%0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e31162 %T Technology-Mediated Enrichment in Aged Care: Survey and Interview Study %A Waycott,Jenny %A Zhao,Wei %A Kelly,Ryan M %A Robertson,Elena %+ School of Computing and Information Systems, The University of Melbourne, 700 Swanston Street, Melbourne, 3010, Australia, 61 383448964, jwaycott@unimelb.edu.au %K aged care %K older adults %K technology %K social enrichment %K virtual reality %K robots %K videoconferencing %K care providers %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technologies such as virtual reality (VR), humanoid robots, and digital companion pets have the potential to provide social and emotional enrichment for people living in aged care. However, there is currently limited knowledge about how technologies are being used to provide enrichment, what benefits they provide, and what challenges arise when deploying these technologies in aged care settings. Objective: This study aims to investigate how digital technologies are being used for social and emotional enrichment in the Australian aged care industry and identify the benefits and challenges of using technology for enrichment in aged care. Methods: A web-based survey (N=20) was distributed among people working in the Australian aged care sector. The survey collected information about the types of technologies being deployed and their perceived value. The survey was followed by semistructured interviews (N=12) with aged care workers and technology developers to investigate their experiences of deploying technologies with older adults living in aged care. Survey data were analyzed using summary descriptive statistics and categorizing open-ended text responses. Interview data were analyzed using reflexive thematic analysis. Results: The survey revealed that a range of commercial technologies, such as VR, tablet devices, and mobile phones, are being used in aged care to support social activities and provide entertainment. Respondents had differing views about the value of emerging technologies, such as VR, social robots, and robot pets, but were more united in their views about the value of videoconferencing. Interviews revealed 4 types of technology-mediated enrichment experiences: enhancing social engagement, virtually leaving the care home, reconnecting with personal interests, and providing entertainment and distraction. Our analysis identified 5 barriers: resource constraints, the need to select appropriate devices and apps, client challenges, limited staff and organizational support, and family resistance. Conclusions: This study demonstrates that technologies can be used in aged care to create personally meaningful enrichment experiences for aged care clients. To maximize the effectiveness of technology-mediated enrichment, we argue that a person-centered care approach is crucial. Although enrichment experiences can be created using available technologies, they must be carefully selected and co-deployed with aged care clients. However, significant changes may be required within organizations to allow caregivers to facilitate individual technology-based activities for enrichment. %M 34975014 %R 10.2196/31162 %U https://aging.jmir.org/2022/2/e31162 %U https://doi.org/10.2196/31162 %U http://www.ncbi.nlm.nih.gov/pubmed/34975014 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33714 %T Perceptions of In-home Monitoring Technology for Activities of Daily Living: Semistructured Interview Study With Community-Dwelling Older Adults %A Camp,Nicola %A Johnston,Julie %A Lewis,Martin G C %A Zecca,Massimiliano %A Di Nuovo,Alessandro %A Hunter,Kirsty %A Magistro,Daniele %+ School of Science and Technology, Nottingham Trent University, College Drive, Clifton, Nottingham, NG3 5FP, United Kingdom, 44 01159418418, nicola.camp@ntu.ac.uk %K aging %K wearable sensors %K environmental sensors %K social robots %K activities of daily living %K aging %K older adults %K elderly %K robots %K wearables %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Many older adults prefer to remain in their own homes for as long as possible. However, there are still questions surrounding how best to ensure that an individual can cope with autonomous living. Technological monitoring systems are an attractive solution; however, there is disagreement regarding activities of daily living (ADL) and the optimal technologies that should be used to monitor them. Objective: This study aimed to understand older adults’ perceptions of important ADL and the types of technologies they would be willing to use within their own homes. Methods: Semistructured interviews were conducted on the web with 32 UK adults, divided equally into a younger group (aged 55-69 years) and an older group (≥70 years). Results: Both groups agreed that ADL related to personal hygiene and feeding were the most important and highlighted the value of socializing. The older group considered several activities to be more important than their younger counterparts, including stair use and foot care. The older group had less existing knowledge of monitoring technology but was more willing to accept wearable sensors than the younger group. The younger group preferred sensors placed within the home but highlighted that they would not have them until they felt that daily life was becoming a struggle. Conclusions: Overall, technological monitoring systems were perceived as an acceptable method for monitoring ADL. However, developers and carers must be aware that individuals may express differences in their willingness to engage with certain types of technology depending on their age and circumstances. %M 35511248 %R 10.2196/33714 %U https://aging.jmir.org/2022/2/e33714 %U https://doi.org/10.2196/33714 %U http://www.ncbi.nlm.nih.gov/pubmed/35511248 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e37521 %T Technology Acceptance and Usability of a Mobile App to Support the Workflow of Health Care Aides Who Provide Services to Older Adults: Pilot Mixed Methods Study %A Miguel Cruz,Antonio %A Lopez Portillo,Hector Perez %A Daum,Christine %A Rutledge,Emily %A King,Sharla %A Liu,Lili %+ Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 1-45 Corbett Hall, 8205 114 Street, Edmonton, AB, T6G 2G4, Canada, 1 7804926461, miguelcr@ualberta.ca %K usability %K technology acceptance %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K older adults %K caregivers %K health care aides %K mobile phone %D 2022 %7 18.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Health care aides are unlicensed support personnel who provide direct care, personal assistance, and support to people with health conditions. The shortage of health care aides has been attributed to recruitment challenges, high turnover, an aging population, the COVID-19 pandemic, and low retention rates. Mobile apps are among the many information communication technologies that are paving the way for eHealth solutions to help address this workforce shortage by enhancing the workflow of health care aides. In collaboration with Clinisys EMR Inc, we developed a mobile app (Mobile Smart Care System [mSCS]) to support the workflow of health care aides who provide services to older adult residents of a long-term care facility. Objective: The purpose of this study was to investigate the technology acceptance and usability of a mobile app in a real-world environment, while it is used by health care aides who provide services to older adults. Methods: This pilot study used a mixed methods design: sequential mixed methods (QUANTITATIVE, qualitative). Our study included a pre– and post–paper-based questionnaire with no control group (QUAN). Toward the end of the study, 2 focus groups were conducted with a subsample of health care aides (qual, qualitative description design). Technology acceptance and usability questionnaires used a 5-point Likert scale ranging from disagree (1) to agree (5). The items included in the questionnaires were validated in earlier research as having high levels of internal consistency for the Unified Theory of Acceptance and Use of Technology constructs. A total of 60 health care aides who provided services to older adults as part of their routine caseloads used the mobile app for 1 month. Comparisons of the Unified Theory of Acceptance and Use of Technology constructs’ summative scores at pretest and posttest were calculated using a paired t test (2-tailed). We used the partial least squares structural regression model to determine the factors influencing mobile app acceptance and usability for health care aides. The α level of significance for all tests was set at P≤.05 (2-tailed). Results: We found that acceptance of the mSCS was high among health care aides, performance expectancy construct was the strongest predictor of intention to use the mSCS, intention to use the mSCS predicted usage behavior. The qualitative data support the quantitative findings and showed health care aides’ strong belief that the mSCS was useful, portable, and reliable, although there were still opportunities for improvement, especially with regard to the mSCS user interface. Conclusions: Overall, these results support the assertion that mSCS technology acceptance and usability are high among health care aides. In other words, health care aides perceived that the mSCS assisted them in addressing their workflow issues. %M 35583930 %R 10.2196/37521 %U https://aging.jmir.org/2022/2/e37521 %U https://doi.org/10.2196/37521 %U http://www.ncbi.nlm.nih.gov/pubmed/35583930 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35373 %T Predicting Falls in Long-term Care Facilities: Machine Learning Study %A Thapa,Rahul %A Garikipati,Anurag %A Shokouhi,Sepideh %A Hurtado,Myrna %A Barnes,Gina %A Hoffman,Jana %A Calvert,Jacob %A Katzmann,Lynne %A Mao,Qingqing %A Das,Ritankar %+ Dascena Inc., 12333 Sowden Rd Ste B PMB 65148, Houston, TX, 77080-2059, United States, 1 (510) 826 950, sshokouhi@dascena.com %K vital signs %K machine learning %K blood pressure %K skilled nursing facilities %K independent living facilities %K assisted living facilities %K fall prediction %K elderly care %K elderly population %K older adult %K aging %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Short-term fall prediction models that use electronic health records (EHRs) may enable the implementation of dynamic care practices that specifically address changes in individualized fall risk within senior care facilities. Objective: The aim of this study is to implement machine learning (ML) algorithms that use EHR data to predict a 3-month fall risk in residents from a variety of senior care facilities providing different levels of care. Methods: This retrospective study obtained EHR data (2007-2021) from Juniper Communities’ proprietary database of 2785 individuals primarily residing in skilled nursing facilities, independent living facilities, and assisted living facilities across the United States. We assessed the performance of 3 ML-based fall prediction models and the Juniper Communities’ fall risk assessment. Additional analyses were conducted to examine how changes in the input features, training data sets, and prediction windows affected the performance of these models. Results: The Extreme Gradient Boosting model exhibited the highest performance, with an area under the receiver operating characteristic curve of 0.846 (95% CI 0.794-0.894), specificity of 0.848, diagnostic odds ratio of 13.40, and sensitivity of 0.706, while achieving the best trade-off in balancing true positive and negative rates. The number of active medications was the most significant feature associated with fall risk, followed by a resident’s number of active diseases and several variables associated with vital signs, including diastolic blood pressure and changes in weight and respiratory rates. The combination of vital signs with traditional risk factors as input features achieved higher prediction accuracy than using either group of features alone. Conclusions: This study shows that the Extreme Gradient Boosting technique can use a large number of features from EHR data to make short-term fall predictions with a better performance than that of conventional fall risk assessments and other ML models. The integration of routinely collected EHR data, particularly vital signs, into fall prediction models may generate more accurate fall risk surveillance than models without vital signs. Our data support the use of ML models for dynamic, cost-effective, and automated fall predictions in different types of senior care facilities. %M 35363146 %R 10.2196/35373 %U https://aging.jmir.org/2022/2/e35373 %U https://doi.org/10.2196/35373 %U http://www.ncbi.nlm.nih.gov/pubmed/35363146 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35696 %T A Model for Estimating Biological Age From Physiological Biomarkers of Healthy Aging: Cross-sectional Study %A Husted,Karina Louise Skov %A Brink-Kjær,Andreas %A Fogelstrøm,Mathilde %A Hulst,Pernille %A Bleibach,Akita %A Henneberg,Kaj-Åge %A Sørensen,Helge Bjarup Dissing %A Dela,Flemming %A Jacobsen,Jens Christian Brings %A Helge,Jørn Wulff %+ Xlab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen, 2200, Denmark, 45 28127945, karinalu@sund.ku.dk %K biological age %K model development %K principal component analysis %K healthy aging %K biomarkers %K aging %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Individual differences in the rate of aging and susceptibility to disease are not accounted for by chronological age alone. These individual differences are better explained by biological age, which may be estimated by biomarker prediction models. In the light of the aging demographics of the global population and the increase in lifestyle-related morbidities, it is interesting to invent a new biological age model to be used for health promotion. Objective: This study aims to develop a model that estimates biological age based on physiological biomarkers of healthy aging. Methods: Carefully selected physiological variables from a healthy study population of 100 women and men were used as biomarkers to establish an estimate of biological age. Principal component analysis was applied to the biomarkers and the first principal component was used to define the algorithm estimating biological age. Results: The first principal component accounted for 31% in women and 25% in men of the total variance in the biological age model combining mean arterial pressure, glycated hemoglobin, waist circumference, forced expiratory volume in 1 second, maximal oxygen consumption, adiponectin, high-density lipoprotein, total cholesterol, and soluble urokinase-type plasminogen activator receptor. The correlation between the corrected biological age and chronological age was r=0.86 (P<.001) and r=0.81 (P<.001) for women and men, respectively, and the agreement was high and unbiased. No difference was found between mean chronological age and mean biological age, and the slope of the regression line was near 1 for both sexes. Conclusions: Estimating biological age from these 9 biomarkers of aging can be used to assess general health compared with the healthy aging trajectory. This may be useful to evaluate health interventions and as an aid to enhance awareness of individual health risks and behavior when deviating from this trajectory. Trial Registration: ClinicalTrials.gov NCT03680768; https://clinicaltrials.gov/ct2/show/NCT03680768 International Registered Report Identifier (IRRID): RR2-10.2196/19209 %M 35536617 %R 10.2196/35696 %U https://aging.jmir.org/2022/2/e35696 %U https://doi.org/10.2196/35696 %U http://www.ncbi.nlm.nih.gov/pubmed/35536617 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33498 %T Using Smart Speaker Technology for Health and Well-being in an Older Adult Population: Pre-Post Feasibility Study %A McCloud,Rachel %A Perez,Carly %A Bekalu,Mesfin Awoke %A Viswanath,K %+ Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, United States, 1 706 224 8893, rachel_faulkenberry@dfci.harvard.edu %K technology %K older adults %K communication inequalities %K digital health %K elderly population %K smart technology %K smart speaker %K well-being %K health technology %K mobile phone %D 2022 %7 9.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Although smart speaker technology is poised to help improve the health and well-being of older adults by offering services such as music, medication reminders, and connection to others, more research is needed to determine how older adults from lower socioeconomic position (SEP) accept and use this technology. Objective: This study aimed to investigate the feasibility of using smart speakers to improve the health and well-being of low-SEP older adults. Methods: A total of 39 adults aged between 65 and 85 years who lived in a subsidized housing community were recruited to participate in a 3-month study. The participants had a smart speaker at their home and were given a brief orientation on its use. Over the course of the study, participants were given weekly check-in calls to help assist with any problems and newsletters with tips on how to use the speaker. Participants received a pretest and posttest to gauge comfort with technology, well-being, and perceptions and use of the speaker. The study staff also maintained detailed process notes of interactions with the participants over the course of the study, including a log of all issues reported. Results: At the end of the study period, 38% (15/39) of the participants indicated using the speaker daily, and 38% (15/39) of the participants reported using it several times per week. In addition, 72% (28/39) of the participants indicated that they wanted to continue using the speaker after the end of the study. Most participants (24/39, 62%) indicated that the speaker was useful, and approximately half of the participants felt that the speaker gave them another voice to talk to (19/39, 49%) and connected them with the outside world (18/39, 46%). Although common uses were using the speaker for weather, music, and news, fewer participants reported using it for health-related questions. Despite the initial challenges participants experienced with framing questions to the speaker, additional explanations by the study staff addressed these issues in the early weeks of the study. Conclusions: The results of this study indicate that there is promise for smart speaker technology for low-SEP older adults, particularly to connect them to music, news, and reminders. Future studies will need to provide more upfront training on query formation as well as develop and promote more specific options for older adults, particularly in the area of health and well-being. %M 35532979 %R 10.2196/33498 %U https://aging.jmir.org/2022/2/e33498 %U https://doi.org/10.2196/33498 %U http://www.ncbi.nlm.nih.gov/pubmed/35532979 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e28260 %T Detecting Anomalies in Daily Activity Routines of Older Persons in Single Resident Smart Homes: Proof-of-Concept Study %A Shahid,Zahraa Khais %A Saguna,Saguna %A Åhlund,Christer %+ Division of Computer Science, Department of Computer Science, Electrical and Space Engineering, Luleå University of Technology, Forskargatan 1, Skellefteå, 931 77, Sweden, 46 704741624, zahraa.shahid@ltu.se %K Activities of daily living %K smart homes %K elderly care %K anomaly detection %K IoT devices %K smart device %K elderly %K sensors %K digital sensors %K Internet of things %D 2022 %7 11.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: One of the main challenges of health monitoring systems is the support of older persons in living independently in their homes and with relatives. Smart homes equipped with internet of things devices can allow older persons to live longer in their homes. Previous surveys used to identify sensor-based data sets in human activity recognition systems have been limited by the use of public data set characteristics, data collected in a controlled environment, and a limited number of older participants. Objective: The objective of our study is to build a model that can learn the daily routines of older persons, detect deviations in daily living behavior, and notify these anomalies in near real-time to relatives. Methods: We extracted features from large-scale sensor data by calculating the time duration and frequency of visits. Anomalies were detected using a parametric statistical approach, unusually short or long durations being detected by estimating the mean (μ) and standard deviation (σ) over hourly time windows (80 to 355 days) for different apartments. The confidence level is at least 75% of the tested values within two (σ) from the mean. An anomaly was triggered where the actual duration was outside the limits of 2 standard deviations (μ−2σ, μ+2σ), activity nonoccurrence, or absence of activity. Results: The patterns detected from sensor data matched the routines self-reported by users. Our system observed approximately 1000 meals and bathroom activities and notifications sent to 9 apartments between July and August 2020. A service evaluation of received notifications showed a positive user experience, an average score of 4 being received on a 1 to 5 Likert-like scale. One was poor, two fair, three good, four very good, and five excellent. Our approach considered more than 75% of the observed meal activities were normal. This figure, in reality, was 93%, normal observed meal activities of all participants falling within 2 standard deviations of the mean. Conclusions: In this research, we developed, implemented, and evaluated a real-time monitoring system of older participants in an uncontrolled environment, with off-the-shelf sensors and internet of things devices being used in the homes of older persons. We also developed an SMS-based notification service and conducted user evaluations. This service acts as an extension of the health/social care services operated by the municipality of Skellefteå provided to older persons and relatives. %M 35404260 %R 10.2196/28260 %U https://aging.jmir.org/2022/2/e28260 %U https://doi.org/10.2196/28260 %U http://www.ncbi.nlm.nih.gov/pubmed/35404260 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e32169 %T Benefits of, Barriers to, and Needs for an Artificial Intelligence–Powered Medication Information Voice Chatbot for Older Adults: Interview Study With Geriatrics Experts %A Gudala,Meghana %A Ross,Mary Ellen Trail %A Mogalla,Sunitha %A Lyons,Mandi %A Ramaswamy,Padmavathy %A Roberts,Kirk %+ School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St #600, Houston, TX, 77030, United States, 1 713 500 3653, Kirk.Roberts@uth.tmc.edu %K medication information %K chatbot %K older adults %K technology capabilities %K mobile phone %D 2022 %7 28.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: One of the most complicated medical needs of older adults is managing their complex medication regimens. However, the use of technology to aid older adults in this endeavor is impeded by the fact that their technological capabilities are lower than those of much of the rest of the population. What is needed to help manage medications is a technology that seamlessly integrates within their comfort levels, such as artificial intelligence agents. Objective: This study aimed to assess the benefits, barriers, and information needs that can be provided by an artificial intelligence–powered medication information voice chatbot for older adults. Methods: A total of 8 semistructured interviews were conducted with geriatrics experts. All interviews were audio-recorded and transcribed. Each interview was coded by 2 investigators (2 among ML, PR, METR, and KR) using a semiopen coding method for qualitative analysis, and reconciliation was performed by a third investigator. All codes were organized into the benefit/nonbenefit, barrier/nonbarrier, and need categories. Iterative recoding and member checking were performed until convergence was reached for all interviews. Results: The greatest benefits of a medication information voice-based chatbot would be helping to overcome the vision and dexterity hurdles experienced by most older adults, as it uses voice-based technology. It also helps to increase older adults’ medication knowledge and adherence and supports their overall health. The main barriers were technology familiarity and cost, especially in lower socioeconomic older adults, as well as security and privacy concerns. It was noted however that technology familiarity was not an insurmountable barrier for older adults aged 65 to 75 years, who mostly owned smartphones, whereas older adults aged >75 years may have never been major users of technology in the first place. The most important needs were to be usable, to help patients with reminders, and to provide information on medication side effects and use instructions. Conclusions: Our needs analysis results derived from expert interviews clarify that a voice-based chatbot could be beneficial in improving adherence and overall health if it is built to serve the many medication information needs of older adults, such as reminders and instructions. However, the chatbot must be usable and affordable for its widespread use. %M 35482367 %R 10.2196/32169 %U https://aging.jmir.org/2022/2/e32169 %U https://doi.org/10.2196/32169 %U http://www.ncbi.nlm.nih.gov/pubmed/35482367 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e31486 %T Stakeholder Perspectives on In-home Passive Remote Monitoring to Support Aging in Place in the Province of New Brunswick, Canada: Rapid Qualitative Investigation %A Read,Emily A %A Gagnon,Danie A %A Donelle,Lorie %A Ledoux,Kathleen %A Warner,Grace %A Hiebert,Brad %A Sharma,Ridhi %+ Faculty of Nursing, University of New Brunswick, 55 Lutz Street, Moncton, NB, E1C 0L2, Canada, 1 506 431 3017, Emily.Read@unb.ca %K aging in place %K home care %K older adults %K passive remote monitoring %D 2022 %7 11.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The province of New Brunswick (NB) has one of the oldest populations in Canada, providing an opportunity to develop and test innovative strategies to address the unique health challenges faced by older adults. Passive remote monitoring technology has the potential to support independent living among older adults. Limited research has examined the benefits of and barriers to the adoption of this technology among community-dwelling older adults. Objective: This study aimed to explore perceptions of in-home passive remote monitoring technology designed to support aging in place from the perspective of older adults, their family or friend caregivers, social workers, and government decision-makers in the province of NB, Canada. Methods: Between October 2018 and March 2020, a rapid qualitative investigation of 28 one-on-one interviews was conducted in person or via telephone. Participants included 2 home support services clients and 11 family or friend caregivers who had used passive remote monitoring technology in their homes; 8 social workers who had worked as case managers for home support services clients; and 7 individuals who were key government decision-makers in the adoption, policy development, and use of the technology in the province of NB. The interviews focused on the following topics: decision to adopt the passive remote monitoring system, barriers to adopting the passive remote monitoring system, benefits of the passive remote monitoring system, impact on client health outcomes, and privacy concerns. The interviews were audio recorded, transcribed, and analyzed by a team of 6 researchers. Data analysis was conducted using a rapid assessment process approach that included matrix analysis. Results: Participants reported that the use of the remote monitoring system allowed older adults to live at home longer and provided caregiver relief. Stakeholders were invested in meeting the home support (home care) needs of older adults. However, when it came to the use of remote monitoring, there was a lack of consensus about which clients it was well-suited for and the role that social workers should play in informing clients and caregivers about the service (role ambiguity, gatekeeping, and perceived conflicts of interest). Conclusions: Our findings highlight many benefits and challenges of the adoption of passive remote monitoring for clients, their family or friend caregivers, and public provincial health and social services systems. Passive remote monitoring is a valuable tool that can provide support to older adults and their family or friend caregivers when it is a good fit with client needs. Further work is needed in NB to increase public and social workers’ awareness of the service and its benefits. %M 35544304 %R 10.2196/31486 %U https://aging.jmir.org/2022/2/e31486 %U https://doi.org/10.2196/31486 %U http://www.ncbi.nlm.nih.gov/pubmed/35544304 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34239 %T Decision-making Factors Toward the Adoption of Smart Home Sensors by Older Adults in Singapore: Mixed Methods Study %A Cao,Yuanyuan %A Erdt,Mojisola %A Robert,Caroline %A Naharudin,Nurhazimah Binte %A Lee,Shan Qi %A Theng,Yin-Leng %+ Centre for Healthy and Sustainable Cities, Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore, 637718, Singapore, yycao@ntu.edu.sg %K aging in place %K health care systems and management %K telehealth %K assistive technology %K assisted living facilities %D 2022 %7 24.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: An increasing aging population has become a pressing problem in many countries. Smart systems and intelligent technologies support aging in place, thereby alleviating the strain on health care systems. Objective: This study aims to identify decision-making factors involved in the adoption of smart home sensors (SHS) by older adults in Singapore. Methods: The study involved 3 phases: as an intervention, SHS were installed in older adults’ homes (N=42) for 4 to 5 weeks; in-depth semistructured interviews were conducted with 18 older adults, 2 center managers, 1 family caregiver, and 1 volunteer to understand the factors involved in the decision-making process toward adoption of SHS; and follow-up feedback was collected from 42 older adult participants to understand the reasons for adopting or not adopting SHS. Results: Of the 42 participants, 31 (74%) adopted SHS after the intervention, whereas 11 (26%) did not adopt SHS. The reasons for not adopting SHS ranged from privacy concerns to a lack of family support. Some participants did not fully understand SHS functionality and did not perceive the benefits of using SHS. From the interviews, we found that the decision-making process toward the adoption of SHS technology involved intrinsic factors, such as understanding the technology and perceiving its usefulness and benefits, and more extrinsic factors, such as considering affordability and care support from the community. Conclusions: We found that training and a strong support ecosystem could empower older adults in their decision to adopt technology. We advise the consideration of human values and involvement of older adults in the design process to build user-centric assistive technology. %M 35749213 %R 10.2196/34239 %U https://aging.jmir.org/2022/2/e34239 %U https://doi.org/10.2196/34239 %U http://www.ncbi.nlm.nih.gov/pubmed/35749213 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35625 %T A Text Messaging Intervention to Support Latinx Family Caregivers of Individuals With Dementia (CuidaTEXT): Development and Usability Study %A Perales-Puchalt,Jaime %A Acosta-Rullán,Mariola %A Ramírez-Mantilla,Mariana %A Espinoza-Kissell,Paul %A Vidoni,Eric %A Niedens,Michelle %A Ellerbeck,Edward %A Hinton,Ladson %A Loera,Linda %A Ramírez,A Susana %A Lara,Esther %A Watts,Amber %A Williams,Kristine %A Resendez,Jason %A Burns,Jeffrey %+ Alzheimer’s Disease Research Center, School of Medicine, University of Kansas Medical Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States, 1 913 588 3716, jperales@kumc.edu %K Latinx individuals %K mHealth %K dementia %K caregiving %D 2022 %7 28.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Latinx family caregivers of individuals with dementia face many barriers to caregiver support access. Interventions to alleviate these barriers are urgently needed. Objective: This study aimed to describe the development of CuidaTEXT, a tailored SMS text messaging intervention to support Latinx family caregivers of individuals with dementia. Methods: CuidaTEXT is informed by the stress process framework and social cognitive theory. We developed and refined CuidaTEXT using a mixed methods approach that included thematic analysis and descriptive statistics. We followed 6 user-centered design stages, namely, the selection of design principles, software vendor collaboration, evidence-based foundation, caregiver and research and clinical advisory board guidance, sketching and prototyping, and usability testing of the prototype of CuidaTEXT among 5 Latinx caregivers. Results: CuidaTEXT is a bilingual 6-month-long SMS text messaging–based intervention tailored to caregiver needs that includes 1-3 daily automatic messages (n=244) about logistics, dementia education, self-care, social support, end of life, care of the person with dementia, behavioral symptoms, and problem-solving strategies; 783 keyword-driven text messages for further help with the aforementioned topics; live chat interaction with a coach for further help; and a 19-page reference booklet summarizing the purpose and functions of the intervention. The 5 Latinx caregivers who used the prototype of CuidaTEXT scored an average of 97 out of 100 on the System Usability Scale. Conclusions: CuidaTEXT’s prototype demonstrated high usability among Latinx caregivers. CuidaTEXT’s feasibility is ready to be tested. %M 35482366 %R 10.2196/35625 %U https://aging.jmir.org/2022/2/e35625 %U https://doi.org/10.2196/35625 %U http://www.ncbi.nlm.nih.gov/pubmed/35482366 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e32322 %T Improving a Mobile Telepresence Robot for People With Alzheimer Disease and Related Dementias: Semistructured Interviews With Stakeholders %A Shin,Marlena H %A McLaren,Jaye %A Ramsey,Alvin %A Sullivan,Jennifer L %A Moo,Lauren %+ Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, 150 South Huntington Avenue (152M), Boston, MA, 02130, United States, 1 857 364 2767, marlena.shin@va.gov %K mild cognitive impairment %K socially assistive robot %K robot technology %K caregiver support %K gerontology %K aging in place %K qualitative research %K mobile phone %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: By 2050, nearly 13 million Americans will have Alzheimer disease and related dementias (ADRD), with most of those with ADRD or mild cognitive impairment (MCI) receiving home care. Mobile telepresence robots may allow persons with MCI or ADRD to remain living independently at home and ease the burden of caregiving. The goal of this study was to identify how an existing mobile telepresence robot can be enhanced to support at-home care of people with MCI or ADRD through key stakeholder input. Objective: The specific aims were to assess what applications should be integrated into the robot to further support the independence of individuals with MCI or ADRD and understand stakeholders’ overall opinions about the robot. Methods: We conducted in-person interviews with 21 stakeholders, including 6 people aged >50 years with MCI or ADRD living in the community, 9 family caregivers of people with MCI or ADRD, and 6 clinicians who work with the ADRD population. Interview questions about the robot focused on technology use, design and functionality, future applications to incorporate, and overall opinions. We conducted a thematic analysis of the data obtained and assessed the patterns within and across stakeholder groups using a matrix analysis technique. Results: Overall, most stakeholders across groups felt positively about the robot’s ability to support individuals with MCI or ADRD and decrease caregiver burden. Most ADRD stakeholders felt that the greatest benefits would be receiving help in emergency cases and having fewer in-person visits to the doctor’s office. Caregivers and clinicians also noted that remote video communication with their family members using the robot was valuable. Adding voice commands and 1-touch lifesaving or help buttons to the robot were the top suggestions offered by the stakeholders. The 4 types of applications that were suggested included health-related alerts; reminders; smart-home–related applications; and social, entertainment, or well-being applications. Stakeholders across groups liked the robot’s mobility, size, interactive connection, and communication abilities. However, stakeholders raised concerns about their physical stability and size for individuals living in smaller, cluttered spaces; screen quality for those with visual impairments; and privacy or data security. Conclusions: Although stakeholders generally expressed positive opinions about the robot, additional adaptations were suggested to strengthen functionality. Adding applications and making improvements to the design may help mitigate concerns and better support individuals with ADRD to live independently in the community. As the number of individuals living with ADRD in the United States increases, mobile telepresence robots are a promising way to support them and their caregivers. Engaging all 3 stakeholder groups in the development of these robots is a critical first step in ensuring that the technology matches their needs. Integrating the feedback obtained from our stakeholders and evaluating their effectiveness will be important next steps in adapting telepresence robots. %M 35503518 %R 10.2196/32322 %U https://aging.jmir.org/2022/2/e32322 %U https://doi.org/10.2196/32322 %U http://www.ncbi.nlm.nih.gov/pubmed/35503518 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35847 %T Delivering Personalized Recommendations to Support Caregivers of People Living With Dementia: Mixed Methods Study %A Cha,Jinhee %A Peterson,Colleen M %A Millenbah,Ashley N %A Louwagie,Katie %A Baker,Zachary G %A Shah,Ayush %A Jensen,Christine J %A Gaugler,Joseph E %+ Medical School and School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, United States, 1 6513523161, cha00003@umn.edu %K caregivers %K caregiving %K Alzheimer %K dementia %K intervention %K COVID-19 %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Estimates suggest that 6.2 million Americans aged ≥65 years are living with Alzheimer dementia in 2021, and by 2060, this number could more than double to 13.8 million. As a result, public health officials anticipate a greater need for caregivers of persons with Alzheimer disease or related dementia and support resources for both people living with dementia and their caregivers. Despite the growing need for dementia caregiver support services, there is a lack of consensus regarding how to tailor these services to best meet the heterogeneous needs of individual caregivers. To fill this gap, Care to Plan (CtP), a web-based tool for caregivers of people living with dementia, was developed to provide tailored support recommendations to dementia caregivers. Objective: The aim of this study is to formally explore the feasibility, acceptability, and utility of CtP for 20 family members of people living with dementia within a health system over a 1-month time period using a mixed methods parallel convergent design. Methods: A moderately sized health system in the mid-Atlantic region was selected as the site for CtP implementation, where 20 caregivers who were family members of people living with dementia were enrolled. The web-based CtP tool was used by caregivers and facilitated by a health care professional (ie, a senior care navigator [SCN]). Caregivers were given a 21-item review checklist to assess barriers and facilitators associated with reviewing CtP with an SCN. Following the 21-item review checklist, semistructured telephone interviews, which included 18 open-ended questions, focused on the facilitators of and barriers to CtP implementation and recommendations for future implementation. Results: Quantitative results suggested that 85% (17/20) of caregivers indicated that CtP was helpful and 90% (18/20) would recommend CtP to someone in a similar situation. The qualitative analysis identified 4 themes regarding facilitators of and barriers to implementation: caregiver factors, SCN factors, CtP tool system factors, and recommendations and resources factors. Conclusions: CtP was found to be not only feasible but also a valuable tool for caregivers seeking resources for themselves and their people living with dementia. Long-term evaluation findings aim to generate results on how CtP can be integrated into care plans for caregivers and how SCNs can provide additional support for caregivers of people living with dementia over an extended period. %M 35503650 %R 10.2196/35847 %U https://aging.jmir.org/2022/2/e35847 %U https://doi.org/10.2196/35847 %U http://www.ncbi.nlm.nih.gov/pubmed/35503650 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e32603 %T Emotional Word Use in Informal Carers of People Living With Dementia: Linguistic Analysis of Online Discussion Forums %A Donnellan,Warren James %A Warren,Jasmine Grace %+ Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, United Kingdom, 44 795 0647 ext 0151, wjd@liverpool.ac.uk %K dementia care %K online forum %K emotional language %K emotional states %K dementia %K aging %K elderly population %K digital health %K online health %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Informal dementia care is uniquely stressful and necessitates effective methods of identifying and understanding the needs of potentially at-risk carers so that they can be supported and sustained in their roles. One such method is examining carers’ engagement in online support platforms. Research has explored emotional word use on online discussion forums as a proxy for underlying emotional functioning. We are not aware of any research that has analyzed the content of posts on discussion forums specific to carers of people living with dementia in order to examine their emotional states. Objective: We addressed the following research questions: (1) To what extent does emotional language use differ between carers of people living with dementia and noncarers? (2) To what extent does emotional language use differ between spousal and parental carers? (3) To what extent does emotional language use differ between current and former carers? Methods: We used the Linguistic Inquiry and Word Count (LIWC) program to examine emotional word use on a UK-based online forum for informal carers of people living with dementia and a discussion forum control group. Carers were separated into different subgroups for the analysis: current and former, and spousal and parental. Results: We found that carers of people living with dementia used significantly more negative, but not positive, emotion words than noncarers. Spousal carers used more emotion words overall than parental carers, specifically more negative emotion words. Former carers used more emotional words overall than current carers, specifically more positive words. Conclusions: The findings suggest that informal carers of people living with dementia may be at increased risk of negative emotional states relative to noncarers. Greater negativity in spousal carers may be explained by increased caregiver burden, whereas greater positivity in former carers may be explained by functional relief of caregiving responsibilities. The theoretical/applied relevance of these findings is discussed. %M 35713942 %R 10.2196/32603 %U https://aging.jmir.org/2022/2/e32603 %U https://doi.org/10.2196/32603 %U http://www.ncbi.nlm.nih.gov/pubmed/35713942 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33165 %T The Acceptability of Digital Technology and Tele-Exercise in the Age of COVID-19: Cross-sectional Study %A Ho,Vanda %A Merchant,Reshma A %+ Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Rd, Tower Block Level 10, Division of Geriatric Medicine, Singapore, 119228, Singapore, 65 6779 5555, reshmaa@nuhs.edu.sg %K senior %K telehealth %K digital exercise %K acceptability %K telemedicine %K elderly %K older adults %K outcome %K isolation %K decline %K function %K adoption %K perception %K exercise %K physical activity %K questionnaire %K COVID-19 %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: With the COVID-19 pandemic, telehealth has been increasingly used to offset the negative outcomes of social isolation and functional decline in older adults. Crucial to the success of telehealth is end user adoption. Objective: This study aims to investigate perception and acceptability of digital technology among Asian older adults. Methods: The Healthy Ageing Promotion Program for You (HAPPY) dual-task exercise was conducted virtually to participants aged ≥60 years. Questionnaires were administered digitally and collected data on demographics, perceptions of digital technology and evaluation of HAPPY, the 6-item Lubben Social Network Scale, intrinsic capacity using the Integrated Care for Older People tool, and a functional screening with the FRAIL scale and five chair rises. Descriptive analysis was used. Results: A total of 42 participants were digitally interviewed. The mean age was 69.1 (4.7) years. Hearing, vision, and 3-item recall difficulty were present in 14% (n=6), 12% (n=5), and 24% (n=10) of participants, respectively. Of the participants, 29% (n=12) had possible sarcopenia and 14% (n=6) were prefrail. Around 24% (n=10) were at risk of social isolation. Most of the participants (n=38, 91%) agreed that technology is good, and 79% (n=33) agreed that technology would allow them to be independent for longer. Over three-quarters of participants (n=33, 79%) agreed that they have the necessary knowledge, and 91% (n=38) had technological assistance available. However, 57% (n=24) were still apprehensive about using technology. Despite 71% (n=30) of older adults owning their devices, 36% (n=15) felt finances were limiting. Through digital HAPPY, 45% (n=19) of participants reported feeling stronger, 48% (n=20) had improved spirits, and 40% (n=17) and 38% (n=16) had improved mood and memory, respectively. Conclusions: The majority of older adults in this study believed in digital technology and had the necessary knowledge and help, but almost half still felt apprehensive and had financial barriers to adopting technology. A digitally administered exercise program especially in a group setting is a feasible option to enhance intrinsic capacity in older adults. However, more work is needed in elucidating sources of apprehension and financial barriers to adopting technology. %M 35294921 %R 10.2196/33165 %U https://aging.jmir.org/2022/2/e33165 %U https://doi.org/10.2196/33165 %U http://www.ncbi.nlm.nih.gov/pubmed/35294921 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34326 %T Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment %A Mao,Alice %A Tam,Lydia %A Xu,Audrey %A Osborn,Kim %A Sheffrin,Meera %A Gould,Christine %A Schillinger,Erika %A Martin,Marina %A Mesias,Matthew %+ Division of Primary Care and Population Health, Department of Medicine, Stanford University, 1265 Welch Road, Stanford, CA, 94305, United States, 1 1 847 769 2725, amao@onlok.org %K telemedicine %K barriers to access to care %K older adults %K eHealth %K e-visit %K access %K accessibility %K barrier %K elder %K gerontology %K geriatric %K need assessment %K mixed method %K cross-sectional %K telehealth %K community care %K independent living %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Despite the increasing availability of telemedicine video visits during the COVID-19 pandemic, older adults have greater challenges in getting care through telemedicine. Objective: We aim to better understand the barriers to telemedicine in community-dwelling older adults to improve the access to and experience of virtual visits. Methods: We conducted a mixed methods needs assessment of older adults at two independent living facilities (sites A and B) in Northern California between September 2020 and March 2021. Voluntary surveys were distributed. Semistructured interviews were then conducted with participants who provided contact information. Surveys ascertained participants’ preferred devices as well as comfort level, support, and top barriers regarding telephonic and video visits. Qualitative analysis of transcribed interviews identified key themes. Results: Survey respondents’ (N=249) average age was 84.6 (SD 6.6) years, and 76.7% (n=191) of the participants were female. At site A, 88.9% (111/125) had a bachelor’s degree or beyond, and 99.2% (124/125) listed English as their preferred language. At site B, 42.9% (51/119) had a bachelor’s degree or beyond, and 13.4% (16/119) preferred English, while 73.1% (87/119) preferred Mandarin. Regarding video visits, 36.5% (91/249) of all participants felt comfortable connecting with their health care team through video visits. Regarding top barriers, participants at site A reported not knowing how to connect to the platform (30/125, 24%), not being familiar with the technology (28/125, 22.4%), and having difficulty hearing (19/125, 15.2%), whereas for site B, the top barriers were not being able to speak English well (65/119, 54.6%), lack of familiarity with technology and the internet (44/119, 36.9%), and lack of interest in seeing providers outside of the clinic (42/119, 35.3%). Three key themes emerged from the follow-up interviews (n=15): (1) the perceived limitations of video visits, (2) the overwhelming process of learning the technology for telemedicine, and (3) the desire for in-person or on-demand help with telemedicine. Conclusions: Substantial barriers exist for older adults in connecting with their health care team through telemedicine, particularly through video visits. The largest barriers include difficulty with technology or using the video visit platform, hearing difficulty, language barriers, and lack of desire to see providers virtually. Efforts to improve telemedicine access for older adults should take into account patient perspectives. %M 35438648 %R 10.2196/34326 %U https://aging.jmir.org/2022/2/e34326 %U https://doi.org/10.2196/34326 %U http://www.ncbi.nlm.nih.gov/pubmed/35438648 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34793 %T The Factors Associated With Nonuse of Social Media or Video Communications to Connect With Friends and Family During the COVID-19 Pandemic in Older Adults: Web-Based Survey Study %A Savage,Rachel D %A Di Nicolo,Sophia %A Wu,Wei %A Li,Joyce %A Lawson,Andrea %A Grieve,Jim %A Goel,Vivek %A Rochon,Paula A %+ Women's Age Lab, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 416 351 3732 ext 3822, rachel.savage@wchospital.ca %K digital technology %K loneliness %K older adults %K COVID-19 %K elderly %K lonely %K mental health %K factor %K usage %K social media %K video %K communication %K connection %K connect %K family %K friend %K age %K support %D 2022 %7 6.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technologies have enabled social connection during prolonged periods of physical distancing and travel restrictions throughout the COVID-19 pandemic. These solutions may exclude older adults, who are at higher risk for social isolation, loneliness, and severe outcomes if infected with SARS-CoV-2. Objective: This study investigated factors associated with nonuse of social media or video communications to connect with friends and family among older adults during the pandemic’s first wave. Methods: A web-based, cross-sectional survey was administered to members of a national retired educators’ organization based in Ontario, Canada, between May 6 and 19, 2020. Respondents (N=4879) were asked about their use of social networking websites or apps to communicate with friends and family, their internet connection and smartphone access, loneliness, and sociodemographic characteristics. Factors associated with nonuse were evaluated using multivariable logistic regression. A thematic analysis was performed on open-ended survey responses that described experiences with technology and virtual connection. Results: Overall, 15.4% (751/4868) of respondents did not use social networking websites or apps. After adjustment, male gender (odds ratio [OR] 1.60, 95% CI 1.33-1.92), advanced age (OR 1.88, 95% CI 1.38-2.55), living alone (OR 1.68, 95% CI 1.39-2.02), poorer health (OR 1.33, 95% CI 1.04-1.71), and lower social support (OR 1.44, 95% CI 1.20-1.71) increased the odds of nonuse. The reliability of internet connection and access to a smartphone also predicted nonuse. Many respondents viewed these technologies as beneficial, especially for maintaining pre–COVID-19 social contacts and routines, despite preferences for in-person connection. Conclusions: Several factors including advanced age, living alone, and low social support increased the odds of nonuse of social media in older adults to communicate with friends and family during COVID-19’s first wave. Our findings identified socially vulnerable subgroups who may benefit from intervention (eg, improved access, digital literacy, and telephone outreach) to improve social connection. %M 35344502 %R 10.2196/34793 %U https://aging.jmir.org/2022/2/e34793 %U https://doi.org/10.2196/34793 %U http://www.ncbi.nlm.nih.gov/pubmed/35344502 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e38363 %T Examining the Impact of COVID-19 on People With Dementia From the Perspective of Family and Friends: Thematic Analysis of Tweets %A Bacsu,Juanita-Dawne R %A O'Connell,Megan E %A Cammer,Allison %A Ahmadi,Soheila %A Berger,Corinne %A Azizi,Mehrnoosh %A Gowda-Sookochoff,Rory %A Grewal,Karl S %A Green,Shoshana %A Knight,Sheida %A Spiteri,Raymond J %+ Department of Psychology, University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 3062504399, juanita.bacsu@usask.ca %K coronavirus 2019 %K COVID-19 %K Twitter %K social media %K dementia %K Alzheimer disease %K thematic analysis %K aging %K older adult %K elderly population %K caregiver %K support service %K peer support %K online health community %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic is taking a serious toll on people with dementia. Given the rapidly evolving COVID-19 context, policymakers and practitioners require timely, evidence-informed research to address the changing needs and challenges of people with dementia and their family care partners. Objective: Using Twitter data, the objective of this study was to examine the COVID-19 impact on people with dementia from the perspective of their family members and friends. Methods: Using the Twint application in Python, we collected 6243 relevant tweets over a 15-month time frame. The tweets were divided among 11 coders and analyzed using a 6-step thematic analysis process. Results: Based on our analysis, 3 main themes were identified: (1) frustration and structural inequities (eg, denied dignity and inadequate supports), (2) despair due to loss (eg, isolation, decline, and death), and (3) resiliency, survival, and hope for the future. Conclusions: As the COVID-19 pandemic persists and new variants emerge, people with dementia and their family care partners are facing complex challenges that require timely interventions. More specifically, tackling COVID-19 challenges requires revisiting pandemic policies and protocols to ensure equitable access to health and support services, recognizing the essential role of family care partners, and providing financial assistance and resources to help support people with dementia in the pandemic. Revaluating COVID-19 policies is critical to mitigating the pandemic’s impact on people with dementia and their family care partners. %M 35667087 %R 10.2196/38363 %U https://aging.jmir.org/2022/2/e38363 %U https://doi.org/10.2196/38363 %U http://www.ncbi.nlm.nih.gov/pubmed/35667087 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35075 %T An Electronic Patient-Reported Outcomes Tool for Older Adults With Complex Chronic Conditions: Cost-Utility Analysis %A Miranda,Rafael N %A Bhuiya,Aunima R %A Thraya,Zak %A Hancock-Howard,Rebecca %A Chan,Brian CF %A Steele Gray,Carolyn %A Wodchis,Walter P %A Thavorn,Kednapa %+ Clinical Epidemiology Program, Ottawa Hospital Research Institute, The General Campus, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada, 1 613 737 8899 ext 72330, kthavorn@ohri.ca %K eHealth %K multimorbidity %K primary care %K cost-effectiveness %K older adult %K elder %K cost %K patient reported outcome %K community %K complex care %K aging %K Canada %K North America %K chronic disease %K chronic condition %K decision tree %K model %K sensitivity analysis %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: eHealth technologies for self-management can improve quality of life, but little is known about whether the benefits gained outweigh their costs. The electronic patient-reported outcome (ePRO) mobile app and portal system supports patients with multiple chronic conditions to collaborate with primary health care providers to set and monitor health-related goals. Objective: This study aims to estimate the cost of ePRO and the cost utility of the ePRO intervention compared with usual care provided to patients with multiple chronic conditions and complex needs living in the community, from the perspective of the publicly funded health care payer in Ontario, Canada. Methods: We developed a decision tree model to estimate the incremental cost per quality-adjusted life year (QALY) gained for the ePRO tool versus usual care over a time horizon of 15 months. Resource utilization and effectiveness of the ePRO tool were drawn from a randomized clinical trial with 6 family health teams involving 45 participants. Unit costs associated with health care utilization (adjusted to 2020 Canadian dollars) were drawn from literature and publicly available sources. A series of sensitivity analyses were conducted to assess the robustness of the findings. Results: The total cost of the ePRO tool was CAD $79,467 (~US $ 63,581; CAD $1733 [~US $1386] per person). Compared with standard care, the ePRO intervention was associated with higher costs (CAD $1710 [~US $1368]) and fewer QALYs (–0.03). The findings were consistent with the clinical evidence, suggesting no statistical difference in health-related quality of life between ePRO and usual care groups. However, the tool would be considered a cost-effective option if it could improve by at least 0.03 QALYs. The probability that the ePRO is cost-effective was 17.3% at a willingness-to-pay (WTP) threshold of CAD $50,000 (~US $40,000)/QALY. Conclusions: The ePRO tool is not a cost-effective technology at the commonly used WTP value of CAD $50,000 (~US $40,000)/QALY, but long-term and the societal impacts of ePRO were not included in this analysis. Further research is needed to better understand its impact on long-term outcomes and in real-world settings. The present findings add to the growing evidence about eHealth interventions’ capacity to respond to complex aging populations within finite-resourced health systems. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 %M 35442194 %R 10.2196/35075 %U https://aging.jmir.org/2022/2/e35075 %U https://doi.org/10.2196/35075 %U http://www.ncbi.nlm.nih.gov/pubmed/35442194 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e32790 %T Associations Between Implementation of the Caregiver Advise Record Enable (CARE) Act and Health Service Utilization for Older Adults with Diabetes: Retrospective Observational Study %A Zheng,Yaguang %A Anton,Bonnie %A Rodakowski,Juleen %A Altieri Dunn,Stefanie C %A Fields,Beth %A Hodges,Jacob C %A Donovan,Heidi %A Feiler,Connie %A Martsolf,Grant %A Bilderback,Andrew %A Martin,Susan C %A Li,Dan %A James,Alton Everette %+ Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY, 10010, United States, 1 212 998 5170, yaguang.zheng@nyu.edu %K electronic health record %K caregiver %K diabetes %K hospital readmission %K emergency department utilization %K CARE Act %K EHRs %K older adults %K utilization %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The Caregiver Advise Record Enable (CARE) Act is a state level law that requires hospitals to identify and educate caregivers (“family members or friends”) upon discharge. Objective: This study examined the association between the implementation of the CARE Act in a Pennsylvania health system and health service utilization (ie, reducing hospital readmission, emergency department [ED] visits, and mortality) for older adults with diabetes. Methods: The key elements of the CARE Act were implemented and applied to the patients discharged to home. The data between May and October 2017 were pulled from inpatient electronic health records. Likelihood-ratio chi-square tests and multivariate logistic regression models were used for statistical analysis. Results: The sample consisted of 2591 older inpatients with diabetes with a mean age of 74.6 (SD 7.1) years. Of the 2591 patients, 46.1% (n=1194) were female, 86.9% (n=2251) were White, 97.4% (n=2523) had type 2 diabetes, and 69.5% (n=1801) identified a caregiver. Of the 1801 caregivers identified, 399 (22.2%) received discharge education and training. We compared the differences in health service utilization between pre- and postimplementation of the CARE Act; however, no significance was found. No significant differences were detected from the bivariate analyses in any outcomes between individuals who identified a caregiver and those who declined to identify a caregiver. After adjusting for risk factors (multivariate analysis), those who identified a caregiver (12.2%, 219/1801) was associated with higher rates of 30-day hospital readmission than those who declined to identify a caregiver (9.9%, 78/790; odds ratio [OR] 1.38, 95% CI 1.04-1.87; P=.02). Significantly lower rates were detected in 7-day readmission (P=.02), as well as 7-day (P=.03) and 30-day (P=.01) ED visits, among patients with diabetes whose identified caregiver received education and training than those whose identified caregiver did not receive education and training in the bivariate analyses. However, after adjusting for risk factors, no significance was found in 7-day readmission (OR 0.53, 95% CI 0.27-1.05; P=.07), 7-day ED visit (OR 0.63, 95% CI 0.38-1.03; P=.07), and 30-day ED visit (OR 0.73, 95% CI 0.52-1.02; P=.07). No significant associations were found for other outcomes (ie, 30-day readmission and 7-day and 30-day mortality) in both the bivariate and multivariate analyses. Conclusions: Our study found that the implementation of the CARE Act was associated with certain health service utilization. The identification of caregivers was associated with higher rates of 30-day hospital readmission in the multivariate analysis, whereas having identified caregivers who received discharge education was associated with lower rates of readmission and ED visit in the bivariate analysis. %M 35727611 %R 10.2196/32790 %U https://aging.jmir.org/2022/2/e32790 %U https://doi.org/10.2196/32790 %U http://www.ncbi.nlm.nih.gov/pubmed/35727611 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e36825 %T A Computerized Cognitive Test Battery for Detection of Dementia and Mild Cognitive Impairment: Instrument Validation Study %A Ye,Siao %A Sun,Kevin %A Huynh,Duong %A Phi,Huy Q %A Ko,Brian %A Huang,Bin %A Hosseini Ghomi,Reza %+ BrainCheck, Inc, 5616 Kirby Dr. # 690, Houston, TX, 77005, United States, 1 888 416 0004, bin@braincheck.com %K cognitive test %K mild cognitive impairment %K dementia %K cognitive decline %K repeatable battery %K discriminant analysis %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Early detection of dementia is critical for intervention and care planning but remains difficult. Computerized cognitive testing provides an accessible and promising solution to address these current challenges. Objective: The aim of this study was to evaluate a computerized cognitive testing battery (BrainCheck) for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment. Methods: A total of 99 participants diagnosed with dementia, mild cognitive impairment (MCI), or normal cognition (NC) completed the BrainCheck battery. Statistical analyses compared participant performances on BrainCheck based on their diagnostic group. Results: BrainCheck battery performance showed significant differences between the NC, MCI, and dementia groups, achieving 88% or higher sensitivity and specificity (ie, true positive and true negative rates) for separating dementia from NC, and 77% or higher sensitivity and specificity in separating the MCI group from the NC and dementia groups. Three-group classification found true positive rates of 80% or higher for the NC and dementia groups and true positive rates of 64% or higher for the MCI group. Conclusions: BrainCheck was able to distinguish between diagnoses of dementia, MCI, and NC, providing a potentially reliable tool for early detection of cognitive impairment. %M 35436212 %R 10.2196/36825 %U https://aging.jmir.org/2022/2/e36825 %U https://doi.org/10.2196/36825 %U http://www.ncbi.nlm.nih.gov/pubmed/35436212 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e28222 %T Using GPS Tracking to Investigate Outdoor Navigation Patterns in Patients With Alzheimer Disease: Cross-sectional Study %A Puthusseryppady,Vaisakh %A Morrissey,Sol %A Aung,Min Hane %A Coughlan,Gillian %A Patel,Martyn %A Hornberger,Michael %+ Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 59 7139, m.hornberger@uea.ac.uk %K Alzheimer disease %K dementia %K spatial disorientation %K getting lost %K outdoor navigation %K risk factors %K environmental %K GPS tracking %K community %K mobile phone %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Spatial disorientation is one of the earliest and most distressing symptoms seen in patients with Alzheimer disease (AD) and can lead to them getting lost in the community. Although it is a prevalent problem worldwide and is associated with various negative consequences, very little is known about the extent to which outdoor navigation patterns of patients with AD explain why spatial disorientation occurs for them even in familiar surroundings. Objective: This study aims to understand the outdoor navigation patterns of patients with AD in different conditions (alone vs accompanied; disoriented vs not disoriented during the study) and investigate whether patients with AD experienced spatial disorientation when navigating through environments with a high outdoor landmark density and complex road network structure (road intersection density, intersection complexity, and orientation entropy). Methods: We investigated the outdoor navigation patterns of community-dwelling patients with AD (n=15) and age-matched healthy controls (n=18) over a 2-week period using GPS tracking and trajectory mining analytical techniques. Here, for the patients, the occurrence of any spatial disorientation behavior during this tracking period was recorded. We also used a spatial buffer methodology to capture the outdoor landmark density and features of the road network in the environments that the participants visited during the tracking period. Results: The patients with AD had outdoor navigation patterns similar to those of the controls when they were accompanied; however, when they were alone, they had significantly fewer outings per day (total outings: P<.001; day outings: P=.003; night outings: P<.001), lower time spent moving per outing (P=.001), lower total distance covered per outing (P=.009), lower walking distance per outing (P=.02), and lower mean distance from home per outing (P=.004). Our results did not identify any mobility risk factors for spatial disorientation. We also found that the environments visited by patients who experienced disorientation versus those who maintained their orientation during the tracking period did not significantly differ in outdoor landmark density (P=.60) or road network structure (road intersection density: P=.43; intersection complexity: P=.45; orientation entropy: P=.89). Conclusions: Our findings suggest that when alone, patients with AD restrict the spatial and temporal extent of their outdoor navigation in the community to successfully reduce their perceived risk of spatial disorientation. Implications of this work highlight the importance for future research to identify which of these individuals may be at an actual high risk for spatial disorientation as well as to explore the implementation of health care measures to help maintain a balance between patients’ right to safety and autonomy when making outings alone in the community. %M 35451965 %R 10.2196/28222 %U https://aging.jmir.org/2022/2/e28222 %U https://doi.org/10.2196/28222 %U http://www.ncbi.nlm.nih.gov/pubmed/35451965 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33856 %T Assessment of Social Behavior Using a Passive Monitoring App in Cognitively Normal and Cognitively Impaired Older Adults: Observational Study %A Muurling,Marijn %A Reus,Lianne M %A de Boer,Casper %A Wessels,Sterre C %A Jagesar,Raj R %A Vorstman,Jacob A S %A Kas,Martien J H %A Visser,Pieter Jelle %+ Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands, 31 (0)204448527, m.muurling@amsterdamumc.nl %K passive monitoring %K smartphone app %K cognitive impairment %K social behavior %K dementia %K mHealth %K mobile app %K cognitive %K mental health %K social withdrawal %K well-being %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: In people with cognitive impairment, loss of social interactions has a major impact on well-being. Therefore, patients would benefit from early detection of symptoms of social withdrawal. Current measurement techniques such as questionnaires are subjective and rely on recall, in contradiction to smartphone apps, which measure social behavior passively and objectively. Objective: This study uses the remote monitoring smartphone app Behapp to assess social behavior, and aims to investigate (1) the association between social behavior, demographic characteristics, and neuropsychiatric symptoms in cognitively normal (CN) older adults, and (2) if social behavior is altered in cognitively impaired (CI) participants. In addition, we explored in a subset of individuals the association between Behapp outcomes and neuropsychiatric symptoms. Methods: CN, subjective cognitive decline (SCD), and CI older adults installed the Behapp app on their own Android smartphone for 7 to 42 days. CI participants had a clinical diagnosis of mild cognitive impairment (MCI) or Alzheimer-type dementia. The app continuously measured communication events, app use and location. Neuropsychiatric Inventory (NPI) total scores were available for 20 SCD and 22 CI participants. Linear models were used to assess group differences on Behapp outcomes and to assess the association of Behapp outcomes with the NPI. Results: We included CN (n=209), SCD (n=55) and CI (n=22) participants. Older cognitively normal participants called less frequently and made less use of apps (P<.05). No sex effects were found. Compared to the CN and SCD groups, CI individuals called less unique contacts (β=–0.7 [SE 0.29], P=.049) and contacted the same contacts relatively more often (β=0.8 [SE 0.25], P=.004). They also made less use of apps (β=–0.83 [SE 0.25], P=.004). Higher total NPI scores were associated with further traveling (β=0.042 [SE 0.015], P=.03). Conclusions: CI individuals show reduced social activity, especially those activities that are related to repeated and unique behavior, as measured by the smartphone app Behapp. Neuropsychiatric symptoms seemed only marginally associated with social behavior as measured with Behapp. This research shows that the Behapp app is able to objectively and passively measure altered social behavior in a cognitively impaired population. %M 35594063 %R 10.2196/33856 %U https://aging.jmir.org/2022/2/e33856 %U https://doi.org/10.2196/33856 %U http://www.ncbi.nlm.nih.gov/pubmed/35594063 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e31916 %T The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials %A Fotteler,Marina Liselotte %A Mühlbauer,Viktoria %A Brefka,Simone %A Mayer,Sarah %A Kohn,Brigitte %A Holl,Felix %A Swoboda,Walter %A Gaugisch,Petra %A Risch,Beate %A Denkinger,Michael %A Dallmeier,Dhayana %+ DigiHealth Institute, Neu-Ulm University of Applied Sciences, Wileystrasse 1, Neu-Ulm, 89231, Germany, 49 731 9762 ext 1616, marina.fotteler@hnu.de %K assistive technology %K older adults %K systematic review %K frailty %D 2022 %7 4.4.2022 %9 Review %J JMIR Aging %G English %X Background: The use of assistive technologies (ATs) to support older people has been fueled by the demographic change and technological progress in many countries. These devices are designed to assist seniors, enable independent living at home or in residential facilities, and improve quality of life by addressing age-related difficulties. Objective: We aimed to evaluate the effectiveness of ATs on relevant outcomes with a focus on frail older adults. Methods: A systematic literature review of randomized controlled trials evaluating ATs was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Ovid Medline, PsycINFO, SocIndex, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CENTRAL (Cochrane Central Register of Controlled Trials), and IEEEXplore databases were searched from January 1, 2009, to March 15, 2019. ATs were included when aiming to support the domains autonomy, communication, or safety of older people with a mean age ≥65 years. Trials performed within a laboratory setting were excluded. Studies were retrospectively categorized according to the physical frailty status of participants. Results: A total of 19 trials with a high level of heterogeneity were included in the analysis. Six device categories were identified: mobility, personal disease management, medication, mental support, hearing, and vision. Eight trials showed significant effectiveness in all or some of the primary outcome measures. Personal disease management devices seem to be the most effective, with four out of five studies showing significant improvement of disease-related outcomes. Frailty could only be assessed for seven trials. Studies including participants with significant or severe impairment showed no effectiveness. Conclusions: Different ATs show some promising results in well-functioning but not in frail older adults, suggesting that the evaluated ATs might not (yet) be suitable for this subgroup. The uncertainty of the effectiveness of ATs and the lack of high-quality research for many promising supportive devices were confirmed in this systematic review. Large studies, also including frail older adults, and clear standards are needed in the future to guide professionals, older users, and their relatives. Trial Registration: PROSPERO CRD42019130249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130249 %M 35377322 %R 10.2196/31916 %U https://aging.jmir.org/2022/2/e31916 %U https://doi.org/10.2196/31916 %U http://www.ncbi.nlm.nih.gov/pubmed/35377322 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34577 %T Naturally Occurring Retirement Communities: Scoping Review %A Parniak,Simone %A DePaul,Vincent G %A Frymire,Clare %A DePaul,Samuel %A Donnelly,Catherine %+ Health Services and Policy Research Institute, Faculty of Health Sciences, Queen's University, Abramsky Hall, Room 309, 21 Arch Street, Kingston, ON, K7L3N6, Canada, 1 343 364 6015, simone.parniak@queensu.ca %K naturally occurring retirement communities %K NORC %K NORC supportive service programs %K aging in place %K older adults %K scoping review %D 2022 %7 14.4.2022 %9 Review %J JMIR Aging %G English %X Background: As Canada’s population ages, there is a need to explore community-based solutions to support older adults. Naturally occurring retirement communities (NORCs), defined in 1986 as buildings or areas not specifically designed for, but which attract, older adults and associated NORC supportive service programs (NORC-SSPs) have been described as potential resources to support aging in place. Though the body of literature on NORCs has been growing since the 1980s, no synthesis of this work has been conducted to date. Objective: The goal of this scoping review is to highlight the current state of NORC literature to inform future research and offer a summarized description of NORCs and how they have supported, and can support, older adults to age in place. Methods: Using a published framework, a scoping review was conducted by searching 13 databases from earliest date of coverage to January 2022. We included English peer- and non–peer-reviewed scholarly journal publications that described, critiqued, reflected on, or researched NORCs. Aging-in-place literature with little to no mention of NORCs was excluded, as were studies that recruited participants from NORCs but did not connect findings to the setting. A qualitative content analysis of the literature was conducted, guided by a conceptual framework, to examine the promise of NORC programs to promote aging in place. Results: From 787 publications, we included 64 (8.1%) articles. All publications were North American, and nearly half used a descriptive research approach (31/64, 48%). A little more than half provided a specific definition of a NORC (33/64, 52%); of these, 13 (39%) used the 1986 definition; yet, there were discrepancies in the defined proportions of older adults that constitute a NORC (eg, 40% or 50%). Of the 64 articles, 6 (9%) described processes for identifying NORCs and 39 (61%) specifically described NORC-SSPs and included both external partnerships with organizations for service delivery (33/39, 85%) and internal resources such as staff, volunteers, or neighbors. Identified key components of a NORC-SSP included activities fostering social relationships (25/64, 39%) and access to resources and services (26/64, 41%). Sustainability and funding of NORC-SSPs were described (27/64, 42%), particularly as challenges to success. Initial outcomes, including self-efficacy (6/64, 9%) and increased access to social and health supports (14/64, 22%) were cited; however, long-term outcomes were lacking. Conclusions: This review synthesizes the NORC literature to date and demonstrates that NORC-SSPs have potential as an alternative model of supporting aging in place. Longitudinal research exploring the impacts of both NORCs and NORC-SSPs on older adult health and well-being is recommended. Future research should also explore ways to improve the sustainability of NORC-SSPs. %M 35436204 %R 10.2196/34577 %U https://aging.jmir.org/2022/2/e34577 %U https://doi.org/10.2196/34577 %U http://www.ncbi.nlm.nih.gov/pubmed/35436204 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e32473 %T Voice-Enabled Intelligent Virtual Agents for People With Amnesia: Systematic Review %A Boumans,Roel %A van de Sande,Yana %A Thill,Serge %A Bosse,Tibor %+ Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, 6525 GD, Netherlands, 31 0622372708, roel.boumans@ru.nl %K intelligent virtual agent %K amnesia %K dementia %K Alzheimer %K systematic review %K mobile phone %D 2022 %7 25.4.2022 %9 Review %J JMIR Aging %G English %X Background: Older adults often have increasing memory problems (amnesia), and approximately 50 million people worldwide have dementia. This syndrome gradually affects a patient over a period of 10-20 years. Intelligent virtual agents may support people with amnesia. Objective: This study aims to identify state-of-the-art experimental studies with virtual agents on a screen capable of verbal dialogues with a target group of older adults with amnesia. Methods: We conducted a systematic search of PubMed, SCOPUS, Microsoft Academic, Google Scholar, Web of Science, and CrossRef on virtual agent and amnesia on papers that describe such experiments. Search criteria were (Virtual Agent OR Virtual Assistant OR Virtual Human OR Conversational Agent OR Virtual Coach OR Chatbot) AND (Amnesia OR Dementia OR Alzheimer OR Mild Cognitive Impairment). Risk of bias was evaluated using the QualSyst tool (University of Alberta), which scores 14 study quality items. Eligible studies are reported in a table including country, study design type, target sample size, controls, study aims, experiment population, intervention details, results, and an image of the agent. Results: A total of 8 studies was included in this meta-analysis. The average number of participants in the studies was 20 (SD 12). The verbal interactions were generally short. The usability was generally reported to be positive. The human utterance was seen in 7 (88%) out of 8 studies based on short words or phrases that were predefined in the agent’s speech recognition algorithm. The average study quality score was 0.69 (SD 0.08) on a scale of 0 to 1. Conclusions: The number of experimental studies on talking about virtual agents that support people with memory problems is still small. The details on the verbal interaction are limited, which makes it difficult to assess the quality of the interaction and the possible effects of confounding parameters. In addition, the derivation of the aggregated data was difficult. Further research with extended and prolonged dialogues is required. %M 35468084 %R 10.2196/32473 %U https://aging.jmir.org/2022/2/e32473 %U https://doi.org/10.2196/32473 %U http://www.ncbi.nlm.nih.gov/pubmed/35468084 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35925 %T Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations %A Kokorelias,Kristina Marie %A Nelson,Michelle LA %A Tang,Terence %A Steele Gray,Carolyn %A Ellen,Moriah %A Plett,Donna %A Jarach,Carlotta Micaela %A Xin Nie,Jason %A Thavorn,Kednapa %A Singh,Hardeep %+ Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University, Rehabilitation Sciences Institute, Toronto, ON, M5G 1V7, Canada, 1 416 946 3724, hardeepk.singh@utoronto.ca %K older adults %K digital technology %K transitions %K older adult population %K digital health %K Digital Hospital %K health intervention %K aging %K gender diversity %K home transition %K epidemiology %D 2022 %7 27.4.2022 %9 Review %J JMIR Aging %G English %X Background: Digital health technologies have been proposed to support hospital-to-home transition for older adults. The COVID-19 pandemic and the associated physical distancing guidelines have propelled a shift toward digital health technologies. However, the characteristics of older adults who participated in digital health research interventions to support hospital-to-home transitions remain unclear. This information is needed to assess whether current digital health interventions are generalizable to the needs of the broader older adult population. Objective: This rapid review of the existing literature aimed to identify the characteristics of the populations targeted by studies testing the implementation of digital health interventions designed to support hospital-to-home transitions, identify the characteristics of the samples included in studies testing digital health interventions used to support hospital-to-home transitions, and create recommendations for enhancing the diversity of samples within future hospital-to-home digital health interventions. Methods: A rapid review methodology based on scoping review guidelines by Arksey and O’Malley was developed. A search for peer-reviewed literature published between 2010 and 2021 on digital health solutions that support hospital-to-home transitions for older adults was conducted using MEDLINE, Embase, and CINAHL databases. The data were analyzed using descriptive statistics and qualitative content analysis. The Sex- and Gender-Based Analysis Plus lens theoretically guided the study design, analysis, and interpretation. Results: A total of 34 studies met the inclusion criteria. Our findings indicate that many groups of older adults were excluded from these interventions and remain understudied. Specifically, the oldest old and those living with cognitive impairments were excluded from the studies included in this review. In addition, very few studies have described the characteristics related to gender diversity, education, race, ethnicity, and culture. None of the studies commented on the sexual orientation of the participants. Conclusions: This is the first review, to our knowledge, that has mapped the literature focusing on the inclusion of older adults in digital hospital-to-home interventions. The findings suggest that the literature on digital health interventions tends to operationalize older adults as a homogenous group, ignoring the heterogeneity in older age definitions. Inconsistency in the literature surrounding the characteristics of the included participants suggests a need for further study to better understand how digital technologies to support hospital-to-home transitions can be inclusive. %M 35475971 %R 10.2196/35925 %U https://aging.jmir.org/2022/2/e35925 %U https://doi.org/10.2196/35925 %U http://www.ncbi.nlm.nih.gov/pubmed/35475971 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35224 %T Virtual Reality Intervention for Managing Apathy in People With Cognitive Impairment: Systematic Review %A Ho,Ka Ying %A Cheung,Po Mang %A Cheng,Tap Wing %A Suen,Wing Yin %A Ho,Hiu Ying %A Cheung,Daphne Sze Ki %+ School of Nursing, The Hong Kong Polytechinc University, Room GH526, Hung Hom, Kowloon, Hong Kong, Hong Kong, 852 27664534, daphne.cheung@polyu.edu.hk %K virtual reality %K apathy %K cognitive impairment %K dementia %K systematic review %D 2022 %7 11.5.2022 %9 Review %J JMIR Aging %G English %X Background: Apathy is common in people with cognitive impairment. It leads to different consequences, such as more severe cognitive deficits, rapid functional decline, and decreased quality of life. Virtual reality (VR) interventions are increasingly being used to manage apathy in individuals with cognitive impairment. However, reports of VR interventions are scattered across studies, which has hindered the development and use of the interventions. Objective: This study aimed to systematically review existing evidence on the use of VR interventions for managing apathy in people with cognitive impairment with regard to the effectiveness, contents, and implementation of the interventions. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The PubMed, Embase, CINAHL, and PsycINFO databases were systematically searched for experimental studies published up to March 13, 2022, that reported the effects of VR interventions on apathy in older adults with cognitive impairment. Hand searching and citation chasing were conducted. The results of the included studies were synthesized by using a narrative synthesis. Their quality was appraised by using the Effective Public Health Practice Project quality assessment tool. However, because the VR interventions varied in duration, content, and implementation across studies, a meta-analysis was not conducted. Results: A total of 22 studies were identified from the databases, of which 6 (27%) met the inclusion criteria. Of these 6 studies, 2 (33%) were randomized controlled trials, 1 (17%) was a controlled clinical trial, and 3 (50%) were quasi-experimental studies. Individual studies showed significant improvement in apathy and yielded within-group medium to large effect sizes. The level of immersion ranged from low to high. Minor adverse effects were reported. The VR content mostly included natural scenes, followed by city views and game-based activities. A background soundtrack was often used with natural scenes. Most (5/6, 83%) of the studies were conducted in a residential care setting and were implemented by health care professionals or researchers. Safety precautions were taken in most (5/6, 83%) of the studies. Conclusions: Although preliminary evidence shows that VR interventions may be effective and feasible for alleviating apathy in people with cognitive impairment, the methodological limitations in the included studies make it difficult to reach a firm conclusion on these points. The implementation of the interventions was highlighted and discussed. More rigorous studies are encouraged. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021268289; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268289 %M 35544317 %R 10.2196/35224 %U https://aging.jmir.org/2022/2/e35224 %U https://doi.org/10.2196/35224 %U http://www.ncbi.nlm.nih.gov/pubmed/35544317 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35929 %T Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review %A Singh,Hardeep %A Tang,Terence %A Steele Gray,Carolyn %A Kokorelias,Kristina %A Thombs,Rachel %A Plett,Donna %A Heffernan,Matthew %A Jarach,Carlotta M %A Armas,Alana %A Law,Susan %A Cunningham,Heather V %A Nie,Jason Xin %A Ellen,Moriah E %A Thavorn,Kednapa %A Nelson,Michelle LA %+ Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada, 1 416 946 3724, hardeepk.singh@mail.utoronto.ca %K transitions %K health %K medical informatics %K aged %K mobile phone %D 2022 %7 19.5.2022 %9 Review %J JMIR Aging %G English %X Background: Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective: To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods: This 2-phase rapid review involved a selective review of providers’ roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults’ hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results: In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients’ status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions: This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045596 %M 35587874 %R 10.2196/35929 %U https://aging.jmir.org/2022/2/e35929 %U https://doi.org/10.2196/35929 %U http://www.ncbi.nlm.nih.gov/pubmed/35587874 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e38896 %T The Effect of Cognitive Function Health Care Using Artificial Intelligence Robots for Older Adults: Systematic Review and Meta-analysis %A Lee,Hocheol %A Chung,Min Ah %A Kim,Hyeji %A Nam,Eun Woo %+ Department of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Unit 412, Chang-jo gwan, 1 Yonseidae-gil, Wonju, 26493, Republic of Korea, 82 33 760 2413, ewnam@yonsei.ac.kr %K older adult population %K older adults %K cognition %K cognitive function %K artificial intelligence %K socially assistive robots %K AI SAR %K social prescription %K dementia %K social support %K aging %K caregiver %K caregiving %K meta-analysis %K review %K Cochrane collaboration %K assistive robot %K assistive technology %D 2022 %7 28.6.2022 %9 Review %J JMIR Aging %G English %X Background: With rapidly aging populations in most parts of the world, it is only natural that the need for caregivers for older adults is going to increase in the near future. Therefore, most technologically proficient countries are in the process of using artificial intelligence (AI) to build socially assistive robots (SAR) to play the role of caregivers in enhancing interaction and social participation among older adults. Objective: This study aimed to examine the effect of intervention through AI SAR on the cognitive function of older adults through a systematic literature review. Methods: We conducted a meta-analysis of the various existing studies on the effect of AI SAR on the cognitive function of older adults to standardize the results and clarify the effect of each method and indicator. Cochrane collaboration and the systematic literature review flow of PRISMA (Preferred Reporting Item Systematic Reviews and Meta-Analyses) were used on original, peer-reviewed studies published from January 2010 to March 2022. The search words were derived by combining keywords including Population, Intervention, and Outcome—according to the Population, Intervention, Comparison, Outcome, Time, Setting, and Study Design principle—for the question “What is the effect of AI SAR on the cognitive function of older adults in comparison with a control group?” (Population: adults aged ≥65 years; Intervention: AI SAR; Comparison: comparison group; Outcome: popular function; and Study Design: prospective study). For any study, if one condition among subjects, intervention, comparison, or study design was different from those indicated, the study was excluded from the literature review. Results: In total, 9 studies were selected (6 randomized controlled trials and 3 quasi-experimental design studies) for the meta-analysis. Publication bias was examined using the contour-enhanced funnel plot method to confirm the reliability and validity of the 9 studies. The meta-analysis revealed that the average effect size of AI SAR was shown to be Hedges g=0.43 (95% CI –0.04 to 0.90), indicating that AI SAR are effective in reducing the Mini Mental State Examination scale, which reflects cognitive function. Conclusions: The 9 studies that were analyzed used SAR in the form of animals, robots, and humans. Among them, AI SAR in anthropomorphic form were able to improve cognitive function more effectively. The development and expansion of AI SAR programs to various functions including health notification, play therapy, counseling service, conversation, and dementia prevention programs are expected to improve the quality of care for older adults and prevent the overload of caregivers. AI SAR can be considered a representative, digital, and social prescription program and a nonpharmacological intervention program that communicates with older adults 24 hours a day. Despite its effectiveness, ethical issues, the digital literacy needs of older adults, social awareness and reliability, and technological advancement pose challenges in implementing AI SAR. Future research should include bigger sample sizes, pre-post studies, as well as studies using an older adult control group. %M 35672268 %R 10.2196/38896 %U https://aging.jmir.org/2022/2/e38896 %U https://doi.org/10.2196/38896 %U http://www.ncbi.nlm.nih.gov/pubmed/35672268 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34764 %T Bridging Connectivity Issues in Digital Access and Literacy: Reflections on Empowering Vulnerable Older Adults in Singapore %A Lim,Haikel A %A Lee,Joanne Sze Win %A Lim,Meng Han %A Teo,Lynn Pei Zhen %A Sin,Natalene Siew Wen %A Lim,Rou Wei %A Chua,Si Min %A Yeo,Jia Qi %A Ngiam,Nerice Heng Wen %A Tey,Angeline Jie-Yin %A Tham,Celine Yi Xin %A Ng,Kennedy Yao Yi %A Low,Lian Leng %A Tang,Kai Wen Aaron %+ Population Health and Integrated Care Office, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore, 65 62223322, aaron_kw_tang@nhg.com.sg %K COVID-19 %K digital literacy %K digital literacy training %K digital disparities %K digital divide %K social construction of health technologies %K health technology %K COVID-19 pandemic %K pandemic %K COVID %K social isolation %K elder %K older adult %K Asia %K access %K barrier %K empower %K volunteer %K vulnerable %K digital skill %K low income %D 2022 %7 3.5.2022 %9 Viewpoint %J JMIR Aging %G English %X This article describes a ground-up initiative for a volunteer-run digital literacy program in Singapore targeting vulnerable older adults, focusing on the barriers faced in running this program and training these beneficiaries. It further offers possible solutions to overcome these hurdles, providing insight for individuals or organizations seeking to start similar ground-up initiatives. %M 35503520 %R 10.2196/34764 %U https://aging.jmir.org/2022/2/e34764 %U https://doi.org/10.2196/34764 %U http://www.ncbi.nlm.nih.gov/pubmed/35503520 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34628 %T Shared Access to Patient Portals for Older Adults: Implications for Privacy and Digital Health Equity %A Wolff,Jennifer L %A Dukhanin,Vadim %A Burgdorf,Julia G %A DesRoches,Catherine M %+ Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Room 692, 624 North Broadway, Baltimore, MD, 21205-1996, United States, 1 410 502 0458, jwolff2@jhu.edu %K patient portal %K electronic health record %K care partners %K proxy %K health equity %K health informatics %K health services %K elderly %K older adults %K aging %K cognition %K health system %K care delivery %K elderly care %D 2022 %7 4.5.2022 %9 Viewpoint %J JMIR Aging %G English %X Growing reliance on the patient portal as a mainstream modality in health system interactions necessitates prioritizing digital health equity through systems-level strategies that acknowledge and support all persons. Older adults with physical, cognitive, sensory, and socioeconomic vulnerabilities often rely on the involvement of family and friends in managing their health, but the role of these care partners in health information technology is largely undefined and poorly understood. This viewpoint article discusses challenges and opportunities of systematic engagement of care partners through shared access to the patient portal that have been amplified in the context of the COVID-19 outbreak and recent implementation of federal information blocking rules to promote information transparency alongside broader shifts toward care delivery innovation and population aging. We describe implementation considerations and the promise of granular, role-based privacy controls in addressing the nuanced and dynamic nature of individual information sharing preferences and fostering person- and family-centered care delivery. %M 35507405 %R 10.2196/34628 %U https://aging.jmir.org/2022/2/e34628 %U https://doi.org/10.2196/34628 %U http://www.ncbi.nlm.nih.gov/pubmed/35507405 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e40508 %T Correction: A Model for Estimating Biological Age From Physiological Biomarkers of Healthy Aging: Cross-sectional Study %A Husted,Karina Louise Skov %A Brink-Kjær,Andreas %A Fogelstrøm,Mathilde %A Hulst,Pernille %A Bleibach,Akita %A Henneberg,Kaj-Åge %A Sørensen,Helge Bjarup Dissing %A Dela,Flemming %A Jacobsen,Jens Christian Brings %A Helge,Jørn Wulff %+ Xlab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen, 2200, Denmark, 45 28127945, karinalu@sund.ku.dk %D 2022 %7 28.6.2022 %9 Corrigenda and Addenda %J JMIR Aging %G English %X %M 35763795 %R 10.2196/40508 %U https://aging.jmir.org/2022/2/e40508 %U https://doi.org/10.2196/40508 %U http://www.ncbi.nlm.nih.gov/pubmed/35763795