catherine %A Caulfield,Brian Michael %+ Insight Centre for Data Analytics, University College Dublin, O'Brien Science Building East, 3rd Floor, Belfield Campus, Dublin, D4, Ireland, 353 0838345003, estefaniaguisadofernandez@gmail.com %K dementia %K informal caregiver %K smart health technologies %K user-centered design %K technology adoption %D 2019 %7 30.04.2019 %9 Review %J JMIR Aging %G English %X Background: Smart Health technologies (s-Health technologies) are being developed to support people with dementia (PwD) and their informal caregivers at home, to improve care and reduce the levels of burden and stress they experience. However, although s-Health technologies have the potential to facilitate this, the factors influencing a successful implementation in this population are still unknown. Objective: The aim of this study was to review existing literature to explore the factors influencing PwD and their informal caregivers’ adoption of s-Health technologies for home care. Methods: Following the Arksey and O’Malley methodology, this study is a scoping review providing a narrative description of the scientific literature on factors influencing s-Health technology adoption for PwD and their informal caregivers. A search was conducted using PubMed, the Cochrane library, the IEEE library, and Scopus. Publications screening was conducted by 2 researchers based on inclusion criteria, and full-text analysis was then conducted by 1 researcher. The included articles were thematically analyzed by 2 researchers to gain an insight into factors influencing adoption that PwD and their informal caregivers have to encounter when using s-Health technologies. Relevant information was identified and coded. Codes were later discussed between the researchers for developing and modifying them and for achieving a consensus, and the researchers organized the codes into broader themes. Results: Emerging themes were built in a way that said something specific and meaningful about the research question, creating a list of factors influencing the adoption of s-Health technologies for PwD and their informal caregivers, including attitudinal aspects, ethical issues, technology-related challenges, condition-related challenges, and identified gaps. A design framework was created as a guide for future research and innovation in the area of s-Health technologies for PwD and their informal caregivers: DemDesCon for s-Health Technologies. DemDesCon for s-Health Technologies addresses 4 domains to consider for the design and development of s-Health technologies for this population: cognitive decline domain, physical decline domain, social domain, and development domain. Conclusions: Although s-Health technologies have been used in health care scenarios, more work is needed for them to fully achieve their potential for use in dementia care. Researchers, businesses, and public governments need to collaborate to design and implement effective technology solutions for PwD and their informal caregivers, but the lack of clear design guidelines seems to be slowing the process. We believe that the DemDesCon framework will provide them with the guidance and assistance needed for creating meaningful devices for PwD home care and informal caregivers, filling a much-needed space in the present knowledge gap. %M 31518262 %R 10.2196/12192 %U http://aging.jmir.org/2019/1/e12192/ %U https://doi.org/10.2196/12192 %U http://www.ncbi.nlm.nih.gov/pubmed/31518262 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12271 %T Prioritizing the Needs of Caregivers of Older Adults to Support Their Help-Seeking Process as a First Step to Developing an eHealth Tool: The Technique for Research of Information by Animation of a Group of Experts (TRIAGE) Method %A Latulippe,Karine %A Tremblay,Mélanie %A Poulin,Valérie %A Provencher,Véronique %A Giguere,Anik MC %A Sévigny,Andrée %A Dubé,Véronique %A Éthier,Sophie %A Guay,Manon %A Carignan,Maude %A Giroux,Dominique %+ Department of Teaching and Learning Studies, Laval University, 2320 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada, 1 418 435 8541, karine.latulippe.3@ulaval.ca %K caregivers %K aged %K help seeking behavior %K community-based participatory research %K eHealth %K telemedicine %D 2019 %7 23.05.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Caregivers of functionally dependent older persons sometimes seek formal services to support their relatives. However, this process of help-seeking is complex. Objective: The overall aim of the study was to use a co-design approach to develop an electronic health (eHealth) tool to support caregivers in their process of help-seeking. This study presents the first step of the design phase, which aimed to prioritize the user needs to be considered during the development of an eHealth tool. Methods: A total of 3 groups of caregivers, community workers, and health and social service professionals participated in either a co-design session (1 or 2) or an advisory committee in 2 rural areas and 1 urban area. The needs identified in the academic literature and during a previous study were sorted (Technique for Research of Information by Animation of a Group of Experts [TRIAGE] method) by the participants (referred to in this study as co-designers) to obtain a consensus on those to be prioritized. Needs identified, grouped, and removed were ranked and compared. Results: Of the initial list of 32 needs, 12 were modified or merged, 3 added, and 7 deleted as the co-designers felt that the needs were poorly formulated, redundant, irrelevant, or impossible to meet. In the end, 19 needs were identified for the design of the eHealth tool. Conclusions: Many of the identified needs are informational (eg, having access to up-to-date information) and are probably met by existing tools. However, many others are emotional (eg, being encouraged to use the services) and offer an interesting challenge to eHealth tool development. International Registered Report Identifier (IRRID): RR2-10.2196/11634 %M 31518269 %R 10.2196/12271 %U http://aging.jmir.org/2019/1/e12271/ %U https://doi.org/10.2196/12271 %U http://www.ncbi.nlm.nih.gov/pubmed/31518269 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e13713 %T “Call a Teenager… That’s What I Do!” - Grandchildren Help Older Adults Use New Technologies: Qualitative Study %A Portz,Jennifer Dickman %A Fruhauf,Christine %A Bull,Sheana %A Boxer,Rebecca S %A Bekelman,David B %A Casillas,Alejandra %A Gleason,Kathy %A Bayliss,Elizabeth A %+ Division of General Internal Medicine, University of Colorado, Mailstop B119, 13001 East 17th Place, Aurora, CO, 80045, United States, 1 303 981 1412, jennifer.portz@ucdenver.edu %K health technology %K eHealth %K family research %K social support %D 2019 %7 06.06.2019 %9 Short Paper %J JMIR Aging %G English %X Background: Although family technical support seems intuitive, there is very little research exploring this topic. Objective: The objective of this study was to conduct a subanalysis of data collected from a large-scale qualitative project regarding older adults’ experiences in using health information technology. Specifically, the subanalysis explored older adults’ experiences with technology support from family members to inform strategies for promoting older adults’ engagement with new health technologies. Although the primary analysis of the original study was theoretically driven, this paper reports results from an inductive, open-coding analysis. Methods: This is a subanalysis of a major code identified unexpectedly from a qualitative study investigating older adults’ use experience of a widespread health technology, the patient portal. A total of 24 older patients (≥65 years) with multiple chronic conditions (Charlson Comorbidity Index >2) participated in focus groups conducted at the patients’ primary clinic. While conducting the primary theoretically driven analysis, coders utilized an open-coding approach to ensure important ideas not reflected in the theoretical code book were captured. Open coding resulted in 1 code: family support. This subanalysis further categorized family support by who provided tech support, how tech support was offered, and the opinions of older participants about receiving family tech support. Results: The participants were not specifically asked about family support, yet themes around family assistance and encouragement for technology emerged from every focus group. Participants repeatedly mentioned that they called their grandchildren and adult children if they needed help with technology. Participants also reported that family members experienced difficulty when teaching technology use. Family members struggled to explain simple technology tasks and were frustrated by the slow teaching process. Conclusions: The results suggest that older adults ask their family members, particularly grandchildren, to support them in the use of new technologies. However, family may experience difficulties in providing this support. Older adults will be increasingly expected to use health technologies, and family members may help with tech support. Providers and health systems should consider potential family support and engagement strategies to foster adoption and use among older patients. %M 31518274 %R 10.2196/13713 %U http://aging.jmir.org/2019/1/e13713/ %U https://doi.org/10.2196/13713 %U http://www.ncbi.nlm.nih.gov/pubmed/31518274 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12327 %T Requirements for an Electronic Health Tool to Support the Process of Help Seeking by Caregivers of Functionally Impaired Older Adults: Co-Design Approach %A Tremblay,Mélanie %A Latulippe,Karine %A Giguere,Anik MC %A Provencher,Véronique %A Poulin,Valérie %A Dubé,Véronique %A Guay,Manon %A Ethier,Sophie %A Sévigny,Andrée %A Carignan,Maude %A Giroux,Dominique %+ Department of Teaching and Learning Studies, Université Laval, 2320 rue des Bibliothèques, Québec, QC, G1V 0A6, Canada, 1 418 656 5161, melanie.tremblay.50@ulaval.ca %K functionally-impaired elderly %K caregivers %K co-design %K eHealth %K telemedicine %K help-seeking behavior %D 2019 %7 07.06.2019 %9 Original Paper %J JMIR Aging %G English %X Background: In Quebec, Canada, many public, community, and private organizations provide resources to caregivers of functionally impaired older adults. Nevertheless, these resources may be difficult for caregivers to find. A co-design study was conducted to address the gap between caregivers and access to resources. The purpose of this study was to support the process of help seeking by caregivers of functionally impaired older adults through electronic health (eHealth). Objective: The purpose of this study was to focus on the identification of functional and content requirements for an eHealth tool to support the help-seeking process of caregivers of functionally impaired older adults. Methods: This study uses a co-design process based on qualitative action research approach to develop an eHealth tool with health and social service professionals (HSSPs), community workers, and caregivers. The participants acted as co-designers in identifying requirements for the tool. A total of 4 design workshops and 1 advisory committee session were held in different locations in Quebec, Canada. Activities were videotaped and analyzed with a conceptual framework of user experience. Results: A total of 11 caregivers, 16 community workers, and 11 HSSPs participated in identifying the requirements for the eHealth tool. Several functional and content requirements were identified for each user need (19). Content requirements differed depending on the category of participant, corresponding to the concept of user segmentation in the design of information and communication technology. Nevertheless, there were disagreements among co-designers about specific functionalities, which included (1) functionalities related to the social Web, (2) functionalities related to the evaluation of resources for caregivers, and (3) functionalities related to the emerging technologies. Several co-design sessions were required to resolve disagreements. Conclusions: Co-designers (participants) were able to identify functional and content requirements for each of the previously identified needs; however, several discussions were required to achieve consensus. Decision making was influenced by identity, social context, and participants’ knowledge, and it is a challenge to reconcile the different perspectives. The findings stressed the importance of allowing more time to deal with the iterative aspect of the design activity, especially during the identification of requirements of an eHealth tool. International Registered Report Identifier (IRRID): RR2-10.2196/11634 %M 31518279 %R 10.2196/12327 %U http://aging.jmir.org/2019/1/e12327/ %U https://doi.org/10.2196/12327 %U http://www.ncbi.nlm.nih.gov/pubmed/31518279 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12114 %T The Aachen Falls Prevention Scale: Multi-Study Evaluation and Comparison %A Rasche,Peter %A Nitsch,Verena %A Rentemeister,Lars %A Coburn,Mark %A Buecking,Benjamin %A Bliemel,Christopher %A Bollheimer,Leo Cornelius %A Pape,Hans-Christoph %A Knobe,Matthias %+ Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Bergdriesch 27, Aachen, 52062, Germany, 49 +492418099477, p.rasche@iaw.rwth-aachen.de %K meta-analysis %K elderly %K self-assessment %K hip injuries %K leg injuries %K sensitivity %K specificity %D 2019 %7 16.05.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Fall risk assessment is a time-consuming and resource-intensive activity. Patient-driven self-assessment as a preventive measure might be a solution to reduce the number of patients undergoing a full clinical fall risk assessment. Objective: The aim of this study was (1) to analyze test accuracy of the Aachen Falls Prevention Scale (AFPS) and (2) to compare these results with established fall risk assessment measures identified by a review of systematic reviews. Methods: Sensitivity, specificity, and receiver operating curves (ROC) of the AFPS were calculated based on data retrieved from 2 independent studies using the AFPS. Comparison with established fall risk assessment measures was made by conducting a review of systematic reviews and corresponding meta-analysis. Electronic databases PubMed, Web of Science, and EMBASE were searched for systematic reviews and meta-analyses that reviewed fall risk assessment measures between the years 2000 and 2018. The review of systematic reviews was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess the methodological quality of reviews. Sensitivity, specificity, and ROC were extracted from each review and compared with the calculated values of the AFPS. Results: Sensitivity, specificity, and ROC of the AFPS were evaluated based on 2 studies including a total of 259 older adults. Regarding the primary outcome of the AFPS subjective risk of falling, pooled sensitivity is 57.0% (95% CI 0.467-0.669) and specificity is 76.7% (95% CI 0.694-0.831). If 1 out of the 3 subscales of the AFPS is used to predict a fall risk, pooled sensitivity could be increased up to 90.0% (95% CI 0.824-0.951), whereas mean specificity thereby decreases to 50.0% (95% CI 0.42-0.58). A systematic review for fall risk assessment measures produced 1478 articles during the study period, with 771 coming from PubMed, 530 from Web of Science, and 177 from EMBASE. After eliminating doublets and assessing full text, 8 reviews met the inclusion criteria. All were of sufficient methodological quality (R-AMSTAR score ≥22). A total number of 9 functional or multifactorial fall risk assessment measures were extracted from identified reviews, including Timed Up and Go test, Berg Balance Scale, Performance-Oriented Mobility Assessment, St Thomas’s Risk Assessment Tool in Falling Elderly, and Hendrich II Fall Risk Model. Comparison of these measures with pooled sensitivity and specificity of the AFPS revealed a sufficient quality of the AFPS in terms of a patient-driven self-assessment tool. Conclusions: It could be shown that the AFPS reaches a test accuracy comparable with that of the established methods in this initial investigation. However, it offers the advantage that the users can perform the self-assessment independently at home without involving trained health care professionals. %M 31518273 %R 10.2196/12114 %U http://aging.jmir.org/2019/1/e12114/ %U https://doi.org/10.2196/12114 %U http://www.ncbi.nlm.nih.gov/pubmed/31518273 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12153 %T Fall Risk Classification in Community-Dwelling Older Adults Using a Smart Wrist-Worn Device and the Resident Assessment Instrument-Home Care: Prospective Observational Study %A Yang,Yang %A Hirdes,John P %A Dubin,Joel A %A Lee,Joon %+ Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 (226) 317 3726, y24yang@uwaterloo.ca %K falls %K elderly %K wearable devices %K machine learning %K interRAI %D 2019 %7 07.06.2019 %9 Original Paper %J JMIR Aging %G English %X Background:  Little is known about whether off-the-shelf wearable sensor data can contribute to fall risk classification or complement clinical assessment tools such as the Resident Assessment Instrument-Home Care (RAI-HC). Objective:  This study aimed to (1) investigate the similarities and differences in physical activity (PA), heart rate, and night sleep in a sample of community-dwelling older adults with varying fall histories using a smart wrist-worn device and (2) create and evaluate fall risk classification models based on (i) wearable data, (ii) the RAI-HC, and (iii) the combination of wearable and RAI-HC data. Methods:  A prospective, observational study was conducted among 3 faller groups (G0, G1, G2+) based on the number of previous falls (0, 1, ≥2 falls) in a sample of older community-dwelling adults. Each participant was requested to wear a smart wristband for 7 consecutive days while carrying out day-to-day activities in their normal lives. The wearable and RAI-HC assessment data were analyzed and utilized to create fall risk classification models, with 3 supervised machine learning algorithms: logistic regression, decision tree, and random forest (RF). Results:  Of 40 participants aged 65 to 93 years, 16 (40%) had no previous falls, whereas 8 (20%) and 16 (40%) had experienced 1 and multiple (≥2) falls, respectively. Level of PA as measured by average daily steps was significantly different between groups (P=.04). In the 3 faller group classification, RF achieved the best accuracy of 83.8% using both wearable and RAI-HC data, which is 13.5% higher than that of using the RAI-HC data only and 18.9% higher than that of using wearable data exclusively. In discriminating between {G0+G1} and G2+, RF achieved the best area under the receiver operating characteristic curve of 0.894 (overall accuracy of 89.2%) based on wearable and RAI-HC data. Discrimination between G0 and {G1+G2+} did not result in better classification performance than that between {G0+G1} and G2+. Conclusions:  Both wearable data and the RAI-HC assessment can contribute to fall risk classification. All the classification models revealed that RAI-HC outperforms wearable data, and the best performance was achieved with the combination of 2 datasets. Future studies in fall risk assessment should consider using wearable technologies to supplement resident assessment instruments. %M 31518278 %R 10.2196/12153 %U http://aging.jmir.org/2019/1/e12153/ %U https://doi.org/10.2196/12153 %U http://www.ncbi.nlm.nih.gov/pubmed/31518278 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e11539 %T An Intervention to Promote Medication Understanding and Use Self-Efficacy: Design of Video Narratives for Aging Patients at Risk of Recurrent Stroke %A Appalasamy,Jamuna Rani %A Joseph,Joyce Pauline %A Seeta Ramaiah,Siva %A Quek,Kia Fatt %A Md Zain,Anuar Zaini %A Tha,Kyi Kyi %+ Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, Malaysia, 60 123253775, jamuna.appalasamy@monash.edu %K Delphi technique %K self-efficacy %K stroke %K personal narratives %K video-audio media %K beliefs %D 2019 %7 21.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: The debilitating effects of recurrent stroke among aging patients have urged researchers to explore medication adherence among these patients. Video narratives built upon Health Belief Model (HBM) constructs have displayed potential impact on medication adherence, adding an advantage to patient education efforts. However, its effect on medication understanding and use self-efficacy have not been tested. Objective: The researchers believed that culturally sensitive video narratives, which catered to a specific niche, would reveal a personalized impact on medication adherence. Therefore, this study aimed to develop and validate video narratives for this purpose. Methods: This study adapted the Delphi method to develop a consensus on the video scripts’ contents based on learning outcomes and HBM constructs. The panel of experts comprised 8 members representing professional stroke disease experts and experienced poststroke patients in Malaysia. The Delphi method involved 3 rounds of discussions. Once the consensus among members was achieved, the researchers drafted the initial scripts in English, which were then back translated to the Malay language. A total of 10 bilingual patients, within the study’s inclusion criteria, screened the scripts for comprehension. Subsequently, a neurologist and poststroke patient narrated the scripts in both languages as they were filmed, to add to the realism of the narratives. Then, the video narratives underwent a few cycles of editing after some feedback on video engagement by the bilingual patients. Few statistical analyses were applied to confirm the validity and reliability of the video narratives. Results: Initially, the researchers proposed 8 learning outcomes and 9 questions based on HBM constructs for the video scripts’ content. However, following Delphi rounds 1 to 3, a few statements were omitted and rephrased. The Kendall coefficient of concordance, W, was about 0.7 (P<.001) for both learning outcomes and questions which indicated good agreement between members. Each statement’s Cronbach alpha was above .8 with SD values within a range below 1.5 that confirmed satisfactory content and construct validity. Approximately 75% (6/8) of members agreed that all chosen statements were relevant and suitable for video script content development. Similarly, more than 80% (8/10) of patients scored video engagement above average, intraclass correlation coefficient was above 0.7, whereas its Kendall W was about 0.7 with significance (P<.001), which indicated average agreement that the video narratives perceived realism. Conclusions: The Delphi method was proven to be helpful in conducting discussions systematically and providing precise content for the development of video narratives, whereas the Video Engagement Scale was an appropriate measurement of video realism and emotions, which the researchers believed could positively impact medication understanding and use self-efficacy among patients with stroke. A feasibility and acceptability study in an actual stroke care center is needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000174280; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=373554&isReview=true %M 31518260 %R 10.2196/11539 %U http://aging.jmir.org/2019/1/e11539/ %U https://doi.org/10.2196/11539 %U http://www.ncbi.nlm.nih.gov/pubmed/31518260 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12134 %T Reading Level and Suitability of Congestive Heart Failure (CHF) Education in a Mobile App (CHF Info App): Descriptive Design Study %A Athilingam,Ponrathi %A Jenkins,Bradlee %A Redding,Barbara A %+ College of Nursing, University of South Florida, 12901 Bruce B Downs Blvd, MDC 22, Tampa, FL, 33612, United States, 1 8139747526, pathilin@health.usf.edu %K health literacy %K reading level %K patient education %K heart failure %K mobile app %D 2019 %7 25.04.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Education at the time of diagnosis or at discharge after an index illness is a vital component of improving outcomes in congestive heart failure (CHF). About 90 million Americans have limited health literacy and have a readability level at or below a 5th-grade level, which could affect their understanding of education provided at the time of diagnosis or discharge from hospital. Objective: The aim of this paper was to assess the suitability and readability level of a mobile phone app, the CHF Info App. Methods: A descriptive design was used to assess the reading level and suitability of patient educational materials included in the CHF Info App. The suitability assessment of patient educational materials included in the CHF Info App was independently assessed by two of the authors using the 26-item Suitability Assessment of Materials (SAM) tool. The reading grade level for each of the 10 CHF educational modules included in the CHF Info App was assessed using the comprehensive online Text Readability Consensus Calculator based on the seven most-common readability formulas: the Flesch Reading Ease Formula, the Gunning Fog Index, the Flesch-Kincaid Grade Level Formula, the Coleman-Liau Index, the Simplified Measure of Gobbledygook Index, the Automated Readability Index, and the Linsear Write Formula. The reading level included the text-scale score, the ease-of-reading score, and the corresponding grade level. Results: The educational materials included in the CHF Info App ranged from a 5th-grade to an 8th-grade reading level, with a mean of a 6th-grade level, which is recommended by the American Medical Association. The SAM tool result demonstrated adequate-to-superior levels in all four components assessed, including content, appearance, visuals, and layout and design, with a total score of 77%, indicating superior suitability. Conclusions: The authors conclude that the CHF Info App will be suitable and meet the recommended health literacy level for American adult learners. Further testing of the CHF Info App in a longitudinal study is warranted to determine improvement in CHF knowledge. %M 31518265 %R 10.2196/12134 %U http://aging.jmir.org/2019/1/e12134/ %U https://doi.org/10.2196/12134 %U http://www.ncbi.nlm.nih.gov/pubmed/31518265 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e11449 %T A National Assessment of Access to Technology Among Nursing Home Residents: A Secondary Analysis %A Powell,Kimberly Ryan %A Alexander,Gregory Lynn %A Madsen,Richard %A Deroche,Chelsea %+ College of Nursing, University of Tennessee, Knoxville, 1200 Volunteer Blvd, Knoxville, TN, 37996, United States, 1 865 974 2369, kpowel25@utk.edu %K nursing homes %K health information technology %K patient access %K patient portals %K personal health records %K patient engagement %K person-centered care %D 2019 %7 05.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: According to the National Center for Health Statistics, there are over 1.7 million nursing home residents in the United States. Nursing home residents and their family members have unique needs and stand to benefit from using technology empowering them to be more informed and engaged health care consumers. Although there is growing evidence for benefits of patient-facing technologies like electronic patient portals on patient engagement in acute and outpatient settings, little is known about use of this technology in nursing homes. Objective: The purpose of this study was to report findings from a secondary analysis of data from a national nursing home study of information technology (IT) adoption, called IT sophistication. We describe the extent to which nursing homes (n=815) allow residents or their representatives to access technology including electronic health records, patient portals, and health information-exchange systems as well as the ability of the residents or representatives to self-report data directly into the electronic health record. Methods: We used descriptive statistics and regression techniques to explore relationships between information technology adoption (IT sophistication) and residents’ or their representatives’ access to technology. Covariates of location, bed size, and ownership were added to the model to understand their potential influence on the relationship between IT sophistication and resident access to technology. Results: Findings revealed that resident access to technology was a significant predictor of the nursing home IT sophistication (P<.001). The inclusion of covariates—nursing home location, bed size, and ownership—with their interactions produced a nonsignificant effect in the model. Residents’ or their representatives’ use of electronic health records and personal health records were both significant predictors of overall IT sophistication (P<.001). Conclusions: As nursing homes continue to progress in technological capabilities, it is important to understand how increasing IT sophistication can be leveraged to create opportunities to engage residents in their care. Understanding the impact of health information technology on outcomes and which technologies make a difference will help nursing home administrators make more informed decisions about adoption and implementation. %M 31518285 %R 10.2196/11449 %U http://aging.jmir.org/2019/1/e11449/ %U https://doi.org/10.2196/11449 %U http://www.ncbi.nlm.nih.gov/pubmed/31518285 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e11451 %T Prevalence and Factors Influencing Use of Internet and Electronic Health Resources by Middle-Aged and Older Adults in a US Health Plan Population: Cross-Sectional Survey Study %A Crouch,Elizabeth %A Gordon,Nancy P %+ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, United States, 1 510 891 3587, nancy.gordon@kp.org %K digital divide %K patient portal %K information-seeking behavior %K health education %K patient preference %K patient surveys %D 2019 %7 26.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Health care organizations are increasingly using electronic health (eHealth) platforms to provide and exchange health information and advice (HIA). There is limited information about how factors beyond internet access affect use of eHealth resources by middle-aged and older adults. Objective: We aimed to estimate prevalence of use of the internet, health plan patient portal, and Web-based HIA among middle-aged and older adults; investigate whether similar sociodemographic-related disparities in eHealth resource use are found among middle-aged and older adults; and examine how sociodemographic and internet access factors drive disparities in eHealth resource use among adults who use the internet. Methods: We analyzed cross-sectional survey data for 10,920 Northern California health plan members aged 45 to 85 years who responded to a mailed and Web-based health survey (2014-2015). We used bivariate and multivariable analyses with weighted data to estimate prevalence of and identify factors associated with internet use and self-reported past year use of the health plan’s patient portal and Web-based HIA resources by middle-aged adults (aged 45 to 65 years; n=5520), younger seniors (aged 65 to 75 years; n=3014), and older seniors (aged 76 to 85 years; n=2389). Results: Although approximately 96% of middle-aged adults, 92% of younger seniors, and 76% of older seniors use the internet to obtain information, about 4%, 9%, and 16%, respectively, require someone’s help to do so. The percentages who used the patient portal and Web-based HIA resources were similar for middle-aged adults and younger seniors but lower among older seniors (59.6%, 61.4%, and 45.0% and 47.9%, 48.4%, and 37.5%, respectively). Disparities in use of the internet, patient portal, and Web-based HIA across levels of education and between low and higher income were observed in all age groups, with wider disparities between low and high levels of education and income among seniors. Multivariable analyses showed that for all 3 age groups, educational attainment, ability to use the internet without help, and having 1 or more chronic condition were significant predictors of patient portal and Web-based HIA use after controlling for gender, race/ethnicity, and internet use. Conclusions: Internet use, and especially use without help, significantly declines with age, even within a middle-aged group. Educational attainment is significantly associated with internet use, ability to use the internet without help, and use of patient portal and Web-based HIA resources by middle-aged and older adults. Even among middle-aged and older adult internet users, higher educational attainment and ability to use the internet without help are positively associated with patient portal and Web-based HIA use. Organizations serving middle-aged and older adults should take into account target population characteristics when developing and evaluating uptake of eHealth resources and should consider offering instruction and support services to boost patient engagement. %M 31518256 %R 10.2196/11451 %U http://aging.jmir.org/2019/1/e11451/ %U https://doi.org/10.2196/11451 %U http://www.ncbi.nlm.nih.gov/pubmed/31518256 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12243 %T Digital Information Technology Use and Patient Preferences for Internet-Based Health Education Modalities: Cross-Sectional Survey Study of Middle-Aged and Older Adults With Chronic Health Conditions %A Gordon,Nancy P %A Crouch,Elizabeth %+ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, United States, 1 5108913587, nancy.gordon@kp.org %K internet %K health status disparities %K aged %K health informatics %K information technology %K health education %D 2019 %7 04.04.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education. Objective: The objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic health conditions. Methods: The study used cross-sectional survey data for 9005 Kaiser Permanente Northern California members aged 45 to 85 years who responded to a mailed and Web-based health survey conducted during 2014 and 2015 and indicated having at least 1 chronic health condition. Bivariate analyses and logistic regression models with weighted data were used to estimate and compare the prevalence of digital information technology use, past-year use of internet-based health information and advice resources, and preferences for using internet-based, mHealth, and traditional health information and advice modalities for adults aged 45 to 65 years, 66 to 75 years, and 76 to 85 years. Results: The percentages of adults who used digital information technologies (computers, smartphones, internet, email, and apps), had obtained health information and advice from an internet-based resource in the past year, and who were interested in using internet-based and mHealth modalities for obtaining health information and advice declined with age. Within age group, prevalence of digital information technologies use and interest in internet-based and mHealth modalities was lower among adults with no college education versus college graduates. Differences in preferences for internet-based health information and advice modalities between the oldest and younger groups and those with lower versus higher education were substantially diminished when we restricted analyses to internet users. Conclusions: Health care providers and organizations serving middle-aged and older adults with chronic health conditions should not assume that patients, especially those who are older and less educated, want to engage with internet-based and mHealth resources. In addition, increasing the engagement of nonutilizers of digital devices and the internet with internet-based health information and advice and mHealth apps might require both instrumental (eg, providing digital information technology devices, internet, and skills training) and social support. As part of patient-centered care, it is important for providers to ascertain their patients’ use of digital information technologies and preferences for obtaining health information and patient education rather than routinely referring them to internet-based resources. It is also important for health care providers and consumer health organizations to user test their Web-based resources to make sure they are easy for older and less educated adults to use and to make sure that it remains easy for adults with chronic conditions to obtain health information and patient education using offline resources. %M 31518291 %R 10.2196/12243 %U http://aging.jmir.org/2019/1/e12243/ %U https://doi.org/10.2196/12243 %U http://www.ncbi.nlm.nih.gov/pubmed/31518291 %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 %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e11331 %T Using Actigraphy to Predict the Ecological Momentary Assessment of Mood, Fatigue, and Cognition in Older Adulthood: Mixed-Methods Study %A Parsey,Carolyn M %A Schmitter-Edgecombe,Maureen %+ Department of Neurology, University of Washington School of Medicine, 325 9th Avenue, Seattle, WA, 98104, United States, 1 206 744 3532, cmparsey@uw.edu %K actigraphy %K aging %K ecological momentary assessment %K mood %K sleep %D 2019 %7 18.01.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Sleep quality has been associated with cognitive and mood outcomes in otherwise healthy older adults. However, most studies have evaluated sleep quality as aggregate and mean measures, rather than addressing the impact of previous night’s sleep on next-day functioning. Objective: This study aims to evaluate the ability of previous night’s sleep parameters on self-reported mood, cognition, and fatigue to understand short-term impacts of sleep quality on next-day functioning. Methods: In total, 73 cognitively healthy older adults (19 males, 54 females) completed 7 days of phone-based self-report questions, along with 24-hour actigraph data collection. We evaluated a model of previous night’s sleep parameters as predictors of mood, fatigue, and perceived thinking abilities the following day. Results: Previous night’s sleep predicted fatigue in the morning and midday, as well as sleepiness or drowsiness in the morning; however, sleep measures did not predict subjective report of mood or perceived thinking abilities the following day. Conclusions: This study suggests that objectively measured sleep quality from the previous night may not have a direct or substantial relationship with subjective reporting of cognition or mood the following day, despite frequent patient reports. Continued efforts to examine the relationship among cognition, sleep, and everyday functioning are encouraged. %M 31518282 %R 10.2196/11331 %U http://aging.jmir.org/2019/1/e11331/ %U https://doi.org/10.2196/11331 %U http://www.ncbi.nlm.nih.gov/pubmed/31518282 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e13302 %T Weekly, Seasonal, and Geographic Patterns in Health Contemplations About Sundown Syndrome: An Ecological Correlational Study %A Madden,Kenneth Michael %A Feldman,Boris %+ Gerontology and Diabetes Research Laboratory, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 4931, kmmadden@mail.ubc.ca %K sundown syndrome %K geriatric medicine %K dementia %K circadian rhythms %K infodemiology %K infoveillance %K internet %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Sundown syndrome (ie, agitation later in the day) is common in older adults with dementia. The underlying etiology for these behaviors is unclear. Possibilities include increased caregiver fatigue at the end of the day and disruption of circadian rhythms by both age and neurodegenerative illness. Objective: This study sought to examine circumseptan (weekly) patterns in search volumes related to sundown syndrome, in order to determine if such searches peaked at the end of the weekend, a time when caregiver supports are least available. We also sought to examine both seasonal differences and associations of state-by-state search activity with both state latitude and yearly sun exposure. Methods: Daily Internet search query data was obtained from Google Trends (2005-2017 inclusive). Circumseptan patterns were determined by wavelet analysis, and seasonality was determined by the difference in search volumes between winter (December, January, and February) and summer (June, July, and August) months. Geographic associations between percent sunny days and latitude were done on a state-by-state basis. Results: “Sundowning” searches showed a significant increase at the end of the weekend with activity being 10.9% (SD 4.0) higher on Sunday as compared to the rest of the week. Search activity showed a seasonal pattern with search activity significantly highest in the winter months (36.6 [SD 0.6] vs 13.7 [SD 0.2], P<.001). State-by-state variations in “sundowning” searches showed a significant negative association with increasing mean daily sunlight (R2=.16, β=-.429 [SD .149], P=.006) and showed a positive association with increasing latitude (R2=.38, β=.648 [SD .122], P<.001). Conclusions: Interest in “sundowning” is highest after a weekend, which is a time when external caregiver support is reduced. Searches related to sundown syndrome also were highest in winter, in states with less sun, and in states at more northerly latitudes, supporting disrupted circadian rhythms as another contributing factor to these behaviors. %M 31518264 %R 10.2196/13302 %U http://aging.jmir.org/2019/1/e13302/ %U https://doi.org/10.2196/13302 %U http://www.ncbi.nlm.nih.gov/pubmed/31518264 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e13135 %T Design and Development of the Brain Training System for the Digital “Maintain Your Brain” Dementia Prevention Trial %A Walton,Courtney Campbell %A Lampit,Amit %A Boulamatsis,Christos %A Hallock,Harry %A Barr,Polly %A Ginige,Jeewani Anupama %A Brodaty,Henry %A Chau,Tiffany %A Heffernan,Megan %A Sachdev,Perminder Singh %A Fiatarone Singh,Maria A %A Valenzuela,Michael %+ Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, Sydney, 2050, Australia, 61 2 9114 4135, michael.valenzuela@sydney.edu.au %K computerized cognitive training %K dementia %K clinical trial design %K older adults %D 2019 %7 27.02.2019 %9 Viewpoint %J JMIR Aging %G English %X Background: Dementia is the leading cause of disability worldwide, and interventions aimed at reducing the prevalence and burden of the disease are urgently needed. Maintain Your Brain (MYB) is a randomized controlled trial of a multimodal digital health intervention targeting modifiable dementia risk factors to combat cognitive decline and potentially prevent dementia. In addition to behavioral modules targeting mood, nutrition, and physical exercise, a new Brain Training System (BTS) will deliver computerized cognitive training (CCT) throughout the trial to provide systematic, challenging, and personally adaptive cognitive activity. Objective: This paper aimed to describe the design and development of BTS. Methods: BTS has been designed with a central focus on the end user. Raw training content is provided by our partner NeuroNation and delivered in several innovative ways. A baseline cognitive profile directs selection and sequencing of exercises within and between sessions and is updated during the 10-week 30-session module. Online trainers are available to provide supervision at different levels of engagement, including face-to-face share-screen coaching, a key implementation resource that is triaged by a “red flag” system for automatic tracking of user adherence and engagement, or through user-initiated help requests. Individualized and comparative feedback is provided to aid motivation and, for the first time, establish a social support network for the user based on their real-world circle of friends and family. Results: The MYB pilot was performed from November 2017 to March 2018. We are currently analyzing data from this pilot trial (n=100), which will make up a separate research paper. The main trial was launched in June 2018. Process and implementation data from the first training module (September to November 2018) are expected to be reported in 2019 and final trial outcomes are anticipated in 2022. Conclusions: The BTS implemented in MYB is focused on maximizing adherence and engagement with CCT over the short and long term in the setting of a fully digital trial, which, if successful, could be delivered economically at scale. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000851268; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=370631&isReview=true %M 31518277 %R 10.2196/13135 %U http://aging.jmir.org/2019/1/e13135/ %U https://doi.org/10.2196/13135 %U http://www.ncbi.nlm.nih.gov/pubmed/31518277